Compassion Focused Therapy

Introduction

Compassion Focused Therapy was founded and developed by the British clinical psychologist, Professor Paul Gilbert, in 2000. It combines understandings of the way that the mind and emotional regulation systems have evolved to work and the psychology of individual development of attachment bonds with the principles of Cognitive Behavioural Therapy and the eastern philosophical traditional practices of mindful, non-judgemental presence in the moment, loving kindness meditation and compassion.

It is used to address depression and anxiety, particularly where the individual tends towards self-monitoring, self-criticism, a hostile, coercive approach to self-control and self-motivation, low self-esteem, rumination, guilt and shame (from feeling inferior).

CFT uses a definition of compassion drawn from Buddhist tradition, which defines compassion as ‘a sensitivity to suffering in self and others, with a commitment to try to alleviate and prevent it’ (The Dalai Lama, 2001). The Dalai Lama (2001). An Open Heart: Practicing Compassion in Everyday Life. Little Brown & Company: Boston, MA. [Google Scholar] [Ref list]. Compassion can be given, received and directed towards the self.

Gilbert puts across that our evolved minds are not always well adapted to responding to complex life challenges and we can tend towards impulsivity, overreactions and overthinking, leaving us struggling to find appropriately balanced responses. He emphasises that it is not our ‘fault’ if we become anxious, irritable, distressed, withdrawn, endlessly striving for things just out of reach or paralysed and unable to respond. The human mind is made up of many parts, which have evolved over time, and sometimes this leads to conflicts between what we want and what is better for ourselves and between what we aim for and where we land. We need to work with our nervous system as it is, rather than expect perfection and berate ourselves when we fall short of the ideal. It is the nature of being human that our minds lead us into actions, thoughts and emotions which cause suffering for ourselves or others. Taking responsibility for our behaviour may lead us to make reparation to others, when we have caused harm. However, self-compassion addresses the distressed state of mind when no further reparative action is possible or desirable.

Gilbert explains that we had no control over our genes or our very early life experiences and our brains are evolved to respond to perceived threats, keeping us alert when we would choose not to be, even when we can rationally see that the problem is not life-threatening. We do not choose to suffer or to make ourselves suffer. Life will throw problems at us and suffering is a natural part of the human condition. We live in a world which bombards us with stimulation of all kinds and this can lead to overwhelm.

Emotional Regulation

CFT introduces the three human affect regulation systems:

• Threat protection and harm avoidance, fight-or-flight (associated with the sympathetic nervous system) and freeze responses (Threat)
• Seeking and acquiring resources, motivations and behaviours (Drive)
• Soothing, nurturing and trusting, caring connection (Safeness) (associated with the parasympathetic nervous system).

The parasympathetic nervous system counteracts the sympathetic nervous system, such that they act in opposition to one another, preparing us to defend against threats or allowing us to engage in connection to trusted others, rest and digestion of nourishment.

Humans are evolved to meet challenges with physical preparedness and mental alertness, however being on heightened alert permanently can interfere with sleep, digestion and the balance of hormones and neurotransmitters. Our mind has evolved to be alert to threats and the need to seek resources to stay alive, but can be overstimulated to a point where we cannot allow ourselves to rest and experience a sense of being safe and content.

The aim of Compassion Focused Therapy is to engage the safeness system, the evolved mammalian affiliative system, linked to bonding with trusted others to receive and give soothing and care, in order to lower anxiety, counteract the ‘defensive’ and ‘seeking resources’ responses and induce a sense of safe contentment and well-being. Compassion is both conceptually a way to address suffering and find acceptance of ourselves and others and also a way to physically calm and soothe the nervous system.

Spending time in a state of safeness is necessary for normal, healthy functioning. The conditions which encourage this state are being mindfully present in the here-and-now, feeling connected to trusted others and giving and receiving compassion. It is not necessary for trusted others to be physically present, although hugs and close contact will invoke a sense of being safe. It is sufficient to mentally visualise being hugged by someone trusted or to picture a conversation with them or speak on a phone call.

Ideally, the earliest experiences of compassion are between the baby and the primary caregiver (often a mother). In depth studies on human attachment have observed this bond in detail. An attentive, sensitive, responsive and compassionate mother will detect when her infant is distressed and attempt to alleviate that, perhaps through a practical response, but also through using gentle physical contact, such as hugs and caresses, a sympathetic facial expression and a calming, patient, warm tone of voice. She offers compassionate soothing in the form of acknowledging the child’s distress and is able to tolerate that distress until the child calms. Unfortunately, when the primary caregiver is inattentive or impatient, due to her own nervous system being overwhelmed at that moment, the child may receive the practical care, but not the emotional regulation. As a small child is unable to regulate their own emotions effectively, the emotional disturbance is unresolved and, while the child will eventually return to a baseline of emotional functioning, the opportunity for the child to learn how to regulate their own emotions has been missed. Where emotions of family members are persistently dysregulated and often close to or beyond the point of being overwhelmed, the child is on a rollercoaster ride in the home and may struggle with emotional regulation later in life.

It is acknowledged by Compassion Focused Therapy practitioners, that those who have received no compassion as children and have persistently received a negative response tend to reject a compassionate approach as alien and even distressing. Clinical experience confirms that those who are most in need of compassion and self-compassion are least open to the experience, which has the potential to offer the emotional regulation that is required. Where there has been emotional abuse, in being used to resolve the parent’s negative emotions, close attachment to others may induce anxiety, so access to compassion from others is limited and, unfortunately a self-compassionate approach is less automatic than a self-critical response.

Cognitive Behavioural Therapy

CBT distinguishes between unhelpful thoughts and behaviours which increase or accentuate negative feelings and alternative helpful, more positive thoughts and behaviours which promote calm contentment.

When in a negative frame of mind, we are primed to perceive threats in the environment around us and exaggerate the level of threat, e.g. ‘I’ll never make the deadline’, ‘I’ve got that wrong’, ‘My boss is displeased with me’,’My partner thinks I’m unattractive’, ‘I won’t be able to pay off the credit card’, ‘My child is behind at school’, etc. These negative thoughts can be amplified by the underlying level of our own fight-or-flight response and our self-critical thoughts: ‘I’m so slow at this’, ‘I always mess up’, ‘I’m not capable of this job’, ‘I hate the way I look’, ‘It’s my fault that I earn so little’, ‘I ought to be a better parent’, etc.

Cognitive Behavioural Therapy is based on the principle that, when a person is anxious or depressed, they will tend to be more negative in their thinking, leading to increased anxiety, as the perception is that the world is full of threats. These negative thought patterns are sometimes called ‘cognitive distortions’ and include catastrophising, polarised, all-or-nothing and black-and-white thinking, taking things personally, focusing on the minor negative experience, while minimising good, positive experiences, giving undue weight to the emotions attached to an experience, jumping to conclusions, etc. In CBT, the person is encouraged to reframe the thought from another perspective, through looking at the evidence for and against the belief, imagining how someone else might view the situation, imagining how the problem will look several years from now, and facing what is the worst case, the best case and how likely are either of those. The person is asked to consider how they would handle scenarios if they do happen and to check whether their thinking is influenced by the level of anxiety. The person is asked to look at evidence, find insight, and practice exposure to the source of threat in order to habituate to the anxiety-inducing situation.

While it is often helpful to bring rational thinking to bear on a situation to become aware of emotional responses and consequent behaviours and lower anxiety, it doesn’t always go far enough to address negativity towards the self. The mind can get stuck in negative loops between self-directed critical thoughts, heightened anxiety and, at times, acting out behaviours arising from the unprocessed, difficult thoughts and emotions. Self-compassion goes beyond the rational thinking of CBT and encourages a state of mindful self-awareness and self-soothing.

Compassionate Practices

Being compassionate requires courage to face up to challenges with honesty, wisdom and commitment, to address problems in ways which are beneficial in the long term for care of oneself. It requires focused attention, sensitivity, empathy, rational reasoning, a non-judgemental approach, tolerance of distress and care. 

Compassion regulates negative moods and emotions through caring behaviours and expressing feelings of warmth, acceptance, reassurance and a desire to soothe distress. When directed towards the self, it aims to reduce  shame, stigma, self-blame, anger, negativity and self-criticism.

The aim is to develop a self-supporting inner voice which soothes, encourages and nurtures the individual through difficult experiences. In effect, we are our own ‘support team’.

Physical practices

Slow down

Slowing down your speech, actions and breathing will induce a sense that there is no cause for alarm and everything can be taken at a measured pace. Speeding up our speech, actions and breathing tells our body that we are under threat.

Soothing rhythm breathing is a practice of allowing our breathing to settle into a slower rhythm, with a very slightly longer outbreath than the inbreath. The breathing is not forced, rather it is relaxed and natural.

Mindfulness

We can learn from looking at and understanding our past experiences and plan for our future well-being, both valuable activities. However, ruminating in a circular way, on the past or possible futures in such a way that leads to anxiety and distress is unhelpful. The past is now out of our control and control of our future is limited by current circumstances, individual capabilities, finances, etc. Sometimes, acceptance of the limitations on our lives is the only possibility and focus on the present is indicated.

Mindfulness is being present and aware of the here-and-now immediate experience, including what is currently happening in your physical environment, as experienced by the senses, the social situation as it is perceived, the state of the body and the emotions. Focus on the present experience requires practice to observe the thoughts and feelings, accept them as part of this moment in time non-judgmentally and let them drift on.

This can be performed as a seated meditation practice, where often the body and the breath are the subject of attention, but can also be practised throughout the day’s activities, while going about daily life. Bringing the focus of attention under control at will takes patience and an acceptance that our thoughts and emotions will travel in all directions, as it is the way our mind works. Rumination, problem-solving and over-thinking are what the mind does, especially when driven by anxiety. It is enough to note that we are having a thought or a particular emotional experience to be mindful again, through observing our inner processes. When we bring awareness, acceptance and compassion to our mental processes we reduce the associated anxiety through observing that we are anxious.

Complete a Compassionate Thought Record

A Compassion THought Record is a form which guides us towards a compassionate view of a situation.

Self-Soothing

Speak to yourself out loud (you may want to be alone!). Express your current concern, your emotions and then talk yourself through with a confident, gentle, open tone of voice, accepting emphatically that this feels challenging and then offering comforting, caring words with a gentle smile.

Compassionate Journaling

Actively seek to appreciate aspects of yourself and the experiences of the day. Is there something you feel grateful for?  What have you done well today? What went wrong and how can it be addressed? Are you judging yourself harshly? How did your emotions fluctuate and can you be compassionate towards the negative emotions?

Compassionate Meditation

Compassionate guided meditations can be soothing and encourage a positive attitude towards yourself.

https://www.compassionatemind.co.uk/resource/resources

Compassionate letter writing

Sometimes, there is a past or current experience which is frequently on our mind and perceived as distressing.

Write yourself a letter to address this distress with compassion. Some people were taught that being self-critical is the way to motivate positive change. However, being encouragingly supportive to yourself is a kinder and more effective way forward. If this seems difficult, try to imagine what you would say to someone else that you care about to help them through. Be honest about the issue, but be positive that you can move forward.

1. Outline all aspects of the problem as you see it and acknowledge what you perceive as detrimental to yourself or others.
2. Describe your feelings which are associated with this situation.
3. List any possible practical changes which you might make to improve the problem.
4. Acknowledge what, with the best will in the world, you think is unlikely to change.
5. Acceptance is not agreeing that the situation is fair, right, just or desirable, as it may be none of the above. Acceptance is acknowledging that we suffer and cannot always resolve the problem, so will not direct energy towards trying to change things beyond our control, but will direct that energy into caring for ourselves instead.
6. Offer yourself compassion and support:

I am finding this so hard and it is distressing me, but I will take care of myself through this, however long it hurts me.

I didn’t choose this situation and it’s making me feel unhappy, but I am my own support team and will do whatever it takes to get myself through to a better state of mind.

I am blaming myself and feel so guilty and ashamed, but humans are not perfect, however hard they try to be. We are not androids and have to work with the evolved bodies and minds which we have. This can lead to acting in ways that we regret. I have tried to make good here and there is nothing more that I can do, so I’m going to heal myself with caring compassion. Just because I’ve messed up doesn’t mean that I don’t deserve to take care of myself ever again. Self-criticism will only keep me stuck from moving forward.  Being compassionate towards myself will lead to me doing better in the future. I am worthy of my own care and will nurture myself forward from here.

Compassionate Imagery: Life-guide

We can use visualisation techniques to promote a sense of self-compassion.

Developing an imaginary life-guide:

Think of one or more people that you have known across your life, in a book, film, game, tv series or from history whom you admire for being wise, courageous, level-headed and compassionate. You may come up with two or three individuals to build a composite image of a life-guide.

Imagine how your life-guide looks. The life-guide may not have a human form or be from the current day; it could be someone from ancient history, from nature, such as a tree or animal, or from a sci-fi or fantasy world. Picture their height, colouring, hair, facial expressions, clothing and other details in your mind’s eye.

Think about their characteristics, their intelligence, life experience, way of interacting with others with confidence, ease, honesty, courage in the face of adversity and their wisdom in solving problems.

Give them a name.

Now imagine yourself explaining your problem to the life-guide. How do they listen attentively? How do they gently question you to understand further the issues?

Picture them in your mind’s eye as very gently smiling when you have finished and offering words of comfort in a soft, comforting, warm tone of voice:

‘’You are struggling and that’s hard. This is distressing you and taking over your thoughts. I wish that I could take your pain away, but sometimes we go through the suffering to reach a place of greater acceptance and ease. I’m here for you, alongside you, to listen and take in your pain.’

The figure may offer to put an arm around you, if that feels right, or to hold your hand, just sit beside you or give you a gentle pat on the back.

You may imagine yourself responding with gratitude and a smile back.

You ask them how to go forward from here.

They respond with comfort:

‘We can’t always know the answer to all questions, but sometimes things change over time and with patience. I’m always here to care for you and only want what’s best for your well-being.’

You can develop the conversation further until you feel supported and comforted.

Compassionate imagery: Self-talk

Picture yourself sitting alone on a bench, in a park or by a stream, feeling anxious, low or upset. Imagine an older, wiser version of yourself arriving, from the future and walking up behind your distressed self, putting a hand on the shoulder and asking to sit alongside the younger you.

‘Can I sit by you? It looks as if you’re not having a good day? Would you like to tell me what is wrong?’

Imagine your current self describing the problem.

‘How do you feel about that today?’

Explain how you feel.

Imagine an empathetic, compassionate, concerned, but self-assured response.

What would your older, wiser self say?

‘This looks huge to you today, but will not be so great in several years’ time.’

‘You are suffering with this, but you will find a way through it and I will support you along the way.’

‘I only want what’s best for you and let’s think together what that might look like.’

‘We can’t change everything, but I care about how you feel and know how hard it is when life gets you down.’

Develop the conversation further forward with your older, wiser self being gentle, knowledgeable, experienced, taking a balanced view, offering alternative perspectives, allowing the current you to express yourself and get annoyed or cry, with the older self reassuring that this moment, with its thoughts and feelings will pass and that your well-being matters to them.

You may like to offer gratitude to the older, wiser self for caring and taking the trouble to spend time with you and hear them reassure yourself that they will always be there.

Resources

The Compassionate Mind. Paul Gilbert

The Compassionate Mind Workbook. A step-by-step guide to developing your compassionate self. Chris Irons and Elaine Beaumont

Self Compassion. Stop beating yourself up and leave insecurity behind. Kristin Neff

The Mindful Self-compassion Workbook. A proven way to accept yourself, build inner strength and thrive. Kristin Neff and Christopher Germer