A Program of Emory University
www.tibet.emory.edu/cbct
Cognitively-Based Compassion Training
(CBCT)
June 6, 2014
Timothy Harrison, Associate Director
Emory-Tibet Partnership, Emory University
Emory-Tibet Partnership
-- a cross-cultural exchange --
• Emory-Tibet Science Initiative (ETSI)
• Cognitively-Based Compassion Training (CBCT)
Lobsang Negi, PhD
Director of ETP
Emory-Tibet Partnership
-- a cross-cultural exchange --
Emory-Tibet Science Initiative (ETSI)
Cognitively-Based Compassion Training
OVERVIEW
• What is compassion?
• Benefits of compassion
• Can we cultivate compassion?
• CBCT Protocol
• CBCT Research
What is Compassion?
com·pas·sion
the desire to relieve others from
suffering or misfortune
synonyms: sympathy, empathy, fellow feeling, care,
concern, solicitude, pity, sensitivity, warmth, love,
tenderness, mercy, leniency, tolerance, kindness,
humanity, charity
What is Compassion?
Peter and Linda Biehl
Amy Biehl
What is Compassion?
What is Compassion?
Easy Nofomela
Ntobeko Peni
What is Compassion?
The Amy Biehl Foundation
Gugulethu, South Africa
What is Compassion?
For most people, to “act what they think” requires that
first they have to un-bundle themselves from all sorts of
encumbrances, most of which are self-imposed, others of
which are not. The longer you spend in life the more
encumbered you get. What Linda and I have discovered is
that when somebody who is important to you is suddenly
stripped away from you, then the conventional
encumbrances tend not to matter. The moment that we
accepted the reality of Amy's death, and reflected on the
reason for it … it really stripped away everything that
could possibly have encumbered us.
-- Peter Biehl, Amy’s father
What is Compassion?
20th Anniversary Memorial
2013
Benefits of Compassion
Compassion and love are not mere luxuries. As the source both
of inner and external peace, they are fundamental to the
continued survival of our species. They are the source of all
spiritual qualities: of forgiveness, tolerance, and all the virtues.
Moreover, they are the very thing that gives meaning to our
activities and makes them constructive.
If we seek happiness for others,
we should practice compassion;
and if we seek happiness for ourselves,
we should also practice compassion!
– The Dalai Lama, Beyond Religion
Benefits of Compassion
(source: Greater Good Science Center, UC-Berkeley)
• Compassionate action (e.g., giving to charity) activates
pleasure circuits in the brain
• Increases self-reported happiness.
• Can reduce risk of heart disease by boosting Vagus Nerve
activity
• Lowers stress hormones and strengthens the immune
response.
• Less rumination about what has gone wrong or might go
wrong
• Activates neural systems that support parental nurturance.
• More optimistic and supportive in communication style
• Decreases vindictiveness toward others.
Benefits of Compassion
(source: Greater Good Science Center, UC-Berkeley)
• Employees who receive more compassion in their workplace
see themselves, their coworkers, and their organization in a
more positive light, report more positive emotions like joy
and contentment, and are more committed to their jobs.
• Societies that take care of their most vulnerable members,
assist other nations in need, and have children who perform
more acts of kindness, are the happier ones.
• Compassionate people are more socially adept and less
vulnerable to loneliness, which causes stress and harms the
immune system.
• Supports commitment to moral principles.
Benefits of Compassion
Helping behavior, along with other types of social interaction,
is associated with positive health outcomes, including reduced
mortality. The present research indicates that helping valued
others predicts reduced mortality specifically because it buffers
the association between stress and mortality. To our
knowledge, this is the first study to find evidence for a stressbuffering mechanism for explaining the beneficial association
of prosocial behavior with mortality.
Poulin et al. | Peer Reviewed | Research and Practice
September 2013, Vol 103, No. 9 | American Journal of
Public Health
Can we cultivate compassion?
“The Two Wolves of the Heart”
- Cherokee Nation Folk Tale
Can we cultivate compassion?
As man advances in civilization, as small tribes join with large
tribes, the simplest reason will tell each individual that he ought
to extend his social instincts and sympathies to all the members
of the same nation, though personally unknown to him. This
point being, once reached, there is only an artificial barrier to
prevent his sympathies extending to the men of all nations and
races… Our sympathies becoming more tender and more widely
diffused, until they are extended to all sentient beings.
– Charles Darwin, Descent of Man
Can we cultivate compassion?
So when Jesus says “Love your enemies,” he is setting forth a
profound and ultimately inescapable admonition.
Have we not come to such an impasse in the modern world
that we must love our enemies– or else?
The chain reaction of evil – hate begetting hate, wars
producing wars – must be broken, or we shall be plunged
into the dark abyss of annihilation.
- Dr. Martin Luther King, Jr.
Strength to Love
Can we cultivate compassion?
Cognitively-Based Compassion Training
a specific approach to developing compassion
• Developed as a protocol for research at Emory University.
• Drawn from the ancient lojong (“mind training”) tradition
of Tibet and rendered into secular form.
• Begins by tapping into the biologically-given potential for
compassion in all of us.
• Makes deliberate effort to expand our compassionate
capacity beyond the limits of in-group/out-group bias.
• Intentionally develops our receptivity to suffering and
intensifies our desire to help others, allowing this
response to be more natural and spontaneous
in our everyday lives.
Progressive Components of CBCT
1.
2.
3.
4.
5.
Attentional Stability
Self-Compassion
Cultivating Impartiality
Developing Appreciation and Empathy
Strengthening Compassion
Compassion Research
Why, in a country that consumes 25% of the world’s
resources (the U.S.), is there an epidemic of loneliness,
depression, and anxiety? Why do so many in the West
who have all of their basic needs met still feel
impoverished? While some politicians might answer,
“It’s the economy, stupid,” based on scientific evidence,
a better answer is, “It’s the lack compassion, stupid.”
-- James Doty, MD, Professor of Neurosurgery at
Stanford University, and Director of the Center
for Compassion and Altruism Research (CCARE)
Emory University School of Medicine
CBCT Pilot Study – Fall 2014
- 10 week CBCT course for 2nd year medical students
- Presented in mentored groups, randomized to 50% of the
students, with booster classes in Spring 2015
- Compassion App in development to promote “stickiness”
- Investigators: Andrew H. Miller, MD, Prof. of Psychiatry,
Jennifer Mascaro, PhD, Anthropology
Dean Christian P. Larsen, MD, DPhil
Executive Associate Dean J. William Eley, MD, MPH
Associate Dean Ira K. Schwartz, MD
Compassion and Stress
Stress is the body’s response to a perceived threat. In
the case of psycho-social threats, the stress is in
response to aversive cognitive appraisals which can
create a prolonged elevation of the immune system
response and chronic inflammation correlated with many
modern epidemics – heart disease, diabetes, asthma,
and even cancer and depression.
Our real enemies are not those who
oppose us.
Our real enemies are the anger and
hatred we feel toward those people.
-- Charles Raison, MD, Dept. of
Psychiatry, University of Arizona
Trier Social Stress Test (TSST)
Benefits: Effects of CBCT on
biochemical stress responses
TSST after
meditation training
0.5
log plasma IL-6, pg/ml
IL-6
log plasma IL-6, pg/ml
TSST prior to
meditation training
0
-0.5
-1.0
-1.5
0
15
30
45
60
75
-1.0
0
15
30
45
60
75
90
Time (min)
TSST
18
plasma cortisol, µg/ml
plasma cortisol, µg/ml
-0.5
-1.5
90
18
16
14
12
10
8
0
0
Time (min)
TSST
Cortisol
0.5
16
14
12
10
8
0
0
15
30
45
TSST
Pace et al. Psychoneuroendocrinol 2009;34:87-98;
Pace et al. Psychoneuroendocrinol 2010; 35: 310-15
60
75
Time (min)
90
0
15
TSST
30
45
60
75
90
Time (min)
low practice
high practice
Depression score Amygdala response
Differential effects of mindful-attention
training vs. compassion training
Mindful-Attention
Training
Compassion
Training
*
Before
After
Desbordes, Negi, et al., Frontiers in Human Neuroscience, 2012
Before
After
Benefits of Compassion Training: Empathic Accuracy
IFG Brain Activation and Reading the Mind in the Eyes
* p < 0.05
p < 0.05
CBCT Group
Control Group
Mascaro et al. SCAN 2013; 8(1):48-55.
*
Reading the Mind in the Eyes Test
Reading the Mind in the Eyes Test
Reading the Mind in the Eyes Test
Benefits of Compassion Training: Empathic Accuracy
IFG Brain Activation and Reading the Mind in the Eyes
* p < 0.05
p < 0.05
CBCT Group
Control Group
Mascaro et al. SCAN 2013; 8(1):48-55.
*
CBCT for At-risk Adolescents in Foster Care
We have no shortage of programs for
kids in care, but they are all focused on
changing external circumstances. We
need a program that brings about inner
change, and I feel that Emory’s
compassion program is exactly what our
children need.
B.J. Walker
Commissioner, GA Division of Human Services, 2009
• Helped youth transform relationships with
caregivers, teachers and peers
• Encouraged concrete changes in their behavior
Lower inflammation and greater hope in
foster care adolescents who practiced CBCT more
more
hope
60000
55000
50000
45000
40000
35000
30000
25000
20000
15000
10000
5000
0
change in Children’s Hope Scale Score
from before to after training
saliva C-reactive protein
controlling for baseline
higher
inflammation
low CBCT
practice*
lower
inflammation
high CBCT
practice*
*below or above median practice
sessions
Pace, Negi, Dodson-Lavelle, Ozawa-de Silva, Reddy, Cole, Danese, Craighead &
Raison (in press). Psychoneuroendocrinology, July 2, 2012
11
10
9
8
7
6
5
4
3
2
1
0
-1
less
hope
low CBCT
practice*
high CBCT
practice*
Reddy, Negi, Dodson-Lavelle, Ozawa-de Silva, Pace, Cole, Raison,
Craighead (in press) Journal Child Family Studies, February 21, 2012
CBCT for Elementary School Children
At first, I was a bit worried
about whether or not we
could teach these
concepts to very young
children, but their creativity
and ability to grasp these
teachings completely blew
my mind.
Brooke Dodson-Lavelle,
CBCT Instructor
Brendan and Brooke with children
in elementary school classroom
Social Circles Task (Children Ages 7-10)
Antonucci et al., 1998
% of children who add friends
% children with
peer friendships
CBCT(N=26)
MINDFULNESS (N=27)
• Only children who learn CBCT add significantly more friends to their social network (p=.005)
• Only children who learn CBCT add significantly more peer (same-class) friendships (p=.019)
(Dodson-Lavelle, Robbins, Ozawa-de Silva, Pace, Negi, Raison, Rochat, in preparation.)
CBCT Research implications to date:
– decreases stress responses
– enhances well-being
– improves mood
– improves interpersonal skills, such as empathy
– improves number and consistency of friendships
– can be implemented at elementary and higher
education levels
Current Research Projects - 2014
• Nurses at the Neonatal Intensive Care Unit,
Children’s Healthcare of Atlanta - Egleston
• Post-Traumatic Stress Disorder Victims, Atlanta VA
Medical Center
• AIDS Patients, Grady Health - Ponce de Leon Center
• Breast Cancer Survivors, U. of Arizona - Tuscon
• Pre-School Parents, U. of Wisconsin - Madison
• Elementary Public School Teachers, International
Community School, Decatur, GA
• Students, Emory University School of Medicine
Progressive Components of CBCT
1.
2.
3.
4.
5.
Attentional Stability
Self-Compassion
Cultivating Impartiality
Developing Appreciation and Empathy
Strengthening Compassion
me
me
me
me
me
Interdependence
In a real sense all life is inter-related. All men are
caught in an inescapable network of mutuality, tied
in a single garment of destiny. Whatever affects
one directly, affects all indirectly.
- Dr. Martin Luther King, Jr.
A human being is part of the whole called by us “universe,” a part
limited in time and space. We experience ourselves, our thoughts
and feelings, as something separate from the rest. A kind of
optical delusion of consciousness. This delusion is a kind of prison
for us, restricting us to our personal desires and to affection for
a few persons nearest to us. Our task must be to free ourselves
from the prison by widening our circle of compassion to embrace
all living creatures and the whole of nature in its beauty. The true
value of a human being is determined by the measure and the
sense in which they have obtained liberation from the self.
We shall require a substantially new manner of thinking if
humanity is to survive.
– Albert Einstein
we
A Program of Emory University
www.tibet.emory.edu/cbct