Compassion: an evolutionary analysis and empirical review

The role of positive emotion in harmful health behavior: Implications for theory and public health campaigns

Meta-analyses have concluded that positive emotions do not reduce appetitive risk behaviors (risky behaviors that fulfill appetitive or craving states, such as smoking and excessive alcohol use). We propose that this conclusion is premature. Drawing on the Appraisal Tendency Framework and related theories of emotion and decision-making, we hypothesized that gratitude (a positive emotion) can decrease cigarette smoking, a leading cause of premature death globally. A series of multimethod studies provided evidence supporting our hypothesis (collective N = 34,222). Using nationally representative US samples and an international sample drawn from 87 countries, Studies 1 and 2 revealed that gratitude was inversely associated with likelihood of smoking, even after accounting for numerous covariates. Other positive emotions (e.g., compassion) lacked such consistent associations, as expected. Study 3, and its replication, provided further support for emotion specificity: Experimental induction of gratitude, unlike compassion or sadness, reduced cigarette craving compared to a neutral state. Study 4, and its replication, showed that inducing gratitude causally increased smoking cessation behavior, as evidenced by enrollment in a web-based cessation intervention. Self-reported gratitude mediated the effects in both experimental studies. Finally, Study 5 found that current antismoking messaging campaigns by the US Centers for Disease Control and Prevention primarily evoked sadness and compassion, but seldom gratitude. Together, our studies advance understanding of positive emotion effects on appetitive risk behaviors; they also offer practical implications for the design of public health campaigns.

Meditation and Compassion Therapy in Psychiatric Disorders: A Pilot Study

Introduction Our study aimed to compare meditation and compassion-based group therapy with the standard of care in patients with eating disorders, drug addiction, alcohol addiction, and depression, concerning acceptance, mindfulness awareness, self-compassion, and psychological distress. Methods A controlled designed study was performed, comparing meditation and compassion-focused group therapy added to the standard of care with the standard of care alone, on patients with eating disorders, drug addiction, alcohol addiction, and mood disorders. Four validated questionnaires were administered: the Acceptance and Action Questionnaire-II (AAQ-II), which assesses the ability to be fully in touch with the present moment; the Mindful Attention Awareness Scale (MAAS), which assesses the ability to experience consciously what is happening in the present moment; the Self-Compassion Scale (SCS), which assesses self-compassion characteristics, including loving-kindness; and the Symptom Checklist-90 (SCL-90), which measures psychological distress (anxiety, depression, psychotic behavior, etc.). Results There was a total of 75 subjects, out of which 48 represented the experimental group, and 27 represented the control group. The overall mean age of the subjects was 44.8 ± 13.2 years. There were statistically significant increases in the experimental group (baseline vs. end of study) for the AAQ-II, MAAS, and SCS scores, and a statistically significant decrease in the SCL-90 score. In the control group, there was a statistically significant decrease in the SCL-90 score, but no significant differences for other measurements. The comparisons between the two groups at the end of the study were as follows: AAQ-II: 0.7 (-5.74 to 7.15), p = 0.827; MAAS: 4.78 (-3.19 to 12.75), p = 0.233; SCS: 5.89 (-3.18 to 14.96), p = 0.199; SCL-90: -0.26 (-0.62 to 0.1), p = 0.157. Conclusion Within the experimental group, all scales improved statistically significantly. There were no statistically significant differences at the end of the study concerning the four scales between the groups. The comparison between groups was limited by data availability.

The Spanish Version of the Sussex-Oxford Compassion for Others Scale (SOCS–O) in Nursing Students: Psychometric Properties and Its Relation with Mindfulness

Objectives

This study aimed to examine the psychometric properties of the Sussex-Oxford Compassion for Others Scale (SOCS–O) in a large sample of Spanish undergraduate nursing students.

Method

After a forward–backward translation process, we conducted a cross-sectional study among nursing students in their first year of training at two Spanish universities. The mean age of the participants (n = 683) was 22.74 years old, and 83.46% were women. Together with compassion for others, mindfulness was also assessed.

Results

Descriptive results revealed high scores across all dimensions of the SOCS–O. The data supported a 3-factor structure with correlated factors (χ2(167) = 363.47, p < 0.01; CFI = 0.96; TLI = 0.95; RMSEA = 0.05, 90% CI = 0.04, 0.05; SRMR = 0.04). Reliability estimates, measured by Cronbach’s alpha, were excellent, ranging from 0.87 to 0.93. Measurement invariance across gender was confirmed. Men exhibited significantly lower levels in all compassion dimensions: Recognizing suffering (mean difference =  − 0.40), Understanding the universality of suffering (mean difference =  − 0.33), and Behavioral compassion (mean difference =  − 0.57) (all p < 0.01). The structural equation model showed a clear relationship between mindfulness and compassion (χ2(581) = 1345.79, p < 0.01; CFI = 0.92; TLI = 0.92; RMSEA = 0.04, 90% CI = 0.04, 0.04; SRMR = 0.06).

Conclusions

The findings showed that the Spanish version of the SOCS–O has robust psychometric properties. The SOCS–O is a reliable tool for measuring compassion with three subscales and helps advance understanding of compassion among student nurses. The positive relationship between mindfulness and compassion suggests that incorporating mindfulness training into nursing curricula could enhance the delivery of compassionate care.

Preregistration

This study was not preregistered.

Exploring the Relationship Between Self-Compassion and Compassion for Others: The Role of Psychological Distress and Wellbeing

We addressed construct validity and explored the relationship between self-compassion and compassion for others using the two main current operationalizations of compassion (Neff's and the Sussex-Oxford Compassion Scales, SOCSs). Relationships with psychological distress and wellbeing, and potential differences in the association between self-compassion and compassion for others by level of psychological distress and wellbeing were also explored. Participants (n = 811) completed the Spanish adaptations of the Self-Compassion Scale (SCS), the Compassion Scale (CS), the SOCSs (for the self/others), the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS), and the Depression Anxiety Stress Scales-21 (DASS-21). We fitted bifactor models to estimate the general factor of each construct for the different operationalizations, and calculated correlations between them. Relationships between self-compassion and compassion for others from the same operationalization were intermediate, while those between the same constructs from different operationalizations were large. Both constructs showed positive associations with wellbeing, while only self-compassion was associated with decreased psychological distress. Participants with good mental health showed higher associations between self-compassion and compassion for others than those with poorer mental health. Self-compassion and compassion for others appear to be dimensional constructs that can converge or diverge. When they converge, it is associated with better mental health.

Childhood trauma exposure, age and self-compassion as predictors of later-life symptoms of depression and anxiety in American Indian adults

BACKGROUND

Although previous research has established a relationship between childhood trauma and later-life anxiety and depression symptoms in American Indian samples, less is known about protective factors that may reduce the strength of this relationship.

OBJECTIVE

The purpose of the present study was to investigate in a sample of American Indian adults, whether age moderates the relationship between self-compassion and poor mental health associated with childhood trauma.

PARTICIPANTS AND SETTING

Seven hundred and twenty-nine self-identifying American Indian adults (age 18-95) residing in the United States completed an online survey.

METHOD

All participants were self-identifying American Indian adults recruited via Qualtrics, which utilized targeted recruiting through managed research panels. Participants self-reported age, gender, income, and completed measures of self-compassion, childhood trauma, and symptoms of anxiety and depression.

RESULTS

Lower self-compassion predicted higher levels of both anxiety symptoms (β = -2.69, R2change = 0.24, t(718) = -15.92, p < .001) and depression symptoms (β = -2.23, R2change = 0.26, t(718) = -16.30, p < .001). In line with our hypothesis, there was a significant three-way interaction between age, childhood trauma exposure and self-compassion in predicting later-life symptoms of anxiety (β = -0.68, t(712) = -3.57, p < .001, R2change = 0.01) and depression (β = -0.54, t(712) = -3.32, p = .001, R2change = 0.01).

CONCLUSIONS

The findings indicate that for older American Indian adults, self-compassion may be a particularly promising protective factor for symptoms of depression for those who have experienced high levels of childhood trauma, and for symptoms of anxiety regardless of childhood trauma exposure.

Validation of the compassionate engagement and action scales, compassion scale, and Sussex-Oxford compassion scales in a French-Canadian sample

Compassion towards oneself and towards others has been associated with positive psychological outcomes, however, research is limited by the availability of valid psychometric measures, particularly in languages other than English. The current study translated (English to French) and validated the following measures: the Compassionate Engagement and Action Scales (CEAS), assessing self-compassion (CEAS-SC), compassion to others (CEAS-TO), and compassion from others (CEAS-FROM); the Compassion Scale (CS); and the Sussex-Oxford Compassion Scales for Self (SOCS-S) and Others (SOCS-O). French-speaking participants were recruited online (N = 384) and completed the translated measures as well as questionnaires assessing self-compassion, depression, anxiety, stress, insecure attachment, mindfulness, and well-being. Confirmatory Factor Analysis supports the original factor structures proposed for the CEAS-FROM (two-factor hierarchical), CS (four-factor hierarchical), SOCS-S and SOCS-O (five-factor hierarchical), with alternate factor structures proposed for CEAS-SC (three-factor) and CEAS-TO (two-factor). Results showed good internal consistency and convergent validity for all scales, supporting the use of total scores for the translated measures.

Conceptualization, use, and outcomes associated with compassion in the care of youth with childhood-onset disabilities: a scoping review

Introduction

To examine the scope of existing literature on the conceptualization, use, and outcomes associated with compassion in the care of youth with childhood-onset disabilities.

Methods

A protocol was developed based on the Joanna Briggs Institute (JBI) scoping review method. MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and EBSCOhost CINAHL, were searched.

Results

Eight studies were selected for inclusion; four used quantitative methodology, and four used qualitative methods. Compassion was not defined a priori or a posteriori in any of the included studies. The concept of self-compassion was explicitly defined only for parents of youth with childhood-onset disabilities in three studies a priori. The most reported outcome measure was self-compassion in parents of youth with childhood-onset disabilities. Self-compassion among parents was associated with greater quality of life and resiliency and lower stress, depression, shame and guilt.

Discussion

There is limited evidence on the conceptualization, use, and outcomes associated with compassion among youth with childhood-onset disabilities. Self-compassion may be an effective internal coping process among parents of youth with childhood-onset disabilities. Further research is required to understand the meaning of compassion to youth with childhood-onset disabilities, their parents and caregivers.

Systematic review registration

https://doi.org/10.17605/OSF.IO/2GRB4.

Compassion in health professionals: Development and validation of the Capacity for Compassion Scale

BACKGROUND

Health professionals witness pain and suffering when they care for sick people and their families. Compassion is a necessary quality in their work as it combines the will to help, alleviate suffering and promote the well-being of both the people they are attending and the professionals themselves. The aim of the study was to design and evaluate the psychometric properties of the Capacity for Compassion Scale (CCS).

DESIGN

A quantitative, descriptive and cross-sectional study was carried out to evaluate the psychometric properties of the scale (reliability, temporal stability, content validity, criterion validity and construct validity).

METHODS

The study was carried out in two phases: pilot study and final validation. The data were collected between April and May 2022. The sample was selected by convenience sampling and was made up of a total of 264 participants, 59 in the pilot phase and 205 in the final validation.

RESULTS

The Capacity for Compassion Scale has been shown to have good psychometric properties in relation to reliability, temporal stability, and content, criterion, and construct validity. Factor analysis showed that there were four subdimensions of the scale: motivation/commitment, presence, shared humanity and self-compassion. The results also indicate that compassionate ability is significantly correlated with age and work experience.

CONCLUSIONS

The Capacity for Compassion Scale shows adequate psychometric properties. This instrument measures the compassion capacity of health professionals, which is a valuable discovery for new lines of research in this field.

IMPACT

Through this scale, low levels of capacity for compassion can be detected that negatively influence the quality of care provided by health professionals. The Capacity for Compassion Scale can therefore contribute to the identification of needs and promote training around compassion for health professionals.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. WHAT PROBLEM DID THE STUDY ADDRESS?: Compassion in health professionals has positive effects on improving the quality of care, the satisfaction of professionals and the work environment. There are compassion cultivation programmes whose validity has been proven for the development of the dimensions of compassion. There is no specific instrument that measures capacity for compassion in healthcare professionals. WHAT WERE THE MAIN FINDINGS?: A scale is designed to measure capacity for compassion in health professionals. This is the only such scale available up until now. The scale measures four dimensions of compassion: motivation/commitment, presence, shared humanity and self-compassion. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: The development of specific programmes that can increase the compassion of health professionals with all the benefits that this can bring to health care is encouraged. It will be possible to analyse the effects of training programmes on the cultivation of compassion.

Morality in the anthropocene: The perversion of compassion and punishment in the online world

Although much of human morality evolved in an environment of small group living, almost 6 billion people use the internet in the modern era. We argue that the technological transformation has created an entirely new ecosystem that is often mismatched with our evolved adaptations for social living. We discuss how evolved responses to moral transgressions, such as compassion for victims of transgressions and punishment of transgressors, are disrupted by two main features of the online context. First, the scale of the internet exposes us to an unnaturally large quantity of extreme moral content, causing compassion fatigue and increasing public shaming. Second, the physical and psychological distance between moral actors online can lead to ineffective collective action and virtue signaling. We discuss practical implications of these mismatches and suggest directions for future research on morality in the internet era.

The pattern theory of compassion

Concepts of empathy, sympathy and compassion are often confused in a variety of literatures. This article proposes a pattern-theoretic approach to distinguishing compassion from empathy and sympathy. Drawing on psychology, Western philosophy, affective neuroscience, and contemplative science, we clarify the nature of compassion as a specific pattern of dynamically related factors that include physiological, cognitive, and affective processes, relational/intersubjective processes, and motivational/action tendencies. We also show that the dynamic nature of the compassion pattern is reflected in neuroscientific findings, as well as in compassion practice. The pattern theory of compassion allows us to make several clear distinctions between compassion, empathy, and sympathy.

Promises and pitfalls of #Relapse narratives in Destigmatization: The mediating role of emotions

The disclosure of recovery journeys on social media by individuals with substance use is a growing trend, but its impact on public attitudes toward stigmatized groups is not well-understood. To address this gap, an experiment was conducted with 1,438 U.S. adults who viewed a series of Instagram posts about a person's recovery journey. Participants were randomly assigned to view posts that either included a relapse episode or not. Structural equation modeling was used for data analyses. The results revealed that presenting a relapse narrative increased feelings of compassion, anger, and pity. In addition, mediation analyses provided evidence supporting the role these emotions played in mediating the effects of a relapse narrative on stigma beliefs and desire for social distance. These findings prompt a reevaluation of digital storytelling practices in health communication strategies, aiming for a balanced representation that can effectively reduce stigma and promote community support for those navigating substance use recovery. It is recommended to incorporate the study's insights into educational content, therapeutic interventions, and policy formulations to foster a more supportive and understanding environment for individuals in recovery.

Highlighting Victim Vividness and External Attribution to Influence Policy Support Regarding the Opioid Epidemic: The Mediating Role of Emotions

Recognizing the need for more evidence-based interventions and the potential of well-crafted messages in communicating the opioid epidemic, this study investigates the effectiveness of two messaging strategies (i.e., victim vividness and external attribution) that have the potential to mitigate stigmatization and influence a wide range of public policies concerning the opioid epidemic. Building upon the attribution theory of interpersonal behavior, an experiment with a 2 (victim vividness: high vs. low) × 2 (external attribution: present vs. absent) between-subjects factorial design was conducted among a national sample of U.S. adults (N = 995). The findings show that the messages with greater victim vividness reduced support for victim-oriented punitive policies, whereas the messages that mentioned external attribution increased support for perpetrator-oriented punitive policies. In addition, the two messaging strategies also worked indirectly through various emotions to influence policy support. Discussions on this study's contributions to both theory and practice are provided.

Cultivating staff equality, diversity, and inclusion in higher education in the post-pandemic era: an organizational compassion perspective

The COVID-19 pandemic has exacerbated pre-existing challenges faced by academic staff in UK higher education and drawn attention to issues of Equality, Diversity, and Inclusion (EDI). Amidst global competitiveness and workplace pressures, challenges such as managerialism, increased workload, and inequalities have worsened, significantly impacting mental health. This paper presents a conceptual analysis connecting EDI with organizational compassion within the context of Higher Education. The prioritization of organizational compassion is presented as a means to enhance sensitivity to EDI in the reconstruction of post-pandemic learning environments. Anchored in the organizational compassion theory and the NEAR Mechanisms Model, our study contributes to the intersection of the organizational compassion, EDI and higher education literatures by exploring how fostering compassion relations can contribute to enhancing EDI. This offers a new perspective to creating a more humane and supportive higher education environment.

Attitudes Toward Organ Donation and Sense of Compassion in Nursing Students

This descriptive type of study was conducted on students studying in the nursing department to determine the relationship between their attitudes toward organ donation and their sense of compassion. Data were collected for students’ sociodemographic characteristics, the Organ Donation Attitude Scale (ODAS), and the compassion scale. The mean age of the participants was 20.40 ± 1.87, 79.7% were female, and 92.8% stated that the kidney could be donated. A very weak negative relationship was found between ODAS positive attitude and negative attitude scores. Between ODAS positive attitudes and the subscales of the compassion scale, it was determined that there was a significant positive correlation with kindness, a weak negative correlation with indifference, a weak positive correlation with common humanity, a weak negative correlation with separation, a weak positive correlation with mindfulness, and a weak negative correlation with disengagement. Nursing students’ organ donation attitudes are affected by compassion.

Online Video-Mediated Compassion Training Program for Mental Health and Well-Being of University Students

College students experiencing psychological distress have significantly greater negative emotions than students who practice compassionate thinking. We have developed Eight Steps to Great Compassion (ESGC), an innovative brief and no-cost online video training program about how to increase compassion among busy and young adult university students. To examine the effectiveness and benefits of the ESGC, a single-group pre-test-post-test quantitative design with undergraduate university students (N = 92; Mage = 20.39) evaluated its effects. The results from the post-test showed that the ESGC had a significant positive impact on increased feelings of compassion towards oneself, compassion for others, and the sense of personal well-being from the pre-test. The analysis of the PERMA-Profiler subscales also reflected a statistically significant increase in overall well-being and health and a decrease in negative emotions and loneliness. From the Post-Survey Lesson Feedback, 88% of the participants reported significant positive changes in themselves and the way that they live due to the program. These findings appear to show important implications for improving healthy minds and reducing negative emotions among university students.

'It's very values driven': A qualitative systematic review of the meaning of compassion according to healthcare professionals

AIMS AND OBJECTIVES

To explore the meaning ascribed to the concept of compassion by healthcare professionals.

BACKGROUND

Compassion is universally regarded as the foundation of healthcare, a core value of healthcare organisations, and essential to the provision of quality care. Despite increasing research on compassion in healthcare, how healthcare professionals understand compassion remains unclear.

DESIGN

A systematic review of qualitative studies was conducted and is reported following PRISMA guidelines.

METHOD

Medline, Emcare, PsychINFO and CINAHL were searched to November 2021 for qualitative studies in English that explored healthcare professionals' understandings of compassion. Included studies were appraised for quality before data were extracted and thematically analysed.

FINDINGS

Seventeen papers met the inclusion criteria. An overarching theme, 'It's very values driven' underpins the four main themes identified: (1) 'It's about people and working with them': Compassion as being human, (2) 'There is this feeling': Compassion as being present, (3) 'If I don't understand them, I won't be able to help': Compassion as understanding, (4) 'Wanting to help in some way': Compassion as action.

CONCLUSIONS

Healthcare professional participants reported compassion as motivated by values and inherent to humanistic healthcare practice. The meanings healthcare professions described were varied and contextual. Qualitative research should further explore healthcare practitioners' experiences of compassion as part of their practice to inform health professions education, policy, and practice.

RELEVANCE TO CLINICAL PRACTICE

To practice with compassion, healthcare professionals require supportive and humanistic organisations that honour each person's humanity and encourage people to be human and compassionate to each other as well as to patients, their families and/or carers. Healthcare professionals need to reflect on what compassion means to them, how it is situated within their unique practice context, and how compassion can enhance clinical practice.

NO PATIENT OR PUBLIC CONTRIBUTION

This systematic review had no patient or public contribution.

Self-compassion and grit mediated the relation between mindfulness and mind wandering based on cross-sectional survey data

Previous research suggests that mindfulness and mind wandering are opposing constructs. However, little is known about why and how they are negatively related. Through a process-oriented approach, this cross-sectional study tested self-compassion and grit as mediators for the relation between mindfulness and mind wandering. A total of 487 self-identified meditators were recruited from the UK (241 female, 49.49%). Participants reported a mean age of 38.98 years (SD = 10.03), with an average of 2.26 h of meditation practice per week (SD = 4.47). Upon informed consent, the participants completed a self-report questionnaire that assessed the core variables under study. Path analysis indicated that mindfulness was related to self-compassion. Greater self-compassion was, in turn, related to greater grit, which was then related to lower mind wandering. Bootstrapping analysis further indicated that self-compassion and grit as mediators between mindfulness and mind wandering, above and beyond age, gender, hours of meditation, income, and education as covariates. The cross-sectional findings provided initial evidence of mediation by showing that mindfulness and mind wandering were related through self-compassion and grit.

The challenge of eco-generativity. Embracing a positive mindset beyond eco-anxiety: a research agenda

Climate change has emerged as a tough challenge affecting the world's society and economy in the twenty-first century. Furthermore, it has been determined that global warming and climate change have detrimental effects on human health both physical and psychological. In this framework, eco-anxiety has emerged as a new construct to assess the distress in relation to climate change and its effects. In the current article, after a study of the literature regarding both eco-anxiety and generativity related to environmental issues, in the search for a healthy response to eco-anxiety, we propose the construct of eco-generativity as a sustainable development-related concept for the health of planet earth and people in the present and in the future. Accordingly, we explore the definitions of generativity in relation to the ecological environment, examining the development of the concept in accordance with the most recent research. Subsequently, according to the lens of psychology of sustainability and sustainable development, we propose key elements of eco-generativity in terms of construct and measures. Finally, a research agenda for future research and intervention on eco-generativity is provided.

Deciding Who Is Worthy of Help: Effect of the Probability of Reciprocity on Individuals' Willingness to Help Others

In order to explain helping strangers in need in terms of reciprocal altruism, it is necessary to ensure that the help is reciprocated and that the costs of helping are thus compensated. Competence and willingness to make sacrifices for the benefactor of the person being helped are important cues for ensuring a return on help because reciprocity would not be possible if the person being helped had neither the competence nor the inclination to give back in the future. In this study, we used vignettes and manipulated the cause of suffering strangers' difficulties and prosociality to investigate participants' compassion for and willingness to help the stranger. In Study 1, we measured willingness to help by using hypothetical helping behaviors that were designed to vary in cost. In Study 2, we measured willingness to help by using the checkbox method in which participants were asked to sequentially check 10 × 10 checkboxes on a webpage, which asked the participants to pay a small but real cost. In both studies, the controllability of the cause and the prosociality were found to independently affect compassion. These two factors also independently affected willingness to help, as measured by both the hypothetical questions and the checkbox method. We consequently discussed the reasons for the independent processing of the competence and behavioral tendency cues.

Development and validation of the Emotional Climate Change Stories (ECCS) stimuli set

Climate change is widely recognised as an urgent issue, and the number of people concerned about it is increasing. While emotions are among the strongest predictors of behaviour change in the face of climate change, researchers have only recently begun to investigate this topic experimentally. This may be due to the lack of standardised, validated stimuli that would make studying such a topic in experimental settings possible. Here, we introduce a novel Emotional Climate Change Stories (ECCS) stimuli set. ECCS consists of 180 realistic short stories about climate change, designed to evoke five distinct emotions-anger, anxiety, compassion, guilt and hope-in addition to neutral stories. The stories were created based on qualitative data collected in two independent studies: one conducted among individuals highly concerned about climate change, and another one conducted in the general population. The stories were rated on the scales of valence, arousal, anger, anxiety, compassion, guilt and hope in the course of three independent studies. First, we explored the underlying structure of ratings (Study 1; n = 601). Then we investigated the replicability (Study 2; n = 307) and cross-cultural validity (Study 3; n = 346) of ECCS. The collected ratings were highly consistent across the studies. Furthermore, we found that the level of climate change concern explained the intensity of elicited emotions. The ECCS dataset is available in Polish, Norwegian and English and can be employed for experimental research on climate communication, environmental attitudes, climate action-taking, or mental health and wellbeing.

Moderate similarity leads to empathic concern, but high similarity can also induce personal distress towards others' pain

Empathic concern and personal distress are common vicarious emotional responses that arise when witnessing someone else's pain. However, the influence of perceived similarity on these responses remains unclear. In this study, we examined how perceived similarity with an injured target impacts vicarious emotional responses. A total of 87 participants watched a video of an athlete in pain preceded by a clip describing the athlete's trajectory, which indicated either high, moderate, or low similarity to the participants. Emotional self-reports, facial expressions, gaze behavior, and pupil diameter were measured as indicators of the participants' emotional responses. Participants in the moderate- and high-similarity groups exhibited greater empathic concern, as evidenced by their display of more sadness compared with those in the low-similarity group. Furthermore, those in the moderate-similarity group exhibited less avoidance by displaying reduced disgust, indicating lower personal distress compared with those in the low-similarity condition. Nevertheless, the high-similarity group displayed just as much disgust as the low-similarity group. These findings suggest that perceived similarity enhances empathic concern to others' suffering, but that high similarity can also lead to personal distress. Future studies on empathy should explore distinct vicarious states using multimodal measurements to further advance our understanding of these processes.

Compassion Focused Therapy for Groups: Transdiagnostic Treatment for Turbulent Times

The concept of compassion has a centuries-long history as a pillar of philosophical and religious discourse as a response to human suffering. More recently, Paul Gilbert, the founder of Compassion Focused Therapy (CFT) has explained compassion evolutionarily as a willingness to enter human suffering and a commitment to alleviating it. In the face of increased (and increasing) suffering in the world, compassion shows promise as both a societal and an individual intervention. In the following article, we discuss the background and theory of CFT, the empirical evidence for CFT delivered in a group therapy format, and present a standardized protocol. We then present an illustrative clinical vignette and discuss the current clinical and research limitations. We call for continued research to expand our understanding of CFT as well as its potential reach, and conclude by recommending CFT as an evidence-based group treatment that is particularly appropriate for the current global climate.

The effects of mindfulness training for emergency department and intermediate care unit nurses

AIM

The aim of this study was to determine the effects of mindfulness and self-compassion skills on the experienced stress and work satisfaction of emergency department (ED) and intermediate care unit employees.

METHODS

All ED and intermediate care unit employees in the study hospital were invited to participate in an introductory lecture about mindfulness, compassion, and the intervention in January 2020. After the lecture, it was possible to enroll in training. This training was postponed due to Covid-19 and started in October 2020.

RESULTS

The most important findings of this study are that instructor-led mindfulness training, and the regular use of a smartphone mindfulness application can significantly reduce stress and burnout and promote mindfulness and well-being of ED and intermediate care unit personnel.

CONCLUSIONS

This study shows that compact mindfulness training via innovative digital technology has a positive effect in reducing ED and intermediate care unit employees stress and burnout, while improving mindfulness and well-being, and this is consistent with the wider literature.

KEY FINDINGS

The regular practice of smartphone-guided mindfulness can reduce stress and burnout, as well as promote mindfulness and well-being among ED and intermediate care unit employees.

Your blush gives you away: detecting hidden mental states with remote photoplethysmography and thermal imaging

Multimodal emotion recognition techniques are increasingly essential for assessing mental states. Image-based methods, however, tend to focus predominantly on overt visual cues and often overlook subtler mental state changes. Psychophysiological research has demonstrated that heart rate (HR) and skin temperature are effective in detecting autonomic nervous system (ANS) activities, thereby revealing these subtle changes. However, traditional HR tools are generally more costly and less portable, while skin temperature analysis usually necessitates extensive manual processing. Advances in remote photoplethysmography (r-PPG) and automatic thermal region of interest (ROI) detection algorithms have been developed to address these issues, yet their accuracy in practical applications remains limited. This study aims to bridge this gap by integrating r-PPG with thermal imaging to enhance prediction performance. Ninety participants completed a 20-min questionnaire to induce cognitive stress, followed by watching a film aimed at eliciting moral elevation. The results demonstrate that the combination of r-PPG and thermal imaging effectively detects emotional shifts. Using r-PPG alone, the prediction accuracy was 77% for cognitive stress and 61% for moral elevation, as determined by a support vector machine (SVM). Thermal imaging alone achieved 79% accuracy for cognitive stress and 78% for moral elevation, utilizing a random forest (RF) algorithm. An early fusion strategy of these modalities significantly improved accuracies, achieving 87% for cognitive stress and 83% for moral elevation using RF. Further analysis, which utilized statistical metrics and explainable machine learning methods including SHapley Additive exPlanations (SHAP), highlighted key features and clarified the relationship between cardiac responses and facial temperature variations. Notably, it was observed that cardiovascular features derived from r-PPG models had a more pronounced influence in data fusion, despite thermal imaging's higher predictive accuracy in unimodal analysis.

Wellness in Chronic Care (WCC) families, illness & disability: an integrative clinical intervention model

This paper describes the Wellness in Chronic Care (WCC) model, an innovative integrative clinical intervention method aimed at helping social workers manage the care of patients living with chronic illnesses and their families. The goal is to propose appropriate clinical responses to the changing reality of the health system. This new reality poses new challenges that require caregivers (social work practitioners and family members) to develop suitable skills and expertise. The intervention method we developed offers a new paradigm that entails partnership and the need to assume responsibility in decision-making while coping with the illness over time. The intervention provides practical tools and methods for coping and managing the illness. These factors have contributed to building a specifically tailored intervention program for patient and family care to achieve an effective and meaningful wellbeing. An assessment of the training program of the intervention model and its implementation is presented. The model was found to be essential yet some found it difficult to make the needed changes.

"They Did Not Know What They Were Doing": Climate Change and Intergenerational Compassion

BACKGROUND AND OBJECTIVES

Compassion is described as an affective experience arising from witnessing the undeserved suffering of another that propels one to provide protection and cooperation. Climate change is often associated with "underserved suffering," especially of younger and future generations. Consequently, contemporary climate discourse has expressed hostility toward older generations for inflicting such suffering. Studies on intergenerational relations within the context of climate change agree that intergenerational solidarity, rather than conflict, is necessary for effective climate action. Because compassion is instrumental to solidarity, in this study, we explore intergenerational climate-related expressions of compassion leading to intergenerational solidarity.

RESEARCH DESIGN AND METHODS

We interviewed 16 climate activists from 8 countries (aged 16-76 years) to understand how they view climate responsibility. Thematic analysis was undertaken to create and explore themes related to intergenerational compassion and solidarity.

RESULTS

Compassion flowed in both directions: from younger to older generations in the form of forgiveness, empathy, and understanding, and from older to younger generations through advocacy, lifestyle changes, and transmission of knowledge and skills. All participants emphasized solutions over accusations. Areas of focus varied between industrialized and developing countries. Cultural factors played an essential role in intergenerational perceptions.

DISCUSSION AND IMPLICATIONS

Climate change can be a polarizing issue with older adults fielding accusations and younger people facing criticism for demanding climate action. Examples of intergenerational compassion can counter ageism, reshape climate narratives, encourage intergenerational cooperation, harness the skills of different generations, and create a sustainable world for all ages.

Focusing attention on others' negative emotions reduces the effect of social relationships on children's distributive behaviors

The present study investigates whether directing five- to six-year-old children's attention to hypothetical resource recipients that included familiar and non-familiar people would affect their favoritism toward a familiar person, as reflected in how they allocated resources. In Experiment 1, we instructed participants to give one of several stickers to another person or keep all the stickers for themselves. Under the control conditions, participants more frequently gave stickers to friends than to non-friends. However, when asked about others' emotions, they distributed stickers equally among friends and non-friends. Therefore, focusing on others' thoughts reduced participants' favoritism toward friends. Experiment 2 tested whether focusing on both emotional valences would affect favoritism toward a familiar person, as reflected in children's resource distribution choices. Experiment 2 was identical to Experiment 1, except we asked participants about the other person's emotional valence. When asked about others' negative emotions, participants distributed the stickers equally between themselves and others. However, when asked about others' positive emotions, they distributed more stickers to friends than to non-friends. Neither others' emotional valence nor group status affected the perceived intensity of their emotion or the participant's emotional state. These results suggest that children's favoritism toward friends can be reduced by encouraging them to think about others' negative emotional states.

Do compassion and self-compassion moderate the relationship between childhood socioeconomic position and adulthood body composition?

The study aims to investigate the associations of compassion and self-compassion with body composition, and whether adulthood compassion and self-compassion moderate the relationship between childhood SEP and adulthood body composition. The participants came from the Northern Finland Birth Cohort 1986 Study (n = 789, 52.1% women), with a mean age of 34.0 years. Compassion and self-compassion were measured with the Dispositional Positive Emotions Scale and Self-Compassion Scale-Short Form, respectively. Body composition was assessed using anthropometric and body fat measurements at a clinic. Childhood SEP included parental occupation, education, and employment. The results showed that high compassion was associated with three out of the five body composition measurements, namely lower waist circumference (B = -0.960, p = 0.039, 95% CI: -1.870; -0.498), body fat percentage (B = -0.693, p = 0.030, 95% CI: -1.317; -0.069), and fat mass index (B = -0.325, p = 0.023, 95% CI: -0.605; -0.044) (adjusted for sex, and childhood and adulthood SEP) but not with body mass index or waist-to-hip ratio. Self-compassion was not associated with body composition. Neither compassion nor self-compassion moderated the association between childhood SEP and adulthood body composition, as the interaction effects were not significant. Therefore, the dispositions did not protect against the negative effects of childhood SEP on adulthood body composition. High other-directed compassion may be, however, associated with healthier body composition.

Interventions for Compassion Fatigue in Healthcare Providers-A Systematic Review of Randomised Controlled Trials

BACKGROUND

Compassion fatigue is a significant issue considering its consequences including negative feelings, impaired cognition, and increased risk of long-term morbidities. We aimed to assess current evidence on the effects of interventions for compassion fatigue in healthcare providers (HCP).

METHODS

We used the Cochrane methodology for Systematic Reviews and Meta-Analyses (PRISMA) for conducting and reporting this review.

RESULTS

Fifteen RCTs (n = 1740) were included. The sample size of individual studies was small ranging from 23 to 605. There was significant heterogeneity in participant, intervention, control, and outcome characteristics. The tools for assessing intervention effects on compassion fatigue included ProQOL, compassion fatigue scale, and nurses compassion fatigue inventory. Thirteen out of the fifteen included RCTs had overall high risk of bias (ROB). Meta-analysis could not be performed given the significant heterogeneity.

CONCLUSIONS

Current evidence on interventions for reducing compassion fatigue in HCPs is inadequate. Given the benefits reported in some of the included studies, well-designed and adequately powered RCTs are urgently needed.

Integrative emotion regulation relates to sympathy and support for outgroups-Independent of situational outgroup behaviour

Intergroup emotions powerfully shape intergroup relations. Anger and fear fuel, while hope and sympathy reduce intergroup strife. This implies that emotion regulation may play an important role in improving intergroup relations. Broadening the scope of prior research, we herein investigate the potential benefits of integrative emotion regulation for improving intergroup relations. Integrative emotion regulation involves actively paying attention to emotions to determine which information they provide. Interindividual differences in the use of integrative emotion regulation correlate with sympathy and supportiveness towards outgroups, but why this is the case is unclear. We tested two possible explanations: a person effect (i.e., interindividual differences in integrative emotion regulation shape respondents' general outlook on outgroups) and a person-situation interaction effect (i.e., integrative emotion regulation reduces the impact of situational factors that would typically dampen sympathy, thereby shaping situation-specific responses to outgroups). In four experiments (total N = 984), we manipulated outgroup behaviour and measured interindividual differences in integrative emotion regulation. We found no interaction between integrative emotion regulation and outgroup behaviour in predicting outgroup-directed sympathy and supportiveness. Instead, integrative emotion regulation consistently correlated positively with supportiveness, mediated by sympathy. These findings suggest that those high in integrative emotion regulation have a more positive, general outlook on outgroups than those low in integrative emotion regulation, but being high in integrative emotion does not alter situational responses.

The promise of compassion-based therapy as a novel intervention for adolescent PTSD

In this review, we summarize current evidence for compassion-based approaches for PTSD and the potential for their application to the adolescent PTSD population. Exposure to traumatic events is common in adolescence and PTSD remains a public health crisis. Accessibility, willingness, and engagement are significant barriers to established treatments for PTSD, with attrition rates as high as 50 %. Compassion-based therapies provide potential solutions to treatment obstacles by providing a non-threatening, transdiagnostic option unburdened by aspects of current trauma treatment which may be associated with treatment resistance (e.g., exposure, trauma narrative, induction of fear). Compassion-based approaches are intuitive for trauma treatment, as compassion activates the self-soothing system, thereby disarming the fear system and promoting affect regulation. Compassion-based treatments demonstrate reductions across a substantial range of PTSD symptoms in adults, however, in adolescents extant literature is sparse, with cross-sectional studies suggesting self-compassion is inversely associated with trauma-related psychopathology. Understanding the impact of compassion-based approaches on adolescent PTSD is warranted as the adolescent developmental period may be a particularly opportune time for this approach. Evaluation of the impact of compassion-based treatment on adolescent PTSD in clinical populations via randomized-controlled studies and comparison of its relative efficacy to current evidence-based practices is warranted.

Aesthetic Motivation Impacts Judgments of Others' Prosociality and Mental Life

The ability to infer others' prosocial vs. antisocial behavioral tendencies from minimal information is core to social reasoning. Aesthetic motivation (the value or appreciation of aesthetic beauty) is linked with prosocial tendencies, raising the question of whether this factor is used in interpersonal reasoning and in the attribution of mental capacities. We propose and test a model of this reasoning, predicting that evidence of others' aesthetic motivations should impact judgments of others' prosocial (and antisocial) tendencies by signaling a heightened capacity for emotional experience. In a series of four pre-registered experiments (total N = 1440), participants saw pairs of characters (as photos/vignettes), and judged which in each pair showed more of a mental capacity of interest. Distractor items prevented participants from guessing the hypothesis. For one critical pair of characters, both characters performed the same activity (music listening, painting, cooking, exercising, being in nature, doing math), but one was motivated by the activities' aesthetic value, and the other by its functional value. Across all activities, participants robustly chose aesthetically-motivated characters as more likely to behave compassionately (Exp. 1; 3), less likely to behave selfishly/manipulatively (Exp. 1; 3), and as more emotionally sensitive, but not more intelligent (Exp. 2; 3; 4). Emotional sensitivity best predicted compassionate behavior judgements (Exp. 3). Aesthetically-motivated characters were not reliably chosen as more helpful; intelligence best predicted helpfulness judgements (Exp. 4). Evidence of aesthetic motivation conveys important social information about others, impacting fundamental interpersonal judgments about others' mental life and social behavior.

Situational assessment of empathy and compassion: Predicting prosociality using a video-based task

Classical psychometric approaches in social science measure individuals' tendency to experience empathy and compassion. Using abstract questionnaire items, they place high demand on subjects' capacity to introspect, memorize, and generalize the corresponding emotions. We employed a Socio-affective Video Task (SoVT)-an alternative approach that measures situationally elicited emotions-and assessed its predictive power over prosocial behavior against classical questionnaires in a sample of Israeli university students. We characterized the conceptual embedding of the SoVT concerning other measures of prosocial affect and cognition, and tested group identification as an alternative precursor to prosocial behavior. Eighty participants rated their reactions to videos that presented the suffering of others or everyday scenes on scales of negative affect (providing a proxy for elicited empathy) and compassion. We then administered classical questionnaires that target empathy (the Interpersonal Reactivity Index) and compassion (the Compassionate Love Scale), as well as measures of hypothetical and real-life helping and prosocial attitudes-including conflict attitudes and intergroup bias. While compassion ratings in the SoVT failed to predict prosociality more accurately than classical questionnaires, the SoVT empathy index succeeded and correlated strongly with other precursors of prosociality. These results support video-based situational assessment as an implicit and robust alternative in the measurement of empathy-related processes.

Explaining the Insufficient Relationship between Affective Empathy and Physical Aggression Based on a Double-edged Sword Model

Affective empathy is generally considered an important inhibitor of aggression. However, the meta-analysis studies on the relationship between affective empathy and aggression have challenged this common-sense view and found no substantial correlation between the two variables. We proposed a double-edged sword model to explain this counterintuitive phenomenon and tested this model by establishing an inconsistent mediation model. A total of 663 college students in China (59.1% female; Mage = 20.69 years) completed questionnaires measuring affective empathy, sympathy, personal distress, anger proneness, and physical aggression. The results showed that on the one hand, affective empathy can indirectly inhibit physical aggression by increasing sympathy; on the other hand, affective empathy can indirectly promote physical aggression through the serial mediation of personal distress and anger proneness. Such two pathways offset each other, leading to an insignificant relation observation between affective empathy and physical aggression. The findings revealed the complexity of the relationship between affective empathy and aggression, which suggested that more efforts to reduce aggression should be made to develop individuals' sympathy, while affective empathy training should be moderate to avoid excessive empathic emotional arousal.

How do mindfulness and compassion programs improve mental health and well-being? The role of attentional processing of emotional information

BACKGROUND AND OBJECTIVES

Although the benefits of Meditation-Based Programs are well documented, the mechanisms underlying these benefits have not been fully elucidated. Therefore, we examined whether: (1) formal training in mindfulness and compassion meditation modifies the distribution of attentional resources towards emotional information; and (2) whether changes in attentional processing of emotional information after the meditation programs mediate the improvements in psychological distress, emotion regulation, and well-being.

METHODS

A sample of 103 participants enrolled in the study: 36 in the mindfulness program (MBSR), 30 in the compassion program (CCT), and 37 in the no-intervention comparison group (CG). The assessment before and after the programs included the completion of an emotional Attentional Blink task (AB) together with self-report measures of psychological distress, emotion regulation, and well-being.

RESULTS

MBSR and CCT reduced similarly the AB deficit, whereas no changes occurred in the CG. This AB reduction was found for the different emotional and non-emotional stimuli (i.e., negative, positive, and neutral), showing a significant disengagement from first-target emotions and significant accessibility of second-target emotions to consciousness. The effects of both meditation programs on the psychological measures were mediated by changes in the AB and emotion regulation skills.

LIMITATIONS

Due to our naturalistic design in a real-world community setting, random assignment of participants was not feasible.

CONCLUSIONS

Meditation may promote more flexible and balanced attention to emotional information, which may be a key transdiagnostic mechanism underlying its benefits on emotional distress and well-being.

A scoping review of the self-reported compassion measurement tools

BACKGROUND

Compassion is closely linked to psychological well-being, and several assessment tools have been developed and studied to assess the level of compassion in different populations and for more precise measurement. There is currently a scarcity of comprehensive knowledge about compassion-related assessment tools, and our research provides an overview of these tools.

AIMS

To identify scales used to measure compassion from different flows, and to assess their measurement properties and quality.

METHODS

Focusing on compassion assessment tools, the authors conducted a thorough search of 10 Chinese and English databases from their establishment until August 14, 2022. Data extracted included the author, year, country, objectives, target population, as well as the primary evaluation content. Using the COSMIN checklist, the methodological quality and measurement properties of the included studies were appraised. This scoping review was registered with the Open Science Framework and followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist.

RESULTS

There were 15,965 papers searched, and 36 compassion-related measurement tools were identified in this study. None of the 36 studies provided possessed all nine psychometric properties, as outlined by the COSMIN criteria. On the basis of a systematic evaluation of quality, measurement qualities were ranked. The results for internal consistency and content validity were relatively favorable, whereas the results for structural validity were variable and the results for the remaining attributes were either uncertain or negative. A Venn diagram was used to illustrate the overlapping groups of compassion measurement tools based on the three-way flow of compassion. An overview of the reference instrument and theoretical basis for the included studies was provided, and half of them did not contain any theoretical or scale-based evidence.

CONCLUSION

In this study, 36 compassion-related measuring instruments were identified, and the methodological quality and measurement properties of the included studies were acceptable. The included measurements were consistent with flows of compassion. A further focus of further research should be on developing theories in the compassion domain and developing instruments for measuring compassion that are multidimensional, multi-populations, and culturally relevant.

Compassion Fatigue as a Self-Fulfilling Prophecy: Believing Compassion Is Limited Increases Fatigue and Decreases Compassion

People's compassion responses often weaken with repeated exposure to suffering, a phenomenon known as compassion fatigue. Why is it so difficult to continue feeling compassion in response to others' suffering? We propose that people's limited-compassion mindsets-beliefs about compassion as a limited resource and a fatiguing experience-can result in a self-fulfilling prophecy that reinforces compassion fatigue. Across four studies of adults sampled from university students and online participant pools in the United States, we show that there is variability in people's compassion mindsets, that these mindsets can be changed with convincing information, and that limited-compassion mindsets predict lower feelings of compassion, lower-quality social support, and more fatigue. This contributes to our understanding of factors that underlie compassion fatigue and supports the broader idea that people's beliefs about the nature of emotions affect how emotions are experienced. Together, this research contributes to developing a strategy for increasing people's capacity to feel compassion and their social support.

Concerns regarding Covid-19 vaccine certificates

Besides vaccine certificates, research suggests leaders also need to trigger society's intrinsic motivation to help in order to achieve lasting and equitable solutions.

Uncovering paradoxes of compassion at work: a dyadic study of compassionate leader behavior

In today's business world, organizations tend to overlook that employees face suffering caused by work and non-work-related events that can negatively impact business organizations in the long run. One way to address this challenge is through leadership acknowledging and alleviating employees' suffering to ensure a company's success. However, research on compassion and leadership in business settings is still relatively scarce. In this study, we aim to extend the organizational compassion literature by addressing our research question: "What are paradoxes induced by compassionate leader behavior in the workplace in the context of social hierarchy?". We conducted a qualitative exploratory study based on 12 semi-structured interviews with six dyads of leaders and their direct subordinates from small, medium, and large firms representing different industries. The findings of our study indicate that compassionate leader behavior goes hand-in-hand with paradoxical situations that both leader and member face in the workplace, supporting the proposition that compassion as a social, interpersonal process is complex and multi-faceted. Our analysis identified 6 compassion paradoxes that spring from compassion from a leader towards a member. Our study differentiates from other research of compassion paradoxes in the sense that it also focuses on the interplay between leader and member. From that perspective, the findings of our study indicate that social hierarchy is playing a crucial role and exacerbating some paradoxical tensions. This consideration implies that to be effective, compassionate leaders need to have or develop the ability to continuously transcend those compassion paradoxes, as well as support their members in transcending the paradoxes they find themselves dealing with. Thus, the findings of our study contribute to management literature in the field of Positive Organizational Scholarship (POS) by highlighting compassion as a critical element of dyadic leader-subordinate relationships that could be reinforced by systematically building more competence in leaders and members to navigate the tensions emerging from the identified compassion paradoxes. Additionally, we provide limitations and recommendations for further research, along with several theoretical and practical implications of the results, which are particularly relevant for practitioners such as managing directors, leaders, employees, human resource managers, academics, and business and HR consultants.

Getting closer: compassion training increases feelings of closeness toward a disliked person

Evidence-based interventions to favor more harmonious interactions in difficult relationships remain scarce. This study examined whether compassion training may have beneficial effects in an ongoing tense relationship with a disliked person, by reducing schadenfreude toward them and increasing felt interpersonal closeness. 108 participants were assigned to one of three 5-week trainings in a longitudinal randomized controlled study: compassion training, reappraisal training (emotion regulation control condition), or Italian language training (neutral active control condition). The disliked person was not targeted during the trainings to test potential transfer effects. Misfortune scenarios and a measure of interpersonal closeness were used to test whether schadenfreude and closeness feelings toward a disliked person changed from pre- to post-training, across different experimental and control groups. Only compassion and reappraisal trainees reported a decrease of schadenfreude feelings toward the disliked person compared to their pre-training ratings, no changes were observed in the Italian language training. Importantly, feelings of closeness toward the disliked person increased in the compassion training group compared to the other two groups. This increase of closeness feelings could be a central mechanism for improving social interactions. These transfer effects open new perspectives concerning emotion regulation interventions in conflict resolution.

Kin relationality and ecological belonging: a cultural psychology of Indigenous transcendence

In this article, we consider prosociality through the lens of an Indigenous "ethics of belonging" and its two constitutive concepts: kin relationality and ecological belonging. Kin relationality predicates that all living beings and phenomena share a familial identity of interdependence, mutuality, and organization. Within the value system of ecological belonging, an individual's identity is constituted in relation to the natural environment, centered on the sentiments of responsibility and reverence for Nature. We detail how Indigenous perspectives upon prosociality differ from Western scientific accounts in terms of the motives, scope, and rewards of altruistic action. Grounded in this understanding, we then profile three self-transcendent states, compassion, gratitude, and awe, and their similarities across Indigenous and Western approaches, and how kin relationality and ecological belonging give rise to cultural variations. We consider convergent insights across Indigenous and Western science concerning the role of ritual and narrative and the cultural cultivation of kin relationality and ecological belonging. We conclude by highlighting how these two core concepts might guide future inquiry in cultural psychology.

Development and Validation of an Ability Measure of Emotion Understanding: The Core Relational Themes of Emotion (CORE) Test

Emotion understanding (EU) ability is associated with healthy social functioning and psychological well-being. Across three studies, we develop and present validity evidence for the Core Relational Themes of Emotions (CORE) Test. The test measures people's ability to identify relational themes underlying 19 positive and negative emotions. Relational themes are consistencies in the meaning people assign to emotional experiences. In Study 1, we developed and refined the test items employing a literature review, expert panel, and confusion matrix with a demographically diverse sample. Correctness criteria were determined using theory and prior research, and a progressive (degrees of correctness) paradigm was utilized to score the test. In Study 2, the CORE demonstrated high internal consistency and a confirmatory factor analysis supported the unidimensional factor structure. The CORE showed evidence of convergence with established EU ability measures and divergent relationships with verbal intelligence and demographic characteristics, supporting its construct validity. Also, the CORE was associated with less relational conflict. In Study 3, the CORE was associated with more adaptive and less maladaptive coping and higher well-being on multiple indicators. A set of effects remained, accounting for variance from a widely used EU test, supporting the CORE's incremental validity. Theoretical and methodological contributions are discussed.

Energizing compassion: using music and community focus to stimulate compassion drive and sense of connectedness

Objectives

The last 20 years have seen considerable research on the nature and biopsychosocial impacts of compassion training on self and others. This training is usually focused on calming and slowing the mind and body and on individual imagery practices and mantras. This study explored the effects of three variations: 1. The impact of using energizing music to generate activation and "drive" for compassion; 2. To focus on imagining "breathing in and breathing out a white light or mist of compassion" to bring compassion to the world; and 3. While listening to energizing music, participants were guided to imagining connecting to the compassion (Sangha) community, imagining oneself as linking with others as part of communities seeking to help the world.

Methods

From approximately 1,600 members of the Compassionate Mind discussion list, participants were invited to take part in a new energizing focused self-practice study. The study involved listening to recorded guidance on the evolutionary model of compassion and the need to address the potentially harmful side of our nature. This was followed by a 4 1/2-min tonglen-informed guided practice of breathing in and breathing out compassion accompanied by energizing music. Forty-three participants completed several self-report scales measuring compassion orientation, wellbeing, social safeness, and positive affect before and following 2 weeks of practice. Participant experiences were recorded from 6 open explorative questions.

Results

Self-report measures taken before and following 2 weeks of practice revealed significant increases in self-compassion, compassion to others, openness to compassion from others, activated positive affect, safe positive affect, social safeness, and wellbeing, with the largest effect size relating to compassion for the self (d = -0.76). In addition, qualitative data revealed that the participants had experienced the practice as energizing, inspiring, and felt socially connected and that it had significant impacts on other aspects of their lives. Some participants noted that engaging with suffering also stimulated sadness.

Conclusion

This study found that pairing energizing music with breathing practices and specific compassion visualizations, focusing on the desire to bring compassion to the world and be part of a compassionate community, was well-accepted and had a range of significant positive impacts. This study indicates the potential value of exploring energizing in comparison to the more standard soothing and settling practices as ways of stimulating the biopsychosocial processes of compassion.

The Language of Compassion: Hospital Chaplains' Compassion Capacity Reduces Patient Depression via Other-Oriented, Inclusive Language

Objectives

Although hospital chaplains play a critical role in delivering emotional and spiritual care to a broad range of both religious and non-religious patients, there is remarkably little research on the best practices or "active ingredients" of chaplain spiritual consults. Here, we examined how chaplains' compassion capacity was associated with their linguistic behavior with hospitalized inpatients, and how their language in turn related to patient outcomes.

Methods

Hospital chaplains (n = 16) completed self-report measures that together were operationalized as self-reported "compassion capacity." Next, chaplains conducted consultations with inpatients (n = 101) in five hospitals. Consultations were audio-recorded, transcribed, and analyzed using Linguistic Inquiry Word Count (LIWC). We used exploratory structural equation modeling to identify associations between chaplain-reported compassion capacity, chaplain linguistic behavior, and patient depression after the consultation.

Results

We found that compassion capacity was significantly associated with chaplains' LIWC clout scores, a variable that reflects a confident leadership, inclusive, and other-oriented linguistic style. Clout scores, in turn, were negatively associated with patient depression levels controlling for pre-consult distress, indicating that patients seen by chaplains displaying high levels of clout had lower levels of depression after the consultation. Compassion capacity exerted a statistically significant indirect effect on patient depression via increased clout language.

Conclusions

These findings inform our understanding of the linguistic patterns underlying compassionate and effective chaplain-patient consultations and contribute to a deeper understanding of the skillful means by which compassion may be manifest to reduce suffering and enhance well-being in individuals at their most vulnerable.

High compassion predicts fewer sleep difficulties: A general population study with an 11-year follow-up

INTRODUCTION

This study investigated the cross-sectional and longitudinal associations between self-reported compassion and sleep quality.

METHODS

The data came from the population-based Young Finns Study with an 11-year follow-up on compassion and sleep (n = 1064). We used regression models, multilevel models, and cross-lagged panel models to analyze the data.

RESULTS

The results showed that high compassion was cross-sectionally associated with lesser sleep deficiency and fewer sleep difficulties. High compassion also predicted fewer sleep difficulties over an 11-year follow-up (adjusted for age, gender, socioeconomic position in childhood and adulthood, body mass index, health behaviors, and working conditions). This association disappeared when controlling for depressive symptoms. The predictive pathway seemed to proceed more likely from high compassion to fewer sleep difficulties than vice versa.

DISCUSSION

Compassion may buffer against sleep difficulties, possibly via reducing depressive symptoms.

Predictors of Medical Students' Compassion and Related Constructs: A Systematic Review

Phenomenon: Compassion, and related constructs such as empathy, are core values in healthcare, with known benefits for both patients and staff. Yet research on the factors that affect compassion and compassion-related constructs remains scattered. This review systematizes and synthesizes studies investigating the predictors of compassion and related constructs among medical students, allowing for a better understanding of the factors that both positively and negatively contribute to the development of compassionate future physicians. Approach: A systematic review of 12 databases for studies from database inception up until April 2020 was conducted. Non-peer-reviewed literature and studies in which >50% of the sample were non-medical students were excluded. Intervention studies were also out of the scope of this review. We assessed risk of bias and confidence in the findings using standardized tools. Data were categorized within the Transactional Model of Physician Compassion, a framework in which compassion is influenced by personal (student), environmental, patient/family, and clinical factors. Findings: Of 14,060 retrieved articles, 222 studies were included. Of these, 95% studied student factors, but only 25% studied environmental, 9% studied patient, and 6% studied clinical factors. Predictors of greater compassion included maturity; work and life experiences; personality traits of openness to experience and agreeableness; skills such as perspective taking, reflection, and mindfulness; and positive role modeling. Conversely, negative attitudes/emotions, burnout, stress, detachment, operating in cultures prioritizing knowledge and efficiency over humanistic care, negative role models, time constraints, and heavy workloads predicted lower compassion. Patient-related factors included "difficult" and "noncompliant" patients or those perceived as responsible for their illness. Overall, 60% of studies had a serious risk of bias, particularly confounding and participant selection biases. Insights: Medical student compassion is predicted by a wide range of factors relating to the student, their training environment, their patients, and the clinical situation. However, existing research has largely focused on student factors (e.g., sociodemographic and dispositional traits), many of which are not amenable to intervention. Skills such as perspective taking, reflection, and mindfulness are associated with higher compassion and may present opportunities for intervention. There is also strong evidence that environmental factors shape students' compassion. Researchers and educators should continue to explore the impact of patient and clinical factors on students' compassion. Studies remain at high risk of bias.

Emotional content and sharing on Facebook: A theory cage match

While emotional content predicts social media post sharing, competing theories of emotion imply different predictions about how emotional content will influence the virality of social media posts. We tested and compared these theoretical frameworks. Teams of annotators assessed more than 4000 multimedia posts from Polish and Lithuanian Facebook for more than 20 emotions. We found that, drawing on semantic space theory, modeling discrete emotions independently was superior to models examining valence (positive or negative), activation/arousal (high or low), or clusters of emotions and was on par with but had more explanatory power than a seven basic emotion model. Certain discrete emotions were associated with post sharing, including both positive and negative and relatively lower and higher activation/arousal emotions (e.g., amusement, cute/kama muta, anger, and sadness) even when controlling for number of followers, time up, topic, and Facebook angry reactions. These results provide key insights into better understanding of social media post virality.

What does shared decision making ask from doctors? Uncovering suppressed qualities that could improve person-centered care

OBJECTIVE

Shared decision making (SDM) is infrequently seen in clinical practice despite four decades of efforts. We propose a need to explore what SDM asks from doctors in terms of enabling competencies and necessary, underlying qualities, and how these can be nurtured or suppressed in medical training.

DISCUSSION

Key SDM tasks call for doctors to understand communication and decision mechanisms to carry them out well, including reflecting on what they know and do not know, considering what to say and how, and listening unprejudiced to patients. Different doctor qualities can support accomplishing these tasks; humility, flexibility, honesty, fairness, self-regulation, curiosity, compassion, judgment, creativity, and courage, all relevant to deliberation and decision making. Patient deference to doctors, lack of supervised training opportunities with professional feedback, and high demands in the work environment may all inflate the risk of only superficially involving patients.

CONCLUSIONS

We have identified ten professional qualities and related competencies required for SDM, with each to be selected based on the specific situation. The competencies and qualities need to be preserved and nurtured during doctor identity building, to bridge the gap between knowledge, technical skills, and authentic efforts to achieve SDM.

The experiences of patients, family caregivers, healthcare providers, and health service leaders with compassionate care following hospitalization with COVID-19: a qualitative study

PURPOSE

This study explored the experiences of patients, caregivers, healthcare providers, and health service leaders of compassion in the care of people hospitalized with COVID-19.

MATERIALS AND METHODS

This study is a secondary analysis of qualitative data deriving from primary research data on recommendations for healthcare organizations providing care to people hospitalized with COVID-19. Participants comprised patients with COVID-19 (n = 10), family caregivers (n = 5) and HCPs in COVID-19 units (n = 12). Primary research data were analyzed deductively under the "lens" of compassion, as defined by Goetz.

RESULTS

Four interacting themes were found: (1) COVID-19 - to care or not to care? The importance of feeling safe, (2) A lonely illness - suffering in isolation with COVID-19, (3) Compassionate care for people with COVID-19 across the hospital continuum, and (4) Sustaining compassionate care for people hospitalized with COVID-19 - healthcare provider compassion fatigue and burnout.

CONCLUSIONS

Compassionate care is not a given for people hospitalized with COVID-19. Healthcare providers must feel safe to provide care before responding compassionately. People hospitalized with COVID-19 experience additional suffering through isolation. Compassionate care for people hospitalized with COVID-19 is more readily identifiable in the rehabilitation setting. However, compassion fatigue and burnout in this context threaten healthcare sustainability.IMPLICATIONS FOR REHABILITATIONHealthcare providers need to feel physically and psychologically safe to provide compassionate care for people hospitalized with COVID-19.People hospitalized with COVID-19 infection experience added suffering through the socially isolating effects of physical distancing.Compassion and virtuous behaviours displayed by healthcare providers are expected and valued by patients and caregivers, including during the COVID-19 pandemic.High levels of compassion fatigue and burnout threaten the sustainability of hospital-based care for people with COVID-19.

Challenges in the Management of Non-Alcoholic Fatty Liver Disease (NAFLD): Towards a Compassionate Approach

Representing a growing ‘silent epidemic’, non-alcoholic fatty liver disease (NAFLD) affects around 25–30% of the general population. Alarmingly, NAFLD increases the risk of cardiovascular disease, both independently and through its strong associations with obesity, type 2 diabetes, and metabolic syndrome, whilst posing a substantial burden from an economic and health-related quality of life perspective. Moreover, growing evidence links NAFLD to common mental health disorders including depression, anxiety, and stress. In this context, recent clinical and research attention further focuses on potential additional problems faced by patients with NAFLD, such as perceived stigma, lack of awareness regarding the condition, and possible feelings of loneliness and isolation that might emerge from unmet support needs. To date, despite a wealth of literature on NAFLD, management of the condition remains challenging and not straightforward, with most cases in primary care being treated with lifestyle modification on top of any other comorbidity treatment. However, for many patients with NAFLD, weight loss is hard to accomplish and/or sustain (e.g., patients may lack the skills, confidence, and motivation required to adhere to dietary changes, and/or may have problems limiting opportunities for increased physical activity). Therefore, tailored interventions which are manageable from the perspective of the individual patient with NAFLD could glean greater results. Accordingly, although there is a lack of research exploring the potential benefits of person-centered and compassion-based approaches to the management of NAFLD, in the present review, we draw on evidence from methods utilized in the treatment of other chronic conditions in postulating the view that such approaches might prove beneficial in the future management of NAFLD.