Compassion into Practice: Understanding Some Challenges · PDF file@derbyshcft Compassion into...

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Compassion into Practice: Understanding Some Challenges
20 November 2013
Paul Gilbert PhD, FBPsS, OBE
Mental Health Research Unit, Kingsway Hospital Derby [email protected]
www. compassionatemind.co.uk www.compassionatelbeing.com

Darzi Report High Quality Care for All 2008
Compassion mentioned in passing just seven times.
Compassion: We find the time to listen and talk when it is needed, make the effort to understand, and get on and do the small things that mean so much not because we are asked to but because we care.

Darzi Report
Well intentioned but a huge and varied agenda -from quality to prevention, seeking GP and local control, and patient satisfaction. Any clear definition of compassion or evidence that the concept is understood any science? No Any understanding of the facilitators and inhibitors of compassion? No Any advice on how to promote it? No - ish

The Two Psychologies of Compassion
Compassion can be defined in many ways:
As a sensitivity to the suffering of self and others with a deep commitment to try to relieve and prevent it.
Two different Psychologies:
To approach, understand and (how to) engage with suffering
To work to alleviate and prevent suffering nurturing.
Each more complex that might at first seem.

Compassion Focused Therapy and Social Mentality Theory
Caring/Help Giving
Specific Competencies
e.g., attention empathy
Facilitators vs Inhibitors
Care/Help Seeking/Receiving
Specific Competencies
e.g., openness responsive
Facilitators vs Inhibitors
Not just interested in what compassion is but how it is experienced as a recipient experienced are being cared about

Compassion as Flow
Different practices for each
Other Self
Self Other
Self Self
Evidence that intentionally practicing each of these can
have impacts on mental states and social behaviour.

Caring-Compassionate Mind
Care for well-being
Sensitivity Sympathy
Distress tolerance
Empathy Non-Judgement
Compassion
ATTRIBUTES Warmth
Warmth
Warmth
Warmth

Caring-Compassionate Mind
Imagery
Attention Reasoning
Feeling Behaviour
Sensory
Care for well-being
Sensitivity Sympathy
Distress tolerance
Empathy Non-Judgement
Compassion
ATTRIBUTES
SKILLS -TRAINING Warmth
Warmth
Warmth
Warmth

Challenges for
compassionate care

NHS?
Numbers

The brain itself is our biggest challenge!!!

The human brain is the product of many millions of years of evolution a process of conserving, modifying and adapting

Sources of behaviour
Emotions Fear, Anxiety, Anger, Lust, Joy
Social Motives Closeness, Belonging, Sex, Status, Respect
Old Brain
Old Brain Psychologies

New Brain Imagination,
Planning, Anticipation Rumination, Reflection
Purposeful focusing of the mind Integration
Self Identity
New Brain Abilities
Getting Smart

Old Brain: Threat -scanning
New Brain: This is all going wrong
Interaction of old and new psychologies
Loops are key to human difficulties

Old Brain: Emotions, Motives, Relationship Seeking-Creating
COMPASSION
New Brain: Imagination, Planning, Rumination, Integration
Need compassion for a very tricky brain
Mindful Brain

Old Brain: Emotions, Motives, Relationship Seeking-Creating
Competitive
New Brain: Imagination, Planning, Rumination, Integration
Need compassion for a very tricky brain
Mindful Brain

A mind that does not know itself
Dangerous, Cruel and Crazy Mind?

Cruelty from inequality

Desire to make others suffer Bully to torture

Cruelty as Entertainment

Intelligence?

Belsen Concentration camp
http://www.google.co.uk/url?sa=i&source=images&cd=&cad=rja&docid=meWVhdjXOuTvUM&tbnid=8l1YuWiWXm6dHM:&ved=0CAgQjRwwAA&url=http://www.ushmm.org/wlc/en/article.php?ModuleId=10005224&ei=yoA-UrO9F-KJ0AXPuoCIBQ&psig=AFQjCNGqV6NoebB5gFKIr1v4q2wZnZBpGQ&ust=1379914314416512

Submissive and obedient (Milgram)

How is it done
Power dynamics a sense of control bullying/control from the top
Make people fearful (for their jobs)
Subordinate behaviour-slowly accommodating to the system - the path often starts slowly
Over-whelmed nothing we can do just hold on to retirement dont rock the boat or burnt out
Create dissociation from suffering
Threaten whistle blowers
Then threatened people who just want to play it safe for family and themselves!!!!!!

Compassion and cruelty (Gilbert 2005)
To understand compassion requires us to understand how compassion gets turned on and off, people can literally disassociate from pain and suffering.
This is no ones fault but it is linked to how the brain works in certain contexts this
carries huge implications and responsibilities for how we build compassionate societies.

Compassionate mind/mentality
Attention Thinking
Reasoning
Behaviour
Motivation Emotions
Imagery Fantasy Compassion
Our motives organise our minds

Competitive mind can block compassion
Compete
Attention Thinking
Reasoning
Behaviour
Motivation Emotions
Imagery Fantasy

Threatened mind can block compassion
Threat
Attention
Thinking Reasoning
Behaviour
Motivation Emotions
Imagery Fantasy

Compassion and Our Emotions

Understanding our Motives and Emotions
Motives evolved because they help animals to survive and leave genes behind
Emotions guide us to our goals and respond if we are
succeeding or threatened
There are three types of emotion regulation
1. Those that focus on threat and self-protection 2. Those that focus on doing and achieving 3. Those that focus on contentment and feeling safe

Types of Affect Regulator Systems
Incentive/resource- focused
Wanting, pursuing, achieving
Activating
Non-wanting/ Affiliative focused
Safeness-kindness
Soothing
Threat-focused
Protection and
Safety-seeking
Activating/inhibiting
Anger, anxiety, disgust
Drive, excite, vitality Content, safe, connected

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