The Role of Mindfulness and Compassion in Enhancing ......15/08/2019 4 0 0.25 0.5 0.75 Compassion Self-Compassion Mindfulness Depression Anxiety Distress Well-being Meta-Analysis of

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Compassion Focused TherapyAn Introduction & Practical Tips

James N. Kirby, Ph.D. [email protected]

Director: Compassionate Mind Research Group

School of Psychology

The University of Queensland

Compassionate Mind Research Group at The University of Queensland

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• What are the core elements of compassion?

• How would you be compassionate?

• How would you like somebody to be compassionate to you?

Part 1: What is Compassion

Many Definitions

“Compassion is an awareness and

sensitivity to the suffering of self and others, with a commitment to try and alleviate and

prevent it”

Paul Gilbert (2014)

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Compassion and Beneficial Links

• Linked to a range of benefits:

– Mental health (e.g., Jazaieri et al., 2013; Kirby, 2016; MacBeth & Gumley, 2012)

– Physiology (e..g, Klemecki, Leiberg, Ricard, & Singer, 2014; Rockliff, Gilbert, McEwan, Lightman, & Glover, 2008)

– Genetic expression (e.g., Slavich & Cole, 2013)

– Emotion regulation (e.g., Seppala, Rossomando, & Doty, 2012; Kirby & Laczko, 2017)

– Social connection (e.g., Crocker & Canevelllo, 2012; Keltner Kogan, Piff, & Saturn, 2014)

– Motivation (e.g., Breines & Chen, 2012)

– Positive parenting responses (e.g., Kirby & Baldwin, 2017)

Various Compassion-Based Interventions

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Compassion

Self-Compassion

Mindfulness

Depression

Anxiety

Distress

Well-being

Meta-Analysis of Compassion-Based InterventionsKirby, Tellegen, & Steindl, 2017

What is Compassion Focused Therapy?

• Developed in the 1980s to target key underlying processes of shame and self-criticism underpinning many depressive disorders

• Barlow et al. (2017) in Behavior Therapy:

– “Despite shame being a core process of depression and PTSD, only a small handful of studies have evaluated the efficacy of interventions for reducing shame in any disorder, with CFT being the most promising (e.g., Gilbert & Procter, 2006) ………

– ”The next generation of psychological interventions need to target process variables, such as shame, with CFT being a clear example of such an approach.”

• Over 50 evaluation studies and growing rapidly

– Particularly for individuals with high levels of shame and self-criticism who do not respond to CBT (Kirby, 2016; Kirby & Gilbert, 2017; Leaviss & Uttley, 2014)

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Compassion Focused Therapy

Developing a compassionate mind involves two main elements working together

1: ‘Sensitivity to the suffering of self and others….’

• Turning towards, and connecting with, our difficult experiences. Engaging with our distress and needs in a non-judgemental manner. COURAGE

2: ‘….with a commitment to try and alleviate and prevent it.’

• Making a commitment to relieve our distress: using strength, care and wisdom. Taking action in a skilful way, motivated by our well-being. DEDICATION

Self-Compassion

Compassion from others

Compassion to others

Each has it own Facilitators and Inhibitors

The Interactive Flow of Compassion

CultureFamiliesSchool

Organisation

Facilitators and Inhibitors to Compassion

Liking

Competence

Deservedness

Empathic

Self-Focused Competitiveness

Dissociation - Denial

Anxiety – Depression

Distress Tolerance

Overwhelmed

Huang & Bargh. 2014; Kirby & Gilbert, 2017

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Our human brain has the amazing capacity to comment on, judge, evaluate and question our own experiences and emotions. However,

these very abilities can get us caught up in all sorts of problems!

Emotion Brain

Stomach acid

Saliva

Meal

Sexual/erotic

A

Arousal

Bully-threaten

Bully-Threaten

Kind, warm

caring

Soothed

Safe

Compassion

Sex

Meal

Brain-Body Responds to its own Internal Creations

Fear depression

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Emotion level

Time

New brain New brain New brain

Dwelling Imagining worst outcome Self-criticising

Old brain

Sometimes Unhelpful

(Sapolsky, 1994)

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What is Compassion Focused Therapy?

• CFT is an approach to Psychotherapy– Can be applied to any therapy modality

• Underpinned by:– Evolutionary Models– The science of neuro, affective and developmental psychology

• Unique Elements:– Psychoeducation – The Tricky Brain– Model of affect regulation with focus on affiliation and the

parasympathetic system– Evolutionary Functional Analysis (EFA) to case conceptualization– Building of compassion-focused motives as an organizing system– Works with fears, blocks and resistances to compassion and

positive emotion• Self-criticism and Shame

Three Circles Model

Soothing and connection

Content, safeness, calm, not-wanting

Drive and achievement

Incentive focused, wanting, pursuing, achieving, status

Threat and self-protectProtection and safety seeking, fight/flight

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Systems out of balance: how would you draw your ‘circles’ in proportion?

Soothing and connectionDrive and

achievement

Threat and self-protection

FUNCTION

Threat-focused

Protection and

Safety-seeking

Activating

Anger

Our Body/Feelings

• Tense, shaky muscles

• Heart increase

• Stomach - sicky

• Sweat

• Voice

Attention, what pops into mind, imagery, thinking

• Narrow-focused and Scan –Search

• Rumination on why angry

• ‘What if…’ and implications

• Internal vs. external

(attribution prediction)

Types Behaviour

• Aggressive display –shout, kick, hit

• Walk out, cut-off

• Passive aggression and sulk

• Dissociate – not feel

Anger Awareness: How it works – as built for us not by us

FUNCTION

Threat-focused

Protection and

Safety-seeking

Activating

Our Body/Feelings

• Tense shoulders

• Heart increase

• Stomach/face

• Voice

• Body memory

Attention, what pops into mind, imagery, thinking

• Narrow-focused and Scan – search

• Rumination and ‘what if…’

• Implications



Types behaviours-active or inhibit us

• Run away

• Avoid hide

• Submit -passive

• Freeze –mind/body block

• Dissociate –not feel

Anxiety Awareness: How it works – as built for us not by us

Anxiety

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Pleasure/Joy

Our Body/feelings

• Activation

• Heart increase

• Pressure to act

• Disrupt sleep

Attention/Thinking

• Narrow-focused

• Acquiring

• Explorative



Behaviour

• Approach

• Engage

• Socialise

• Restless

• Celebrating

FUNCTION

Incentive/

resource-focused

Wanting, pursuing, achieving, consuming

Activating

Achievement Awareness: How it works – as built for us not by us

Well-being

Body/feelings

• Calm

• Slow

• Content

• Safe

Attention/Thinking

• Open-focused

• Reflective

• Pro-social

• Internal v. external


Behaviour

• Peaceful

• Gentle

• Pro-social

FUNCITON

Soothing/Connection

Non-wanting

Safeness

Affiliative focused

Soothing Awareness: How it works – as built for us not by us

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Between self and others: Soothing regulates threat response

Between self-to-self: Soothing regulates threat response

ThreatSoothing

and connection

Calms/Encourages




Three Circles Model

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Systems out of balance: how would you draw your ‘circles’ in proportion?

Soothing and connectionDrive and

achievement

Threat and self-protection

Failure

Inner-Critic

Disappointment Gap

Ideal Self

Hard-working

Relaxed and confident

Caring of others

Insightful

Actual Self

Lazy

Worried and concerned

Get angry with others

Dumb

Attack Self: Idiot! Why did you do that for? Why am I so bloody worried all the time? Why don’t I just get on and do things? I am uselessAttack Others: Why do others always seem so confident? I can’t stand Karen and how good she is!Give Up: This just isn’t worth it. I’m bound to stuff it up again, everybody knows I will.

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Three Circles Model

Soothing and connection

Content, safeness, calm, not-wanting




Compassion

Three Circles Model & Motivation

Soothing and

ConnectionContent,

safeness, calm, not-wanting



Threat and self-protect

Protection and safety seeking, fight/flight

Competitive

Fears of Compassion

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Inhibitors to Compassion

• Fears– I would like to, but I’m frightened too

• Resistances– Not really frightened, just don’t seen the point

– Somewhat dismissive

• Blocks

– Not frightened or resistant. But blocked for example by having reduced opportunities, lack of prioritization, lack of insight or knowledge

Fears of Compassion

• Resisting compassion because it resulted in feelings of vulnerability – particularly grief, not wanting to break downyearning what I never got or don’t have

• In the first evaluation of group CFT, Gilbert & Procter (2006) noted that many participants ‘had a real fear of becoming self-compassionate’

• “If you get close to me you’ll see the bad in me, and if I get close to you I’ll see the bad in you.” (Gilbert & Procter, 2006)

• “Others have the power to reject and hurt me; they can turn nasty at any moment” (Gilbert & Procter, 2006)

• High self-critics find self-compassion and receiving compassion from others quite difficult

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Fears of Compassion Scale

• Compassion For Others

– People will take advantage of me if they see me as too compassionate

– Being compassionate towards people who have done bad things is letting them off the hook

– There are some people in life who don’t deserve compassion

– I fear that being too compassionate makes people an easy target

– I fear that If I am too compassion, some people will become dependent on me

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• Compassion From Others

– I fear that when I need people to be kind and understanding they won’t be

– When people are kind and compassionate towards me I feel anxious or embarrassed

– I’m fearful of becoming dependent on the care of others because they might not always be available or willing to give it

– If I think someone is being kind and caring towards me, I put up a barrier


• Compassion For Self

– I fear that if I become too compassionate to myself I will lose my self-criticism and my flaws will show

– I fear that if I start to feel compassion and warmth for myself I will feel overcome with a sense of loss/grief

– I fear that if I am more self-compassionate I will become a weak person

– I fear that if I develop compassion for myself, I will become someone I do not want to be

Quick Facts

• 21 studies, from 154 samples included

• Studies across a 5 year period (2012-2017)

• 5, 233 participants data meta-analysed

• 7 different countries (USA, UK, Canada, Australia, Portugal, Japan, and Scotland)

• 13 were cross-sectional surveys; 8 pre-intervention correlations

• 5 clinical sample, 16 non-clinical

• 31% Male; 69% Female

• Average age: 30.45 years (range 18.64 years – 45 years; SD = 9.71)

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Fears of Compassion for Others & Mental Health Outcomes

-0.25 0 0.25 0.5

Self-criticism

Shame

Well-being

Distress

Anxiety

Depression

Data from 38 samples

Fears of Compassion from Others & Mental Health Outcomes

-0.5 -0.25 0 0.25 0.5 0.75

Self-criticism

Shame

Well-being

Distress

Anxiety

Depression


Fears of Compassion for Self & Mental Health Outcomes

-0.75 -0.5 -0.25 0 0.25 0.5 0.75

Self-criticism

Shame

Well-being

Distress

Anxiety

Depression


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Compassion & Differential Responding

• Have to mindful and sensitive to how we are introducing compassion or positive affiliation with clients.

• Sometimes there can be a tendency or misunderstanding that there is a ‘bag of compassion tricks’ almost like a ‘toolkit’ of practices we can just provide a panacea

• Need to be aware some will respond unfavourably to the practice.

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Implications

• Given the known benefits of compassion in promoting psychological well-being, it is important that any fear, block or resistance to it in psychotherapy is addressed as part of the therapeutic process.

• Be aware:

• New experiences of compassion and soothing can bring up old emotional experiences, linked to threat. This is not our fault.

• Crucial is validating the fears, blocks & resistances of clients and empathising with why he/she would not want to become compassionate or trusting

• Explore in therapy these potential difference responses before starting to implement compassion or kindness based interventions

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Compassion Based Exercises

• Step 1

– Body posture

– Voice tone

– Friendly facial expression

– Soothing Rhythm Breathing

• Step 2

– Activate Compassionate Self

• Step 3

– Apply to life difficulty

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Documents

The Role of Mindfulness and Compassion in Enhancing ......15/08/2019 4 0 0.25 0.5 0.75 Compassion Self-Compassion Mindfulness Depression Anxiety Distress Well-being Meta-Analysis of