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‘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

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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.
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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
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‘Being kinder to myself’
References
... Although, there is limited empirical understanding of how CFT and CMT impacts upon the three emotion regulation systems proposed by the CFT model, particularly the drive system (Panting, 2018). There is growing evidence highlighting the effectiveness of CMT on increasing levels of compassion and subsequently reducing levels of emotional distress in both non-clinical (Matos et al., 2017) and clinical populations (Beaumont et al., 2012;Gilbert & Procter, 2006;Mayhew & Gilbert, 2008). CMT practices involve working with physiological processes (i.e., body posture, breathing, facial expressions and voice tones) as well as developing compassionate qualities such as wisdom, strength and commitment to stimulate the three flows of compassion (Matos, Duarte, Duarte, Gilbert, & Pinto-Gouveia, 2018). ...
... Currently, there is no consensus on the most useful CMT practices, with several variations in the literature (Beaumont et al., 2012;Gilbert & Procter, 2006;Matos et al., 2017;Mayhew & Gilbert, 2008). For example, Matos et al.'s (2017) CMT intervention consisted of participants attending a two hour face-to-face psychoeducational session, followed by a set of daily audio recorded CMT practices for two weeks, which resulted in significant increases across all three flows of compassion, as well as reductions in levels of selfcriticism, depression and stress. ...
... Indeed, self-criticism has been associated with difficulties in accessing feelings of self-compassion (Gilbert & Procter, 2006;Warren, Smeets, & Neff, 2016), as well as being a barrier to effective treatment outcomes (Warren et al., 2016). While there is currently no consensus on the most useful CMT practices, with variations in the literature (Beaumont et al., 2012;Gilbert & Procter, 2006;Matos et al., 2017;Mayhew & Gilbert, 2008), the current CMT practices primarily focused on enhancing the three flows of compassion. The findings of this study suggest it may also have been helpful to include a CMT practice specifically targeting self-criticism, to then enhance self-compassion. ...
Thesis
The first chapter is a systematic review and meta-analysis which aimed to explore the relationship between self-compassion and compassion towards others among healthcare professionals. The review was conducted in line with PRISMA guidelines and a multi-base search identified 11 studies that met the inclusion criteria for the review. Overall, a small positive association was found between self-compassion and compassion towards others. This review offers preliminary support that it may be possible for interventions to target self-compassion to enhance compassionate care among healthcare professionals. Although, due to the cross-sectional nature of the included studies, conclusions regarding a causal relationship is limited. Future research directions are discussed. The second chapter is an empirical paper which aimed to reduce burnout and self-criticism among mental healthcare professionals using Compassionate Mind Training (CMT; Gilbert, 2000) to increase the three flows of compassion (to self, towards others and from others). In total, 205 mental healthcare professionals participated in Part A of the study, exploring baseline associations between the three flows of compassion, burnout and self-criticism. Cross-sectional analyses revealed significant negative associations between self-compassion and compassion from others and burnout, while compassion towards others negatively associated with client-related burnout only. Burnout positively associated with self-criticism, depression, anxiety and stress. Part B of the study consisted of a randomised controlled trial with 68 mental healthcare professionals. Analyses revealed openness to receiving compassion from others significantly increased and personal and work-related burnout significantly decreased post-intervention. These findings have important clinical implications for understanding and reducing burnout and self-criticism among mental healthcare professionals. Keywords: Mental Healthcare Professionals, Burnout, Self-Criticism, Compassionate Mind Training, Flows of Compassion, Self-Compassion, Compassion towards Others, Compassion from Others.
... Evidence has suggested significant benefits of adding CFT-based approaches to CBT for a range of psychiatric problems (Beaumont et al., 2012;Gale et al., 2014). Several studies have also shown that CFT interventions increase the ability to selfsoothe, distress tolerance, reduce shame and self-criticism, enhance self-perception, and positively affect cognitive patterns associated with particular psychiatric disorders, such as eating disorders and personality disorders (Ashworth et al., 2011;Beaumont et al., 2012;Gale et al., 2014;Gilbert & Procter, 2006;Judge et al., 2012;Laithwaite et al., 2009;Lucre & Corten, 2013). ...
... Evidence has suggested significant benefits of adding CFT-based approaches to CBT for a range of psychiatric problems (Beaumont et al., 2012;Gale et al., 2014). Several studies have also shown that CFT interventions increase the ability to selfsoothe, distress tolerance, reduce shame and self-criticism, enhance self-perception, and positively affect cognitive patterns associated with particular psychiatric disorders, such as eating disorders and personality disorders (Ashworth et al., 2011;Beaumont et al., 2012;Gale et al., 2014;Gilbert & Procter, 2006;Judge et al., 2012;Laithwaite et al., 2009;Lucre & Corten, 2013). Compassion training techniques applied in CFT have also demonstrated impacts in biological measures such as changes in activity in brain regions associated with emotional regulation (Begley, 2007;Davidson et al., 2003;Longe et al., 2010), heart rate variability, and cortisol levels in directions suggesting improved emotion regulation (Rockliffe et al., 2008). ...
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Hoarding Disorder (HD) was formally recognized as a mental health diagnosis in 2013. A number of therapeutic methods have been developed and tailored for HD, including Cognitive Behavioral Therapy (CBT) and Compassion Focused Therapy (CFT). The aims of this article are threefold: First, to provide a description of the rationale of developing a group CFT protocol for HD (CFT-HD); Second, to introduce the theoretical framework, treatment targets, and techniques of CFT-HD; Third and finally, to share existing empirical evidence of CFT-HD, and an ongoing study on CFT-HD conducted in a private practice setting. Implications of the development of and research findings on CFT-HD, as well as future directions, are discussed.
... CFT has been shown to be an effective intervention in treating a broad spectrum of clinical areas including, psychosis (Braehler et al., 2013); acquired brain injury (O'Neill & McMillan, 2012); depression and anxiety (Noorbala, Borjali, Ahmadian-Attari, & Noorbala, 2013); Post-traumatic Stress Disorder (Beaumont, Galpin, & Jenkins, 2012); Foresnic populations (Laithwaite et al., 2009); and individuals with an Eating Disorder (Gale, Gilbert, Read, & Goss, 2014;Kelly, Wisniewski, Martin-Wagar, & Hoffman, 2016). A recent Systematic Review of CFT (Craig, Hiskey, & Spector, 2020) found that CFT was as effective as other psychological interventions and more effective than no interventions. ...
... The specific goal of targeting levels of self-compassion, compassion to others, and threat has been noted to contribute to a reduction of distress associated with a range of mental health difficulties (Clarke, 2009;Craig et al., 2020;Gilbert & Proctor, 2006;Tangney & Dearing, 2003;Whelton & Greenberg, 2005) which is also supported by the data gathered within this research. There is available research evidencing an improvement in levels of self-criticism and shame positively impacts specific diagnostic categories (Beaumont et al., 2012;Braehler et al., 2013;Noorbala et al., 2013;O'Neill & McMillan, 2012). Whilst specific diagnostic categories were examined in the current research, the groups were 'trans-diagnostic' and there was a significant improvement in presentation (based upon the CORE-OM) for those attending the sessions. ...
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Objectives: This study aimed to examine the effectiveness of a compassion-focused therapy (CFT) group in improving patient outcomes compared to those receiving treatment as usual (TAU) with a trans-diagnostic population who are inpatients within an acute psychiatric ward. Design: Quantitative data were gathered as part of routine clinical practice within three adult psychiatric wards using the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at admission and discharge and non-standardized Likert scales pre- and post-group sessions. Method: Between April and August 2017, the Acute Psychology Service (APS) gathered CORE-OM admission and discharge data from inpatients across three acute wards (n = 32) whilst 249 pre/post-group data sets were gathered from CFT group work undertaken on the inpatient wards. Current inpatients self-allocated to receive either CFT or TAU based on their desire for psychological involvement. Those self-allocating to receive psychological involvement (n = 19) were compared to those who did not (n = 13) across the four subdomains of the CORE-OM: Wellbeing, Functioning, Problem/Symptoms, and Risk. The Likert scales included subdomains to evaluate changes in self-compassion, compassion to others, and threat. Those receiving CFT group work also received TAU. Results: Significant improvements to all CORE-OM subdomains were observed for those receiving CFT group input, in particular the Wellbeing and Functioning subdomains. Those receiving TAU only noted a significant improvement in the area of Risk whilst levels of Wellbeing were identical at admission and discharge with no improvements noted. Pre/post-group results indicated significant results for areas of self-compassion and compassion to others, whilst results by session for the threat subdomain are mixed dependant on session. Overall, all areas noted significant improvements. Session content was observed to be most effective for breathing and Mindfulness-based sessions and those utilizing imagery techniques. Conclusion: Compassion-Focused Therapy appears to be an effective group intervention for a trans-diagnostic population within adult inpatient settings. Patient outcomes are positively improved across a range of areas whilst undertaking psychological input in the form of CFT group work whilst also receiving TAU during an inpatient admission. The use of the CFT model to address trans-diagnostic difficulties supports targeting underlying psychological constructs in comparison to symptom treatment alone. Practitioner points: Compassion-focused therapy is a multi-model approach designed to target high levels of self-criticism. Previous research has demonstrated its effectiveness for a range of specific diagnosis; however, there is a limited research base with open groups and a trans-diagnostic population. Groups can be structured with standalone sessions to accommodate the unpredictable admissions and discharge patterns of acute psychiatric wards. Group sessions focused around Mindfulness and Imagery yielded the greatest significant improvements to pre-sessions scores. The provision of compassion-focused therapy groups within trans-diagnostic inpatient settings is feasible and has shown to significantly improve overall levels of distress and risk compared to those receiving treatment as usual. The lack of standardized Likert group measures limits the power of the study. Whilst a RCT would provide more reliable data, this was not possible as part of routine clinical practice for ethical reasons.
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