2 慈悲与心理灵活性

2 同情与心理灵活性尽管同情本身尚未被正式纳入ACT（接纳承诺疗法）过程模型中，但ACT实践者和研究人员已经探索了同情和自我同情在心理治疗中的作用有一段时间了（Forsyth & Eifert, 2007; Hayes, 2008c; Luoma et al., 2011; Schoendorff et al., 2011; Tirch, 2010; Van Dam et al., 2010）。为了从ACT的角度理解同情，我们需要花时间来考察关系框架理论（RFT；Hayes等, 2001），这是认知行为科学(CBS)内的基础认知理论，并且是ACT的基石。RFT为我们提供了一种基于最基本的行为原则来理解人类思考和感受的方法。它的一个优点在于，通过建立关于心智功能基本单元的知识，我们可以开发并科学地测试解决人类心理痛苦这一复杂问题的新方法。RFT描述了正念、自我发展以及视角转换等众多心理现象的过程。此外，RFT还提供了考虑人类如何发展自我意识和他人意识，以及我们如何构建时间和空间体验的方式（Barnes-Holmes等, 2001; Törneke, 2010）。

经过超过十年的广泛传播后，RFT已成为全球研究倡议的基础。这种从基础层面探索认知和语言根本原理的研究是当今行为心理学中最活跃的研究项目之一。该领域研究的核心概念之一是一种称为关系框架化或衍生关系响应的过程，旨在对人类象征性思维中发生的确切情况提供详尽解释。正如我们将讨论的那样，所有这些对于理解同情这门新兴的应用科学特别相关。

当我们在一种情境化的语言理解背景下培训治疗师时，我们经常邀请同行将理论视为不仅仅是学术练习，而是作为至关重要的心理治疗过程中不可或缺且动态变化的部分来看待。我们的假设影响着我们如何看待来访及自己，而对思想、情感和行动基础有更清晰的理解将帮助我们发展个案概念化，为干预提供明确的目标，并影响对话的风格与流程。比如你是一位更加传统的精神分析师，你的假设认为治疗工作涉及转移神经症的解决；那么从你的面部表情到房间内自我暴露的程度都将受到这些假设的影响。你的目标将影响你在治疗讨论流程中所建议的方向。相反，如果你是一位贝克式的认知治疗师，致力于帮助来访识别并直接改变功能失调的认知，则会有另一套不同的假设，这会创造与来访互动时相当不同的方向。通过花时间探讨联结情绪的进化根源并加深对认知和语言中涉及的行为原则的理解，我们正在为自己打开新的假设和评估、个案概念化以及治疗计划的新可能性。在这个过程中，我们也为治疗关系带来了自己的新维度。

衍生关系反应与视角转换正如许多ACT实践者所知，“衍生关系反应”是RFT中用来描述语言学习的一个术语。简单来说，衍生关系反应涉及一个人在刺激之间推导出关系的能力，并且随着这些关系被推导出来，相关刺激的功能可以被转移和转化。对于我们而言，当我们说“刺激的功能”时，我们指的是环境中的经验变化（刺激）如何预测并影响个人的行为。例如，如果将英文单词“dog”与巴斯克语中的“txakur”（意为狗）建立等价关系，则可能将“dog”这个词的功能（吸引性的或厌恶性的，取决于个人对狗的经验）转移到“txakur”这个词上。如果有人随后告诉你照顾你的txakur，因为它在后门附近来回走动并且偷偷地转圈，你会知道该怎么做。这种形式的学习关系反应依赖于上下文线索以及不依赖于刺激的正式属性（如感官外观特性）或直接体验的刺激间的关系。例如，“dog”或“txakur”这两个词在任何方面都不像直接体验动物那样，但当作为刺激时，这两个词都可以让听众联想到一系列与狗相关的联想和内心体验。到目前为止，已有数百项研究证明了衍生关系反应在语言学习和认知中的作用（Dymond et al., 2010）。基本上，RFT建议衍生关系反应是思考、知晓和说话的基本构建块。当我们探索同情心的科学以帮助ACT实践者时，很明显，从RFT的角度来解释同情心可以帮助我们更好地理解同情心是如何运作的，我们如何能够开发方法来预测和影响同情行为，以及我们如何能够越来越精确、深入和广泛地理解同情。

关系框架衍生反应可以涉及不同类型的关系，有时被称为关系框架，这也正是RFT名称的由来。以下是一些不同种类的关系框架的例子：

比较关系：比如更大/更小、更快/更慢
空间关系：比如上方/下方、后面/前面
层次关系：比如这是那个的一部分
视角关系：比如这里/那里、现在/那时、我/你在RFT以及因此在ACT中，体验共情、同情、共同人性感甚至自我意识都被视为涉及到我们学会创造视角关系的能力，这一过程被称为灵活的视角转换（Hayes et al., 2012; Vilardaga, 2009）。换句话说，在RFT术语中，自我的体验来自于一种特定形式的习得性衍生关系反应，它建立了一个视角——一个相对于其他观点位于时间和空间中的观点。这种言语行为被描述为指示性关系框架化，其中“指示性”一词简单地说就是“通过展示”。

当我们使用行为分析的语言时，可以说这些指示性关系是通过持续的社会互动塑造的训练关系操作行为（Barnes-Holmes等, 2001）。但因为不是每个人都有基于行为分析的语言背景，我们也可以简单地说，指示性关系是我们如何在心理上表示和体验世界、自我以及时间流动的基本元素。RFT认为，人类在童年时期接受的语言训练导致了我们对自我的体验，这种体验是通过与我们的言语社群——家庭和社会中的其他人互动而逐渐发展的。例如，父母可能会问一个小孩她刚才做了什么，甚至她是谁或明天会做什么。孩子们也可能被要求将自己与他人进行对比。比如，一位家长可能会说：“你今天是个非常好的女孩！谢谢你立刻收拾好玩具。派对上有些女孩甚至不听父母的话。做得好。”RFT主张，为了保持我们在语言交流中的一致性，儿童必须创建一个参考框架和观点，因此形成一种视角。随着时间的推移，这个视角被体验为一种自我感（Hayes等, 1999; Törneke, 2010）。

在RFT和ACT中，涉及我/你、这里/那里、那时/现在等指示性关系都被视为涉及到视角转换，并代表了带给我们自我体验的基础过程。此外，为了让“我”这个概念有意义，就必须有“你”的参与。同样地，为了让“这里”作为观点具有意义，就必须有一个“那里”。我们的自我意识来源于这种视角转换，这是一种在“你-那里-那时”的背景下浮现出来的“我-这里-现在”的体验。我们可以用多种方式象征性地表示这些视角。例如，我们可以想象相对于另一个视角的自己的视角：如果我发现自己不得不像她那样独自抚养那个孩子，我会有什么感觉？或者作为一个士兵在战争中会是什么样子？我们还可以想象相对于所有其他视角的自己的视角：我觉得我是世界上唯一这样感觉的人！

从ACT模型的角度思考，自我更像是一种体验流，而不是一个独立存在的实体。甚至可以说我们“从事着自我化的过程”比说我们“拥有一个自我”更为准确。

自我作为背景当人们被问及他们是谁时，他们通常会通过讲述某种形式的生命故事或自我叙述来回应。例如，“我的名字是弗雷德，我来自德克萨斯州，我是一名律师。”从ACT的角度来看，这种自我感被称为内容性自我（self-as-content）。然而，正念和同情允许体验另一种类型的自我。这种自我存在就像一个观察者，一个一直在默默注视着你经历的“你”，每时每刻都在这样做，并且总是处于“现在”。在历史上，许多提倡培养同情心以减轻人类痛苦的智慧传统也描述了冥想者和其他实践者可能如何接触一种超越性的自我意识。这种自我意识有许多不同的称呼，包括“观察自我”、“清晰之光”、“存在的根基”以及“大心”。这是一种难以用常规语言表达的经验，更不用说用技术性、科学的概念来表达了。在ACT中，这种自我意识被认为是源自一种称为背景性自我（self-as-context）的经验（Hayes等, 1999）。背景性自我被描述为多种指示性框架类别的融合，它带来了作为活着的“我-这里-现在”的体验以及一个观察自我的存在。

那么，这个与叙事自我相区别的观察自我是如何产生的呢？为了理解这一点，让我们回到ACT关于人类语言和认知的研究基础——RFT。正如前面讨论的那样，人类的关系反应的一部分涉及训练有素的视角转换能力。通过这些过程，我们对存在的体验包含了一种自身作为观点的感知，在这种观点面前，我们的整个生命体验得以展开。在ACT中，这种作为观察者的自我感知被称为背景性自我，因为它确实作为一种体验性的自我感觉，充当了我们经验发生的背景（Hayes等, 1999）。当我们回应自己的反应时，这种观察自我的感知很重要，因为尽管这个观察者可以注意到意识的内容，但它并不等同于那些内容。正如我们有手臂但不仅仅是我们手臂一样，我们有思想，但我们不仅仅是那个体验。情绪不会感受自己，思想不会观察自己，身体疼痛也不会体验自己。在我们的生活中，我们可以注意到一个观察自我的存在——这可能是意识本身——所有我们的体验都在其面前出现、存在并最终消失。

自我作为背景的这种感觉对于同情心尤为重要。例如，它显然与Neff（2003b）定义的自我同情的组成部分：正念、自我友善和共同人性相联系。仔细观察自我作为背景与自我同情之间的关系，我们可以看到，回到对自我作为背景的意识提供了一种非依附且不认同的关系来对待我们的体验。在这种方式下，Neff提出的正念和共同人性的自我同情成分似乎代表了灵活视角转换过程的激活，这构成了自我作为背景的体验模式的基础，以及从我们持续的自我叙述或内容性自我的解离（或去认同）。这些过程的激活及伴随的自我同情体验可以帮助减弱痛苦的私人事件和故事对我们习惯性的影响。此外，从“我-这里-现在”的存在角度来看，我们可以像看待他人的痛苦一样看待自己的痛苦，并在没有言语学习历史主导干扰的情况下被那种经历中的痛苦所触动，避免潜在的羞耻自我评价（Hayes, 2008a; Vilardaga, 2009）。

当你回忆起那些描述自己在心理问题中真的陷入困境的来访时——也许他们深陷于沉思和忧虑之中，等待着生活开始——他们的体验中最突出的是什么？你是否记得他们感到多么孤立无援，以及他们如何与自己的故事紧密相连？在最近的一次会谈中，我们的一个来访说：“我这一辈子都是这样。我就是无法停止担心我的健康。我知道我是个疯子，我希望我能像办公室里的其他人一样，能把事情处理得井井有条。而且，我真的非常强烈地感觉到我会得脑瘤——这只是时间问题。这一切对我来说太沉重了。”在极度焦虑的情况下，人们往往难以采取灵活的视角并脱离对自己故事的认同。对于这位来访来说，关于污染、辐射和脑瘤的强迫性担忧并不是他脑海中的想法，而是世界上的真实威胁。他感觉自己孤独、古怪，身心俱疲，并且被困在一个永恒的痛苦之地。他就是他的自我故事，并深深地认同它。

当与这样的来访工作时，接受过训练以注意到心理灵活性和同情障碍的ACT治疗师可能会做出以下类型的观察：

来访在灵活视角转换方面的困难
来访似乎多么认同并融合于他的自我叙述
持续的自我比较和缺乏共同人性的感觉如何导致羞耻、恐惧以及参与生活的困难
故意见证来访即使在身体健康的阶段也体验到灾难性疾病时的痛苦情绪是多么令人感动

所有这些过程都与培养自我同情高度相关，它们都可以通过符合ACT的观点来看待，并通过符合ACT的治疗手段来处理。

从CBS（认知行为科学）和ACT（接纳承诺疗法）文献中，心理灵活性作为一套基于证据的心理治疗过程出现，它涉及在通常会缩小行为范围的痛苦事件面前，发展出扩展且适应性强的行为库。心理灵活性与抑郁、焦虑和精神病理学有很强的负相关性，而与生活质量有很高的正相关性（Kashdan & Rottenberg, 2010）。此外，心理灵活性已经在大量的随机对照试验中被证明是心理治疗的中介因素，并且其组成过程已经通过行为研究以及探索这些成分神经关联的神经生理学研究得到确认和支持（Ruiz, 2010; Whelan & Schlund, 2013）。虽然心理灵活性模型由六个元素构成（价值自主、承诺、自我作为背景、解离、愿意接受以及与当下时刻的接触），但该模型可以分为两个主要的重点领域。

第一个领域包括正念和接纳过程（自我作为背景、解离、愿意接受以及与当下时刻的接触）。第二个领域则涉及创造并参与有意义、目的性和活力的生活模式的价值行动（这本质上包含了自我作为背景的过程和与当下时刻的接触）。尽管在ACT中价值观是自由选择而非规定性的，ACT联合创始人Steven Hayes (2008c) 提出，同情实际上可能是从心理灵活性模型中自然产生的唯一一个价值观。根据Hayes的说法，自我同情和同情的根源可能来自构成心理灵活性的六个核心过程，有时也被称为六边形过程（hexaflex processes）（Hayes et al., 2006），如图1所示。

现在时刻接纳价值观心理灵活性承诺解离自我作为背景图1. 六边形：心理灵活性中的交互过程。

鉴于您对本书的兴趣，您很可能已经熟悉了这些过程以及它们所支持的不断增长的干预和技术集合。

然而，每个组成部分都与同情和自我同情的某些方面有着特定的关系，这对评估、干预和治疗都有影响。当我们开始探讨这些关系时，值得注意的是，这六个过程相互作用以实现几个目标：

将人们带入与其当前体验的直接经验接触
打断可能会缩小可用行为范围的心智事件的字面化体验
促进经验上的接纳
帮助人们放下过度认同叙事性的自我或内容性自我
协助价值观自主的过程
促进对有价值行动和方向的承诺

如果我们允许自己正念地反思这些过程代表什么，并意识到实现它们意味着什么，我们就可以感受到ACT模型如何包容并补充了我们遇到的世界苦难的敏感性以及减轻这种苦难的动力。通过考察当前对同情的理解如何与心理灵活性相关联，我们可以发现发展和整合情境及同情聚焦行为疗法的基础。

自我同情、正念与心理灵活性

心理灵活性和Kristin Neff（2003a）对自我同情的概念化都是多维度的结构，涉及正念、一种扩展的自我意识体验以及致力于实现特定价值目标的承诺。在自我同情的情况下，减轻个人痛苦是一个明确的目标；而在心理灵活性中，则隐含着更广泛的价值观，即减轻痛苦并促进肯定生活的行动。

当我们考虑ACT中的自我同情角色时，有一种倾向是试图将自我同情融入到六边形模型（hexaflex model）中。心理灵活性和自我同情都是在广泛的成果和过程研究中表现出临床效用的结构（Neff, 2011; Ruiz, 2010）。例如，基于正念的认知疗法的控制结果研究表明，自我同情可能比单纯的正念更能解释精神病理学的变化（Kuyken等, 2010）。同样地，Van Dam及其同事（2010）发现，在一个大型社区样本中，自我同情对心理健康独特变异的解释量可能是正念测量的十倍之多。

尽管有自然的倾向去简化或无缝整合自我同情与六边形模型，但重要的是要记住，无论是自我同情还是心理灵活性都不是行为科学严格意义上的技术术语。Neff对自我同情的定义是基于佛教慈悲概念的操作化（Neff, 2003a），而心理灵活性的结构则基于RFT关于语言、认知和规则指导行为的基础研究。然而，六边形概念旨在成为描述RFT基本原理的临床适用、中层术语，使用相对日常的语言。六边形组件是有用的描述符，但它们不必代表人类福祉和心理灵活性所涉及的一切。CBS的独特之处在于应用基本的行为原则来解释人类行为的预测和影响。正如我们将描述的那样，进一步的CBS研究可能有助于识别更有效的方式来处理自我或他人同情中的强大心理治疗过程变量。类似地，以同情为中心的技术可能会以符合其理论基础的方式扩展ACT的技术基础。

自我同情与心理灵活性的关系

自我同情与心理灵活性之间的关系揭示了显性和隐性的交互过程层面。就模型间的明显关系而言，我们可以看到自我同情的第一个组成部分——正念，在六边形模型中表现为一种灵活且集中的注意力形式，涵盖了与当下时刻的接触、接纳、解离以及自我作为背景（Wilson & DuFrene, 2009）。自我同情的第二个组成部分——共同人性，显然与自我作为背景的经验相关，这是灵活视角转换的功能。在心理灵活性方面，我们可以想象随着从狭窄的个体叙事自我转向参与人类经验相互关联网络的“我们-性”感，会涌现出一种共同的人性感觉（Gilbert, 1989; Hayes & Long, 2013）。自我同情的第三个也是最后一个组成部分——自我友善，指的是支持性地对待自己，并带有同情心，包括“仁慈和鼓励而不是残忍或贬低的内心对话”（Neff & Tirch, 2013, p. 79）。在六边形模型中，这种向自我展示温暖关注和善良行为的有意介入体现在自由选择价值观的创作过程中，以及为实现有价值目标而采取的承诺行动模式。

这个自我同情与心理灵活性之间关系的模型如图2所示。

正念自我友善现在时刻接纳价值观心理灵活性解离承诺自我作为背景共同人性图2. 自我同情与心理灵活性

除了这些给定过程之间的明显功能相似性外，两个模型都强调了它们各自组成部分的相关性。因此，自我同情与心理灵活性之间的关系也包含了跨过程的细微差别和内在联系。例如，虽然自我友善似乎更清楚地与价值观创作和承诺行动相关，但构建一个自我并将那种自我视为我们可能给予他人的善意，本身就是一种灵活视角转换的行为，因此与自我作为背景的过程相关。同样地，一个人要想有意识地将自我友善带到她的体验流中，她必须足够地与当下时刻保持联系，才能有机会促成这样的转变。因此，在使用基于自我同情的干预措施时，ACT实践者可以利用自己的临床智慧和洞察力，注意到他们在来访生活中观察到的对应关系和联系。

CFT模型与心理灵活性

在CFT（同情聚焦疗法）中提出的同情模型，其许多构建来源于发展心理学、同理心和情感神经科学的研究。然而，在CFT中，同情的核心定义根植于古代智慧传统。大约2600年前，在历史上的佛陀释迦牟尼时期，沿着丝绸之路区域出现了许多沉思传统。这些思想流派强调通过冥想实践来减轻痛苦，并注重培养同情的重要性。综合这些方法并创新新的观点和技术，佛陀发展了一套个人从痛苦中解脱的方案，其中包括特定的同情训练。自那时以来，关于同情究竟是什么及其意义有很多讨论，但在CFT中采用了一个相当标准的定义：对自己和他人痛苦存在的敏感性，以及致力于尝试减轻和预防这种痛苦。

这个定义指出了前面提到的两种基本的同情心理学：

参与心理学：涉及对痛苦的开放和工作。
缓解心理学：涉及发展必要的智慧和技能以减轻或防止痛苦及其原因。

在CFT模型中，这两种核心方面的同情各自包括几个子组成部分，如图3所示，“属性”对应于参与心理学，“技能培训”对应于缓解心理学。

多模式同情心训练技能培训想象温暖属性注意力敏感度关心福祉推理同情非评判感觉温暖温暖痛苦容忍共情行为感官温暖图3. 同情圈。（转载自Gilbert, 2009a，经Constable and Robinson许可）

参与心理学的组成部分

访问关怀动机：培养内在的动力去关心他人。
对痛苦的敏感度：能够感知到自己和他人的痛苦。
同情：对于他人的困境产生共鸣。
痛苦容忍：能够忍受自己和他人的痛苦。
共情：理解并感受他人的情绪状态。
非评判：保持开放和接纳的态度，不对自己或他人的经历进行评价。缓解心理学的组成部分
注意力：集中注意力的能力，特别是在练习同情时。
想象：利用想象力来创造积极的内心体验。
推理：逻辑思维能力，帮助理解情况和找到解决方案。
行为：采取行动以减轻痛苦。
感官：通过感官体验促进内心的温暖感。
感觉：培养正面的情感体验，比如温暖和安全的感觉。

CFT模型与心理灵活性的关系

CFT模型与ACT中的心理灵活性概念有显著的重叠之处。两者都强调了正念、接纳、灵活视角转换以及价值观驱动的行为。以下是CFT与心理灵活性之间的一些联系：

正念：CFT中的注意力训练和ACT中的“接触当下时刻”都强调了正念的重要性，即完全地活在当前的经验中。
接纳：CFT中的痛苦容忍和ACT中的“接受”过程都鼓励个体面对并接受痛苦，而不是逃避或否认它。
灵活视角转换：CFT中的同情和ACT中的“自我作为背景”都要求个体能够从更广阔的视角来看待自己的经验和处境。
价值观驱动的行为：CFT中的“关心福祉”和ACT中的“价值观”都强调了根据个人的价值观来指导行为，以实现有意义的生活。

实践应用

在实践中，治疗师可以结合CFT和ACT的方法，为来访提供一个更加全面的心理健康干预方案。例如：

正念练习：通过引导来访进行正念冥想，帮助他们更好地关注当下的体验，减少对负面思维的依附。
痛苦容忍技巧：教授来访如何忍受痛苦，而不是试图立即消除所有不适。
同情训练：通过各种练习，如慈悲冥想，帮助来访培养对自己和他人的同情心。
价值观澄清：帮助来访明确他们的个人价值观，并基于这些价值观制定具体的行为计划。通过这样的综合方法，治疗师可以帮助来访增强心理灵活性，同时培养更深层次的自我同情和对他人的同情，从而提高整体的心理健康水平。

参与心理学的组成部分

重要的是，同情参与的心理学各组成部分是相互依赖的。例如，我们越是发展痛苦容忍能力，就可能越愿意和有动力去培养同情心。同样地，如果我们拥有更多的同理心，并且能够无评判地理解自己的内心，那么我们就可能更好地容忍痛苦，从而增加动机。另一方面，如果这些属性中的任何一个出现问题，同情本身也可能受到影响。例如，如果情感投入（同情）较低或缺乏痛苦容忍力和同理心，那么唤起同情可能会非常困难。

关怀福祉的动力。尽管参与心理学的所有组成部分都是相互关联的，在CFT中，我们首先认识到，关心自己和他人的福祉并尝试减轻或预防痛苦是同情旅程的核心。来访可能因为多种原因而不愿面对痛苦或对培养同情心不感兴趣。他们可能认为这不会对自己有所帮助，认为这是软弱的表现，或是觉得自己不配得到同情；或者当他们进行同情时，会感到难以承受的悲伤和恐惧（Gilbert等, 2012）。此外，某些来访可能由于学习历史的影响而存在动机障碍，这些障碍超出了他们的意识范围。然而，在CFT中，同情心灵的体验始于遇到痛苦时想要减轻痛苦并为生物福利做出贡献的动力。

敏感性。在CFT中，敏感性指的是我们如何关注痛苦，无论是自己的还是他人的：我们如何注意到它并将注意力集中在上面，而不是回避或试图逃避。这种敏感性涉及有意专注于我们在世界或自身所遇到的痛苦的当下意识。

同情。在CFT中，同情指的是源于自动激活的情绪调谐能力的一种反射性和响应性的情感联系。例如，如果你看到一个孩子跌倒受伤，这可能会立即触发你内心的不适感。你可能会皱眉或感到不得不采取行动。这种同情也可以指向内在。当我们关注自己的痛苦时，这不是一种情绪中立的经历；它带有情感成分，同情的心灵能够感受到痛苦。

痛苦容忍力。为了有动力接触痛苦、对痛苦的存在保持敏感，并以同情的方式感受痛苦，需要有能力容忍随之而来的情绪、想法和身体感觉。正如Gilbert (2009a) 所描述的，这种痛苦容忍力的能力与接纳密切相关：“虽然与接纳相关但并不完全相同，容忍力是指能够随着情绪的发生而停留……接纳可以包含容忍，但它也是一种对困难的深刻哲学态度。它是接受现实，‘让它存在’，不再斗争或挣扎”（第200-201页）。接纳和痛苦容忍力都不是屈服于现状；相反，两者都体现了为了实现同情的目标，故意愿意留在挑战性经历中的意愿。

同理心

参与心理学中较为复杂的元素之一是同理心，因为它既是一个直观的过程，也是一种更为深思熟虑的方法（Decety & Ickes, 2011）。例如，你可能会有意识地想象自己处于另一个人的境地，比如从同理的角度看待来访的悲伤。然而，同理心也可能是隐含的，比如与朋友交谈时，仅仅注意到他似乎很焦虑，并且自然而然地想到他对某事感到担忧的原因。同理心的反应已经被多种方式描述过，包括心智理论（Premack & Woodruff, 1978）、心智化（Fonagy, Target, Cottrell, Phillips, & Kurtz, 2002），以及如前所述的视角转换（McHugh & Stewart, 2012），这是一个核心的情境行为概念。当我们对自己内心过程开放并有所觉察时，我们可能更容易对他人的感受产生同理心。例如，那些害怕或逃避自己情感（如强烈的愤怒）或幻想的人，可能难以理解或同情处于这些状态中的他人。

非评判

同情的最后一个组成部分是非评判能力，即允许自己体验某些情绪和心理事件而不受谴责、判断或羞愧的控制。非评判并不意味着冷漠或无动于衷；相反，它代表了一种认识，即严厉的评价、羞耻感和自我批评会促使回避行为，加剧情绪痛苦，并加重苦难。因此，在CFT中，我们的目标是“在不加以谴责的情况下，面对他人和我们自己的复杂情绪和生活”（Gilbert, 2009a, p. 205）。

缓解心理学的组成部分

缓解心理学（包括预防）涉及一系列技能，这些技能可以在心理治疗和日常生活中创造减轻痛苦的潜力。许多CFT干预措施特别训练这些技能以培养同情心。这些干预措施包括椅子工作、引导想象、正念训练、基于同情的暴露和反应预防，以及在治疗关系中运用同情（Gilbert, 2009a; Tirch, 2012）。重要的是，正如同情参与的属性是相互依赖的一样，同情缓解的技能也是彼此建立的。例如，同情的行为包含了同情推理的智慧，并可以由正念的、同情的关注来引导。

注意力

注意力的集中、引导和调节训练是CFT的重要组成部分（Gilbert & Choden, 2013）。CFT中的许多初步注意力训练都涉及正念，因为这种专注而灵活的注意力能够促进去认同化，并具有引导和移动意识的能力。实际上，正念作为同情训练的背景已有数千年的历史（Tirch, 2010）。此外，CFT还提供了如何将注意力导向同情体验的指导。例如，一个练习可能是将一整天中遇到的帮助者作为正念关注的对象。另一种这样的训练可能是感恩的正念冥想。基于正念的基础，集中注意力训练，以及连贯呼吸训练（Brown & Gerbarg, 2012），CFT进一步扩展到包括对心理、身体和情感领域的注意力引导。

想象

想象在认知和行为疗法中越来越被认可为一种强大的治疗工具（Hackmann, Bennett-Levy, & Holmes, 2011）。想象本身可以刺激一系列生理系统和情感体验。在CFT中，我们会与来访分享这一见解，并指出同情心的想象练习旨在通过刺激相关的生理系统来建立同情的能力。CFT使用了多种想象练习，包括构建一个同情版本的自我、想象一个安全且充满同情的地方，以及创造一个理想中的同情伴侣的形象（Gilbert & Choden, 2013）。

推理

真正的同情显然不是不明智的选择；因此，在缓解心理学中，能够退一步并以明智、平衡的角度看待情况是一项重要技能。在进行同情时，尽可能自由清晰地思考是非常重要的，因为通过对困难问题的深入思考和运用适应性推理，通常能帮助我们选择对他人或自己不喜欢的事物发展同情（Loewenstein & Small, 2007）。我们也可能从同情的角度审视自己的思维，并意识到思想如何将我们困在旧有的、无益的行为模式中。

行为

在CFT模型中，同情行为基本上是指任何有意图地针对人们痛苦并尝试减轻和预防痛苦的行为。在这种意义上，行为指的是外显行为而不是内心的私密行为；它指的是我们可以用双手双脚去实施和实现我们的同情动机和意图的行为。当然，这样的行为应该是明智且有技巧的，而不仅仅是反射性的救援，后者可能实际上并没有帮助到同情的对象。通常，培养同情行为需要勇气，当我们接触到对痛苦的认识时更是如此。例如，对于患有广场恐惧症的人来说，自我同情并不意味着坐在家里避免困难的情绪；它要求练习外出并面对焦虑（Tirch, 2012）。本质上，同情行为意味着与导致痛苦的事物接触，并且这当然与承诺和愿意参与有关。

感官体验

在某种程度上，作为亲社会过程的同情抚慰能力是通过副交感神经系统运作的（Porges, 2007）。因此，帮助来访更多地发展副交感神经系统是有益的。为此，我们使用涉及各种呼吸技术和身体姿势的练习。我们还教来访如何使用面部表情和声音来激发体内的同情感受，并使用方法表演技术帮助人们体验同情过程。例如，当来访和治疗师第一次学习建立内在的声音和同情自我的形象时，CFT训练者会邀请他们将正念注意力集中在微笑的物理体验上，而不是保持中性表情。同样，他们被指导将注意力放在听到温暖的声音问候他们的体验上，而不是中性声音问候时的体验。感官敏感性可以引导我们每一刻的同情体验，并刺激与同情心灵相关的情感系统。

情感

大多数情况下，同情的情感体验与连接、温暖和善良等情绪相关联，部分原因是这些是亲社会的安抚情绪，能够激活安全感和满足感，从而为行动创造一个安全的基础。同情的情绪也可以包含一种勇气和面对困难事物的意愿。此外，在某些时候，愤怒或恐慌也可能激发同情。例如，看到对饥饿无动于衷时产生的愤怒，就像1980年代Bob Geldof和Midge Ure创建慈善超级组合Band Aid来筹集资金缓解埃塞俄比亚饥荒的情况一样。同样，当有人意识到一个孩子被困在着火的房子里并冲进去营救她时，恐慌可以激活同情的感受和行动。显然，区分同情情感培养的关键不在于情绪的质量，而在于其功能及其与减轻或预防痛苦动机之间的联系。

ACT过程、CFT模型与同情灵活性

CFT模型中的每一个过程都可以与ACT六边形模型中的过程相联系，这些过程共同作用于心理灵活性。正如Neff（2003a）的自我同情模型一样，这些过程都是中层术语，并不完全一一对应。然而，从概念和技术上将同情与心理灵活性整合起来，为临床医生提供了机会，以设计专注于帮助来访过上适应性和同情生活的干预措施。通过这种方式，审视同情灵活性模型使我们朝着适应性、基于证据的过程和原则迈进，从而使我们能够在与来访的交流中运用我们的临床智慧、创造力和同情心。

同情灵活性反映了一种特定的心理灵活性品质。借鉴之前的相关概念定义（Dahl et al., 2009; Gilbert, 2010; Hayes et al., 2012; Kashdan & Rottenberg, 2010），我们将同情灵活性定义为作为有意识且情感响应的人类，完全接触当下时刻的能力，具备以下特质：

对自己和他人痛苦存在的敏感性
减轻和预防自己及他人痛苦的动机
在竞争和变化的环境、情感和动机需求下持续适应，并承诺将注意力和资源重新投入到减轻和预防自己及他人的痛苦上
能够灵活地转换视角，并获得对自己和他人更广泛的理解，包括共情和同情的体验
从过度的影响评价性和批判性思维中解脱出来
对人类经验本身保持开放和非谴责的态度，从而培养必要的意愿去容忍自己和他人所遇到的痛苦

图4中对同情灵活性的进一步阐述提供了一个概念性的浏览，展示了CFT理论中同情关键要素的关系，阐明了它们最相关的六边形过程以及如何在咨询室中针对这些过程进行干预。

同情灵活性模型

关怀福祉与价值观

在ACT（接受与承诺疗法）中，有意义、有目的和充满活力地生活，以服务于自由选择的价值观，是心理灵活性模型中的核心驱动原则。从某种意义上说，所有其他过程都汇聚在一起，进一步促进个人参与有意义的行为。正如ACT所讨论的，价值观既不是要达到的目标，也不是生活的规则；它们本质上是具有奖励性质的行为。价值观工作的一个重要部分涉及澄清和书写那些可以描述为我们在世界上的行为意图。当然，某种行为内在强化的程度可能与我们的物种遗传历史有关。具有适应性进化功能的行为，如进食或性行为，对大多数人来说比吸尘或观看油漆干燥更有可能是强化性的。同样，关怀本能和合作的内在适应性和进化性质使得关怀福祉成为大多数人在一生中固有的、强烈持有的价值观。

ACT文献强调价值观是自由选择的；然而，正如之前提到的，同情可能是心理灵活性模型中固有的一个价值观（Hayes, 2008c）。在CFT（同情聚焦疗法）中，同情始于一种对自身及他人福祉的关怀动机。这体现了人类照顾行为对我们物种生存的重要性。CFT强调了进化动机的重要性：这些价值观源自并嵌入我们深层次的进化指令中，并体现在古老的脑结构和功能中。关怀福祉的动机显然是六边形模型中的一个价值观，但它也显然与地球上复杂生物展示的一些最古老的行为相关。尽管如此，个体的学习历史可能会干扰我们接触和行动这种动机的方式。当人们在支持和温暖的经历中遭遇创伤时，他们可能会遇到同情动机的障碍。

来自ACT及其心理学模型的几种价值观书写技术对于增强意识和建立同情动机非常有效。这些技术包括体验式想象练习，来访会设想自己未来的一天，那时他更充分地活出了自己的价值观。另一种流行的技术是让来访想象自己过完充实丰富的生活后去世，听到人们对她生前的悼词，描述她是如何实现了一种极具个人意义的生活。这些以及其他类似的技术可以让来访情感上接触到他们最希望如何生活。当这些工作包含同情焦点时，这些实践可以建立关怀福祉的动机，甚至可能是爱与被爱的开放性。此外，即使这些技术在使用时没有明确强调同情，许多人也很可能会意识到对他们来说，爱的关系是多么重要。

缓解心理学与承诺行动

承诺行动代表了个体持续参与支持有意义生活模式的行为，并促进实现能够带来意义、目的和活力的价值目标的能力（Dahl et al., 2009）。由于行为改变很少能毫无偏差地进行，承诺行动也包括在偏离我们设定的路径后返回到有价值的行为模式中（K.G. Wilson & DuFrene, 2009）。例如，如果一个已经戒酒13个月的人在婚礼上喝了一杯香槟，承诺行动可能包括停止这种偏差并重新参加12步会议。

许多基于证据的治疗技术，从暴露与反应预防到想象性重现，从行为激活到练习自信表达，都可以被视为人们为了实现其价值目标而面对困难经历时所采取的承诺行动步骤。在CFT中，缓解心理学中的各种技术都是服务于培养同情心这一价值观的承诺行为。例如，同情心意象练习、克制成瘾行为、同情聚焦暴露疗法以及发展权威而非暴力的自信技巧，这些都是承诺行动的形式。这些技术可以服务于多种价值观，如成为一个善良的父母或过更健康的生活方式——这些价值观反过来又服务于减轻自身和他人痛苦的更高层次的价值观。

敏感性和当下时刻的接触

在CFT中，敏感性指的是对我们在世界上遇到的苦难进行当下的觉察，这显然与正念有关。随着我们培养更大的当下敏感性，我们可能会更好地注意到苦难的存在，以一种接纳的态度来对待它，而不是因为焦虑或厌恶而回避。这种敏感性还可以帮助我们增加对情绪和情绪记忆微妙层面的意识。通过这种方式，我们可以变得更有能力，也更准备好面对苦难和挑战性的情绪，同时增强我们有时间做出反应的感觉。

在缓解心理学中，这种敏感性的概念使用方式类似于心理灵活性过程中的当下觉察（Hayes et al., 2012）。事实上，有时被称为自我作为过程（Blackledge & Drake, 2013）的当下觉察，可以定义为对当下展开的内容进行有目的、直接的关注。在六边形模型中，当下觉察还涉及灵活的觉知。接触当下意味着转向我们的体验，无论它是什么，而不是在痛苦或羞耻中逃避此刻，或迷失在叙事内容中。

正如正念和注意力训练文献所展示的那样，有可能培养和增强个体对当下时刻的灵活、专注的注意力（Baer, 2003; Garland et al., 2010）。这种注意力可以通过在心理治疗过程中和作为家庭作业的多个当下觉察练习来训练。这些练习可以从简单的将注意力转移到身体的不同焦点开始，甚至是在环境中的不同焦点。随着时间的推移，这些注意力练习可以扩展到在长时间的正念冥想期间故意带入接受性的觉知。

在传统的正念训练中，当下觉察旨在培养有益的心理状态，包括同情心（Rapgay, 2010; Tirch, 2010; Wallace, 2009）。当我们把重点放在同情上时，作为正念基础的当下觉察就成为了一个通过有意识的同情意图来培养有利于同情和福祉的心境的背景，这个意图还包括同情动机和其他涉及自我和视角转换的六边形过程。

同情、共情与自我作为背景

ACT的心理灵活性模型认为，幸福感和对生活挑战的适应性反应可以通过培养一种能力来实现，即连接并体验自我作为一个意识的觉知（Hayes et al., 2012）。在我们生活中发生的许多变化以及无数展开的情境中，人类维持着一种“我-这里-现在”的体验感。正如前所述，在六边形心理灵活性模型中，这种将自己视为体验的观察者的感觉，与意识内容分离但又观察体验流动的状态，被称为自我作为背景。培养自我作为背景允许一种体验性的自我参照模式，可以作为培养同情心的基础。实际上，这种自我参照模式具有离散的神经元特征，并涉及可以训练的独特过程（Barnes-Holmes, Foody, & Barnes-Holmes, 2013; Farb et al., 2007）。

灵活的视角转换还包括个体能够从他人的角度出发，推断对方的意图和感受，这在心智理论任务和心理化过程中是常见的情况。这种能力使我们能够跳出自我，从另一个存在的角度心理地看待世界，从而使我们的痛苦心理事件和情绪记忆对我们产生较少的影响。有趣的是，在前语言水平上，灵活视角转换的任务由副交感神经系统的有效部署促进，该系统参与放松和平静（Porges, 2007）。因此，从“我-这里-现在”的存在角度来看，你可以像看待他人的苦难一样看待自己的苦难，并被这种体验中的痛苦所触动，而不受学习历史的干扰及其潜在的羞耻自我评价的影响（Hayes, 2008a; Vilardaga, 2009）。能够最好容纳这种体验的生物环境包括亲社会情感反应系统的激活，以及可以描述为安全或平静的隐含或显式体验。因此，当你站在见证自己甚至他人的苦难时，你可能会受到感动而采取行动来减轻这种苦难。这样，平静开始向行动转变。

在情境行为术语中，CFT的来访学习如何从自我作为背景的角度观察他们的体验，以及如何逐渐脱离他们的自我故事和叙事，或自我作为内容（Hayes et al., 2012）。这种去认同的过程有时甚至被称为“非个性化”，长期以来一直是CFT的核心心理治疗步骤；但现在才开始以情境术语进行概念化。

重要的是，参与心理学的两个核心属性——也就是我们进化出的同情能力的两个主要组成部分——涉及灵活的视角转换。这两个属性是同情和共情。尽管两者都涉及灵活视角转换的维度，但在CFT中，这些术语的使用方式非常不同。

在CFT中，同情被定义为我们对他人的痛苦或甚至是我们自身的痛苦的反射性情感反应。当我们被痛苦所触动并在共鸣的情感层面上受到影响时，同情反应就会发生，无需复杂的认知分析。这种情感共鸣被18世纪哲学家大卫·休谟捕捉到，他将人与人之间情感反应的传递比作小提琴弦的谐振振动（Hume, 2000）。在同情回应中，我们自动且毫不费力地采用他人的情感视角，被我们经历的痛苦所触动，并被迫采取行动作出回应。

相比之下，在CFT中，共情被定义为对另一个人经历的高度专注的意识，其中包括理解、视角以及能够推导和构建那个人的经历会是什么样的能力。

CFT提供了一系列意象和沉思练习，以及在会议期间的人际互动练习，这些练习提供了灵活视角转换、同情和共情的训练。以下临床示例说明了其中的一些方法。

临床案例：培养观察自我与同情意图

Gene是一名25岁的来访，他表现出抑郁和社交焦虑的症状。他因为自己的害羞而讨厌自己，并且在概念化自我方面表现出高度的融合。为了创造条件让Gene在他的羞耻感和自我敌意面前体验到同情，治疗师在关系中工作，以促进灵活的视角转换和一些自我同情意图的出现。

来访： 我害羞。我一直都很害羞。在我家里，我是那个害羞的人——如果你愿意的话，可以说是个弱者。基本上，我就是一个永远不会敢于做任何有价值事情的抑郁失败者。我甚至连女朋友都找不到！

治疗师： 听到你一直带着这样的自我观念感到很难过。这种情况有多久了？

来访： 从我能记事起就是这样。这不是一个观念；这就是我。

治疗师： 所以这么长时间以来，认为自己是弱小和害羞的想法几乎概括了你的自我感觉。

来访： 这就是我。我的家人过去常常拿这个开玩笑。现在他们不敢再开玩笑了，但我知道他们仍然这样想。某种程度上，这甚至更糟。

治疗师： 哎呀！那一定很痛吧。

来访： 是的。但他们是对的。我就是弱小和害羞。

治疗师： 所以“弱小”和“害羞”这两个词代表了你是谁？

来访： 嗯，差不多。（低头看）

治疗师： 听起来真的很痛苦。（停顿）但是我们可以花一分钟来看看这两个词吗？

来访： 你是什么意思？

治疗师： （把这两个词写在一张纸上，举到离来访几英尺远的地方。）你能注意到它们在那里吗？

来访： 能。

治疗师： 你能注意到它们告诉你这就是你吗？

来访： 能。

治疗师： 你能注意到当你的自我感觉被简化为这两个词时的感觉吗？

来访： 是的，这很痛苦……也很沮丧。

治疗师： 我敢打赌。我能听到你多么认同这些词。当我看到这些词给你带来的痛苦时，我真的希望这种痛苦能够停止。你呢？

来访： 我也一样。

治疗师： 所以你也能注意到这一点。你还能注意到，你的一部分正在注意到这些词以及它们让你的感受吗？

来访： 呃……是的，我想是这样……

治疗师： 你能注意到你在这里，而这些词和它们带给你的感受，可以说是在那里吗？（再次把纸举到离来访几英尺远的地方。）它们存在，而且它们很痛苦，同时你也能注意到它们的存在和伴随它们的痛苦。

来访： 是的？

治疗师： 所以，你有一部分在注意并听到这些词，一个“观察者”的部分。这个“观察者的你”，能够注意到这些词以及它们引发的感受——你会把这个观察者描述成弱小和害羞吗？（停顿）你会用这些词批评时产生的愤怒或焦虑来描述这个观察者吗？或者你会用不同的方式来描述它？

来访： 嗯……这是一个奇怪的问题。……我想我会说它是不同的。它似乎更加疏远。也许没那么痛苦？

治疗师： 嗯哼。所以你能注意到痛苦，注意到你希望让它消失的愿望，同时也注意到你在注意到它。我们的大脑确实有很多复杂的东西。是否有可能，在每一个时刻，都有一个部分在那里，能够注意到出现的任何东西，即使它可能是痛苦的？这个观察者的你是不是就在那里，随着每一刻的到来，去注意和体验每个瞬间？

来访： 是的。我只是讨厌它。

治疗师： 看着你，我开始意识到你背负着这种弱小的自我感觉已经多久了，背负着这个词“弱小”带来的痛苦。（呼气）我在想，什么时候对你来说更容易承受这种痛苦？是当你评判你的痛苦并与之抗争时容易些？还是当你只是注意到这种情感上的痛苦，并允许一些关怀的意图出现在这里，允许你自己有……希望痛苦可能会有所缓解时容易些？

来访： 我想是当我停止评判，只是允许自己有那种愿望时。……然后痛苦可能会消退。

治疗师： 现在你的声音里有一种温暖……不是强迫痛苦离开，而是退后一步，以一种善意的意图看待自己。

来访： 嗯……我觉得确实有点温暖或柔和了。

无评判与接纳

在心理灵活性的六边形模型中，接纳的概念不同于传统的接受、屈服或放弃。关键在于，在ACT（接受与承诺疗法）中，接纳包括了意愿的元素，定义为自愿选择接触困难的心理事件和情绪体验。这种形式的心理接纳被定义为“对每一刻体验采取一种有意图的开放、接纳、灵活且无评判的态度”（Hayes et al., 2012, p. 77）。从同情的角度来看，这个接纳的过程意味着选择对我们遇到的世界和自己身上的苦难保持开放的态度，即使这些苦难难以承受。当然，当我们遇到不想面对的经历时，很容易采取回避和控制策略，但体验性回避也是我们许多痛苦的根源（Ruiz, 2010）。

为了帮助来访面对他们的恐惧、羞耻甚至自我批评，CFT（同情聚焦疗法）旨在帮助他们采用敏感、无评判且接纳的态度来对待作为人类固有的痛苦。这并不是为了受苦而刻意留在痛苦之中，也不是自虐式的努力。同情不是仅仅坐在生活冰冷肮脏的浴缸里，以便你能“感受你的感受”或“变得接纳”。正如心理灵活性模型所建议的那样，出于同情动机的接纳涉及愿意接触我们遇到的苦难（通过参与心理学），以及愿意感受到我们在开始采取行动减轻遇到的苦难并朝向更大的福祉前进时所涉及的痛苦（通过缓解心理学）。

临床案例：培养接纳、无评判与同情

痛苦耐受与解离

人类认知、象征性表征以及衍生关系反应的进化特性，导致我们倾向于以强烈影响后续行为的方式回应我们的思维的字面意义和刺激功能（Blackledge & Drake, 2013）。随着讨论的深入，我们将详细介绍这一过程。现在我们可以注意到，想象中的事件可以控制从我们的生物系统到外显行为的一切。为了忍受痛苦，我们必须有足够的自由度，不受心理事件的影响，从而能够在面对痛苦体验的同时进行自由选择的行为。在ACT的心理灵活性模型中，解离代表了一种可训练的能力，即中断或转化心理事件的影响，提供一些从我们进化心灵中产生的事件所支配和控制的解放（Hayes et al., 1999）。ACT提供了许多经验证实的技术来促进解离，这些技术贯穿于CBS文献中。最近，这些方法开始被改编成针对焦虑的同情聚焦疗法（Tirch, 2012）。

（笑着说。）我喜欢这样。

CBS、同情与佛教心理学

西方科学继续深化我们对同情的理解，以及它在人类心理成长、适应性行为功能、心理灵活性和福祉中所起的核心作用。科学方法使我们能够扩展理解并测试其应用。然而，我们仍然可以从冥想传统数千年来的前科学现象学研究中找到智慧。在佛教心理学中，讨论了同情的几个不同方面，每个方面都反映了同情体验的一种细微差别。例如，慈心（metta）的概念代表了慈爱和希望所有众生幸福和平的愿望。另一个佛教中的同情概念——菩提心（bodhicitta），对于ACT框架下的同情理论非常重要，因为它展示了个体的自我感如何紧密地参与到同情体验之中。

菩提心代表了一种利他的愿望，即希望所有众生摆脱苦难。据说这种心态会在高级冥想者认识到并体验到万物相互联系的自我感后产生。如果我们以科学假设的方式来看待这个前科学的概念——菩提心，我们可以假设持续的正念练习会导致自我感的转变，使得所有的心理现象变得不那么实在。此外，这种自我感的转变允许人们认识到万物及其所有生命的相互联系，而所有概念上的划分和分离只是言语构造和心智中象征事件的关系表现。因此，菩提心的生起可能涉及放弃评价性的自我概念，这些概念按定义将我们置于与他人的对立位置。事实上，甚至自我的概念也可以被看作是一个持续的过程，即将每一刻的经验相互关联起来，创造了一个基于无形和空性（sunyata）的现实体验的概念过程。这种视角的转变被认为会激发一种愿望，即减轻所有众生的所有苦难。因此，在佛教心理学中，同情源于从基于内容的自我感知向作为纯粹注意力流的自我体验的根本转变。显然，这样的构想与CBS中灵活视角转换的概念之间存在高度的一致性，其中自我作为背景的体验对于解脱痛苦至关重要。

通过将焦点从基于内容的自我转移到心理灵活的视角，可以避免持续追求高自尊（及其伴随的自恋和社会比较带来的负面影响）。这也许可以解释为什么实践自我同情比培养自尊更有益（Neff, 2009）。心理灵活性消除了对基于内容的自我进行好坏评判或评估的需要，因为自我被视为一个体验过程而不是实体化的存在。这有助于减少羞耻和责备的自我对话，并增加在痛苦情境中对自己仁慈的能力。心理灵活性还允许个人承诺采取符合核心价值观的行为，或许这也是自我同情与更高动机相联系的原因之一。正如探索当代应用心理学中的同情理论一样，探讨心理灵活性与佛教心理学对同情的概念化之间的关系也揭示了一个机会窗口，进一步发展适合解决人类痛苦问题的科学。

知识点阐述

同情与心理灵活性：佛教心理学中的同情概念强调了自我感的转变，这一转变是通过正念练习实现的。这种转变不仅促进了对他人苦难的同情，还减少了自我批评和负面自我对话，从而增强了个体的心理韧性。心理灵活性允许个体超越固定的自我概念，接受自己作为一个不断变化的体验过程，从而更有效地应对生活中的挑战。
自我同情与自尊：研究表明，培养自我同情比单纯提高自尊更能带来积极的结果。这是因为自我同情关注的是无条件的自我接纳和支持，而不是基于成就或外在标准的自我评价。这种做法有助于减少因过度竞争和社交比较而产生的消极情绪，如自恋和自卑。
灵活视角与价值导向行动：心理灵活性鼓励个体采用灵活的视角看待自我，这有助于他们根据自己的核心价值观做出决策和行动。这种能力不仅提高了个体的内在满足感，还增强了他们在面对困难时坚持目标的决心。
东西方心理学的融合：本文展示了现代心理学如何从古老的佛教思想中汲取灵感，特别是关于同情和心理灵活性的概念。这种跨文化的交流为理解和解决人类的心理健康问题提供了新的途径，表明了整合不同文化智慧的重要性。

本章知识点阐述

知识点阐述

同情与ACT：虽然同情还未成为ACT（接纳承诺疗法）正式的一部分，但它在心理治疗中的重要性逐渐被认识到。同情可以帮助个体更好地接受自己的经历，促进心理灵活性。关系框架理论(RFT)：RFT是ACT背后的基础理论之一，它试图用行为主义的观点解释复杂的心理过程如正念、自我成长等。RFT强调人们如何通过学习形成复杂的关系网络，从而影响他们对世界的感知和反应方式。心理治疗中的假设作用：不同流派的心理治疗师根据各自理论背景持有不同的假设，这直接影响了他们对待患者的态度及治疗方法的选择。例如，精神分析倾向于处理潜意识冲突，而认知行为疗法则侧重于改变不健康的思维方式。同情的科学依据：通过研究情感联系的进化基础及其背后的认知机制，可以为理解和培养同情心提供科学支持。这种方法不仅有助于深化对同情本质的认识，还能指导临床实践中如何有效利用同情来促进心理健康。治疗关系的重要性：良好的治疗关系被认为是成功治疗的关键因素之一。治疗师通过调整自身态度和行为，能够创建一个支持性的环境，让患者感到被理解和接纳，这对于促进积极变化至关重要。

知识点阐述衍生关系反应：这是RFT的核心概念之一，指个体根据已有的知识和经验推导出新的关系，从而使得不同的刺激物之间的功能得以转移。这个过程对于理解和处理复杂的人类思维至关重要。语言学习与认知：衍生关系反应展示了人类如何通过语言学习新知识，并利用这些知识去适应环境。这种能力不仅限于简单的词汇对应，还包括更为复杂的概念关联，如情感表达和社会互动。关系框架：RFT定义了几种基本的关系框架类型，包括比较关系、空间关系、层次关系和视角关系。每种关系框架都代表了一种特定的认知模式，帮助人们组织信息并进行有效的沟通。共情与同情的培养：从RFT角度来看，共情和同情被视为一种特殊类型的视角关系，即灵活的视角转换。这意味着能够站在他人的立场上思考问题，对于促进人际关系和谐及提高社会适应能力具有重要意义。自我意识的发展：RFT认为自我意识也是通过学习而来的，特别是通过掌握如何在时间与空间中定位自己的视角。这种能力使个体能够在社交环境中更好地理解自己与他人之间的关系，进而支持心理健康和个人成长。

知识点阐述指示性关系：在RFT中，指示性关系是指个体如何通过社会互动来学习并建立关于自我、他人及周围世界的认知。这类关系强调了个人如何定位自己相对于他人的位置，从而构建出自我意识。自我意识的发展：根据RFT理论，自我意识是通过语言训练和持续的社会交往逐步形成的。这一过程包括理解自身的行为、情感状态以及未来计划，同时也涉及到与他人的比较。视角转换的重要性：学会从不同角度看待事物对于发展同情心和共情能力至关重要。它帮助人们更好地理解自己与他人之间的联系，促进更加健康的人际关系。自我体验的理解：在ACT模型下，自我被视为一种不断变化的体验而非固定不变的本质。这意味着关注于当下的经验，而不是试图定义一个静态的自我形象。 “自我化”过程：该术语强调了自我并非先天固有的属性，而是通过一系列经历和互动动态构建的结果。这提醒我们应当重视成长过程中各种因素的作用，包括文化背景、教育和个人经历等。

知识点阐述内容性自我 vs. 背景性自我：在ACT理论中，内容性自我指的是个人通过特定的角色、成就或身份来定义自己的方式；而背景性自我则是一种更加抽象和普遍的自我意识，它作为一个不变的观察者存在于个体的各种体验背后。正念与同情的作用：正念练习帮助个体发展出一种更加客观地观察自己思维和情感的能力，从而促进背景性自我的体验。同时，同情心的培养有助于个体更好地理解和接纳自己及他人的经历，增强内心的平静和连接感。观察自我的重要性：认识到有一个持续存在的观察自我可以帮助个体区分自己的思想和情绪与其核心本质之间的区别，这对于管理负面情绪和提升心理健康至关重要。历史上的智慧传统：无论是佛教中的“明觉”还是道教中的“无为”，很多东方哲学都强调了超越日常思维模式的重要性，以达到一种更高的意识状态。这些理念与ACT中的背景性自我概念有着相似之处。自我意识的层次：ACT理论提供了一个框架，让人们能够探索不同层面的自我意识，从具体的自我形象到更为深邃的背景性自我，从而增进对自我本质的理解。

知识点阐述自我同情与自我作为背景：自我同情强调了对自己的善意和理解，而自我作为背景则是一种超越个人经历的更广泛视角。两者结合起来可以促进个体的心理灵活性，帮助他们更好地应对挑战。 Neff的自我同情三要素：Kristin Neff提出了自我同情的三个核心元素：正念（认识到当前时刻的经历）、自我友善（对自己怀有善意而非批评）和共同人性（认识到苦难是人类共有的经历）。这些元素有助于个体发展出更加积极和包容的态度。解离与去认同：在ACT中，解离指的是将自己与负面思维和情感分开的能力，从而减少其影响力。去认同则是指不再完全认同自己的故事或角色，而是将其视为一种流动的体验。心理灵活性的重要性：心理灵活性是指能够根据情境变化调整自己的思维、情感和行为。这对于应对生活中的压力和挑战至关重要，因为它允许个体保持开放性和适应性。 ACT治疗策略：ACT治疗师通过识别阻碍心理灵活性的因素，如过度认同自我叙述、缺乏灵活视角等，来帮助来访建立更健康的心理状态。具体策略可能包括正念练习、价值观澄清、承诺行动等方法，以促进来访的自我同情和个人成长。

知识点阐述心理灵活性的定义：心理灵活性是指个体在面对困难情况时能够保持开放态度、调整自己的思维和行为的能力。它有助于个体维持健康的心理状态，减少负面情绪的影响，并提高生活质量。心理灵活性的核心要素：心理灵活性模型包含六个核心要素，即价值自主、承诺、自我作为背景、解离、愿意接受以及与当下时刻的接触。这些要素共同作用，帮助个体更有效地应对生活中的挑战。心理灵活性与心理健康：研究表明，心理灵活性与较低水平的抑郁、焦虑和其他心理问题相关联，同时与较高的幸福感和生活质量有关。这意味着培养心理灵活性可以成为一种有效的心理健康干预策略。同情与心理灵活性：同情被视为心理灵活性的一个内在组成部分，尤其是自我同情。通过培养正念、接纳、解离等过程，个体不仅能够更好地理解自己的情感，还能对他人的痛苦产生共鸣，并采取积极行动来缓解痛苦。实践应用：在临床实践中，ACT治疗师可以通过一系列技术和练习来帮助来访增强心理灵活性，比如通过正念冥想来提升当下的意识，使用解离技术来减少对负面思维的依附，以及通过明确个人价值观来指导有意义的行为。这些方法有助于来访建立起更加灵活和富有同情心的生活方式。

知识点阐述自我同情与心理灵活性的交集：自我同情和心理灵活性共享一些核心要素，如正念、接纳和灵活视角转换。这些共同点表明两者在促进个体健康和福祉方面有着密切的关系。正念的作用：正念是自我同情和心理灵活性的关键组成部分，它帮助个体保持当下的意识，减少对负面思维的依附，并促进对当前体验的开放态度。共同人性的理解：认识到所有人都会经历困难和挑战，这有助于培养一种普遍的同情心态，从而增强个体的心理韧性。自我友善的重要性：自我友善不仅是对自己宽容和支持的态度，还涉及到如何通过积极的内部对话来促进个人成长和恢复。综合应用：在实际操作中，ACT实践者可以通过结合自我同情和心理灵活性的原则，设计出更加全面有效的治疗方案，帮助来访更好地应对生活中的挑战。

知识点阐述相互依存的关系：参与心理学的各个组成部分（如痛苦容忍力、同理心、无评判的理解等）是相互支持的。增强其中一个方面通常会促进其他方面的提升，反之亦然。关怀福祉的动力：在CFT中，建立对自我及他人福祉的关注是同情发展的起点。这包括了对减轻痛苦的基本愿望，以及对那些可能阻碍这一过程的潜在心理障碍的认识。敏感性：敏感性涉及到对痛苦的觉察，无论是自身的还是他人的。这种觉察要求个体能够在遇到痛苦时不回避，而是直接面对。同情：同情是一种自发的情感反应，它基于个体对他人或自身痛苦的共鸣。这种情感连接不仅限于外部观察，也适用于个人对自己的痛苦的感受。痛苦容忍力：痛苦容忍力是个体在面对负面情绪、思维和身体感觉时能够忍受的能力。这种能力与接纳的态度紧密相连，意味着个体能够接受当前的困境，而不是对抗或逃避。通过这些知识点，我们可以看出CFT强调了个体在处理痛苦时的积极态度和应对策略，这对于培养同情心和提高生活质量至关重要。

知识点阐述同理心：同理心是一种既能自然发生也能通过有意识努力培养的能力。它涉及到设身处地为他人着想，以及对他人情绪状态的敏感性。同理心可以通过多种方式表达，包括心智理论、心智化和视角转换等。当个体对自己的情感和经历更加开放和了解时，他们更有可能发展出对他人的深刻同理心。非评判：非评判是指能够在没有负面评价、羞耻或自我批评的情况下体验情绪和心理事件。这种态度有助于减少回避行为，降低情绪痛苦，并防止苦难的加剧。在CFT中，培养非评判的态度是为了更好地理解和接纳自己及他人的复杂情绪和经历。缓解心理学的技能：缓解心理学的技能旨在通过特定的训练来减轻痛苦。这些技能包括椅子工作、引导想象、正念训练等。这些技能相互支持，共同作用，帮助个体在心理治疗和日常生活中更好地应对困难和挑战。注意力训练：注意力训练是CFT的一个关键部分，它通过正念实践帮助个体培养专注而灵活的注意力。这种训练不仅有助于提高对当前体验的意识，还能促进去认同化，从而更好地管理情绪和心理状态。通过将注意力集中在积极的体验上，如感恩和同情，个体可以增强内在的平静和幸福感。通过这些知识点，我们可以看到CFT强调了通过培养同理心、非评判态度和各种技能来提高个体的心理灵活性和生活质量。这些方法不仅有助于个人的成长和发展，也为治疗师提供了有效的工具来帮助来访应对生活中的挑战。

知识点阐述想象：想象是一种强大的心理工具，可以通过模拟正面情境来促进情绪和生理反应。在CFT中，利用想象来创建同情的场景或角色，有助于增强个体的同情能力和积极情绪体验。这些练习不仅能够激活相关的生理系统，还能帮助个体更好地理解和接纳同情的概念。推理：在同情过程中，具备清晰和平衡的思维方式非常重要。这种智慧的视角可以帮助个体更有效地处理复杂的情况，尤其是在面对自己或他人的负面特质时。通过理性分析，个体可以学会如何在不愉快的情境下发展同情心，从而促进个人成长和心理健康。行为：同情行为是指那些旨在直接应对和减轻他人痛苦的具体行动。这些行为应当是经过深思熟虑的，而非简单的冲动反应。在CFT中，鼓励个体采取实际行动来表达同情，即使这意味着面对自己的恐惧或不适。这种行为上的实践有助于强化内在的同情动机，并最终转化为实际的帮助和支持。感官体验：通过感官体验，如特定的呼吸技巧、身体姿态、面部表情和语音，可以激活副交感神经系统，从而促进放松和平静的感觉。这种方法不仅增强了个体的身心连接，还有助于产生更加深刻和真实的同情体验。通过这些具体的感官练习，个体可以在日常生活中更容易地感受到同情的力量，并将其应用于实际情境中。通过这些知识点，我们可以看到CFT强调了通过多种途径来培养和发展同情心，这些方法不仅包括心理层面的调整，还包括生理和行为层面的实践。综合运用这些方法，可以帮助个体更好地应对生活中的挑战，提升整体的心理健康水平。

知识点阐述情感：同情的情感体验通常与积极的情绪如连接、温暖和善良相关联。这些情绪不仅能够带来内心的平静和满足感，还能激励个体采取行动去帮助他人。值得注意的是，有时负面情绪如愤怒或恐慌也能激发同情行为，这取决于这些情绪是否与减轻或预防痛苦的动机相连。同情灵活性：同情灵活性是一种特殊类型的心理灵活性，它结合了对痛苦的敏感性、减轻痛苦的动机、适应性反应以及对情境的灵活理解。这种灵活性允许个体在面对复杂情况时保持开放和非评判的态度，同时有效地应对个人和他人的痛苦。 ACT过程与CFT模型的整合：CFT模型中的各个过程可以与ACT的六边形模型中的过程相对应，这些过程共同促进了心理灵活性的发展。通过将同情与心理灵活性的概念和技术结合起来，临床医生可以设计出更加有效的干预措施，帮助来访在生活中实现适应性和同情心。同情灵活性的要素：同情灵活性包括对痛苦的敏感性、减轻痛苦的动机、适应性调整、视角转换能力、从评价性思维中解脱出来的能力，以及对人类经验保持开放和非谴责的态度。这些要素共同构成了一个全面的框架，指导个体如何在日常生活中实践同情。通过这些知识点，我们可以看到同情灵活性不仅是对个体心理状态的一种描述，也是在实际生活中实践同情的具体指南。它强调了在面对挑战时保持灵活性和适应性的重要性，同时也指出了同情在促进心理健康和个人成长中的核心作用。

知识点阐述关怀福祉与价值观：在ACT中，基于自由选择的价值观来过有意义、有目的且充满活力的生活，是心理灵活性的核心原则。价值观不仅仅是目标或规则，而是指那些能够带来内在满足感的行为。这些行为往往与我们的进化历史有关，比如进食和性行为，因为它们对生存至关重要。因此，关怀福祉作为一种价值观，也是深深植根于人类进化史中的。同情作为固有价值：虽然ACT强调价值观是自由选择的，但同情被视为心理灵活性模型中的一种固有价值。CFT认为，同情源于对自身及他人福祉的关怀动机，这反映了人类照顾行为在进化中的重要性。这种动机不仅是一种价值观，还与大脑中古老的结构和功能相关联。价值观的书写技术：ACT提供了一些有效的技术来帮助个体明确和书写他们的价值观。例如，通过体验式想象练习，来访可以设想自己未来的生活状态，从而加深对自己价值观的理解。这些技术可以帮助来访在情感上连接到他们最渴望的生活方式。当这些技术结合同情焦点时，它们可以增强关怀福祉的动机，并促进爱与被爱的能力。通过这些知识点，我们可以看到关怀福祉不仅是ACT和CFT中的一个重要概念，而且它也是人类进化过程中固有的价值观之一。利用特定的技术和方法，个体可以更好地理解和实践这些价值观，从而在日常生活中实现更有意义和充满同情的生活。

知识点阐述承诺行动：承诺行动是指个体持续参与支持其价值观和有意义生活模式的行为。即使在出现偏差时，个体也能回到这些有价值的行为模式中。在CFT中，承诺行动包括了一系列旨在培养同情心的技术，如同情心意象练习、克制成瘾行为等。这些技术不仅有助于实现个人的具体价值观，还服务于更高层次的目标，即减轻自身和他人的痛苦。敏感性与当下觉察：在CFT中，敏感性指的是对当下苦难的觉察，这与正念的概念密切相关。通过提高对当下时刻的敏感性，个体可以更好地观察和接纳苦难，而不被焦虑或厌恶所驱使。这种敏感性还有助于增强对情绪和情感记忆的细微层面的认识，从而更好地准备应对苦难和挑战性的情绪。当下觉察的训练：通过一系列的练习，可以在心理治疗过程中培养和提升个体的当下觉察能力。这些练习从简单的注意力转移开始，逐渐扩展到更复杂的正念冥想实践。当下觉察不仅有助于提高对当前体验的觉知，还能为培养同情心提供一个有利的心理背景。正念与同情：传统正念训练中的当下觉察旨在培养有益的心理状态，包括同情心。当将同情心作为训练的重点时，当下觉察成为了培养同情心境的基础，这种心境包括同情动机和其它相关的心理灵活性过程，如自我觉知和视角转换。通过这些知识点，我们可以看到CFT如何利用承诺行动和当下觉察来促进个体的心理灵活性和同情心的发展。这些方法不仅有助于个体更好地应对生活中的挑战，还能够在日常生活中实践同情，从而提升整体的心理健康和幸福感。

知识点阐述自我作为背景：在ACT的心理灵活性模型中，培养自我作为背景的能力意味着个体能够意识到自己是一个观察者，而不是体验的内容本身。这种自我参照模式有助于个体保持一种客观的视角，从而更好地应对生活中的挑战。在CFT中，这一概念被用来作为培养同情心的基础，因为通过这种方式，个体可以更清晰地看到自己的苦难，而不被个人的历史经验所束缚。灵活的视角转换：灵活的视角转换是指个体能够从他人的角度出发，理解和感受对方的情绪和意图。这种能力不仅有助于建立更好的人际关系，还能帮助个体减少自身痛苦经历的影响。研究表明，这种能力与副交感神经系统的活动有关，后者负责身体的放松和平静状态。同情与共情的区别：在CFT中，同情是一种反射性的情感反应，当个体目睹他人的痛苦时，会自动产生共鸣并感到被触动。共情则更加深入，它涉及到对他人经历的理解、视角以及推导其经历的能力。虽然两者都涉及灵活的视角转换，但共情需要更多的认知加工和理解。训练方法：CFT通过一系列意象、沉思和人际互动练习来训练个体的灵活视角转换、同情和共情能力。这些练习旨在帮助个体更好地理解他人，同时也能更好地处理自己的情绪和经历。通过这些知识点，我们可以看到CFT如何利用自我作为背景的概念来促进个体的心理灵活性和同情心的发展。这种方法不仅有助于个体更好地应对生活中的挑战，还能够在日常生活中实践同情，从而提升整体的心理健康和幸福感。此外，区分同情和共情也有助于个体更有效地与他人建立联系，并在面对困难时采取更有建设性的行动。

知识点阐述自我作为背景与同情意图的培养：在这个案例中，治疗师通过一系列对话帮助Gene区分了他的自我概念（即“弱小”和“害羞”）和他的观察者自我。通过这种方式，Gene能够从一个更客观的角度来看待自己的负面自我评价，从而减轻了这些标签所带来的痛苦。这种方法的核心在于帮助来访认识到他们不仅是一个经历痛苦的人，也是一个能够观察和理解这些痛苦的人。灵活的视角转换：治疗师引导Gene进行了一种灵活的视角转换练习，让他注意到自己对这些负面标签的反应。这种练习有助于Gene从一个更加客观的位置来观察自己的想法和情绪，而不是完全沉浸在其中。通过这种方式，Gene能够逐渐减少对这些负面自我概念的认同，从而减轻心理负担。自我同情：治疗师鼓励Gene对自己产生同情心，而不是仅仅批判自己。通过询问Gene何时更容易承受痛苦，治疗师引导他认识到，当他对自己的痛苦抱有同情而非评判时，痛苦会变得更容易处理。这种自我同情的态度有助于建立内在的支持系统，使个体能够在面对困难时更加坚韧。语言和身体语言的作用：治疗师通过具体的语言和身体语言（如写下词语、展示给来访看）来帮助Gene具体化他的负面自我概念，并通过提问引导他反思这些概念。这种互动方式不仅增强了来访的参与感，也使得抽象的概念变得更加具体和可操作。通过这些知识点，可以看到CFT如何利用具体的练习和技术来帮助个体重新评估和改变他们的自我概念，进而培养出更多的自我同情和心理灵活性。这种方法不仅有助于缓解抑郁和焦虑症状，还能够提升个体的整体心理健康水平。

知识点阐述无评判与接纳：在ACT中，接纳不仅仅是被动地接受现实，而是一种主动的选择，即愿意接触和经历当前的任何体验，无论是愉快的还是不愉快的。这种接纳的态度是基于一个开放、接纳、灵活且无评判的心态。在同情的背景下，这意味着愿意面对和接纳个人及他人所经历的痛苦，而不是逃避或压抑这些感受。这种接纳有助于减少因回避带来的额外痛苦，并促进更积极的应对方式。同情与行为改变：CFT强调通过同情的方式帮助个体面对自身的脆弱和痛苦。这种同情不仅限于对自己，也包括对他人的理解和支持。通过鼓励个体以一种非评判性和接纳的态度来面对自己的负面情绪和自我批评，CFT帮助个体建立起一种内在的善良和勇气，从而更加愿意面对和处理问题。这种方法不仅有助于减轻个体的痛苦，还能够促进其心理健康和个人成长。功能分析与内心批判者：在CFT中，功能分析是一种重要的工具，它帮助个体识别和理解内心批判者的功能。通过这种方式，个体可以更好地了解自我批评是如何影响他们的行为和情绪的。一旦个体认识到自我批评的实际作用，他们就可以开始学习如何以一种更有建设性的方式与之互动，从而减少其负面影响。临床实践中的应用：在上述案例中，治疗师通过同情的对话和练习，帮助Gene从自我批评中解脱出来，并引导他逐渐接受自己的感受。这种做法不仅有助于Gene更好地准备即将到来的画廊展览，还帮助他在面对未来的挑战时能够更加自信和有动力。通过这种方式，CFT不仅关注症状的缓解，还注重个体整体的心理健康和生活质量的提升。通过这些知识点，我们可以看到CFT如何利用具体的技巧和方法来帮助个体培养接纳、无评判和同情的态度。这种方法不仅有助于减轻个体的痛苦，还能够促进其心理健康和个人成长。

知识点阐述接纳与无评判：在这个案例中，治疗师引导Gene认识到他的自我批评虽然表面上是为了激励他，但实际上却让他感到更加沮丧和无助。通过讨论和反思，Gene开始理解到接纳自己的感受并不等同于接受自己是“坏的”，而是能够面对负面情绪而不被其定义。这种接纳的态度是心理灵活性的一个重要组成部分，有助于个体更好地处理困难的情绪体验。同情的勇气：Gene在对话中展现出了一种新的勇气，即能够在面对痛苦和批评时仍然选择前进。这种勇气不仅体现在他愿意面对自己的脆弱，还体现在他能够以一种更有建设性的方式与内在批评者对话。这种转变表明，同情不仅可以用来安慰自己，还可以作为一种力量，帮助个体克服障碍，实现目标。功能分析与内在批评者：治疗师通过功能分析的方法帮助Gene识别内在批评者的作用。这种方法揭示了批评者背后隐藏的意图——保护Gene免于失败。然而，这种保护方式实际上导致了相反的效果，使Gene感到更加无力。通过这种分析，Gene开始意识到改变与批评者互动方式的重要性，从而找到更有效的方法来激励自己。临床实践中的应用：本案例展示了如何在治疗过程中使用具体的技巧来帮助个体处理内在批评者。通过富有同情心的对话，治疗师帮助Gene重新定义了与批评者的关系，鼓励他以一种更积极和支持性的态度对待自己。这种实践不仅有助于缓解个体的即时痛苦，还能促进长期的心理健康和个人成长。通过这些知识点，我们可以看到CFT如何利用具体的技术和方法来帮助个体培养接纳、无评判和同情的态度。这种方法不仅有助于减轻个体的痛苦，还能增强他们的心理韧性，促进整体的心理健康。

知识点阐述痛苦耐受与解离：在ACT框架下，痛苦耐受是指个体能够保持在痛苦体验中的能力，而不被这些体验完全控制。解离则是指通过特定技巧减少或改变思维内容对个体情感和行为的影响。两者都是心理灵活性的重要组成部分，帮助个体更好地应对负面情绪和想法。在CFT中，痛苦耐受更多地与接纳和愿意接触痛苦有关，而解离则涉及从习惯性的反应模式中脱离出来，以便采取更灵活的行为。接纳与解离的关系：接纳意味着允许自己体验当前的情绪和感受，而不是试图逃避或压抑它们。解离则是在意识到这些情绪和想法的同时，学会不被它们所左右。两者共同构成了开放反应风格，使个体能够在面对痛苦时保持心理上的灵活性。这种结合有助于个体培养更强的内在力量，以更加积极和建设性的方式应对生活中的挑战。同情聚焦疗法的应用：在这个案例中，John面临的是社交焦虑和对自身能力的怀疑。通过同情聚焦疗法，治疗师可以帮助John认识到自己的价值和贡献，同时学习如何以一种更加同情的态度对待自己的弱点和不足。这种方法不仅能够减轻John的负面情绪，还能增强他的自信心和社交能力。通过激活同情动机，John可以更好地接纳自己，从而提高生活质量。具体技巧的应用：在实际治疗过程中，治疗师可能会使用各种技巧来促进解离和接纳，如正念练习、认知重构、暴露疗法等。这些技巧旨在帮助个体识别和改变自动化的思维模式，同时学会在面对痛苦时保持内心的平静和清晰。通过这些实践，个体可以逐步建立更加健康和适应性的应对机制。通过这些知识点，我们可以看到ACT和CFT如何通过具体的技巧和方法来帮助个体提高心理灵活性，从而更好地应对生活中的挑战。这种方法不仅有助于缓解即时的痛苦，还能够促进长期的心理健康和个人成长。

知识点阐述认知解离：在这个对话中，治疗师使用了一种具象化的技巧来帮助来访识别和表达他的痛苦思想。通过让来访用手势表示“记忆问题”在他心中的位置，治疗师帮助来访直观地看到这个想法是如何影响他的日常生活的。这种方法有助于来访将自己与痛苦的思想分离，从而减少其对情绪的影响。接纳与自我同情：面对记忆问题带来的困扰，治疗师鼓励来访接受当前的状况，并尝试对自己更加宽容。通过这种方式，来访可以学会不再对自己过于苛责，而是以一种更为理解和同情的态度对待自己的困境。这种自我同情对于提高个体的心理韧性至关重要。情感支持与社会联系：来访提到他在社交场合中的尴尬和孤立感，甚至认为自己给别人的“情感支持”是无用的。治疗师指出，这种感觉可能让他感到更加孤独。通过讨论这些问题，治疗师帮助来访认识到人际关系的重要性，并鼓励他寻求更多的情感支持和社会联系，以减轻孤独感。心理灵活性：ACT强调心理灵活性，即能够在面对困难情境时保持开放、灵活的态度。在这个案例中，治疗师引导来访认识到他的痛苦思想如何阻碍了他的生活，并探索如何以一种新的方式应对这些思想。这种灵活性不仅有助于缓解即时的情绪困扰，还能促进长期的心理健康。通过这些知识点，我们可以看到治疗师如何利用具体的技巧来帮助来访处理记忆问题所带来的负面情绪，并逐步培养出更加积极和适应性的应对策略。这种方法不仅有助于缓解来访的即时痛苦，还能够增强他的心理韧性，改善其生活质量。

2 Compassion and Psychological Flexibility Although compassion in itself has yet to be integrated as a formal component of the ACT process model, ACT practitioners and researchers have been explor- ing the role of compassion and self-compassion in psychotherapy for some time now (Forsyth & Eifert, 2007; Hayes, 2008c; Luoma, Drake, Kohlenberg, & Hayes, 2011; Schoendorff, Grand, & Bolduc, 2011; Tirch, 2010; Van Dam, Earleywine, & Borders, 2010). In order to approach an understanding of com- passion from an ACT perspective, we need to spend some time examining rela- tional frame theory (RFT; Hayes et al., 2001), the underlying theory of cognition within CBS and the foundation for ACT. RFT provides us with an approach to understanding how human beings think and feel, based in the most basic behav- ioral principles. One advantage it offers is that, by building our knowledge about the basic units of mental functioning, we can develop and scientifically test new ways of addressing the complex problem of human psychological suffering. RFT describes the processes of mindfulness, self-development, and perspective taking, among many other mental phenomena. RFT also provides a useful way of considering how humans may develop a sense of self and a sense of others and how we frame our experience of time and space (Barnes-Holmes, Hayes, & Dymond, 2001; Törneke, 2010).

After just over a decade of widespread dissemination, RFT has become the foundation for a worldwide research initiative. This exploration of the funda- mentals of cognition and language from the ground up is one of the most active research programs in behavioral psychology today. One of the central concepts involved in this field of study is a process called relational framing, or derived relational responding, which aims to provide a thorough account of exactly what takes place in human symbolic thinking. As we will discuss, all of this has particular relevance for understanding the emergent, applied science of compassion.

When training therapists in these theories that ground our work in a con- textual understanding of language, we often invite our colleagues to look at the theory as something more than an academic exercise and see these concepts as essential and dynamic pieces of a vital psychotherapeutic process. Our assump- tions inform how we view our clients and ourselves, and having a clearer under- standing of the foundations of thoughts, feelings, and action will help us develop case conceptualizations, provide clear targets for interventions, and influence the style and flow of our conversations. Say that you are a more traditional psy- choanalyst and your assumptions about how the therapy will work involve the resolution of a transference neurosis; everything from your facial expression to the degree of self-disclosure in the room will be influenced by those assump- tions. Your aims will influence the directions that you suggest in the flow of the therapeutic discussion. Alternatively, if you are a Beckian cognitive therapist, interested in helping clients identify and directly change dysfunctional cogni- tions, you will have a different set of assumptions, and they will create quite different directions in relating to clients. By taking the time to explore the evolutionary roots of our affiliative emo- tions and increase our understanding of the behavioral principles involved in cognition and language, we are opening ourselves to new assumptions and new possibilities for assessment, case conceptualization, and treatment planning. We are also bringing new dimensions of ourselves to the therapeutic relationship in the process.

Derived Relational Responding and Perspective Taking As many ACT practitioners know, “derived relational responding” is a term used in RFT to describe verbal learning. Simply put, derived relational respond- ing involves a person’s ability to derive relations among stimuli, and as these relations are derived, the functions of the related stimuli can be transferred and transformed. For our purposes, when we say the “function of a stimulus,” we mean the way that an experienced change in an environment (stimulus) can predict and influence the behavior of a person. For example, deriving a relation of equivalence between the word “dog” and the word “txakur” (“dog” in the Basque language) may transfer the functions of the word “dog” (appetitive or aversive, depending on one’s experience with dogs) to the word “txakur.” If someone were then to tell you to take care of your txakur because it was pacing by the back door and walking in circles furtively, you would know what to do. This form of learned relational responding depends upon contextual cues and derived relationships among stimuli that are not dependent upon formal prop- erties of the stimuli (such as the sensory appearance qualities) or direct experi- ence of them. For example, neither the word “dog” nor the word “txakur” is in any way similar to the direct experience of the animal, but both of these words, when serving as a stimulus, can have the effect of bringing to mind for the lis- tener a host of associations and inner experiences related to dogs. At this point, hundreds of studies have demonstrated derived relational responding’s role in verbal learning and cognition (Dymond, May, Munnelly, & Hoon, 2010). Essentially, RFT suggests that derived relational responding is the fundamental building block of thinking, knowing, and speaking. As we explore the science of compassion for ACT practitioners, it is clear that an RFT account of compassion could help us better understand how compassion may function, how we may be able to develop methods to predict and influence compassionate behaviors, and how we can come to understand compassion with increasing precision, depth, and scope.

Relational Frames Derived responding can involve different kinds of relations, which are some- times referred to as relational frames, giving us the name for RFT. Here are a few examples of different kinds of relational frames: • Comparative relations: for example, bigger/smaller and faster/slower • Spatial relations: for example, above/below and behind/in front • Hierarchical relations: for example, this is a part of that • Perspective relations: for example, here/there, now/then, and I/you In RFT, and therefore in ACT, the abilities to experience empathy, compas- sion, a sense of common humanity, and even a sense of self all are viewed as involving our learned capacity for creating perspective relations, a process known as flexible perspective taking (Hayes et al., 2012; Vilardaga, 2009). This is to say that, in RFT terms, the experience of self emerges from a particular form of learned derived relational responding that establishes a perspective—a point of view that is situated in time and space relative to other points of view. This form of verbal behavior is described as framing deictic relations, with the term “deictic” simply meaning “by demonstration.”

When we use the language of behavior analysis, we can say that these deictic relations are trained relational operant behaviors shaped by ongoing social interactions (Barnes-Holmes et al., 2001). But because not everyone has a com- fortable background in that kind of language based on behavior analysis, we will also simply say that deictic relations are the fundamental elements of how we mentally represent and experience the world, ourselves, and the flow of time. RFT posits that the language training humans undergo in childhood results in our experience of having a self, which gradually develops through our inter- actions with others in our verbal community: our family and society in general. For example, a parent might ask a young child what she just did, or even who she is or what she will be doing tomorrow. Children might also be invited to contrast themselves with others. For example, a parent might say, “You were a very good girl today! Thanks for cleaning up your toys right away. Some girls at the party didn’t even listen to their parents. Good job.” RFT asserts that in order to establish consistency in our verbal communication, it’s absolutely nec- essary for children to create a frame of reference and point of view, and hence a perspective. Over time, this perspective is experienced as a sense of self (Hayes et al., 1999; Törneke, 2010).

In RFT and ACT, deictic relations that involve I/you, here/there, and then/ now all are viewed as involving perspective taking and represent the elemental processes that bring our experience of self into being. Furthermore, in order for the concept “I” to have any meaning, there must be a “you” involved. Similarly, in order for “here” to have meaning as a point of view, there must be a “there.” Our sense of a self arises from this perspective taking, an experience of “I-here- now-ness” that emerges in the context of “you-there-then-ness.” We can represent these perspectives symbolically in a number of ways. For example, we can imagine our perspective relative to another perspective: How would I feel if I found myself having to raise that child on my own like she did? or What would it be like to be a soldier at war? We can also imagine our perspective relative to all other perspectives: I feel like I’m the only person in the world who feels this way! Thinking from within the ACT model, the self is less a thing in itself and more a flow of experience. It might even be more accurate to say that we “engage in selfing” than that we “have a self.”

Self-as-Context When people are asked who they are, they often respond by telling some form of life story, or self-narrative. And these kinds of responses, such as “My name is Fred, I’m from Texas, and I’m an attorney,” make perfect sense. From an ACT perspective, this sense of self is known as self-as-content. However, mindfulness and compassion allow for experiencing a different kind of self. This self exists as a sort of observer, a silent “you” who has been watching your expe- rience, moment by moment, for a very long time and is always doing so “now.” Throughout history, many of the wisdom traditions that prescribe the culti- vation of compassion as a method for alleviating human suffering also outline ways that meditators and other practitioners might access a transcendent sense of self. This sense of self has been referred to many ways, including “the observ- ing self,” “the clear light,” “the ground of being,” and “big mind.” It is an experi-ence that has been difficult to express in conventional language, let alone technical, scientific concepts. In ACT, this sense of self is seen as emerging from an experience known as self-as-context (Hayes et al., 1999). Self-as-context has been described as a convergence of major classes of deictic framing that results in an experience of the “I-here-now-ness” of being alive and an observing self.

How is it that this observing self, distinct from a narrative self, arises? In order to understand this, let’s return to ACT’s roots in research on human lan- guage and cognition—RFT. As discussed, part of human relational responding involves trained capacities for perspective taking. Through these processes, our experience of being includes a sense of ourselves as a point of perspective before which the entirety of our experience unfolds throughout life. In ACT, this sense of oneself as an observer is referred to as self-as-context because it is an experiential sense of self that does indeed serve as the context within which our experiences are contained (Hayes et al., 1999). As we respond to our own responding, this sense of an observing self is important because, while this observer can notice the contents of consciousness, it is not the same as those contents. Just as we have arms but are more than our arms, we have thoughts, but we are more than that experience. Emotions don’t feel themselves, thoughts don’t observe themselves, and physical pain doesn’t experience itself. Throughout our lives, we can notice the presence of an observing self—which may be aware- ness itself—before which all of our experiences arise, exist, and, in time, disappear.

This sense of self-as-context is particularly important with regard to com- passion. For example, it clearly links with the components of self-compassion as defined by Neff (2003b): mindfulness, self-kindness, and common humanity. Looking at the relationship between self-as-context and self-compassion in detail, we can see that returning to an awareness of self-as-context offers a non- attached and disidentified relationship to our experiences. In this way, Neff’s self-compassion components of mindfulness and a sense of common humanity appear to represent the activation of the ACT process of flexible perspective taking that underlies the self-as-context mode of experiencing, as well as defu- sion (or disidentification) from our ongoing self-narrative, or self-as-content. The activation of these processes and the accompanying experience of self- compassion can help loosen the habitual influence that painful private events and stories hold over us. Furthermore, from the perspective of the “I-here-now- ness” of being, we can view our own suffering as we might view the suffering of others and be touched by the pain in that experience without the dominant interference of our verbal learning history, with its potential for shaming self- evaluations (Hayes, 2008a; Vilardaga, 2009).

When you remember clients who described being really stuck in their psy- chological problems—perhaps those who were mired in rumination and worry and waiting for their lives to start—what stands out about their experience? Do you recall how isolated they felt and how identified they were with their stories? In a recent session, one of our clients said, “I’ve been like this all my life. I just can’t stop worrying about my health. I know I’m some kind of crazy person, and I wish I could be like the other people in my office, who have their stuff together.

On top of that, it really, really feels like I’m going to get a brain tumor—that it’s only a matter of time. This is too much for me.” Under conditions of intense anxiety, people often have difficulty adopting a flexible perspective and step- ping out of identification with their stories. For this client, obsessive worries related to contamination, radiation, and brain tumors didn’t affect him as thoughts in his mind, but as genuine, looming threats in the world. He felt he was alone, bizarre, mentally and physically ill, and stuck in a place of perpetual anguish. He was his self-story and identified with it deeply.

When working with such clients, an ACT therapist, who is trained to notice obstacles to psychological flexibility and compassion, might make the following types of observations: • The difficulty the client is having with flexible perspective taking • How identified and fused with his self-narrative the client appears to be • How persistent self-comparisons and lack of a sense of common human- ity contribute to feelings of shame, dread, and difficulty in engaging with life • How emotionally moving it can be to deliberately witness the pain of the client as he experiences a physically healthy phase of life as if it were a time of catastrophic illness All of these processes are highly relevant to the cultivation of self-compassion, and all of them can be viewed through an ACT-consistent lens and approached through ACT-consistent therapeutic moves.

Emerging from the CBS and ACT literature as a set of evidence-based psycho- therapy processes, psychological flexibility involves the development of expand- ing and adaptive behavioral repertoires that can be maintained in the presence of distressing events that typically narrow behavioral repertoires. Psychological flexibility has a strong negative correlation with depression, anxiety, and psy- chopathology and a high positive correlation with quality of life (Kashdan & Rottenberg, 2010). Furthermore, psychological flexibility has been demonstrated to serve as a psychotherapy mediator in a large number of randomized con- trolled trials, and its component processes have been identified and supported by behavioral research, as well as neurophysiological research exploring the neural correlates of those components (Ruiz, 2010; Whelan & Schlund, 2013). While psychological flexibility is a model of six elements (values authorship, commitment, self-as-context, defusion, willingness, and contact with the present moment), the model can be divided into two major areas of emphasis.

The first area involves mindfulness and acceptance processes (self-as-context, defusion, willingness, and contact with the present moment). The second area involves the authorship of and engagement in valued patterns of action that contribute to living a life of meaning, purpose, and vitality (which inherently entails the processes of self-as-context and contact with the present moment). Although in ACT values are freely chosen and not prescribed, ACT cofounder Steven Hayes (2008c) has suggested that compassion may, in fact, be a value that emerges inherently from the psychological flexibility model—and the only value that does so. According to Hayes, the roots of both self-compassion and compassion may emerge from the six core processes that comprise psychological flexibility, sometimes known as hexaflex processes (Hayes, Luoma, Bond, Masuda, & Lillis, 2006), as illustrated in figure 1.

Present Moment Acceptance Values Psychological Flexibility Commitment Defusion Self-as-Context Figure 1. The hexaflex: Interacting processes in psychological flexibility.

Given your interest in this book, you may well be familiar with these pro- cesses and the growing body of interventions and techniques they inform.

However, each component has a particular relationship to aspects of compas- sion and self-compassion, with implications for assessment, intervention, and treatment. And as we begin to explore these relationships, it is worth noting that these six processes work together interactively to several ends: • Bringing people into direct experiential contact with their present- moment experiences • Disrupting a literalized experience of mental events that may narrow the range of available behaviors • Promoting experiential acceptance • Helping people let go of overidentification with a narrative sense of self, or self-as-content • Assisting in the process of values authorship • Facilitating commitment to valued actions and directions If we allow ourselves to mindfully reflect on what these processes represent and realize what it would mean to actualize them, we can approach a felt sense of how the ACT model encompasses and complements sensitivity to the suffer- ing we encounter in the world and the motivation to alleviate that suffering. By examining how current conceptualizations of compassion relate to psychologi- cal flexibility, we can discover the foundation for the development and integra- tion of a contextual and compassion-focused behavior therapy.

Self-Compassion, Mindfulness, and Psychological Flexibility Both psychological flexibility and Kristin Neff’s (2003a) conceptualization of self-compassion are multidimensional constructs that involve mindfulness, the experience of an expansive sense of self, and a commitment to serve specific valued aims. In the case of self-compassion, the alleviation of one’s own suffer- ing is an explicit aim, and in the case of psychological flexibility, a broader value of alleviating suffering and promoting life-affirming action is inherent. As we consider the role of self-compassion in ACT, there is a temptation to find a way to fit self-compassion into the hexaflex model. Both psychological flexibility and self-compassion are constructs that have demonstrated clinical utility across a wide range of outcome and process studies (Neff, 2011; Ruiz, 2010). For example, controlled outcome research on mindfulness-based cogni- tive therapy has suggested that self-compassion may account for more variance in psychopathology than mindfulness alone (Kuyken et al., 2010). Similarly, Van Dam and colleagues (2010) found that self-compassion accounted for as much as ten times more unique variance in psychological health than a measure of mindfulness did in a large community sample.

Despite the natural pull to reduce or integrate self-compassion and the hexa flex in a seamless way, it is important to remember that neither self-compassion nor psychological flexibility is a technical term in the strictest sense of behavioral science. Neff’s definition of self-compassion is an operationalization based on a reading of Buddhist concepts of compassion (Neff, 2003a), and the construct of psychological flexibility is based upon processes derived from basic RFT research on language, cognition, and rule-governed behavior. However, the hexaflex concepts are meant to be clinically applicable, middle-level terms for describing the underlying principles of RFT in somewhat everyday language. The hexaflex components are useful descriptors, but they need not represent everything that is involved in human well-being and psychological flexibility. What distinguishes CBS is the application of fundamental behavioral principles in accounting for the prediction and influence of human behavior. As we will describe, further CBS research may help identify more effective ways of working with the powerful psychotherapy process variable present in compassion for self or others. Similarly, compassion-focused techniques may expand the technical base of ACT in ways consistent with its theoretical underpinnings.

Relating self-compassion to psychological flexibility reveals both explicit and implicit levels of interacting processes. In terms of overt relationships between the models, we can see that the first component of self-compassion, mindfulness, is represented in the hexaflex as a form of flexible and focused attention that encompasses contact with the present moment, acceptance, defusion, and self-as-context (K. G. Wilson & DuFrene, 2009). The second component of self-compassion, common humanity, clearly relates to the experi- ence of self-as-context, emerging as a function of flexible perspective taking. In terms of psychological flexibility, we can imagine a sense of common humanity arising with a shift from a narrow focus on the individual, narrative self to the sense of “we-ness” involved with being a part of the interconnected web of human experience (Gilbert, 1989; Hayes & Long, 2013). The third and final component of self-compassion, self-kindness, relates to treating oneself support- ively and with sympathy and includes “internal dialogues that are benevolent and encouraging rather than cruel or disparaging” (Neff & Tirch, 2013, p. 79). In the hexaflex, this type of deliberate engagement of warm regard and kind behavior toward the self is represented in the processes of authorship of freely chosen values and patterns of committed action to serve valued aims. This model of the relationship between self-compassion and psychological flexibility is illustrated in figure 2.

Mindfulness Self-Kindness Present Moment Acceptance Values Psychological Flexibility Defusion Commitment Self-as-Context Common Humanity Figure 2. Self-compassion and psychological flexibility.

Beyond these obvious functional similarities between given processes, both models stress relatedness among their individual components. Accordingly, the relationships between self-compassion and psychological flexibility also contain subtleties and inherent relationships across processes. For example, while self- kindness appears to be more clearly related to values authorship and committed action, the very act of construing a self and regarding that self with the kindness we might extend to another is an act of flexible perspective taking and therefore related to the process of self-as-context. Similarly, for a person to con- sciously bring self-kindness to her flow of experience, she must be sufficiently in contact with the present moment to have the opportunity to facilitate such a shift. As a result, when working with self-compassion-based interventions, ACT practitioners can use their own clinical wisdom and insight to note the corre- spondences and relationships they discern in the lives of their clients.

The CFT Model and Psychological Flexibility The model of compassion presented in CFT derives many of its constructs from research on developmental psychology, empathy, and affective neurosci- ence. Nevertheless, in CFT the core of the definition of compassion has its roots in ancient wisdom traditions. About 2,600 years ago, during the time of the historical Buddha, Siddhartha Gautama, there was a proliferation of con- templative traditions throughout the region along the Silk Road. These schools of thought emphasized the alleviation of suffering through meditative practices with a focus on the importance of cultivating compassion. Synthesizing these methods and innovating new perspectives and techniques, the Buddha devel- oped a program for personal liberation from suffering that involved specific training in compassion. Since then, there have been many discussions of what compassion actually is and what it means, but a fairly standard definition has emerged, and it is used in CFT: sensitivity to the presence of suffering in oneself and others, with a commitment to try to alleviate and prevent such suffering.

The definition points to the two basic psychologies of compassion discussed earlier: • The psychology of engagement, which involves opening up to and working with suffering • The psychology of alleviation, which involves working to develop the wisdom and skill necessary to alleviate or prevent suffering and its causes Within the CFT model, these two central aspects of compassion each include several subcomponents, as shown in figure 3, where “Attributes” corre- sponds to the psychology of engagement, and “Skills Training” corresponds to the psychology of alleviation.

Multimodal Compassionate Mind Training SKILLS TRAINING Imagery Warmth ATTRIBUTES Attention Sensitivity Care for Well-Being Reasoning Sympathy Compassion Nonjudgment Feeling Warmth Warmth Distress Tolerance Empathy Behavior Sensory Warmth Figure 3. The compassion circle. (Reprinted from Gilbert, 2009a, with permis- sion from Constable and Robinson.)

The psychology of engagement involves identifying and cultivating specific competencies, labeled as Attributes in figure 3: accessing the motivation to be caring, sensitivity to distress, sympathy, distress tolerance, empathy, and non- judgment. These attributes are drawn from research on caregiving and altruis- tic behaviors, and they appear to be the foundational elements of a compassionate orientation (Gilbert, 2010). The psychology of alleviation (or prevention) involves further competencies for appropriate reflection and action, labeled as Skills Training in figure 3: attention, imagery, reasoning, behavior, sensory, and feeling. CFT uses a systematic approach to train and cultivate these capacities and skills and thereby develop compassion. The subcomponents of the two psy- chologies—of engagement and alleviation—are outlined below.

Components of the Psychology of Engagement Importantly, the components of the psychology of compassionate engage- ment are interdependent. For example, the more we develop distress tolerance, the more willing and motivated we might be to develop compassion. Likewise, the more empathy we have, along with an ability to understand our own minds without judgment, the more we may be able to tolerate distress, increasing moti- vation. On the other hand, if any of these attributes falter, compassion itself may also falter. For example, it will probably be difficult to summon compassion if emotional engagement (sympathy) is low or distress tolerance or empathy are lacking.

Motivation to care for well-being. Although all of the components of the psy- chology of engagement are interrelated, in CFT we start by recognizing that motivation to be caring and try to alleviate or prevent suffering in oneself and others is central to the compassion journey. There are many reasons why clients may not be motivated to engage with suffering or interested in cultivating com- passion. They may think that it will not help them, that it is weak, that it is undeserved, or that when they engage in compassion they will have overwhelm- ing feelings of sadness and fear (Gilbert et al., 2012). Also, certain clients may have obstacles to motivation that are artifacts of their learning history and thus outside of their conscious awareness. Nevertheless, in CFT the experience of the compassionate mind begins with motivation to alleviate suffering as it is encountered and contribute to the welfare of living things.

Sensitivity. In CFT, sensitivity refers to how we pay attention to suffering, both our own and that of other people: how we come to notice it and hold it in our attention without turning away or trying to avoid it. This sensitivity involves present-moment awareness that is intentionally focused upon the presence of suffering as we encounter it in the world or in ourselves.

Sympathy. In CFT, sympathy refers to a reflexive and responsive emotional connectedness with suffering derived from the automatically engaged capacity to be emotionally attuned. For example, if you see a child stumble and hurt himself, this could trigger immediate unpleasant feelings within you. You might wince or feel compelled to act. This sympathy can also be directed within. When we pay attention to our own suffering, it is not an emotionally neutral experience; it comes with a feeling component, and the compassionate mind is capable of feeling into the pain.

Distress tolerance. Being motivated to engage with suffering, sensitive to the presence of suffering, and attuned to suffering with sympathy requires the ability to tolerate the difficult emotions, thoughts, and bodily sensations that arise. As described by Gilbert (2009a), this capacity for distress tolerance is closely related to acceptance: “Linked with but not identical to acceptance, tolerance is the ability to stay with emotions as they happen… Acceptance can involve toler- ance, but it is also a deep philosophical orientation to one’s difficulties. It’s a coming to terms, ‘letting it be,’ not fighting or struggling any longer” (pp. 200– 201). Neither acceptance nor distress tolerance is submissive resignation; rather, both speak to an intentional willingness to remain in the presence of challeng- ing experiences in the service of compassionate aims.

Empathy. One of the more complex elements of the psychology of engagement is empathy, as it is both an intuitive process and a more deliberate approach (Decety & Ickes, 2011). For example, you might deliberately imagine what it would be like to find yourself in another person’s shoes, as when viewing a cli- ent’s sadness from an empathic perspective. However, empathy might also be implicit, such as having a discussion with a friend, simply noticing that he seems anxious, and having a hypothesis about his concern pop into your mind. Empathic responding has been described many ways, including theory of mind (Premack & Woodruff, 1978), mentalization (Fonagy, Target, Cottrell, Phillips, & Kurtz, 2002), and, as discussed, perspective taking (McHugh & Stewart, 2012), a central contextual behavioral concept. We may be better able to empa- thize with others when we are open to and aware of our own processes. For example, individuals who are frightened or avoidant of their own feelings (e.g., intense rage) or fantasies may struggle to understand or empathize with others in those states.

Nonjudgment. The final component of compassion is the ability to allow oneself to experience certain emotions and mental events without falling under the control of condemnation, judgment, or shaming. Nonjudgment doesn’t mean indifference or apathy; rather, it represents a recognition that harsh eval- uations, shame, and self-criticism can drive avoidance, contribute to emotional pain, and exacerbate suffering. So in CFT, we aim to “engage with the com- plexities of other people’s and our own emotions and lives without condemning them” (Gilbert, 2009a, p. 205).

Components of the Psychology of Alleviation The psychology of alleviation (which includes prevention) involves a set of skills that can create the potential to alleviate suffering in the context of psychotherapy and in daily life. A number of CFT interventions involve specifi- cally training these skills to develop compassionate mind. These interventions include chair work, guided imagery, mindfulness training, compassion-focused exposure and response prevention, and working with compassion within the therapeutic relationship (Gilbert, 2009a; Tirch, 2012). Importantly, just as the attributes of compassionate engagement are interdependent, the skills of com- passionate alleviation build upon one another. For example, compassionate behavior involves the wisdom of compassionate reasoning and can be guided by mindful, compassionate attention.

Attention. Training in focusing, guiding, and modulating attention is a signifi- cant element of CFT (Gilbert & Choden, 2013). Much of the preliminary atten- tion training in CFT involves mindfulness, as this focused, flexible attention allows for disidentification and the ability to guide and move awareness. Indeed, mindfulness has served as a context for compassion training for millennia (Tirch, 2010). Additionally, CFT provides instruction in how to direct attention to the experience of compassion. For example, an exercise might be to devote mindful attention to people who are experienced as helpful throughout one day. Another form of such training might be a meditation practice of mindfulness of gratitude. Building on a foundation of mindfulness, focused attention training, and training in coherent breathing (Brown & Gerbarg, 2012), CFT extends to include guidance in directing attention to psychological, physical, and emo- tional domains.

Imagery. Imagery has increasingly been acknowledged as a powerful therapeu- tic tool in cognitive and behavioral therapies (Hackmann, Bennett-Levy, & Holmes, 2011). Imagery itself can stimulate a range of physiological systems and emotional experiences. In CFT, we share this insight with clients and point out that compassion imagery practices are designed to build the capacity for com- passion, in part by stimulating related physiological systems. CFT makes use of a number of imagery exercises, including construction of a compassionate version of the self, imagining a compassionate and safe place, and creating the image of an ideal compassionate companion (Gilbert & Choden, 2013). Reasoning. True compassion obviously isn’t an unintelligent option; therefore, being able to stand back and take a wise, balanced perspective on situations is an important skill in the psychology of alleviation. It is important to think as freely and clearly as possible when engaging with compassion, because thinking through difficult questions and applying adaptive reasoning is often what helps us choose to develop compassion for things we don’t like in others or ourselves (Loewenstein & Small, 2007). We may also take a compassionate perspective on our thinking itself and realize the ways in which thoughts can ensnare us in old, unhelpful patterns of action.

Behavior. Within the CFT model, compassionate behavior is basically any behavior that intentionally addresses people’s suffering and tries to alleviate and prevent it. Behavior, in this sense, refers to overt behaviors rather than private behaviors in the mind; it refers to what we can do with our hands and feet to act upon and realize our motivation and intentions for compassion. Of course, such behavior would be wise and skillful, not simply reflexive rescuing, which may not actually help the target of compassion. Commonly, the cultivation of compassionate behavior involves courage as we come into contact with our awareness of suffering. For example, for a person who is agoraphobic, self- compassion does not mean sitting at home and avoiding difficult feelings; it requires practice in going out and facing the anxiety (Tirch, 2012). In essence, compassionate behavior means engaging with that which is causing suffering, and it is, of course, linked to commitment and willingness to engage. Sensory experiencing. To some extent, the capacity for soothing through com- passion, as an affiliative process, operates through the parasympathetic nervous system (Porges, 2007). It is therefore useful to help clients engage in more devel- opment of the parasympathetic nervous system. To do this, we use exercises that involve various breathing techniques and body postures. We also teach clients how to use facial expressions and voice to stimulate feelings of compas- sion within the body, and we use method acting techniques to help people experience engagement with the process of compassion. For example, when clients and therapists alike are first learning to build an inner voice and image of a compassionate self, CFT trainers invite them to bring mindful attention to the physical experience of smiling as opposed to having a neutral expression. Similarly, they are instructed to bring attention to the experience of listening to a warm voice greeting them, as opposed to what happens when a neutral voice greets them. Sensory sensitivity can guide our moment-by-moment experience of compassion and can stimulate the emotional systems involved in the compas- sionate mind.

Feeling. For the most part, compassionate affective experiences are associated with emotions involving connection, warmth, and kindness, partly because these are affiliative and soothing emotions that activate an experience of safe- ness and contentment, which can create a secure base for action. Compassionate emotions can also involve a sense of courage and willingness to face difficult things. Furthermore, there are times when feeling anger or panic might trigger compassion. An example would be anger at seeing indifference to starvation, as happened in the 1980s when Bob Geldof and Midge Ure created the charity supergroup Band Aid to raise money for alleviating famine in Ethiopia. Likewise, panic can activate compassionate feelings and action, as when someone realizes a child is trapped in a burning house and rushes in to rescue her. Clearly, it’s not so much the quality of an emotion but its function and its link to the motivation to alleviate or prevent suffering that distinguishes the cultivation of compas- sionate emotions.

ACT Processes, the CFT Model, and Compassionate Flexibility Each of the processes involved in the CFT model of compassion can be related to the ACT hexaflex processes that together effect psychological flexi- bility. Just as with Neff’s model of self-compassion (2003a), these processes are all middle-level terms and do not precisely map onto one another. However, conceptually and technically integrating compassion and psychological flexibil- ity in this way provides opportunities for clinicians to create focused interven- tions designed to help clients live adaptive and compassionate lives. In this way, examining a model of compassionate flexibility orients us toward adaptive, evidence-based processes and principles so that we can bring our clinical wisdom, creativity, and compassion to the human exchange we have with our clients.

Compassionate flexibility reflects a particular quality of engaged psychologi- cal flexibility. Drawing from previous definitions of relevant concepts (Dahl et al., 2009; Gilbert, 2010; Hayes et al., 2012; Kashdan & Rottenberg, 2010), we define compassionate flexibility as the ability to contact the present moment fully, as a conscious and emotionally responsive human being with the following qualities: • Sensitivity to the presence of suffering in oneself and others • Motivation to alleviate and prevent human suffering in oneself and others • Persistent adaptation to competing and changing environmental, emo- tional, and motivational demands and commitment to returning atten- tion and resources to the alleviation and prevention of suffering in oneself and others • The ability to flexibly shift perspective and access a broader sense of oneself and others, involving the experiences of empathy and sympathy • The ability to disentangle oneself from the excessive influence of evalu- ative, judgmental thoughts • Maintaining an open and noncondemning perspective on human expe- rience itself, thereby cultivating necessary and sufficient willingness to tolerate the distress encountered in oneself and others The following elaboration of compassionate flexibility (illustrated in figure 4) provides a conceptual walk through the key elements of compassion as for- mulated within CFT theory, illuminating the hexaflex processes they relate to most significantly and how such processes might be targeted in the consultation room.

Sensitivity Distress Tolerance Care for Well-Being Compassionate Flexibility Committed Action to Alleviate Human Suffereing Nonjudgment Empathy and Sympathy Figure 4. A model of compassionate flexibility illustrating some of the relation- ships between CFT processes and ACT’s hexaflex model of psychological flexibility.

Care for Well-Being and Values In ACT, living a life of meaning, purpose, and vitality in the service of freely chosen values is the core driving principle within the model of psychological flexibility. In a sense, all of the other processes come together to further increase engagement in personally meaningful actions. As discussed in ACT, values are neither goals to be attained nor rules to live by; they are inherently rewarding behaviors. A large part of values work involves clarification and authorship of behaviors that can be described as embodied intentions for how we wish to act in the world. Of course, some of the degree to which a behavior is intrinsically reinforcing may be related to our species’s genetic history. Behaviors that have adaptive evolutionary functions, such as eating or having sex, are more likely to be reinforcing for most people than, say, vacuuming or watching paint dry. Similarly, the inherent adaptive, evolutionary nature of the caregiver instinct and cooperation has made motivation to care for well-being an inherently rein- forcing and very strongly held value for most people throughout life.

The ACT literature stresses that values are freely chosen; however, as noted previously, compassion may be the one value that is inherent in the psychologi- cal flexibility model (Hayes, 2008c). In CFT, compassion begins with an emer- gent motivation to care for well-being, both our own and that of others. This speaks to the importance of human caregiving in our species’s survival. CFT stresses the importance of evolved motives: values that issue from and are embedded in our deep evolutionary imperatives and embodied in evolutionarily ancient brain structures and functions. Motivation to care for well-being is clearly a value in the hexaflex usage of the term, yet it is also clearly related to some of the oldest behaviors exhibited by complex organisms on this planet. Nevertheless, individual learning history can interfere with how we contact and act upon this motivation. When people have encountered trauma in associa- tion with their experiences of support and warmth, they may have obstacles to their compassionate motivation.

Several techniques for values authorship derived from ACT and its psycho- logical model are effective for enhancing awareness of and building compassion- ate motivation. These techniques include experiential imagery exercises in which the client envisions a day in the life of a future self who is living his values more fully. In another popular technique, the client imagines that she has died after living a full, rich life and is hearing what people offer as a eulogy for her, describing how she had realized a life of great personal meaning. These and other, similar techniques can bring clients into emotional contact with how they most wish to live their lives. When such work includes a compassionate focus, these practices can build the motivation to care for well-being and perhaps to be loving and open to love. Furthermore, even when these techniques are used without explicitly emphasizing compassion, many people are likely to contact how important loving relationships are for them.

The Psychology of Alleviation and Committed Action Committed action represents an individual’s ability to consistently engage in behaviors that support valued patterns of meaningful life activity and promote the realization of valued aims that create an experience of meaning, purpose, and vitality (Dahl et al., 2009). Because behavioral change rarely proceeds perfectly in an unwavering direction, committed action also involves returning to valued patterns after lapses in traveling the path we have set for ourselves (K.G. Wilson & DuFrene, 2009). For example, if a person who has been in recov- ery from alcohol dependence for thirteen months has a glass of champagne at a wedding, committed action may include halting the lapse and returning to 12- step meetings.

Many evidence-based therapy techniques, from exposure and response pre- vention to imaginal reliving, and from behavioral activation to practicing asser- tiveness, can be viewed as committed action steps in which people face difficult experiences in the service of their valued aims. In CFT, the range of techniques drawn from the psychology of alleviation are all committed behaviors that serve the value of cultivating compassion. Examples include compassionate imagery practice, engagement in refraining from addictive behaviors, compassion- focused exposure to fears, and developing authoritative, nonviolent assertive- ness skills, all of which are forms of committed action. These techniques may serve various values, such as being a kind parent or living a more healthful lifestyle—values that in turn may serve the superordinate value of alleviating suffering where it is found, both in ourselves and in others.

Sensitivity and Contact with the Present Moment In CFT, sensitivity means present-moment awareness that is directed toward engagement with the suffering we encounter in the world, which has an obvious relationship to mindfulness. As we cultivate greater present-moment sensitivity, we may be better able to simply notice the presence of suffering as it arises, holding it within an accepting awareness that does not turn away out of anxiety or aversion. Such sensitivity can also help us increase our awareness of the subtle dimensions of emotions and emotional memories. In this way, we may become better able, and better prepared, to encounter suffering and challenging emotions, with an increased sense that we have time to respond.

In the psychology of alleviation, this concept of sensitivity is used in a way that is similar to the psychological flexibility process known as present-moment awareness (Hayes et al., 2012). In fact, present-moment awareness, which is sometimes referred to as self-as-process (Blackledge & Drake, 2013), can be defined as purposeful, direct attention to the contents of the present moment as they unfold. In the hexaflex, present-moment attention also involves flexible awareness. Contacting the present moment means turning toward our experi- ence, whatever it may be, in the moment, rather than turning away from the moment in pain or shame or getting lost in narrative content.

As the literature on mindfulness and attentional training has demonstrated, it is possible to cultivate and enhance an individual’s capacity for flexible, focused attention to the present moment (Baer, 2003; Garland et al., 2010). Such attention can be trained using a number of present-moment awareness exercises during psychotherapy sessions and as homework. These practices may begin with simple movement of attention to different focal points in the body, or even in the environment. In time, these attentional practices may extend to deliberately bringing receptive awareness to one’s experience during long periods of mindfulness meditation.

In classical mindfulness training, present-moment awareness served the aim of cultivating wholesome mental states, including compassion (Rapgay, 2010; Tirch, 2010; Wallace, 2009). When we bring a focus on compassion to such training, the present-moment awareness that is foundational to mindfulness serves as a context for cultivating states of mind conducive to compassion and well-being through a deliberate compassionate intention that also includes com- passionate motivation and additional hexaflex processes involving the self and perspective taking.

Sympathy, Empathy, and Self-as-Context ACT’s psychological flexibility model holds that well-being and adaptive responding to the challenges of life are served by developing an ability to connect with and inhabit an experiential sense of the self as an awareness of our own awareness (Hayes et al., 2012). Throughout the many changes that occur in our lives and the myriad of contexts that will unfold for us, we humans maintain a sense of the “I-here-now-ness” of our experience. As mentioned, this sense of oneself as an observer of one’s experience, separate from the content of con- sciousness yet observing the flow of experience, is referred to as self-as-context in the hexaflex model of psychological flexibility. Cultivating self-as-context allows for an experiential mode of self-reference that can serve as a foundation for the cultivation of compassion. In fact, this mode of self-reference has a dis- crete neuronal signature and involves distinct processes that can be trained (Barnes-Holmes, Foody, & Barnes-Holmes, 2013; Farb et al., 2007).

Flexible perspective taking can also involve an individual’s ability to take the perspective of another and infer that person’s intentions and feelings, as is the case with theory of mind tasks and mentalization. This ability allows us to step outside of ourselves and psychologically view the world from the perspec- tive of another being, which may allow our painful mental events and emotional memories to hold less influence over us. Interestingly, at a preverbal level, tasks involved in flexible perspective taking are facilitated by efficient deployment of the parasympathetic nervous system, which is involved in relaxation and sooth-ing (Porges, 2007). So from the perspective of the “I-here-now-ness” of being, you can view your own suffering as you might view the suffering of another and be touched by the pain in that experience, without being dominated by interfer-ence from your learning history, with its potential for shaming self-evaluations (Hayes, 2008a; Vilardaga, 2009). The biological context that can best contain this experience involves the activation of affiliative emotional response systems, along with an implicit or explicit experience that can be described as safeness or stillness. Accordingly, when you stand as witness to your own suffering or even suffering in others, you may be moved to take action to alleviate that suf- fering. In this way, stillness begins the movement toward action.

In contextual behavioral terms, CFT clients learn how to observe their experience from the vantage point of self-as-context and how to gradually dis- identify from their self-stories and narrative, or self-as-content (Hayes et al., 2012). This process of disidentification, which is sometimes even referred to as “depersonalizing,” has been a central psychotherapeutic move in CFT for some time; but only now is it beginning to be conceptualized in contextual terms.

Importantly, two of the central attributes of the psychology of engagement— which is to say two of the primary components of our evolved capacity for com- passion—involve flexible perspective taking. These attributes are sympathy and empathy. These terms are used very differently from one another in CFT, though both involve dimensions of flexible perspective taking.

In CFT, sympathy is defined as a reflexive, emotional response to our aware- ness of the distress we witness in others or even in ourselves. When we are moved by the presence of suffering on a resonant emotional level, sympathetic responses occur, without elaborate cognitive analysis. This sort of emotional resonance is captured by eighteenth-century philosopher David Hume, who compared the transmission of emotional responses between humans to the harmonic vibration of violin strings (2000). In sympathetic responding, we automatically and effortlessly adopt the emotional perspective of another, are moved by the suffering we experience, and are compelled to do something to respond.

In contrast, within CFT empathy is defined as a heightened, focused aware- ness of the experiences of another person that includes understanding, perspec- tive, and an ability to derive and construe what that person’s experience would be like.

CFT offers a range of imagery and contemplative practices, as well as in- session interpersonal exercises, that provides training in flexible perspective taking, sympathy, and empathy. The following clinical example illustrates a few of these approaches.

Clinical Example: Cultivating the Observing Self and Compassionate Intention Gene is a twenty-five-year-old client who presents with depression and social anxiety. He hates himself for his shyness and displays high degrees of fusion with a conceptualized self. To create the conditions for Gene to experience compassion in the presence of his shame and self-hostility, the therapist works within the relationship to facilitate flexible perspective taking and the emer- gence of some self-compassionate intention.

Client: I’m shy. I’ve always been shy. In my family I’m known as the shy one—the weakling, if you will. Basically, I’m just a depressed loser who will never dare to do anything worthwhile. I can’t even get a girlfriend! Therapist: I’m sad to hear that you’ve been walking around with this notion of yourself as shy and weak. How long has it been like this? Client: For as long as I can remember. It’s not a notion; it’s who I am. Therapist: So for all this time, the thought of being weak and shy has pretty much summed up your sense of who you are. Client: I t is who I am. They used to make jokes about this in my family. Now they don’t dare joke anymore, but I know they still think it. In a way, that makes it even worse. Therapist: Ouch! That must hurt. Client: Yes. But they’re right. I am weak and shy. Therapist: So “weak” and “shy” are the two words that stand for who you are? Client: Yeah. Pretty much. (Looks down.) Therapist: That sounds so painful. (Pauses.) But can we look at these two words for a minute? Client: What do you mean? Therapist: (Writes the words on a piece of paper and holds it a few feet from the cli- ent’s face.) Can you notice them standing there, as it were? Client: Yes. Therapist: Can you notice them telling you that’s who you are? Client: Yes. Therapist: Can you notice how it feels to have your sense of self reduced to these two words? Client: Yes, it’s painful…and depressing. Therapist: I’ll bet. I can hear how much you identify with these words. When I see how much this causes you pain, I really wish for this suffering to cease. How about you? Client: Me too. Therapist: So you can notice that too. And can you also notice that there is a part of you noticing these words and how they make you feel? Client: Errr. …Yes, I think so… Therapist: Can you notice that you are here, and that these words and how they make you feel are, so to speak, there? (Holds the piece of paper a few feet from the client’s face again.) They are present, and they are painful, and you can also notice them being present and notice the pain that comes with them. Client: Yes? Therapist: So, there’s a part of you that notices and hears these words, an “observer” part of you. This “observer you,” the part of you that can notice both the words and the feelings the words evoke—would you describe this observer you as weak and shy? (Pauses.) Would you describe this observer you by the feelings that arise when it’s criti- cized by these words, such as anger or anxiety? Or would you describe this observer you in a different way? Client: mm. …That’s a weird question. …I guess I would say it’s different. H It’s somehow more distanced. Maybe it hurts less? Therapist: Uh-huh. So you can notice the pain, notice your wish to make it go away, and also notice that you’re noticing it. There sure is a lot going on in our tricky brains. Could it be that at every moment, there’s a part of you that’s there and can notice whatever shows up, painful though it may be? Isn’t it the case that this observer you is just there, along for the ride, noticing and experiencing each moment, moment by moment? Client: Yeah. It’s just that I hate it. Therapist: As I look at you, I’m starting to realize how long you’ve carried this sense of yourself as weak, carried this pain around the word “weak.” (Exhales.) I’m wondering, when is it easier for you to bear this pain? Is it easier when you’re judging your suffering and fighting with it? Or is it easier when you’re simply noticing this emotional suffering and allowing some caring intention to be here now, allowing yourself this…wish that the pain might somehow relent? Client: I guess it’s when I stop the judging and just allow myself that wish. … Then the pain might fade. Therapist: That feels like warmth in your voice now…not forcing the pain away, but standing back and looking upon yourself with a kind intention. Client: Well. …I guess it does feel somehow warmer or softer.

Nonjudgment and Acceptance In the hexaflex model of psychological flexibility, the concept of acceptance is different from a conventional notion of acceptance as resignation, giving in, or giving up. Crucially, in ACT acceptance includes an element of willingness, defined as a voluntary choice to be in contact with difficult mental events and emotional experiences. This form of psychological acceptance is defined as “the adoption of an intentionally open, receptive, flexible, and nonjudgmental posture with respect to moment-to-moment experience” (Hayes et al., 2012, p. 77). In terms of compassion, this process of acceptance means choosing to remain open to our awareness of suffering as we encounter it in the world and in ourselves, even when it is difficult to bear. Of course, it is all too easy to engage in avoidance and control strategies when we encounter experiences that we don’t wish to face, yet experiential avoidance also drives much of our suffer- ing (Ruiz, 2010).

In order to help clients face their fears, their shame, and even their self- criticism, CFT aims to help them adopt a sensitive, nonjudgmental, and accept- ing awareness of the pain inherent in being human. This is not a white-knuckle or masochistic striving to remain in the presence of suffering for the sake of suffering. Compassion is not about just sitting in the cold, dirty bathwater of life so you can “feel your feelings” or “be accepting.” As the psychological flexibility model suggests, acceptance in the service of compassionate motivation involves a willingness to be in contact with suffering as we encounter it (through the psychology of engagement), and a willingness to feel the pain involved as we begin to take action to do something about the suffering we encounter and move toward greater well-being (through the psychology of alleviation).

Clinical Example: Cultivating Acceptance, Nonjudgment, and Compassion We return to the example of Gene for an illustration of how we can use a com- passionate therapeutic relationship to help train clients to disidentify from their thoughts and emotions, access their inner wisdom through a functional analysis of their inner critic, and move toward willingness from a place of self-kindness and courage. Gene has been offered a gallery show for his paintings, but rather than work on this, he has been staying in bed, smoking marijuana, and binge-watching TV programs, bringing on a barrage of self-criticism. He has been responding through profound experiential avoidance that has been keeping him from engaging in activities that give him a sense of meaning, purpose, and vitality. This session takes place a few weeks prior to Gene’s gallery opening, and Gene has been completely avoidant in the week preceding the session.

Client: o, I’ve been beating myself up all week again. I’ve hardly gotten out S of bed. I just smoke weed and play video games most days. I’m disgusting. Therapist: Well, this week has been very much like the rest of the month. You’ve been curling up and hiding. That’s very sad, really. Client: eah, I wish I were getting out to see my friends or to the studio, but Y I just feel like I can’t face it anymore. I can’t even think about painting. Therapist: What is your anxiety? Client: y anxiety? Hmm. I guess that I’m afraid that if I bump into anyone, M I’m going to remember that I suck, that everybody dumps me, and that I am not working hard enough. I need to get more done and get my work in for the gallery show, and I’m screwing up. Therapist: That part of you that tells you “you suck” and “you’re not enough”— what emotions show up when that part drags in that old story? Client: Ugh. You know how it is, Doc. Despair, misery, and total dread. Therapist: “Despair, misery, and total dread.” This is a pretty heavy trio you’ve got showing up. It’s tragic, really. (The therapist is clearly moved by this sadness but is half smiling in the presence of these emotions.) Sometimes this life just feels like shit, doesn’t it? Client: ( Laughs and allows a few tears.) Yes, indeed, it does. That’s why we’re talking. Therapist: Exactly. That is why we are talking. …Let’s dig into this experience a bit, shall we? (The client nods.) So let’s imagine that we had a magic pill like in the movie The Matrix—you know, the movie where everything that was going on was like an illusion in a computer? Let’s say we have this magic pill, and if you took it, the part of you that tells you that you suck would go away forever. You could walk right out that door and never have the ability to tell yourself “you suck” or “you’re not enough” again. What would you be most afraid would happen if you took it? Client: That would be great. Nothing bad would happen. Therapist: Well, okay, maybe that’s the case. But what would your anxious self be afraid of if you took this pill and left my office without that harsh inner critic telling you your flaws? Client: I see what you’re doing here. Okay, my anxious self would be most afraid that I would be lazy—that I wouldn’t get out of bed or live up to my potential. Therapist: Okay, so that anxious self believes that the criticism is needed to keep you living your life effectively? Right? Client: Yes. Therapist: So, the critic is trying to help you to live up to your potential? Client: Uh-huh. That critic is trying to protect me from failing. Therapist: I see. So we can imagine that this critic has an intention to help you. But, is it really helping you? Client: No effing way! This voice shows up telling me that I’m a piece of garbage, and I feel so exhausted by it that I just want to check out and cry. That’s the irony. I’m afraid that if the criticism would stop, I’d be lazy, but all it does is make me shut down and hide, which is basically the same thing. I feel so trapped in all of this. Therapist: “Trapped.” Your mind tells you that you’re trapped, that you can’t get out of bed. That is just so sad and so heavy. What part of that experi- ence of being criticized and trapped are you least willing to feel? Client: Least willing to feel? Hmm. Well, I think it would be feeling ashamed that I’m not working hard enough. That’s very tough. Therapist: It sounds like it is. It’s a feeling that’s led you to stay in bed and be very stoned, checked out, and all alone. That is tough. I hear you telling me that the part of this that you really don’t want to feel is this sense of shame for not doing enough. Please tell me, what would you have to stop caring about to not feel bad about ignoring your work? Client: What would I have to stop caring about? Okay. Well, if I were going to totally stop feeling ashamed of blowing off my art and my work, I would have to basically not care about being an artist. Therapist: Are you willing to do that today? Are you willing to leave this office and not care if you’re working on your art and your craft? Client: No. My art means everything to me. It really does. Therapist: Yes! It does. That’s a beautiful thing. So, if feeling sad and ashamed was a necessary part of carrying your life forward and being the version of yourself you wish to be—being the artist you wish to be— would you be willing to feel sad and ashamed? Client: I ’m feeling sad and ashamed anyway! But, yes, if facing those feelings was a part of living my life and being the artist I can be, I guess I can feel them. Therapist: That, Gene, is compassionate courage. That’s acceptance and will- ingness. Can you feel what it’s like to touch that accepting part of you? Client: Yes. I don’t like to feel the dread and anxiety that show up with this criticism, though. It sucks. Therapist: What a leap you’ve made there, Gene. You’ve moved from “I suck” to “It sucks to feel so criticized”! You can feel bad without buying into the idea that you are bad. That’s a huge step. We’ve seen how much you care about being an artist and how you’ve learned to have an inner critic who keeps telling you that you suck and that you’re awful. And when we looked at that critic’s intention, we could sort of see how he was aiming to protect you from failure… Client: ( Speaks with animation, eager to join in.) And we also saw how all he’s doing is making me feel worse by telling me “you’re awful.” It’s funny how that part of me tries to get me moving and succeeding by telling me the same sort of critical crap that my stepmother told me for years. I don’t respond to that kind of abuse. It makes me just shut down. Therapist: That’s a remarkable connection. So the part of you that hears this criticism is like you were when you were a boy. That part tries its best to do what makes the critic happy while listening to relentless criti- cism. When we think of that boy, with all of his hopes and fears, what might we want to say to him from a place of compassion and strength? Client: I would want to tell him to just keep on going. I want him to get up and go to the studio, even when those voices are saying he’s shit. He doesn’t have to give in, and he doesn’t have to give up. Even if the critic keeps going on and on, he can do it. Therapist: That’s very moving. You’re finding a kind of bravery in your accep- tance and compassion. So, it seems you’re willing to carry this and live your life deeply. Client: Hey man, it’s easier said than done, right? But, yes, I definitely want to do that. Therapist: One last thing on this. That critical part of you that thinks it’s helping by badgering you and calling you names—the part that’s really bringing you down? What would you want to say to that part from a place of wisdom, compassion, and strength? If you could, imagine what it would be like to speak from that compassionate courage and tell the critic what you want to say. Client: ( Sits up straight.) I would say this: “Listen, buddy, you’re going about this all wrong. I don’t respond to abuse, so if you want to help me get moving, you’ve got to speak to me like a human being. I know you’re trying to help, but could you just lighten up a little?” Therapist: That’s wonderful, really. How did it feel to say that? Client: I think I get it, Doc. I can get moving this week, even if the critic keeps it up. Phew! This is exhausting work today. Therapist: Yes, it is. But you’re doing it. You’re looking out for yourself. I’m glad you’re facing these things here. Client: I need to face them somehow.

Distress Tolerance and Defusion The evolved nature of human cognition, symbolic representation, and derived relational responding has resulted in a tendency to respond to the literal meanings and stimulus functions of our thinking in ways that strongly influ- ence our subsequent behavior (Blackledge & Drake, 2013). We will be getting into quite a bit of detail about this process as we continue. For now, we can note that imaginal events can exert control over everything from our biological systems to our overt behaviors. In order to tolerate distress, we must have suf- ficient freedom from the influence of mental events to be able to remain in the presence of painful experiences while engaging in freely chosen actions. In ACT’s model of psychological flexibility, defusion represents a trainable ability to disrupt or transform the effects of mental events, providing some liberation from being dominated and controlled by events arising in our evolved minds (Hayes et al., 1999). ACT offers many empirically supported techniques for facilitating defusion, which are present throughout the CBS literature. More recently, these methods have begun to be adapted into compassion-focused therapies for anxiety (Tirch, 2012).

The CFT concept of distress tolerance differs from defusion in many ways. In fact, distress tolerance is highly involved with acceptance and willingness (Gilbert, 2010). However, the capacity to stand back from the historically deter- mined influences that mental events may have upon us and act differently than we have habitually involves defusion from the functions of these events. For example, consider a client who experiences chronic shame and self-criticism and needs to give a presentation at work. If his mind is telling him that he needs to stay home to avoid the anxiety he will face in public speaking, his ability to tolerate the distress he will feel when standing before his colleagues will call upon his capacity to defuse from the dominance of past events.

The relationship between defusion and acceptance is very close and interde- pendent, with the two processes combining to form what, in ACT parlance, is referred to as an open response style. In CFT, distress tolerance and nonjudgment interact in a similar way. As we are able to defuse from our habitual responses, ease the grip of self-condemnation and judgmental thinking, accept the diffi- cult experiences that face us, and tolerate distress, we are better able to face suffering and take steps to alleviate it. Furthermore, activating our evolved capacity for affiliative emotions, centeredness, and compassionate motivation can enhance our ability to be accepting and open. In this way, these somewhat parallel processes in the psychological flexibility model and the psychology of compassion interact, in each case affording both new perspectives on how to relate to our experience and a range of methods for moving toward greater com- passion, flexibility, and well-being.

Clinical Example: Training Acceptance and Defusion with a Compassionate Focus John is a sixty-five-year-old man who complains of incapacitating attentional difficulties, though doctors haven’t found any evidence of cognitive impairment or attention deficits. He manages a well-liked natural food store that hosts a number of community activities. He’s been involved in community projects all his life and genuinely loves being of service to others. Yet he often feels like a fraud and experiences significant social anxiety and fears of public speaking. Lately he has become acutely preoccupied with his “memory issues.” He feels so guilty about them that he finds it hard to pay attention to what others are saying and has become deeply depressed.

Therapist: How’s it going? Client: Bad. On my way here, I crossed to the other side of the street so I wouldn’t have to meet this lady I know from the shop. I couldn’t remember her name or what she talked to me about just yesterday! It was some upsetting family matter, but I can’t remember what. My damned memory! So I crossed the street to avoid her. I’m not sure if she saw me. I hope not! I feel like such a coward, and like such a fraud for the “emotional support” I gave her yesterday. If I can’t remember it now, it must not have been worth much. (Sighs heavily.) Therapist: It’s really tough to feel so bad and so preoccupied with the thought that you can’t remember what people tell you. Client: Yes, it’s hard. Therapist: I hope you can find relief from the weight of that. Client: Can I? Therapist: I hope you can. It would be a relief because it’s so hard for you to be going through that. Client: Yes, and I feel it’s only getting worse. Therapist: I’m having an image of this painful thought, about not being able to remember, standing between you and the people you’re talking to. Where does it stand? (Raises his hand and holds it several inches from the side of his own head.) There? (Brings his hand closer to the side of his head.) There? (Brings his hand in front of his eyes so his line of sight to the client is blocked.) Here? Client: ( Raises his hand in turn and brings it in front of his eyes.) More like here. Therapist: Wow. I want to stop for a moment to acknowledge how painful it is for you to have this thought effectively blocking you from being fully present with other people. I know how important others are to you. Client: Yes, it’s really hard. Therapist: And you must feel so alone. It’s as if it’s cutting you off from others. Client: Yes. Even my wife can’t fully understand how I feel. Therapist: Maybe we can make some room for how terribly painful it is for you to have this thought stand in your way and isolate you so much. Client: How do I do that? Therapist: Well, John, I don’t think it makes you a fraud to have it there. I just think it makes life very hard for you. Client: It sure does. Therapist: So when life is so hard, what could help you most—bringing more harshness and judgment into the equation? Or do you need more kindness? Client: I guess kindness. But I’m not very good at being kind to myself. Therapist: Perhaps we can also make room for that as you learn how to be kinder to yourself and the difficulties you’re going through. Client: (Smiles.) I’d like that.

CBS, Compassion, and Buddhist Psychology Western science continues to advance our understanding of compassion and the central role it can play in human psychological growth, adaptive behav- ioral functioning, psychological flexibility, and wellness. The scientific method allows us to expand our understanding and test its applications. However, we can continue to find wisdom in the thousands of years of prescientific phenom- enological research conducted by contemplative traditions. In Buddhist psy- chology, several different aspects of compassion are discussed, and each reflects a nuance of the experience of compassion. For example, the concept of metta represents loving-kindness and a desire for all beings to be happy and at peace. Another Buddhist aspect of compassion, bodhicitta, is very significant to an ACT formulation of compassion, as it provides an illustration of how an indi- vidual’s sense of self might be intimately involved in the experience of compassion.

Bodhicitta represents an altruistic aspiration for the end of suffering for all beings. It is said to arise among advanced meditators after they have recognized and encountered a sense of self that acknowledges and experiences the inter- connectedness of all things. If we were to view the prescientific concept of bodhicitta in the way we would view a scientific hypothesis, we might posit that ongoing mindfulness practice leads to a shift in the sense of self such that all mental phenomena become insubstantial. In addition, this shift in sense of self allows for recognition of the interconnectedness of all things and all beings, with all conceptual divisions and separations being merely verbal constructions and acts of relating symbolic events in the mind. In this way, the arising of bodhicitta may involve letting go of evaluative self-concepts, which, by definition, place us in a position of opposition to others. Indeed, even the concept of a self may be viewed as an ongoing process of relating moment-to- moment experiences to one another, creating a conceptual process of experi- encing reality that is actually based upon formlessness and sunyata, or emptiness. This shift of perspective is hypothesized to evoke a desire to alleviate all suffer-ing in all beings. Therefore, in Buddhist psychology, compassion arises from a fundamental shift in perspective away from a content-based sense of self and toward an experience of self as a stream of bare attention. Clearly, there is a high degree of conceptual continuity between such a formulation and CBS con- cepts of flexible perspective taking, with the experience of self-as-context being crucial to liberation from suffering.

By shifting the focus away from a content-based self and adopting a psycho- logically flexible perspective, the ongoing pursuit of high self-esteem (and its attendant downsides in terms of narcissism and damaging social comparisons) can be avoided. This may help explain why the practice of self-compassion leads to more beneficial outcomes than the cultivation of self-esteem (Neff, 2009). Psychological flexibility obviates the need to judge or evaluate a content-based self as good or bad, given that the self is seen as an experiential process rather than a reified entity. This may facilitate a reduction in shaming and blaming self-talk and an increase in the ability to be kind to oneself in contexts of suf- fering. Psychological flexibility also allows individuals to commit to courses of action that align with their core values, perhaps helping to explain why self- compassion is linked to greater motivation. As was the case with exploring contemporary theories of compassion in applied psychology, exploring the rela- tionship between psychological flexibility and Buddhist psychology’s conceptu- alization of compassion also reveals a window of opportunity to further a science well-suited to addressing the problem of human suffering.