Compassion-Focused Therapy (CFT) is a form of psychotherapy that was developed by psychologist Paul Gilbert in the early 2000s. CFT builds on Buddhist principles that encourage compassion towards the self and others in order to achieve happiness. Gilbert designed CFT to treat what he referred to as transdiagnostic problems, or problems that he recognised were common to many psychological disorders. These transdiagnostic problems are high levels of shame and self-criticism. According to Gilbert, people with high levels of shame and self-criticism commonly find it difficult to feel self-compassion and have an overall negative sense of self. This makes them vulnerable to developing mental health difficulties. In terms of what causes a person to develop high levels of shame and self-criticism, Gilbert suggests that this development is rooted in a person’s past experiences. For instance, someone who has a history of abuse or who has experienced significant neglect or lack of affection and comfort while growing up may become overly critical of themselves, which in turn impairs on their overall self-image and functioning.
Research suggests that individuals who have high levels of shame and self-criticism may develop an imbalance in the parts of their brain responsible for controlling emotional responses. There are at least three distinct parts of the brain that are responsible for managing different emotional response systems. These emotional response systems are (1) Threat and Protection ( 2) Drive, Excitement and Resource-seeking, and (3) Contentment, Soothing and Safeness. CFT aims to balance these emotional response systems through a focus on developing self-compassion attributes and compassionate skills. Each of these emotional response systems and how they are targeted in CFT is explained below.
Threat and Protection. As human beings we have developed the ability to sense threat and protection. This system and the feelings of anxiety that come with recognising something threatening act to keep us safe when we need it. This system develops early on in life. Therefore someone who has had overly negative experiences growing up may become predisposed to act ineffectively to threats later on. For example, an individual who has high levels of shame and self-criticism may come to act overly submissive to the threats that exist in their lives – they may become avoidant, extremely anxious and perceive themselves as weak. As well as this, they may be uncertain of where protection lies and put their trust in the wrong sources. When you consider this, it becomes evident how an imbalance in one or more of these emotional response systems can lead to mental health difficulties later on. CFT aims to focus an individual on the functions of their behaviours. In this way, they can come to understand how they were developed and that they are not in fact responsible for their symptoms. This helps to initiate feelings of self-compassion.
Drive, Excitement and Resource-seeking. Just as humans need to be able to remain safe, they also need to be motivated to search for rewards and resources. The Drive, Excitement and Resource-seeking emotional response system is responsible for eliciting the emotional pleasure that come with obtaining food, sexual opportunities, friendships etc. This system is responsible for directing overall life goals. An individual with a poorly developed system may emerge with an under or over-stimulated Drive system, both of which can lead to negative emotion consequences. In this instance, CFT aims to help an individual to explore their goals and reflect on how they behave in aiming to attain them.
Contentment, Soothing and Safeness. This system is not associated with any threat or desire and is instead responsible for overall feelings of well-being. Psychological theory suggests that this system’s development is based upon a person’s attachment style or how they well they developed early caring relationships with their parents or primary caregivers. So if an individual did not develop healthy attachment patterns with their parents, they may struggle to self-soothe or de-stress during times of threat and instead develop maladaptive behaviours in order to contain their distress. CFT aims to establish a sense of safety for the client in order to allow them to feel safe and explore their compassionate self.
While CFT as a therapy is still in its relative infancy, research has shown it to be promising for the treatment of a number of mental health difficulties including, depression, social anxiety, acquired brain injury, psychosis, post-traumatic stress disorder, personality disorders, eating disorders, bi-polar disorder, and perinatal and mother-infant distress. A recent study by psychologists Dr. Joanna Leaviss and Dr. Lesley Uttley examined and summarised all of the current research evidence for the effectiveness of CFT. They found that overall the research on CFT has yielded largely positive findings and while more research is needed, it appears to be an effective form of psychotherapy for individuals with high levels of self-criticism.
So given that CFT has the potential to treat a wide breadth of psychological symptoms through a focus on balancing three distinct emotional response systems, how exactly is the treatment delivered? CFT is delivered through individual therapy sessions that focus on developing attributes of compassion and specific compassion-focused skills through compassionate mind-training. It is thought that this training leads a person to replace their high levels of shame and self-criticism with a more positive mind-set.
The attributes of compassion according to Gilbert are as follows: A desire to care for an individual’s own well-being as well as the well-being of those around them; a sensitivity or understanding of distress and needs and how to respond to them; being both sympathetic and empathetic to oneself and those around them; being able to tolerate distress effectively rather than avoid or deny it; and being non-judgemental or critical of oneself.
Gilbert also suggests that the skills of compassion are central to many psychotherapeutic approaches and overall promote a greater sense of warmth and support for the individual when used on themselves and others. These skills include:
- Compassionate attention involves focusing on what is positive and helpful to a given situation. In order to develop this skill, therapists will train the client to identify their strengths and positive as well as attention-directing exercises.
- Compassionate reasoning involves reasoning with the world and our surroundings in a positive but logical manner. Here, therapists will validate compassionate reasoning and educate the client on obstacles to this way of thinking.
- Compassionate behavior refers to behaviour that is effective towards distressing or difficult situations. With this skill, the therapist encourages the client to have courage and replace maladaptive behaviors such as avoidance with new compassionate behaviors. This is often done using exposure work whereby the client faces difficult situations in a stepped fashion. This leads to them overcoming their anxieties and finding alternative ways of being. Behaving compassionately should also help to boost positive emotions.
- Compassionate imagery refers to the practice of exercises that create compassionate feelings. Here the therapist guides the client in exploring their image of compassion. This allows the client to get a better understanding of how their compassion should look and feel.
- Compassionate feeling refers to having the ability to allow one’s self to feel compassion. The therapist facilitates this skill development throughout the overall treatment process.
- Compassionate sensation is the skill that involves allowing one’s self to explore the feelings that being compassionate has on their bodies.