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Altering the Trajectory of Affect and Affect Regulation: the Impact of Compassion Training

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A growing literature has begun to document the effects of compassion training on a variety of important interpersonal behaviors (e.g., helping behavior). What is not yet well understood, however, is what impact compassion training has on affect and affect regulation. To examine this issue, we implemented a 9-week compassion training program in which 51 adults provided twice-daily ratings of four affective states (anxiety, calm, fatigue, alertness) as well as their desire and capability to regulate these affective states. In addition, participants provided weekly responses regarding five specific regulatory strategies. Analysis of day-to-day trajectories of affective experience showed a decrease in anxiety and increase in calmness. Day-to-day trajectories of affect regulation demonstrated that participants were more likely to choose to accept and thus not influence or modulate affective experience (as opposed to dampen, enhance, or hold on to or maintain the affective state). At the same time, participants also reported being more capable in meeting their respective regulatory goals. Finally, analysis of week-to-week trajectories of specific regulatory strategies over the course of the compassion training program demonstrated that participants shifted to lesser use of expressive suppression and greater acceptance when experiencing stress/anxiety. These results suggest that interventions such as compassion training may help modulate specific affective states and modify the use of and self-efficacy for specific regulatory strategies.
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ORIGINAL PAPER
Altering the Trajectory of Affect and Affect Regulation:
the Impact of Compassion Training
Hooria Jazaieri
1
&Kelly McGonigal
2
&Ihno A. Lee
3
&Thupten Jinpa
2
&James R. Doty
2,4
&
James J. Gross
3
&Philippe R. Goldin
5
#Springer Science+Business Media, LLC 2017
Abstract A growing literature has begun to document the
effects of compassion training on a variety of important inter-
personal behaviors (e.g., helping behavior). What is not yet
well understood, however, is what impact compassion training
has on affect and affect regulation. To examine this issue, we
implemented a 9-week compassion training program in which
51 adults provided twice-daily ratings of four affective states
(anxiety, calm, fatigue, alertness) as well as their desire and
capability to regulate these affective states. In addition, partic-
ipants provided weekly responses regarding five specific reg-
ulatory strategies. Analysis of day-to-day trajectories of affec-
tive experience showed a decrease in anxiety and increase in
calmness. Day-to-day trajectories of affect regulation demon-
strated that participants were more likely to choose to accept
and thus not influence or modulate affective experience (as
opposed to dampen, enhance, or hold on to or maintain the
affective state). At the same time, participants also reported
being more capable in meeting their respective regulatory
goals. Finally, analysis of week-to-week trajectories of specif-
ic regulatory strategies over the course of the compassion
training program demonstrated that participants shifted to
lesser use of expressive suppression and greater acceptance
when experiencing stress/anxiety. These results suggest that
interventions such as compassion training may help modulate
specific affective states and modify the use of and self-efficacy
for specific regulatory strategies.
Keywords Affect .Affect regulation .Affective trajectories .
Affect dynamics .Self-efficacy .Compassion .Diary study .
Experience sampling .Ecological momentary assessment .
Multilevel analysis
One commonly cited definition of compassion is a Bfeeling
that arises in witnessing anothers suffering and that motivates
a subsequent desire to help^(Goetz et al. 2010b,p.352).To
date, much of the research on compassion has focused on the
latter part of this definitiontrait compassion has been shown
to predict things such as generosity (Saslow et al. 2013), vol-
unteerism (Omoto et al. 2009), and altruistic behavior (Batson
et al. 1999). Structured compassion training programs have
been shown to be effective in improving altruism and caring
behaviors (e.g., Jazaieri et al. 2016a;Wengetal.2013). Much
less is known about the association between compassion train-
ing and peoples affective responses, their attempts at regulat-
ing these affective responses, and their self-efficacy beliefs
(i.e., their beliefs about their ability to regulate these affective
states).
Affect is an overarching term that includes states such as
stress, mood, and emotion (Gross and Thompson 2007).
Affective states unfold over time and vary in type, quality,
intensity, duration, and frequency (Gross and Thompson
2007). Such variations in affective states are consequential
for health and well-being and may be influenced both by an
individuals attempts at regulating these affective states and by
his or her affect regulation self-efficacy.
*Hooria Jazaieri
hooria@berkeley.edu
1
Department of Psychology, Institute of Personality and Social
Research, University of California, Berkeley, 4152 Tolman Hall,
Berkeley, CA 94720-1650, USA
2
Center for Compassion and Altruism Research and Education, Palo
Alto, CA, USA
3
Department of Psychology, Stanford University, Stanford, CA, USA
4
School of Medicine, Stanford University, Stanford, CA, USA
5
Betty Irene Moore School of Nursing, University of California,
Davis, Sacramento, CA, USA
Mindfulness
DOI 10.1007/s12671-017-0773-3
One method of examining affect trajectories has been daily
experience sampling. While daily experience sampling has
been utilized to examine affect in non-clinical populations
(e.g., Brans et al. 2013; Brose et al. 2015; Brown and Ryan
2003; Csikszentmihalyi and Hunter 2003; Goetz et al. 2010a;
Killingsworth and Gilbert 2010), most of these studies have
utilized relatively short-term daily assessments (e.g., ranging
from 2 to 21 days). Due to the relative ease of assessment,
most empirical studies with non-clinical populations have uti-
lized weekly assessments to examine affective trajectories
(e.g., Srivastava et al. 2009; Tamir et al. 2007).
Affect regulation refers to attempts made to influence what,
when, and how a person experiences various affective states
(e.g., Jazaieri et al. 2013b). One crucial determinant of affect
regulation is the goals people have at any given time (Gross
and Jazaieri 2014). For example, regulatory goals may include
increasing (enhancing), decreasing (dampening), keeping
around (maintaining), or accepting (embracing while not
modulating at all) ones current affective state. A second im-
portant determinant of affect regulation is the specific strate-
gies that one chooses in order to achieve ones regulatory
goal(s) (Gross and Jazaieri 2014).
Two of the most well-researched regulatory strategies are
cognitive reappraisal and expressive suppression (Gross
2002). Cognitive reappraisal, largely considered to be an
Badaptive^strategy (e.g., Gross 2002; John and Gross
2004), refers to efforts made to alter ones affect by modifying
the subjective meaning of the situation. When employed ap-
propriately, cognitive reappraisal can modify onesreactions
to affect-provoking situations and enhance psychological flex-
ibility and emotional well-being (Gross and Thompson 2007).
On the other hand, expressive suppression is mostly consid-
ered to be a Bmaladaptive^regulatory strategy (e.g., Gross
2002; John and Gross 2004) and refers to efforts made to alter
ones own physiological, experiential, or behavioral responses
in a given situation. Expressive suppression is used once one
has experienced the onset of the affective experience. Across
affect, social functioning, and well-being, converging empiri-
cal research suggests that individuals who engage in cognitive
reappraisal seem to fare much better in life than those who rely
primarily on suppression (e.g., Gross 2002; John and Gross
2004).
The regulatory strategy of situation modification refers to
attempts to alter external (rather than internal) features of ones
environment in an effort to influence ones affect. Situation
modification can be used in anticipation of problematic affect
and before the full onset of the affective state. Situation mod-
ification is considered to be problem focused coping (Lazarus
and Folkman 1984) whereby affective states are modulated
via stimulus control. Another regulatory strategy is attentional
deployment, which refers to efforts to direct (or redirect) at-
tention in such a way as to alter ones affective response. Two
of the most well-researched forms of attentional deployment
are distraction and ruminationboth largely considered to be
maladaptive strategies (Gross 2014). Finally, acceptance has
recently been considered to be a skillful method for regulating
ones affect (e.g., Gratz and Roemer 2004; Hayes et al. 1994,
1996;Linehan1993,2015). Rather than trying to change or
control ones affect in some way, acceptance refers to allowing
ones experience and affect to arise and change effortlessly of
their own accord. Empirical research has found that paradox-
ically, acceptance is quite effective in reducing negative affec-
tive states (Aldao et al. 2010; Hayes et al. 2012;Kengetal.
2016;Levittetal.2004). While some researchers conceptual-
ize acceptance as a form of cognitive reappraisal, we have
followed the conceptualization put forth by others (see
Aldao et al. 2010) who study mindfulness-based programs
and examine acceptance as a separate regulatory strategy, dis-
tinct from cognitive reappraisal.
Commonly, researchers focus on the frequency of use of
specific regulatory strategies such as those listed above
(Gross and John 2003). However, more recently, researchers
have become interested in examining regulatory self-
efficacy or capability, the belief one has in ones abilities to
implement specific regulatory strategies (e.g., Goldin et al.
2009; Goldin et al. 2012a). Regulatory self-efficacy or capa-
bility has become an increasingly important construct to
measure and has been shown to be predictive of longer term
treatment outcomes (e.g., Goldin et al. 2012a). Self-efficacy
beliefs have also been linked to enhanced affect regulation
and psychosocial functioning more generally (e.g., Bandura
et al. 2003).
There are likely many ways of influencing affect trajecto-
ries, affect regulation, and affect regulation self-efficacy. The
most common approach to date has been to use formal clinical
treatment interventions with clinical samples (e.g., Aldao et al.
2014;Goldinetal.2014; Jazaieri et al. 2016b). However, such
treatments are often expensive and are generally limited to
individuals who meet criteria for specific psychopathology.
It is possible that sub-clinical or Bhealthy^individuals who
also experience challenging affective states might benefit from
enhancing skills to alter affective trajectories and enhance reg-
ulation and self-efficacy.
This has motivated researchers to explore novel interven-
tion programs, such as compassion training. Compassion is a
multidimensional construct that includes an affective compo-
nent (e.g., Goetz et al. 2010a;Jinpa2015; Jinpa and Weiss
2013). Some scholars have even conceptualized compassion
training as a form of cognitive reappraisal (e.g., Dahl et al.
2015; Engen and Singer 2015); however, only recently has
compassion as a state, trait, and intervention been researched
in Western science (e.g., Hutcherson et al. 2008; Klimecki
et al. 2012;Wengetal.2013). The foundation of compassion
training is mindfulness, or the ability to notice and pay atten-
tion (in the case of compassion, paying attention to suffering).
The empirical literature has established that mindfulness
Mindfulness
trainings can influence affect and regulation in clinical (e.g.,
Goldin and Gross 2010;Goldinetal.2012b;Jazaierietal.
2016b) and non-clinical populations (e.g., Chambers et al.
2008; Jha et al. 2010); however, far less is known about affect
and affect regulation within the context of compassion train-
ing more generally.
To date, the majority of theoretical and empirical work on
compassions relationship to affect has focused on one specif-
ic component of compassion, for example, self-compassion
(e.g., Raes 2010; Van Dam et al. 2011). When considering
positive psychology interventions aimed at increasing positive
emotions, loving-kindness meditation (one specific compo-
nent or form of compassion practice where one cultivates the
wish of happiness for others) has been shown to be beneficial
for ones affective state (Cohn and Fredrickson 2010;
Fredrickson et al. 2008). What has not yet been addressed,
however, is the impact of broader compassion training inter-
ventions on affective outcomes.
Our goal in the present study was to investigate affective
outcomes (trajectories, regulation, and self-efficacy) in CCT
within a community sample of adults. With regard to day-to-
day affective experience, we predicted reductions in anxiety
and fatigue and increases in calmness and alertness following
compassion training. We also predicted that compassion train-
ing would induce a greater desire to downregulate or dampen
negative affective states (anxiety and fatigue) and upregulate
or enhance positive affective states (calmness and alertness).
Relatedly, we predicted that participants would endorse great-
er capabilities in meeting all of their regulatory goals. With
regard to week-to-week trajectories of regulatory strategy use,
we predicted that participants would report decreases in situ-
ation modification and attentional deployment when
interacting with others and decreases in expressive suppres-
sion when experiencing stress/anxiety. Lastly, we predicted
that participants would report increases in cognitive reapprais-
al when interacting with others and increases in acceptance
when experiencing stress/anxiety.
Method
Participants
Participants in this study were a subset (only those participants
randomized to immediate CCT as the participants in the
waitlist condition did not provide daily or weekly responses)
of a larger randomized controlled trial (Jazaieri et al. 2013a).
In this paper, we examine daily and weekly responses regard-
ing affective trajectories, regulation, and self-efficacy from the
51 participants who received the CCT intervention and had at
least a 50% response rate across all daily and weekly assess-
ment points over the 10-week period (9 out of the 60 partici-
pants randomized to immediate CCT did not meet this
criteria). A full CONSORT diagram is available in Jazaieri
et al. (2013a)(Fig.1). Participants in this study were primarily
middle aged (M(years) = 44.36, SD = 12.14), women (70.6%;
n= 36), and Caucasian (76.5%; n=39).
Procedure
Potential participants were recruited through web-based on-
line community listings throughout the San Francisco Bay
Area, email listservs, and advertisements on community bul-
letin boards. Potential participants had to pass an initial online
screening procedure which excluded individuals who self-
endorsed bipolar disorder, major depressive disorder, psycho-
sis, or active suicidal ideation. Participants provided informed
consent in accordance with Stanford University Human
Subjects Committee rules and were not paid for their
participation.
Fig. 1 Screenshot example of iPhone question assessing anxiety, desire
to regulate anxiety, and capability of regulating anxiety
Mindfulness
Compassion Cultivation Training
Compassion Cultivation Training (CCT) is a comprehensive
compassion training program with a dialectical focus on (a)
how one relates to suffering (that of oneself and others) and (b)
how one intentionally generates positive feelings for oneself
and others (loving-kindness). On the one hand, CCT develops
compassion, a mental capacity to regulate distress (e.g., stress
and anxiety) and maintain calm in response to suffering (for
oneself and others). On the other hand, CCT generates loving-
kindness, or the mental capacity to generate positive states
such as care, connectedness, and appreciation for oneself
and others. These two dialectics, compassion and loving-kind-
ness, are cultivated in an effort to more willingly and effec-
tively engage with any suffering that is present. Training of
present moment attention and the willingness to hold both
suffering and loving-kindness is intended to help people relate
to emotion and difficult experiences in a new way (Jazaieri
et al. 2014).
CCT is designed to be a structured, secular, and compre-
hensive, self- and other-focused compassion meditation train-
ing program. CCT consists of a 2-h introductory orientation,
eight once weekly 2-h classes, and daily compassion-focused
meditation practices. Specific content of the program includes
progressing through six sequential steps starting with the es-
sential and foundational skill of settling and focusing the mind
(attention training). Steps 25 pertain to the actual compassion
cultivation including loving-kindness and compassion for a
loved one (step 2), loving-kindness and compassion for one-
self (step 3), establishing the basis for compassion towards
others (step 4), cultivating compassion for others (step 5),
and lastly, active compassion practice (step 6). For a more
detailed description of the six steps in CCT, see Jinpa (2015)
and Jinpa and Weiss (2013). Each step in CCT builds upon the
prior, always beginning with settling and focusing the mind
(step 1). To integrate these practices into daily life, participants
are expected and encouraged to engage in daily home medi-
tation practice for at least 15 min (building up to approximate-
ly 30 min) using recorded guided meditations. The feasibility
of enhancing compassion through CCT has been established
(see Jazaieri et al. 2013a). When utilizing pre-to-post assess-
ments, CCT has been shown to produce significant increases
in trait mindfulness and happiness and decreases in worry,
stress, and suppression of emotional expression (Jazaieri
et al. 2014).
Measures
Daily Experience Sampling Participants were contacted at
fixed times twice daily throughout the duration of the course,
once in the morning and once in the evening (for additional
details, see Jazaieri et al. 2016a). To assess the affect trajecto-
ries of anxiety, calm, fatigue, and alert, participants responded
to the question: BHow [affective state] are you feeling right
now?^on a 7-point Likert scale ranging from 1 (not at all)to7
(very much). To assess affect regulation, participants
responded to the question: BWith regards to this feeling, do
you currently want to:^Bdampen it,^Bmaintain it,^Benhance
it,^or Bnot influence it at all.^To assess affect regulation self-
efficacy, participants were asked, with regard to the selected
strategy (dampen, maintain, enhance, or not influence), BDo
you feel capable of achieving this?^again rated on a 7-point
scale ranging from 1 (not at all) to 7 (very much). See Fig. 1
for an example of how these three questions appeared within
the context of anxiety.
Weekly Diaries To investigate weekly changes in affect reg-
ulation during CCT, we administered an inventory that our
laboratory has developed and have utilized in other studies
(e.g., Aldao et al. 2014;Goldinetal.2014). Participants were
trained on the use of the weekly inventory prior to the start of
the CCT program. During CCT, participants were emailed the
weekly questionnaire each week, on the day prior to their CCT
class. Instructions were to Bselect the percentage that indicates
how often you used a particular strategy toreduce any stress or
anxiety. 0% indicates that you used a particular strategy 0% of
the time and 100% indicates that you used a particularly strat-
egy 100% of the time^during the past week.
Specifically, to assess the regulatory strategy of situation
modification we asked, BHow often did you try to modify
your interactions with others (change the situation itself)?^
To assess attentional deployment we asked, BHow often did
you try to distract yourself during interactions with others?^
To assess cognitive reappraisal we asked, BHow often did you
try to change the way you were thinking or interpreting while
interacting with others?^To assess expressive suppression we
asked, BHow often did you try to hideany visible signs of your
stress or anxiety?^Finally, to assess acceptance we asked,
BHow often did you try to just accept your stress or anxiety
and not change it in any way?^In the weekly assessment
situation modification, attention deployment, and cognitive
reappraisal were pertaining to interactions with others while
expressive suppression and acceptance were pertaining spe-
cifically to states of stress or anxiety.
Data Analyses
The daily data have a two-level structure, (diary ratings (level
1) nested within participant (level 2)), which is best analyzed
with multilevel modeling procedures. Univariate analyses ex-
amined daily changes in affect trajectories (feeling anxious,
calm, fatigued, alert), affect regulation (dampen, maintain,
enhance, or not influence), and affect regulation self-efficacy
(for anxiety, calm, fatigue, alertness). Separately, multivariate
analysis examined whether the changes in affect regulation
self-efficacy during CCT were related to changes in affect
Mindfulness
trajectories as well as to changes in affect regulation for each
of the four affective states.
The weekly data have a similar two-level structure, with
weekly measures (level 1) nested within participant (level 2).
Univariate analysis examined the weekly changes in affect
regulation (situation modification, attentional deployment, re-
appraisal, suppression, acceptance).
Multilevel analyses were conducted using the following
approach: (a) To account for serial dependency in repeated
measures, we specified an autoregressive residual covariance
matrix. This specification ensures that each dependent vari-
able represents a change in relation to previous scores. (b) For
the daily analyses, the diary number (e.g., diary #3, diary #4)
was includedas a level-1 predictor to test for variation in affect
trajectories and affect regulation during CCT. For the weekly
analyses, week was included as a level-1 predictor. (c) All
intercepts and slopes were specified as random effects, with
covariances allowed among all random components. Our pri-
mary interest was in the covariance across time in (1) affect
regulation self-efficacy and affect trajectories and (2) affect
regulation self-efficacy and the desire to regulate affect.
The daily analyses were based on 112 ratings per person
collected over the CCT course. The weekly analyses were
based on ratings (assessed once per week) collected over the
CCT course. Missing values (daily, 23.4%; weekly, 2.9%)
were handled using full-information maximum likelihood
(FIML) estimation procedures, which generate unbiased pa-
rameter estimates and standard errors using all available ob-
servations (Enders 2001). On average, the percentage of miss-
ing data increased slightly from week 1 (17%) to week 8
(31%); however, no common or consistent patterns of day-
to-day Bmissingness^were found throughout CCT.
Univariate analyses were conducted using SAS PROC
MIXED (for continuous outcomes) and PROC GLIMMIX
(for binary outcomes); multivariate analyses were conducted
in Mplus v.6.1 (Muthén and Muthén 19982010). All predic-
tors were group-mean centered which standardizes within-
person responses and is typical for analyses targeting
intraindividual change.
Results
All trajectories are displayed in Figs. 2,3,and4; estimates are
reported in Table 1. With regard to affect trajectories, during
CCT there were significant decreases in anxiety (γ=.02,
p= .01) and increases in calmness (γ= .04, p< .01) with
significant variance across participants (ps < .01). Fatigue
and alertness did not change significantly over time, but did
vary across individuals (ps < .01).
With each successive rating, participants were less likely to
want to reduce their anxiety (OR=.989, 95% CI = (.983, .994))
and fatigue (OR = .987, 95% CI = (.981, .994)), as well as less
likely to want to enhance their feelings of calmness
(OR = .989, 95% CI = (.983, .995)) and alertness
(OR = .993, 95% CI = (.988, .998) (Fig. 3). Participants also
reported feeling more capable of regulating their affective
states of anxiety (γ=.03,p= .04), calmness (γ=.03,
p= .03), fatigue (γ=.03,p= .05), and alertness (γ=.03,
p= .04), with significant individual variability in these trajec-
tories (ps < .01). While feelings of self-efficacy or capability
in regulating ones affective states increased throughout CCT,
the desire to actually regulate affect (i.e., downregulate nega-
tive affect, upregulate positive affect) decreased (Fig. 4)
hinting again at the paradoxical effects of acceptance within
the context of this comprehensive compassion training
program.
During CCT, we found an inverse relationship between
reductions in anxiety and increases in regulation self-
efficacy of anxiety (r=.68, p< .01). Similarly, increases in
calmness were related to increases in regulation self-efficacy
of calmness (r=.67,p< .01). These correlations did not differ
in size between anxiety and calmness (χ
2
(1) = .71, p>.05)
(significance was evaluated using the difference in 2log-
likelihoodvaluesobtained from a focal model and comparison
(nested) model, which is chi-square distributed). A similar
pattern of correlational results for fatigue and alertness and
their respective regulation self-efficacy were found.
However, given the non-significant trajectories in the fatigue
and alertness trajectories, these correlations are not as mean-
ingful and interpretable.
In addition, increases in regulation self-efficacy were relat-
ed to decreases in the desire to regulate affect. Specifically,
there were inverse associations between regulation self-
efficacy and desire to regulate for anxiety (r=.51,
p< .01), calmness (r=.71, p< .01), fatigue (r=.55,
p< .01), and alertness (r=.38, p<.05).
All affect regulation trajectories are displayed in Fig. 5;
estimates are reported in Table 1. Throughout the course of
the compassion intervention the use of suppression decreased
(γ=.02, p= .002) and the use of acceptance increased
(γ= .02, p= .002) when experiencing stress/anxiety. The
1
2
3
4
5
6
7
Intensity (1 7)
Time
Affect Trajectories
Anxious
Calm
Fatigued
Alert
Fig. 2 Day-to-day affect trajectories during CCT (reported as means)
Mindfulness
frequency with which participants engaged in situation mod-
ification, attentional deployment, and cognitive reappraisal
during interactions with others did not change over time; how-
ever, these trajectories varied across individuals (ps < .01).
Discussion
The goal of this study was to investigate affect trajectories,
affect regulation, and affect regulation self-efficacy in a com-
munity sample of adults enrolled in a 9-week compassion
training program. We sought to extend the literature in four
important ways. First, rather than focusing on one specific
aspect of compassion (e.g., self-compassion or loving-kind-
ness), we utilized a 9-week comprehensive compassion med-
itation training program (CCT) that has been shown to
enhance multiple forms of compassion (Jazaieri et al.
2013a). Second, we sought to broaden the examination of
affect regulation beyond cognitive reappraisal and expressive
suppression and also consider the regulatory strategies of
situation modification, attentional deployment, and accep-
tance. Third, we sought to utilize more nuanced methodolog-
ical approaches (daily and weekly reports) to examine the
stability and change of affect and regulation. Finally, we
sought to add to the literature by examining these affective
outcome trajectories over an extended period of time (9-
weeks).
In partial support of our hypothesis with regards to day-to-
day experiences of affect trajectories, we found reductions in
anxiety and increase in calmness trajectories over the course
of the intervention. There were no changes in the states of
fatigue or alertness over the course of CCT. When considering
day-to-day intention to regulate affect, contrary to our hypoth-
eses, participants were more likely to choose to not influence
their affective states (as opposed to down-regulate negative
states of anxiety and fatigue or upregulate positive states of
calmness and alertness). Participants also reported being more
capable in meeting their respective regulatory goals.
Interestingly, although we did not predict this, while partici-
pants reported being more capable at regulating affective
states, they simultaneously reported less desire to regulate.
Finally, when considering the week-to-week trajectories of
affect regulation over the course of the program, participants
reported decreases in expressive suppression and increases in
acceptance of affective states (stress/anxiety). Contrary to our
hypotheses, there were no changes in situation modification,
attentional deployment, or cognitive reappraisal during inter-
actions with others.
While the absence of a comparison condition prohibits
making conclusive interpretations of these results, preliminary
evidence from this study suggests that this compassion train-
ing program may reduce anxiety and increase feelings of
calm, which may be related to increases in the capability to
regulate both of these states. Prior research has shown that
0.15
0.2
0.25
0.3
0.35
0.4
0.45
0.5
0.55
0.6
Freqeuency (%) of Wanting to Regulate
Time
Affect Regulation
Dampen Anxiety
Enhance Calm
Dampen Fatigue
Enhance Alertness
Fig. 3 Day-to-day desire to
regulate affect during CCT
(reported as frequency
percentages)
4.25
4.5
4.75
5
5.25
5.5
Capability (1 7)
Time
Affect Regulation Self Efficacy
Anxious
Calm
Fatigued
Alert
Fig. 4 Day-to-day affect regulation self-efficacy during CCT (reported
as means)
Mindfulness
compassion training can increase positive affective experi-
ences, even in response to witnessing others in distress
(Klimeckietal.2012). Furthermore, experimental studies
with expert practitioners of compassion meditation have
shown that compassion meditation primarily increased posi-
tive affect and that cognitive reappraisal primarily decreased
negative affect when viewing video clips of people in distress
(Engen and Singer 2015). While not the goal of compassion
Table 1 Fixed and random
effects from the multilevel
analyses of affect trajectories,
affect regulation, and affect
regulation self-efficacy
Fixed effects Random effects
Intercept (γ
00
) Slope (γ
01
) Intercept (τ
00
)Slope(τ
11
)
Daily
Affect trajectories
a
Anxiety 3.096** .022* .403** .0024**
Calmness 4.532** .039** .567** .0036**
Fatigue 3.759** .011 .620** .0041**
Alertness 4.486** .002 .479** .0030**
Affect regulation
b
Reduce anxiety .380 .011** 1.774** .0003
Enhance calmness .524
.011** 3.216** .0003**
Reduce fatigue .598* .013** 2.355** .0004
Enhance alertness 1.324** .007** 2.941** .0002
Affect regulation self-efficacy
a
Anxiety 4.973** .025* 1.091** .0060**
Calmness 4.950** .029* 1.082** .0075**
Fatigue 4.898** .028* 1.344** .0091**
Alertness 5.051** .027* 1.051** .0072**
Wee kl y
Affect regulation
Situation modification .299** .006 .036** .0010**
Attentional deployment .383** .008 .047** .0008**
Cognitive reappraisal .259** .001 .024** .0006**
Expressive suppression .408** .017** .040** .0004
Acceptance .343** .017** .018** .0007*
=p<.06,*=p<.05,**=p< .01. Unstandardized estimates are reported
a
Slope parameters were generated from rescaled outcome variables (multiplied by 10) to facilitate reporting of
estimates. Rescaling does not affect statistical significance
b
Outcomes are binary, so the fixed effect estimates reflect log-odds ratios. Traditional odds ratios (e
β
)arereported
in the text
20
25
30
35
40
45
50
Frequency of Regulation (%)
Time
AffectRegulation
Situation
Modification
Cognitive
Reappraisal
Attentional
Deployment
Expressive
Suppression
Acceptance
Fig. 5 Week-to-week affect
regulation during CCT (reported
as frequency percentages)
Mindfulness
practice, the literature suggests that compassion meditation
(and specific subtypes such as loving-kindness meditation)
is associated with increases in positive affect and decreases
in negative affect (for reviews, see Hofmann et al. 2011; Zeng
et al. 2015). The current study provides some preliminary
evidence that calm, a low arousal positive state that is consid-
ered to be a valued state (Koopmann-Holm et al. 2013), may
be able to be increased through compassion training. A ran-
domized controlled trial with a comparison condition will be
able to more definitively address the role of compassion train-
ing on the affective state of calm. Although not tested here, it
is possible that these increases in calm may be related to de-
creases in personal distress, which in turn may be linked to
increased regulatory self-efficacy. This is an important area for
continued investigation.
Preliminary findings from this study suggest that CCT may
result in increased abilities to regulate affective experience
while also shifting towards choosing to not influence affective
states in any wayperhaps suggesting that participants in this
compassion training may be more willing to accept onesaf-
fective states (both positive and negative) without choosing to
influence them in any way. This increase in self-efficacy or
perceived capability to regulate affective states may have led
to a greater willingness to experience and/or acceptance of
different affective states, with concomitant decreases in the
need to implement any form of regulation. These intriguing
findings highlight the potential role of affect regulation self-
efficacy in promoting acceptance of affect experience. Given
that CCT is a comprehensive compassion training program
with a dialectical focus on how one relates to suffering (i.e.,
recognizing and approaching, rather than avoiding, suffering)
and also loving-kindness (a state of generating positive emo-
tions for oneself and others), it is reasonable to expect an
increase in acceptance of both positive and negative states.
While this increase in ones self-efficacy in regulating affect
would likely yield fewer failed regulatory experiences, it is
also possible that people are more efficacious in their regula-
tory attempts which may lead to fewer repeated attempts of
regulation. In the present study, it is difficult to assess the
directionality of the actual regulatory efficacy and desire to
regulate affective statesfuture research employing a true
experimental design will be able to address the causal nature
of this intriguing relationship.
These daily findings converge nicely with our findings
from the weekly assessments of specific emotion regulatory
strategies, which demonstrated decreases in suppression and
increases in acceptance of affective states (stress/anxiety).
These findings also parallel prior research of pre-post CCT
individual difference findings of emotion regulation which
utilized the Emotion Regulation Questionnaire (ERQ; Gross
and John 2003) and demonstrated a reduction in expressive
suppression, but no changes in general use of cognitive reap-
praisal following CCT when compared to the waitlist control
condition (Jazaieri et al. 2014). Taken together, these prelim-
inary daily and weekly data paired with the prior trait level
data from the randomized controlled trial suggests that on a
daily, weekly, and trait level, this type of compassion training
program may reduce expressive suppression of affect and in-
crease acceptance of positive and negative affective states.
Limitations and Future Research
The present investigation should be interpreted in the context
of several important limitations. This study examined a new
and comprehensive compassion training program. Without
utilizing a comparison condition in addition to CCT, it is dif-
ficult to understand to what extent compassion training influ-
enced daily and weekly affect and affect regulation. Future
research examining affect trajectories, affect regulation, and
affect regulation self-efficacy in compassion training would
benefit from utilizing an active control condition to fully un-
derstand the effects. In the daily experience sampling, we
examined four specific affective statesanxious, calm, fa-
tigued, and alertthat represent different combinations of va-
lence and arousal. We did not find effects on the states of alert
(a high arousal, positive state) or fatigue (a low arousal, neg-
ative state). Future research may choose to examine additional
combinations of high and low arousal and positive and nega-
tive affective states such as joy, awe, and boredom. Relatedly,
in our weekly diary, we were interested in expanding the focus
beyond cognitive reappraisal and expressive suppression to
examine additional forms of affect regulation including situa-
tion modification, attentional deployment, and acceptance. It
is only through detailed empirical investigation into additional
strategies that we can more fully understand the effectiveness
(or potential ineffectiveness) of different regulatory strategies.
Given that dozens of regulatory strategies exist (for a review,
see Webb et al. 2012), future research may choose to examine
additional strategies (e.g., situation selection; Gross 1998), or
subtypes of strategies (e.g., mindfulness as a form of
attentional deployment; Neacsiu et al. 2014). It will also be
important to use similar context frames across all strategies
(e.g., all related to stress/anxiety contexts or all items related to
social interactions with others) in order to address the gener-
alizability of improvements in regulatory strategy use. Finally,
this study relied on daily and weekly self-reports of affect and
regulation. Future studies of compassion training must move
beyond self-report to include implicit or behavioral measures,
observer reports (e.g., romantic partners, co-workers, peers),
and physiological markers.
Collectively, the findings from this study suggest that in-
terventions such as this comprehensive compassion training
program may help modulate specific affective states (anxiety
and calm), and modify ones self-efficacy and use of various
affect regulation strategies. This study was novel in that it
utilized nuanced methodological approaches ranging from
Mindfulness
daily experience sampling to weekly diaries, which allowed us
to look at trajectories of change, while also sampling a variety
of regulation strategies beyond cognitive reappraisal and ex-
pressive suppression. Taken together, this study provides valu-
able preliminary information about the stability and change
related to affective processes during a comprehensive compas-
sion training program.
Acknowledgements The authors would like to thank the handling ed-
itor as well as the two anonymous reviewers for their thoughtful com-
ments that strengthened this paper. We would also like to thank senior
CCT teachers Margaret Cullen and Erika Rosenberg for their contribu-
tions to the development of the CCT protocol and teaching of CCT.
Finally, we would like to thank Benjamin Olmsted for developing the
app used in this research.
Author Contributions HJ co-designed the study, executed the study,
assisted with data analyses, and wrote the manuscript. KM taught CCT
and assisted with editing of the manuscript. IL conducted data analyses
and assisted with writing and editing of the manuscript. TJ created CCT
and assisted with the editing of the manuscript. JD assisted with editing of
the manuscript. JG collaborated in the writing and editing of the manu-
script. PG co-designed the study and collaborated in the writing and
editing of the manuscript.
Compliance with Ethical Standards The research study was ap-
proved by the ethics committee at Stanford University, prior to participant
recruitment.
Conflict of Interest The authors declare that they have no conflicts of
interest.
Funding This research was supported by a Fetzer grant as well as
funding from Stanfords Center for Compassion and Altruism Research
and Education (CCARE).
Human and Animal Rights All procedures performed in studies in-
volving human participants were in accordance with the ethical standards
of the institutional research committee and with the 1964 Helsinki decla-
ration and its later amendments.
Informed Consent Informed consent was obtained from all individual
participants prior to their inclusion in the study.
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Mindfulness
... Undergoing the CCT intervention, participants spent shorter time thinking about unpleasant things compared to those who did not undergo the intervention. Moreover, the study [16] found that participants reported decreased anxiety, increased calmness, and increased ability to accept their aff ective experiences. ...
... However, the authors did state that the participants at the onset of testing did not show high levels of burnout. On the other hand, their study showed that CCT actually can increase mindfulness, self-compassion, and work satisfaction while decreasing fear of compassion [16]. The eff ect of CCT in healthcare was the subject of another study [17], in which the authors examined cancer patients and their perspectives. ...
... H3: The increased level of self-compassion will persist even 2 months after the completion of the CCT intervention [1, 16,17]. ...
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... First, compassionate individuals report lower stress levels, have lower stress-reactivity, and have higher stress-buffering factors such as higher perceptions of social support (Abelson et al., 2014;Brito-Pons et al., 2018;Cosley et al., 2010). Second, high compassion is clearly associated with components of effective emotion regulation, including more frequent use of acceptance and upward regulation of positive affect (Engen & Singer, 2014;Jazaieri et al., 2018). There is strong evidence that both lower stress and adaptive emotion regulation strategies are, in turn, linked with fewer sleep difficulties (de Grey et al., 2018;Ong et al., 2012;Sanford et al., 2015). ...
... Research has shown, for instance, that high compassion is associated with lower self-reported and physiologically measured levels of stress (Abelson et al., 2014;Engert et al., 2017;Saarinen et al., 2021), including the stronger activity of the vagus nerve of the parasympathetic nervous system (Porges, 2001;Stellar & Keltner, 2017). High compassion is also found to be associated with more adaptive coping styles in stressful situations, for instance, greater acceptance in the face of adversity (Jazaieri et al., 2018). Experienced stress, in turn, is a well-known risk factor for sleep difficulties, such as sleep discontinuity, sleep deficiency, and lesser amounts of deep sleep (Åkerstedt, 2006). ...
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Introduction This study investigated the cross‐sectional and longitudinal associations between self‐reported compassion and sleep quality. Methods The data came from the population‐based Young Finns Study with an 11‐year follow‐up on compassion and sleep (n = 1064). We used regression models, multilevel models, and cross‐lagged panel models to analyze the data. Results The results showed that high compassion was cross‐sectionally associated with lesser sleep deficiency and fewer sleep difficulties. High compassion also predicted fewer sleep difficulties over an 11‐year follow‐up (adjusted for age, gender, socioeconomic position in childhood and adulthood, body mass index, health behaviors, and working conditions). This association disappeared when controlling for depressive symptoms. The predictive pathway seemed to proceed more likely from high compassion to fewer sleep difficulties than vice versa. Discussion Compassion may buffer against sleep difficulties, possibly via reducing depressive symptoms.
... For the meta-analysis, the intervention group in Jazaieri et al. (2018) was extracted and analyzed as a nonrandomized prepost comparison because it measured anxiety only in the intervention group and no data were available for the control group. The intervention group in Galante et al. (2016) was also extracted as a nonrandomized prepost comparison because only the prepost change in anxiety was available. ...
... Only one study was available for each of the other variables. Positive emotions (Galante et al., 2016), common humanity and decentering (Roca et al., 2021), cognitive distortions , the efficacy of self-regulation of anxiety (Jazaieri et al., 2018), and cortisol (Engert et al., 2017) were found to be potential mediators, while changes in salivary C-reactive protein did not correlate with changes in anxiety . Few studies have also highlighted moderators. ...
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Objectives It is debatable whether loving-kindness and compassion meditation (LKCM) effectively reduces anxiety, and previous studies have reported inconsistent findings. This study provides a systematic review and meta-analysis of the effects of LKCM on anxiety. Method Studies that took LKCM as the main body and measured anxiety as an outcome were included. There were no exclusion criteria for sample characteristics or control groups. Results Among 327 empirical studies published up to March 2022 on LKCM, 59 measured anxiety as an outcome. Meta-analyses showed that LKCM interventions are effective in reducing anxiety (d = -0.28, k = 19, n = 1284 for randomized controlled trials; d = -0.48, k = 26, n = 1177 for nonrandomized trials; d = -0.58, k = 6, n = 503 for laboratory experiments). The heterogeneity was high between studies. Subgroup analyses for randomized controlled trials found that studies combining loving-kindness meditation and mindfulness meditation outperformed studies adopting loving-kindness meditation alone. Moreover, studies with waitlist controls had greater effect sizes than studies with active controls. The type of anxiety, participant characteristics, protocol, or length of intervention had no statistically significant moderating effects. Individual studies supported mindfulness and self-compassion as important mechanisms, but the amount of meditation practice made a limited contribution. Conclusions LKCM interventions can be effective in reducing anxiety. The incremental value of combining mindfulness meditation with loving-kindness meditation is encouraging. More research is needed, especially on specific populations suffering from anxiety disorders. Preregistration PROSPERO CRD42021245515
... Compassion can also help those experiencing chronic pain (Wren et al., 2012), spina bifida (Hayter & Dorstyn, 2013), and cancer (Gillanders, Sinclair, MacLean, & Jardine, 2014) to resiliently adjust to these medical conditions. Compassion practices also have shown to help people accept distressing life contexts without the need to necessarily affectively regulate distress (Jazaiere, McGonigal, Lee, et al., 2018). In an interesting finding in their study, Jazaiere, McGonigal, Lee, et al. (2018) found that participants who attended a multiweek compassion training program had two things occur. ...
... Compassion practices also have shown to help people accept distressing life contexts without the need to necessarily affectively regulate distress (Jazaiere, McGonigal, Lee, et al., 2018). In an interesting finding in their study, Jazaiere, McGonigal, Lee, et al. (2018) found that participants who attended a multiweek compassion training program had two things occur. First, participants experienced a greater self-efficacy in their capacity to regulate their negative emotional distress. ...
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Global rates of stress and mental health distress have reached all-time highs. Given the scale of the problem, the development and dissemination of stress management strategies ought to be accessible, trainable, and low-cost. Growing evidence indicates that the utilization of compassion-based skills has positive effects on stress reduction, enhanced mental wellbeing, and emotional resilience. In this chapter, the science of compassion will be highlighted and reviewed. This chapter explores the psychological and neurobiological foundations of compassion and how those factors can be trainable motivations and behaviors. The science of compassion demonstrates that people can reduce stress in their lives by engendering the perspective taking, emotion regulation, and relational skills within compassionate behaviors. Given contemporary workplace stressors, the application of compassion to address stress and wellbeing in the workplace is explored.
... The experience of increased empathic distress may affect certain groups more frequently, including health professionals. Compassion can be enhanced with training Valk et al., 2017), simultaneously leading to a decrease in empathic distress (Dowling, 2018;Jazaieri et al., 2018;Klimecki et al., 2013Klimecki et al., , 2014Singer and Engert, 2019). To understand and optimise compassion training, it is important to be able to accurately track its effects. ...
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Introduction: Though empathy, compassion, and Theory of Mind (ToM) are related, they have been distinguished conceptually and empirically across behavioural and neuroimaging experiments. The EmpaToM task was the first realistic paradigm developed for use in functional Magnetic Resonance Imaging (fMRI), which can reliably detect and distinguish three different types of neural pathways crucial for understanding others with a single well-controlled task. Though the paradigm holds the potential for use in research settings as well as clinical practice , it has thus far only been validated in German speaking populations, using stimuli in German language, restricting its usability across countries. We present an English-language translation of the original paradigm here. Method: Thirty-two English speaking adults underwent fMRI scanning, during which we collected neural and behavioural data as in the original validation of the EmpaToM task. Results: Apart from minor differences, these results replicated the main behavioural and neural findings observed during the validation of the German paradigm. Participants reported increased negative affect and activity in brain regions previously associated with empathy when observing video clips with negative vs neutral valence. They further reported increased compassion. The pattern of neural activity differentiating empathy from compassion was largely consistent with previous research. Increased activity in regions previously associated with ToM were observed in response to stimuli with ToM vs factual reasoning content. Conclusion: We therefore conclude that the English version of the EmpaToM task can be used to reliably assess empathy, compassion, and ToM on a behavioural as well as neuronal level across English speaking countries and institutions.
... El Entrenamiento en el Cultivo de la Compasión (CCT, de sus siglas en inglés), ha mostrado resultados prometedores, entre ellos: a) el aumento de la compasión (hacia uno mismo y hacia los demás), de la empatía 20-24 y de las habilidades de mindfulness 20,21,24,25 ; b) la disminución de la rumiación 21,23 , la depresión, el estrés y la ansiedad 20,21,23,26 y; c) el aumento de los sentimientos de conexión con otros 27 . ...
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Objective: The project aimed to adapt to the Polish of the revised version of the Compassion Scale for Others created by Elisabeth Pommier, Kristin Neff, and Tóth-Király. Adaptation took place in two main stages: cultural and psychometric validation. Methods and materials: The research used the 2020 CS-R scale, a metric with selected demographic data, a NEO-FFI personality test, and the Self-Compassion Scale (SCS-PL). Participants: 645 adults living in these Polish participated in the study. Results: The data obtained in the process of adaptation and validation allow the introduction of the Compassion for Others Scale on the ground of Polish. CS-R-PL enables Polish practitioners and researchers to assess their skills in practicing compassion, for example, among specialists or people already professionally involved in helping, to plan and create appropriate training in this area.
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The present study examined the relative effects of mindful acceptance and reappraisal on metacognitive attitudes and beliefs in relation to rumination and negative experiences. A small but growing literature has compared the effects of these strategies on immediate emotional experience but little work has examined the broader, metacognitive impact of these strategies, such as maladaptive beliefs about rumination. One hundred and twenty-nine participants who reported elevated symptoms of depression were randomly assigned to receive brief training in mindful acceptance, reappraisal, or no training prior to undergoing an autobiographical sad mood induction. Participants rated their beliefs in relation to rumination and negative experiences before and after instructions to engage in mood regulation. Results showed that relative to reappraisal or no training, training in mindful acceptance resulted in greater decreases in maladaptive beliefs about rumination. The study suggests that training in mindful acceptance promotes beneficial changes in metacognitive attitudes and beliefs relevant to depression, and contributes to a greater understanding of the mechanisms through which mindfulness-based interventions lead to positive outcomes.
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While it has been suggested that loving-kindness meditation (LKM) is an effective practice for promoting positive emotions, the empirical evidence in the literature remains unclear. Here, we provide a systematic review of 24 empirical studies (N = 1759) on LKM with self-reported positive emotions. The effect of LKM on positive emotions was estimated with meta-analysis, and the influence of variations across LKM interventions was further explored with subgroup analysis and meta-regression. The meta-analysis showed that (1) medium effect sizes for LKM interventions on daily positive emotions in both wait-list controlled RCTs and non-RCT studies; and (2) small to large effect sizes for the on-going practice of LKM on immediate positive emotions across different comparisons. Further analysis showed that (1) interventions focused on loving-kindness had medium effect size, but interventions focused on compassion showed small effect sizes; (2) the length of interventions and the time spent on meditation did not influence the effect sizes, but the studies without didactic components in interventions had small effect sizes. A few individual studies reported that the nature of positive emotions and individual differences also influenced the results. In sum, LKM practice and interventions are effective in enhancing positive emotions, but more studies are needed to identify the active components of the interventions, to compare different psychological operations, and to explore the applicability in clinical populations.
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