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Compassion Focused TherapyAn Introduction & Practical Tips
James N. Kirby, Ph.D. [email protected]
Director: Compassionate Mind Research Group
School of Psychology
The University of Queensland
Compassionate Mind Research Group at The University of Queensland
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• What are the core elements of compassion?
• How would you be compassionate?
• How would you like somebody to be compassionate to you?
Part 1: What is Compassion
Many Definitions
“Compassion is an awareness and
sensitivity to the suffering of self and others, with a commitment to try and alleviate and
prevent it”
Paul Gilbert (2014)
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Compassion and Beneficial Links
• Linked to a range of benefits:
– Mental health (e.g., Jazaieri et al., 2013; Kirby, 2016; MacBeth & Gumley, 2012)
– Physiology (e..g, Klemecki, Leiberg, Ricard, & Singer, 2014; Rockliff, Gilbert, McEwan, Lightman, & Glover, 2008)
– Genetic expression (e.g., Slavich & Cole, 2013)
– Emotion regulation (e.g., Seppala, Rossomando, & Doty, 2012; Kirby & Laczko, 2017)
– Social connection (e.g., Crocker & Canevelllo, 2012; Keltner Kogan, Piff, & Saturn, 2014)
– Motivation (e.g., Breines & Chen, 2012)
– Positive parenting responses (e.g., Kirby & Baldwin, 2017)
Various Compassion-Based Interventions
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0 0.25 0.5 0.75
Compassion
Self-Compassion
Mindfulness
Depression
Anxiety
Distress
Well-being
Meta-Analysis of Compassion-Based InterventionsKirby, Tellegen, & Steindl, 2017
What is Compassion Focused Therapy?
• Developed in the 1980s to target key underlying processes of shame and self-criticism underpinning many depressive disorders
• Barlow et al. (2017) in Behavior Therapy:
– “Despite shame being a core process of depression and PTSD, only a small handful of studies have evaluated the efficacy of interventions for reducing shame in any disorder, with CFT being the most promising (e.g., Gilbert & Procter, 2006) ………
– ”The next generation of psychological interventions need to target process variables, such as shame, with CFT being a clear example of such an approach.”
• Over 50 evaluation studies and growing rapidly
– Particularly for individuals with high levels of shame and self-criticism who do not respond to CBT (Kirby, 2016; Kirby & Gilbert, 2017; Leaviss & Uttley, 2014)
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Compassion Focused Therapy
Developing a compassionate mind involves two main elements working together
1: ‘Sensitivity to the suffering of self and others….’
• Turning towards, and connecting with, our difficult experiences. Engaging with our distress and needs in a non-judgemental manner. COURAGE
2: ‘….with a commitment to try and alleviate and prevent it.’
• Making a commitment to relieve our distress: using strength, care and wisdom. Taking action in a skilful way, motivated by our well-being. DEDICATION
Self-Compassion
Compassion from others
Compassion to others
Each has it own Facilitators and Inhibitors
The Interactive Flow of Compassion
CultureFamiliesSchool
Organisation
Facilitators and Inhibitors to Compassion
Liking
Competence
Deservedness
Empathic
Self-Focused Competitiveness
Dissociation - Denial
Anxiety – Depression
Distress Tolerance
Overwhelmed
Huang & Bargh. 2014; Kirby & Gilbert, 2017
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Our human brain has the amazing capacity to comment on, judge, evaluate and question our own experiences and emotions. However,
these very abilities can get us caught up in all sorts of problems!
Emotion Brain
Stomach acid
Saliva
Meal
Sexual/erotic
A
Arousal
Bully-threaten
Bully-Threaten
Kind, warm
caring
Soothed
Safe
Compassion
Sex
Meal
Brain-Body Responds to its own Internal Creations
Fear depression
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Emotion level
Time
New brain New brain New brain
Dwelling Imagining worst outcome Self-criticising
Old brain
Sometimes Unhelpful
(Sapolsky, 1994)
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What is Compassion Focused Therapy?
• CFT is an approach to Psychotherapy– Can be applied to any therapy modality
• Underpinned by:– Evolutionary Models– The science of neuro, affective and developmental psychology
• Unique Elements:– Psychoeducation – The Tricky Brain– Model of affect regulation with focus on affiliation and the
parasympathetic system– Evolutionary Functional Analysis (EFA) to case conceptualization– Building of compassion-focused motives as an organizing system– Works with fears, blocks and resistances to compassion and
positive emotion• Self-criticism and Shame
Three Circles Model
Soothing and connection
Content, safeness, calm, not-wanting
Drive and achievement
Incentive focused, wanting, pursuing, achieving, status
Threat and self-protectProtection and safety seeking, fight/flight
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Systems out of balance: how would you draw your ‘circles’ in proportion?
Soothing and connectionDrive and
achievement
Threat and self-protection
FUNCTION
Threat-focused
Protection and
Safety-seeking
Activating
Anger
Our Body/Feelings
• Tense, shaky muscles
• Heart increase
• Stomach - sicky
• Sweat
• Voice
Attention, what pops into mind, imagery, thinking
• Narrow-focused and Scan –Search
• Rumination on why angry
• ‘What if…’ and implications
• Internal vs. external
(attribution prediction)
Types Behaviour
• Aggressive display –shout, kick, hit
• Walk out, cut-off
• Passive aggression and sulk
• Dissociate – not feel
Anger Awareness: How it works – as built for us not by us
FUNCTION
Threat-focused
Protection and
Safety-seeking
Activating
Our Body/Feelings
• Tense shoulders
• Heart increase
• Stomach/face
• Voice
• Body memory
Attention, what pops into mind, imagery, thinking
• Narrow-focused and Scan – search
• Rumination and ‘what if…’
• Implications
• Internal vs. external
(attribution prediction)
Types behaviours-active or inhibit us
• Run away
• Avoid hide
• Submit -passive
• Freeze –mind/body block
• Dissociate –not feel
Anxiety Awareness: How it works – as built for us not by us
Anxiety
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Pleasure/Joy
Our Body/feelings
• Activation
• Heart increase
• Pressure to act
• Disrupt sleep
Attention/Thinking
• Narrow-focused
• Acquiring
• Explorative
• Internal vs. external
(attribution prediction)
Behaviour
• Approach
• Engage
• Socialise
• Restless
• Celebrating
FUNCTION
Incentive/
resource-focused
Wanting, pursuing, achieving, consuming
Activating
Achievement Awareness: How it works – as built for us not by us
Well-being
Body/feelings
• Calm
• Slow
• Content
• Safe
Attention/Thinking
• Open-focused
• Reflective
• Pro-social
• Internal v. external
(attribution prediction)
Behaviour
• Peaceful
• Gentle
• Pro-social
FUNCITON
Soothing/Connection
Non-wanting
Safeness
Affiliative focused
Soothing Awareness: How it works – as built for us not by us
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Between self and others: Soothing regulates threat response
Between self-to-self: Soothing regulates threat response
ThreatSoothing
and connection
Calms/Encourages
Drive and achievement
Incentive focused, wanting, pursuing, achieving, status
Threat and self-protectProtection and safety seeking, fight/flight
Three Circles Model
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Systems out of balance: how would you draw your ‘circles’ in proportion?
Soothing and connectionDrive and
achievement
Threat and self-protection
Failure
Inner-Critic
Disappointment Gap
Ideal Self
Hard-working
Relaxed and confident
Caring of others
Insightful
Actual Self
Lazy
Worried and concerned
Get angry with others
Dumb
Attack Self: Idiot! Why did you do that for? Why am I so bloody worried all the time? Why don’t I just get on and do things? I am uselessAttack Others: Why do others always seem so confident? I can’t stand Karen and how good she is!Give Up: This just isn’t worth it. I’m bound to stuff it up again, everybody knows I will.
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Three Circles Model
Soothing and connection
Content, safeness, calm, not-wanting
Drive and achievement
Incentive focused, wanting, pursuing, achieving, status
Threat and self-protectProtection and safety seeking, fight/flight
Compassion
Three Circles Model & Motivation
Soothing and
ConnectionContent,
safeness, calm, not-wanting
Drive and achievement
Incentive focused, wanting, pursuing, achieving, status
Threat and self-protect
Protection and safety seeking, fight/flight
Competitive
Fears of Compassion
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Inhibitors to Compassion
• Fears– I would like to, but I’m frightened too
• Resistances– Not really frightened, just don’t seen the point
– Somewhat dismissive
• Blocks
– Not frightened or resistant. But blocked for example by having reduced opportunities, lack of prioritization, lack of insight or knowledge
Fears of Compassion
• Resisting compassion because it resulted in feelings of vulnerability – particularly grief, not wanting to break downyearning what I never got or don’t have
• In the first evaluation of group CFT, Gilbert & Procter (2006) noted that many participants ‘had a real fear of becoming self-compassionate’
• “If you get close to me you’ll see the bad in me, and if I get close to you I’ll see the bad in you.” (Gilbert & Procter, 2006)
• “Others have the power to reject and hurt me; they can turn nasty at any moment” (Gilbert & Procter, 2006)
• High self-critics find self-compassion and receiving compassion from others quite difficult
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Fears of Compassion Scale
• Compassion For Others
– People will take advantage of me if they see me as too compassionate
– Being compassionate towards people who have done bad things is letting them off the hook
– There are some people in life who don’t deserve compassion
– I fear that being too compassionate makes people an easy target
– I fear that If I am too compassion, some people will become dependent on me
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Fears of Compassion Scale
• Compassion From Others
– I fear that when I need people to be kind and understanding they won’t be
– When people are kind and compassionate towards me I feel anxious or embarrassed
– I’m fearful of becoming dependent on the care of others because they might not always be available or willing to give it
– If I think someone is being kind and caring towards me, I put up a barrier
Fears of Compassion Scale
• Compassion For Self
– I fear that if I become too compassionate to myself I will lose my self-criticism and my flaws will show
– I fear that if I start to feel compassion and warmth for myself I will feel overcome with a sense of loss/grief
– I fear that if I am more self-compassionate I will become a weak person
– I fear that if I develop compassion for myself, I will become someone I do not want to be
Quick Facts
• 21 studies, from 154 samples included
• Studies across a 5 year period (2012-2017)
• 5, 233 participants data meta-analysed
• 7 different countries (USA, UK, Canada, Australia, Portugal, Japan, and Scotland)
• 13 were cross-sectional surveys; 8 pre-intervention correlations
• 5 clinical sample, 16 non-clinical
• 31% Male; 69% Female
• Average age: 30.45 years (range 18.64 years – 45 years; SD = 9.71)
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Fears of Compassion for Others & Mental Health Outcomes
-0.25 0 0.25 0.5
Self-criticism
Shame
Well-being
Distress
Anxiety
Depression
Data from 38 samples
Fears of Compassion from Others & Mental Health Outcomes
-0.5 -0.25 0 0.25 0.5 0.75
Self-criticism
Shame
Well-being
Distress
Anxiety
Depression
Data from 59 samples
Fears of Compassion for Self & Mental Health Outcomes
-0.75 -0.5 -0.25 0 0.25 0.5 0.75
Self-criticism
Shame
Well-being
Distress
Anxiety
Depression
Data from 57 samples
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Compassion & Differential Responding
• Have to mindful and sensitive to how we are introducing compassion or positive affiliation with clients.
• Sometimes there can be a tendency or misunderstanding that there is a ‘bag of compassion tricks’ almost like a ‘toolkit’ of practices we can just provide a panacea
• Need to be aware some will respond unfavourably to the practice.
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Implications
• Given the known benefits of compassion in promoting psychological well-being, it is important that any fear, block or resistance to it in psychotherapy is addressed as part of the therapeutic process.
• Be aware:
• New experiences of compassion and soothing can bring up old emotional experiences, linked to threat. This is not our fault.
• Crucial is validating the fears, blocks & resistances of clients and empathising with why he/she would not want to become compassionate or trusting
• Explore in therapy these potential difference responses before starting to implement compassion or kindness based interventions
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Compassion Based Exercises
• Step 1
– Body posture
– Voice tone
– Friendly facial expression
– Soothing Rhythm Breathing
• Step 2
– Activate Compassionate Self
• Step 3
– Apply to life difficulty
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