What is compassion-focused therapy?

Sometimes, we’re our own worst critic. Living with mental health conditions like depression can make your inner voice even harsher and keep you locked in a cycle of toxic self-critique. Compassion-focused therapy (CFT) was created to help you feel less shame and more compassion, both for yourself and others.

Although CFT is a newer treatment method, research suggests it could be helpful for mental health conditions like depression and eating disorders. Even if you don’t live with a mental health condition, if you have a hard time with harsh self-criticism, CFT could help.

How compassion-focused therapy works

Compassion-focused therapy combines cognitive behavioral therapy (CBT) with other areas of research to help people manage shame and self-criticism. CFT combines elements of neuroscience, evolutionary psychology, and mindfulness. 

Biological evolutionary theories play a big role in how CFT works. CFT practitioners work with the theory that people have evolved to have three separate emotion regulation systems. These biological systems help us survive but can also affect our emotions and behaviors.

According to CFT, these three systems are:

1. The threat system: This system evolved to keep us safe from threats, and it’s linked with the fight-or-flight or stress response. It’s associated with emotions like fear, anxiety, and anger.

2. The drive system: This system is about helping us pursue and achieve our goals. It’s linked with emotions like excitement and pleasure, but it can also turn to shame and self-criticism if you aren’t able to meet your goals.

3. The soothing system: CFT teaches that we’re also all born with a soothing system that helps us feel caring, both for ourselves and others. This system helps us understand that we’re safe and at ease. 

CFT practitioners teach that a lot of our emotional pain comes from the first two systems. One of the goals of this method is to learn how to activate your soothing system more regularly to feel more safe, calm, and content. 

When your soothing system is activated, you don’t feel angry or frightened. You also don’t feel the shame that comes from not meeting your own expectations. Through specific techniques, a therapist can help you tap into your soothing system and learn how to have more compassion both for yourself and others.

Compassion-focused therapy techniques

With CFT, it’s up to each therapist (and client) to decide on how many sessions it’ll take, and what specific interventions to use in each session.

The main technique that’s used in CFT is called compassionate mind training (CMT). CMT has also been adapted to be a stand-alone, structured group intervention ^[1].

Some specific techniques your therapist might use during CMT include:

• Appreciation exercises: These exercises help you pay attention to things in your life that feel pleasant or meaningful. This can strengthen neural pathways linked to contentment and reduce the dominance of your threat system.

• Compassionate letter writing: You write a letter to yourself from the perspective of a compassionate, understanding voice. This can help you practice responding to your own struggles with warmth instead of criticism.

• Mindfulness exercises: Mindfulness helps you notice your thoughts and feelings without judgment. In CFT, mindfulness is used to slow down self-critical thinking so you can access your soothing system more easily.

• Imagery techniques: CFT therapists may guide you through visualizations that help you imagine compassion, safety, or warmth. These images activate parts of the brain linked with caregiving and calm.

• Breathing techniques: Slow, soothing breathing can help bring your body out of a threat or stress state. This can make it easier to feel settled and treat yourself with kindness.

What conditions CFT is used for

CFT is relatively new compared to more established evidence-based practices like CBT. So we need more research to be able to say for sure what mental health conditions it can treat. 

So far, research suggests CFT can help increase self-compassion in people who live with conditions like:

• Depression ^[2]

• Eating disorders ^[3]

• Substance use disorders ^[3]

• Intellectual disabilities ^[4]

You don’t need to live with a mental health diagnosis to benefit from CFT. If you feel like you judge yourself too harshly, feel a lot of guilt, or have perfectionistic tendencies, CFT may be helpful for you. 

CFT might also be helpful for any other condition linked to shame. For example, people who’ve experienced trauma often live with shame and self-criticism. People with neurodevelopmental conditions like attention-deficit hyperactivity disorder (ADHD) often blame themselves for their differences. CFT might be effective in helping you be kinder to yourself in these situations. 

Research has found ^[2] that CFT is not only useful for reducing mental health symptoms, but also for promoting positive mental health in everyone.

How to get started with CFT

If you think CFT could help you experience less shame and self-criticism, it may be worthwhile to try. You don’t necessarily need to choose between CFT and another type of therapy. Research shows ^[5] that combining CFT with another evidence-based therapy method, like CBT, can be helpful. Especially if you’re new to therapy, it might be a good idea to talk to your provider about whether it might be best to do CFT in addition to a more traditional method. 

Only licensed mental health professionals can provide CFT. They don’t necessarily need to have a special certification, but experience is important. When considering a therapist, ask questions like:

• How will you integrate CFT principles and techniques into my treatment?

• What experience do you have using CFT to work with people like me?

• What should I expect during my first few sessions using CFT?

Clinician’s take

People often resist advice like, ‘just be kinder to yourself,’ because it feels vague, unrealistic, or emotionally unsafe when self-criticism has been their coping strategy for years. CFT makes a difference by teaching people how to generate safety, warmth, and support in the body, not just the mind.

Ashley Ayala, LMFT

Clinical reviewer