Non-verbal communication of compassion: measuring psychophysiologic effects

Hossam A Shaltout,Kathi J Kemper

doi:10.1186/1472-6882-11-132

Hossam A Shaltout, Kathi J Kemper

Open Access

https://doi.org/10.1186/1472-6882-11-132

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Abstract

BackgroundCalm, compassionate clinicians comfort others. To evaluate the direct psychophysiologic benefits of non-verbal communication of compassion (NVCC), it is important to minimize the effect of subjects' expectation. This preliminary study was designed to a) test the feasibility of two strategies for maintaining subject blinding to non-verbal communication of compassion (NVCC), and b) determine whether blinded subjects would experience psychophysiologic effects from NVCC.MethodsSubjects were healthy volunteers who were told the study was evaluating the effect of time and touch on the autonomic nervous system. The practitioner had more than 10 years' experience with loving-kindness meditation (LKM), a form of NVCC. Subjects completed 10-point visual analog scales (VAS) for stress, relaxation, and peacefulness before and after LKM. To assess physiologic effects, practitioners and subjects wore cardiorespiratory monitors to assess respiratory rate (RR), heart rate (HR) and heart rate variability (HRV) throughout the 4 10-minute study periods: Baseline (both practitioner and subjects read neutral material); non-tactile-LKM (subjects read while the practitioner practiced LKM while pretending to read); tactile-LKM (subjects rested while the practitioner practiced LKM while lightly touching the subject on arms, shoulders, hands, feet, and legs); Post-Intervention Rest (subjects rested; the practitioner read). To assess blinding, subjects were asked after the interventions what the practitioner was doing during each period (reading, touch, or something else).ResultsSubjects' mean age was 43.6 years; all were women. Blinding was maintained and the practitioner was able to maintain meditation for both tactile and non-tactile LKM interventions as reflected in significantly reduced RR. Despite blinding, subjects' VAS scores improved from baseline to post-intervention for stress (5.5 vs. 2.2), relaxation (3.8 vs. 8.8) and peacefulness (3.8 vs. 9.0, P < 0.05 for all comparisons). Subjects also had significant reductions in RR (P < 0.0001) and improved HRV (P < 0.05) with both tactile and non-tactile LKM.ConclusionIt is possible to test the effects of LKM with tactile and non-tactile blinding strategies; even with blinding in this small preliminary study, subjects reported significant improvements in well-being which were reflected in objective physiologic measures of autonomic activity. Extending compassion is not only good care; it may also be good medicine.Trial registration numberUS National ClinicalTrials.gov registration number, NCT01428674

Highlights

IntroductionBetter understanding of the psychophysiologic mechanisms by which clinicians’ NVC of compassion (NVCC) (both non-verbal/non-tactile, and nonverbal/tactile communication) benefits patients could lead to innovations in educational strategies to maximize these benefits for a variety of clinicians, including psychotherapists, physicians, massage therapists, nurses, acupuncturists, and others who interact directly with patients
Feasibility Blinding was maintained, i.e., all subjects reported that the practitioner was reading during baseline, reading during the non-tactile loving-kindness meditation (LKM) and touching during the tactile LKM
The practitioner maintained a meditative state during both tactile and nontactile LKM interventions as reflected by her verbal report and in changes in respiratory rate (RR)

Summary

Introduction

Better understanding of the psychophysiologic mechanisms by which clinicians’ NVCC (both non-verbal/non-tactile, and nonverbal/tactile communication) benefits patients could lead to innovations in educational strategies to maximize these benefits for a variety of clinicians, including psychotherapists, physicians, massage therapists, nurses, acupuncturists, and others who interact directly with patients. It may lay evidence-based groundwork to develop brief training interventions for parents or other caregivers to learn to effectively extend compassion and reduce stress in hospitalized or palliative care patients. A non-tactile strategy would be relevant for studies of psychotherapists or social workers, while a tactile strategy would be relevant for studies of massage therapists and other body workers, acupuncturists, and other therapies or diagnostic maneuvers involving tactile contact

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