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Compassion at the mirror: Exposure to a mirror increases the efficacy of a self-compassion manipulation in enhancing soothing positive affect and heart rate variability


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We tested whether a mirror could enhance the efficacy of a self-compassion manipulation in increasing soothing positive affect and heart rate variability (HRV). Eighty-six participants generated four phrases they would use to soothe and encourage their best friend. Second, they described an episode where they criticized themselves and were assigned to one of three conditions: (a) repeat the four phrases to themselves while looking at the mirror; (b) repeat the four phrases to themselves without the mirror; (c) look at themselves in the mirror without repeating the phrases. Participants in condition (a) reported higher levels of ‘soothing’ positive affect and HRV compared to participants in conditions (b) and (c). The effect of the ‘phrases at the mirror’ manipulation on soothing affect was mediated by increased common humanity. The mirror enhances the efficacy of this self-compassion manipulation in activating the soothing affect system connected with parasympathetic nervous system activity.
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The Journal of Positive Psychology
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Compassion at the mirror: Exposure to a mirror
increases the efficacy of a self-compassion
manipulation in enhancing soothing positive affect
and heart rate variability
Nicola Petrocchi , Cristina Ottaviani & Alessandro Couyoumdjian
To cite this article: Nicola Petrocchi , Cristina Ottaviani & Alessandro Couyoumdjian (2017)
Compassion at the mirror: Exposure to a mirror increases the efficacy of a self-compassion
manipulation in enhancing soothing positive affect and heart rate variability, The Journal of Positive
Psychology, 12:6, 525-536, DOI: 10.1080/17439760.2016.1209544
To link to this article:
Published online: 14 Jul 2016.
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VOL. 12, NO. 6, 525536
Compassion at the mirror: Exposure to a mirror increases the ecacy of a self-
compassion manipulation in enhancing soothing positive aect and heart rate
Nicola Petrocchia,b, Cristina Ottavianib and Alessandro Couyoumdjiana
aDepartment of Psychology, Sapienza University of Rome, Rome, Italy; bIRCCS Santa Lucia Foundation, Rome, Italy
We tested whether a mirror could enhance the ecacy of a self-compassion manipulation in
increasing soothing positive aect and heart rate variability (HRV). Eighty-six participants generated
four phrases they would use to soothe and encourage their best friend. Second, they described an
episode where they criticized themselves and were assigned to one of three conditions: (a) repeat
the four phrases to themselves while looking at the mirror; (b) repeat the four phrases to themselves
without the mirror; (c) look at themselves in the mirror without repeating the phrases. Participants
in condition (a) reported higher levels of ‘soothing’ positive aect and HRV compared to participants
in conditions (b) and (c). The eect of the ‘phrases at the mirror’ manipulation on soothing aect was
mediated by increased common humanity. The mirror enhances the ecacy of this self-compassion
manipulation in activating the soothing aect system connected with parasympathetic nervous
system activity.
Self-criticism has been dened as an integrated system
of beliefs, emotions and attitudes that people might acti-
vate towards themselves mainly in response to failures or
setbacks (Gilbert, 2005; Whelton & Greenberg, 2005). This
process often takes the form of negative and coercive self-
talk and inner hostile voices, which stimulate the same
neurophysiological systems as criticism generated by oth-
ers (Gilbert, Baldwin, Irons, Baccus, & Palmer, 2006; Longe
et al., 2010). As a result of the self-harassing dynamic,
highly self-critical individuals are thought to have an
over-stimulated and poorly regulated threat emotional
system, with subsequent negative aectivity and under-
developed capacities for compassionate self-soothing
activities (thoughts, self-talk and images; Gilbert & Procter,
2006). Even if self-monitoring and self-correcting activi-
ties are normal components of non-clinical psychological
functioning, more severe forms of self-criticism have been
examined as a vulnerability risk factor for most psycho-
pathological conditions (for a review see Schanche, 2013).
Several therapeutic approaches, such as Compassion
Focused Therapy (CFT; Gilbert, 2010, 2014) and Mindful
Self-Compassion training (MSC; Ne & Germer, 2013), have
been developed with the aim of increasing compassion
and self-compassion as an antidote to self-criticism. The
primary aim of these approaches is to increase acceptance
and compassion for one’s own distress, and to strengthen
the ability to refocus and consciously activate ‘safeness
self-signaling systems (Boersma, Håkanson, Salomonsson,
& Johansson, 2014). These self-soothing activities oper-
ate through the stimulation of particular types of positive
aect (contentment, safeness, lovability, serenity) associ-
ated with the attachment and caring motivational systems.
Physiologically, they are connected to increased activity
of the vagus nerve and corresponding higher heart rate
variability (Porges, 2007). These types of warm positive
feelings have been found to be distinct from energizing
positive aect (happiness, excitement, enthusiasm) associ-
ated with achievement, excitement and resource seeking
(Depue & Morrone-Strupinsky, 2005; Gilbert etal., 2008;
Panksepp, 1998). It is the safeness and contentment types
of positive aect that have been specically linked to less
depression, anxiety and self-criticism, as well as more
self-reassurance and attachment secureness (Gilbert etal.,
2008; Kelly, Zuro, Leybman, & Gilbert, 2012). Thus, stimu-
lating the capacity for feeling a positive sense of content-
ment, safeness, and self-reassurance is the primary goal
of compassion-oriented interventions (Germer, 2009;
Gilbert, 2010).
One of the practices employed in CFT and other com-
passion-focused trainings is ‘compassionate self-talk’
(Gilbert, 2010). Subjects are asked to become aware of
© 2016 Informa UK Limited, trading as Taylor & Francis Group
Self-criticism; self-
compassion; heart rate
variability; mirror; self-talk;
Received 31 December 2015
Accepted 14 June 2016
CONTACT Nicola Petrocchi
exposure tool has been extensively documented in the
treatment of eating disorders (see, e.g. Hildebrandt, Loeb,
Troupe, & Delinsky, 2012). It is also currently employed to
improve positive self-awareness and self-representation in
subjects diagnosed with autism spectrum disorder (Du
& Flattery, 2014). Mahoney (1991) has described a tech-
nique in which clients are asked to look at themselves in
a mirror while spontaneously describing their experience,
with the goals of enhancing clients’ self-exploration and
facilitating the emergence of a new ‘dialoguing with one
self’ (Williams, Diehl, & Mahoney, 2002, p. 23). There is some
evidence that this technique improves awareness of the
current emotional experience (Williams etal., 2002) and
self-acceptance (Beskow & Palm, 1998).
A similar technique, called ‘self-mirroring’ has been
recently described by Vinali etal. (2015): patients are asked
to watch a video of their face while recalling a signicant
life event. The video recording is supposed to ‘mirror’ their
emotions and appraisal patterns, improving patients’ abil-
ity to recognize and compassionately empathize with their
own emotional distress.
The present study
Given these preliminary results that both compassionate
self-talk and the mirror may positively impact self-relating,
we hypothesized that the eects of compassionate self-
talk might be amplied by performing this exercise in
front of a mirror. The repetition of positive armations in
front of a mirror as a way to increase self-acceptance has
been extensively described and recommended for years in
numerous ‘pop psychology’ books, websites, and self-help
resources (see, e.g. Hay, 1991; Hay House, 2015), but to the
best of our knowledge, it has never been empirically tested.
Moreover, Gilbert (2010) suggested that self-compassion
practices involving the repetition of self-compassionate
phrases might be potentiated by the use of a mirror as
a way to ‘externalize the ‘object’ of our compassion (i.e.
the self). In fact, eye-gaze and facial expressions are
salient components of our empathic responses (Cowan,
Vanman, & Nielsen, 2014). Considering that self-related
stimuli (e.g. our own face) are more relevant to us than
stimuli related to others (Brédart, Delchambre, & Laureys,
2006), and that the sense of self seems to be inherently
linked to one’s own face (Porciello etal., 2014), looking
at our own eyes and face while experiencing compassion
towards ourselves might impact our psychophysiology
more than just verbalizing self-compassionate phrases.
Moreover, empathetic processes are supported by, and
require, the embodied expression and communication of
emotions that only the face provides (Cole, 2001). Thus,
wehypothesized that the use of a self-reection tool might
improve our ability to empathize alsowith ourselves.
the content and emotional tone of their ‘internal dialogue’
when they face setbacks, and to consciously render it
more compassionate, encouraging and non- judgmentally
accepting of the self. Intentionally creating compassion-
ate self-statements after a self-criticism induction has
proven to be eective in increasing positive aect, without
undermining people’s willingness to accept responsibility
for the negative actions, and in improving perception of
similarity to other people (common humanity; Leary, Tate,
Adams, Allen, & Hancock, 2007). It has also shown ecacy
in lowering shame and depression (Kelly, Zuro, & Shapira,
2009), increasing self-improvement motivation, and boost-
ing willingness to make amends and avoid repeating a
moral transgression (Breines & Chen, 2012). Creating
and reading aloud positive self-statements, instead of
neutral self-statements, has been shown to reduce self-
deprecatory thoughts and increase self-esteem in a group
of low self-esteem subjects (Lange, Richard, Gest, Vries, &
Lodder, 1998). It has also been considered as an impor-
tant aid for the treatment of emotional disorders (Lange,
Richard, Kiestra, & van Oostendorp, 1997). Evidence seems
to suggest that this intervention could be improved by the
use of a mirror.
The mirror as a psychotherapeutic tool
The capacity of the mirror to induce a state of self-focused
attention has made it the object of investigation in the
research eld on self-awareness and self-focusing (Silvia,
2002). According to objective self-awareness theory, when
individuals are in a state of self-awareness (for example,
when they are exposed to their mirror reection), they
tend to compare themselves to their standards (Duval
& Wicklund, 1972). Self-to-standard comparison often
brings unfavorable results, activating negative emotions
as a result.
However, results regarding the aversive nature of
self-focused attention induced by mirror exposure have
not always been consistent. In fact, research has shown
that exposure to a mirror can reduce self-critical eval-
uations. For example, Hofmann and Heinrichs (2002)
asked undergraduate college students to record three
self positive and three self negative attributes after sit-
ting in front of a mirror for 5min. Individuals with prior
mirror exposure showed a greater balance between pos-
itive and negative self-statements, and fewer self-critical
statements concerning non-socially relevant personality
characteristics, than participants without previous mir-
ror exposure. In a later study, Hofmann and Heinrichs
(2003) replicated these ndings with social anxiety dis-
order patients.
The mirror has also been applied in the treatment of
dierent psychopathological conditions. Its use as an
Specically,we predicted that repeating self-compas-
sionate phrases in front of a mirror after a brief induction of
self-criticism would produce a higher increase in positive
aect (in particular, the ‘soothing’ positive aect linked
to increased self-reassurance and safeness) compared to
repeating the phrases without the mirror, or to just looking
at the mirror without repeating the phrases.
However, the repetition of the phrases at the mirror
was not expected to increase activated positive aect. In
fact, compassion-focused interventions are specically
designed to increase soothing positive aect (Gilbert etal.,
2008; Kelly etal., 2012).
Research has reported mixed ndings regarding the
impact of compassion-focused interventions on nega-
tive aect: some studies have documented decreased
negative aect in response to the intervention (Gilbert &
Procter, 2006; Ne & Germer, 2013), while other stud-
ies have reported no specic eects on negative aect
(Klimecki, Leiberg, Lamm, & Singer, 2013; Odou & Brinker,
2015). Given these mixed ndings, no specic predictions
were formulated as to the eect of the intervention on
negative aect.
Given that increased HRV is specically connected to
the emotional state of compassion and not to positive
aect in general (Stellar, Cohen, Oveis, & Keltner, 2015),
we also expected that HRV would increase in the ‘phrases
at the mirror’ condition more than in the other two condi-
tions, in line with the increase in soothing positive aect
expected in that condition.
It was also hypothesized that the effect of repeating
the phrases in front of a mirror would be partially medi-
ated by an increase in common humanity, a component
of self-compassion (Neff, 2003) which reflects how ‘not
so abnormal and shameful’ we apprise our defects and
suffering, and how able we are to remind ourselves that
thoughts and feelings of inadequacy are shared by most
people. Data have shown that increased self-awareness,
induced also by mirror exposure (Hofmann & Heinrichs,
2002, 2003), is positively linked to theory of mind, which
is the ability to understand that others, similar to us,
have complex mental states (beliefs, desires, emotions,
knowledge, etc.) and, consequently, share with us the
same potential for suffering (Keenan, Gallup, & Falk,
2003). Following this line of reasoning, we hypothe-
sized that the state of self-awareness generated by mir-
ror exposure might strengthen the de-shaming effect
of the self-compassion phrases, by fostering a sense of
‘not-aloneness’ in our shortcoming, and of belonging
to a shared human vulnerability to suffering and the
causes of it.
The mirror, helping subjects to have an ‘external view’
of themselves and their issues, was expected to improve
this dimension and, as a consequence, to increase the level
of compassionate feelings experienced toward their own
The sample was composed of 43 men and 47 women,
mean age 26.34years (SD=7.8) recruited from the gen-
eral population. Four subjects were not included in the
analyses due to unreliable physiological measures, leaving
a sample of 86 participants (40 men). Recruitment was con-
ducted through yers, websites, and social networks. All
subjects were Caucasian and native Italian speaking. Data
on income or socioeconomic status of participants were
not collected. Exclusionary criteria were major psychiatric
or cognitive problems, psychotic or organic illnesses, sub-
stance abuse, cardiovascular disease, use of drugs/medi-
cations that might aect cardiovascular function, obesity
(body mass index> 30kg/m2), menopause, use of oral
contraceptives during the previous 6months, and preg-
nancy or childbirth within the last 12months. The protocol
was approved by the local Ethics Committee.
Design and procedure
Participants were asked to refrain from (a) eating, (b) drink-
ing alcohol, tea or coee, and (c) strenuous exercise 2h
preceding the scheduled appointment. The experiment
was conducted as a randomized group comparison design.
In order to obscure the focus on self-compassion and
self-criticism and reduce the likelihood of biased ratings
on mood items, participants were told that the aim of the
study was to test for eects of dierent interventions on
dierent types of thoughts and feelings.
The experimental phase took place in a one-to-one ses-
sion in a small quiet oce. After being informed about
the procedure, participants provided informed consent,
were asked to sit in front a computer monitor, and were
hooked up with the electrocardiogram (ECG) electrodes.
The initial steps of the experimental procedure were the
same for all three conditions. Participants were rst asked
to relax for 5 min while leang through a magazine with
neutral content in order to acquire a baseline ECG record-
ing. They were then asked to rate their momentary aect
using visual analogue scales (VASs at Time 1 – Baseline; see
Section ‘Measures for more details). All participants were
then instructed by a 2min audio recording to generate
and write four compassionate phrases. The instructions
were as follows:
I am now going to ask you to imagine that one of your
dearest friends is experiencing an upsetting situation,
which involves some kind of rejection, disappointment
or failure, and that he/she is very self-critical about it.
experimental manipulation was followed by a nal assess-
ment of momentary aect (using VASs) and common
humanity feelings (Time 3). At this point, participants in
all conditions were also asked to rate how closely they
were able to follow the manipulation instructions (from
0=completely unable to 4=completely able) and how
dicult it was for them to follow the manipulation instruc-
tions (from 0=very dicult to 4=very easy). Participants
in condition c) were also asked if, during the mirror expo-
sure, they repeated the phrases previously created (yes/no)
or if they engaged in some kind of conscious and active
compassionate self-talk (yes/no).
Finally, participants were debriefed and oered profes-
sional counseling in case of any emotional distress caused
by the experiment.
Dispositional questionnaires and questions regarding
habits (‘how often and for how long do you look at yourself
in the mirror in a typical day?’; see the Section ‘Measures’
for more details) were administered after the experimental
procedure (to obscure the goal of the experiment), using
QuestionPro survey website. A web link for the online sur-
vey was sent to participants via email after the completion
of the experimental procedure. See Figure 1 for a ow chart
of the procedure.
Dispositional measures
Socio-demographic and personal information
Participants were asked to complete a socio-demographic
form, which included items regarding gender, age, level
of education, height and weight for BMI calculation, and
smoking habits (‘are you a smoker?’ Yes/No).
The Center for Epidemiologic Studies Depression Scale
(CES-D; Radlo, 1977) was administered. The CES-D is a
20-item self-report scale that assesses the frequency of
occurrence of symptoms of depression during the past
week. In this study internal consistency was α=0.91.
The Spielberger State-Trait Anxiety Inventory – Trait
Form (STAI; Spielberger, Gorsuch, & Lushene, 1970) was
employed. STAI-Trait is a 20-item self-report measure of
anxiety proneness that requires participants to rate their
frequency of anxiety symptoms. In this study internal con-
sistency was α=0.93.
Trait self-criticism, self-attacking, and self-reassuring
The Forms of Self-criticizing/attacking and Self-reassuring
Scale (FSCRS; Gilbert, Clarke, Hempel, Miles, & Irons, 2004)
Please write four phrases thatyou would use to soothe
and encourage him/her, and that express compassion,
understanding, and unconditional acceptance for your
friend and for the part of the self that he/she dislikes.
Instructions for generating compassion-focused phrases
were based on descriptions of this method as detailed by
Gilbert (2010).
This was followed by the induction of self-critical nega-
tive emotions: participants were asked to think about and
write a detailed description (5 min) of a recent episode in
which they harshly criticized themselves, or felt ashamed
and disappointed by themselves. Then, the aect VASs
were administered again (Time 2). State level of common
humanity feelings regarding the content of their self-criti-
cism episode was also assessed at this point (see Measures
section for more details).
Subsequently, participants were randomly assigned
to 1 of 3 experimental conditions where they had to: (1)
repeat the four phrases to themselves while looking at a
mirror (n=30), (2) repeat the four phrases to themselves
without a mirror (n=28); or (3) look at themselves in a
mirror without repeating the phrases (n=28). Instructions
were delivered through a 3 min audio recording. The
Figure 1.Flow chart of the experimental procedure.
State common humanity
At Time 2 and Time 3, participants were asked to rate, on
a 7-point Likert scale, four items adapted from the com-
mon humanity subscale of the Self-compassion Scale
(Ne, 2003), to assess the current level of this dimension
regarding the content of the self-criticism episode. The
four items were: ‘In this moment, I see my failings as part of
the human condition’, ‘In this moment, I feel that there are
lots of other people in the world experiencing failures and
imperfections’, ‘In this moment, my aws and inadequacies
make me feel more separate and cut o from the rest of
the world’ and ‘In this moment, I feel alone in my failure
and feelings of inadequacy’. After reversing the scores of
the two negative items, the mean of the four items was
computed and employed in subsequent analyses. Internal
consistency for this parcel was α=0.79.
Psychophysiological measures
The electrocardiogram (ECG) was continuously monitored
(Monitoring, Adatec s.r.l., Italy) throughout the experiment
with a standard electrode conguration (right clavicle and
precordial site V6). Three disposable Ag- AgCl electrodes
were used. The ECG signal was digitized at 1000Hz and
inspected oine using Monitoring software (Adatec s.r.l.,
Italy). Successive R waves (identied by an automatic beat
detection algorithm) were visually inspected, and any
irregularities were edited. Heart rate and a time domain
measure of HRV (Root Mean Square Successive Dierence;
RMSSD) were then obtained for baseline, induction,
and each experimental condition using HRV Analysis
Software (Niskanen, Tarvainen, Ranta-Aho, & Karjalainen,
2004). According to the Task Force guidelines, the RMSSD
reects the integrity of vagus nerve-mediated autonomic
control of the heart (Task Force of the European Society
of Cardiology & the North American Society of Pacing &
Electrophysiology, 1996).
Data analyses
The analyses were carried out using SPSS Version 21. Only
signicant (p<0.05) results are reported. To control for
the presence of preexisting baseline dierences between
the three experimental subgroups, a series of one-way
Analyses of Variance (ANOVAs) were computed on all the
dispositional (socio-demographic variables and trait ques-
tionnaires), state (NA, activated PA, soothing PA, and state
common humanity) and physiological measures (HR and
We tested for the eectiveness of the self-criticism
induction (manipulation check) by comparing all out-
come measures (NA, activated PA, soothing PA, HR and
HRV) at T1 and T2 using Bonferroni corrected paired
was employed. The scale consists of 22 items assessing the
way people ‘treat themselves’ when things go wrong. This
measure is composed by three dimensions: inadequate
self, which assesses feelings of inadequacy and a sense
of frustration towards the self; hated self, which assesses
a feeling of self-hate and desire to hurt the self; and reas-
sured self, which indicates the ability to be self-soothing
and reassuring when facing failures. In the present study
Cronbach’s α for the Hated-Self scale was 0.80, for the
Reassured-Self scale was 0.88, and for the Inadequate-Self
scale was 0.93.
Trait self-consciousness and social anxiety
The Self-Consciousness Scale Revised (Scheier & Carver,
1985) was employed to assess dispositional private and
public self-consciousness, and social anxiety. In the pres-
ent study Cronbach’s α for the Private self-consciousness
scale was 0.83, for the Public self-consciousness scale was
0.84, and for the Social anxiety scale was 0.86.
Other stable features
Questions regarding perceived pleasantness of the face (1
item, rated on a 7-point Likert scale), minutes spent in front
of the mirror every day (1 item, rated on a 7-point Likert
scale), and perceived pleasantness of the voice (1 item, rated
on a 7-point Likert scale) were also included.
State measures
Visual analogue scales – VASs
At Time 1 (baseline), Time 2 (after the self-criticism induc-
tion), and Time 3 (after the experimental manipulation),
participants were asked to rate their current levels of neg-
ative and positive aect on several visual analogue 100-
point scales (VAS). The VAS is a measure of aect intensity
that is valid for registering short-term changes in aect
(Albersnagel, 1988). Negative aect (NA) was assessed
by four emotions related to the self-criticism induction
(ashamed, disgusted with themselves, guilty, angry at
The activated and the soothing positive aect were
assessed by two subscales of the Activation and Safe/
Content Aect Scale (Gilbert et al., 2008). Four items
with the highest factorial loading of the activated posi-
tive aect (lively, energetic, excited, enthusiastic) and the
soothing positive aect (safe, secure, content, warm) were
Given their high internal consistency (Cronbach’s α for
negative aect=0.82; activated positive aect: α=0.76;
soothing positive aect: α = 0.73), responses to items
belonging to the same aect system were aggregated
to compute the mean. These three items’ parcels will be
referred to as ‘NA’, ‘activated PA’, and ‘soothing PA’.
recommended cut-o points (Kline, 1998), consistent with
the assumption of approximate normal distributions.
Initial data screening revealed no signicant base-
line dierences at trait and state measures at Time 1 (all
ps>0.05). Chi-square tests showed no dierences between
the three groups for gender (p=0.07) and smoking habits
(p=0.06). However, the three groups showed a dierence in
age, F(2,83) = 3.86, p<0.05: participants in the ‘mirror-only’
group were signicantly younger than those in the ‘phrases
at the mirror’ group (see Table 1 for means, standard devi-
ations and statistics). Moreover, the three groups diered
on level of education, F(2,83) = 4.44, p<0.05: the ‘phrases
only’ participants had a signicantly higher level of educa-
tion than those in the ‘phrases at the mirror’ group. Thus,
age and level of education were included as covariates in
all following analyses. The assumption of homogeneity of
variances and homogeneity of regression slopes was met
for all the dependent variables.
Eect of self-criticism induction
Bonferroni corrected paired t-tests indicated that NA sig-
nicantly increased from Time 1 (before the self-criticism
induction) to Time 2 (after the self-criticism induction) (all
ps<0.001). The activated PA, and the soothing PA, signi-
cantly decreased from T1 to T2 (all p<0.001). Furthermore,
HR increased and HRV decreased from T1 to T2. The induc-
tion can therefore be considered eective in increasing
negative aect connected to self-criticism, and in reducing
positive aect, with associated increase in HR and decrease
in HRV (see Table 2).
Eect of experimental manipulation
GLM results showed a main eect of Time on all dependent
variables, except for HR and HRV. Negative aect signi-
cantly decreased from T2 to T3 (all ps<0.01; see Table 2 for
means, standard deviations, and statistics). The activated
PA and the soothing PA, signicantly increased from T2 to
T3 (all ps<0.05).
A signicant Time × Group interaction emerged for
the soothing PA (see Figure 2) and for HRV, (see Figure 3).
To test for the eects of our experimental manipula-
tion, a series of 3 × 3 General Linear Models (GLMs) with
Group (phrases at the mirror vs phrases without the mirror
vs mirror without phrases) as a between subject variable,
Time (Time 1, Time 2, Time 3) as a within subject variable,
and Gender as covariate were conducted on NA, activated
PA, soothing PA, HR and HRV. Partial eta-squared (η
) were
calculated to quantify the eect sizes.
Then, bootstrapping tests of mediation were performed
using the Preacher and Hayes (2008) PROCESS macro with
5000 bootstrap samples. This approach provides unstand-
ardized betas for the indirect eect estimates, and the
corresponding 95% bias-corrected and accelerated con-
dence intervals. If the values between the upper and
lower condence limits do not include zero, this indicates
a statistically signicant mediation eect. In this study, the
independent variable was Group, the dependent variables
were the change score from Time 2 to Time 3 of outcome
variables that showed a signicant Group × Time inter-
action in the previous GLMs, and the mediator was the
change score in state common humanity from Time 2 to
Time 3.
To control for dierences between how closely partic-
ipants followed the instructions and how dicult it was
for them, one-way ANOVAs with Bonferroni post hoc cor-
rection were computed on these two items between the
three experimental subgroups (see Section ‘Design and
Procedure’ for more details).
Preliminary analyses and group dierences at
Twelve univariate outliers were found. However, consid-
ering the little dierence existing between mean and 5%
trimmed mean, all outliers were considered as not distort-
ing data and, therefore, included in the main analyses. No
multivariate outliers were found using the Mahalanobis
statistic. Based on examination of the Kolmogorov–
Smirnov and Shapiro–Wilk statistic, several variables were
not normally distributed. However, Skewness’ and Kurtosis’
values were not severely biased, as these were below the
Table 1.Mean scores, standard deviations and statistics for age, level of education and body mass index. Only significant statistics are
Note: Level of education scores: 0 = Junior high school; 1 = Senior high school; 2 = Bachelor’s degree; 3 = Master’s degree, 4 = Doctoral degree or a second-level
Master’s degree, ns = non significant.
Phrases at the mirror Group M (SD) Phrases only Group M (SD) Mirror only Group M (SD) Statistics
Age 29.10a26.10 23.5ba > b
(4.03) (3.3) (3.2) p < 0.01
Level of education 2.5a3.1b2.7 b > a
(0.63) (0.56) (0.62) p < 0.05
BMI (kg/m2) 21.82 21.50 22.01 ns
(1.1) (1.2) (1.1)
Gender was not a signicant covariate in both models. Post
hoc Bonferroni corrected analyses showed no dierences
between the 3 groups at Time 1 and the Time 2. However,
at Time three there were statistically signicant dier-
ences in the soothing PA, F(2, 81) = 5.8, p<0.01, partial
η2=0.12 and HRV, F(2, 81) = 4.7, p=0.012, partial η2=0.97.
Bonferroni corrected pairwise comparisons showed that
the ‘phrases at the mirror’ group scored signicantly higher
than the other two groups on both the soothing PA and
HRV (see Table 2 for means, standard deviations, and sta-
tistics). No other signicant dierences emerged.
Mediating eect of common humanity
Two distinct bootstrapping tests of mediation were
performed, with Group as the independent variable,
change score in common humanity from Time 2 to Time
3 as a mediator, and the soothing PA and HRV change
scores from Time 2 to Time 3 as the dependent variables,
Overall, the model with change score in soothing PA
as the dependent variable accounted for 19.4% of its
variance. Importantly, the indirect eect of group on the
dependent variable (via score increase in common human-
ity) was signicant (B=−1.47; CI [−3.89, −0.09]), suggesting
that increases in common humanity mediated the eect
of Group on the soothing PA increases. In addition, results
indicated that the direct eect of Group on the dependent
variable remained signicant (B=−5.52, CI [−9.5, −1.53])
when the mediator was included in the model, thus sug-
gesting a partial mediation (see Figure 4 for unstandard-
ized coecients).
The model with HRV change score as the dependent
variable accounted for 12.8% of its variance. However, the
indirect eect of Group on the dependent variable (via
score increase in common humanity) was not signicant
(B=−1.08; CI [−3.63, 0.07]), suggesting that score increase
Figure 2. Time × Group interaction for the ‘soothing positive
affect’ VASs.
Table 2.Mean scores, standard deviations, and statistics of affect systems (VASs), common humanity, HR, and HRV (RMSSD) in the three groups before the emotion induction (T1), after the
self-criticism induction (T2), and after the intervention (T3).
Note: M & P = mirror and phrases; HR = heart rate; RMSSD = root mean square of the successive differences. Only significant statistics are reported. ns = non significant.
T1 T2 T3 Statistics
M & P M (SD) Phrases M (SD) Mirror M (SD) M & P M (SD) Phrases M (SD) Mirror M (SD) M & P M (SD) Phrases M (SD)
Mirror M
Main eect of
Time × group
Negative affect 19.7 (19.4) 17.9 (18.9) 17.7 (14.4) 43.5 (17.7) 38.9 (22.2) 40.4 (18.5) 23.7 (26.3) 27.3 (25.7) 26.5 (21.1) F(4,162) = 8.04, p
< 0.01, partial η2
= 0.09
Activated PA 50.9 (16.9) 49.8 (16.4) 52.4 (19.2) 35.2 (18.8) 40.6 (18.5) 42.1 (15.8) 49.3 (19.1) 45.9 (18.6) 47.4 (22.2) F(4,162) = 4.65, p
< 0.05, partial η2
= 0.05
Soothing PA 50.1 (18.8) 46.6 (18.1) 47.9 (16.6) 31.6 (11.1) 32.8 (16.8) 34.3 (15.3) 56.5 (17.1) 41.5 (18.6) 44.5 (17.5) F(4,162) = 11.36, p
< 0.01, partial η2
= 0.12
F(4,162) = 6.16,
p < 0.01,
partial η2 =
/ 4.75 (0.89) 4.88 (1.44) 4.97 (1.60) 5.19 (1.09) 5.06 (1.19) 4.8 (1.23) ns F(2,83) = 3.58, p
< 0.05, partial
η2 = 0.08
HR (bpm) 82.4 (7.7) 82.5 (10.6) 81.1 (11.1) 84.6 (12.4) 83.7 (10.4) 82.5 (11.4) 84.2 (7.3) 81.5 (9.6) 81.3 (9.9) ns ns
RMSSD (ms2) 66.1 (21.1) 71.4 (17.1) 69.1 (22.9) 58.1 (17.9) 58.9 (15.4) 59.07 (15.5) 81.4 (27.6) 68.6 (15.2) 67.6 (16.8) ns F(4,162) = 7.24,
p < 0.01,
partial η2 =
& Chen, 2009). In fact, the warm and positive feelings of
safeness and contentment stemming from compassion-
ate self-relating have been shown to protect against the
depressogenic eects of shame and self-criticism (Gilbert
etal., 2008).
The main purpose of this study was to investigate
whether the ecacy of a 5-min compassionate self-talk
manipulation in augmenting positive emotions could be
enhanced by performing it in front of a mirror and direct-
ing the phrases toward participants’ own reection. As
expected, results showed that repeating the phrases in
front of the mirror enhanced the soothing positive aect
more than repeating the phrases out loud, without the
mirror, or just looking at their reection in the mirror
without repeating the phrases. The soothing aect sys-
tem is triggered by signals of social connectedness and
safeness (Carter, 1998; Depue & Morrone-Strupinsky, 2005;
Wang, 2005). Increases in this particular type of positive
aect, which is linked to the caring motivational system,
and to aliative warm relationships, are the target of all
compassion-focused interventions. Research has shown
that from birth, the brain has specialized systems that
are highly responsive to social stimuli (warm voice tones,
facial expressions, touching, and holding; Schore, 1994;
Trevarthen & Aitken, 2001), and that these social signals
are major regulators of arousal, emotions, and physiolog-
ical processes (Cacioppo, Berston, Sheridan, & McClintock,
2000). Thus, the mirror seems to be an eective addition to
the self-talk exercise because it intensies exactly the type
of positive emotions that are considered to have a major
protective eect against self-criticism and shame-based
diculties. Physiological data supported this result: HRV,
an index of adaptive emotion regulation, high levels of
‘safety-based’ positive emotions (Thayer, Åhs, Fredrikson,
Sollers, & Wager, 2012), and a physiological marker of com-
passion (Stellar etal., 2015), increased when the phrases
were repeated in front of the mirror more than in the other
two conditions.
One possible explanation for this eect is that the mir-
ror increases the quantity of positive self-relating social
signals that we can process (not only the voice but also
the reection of our facial expressions and the gaze), thus
intensifying the emotional response that these signals
tend to elicit (feeling of safeness and lovability that are
more directly conveyed by non verbal communication).
Moreover, watching our own face in the mirror strongly
activates the mirror neuron system (Platek etal., 2006;
Uddin, Kaplan, Molnar-Szakacs, Zaidel, & Iacoboni, 2005),
which, through the mechanism of ‘embodied simulation
(Gallese, 2013), facilitates a direct, pre-reexive form of
action understanding not exclusively dependent upon
mentalistic/linguistic abilities (Gallese, 2003). We can spec-
ulate that the activation of this system may have induced
in common humanity did not mediate the eect of Group
on HRV increase.
Additional analyses
There were no dierences among the three groups on how
closely participants were able to follow instructions of the
assigned experimental condition, F(2, 83) = 1.8, p=0.7.
However, for participants in the phrases only Group it was
more dicult to follow the instructions, F(2, 83) = 3.75,
p<0.05, partial η2=0.11, M=2.9, SD=0.6 than for partic-
ipants in the mirror only Group (M=2.1, SD=0.8). None
of the participants in the mirror only Group repeated the
phrases previously created during the mirror exposure or
consciously engaged in an active compassionate self-talk.
The ability to be reassuring, encouraging and compas-
sionate towards ourselves when things go wrong in life is
related to increased resilience and, in general, better psy-
chological health (Neely, Schallert, Mohammed, Roberts,
Figure 3.Time × Group interaction for HRV (RMSSD; ms2).
Figure 4.Path diagram for the mediation model. Note: **p<0.01;
***p < 0.001. cs = change score (from Time 2 to Time 3). All
coefficients are unstandardized.
Repeating the phrases at the mirror did not lessen neg-
ative emotions more than the other two conditions. These
ndings conrmed that even if positive and negative aect
are evidently two related constructs, at the same time they
are separate dimensions, and not two opposite points on
the same continuum (Baumeister & Bushman, 2010). Our
results are in line with previous research showing that
compassion-focused interventions do not specically
impact negative aect, or, at least, no more than other
interventions (Klimecki etal., 2013; Odou & Brinker, 2015).
This may be due to the nature of compassion interven-
tions. Dierently from positive reappraisal and cognitive
restructuring, which are mostly aimed to ‘restructure’ and
change the very content of the self-critical process (e.g. ‘I’m
not so bad; I don’t have enough evidence supporting this
negative assumption about myself’), thus improving neg-
ative aect, compassion-focused coping may provide indi-
viduals with an eective way to accept negative emotions,
which might not be directly impacted by the intervention.
The mirror seems to potentiate the compassionate
self-talk manipulation through focusing on kindness and
connectedness in the face of an emotionally painful expe-
rience, thus increasing the positive emotions of the sooth-
ing system and HRV.
Two major limitations must be considered when
interpreting the results of this study. Firstly, we did not
conduct an extensive qualitative content analysis of
the type of phrases that participants produced in the
first part of the experiment. Differences in content and
‘intensity’ of the phrases among the groups may have
been responsible for the pattern of results we observed.
However, an informal content analysis conducted sepa-
rately by the three authors seemed to suggest a general
homogeneity in terms of content and emotional inten-
sity of the phrases among the three groups. Random
examples of phrases have been reported in Appendix 1.
General themes of unconditional acceptance, under-
standing and empathy towards the suffering, willing-
ness to support and help, common humanity, and warm
encouragement seem to indistinctively recur among all
the three groups.
The second limitation is that even if we asked partici-
pants to rate how closely they followed the instructions
and how dicult it was for them to follow the instructions,
we did not directly control for participants’ compliance to
the experimental task (through audio or video recordings).
Limitations notwithstanding, results suggest that the
mirror is an eective tool for improving the eectiveness
of a compassion-focused exercise, considering that it
could be easily implemented in clinical practice. Further
research is needed to determine moderators (e.g., dier-
ent fears of compassion; Gilbert, McEwan, Matos, & Rivis,
2011) and other possible mediators of this eect, such as,
participants’ emotional emphasizing of their own distress,
facilitating the emergence of self-compassion, as also sug-
gested by Vinai etal. (2015). This is indirectly supported
by recent research showing that exposure to our face
facilitates identication of emotional facial expressions
(Li & Tottenham, 2011, 2013), which is strongly related to
empathetic processes (Besel & Yuille, 2010).
Another way to explain the amplifying eect of the mir-
ror manipulation on soothing positive aect and HRV is
linked to the ‘objectifying properties’ of the mirror. When
we look at our own mirror reection, we may experience
ourselves from an external point of view, which may help
us be more objective and less biased by our internal rep-
resentations of ourselves (Silvia & O’Brien, 2004). In fact,
research employing immersive virtual reality has shown
that identication with a virtual body as a way to experi-
ence self-compassion from an embodied rst-person per-
spective increased self-compassion and feelings of being
safe in a group of highly self-critical females (Falconer etal.,
Interestingly, the addition of the mirror component
did not impact females dierently than males. Research
on self-objectication suggests that exposure to mirrors
can have negative aective and cognitive consequences
for females in particular, including increasing body shame
(Fredrickson, Roberts, Noll, Quinn, & Twenge, 1998).
However, it is possible that asking participants to generate
compassionate phrases in the rst part of the experiment,
thus activating a compassionate mind-set, has dampened
the shame reaction often linked to mirror exposure, espe-
cially for women; though, further research is needed to
explore this issue more fully.
Another possible explanation for the eect of the mir-
ror addition is that when we look at ourselves from an
external point of view, we can appraise our qualities like
we appraise other people’s features, and apply to our-
selves the same standards that we use to evaluate others,
which are usually milder (Leahy, 2003). This might help
us remind that we have boundaries and aws like every
other human being, and that suering, personal failures,
inadequacies are part of the shared human experience.
This insight, which has been dened ‘common human-
ity’ by Ne (2003), is one of the major components of
self-compassion, because it lessens the degree of blame
and harsh judgment we may have placed on ourselves for
our failings, softening feelings of abnormality and isola-
tion. In fact, our data showed that the enhancement in the
soothing aect system produced by repeating the phrases
at the mirror was partially mediated by an increase in com-
mon humanity. However, common humanity did not play
the same mediating role in HRV increases, suggesting that
other possible mediating factors must be hypothesized
and further investigated.
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Disclosure statement
No potential conict of interest was reported by the authors.
Support for investigators (CO) was received from the Italian
Ministry of Health Young Researcher [grant number GR-2010-
Nicola Petrocchi
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Appendix 1.Random selection of compassionate phrases from the three groups.
Phrases at the mirror group Phrases only group Mirror only group
I’ll always be there for you, whatever you
might need.
What counts for me, it’s not what you do but
what you are
Making mistakes is human; it’s OK even if you fail
It’s not the end of the world! We will find a
way together
I’m sorry that you are sad, but you can count on
me; everything will be all right
Life is sour sometimes, but we are all together in this, you
will never be alone
We can all do mistakes Over the years, I’ve seen all your changes and
I’ve learned how to love each and every part
of you. I love you
Take your time, take a bath, cuddle yourself.
I will be here even when all things will start
falling apart; you are my friend, my sister, I
will never leave you alone.
I know what you are feeling, but you can always
count on me
A day will come when you will think back to this moment
and you will smile at it
I know that you are struggling now, but
please don’t forget that there are people
loving you, and waiting for you to feel
After all this, you will be stronger that before I know how difficult this moment is for you: loss, betrayals
etc. But I will be by your side, whatever happens.
I’m sorry that you are feeling sad, I’ll be by
your side
Life is like that: there will always be difficulties
and sad moments. But we can decide to be
strong enough to face them.
I love you for what you are, exactly as you are, not for what
you do.
Don’t let anyone judge you, you are the only
person that can say what’s right or wrong
for you
Don’t take your self-critical voice so seriously;
you are much wiser and bigger than that silly
The parts of yourself that you don’t like, are parts of you that
need your attention and love
You’ve been strong in the past, and you will
be able to find your strength now too.
I’m here and I will be here forever; I’ll always try
to help you in any way possible
Think about all the positive things that you did and do.
Don’t be too hard and critical on yourself,
everyone makes mistakes.
What counts is that you had the strength to
share these difficult feelings with someone
Don’t worry we will fix this together
Don’t worry, the sun will come back, eventu-
ally; and I’ll be here with you till it comes.
What can I do for you? It’s better if we are in
I understand you completely, how can I help you?
When you are sad, you can count on me I’m your friend and I love you; I accept you
exactly as you are
Everyone makes mistakes, but we can always learn from
them. Don’t worry, we will find a solution together.
... Traditionally, mirrors [6] or cameras [28] are used to induce self-awareness, considering that the sense of self seems to be inherently linked to one's own face [23]. In modern VR-training settings where the face is usually covered with the equipment, inducing self-awareness is challenging [22]. To face this challenge, recent research introduced the use of personalized avatars. ...
Conference Paper
Full-text available
Self-awareness is a critical factor in social interaction. Teachers being aware of their own emotions and thoughts during class may enable reflection and behavioral change. While inducing self-awareness through mirrors or video is common in face-to-face training, it has been scarcely examined in digital training with virtual avatars. This paper examines the relationship between avatar visual similarity and inducing self-awareness in digital training environments. We developed a theory-based methodology to reliably manipulate perceptually relevant facial features of digital avatars based on human-human identification and emotional predisposition. Manipulating these features allows to create personalized versions of digital avatars with varying degrees of visual similarity.
... Self-compassion is acknowledged as another strategy that individuals employ to cope with feelings of failure or inadequacy as it relates to one's appearance and dietary lapses (Thøgersen-Ntoumani et al., 2021;Turk & Waller, 2020) and minimizes arousal in response to threats in social-evaluative contexts (Arch et al., 2014;Petrocchi et al., 2017). Selfcompassion is conceptualized as an emotion regulation (vs compensation) strategy as it mitigates negative emotions (Inwood & Ferrari, 2018), suggesting it may be associated with the magnitude of dissonance aroused when individuals become aware of body-related discrepancies. ...
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The current mixed method study aimed to examine (1) the types of body-related discrepancies that college-aged women face, (2) the association between women's motivation for eating regulation and intent to engage in healthy and disordered eating following such experiences, and (3) the mediating role of affect and compensation strategies in these relationships. Thematic analysis of narratives from a body-related self-discrepancy recall task revealed that Canadian college-aged women (N = 398) experience discrepancies related to the appearance and care of their bodies. These experiences were more likely to occur in a non-social-evaluative setting. A path analysis revealed that autonomous eating regulation was associated with healthy eating intentions, whereas controlled eating regulation was associated with disordered eating intentions following a recalled body-related discrepancy. These distinct pathways were partly explained by levels of self-compassion and selection of distinct behavioral and cognitive compensation strategies. Findings suggest that those with autonomous eating regulation possess a resource, self-compassion, which aids self-regulation following body-related threats.
... This concept is widely used when facing problems, unfortunately, the good effects do not always apply to everyone. In some cases, people who have focused on positive things when experiencing problems later feel worse, worthless, and blame themselves (Chan & Mak, 2017;Petrocchi et al., 2017;Sudiansyah et al., 2023). For example, as in a study conducted by previous study the repetition of self-positive statements can be ineffective and make things worse, especially for those with low self-esteem (Wood et al., 2009). ...
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Toxic Positivity is known as the concept of over-promotion of happiness. This concept believes that staying positive by ignoring negative emotions is the right solution in dealing with problems. This misconception about the concept of staying positive is certainly not by the fact that negative emotions are unavoidable in human life. The aims of this study is to analyze more deeply the meaning of the concept of toxic positivity, in terms of what those who experience toxic positivity think and feel, especially in the context of relationships. This qualitative research with a phenomenological approach focuses on the experiences of individuals with toxic positivity in their social relationship life, starting from what responses, feelings, and impacts arise when getting toxic positivity. Data collection in this study was conducted through interviews. The data obtained were then processed and categorized into the following themes. The findings show that toxic positivity is perceived as an inappropriate motivational response. The toxic positivity response elicits feelings of not being understood, anger, and disappointment, with negative impacts not only physically but also psychologically. The perpetrators are considered to come from individuals who have never experienced similar problems before and lack empathy. In addition, toxic positivity was also found in verbal abuse.
... So srdcovou variabilitou ako ukazovateľom aktivácie parasympatiku pri praktizovaní súcitu a sebasúcitu pracovali viacerí výskumníci (e. g. Arch et al., 2014;Ehrenreich, 2020;Petrocchi et al., 2017;Steffen et al., 2020;Svendsen et al., 2016). V slovenských podmienkach Halamová a kolektív (2019) pri skúmaní efektu imaginácií zistili, že srdcová variabilita bola najvyššia pri sebasúcitnej imaginácii v porovnaní so sebakritickou a sebaprotektívnou imagináciou a aj v porovnaní s pokojovými podmienkami. ...
... 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. ...
Full-text available
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:
... Specifically, we replicated a design used with healthy controls that examined HRV response during CFT pre and post a two-week selfdirected training period 5,32 . Based on CFT's theoretical model and research published previously with healthy controls, we first expected that CFT exercises will significantly increase HRV compared to a resting state 5,23,[32][33][34] . Second, we expected that how often participants engaged in the compassionate-self practice across the two-week period will be a significant factor in differential HRV response 32,35 . ...
Heart-rate variability (HRV) is a marker of parasympathetic nervous system activity, and is a robust predicter of improved mental and physical health. Current psychotherapeutic interventions are effective at reducing self report depressive symptoms, but few have improved HRV within a sample of severe depressive symptoms. This study explores the impact of a brief Compassion Focused Therapy exercise (CFT) on HRV. Results suggested that a brief CFT exercise can successfully target depressive physiology, at two distinct timepoints, pre- and post- a two-week self-directed training period. Specifically, we first show that CFT can significantly improve HRV at the state level, but not at the trait level after a two-week intervention. Second, CFT can increase a subset of participants HRV above a clinical cut-off of low resting HRV. Third, the frequency of practice (i.e., listening to the audio recording) during the self-directed training component was very low, with 50% not accessing the practice. Finally, during the CFT exercise at post-two-week training HRV decreased across time, indicating participants had a greater engagement in the threat component of the CFT exercise, a feature to be more fully examined in prospective studies. This study suggests the value of future research with larger-scale randomized control trials, to further explore the modulation of parasympathetic physiology using compassion practices.
... Increased parasympathetic nervous system activity (PNS) is associated with increased vagally mediated heart rate variability [vmHRV; (14,15,(46)(47)(48)(49)]. The vagus nerve acts as a "brake" in the sympathetic nervous system (SNS). ...
Full-text available
Introduction Literature has pointed the need for intervention programs specifically tailored to target the treatment needs of young offenders, as well as the need to test the efficacy of such programs through physiological indexes of emotion regulation (e.g., heart rate variability; HRV), complementing self-reports typically used as outcome measures. The PSYCHOPATHY.COMP is a 20-session individual intervention program based on Compassion Focused Therapy aiming to reduce psychopathic traits and disruptive behavior among young offenders through the development of a compassionate motivation, while stimulating the soothing system as a strategy to improve emotion regulation. Previous research with young offenders has shown decreases in vagally mediated HRV (vmHRV) when the soothing system is activated. This physiological pattern seems to mirror threat-like responses that contrast with relaxed states. Methods To test the efficacy of the PSYCHOPATHY.COMP, a clinical trial was implemented encompassing a treatment ( n = 56) and a control group ( n = 53). Treatment participants attended the PSYCHOPATHY.COMP, while controls received the Treatment As Usual (TAU) delivered in Portuguese juvenile detention facilities. HRV data was collected throughout a standardized procedure (encompassing resting, reactivity and recovery phases) specifically designed to trigger the soothing system. Participants were assessed at pre-treatment, post-treatment and 6-months follow-up. Results Although treatment participants continued to process the soothing system as unpleasant (with decreased vmHRV), they seem to become able to adaptively recover from the stimuli without avoiding it or resorting to maladaptive coping strategies. The physiological pattern was in line with participants’ decreases in difficulties in emotion regulation across the assessment periods. In contrast, controls seemed to have actively employed coping strategies associated with increases in vmHRV not only when the soothing system was triggered, but also when recovering from the stimuli. Congruently, for controls, increases in difficulties in emotion regulation were found, with increases in the lack of emotional clarity across the assessment periods. Discussion Findings offer new evidence for the efficacy of the PSYCHOPATHY.COMP program in improving emotion regulation in young offenders, assessed through both self-report and physiological measures. Additionally, findings support the assessment of the autonomic balance as a treatment efficacy index in future research, targeting the rehabilitation of these youth. Clinical trial registration , identifier NCT03971682.
While meditation is commonly practiced by individuals on their own, several programmes have incorporated dyadic forms, too. However, the setting – meditating alone or in dyads – and its impact on the effects of meditation have not yet been examined. We expected that dyadic compassion meditation (CM) may improve perceived social closeness more compared to closely-matched individual CM. N = 50 couples were randomly assigned to do a brief 15-min CM induction either together with their partner or individually. Social closeness was rated by both partners. Secondary outcomes were positive and negative affect as well as parasympathetic response, indicated by heart rate variability (HRV). Due to the dyadic data structure, multilevel models were tested. We found no difference between dyadic and individual CM in self-report. After both forms social closeness and positive affect were improved, while negative affect decreased. Only HRV differed between the two conditions over time: while HRV significantly decreased in the individual condition, there was no such change in the dyadic condition. The accompanying physiological profile suggests that CM may involve effort at least in the individual CM. Done individually or with a partner, brief CM can foster social closeness and improve affect and can be employed to improve socio-emotional well-being.
This chapter reviews the literature on self-compassion and peripheral immune and stress response-related physiology. Specifically, we review the evidence related to self-compassion and relevant immune and stress response system (autonomic, hypothalamic–pituitary–adrenal axis, peripheral inflammatory) biomarkers, as well as evidence that self-compassion promotes resilience by modifying psychophysiological responses to stress. The chapter is organized by type of self-compassion studies, beginning with observational/correlational studies of the relationship between dispositional or trait self-compassion and a range of psychophysiological measures. The middle section focuses on studies on the immediate physiological effects of briefly induced or briefly trained self-compassion in laboratory settings, relative to a range of active and passive control conditions. The final section focuses on randomized and single-arm trials on the physiological benefits of structured, multi-week interventions intended to train self-compassion in a more enduring and systematic manner. We end with a brief summary of overall findings and recommendations for future studies in this area.KeywordsSelf-compassionCompassionHeart rate variabilityHeart rateAlpha-amylaseCortisolPhysiologyStress
As demonstrated by the chapters in this Handbook, self-compassion is associated with myriad benefits for mental health and psychological well-being. The beneficial impact of self-compassion is perhaps even more evident in psychotherapy, where self-compassion has long held a role under the umbrella of “self-acceptance.” Drawing primarily on compassion-focused therapy and the mindful self-compassion program, this chapter provides guidance on how to integrate self-compassion into psychotherapy and provides and overview of the evidence connecting self-compassion with therapeutic processes and outcomes.The chapter begins by locating self-compassion in the context of psychotherapy, past and present. Next, we outline the evidence for self-compassion as a transdiagnostic and transtheoretical mechanism of action in therapy. The majority of this chapter describes three levels by which self-compassion can be integrated into psychotherapy—compassionate presence, compassionate relationship, and compassionate interventions—along with supporting research. When all three levels are part of treatment, it can be considered fully self-compassion based. Finally, we explore emotion regulation as the basic mechanism by which self-compassion works in psychotherapy, along with underlying neurophysiological and psychological processes, especially the cultivation of secure attachment and the alleviation of shame.KeywordsSelf-compassionPsychotherapyTherapeutic relationshipTherapeutic allianceEmotion regulation
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Most forms of psychological distress encompass both the relation to the self in the form of shame and self-criticism, as well as the relation to others in the form of distance and isolation. These are often longstanding and pervasive problems that permeate a wide range of psychological disorders and are difficult to treat. This paper focuses on how problems with shame and self-criticism can be addressed using compassion focused therapy (CFT). In a pilot study we tested the effectiveness of CFT with a single case experimental design in six individuals suffering from social anxiety. The aim was to establish whether CFT lead to increases in self-compassion, and reductions in shame, self-criticism and social anxiety. Moreover, the aim was to investigate to what extent participants were satisfied and experienced CFT as helpful in coping with social anxiety and in increasing self-compassion. Taken together the preliminary results show that CFT is a promising approach. CFT was effective for 3 of 6 participants, probably effective for 1 of 6 and more questionably effective for 2 of 6 participants. These results add to the empirical evidence that CFT is a promising approach to address problems with self-compassion. This research body is as of yet small, and more studies are needed.
Self-compassion - having a healthy, mindful and kind self-attitude - may be a better way to cope with negative experiences than distraction. This was tested in 152 undergraduates who underwent a negative mood induction and then completed either a self-compassionate writing task or a distraction task. Results showed that participants who wrote self-compassionately experienced increases in positive affect while participants who distracted experienced reductions in positive affect. Both groups significantly reduced in negative affect; however, there was no significant difference between them. An interaction was found between rumination and time, demonstrating that high ruminators experienced greater reduction of sadness than low ruminators. The current findings demonstrate greater short-term benefits of approaching a negative mood using self-compassion compared to distraction and results are discussed in the context of the broaden and build theory of positive emotions.