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 counselling (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 psycho-social intervention that aims to reduce symptoms of various mental health conditions, primarily depression and anxiety disorders. Cognitive behavioral therapy is one of the most effective means of treatment for substance abuse and co-occurring mental health disorders. CBT 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.

<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.

Cognitive analytic therapy (CAT) is a form of psychological therapy initially developed in the United Kingdom by Anthony Ryle. This time-limited therapy was developed in the context of the UK's National Health Service with the aim of providing effective and affordable psychological treatment which could be realistically provided in a resource constrained public health system. It is distinctive due to its intensive use of reformulation, its integration of cognitive and analytic practice and its collaborative nature, involving the patient very actively in their treatment.

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.

Acceptance and commitment therapy is a form of psychotherapy, as well as a branch of clinical behavior analysis. It is an empirically based psychological intervention that uses acceptance and mindfulness strategies along with commitment and behavior-change strategies to increase psychological flexibility.

<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.

<span class="mw-page-title-main">History of psychotherapy</span>

Although modern, scientific psychology is often dated from the 1879 opening of the first psychological clinic by Wilhelm Wundt, attempts to create methods for assessing and treating mental distress existed long before. The earliest recorded approaches were a combination of religious, magical and/or medical perspectives. Early examples of such psychological thinkers included Patañjali, Padmasambhava, Rhazes, Avicenna and Rumi.

Emotionally focused therapy and emotion-focused therapy (EFT) are a set of related approaches to psychotherapy with individuals, couples, or families. EFT approaches include elements of experiential therapy, systemic therapy, and attachment theory. EFT is usually a short-term treatment. EFT approaches are based on the premise that human emotions are connected to human needs, and therefore emotions have an innately adaptive potential that, if activated and worked through, can help people change problematic emotional states and interpersonal relationships. Emotion-focused therapy for individuals was originally known as process-experiential therapy, and it is still sometimes called by that name.

Social anxiety is the anxiety and fear specifically linked to being in social settings. Some categories of disorders associated with social anxiety include anxiety disorders, mood disorders, autism spectrum disorders, eating disorders, and substance use disorders. Individuals with higher levels of social anxiety often avert their gazes, show fewer facial expressions, and show difficulty with initiating and maintaining a conversation. Social anxiety commonly manifests itself in the teenage years and can be persistent throughout life; however, people who experience problems in their daily functioning for an extended period of time can develop social anxiety disorder. Trait social anxiety, the stable tendency to experience this anxiety, can be distinguished from state anxiety, the momentary response to a particular social stimulus. Half of the individuals with any social fears meet the criteria for social anxiety disorder. Age, culture, and gender impact the severity of this disorder. The function of social anxiety is to increase arousal and attention to social interactions, inhibit unwanted social behavior, and motivate preparation for future social situations.

A clinical formulation, also known as case formulation and problem formulation, is a theoretically-based explanation or conceptualisation of the information obtained from a clinical assessment. It offers a hypothesis about the cause and nature of the presenting problems and is considered an adjunct or alternative approach to the more categorical approach of psychiatric diagnosis. In clinical practice, formulations are used to communicate a hypothesis and provide framework for developing the most suitable treatment approach. It is most commonly used by clinical psychologists and is deemed to be a core component of that profession. Mental health nurses, social workers, and some psychiatrists may also use formulations.

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.

<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.

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.

Interpersonal neurobiology (IPNB) or relational neurobiology is an interdisciplinary framework that was developed in the 1990s by Daniel J. Siegel, who sought to bring together scientific disciplines to demonstrate how the mind, brain, and relationships integrate. IPNB views the mind as a process that regulates the flow of energy and information through its neurocircuitry, which is then shared and regulated between people through engagement, connection, and communication. Drawing on systems theory, Siegel proposed that these processes within interpersonal relationships can shape nervous system maturation. Siegel claimed that the mind has an irreducible quality which informs this approach.

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.
  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". British Journal of Clinical Psychology. 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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