Summary of the impact

Researchers in the Centre for Psychological Research developed compassion-focussed therapy (CFT), which has been used to treat depression and anxiety by reducing shame and self-criticism. CFT has also been applied successfully to eating disorders, personality disorders, psychoses and other disorders, and has been introduced in NHS treatment centres. Training programmes have equipped therapists to deliver CFT. The benefits of CFT have also been made available directly to the public through self-help books and materials, and through the Compassionate Mind Foundation charity. The CFT approach has also been extended to improve wellbeing among the general population as well as those affected by psychological disorders.

Underpinning research

The research consists of:

• Theoretical analyses of the evolutionary origins of the affiliative emotions at the heart of compassion focused therapy (CFT).
• Analyses of brain mechanisms underlying processes related to CFT, including self-criticism and self-reassurance.
• Differentiation of subtly related but distinct aspects of shame, self-criticism and self-reassurance.
• Development of valid and reliable measures of the constructs and processes targeted by CFT, including self-criticism, shame, compassion for self and other, and fear of compassion.
• Development of specific therapeutic techniques to increase self-compassion and reduce self-criticism, including, for example, evaluation of the use of compassionate imagery.
• Development of compassionate mind training, which is a set of skills and techniques that make the compassionate approach much more flexible and adaptable for different treatment approaches.
• Evaluations of CFT in different patient groups.
• Application of the compassion-focused approach in different clinical settings and for different psychological disorders.
• Development of compassion-focussed approaches to improve wellbeing among the general population.

The research was conducted by Professor Paul Gilbert and colleagues, including Dr Frances Maratos, Dr Kirsten McEwan and Dr Corinne Gale, and took place at the University of Derby and the Mental Health Research Unit (MHRU), which is a joint project between the University and Derbyshire Mental Health Services NHS Trust. The University had a contract with the Trust and contributed £12,000 annually since 2003 towards the running costs of the MHRU. Professor Gilbert has a University chair that was awarded in 1996. Professor Gilbert and other members of the MHRU are also members of the University's Centre for Psychological Research, and there are many joint activities, including project work, PhD student supervision, and research grant applications. Professor Gilbert has also contributed every year to undergraduate and postgraduate teaching at the university, and the university offers training courses for therapists in compassion-focussed therapy. Professor Gilbert was included as a category C member of staff in the University's submission for RAE 2008 in UOA 44, and in February 2013 was appointed to a part-time research fellowship with the University.

Kirsten McEwan and Corinne Gale were employed in the MHRU from 2004 to 2012 as research psychologist and research coordinator respectively. Both were also enrolled as part-time University of Derby PhD students, and both completed successfully in 2012. Kirsten McEwan was jointly supervised by Paul Gilbert and Frances Maratos, and Corinne Gale was jointly supervised by Paul Gilbert and James Elander. In 2012, Kirsten McEwan took up a postdoctoral research post at the University of Cardiff, and Corinne Gale took up a clinical psychology training place at the University of Leicester.

References to the research

[This paper, with 124 citations on Google Scholar as of October 2013, sets out the evolutionary basis of the concepts and processes that are central to compassion focused therapy.]

[This paper, submitted by the University of Derby for RAE 2008 in UOA 44 and with 76 citations on Google Scholar as of October 2013, was an early demonstration of the clinical value of compassion-focussed interventions, and led to more extensive adoption and application of CFT.]

[This paper, submitted by the University of Derby for RAE 2008 in UOA 44 and with 89 citations on Google Scholar as of October 2013, describes a new scale, developed by the authors, to assess self-criticism, which was known to be a major vulnerability factor for psychopathology. This research enabled therapeutic approaches targeting self-criticism to be developed and applied more widely.]

[This paper, with 272 citations on Google Scholar as of October 2013, explains the basis for compassionate mind training, a sub-component of CFT, and demonstrates its clinical value.]

[This paper, submitted by the University of Derby for REF 2014 in UOA 04, and with 50 citations on Google Scholar as of October 2013, describes research conducted by a team including two University of Derby researchers entered in REF 2014 (Maratos and Gilbert). The research provided evidence of the physiological basis and distinctiveness of symptoms and processes that are targeted by CTF.]

[This paper, submitted by the University of Derby for REF 2014 in UOA 04 and with 18 citations on Google Scholar as of October 2013, added to a growing literature on the importance of recognising the pathogenic effects of negative self-critical thoughts and feelings about the self, which is the basis of CFT.]

Details of the impact

Developed initially for depression, compassion-focussed therapy (CFT) has been applied for eating disorders (Gale et al., 2012), personality disorders (Lucre and Corten, 2012) and psychosis (Braehler et al., 2012), including in high security settings (Laithwaite et al., 2009). It was applied and evaluated for heterogonous mental health problems in community mental health settings (Judge et al., 2012), and to promote compassionate self-regulation in smoking cessation (Kelly et al. (2010). Compassion-focused therapy has been incorporated into NHS treatment services in Coventry (Gale et al., 2012), Leicester (Lucre and Corten, 2012), Glasgow (Judge et al., 2012), and Ayrshire and Arran, Scotland (Braehler et al., 2012). At the Coventry Eating Disorders Service, 745 patients were referred for treatment between April 2002 and October 2009 (Gale et al., 2012), and since 2008 approximately 70 patients with eating disorders receive CFT each year.

In Scotland, group-based CFT was introduced from 2008 for patients referred by community mental health teams in Greater Glasgow (Judge et al., 2012), and the Integrated Care Pathway of the First Episode Psychosis Service covering the whole of Glasgow (pop. 800,000) is guided by the use of compassion-focussed formulation. In a trial of CFT for patients with psychosis referred from NHS clinical services in Ayrshire and Arran, Scotland, CFT was associated with "significantly more improvement and less exacerbation at follow-up" than treatment as usual (Braehler et al., 2012, p. 208). The clinical psychologist responsible for the service described CFT as leading to many positive changes among the service as whole, including "increased detection, assessment and treatment of psychological difficulties in patients with psychosis", "development of specialist clinical skills in psychology staff", and "greater uptake of other group-based social activities within mental and social services following the groups by patients who were previously disabled by high levels of social anxiety and paranoia" (personal correspondence, 2013).

The Compassionate Mind Foundation UK was set up in 2006 and registered as a charity in 2007. The Foundation has increased the impact of research on CFT by:

• Providing regional supervision groups for clinicians to come together and talk about their cases.
• Making downloadable compassion-focused therapy materials and resources, including video materials, scales related to compassion-focused therapy and research, compassion-focused exercises, training manuals and training materials, and information about clinical supervision, available through its website (http://www.compassionatemind.co.uk/).
• Extending the work of the Foundation internationally, by establishing the Compassionate Mind Foundation USA (set up in 2013) (http://compassionfocusedtherapy.com/).

There is also an active programme of training at the University of Derby for therapists and practitioners wishing to offer compassion-focussed therapy. This includes:

• A series of workshop events and short courses organised by the University in conjunction with the Compassionate Mind Foundation. One three-day workshop event on 23rd, 24th and 25th January, 2012, for example, provided an introduction to compassion-focussed therapy for shame and self-critical difficulties for 45 trainees, including 20 NHS delegates. Since 2012, introductory workshops with up to 70 trainees per workshop, and advanced workshops with attendance limited to 40 trainees per workshop, have been held at the University's Enterprise Centre, and attracted trainees from NHS Trusts, voluntary sector organisations and independent practitioners right across the UK.
• A Postgraduate Certificate in Compassion Focused Therapy, which began in January 2012 and is presently training the third cohort. Over 30 individuals have received training to date, and seven students, including six from Derbyshire Healthcare NHS Trust, graduated in September 2012, and 11, including nine from Derbyshire Healthcare NHS Trust, graduated in May 2013.

The profile and reputation of CFT has been further increased by Professor Gilbert's honorary and visiting professorial positions. For example, he is currently visiting professor at the Universities of Combria, Portugal, and Fribourg, Switzerland, and has addressed over 12 international conferences as invited keynote speaker since 2008 (see REF5 section on contribution to the discipline). Articles in general readership publications such as The Psychologist have been used to explain the scientific and therapeutic basis of CFT and introduce the key therapeutic concepts. Professor Gilbert and colleagues have also written or edited 18 books and contributed chapters to a further 43 books, which make the philosophy, evidence base and therapeutic approach of CFT widely available to academics and practitioners.

Professor Gilbert's authored books include the best-selling Overcoming Depression (2009), and Compassion Focused Therapy (2010), which are published in at least 12 countries, including Bulgaria, Canada, China, Denmark, Estonia, Germany, Greece, Norway, Poland, Sweden, UK, USA and Wales (Welsh Language). Both books are listed on Amazon best-selling lists and have many excellent customer reviews. As of February 2013, Overcoming Depression had sold 159,000 copies and The Compassionate Mind had sold 39,000 copies. Overcoming Depression is listed as recommended reading in the national `Reading Well Books on Prescription' scheme, delivered by The Reading Agency and the Society of Chief Librarians, with funding from the Arts Council England. The scheme, recently launched on 4th June 2013, provides book-based cognitive behavioural therapy to help people understand and manage common mental health conditions.

The CFT approach has also been developed and adapted for the general public and selected groups affected by wellbeing challenges. For example, a Leverhulme Trust-funded 2010-11 project evaluated a web-based `compassion game' to promote wellbeing for the general public (http://derby.ac.uk/news/focus-on-compassion-to-boost-wellbeing), and an online resource for students to promote wellbeing and reduce assessment anxiety was developed and evaluated in 2013.

Paul Gilbert has also made a significant contribution to public understanding and awareness of mental health issues generally, and of the role of compassion-focused approaches more specifically, through national and international media events and appearances, including on BBC Radio 4, in The Guardian, The Independent, and The Times, and internationally. Numerous talks, workshops, self-help and instructional video materials are also publicly available on YouTube.

In January 2011, Professor Gilbert was awarded the OBE for services to mental healthcare.

Sources to corroborate the impact

1. Braehler, C., Gumley, A., Harper, J., Wallace, S., Norrie, J., and Gilbert, P. (2012). Exploring change processes in compassion focused therapy in psychosis: Results of a feasibility randomized controlled trial. British Journal of Clinical Psychology, 52, 199-214. DOI: 10.1111/bjc.12009
2. Gale, C., Gilbert, P., Read, N., and Goss, K. (2012). Evaluation of the impact of introducing Compassion Focused Therapy to a standard treatment programme for people with eating disorders. Clinical Psychology and Psychotherapy. Advance online publication DOI: 10.1002/cpp.1806
3. Judge, L., Cleghorn, A., McEwan, K., and Gilbert. P. (2012). An exploration of group-based compassion focused therapy for a heterogeneous range of clients presenting to a community mental health team. International Journal of Cognitive Therapy, 5, 420-429.
4. Kelly, A., Zuroff, D., Foa, C.L., and Gilbert, P. (2010). Who benefits from training in self-compassionate self-regulation? A study of smoking reduction. Journal of Social and Clinical Psychology, 29, 727-755.
5. Laithwaite, H., O'Hanlon, M., Collins, P., Doyle, P., Abraham, L., and Porter, S. (2009). Recovery after psychosis (RAP). A compassion focused programme for individuals residing in high security settings. Behavioural and Cognitive Psychotherapy, 37, 511-526. DOI: 10.1017/S1352465809990233
6. Lucre, K.M., and Corten, N. (2012). An exploration of compassion-focused therapy for personality disorder. Psychology and Psychotherapy: Theory, Research and Practice. Advance online publication. DOI:10.1111/j.2044-8341.2012.02068.x
7. Personal correspondence (2013) from the Clinical Psychologist responsible for introducing CFT within the Clinical Psychology and Community Health Services of HNS Ayrshire and Arran, Scotland, between September 2008 and March 2010, and from the Consultant Clinical Psychologist responsible for the compassion-focused Integrated Care Pathway for the First Episode Psychosis Service, Glasgow.
8. Personal correspondence (2013) from the Editor, Constable and Robinson publishers, with sales figures for The Compassionate Mind and Overcoming Depression, and the confirmed recommended reading list for the national `Books on Prescription' scheme.