Content uploaded by Elaine Beaumont
Author content
All content in this area was uploaded by Elaine Beaumont on Jul 25, 2015
Content may be subject to copyright.
Counselling Psychology Review, Vol. 27, No. 1, March 2012 31
© The British Psychological Society – ISSN 0269-6975
THIS STUDY aims to explore differences
in treatment outcome measures, follow-
ing a traumatic incident, of either Cog-
nitive Behaviour Therapy (CBT) or CBT
coupled with using Compassionate Mind
Training (CMT) techniques. CBT is a treat-
ment which challenges the way individuals
think and behave, which has been found to
be highly effective in treating individuals
who have suffered from a traumatic event.
It is the recommended therapy for post-
traumatic stress disorder (PTSD) (NICE,
2005).
It is important to note that, in some cases,
individuals that have been involved in a trau-
matic experience feel significant levels of
shame and/or guilt (Jonsson & Segesten,
2004; Lee, 2009). Whilst CBT may be effec-
tive in reducing other symptoms of PTSD,
these individuals may also benefit from using
self-soothing techniques, such as developing
empathy, loving kindness and compassion
for themselves, in a non-judgemental way
(Gilbert & Irons, 2005; Harman & Lee, 2010;
Neff, Kirkpatrick & Rude 2007). This might
be described in everyday, non-technical
Research Paper
‘Being kinder to myself’:
A prospective
comparative study, exploring post-trauma
therapy outcome measures, for two groups
of clients, receiving
either
Cognitive
Behaviour Therapy
or
Cognitive Behaviour
Therapy and Compassionate Mind Training
Elaine Beaumont, Adam Galpin & Peter Jenkins
Background/Aims/Objectives: This prospective, comparative outcome study was designed to contrast the
relative impact of differing therapeutic interventions for trauma victims, carried out by the same therapist.
Methods/Methodology: A non-random convenience sample (N=32) of participants, referred for therapy
following a traumatic incident, were randomly assigned to receive up to 12 sessions of either Cognitive
Behaviour Therapy (CBT), or CBT coupled with Compassionate Mind Training (CMT). A repeated
measures design was used and data was analysed using analysis of variance. Data was gathered pre-therapy
and post-therapy, using three self-report questionnaires (Hospital Anxiety and Depression Scale; Impact of
Events Scale; the Self-Compassion Scale).
Results/Findings: Results supported two of the three original hypotheses. Participants in both conditions
experienced a highly statistically significant reduction in symptoms of anxiety, depression, avoidant
behaviour, intrusive thoughts and hyper-arousal symptoms post-therapy. Participants in the combined CBT
and CMT condition developed statistically significant higher self-compassion scores post-therapy than the
CBT-only group [F(1,30)=4.657, p≤.05]. There was no significant difference between treatment groups.
Discussion/Conclusions: The results suggest that CMT may be a useful addition to CBT for clients suffering
with trauma-related symptoms. In conclusion, high levels of self-compassion are linked to a decrease in anxiety
and depression and trauma-related symptoms.
Keywords: trauma; cognitive behaviour therapy; compassionate mind training; counselling psychology.
32 Counselling Psychology Review, Vol. 27, No. 1, March 2012
language, as encouraging the client to con-
sider ‘being kinder to myself’, as an aid to
therapeutic recovery, following a traumatic
incident.
CBT and CMT are powerful therapies to
contemplate combining in some fashion and
research in this area is still relatively new
(Gilbert et al., 2006). Research suggests,
however, that through combining CBT and
CMT, individuals will learn to challenge their
own behaviour, thoughts and negative ‘self-
talk’, by being more caring and sympathetic,
rather than being critical and judgmental.
Counselling psychology is committed to
evidence-based practice and aims to provide
therapy that is geared toward each individu-
als needs. The new ‘third wave’ approaches
incorporate techniques such as CMT and
mindfulness and more focus is put on the
therapeutic relationship. This offers coun-
selling psychologists and clinicians the
chance to work with individuals using a
pluralistic approach as therapy is geared
toward the client’s needs (Cooper &
McLeod, 2011).
CBT and CMT have certain similarities,
in that both use assessment, case formula-
tion and work in collaboration with the
client. In addition, both examine the role
which behaviour, cognition and emotion
play and how the body may respond to a per-
ceived threat. However, Lee (2009) proposes
that CMT can also act as an effective supple-
mentary therapy to CBT, since it offers a way
to work specifically with the crucial emotions
of shame, guilt and self-blame. CMT accord-
ingly aims to provide key skills in addition to
CBT and, therefore, aims to aid relapse pre-
vention. Table 1 lists some of the key differ-
ences between CBT and CMT.
Project Aim
This research aims to examine differences in
treatment outcome measures, following a
traumatic incident. Two groups will be com-
pared, with the first group receiving only
CBT and the second group receiving CBT
combined with CMT.
Project objectives
(1) To carry out analysis of CBT and CMT, in
order to determine the relative effects that
both therapeutic interventions have on
trauma-related symptoms.
(2) To examine the role self-compassion can
play, in helping individuals who have been
involved in a traumatic incident.
Hypothesis
There will be a significant difference in out-
come measures post-therapy:
(1) It is hypothesised that individuals in both
groups will have significantly lower scores
post- therapy on the Impact of Events Scale,
Hospital Anxiety and Depression Scale and
higher scores on the Self-Compassion Scale.
(2) There will be a significant difference
between the two therapy groups. Individuals
who receive a course of CBT and CMT fol-
lowing a traumatic incident will have lower
scores post-therapy on the Impact of Events
Scale and Hospital Anxiety and Depression
Scale than individuals in the CBT only
group.
(3) It is hypothesised that individuals who
receive a course of CBT and CMT following
a traumatic incident will have significantly
higher scores post-therapy on the Self-Com-
passion Scale than individuals in the CBT-
only condition.
Methodology
A quantitative approach was selected for this
research project, whereby data collection is
carried out in a systematic manner. While
quantitative methods do not necessarily
demonstrate unassailable ‘truths’ in the con-
ventional positivist manner, they are,
nonetheless, useful in establishing the
potential value to counselling psychologists
of adopting innovative techniques (e.g. see
Goldstein, 2010). Quantitative methods aim
to be testable and replicable, affording the
experimenter a degree of control over key
variables. In this study, the independent vari-
ables were the type of therapy provided
(CBT or CBT + CMT) and the time of assess-
ment (pre- or post-therapy). The dependent
Elaine Beaumont, Adam Galpin & Peter Jenkins
Counselling Psychology Review, Vol. 27, No. 1, March 2012 33
‘Being kinder to myself’
Table 1: Some of the differences in approach and treatment techniques used in
CBT and CMT.
Approach used
Reflective approach
client-based interventions
Therapist-based interventions
Educational interventions
Therapist based interventions
which include reflective tasks
carried out by the client as
homework tasks
Cognitive Behavioural Therapy
Writing about the trauma,
learning to take charge of the
memory.
Use of exposure therapy –
revisiting the trauma scene,
imaginal exposure.
Cognitive restructuring to
examine core beliefs,
dysfunctional assumptions and
negative automatic thoughts.
Challenging assumptions and
thinking errors.
Anxiety management training,
relaxation and distraction
techniques.
Learning to think objectively.
Learning to observe physical,
emotional and cognitive
reactions.
Reliving work – exploring the
worst memory and using coping
strategies.
Completion of thought
records/charts/cost benefit
analysis to explore emotions,
thoughts, behaviour and bodily
reactions.
Compassionate Mind Training
Compassionate letter writing –
focusing on being kind,
supportive and nurturing.
Developing sensitivity, sympathy,
acceptance and insight into one’s
own difficulties through self-
reflection.
Refocusing attention by
reflecting on what would be
helpful.
Thought balancing/self-
monitoring – paying attention to
thoughts and feelings and
monitoring them.
Use of ‘the empty chair’
technique (experiencing feelings
brought up by the ‘internal self-
critic’ and then exploring what
the compassionate self could
say/do).
Exploring self-critical rumination.
Relaxation techniques.
Mindfulness – learning how to
pay attention in the present
moment without judging or
criticising.
Learning to observe self
(similar to the CBT condition but
including self-kindness, warmth
and challenging the ‘internal
bully’).
Examining positives – for
example, acknowledging what
went well and focusing on
specific qualities.
Use of Self-compassion
diary/journal.
Use of imagery to help deal with
the problem (imagine the
compassionate self dealing with
this problem).
34 Counselling Psychology Review, Vol. 27, No. 1, March 2012
variables were the scores on the question-
naires pre-therapy and post-therapy.
Questionnaires were given to participants
and scores collated, using Likert-type scales.
The three questionnaires used in the study
have been found to be reliable measuring
tools and have high internal validity (Neff,
2003; Snaith & Zigmond 1994; Weiss & Mar-
mar, 1996).
Sample construction
A non-random purposive sample of 32 par-
ticipants was devised for this study. Partici-
pants were individuals referred for a course
of CBT by a range of agencies, following a
trauma-related incident. Table 2 lists the
number of participants allocated to each
condition and the type of trauma they expe-
rienced.
Thirty-two participants agreed to take
part in the study and were randomly put into
one of two groups, depending on the type of
trauma-related incident experienced. For
example, 12 individuals were referred
because of a car accident and were randomly
assigned so, that there were six individuals in
each group. One group received CBT for up
to 12 weeks and the second group received
CBT combined with CMT for up to 12 weeks.
Procedure and study design
All participants received CBT from a single
qualified and BABCP-accredited cognitive
behavioural psychotherapist (EB). All partic-
ipants were informed that they would receive
CBT, in accordance with NICE Guidelines
(NICE, 2005). Participants in the CMT
group were advised that, as part of therapy,
they would explore and learn techniques
which could help them develop empathy for
themselves and acceptance of their distress.
Three questionnaires were used to col-
lect the data, measuring anxiety, depression,
self-compassion and trauma-related symp-
toms. A repeated measures design was used,
with participants completing questionnaires
pre-therapy and post-therapy.
Individual treatment plans were designed
to ensure that the therapeutic interventions
employed met the needs of each individual.
CBT techniques such as cognitive restructur-
ing, behavioural activation, graded exposure,
relapse prevention and Socratic dialogue were
used in both conditions. Individuals in the
CMT group used imagery by bringing to mind
a loving, accepting and caring image which,
helped to challenge ‘the internal bully’. Addi-
tionally, CMT interventions included compas-
sionate letter writing and grounding work
Elaine Beaumont, Adam Galpin & Peter Jenkins
Table 2: Type of trauma experienced and the number of participants allocated
to each group.
Type of traumatic episode experienced Number of individuals Number of individuals
in the CBT-only group in the combined
CBT and CMT group
Accident at work 6 5
Car accident 6 6
Fatal accident/Traumatic grief 1 2
Diagnosis of life-threatening illness 1
Accident (resulting in disability) 1 1
Witness of violent crime 1
Sexual assault 1
Domestic violence 1 1
TOTAL 16 16
Counselling Psychology Review, Vol. 27, No. 1, March 2012 35
(using a memory trigger such as a precious
stone or smell that the individual could associ-
ate with relaxation and safety).
Data collection and selection of
research instruments
Data was collected by using three measure-
ment tools. This questionnaire-based
method was used, as it is a standardised,
effective and economical way of collecting
information. The instruments included:
The Hospital Anxiety and Depression
Scale (Snaith & Zigmond, 1994).
The Impact of Events Scale – Revised
(Horowitz et al., 1979; Weiss & Marmar,
1996).
Self-Compassion Scale (SCS) – Short
Form (Raes et al., 2010).
Ethical considerations
Ethical approval was given by the College
Research Governance and Ethics Committee
at Salford University. The British Association
for Behavioural and Cognitive Psychothera-
pies (BABCP) Ethical Guidelines (2009) and
the UK Council for Psychotherapy (UKCP)
Ethical Principles and Code of Professional
Conduct (2009) were adhered to through-
out this study.
Results
The data was analysed using a mixed 2
(group: CBT, CBT + CMT) x 2 (time of test-
ing: pre- and post-therapy) Analysis of Vari-
ance (ANOVA).
Symptoms of depression before and
after therapy
The results of the depression questionnaire
for both groups pre- and post-therapy can be
seen in Figure 1.
A significant reduction in depression was
observed from a pre-therapy mean score
(13.78) to a post-therapy mean score (5.37)
[F(1, 30)=223.935, p≤0.001].
The main effect comparing the two types
of intervention was not significant, suggesting
no difference in the overall levels of depres-
sion between the two treatment groups
[F(1,30)=2.057, p=.162]. However, a robust
interaction between treatment group pre and
post-therapy was also observed
[F(1,30)=14.734, p≤0.001]. Although mean
scores decrease post-therapy in both groups,
the CBT group is starting from a lower group
mean (12) than the combined CBT and CMT
group mean (15.56). The CBT + CMT group
proceeds to a lower group mean post-therapy
than the CBT group, which results in a greater
‘Being kinder to myself’
Table 3: Pre-therapy and post-therapy mean scores and standard deviations for the
CBT-only group and the combined CBT and CMT group.
Scale CBT Group (N=16) CBT + CMT Group (N=16)
Pre-therapy Post-therapy Difference Pre-therapy Post-therapy Difference
(Mean SD) (Mean SD) (Mean SD) (Mean SD) (Mean SD) (Mean SD)
HADS
Anxiety 12.69 (3.72) 5.37 (2.33) 7.32 (3.32) 14.56 (4.18) 5.12 (1.41) 9.44 (4.32)
Depression 12 (4.88) 5.75 (2.17) 6.25 (3.71) 15.56 (3.10) 5 (1.63) 10.56 (2.53)
IES
Avoidance 20.18 (5.42) 7.75 (3.97) 12.43 (4.22) 21.56 (3.83) 5.75 (2.64) 15.81 (5.06)
Hyperarousal 15.87 (3.54) 5.06 (3.75) 10.81 (2.9) 13.81 (5.14) 3.44 (2.58) 10.37 (4.35)
Intrusion 22.25 (4.01) 7 (4.35) 15.25 (5.69) 23.25 (5.22) 7.25 (4.04) 16 (5)
SCS
Compassion 1.94 (0.51) 3.21 (0.57) 1.27 (0.7) 2.13 (0.75) 3.72 (0.57) 1.59 (0.88)
36 Counselling Psychology Review, Vol. 27, No. 1, March 2012
Elaine Beaumont, Adam Galpin & Peter Jenkins
Figure 1: Mean Scores pre-therapy and post-therapy for symptoms of depression in the
CBT group and the CBT and CMT combined group.
Figure 2: Mean Scores pre-therapy and post-therapy for symptoms of avoidance for the
CBT group and the combined CBT and CMT group.
Counselling Psychology Review, Vol. 27, No. 1, March 2012 37
reduction in symptoms of depression in the
CBT and CMT group (reduction=10.56) than
the CBT group (reduction=6.25).
An independent group’s t-test on scores
of the amount of improvement was com-
puted by subtracting post-therapy scores
from pre-therapy scores. The results suggest
a significantly greater improvement in the
CBT+CMT group [t(30)=–3.838, p≤0.001].
In order to examine this two further t-tests
were conducted to examine pre-therapy and
post-therapy scores for both groups. Prior to
therapy the two groups start with signifi-
cantly different average scores
[t(30)=–2.463, p≤0.01]. Final scores reveal
no significant difference in average scores
[t(30)=1.103, p=.279]. Although there is no
significant difference in average scores post-
therapy, the improvement was greater in the
combined CMT and CBT group.
Symptoms of avoidance before and
after therapy
The results of the avoidance questionnaire
for both group’s pre- and post-therapy can
be seen in Figure 2.
A significant reduction in avoidance
symptoms was observed from a pre-therapy
mean score (20.87) to a post-therapy mean
score (6.75) [F(1,30)=293.596, p≤0.001].
The main effect comparing the two
types of intervention was not significant,
suggesting no difference in the overall lev-
els of symptoms of avoidance between the
two treatment groups [F(1,30)=0.69,
p=.794]. However, a significant interaction
between treatment group pre- and post-
therapy and symptoms of avoidance was
observed [F(1,30)=4.190, p≤0.05]. Although
mean scores decrease post-therapy in both
groups, the combined CMT and CBT group
is starting from a higher group mean
(21.56) than the CBT group (20.18). The
CBT group proceeds to a higher group
mean (7.75) post-therapy than the CBT and
CMT group mean (5.75), which suggests a
higher reduction in symptoms of avoidance
in the CBT and CMT group post-therapy.
In order to clarify this interaction a series of
t-tests were conducted to compare pre- and
post-therapy scores and the amount of
improvement for each group.
The mean improvement (12.43) was
lower for the CBT group than the combined
CMT and CBT group (15.81). The amount
of improvement was significantly greater for
the CMT + CBT group [t(30)=–2.047,
p≤0.05]. In order to examine this two further
t-tests were conducted to examine pre-
therapy scores and post-therapy scores for
both groups. Prior to therapy the two groups
start with no significant difference in average
scores [t(30)=–.829, p=.414]. Final scores
reveal no significant difference in average
scores [t(30)=1.675, p=.052.]. Although
there is no significant difference in average
scores post-therapy the improvement was
greater in the combined CMT and CBT
group.
Symptoms of anxiety before and after
therapy
The results of the anxiety questionnaire for
both groups pre- and post-therapy can be
seen in Figure 3.
For the anxiety questionnaire there was a
highly significant reduction of anxiety symp-
toms from a pre-therapy mean score (13.62)
to a post-therapy mean score (5.25)
[F(1,30)=151.187, p≤0.001].
The main effect comparing the two types
of intervention was not significant suggest-
ing no difference in the overall levels of anx-
iety between the two treatment groups
[F(1,30)=0.885, p=.354]. No significant inter-
action between treatment group pre- and
post-therapy and symptoms of anxiety was
observed [F(1,30)=2.43, p=.129].
Symptoms of hyper-arousal before and
after therapy
The results of the hyper-arousal question-
naire for both group’s pre- and post-therapy
can be seen in Figure 4.
A highly significant reduction of hyper-
arousal symptoms was observed from a pre-
therapy mean score (14.84) to a post-therapy
mean score (4.25) [F(1,30)=262.657,
‘Being kinder to myself’
38 Counselling Psychology Review, Vol. 27, No. 1, March 2012
Elaine Beaumont, Adam Galpin & Peter Jenkins
Figure 3: Mean Scores pre-therapy and post-therapy for anxiety symptoms in the
CBT group and the combined CBT and CMT group.
Figure 4: Mean Scores pre-therapy and post-therapy for the CBT group and the
combined CBT and CMT group.
Counselling Psychology Review, Vol. 27, No. 1, March 2012 39
p≤0.001]. The main effect comparing the
two types of intervention was not significant
[F(1,30)=2.365, p=.135]. And no interaction
between treatment group and time of assess-
ment pre-therapy and post-therapy was
observed [F(1,30)=.112, p=.740].
Symptoms of intrusion before and after
therapy
The results of the intrusion questionnaire
for both group’s pre- and post-therapy can
be seen in Figure 5.
A highly significant reduction in symp-
toms of intrusion was observed from a pre-
therapy mean score (22.75) to a post-therapy
mean score (7.12) [F(1,30)=272.846,
p≤0.001]. The main effect comparing the
two types of intervention was not significant
[F(1,30)=.250, p=.621] and no significant
interaction was observed [F(1,30)=.157,
p=.695].
Self-compassion before and after
therapy
The results of the self-compassion question-
naire for both groups pre- and post-therapy
can be seen in Figure 6.
For the self-compassion questionnaire
there was a highly significant main increase
of self-compassion symptoms from pre-
therapy mean score (2.04) to post-therapy
mean score (3.47) [F(1,30)=103.036,
p≤0.001]. The main effect comparing the
two types of intervention was significant,
suggesting a difference in the overall levels
of self-compassion post-therapy between the
two treatment groups [F(1,30)=4.657,
p≤.05]. The CMT and CBT group mean
increases to (3.72) and the CBT group mean
increases to (3.21). However, no interaction
was observed [F(1,30)=1.292, p=.265].
Analysis and discussion of findings
The results indicate that participants in both
the CBT-only and combined CBT and CMT
treatment groups experienced highly signifi-
cant reductions in symptoms of anxiety,
depression, avoidant behaviours, intrusive
thoughts and hyper-arousal. Additionally,
the results indicate that participants in both
conditions experienced a statistically signifi-
cant increase in self-compassion. Statistical
analysis indicates that participants in the
combined CBT and CMT treatment group
developed more self-compassion post-
therapy than the participants in the CBT-
only treatment group. However, the analysis
indicates no statistically significant differ-
ence between both treatments in terms of
reduction in symptoms of avoidance, intru-
sive thoughts, hyper-arousal, anxiety and
depression.
Therefore, the findings from this study
support the first hypothesis, i.e. that individ-
uals in both conditions would have lower
scores post-therapy on the Impact of Events
Scale, Hospital Anxiety and Depression Scale
and higher scores on the Self-Compassion
Scale.
The findings from the study, however, do
not support the second hypothesis that there
would be a statistically significant difference
between the two therapy groups post-therapy.
Individuals who received a course of CBT
combined with CMT, following a traumatic
incident, did report lower scores post-therapy
on the IES and HADS questionnaires, but the
difference was not significant. However, the
results suggest that participants in the com-
bined CBT and CMT condition did report
fewer symptoms of anxiety and depression
post-therapy and reported higher scores on
the HADS and IES pre-therapy. The only
exception to this was on the hyper-arousal
scale, where individuals in the CBT-only con-
dition reported higher scores pre-therapy
than the combined CBT and CMT treatment
group. This, incidentally, supports the find-
ings of Gilbert and Proctor (2006), who
found a significant reduction in symptoms of
anxiety, depression, self-criticism and an
increase in feelings of self-warmth and self-
care in clients in a group-setting (N=6), sug-
gesting that CMT can be an effective
therapeutic intervention.
The findings from this study also support
the third hypothesis, i.e. that individuals who
receive a course of combined CMT and CBT,
‘Being kinder to myself’
40 Counselling Psychology Review, Vol. 27, No. 1, March 2012
Elaine Beaumont, Adam Galpin & Peter Jenkins
Figure 5: Mean Scores pre-therapy and post-therapy for the CBT group and the
combined CBT and CMT group.
Figure 6: Mean Scores pre-therapy and post-therapy for the CBT group and the
combined CBT and CMT group.
Counselling Psychology Review, Vol. 27, No. 1, March 2012 41
following a traumatic incident, will have sig-
nificantly higher scores on the Self-Compas-
sion Scale than individuals in the CBT-only
group. The results are consistent with the
findings of Neff, Kirkpatrick and Rude
(2007), who found that CMT increased self-
esteem and self-compassion, with a sample of
college students (N=91).
The results from the present study are
consistent with the results found by Thomp-
son and Waltz (2008). These researchers
found a correlation between symptoms of
avoidance, self-criticism and self-compassion.
In their study, students who scored higher on
the SCS scale engaged less in avoidant behav-
iours and students who reported a traumatic
event were more self-critical and self-judge-
mental. However, as this was a correlational
study, it is difficult to establish cause and
effect. However, the results do suggest that
individuals suffering with PTSD symptoms
could benefit from developing loving kind-
ness and self-compassion.
Furthermore, the findings from the pres-
ent study support the work of Brewin et al.
(2000), Ehlers and Clark (2000) and Grey et
al. (2001) who found negative emotions,
such as shame and worry about current
threat, leads to avoidant behaviours. How-
ever, although in the present study there was
a significant difference between the two
therapy groups and measures of self-compas-
sion post-therapy, there was no statistically
significant difference post-therapy for
avoidant symptoms. The scores on the
avoidant scale for participants in the com-
bined CBT and CMT group were higher to
begin with before therapy and lower after
therapy, than the CBT-only group. This sug-
gests that individuals benefited from using
techniques which helped develop self-com-
passion, as this in turn helped them reduce
avoidant behaviours.
The reason that results may not be statis-
tically significant for each of the subscales on
the HADS and IES could be because partici-
pants were not allocated to groups depend-
ing on scores from the questionnaires. This
may be a flaw within the design of the
research, as the mean scores pre-therapy
were slightly higher in the CMT condition
for each subscale, apart from hyper-arousal.
If participants in the present study had been
allocated to one of the two treatment groups
depending on scores from the question-
naires, there may then have been a signifi-
cant statistical difference in the results.
However, participants had been allocated to
one of the two groups depending on the
type of trauma experienced, for example, traffic
accidents, accidents at work and so on.
Further research could therefore examine
type of personality, social support offered at
home and/or work and individual resilience,
as any of these external variables could have
had an effect on therapy outcome.
Limitations of the study
Although the results suggest an improve-
ment in both conditions, there was no
‘no-treatment’ comparison group. There-
fore, individuals may have improved because
of external factors (Corney & Simpson,
2005). Another limitation of the current
study derives from the small sample size
(N=32), potentially limiting generalisability
to other populations. Initially it was thought
that dropout rates would be a limitation of
this study, however, this was proved not to be
the case, as 32 out of the original 36 individ-
uals completed therapy.
Despite these limitations, the present
study does, however, have relatively high eco-
logical validity, because it examines the role
trauma-related symptoms and self-compas-
sion play in a real-life setting with individuals
referred for a therapeutic intervention.
Further research could use a mixed
methods approach as qualitative data could
have provided detailed information about
the subjective experience of each client.
Reflection, summary and conclusions
This paper has explored differences in treat-
ment outcome measures, following a post-
trauma course of either CBT on its own, or
CBT combined with CMT. Thirty-two indi-
viduals took part in this study and a repeated
‘Being kinder to myself’
42 Counselling Psychology Review, Vol. 27, No. 1, March 2012
measures design was used, as individuals
completed questionnaires pre-therapy and
post-therapy. There was a statistically signifi-
cant improvement in both groups post-
therapy. The results show that individuals in
the CMT group reported significantly higher
scores (i.e. developed more self-compassion)
post-therapy on the Self-Compassion Scale,
than individuals in the CBT-only group.
Furthermore, the mean scores suggest symp-
toms of avoidance, anxiety, depression,
intrusion and hyper-arousal reduced more in
the combined CBT/CMT group, although
the statistical analysis shows that there was no
significant difference between the two treat-
ment groups for these symptoms.
The findings from the study support the
work of various theorists, including Ehlers
and Clark 2000; Gilbert and Proctor, 2006;
Harman and Lee, 2010; Neff, Kirkpatrick
and Rude, 2007; and Thompson and Waltz,
2008. However, a degree of caution is
required in the interpretation of the results,
particularly as CMT as an intervention has
not yet been fully subjected to extensive,
rigorous evaluation.
Counselling psychology welcomes the
opportunity to integrate new developments
within existing therapeutic approaches
(O’Brien, 2010). It is essential that new treat-
ment options be examined so that we as a
counselling and psychotherapy profession
provide therapy that meets our client’s
needs.
The present study adds to the debate sur-
rounding the new ‘third wave’ approaches,
which suggests that compassion based
approaches can help create feelings of sooth-
ing, loving kindness and safeness. One indi-
vidual made a very moving comment near
the end of therapy: ‘Learning to be kind to
myself is the greatest gift I have ever treated
myself to.’
A much-reported weakness of CBT is that
individuals may say that they understand the
logic of the approach, but report that they
do not ‘feel any better’ (Gilbert, 2010; Grant
et al., 2010; Leahy, 2001). The results pre-
sented in this paper suggest that, in order to
feel differently, individuals could benefit
from developing self-compassion and by
learning to access their own emotional regu-
lation systems (Gilbert, 2010). Therefore,
individuals may feel more benefit from
therapy by learning to understand why they
feel the way they do. This process can be
assisted by clients learning to challenge self-
criticism and their own ‘internal bully’ in a
non-judgemental way, by their adopting the
stance of ‘being kinder to myself’.
About the Authors
Elaine Beaumont is a Cognitive Behavioural
Psychotherapist (BABCP Accredited and
UKCP Registered) and a Lecturer in Coun-
selling & Psychotherapy at the University of
Salford.
Adam Galpin is a Senior Lecturer in Psy-
chology at the University of Salford.
Peter Jenkins is a Senior Lecturer in Coun-
selling, University of Manchester
Correspondence
Elaine Beaumont
Lecturer in Counselling and Psychotherapy,
School of Nursing, Midwifery and
Social Work,
University of Salford,
Frederick Road Campus,
Allerton Building Room L818,
Salford M6 6PU.
Email: E.A.Beaumont@salford.ac.uk
Tel: 0161 295 2388
Elaine Beaumont, Adam Galpin & Peter Jenkins
Counselling Psychology Review, Vol. 27, No. 1, March 2012 43
British Association for Behavioural Counselling and
Psychotherapy (BABCP) (2009). Standards of
Conduct. Retrieved 4 January 2010, from:
http://babcp.com/news/new-standards-of-
conduct-adopted/.
Brewin, C.R., Andrews, B. & Rose, S. (2000). Fear,
helplessness and horror in post-traumatic stress
disorder: Investigating DSM-IV Criterion 2A in
victims of violent crime. Journal of Traumatic Stress,
13, 499–509.
Cooper, M. & McLeod, J. (2011). Pluralistic counselling
and psychotherapy. London: Sage.
Corney, R. & Simpson, S. (2005). Thirty-six month
outcome data from a trial of counselling with
chronically depressed patients in a general
practice setting. Psychology and Psychotherapy:
Theory, Research and Practice, 78, 127–138.
Creamer, M., Bell, R. & Failla, S. (2003). Psycho-
metric properties of the Impact of Event Scale –
Revised. Behaviour Research & Therapy, 41(12),
1489–1496.
Ehlers, A. & Clark, D.M. (2000). A cognitive model of
post-traumatic stress disorder. Behaviour Research
and Therapy, 38, 319–345.
Fecteau, G. & Nicki, R. (1999). Cognitive behavioural
treatment of post-traumatic stress disorder after
motor vehicle accident. Behavioural and Cognitive
Psychotherapy, 27, 201–214.
Gilbert, P. & Irons C. (2005). Focused therapies and
compassionate mind training for shame and
self-attacking. In, P. Gilbert (Ed.), Compassion:
Conceptualisations, research and use in psychotherapy.
London: Routledge.
Gilbert, P., Baldwin, M., Irons, C., Baccus, J. &
Palmer, M. (2006). Self-criticism and self-warmth:
An imagery study exploring their relation to
depression. Journal of Cognitive Psychotherapy:
An International Quarterly, 20, 183–200.
Gilbert, P., & Proctor. S. (2006). Compassionate Mind
Training for people with high shame and self-
criticism: Overview and pilot study of a group
therapy approach. Clinical Psychology and
Psychotherapy, 13, 353–379.
Gilbert, P. (2010). Compassion focused therapy. London:
Routledge.
Goldstein, R. (2010) The future of counselling psy-
chology. In R. Woolfe, S. Strawbridge, B. Douglas
& W. Dryden (Eds.), Handbook of counselling
psychology (3rd ed.). London: Sage.
Grant, A., Townend, M., Mulhern, R. & Short, N.
(2010). Cognitive behavioural therapy in mental
health care. London: Sage.
Grey, N., Holmes, E. & Brewin, C.R. (2001). Peri-trau-
matic emotional ‘hotspots’ in traumatic memory:
A case series of patients with post-traumatic stress
disorder. Behavioural and Cognitive Psychotherapy,
29, 367–372.
Harman, R. & Lee, D. (2010). The role of shame and
self-critical thinking in the development and
maintenance of current threat in post-traumatic
stress disorder. Clinical Psychology and Psychother-
apy, 17, 13–24.
Horowitz, M, Wilner, N. & Alvarez, W. (1979). Impact
of Event Scale: A measure of subjective stress.
PSYC Medicine, 41, 209–218.
Jonsson, A. & Segesten, K. (2004). Guilt, shame and
need for a container: A study of post-traumatic
stress among ambulance personnel. Accident
Emergency Nursing, 12(4), 215–223.
Leahy, R. (2001). Overcoming resistance in cognitive
therapy. New York: Guilford Press.
Lee, D.A (2009). Compassion focused cognitive
therapy for shame-based trauma memories and
flashbacks in PTSD. In N. Grey (Ed.), A casebook
of cognitive therapy for traumatic stress reactions.
Chapter 15. London: Routledge.
National Institute for Health and Clinical Excellence
(NICE) (2005). Guidelines for post-traumatic stress
disorder (PTSD): The management of PTSD in adults
and children in primary and secondary care.
Retrieved 12 December 2009, from:
www.nice.org.uk/CG26.
Neff, K.D. (2003). The development and validation
of a scale to measure self-compassion. Self and
Identity, 2, 223–250.
Neff, K.D., Kirkpatrick, K.L. & Rude, S. (2007).
Accepting the human condition: Self-compassion
and its links to adaptive psychological function-
ing. Journal of Personality, 41, 139–154.
O’Brien, M. (2010). Towards integration. In R.
Woolfe, S. Strawbridge, B. Douglas & W. Dryden
(Eds.), Handbook of counselling psychology
(3rd ed.). London: Sage.
Raes, F., Pommier, E., Neff, K., & Van Gucht, D.
(2010). Construction and factorial validation of a
short form of the Self-Compassion Scale. Clinical
Psychology & Psychotherapy. DOI:10.1002/cpp.702.
Snaith, R.P. & Zigmond, A.S. (1994). The Hospital
Anxiety and Depression Scale Manual. Berkshire:
Nelson Publishing.
Thompson, B. & Waltz, J. (2008). Self-compassion
and PTSD symptom severity. Journal of Traumatic
Stress, 21(6), 556–558.
United Kingdom Council for Psychotherapy (UKCP)
(2009). Codes of Ethics and Practice. Retrieved
12 December 2009, from:
www.psychotherapy.org.uk/ethics_and_
training.html.
Weiss, D.S. & Marmar, C.R. (1996). The Impact of
Event Scale – Revised. In J. Wilson & T.M. Keane
(Eds.), Assessing psychological trauma and PTSD
(pp.399–411). New York: Guilford Press.
‘Being kinder to myself’
References
