Motivation and emotion/Book/2020/Compassion training

Overview
"True compassion means not only feeling another's pain but also being moved to help relieve it." - Daniel Goleman



As Goleman explains in his 2007 TED talk, individuals are neurologically wired to mimic the neural state of what they view someone else to be in. It is an automatic way of putting yourself in the shoes of another and imagining what they might be thinking and feeling. Through this "neuro-wifi", individuals are – therefore – capable to feel for others and become automatically prepared to help. Yet, why don't we? Why do we help in some situations but not in others?

As a relatively new field, research is far from fully answering these questions. Compassion has been a point of interest over recent time and we have only begun to study it in detail. In this chapter, available research is presented as we consider the role of compassion and how it can be developed through training. The process of restorative justice is briefly discussed as a display of compassionate thinking in the real world and limitations of compassion training studies are outlined. Focus questions:
 * What is compassion?
 * What is the role of compassion?
 * How can compassion be developed through training?

Defining compassion
The most accepted definition of compassion is the feeling that arises upon seeing someone suffer and which, subsequently, brings about a desire to help (Goetz et al., 2010). In particular, Jazaieri et al. (2013) outline four stages of compassion:


 * 1) An awareness of how another person is feeling (cognitive component)
 * 2) An emotional response – often concern – for others (affective component)
 * 3) A wish to relieve the suffering of a person (intentional component), and
 * 4) A drive to relieve suffering (motivational or behavioural component)

There is also self-compassion – the understanding and kindness towards one's own self during times of pain and misfortune (Neff et al., 2007). Compared to compassion for others, this type of compassion focuses more on a mindful awareness of negative experiences and how to deal with the thoughts and feelings associated with them in a non-detrimental manner.

Compassion, empathy, and sympathy are often studied together because of the striking similarities across all three dimensions. However, it has been conceptually clarified that the three are actually distinct from one another (Jeffrey, 2016).

Perhaps compassion and empathy are most interchangeably used, both in everyday life and in psychological literature. Empathy mainly involves an awareness of the feelings of others and sharing those feelings (Jeffrey, 2016). In contrast, compassion goes beyond sharing in the negative feelings of another, and instead focuses on feelings of warmth, care, and concern for others. Thus, unlike empathy, "compassion is feeling for and not feeling with the other" (Singer & Klimecki, 2014, p. 1).

Sympathy does not differ in its ability to recognise the feelings of others. Though upon recognising how the other is feeling, sympathy leads more into feeling sorry or feelings of pity towards this person (Jeffrey, 2016). Sympathy is more heavily associated with a selfish motivation, whereby any action taken towards the suffering person is in order to decrease the emotional strain from feeling pity.

As can be seen, the differences between compassion, empathy, and sympathy are subtle. Some authors consider empathy to be a skilled response, sympathy and compassion as reactive responses, and compassion holding a more reactive force that drives a behaviour or action (Jeffrey, 2016; Singer & Klimecki, 2014). Others regard compassion as a skill on its own, which therefore means it can be trained and practiced (Gilbert, 2009). We may consider placing empathic or sympathetic states under the umbrella term of compassion, working cohesively and interdependently to relieve a part of someone’s suffering (Goetz et al., 2010).

Role of compassion
Why is compassion a good thing? Why is it important to train compassion?

Weng et al. (2015) recognised that to cultivate an increasingly interconnected world, there is a need to behave altruistically and cooperatively. In other words, people need to be kind to one another and hone compassion so that they are motivated to relieve the suffering of others. Compassion training is a major contribution to greater altruistic behaviour. This hope, to create a kinder, more prosocial society, underlies the aims and goals of compassion training.

Some professions require a certain level of compassion competence. For example, Lee and Seomun (2016) found that among nurses' professional quality of lives, compassion competence increased work satisfaction and prevented burnout. Conversely, dementia caregivers who were highly compassionate reported more intrusive thoughts and thus, negative affect, towards the suffering of their patient (Schulz et al., 2016). Compassion can elicit numerous effects in different situations, but compassion fatigue can be a problem in occupations that involve compassionate thinking and high emotional workload (Sinclair et al., 2016). Hence, there is an importance for compassion in patient-practitioner relationships.

Self-compassion is just as important as the compassion you share with others. Neff and colleagues (2007) found that higher self-compassion reduces self-judgement anxiety because individuals have a more understanding view that humans are naturally imperfect. In turn, this decreased the pressure for participants who had to describe a personal weakness in a mock interview study. Moreover, increased self-compassion lead to a more positive psychological well-being through reports of decreased self-criticism, depression, and anxiety (Neff et al., 2007). This kindness to oneself and the ability to limit harsh self-judgement can be cultivated through compassion training.

Types of compassion training
Individually and socially, compassion plays a significant role in psychological well-being. The main section of this chapter explores how compassion can be trained through six techniques that have been empirically supported. Buddhism holds a long tradition of compassion teachings and a large amount of compassion-focused interventions derive from this tradition (Gilbert, 2009).

 Consider this scenario. Bob scores badly on an important paper and it becomes tempting for him to fall into despair. He feels ashamed and starts to think negative thoughts such as that he is incompetent, a ‘good-for-nothing’, and so on. Could compassion training help Bob?

As you read about the different types of compassion training, try and apply them to Bob's scenario.

Cognitive-based compassion training
Cognitive-based compassion training includes mindfulness and cognitive-restructuring skill development to limit the negative experiences of suffering and to cultivate a more understanding way of thinking (Kirby, 2016).

Cognitive-based compassion training (CBCT) training modules provide for skill acquisition in attentional control, insights into sensations, thoughts and feelings, self-compassion, gratitude, empathy, empathic concern, and engaged compassion (Ash et al., 2019). Meditative techniques, such as breathing exercises, are taught as the foundation to stabilise the mind and focus attention towards a particular task or feeling.

A six-week CBCT intervention was employed with an at-risk adolescent sample (Reddy et al., 2013). Psychosocial measures found no significant change pre- and post-intervention. However, compared to a wait-list group, the intervention participants evaluated the program positively and found themselves using the strategies learnt to deal with stress and anger, and remembered to act compassionately. Furthermore, the participants reported learning about perspective-taking, non-judgement, and compassion – which they felt they have more conscious awareness of after CBCT.

Gilbert (2009) introduced compassion-focused therapy (CFT) as a way of applying a compassion model to a therapeutic setting. Compassionate mind training (CMT) is at the core of CFT and refers to the activities used in therapy that aim to develop compassionate skills and attributes. Some key skills involve compassionate thinking and imagery to help clients generate feelings of compassion for the self and others, compassionate reasoning, and practising compassionate behaviour (Gilbert, 2009; Leaviss & Uttley, 2015). CFT often includes journaling as clients are encouraged to really focus, understand, and feel compassion – particularly during negative thought processes – and to reflect on this later on.

A pilot study by Gilbert and Procter (2006) found that participants with chronic difficulties showed significant decreases on self-criticism and shame following 12 two-hour CMT sessions. Participants also learnt behaviours in self-soothing and reassurance for the self. The human warmth system is related to care and affection, so the idea is to activate it while engaging in CFT to combat negative thinking and hone self-compassion.

Meditation-based compassion training


This section considers interventions that are most influenced by Buddhism and its teachings of mindfulness and compassion. The purpose of meditation-based training is to enhance positive emotional affect, reduce negative feelings, and increase kindness and compassion (Hofmann et al., 2011). The concept of "mindfulness" is taught as an awareness of one’s painful experiences and accepting a balanced view towards these experiences (Neff & Germer, 2012).

For instance, mindful self-compassion (MSC) emphasises developing an inner compassionate voice (Kirby, 2016). It teaches basic mindfulness skills in formal (sitting meditation) and informal (during everyday life) settings to nurture self-compassion. Given that mindfulness precedes self-compassion, as well as constituting an integral part of it, MSC studies have found that developing mindfulness improves psychological well-being and compassionate selves (Neff & Germer, 2012).

MSC is particularly beneficial as an intervention for intimate partner abuse survivors (Tesh et al., 2015). Victims are often plagued with self-blame, shameful feelings, post-traumatic symptoms, and suicidal thoughts. One advantage of MSC is that it can be adapted to suit the client and other treatments, which is useful since survivors may be at different stages of recovery. Not only did MSC create a supportive and nurturing environment between practitioners and survivors, but survivors were also given a medium where they can replace negative emotional responses with self-kindness, resilience, and self-loving.

A key element in meditation-based compassion training is compassion meditation (CM) and loving-kindness meditation (LKM). Traditionally they are combined and can be used as a single intervention, but are more commonly integrated in other types of compassion training, making them the most prominent techniques in compassion training to date (Hofmann et al., 2011). CM focuses on relieving one’s suffering, whereas LKM includes loving and kind concern for the well-being of others. Results showed that an increase in these positive emotions lead to increased life satisfaction and decreased depressive symptoms (Fredrickson et al., 2008). Moreover, a review found that CM and LKM caused enhanced activation of brain areas related to emotional processing and empathy, such as the insula and anterior cingulate cortex (Hofmann et al., 2011).

Compassion cultivation training
Compassion cultivation training (CCT) programs include the most overlapping blend between Buddhist practice and Western psychology (Kirby, 2016). Compared to other compassion interventions, CCT programs are the most structured as each week builds on the content from the week before. Programs are designed to support learning and communication, building understanding and practice for compassion through direct experiences over approximately two months (Goldin & Jazaieri, 2017). Active group discussions and interactive practical exercises designed to promote open-heartedness and connection to others form the bulk of each weekly session.

In a community sample, participants randomly assigned to a CCT program found significant improvements across three domains of compassion (compassion for others, compassion from others, and self-compassion) compared to a wait-list group (Jazaieri et al., 2013). Time spent on formal meditation practices was positively associated with compassion for others. These findings showcase the efficacy of CCT as a form of compassion training.

Other forms of training
Cultivating emotional balance (CEB) differs greatly from the compassion-based training programs discussed earlier. Unlike the other programs which are heavily influenced by Buddhist teachings, CEB is a secular intervention based on Western sciences (Kirby, 2016). The focus of CEB is to teach clients how to understand and recognise the emotions of others. However, these practices have the potential for compassion training by teaching clients how to recognise the suffering of self and others, and to manage emotional responses more effectively. Sansó and colleagues (2017) implemented a CEB program for professional caregivers of intellectually disabled patients. Not only did emotional regulation and psychological well-being improve, but the CEB intervention also promoted mindfulness, self-care, and self-compassion. Like other compassion training programs, reduced depressive and anxiety symptoms were demonstrated.

 Perhaps Bob can benefit from compassion training. He could learn that it is acceptable – in fact, normal – to make mistakes and that he should be more caring towards himself. He may also develop a strength to deal with such hardships the more self-compassionate he becomes. Through compassion training, Bob can learn strategies to limit negative thoughts and enhance positive emotions through self-kindness.

Restorative justice
A practical application of compassion training to real-world situations can be found in restorative justice. Restorative justice aims evoe compassion from all parties involved in a situation in which harm was caused. Marshall (1996, as cited in Daly, 2002, p. 57-58) defines restorative justice as "a process whereby all the parties with a stake in a particular offence come together to resolve collectively how to deal with the aftermath of the offence and its implications for the future". The three foundational ideas that underlie restorative justice are as follows (Centre for Justice and Reconciliation, 2020):


 * 1) Repair – the harm caused by a crime should be repaired.
 * 2) Encounter – involved parties decide how to do so through mediated discussions.
 * 3) Transformation – this may cause fundamental changes in people, relationships, and communities.

As one can imagine, the aftermath of a crime is already difficult to deal with, let alone having to meet the victim or offender as well. However, restorative justice aims to empower victims by allowing them to seek the closure that they need, be compensated for the wrong done to them, and gain some sort of apology (Braithwaite, 2006).



Restorative justice implores the compassionate self to come forth in this emotional process (Braithwaite, 2006). For victims, the compassionate self is needed to view the offender as more than just a "criminal"; people beyond their crimes. For offenders, the compassionate self can help them understand that what they did was wrong, the harm causes, and to prevent reoccurrence in the future.

So, does restorative justice work? A meta-analysis of restorative justice in juvenile offenders found promising, yet uncertain, benefits across 84 evaluations (Wilson et al., 2017). In general, there was a moderate decrease in delinquent behaviours with restorative justice practices compared to traditional juvenile programs. However, this finding lacks reliability since more credible studies found smaller results. Advantages for restorative justice youths include a greater perception of fairness and less interest in delinquency. Victims also perceived more satisfaction with restorative justice and improved attitudes towards the juvenile, and were more willing to forgive offenders.

Compassion sits at the core of restorative justice to cultivate understanding between people of two opposing sides. This method of handling conflict is currently highly debated as some may view it as "letting the offender off easy" (Braithwaite, 2006). Nevertheless, restorative justice provides a practical view of nurturing compassion and puts a system in place that can help to develop an interconnected, kind, and cooperative society.

Test your understanding
{Which type of compassion training is a secular intervention, stemming away from traditionally Buddhist practices? - Meditation-based compassion training + Cultivating emotional balance - Cognitive-based compassion training - Loving-kindness mediation - Compassion cultivating training
 * type=""}

{Which option is a display of compassion from the victim? - Refusing to communicate with the offender - Judging the offender for their crime + Being an active party to collectively resolve how to deal with the aftermath of an offence - None of the above show a compassionate victim
 * type=""}

Limitations
Given that compassion training has only started to gain prominence since the late 20th century, there are numerous factors that need to be considered to develop this field of research. Firstly, studies of each type of compassion training are fairly recent and underdeveloped. Most pilot studies show promising benefits and are generally well-accepted by all participants, but there is a potential for further testing and follow-up studies to determine long-term benefits. Also, samples tend to be relatively small and homogenous, which make it difficult to generalise the findings to other populations.

Secondly, although qualitative findings are consistently positive, quantitative results of psychosocial measures are less robust. Neuroimaging studies have been conducted, though they are sparse, so there is a need to further investigate a biological effect of compassion training and how this may help us be more compassionate.

Finally, the current available research holds a kind of ignorance towards the dark side of compassion. Like many psychological phenomena, context matters. Perhaps being compassionate is not the answer to all problems, especially if it may lead to being exploited. The controversy of restorative justice connects well with this limitation. Where should we draw the line about the need and importance of being compassionate? There are many more aspects of compassion and compassion training to consider.

Conclusion
This chapter explored how compassion can be trained. Six types of compassion training were introduced and restorative justice was discussed as a real life method of cultivating compassion. Key points are:


 * Definitions of compassion are multi-faceted. Simply put, compassion is caring and kindness towards others and the self.
 * Compassion training is heavily influenced by traditional Buddhist practices.
 * Cognitive-based compassion training involve mindfulness and cognitive-restructuring skill development.
 * Meditation-based compassion training enhances positive emotional affect, reduces negative feelings, and increases kindness and compassion.
 * Compassion cultivation training includes structured group-based activities designed to promote open-heartedness and connection to others.
 * Cultivating emotional balance is less connected to Buddhist teachings and focuses on emotion recognition and regulation. Pathways to compassion may involve recognising the suffering of self and others and managing emotional responses effectively.
 * Restorative justice seeks to bring out compassionate selves from victims and offenders.
 * Compassion training is generally effective, but future directions of research are needed to develop this topic further.