Understanding Depression and Compassion Focused Therapy | Gregoris Simos

Summary

Podcast Summary: Compassion in a T-Shirt

Episode: Understanding Depression and Compassion Focused Therapy
Guest: Professor Gregoris Simos
Host: Dr. Stan Steindl
Date: February 12, 2025

---

Overview

In this engaging episode, Dr. Stan Steindl interviews Professor Gregoris Simos, an internationally renowned psychiatrist and expert in psychotherapy from the University of Macedonia, Greece. Their discussion centers on Professor Simos’s work in Compassion Focused Therapy (CFT), his co-edited landmark book "Compassion Focused Therapy: Clinical Practice and Applications," and, most importantly, his integration of CFT in understanding and treating depression. The conversation also delves into the relationship between self-compassion and empathy, conceptual models of depression, the interplay of shame, and the fascinating synthesis of CFT with schema therapy.

---

Key Discussion Points and Insights

1. The Making of “Compassion Focused Therapy: Clinical Practice and Applications”

[01:49–08:06]

• Genesis of the Book: The idea emerged after a successful symposium on self-compassion in 2018. A publisher’s invitation led Professor Simos to partner with Paul Gilbert, the originator of CFT.
• Collaborative Effort: The project blossomed into a major compendium, featuring foundational theory by Gilbert (ten chapters) and practical/clinical chapters from numerous international experts.
• Notable Quote:

  "I could have never done this book without Paul Gilbert. He is the master. He's the one." — Prof. Simos [02:49]

• Purpose: The book fills a gap by serving as a “reference book” for at least the next decade, synthesizing theory and practice.

2. Self-Compassion, Empathy, and Emotion Regulation

[08:53–14:10]

• Research Findings: Professor Simos’s symposium work revealed significant correlations between self-compassion and empathy, as well as self-compassion and emotion regulation.
• Understanding the Link: Self-compassion is seen as "self-empathy," and emotional regulation is harder for those lacking self-compassion.
• Quote:

  "Self compassion actually equals self empathic for oneself... To be empathic with others but also to want to help and prevent their suffering." — Prof. Simos [10:54]

3. CFT’s Three Circles Model and Depression

[14:10–22:20]

• Model Explanation: Depression, in CFT terms, is characterized by:
  • Overactive Threat System: “A civil war inside.” Heightened self-criticism leads to internal strife and pain ([14:10], [20:55]).
  • Inhibited Drive System: Marked by low motivation and energy.
  • Exhausted Soothing System: The capacity for self-comfort is nearly depleted.
• Metaphors: Simos likens depression to a “civil war” within, where self-attacking parts do deep harm.
• Host Reflection: Dr. Steindl references Kristen Neff’s “enemy or ally” metaphor and the tragedy of needing, yet being cut off from, soothing and connection ([18:53–20:55]).
• Notable Quotes:

  "This internalized threat produced by self-criticism—it's actually a civil war. Half of my person fights with the other half. But this is a disaster." — Prof. Simos [14:10]
  "The soothing system... is exhausted. It cannot do anything more." — Prof. Simos [16:35]

4. Sadness, Shame, and Depression’s Dynamics

[22:28–28:15 | 40:53–46:57]

• Sadness in Depression: Sadness becomes pervasive, disabling the soothing system and feeding learned helplessness. It’s both expected and adaptive in some contexts, but in depression, it can be overwhelming and paralyzing.
• Shame’s Role: Shame feeds and feeds off depression, especially via social rank and defeat dynamics. The sense of being fundamentally flawed, withdrawal from others, and the fear of being "found out" sustain depression.
• Notable Quotes:

  "Shame actually empowers a negative self view... and there's a reciprocal relationship. The more shame I feel, the more depressed I become." — Prof. Simos [44:37]
  "If I have so many flaws, I feel very much the same and same actually... triggers the threat circle. And when this is triggered, it causes pain, disaster." — Prof. Simos [44:37]

5. Evolutionary and Psychological Models of Depression

[28:15–38:18]

• Three Key Models:
  1. Control and Learned Helplessness: Depression arises when one loses the belief in their ability to affect their environment or outcomes.
  2. Attachment and Relational Loss: Insecure/failed relationships breed loneliness, which increases depression.
  3. Social Rank, Defeat, and Entrapment: Drawing on primate hierarchies, Simos notes how defeat and withdrawal mirror depressive states to avoid greater threat.
• Evolutionary Utility: Depression may once have been adaptive—a period of withdrawal and recuperation—but is maladaptive in the modern context ([34:47–36:23]).
• Notable Example: Reference to Seligman’s learned helplessness experiments ([37:55–38:18]).

6. Fear, Blocks, and Resistance to Self-Compassion in Depression

[48:23–52:47]

• Misunderstandings: Self-compassion is often misconstrued as weakness or passivity.
• Resistance: People may resist changing their identity, fearing the unfamiliarity of self-compassion or happiness itself (“the calm before the storm”).
• Quotes:

  "People sometimes fear compassion... because they think they might become weak" — Prof. Simos [48:33]
  "There are people who actually are fearful of being calm, of feeling happy because they say, ‘okay... the disaster is coming now.’" — Prof. Simos [51:08]

7. Integrating CFT and Schema Therapy

[53:58–67:48]

• Rationale for Integration: Both approaches address deep-rooted, long-standing patterns, especially where compassion has been missing (e.g., emotional deprivation, abuse).
• Key CFT Elements: Simos highlights the powerful refrain "it’s not your fault," using personal examples to illustrate how circumstances beyond our control shape us.
• Therapist’s Role: Compassionate presence and “limited reparenting” in schema therapy mirror the compassionate stance of CFT.
• Endpoint vs. Means: Healthy Adult (schema therapy) is an endpoint; the Compassionate Self (CFT) is both a means and an end.
• Experiential Techniques: Both therapies use “chair work” and other experiential interventions to evoke and nurture healthier self-states.
• Notable Quotes:

  "There are things that are inevitable... It’s not my fault that I was born in that family... But I didn’t choose to have this father and this mother anyway." — Prof. Simos [56:31]
  "The most hearting schemas are the ones where compassion was missing... I think compassion, self-compassion training, is probably quite good for those humans." — Prof. Simos [60:43]
  "Helping someone, the compassionate self, is not the endpoint — it's the means." — Prof. Simos [60:43]
  "The way schema therapists provide limited reparenting is like what the CFT therapist provides…with compassion." — Prof. Simos [64:56]

---

Memorable Moments and Quotes

• On Self-Criticism as Civil War: "It's very painful... you might be fighting your brother, might be fighting someone that used to be your friend. So this is very painful to have a civil war instead of having a war with an enemy outside." — Prof. Simos [20:55]
• On the Tragedy of Disconnection: "The person who's very, very depressed really needs and yearns for social connection... and yet is feeling so disconnected, so detached from others..." — Dr. Steindl [18:53]
• CFT Accessibility: "Compassion Focus Therapy, our book, has been translated into Italian, Portuguese, Turkish, and Korean... I think it's a great success..." — Prof. Simos [70:26]
• On the Therapist’s Compassion: "In any treatment... we need compassion, self-compassion. This is something that can fit everywhere." — Prof. Simos [62:45]

---

Important Segment Timestamps

• Book Development and Purpose: [01:49–08:06]
• Empathy and Self-Compassion Research: [09:02–14:10]
• CFT Depression Formulation (Three Circles): [14:10–22:20]
• Sadness, Shame and Social Rank in Depression: [22:28–28:15]; [40:53–46:57]
• Psychological Models and Evolutionary Perspective: [28:15–38:18]
• Fear and Resistance to Compassion (in Depression): [48:23–52:47]
• CFT x Schema Therapy Integration: [53:58–67:48]
• Translations and CFT’s International Reach: [70:26–71:21]

---

Tone and Style Notes

• Warm, Compassionate, and Thoughtful: Both Dr. Steindl and Prof. Simos maintain an empathic, humble, and personally relatable tone throughout.
• Anecdotal and Practical: Simos frequently grounds abstract concepts in personal or clinical anecdotes.
• Accessible Language: Complex psychological models are clearly explained with concrete metaphors and simple analogies.

---

This episode is essential listening for clinicians, researchers, and anyone interested in the deep psychological roots and treatment of depression through compassion-focused approaches. Prof. Simos offers practical insights and moving metaphors that illuminate both the challenges and the hope within compassionate clinical care.

Transcript

[A]

Hi, I'm Dr. Stan Steindl. Welcome to Compassion in a T shirt. Gregoris Simos, MD is Professor of Psychopathology, University of Macedonia, Thessaloniki, Greece. He's an internationally respected psychiatrist and a recognized authority on contemporary psychotherapies including cognitive behaviour therapy and compassion focused therapy. In 2022 he and Professor Paul Gilbert edited and contributed to Compassion Focused Clinical Practice and Applications, which really is the big book of all things cft. Many wonderful CFT researchers and practitioners offer their insights into how and why compassion and self compassion are so important for psychological well being. Highly recommended in our conversation today.

[B]

Great.

[A]

Grigoras speaks about an area of particular interest to him which is compassion focused therapy for depression. He offers a number of very helpful ideas about how to conceptualise and work with depression from an evolutionary biopsychosocial compassion focused approach. I'm very grateful to Gregoris for speaking with me in English, especially given it's not his primary language. Oh, and keep an eye out towards the end to to hear his thoughts on integrating CFT and schema therapy. This is an integration. I'm feeling very interested in myself and so I bring you Professor Gregoris Simos. Today I have with me Professor Gregoris Simos. Welcome to Compassion in a T shirt.

[B]

Thank you very much. Thank you.

[A]

It's wonderful to have you and to get to speak to you all the way from Greece. Now I was just going to dive into some questions. You edited the book Compassion Focused Therapy, Clinical Practice and Applications along with Professor Paul Gilbert of course. And this really is such a wonderful and important resource for CFT therapists, but also researchers. What was the whole process like, you know, creating such a well comprehensive piece of work, collecting the chapters of course from Paul, but also all of the other authors. There's a couple of Aussie authors on there which I noticed. James Bennett Levy and Tara Hickey and my close colleague James Kirby. So yeah, what was, what was that all like to bring that, that book together?

[B]

Yes, I would say that I could have never done this book without Paul Gilbert.

[A]

Yes.

[B]

Allow me to say that the story starts in September 2018 and we actually published it in 2022. It took us three years and a half to have it. So in September 19 to 2018 we had had the EABCITY Congress in Sofia, Bulgaria and my colleagues and I presented a symposium on self compassion and the next day I went to one of those stunts that publishers have and they invited me to write a book on self compassionate compassion. Ah. And they were delighted by our symposium. It was very well attended and it was very interesting. So they, they, they asked me, will you write a book on compassion for us? I said listen, give me some time. And what I thought was that I could have never done a book on CFT without Paul Gilbert. So the first thing I did was to email Paul and say, are we going to write book, to edit a book together? And he said, he said I can write a chapter for that, but I have been doing, or I've been thinking of doing something like this with my publisher. Not this publisher. I said, are you. No, no, I need you as a, as a co editor, not, not for, not the right chapter. And he said, and finally we agreed that we could do such a book together in his publisher. Okay, right. So we started that and at first it was a book Safety for Combustion Focused Therapy by Simos and Gilbert and we started collecting co authors and contributors. I think we owe all, we owe all this to Paul Gilbert. He is the master. He's the one. So he, he was the one who actually suggested, okay, let's email him for anxiety, let's imagine for safety with Sid and resume him for eating disorders and, and so on. So we started inviting people to contribute to, to our book and I would say that it was very welcome. I mean, I cannot remember if anyone said no, no, I cannot, I cannot do that. Probably one or no more than one. So it was a challenge for all those people to visit this book. So I need, this is what we, we needed a big book with all those things inside because there are quite a lot of, of books, of excellent books on cfd, both self health and those for, for clinicians. But we have never had this kind of, this, this is a reference book, I would say. And allow me to say that I think that it must be the book for the next ten years at least. I don't think there's, there's a place for another similar book in the years to come. But anyway, anyway, I think that that was the book that was missing. So we started, we started inviting contributors, signing contracts with the publisher and, and so on. And then Paul had to decide whether he would have a different, a separate book writing on compulsory focus therapy, but not like the one we were doing and he had been a little bit ambivalent or whether it should be a separate book or we should combine that book. Finally, as you know, we combine that. The first 10, 10 chapters are from Paul Gilbert and the, the other 17 samples are from various people around. This was exciting. This was very exciting.

[A]

Yes.

[B]

I thought several times that I should, I should Try to count the emails we exchanged with Paul Gilbert and contributors. But then I thought it's impossible. I don't think I can count thousands and thousands.

[A]

Too big a number.

[B]

Yes, yes. And with the contributors of this book, with the chapters. But there we are. That was an excellent thing done. Excellent. Yes, yes. Yeah.

[A]

Oh no, that's wonderful to hear that story. It really is a very comprehensive compendium, isn't it? Of both the theory Paul offers, I think. Did you say 10 chapters which really describe, you know, a lot of the background and the theory and his. His sort of model of the mind. And then it's got a. Another 17 chapters that are both kind of practical and kind of for clinicians and. And so on and specific topics. Special top. It really is a very kind of wonderful compendium. Little question for you. When you were presenting that very original symposium in 2018 or so.

[B]

1818.

[A]

Yes, yes. Was that a CFT symposium or what approach were you taking to self compassion there?

[B]

No, no, it was actually on psychopathology. I have the diet abstracts we submitted. The first one was the relations the relationship of self compassion to empathic understanding of others. We actually administered the Self Compassion Scale and the Interpersonal Reactivity Index that actually assesses empathy. And we found also quite a good and welcome correlation between self compassion and interpersonal index and empathy. The second one was on self compassion difficulties in emotional regulation. Actually we administer emotional regulation in the Self Compassion scale and we saw that without self compassion difficulties in CMOS regulation are great. So this was a welcome find also. And the third one was the self compassion and fear of compassion for and from others. There was a recent article by Paul Gilbert then on a self compassion scale, self compassion for others, fear of self compassion for others and fear of compassion from others. And so we administered these three questionnaires. So we had some, some very good findings.

[A]

Yes, that's quite fascinating that that self compassion. So the compassion that we might offer ourselves is significantly correlated with the empathy that we might be able to sort of use with others in a sense.

[B]

So there's a. That.

[A]

That's a. What do you make of that? What might be self compassion's role in empathy for others?

[B]

I think self compassion actually equals self empathic for oneself. It is something like similar. I mean if one is self compassionate for himself, he is also self empathic for himself. So that that was actually empathized in some way is part of self compassion. Self compassion is to become. To be empathy empathic with others but also to. To want to help and prevent their suffering or help with this. And self empathic is understanding the others, the, the pain of others, the suffering of others. So that, that was actually the finding we, we, we had. But that was expected, I guess.

[A]

Yes, I suppose so. And also I, I think if a, if I'm, if I'm able to be self compassionate and in other words help to down regulate a little bit my threat system and perhaps shift into a more soothing affiliative system, then perhaps that provides a nice solid ground from which I can then turn my attention to others and I can start to empathize with others and perhaps their feelings or the meanings there for them and what they're experiencing. So I suppose yes, it does make a lot of sense, doesn't it that, that those two.

[B]

On the other hand, I think there is a direct relationship between self compassion for others and empathy for others. This is a direct relationship, I would say. Yes.

[A]

From Paul's, Paul Gilbert's model, of course. Yes. Empathy is one of the competencies, isn't it of compassion? And so we bring that competency of empathy to our compassionate motivation. So yeah, that's, that's very interesting. And then there was the, the relationship between self compassion and difficulties with emotion regulation. So that would be a negative correlation I suppose. And, and a person is less self compassion than they might have higher, higher difficulties. And then also exploring the relationships between self compassion and some of the fears of compassion as well. Wonderful. Well, you made several contributions to chapters in, in the compassion focused therapy book, but the one that really stood out to me and I suppose I'd be interested in hearing more about from you is is the chapter about working with depression via cft. And as you know, one of the, well I guess we were just referring to the three circles model of emotions or emotion regulation. The threat system, the drive system, the soothing system. Could you give us a sense of how you might see the three circles formulation of depression? I suppose. In other words, how a threat drive and soothing systems activated or inhibited in depression. How does all that work?

[B]

Yes okay. First allow me to say that I, I, I, I, I choose to, to write this chapter on depression before because I thought that it would be an easy, an easy chapter. It was not because I knew that Paul Gilbert has spent ages in, in depression so studying depression, the writing writing on depression. So I thought I had also attended a workshop by, I can't really remember if it was Topping Bell or Chris Irons CFT for depression. So I thought okay, I have the, the knowledge about that so I can, can Write that. But it was very difficult to conceptualize all this thing. And as you can see my chapter is about 70% conceptualization of depression in terms of CFT and then only a small part on treatment. So I try to make it clear how those things relate depression relates to the evolutionary model introduced by. So I think yes, yes, the question has to do with the three system circles and I would say that if we take a closer look we'll see that first of all the threat system is activated because there is a growing relationship between depression and self criticism. And self criticism in an attacking effect. I quite thinking of what I'm going to present here. I thought that this is a civil war, this internalized, internalized threat that's produced by self criticism. It's actually a civil war. Half of my passion fights with the other half. But this is a disaster. This is a disaster. So I think the, the threat system is activated of there is an over reactivity of the third systems. There are quite a lot of negative thought patterns. I'm a failure, I don't like, I don't count, I'm dead, I'm lost, I'm so and don't count and so on. So this is a very harsh, I would say self criticism. That is a very harsh threat system condition. On the other hand, drive system is rather inhibited because there is a very, very reduced motivation and low energy. We know that from clinical practice that depressed patients or clients lack motivation. They don't want to get out of their bed, that cannot work. They don't feel like meeting friends and so on. So they spent hours inactive, almost completely inactive. That means that the drive system is very, very much inhibited because of the reduced motivation, the low energy it implies. And I must also say that the soothing system is inhibited. I don't think there is any significant part of the soothing system alive. I would say that the soothing system. I was about to, to use the word exhausted. I was thinking of today's speaking and I said that probably the, the soothing system is exhausted. He cannot do anything more than what he usually does. But depression is so powerful and so this is this is this is this. This actually creates difficulties for self compassion. There's lack of comfort, there's increased self criticism that so this deactivated I would say mostly the soothing system. So there's an imbalance on the other hand between those three cycles. I mean the, this is a huge cycle of thread system and a smaller, very small size for drive system and shooting system. Is that right? Does it make sense Well, I really.

[A]

I really appreciate the way that you're describing it and those metaphors. I mean, I think the idea of a civil war really does speak to it, doesn't it? I remember I spoke to Dr. Kristen Neff recently as well on this channel, and she described the point of, you know, what if we're going into battle, do we want our enemy alongside or do we want an ally sort of a thing. And she described how sometimes self criticism is more like the enemy, I guess, you know, and sort of whittling away at our confidence and our motivation and all the rest of it. And your metaphor is, is kind of really interesting as well. It is like a civil war. There's these different parts within us that are kind of having a battle and the self criticism is, is really attacking, you know, some of those more vulnerable parts. So we end up with a, a very activated threat system. Unlike certain other conditions like anxiety, for example, where we might have a, a big threat system and a big drive system, you know, trying to overcompensate or be perfect or things like that. In depression, it really inhibits drive and, and suddenly we've lost all motivation and, and, and that sort of thing. And then the tragedy of it really is the effect on the soothing affiliative system, isn't it? Because the person who's very, very depressed really needs and yearns for social connection and for comfort and yet is feeling so disconnected, so detached from others and to the point where others sometimes start to start to drift away too, because they don't really know how to relate to the depressed person. And so there's a tragic kind of inhibition or deactivation of the soothing system as well.

[B]

Yes. Allow me to say that if we would, if we talk about war, that means that we have someone just the opposite side who, I don't know who I don't like, who maybe I hate. But civil war is very, very different. I mean, it's, it's very painful. I mean, because you might be fighting your brother, might, might be fighting someone that used to be your friend. So this is very painful to have a civil war instead of having a war with an enemy outside of my territory or so on. So that's some, that's a kind of difference, I would say.

[A]

Yes, I see what you mean. It's the sort of, the quality of self criticism is more like the civil war where the battle is going on within and amongst, you know, the, the parts of ourselves that really we should bring love to, but instead we bring hate and loathing. And and that's probably the the. The.

[B]

The. The.

[A]

The toughest bit really around self criticism is that self loathing and self hate and and and just how painful that is and leads to depression.

[B]

It hurts too much. It hurts too much.

[A]

Sometimes we think about the three big emotions, I guess anger, anxiety and sadness. Often in CFT we might be working with that. And I suppose I'm curious about your thoughts about sadness and, and really what you said just there. You know, it. It hurts too much.

[B]

There's.

[A]

There's so much well grief and loss and, and sadness that's, that's often associated with the. With all of those dynamics that, that are at play there. What would you say about that? What are your thoughts about kind of sadness and where that might fit into the. The three circles model or or how that might be related to depression?

[B]

I think that sadness also has to do with all. All three of those cycles. First of all it has to do with a soothing system that is underactive. Actually Actually it is believed that depression in. In some in some sadness in some way can be. It's something that can be dealt with in this ruling system. I can reflect standard it beat, take a deep breath and face my problems. So that's causing me sadness. But I, I think that sadness actually in. In depression is so pervasive that it actually tends shooting system out turn it off in, in some some way. So it's, it's completely cruel. I would say to say to yourself you are bad, you are not account for nothing, you are nothing and so on. It's. It's very very unsolding thing. I I would. I would say so the threat system also is I would say over overreacting the shooting system because in depression I think it's. It's. It's quite significant how how powerful the self criticism is. But self criticism actually hurts. Self criticism actually mobilize the threat system and the threat system actually causes suddenness as well as anxiety sometimes and anger. But sadness is also quite expected for someone who is depressed. His sad. He's very sad sometimes all times in our lives that will become sad for something. I've lost something something. I didn't get the promotion I wanted. This is something okay but I, I can work with that that with this this. This service but independent. I think I run out of fuel. I would say I don't. I don't think I can. I can handle it any anyway. And of course drive I would say also is in in some way inhibited because of sadness because if I think that there is no battle I can win. I then put my rifle down and put my, my, my, the things I have to fight, I put them down. I, I just give myself, give myself in. So I think that sadness also in some way interacts with the drive system.

[A]

I, I appreciate that The. A couple of thoughts came to mind. I mean, the first is that sadness can be quite adaptive in a sense. You know, sadness can sometimes be something that brings people closer in a way because they feel moved by our sadness and they want to.

[B]

Yes, yes.

[A]

Kind of help and it can have that sort of a function. When you were talking about the threat system side, it really reminded me of how there's a critic and then there's also the criticized part of us. And so that's the civil war, isn't it? Is the critic attacking a part of us that is then the criticized part. And it's that part, I suspect, that feels the sadness, the hurt and the tragedy of that self attack leaves that part of ourselves feeling deeply sad. And that's the bit that is inhibiting. It's a kind of a learned helplessness maybe arises at that level. I think you described the control and learned helplessness kind of model there in your chapter and perhaps that's where that comes in. Can you elaborate a little bit on how you drew some of those other theories or models into your discussion around CFT for depression?

[B]

Okay, let's go first to the control and learn helplessness model. According to that, we need to feel a sense of control over our lives and our environment. As far as I feel that I don't have control, I actually withdraw. I actually start fighting for what I think will make my life better. I accept that this is it. I'm unhappy, I'm depressed, I'm weak, I have failed. So if, if actually I cannot, I feel that I cannot control my, my life and my, my circumstances, my, my environment. I actually resigned from life. I mean like they give up. Say that is the learned helplessness that I, I give, I give up. I don't try anymore. So this is something like we feel when we are depressed because loss of control is, is really, really something that is. It's unbearable. I don't think I can stand that. We have also to do with the attachment relational loss models. So we all, we all feel that we need a secure attachment to thrive and feel quite well in relationships. If we have insecure or anxious or avoidant attachment in our childhood, then we are doing not very, very well with our relationships and not doing well with my relationship. Means that I will remain alone. And we know that there's a straight direct relationship between loneliness and depression. Because if I feel alone, I don't have all this social support. I need to thrive and be, be able to compensate for what I'm suffering. So I think attachment and relational loss models also, also correlate to depression because of the bad relationships I have, the failings in my relationship, the loneliness, consequent loneliness and all of those the bad things it it, it replies it implies, I would say not replies it implies. Yes. So social rank is another, another quite quite good theory. Defeat and entrapment model. And when, when I, when I teach my, my, my trainees in, in CBT or psychotherapy anyway, I, I remind them of how it is the kingdom of apes. The, the most powerful two apes have to fight to each other. One will win and he will be the guy of the tribe. Yes. The other one has to knit needle, put his head on the ground and give up. Because if he goes on fighting with the powerful one, he's going to die. If he's not going, if he's not going to start to stop fighting, probably he will be expelled from the tribe. But if you are expelled from the tribe, you lose quite a lot of safeness. You lose quite a lot of safety. Being in a tribe means that we are too many, too many partners around. We can fight any, any enemy. But being alone, I don't have any chance of surviving. So he has to knee, kneel and put his head on the ground and says, here I am, I, I don't, I don't fight anymore. So this is kind of depression. That means someone who, who withdraws in order in order to, to show that he actually acknowledged his, his defeat. And that's it. Sometimes there is a theory about reserving sources probably probably become becoming. I mean depression was supposed to be adaptive some ages ago, but nowadays depression is not, is not adaptive any. Anyway. Although I, I said to my, to my patients that listen, what's depression? Depression is how, how the the tiredness you feel when you fight for your life, when you fight in your job, fight in your relationship. So you, you get time and when you get that, you get depressed. What does it mean? It means that you stop, you kneel and you take some deep breaths, wait to regret your strength. And when you feel okay, then you stand up and go on. That's what I, how I describe depression to my clients and they can really understand that. So depression is a way to, to fuel, but to fuel my, my batteries because I Feel very much tired. I feel that I cannot really deal with all the pressure I feel. So I can go back, go back, sit down and reflect. Try to find a way in, in a peaceful way to, to find some solutions to my problems. So this is an evolutionary way thinking that depression is a way to actually to, to, to. To recharge your batteries, to, to get the strengths you, you need. But if you want to get yourself, you have to rest. It's not rest and digest, but rest being big. In depression you don't have to work, you don't have to. To have a reciprocal relationship with others. You are alone. But okay, you are thinking very, in very, in very disturbed way. But in some way depression could have been some ages ago a way to withdraw and readjust to situation and to new situation. And maybe depression might have been adapted ages ago, but probably it's not adaptive in our nowadays communities where we have very many problems to solve, peace and core. And I have to do a job that I don't like. I have probably a spouse I don't like, I don't love. So I have to quite a lot of things to struggle for. So depression in, in some way is the, and, and is something I cannot, I cannot escape. It's not adaptive, but I cannot escape the depression because we have a little bit, a little bit very different conditions of living in nowadays. Yeah.

[A]

Yes. No, you, well, you've mentioned a number of really important points there and actually this was a part of your chapter that I really appreciated was when you sort of outlined three key areas of models. There's the control and the learned helplessness model, the attachment and relational loss models and the social rank, defeat and entrapment models. And so yeah, as you've just described those sort of three there. I remember when I was maybe at uni, maybe even first year psychology, I feel like I remember studies where they put poor dogs into cages that had metal floors and then they would send electric shocks through the floors and the dogs at first would run and jump and try to escape the electric shocks but in the end they weren't able to escape. So they would just lie down and take it, you know that they would just take the hits sort of thing. And it really, I mean it made a big impact on me at the time because it seemed, seemed like a, a bit of a rough thing to do to those poor dogs. But it also made the impact that that's kind of sometimes the feeling in depression isn't it is, is that there's just these relentless hits that we take. And in the end.

[B]

I think this is the experiment that actually certainly helped learn helplessness. I mean this, this is what, what one might actually arrive as a conclusion that whatever I do, the electricity is there, so don't fight.

[A]

Yes, exactly. I think it might have even been. Was that a Seligman study? I should look that up. Yeah. And then there's the. Obviously it's the attachment and relational stuff, the social rank and, and that, that part of it seems really important as well. And, and I might come back to that in a moment. So there were those three models and then I was going to ask you about the, the sort of. The evolutionarily adaptive theory around depression. And I appreciate what you said there. It's almost like shifting into a recuperative mode or something. You know, that, that when, when the stressors and the sort of the various activities of life become overwhelming, then the primitive human or the primitive living being might retreat and withdraw and recuperate before going back out into the fray sort of thing. And that in a way, depression, maybe sort of the origins of depression in an evolutionary sense might be something like that, that it was a way to recuperate. But like so many evolved aspects of the human brain and body and so on, there's trade offs, I guess, and we're now really experiencing that, you know, depression has become something that's perhaps not recuperative in that way, but is really very difficult to shake. So back to the social rank piece. Shame, I guess, is one of the consequences there that you, you described it with the, the. Was it the gorillas or the, the sort of the primates that the one that loses the social rank has to bend the knee and has to bow the head and has to kind of sort of subjugate, I guess, to itself, to the, to the higher ranking member of the group in order to not be thrown out into the wilds in order to stay, you know, somehow safely in the group. And, and that just reminds me, I guess, of, of just that experience of shame that we can have and, and how that's part of depression perhaps as well. Would you have any thoughts there about shame and depression and where CFT can be helpful?

[B]

Okay, okay. I would say that if I give. Given a fight and I have lost, that's a fact. So maybe it's producing shame, but this is a fact. Unfortunately, many people who feel same shamed for what they are, what they have done and so on, on is not a fact. It is the way they perceive the reality. So if, if I cannot actually Be, that's not right. So I mean as far as I can, I can say it's reality as, as there are hundreds of ways to perceive the same reality. So people in depression think in a way that actually devaluates the values them and they, they, they make them think that I'm not adequate, I'm not worthy, I'm fundamentally flawed. So it makes them feel shamed. But this is very, a very unhappy feeling and there is a fear of being exposed to others. Okay, no one is perfect. I know what my flaws are, but I do want to show, I don't want to show them to the others. So if they actually understand what my flows are, I will feel really unhappy and very ashamed. So in the role of depression, same actually, actually empowers a negative self view. And there's a reciprocal, reciprocal relationship. The more, the more same I feel, the more depressed depressed I, I become and the more depressed I am. The most shameful I, I, I feel. Because we know from cognitive therapy there that probably people in depression and not only depression actually think in, in, in black and white ways concerning themselves and, and others. So I am others perfect or nothing. So I have so many flaws or I have known. So if I have so many flows, I feel very much the same and same actually. PFSA conscious consequence social withdrawal. If I think that I'm too much flawed, I have to, to say no, I'm not coming if they are inviting me somewhere. I think if, if I uncover myself they will understand how flawed I am. So I'm not going to there. So there is an inevitable withdrawal, social withdrawal when one feels shamed. And this also actually activates the threats, the threat system because it's a little bit again like a civil war because both self criticism and same actually are the ones who trigger the, the threat circle. And when this is triggered, it causes pain, disaster.

[A]

Yes, I, I appreciate that idea of the reciprocal nature of shame and depression. That, that's really helpful. It's, it's a little bit chicken and egg in a way, isn't it? Which comes first? You know, sometimes it might be shame that starts and, and the, in the feelings of inadequacy or inferiority or low self worth perhaps that starts to drive the depression, but then the depression can also start to, to drive the, the shame. And, and so it, they really do feed off each other a lot. And, and, and it is, it's, it's a kind of a, a social threat function, isn't it? The shame. It feels like how am I being held in the minds of others are others seeing me as inadequate and unworthy. And maybe if they are, then I should see myself as inadequate and unworthy. And so it's threat system activating, but in particular it's that kind of social, social threat and threat to I guess social rank really and where something belongs.

[B]

In the group somehow. Yes. By the way, you, you revive reminded me that there is so much writing or repetitive negative thinking and repetitive negative thinking and how repetitive negative thinking is a psychological market for depression. And as far as someone is repeatedly thinking in a negative way, he finds himself not good enough, not perfect enough and he finds himself self attacking. He finds himself feeling self criticized and self ashamed. So.

[A]

I remember Chris Irons, I think it was describes the unholy trinity of negative thinking which is sort of self criticism, rumination and worry. You know that those three really are very, all of them. They, they serve to. To activate threat system and, and can also really contribute to. To depression.

[B]

I suppose. I can't really remember the name of a female researcher who actually passed away, but she has given her life in the negative. Repetitive negative thinking. I can't really remember her name but she's the one who actually wrote quite a lot and had quite a lot of experiments and studies on repetitive negative thinking. So. And as a marker of depression.

[A]

Yes.

[B]

Good.

[A]

I mean one of the things that I'm sensing from you talking about depression and the formulation there is that it really is in and around threat system activation, social threat, certain social fears not least around attachment and relationships inhibited soothing system, activated threat system. What are some of the. The fears blocks and resistances there for a person with depression perhaps who might think about self compassion but then feel like they sort of balk at the idea. What, what have you noticed about all that?

[B]

Yes, I think that compassion, self compassion is a word that there are quite creates quite a lot of misunderstandings.

[A]

Yes.

[B]

Some people perceive self compassion as giving up others if it's the right way of saying that giving up to others if you are self, if you are compassionate to others. So people sometimes feel compassion as well as self compassion because they think they might become weak if they get too much about others and giving too much to others. And they sometimes fear that they will lose control over the behavior and if they do so much of. For. For relieving the pain, the pain of others and being so compassionate and so on. Sometimes people are fear to change because they, they think okay, I know who I am, I know what I'm doing, but I feel safe with that. Maybe It's a little bit maladaptive, but I feel safe with that. It's, it's, it's quite familiar for me. How would I be if I change? How would I be if I become more compassionate to others? How will I be if I am, I feel become more self compassionate? So they prefer to stay where they are because it's familiar. It's not something they don't know. I think there are the, the, the, the main fears of self compassion.

[A]

Yes.

[B]

Yeah.

[A]

Now that's, there's two sort of threads there. One is that compassion or self compassion is, is kind of weak or, or dangerous. People might take advantage of me. It, it feels exposing in, in that kind of way. And then the other block is, you know, who do I become if I make a change like this? You know, I'm so familiar with and, and almost comfortable in my current state. It's scary to imagine how things might be different and what life would be like. I think Paul is doing some research if I'm right about fears of positive emotions, fears of happiness for example, and that sort of thing. Do you ever find something there that people feel fearful or sort of apprehensive in some way about being happy?

[B]

There is a saying that I feel like the calmness before the. How did you say, how do you call it? The bad weather and the storm. Yes, yes. So there are people who actually are fearful of being calm, of feeling happy because they say okay, I'm feeling happy. So I think the disaster is coming now. So they don't feel very well with being relaxed or happy because they think it's the calmness before the storm.

[A]

But the storm. Yes, that's interesting because you kind of between a rock and a hard place, if you're feeling very depressed and you're feeling self critical, then that's kind of threat system activating. But if you're feeling calm or even happy, then that's threat system activating as well. Because you're fearful of the storm. That's sure to follow. You're fearful of things going wrong again and so on. So it's almost like either way the person might be threat system activated.

[B]

I think probably. Yes, yes, you are, you are right to that, Stan. I think that there are people who, when they feel happy or contented, they, they think like do I deserve that? What if I don't deserve it? And I will be in some way punished for having something I don't deserve. And it generates threat again.

[A]

It generates threat again. Yes. I was just thinking that, that it's It's a little bit all roads lead to Rome or perhaps all roads lead to Athens, perhaps would be better. It all brings us back to threat system. Now one of the things that I've noticed you seem to be becoming interested in is sort of the integration of CFT with schema therapy and that's something I'm very interested in as well. I recently spoke to some Australian colleagues on this channel who were looking at schema therapy but applied to forensic populations. And so that was, that was a, and where does compassion fit in there? Which was a very interesting conversation. But yeah, how do you envision CFT and schema therapy perhaps working together maybe with or in the context of depression? Are there particular unique sorts of aspects to that or benefits to that? What are your thoughts there?

[B]

Yes, I think that schema therapy deals with long term problems and I think the, the lack of self compassion, of compassion for others is a long standing problem also. So this is part of our personality, this is part of our character. How self compassionate I am to myself, how compassionate I am to others. So they both deal with long standing problems. On the other hand I say that okay, I once trained in, I have been a cognitive behavior therapist for the last 40 years but nevertheless I trained in, in chemotherapy several years ago. I don't think that I have trained in compassion for therapy. I have attended several, several workshops. I have attended the introductory three day course of the compassionate mind training thing and the advanced skills three day training. So but I don't feel myself, I'm a competent Compass focus therapist. Anyway, so I have been thinking that first I have to to say that there are a couple of things I like very much in Compassion Focus. This is not your fault. Uhhuh. I, I say that to almost every single patient I see. It's not your fault. And they like that, they like that. I, I, I, I, I, I actually try to make them think that okay, it's not my fault does mean that I will be someone that does not care for anything. So but this is not your fault because there is a tricky brain there. But this tricky brain was created through the thousand and thousand thousand of, of ages. This is the way our brain works. So it's not your, it's your not your fault. So I say them about our tricky brain and it's not our fault. I also give them a personal, personal example, a personal self disclosure. I said listen, I was born when I was born. But what compassion therapy asks me is to imagine how I had been if I was born to the house next to us.

[A]

Yes.

[B]

And I say, but my, I would have been. If I was born in the house next to us, in the house next to us lived a Jewish family. So if I had been born in the house next class, I had been Jewish and not Christians, I would have had another father and another mother. And my, my, my, my faith would have been very, very different because the family who was living by us at late 50, 70, late 50s, actually moved to Tel Aviv. So I would have not been. Been living in Greece, I would have been born in Greece, but I would been living in Tel Aviv. And I don't know if I would have been a medical doctor in Tel Aviv. Maybe I have been a driver of a fighting airplane or something else. So may I have been killed in one of those bombings there. And, and so, and so I would have been someone completely different, but this would have not been something I had chosen to be. So think of that, think of them so they actually understand that something. There are things that are inevitable. There are things that they have not chosen to be or to, to, to become, but they have been there and they become. Because the situation was that the father was here, the mother was the, what is the social situation, the economic situation of the family. One was born, actually, it was that. So it makes them think that, okay, I'm probably not, not my fault that I was born in that family, had that father, had that father that was actually addicted to alcohol or my mother who was depressed and so on. And that's what I became. But I became because it was my father. This was, this was the father I was given and this was the mother I was given. But I didn't choose to have this father and this month anyway, so. And they really, and enjoy in some way that, so those small things would actually, actually I think can be used in any, in any psychotherapy because it give quite great relief to the suffering client. It's not my fault.

[A]

Yes, and actually, if I think about schema therapy, one of the things that's not our fault is the way that we experience certain emotional wounds, unmet needs, and then we just very naturally come up with a way to make sense of that, which is certain schemas, certain ways of seeing ourselves or others or the world. And then we got to cope with that, so we develop certain coping modes and, and you know, none of that's our fault really. In fact, it's, it's just the way that that young person that we were was able to try to survive in, in the world that, that they were confronted with and, and so linking the, it's not my fault to that notion of, of schemas and, and developing, you know, certain coping modes, you know, seems to be a, a really nice way in for people to, to understand themselves but kind of accept some of those, those different elements. I guess it's not my fault, but it is my responsibility. So that, that's the sort of, the next bit too I guess is, is how do we manage those coping modes? Actually, what are your thoughts about healthy adult mode in skin therapy? I mean do you see that as sort of the same as the compassionate self? Do you see it as, as kind of similar or the compassion is a part of that or, or would you see them as quite different aspects of the self?

[B]

Yes. Stan, allow me to go a little bit back backwards. I think if, if we, if we look carefully at schemas, we can see that the most significant, I mean the most hearting schemas are the ones where compassion was missing. Emotional deprivation, mistrust, abuse, abandonment. No compassion, no compassion, no compassion, no compassion. I think there was humans that predominate, that were predominated by the lack of compassion those humans. So I think compassion, self compassion training, compassionate way of thinking and feeling is probably quite good for those humans. Concerning the healthy adult mode or the compassion itself, I would say that the healthy adult mode is the end point of treatment. Endpoint of treatment means that okay, we have dealt with your schemas, with your moods and you have become a healthy adult. Go away. But I think compassion itself is the means to get there. Helping someone, of helping someone is not the endpoint product of statement, it's the means. The compassionate self, I guess it's the end point of course, but this is a means that will actually imply changes, I mean hopeful changes. So I thought that probably there could be. I mean self compassion is something we can use everywhere. I said I can, I can think in, in any, in any psychotherapy, self compassion in any, in any, in any treatment might it be mental health or, or physiological problems with. Yes, we need compassion in, in any part of our life. But in any part of medicine, in any part of psychology, in any part of psychotherapy, we need compassion, self compassion. So I think this is something that can fit everywhere say. But I, I think that it will be much more meaning may making if we actually introduce self compassion to schema therapy. I don't know how chemotherapists feel about this. Actually. This is nothing. I mean using a little bit of compassion in, in chemotherapy. Actually I'm not a Schema therapist. I mean I have trained in chemotherapy, but I would say I'm too old for a three year treatment. A three year treatment duration treatment. I mean I cannot stand long term, long term treatments now. So, and chemotherapy is a long term treatment so I prefer cognitive behavior therapy instead. But I think that we can, we can use the compassion in, in schema schema therapy because I, I would, I would also say that, I mean it's, it's, it's very important that the CFT therapist is a compassionate one. But I think in, it is something like this when in, in, in schema therapy the therapist actually does the limited rebounding.

[A]

Yes.

[B]

Because limited parenting means that I'm giving my best, the best thing I can give to my client and I am as much as more compassionate I can feel towards him and toward her. So that's why I think that there are similarities because the way that actually the schema therapist provides limited repairing is like what the CFT therapist provides his client. I've never tried that, I mean in, in, in, in, in a more scientific randomized control trial way, but I think it helps. It's a little bit unstructured, but I think it helps.

[A]

Yes, I've always appreciated the way that Paul Gilbert coined the term compassion focused therapy because it does allow for bringing a compassion focus to all sorts of approaches. We might do compassion focused cbt, we might do compassion focused schema therapy. And it really is about taking some of those really powerful bits from CFT and infusing other approaches with warmth and strength and wisdom and compassion. And that can be really helpful. And you mentioned that many of those most difficult schemas, emotional deprivation, abandonment, social isolation, failure, mistrust, abuse, they really arise out of early experiences where there is a striking absence of compassion, I suppose. And when you raised that point about the limited reparenting, in a sense that is the therapist with a compassionate motivation and bringing that compassion, that experience of compassion to the, to the client and offering the very thing that they missed out on, you know, all of those years ago and giving them an experience of what it is to be cared for and, and what it is to be safe and secure and what it is to, to have that kind of very genuine compassionate motivation brought to them. So it, yes, it does feel like that. That's kind of really a key and powerful part of how the therapist might, might approach, well, any therapy really.

[B]

And I think they both use experiential techniques in the same way I, I use my healthy adult to help the abandoned child or I Use my compassionate self to actually to guide my non compassionate other self. And so experiential. I mean techniques are, are the same.

[A]

Yes. Yeah. I did a session recently with someone and, and we were using schema therapy and we were doing chair work in a schema therapy way. And, and when I invited him to change chairs and to, to sit in the healthy adult mode, we did a.

[B]

Little.

[A]

Body based compassionate practice first to move into that mode. So yeah, I definitely really do love the idea of, of bringing those two together. Well, Gregoris, thank you very much for spending some time with me and speaking with me about all things CFT and depression and the schema therapy stuff. If people are interested in your work or would like to be in touch. How can people be in touch with you?

[B]

Actually I'm in, in, in. In the face of. I want to. I, I go to my private practice only once a week. Okay. And I'm just, I'm retiring. I mean I have retired from my university three and a half years ago, so I'm trying to retire from my private practice also. But if someone wants to find me. Yes, he or she will find my email address. That is gcmos, dot etc. Yes, yes, yes. I would say that I am, excuse me, I'm 100% active, although I'm retired. I mean. Yes, yes, right. Okay.

[A]

That's a good way to, good way to say it. And of course people can definitely sort of have a look at Compassion focused therapy clinical practice and applications that will give them a good sense of, of you know, where you're coming from as well. So anyway, well, thank you very much for.

[B]

Let me, Let me remind you that Compassion Focus Therapy, our book has been translated into Italian, Portuguese, Turkish and Korean. And my, my publisher has already agreed that we are going to translate our book into Greek too. I mean.

[A]

Aha.

[B]

Yes. So I think it's, I think it's, I think it's a great success because if we talk about Portuguese then it means that half the North America speaks Portuguese ideas. So this will be a book that will be, can be read by South American colleagues.

[A]

Yes, yes. That makes it sort of very, very accessible really. Which is the key is the dissemination of cft.

[B]

Stan, thank you very much for inviting me. I have been very, very anxious. How I can go on with that? I, I thought you did very well. Those are my notes.

[A]

No, no.

[B]

Almost as if I'm giving exams, but any. Anyway, this is me.

[A]

I mean, well, you, you passed with flying colors.

[B]

Thank you. Thank you.

[A]

Gregoris Simos. I, I really appreciate it. And thank you for being on Compassion in a T shirt.

[B]

Thank you. Thank you very much.