Transcript BABCP Keynote - Compassionate Mind Foundation

Compassion-Focused-Therapy
Model and Research
Paul Gilbert, Kirsten McEwan, Corinne Gale & Jean Gilbert
Mental Health Research Unit,
Kingsway Hospital, Derby UK
www: Compassionatemind.co.uk
Talk Today
Outline basic philosophy and model of
Compassion focused Therapy
Note the powerful effects of our selfevaluation systems (self-criticism vs self
compassion)
Explore the main therapeutic work as
overcoming the fear of compassion and self
compassions
To understand ourselves we must
understand our brains
why we have complex brains and minds that are
difficult to understand regulate
1. Old Brain
Emotions:
Behaviours:
Relationships:
Anger, anxiety, sadness, joy, lust
Fight, flight, withdraw, engage
Sex, status, attachment, tribalism
2. New Brain
Imagination, fantasise, look back and forward, plan, ruminate
Integration of mental abilities
Self-awareness, self-identity, and self-feeling
3. Social Brain
Need for affection and care
Socially responsive, self-experience and motives
What happens when new brain is recruited to pursue old brain passions?
Interaction
of old of
and
new psychologies
Sources
behaviour
New Brain: Imagination,
Planning, Rumination, Integration
Old Brain: Emotions, Motives, Relationship
Seeking-Creating
Archetypal
Understanding our Motives and
Emotions
Motives evolved because they help animals to
survive and leave genes behind
Emotions guide us to our goals and respond if we
are succeeding or threatened
There are three types of emotion regulation
1. Those that focus on threat and self-protection
2. Those that focus on doing and achieving
3. Those that focus on contentment and feeling safe
Types of Affect Regulator Systems
Content, safe, connected
Drive, excite, vitality
Non-wanting/
Affiliative focused
Incentive/resourcefocused
Safeness-kindness
Wanting, pursuing,
achieving, consuming
Soothing
Activating
Threat-focused
Protection and
Safety-seeking
Activating/inhibiting
Anger, anxiety, disgust
Self-Protection
In species without attachment only
1-2% make it to adulthood to
reproduce. Threats come from
ecologies, food shortage, predation,
injury, disease. At birth individuals
must be able to “go it alone” be
mobile and disperse
Dispersal and avoid others
Protect and Comfort: Less ‘instinctive
brain – post birth learning
The Mammalian Importance of
Caring Minds
Caring as “looking after”. Seeking closeness
rather than dispersion. Individuals obtain
protection, food, and care when ill. Key also is
soothing-calming and physiological regulation.
Few offspring but high survival rate in
comparison to species without attachment.
Affection and kindness
Co-operative and mutual support can develop as
we see that our prosperity impacts on that of
others, sharing and not-exploiting
Affectionate Interactions
Secure attachment linked to self-confidence, empathy and use
of attachment strategies when stressed (Mikulincer & Shaver
2005)
Maturation of the brain (e.g. frontal cortex) and affect
regulation (Gerhardt, 2004; Schore, 1994)
Effects of low birth weight (Tully et al, 2004. JCCP, 72, 218226)
Testosterone and aggression (Booth et al., 2003.
Developmental Psychology, 39, 85 – 98)
Self-to-self-relating e.g. self criticism vs self-reassurance
Internal Threat and Soothing
Self-affiliation –
experiences a lovable self
Calms
Affiliative/
Soothing
Threat
Internal representations of helpful
others and sources of comfort
Emotional memories of
soothing
Neurophysiological
networks
Internal Threat and More threat
No self-affiliation –
experiences a unlovable
self
Calms
Threat
Affiliative/
Soothing
Neurophysiologica
networks
Others are threats or
alarming
Emotional memories of no
soothing
Compassion Solutions
Ancient wisdom
Compassion is the road to happiness
(Buddhism)
Evolution
Evolution has made our brains highly
sensitive to internal and external kindness
Neuroscience
Specific brain areas are focused on detecting
and responding to kindness and compassion
Compassion
Compassion can be defined in many ways: “As a
sensitivity to the suffering of self and others with a
deep commitment to try to relieve it” Dalai Lama
Eight fold path - represents a multi-modal
approach for training one’s mind
Compassion as Flow
Different practices for each
Other
Self
Self
Other
Self
Self
Non linear empathy for other begins early in life
Data
• Practice of imagining compassion for others produces changes in
frontal cortex and immune system (Lutz et al, 2009)
• Loving kindness meditation (compassion directed to self, then
others, then strangers) increases positive emotions, mindfulness,
feelings of purpose in life and social support and decreases illness
symptoms (Frederickson et al, 2008, JPSP)
• Compassion meditation (6 weeks) improves immune function, and
neuroendocrine and behavioural responses to stress (Pace, 2008,
PNE)
• Viewing sad faces, neutrally or with a compassionate attitude
influences neurophysiological responses to faces (Ji-Woong Kim,
2009, NP)
• Compassion training reduces shame and self-criticism in chronic
depressed patients (Gilbert & Proctor, 2006, CPP)
Key Targets of Therapy
Attention
Thinking
Reasoning
Imagery
Fantasy
Behaviour
Motivation
Emotions
Their pattern gives rise to a certain type of mind
Compassionate Mind
Attention
Imagery
Fantasy
Motivation
Thinking
Reasoning
Compassion
Emotions
Behaviour
Threatened Mind can block Compassion
Thinking
Reasoning
Attention
Imagery
Fantasy
Motivation
Behaviour
Threat
Emotions
Self-Critical Mind is also Threat-focused
Mind
Thinking
Reasoning
Attention
Imagery
Fantasy
Motivation
SelfCritical
Behaviour
Emotions
How our own thoughts and images affect our brains
Sexual
Bully-threat
Meal
Meal
Sex
Emotion Brain
Bullythreat
Kind, warm
and caring
Compassion
Soothed
Safe
Stomach acid
Salvia
Fearful
Arousal
Pink represents our inner images and thoughts
Depressed
Questions
How does self-criticism and self-compassion/
reassurance work in the brain?
Are their individual differences linked to trait
self- criticism?
How might compassion training influence
neurophysiology?
fMRI Study (Aston University)
STUDY Olivia Longe, Gina Rippon, Paul Gilbert & Frankie Maratos
SelfCriticize
SelfReassure
SelfCriticize
SelfReassure
“A third job rejection
letter in a row arrives
in the post”
Emotion Scenario(-)
“The second free local
newspaper in a row
arrives in the post”.
Neutral Scenario
• 2X2 Factorial: 2 X Statement Scenarios, 2 X Imagery Perspectives
•
Statements pre-tested (n=12), for imagability (i.e. ease of imagining self-critical or selfreassuring thoughts), 1-7 Likert Scale.
Self-Criticism during Emotional Scenarios vs. Neutral
Axial slices displaying left lateral PFC (BA 47, 45,9) and right lateral
PFC (BA 46) activation
Longe, et al (2010). Having a word with yourself: NeuroImage, 49, 1849-1856
Self-Reassurance during Emotional Scenarios vs.
Neutral
Whole brain and axial slices displaying left temporal pole (BA
38) and insula activation
Longe, et al (2010). Having a word with yourself: NeuroImage, 49, 1849-1856
Parent recall and SC and SR
Irons Gilbert Baldwin et al., 2006 Br J Clin Psych
.24
Rejection
(.31)
Inadequate
Self
.31
.26
(.33)
(.60)
.15
(.25)
Overprotection
Depression
.22
Hated Self
(.55)
-.31
(-.56)
.37
Warmth
(.30)
Reassure Self
Parent recall and SC and SR
Irons Gilbert Baldwin et al., 2006 Br J Clin Psych
.24
Rejection
(.31)
Inadequate
Self
.31
.26
(.33)
(.60)
.15
(.25)
Overprotection
Depression
.22
Hated Self
(.55)
-.31
(-.56)
.37
Warmth
(.30)
Reassure Self
Imagining a self-critical part of self
197 students from Derby and McGill Universities
(with Chris Irons and Mark Baldwin)
Self-criticism
Power
Anger
0.53
0.51
Self-reassurance
Power
Anger
- 0. 33
- 0.33
Imagining a Self-Compassionate
Part of Self
197 students from Derby and McGill Universities
(with Chris Irons and Mark Baldwin)
Self-criticism
Power
Warm
- 0.54
- 0.34
Self-reassurance
Power
warm
0. 58
0.43
Gilbert et al (2005)
Compassionate Mind
Attention
Imagery
Fantasy
Motivation
Thinking
Reasoning
SelfCompassionate
Emotions
Behaviour
Why a Compassion Focus?
People with chronic problems often come from
neglectful or abusive backgrounds, have high
levels of shame, and are often self-critical, selfdisliking, or self-hating
Live in a world of constant internal and external
threat
Have few experiences of feeling safe or soothed
and are not able to do this for themselves. Often
do poorly in trials
Internal Threat and Soothing
Self-Criticism
Compassionate
Re-focusing
Calms
Worry
Rumination
Threat
Affiliative/
Soothing
Compassionate
imagery
Fear of Compassion
Certain types of positive feelings are threatening
It is dangerous to feel safe
Compassion feeling are linked to beliefs such that
it’s an indulgence and weakness
Activated grief and or abuse memories
PROBLEM -Compassion is a threat
Compassionate
Re-focusing
Affiliaitve/
Soothing
Threat
Compassionate
imagery
Shame-self
criticism
Mentalizing
Fear of
closeness
Trauma
Memory
Meta- beliefs
Kindness, Attachment and Threat
Kindness from therapist or imagery
Fight, flight
shut down
Activate attachment system
Activate memories
Neglect
aloneness
Fight, flight
shut down
Abuse, shame
vulnerable
Activate learnt and current defences - cortisol
Bowlby: Kindness opens the attachment system and then whatever ever fears, anger
or despair is coded there will become available and can be intensely threatening
Study of reactions to
compassionate imagery
• Control of the mechanisms for balance between
sympathetic and parasympathetic nervous system have
been modified and are linked to evolution of mammalian,
attachment and social engagement systems
• This relative balance can be measured in heart rate
variability
• Heart rate variability linked to adaptive balance and
flexibility, soothing and safeness - low variability to
relative control/dominance of one over the other - threat
Parasympathetic
nerves to heart
Slows HR
Sympathetic
nerves to heart
Increases HR and
stroke volume
Successive Interbeat Intervals
(ms)
945
897
858
799
821
846
851
858
879
879
Standard Deviation of
Inter-beat Intervals
over 300 second
period = SDNN
Tasks of study
Relaxation condition was focusing on relaxing
calming images/thoughts
Control condition was to imagine making your
favourite sandwich and the pleasure you will get
from eating it (control for type of positive affect and
also the effects of mental imagery)
Compassion imagery was to imagine their ideal
compassionate person and how kind, warm and
caring they were for the self
Diagram showing mean SDNN for each group at baseline & during imagery
conditions
SDNN change grouping
variable
Grp 1downs
Grp 2 ups
65.00
Mean SDNN
60.00
55.00
50.00
45.00
40.00
Baseline
Control Imagery
Condition
Compassionate
Imagery
Diagram showing mean cortisol for each group at baseline & after Imagery
Grouping variabile for
SDNN change
Grp 1downs
Grp 2ups
5.800
Mean cortisol (ng/ml)
5.600
5.400
5.200
5.000
4.800
CortA
CortB
Sample
Correlations between change in HRV
and self-report scales
SDNN
Inadequate Self
-.54*
Anxious Attachment
-.48*
Depend Attachment
.52*
Social Safeness
.57**
* p<.05
** p <.01
Fears of Compassion
Basic Beliefs and Meta-cognitions
Fear of Compassion For Others
Scale
People will take advantage of you if you are
too compassionate
If I’m too compassionate, others will become
too dependent on me
I can’t tolerate others distress
Fear of Compassion From Others
Scale
I fear that if I need other people to be kind, they
wont be
I worry that people are only kind and
compassionate if they want something from me
If I think someone is being kind & caring towards
me, I put up a barrier
Fear of Compassion Towards
Self Scale
I fear that if I develop compassion for
myself, I will become someone I don’t want
to be
I fear that if I am more self-compassionate
I will become a weak person
I fear that if I start to feel compassion for myself,
I will be overcome with loss/grief
Fear of Compassion Data
Com for
others
Com from
Others
Com for
others
Com from
Others
. 47**
Self com
. 37**
. 67**
Fear of Compassion Data
C for
Others
C from
Others
Self Com
Anxiety
. 22**
. 46**
. 44**
Dep
. 17*
. 37**
. 40*
Tentative ideas
To emotional (shame type) events - being selfreassuring vs self-critical activates different brain
systems
People high in self-criticism seem to struggle to
activate soothing system and may find efforts to be self
-compassionate a threat – (sadness?)
Question: can we teach self-critics to be self soothing
and would this ‘training affect’ change physiological
responses to threatening-self linked events?
Therapy
Life history and contextual rather than symptom focused
Background,
key threats,
safety strategies
undesired/unintended consequence
High focus on validation, on “not your fault,” courage and
doing your best.
Clarify three circle model and why we will explore helpful
behaviour for each circles
Desensitisation to affiliative positive affect – to be able to
feel safe and self compassionate
Treatment
• Attendance one of two programmes
• Patients invited to take part in a research trial of
CMT at community meetings
• Criteria for inclusion were mid treatment (six months
to one year), well engaged with the service and to have
self-attacking, negative thoughts
• Nine patients agreed to take part in the study (five
men and four women)
• Three did not complete the study: hence six completed
• Twelve two hour sessions
• Gradual process of developing compassionate imagery
and soothing exercises and then engaging with self
critical thinking
Data From Group Study
Pre and Post Compassionate M ind
Training
60
56.4
54.2
50
Before
Scale
40
After
30
20
18.8
10.2
10
0
Self criticism
Self compassion
Data From Group Study
Functions of Se lf-to-Se lf Re lating
30
25
28
(15.79)
21.67
(11.74)
17.5
(8.62)
Score
20
Bef ore
15
9.6
(8.45)
10
5
0
Self Correction
Self Persecution
Af ter
Data From Group Study
HADS
16
14.67
(3.78)
14
10.33
(2.67)
12
Score
10
8
6.83
(2.93)
Bef ore
4.3
(2.73)
6
4
2
0
Anxiety
Depression
Subs cale
Af ter
Data From Group Study
Forms of Se lf-to-Se lf Re lating
31.33
(5.16)
19.83
(8.21)
14.5 15.17
(7.01) (3.76)
5.67 6.17
(5.40) (6.40)
el
f
S
re
su
ea
s
H
at
ed
R
In
a
de
q
ua
te
S
se
el
lf
f
Score
35
30
25
20
15
10
5
0
Before
After
Data From Group Study
Social Com parison
70
60
58 .6 7
( 2 6 .0 0 )
Score
50
40
3 4 .8 3
( 2 1.50 )
Before
After
30
20
10
0
Social
comparison
Reflections
I would just like to tell you all here today what (CMT)
means to me. It seemed to awaken a part of my brain that
I was not aware existed.
The feeling of only ever having compassion for other
people and never ever contemplating having any for
myself.
Suddenly realising that it’s always been there, just that I
have never knew how to use it towards myself.
It was such a beautiful, calming feeling to know it was Ok
to feel like this towards myself without feeling guilty or
bad about it.
Being able to draw on this when I was frightened and
confused, to calm myself down and to put things in
prospective and say to myself “IT’S OK TO FEEL LIKE
THIS.
Reflections
Having compassion for myself means I feel so much more at
peace with myself. Knowing that it is a normal way of life to
have compassion for myself and it’s not an abnormal way of
thinking, but a very healthy way of thinking. It felt like I
was training my mind to switch to this mode when I start to
feel bad about myself or life situations were starting to get
on top of me.
What is striking about this, and what other participants
thought, was how much they had (previously) felt that being
self-compassionate and empathic to one’s distress was a selfindulgence or weakness and definitely not something to
cultivate.
Mayhew and Gilbert 2008
Three voices hearers with CFT
Results showed decreases for all participants
in
depression,
psychoticism,
anxiety,
paranoia, OCD and interpersonal sensitivity.
All participants’ auditory hallucinations
became less malevolent, less persecuting and
more reassuring
Some other studies
Laithwaite et al., (2010) (University of Glasgow) in a
study of group based CFT study for 19 clients in a high
security psychiatric at Carstairs found
“… a large magnitude of change for levels of
depression and self-esteem ….. A moderate magnitude
of change was found for the social comparison scale
and general psychopathology, with a small magnitude
of change for shame. These changes were maintained
at 6-week follow-up”.
Conclusions
•
CFT linked to evolved and neurophysiological systems : Must
distinguish different types of positive emotion systems
•
Self-to-self relationships are important mediators between early
rearing styles and distressed states
•
CFT focuses on this inner relationship – shifting it to a self
compassionate one
•
First movements to compassion in self-critics are often aversive so
this system needs to be ‘detoxified’
•
Takes time and should focus on practice rather than focusing on
feelings first up
•
Clients like the neurophysiological and Mind Training aspects -like ‘going to the gym’ analogies