Psihoterapia Prin Compasiune

CompassionCompassion--FocusedFocused--Therapy Therapy

Model and ResearchModel and Research

Paul Gilbert, Kirsten McEwan, Corinne Gale & Jean GilbertPaul Gilbert, Kirsten McEwan, Corinne Gale & Jean Gilbert

Mental Health Research UnitMental Health Research Unit, ,

Kingsway Hospital, Derby UKKingsway Hospital, Derby UK

www: Compassionatemind.co.ukwww: Compassionatemind.co.uk

Talk TodayTalk Today

OutlineOutline basicbasic philosophyphilosophy andand modelmodel ofof

CompassionCompassion focusedfocused TherapyTherapy

NoteNote thethe powerfulpowerful effectseffects ofof ourour selfself--

evaluationevaluation systemssystems (self(self--criticismcriticism vsvs selfselfevaluationevaluation systemssystems (self(self--criticismcriticism vsvs selfself

compassion)compassion)

ExploreExplore thethe mainmain therapeutictherapeutic workwork asas

overcomingovercoming thethe fearfear ofof compassioncompassion andand selfself

compassionscompassions

To understand ourselves we must To understand ourselves we must

understand our brainsunderstand our brains

why we have complex brains and minds that are why we have complex brains and minds that are

difficult to understand regulatedifficult to understand regulate

1. Old Brain 1. Old Brain

Emotions:Emotions: Anger, anxiety, sadness, joy, lustAnger, anxiety, sadness, joy, lust

Behaviours:Behaviours: Fight, flight, withdraw, engageFight, flight, withdraw, engage

Relationships:Relationships: Sex, status, attachment, tribalismSex, status, attachment, tribalism

2. New Brain2. New Brain

Imagination, fantasise, look back and forward, plan, ruminateImagination, fantasise, look back and forward, plan, ruminateIntegration of mental abilitiesIntegration of mental abilitiesIntegration of mental abilitiesIntegration of mental abilities

SelfSelf--awareness, selfawareness, self--identity, and selfidentity, and self--feelingfeeling

3. Social Brain3. Social Brain

Need for affection and care Need for affection and care

Socially responsive, selfSocially responsive, self--experience and motivesexperience and motives

What happens when new brain is recruited to pursue old brain passions?What happens when new brain is recruited to pursue old brain passions?

Sources of behaviourSources of behaviour

Old BrainOld Brain: Emotions, Motives, Relationship : Emotions, Motives, Relationship

New BrainNew Brain:: Imagination, Imagination,

Planning, Rumination, IntegrationPlanning, Rumination, Integration

Interaction of old and new psychologies

Old BrainOld Brain: Emotions, Motives, Relationship : Emotions, Motives, Relationship

SeekingSeeking--CreatingCreating

ArchetypalArchetypal

Understanding our Motives and Understanding our Motives and

EmotionsEmotions

Motives evolved because they help animals to Motives evolved because they help animals to survive and leave genes behindsurvive and leave genes behind

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

There are three types of emotion regulationThere are three types of emotion regulation

1.1. Those that focus on threat and selfThose that focus on threat and self--protectionprotection

2.2. Those that focus on doing and achievingThose that focus on doing and achieving

3.3. Those that focus on contentment and feeling safeThose that focus on contentment and feeling safe

Types of Affect Regulator SystemsTypes of Affect Regulator Systems

Incentive/resourceIncentive/resource--

focusedfocused

Wanting, pursuing,

achieving, consuming

NonNon--wanting/wanting/

Affiliative focusedAffiliative focused

Safeness-kindness

Soothing

Drive, excite, vitalityDrive, excite, vitality Content, safe, connectedContent, safe, connected

achieving, consuming

Activating

Soothing

ThreatThreat--focused focused

Protection andProtection and

SafetySafety--seekingseeking

Activating/inhibitingActivating/inhibiting

Anger, anxiety, disgustAnger, anxiety, disgust

SelfSelf--ProtectionProtection

InIn speciesspecies withoutwithout attachmentattachment onlyonly

11--22%% makemake itit toto adulthoodadulthood toto

reproducereproduce.. ThreatsThreats comecome fromfrom

ecologies,ecologies, foodfood shortage,shortage, predation,predation,ecologies,ecologies, foodfood shortage,shortage, predation,predation,

injury,injury, diseasedisease.. AtAt birthbirth individualsindividuals

mustmust bebe ableable toto “go“go itit alone”alone” bebe

mobilemobile andand dispersedisperse

Dispersal and avoid othersDispersal and avoid others

Protect and Comfort: Less ‘instinctive Protect and Comfort: Less ‘instinctive

brain brain –– post birth learningpost birth learning

The Mammalian Importance of The Mammalian Importance of

Caring MindsCaring Minds

CaringCaring asas “looking“looking after”after”.. SeekingSeeking closenesscloseness

ratherrather thanthan dispersiondispersion.. IndividualsIndividuals obtainobtain

protection,protection, food,food, andand carecare whenwhen illill.. KeyKey alsoalso isis

soothingsoothing--calmingcalming andand physiologicalphysiological regulationregulation..

FewFew offspringoffspring butbut highhigh survivalsurvival raterate ininFewFew offspringoffspring butbut highhigh survivalsurvival raterate inin

comparisoncomparison toto speciesspecies withoutwithout attachmentattachment..

AffectionAffection andand kindnesskindness

CoCo--operativeoperative andand mutualmutual supportsupport cancan developdevelop asas

wewe seesee thatthat ourour prosperityprosperity impactsimpacts onon thatthat ofof

others,others, sharingsharing andand notnot--exploitingexploiting

Affectionate InteractionsAffectionate Interactions

Secure attachment linked to selfSecure attachment linked to self--confidence, empathy and use confidence, empathy and use of attachment strategies when stressed (Mikulincer & Shaver of attachment strategies when stressed (Mikulincer & Shaver 2005)2005)

Maturation of the brain (e.g. frontal cortex) and affect Maturation of the brain (e.g. frontal cortex) and affect regulation (Gerhardt, 2004; Schore, 1994)regulation (Gerhardt, 2004; Schore, 1994)

Effects of low birth weight (Tully et al, 2004. JCCP, 72, 218Effects of low birth weight (Tully et al, 2004. JCCP, 72, 218--226)226)

Testosterone and aggression (Booth et al., 2003. Testosterone and aggression (Booth et al., 2003. Developmental Psychology, 39, 85 Developmental Psychology, 39, 85 –– 98)98)

SelfSelf--toto--selfself--relating e.g. self criticism relating e.g. self criticism vsvs selfself--reassurancereassurance

Internal Threat and SoothingInternal Threat and Soothing

Threat

Affiliative/ Soothing

Calms

Self-affiliation –

experiences a lovable self

Internal representations of helpful

others and sources of comfort

Emotional memories of

soothing

Neurophysiological

networks

Internal Threat and More threatInternal Threat and More threat

Threat

Affiliative/ Soothing

Calms

No self-affiliation –

experiences a ununlovable

self

Others are threats or

alarming

Emotional memories of no

soothing

Neurophysiological

networks

Compassion SolutionsCompassion Solutions

Ancient wisdomAncient wisdom

Compassion is the road to happiness Compassion is the road to happiness

(Buddhism(Buddhism))

Evolution Evolution Evolution Evolution

Evolution has made our brains highly Evolution has made our brains highly

sensitive to internal and external kindnesssensitive to internal and external kindness

NeuroscienceNeuroscience

Specific brain areas are focused on detecting Specific brain areas are focused on detecting

and responding to kindness and compassionand responding to kindness and compassion

CompassionCompassion

CompassionCompassion cancan bebe defineddefined inin manymany waysways:: “As“As aasensitivitysensitivity toto thethe sufferingsuffering ofof selfself andand othersothers withwith aadeepdeep commitmentcommitment toto trytry toto relieverelieve it”it” DalaiDalai LamaLama

EightEight foldfold pathpath -- representsrepresents aa multimulti--modalmodalapproachapproach forfor trainingtraining one’sone’s mindmind

Compassion as FlowCompassion as Flow

Different practices for eachDifferent practices for each

OtherOther SelfSelf

SelfSelf OtherOther

SelfSelf SelfSelf

NonNon linearlinear empathyempathy forfor otherother beginsbegins earlyearly inin lifelife

DataData•• PracticePractice ofof imaginingimagining compassioncompassion forfor othersothers producesproduces changeschanges inin

frontalfrontal cortexcortex andand immuneimmune systemsystem (Lutz(Lutz etet al,al, 20092009))

•• LovingLoving kindnesskindness meditationmeditation (compassion(compassion directeddirected toto self,self, thenthenothers,others, thenthen strangers)strangers) increasesincreases positivepositive emotions,emotions, mindfulness,mindfulness,feelingsfeelings ofof purposepurpose inin lifelife andand socialsocial supportsupport andand decreasesdecreases illnessillnesssymptomssymptoms (Frederickson(Frederickson etet al,al, 20082008,, JPSP)JPSP)

•• CompassionCompassion meditationmeditation ((66 weeks)weeks) improvesimproves immuneimmune function,function, andandneuroendocrineneuroendocrine andand behaviouralbehavioural responsesresponses toto stressstress (Pace,(Pace, 20082008,,PNE)PNE)

•• ViewingViewing sadsad faces,faces, neutrallyneutrally oror withwith aa compassionatecompassionate attitudeattitudeinfluencesinfluences neurophysiologicalneurophysiological responsesresponses toto facesfaces (Ji(Ji--WoongWoong Kim,Kim,20092009,, NP)NP)

•• CompassionCompassion trainingtraining reducesreduces shameshame andand selfself--criticismcriticism inin chronicchronicdepresseddepressed patientspatients (Gilbert(Gilbert && Proctor,Proctor, 20062006,, CPP)CPP)

Key Targets of TherapyKey Targets of Therapy

AttentionAttentionThinkingThinking

ReasoningReasoning

BehaviourBehaviourImagery Imagery FantasyFantasy BehaviourBehaviour

MotivationMotivation EmotionsEmotions

Their pattern gives rise to a certain type of mindTheir pattern gives rise to a certain type of mind

FantasyFantasy

Compassionate MindCompassionate Mind

AttentionAttentionThinkingThinking

ReasoningReasoning

BehaviourBehaviourImagery Imagery FantasyFantasy CompassionCompassion BehaviourBehaviour

MotivationMotivation EmotionsEmotions

FantasyFantasy CompassionCompassion

Threatened Mind can block CompassionThreatened Mind can block Compassion

AttentionAttentionThinkingThinking

ReasoningReasoning

BehaviourBehaviourImagery Imagery FantasyFantasy ThreatThreat BehaviourBehaviour

MotivationMotivation EmotionsEmotions

FantasyFantasy ThreatThreat

SelfSelf--Critical Mind is also ThreatCritical Mind is also Threat--focused focused

MindMind

AttentionAttentionThinkingThinking

ReasoningReasoning

BehaviourBehaviourImagery Imagery FantasyFantasy

SelfSelf--

CriticalCriticalBehaviourBehaviour

MotivationMotivation EmotionsEmotions

FantasyFantasy CriticalCritical

Meal

SexualBully-threat

Emotion BrainEmotion BrainEmotion BrainEmotion Brain

How our own thoughts and images affect our brainsHow our own thoughts and images affect our brains

Kind, warm

and caring

Meal Sex Bully-

threat

CompassionEmotion BrainEmotion BrainEmotion BrainEmotion Brain

Stomach acid

Salvia Arousal

Fearful

Depressed

Soothed

Safe

Compassion

Pink represents our inner images and thoughts

QuestionsQuestions

HowHow doesdoes selfself--criticismcriticism andand selfself--compassion/compassion/

reassurancereassurance workwork inin thethe brain?brain?

AreAre theirtheir individualindividual differencesdifferences linkedlinked toto traittraitAreAre theirtheir individualindividual differencesdifferences linkedlinked toto traittrait

selfself-- criticism?criticism?

HowHow mightmight compassioncompassion trainingtraining influenceinfluence

neurophysiology?neurophysiology?

fMRI Study (Aston University)STUDY Olivia Longe, Gina Rippon, Paul Gilbert & Frankie Maratos

Self-Reassure

Self-Criticize

Self-Reassure

Self-Criticize

• 2X2 Factorial: 2 X Statement Scenarios, 2 X Imagery Perspectives

• Statements pre-tested (n=12), for imagability (i.e. ease of imagining self-critical or self-reassuring thoughts), 1-7 Likert Scale.

Emotion Scenario(-) Neutral Scenario

“A third job rejection letter in a row arrives in the post”

“The second free local newspaper in a row arrives in the post”.

Self-Criticism during Emotional Scenarios vs. Neutral

Axial slices displaying left lateral PFC (BA 47, 45,9) and right lateral

PFC (BA 46) activation

Longe, et al (2010). Having a word with yourself: NeuroImage, 49, 1849-1856

Self-Reassurance during Emotional Scenarios vs.

Neutral

Whole brain and axial slices displaying left temporal pole (BA

38) and insula activation

Longe, et al (2010). Having a word with yourself: NeuroImage, 49, 1849-1856

Parent recall and SC and SRParent recall and SC and SRIrons Gilbert Baldwin et al., 2006 Br J Clin PsychIrons Gilbert Baldwin et al., 2006 Br J Clin Psych

Rejection Inadequate

Self

.24

(.31)

.26

(.60)

.15

(.25)

.31

(.33)

Overprotection

Warmth

Hated Self

Reassure Self

Depression

.37

(.30)

-.31

(-.56)

.22

(.55)

Parent recall and SC and SRParent recall and SC and SRIrons Gilbert Baldwin et al., 2006 Br J Clin PsychIrons Gilbert Baldwin et al., 2006 Br J Clin Psych

Rejection Inadequate

Self

.24

(.31)

.26

(.60)

.15

(.25)

.31

(.33)

Overprotection

Warmth

Hated Self

Reassure Self

Depression

.37

(.30)

-.31

(-.56)

.22

(.55)

Imagining a selfImagining a self--critical part of selfcritical part of self

197 students from Derby and McGill Universities197 students from Derby and McGill Universities

(with Chris Irons and Mark Baldwin)(with Chris Irons and Mark Baldwin)

SelfSelf--criticismcriticism

PowerPower AngerAngerPowerPower AngerAnger

0.530.53 0.510.51

SelfSelf--reassurancereassurance

PowerPower AngerAnger

-- 0. 330. 33 -- 0.330.33

Imagining a SelfImagining a Self--Compassionate Compassionate

Part of SelfPart of Self

197 students from Derby and McGill Universities197 students from Derby and McGill Universities

(with Chris Irons and Mark Baldwin)(with Chris Irons and Mark Baldwin)

SelfSelf--criticismcriticism

PowerPower WarmWarmPowerPower WarmWarm

-- 0.540.54 -- 0.340.34

SelfSelf--reassurancereassurance

PowerPower warmwarm

0. 580. 58 0.430.43

Gilbert et al (2005)Gilbert et al (2005)

Compassionate MindCompassionate Mind

AttentionAttentionThinkingThinking

ReasoningReasoning

BehaviourBehaviourImagery Imagery FantasyFantasy

SelfSelf--CompassionateCompassionate BehaviourBehaviour

MotivationMotivation EmotionsEmotions

FantasyFantasy CompassionateCompassionate

Why a Compassion Focus?Why a Compassion Focus?

PeoplePeople withwith chronicchronic problemsproblems oftenoften comecome fromfromneglectfulneglectful oror abusiveabusive backgrounds,backgrounds, havehave highhighlevelslevels ofof shame,shame, andand areare oftenoften selfself--critical,critical, selfself--disliking,disliking, oror selfself--hatinghating

LiveLive inin aa worldworld ofof constantconstant internalinternal andand externalexternalLiveLive inin aa worldworld ofof constantconstant internalinternal andand externalexternalthreatthreat

HaveHave fewfew experiencesexperiences ofof feelingfeeling safesafe oror soothedsoothedandand areare notnot ableable toto dodo thisthis forfor themselvesthemselves.. OftenOftendodo poorlypoorly inin trialstrials

Self-Criticism

Internal Threat and SoothingInternal Threat and Soothing

Worry Threat

Compassionate

Re-focusing

Affiliative/ Soothing

Calms

Rumination

Worry Soothing

Compassionate imagery

Fear of CompassionFear of Compassion

Certain types of positive feelings are threateningCertain types of positive feelings are threatening

It is dangerous to feel safeIt is dangerous to feel safe

Compassion feeling are linked to beliefs such that Compassion feeling are linked to beliefs such that

it’s an indulgence and weaknessit’s an indulgence and weakness

Activated grief and or abuse memoriesActivated grief and or abuse memories

PROBLEM PROBLEM --Compassion is a threatCompassion is a threat

Threat

Compassionate

Re-focusing

Affiliaitve/Soothing

Compassionate imagery

Shame-self

criticism

Trauma

Memory

Meta- beliefsFear of

closeness

Mentalizing

Kindness, Attachment and ThreatKindness, Attachment and Threat

Kindness from therapist or imageryKindness from therapist or imagery

Activate attachment systemActivate attachment system

Activate memoriesActivate memoriesFight, flightFight, flight Fight, flightFight, flight

shut downshut down

NeglectNeglect

alonenessaloneness

Abuse, shame Abuse, shame vulnerablevulnerable

ActivateActivate learnt and current defences learnt and current defences -- cortisolcortisol

shut downshut down shut downshut down

Bowlby: Kindness opens the attachment system and then whatever ever fears, anger Bowlby: Kindness opens the attachment system and then whatever ever fears, anger or despair is coded there will become available and can be intensely threateningor despair is coded there will become available and can be intensely threatening

Study of reactions to Study of reactions to

compassionate imagerycompassionate imagery

•• ControlControl ofof thethe mechanismsmechanisms forfor balancebalance betweenbetweensympatheticsympathetic andand parasympatheticparasympathetic nervousnervous systemsystem havehavebeenbeen modifiedmodified andand areare linkedlinked toto evolutionevolution ofof mammalian,mammalian,attachmentattachment andand socialsocial engagementengagement systemssystemsattachmentattachment andand socialsocial engagementengagement systemssystems

•• ThisThis relativerelative balancebalance cancan bebe measuredmeasured inin heartheart rateratevariabilityvariability

•• HeartHeart raterate variabilityvariability linkedlinked toto adaptiveadaptive balancebalance andandflexibility,flexibility, soothingsoothing andand safenesssafeness -- lowlow variabilityvariability totorelativerelative control/dominancecontrol/dominance ofof oneone overover thethe otherother -- threatthreat

Parasympathetic Parasympathetic

nerves to heartnerves to heart

Slows HRSlows HR

Sympathetic Sympathetic

nerves to heartnerves to heart

Increases HR and Increases HR and

stroke volumestroke volume

Successive InterSuccessive Inter--beat Intervals beat Intervals

(ms) (ms)

945945

897897

858858

799799

821821

846846

851851

858858

879879

879879

Standard Deviation of Standard Deviation of InterInter--beat Intervals beat Intervals over 300 second over 300 second period = SDNNperiod = SDNN

Tasks of studyTasks of study

RelaxationRelaxation conditioncondition waswas focusingfocusing onon relaxingrelaxing

calmingcalming images/thoughtsimages/thoughts

ControlControl conditioncondition waswas toto imagineimagine makingmaking youryour

favouritefavourite sandwichsandwich andand thethe pleasurepleasure youyou willwill getgetfavouritefavourite sandwichsandwich andand thethe pleasurepleasure youyou willwill getget

fromfrom eatingeating itit (control(control forfor typetype ofof positivepositive affectaffect andand

alsoalso thethe effectseffects ofof mentalmental imagery)imagery)

CompassionCompassion imageryimagery waswas toto imagineimagine theirtheir idealideal

compassionatecompassionate personperson andand howhow kind,kind, warmwarm andand

caringcaring theythey werewere forfor thethe selfself

65.00

60.00

55.00

Mean SDNN

Grp 2 ups

Grp 1downs

SDNN change grouping variable

Diagram showing mean SDNN for each group at baseline & during imagery conditions

Compassionate Imagery

Control ImageryBaseline

Condition

50.00

45.00

40.00

Mean SDNN

5.800

5.600

5.400

Mean cortisol (ng/ml)

Grp 2ups

Grp 1downs

Grouping variabile for SDNN change

Diagram showing mean cortisol for each group at baseline & after Imagery

CortBCortA

Sample

5.200

5.000

4.800

Mean cortisol (ng/ml)

Correlations between change in HRV Correlations between change in HRV

and selfand self--report scalesreport scales

SDNNSDNN

Inadequate SelfInadequate Self Anxious AttachmentAnxious Attachment

--.54*.54* --.48*.48*

Depend AttachmentDepend Attachment Social SafenessSocial Safeness

.52*.52* .57**.57**

* p<.05 ** p <.01* p<.05 ** p <.01

Fears of CompassionFears of Compassion

Basic Beliefs and MetaBasic Beliefs and Meta--cognitionscognitionsBasic Beliefs and MetaBasic Beliefs and Meta--cognitionscognitions

Fear of Compassion Fear of Compassion ForFor Others Others

ScaleScale

PeoplePeople willwill taketake advantageadvantage ofof youyou ifif youyou areare

tootoo compassionatecompassionate

IfIf I’mI’m tootoo compassionate,compassionate, othersothers willwill becomebecome

tootoo dependentdependent onon meme

II can’tcan’t toleratetolerate othersothers distressdistress

Fear of Compassion Fear of Compassion FFromrom Others Others

ScaleScale

II fearfear thatthat ifif II needneed otherother peoplepeople toto bebe kind,kind, theytheywontwont bebe

II worryworry thatthat peoplepeople areare onlyonly kindkind andandcompassionatecompassionate ifif theythey wantwant somethingsomething fromfrom meme

IfIf II thinkthink someonesomeone isis beingbeing kindkind && caringcaring towardstowardsme,me, II putput upup aa barrierbarrier

Fear of Compassion Fear of Compassion Towards Towards

SelfSelf ScaleScale

I fear that if I develop compassion for I fear that if I develop compassion for

myself, I will become someone I don’t want myself, I will become someone I don’t want

to beto be

I fear that if I am more selfI fear that if I am more self--compassionate compassionate

I will become a weak personI will become a weak person

I fear that if I start to feel compassion for I fear that if I start to feel compassion for myself, myself,

I will be overcome with loss/griefI will be overcome with loss/grief

Fear of Compassion DataFear of Compassion Data

Com Com for for

others others

Com Com fromfrom

OthersOthers

Com Com for for

othersothers

Com Com fromfrom

OthersOthers. 47**. 47**

SelfSelf comcom . 37**. 37** . 67**. 67**

Fear of Compassion DataFear of Compassion Data

C C forfor

OthersOthers

C C fromfrom

OthersOthers

Self Self ComCom

AnxietyAnxiety . 22**. 22** . 46**. 46** . 44**. 44**AnxietyAnxiety . 22**. 22** . 46**. 46** . 44**. 44**

DepDep . 17*. 17* . 37**. 37** . 40*. 40*

Tentative ideasTentative ideas

ToTo emotionalemotional (shame(shame type)type) eventsevents -- beingbeing selfself--

reassuringreassuring vsvs selfself--criticalcritical activatesactivates differentdifferent brainbrain

systemssystems

PeoplePeople highhigh inin selfself--criticismcriticism seemseem toto strugglestruggle totoPeoplePeople highhigh inin selfself--criticismcriticism seemseem toto strugglestruggle toto

activateactivate soothingsoothing systemsystem andand maymay findfind effortsefforts toto bebe selfself

--compassionatecompassionate aa threatthreat –– (sadness?)(sadness?)

QuestionQuestion:: cancan wewe teachteach selfself--criticscritics toto bebe selfself soothingsoothing

andand wouldwould thisthis ‘training‘training affect’affect’ changechange physiologicalphysiological

responsesresponses toto threateningthreatening--selfself linkedlinked events?events?

TherapyTherapy

Life history and contextual rather than symptom focusedLife history and contextual rather than symptom focused

Background, key threats, safety strategies Background, key threats, safety strategies undesired/unintended consequenceundesired/unintended consequence

High focus on validation, on “not your fault,” courage and High focus on validation, on “not your fault,” courage and doing your best.doing your best.doing your best.doing your best.

Clarify three circle model and why we will explore helpful Clarify three circle model and why we will explore helpful behaviour for behaviour for eacheach circlescircles

Desensitisation to affiliative positive affect Desensitisation to affiliative positive affect –– to be able to to be able to feel safe and self compassionatefeel safe and self compassionate

TreatmentTreatment

•• Attendance one of two programmesAttendance one of two programmes

•• Patients invited to take part in a research trial of Patients invited to take part in a research trial of

CMT at community meetingsCMT at community meetings

•• Criteria for inclusion were mid treatment (six months Criteria for inclusion were mid treatment (six months

to one year), well engaged with the service and to have to one year), well engaged with the service and to have

selfself--attacking, negative thoughtsattacking, negative thoughtsselfself--attacking, negative thoughtsattacking, negative thoughts

•• Nine patients agreed to take part in the study (five Nine patients agreed to take part in the study (five

men and four women)men and four women)

•• Three did not complete the study: hence six completed Three did not complete the study: hence six completed

•• Twelve two hour sessionsTwelve two hour sessions

•• Gradual process of developing compassionate imagery Gradual process of developing compassionate imagery

and soothing exercises and then engaging with self and soothing exercises and then engaging with self

critical thinking critical thinking

Data From Group StudyData From Group Study

Pre and Post Compassionate Mind

Training

54.2 56.4

50

60

10.2

18.8

0

10

20

30

40

Self criticism Self compassion

Scale

Before

After

Data From Group StudyData From Group Study

Functions of Self-to-Self Relating

28

(15.79)

17.5

21.67

(11.74)25

30

17.5

(8.62)

9.6

(8.45)

0

5

10

15

20

Self Correction Self Persecution

Score Before

After

Data From Group StudyData From Group Study

HADS

10.33

(2.67)

14.67

(3.78)

10

12

14

16

4.3

(2.73)

6.83

(2.93)

0

2

4

6

8

10

Anxiety Depression

Subscale

Score Before

After

Data From Group StudyData From Group Study

Forms of Self-to-Self Relating

31.33

(5.16)

15.17

(3.76)

14.5

(7.01)

19.83

(8.21)20

25

30

35

Score (3.76)

6.17

(6.40)

(7.01)

5.67

(5.40)

0

5

10

15

Inadeq

uate Self

Hated self

Reassure Self

Score

Before

After

Data From Group StudyData From Group Study

Others as Shamer

48 .5

( 17 . 2 7 )

36 . 3 3

( 12 . 13 )40

50

60

Social Comparison

3 4 .8 3

58 .6 7

( 2 6 .0 0 )

40

50

60

70

( 12 . 13 )

0

10

20

30

40

Ot hers as Shamers

Before

After

3 4 .8 3

( 2 1.50 )

0

10

20

30

40

Social

comparison

Score Before

After

ReflectionsReflections

II wouldwould justjust likelike toto telltell youyou allall herehere todaytoday whatwhat (CMT)(CMT)meansmeans toto meme.. ItIt seemedseemed toto awakenawaken aa partpart ofof mymy brainbrain thatthatII waswas notnot awareaware existedexisted..

TheThe feelingfeeling ofof onlyonly everever havinghaving compassioncompassion forfor otherotherpeoplepeople andand nevernever everever contemplatingcontemplating havinghaving anyany forformyselfmyself..

SuddenlySuddenly realisingrealising thatthat it’sit’s alwaysalways beenbeen there,there, justjust thatthat IISuddenlySuddenly realisingrealising thatthat it’sit’s alwaysalways beenbeen there,there, justjust thatthat IIhavehave nevernever knewknew howhow toto useuse itit towardstowards myselfmyself..

ItIt waswas suchsuch aa beautiful,beautiful, calmingcalming feelingfeeling toto knowknow itit waswas OkOktoto feelfeel likelike thisthis towardstowards myselfmyself withoutwithout feelingfeeling guiltyguilty ororbadbad aboutabout itit..

BeingBeing ableable toto drawdraw onon thisthis whenwhen II waswas frightenedfrightened andandconfused,confused, toto calmcalm myselfmyself downdown andand toto putput thingsthings ininprospectiveprospective andand saysay toto myselfmyself “IT’S“IT’S OKOK TOTO FEELFEEL LIKELIKETHISTHIS..

ReflectionsReflections

HavingHaving compassioncompassion forfor myselfmyself meansmeans II feelfeel soso muchmuch moremore atatpeacepeace withwith myselfmyself.. KnowingKnowing thatthat itit isis aa normalnormal wayway ofof lifelife totohavehave compassioncompassion forfor myselfmyself andand it’sit’s notnot anan abnormalabnormal wayway ofofthinking,thinking, butbut aa veryvery healthyhealthy wayway ofof thinkingthinking.. ItIt feltfelt likelike IIwaswas trainingtraining mymy mindmind toto switchswitch toto thisthis modemode whenwhen II startstart totofeelfeel badbad aboutabout myselfmyself oror lifelife situationssituations werewere startingstarting toto getgetonon toptop ofof meme..onon toptop ofof meme..

WhatWhat isis strikingstriking aboutabout this,this, andand whatwhat otherother participantsparticipantsthought,thought, waswas howhow muchmuch theythey hadhad (previously)(previously) feltfelt thatthat beingbeingselfself--compassionatecompassionate andand empathicempathic toto one’sone’s distressdistress waswas aa selfself--indulgenceindulgence oror weaknessweakness andand definitelydefinitely notnot somethingsomething totocultivatecultivate..

Mayhew and Gilbert 2008Mayhew and Gilbert 2008

Three voices hearers with CFTThree voices hearers with CFT

ResultsResults showedshowed decreasesdecreases forfor allall participantsparticipants

inin depression,depression, psychoticism,psychoticism, anxiety,anxiety,

paranoia,paranoia, OCDOCD andand interpersonalinterpersonal sensitivitysensitivity..

AllAll participants’participants’ auditoryauditory hallucinationshallucinations

becamebecame lessless malevolent,malevolent, lessless persecutingpersecuting andand

moremore reassuringreassuring

Some other studies

Laithwaite et al., (2010) (University of Glasgow) in a Laithwaite et al., (2010) (University of Glasgow) in a

study of group based CFT study for 19 clients in a high study of group based CFT study for 19 clients in a high

security psychiatric at Carstairs found security psychiatric at Carstairs found

“… a large magnitude of change for levels of “… a large magnitude of change for levels of “… a large magnitude of change for levels of “… a large magnitude of change for levels of

depression and selfdepression and self--esteem ….. A moderate magnitude esteem ….. A moderate magnitude

of change was found for the social comparison scale of change was found for the social comparison scale

and general psychopathology, with a small magnitude and general psychopathology, with a small magnitude

of change for shame. These changes were maintained of change for shame. These changes were maintained

at 6at 6--week followweek follow--upup”.”.

ConclusionsConclusions•• CFT linked to evolved and neurophysiological systems : Must CFT linked to evolved and neurophysiological systems : Must

distinguish different types of positive emotion systemsdistinguish different types of positive emotion systems

•• SelfSelf--toto--self relationships are important mediators between early self relationships are important mediators between early rearing styles and distressed states rearing styles and distressed states

•• CFT focuses on this inner relationship CFT focuses on this inner relationship –– shifting it to a self shifting it to a self compassionate onecompassionate one

•• First movements to compassion in selfFirst movements to compassion in self--critics are often aversive so critics are often aversive so this system needs to be ‘detoxified’ this system needs to be ‘detoxified’

•• Takes time and should focus on practice rather than focusing on Takes time and should focus on practice rather than focusing on feelings first upfeelings first up

•• Clients like the neurophysiological and Mind Training aspects Clients like the neurophysiological and Mind Training aspects ----like ‘going to the gym’ analogieslike ‘going to the gym’ analogies