Dennis Tirch , Ph.D. The Center for Mindfulness and Compassion-Focused Therapy

1. The Contextual Science of Compassion in ACTionComponentsJune 20, 2014Association for Contextual Behavioral ScienceWorld Conference 12Minneapolis, MN Dennis Tirch, Ph.D. The Center for Mindfulness and Compassion-Focused Therapy Russell L. Kolts, Ph.D. Eastern Washington University

2. Kind of soft, fluffy, and pink • “airy-fairy” • Being nice all of the time • Always giving people exactly what they want. What does “compassion” mean to me?

3. Two psychologies at work: sensitivity to suffering, and motivation to help. • Compassion begins by approaching suffering…which is why the CFT-anger group is called True Strength. Compassion – being moved by suffering, and motivated to alleviate it.

4. Emphasis on mindful awareness (awareness and sensitivity to suffering) combined with workable action (helping and motivation to help). I would argue that ACT is a Compassion-Based Therapy

5. Compassion Focused Therapy is based in a few Basic Ideas “Hope Comforting Love in Bondage” courtesy of the Birmingham Museums and Art Gallery Collections, Birmingham, UK Artist: Sidney Harold Meteyard, 1901

6. Our brains are brilliant but problematic ‘patchwork quilts’ of evolved structures and functions. • Tricky dynamics between “old” emotional brains and “new” brains Our brains, and the way they organize our minds, are the products of evolution

7. “We all just find ourselves here…” • Emotions as evolved capacities with specific purposes (3 Circles) • Emotions not as isolating, but as common elements that unite us. • Mindful observations of threat emotions as prompts for compassion. A Compassionate Understanding of Our Emotions

8. Old, emotional brain is very powerful, not very clever. • Threat emotions narrow our attention, lower our cognitive flexibility, and strongly influence the contents and process of our reasoning. • Emotional inertia via the interplay of emotional “old-brain”,“new brain”, and body Tricky Brains!

9. We experience powerful motives and emotions that enabled our ancestors to survive but are often unworkable within our current contexts.

10. 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. CFT focuses on three types of emotion regulation system: Those that focus on threat and self-protection Those that focus on doing and achieving Those that focus on contentment and feeling safe

11. Types of Affect Regulator Systems Content, Safe, Connected Drive, Excitement, Vitality Non-wanting/ Affiliative focused Safeness-kindness Soothing Incentive/resource- focused Wanting, pursuing, achieving, consuming Activating Threat-focused Protection and Safety-seeking Activating/inhibiting Anger, Anxiety, Fear, Disgust

12. The Threat System Threat-focused Protection and Safety-seeking Activating/inhibiting Anger, Anxiety, Disgust

13. Our Old/Emotional Brains are Biased toward Processing Threat In species without attachment, typically 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. Survival depends on efficiently detecting and responding to threat.

14. Motivations and Emotions Organize Our Minds in Very Powerful Ways

15. Thinking Reasoning Attention Imagery Fantasy Anger Behaviour Motivation Emotions

16. Threat-focused Protection and Safety-seeking Activating/inhibiting Anger Body/feelings Tense Heart increase Pressure to act Anger Attention/Thinking Narrow-focused Transgression/block Scan – search Behaviour Increase outputs Aggressive displays Approach Dissociate

17. Threat-focused Protection and Safety-seeking Activating/inhibiting Anxiety • Body/feelings • Tense • Heart increase • Dry mouth • “Butterflies” • Afraid • Attention/Thinking • Narrow-focused • Danger threat • Scan – search • Behavior • Passive avoidance • Active avoidance • Submissive display • Dissociate

19. The Drive and Resource Acquisition System Drive, Excitement, Vitality Incentive/resource- focused Wanting, pursuing, achieving, consuming Activating Threat-focused Protection and Safety-seeking Activating/inhibiting Anger, Anxiety, Fear, Disgust

20. Incentive/ resource-focused Wanting, pursuing, achieving, consuming Activating Excited Body/feelings Activation Heart increase Pressure to act Disrupt sleep • Attention/Thinking • Narrow-focused • Acquiring • Explorative Behaviour Approach Engage Socialise Restless Celebrating

21. The Safeness System Content, Safe, Connected Drive, Excitement, Vitality Non-wanting/ Affiliative focused Safeness-kindness Soothing Incentive/resource- focused Wanting, pursuing, achieving, consuming Activating Threat-focused Protection and Safety-seeking Activating/inhibiting Anger, Anxiety, Fear, Disgust

22. Non-wanting/ Affiliative-focused Safeness-kindness Soothing Well-being • Body/feelings • Calm • Slow • Well-being • Content Behaviour Peaceful Gentle Prosocial • Attention/Thinking • Open-focused • Reflective • Prosocial

24. Thinking Reasoning Attention Imagery Fantasy Compassion Behaviour Motivation Emotions

25. A big part of CFT is helping people to work with these implicit emotion-regulation systems and learn to balance them by helping themselves feel safe.

26. 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, self-disliking, 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. Soothing system poorly developed and will often say, “I understand the theory but do not feel relieved or safe.” This makes sense if that system is not working or developed.

27. Blaming and shaming ourselves and others keeps us locked in threat-based emotions, fueling our problems. • Shame-based pain/distress fosters avoidance. • Warming things up can help us feel safe, balance emotions, and skillfully approach difficulties rather than avoid them. Why Compassion? Shame is a core source of Threat

28. We have unlimited access to our own internal experiences, and very limited access to those of others. (“I feel like a wreck, but they seem to be doing alright!”) • Evolution shaped us to be very concerned about how we exist in the minds of others, and how we compare to them. “There’s something wrong with me.”

29. So we’re set up to self-shame and self-criticize…but this keeps us stuck in the threat circle and feeling isolated &disconnected, and sets us up to avoid difficult experiences rather than to acknowledge and work with them.

30. Compassion - “Being moved by suffering and motivated to alleviate it” • Compassion involves approaching and working with suffering.

31. The two-teachers metaphor: • Critical teacher vs Compassionate teacher • Which teacher would you want your child to have? • Which would help your child learn & progress? • When you observe yourself struggling or feeling threat emotions, which teacher does the voice in your head sound like? Introducing Compassion-Work via Perspective Taking

32. The goal is to help our clients cultivate qualities that will help them to effectively work with difficult emotions and situations: • Compassion • Mindful awareness • Courage and Confidence • Kindness • Wisdom Compassionate Self Work

33. Imagining how we would think, feel, behave, appear, experience, and understand if we had these compassionate qualities. • Imagining the compassionate self in action: • From this perspective, how would you understand this situation? Feel? Think? Work with it? Method Acting + Imagery

34. Emphasis on awareness, mindfulness – cultivating qualities that facilitate open awareness and reflectiveness. • However, knowing that we often will relate to ourselves in terms of a narrative, compassionate self work enables clients to cultivate an adaptive, value-driven version of the self. Halfway between Self-as-context and Self-as-content

35. “Awareness not as content-free, but as not content-bound” • Steve Hayes, 6/19/14 • We can “harness what language can offer us” • Jennifer Plumb, 6/19/14

36. Bring up a challenging situation. Focus on bodily feelings, thoughts, motivations, and fantasized behaviors. What does this self feel like, think, say, want to do? - Angry Self - Anxious Self - Sad Self - Compassionate Self – the “Captain of the Ship” Exploring Emotions: The 4 Square/Multiple Selves Exercise

37. Thinking Reasoning Attention Imagery Fantasy Anger Behaviour Motivation Emotions

38. A lot going on here: • Increasing awareness of various threat emotions that may be avoided. • Gives a window into the dynamics of self-criticism. • Exploring different emotional perspectives and how they organize the mind. • Learning to shift in and out of different emotions – and building confidence that they can do this without getting stuck. • The Compassionate-self in action – ability to have compassion for these emotional selves. The Four-Square Exercise

39. A bit of data from an initial trial applying CFT to problematic anger:- 12-week, 2 hour per week group at a minimum/medium security prison- pre-test 2 weeks prior, post-test 2 weeks following- non-random assignment to treatment & wait-list groups- CFT group n = 9, Control n = 7

40. Significant Group X Time Interaction: STAXI Anger Expression Index – F (1,10) = 7.06, p = .024 (Blue line = CFT group).

41. Significant Group X Time Interaction: MAI Anger-Out scale – F (1,14) = 5.85, p = .03.

42. Significant Group X Time Interaction: MAI Anger-In scale – F (1,14) = 7.08, p = .019.

43. Except for decreases in fears of expressing compassion to others, the Group X Time interactions for changes in measures of compassion were generally not significant. • Fear of Compassion Scale • Expressing to Others F (1,12) = 8.43, p = .013* • Receiving from Others F (1,13) = 4.30, p = .058 • Compassion to Self F (1,11) = .858, p = .374 • IRI Empathic Distress - F (1,13) = .311, p = .59 • Self-Compassion Scale Total – F (1,13) = 1.83, p =.20 (the CFT-group within-group changes and main effects of time were quite significant)

44. Example non-significant finding for Group X Time Interaction: IRI Perspective Taking – F (1,13) = 3.80, p = .073.

45. FOC Scale – Fear of Expressing Compassion to Others

46. FOC Scale – Fear of Receiving Compassion from Others

47. FOC Scale – Fear of Self-Compassion

48. Self Compassion Scale Total Score

49. Correlations between change scores for anger and compassion measures within CFT Group *p < .05 **p<.01

50. The Compassionate Mind Guide to Managing Your Anger Available from www.newharbinger.com for 30% off and free shipping: code ACBS14 Living with an Open Heart Available from Amazon.com - US version to be released by Shambhala in 2015, as An Open Hearted Life