Modalities / Cognitive-Behavioral

Compassion-Focused Therapy

Paul Gilbert · 2005
Key text: The Compassionate Mind (2009)
Cognitive-Behavioral Focus: Experiential + Skill Short-medium Individual + Group

Core Mechanism

Activating the soothing/affiliative system through compassion practices counteracts threat-based shame and self-criticism

Ontology

Shame and self-criticism driven by overactive threat system and underdeveloped soothing/safeness system

Therapeutic Voice

"Imagine your compassionate self — wise, strong, warm. What would that self say to you right now?"

View of the Person

A being with an overactive threat system and underdeveloped soothing system — shame is the core problem, compassion the antidote


Evidence

Not yet in major guidelines

10+ RCTs

Kirby et al. (2017)

Growing evidence. Moderate effects on self-compassion, depression, anxiety.

Depression & Mood Disorders
Effect: g = 0.64
~45-55% response
Kirby et al., 2017 (2017)

Conditions

Epistemology

EmpiricistContemplative

Blind Spots

Compassion imagery can paradoxically increase distress in highly shame-prone individuals initially; limited outside depression/shame

Contraindications

Active psychosis, clients for whom compassion activates intense shame or fear (requires careful titration rather than full contraindication), severe dissociation, situations requiring immediate behavioral crisis intervention


Training

CFT workshops + supervised practice. Foundation 2-3 days. Builds on CBT + evolutionary psychology

Compassionate Mind Foundation

Foundation: 16-24 hrs; advanced additional

$500-2K

Equity & Cultural Adaptations

Cross-cultural adaptationsLGBTQ+ affirming adaptationsMen's mental health adaptationsMilitary/veteran-specific adaptationsDisability/chronic illness affirming

Philosophical Roots

Buddhist compassion practices (Dalai Lama, Shantideva); evolutionary psychology (Gilbert — three emotion regulation systems); attachment theory; Neff (self-compassion research)

Related Modalities


Clinical Vignettes

See how Compassion-Focused Therapy formulates these cases:

Test Yourself

CFT's three emotion systems?

Show answer

Threat, drive, soothing. Many clients: overdeveloped threat, underdeveloped soothing.


Sources

Kirby, J.N., et al. (2017). Meta-analysis of compassion-based interventions. Behavior Therapy, 48(6), 778-792.