Novel therapy teaches abuse survivors not to fear kindness

Survivors of abuse, abandonment and neglect who struggle to understand the kind facial expressions of others - such as a smile - could benefit from a novel therapy tool developed by a mental health researcher with expertise in mood disorders.

Patients suffering from anxiety or depression - such as incest survivors and people with attachment disorders - can be highly self-critical and feel threatened by the compassionate of others, responding to them with fear or grief. This can have crippling consequences for the recovery of patients, who may have a limited ability to form meaningful relationships with others and find it hard to relate to their environment.

Research work conducted for her University of Derby doctorate by Dr Kirsten McEwan, who is now based at Cardiff University's School of Medicine, developed a facial stimulus set to assess the degree to which individuals - who scored highly for self-criticism, depression and anxiety - might struggle to process and receive compassion.

The research found individuals scoring highly for self-criticism struggled to process and pay attention to compassionate emotions. This could be a factor in continuing and block therapeutic interventions.

Further to this work, research funding from the Leverhulme Foundation enabled the development of an online 'compassion game', training individuals to recognise kindness and compassion.

This was achieved using a visual search task to retrain the automatic, unconscious biases towards threatening stimuli commonly shown by people with mood disorders. Participants in the study were asked to identify the faces showing compassion among a number of images of actors displaying critical expressions.

Academic journal, Plos One, has just published Dr McEwan's research. It involved national and international collaborations, and her PhD project was jointly supervised by Professor Paul Gilbert, and Drs Sigrid Lipka and Frances Maratos, at the University of Derby.

Kind Faces

Commenting on the research findings, Dr McEwan said: "We found the more self-critical participants were, the less able they were to find kind and compassionate faces amongst an array of more critical expressions. Conversely, participants of a less self-critical disposition demonstrated an enhanced awareness of kind faces.

"The new facial stimulus set was used in a Cognitive Bias Modification Task (CBMT) comprising an online 'compassion game'. Participants practiced this CBMT compared with a control condition online for two weeks.

"We found significant improvements across a variety of self-reported wellbeing outcome measures; including self-criticism, depression, anxiety and stress. The aim of the game is to desensitise patients to compassionate images and rid them of threatening feelings."

She added: "The NHS is currently grappling with the challenge of making unprecedented efficiency savings whilst improving the nation's mental health. This computer-based intervention offers the potential to deliver a cheap and easily accessible treatment for depression and anxiety, in a non-stigmatising environment."

Good Will Hunting

Inspiration for this research came from the anecdotal evidence of Derbyshire Healthcare NHS Foundation Trust clinicians, who observed that difficulties in processing the emotions of others were a big hindrance to patient recovery. In popular culture, this problem is exemplified in the film Good Will Hunting, in which a young genius struggling to come to terms with his abusive childhood rejects the therapy and friendship offered by those outside his circle of friends.

Dr Sigrid Lipka, University Reader in Psychology at the University of Derby, said: "Kirsten's work, conducted as part of her PhD at the University, is a great example of psychological research bringing together various areas of psychology in an interdisciplinary and international collaboration. It is innovative research with real potential for creating considerable practical impact in clinical settings."

There is increasing evidence to show that the ability to process compassion from others triggers the release of natural chemicals such as endorphins and opiates; which aid a significant reduction in anxiety, depression and self-criticism, and regulates how threatened patients feel during therapy.

More information: McEwan K, Gilbert P, Dandeneau S, Lipka S, Maratos F, et al. (2014) "Facial Expressions Depicting Compassionate and Critical Emotions: The Development and Validation of a New Emotional Face Stimulus Set." PLoS ONE 9(2): e88783. DOI: 10.1371/journal.pone.0088783

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