Slides van de presentatie van Paul Gilbert tijdens Congres Integrale Psychiatrie 2012

1. Why do we need Compassion?
Compassion Focused Therapy Life is Hard
Groningen April 20th
Paul Gilbert PhD, FBPsS, OBE
Mental Health Research Unit, Kingsway
Unit,
Hospital Derby
p.gilbert@derby.ac.uk
www. compassionatemind.co.uk
www.compassionatelbeing.com
Collaborators
Compassion??
Jean Gilbert
Kirsten McEwan
• Specific feelings and acts
Corinne Gale
Chris Irons • Desires to be a certain king of self
Marcela Maratos
David Zuroff
Allison Kelly That which arises from deep insight into the
nature of our ‘reality’
reality’
• Buddhist view
• Evolutionary view
Compassion begins with a reality check The human brain is the product of many millions of years of
evolution – a process of conserving, modifying and
We are an emergent species in the ‘flow of life’ so
life’ adapting
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
(25,000-
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

2. New Brian Abilities
Sources of behaviour
Old Brain Psychologies Sources of behaviour
New Brain
Emotions Imagination,
Fear, Anxiety, Anger, Lust, Joy Planning, Anticipation
Rumination, Reflection
Social Motives Purposeful focusing of the mind
Closeness, Belonging, Sex, Status, Respect Integration
Old Brain Self Identity
Getting ‘Smart’
Smart’
Interaction of old and new psychologies
Interaction of old of behaviour
Sources and new psychologies Sources of behaviour
and mindful brain
New Brain: Imagination, Mindful Brain
Planning, Rumination, Integration
Glitches New Brain: Imagination,
Old Brain: Emotions, Motives, Relationship Planning, Rumination, Integration
Seeking-Creating
Archetypal Old Brain: Emotions, Motives,
Relationship Seeking-Creating
Archetypal
Thinking brain can cause serious problems in using
old affect and motive systems
Interaction of old and new psychologies
Sources of behaviour
and mindful brain
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
Mindful Brain figure out
Life involves dealing with tragedies (threats, losses,
New Brain: Imagination, diseases, decay, death) and people do the best they can
Planning, Rumination, Integration
Much of what goes on in our minds is not of ‘our design’
design’
and not our fault
Old Brain: Emotions, Motives,
Relationship Seeking-Creating Compassion rooted in deep insight of what
COMPASSION we are all in this ‘suffering’ together –
suffering’
It’s a set up!

3. Understanding our Motives and Types of Affect Regulator
Emotions Systems
Drive, excite, vitality Content, safe, connected
Motives evolved because they help animals to
survive and leave genes behind Non-wanting/
Incentive/resource- Affiliative focused
focused
Emotions guide us to our goals and respond if we Wanting, pursuing,
Safeness-kindness
are succeeding or threatened achieving Soothing
Activating
There are three types of emotion regulation
Threat-focused
1. Those that focus on threat and self-protection
self- Protection and
Safety-seeking
2. Those that focus on doing and achieving
Activating/inhibiting
3. Those that focus on contentment and feeling safe
Anger, anxiety, disgust
Types of Affect Regulator
Systems
Drive, excite, vitality Content, safe, connected
Non-wanting/
Incentive/resource- Affiliative focused
focused
Safeness-kindness
Wanting, pursuing,
achieving Soothing
Activating
Threat-focused
Protection and
Safety-seeking
Activating/inhibiting
Anger, anxiety, disgust

4. Safeness,
Affiliation and
affect regulation
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, 2002.

5. Types of Affect Regulator Systems
Drive, excite, vitality Content, safe, connected
Non-wanting/
Incentive/resource- Affiliative focused
focused
Safeness-kindness
Wanting, pursuing,
achieving Soothing
Activating
Threat-focused
Protection and
Safety-seeking
Activating/inhibiting
Anger, anxiety, disgust
The Mammalian Importance of
Caring Minds
Caring as “looking after”. Seeking closeness
after”
rather than dispersion. Individuals obtain
protection, food, and care when ill. Key also is
soothing-calming and physiological regulation.
soothing-
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
Co-
affiliative systems and helps regulate threat
Study of Types of Positive Affect Types of Positive affect
Factor
Items 1 2 3
Participants asked how characteristic specific emotions Energetic .802 .217 .225
were for them (N = 203) Lively .782 .117 .351
Adventurous .642 .265 .148
Active .608 .274 .192
0 = Not Ch. 4 = Very Ch. Enthusiastic .600 .159 .392
Dynamic .584 .282 .267
Excited .552 .214 .289
Energetic 0 1 2 3 4 Eager .401 .032 .244
Relaxed .262 .794 .258
Excited 0 1 2 3 4 Peaceful .222 .747 .424
Calm .191 .675 .445
Tranquil .186 .664 .395
Laid back .169 .601 .241
Relaxed 0 1 2 3 4 Serene .221 .548 .339
Safe .214 .426 .740
Safe 0 1 2 3 4 Content .310 .494 .702
Secure .362 .422 .606
Warm .231 .166 .503

6. Between self and others
Correlations
Dep Anxiety Stress
Self
Self-to self to self
Activated -0.17* -0.16* -0.08
-0.27** -0.15* -0.20** Calms
Threat Affiliative/
Relaxed -0.30** -0.22** -0.38** Soothing
-0.22** -0.17* -0.37**
Safeness -0.38** -0.29 ** -0.33**
-0.47** -0.27** -.041**
120 Million year evolving system to regulate threat
Physiological Systems Compassion Solutions
Major physiological systems that are focused on Ancient wisdom Compassion is the road to
attachment and affiliation – e.g., oxytocin happiness (Buddhism)
• Facilitates monogamous bonding Evolution Evolution has made our brains highly
• Facilitates conspecific recognition sensitive to external and internal kindness
• Facilitates attachment
• Increases trust Neuroscience Specific brain areas are focused on
• Increases competencies in mind reading tasks detecting and responding to kindness and
• Increases feelings of liking others compassion
• Reduces activation in the amygdala to threat faces
Social and developmental; psychology History of
Source Macdonald and Madonald 2010 The Peptide That Binds: A Systematic
Systematic
Review of Oxytocin and its Prosocial Effects in Humans Harvard Review of affiliation affects brain maturation, emotion
Psychiatry 1-21 regulation, prosocial behaviour and sense of self
What do we need to feel compassion?
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” Dalai Lama
it”
Now there is increasing focus on what
compassion and is and how it works

7. Caring-Compassionate Mind
Caring-
Distress tolerant and empathy
Warmth Warmth
ATTRIBUTES
Sensitivity Sympathy
Care for Compassion Distress
well-being
well- tolerance
Non-Judgement
Non- Empathy
Warmth Warmth
Caring-Compassionate Mind
Caring-
Non-judgement – we all struggle
Non-
SKILLS -TRAINING
Warmth Warmth
Imagery
ATTRIBUTES
Attention Reasoning
Sensitivity Sympathy
Distress
Care for Compassion tolerance
well-being
Feeling Non-Judgement Empathy Behaviour
Sensory
Warmth Warmth
Compassion Behaviour
Focus of Compassion
Two very Different Psychologies Commonly Misunderstood
Develop kindness, support and encouragement to promote
1 Inner circle awareness engagement and the courage we need - to take the actions we need – in order
understanding – engaging with difficult to promote the flourishing and well-being of ourselves and
well-
emotions 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
2 Outer circle focus on alleviations, changing emotion, the traumatised person engages with ‘healing’
healing’
their memories
loving-kindness and enthusiasm – engaging
loving-
with positive and affiliative emotions
Hence the importance of building CAPACITY

8. Compassionate Process
Problems with Compassion
Mindful Compassionate Engagement
Motivation, sensitivity, sympathy, distress tolerance, • Problems of the inner circle with: Motivation;
empathy nonjudgement/acceptance attention/sensitivity; sympathy, distress
tolerance; empathy; and judging
Wisdom
Courage
• Problems with the positive and afiliative
Mindful Compassionate Alleviation emotions – linked to the problems with the
soothing affiliative systems.
Motivation, attention, thinking, behaviour, feeling,
• Linked to attachment history/style?? Peer
imagery, sensory focusing attachment/style??
Build compassionate capacity for engaging and changing
Compassionate mind/mentality Competitive mind can block Compassion
Thinking
Thinking Attention
Attention Reasoning
Reasoning
Imagery
Imagery Compete Behaviour
Compassion Behaviour Fantasy
Fantasy
Motivation Emotions
Motivation Emotions
Threatened mind can block compassion Compassion as Flow
Thinking Different practices for each
Attention Reasoning
Other Self
Imagery
Fantasy Threat Behaviour Self Other
Self Self
Motivation Emotions
Evidence that intentionally practicing each of these can
have impacts on mental states and social behaviour

9. Data Compassion Behaviour as Courage
• Practice of imagining compassion for others produces changes in
frontal cortex and immune system (Lutz et al, 2009) Develop kindness, support and encouragement to promote
the courage we need - to take the actions we need – in order
• Loving kindness meditation (compassion directed to self, then to promote the flourishing and well-being of ourselves and
well-
others, then strangers) increases positive emotions, mindfulness,
mindfulness, others
feelings of purpose in life and social support and decreases illness
illness
symptoms (Frederickson et al, 2008, JPSP)
The agoraphobic develops the courage to go out and expose
• Compassion meditation (6 weeks) improves immune function, and themselves to fear; the abused wife leaves her violent
neuroendocrine and behavioural responses to stress (Pace, 2008,
PNE) husband; the depressed person works on the fear of
emotion, the traumatised person engages with ‘healing’
healing’
• Viewing sad faces, neutrally or with a compassionate attitude their memories
influences neurophysiological responses to faces (Ji-Woong Kim,
(Ji-
2009, NP)
Hence the importance of building affiliative CAPACITY to
• Compassion training reduces shame and self-criticism in chronic
self- work on the painful things – not ascent to angelic status
depressed patients (Gilbert & Proctor, 2006, CPP)
Compassionate and self-image goals were assessed with 13 items. All items
self-
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).
(not all) (always).
to,” Findings (N 199)
Average compassionate goals predicted closeness, clear
Seven items assessed compassionate goals, namely, “be supportive of others,”
others,” and connected feelings, and increased social support and
“have compassion for others’ mistakes and weaknesses,” “avoid doing
others’ weaknesses,” trust over the semester; self-image goals attenuated these
self-
anything that would be harmful to others,” “make a positive difference in
others,” effects.
someone else’s life,” “be constructive in your comments to others,” “avoid
else’ life,” others,”
being selfish or self-centered,” and “avoid doing things that aren’t helpful to
self- centered,” aren’
me or others.”
others.” Average self-image goals predicted conflict, loneliness,
self-
and afraid and confused feelings; compassionate goals
Six items assessed self-image goals, namely, “get others to recognize or
self- attenuated these effects.
acknowledge your positive qualities,” “convince others that you are right,”
qualities,” right,”
“avoid showing your weaknesses,” “avoid the possibility of being wrong,”
weaknesses,” wrong,”
“avoid being rejected by others,” and “avoid taking risks or making
others,” People with compassionate goals create a supportive
mistakes.”
mistakes.” environment for themselves and others, but only if they do
not have high self-image goals
self-
Crocker, J & Canevello, A (2008) Creating and undermining social support
in communal relationships: The role of compassionate and self-image goals.
self-
Journal of Personality and Social Psychology, Vol 95(3), Sep 2008, 555-575
2008, 555- 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
self-
95(3), Sep 2008, 555-575
555-
Kindness, Attachment and Threat
Kindness from therapist or imagery
Fear of Activate attachment system
Activate memories
Fight, flight Fight, flight
Compassion shut down
Neglect Abuse, shame
vulnerable
shut down
aloneness
Activate learnt and current defences - cortisol

10. Treatment Data From Group Study
• Attendance one of two programmes Pre and Post Compassionate M ind
• Patients invited to take part in a research trial of Training
CMT at community meetings
• Criteria for inclusion were mid treatment (six months 60 54.2 56.4
to one year), well engaged with the service and to have
50
self-attacking, negative thoughts
self-
40 Before
• Nine patients agreed to take part in the study (five
Scale
men and four women) Af ter
30
• Three did not complete the study: hence six completed 18.8
20
• Twelve two hour sessions 10.2
10
• Gradual process of developing compassionate imagery
and soothing exercises and then engaging with self 0
critical thinking Self criticism Self compassion
Data From Group Study Reflections
HADS I would just like to tell you all here today what (CMT)
14.67
means to me. It seemed to awaken a part of my brain that
16 (3.78)
I was not aware existed.
14
The feeling of only ever having compassion for other
10.33
people and never ever contemplating having any for
12
(2.67)
myself.
10 Suddenly realising that it’s always been there, just that I
it’
6.83 have never knew how to use it towards myself.
core
Bef ore
8 (2.93)
Af ter
S
4.3
6
(2.73) It was such a beautiful, calming feeling to know it was Ok
4 to feel like this towards myself without feeling guilty or
bad about it.
2
Being able to draw on this when I was frightened and
0 confused, to calm myself down and to put things in
Anxiety Depression prospective and say to myself “IT’S OK TO FEEL LIKE
IT’
Subs cale THIS.
Reflections Conclusion
Having compassion for myself means I feel so much more at
Attachment and affiliation evolved as a major threat
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
it’ regulator – mental and physical help and positive
thinking, but a very healthy way of thinking. It felt like I social relationships are underpinned by them
was training my mind to switch to this mode when I start to
feel bad about myself or life situations were starting to get These systems have become compromised in many folk
on top of me.
with affective disturbances –
What is striking about this, and what other participants
thought, was how much they had (previously) felt that being and even in our competitive societies themselves
self-compassionate and empathic to one’s distress was a self-
self- one’ self-
indulgence or weakness and definitely not something to Our future will be influenced by how compassionately
cultivate.
focused we become in how we live our internal lives
and create societies

11. Where next in Compassion? Evolved Systems and Types of Mind
Self and Social Identity:
Automatic vs the chosen/
• Compassion is a complex and multifaceted process trained self
that organises our minds
Interacting
• Still ongoing debates about key elements although processing
Cognitive/meta-cognitive
Cognitive/meta-
motivation and intention are central symbol systems:
systems Thinking mind
• Compassion should be distinguished from sympathy
empathy, kindness but rooted in affect regulation Patterned
Basic Social Motivational
systems by and Role Seeking Systems:
• Genuine compassion that involves equanimity, experiences Status; Sex; Caring
openness and empathic competencies and that
changes psychological and physiological processes Basic emotion regulation:
should be distinguished from automatic kindness Threat; Seeking, and
and concerns with self presentation Contentment/Soothing
Where next in Compassion Conclusion
• Training compassion is much more complex than it • Many physiological systems function best under
appears and requires substantial research conditions of social affiliation and safeness
• Training needs to take in not only the level of competencies • Must distinguish between different types of positive affect
but also blocks and fears to compassion
• The balance of threat based emotions to positive ones
• Training based in the Tibetan traditions have a series of (depressed anxious and hostile) are linked to social
steps safeness and affiliation
• Training based in psychotherapy research may have • The study and promotion of internal and external
similar steps or different ones –ways of developing specific afiliation should be a priority -- and understanding the
physiological systems that support compassion such as evolutionary roots and brain mechanisms for affiliation
oxytocin supplementation require further research will play a key role in this endeavour
Showing we care