Recently, I deep-dived into Compassion Focused Therapy, a relatively novel approach to psychotherapy that has both supported my self-care journey as well as my work as a coach & communication clinician. For anyone who is interested in learning more about CFT, I’ve compiled the following.

This document will be chunked into a glossary, a short main body, a reference list, a list of related short videos, and then materials from Dr. Gilbert and his colleagues related to CFT.  

1. Glossary and acronyms for key therapies, from the Psychology Today online site

Compassion Focused Therapy (CFT): a therapeutic approach that aims to help those who struggle with shame and self-criticism, often resulting from early experiences of abuse or neglect.

Cognitive Behavioral Therapy (CBT): a short-term form of psychotherapy based on the idea that the way someone thinks affects the way they feel and behave. The goal of treatment is to help clients identify, challenge, and change maladaptive thought patterns in order to change their responses to difficult situations.

Dialectical Behavioral Therapy (DBT): a structured program of psychotherapy with a strong educational component designed to provide skills for managing intense emotions and negotiating social relationships. The “dialectic” in dialectical behavior therapy is an acknowledgment that real life is complex, and health is not a static thing but an ongoing process hammered out through a continuous Socratic dialogue with the self and others.

Person-Centered Therapy (PCT): a non-authoritative approach that allows clients to take more of a lead in sessions such that, in the process, they discover their own solutions.  Clinician/expert behaviors are most critical in this approach, particularly: unconditional positive regard, accurate and informed empathy, and congruence, or authenticity.

Trauma-Informed Care (TIC): Trauma-informed care includes realizing how many patients, family members, and workers are affected by trauma; recognizing how trauma affects individuals; responding by using knowledge about trauma to inform serving families; and resisting re-traumatization/preventing further traumatic stress (SAMHSA, 2015). 

Adverse Childhood Experiences (ACES) study: The CDC maintains a plain-language explanation of ACES (linked here) with links to many related resources.

2. Compassion Focused Therapy (CFT)

CFT, developed by Paul Gilbert and formalized in the late 2010s, is a therapeutic approach that aims to help those who struggle with shame and self-criticism, often resulting from early experiences of abuse or neglect (Psychology Today, 2023). Gilbert explicitly mentions Carl Rogers, who developed person centered therapy (PCT), as well as Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Buddhist compassion practices, neuroscience, and evolutionary theory as contributions to his novel approach (Gilbert, 2010).  In his paper introducing CFT (Gilbert, 2009), he also refers to CFT as, “Compassion Mind Training.”  I quite like that euphemism, and it gets at how critical Buddhism and neuroscience are to him and other practitioners of CFT.

I also want to add, and this is my analysis, that it would be entirely appropriate to deem CFT as, “trauma-informed, person-centered dialectal/cognitive behavioral therapy.”  This is important to note because Gilbert, et al, are not simply inventing a thing from thin air.  They’ve accumulated evidence from formalized and studied methodologies and then…added aspects of buddhism, mindfulness, and meditation.

Gilbert indicates the importance, for human wellbeing, of honing one’s abilities to, 1. provide compassion to others, 2. receive compassion from others, and, most critically, 3. engage in self-compassion.  He also frames three evolutionary affect, or emotional, regulation systems.  First, the Threat system, what we all know as, “fight, flight, freeze or appease,” or the sympathetic nervous system (SNS).  Next, the Soothe system, what we all know as, “rest and digest,” or the parasympathetic nervous system (PNS).  Notably, and I think it’s VERY cool and important, Gilbert includes a Drive system, which might be called a “get up and go” system. With it, we feel excitement and motivation and seek rewards or pleasure in active goal-seeking behaviors.  Every indication from Gilbert and others (see references and related videos, below) is that the Drive system is more closely aligned or related to the Threat system, or SNS, though also can contribute to downshifting from the Threat to the Soothe system, or PNS.  And this makes sense, right?  We’re talking about “activation” rather than “calming,” and both Drive and Threat are activating, while Soothe is calming.  It seems that the Drive system is one wherein the prefrontal cortex, or what we call “executive functioning,” is online and supports homeostasis so that the person doesn’t shift to Threat.  (However, there is no neurological evidence of this additional aspect of the autonomic nervous system.  It does make a lot of theoretical, philosophical, and practical sense.  I say “practical” while considering informational interviewing, dialectical behavioral therapy, and the anecdotal fact that I’ve used some of these techniques with clients and found them to be quite efficacious.)

The challenge is that many people; through lived experiences, traumas, and even existing as disabled and/or neurodivergent and/or “unacceptably different” in a larger society that demands assimilation and compliance; have overactive or over-sensitive Threat systems.  Sensory dysfunction, or how we gather and process the signals coming into our nervous systems, is another contributing factor here.  And we know that with Autism, ADHD, other neurodivergences, and p/cTSD, sensory dysfunction is common.  What we can, I think, comfortably assume, and if we are trauma-informed it’s precisely what is indicated, that all of our clients come with their own personal journeys of traumas and nervous system dysregulation.

There is a small but promising evidence base (see references) pointing in the direction of CFT being ameliorative for people who cannot easily or readily engage in self-compassion, but who rather engage more reflexively in self-criticism or even self-loathing.  There is no strong or published evidence of the use and impact of CFT on Autistic, neurodivergent, and/or intellectually and developmentally disabled populations, per se…but the resources included in the references below point in a positive direction.

These aspects of CFT, when taken with the framing of trauma-informed care, or TIC, (I have a separate piece and resources related to TIC, if you ever want to see it it is here) align incredibly well with person-centered and neurodiversity-affirming frameworks, as opposed to medical, pathological, purely cognitive, or radical behaviorist frameworks.

My only caveat is that Gilbert often references Simon Baron-Cohen, an autism researcher strongly associated with the medical, pathology, and “Autism Speaks,” worlds.  I don’t get the sense that Gilbert is entirely on-board, and ultimately he is not in the Autism world in any way.  Baron-Cohen is certainly further from strict radical behaviorism and ABA, though still is not a neurodiversity-affirming professional.  I only mention this because Autistic, Neurodivergent, Intellectually and Developmentally Disabled people may ask this or a similar question.  The bottom line is WE (neurodivergent people) have never defined us, have never really even had a seat at the table making decisions about us, and thus just about anything from a therapeutic perspective is going to lag behind the state of things at present.  It seems that Gilbert and CFT folks would be very open to the neurodiversity framework as well as trauma-informed care.

That’s what I’ve been able to gather from what is listed below.  The videos are all very short and quite accessible/plain-language, and engaging.

3. References

“Compassion-Focused Therapy.” Wikipedia, 14 Aug. 2023, en.wikipedia.org/wiki/Compassion-focused_therapy#:~:text=Compassion%2Dfocused%20therapy%20(CFT). Accessed 4 Jan. 2024.

Craig C, Hiskey S, Spector A. Compassion focused therapy: a systematic review of its effectiveness and acceptability in clinical populations. Expert Rev Neurother. (2020) Apr;20(4):385-400. doi: 10.1080/14737175.2020.1746184. Epub 2020 Apr 10. PMID: 32196399.

Gilbert, P. (2009). Introducing compassion-focused therapy. Adv. Psychiatr. Treat. 15, 199–208. doi: 10.1192/apt.bp.107.005264

Gilbert, P. (2010). Compassion Focused Therapy: Distinctive Features (1st ed.). Routledge. https://doi.org/10.4324/9780203851197

Gilbert P. The origins and nature of compassion focused therapy. Br J Clin Psychol. (2014) Mar;53(1):6-41. doi: 10.1111/bjc.12043. PMID: 24588760.

Gilbert, P. (2020). Compassion: From its evolution to a psychotherapy. Frontiers in Psychology, 11, Article 586161. https://doi.org/10.3389/fpsyg.2020.586161

Mason D, Acland J, Stark E, Happé F, Spain D. Compassion-focused therapy with autistic adults. Front Psychol. (2023) Oct 26;14:1267968. doi: 10.3389/fpsyg.2023.1267968. PMID: 37965655; PMCID: PMC10641016.

Millard, L. A., Wan, M. W., Smith, D. M., & Wittkowski, A. (2023). The effectiveness of compassion focused therapy with clinical populations: A systematic review and meta-analysis. Journal of Affective Disorders, 326, 168–192. https://doi.org/10.1016/j.jad.2023.01.010

Psychology Today Staff. “Compassion-Focused Therapy.” Psychology Today, 28 February 2023, www.psychologytoday.com/us/therapy-types/compassion-focused-therapy.

Tirch, Dennis. “CFT: Focusing on Compassion in Next-Generation CBT | Psychology Today.” Www.psychologytoday.com, 15 July 2014, www.psychologytoday.com/us/blog/practice-compassion/201407/cft-focusing-on-compassion-in-next-generation-cbt. Accessed 4 Jan. 2024

4. Related Short Videos

Compassion Focused Therapy With Dr. Paul Gilbert: https://www.youtube.com/watch?v=4kF7FRy0_xs&t=358s

The Three Emotional Regulation Systems of Compassion Focused Therapy: https://www.youtube.com/watch?v=HX2N9Z6KKI8

Kristen Neff: The Three Components of Self-Compassion: https://www.youtube.com/watch?v=11U0h0DPu7k

Kristen Neff: Overcoming Objections to Self-Compassion:
https://www.youtube.com/watch?v=YFhcNPjIMjc

Developing a Compassionate Mind (for parents and caregivers): https://www.youtube.com/watch?v=ufK-0qANOd8&ab_channel=balancedminds

Making Sense of Stress With CFT’s Three Circles: https://www.youtube.com/watch?v=6TTtnw7Zizs&ab_channel=TheresaDahm

Dr. Dan Siegel’s Hand Model of the Brain: https://youtu.be/LdaUZ_wbD1c?si=gSH0bbWfD9a3wKwt 

Soothing Rhythm Breathing – Compassion Focused Therapy Exercise #LewisPsychology
https://www.youtube.com/watch?v=zS4pA17JMUw&ab_channel=LewisPsychology

How Childhood Trauma Affects Health Across A Lifetime: https://youtu.be/95ovIJ3dsNk?si=UvU8vDoY7USk9Fav

5. Resources from the CFT folks

While much of what happens in CFT is akin to CBT and DBT, and it is quite trauma-informed and client-centered, the primary innovation is the infusion of mindfulness, meditation, and Buddhist constructs of suffering, compassion, and growth.  I’ve used “soothing rhythmic breathing” with a client who REALLY loved it, and I plan to incorporate other aspects.  This stuff is not complex and we are all quite capable of infusing when and if we feel it appropriate.

Okay…so the first link here is to a series of audio exercises.

https://www.compassionatemind.co.uk/resource/audio

With regards to the exercises led by Dr. Gilbert himself, I would only offer that he has the first two out of order.  He mentions the second, “Postures, Faces, and Voice Tones,” in the first, “Soothing, Rhythmic Breathing,” so my only recommendation for a clinician or coach to use these would be to start with the second.

https://www.compassionatemind.co.uk/cft-publications-2023

Here, then, is the CFT folks list of publications, including a hearty meta-analysis from this year that, again, points in a positive direction.

https://www.compassionatemind.co.uk/resource/scales

Finally, here is a collection of scales created for clients to complete.  From a simple perspective, and very similar to how we use our skills checklist, one can see self-reported changes across time.  I just think some of the scales might be useful, and the folks are very generous with providing permission for just about anyone to use or even translate them.