Compassion Training and Resilience

CENTILE International Conference to

Promote Resilience, Empathy, and Well-Being in Healthcare Professionals

Workshop Session October 19, 2015

Steven Rosenzweig, MD Clinical Associate Professor,

Director of Professionalism Education, Drexel Univ College of Medicine [email protected]

Timothy Harrison Assistant Director for Cognitively-Based Compassion Training, Emory-Tibet Partnership, Emory University

[email protected]

Compassion Training and Resilience

Integrating Cognitive-Based Compassion Training (CBCT) & Other Contemporary Models for Health Care Professionals

Humanism

Ethics (virtue)

Professional formation

When

empathic concern

tips over into

Compassion…

the motivation to relieve suffering,

activated by empathy,

grounded in the positive emotional experience

of caring, kindness, attunement and

Contemplative Traditions

Psychology Neurobiology

Empathy vs Compassion

Secular Compassion-training

 Cognitively Based Compassion-training (Pace, Negi et al. 2009, Desbordes, Negi et al. 2012)

 Compassion Cultivation Training (Jazaleri, McGonical et al. 2013)

 Compassion Focused Therapy (Gilbert 2010)

 Mindful Self Compassion program (Neff and Germer 2013)

 Contemplative Emotion Training (Kemeny, Foltz et al. 2012)

Compassion-training – common

elements



Calm, stable presence (mindfulness)



Inquiry



Empathy expansion

Cognitively-Based

Compassion Training

Emory University

However the tea is prepared, the primary

ingredient is always water. While we can

live without tea, we can't live without

water. Likewise, we are born free of

religion, but we are not born free of the

need for compassion.

- The Dalai Lama

While compassion at the biological level

can be unconditional, like the mother’s

love for her baby, it is also biased and

limited in scope. Nevertheless, it is of

the utmost importance, because it is the

seed from which unbiased compassion

can grow. We can take our innate

capacity for warm-heartedness and,

using our intelligence and conviction,

expand it.

– The Dalai Lama

Beyond Religion: Ethics for a Whole World

As man advances in civilization, … 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 … There is only an artificial barrier to prevent his sympathies … becoming more tender and more widely diffused, until they are extended to all sentient beings.

– Charles Darwin, The Descent of Man

Benefits of Compassion

The human capacity to care for others is not

something trivial or something to be taken for

granted. Rather, it is something we should cherish.

Compassion is a marvel of human nature, a

precious inner resource, and the

foundation of our

well-being and the harmony of our societies

.

If, therefore, we seek happiness for ourselves, we

should practice compassion; and if we seek

happiness for others, we should also practice

compassion!

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

Associate Dean Ira K. Schwartz, MD

Emory School of Medicine - 2nd Year Students, 2015

10 week CBCT course, randomized with wait-list control, n~60

Investigators: A. H. Miller, MD, Prof. of Psychiatry, J. Mascaro, PhD, Anthropology 2015 Poster Presentation – Submitted for Publication – In Review

TSST prior to meditation training TSST after meditation training 0.5 0 -0.5 -1.0 -1.5 0 15 30 45 60 75 90 TSST 0.5 0 -0.5 -1.0 -1.5 0 15 30 45 60 75 90 TSST log pl as m a I L -6, pg/ m l log pl as m a I L -6, pg/ m l low practice high practice

Time (min) Time (min)

18 12 10 8 0 0 15 30 45 60 75 90 TSST 16 14 18 12 10 8 0 0 15 30 45 60 75 90 TSST 16 14 pl as m a c or ti s ol , µ g/ m l pl as m a c or ti s ol , µ g/ m l

Time (min) Time (min)

IL-6

Cortisol

Benefits: Effects of CBCT on biochemical

stress responses

Pace et al. Psychoneuroendocrinol 2009;34:87-98; Pace et al. Psychoneuroendocrinol 2010; 35: 310-15

Desbordes, Negi, et al., Frontiers in Human Neuroscience, 2012

Differential effects of mindful-attention

training vs. compassion training

A m y g d ala re s pons e Before After Dep ressio n sco re Mindful-Attention Training

*

Compassion Training Before After

CBCT Group Control Group

Benefits of Compassion Training: Empathic Accuracy

IFG Brain Activation and Reading the Mind in the Eyes

Mascaro et al. SCAN 2013; 8(1):48-55.

*

*

p < 0.05

CBCT Research Projects 2015



Students, Emory University School of Medicine



NICU Nurses, Children’s Healthcare of Atlanta



PTSD Sufferers, San Diego VA Medical Center



AIDS Patients, Grady Midtown (Ponce Clinic)



Breast Cancer Survivors, U. of Arizona - Tuscon



Pre-School Parents, U. of Wisconsin - Madison

Cognitively-Based Compassion Training:

specific approach to cultivating compassion

•

Developed as a protocol in 2005 for research at Emory University by Lobsang Tenzin Negi, PhD, former monk, Professor, and Director of the Emory-Tibet Partnership

•

Drawn from the lo jong (“mind training”) traditions of Tibetan Buddhism, and combined with insights from contemporary emotion science and neuroscience.

•

Secularized so that the practices are accessible to individuals of any – or no - faith tradition.

Progressive Skills/ Mindsets of CBCT

I. Attentional Stability and Clarity

II. Insight into Nature of Mental Experience

III. Self-compassion / Self-care

IV. Cultivating Impartiality

V. Appreciation & Affection for Others

VI. Empathy & Engaged Compassion