Talk Today

1. Compassion-Focused-Therapy Model and ResearchPaul Gilbert, Kirsten McEwan, Corinne Gale & Jean GilbertMental Health Research Unit, Kingsway Hospital, Derby UKwww: Compassionatemind.co.uk

2. Talk Today Outline basic philosophy and model of Compassion focused Therapy Note the powerful effects of our self- evaluation systems (self-criticism vs self compassion) Explore the main therapeutic work as overcoming the fear ofcompassion and self compassions

3. To understand ourselves we must understand our brains

4. why we have complex brains and minds that are difficult to understand regulate 1. Old Brain Emotions: Anger, anxiety, sadness, joy, lust Behaviours: Fight, flight, withdraw, engage Relationships: 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?

5. Interaction of old and new psychologies Sources of behaviour New Brain:Imagination, Planning, Rumination, Integration Old Brain: Emotions, Motives, Relationship Seeking-Creating Archetypal

6. 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 Those that focus on threat and self-protection Those that focus on doing and achieving Those that focus on contentment and feeling safe

7. Types of Affect Regulator Systems Content, safe, connected Drive, excite, 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, disgust

8. 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

9. Dispersal and avoid others

10. Protect and Comfort: Less ‘instinctive brain – post birth learning

12. 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

13. 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, 218-226) Testosterone and aggression (Booth et al., 2003. Developmental Psychology, 39, 85 – 98) Self-to-self-relating e.g. self criticism vs self-reassurance

14. Internal Threat and Soothing Self-affiliation – experiences a lovable self Calms Affiliative/ Soothing Threat Neurophysiological networks Internal representations of helpful others and sources of comfort Emotional memories of soothing

15. Internal Threat and More threat No self-affiliation – experiences a unlovable self Calms Affiliative/ Soothing Threat Neurophysiological networks Others are threats or alarming Emotional memories of no soothing

16. 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

17. 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

18. Compassion as Flow Different practices for each Other Self Self Other Self Self Non linear empathy for other begins early in life

19. 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)

20. Key Targets of Therapy Thinking Reasoning Attention Imagery Fantasy Behaviour Motivation Emotions Their pattern gives rise to a certain type of mind

21. Compassionate Mind Thinking Reasoning Attention Imagery Fantasy Compassion Behaviour Motivation Emotions

22. Threatened Mind can block Compassion Thinking Reasoning Attention Imagery Fantasy Threat Behaviour Motivation Emotions

23. Self-Critical Mind is also Threat-focused Mind Thinking Reasoning Attention Imagery Fantasy Self- Critical Behaviour Motivation Emotions

24. How our own thoughts and images affect our brains Sexual Bully-threat Meal Sex Meal Bully- threat Kind, warm and caring Emotion Brain Compassion Soothed Safe Stomach acid Salvia Fearful Depressed Arousal Pink represents our inner images and thoughts

25. 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?

26. fMRI Study (Aston University)STUDY Olivia Longe, Gina Rippon, Paul Gilbert & Frankie Maratos • 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 self-reassuring thoughts), 1-7 Likert Scale. Self- Criticize Self- Reassure Self- Criticize Self- Reassure “A third job rejection letter in a row arrives in the post” “The second free local newspaper in a row arrives in the post”. Emotion Scenario(-) Neutral Scenario

27. 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

28. 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

29. Parent recall and SC and SRIrons Gilbert Baldwin et al., 2006 Br J Clin Psych .24 (.31) Inadequate Self Rejection .31 (.33) .26 (.60) .15 (.25) Overprotection Depression .22 (.55) Hated Self -.31 (-.56) .37 (.30) Warmth Reassure Self

30. Parent recall and SC and SRIrons Gilbert Baldwin et al., 2006 Br J Clin Psych .24 (.31) Inadequate Self Rejection .31 (.33) .26 (.60) .15 (.25) Overprotection Depression .22 (.55) Hated Self -.31 (-.56) .37 (.30) Warmth Reassure Self

31. 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

32. 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)

33. Compassionate Mind Thinking Reasoning Attention Imagery Fantasy Self- Compassionate Behaviour Motivation Emotions

34. 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

35. Internal Threat and Soothing Self-Criticism Compassionate Re-focusing Calms Affiliative/ Soothing Threat Worry Rumination Compassionate imagery

36. 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

37. PROBLEM -Compassion is a threat Compassionate Re-focusing Affiliaitve/Soothing Threat Compassionate imagery Shame-self criticism Mentalizing Fear of closeness Trauma Memory Meta- beliefs

38. Kindness, Attachment and Threat Kindness from therapist or imagery Activate attachment system Activate memories Fight, flight shut down Fight, flight shut down Neglect aloneness Abuse, shame vulnerable Activatelearnt 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

39. 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

40. Parasympathetic nerves to heart Slows HR Sympathetic nerves to heart Increases HR and stroke volume

41. Successive Inter-beat Intervals (ms) 945 897 858 799 821 846 851 858 879 879 Standard Deviation of Inter-beat Intervals over 300 second period = SDNN

42. 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

45. Correlations between change in HRV and self-report scalesSDNN Inadequate Self Anxious Attachment -.54* -.48* Depend Attachment Social Safeness .52* .57** * p<.05 ** p <.01

46. Fears of Compassion Basic Beliefs and Meta-cognitions

47. 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

48. 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

49. 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

50. Fear of Compassion Data