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A pilot exploration of heart rate variability and salivary Cortisol responses to compassion-focused imagery.



This study measured heart-rate variability and cortisol to explore whether Compassion-Focused Imagery (CFI) could stimulate a soothing affect system. We also explored individual differences (self-reported self-criticism, attachment style and psychopathology) to CFI. Participants were given a relaxation, compassion-focused and control imagery task. While some individuals showed an increase in heart rate variability during CFI, others had a decrease. There was some indication that this was related to peoples self-reports of self-criticism, and attachment style. Those with an increase in heart rate variability also showed a significant cortisol decrease. Hence, CFI can stimulate a soothing affect system and attenuate hypothalamic-pituitary-adrenal axis activity in some individuals but those who are more self-critical, with an insecure attachment style may require therapeutic interventions to benefit from CFI.
Clinical Neuropsychiatry (2008) 5, 3,
© 2008 Giovanni Fioriti Editore s.r.l.
Helen Rockliff, Paul Gilbert, Kirsten McEwan, Stafford Lightman and David Glover
This study measured heart-rate variability and cortisol to explore whether Compassion-Focused Imagery (CFI)
could stimulate a soothing affect system. We also explored individual differences (self-reported self-criticism, attachment
style and psychopathology) to CFI. Participants were given a relaxation, compassion-focused and control imagery
task. While some individuals showed an increase in heart rate variability during CFI, others had a decrease. There was
some indication that this was related to peoples self-reports of self-criticism, and attachment style. Those with an
increase in heart rate variability also showed a significant cortisol decrease. Hence, CFI can stimulate a soothing
affect system and attenuate hypothalamic-pituitary-adrenal axis activity in some individuals but those who are more
self-critical, with an insecure attachment style may require therapeutic interventions to benefit from CFI.
Key Words: Compassion  Cortisol  Depression  Imagery  Heart Rate Variability  Self-Criticism
Declaration of Interest: None
Helen Rockliff, Paul Gilbert, Kirsten McEwan, Mental Health Research Unit, Kingsway Hospital, Derby, UK DE22 3LZ
Professor Stafford Lightman, Henry Wellcome Laboratories for Integrative Neurosciences & Endocrinology, Bristol, UK
David Glover, Manchester Royal Infirmary, Manchester, UK
Corresponding Author
Professor Paul Gilbert, Mental Health Research Unit, Kingsway Hospital, Derby, UK DE22 3LZ
Email:  Fax: 01332 624576
Self-criticism is a major vulnerability factor to
psychopathology (Gilbert & Procter 2006, Whelton &
Greenberg 2005, Zuroff et al. 2005). In addition, it can
undermine the success of traditional psychotherapies
such as Cognitive Behavioural therapy (Rector et al.
2000). Recent research has explored the use of
compassion-focused imagery (CFI) as part of a
therapeutic process to help people who are highly self-
critical (Gilbert 2000; Gilbert & Irons 2004, 2005;
Wheatley et al. 2007)
For thousands of years imagination has been used
to stimulate various physiological states (Frederick &
McNeal 1999, Leighton 2003). Sexual, anxious, excited
and calm feelings, along with self-confidence and
preparation for tasks, can be stimulated via the
imagination (Singer 2006). Mental imagery has also
been used as a therapeutic aid to help desensitisation to
aversive stimuli, coping with stress, and for the
promotion of positive states of mind (Arbuthnott et al.
2001, Hall et al. 2006, Holmes et al. 2007, Singer 2006).
Recent research and clinical work has focused on the
value of helping patients develop self-compassion via
various means including imagery (Gilbert 2007; Gilbert
& Irons 2004, Gilbert et al. 2006).
Compassion evolved with the attachment system,
such that signals of care, support and kindness, help to
calm and sooth distressed individuals (Bowlby 1969).
The soothing/calming that results from receiving
kindness and support from others has been linked to a
specific oxytocin-opiate affiliative type of positive
affect regulation system (Carter 1998, Depue &
Morrone-Strupinsky 2005, Wang 2005) and reduces
sensitivity in the amygdala, especially to socially
threatening stimuli (Kirsch et al. 2005). This can be
contrasted with an agentic positive affect regulation
system associated with drive and excitement (Depue
& Morrone-Strupinsky 2005). Imagery and fantasising
are believed to access these different systems  much
as other forms of imagery stimulate other affect systems
(e.g., anxious or sexual).
Porgess Polyvagal theory (2003, 2007) details
how the evolution of the myelinated vagus nerve has
supported interpersonal approach behaviours that
enable social affiliations, caring and sharing. The
myelinated vagus nerve evolved with attachment and
the ability for infants to be calmed by parental caring
behaviours (Depue & Morrone-Strupinsky 2005). This
addition to the autonomic nervous system can inhibit
sympathetically driven threat-defensive behaviours
(e.g. fight/flight) and hypothalamic-pituitary adrenal
(HPA) axis activity, and promote a calm physiological
state, conducive to interpersonal approach and social
Heart Rate Variability and Salivary Cortisol Responses to Compassion-Focused Imagery
Clinical Neuropsychiatry (2008) 5, 3
affiliation. In general, the safer people feel, the more
open and flexible they can be in response to their
environment (Gilbert 1993). This is reflected in the
dynamic balancing of the sympathetic and para-
sympathetic nervous systems that give rise to the
variability in heart rate (Porges 2007). Hence, feeling
safe is linked to HRV, and higher HRV is linked to a
greater ability to self-sooth when stressed (Porges 2007).
In contrast, when individuals feel unsafe, they will
tend to rely on more threat focused and stereotyped
defensive behaviours (Dickerson & Kemeny 2004,
Gilbert 1993) characterised by a less flexible balance
of the sympathetic and parasympathetic nervous
systems, with lower tone in the myelinated vagus nerve
(Porges 2007). This relative inflexibility and unbalance
of the autonomic nervous system, associated with lower
measures of HRV, has been associated with both mental
and physical ill health (Appelhans & Luecken 2006;
Thayer & Lane 2007).
This study is a pilot exploration of both the impact
of baseline HRV measures on individual experiences
of CFI, and the acute effects of CFI on HRV and cortisol.
Imagery conditions were designed to stimulate two
different types of positive affect. One type focused on
being the recipient of compassion, while the control
imagery focused on anticipation of reward (making
ones ideal sandwich). Having two types of imagery
targeted to stimulate the two different positive affects
enables exploration of the specificity effects of positi-
ve affect on HRV.
We also explored the influence of self-reported
self-criticism, self-compassion, attachment style, ease
of feeling socially safe and stress, anxiety and
depression on HRV responses to the CFI. We
hypethesised whether self-criticism was associated with
people finding CFI difficult and if this would be
reflected in HRV and cortisol measures.
Participants were recruited from the University of
Derby (n =184) and completed a self-report screening
questionnaire. Inclusion criteria were: aged between 18
and 35 years; BMI between 19 and 28; non-smoker;
not-currently using medication (except contraception)
or illicit drugs; consuming under 30 units alcohol per
week; not working night shifts; no history of
cardiovascular problems; and no major mental health
problems (47 met these criteria). The final analyses
consisted of 22 participants, exclusions included: A
heart arrhythmia, being unable to sit still and concen-
trate, falling asleep, and imagining pity rather than
All experimental sessions commenced at 14:00 (to
allow consistent recording of cortisol levels) in the
psychology department at the University of Derby.
Participants were welcomed by the researcher and
seated in a relaxed but upright position with arm and
head supports for the duration of the study. Figure 1
outlines the procedure.
Imagery was verbally guided by the researcher.
Each condition (relaxation/baseline, compassion and
control) lasted five and a half minutes. This was to
ensure that 300 seconds of artefact-free ECG data was
available for calculation of HRV metrics (Task Force
1996). During relaxation participants were asked to
allow the tension to drain from each of their muscles
in turn. Previous studies have used a variety of different
instructions for obtaining baseline measures, including
continuous counting, instructions to relax (Osumi et
al. 2006) and no baseline but inclusion of a control
condition (Takahashi et al. 2005).
The CFI imagery asked participants to imagine
compassion for them coming from an external source.
The researcher suggested that some people find it
Figure 1. Procedure
Continuous ECG recorded
,PDJHU \
Helen Rockliff et al.
Clinical Neuropsychiatry (2008) 5, 3
helpful to create a mental picture of this compassionate
other (human or non-human). It was stressed that the
image was to help them feel they were the recipient of
compassion, and it was feeling that compassion that
the research was exploring.
Participants were verbally prompted every 60
seconds by the researcher with various statements such
as: Allow yourself to feel that you are the recipient of
great compassion; allow yourself to feel the loving-
kindness that is there for you.
Control Imagery
As noted, the positive affect system underpinning
appetitive and resource acquiring activity is different
to the soothing/contentment system (Depue & Morrone-
Strupinsky 2005). Therefore to compare different types
of positive affect inducing imagery, our control imagery
focused on preparing ones favourite sandwich.
Participants were prompted every 60 seconds with
statements like Imagine entering the shop of your
choice and taking some time to browse and look around
at the selection of food before you and Imagine
preparing your bread and beginning to build your sand-
wich. The full script is available on request.
Laboratory Measures
A three lead ECG was recorded using Ag-AgCl
disposable electrodes with Biopac PRO Lab software
version 3.6.7 and MP30 Hardware (Linton Instru-
mentation). Data was sampled at 1Khz to ensure
millisecond accuracy of the Inter-Beat Intervals (IBIs).
IBIs were determined off line using the Biopac R-wave
detection algorithm for 3 x 300 second periods
corresponding to baseline and each imagery condition.
All IBIs were manually checked by a researcher to
ensure their accuracy, and to correct missed and ectopic
beats due to the reported effects from such errors
(Berntson et al. 2005). Artefacts were corrected
according to the Task Force (1996) recommendations.
Heart Rate Variability Metrics
Using the artefact corrected ECG data, inter-beat
intervals were measured and from these heart rate was
calculated. CMetx software (Allen et al. 2007) was used
to calculate the SDNN, the standard deviation of inter-
beat intervals, a measure recommended by the Task
Force (1996). This is a global measure of HRV,
reflecting the sum of all of cyclic components
contributing to the variation of inter-beat intervals. This
was chosen as an appropriate measure for pilot work,
which would give good indication as to the likely merit
of further exploration using other measures of HRV.
To obtain measures of HRV reactivity to CFI the
raw HRV metrics corresponding to each condition
(baseline, compassion and control) were used to
calculate participants change in HRV values. These
change values were calculated by subtracting each
participants control imagery HRV value from their CFI
HRV value. (The control imagery HRV value was used
as it attempts to keep constant the possible effects of
mental effort and visualisation on HRV). Since HRV
shows less acute reactivity in individuals with low HRV
(Porges 2007), we adjusted the raw HRV change values
in proportion to the participants baseline value by
expressing HRV change values as a percentage of the
baseline HRV value. These variables, which we will
refer to as HRV change, make the magnitude of HRV
response to imagery comparable between individuals.
Saliva samples were collected using salivettes
(Sarstedt Ltd). The final cortisol sample was optimally
timed to allow for a delay in possible HPA axis response
to CFI (Dickerson & Kemeny 2004). All samples were
frozen before being assayed for cortisol by Obsidian
Research Ltd (Port Talbot, UK) using an Enzyme-
Linked ImmunoSorbent Assay (ELISA).
Self-Report Measures
Participants completed a demographics form, the
following self-report scales and additional questions.
Forms of Self-Criticism/Self-Reassuring Sca-
le (FSCRS) (Gilbert et al. 2004).
This 22-item scale assesses participants thoughts
and feelings about themselves during a perceived
failure. Two subscales measure forms of self-criticising,
(inadequate self and hated self) and one subscale
measures tendencies to be reassuring to the self
(reassured Self). Participants respond on a Likert scale
0  4. The scale has good reliability with Cronbachs
alphas of .90 for inadequate self, .86 for hated self, and
.86 for reassured self (Gilbert et al. 2004).
Self-Compassion Scale (SCS) (Neff 2003)
This 26-item scale assesses levels of self-
compassion. There are three factors of positive self-
compassion: self-kindness, common humanity and
mindfulness, and three factors that focused on a lack of
self-compassion: self-judgement, isolation and over-
identification. Participants indicate how often they
engage in these ways of self-relating on a Likert scale
1  5. The scale has good reliability (Cronbachs alphas
ranging from .75 to .81).
Adult Attachment Scale (Collins & Read 1990)
This 18-item scale measures three attachment
dimensions. Depend measures abilities to depend on
others, anxious measures degree of worry about
abandonment and close measures ease of getting close
to others. Respondents are asked to rate on a Likert
scale 1  5 how characteristic each statement is of them.
Heart Rate Variability and Salivary Cortisol Responses to Compassion-Focused Imagery
Clinical Neuropsychiatry (2008) 5, 3
The Cronbachs alphas were 0.75 for depend, 0.72 for
anxiety and 0.69 for close.
Social Safeness Scale (Gilbert et al. submitted)
This 11-item scale was developed to measure the
extent to which people experience their social world as
safe, warm and soothing, and their ability to enjoy
feelings of closeness with others. Each item is scored
on a Likert scale 0 4. This scale had a Cronbachs
alpha of .82.
Depression, Anxiety and Stress Scale (DASS-
21) (Lovibond & Lovibond 1995)
This 21-item shortened version of the DASS-42
consists of three subscales measuring depression,
anxiety and stress. Participants are asked to rate how
much each statement applied to them over the past
week, on a Likert scale 0  4. The DASS-21 subscales
have Cronbachs alphas of .94 for Depression, .87 for
Anxiety and .91 for Stress (Antony et al. 1998).
Analysis was conducted using SPSS version 14.
The data were screened for normality of distribution
and for outliers.
CFI. Some people showed a reduction in HRV
(measured by SDNN) in response to compassion, while
others showed an increase. We felt these were important
differences and therefore split participants into two
groups. Group 1 contains 11 individuals who showed a
reduction in SDNN value from control to CFI (called
Group 1SDNNdowns), while Group 2 contains 11
individuals who showed an increase in SDNN value
during the CFI (called Group 2SDNNups). This equal
number arose by chance.
Means and standard deviations for each
condition and group are reported in Table 1. In addition,
the mean SDNN for each group during each condition
are depicted in Diagram 1.
The SDNN was analysed using repeated measures
ANOVAs to explore the effects of imagery condition
(relaxation, control and compassion) and group (i.e.
whether participants decreased or increased in SDNN
in response to CFI). The SDNN value calculated for
each imagery condition was used as within-subjects
variable, and group was used as a between-subjects
variable. Post hoc t-tests were performed to explore
where any significant differences lay between different
imagery tasks.
The ANOVA showed both a significant main effect
of imagery condition (F(1.15, 23.00) =4.41, p=.042)
and interaction effects with group (F(1.15, 23.00) =5.18,
p=.028). The difference in mean SDNN value between
Group 1SDNNdowns and Group 2SDNNups is apparent at
relaxation and is accentuated during the CFI. However,
the groups are very similar in SDNN during the control
imagery. The implications of this are that for some po-
sitive imagery tasks (e.g. making a sandwich), there
are no discriminatory effects on HRV. However, for
positive imagery associated with affiliative
interpersonal affects (warmth, kindness and social
connectedness) certain individuals responded with a
decrease in HRV whilst others had an increase in HRV.
The post hoc t-test revealed a significant difference
between groups during the CFI (t(20)=-2.20 p=.043).
This is visually represented in Diagram 1.
Cortisol values after relaxation and before CFI
(Cortisol A), and after CFI (Cortisol B) were analysed
using a repeated measures ANOVA, with group as a
between-subjects variable. There was a significant main
effect of imagery on cortisol value (F = 4.54, (df =1,
19) p = .046) but no significant interaction of group.
Post-hoc t-tests revealed a non-significant difference
between the two groups cortisol A values (Group
1SDNNdowns = 5.80ng/ml, Group 2SDNNups = 5.40ng/ml).
Both groups showed a mean cortisol value decrease
after CFI (Group 1SDNNdowns = 5.70ng/ml; Group 2SDNNups
= 4.92ng/ml). However, for Group 2SDNNups this decrease
in cortisol was significant, while for Group 1SDNNdowns
the decrease was non-significant. This greater decrease
in Group 2SDNNups resulted in a significant difference
between the group means for cortisol B (t=2.50, p=
.022) and can be seen clearly in Diagram 2. Cortisol A
correlated negatively with change in cortisol meaning
that the lower a participants initial cortisol value was,
Table 1. Means and standard deviations of SDNN across
conditions for both groups
Condition SDNN
Group1M(SD) Group2M(SD)
Baseline (Relaxation) 55.28 (17.74) 64.06 (23.35)
Compassion imagery 44.61 (17.09) 60.05 (16.44)
Control imagery 53.85 (15.25) 51.51 (18.87)
Participants reported boredom and fatigue
during the second CFI (C2) and therefore we removed
this data as it was unreliable.
Heart rate changes and HRV changes are related
but distinctly different measures. We therefore
performed an ANOVA to determine whether there were
any differences in heart rate between the three
experimental conditions, or between groups. There were
no significant differences, indicating that any changes
in HRV found were not merely a product of changes in
heart rate. Physical demands were kept constant
throughout the study to ensure that any changes in the
measures taken could be attributed to thought induced
alterations of metabolic demand.
Heart Rate Variability
The HRV data showed two opposing responses to
Helen Rockliff et al.
Clinical Neuropsychiatry (2008) 5, 3
Diagram 1
Diagram 2
Heart Rate Variability and Salivary Cortisol Responses to Compassion-Focused Imagery
Clinical Neuropsychiatry (2008) 5, 3
the bigger their decrease in cortisol during compassion
also was. These results show that for people who had
an increase in HRV during CFI there was a significant
decrease in cortisol. While for those who had a decrease
in HRV during CFI, there was a minimal non-significant
decrease, as would be expected from diurnal rhythm
Mauchlys test indicated that the assumption of
sphericity was violated for SDNN. Therefore,
Greenhouse-Geisser estimates of sphericity were used
to correct the degrees of freedom. Calculations of effect
size (indicated by partial eta squared) revealed that
effect sizes associated with cortisol measures were
higher (i.e. ω2>.08). than for SDNN (ω2= <.08).
Self-Report Scales
Data were screened for normality of distributions,
skewness values ranged from 0.09 to 1.43 and Kurtosis
values from -0.23 to 1.42. The hated self  subscale
derived from the forms of self-criticism and
reassurance scale was skewed and kurtotic. This is
not surprising to find in a non-clinical population due
to a floor effect, and we chose to remove this subscale
from further analyses. T-tests were conducted to
examine differences in self-report scores between
groups 1SDNNdowns and 2 SDNNups. A significant difference
was found between social safeness scores (t=0.03),
with Group 1SDNNdowns having a lower mean score
(38.00) than Group 2SDNNups (44.64). We also noted that
the group differences on the other self-report variables
are all in the predicted directions, however statistical
significance was not reached, possibly a limitation of
the small numbers.
Correlation Analysis
Pearsons correlation coefficients for self-report
scales, cortisol measures, baseline HRV and HRV
change data are given in Table 2.
Change in SDNN was positively correlated with
ability to depend on others (adult attachment scale),
and with the social safeness and pleasure scale (r =
.52, .014 and r = .57, p = .006 respectively). In other
words, HRV response to CFI is linked to peoples
current experiences of themselves in social
relationships. This is further indicated with the
contrasting result that anxious attachment was
negatively correlated with change in SDNN (r = -.48,
p = .025). We also found self-criticism that focuses on
feelings of self-inadequacy was negatively associated
with reduced HRV when trying to engage in CFI (r=-.54).
In addition, although not significant, the ability to be
self-reassuring (r=.36) and self-compassionate (r=.33)
were positively correlated with SDNN change.
This study aimed to explore the impact of CFI on
two different physiological measures (HRV and
cortisol) we also explored individual differences
informed by clinical observations that some people find
CFI difficult or threatening (Gilbert 2007). Our data
indicates two key processes. First, CFI does impact on
HRV. Some people show a clear increase in HRV,
whereas others show a more threat-like response with
a reduction in HRV. We also found that those individuals
who showed elevated HRV to compassionate imagery
experienced a drop in cortisol, indicative of a soothing
effect on the HPA axis. In contrast, those who showed
a reduction in HRV experienced a non-significant
cortisol change. There is research suggesting that some
individuals with secure attachments, typically engage
in soothing images and memories of feeling cared for
and these can aid emotional regulation (Baldwin 2005,
Mikulincer & Shaver 2007). Buddhism also specifically
focuses on training people in CFI (Leighton 2003).
It appears that different people have different
physiological responses to CFI. So the question is to
try to identify the sources of these differences. Why do
some people benefit from CFI and experience it as
soothing while others appear threatened? We explored
this with self-report measures. The self-report data
suggests that peoples experiences of CFI are related
to current experiences of social safeness; Group 2SDNNups
had higher mean scores of social safeness. Although
other self-report measures did not show significant
differences between the two groups, all differences
showed trends in the expected directions (e.g. Group
1SDNNdowns had higher mean scores of self-criticism, self-
coldness, anxious attachment and psychopathologies;
whilst Group 2SDNNups had higher mean scores of self-
compassion, self-reassurance and ability to depend on
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Table 2. Correlations between change in HRV measures and self-report scales
Note for readers interested in the results of other HRV metrics: RMSSD change also showed a correlation with the Depend
attachment subscale (r = .44, p =.043), Toichis Cardiac Vagal Index change also showed positive correlations with the Depend
attachment subscale (r = .45, p =.034), Toichis Cardiac Sympathetic Index also showed a significant correlation with the social
safeness and pleasure scale (r = .45, p =.035)
Helen Rockliff et al.
Clinical Neuropsychiatry (2008) 5, 3
others and experience close relationships). This would
fit with Gilberts (1989) concepts of a safeness system
and Porges (2003, 2007) view that higher HRV is linked
to interpersonal approach and socially adaptive
Further evidence for this link was revealed in the
pattern of correlations. A significant positive correlation
was found between change in SDNN during CFI and
social safeness and ability to depend on others. In
contrast, anxious attachment was negatively associated
with SDNN change; in other words, anxious attachers
may find CFI more threatening. The data raises
important implications for psychotherapy (Gilbert &
Irons 2005; Gilbert & Procter 2006). The differences
in HRV response seen between participants reflect
clinical observations; that for some people (particularly
self-critics and those scoring low in social safeness),
focusing on compassion can at first be unfamiliar,
threatening and feel unsafe (Gilbert 2007; Gilbert &
Irons 2005; Gilbert et al. 2006). Self-critics often report
feeling reluctant to let go of their self-criticism for
fear of their standards slipping; that they might
become selfish or arrogant, or that it constitutes a
change to self-identity. They can also fear compassion
because they feel they do not deserve compassion or
because it is unfamiliar, triggers sadness, or it is
frightening to let others (even imagined ones) get close
(Gilbert & Procter 2006).
It is unclear which aspects of compassion are
particularly threatening because our CFI involved
experiencing acceptance, loving kindness, warmth, and
compassion. Clinically, people often experience sadness
and grief when their attachment systems are activated
(Bowlby 1969, 1980). Compassionate imagery involves
activating these systems and drawing on emotional
memories of attachment (Gilbert 2007). The finding
that self-criticism was linked to an SDNN decrease
when engaging in CFI provides further support that self-
critics may find CFI difficult at first, this could also be
related to a lack of compassionate memories on which
to draw. This difficulty, and/or negative response to
feeling compassion for the self, can be a barrier to the
development of self-compassion, and could also be a
cause of the HRV decrease seen in Group 1SDNNdowns.
This suggestion fits with data by Segerstrom and
Solberg Nes (2007) who found HRV decreases to be
associated with self-regulatory processes, such as
inhibition of emotion.
A number of authors have noted that self-criticism
is a major vulnerability factor for low mood and
psychopathologies (Whelton & Greenburg 2005). Both
criticism from others (Dickerson & Kemeny 2004) and
self-criticism is linked to HPA axis arousal and cortisol
release (Mason et al. 2001). Gilbert (2007) suggests
that chronic self-criticism continually stimulates the
threat system thus having a detrimental impact on po-
sitive affect.
We concentrated on reporting the SDNN as
recommended by the global HRV metric Task Force,
(1996). However, there are other methods for exploring
the periodic processes involved in HRV, which may
shed more light on the relationships indicated by this
study. Second, we did not measure respiration or muscle
tension, and consequently the HRV changes could be
attributable to changes in breathing rate/depth, or
muscle tension. However, physical demands were kept
constant throughout the study making this unlikely.
Yet to be explored is whether training and working
through the fears and blocks to self-compassion, will
impact on HRV and other neurophysiological processes
linked to social soothing, and if this methodology could
be adapted for evaluating psychotherapies. Given the
increasing interest in compassion as a therapeutic aid,
further research into the neurophysiological mediators
and effects of compassion, may indicate ways of
developing psychotherapeutic techniques (Gilbert &
Irons 2005).
The authors would like to thank Linton
Instrumentation (Diss, Suffolk) for their facilitative
attitude and help with using Biopac software. This work
was undertaken by the Mental Health Research Unit who
received a proportion of its funding from the Department
of Health. The views expressed in this publication are those
of the authors and not necessarily those of the Department
of Health.
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... Kelly, Zuroff, Foa, & Gilbert, (2010) also suggest that the ability to activate compassionate visualization makes compassionate intervention more effective. According to Rockliff, Gilbert, McEwan, Lightman, and Glover (2008), compassion-focused imagery had an impact on the affective soothing system of people, while more self-critical ones can benefit more from such intervention. Imagery is often used in compassionate and self-compassionate interventions as a tool to cultivate this inner compassionate voice (e.g., Neff, 2003;Rockliff et al., 2008). ...
... According to Rockliff, Gilbert, McEwan, Lightman, and Glover (2008), compassion-focused imagery had an impact on the affective soothing system of people, while more self-critical ones can benefit more from such intervention. Imagery is often used in compassionate and self-compassionate interventions as a tool to cultivate this inner compassionate voice (e.g., Neff, 2003;Rockliff et al., 2008). ...
... Some studies show physiological differences between high and low-self-critics. According to Rockliff et al., (2008), low self-critics are characterized by increased heart rate variability, lower levels of the stress hormone (cortisol) and reduced pituitary activity. They note that all of these indicators are connected with relaxation and calmness. ...
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As self-criticism is considered to be the major underlying factor of all sorts of psychopathology, it is meaningful to explore the differences between how people deal with their self-criticism based on their level of self-criticism. The aim of this study was to categorise descriptions and investigate differences between 5 high and 5 low self-critical participants in their self-critical, self-protective and self-compassionate imageries. The total sample consisted of 10 university students, who were selected from a larger sample of 88 participants based on their extreme score from The Forms of Self-Criticising/Attacking and Self-Reassuring Scale. For analysis, we exploited Consensual Qualitative Research with two assessors and one auditor. The compassionate imagery was used to evoke the inner critic, protector and compassionate voice. The results showed differences in the imageries based on the level of self-criticism. Both high and low self-critics displayed difficulties in overcoming their self-criticism. Contrary to high self-critics, low self-critics showed more constructive and positive strategies for dealing with their self-criticism. Our study presented several different patterns between high and low self-critical participants in self-critical, self-compassionate, and self-protective imagery which could be used for diagnostic purposes in the future.
... Practicing self-compassion has shown to reduce interpersonal problems and psychological distress (Mak et al., 2018;Schanche et al., 2011), personal pathology and psychiatric symptoms including stress (e.g., Lutz et al., 2008), depression Shapira & Mongrain, 2010), and anxiety (e.g., Van Dam et al., 2011). Several longitudinal studies and laboratory experiments have also discussed the impact of compassion on direct physiological health improvements, such as reduced sympathetic nervous system activation, increased heart rate variability, and reduced inflammatory responses following exposure to a lab stressor (Arch et al., 2014;Breines et al., 2014Breines et al., , 2015Crocker & Canevello, 2012;Rockliff et al., 2008), and indirect health benefits caused from healthy behaviour such as healthy eating Schoenefeld & Webb, 2013), exercise (Magnus et al., 2010), medical adherence (Brion et al., 2014), dietary adherence (Dowd & Jung, 2017), and terminating smoking (Kelly et al., 2010). ...
... This model explains how various psychosocial vulnerabilities can be understood using the interplay between these three regulatory systems (Gilbert, 2005a(Gilbert, , 2015. Whilst an overactive threat system is found to inhibit compassion cultivation, the soothing system holds the capacity to suppress the threat and drive systems and facilitate the manifestation of compassion (Gilbert et al., 2008). ...
... On the other hand, the soothing system seeks signals of care, warmth, and affiliation, and arouses calmness and reassurance (Gilbert et al., 2008). Therefore, in the presence of social safeness, the warm, calming experience of feeling cared about, reassured by, and connected to others in the society, people are more likely to generate warm affiliative feelings such as compassion (Gilbert et al., 2009). ...
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The concept and benefits of practicing compassion have been recognised and discussed in the contemplative traditions for thousands of years. However, it is within the last two to three decades, that research and psychotherapy have shown an increased interest in integrating compassion for addressing mental health difficulties and increased well-being. Although heavily influenced by Buddhist philosophy and Eastern traditions, compassion related studies and interventions are mostly developed and applied in the Western communities. In fact, compassion-based studies are particularly scarce in the Asian context. Therefore, whilst briefly outlining the theories and existing compassion-based interventions, this thesis explored the cross-cultural applicability of compassion-based interventions in the Asian communities. A rigorous qualitative investigation discussed that compassion is a culturally embraced concept in Sri Lanka, a Buddhist influenced, collectivistic Asian community, and discussed the challenges Sri Lankan participants (n = 10) experience when practicing compassion. Participants discussed that showing compassion to others was easier than showing compassion to themselves, whilst religion, society, and upbringing influenced these experiences. To understand whether these compassionate experiences are similar across cultures, a cross-sectional quantitative study was conducted among Sri Lankan (n = 149) and UK (n = 300) participants. This study indicated that some similarities (e.g., compassion to and from others, depression, anxiety) and some differences (e.g., self-compassion and self-reassurance, fears of compassion and external shame were higher in the Sri Lankan group, and social safeness was higher in the UK group) existed in the levels of compassion, and facilitators and inhibitors of compassion across the two samples. Therefore, it was important to note that the impact of compassion-based interventions might have cross-cultural differences. To test this, a longitudinal Compassionate Mind Training was implemented among Sri Lankan (n = 21) and UK participants (n = 73), which produced promising results towards increasing compassion for the self and others, along with significant reductions in distress and improvements in well-being in participants across both countries. Thus, this thesis suggests that although research is limited in exploring the cross-cultural applicability of compassion, compassion-based interventions can be used effectively in the Asian communities.
... CFI aims to activate affiliative positive affect and to create long-lasting change by helping the client practice their 'compassionate self´and integrate this into their sense of self-identity, so that it shapes future patterns of thinking, behaving, feeling and attention [6]. Single trials of CFI in non-or sub-clinical populations have shown a reduction of negative affect, an increase in self-esteem, and physiological changes associated with the attenuation of threat-defensive behaviors [18][19][20]. Regular CFI practice has increased self-compassion and reduced negative affect in clinical and non-clinical populations [20][21][22][23]. ...
... Single trials of CFI in non-or sub-clinical populations have shown a reduction of negative affect, an increase in self-esteem, and physiological changes associated with the attenuation of threat-defensive behaviors [18][19][20]. Regular CFI practice has increased self-compassion and reduced negative affect in clinical and non-clinical populations [20][21][22][23]. ...
... Despite these promising findings, negative reactions to CFI have been observed. Some individuals have shown increased stress hormone release during CFI [25], or decreased HRV indicating a threat-focused response [20]. Thus, the assessment and treatment of factors that inhibit a positive response to CFI is important. ...
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Compassion-focused imagery (CFI) can be an effective emotion-regulation technique but can create threat-focused responses in some individuals. However, these findings have been based on tasks involving receiving compassion from others. This study sought to examine whether CFI involving self -compassion is less threatening than relaxation and whether any threat-responses decrease with practice. Method: 25 participants with high self-criticism and/or low self-compassion completed self-report measures of symptoms of depression and anxiety, then engaged in three tasks (control task, relaxation imagery, and CFI) three or four times every three days. Heart-rate variability (HRV) was collected during each task and clinically significant change was calculated between baseline and CFI scores, and between baseline and relaxation. Results: Across all participants, HRV was significantly higher during CFI than during relaxation. More individuals had a clinically significant increase in HRV in response to CFI (56%) than in response to relaxation (44%), and fewer had a clinically significant decrease in HRV during CFI (16%) than during relaxation (28%). Repeated trials did not improve responses to CFI. Conclusions: Even in high self-critics with clinical levels of symptoms, self-compassionate imagery may soothe physiological arousal without prior groundwork and is less likely to be aversive than standard relaxation tasks. For those who are not benefiting, practice alone is not sufficient to improve response.
... To date, experimental studies examining the relationship between vagal activation and positive affect-including compassion-have tended to use top-down cognitive-behavioral strategies to induce/enhance these states while measuring HRV(e.g. [31][32][33]). In addition, however, bottom-up methods for activating the VN have been proposed [17,34]; these tend to involve some form of regulated breathing or HRV biofeedback. ...
... Importantly, in addition to examining the stand-alone effects of tVNS on self-compassion and related outcomes, we will test the effects of combining tVNS with a behavioral intervention (compassionate mental imagery) that itself reliably increases subjective self-compassion [33,[42][43][44]. In fact, according to a psychophysiological model of compassion [20], vagal activation generates the physiological conditions necessary for compassionate responding, but is insufficient for generating such responding. ...
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Background: The vagus nerve (VN) is a neural nexus between the brain and body, enabling bidirectional regulation of mental functioning and peripheral physiology. Some limited correlational findings suggest an association between VN activation and a particular form of self-regulation: compassionate responding. Interventions that are geared towards strengthening self-compassion in particular, can serve as an antidote to toxic shame and self-criticism and improve psychological health. Objective: We describe a protocol for examining the role of VN activation on 'state' self-compassion, self-criticism, and related outcomes. By combining transcutaneous vagus nerve stimulation (tVNS) with a brief imagery-based self-compassion intervention, we aim to preliminarily test additivity versus synergy between these distinct bottom-up and top-down methods for putatively regulating vagal activity. We also test whether the effects of VN stimulation accumulate with daily stimulation and daily compassionate imagery practice. Methods: Using a randomized 2 x 2 factorial (stimulation x imagery condition) design, healthy volunteers (n = 120) receive active (tragus) or sham (earlobe) tVNS plus standardized (audio-recorded) self-compassionate or sham mental imagery instructions. These interventions are delivered in a university-based psychological laboratory in two sessions, one week apart, as well as being self-administered between sessions by participants at home. Pre-stimulation, peri-stimulation and post-imagery measures of state self-compassion, self-criticism and related self-report outcomes are assessed in two lab sessions, separated by a week (Days 1 and 8). Heart rate variability is used as a physiological metric of vagal activity and an eye-tracking task assesses attentional bias to compassionate faces during the two lab sessions. On Days 2-7, participants continue their randomly assigned stimulation and imagery tasks at home, and complete state measures at the end of each remote session. Discussion: Demonstrating modulation of compassionate responding using tVNS would support a causal link between VN activation and compassion. This would provide a basis for future studies of bioelectronic approaches to augmenting therapeutic contemplative techniques. Clinical trials registration:, Identifier: NCT05441774 (Date: July 1st 2022). Osf registration:
... However, no published study has yet examined the associations among fear of compassion and these personality traits, which is the purpose of the current study. Fear of compassion is characterized by a fear of positive emotions that are likely to be represented in FFM dimensions (Arieti & Bemporad, 1980;Gilbert, 2010;Rockliff, Gilbert, McEwan, Lightman, & Glover, 2008). For example, Gilbert et al. (2011) defined fear of compassion specifically as a fear of the affiliative behavior that is characteristic of extroverted individuals. ...
Compassion and self-compassion have significant benefits for well-being and mental health. Recent literature has demonstrated that some individuals experience fear when receiving compassion from oneself or others. Fear of compassion from oneself, from others, and for others are separate but related constructs that have been strongly linked to self-criticism, depression, anxiety, and stress among college students. The present study examines how fears of compassion (measured by the Fear of Compassion scales) relate to Big Five personality traits (measured by the NEO Five Factor Inventory; Costa & McCrae, 1992) in college students. Bivariate correlational analyses revealed fear of compassion to be correlated positively with neuroticism and negatively with extraversion, agreeableness, and conscientiousness. These findings add to the literature in understanding which individuals harbor fear of compassion. Clinical implications and recommendations are discussed.
... Self-criticism has been associated with lower positive emotional expressivity, and this reduced expression of positive emotion was found to mediate the relation between self-criticism and belonging . Relative to those low in self-criticism, research suggests that HSCs appear to have an aversive threat response to affiliative imagery (Duarte et al., 2015;Rockliff et al., 2008) and report more fear related to giving and receiving compassion, an affiliative positive emotion (for a metaanalysis, see Kirby et al., 2019). Theorists have posited that the activation of threat-related arousal in response to affiliative cues is likely due to the well documented association between self-criticism and insecure attachment (Gilbert et al., , 2011Werner et al., 2019). ...
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Research suggests the link between self-criticism and low social belonging is partially explained by lower expression of positive emotions (Luoma & Chwyl, 2020), however, it is not well understood why high self-critics (HSCs) express less positive emotions. The purpose of this study is to investigate the underlying mechanisms that might explain this reduced expression of positive emotions. Participants were recruited from an adult, community sample (N = 303). Participants came to the laboratory and were shown two short videos intended to reflect two different situations where social bonding might be possible, caregiving in response to another’s distress and responding with friendship/cooperation responses to another’s positive affect. They completed questionnaires pre- and post-video. We hypothesized that HSCs would respond to both videos with more negative emotions compared to low self-critics (LSCs) and would report more negative emotions in response to the caregiving stimulus compared to the friendship/cooperation stimulus. We further predicted HSCs would use more expressive suppression (ES) as an emotion regulation strategy and that their use of ES would be partially explained by increased negative emotions. Hypotheses were partially supported. Participants’ level of self-criticism positively predicted expressive suppression as well as negative emotions in response to both videos. HSCs reported higher shame across both videos, while low self-critics (LSC) reported variable shame across videos. HSCs’ increased use of ES was partially explained by their increase in negative emotions. These findings suggest HSCs may be using ES in response to contextually incongruent emotions. Clinical implications include providing HSCs with corrective emotional experiences in social-bonding contexts and helping them express their incongruent negative emotions in a safe setting.
... Research on self-compassion shows that it promotes psychological health and positive affect and decreases negative affect (Bluth & Neff, 2018;Neff et al., 2007;Wakelin et al., 2021;Zessin et al., 2015). Self-compassion has also been found to predict lower levels of anxiety and depression (Egan et al., 2022;Trindade & Sirois, 2021) , to increase the ability to cope with life stressors (Rockliff et al., 2008), and to be associated with increased psychological well-being (Zessin et al., 2015). ...
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Objectives Insight dialogue (ID) is a formal practice of dialogic meditation that brings into relationship practices deriving from Buddhist psychology that are typically limited to individual practice. The purpose of the current study was to examine the psychological effects of an ID intervention in promoting adults’ mindfulness, self-compassion, and psychological well-being. Our hypotheses were that individuals taking part in an ID retreat would experience an increase in mindfulness, self-compassion, and psychological well-being. Methods Participants (n = 100; Mage = 55.69; SD = 11.54) recruited from five ID retreats conducted across North America completed a battery of questionnaires including the Five Facet Mindfulness Questionnaire, the Self-Compassion Scale, and the Scales of Psychological Well-Being. Data were collected before and after each ID retreat. Results Significant effects of the ID practice from pre-retreat to post-retreat on mindfulness, self-compassion, and psychological well-being were found, evidencing the benefits of this innovative interpersonal practice which brings the qualities typically cultivated in silent individual practice of mindfulness to the relationship. Conclusions This study provided initial evidence that ID retreats may increase mindfulness, self-compassion, and psychological well-being.
... CFI is proposed to activate the soothing system by providing an internal compassionate representation and by facilitating feelings of warmth and affiliation (Gilbert & Irons, 2005). Physiological studies indicate that CFI can evoke different heart rate variability and cortisol reactions; some individuals experiencing increased heart rate variability (HRV) and a drop in cortisol (suggesting activation of soothing system), whereas others showing reduced HRV (suggesting a threat-based reaction) (Rockliff et al., 2008). These differences indicated that individuals with high-self criticsm and insecure attachment may experience CFI to be threatening. ...
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Background: Compassion-focused imagery (CFI) is a technique used to facilitate self-compassion by constructing and exploring imagery of a compassionate ideal. It is commonly used in Compassionate Mind Training, as part of a wider skills training intervention. This review aimed to explore the effectiveness of CFI on psychological outcomes when used as a brief standalone intervention across clinical and non-clinical adult populations. Population-specific effects were also explored. Methods: Following an extensive literature search, twenty studies were identified for inclusion in the review. Quality and risk of bias assessment was completed using the Effective Public Health Practice Project (EPHPP) tool. Where available, effect sizes were calculated for outcome measures of self-compassion, self-criticism and shame. Study findings were qualitatively synthesized. Results: Most of the studies reported improvements in psychological outcomes, such as improvements in self-compassion and positive affect, reduction in self-criticism, shame and paranoia. Across measures of self-compassion, self-criticism and shame, the effect sizes ranged between 0.02-1.1 and estimated treatment effects range between 0.09-1.39. Preliminary evidence is promising, with most studies reporting improvements in psychological outcomes; however the evidence is limited by the methodological challenges and heterogeneity within the literature. Studies which implemented CFI in severe head injury samples reported limited improvements. Improvements in paranoia measures were more consistently reported in non-clinical samples, when compared to studies using clinical samples. High levels of self-criticism emerged as an important potential barrier in individuals' ability to engage with CFI tasks.
... The emotional reactions may have been different were this instruction included in the practice. Additionally, future studies could test the moderation of other related constructs, such as fear of compassion (Rockliff et al., 2008), self-criticism (Longe et al., 2010), self-kindness (Przyrembel et al., 2019) or brooding (Barnhofer et al., 2010). Finally, the design in Study 2 was underpowered for the moderating effect due to the small sample size. ...
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Our understanding of the emotions elicited by loving-kindness meditation (LKM) at early stages of practice is limited, despite the influence that these emotions may have on later engagement. Past work suggests that LKM may elicit emotional ambivalence at early stages of the practice, but it is still unclear whether the content of LKM activates this ambivalence and who is more likely to experience it. Given the specific content of LKM, we defend that this meditation is likely to elicit empathetic emotions, both positive (compassion and gratitude) and negative (guilt), to a greater extent than an active control. Guilt is likely to be elicited by memories of incidents where naïve meditators were not able to experience compassion and/or by the difficulties in sending compassionate love to disliked others during the meditation. Furthermore, individuals with greater self-discrepancy and lower self-esteem are more likely to experience guilt. These hypotheses were tested in two experimental studies with community and student samples (n = 55 and n = 33, respectively) and This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
Human Nature and Suffering is a profound comment on the human condition, from the perspective of evolutionary psychology. Paul Gilbert explores the implications of humans as evolved social animals, suggesting that evolution has given rise to a varied set of social competencies, which form the basis of our personal knowledge and understanding. Gilbert shows how our primitive competencies become modified by experience - both satisfactorily and unsatisfactorily. He highlights how cultural factors may modify and activate many of these primitive competencies, leading to pathology proneness and behaviours that are collectively survival threatening. These varied themes are brought together to indicate how the social construction of self arises from the organization of knowledge encoded within the competencies. This Classic Edition features a new introduction from the author, bringing Gilbert’s early work to a new audience. The book will be of interest to clinicians, researchers and historians in the field of psychology.
The present study investigated the abnormalities of cardiovascular responses to contextual or explicit emotional stimuli with respect to the two facets of psychopathy in a Japanese undergraduate population assessed by a Japanese version of the Primary and Secondary Psychopathy Scales. In study 1, recording heart rate and fingertip skin temperature while the participants watched an unpleasant movie, we found that the participants with high tendencies toward antisocial behavior (n = 16) showed smaller reactivity than those with low tendencies toward antisocial behavior (n = 16). By contrast, in study 2, heart rate orienting responses to affective slides were recorded, and the participants with high tendencies toward emotional detachment (n = 15) showed smaller responses to unpleasant slides than those with low tendencies toward emotional detachment (n = 16). Consistent with previous studies which recorded skin conductance and startle eye blink with psychopaths, these findings using a non-institutionalized sample also suggest that affective dysfunction in psychopathy is based on two specific physiological mechanisms.
This article defines and examines the construct of self-compassion. Self-compassion entails three main components: (a) self-kindness—being kind and understanding toward oneself in instances of pain or failure rather than being harshly self-critical, (b) common humanity—perceiving one's experiences as part of the larger human experience rather than seeing them as separating and isolating, and (c) mindfulness—holding painful thoughts and feelings in balanced awareness rather than over-identifying with them. Self-compassion is an emotionally positive self-attitude that should protect against the negative consequences of self-judgment, isolation, and rumination (such as depression). Because of its non-evaluative and interconnected nature, it should also counter the tendencies towards narcissism, self-centeredness, and downward social comparison that have been associated with attempts to maintain self-esteem. The relation of self-compassion to other psychological constructs is examined, its links to psychological functioning are explored, and potential group differences in self-compassion are discussed.