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Compassion Based CBT workshop with Prof Paul Gilbert

Posted on January 9, 2014 at 12:09 PM Comments comments (0)
This is a workshop delivered by Prof Paul Gilbert at Palo Alto University in 2013 about the scientific premise and technique of Compassion Focused Therapy. 

Overview of Compassion Focused Therapy and the process of change with compassion. 

CFT is a psychological model, although it uses elements of CBT, humanistic and psychodynamic therapies. CFT started with Prof Gilbert's interest in patients who were struggling with standard therapies (diagnosis of Borderline Personality Disorder). These patients were focused on shame and self-criticism, which is linked to poor outcomes. He wanted to understand evolutionary mechanisms which maintained emotional problems. 

Cognitive Behaviour Therapy traditionally focuses on replacing on unhelpful thoughts and behaviour with helpful thoughts and behaviour. However some clients say they see the logic of the alternative thoughts but do not feel reassured or helped at the emotional level. They also say: "I know I am not to blame but I still feel to blame"

We need to feel congruent emotion in order for our thoughts to be meaningful to us. Emotions "tag" meaning onto experiences. In order to be reassured by the thought "I am loveable", this needs to be linked with the experience of 'being loveable'. Many patients who come from traumatic backgrounds have few memories of being loveable or soothed and thus may struggle to feel reassured and safe by alternative thoughts. 

Compassion focused therapy targets the activation of the soothing system so that it can be more readily accessed and used to help regulate threat-based emotions of anger, fear, disgust and shame. 

Evolutionary model of psychopathology 

We are an emergent species in the 'flow of life' so our brains, with their mechanisms for motives, emotions and competencies are products of evolution, designed to function in certain ways. 

Anxiety disorders are related to how cognitions trigger innate defences - fight, flight, demobilisation (Marks, 1987) or danger modes (Beck, 1996)

Depressions are related to evolved mechanisms for coping with defeats and loss (Beck, 1987; Gilbert, 1992)

Personality disorders are related to the under or over development of innate strategies (e.g. cooperation vs. competition) (Beck, Freeman et al. 1990; Gilbert, 1987)

The social circumstances of our lives, over which we have no control, have major implications for the kinds of minds we have, the way our genes become expressed, the kids of brains we end up with, the kind of person we become, the values we endorsed and the lives we live. 

How new psychologies emerged in the world
500 mil years ago - Reptilian psychology (territory, fear, aggression, sex, hunting)
120 mil years ago - Mammalian psychology (capacity for caring, group, alliance building, play, status)
2 mil years ago - Human psychology emerged (capacity for symbolic thought and self-identity, theory of mind, meta-cognition)
1 mil years ago - Human capacity for extended caring (looking after the old or the sick) 

Why we have complex brains and minds that are difficult to understand and regulate

The Old Brain: Emotions (anger, anxiety, sadness, joy, lust); Behaviours (fight, flight, withdraw, engage) Relationships (sex, status, attachment, tribalism)
New Brain: Imagination, fantasise, look back and forward, collating and integrating vast amounts of information from different modalities- sensory emotional, plan, ruminate. 
Social Brain: Need for affection and care 

The brain has a number of built-in biases. Biased learning (fear of snakes, heights). Biases can be implicit or explicit. We tend to be self-focused, kin-focused and exhibit in-group preferences. 

We have a capacity to become aware of being awareness. Mindfulness is the capacity to observe one's mind and it naturally calms us down. Compassion comes is a motivating system rooted in the caring system. Compassion has to be understood as an interaction - it depends also on the other being responsive to being cared for. 

The mind is primarily a social signalling system (See Tronick's 'still face' experiment, Joseph Campos experiment on the role of non-verbal communication guiding behaviour in babies) 

Humans have fundamentally have a desire to be helpful( Warneken and Tomasello experiments in compassion in babies). 

Evolutionary functional analysis 

There are three types of emotions, which act as motivators: 
-those that focus on threat and self-preservation
-those that focus on doing and achieving 
-those that focus on contentment and feeling safe. 

The threat system is the dominant system in your brain. It is designed to over-rule and switch off everything else. Attention becomes narrow-focused, scans for threats, moves towards thinking about what could go wrong. In anger and anxiety the body feelings overlap. Borderline patients are not able to distinguish between tension and anxiety. 

Compassion in the brain

Posted on January 8, 2014 at 4:52 PM Comments comments (93)
Professor Paul Gilbert gives the Meng Wu lecture at CCARE (Stamford University). He is currently developing the Compassionate Mind Training Mind programme in the UK. In this lecture Prof Gilbert describes the interaction of three different types of affective regulator system: the drive/seeking system, the threat system and the affiliative (care) system. Prof Gilbert has developed a training programme to support clients from shifting from the threat system into the care system, by expanding their ability for compassion. 

Prof Gilbert comes from a tradition (clinical psychology), which understands compassion as primarily a cognitive and motivational process. The attributes of compassion are: sensitivity, care, non-judgement, empathy (understood here as perspective taking), distress tolerance and sympathy (understood here as the ability to feel the pain of another). 

Compassion can be seen as a brain-organising process. His research suggests that compassion can be increased through the training of particular skills: 
Attention - Choosing to pay attention to what is helpful to us, to the positive things that happen to us and turn attention away from the negatives (we are more inclined to focus on the negative) 
Imagery - Being able to activate an internal nurturing Parent. Soothing self-talk. 
Reasoning - "Compassion isn't stupid". It's important that we are able to reason and reflect, standing back and understanding things, thinking about the wider picture, not just about our immediate circle of concern. 
Behaviour - The behaviours of compassion are often courageous. Doing the things one needs to do in order to flourish. Paying attention to one's breathing, one's tone of voice, one's posture (all of which stimulate the vagal system). Feeling the anger but not reaching for the hammer. 
Feeling - Enhancing positive, warm feelings, kindness. Expanding our window of affective tolerance. Descent into suffering, pain, anger but not being overwhelmed by it. The point of mind-training is not to get rid of feelings. 

Not Knowing is the Royal Road to Feeling Both a Shameful Fool and Creative Healer

Posted on July 2, 2013 at 10:26 AM Comments comments (4)
A moving article by psychiatrist and psychotherapist Robert Lewis asking:  "How does one both be the  responsible healer who maintains the frame and the wounded healer inside the frame with the wounded  patient? In some ways, one hopes to embody a presence, not unlike that of the parent who both takes responsibility for his child and yet remembers that the child (patient) knows at least as much about where  your journey together must go."

Stanford prison experiment

Posted on December 12, 2012 at 6:30 AM Comments comments (98)
"The Stanford prison experiment was a study of the psychological effects of becoming a prisoner or prison guard. The experiment was conducted from August 14 to 20, 1971 by a team of researchers led by Psychology professor Philip Zimbardo (Also the host of the documentary series Discovering Psychology) at Stanford University. It was funded by a grant from the U.S. Office of Naval Research and was of interest to both the US Navy and Marine Corps in order to determine the causes of conflict between military guards and prisoners.

Twenty-four students were selected out of 75 to play the prisoners and live in a mock prison in the basement of the Stanford psychology building. Roles were assigned randomly. The participants adapted to their roles well beyond what even Zimbardo himself expected, leading the "Officers" to display authoritarian measures and ultimately to subject some of the prisoners to torture. In turn, many of the prisoners developed passive attitudes and accepted physical abuse, and, at the request of the guards, readily inflicted punishment on other prisoners who attempted to stop it. The experiment even affected Zimbardo himself, who, in his capacity as "Prison Superintendent," lost sight of his role as psychologist and permitted the abuse to continue as though it were a real prison. Five of the prisoners were upset enough by the process to quit the experiment early, and the entire experiment was abruptly stopped after only six days. The experimental process and the results remain controversial.

The results of the experiment are said to support situational attribution of behavior rather than dispositional attribution. In other words, it seemed the situation caused the participants' behavior, rather than anything inherent in their individual personalities. In this way, it is compatible with the results of the also-famous Milgram experiment, in which ordinary people fulfilled orders to administer what appeared to be agonizing and dangerous electric shocks to a confederate of the experimenter."

Compassionate provision of healthcare

Posted on December 11, 2012 at 5:02 PM Comments comments (2)

This lecture was delivered at CCARE Stamford on the 8th of November, 2012.

There is strong scientific evidence which shows that whole-person compassionate care is safer, more effective, achieves better outcomes, saves time, reduces demand, makes work meaningful and costs less. Yet doctors and nurses say "we just don't have time to care". Healthcare has become dehumanised. 

Dr. Youngson draws on Paul Gilbert's model of compassion (2009). Compassion involves the ability to tolerate distress, to stay with the suffering of the patient in the most awful circumstances. 

The Buddha’s Brain

Posted on December 11, 2012 at 10:56 AM Comments comments (104)
What Modern Science Is Revealing About the Ancient Practice of Meditation

"The Buddha’s Brain: What Modern Science Is Revealing About the Ancient Practice of Meditationwas the theme of an enlightening evening with Dr. Richard Davidson and Matthieu Ricard, moderated by Krista Tippett. 

The event was held at the Ted Mann Concert Hall at the University of Minnesota on Friday, October 12, 2012 where it played to a packed house of over eleven hundred people.For thousands of years, contemplatives and mystics the world over, have experienced the power of meditation first hand. In the present day, a remarkable collaboration between some of the world’s leading neuroscientists and advanced meditators is beginning to shed new light on this ancient practice.

Two of the world’s leading experts on the science of meditation discuss how mental training can help us recondition the mind and rewire the brain to experience wellbeing, compassion, and insight. Longtime friends and collaborators Dr. Richard Davidson and Matthieu Ricard discuss their groundbreaking work, which illuminates how reconditioning the mind through meditation brings lasting changes in the structure and functioning of the brain.

Dr. Richard Davidson is one of the world’s foremost brain scientists. Director of the Center for Investigating Healthy Minds and the Waisman Laboratory for Brain Imaging and Behavior at the University of Wisconsin-Madison, Dr. Davidson specializes in research on brain function, especially regarding positive emotions and meditation. In addition to being listed as one of Time Magazine’s one hundred most influential people in the world, he has also received the most prestigious award given by the American Psychological Association for lifetime achievement. He has published more than 150 articles, twelve books, and many chapters and reviews. He is a member of the board of the Mind and Life Institute, an organization dedicated to collaborative research between scientists and Buddhist scholars and meditators.

Matthieu Ricard is a Buddhist monk, author, translator, and photographer. In 1972, Matthieu earned a Ph.D. in cell genetics at the renowned Institute Pasteur under the French Nobel Laureate Francois Jacob. After traveling to India to study Tibetan Buddhism, he left his life as a scientist and ordained as Buddhist monk. Matthieu has published many books and served as the interpreter for the Dalai Lama. He is actively engaged, as a research subject and advisor, in the studies at various universities around the world on the effects mind training and meditation have on the brain. He is also an active member of the Mind and Life Institute."

The science of compassion. Cultivating compassion.

Posted on December 10, 2012 at 5:58 PM Comments comments (103)

Richard J. Davidson is one of the pioneer researchers in the neuroscience of emotion.

He has studied "experts in compassion", Budhist monks who have over 10.000 hours of formal practise in compassion meditation. They monitored areas of the brain that were going to be "recruited" during mediation.   

When practitioners begin to meditate they show a dramatic increase in gamma oscillations. There is no specific circuit in the brain dedicated to compassion but compassion training affects parts of the brain that are involved in many other kinds of function.

Circuits that are known to be involved in emotion and empathy - the Anterior Insula (AI), Temporal Parietal Junction (TPJ) and the Amygdala are being modulated during meditation.

They also looked at changes in the functioning of the autonomic nervous system. Compassion induces changes in heart rate. When the experts practice compassion there is a higher coupling between the activity in the brain (insula and the dorsal anterior cingulate) and heart rate. 

Even two weeks' daily 30 minute practice of compassion meditation changes the activity in the brain and stimulates altruistic behaviour. In an experiments practitioners were asked to contemplate and visualize the suffering and then wish the freedom from suffering for: a person they love, for themselves, for a stranger, for a person whom they find difficult and all beings. The phrase most used was: "May you be free from suffering. May you experience joy and ease. They were instructed to notice visceral sensations (especially in the area of the heart) and were instructed to feel compassion emotionally not simply repeat phrases cognitively. 

The researchers collected brain data and behavioural data before and after the training and noticed that compassion training changed brain function and also resulted in people being more likely to act altruistically.

The science of compassion 2012. Polyvagal theory

Posted on December 7, 2012 at 7:53 PM Comments comments (2)
Origins of compassion. A phylogenetic Perspective. This was a presentation delivered at the Compassion Conference (Telluride, 2012)

Stephen A. Porges, Phd, is the author of the polyvagal theory, which states that the tenth cranial nerve plays an important role in affiliative motivation. He focuses on core processes in the body on which psychological processes may reside. 

Dr Porges states that compassion is uniquely mammalian and  neuro-physiologically incompatible with judgemental, evaluative and defensive behaviours and feelings that recruit older (reptilian) neural circuits regulating autonomic function. The effectiveness of meditation, listening, chant, posture and breath on fostering mental states and health is due to a common phylogenetic change in the neural regulation of the autonomic nervous system. These practices are all recruiting the newer mammalian circuits. 

Unlike reptiles, mammals have two vagal circuits. The ancient vagus is unmyelinated and regulates gut and sub-diaphragmatic organs. The myelinated vagus is specifically mammalian and regulates supra-diaphragmatic organs (lungs and heart).

Bi-directional interactions among brainstem source nuclei of the myelinated vagus and several cranial nerves that regulate the striated muscles of the face and head result in "face-heart" connection with "portals" that regulate "state". The myelinated vagus down-regulates stress response. This system provides portals of manipulation. These state regulating portals are the voice (self-talk, chants), ear (listening to another), facial muscles (relaxing them), breathing (prolonging exhalation) and posture (dance, open posture) 

Compassion requires turning off our defenses. Our physiological state colours our perception of the world. The same stimuli can trigger different responses depending on our physiological states. The autonomic nervous system is also related to the brain. Our visualisations, thoughts can be transmitted from brain to body, but also the body can promote information upward, changing our cognitive states and our capacity to relate to the world. The vagus nerve essentially reads our body and sends the information to the cortex.

Defense turns off the mammalian "innovations", essentially the ANS and the face-heart connection. Faces become blank or flat when people become scared or challenged or in pain. The neural tone to the heart increases. When the face becomes animated, the vagal activity to the heart is calming. 

Compassion requires turning off biobehavioural defense systems in the "dyad" to enable both "compassionate" individual and the other to be safe, to be proximal and to enable physical contact. We are capable of picking up from facial cues whether someone is genuinely compassionate or acting out of duty. The delivery of service in a medical model requires the person to be genuinely loving and caring for the target person to be receptive to that type of support. 

Polyvagal Theory. Explains the functional relevance of the mammalian modifications of the ANS and emphasizes the adaptive consequences of detecting risk on physiological state, social behaviour, psychological experience and health. We use our newer circuits first and when they don't serve to put us in safer environments, we use older and older circuits. It is not a cognitive or a perceptual response. 

Neuroception is the body's ability to detect risk outside awareness and when it detects risk it shifts us into these different states. We take cues both from the external world and from inside the body and this is interpreted by the nervous system (an unconscious response) and this triggers different physiological states. In a state of safety we can spontaneously engage with others (eye contact, good facial expression, voice has prosody and when we do all this this supports visceral homeostasis and health). When we feel safe we are able to use another person in the dyadic interaction to help regulate our state. 

When our nervous system detects features that are not safe, then it goes into a more mobilised state. Muscle tension increases, heart rate increases, the voice is squeaky - you are now prepared for fight-flight behaviour. If the nervous system identifies the situation as life threatening and there is no possibility of getting away, the system shuts down (immobilisation, death feigning). Society is always pushing people to their limits. We need to down-regulate mobilisation to put people in the safe state and in this state we can be bold, creative and engaged.

The dyad is essential in regulating physiological state. Mother-infant interaction promotes a feeling of safety. This is not solely a human response - this is shared by other mammals. Face to face interaction helps tie the vagal nerve (the tenth)
to facial muscles, the larynx and the heart. When you are safe you can be immobilised without fear. This can only occur following the establishment of "safety" via the social engagement system. Without feeling safe, immobilisation triggers life-threat experiences. 

Bodily feelings influence our awareness of others and either potentiate spontaneous social engagement behaviours and feelings of compassion or defensive reactions and judgemental feelings. Compassion is a manifestation of our biological need to engage and to be with others and a component of our biological quest for safety in the proximity of another.