1. An Introduction to Compassion Focused Therapy and Compassionate Mind Training
Dr Brett Grellier – Psychology Services
Counselling Psychologist
Westminster Rough Sleeping Services
March 2016
Experienced novice
My interest in compassion began a few years ago when working in the addictions department of SLaM as an absence of a nurturing attachment figure in childhood, poor emotional regulation and self criticism were often present in the client group. I read Paul Gilbert’s Compassionate Mind tome and began to include the role of self-criticism in formulations with clients and to encourage a kinder and warmer alternative to the self-critical thoughts. It wasn’t until I joined the Lewisham IAPT team that I had any formal training and last year I attended the two day introductory workshop with Mary Welford and then later in the year attended the three day advanced workshop with Paul Gilbert, in which Deborah (Perfect nurturer) Lee also presented. It was at this second conference that Paul gave his blessing for me to provide a training day for my colleagues in SLaM IAPT services. I belong to an online forum in which people share papers on the approach and also share cases, which other forum members then help with. I also attend a CFT special interest group at UCL facilitated by Chris Irons, who has co-authored many papers on the approach with Paul Gilbert. This is rather like a group supervision session. I integrate CMT into much of my work now and have used a primarily CFT intervention with clients who present with ‘treatment resistant’ depression, anger and emotional regulation difficulties.

2. Overview of the day 9.30 – 11am: Background and Theory Applications
Interventions
11 – 11.20am: Coffee Break
11.20am – 1pm: Therapy Stages
3 circles model
1 – 2pm: Lunch
2 – 3.30pm: Development of Compassion
Threat & Safety Strategy Formulation
Case Studies
3.30 – 3.50pm: Tea Break
3.50 – 4.30pm: Compassionate behaviour change Compassionate thought record

3. Compassion pioneers Paul Gilbert: The Compassionate Mind Approach.
Chris Germer: The Mindful Path to Self-Compassion
Kristen Neff: Guided Self-Compassion. Research professor
Charles Raison: Cognitively-Based Compassion Training. Science of Compassion
Daniel Siegel: Interpersonal Neurobiology
Compassion Focused approaches come under the umbrella of third wave CBT approaches that also includes Acceptance and Commitment Therapy (ACT; Hayes, Strosahl & Wilson, 1999), Mindfulness-Based Cognitive Therapy (MBCT; Segal, Williams and Teasdale, 2002) and Dialectical Behaviour Therapy (DBT; Linehan, 1993)
David Veale – working with OCD

4. Evidence base
In small scale studies CFT demonstrated to be effective in treatment of depression (shame and self-criticism), emotional regulation problems, eating disorders, anxiety disorders. Emerging evidence that it can be effective in reducing distress for people experiencing psychosis.
Paul Gilbert is currently working towards carrying out RCTs looking at the effectiveness of CFT.
Kristen Neff and Chris Germer (2012). 8 week Mindful Self-Compassion Programme. Increased self-compassion, compassion for others, mindfulness, happiness and life satisfaction and reduced stress, anxiety and depression. All skills maintained at 1 year follow up, with further gains in life satisfaction.
Charles Raison (2011). Compassion practice leads to reduction in IL-6 (cytokine) production and faster cortisol recovery following stressful event – reduces inflammatory responses to psychosocial stressors reducing risk of depression and physical illness such as heart disease and arthritis.
IL-6 is relevant to many diseases such as diabetes,[15] atherosclerosis,[16] depression,[17] Alzheimer's Disease,[18] systemic lupus erythematosus,[19] prostate cancer,[20] and rheumatoid arthritis.[21]
Effects are lasting

5. Compassion: Definitions
As loving kindness: open-heartedness “deep feeling and understanding of the suffering of self and others with a deep commitment to try to relieve it and prevent it” Dalai Lama
“The ability to experience affiliative emotions” Paul Gilbert
“A feeling of open-heartedness to all senses and sense of intra-dependence” Kristen Neff
“Experience of suffering with a wish to relieve it” Chris Germer
Ask group for their definitions of compassion. This is not a sugar coated approach, the opposite is true in that it opens the client up to their own suffering. Chris Germer – Shining light into dark places and find out what’s lurking there and illuminates the relationship matrix in which our sense of self was created. WRITE UP ON FLIPCHART
RM: It’s like opening a door to the parts of life you have hidden away and then holding up a light to see inside.

6. Empathy & Compassion
Compassion – a motivational system that links to sensitivity to suffering with a desire to do something about it.
Empathy – a competency that links emotional understanding and perspective taking.

7. Compassion Focused Therapy (CFT) and Compassionate Mind Training (CMT)
CFT is a CBT approach with particular focus on evolutionary factors (tricky and hard to regulate brain) and classical conditioning.
CFT was developed to target shame and self-criticism
CFT offers a way of focusing therapy, guiding therapeutic interventions especially for the development of self-soothing and self-compassion
Compassionate Mind Training (CMT) refers to the specific training and use of guided exercises to develop compassionate attributes of compassionate motivation, sensitivity, sympathy, distress tolerance, empathy, non-judging and non-condemning.
I will be using acronyms from now on
Primitive brain and modern brain (frontal) sometimes working against each other or modern brain further inflaming primitive brain.

8. Why CFT?
Often clients understand on rational basis but negative affect remains - CFT works with specific affect regulation systems (“I know it but I don’t feel it”)
Clients with shame and self- criticism often come from harsh backgrounds and find it difficult to feel reassured or safe
CFT focuses on developing people’s abilities to feel inner safeness and self-reassurance as antidote to self- criticalness
Tones up and fosters certain types of positive emotions and well as reducing negative ones
Logic and emotion can be in conflict and we have different processing systems linked to each. One is linked to what is called implicit (automatic processing) which is non-conscious, fast, emotional, requires little effort, is subject to classical conditioning and self identity functions, and may generate feelings and fantasies even against conscious desires. This can be contrasted with an explicit (controlled) processing system, which is slower, consciously focused, reflective, verbal and effortful. There is no simple connection of cognition to emotion, and there are different neurophysiological states underpinning them (Panksepp, 1998).

9. Group Exercise Intuitive wisdom of shame
Think about a shame related event, feeling or fantasy and imagine it?
Now think about speaking about this
My first automatic feelings would be?
Complete the exercise
Key fears
Coping behaviours
What have we learnt from this exercise?

10. Main influences Interpersonal neurophysiology Evolutionary theory
Buddhist Psychology
Attachment theory
CBT interventions

11. Evolutionary Theory
Threat-focused system has evolved from older evolutionary structures in the brain, such as the amygdala and the limbic system – Fight/Flight/Freeze
Affiliative-focused behaviours involve an evolved capacity for human beings to feel “safeness” and to feel soothed in the presence of stable, warm , empathic interactions with others. (Gilbert, 2009)
Wang (2005) hypothesises that compassion emerges from an evolutionary determined “species preservative” neurophysiological system, resulting from the need for defenceless young to be cared for in order to survive
Anxiety: Fight/flight/freeze responses to perceived threat
Depression: Loss of social status
It involves the activation of a sudden and maximally effective defensive behavioural response, such as the classic fight/flight/freeze response.
This affiliative-focused “safeness system” involves non-verbal behaviours that may resemble the stable, caring context that an engaged and effective parent may establish with his or her child. One of the aims of CFT is training clients in accessing and employing this system of self-soothing through the felt experience of compassion

12. The Flow of Life We just find ourselves here.
We didn’t choose to be born, nor choose the genes that made us
We didn’t choose our emotions
We didn’t choose our basic temperaments
We didn’t choose our body and how it works
We didn’t choose our basic human desires and needs
We didn’t choose the time in history that we were born

13. Our biological selves
Our minds brains and bodies have evolved over millions of years.
Much of goes on in our mind is not ‘of our design’ and not our fault.
We were designed to feel, want and need certain things.
We are designed for survival not happiness
Both pain and emotion have evolved to protect us, but the can be both difficult to manage.

14. Reptilian Brain
For the reptile, conscious choice is not an option – sensation is the language of the reptilian brain. All behaviours and every movement is instinctual.
It is encoded with the instinctual plans for the behaviours that ensure the survival of the species (self-preservation and reproduction).
All defensive strategies (Fight, Flight, Freeze) are genetically programmed into this primitive and highly effective brain.
Biologically and physiologically, the reptilian brain is essential to all animals, including humans.

15. Mammalian Brain
Mammals have brains that include both a reptilian core and a more elaborate structure known as the limbic brain.
The limbic brain is the primary site of complex emotional and social behaviours lacking in the reptile.
These behaviours do not take the place of instinctual impulses from the reptilian brain, they complement and enhance them – this gives the mammal more choices than the reptile.
Mammals have developed an understanding of their increased survivability as a group.
Emotions give mammals a more highly developed way to store and communicate information.

16. Human Brain
The human brain, known as the neo-cortex, allows us to form thoughts and to develop language.
This allows rational thinking, planning, worrying, ruminating, imagination, self-awareness and self-identity.
Our human (or ‘new brain’) is built by our early relationships and our early environment. We are literally shaped and moulded by our family and what we experience.
In the healthy human instinct, emotion, and intellect work together to create the widest range of choices possible in any given situation.
The interaction between the reptilian, mammalian and human brains can, however, create conflicts within us. They can get stuck in unhelpful loops.

17. Old Brain vs. New brain Our brains are ‘tricky’ and hard to manage.
Animals don’t worry about the past or the future.
Animals don’t worry about their self-image or getting older.
Animals don’t judge or criticise their own natural responses and experiences as we do.

18. OUR TRICKY BRAINS: ‘OLD’ and ‘NEW’
NEW BRAIN:
Imagine, plan, ruminate, self-monitor
OLD BRAIN:
Motives (harm-avoidance, food, sex, caring, status)
Emotions (anger, anxiety, sadness, joy)
Behaviours (fight, flight, shut down, caring)
The interaction between old and new ‘minds’ can create conflicts within us. It can get us stuck into unhelpful loops

19. Buddhist conceptualisations of Compassion
Karuna – A Pali term that translates as “compassion” that involves a desire to prevent harm from occurring to others and the self.
Metta – “loving kindness” that involves a desire to bring happiness and positive emotional experience to others and the self from the Theravada tradition
Bodhicitta – not easily translated but suggests that all phenomena are inextricably woven and contemplative experience of this sense of connection will eventually result in an altruistic aspiration to work towards the alleviation of suffering for all beings
Several concepts from Buddhist Psychology relate to the word ‘compassion’ as it is coming to be used in cognitive and behavioural therapies.
“Compassion is the feeling that arises from the realisation of the deeper reality that we are all connected, we are all one”
Pronounce: Bod I citta

20. Conceptualisations of Mindfulness
Sati is the original Pail term that has been translated into English as “mindfulness”. Sati is a state of mind that can be said to involve a blend of attention, awareness and memory (Kabat-Zinn, 2009)
“The awareness that arises through paying attention, on purpose in the present moment, and non-judgementally” Kabat-Zinn (1994)
Many Buddhist practices are designed to foster the cultivation of compassion but the majority of these practices emerge from a foundation in the development of sati. (Tirch, 2010)
Jon Kabat-Zinn popularised the use of “mindfulness” in his Mindfulness-Based Stress Reduction programme and by creating an operational definition of mindfulness that has become standard in psychological writing and practice.

21. Mindfulness demonstration: Raisin exercise

22. Mindfulness training and structural brain changes
Scientific examination of mindfulness may be the beginning of a clinical neuro-phenomenology of a new model of mental health (Tirch, 2010)
Awareness of internal mental processes promotes neural integration (Siegel, 2007)
Neuroimaging research revealed increased thickness in middle prefrontal area and the right insula (Lazar, 2005)
Middle prefrontal areas associated with caregiver behaviour and compassion (Wang, 2005)
Insula serves as a communication channel between the limbic system and the middle prefrontal areas and also links and synthesises information about bodily sensations, emotions and the representation of others

23. Anterior Cingulate Cortex
EEG and fMRI imaging studies of meditation suggest that it is involved in changes in the ACC Cahn and Pollich (2006)
ACC involved attentional focus, decision making processes, experience of “love”, attachment and caregiving, resolution of conflict, emotional regulation and adaptive responses to changing conditions.
ACC may be involved in a neural homeostatic mechanism that regulates an individual’s response to distress (Corrigan , 2004)
Emotional regulation and affiliative feeling
fMRI – Functional Magnetic Resonance Imagery: detects changes in blood oxygenation and flow that occur in response to neural activoty. It can produce activation maps that show which parts of the brain are involved in particular mental processes.
EEG: Electroencephalogram – records electrical activity in the brain.

24. Medial Prefrontal cortex
fMRI technology has contrasted the neural correlates involved in a “narrative” and “experiential” modes of self-reference
The mPFC is involved in maintaining a sense of self across time, comparing one’s traits to those of others and the maintenance of self-knowledge (Farb et al, 2007)
Experienced meditators – decreased mPFC activity and increased processing of emotional memories
Novice meditators had stronger coupling between narrative self- reference and areas involved in the translation of visceral emotional states into conscious feelings
A “narrative” sense of self roughly corresponds to a conventional Western view of the self as a pervasive and ongoing, separate individual identity enduring across time and situation.
The “experiential” model of self-reference corresponds to the present moment focused awareness found in mindfulness meditation, and represents the mode of being that has been described as an “Observing Self”.
Mindfulness – helps to switch off the dominant judgemental and narrative sense of self and switch on the observing self, which aids emotional processing.

25. Process and Stages of CFT & CMT
Validation of fears, painful experiences, threat sensitivities
Make sense of safety behaviours/strategies and core beliefs
Identify critic or inner bully as safety strategy
Explain 3-circles model and how thoughts, memories and images affect the brain
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26. Process and Stages of CFT & CMT It’s not your fault focus
We are evolved beings with built in self-protection and resource systems
Distinguish taking responsibility from condemning and blaming
Recognise that safety behaviours may not be dismantled until alternatives are in place
Move from shame and self- criticism to sadness and grief and then process the grief

27. Process and Stages of CFT & CMT Development of compassion for self
Discuss compassion as a focus and ‘direction of travel’
Note the foci of compassion: compassion for others to self; from self to others and from self-to-self
Through the therapeutic relationship
Mindfulness with re-focusing of attention, behaviour, thoughts and feelings
Use letter writing and imagery
Orientating to compassionate self-identity
Practice daily – brief and frequent

28. Psycho-education: our brain structure
1. Old Brain (Reptilian)
Emotions: Anger, anxiety, sadness, joy, lust
Behaviours: Fight, flight, withdrawal, engagement
Relationships: Sex, power, status, attachment, tribalism
2. Social Brain Mammalian)
Need for affection and care
Socially responsive, self-experience and motives
3. New Brain (Human)
We can imagine, fantasise, look back and forward, plan, ruminate
We can integrate mental abilities
We can create a sense of self- awareness, self-identity, and self-feeling

29. Link between 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:
1. Those that focus on threat and self- protection
2. Those that focus on doing and achieving
3. Those that focus on contentment and feeling safe

30. Brain Diagram (psycho-education)

31. Psycho-education: What is Compassion?
“Sensitivity to the suffering of the self and others with a commitment to relieve it” Dalai Lama
Learning to become sensitive to things causing difficulty or pain
Understanding the nature and causes of our suffering in a non- judgemental way
Understanding kindness and care as courage (not weakness)
Develop a motivation to be helpful to ourselves and others
Group discussion: Ask the participants to give their definitions of compassion. Buddhist: As loving kindness: open-heartedness “deep feeling and understanding of the suffering of self and others with a deep commitment to try to relieve it and prevent it” Dalai Lama. Ethical behaviour, Patience, generosity, wisdom, concentration, courage, effort.

32. Three Systems model
Each of the three systems orientate the mind and body in particular ways to prepare us for different forms of action. The systems are interrelated, interact with and regulate each other.

33. Threat System How it evolved: For survival and self protection.
What it does: Alerts us to potential danger and triggers our fight/flight response.
How it helps: It keeps us safe and away from danger.

34. What an idiot I am. It’s all my fault.
Three types of threat
External Threat (the leopard)
Social Threat (the need to be part of the group).
Internal Threat (the negative things we tell ourselves).
What an idiot I am. It’s all my fault.

35. How threat system can create problems for us
Operates on a ‘better safe than sorry’ principle and so often prepares us for danger when there is none present.
Activated in the primitive reptilian part of the brain that can be confused by signals from the modern world and from the newer frontal part of our brain
e.g. advertising interpreted as a social threat
If we are criticising ourselves this is reacted to in the same way as a ‘real’ external threat

36. Drive System How it evolved: For motivation towards needed goals
What it does: Motivates us to get the stuff we need.
Non-social: Resources, shelter, acquisition.
Social: Achievements, relationships
(think of the buzzy feeling you get when you meet a good friend you haven’t seen for some time)

37. Drive System
How it helps: It activates our reward system to make us feel good when we achieve goals that help us to flourish in our environment and to build positive relationships.
How it can be a problem: It can drive unhelpful behaviours like substance use or over-eating. We can also focus on drive/achievement to the detriment of other aspects of our lives.

38. Soothing system
How it evolved: To allow us to rest and digest after activity. In mammals it also linked to the attachment system (ensuring mothers/caregivers provide nurturance and care for helpless young)
What it does: It gives us a warm connected sense and a motivation towards nurturing. It allows us to feel soothed in the presence of a caring person.

39. Soothing System
How it helps: It allows us to recuperate and disengage and to feel connected to the people around us. Social connections and the ability to feel soothed buffer against both physical and mental health problems.
How it can be a problem: When it becomes closely tied with the threat system, e.g. when those who are supposed to care for us are also frightening or abusive.

40. Interaction of 3 systems
Threat-based Drive – great to win but what happens when we come second?
Contingent self-worth – striving to achieve to avoid feeling inferior
Affiliative & Threat link – if something bad happens most helpful to be in presence of caring other
Jennifer Crocker – contingent self-worth
Wibble wobble doll – soothing prevents us falling flat on our faces in presence of threat

41. Psycho-education: summary
We have brains designed for survival.
The survival instinct means our brains look out for threat all of the time.
The human brain is tricky because we can reflect back on the past and worry about the future.
The old part of our brain can’t distinguish between a real external threat (the leopard) and internal threat (negative things we think or say about ourselves).
Being kind and encouraging of ourselves is very important.
We can develop self-compassion through soothing exercises and being kind to ourselves.

42. Homelessness
Drive and Soothing regulate the threat system.
Better safe than sorry – Antelope
Billboard of face cream
How might the three emotional regulation systems be influenced by the experience of being street homeless?

43. Time to practice
In triads of worker, client and observer, practice talking through the 3 systems role playing a client that you are currently working with.

44. How the threat system organises our mind
Consider what might be in each area: e.g. in a threat mind-set where would your attention be?
How the threat system organises our mind
Attention
Emotional experience
Thinking and reasoning
THREAT:
‘I’m in danger!’
Imagery and fantasy
Motivation
Behaviour

45. How the drive system organises our mind
Consider what might be in each area: e.g. in a drive mind-set what would your motivation be?
How the drive system organises our mind
Attention
Emotional experience
Thinking and reasoning
DRIVE:
‘I want that!’
Imagery and fantasy
Motivation
Behaviour

46. How the soothing system organises our mind
Consider what might be in each area: e.g. in a soothing mind-set what would your emotional experience be?
How the soothing system organises our mind
Attention
Emotional experience
Thinking and reasoning
SOOTHING:
‘I am valued and connected’
Imagery and fantasy
Motivation
Behaviour

47. Soothing Rhythm Breathing
Soothing rhythm breathing is the basis for many of the compassion exercises we will learn.
Soothing is linked to feelings of safeness.
We can use these feelings to help manage threat based emotions such as fear, disgust and shame.
Soothing Rhythm Breathing Exercise – then feedback

48. Case example: Macey
Anger – feels incontrollable and frightened by lack of control. Verbally aggressive towards boyfriend and family and physically violent towards objects.
Low mood – described feeling less and less optimistic that she could change her behaviours. Triggered by self-critical thoughts, also highly sensitive to perceived criticism from others.
Social anxiety – self-monitoring/self criticism in social situations
Current relationships – on/off boyfriend of two years. No contact with father. Strained relationship with mother
Has some close girlfriends but feel guilty for overburdening them with boyfriend problems.
Strengths – intelligent, good career prospects. Loves music and having musical people around her. Writes music and poetry as emotional release but lacks confidence to share
Anger and violence reinforced through observational learning (father, mother’s partner’s) and operant conditioning (negative reinforcement anger and aggression stopped the worst excesses of mother’s boyfriend’s behaviour).
This strategy was effective to keep Macey safe in childhood but was no longer helpful. “Not your fault” emphasis.
Toxic environment led to beliefs that others were dangerous, attacking and unpredictable, the world as chaos and self as defective and unlovable.
These beliefs hypothesised to feed the self-criticism and shame.
Childhood: drug use and parties. Father was in and out of prison and when at home sometimes outgoing and fun but also violent and aggressive particularly towards mother. Mother – cruel and hurtful, Macey felt hated by her mother. After father left when Macey was 9 mother had boyfriends who were shaming of both mother, Macey and her sister. Macey felt she had to protect her mother and younger sister
Current relationships: who did not demonstrate his love verbally and would not acknowledge their relationship. Macey said that her relationship pattern was to be very loving and be everything she perceived the other person wanted her to be for the first few months and then become needy and demanding. Looking for perfect other that was never there in childhood.

49. Case example: Macey

50. Safe Place Exercise
Now I want you to let come to mind a place that is very comfortable and peaceful to you. It could be a place you have been to, a place you would like to go, or a place that is purely of your imagination. When a place like this begins to come to mind, I want you to raise one hand to let me know.

51. ANGER Attention Thinking and reasoning
Can’t concentrate on anything else
Thinking and
reasoning
I have to get it out
You’re taking the mick
Hot, tense, want to run away or attack
ANGER
Drained of energy
Imagery and
Fantasy
Red
Behaviour
Shouting
Left the conversation
Motivation
Belittle him
Emotions
Anger
Frustration

52. Russell Kolts on Anger
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53. Flow of Compassion Compassion flowing out Compassion flowing in
Self to self compassion
Leading to multiple self work

54. Origins of self-criticism exercise
Identify the kind of individuals who put us on the road to self-criticism.
Think of the critical others and specifically the behaviours, voice tone, attitude towards you and how they showed criticism.
Did they actually have your best interests at heart?
What right did thy have to pass judgement on you?
What happened in their life to make them such a critic or feel the need to put others down?

55. When someone saw the goodness in you
Think of a time when someone saw the good in you.
How did that feel?
Think specifically about the behaviours, voice tone, attitude towards you and how they showed they saw the best in you.
Did they have your best interests at heart?

56. Punitive vs. Encouraging teacher analogy
Imagine you had a child in school who was struggling to learn and get on with classmates and the teacher tells you that they will sit your child in front of class and bring them to account every time they get something wrong. Then imagine that instead the teacher said that they would encourage your child and help him or her to gain confidence. Which of the teachers would you prefer for your child?
Why then, do we so often send ourselves to the punitive teacher?
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57. Developing qualities of inner compassion
Valuing Compassion
Empathy
Sympathy
Forgiveness
Acceptance/tolerance
Developing feelings of warmth
Growth
Taking responsibility
Training
Please see handout sent with the training slides

59. Compassionate images Buddha Virgin Mary Aslan Nelson Mandela
Princess Diana
Baloo
Compassionate version of self
All have qualities of strength, warmth, non-judgement and wisdom

60. Common myths about Compassion (Deborah Lee, 2012)
Compassion is OK for others but I don’t deserve it.
Compassion will not last and it will be taken away from me so what’s the point in starting it?
Compassion is like wallowing in your own self-pity.
Compassion is far too self-indulgent and selfish.
Compassion in for weaklings and ‘wusses’.
Real me don’t ‘do’ compassion.
Compassion is fluffy, soft, airy-fairy and ‘group-huggy’.
Compassion makes you vulnerable to others who will take advantage of you.
Being compassionate means that I will never be allowed to be cross, angry, raging, or to run away from anything or be totally selfish again.
Being compassionate let’s me off the hook and I don’t need to take responsibility for anything that goes wrong in my life.

61. Blocks to Compassion Compassion as weak and not courageous
Anger and macho behaviour that we retreat to in the face of things that threaten us is exactly that – a retreat
Compassion is where the real courage comes to bear, because compassion is defined by contact with suffering.
Fear of positive emotion
Engaging gently and playfully can help first steps; playfulness can create emotional contexts that facilitate exploration and are de-shaming
Desensitisation (habituation)
Function analysis – what are the greatest fears/threats of developing compassion? What are the key blocks? If one visualises oneself as a compassionate person in the future, what problems are associated with that?
Conditioning can link desire to feel safe with threat – fearful attachment.
Other issues – grieving, meta-cognitive beliefs – “it’s self indulgent”, lack of feeling (alexithymia), devleopmental difficulteis.
Research into fear of compassion needed

62. Myth-Busting exercise
In triads practice resolving the following blocks to compassion
Compassion is the soft option.
Compassion is the same as pity.
Needing compassion makes us weak.
Use the previous slides and the Russell Kolts talk to help guide you.

63. How we relate to our self
Formulation
Experiences
Key Fears/
Threats
Coping/
Safety Strategies
(‘best efforts’)
Unintended/
Unwanted
Consequences
How we relate to our self
Blame
Criticism

64. The suit of armour and coping
Coping strategies are a bit like armour that we have understandably collected during our lives to protect ourselves from threat (e.g. to hide our vulnerabilities from others).
At some point in our lives the armour may well have been essential to protect us. It made sense that we had it.
Unfortunately, certain protective measures can have unwanted and unexpected effects.
What might be the problem with developing a large suit of armour?
What might be the problem in wearing heavy armour when the original problem has passed?

65. A short story about emotions
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67. INTENDED CONSEQUENCES POSSIBLE UNINTENDED CONSEQUENCES OR DRAWBACKS
COPING STRATEGY
Examples
INTENDED CONSEQUENCES
POSSIBLE UNINTENDED CONSEQUENCES OR DRAWBACKS
Always putting on a brave face
Be as others want
Withdrawing from other people
Avoid situations where I can ‘fail’
Drinking alcohol to cope
Trying to be perfect
Analysing and going over my mistakes
Preparing for the worst/ worrying

68. Goals of formulation Link early experiences to current difficulties
To realise that “It’s not my fault”
To help the person to emotionally connect to their experience
To provide motivation to move onto the exercises and make changes

69. Group Role Play: Threat-focused formulations
Background/Historical influences: consider memories of early relationships with caretakers, environmental factors, key events, trauma. What kinds of threats do you think affected you growing up?
Are there any memories that stick in your mind?
What key fears have these left you with? External – the world, others. Internal – existential experience of self, e.g. alone, empty
How have you tried to protect yourself – what kinds of safety strategies do you have for preventing those fears occurring today? Give validation to these as understandable and best efforts to stay safe.
Although these safety strategies can be more than understandable they may have unforeseen and undesired consequences. What do you think these might be?
After generating unintended consequences ask the person to read them out and ask them, “how does this leave you feeling about yourself”, and link back to key fears.
Add in CFT for anger doc
2. mention the man who remembered the look of hate from his mother when he shared his passion, music.
4. This is important and not phrased as dysfunctional

70. Threat and Safety Strategy Formulation
Past Experiences
Key Fears/Threats
Protective/
coping Strategies
Unintended
Consequences

71. Threat & Safety Strategy Formulation

72. Taking a compassionate perspective
One or two people in the group share something they have struggled with recently.
Focus on your breathing
Now bring your compassionate image to mind
Focus on sensory qualities (smell, sound, touch, taste, vision)
What would your compassion part/image say?
How do they see this situation?
What opportunities for growth and change might be here?
What is a compassionate thing to do now for you?

74. Summary: Compassionate mind training
Mindfulness practice
Soothing Rhythm Breathing
Safe place imagery
Building a compassionate image
Compassion flowing out
Compassion flowing in
Self-to-self relating
Compassion MP3 recordings
compassion-meditations-mp3.html
tations_downloads.php

75. The Compassionate-Thought Record
What is the situation I find myself in?
What physical sensations am I experiencing?
What emotions am I feeling?
What is my mind telling me?
Can I mindfully and compassionately make space for this experience here and now?
How might I respond through compassionate thinking?
After engaging in compassionate thinking while feeling anxious and distressed, what do I notice about my current emotions, thoughts, body sensations and behavioural urges? What is happening for me, right now?

76. Compassionate mind/mentality
Thinking
Reasoning
Attention
Imagery Fantasy
Compassion
Behaviour
Motivation
Emotions 76 76

77. Or you can use a regular thought diary and carry out a compassionate imagery exercise

79. Group Exercise Compassionate Thought Diary
Work in triads
Think of a recent situation, not too traumatic, that had led you to have unhelpful thoughts and difficult feelings
Carry out the few columns of the thought diary in the normal way until you reach the alternative thought
The therapist then carries out the soothing rhythm breathing exercise and guides the client to picture his or her compassionate image.
Then ask what would your compassionate image say about this and given that what is a more compassionate alternative.
Ask the client to re-rate beliefs.
Point out that this method involves using a regular thought diary and then invoking the compassionate image to activate the soothing system before coming up with an alternative thought. The previous two slides bring a compassionate perspective to the whole process.

80. Putting the learning into practice

81. References I
Depue, R.A. and Morrone-Strupinsky, J.V (2005). A neurobehavioural model of affiliative bonding. Behavioural and Brain Sciences, 28,
Germer, C.K. and Salzburg, S. (2009). The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions. The Guilford Press.
Gilbert, P. (2007). Evolved Minds and Compassion in the Therapeutic relationship. In P. R. Leahy (Eds.), The Therapeutic Relationship in the Cognitive Behavioural Therapies. New York: Routledge.
Gilbert, P. (2007). Psychotherapy and Counselling for Depression (3rd edition). Sage.
Gilbert, P. (2010). The Compassionate Mind. Constable.
Gilbert, P. (2010). Compassion Focused Therapy: Distinctive Features. Routledge.

82. References II
Hayes, S.C., Stroshal, K.D. and Wilson, K.G. (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behaviour Change. New York: Guilford.
Kabat-Zinn, J. (1994). Wherever you go there you are. New York: Hypericon.
Kelly, A.C., Zuroff, D.C. and Shapiro, L.B. (2009). Soothing Oneself and Resisting Self-Attacks: The Treatment of Two Intrapersonal Deficits in Depression Vulnerability. Cognitive Therapy Research, 33,
Kolts, R. (2012). The Compassionate Mind Approach to Managing Your Anger. Robinson.
Linehan, M.M. (1993). Cognitive Behavioural Treatment of Borderline Personality Disorder. New York: Guilford.
Neff, K. (2011). Self Compassion. Hodder and Stauton.

83. References III
Segal, Z.V., Williams, J.M.G. and Teasdale, J. (2002). Mindfulness-Based Cognitive Therapy for Depression: A New Approach to Preventing Relapse. New York: Guilford Press
Siegel, D. (2011). Mindsight: Transform your Brain with the New Science of Kindness. One World Publications.
Tirch, D. (2012). The Compassionate Mind Approach to Managing Anxiety. Robinson.
Websites and links
(discussion between Paul Gilbert, Kristen Neff and Chris Germer)
(Tim Anstiss talks about evolutionary explanation of depression)