Depression: symptoms, causes, how to heal

Index of the depression page

  • What is depression?
    • Genetic factors of depression
    • Biological factors of depression
    • Psychosocial factors of depression
  • Symptoms Of Depression – What Are The Symptoms Of Depression?
    • The most common somatic symptoms of depression are:
    • Typical emotional symptoms of depression in depressed people are:
    • The main behavioral symptoms of depression are:
    • The main cognitive symptoms, on the other hand, are:
  • Causes of Depression – What Are the Causes of Depression?
    • Genetic factors that can cause depression
    • Biological factors that can cause depression
    • Psychosocial factors that can cause depression
  • Mechanisms for maintaining depression – what are the mechanisms for maintaining depression?
    • The depressogenic schemes
    • Rumination
    • Evaluation of one’s depressive symptoms
  • Healing Depression – How is Depression Treated? How can depression be cured?
    • Healing from depression with behavioral techniques
    • Healing depression with cognitive techniques
    • The ABC model – a technique for identifying and monitoring automatic thoughts
  • Preventing Depression Relapse – How Can You Prevent Depression Relapse?
    • Why Does Depression Return?
    • Preventing the relapse of depression with Mindfulness-Based Cognitive Therapy (MBCT)
    • Preventing relapse with Compassion Focused Therapy (CFT)
  • Depression: Insights into the topic of depression
  • Depression: News from the AT Beck Institute on Depression
  • Do you need help?
  • Download our free brochures
    • “Depression” by Dr. Antonella Montano and  Dr. Roberta Borzì
    • “Anxiety and panic disorder” by Dr. Antonella Montano and  Dr. Roberta Borzì

What is depression?

The depression has been called “the evil of the century”, he hears about more and more often but not everyone knows really what it is. The depression is a mood disorder, that is, the psychic function that accompanies adaptation to our inner world, the psychological and the external one: the tone is high when we are in pleasant conditions, goes down when we live in unpleasant situations.

The depression is a mood disorder that affects over 350 million people in the world without distinction of sex, age, social status.

Those suffering from depression experience persistent anguish, loss of interest in activities that normally give pleasure and difficulty in carrying out even the simplest daily actions, for at least two weeks, sometimes with negative consequences on interpersonal relationships. However, depression can be prevented and treated – adequate knowledge of depressive disorder can help reduce associated stigma and motivate people to seek help.

People with depression perceive themselves as inadequate and worthless, they view their surroundings as “hostile” and unsupportive, and the future appears uncertain and full of difficulties. Specifically, they experience some of the following symptoms: loss of energy, change in appetite, insomnia or hypersomnia, anxiety, reduced concentration, indecision, restlessness, feelings of worthlessness, guilt or hopelessness, thoughts of self-harm or suicide.

The ideas of death are intrinsic to depressive pathology , characterized by themes of guilt, unworthiness, ruin and are supported by the belief that there is no other way out of the condition of suffering and that, therefore, the only way to relieve pain. emotional and no longer represent a burden for others is to commit suicide.

Depression genetic, biological and psychosocial factors

Thinking that depression is due to a single cause is not really correct; it is a multifactorial disorder where genetic, biological and psychosocial aspects interact with each other.

Genetic factors of depression

There is a number of empirical evidences that prove the important hereditary component in depression. Studies show an increased risk (5% – 25%) of developing a similar disorder in first degree relatives of patients with major depression. This does not mean that depression is inevitable, but that you can be vulnerable to the disorder. The genetic factor does not fully explain the occurrence of the disorder.

Biological factors of depression

Depression derives from an alteration in the function of the monoaminergic systems ( noradrenaline (NA), serotonin (5HT) dopamine ), which contribute to the appearance of somatic, cognitive, emotional and relational disorders; both serotonin and noradrenaline carry out their action within brain nuclei responsible for the control of a whole series of functions that are altered in depression (modulation of mood, regulation of affectivity, control of some cognitive functions, regulation of sleep and appetite, motivation)

Psychosocial factors of depression

The stressful events favoring the development of depression are experienced by the subject as irreversible, irreparable and total losses. Some of these can be:

  • Physical illnesses
  • Marital separations
  • Difficulty in family relationships
  • Serious conflicts and / or misunderstandings with other people
  • Important changes in role, home, work,
  • Layoffs
  • Business or economic failures
  • Being the victim of a crime or abuse even as a child
  • Loss of a loved one
  • Breakup of marriage or engagement
  • Problems with justice
  • Failures at school

Depressed people feel unable to cope with situations and consider themselves inferior to others and this implies an invalidation of the individual and of his entire existential perspective: past, present and future.

The depression left untreated can prevent people to work and to participate in family and social life, to arrive at a real social disability and employment and therefore a heavy impact on the quality of life of the person and those around him next. The American Heart Association (2014) found that depression is associated with an increased risk of developing cardiovascular and cerebrovascular disease. Depression, if left untreated, worsens heart failure outcomes and is associated with higher mortality.

Symptoms Of Depression – What Are The Symptoms Of Depression?

  1. Dalì, “Thoughts” (1925)

It is correct to speak of depression only when the mood loses its natural character of flexibility, that is, when it is always low and is no longer influenced by favorable external factors, causing discomfort and interfering with normal activities, life and freedom of act of a person.

Characteristic of depression is the tendency to evaluate every situation in a negative and pessimistic way, which is why it represents a pathology of cognitive patterns, thoughts and sensations that make us feel ” down in the dumps “; it occurs when you feel that all positive feelings about the future are gone and you feel unable to appreciate the pleasurable aspects of life. The loss of the ability to feel pleasure, joy, affection and amazement takes the name of ANEDONIA: this factor represents the main character of depression .

It is often believed that depression is a simple lowering of mood, instead it must be kept in mind that to characterize depression is a set of symptoms that compromise the way a person thinks, thinks and portrays himself, others and the outside world. .

Feeling depressed means seeing the world as if you were wearing glasses with dark lenses: everything becomes gray, dull and difficult to deal with, even carrying out normal daily activities such as getting out of bed, washing, calling a friend, shopping.

The depression , which in the video is called the “black dog” presents different symptoms, such as, lack of appetite, sleeplessness, lack of concentration, irritability, sadness, social isolation, etc., which are to have a heavy impact on quality of life person who suffers from it, to the point of believing that dying is the only way out. Obviously this is not the case: seeking help is essential because healing from depression is possible.

More specifically, depression manifests itself through numerous symptoms, which can be summarized in four broad areas: somatic symptoms, emotional symptoms, behavioral symptoms, cognitive symptoms:

The  most common somatic symptoms of depression are:

  • loss of energy,
  • sense of fatigue,
  • impaired concentration and memory,
  • motor agitation and nervousness,
  • weight loss or gain,
  • sleep disturbances (insomnia or hypersomnia),
  • lack of sexual desire,
  • physical pain,
  • sense of nausea.

 Typical emotional symptoms of depression in depressed people are:

  • sadness,
  • anguish,
  • despair,
  • sense of guilt,
  • empty,
  • lack of hope in the future,
  • loss of interest in any business,
  • irritability and anxiety.

The main behavioral symptoms of depression are:

  • reduction of daily activities,
  • avoidance of people and social isolation,
  • passive behaviors,
  • reduction of sexual activity
  • suicide attempts.

The main cognitive symptoms, on the other hand, are:

  • ideational slowdown,
  • inability to make decisions,
  • impaired concentration and memory,
  • depressive rumination,
  • negative thoughts about yourself, the world and the future,
  • ideas of guilt, unworthiness, ruin,
  • self-depreciation,
  • self-pity,
  • perception of slowed down time,
  • perception of the current state of mind as an endless condition.

The above is amply supported by DSM 5 (2013), thanks to which it is possible to detail the depressive symptomatology with respect to its course (for example, seasonal) and its severity (mild, moderate, severe). In addition, the DSM 5 can specify the current clinical status of the major depressive disorder or the characteristics of the most recent episode, in complete remission: with mixed manifestations, catatonic, melancholic, atypical, with anxiety, mild to severe, with serious risk. suicide and with onset in the postpartum.

Causes of Depression – What Are the Causes of Depression?

  1. Kahlo, “The wounded deer” (1946)

The depression is a disease that results from the combination of factors that interact with each other and that varies from person to person. These factors can be grouped into three main categories: genetic, biological and psychosocial factors. It occurs mainly in women and has a strong hereditary component.

Factors which, in combination, can cause depression:

Genetic factors that can cause depression

The genetic hypothesis has been supported by many and numerous studies prove that first degree relatives of patients with major depression have a greater risk of developing the same disorder; obviously it is important to keep in mind that being vulnerable to a disorder does not necessarily mean developing it.

Biological factors that can cause depression

Most of the communication between cells in the nervous system is the work of chemicals called neurotransmitters. Depression would be due to the insufficient activity of some neurotransmitter systems (for example, the monoaminergic ones) and to the consequent different functionality of specific brain areas that regulate sleep, appetite, sexual desire and mood. The depression may be connected to a hypersensitivity of the Central Nervous System to changes of estrogen and progestin, both related to the menstrual cycle that childbirth.

Although depression has generally been explained by the monoamine theory, it is much more multifactorial. In this context, Jeon and Kim (2018) have provided an understanding of neuroinflammation and neurovascular dysfunction in depression that would allow for a more comprehensive approach to the disorder.

Inflammation is an allostatic load (state of altered physiological activity) involving the immune, endocrine and nervous systems. Neuroinflammation is involved in the pathophysiology of depression by increasing proinflammatory cytokines, activating the hypothalamus-pituitary-adrenal axis, increasing resistance to glucocorticoids and influencing the synthesis and metabolism of serotonin, neuronal apoptosis and neurogenesis and neuroplasticity. The vascular depression hypothesis is supported by evidence of the association between vascular disease and late-onset depression and between ischemic brain lesions and depressive symptoms.

Psychosocial factors that can cause depression

The stressful events favoring the development of depression are experienced by the subject as irreversible, irreparable and total losses.

The content of thoughts associated with depression, as Beck himself had already observed, is typically characterized by a negative view of the individual himself, his future and the world. The main themes are failure , inability and hopelessness . In a note, dated January 11, 1965, Beck underlined the presence of three depressogenic cognitive patterns whose main themes were: loss, hopeless and self-blame. Beck will later call these issues “negative expectations about oneself, the world and the future,” concepts that will become known as the “cognitive triad” of depression. The depression it can be caused by a single event or a series of stressful events that can induce a sense of discomfort, such as:

  • Physical illnesses
  • Marital separations
  • Difficulty in family relationships
  • Serious conflicts and / or misunderstandings with other people
  • Important changes in role, home, work,
  • Layoffs
  • Business or economic failures
  • Being the victim of a crime or abuse even as a child
  • Loss of a loved one
  • Breakup of marriage or engagement
  • Problems with justice
  • Failures at school

The presence of childhood traumatic experiences can also generate emotional suffering that will lead to a depressed mood, with despair and a sense of helplessness.

Mechanisms for maintaining depression – what are the mechanisms for maintaining depression?

  1. van Gogh, “Wheatfield with the Flight of Crows” (1890)

Mechanisms for maintaining depression, what keeps depression ?

Depression maintenance factors are those mechanisms that can stabilize and chronicize what could sometimes be an   isolated depressive episode .

People who have been depressed react to sadness or a change in mood differently than people who have never been, and this depends on a distinctive feature of our memory system. Contexts, in fact, activate memories: for example, if we find ourselves listening to a song, this can bring out a possible memory of the past that we may not have thought of for years, a place, a person, a particular occasion.

Furthermore, it is known that when we learn something new the chances of recalling it are greater if we recall it in the same environment in which we learned it. Applying this same principle to the context of our thoughts and mood, when we feel sad, discouraged or depressed, we will probably also have negative thoughts of self-criticism related to that particular state of mind. So every time we experience a negative emotion again for any reason, our mind will tend to recall those negative thoughts.

In light of this, each time we have another period of  depression , the connection between depressed mood and negative thoughts will consolidate, thus raising the probability that the cycle will repeat itself (Siegel, 2012).

Here are the main mechanisms that keep the disorder:

The depressogenic patterns :

the concept of schema highlights why a depressed patient continues to suffer and feel defeated despite the facts demonstrate the presence of positive aspects and events in his life. The patterns explain the maintenance of lasting negative attitudes towards oneself, the world and the future that individuals may have built since childhood. The depressed person will tend to interpret current events as a confirmation of pre-existing depressogenic patterns, selecting and distorting all other available information.

Rumination :

the constant work that the patient does on his depressive thoughts, will lead him to increase and maintain  depression  because it will make him stay focused on the negative thoughts, responsible for lowering the mood. This process is called rumination : it is a repetitive form of attention paid to oneself, to the fact that one is depressed, to one’s symptoms and their causes, meanings and consequences, characterized by recurrence and persistence (Nolen-Hoeksema, 1999); it represents a wrong way, based on emotions and centered on the person, to face the problematic situation that one lives, that is to fight the depressed mood.

Ruminating on thoughts, on losses, on failures, on the way of being, constantly retracing the same thoughts only gives the illusion that sooner or later you will feel better, instead the only thing that rumination leads to is to keep the person focused. only on the negative and catastrophic aspects of them, increasing the suffering and therefore the depressed mood .

Evaluation of one’s depressive symptoms :

often, the person suffering from depression tends to criticize and devalue himself precisely because he is depressed, ill, defective. Sometimes, to avoid this form of personal criticism, the individual tries to implement attempts at solution and takes measures, which, however, prove useless and can further aggravate the problem itself.

For example, if the depressed person feels tired and without energy, he will reduce his daily activity, without knowing that passivity and inactivity have, instead, the effect of increasing the sense of fatigue, so he will feel even more without energy. and he will be more convinced that he cannot do anything; as a result, her sense of inadequacy will increase , her belief that she is ill, with no way out. This leads the person to isolate himself , keeping even the closest family members at a distance, who could react, in turn, with rejection and criticism; this external response will be interpreted as a confirmation of one’s negative beliefs, with a consequent increase in self – criticism and isolation .

Healing Depression – How is Depression Treated? How can depression be cured?

CD Friedrich, “The Wanderer on the Sea of ​​Fog” (1818)

In a 2018 study by Ijaz et al. Psychotherapy, added to traditional drug therapy (with antidepressants), has been highlighted to be beneficial for depressive symptoms and for short-term response and remission rates for patients with TRD (treatment-resistant depression). The medium- and long-term effects seem equally beneficial.

The  Cognitive – Behavioral Therapy  of depression is based on the combined use of behavioral and cognitive techniques. Considering the difficulties of attention, concentration, memory of the depressed subject , it is not advisable to intervene immediately on thoughts and emotions and consequently behavioral techniques are used first; as soon as the patient begins to engage in some purposeful constructive activity and there is, therefore, an improvement in mood and a modification of negative beliefs about their abilities and possibilities for change, it is possible to start working more directly on the cognitive components Technical specifications.

Healing from depression with behavioral techniques

The Behavioral Techniques are used above all in the first phase of treatment and have the purpose of promoting BEHAVIORAL ACTIVATION . Depressive symptoms dramatically change people’s lives, daily activities, and behavior. Many of these changes make the problem worse.

For example, lack of motivation or energy leads the depressed person to cut back on activities, neglect daily tasks and responsibilities, leaving others to make decisions often.

As we have already said, when you reduce your activities you tend to become less and less motivated, more tired and with less energy, triggering a vicious circle that thus determines a further worsening of the mood.

Deciding not to do the things you usually love to do anymore necessarily precludes the possibility of experiencing positive emotions and events.

Daily responsibilities and work tasks pile up because you don’t have the strength to do them, and just thinking about this growing list of missed activities can cause guilt or confirm your idea of ​​being inadequate, unable or failed, making it even worse. depressive state.

One way to break this vicious circle is to increase your current level of activity, especially the pleasant ones. This gives the possibility, in fact, to think about something else, not to ruminate and to look forward, thus slowly regaining control of one’s life and reliving again the pleasure of experiencing positive emotions.

We must not start by proposing to do too many activities all at once, because when you are depressed even the single actions that previously did not require any effort become a huge obstacle to overcome and seem to require a lot of energy.

Since thoughts such as “it’s too hard”, “I’ll never make it”, “I don’t have the strength” or “I won’t have fun doing it” may block, an initial goal might be to do a task that requires little. time.

Everyone will choose a task, even a small one, to start with .

To help you, in the complete brochure  you will find a list of enjoyable activities from which you can select the ones you want to include in your weekly program (page 12), a scheme in which to indicate the date and activity you have done, as well as the level of perceived depression, a sense of mastery and pleasure (page 13) and a weekly program of activities (page 14).

Healing depression with cognitive techniques

Cognitive Techniques allow those suffering from depression to become aware of their thoughts and beliefs to learn how to modify them, thus managing their suffering.

The cornerstone of Cognitive – Behavioral Therapy of emotional disorders, and therefore also of depression , is: “The way you think affects the way you feel”.

People, especially during episodes of intense depression , fail to understand that their thoughts influence their moods and that they play an important mediating function between the situation and the emotion with the consequent physiological reaction and between the situation. and behavior.

Let’s see with a practical example how thoughts influence the state of mind .

Imagine being invited on a blind date.

You meet this person in a place full of people and you start talking, but after introducing himself he / she just answers your questions without looking you in the eye and looking elsewhere.

Imagine the emotions you might feel if these three different thoughts crossed your mind:

  • What a rude person! He doesn’t even look at me while I talk to him / her! But why did he invite me!
  • Perhaps he is thinking that I am not interesting and that I am boring.
  • Maybe he’s shy and doesn’t look me in the eye.

Most likely, these three thoughts of evaluating the behavior of the other described above are associated with three different emotional reactions. In the first case, for example, you will feel anger or frustration; in the second, disappointment and in the third hope.

Therefore, it is not the event itself that determines what you feel, but the way you interpret the situation through your thoughts.

In Cognitive – Behavioral Therapy there are two streams of thought, one of which we are most aware called voluntary thoughts , and others so fast and immediate that they are defined as ” automatic “. Often, precisely because they are so fast, we do not have the awareness of the presence of automatic thoughts, but we have it more than the resulting emotions and the related physical sensations that accompany them.

The ABC model – a technique for identifying and monitoring automatic thoughts

Learning to recognize and modify automatic dysfunctional thoughts can positively affect your mood. Typical negative automatic thoughts that run through the minds of depressed people are: “I’m a failure! I will never be able to do anything! I’m a fool ”,“ They all consider me a fool and a loser, and they will surely leave me alone! ”.

ABC analysis is a technique for identifying and monitoring automatic thoughts.

A Triggering event
First you need to identify A which represents an event or a situation in which you have experienced a strong negative emotion such as depression.

Point A describes the situation in the same way a camera would record it, that is, by telling only the facts, without reporting opinions and / or feelings.

A = Yesterday I was walking on the street and there were a lot of people around me. At one point I notice a friend of mine who is walking right in my direction, but when he comes near me he doesn’t say hello and passes by.

C Emotional and behavioral consequences
The next step is to identify C, which includes the emotions and behaviors that followed the event A. First, therefore, after identifying A, we need to identify the emotions felt in that situation and assign a score of intensity on a scale ranging from 0 to 100 (the higher the number the more intense the emotion). You can also write down the behaviors you adopted in that situation, such as going home immediately.

C = sadness 40%, disappointment 80%, upset 60%. I’ll go home right away

B your thoughts
At this point, the B’s are identified, the thoughts, that is what goes through your head at that moment.

B = – He saw me and didn’t even greet me! – Surely he didn’t want to talk to me and pretended not to see me – He must have thought he didn’t want to waste time with a boring person like me!

After identifying A and C, therefore, to facilitate the identification of thoughts (B) we can ask ourselves : “What was I thinking when the event occurred?”, “What was going through my mind?”.

With the therapist’s help, the patient learns to discuss the thoughts that cause one to experience a negative emotion and to formulate alternative and more functional explanations (building a list as long as possible). This cognitive discussion has the function of helping the patient to distance himself from his thoughts and to begin to consider them as psychological events and not as data of reality.

Preventing Depression Relapse – How Can You Prevent Depression Relapse?

  1. van Gogh, “Old man in sorrow” (1890)

Preventing the relapse of depression

The  depression  is often a chronic condition that has some consequences that, although minor, interfere with normal daily activities and prevent the person to appreciate life and enjoy it fully.

Why Does Depression Return?

When people, for whatever reason, start thinking more negatively, depression reappears  , because it is the thought that creates the emotion. During the first depressive episode, however, this negativity does not emerge immediately when the first thoughts are formulated, but it takes some time. After repeated depressive episodes, strong associations are formed and this means that even a small trigger, such as a normal mood drop, can be interpreted negatively and thus become a critical starting point for the reappearance of depression .
From this critical point a spiral of negative ruminative thought is triggered which can progressively lead to a sense of despair. Feeling hopeless then leads to social withdrawal and the avoidance of an increasing number of situations. Once the old thoughts are activated, often unconsciously, it is difficult to break free from the vicious circle that triggers a new depressive episode, because it is often the result of an instinctual reaction, just as it is to break free from quicksand (Segal, Williams & Teasdale, 2013).

It is of enormous importance to remember that even when people feel good, the link between the negative mood and negative thoughts remains ready to be reactivated. This implies, therefore, that in order to change one’s attitude towards  depression it  is necessary to learn the strategies to prevent that, through rumination, one ends up again in a spiral out of control, even starting from a slight decrease in mood.

Preventing the relapse of depression with Mindfulness-Based Cognitive Therapy (MBCT)

Studies by Zindel Segal (Toronto), Mark Williams (Wales) and John Teasdale (Cambridge) have given birth to the Mindfulness-Based Cognitive Therapy (MBCT) program . This protocol, which is a reworking of Jon Kabat-Zinn’s work on  the Stress Reduction Program (MBSR) already experimented on more than 24,000 patients in the last 20 years at the University of Massacchusetts, he investigated how meditation can help people get better after being successfully treated for depression. The work of Segal, Williams and Teasdale has been based on the observation that, once a patient has recovered from a depressive episode, a relatively small amount of negative mood, which can present itself, as we have said, for any reason, can re-trigger a great deal of classic negative thoughts of depression.

“I am a failure”, “I am weak”, “I am worthless”, “I am hopeless” bring with them physical sensations of weakness, fatigue or inexplicable pain. Both negative thoughts and fatigue often seem, in the eyes of others, disproportionate to the situation.

Patients who believe they are cured may feel back to square one.
They find themselves in a ruminative loop that continually leads them to ask themselves “what went wrong?”, “Why is it happening to me?”, “Where will all this take me?”. Such rumination causes people to almost obsessively search for an answer, but in reality it only causes a prolongation and worsening of the depression. The  MBCT protocol  is designed to help those suffering from periods of depression and chronic unhappiness through a tool that allows them to deal with all of this when it recurs. The evidence for efficacy of MBCT is so robust that the Anglo-Saxon National Institute for Clinical and Health Excellence (NICE) recommends it to anyone who has had two or more depressive episodes.

In particular:

  • MBT is more effective than maintenance doses of antidepressants in preventing a relapse into depression
  • Three-quarters of those who took an MBCT course and took antidepressants were able to stop their medications within 15 months
  • MBT can also reduce the severity of symptoms in people who are experiencing a depressive episode
  • MBT appears to reduce Beck Depression Inventory (BDI) scores in subjects with drug resistant depression

The  Mindfulness-Based Cognitive Therapy (MBCT)  includes simple guided meditations that help participants to become more aware and able to accept the present as it is, to get in touch with the changes of mind and body from moment to moment.
The main purpose of an MBCT course is, as we said, to help those who have suffered from depression in the past to learn skills that will help them prevent relapse in the future.


  • Recognize when the mood is about to subside
  • Becoming more aware of thoughts, emotions and physical sensations from moment to moment
  • Choose the most effective response to any unpleasant thoughts, feelings or situations you encounter
  • Develop a different way of relating to feelings, thoughts and emotions
  • Learning to consciously accept and recognize unwanted emotions and thoughts rather than going through habitual and automatic routines that tend to perpetuate difficulties
  • Find out what makes it more vulnerable to relapse and the activation of the vicious circles that cause the disorder to recur
  • Blocking the escalation of negative thoughts and focusing on the present moment, rather than keeping an eye on the past or the future
  • Acquire a way of thinking and paying attention different from the usual one, without the automatic pilot

For further information consult the page dedicated to MBCT go to the page

Mindfulness-Based Cognitive Therapy (MBCT)

Preventing relapse with Compassion Focused Therapy (CFT)

The Compassion Focused Therapy (CFT) is a therapy developed by psychotherapist and researcher Paul Gilbert, professor of Clinical Psychology at the University of Derby (UK) for many years studied human psychology from an evolutionary point of view. This approach integrates data from neuroscience and psychology with the teachings of the Buddhist tradition: “ if you want others to be happy, practice compassion; if you want to be happy yourself, practice compassion ”(Dalai Lama, 1995).

The Compassion Focused Therapy (CFT) is therefore a type of therapy that unfolds in the relationship between the psychotherapist and his patient: through the latter, in fact, the patient experiences in “the therapist’s mind” the satisfaction of its need to be calmed and reassured . In this way the activation of the system focused on the threat is counteracted and the patient learns and builds, through this experience, new for him, his own safety system that will help him regulate emotions and remove feelings of shame and self-criticism.

The heart of the CFT is represented by the Compassionate Mind Training (CMT) , composed of a set of techniques. Some of these are:

  • Writing compassionate letters to yourself;
  • Write compassionate thoughts on slips of paper that you always carry with you;
  • Listening to compassionate phrases spoken by the therapist and recorded on a tape;
  • Construction of compassionate images (eg “the perfect breeder”) to be recalled when necessary;
  • Read your judgmental thoughts aloud as if listening to them were a friend in the same situation;
  • Name self-criticism and / or use the image of a person;
  • Three chair technique: one represents desires, the other represents duties and social standards introjected in conflict with desires. In the third (compassionate) chair the patient is seated and here he learns to empathize with both sides in conflict.

The aim is to encourage in the patient the construction of a non-judgmental and caring internal part and the expression and denomination of emotions, reading them adequately and in a non-interpretative way.

The goal of Compassion Focused Therapy (CFT) is not to change what a person feels (feel good), but the way they relate to what they feel (feel good), learning to tolerate their negative emotions and be with own suffering, caressing each other. 


by Abdullah Sam
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