Introducing compassion-focused therapy in CBT

[Daniel E.]

Evidence-based therapies
NewHarbinger.com

Compassion-focused therapy (CFT) is a form of psychotherapy that emphasizes the development of self-compassion in people who are prone to feelings of shame and self-criticism. Created by Paul Gilbert and his colleagues, this therapy is rooted in Mahayana Buddhist psychology, which considers compassion and mindfulness to be central to healing the mind. CFT develops four skills: compassionate attention, compassionate thinking, compassionate behavior, and compassionate feeling. This therapy has been proven effective for the treatment of eating disorders, depression, anxiety, and other mental health conditions, and can even benefit those who do not suffer from these disorders as it improves emotional regulation, distress tolerance, and nonjudgment.

Related book:
The Compassionate Mind: A New Approach to Life's Challenges by Paul Gilbert

--------------------------------------------------

An Introduction to Compassion Focused Therapy in Cognitive Behavior Therapy
International Journal of Cognitive Therapy, 2010

This article outlines the early origins of Compassion Focused Therapy (CFT) from within the Cognitive Behavioral tradition (CBT). It will then focus on how our new understanding in the areas of affect regulation systems, and the importance of affiliative and kind relationships in regulating mental states, point to key processes that underpin mental health difficulties—as well as to possible mechanisms for therapy and change. CFT recognizes the huge debt to Eastern psychologies such as Buddhism that have articulated the importance of compassion for our personal and social well-being for thousands of years. However CFT was originally developed for, and with, people who suffer from high levels of shame and self-criticism and who find experiences of support, kindness, and compassion—both from themselves and from others—difficult or even frightening. The article will provide the conceptual background for the articles that follow which focus on the applications of CFT.

--------------------------------------------------

Introducing compassion-focused therapy
Advances in Psychiatric Treatment, 2009

Shame and self-criticism are transdiagnostic problems. People who experience them may struggle to feel relieved, reassured or safe. Research suggests that a specialised affect regulation system (or systems) underpins feelings of reassurance, safeness and well-being. It is believed to have evolved with attachment systems and, in particular, the ability to register and respond with calming and a sense of well-being to being cared for. In compassion-focused therapy it is hypothesised that this affect regulation system is poorly accessible in people with high shame and self-criticism, in whom the ‘threat’ affect regulation system dominates orientation to their inner and outer worlds. Compassion-focused therapy is an integrated and multimodal approach that draws from evolutionary, social, developmental and Buddhist psychology, and neuroscience. One of its key concerns is to use compassionate mind training to help people develop and work with experiences of inner warmth, safeness and soothing, via compassion and self-compassion.

 

[sarek]

I think this is an very important piece of information that will help me understand and care for my gf in a better way. I have always felt that compassion is a critical element in healing. She is now at last receiving professional help as well and that should make all the difference.

 

[Daniel E.]

Another one of the researchers is Kristin Neff:

Self-compassion - Wikipedia, the free encyclopedia
Self-Compassion - Kristen Neff

An adaptation from the short version of her Self-Compassion Scale:

Negatively correlated with self-compassion:

Over-identification:

• When I fail at something important to me I become consumed by feelings of inadequacy.
• When I’m feeling down I tend to obsess and fixate on everything that’s wrong.

Self-judgment:

• I’m disapproving and judgmental about my own flaws and inadequacies.
• I’m intolerant and impatient towards those aspects of my personality I don’t like.

Isolation:

• When I’m feeling down, I tend to feel like most other people are probably happier than I am.
• When I fail at something that’s important to me, I tend to feel alone in my failure.

Positively correlated with self-compassion:

Self-kindness:

• I try to be understanding and patient towards those aspects of my personality I don’t like.
• When I’m going through a very hard time, I give myself the caring and tenderness I need.

Mindfulness:

• When something painful happens I try to take a balanced view of the situation.
• When something upsets me I try to keep my emotions in balance.

Common humanity:

• I try to see my failings as part of the human condition.
• When I feel inadequate in some way, I try to remind myself that feelings of inadequacy are shared by most people.

And another author is Christopher Germer, who mentions both researchers (Paul Gilbert & Kristin Neff) in his book The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions.

(A related concept is self-acceptance, a.k.a. "unconditional positive self-regard.")

 

[Daniel E.]

The Mindful Path to Self Compassion: Interview with Christopher Germer
PsychCentral blog: Mindfulness & Psychotherapy
By Elisha Goldstein, Ph.D.
May 2010

Today I have the pleasure of bringing to you another renowned Psychologist who integrates the practice of Mindfulness and Psychotherapy, Christopher Germer, PhD. Christopher is a clinical psychologist in private practice in Arlington, Massachusetts and author of the recent book The Mindful Path to Self-Compassion: Freeing Yourself from Destructive Thoughts and Emotions

.

He is a founding member of the Institute for Meditation and Psychotherapy, a clinical instructor in psychology at Harvard Medical School, and co-editor of Mindfulness and Psychotherapy

. Christopher also conducts workshops internationally on the art and science of mindful self-compassion.

Today Christopher is going to talk to us about what compassion is and why our cultures suffers from a prevalence of unworthiness.

Elisha: What is compassion exactly and why do you think it’s getting so much attention lately?
Christopher: The Dalai Lama defines compassion as the wish for others to be free from suffering. That’s a little different than loving-kindness, which is the wish for others to be happy. We need to be in the presence of suffering to experience compassion.

Compassion comes from the Latin roots com (with) and pati (suffer). When we’re being compassionate, we “suffer with” another. However, the pain isn’t usually overwhelming because it’s tempered by a deep feeling of mutuality. The sense of connection softens the bite.

Tsoknyi Rinpoche, a Tibetan meditation teacher, says the following about compassion:

There’s some sense of being wide awake and free. At the same time, there’s some tenderness that arises without any cause or condition. There is a deep-felt sense of being tender. Not sad in a depressed way, but tender, and somewhat delighted at the same time. There’s a mixture. There’s no sadness for oneself. Nor is there sadness for anyone in particular, either. It’s like being saturated with juice, just like an apple is full of juice.
​

In most religions, compassion for oneself is used as an example for how to be compassionate toward others. For example, “Love your neighbor as yourself.” The Dalai Lama considers self-compassion as necessary for cultivating compassion for others. However, nowadays it’s often easier to have the tender feeling of compassion toward others than toward ourselves. We’re likely to feel self-indulgent or unworthy the minute we offer ourselves the same kindness we’d give to another person when they need it. Ironically, we now use the feeling of compassion for others as an illustration for what it may feel like to be compassionate toward oneself.

Why is compassion getting so much attention lately? That’s a complex question. As the Indian sage Nisargadatta Maharaj said, the single cause of most events is the “universe of causes.” From my limited point of view, however, it’s the science that’s making the difference.

In our culture, science is the arbiter of truth, for better or worse. Compassion has always been one of those invisible qualities that makes a big difference in our lives—like love, truth and peace—but now compassion is directly observable on brain scans. Richie Davidson at the University of Wisconsin once promised the Dalai Lama to put compassion on the scientific map, and he and other researchers around the world have done just that. Compassion falls under the umbrella of “affective neuroscience.” There are also many psychological studies underway right now that explore the emotional, physical, and psychological benefits of compassion, such as those at Emory University and the Center for Compassion and Altruism at Stanford University.

A humorous explanation for the current interest in compassion might come from Steven Hayes at the University of Reno: “The crazies are driving the bus!” Erstwhile hippies are now senior researchers and grant reviewers at major organizations that enable this kind of research to be done.

Psychotherapy is another place where compassion is getting a lot of attention. Buddhist psychology is reshaping the science and practice of psychotherapy in America, and compassion is a key component of Buddhist psychology.

Finally, it’s possible that the world is getting smaller with the Internet and we feel an urgent, global need for compassion—compassion for ourselves, for others, and for our environment. News of people who die in an earthquake or a mineshaft is felt within hours in our living rooms. The only way to bear all that suffering without fatigue and resignation is to keep our hearts open with compassion.

Elisha: Feeling unworthy, deficient or defective is so prevalent in our culture. What are the factors that have led to this?
Christopher: That’s an interesting question, and one that we probably need a whole lot more research to answer!

In our American culture, we’re taught we need to be exceptional to be worthwhile. Kristin Neff, a pioneering researcher in the field of self-compassion, likes to ask, “How would you feel if somebody told you that you were “average”—average looking, average intelligence, average talent?” Most probably it would hurt your feelings. Perhaps we’d even add a few choice comments directed at ourselves, such as, “You’re so stupid!” “What a loser!” “No one will love you.”

Feelings of disconnection and loneliness probably play a role in our feelings of unworthiness. About 60% of Americans—20% of the population—suffer from loneliness. And being alone in one’s own mind puts us at the mercy of self-critical thinking. Anne Lamott once wrote, “My mind is a neighborhood I try not to go into alone.”

It’s an open question, though, if people living in other cultures suffer less than we do from feelings of unworthiness. Asian cultures seem to have a more connected sense of self, but if the culture uses shame as a means of social control, then being alone might protect us from emotional injury. Conversely, if compassion is emphasized in parenting and social contacts, such as in Thailand, then feeling connected to those around us is probably a good thing for our self-esteem.

Kristin Neff did some cross-cultural research and found that self-compassion—the opposite of self-criticism—was highest in Thailand, lowest in Taiwan, and the United States fell somewhere in between. That means that people living in an Asian culture—where people are less likely to feel alone than in the United States—might still feel unworthy, defective and deficient. In all three cultures, however, Kristin and her colleagues found that high levels of self-compassion predicted greater life satisfaction and less depression. It therefore seems that no matter which country or culture we come from, self-compassion is still good for our mental health!

Elisha Goldstein, Ph.D. is a Clinical Psychologist and conducts a private practice in West Los Angeles. He is co-author of A Mindfulness-Based Stress Reduction Workbook.

 

[Daniel E.]

Re: Empathy: A Two Edged Sword?

In most religions, compassion for oneself is used as an example for how to be compassionate toward others. For example, “Love your neighbor as yourself.” The Dalai Lama considers self-compassion as necessary for cultivating compassion for others. However, nowadays it’s often easier to have the tender feeling of compassion toward others than toward ourselves. We’re likely to feel self-indulgent or unworthy the minute we offer ourselves the same kindness we’d give to another person when they need it. Ironically, we now use the feeling of compassion for others as an illustration for what it may feel like to be compassionate toward oneself.

Similarly:

Why It's Okay (Actually, Essential) to Put Yourself First - Oprah.com

Are Women Too Compassionate for Their Own Good? - Psychology Today

 

[Daniel E.]

What Self-Compassion is Not
by Kristin Neff, PhD
Self-Compassion.org

When individuals feel self-pity, they become immersed in their own problems and forget that others have similar problems. They ignore their interconnections with others, and instead feel that they are the only ones in the world who are suffering. Self-pity tends to emphasize egocentric feelings of separation from others and exaggerate the extent of personal suffering. Self-compassion, on the other hand, allows one to see the related experiences of self and other without these feelings of isolation and disconnection. Also, self-pitying individuals often become carried away with and wrapped up in their own emotional drama. They cannot step back from their situation and adopt a more balanced or objective perspective. In contrast, by taking the perspective of a compassionate other towards oneself, "mental space" is provided to recognize the broader human context of one?s experience and to put things in greater perspective. (?Yes it is very difficult what I?m going through right now, but there are many other people who are experiencing much greater suffering. Perhaps this isn?t worth getting quite so upset about...")

Self-compassion is also very different from self-indulgence. Many people say they are reluctant to be self-compassionate because they?re afraid they would let themselves get away with anything. ?I?m stressed out today so to be kind to myself I?ll just watch TV all day and eat a quart of ice cream.? This, however, is self-indulgence rather than self-compassion. Remember that being compassionate to oneself means that you want to be happy and healthy in the long term. In many cases, just giving oneself pleasure may harm well-being (such as taking drugs, over-eating, being a couch potato), while giving yourself health and lasting happiness often involves a certain amount of displeasure (such as quitting smoking, dieting, exercising). People are often very hard on themselves when they notice something they want to change because they think they can shame themselves into action ? the self-flagellation approach. However, this approach often backfires if you can?t face difficult truths about yourself because you are so afraid of hating yourself if you do. Thus, weaknesses may remain unacknowledged in an unconscious attempt to avoid self-censure. In contrast, the care intrinsic to compassion provides a powerful motivating force for growth and change, while also providing the safety needed to see the self clearly without fear of self-condemnation.

 

[Daniel E.]

The Three Elements of Self-Compassion
by Kristin Neff, PhD
Self-Compassion.org

Self-kindness. Self-compassion entails being warm and understanding toward ourselves when we suffer, fail, or feel inadequate, rather than ignoring our pain or flagellating ourselves with self-criticism. Self-compassionate people recognize that being imperfect, failing, and experiencing life difficulties is inevitable, so they tend to be gentle with themselves when confronted with painful experiences rather than getting angry when life falls short of set ideals. People cannot always be or get exactly what they want. When this reality is denied or fought against suffering increases in the form of stress, frustration and self-criticism. When this reality is accepted with sympathy and kindness, greater emotional equanimity is experienced.

Common humanity. Frustration at not having things exactly as we want is often accompanied by an irrational but pervasive sense of isolation – as if “I” were the only person suffering or making mistakes. All humans suffer, however. The very definition of being “human” means that one is mortal, vulnerable and imperfect. Therefore, self-compassion involves recognizing that suffering and personal inadequacy is part of the shared human experience - something that we all go through rather than being something that happens to “me” alone. It also means recognizing that personal thoughts, feelings and actions are impacted by “external” factors such as parenting history, culture, genetic and environmental conditions, as well as the behavior and expectations of others. Thich Nhat Hahn calls the intricate web of reciprocal cause and effect in which we are all imbedded “interbeing.” Recognizing our essential interbeing allows us to be less judgmental about our personal failings. After all, if we had full control over our behavior, how many people would consciously choose to have anger issues, addiction issues, debilitating social anxiety, eating disorders, and so on? Many aspects of ourselves and the circumstances of our lives are not of our choosing, but instead stem from innumerable factors (genetic and/or environmental) that we have little control over. By recognizing our essential interdependence, therefore, failings and life difficulties do not have to be taken so personally, but can be acknowledged with non-judgmental compassion and understanding.

Mindfulness. Self-compassion also requires taking a balanced approach to our negative emotions so that feelings are neither suppressed nor exaggerated. This equilibrated stance stems from the process of relating personal experiences to those of others who are also suffering, thus putting our own situation into a larger perspective. It also stems from the willingness to observe our negative thoughts and emotions with openness and clarity, so that they are held in mindful awareness. Mindfulness is a non-judgmental, receptive mind state in which one observes thoughts and feelings as they are, without trying to suppress or deny them. We cannot ignore our pain and feel compassion for it at the same time. At the same time, mindfulness requires that we not be “over-identified” with thoughts and feelings, so that we are caught up and swept away by negative reactivity.

 

[Daniel E.]

From Self-Esteem to Self-Acceptance
by Pavel G. Somov, PhD

Self-acceptance is an acknowledgment of the reality of what you are: a life in progress. Whereas self-esteem is a recurring life-performance evaluation, self-acceptance is evaluation-proof tenure. While self-evaluation is inherently dependent on arbitrary definitions of worth and value, self-acceptance is independent of evaluation and is therefore immune to the ebb and flow of circumstance. And as such, self-acceptance sets you free.

I'm not advocating anarchy. Sure, trying to prove your value to others might help you get a job or a date. True, in this human barter of value, we do have to sell ourselves up to a point. We all have needs and desires to feed. Making a good first impression and being able to meet others' expectations is all part of the game of social survival. The problem is that we take this game of survival a hit too seriously, forgetting to stop playing when there is nothing of value to gain...

excerpted from: Present Perfect: A Mindfulness Approach to Letting Go of Perfectionism and the Need for Control

 

[rdw]

Thanks for these posts - these are just what I needed to read today! How timely...

 

[Daniel E.]

"No amount of self-improvement can make up for any lack of self-acceptance."

~ Robert Holden

---------- Post added at 01:22 PM ---------- Previous post was at 12:20 PM ----------

The introduction and first chapter of the book The Mindful Path to Self-Compassion:

http://www.guilford.com/excerpts/germer2.pdf

 

[Daniel E.]

Sanctuary and Secure Attachment

...I had introduced my group to Harry Harlow, the father of attachment theory in the scientific community, during the portion of our time where we discuss the science that underlies EBT [emotional brain training]. I thought of Harlow's baby monkey #106 who spent 18 hours a day meeting his need for sanctuary by attaching to his surrogate cloth mother. I felt such compassion for that little monkey living in a research environment yet being true to his need for secure attachment, for sanctuary...

As adults we create inside ourselves the inner sanctuary that allows us to grow and heal and flourish and in some ways what we do seems so different than those little monkeys. Yet when I use the cycle tool for my own work, I can see myself in those little monkeys settling in with their cloth mothers. I can feel my compelling need for sanctuary as I work my way through the natural flow of feelings, especially when I arrive at "I feel guilty that...". My sanctuary supports me in finding that stress circuit in my brain, that unreasonable expectation that fans my stress and amplifies it. It is my sanctuary, that safe place where I can fully see myself with warmth and compassionate curiosity that allows me to sit with those unreasonable expectations, those stress producing circuits and weaken them and find the reasonable expectation that will lead me to a brain state of joy.

 

[Daniel E.]

An excerpt from The Mindful Path to Self-Compassion:

Mindfulness
Just as self-compassion is implicit in mindfulness practice, mindfulness can be found in self-compassion. Mindfulness is nonattached awareness—it gives us the ability to accept painful thoughts and feelings in an even, balanced manner. The opposite of mindfulness—overidentification—happens when we lose ourselves in emotional reactivity. Pain narrows perception. Mindful awareness helps us recognize when we're in pain, when we're criticizing ourselves, and when we're isolating ourselves and points the way out.

A mindfulness item from the Self-Compassion Scale is "When I'm feeling down, I try to approach my feelings with curiosity and openness." The opposite of mindfulness is seen in the statement "When I'm feeling down, I tend to obsess and fixate on everything that's wrong."

 

[Daniel E.]