Compassion Training Research Articles

Understanding the concept of compassion from the perspectives of nurses.

The high level of satisfaction of users of a health service is largely due to the fact that they receive excellent care from healthcare professionals. Compassionate care is an essential component of excellent care. But what do nurses understand compassion to be? To analyse the concept of compassion from the perspective of nurses in the Andalusian Public Health System, Spain. This is a qualitative study following the grounded theory model. Four focus groups and 25 in-depth interviews were conducted. A total of 68 nursing professionals working in the Andalusian Public Health System (Spain) participated. Theoretical sampling was used, with participants being recruited using the snowball technique. This research was approved by the Research Ethics Committee of the Centro-Almería Health District (CEICA 27/9/17). From the analysis of the data, four themes emerged that helped to understand the concept of compassion according to nurses: 'Negative perception of the term compassion', 'Compassion and empathy as synonyms', 'Beyond empathy', and 'Effects of having a compassionate attitude'. Nurses perceive the concept of compassion differently to each other and even contradictorily. This concept is imbued with cultural elements, which adds confusion to understanding it, and is even perceived as something negative similar to pity. Nurses confuse the concepts of empathy and compassion as if they were synonymous. Before considering training in compassion for healthcare professionals, it is essential to clarify the concept of compassion through educational interventions.

Mindfulness-Based Compassion Training for Health Professionals Providing End-of-Life Care: Impact, Feasibility, and Acceptability.

Background: Health professionals who care for patients and their families at the end of life (EOL) may experience gratitude, and enhanced spirituality and meaning in life, yet they are also at increased risk of psychological distress, compassion fatigue, and occupational burnout given the stressors they encounter in their work. Objectives: This research evaluated the feasibility and acceptability of a novel six-week mindfulness-based compassion training intervention, which was tailored to health professionals involved in EOL care ("MBCT4HP"), and explored its impact on levels of psychological distress, compassion fatigue, compassion satisfaction, occupational burnout, self-compassion, and mindfulness. Design: We adopted an observational, repeated measures pilot study. Setting/Subjects: Thirty-one health professionals participated. The intervention comprised six, weekly sessions (totaling seven hours) designed to foster compassion for self and others, including formal and informal compassion and mindfulness practices, daily home practice, and a reflective experiential pedagogy. Measurements: Validated outcome measures for anxiety, depression, and stress; compassion satisfaction, compassion fatigue (burnout, secondary traumatic stress); occupational burnout (emotional exhaustion, personal accomplishment, and depersonalization), self-compassion, and mindfulness were administered at baseline, end of intervention, and eight weeks postintervention. The feasibility and acceptability of the intervention was assessed using attendance records, home practice logs, and self-report satisfaction items. Descriptive statistics and Generalized Linear Mixed Models were used to analyze the data. Results: Participants reported that the sessions were useful, relevant, easy to understand, and that they gave them sufficient knowledge to implement the strategies learned. Levels of anxiety, compassion fatigue (burnout only), and emotional exhaustion decreased over time with some decay in effects at follow up, and levels of compassion satisfaction and self-compassion increased with time. Conclusions: The intervention was feasible and acceptable to health professionals involved in EOL care and had a positive impact on levels of anxiety, compassion fatigue (burnout), emotional exhaustion, compassion satisfaction, and self-compassion.

Effects of Loving-Kindness and Compassion Training on Trait Anger and Anger Coping Behavior in Female University Students

Effects of Loving-Kindness and Compassion Training on Trait Anger and Anger Coping Behavior in Female University Students

A Chaplain Shadowing Program to Teach Compassionate Care Among Physicians-in-Training.

To the Editor: In this letter, we share our belief in the importance of compassion and empathy training and briefly describe a successful method of teaching compassionate care through a chaplain shadowing program. Compassion and empathy are fundamental human aspects of providing patient- and family-centered care. With changes in health care leading to limited time for physical patient contact, work hour restrictions for trainees, the rise of shift-work culture, and medical advances decreasing the length of patient stay, opportunities to build rapport and trust as a physician are limited. However, the need for compassion as a fundamental component of care has not changed. This challenges physicians-in-training to be equipped with even better communication and interpersonal skills to develop trust with their patients. Methods to teach and assess compassion are challenging, and curriculum leaders struggle to reach a balance between the need to convey the importance of specific behaviors and the use of formal assessment as a tool to motivate learning of those behaviors.1 One way that medical students at our institution learn to practice compassionate care is by shadowing board-certified chaplains on hospital rounds through their membership in Leadership Through Ethics, a student-driven program.2 At the conclusion of these shadowing experiences, students have the opportunity to debrief, ask the chaplain questions, and submit written reflections on their experiences. Unprompted reflections highlight students’ perceived values and roles of the pastoral care department in connecting with patients and families as well as role-modeling compassion and empathy in their interactions. Furthermore, the unprompted written reflections and debriefing discussions may be used to communicate the values of compassion and empathy as alternative paradigms to formal assessment. Students furthermore have the opportunity to practice spiritual assessments and reflect on the personal impact these interactions have toward their future careers. We began our shadowing program in the Spring of 2016 and have received generally enthusiastic responses to it from students. Chaplains are vital members of the interdisciplinary care team and often have the interpersonal skills and availability to connect with patients and families, no matter what their religious affiliations, on a different level than most clinicians. It is important for physicians-in-training to incorporate the basic skills of performing a spiritual assessment into their everyday practice using the framework provided by the chaplains. As a way of modeling the importance of compassionate health care and integrating spiritual care into clinical training, pastoral care shadowing has proved to be an effective teaching modality at our medical school.

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.

A Happy Heart Comes First: Heart-Based Compassion Training

Practicing mindfulness, acceptance, and compassion have in recent years become widely accepted as part of biofeedback therapy. Compassion, in particular, has a measurable physiological basis through the conventional HRV biofeedback instrumentation. The present article reviews the research basis for the integration of compassion in the treatment of biofeedback beyond the essential eclectic use of compassionate practices in biofeedback therapy. Also, it offers two ways of integrating compassion within biofeedback-based interventions.

The effectiveness of smartphone compassion training on stress among Swedish university students: A pilot randomized trial.

To investigate the effects of a 6-week smartphone compassion training intervention on mental health. Fifty-seven Swedish university students (mean age = 25, SD = 5) reporting high levels of stress were randomized to compassion training (n = 23), mindfulness (n = 19), or waitlist (n = 15). Multilevel models indicated that both compassion and mindfulness training increased self-compassion compared to the waitlist, while only compassion significantly reduced stress. Between-group effect sizes for compassion compared to waitlist were large for both self-compassion (d = 1.61) and stress (d = 0.94). Compassion and mindfulness did not differ significantly, but effect sizes were in favor of compassion. Secondary outcomes indicated positive effects on emotional awareness, while no effect was found for global psychological distress. Our results suggest that compassion training via a smartphone application can improve self-compassion and reduce stress among university students. Future studies in larger clinical samples are warranted.

Compassionate Mind Training: An 8-week group for the general public.

There is an increasing interest in how compassion training, and in particular, the cultivation of self-compassion may be an important component in the reduction of distress and promotion of well-being. Compassion Focused Therapy (CFT) has shown promising results in this area, with positive outcome studies in a wide range of mental health problems. However, following the successful development of short mindfulness-based programmes (e.g., Mindfulness-based Stress Reduction and Mindfulness-based Cognitive Therapy) and compassion/self-compassion programmes (e.g., Mindful Self-Compassion) that can be accessed by the general public, we were keen to develop and research an 8-week Compassionate Mind Training (CMT) course, based on the CFT model. Within-subjects pre-to-post-group comparison. Following an 8-week CMT groups, participants in the general population (n=55) completed pre- and post-measures (with 22 of these also providing 3-month follow-up data) on self-compassion, compassion for others, compassion from others, attachment, self-criticism, positive emotion, well-being, and distress. Significant increases in compassion, self-reassurance, social rank, positive emotions, and well-being were found, alongside reductions in self-criticism, attachment anxiety, and distress. Changes were maintained at 3-month follow-up. Change scores indicated the importance of increases in self-compassion and reductions in self-criticism in overall improvements in well-being and psychological distress. Findings offer preliminary support for the usefulness of group CMT in community samples. Compassionate Mind Training (CMT) groups appear to be applicable and beneficial in community samples. CMT psychoeducation and practices appear to bring positive changes to a variety of psychological processes, including attachment, self-criticism, self-compassion, well-being, and distress. Further studies are required to investigate whether the mechanisms through which CMT is beneficial.

"Compassion Fatigue" is a Misnomer: How Compassion Can Increase Quality of Life.

Health-care workers are at risk of experiencing negative consequences for their own health and job performance due to a wide variety of stressors. Care providers suffer from varying expressions of a generalized symptom set that has been termed "burnout" or "compassion fatigue." These terms can help us understand the phenomenon that is happening in our health system, but a strong understanding of the physical, mental, emotional, and psychological implications will increase the efficacy of treatment and benefit of preventive care. This article asserts that the term "compassion fatigue" is a misnomer, resulting in a misunderstanding of the causes and effects of compassion on the individual. This article challenges the term, positing that it has become outdated based on what we now know about the neuroscience of compassion, empathy, and mindfulness. Instead, this discussion offers the relevance of the term "empathic distress leading to empathic distress fatigue," suggesting that contemplative practice, mindfulness, and compassion training can protect and empower health-care providers.

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.

Comparing Web-Based Mindfulness With Loving-Kindness and Compassion Training for Promoting Well-Being in Pregnancy: Protocol for a Three-Arm Pilot Randomized Controlled Trial.

BackgroundPromoting psychological well-being and preventing distress among pregnant women is an important public health goal. In addition to adversely impacting the mother’s health and well-being, psychological distress in pregnancy increases the risk of poor pregnancy outcomes, compromises infant socioemotional development and bonding, and heightens maternal and child vulnerability in the postpartum period. Mindfulness and compassion-based interventions show potential for prevention and early intervention for perinatal distress. As there is an established need for accessible, scalable, flexible, and low-cost interventions, there is increased interest in the delivery of these programs on the web. This project aims to pilot a three-arm randomized controlled trial (RCT) to determine the feasibility of a full-scale RCT comparing 2 web-based interventions (mindfulness vs loving-kindness and compassion) with a web-based active control condition (progressive muscle relaxation).ObjectiveThe primary objective of this study is to assess the feasibility of an RCT protocol comparing the 3 conditions delivered on the web as a series of instructional materials and brief daily practices over a course of 8 weeks. The second objective is to explore the experiences of women in the different intervention conditions. The third objective is to estimate SD values for the outcome measures to inform the design of an adequately powered trial to determine the comparative efficacy of the different conditions.MethodsPregnant women (n=75) participating in a longitudinal birth cohort study (the ORIGINS project) will be recruited to this study from 18 weeks of gestational age. We will assess the acceptability and feasibility of recruitment and retention strategies and the participants’ engagement and adherence to the interventions. We will also assess the experiences of women in each of the 3 intervention conditions by measuring weekly changes in their well-being and engagement with the program and by conducting a qualitative analysis of postprogram interviews.ResultsThis project was funded in September 2019 and received ethics approval on July 8, 2020. Enrollment to the study will commence in September 2020. Feasibility of a full-scale RCT will be assessed using ADePT (a process for decision making after pilot and feasibility trials) criteria.ConclusionsIf the study is shown to be feasible, results will be used to inform future full-scale RCTs. Evidence for flexible, scalable, and low-cost interventions could inform population health strategies to promote well-being and reduce psychological distress among pregnant women.Trial RegistrationAustralian New Zealand Clinical Trials Registry Number 12620000672954p; http://anzctr.org.au/ACTRN12620000672954p.aspxInternational Registered Report Identifier (IRRID)PRR1-10.2196/19803

The Sciencization of Compassion

Recent neuroscientific research has caused a paradigm shift in our understanding of the meaning and scope of compassion. Derived from the Latin root compassiō, compassion used to be a religious emotion that implied suffering with the perceived sufferer, whereas now it is examined as a psychological, neuroscientific, neurobiological, and thus natural, phenomenon. The newly arisen research interest in compassion led to the development of secular compassion training programs that follow closely in the footsteps of the “mindfulness revolution.” Whereas the latter has been criticized for its reductionist appropriation of Buddhist thought by the capitalist west, in this paper, I demonstrate that the secularization of compassion is the result of innovative activities by representatives of the Buddhist traditions. I argue that some of the causes for the recent secularization and sciencization can be traced back into the fourteenth century Tibet, namely to the innovative exegetical activities of the scholars of the Tibetan Lojong tradition. I argue that from the perspective of the tradition, the sciencization of compassion resembles a deliberate purposeful “translation” effort that fits into the “two-track approach” of Buddhist propagation.

The Use of Common Humanity Scenarios to Promote Compassion in Healthcare Workers

ABSTRACT The importance of compassion in healthcare is universally acknowledged. However, the factors that enhance compassion are not well understood. The perception of common humanity has been proposed as a prosocial perspective that leads to unbiased universal compassion. There has been a lack of research into the relationship between common humanity and compassion. This study examined the use of common humanity scenarios to promote compassion in healthcare workers. Seventy-five healthcare workers were randomly assigned to two groups and shown a different common humanity scenario. The healthcare workers were asked what effect viewing the videos had on their perception of common humanity and compassion. Thematic analysis was used to identify themes. Four main themes emerged: (a) common bonds; (b) people have the same needs; (c) no one wants to suffer; (d) seeing strangers helping others is motivating. Healthcare workers reported feelings of care, concern, and compassion after viewing common humanity scenarios. IMPLICATIONS Viewing common humanity scenarios appears to lead to enhanced feelings of connection to others and compassion in healthcare workers. Using common humanity scenarios may be a useful compassion training strategy in healthcare. Further research is necessary to gain a better understanding of how viewing common humanity material influences compassion.

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.

Sustainable Compassion Training: Integrating Meditation Theory With Psychological Science.

Meditation programs continue to proliferate in the modern world, with increasing participation from scientists and many others who seek to improve physical, mental, relational, and social flourishing. In developing such programs, the meditation practices have been adapted to meet the needs of modern cultures. However, through that adaptation, important contextual factors of traditional contemplative cultures are often dropped or forgotten. This article presents a system of compassion and mindfulness training, Sustainable Compassion Training (SCT), which is designed to help people cultivate increasingly unconditional, inclusive, and sustainable care for self and others. SCT aims to recover important contextual factors of meditation that flexibly meet the diverse needs of modern secular and religious participants. SCT draws on Tibetan Buddhism in dialogue with caregivers, other contemplative traditions and relevant scientific theories to inform meditative transformation for secular contexts. We provide an overview of SCT meditations that includes both contemplative and scientific theories that draw out important features of them. Each meditation includes novel hypotheses that are generated from this dialogical process. We also provide links to audio-guided meditations.

Compassion for self versus other: A critical review of compassion training research

ABSTRACT There is rapidly growing interest in Western compassion trainings that rely especially on traditional Buddhist practices. This growing body of research distinguishes between two distinct compassion constructs, namely self-compassion versus other-oriented compassion (hereafter, other-compassion). However, the Buddhist traditions from which most studied compassion practices derive emphasize the relevance of compassion for breaking down artificial barriers between self and other. We therefore conducted a comprehensive review of 94 randomized controlled trials on compassion training, examining how the dualistic division of compassion (into self- versus other-compassion) has shaped compassion training research to date. Our review finds patterns both consistent (e.g. a disproportionate focus on the self-oriented benefits of compassion trainings) and inconsistent (e.g. particular pairings of self-other emphasis across training and outcome) with the dualistic division of compassion. Overall, findings reveal the need for more research on social benefits of self- and other-compassion training, as well as less dualistic approaches to compassion.

Feasibility of the Internet Attachment-Based Compassion Therapy in the General Population: Protocol for an Open-Label Uncontrolled Pilot Trial.

BackgroundCompassion-based interventions delivered over the internet are showing promising results for the promotion of psychological health and well-being. Several studies have highlighted their feasibility, acceptance, and preliminary efficacy. However, this is an incipient field of research, and to the best of our knowledge, there are no data available from Spanish-speaking countries.ObjectiveThe aim of this study is to investigate the feasibility, acceptance, and preliminary efficacy of the Internet Attachment–Based Compassion Therapy (iABCT), a web-based version of the Attachment-Based Compassion Therapy, in Spanish speakers from the general population.MethodsThis feasibility study features a single-arm, uncontrolled, within-group design with an embedded qualitative and quantitative process evaluation at baseline, immediately after the intervention and at the 3-month follow-up. A minimum of 35 participants from the general population will be allocated to iABCT. Feasibility measures will include attrition rate, patterns of use of the web-based system, and participants’ acceptability, usability, and opinion. The primary outcome was measured using the Pemberton Happiness Index. Secondary outcomes were measured using the Compassion Scale, Self-Compassion Scale, Forms of Self-Criticizing/Attacking and Self-Reassuring Scale-Short form, Five Facets of Mindfulness Questionnaire, Relationships Questionnaire, General Health Questionnaire, Non-Attachment Scale, International Positive and Negative Affect Schedule Short Form, Purpose-In-Life Test, and difficulties regarding the practice of compassion (Compassion Practice Quality Questionnaire). Mixed models will be used to evaluate primary and secondary outcome measures. A qualitative content analysis of the participants’ qualitative responses will also be performed.ResultsEnrollment started in February 2020 and will be finished in April 2020. Data analysis will start in October 2020.ConclusionsTo our knowledge, this study will, for the first time, show data on the feasibility, acceptability, and preliminary efficacy of web-based compassion (and self-compassion) training—that is, the adapted iABCT—in Spanish speakers from the general population. Further aspects of their implementation (ie, facilitators, barriers, and unwanted effects) and mechanisms of change will be investigated. This study will allow the revision and fine-tuning of the developed intervention, study design, and planning procedures, as well as the initiation of a future randomized controlled trial.Trial RegistrationClinicaltrials.gov: NCT03918746. Registered on April 17, 2019. Protocol version 1, 6 March 2019.International Registered Report Identifier (IRRID)PRR1-10.2196/16717

Healthcare providers perspectives on compassion training: a grounded theory study

BackgroundThere is little concrete guidance on how to train current and future healthcare providers (HCPs) in the core competency of compassion. This study was undertaken using Straussian grounded theory to address the question: “What are healthcare providers’ perspectives on training current and future HCPs in compassion?”MethodsFifty-seven HCPs working in palliative care participated in this study, beginning with focus groups with frontline HCPs (n = 35), followed by one-on-one interviews with HCPs who were considered by their peers to be skilled in providing compassion (n = 15, three of whom also participated in the initial focus groups), and end of study focus groups with study participants (n = 5) and knowledge users (n = 10).ResultsStudy participants largely agreed that compassionate behaviours can be taught, and these behaviours are distinct from the emotional response of compassion. They noted that while learners can develop greater compassion through training, their ability to do so varies depending on the innate qualities they possess prior to training. Participants identified three facets of an effective compassion training program: self-awareness, experiential learning and effective and affective communication skills. Participants also noted that healthcare faculties, facilities and organizations play an important role in creating compassionate practice settings and sustaining HCPs in their delivery of compassion.ConclusionsProviding compassion has become a core expectation of healthcare and a hallmark of quality palliative care. This study provides guidance on the importance, core components and teaching methods of compassion training from the perspectives of those who aim to provide it—Healthcare Providers—serving as a foundation for future evidence based educational interventions.

Recovering the Relational Starting Point of Compassion Training: A Foundation for Sustainable and Inclusive Care

The cultivation of compassion through meditation training is of increasing interest to scientists, health-care providers, educators, and policymakers as an approach to help address challenging personal and social issues. Yet people encounter critical inner psychological barriers to compassion that limit the effectiveness of compassion training—including the lack of a secure base, aversion to suffering, feeling alone in suffering, and reductive impressions of others. These barriers emerge, in part, from a lack of relational support and are exacerbated by modernist conceptions that present meditation as an autonomous, self-help practice. This article proposes a solution centered on relationality that is derived from the integration of diverse areas of psychology with contemplative traditions. Theories and findings from social, developmental, and health psychology can inform meditation programs and help recover important relational elements of compassion training from traditional cultures that address common barriers to compassion and thus promote more sustainable and inclusive care. In so doing, this article illustrates the value of psychological theories for translating important contextual elements from contemplative traditions into diverse modern settings.

Compassion in mental health: a literature review

Purpose This paper aims to systematically review the current literature on compassion in mental health from a historical, service user and carer (SUAC)/academic researcher perspective with respect to the current paradigm/biomedical model. Design/methodology/approach Searches were conducted in CIANHL Complete, Academic Search Complete, British Education Index, ERIC, MEDLINE, PsycArticles, Scorpus, Proquest Central using a simplified PRISM approach. Findings In the UK, the SUAC-movement facilitated the adoption of more compassionate mental health in statutory services. Across the world, compassion-based approaches may be viewed as beneficial, especially to those experiencing a biomedical model “treatment”. Health-care workers, suffering burnout and fatigue during neoliberal economics, benefit from compassion training, both in their practice and personally. Randomised control trials (RCTs) demonstrate compassion-type interventions are effective, given sufficient intervention timing, duration and design methodology. Psychology creates outcome measures of adequacies and deficiencies in compassion, demonstrating their importance statistically, with reservations. The effective protection of mental health by self-compassion in both SUACs and health care professionals is evident. It is clear from qualitative research that SUACs prefer compassionate mental health. It also makes a large difference to mental health in general populations. Implications for practice and suggestions for future research are given, including a necessity to fund RCTs comparing compassionate mental health interventions with the biomedical model. Unless statutory mental health services adopt this emerging evidence base, medics and their SUACs will continue to rely on pharmaceuticals. Originality/value This is the first integrated literature review of compassion in mental health from a historical, SUAC/academic researcher viewpoint using all research methodologies.