Compassion-Focused-Therapy Model and Research Paul Gilbert, Kirsten McEwan, Corinne Gale

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Compassion-Focused-Therapy Model and Research
Paul Gilbert, Kirsten McEwan, Corinne Gale
Jean GilbertMental Health Research Unit,
Kingsway Hospital, Derby UKwww
Compassionatemind.co.uk

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Talk Today

• Outline basic philosophy and model of Compassion
  focused Therapy
• Note the powerful effects of our self- evaluation
  systems (self-criticism vs self compassion)
• Explore the main therapeutic work as overcoming
  the fear of compassion and self compassions

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To understand ourselves we must understand our
brains
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why we have complex brains and minds that are
difficult to understand regulate

• 1. Old Brain
• Emotions Anger, anxiety, sadness, joy,
  lust
• Behaviours Fight, flight, withdraw,
  engage
• Relationships Sex, status, attachment,
  tribalism
• 2. New Brain
• Imagination, fantasise, look back and forward,
  plan, ruminate Integration of mental abilities
• Self-awareness, self-identity, and self-feeling
• 3. Social Brain
• Need for affection and care
• Socially responsive, self-experience and motives
• What happens when new brain is recruited to
  pursue old brain passions?

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Sources of behaviour
Interaction of old and new psychologies
New Brain Imagination, Planning, Rumination,
Integration
Old Brain Emotions, Motives, Relationship
Seeking-Creating Archetypal
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Understanding our Motives and Emotions

• Motives evolved because they help animals to
  survive and leave genes behind
• Emotions guide us to our goals and respond if we
  are succeeding or threatened
• There are three types of emotion regulation
• Those that focus on threat and self-protection
• Those that focus on doing and achieving
• Those that focus on contentment and feeling safe

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Types of Affect Regulator Systems
Content, safe, connected
Drive, excite, vitality
Non-wanting/ Affiliative focused Safeness-kindnes
s Soothing
Incentive/resource- focused Wanting, pursuing,
achieving, consuming Activating
Threat-focused Protection and Safety-seeking Act
ivating/inhibiting
Anger, anxiety, disgust
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Self-Protection

• In species without attachment only 1-2 make it
  to adulthood to reproduce. Threats come from
  ecologies, food shortage, predation, injury,
  disease. At birth individuals must be able to go
  it alone be mobile and disperse

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Dispersal and avoid others
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Protect and Comfort Less instinctive brain
post birth learning
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The Mammalian Importance of Caring Minds

• Caring as looking after. Seeking closeness
  rather than dispersion. Individuals obtain
  protection, food, and care when ill. Key also is
  soothing-calming and physiological regulation.
  Few offspring but high survival rate in
  comparison to species without attachment.
  Affection and kindness
• Co-operative and mutual support can develop as we
  see that our prosperity impacts on that of
  others, sharing and not-exploiting

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Affectionate Interactions

• Secure attachment linked to self-confidence,
  empathy and use of attachment strategies when
  stressed (Mikulincer Shaver 2005)
• Maturation of the brain (e.g. frontal cortex) and
  affect regulation (Gerhardt, 2004 Schore, 1994)
• Effects of low birth weight (Tully et al, 2004.
  JCCP, 72, 218-226)
• Testosterone and aggression (Booth et al., 2003.
  Developmental Psychology, 39, 85 98)
• Self-to-self-relating e.g. self criticism vs
  self-reassurance

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Internal Threat and Soothing
Self-affiliation experiences a lovable self
Calms
Affiliative/ Soothing
Threat
Neurophysiological networks
Internal representations of helpful others and
sources of comfort
Emotional memories of soothing
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Internal Threat and More threat
No self-affiliation experiences a unlovable self
Calms
Affiliative/ Soothing
Threat
Neurophysiological networks
Others are threats or alarming
Emotional memories of no soothing
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Compassion Solutions
Ancient wisdom Compassion is the road to
happiness (Buddhism) Evolution Evolution has
made our brains highly sensitive to internal and
external kindness Neuroscience Specific brain
areas are focused on detecting and responding to
kindness and compassion
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Compassion

• Compassion can be defined in many ways As a
  sensitivity to the suffering of self and others
  with a deep commitment to try to relieve it
  Dalai Lama
• Eight fold path - represents a multi-modal
  approach for training ones mind

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Compassion as Flow

• Different practices for each
• Other Self
• Self Other
• Self Self
• Non linear empathy for other begins
  early in life

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Data

• Practice of imagining compassion for others
  produces changes in frontal cortex and immune
  system (Lutz et al, 2009)
• Loving kindness meditation (compassion directed
  to self, then others, then strangers) increases
  positive emotions, mindfulness, feelings of
  purpose in life and social support and decreases
  illness symptoms (Frederickson et al, 2008, JPSP)
• Compassion meditation (6 weeks) improves immune
  function, and neuroendocrine and behavioural
  responses to stress (Pace, 2008, PNE)
• Viewing sad faces, neutrally or with a
  compassionate attitude influences
  neurophysiological responses to faces (Ji-Woong
  Kim, 2009, NP)
• Compassion training reduces shame and
  self-criticism in chronic depressed patients
  (Gilbert Proctor, 2006, CPP)

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Key Targets of Therapy
Thinking Reasoning
Attention
Imagery Fantasy
Behaviour
Motivation
Emotions
Their pattern gives rise to a certain type of mind
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Compassionate Mind
Thinking Reasoning
Attention
Imagery Fantasy
Behaviour
Compassion
Motivation
Emotions
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Threatened Mind can block Compassion
Thinking Reasoning
Attention
Imagery Fantasy
Behaviour
Threat
Motivation
Emotions
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Self-Critical Mind is also Threat-focused Mind
Thinking Reasoning
Attention
Imagery Fantasy
Self- Critical
Behaviour
Motivation
Emotions
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How our own thoughts and images affect our brains
Sexual
Bully-threat
Meal
Sex
Meal
Bully- threat
Kind, warm and caring
Emotion Brain
Compassion
Soothed Safe
Stomach acid Salvia
Fearful Depressed
Arousal
Pink represents our inner images and thoughts
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Questions

How does self-criticism and self-compassion/
reassurance work in the brain? Are their
individual differences linked to trait self-
criticism? How might compassion training
influence neurophysiology?
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fMRI Study (Aston University)STUDY Olivia Longe,
Gina Rippon, Paul Gilbert Frankie Maratos

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

Self- Reassure
Self- Criticize
Self- Reassure
Self- Criticize
A third job rejection letter in a row arrives in
the post
The second free local newspaper in a row arrives
in the post.
Emotion Scenario(-)
Neutral Scenario
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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
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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
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Parent recall and SC and SRIrons Gilbert
Baldwin et al., 2006 Br J Clin Psych
.24 (.31)
Inadequate Self
Rejection
.26 (.60)
.31 (.33)
.15 (.25)
Overprotection
Depression
.22 (.55)
Hated Self
-.31 (-.56)
.37 (.30)
Warmth
Reassure Self
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Parent recall and SC and SRIrons Gilbert
Baldwin et al., 2006 Br J Clin Psych
.24 (.31)
Inadequate Self
Rejection
.26 (.60)
.31 (.33)
.15 (.25)
Overprotection
Depression
.22 (.55)
Hated Self
-.31 (-.56)
.37 (.30)
Warmth
Reassure Self
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Imagining a self-critical part of self

• 197 students from Derby and McGill Universities
• (with Chris Irons and Mark Baldwin)
• Self-criticism
• Power Anger
• 0.53 0.51
• Self-reassurance
• Power Anger
• - 0. 33 - 0.33

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Imagining a Self-Compassionate Part of Self

• 197 students from Derby and McGill Universities
• (with Chris Irons and Mark Baldwin)
• Self-criticism
• Power Warm
• - 0.54 - 0.34
• Self-reassurance
• Power warm
• 0. 58 0.43
• Gilbert et al (2005)

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Compassionate Mind
Thinking Reasoning
Attention
Imagery Fantasy
Self- Compassionate
Behaviour
Motivation
Emotions
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Why a Compassion Focus?

• People with chronic problems often come from
  neglectful or abusive backgrounds, have high
  levels of shame, and are often self-critical,
  self-disliking, or self-hating
• Live in a world of constant internal and external
  threat
• Have few experiences of feeling safe or soothed
  and are not able to do this for themselves. Often
  do poorly in trials

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Internal Threat and Soothing
Self-Criticism
Compassionate Re-focusing
Calms
Affiliative/ Soothing
Threat
Worry
Rumination
Compassionate imagery
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Fear of Compassion

• Certain types of positive feelings are
  threatening
• It is dangerous to feel safe
• Compassion feeling are linked to beliefs such
  that its an indulgence and weakness
• Activated grief and or abuse memories

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PROBLEM -Compassion is a threat
Compassionate Re-focusing
Affiliaitve/Soothing
Threat
Compassionate imagery
Shame-self criticism
Mentalizing
Trauma Memory
Meta- beliefs
Fear of closeness
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Kindness, Attachment and Threat

• Kindness from therapist or imagery

Activate attachment system Activate memories
Fight, flight shut down
Fight, flight shut down
Neglect aloneness
Abuse, shame vulnerable
Activate learnt and current defences - cortisol
Bowlby Kindness opens the attachment system and
then whatever ever fears, anger or despair is
coded there will become available and can be
intensely threatening
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Study of reactions to compassionate imagery

• Control of the mechanisms for balance between
  sympathetic and parasympathetic nervous system
  have been modified and are linked to evolution of
  mammalian, attachment and social engagement
  systems
• This relative balance can be measured in heart
  rate variability
• Heart rate variability linked to adaptive balance
  and flexibility, soothing and safeness - low
  variability to relative control/dominance of one
  over the other - threat

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Parasympathetic nerves to heart Slows HR
Sympathetic nerves to heart Increases HR and
stroke volume
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Successive Inter-beat Intervals
(ms) 945 897 858 799 821 84
6 851 858 879 879
Standard Deviation of Inter-beat Intervals over
300 second period SDNN
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Tasks of study
Relaxation condition was focusing on relaxing
calming images/thoughts Control condition was to
imagine making your favourite sandwich and the
pleasure you will get from eating it (control
for type of positive affect and also the effects
of mental imagery) Compassion imagery was to
imagine their ideal compassionate person and how
kind, warm and caring they were for the self

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Correlations between change in HRV and
self-report scales SDNN

• Inadequate Self Anxious Attachment
• -.54 -.48
• Depend Attachment Social Safeness
• .52 .57
• plt.05 p lt.01

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Fears of Compassion

• Basic Beliefs and Meta-cognitions

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Fear of Compassion For Others Scale

• People will take advantage of you if you are too
  compassionate
• If Im too compassionate, others will become too
  dependent on me
• I cant tolerate others distress

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Fear of Compassion From Others Scale

• I fear that if I need other people to be kind,
  they wont be
• I worry that people are only kind and
  compassionate if they want something from me
• If I think someone is being kind caring towards
  me, I put up a barrier

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Fear of Compassion Towards Self Scale

• I fear that if I develop compassion for myself, I
  will become someone I dont want to be
• I fear that if I am more self-compassionate I
  will become a weak person
• I fear that if I start to feel compassion for
  myself, I will be overcome with loss/grief

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Fear of Compassion Data
Com for others Com from Others
Com for others
Com from Others . 47
Self com . 37 . 67
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Fear of Compassion Data
C for Others C from Others Self Com
Anxiety . 22 . 46 . 44
Dep . 17 . 37 . 40
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Tentative ideas

• To emotional (shame type) events - being
  self-reassuring vs self-critical activates
  different brain systems
• People high in self-criticism seem to struggle to
  activate soothing system and may find efforts to
  be self -compassionate a threat (sadness?)
• Question can we teach self-critics to be self
  soothing and would this training affect change
  physiological responses to threatening-self
  linked events?

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Therapy

• Life history and contextual rather than symptom
  focused
• Background, key threats, safety
  strategies undesired/unintended consequence
• High focus on validation, on not your fault,
  courage and doing your best.
• Clarify three circle model and why we will
  explore helpful behaviour for each circles
• Desensitisation to affiliative positive affect
  to be able to feel safe and self compassionate

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Treatment

• Attendance one of two programmes
• Patients invited to take part in a research trial
  of CMT at community meetings
• Criteria for inclusion were mid treatment (six
  months to one year), well engaged with the
  service and to have self-attacking, negative
  thoughts
• Nine patients agreed to take part in the study
  (five men and four women)
• Three did not complete the study hence six
  completed
• Twelve two hour sessions
• Gradual process of developing compassionate
  imagery and soothing exercises and then engaging
  with self critical thinking

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Data From Group Study
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Data From Group Study
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Data From Group Study
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Data From Group Study
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Data From Group Study
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Reflections

• I would just like to tell you all here today what
  (CMT) means to me. It seemed to awaken a part of
  my brain that I was not aware existed.
• The feeling of only ever having compassion for
  other people and never ever contemplating having
  any for myself.
• Suddenly realising that its always been there,
  just that I have never knew how to use it towards
  myself.
• It was such a beautiful, calming feeling to know
  it was Ok to feel like this towards myself
  without feeling guilty or bad about it.
• Being able to draw on this when I was frightened
  and confused, to calm myself down and to put
  things in prospective and say to myself ITS OK
  TO FEEL LIKE THIS.

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Reflections

• Having compassion for myself means I feel so much
  more at peace with myself. Knowing that it is a
  normal way of life to have compassion for myself
  and its not an abnormal way of thinking, but a
  very healthy way of thinking. It felt like I was
  training my mind to switch to this mode when I
  start to feel bad about myself or life situations
  were starting to get on top of me.
• What is striking about this, and what other
  participants thought, was how much they had
  (previously) felt that being self-compassionate
  and empathic to ones distress was a
  self-indulgence or weakness and definitely not
  something to cultivate.

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Mayhew and Gilbert 2008

• Three voices hearers with CFT
• Results showed decreases for all participants in
  depression, psychoticism, anxiety, paranoia, OCD
  and interpersonal sensitivity. All participants
  auditory hallucinations became less malevolent,
  less persecuting and more reassuring

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Some other studies

• Laithwaite et al., (2010) (University of Glasgow)
  in a study of group based CFT study for 19
  clients in a high security psychiatric at
  Carstairs found
• a large magnitude of change for levels of
  depression and self-esteem .. A moderate
  magnitude of change was found for the social
  comparison scale and general psychopathology,
  with a small magnitude of change for shame. These
  changes were maintained at 6-week follow-up.

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Conclusions

• CFT linked to evolved and neurophysiological
  systems Must distinguish different types of
  positive emotion systems
• Self-to-self relationships are important
  mediators between early rearing styles and
  distressed states
• CFT focuses on this inner relationship shifting
  it to a self compassionate one
• First movements to compassion in self-critics are
  often aversive so this system needs to be
  detoxified
• Takes time and should focus on practice rather
  than focusing on feelings first up
• Clients like the neurophysiological and Mind
  Training aspects --like going to the gym
  analogies