1. Compassion-Focused-Therapy Model and Research Paul Gilbert, Kirsten McEwan, Corinne Gale & Jean Gilbert Mental Health Research Unit, Kingsway Hospital, Derby UK www: Compassionatemind.co.uk

2. 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 2

3. To understand ourselves we must understand our brains

4. What happens when new brain is recruited to pursue old brain passions?
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? 4

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

6. 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

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

8. 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

9. Dispersal and avoid others

10. Protect and Comfort: Less ‘instinctive brain – post birth learning

12. 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

13. 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, JCCP, 72, )
Testosterone and aggression (Booth et al., Developmental Psychology, 39, 85 – 98)
Self-to-self-relating e.g. self criticism vs self-reassurance

14. 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

15. 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

16. Compassion Solutions Compassion is the road to happiness (Buddhism)
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

17. 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 one’s mind

18. Compassion as Flow Self Other Self Self Different practices for each
Non linear empathy for other begins early in life

19. 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)

20. Key Targets of Therapy
Thinking
Reasoning
Attention
Imagery Fantasy
Behaviour
Motivation
Emotions
Their pattern gives rise to a certain type of mind

21. Compassionate Mind Compassion Thinking Reasoning Attention
Imagery Fantasy
Compassion
Behaviour
Motivation
Emotions

22. Threatened Mind can block Compassion
Thinking
Reasoning
Attention
Imagery Fantasy
Threat
Behaviour
Motivation
Emotions

23. Self-Critical Mind is also Threat-focused Mind
Thinking
Reasoning
Attention
Imagery Fantasy
Self-
Critical
Behaviour
Motivation
Emotions

24. 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

25. 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?

26. fMRI Study (Aston University) STUDY Olivia Longe, Gina Rippon, Paul Gilbert & Frankie Maratos
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.
Self-
Criticize
Self-
Reassure
Self-
Criticize
Self-
Reassure
“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

27. 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, 27

28. 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, 28

29. Parent recall and SC and SR Irons Gilbert Baldwin et al
Parent recall and SC and SR Irons Gilbert Baldwin et al., 2006 Br J Clin Psych
.24
(.31)
Inadequate Self
Rejection
.31
(.33)
.26
(.60)
.15
(.25)
Overprotection
Depression
.22
(.55)
Hated Self
-.31
(-.56)
.37
(.30)
Warmth
Reassure Self

30. Parent recall and SC and SR Irons Gilbert Baldwin et al
Parent recall and SC and SR Irons Gilbert Baldwin et al., 2006 Br J Clin Psych
.24
(.31)
Inadequate Self
Rejection
.31
(.33)
.26
(.60)
.15
(.25)
Overprotection
Depression
.22
(.55)
Hated Self
-.31
(-.56)
.37
(.30)
Warmth
Reassure Self

31. Imagining a self-critical part of self
197 students from Derby and McGill Universities
(with Chris Irons and Mark Baldwin)
Self-criticism
Power Anger
Self-reassurance

32. Imagining a Self-Compassionate Part of Self
197 students from Derby and McGill Universities
(with Chris Irons and Mark Baldwin)
Self-criticism
Power Warm
Self-reassurance
Power warm
Gilbert et al (2005)

33. Compassionate Mind Self- Compassionate Thinking Reasoning Attention
Imagery Fantasy
Self-
Compassionate
Behaviour
Motivation
Emotions

34. 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

35. Internal Threat and Soothing Compassionate imagery
Self-Criticism
Compassionate
Re-focusing
Calms
Affiliative/ Soothing
Threat
Worry
Rumination
Compassionate imagery

36. Fear of Compassion Certain types of positive feelings are threatening
It is dangerous to feel safe
Compassion feeling are linked to beliefs such that it’s an indulgence and weakness
Activated grief and or abuse memories

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

38. 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

39. 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

40. Parasympathetic nerves to heart
Slows HR
Sympathetic nerves to heart
Increases HR and stroke volume

41. Successive Inter-beat Intervals
(ms)
945
897
858
799
821
846
851
879
Standard Deviation of Inter-beat Intervals over 300 second period = SDNN

42. 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

45. Correlations between change in HRV and self-report scales SDNN
Inadequate Self Anxious Attachment
-.54* *
Depend Attachment Social Safeness
.52* **
* p< ** p <.01

46. Basic Beliefs and Meta-cognitions
Fears of Compassion
Basic Beliefs and Meta-cognitions

47. Fear of Compassion For Others Scale
People will take advantage of you if you are too compassionate
If I’m too compassionate, others will become too dependent on me
I can’t tolerate others distress

48. 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

49. Fear of Compassion Towards Self Scale
I fear that if I develop compassion for myself, I will become someone I don’t 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

50. Fear of Compassion Data
Com for others
Com from Others
. 47**
Self com
. 37**
. 67**

51. Fear of Compassion Data
C for Others
C from Others
Self Com
Anxiety
. 22**
. 46**
. 44**
Dep
. 17*
. 37**
. 40*

52. 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?

53. 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

54. 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

55. Data From Group Study

56. Data From Group Study

57. Data From Group Study

58. Data From Group Study

59. Data From Group Study

60. 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 it’s 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 “IT’S OK TO FEEL LIKE THIS.

61. 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 it’s 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 one’s distress was a self-indulgence or weakness and definitely not something to cultivate.

62. 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

63. 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”.

64. 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