Does Loving-Kindness Meditation Reduce Anxiety? Results from a Randomized Controlled Trial

Abstract

Although loving-kindness meditation (LKM) has shown some promise as a psychological intervention, little is known about the effectiveness of LKM for reducing one of the most prevalent mental health problems: anxiety. To build knowledge in this area, we conducted a randomized controlled trial, assigning nonclinical undergraduates to either a 4-session, group-based LKM intervention (n = 38) or a waitlist control (n = 33). Self-reported anxiety, compassionate love, and self-compassion were assessed at pretreatment, posttreatment, and 8-week follow-up. Relative to control participants, participants in the LKM intervention reported higher compassionate love and self-compassion at posttreatment and higher self-kindness (a component of self-compassion) at follow-up. Anxiety ratings did not significantly differ between conditions at posttreatment or follow-up. Study limitations and directions for future research are discussed.

Full text

Loving-Kindness Meditation for Anxiety
Does Loving-Kindness Meditation Reduce Anxiety?
Results from a Randomized Controlled Trial
Abstract
1

Loving-Kindness Meditation for Anxiety
Although loving-kindness meditation (LKM) has shown some promise as a psychological
intervention, little is known about the effectiveness of LKM for reducing one of the most
prevalent mental health problems: anxiety. To build knowledge in this area, we
conducted a randomized controlled trial, assigning nonclinical undergraduates to either a
4-session, group-based LKM intervention (
n
= 38) or a waitlist control (
n
= 33). Self-
reported anxiety, compassionate love, and self-compassion were assessed at pretreatment,
posttreatment, and 8-week follow-up. Relative to control participants, participants in the
LKM intervention reported higher compassionate love and self-compassion at
posttreatment and higher self-kindness (a component of self-compassion) at follow-up.
Anxiety ratings did not significantly differ between conditions at posttreatment or follow-
up. Study limitations and directions for future research are discussed.
Keywords:
loving-kindness; meditation; anxiety; compassionate love; self-compassion;
self-kindness
Introduction
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Loving-Kindness Meditation for Anxiety
Loving-kindness meditation (LKM) has been practiced for over 2500 years
(Kornfield, 1993), yet its utility as a psychological intervention has been explored only
recently (Hofmann, Grossman, & Hinton, 2011). The aim of LKM is to cultivate
unconditional feelings of love, kindness, and acceptance (Salzberg, 1995). During
traditional LKM, the practitioner directs loving-kindness— in a stepwise fashion—
toward oneself, then toward loved ones, acquaintances, strangers, and finally toward all
sentient beings (Galante, Galante, Bekkers, & Gallacher, 2014; Hofmann et al., 2011;
Salzberg, 1995). Like mindfulness meditation (see Kabat-Zinn, 1994), LKM is versatile;
it can be practiced at any time and in a variety of postures (e.g., lying, sitting, walking;
see Hofmann et al., 2011; Salzberg, 1995).
There is some preliminary evidence that LKM improves health and well-being
(Galante et al., 2014; Hofmann et al., 2011; Shonin, Gordon, Compare, Zangeneh, &
Griffiths, 2015). In a comprehensive review, Hofmann, Grossman, and Hinton (2011)
reported that LKM is associated with an increase in positive affect and a decrease in
negative affect. Similarly, in a recent meta-analysis of 22 studies, Galante et al. (2014)
found that, relative to passive controls, kindness-based meditation programs were
moderately effective in enhancing mindfulness, compassion, and self-compassion and
alleviating depression.
Although extant data support the use of LKM for treating depression, much less is
known about the impact of LKM on anxiety (see Galante et al., 2014). To the best of our
knowledge, there have been only three peer-reviewed, randomized controlled trials
(RCTs) that have tested whether kindness-based interventions reduce anxiety in adults
(Desbordes et al., 2012; Neff & Germer, 2012; Shahar et al., 2014). Two of these were
waitlist RCTs; Neff and Germer (2012) discovered that an 8-session compassion
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Loving-Kindness Meditation for Anxiety
intervention outperformed waitlist in reducing anxiety among healthy (nonclinical)
participants, whereas Shahar et al. (2014) found that a 7-session LKM intervention did
not outperform waitlist in reducing anxiety among self-critical participants. Regarding
active controls, Desbordes et al. (2012) found that a compassion intervention was no
more effective than a mindfulness intervention and a health education intervention in
reducing anxiety symptoms in healthy adults.
Several shortcomings are apparent in this literature. First, there is a lack of data
on the effectiveness of LKM for anxiety. Second, the data that do exist are derived from
relatively small samples (
N
s range from 38 to 51), particularly composed of nonclinical
participants. Third, the findings in this area are inconsistent, with one study reporting
significant effects relative to waitlist (Neff & Germer, 2012), and another reporting
nonsignificant effects relative to waitlist (Shahar et al., 2014). Given the current status of
the literature, it remains unclear whether LKM is effective for alleviating one of the most
widespread mental health problems: anxiety (see Grant et al., 2004).
The goal of this study was to assess the effects of a LKM intervention, relative to
waitlist control, on anxiety and on two qualities ostensibly cultivated in LKM:
compassionate love and self-compassion. The anxiety measure selected for the current
study (State-Trait Anxiety Inventory-Trait Form; Spielberger, Gorsuch, Lushene, Vagg,
& Jacobs, 1983) has shown responsiveness to LKM’s effects in other research (Neff &
Germer, 2012). Moreover, akin to research documenting positive results (Neff &
Germer, 2012), we recruited and enrolled nonclinical participants. The present study
attempted to build on previous research by testing LKM’s effects with a relatively large
sample (i.e.,
N
≥
55). We hypothesized that: a) participants in the LKM intervention
would report decreases in anxiety and increases in compassionate love and self-
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Loving-Kindness Meditation for Anxiety
compassion from pretreatment to posttreatment and from pretreatment to follow-up, and
b) participants in the LKM intervention would report lower levels of anxiety and higher
levels of compassionate love and self-compassion at posttreatment and follow-up,
relative to control participants.
Method
Participants
Participants were 71 undergraduate students from a public Midwestern university.
The sample was 77% female with a mean age of 19.1 years (
SD
= 1.17). About 78% of
participants identified as White/Caucasian, 17% identified as Black or African American,
3% identified as Hispanic or Latino/Latina, and 2% identified as “other.”
Procedure
This study was conducted in the psychology department of a Midwestern
university. IRB approval was obtained, and all ethical standards were followed; no
adverse events were reported throughout the duration of the study. An intended sample
size of 55-60 participants was derived from a review of the literature and from a power
analysis using a medium effect size (e.g., see Galante et al., 2014). See Figure 1 for a
procedure flow chart.
We recruited undergraduate students via the psychology department’s web-based,
experiment sign-up system. In total, 71 students arrived to a psychotherapy laboratory
for the current study and signed the informed consent. A packet of study measures,
which included a demographics form, STAI, CLS, and SCS, was then administered for
the pretreatment assessment. As each participant completed the packet, a random card
from a shuffled deck was distributed to the participant to determine condition assignment;
38 participants were assigned to the LKM intervention, and 33 participants were assigned
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Loving-Kindness Meditation for Anxiety
to the waitlist control. LKM participants were given a choice of which night to attend the
LKM intervention (three nights/groups total; see LKM Intervention). Because the LKM
intervention was approximately four weeks in duration, we asked the control participants
to return four weeks after the pretreatment assessment for the posttreatment assessment.
Four LKM participants dropped from the study (did not return phone
calls/emails), and seven control participants failed to show for the posttreatment
assessment (did not return phone calls/emails). The remaining 34 LKM participants and
the remaining 26 control participants completed the posttreatment assessment; the
posttreatment assessment included the STAI, CLS, and SCS (as well as the LKM practice
survey for LKM participants). As compensation, participants received research credits
for an introductory psychology course (partial credit was awarded for partial
participation).
Eight weeks after the posttreatment assessment, the remaining participants (LKM
n
= 34, control
n
= 26) were mailed the follow-up assessment and $10 as compensation;
like the posttreatment assessment, the follow-up assessment included the STAI, CLS, and
SCS (as well as the LKM practice survey for LKM participants). In total, 33 LKM
participants and 24 control participants completed and returned the follow-up assessment.
LKM Intervention. The LKM intervention entailed four weekly 90-minute
sessions, which were delivered in a group format with 10-14 participants per group.
There were three LKM groups in total, each occurring on a different night of the week,
and each led by a different facilitator (see LKM Facilitators). The LKM intervention was
limited to four sessions to reduce burden on participants and facilitators; brief LKM
interventions have been shown to be effective in past research (see Galante et al., 2014).
All LKM sessions were audio-recorded to evaluate treatment fidelity (see LKM Fidelity).
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Loving-Kindness Meditation for Anxiety
A manual was developed for the LKM intervention (for copy of the manual,
please contact first author). The intervention was inspired by the contemporary
meditation literature (e.g., Gyatso, 2001; Hanh, 1976; Kabat-Zinn, 1994; Kornfield,
2002; Salzberg, 1995) and included psychoeducation, formal meditation, and group
discussion. In all sessions, participants were instructed to: 1) sit or lay with closed eyes,
paying attention to the breath and body; 2) imagine receiving kindness, love, and
compassion from a loving person; and 3) imagine sending those feelings— in a stepwise
fashion— to oneself, family and friends, one’s community, all people, and finally to all
sentient beings. Additional meditations were incorporated into the program. For
example, in session three, participants were encouraged to direct loving-kindness toward
a “difficult” person (i.e., a person who is typically associated with negative feelings; see
Salzberg, 1995). In another meditation, participants were instructed to walk outside,
while attempting to project loving-kindness toward people, animals, and nature in
general. Participants were asked to practice these formal meditations between sessions
and to apply loving-kindness skills in their day-to-day life.
LKM Facilitators. There were three LKM facilitators, each of whom led an
LKM group. One facilitator was a doctoral candidate in clinical psychology (first author
of this research), another was a licensed social worker, and the third was a physician. All
facilitators had personal experience in LKM and mindfulness meditation (
M
years of
experience
≈
10 years). The doctoral candidate had two years of experience teaching
meditation, and the social worker had four years of experience teaching meditation. The
physician had never formally led meditations but is an advanced meditator and a
consciousness researcher. Before the study began, the facilitators studied the LKM
7

Loving-Kindness Meditation for Anxiety
intervention manual and practiced leading the meditations. After the groups began, the
facilitators met weekly to discuss group process and to ensure treatment fidelity.
LKM Fidelity. The audio-recordings were used to evaluate treatment fidelity.
Specifically, two undergraduate research assistants independently rated a random sample
of the audio-recorded sessions (50% of all sessions) to determine if facilitators adhered to
the essential tasks described in the manual. After averaging the two ratings, it was found
that 96% of the essential tasks had been addressed by the facilitators.
Measures
Anxiety. The trait form of the State-Trait Anxiety Inventory (STAI; Spielberger
et al., 1983) is a 20-item, self-report measure of trait anxiety. Each item (example item:
“
I feel nervous and restless.
”) is rated on a Likert scale that ranges from 1 “almost never”
to 5 “almost always.” The STAI is widely used and extensively validated with clinical
and nonclinical samples (Julian, 2011; Spielberger et al., 1983). Consistent with past
research, a summed total was computed for the current study (Cronbach α = 0.95 at
pretreatment).
Compassionate Love. The 21-item Compassionate Love Scale (CLS; Sprecher
& Fehr, 2005) assesses cognitions, feelings, and behaviors that are focused on
understanding, caring, and helping others, particularly when others are suffering or in
need. The CLS has two versions: one that refers to close others (e.g., family and friends),
and one that refers to strangers and humanity generally. The strangers/humanity version
was used in the current study. Each item (example item: “
When I hear about a stranger
going through a difficult time, I feel a great deal of compassion for him or her
.”) is rated
on a Likert scale that ranges from 1 “not at all true of me” to 7 “very true of me.”
Research indicates that CLS is related, yet distinct from measures of empathy, prosocial
8

Loving-Kindness Meditation for Anxiety
behavior, and social support (Sprecher & Fehr, 2005). Consistent with past research, a
mean total was computed for the current study (Cronbach α = 0.94 at pretreatment).
Self-Compassion. The 26-item Self-Compassion Scale (SCS; Neff, 2003)
contains six subscales: self-kindness, self-judgment, common humanity, isolation,
mindfulness, and over-identification. Each item (example item: “
I’m kind to myself
when I’m experiencing suffering.
”) is rated on a Likert scale that ranges from 1 “almost
never” to 5 “almost always.” The SCS has exhibited a sound factor structure, good
convergent validity (e.g., inversely correlated with lower anxiety and depression and
positively correlated with satisfaction with life), and adequate discriminant validity (e.g.,
nonsignificantly correlated with social desirability and narcissism) (for a review, see
Neff, 2015). Consistent with past research, we computed a mean for each subscale
(Cronbach αs ranged from 0.83 to 0.90 at pretreatment) and then reverse-scored
negatively-worded items to derive a grand mean (Cronbach α = 0.94 at pretreatment).
LKM Practice. A novel survey was developed for this study. The survey
included the following items: 1) “please write down how much time you spent this week
practicing formal meditations outside of class” and 2) “I was able to bring the attitudes,
intentions, and principles discussed in the group into my daily life, whether meditating or
not” (rated on a Likert scale that ranges from 1 “strongly disagree” to 5 “strongly agree”).
This survey was administered to LKM participants at posttreatment and follow-up.
Data Analyses
To assess differences on demographic and pretreatment outcome data,
independent samples
t
tests and chi-square tests of independence were used. We
employed a repeated measures MANOVA to determine if there was a significant change
on the three outcomes (STAI, CLS, SCS) over time between the LKM intervention and
9

Loving-Kindness Meditation for Anxiety
control; time (pretreatment, posttreatment, follow-up) was entered as a within-subjects
factor, and treatment condition (LKM vs. control) was entered as a between-subjects
factor. Given that our hypotheses were made a priori, and that our omnibus test
(MANOVA) contained all measures at both posttreatment and follow-up, alpha
corrections were not applied for the subsequent ANCOVAs (controlling for pretreatment
scores) used to examine significant effects at posttreatment (
n
= 60) and follow-up (
n
=
57). Within-group effects were assessed with paired samples t-tests. When a between-
group or within-group effect was statistically significant, an effect size was calculated.
Between-groups effect sizes were calculated as the difference in the posttest means
divided by the pooled standard deviation (Cohen, 1988). Within-group effect sizes were
calculated as the difference in the pretest and posttest means divided by the pooled
standard deviation, correcting for the dependence between means (Morris & DeShon,
2002). The absolute values of effect sizes are reported. To interpret Cohen’s
d
,
an effect
size of
d
= .2 was considered small,
d
= .5 was considered medium, and
d
= .8 was
considered large (Cohen, 1988).
Results
Of all the items on the collected measures, less than 0.01% had a missing value.
These missing values were replaced using mean of nearby points. No problems were
found when checking for normality and outliers. At pretreatment, LKM participants and
control participants did not significantly differ (
p
values > .05) on any of the
demographics and pretreatment outcomes, implying that randomization was successful.
Nevertheless, Levene’s test implied that the homoscedasticity assumption was violated
for CLS (compassionate love) scores at pretreatment, and so α for treatment effects on
10

Loving-Kindness Meditation for Anxiety
this dependent variable was set at 0.025 (see Fidell & Tabachnick, 2003). Dropouts were
not significantly different than completers on pretreatment data.
A repeated measures MANOVA showed that there was a significant time by
treatment condition interaction, Wilks’ Lambda = 0.76,
F
(6, 50) = 2.70,
p
= .024. Thus,
treatment effects were examined at posttreatment and follow-up.
To examine treatment effects at posttreatment, a series of one-way ANCOVAs
were conducted (see Table 1). When controlling for pretreatment scores, posttreatment
STAI (anxiety) scores did not significantly differ between conditions. When controlling
for pretreatment scores, participants in the LKM intervention reported significantly
higher CLS (compassionate love) and SCS (self-compassion) scores at posttreatment, as
compared to control participants. Regarding the SCS subscales, participants in the LKM
intervention reported significantly higher Self-Kindness (
F
= 10.54,
p
= .002,
d
= 0.64)
and Common Humanity (
F
= 5.23,
p
= .026,
d
= 0.46) scores at posttreatment (controlling
pretreatment scores), as compared to control participants; all other between-group effects
at posttreatment were nonsignificant. Within-group, pre- to posttreatment effects were
significant for STAI (
p
= .002,
d
= 0.60), CLS (
p
< .001,
d
= 0.76), SCS (
p
= .007,
d
=
0.51), Self-Kindness (
p
= .006,
d
= 0.53), Self-Judgment (
p
= .029,
d
= 0.40), Isolation (
p
= .023,
d
= 0.41), and Mindfulness (
p
= .018,
d
= 0.43).
To examine treatment effects at follow-up, a series of one-way ANCOVAs were
conducted (see Table 1). When controlling for pretreatment scores, follow-up STAI,
CLS, and SCS scores did not significantly differ between conditions. Regarding the SCS
subscales, participants in the LKM intervention reported significantly higher Self-
Kindness (
F
= 4.33,
p
= .042,
d
= 0.44) at follow-up (controlling pretreatment scores), as
compared to control participants; all other between-group effects at follow-up were
11

Loving-Kindness Meditation for Anxiety
nonsignificant. Within-group, pretreatment to follow-up effects were significant for
STAI (
p
= .001,
d
= 0.66), CLS (
p
= .013,
d
= 0.44), SCS (
p
= .013,
d
= 0.45), Self-
Kindness (
p
= .041,
d
= 0.38), Self-Judgment (
p
= .018,
d
= 0.41), Isolation (
p
= .013,
d
=
0.43), and Over-Identification (
p
= .019,
d
= 0.44).
Finally, we evaluated the LKM practice data. Participants assigned to LKM
reported at-home LKM practice at posttreatment (
M
≈
29 minutes over prior week;
SD
=
34) and follow-up (
M
≈
15 minutes over prior week;
SD
= 29). Moreover, participants
generally agreed with the statement “I was able to bring the altitudes, intentions, and
principles discussed in the group into my daily life, whether meditating or not” at
posttreatment (
M
= 3.94;
SD
= 0.40) and follow-up (
M
= 3.93;
SD
= 0.84). These two
indices of LKM practice (i.e., amount of practice time and agreement with statement) did
not predict treatment outcomes.
Discussion
We tested the effectiveness of a 4-session LKM intervention with nonclinical
undergraduate students. Contrary to our hypotheses, the LKM intervention was no more
effective than waitlist in alleviating anxiety at posttreatment and follow-up.
Nevertheless, the LKM intervention did outperform waitlist on compassionate love and
self-compassion at posttreatment and a component of self-compassion (i.e., self-kindness)
at follow-up.
Changes in anxiety over the course of the LKM intervention were not
significantly different from the changes in anxiety that occurred naturally over time (i.e.,
in the waitlist). These results are virtually identical to those reported by Shahar et al.
(2014), who suggested that LKM’s focus on positive affect (e.g., love and kindness) may
be better suited for the treatment of depression than for the treatment of anxiety. Indeed,
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Loving-Kindness Meditation for Anxiety
anxiety disorders are generally not characterized by low levels of positive affect (Brown,
Chorpita, & Barlow, 1998), and thus the enhancement of positive affect via LKM (see
Galante et al, 2014; Hutcherson et al., 2008) may be a superfluous step in the treatment of
anxiety. Although we find this explanation compelling, we believe that the literature is
not developed enough to support a definitive conclusion about the effectiveness of LKM
for anxiety. At present, there is insufficient evidence to support LKM’s effectiveness for
anxiety, which should not be confused with the claim that LKM is an ineffective
treatment for anxiety.
The LKM intervention was superior to waitlist on posttreatment ratings of
compassionate love and self-compassion. These two qualities are central to the theorized
mechanism of change in LKM. That is, LKM is thought to increase self-compassion and
compassion for others, which in turn might reduce psychopathology (see Shahar et al.,
2014). The present results imply that LKM impacts these putative mediators (see “a
path” in a mediation model; Preacher & Hayes, 2004). Our between-group effect sizes
for compassionate love and self-compassion were, however, somewhat smaller than those
reported by other researchers (e.g., see Neff & Germer, 2012; Shahar et al., 2014). This
is perhaps unsurprising given that our intervention was relatively brief.
Of all the facets of self-compassion (i.e., self-kindness, self-judgment, common
humanity, isolation, mindfulness, and over-identification; see Neff, 2003), self-kindness
was most consistently affected by the LKM intervention. Specifically, LKM generated
medium-to-large effects on self-kindness at posttreatment and follow-up, relative to
waitlist. In light of LKM’s robust effects on self-kindness, it stands to reason that LKM
might be an effective antidote for the self-criticism that characterizes social anxiety
(Werner et al., 2012) and depression (Gilbert & Procter, 2006; Luyten et al., 2007;
13

Loving-Kindness Meditation for Anxiety
Shaher et al., 2014), the shame and embarrassment that characterizes eating
psychopathology (Ferreira, Matos, Duarte, Pinto-Guoveia, 2014; Goss & Allan, 2010), as
well as the self-invalidation that characterizes maladaptive interpersonal dependency
(McClintock, Anderson, & Cranston, 2015) and borderline personality disorder (Linehan,
1993). Research is needed to explore these applications of LKM.
Although we have evidence that compassionate love, self-compassion, and self-
kindness were enhanced by the LKM intervention, it remains unclear which elements of
the LKM intervention were responsible for these effects. Of note, the frequency of at-
home LKM practice was found to be unrelated to treatment outcomes. Certainly, this
index of practice frequency does not reflect the rich and potentially profound experience
of loving-kindness practice. It is conceivable that the quality— rather than frequency—
of practice predicts treatment outcomes (see McClintock et al., 2015; Vettese, Toneatto,
Stea, Nguyen, & Wang, 2009).
The current research has several limitations. Our sample was relatively
monolithic with regard to race, gender, and age; caution is warranted when attempting to
generalize the present findings to men, racially diverse groups, adolescents, or older
adults. Moreover, we did not specifically enroll participants with anxiety pathology;
anxiety scores were elevated at pretreatment, although considerably lower than scores
obtained from clinical samples (e.g., see Abramowitz & Deacon, 2006). It is possible
that a different pattern of results would emerge when testing LKM’s effectiveness for
treating anxiety disorders.
Beyond sample characteristics, there were a few measurement issues. First, we
did not assess for potential cofounds (e.g., concurrent treatment), and so it is possible that
internal validity was compromised and was not properly detected. Second, all research
14

Loving-Kindness Meditation for Anxiety
data were collected via self-report, suggesting that shared method variance and response
biases might have influenced our results. Third, although adherence ratings implied that
the LKM intervention was delivered with fidelity, non-allowable behaviors (e.g.,
cognitive restructuring techniques) were not identified or assessed. Finally, participants
were compensated (with $10 and course credit), which is unusual in intervention research
and might have unduly affected our results.
Future research should avoid the shortcoming of the current study. To evaluate
the potential clinical utility of LKM, a large RCT should be conducted that enrolls
demographically diverse participants who meet criteria for an anxiety disorder.
Furthermore, to make the study more methodologically rigorous, an active (i.e., non-
inert) comparison condition could be included to control for nonspecific factors (e.g.,
credibility of treatment, outcome expectations, interaction with a facilitator). Bootstrap
analyses (see Preacher & Hayes, 2004) could also be employed to test mediation models
(e.g., treatment condition  compassion enhancements  anxiety reduction). Yet
another direction is to explore client characteristics and process variables that might
moderate response to LKM interventions. That is, LKM is presumably more effective for
some clients, and in some contexts, than it is for others. Finally, given that effects were
achieved in the current study with a 4-session LKM intervention, future research should
clarify the “dose” of LKM that is needed to generate therapeutic effects.
Conclusions
This study provides evidence that a brief LKM intervention can enhance
compassion for self and compassion for others in nonclinical undergraduates. Contrary
to our a priori hypotheses, the LKM intervention was not significantly more effective
than waitlist in reducing anxiety. These results, combined with the equivocal results
15

Loving-Kindness Meditation for Anxiety
previously reported on this topic (Desbordes et al., 2012; Neff & Germer, 2012; Shahar et
al., 2014), suggest that the utilization of LKM for treating anxiety should be met with
healthy skepticism. Indeed, pending further research, LKM should be eschewed as a
first-line treatment for adult anxiety.
Compliance with Ethical Standards
Funding: This study was not externally funded.
Conflict of interest: Author A declares that he has no conflict of interest. Author B
declares that he has no conflict of interest. Author C declares that he has no conflict of
interest.
Ethical approval: All procedures performed in studies involving human participates
were in accordance with the ethical standards of the institutional and/or national research
committee and with the 1964 Helsinki declaration and its later amendments or
comparable ethical standards.
Informed consent: Informed consent was obtained from all individual participants
included in the study.
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Loving-Kindness Meditation for Anxiety
References
Abramowitz, J. S., & Deacon, B. J. (2006). Psychometric properties and construct
validity of the Obsessive-Compulsive Inventory-Revised: Replication and
extension with a clinical sample.
Anxiety Disorders, 20
, 1016-1035.
Brown, T. A., Chorpita, B. F., & Barlow, D. H. (1998). Structural relationships among
dimensions of the
DSM-IV
anxiety and mood disorders and dimensions of
negative affect, positive affect, and autonomic arousal.
Journal of Abnormal
Psychology, 107,
179-192.
Cohen, J. (1988).
Statistical power analysis for the behavioral sciences.
Hillsdale, NJ:
Lawrence Earlbaum Associates.
Desbordes, G., Negi, L. T., Pace, T. W. W., Wallace, B. A., Raison, C. L., & Schwartz,
E. L. (2012). Effects of mindful-attention and compassion meditation training on
amygdala response to emotional stimuli in an ordinary, non-meditative state.
Frontiers in Human Neuroscience, doi: 10.3389/fnhum.2012.00292.
Fidell, L., & Tabachnick, B. (2003).
Preparatory data analysis
. Hoboken, NJ: John Wiley
& Sons.
17

Loving-Kindness Meditation for Anxiety
Ferreira, C., Matos, M., Duarte, C., & Pinto-Gouveia, J. (2014). Shame memories and
eating psychopathology: The buffering effect of self-compassion.
European
Eating Disorders Review: The Journal of the Eating Disorders Association, 22,
487-494.
Galante, J., Galante, I., Bekkers, M. J., & Gallacher, J. (2014). Effect of kindness-based
meditation on health and well-being: A systematic review and meta-analysis.
Journal of Consulting and Clinical Psychology, 82,
1101-1114.
Gyatso, T. (2001).
The compassionate life
. Boston, MA: Wisdom Publications.
Gilbert, P., & Procter, S. (2006). Compassionate mind training for people with high
shame and self-criticism: Overview and pilot study of a group therapy approach.
Clinical Psychology & Psychotherapy, 13,
353-379.
Goss, K., & Allan, S. (2010). Compassion focused therapy for eating disorders.
International Journal of Cognitive Therapy, 2,
141-158.
Grant, B. F., Stinson, F. S., Dawson, D. A., Chou, S. P., Dufour, M. C., Pickering, R. P.,
& Kaplan, K. (2004). Prevalence and co-occurrence of substance use disorders
and independent mood and anxiety disorders: Results from the national
epidemiologic survey on alcohol and related conditions.
Archives of General
Psychiatry, 61,
807-816.
Hanh, T.N. (1976).
The miracle of mindfulness.
Boston, MA: Beacon Press Books.
Hofmann, S. G., Grossman, P., & Hinton, D. E. (2011). Loving-kindness and compassion
meditation: Potential for psychological interventions.
Clinical Psychology
Review, 31,
1126-1132.
Hutcherson, C.A., Seppala, E.M., & Gross, J.J. (2008). Loving-kindness meditation
increases social connectedness.
Emotion, 5,
720-724.
18

Loving-Kindness Meditation for Anxiety
Julian, L. J. (2011). Measures of anxiety; State-Trait Anxiety Inventory (STAI), Beck
Anxiety Inventory (BAI), and Hospital Anxiety and Depression Scale-Anxiety
(HADS-A).
Arthritis Care & Research, 63
, S467-S472
.
Kabat-Zinn, J. (1994).
Wherever you go, there you are: Mindfulness meditation in
everyday life.
New York, NY: Hyperion.
Kornfield, J. (1993).
A path with heart: A guide through the perils and promises of
spiritual life.
New York, NY: Bantam Books.
Kornfield, J. (2002).
The art of forgiveness, lovingkindness, and peace.
New York, NY:
Bantam Books.
Linehan, M. M. (1993).
Cognitive-behavioral treatment of borderline personality
disorder
. New York, NY: Guilford Press.
McClintock, A.S., Anderson, T., & Cranston, S. (2015). Mindfulness therapy for
maladaptive interpersonal dependency: A preliminary randomized controlled trial.
Behavior Therapy, 46,
856-868.
Morris, S. B., & DeShon, R. P. (2002). Combining effect size estimates in meta-analysis
with repeated measures and independent-groups designs.
Psychological Methods,
7,
105-125.
Neff, K. D. (2003). The development and validation of a scale to measure self-
compassion.
Self and Identity, 2,
223-250
Neff, K. D. (2015). The self-compassion scale is a valid and theoretically coherent
measure of self-compassion.
Mindfulness,
1-11.
Neff, K. D., & Germer, C. K. (2012). A pilot study and randomized controlled trial of the
mindful self-compassion program.
Journal of Clinical Psychology, 69,
28-44.
19

Loving-Kindness Meditation for Anxiety
Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect
effects in simple mediation models.
Behavior Research Methods, Instruments, &
Computers, 36,
717-731.
Salzberg, S. (1995).
Lovingkindness: The revolutionary art of happiness.
Boston, MA:
Shambhala.
Shahar, B., Szsepsnewol, O., Zilcha-Mano, S., Haim, N., Zamir, O., Levi-Yeshuvi, S., &
Levit-Binnun, N. (2014). A wait-list randomized controlled trial of loving-
kindness meditation programme for self-criticism.
Clinical Psychology &
Psychotherapy, 22,
346-356.
Shonin, E., Gordon, W. V., Compare, A., Zangeneh, M., & Griffiths, M. D. (2015).
Buddhist-derived loving-kindness and compassion meditation for the treatment of
psychopathology: A systematic review.
Mindfulness, 6,
1161-1180.
Spielberger, C. D., Gorsuch, R. L., Lushene, R., Vagg, P. R., & Jacobs, G. A. (1983).
Manual for the State-Trait Anxiety Inventory.
Palo Alto, CA: Consulting
Psychologists Press.
Sprecher, S. & Fehr, B. (2005). Compassionate love for close others and humanity.
Journal of Social and Personal Relationships, 22,
629-651.
Vettese, L. C., Toneatto, T., Stea, J., Nguyen, L., Wang, J. J., (2009). Do mindfulness
meditation participants do their homework? And does it make a difference? A
review of the empirical evidence.
Journal of Cognitive Psychotherapy, 23,
198-
225.
Werner, K. H., Jazaieri, H., Goldin, P. R., Ziv, M., Heimberg, R. G., & Gross, J. J.
(2012). Self-compassion and social anxiety disorder.
Anxiety, Stress, & Coping,
25
, 543-558.
20

Loving-Kindness Meditation for Anxiety
Table 1: Means and Standard Deviations for Measures and Results of ANCOVA and
Cohen’s
d
for Treatment Effects.
Note.
STAI= State-Trait Anxiety Inventory-Trait Form, CLS= Compassionate Love Scale, SCS=
Self-Compassion Scale, Pre= pretreatment (
n
= 71), Post= posttreatment (
n
= 60), FU= follow-up
(
n
= 57),
d
= Absolute value of Cohen’s d (between group comparison), CI = confidence interval
21
Measures LKM Control
F p d
95% CI
M SD M SD
STAI Pre 41.53 11.60 38.27 11.78
STAI Post 36.44 9.66 36.46 9.60 1.53 .221
STAI FU 35.76 8.72 36.67 9.55 2.37 .130
CLS Pre 4.66 0.92 4.72 0.51
CLS Post 5.20 0.73 4.77 0.80 9.19 .004 0.57 0.04 to 1.08
CLS FU 5.00 0.90 4.90 0.74 0.73 .400
SCS Pre 3.06 0.87 3.19 0.67
SCS Post 3.40 0.67 3.21 0.75 4.43 .040 0.27 -0.25 to 0.78
SCS FU 3.34 0.75 3.16 0.73 2.93 .093

Loving-Kindness Meditation for Anxiety
Figure 1: Procedure Flow Chart
34 completed posttreatment assessment
4 dropped prior to posttreatment
assessment (did not return phone calls/emails)
Recruitment via psychology department’s web-based
experiment sign-up system
34 analyzed at posttreatment
33 analyzed at follow-up
33 completed follow-up assessment
1 lost to follow-up (did not return phone
calls/emails)
24 completed follow-up assessment
2 lost to follow-up (did not return phone
calls/emails)
Allocated to Control (
n
=33)
26 analyzed at posttreatment
24 analyzed at follow-up
Enrollment and completion of
pretreatment assessment (
N
=71)
Allocaon
Follow-Up
Analysis
Allocated to LKM Intervention (
n
=38)
22

Loving-Kindness Meditation for Anxiety
23