Understanding Compassion and Basic Story

its Fears, Blocks and Resistances:

Evolution has created organisms to pursue survival and
reproduction
EABCT
5 September Greece This gives rise to a number of basic social motives and emotions
that organise the mind in different ways - and can be in conflict

Paul Gilbert, PhD, FBPsS,OBE

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Motives are evolved guidance systems that

organise the mind
Not just passive and reacting but also seeking
Basic Story
Evolution has created organisms to pursue survival and reproduction
Caring Competing Sexual Cooperating This gives rise to a number of basic motives and emotions that
organise the mind in different ways - and can be in conflict

Attention Cognitive processes cannot create basic motives like caring

but can help to regulate them and help people cultivate them
Thinking
Body/brain
But why would you want to enhance and train compassion?

Feeling
Behaviour

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Beneficial Effects of Caring and Compassion Basic Story

• Linked to a range of benefits:
 Mental Health (Jazaieri et al., 2013; Kirby, 2016; Martos et al., 2018) But why would you want to focus on caring motives?
 Physiology (Klemecki, Leiberg, Ricard, & Singer, 2014; Rockliff, et al, Weng et al, 2018)
 Genetic expression (Cowan et al., 2016; Slavich & Cole, 2013,2017) Because many clients have compromised caring in their
 Emotion regulation (Seppala, Rossomando, & Doty, 2012; Kirby & Laczko, 2017) early lives and can struggle with this motivational system
 Social connection (Crocker & Canevelllo, 2012; Keltner Kogan, Piff, & Saturn, 2014) and thereby be unable to access core physiological
 Motivation (Breines & Chen, 2012)
systems that are central for emotion regulation and
 Positive parenting (Kirby & Baldwin, 2017)
processing
 Prosocial behaviour (Basran et al 2019)

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 Our minds are full of algorithms
Evolved motives have stimulus-response algorithms (if A then do B) So what is caring?
Evolved with physiological ‘wiring’
The (‘if A do then B’ - stimulus-response) algorithm of Caring Motivation
if predator then activate arousal and run/hide
The Mother is

Sensitive to the suffering/distress and needs of her

if food then approach salivate and eat-digest infant and can act to try to alleviate and prevent it

The archetypal nature of maternal caring

if (infant) distress/need then act to alleviate is the template for subsequent evolution

An array of evolved complex physiological systems to support

this archetypal motivational process

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Some Features of Caring Motivation

The Mother is Attachment and Affiliation
 Paying attention
 Feeding The evolution of attachment and affiliative behaviour created a
 Providing Appropriate range of neurophysiological and physiological structures
 Protecting - rescuing
actions and (oxytocin, vagus nerve, frontal cortex) that when activated
 Temperature regulation
 Comforting - soothing feedback organise the mind, help calm threat processing and promote
 Encouraging (learning and risk taking) prosociality and wellbeing.
 Mentoring
 Playing Compassion focused therapy stimulates and ‘strengthens’
these faculties and qualities of mind
Different aspects of caring stimulate different
physiological systems

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Autonomic nervous system

 SNS activity is associated
with increased heart rate, Parasympathetic
but PNS activity is associated nerves to heart
with decreased heart rate
 Heart rate – during
outbreath BPM
Slows HR
 slow down
 Without the PNS (and vagus
nerve) your heartbeat would
be around 120 BPM
 Importantly, the vagus nerve
is also associated with
affiliation, tend & befriend, Sympathetic nerves
general positive emotional
tone to heart

…and so why soothing rhythm Increases HR

breathing, voice tones. and
facial expression can be help

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 Safeness -The Vagus Nerve  Vagal tone predicts:
• Calm behavioural states Caring behaviour overlaps
reward areas in the brain
• Experiencing more positive
emotional and social states
Vagus as major links to
• Lower blood pressure etc.
Frontal Cortex
 Rate, depth and rhythm of the breath

Lovingkindness meditation
 Mindfulness increases ‘vagal tone’
reduces threat sensitivity in the
amygdala
 Associated with affiliation, tend
& befriend, voice tone and face
(Weng, H. Y., Lapate, R. C., Stodola, D. E.,
Rogers, G. M., & Davidson, R. J. (2018). Visual
 Responsive to cues of safeness attention to suffering after compassion training is
associated with decreased amygdala
responses. Frontiers in psychology, 9, 771.

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The S-R Algorithm of Compassion Evolution: From caring to compassion

Compassion can be defined in many ways but focuses on different processes

Human
As a sensitivity to the suffering/distress of self and others with a commitment cognitive
to try to alleviate and prevent it competencies

Mammalian • Knowing
Different Psychologies awareness Compassion
• To approach, notice, understand and (how to) engage with
Caring
suffering/distress - looking into its causes - COURAGE • Empathic
awareness
• To work to alleviate and prevent suffering/distress – work to acquire
wisdom and skills - DEDICATION for WISDOM • Knowing
intentionality

Each more complex than might at first seem

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Compassion is not one process but depends

Compassion and Cognition on the context
• The connection between caring and compassion relates to the
utilisation of complex cognitive competencies and knowing
intentionality

• How we use our powers of reason to reason compassionately,

• to be mindful compassionately
• to be empathic compassionately

• How we use our insights to train our minds personally and culturally

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 Compassion and Courage

Many people who work to

help/save others are prepared
to suffer and be in high
threat/distress states
How they regulate those states
and stay ‘true’ to their
‘motives’ needs more research
Core is wise courage – being
aware of but resisting inner
inhibitors –facing the feared

Ebola Clinic

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Compassion and Courage

Compassion
Moving to our own suffering Desire and intention
to be helpful not
can take us (first) to high harmful
threat/distress states
Emotions
How do we regulate those Context related
states and stay ‘true’ to our Anxiety Anger Competencies
Sadness Empathy
‘motives’ for healing distress tolerance
Joyfulness
Guilt reasoning, mindful
Core is wise courage – being
aware of but resisting inner
inhibitors – facing the feared Behaviours
Action
Soothing

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Core Self-Identity Compassionate mind

May I be helpful not hurtful or harmful

The psychobiological organisation of a mind for the

A daily affirmation enactment of compassion - appropriate to its context

Can be applied to groups and organisations too

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 Motives are evolved guidance systems that
Competitive Mentality
organise the mind Caring Mentality

Not just passive and reacting but also seeking

Down rank Up Rank Process
Distress sensitivity
Social comparison- Social comparisons –
Able to help
inferior superior-entitled Distress tolerant
Caring Competing External shame Humiliation Soothing-active
Submissive Aggressive Joy-guilt
Striving Striving Empathic
Angry Self- - critical Other blaming/critical Self-reassuring
Attention
Measures
Thinking Social comparison Measures
Compassion engagement and action scales
External shame
FoC
Body/brain Striving
Self-criticism Self-reassurance

Feeling
Gilbert, P. (2019). Psychotherapy for the 21st century: An integrative, evolutionary, contextual, biopsychosocial
Behaviour approach. Psychology and Psychotherapy: Theory, Research and Practice. 92, 164-189. DOI: 10.1111/papt.12226

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Competitive Mentality
All Social Motives Emotions and Competencies have Flow
Caring Mentality

Down rank Up Rank Process

Distress sensitivity Self-Focused
Social comparison- Social comparisons –
Able to help
inferior superior-entitled Distress tolerant
External shame Humiliation Soothing-active
Submissive Aggressive Joy-guilt
Striving Striving Empathic
Motives,
Angry Self- - critical Other blaming/critical Self-reassuring Emotions,
Competencies
Measures
Measures
From others To others
Social comparison
External shame Compassion engagement and action scales
Striving FoC
Self-criticism Self-reassurance

Gilbert, P. (2019). Psychotherapy for the 21st century: An integrative, evolutionary, contextual, biopsychosocial Each has its own facilitators and inhibitors
approach. Psychology and Psychotherapy: Theory, Research and Practice. 92, 164-189. DOI: 10.1111/papt.12226

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All Social Motives Emotions and Competencies have Flow

Self-Focused

Motives,
Emotions,
Competencies
From others To others

Each has its own facilitators and inhibitors

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 Consider the problems of being cut off from a very
Fears, blocks and resistances important source of physiological regulation

 Inability to experience compassion from others is associated with mental health

•Fears Feels alien, doesn't feel right, not sure what will happen, problems, can impact on the therapeutic relationship because client does not
makes me sad, could make me weak experience the therapist as helpful or being motivated to help them -- Consider
too the impacts on intimate relationships and in role of ‘helper’ - consider shame

•Blocks misunderstanding compassion, lack of insight, don't

know what to do, lack of support  inability to be compassionate to the self is associated with high levels of self-
criticism and to mental health problems and relationship difficulties

• Resistances too costly, don't deserve, negative consequences

 inability to be compassionate to others is associated with narcissism and other
anti social behaviours

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What patients say about self-compassion

Pauley, G., & McPherson, S. (2010). The experience and meaning of compassion and self-compassion for individuals
with depression or anxiety. Psychology and Psychotherapy: Theory, Research and Practice, 83(2), 129-143

• “I’m my own worst critic so I can sit and understand things in other people but I
wouldn’t necessarily accept them in myself”

• “When I’m depressed, I just really, really don’t like myself, so, there’s no way that
I’m going to feel compassion for myself”

• “I know people that are very kind to themselves and they’re good to themselves
and look after themselves and I think they’re much better off for it. But I don’t
think I’m really ever going to be able to do that”

• “When I feel depressed it’s almost impossible to be forgiving towards myself,

because when I feel depressed I think that it’s my fault”

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Kindness, Attachment and Threat

Fears of Compassion Gilbert, P. (2009). Developing a compassion focused approach in cognitive behavioural therapy. In, Simos,
G. (Ed). Cognitive Behaviour Therapy, a Guide to the Practicing Clinician. Volume II. London, Routledge.

• ‘Dread. Erm, it's as if, I don't know, it's as if I was Compassion from therapist or imagery
frightened of it [self-compassion]. I was
frightened of how I was going to feel. How I was
going to react. Because I was never used to Activate attachment system
doing things to help myself’ Activate memories Fight, flight
Fight, flight
shut down
shut down
Fear I will lose my self-identity Neglect Abuse, shame
“Am I going to like the person that I might aloneness vulnerable
become? Because I've been like this, with these
memories and these thoughts and this for so
long”
Activate learnt and current defences - cortisol
Lawrence, V. A., & Lee, D. (2014). An exploration of people's experiences of compassion focused therapy for
trauma, using interpretative phenomenological analysis. Clinical psychology & psychotherapy, 21(6), 495-507. Compassion opens the attachment system and then whatever fears, anger or despair is
coded there will become available and can be intensely threatening

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 Negative beliefs of compassion Fears of compassion questionnaire study

• Negative beliefs about the nature of compassion – • Developed three scales measuring the various fears of having compassion for
Compassion is a weakness or individual –just being kind or others, for self and receiving compassion from others.
nice – missing courage and wisdom aspect
• Students (N=220), therapists (N=53) and depressed patients (N=53)
• Negative beliefs about the value of compassion – completed the new scales with measures of self-criticism and
psychopathology
• Not useful when times are tough

• Negative beliefs about the ability to develop compassion - Gilbert, P., McEwan, K., Gibbons, L., Chotai, S., Duarte, J. & Matos, M. (2011) Fears of compassion and happiness in
relation to alexithymia, mindfulness and self-criticism. Psychology and Psychotherapy. 84, 239–255
would like to develop it but can’t

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Fear of compassion for others scale Fear of compassion from others scale

• People will take advantage of you if you are too compassionate • I fear that if I need other people to be kind, they wont be

• If I’m too compassionate, others will become too dependent on • I worry that people are only kind and compassionate if they want
me something from me

• I can’t tolerate others distress • If I think someone is being kind and caring towards me, I put up a
barrier

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Fear of Compassion Data

Fear of compassion for self scale
FCom for FCom from
• I fear that if I develop compassion for myself, I will become others Others
someone I don’t want to be

• I fear that if I am more self-compassionate I will become a weak Com from

person Others . 47**

• I fear that if I start to feel compassion for myself, I will be

overcome with loss/grief
Self Com . 37** . 67**

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 Fears of Compassion Data Fears of Compassion Data
Self Criticism Students (222) Depressed 53
Students (222) Depressed 53
FCom for FCom from FSelf Com FCom for FCom from FSelf Com
Others Others Others Others
Inadequate . 31** . 39** . 45**
. 19** . 33** . 29**
.51** .55** .67** Anxiety .42** .49** .36**
Hated .10 .37** .47**
.05 .52** .62**
. 17* . 37** . 40*
-. 08 -. 19** -. 33**
Dep .24 .62** .52**
Reassured -.42* -.43** -.61**
Gilbert, P., McEwan, K., Gibbons, L., Chotai, S., Duarte, J. & Matos, M. (2011) Fears of compassion and happiness in
relation to alexithymia, mindfulness and self-criticism. Psychology and Psychotherapy. 84, 239–255

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Basran et al., (2019) Styles of Leadership, Fears of Compassion, and Fears of Compassion Data
Competing to Avoid Inferiority. Front. Psychol. 9:2460 Social Safeness

N=219 Com for Com from Others Self Com I feel connected to others I feel secure and wanted
Others
I have a sense of belonging I feel accepted by people
Ruthless self . 33** . 32** . 37**
Ambition
N=219 FCom for FCom from FSelf Com
Narcissism Others Others
.23** .19** .18**

Fear of SS -. 30** -. 55** -. 47**

. 46** . 46** . 48**
Inferiority

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Tasks of study

Relaxation condition was focusing on relaxing calming

images/thoughts

Control condition was to imagine making your

favourite sandwich and the pleasure you will get from
eating it (control for type of positive affect and also
the effects of mental imagery)

Compassion imagery was to imagine their ideal

Rockliff, H., Gilbert, P.,
compassionate person and how kind, warm and caring McEwan, K., Lightman S., &
Glover, D. (2008) A pilot
exploration of heart rate
they were for the self variability and salivary cortisol
responses to compassion
focused imagery. Journal of
Clinical Neuropsychiatry, 5,
132-139

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 Correlations between change in HRV
and self-report scales
SDNN

Inadequate Self Anxious Attachment

-.54* -.48*

Depend Attachment Social Safeness

.52* .57**

* p<.05 ** p <.01

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Results Oxytocin study

Major physiological systems that are focused on affiliation – e.g.,
oxytocin
• Some participants responded to compassionate imagery with a
decrease in HRV and showed no significant change in cortisol, • Facilitates monogamous bonding
indicative of an aversive response
• Facilitates conspecific recognition
• Facilitates attachment
• These individuals tended to score higher in self-criticism • Increases trust
• Increases competencies in mind reading tasks
• Increases feelings of liking others
• Reduces activation in the amygdala to threat faces

Source Macdonald and Madonald 2010 The Peptide That Binds: A Systematic Review of Oxytocin
and its Prosocial Effects in Humans Harvard Review of Psychiatry 1-21

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Tasks of study

Participants (N=44) were randomly given a placebo or

oxytocin spray in a cross-over design

Relaxation condition focused on calming

images/thoughts

Compassion imagery was to imagine their ideal

compassionate person and how kind, warm and caring
they were for the self

Rockliff, H., Karl, A., McEwan, K., Gilbert, J., Matos, M. & Gilbert, P. (2011). Effects of intranasal oxytocin on
compassion focused imagery. Emotion, 11, 1388-1396. DOI: 10.1037/a0023861

Rockliff, H., Karl, A., McEwan, K., Gilbert, J., Matos, M. & Gilbert, P. (2011). Effects of intranasal oxytocin on compassion focused imagery. Emotion,
11, 1388-1396. DOI: 10.1037/a0023861

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 Results

• Participants higher in self-criticism and lower in self-reassurance,

social safeness and attachment security tended to have less
positive experiences of compassionate imagery under oxytocin
compared with placebo.
• The effects of oxytocin may depend on self-evaluative and
attachment styles

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Fear of compassion and identifying

emotions study
Fear of Happiness Scale

• Developed a scale to measure general fears of positive feelings - • I am frightened to let myself become too happy
Fear of Happiness Scale.
• I worry that if I feel good something bad could happen
• Students (N=185) completed self-report measures of fears of
compassion, fears of happiness, emotion identification
(alexithymia), empathy, mindfulness, self-criticism and • I feel I don't deserve to be happy
psychopathology.
• Question: Are fears of compassion related to other fears of
positive emotion? --- YES

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Fears of Compassion Data

Fear of Positive Feelings

Anxiety .54**
Dep .70**

Comp .69**
From Others
Self-Com .56**
Gilbert, P., McEwan, K., Gibbons, L., Chotai, S., Duarte, J. & Matos, M. (2013). Fears of compassion and happiness in relation to alexithymia,
mindfulness and self-criticism. Psychology and Psychotherapy. 84, 239–255 DOI:10.1348/147608310X526511.

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Summary
• 21 studies, from 154 samples included
• Studies across a 5 year period (2012-2017)
• 5, 233 participants data meta-analysed
• 7 different countries (USA, UK, Canada, Australia, Portugal, Japan, and
Scotland)
• 13 were cross-sectional surveys; 8 pre-intervention correlations
• 5 clinical sample, 16 non-clinical
• 31% Male; 69% Female
• Average age: 30.45 years (range 18.64 years – 45 years; SD = 9.71)

• Thanks to James Kirby University of Queensland for providing the data

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 Fears of Compassion for Others &
Mental Health Outcomes
Data from 38 samples

Depression
Anxiety
Distress
0.2 0.5 0.8
Well-being
Small Medium Large
Shame
Self-criticism

-0.25 0 0.25 0.5

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Fears of Compassion from Others & Fears of Compassion for Self & Mental
Mental Health Outcomes Health Outcomes
Data from 59 samples
Data from 57 samples
Depression
Depression
Anxiety
Anxiety
Distress Distress

Well-being Well-being
Shame
Shame
Self-criticism
Self-criticism
-0.75 -0.5 -0.25 0 0.25 0.5 0.75
-0.5 -0.25 0 0.25 0.5 0.75

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Fears of Compassion from Others

Between Groups
TimexGroup effect
F = 6.88; p = .010
η2p = .071

Within Groups
t EG= 2.84; p = .006
t CG= 0.99; p = .327

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 Fears of Compassion to Others Fears of Compassion for Self

Between Groups Between Groups

TimexGroup effect TimexGroup effect
F = 521.07; p < .001 F = 14.28; p < .001
η2p = .190 η2p = .142

Within Groups Within Groups

t EG= 5.33; p <.001 t EG= 4.28; p <.001
t CG= 1.41; p = .167 t CG= 1.38; p = .177

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Compassion as Ascent or Decent?

• Compassion is not getting rid of the difficult contents of the

mind ‘soothing away‘ but engaging with them

• Compassion is the capacity to develop the courage and

wisdom with the physiological infrastructures to engage with
suffering in self and others

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Thank you all and for the CBT

Compassion and Cognition
community in promoting this
• The connection between caring and compassion relates to the work
utilisation of complex cognitive competencies and knowing
intentionality

• How we use our powers of reason to reason compassionately is not

only essential for our personal well being but the well being of our
relationships, communities and world

• The processes that block our ability to be compassionate to self and May your compassionate mind
others is the most serious challenge to humanity
support and guide you through
the challenges ahead

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 Some references
Asano K, Tsuchiya M, Ishimura I, Lin S, Matsumoto Y, Miyata H, Kotera, Y.,
Shimizu1, E., Gilbert, P. (2017). The development of fears of compassion scale Gilbert, P & Mascaro, J. (2017). Compassion: Fears, blocks, and
Japanese version. PLoS ONE 12(10): e0185574. resistances: An evolutionary investigation. In, Seppälä, E.M., Simon-
https://doi.org/10.1371/journal.pone.0185574 Thomas, E., Brown, S.L., Worline, M.C., Cameron, L & Doty, J. R. (Eds).
The Oxford Handbook of Compassion Science. (p.399-420). New York:
Basran J., Pires, C., Matos, M., McEwan, K & Gilbert, P. (2019). Styles of Oxford University Press.
leadership, fears of compassion, and competing to avoid inferiority. Frontiers.
Psychology. 9:2460. doi: 10.3389/fpsyg.2018.02460. Kirby, J. N., Day, J., & Sagar, V. (2019). The ‘Flow’ of compassion: A meta-
analysis of the fears of compassion scales and psychological
Gilbert, P., McEwan, K., Catarino, F., Baião, R., & Palmeira, L. (2014). Fears of functioning. Clinical Psychology Review, 70, 26-39.
happiness and compassion in relationship with depression, alexithymia, and
attachment security in a depressed sample. British Journal of Clinical Merritt, O. A., & Purdon, C. L. (2020). Scared of compassion: Fear of
Psychology, 53(2), 228-244. https://doi.org/10.1111/bjc.12037. compassion in anxiety, mood, and non-clinical groups. British Journal of
Clinical Psychology.
Gilbert, P., McEwan, K., Catarino, F & Baião, R. (2014). Fears of compassion in a
depressed population: Implications for psychotherapy. Journal of Depression and Pauley, G., & McPherson, S. (2010). The experience and meaning of
Anxiety http://dx.doi.org/10.4172/2167-1044.S2-003. compassion and self-compassion for individuals with depression or
anxiety. Psychology and Psychotherapy: Theory, Research and
Gilbert, P., McEwan, K., Catarino, F & Baião, R. (2014). Fears of negative emotions Practice, 83(2), 129-143.
in relation to fears of happiness, compassion, alexithymia and psychopathology in
a depressed population: A preliminary study. Journal of Depression and Anxiety Rockliff, H., Gilbert, P., McEwan, K., Lightman S., & Glover, D. (2008) A
http://dx.doi.org/10.4172/2167-1044.S2-004 pilot exploration of heart rate variability and salivary cortisol responses
to compassion focused imagery. Journal of Clinical Neuropsychiatry, 5,
Gilbert, P., McEwan, K., Gibbons, L., Chotai, S., Duarte, J. & Matos, M. (2013). 132-139.
Fears of compassion and happiness in relation to alexithymia, mindfulness and
self-criticism. Psychology and Psychotherapy. 84, 239–255 Rockliff, H., Karl, A., McEwan, K., Gilbert, J., Matos, M. & Gilbert, P.
DOI:10.1348/147608310X526511. (2011). Effects of intranasal oxytocin on compassion focused imagery.
Emotion, 11, 1388-1396. DOI: 10.1037/a0023861
Gilbert, P., McEwan, K., Matos, M & Rivis, A. (2011). Fears of compassion:
Development of three self-report measures. Psychology and Psychotherapy, 84, Lawrence, V. A., & Lee, D. (2014). An exploration of people's experiences
239-255. DOI:10.1348/147608310X526511 of compassion focused therapy for trauma, using interpretative
phenomenological analysis. Clinical psychology & psychotherapy, 21(6),
495-507.

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