Compassion and Loving-Kindness Meditation: An Overview and Prospects for the Application in Clinical Samples

The impact of compassion-based interventions on perioperative anxiety and depression: A systematic review and meta-analysis

BACKGROUND

The perioperative period can be a stressful time for many patients. Concerns for the procedure or fearing potential complications contribute to perioperative anxiety and depression, which significantly impact patient wellbeing and recovery. Understanding the psychological impact of the perioperative period can inform individualized care focused on each patient's unique stressors. Compassion-based interventions are limited but have shown benefits in non-surgical healthcare settings, and can provide support by prioritizing empathy and understanding in the perioperative period. This review evaluates the impact of compassion-based interventions on anxiety and depression among adult surgical patients.

METHODS

A systematic review of 25 randomized controlled trials was conducted with a meta-analysis of 14 studies for anxiety and 9 studies for depression that provided sufficient information.

RESULTS

The included studies tested compassion-based interventions that focused on enhanced communication, emotional support, and individualized attention from healthcare professionals. In 72 % of the studies, the interventions decreased anxiety and depression, compared to control groups. These interventions improved health-related outcomes such patient satisfaction and postoperative complications. The meta-analysis indicated a large effect of the compassion-based interventions for anxiety (g = -0.95) and depressive symptoms (g = -0.82). The findings were consistent among various surgeries and patient populations.

LIMITATIONS

Many of the included studies lacked clarity in their methods and only 14 studies provided sufficient information for the meta-analysis.

CONCLUSIONS

Given the growing evidence suggesting that compassion-based psychological interventions are feasible and applicable in the perioperative setting, their inclusion in routine care could reduce depression and anxiety around surgery and improve patient outcomes and experiences.

The Impact of Loving-Kindness Meditation on Job-Related Burnout of Nurses Working in Neonatal Intensive Care Unit: A Randomized Clinical Trial Study

Job-related burnout is one health outcome in nurses working in neonatal intensive care units (NICUs) due to the heavy workload, which results in negative physical and psychological consequences. One newly introduced approach to improve coping is loving-kindness meditation (LKM). Some studies have shown the effectiveness of the LKM on the mental health of nurses, though more evidence is required to support them. This study aimed to investigate the effectiveness of the LKM on job-related burnout of nurses working in NICU. This clustered controlled randomized clinical trial assessed job-related burnout before and after a month of practicing LKM guided through a virtual method. A total of 66 eligible NICU nurses from 2 referral children hospitals in Tehran were randomly assigned to 2 control (n = 33) and intervention (n = 33) groups. The intervention was performed 3 times a week for 1 month in the form of 20-minute audio files of LKM for the intervention group, and educational files on mental health during the COVID-19 pandemic were sent to the control group. The instruments used in this study were the demographic information questionnaire and the Maslach Burnout Inventory, which participants completed before and after the intervention. The mean difference in the overall scores of burnout before and after the intervention in the intervention group was significantly reduced (P = .003), but no significant difference was observed in the control group (P = .018). These findings support the benefit of LKM in NICU nurses in reducing burnout.

Feasibility of a Telephone-Delivered Group Meditation Intervention for Chronically Ill Socially Isolated Older Adults

OBJECTIVES

This pilot study assessed the feasibility of a group-based telephone-delivered meditation intervention to reduce social isolation in older adults. It included weekly training sessions and daily practices of loving-kindness meditation in small groups via telephone conferences for six weeks and an extended group meditation practice for another six weeks.

METHODS

Community-living older adults (age 60+) with multiple chronic conditions and experiencing social isolation were recruited. Each participant was assessed at the pretest, posttest, and follow-up (6 and 12 weeks after pretest). Outcome measures included social interaction, loneliness, and depressive symptoms. Open-ended questions were asked in the posttest and follow-up.

RESULTS

Sixteen individuals enrolled, and fourteen completed the program (87.5% retention). Completers showed high levels of adherence (95% attendance to training) and acceptability and a statistically significant increase in social interaction at follow-up. Qualitative data suggest that participants experienced changes in emotion regulation, motivation and confidence, and sense of belonging.

CONCLUSIONS

A group-based telephone-delivered meditation intervention targeting chronically ill older adults who experience social isolation is technically feasible, very acceptable, and potentially beneficial to them.

CLINICAL IMPLICATIONS

Older adults enjoy learning meditation. Telephone conferencing is a low-cost tool for engaging socially isolated older adults in social interactions and group meditation.

Exploring the impact of compassion and leadership on patient safety and quality in healthcare systems: a narrative review

BACKGROUND

Patient safety and healthcare quality are considered integral parts of the healthcare system that are driven by a dynamic combination of human and non-human factors. This review article provides an insight into the two major human factors that impact patient safety and quality including compassion and leadership. It also discusses how compassion is different from empathy and explores the impact of both compassion and leadership on patient safety and healthcare quality. In addition, this review also provides strategies for the improvement of patient safety and healthcare quality through compassion and effective leadership.

METHODS

This narrative review explores the existing literature on compassion and leadership and their combined impact on patient safety and healthcare quality. The literature for this purpose was gathered from published research articles, reports, recommendations and guidelines.

RESULTS

The findings from the literature suggest that both compassion and transformational leadership can create a positive culture where healthcare professionals (HCPs) prioritise patient safety and quality. Leaders who exhibit compassion are more likely to inspire their teams to deliver patient-centred care and focus on error prevention.

CONCLUSION

Compassion can become an antidote for the burnout of HCPs. Compassion is a behaviour that is not only inherited but can also be learnt. Both compassionate care and transformational leadership improve organisational culture, patient experience, patient engagement, outcomes and overall healthcare excellence. We propose that transformational leadership that reinforces compassion remarkably improves patient safety, patient engagement and quality.

Self-Compassion and Self-Forgiveness in Alcohol Risk, Treatment and Recovery: A Systematic Review

INTRODUCTION

Self-compassion and self-forgiveness are two self-focused, positive coping approaches that may reduce risk of problem drinking and/or aid in treatment/recovery from alcohol use disorder. The present systematic review aimed to evaluate support for the unique and complementary roles of self-compassion and self-forgiveness in alcohol outcomes.

METHODS

A systematic literature search yielded 18 studies examining self-compassion, 18 studies examining self-forgiveness and 1 study examining both constructs in alcohol outcomes.

RESULTS

Findings suggest greater self-compassion and self-forgiveness relate to lower likelihood of problem drinking. Self-forgiveness was considerably more researched in treatment/recovery outcomes than self-compassion; self-forgiveness-based interventions appear able to improve drinking-adjacent outcomes, and self-forgiveness may increase across various alcohol treatments. Finally, research suggests that associations of self-compassion and/or self-forgiveness with alcohol outcomes could be driven by numerous factors, including coping-motivated drinking, depression, psychache, social support perceptions, mental health status and/or psychiatric distress.

CONCLUSIONS

Self-compassion and self-forgiveness both appear protective against harmful alcohol outcomes. Nevertheless, many questions remain about the role of self-forgiveness and, particularly, self-compassion in alcohol treatment and recovery outcomes. Future research should examine whether targeted interventions and/or adjunctive therapeutic supports designed to increase self-compassion or self-forgiveness can reduce alcohol use disorder symptoms to facilitate alcohol treatment and recovery success.

Longitudinal associations between psychedelic use and meditation practices in the United States and the United Kingdom

BACKGROUND

Previous research has proposed that there may be potential synergies between psychedelic and meditation interventions, but there are still knowledge gaps that merit further investigation.

METHODS

Using a longitudinal observational research design with samples representative of the US and UK adult population with regard to sex, age, and ethnicity (N = 9732), we investigated potential associations between self-reported psychedelic use and meditation practice.

RESULTS

The follow-up survey was completed by 7667 respondents (79% retention rate), with 100 respondents reporting psychedelic use during the 2-month study period (1.3% of follow-up respondents). In covariate-adjusted regression models, psychedelic use during the study period was associated with greater increases in the number of days of mindfulness meditation practice in the past week (B = 0.40, p = 0.004). Among those who reported psychedelic use during the study period, covariate-adjusted regression models revealed that the subjective experience of insight during respondents' most intense psychedelic experience in that period was also associated with greater increases in the number of days of mindfulness and loving-kindness or compassion meditation practice in the past week (B = 0.42, p = 0.021; B = 0.38, p = 0.017). Notably, more days of loving-kindness or compassion meditation practice in the past week at baseline was associated with less severe subjective feelings of death or dying during respondents' most intense psychedelic experience in the study period (B = -0.29, p = 0.037).

CONCLUSIONS

Psychedelic use might lead to greater engagement with meditation practices such as mindfulness meditation, while meditation practices such as loving-kindness or compassion medication might buffer against certain challenging experiences associated with psychedelic use.

Compassionomics: The Science and Practice of Caring

PURPOSE

To summarize the scientific evidence that compassion can measurably improve patient outcomes, health care quality and safety, and the well-being of health care providers, and to consider specific strategies for cultivating compassion and better communicating it to patients.

DESIGN

Perspective.

METHODS

We selectively reviewed the literature on compassion in health care, including obstacles to its expression and the demonstrated effects of provider compassion on patient outcomes, health care quality and cost, and provider well-being. We also review evidence regarding the trainability of compassion, discuss proven methods for cultivating individual compassion, and recommend strategies for incorporating it into routine medical practice.

RESULTS

Compassion is the emotional response to another's pain or suffering, accompanied by a desire to alleviate it. Review of the literature shows that compassionate health care measurably improves physical and psychological patient outcomes, increases patient adherence, improves health care quality and safety, increases financial margins, and prevents physician burnout. Psychophysiological research shows that empathy and compassion can be actively cultivated through intentional practice. Validated models of compassion-based interactions can facilitate the consistent expression of compassion in daily medical practice.

CONCLUSIONS

Given its many proven benefits to patients, health care organizations, and providers, compassion should be cultivated by health care providers and systems and considered an essential component of optimal medical care.

Loving-kindness and compassion meditations in the workplace: A meta-analysis and future prospects

Loving-kindness and compassion meditation (LKCM) have been well applied among employees to improve their health and well-being. Existing studies on LKCM have also provided supportive evidence of its benefits and effectiveness under organizational contexts. The current meta-analytical study aimed to systematically summarise the effects of LKCM in the workplace and to outline directions for future research and practice. Among 327 empirical studies on LKCM published until March 2022, 21 trials focussed on employees and provided sufficient information, which were included in the following meta-analysis. The results showed that LKCM benefited eight categories of workplace outcomes. Specifically, LKCM effectively decreased employees' burnout (g = 0.395, k = 10) and stress (g = 0.544, k = 10) and facilitated their mindfulness (g = 0.558, k = 14), self-compassion (g = 0.646, k = 12), personal mental health (g = 0.308, k = 13), job attitudes (g = 0.283, k = 4), interpersonal relationships (g = 0.381, k = 12), and psychological resources (g = 0.406, k = 6). The results of moderation analyses further indicated that the participants' job type, gender, and the focus of LKCM might differentially fluctuate the magnitude of LKCM effects. To advance research and best practice, we finally pointed out several issues that deserve attention, such as long-term effects, underlying mechanisms, potential moderators, and outcomes or influential factors at the organizational level.

Implications for a mindfulness-enhanced positive affect induction: A brief commentary toward acute pain management

Over the past decade research has increased on dynamics between mindfulness, positive affect, and pain. While there have been studies examining the direct use of positive psychology for pain management, few have examined the use of a specific mindfulness-enhanced positive affect induction (i.e. a singular brief technique engendering mindfulness and strong positive affect) toward acute pain and pain flare management. This topical commentary discusses the need for such a technique toward bolstered gold-standard interventions, related studies, and possible future directions for acute and post-surgical pain management. Future research is encouraged to build from prior research on loving-kindness meditation and examine novel, brief mindfulness-enhanced positive affect inductions for acute pain management.

The effects of short video app-guided loving-kindness meditation on college students' mindfulness, self-compassion, positive psychological capital, and suicide ideation

OBJECTIVE

The study investigated the effects of a short video app guided loving-kindness meditation (LKM) on college students' mindfulness, self-compassion, positive psychological capital, and suicide ideation. The purpose of the study is to investigate the intervention effect of LKM training on suicidal ideation among college students with the help of the short video application and to provide an empirical basis for the exploration of early suicide intervention strategies for college students.

METHODS

We recruited 80 college students from a university in China. The final 74 eligible participants were divided into two groups: app use group (n = 37) and the control group (n = 37). The app group accepted an 8-week app use interference, while the control group underwent no interference. We measured four major variable factors (mindfulness, self-compassion, positive psychological capital, and suicide ideation) before and after the app use intervention.

RESULTS

In the app group, self-compassion and positive psychological capital were significantly higher, and suicide ideation was significantly lower than the control group. In the control group, there were no noticeable differences in any of the four variables between the pre-test and post-test.

CONCLUSIONS

Our findings demonstrate that the short video app guided LKM may help to improve self-compassion, and positive psychological capital, and reduce suicide ideation. The finding of the short video app-guided LKM's effect extends our understanding of the integrative effects of positive psychology and digital media on the reduction of suicide ideation.

Outcome Expectancies, Effects, and Mechanisms of Brief Training in Mindfulness Meditation vs. Loving-Kindness Meditation vs a Control Condition for Pain Management: A Randomized Pilot Study

This study investigated the analgesic effects of a single session of mindfulness meditation (MM) and loving-kindness meditation (LKM) relative to a control. A total of 100 adults with chronic or current problematic pain completed a survey and were randomized to a 20-minute MM, LKM, or audiobook control. Co-primary outcomes of pain intensity and unpleasantness and mediators of mindfulness and self-compassion were assessed pre- and posttraining. Expectancies were assessed pretraining. Pain type (chronic vs current problematic) was a covariate. Relative to the control, higher expectancies were reported for MM and LKM (P < .001). MM (d = 0.41, P = .032) and LKM (d = 0.38, P = .027) had medium effects on pain intensity, with greater decreases than control (d = 0.05, P = .768). All conditions had small effects on unpleasantness. Mindful observing increased more within MM (d = 0.52, P = .022) and the control (d = 0.50, P = .011) than LKM (d = 0.12, P = .50); self-compassion increased more in LKM (d = 0.36, P = .042) than MM (d = 0.27, P = .201) and the control (d = 0.22, P = .249). The mediation models were nonsignificant. Pain type was a nonsignificant covariate. Overall, MM and LKM were associated with positive expectancies and small-medium pain intensity reductions, which did not differ by pain type. Although MM and LKM were associated with changes in theorized mediators, these changes did not underlie improvement.

Meditation Quality Matters: Effects of Loving-Kindness and Compassion Meditations on Subjective Well-being are Associated with Meditation Quality

Loving-kindness and compassion meditations (LKCM) are considered a promising practice for increasing long-term well-being. While previous studies have mainly focused on meditation practice quantity, the current study provides an initial exploration of the quality of meditation during multiweek LKCM training. Data were collected through offline (Study 1; N = 41) and online (Study 2; N = 243) LKCM interventions. Quality of meditation was measured using two kinds of difficulties experienced during LKCM each week/unit (i.e., difficulty in concentration and difficulty in generating prosocial attitudes). Subjective well-being (SWB) was assessed by life satisfaction before and after training as well as positive and negative emotions each week/unit. Two studies consistently suggested that meditation quality was significantly associated with changes in SWB. Study 1 even showed that quality had a stronger association with SWB than did meditation quantity. Moreover, both short-term (measured each week/unit) and long-term (measured across the entire training period) associations between the quality of meditation and SWB were significant. Focusing on meditation quality, our findings provide theoretical and methodological pathways for understanding the contribution of meditation practice to LKCM training, which is helpful for guiding future research and best practices.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10902-022-00582-7.

The effects of loving-kindness and compassion meditation on life satisfaction: A systematic review and meta-analysis

Loving-kindness and compassion meditation (LKCM) was a promising intervention for improving life satisfaction, but previous findings have been inconsistent. The current study provides a systematic review and meta-analysis, including 23 empirical studies on LKCM with life satisfaction as an outcome variable. The primary meta-analysis indicated that LKCM significantly enhanced life satisfaction in pre-post design (g = 0.312, k = 15, n = 451), but the significance disappeared in the additional meta-analysis based on randomized controlled trials (g = 0.106, k = 6, n = 404). Moderator analyses found significant effects for type of control (i.e., the effects of LKCM were inferior to active control group, but superior to waitlist condition), but not for other moderators (i.e., participant type, previous meditation experience, specific protocol, components of LKCM, combination with mindfulness mediation, and intervention length). Narrative review identified self-compassion and positive emotions as important mediators. The practice time of LKCM had indirect but not direct association with life satisfaction. The findings supported that LKCM is promising in increasing life satisfaction, but more studies are needed to investigate the effects with more rigorous designs. Future studies should investigate other potential mechanisms and clarify whether LKCM change the reality or the perception of life.

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.

The protective effect of mindfulness and compassion meditation practices on ageing: Hypotheses, models and experimental implementation

Alzheimer's disease (AD) represents a major health and societal issue; there is no treatment to date and the pathophysiological mechanisms underlying this disease are not well understood. Yet, there is hope that AD risk factors and thus the number of AD cases can be significantly reduced by prevention measures based on lifestyle modifications as targeted by non-pharmacological preventive interventions. So far, these interventions have rarely targeted the psycho-affective risk factors related to depression, stress, anxiety, and feeling of loneliness, which are all prevalent in ageing. This paper presents the hypothesis that the regular practice of mindfulness meditation (MM) and loving-kindness and compassion meditation (LKCM) in the ageing population constitutes a lifestyle that is protective against AD. In this model, these practices can promote cognition, mental health, and well-being by strengthening attention control, metacognitive monitoring, emotion regulation and pro-social capacities. Training these capacities could reduce the risk of AD by upregulating beneficial age-related factors such as cognitive reserve, and down-regulating detrimental age-related factors, such as stress, or depression. As an illustration, we present the Medit-Ageing study (public name Silver Santé Study), an on-going European project that assesses the impact and mechanisms of non-pharmacological interventions including meditation, in the ageing population.

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

BACKGROUND

Promoting psychological well-being and preventing distress among pregnant women is an important public health goal. In addition to adversely impacting the mother's health and well-being, psychological distress in pregnancy increases the risk of poor pregnancy outcomes, compromises infant socioemotional development and bonding, and heightens maternal and child vulnerability in the postpartum period. Mindfulness and compassion-based interventions show potential for prevention and early intervention for perinatal distress. As there is an established need for accessible, scalable, flexible, and low-cost interventions, there is increased interest in the delivery of these programs on the web. This project aims to pilot a three-arm randomized controlled trial (RCT) to determine the feasibility of a full-scale RCT comparing 2 web-based interventions (mindfulness vs loving-kindness and compassion) with a web-based active control condition (progressive muscle relaxation).

OBJECTIVE

The primary objective of this study is to assess the feasibility of an RCT protocol comparing the 3 conditions delivered on the web as a series of instructional materials and brief daily practices over a course of 8 weeks. The second objective is to explore the experiences of women in the different intervention conditions. The third objective is to estimate SD values for the outcome measures to inform the design of an adequately powered trial to determine the comparative efficacy of the different conditions.

METHODS

Pregnant women (n=75) participating in a longitudinal birth cohort study (the ORIGINS project) will be recruited to this study from 18 weeks of gestational age. We will assess the acceptability and feasibility of recruitment and retention strategies and the participants' engagement and adherence to the interventions. We will also assess the experiences of women in each of the 3 intervention conditions by measuring weekly changes in their well-being and engagement with the program and by conducting a qualitative analysis of postprogram interviews.

RESULTS

This project was funded in September 2019 and received ethics approval on July 8, 2020. Enrollment to the study will commence in September 2020. Feasibility of a full-scale RCT will be assessed using ADePT (a process for decision making after pilot and feasibility trials) criteria.

CONCLUSIONS

If the study is shown to be feasible, results will be used to inform future full-scale RCTs. Evidence for flexible, scalable, and low-cost interventions could inform population health strategies to promote well-being and reduce psychological distress among pregnant women.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry Number 12620000672954p; http://anzctr.org.au/ACTRN12620000672954p.aspx.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/19803.

The Effect of Loving-Kindness Meditation on Flight Attendants' Spirituality, Mindfulness and Subjective Well-Being

Background: This study investigated: (1) the effects of the loving-kindness meditation (LKM) on mindfulness, subjective well-being (SWB), and spirituality and (2) the relationships between mindfulness, spirituality, and SWB. Methods: 98 flight attendants from Xiamen Airlines in China were recruited and randomly assigned to the LKM training group (n = 49) or the waiting control group (n = 49). The LKM training group underwent an 8-week LKM training intervention, and the control group did not undergo intervention. The three main variables (SWB, mindfulness, and spirituality) were measured both before (pre-test) and after (post-test) the LKM training intervention. Results: In the experimental group, SWB and spirituality increased significantly. In the control group, no significant differences were observed for the three variables between the pre-test and post-test. Conclusions: Our results indicated that LKM may help to improve SWB and spirituality. However, the mechanisms which underlie the effects of the LKM on mindfulness, spirituality, SWB, and other psychological constructs require further elucidation.

Cost-Utility of Attachment-Based Compassion Therapy (ABCT) for Fibromyalgia Compared to Relaxation: A Pilot Randomized Controlled Trial

A recent study has supported the efficacy of Attachment-Based Compassion Therapy (ABCT) compared to relaxation (REL) for the management of fibromyalgia (FM). The main objective of this paper is to examine the cost-utility of ABCT compared to REL in terms of effects on quality-adjusted life years (QALYs) as well as healthcare costs. Forty-two Spanish patients with FM received 8 weekly group sessions of ABCT or REL. Data collection took place at pre- and 3-month follow-up. Cost-utility of the two treatment groups (ABCT vs. REL) was compared by examining treatment outcomes in terms of QALYs (obtained with the EQ-5D-3L) and healthcare costs (data about service use obtained with the Client Service Receipt Inventory). Data analyses were computed from a completers, ITT, and per protocol approach. Data analysis from the healthcare perspective revealed that those patients receiving ABCT exhibited larger improvements in quality of life than those doing relaxation, while being less costly 3 months after their 8-week treatment program had ended (completers: incremental cost M, 95% CI = €−194.1 (−450.3 to 356.1); incremental effect M, 95% CI = 0.023 QALYs (0.010 to 0.141)). Results were similar using an ITT approach (incremental cost M, 95% CI = €−256.3 (−447.4 to −65.3); incremental effect M, 95% CI = 0.021 QALYs (0.009 to 0.033)). A similar pattern of results were obtained from the per protocol approach. This RCT has contributed to the evidence base of compassion-based interventions and provided useful information about the cost-utility of ABCT for FM patients when compared to relaxation. However, the small sample size and short follow-up period limited the generalizability of the findings.

Ehrfurcht/Dankbarkeit als säkulare Form der Spiritualität bei jungen Erwachsenen und Ordens-Christen

Wenn das Interesse an der institutionalisierten Religiosität scheinbar abnimmt, hat dann Ehrfurcht/Dankbarkeit als eher säkulare und individuelle Form einer wahrnehmenden anstatt kognitiv geprägten Spiritualität eine Bedeutung auch für junge Erwachsene? Wie ist dieser Aspekt von Spiritualität bei jungen Erwachsenen und Ordens-Christen (als Kontrast-Gruppe) ausgeprägt? Um diesen Fragen nachzugehen, wurden 1.622 Personen (60 % Frauen, 40 % Männer) aus unterschiedlichen Alters- und Rekrutierungsgruppen mit dem standardisierten Fragebogen zur Erfassung von Ehrfurcht/Dankbarkeit (GrAw-7) untersucht. Es zeigte sich, dass Gefühle staunender Ehrfurcht und daraus resultierende Dankbarkeit von allen hier untersuchten Personen- und Altersgruppen erlebt werden, jedoch in divergenter Ausprägung, wobei die älteren Ordens-Christen die höchsten Scores hatten und die jungen Erwachsenen die niedrigsten. Auch von Personen ohne Religionszugehörigkeit (bzw. solchen, die gemäß Selbsteinschätzung weder religiös noch spirituell sind) wurde Ehrfurcht/Dankbarkeit empfunden, jedoch signifikant geringer als von Personen mit Religionszugehörigkeit (bzw. mit einer Selbsteinschätzung, spirituell und/oder religiös zu sein). Diese perzeptive Form der Spiritualität kann als Achtsamkeit dem Augenblick gegenüber aufgefasst werden, für die sensibilisiert werden kann. Sie bedarf keiner spezifischen religiösen Ausrichtung oder Weltanschauung und könnte eine gesellschaftlich und individuell relevante Ressource gerade in säkular geprägten Gesellschaften darstellen.

The effect of four Immeasurables meditations on depressive symptoms: A systematic review and meta-analysis

The Four Immeasurables Meditations (FIM) intervention have been shown as a promising intervention for reducing depressive symptoms. The current study is a systematic review of FIM intervention effects on depressive symptoms. Among 192 empirical research articles on FIM published before May 2019, 40 independent trials from 35 records measured depressive symptoms. The meta-analysis included 21 randomized controlled trials (RCT; n = 1468) and 16 uncontrolled trials (n = 376). The results supported overall effectiveness of FIM on depressive symptoms (d = 0.38 for RCT and d = 0.87 for uncontrolled trials). Moderator analysis indicated the effects differed across protocols, and effects were smaller in RCT using active control groups. No significant differences were observed for participant type, measures, intervention length, or intervention components. Individual studies found no direct association between meditation practice time and effects, and mindfulness and self-compassion were widely supported as mechanisms of change. Current evidence supports FIM as an effective intervention for reducing depressive symptoms, but additional studies with more rigorous designs using active control groups are needed. Further investigation should be encouraged regarding specific protocols and participants, the contribution of meditation practice, and other mechanisms such as positive emotions.

Metta-based group meditation and individual cognitive behavioral therapy (MeCBT) for chronic depression: study protocol for a randomized controlled trial

BACKGROUND

Depression is a widespread disorder with severe impacts for individuals and society, especially in its chronic form. Current treatment approaches for persistent depression have focused primarily on reducing negative affect and have paid little attention to promoting positive affect. Previous studies have shown that metta meditation increases positive affect in chronically depressed patients. Results from previous trials provide evidence for the efficacy of a stand-alone metta meditation group treatment in combination with mindfulness-based approaches. Further research is needed to better understand the implementation of meditation practice into everyday life. Therefore, mindfulness and metta meditation in a group setting are combined with individual cognitive behavioral therapy (CBT) into a new, low-intensity, cost-effective treatment ("MeCBT") for chronic depression.

METHODS/DESIGN

In this single-center, randomized, observer-blinded, parallel-group clinical trial we will test the efficacy of MeCBT in reducing depression compared to a wait-list control condition. Forty-eight participants in a balanced design will be allocated randomly to a treatment group or a wait-list control group. Metta-based group meditation will be offered in eight weekly sessions and one additional half-day retreat. Subsequent individual CBT will be conducted in eight fortnightly sessions. Outcome measures will be assessed at four time points: before intervention (T0); after group meditation (T1); after individual CBT (T2); and, in the treated group only, at 6-month follow-up (T3). Changes in depressive symptoms (clinician rating), assessed with the Quick Inventory of Depressive Symptoms (QIDS-C) are the primary outcome. We expect a significant decline of depressive symptoms at T2 compared to the wait-list control group. Secondary outcome measures include self-rated depression, mindfulness, benevolence, rumination, emotion regulation, social connectedness, social functioning, as well as behavioral and cognitive avoidance. We will explore changes at T1 and T2 in all these secondary outcome variables.

DISCUSSION

To our knowledge this is the first study to combine a group program focusing on Metta meditation with state-of-the art individual CBT specifically tailored to chronic depression. Implications for further refinement and examination of the treatment program are discussed.

TRIAL REGISTRATION

ISRCTN, ISRCTN97264476. Registered 29 March 2018 (applied on 14 December 2017)-retrospectively registered.

Changes in Empathy Mediate the Effects of Cognitive-Behavioral Group Therapy but Not Mindfulness-Based Stress Reduction for Social Anxiety Disorder

Social anxiety disorder (SAD) has been shown to be associated with difficulty in the ability to vicariously share others' positive emotions (positive affective empathy). Mixed evidence also suggests potentially impaired recognition of the positive and negative emotions of others (cognitive empathy) and impaired or enhanced sharing of the negative emotions of others (negative affective empathy). Therefore, we examined whether two efficacious treatments for SAD, cognitive-behavioral group therapy (CBGT) and mindfulness-based stress reduction (MBSR), improve empathy in SAD relative to a wait-list condition and whether improvements in empathy mediate improvements in social anxiety. In the context of a randomized controlled trial, participants with SAD completed an empathy task at baseline, posttreatment/wait-list (N = 81), and 1-year follow-up (N = 37). Relative to both MBSR and wait-list, CBGT resulted in significant improvements in positive affective empathy. CBGT-related changes in positive affective empathy also mediated improvements in social anxiety at both posttreatment/wait-list and at 1-year follow-up. Other indices of empathy did not change differentially across the three conditions. Therefore, one way in which CBGT may specifically confer benefits to individuals with SAD is through increasing their ability or willingness to share in the positive emotions of others.

Meditation techniques v. relaxation therapies when treating anxiety: a meta-analytic review

To what extent meditation techniques (which incorporate practices to regulate attention, construct individual values, or deconstruct self-related assumptions), are more or less effective than relaxation therapy in the treatment of anxiety, is not clear. The aim of this study was to examine the effectiveness of meditation compared to relaxation in reducing anxiety. A systematic review from PubMed, Embase, PsycInfo and the Cochrane Central was conducted. A meta-analysis of 14 RCTs (n = 862 participants suffering from anxiety disorders or high trait anxiety) was performed. Effect sizes (ESs) were determined by Hedges' g. Heterogeneity, risk of publication bias, quality of studies/interventions, and researcher allegiance, were evaluated. Meditation techniques incorporated attentional elements, and five of them also added constructive practices. No studies were found using deconstructive exercises. The overall ES was g = -0.23 [95% confidence interval (CI) -0.40 to -0.07], favouring meditation (number needed to treat = 7.74). Heterogeneity was low (I2 = 2; 95% CI 0 to 56). There was no evidence of publication bias, but few studies and interventions were of high quality, and allegiance might be moderating results. Meditation seems to be a bit more effective than relaxation in the treatment of anxiety, and it might also remain more effective at 12-month follow-up. However, more research using the full spectrum of meditation practices to treat different anxiety disorders, including independent studies to avoid researcher allegiance, is needed if we are to have a precise idea of the potential of these techniques compared to relaxation 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.

Solicitous and invalidating responses are associated with health-care visits in fibromyalgia

Objectives

Health-care use in FM is substantial. Besides the severity of the disease and psychological factors, previous research suggests that the social environment can influence patients’ health-care use. In this study, we describe health-care use in patients with FM and investigate the relationship of social responses of the partner and family with health-care use.

Methods

Cross-sectional data of 280 patients with FM were analysed. Sociodemographic variables, health-status variables, health-care use, partner’s solicitous and punishing responses, and invalidation (i.e. discounting and lack of understanding) by family were assessed. Heath-care use was defined as the number of visits to physicians and health professionals. Associations of independent variables with health-care use were examined using univariate and hierarchical regression analyses.

Results

In the preceding 6 months, 99% of the patients visited at least one physician and 66% visited at least one health professional. The mean (s.d.) total health-care visits and the number of different disciplines consulted were 18.5 (17.7) and 3.6 (1.7), respectively. Being female, paid employment, having a co-morbid condition, a higher severity of FM, more partner’s solicitous responses and more invalidating responses by family were univariately associated with visits to a physician. Having a co-morbid condition, severity of FM and invalidation by family were uniquely associated with visits to a physician. No other associations were found.

Conclusion

Therapeutic attention to patients’ close social environment might be a useful approach to improve health-related outcomes, including health-care use, in patients with FM.