Compassion Focused Therapy to Counteract Shame, Self-Criticism and Isolation. A Replicated Single Case Experimental Study for Individuals With Social Anxiety

Abstract

Most forms of psychological distress encompass both the relation to the self in the form of shame and self-criticism, as well as the relation to others in the form of distance and isolation. These are often longstanding and pervasive problems that permeate a wide range of psychological disorders and are difficult to treat. This paper focuses on how problems with shame and self-criticism can be addressed using compassion focused therapy (CFT). In a pilot study we tested the effectiveness of CFT with a single case experimental design in six individuals suffering from social anxiety. The aim was to establish whether CFT lead to increases in self-compassion, and reductions in shame, self-criticism and social anxiety. Moreover, the aim was to investigate to what extent participants were satisfied and experienced CFT as helpful in coping with social anxiety and in increasing self-compassion. Taken together the preliminary results show that CFT is a promising approach. CFT was effective for 3 of 6 participants, probably effective for 1 of 6 and more questionably effective for 2 of 6 participants. These results add to the empirical evidence that CFT is a promising approach to address problems with self-compassion. This research body is as of yet small, and more studies are needed.

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Appendix 1 Session content description

Appendix 1 Session content description

Session 1 Psycho education on shyness, how the brain evolved through evolution and sets us up with sensitivity to social threat, how emotions are regulated in different systems (threat, soothing and achievement), compassion and mindfulness. In session, collaborative, case-conceptualization to connect emotion regulation systems to the participants’ own lives. In session mindfulness soothing breathing exercise. Homework: daily practice in soothing breathing.

Session 2 Psycho education on shame, self-criticism and barriers to feeling compassion. Further conceptualization of the participant’s problems focusing on the threat system, coping strategies to regulate anxiety symptoms and compassionate understanding of oneself. Homework: daily monitoring with focus on identifying self-criticism, daily practice in soothing breathing.

Session 3 Psycho education on the function of critical thoughts and on imagery. In session experiential exercise on how imagery can help to create warm, helpful and compassionate feelings while negative thoughts create negative feelings. Homework: daily monitoring and mindfulness of self-critical automatic thoughts, daily practice of imagery exercise “Safe Place”, daily practice in soothing breathing.

Session 4 Psycho education on self-validation. In session training in generating more compassionate thoughts as an alternative to self-critical thoughts. In session imagery exercise on feeling compassion from others. Homework: daily training in generating compassionate thoughts as alternative to self-critical thoughts, daily practice of imagery exercise “Receiving compassion from others”, daily practice in soothing breathing.

Session 5 Psycho education on safety behaviors. In session training on identification of safety behaviors in relation to own shyness and social anxiety. Homework: daily monitoring and challenging of safety behaviors, daily practice of imagery exercise “Feeling compassion for others”, daily practice in soothing breathing.

Session 6 Psycho education on how life values can motivate and help people to cope with difficult emotions in order to reach a long term goals. In session training on mapping important values using a life compass. Introduction of guiding principles validation, acceptance, direction and compassion as an aid in facing difficult situations in daily life. Homework: exposure to a difficult situation using guiding principles, daily practice of imagery exercise “Feeling compassion for oneself and others”, daily practice in soothing breathing.

Session 7 In session work on how to integrate compassion in one’s life and action and how to use compassion to meet difficult situations. Homework: exposure to a difficult situation using guiding principles, assignment on writing a compassionate letter to self, daily practice in soothing breathing.

Session 8 Collaborative summary of the intervention. In session work on making a plan in order to continue to evolve and meet difficulties with compassion for self and others.

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Boersma, K., Håkanson, A., Salomonsson, E. et al. Compassion Focused Therapy to Counteract Shame, Self-Criticism and Isolation. A Replicated Single Case Experimental Study for Individuals With Social Anxiety. J Contemp Psychother 45, 89–98 (2015). https://doi.org/10.1007/s10879-014-9286-8

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Keywords

  • Compassion focused therapy
  • Self-criticism
  • Shame
  • Social anxiety