While psychotic-like experiences themselves are not necessarily distressing, appraisals and responses to anomalies do predict distress, as do factors relating to the social context. This adds support to the cognitive-behavioural models, and continuum models, of positive psychotic symptoms.

This is the first attempt to explore the effects of a CFT-informed approach in acute mental health settings. These groups were well received by staff and patients, with some therapeutic impact despite being comparatively short and set against the background of a busy inpatient ward. These groups can be open and transdiagnostic, with stand-alone topics and practices having positive impacts on distress and calmness. Future studies need to focus on adapting content and pacing for this group of people based on ongoing feedback from participants.

It is not the OOE itself that determines the development of a clinical condition, but rather the wider personal and interpersonal contexts that influence how this experience is subsequently integrated. Theoretical implications for the refinement of psychosis models are outlined, and clinical implications for the validation and normalization of psychotic-like phenomena are proposed.

Objectives There is an increasing interest in how compassion training, and in particular, the cultivation of self‐compassion may be an important component in the reduction of distress and promotion of well‐being. Compassion Focused Therapy (CFT) has shown promising results in this area, with positive outcome studies in a wide range of mental health problems. However, following the successful development of short mindfulness‐based programmes (e.g., Mindfulness‐based Stress Reduction and Mindfulness‐based Cognitive Therapy) and compassion/self‐compassion programmes (e.g., Mindful Self‐Compassion) that can be accessed by the general public, we were keen to develop and research an 8‐week Compassionate Mind Training (CMT) course, based on the CFT model. Design Within‐subjects pre‐to‐post‐group comparison. Methods Following an 8‐week CMT groups, participants in the general population (n = 55) completed pre‐ and post‐measures (with 22 of these also providing 3‐month follow‐up data) on self‐compassion, compassion for others, compassion from others, attachment, self‐criticism, positive emotion, well‐being, and distress. Results Significant increases in compassion, self‐reassurance, social rank, positive emotions, and well‐being were found, alongside reductions in self‐criticism, attachment anxiety, and distress. Changes were maintained at 3‐month follow‐up. Change scores indicated the importance of increases in self‐compassion and reductions in self‐criticism in overall improvements in well‐being and psychological distress. Conclusions Findings offer preliminary support for the usefulness of group CMT in community samples. Practitioner points Compassionate Mind Training (CMT) groups appear to be applicable and beneficial in community samples. CMT psychoeducation and practices appear to bring positive changes to a variety of psychological processes, including attachment, self‐criticism, self‐compassion, well‐being, and distress. Further studies are required to investigate whether the mechanisms through which CMT is beneficial.

This paper presents an outline of voice-hearing phenomenology in the context of evolutionary mechanisms for self- and social- monitoring. Special attention is given to evolved systems for monitoring dominant-subordinate social roles and relationships. These provide information relating to the interpersonal motivation of others, such as neutral, friendly or hostile, and thus the interpersonal threat, versus safe, social location. Individuals who perceive themselves as subordinate and dominants as hostile are highly vigilant to down-rank threat and use submissive displays and social spacing as basic defenses. We suggest these defense mechanisms are especially attuned in some individuals with voices, in which this fearful-subordinate – hostile-dominant relationship is played out. Given the evolved motivational system in which voice-hearers can be trapped, one therapeutic solution is to help them switch into different motivational systems, particularly those linked to social caring and support, rather than hostile competition. Compassion focused therapy (CFT) seeks to produce such motivational shifts. Compassion focused therapy aims to help voice-hearers, (i) notice their threat-based (dominant-subordinate) motivational systems when they arise, (ii) understand their function in the context of their lives, and (iii) shift into different motivational patterns that are orientated around safeness and compassion. Voice-hearers are supported to engage with biopsychosocial components of compassionate mind training, which are briefly summarized, and to cultivate an embodied sense of a compassionate self-identity. They are invited to consider, and practice, how they might wish to relate to themselves, their voices, and other people, from the position of their compassionate self. This paper proposes, in line with the broader science of compassion and CFT, that repeated practice of creating internal patterns of safeness and compassion can provide an optimum biopsychosocial environment for affect-regulation, emotional conflict-resolution, and therapeutic change. Examples of specific therapeutic techniques, such as chair-work and talking with voices, are described to illustrate how these might be incorporated in one-to-one sessions of CFT.