Compassion meditation enhances empathic accuracy and related neural activity

A mixed-method evaluation of implementation determinants for chaplain intervention in a hospital setting

Healthcare chaplains address broad social and emotional dimensions of care within a pluralistic religious landscape. Although the development and evaluation of chaplaincy interventions has advanced the field, little research has investigated factors influencing the implementation of new chaplain interventions. In this mixed-method study, we examined attitudes about evidence-based interventions held by chaplain residents (n = 39) at the outset of an ACPE-accredited residency program in the southeast United States. We also used semi-structured interviews (n = 9) to examine residents' attitudes, beliefs, and decision-making processes after they trained in the delivery of a novel manualized intervention, Compassion-Centered Spiritual Health (CCSH). Most residents reported favorable attitudes toward manualized approaches prior to training. Interviews revealed complex decision-making processes and highlighted personal motivations and challenges to learning and implementing CCSH. Implementation science can reveal factors related to motivation, intention, and training that may be optimized to improve the implementation of healthcare chaplaincy interventions.

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.

A compassion-based treatment for couples with the female partner suffering from current depressive disorder: A randomized-controlled trial

BACKGROUND

Studies have shown that depression and interpersonal relationships are interdependently connected and that including the intimate partner in treatment for depression has beneficial effects. Given evidence that compassion is both an interpersonal quality and a promising treatment target, the goal of this study was to examine the effects of a compassion-based, contemplative treatment for couples employing a multi-method approach for evaluation.

METHODS

In a pre-post-follow-up design, n = 53 different-sex couples including women with current depression were randomly assigned to a 10-week-long CBCT®-fC (Cognitively-Based Compassion Training/intervention for couples) or treatment-as-usual (TAU) condition. Multi-level linear regression models and post-hoc contrasts were calculated to determine changes in depressive symptoms, mindfulness and self-compassion, interpersonal functioning and neuroendocrine markers collected during a partnership appreciation task (PAT) in the laboratory before and after CBCT-fC treatment.

RESULTS

While CBCT-fC led to a comparable decrease of depressive symptoms as TAU, the training specifically increased self-compassion and mindfulness versus TAU. Interestingly, interpersonal functioning did not improve, which was also reflected in participants' preferred self-focus in-between-session practices, instead of practices with interpersonal focus. There were no group-specific changes in psychobiological stress-marker reactivity.

CONCLUSIONS

CBCT-fC was effective in decreasing current depressive symptomatology and increasing mindfulness, and self-compassion. Especially the motivation to participate, such as improving interpersonal functioning, should be addressed and intrinsic motives of the partners to be involved. In highly burdened individuals, self-regulation may need to be improved before co-regulation can be addressed, which would requiring longer treatments. Facilitating factors for engaging in the practice between-sessions seem meaningful.

Discovering compassion in medical training: a qualitative study with curriculum leaders, educators, and learners

Background

Compassion is considered a fundamental human capacity instrumental to the creation of medicine and for patient-centered practice and innovations in healthcare. However, instead of nurturing and cultivating institutional compassion, many healthcare providers cite the health system itself as a direct barrier to standard care. The trend of compassion depletion begins with medical students and is often attributed to the culture of undergraduate medical training, where students experience an increased risk of depression, substance use, and suicidality.

Objectives

This qualitative study aims to develop a more comprehensive understanding of compassion as it relates to undergraduate medical education. We used focus groups with key stakeholders in medical education to characterize beliefs about the nature of compassion and to identify perceived barriers and facilitators to compassion within their daily responsibilities as educators and students.

Methods

Researchers conducted a series of virtual (Zoom) focus groups with stakeholders: Students (N = 14), Small Group Advisors (N = 11), and Medical Curriculum Leaders (N = 4). Transcripts were thematically analyzed using MAXQDA software.

Results

Study participants described compassion as being more than empathy, demanding action, and capable of being cultivated. Stakeholders identified self-care, life experiences, and role models as facilitators. The consistently identified barriers to compassion were time constraints, culture, and burnout. Both medical students and those training them agreed on a general definition of compassion and that there are ways to cultivate more of it in their daily professional lives. They also agreed that undergraduate medical education - and the healthcare culture at large - does not deliberately foster compassion and may be directly contributing to its degradation by the content and pedagogies emphasized, the high rates of burnout and futility, and the overwhelming time constraints.

Discussion

Intentional instruction in and cultivation of compassion during undergraduate medical education could provide a critical first step for undergirding the professional culture of healthcare with more resilience and warm-hearted concern. Our finding that medical students and those training them agree about what compassion is and that there are specific and actionable ways to cultivate more of it in their professional lives highlights key changes that will promote a more compassionate training environment conducive to the experience and expression of compassion.

An updated classification of meditation methods using principles of taxonomy and systematics

This paper revisits the proposal for the classification of meditation methods which we introduced in our initial 2013 publication, "Toward a Universal Taxonomy and Definition of Meditation". At that time, we advanced the thesis that meditation methods could be effectively segregated into three orthogonal categories by integrating the taxonomic principle of functional essentialism and the paradigm of Affect and Cognition; and we presented relevant research findings which supported that assertion. This iteration expands upon those theoretical and methodological elements by articulating a more comprehensive Three Tier Classification System which accounts for the full range of meditation methods; and demonstrates how recent neuroscience research continues to validate and support our thesis. This paper also introduces a novel criterion-based protocol for formulating classification systems of meditation methods, and demonstrates how this model can be used to compare and evaluate various other taxonomy proposals that have been published over the past 15 years.

A Preliminary Assessment of Compassion Fatigue in Chimpanzee Caregivers

Compassion fatigue is defined as "traumatization of helpers through their efforts at helping others". It has negative effects on clinicians including reduced satisfaction with work, fatigue, irritability, dread of going to work, and lack of joy in life. It is correlated with patients' decreased satisfaction with care. Compassion fatigue occurs in a variety of helping professions including educators, social workers, mental health clinicians, and it also appears in nonhuman animal care workers. This study surveyed caregivers of chimpanzees using the ProQOL-V to assess the prevalence of compassion fatigue among this group. Compassion satisfaction is higher than many other types of animal care workers. Conversely, this group shows moderate levels of burnout and secondary traumatic stress; higher levels than other types of animal care workers and many medical professions. While compassion fatigue has an effect on the caregiver's experience, it has potential to affect animal welfare. Caregivers are an integral part of the chimpanzee social network. Compassion fatigue affects the caregiver's attitude, this could in turn affect the relationship and degrade the experience of care for captive chimpanzees. Compassion fatigue can be mitigated with professional development, mindfulness training, interrelationships among staff, and specialized training. This preliminary assessment indicates the work ahead is educating caregivers about compassion fatigue and implementing procedures in sanctuaries to mitigate burnout and secondary traumatic stress.

Synchrony During Online Encounters Affects Social Affiliation and Theory of Mind but Not Empathy

Moving together in time affects human social affiliation and cognition. However, it is unclear whether these effects hold for on-line video meetings and whether they extend to empathy (understanding or sharing others' emotions) and theory of mind (ToM; attribution of mental states to others). 126 young adult participants met through online video in unacquainted pairs. Participants either performed 3 min of synchronous arm movements paced by sounds (n = 40), asynchronous movements (n = 46) or a small talk condition (n = 40). In a subsequent empathy task, participants engaged in a conversation. A video recording of this conversation was played back, and each participant rated, at predetermined time points, how they felt and how they thought their partner felt. From this we calculated empathic accuracy (accuracy of the estimation of the other's emotions) and emotional congruence (emotion sharing). ToM was measured by showing videos of geometrical shapes interacting and asking the participants to describe what happened, measuring the amount of intentionality. We found that participants in the synchrony condition rated feeling greater closeness and similarity to their partners relative to the asynchronous condition. Further, participants in the synchrony group tended to ascribe more intentionality to the abstract shapes than participants in asynchrony condition, suggesting greater ToM. Synchrony and asynchrony groups did not reliably differ in empathic accuracy nor emotional congruence. These results suggest that moving in synchrony has effects on social affiliation measures even in online encounters. These effects extend to ToM tendencies but not empathic accuracy or emotion sharing. These results highlight the potential of synchronous movement in online encounters to affect a subset of social cognition and affiliation measures.

Reading language of the eyes

The need for assessment of social skills in clinical and neurotypical populations has led to the widespread, and still increasing use of the 'Reading the Mind in the Eyes Test' (RMET) developed more than two decades ago by Simon Baron-Cohen and colleagues for evaluation of social cognition in autism. By analyzing most recent clinical and brain imaging data, we illuminate a set of factors decisive for using the RMET. Converging evidence indicates: (i) In neurotypical individuals, RMET scores are tightly correlated with other social skills (empathy, emotional intelligence, and body language reading); (ii) The RMET assesses recognition of facial affect, but also heavily relies on receptive language skills, semantic knowledge, and memory; (iii) RMET performance is underwritten by the large-scale ensembles of neural networks well-outside the social brain; (iv) The RMET is limited in its capacity to differentiate between neuropsychiatric conditions as well as between stages and severity of a single disorder, though it reliably distinguishes individuals with altered social cognition or elevated pathological traits from neurotypical persons; (v) Merely gender (as a social construct) rather than neurobiological sex influences performance on the RMET; (vi) RMET scores do not substantially decline in healthy aging, and they are higher with higher education level, cognitive abilities, literacy, and mental well-being; (vii) Accuracy on the RMET, and engagement of the social brain, are greater when emotions are expressed and recognized by individuals with similar cultural/ethnic background. Further research is required to better inform usage of the RMET as a tool for swift and reliable examination of social cognition. In light of comparable visual input from the RMET images and faces covered by masks due to COVID-19 regulations, the analysis is of value for keeping efficient social interaction during the current pandemic, in particular, in professional settings related to social communication.

"Today I Can Look in the Mirror and Like Myself": Effects of a Trauma-Informed Mindful Recovery Program on Self-Compassion

Background

Opioid-related deaths continue to rise. Psychological trauma is commonly comorbid with Opioid Use Disorder (OUD). Adverse childhood experiences can disrupt the development of emotion regulation, increasing risk of substance use. Self-compassion may reduce OUD risk and outcomes by facilitating emotion regulation, decreasing the toxicity of shame, and reducing internalized stigma that can hinder recovery. Mindfulness practice enhances self-compassion.

Methods

This study is part of a pilot (N = 18) of the Mindful Recovery OUD Care Continuum (M-ROCC) during buprenorphine office-based opioid treatment (OBOT). The present study was conducted to gain a deeper understanding of the intervention’s effects on self-compassion development, and to explore differential changes in self-compassion during the intervention among participants with varying intensity of trauma exposure measured by high levels of childhood adversity (defined by 4+ adverse childhood experiences (ACEs) at baseline). We conducted secondary analyses of a subset of qualitative interview data (N = 11 unique participants) collected for the pilot study (weeks 4 and 24, 14 total interviews) to elaborate upon changes in Self-Compassion Scale (SCS-SF) scores.

Results

In the primary pilot study, participants’ mean SCS-SF scores shifted significantly from baseline to week 24, β = 0.22, p = 0.028. This change is elaborated upon through interviews. Despite pervasive challenges to becoming more self-compassionate (e.g., trauma histories and substance use), participants reported increased compassionate self-responding and decreased uncompassionate self-responding. Mindfulness training was identified as the primary mechanism underlying the shift. Kindness to self and others and—to a lesser extent an increased sense of common humanity—were also identified as key to overall self-compassion. Compared to those in the lower ACEs group, participants in the higher ACEs group tended to have lower baseline self-compassion scores (d = 1.09, p = 0.055).

Conclusion

M-ROCC may increase self-compassion among patients with OUD during OBOT by increasing compassionate, and decreasing uncompassionate, self-responding. Patients with OUD with greater childhood adversity tended to have lower levels of self-compassion, which improved with M-ROCC. Future trials with larger samples are needed to confirm these potential outcomes, mechanisms, and differential impacts between ACEs subgroups.

Towards a mechanistic understanding of mindfulness-based stress reduction (MBSR) using an RCT neuroimaging approach: Effects on regulating own stress in social and non-social situations

Although much research has shown that mindfulness-based interventions (MBIs) can reduce psychological stress, it is less clear if effects generalize to everyday social situations, which range among the largest stress triggers. Furthermore, mechanisms of MBIs have not been fully established. Emotion regulation (ER) has been suggested as one key mechanism, yet the role of cognitive reappraisal and acceptance strategies is still under debate. To address these questions, a neuroimaging-based randomized controlled trial (RCT) was performed (n=68), comparing mindfulness-based stress reduction (MBSR) with a reading/listening intervention (READ), using a novel dyadic paradigm for self and other emotion regulation under stress as primary outcome on behavior and brain levels and established empathy measures (clinicatrials.gov NCT03035669). Compared to READ, MBSR led to self-reported stress reduction through both cognitive reappraisal and acceptance only when regulating self and not when regulating others' distress. In addition, MBSR led to increased brain activation over time for regulating own (parietal cortex) and others' (precuneus, TPJ) emotions through cognitive reappraisal and acceptance, albeit this effect was also seen for the reading intervention for regulating own stress via reappraisal. Brain changes did not scale with subjective stress reduction and amount of meditation practice. More distant generalization effects of MBSR on socio-emotional functioning (cognitive empathy and compassion) could also not be shown. This study identified both cognitive reappraisal and acceptance as two ER mechanisms of MBSR, but indicates that effects do not extend to social settings.

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

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

Mentalizing with the future: Electrical stimulation of the right TPJ increases sustainable decision-making

While many people acknowledge the urgency to drastically change our consumption patterns to mitigate climate change, most people fail to live sustainably. We hypothesized that a lack of sustainability stems from insufficient intergenerational mentalizing (i.e., taking the perspective of people in the future). To causally test our hypothesis, we applied high-definition transcranial direct current stimulation (HD-tDCS) to the temporo-parietal junction (TPJ). We tested participants twice (receiving stimulation at the TPJ or the vertex as control), while they engaged in a behavioral economic paradigm measuring sustainable decision-making, even if sustainability was costly. Indeed, excitatory anodal HD-tDCS increased sustainable decision-making, while inhibitory cathodal HD-tDCS had no effect. These finding cannot be explained by changes in participants' fairness norms or their estimation of how other people would behave. Shedding light on the neural basis of sustainability, our results could inspire targeted interventions tackling the TPJ and give neuroscientific support to theories on how to construct public campaigns addressing sustainability issues.

Early and Late Neural Correlates of Mentalizing: ALE Meta-Analyses in Adults, Children and Adolescents

The ability to understand mental states of others is referred to as mentalizing and enabled by our Theory of Mind. This social skill relies on brain regions comprising the mentalizing network, as robustly observed in adults, but also in a growing number of developmental studies. We summarized and compared neuroimaging evidence in children/adolescents and adults during mentalizing using coordinate-based activation likelihood estimation meta-analyses to inform about brain regions consistently or differentially engaged across age categories. Adults (N = 5286) recruited medial prefrontal and middle/inferior frontal cortices, precuneus, temporoparietal junction and middle temporal gyri during mentalizing, which were functionally connected to bilateral inferior/superior parietal lobule and thalamus/striatum. Conjunction and contrast analyses revealed that children and adolescents (N = 479) recruit similar, but fewer regions within core mentalizing regions. Subgroup analyses revealed an early continuous engagement of middle medial prefrontal cortex, precuneus and right temporoparietal junction in younger children (8-11y) and adolescents (12-18y). Adolescents additionally recruited the left temporoparietal junction and middle/inferior temporal cortex. Overall, the observed engagement of the medial prefrontal cortex, precuneus and right temporoparietal junction during mentalizing across all ages reflects an early specialization of some key regions of the social brain.

Synchrony with distress in affective empathy and compassion

Sensitivity to suffering of others is a core factor in social cohesion and evolutionary success. The emergence of such sensitivity may occur via two neuro-functional mechanisms. One is sharing the pain and distress of others, which relies on affective empathy. The other involves a caring concern for others' wellbeing, termed compassion. Both affective empathy and compassion are triggered by cues of pain and distress, exhibited by suffering targets. Yet, the mechanisms underlying distress processing in empathy and compassion are not clear. In the current research, we investigated synchrony with a target's distress, as a putative mechanism for continuous processing of distress cues. Participants viewed a video of a target in distress when given two different instructions: they were asked to continuously rate their distress in the affective empathy condition, or their feelings of care in the compassion condition. We used these dynamic ratings as well as participants' autonomic and facial responses to assess multi-channel synchrony with the target's self-rated distress fluctuations. Dynamic ratings and facial corrugator responses were significantly positively synchronized with the target's distress. For the corrugator responses, synchrony with the target was more pronounced than synchrony with participants' own ratings. Autonomic responses exhibited negative synchrony with the target's distress. Synchrony was higher in the affective empathy than in the compassion condition, across channels. These results point to the key role of subjective and physiological synchrony with the target's distress in empathic sharing of negative experiences. They also highlight the attenuation of embodied resonance with distress in compassionate experiences.

Neurocognitive mechanisms underlying improvement of prosocial responses by a novel implicit compassion promotion task

Compassion is closely associated with prosocial behavior. Although there is growing interest in developing strategies that cultivate compassion, most available strategies rely on effortful reflective processes. Furthermore, few studies have investigated neurocognitive mechanisms underlying compassion-dependent improvement of prosocial responses. We devised a novel implicit compassion promotion task that operates based on association learning and examined its prosocial effects in two independent experiments. In Experiment 1, healthy adults were assigned to either the compassion or control group. For the intervention task, the compassion group completed word fragments that were consistently related to compassionate responses toward others; in contrast, the control group completed word fragments related to emotionally neutral responses toward others. Following the intervention task, we measured attentional biases to fearful, sad, and happy faces. Prosocial responses were assessed using two measures of helping: the pen-drop test and the helping intentions rating test. In Experiment 2, independent groups of healthy adults completed the same intervention tasks used in Experiment 1. Inside a functional MRI scanner, participants rated empathic care and distress based on either distressful or neutral video clips. Outside the scanner, we assessed the degree of helping intentions toward the victims depicted in the distressful clips. The results of Experiment 1 showed that the compassion promotion task reduced attentional vigilance to fearful faces, which in turn mediated a compassion promotion task-dependent increase in helping intentions. In Experiment 2, relative to the control group, the compassion group showed reduced empathic distress and increased activity in the medial orbitofrontal cortex in response to others' suffering. Furthermore, increased functional connectivity of the medial orbitofrontal and inferior parietal cortex, predicted by reduced empathic distress, explained the increase in helping intentions. These results suggest the potential of implicit compassion promotion intervention to modulate compassion-related and prosocial responses as well as highlight the brain activation and connectivity related to these responses, contributing to our understanding of the neurocognitive mechanisms underlying compassion-dependent prosocial improvement.

Neuropsychological and socio-cognitive deficits in patients with obstructive sleep apnea

Introduction: Patients with obstructive sleep apnea (OSA) suffer from several neurocognitive deficits. We investigated the cognitive and socio-cognitive profiles of patients with severe OSA, controlling for potentially relevant mediating variables (i.e. age, body-mass index, cognitive reserve and depression). Moreover, we studied the neuropsychological profile of a high-risk OSA phenotype characterized by severe OSA and severe nocturnal hypoxemia.Method: We assessed 29 previously untreated severe OSA patients with a mean age of 55.6 (± 9.9 years) and a mean apnea-hypopnea index (AHI) of 53.1 (± 17.4). A control group of 34 healthy participants was also enrolled. Participants completed an extensive neuropsychological battery that included social cognition, a relatively new investigation area among OSA patients.Data analysis: Data were analyzed with a Bayesian approach. Specifically, Bayesian ANCOVA was used to investigate whether the grouping variable could predict test performance. Age, body-mass index, cognitive reserve and state of depression were added as covariates to the null model to weight the effects of these potential confounding factors. Three groups were analyzed: healthy controls (H), OSA with severe apnea and severe nocturnal oxygen desaturation (D⁺), and OSA with severe apnea non-desaturators (D^-). Performances on the various neuropsychological tests were treated as the dependent variables.Results: The results indicate that non-verbal reasoning, the theory of mind skills, and mental shifting ability were impaired in OSA patients. Patients with severe nocturnal hypoxemia underperformed compared to patients with the same severity of apnea but non-desaturators. Additionally, we observed a trend toward a worse performance among OSA desaturator patients in the following abilities: constructional ability, short term verbal memory, phonological fluency, and the ability to inhibit automatic and dominant responses.Conclusion: The data suggest a key role of hypoxemia in affecting cognitive functioning in OSA patients. Executive functions and the concomitant involvement of social cognition are particularly affected.

Effects of Compassion Training on Brain Responses to Suffering other

Compassion meditation (CM) is a promising intervention for enhancing compassion, although its active ingredients and neurobiological mechanisms are not well-understood. To investigate these, we conducted a three-armed placebo-controlled randomized trial (N = 57) with longitudinal functional magnetic resonance imaging (fMRI). We compared a 4-week CM program delivered by smartphone application with (i) a placebo condition, presented to participants as the compassion-enhancing hormone oxytocin, and (ii) a condition designed to control for increased familiarity with suffering others, an element of CM which may promote compassion. At pre- and post-intervention, participants listened to compassion-eliciting narratives describing suffering others during fMRI. CM increased brain responses to suffering others in the medial orbitofrontal cortex (mOFC) relative to the familiarity condition, p < 0.05 family-wise error rate corrected. Among CM participants, individual differences in increased mOFC responses positively correlated with increased compassion-related feelings and attributions, r = 0.50, p = 0.04. Relative to placebo, the CM group exhibited a similar increase in mOFC activity at an uncorrected threshold of P < 0.001 and 10 contiguous voxels. We conclude that the mOFC, a region closely related to affiliative affect and motivation, is an important brain mechanism of CM. Effects of CM on mOFC function are not explained by familiarity effects and are partly explained by placebo effects.

Psychiatric Neural Networks and Precision Therapeutics by Machine Learning

Learning and environmental adaptation increase the likelihood of survival and improve the quality of life. However, it is often difficult to judge optimal behaviors in real life due to highly complex social dynamics and environment. Consequentially, many different brain regions and neuronal circuits are involved in decision-making. Many neurobiological studies on decision-making show that behaviors are chosen through coordination among multiple neural network systems, each implementing a distinct set of computational algorithms. Although these processes are commonly abnormal in neurological and psychiatric disorders, the underlying causes remain incompletely elucidated. Machine learning approaches with multidimensional data sets have the potential to not only pathologically redefine mental illnesses but also better improve therapeutic outcomes than DSM/ICD diagnoses. Furthermore, measurable endophenotypes could allow for early disease detection, prognosis, and optimal treatment regime for individuals. In this review, decision-making in real life and psychiatric disorders and the applications of machine learning in brain imaging studies on psychiatric disorders are summarized, and considerations for the future clinical translation are outlined. This review also aims to introduce clinicians, scientists, and engineers to the opportunities and challenges in bringing artificial intelligence into psychiatric practice.

Compassion As an Intervention to Attune to Universal Suffering of Self and Others in Conflicts: A Translational Framework

As interpersonal, racial, social, and international conflicts intensify in the world, it is important to safeguard the mental health of individuals affected by them. According to a Buddhist notion "if you want others to be happy, practice compassion; if you want to be happy, practice compassion," compassion practice is an intervention to cultivate conflict-proof well-being. Here, compassion practice refers to a form of concentrated meditation wherein a practitioner attunes to friend, enemy, and someone in between, thinking, "I'm going to help them (equally)." The compassion meditation is based on Buddhist philosophy that mental suffering is rooted in conceptual thoughts that give rise to generic mental images of self and others and subsequent biases to preserve one's egoism, blocking the ultimate nature of mind. To contextualize compassion meditation scientifically, we adopted a Bayesian active inference framework to incorporate relevant Buddhist concepts, including mind (buddhi), compassion (karuna), aggregates (skandhas), suffering (duhkha), reification (samaropa), conceptual thoughts (vikalpa), and superimposition (prapañca). In this framework, a person is considered a Bayesian Engine that actively constructs phenomena based on the aggregates of forms, sensations, discriminations, actions, and consciousness. When the person embodies rigid beliefs about self and others' identities (identity-grasping beliefs) and the resulting ego-preserving bias, the person's Bayesian Engine malfunctions, failing to use prediction errors to update prior beliefs. To counter this problem, after recognizing the causes of sufferings, a practitioner of the compassion meditation aims to attune to all others equally, friends and enemies alike, suspend identity-based conceptual thoughts, and eventually let go of any identity-grasping belief and ego-preserving bias that obscure reality. We present a brain model for the Bayesian Engine of three components: (a) Relation-Modeling, (b) Reality-Checking, and (c) Conflict-Alarming, which are subserved by (a) the Default-Mode Network (DMN), (b) Frontoparietal Network (FPN) and Ventral Attention Network (VAN), and (c) Salience Network (SN), respectively. Upon perceiving conflicts, the strengthening or weakening of ego-preserving bias will critically depend on whether the SN up-regulates the DMN or FPN/VAN, respectively. We propose that compassion meditation can strengthen brain regions that are conducive for suspending prior beliefs and enhancing the attunements to the counterparts in conflicts.

Cognitive Empathy as Imagination: Evidence From Reading the Mind in the Eyes in Autism and Schizotypy

How is cognitive empathy related to sociality, imagination, and other psychological constructs? How is it altered in disorders of human social cognition? We leveraged a large data set (1,168 students, 62% female) on the Reading the Mind in the Eyes test (RMET), the Autism Quotient (AQ), and the Schizotypal Personality Questionnaire (SPQ-BR) to test the hypotheses that the RMET, as a metric of cognitive empathy, reflects mainly social abilities, imagination, or both. RMET showed the expected female bias in performance, though only for eyes that expressed emotions and not for neutral expressions. RMET performance was significantly, and more strongly, associated with the AQ and SPQ subscales that reflect aspects of imagination (AQ-Imagination and SPQ-Magical Ideation) than aspects of social abilities (AQ-Social, AQ-Communication, and SPQ-Interpersonal subscales). These results were confirmed with multiple regression analysis, which also implicated increased attention (AQ-Attention Switching and, marginally non-significantly, AQ-Attention to Detail) in RMET performance. The two imagination-related correlates of RMET performance also show the strongest sex biases for the AQ and SPQ: male biased in AQ-Imagination, and female biased in SPQ-Magical Ideation, with small to medium effect sizes. Taken together, these findings suggest that cognitive empathy, as quantified by the RMET, centrally involves imagination, which is underdeveloped (with a male bias) on the autism spectrum and overdeveloped (with a female bias) on the schizotypy spectrum, with optimal emotion-recognition performance intermediate between the two. The results, in conjunction with previous studies, implicate a combination of optimal imagination and focused attention in enhanced RMET performance.

Toward a Compassionate Intersectional Neuroscience: Increasing Diversity and Equity in Contemplative Neuroscience

Mindfulness and compassion meditation are thought to cultivate prosocial behavior. However, the lack of diverse representation within both scientific and participant populations in contemplative neuroscience may limit generalizability and translation of prior findings. To address these issues, we propose a research framework called Intersectional Neuroscience which adapts research procedures to be more inclusive of under-represented groups. Intersectional Neuroscience builds inclusive processes into research design using two main approaches: 1) community engagement with diverse participants, and 2) individualized multivariate neuroscience methods to accommodate neural diversity. We tested the feasibility of this framework in partnership with a diverse U.S. meditation center (East Bay Meditation Center, Oakland, CA). Using focus group and community feedback, we adapted functional magnetic resonance imaging (fMRI) screening and recruitment procedures to be inclusive of participants from various under-represented groups, including racial and ethnic minorities, gender and sexual minorities, people with disabilities, neuropsychiatric disorders, and/or lower income. Using person-centered screening and study materials, we recruited and scanned 15 diverse meditators (80% racial/ethnic minorities, 53% gender and sexual minorities). The participants completed the EMBODY task - which applies individualized machine learning algorithms to fMRI data - to identify mental states during breath-focused meditation, a basic skill that stabilizes attention to support interoception and compassion. All 15 meditators' unique brain patterns were recognized by machine learning algorithms significantly above chance levels. These individualized brain patterns were used to decode the internal focus of attention throughout a 10-min breath-focused meditation period, specific to each meditator. These data were used to compile individual-level attention profiles during meditation, such as the percentage time attending to the breath, mind wandering, or engaging in self-referential processing. This study provides feasibility of employing an intersectional neuroscience approach to include diverse participants and develop individualized neural metrics of meditation practice. Through inclusion of more under-represented groups while developing reciprocal partnerships, intersectional neuroscience turns the research process into an embodied form of social action.

Ways of Knowing Compassion: How Do We Come to Know, Understand, and Measure Compassion When We See It?

Over the last decade, empirical research on compassion has burgeoned in the biomedical, clinical, translational, and foundational sciences. Increasingly sophisticated understandings and measures of compassion continue to emerge from the abundance of multidisciplinary and cross-disciplinary studies. Naturally, the diversity of research methods and theoretical frameworks employed presents a significant challenge to consensus and synthesis of this knowledge. To bring the empirical findings of separate and sometimes siloed disciplines into conversation with one another requires an examination of their disparate assumptions about what compassion is and how it can be known. Here, we present an integrated theoretical review of methodologies used in the empirical study of compassion. Our goal is to highlight the distinguishing features of each of these ways of knowing compassion, as well as the strengths and limitations of applying them to specific research questions. We hope this will provide useful tools for selecting methods that are tailored to explicit objectives (methods matching), taking advantage of methodological complementarity across disciplines (methods mixing), and incorporating the empirical study of compassion into fields in which it may be missing.

Overcoming the limits of empathic concern: the case for availability and its application to the medical domain

Empathic concern is essential to our social lives because it motivates helping behavior. It has, however, well-known shortcomings such as its limitation in scope. Here, we highlight a further shortcoming of empathic concern: it contributes little to understanding the relevant features of complex social situations (e.g. the causes of somebody's distress), and unaided by further cognitive inputs, likely fails to produce effective helping. We then elaborate on the conditions needed for an accurate assessment of others' situations: the ability to pay attention and try to understand others for their own sake. We explain that when combining these abilities with the valuing aspect of empathic concern, we obtain "availability", an understudied mental state which plays a crucial role in helping motivation. We provide a detailed definition of that notion and show how availability can be trained and exercised by health professionals in order to improve their care and relationships with patients.

Compassion Meditation for Veterans with Posttraumatic Stress Disorder (PTSD): a Nonrandomized Study

Compassion meditation (CM) is a contemplative practice that is intended to cultivate the ability to extend and sustain compassion toward self and others. Although research documents the benefits of CM in healthy populations, its use in the context of psychopathology is largely unexamined. The purpose of this study was to refine and initially evaluate a CM protocol, Cognitively Based Compassion Training (CBCT®), for use with Veterans with PTSD. To this end, our research team developed and refined a manualized protocol, CBCT-Vet, over 4 sets of groups involving 36 Veterans. This protocol was delivered in 8–10 sessions, each lasting 90–120 min and led by a CBCT®-trained clinical psychologist. Quantitative and qualitative data were used to identify areas to be improved and to assess change that occurred during the treatment period. Based on pooled data from this series of groups, CM appears to be acceptable to Veterans with PTSD. Group participation was associated with reduced symptoms of PTSD (partial eta squared = .27) and depression (partial eta squared = .19), but causality should not be inferred given the nonrandomized design. No change was observed in additional outcomes, including positive emotion and social connectedness. The results of this open trial support additional exploration of CM as part of the recovery process for Veterans with PTSD.

Neurophysiological and behavioural markers of compassion

The scientific study of compassion is burgeoning, however the putative neurophysiological markers of programs which actively train distress tolerance, such as Compassionate Mind Training (CMT), are less well known. Herein we offer an integrative, multi-method approach which investigated CMT at neural, physiological, self-report, and behavioural levels. Specifically, this study first assessed participants' neural responses when confronted with disappointments (e.g., rejection, failure) using two fundamental self-regulatory styles, self-criticism and self-reassurance. Second, participant's heart-rate variability (HRV) - a marker of parasympathetic nervous system response - was assessed during compassion training, pre- and post- a two-week self-directed engagement period. We identified neural networks associated with threat are reduced when practicing compassion, and heightened when being self-critical. In addition, cultivating compassion was associated with increased parasympathetic response as measured by an increase in HRV, versus the resting-state. Critically, cultivating compassion was able to shift a subset of clinically-at risk participants to one of increased parasympathetic response. Further, those who began the trial with lower resting HRV also engaged more in the intervention, possibly as they derived more benefits, both self-report and physiologically, from engagement in compassion.

Primary functional brain connections associated with melancholic major depressive disorder and modulation by antidepressants

The limited efficacy of available antidepressant therapies may be due to how they affect the underlying brain network. The purpose of this study was to develop a melancholic MDD biomarker to identify critically important functional connections (FCs), and explore their association to treatments. Resting state fMRI data of 130 individuals (65 melancholic major depressive disorder (MDD) patients, 65 healthy controls) were included to build a melancholic MDD classifier, and 10 FCs were selected by our sparse machine learning algorithm. This biomarker generalized to a drug-free independent cohort of melancholic MDD, and did not generalize to other MDD subtypes or other psychiatric disorders. Moreover, we found that antidepressants had a heterogeneous effect on the identified FCs of 25 melancholic MDDs. In particular, it did impact the FC between left dorsolateral prefrontal cortex (DLPFC)/inferior frontal gyrus (IFG) and posterior cingulate cortex (PCC)/precuneus, ranked as the second 'most important' FC based on the biomarker weights, whilst other eight FCs were normalized. Given that left DLPFC has been proposed as an explicit target of depression treatments, this suggest that the limited efficacy of antidepressants might be compensated by combining therapies with targeted treatment as an optimized approach in the future.

Group membership dictates the neural correlates of social optimism biases

Optimism bias, i.e. expecting the future to hold more desirable than undesirable outcomes, also extends to people that we like or admire. However, it remains unknown how the brain generates this social optimism bias. In this study, respondents estimated the likelihood of future desirable and undesirable outcomes for an in-group and three out-groups: warm-incompetent, cold-competent, and cold-incompetent. We found a strong social optimism bias for the in-group and the warm out-group and an inverted pattern for the cold-incompetent out-group. For all groups, scores of social optimism bias correlated with the brain activity in structures that respondents differentially engaged depending on the target social group. In line with our hypotheses, evaluating the in-group recruited the ventromedial prefrontal cortex and the precuneus/posterior cingulate cortex, whereas evaluating the warm out-group engaged the posterior insula, mid cingulate cortex, and somatosensory cortices. These findings suggest different underlying cognitive mechanisms of social optimism bias for these groups, despite similar behavioural patterns. Thinking about the cold out-groups recruited the right anterior temporal lobe, and temporoparietal junction. Evaluating the cold-incompetent out-group additionally recruited the anterior insula, inferior frontal cortex and dorsomedial frontal cortex. We discuss these neuroimaging findings with respect to their putative cognitive functions.

Does Mindfulness Training Without Explicit Ethics-Based Instruction Promote Prosocial Behaviors? A Meta-Analysis

Scholarly discourse has raised concerns about the gravitas of secular mindfulness trainings in promoting prosocial outgrowths, as these trainings lack ethics-based concepts found in contemplative traditions. Random-effects meta-analyses were conducted to test whether mindfulness trainings absent explicit ethics-based instructions promote prosocial action. There was a range of small to medium standardized mean difference effect sizes of mindfulness training on overt acts of prosociality when compared with active and inactive controls, k = 29, N = 3,100, g = .426, 95% confidence interval (CI)( g) = [.304, .549]. Reliable effect size estimates were found for single-session interventions that measured prosocial behavior immediately after training. Mindfulness training also reliably promotes compassionate (but not instrumental or generous) helping and reliably reduces prejudice and retaliation. Publication bias analyses indicated that the reliability of these findings was not wholly dependent on selective reporting. Implications for the science of secular mindfulness training on prosocial action are discussed.

Differential benefits of mental training types for attention, compassion, and theory of mind

Mindfulness- and, more generally, meditation-based interventions increasingly gain popularity, effectively promoting cognitive, affective, and social capacities. It is unclear, however, if different types of practice have the same or specific effects on mental functioning. Here we tested three consecutive three-month training modules aimed at cultivating either attention, socio-affective qualities (such as compassion), or socio-cognitive skills (such as theory of mind), in three training cohorts and a retest control cohort (N = 332). While attentional performance improved most consistently after attention training, compassion increased most after socio-affective training and theory of mind partially improved after socio-cognitive training. These results show that specific mental training practices are needed to induce plasticity in different domains of mental functioning, providing a foundation for evidence-based development of more targeted interventions adapted to the needs of different education, labor, and health settings.

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

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

The neurophysiological basis of compassion: An fMRI meta-analysis of compassion and its related neural processes

Theoretical and neurophysiological investigations into compassion are burgeoning, yet the putative neural mechanisms which underpin such processes are less well understood. Therefore, we have conducted an Activation-Likelihood Estimate meta-analysis in order to ascertain the shared neural processes consistently identified as relevant to compassion. Our analysis of sixteen fMRI studies revealed activation across seven broad regions, with the largest peaks localized to the Periaqueductal Grey, Anterior Insula, Anterior Cingulate, and Inferior Frontal Gyrus. Overall, we identified a tendency for studies to operationalize compassion in one of three ways, as driven either 'top-down', 'bottom-up', or modified by target context. We failed to identify regions purportedly common to compassion such as the DLPFC, OFC, and Amygdala, possibly due to a small number of studies which used Loving-Kindness meditation. We argue future research in compassion science continue a multi-modal approach to examine links between neural activity and actual prosocial behavior, and recommend the application of fMRI paradigms on compassion with clinically diagnosed populations to parallel current trends in psychotherapy such as Compassion Focused Therapy.

Integrating Metta Into CBT: How Loving Kindness and Compassion Meditation Can Enhance CBT for Treating Anxiety and Depression

Loving kindness meditation and compassion meditation are traditional Buddhist practices that have recently been introduced and investigated in psychotherapy with promising results. Both meditation practices emphasize metta, a mental state of positive energy and kindness towards oneself and other beings, as opposed to the anger, hostility, or self-loathing that often accompany emotional problems.

We conducted a qualitative review of the literature to produce an integrative review.

Metta meditation appears to be particularly useful for treating depression and social anxiety, both characterized by low positive affect and negative attitudes and core beliefs about the self.

Metta meditation can aid therapy by promoting more adaptive self-images, social connectedness, and emotional experiences.

Loving kindness and compassion meditation (metta) have been recently introduced in psychotherapy.

Metta addresses shame, anger, and hostility, and promotes an accepting attitude towards oneself.

Metta meditation increases positive affect.

Metta meditation can be particularly useful in social anxiety and depression.

What Do You Have in Mind? Measures to Assess Mental State Reasoning in Neuropsychiatric Populations

Social interaction is closely associated with both functional capacity and well-being. Previous research has not only revealed evidence of social dysfunction in individuals with a wide range of psychiatric and neurological disorders but also generated an abundance of potential measures for assessing social cognition. This review explores the most popular measures used within neuropsychiatric populations to investigate the ability to recognize or reason about the mental states of others. Measures are also critically analyzed in terms of strengths and limitations to aid task selection in future clinical studies. The most frequently applied assessment tools use verbal, visual or audiovisual forms of presentation and assess recognition of mental states from facial features, self-rated empathy, the understanding of other's cognitive mental states such as beliefs and intentions, or the ability to combine knowledge of other's thoughts and emotions in order to understand subtle communications or socially inappropriate behavior. Key weaknesses of previous research include limited investigation of relationships with clinical symptoms, and underutilization of measures of everyday social functioning that offer a useful counterpart to traditional "lab" tasks. Future studies should aim to carefully select measures not only based on the range of skills to be assessed but also taking into account potential difficulties with interpretation and the need to gain insight into the application of social cognitive skills as well as ability per se. Some of the best measures include those with well-matched control trials (e.g., Yoni Task) or those that restrict the influence of verbal deficits (e.g., intentions comic strip task), elicit spontaneous mentalizing (e.g., Animations Task), and possess greater ecological validity (e.g., Movie for the Assessment of Social Cognition). Social cognitive research within psychiatric populations will be further enhanced through the development of more closely matched control tasks, and the exploration of relationships between task performance, medication, strategy use, and broader emotional and motor functions.

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

Background

Cancer survivors and their informal caregivers (family members, close friends) often experience significant impairments in health-related quality of life (HRQOL), including disruptions in psychological, physical, social, and spiritual well-being both during and after primary cancer treatment. The purpose of this in-progress pilot trial is to determine acceptability and preliminary efficacy (as reflected by effect sizes) of CBCT® (Cognitively-Based Compassion Training) compared with a cancer health education (CHE) attention control to improve the primary outcome of depressive symptoms and secondary outcomes of other HRQOL domains (e.g., anxiety, fatigue), biomarkers of inflammation and diurnal cortisol rhythm, and healthcare utilization-related outcomes in both cancer survivors and informal caregivers.

Methods

Forty dyads consisting of solid tumor survivors who have completed primary treatments (chemotherapy, radiation, surgery) and their informal caregivers, with at least one dyad member with ≥ mild depressive symptoms or anxiety, will be recruited from Tucson, Arizona, USA. Survivor-caregiver dyads will be randomized together to complete either CBCT or CHE. CBCT is a manualized, 8-week, group meditation-based intervention that starts with attention and mindfulness and builds to contemplative practices aimed at cultivating compassion to the self and others. The goal of CBCT is to challenge unexamined assumptions about feelings and behaviors, with a focus on generating spontaneous self-compassion and increased empathic responsiveness and compassion for others. CHE is an 8-week, manualized group intervention that provides cancer-specific education on various topics (e.g., cancer advocacy, survivorship wellness). Patient-reported HRQOL outcomes will be assessed before, immediately after (week 9), and 1 month after CBCT or CHE (week 13). At the same time points, stress-related biomarkers of inflammation (e.g., plasma interleukin-6) and saliva cortisol relevant for survivor and informal caregiver wellness and healthcare utilization will be measured.

Discussion

If CBCT shows acceptability, a larger trial will be warranted and appropriately powered to formally test the efficacy of this dyadic intervention. Interventions such as CBCT directed toward both survivors and caregivers may eventually fill a gap in supportive oncology care programs to improve HRQOL and healthcare utilization in both dyad members.

Trial registration

Clinicaltrials.gov, NCT03459781. Prospectively registered on 9 March 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-019-3320-9) contains supplementary material, which is available to authorized users.

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

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

The Neuroscience of Happiness and Well-Being: What Brain Findings from Optimism and Compassion Reveal

Increasing behavioral data support the value of developing positive traits and attitudes to promote mental health and human flourishing. A neuroscience approach to understanding the mechanisms of the key constructs of optimism and compassion is relevant toward improving identification and measurement of relevant traits, progress and barriers to cultivating these traits, and identifying which mental health-promoting practices are most effective in promoting growth of optimism and compassion.

Evolution from four mental states to the highest state of consciousness: A neurophysiological basis of meditation as defined in yoga texts

This chapter provides a theoretical introduction to states of consciousness and reviews neuroscientific investigations of meditation. The different states of consciousness consist of four mental states, i.e., cancalata (random thinking), ekagrata (non-meditative focusing), dharna (focused meditation), and dhyana (meditation) as defined in yoga texts. Meditation is a self-regulated mental process associated with deep relaxation and increased internalized attention. Scientific investigations on meditation reported changes in electrophysiological signals and neuroimaging measures. But most outcomes of meditation studies showed inconsistent results, this may be due to heterogeneity in meditation methods and techniques evolved in the last 200 years. Traditionally, the features of meditation include the capacity to sustain a heightened awareness of thoughts, behaviors, emotions, and perceptions. Generally, meditation involves non-reactive effortless monitoring of the content of experience from moment to moment. Focused meditation practice involves awareness on a single object and open monitoring meditation is a non-directive meditation involved attention in breathing, mantra, or sound. Therefore, results of few empirical studies of advanced meditators or beginners remain tentative. This is an attempt to compile the meditation-related changes in electrophysiological and neuroimaging processes among experienced and novice practitioners.

Compassion Focused Approaches to Working With Distressing Voices

This paper presents an outline of voice-hearing phenomenology in the context of evolutionary mechanisms for self- and social- monitoring. Special attention is given to evolved systems for monitoring dominant-subordinate social roles and relationships. These provide information relating to the interpersonal motivation of others, such as neutral, friendly or hostile, and thus the interpersonal threat, versus safe, social location. Individuals who perceive themselves as subordinate and dominants as hostile are highly vigilant to down-rank threat and use submissive displays and social spacing as basic defenses. We suggest these defense mechanisms are especially attuned in some individuals with voices, in which this fearful-subordinate – hostile-dominant relationship is played out. Given the evolved motivational system in which voice-hearers can be trapped, one therapeutic solution is to help them switch into different motivational systems, particularly those linked to social caring and support, rather than hostile competition. Compassion focused therapy (CFT) seeks to produce such motivational shifts. Compassion focused therapy aims to help voice-hearers, (i) notice their threat-based (dominant-subordinate) motivational systems when they arise, (ii) understand their function in the context of their lives, and (iii) shift into different motivational patterns that are orientated around safeness and compassion. Voice-hearers are supported to engage with biopsychosocial components of compassionate mind training, which are briefly summarized, and to cultivate an embodied sense of a compassionate self-identity. They are invited to consider, and practice, how they might wish to relate to themselves, their voices, and other people, from the position of their compassionate self. This paper proposes, in line with the broader science of compassion and CFT, that repeated practice of creating internal patterns of safeness and compassion can provide an optimum biopsychosocial environment for affect-regulation, emotional conflict-resolution, and therapeutic change. Examples of specific therapeutic techniques, such as chair-work and talking with voices, are described to illustrate how these might be incorporated in one-to-one sessions of CFT.

Rationale, Methods, Feasibility, and Preliminary Outcomes of a Transdiagnostic Prevention Program for At-Risk College Students

PURPOSE

Early adulthood represents one period of increased risk for the emergence of a serious mental illness. The college campus provides a unique opportunity to assess and monitor individuals in this at-risk age group. However, there are no validated early detection programs that are widely implemented on college campuses. In an effort to address this gap, we designed and tested an early detection and prevention program tailored to college students. A transdiagnostic approach was employed because of evidence for shared risk factors across major mental illnesses.

DESIGN

Single arm, prospective study evaluating outcomes following a 4-week intervention.

METHOD

Three in-person mental health screenings were conducted on the campus of one university. Undergraduate students with at least mildly elevated, self-reported levels of depressive or subclinical psychotic symptoms, who were not receiving treatment for these symptoms, were invited to participate in a 4-session workshop focused on increasing self- and other- awareness and emotion regulation using established mindfulness, self-compassion, and mentalization principles and experiential exercises. Symptoms, resilience-promoting capacities, and aspects of social functioning were assessed pre- and post- intervention.

RESULTS

416 students were screened and a total of 63 students participated in the workshop. 91% attended at least 3 of the 4 sessions. The majority of participants found the workshop interesting and useful and would recommend it to a friend. Significant pre-to-post reductions in symptoms (depression, anxiety, and subclinical psychotic symptoms, ps < 0.004) and improvements in resilience-promoting capacities (self-compassion and self-efficacy, ps < 0.006) and indices of social functioning (social motivation, activity, and a measure of comfort with the physical presence of others, ps < 0.04) were observed. Moreover, the significant increases in resilience-promoting capacities correlated with the reductions in affective symptoms (ps < 0.03).

CONCLUSIONS

These findings suggest that an on-campus mental health screening and early intervention program is feasible, acceptable, and may be associated with improvements in resilience-related capacities and symptom reductions in young adults with non-impairing, subclinical symptoms of psychopathology. Follow-up work will determine whether this program can improve both shorter and longer-term mental health and functional outcomes in this at-risk population.

The Age-Well observational study on expert meditators in the Medit-Ageing European project

INTRODUCTION

The Age-Well observational, cross-sectional study investigates the affective and cognitive mechanisms of meditation expertise with behavioral, neuroimaging, sleep, and biological measures sensitive to aging and Alzheimer's disease (AD).

METHODS

Thirty cognitively unimpaired individuals aged 65 years or older with at least 10,000 hours of practice in mindfulness meditation (MM) and loving-kindness and compassion meditation (LKCM) are selected. The outcomes are the neuroimaging brain correlates of MM and LKCM and the assessments of long-term meditation practices on behavioral, neural, and biological measures as compared to nonmeditator older controls from the Age-Well randomized controlled trial.

RESULTS

Recruitment and data collection began in late 2016 and will be completed by late 2019.

DISCUSSION

Results are expected to foster the understanding of the effects of meditation expertise on aging and of the mechanisms of action underlying the meditation intervention in the Age-Well randomized controlled trial. These finding will contribute to the design of meditation-based prevention randomized controlled trials for the aged population and to the exploration of the possible long-time developmental trajectory of meditation training.

Emotion Regulation Using Virtual Environments and Real-Time fMRI Neurofeedback

Neurofeedback (NFB) enables the voluntary regulation of brain activity, with promising applications to enhance and recover emotion and cognitive processes, and their underlying neurobiology. It remains unclear whether NFB can be used to aid and sustain complex emotions, with ecological validity implications. We provide a technical proof of concept of a novel real-time functional magnetic resonance imaging (rtfMRI) NFB procedure. Using rtfMRI-NFB, we enabled participants to voluntarily enhance their own neural activity while they experienced complex emotions. The rtfMRI-NFB software (FRIEND Engine) was adapted to provide a virtual environment as brain computer interface (BCI) and musical excerpts to induce two emotions (tenderness and anguish), aided by participants' preferred personalized strategies to maximize the intensity of these emotions. Eight participants from two experimental sites performed rtfMRI-NFB on two consecutive days in a counterbalanced design. On one day, rtfMRI-NFB was delivered to participants using a region of interest (ROI) method, while on the other day using a support vector machine (SVM) classifier. Our multimodal VR/NFB approach was technically feasible and robust as a method for real-time measurement of the neural correlates of complex emotional states and their voluntary modulation. Guided by the color changes of the virtual environment BCI during rtfMRI-NFB, participants successfully increased in real time, the activity of the septo-hypothalamic area and the amygdala during the ROI based rtfMRI-NFB, and successfully evoked distributed patterns of brain activity classified as tenderness and anguish during SVM-based rtfMRI-NFB. Offline fMRI analyses confirmed that during tenderness rtfMRI-NFB conditions, participants recruited the septo-hypothalamic area and other regions ascribed to social affiliative emotions (medial frontal / temporal pole and precuneus). During anguish rtfMRI-NFB conditions, participants recruited the amygdala and other dorsolateral prefrontal and additional regions associated with negative affect. These findings were robust and were demonstrable at the individual subject level, and were reflected in self-reported emotion intensity during rtfMRI-NFB, being observed with both ROI and SVM methods and across the two sites. Our multimodal VR/rtfMRI-NFB protocol provides an engaging tool for brain-based interventions to enhance emotional states in healthy subjects and may find applications in clinical conditions associated with anxiety, stress and impaired empathy among others.

A Systematic Review and Meta-analysis of the Effects of Meditation on Empathy, Compassion, and Prosocial Behaviors

Increased attention has focused on methods to increase empathy, compassion, and pro-social behavior. Meditation practices have traditionally been used to cultivate pro-social outcomes, and recently investigations have sought to evaluate their efficacy for these outcomes. We conducted a systematic review and meta-analysis of meditation for pro-social emotions and behavior. A literature search was conducted in PubMed, MEDLINE, PsycINFO, CINAHL, Embase, and Cochrane databases (inception-April 2016) using the search terms: mindfulness, meditation, mind-body therapies, tai chi, yoga, MBSR, MBCT, empathy, compassion, love, altruism, sympathy, or kindness. Randomized controlled trials in any population were included (26 studies with 1,714 subjects). Most were conducted among healthy adults (n=11) using compassion or loving kindness meditation (n=18) over 8-12weeks (n=12) in a group format (n=17). Most control groups were wait-list or no-treatment (n=15). Outcome measures included self-reported emotions (e.g., composite scores, validated measures) and observed behavioral outcomes (e.g., helping behavior in real-world and simulated settings). Many studies showed a low risk of bias. Results demonstrated small to medium effects of meditation on self-reported (SMD = .40, p < .001) and observable outcomes (SMD = .45, p < .001) and suggest psychosocial and neurophysiological mechanisms of action. Subgroup analyses also supported small to medium effects of meditation even when compared to active control groups. Clinicians and meditation teachers should be aware that meditation can improve positive pro-social emotions and behaviors.