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Compassion-focused therapy is a novel form of psychotherapy developed by Paul Gilbert to help treat severe and enduring mental health problems in individuals who live with high levels of self-criticism and shame. CFT is based on the principles of neuroscience and has been designed to address complex psychiatric problems resistant to conventional forms of treatment. Compassion-focused therapy is especially useful for those who feel ashamed of something unimportant or uncontrollable, or who are overly self-critical. It is also an effective form of therapy for those who have difficulty feeling compassion for others and themselves. By applying the principles of compassion-focused therapy, patients learn to display more warmth, compassion and understanding in social situations and towards themselves.

CFT combines techniques in cognitive behavioural therapy with concepts in evolutionary psychology, social psychology, Buddhism, developmental psychology and neuroscience. Compassion is at the core of CFT and the ability to feel compassion and use it effectively to improve one’s psychological health is understood as an essential trait in transforming problematic cognitive patterns and emotional reactions (such as anxiety, anger and shame) into more productive thoughts and feelings that play a constructive role in a person’s life.

The goal of CFT is to offer warmth, safety and a calming atmosphere and to help individuals learn the key skills required in developing self-compassion and compassion for others. These skills include care, sensitivity, distress tolerance, empathy and non-judgement. CFT may be used as a framework within which to focus other psychological interventions, as these may become more effective within a climate in which systems of positive emotional regulation are activated.

How CFT works

Compassion-focused therapy (CFT) is rooted in current understandings of the three basic emotional regulation systems that affect behaviour and emotional health.

  • The threat and self-protection system

Regarded by many psychologists as the dominant emotional regulation system, this is the system that recognizes danger and responds appropriately. It is also the locus of negative emotions such as anger, dread and disgust. For people seeking counselling, the threat and self-protection system is often in overdrive resulting in overwhelming feelings of anxiety and fear. Negative emotions may manifest as activating responses (such as the fight or flight impulse) or may be deactivating (resulting in feelings of paralysis, despair, helplessness and defeat). The goal of CFT is to bring the threat and self-protection system in better alignment with the other emotional regulation systems that work with more positive emotions. This can reduce the overall negative impact of overwhelming negative emotions.

  • The drive and excitement system

What is not commonly recognized by other forms of therapy, is that positive emotions are regulated by entirely different regulation systems and that these systems play a crucial role in how perceived threats are handled and in a general sense of wellbeing. The drive and excitement system represents the activating and thrill-seeking aspects of positive emotion and is related to competitive behaviour and the acquisition of resources and social standing believed to be beneficial.

  • The contentment and social safeness system

“Deactivating” positive emotions – feelings of restfulness, peace and contentment – are crucial to maintaining good mental health. This translates into the ability to feel contentment and safety – rather than anxiety – in times of relaxation. CFT regards these positive emotions not merely as the “absence of threat” but actively cultivates feelings of safety and contentment in the clinical environment. Compassion-focused therapy recognizes that aversion to the positive emotional regulation systems can be acquired in childhood, for example when parents brand relaxation as “laziness” or when feelings of contentment are perceived as “lowering one’s guard”. As such, aversion to positive emotions plays a significant role in the persistence of mental health problems. The goal of compassion-focused therapy is to shed light on the connection between ingrained cognitive patterns and the three emotional regulation systems. This is done using a variety of techniques, including CBT, group compassion training and meditation. By learning how these systems work, it becomes easier to control one’s reactions when one of these systems is activated. For example, by applying methods in compassion-focused therapy, one might learn to reduce the impact of the “warning” system and instead appeal to the “contentment and safeness” system. CFT techniques also make it easier to recognize which of the emotional regulation systems is activated in any given situation.

By learning to “bypass” the motivation and warning system when necessary, one can, according to CFT, examine one’s own emotional state more objectively. This means that individuals can learn to be open to new ideas and to regard their emotional state with less judgement and more understanding.

CFT Treatment

Compassion-focused therapy is based on the evolutionary role of compassion in our psychological development and our ability to regulate our own behaviour. The care of a parent towards an infant and the effect of such care on our psychological development serves as a model for CFT. For the therapist, compassion-based therapy involves empowering individuals to develop self-compassion, compassion for others and openness to receiving compassion from others, particularly in response to adversity or threatening situations. During the journey, the client learns how to encounter emotions in a non-judgmental way by treating feelings positively and with curiosity. Compassion-focused therapy makes it easier for people to accept the challenges and potential difficulties they face and to find solutions to existing problems. The main focus is thus on developing the tools and mental habits that can help individuals find solutions to their problems, rather than solving potential life problems directly. CFT is about developing a compassionate relationship with others that makes it easier for the individual to process challenges and develop personalized methods for solving life’s problems. Crucial to this process is that the individual assumes an understanding and accepting state of mind and learn to experience empathy towards suffering and its emotional impact. This results in individuals not blaming themselves as much for their self-perceived shortcomings, thus freeing them from the emotional baggage of excessive self-criticism. This also makes it easier to identify and examine potential solutions to psychological and relational problems.

CFT exercises

Representing a fusion of Western and Eastern philosophies of wellbeing, the primary goal of compassion-focused therapy is to activate the individual’s emotional-response systems for generating positive emotions through compassion for others and oneself. Through training and guided exercises, the individual is encouraged to develop sensitivity for the difficulties of others and to cope with their own psychological disturbances by fostering self-tolerance and compassion. CFT exercises enhance the individual’s ability to enter a non-judgmental state of mind. Common CFT exercises include:

  • Exercises that focus on appreciation and acceptance. These can include making lists of positive attributes about yourself or about others, or active attempts to find positive aspects in yourself. Compassionate letter-writing, where you write a letter to yourself from the perspective of someone who loves you unconditionally, is often used in the therapeutic context.

  • Exercises that increase mindfulness. Simply defined, mindfulness is the ability to focus on one’s own thoughts and be aware of them. It is also important that you reduce your reactions to what you observe in your mind as much as possible.

  • Guided thinking exercises where the patient’s imagination form images and shapes that stimulate the calming system and promote compassion. This may include guided visualizations or body scan exercises.

Visualization is an important technique in helping people who suffer from excessive self-criticism. With the guidance of a therapist, patients are encouraged to describe the feeling in as much detail as possible in order to surrender to that feeling without being overwhelmed by it. The process involves empathy for one’s own feeling states and the consequences of one’s upbringing in order to cultivate radical self-acceptance.

CFT Research

Although compassion-focused therapy is a fairly novel form of psychotherapy, research has shown it to be an effective treatment modality for a number of psychological disorders. This is because CFT is targeted at treating shame and self-criticism – problems that underlie many different psychological diagnoses. Recovering from psychosis or suffering from mood-disorders are often associated with high levels of shame and self-criticism. In treating depression, research has shown that CFT is more effective than other forms of treatment. 

Research on CFT has shown that compassion can be taught and learnt through training and that fear of compassion can be reduced in the clinical environment. CFT is based on research that shows a direct link between self-compassion and an increased sense of wellbeing and quality of life. Compassion regulates negative affect through caring behaviours. By coaching individuals to express and communicate feelings of warmth and safeness, the effects of negative emotions are reduced. CFT also builds on research on the positive effects of meditation. Meditation reduces stress and increases positive emotions, feelings of purpose in life and a sense of social support. Meditation also promotes healthy coping strategies. From a biological perspective, compassion has been shown to reduce stress-linked immune responses and research on compassion-based exercises such as letter-writing shows a reduction in symptoms of depression. These exercises are effective because they enhance activation of the brain areas involved in emotional processing and empathy.  Neuroendocrine studies suggest that compassion-based techniques reduce stress-induced distress and immune response. Studies have also found that compassion-based training and therapy can have positive effects within a relatively short time.

Because it targets shame and self-criticism, compassion-focused therapy is a promising treatment for eating disorders and diagnoses associated with self-harming behaviours. A modified version of CFT – CFT-E – has been developed to treat such problems. CFT-E confronts patients’ self-critical thoughts and negative emotions directed at themselves.

CFT Training

Although there is currently no certification for CFT practitioners in the UK, trained psychologists can undergo special training to become practitioners of the method. The Compassionate Mind Foundation, established by Paul Gilbert, offers training and workshops in the method and some universities are also beginning to offer CFT training as a postgraduate certificate. More commonly, CFT and its associated techniques are incorporated into general psychotherapy education.

CFT in conclusion

The compassion described in CFT refers to a particular mental state where individuals are motivated to control their emotions through empathy. By employing compassionate mind training, psychotherapists can help people suffering from excessive shame and self-criticism to develop skills in extending compassion to others and themselves. CFT assists in actively cultivating such compassion. In this way, CFT can contribute to positive cognitive and life changes.

Updated: 2022-11-14

Author: Willemien Froneman

Reviewed by: Antigone Lanitis