We, at PRIME-RU, are very keen to host guest articles on our website and in newsletters. Below you can read an amazing article by Leah Millard who is PhD student in Clinical Psychology in the University of Manchester.

“A sensitivity to the suffering in our self”: A Brief Introduction to Perinatal Compassion Focused Therapy

Shame and Self-Criticism

The so-called ‘myths of motherhood’ is the preconceived idea that when mothers give birth, they are instantly inundated with a rush of love, that they form an instant connection to their newborn and that mothering is something that just comes naturally. This is the message that is displayed across social media platforms, television, and magazines, despite this not being the experience of many. These expectations may suggest to mothers that they are not doing as well as they should be and may cause feelings of inadequacy and thinking that they are at fault, which can trigger internal shame and self-criticism.

Shame and self-criticism are common across a range of mental health difficulties (Gilbert & Irons, 2004), including those experienced during the postpartum period, such as postnatal depression. Maternal mental health difficulties may also affect the infant. The mother-infant attachment can be potentially disrupted from maternal distress and lead to long-term emotional and cognitive developmental problems within the infant (Stein et al., 2014).

To address internal shame and self-criticism and potential attachment difficulties, Michelle Cree, a consultant clinical psychologist of the Derby Perinatal Mental Health Service, developed an adaptation of Paul Gilbert’s Compassion Focused Therapy (CFT) specifically for those in the postpartum period (Cree, 2010; 2015).

Compassion Focused Therapy

CFT integrates a broad range of areas within psychology, such as neuroscience, evolutionary, social, and developmental psychology as well as being rooted within Buddhist traditions (Gilbert, 2014). In a recent review of 29 studies, Craig et al. (2020) revealed that CFT was effective in reducing symptomology and improving self-compassion across a spectrum of psychological difficulties including anxiety, depression, personality disorders and eating disorders. Such conditions are not uncommon amongst those within the postpartum period; therefore, it raises the question of whether this therapy could be beneficial for mothers.

Defining Compassion

Within CFT, compassion is defined as “a sensitivity to the suffering in self and others, with a commitment to try to alleviate and prevent it” (Gilbert, 2014, p.19). In other words, compassion is learning to engage with suffering, as well as being motivated to learn the skills to reduce it.

To alleviate suffering, CFT applies the six compassionate skills, which are compassionate imagery, attention, feeling, behaviour, reasoning, and sensory skills (Gilbert, 2014). This allows individuals to engage with the six key attributes of compassion (sensitivity, care for well-being, non-judgement, sympathy, sensitivity, and distress tolerance). For example, Cree (2010) noted that distress tolerance is often commonly addressed in perinatal compassion focused therapy (P-CFT) due to the regular distress tolerance techniques not being as accessible due to the infant (e.g., cleaning, going for a run, reading a book). Alongside this, Cree (2010) introduced seven maternal attributes for a secure infant attachment: motivation to care for infant, maternal sensitivity, attunement, emotional regulation, maternal mind-mindedness, nonjudgmental acceptance of infant and warmth toward infant.

Perinatal Compassion Focused Therapy (P-CFT)

P-CFT focuses on the mother’s self-compassion and any difficulties associated with the mother-infant relationship. These difficulties are addressed by explaining how various factors can influence the experience of having a baby and emphasising the importance of the ‘soothing-oxytocin’ system.

CFT is based on the theory of three primary emotional regulatory systems (Gilbert, 2009). The first being the threat system, which has evolved to be a human’s protective system and triggers fight or flight responses. It is often associated with feelings, such as anxiety, anger, or disgust. Secondly, the goal-orientated drive system, which is associated with feelings of excitement or drive. Finally, there is the soothing-oxytocin system that creates feelings of calmness, safeness, and an overall sense of ‘peaceful contentedness’ (Cree, 2015, p.104). These systems are balanced depending on the situation (e.g., if a loved one or a friend is in danger, the threat system will activate and suppress the other systems). Cree (2015) explains that new mothers often move between the threat and drive systems and the soothing-oxytocin system is often not activated.

As the name suggests the soothing-oxytocin system produces oxytocin, which is considered an important element within mother-infant attachment. The levels of oxytocin significantly increase towards the end of the third trimester, during labour and breast-feeding within the first hour of birth, which promotes attachment. However, Gilbert (2014) argued that shame derives from the threat system. In consequence of this, those with high levels of self-criticism and shame have a threat system that is overactivated, and a drive and soothing-oxytocin system that are both suppressed (Gilbert, 2014). An underactive soothing system means less oxytocin is produced, potentially disrupting mother-infant attachment (Cree, 2010). P-CFT aims to facilitate the soothing-oxytocin system by using the compassionate key attributes and skills.

Cree’s (2010, 2015) adaptation is currently being delivered across perinatal services within the Greater Manchester Mental Health (GMMH) NHS Foundation Trust. However, the extent of its benefits amongst those with mental health difficulties in the postpartum period have yet to be established through research. Within PRIME RU, the potential benefits of P-CFT are to be examined through my PhD project. This will involve a mixed methods investigation to determine whether P-CFT may lead to improvements of maternal mental health and the mother-infant relationship.

If you have any comments about this article or any questions regarding my PhD project, please contact me via email at  leah.millard@postgrad.manchester.ac.uk.

Key References

Craig, C., Hiskey, S., & Spector, A. (2020). Compassion focused therapy: A systematic review of its effectiveness and acceptability in clinical populations. Expert Review of Neurotherapeutics, 20(4), 385-400. https://doi.org/10.1080/14737175.2020.1746184

Cree, M. (2010). Compassion focused therapy with perinatal and mother-infant distress. International Journal of Cognitive Therapy, 3(2), 159-171. https://doi.org/10.1521/ijct.2010.3.2.159.

Cree, M. (2015). The compassionate mind approach to postnatal depression: Using compassion focused therapy to enhance, mood, confidence and bonding. Robinson.

Gilbert, P. (2009). The compassionate mind: A new approach to life’s challenges. Constable

Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6-41. https://doi.org/10.1111/bjc.12043