Psychological therapies aimed at reducing emotional distress take many forms and continue to develop apace. Over the past two decades, there has been an increasing focus on the role of compassion as a part of such treatments, with a recent meta-analysis (MacBeth & Gumley, 2012) evidencing that increased compassion is associated with lower levels of depression, anxiety and stress.

A recent review by Kirby (2016) cited six different compassion related evidence-based approaches. Of these Compassion Focused Therapy (CFT: Gilbert, 2010) is particularly noteworthy, as it emerged from an understanding that clients experiencing shame and high levels of self-criticism often respond poorly to traditional Cognitive Behavioural Therapy (CBT). This is potentially highly important given CBT is often considered a treatment of choice for many psychiatric disorders and psychological difficulties (see UK National Institute for Health and Care Excellence guidance https://www.nice.org.uk/guidance).

Poor responses to CBT are not typically due to low levels of engagement with the various tasks that are set as part of treatment (Bulmash, Harkness, Stewart & Bagby, 2009). Rather some clients seem to have difficulty in generating the inner warmth, kindness and supportive tone needed to bring such work alive (Harris & Hiskey, 2015).

Taking a working definition of compassion as a sensitivity to suffering with a motivation to reduce or alleviate it, CFT was developed with attention to evolutionary psychology, neuroscience and attachment theory (Gilbert, 2010). It is largely based on the premise that human pro-social/affiliative motivations and a related internal sense of psychological safeness can have a significant impact upon one's experience of both oneself and one’s ability to regulate upsetting emotions.

CFT orients clients to develop compassionate based motivations, attentional deployment, thinking, imagery, and actions. It utilises many interventions/strategies common to CBT, Mindfulness and Emotional Focused Therapy but, as the name suggests, always from a compassionate viewpoint.

CFT distinguishes between three types of motivational system, often referred to as Threat, Drive and Soothing, which are thought to have arisen to serve quite different evolutionary goals. Emotions are seen as providing the impetus to direct the self, following the activation of each system.

The Threat system detects and protects animals from perceived danger, via feelings such as fear, anger, sadness and disgust and leads to a rapid relevant response (e.g. flight, fight, withdrawal, emission). The Drive system relates to detecting and acquiring the resources needed to survive and thrive and leads to feelings of excitement and pleasure (with the attendant desire to repeat these activities). The Soothing system relates to experiencing positive affiliative connections with others (i.e. to tend and befriend), leading to feelings of contentment and peace, which motivate a caring response to in-group members.

The three systems inter-relate, co-regulate and are influenced by higher cortical thinking and reasoning abilities, unique to humans culminating in what in CFT is known as a ‘tricky’ brain.

Gilbert (2014) points to four phases within CFT: 1) sharing knowledge with clients about the evolutionary processes that have led to the development of our tricky brains, the three system model and a sense that we are motivated by forces not of our choosing but that remain our responsibility to work with, 2) developing a shared psychological formulation of how experiences in earlier life have shaped client motivational systems and that the development of key fears about the self, world and others will have led to safety/defensive behaviour that can, in certain contexts, have unintended consequences, 3) training the mind in compassionate practices such as breathing, cognitive and behavioural techniques, 4) applying the skills developed to agreed life problems that first bought the client to therapy.

CFT has a growing evidence base for both groups and individuals (Judge, Cleghorn, McEwan & Gilbert, 2012; Leaviss & Uttley, 2014; Kirby, 2016). It has proven effective in enhancing well-being and reducing symptoms of depression and anxiety, as well as tacking shame and self-criticism across varying client populations.

Studies show that it can help manage symptoms in people with personality issues (Gilbert & Procter, 2006; Lucre & Corten, 2013), eating disorders (Gale, Gilbert, Read, & Goss, 2014; Goss & Allan, 2014), psychosis (Braehler, Gumley, Harper, Wallace, Norrie & Gilbert, 2013), post-traumatic stress disorder (Lee & James, 2012), problematic anger (Kolts, 2012) and also help people with specialist needs such as clients with intellectual disabilities (Clapton, Williams & Griffith, 2017) or mild to moderate dementia (Craig, Hiskey, Royan, Poz & Spector, in press).

In conclusion, CFT has developed over recent years to become an effective and highly acceptable psychological treatment for a range of issues that bring clients to therapy . A wealth of further information on this therapy and the wider compassionate initiative it has led to can be found at The Compassionate Mind Foundation website (https://compassionatemind.co.uk/).

References

Braehler, C., Gumley, A., Harper, J., Wallace, S., Norrie, J. & Gilbert, P. (2013). Exploring change processes in compassion-focused therapy in psychosis: results of a feasibility randomised control trial. British Journal of Clinical Psychology, 52, 199-214
Bulmash E., Harkness, K. L., Stewart, J. G., & Bagby, R. M. (2009). Personality, stressful life events, and treatment response in major depression. Journal of Consulting and Clinical Psychology, 77(6), 1067-1077.
Clapton, N.E., Williams, J. & Griffith, G. M. (2017) ‘Finding the person you really are … on the inside’: Compassion focused therapy for adults with intellectual disabilities. Journal of Intellectual Disabilities, Volume: 22 issue: 2, page(s): 135-153. Article first published online: January 20, 2017; Issue published: June 1, 2018. https://doi.org/10.1177/1744629516688581
Craig, C., Hiskey, S., Royan, L., Poz, R. & Spector, A. (in press) Compassion Focused Therapy for People with Dementia: A Feasibility Study. International Journal of Geriatric Psychiatry
Gale, C., Gilbert, P., Read, N. & Goss, K. (2014). An evaluation of the impact of introducing compassion focused therapy to a standard treatment programme for people with eating disorders. Clinical Psychology and Psychotherapy, 21, 1-12
Gilbert, P. & Proctor, S. (2006). Compassionate mind training for people with high shame and self-criticism: overview and pilot study of a group therapy approach. Clinical Psychology and Psychotherapy, 13, 353-379
Gilbert, P. (2010). An introduction to compassion focused therapy in cognitive behaviour therapy. International Journal of Cognitive Therapy, 3(2), 97-112.
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology 53, 6–41.
Goss, K., & Allan, S. (2014). The development and application of compassion‐focused therapy for eating disorders (CFT‐E). British Journal of Clinical Psychology, 53(1), 62-77.
Harris, D. L., & Hiskey, S. (2015). Homework in therapy: A case of it ain't what you do, it's the way that you do it?. The Cognitive Behaviour Therapist, 8, 1-11.
Judge, L. & Cleghorn, A., McEwan, K. & Gilbert, P. (2012). An exploration of group based compassion focused therapy for a heterogeneous range of clients presenting to a community mental health team. International Journal of Cognitive Therapy, 5(4), 420-429
Kirby, J. N. (2016). Compassion interventions: The programmes, the evidence, and implications for research and practice. Psychology and Psychotherapy: Theory, Research and Practice. 2017 Sep;90(3):432-455. doi: 10.1111/papt.12104. Epub 2016 Sep 24
Kolts, R. L. (2012) The Compassionate-Mind Guide to Managing Your Anger: Using Compassion-Focused Therapy to Calm Your Rage and Heal Your Relationships. Robinson Publishing: USA.
Leaviss, J. & Uttley, L. (2014). Psychotherapeutic benefits of compassion focused therapy: an early systematic review. Psychological Medicine, 45, 927-945
Lee, D. & James, S. (2012) The Compassionate Mind Approach to Recovering from Trauma: Constable and Robinson Ltd: London.
Lucre, K. & Corten, N. (2013). An exploration of group compassion focused therapy for personality disorder. Psychology and Psychotherapy: Theory, Research, and Practice, 86, 387-400
MacBeth, A., & Gumley, A. (2012). Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32, 545–552. doi:10.1016/j.cpr.2012.06.003.

Dr Syd Hiskey is a Consultant Clinical Psychologist in Private Practice. He is an Honorary Senior Lecturer in the Department of Health and Social Care at the University of Essex. He regularly lectures on trauma and psychological treatments following traumatic experiences, as well as on aspects of neuropsychology and also Compassion Focused Therapy to trainee clinical psychologists (Essex-Tavistock Course, University of Essex). Dr Hiskey is a registered Practitioner Psychologist with the Health and Care Professions Council, and an Associate Fellow, Chartered Clinical Psychologist, Chartered Scientist and Expert Witness with the British Psychological Society. He is a member of the Division of Clinical Psychology, Division of Neuropsychology and Faculty of the Psychology of Older People (British Psychological Society) and an Accredited Cognitive Behavioural Psychotherapist with the British Association of Behavioural and Cognitive Psychotherapists.

Psychological therapies aimed at reducing emotional distress take many forms and continue to develop apace. Over the past two decades, there has been an increasing focus on the role of compassion as a part of such treatments, with a recent meta-analysis (MacBeth & Gumley, 2012) evidencing that increased compassion is associated with lower levels of depression, anxiety and stress.

A recent review by Kirby (2016) cited six different compassion related evidence-based approaches. Of these Compassion Focused Therapy (CFT: Gilbert, 2010) is particularly noteworthy, as it emerged from an understanding that clients experiencing shame and high levels of self-criticism often respond poorly to traditional Cognitive Behavioural Therapy (CBT). This is potentially highly important given CBT is often considered a treatment of choice for many psychiatric disorders and psychological difficulties (see UK National Institute for Health and Care Excellence guidance https://www.nice.org.uk/guidance).

Poor responses to CBT are not typically due to low levels of engagement with the various tasks that are set as part of treatment (Bulmash, Harkness, Stewart & Bagby, 2009). Rather some clients seem to have difficulty in generating the inner warmth, kindness and supportive tone needed to bring such work alive (Harris & Hiskey, 2015).

Taking a working definition of compassion as a sensitivity to suffering with a motivation to reduce or alleviate it, CFT was developed with attention to evolutionary psychology, neuroscience and attachment theory (Gilbert, 2010). It is largely based on the premise that human pro-social/affiliative motivations and a related internal sense of psychological safeness can have a significant impact upon one's experience of both oneself and one’s ability to regulate upsetting emotions.

CFT orients clients to develop compassionate based motivations, attentional deployment, thinking, imagery, and actions. It utilises many interventions/strategies common to CBT, Mindfulness and Emotional Focused Therapy but, as the name suggests, always from a compassionate viewpoint.

CFT distinguishes between three types of motivational system, often referred to as Threat, Drive and Soothing, which are thought to have arisen to serve quite different evolutionary goals. Emotions are seen as providing the impetus to direct the self, following the activation of each system.

The Threat system detects and protects animals from perceived danger, via feelings such as fear, anger, sadness and disgust and leads to a rapid relevant response (e.g. flight, fight, withdrawal, emission). The Drive system relates to detecting and acquiring the resources needed to survive and thrive and leads to feelings of excitement and pleasure (with the attendant desire to repeat these activities). The Soothing system relates to experiencing positive affiliative connections with others (i.e. to tend and befriend), leading to feelings of contentment and peace, which motivate a caring response to in-group members.

The three systems inter-relate, co-regulate and are influenced by higher cortical thinking and reasoning abilities, unique to humans culminating in what in CFT is known as a ‘tricky’ brain.

Gilbert (2014) points to four phases within CFT: 1) sharing knowledge with clients about the evolutionary processes that have led to the development of our tricky brains, the three system model and a sense that we are motivated by forces not of our choosing but that remain our responsibility to work with, 2) developing a shared psychological formulation of how experiences in earlier life have shaped client motivational systems and that the development of key fears about the self, world and others will have led to safety/defensive behaviour that can, in certain contexts, have unintended consequences, 3) training the mind in compassionate practices such as breathing, cognitive and behavioural techniques, 4) applying the skills developed to agreed life problems that first bought the client to therapy.

CFT has a growing evidence base for both groups and individuals (Judge, Cleghorn, McEwan & Gilbert, 2012; Leaviss & Uttley, 2014; Kirby, 2016). It has proven effective in enhancing well-being and reducing symptoms of depression and anxiety, as well as tacking shame and self-criticism across varying client populations.

Studies show that it can help manage symptoms in people with personality issues (Gilbert & Procter, 2006; Lucre & Corten, 2013), eating disorders (Gale, Gilbert, Read, & Goss, 2014; Goss & Allan, 2014), psychosis (Braehler, Gumley, Harper, Wallace, Norrie & Gilbert, 2013), post-traumatic stress disorder (Lee & James, 2012), problematic anger (Kolts, 2012) and also help people with specialist needs such as clients with intellectual disabilities (Clapton, Williams & Griffith, 2017) or mild to moderate dementia (Craig, Hiskey, Royan, Poz & Spector, in press).

In conclusion, CFT has developed over recent years to become an effective and highly acceptable psychological treatment for a range of issues that bring clients to therapy . A wealth of further information on this therapy and the wider compassionate initiative it has led to can be found at The Compassionate Mind Foundation website (https://compassionatemind.co.uk/).

References

Braehler, C., Gumley, A., Harper, J., Wallace, S., Norrie, J. & Gilbert, P. (2013). Exploring change processes in compassion-focused therapy in psychosis: results of a feasibility randomised control trial. British Journal of Clinical Psychology, 52, 199-214
Bulmash E., Harkness, K. L., Stewart, J. G., & Bagby, R. M. (2009). Personality, stressful life events, and treatment response in major depression. Journal of Consulting and Clinical Psychology, 77(6), 1067-1077.
Clapton, N.E., Williams, J. & Griffith, G. M. (2017) ‘Finding the person you really are … on the inside’: Compassion focused therapy for adults with intellectual disabilities. Journal of Intellectual Disabilities, Volume: 22 issue: 2, page(s): 135-153. Article first published online: January 20, 2017; Issue published: June 1, 2018. https://doi.org/10.1177/1744629516688581
Craig, C., Hiskey, S., Royan, L., Poz, R. & Spector, A. (in press) Compassion Focused Therapy for People with Dementia: A Feasibility Study. International Journal of Geriatric Psychiatry
Gale, C., Gilbert, P., Read, N. & Goss, K. (2014). An evaluation of the impact of introducing compassion focused therapy to a standard treatment programme for people with eating disorders. Clinical Psychology and Psychotherapy, 21, 1-12
Gilbert, P. & Proctor, S. (2006). Compassionate mind training for people with high shame and self-criticism: overview and pilot study of a group therapy approach. Clinical Psychology and Psychotherapy, 13, 353-379
Gilbert, P. (2010). An introduction to compassion focused therapy in cognitive behaviour therapy. International Journal of Cognitive Therapy, 3(2), 97-112.
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology 53, 6–41.
Goss, K., & Allan, S. (2014). The development and application of compassion‐focused therapy for eating disorders (CFT‐E). British Journal of Clinical Psychology, 53(1), 62-77.
Harris, D. L., & Hiskey, S. (2015). Homework in therapy: A case of it ain't what you do, it's the way that you do it?. The Cognitive Behaviour Therapist, 8, 1-11.
Judge, L. & Cleghorn, A., McEwan, K. & Gilbert, P. (2012). An exploration of group based compassion focused therapy for a heterogeneous range of clients presenting to a community mental health team. International Journal of Cognitive Therapy, 5(4), 420-429
Kirby, J. N. (2016). Compassion interventions: The programmes, the evidence, and implications for research and practice. Psychology and Psychotherapy: Theory, Research and Practice. 2017 Sep;90(3):432-455. doi: 10.1111/papt.12104. Epub 2016 Sep 24
Kolts, R. L. (2012) The Compassionate-Mind Guide to Managing Your Anger: Using Compassion-Focused Therapy to Calm Your Rage and Heal Your Relationships. Robinson Publishing: USA.
Leaviss, J. & Uttley, L. (2014). Psychotherapeutic benefits of compassion focused therapy: an early systematic review. Psychological Medicine, 45, 927-945
Lee, D. & James, S. (2012) The Compassionate Mind Approach to Recovering from Trauma: Constable and Robinson Ltd: London.
Lucre, K. & Corten, N. (2013). An exploration of group compassion focused therapy for personality disorder. Psychology and Psychotherapy: Theory, Research, and Practice, 86, 387-400
MacBeth, A., & Gumley, A. (2012). Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 32, 545–552. doi:10.1016/j.cpr.2012.06.003.

Dr Syd Hiskey is a Consultant Clinical Psychologist in Private Practice. He is an Honorary Senior Lecturer in the Department of Health and Social Care at the University of Essex. He regularly lectures on trauma and psychological treatments following traumatic experiences, as well as on aspects of neuropsychology and also Compassion Focused Therapy to trainee clinical psychologists (Essex-Tavistock Course, University of Essex). Dr Hiskey is a registered Practitioner Psychologist with the Health and Care Professions Council, and an Associate Fellow, Chartered Clinical Psychologist, Chartered Scientist and Expert Witness with the British Psychological Society. He is a member of the Division of Clinical Psychology, Division of Neuropsychology and Faculty of the Psychology of Older People (British Psychological Society) and an Accredited Cognitive Behavioural Psychotherapist with the British Association of Behavioural and Cognitive Psychotherapists.