Psychological therapies aimed at reducing emotional distress take many forms and continue to develop apace. However 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.

Compassion focused therapy

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.

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 tackling 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 & Jones, 2018) or mild to moderate dementia (Craig, Hiskey, Royan, Poz & Spector, 2018).

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/). 

the compassionate mind foundation

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