Compassion-focused therapy

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Compassion Focused Therapy (CFT) is a system of psychotherapy developed by Professor Paul Gilbert (OBE) that integrates techniques from cognitive behavioral therapy with concepts from evolutionary psychology, social psychology, developmental psychology, Buddhist psychology, and neuroscience. According to Gilbert, "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." [1] : 199 

Contents

Overview

A central therapeutic technique of CFT is compassionate mind training, [2] [3] which teaches the skills and attributes of compassion. [4] Compassionate mind training helps transform problematic patterns of cognition and emotion related to anxiety, anger, shame and self-criticism. [1] : 208 

Biological evolution forms the theoretical backbone of CFT. Humans have evolved with at least three primal types of emotion regulation system: the threat (protection) system, the drive (resource-seeking) system, and the soothing system. [1] : 200  [5] : 43  CFT emphasizes the links between cognitive patterns and these three emotion regulation systems. [5] : 59  Through the use of techniques such as compassionate mind training and cognitive behavioral therapy (CBT), counselling clients can learn to manage each system more effectively and respond more appropriately to situations. [6]

Compassion Focused Therapy is especially appropriate for people who have high levels of shame and self-criticism and who have difficulty in feeling warmth toward, and being kind to, themselves or others. [1] CFT can help such people learn to feel more safeness and warmth in their interactions with others and themselves. [1]

Numerous methods are used in CFT to develop a person's compassion. For example, people undergoing CFT are taught to understand compassion from the third person, before transferring these thought processes to themselves. [7] : 317 

Core principles

CFT is largely built on the idea that the evolution of caring behavior has major regulatory and developmental functions. [8] : 4  The central focus of CFT is to concentrate on helping clients relate to their difficulties in compassionate ways, as well as provide them with effective tools to work with challenging circumstances and emotions they encounter. [9] CFT helps those learn tools to engage with their battles in accepting and encouraging ways, thereby aiding themselves to feel confident about accomplishing difficult tasks and dealing with challenging situations. [9]

This is facilitated by:

According to evolutionary analysis, there are three types of functional emotion regulation systems: drive, safety and threat. CFT is based on the relationship and interactions between these systems. One is born with each system but our surroundings implicate whether one utilizes and sustains the non-survival-based systems (drive and caregiving). [10]

Using CFT enriches the compassion-based soothing system, while withdrawing from the threat-focused emotional regulation system. In turn, this will augment the ability to activate (drive) and work towards valued goals. [8] : 11 

Applications

Compassion Focused Therapy has been investigated as a novel treatment for a wide variety of psychological disorders. A 2012 randomized controlled trial showed CFT to be a safe and clinically effective treatment option for psychosis patients. [11] CFT was shown to be more effective than "treatment as usual", with particular efficacy in reducing depression symptoms. [11] A further 2015 literature review of 14 different studies showed promising psychotherapeutic benefits of CFT, especially when treating mood disorders. [12] A recent meta analysis found good support for CFT as a treatment for a variety of psychological difficulties. [13] However, further large-scale trials are necessary in order for CFT to become an accepted, "evidence-based" treatment for these disorders. [12]

CFT has also been explored as a treatment for individuals with eating disorders. This slightly modified version of CFT, CFT-E, has had promising results in treating adult outpatients with restrictive eating disorders as well as with binging and purging disorders. [14] A 2014 literature review found CFT-E to be a particularly effective treatment for eating disorders due to the fact that it confronts the "high levels of shame and self‐criticism" that patients often experience. [14] More recent primary studies have further proved CFT-E to be a safe and effective intervention for eating disorders. [15]

CFT is also being studied as a rehabilitation method for patients with acquired brain injuries (ABI). Preliminary, small-scale studies have shown CFT to be safe and beneficial in treating anxiety and depressive symptoms of ABI patients, although further large-scale studies are needed. [16]

As well as being a psychological therapy (for individuals and groups), Compassionate Mind Training (CMT) has been shown to be an effective approach for reducing psychological distress in the general public. A variety of studies have found that engaging in guided audios, [17] online courses, [18] [19] an 8 week group [2] and using an app (The Self-Compassion App) can lead to reductions in self-criticism, shame, attachment insecurity, depression and anxiety symptoms, as well as increasing self-compassion, positive emotions and wellbeing.

CMT has also been used as an effective approach in schools, [20] with results suggesting a variety of benefits for teachers who engaged in an 8 week compassion training course. [21]

Limitations

Beaumont and Hollins Martin (2015) [22] examined narrative reviews of 12 research findings that has shown use of CFT to treat and experiment with psychological outcomes in clinical populations. The researchers found that overall, there are improvements of mental health issues with CFT intervention, especially when combined with approaches such as cognitive behavioral therapy (CBT). [22]

Beaumont and Hollins Martin (2015) found a major limitation in the empirical studies are the small number of participants involved in each case. For instance, Gilbert and Proctor (2006) showed small reductions in depression, anxiety, self-criticism and shame, however their participant group involved only 6 members. [23] The small number of participants can cause bias or facilitate a problem of generalization for the broader population. For instance, out of the twelve studies only two individually supported effectiveness of CFT. A study conducted by Lucre and Corten (2012) [24] found CFT to be effective for treating patients with personality disorders, and another study by Heriot-Maitland et al. (2014) [25] found that treating clients in acute inpatient settings was effective. [22]

Recommendations

The findings of Beaumont and Hollins Martin (2015) recommended that the effectiveness of CFT needs further extensive research in order to fully examine reductions in mental illnesses and overall improvements in quality of life. [22] This study recommends for consideration of larger samples of participants in order to ensure that CFT can be independently effective without other psychotherapy interventions involved such as CBT.

Related Research Articles

<span class="mw-page-title-main">Cognitive behavioral therapy</span> Type of therapy to improve mental health

Cognitive behavioral therapy (CBT) is a form of psychotherapy that aims to reduce symptoms of various mental health conditions, primarily depression, PTSD and anxiety disorders. Cognitive behavioral therapy focuses on challenging and changing cognitive distortions and their associated behaviors to improve emotional regulation and develop personal coping strategies that target solving current problems. Though it was originally designed to treat depression, its uses have been expanded to include many issues and the treatment of many mental health and other conditions, including anxiety, substance use disorders, marital problems, ADHD, and eating disorders. CBT includes a number of cognitive or behavioral psychotherapies that treat defined psychopathologies using evidence-based techniques and strategies.

Psychotherapy is the use of psychological methods, particularly when based on regular personal interaction, to help a person change behavior, increase happiness, and overcome problems. Psychotherapy aims to improve an individual's well-being and mental health, to resolve or mitigate troublesome behaviors, beliefs, compulsions, thoughts, or emotions, and to improve relationships and social skills. Numerous types of psychotherapy have been designed either for individual adults, families, or children and adolescents. Certain types of psychotherapy are considered evidence-based for treating some diagnosed mental disorders; other types have been criticized as pseudoscience.

Abnormal psychology is the branch of psychology that studies unusual patterns of behavior, emotion, and thought, which could possibly be understood as a mental disorder. Although many behaviors could be considered as abnormal, this branch of psychology typically deals with behavior in a clinical context. There is a long history of attempts to understand and control behavior deemed to be aberrant or deviant, and there is often cultural variation in the approach taken. The field of abnormal psychology identifies multiple causes for different conditions, employing diverse theories from the general field of psychology and elsewhere, and much still hinges on what exactly is meant by "abnormal". There has traditionally been a divide between psychological and biological explanations, reflecting a philosophical dualism in regard to the mind–body problem. There have also been different approaches in trying to classify mental disorders. Abnormal includes three different categories; they are subnormal, supernormal and paranormal.

<span class="mw-page-title-main">Compassion</span> Moved or motivated to help others

Compassion is a social feeling that motivates people to go out of their way to relieve the physical, mental, or emotional pains of others and themselves. Compassion is sensitivity to the emotional aspects of the suffering of others. When based on notions such as fairness, justice, and interdependence, it may be considered partially rational in nature.

<span class="mw-page-title-main">Dialectical behavior therapy</span> Psychotherapy for emotional dysregulation

Dialectical behavior therapy (DBT) is an evidence-based psychotherapy that began with efforts to treat personality disorders and interpersonal conflicts. Evidence suggests that DBT can be useful in treating mood disorders and suicidal ideation as well as for changing behavioral patterns such as self-harm and substance use. DBT evolved into a process in which the therapist and client work with acceptance and change-oriented strategies and ultimately balance and synthesize them—comparable to the philosophical dialectical process of thesis and antithesis, followed by synthesis.

Clinical psychology is an integration of human science, behavioral science, theory, and clinical knowledge for the purpose of understanding, preventing, and relieving psychologically-based distress or dysfunction and to promote subjective well-being and personal development. Central to its practice are psychological assessment, clinical formulation, and psychotherapy, although clinical psychologists also engage in research, teaching, consultation, forensic testimony, and program development and administration. In many countries, clinical psychology is a regulated mental health profession.

Eye movement desensitization and reprocessing (EMDR) is a form of psychotherapy that is a recommended treatment for post-traumatic stress disorder (PTSD), but remains controversial within the psychological community. It was devised by Francine Shapiro in 1987 and originally designed to alleviate the distress associated with traumatic memories such as PTSD.

Psychodynamic psychotherapy and psychoanalytic psychotherapy are two categories of psychological therapies. Their main purpose is revealing the unconscious content of a client's psyche in an effort to alleviate psychic tension, which is inner conflict within the mind that was created in a situation of extreme stress or emotional hardship, often in the state of distress. The terms "psychoanalytic psychotherapy" and "psychodynamic psychotherapy" are often used interchangeably, but a distinction can be made in practice: though psychodynamic psychotherapy largely relies on psychoanalytical theory, it employs substantially shorter treatment periods than traditional psychoanalytical therapies. Psychodynamic psychotherapy is evidence-based; the effectiveness of psychoanalysis and its relationship to facts is disputed.

<span class="mw-page-title-main">Buddhism and psychology</span> Buddhism, Mindfulness and Psychology

Buddhism includes an analysis of human psychology, emotion, cognition, behavior and motivation along with therapeutic practices. Buddhist psychology is embedded within the greater Buddhist ethical and philosophical system, and its psychological terminology is colored by ethical overtones. Buddhist psychology has two therapeutic goals: the healthy and virtuous life of a householder and the ultimate goal of nirvana, the total cessation of dissatisfaction and suffering (dukkha).

In psychology, self-compassion is extending compassion to one's self in instances of perceived inadequacy, failure, or general suffering. American psychologist Kristin Neff has defined self-compassion as being composed of three main elements – self-kindness, common humanity, and mindfulness.

Leslie Samuel Greenberg is a Canadian psychologist born in Johannesburg, South Africa, and is one of the originators and primary developers of Emotion-Focused Therapy for individuals and couples. He is a professor emeritus of psychology at York University in Toronto, and also director of the Emotion-Focused Therapy Clinic in Toronto. His research has addressed questions regarding empathy, psychotherapy process, the therapeutic alliance, and emotion in human functioning.

Emotionally focused therapy and emotion-focused therapy (EFT) are related humanistic approaches to psychotherapy that aim to resolve emotional and relationship issues with individuals, couples, and families. These therapies combine experiential therapy techniques, including person-centered and Gestalt therapies, with systemic therapy and attachment theory. The central premise is that emotions influence cognition, motivate behavior, and are strongly linked to needs. The goals of treatment include transforming maladaptive behaviors, such as emotional avoidance, and developing awareness, acceptance, expression, and regulation of emotion and understanding of relationships. EFT is usually a short-term treatment.

PTSD or post-traumatic stress disorder, is a psychiatric disorder characterised by intrusive thoughts and memories, dreams or flashbacks of the event; avoidance of people, places and activities that remind the individual of the event; ongoing negative beliefs about oneself or the world, mood changes and persistent feelings of anger, guilt or fear; alterations in arousal such as increased irritability, angry outbursts, being hypervigilant, or having difficulty with concentration and sleep.

Cognitive behavioral therapy (CBT) is derived from both the cognitive and behavioral schools of psychology and focuses on the alteration of thoughts and actions with the goal of treating various disorders. The cognitive behavioral treatment of eating disorders emphasizes on the minimization of negative thoughts about body image and the act of eating, and attempts to alter negative and harmful behaviors that are involved in and perpetuate eating disorders. It also encourages the ability to tolerate negative thoughts and feelings as well as the ability to think about food and body perception in a multi-dimensional way. The emphasis is not only placed on altering cognition, but also on tangible practices like making goals and being rewarded for meeting those goals. CBT is a "time-limited and focused approach" which means that it is important for the patients of this type of therapy to have particular issues that they want to address when they begin treatment. CBT has also proven to be one of the most effective treatments for eating disorders.

Cognitive emotional behavioral therapy (CEBT) is an extended version of cognitive behavioral therapy (CBT) aimed at helping individuals to evaluate the basis of their emotional distress and thus reduce the need for associated dysfunctional coping behaviors. This psychotherapeutic intervention draws on a range of models and techniques including dialectical behavior therapy (DBT), mindfulness meditation, acceptance and commitment therapy (ACT), and experiential exercises.

<span class="mw-page-title-main">Paul Gilbert (psychologist)</span> British clinical psychologist

Paul Raymond Gilbert is a British clinical psychologist. Gilbert is the founder of compassion focused therapy (CFT), compassionate mind training (CMT) and the author of books such as The Compassionate Mind: A New Approach to Life's Challenges and Overcoming Depression.

Trauma focused cognitive behavioral therapy (TF-CBT) is an evidence-based therapeutic approach that aims at addressing the needs of individuals with post traumatic stress disorder (PTSD) and other difficulties related to traumatic life events. This treatment was developed and proposed by Drs. Anthony Mannarino, Judith Cohen, and Esther Deblinger in the 1990's. The goal of TF-CBT is to provide psychoeducation to both the victim and non-offending caregivers, then help them identify, cope, and re-regulate maladaptive emotions, thoughts, and behaviors. Research has shown TF-CBT to be effective in treating childhood PTSD and with children who have experienced or witnessed traumatic events, including but not limited to physical or sexual victimization, child maltreatment, domestic violence, community violence, accidents, natural disasters, and war. While originally studied as a treatment for children and adolescents, its use has more recently expanded to include adult patients. Additionally, TF-CBT has been applied to and found effective in treating complex posttraumatic stress disorder (cPTSD).

Metacognitive therapy (MCT) is a psychotherapy focused on modifying metacognitive beliefs that perpetuate states of worry, rumination and attention fixation. It was created by Adrian Wells based on an information processing model by Wells and Gerald Matthews. It is supported by scientific evidence from a large number of studies.

Trauma-sensitive yoga is yoga as exercise, adapted from 2002 onwards for work with individuals affected by psychological trauma. Its goal is to help trauma survivors to develop a greater sense of mind-body connection, to ease their physiological experiences of trauma, to gain a greater sense of ownership over their bodies, and to augment their overall well-being. However, a 2019 systematic review found that the studies to date were not sufficiently robustly designed to provide strong evidence of yoga's effectiveness as a therapy; it called for further research.

Sexual trauma therapy is medical and psychological interventions provided to survivors of sexual violence aiming to treat their physical injuries and cope with mental trauma caused by the event. Examples of sexual violence include any acts of unwanted sexual actions like sexual harassment, groping, rape, and circulation of sexual content without consent.

References

  1. 1 2 3 4 5 Beaumont, Elaine; Bell, Tobyn; McAndrew, Sue; Fairhurst, Helen (2021-03-16). "The impact of compassionate mind training on qualified health professionals undertaking a compassion-focused therapy module". Counselling and Psychotherapy Research. 21 (4): 910–922. doi:10.1002/capr.12396. ISSN   1473-3145.
  2. 1 2 Irons, Chris; Heriot-Maitland, Charles (September 2021). "Compassionate Mind Training: An 8-week group for the general public". Psychology and Psychotherapy: Theory, Research and Practice. 94 (3): 443–463. doi:10.1111/papt.12320. ISSN   1476-0835. PMID   33222375.
  3. ↑ Matos, Marcela; Duarte, Cristiana; Duarte, Joana; Pinto-Gouveia, José; Petrocchi, Nicola; Basran, Jaskaran; Gilbert, Paul (2017-12-01). "Psychological and Physiological Effects of Compassionate Mind Training: a Pilot Randomised Controlled Study". Mindfulness. 8 (6): 1699–1712. doi:10.1007/s12671-017-0745-7. hdl: 10316/46588 . ISSN   1868-8535.
  4. ↑ Gilbert, Paul; Simos, Gregoris (2022). Compassion Focused Therapy: Clinical Practice and Applications.
  5. 1 2 Gilbert, Paul (2010). Compassion-focused therapy: distinctive features. The CBT distinctive features series. London; New York: Routledge. ISBN   9780415448079. OCLC   463971957.
  6. ↑ Rayner, Gillian Clare; Bowling, Gosia; Bluff, Lisa; Wright, Karen; Ashworth-Lord, Anneliese; Laird, Catriona (September 2022). "A multi-method evaluation of a compassion-focused cognitive behavioural psychotherapy group for people who self-harm". Counselling and Psychotherapy Research. 22 (3): 569–582. doi: 10.1002/capr.12516 . ISSN   1473-3145.
  7. ↑ Horwood, Victoria; Allan, Steven; Goss, Kenneth; Gilbert, Paul (June 2020). "The development of the Compassion Focused Therapy Therapist Competence Rating Scale". Psychology and Psychotherapy: Theory, Research and Practice. 93 (2): 387–407. doi:10.1111/papt.12230. ISSN   1476-0835.
  8. 1 2 Heriot-Maitland, Charles; Levey, Valerie (August 2021). "A case report of compassion-focused therapy for distressing voice-hearing experiences". Journal of Clinical Psychology. 77 (8): 1821–1835. doi:10.1002/jclp.23211. ISSN   0021-9762. PMID   34252979.
  9. 1 2 Stroud, James; Griffiths, Carys (September 2021). "An evaluation of compassion-focused therapy within adult mental health inpatient settings". Psychology and Psychotherapy: Theory, Research and Practice. 94 (3): 587–602. doi:10.1111/papt.12334. ISSN   1476-0835. PMID   33629804.
  10. 1 2 3 4 5 6 7 8 Gilbert, Paul; Irons, Chris (2015). "Compassion Focused Therapy". The beginner's guide to counselling and psychotherapy. Palmer, Stephen, 1955- (2nd ed.). Los Angeles: SAGE Publications. pp. 3–5. ISBN   9780857022349. OCLC   905565554.
  11. 1 2 Braehler, Christine; Gumley, Andrew; Harper, Janice; Wallace, Sonia; Norrie, John; Gilbert, Paul (24 October 2012). "Exploring change processes in compassion-focused therapy in psychosis: Results of a feasibility randomized controlled trial". Clinical Psychology. 52 (2): 199–214. doi:10.1111/bjc.12009. PMID   24215148.
  12. 1 2 Leaviss, J; Uttley, L (2015). "Psychotherapeutic benefits of compassion-focused therapy: an early systematic review". Psychological Medicine. 45 (5): 927–945. doi:10.1017/S0033291714002141. PMC   4413786 . PMID   25215860.
  13. ↑ Petrocchi, Nicola; Ottaviani, Cristina; Cheli, Simone; Matos, Marcela; Baldi, Beatrice; Basran, Jaskaran K.; Gilbert, Paul (June 2024). "The impact of compassion-focused therapy on positive and negative mental health outcomes: Results of a series of meta-analyses". Clinical Psychology: Science and Practice. 31 (2): 230–247. doi:10.1037/cps0000193. ISSN   1468-2850.
  14. 1 2 Goss, K; Allan, S (21 February 2014). "The development and application of compassion-focused therapy for eating disorders (CFT-E)". British Journal of Clinical Psychology. 53 (1): 62–77. doi:10.1111/bjc.12039. PMID   24588762.
  15. ↑ Kelly, Allison Catherine; Lucene, Wisniewski; Ellen, Hoffman (30 May 2016). "Group-based compassion-focused therapy as an adjunct to outpatient treatment for eating disorders: a pilot randomized controlled trial". Clinical Psychology & Psychotherapy. 24 (2): 475–487. doi:10.1002/cpp.2018. PMID   27237928.
  16. ↑ Ashworth, Fiona; Clarke, Alexis; Jones, Lisa; Jennings, Caroline; Longworth, Catherine (15 August 2014). "An exploration of compassion-focused therapy following acquired brain injury". Psychology and Psychotherapy. 88 (2): 143–162. doi:10.1111/papt.12037. PMID   25123589.
  17. ↑ Matos, Marcela; Duarte, Joana; Duarte, Cristiana; Gilbert, Paul; Pinto-Gouveia, José (2018-08-01). "How One Experiences and Embodies Compassionate Mind Training Influences Its Effectiveness". Mindfulness. 9 (4): 1224–1235. doi:10.1007/s12671-017-0864-1. hdl: 10316/46590 . ISSN   1868-8535.
  18. ↑ Northover, Clare; Deacon, Jack; King, John; Irons, Chris (2021-09-21). "Developing Self-Compassion Online: Assessing the Efficacy and Feasibility of a Brief Online Intervention". OBM Integrative and Complementary Medicine. 6 (4): 1. doi: 10.21926/obm.icm.2104056 .
  19. ↑ "#1 Compassion Focused Therapy & Self-Compassion Resources" . Retrieved 2024-06-08.
  20. ↑ "Compassion in the Classroom | Home". www.cmtschools.org. Retrieved 2024-06-08.
  21. ↑ Matos, Marcela; Albuquerque, Isabel; Galhardo, Ana; Cunha, Marina; Lima, Margarida Pedroso; Palmeira, Lara; Petrocchi, Nicola; McEwan, Kirsten; Maratos, Frances A.; Gilbert, Paul (2022-03-01). "Nurturing compassion in schools: A randomized controlled trial of the effectiveness of a Compassionate Mind Training program for teachers". PLOS ONE. 17 (3): e0263480. Bibcode:2022PLoSO..1763480M. doi: 10.1371/journal.pone.0263480 . ISSN   1932-6203. PMC   8887735 . PMID   35231057.
  22. 1 2 3 4 Beaumont, Elaine; Hollins Martin, Caroline (2015). "A narrative review exploring the effectiveness of Compassion-Focused Therapy". Counselling Psychology Review. 30 (1): 21–32. doi:10.53841/bpscpr.2015.30.1.21.
  23. ↑ Gilbert, Paul; Proctor, Sue (November 2006). "Compassionate mind training for people with high shame and self-criticism: Overview and pilot study of a group therapy approach". Clinical Psychology & Psychotherapy. 13 (6): 353–379. CiteSeerX   10.1.1.362.7507 . doi:10.1002/cpp.507.
  24. ↑ Lucre, K.; Corten, N. (2012). "An exploration of group compassion-focused therapy for personality disorder". Psychology and Psychotherapy: Theory, Research and Practice. 86 (4): 387–400. doi:10.1111/j.2044-8341.2012.02068.x. PMID   24217864.
  25. ↑ Heriot-Maitland, C.; Vidal, J.B; Ball, S.; Irons, C. (March 2014). "A compassionate-focused therapy group approach for acute inpatients: Feasibility, initial pilot outcome data, and recommendations". British Journal of Clinical Psychology. 53 (1): 78–94. doi:10.1111/bjc.12040. PMID   24588763.
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