A 35-year-old woman with recurrent major depressive disorder and a history of childhood emotional abuse presents with pervasive shame and intense self-criticism. Standard CBT has had limited success because although she can generate rational alternative thoughts on paper, she reports that these thoughts 'don't feel true' and she still feels deeply flawed and defective. Her therapist shifts to an approach that conceptualizes her self-criticism as an overactive threat system and her inability to feel soothed by rational thoughts as an underdeveloped affiliative-soothing system. The therapist introduces compassionate mind training, including imagery exercises in which the patient generates feelings of warmth and care toward herself.