Findings supporting the clinical applications of mindfulness have stimulated research into other meditation techniques. In particular, there is growing scientific enquiry into the effectiveness of Buddhist-derived compassion techniques for treating a wide variety of health-related disorders. Compassion-Based Interventions (CBIs) usually employ compassion meditation as a central therapeutic technique and invariably follow a secular format (with minimal use of Buddhist terminology). Compassion meditation is described as the meditative development of affective empathy as part of the visceral sharing of others’ suffering.1 The technique involves the patient using meditative imagery and/or breathing practices in order to intentionally direct compassionate feelings towards 1) themselves (known as self-compassion); 2) an individual (for example, a friend or person deemed to be a cause of distress, such as a difficult work colleague); 3) a group of individuals (or ‘living beings’ in general); and/or 4) a situation (for example, the devastation caused by a natural disaster or war).1 While cultivating such feelings, the patient has conviction that they are enhancing the wellbeing of the person or persons concerned.1
Examples of CBIs include 8- to 12-week group interventions such as Compassion-Cultivation Training, Compassion-Focused Therapy, and Cognitively Based Compassion Training (CBCT). An increasing number of mindfulness-based interventions — particularly those categorised as second-generation mindfulness-based interventions2 — have also integrated compassion and compassion-related meditation techniques (for example, Compassion-Mindfulness Therapy, Mindful Self-Compassion Programme, Attachment-Based Compassion Therapy, and Meditation Awareness Training).
Emerging findings demonstrate a moderate-strength positive relationship (Pearson’s r = 0.47; n = 16 416 across 79 samples) between self-compassion and different forms of wellbeing (cognitive, psychological, and affective).3 Self-compassion is also positively correlated with emotional intelligence, mindfulness, intrinsic motivation, and perceived self-competence.4 Compassion towards others is associated with, for example, reduced levels of depression,5 pro-social behaviour and social connectedness,6 and reduced emotional supression.1 Compassion meditation can also enhance regulation of neural emotional circuitry via increased activation of the insula and cingulate cortices of the limbic region (a brain area linked with empathy).7 Furthermore, some individuals with chronic pain conditions (for example, fibromyalgia) report that compassion meditation helps them become less preoccupied with their poor health.8
Exploratory randomised control trials (RCTs) indicate that CBIs are effective treatments for (among other conditions) psychosis, binge-eating disorder, depression and anxiety, and diabetes.1 RCTs also demonstrate that CBIs can lead to improvements in happiness and life satisfaction, reductions in innate immune and distress responses to psychosocial stress (assessed using plasma concentrations of interleukin-6), reductions in salivary concentrations of inflammatory biomarker C-reactive protein, and assigning greater value to ‘low arousal positive states’ such as feeling calm.1
METHODOLOGICAL ISSUES AND RISKS
Although there appears to be treatment applications for CBIs, methodological weaknesses limit the generalisability of such findings. For example, one recent systematic review (n = 1312 across 20 intervention studies) assessed CBI study quality using the Quality Assessment Tool for Quantitative Studies and concluded the studies were of ‘moderate’ methodological quality.1
This conclusion was due to various issues including 1) not assessing fidelity of implementation from the standard intervention protocol; 2) not assessing participant adherence to practice; 3) over-reliance on self-report measures; 4) non-justification of sample sizes; 5) poorly designed and poorly defined control conditions (not controlling for therapeutic factors such as group interaction, psycho-education, and instructor experience); and/ or 6) absence of follow-up assessments to evaluate maintenance effects.
Aside from poor methodological quality, other issues that may impede the clinical integration of CBIs relate to the challenges of assimilating Eastern techniques into Western culture.1,2 There are concerns as to whether CBI instructors are sufficiently trained in both the nuances and risks of meditation.1 One such risk (particularly when practising compassion meditation) is the patient developing compassion fatigue.1 For example, a study of the aforementioned CBCT intervention reported that participants were instructed to generate what the authors called ‘active compassion’, involving proactively working to alleviate others’ suffering.5 Traditionally, however, prior to viscerally sharing or working to ease others’ suffering, meditation practitioners would train for many years in order to cultivate meditative and emotional stability within themselves.1 Therefore, there may be risks associated with certain CBIs instructing patients — including patients with psychiatric conditions — to actively alleviate others’ suffering following just 16 hours of meditation instruction (eight × 2-hour weekly sessions).1
Being compassionate is arguably a core requirement of any healthcare professional but specifically training patients to use compassion meditation represents an innovative direction in non-pharmacological intervention research. According to Buddhist theory, empathic thought patterns help to undermine self-obsessed maladaptive cognitive schemas as well as regulate negative thought rumination (both of which are known determinants of psychopathology).1
Preliminary findings appear to support this position but further studies are clearly required in order to replicate outcomes and ascertain the specific user groups for which CBIs may be suitable, whether compassion meditation is more efficacious when practised with mindfulness, and whether there are any risks associated with CBIs.
- © British Journal of General Practice 2017