Sep 20, 2018
Couldn't we all be a little kinder to ourselves?
Find out how self-compassion can influence us and hear about how compassion focussed therapy helped Chris with depression.
Prof. Paul Gilbert and Chris Winson talk to Dr Lucy Maddox.
Show Notes and Transcript:
If you’re interested in finding out more about the British Association for Behavioural and Cognitive Psychotherapies, or about Compassion Focussed Therapy here are some resources...
babcp.com is the British Association for Behavioural and Cognitive Psychotherapies website and it links to the CBT register of accredited CBT therapists in the UK (or go straight to cbtregisteruk.com). BABCP also has a Compassion special interest groups which members can join.
https://compassionatemind.co.uk/ is the website of the Compassionate Mind Foundation.
https://underwaterbreathes.wordpress.com/ is Chris Winson's blog.
On Twitter, the hashtag #365daysofcompassion was created by Chris and connects you to other people using principles from CFT to help with everyday life.
Gilbert, P. (2010). Compassion focused therapy: Distinctive features. Routledge.
Welford, M. (2016). Compassion focused therapy for dummies. John Wiley & Sons.
Irons, C., & Beaumont, E. (2017). The Compassionate Mind Workbook: A step-by-step guide to developing your compassionate self. Robinson.
Welford, M. (2012). The Compassionate Mind Approach to Building Self-confidence Using Compassion Focused Therapy. Constable & Robinson.
Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6-41.
Gilbert, P. (2015). Affiliative and prosocial motives and emotions in mental health. Dialogues in clinical neuroscience, 17(4), 381.
Lucy: This is Let’s Talk About CBT and I’m Dr Lucy Maddox.
This episode is all about a type of talking therapy called compassion-focused therapy. It sometimes gets called CFT. This is one of the family of cognitive behavioural therapies or CBTs.
For today’s podcast I went to Derby to speak to Professor Paul Gilbert and Chris Winson.
Paul: Yes, so hello. I'm Paul Gilbert, clinical psychologist. Retired from the health service but still work as a professor at the local university and also the University of Queensland where we’re doing research on compassion-focused therapy.
Chris: My name’s Chris Winson and I’ve gone through a CBT form of therapy called compassion-focused therapy, CFT. And that was to help with depression.
Lucy: I asked both Paul and Chris how they described CFT.
Paul: So compassion really is about the way in which we turn towards suffering and try to alleviate suffering where we can and prevent it. Learning to have the courage to face the pain that we need to face with the wisdom to know what to do to actually help ourselves and prevent it.
Chris: CFT is all about really kind of engaging with a lot of the thoughts that we all have and that depression particularly kind of amplifies. And kind of not shying away from those emotions but engaging with them with a kindness and an encouragement to perhaps work with it rather than reacting perhaps as you would do intuitively.
And in my instance with something like depression, compassion-focused therapy really does help towards those self-critical, self-judgemental, perfectionist kind of thoughts that depression really kind of takes and turns the volume up on to maximum.
Lucy: Paul was the first person to develop CFT.
Paul: During the 70s and 80s we were all pursuing cognitive therapy, and quite well too I think. So we were working with very complex and severe people with depression. And they could be quite good at developing alternative thoughts to some of the more difficult beliefs and attitudes to self-help.
But they would often say, “Yes, I can see the logic in these alternatives, like I think I’m a failure but in reality I can see I’ve achieved this, that and the other. I can’t really feel any different.”
So one day, and I’d like to tell you it was because it was wisdom and because I was so clever, but unfortunately it wasn’t. It was simply accidental. I asked this lady, “Well, how do you hear these alternative thoughts in your mind? Speak them out.” “Well, what do you mean?” I said, “Speak them out as you actually hear them.” And she said, “Okay. Okay, so you’re depressed, so you’ve got a husband who loves you and he stands by you, hasn’t he? You’ve got children who love you. For God’s sake, look at the evidence!”
So I said, “Oh my goodness. Is that actually how you hear them?” And she said, “Yeah.”
So I thought, “Ooh.” So I said, “Well, what would happen, imagine that you had the same alternative thoughts that you could see that in reality your husband did care about you and you had children who loved you and were doing very well at school and so on. You’d been a good mother to them. And this was with a voice that was very kind and compassionate to you because it realised all the struggle you’d had in your life and the depression you’d been fighting against. What would happen if you thought about that or said that in your mind with that tone?”
And she looked at me as if I was mad and she said, “Absolutely not. I’d never been kind to myself. I can’t see the point of it. It’s just, that’s weak, that’s not going to work at all.”
So that was the beginning really, it’s where we began to realise that it’s not just the content of people’s thinking, it’s also the emotional textures that they are relating themselves with.
Lucy: So how do you work on the tone that someone speaks to themselves in?
Paul: Slowly. (Laughs) Well, the first thing is a series of steps. I mean all successful therapy really takes people through stages, through steps, right? So the first step is really helping people think about why that would be useful. Why would it be useful for you to begin to change, pay attention to and change the emotional texture of your thinking, not just the content?
Chris: It’s not so much initially changing the words that you might be saying to yourself, but it’s changing the tone. It’s very powerful actually to start to change that. From that you can then build and start to change some of the words that you say to yourself. So you then change that into a gentle encouragement.
Our brains are kind of evolved to protect us but often in modern life that kind of goes out of control a little bit. And we become constantly on alert, constantly kind of feeling threatened with a drive that can sometimes be out of control almost. And we start to work on reaction and emotional reaction rather than perhaps to the reality and with clear intention.
So for me CFT has just brought that different way of engaging. And it’s almost a pause between the thought and then how I react to that.
Lucy: Compassion-focused therapy is based on evolutionary psychology. Paul describes three systems that we all have in our bodies. The threat system, the drive system and the soothing or affiliative system.
Paul: There are three types of emotional regulation systems. One of the functions of emotion is to alert you to dangers and trigger actions.
So fight and flight, obviously. Anger and anxiety. Their primary function is to threat. And they are designed to come on very quickly and they’re designed to turn off all other emotions. So if you’re walking in the jungle and hear the sound of a lion, you have to lose interest in what you’re eating and who you’re talking to and the nature of the conversation. You’d better pay attention and run you see.
So the threat system is the one that really causes us the rumination. We worry about so on and so. If you go Christmas shopping and you go into 10 shops, and in nine of the shops the assistants are really helpful to you then you go into one shop and the assistant is really rude, they make you wait. So you come out of a shop. Who are you thinking about on your way home? But 90% of the people were good, yeah?
So why don’t we ruminate and go over and over in our mind about how wonderful people are, how kind they are? Partly because you're not biologically designed to do that because your threat system will always take preference, right?
So part of what being mindful is about is to notice when your threat system is running your show. Because it will.
Now you have a drive system and that’s the system that’s activated when good things happen to you. And sometimes with depression you're wanting to try and stimulate that because when you get depressed you lose the interest in doing things. You lose the pleasure in doing things. The emotion goes. Not necessarily the motive, you may still want to go to the party or whatever it is but you’ve just got no energy or you don’t anticipate you’ll enjoy it. Or you’ll anticipate you’ll be anxious. So that’s your drive system.
But then there’s another system which has often forgotten which is called arrest and digest, or a soothing system. Now very, very briefly you have a sympathetic nerve system which speeds up so you breathe faster, your heart beats faster, your blood pressure goes up. And you have a parasympathetic that slows you down. So it slows the heartrate, it slows your breathing, it brings your blood pressure down.
And these two systems are working side by side all the time. So these systems are closely, like an orchestra, they’re working very tightly together, they’re balancing each other.
So when animals are no longer trying to achieve things, do things, excited, going out and do stuff, and they’re no longer under threat, the body goes into what is called this rest and digest. It slows down and it slows down because there’s a parasympathetic system.
Now there are many things that stimulate that system, such as breathing, posture, thinking. But one of the things that’s very important for stimulating the soothing system is affiliative signals.
Lucy: What’s an affiliative signal?
Paul: It’s like a friendly sort of benevolent signal like a signal of being cared about and taken an interest in. Affiliative means friendly. Unfortunately some of the people that we work with, that system doesn’t work very well. They’re not very able to accept kindness coming in. They don’t see it. They may think they’re not worthy of it. They’ll have beliefs like, “Well, okay, you're wanting to be kind to me but if you really knew what went on in my head you wouldn’t think I was worth it. It’s only because you don’t really know.”
So that takes us into a shame dimension. The fear of shame and so on. And if I got close to you then I would see that maybe you're not as honest as you say. Maybe you’re just doing this because you’re paid to do it, you’re a therapist and so on.
So the whole point really is that that system then doesn’t work so well. So what CFT therapists do is they spend a lot of time focusing on how to help individuals experience of affiliative, friendly signals that will influence that, get that system working.
Chris: It’s a very elegant model to be able to understand quite complicated neuroscience. The interesting thing when you look at that model for me is that it’s understandable that our threat systems are often enabled. We don’t have to worry about being eaten by a tiger anymore. But that’s where it kind of came from.
And we live in a modern society where often there are threats around us in terms of, it could be doing presentations, and we don’t relax from that.
Lucy: Compassion-focused therapists usually explain this model to their clients as part of the treatment tying the model to the person’s goals.
CFT uses a range of different exercises which work on the threat, drive or soothing systems, either to calm those systems down or pep them up depending on what would be most helpful.
Chris: There’s a few things that we did. So one was to look at that model and to kind of think about if I had to score on a one to 10 of how, which of those systems were kind of in play, drive and threat were probably at 10 and affiliate was probably down there at one or two.
And then it was understanding to bring balance around those. CFT does bring mindfulness practices in.
Lucy: Mindfulness is just about trying to keep our attention in the present moment instead of worrying about stuff that’s already happened or that hasn’t even happened yet, and trying to do this without judging yourself or having a go at yourself when your mind is hopping about.
Chris: It also helped to do some exercises around the concept of the different selves. So we all have our different selves or our different voices. And depression particularly brings out that critical and the judgement-type voices. And the perfectionist voices.
So some of the exercises sort of actually work upon the compassion voice and to develop the idea of a compassionate self. And that’s actually something that I’ve really adopted. So when I am feeling anxious or concerned I try to bring to mind what the compassionate self would look like. And what would they be saying to me. Because we’re very good at supporting our friends when they’re feeling distressed, it’s then bringing that to ourselves.
I found compassionate writing very helpful as well. So I now keep a journal which varies on day-to-day what I write in it, how much I write in it. But it’s something that I can help to work through what I might be thinking about.
And there are some exercises around writing compassionate letters to yourself which again is not all saying, “Oh you’re great, I love you.” It’s about reflecting on how you're feeling and really giving yourself some support and encouragement during those periods.
Lucy: And does it work? I asked Paul to talk us through the evidence base.
Paul: Yeah, people forget there are two types of evidence. Evidence of process, evidence of outcome. Right? So evidence of process means that we do understand how the system works. So the evidence is, is there such a thing as a parasympathetic system? Well actually there is. There’s plenty of evidence for that. Is it true that affiliative signals influence…? Well actually, yes, it does. Is it the case that people who have been traumatised and depressed, that system doesn’t work very well? Yes.
So in terms of the process we’re probably one the better therapies in terms of process evidence. And in fact the whole basis of CFT is rooted in the science of how the mind and body actually work.
One of the issues that sometimes CBT is accused of, is being a little bit heady, a bit too much in the head and not enough in the body and not enough in the actual physiological mechanisms. But we’re very into the… so the evidence of process is very good.
Evidence of outcome is more difficult partly because turning these insights and these gradual modules of how you work with different aspects of motivation and emotion is tricky. So we’ve now got quite a good set of therapies and we’ve got a number of people who’ve worked very hard at adapting the basic CFT for different groups such as like psychosis or depression and trauma and so forth.
Moving that into RCTs evidence of outcomes is very expensive. But there are a number of trials, good trials, RCTs now going on around the world which is showing that CFT is really acceptable, people like it. It does produce physiological change and it does produce benefit to people who have mental health difficulties.
Lucy: I asked Chris about his personal experience of whether CFT had been helpful or not.
Chris: I really liked the emotional systems model, those three; threat, drive and soothing, because I think that really helps to understand how and why we may think in a certain way. And then that compassion to yourself and that’s the big one. The self-compassion is probably the big thing, to understand what that really means. And to understand that that’s not selfish.
And actually it takes quite a bit of courage sometimes to do that self-compassion piece.
And I think when you're a leader, as I was a manager and a leader, you don’t always want to express how you're feeling. Even though they were the messages I was giving out to my managers and my teams that it was okay to talk about things. I kind of kept it all behind a mask.
And I think natural reaction if you talk to men about compassion and self-compassion, sitting with your emotions, is going to be, “That’s not what men do,” or, “How is that helpful?” Or, “That’s just giving in.” It’s not.
And actually it takes quite a lot of courage and bravery to actually say, “Actually I don’t feel very good and I’m going to talk about why that is. And actually I’m going to ask for some help.”
And being able to sit with your emotions whether it’s whatever the feeling is, whether it’s anger, whether it’s impatience, whether it’s that self-criticism and perfectionist, to actually really sit and engage with that and to actually say there are some parts of this that I don’t really like that I’m feeling like this, that’s not easy.
Lucy: Paul agreed that it takes a lot of courage to embrace compassion.
Paul: When we bring compassion into our own lives and we address our trauma compassionately, we address our criticism and our shame with compassion, things change. So compassion is not in any sense a weakness. In order to engage with suffering, because that’s what it is, to really engage with suffering and turn towards it, be prepared to engage with it and try as best you can to do something about it, that’s a courageous act. It’s not an act of weakness. It’s not a softness. Compassion is the courage to engage with suffering with the wisdom to know what to do.
Chris: I think it kind of has changed my life to address the depression. But it’s actually allowed me to do some things that I would not have done before. I’ve been looking forward to doing this podcast from a couple of months back from when we first talked about doing it, for many reasons.
And then particularly overnight and then this morning I kind of thought, “Oh, okay, I’m doing the podcast today.” And all those kind of thoughts start to come back to your mind. So, “I’m going to mess it up, I won’t say anything that I want to say, it’ll be a failure.” All those kind of thoughts start to come into your mind. And what CFT has taught me is to say, “Okay, I recognise that, and that’s kind of my anxious self and there’s my judgemental self in there and the critical self. And I’m going to thank them for making those comments.” And fundamentally my mind is, my threat system there is trying to protect me.
And then the other part of the CFT which I’ve not really probably mentioned yet is about values because I think you really start to understand what’s important to you. And that doesn’t mean it has to be some to light suddenly comes through clouds and hits you and it’s like, “Oh okay, that’s what my life’s about.” And so it’s important for me, as it has been with my writing, to kind of try and share, both to raise awareness of depression, but actually also to share about CFT because that has for me made such a difference.
I'm so kind of passionate about sharing that that that offsets the anxiety and the natural concern to be doing an interview like this.
I think it’s given me a different relationship with… first of all it gave me a different relationship with depression. And I think overall, however, it’s given me a different relationship with my thoughts overall.
I think it’s actually just allowed me to actually engage with myself in a different way. It’s not just about handling distressing thoughts. It actually really does help you to be present and enjoy moments.
Lucy: Chris has been writing a blog about compassion-focused therapy and also running a Twitter hashtag, #365DaysOfCompassion, to share ideas about the therapy.
Chris: I’ve never really felt that I was a creative person. When you do the writing, when you do stuff like that and you put the blog out, it’s incredibly vulnerable. But what self-compassion says to me is but this is important for you to share your story and to try and help and therefore it kind of encourages me and supports me through that process.
Lucy: I asked Chris and Paul if they had any advice for people considering compassion-focused therapy.
Paul: I’d obviously recommend it. I think it’s a good therapy obviously. But people have to make their own decisions.
It’s holistic. In other words it pays attention to people’s motives, their emotions, their cognitions, their behaviours, their fantasies, hopes and wishes. And so forth. So all of those things. It doesn’t privilege any one particular although it is probably now more of a motivational theory, motivational process that developing people’s intentionality, being clear about one’s intention in life. If you choose to be the person that at best, what kind of person would be choose?
Now people often start, “Well, I want to be successful, I want to be famous, I want money,” blah, blah, blah, blah. But if you can help them also orientate themselves to a compassion intention, “I want to be a person that wherever I can I’ll be helpful rather than harmful, and really hold that and I’m going to do that to myself wherever I can, I will be helpful to myself and not harmful to myself,” that intentionality flourishes and we’ve treated a lot of people with CFT now and it just changes their values.
Chris: I think timing is important. So I didn’t go straight into CBT. I probably would have struggled initially to have engaged with the idea of a compassionate part and sitting with emotions perhaps at the height of the depression and you’ve got to be receptive. And be prepared to work at it because it is hard.
I can remember one therapy session that came out of, and I have told my therapist this, that I’ve sat in the car afterwards very emotional and almost walked back in to say, “I’m not doing this anymore.”
But actually that was a breakthrough moment because – which I recognise now – because I’d finally started to open up. And I’d finally started to understand and accept that depression was there and that actually I could there see how compassion and CFT was going to start to help.
Lucy: A big thanks to Chris and Paul for their interviews.
I hope that’s helped explain some of the ideas around compassion-focused therapy. I think probably most of us could benefit from being a little kinder in the way we speak to ourselves.
If you’d like more information or resources, please check out the show notes for some references and links.
This podcast is brought to you by the British Association for Behavioural and Cognitive Psychotherapies, or BABCP. For more information about BABCP and CBT in general check out www.BABCP.com.
Thanks to Gabe Stebbing for the title music, Aaron Zimm for the incidental music, Paul Gilbert and Chris Winson for speaking to me, and Eliza Lomas for editing consultation.
Any feedback or ideas, please do let us know. And please rate us on iTunes if you’ve enjoyed the show.
Next time we’ll be exploring another of the CBT family. So I hope you come back for that.
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