Uploaded on

Slides van de presentatie van Paul Gilbert tijdens Congres Integrale Psychiatrie 2012

Slides van de presentatie van Paul Gilbert tijdens Congres Integrale Psychiatrie 2012

  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Be the first to comment
    Be the first to like this
No Downloads


Total Views
On Slideshare
From Embeds
Number of Embeds



Embeds 0

No embeds

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

    No notes for slide


  • 1. Why do we need Compassion? Compassion Focused Therapy Life is Hard Groningen April 20th Paul Gilbert PhD, FBPsS, OBE Mental Health Research Unit, Kingsway Unit, Hospital Derby p.gilbert@derby.ac.uk www. compassionatemind.co.uk www.compassionatelbeing.com Collaborators Compassion?? Jean Gilbert Kirsten McEwan • Specific feelings and acts Corinne Gale Chris Irons • Desires to be a certain king of self Marcela Maratos David Zuroff Allison Kelly That which arises from deep insight into the nature of our ‘reality’ reality’ • Buddhist view • Evolutionary view Compassion begins with a reality check The human brain is the product of many millions of years of evolution – a process of conserving, modifying andWe are an emergent species in the ‘flow of life’ so life’ adaptingour brains, with their motives, emotions andcompetencies are products of evolution, designed tofunction in certain waysOur lives are short (25,000-30,000 days), decay and (25,000-end. We are subject to various malfunctions anddiseases – in a genetic lottery. Everything changes –the nature of impermanence – the nature of tragedyThe social circumstances of our lives, over which wehave no control, have major implications for thekinds of minds we have, the kind of person webecome, the values we endorse, and the lives we live
  • 2. New Brian Abilities Sources of behaviour Old Brain Psychologies Sources of behaviour New Brain Emotions Imagination, Fear, Anxiety, Anger, Lust, Joy Planning, Anticipation Rumination, Reflection Social Motives Purposeful focusing of the mind Closeness, Belonging, Sex, Status, Respect Integration Old Brain Self Identity Getting ‘Smart’ Smart’ Interaction of old and new psychologiesInteraction of old of behaviour Sources and new psychologies Sources of behaviour and mindful brain New Brain: Imagination, Mindful Brain Planning, Rumination, Integration Glitches New Brain: Imagination, Old Brain: Emotions, Motives, Relationship Planning, Rumination, Integration Seeking-Creating Archetypal Old Brain: Emotions, Motives, Relationship Seeking-Creating Archetypal Thinking brain can cause serious problems in using old affect and motive systems Interaction of old and new psychologies Sources of behaviour and mindful brain So, Basic Philosophy is That: We all just find ourselves here with a brain, emotions and sense of (socially made) self we did not choose but have to Mindful Brain figure out Life involves dealing with tragedies (threats, losses, New Brain: Imagination, diseases, decay, death) and people do the best they can Planning, Rumination, Integration Much of what goes on in our minds is not of ‘our design’ design’ and not our fault Old Brain: Emotions, Motives, Relationship Seeking-Creating Compassion rooted in deep insight of what COMPASSION we are all in this ‘suffering’ together – suffering’ It’s a set up!
  • 3. Understanding our Motives and Types of Affect Regulator Emotions Systems Drive, excite, vitality Content, safe, connected Motives evolved because they help animals to survive and leave genes behind Non-wanting/ Incentive/resource- Affiliative focused focused Emotions guide us to our goals and respond if we Wanting, pursuing, Safeness-kindness are succeeding or threatened achieving Soothing Activating There are three types of emotion regulation Threat-focused1. Those that focus on threat and self-protection self- Protection and Safety-seeking2. Those that focus on doing and achieving Activating/inhibiting3. Those that focus on contentment and feeling safe Anger, anxiety, disgust Types of Affect Regulator Systems Drive, excite, vitality Content, safe, connected Non-wanting/ Incentive/resource- Affiliative focused focused Safeness-kindness Wanting, pursuing, achieving Soothing Activating Threat-focused Protection and Safety-seeking Activating/inhibiting Anger, anxiety, disgust
  • 4. Safeness, Affiliation and affect regulationPerry B (2002) Childhood Experience and the Expression ofGenetic Potential: What Childhood Neglect Tells Us About Natureand Nurture Brain and Mind 3:79–100, 2002.
  • 5. Types of Affect Regulator Systems Drive, excite, vitality Content, safe, connected Non-wanting/ Incentive/resource- Affiliative focused focused Safeness-kindness Wanting, pursuing, achieving Soothing Activating Threat-focused Protection and Safety-seeking Activating/inhibiting Anger, anxiety, disgust The Mammalian Importance of Caring Minds Caring as “looking after”. Seeking closeness after” rather than dispersion. Individuals obtain protection, food, and care when ill. Key also is soothing-calming and physiological regulation. soothing- Few offspring but high survival rate in comparison to species without attachment, affection and kindness Promotes courage and engagement Co-operative and mutual support stimulates Co- affiliative systems and helps regulate threat Study of Types of Positive Affect Types of Positive affect Factor Items 1 2 3Participants asked how characteristic specific emotions Energetic .802 .217 .225were for them (N = 203) Lively .782 .117 .351 Adventurous .642 .265 .148 Active .608 .274 .192 0 = Not Ch. 4 = Very Ch. Enthusiastic .600 .159 .392 Dynamic .584 .282 .267 Excited .552 .214 .289Energetic 0 1 2 3 4 Eager .401 .032 .244 Relaxed .262 .794 .258Excited 0 1 2 3 4 Peaceful .222 .747 .424 Calm .191 .675 .445 Tranquil .186 .664 .395 Laid back .169 .601 .241Relaxed 0 1 2 3 4 Serene .221 .548 .339 Safe .214 .426 .740Safe 0 1 2 3 4 Content .310 .494 .702 Secure .362 .422 .606 Warm .231 .166 .503
  • 6. Between self and others Correlations Dep Anxiety Stress Self Self-to self to self Activated -0.17* -0.16* -0.08 -0.27** -0.15* -0.20** Calms Threat Affiliative/ Relaxed -0.30** -0.22** -0.38** Soothing -0.22** -0.17* -0.37** Safeness -0.38** -0.29 ** -0.33** -0.47** -0.27** -.041** 120 Million year evolving system to regulate threat Physiological Systems Compassion SolutionsMajor physiological systems that are focused on Ancient wisdom Compassion is the road to attachment and affiliation – e.g., oxytocin happiness (Buddhism)• Facilitates monogamous bonding Evolution Evolution has made our brains highly• Facilitates conspecific recognition sensitive to external and internal kindness• Facilitates attachment• Increases trust Neuroscience Specific brain areas are focused on• Increases competencies in mind reading tasks detecting and responding to kindness and• Increases feelings of liking others compassion• Reduces activation in the amygdala to threat faces Social and developmental; psychology History ofSource Macdonald and Madonald 2010 The Peptide That Binds: A Systematic Systematic Review of Oxytocin and its Prosocial Effects in Humans Harvard Review of affiliation affects brain maturation, emotion Psychiatry 1-21 regulation, prosocial behaviour and sense of self What do we need to feel compassion? 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 and prevent it” Dalai Lama it” Now there is increasing focus on what compassion and is and how it works
  • 7. Caring-Compassionate Mind Caring- Distress tolerant and empathy Warmth Warmth ATTRIBUTES Sensitivity Sympathy Care for Compassion Distress well-being well- tolerance Non-Judgement Non- EmpathyWarmth Warmth Caring-Compassionate Mind Caring- Non-judgement – we all struggle Non- SKILLS -TRAINING Warmth Warmth Imagery ATTRIBUTES Attention Reasoning Sensitivity Sympathy Distress Care for Compassion tolerance well-being Feeling Non-Judgement Empathy Behaviour Sensory Warmth Warmth Compassion Behaviour Focus of Compassion Two very Different Psychologies Commonly Misunderstood Develop kindness, support and encouragement to promote 1 Inner circle awareness engagement and the courage we need - to take the actions we need – in order understanding – engaging with difficult to promote the flourishing and well-being of ourselves and well- emotions others The agoraphobic develops the courage to go out and expose themselves to fear; the abused wife leaves her violent husband; the depressed person works on the fear of 2 Outer circle focus on alleviations, changing emotion, the traumatised person engages with ‘healing’ healing’ their memories loving-kindness and enthusiasm – engaging loving- with positive and affiliative emotions Hence the importance of building CAPACITY
  • 8. Compassionate Process Problems with Compassion Mindful Compassionate Engagement Motivation, sensitivity, sympathy, distress tolerance, • Problems of the inner circle with: Motivation; empathy nonjudgement/acceptance attention/sensitivity; sympathy, distress tolerance; empathy; and judging Wisdom Courage • Problems with the positive and afiliative Mindful Compassionate Alleviation emotions – linked to the problems with the soothing affiliative systems. Motivation, attention, thinking, behaviour, feeling, • Linked to attachment history/style?? Peer imagery, sensory focusing attachment/style??Build compassionate capacity for engaging and changing Compassionate mind/mentality Competitive mind can block Compassion Thinking Thinking Attention Attention Reasoning Reasoning Imagery Imagery Compete Behaviour Compassion Behaviour Fantasy Fantasy Motivation Emotions Motivation Emotions Threatened mind can block compassion Compassion as Flow Thinking Different practices for each Attention Reasoning Other Self Imagery Fantasy Threat Behaviour Self Other Self Self Motivation Emotions Evidence that intentionally practicing each of these can have impacts on mental states and social behaviour
  • 9. Data Compassion Behaviour as Courage• Practice of imagining compassion for others produces changes in frontal cortex and immune system (Lutz et al, 2009) Develop kindness, support and encouragement to promote the courage we need - to take the actions we need – in order• Loving kindness meditation (compassion directed to self, then to promote the flourishing and well-being of ourselves and well- others, then strangers) increases positive emotions, mindfulness, mindfulness, others feelings of purpose in life and social support and decreases illness illness symptoms (Frederickson et al, 2008, JPSP) The agoraphobic develops the courage to go out and expose• Compassion meditation (6 weeks) improves immune function, and themselves to fear; the abused wife leaves her violent neuroendocrine and behavioural responses to stress (Pace, 2008, PNE) husband; the depressed person works on the fear of emotion, the traumatised person engages with ‘healing’ healing’• Viewing sad faces, neutrally or with a compassionate attitude their memories influences neurophysiological responses to faces (Ji-Woong Kim, (Ji- 2009, NP) Hence the importance of building affiliative CAPACITY to• Compassion training reduces shame and self-criticism in chronic self- work on the painful things – not ascent to angelic status depressed patients (Gilbert & Proctor, 2006, CPP)Compassionate and self-image goals were assessed with 13 items. All items self-began with the phrase, “In the past week, in the area of friendships, howmuch did you want to or try to,” and items were rated on a scale rangingfrom 1 (not at all) to 5 (always). (not all) (always). to,” Findings (N 199) Average compassionate goals predicted closeness, clearSeven items assessed compassionate goals, namely, “be supportive of others,” others,” and connected feelings, and increased social support and“have compassion for others’ mistakes and weaknesses,” “avoid doing others’ weaknesses,” trust over the semester; self-image goals attenuated these self-anything that would be harmful to others,” “make a positive difference in others,” effects.someone else’s life,” “be constructive in your comments to others,” “avoid else’ life,” others,”being selfish or self-centered,” and “avoid doing things that aren’t helpful to self- centered,” aren’me or others.” others.” Average self-image goals predicted conflict, loneliness, self- and afraid and confused feelings; compassionate goalsSix items assessed self-image goals, namely, “get others to recognize or self- attenuated these effects.acknowledge your positive qualities,” “convince others that you are right,” qualities,” right,”“avoid showing your weaknesses,” “avoid the possibility of being wrong,” weaknesses,” wrong,”“avoid being rejected by others,” and “avoid taking risks or making others,” People with compassionate goals create a supportivemistakes.”mistakes.” environment for themselves and others, but only if they do not have high self-image goals self-Crocker, J & Canevello, A (2008) Creating and undermining social supportin communal relationships: The role of compassionate and self-image goals. self-Journal of Personality and Social Psychology, Vol 95(3), Sep 2008, 555-575 2008, 555- Crocker, J & Canevello, A (2008) Creating and undermining social support in communal relationships: The role of compassionate and self-image goals. Journal of Personality and Social Psychology, Vol self- 95(3), Sep 2008, 555-575 555- Kindness, Attachment and Threat Kindness from therapist or imagery Fear of Activate attachment system Activate memories Fight, flight Fight, flight Compassion shut down Neglect Abuse, shame vulnerable shut down aloneness Activate learnt and current defences - cortisol
  • 10. Treatment Data From Group Study • Attendance one of two programmes Pre and Post Compassionate M ind • Patients invited to take part in a research trial of Training CMT at community meetings • Criteria for inclusion were mid treatment (six months 60 54.2 56.4 to one year), well engaged with the service and to have 50 self-attacking, negative thoughts self- 40 Before • Nine patients agreed to take part in the study (five Scale men and four women) Af ter 30 • Three did not complete the study: hence six completed 18.8 20 • Twelve two hour sessions 10.2 10 • Gradual process of developing compassionate imagery and soothing exercises and then engaging with self 0 critical thinking Self criticism Self compassion Data From Group Study Reflections HADS I would just like to tell you all here today what (CMT) 14.67 means to me. It seemed to awaken a part of my brain that 16 (3.78) I was not aware existed. 14 The feeling of only ever having compassion for other 10.33 people and never ever contemplating having any for 12 (2.67) myself. 10 Suddenly realising that it’s always been there, just that I it’ 6.83 have never knew how to use it towards myself. core Bef ore 8 (2.93) Af ter S 4.3 6 (2.73) It was such a beautiful, calming feeling to know it was Ok 4 to feel like this towards myself without feeling guilty or bad about it. 2 Being able to draw on this when I was frightened and 0 confused, to calm myself down and to put things in Anxiety Depression prospective and say to myself “IT’S OK TO FEEL LIKE IT’ Subs cale THIS. Reflections ConclusionHaving compassion for myself means I feel so much more at Attachment and affiliation evolved as a major threatpeace with myself. Knowing that it is a normal way of life tohave compassion for myself and it’s not an abnormal way of it’ regulator – mental and physical help and positivethinking, but a very healthy way of thinking. It felt like I social relationships are underpinned by themwas training my mind to switch to this mode when I start tofeel bad about myself or life situations were starting to get These systems have become compromised in many folkon top of me. with affective disturbances –What is striking about this, and what other participantsthought, was how much they had (previously) felt that being and even in our competitive societies themselvesself-compassionate and empathic to one’s distress was a self-self- one’ self-indulgence or weakness and definitely not something to Our future will be influenced by how compassionatelycultivate. focused we become in how we live our internal lives and create societies
  • 11. Where next in Compassion? Evolved Systems and Types of Mind Self and Social Identity: Automatic vs the chosen/• Compassion is a complex and multifaceted process trained self that organises our minds Interacting• Still ongoing debates about key elements although processing Cognitive/meta-cognitive Cognitive/meta- motivation and intention are central symbol systems: systems Thinking mind• Compassion should be distinguished from sympathy empathy, kindness but rooted in affect regulation Patterned Basic Social Motivational systems by and Role Seeking Systems:• Genuine compassion that involves equanimity, experiences Status; Sex; Caring openness and empathic competencies and that changes psychological and physiological processes Basic emotion regulation: should be distinguished from automatic kindness Threat; Seeking, and and concerns with self presentation Contentment/Soothing Where next in Compassion Conclusion• Training compassion is much more complex than it • Many physiological systems function best under appears and requires substantial research conditions of social affiliation and safeness• Training needs to take in not only the level of competencies • Must distinguish between different types of positive affect but also blocks and fears to compassion • The balance of threat based emotions to positive ones• Training based in the Tibetan traditions have a series of (depressed anxious and hostile) are linked to social steps safeness and affiliation• Training based in psychotherapy research may have • The study and promotion of internal and external similar steps or different ones –ways of developing specific afiliation should be a priority -- and understanding the physiological systems that support compassion such as evolutionary roots and brain mechanisms for affiliation oxytocin supplementation require further research will play a key role in this endeavour Showing we care