3 CFT：起源、进化背景及初步练习

3 CFT：起源、进化背景及实践入门

尽管CFT（慈悲聚焦疗法）经常作为一种独立的治疗模式被实践，但它的方法设计得足够灵活，使得主要在其他治疗模型中工作的从业者也能使用。正如Paul Gilbert在培训中经常提到的，“我们称其为慈悲聚焦疗法，而不是单纯的慈悲疗法，因为它是一种将慈悲焦点引入你所学习并实践的治疗方法的方式。”因此，许多CBT（认知行为疗法）、ACT（接受与承诺疗法）以及其他形式的心理治疗从业者已经将CFT和慈悲心态训练的元素整合到他们的实践中，而无需放弃他们之前的学习成为纯粹意义上的“CFT治疗师”。

探索CFT的专业培训，无论是作为一门独立学科还是以纯正的形式，都有明显的价值——事实上，本书的两位作者已将CFT的理论、研究及其实践置于其职业使命的核心位置。然而，仅仅接触一些关于慈悲科学以及CFT方法的文献，就可以为ACT治疗师提供基于证据的方法来将其整合入自己的实践中，并提醒他们注意将CFT中的过程和程序带入与ACT相一致干预措施中的理论与实践可能性，从而创造出一种具有慈悲聚焦特点的ACT。

ACT与CFT平行发展的路径

ACT和CFT是在不同的科学社区、文化背景下以及基于不同假设集发展起来的。多年来，这两种方法相对独立地发展着。例如，ACT源于行为分析传统、CBS（行为科学）以及功能情境主义哲学；而CFT则更多地根植于情感神经科学和发展心理学的研究成果（Gilbert, 2009a）。尽管如此，在它们的发展方向上仍存在某些共同点。比如，两者都采取了自下而上的方式来开发治疗方法，强调基于证据的过程和原则比治疗包更重要，并且都将临床假设建立在基础科学之上。此外，CFT和ACT都借鉴了冥想传统、人本主义疗法以及利用想象和隐喻来生成综合性体验式行为疗法的方法（Gilbert, 2010; Hayes et al., 1999）。经过多年的平行发展之后，近年来一系列因素促使慈悲科学与心理灵活性科学汇聚一堂，并促进了促进新视角和临床技术增长的讨论。CFT与CBS整合的前因涉及到了研究、应用和理论等多个方面，本章将会探讨所有这些因素。

慈悲聚焦研究

近年来，关于慈悲心理学尤其是CFT（慈悲聚焦疗法）的研究基础正在以惊人的速度增长，涉及慈悲主题的研究和临床出版物数量迅速增加。例如，在过去的十年中，对培养慈悲的好处的探索有了显著的增长，特别是通过意象练习的方式（Fehr, Sprecher, & Underwood, 2008）。一项早期的研究（Rein, Atkinson, & McCraty, 1995）发现，被引导进行慈悲意象的人在免疫功能指标（S-IgA）上体验到了积极影响，而被引导进行愤怒意象则产生了负面影响。此外，神经科学与成像研究表明，想象对他人的慈悲可以改变前额叶皮层、免疫系统以及整体幸福感（Lutz et al., 2008）。值得注意的是，一项研究（Hutcherson, Seppala, & Gross, 2008）发现，即使是短暂的慈爱冥想也能增强对陌生人的社会连结感和归属感。

另一项关于慈悲冥想益处的研究（Fredrickson, Cohn, Coffey, Pek, & Finkel, 2008）将67名参与者分配到慈爱冥想组，72名参与者作为等待名单对照组。结果表明，参与每周一次共六次的一小时小组活动，并基于慈爱冥想CD进行家庭练习，减少了疾病症状，增加了正面情绪、正念水平以及生活目的感和社会支持感。还有一项研究（Pace et al., 2009）发现，为期六周的慈悲冥想改善了免疫功能，同时增强了对压力的神经内分泌和行为反应。最后，一项简单的练习，如给自己写一封慈悲信件，也被发现能够帮助应对困难的生活事件并减少抑郁情绪（Leary, Tate, Adams, Allen, & Hancock, 2007）。

所有这些研究对于ACT（接受与承诺疗法）实践者来说都具有潜在价值，因为大多数这些研究没有特定机制假设的负担，且通常不基于某一特定理论取向。正如第二章所展示的那样，应用慈悲心理学背后的流程和潜在程序很大程度上与ACT一致，为CBS（行为科学）社区探索新的途径提供了可能。

在进一步的相关研究中，发现了一些完全符合ACT原则的慈悲聚焦干预组成部分，这些成分能增强心理治疗效果，并作为结果的中介变量。例如，一项研究（Schanche, Stiles, McCullough, Svartberg, & Nielsen, 2011）发现，自我同情是减轻主要涉及焦虑、恐惧和回避的性格障碍相关负面情绪的重要中介，并建议将自我同情作为治疗干预的目标。另一项研究（Beaumont, Galpin, & Jenkins, 2012）比较了CBT（认知行为疗法）与CBT加上CFT在有创伤史的来访中的效果，发现在CBT加上CFT条件下有更佳改善的趋势但未达到统计学意义。在这项研究中，CFT与显著提高的自我同情有关，这一发现促使作者提出发展慈悲可能是治疗的一个重要补充。在一项关于正念为基础的认知疗法对抑郁症有效性的研究（Kuyken et al., 2010）中，研究人员发现自我同情是正念与恢复之间的重要中介因素。事实上，在一个关于临床和非临床环境研究的元分析中，发现慈悲聚焦干预措施非常有效（Hofmann et al., 2011）。研究表明，自我同情可以与自尊区分开来，并且在某些方面比自尊更能预测幸福感（Neff & Vonk, 2009）。使用自我同情量表（Neff, 2003a）进行的相关研究显示，即使控制了自我批评，自我同情仍能提供对抗焦虑和抑郁的保护作用。报告高水平自我同情的人们也报告了多个积极心理特质的高度表现，包括自主性、能力和情绪智力（Neff, 2003a; Neff, Rude, et al., 2007）。

除了越来越多的研究支持慈悲作为心理治疗和日常生活中有益过程之外，CFT本身也通过结果研究获得了越来越多的经验性支持。一项早期的临床试验（Gilbert & Procter, 2006）涉及一群参加日间医院的慢性心理健康问题患者，发现CFT显著减少了自我批评、羞耻感、自卑感、抑郁和焦虑。

另一项未经对照的试验（Ashworth, Gracey, & Gilbert, 2011）发现，对于有获得性脑损伤的人群来说，CFT是一个有益的补充和焦点。此外，一项重要的随机对照试验使用CFT对精神病障碍患者进行治疗（Braehler, Harper, & Gilbert, 2012），与常规治疗相比，发现临床上有显著改善，并且增加了慈悲心，同时具有很高的耐受性和低脱落率。类似地，一项临床试验（Laithwaite et al., 2009）在法医心理健康背景下恢复期的精神病患者样本中，发现与其他人相比，在抑郁、自尊以及自我感知方面有显著改善。其他结果研究表明，CFT对于治疗人格障碍（Lucre & Corten, 2012）、进食障碍（Gale, Gilbert, Read, & Goss, 2012）以及向社区心理健康团队求助的异质性心理健康问题（Judge, Cleghorn, McEwan, & Gilbert, 2012）非常有效。随着CFT逐渐更广泛地传播，越来越多的临床医生和研究人员掌握了其方法和哲学的理解与技能，未来的结果研究将进一步测试这一模型，促进创新和改进。

即使CFT和慈悲心理学正在经历快速的过程和结果研究扩展，ACT及其心理灵活性模型也在持续产生呈指数增长的研究、应用和治疗创新。显然，情境行为疗法在基于证据的疗法的文化讨论中占据了核心地位。此外，情境行为科学越来越多地将语言和认知模型置于进化理论之中（D. S. Wilson et al., 2012）。由于进化理论是CFT概念诞生的概念起点，从《人性与苦难》（Gilbert, 1989）中最早的CFT概念暗示开始，这使得ACT和CFT进一步走到了共同的基础之上。因此，在CFT和ACT中，我们看到了两种虽然通过不同视角看待人类痛苦的问题，但有着许多共通之处的方法。看来，一种共同的关注点是可能实现的，而这些互补视角之间的任何摩擦所提供的对话和多样性可以产生同样多的启示。

情境下的慈悲聚焦应用与CBS社群

正如本书所证明的那样，慈悲心理学与情境心理学的整合正在进行中，无论是CFT的应用还是CBS社群的发展都是如此。在过去几年里，一些ACT心理学家已经将慈悲聚焦技术融入他们的工作中，从在干预措施和培训中加入慈悲心理学元素（Forsyth & Eifert, 2007; Wright & Westrup, in press; Yadavaia, 2013）到研究自我同情作为ACT自助书籍中的过程变量（Van Dam, Sheppard, Forsyth, & Earleywine, 2011）再到探讨慈悲如何与价值观形成过程相关联（Dahl et al., 2009）。在ACT的研究和实践中，早期关于慈悲的工作大多涉及Kristin Neff (2003a) 所界定的自我同情概念。对此趋势的回应是，Neff的自我同情模型已被转化为心理灵活性过程（Neff & Tirch, 2013）。如前所述，这两个模型之间存在着相当大的概念连续性，特别是在两者都强调正念、去认同化以及体验普遍人性作为幸福中心的重要性方面。

近年来，CFT越来越多地与情境行为科学运动建立联系，后者构成了ACT治疗发展的科学基础。这种联系通过培训项目、理论讨论小组以及研究合作得以实现，涉及CFT创始人Paul Gilbert和许多情境行为科学协会（ACBS）成员，包括在ACBS内部组织的慈悲聚焦特别兴趣小组。就治疗发展而言，最近一项基于自助的CFT焦虑干预措施已经整合了心理灵活性模型的元素（Tirch, 2012）。此外，参与首次随机对照试验展示CFT在治疗精神病方面有效性的研究团队成员们现在正在研究ACT过程如何可能对精神病后的抑郁症治疗有用（White et al., 2011）。显然，这一对话的核心已经从CFT的两种慈悲心理学与ACT的心理灵活性模型之间的关系演变而来。

CFT在处理以羞耻为基础的困难中的根源

慈悲聚焦疗法是为那些具有高水平羞耻感和自我批评的人群开发的，这些因素对于易患精神病理学的脆弱性是跨诊断的（Gilbert & Irons, 2005; Zuroff, Santor, & Mongrain, 2005），并且可以严重干扰治疗进展（Bulmash, Harkness, Stewart, & Bagby, 2009; Rector, Bagby, Segal, Joffe, & Levitt, 2000）。培养慈悲和亲社会情绪是解决羞耻感和自我批评的核心过程（Gilbert & Irons, 2005），这通常涉及对自我谴责想法的过度关注或融合，以及愤怒（Kolts, 2012）、焦虑或厌恶的情绪（Gilbert & Irons, 2005; Whelton & Greenberg, 2005）。此外，多种诊断中的焦虑和抑郁症状与更高水平的羞耻感和自我批评相关（Kannan & Levitt, 2013; Zuroff et al., 2005），而较低水平的自我同情则与此相反（Neff, 2009）。当人们的经验被威胁导向的想法和基于威胁的情绪所主导时，他们往往会有狭窄的注意力范围和行为模式，同时减少共情能力（Fredrickson, 2001; Hayes & Shenk, 2004; Negd, Mallan, & Lipp, 2011; Wachtel, 1967）。

这些影响可能导致较少的奖励来源和更少的机会获得有意义、有目的的生活（Eifert & Forsyth, 2005）。研究表明，自我批评带来的负面影响部分是由伴随自我批评的失望、愤怒和轻蔑等情绪引起的，而不仅仅是思想的形式和内容（Whelton & Greenberg, 2005）。

Paul Gilbert描述了他大约二十年前开始发展慈悲聚焦方法的过程，当时他在使用认知行为疗法帮助人们重新评估和重构他们的抑郁或焦虑思维（Tirch & Gilbert, in press）。Gilbert发现，当人们试图产生基于证据的想法时，这些替代想法的内在语气往往仍然是敌对的或是恐惧的（Gilbert et al., 2012）。充满自我敌意和羞辱的内心对话似乎不如将语气转向温暖、友善和慈悲的情感体验那样有效。这促使Gilbert及其同事在英国及国际上探索归属、依恋和情绪调节的基本心理学科学——这一探索至今仍在继续。有趣的是，这一初始发展阶段大致与美国CBS和ACT最早创新时期同步。

CFT与进化理论

CFT的一个关键焦点是利用进化的见解作为心理教育的基础，帮助人们通过去个性化的方式来处理羞耻感和自我批评。如前所述，这一点与ACT中的解离过程相呼应。情境行为科学，顾名思义，高度关注引发心理事件的情境。类似地，CFT将心理事件和人类痛苦置于三个主要领域中进行情境化：

痛苦源于我们是具有生物身体的进化生物：这些身体容易受伤、退化、患病并最终死亡。此外，我们的大脑进化出了执行物种适宜（原型）动机和行为的能力，例如与父母建立依恋关系、加入群体、寻求地位、被选为性伴侣或作为父母行事。这将心理痛苦置于一个进化背景中，这种背景下大脑充满了冲突的动机、情绪以及思考方式，因此具有丰富的痛苦潜力。因此，许多发生在头脑中的事情并不是“我们的错”；然而，我们可以学习培养有助于应对这些情况的技能和方法。
痛苦源于个体的学习历史：包括生活经历如何不仅在生理层面，还在安全策略、目标、价值观和自我认同等层面上影响表型发展。
痛苦源于个体当下的情境：多种因素可能在每一刻产生体验。

进化背景

采用进化方法来处理心理健康问题（Gilbert, 1989, 1998; Nesse, 1998）使我们易于认识到，我们的大脑设置得充满妥协和权衡（Brune et al., 2012; Gilbert, 2001）。因此，CFT通常从介绍基于当前进化理解的心理教育模型开始。随着时间的发展，这一模型变得越来越复杂，并且在去羞耻化和去个性化思维内容的过程中变得更加核心。

现实检验

CFT有多种方法可以帮助来访将其体验置于进化背景中，包括故事讲述、心理教育、隐喻以及开发考虑人类情感进化功能的合作案例概念化。在治疗初期，大多数CFT治疗师会使用一种称为“现实检验”的半结构化讨论，向来访介绍进化的背景，并帮助他们认识到很多生活体验超出了他们的选择范围，而痛苦是人类生活的一部分自然现象。

在CFT中，很多看似心理教育的内容实际上是一种通过治疗师和来访之间的讨论引导发现的过程，以促进根本性和哲学性的视角转变。虽然许多形式疗法的理论和实践似乎都是独立的工作部分，但在CFT中，参与进化模型是培养对人性本质的正念洞察力的重要组成部分，这种方法可以激发慈悲心。采用积极投入、开放和有意图地唤起情绪的态度，CFT从业者经常以这种方式开始他们的工作，帮助来访体验性地应用进化心理学关于心智本质的见解。

干预：现实检验

现实检验 是一种合作讨论，涉及故事、隐喻和引导发现。治疗师与来访一起通过反思我们都是同一物种并共享共同的人性这一事实来探索人类痛苦的进化背景。治疗师可能会这样开始解释：“我们都是由基因以大致相同的方式构建而成的，这造就了我们非常复杂的头脑。每个人的大脑都有共同的情绪、动机和思维方式。有些心理体验是非常有帮助的，比如在面对环境挑战时解决问题。其他的心理事件则可能相当痛苦，比如担忧那些我们无法控制的未来事件。”随后，治疗师和来访可能会进一步进行引导发现，在此过程中治疗师使用苏格拉底式的提问来探索来访对她作为生命流中一个涌现存在的角色的反应。

当CFT治疗师听到来访的反应和问题时，他会进行情感匹配，通过非言语沟通、情感表达以及去病理化的语言来验证来访的情感反应。即使在这个治疗的早期阶段，治疗师也可能使用共情桥梁技术，放慢对话节奏，并有意地利用治疗师自身情绪过程的正念来激发来访灵活的视角转换。从一开始，CFT治疗师就旨在通过来访的眼睛理解世界，与来访一起思考而不是为他们思考。

在引入进化模型后，CFT治疗师会反思这样一个事实：因为我们是生物体，生活中充满了苦难。治疗师提供了许多这样的例子，例如，“有数百万种潜在的病毒和疾病可以影响人类状况，而且我们很容易受伤，有时会有长期后果。我们的生命相对较短，平均大约25,000到30,000天，在这段时间里，我们可能会有一段时间的繁荣，但我们会逐渐退化并失去功能。”

接下来，治疗师指出社会情境的观点，即任何人都是“他自己或她自己的一种特定版本，受到其社会学习历史的影响”。CFT治疗师经常用以下例子来说明这一点：“如果我在三天大的时候被绑架，并被一个暴力毒品团伙抚养长大，我今天会成为什么样的人？毒贩子的儿子们长大后通常会参与家族生意中的暴力犯罪。尽管我不愿意认为自己会成为那种人，但在那样的成长环境下，我可能会变成一个完全不同的人。”治疗师邀请来访详细反思这一点。随着来访认识到治疗师自己也可能会变得具有攻击性甚至杀人，可能是被监禁或已经死亡——换句话说，是一个完全不同类型的人——这可以引发一种转变，认识到我们都是自己的某种版本。事实上，早年的经历甚至可以影响基因表达和不同大脑区域的成熟——这就是社会情境的强大之处。然后，不出所料，治疗师提出下一个问题是：“是否有可能开始训练并选择那些能够组织我们的思维和自我感觉，从而更有利于幸福的自我版本呢？”

现实检验不仅仅是一种简单的心理教育，它是帮助来访实践接纳和解离的第一步。同时，他们也开始承担起参与改变过程的责任，并培养有利于他们福祉的心理状态。

旧脑与新脑的互动

为了向来访展示人类心灵既可能极具破坏性又可能极其关怀和慈悲，CFT治疗师通常会绘制一个大脑轮廓图，并按照图5所示进行标注。

图5. 正念、慈悲与旧脑及新脑功能之间的相互作用

（图5. 正念、慈悲与旧脑及新脑功能之间的相互作用。转载自Gilbert & Choden, 2013，经Constable and Robinson许可。）

讨论早期进化的大脑功能时，为了简化起见，治疗师将这些功能称为旧脑心理学。这包括许多我们与其他动物共有的行为、社会动机和情绪，例如领土性、冲突与攻击性互动、群体归属、结盟、性欲望、照顾后代，以及关键的是，通过回应亲昵和联结而变得更为平静。

这是CFT与ACT之间的一个区别点。情境行为科学（CBS）基于一套假设，其中整个有机体在特定背景下的行为是预测和影响行为的分析单位；而CFT则探索大脑作为地球上生命流动背景下一系列进化能力的涌现集合。虽然这也是一种情境主义，但CFT是在有机体内寻找情绪的进化功能分析，而不是明确地将心理事件视为依赖变量。条件反射原则和体现的情感过程在CFT中都是必不可少的。这是CFT理论中情感反应中心地位的一部分，导致在整个模型中对情绪调节、依恋和联结过程的强烈重视。因此，目的是帮助人们清晰地认识到，这些动机和情绪系统是我们天生就有的，而非后天形成的。作为一个物种，我们只是发现自己处于这种状态，拥有许多旧脑功能以及强烈、迫切且由情绪驱动的行为模式（Gilbert, 2009a）。

接下来，CFT治疗师探讨与进化的新脑或思考脑相关的人类问题。确实，人类被称作“思考的猿”（Byrne, 1995）。不幸的是，我们的思考能力既带来了问题也带来了好处。如第一章所述，大约两百万年前，人类开始发展出一系列新的认知能力：想象力、推理、反思、预期以及自我意识的生成。正如所讨论的，情境行为理论和研究表明，这些心理能力基于人类开始在环境中推导刺激之间的关系的方式（Roche, Cassidy, & Stewart, 2013）。对于人类而言，“遗传进化的潜能加上社会群体的强化历史”（Hayes et al., 2012, p. 360）导致了CFT所指的新脑心理学的一系列能力：语言使用、象征理解、问题解决以及通过认知的学习扩展。

CFT的核心原则之一是理解这些新脑能力如何与旧脑动机和情绪系统相互联系、激发并被激发。尽管情绪可能源自于前言语的旧脑进化反应模式，但人类的情绪体验是通过我们的认知和言语行为表达和衍生出来的，这些行为受到社会环境的影响，并涉及我们的新脑能力。CFT认为，出生前确定的硬连线情绪和动机反应与新脑认知能力之间的互动是许多人痛苦的根源之一。一个聪明的大脑如果被部落复仇所驱动，可能会导致可怕的暴行和核武器。同样，如果一个具有新脑能力的大脑与关心和帮助他人的动机系统相连，那么你就会找到慈悲的来源（Gilbert, 2009b）。

CFT治疗师使用隐喻和例子帮助来访体验和理解旧脑和新脑能力之间的互动，比如想象一只斑马从狮子面前逃跑。一旦斑马逃脱，它很快就会平静下来，回到吃草或其他斑马活动。斑马基于威胁的情绪可能在几分钟内恢复到基线水平的平静，但这对人类来说是不可能的，因为我们的认知能力使我们能够预测事件并创建内部的可能性表征。如果斑马像人一样思考，它可能会开始沉思，想象如果狮子抓住它会发生什么，或者明天会遇到什么。这只斑马随后会经历侵入性的模拟、图像和幻想，关于被活生生吃掉的情景，或者如果明天没有发现狮子会发生什么，甚至两只狮子出现的灾难！虽然人类大脑可以解决问题并催生科学和文化，但它也可能让我们陷入可怕的内心循环，因为我们的思想和想象允许我们在脑海中运行无数可能性的模拟，刺激涉及进化动机和情绪的生理系统。这就是Robert Sapolsky著名著作《为什么斑马不会得胃溃疡》（2004）中的精髓。

CFT中的情绪调节过程

CFT专注于深层次的进化情绪和动机系统，以及特定情感调节系统的刺激与培养。它遵循心理学科学的观点，即情绪服务于进化和涌现的动机，并且情绪还能构建和加强动机。正如Silvan Tompkins（1963）多年前所说，虽然人们可以被任何事物所激励，但情绪使这种激励变得重要；没有情绪，激励就无足轻重。然而，动机和情绪遵循重要的进化轨迹，如成为群体的一部分、获得地位、发展友谊、寻找性伴侣、建立依恋关系以及照顾后代（Gilbert, 1989, 2009a），同时也表明我们做得好还是不好。这些进化轨迹与社会和其他行为相关，这些行为本身具有强化作用。

因此，情绪是在实时中指导我们的行动，并且情绪的预期常常引导动机和行为。进化分析和情感神经科学研究（Depue & Morrone-Strupinsky, 2005）表明，至少存在三种类型的情绪系统（图6）。有时被称为三环模型，这个CFT的人类情绪模型描述了人类情绪调节中涉及的复杂互动过程，并旨在以临床适用的方式解释一些复杂的科学知识。因此，该模型可能有简化事物的风险。尽管如此，它形成了一个桥梁，允许我们在直接与来访及其自身的慈悲智慧工作时，将对人类情绪进化的理解带入咨询室。

驱动/兴奋/活力	满足/安全/联结
激励/资源导向	非渴求/亲和导向
渴望、追求、成就、消费	安全感、善意、安抚
激活	威胁导向
保护和寻求安全	激活/抑制
愤怒、焦虑、厌恶

图6. 三个主要的情绪调节系统。（转载自Gilbert, 2009a，经Constable and Robinson许可。）

激励/资源导向系统

模型中的第一个情绪调节系统是激励/资源导向系统，它涉及一系列有助于追求目标、消费和实现的人类行为（Gilbert, 2007, 2009a）。这些情绪包括喜悦、愉悦和兴奋。它们与达成目标、获胜和成功有关，并服务于获取增强生存和繁殖成功的资源的动机。激励/资源导向系统比其他情绪调节系统更可能激活多巴胺（奖励）系统。当我们参与追求目标、寻求兴奋并感到一种获取和成就的动力时，这个情绪系统就被激活，并在我们如何行动和回应周围世界方面起着关键作用。

重要的是，CFT认识到当特定情绪系统被激活时，我们的许多体验维度都会受到影响。例如，想象一下你发现自己赢得了巨额跨州彩票，很快就会有数亿资金存入你的银行账户。你会在身体上感受到什么？你的脑海中可能会触发哪些想法？会有什么情绪涌动？你的注意力会集中而紧张，还是宽泛而游离？会产生哪些冲动？你是否会整夜不眠，思考如何处理这笔新钱和新的可能性？显然，作为环境事件——甚至只是想到这样的事件——当激励/资源导向系统被激活时，我们的许多存在维度都会受到影响和影响。

威胁导向系统

三环模型中的第二个情绪调节系统是高度敏感的威胁导向系统。我们的基因祖先面对着持续存在的威胁，如捕食者、疾病和自然灾害，进化出了一种“宁可安全也不后悔”的机制，以便快速检测环境中的威胁并迅速作出反应。威胁导向系统涉及大脑中一些较古老的进化结构，包括杏仁核、边缘系统以及血清素系统（Gilbert, 2010），这些系统激活防御行为，如经典的战斗、逃跑或冻结反应。相关的情绪包括愤怒、焦虑和厌恶（LeDoux, 1998）。我们经常向来访描述这个系统为“总是开启的、24/7运行的、宁可安全也不后悔的威胁检测心智”。无论是因为还是尽管有这种冗长的表述，来访立即就能知道我们指的是哪种类型的情绪状态。

非渴求/亲和导向系统

相比之下，三环模型中的第三个情绪调节系统是非渴求/亲和导向系统，它基于满足感和联结的体验。当动物没有受到威胁或不需要满足生存和繁殖需求时，它们可以处于静止状态，因此进化出了服务于“休息和消化”功能的情绪和状态，并提供安全感和平静感。对于许多动物来说，平静可以通过简单地移除威胁来实现。然而，在哺乳动物依恋关系的进化过程中，“休息和消化”系统经历了适应，使得亲和信号也能触发平静反应，并表示一种安全状态（Carter, 1998; Porges, 2007）。因此，当婴儿感到不安时，父母的存在和身体接触可以下调威胁处理过程，使婴儿平静下来。这反映在亲和导向的体验和情绪中，如养育、验证和支持，这些情绪涉及催产素和阿片类系统（Gilbert, 2007）。

通过这种方式，人类天生就会对善意和温暖作出反应，通过下调焦虑系统并感受到安抚来实现。这涉及到在与他人稳定、温暖、共情互动时，遗传上预设的能力来感受安全和平静（Gilbert, 2010）。这种亲和导向的安全系统被那些唤起稳定、关爱情境的经历所激活，这些情境是由一个投入且有效的父母与其孩子建立起来的（Bowlby, 1968; Fonagy & Target, 2007; Sloman, Gilbert, & Hasey, 2003）。因此，人类照顾和养育的进化影响了迷走神经的结构、自主神经系统的功能、情感调节和人类社会行为（Porges, 2003）。在很多方面，亲和导向的情绪系统是同情体验的核心。

情境的重要性

这三个情绪系统中的每一个，当被环境中的事件甚至心理活动激活时，都会组织我们的行动和心理事件。根据环境触发的情绪世界，我们可能会准备好恐惧地逃离物理危险，或者快乐地冲下场赢得重要的比赛。同情心涉及我们在安全、满足和内在权威方面的体验，这些体验并不总是显而易见的，但它们可以在持久的基础上赋予我们力量。通过刻意运用正念意识并激活我们的同情体验，我们可能找到了一个稳定和准备就绪的状态，从这里我们可以迈向有意义的生活。

CFT中的依恋、安抚和亲和情绪

现有大量证据表明，随着哺乳动物进化出活产方式以生育未成熟的后代，依恋系统成为婴儿与父母之间情感调节的核心（Cozolino, 2010; Mikulincer & Shaver, 2007a; Siegel, 2012）。随着人类语言和认知能力的进化，人类大脑体积扩大，达到了约92立方英寸（1500毫升），几乎是我们的近亲黑猩猩大脑体积的三倍。因此，如果人类在妊娠期间发育得更完全，那么大脑会变得太大，以至于无法通过产道。所以，可以说人类是“半成品”出生的。人类婴儿非常脆弱，且出生率低，这些因素要求我们采取保护、支持和照顾的行为来确保物种的生存。正如所指出的，这导致了副交感神经和交感神经系统的重要进化修改，使副交感神经系统能够在面对关心、安全和亲和的人时产生平静反应（Porges, 2007）。

此外，一系列专门用于检测和响应亲和信号的大脑系统也进化了出来，包括催产素系统（Carter, 1998）。催产素有助于建立信任和亲和关系，并在亲和关系中被刺激（Uvnäs Moberg, 2013）。此外，催产素对杏仁核的威胁处理有直接的镇静作用（Kirsch et al., 2005）。因此，现在有大量的证据表明，亲和行为体验高度调节情绪，特别是与威胁相关的情绪（Uvnäs Moberg, 2013）。依恋理论家认为，健康依恋纽带中的亲和情绪体验为人们提供了一个安全基地，从这里他们可以开始探索世界并面对挑战（Bowlby, 1969, 1973; Mikulincer & Shaver, 2007）。

CFT基于依恋理论的方法，同时认识到内部工作模型可能作为安全基地的来源存在问题。许多人经历过由照顾者或在照顾行为背景下的虐待、创伤或忽视。这可能导致通过经典条件反射原理，将安抚系统的激活与增加的威胁联系起来，从而导致对同情的恐惧和难以激活安抚系统（Gilbert, 2010）。因此，同情聚焦疗法试图以一种渐进且不压倒性的方式，激发亲和导向的情绪系统，作为内部参照点和组织过程。在接下来的章节中，我们将描述一些技术、可视化和练习，它们可以培养慈悲心并产生慈悲灵活性。然而，在CFT中，慈悲心的培养始于注意力的部署，以及通过正念和缓慢而有节奏的呼吸（如舒缓节奏呼吸练习）故意激活安抚系统（Gilbert, 2009a; Tirch, 2012）。

干预：舒缓节奏呼吸

在CFT中，来访通常会在治疗的早期阶段被介绍到舒缓节奏呼吸，这是一种基于正念呼吸的慈悲聚焦变体。此后，该技术成为一系列慈悲心训练实践的基础和第一步。部分地，这种练习源自佛教集中冥想和正念冥想的元素，并进行了调整，以创建一种简短且易于理解的形式，适用于心理治疗的情境。冥想是一种邀请，让你在呼吸体验中找到一个静止点，从这个静止点出发，可以观察心灵的来来往往。这种静止涉及副交感神经系统的激活以及随之而来的平静与放松，这些都是由协调呼吸带来的（Brown & Gerbarg, 2012）。类似的练习也是经典正念（Rapgay & Bystrisky, 2009）、藏传萨玛塔冥想和禅宗冥想的一部分。

以下是我们提供的舒缓节奏呼吸指导（改编自Tirch, 2012），以帮助您引导和结构化这项练习，无论是为自己还是为来访。（有关此练习的可下载音频，请访问http://www.newharbinger.com/30550；更多详情请参阅本书背面。）正如本书中的其他部分一样，让您的体验引导您，使用自己的语言和节奏，而不是严格遵循脚本。关键在于，如同许多慈悲心训练一样，要将注意力导向并进入一种有利于体验慈悲的身体和心理状态。这项练习通常是在坐姿下进行，背部保持直立但柔软。理想的环境是一个舒适的地方，没有干扰或打扰。

舒缓节奏呼吸指南

准备姿势：
- 请找一个舒适的位置坐下，双脚平放在地上，背部保持直立但柔软。
- 尽可能让自己感到安定和扎根于体验中。
- 当您准备好时，闭上眼睛，也许可以采取友好或放松的面部表情，微微一笑。
- 开始将注意力集中在呼吸上，感受气息进出身体的温和流动。
- 尽可能温和地保持对呼吸的关注，不试图改变或纠正任何东西，只是与呼吸同在。
深入呼吸觉察：
- 随着您对呼吸流动的意识加深，感受呼吸下降到腹部，注意腹部和胸部的起伏。
- 尽可能让空气到达肺部底部。
- 呼气时，注意到腹部的下降或轻微收缩。
- 感受每次吸气时肋骨下方肌肉的移动。
- 注意腹部的起伏，让呼吸找到自己的节奏和速度，简单地让呼吸自然发生，顺应呼吸的节奏，时刻跟随。
延长呼气：
- 现在延长呼气，让呼吸进入缓慢、舒缓的节奏。
- 吸气数三秒，稍作停顿，然后呼气数三秒，再短暂停顿。
- 如果可以的话，将这个节奏扩展到每次吸气和呼气各数四秒，然后五秒。
- 轻松地保持这个时间，将其作为指导和脉搏。
- 每当您的思绪飘散到想法、图像或干扰时，温柔地记住这是思维的本质；在下一个吸气时，将注意力重新带回舒缓的呼吸节奏。
结束练习：
- 尽可能长时间地保持对舒缓呼吸节奏的关注，感受每一次吸气通过肺部下降，注意腹部的起伏，感受到呼气时的释放。
- 练习这种舒缓节奏的呼吸几分钟后，允许自己注意到何时准备好结束这项练习。
- 然后呼气，完全放下这个练习。
- 按照自己的节奏，将意识带回周围环境，睁开眼睛，回到当下的体验。

本章知识点阐述

知识点扩展

CFT (Compassion-Focused Therapy) 是一种心理治疗方法，它强调通过培养个人对自我和他人的同情心来改善心理健康状态。这种方法特别适合那些对自己过于苛刻或感到羞耻的人。
ACT (Acceptance and Commitment Therapy) 则是另一种心理治疗方法，它鼓励个体接受自己的想法和感受，同时致力于实现个人价值观指导下的有意义的行为。

这两种方法虽然起源于不同的理论背景，但在实践中展现出了一定程度上的互补性。例如，通过结合CFT中的同情心培养技巧与ACT的价值导向行动策略，可以帮助人们更好地应对情绪困扰，同时朝着个人目标前进。

在实际应用中，心理治疗师可能会根据患者的具体情况灵活运用这些方法的不同元素，以达到最佳疗效。这种跨学科的整合不仅反映了现代心理学领域内对于更全面理解人类心灵的努力，也体现了向更加个性化治疗方案发展的趋势。

知识点扩展

慈悲聚焦疗法 (Compassion-Focused Therapy, CFT) 强调通过培养个体对自己和他人的慈悲心来改善心理健康状况。这种方法特别适用于那些对自己过于苛刻或感到羞耻的人。
自我同情 是一种关键的心理健康资源，它指的是当面临失败或痛苦时，个体能够给予自己理解、善意和支持的能力。自我同情与自尊不同，它鼓励人们接受自己的不足而不是简单地追求正面评价。
正念和 慈悲冥想 是两种常见的训练方法，它们可以帮助个体提高其对当前经历的觉察力，同时培养对他人的慈悲态度。这些练习不仅有助于个人的情绪调节，还能促进身体健康。

在实际应用中，结合 ACT 的价值观导向行动策略与 CFT 的慈悲培养技巧，可以帮助人们更好地处理情感困扰，促进个人成长和发展。这种跨学科的方法反映了现代心理学领域内对于更加全面理解和治疗人类心灵的努力。

通过上述研究可以看出，慈悲相关的干预措施在多种情境下均显示出积极效果，这提示我们在设计心理健康项目时应考虑纳入这些元素。此外，这些发现也为未来如何整合不同的心理治疗方法提供了指导方向。

知识点扩展

慈悲聚焦疗法 (CFT) 不仅被证明能够有效减少个体的自我批评、羞耻感等负面情绪，还在多种心理健康状况中显示出积极效果，包括精神分裂症、人格障碍及进食障碍等。这表明CFT作为一种治疗方法具有广泛的适用性。
心理灵活性 是ACT的核心概念之一，它指的是个体能够在面对困难时保持开放的态度，采取有效的行动以符合个人的价值观。当结合了CFT的慈悲培养技巧后，这种灵活应对能力可能会得到进一步增强。

通过将 自我同情 作为心理灵活性的一个组成部分，Neff & Tirch (2013) 的工作展示了如何将慈悲原则融入到ACT框架内，从而为治疗提供了一种新的视角。这种方法不仅有助于提高个体处理情感困扰的能力，还促进了他们对自身经历的接受度以及对他人苦难的理解。

进化理论 在CFT和ACT的发展过程中扮演了重要角色，两者都试图从进化的角度理解人类行为模式及其背后的心理机制。这种跨学科的方法有助于深化我们对复杂心理现象的理解，并为开发更加有效的干预策略提供了依据。

随着更多研究者和实践者参与到CFT与ACT的融合工作中，未来有可能出现更多创新性的治疗方法。这样的整合不仅反映了现代心理学领域内的发展趋势，也为解决各种心理健康问题提供了更为全面和个性化的解决方案。

知识点扩展

CFT (Compassion-Focused Therapy) 和 ACT (Acceptance and Commitment Therapy) 的结合体现了现代心理学领域内不同治疗方法之间相互借鉴的趋势。两者都强调了个体在面对困难时采取灵活应对策略的重要性，但各自侧重点有所不同：CFT侧重于通过培养慈悲心来缓解羞耻感和自我批评，而ACT则侧重于接受当前经验并致力于价值驱动的行为。
羞耻感 和 自我批评 是导致多种心理健康问题的重要因素。CFT通过促进个体对自己和他人的慈悲态度，帮助人们减轻这些负面情绪的影响。这种方法不仅有助于改善个体的心理状态，还能增强其社交技能和社会支持网络。
心理灵活性 是ACT的一个核心概念，它指的是个体能够根据情况变化调整自己的思维和行为，以便更好地适应环境。结合CFT的慈悲培养技巧，可以帮助个体更加开放地面对自身经历，从而提高其整体幸福感。

通过将 CFT 与 ACT 结合起来，临床工作者可以为患者提供一个更加全面的支持系统，既注重情感层面的关怀，也强调实际行动上的改变。这种综合方法为解决复杂心理健康问题提供了新的视角，并且有助于促进个体的整体康复。

进化理论 在理解人类行为模式及其背后的心理机制方面起到了关键作用。CFT和ACT的发展过程中均考虑到了这一点，尝试从进化的角度解释为什么某些情绪反应和行为模式会在特定情境下出现，从而为设计有效的干预策略提供了理论依据。

知识点扩展

进化理论 在CFT中的应用强调了人类心理机制的生物学基础，特别是大脑如何为了适应生存和繁衍的需求而进化出特定的行为模式。这种视角有助于个体理解自己的感受和行为并非完全由个人意愿控制，而是受到进化压力的影响。
去个性化 是CFT中的一个重要概念，它意味着帮助个体认识到自己的想法和情绪并不完全代表个人身份或价值。通过这种方式，个体能够更加客观地看待自己的内心世界，从而减少因负面情绪带来的自我批评。
现实检验 作为一种具体的CFT技术，旨在帮助个体认识到自身经历的普遍性和不可避免性。通过引入进化心理学的概念，个体能够更好地接受自身的局限性，进而减轻因无法控制的生活事件而产生的自责感。
合作案例概念化 是CFT治疗过程中的一种方法，其中治疗师与患者共同构建一个关于患者经历及其背后原因的故事。这种方法不仅促进了患者的自我理解，还增强了他们面对困难时的适应能力。

通过结合进化理论，CFT提供了一种新的框架来理解和处理人类的情感和行为。这种方法鼓励个体采取更加宽容的态度对待自己，同时也为治疗师提供了更多工具来帮助患者实现长期的心理健康改善。

知识点扩展

现实检验 是CFT中用于帮助个体理解和接受自身经历的一种技术。它不仅提供了关于人类共通性的深刻见解，还促进了个体对自己内心世界的同情心。
情感匹配 和 共情桥梁 是CFT中用来增强治疗关系和促进来访情感开放的重要技术。这些方法有助于建立信任感，使来访感到被理解和接纳。
通过 社会情境 的视角来看待个人发展，可以帮助个体认识到他们的行为和性格特征并非完全由个人意志决定，而是受到广泛的社会因素影响。这种认识有助于减少自我责备，并鼓励个体采取更加积极的态度对待生活中的挑战。
正念和慈悲在CFT中被视为重要的工具，它们帮助个体更好地管理自己的情绪反应，同时促进对他人和社会的理解与连接。
旧脑与新脑的概念强调了大脑不同部分的功能及其对情绪和行为的影响。了解这些机制有助于个体学会如何调节自己的情绪，从而改善心理健康。通过结合进化理论，CFT提供了一种全面的方法来处理复杂的情绪和行为问题，支持个体实现更健康的生活方式。

知识点扩展

旧脑与新脑 的概念强调了大脑不同部分的功能及其对情绪和行为的影响。旧脑负责基本的生存功能，如恐惧反应和攻击性行为，而新脑则处理复杂的认知任务，如抽象思维和计划未来。了解这两种脑功能有助于个体更好地管理自己的情绪和行为。
进化心理学 是CFT的重要组成部分，它帮助个体认识到许多情绪和行为模式并非个人选择的结果，而是长期进化过程中形成的基本机制。这种认识有助于减少自我责备，促进对自己和他人的同情心。
情绪调节 在CFT中占据核心位置。通过理解和接受情绪的自然属性，个体可以学习更有效地管理它们，从而提高生活质量。这包括识别触发情绪的因素、学会以健康的方式表达情绪以及培养积极的情绪体验。
认知能力 虽然给人类带来了巨大的优势，如创新和技术进步，但也可能导致过度担忧和心理压力。CFT鼓励个体认识到这一点，并通过正念练习等方法来减轻由此产生的负面影响。
社会环境 对个体的发展有着深远的影响。CFT强调了社会支持和良好人际关系的重要性，这些因素不仅影响着个体的心理健康，还影响着其整体幸福感。通过加强社交技能和建立积极的社会网络，个体可以更好地应对生活中的挑战。
比喻和实例 是CFT中常用的教育工具，它们帮助个体以直观易懂的方式理解复杂的心理概念。通过这种方式，个体不仅能够更好地理解自己，还能学会如何应用这些知识来改善日常生活。

知识点扩展

旧脑与新脑 的概念强调了大脑不同部分的功能及其对情绪和行为的影响。旧脑负责基本的生存功能，如恐惧反应和攻击性行为，而新脑则处理复杂的认知任务，如抽象思维和计划未来。了解这两种脑功能有助于个体更好地管理自己的情绪和行为。
进化心理学 是CFT的重要组成部分，它帮助个体认识到许多情绪和行为模式并非个人选择的结果，而是长期进化过程中形成的基本机制。这种认识有助于减少自我责备，促进对自己和他人的同情心。
情绪调节 在CFT中占据核心位置。通过理解和接受情绪的自然属性，个体可以学习更有效地管理它们，从而提高生活质量。这包括识别触发情绪的因素、学会以健康的方式表达情绪以及培养积极的情绪体验。
认知能力 虽然给人类带来了巨大的优势，如创新和技术进步，但也可能导致过度担忧和心理压力。CFT鼓励个体认识到这一点，并通过正念练习等方法来减轻由此产生的负面影响。
社会环境 对个体的发展有着深远的影响。CFT强调了社会支持和良好人际关系的重要性，这些因素不仅影响着个体的心理健康，还影响着其整体幸福感。通过加强社交技能和建立积极的社会网络，个体可以更好地应对生活中的挑战。
比喻和实例 是CFT中常用的教育工具，它们帮助个体以直观易懂的方式理解复杂的心理概念。通过这种方式，个体不仅能够更好地理解自己，还能学会如何应用这些知识来改善日常生活。

知识点扩展

情绪调节 是CFT的核心组成部分之一，它关注于帮助个体理解和管理自己的情绪反应。通过识别不同的情绪系统及其功能，个体能够更好地认识自己在不同情境下的情绪状态，并采取适当的策略来应对。
进化视角 在CFT中扮演着至关重要的角色，因为它帮助个体理解情绪不仅仅是个人经历的结果，而是长期进化过程中形成的适应机制。这种理解有助于减少对负面情绪的自我指责，促进更健康的情绪处理方式。
激励/资源导向系统 与积极的情绪体验紧密相关，如快乐、兴奋等。这些情绪不仅让人感到愉悦，还促使人们去追求目标、解决问题和享受生活。了解这一系统的工作原理可以帮助个体利用积极情绪来提升生活质量。
情绪体验的多维度 表明情绪不仅仅是一种单纯的感觉，它还会对思维、行为和生理状态产生广泛的影响。例如，在面对巨大财富时，除了激动和高兴外，还可能伴随着焦虑、不安甚至是失眠。这提示我们在进行情绪调节时需要考虑其全面的影响。
多巴胺系统 与奖赏和快感密切相关，是激励/资源导向系统的关键组成部分。当个体追求目标或体验到成功时，多巴胺水平会上升，带来愉悦感和动力。了解这一点有助于个体通过设定合理的目标和庆祝小成就来提高幸福感。
实际应用 中，CFT治疗师会教导个体如何识别和利用不同的情绪系统，以便在日常生活中做出更有益的选择。例如，通过练习感恩日记记录每天的小成就，可以激活激励/资源导向系统，从而提升整体的心理健康水平。

知识点扩展

威胁导向系统 是一种高度敏感的情绪调节系统，它帮助个体快速识别和应对潜在的威胁。这种系统在进化过程中发展出来，以确保个体能够迅速采取行动保护自己。理解这一系统有助于个体认识到自己的某些强烈情绪反应可能是自然的生存机制，从而减少对自己情绪的负面评价。
非渴求/亲和导向系统 提供了一种平衡，使个体能够在没有威胁的情况下体验到平静、安全和连接。这种系统强调了人际关系和社会支持在促进心理健康中的重要性。通过理解和利用这一系统，个体可以学会如何通过建立积极的人际关系来提高自己的幸福感。
催产素和阿片类系统 在亲和导向系统中起着关键作用，它们与亲密关系和社交互动有关。催产素通常被称为“爱情荷尔蒙”，因为它能促进信任、亲密和纽带的形成。了解这些生理机制可以帮助个体更好地理解人际互动如何影响情绪和行为。
情境的重要性 强调了外部环境和内部心理状态对情绪调节的影响。不同的情境可以激活不同的情绪系统，从而导致不同的行为反应。通过意识到这一点，个体可以更有意识地选择适合当前情境的情绪调节策略。
正念和同情 的实践可以帮助个体更好地管理情绪，特别是在面对压力和挑战时。通过培养正念意识，个体可以更加客观地观察自己的情绪，而不被情绪所控制；通过激发同情心，个体可以更好地理解和接纳自己及他人的感受，从而促进更健康的人际关系和社会互动。
应用中，治疗师可以引导个体通过练习正念冥想、感恩日记等方法来增强亲和导向系统的作用，同时教授他们如何在日常生活中识别和应对威胁导向系统带来的过度警觉和焦虑。通过这样的综合方法，个体不仅能够更好地管理自己的情绪，还能提升整体的心理健康水平。

知识点扩展

依恋系统 在人类情感发展和心理健康中扮演着关键角色。它不仅帮助婴儿与父母建立紧密的情感联系，还为个体提供了一种安全感，使其能够探索外部世界并应对挑战。了解依恋的重要性有助于理解个体在成长过程中形成的内心模式如何影响其成年后的行为和人际关系。
催产素 是一种重要的神经肽，它在建立信任和亲和关系中起着重要作用。催产素不仅促进社会联系，还能减少焦虑和压力反应。通过增强催产素的作用，个体可以更好地应对社交互动中的负面情绪，并提高整体的心理福祉。
副交感神经系统 在维持身体的休息和消化功能方面至关重要，同时也负责产生平静和放松的感觉。通过激活副交感神经系统，个体可以在面对压力时更快地恢复平静状态。这对于管理长期的压力和焦虑尤为重要。
经典条件反射 可能会导致某些情境下安抚系统的激活反而引发更多的威胁感。例如，那些经历过童年创伤的人可能会在尝试接受安慰时感到不安。CFT通过逐步引导个体重新学习如何在安全和支持的环境中感受到安抚，从而克服这种负面的条件反射。
慈悲聚焦疗法 (CFT) 旨在通过多种技术和练习来培养个体的慈悲心。这些方法包括正念冥想、可视化练习和特定的呼吸技巧，旨在帮助个体学会自我安抚和对他人的同情。通过这些实践，个体可以逐渐建立起一种更加积极和健康的情绪调节机制。

应用

在应用中，治疗师可以使用诸如舒缓节奏呼吸等练习来帮助来访启动安抚系统，从而减轻焦虑和压力。通过持续的练习，个体不仅可以改善自己的情绪状态，还可以提高对他人痛苦的理解和同情能力，从而促进更和谐的人际关系和社会互动。

知识点扩展

舒缓节奏呼吸 是一种结合了正念冥想和慈悲聚焦疗法的技术，旨在帮助个体达到身心的平静状态。通过这种练习，个体可以更好地管理压力和焦虑，同时增强自我同情的能力。
副交感神经系统 的激活有助于身体进入“休息和消化”模式，从而降低心率、血压和应激激素水平。这不仅有助于缓解即时的压力反应，还能促进长期的心理健康。
正念是这一练习的核心，它强调非评判性地关注当前的体验。通过培养正念，个体可以学会更客观地观察自己的思想和情绪，而不被它们所控制。
适应性反应 在ACT实践中，当下时刻的稳定体验代表了心理灵活性的基础。通过培养慈悲心，个体能够发展出更广泛的适应性应对策略，以应对生活中的挑战，从而实现更有意义的生活。
应用中，治疗师可以通过引导来访进行舒缓节奏呼吸练习，帮助他们建立一种内在的安全感和平静感。这种练习不仅可以在治疗过程中使用，也可以作为日常生活中的一种自我调节工具，帮助个体更好地应对压力和负面情绪。
逐步引导 对于那些经历过创伤或有强烈焦虑感的个体来说，逐步引导他们进入这种平静状态尤为重要。通过渐进式的练习，个体可以逐渐学会如何在安全和支持的环境中感受到安抚，从而克服过去的负面条件反射。

3 CFT: Origins, Evolutionary Context, and Opening Practices While CFT is often practiced as a freestanding therapeutic modality in its own right, its methods have been designed in such a way that they can be used by practitioners who operate primarily in other therapy models. As Paul Gilbert has often stated in trainings, “We call this compassion-focused therapy, and not compassion therapy, because it is a way of bringing a compassion focus to the therapy that you have learned to practice.” As a result, many practitioners of CBT, ACT, and other forms of psychotherapy have integrated elements of CFT and compassionate mind training into their practice without divesting them- selves of their prior learning and becoming “CFT therapists” in every sense. There is clear value in exploring training in CFT, in its own right and in an undiluted form—indeed, two of the authors of this book have made the theory, research, and practice of CFT central to their professional missions. However, just some exposure to the literature on the science of compassion and the methods of CFT can provide ACT therapists with an evidence-based entrée into integrating this approach into their practice, and alert them to theoretical and practical possibilities for bringing processes and procedures from CFT into an ACT-consistent intervention, creating a compassion-focused ACT.

The Parallel Paths of ACT and CFT ACT and CFT began to develop in quite distinct scientific communities, under different cultural circumstances and working with differing sets of assumptions. For many years these approaches developed in isolation from one another. For example, whereas ACT has emerged from the behavior analytic tradition, CBS, and the philosophy of functional contextualism, CFT has arisen more from affective neuroscience and developmental psychology research (Gilbert, 2009a). Nevertheless, both ACT and CFT have shared some assumptions in their ori- entations. For example, both have followed a bottom-up approach to developing treatment, have emphasized the importance of evidence-based processes and principles over treatment packages, and have rooted their clinical assumptions in basic science. Furthermore, both CFT and ACT have drawn upon elements of contemplative traditions, humanistic therapies, and the use of imagery and metaphor to generate integrative, experiential approaches to behavior therapy (Gilbert, 2010; Hayes et al., 1999). After years of growth along parallel paths, a number of factors have come together in recent years to bring the sciences of compassion and psychological flexibility together and engage them in a growing discussion that is facilitating new perspectives and clinical techniques. Many of the antecedents of the integration of CFT and CBS involve research, applica- tions, and theory, and this chapter will discuss all of these factors.

Compassion-Focused Research Over the last few years, the research base for compassion psychology gener- ally and CFT specifically has been growing at a remarkable rate, with a rapid increase in the number of research and clinical publications addressing compas- sion. For example, the last ten years have seen a major upsurge in exploration into the benefits of cultivating compassion, especially through imagery practice (Fehr, Sprecher, & Underwood, 2008). One early study (Rein, Atkinson, & McCraty, 1995) found that people who were guided in compassion imagery experienced positive effects on an indicator of immune functioning (S-IgA), whereas being guided in anger imagery had negative effects. Furthermore, neu- roscience and imaging research has demonstrated that practices of imagining compassion for others produce changes in the frontal cortex, the immune system, and overall well-being (Lutz et al., 2008). Notably, one study (Hutcherson, Seppala, & Gross, 2008) found that even just a brief loving-kindness meditation increased feelings of social connectedness and affiliation toward strangers. Another study of the benefits of compassion meditation (Fredrickson, Cohn, Coffey, Pek, & Finkel, 2008) allocated sixty-seven participants to a loving- kindness meditation group and seventy-two to a waiting list control. It found that engaging in six one-hour weekly group sessions with home practice based on a CD of loving-kindness meditation decreased illness symptoms and increased positive emotions, mindfulness, and feelings of purpose in life and social support. Yet another study (Pace et al., 2009) found that compassion meditation over the course of six weeks improved immune function and both neuroendocrine and behavioral responses to stress. Finally, an exercise as simple as writing a com- passionate letter to oneself has been found to improve coping with difficult life events and reduce depression (Leary, Tate, Adams, Allen, & Hancock, 2007). All of this research is of potential value for ACT practitioners, as most of these studies have proceeded without the burden of a particular set of mecha- nistic assumptions and often aren’t based in a particular theoretical orientation. And as demonstrated in chapter 2, the underlying processes and potential pro- cedures involved in applied compassion psychology are largely ACT consistent, leading to new avenues for the CBS community to explore.

In further relevant research, several compassion-focused intervention com- ponents that are entirely ACT consistent have been found to enhance psycho- therapy outcomes, and to serve as mediator variables in outcomes. For example, one study (Schanche, Stiles, McCullough, Svartberg, & Nielsen, 2011) found that self-compassion was an important mediator of reduction in negative emo- tions associated with personality disorders that chiefly involve anxiety, fear, and avoidance (Cluster C disorders), and recommended self-compassion as a target for therapeutic intervention. Another study (Beaumont, Galpin, & Jenkins, 2012) compared CBT to CBT plus CFT in clients with a history of trauma and found a nonsignificant trend for greater improvement in the CBT plus CFT condition. In this study, CFT was associated with significantly greater improve- ment in self-compassion, a finding that led the authors to suggest that develop- ing compassion could be an important adjunct to therapy. In a study of the effectiveness of mindfulness-based cognitive therapy for depression (Kuyken et al., 2010), researchers found that self-compassion was a significant mediator between mindfulness and recovery. In fact, in a meta-analysis of research con- cerning both clinical and nonclinical settings, compassion-focused interven- tions were found to be significantly effective (Hofmann et al., 2011). Research has shown that self-compassion can be distinguished from self-esteem and pre- dicts some aspects of well-being better than self-esteem (Neff & Vonk, 2009). And in correlational research using the Self-Compassion Scale (Neff, 2003a), self-compassion has been found to offer protection against anxiety and depres- sion, even when controlling for self-criticism. People who report high levels of self-compassion on the Self-Compassion Scale also report high levels of many positive psychological traits, including autonomy, competence, and emotional intelligence (Neff, 2003a; Neff, Rude, et al., 2007).

In addition to the growing body of research supporting compassion as a beneficial process in psychotherapy and in everyday life, CFT itself is seeing increasing empirical support through outcome research. An early clinical trial involving a group of people with chronic mental health problems who were attending a day hospital (Gilbert & Procter, 2006) found that CFT significantly reduced self-criticism, shame, sense of inferiority, depression, and anxiety.

Another study (Ashworth, Gracey, & Gilbert, 2011), which was an uncontrolled trial, found CFT to be a helpful addition and focus for people with acquired brain injury. Additionally, an important randomized controlled trial using CFT for people with psychotic disorders (Braehler, Harper, & Gilbert, 2012) found significant clinical improvement and increases in compassion, as well as high levels of tolerability and low attrition, as compared to a treatment-as-usual con- dition. Similarly, a clinical trial (Laithwaite et al., 2009) found significant improvements in depression, self-esteem, and sense of self, as compared to others, in a sample of patients in recovery from psychosis in a forensic mental health setting. In other outcome research, CFT has been found to be signifi- cantly effective for the treatment of personality disorders (Lucre & Corten, 2012), eating disorders (Gale, Gilbert, Read, & Goss, 2012), and heterogeneous mental health problems in people presenting to community mental health teams (Judge, Cleghorn, McEwan, & Gilbert, 2012). As CFT continues to become more widely disseminated and growing numbers of clinicians and researchers acquire understanding and skill in its methods and philosophy, increasing outcome research will further test the model, leading to innovation and improvement.

And even as CFT and compassion psychology have been experiencing a rapid expansion of process and outcome research, ACT and its model of psy- chological flexibility has continued to generate an exponentially growing body of research, applications, and therapeutic innovations. Clearly, contextual approaches to behavior therapy have assumed a central role in the cultural dis- cussion regarding evidence-based therapies. Additionally, contextual behavioral science has increasingly situated its model of language and cognition within evolutionary theory (D. S. Wilson et al., 2012). Because evolutionary theory was the conceptual birthplace of CFT, starting with the earliest intimations of CFT concepts in Human Nature and Suffering (Gilbert, 1989), this has drawn ACT and CFT further onto common ground. Thus, in CFT and ACT we see two approaches that have a great deal of commonality, even as they look at the question of human suffering through somewhat different lenses. It appears that a common focus is possible, and that the dialogue and diversity provided by any friction between these complementary perspectives can generate as much light as heat.

Contextual Compassion-Focused Applications and the CBS Community As evidenced by the existence of this book, the integration of compassion psychology and contextual psychology is proceeding, in terms of both applica- tions of CFT and developments in the CBS community. Over the last few years, a number of ACT psychologists have integrated compassion-focused techniques into their work, from adding elements of compassion psychology into interven- tions and training (Forsyth & Eifert, 2007; Wright & Westrup, in press; Yadavaia, 2013) to researching self-compassion as a process variable in ACT self-help books (Van Dam, Sheppard, Forsyth, & Earleywine, 2011) to examin- ing how compassion may relate to the process of values authorship (Dahl et al., 2009). Much of the early compassion-related work within ACT, in both research and practice, involved the concept of self-compassion as delineated by Kristin Neff (2003a). In response to this trend, Neff’s model of self-compassion has been translated into psychological flexibility processes (Neff & Tirch, 2013). As noted, there is a good amount of conceptual continuity between the two models, particularly concerning how both emphasize the importance of mindfulness, disidentification, and an experience of common humanity as being central to well-being.

Over the past several years, CFT has increasingly been involved in building bridges with the contextual behavioral science movement, which forms the sci- entific foundation for ACT treatment development. This has occurred through training initiatives, theoretical discussion panels, and research collaborations involving CFT founder Paul Gilbert and many members of the Association for Contextual Behavioral Science (ACBS), including the organization of the Compassion-Focused Special Interest Group within ACBS. In terms of treat- ment development, a recent CFT self-help–based intervention for anxiety has integrated elements of the psychological flexibility model (Tirch, 2012). Furthermore, members of the research team involved in the first randomized controlled trial demonstrating the effectiveness of CFT in the treatment of psy- chosis (Braehler et al., 2012) are now studying how ACT processes may be useful for the treatment of depression after psychosis (White et al., 2011). Clearly, the core of this conversation has evolved from the relationship between CFT’s two psychologies of compassion and ACT’s model of psychological flexibility.

The Roots of CFT in the Treatment of Shame-Based Difficulties Compassion-focused therapy was developed with and for people who have high levels of shame and self-criticism, elements that are transdiagnostic for vulner- ability to psychopathology (Gilbert & Irons, 2005; Zuroff, Santor, & Mongrain, 2005), and that can seriously interfere with therapeutic progress (Bulmash, Harkness, Stewart, & Bagby, 2009; Rector, Bagby, Segal, Joffe, & Levitt, 2000). Cultivating compassion and affiliative emotions is a core process for addressing shame and self-criticism (Gilbert & Irons, 2005), which often involve preoccu- pation or fusion with thoughts of self-condemnation and emotions of anger (Kolts, 2012), anxiety, or disgust (Gilbert & Irons, 2005; Whelton & Greenberg, 2005). Furthermore, anxiety and depressive symptoms across several diagnoses are correlated with higher levels of shame and self-criticism (Kannan & Levitt, 2013; Zuroff et al., 2005) and lower levels of self-compassion (Neff, 2009). Moreover, when people’s experience is dominated by such threat-focused thoughts and threat-based emotions, they often have narrowed attention and behavioral repertoires, as well as a reduced capacity for empathy (Fredrickson, 2001; Hayes & Shenk, 2004; Negd, Mallan, & Lipp, 2011; Wachtel, 1967).

These effects may lead to fewer sources of reward and less access to a meaning- ful, purposeful life (Eifert & Forsyth, 2005). Research (Whelton & Greenberg, 2005) has shown that the negative effects of self-criticism are brought about in part by emotions of disappointment, anger, and contempt that accompany self- criticism, and not solely the form and content of thoughts.

Paul Gilbert has described how he initially began developing a compassion- focused approach twenty years ago when using cognitive behavioral therapy to help people reevaluate and reframe their depressed or anxious thinking (Tirch & Gilbert, in press). Gilbert found that when people were trying to generate evidence-based thoughts, the inner tone of these alternative thoughts was often still hostile or frightened (Gilbert et al., 2012). Inner dialogues characterized by self-hostility and shaming did not seem to respond as well to cognitive disputa- tion as they did to a shift in tone toward a warm, kind, and compassionate emotional experience. This set in motion an exploration of the basic psycho- logical science of affiliation, attachment, and emotion regulation by Gilbert and his colleagues in the UK and internationally—an exploration that has contin- ued to this day. Interestingly, the period of this initial development is roughly synchronous with the earliest innovations of CBS and ACT in the United States.

CFT and Evolutionary Theory A key focus of CFT is using evolutionary insights as a basis for psychoeducation and helping people address shame and self-criticism by depersonalizing the con- tents and processes of the mind. As noted, this is resonant with the ACT process of defusion. Contextual behavioral science, as its name implies, is highly focused on the contexts that give rise to mental events. In a related way, CFT contextualizes mental events and human suffering in three primary domains: • Suffering arises because we are evolved beings with biological bodies that are easy to injure and that deteriorate, become diseased, and die. Moreover, our brains are evolved to enact species-appropriate (archetypal) motives and behaviors, such as forming attachments to parents, joining groups, seeking status, being selected as a sexual partner, or acting as a parent. This places mental suffering in an evolutionary context that has given rise to a brain full of conflicting motives, emotions, and ways of thinking and therefore is rich in its potential for suffering. Thus, much of what goes on in the mind is not our “fault”; however, we can learn to cultivate skills and approaches that are helpful. • Suffering arises within the context of the individual’s learning history, including the ways in which life experiences have influenced phenotypic development not only at the physiological level, but also at the level of safety strategies, goals, values, and self-identities. • Suffering arises within the present-moment context of the individual: the multitude of factors that may be giving rise to moment-by-moment experience.

The Evolutionary Context Using an evolutionary approach to the issues of mental health (Gilbert, 1989, 1998; Nesse, 1998) makes it easy to recognize that our minds are set up in such a way that they are full of compromises and trade-offs (Brune et al., 2012; Gilbert, 2001). So CFT generally begins with introducing a psychoeduca- tional model based upon current evolutionary understanding. Over time, this model has become more sophisticated and central to the process of de-shaming and depersonalizing the contents of the mind.

The Reality Check There are various CFT methods for helping clients situate their experience in an evolutionary context, including stories, psychoeducation, metaphors, and the development of a collaborative case conceptualization that takes the evolu- tionary functions of human emotions into account. Early in therapy, most CFT therapists use a semistructured discussion known as the Reality Check to intro- duce clients to the context of evolution, and help them see that much of their life experience has been beyond their choosing and that suffering is a natural part of human life.

Within CFT, a lot of what appears to be psychoeducation is actually a way of engendering a fundamental and philosophical shift of perspective, through a process of guided discovery facilitated via discussions between the therapist and client. While the theory and practice of many forms of therapy appear to be separate aspects of the work, engaging with the evolutionary model in CFT is an essential part of cultivating mindful insight into the nature of being human, an approach that can evoke compassion. Adopting an engaged, open, and delib- erately emotionally evocative demeanor, CFT practitioners often begin their work in this way to help clients experientially apply insights from evolutionary psychology regarding the nature of the mind.

Intervention: The Reality Check The Reality Check is a collaborative discussion that involves stories, metaphors, and guided discovery. Together, client and therapist explore the evolutionary context of human suffering by reflecting on the fact that we all are of the same species and share our common humanity. The therapist may begin by explain- ing, “We are all built by genes in more or less the same way, and this has given rise to our very tricky brain. Everyone’s brain has common emotions, motives, and ways of thinking. Some of these mental experiences are very helpful, such as problem solving in the face of environmental challenges. Other mental events can be quite painful, such as worrying about events far in the future that we can’t have any control over.” The client and therapist may then engage in further guided discovery in which the therapist uses Socratic questioning to explore the client’s reaction to her role as an emergent being in the flow of life.

As the CFT therapist hears the client’s reactions and questions, he engages in affect matching, validating the client’s emotional response through nonverbal communication, affective expressiveness, and de-pathologizing language. Even at this early stage in therapy, the therapist may also use empathic bridging, slowing down the dialogue and deliberately using mindfulness of the therapist’s own emotional processes to evoke flexible perspective taking on the part of the client. From the outset, CFT therapists are aiming to understand the world through their clients’ eyes, while thinking with clients and not for them. Following the introduction of the evolutionary model, the CFT therapist reflects on the fact that because we are biological beings, life is full of suffering.

The therapist provides a range of examples of this, such as, “There are millions of potential viruses and diseases that can afflict the human condition, and we are quite easy to injure, sometimes with long-term consequences. Our lives are relatively short, about twenty-five thousand to thirty thousand days on average, and during this time we may flourish for a while, but we will gradually deterio- rate and lose functions.”

Following this, the therapist makes the social contextual point that anyone is “only one particular version of himself or herself, shaped by his or her social learning history.” CFT therapists often use the following example to illustrate the point: “If I had been kidnapped as a three-day-old baby and raised by a violent drug gang, what kind of person would I be today? When they grow up, the sons of drug enforcers in cartels conduct violent crimes as part of the family business. As much as I don’t want to think I could be that sort of person, it is possible that with such a learning history, I would be a very different version of myself.” The therapist invites the client to reflect on this in some detail. As the client gains insight into the fact that the therapist himself might have become aggressive or even murderous, possibly incarcerated or already dead—in other words, a very different type of person—this can initiate a shift toward recogniz- ing that we are all just versions of ourselves. Indeed, early experiences can even affect genetic expression and the maturation of different brain areas—that is how powerful social contexts are. Then, not surprisingly, the next question the therapist poses is: “Is it possible to start to train and choose versions of ourselves that will organize our minds and sense of self in a way that is more conducive to well-being?”

Far from being mere psychoeducation, the Reality Check is a first step on the way to helping clients practice acceptance and defusion. Furthermore, at the same time they are beginning to take responsibility for engaging in change processes and for cultivating mental states conducive to their well-being. The Interaction of the Old Brain and New Brain To show clients how potentially destructive the human mind can be—as well as highly caring and compassionate—CFT therapists typically draw an outline of the brain and begin to label it as shown in figure 5.

Figure 5. Interactions between mindfulness, compassion, and older and newer brain functions. (Reprinted from Gilbert & Choden, 2013, with permission from Constable and Robinson.)

In discussing brain functions that evolved earlier, for the sake of simplicity the therapist refers to them as old-brain psychology. This includes many behav- iors, social motivations, and emotions we share with other animals, such as being territorial, having conflicts and aggressive interactions, belonging to groups, forming alliances, having sexual desires, looking after offspring, and, crucially, responding to affection and affiliation by becoming more calm.

This is a point of distinction between CFT and ACT. Whereas CBS pro- ceeds from a set of assumptions wherein the act of an entire organism in context is the agreed upon unit of analysis for the prediction and influence of behavior, CFT explores the brain as an emergent, collective set of evolved capacities in the context of the flow of life on earth. While this is a contextualism of a certain stripe, CFT looks within the organism for an evolutionary functional analysis of emotion, rather than viewing mental events explicitly as dependent variables. Both conditioning principles and embodied affective processes are essential in CFT. This is a part of the centrality of emotional responding within CFT theory, leading to a strong emphasis on processes of emotion regulation, attachment, and affiliation throughout the model. So, the idea is to help people gain clear insight into the fact that these motivational and emotional systems have been built into us, not by us. As a species, we simply find ourselves here, with a mind that has many old-brain functions and intense, compelling, and emotionally driven patterns of action (Gilbert, 2009a).

Next, CFT therapists explore human problems related to the evolved new brain, or thinking brain. Indeed, humans have been referred to as the thinking ape (Byrne, 1995). Unfortunately, our evolved capacity for thinking creates both problems and benefits. As mentioned in chapter 1, around two million years ago humans began to develop a whole range of new cognitive abilities: imagination, reasoning, reflecting, anticipating, and generating a sense of self. And as discussed, contextual behavioral theory and research suggest that these mental abilities are based upon the way humans began to derive relations among stimuli in our environment (Roche, Cassidy, & Stewart, 2013). For humans, a “combination of our genetically evolved capacity and a history of reinforcement by a social community” (Hayes et al., 2012, p. 360) has resulted in the range of capacities that CFT refers to as new-brain psychology: language use, symbolic understanding, problem solving, and elaboration of learning through cognition.

One of the core principles in CFT is understanding the way these new-brain competencies link into, stimulate, and are stimulated by old-brain systems of motivation and emotion. While emotions may emerge from preverbal, old-brain evolutionary response patterns, the human experience of emotion is expressed and derived from our cognitive and verbal behaviors, which are shaped by social contexts and involve our new-brain capacities. CFT posits that the interaction of hardwired emotional and motivational responding, determined prior to birth with new-brain cognitive abilities, is part of the source of much human suffer- ing. Take an intelligent mind and fuel it with tribal vengeance, and you can end up with horrendous atrocities and nuclear weapons. Equally, take a mind with new-brain competencies and link these into motivational systems that are con- cerned with caring and helping others, and you find the sources of compassion (Gilbert, 2009b).

CFT therapists help clients experience and understand the interaction of old-brain and new-brain abilities using metaphors and examples, such as imag- ining a zebra running away from a lion. Once the zebra gets away, it will quickly calm down and go back to eating or other zebra activities. Whereas the zebra’s threat-based emotions may return to baseline calm within minutes, this is unlikely for humans because of our capacity for cognition, with which we predict events and create internal representations of possibilities. If a zebra thought as humans do, it might start to ruminate, imagining what might have happened if the lion had caught it and what it might encounter tomorrow. This zebra would then experience intrusive simulations, images, and fantasies related to being eaten alive, or what might happen if it doesn’t spot the lion tomorrow, or even the disaster of two lions turning up! While the human brain can solve problems and give rise to science and culture, it can also trap us in terrible internal loops because our thoughts and imaginations allow us to run simulations of numerous possibilities in our mind, stimulating physiological systems involving evolved motives and emotions. This is the essence of Robert Sapolsky’s famous book Why Zebras Don’t Get Ulcers (2004).

Emotion Regulation Processes in CFT CFT is focused on deep, evolved emotion and motivational systems and the stimulation and cultivation of specific affect regulating systems. It follows the psychological scientific view that emotions serve evolved and emergent motives, and that emotions also build and strengthen motives. As Silvan Tompkins (1963) said many years ago, while one can be motivated for anything, with emo- tions it matters, and without emotions it doesn’t. However, motives and emo- tions follow important evolutionary trajectories, such as being part of a group, gaining status, developing friendships, finding sexual partners, creating attach- ment, and caring for offspring (Gilbert, 1989, 2009a), and also signal how well or poorly we are doing. These evolutionary trajectories relate to social and other behaviors that are inherently reinforcing.

So emotions are evolved to orient our actions in real time, and the anticipa- tion of emotions is what often guides motives and behaviors. Evolutionary anal- ysis and affective neuroscience research (Depue & Morrone-Strupinsky, 2005) suggest that there are at least three types of emotional systems (figure 6). Sometimes referred to as the three-circle model, this CFT model of human emotions is a description of the complex interacting processes involved in human emotion regulation, and it aims to make sense, in a clinically applicable way, of some complicated science. As such, the model might run the risk of oversimplifying things. Nevertheless, it forms a bridge that allows us to bring an understanding of the evolution of human emotion into the consultation room as we work directly with clients and their own compassionate wisdom.

Driven, excited, vitalContent, safe, connected Incentive/ resource-focusedNonwanting/ Affiliative focused Wanting, pursuing, achieving, consumingSafeness, kindness Soothing Activating Threat-focused Protection and Safety seeking Activating/inhibiting Angry, anxious, disgusted Figure 6. The three major emotion regulation systems. (Reprinted from Gilbert, 2009a, with permission from Constable and Robinson.)

The Incentive/Resource-Focused System The first of the three emotion regulation systems in the model is the incen- tive/resource-focused system, which involves the range of human behaviors that contribute to pursuing aims, consuming, and achieving (Gilbert, 2007, 2009a). These are emotions of joy, pleasure, and excitement. They are associated with achieving, winning, and succeeding and serve the motive of acquiring resources that enhance survival and reproductive success. The incentive/resource-focused system likely activates dopaminergic (reward) systems to a greater degree than do other emotion regulation systems. When we are engaged in pursuing aims and seeking excitement and feel a drive toward acquisition and accomplish- ment, this emotional system is activated and plays a key role in how we act and respond to the world around us.

Importantly, CFT recognizes that many dimensions of our experience are affected when a particular emotion system is activated. For example, imagine that you discover you won a huge, multistate lottery and would soon have hun- dreds of millions of dollars wired into your bank account. What might you feel in your body? What thoughts would likely be triggered in your mind? What emotions might move through you? Would your attention be focused and tight, or broad and wandering? What urges would arise? Might you find yourself up all night, wondering what to do with all of this new money and new possibility? Clearly, as an environmental event—or even just the thought of such an event— activates the incentive/resource-focused system, many dimensions of our being are affected and influenced.

The Threat-Focused System The second emotion regulation system in the three-circle model is the highly sensitive threat-focused system. Our genetic ancestors, who faced the persistent presence of threats such as predators, disease, and natural disasters, evolved to possess a “better safe than sorry” process for quickly detecting threats in the environment and responding rapidly. The threat-focused system involves some of the older evolutionary structures in the brain, including the amygdala and the limbic system, and the serotonergic system (Gilbert, 2010), which activates defensive behaviors, such as the classic fight, flight, or freeze response. The emotions involved are along the lines of anger, anxiety, and disgust (LeDoux, 1998). We often describe this system to our clients as the “always-on, 24/7, better-safe-than-sorry, threat-detection mind.” Whether because of or in spite of that excessive verbiage, clients immediately know what type of emotional state we are referring to.

The Nonwanting/Affiliative-Focused System In contrast, the third emotion regulation system in the three-circle model, the nonwanting/affiliative-focused system, is based on the experience of content- ment and connection. When animals are not under threat or seeking to fulfill survival and reproduction needs, they can be quiescent, hence the evolution of emotions and states that serve the functions of “rest and digest” and offer the experience of safeness and peacefulness. For many animals, calming can occur simply by removal of the threat. However, during the evolution of mammalian attachment, the rest and digest system underwent adaptations such that affilia- tive signals could also trigger a calming response and signal a state of safeness (Carter, 1998; Porges, 2007). Thus, when an infant is distressed, the presence of the parent and physical contact can downregulate threat processing and calm the infant. This is reflected in affiliative-oriented experiences and emotions, such as nurturance, validation, and empathy, which involve the oxytocin and opioid systems (Gilbert, 2007).

In this way, humans have evolved to naturally respond to kindness and warmth through a downregulation of the anxiety systems and a felt sense of soothing. This involves a genetically predisposed capacity to feel a sense of safe- ness and soothing in the presence of stable, warm, empathic interactions with others (Gilbert, 2010). This affiliative-focused safeness system is activated by experiences that evoke the stable, caring context that an engaged and effective parent establishes with her child (Bowlby, 1968; Fonagy & Target, 2007; Sloman, Gilbert, & Hasey, 2003). Accordingly, the evolution of caregiving and nurtur- ing in humans has influenced the structure of the vagus nerve, the functions of the autonomic nervous system, affect regulation, and human social behaviors (Porges, 2003). In many ways, the affiliative-focused emotional system is central to the experience of compassion.

Context Matters Each of these three emotional systems, when activated by events in the environment or even in the mind, serves to organize our actions and mental events. We may become prepared to fearfully run from physical danger or to joyously run downfield to win the big game, depending on what the environ- ment triggers in our emotional world. Compassion involves our experience of safeness, contentment, and inner authority in ways that aren’t always obvious, and such experiences can be empowering in a lasting manner. By deliberately deploying mindful awareness and activating our experience of compassion, we may be finding a place of stability and readiness from which to step forward into a meaningful life.

Attachment, Soothing, and Affiliative Emotions in CFT There is now considerable evidence that as mammals evolved live birth for immature offspring, the attachment system became central to the organization of emotional regulation between infant and parent (Cozolino, 2010; Mikulincer & Shaver, 2007a; Siegel, 2012). With the evolution of the human capacity for language and cognition, the size of the human brain expanded, so that we have a brain that, at around 92 cubic inches (1,500 cc), is nearly three times the size of that of our nearest evolutionary relative, the chimpanzee. As such, the human brain would grow far too large for offspring to pass through the birth canal if humans were to develop more fully than they currently do in gestation. Therefore, we humans are born with our brain development “half-baked,” so to speak. Human infants are very vulnerable and we have a low birth rate, factors that require behaviors of protection, support, and caring for our species to survive. As noted, this has resulted in significant evolutionary modifications to the parasympathetic and sympathetic nervous system to enable the parasympa- thetic nervous system to produce a calming response in the presence of others who are caring, safe, and affiliative (Porges, 2007).

In addition, a range of specialized brain systems for detecting and respond- ing to affiliative signals evolved, including the oxytocin system (Carter, 1998). Oxytocin helps build trust and affiliative relationships and is stimulated in and by affiliative relationships (Uvnäs Moberg, 2013). Moreover, oxytocin exerts direct effects that calm threat processing in the amygdala (Kirsch et al., 2005). So there is now considerable evidence that the experience of affiliative behavior regulates emotion to a high degree, and particularly emotions related to threats (Uvnäs Moberg, 2013). Attachment theorists suggest that the affiliative emo- tional experiences involved in healthy attachment bonds serve as a secure base from which people can begin to explore their world and face challenges (Bowlby, 1969, 1973; Mikulincer & Shaver, 2007).

CFT builds on attachment theorists’ approach while recognizing that inter- nal working models of others may be problematic as sources for a secure base. Many people have experienced abuse, trauma, or neglect by caregivers or in the context of caregiving behaviors. This can cause activation of the soothing system to be associated with increased threat through classical conditioning principles, which can result in fear of compassion and difficulty with activation of soothing (Gilbert, 2010). Therefore, compassion-focused therapy seeks to stimulate the affiliative-focused emotional system as an internal point of refer- ence and organizing process in a manner that is gradual and not overwhelming. In the chapters to come, we will describe a number of techniques, visualiza- tions, and practices that can cultivate compassionate mind and generate compassionate flexibility. However, in CFT the cultivation of compassion begins with deployment of attention and the deliberate engagement of the soothing system through a blend of mindfulness and slow, rhythmically steady breathing (Gilbert, 2009a), via such exercises as Soothing Rhythm Breathing (Tirch, 2012).

Intervention: Soothing Rhythm Breathing In CFT, clients are typically introduced to Soothing Rhythm Breathing, a compassion-focused variant on mindful breathing, early in the course of therapy. Thereafter, the technique becomes the foundation and first step in a succession of practices involved in compassionate mind training. In part, the practice is derived from elements of Buddhist concentration meditation and mindfulness meditation, with adaptations to create a brief and clearly understandable form that is useful in the context of psychotherapy. The meditation is an invitation to find a point of stillness in the experience of breathing from which it is pos- sible to observe the comings and goings of the mind. This stillness involves activation of the parasympathetic nervous system and the attendant calming and relaxation, all resulting from coherent breathing (Brown & Gerbarg, 2012). Similar practices are a part of classical mindfulness (Rapgay & Bystrisky, 2009), Tibetan samatha meditation, and Zen meditation.

Below, we present instructions for Soothing Rhythm Breathing (adapted from Tirch, 2012) to assist you in guiding and structuring the practice, whether for yourself or for clients. (For a downloadable audio recording of this practice, please visit http://www.newharbinger.com/30550; see the back of this book for more information.) As is the case throughout this book, allow your experience to lead you, using your own words and pacing rather than adhering rigidly to the script. The key to it, as in much of compassionate mind training, is to direct attention and access a state of body and mind that is conducive to the experi- ence of compassion. This exercise is usually conducted in a seated position with the back upright yet supple. The ideal setting is a comfortable place, free from distractions or interruptions.

As we will often begin our practices, please find a comfortable place to be, where you can place both of your feet on the floor and allow your back to adopt an upright yet supple posture. As much as you can, allow yourself to feel settled and grounded into the experience. When you feel willing, allow your eyes to close, perhaps adopting a friendly or relaxed facial expression, perhaps smiling slightly. Begin to draw your attention to the gentle flow of the breath in and out of the body. Feel your connection to the breath as you inhale and exhale. As best you can, hold your focus on the breath with a gentle and allowing spirit, not aiming to change or correct anything, but simply being with the act of breathing.

As you begin to deepen your awareness of the flow of the breath, feel your breath descend into your belly, noticing the rise and fall of your abdomen and chest. As best you can, allow the air to reach the bottom of your lungs. As you exhale, notice the falling or gentle shrinking of the abdomen. Feel the muscles under the rib cage moving with each inhalation. As you notice the rising and falling of the belly, allow your breath to find its own rhythm and pace, simply allowing the breath to breathe itself and giving way to your breath’s own rhythm, moment by moment. With each in-breath, feel as if you are breathing attention into the body, and with each out-breath, feel your entire body letting go.

Now extend and lengthen the out-breath, and allow the breath to settle into a slow, soothing rhythm. Breathe in for a count of three seconds, pause for a moment, then breathe out for a count of three seconds, and briefly pause again. As you’re able, extend this rhythm to a count of four seconds for each in-breath and out-breath, and then five seconds. Hold this timing lightly, using it as a guide and a pulse. Whenever your mind wanders away to thoughts, images, or distractions, gently remember that this is the nature of mind; upon the next in-breath, bring your attention back to this soothing rhythm of the breath.

Remain with this attention to the soothing rhythm of your breath as much as you can, feeling each inhalation descending through the lungs, noticing the rising and falling of the abdomen, and sensing the release of the exhalation. After practicing breathing in this soothing rhythm for a few minutes, allow yourself to notice when you are ready to bring this practice to a close. Then exhale and let go of this exercise entirely. At your own pace, bring your awareness back to your surroundings, opening your eyes and returning to your experience right now.

The Soothing Rhythm Breathing practice aptly illustrates how CFT accesses particular bodily and mental states in preparation for engaging more deeply with life’s challenges. In this context, the concept of soothing refers to the experience of centeredness, preparedness, and mindful awareness that develops from the activation of affiliative emotions and secure attachment experiences. For the ACT practitioner, this experience of stabilization in the present moment represents the foundation of psychological flexibility, linking the cultivation of compassion to the development of broader repertoires of adaptive responses to the difficulties that arise on the road to a life well lived.