Compassion-Focused Therapy

In a paper published in the British Journal of Clinical Psychology, Gilbert says that our affiliative tendencies and emotion regulation systems can be harnessed to help us alleviate mental health concerns. Compassion-focused therapy (CFT) techniques aim to facilitate this process by helping participants foster compassion toward themselves and others.

CFT exercises can look similar to those of cognitive behavioral therapy. However, CFT techniques are focused on developing compassion, sympathy, distress tolerance, and sensitivity to facilitate attitudes of non-judgment. Some common techniques taught by a CFT therapist include:

• Compassion imagery: This can be a series of exercises that help an individual gain an increased understanding of what compassion looks like. The therapist may ask the client to talk about what compassion would look like in various situations, including using their voice and expressions to demonstrate. They may also use visualization to play the role of a compassionate observer to situations in their own lives where they’re typically self-critical. 
• Mindfulness: Therapists often work with clients on mindfulness exercises designed to bring attention to the current moment. This can include meditation, breathing exercises, and body scans. 
• Appreciation exercises: The therapist may work with the client on activities focusing on things they enjoy. In doing so, they train them to savor the moment during good times, list things they enjoy, and other positive reinforcement behaviors. 
• Compassion behavior tasks: A type of exposure therapy, compassion behavior tasks includes the therapist guiding their client to practice using kind and encouraging dialogue toward themselves during emotionally difficult situations. 

For those who experience feelings of fear or guilt during enjoyable activities, a therapist may work with them to practice accepting positive thoughts and feelings during enjoyable moments as well. 

Compassion-focused therapy (CFT) often begins with education. The therapist may start by teaching their client how the brain has evolved, what emotional regulation systems are, and how they’re connected to our sense of self. 

Next comes skill-building. The therapist partners with their client to help them grow mindfulness, compassion, and self-compassion through a series of guided exercises. The client may be taught to recognize when self-criticism appears with a toolbox of techniques to facilitate a more positive reaction. Often, they’re told to visualize their “critic” as another person to examine the feelings they evoke and learn to understand self-criticism more intimately. 

CFT takes practice. The therapist often gives their client homework to complete outside of sessions. This allows them to practice these techniques and cultivate non-judgmental and non-condemning behaviors toward themselves and others. Focus on self can be difficult for people who may be highly self-critical, and it may take some time for them to get used to it. The homework assignments can help with this. 

CFT can be effective for individuals who experience self-criticism, helping them to learn and practice techniques that facilitate thoughts and feelings of greater acceptance toward themselves and others. 

There are several mental health conditions for which CFT may be a helpful approach, although there has been more research on some than on others. For example, CFT has shown promise in treating anxiety and mood disorders, especially for those who use self-critical behaviors as a coping mechanism² for symptoms of these disorders. 

Pilot studies have also shown promise in CFT for both eating disorders and those who experience psychosis. However, more research is necessary to determine whether this therapy can be effective for these conditions. CFT is a newer therapy, so the research needs more evidence of its efficacy, although early positive results justify further studies. 

An early systematic review published in 2015 found that early research on the use of CFT for mood disorders was generally favorable, especially for mood disorders that were high in self-criticism. Citing its rising popularity, the review suggests that more large-scale, high-quality trials were called for to qualify CFT as an evidence-based practice. 

A more recent systematic review from 2020 revisits the evidence, concluding that CFT is well-accepted by both clients and therapists and that it shows promise for treatment of a variety of mental health conditions, especially in a group format implemented over a total of over 12 hours. This review calls for an updated standard manual to be universally deployed so that further research may reduce any existing methodological limitations. 

A study conducted by Paul Gilbert and his colleague Sue Procter—published in the journal Clinical Psychology and Psychotherapy—showed that compassionate mind training can decrease shame and self-criticism, as well as feelings of inferiority. There is also evidence that CFT can alleviate symptoms of psychotic disorders. In a study published in the British Journal of Clinical Psychology, researchers found that compassion-focused therapy reduced anxiety, depression, and hallucinations in participants experiencing psychosis. 

Research suggests that even short-term versions of compassionate mind training can produce positive effects. Following a two-week compassionate mind training program, participants in a pilot study experienced improvements in both psychological and physiological symptoms of stress. 

In another study published in the British Journal of Clinical Psychology, researchers found that compassion-focused therapy can improve symptoms of eating disorders. Additionally, an article published in the British Journal of Nursing posits that CFT principles can help improve resiliency in healthcare professionals. 

The Compassionate Mind Foundation has a research section on its website, where visitors can find further studies on compassion-focused therapy.

There’s no existing formal certification for CFT. For anyone interested in this type of therapy, a good place to start may be finding a therapist who can administer cognitive behavioral therapy with a focus on mindfulness (called mindfulness-based cognitive therapy).³ The therapist may also share in their credentials that they have training in CFT. It would have a bigger impact to find a therapist that’s comfortable to work with, as the exercises in self-compassion can require a strong level of trust. 

This type of specialization can be difficult to find in some geographical areas. Online therapy can be a good choice for those who may not live near a therapist who practices CFT. With an online therapy platform like BetterHelp, you can be matched with a licensed therapist who meets your needs and may be switched at any time with no financial penalty. Therapy sessions are held over video conferencing, messages, or phone.