Using Self Compassion to Enhance CBT Work

People who suffer from anxiety and OCD are quick to be critical of themselves when they are triggered as well as during their CBT treatment. I always note this in therapy and encourage them to find another way to describe what they are experiencing without beating up on themselves. However, while I was attending the International Obsessive Compulsive Foundation’s annual conference last summer, I went to a workshop that discussed recent research that looked at the effects in the brain when people practice self compassion along with Exposure and Response Prevention. They looked at participant’s brain activities who used only ERP vs. those who used ERP and self compassion. They reported that  self compassion enhances CBT with ERP and quiets the part of the brain responsible for anxiety. I found this to be critical information and vowed to teach self compassion to all of my clients as part of their treatment, rather than as a side note.

Self compassion is a fairly simple concept but often difficult for clients to do. We usually start with a conversation about whether their self criticism has been helpful. Then I have them practice putting their hand on their heart and saying, “Even though _______( I have these thoughts, I gave into my worries, I stayed in bed too long, etc.), I love and accept myself”. I have them sit with that experience for a bit and share what it feels like to be kind to themselves. Sometimes, they say, “what if I don’t love and accept my self?”.  This leads to a discussion of what we are working towards: being able to have thoughts and feelings that do not align with the essence of who they are and loving themselves anyway.

Cognitive behavioral therapy is enhanced when our clients are able to be kind toward themselves even when it seems that anxiety and OCD are beating them up. Tara Brach talks about creating a space between the first arrow (the anxiety provoking trigger) and the second arrow (our response to that stressful event). She states that it is the second arrow that is the one that is harmful to us. Teaching your client to take a breath after a trigger, say something kind to themselves, and ride out the anxiety is a healthy way to prevent a response that may harm them by giving anxiety and OCD more power.


For more ways to help your client develop self compassion you can read:

Love thy self: 5 practices for the harsh inner critic

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