Position paper – CFT for psychosis

Abstract

PurposeThis paper outlines the theoretical and empirical basis for compassion focused therapy (CFT) for psychosis, the gaps in the current knowledge and research, as well as some of the challenges for addressing gaps. It will guide the direction of future work and the steps needed to develop and advance this approach.MethodThis paper reviews evidence of how evolutionary models such as social rank theory and attachment theory have greatly contributed to our understanding of psychosis and provide a clear rationale and evidence base for the mechanisms of change in CFT for psychosis. It reviews the evidence for outcomes of compassion training more generally, and early feasibility evaluations of CFT for psychosis.ResultsThe process evidence shows that people with psychosis have highly active social rank and threat systems, and the benefits of switching into attachment and care systems, which can support emotion regulation and integrative mind states. The outcomes evidence shows that compassion training impacts not only psychological outcomes, but also physiological outcomes such as neural circuits, immune system, and the autonomic nervous system. Within the psychosis field, outcomes research is still in the early days, but there are good indications of feasibility and a clear path forward for the next steps.ConclusionsCFT for psychosis is an approach that integrates biopsychosocial processes, an integration that's evidenced across each aspect of the model, from theoretical foundations (evolution‐informed) to interventions (e.g., body/breath training and relational techniques), to evaluation. Future RCTs are required to understand the effects on biopsychosocial outcomes for people with psychosis.

A case series study of compassion‐focused therapy for distressing experiences in psychosis

“…There is growing evidence for the effectiveness of CFT in targeting these processes across different clinical populations (Millard et al, 2023 ), for example, complex difficulties (Gilbert & Procter, 2006 ), personality disorders (Lucre & Corten, 2013 ), eating disorders (Gale et al, 2014 ) and bipolar affective disorder (Gilbert et al, 2022 ). Theoretical reviews by Gumley et al ( 2010 ), Heriot‐Maitland et al ( 2019 ) and Heriot‐Maitland ( 2023 ) suggest that CFT is ideally suited to address the kinds of threat‐based difficulties experienced by people with psychosis.…”