What Is… Compassion-Focused Therapy

In this series, I dig a little deeper into the meaning of psychology-related terms. This week’s term is compassion-focused therapy.

Compassion-focused therapy (CFT) was developed by Paul Gilbert and draws on compassion to eliminate suffering, including shame and self-criticism. The theoretical basis spans a number of fields and incorporates both Western and Eastern philosophies.

Part of what motivated the development of CFT was that some clients doing cognitive behavioural therapy (CBT) were struggling to believe the alternative/balanced thoughts they were coming up with. Gilbert believed this was because of high levels of shame and self-criticism.

How the brain functions

CFT looks at three evolutionary levels of the brain:

• the primitive reptilian brain: focused on survival
• the mammalian brain: concerned with social dynamics
• the human brain: involved in caregiving, attachment, and higher-order thinking.

Problematic thinking loops can develop when human brain functions like rumination get caught up with old brain functions related to motives, emotions, and behaviours. As a result, threats that would otherwise be temporary get prolonged with self-criticism and imagining the worst possible outcomes. Mindfulness and compassion are important in disrupting these thinking loops.

CFT also describes three systems within the brain:

• threat system: includes fight or flight responses
• drive system: relates to motivation and achievement
• care-giving system: responsible for soothing and calm

The balance between these systems is determined by the environments that we’ve been exposed to. A key goal of CFT is to strengthen the care-giving system while toning down the threat system (which tends to fuel self-criticism).

Defensive behaviours

Primary fears arise from past experiences that influence the shame, self-blame, and self-criticism we develop. Internal fears include anxiety, depression, shame, and rage, while external fears include rejection and being harmed by others. To manage these fears, we may turn to defensive behaviours.

Internal defensive behaviours are used to avoid difficult emotions. These defensive behaviours include dissociation, substance misuse, and self-harm. External defensive behaviours are used in an attempt to avoid harm from others, and they may include self-blame, self-silencing, submissiveness, and keeping others at a distance.

CFT examines the unintended outcomes of these attempts to protect ourselves and how these outcomes affect how we relate to ourselves.

The nature of compassion

CFT involves cultivating a stronger compassionate self identity. Gilbert described two aspects of compassion: engaging with and alleviating/preventing suffering.

He identified several attributes associated with compassion:

• sensitivity: opening up to experiences of pain and suffering
• sympathy: bringing warmth rather than criticism
• distress tolerance: being willing to endure discomfort and being able to self-soothe
• empathy: understanding emotional experiences
• non-judgment: moving away from judging, labelling, and self-blaming
• care for well-being: motivation for care-giving and nurturance

He also identified several relevant skill areas:

• imagery: used to stimulate particular kinds of emotions
• reasoning: includes perspective-taking to determine what will genuinely be helpful
• behaviour: doing things that are helpful to others, engaging in appreciation/gratitude
• sensory: includes breathing practices and body postures to stimulate the parasympathetic nervous system
• feeling: connecting with emotions associated with affiliation
• attention: cultivate mindfulness

Therapeutic interventions

CFT identifies a number of qualities that help in developing inner compassion. These include empathy, forgiveness, acceptance, tolerance, and taking responsibility for self-critical thinking.

Therapeutic techniques include:

• soothing breathing rhythm practices
• body scanning and relaxation
• creating a safe space and imagining the sensory stimuli there
• imagery: viewing compassion as a colour flowing from others to self, self to others, and self to self
• compassion meditation directed outward to others
• recalling memories of when you experienced compassion to evoke compassion flowing into the self
• developing a sense of ideal compassionate self – What would it look and sound like? How would it relate to you and you to it?
• compassionate letter-writing

The self-critic is mentalized to try to understand what’s driving it, and then compassion is directed at those underlying difficult emotions and feelings of vulnerability. This process can include giving the self-critic a name and persona and imagining how it looks and sounds, and creating imaginary conversations between the self-critic and the ideal compassionate self.

Had you heard of CFT before? How compassionate do you think you are towards yourself?

Resources

• Compassionate Mind Australia: handouts and exercises
• Compassionate Mind Foundation: a selection of audio and video resources available
• Irish Centre for Compassion Focused Therapy: audio resource
• Training Our Minds in, with and for Compassion: An Introduction to Concepts and Compassion-Focused Exercises by Dr. Paul Gilbert

References

• Brighton Therapy Partnership: What Is Compassion-Focused Therapy?
• Dale-Hewitt, V., Irons, C., Braham, L. & Smith, S. (2016). 10. Compassion Focused Therapy. In Formulation in Action: Applying Psychological Theory to Clinical Practice (pp. 161-184). De Gruyter Open Poland.
• Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6-41.
• New Harbinger Publications clinicians corner: Cultivating Compassion in Sessions: The Six Attributes of CFT
• PositivePsychology.com: 16 Compassion Focused Therapy Training Exercises and Worksheets
• The Compassionate Mind Foundation