3 CFT：起源、进化背景及初步练习
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 expe- rience 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.