Compassion Focused Therapy Fields Conference Feb 22. Paul Gilbert PhD, FBPsS, OBE

Transcription

1 Compassion Focused Therapy Fields Conference Feb 22 Paul Gilbert PhD, FBPsS, OBE Mental Health Research Unit, Kingsway Hospital Derby www. compassionatemind.co.uk Collaborators Jean Gilbert Kirsten McEwan Corinne Gale Chris Irons Marcela Maratos David Zuroff Allison Kelly 1

2 The Two Psychologies of 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 and prevent it Two different Psychologies To approach, understand and (how to) engage with suffering To work to alleviate and prevent suffering - nurturing Each more complex that might at first seem Compassion Focused Therapy: A Social Mentality Caring/Helping Giving Care/Help Seeking/Receiving Specific Competencies e.g., attention empathy Specific Competencies e.g., openness responsive Facilitators vs Inhibitors Facilitators vs Inhibitors 2

3 Compassion begins with a reality check We are an emergent species in the flow of life so our brains, with their motives, emotions and competencies are products of evolution, designed to function in certain ways Our lives are short (25,000-30,000 days), decay and end. We are subject to various malfunctions and diseases in a genetic lottery. Everything changes the nature of impermanence the nature of tragedy The social circumstances of our lives, over which we have no control, have major implications for the kinds of minds we have, the kind of person we become, the values we endorse, and the lives we live Need compassion for a very tricky brain Sources of behaviour New Brain: Imagination, Planning, Rumination, Integration Old Brain: Emotions, Motives, Relationship Seeking-Creating 3

4 So, Basic Philosophy is That: We all just find ourselves here with a brain, emotions and sense of (socially made) self we did not choose but have to figure out Life involves dealing with tragedies (threats, losses, diseases, decay, death) and people do the best they can Much of what goes on in our minds is not of our design and not our fault Compassion rooted in deep insight of what we are all in this suffering together It s a set up! Built in Biases Compassion insights Biased learning e.g., fear of snakes not electricity Biases can be implicit (non-conscious) or explicit (Conscious) Self-focused Kin preferences (nepotism) In-group preferences (tribalism) 4

5 Need compassion for a very tricky brain Sources of behaviour Mindful Brain New Brain: Imagination, Planning, Rumination, Integration Old Brain: Emotions, Motives, Relationship Seeking-Creating COMPASSION Need compassion for a very tricky brain Sources of behaviour Mindful Brain New Brain: Imagination, Planning, Rumination, Integration Old Brain: Emotions, Motives, Relationship Seeking-Creating Competitive 5

6 Motives and Social Mentalities Many basic evolved social motives: To compete for resources (seeking acquiring and defend hierarchies) Belong to groups, co-operate share Care for offspring and help others Elicit help and care Sexual Social Mentalities Require competencies to send and receive social signals that are motive congruent create interactional sequences that are mutually influencing Send Receive SELF OTHER Receive Send CFT focuses on the fact the brain evolved to response to social signal and communications - 6

7 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 Drive, excite, vitality Content, safe, connected Incentive/resourcefocused Wanting, pursuing, achieving Activating Non-wanting/ Affiliative focused Safeness-kindness Soothing Threat-focused Protection and Safety-seeking Activating/inhibiting Anger, anxiety, disgust 7

8 Types of Affect Regulator Systems Drive, excite, vitality Content, safe, connected Incentive/resourcefocused Wanting, pursuing, achieving Activating Non-wanting/ Affiliative focused Safeness-kindness Soothing Threat-focused Protection and Safety-seeking Activating/inhibiting Anger, anxiety, disgust 8

9 Perry B (2002) Childhood Experience and the Expression of Genetic Potential: What Childhood Neglect Tells Us About Nature and Nurture Brain and Mind 3:79 100, Safeness, Affiliation and affect regulation 9

10 Types of Affect Regulator Systems Drive, excite, vitality Incentive/resourcefocused Wanting, pursuing, achieving Activating Content, safe, connected Non-wanting/ Affiliative focused Safeness-kindness Soothing Threat-focused Protection and Safety-seeking Activating/inhibiting Anger, anxiety, disgust 10

11 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 Promotes courage and engagement Co-operative and mutual support stimulates affiliative systems and helps regulate threat Between self and others Self-to self Self to self Threat Calms Affiliative/ Soothing 120 Million year evolving system to regulate threat 11

12 Evolutionary View The basis of compassion is rooted in evolution of caring behaviour Capacity to focus on the other Recognise connection to other (e.g., infant, kin, group) Provide what is needed for growth Protection Responding to distress calls. Psychology of Caring-Nurturance Fogel, Melson and Mistry work (1986) define the core elements of care-nurturance as:... the provision of guidance, protection and care for the purpose of fostering developmental change congruent with the expected potential for change of the object of nurturance (p.55). They suggest that nurturance involves: Awareness of the need to be nurturing, Motivation to nurture, Understanding what is needed to be nurturing Expression of nurturing feelings, with an ability to match nurturing with the Feedback from the impact on the other 12

13 Caring- Helping Begins in childhood children take an interest in caring for others e.g., get support if distressed helping Helping others overcome blocks to their goals Practice as in play with dolls/toys Have a preference to play with caring toy Requires empathy and mentalising The Two Psychologies of 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 and prevent it Two different Psychologies To approach, understand and (how to) engage with suffering To work to alleviate and prevent suffering - nurturing Each more complex that might at first seem 13

14 14 Caring-Compassionate Mind Care for well-being Sensitivity Sympathy Distress tolerance Empathy Non-Judgement Compassion ATTRIBUTES ATTRIBUTES ATTRIBUTES ATTRIBUTES Warmth Warmth Warmth Warmth Caring-Compassionate Mind Imagery Attention Reasoning Feeling Behaviour Sensory Care for well-being Sensitivity Sympathy Distress tolerance Empathy Non-Judgement Compassion ATTRIBUTES ATTRIBUTES ATTRIBUTES ATTRIBUTES SKILLS SKILLS SKILLS SKILLS -TRAINING TRAINING TRAINING TRAINING Warmth Warmth Warmth Warmth

15 Compassionate Process Mindful Compassionate Engagement Motivation, sensitivity, sympathy, distress tolerance, empathy nonjudgement/acceptance Wisdom Courage Mindful Compassionate Alleviation Motivation, attention, thinking, behaviour, feeling, imagery, sensory focusing Build compassionate capacity for engaging and changing 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) 15

16 Compassion Behaviour as Courage Develop kindness, support and encouragement to promote the courage we need - to take the actions we need in order to promote the flourishing and well-being of ourselves and others The agoraphobic develops the courage to go out and expose themselves to fear; the abused wife leaves her violent husband; the depressed person works on the fear of emotion, the traumatised person engages with healing their memories Hence the importance of building affiliative CAPACITY to work on the painful things not ascent to angelic status Compassionate and self-image goals were assessed with 13 items. All items began with the phrase, In the past week, in the area of friendships, how much did you want to or try to, and items were rated on a scale ranging from 1 (not at all) to 5 (always). Seven items assessed compassionate goals, namely, be supportive of others, have compassion for others mistakes and weaknesses, avoid doing anything that would be harmful to others, make a positive difference in someone else s life, be constructive in your comments to others, avoid being selfish or self-centered, and avoid doing things that aren t helpful to me or others. Six items assessed self-image goals, namely, get others to recognize or acknowledge your positive qualities, convince others that you are right, avoid showing your weaknesses, avoid the possibility of being wrong, avoid being rejected by others, and avoid taking risks or making mistakes. Crocker, J & Canevello, A (2008) Creating and undermining social support in communal relationships: The role of compassionate and self-image goals. Journal of Personality and Social Psychology, Vol 95(3), Sep 2008,

17 Findings (N 199) Average compassionate goals predicted closeness, clear and connected feelings, and increased social support and trust over the semester; self-image goals attenuated these effects. Average self-image goals predicted conflict, loneliness, and afraid and confused feelings; compassionate goals attenuated these effects. People with compassionate goals create a supportive environment for themselves and others, but only if they do not have high self-image goals Crocker, J & Canevello, A (2008) Creating and undermining social support in communal relationships: The role of compassionate and self-image goals. Journal of Personality and Social Psychology, Vol 95(3), Sep 2008, Compassionate mind/mentality Attention Thinking Reasoning Imagery Fantasy Compassion Behaviour Motivation Emotions 17

18 Competitive mind can block Compassion Attention Thinking Reasoning Imagery Fantasy Compete Behaviour Motivation Emotions Threatened mind can block compassion Attention Thinking Reasoning Imagery Fantasy Threat Behaviour Motivation Emotions 18

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20 For CFT The psychology of seeking/receiving is as important as the psychology of giving Compassion as Flow Different practices for each Other Self Self Self Other Self Evidence that intentionally practicing each of these can have impacts on mental states and social behaviour 20

21 Compassion Solutions Ancient wisdom Compassion is the road to happiness (Buddhism) Evolution Evolution has made our brains highly sensitive to external and internal kindness Neuroscience Specific brain areas are focused on detecting and responding to kindness and compassion Social and developmental psychology History of affiliation affects brain maturation, emotion regulation, prosocial behaviour and sense of self Being cared for and Physiology The evolution of caring brings major changes in physiological regulation Relationships are physiological regulators Gene expression Stress reactivity Immune system function Frontal cortex Illness and recovery Core values Self-identities Compassion and empathy 21

22 Compassion Focused Therapy: A Social Mentality Caring/Helping Giving Care/Help Seeking/Receiving Specific Competencies e.g., attention empathy Specific Competencies e.g., openness responsive Facilitators vs Inhibitors Facilitators vs Inhibitors CFT: Deliver compassion by stimulating evolved brain systems Social mentality theory suggests that you can use a social communicative/signalling process to deliver your message Compassionate self Compassionate other 22

23 Fear of Compassion The Hard Side of Compassion Loved Stranger Hated Oxytocin may increase prosocial affects for others but increase hostility to those seen as threats Self-compassion too is easier for pain than for shame and the hated part of self 23

24 Self and others Self and self Self-to self Threat Shame Affiliative/ Soothing 120 Million year evolving systems to regulate threat Social relationships are the most important sources of meaning, self regulation and learning Kindness, Attachment and Threat Kindness from therapist or imagery Fight, flight shut down Activate attachment system Activate memories Fight, flight shut down Neglect aloneness Abuse, shame vulnerable Activate learnt and current defences - cortisol 24

25 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 25

26 Data From Group Study 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. 26

27 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. Conclusion Humans are capable of wonderful things, but also terrible things. Our minds are really a mixed range of potential motives, ways of thinking and behaving and we easily dissociate one state of mind from another By improving our understanding of the nature of compassion, it s facilitators and inhibitors, both as a giver and receiver, we may be better placed to cultivate the good in us. This could be the focus for the next generation 27