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Research Paper ‘Being kinder to myself ’: A prospective comparative study, exploring post-trauma therapy outcome measures, for two groups of clients, receiving either Cognitive Behaviour Therapy or Cognitive Behaviour Therapy and Compassionate Mind Training Elaine Beaumont, Adam Galpin & Peter Jenkins Background/Aims/Objectives: This prospective, comparative outcome study was designed to contrast the relative impact of differing therapeutic interventions for trauma victims, carried out by the same therapist. Methods/Methodology: A non-random convenience sample (N=32) of participants, referred for therapy following a traumatic incident, were randomly assigned to receive up to 12 sessions of either Cognitive Behaviour Therapy (CBT), or CBT coupled with Compassionate Mind Training (CMT). A repeated measures design was used and data was analysed using analysis of variance. Data was gathered pre-therapy and post-therapy, using three self-report questionnaires (Hospital Anxiety and Depression Scale; Impact of Events Scale; the Self-Compassion Scale). Results/Findings: Results supported two of the three original hypotheses. Participants in both conditions experienced a highly statistically significant reduction in symptoms of anxiety, depression, avoidant behaviour, intrusive thoughts and hyper-arousal symptoms post-therapy. Participants in the combined CBT and CMT condition developed statistically significant higher self-compassion scores post-therapy than the CBT-only group [F(1,30)=4.657, p≤.05]. There was no significant difference between treatment groups. Discussion/Conclusions: The results suggest that CMT may be a useful addition to CBT for clients suffering with trauma-related symptoms. In conclusion, high levels of self-compassion are linked to a decrease in anxiety and depression and trauma-related symptoms. Keywords: trauma; cognitive behaviour therapy; compassionate mind training; counselling psychology. T HIS STUDY aims to explore differences in treatment outcome measures, following a traumatic incident, of either Cognitive Behaviour Therapy (CBT) or CBT coupled with using Compassionate Mind Training (CMT) techniques. CBT is a treatment which challenges the way individuals think and behave, which has been found to be highly effective in treating individuals who have suffered from a traumatic event. It is the recommended therapy for posttraumatic stress disorder (PTSD) (NICE, 2005). It is important to note that, in some cases, individuals that have been involved in a traumatic experience feel significant levels of shame and/or guilt (Jonsson & Segesten, 2004; Lee, 2009). Whilst CBT may be effective in reducing other symptoms of PTSD, these individuals may also benefit from using self-soothing techniques, such as developing empathy, loving kindness and compassion for themselves, in a non-judgemental way (Gilbert & Irons, 2005; Harman & Lee, 2010; Neff, Kirkpatrick & Rude 2007). This might be described in everyday, non-technical Counselling Psychology Review, Vol. 27, No. 1, March 2012 © The British Psychological Society – ISSN 0269-6975 31 Elaine Beaumont, Adam Galpin & Peter Jenkins language, as encouraging the client to consider ‘being kinder to myself’, as an aid to therapeutic recovery, following a traumatic incident. CBT and CMT are powerful therapies to contemplate combining in some fashion and research in this area is still relatively new (Gilbert et al., 2006). Research suggests, however, that through combining CBT and CMT, individuals will learn to challenge their own behaviour, thoughts and negative ‘selftalk’, by being more caring and sympathetic, rather than being critical and judgmental. Counselling psychology is committed to evidence-based practice and aims to provide therapy that is geared toward each individuals needs. The new ‘third wave’ approaches incorporate techniques such as CMT and mindfulness and more focus is put on the therapeutic relationship. This offers counselling psychologists and clinicians the chance to work with individuals using a pluralistic approach as therapy is geared toward the client’s needs (Cooper & McLeod, 2011). CBT and CMT have certain similarities, in that both use assessment, case formulation and work in collaboration with the client. In addition, both examine the role which behaviour, cognition and emotion play and how the body may respond to a perceived threat. However, Lee (2009) proposes that CMT can also act as an effective supplementary therapy to CBT, since it offers a way to work specifically with the crucial emotions of shame, guilt and self-blame. CMT accordingly aims to provide key skills in addition to CBT and, therefore, aims to aid relapse prevention. Table 1 lists some of the key differences between CBT and CMT. Project Aim This research aims to examine differences in treatment outcome measures, following a traumatic incident. Two groups will be compared, with the first group receiving only CBT and the second group receiving CBT combined with CMT. 32 Project objectives (1) To carry out analysis of CBT and CMT, in order to determine the relative effects that both therapeutic interventions have on trauma-related symptoms. (2) To examine the role self-compassion can play, in helping individuals who have been involved in a traumatic incident. Hypothesis There will be a significant difference in outcome measures post-therapy: (1) It is hypothesised that individuals in both groups will have significantly lower scores post- therapy on the Impact of Events Scale, Hospital Anxiety and Depression Scale and higher scores on the Self-Compassion Scale. (2) There will be a significant difference between the two therapy groups. Individuals who receive a course of CBT and CMT following a traumatic incident will have lower scores post-therapy on the Impact of Events Scale and Hospital Anxiety and Depression Scale than individuals in the CBT only group. (3) It is hypothesised that individuals who receive a course of CBT and CMT following a traumatic incident will have significantly higher scores post-therapy on the Self-Compassion Scale than individuals in the CBTonly condition. Methodology A quantitative approach was selected for this research project, whereby data collection is carried out in a systematic manner. While quantitative methods do not necessarily demonstrate unassailable ‘truths’ in the conventional positivist manner, they are, nonetheless, useful in establishing the potential value to counselling psychologists of adopting innovative techniques (e.g. see Goldstein, 2010). Quantitative methods aim to be testable and replicable, affording the experimenter a degree of control over key variables. In this study, the independent variables were the type of therapy provided (CBT or CBT + CMT) and the time of assessment (pre- or post-therapy). The dependent Counselling Psychology Review, Vol. 27, No. 1, March 2012 ‘Being kinder to myself’ Table 1: Some of the differences in approach and treatment techniques used in CBT and CMT. Approach used Cognitive Behavioural Therapy Compassionate Mind Training Reflective approach client-based interventions Writing about the trauma, learning to take charge of the memory. Use of exposure therapy – revisiting the trauma scene, imaginal exposure. Compassionate letter writing – focusing on being kind, supportive and nurturing. Developing sensitivity, sympathy, acceptance and insight into one’s own difficulties through selfreflection. Refocusing attention by reflecting on what would be helpful. Therapist-based interventions Cognitive restructuring to examine core beliefs, dysfunctional assumptions and negative automatic thoughts. Challenging assumptions and thinking errors. Thought balancing/selfmonitoring – paying attention to thoughts and feelings and monitoring them. Use of ‘the empty chair’ technique (experiencing feelings brought up by the ‘internal selfcritic’ and then exploring what the compassionate self could say/do). Exploring self-critical rumination. Educational interventions Anxiety management training, relaxation and distraction techniques. Learning to think objectively. Learning to observe physical, emotional and cognitive reactions. Relaxation techniques. Mindfulness – learning how to pay attention in the present moment without judging or criticising. Learning to observe self (similar to the CBT condition but including self-kindness, warmth and challenging the ‘internal bully’). Therapist based interventions which include reflective tasks carried out by the client as homework tasks Reliving work – exploring the worst memory and using coping strategies. Completion of thought records/charts/cost benefit analysis to explore emotions, thoughts, behaviour and bodily reactions. Examining positives – for example, acknowledging what went well and focusing on specific qualities. Use of Self-compassion diary/journal. Use of imagery to help deal with the problem (imagine the compassionate self dealing with this problem). Counselling Psychology Review, Vol. 27, No. 1, March 2012 33 Elaine Beaumont, Adam Galpin & Peter Jenkins variables were the scores on the questionnaires pre-therapy and post-therapy. Questionnaires were given to participants and scores collated, using Likert-type scales. The three questionnaires used in the study have been found to be reliable measuring tools and have high internal validity (Neff, 2003; Snaith & Zigmond 1994; Weiss & Marmar, 1996). Sample construction A non-random purposive sample of 32 participants was devised for this study. Participants were individuals referred for a course of CBT by a range of agencies, following a trauma-related incident. Table 2 lists the number of participants allocated to each condition and the type of trauma they experienced. Thirty-two participants agreed to take part in the study and were randomly put into one of two groups, depending on the type of trauma-related incident experienced. For example, 12 individuals were referred because of a car accident and were randomly assigned so, that there were six individuals in each group. One group received CBT for up to 12 weeks and the second group received CBT combined with CMT for up to 12 weeks. Procedure and study design All participants received CBT from a single qualified and BABCP-accredited cognitive behavioural psychotherapist (EB). All participants were informed that they would receive CBT, in accordance with NICE Guidelines (NICE, 2005). Participants in the CMT group were advised that, as part of therapy, they would explore and learn techniques which could help them develop empathy for themselves and acceptance of their distress. Three questionnaires were used to collect the data, measuring anxiety, depression, self-compassion and trauma-related symptoms. A repeated measures design was used, with participants completing questionnaires pre-therapy and post-therapy. Individual treatment plans were designed to ensure that the therapeutic interventions employed met the needs of each individual. CBT techniques such as cognitive restructuring, behavioural activation, graded exposure, relapse prevention and Socratic dialogue were used in both conditions. Individuals in the CMT group used imagery by bringing to mind a loving, accepting and caring image which, helped to challenge ‘the internal bully’. Additionally, CMT interventions included compassionate letter writing and grounding work Table 2: Type of trauma experienced and the number of participants allocated to each group. Type of traumatic episode experienced Number of individuals in the CBT-only group Number of individuals in the combined CBT and CMT group Accident at work 6 5 Car accident 6 6 Fatal accident/Traumatic grief 1 2 Diagnosis of life-threatening illness 1 Accident (resulting in disability) 1 Witness of violent crime 1 Sexual assault 1 1 Domestic violence 1 1 TOTAL 16 16 34 Counselling Psychology Review, Vol. 27, No. 1, March 2012 ‘Being kinder to myself’ Results (using a memory trigger such as a precious stone or smell that the individual could associate with relaxation and safety). The data was analysed using a mixed 2 (group: CBT, CBT + CMT) x 2 (time of testing: pre- and post-therapy) Analysis of Variance (ANOVA). Data collection and selection of research instruments Symptoms of depression before and after therapy Data was collected by using three measurement tools. This questionnaire-based method was used, as it is a standardised, effective and economical way of collecting information. The instruments included: The Hospital Anxiety and Depression Scale (Snaith & Zigmond, 1994). The Impact of Events Scale – Revised (Horowitz et al., 1979; Weiss & Marmar, 1996). Self-Compassion Scale (SCS) – Short Form (Raes et al., 2010). The results of the depression questionnaire for both groups pre- and post-therapy can be seen in Figure 1. A significant reduction in depression was observed from a pre-therapy mean score (13.78) to a post-therapy mean score (5.37) [F(1, 30)=223.935, p≤0.001]. The main effect comparing the two types of intervention was not significant, suggesting no difference in the overall levels of depression between the two treatment groups [F(1,30)=2.057, p=.162]. However, a robust interaction between treatment group pre and post-therapy was also observed [F(1,30)=14.734, p≤0.001]. Although mean scores decrease post-therapy in both groups, the CBT group is starting from a lower group mean (12) than the combined CBT and CMT group mean (15.56). The CBT + CMT group proceeds to a lower group mean post-therapy than the CBT group, which results in a greater Ethical considerations Ethical approval was given by the College Research Governance and Ethics Committee at Salford University. The British Association for Behavioural and Cognitive Psychotherapies (BABCP) Ethical Guidelines (2009) and the UK Council for Psychotherapy (UKCP) Ethical Principles and Code of Professional Conduct (2009) were adhered to throughout this study. Table 3: Pre-therapy and post-therapy mean scores and standard deviations for the CBT-only group and the combined CBT and CMT group. Scale CBT Group (N=16) CBT + CMT Group (N=16) Pre-therapy Post-therapy Difference (Mean SD) (Mean SD) (Mean SD) Pre-therapy Post-therapy Difference (Mean SD) (Mean SD) (Mean SD) HADS Anxiety Depression 12.69 (3.72) 12 (4.88) 5.37 (2.33) 5.75 (2.17) 7.32 (3.32) 6.25 (3.71) 14.56 (4.18) 15.56 (3.10) 5.12 (1.41) 5 (1.63) 9.44 (4.32) 10.56 (2.53) IES Avoidance Hyperarousal Intrusion 20.18 (5.42) 15.87 (3.54) 22.25 (4.01) 7.75 (3.97) 5.06 (3.75) 7 (4.35) 12.43 (4.22) 21.56 (3.83) 10.81 (2.9) 13.81 (5.14) 15.25 (5.69) 23.25 (5.22) 5.75 (2.64) 3.44 (2.58) 7.25 (4.04) 15.81 (5.06) 10.37 (4.35) 16 (5) SCS Compassion 1.94 (0.51) 3.21 (0.57) 3.72 (0.57) 1.59 (0.88) 1.27 (0.7) Counselling Psychology Review, Vol. 27, No. 1, March 2012 2.13 (0.75) 35 Elaine Beaumont, Adam Galpin & Peter Jenkins Figure 1: Mean Scores pre-therapy and post-therapy for symptoms of depression in the CBT group and the CBT and CMT combined group. Figure 2: Mean Scores pre-therapy and post-therapy for symptoms of avoidance for the CBT group and the combined CBT and CMT group. 36 Counselling Psychology Review, Vol. 27, No. 1, March 2012 ‘Being kinder to myself’ reduction in symptoms of depression in the CBT and CMT group (reduction=10.56) than the CBT group (reduction=6.25). An independent group’s t-test on scores of the amount of improvement was computed by subtracting post-therapy scores from pre-therapy scores. The results suggest a significantly greater improvement in the CBT+CMT group [t(30)=–3.838, p≤0.001]. In order to examine this two further t-tests were conducted to examine pre-therapy and post-therapy scores for both groups. Prior to therapy the two groups start with significantly different average scores [t(30)=–2.463, p≤0.01]. Final scores reveal no significant difference in average scores [t(30)=1.103, p=.279]. Although there is no significant difference in average scores posttherapy, the improvement was greater in the combined CMT and CBT group. t-tests were conducted to compare pre- and post-therapy scores and the amount of improvement for each group. The mean improvement (12.43) was lower for the CBT group than the combined CMT and CBT group (15.81). The amount of improvement was significantly greater for the CMT + CBT group [t(30)=–2.047, p≤0.05]. In order to examine this two further t-tests were conducted to examine pretherapy scores and post-therapy scores for both groups. Prior to therapy the two groups start with no significant difference in average scores [t(30)=–.829, p=.414]. Final scores reveal no significant difference in average scores [t(30)=1.675, p=.052.]. Although there is no significant difference in average scores post-therapy the improvement was greater in the combined CMT and CBT group. Symptoms of avoidance before and after therapy Symptoms of anxiety before and after therapy The results of the avoidance questionnaire for both group’s pre- and post-therapy can be seen in Figure 2. A significant reduction in avoidance symptoms was observed from a pre-therapy mean score (20.87) to a post-therapy mean score (6.75) [F(1,30)=293.596, p≤0.001]. The main effect comparing the two types of intervention was not significant, suggesting no difference in the overall levels of symptoms of avoidance between the two treatment groups [F(1,30)=0.69, p=.794]. However, a significant interaction between treatment group pre- and posttherapy and symptoms of avoidance was observed [F(1,30)=4.190, p≤0.05]. Although mean scores decrease post-therapy in both groups, the combined CMT and CBT group is starting from a higher group mean (21.56) than the CBT group (20.18). The CBT group proceeds to a higher group mean (7.75) post-therapy than the CBT and CMT group mean (5.75), which suggests a higher reduction in symptoms of avoidance in the CBT and CMT group post-therapy. In order to clarify this interaction a series of The results of the anxiety questionnaire for both groups pre- and post-therapy can be seen in Figure 3. For the anxiety questionnaire there was a highly significant reduction of anxiety symptoms from a pre-therapy mean score (13.62) to a post-therapy mean score (5.25) [F(1,30)=151.187, p≤0.001]. The main effect comparing the two types of intervention was not significant suggesting no difference in the overall levels of anxiety between the two treatment groups [F(1,30)=0.885, p=.354]. No significant interaction between treatment group pre- and post-therapy and symptoms of anxiety was observed [F(1,30)=2.43, p=.129]. Symptoms of hyper-arousal before and after therapy The results of the hyper-arousal questionnaire for both group’s pre- and post-therapy can be seen in Figure 4. A highly significant reduction of hyperarousal symptoms was observed from a pretherapy mean score (14.84) to a post-therapy mean score (4.25) [F(1,30)=262.657, Counselling Psychology Review, Vol. 27, No. 1, March 2012 37 Elaine Beaumont, Adam Galpin & Peter Jenkins Figure 3: Mean Scores pre-therapy and post-therapy for anxiety symptoms in the CBT group and the combined CBT and CMT group. Figure 4: Mean Scores pre-therapy and post-therapy for the CBT group and the combined CBT and CMT group. 38 Counselling Psychology Review, Vol. 27, No. 1, March 2012 ‘Being kinder to myself’ p≤0.001]. The main effect comparing the two types of intervention was not significant [F(1,30)=2.365, p=.135]. And no interaction between treatment group and time of assessment pre-therapy and post-therapy was observed [F(1,30)=.112, p=.740]. Symptoms of intrusion before and after therapy The results of the intrusion questionnaire for both group’s pre- and post-therapy can be seen in Figure 5. A highly significant reduction in symptoms of intrusion was observed from a pretherapy mean score (22.75) to a post-therapy mean score (7.12) [F(1,30)=272.846, p≤0.001]. The main effect comparing the two types of intervention was not significant [F(1,30)=.250, p=.621] and no significant interaction was observed [F(1,30)=.157, p=.695]. Self-compassion before and after therapy The results of the self-compassion questionnaire for both groups pre- and post-therapy can be seen in Figure 6. For the self-compassion questionnaire there was a highly significant main increase of self-compassion symptoms from pretherapy mean score (2.04) to post-therapy mean score (3.47) [F(1,30)=103.036, p≤0.001]. The main effect comparing the two types of intervention was significant, suggesting a difference in the overall levels of self-compassion post-therapy between the two treatment groups [F(1,30)=4.657, p≤.05]. The CMT and CBT group mean increases to (3.72) and the CBT group mean increases to (3.21). However, no interaction was observed [F(1,30)=1.292, p=.265]. Analysis and discussion of findings The results indicate that participants in both the CBT-only and combined CBT and CMT treatment groups experienced highly significant reductions in symptoms of anxiety, depression, avoidant behaviours, intrusive thoughts and hyper-arousal. Additionally, the results indicate that participants in both conditions experienced a statistically significant increase in self-compassion. Statistical analysis indicates that participants in the combined CBT and CMT treatment group developed more self-compassion posttherapy than the participants in the CBTonly treatment group. However, the analysis indicates no statistically significant difference between both treatments in terms of reduction in symptoms of avoidance, intrusive thoughts, hyper-arousal, anxiety and depression. Therefore, the findings from this study support the first hypothesis, i.e. that individuals in both conditions would have lower scores post-therapy on the Impact of Events Scale, Hospital Anxiety and Depression Scale and higher scores on the Self-Compassion Scale. The findings from the study, however, do not support the second hypothesis that there would be a statistically significant difference between the two therapy groups post-therapy. Individuals who received a course of CBT combined with CMT, following a traumatic incident, did report lower scores post-therapy on the IES and HADS questionnaires, but the difference was not significant. However, the results suggest that participants in the combined CBT and CMT condition did report fewer symptoms of anxiety and depression post-therapy and reported higher scores on the HADS and IES pre-therapy. The only exception to this was on the hyper-arousal scale, where individuals in the CBT-only condition reported higher scores pre-therapy than the combined CBT and CMT treatment group. This, incidentally, supports the findings of Gilbert and Proctor (2006), who found a significant reduction in symptoms of anxiety, depression, self-criticism and an increase in feelings of self-warmth and selfcare in clients in a group-setting (N=6), suggesting that CMT can be an effective therapeutic intervention. The findings from this study also support the third hypothesis, i.e. that individuals who receive a course of combined CMT and CBT, Counselling Psychology Review, Vol. 27, No. 1, March 2012 39 Elaine Beaumont, Adam Galpin & Peter Jenkins Figure 5: Mean Scores pre-therapy and post-therapy for the CBT group and the combined CBT and CMT group. Figure 6: Mean Scores pre-therapy and post-therapy for the CBT group and the combined CBT and CMT group. 40 Counselling Psychology Review, Vol. 27, No. 1, March 2012 ‘Being kinder to myself’ following a traumatic incident, will have significantly higher scores on the Self-Compassion Scale than individuals in the CBT-only group. The results are consistent with the findings of Neff, Kirkpatrick and Rude (2007), who found that CMT increased selfesteem and self-compassion, with a sample of college students (N=91). The results from the present study are consistent with the results found by Thompson and Waltz (2008). These researchers found a correlation between symptoms of avoidance, self-criticism and self-compassion. In their study, students who scored higher on the SCS scale engaged less in avoidant behaviours and students who reported a traumatic event were more self-critical and self-judgemental. However, as this was a correlational study, it is difficult to establish cause and effect. However, the results do suggest that individuals suffering with PTSD symptoms could benefit from developing loving kindness and self-compassion. Furthermore, the findings from the present study support the work of Brewin et al. (2000), Ehlers and Clark (2000) and Grey et al. (2001) who found negative emotions, such as shame and worry about current threat, leads to avoidant behaviours. However, although in the present study there was a significant difference between the two therapy groups and measures of self-compassion post-therapy, there was no statistically significant difference post-therapy for avoidant symptoms. The scores on the avoidant scale for participants in the combined CBT and CMT group were higher to begin with before therapy and lower after therapy, than the CBT-only group. This suggests that individuals benefited from using techniques which helped develop self-compassion, as this in turn helped them reduce avoidant behaviours. The reason that results may not be statistically significant for each of the subscales on the HADS and IES could be because participants were not allocated to groups depending on scores from the questionnaires. This may be a flaw within the design of the research, as the mean scores pre-therapy were slightly higher in the CMT condition for each subscale, apart from hyper-arousal. If participants in the present study had been allocated to one of the two treatment groups depending on scores from the questionnaires, there may then have been a significant statistical difference in the results. However, participants had been allocated to one of the two groups depending on the type of trauma experienced, for example, traffic accidents, accidents at work and so on. Further research could therefore examine type of personality, social support offered at home and/or work and individual resilience, as any of these external variables could have had an effect on therapy outcome. Limitations of the study Although the results suggest an improvement in both conditions, there was no ‘no-treatment’ comparison group. Therefore, individuals may have improved because of external factors (Corney & Simpson, 2005). Another limitation of the current study derives from the small sample size (N=32), potentially limiting generalisability to other populations. Initially it was thought that dropout rates would be a limitation of this study, however, this was proved not to be the case, as 32 out of the original 36 individuals completed therapy. Despite these limitations, the present study does, however, have relatively high ecological validity, because it examines the role trauma-related symptoms and self-compassion play in a real-life setting with individuals referred for a therapeutic intervention. Further research could use a mixed methods approach as qualitative data could have provided detailed information about the subjective experience of each client. Reflection, summary and conclusions This paper has explored differences in treatment outcome measures, following a posttrauma course of either CBT on its own, or CBT combined with CMT. Thirty-two individuals took part in this study and a repeated Counselling Psychology Review, Vol. 27, No. 1, March 2012 41 Elaine Beaumont, Adam Galpin & Peter Jenkins measures design was used, as individuals completed questionnaires pre-therapy and post-therapy. There was a statistically significant improvement in both groups posttherapy. The results show that individuals in the CMT group reported significantly higher scores (i.e. developed more self-compassion) post-therapy on the Self-Compassion Scale, than individuals in the CBT-only group. Furthermore, the mean scores suggest symptoms of avoidance, anxiety, depression, intrusion and hyper-arousal reduced more in the combined CBT/CMT group, although the statistical analysis shows that there was no significant difference between the two treatment groups for these symptoms. The findings from the study support the work of various theorists, including Ehlers and Clark 2000; Gilbert and Proctor, 2006; Harman and Lee, 2010; Neff, Kirkpatrick and Rude, 2007; and Thompson and Waltz, 2008. However, a degree of caution is required in the interpretation of the results, particularly as CMT as an intervention has not yet been fully subjected to extensive, rigorous evaluation. Counselling psychology welcomes the opportunity to integrate new developments within existing therapeutic approaches (O’Brien, 2010). It is essential that new treatment options be examined so that we as a counselling and psychotherapy profession provide therapy that meets our client’s needs. The present study adds to the debate surrounding the new ‘third wave’ approaches, which suggests that compassion based approaches can help create feelings of soothing, loving kindness and safeness. One individual made a very moving comment near the end of therapy: ‘Learning to be kind to myself is the greatest gift I have ever treated myself to.’ 42 A much-reported weakness of CBT is that individuals may say that they understand the logic of the approach, but report that they do not ‘feel any better’ (Gilbert, 2010; Grant et al., 2010; Leahy, 2001). The results presented in this paper suggest that, in order to feel differently, individuals could benefit from developing self-compassion and by learning to access their own emotional regulation systems (Gilbert, 2010). Therefore, individuals may feel more benefit from therapy by learning to understand why they feel the way they do. This process can be assisted by clients learning to challenge selfcriticism and their own ‘internal bully’ in a non-judgemental way, by their adopting the stance of ‘being kinder to myself’. About the Authors Elaine Beaumont is a Cognitive Behavioural Psychotherapist (BABCP Accredited and UKCP Registered) and a Lecturer in Counselling & Psychotherapy at the University of Salford. Adam Galpin is a Senior Lecturer in Psychology at the University of Salford. Peter Jenkins is a Senior Lecturer in Counselling, University of Manchester Correspondence Elaine Beaumont Lecturer in Counselling and Psychotherapy, School of Nursing, Midwifery and Social Work, University of Salford, Frederick Road Campus, Allerton Building Room L818, Salford M6 6PU. Email: [email protected] Tel: 0161 295 2388 Counselling Psychology Review, Vol. 27, No. 1, March 2012 ‘Being kinder to myself’ References British Association for Behavioural Counselling and Psychotherapy (BABCP) (2009). Standards of Conduct. Retrieved 4 January 2010, from: http://babcp.com/news/new-standards-ofconduct-adopted/. Brewin, C.R., Andrews, B. & Rose, S. (2000). 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