A talk that outlines the basic philosophy and model of compassion-focused therapy

1. Compassion-Focused-Therapy
Model and Research
By Justin La Rose

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

3. To understand ourselves we must
understand our brains

4. 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?

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

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
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

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

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, 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

14. Internal Threat and Soothing
Threat
Affiliative/
Soothing
Calms
Internal representations of helpful
others and sources of comfort
Emotional memories of
soothing
Neurophysiological
networks
Self-affiliation –
experiences a lovable self

15. Internal Threat and More threat
Threat
Affiliative/
Soothing
Calms
Others are threats or
alarming
Emotional memories of no
soothing
Neurophysiologica
networks
No self-affiliation –
experiences a unlovable
self

16. 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

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
Different practices for each
Other Self
Self Other
Self Self
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
Attention
Thinking
Reasoning
Behaviour
Motivation Emotions
Their pattern gives rise to a certain type of mind
Imagery
Fantasy

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

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

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

24. Meal
Sexual Bully-threat
Emotion Brain
Stomach acid
Salvia Arousal
Fearful
Depressed
How our own thoughts and images affect our brains
Kind, warm
and caring
Soothed
Safe
Meal Sex Bully-
threat
Compassion
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.
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-
Reassure
Self-
Criticize
Self-
Reassure
Self-
Criticize

27. 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-Criticism during Emotional Scenarios vs. Neutral

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, 1849-1856

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

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

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
0.53 0.51
Self-reassurance
Power Anger
- 0. 33 - 0.33

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
- 0.54 - 0.34
Self-reassurance
Power warm
0. 58 0.43
Gilbert et al (2005)

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

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

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
Threat
Compassionate
Re-focusing
Affiliaitve/
Soothing
Compassionate
imagery
Shame-self
criticism
Trauma
Memory
Meta- beliefsFear of
closeness
Mentalizing

38. Kindness, Attachment and Threat
Kindness from therapist or imagery
Activate attachment system
Activate memories
Neglect
aloneness
Abuse, shame
vulnerable
Activate learnt and current defences - cortisol
Fight, flight
shut down
Fight, flight
shut down
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. Sympathetic
nerves to heart
Increases HR and
stroke volume
Parasympathetic
nerves to heart
Slows HR

41. Successive Inter-
beat Intervals
(ms)
945
897
858
799
821
846
851
858
879
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

43. Compassionate
Imagery
Control ImageryBaseline
Condition
65.00
60.00
55.00
50.00
45.00
40.00
MeanSDNN
Grp 2 ups
Grp 1downs
SDNN change grouping
variable
Diagram showing mean SDNN for each group at baseline & during imagery
conditions

44. CortBCortA
Sample
5.800
5.600
5.400
5.200
5.000
4.800
Meancortisol(ng/ml)
Grp 2ups
Grp 1downs
Grouping variabile for
SDNN change
Diagram showing mean cortisol for each group at baseline & after Imagery

45. Correlations between change in HRV
and self-report scales
SDNN
Inadequate Self Anxious Attachment
-.54* -.48*
Depend Attachment Social Safeness
.52* .57**
* p<.05 ** p <.01

46. 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
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
Pre and Post Compassionate Mind
Training
10.2
18.8
54.2 56.4
0
10
20
30
40
50
60
Self criticism Self compassion
Scale
Before
After

56. Data From Group Study
Functions of Self-to-Self Relating
28
(15.79)
17.5
(8.62)
21.67
(11.74)
9.6
(8.45)
0
5
10
15
20
25
30
Self Correction Self Persecution
Score
Before
After

57. Data From Group Study
HADS
10.33
(2.67)
14.67
(3.78)
4.3
(2.73)
6.83
(2.93)
0
2
4
6
8
10
12
14
16
Anxiety Depression
Subscale
Score
Before
After

58. Data From Group Study
Forms of Self-to-Self Relating
31.33
(5.16)
15.17
(3.76)
6.17
(6.40)
14.5
(7.01)
5.67
(5.40)
19.83
(8.21)
0
5
10
15
20
25
30
35
Inadequate
S
elf
H
ated
self
R
eassure
S
elf
Score
Before
After

59. Data From Group Study
Social Comparison
3 4 .8 3
( 2 1.50 )
58 .6 7
( 2 6 .0 0 )
0
10
20
30
40
50
60
70
Social
comparison
Score
Before
After

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