There is good evidence then to suggest that focusing on the cultivation of compassion, such that individuals have more affiliative relationships with themselves and others, could well be an important process in the development of psychotherapy for depression. Indeed, compassion may well have an important role to play in rebalancing attachment-based difficulties [14
]. However, as CFT developed, it became clear that there are important blocks, fears, and resistances to the concept of compassion and the experience of affiliative emotion [51
]. Gilbert et al. developed a measure of ‘fears of compassion’ and found them to be highly correlated to psychopathology symptoms. In a follow-up study, Gilbert et al. [52
] found fears of compassion to be linked to fears of happiness in general, and problems with emotional processing (alexithymia) and mindfulness. This studies of the fears of compassion to date however have been with non-clinical populations. The study looks at these different fears of compassion in a clinical population.
There are in fact many reasons why people can become fearful of compassion and affiliative emotion and block it, thereby increasing their vulnerability to mood disorders and reducing recovery. One reason is they see compassion as a weakness or indulgence and require clarity on the definition and process. Another reason is children who have experienced abuse and neglect may have these emotional memories reactivated by cues of kindness, because they stimulate the attachment system and hence trigger whatever memory is coded there. Indeed, people from traumatic backgrounds can have what has been called “attachment phobia”, and fear
affilative emotion [53
] outlined how abusive and/or neglectful parenting creates approach-avoidance conflicts. For example, for most children, the source of distress resolution is to return to the parent for comfort, support and understanding. However, unpredictable and abusive parents, who are poor at mentalizing and empathy, can also be the source of threat to the child. So the natural (innate) system of seeking comfort is blocked because although the parent and be a source of safeness he/she can be the very threat the child needs to escape from. Liotti [55
] describes how those children who are threatened by their parents, and therefore cannot use them as a soothing object, enter states of “threat without resolution.” In these conditions the only resolution may be withdrawal and avoidance and trying to close down. These kinds of fears can be understood using classical conditioning of emotional memories [56
]. Hence, not only do these individuals have few positive memories of affection and joyfulness they may also have few memories of comfort and soothing when under stress, and instead have many aversive memories associated with wanting or seeking closeness, kindness and compassion.
In contrast, some authors suggest that people can be fearful of compassion and affiliative feelings if they are also fearful of their own damaging potential for rage [57
] - a scenario beautifully enacted in the film “Good Will Hunting”. A typical scenario for a patient would be “If you really knew me, and what went on in my mind you would not think I deserve compassion.” So a sense of shame, and believing that there are “bad things (feelings, thoughts and fantasies) inside of one” which cannot be revealed, may be a major block to being open to affiliation. So the ability to be open to affiliation may first require individuals to acknowledge and work on their rage; compassion and feelings of affiliation may be quite difficult in the context of a lot of unprocessed rage [4
]. Here the therapist teaches 'compassion for and with rage'.
involved in fear of compassion and affiliative feelings is unprocessed grief. Gilbert and Irons [58
] suggested that some people are in a state of frozen grief. If therapeutic compassion and kindness begin to activate the attachment and affiliative systems, the feelings of loneliness and poor attachment become more prominent, stimulating grieving, which for some people can seem overwhelming and result in blocking. For example, one recent patient acknowledged that as she began to experience compassion for herself she became aware of how lonely she had been as a child, and fearful of her parents. “All my life I seem to have felt cut off from others, really.” Compassion is a process which can start to facilitate exposure to these avoided feelings and memories but in doing so, grieving and sadness are often part of the process. Recently, Lecours and Bouchard [59
] have shown that borderline personality disorder severity is linked to difficulties in experiencing sadness and grief.
The capacity to develop compassion for self and others probably depends upon some capacity for empathy and mentalizing, which for some people can be compromised especially when under stress [60
]. So it is plausible that difficulties with empathy and mentalising will also compromise compassion [52
Another major reason people can run into difficulties with compassion and affiliative positive emotion is partly because the self-monitoring and self-correcting systems have been primarily entrained to self-criticism rather than self-validation or self-support. Self-criticism is of course the opposite of self-compassion, especially when associated with feelings of anger and contempt for the self [42
]. Self-criticism has long been linked to increased vulnerability to psychopathology [63
] and poor recovery [64
]. There is an important link between fears of compassion and internal feelings of hostility towards the self and self-criticism [51
]. Self-critical individuals often struggle with standard therapies [64
] and have become a focus for compassion focused therapy [13
]. A series of studies have shown that shameprone and self-critical individuals tend to come from more difficult attachment backgrounds and have problematic attachment strategies which can interfere with being open to affiliative and compassionate feelings [34
Indeed, self-critics can respond to compassionate imagery with threat responses as measured by reduced heart rate variability [66
], greater amygdala activation [67
] and are less likely to have pleasurable affiliative experiences to compassion imagery when given oxytocin [68
]. In fact, as noted above, when self-critical people are invited to focus on feeling connected and being open to receiving compassion, care and concern from others, this often stimulates feelings of grief or an awareness of “how lonely one feels”, and/or a sense of not deserving compassion [68
]. In addition, research on emotion processing has shown that individuals who are depressed, anxious, insecurely attached or self-critical show diminished emotional processing of affiliative, kind and compassionate social cues such as positive facial expressions [69
So this review shows that compassion is complex, it can be focused on others, self or receiving compassion and there are a range of reasons why individuals may block compassion. Typically, receiving compassion, particularly in the context of distress, is especially difficult for some people. However, affiliative emotions, and the capacity to be emotionally regulated through caring and affiliative relationships are central to human functioning and recovery from depression. Patients
who can't access these evolved systems, because of fear and avoidance, are cut off from major sources of affect regulation and the contexts for developing social cognition [36
]. Hence this area requires further research on affiliative emotion in clinical populations.