Compassion Focused Therapy

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What if I told you that there was a pill, that if you took it, would reduce your levels of worry, rumination, shame, and self criticism and make you less likely to suffer from mental health problems?

Additionally, that it would give you more optimism and curiosity, make you more creative, boost positive emotions, and improve your relationships with others.

What if I also told you that it was completely free, and had zero side effects?

Would you take it?

That pill exists, and it’s called compassion. 

Spiritual traditions and religions have been recommending it as a way to greater wellbeing for thousands of years, and until recently, it was confined to these domains. 

However, new scientific research is beginning to shed light on the incredible potential compassion has for improving wellbeing. Approaches such as Compassion Focused Therapy (CFT) have been developed as a way to harness its power to help people remove unnecessary suffering from their lives, and realise more of their potential.

In this post, we’ll explore some of the key ideas CFT is built upon, debunk some commonly held myths around compassion (e.g. that it’s soft or indulgent) and explore the critical role it plays in mental health and wellbeing. 

But first, we need to define exactly what we mean by compassion. 


Defining Compassion

Compassion Focused Therapy

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There are many definitions out there, but since we are focusing on Compassion Focused Therapy in this post, we’ll use the definition provided by the developer of CFT – Professor Paul Gilbert. 

Paul defines compassion as:

“The sensitivity to suffering in self and others with a commitment to try to alleviate and prevent it.”  

The definition is important because it shows us that compassion is a motive that has very little to do with emotions. 

Often compassion is confused with things like pity, softness, empathy, and lumped into the same category as these terms. However, Gilbert’s definition shows us that compassion goes beyond emotional states, as the emotions we experience when being compassionate can take many forms.

Take the example of the firefighters who rushed into the World Trade Centre following the 9-11 attacks, putting their own lives at risk to help others. 

If you think about it, their behaviour fits Gilbert’s definition quite well. 

They were sensitive to the distress and suffering of the people inside, and committed to try and alleviate it and prevent it by attempting to rescue them.

Another example is that when COVID-19 broke out, more than 7,000 ex-nurses offered to come out of retirement to help out on hospital wards. Again, this fits our definition of compassion quite well. These individuals were sensitive to the suffering of others, and committed to do something about it. 

Both examples also show us that compassion is in no way ‘soft’.

They required a great deal of courage, and it is likely that these firefighters and nurses experienced high levels of anxiety as a result of their compassion.

Other examples of compassion that fit our definition may include: 

  • A counsellor helping somebody through a bereavement 
  • A mother soothing her crying daughter after falling off her bike and cutting her knee
  • A human rights activist (e.g. Martin Luther King) leading a public demonstration for equality. 

The key thing to remember is that compassion is a motive – which means we can experience a wide range of emotions when being compassionate.


Understanding Our Evolutionary Origins

Compassion Focused Therapy

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“Our troubles arise from the fact that we do not know what we are and cannot agree on what we want to be. The primary cause of this intellectual failure is ignorance of our origins. We did not arrive on this planet as aliens. Humanity is part of nature, a species that evolved among other species. The more closely we identify ourselves with the rest of life, the more quickly we will be able to discover the sources of human sensibility and acquire the knowledge on which an enduring ethic, a sense of preferred direction, can be built. — E.O. Wilson 

A core component of CFT involves helping people understand their evolutionary origins. 

The logic behind this is that if you know, at a deep level, that you just woke up one day in the flow of life, and that a large part of your thoughts, feelings and behaviour (up until now) have been shaped by evolved mechanisms as well your environment, then you realise that the things you might be most ashamed about are not your fault. 

The evolutionary view of life lets us see that we didn’t choose any of this. 

We didn’t choose to have a tricky self critical mind that constantly beats us up from the inside out. We didn’t choose to have a preference for sugary, fatty foods that lead to poor health. We didn’t choose the emotions we are capable of experiencing, such as anger, fear, anxiety, shame and regret. We didn’t choose the town we were born in, or the parents that brought us up. 

We simply woke up one day, as this person, in this situation, with a body, mind and genetic profile that has been shaped by millions of years of evolution to survive in an environment that is almost completely unrecognisable from the one we currently find ourselves in. 

On top of this, the new science of epigenetics shows us that the environment we find ourselves in plays a huge role in shaping the people we become, and tells us that had we been born at a different place and time, we would be different people entirely. 

To illustrate this, think of two brothers who lose both of their parents in a tragic car accident a few months after they are born. 

When they are put up for adoption, one brother goes to foster parents that provide him with a nurturing environment, send him to a good school, ensure he eats the right food, and offer him support and guidance as he grows up. The other brother, however, goes to violent, abusive parents who are addicted to heroin. He is exposed to domestic violence, is regularly abused, gets fed poorly, and lives in a rough neighbourhood where he is constantly under the threat of violence. 

Now imagine just how differently the two brothers might turn out.

Although this is hypothetical, it illustrates an important point: our context plays a huge role in shaping who we become. 

Different contexts produce different individuals. 

Therefore, if we can understand this, we realise that a lot of the things we might be most ashamed about are not our fault. They were simply ‘put there’ by evolution, or were adaptations to the environmental circumstances we were raised in. 

Gilbert and his colleagues argue that this is a crucial first step in developing compassion for ourselves and others.

However, compassion isn’t simply about ‘letting ourselves off the hook’. 

The next step is to realise that although these things are not our fault, they are our responsibility

Our job in the modern world is to cultivate enough self awareness to understand how our minds work, and “overwrite” our evolutionary and cultural programming, so that we can consciously create a version of ourselves based on what we truly value in life. 

So now, let’s take a look at a simple CFT model for understanding the mind.


The 3 Emotion Systems

 

Compassion Focused Therapy

The CFT model divides the mind into three basic systems: 

  1. The Threat System (Fight, flight and freeze)
  2. The Drive System (Find mates and resources)
  3. The Soothing System (Bonding & Recovery)

All three systems served an evolutionary purpose in our distant past. 

The threat system enabled us to be vigilant and escape predators. The drive system motivated us to seek resources, find a mate, hunt animals and forage for food. The soothing system helped us to foster positive social relationships and recover from the stressors of the day, so we would be refreshed and energised for the next day’s efforts. 

Those within CFT argue that these systems are primary, and that whichever one is currently “online” influences the thoughts, feelings and behaviours that follow.

For example, if your threat system is active, you are likely to experience negative thoughts and emotions, which serve the purpose of keeping you safe from the danger. (The threat system can also be triggered by feelings of exclusion, bullying, and an overly negative internal critic.)

If your drive system comes online, then you are likely to experience emotions and thoughts that energise you and motivate action. 

And if your soothing system is active, you will experience calm and relaxation, helping you to recover and bond with others.

Let’s look at an example which illustrates just how primary these systems are in influencing our thoughts and behaviour, and how they can become active in different situations.

Compassion Focused Therapy

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Imagine you are out at your favourite restaurant with your romantic partner. You are seated beside a warm, crackling fire, and feel relaxed as you connect deeply in a meaningful conversation over dinner. In this situation, it is likely that your soothing system is running the show, causing you to feel content and safe.

After the meal, you walk home and have to pass through some dark alleys on the way. 

As you turn a corner, you are suddenly confronted with a group of ten hooded males, with nobody else in sight.

Compassion Focused Therapy

What thoughts and emotions might you experience now? The chances are that you will move into the ‘threat system’, which quickly brings a range of worst case scenarios to mind. Your heart rate increases. You look to see if they have weapons. Maybe you reach for your phone and get ready to call the police. 

Luckily, nothing happens and you pass by unscathed – it turns out they were a group of graffiti artists working on a new mural. 

Relieved, you laugh about it with your partner, and decide to pick up a celebratory bottle of wine on your way home. Inside the store, you remember that the National Lottery is tonight, and, encouraged by your earlier luck, you buy a ticket. You rush home and get there just in time to see the results read out. The presenter reads out the exact numbers on your ticket, and you realise you’ve just won £10 million! 

Now, the ‘Drive System’ kicks into overdrive. 

Think about the effect this would have on your thoughts and emotions. You’d probably find it hard to contain your excitement, and there’s a good chance you’d have great difficulty in getting to sleep that night. 

This example highlights how primary these emotion systems (soothing, threat, and drive) are, and the extent to which they influence our thoughts, feelings and behaviour. The problem with modern life, particularly in the competitive cultures we have created in western society, is that our emotion systems are out of balance, and mainly stimulate our threat and drive systems, at the expense of our soothing system.

When people come to therapy, it is often because they are spending a disproportionate amount of time in the threat system – which leads to a whole range of mental health problems.

A key goal of CFT then, is to help clients restore balance; reducing the threat system, building the drive system (in a sustainable way), and growing the soothing system.


The Three Flows of Compassion

Compassion Focused Therapy

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You can’t pour from an empty cup

Many aspects of our psychology have a ‘flow’ like quality to them. 

Take anger as an example. We can direct anger towards others, we can receive anger from others, and we can be angry at ourselves in the form of self criticism. 

The same goes for compassion. 

The CFT model posits that compassion ‘flows’ in the following three ways:

You —- > Other (Giving compassion to others)

Other —– > You (Receiving compassion from others)

You ——> You (Being compassionate towards yourself).

For optimal mental health and wellbeing, it’s vital to focus on all three flows. You should be able to give compassion to others, receive compassion from others, and also be compassionate towards yourself.

It’s important to take all three into account, as very often we can be deficient in one area.

For example, I have a friend who is always helping others to such an extent that he never has a minute for himself – which often leads to feelings of burnout and frustration. Barbara Oakley’s research into ‘pathological altruism’ has shown that pathologies of altruism can cause depression and burnout in healthcare professionals, lead to health issues, and may even underpin some personality disorders. 

Image credit; Dr Chris Irons (https://balancedminds.com/)

This graph illustrates the importance of finding balance between the three flows.

As we can see from the bottom left, those who score lowest in care seeking, also score lowest in self compassion. In other words, if you’re bad at receiving care from others, you also tend to have low levels of self compassion.

Interestingly, this group also scores highly in giving care to others, which suggests that people with a strong motivation to help others, often lack the ability to care for themselves, and have difficulty receiving care from others.

This is what it means to ‘pour from an empty cup’ – it’s unsustainable in the long run, and often leads to burnout.

As the top right of the graph shows, those who score highest in self compassion and care seeking, also score highest in caregiving. Therefore, this research suggests that if you’re committed to caring for others (in the long run), then the best strategy is to develop a compassionate relationship with yourself, and learn how to receive care from others.

Otherwise, you’re likely to experience burnout and all of the associated difficulties that come with it.

Since self compassion is the area that most people struggle with, let’s look at how you can begin developing a more compassionate relationship with yourself.


Developing Self Compassion

Compassion Focused Therapy

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During our Third Wave Online Conference, I asked Dr Chris Irons about his advice on how to start building a compassionate mind. 

Chris told me that the key thing was intention

It’s the intention to turn towards the difficulties in your life. It’s the intention to start treating yourself as you would if you were someone you loved or cared for.

This isn’t about ‘letting ourselves off the hook’. 

It’s about having the core intention to do what’s best for you in the long run. It’s taking the big picture of your life into account, and doing things today, that your ‘future self’ would thank you for, and be proud of. 

As Chris said in the session:

“If you think about your life, you will spend far more hours in relationship with yourself than you will do with anybody else that you meet in this life.”

Therefore, it’s vital to get this relationship right. 

So, the next time you are faced with a difficult or challenging situation, it can help to ask: ‘What would I advise a best friend to do in this situation?’ 

Often the answer won’t be about ‘letting yourself off the hook’. 

Rather, it might involve doing the difficult thing that you know would be good for you in the long run. 

For example, starting on an essay you’ve been procrastinating on, having an uncomfortable conversation with a loved one, going to the gym, etc.

If you get this intellectually, but still struggle with the idea of developing a compassionate relationship with yourself, Chris has developed The Compassionate Mind Workbook with his colleague Dr Elaine Beaumont. 

This is a step-by-step guide to CFT, which includes a range of evidence-based exercises from Buddhist practices and western psychological science aimed at helping you build a compassionate mind.


Conclusion

A growing body of research is indicating that compassion may be a ‘superpower’ of mental health and wellbeing. 

If we harness it, it has the potential to improve our own quality of life, and help us create more prosocial societies that bring out the best in human nature. 

If you are interested in making compassion a bigger part of your life, some of the ideas covered in this post can provide a good starting point.

To recap:

1.) Realise that compassion is not “soft”, indulgent or an emotion – but rather the sensitivity to suffering and the commitment to try and alleviate it

2.) Understand that your mind has been shaped by millions of years of evolution and environmental forces, and that it’s not your fault. But it is your responsibility to learn how it works, so you can better navigate this life

3.) Have the awareness that you have three basic emotion systems, and whichever one is ‘online’, has a huge influence on the thoughts and behaviours that follow. Learn how to consciously shift into the soothing system to regulate emotional wellbeing

4.) Realise that you can’t pour from an empty cup. If you want to care for others (in the long run) and not burn out, you have to learn both how to receive care from others and be compassionate towards yourself

5.) Know that you are always in a relationship with yourself. Develop the core intention to treat yourself as if you are somebody you love and care for.


Follow Up Resources

Books

The Compassionate Mind Workbook – Dr Chris Irons and Dr Elaine Beaumont

The Compassionate Mind – Professor Paul Gilbert

Living Like Crazy – Professor Paul Gilbert

Lectures & Interviews

Please click here for a ‘mini lecture’ which summarises some of the key ideas from this post.

Free lecture series from Paul Gilbert: The Nature of Compassion, Fear, Safe Relating and World Change

Compassion Focused Therapy: An Introduction – Professor Paul Gilbert

The Science of Self Compassion – Dr Kristin Neff

Evolution and Compassion Focused Therapy – Professor Paul Gilbert

Evolutionary Psychology, Compassion and Change – Professor Paul Gilbert

Online Courses

Foundations of Compassion Focused Therapy – Dr Dennis Tirch

Papers

Compassion: From Its Evolution to a Psychotherapy – Professor Paul Gilbert

Websites

The Compassionate Mind Foundation

Balanced Minds

The Center for Compassion Focused Therapy (New York)