What is Compassion Focused Therapy?

Compassion Focused Therapy (CFT) is an offshoot of CBT.  It was designed for people with high levels of self-criticism or shame.   It is supposed to be helpful for people who can reason against their fears or beliefs but who find that their feelings don’t change.

The theory behind CFT is that we have evolved a set of mental systems because they helped our ancestors survive.   The relevant ones are the drive and motivation system (search for something, feel rewarded, want to search again), the threat and protect system (recognise danger and activate the fight/flight/freeze response) and the soothing and contentment system.  Due to our genes, our early experiences and our environment some of us have overdeveloped threat systems and undeveloped soothing systems.  CFT teaches us to redress the balance by developing our soothing system.  There are a core set of exercises which include meditations, imagination and imagery and thinking through beliefs and coping mechanisms.

There are self-help resources available and I’ve linked to a few below. CFT exercises can touch on difficult and painful issues and memories so a lot of resources suggest it may be better to work with a therapist.  That was true in my case.

How good is the evidence for CFT?

2014 study says there isn’t enough of the kind of research necessary to consider CFT to be evidence based. Studies have been conducted but they generally have too few people participating in them, or other limitations. This means that we don’t know if CFT is better than existing treatments.

My personal experience with CFT: 

It has been difficult, bringing up some difficult emotions but I feel it is worth it to soften that critical voice in my head and to learn to look after myself better and more kindly.  I started with CFT in one to one high intensity CBT sessions where we talked through some of my early experiences, my beliefs, fears and my feelings about myself.  I’ve found the group therapy sessions I’m currently going to really helpful.  The theory and techniques are introduced gradually and repeated so it’s not too threatening and I’m gradually opening up to a new way of thinking.  I can see there’s an awful lot of work to be done and it’s going to take a lot of time and patience.  But I’m really looking to forward to having a calmer more compassionate way of talking to myself and responding to mistakes and difficulties.

How do I think CFT fits into self-management of chronic illness?

  • A chance to develop new or better coping strategies if our old ones are no longer accessible.  For example, worrying, perfectionism, and over-preparing are not ideal ways of coping but they may have been okay in the past.  But they take up far too much precious time and energy for a chronically ill person.
  • An antidote to criticism and judgement from ourselves, people around us and in the media.
  • Learn to support ourselves in doing what is best for ourselves, even when it is hard.
  • Learn to support ourselves in accepting and coming to terms with the changes to our lives.
  • Learning to alleviate anxiety and fear.
  • Learning to address unhelpful beliefs with understanding and kindness.

Resources

  • Compassionate Mind Foundation
  • Paul Gilbert, Overcoming Depression A long and detailed book that I found really helpful. It’s written clearly, with some memorable turns of phrase and exercises to practise with.  This is my favourite because it strikes the right balance of depth of explanation and practical exercises for me.
  • Mary Welford, A Compassionate Mind Approach to Building Self-Compassion A shorter, easier read than Overcoming Depression with exercises to work through. Some of the exercises on thinking about where my lack of confidence had come from were emotionally challenging. I was glad I had covered some of this with a counsellor before reading the book.
  • Paul Gilbert, The Compassionate Mind (I’m only half way through this book so far) I like reading about the background to how the therapy was developed and where research is going.  However, there may be more detailed theory here than some people will enjoy.  I like that Paul Gilbert acknowledges the role of our culture and social context in producing an environment that isn’t supportive of compassion.
  • Kristen Neff website Meditations and exercises
  • Chris Germer website Meditations and exercises
  • CCI Self-Compassion A series of 7 workbooks (PDF) introducing concepts and exercises for building self-compassion.

Making the most of small pleasures

“Whatever else there is, there’s this as well” – Maitreyabandhu1

It’s hard being ill, I have lost so much and there’s so much I can’t do.  This drags down my mood and my well-being.  There’s also a lot of physical discomfort too.

I first came across the idea of deliberately looking for the pleasurable aspects of my experience, no matter how tiny, when I worked through Mindfulness for Health, a self-help book for coping with chronic pain and illness.

I’m coming back to these ideas again now because I have just started doing vestibular rehabilitation exercises with the aim of restoring some of my balance function by retraining my brain.  The process of doing these exercises brings on motion sickness.  I’m spending a lot of my day feeling horrible and I worry that this will bring my mood down considerably.

Hopefully by practising deliberately identifying and paying attention to pleasure, however small and insignificant it might seem, I’ll be able to counter that to some extent.

Since realising that I need to actively seek out and create pleasurable experiences I have found three strategies for making sure I have plenty of opportunities and make the most of them.

Strategy 1: Schedule pleasurable activities

Make sure there is something fun or pleasant on your schedule each day.  For example, I recently added time to have a cup of tea with my partner when he gets home from work.  It might seem unromantic but putting it on my calendar makes it much more likely to happen.  If many of the things you enjoyed are now difficult maybe experiment with new things, or revisit old things.  I fell out of the habit of reading novels when I was so busy with my PhD, and I hadn’t read poetry since A-Level English Literature.  But it has given me a great deal of pleasure to pick them both up again.

Schedule events to look forward to.  Occasionally including things that might be a bit ambitious.  I think it’s okay to test limits sometimes so long as my ‘normal’ approach is being kind and considerate of my condition.  Occasionally I plan to do something that means a lot to me but really isn’t compatible with my condition.  In my case this would be going to a gig.  I love live music but it’s about the most migraine-unfriendly activity I can think of.  I still go once or twice a year with help from my friends or partner and by using the facilities for disabled people at the venues.  Sometimes I have to cancel at the last minute, sometimes I only manage to stay for half the evening, but it’s worth it.  When it is even half successful I can feel like myself again and get such a lift it is worth pushing my limits a little and testing what I can do.

Make a list of pleasurable things.  On a bad day it’s hard to think and nothing feels appealing and everything is too difficult.  It is helpful to have a list ready to go, like a menu to choose from.  Then there is no need to think, just pick out the first thing that appeals.   My counsellor pointed me toward a “big list of pleasurable activities” and ideas for self-soothing activities in the Dialectical Behaviour Therapy Skills Workbook to provide some inspiration.  Other lists can be found on the internet, like this one with over 300 suggestions from the Centre for Clinical Interventions, and uses as a starting point for building your own list.

Strategy 2: Look for pleasurable aspects of my current experience

This approach came from chapter 5 of Mindfulness for Health.  Vidyamala Burch talks about how even when we are suffering from pain and illness we can still find pleasure in our daily lives by “learning how to seek out subtle experiences”.

“The pleasant experiences that you become attuned to may even seem rather ordinary, such as an absence of hunger or a tiny tingling somewhere in your body. But it’s important to learn to recognise these, to appreciate and enjoy them.” – Mindfulness for Health

And don’t worry if you can’t find anything – instead try to accept your experience as it is.

Paying attention to pleasurable sensations.  The kind of things I might look for are physical sensations, think about the different senses, temperature, touch, pressure, texture, visual, sounds, smells and tastes.  The other day when I was doing my exercises I felt really grotty, but I also had a soft cushion, a hot chocolate, a warm wheat bag, and a tiny patch of sunlight on my arm.  These are all really small experiences that would have gone unnoticed in my ‘normal’ life.  This isn’t a Pollyannaish suggestion to look on the bright side.  It is perfectly okay to be sad about the things I miss.  But I don’t want my life to be any more miserable that it needs to be either.

Treasuring little moments of happiness and fully engaging with them.  I try to pay attention when something funny, or cute, or enjoyable happens.  Even the really small moments, like a child making faces on the bus, or when a robin comes to sit by me at the allotment are worth treasuring.  I try to stop what I’m doing and pay attention, to note to myself that this is funny, or happy.  And I try to do something that will help me to keep it in my memory.  I don’t think it matters if the source of the pleasure is big or small, it is experiencing the emotion that is important.

Ways to make the memory stick:

  • Gratitude journal
  • Happiness jar
  • Imagine telling someone about your experience
  • Taking a photo

Strategy 3: Make my daily routine activities as pleasurable as possible.

Because I can’t do everything I want to I have saved money in some areas.  Some of that gets spent on adding a little more luxury or a little more pleasure to the things I have to do every day.  If I can I like to make it feel good, rather than feel like a chore.  If I need to exercise I try and find something that I like, rather than making myself do something boring.  When I needed to improve my diet, I tried to find a set of healthy meals that I’d actually enjoy.  It takes a bit of time and creativity to figure out how I could do what I need to do to manage my symptoms in ways that still reflect my personality and tastes.

A few examples:

    • develop rituals to help create a mood
    • use essential oils to fragrance facial oils, shampoo, room fragrance etc.
    • starting a collection of loose leaf herbal teas so my tea breaks are a little fancier
    • adding a little oil to the bath (taking care as it can get slippery)
    • allowing a little more time so an activity isn’t rushed (rest after a shower)
    • taking steps to reduce discomfort
    • making evening face cleansing into a facial massage with the oil cleansing method

How does looking for pleasure help me?

It reminds me that two different things can be true at once.  Yes, I am in discomfort and struggling, but I can still enjoy the pleasant aspects of life too.

It makes me feel more like myself and less like an invalid.  I am living the life I have and enjoying my life to the best of my ability.

I have things to look forward to that remind me that I am still the same person I was before.  However, it also requires me to accept that my circumstances have changed and be prepare to adapt.

Putting it into practice

  • Don’t leave it to chance: set reminders, add it to your to-do list
  • Write a plan to build it into a habit,
  • Experiment with all the techniques – give each one a good try until you find some that work for you.
  • Make time for it.
  • Practice.

Are there any downsides?

There can be a risk of disappointment if you make plans and have to cancel.  You may also feel like you are letting other people down if you have to cancel last minute.  It takes time to get used to doing this, and some friends will be more understanding than others.

I think there’s also a risk of increasing sadness sometimes.  If I look for pleasure and can feel very little, my thoughts can drift towards things I’ve lost or how hard my life is.  I feel that the benefits outweigh the risks for me.

I like the WOOP method for tackling potential problems.  By having an idea of how I might respond to any feelings of sadness or thinking about what I’ll do if I’m too unwell to go out in advance I’ve found it easier to make plans to incorporate more opportunities to look for pleasure in my life.

Notes

  1. ‘This’ by Maitreyabandhu,  Crumb Road, quoted in Burch & Penman Mindfulness for Health

Worry Time

By life has been full of terrible misfortunes, most of which never happened”
Michael de Montaigne

I have always been something of a worrier.  I was okay with that and sometimes found it useful as I’d make extra effort to rehearse something in advance or think through what might go wrong.

But now I have a chronic migraine I don’t really have the luxury of spending time checking everything twice (at least) when my energy is so limited.  The second problem is that chronic illness has been very wearing emotionally and I’m now much more prone to tipping into anxiety, and that can be paralysing.  The final problem is that there are more things to worry about.  In the past, walking across a busy room didn’t take a moment’s thought.  I didn’t use to worry about whether I’d want to be sick when choosing a seat in the cinema.  Now all those things have become a source of doubt and worry.

The upshot is I don’t want to waste my time, physical or mental energy on worrying about trivial things.  And if I do have a legitimate concern I’d rather tackle it in a more useful way than worrying.

A counsellor I saw in the summer introduced me to the strategy of postponed worry.  During the day all your worries get noted down, then at the allotted time you work your way through them using the worry tree to decide how to deal with them. Then you set your timer for 10 or 15 minutes and worry as much as you like. When the time is up you go back to noting down worries again ready for the next day’s worry session. It seemed mad but it was pretty effective.