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Compassion Focused Therapy and autoimmune conditions: attachment reprogramming for healing

By Dr. Anna Huysse-Gaytandjieva

Many of you may encounter clients presenting with inflammatory psychological symptoms, often linked to autoimmune conditions, whether in their subclinical or clinical stages [1]. These conditions commonly involve both immune and emotional components, underscoring the necessity of addressing both through safeness-based therapies such as Compassion-Focused Therapy. In this post, I offer insights into how shifting motives, fostering safeness, and reprogramming attachment can play a crucial role in managing these conditions.

For over 20 years, I have worked with individuals navigating the complexities of autoimmune disorders. Through this experience, I’ve gained a deep understanding of the intricate connections between mind and body. While this post may seem like an introduction to my upcoming book, Autoimmunity: The Price of Belonging, the ideas presented here are a core part of the framework I’ve developed through years of clinical practice and research. These concepts serve as the foundation of my approach to managing autoimmune diseases and are explored in depth in the book.

‘Autoimmunity: The Price of Belonging’ presents a novel perspective on autoimmune diseases. Rather than viewing autoimmune disorders as isolated biological conditions, I argue that they are deeply interconnected within a broader familial framework shaped by evolutionary history, social relationships, and human needs.

Autoimmune diseases and the absence of safeness

Autoimmune diseases in the psychosomatic field are viewed through the lens of the mind-body connection, focusing on how emotional states and psychological stress can affect the immune system, potentially causing or worsening these conditions [2]. Research in this area often examines how stress and other psychological factors impact immune responses.

In understanding autoimmune conditions, it’s important to go beyond the traditional focus on stress and emotions. While these are linked to disease, stress is the default response when the body lacks safeness [3].

Our immune system reacts to emotions, but emotions alone are not the primary cause of immune system dysregulation. Emotions are temporary, while motives have a more long-term influence on our immune system. I argue that it is the underlying motives that can trigger autoimmunity in predisposed individuals. Motives, such as the need for safeness, achievement, and connection, have a profound impact on our immune system. Shifting motives not only alters emotional states but also has a tangible effect on immune function.

The motive of safeness is crucial in regulating immune responses. Building on the work of the father of autoimmune diseases, Dr. Noel Rose [4], I have found that it is not stress per se but the absence of safeness that perpetuates a cycle of threat responses, adversely affecting autoimmune-prone individuals. Without a sense of safeness, the body remains in a constant state of threat, driving immune overactivation and keeping it in defense mode.

Many patients with autoimmune diseases report early-life adverse events, such as childhood trauma, neglect, or strained family dynamics [5]. These experiences disrupt a person’s sense of belonging and internal security, affecting their immune system’s ability to regulate itself. The lack of emotional and psychological safeness keeps the body in defense mode, contributing to flare-ups and chronic health issues.

Through my work with Compassion-Focused Therapy, trauma treatments with Eye Movement Desensitization and Reprocessing (EMDR) [6], HRV monitoring, and lifestyle adjustments [7, 8], I have found that restoring an internal sense of safeness is key to improving immune function and reducing flare-ups. My clinical experience shows that when individuals can cultivate safeness, they gain greater control over both their emotional and physical health.

As illustrated in the graph below, the interaction between environmental triggers, evolutionary factors, and individual predispositions plays a critical role in autoimmune conditions.

The threat system and autoimmune patients: a CFT perspective

I view the threat system as the default state when there is an absence of safeness. For autoimmune patients the threat system is constantly activated in the absence of safeness. This chronic activation contributes to both emotional and immune system dysregulation.

This system, which evolved to help us survive immediate dangers, becomes overactive when faced with ongoing threats—both external and internal. For autoimmune patients, this heightened activation can exacerbate their condition and impair their ability to regulate immune responses.

One of the unique challenges for autoimmune patients is the long preclinical phase of their illness. During this phase, the immune system may be gradually malfunctioning, but symptoms are either subtle or undetectable. The body, however, is already sensing something is wrong, which keeps the threat system on high alert. The uncertainty of when or if the disease will fully manifest creates a sense of chronic threat, even before a diagnosis is made.

Once the disease becomes clinically apparent, the unpredictable flare-ups that characterize many autoimmune conditions continue to keep the threat system activated. Autoimmune patients often live with the fear that their symptoms could worsen at any time, without warning. This constant uncertainty fuels both external and internal threat responses, creating a vicious cycle of stress and immune dysregulation.

Moreover, autoimmune patients often endure numerous medical check-ups and diagnostic tests during both the preclinical and symptomatic phases. Being repeatedly told that nothing is wrong—while continuing to feel physically and emotionally unwell—adds to the sense of external threat. This medical invalidation, where patients are told they are “healthy” despite feeling terrible, reinforces feelings of uncertainty, frustration, and powerlessness. Each medical dismissal can push the patient deeper into their threat system, as they begin to doubt their own experiences and struggle with unresolved symptoms.

External stressors include these frequent medical appointments, invalidation from healthcare providers, as well as physical symptoms and environmental factors. Together, they keep the individual in a state of constant vigilance, fuelling chronic stress.

Internal threats, such as self-blame, shame, or feelings of inadequacy, further intensify the threat response. Patients often internalize the lack of medical answers as a personal failure, perpetuating a self-attack dynamic. This internal threat mirrors the immune system’s self-attack in autoimmune diseases, creating a cycle of emotional and physical harm.

Safeness, the drive System, and the soothing system

The importance of distinguishing between safety [9] and safeness is one of the main contributions of Paul Gilbert’s work [10]. While CFT has long been attachment-based, my contribution to CFT includes exploring how the drive system serves as a safe base (linked to the father archetype) and the soothing system acts as a safe haven (connected to the mother archetype). These systems are central to reprogramming attachment and fostering healing in individuals with autoimmune conditions:

The drive system as a safe base:

In autoimmune patients, the drive system is often threat-driven, with individuals spending more time looping in the threat system and only occasionally accessing the drive state. This drive is not based on healthy motivation but is survival-focused (“threat-based” as we call it in CFT), pushing individuals to act out of fear rather than from a secure base. The drive system, linked to energy, differentiation, and the father figure, plays a key role in ego formation. When it functions from a place of safeness, it helps individuals form healthy boundaries (including immune boundaries), pursue goals, and regulate their emotional energy. Reprogramming this system to function from a secure base allows individuals to shift out of threat-based responses and into a more balanced, purposeful state.

The soothing system as a safe haven:

The soothing system, connected to the mother archetype, supports emotional recovery and allows the body to engage in healing and restorative processes. For autoimmune patients, reprogramming the soothing system is essential for calming heightened emotional and physiological responses, which helps reduce the immune system’s overactivity.

By understanding the drive system’s role in both differentiation and energy, and the soothing system’s role in emotional recovery, patients can reprogram these systems through safeness interventions. This holistic approach addresses deeper motivational structures, leading to both emotional and immune resilience. The immune system, like any other system, benefits from regular training.

The Dark Side of Belonging

A major theme in ‘Autoimmunity: The Price of Belonging’ is the complexity of belonging [11]. In my opinion, a true sense of belonging cannot exist without a foundation of safeness, as it creates the opportunity for individuals to be their authentic selves within a group. On the other hand, if there is no differentiation, belonging becomes shallow or even unhealthy because individuals cannot express their true selves. Unhealthy belonging can lead to health issues, whereas a healthy sense of belonging balances safeness with differentiation.

While belonging is a fundamental human need, it also has a dark side. The drive to survive, fit in, and be accepted can lead to unhealthy behaviors that compromise our well-being, particularly when the need for connection overrides our ability to care for ourselves.

For example, individuals who grow up in dysfunctional families may maintain harmful relationships due to a deep need for belonging, perpetuating stress and emotional strain. These dynamics can drive immune dysregulation and chronic illness. Similarly, the pressure to conform in social or professional environments can push individuals to ignore their health, further intensifying autoimmune symptoms. In my work, I emphasize the importance of balancing connection with the development of a healthy, differentiated self—supported by the drive system’s connection to energy and ego formation.

Understanding this dark side of belonging helps autoimmune patients recognize toxic patterns in relationships and social structures that may contribute to their health issues. By reshaping their relationships and creating healthier boundaries, individuals can foster both emotional and immune health.

In this post, I’ve discussed the role of Compassion-Focused Therapy in managing autoimmune conditions by reprogramming the drive and soothing systems. However, there is another layer to this work, one that involves Positive Psychotherapy and its exploration of primary and secondary capabilities [12]. Through this lens, the soothing system, linked to the mother archetype, represents our primary capabilities, while the drive system, connected to the father archetype, reflects our secondary capabilities.

I delve deeper into how these fundamental concepts of safeness and motivation shape both emotional and immune responses in my upcoming book Autoimmunity: The Price of Belonging. There, I explore the intricate balance between these systems and how reprogramming them can lead to profound healing.

Stay tuned for more insights in the book!

A holistic and interdisciplinary approach

In Autoimmunity: The Price of Belonging, I argue that autoimmune diseases cannot be fully understood through a purely biological perspective. These conditions are deeply intertwined with our emotional and social environments. Drawing on insights from psychoneuroimmunology, evolutionary medicine, and social neuroscience, I explore how emotional disruptions, social disconnection, and the absence of safeness drive immune dysfunction.

Throughout the book, I emphasize the need for an integrative approach that considers emotional, social, and biological factors together. Early life experiences, especially in attachment relationships, shape how the immune system responds later in life. Individuals with insecure attachments are more likely to develop autoimmune conditions, as their bodies remain in a heightened state of threat. This insight allows us to see autoimmune diseases as more than just biological events – they are deeply rooted in our emotional need for connection, differentiation, and safeness.

To present a comprehensive understanding of autoimmune diseases, I have included interviews with top experts from fields such as immunology, psychology, and neuroscience. These experts offer cutting-edge insights into how emotional health and immune function are intricately linked. By integrating perspectives from different disciplines, the book offers a holistic view of the brain-body connection and explores how therapeutic approaches like CFT [13], trauma processing [14], HRV [15], and lifestyle changes can alter the trajectory of autoimmune conditions.

These expert interviews provide readers with the most up-to-date research, allowing them to deepen their understanding of autoimmune disease management and the broader mind-body connection.

Conclusion

Having spent decades working with autoimmune patients, I believe an integrative approach offers a powerful pathway to managing these complex conditions. While there is no cure for autoimmune diseases, there are real opportunities for healing and prevention.

Whether you are a healthcare professional, therapist, or someone affected by autoimmune conditions, these insights can provide new ways to approach healing. My upcoming book, ‘Autoimmunity: The Price of Belonging’, delves deeper into these ideas, offering a comprehensive guide to understanding the mind-body connection in autoimmune diseases.

I hope these reflections have been helpful, and I look forward to continuing this important conversation with you.

© 2024 Dr. Anna Huysse-Gaytandjieva. All rights reserved.

References:

1. Drexhage, H., Immuno-psychiatrie. Het immuunsysteem-uit-balans als oorzaak van psychiatrische aandoeningen. 2023, Amsterdam: SWP
2. Stojanovich, L., Stress and autoimmunity. Autoimmunity Reviews, 2010. 9(5): p. A271-A276.
3. Brosschot, J.F., B. Verkuil, and J.F. Thayer, Generalized Unsafety Theory of Stress: Unsafe Environments and Conditions, and the Default Stress Response. International Journal of Environmental Research and Public Health, 2018. 15(3): p. 464.
4. Rose, N.R., Prediction and Prevention of Autoimmune Disease in the 21st Century: A Review and Preview. Am J Epidemiol, 2016. 183(5): p. 403-6.
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11. Allen, K.A., The Psychology of Belonging 2020, London: Routledge.
12. Messias, E., H. Peseschkian, and C. C., Positive Psychiatry, Psychotherapy and Psychology Clinical Applications. 2020: Springer Cham.
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14. D’Acquisto, F., Affective immunology: where emotions and the immune response converge. Dialogues in Clinical Neuroscience, 2017. 19(1): p. 9-19.
15. Watkins, A., Mind-body medicine. A clinicians guide to psychoneuroimmunology. . 1997: Churchill Livingstone.

This post was originally published on the BalancedMinds website by the invitation of Dr. Chris Irons. You can find it here