Motivation and emotion/Book/2021/Compassion

Overview
Do you ever wonder why when you see someone suffering, you have the innate compulsion to want to ease their pain? Compassion is the complex emotional construct of human evolution (Gilbert, 2019). Through the neurophysiological markers that allow us to draw physical contrasts between compassion being formed, to the act of compassion being formed within an individual’s everyday life (Kim et al., 2020). Compassion has both benefits and negatives for individuals, from enhancing social interaction to well-being (Neff, 2003), to causing a surplus and overuse of the emotion (Cavanagh et al., 2019). With the neurophysiological markers and the understanding of how compassion has evolved and the potential harms when not properly regulated, compassion training has been introduced to allow humans to inhibit a better practise and understanding of compassion.

Neurophysiological


Although there have been many debates on the actual definition of compassion (Gilbert, 2019), whether it is an emotion or a complex construct, it has been consistently shown that compassion can be shown neurologically (Kim et al., 2020). Through the first meta-analysis conducted on compassion, comprising of 16 peer reviewed articles (Kim et al., 2020), brain activation was found consistent in brain region through across multiple studies. In the meta-analysis Kim et al. used a software called GingerALE which would locate above-chance clustering of the foci between experiments, using an estimation likelihood estimation (ALE) (Laird et al., 2005). This software provided cluster size, location, and anatomic labelling. Although the software could analyse above-chance foci clustering, not all experiments were consistent in their testing measures, this caused the 16 articles to be broken up into subcategories which were then tested against one another for a more accurate reading on brain activation.

These three categories consisted of: stimulus which was considered the emotional tasks, typically isolating the effects of negative stimuli, mindset which is the tasks that were considered top-down or cultivations of compassion, and target which is classed as the affect caused by an interaction with stimuli presented (unattractive vs attractive).

ALE had found that seven regions of the brain showed consistent activation across multiple of the studies included in the meta-analysis being the Anterior Cingulate, Bilateral Inferior Frontal Gyrus, Bilateral Insula, Middle Frontal Gyrus, Medial Frontal Gyrus and Basal Ganglia/Thalamus circuitry (Engström & Söderfeldt, 2010; Kim et al.,2020; Mascaro et al., 2012).

Out of the seven regions, two were found to have the most significant activation (Kim et al. 2020). The Anterior Cingulate Cortex and the Anterior Insula. The anterior Cingulate Cortex is responsible for the important cognitive roles, such as decision making and impulse control but has also been determined to play a role in the emotion of empathy (Stevens et al., 2011). The Anterior Insula is geared more towards the breaking down of negative sensory input, this region of the brain, although considered one of the least understood areas, has shown activation during negative visual stimuli (Uddin et al., 2017). These two regions are considered integral parts of the salience network. The salience network is usually tapped into when a person experiences or observes another’s pain (Cao et al., 2017). The activation of these regions was primarily found throughout stimulus tasks, consisting mostly of the presentation of negative stimuli, but was also found through mindset tasks, through tapping into past experiences (Kim et al., 2020).

Continuing with more neurophysiological affects compassion has on the body, the parasympathetic nervous system was found to be activated during compassion training. A study conducted by Kim et al. (20202) has shown that heart rate variability (HRV) was a trait found consistent with compassionate mind training. The compassionate mind training measured HRV before the compassion training and two weeks post training. It was found that that HRV was lower in the participants that practised compassion yet was at a higher level for those that were more self-critical. Lower HRV was also related to participants that were more consistent and engaged in the self-directed task more.

Evolution and Prosocial Behaviour


Human evolution has proven the development of not only complex emotions like compassion, but also the complex social structures that emotions like compassion abide by (Gilbert, 2019). Compassion is thought to have developed from the mammalian instinct to care for offspring. For compassion to evolve throughout history, three key factors were needed to pave the way, these key factors being knowing awareness, empathetic awareness and knowing intentionally, which all comprise to make up human social intelligence (Gilbert, 2019; Gilbert, 2016). This need to care for others was often seen through the way in which mothers would interact with their infants (Gilbert, 2015). The interaction between mother and infant has shown the innate motivation expression in humans to care for their kin, as they would soothe the child as it cried, as well as provided care that is needed, despite the infant not being able to convey in words what is inherently needed (Gilbert, 2015). Although the development of compassion can be derived from the initial interactions between mother and infants, it has also been expressed through human interaction with non-kin (Gilbert, 2019; Gilbert 2015). The term compassion has been taken from the Latin term compati, which essentially means “to suffer with”. It is not surprising that the natural urge to help another individual to success, especially in a time of need has been carried over from kin to non-kin. To care and feel compassion and act on these motivations requires a certain level of social competencies, drawing back on the neurophysiological aspect of compassion, dysfunction of either the Basal Ganglia or the Thalamus has been related to difficulty both expressing and processing emotions and salient emotional cues (Kim et al., 2020). Without these competencies, people cannot accurately apply their knowledge to provide what is considered compassionate care (Gilbert, 2019). IT can be seen through history that our primates adapted over time to inhibit a higher and more precise level of care (Gilbert, 2015), as more humans were surviving broken bones, and humans were less likely to be intimidated and scared by those that were seen as distressed or deformed. The advance in the cognitive ability to better care for each other, as well as the motivational drive that was needed to develop the intelligence to understand illnesses and fight against them shows a major enhancement for compassion (Gilbert, 2019; Gilbert, 2015).



Moving on to the more social aspect of compassion. Compassion has allowed caring to surpass the initial taking care of another person, to allow people to be able to resonate with the person being cared for, to be able to connect on a more intellectual level (Gilbert, 2015). In research conducted by Gilbert et al. (2019), people were asked to participate in tasks and then determine whether they were tasks of kindness or compassion. The participants were given 18 scenarios and had to categorise them in either kindness, which was found to be focused on well-being, and compassion, found to be focused on the suffering of an individual. Throughout the study, the main finding was that compassion could be easily categorised by its characteristics that align with the suffering of an individual (Gilbert et al., 2019). Along with this differentiation between the two emotional constructs, there was also significantly different emotional patterns displayed by the participants, as compassion was significantly higher reported in anxiety, anger and disgust versus the kindness scenarios (Gilbert et al., 2019).

Pro's
As compassion has been found to be of importance socially (Gilbert, 2015), compassion has extended benefits, including personal well-being elevation through uses of self-compassion.

Higher Self-Confidence
In a study conducted by Moffitt et al,. (2018), they measured how self-compassion affects the levels of body dissatisfaction amongst a sample of women. Self-compassion was used in intervention programs amongst women with high levels of body dissatisfaction. Although eating disorders are not a direct cause of through low levels of self-compassion, body dissatisfaction has a positive association to eating disorders. studies show that self-compassionate practises can help alleviate the amount of body dissatisfaction individuals have, in turn lowering their chances of developing an eating disorder (Kelly et al., 2013, Neff, 2003). Often elf-esteem programs were used and found to have a positive impact on regulating adaptive thoughts, as well as eating habits amongst women. They were also found to sometimes create a negative thought process amongst women, and even worsen their symptoms of body dissatisfaction. Self-esteem differs from self-compassion, as often self-esteem highlights the ideas of being "better than others", or encourages inhibiting a thought process that can cause relapse in negative thinking. Moffitt et al,. (2018) discovered that self-compassion intervention for body dissatisfaction proved to have significant effects on the amount of women reporting negative body image thoughts.

Lower Risk of Certain Illness
Maladaptive thinking has high correlation to both anxiety and depression (Samtani & Moulds, 2017). Self-compassion has been found to be an effective mediator for maladaptive thinking through the redirection of the how a person internalises these thoughts. Studies have found that instead of fighting the natural way a person thinks when they experience an unpleasant situation (Allen & Leary, 2010), it is better to help them build up a better framework at combating what these thoughts mean to them. Attacking the problem from the angle of thought adaption, instead of thought change has lessened the amount of people reporting higher levels of depression. This maladaptive thinking has been related to compassion using self-compassion. Self-compassion has become a recent target of studies and its effects on a person's well-being (Neff, 2003).

In a study conducted by Ferrari et al (2018), they sought to discuss the relationship between self-compassion and depression through the mediation of perfectionism thoughts. Two scales and one questionnaire were administered to a sample of 515 teenagers and adults, measuring their levels of self-compassion, perfectionism, and depression. This study was specifically looking at how a person’s relationship with difficult thoughts could change their susceptibility to depression, instead of changing their complete thought process. The result of the experiment shows that the use of cognitive strategy helps combat maladaptive perfectionism thoughts and lowered the percentage of people reporting higher levels of depression.

Through the reduction of maladaptive thinking, it has been shown to effectively lower an individual’s risk of developing illnesses like anxiety and depression, but it also provides individuals with a strong foundation towards fighting against these illnesses if they are suffering (Neff, 2003). Taking the self-compassionate approach towards problems that may arise in one's life allows for a space of "buffering", in the sense that a person will become less critical of oneself and will actively be able to work through the suffering the individual is going through. Like how they would be compassionate towards others and help them in their suffering, to alleviate any pain (Samtani & Moulds, 2017).

Academic success
Academic success has been found to have negative correlation to low perceived competency and low self-compassion level. Neff et al., (2005) conducted a study that analysed the mental thought processes of individuals that received midterm results they personally would consider a failure mark. Students that took these marks and understood that failing is part of the human experience and were aware and mindful of their emotions and thoughts were associated positively with mastery goals, but negatively associated with performance goals. Students that were higher in self-compassion reportedly had taken the midterm results as an area to grow and learn from their experience, whilst in comparison to the students that were low in self-compassion. Low self-compassionate students would take this as a reason they should not strive to continue and that they will not be able to bounce back from this experience.

Healthier Relationships
Being kind to others often comes naturally, but when it comes to ourselves it is reported that we are significantly less kind (Chierchia & Singer, 2017; Neff 2013). There have been numerous studies done in relation to how this disparity between kindness to us can affect how we interact with people (Chierchia & Singer, 2017). Studies were conducted to analyse the brain activities of individuals when they were asked to do tasks that demonstrated self-compassion (Chierchia & Singer, 2017). Whilst participants engaged in compassion related tasks, it was shown that the Medial Orbitofrontal Cortex and Ventral Striatum was activated. This area of the brain is specifically related to concern, positive affect and feeling of warmth. This neural interaction proves that compassion can be trained like any other cognitive ability, which in turn means that that both compassion and self-compassion can be strengthened. Compassion training has found to have a significant, positive effect on interpersonal relationships an individual has as it develops trust, cooperation, and tolerance. Neff and Beretvas (2013) established a study that demonstrated how an individual being self-compassionate can affect their relationship with a partner. 104 couples participated in the study with a self-reported self-compassion scale. individuals that reported higher levels of self-compassion were reported to be less verbally abusive and more caring by their significant other. Overall, more positive attributes were assigned to individuals by their significant other, whilst also estimating relatively accurately how self-compassionate they think their partner is, providing evidence that self-compassion is an observable trait.

Lily has been feeling down, she has often had negative thoughts about her self-image. These problems arose when Lily put on weight during the COVID-19 lockdown. According to compassion-based exercises to improve mental health, Lily can help combat her negative thinking to improve her emotions by doing the following:

-Exploring self-compassion through writing: this task asks lily to write down what specifically is bothering her and causing her negative thinking. This provides Lily with a healthy outlet to visualise her thoughts, as well as work through what is really bothering her. It is also advised that Lily remain gentle with herself and abstain from being overly critical.

-Treat yourself how you would treat a friend: It is recommended that Lily looks at the situation as if her friend was going through the same experience. Using language and speaking to herself as if she was a friend allows Lily to open a more positive dialog towards herself, allowing her to be more compassionate.

(Dreisoerner et al., 2020; Neff, 2015)

Con's
Compassion in theory has been found highly beneficial, not only for social interaction, but also for the individual's well-being (Neff, 2003). The con's of compassion come with the overuse of compassion within an individual, eventually wearing down the capacity a person holds to continue to maintain a compassionate lifestyle in all aspects of their lives (Cavanagh et al., 2019).

Compassion Fatigue
Compassion fatigue is when an individual has a lowered mental capacity after constant exposure to stimulus of an individual/s suffering (Cavanagh et al., 2019). Compassion fatigue is often found a lot within professional field that require an individual to take on a large mental load of stress and provide compassionate care, for an example, nurses. Often nurses, when places in high demand environments, experience compassion fatigue and burn out and are no longer able to perform to a level at which they were performing before both compassion fatigue and burn out had set in (Cavanagh et al., 2019). The study conducted by Cavanagh et al. has found that nurses and practitioners that scored higher on the burn out and compassion fatigue surveys, were more likely to be associated to high psychological distress or even have symptoms relevant to illnesses like depression and anxiety. As although compassion training can help reduce the risk of developing anxiety and depression (Neff, 2003), when an individual is consistently subjected to an environment that is highly demanding of compassionate care, it can be harmful and cause susceptibility towards those illnesses (Cavanagh et al., 2019).

Higher Levels of Oxytocin
Oxytocin has been found to be released when mammalian creatures engage in prosocial behaviours (Gilbert, 2015). This relation to prosocial behaviours, has significant ties into the emotion of compassion. As compassion is evidently a marker for prosocial behaviours, people have been seen engaging in tasks of caring for another to reduce the amount of suffering (Gilbert, 2019). Taking these actions, introduced from compassion, oxytocin has been found to be associated in instances of caring, social memory and bond building (Dobewall et al., 2021). This extra boost of oxytocin when presented with a threat, especially towards a person in an individual’s care, can elicit non-social behaviours (Dobewall et al., 2021). This increased levels of oxytocin and threatening stimuli can then lead individuals to engage in more aggressive behaviour (Davydova et al., 2020). These non-social behaviours can include hostility towards outsiders and increased “courage to protect”, reverting to very primal instincts to protect (Gilbert, 2015).

Lily is a nurse and recently she has been feeling angry and burnt out. Lily is suffering from compassion fatigue and has recognised her symptoms; she has also recognised her overtime hours as a nurse as being a trigger for compassion fatigue.

To help combat Lily's compassion fatigue she has decided to put in two weeks of leave. During these two weeks of leave Lily has decided to optimise doing activities that she really enjoys and helps her relax, one of which is gardening.

After her two weeks off, Lily has put in healthy boundaries surrounding her work/life balance and will be better monitoring how many overtime hours she can commit to.

(Cavanagh et al., 2019)

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- Doing a sibling's washing. + Helping someone with a skinned knee. - Feeding your dog. + Mowing the grass for your elderly neighbour.

How Can Compassion be Fostered?
Compassion is utilised through different compassion training practices (Kirby et al., 2017). Compassion training practises usually focuses on different types of meditations that not only elevate a person’s capabilities in self-regulating maladaptive thinking, but also enhance a person’s prosocial behaviours (Condon & Makransky, 2020). It was discussed in multiple studies that the forming of a stable base is integral to ensuring individuals can undergo effective compassion training (Condon & Makransky, 2020; Gilbert, 2020). These stable bases consist of an individual accessing their hidden emotions, to allow for things they usually repress to come to the forefront of their minds. Once an individual has accessed these emotions, it is integral they start to develop an understanding of where these emotions have come from and work through to the “root” of these emotions. Working through these emotions allows for a person to develop a stronger “base”, which is considered a person’s emotional intelligence not only with oneself but with others. The emotional intelligence that a person gains from better understanding their own emotions not only allows them to effectively undergo compassion training but allows them to participate in more compassionate social interactions with others (Condon & Makransky, 2020; Mascaro et al., 2012).

Moving onto what is considered compassion training. Compassion training exercises range vastly in technique and activity (Condon & Makransky, 2020). Majority of the exercises ask an individual to really look within at their own emotions and is highly focused on self-compassion. Compassionate self-talk and writing are found largely across many compassion training studies (Kirby et al., 2017). Although there is a large focus towards self-care when it comes to compassion training, self-compassion training has been sought after in influencing more prosocial behaviours in individuals (Condon & Makransky, 2020). Many people when engaging in compassion training often do not believe themselves, let alone other individuals when it comes to compassion-based tasks. This is managed by having people develop their secure base, to which prosocial behaviour is positively associated (Gilbert, 2020). When engaging in compassion training, individuals have reported lower levels of anxiety and depression. These lower levels of anxiety and depression have been further associated with less critical self-talk (Gilbert, 2020; Neff 2003). By fostering compassion in an individual’s life, it is expressed that they are more likely to experience less maladaptive thoughts and behaviours, as well as have more prosocial interactions with other individuals.

Independent task: Choose one of Dr Neff's self-compassion exercises to practice building your own compassion.

Conclusion
Compassion is a complex construct, with many used definitions (Gilbert, 2015). With recent studies on the utilisation of compassion, it has been found that not only is compassion a development from human evolution, but also neurologically present within the human brain (Gilbert, 2019; Kim et al., 2020). This further understanding of compassion has pioneered the way for development and utilisation of compassion. Compassion has shown not only better individuals lives by reducing symptoms, and potential to develop maladaptive illnesses and behaviours, but to also boost the prosocial behaviours between individuals (Condon & Makransky, 2020). Overall, in essence of compassion and all its functions within human life, it has shown to be profoundly important and further research into the applications of compassion is highly encouraged.