Critical compassion
Considering the elements of a compassionate approach which can support mental wellbeing, including the role of the self-critic.
Hello and welcome to the latest Compassionate Nature article, with a return to research relating to compassion after several nature based articles.
“Kindness, gentleness, warmth and compassion are like basic vitamins for our minds.”
Fifteen years ago Professor Paul Gilbert published his book The Compassionate Mind , which those words are taken from. The book provides an introduction to Compassion Focused Therapy (CFT) and associated Compassionate Mind Training (CMT) practices for a wider readership outside of clinical psychology.
CFT has featured in previous articles, in relation to how we offer compassion to ourselves and others and helping with addressing eating disorders along with considering the role of compassion-based imagery However these posts did not go into all of the elements of CFT, which this article partly addresses by considering some of its theoretical elements and how they may influence approaches and outcomes within therapy. One challenge which I hope to overcome in this piece is to express theoretical perspectives and psychological constructs in an accessible way which is of wider interest than those working in clinical psychology and psychotherapy professions.
Compassionate nature is a free publication, supported by a global readership. Please consider subscribing for free to support my writing and never miss a weekly post. You don’t need to use Substack to subscribe, just an email address which will only ever be used to send each published article.
CFT considers three flows of compassion (to others, from others and to oneself) and provides a theoretical model of three emotional regulation systems, often presented as three circles coloured red for threat, blue for drive and green for soothing. These are not specific systems, but rather a construct linked to underlying behaviours, cognition, emotion and neurophysiological processes. Our threat system does what it says, it reacts to threats and invokes a response, which may be to fight or to flee, or in some cases to freeze. While this is a very helpful process, we may suffer by responding to perceived threats, elongated exposure to threats and over-evaluation or over-assessment of threats, which are not helpful. Drive is also a helpful system, enabling us to seek out resources and undertake actions. However drive may also be unhelpful, when it is very focused on achievement or supports unhealthy competition with either ourself or others. The soothing system links to restorative physiological processes, which enable us to relax and recover from threat-invoked responses, such as stress.
Sometimes a view is expressed of balancing the three systems, and it can helpful to imagine the circles in different sizes to understand if one is more dominant than others. However I think it is more apt to consider the dynamics of the three within a context - after all, if I were attacked by an animal I would want my soothing circle to be fairly small at that point. This illustrates an issue linked to mental wellbeing. If I was attacked by an animal and took the flight option to escape, once away from the threat my soothing system could then be invoked to restore the physical resources used in fleeing. However we have the ability to reflect and think about outcomes, so while away from the actual threat, I may ruminate on what may have happened or be critical of why I hadn’t spotted the threat earlier. This can result in the threat and drive systems remaining engaged, reducing restoration. This kind of extended and prolonged exposure to threat-based responses with reduced restoration is detrimental to both physiological and psychological health. This effect may be exacerbated by social factors and social contexts of modern life.
Some recently published papers have looked at social constructs relating to compassion, and also our understanding of the self-critic which is often addressed specifically by compassion-based therapies.
Threat, safety and safeness
In 1993 Paul Gilbert published a perspective paper which highlighted that in addition to considering how individuals assess and react to threats, how they assess a sense of safety should also be considered within clinical psychology. The paper was informed by several theoretical perspectives which influenced CFT, including social mentalities, evolutionary psychology, and attachment theory, along with associated physiological processes.
Psychology geek aside - social mentalities refers to behaviour and thoughts that relate to social roles and social interactions which have evolved to support our survival. These include care-seeking (interacting with others who offer support or provide resources) and care-giving (motivations to help others). While these have evolved to support social interactions and communities, it is proposed that we also apply these social mentalities to ourselves. The mentalities are supported by a number of different biological processes (e.g. hormones, specific neural networks) which it is argued can be invoked during both external social and internal interactions. Perhaps most interesting is the perspective that we can activate both towards ourselves at the same time. That is, we can be both aware of our distress or needs (care seeking) and be able to respond with compassion towards ourself (caregiving).
Paul has recently revisited that 1993 paper with an updated perspective (2024), offering greater definition and distinction between threat awareness, safety and safeness, along with the social considerations of these three constructs. It might seem odd to be defining these, however while threat is widely understood, within psychotherapy safeness and safety are often used to mean the same thing, when they are different.
As highlighted above, threats can be both external (e.g. physical attack, social status) and internal (e.g. negative self- evaluation, maladaptive rumination). Safety can be defined through two dimensions, the absence of threat and the presence of support. Related behaviours include safety-checking, which involves constantly checking for the absence of threats and avoidance behaviours, while safety-seeking relates to steps taken to address threats and awareness of potential threats, including taking actions which are believed to prevent those threats. These behaviours are all linked to biological processes designed to support us manage threats.
How we seek safety matters. Excessive safety checking behaviours are linked with several mental health issues while excessive self-monitoring has links with unhelpful levels of perfectionism. Perfectionism or self-criticism may be used as a preventative strategy to avoid making errors, which may be associated with not feeling safe socially. We can also develop selective attention toward threats, resulting in “safe rather than sorry” approach, so even when the threat is reduced or absent the associated related emotions of anxiety and distress remain. While these behaviours and strategies may provide short term relief this is not the same as feeling safe.
Safeness in contrast invokes biological processes relating to restoration and involves the awareness of both internal and external resources that allow us to cope with threats and to manage risks. Levels of social safeness have positive associations with how we feel we compare to others and a negative association with guilt and shame. Research also suggests that social safeness provided via elements such as community and prosocial behaviour has a positive influence to our sense of threat.
Social aspects also influence our thoughts and behaviours. For example, when feeling threatened are we able to seek help, without feeling associated emotions such as guilt or shame or without fear of being rejected or seen as a burden? Similarly when we use coping thought patterns on ourselves are we doing so with a reassuring, supportive emotional tone or a harsh judgmental one?
Research indicates key differences between a safety process that is used for monitoring the absence of threat compared to the safety process used to monitor for the presence of support. This is important as it suggests that when both processes are engaged and supported then individuals feel more behavioural activation (such as solving problems which are causing distress) and greater positive affect. The paper therefore argues that we not only monitor for the absence of threat and the presence of supportive resources, but also for the presence of positive social signals from others.
In the absence of threat and in the presence of support along with positive social signals, we thrive.
Getting personal
Eli Cwinn, Tobyn Bell and James Kirby’s 2023 paper also explored social mentalities, considering how these are interpersonal (compassion to and from others) and intrapersonal (to one-self) relationships, aligning with the three flows of compassion suggested within CFT. These relationships can be influential on the three emotional regulation systems of threat, drive and soothing, especially within a therapeutic setting.
However the authors argue that there is a research gap on how interpersonal relationships may influence engagement with CFT. For example, for some clients a caring response may be associated with harm, which engages their threat system. The therapist has to constantly assess how their social signals are being received and adapt accordingly.
Similarly how the therapist helps engage the client’s drive system is important. Over-focus on the drive system may foster an achievement focus or competitive response, which may leave the client feeling a failure within therapy. It could induce the perception of the therapists as an expert resulting in a submissive sense within the client resulting in feelings of inadequacy. Within CFT the focus on self-compassion rather than self-esteem helps to manage this risk.
The authors also highlight the difference between safety and safeness, highlighting the point that safety is being able to defend against threats while safeness is the absence of the threat and presence of needed resources. To support safeness therapists are encouraged to provide an environment where the client can be themselves without fear of judgement.
In addressing the intrapersonal, self-compassion and self-criticism can be seen as internal versions of interpersonal constructs. For example the interpersonal experience of bullying is similar to the intrapersonal experience of a harsh self-critic, the difference being that in the intrapersonal relationship the bully is also part of oneself. This can be a key factor to the fears or barriers that clients may face with developing greater self-compassion, which the therapist will need to help them overcome.
The paper includes a worked example of how these points can be applied within a therapy setting and how they may contribute to a clients needs. The paper underlines that interventions such as CFT provide opportunities to use these interpersonal and intrapersonal constructs to help clients, which other formats of therapy may not.
Being critical
Maladaptive or high levels of self-criticism are linked with many mental health issues and a reduction in overall wellbeing, so it is seen as an influential transdiagnostic factor. However while self-criticism appears an established psychological construct, a 2024 meta-review (a review of systematic reviews and meta-analyses) by Vittoria Zaccari and colleagues poses a number of questions. Is self-criticism a symptom or a cause? Is it a stable trait, part of someone’s personality or a coping strategy ? Is it a spectrum of self-monitoring, ranging from adaptive/helpful to maladaptive/unhelpful, which influences motivation and emotion?
As is often the case in psychology there are varying. often similar, definitions of self-criticism. The authors define self-criticism as a negative evaluation of one’s behaviours and thoughts, along with a negative sense of self through self-scrutiny. The authors selected 5 systematic and/or meta-analyses which considered the role of the self-critic. Of the selected studies, 4 were from European countries and 1 was from the US, and were published between 2018 and 2021. The authors identified several themes from their review of the selected papers.
Firstly there are a number of theoretical viewpoints on the self-critic construct and often the authors of the reviewed research did not fully define what they meant when measuring self-criticism nor which theory it was linked to. Self-criticism is seen a multi- dimensional construct, however much of the research did not include this, which may impair assessment of self-criticism and comparison of results across studies.
A research gap appears to be around the aetiology of self-criticism, with research mainly focusing on its impact and relationship with wellbeing. This means there may be limited insight into different types of self-criticism and the risk factors linked to it developing. Relatedly, there appears to be a gap in research around the target of the self-criticism, with some studies considering overall impacts while others focused on impacts to specific factors, such as behaviours or thoughts.
While a lot of the research reviewed viewed a negative emotional valance to self-criticism, only a few actually defined what they meant by this. The authors suggest more discussion and definition around levels of emotional tone of the inner critic would be helpful. The emotional reaction to self-criticism was also deemed to be poorly represented in research, with more granular emotional definitions required.
Lastly the authors suggest that the research reviewed has not added to how self-criticism relates to specific mental health issues nor if self-criticism is a trait or a coping strategy.
The review recommends a number of future research areas on self-criticism. These include considering different forms of self-criticism and how they specifically relate to emotions. cognition and behaviour. They highlight the need to clarify the relationship between self-criticism to guilt and shame, along with the link between self-criticism and mental health issues.
This has been a more theoretical based article than most Compassionate Nature articles and perhaps one more of interest to those working in clinical psychology and psychotherapy. I thought it would be interesting to try and share some of the thinking and research that informs a compassion-focused approach like CFT/CMT to mental wellbeing, as in recent years there has been growing interest and promotion of self-compassion, although not all of that has been evidence based. It has been a very hard article to write though (accompanied by a loud self-critic!) and I have not covered all the points with the three papers. They are all open access, so if you would like to delve into them in more detail they are available via the links.
Before being involved with research on compassion, I had a personal introduction to CFT, with an overview of the “three circle” model in a therapeutic setting. Lots of it made sense and continues to be helpful. Through a series of happy, sometimes random connections and events, my experience of CFT lead to the creation in January 2018 of the #365DaysOfCompassion hashtag and the start of daily compassion inspired posts on social media , alongside a weekly Review magazine and a series of videos explaining CFT. A community has grown round that idea and the hashtag is still going strong after seven and half years. Also during 2018 I was fortunate to be invited by Lucy Maddox to record a short podcast episode on CFT alongside Paul for the BABCP, providing a perspective from the patient/client side of the therapeutic relationship. These resources are shared here as they may be helpful if you would like to know more about CFT outside of the more theoretical perspectives.
While a formal intervention such as CFT may not be needed, perhaps bringing just that little more compassion into our internal life may help to turn the inner critic into an inner supporter and provide a more helpful social relationship with ourselves.
Thanks ever so much for reading this article. All the research reviewed are open access studies, so are free to read in detail via the article links or from the references below. If you think this article would be helpful to someone else please do share on, it is a freely available public piece.
I would also love to hear what you think. Please a comment, send me an email at TheCompassionateNatureHub@gmail.com or leave a reply if you see it via social media.
You can also support my work for free by subscribing to the publication. All you need is an email address. Your support means a great deal - thank you
References
Cwinn, E., Bell, T., & Kirby, J. (2023). Theory and Interpersonal Processes in Compassion Focused Therapy. OBM Integrative and Complementary Medicine, 8(4), 1-36. https://doi.org/10.21926/obm.icm.2304056
Gilbert, P. (2024). Threat, safety, safeness and social safeness 30 years on: Fundamental dimensions and distinctions for mental health and well‐being. British journal of clinical psychology. https://doi.org/10.1111/bjc.12466
Zaccari, V., Mancini, F., & Rogier, G. (2024). State of the art of the literature on definitions of self-criticism: a meta-review. Frontiers in Psychiatry, 15, 1239696. https://doi.org/10.3389/fpsyt.2024.1239696