Cognitively-Based Compassion Training Research Articles

Cultivating empathy and compassion: Lived experiences of engagement with cognitively‐based compassion training in the US

AbstractThis qualitative study presents an analysis of data taken from 16 participants who were interviewed during and 1 year after they attended a course in Cognitively‐Based Compassion Training (CBCT), a meditation course that seeks to help participants cultivate empathy and compassion. The study sought to examine what benefits, if any, participants in a CBCT course reported with regard to their understanding and practice of empathy and compassion; and secondly, if their statements in the interviews exhibited understandings and practices consonant with emotional, social, and cognitive resilience as identified in the existing literature, and consonant with empathy and compassion as defined in CBCT and in existing literature on compassion. The study found that participant interviews provided significant evidence of the development of skills identified in the literature as components of emotional, cognitive, and social resilience, and that participant descriptions and definitions of compassion closely matched those existing in the literature.

Self-Compassion-Based Interventions in Oncology: A Review of Current Practices

Self-compassion consists of an attitude of self-support and self-benevolence. In the general population, increased self-compassion has been associated with well-being and decreased psychopathology. In oncology, higher self-compassion has also been linked with various benefits, such as lower emotional distress, fatigue, body-image disturbances, and sleep difficulties. Self-compassion also seems to foster treatment adherence. Various interventions based on self-compassion have recently been designed and tested in different clinical and non-clinical populations. They are particularly relevant in oncology, as patients are increasingly interested in complementary approaches to help them manage their symptoms and difficulties benevolently and without judgment. In this review, we described various self-compassion-based interventions that have been or will be proposed to patients with cancer, as well as their first results. The main interventions that have been tested are compassion-focused therapy, the combination of self-hypnosis and self-compassion learning, mindful self-compassion training, cognitively-based compassion training, and loving-kindness meditation. Other interventions include a self-compassion-focused writing activity, a mobile self-compassion application, and a self-compassion group therapy focused on the fear of cancer recurrence. Many of these studies were quasi-experimental or protocols. However, existing results tend to suggest the benefits of these interventions to improve different symptoms often endured by patients with cancer. Further research is needed to conduct rigorous studies on these approaches and to determine how and for whom they are efficient.

Emerging Life Sciences Series: Q&A with the Editor

Emerging Life Sciences Series: Q&A with the Editor

Kynurenine Metabolism as a Mechanism to Improve Fatigue and Physical Function in Postmenopausal Breast Cancer Survivors Following Resistance Training.

This pilot examines whether resistance training (RT) can induce changes in kynurenine (KYN) metabolism, which may contribute to improved physical function in breast cancer survivors (BCSs). Thirty-six BCSs (63.2 ± 1.1 years) underwent assessments of physical function and visual analog scale (100 cm) fatigue and quality of life before and after 12 weeks of RT (N = 22) or non-exercise control (CBCT©: Cognitively Based Compassion Training, N = 10). Blood was collected before and after interventions for assessment of KYN, kynurenic acid (KYNA), and peroxisome proliferator-activated receptor γ co-activator 1α (PGC-1α). At baseline, the women were moderately fatigued (mean score: 46 cm) and at risk of poor functional mobility. A group*time interaction was observed for all measures of strength with improvements (~25–35%) following RT (p’s < 0.01), but not CBCT. Time effects were observed for fatigue (−36%) and quality of life (5%) (p’s < 0.01), where both groups improved in a similar manner. A group*time interaction was observed for KYN (p = 0.02) and PGC-1α (p < 0.05), with KYN decreasing and PGC-1α increasing following RT and the opposite following CBCT. These changes resulted in KYN/KYNA decreasing 34% post-RT, but increasing 21% following CBCT. These data support RT as a therapeutic intervention to counteract the long-term side effect of fatigue and physical dysfunction in BCSs. Additionally, the results suggest that this effect may be mediated through the activation of PGC-1α leading to alterations in KYN metabolism.

Change Mechanism of Cognitively-Based Compassion Training for Couples with Depression: An Exploratory Empirical Investigation of Process Variables.

Objective: Compassion training seems to be a promising intervention for couples to improve individual psychopathology and relationship quality. Beyond studying the efficacy of training such as Cognitively-Based Compassion Training for Couples (CBCT-fC), it is important to gain insights into the putative mechanisms along the process. Methods: Theoretically derived presumed mechanisms of compassion training (clarification of values, self-regulation, decentering, and exposure) and additional therapeutic factors (emotional bond, social learning, and clarification of meaning) were studied over the course of a 10-session-long group-based CBCT-fC among women with depressive disorders. Results: Dyadic growth curve models indicated that emotional bond, social learning, and clarification of meaning increase over time in both partners. In decentering and clarification of values, women who suffered from depression showed a larger increase than men, while men had higher values at the start of the training. Conclusions: Women with depression seem to benefit from CBCT-fC in terms of an increase in decentering and value clarification, important mechanisms of compassion training. This study is the first to show that theoretically derived mechanisms of compassion and additional therapeutic factors can describe the process along secular contemplative training sessions, which are increasingly implemented in the health care system. Future studies should explore the relationship of mechanisms and the outcome along the process of the training. Study Registration: Trial registration number NCT03080025.

Learning Compassion and Meditation: A Mixed-Methods Analysis of the Experience of Novice Meditators.

Over the last decade, numerous interventions and techniques that aim to engender, strengthen, and expand compassion have been created, proliferating an evidence base for the benefits of compassion meditation training. However, to date, little research has been conducted to examine individual variation in the learning, beliefs, practices, and subjective experiences of compassion meditation. This mixed-method study examines changes in novice meditators’ knowledge and contemplative experiences before, during, and after taking an intensive course in CBCT® (Cognitively-Based Compassion Training), a contemplative intervention that is increasingly used for both inter- and intrapersonal flourishing. The participants in this study (n = 40) were Christian healthcare chaplains completing a 1-year residency in Clinical Pastoral Education (CPE) who learned CBCT as part of their professional chaplaincy training curriculum. Prior to and upon completion of training, we surveyed participants to assess their beliefs about the malleability of compassion, types of engagement in compassion meditation, and perceptions of the impact of taking CBCT. We also conducted in-depth interviews with a subset of participants to gain a qualitative understanding of their subjective experiences of learning and practicing compassion meditation, a key component of CBCT. We found that participants reported increases in the extent to which they believed compassion to be malleable after studying CBCT. We also found high levels of variability of individual ways of practicing and considered the implications of this for the study of contemplative learning processes. This multi-methodological approach yielded novel insights into how compassion practice and compassion-related outcomes interrelate, insights that can inform the basic scientific understanding of the experience of learning and enacting compassion meditation as a means of strengthening compassion itself.

Cognitively Based Compassion Training for HIV Immune Nonresponders-An Attention-Placebo Randomized Controlled Trial.

Chronic inflammation is associated with increased morbidity and mortality for people with HIV (PWH). Psychological stress is an important contributor to this chronic inflammation. We hypothesized that a cognitively based compassion training (CBCT) approach could reduce inflammation and psychological stress in immune nonresponder PWH. An attention-placebo randomized controlled trial design to evaluate the acceptability of CBCT among PWH and its effects on key aspects of stress and immune function compared with an active-attention control group (NCT02395289). This study was conducted at an HIV clinic in Atlanta, Georgia. Eligible individuals determined by (1) adherence to antiretroviral therapy for at least a year, (2) virologic suppression; and (3) stable CD4+ T-cell counts <350 cells/μL were randomized in a 2:1 ratio to either CBCT or control in 2 study periods: April-May, 2016, and September-December, 2016. Psychological measures and inflammatory biomarkers associated with HIV disease progression (IL-1β, TNF-α, sCD14, IL-6, and IL-10) were obtained for all study participants at baseline and at the time of study completion. We found a significant association between CBCT practice time engagement and fold reduction in IL-6 and TNF-α levels. There was no association between CBCT practice time and other biomarkers markers assessed (IL-1β, sCD14, and IL-10). These changes were coincident with significant increases in self-reported psychological well-being and HIV disease acceptance and in benefits for CBCT participants. We also observed fewer instances of virologic failure for those in the CBCT arm compared with controls. CBCT is a novel and feasible nonmedication-based intervention that could reduce inflammation and psychological stress in PWH.

Cognitively‐Based Compassion Training (CBCT) Improves Immune Function and Prosocial Behavior in Humans

Cognitively‐Based Compassion Training (CBCT) empowers humans to improve their immune function and prosocial behavior. This paper begins by explaining the sociological context and definition of CBCT. It also offers a high-level overview of its six interrelated modules that are intended to yield resilience, compassion, and wellbeing. Next, the paper explores the extent to which CBCT can boost immune function in humans. This benefit is analyzed through the lenses of both cortisol level balance and inflammation in response to stress (as indicated by cytokine IL-6 blood levels and c-reactive protein saliva levels, respectively). The paper then considers how CBCT can improve prosocial behavior in humans. It achieves this by increasing social connections and the likelihood of altruistic actions. Lastly, the poster suggests further avenues of inquiry that could enable researchers to better understand the extent of the aforementioned internal and external benefits.

Integrating the Ignatian Pedagogical Paradigm with Buddhist-Inspired Compassion Meditation

While Ignatian pedagogy is distinctive in Jesuit education, scholarly attention on its applications is scanty. This article demonstrates the relevance of the Ignatian Pedagogical Paradigm (IPP) to compassion cultivation through showing how it integrates into a Buddhist-inspired contemplation program, Cognitively-Based Compassion Training® (CBCT®). Using a case study of a CBCT® course at a Jesuit University that developed students’ “whole person” and ethical discernment, this research analyzes how CBCT® works with the IPP’s five elements: context, experience, reflection, action, and evaluation. This study evaluates participants’ changes in their emotional well-being and ethical concerns by employing psychological measurements such as the Compassionate Love for Humanity Scale. The discussion concludes by elucidating how I have adapted this integrative pedagogical method to teach an undergraduate credited course, “Buddhist Meditation and Practice.” Broadly, this study contributes to a larger conversation about how educators can create an environment that supports both cognitive and affective learning.

Changes in the Semantic Construction of Compassion after the Cognitively-Based Compassion Training (CBCT®) in Women Breast Cancer Survivors.

The growing body of research on compassion has demonstrated its benefits for healthcare and wellbeing. However, there is no clear agreement about a definition for compassion, given the novelty of the research on this construct and its religious roots. The aim of this study is to analyze the mental semantic construction of compassion in Spanish-speaking women breast cancer survivors, and the effects of the Cognitively-Based Compassion Training (CBCT®) on the modification of this definition, compared to treatment-as-usual (TAU), at baseline, post-intervention, and six-month follow-up. Participants were 56 women breast cancer survivors from a randomized clinical trial. The Osgood's Semantic Differential categories (evaluative, potency, and activity scales) were adapted to assess the semantic construction of compassion. At baseline, participants had an undefined idea about compassion. The CBCT influenced subjects' semantic construction of what it means to be compassionate. Findings could lead to future investigations and compassion programs that adapt to a specific culture or population.

Integrating Contemplative and Ignatian Pedagogies in a Buddhist Studies Classroom

The burgeoning application of contemplative pedagogy (CP) in Buddhist studies courses has been widely discussed; yet, how educators incorporate it with other teaching strategies has not attracted much scholarly attention. Drawing from the author’s teaching experience at a Jesuit University, this article demonstrates that integrating CP’s first-person, second-person, and third-person approaches with the Ignatian Pedagogical Paradigm (IPP) will create a multidimensional environment in learning Buddhism in higher education. This article first argues that the issue of avoiding even implied proselytizing can be successfully overcome, as it is related to the application of Buddhist-inspired contemplative practice, such as Cognitively-Based Compassion Training®, in class. Next, based on the principles of CP and the IPP, this study shows specific examples of multisensory contemplation activities that expand students’ ways of knowing about Buddhist practice and foster their consideration for others. Third, to complement the Jesuit educational purpose of students’ spiritual growth, and the CP’s advocating for inner growth, this research navigates these concerns in a way that also enhances students’ learning in the course content. In conclusion, a combination of CP and the IPP facilitates the whole-person development as well as deepens students’ understanding of Buddhism.

Effects of Cognitively-Based Compassion Training on Parenting Interactions and Children’s Empathy

Cognitively-Based Compassion Training (CBCT) aims to cultivate participants’ compassion and enhance their well-being. CBCT was developed for college students and has been adapted for several unique populations, such as children in foster care, but it has only recently been used with parents of infants and young children. This analysis of data from a preliminary efficacy study examined effects of CBCT on parenting interactions and early empathy in infants and young children (aged 9 months to 5 years, 4 months). The study also examined the perceived benefits and challenges of participating in a 20-h CBCT intervention for parents. Thirty-nine families from university-affiliated preschools participated in this study; 25 parents were in the CBCT group and 14 parents were in a wait list control group. Parents were evaluated before and after the intervention, as well as after each session on their impressions of the class and experience with the assignments. Families were evaluated at pre- and post-intervention on observed parent-child interactions and child empathy. Parents found that participating in CBCT was a positive, even life-changing experience for them, though finding time to practice the guided meditations was difficult. However, CBCT did not improve sensitive and responsive interactions between parents and children or young children’s empathy assessed in a lab setting. CBCT for parents was viewed positively by participants but it did not change their observed parenting interactions or young children’s observed empathy across a 3-month period.

Compassion Meditation Training for Hospital Chaplain Residents: A Pilot Study

This study examines the effectiveness of incorporating compassion meditation training into a clinical pastoral education (CPE) curriculum to enhance compassion satisfaction and reduce burnout among hospital chaplain residents. Specifically, a longitudinal, quasi-experimental design was used to examine the impact of Cognitively-Based Compassion Training (CBCT), a group-delivered compassion meditation intervention. Hospital chaplain residents (n = 15) were assigned to participate in a CBCT intervention or a waitlist comparison group. Chaplains assigned to CBCT reported significant decreases in burnout and anxiety compared to the waitlist group; effects were not maintained at 4-month follow-up. Other outcomes, including compassion satisfaction, did not differ significantly but were trending in the expected direction. Findings suggest that compassion meditation training incorporated into CPE promotes chaplain wellbeing, although it may be necessary to extend CBCT throughout residency to sustain effects.

A model for cognitively-based compassion training: theoretical underpinnings and proposed mechanisms

Across cultures and belief systems, compassion is widely considered to be beneficial for the development of personal and social wellbeing. Research indicates that compassion-training programs have broad health benefits, but how and why compassion-training programs are effective is still relatively unknown. This paper describes the theoretical underpinnings of a specific compassion-training program, CBCT® (Cognitively-Based Compassion Training), and proposes an integrative model that draws on existing health behavior constructs to identify CBCT’s core components and hypothesizes their directionality and interaction. The model includes two primary categories of skill development: (1) intrapersonal skills leading to greater resiliency, and (2) interpersonal skills leading to greater compassion. It is hypothesized that these two pathways are mutually reinforcing and both contribute to greater wellbeing. This model provides a foundation for theory-driven research on the underlying mechanisms in CBCT training. An understanding of CBCT’s mechanisms is a critical step towards optimizing and personalizing the intervention to meet the needs of specific populations.

Cognitively-Based Compassion Training for parents reduces cortisol in infants and young children.

This study tests a group-based secular contemplative practice intervention, Cognitively-Based Compassion Training (CBCT), with parents of young children. We report on a randomized controlled preliminary efficacy study. Certified teachers administered CBCT for 20 hr across 8 to 10 weeks in two cohorts of parents with infants and young children. The intervention group was compared to a waitlist control group. Thirty-nine parents and their children, who ranged in age from 4 months to 5 years, were evaluated at pre- and postintervention (n = 25 intervention, n = 14 waitlist control) on hair cortisol concentration. Parents also completed self-administered questionnaires at both time points regarding demographics, physical symptoms of stress, parenting stress, self-compassion, and mindfulness. Children of parents in the CBCT group experienced significant decreases in cortisol at the postintervention assessment, as compared with the control group. However, parent cortisol and self-report measures did not significantly change other than a small effect on clinical levels of parenting stress. CBCT may be a positive new way to intervene with parents to lower infants' and young children's cumulative physiological stress.

For Whom Does Cognitively Based Compassion Training (CBCT) Work? An Analysis of Predictors and Moderators among African American Suicide Attempters.

Both Cognitively-Based Compassion Training (CBCT) and support-based group intervention have been found to be effective for African American suicide attempters in reducing suicidal ideation and depression, as well as enhancing self-compassion. This study aims to further our understanding of effective interventions by exploring participants' responses to both interventions. Exploratory analyses were conducted in a sample of low-income African Americans who had attempted suicide (n=82) to determine how baseline demographic and psychological characteristics would (1) predict outcomes (i.e., suicidal ideation, depression, and self-compassion) regardless of intervention conditions, and (2) moderate outcomes in interaction with intervention condition. Non-reactivity, a mindfulness facet, was identified as an intervention moderator for suicidal ideation and depressive symptoms, suggesting that CBCT outperformed the support group for African American suicide attempters who had low baseline non-reactivity (or high reactivity). Individuals who had high non-reactivity at baseline appeared to benefit more from both conditions in self-compassion as an outcome. There was a pattern that homeless individuals benefited less in terms of their levels of depressive symptoms and self-compassion as outcomes regardless of the assigned condition. When applying Bonferroni corrections, only non-reactivity as an intervention moderator for depressive symptoms was significant. Findings reveal the relevance of mindfulness and to a lesser extent socioeconomic status in informing compassion-based intervention outcomes with this underserved population and the importance of intervention matching and tailoring to maximize treatment effects. Future large trials are needed to replicate findings and directions indicated from the current pilot study.

Cognitively-Based Compassion Training versus cancer health education to improve health-related quality of life in survivors of solid tumor cancers and their informal caregivers: study protocol for a randomized controlled pilot trial

BackgroundCancer survivors and their informal caregivers (family members, close friends) often experience significant impairments in health-related quality of life (HRQOL), including disruptions in psychological, physical, social, and spiritual well-being both during and after primary cancer treatment. The purpose of this in-progress pilot trial is to determine acceptability and preliminary efficacy (as reflected by effect sizes) of CBCT® (Cognitively-Based Compassion Training) compared with a cancer health education (CHE) attention control to improve the primary outcome of depressive symptoms and secondary outcomes of other HRQOL domains (e.g., anxiety, fatigue), biomarkers of inflammation and diurnal cortisol rhythm, and healthcare utilization-related outcomes in both cancer survivors and informal caregivers.MethodsForty dyads consisting of solid tumor survivors who have completed primary treatments (chemotherapy, radiation, surgery) and their informal caregivers, with at least one dyad member with ≥ mild depressive symptoms or anxiety, will be recruited from Tucson, Arizona, USA. Survivor-caregiver dyads will be randomized together to complete either CBCT or CHE. CBCT is a manualized, 8-week, group meditation-based intervention that starts with attention and mindfulness and builds to contemplative practices aimed at cultivating compassion to the self and others. The goal of CBCT is to challenge unexamined assumptions about feelings and behaviors, with a focus on generating spontaneous self-compassion and increased empathic responsiveness and compassion for others. CHE is an 8-week, manualized group intervention that provides cancer-specific education on various topics (e.g., cancer advocacy, survivorship wellness). Patient-reported HRQOL outcomes will be assessed before, immediately after (week 9), and 1 month after CBCT or CHE (week 13). At the same time points, stress-related biomarkers of inflammation (e.g., plasma interleukin-6) and saliva cortisol relevant for survivor and informal caregiver wellness and healthcare utilization will be measured.DiscussionIf CBCT shows acceptability, a larger trial will be warranted and appropriately powered to formally test the efficacy of this dyadic intervention. Interventions such as CBCT directed toward both survivors and caregivers may eventually fill a gap in supportive oncology care programs to improve HRQOL and healthcare utilization in both dyad members.Trial registrationClinicaltrials.gov, NCT03459781. Prospectively registered on 9 March 2018.

Compassion Meditation for Posttraumatic Stress Disorder in Veterans: A Randomized Proof of Concept Study.

There is considerable interest in developing complementary and integrative approaches for ameliorating posttraumatic stress disorder (PTSD). Compassion meditation (CM) and loving-kindness meditation appear to offer benefits to individuals with PTSD, including symptom reduction. The present study was a pilot randomized controlled trial of CM for PTSD in veterans. The CM condition, an adaptation of Cognitively-Based Compassion Training (CBCT®), consists of exercises to stabilize attention, develop present-moment awareness, and foster compassion. We compared CM to Veteran.calm (VC), which consists of psychoeducation about PTSD, rationale for relaxation, relaxation training, and sleep hygiene. Both conditions consist of 10 weekly 90-min group sessions with between-session practice assignments. A total of 28 veterans attended at least one session of the group intervention and completed pre- and posttreatment measures of PTSD severity and secondary outcomes as well as weekly measures of PTSD, depressive symptoms, and positive and negative emotions. Measures of treatment credibility, attendance, practice compliance, and satisfaction were administered to assess feasibility. A repeated measures analysis of variance revealed a more substantive reduction in PTSD symptoms in the CM condition than in the VC condition, between-group d = -0.85. Credibility, attendance, and satisfaction were similar across CM and VC conditions thus demonstrating the feasibility of CM and the appropriateness of VC as a comparison condition. The findings of this initial randomized pilot study provide rationale for future studies examining the efficacy and effectiveness of CM for veterans with PTSD.

Enhancing Social Interaction in Depression (SIDE study): protocol of a randomised controlled trial on the effects of a Cognitively Based Compassion Training (CBCT) for couples

IntroductionPositive social interactions (PSIs) and stable relationships can exert substantial benefits on health. However, patients suffering from depression benefit less from these health-promoting effects. Moreover, relationship quality and even partners’...

The Efficacy of Cognitively-Based Compassion Training for African American Suicide Attempters

This study is a pilot Randomized Controlled Trial (RCT) that compares the effectiveness of a Cognitively-Based Compassion Training (CBCT) group treatment to a support group in reducing depressive symptoms and suicidal ideation and increasing self-compassion and mindfulness in low-income African Americans who had attempted suicide (n = 82). After completing several measures, including the Beck Scale for Suicide Ideation (BSS), Beck Depression Inventory—II (BDI-II), Self-Compassion Scale (SCS), and Five Facet Mindfulness Questionnaire (FFMQ), participants were assigned randomly to attend either a 6-session CBCT group or a 6-session support group. Although following intervention participants randomized to both groups had comparable reductions in levels of depressive symptoms and suicidal ideation and no significant changes in their levels of mindfulness, improvements in levels of self-compassion were found only for those receiving the CBCT intervention. In addition, for individuals in the CBCT group but not in the support group, the degree of improvement in self-compassion predicted the level of reduction in depressive symptoms and suicidal ideation and the degree of improvement in mindfulness predicted the level of reduction in depressive symptoms. Taken together, the results indicate that CBCT is potentially valuable for this population and its emphasis on self-compassion and mindfulness is associated with improved psychological functioning.