Compassion Focused Therapy:Methods, and scaling Applications

Dr. Yotam Heineberg Psy.D.

Clinical supervisor and lecturer Palo Alto University

Applied Psychological Interventions CCARE, Center for Compassion & Altruism Research & Education

Stanford University Medical School

Compassion as Flow

A comprehensive psychology of engagement

Self Other

Other Self

Self Self

Sources of behaviourInteraction of old and new psychologies

Mindful Brain

Old Brain: Motives (food, sex, relationship seeking, caring, status)

Emotions (anger, anxiety, sadness, joy)Behaviours (fight, flight, submission etc)

New Brain: Imagination, Planning, Rumination,

Yearning, Mentalisation

COMPASSION

Key Targets of Therapy

Attention ThinkingReasoning

Behaviour

Motivation Emotions/Sensory

Specific schemas may impact interpretations

Imagery Fantasy

Threatened Mind can block Compassion

AttentionThinkingReasoning

Behaviour

Motivation

Imagery Fantasy Threat

Emotions/Sensory

Compassionate Mind

Attention ThinkingReasoning

Behaviour

Motivation

Imagery Fantasy Compassion

Emotions/Sensory

Core mission Global Increase of Compassion

• Compassion is strongly correlated with improved immune system, and physical wellbeing, as well as improved psychological functioning (Pace et al. 2008; Gilbert, McEwan, Matos, Rivis, 2010)

Fears of Compassion scale - Fear of expressing compassion for others - Fear of receiving compassion from others - Fear of expressing compassion for yourself

(Gilbert, McEwan, Matos, Rivis, 2010)

Compassion as an organizing motivation can be blocked in 3 ways

Fear of Compassion and psychological wellbeing

- The capacity to give and receive compassion, correlates significantly with measures of stress, depression and anxiety. (Martin, Heineberg, Berger, Seppala, Doty & Zimbardo, 2013 working paper)

Fears of compassion

Stress Anxiety Depression

Compassion for Others

.32** .39** .35**

Compassion from Others

.56** .57** .71**

Compassion for Self .54** .58** .74**

How do our motives and emotions organise?

Motives evolved because they help animals to survive, seek out things that are important (e.g. food, shelter, relationships, status, reproduction etc) and leave genes behind

Emotions guide us to our motivations/goals and respond if we are succeeding or threatened

Three primary types of emotion regulation systems

1. Those that focus on threat and self-protection2. Those that focus on doing and achieving3. Those that focus on contentment and feeling safe

Emotion Regulation Systems: – ‘Three Circle’ Model

Threat-focused

Protection and Safety-seeking

Activating/Inhibiting

HPA/Serotonin?

Anger, Anxiety, Disgust

Emotion Regulation Systems: – ‘Three Circle’ Model

Incentive/resource- focused

Wanting, pursuing, achieving, consuming

Dopamine?

Threat-focused

Protection and Safety-seeking

HPA/Serotonin?

Anger, Anxiety, Disgust

Drive, Excite, Vitality

Types of Affect Regulation Systems

Incentive/resource- focused

Wanting, pursuing, achieving, consuming

Activating

Dopamine?

Non-wanting/Affiliative focused

Safeness-kindness

Soothing

Oxytocin/Opiates?

Threat-focused

Protection and

Safety-seeking

Activating/inhibiting

Anger, anxiety, disgust

Drive, excite, vitality Content, safe, connected

Emotion Regulation Systems: – ‘Three Circle’ Model

Incentive/resource- focused

Wanting, pursuing, achieving, consuming

Dopamine?

Non-wanting/Affiliative focused

Safeness-kindness

Opiates/Oxytocin?

Threat-focused

Protection and Safety-seeking

Activating/Inhibiting

HPA/Serotonin?

Anger, Anxiety, Disgust

Drive, Excite, Vitality Content, Safe, Soothed

Relationship between Threat and Soothing

Threat SoothingCalms

How are the three systems balanced for many of us?

Threat-focused & safety seeking

Anxiety, anger, sadness

One aim of CFT?...Balance

Incentive/resource- focused

Wanting, pursuing, achieving, consuming

Dopamine?

Non-wanting/Affiliative focused

Safeness-kindness

Opiates/Oxytocin

Threat-focused

Protection and Safety-seeking (Behaviours, Emotions, Thoughts)

HPA/Serotonin?

Anger, Anxiety, Disgust

Drive, Excite, Vitality Content, Safe, Soothed

Good vibe is good for ya!

But how do we bring the good vibe?

What are the vehicles of change?

The 3 Pillars of psychological intervention

1. Expert mediated – e.g. Psychotherapy, meditation

2. Community engagement - Psycho-Educational – Train the Trainers e.g. teacher mediated, and other Paraprofessionals

3. Web-Based – Apps and interactive programse.g. using computer, tablets and smart phones (Tomorrow in more detail)

Expert MediatedCompassion Focused Therapy

• Dr. Paul Gilbert • Faculty & head of mental health unit at

the University of Derby, UK. • Offers intensive CFT workshop trainings

to clinicians all over the world.

• Wrote over 20 books, and hundreds of published articles.

• CFT represents a cutting edge integration of scientific findings to comprise a highly effective therapy!

• We believe the CFT outlook can scale, and effectively reach both clinical and non-clinical populations all over the world.

Psycho-educational – Train the Trainers

• Dr. Rony Berger • Rony developed ERASE-Stress, an

evidence based teacher mediated program that reached over 60,000 children in 13 different countries!

• In collaboration with Dr. Philip Zimbardo, Rony is pioneering:

• ERASE-Stress-Pro Social The next generation! A teacher mediated program aimed at reducing stress, and increasing compassion and pro social behaviors by integrating CFT principles and other data driven practices!

Can we offer an adult psycho-educational“Train the Trainers” compassion program?

• Peer-led groups on issues such as bereavement, anxiety, body image and eating disorders have been successfully facilitated by students (Battle, Greer, Ortiz-Hernández & Todd, 2013; Genie& William, 1990; Fontana, Hyra, Godfrey, Cermak, 1999)

• Can we train college seniors in delivering compassion perspectives to freshmen/women?

• Can core CFT principles, supported by synergistic & proven practices, be shared with broader audiences?

• But wait, what about the meditation practices, how will we be able to offer high quality experiences without an expert teacher on the ground?

Web based compassion training!(aka Can we offer meditation online?)

Audio files containing various forms of compassion practices have been shown to produce positive changes related to:• Compassion• Depression• Stress • Anxiety • Reduction in self coldness and self criticism • Feelings of social connection, Positivity towards strangers • Altruism• Altered brain functioning (e.g. Dorsolateral Prefrontal Cortex, DLPFC)(McEwan & Gilbert, in press; Hutcherson, Seppala, & Gross, 2008; Weng, Fox, Shackman, Stodola, Caldwell, Olson, Rogers & Davidson 2013).

• Conclusion for future research directions – we should collaborate to create simple web enabled platforms to offer various audio files that represent different compassion outlooks, in order to test the specific impact of each practice, similarities and differences, and arrive at the BEST practices for different circumstances and populations.

CFT: Compassionate Mind - Alleviation

Imagery/Visualization

Attention Reasoning

Feelings/Emotions

BehaviourSensory

Care for well-being

Sensitivity Sympathy

Distress tolerance

EmpathyNon-Judgement

Compassion

ATTRIBUTES

SKILLS -TRAININGWarmth

Warmth

Warmth

Warmth

Thank you so much for your time and attention!&

Deep gratitude to:

• Dr. Paul Gilbert• Dr. Chris Irons • Dr. Dan Martin • Dr. Phil Zimbardo• Dr. Ricardo Munoz • Dr. Rony Berger

Web based compassion training!(aka Can we offer meditation online?)

• Audio files containing various forms of compassion practices have been shown to increase self-compassion, and self-reassurance and significant reductions in self-coldness, inadequate self-criticism and depression, anxiety and stress, as well as increase feelings of social connection and positivity towards strangers, in addition to associations with altruistic tendencies, and altered activation in brain regions implicated in social cognition and emotion regulation, including the inferior parietal cortex and dorsolateral prefrontal cortex (DLPFC),and in DLPFC connectivity with the nucleus accumbens (McEwan & Gilbert, in press; Hutcherson, Seppala, & Gross, 2008; Weng, Fox, Shackman, Stodola, Caldwell, Olson, Rogers & Davidson 2013).

• Conclusion for future research directions – we should collaborate to create simple web enabled platforms to offer various audio files that represent different outlooks, in order to test the specific impact of each practice, similarities and differences, and arrive at the BEST practices for different circumstances and populations.

Thanks for your time & Attention!