ArticlePDF Available

Abstract and Figures

Objectives Schools are experiencing an unprecedented mental health crisis, with teachers reporting high levels of stress and burnout, which has adverse consequences to their mental and physical health. Addressing mental and physical health problems and promoting wellbeing in educational settings is thus a global priority. This study investigated the feasibility and effectiveness of an 8-week Compassionate Mind Training program for Teachers (CMT-T) on indicators of psychological and physiological wellbeing. Methods A pragmatic randomized controlled study with a stepped-wedge design was conducted in a sample of 155 public school teachers, who were randomized to CMT-T ( n = 80) or a waitlist control group (WLC; n = 75). Participants completed self-report measures of psychological distress, burnout, overall and professional wellbeing, compassion and self-criticism at baseline, post-intervention, and 3-months follow-up. In a sub-sample (CMT-T, n = 51; WLC n = 36) resting heart-rate variability (HRV) was measured at baseline and post-intervention. Results CMT-T was feasible and effective. Compared to the WLC, the CMT-T group showed improvements in self-compassion, compassion to others, positive affect, and HRV as well as reductions in fears of compassion, anxiety and depression. WLC participants who received CMT-T revealed additional improvements in compassion for others and from others, and satisfaction with professional life, along with decreases in burnout and stress. Teachers scoring higher in self-criticism at baseline revealed greater improvements post CMT-T. At 3-month follow-up improvements were retained. Conclusions CMT-T shows promise as a compassion-focused intervention for enhancing compassion, wellbeing and reducing psychophysiological distress in teachers, contributing to nurturing compassionate, prosocial and resilient educational environments. Given its favourable and sustainable effects on wellbeing and psychophysiological distress, and low cost to deliver, broader implementation and dissemination of CMT-T is encouraged.
Content may be subject to copyright.
RESEARCH ARTICLE
Nurturing compassion in schools: A
randomized controlled trial of the
effectiveness of a Compassionate Mind
Training program for teachers
Marcela MatosID
1
*, Isabel Albuquerque
1
, Ana Galhardo
1,2
, Marina Cunha
1,2
,
Margarida Pedroso LimaID
1
, Lara Palmeira
1,3
, Nicola Petrocchi
4
, Kirsten McEwan
5
,
Frances A. Maratos
5
, Paul Gilbert
5
1University of Coimbra, Faculty of Psychology and Educational Sciences, Center for Research in
Neuropsychology and Cognitive and Behavioural Intervention (CINEICC), Coimbra, Portugal, 2Instituto
Superior Miguel Torga, Coimbra, Portugal, 3Universidade Portucalense, Infante D. Henrique, Porto,
Portugal, 4John Cabot University, Rome, Italy, 5University of Derby, College of Health, Psychology & Social
Care, Derby, United Kingdom
*marcela.matos@fpce.uc.pt
Abstract
Objectives
Schools are experiencing an unprecedented mental health crisis, with teachers reporting
high levels of stress and burnout, which has adverse consequences to their mental and
physical health. Addressing mental and physical health problems and promoting wellbeing
in educational settings is thus a global priority. This study investigated the feasibility and
effectiveness of an 8-week Compassionate Mind Training program for Teachers (CMT-T)
on indicators of psychological and physiological wellbeing.
Methods
A pragmatic randomized controlled study with a stepped-wedge design was conducted in a
sample of 155 public school teachers, who were randomized to CMT-T (n= 80) or a waitlist
control group (WLC; n= 75). Participants completed self-report measures of psychological
distress, burnout, overall and professional wellbeing, compassion and self-criticism at base-
line, post-intervention, and 3-months follow-up. In a sub-sample (CMT-T, n= 51; WLC n=
36) resting heart-rate variability (HRV) was measured at baseline and post-intervention.
Results
CMT-T was feasible and effective. Compared to the WLC, the CMT-T group showed
improvements in self-compassion, compassion to others, positive affect, and HRV as well
as reductions in fears of compassion, anxiety and depression. WLC participants who
received CMT-T revealed additional improvements in compassion for others and from oth-
ers, and satisfaction with professional life, along with decreases in burnout and stress.
Teachers scoring higher in self-criticism at baseline revealed greater improvements post
CMT-T. At 3-month follow-up improvements were retained.
PLOS ONE
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 1 / 36
a1111111111
a1111111111
a1111111111
a1111111111
a1111111111
OPEN ACCESS
Citation: Matos M, Albuquerque I, Galhardo A,
Cunha M, Pedroso Lima M, Palmeira L, et al.
(2022) Nurturing compassion in schools: A
randomized controlled trial of the effectiveness of a
Compassionate Mind Training program for
teachers. PLoS ONE 17(3): e0263480. https://doi.
org/10.1371/journal.pone.0263480
Editor: Walid Kamal Abdelbasset, Prince Sattam
Bin Abdulaziz University, College of Applied Medical
Sciences, SAUDI ARABIA
Received: November 3, 2021
Accepted: December 30, 2021
Published: March 1, 2022
Copyright: ©2022 Matos et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: Data cannot be
shared publicly because of the sensitive nature of
some of the data collected. The data that support
the findings of this study will be made available
upon reasonable request from the University of
Coimbra Institutional Data Access (contact via
cineicc@fpce.uc.pt) for researchers who meet the
criteria for access to confidential data.
Conclusions
CMT-T shows promise as a compassion-focused intervention for enhancing compassion,
wellbeing and reducing psychophysiological distress in teachers, contributing to nurturing
compassionate, prosocial and resilient educational environments. Given its favourable and
sustainable effects on wellbeing and psychophysiological distress, and low cost to deliver,
broader implementation and dissemination of CMT-T is encouraged.
Introduction
The promotion of mental wellbeing constitutes a public health priority, with mental health dif-
ficulties being leading causes of disability and representing a long-lasting and major economic,
social and health burden [1]. The United Nations 2030 Agenda for Sustainable Development
[2] highlights the importance of promoting health and wellbeing for all ages and accentuates
the need to foster compassion and empathy to tackle global inequality and cultivate peaceful
and resilient societies.
Schools are withstanding an unprecedented mental health crisis and have become increas-
ingly stressful environments for the whole educational community [3]. Facing the multiple
challenges of working in schools (e.g., excessive workload, time pressures, bureaucracy, pupil
disruptive behaviours), teachers report high levels of stress and burnout within all education
sectors and across countries [4]. In Portugal, the latest education sector research revealed that
75% of teachers present high levels of burnout, with 25% reporting extreme burnout and 84%
intending to leave the profession due to stress and competitive pressures [5]. Along with this
retention crisis in the teaching profession, long-term teacher stress is associated with a range
of poor wellbeing and professional outcomes, which carry significant socioeconomic costs. For
example, absenteeism and staff turnover, reduced self-efficacy [6,7], poor wellbeing and burn-
out [810], with adverse consequences to mental [6,11] and physical health [5,12,13]. The
prolonged activation of stress-responsive physiological systems (e.g., hypothalamic-pituitary-
adrenal axis; sympathetic nervous system) not only impairs psychological wellbeing [14] but
also negatively affects neuroendocrine (e.g., cortisol), autonomic (e.g., heart rate variability,
HRV) and immune-inflammatory responses [14,15], with long-lasting changes in stress-
related gene expression [16,17], which have a detrimental impact on mental and physical
health.
In addition, teacher’s stress negatively impacts pupils’ social adjustment, academic perfor-
mance [18] and mental wellbeing [1921]. For example, Oberle and Schonert-Reichl [22]
revealed that student’s cortisol levels were much higher in classrooms led by a teacher who
reported feeling overwhelmed. Longitudinal studies have further revealed that teachers report-
ing higher burnout early in the year have classrooms presenting more behavioural problems
across the year [23]. When teachers report lower levels of work-related stress, students find
those teachers more interested and enthusiastic in teaching [24], which influences pupils’
motivation and affect [25,26]. In addition, teachers’ wellbeing is linked to an array of positive
outcomes, such as positive classroom processes (e.g., teachers’ active support towards students,
classroom social climate), as well as students’ self-efficacy, subjective wellbeing, achievement,
and motivation and attitude towards learning [27,28].
One source of teacher stress is the competitive dynamic of modern neoliberal societies that
have come to texture learning environment and schools [29,30]. This competitiveness is a
major source of stress, which is particularly evident in schools. This competitiveness is a major
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 2 / 36
Funding: This work has been funded by the Reed
Foundation (UK) and supported by the
Compassionate Mind Foundation (UK).
Competing interests: The authors have declared
that no competing interests exist.
source of stress, affecting both teachers (e.g., heavier workloads, achievement focus, perfor-
mance evaluation) and pupils (e.g., focus on academic achievement, self-interest). In fact, self-
and other-focused competitive pressures have been highlighted as a key source for teachers
and pupil mental health problems [3134], and underlie fears of failure, feelings of shame and
negative social comparisons, self-criticism and resistances to compassion [3537].
Schools are crucial social arenas that can promote competitiveness and self-interest or culti-
vate prosociality and compassion, and where these two distinct motivational systems: competi-
tiveness vs compassion, with their social information flows and biological patterns, become
choreographed and played out [36,38]. Contrary to competitive motives, when individuals are
caring and sharing, particular physiological systems linked to affiliation and social connected-
ness are stimulated [e.g., parasympathetic nervous system, oxytocinergic system), which con-
tribute to wellbeing, stress management and emotion regulation, 39,40]. In fact, studies show
that social relationships and adversity impact one’s physiology even at the epigenetic level
[e.g., differential methylation in oxytocin receptor gene_OXTR, 17].
Compassion, commonly defined as a sensitivity to suffering in self and others with a com-
mitment to try to alleviate and prevent it [41,42], is an innate prosocial motivation that
evolved with the mammalian caring system. Compassion has benefits for mental health, emo-
tion regulation and social relationships [e.g., 4347]. Furthermore, compassion positively
impacts physiological health, including influences in genetic expression [e.g., lower levels of
CTRA-related gene expression, 48; epigenetic profiles of the OXTR, 49]. Experimental studies
have also documented that cultivating compassion impacts physiological systems, reducing
arousal and increasing parasympathetic activation [e.g., heart-rate variability, HRV, 5053],
decreasing sensitivity to threat [49], and activating specific neural circuits distinct from empa-
thy and mindfulness training [54].
Given the burgeoning evidence of the numerous benefits of compassion over the past
decade, several interventions have been developed that specifically aim to cultivate compassion
[51]. A growing body of empirical evidence has testified their positive impact on mental and
physical wellbeing and prosocial behaviour [5557]. One of these approaches is an evolution-
ary and biopsychosocial evidence-based approach called Compassionate Mind Training
[CMT; 42,58,59]. CMT was developed as an intervention for the general public and comprises
psychoeducation and a set of core compassion and mindfulness practices taken from Compas-
sion Focused Therapy [CFT; 58,60,61]. CFT, based upon evolutionary psychology, attach-
ment theory, psychological science, and an understanding of motivational systems, is a
transdiagnostic therapy for individuals dealing with shame and self-criticism, and currently
delivered to patients with a wide range of mental and physical health difficulties. CFT has been
shown to be an effective approach in a multitude of clinical conditions and symptoms [62,63].
CMT is designed to activate and develop evolved, affiliative care-focused motivational sys-
tems and emotions in order to down-regulate competitive and threat-focused systems and
stimulate psychological and neurophysiological processes (primarily associated with the para-
sympathetic system) conductive to better emotion regulation, wellbeing, health and social rela-
tionships [58,60,61]. CMT uses a range of evidence-based practises such as breathing
techniques, visualisations and behavioural practises to stimulate the vagus nerve, balance the
autonomic nervous system [64] and recruit various neuro circuits associated with compassion
[53,54]. CMT strives to cultivate a compassionate mind which includes the three interactive
flows of compassion: the ability to be compassionate toward the self, and others, as well as to
receive compassion from others. Each of these make a contribution to well-being and prosocial
behaviour, but each can also have fears, blocks, and resistances that need to be tackled [58,61,
65]. CMT also addresses key issues linked to competitive threats such as self-criticism and
fears of compassion [58,60,65].
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 3 / 36
CMT seeks to develop mental competencies and physiological states that promote two fun-
damental interrelated processes of compassion. The first is the ability to be sensitive and turn
towards suffering in self and others, to tolerate and engage with this suffering, rather than
avoid it or dissociate, which is related to many attributes, such as the motivation to care and
the capacity for feeling sympathy and empathy. The second is the commitment to alleviate and
prevent suffering and requires a particular set of affiliative skills in the sphere of attention,
emotion, cognition and behaviour conducive to the development of a compassionate mind
[58,61]. Importantly, this means that individuals need to develop the courage to move towards
suffering and potentially painful situations or mental states, but also the wisdom of knowing
what to do. Hence CMT is centred around the development of competencies needed to coura-
geously turn towards and engage with difficulties in self and others, and a variety of skills linked
to reasoning, mentalizing and emotional regulation, which enable compassion motives to be
translated into compassionate actions [42,61,65].
CMT has been tailored for use with different formats (e.g., length, practices) in nonclinical
populations, namely the general public [66,67], health care educators and providers [68], men-
tal health professionals [69], nurses [70,71], firefighters [72] and psychotherapy students [73].
There is a mounting evidence base for CMT effectiveness in improving mental and physiologi-
cal health and prosocial behaviour [56,59,62,63]. A pilot randomised controlled study in a
community sample [67,74] found that a brief CMT intervention promoted beneficial psycho-
logical changes associated with wellbeing and improvements in HRV. Higher HRV is indica-
tive of higher parasympathetic nervous system outflow via the vagus nerve activity and is
associated with self-compassion, feelings of perceived safeness and warmth and greater ability
to self-soothe when stressed [e.g., 64,7578]. A recent uncontrolled study demonstrated the
promising effects of an 8-week CMT group intervention for the general public, in increasing
levels of compassion, positive emotions and wellbeing, and reducing self-criticism and psycho-
logical distress, and validated the maintenance of these changes at 3-month follow-up [66]. In
addition, a randomised controlled trial of CFT intervention as guided self-help in an adult
community sample reported positive effects on wellbeing and psychopathological indicators
up to 12 months after baseline [79].
This knowledge that promoting compassion (for self and others) has a range of psychologi-
cal and physiological benefits for mental and physical wellbeing and prosocial behaviour [55]
needs to be prioritised and incorporated into teacher education and into schools [36,80] and
is aligned with international guidelines for the promotion of health and wellbeing [2,27]. Like-
wise, in Portugal, government recommendations for Education emphasise the importance of
advancing health literacy and social-emotional competencies in educational settings to pro-
mote health and psychological wellbeing [81,82].
Recognising the growing problems of stress in schools and the crisis within the teaching
profession, there are now a number of projects to improve wellbeing and resilience in teachers,
with those stemming from compassion and mindfulness-based interventions demonstrating
to be particularly effective [8386]. One of these is the Compassionate Schools Research Initia-
tive, which implemented and evaluated a 6-module Compassion Mind Training for Teachers
(CMT-T), building upon previous CFT and CMT programs [67], in schools in Portugal and
the UK. In the UK, an earlier version of the CMT-T, applied in 70 teachers and support staff,
was feasible and well-received, with participants (N= 34) positively evaluating the curriculum
and the practices and its helpfulness for dealing with emotional difficulties [32]. A subsample
of 20 teachers completed pre- and post-self-report assessments and showed significant
decreases in self-criticism and increases in self-compassion at post-intervention; however,
burnout and psychopathology did not significantly change [32].
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 4 / 36
In Portugal, an uncontrolled pilot study with 31 teachers showed that CMT-T was feasible
and well-received, increased teachers’ compassion for others, self-compassion and compassion
to others motivations and actions, and reduced depression, stress and fears of compassion to
others [87]. Importantly, when self-criticism was controlled for, a decrease in burnout and an
increase in self-compassion and in satisfaction with professional life were additionally found.
In line with previous studies [8890], this finding emphasises the importance of targeting self-
criticism across the intervention, given its key role in how CMT-T operates in promoting
teachers’ abilities to be compassionate towards themselves and thus fostering their wellbeing
and diminishing psychological distress. Furthermore, this study found that fears of compas-
sion for others mediated the impact of CMT-T on teachers’ burnout and that self-compassion
mediated the intervention effect on psychological wellbeing. Thus, these findings emphasise
the importance of targeting both the fears, blocks and resistances to compassion alongside cul-
tivating self-compassion abilities in teachers to decrease distress and promote psychological
wellbeing. Finally, the qualitative experience of the CMT-T for both participants and facilita-
tors suggested that future iterations of the program might benefit from extending the duration
of sessions and length of the program [87]. Another study explored the international utility of
the CMT-T and concluded this is a feasible, useful and effective intervention in cross-cultural
educational settings, not only in terms of introducing and promoting a compassion-based
school ethos but also on cultivating the psychological wellbeing of those working in education
[91].
Therefore, CMT-T may provide a suitable approach to counteract the current challenges in
educational settings and inspire a shift from competitiveness/threat-based to compassionate/
affiliative motivational systems, to improve educators’ stress regulation, prosocial qualities,
behaviour and wellbeing. Still, a further evaluation of the pragmatic effectiveness of a refined
version of CMT-T on teachers’ wellbeing and mental health, using a larger sample size and a
randomized controlled design, is needed. Moreover, the impact of the CMT-T on affiliative-
and stress-related biophysiological markers, particularly on the parasympathetic activity as
measured through HRV [40,56], warrants empirical support. Additionally, as an alternative to
traditional parallel designs, the use of a stepped wedge design would allow exposing both the
intervention and control groups to the CMT-T, while also establishing a within-subjects psy-
chological and physiological baseline in the control group and controlling for the confounding
effect of time [92].
Given the growing research on the multidimensional benefits of compassion cultivation,
and pilot studies on CMT-T, the current study sought to further explore the feasibility and
effectiveness of the CMT-T on teachers’ psychological distress, wellbeing and compassion to
self and others, by evaluating a refined 8-week version of the CMT-T and using a randomised
controlled and stepped wedge design. CMT-T specifically aimed at promoting positive affect
and satisfaction with professional life and reducing symptoms of depression, anxiety, stress,
and burnout (primary outcome variables), by increasing the flows of compassion (for self, for
others and from others), self-compassion and compassion to others motivations and actions,
and by diminishing fears of compassion (for self, for others and from others) and self-criticism
(secondary/process outcome variables). Furthermore, the present study aimed to explore the
impact of the CMT-T on heart rate variability (HRV), an indicator of vagal regulatory activity
and a physiological marker of a person’s ability to flexibly respond to environmental challenges
and regulate emotional responses [56,75], which has been proposed as a primary measure to
assess and train compassion [56]. It was hypothesised that CMT-T produces significant
increases in HRV. In addition, the present study aimed at examining the impact of the CMT-T
on teachers who received the intervention after a period of baseline observations where they
acted as controls. It was hypothesised that these participants would reveal no significant
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 5 / 36
changes from baseline to pre-intervention but would reveal significant changes in both out-
come and process variables after receiving the CMT-T intervention.
In light of previous research pointing to the role of individual differences in self-criticism
on how individuals respond to compassion-based interventions in general [8890], and on the
impact of CMT-T in particular [87], we also explored how self-criticism might influence the
effects of the CMT-T intervention. Baseline self-criticism was hypothesized to impact the
CMT-T effects on the process and outcome variables. Furthermore, we examined whether
changes from pre-to-post CMT-T were different when comparing high and low self-critics, as
well as whether there were differences between these two groups in the magnitude of change.
In addition, the current study aimed to examine whether the effects of attending the CMT-T
were sustained at 3-month post-intervention.
Finally, given that the inter-relationship between the three flows of compassion (i.e., com-
passion for others, being open to compassion from others, and self-compassion) is a key aspect
of the CFT/CMT approach [61,93], we explored whether the associations between the flows of
compassion would change from before to after the CMT-T, particularly whether these were
strengthened after training.
Methods
Study design
The current study was a pragmatic two-arm randomized controlled trial (RCT), with one
intervention group (CMT-T) and one waitlist control group (WLC), and a stepped-wedge
design where all groups and participants in groups were offered the intervention. This study
was approved by the Ethics Committee of the Faculty of Psychology and Educational Sciences
of the University of Coimbra (CEDI22.03.2018), and registered at ClinicalTrials.gov (Identi-
fier: NCT05107323; Compassionate Schools: Feasibility and Effectiveness Study of a Compas-
sionate Mind Training Program to Promote Teachers Wellbeing). The findings of this RCT
are reported conform the Consolidated Standards of Reporting Trials (CONSORT) guidelines
[94; see S1 File] and the Journal Article Reporting Standards (JARS) for research in psychology
[95].
Given the stepped wedge design, there were four assessment moments in the study: 1) Time
1 (T1)—baseline/pre-intervention assessment, was completed by the CMT-T group and the
WLC group during the week previous to the start of the CMT-T intervention; 2) Time 2 (T2)
—post-intervention assessment one was completed by CMT-T group and WLC group during
the first-week post-intervention; 3) Time 3 (T3)—post-intervention assessment two, was com-
pleted by WLC group participants one week after they had also received the CMT-T interven-
tion; 4) 3-months Follow-up assessment, this was conducted three months after the CMT-T
conclusion (for all participants who completed the intervention). In T1, T2, and T3 all partici-
pants completed a set of self-report questionnaires assessing primary and secondary outcomes.
A subsample of participants (n= 55 in the experimental group, and n= 40 in the WLC group)
underwent the HRV measurement at T1, T2, and T3. In the 3-month follow-up assessment,
only self-report data were collected.
The study was implemented between October 2018 and August 2019, across the following
phases: 1) October/November 2018 (T1 for CMT-T Groups 1&2 and for WLC Groups 1&2);
2) December 2018/January 2019 (T2 for CMT-T Groups 1&2 and for WLC Group 1&2; WLC
Group 1&2 started the intervention; T1 for WLC Group 3); 3) March 2019 (T3 for WLC
Group 1&2 after receiving the intervention; T2 for WLC Group 3, before starting the interven-
tion; T1 for CMT-T Group 3); 4) May 2019 (T2 for CMT-T 3 Group; T3 for WLC Group 3,
after receiving the intervention); 5) Follow-up assessment was conducted between March-
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 6 / 36
August 2019 by all participants who received the intervention 3-months after their respective
group finished the CMT-T.
Participants and recruitment
In May/June 2018, participants were recruited amongst teaching staff in public schools (pre to
high school grades) in the centre region of Portugal (Viseu and Coimbra districts). Schools’
boards were invited to participate in the study. Four schools enrolled in the project, provided
further ethical approval and invited all teaching staff to attend an informative 2-h session
about the study. This recruitment session was led by the research team in each school and
included a brief description of the study aims, procedures, conditions for participation and
ethical considerations. Additionally, a leaflet containing this information was distributed
among staff by the schools’ Board. Teachers interested in participating in the study contacted
the research team via email. They were then contacted via email and assessed for inclusion cri-
teria and required to provide informed consent. Informed consent clarified the voluntary, con-
fidential and anonymous nature of the study and data protection rights. Each participant
created a unique and numerical code to guarantee confidentiality that was used in all assess-
ment tasks. The assessment moments and intervention were conducted at the schools.
Participants were eligible for participation if they: (a) were teachers in the enrolled schools;
and (b) provided informed consent. Fig 1 displays the flow of participants. Overall, 164 teach-
ers showed interest to take part in the study and met the eligibility criteria. Nine teachers failed
to attend the baseline assessment. After baseline assessment, 155 participants were randomly
assigned within each school to either the CMT-T intervention (CMT-T group) or the waitlist
control (WLC) group. Each WLC group started the CMT-T after their parallel CMT-T group
completed the intervention, i.e., after approximately two months. In total, six groups received
the CMT-T (nper group M= 18), which was delivered in the school setting. From the initial
80 participants allocated to the CMT-T group, five failed to attend any session. Moreover, nine
participants dropped-out (11.25%) because of work schedule incompatibility, and were
excluded from further analysis. From the initial 75 participants allocated to the WLC group, 29
did not attend the second assessment and were also excluded from the analysis. The remaining
46 participants from the WLC group were allocated to the intervention at Time 2. From those,
37 received the intervention, and nine opted not to receive the intervention. There were no
dropouts from the intervention at Time 2.
Sociodemographic characteristics of participants are presented om Table 1. The study sam-
ple was composed of 155 teachers working in public schools from Portugal’s centre region. Par-
ticipants’ age ranged from 25 to 63 years old, with a mean age of 51.35 (SD = 7.24). The
majority of the participants was female (92.9) and held a graduate/honors degree (67.1%) or
had completed a master’s degree (23.9%). Most participants were married (65.8%), 16.8% were
divorced, and 13.5% were single. In terms of teaching-related characteristics, participants had
been working as teachers for 10 months to 41 years (M= 27.01, SD = 8.29), and taught in several
grade levels: 12.3% were preschool teachers, 16.1% taught in elementary school, 15.4% in middle
school, 36.1% in high school, and 14.8% in special education. The participants qualified as mid-
dle or high school grade level teachers taught in the following content areas: 25.5% languages,
6.5% social and human sciences, 13.5% mathematics and experimental sciences, 2.6% artistic
expression, 0.4% physical education, and 3.9% information technologies. Eight teachers did not
provide information about these aspects. Regarding school setting, teachers were recruited in
two large middle/high schools from an urban area, in one cluster of schools that included large
schools from a semi-urban area and small schools from rural areas, and in one cluster of schools
from an urban area including a large school and small schools from urban as well rural areas.
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 7 / 36
Independent samples ttests and chi-squared tests indicated that the intervention group and
the waitlist control group were similar in age, sex, marital status, years of teaching and teaching
subject areas, indicating a successful randomization. Significant differences were found
between the two groups in education level and teaching grade level.
Fig 1. Flowchart of study participants.
https://doi.org/10.1371/journal.pone.0263480.g001
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 8 / 36
Intervention
The Compassionate Mind Training Program for Teachers (CMT-T). The Compassion-
ate Mind Training program for Teachers (CMT-T) is a compassion mind training intervention
tailored for teaching staff and delivered in a group format across eight sessions of approxi-
mately 2.5 hours each. The 8-week CMT-T is a refined version of the 6-week CMT-T curricu-
lum [87], which was developed based on an earlier version of the program for school staff
designed and tested by Maratos et al. [32] and on a brief CMT program for the general public
[67]. The feasibility and preliminary effectiveness of the pilot version of the CMT-T showed
Table 1. Baseline characteristics of the participants (N= 155).
Characteristic Total (N= 155) CMT-T (n= 80) WLC (n= 75) Test statistic (p-value)
Age, years t
(153)
= .32 (p= .747)
Mean (SD) 51.35 (7.24) 51.54 (8.21) 51.16 (6.09)
Range 25–63 25–63 28–62
Sex n(%) χ
2
= .04 (p= .840)
Male 11 (7.1) 6 (7.5) 5 (6.7)
Female 144 (92.9) 74 (92.5) 70 (93.3)
Marital status n(%) χ
2
= 2.28 (p= .684)
Single 21 (13.5) 13 (16.3) 8 (10.7)
Married/Registered partnership 102 (65.8) 52 (65) 50 (66.6)
Divorced 26 (16.8) 12 (15) 14 (18.7)
Widowed 6 (3.9) 3 (3.8) 3 (4)
Education level n(%) χ
2
= 12.70 (p= .005)
Bachelor 3 (1.9) - 3 (4)
Graduate/Honors 104 (67.1) 60 (75) 44 (58.7)
Postgraduate specialisation 11 (7.1) 1 (1.3) 10 (13.3)
Masters 37 (23.9) 19 (23.8) 18 (24)
Years of teaching experience, years t
(153)
= .07 (p= .946)
Mean (SD) 27.01 (8.29) 27.05 (9.56) 26.96 (6.73)
Range 0.83–41 0.83–41 2–38
Teaching grade level n(%) χ
2
= 18.54 (p= .001)
Preschool 19 (12.3) 8 (10.0) 11 (14.7)
Elementary school 25 (16.1) 18 (22.5) 7 (9.3)
Middle school 24 (15.5) 4 (5.2) 20 (26.7)
High school 56 (36.1) 34 (42.2) 22 (29.3)
Special education (All levels) 23 (14.8) 11 (13.8) 12 (16.0)
Missings 8 (5.2) 5 (6.3) 3 (4.0)
Teaching subject areas n(%) χ
2
= 11.26 (p= .128)
Several areas (Pre and Elementary School) 44 (28.4) 26 (32.5) 18 (24.0)
Languages 38 (24.5) 13 (16.3) 25 (33.3)
Social and human sciences 10 (6.5) 8 (10.0) 2 (2.7)
Mathematics and experimental sciences 21 (13.5) 12 (15.0) 9 (12)
Artistic expression 4 (2.6) 1 (1.2) 3 (4.0)
Physical education 1(0.6) 1 (1.2) 0 (0.0)
Information technologies 6 (3.9) 3 (3.7) 3 (4.0)
Special Education (All areas) 23 (14.8) 11 (13.8) 12 (16.0)
Missings 8 (5.2) 5 (6,3) 3 (4.0)
Note. CMT-T = Compassionate Mind Training for Teachers; WLC = Waitlist control group.
https://doi.org/10.1371/journal.pone.0263480.t001
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 9 / 36
promising results in Portugal and the UK [87,91]. However, the implementation and evalua-
tion of this pilot version indicated that the program could be improved in a few aspects [87].
The CMT-T was hence refined to accommodate these alterations, specifically in the number of
sessions, duration of the sessions, and the tackling of the self-criticism topic (cf. Results section
for a detailed description of the Adaption). There are six different modules addressed during
the 8-sessions of the refined CMT-T. A brief overview of the six modules is presented in
Table 2. In each session, besides presenting relevant theoretical constructs addressed in that
session, participants are invited to complete experiential exercises, compassion and mindful-
ness meditation practices, and work in small groups to share their experiences, followed by a
plenary session.
Teachers attending the 8-week CMT-T were invited to practice the CMT-T exercises daily.
In addition to self-report measures, teachers were asked to complete weekly Practice Diaries
and Session Evaluation forms. Access to the Project website (https://escolascompassivas.
wixsite.com/cmtescolas) allowed participants further information about the program, psy-
choeducation information and materials, practices instructions and audio files containing the
meditation practices. Weekly gentle reminder emails were sent to participants motivating
them to practice the exercises. A final CMT and Forest Bathing 1-day retreat was held at the
end of the intervention.
Table 2. CMT-T modules, contents, practices and exercises.
Module Theme Contents Practices and Exercises
1Compassion and the evolutionary nature of
the human mind
How do human minds work?
What is compassion?
(evolutionary model framework)
Facilitators and inhibitors of compassion
Soothing Rhythm Breathing
Compassionate facial expression and voice tone
Compassionate listening
2Understanding the functions of our
emotions: The three circles model
The three affect systems: Threat, Drive and Safeness/
Soothing
What are the functions of human emotions?
Functional analysis of Threat, Drive and Safeness/Soothing
emotions
Soothing Rhythm Breathing Compassionate
facial expression and voice tone nerve.
Spotlight of Attention Exercise
Mindfulness of the Senses
3Building a compassionate mind/self The three compassion flows
The two psychologies/components of compassion
Compassion competencies and skills
The compassionate self–qualities
How can we develop a warm and caring relationship with
ourselves and with others?
How to manage fears, blocks and resistances to compassion
Safe place
Cultivating the Ideal Compassionate Self
Embodiment of the Compassionate self
Directing Compassion to Others and to Self
4Working with emotions: The role of
compassionate self
Functional analysis of emotions
Emotional conflicts
Using the compassionate self to work with difficult emotions
How to manage fears, blocks and resistances to compassion
Ideal Compassionate Other
Multiple selves exercise
Functional analysis of emotions
5Understanding and working with self-
criticism: The role of compassionate self
Functional analysis of self-criticism
Compassionate self-correction
Using of the compassionate self in dealing with self-criticism
How to manage fears, blocks and resistances to compassion
Mindful breathing
Functional analysis of self-criticism
Compassionate self-correction
Compassion for the Inner Critic
6Compassion always and everywhere The multiple faces of compassion
Compassionate behaviours
Working with difficulties experienced with compassionate
behaviour
How to manage fears, blocks and resistances to compassion
Compassionate planning
Anticipating difficulties and setbacks in compassion
engagement
Manifesting compassion wherever we are and whenever we
encounter suffering and difficulties (in self/others)
Gratitude practice
Mindfully remembering
Self-compassion break
The Compassion PDA
Compassionate letter writing
Compassionate flashcards
Aspiration Wheel exercise
https://doi.org/10.1371/journal.pone.0263480.t002
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 10 / 36
The CMT-T team comprised five certified clinical psychologists with a PhD degree and
CFT/CMT based clinical intervention experience and one teacher with a PhD degree, CFT
training and certified mindfulness teacher training. Each training group had two lead facilita-
tors, who facilitated the group, presented the content, led experiential exercises and promoted
the discussion. All facilitators strictly followed the CMT-T manual and one of them guided all
six groups. According to the BSP (2018) recommendations, the CMT-T team informed the
participants that they could get in contact with the practitioners between the sessions in case
they had any doubts or questions about the sessions’ contents.
Waitlist control condition
Participants in the waiting list control group were not offered an intervention. After their par-
allel CMT-T group completed the intervention, participants in this group received the CMT-T
intervention, and completed a post-intervention assessment (T3).
Measures
Demographics form: Sociodemographic data were collected regarding age, marital status,
teaching-related variables (e.g., education degree and teaching years).
Feasibility. Feasibility was assessed according to three criteria of Bowen et al. [96] frame-
work: acceptability (defined as importance, relevance, and perceived helpfulness of sessions
and exercises, as well as motivation and willingness to recommend the CMT-T to peers), prac-
ticality (assessed by program attendance and dropout), and adaptation (operationalized as
adjustments made to the CMT-T curriculum from its pilot version [82].
Primary outcomes. Types of Positive Affect Scale [TPAS; 97,98]. The TPAS is a 18-items
scale that measures the degree to which people experience different positive emotions. The
scale assesses three different types of positive affect: activated positive affect (e.g., excited,ener-
getic,eager), relaxed positive affect (e.g., relaxed,calm,serene), and safe positive affect (e.g.,
safe,content,secure). Each item/word is rated on a 5-point scale, and participants are asked to
rate how characteristic each feeling is of them, ranging from not characteristic of me (0) to very
characteristic of me (4). The Cronbach’s alphas for each subscale were .83 for relaxed and active
positive affect and .73 for safeness/contentment positive affect [97]. In our sample, a Cronbach
alpha of .74 was found for activated positive affect, .84 for relaxed positive affect and .81 for
safe/content positive affect.
Satisfaction with Teachers’ Professional Life [SWTPL; 99,100]. The SWTPL is a 5-item scale
aimed to assess global satisfaction with teachers’ professional life. Teachers rate each item by
using a 5 Likert-type scale, ranging from I completely disagree (1) to I completely agree (5). In
the original study, the SWTPL showed a Cronbach alpha of .91 [100]. In the current study, a
Cronbach alpha of .83 was found.
Depression, Anxiety and Stress Scales-21 [DASS-21; 101,102]. The DASS-21 is a self-report
instrument comprising three subscales that address depressive (seven items), anxiety (seven
items) and stress symptoms (seven items). Participants are asked to rate the frequency of
symptoms during the previous week using a 4-point scale from did not apply to me at all (0) to
applied to me very much,or most of the time (3). The Cronbach’s alphas for each subscale were
.94 for depression, .87 for anxiety and .91 for stress [103]. In this study, Cronbach alpha values
were .88 for depression, .84 for anxiety and .87 for stress.
Shirom-Melamed Burnout Measure [SMBM; 104,105]. The SMBM is a 14-items self-report
measure addressing work-related burnout using a 7-point scale, ranging from never (1) to
always (7). The SMBM comprises three dimensions associated with work: physical exhaustion,
cognitive weariness, and emotional exhaustion, with higher scores reflecting greater burnout
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 11 / 36
symptoms. In the current study, the total score was used, and higher scores correspond to
greater levels of burnout symptoms. Previous studies with the SMBM found excellent reliabil-
ity [e.g., α= .96 for the total score; 106]. In the current study, a Cronbach alpha of .94 was
found for the total score, and Cronbach alpha values were .93 for physical burnout, .96 for cog-
nitive burnout and .86 for emotional burnout.
Secondary outcomes. Compassionate Engagement and Action Scales [CEAS; 93,107]. The
CEAS assesses the three flows of compassion according to Gilbert’s evolutionary multidimen-
sional model of compassion and the CFT framework: 1) Self-compassion, 2) Compassion for
others, 3) Compassion from others. Each of these scales measures a) Compassionate Engage-
ment (i.e., sensitivity to and motivation to engage with suffering) with items tapping into the
competencies of sensitivity, sympathy, empathy, distress tolerance, non-judgment and care for
wellbeing; and b) Compassionate Action (i.e., committed actions to try to alleviate and prevent
suffering), with items focused on domains of helpful 1. attending, 2. thinking/reasoning, 3.
behaving and 4. emotion/feeling. A definition of compassion is provided in the instructions of
each scale. Items are rated according to the frequency of responding to one’s own suffering,
others’ suffering or the experience of receiving compassion from others. A response scale rang-
ing from never (1) to always (10) is used for rating the items. In the original study, all subscales
presented acceptable to high reliabilities (range of .72 to .94) [93]. In the present study, the
self-compassion subscale showed a Cronbach alpha of .90, the compassion for others subscale
of .90, and the receiving compassion from others subscale of .96.
Compassion Motivation and Action Scales [CMAS; 108,109]. The CMAS encompasses two
dimensions assessing self-compassion and compassion to others motivation and action and
was developed based on a Motivational Interviewing approach to compassion. The two dimen-
sions examine one’s desire, ability, reasons, and need for compassion to others and for oneself,
as well as the commitment to compassionate and self-compassionate action. This 30-item self-
report measure was designed to be specifically used as a measure of the change in compassion-
ate motivation and action over time in clinical practice and intervention research. The self-
compassion dimension encompasses 18 items and three subscales, (1) self-compassion inten-
tion, (2) self-compassion distress tolerance, and self-compassionate action. The compassion to
others dimension includes 12 items tackling the same three subscales. A 7-point scale ranging
from completely disagree (1) to completely agree (7) is used to rate each item. In the original
study, the self-compassion scale presented a Cronbach alpha of .94 and the compassion to oth-
ers Scale of .88. [108]. In the present study, the self-compassion scale showed a Cronbach
alpha of .91 and the compassion to others scale of .85.
Fears of Compassion Scale [FoC; 110,111]. The FoC is a broadly used self-report measure of
fears, blocks and resistances to compassion. It assesses barriers to giving compassion to others
(10 items), receiving compassion from others (13 items), and being self-compassionate (15
items). The 38 items are answered on a 5-point Likert scale ranging from don’t agree at all (0)
to completely agree (4). In the original study, Cronbach alphas were .85 for fear of compassion
for self, .87 for fear of compassion from others and .78 for fear of compassion for others [110].
Cronbach alpha values for the fears of giving compassion to others, receiving compassion
from others, and being self-compassionate were .87, .88, and .89, respectively.
Forms of Self-Criticism and Self-Reassurance Scale [FSCRS; 112,113]. The FSCRS is a
22-items self-report instrument assessing how one thinks and reacts when dealing with failures
or setbacks. The FSCRS encompasses two forms of self-criticism: (1) inadequate-self and (2)
hated-self and (3) assesses the ability to be self-reassuring. Each item follows the statement
"When things go wrong for me. . .", and respondents are asked to choose in a 5-point scale,
ranging from not at all like me (0) to extremely like me (4), the degree to which each item
relates to their own experience. Additionally, in the current study, a self-criticism index was
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 12 / 36
computed to the three subscales by summing the inadequate-self and hated-self subscales
[SC-FSCRS; 114]. The original study revealed a Cronbach alpha of .87 for self-criticism. In the
current sample, Cronbach alpha values were as follows: .80 for the inadequate-self, .67 for
hated-self, .86 for the ability to self-reassure and .85 for the self-criticism index.
Emotional Climate in Organizations Scales [ECOS; 115]. ECOS was developed based on the
affect regulation systems model proposed by Gilbert [116] and assesses the presence/activation
of the three affect regulation systems: threat, drive, soothing/safeness. Within three scales: 1)
emotional climate, 2) satisfaction of needs, 3) motives underlying one’s actions. In the current
study, only the emotional climate scale was used. Each scale comprises 15 items (five items for
each type of emotion system), rated in a 5-point Likert-type scale scored between never (0) and
always (4). Preliminary psychometric properties results suggest that the ECOS scales are valid
and reliable: 1) Emotional Climate Scale: Threat α= .75, Drive α= .86, Safeness/soothing α=
.83; Albuquerque et al., submitted manuscript). In the current study, the Emotional Climate
Scale revealed Cronbach’ alpha values of .74, .84 and .81 for the threat, drive, and soothing/
safeness scales.
Hear-rate variability. Heart-rate variability assessment. To control for possible confound-
ing variables in the HRV analysis, participants completed a set of health-related questions
before each HRV measurement, including height and weight (for BMI calculation), history/
presence of cardiovascular or circulatory diseases, current medication intake, smoking habits
(’are you a smoker?’ Yes/No), food intake (in the previous 2h), caffeine and alcohol intake (in
the previous 4h), vigorous physical exercise (in the past 24h). For the measurement of HRV,
the electrocardiogram (ECG) was recorded using Firstbeat Bodyguard2 (Firstbeat Technolo-
gies Ltd.) with a standard electrode configuration (right clavicle and precordial site V6). Two
disposable Ag-AgCl electrodes were used. Participants were hooked up with the electrocardio-
gram (ECG) and asked to relax in a seated position for 5 minutes in order to obtain a measure
of resting-state heart rate variability (HRV). Raw data (R-R intervals) were then imported into
Kubios (version 2.1, 2012, Biosignal Analysis and Medical Imaging Group, University of Kuo-
pio, Finland, MATLAB). Successive R waves (identified by an automatic beat detection algo-
rithm) were visually inspected, and any irregularities were edited using Kubios’ automatic
artefact correction algorithm (the maximum level of artefact correction applied was 2%).
Heart rate and a time domain measure of HRV (Root Mean Square Successive Difference;
RMSSD) were then obtained for pre- and post-intervention in both groups using Kubios
[117]. According to the Task Force guidelines, the RMSSD reflects the integrity of vagus
nerve-mediated autonomic control of the heart [118].
Sample size
Power analysis was calculated at priori using GPower 3.1 for Analysis of Variance (ANOVA).
Results indicated that a sample size of 27 per condition (n= 54) was needed, using a significance
level of .05 and a power of 95% to detect significant fixed effects, main effects, and interaction
effects, with a large effect size (f= 0.25). Anticipating a 20% dropout rate, 65 participants were
needed. Different strategies were used to minimize drop out from the study, such as sending weekly
e-mail reminders for daily practice and emails for completing the self-report questionnaires.
Randomization and blinding
Blocked randomization in a 1:1 ratio (block size = 6) took place within each enrolled school
following the baseline assessment. Using a computer-based random allocation sequence
(www.random.org), eligible participants were randomly assigned to an experimental or to a
control condition within each school by a member of the research team. Due to the stepped
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 13 / 36
wedge design of the study, blinding of participants was not possible as they had to be informed
whether they would start with the intervention immediately or after 2 months.
Statistical analyses
All data analyses were performed using IBM SPSS Statistics for Windows (Version 27.0), and
the alpha level was set at .05. Descriptive statistics were calculated to characterise participants’
demographic and professional data. Baseline differences between the Compassionate Mind
Training for Teachers (CMT-T) intervention group and the waitlist control (WLC) group
were examined for demographics and for outcome variables in the study. For continuous vari-
ables, independent samples t-tests were conducted, and for categorical variables, chi-square
tests were performed. Independent samples t-tests and repeated measures ANOVA assump-
tions were verified through skewness and kurtosis. No severe violation of normal distribution
was found (|Sk| <3 and |Ku| <8–10) [119].
To examine mean differences between pre-intervention (T1) and post-intervention (T2) in
the primary outcomes (teachers’ burnout, depression, anxiety, stress, positive affect, satisfac-
tion with professional life), secondary outcomes (flows of compassion, self-compassion and
compassion motivations and actions, self-criticism, fears of compassion) and HRV, a series of
2 (condition) ×2 (time) repeated measures analysis of variance (ANOVA) were performed
(considering the CMT-T and the WLC group as the between-subjects factor) to test the
hypothesis that differences between pre-intervention and post-intervention differ between
conditions. A significant timexgroup interaction effect suggests that the differences found
between questionnaire scores at pre-intervention and post-intervention vary according to the
condition to which the participants belong to. Furthermore, in order to examine the mean dif-
ferences in the outcome variables within each group, a series of repeated measures analyses of
variance (ANOVAs) were conducted for each group comparing pre- and post-intervention.
Sphericity assumption for the repeated measures ANOVAs was analysed through Mauchly’s
W. Whenever this assumption was not verified, we used the Greenhouse-Geisser epsilon (ε<
.75), which corresponds to a probability correction factor of the F-statistics’ significance [120].
For ANOVAs, effect sizes were calculated using partial eta square (η
2
p) and were interpreted
as follows: partial η2 values of .01 small, .06 medium and .14 large effect sizes [121]. For inde-
pendent and paired-samples t-tests, effect sizes were calculated using Cohen’s d, with values
between .2 and .4 representing small effects; between .5 and .7 medium effects and above .8
large effects. A confidence interval of 95% was used in all the analyses.
In addition, to explore the role of self-criticism on the effects of the CMT-T intervention,
baseline self-criticism was included as a covariate. Subsequently, in the CMT-T group, high
and low self-criticism groups were generated based on 75/25 percentiles of self-criticism base-
line scores (High self-criticism: Self-criticism_Total >18; Low self-criticism: Self-
criticism_Total <10). Paired-samples t-tests were then computed to examine mean differ-
ences in primary and secondary outcomes between high and low self-critics in the CMT-T
group between pre (T1) to post-intervention (T2). To examine potential differences in the
magnitude of change from pre-to-post intervention between high and low self-critics, change
scores (T2 –T1) were computed, and independent samples t-test were calculated.
A stepped wedge analysis was performed in the subgroup of participants who participated
in the WLC group between T1 and T2 and then completed the CMT-T between T2 and T3.
Repeated Measures ANOVAs were performed to test differences from baseline to pre-inter-
vention and post-intervention in all outcome variables. Post-Hoc analyses were used to explore
pairwise differences (baseline-to-pre-intervention; baseline-to-post-intervention, and pre-to-
post-intervention).
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 14 / 36
In order to assess whether the post-CMT results were maintained, repeated measures ANO-
VAs were computed to test for mean differences between post-treatment (T2) and 3-months
follow-up (T3). Finally, Pearson product-moment correlation analyses were calculated to
explore whether the CMT-T would strengthen the associations between the three flows of
compassion from pre- to post-intervention in all participants who completed the CMT-T
(N= 103).
Results
CMT-T feasibility
Acceptability. The majority of teachers assessed the CMT-T as very/extremely important
(93.8%, n= 91), found the sessions very/extremely relevant (95.9%, n= 93) and helpful (96.8%,
n= 93), and the practices from moderately to extremely adequate (99%, n= 96). Most teachers
were highly motivated to attend the training (86.6%, n= 84) and would recommend it to oth-
ers (96.9%, n= 94). The sessions considered most helpful were Modules 3 (Building a compas-
sionate mind/self; 20.9%), 4 (Working with emotions:The role of compassionate self; 19.35%), 5
(Understanding and working with self-criticism:The role of compassionate self; 16.6%) and 2
(Understanding the functions of our emotions:The three circles model; 14.85%), with 14.75% of
teachers (29.5%) rating all modules as most helpful. The practices rated as most helpful were
Soothing Rhythm Breathing (78.9%), Compassion for the self (73.7%), Building the compas-
sionate self (63.2), Mindfulness (60%) and Safe Place Imagery (58.9%).
Practicality. Overall, the intervention had a high attendance rate. From the 103 partici-
pants that completed the CMT-T intervention (66 at time 1 plus 37 at time 2), 94 attended the
majority (5) of the eight sessions (M= 6.45, SD = 1.46). The nine (11.25%) participants that
dropped out from the intervention attended on average 1.3 sessions.
Adaptation. A pilot version of the CMT-T, comprising the same six modules delivered
across six weekly sessions, was implemented in both Portugal and the UK, and its feasibility
and impact were assessed with promising results (e.g., 87). Nevertheless, this pilot version eval-
uation suggested the intervention could be improved in a few aspects. Therefore, the CMT-T
was revised in terms of the number of sessions (from 6 to 8) and the length of the sessions was
increased (30 more min per session) to allow the content of the modules to be fully covered
and participants to follow the sessions at a gentler pace. Moreover, the topic of self-criticism
emerged as a relevant theme that influenced the impact of the CMT-T. Thus, in the revised
version of the CMT-T, self-criticism was addressed in several sessions across the intervention
(and not only in session 5).
Baseline differences
Baseline differences between the groups were explored for all outcome measures. At baseline
the WLC group revealed higher levels of burnout total (t(150) = -2.479, p= .027, Cohen’
d= 0.04), and depressive symptoms (t(150) = - 2.570, p= .011, Cohen’ d= 0.04), in comparison
with the CMT-T group. All differences represent very small effect sizes. No differences at the
onset of the study were found for any other study variable.
Differences between groups in changes from pre-intervention to post-
intervention
Repeated measures ANOVAs comparing the CMT-T and WLC groups between baseline (T1)
and post-intervention (T2) (Table 3) showed significant direct main effects of time for self-
compassion and compassion to others motivation and action, fears of compassion for others,
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 15 / 36
burnout, depression, anxiety and stress, and safe, relaxed and activated positive affect.
Medium-to-large effects sizes were found, except for burnout and stress, where effect sizes
were small. A significant direct main effect of time for HRV (RMSSD) with a medium effect
size was found. Significant direct group effects were found for compassion for self, compassion
to others motivation and action, fears of compassion for self, self-criticism, intrapersonal
mindfulness, safe and activated positive affect, depression and stress, with effect sizes ranging
from small to medium.
Table 3. Means, standard deviations before (T1) and after (T2) the CMT-T, time main effect, group main effect and time group interaction effect.
CMT-T Group
(N= 66)
WLC Group
(N= 46)
Time Group Time X Group
Measures Time M SD M SD F p η
2
pF p η
2
pF p η
2
p
Compassion for Self (CEAS) T1 63.05 14.93 60.37 17.44 2.52 .115 .023 4.92 .029 .044 7.65 .007 .066
T2 68.52 14.99 58.89 16.12
Compassion for Others (CEAS) T1 76.63 13.04 75.72 13.08 0.208 .649 .002 2.59 .110 .023 5.47 .021 .048
T2 78.73 12.26 72.59 12.40
Compassion from Others (CEAS) T1 64.05 18.16 61.64 18.28 0.24 .625 .002 1.66 .201 .015 1.14 .287 .010
T2 64.83 16.32 59.53 14.36
Self-Compassion Motivation & Action (CMAS) T1 89.71 14.31 87.21 10.93 51.39 <.001 .318 26.40 .000 .194 40.06 <.001 .267
T2 107.18 12.57 88.30 12.31
Compassion to others Motivation & Action (CMAS) T1 58.42 10.41 56.63 9.08 47.28 <.001 .303 12.39 .001 .101 16.10 <.001 .128
T2 69.24 9.80 59.50 10.40
Fears of Compassion for Self T1 7.47 7.51 9.13 7.69 1.66 .201 .015 7.42 .008 .063 5.83 .017 .050
T2 4.76 7.11 9.96 8.22
Fears of Compassion for Others T1 13.89 7.04 12.35 6.52 18.86 <.001 .146 1.15 .287 .010 20.41 <.001 .157
T2 8.39 7.23 12.46 6.67
Fears of Compassion From Others T1 10.14 7.59 11.18 8.28 0.94 .334 .009 2.95 .089 .26 4.51 .036 .040
T2 8.28 7.88 11.93 8.84
Self-criticism T1 15.68 7.19 18.80 8.94 0.11 .743 .001 8.27 .005 .071 2.95 .089 .027
T2 14.40 7.34 19.67 9.77
Safe PA T1 2.38 .70 2.29 .66 13.61 <.001 .111 6.16 .015 .053 11.10 .001 .092
T2 2.81 .69 2.31 .71
Relaxed PA T1 2.18 .75 2.13 .83 12.80 .001 .105 3.17 .078 .028 9.17 .003 .078
T2 2.62 .80 2.17 .81
Activated PA T1 2.64 .69 2.50 .74 9.95 .002 .084 4.77 .031 .042 6.62 .011 .057
T2 2.94 .55 2.53 .75
Satisfaction with Professional Life T1 14.62 4.88 12.57 4.47 1.63 .205 .015 1.33 .251 .012 7.316 .008 .063
T2 14.06 5.23 14.11 5.02
Burnout T1 48.26 16.32 54.47 15.17 4.72 .032 .041 3.38 .069 .030 0.95 .333 .009
T2 46.89 14.11 50.89 16.56
Depression T1 2.94 3.13 4.72 4.49 13.44 <.001 .109 11.02 .001 .091 0.06 .803 .001
T2 1.82 1.68 3.74 3,83
Anxiety T1 2.97 3.54 4.24 3.65 10.78 .001 .089 3.99 .048 .035 0.22 .643 .002
T2 2.13 2.63 3.13 3.56
Stress T1 6.45 3.84 8.02 4.28 4.56 .035 .040 6.52 .012 .056 0.03 .867 .000
T2 5.71 2.97 7.15 3.53
HRV (RMSSD in ms
2
)
CMT-T (n= 51); WLC (n= 36)
T1 31.48 21.94 32.49 18.98 5.29 .024 .059 0.18 .892 <.001 0.76 .386 .009
T2 37.62 31.85 35.26 20.08
Note: CMAS = Compassion Motivation and Action Scale; CEAS = Compassion Engagement and Action Scales; PA = Positive affect.
https://doi.org/10.1371/journal.pone.0263480.t003
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 16 / 36
There was a significant medium-to-large effect of the intervention (i.e., time x group inter-
action effects) on compassion for self, self-compassion and compassion to others motivation
and action, fears of compassion for others, safe, relaxed and activated positive affect, and satis-
faction with professional life. Significant time x group interaction effects with small effect sizes
were found for compassion for others and fears of compassion for self and from others.
Differences within groups in changes from pre-intervention to post-
intervention
Mean differences from pre- to post-intervention in the study variables were then examined
within each group through repeated measured ANOVAs. According to Table 4, when compar-
ing mean scores in the CMT-T group before (T1) and after the program completion (T2),
regarding those variables with significant time x group effects, significant increases were found
in compassion for self, self-compassion motivation and action, compassion to others motiva-
tion and action, and in safe, relaxed and activated positive affect. Furthermore, there were sig-
nificant decreases in fears of compassion for self, for others and from others. Results regarding
those variables where no significant time x group effects were found, revealed that in the
CMT-T group, there was also a significant decrease in depression and anxiety symptoms. The
same analysis was conducted in the WLC group, a significant decrease was found for compas-
sion for others, along with an increase in satisfaction with professional life, from T1 to T2. Sig-
nificant decreases were also found for burnout and anxiety symptoms.
We did not find a significant time x group interaction effect on HRV. However, given the
reduced number of participants undertaking HRV measurements which might have impacted
Table 4. Mean comparisons at T1 and T2 in the CMT-T and the in WLC group.
CMT-T
Group _T1
(N= 66)
CMT-T
Group_T2
(N= 66)
WLC
Group_T1
(N= 46)
WLC
Group_T2
(N= 46)
M SD M SD F
(65)
pη
2
pM SD M SD F
(45)
pη
2
p
Compassion for Self (CEAS) 63.05 14.93 68.52 14.99 9.71 .003 .134 60.37 17.44 58.89 16.12 .78 .382 .017
Compassion for Others (CEAS) 76.63 13.04 78.73 12.26 1.80 .184 .028 75.72 13.08 72.59 12.40 4.46 .040 .090
Compassion from Others (CEAS) 64.05 18.16 64.83 16.32 0.20 .655 .003 61.64 18.28 59.53 14.36 1.06 .309 .024
Self-Compassion Motivation & Action (CMAS) 89.71 14.31 107.18 12.57 83.96 <.001 .564 87.21 10.93 88.30 12.31 0.56 .459 .012
Compassion to others Motivation & Action (CMAS) 58.42 10.41 69.24 9.80 74.47 <.001 .534 56.63 9.08 59.50 10.40 3.43 .070 .071
Fears of Compassion for Self 7.47 7.51 4.76 7.11 8.18 .006 .112 9.13 7.69 9.96 8.22 0.56 .460 .012
Fears of Compassion for Others 13.89 7.04 8.39 7.23 44.96 <.001 .409 12.35 6.52 12.46 6.67 0.01 .905 .000
Fears of Compassion From Others 10.14 7.59 8.28 7.88 5.51 .022 .078 11.18 8.28 11.93 8.84 0.62 .434 .014
Self-criticism 15.68 7.19 14.40 7.34 2.22 .141 .034 18.80 8.94 19.67 9.77 1.04 .313 .023
Safe PA 2.38 .70 2.81 .69 28.65 <.001 .309 2.29 .66 2.31 .71 0.06 .811 .001
Relaxed PA 2.18 .75 2.62 .80 25.47 <.001 .285 2.13 .83 2.17 .81 0.14 .715 .003
Activated PA 2.64 .69 2.94 .55 24.87 <.001 .280 2.50 .74 2.53 .75 0.11 .739 .002
Satisfaction with Professional Life 14.62 4.88 14.06 5.23 1.34 .252 .020 12.57 4.47 14.11 5.02 6.08 .018 .119
Burnout 48.26 16.32 46.89 14.11 0.83 .367 .013 54.47 15.17 50.89 16.56 4.66 .036 .096
Depression 2.94 3.13 1.82 1.68 11.21 .001 .147 4.72 4.49 3.74 3.83 3.99 .053 .081
Anxiety 2.97 3.54 2.13 2.63 4.99 .029 .071 4.24 3.65 3.13 3.56 5.70 .021 .112
Stress 6.45 3.84 5.71 2.97 2.19 .144 .033 8.02 4.28 7.15 3.53 2.53 .118 .053
HRV (RMSSD in ms
2
)
CMT-T (n= 51); WLC (n= 36)
31.48 21.94 37.62 31.85 5.96 .018 .107 32.49 18.98 35.26 20.08 .894 .351 .025
Note: CMAS = Compassion Motivation and Action Scale; CEAS = Compassion Engagement and Action Scales; PA = Positive affect.
https://doi.org/10.1371/journal.pone.0263480.t004
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 17 / 36
on the significance of the time x group interaction, the medium effect size found for the direct
main effects of time, and a clear trend emerging by the visual inspection of the plot (Fig 2), we
exploratively inspected mean differences at HRV (RMSSD) before (T1) and after the CMT-T
(T2) in the two groups, separately. Repeated measured ANOVA showed a significant increase
in HRV from T1 to T2, with a large effect size, only in the experimental group. Interestingly,
the WLC showed a non-significant increase in HRV from T1 to T2 (see Table 4).
The role of self-criticism
When controlling for baseline self-criticism, a significant time x self-criticism interaction effect
was found (F= 1.90, p= .020, η
2
p = .368). In addition, significant effects of the intervention
(i.e., time x group effects) were found for: compassion for self (F= 10.24, p= .002, η
2
p = .095),
compassion for others (F= 4.33, p= .040, η
2
p = .043), self-compassion motivation and action
(F= 47.22, p<.001, η
2
p = .327), compassion to others motivation and action (F= 14.37, p<
.001, η
2
p = .129), fears of compassion for self (F= 5.41, p= .022, η
2
p = .053) and for others
(F= 15.36, p<.001, η
2
p = .137), as well as safe (F= 9.23, p= .003, η
2
p = .087), relaxed
(F= 8.48, p= .004, η
2
p = .080) and activated (F= 5.73, p= .019, η
2
p = .056) positive affect, and
satisfaction with professional life (F= 5.35, p= .023, η
2
p = .052).
Paired-samples T-tests comparing high and low self-critics in the CMT-T group between
baseline (T1) and post-intervention (T2) were then performed (Table 5). The high self-critics
showed a significant increase in compassion for self, self-compassion motivation and action,
Fig 2. Time ×group interaction for HRV (RMSSD; ms2).
https://doi.org/10.1371/journal.pone.0263480.g002
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 18 / 36
compassion to others motivation and action, and in safe, relaxed and activated positive affect.
These participants also revealed a significant decrease in fears of compassion for self and for
others, in self-criticism and in depression and anxiety symptoms. As for the low self-critics,
they showed a significant increase in self-compassion and compassion to others motivations
and actions, and in safe, relaxed and activated positive affect, as well as significant decreases in
fears of compassion for others. All effect sizes ranged from medium to large.
To examine potential differences in the magnitude of change from pre-to-post intervention
between high and low self-critics, change scores (T2 –T1) were computed, and independent
samples t-test’s calculated. Results revealed no significant differences between high and low
self-critics in the magnitude of change in all study variables, with the exception of anxiety [t
(47)
= -2.10, p= .041] and self-criticism [t
(46)
= -3.57, p= .001], where the change was greater in the
high self-criticism group.
Stepped wedge analysis: Differences in changes from baseline, pre-
intervention to post-intervention within the WLC group’ participants who
completed the CMT-T
Repeated Measures ANOVAs were performed to test differences in all study’s variables from
baseline to pre-intervention and post-intervention (Table 6) in the WLC group participants
who completed the CMT-T between T2 and T3. At post-intervention, participants presented
increased levels of the three flows of compassion (for self, for others and from others), self-
compassion and compassion to others motivations and actions, positive affect (safe, relaxed,
activated) and satisfaction with professional life, as well as decreased fears of compassion (for
self, for others and from others), burnout, depression, anxiety and stress symptoms. All differ-
ences reflected large effect sizes.
Table 5. Mean comparisons at T1 and T2 for the high self-criticism group (N= 31) and the low self-criticism group (N= 18) within the CMT-T group.
High Self-
criticism _T1
High Self-
criticism _T2
Low Self-
criticism _T1
Low Self-
criticism _T2
M SD M SD t p d M SD M SD t p d
Compassion for Self (CEAS) 60.80 16.75 67.27 14.80 -2.17 .038 .40 67.59 12.88 69.94 15.25 -0.70 .495 .17
Compassion for Others (CEAS) 76.24 14.24 79.04 13.54 -1.17 .253 .22 79.67 13.23 77.00 13.80 0.82 .426 .19
Compassion from Others (CEAS) 61.60 18.08 60.80 16.96 0.32 .750 .06 72.50 15.62 68.56 15.19 1.32 .204 .25
Self-Compassion Motivation & Action (CMAS) 87.32 15.43 108.58 12.03 -7.07 <.001 1.27 91.39 11.29 104.39 14.39 -3.52 .003 .83
Compassion to Others Motivation & Action (CMAS) 59.16 11.37 70.45 9.15 .6.11 <.001 1.10 55.72 9.70 66.22 11.99 -3.79 .001 .93
Fears of Compassion for Self 10.45 8.69 6.16 9.36 2.27 .031 .41 3.89 4.52 2.33 2.89 2.04 .058 .48
Fears of Compassion for Others 15.39 6.13 10.06 7.81 4.95 <.001 .89 11.28 7.78 7.50 6.37 2.92 .010 .69
Fears of Compassion from Others 12.90 8.22 10.29 9.72 1.66 .108 .30 6.17 5.93 5.22 4.67 0.91 .375 .22
Self-Criticism 21.83 4.80 17.80 6.89 3.17 .004 .58 7.28 2.52 9.89 5.95 -2.34 .032 .55
Safe PA 2.14 .68 2.63 .65 -3.90 .001 .72 2.72 .78 3.06 .70 -3.06 .007 .74
Relaxed PA 2.05 .91 2.66 .77 -4.86 <.001 .88 2.34 .62 2.68 .86 -2.39 .029 .56
Activated PA 2.45 .77 2.86 .56 -4.74 <.001 .86 2.82 .65 3.08 .55 -2.39 .029 .56
Satisfaction with Professional Life 13.77 5.12 13.77 5.59 0.00 1.00 .00 15.88 5.28 15.53 5.77 .536 .599 .13
Burnout 54.65 14.80 53.23 13.33 .631 .533 .11 43.67 17.43 40.78 13.99 0.97 .348 .23
Depression 4.03 3.54 2.23 1.54 3.15 .004 .56 2.00 2.77 1.17 1.29 1.59 .131 .39
Anxiety 4.35 4.23 2.74 3.31 2.62 .014 .47 1.50 1.69 1.78 1.73 -0.55 .593 .13
Stress 7.29 4.25 6.48 3.20 1.02 .320 .18 6.28 3.34 5.06 2.64 1.41 .178 .33
Note: CMAS = Compassion Motivation and Action Scale; CEAS = Compassion Engagement and Action Scales; PA = Positive affect.
https://doi.org/10.1371/journal.pone.0263480.t005
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 19 / 36
Furthermore, post-hoc pairwise comparisons revealed no significant changes from baseline
to pre-intervention in any of the study variables except for symptoms of depression and anxi-
ety, which decreased between T1 and T2. Between baseline and post-intervention, participants
showed significant improvements in self-compassion and compassion from others, self-com-
passion and compassion to others motivations and actions, positive affect (safe, relaxed, acti-
vated) and satisfaction with professional life, along with significant reductions in fears of
compassion (for self, for others and from others), burnout, and depression, anxiety and stress
symptoms. In addition, between pre-intervention and post-intervention, participants revealed
significant increases in the three flows of compassion (for self, for others and from others), in
self-compassion and compassion to others motivations and actions and in positive affect (safe,
relaxed, activated). They also revealed significant decreases in fears of compassion (for self, for
Table 6. Means and SDs of the outcome measures at baseline (T1), pre-intervention (T2) and post-intervention (T3) and repeated measures analysis of variance
(N= 37) and pairwise comparisons, for the WLC group participants who completed the CMT-T intervention between T2 and T3.
Baseline
(T1)
Pre-intervention
(T2)
Post-Intervention
(T3)
F p η
2
p Pairwise Comparisons
Outcome measures M (SD) M (SD) M (SD) T1-T2 p T1-T3 p T2-T3 p
Compassion for Self (CEAS)
a
59.66
(16.51)
59.22 (15.79) 68.38 (16.12) 9.84 .001 .241 .438
(1.79)
.809 -8.72
(2.83)
.004 -9.16
(2.25)
<.001
Compassion for Others
(CEAS)
74.66
(14.52)
73.06 (13.19) 77.75 (12.66) 3.68 .031 .106 1.59
(1.76)
.372 -3.09
(1.82)
.100 -4.69
(1.69)
.009
Compassion from Others
(CEAS)
a
60.06
(18.55)
58.63 (15.02) 68.50 (16.61) 7.10 .004 .186 1.44
(2.43)
.559 -8.44
(3.46)
.021 -9.88
(2.49)
<.001
Fears of Compassion for Self 9.84 (8.72) 10.66 (8.48) 5.28 (6.99) 9.31 <.001 .231 -.813
(1.35)
.551 4.56
(1.40)
.003 5.38
(1.28)
<.001
Fears of Compassion for
Others
13.28
(6.91)
12.66 (7.20) 6.31 (5.41) 24.45 <.001 .441 .625
(.997)
.527 6.97
(1.20)
<.001 6.34
(1.12)
<.001
Fears of Compassion From
Others
12.66
(8.94)
12.47 (9.40) 8.50 (7.79) 6.84 .002 .181 .188
(1.19)
.876 4.16
(1.31)
.003 3.97
(1.30)
.005
Self-Compassion Motivation &
Action (CMAS)
87.13
(11.39)
88.25 (11.64) 108.06 (13.39) 70.09 <.001 .693 -1.13
(1.79)
.535 -20.94
(2.01)
<.001 -19.81
(2.15)
<.001
Compassion to others
Motivation & Action (CMAS)
55.84
(9.16)
59.25 (9.63) 71.16 (9.01) 46.02 <.001 .598 -3.31
(1.82)
.071 -15.31
(1.61)
<.001 -11.91
(1.58)
<.001
Self-criticism
a
17.75
(8.53)
18.72 (9.16) 18.08 (10.82) .310 .664 .010 -.97 (.94) .311 -.34
(1.58)
.829 .63 (1.14) .587
Burnout
a
53.75
(14.99)
50.28 (17.39) 43.22 (15.56) 9.53 .001 .235 3.47
(1.75)
.056 10.53
(2.71)
.001 7.06
(2.78)
.016
Depression
a
4.97 (4.76) 3.28 (3.43) 2.38 (2.59) 8.59 .001 .217 1.69 (.57) .006 2.59 (.78) .002 .91 (.52) .092
Anxiety 4.16 (3.73) 2.53 (3.03) 2.09 (2.25) 8.73 .001 .220 1.63 (.53) .004 2.06 (.55) .001 .44 (.48) .370
Stress 8.28 (4.22) 7.13 (3.77) 6.50 (2.65) 3.32 .043 .097 1.16 (.64) .081 1.78 (.79) .031 .63 (.66) .354
Safe PA 2.33 (.74) 2.40 (.71) 2.78 (.76) 9.55 <.001 .235 -.07 (.11) .517 -.45 (.12) .001 -.38 (.10) .001
Relaxed PA 2.10 (.76) 2.18 (.80) 2.70 (.83) 13.08 <.001 .297 -.08 (.11) .492 -.60 (.12) <.001 -.52 (.15) .002
Activated PA 2.53 (.84) 2.59 (.83) 2.79 (.79) 3.95 .024 .113 -.06 (.09) .531 -.26 (.10) .017 -.20 (.09) .045
Satisfaction with Professional
Life
13.41
(4.43)
14.94 (5.04) 15.78 (4.50) 6.13 .004 .165 -1.53
(.79)
.063 -2.36
(.60)
<.001 -.84 (.65) .204
Threat Emotions - 6.25 (2.89) 5.72 (2.80) 3.61 .065 .094 - - - - .53 (.28) .065
Soothing Emotions - 13.31 (2.75) 14.06 (2.46) 3.97 .050 .102 - - - - -.75 (.38) .050
Drive Emotions - 11.92 (3.31) 13.33 (3.22) 13.69 .001 .281 - - - - -1.42
(.38)
.001
HRV (RMSSD in ms
2
; n = 36) 32.49
(18.98)
35.25 (20.08) 35.04 (17.85) .46 .631 .010 -2.76
(17.55)
.351 .21
(21.07)
.952 -2.55
(18.73)
.419
Note:
a
= Greenhouse-Geisser correction; CMAS = Compassion Motivation and Action Scale; CEAS = Compassion Engagement and Action Scales; PA = Positive affect.
https://doi.org/10.1371/journal.pone.0263480.t006
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 20 / 36
others and from others) and burnout. The emotional climate at work was also assessed in these
participants at T2 and T3, and significant increases in soothing/safeness and drive/vitality
emotions at work were found from pre-to-post-intervention. A decrease in threat emotions at
work was also observed, but did not reach the significance threshold.
Three-month follow-up comparison with post-intervention
Repeated measures ANOVAs results considering post-CMT-T (T2) and the 3-months follow-
up (T3) are presented in Table 7. No significant differences were found for all the considered
variables pointing to the maintenance of the CMT-T therapeutic gains, except for self-compas-
sion motivations and actions and compassion (to others) motivations and actions. Pairwise
comparisons showed a significant decrease from T2 to T3 in the self-compassion motivations
and actions (p<.001) and in the compassion to others motivations and actions (p= .020).
How are the flows of compassion related pre- and post-intervention?
We explored whether the association between the flows of compassion changed from pre-to-post
intervention in all participants who completed the CMT-T. Prior to the CMT-T, correlations
between the three flows were moderate: r
Self-compassion—Compassion for Others
= .54, p<.001;
r
Self-compassion—Compassion From Others
= .40, p<.001; r
Compassion for Others—Compassion From Others
=
.39, p<.001. After the intervention, correlations between the flows increased in magnitude across
all the flows: r
Self-compassion—Compassion for Others
= .60, p<.001; r
Self-compassion—Compassion From Others
=
.54, p<.001; r
Compassion for Others—Compassion From Others
= .52, p<.001.
Table 7. Mean comparisons at post-CMT-T (T3) and 3-months follow-up (T4), effect size and observed power (N= 48).
T3 T4
Outcome measures M SD M SD F
(1, 46)
pη
2
p Observ. power
Compassion for Self (CEAS) 69.35 13.92 66.89 13.10 2.93 .094 .06 .389
Compassion for Others (CEAS) 78.33 12.26 77.16 12.51 0.84 .366 .02 .145
Compassion from Others (CEAS) 63.22 16.41 60.57 14.04 2.02 .162 .04 .285
Self-Compassion Motivation & Action (CMAS) 109.72 10.10 102.72 13.05 14.52 <.001 .24 .961
Compassion to others Motivation & Action (CMAS) 71.49 9.75 67.37 11.12 5.82 .020 .12 .654
Fears of Compassion for Self 6.28 8.70 8.19 12.28 2.03 .161 .04 .286
Fears of Compassion for Others 8.74 7.79 10.02 9.45 2.24 .141 .05 .311
Fears of Compassion From Others 9.32 8.73 10.11 10.98 0.40 .532 .01 .095
Self-criticism 16.88 9.50 15.84 9.90 0.64 .427 .02 .123
Safe PA 2.76 0.75 2.70 0.67 0.32 .572 .01 .086
Relaxed PA 2.78 0.63 2.76 0.69 0.02 .884 .00 .052
Activated PA 2.82 0.63 2.87 0.64 0.46 .499 .01 .102
Satisfaction with Professional Life 15.33 4.44 15.59 4.45 0.26 .614 .01 .079
Burnout 43.59 12.35 45.02 16.49 0.52 .476 .01 .108
Depression 2.30 2.26 2.93 3.83 1.33 .255 .03 .204
Anxiety 2.45 2.64 2.43 3.18 0.00 .957 .00 .050
Stress 6.29 2.69 5.47 3.63 3.18 .081 .07 .415
Threat Emotions 5.48 2.65 5.08 2.66 1.02 .322 .04 .163
Soothing Emotions 13.94 2.30 13.88 1.93 0.05 .835 .00 .055
Drive Emotions 13.25 2.69 13.21 2.32 0.01 .929 .00 .051
Note: CMAS = Compassion Motivation and Action Scale; CEAS = Compassion Engagement and Action Scales; PA = Positive affect.
https://doi.org/10.1371/journal.pone.0263480.t007
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 21 / 36
Discussion
Schools are facing an unparalleled mental health crisis. Teachers within all education sectors
and across countries increasingly reveal elevated stress and burnout and intend to leave the
profession [3,4]. This scenario is particularly concerning in Portugal, where teachers’ stress
and burnout are prevalent and associated with the competitive pressures and growing reten-
tion crisis in the teaching profession [5]. Importantly, teachers’ stress has adverse conse-
quences to their mental and physical health and negatively influences pupils [e.g., 5,8].
Furthermore, this raises serious economic, healthcare and societal challenges. Therefore, it is
crucial to promote adaptive cognitive and emotional regulation that supports teachers in cop-
ing with the challenges of the school context and promotes their mental wellbeing.
Growing empirical support has highlighted the beneficial impact of compassionate-based
interventions on improving emotional regulation skills central to stress regulation [63]. In
educational settings, the Compassionate Schools Research Initiative developed and examined
the impact of a Compassion Mind Training intervention for Teachers (CMT-T), in schools in
Portugal and the UK, and found empirical support for its international utility, feasibility and
preliminary effectiveness on a range of mental health indicators [32,87,91]. The current study
intended to expand this preliminary evidence and test the feasibility and effectiveness of a
refined version of the CMT-T on teachers’ psychological distress, wellbeing, compassion to
self and others, and heart rate variability (HRV), using a randomised controlled and stepped
wedge design in a larger sample.
The CMT-T had a high attendance rate, and teachers considered the intervention very
important and helpful. They were highly motivated to attend the sessions and would recom-
mend it to colleagues. These findings suggest that the revised 8-week CMT-T was highly rated
in terms of acceptability and revealed adequate practicality and adaptation, providing evidence
that the CMT-T is a feasible intervention for teachers. These feasibility results are in support of
previous pilot studies using an earlier version of the CMT-T in Portugal and the UK [32,87,
91], reinforcing the acceptability of CMT-T modules and practices. In particular, teachers
found the modules’ Building a compassionate mind/self’, ’Understanding and working with
self-criticism’, and ’Understanding the functions of our emotions’ to be the most helpful. In
general, this is similar to the results reported in the Portuguese pilot study [87]. In both studies,
the two modules addressing the soothing system’s cultivation and the development of the com-
passionate mind/self and, multiple selves, were chosen by teachers as the most useful. Interest-
ingly in this refined CMT-T, where self-criticism was targeted throughout the intervention,
the module focused on the functional analysis of self-criticism and using the compassionate
self to deal with it was also identified as a very relevant one. In line with Matos et al. [87], the
practices assessed as the most helpful by the teachers were the Soothing Rhythm Breathing,
Compassion for the self, Building the compassionate self, followed by Mindfulness and Safe
Place Imagery. These acceptability results extend current knowledge on the evaluation of CMT
interventions with community samples [e.g., 66,67,74] and should inform the development,
implementation and evaluation of CMT interventions in future research.
The present randomised controlled study revealed significant time x group interaction
effects of the CMT-T on compassion for self, self-compassion and compassion to others
motivation and action, fears of compassion for others, safe, relaxed and activated positive
affect, and satisfaction with professional life, with medium to large effect sizes. Moreover,
significant time x group interaction effects with small effect sizes were also found for com-
passion for others and fears of compassion for self and from others. These findings partially
support our hypotheses and are discussed in detail below concerning the process and out-
come variables.
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 22 / 36
The results highlighted several differences between groups. Regarding the effects of the
CMT-T on self-compassion, compared with the WLC group, teachers in the CMT-T group
revealed a significant increase in compassion for self and self-compassion motivation and
action and a significant reduction in fears of compassion for self. These changes represented
medium to large effect sizes. Stepped wedge analyses further corroborated these findings
revealing that teachers who received the intervention after acting as controls also showed sig-
nificant improvements in compassion for self and self-compassion motivation and action, and
significant decreases in fears of compassion for self after completing the CMT-T. These results
corroborate our hypotheses, indicating that after the CMT-T, teachers improved their sensitiv-
ity and engagement with their own suffering, along with an enhanced motivation to engage
with life’s difficulties and suffering with a caring and accepting attitude towards oneself,
instead of withdrawing, avoiding or denying those difficulties. They also revealed an increased
ability to tolerate distress concerning oneself, to be kind and supportive when facing hardships,
and showed a greater capacity to act compassionately towards themselves. Simultaneously, the
CMT-T produced a decline in fears, blocks and resistances to be self-compassionate. These
results extend those reported by Matos et al. [87], documenting significant increases in teach-
ers’ self-compassion motivation and action (as assessed by the CMAS) after the CMT-T, but
where changes in self-compassion attributes and competencies (as measured by the CEAS),
and fears of compassion for self, did not reach statistical significance. In the present study, sig-
nificant improvements in compassion engagement and action towards oneself (as measured
by the CEAS) were additionally found in teachers at post-intervention, which is in line with
previous studies showing similar results using CMT in community samples [66,67]. This find-
ing suggests that this refined longer version of CMT-T not only promotes an increase in one’s
motivation to be accepting and caring, to tolerate distress, and to commit to behaving compas-
sionately towards oneself (as assessed by the CMAS), but also diminishes the inhibitors to be
self-compassionate, and fosters the sensitivity to and engagement with one’s suffering includ-
ing competencies of sensitivity, sympathy, empathy, distress tolerance, non-judgment and care
for wellbeing (i.e., self-compassionate engagement) and committed actions to try to alleviate
and prevent one’s suffering (i.e., self-compassionate action). Our results go beyond those of an
earlier version of the CMT-T where improvements in self-compassion [as measured by the
Self-Compassion Scale, SCS; 122] were only significant with increased practice of the tech-
niques introduced [and not just session attendance), as supported by the qualitative analyses
[32]. Furthermore, these findings are also in support of studies using CMT in other professions
that found significant increases in self-compassion (as measured by the SCS) in health care
educators and providers [68], mental health professionals [69], psychotherapy students [73],
and firefighters [72].
The CMT-T also targets the cultivation of compassion for others [58,61], and participants
in the CMT-T group revealed significant increases in compassion to others motivation and
action (as measured by the CMAS) and a significant reduction in fears of compassion for oth-
ers, from pre to post-intervention, with medium to large effect sizes. These findings partially
support our hypotheses and indicate that the CMT-T seems to reduce teachers’ fears, blocks
and resistances of being compassionate to others while also promoting their motivation, dis-
tress tolerance, and commitment to act in compassionate ways towards others. Even though
there was a trend towards positive change in compassion for others engagement and action (as
measured by the CEAS), this increase did not reach the threshold of significance, contrarily to
what was found in the CMT-T pilot study [87]. This finding might be attributable to a ceiling
effect, which has been reported in previous studies with this measure [93] and using CMT in
community samples [66,67] as participants’ baseline scores were higher in compassion for
others, in comparison to the other two flows of compassion, which might be related to a social
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 23 / 36
desirability bias. In fact, results from the stepped wedge analyses support this hypothesis and
show that, after receiving the CMT-T intervention, WLC participants also exhibited significant
increases in compassion for others (as measured by the CEAS) as well as in compassion to oth-
ers motivation and action and significant decreases in fears of compassion for others. A more
in-depth observation of these findings revealed that even though the post-intervention scores
of the CMT-T and the WLC participants who received the intervention between T2 and T3
were similar, the former presented baseline levels higher than the pre-intervention scores of
the latter. In fact, in group comparisons analyses, the WLC group showed a significant
decrease in compassion for others between baseline and pre-intervention (with a medium
effect size). This was an unexpected finding, which might be related to the elevated baseline
scores in this measure and to the parallel increase in burnout levels in these WLC participants.
As a whole, the present results add to prior CMT studies with teachers where this flow of com-
passion was not specifically evaluated using a recognised quantitative measure [32] and with
other professions [e.g., healthcare educators and professionals, 68,69; fire service personnel,
72].
In regard to changes in compassion from others, teachers in the CMT-T group significantly
decreased their fears of receiving compassion from others (with a medium effect size),
although no significant differences were found in compassion received from others as mea-
sured by the CEAS, which assesses how one perceives other people’s motivation and ability to
engage with one’s suffering and to take action to alleviate one’s distress. Stepped wedge analy-
ses further add to these results, revealing significant increases in the perception of compassion
received from others (as measured by the CEAS) and reductions in fears of compassion from
others. These findings extend the ones described in the CMT-T pilot study [87], where neither
compassion from others nor fears of receiving compassion from others significantly changed
from pre- to post-intervention. In the current study, and as expected, the CMT-T produced a
reduction in teachers’ inhibitors and resistances to being the recipient of compassion from
others which is related to an improvement in one’s ability to be open and willing to receive
compassion from others. Mixed results regarding CMT-T induced increases in the perception
of others being more compassionate towards the self in this study warrant further exploration.
Overall, our results are aligned with previous studies using CMT in community samples [66,
67] and add to preceding research implementing CMT with teachers [32,91] and other profes-
sionals [6870,72,73] that did not assess this flow of compassion.
An important aspect of the CFT/CMT approach is the consideration of the inter-relationship
between the three flows of compassion (CEAS: compassion for others, being open to compas-
sion from others, and self-compassion). In line with our hypothesis, results showed that the
association between the three flows of compassion was strengthened after the CMT-T imple-
mentation. These data highlight that CMT-T seems to enhance the general level of several com-
ponents of the three flows of compassion and reinforce engenderment of a compassionate mind
in which higher scores in one flow of compassion tend to be accompanied by higher scores in
another flow. These results are analogous to previous research exploring CMT in the general
population [e.g., 66,67] and provide further support to the assumption that CMT stimulates the
caring motivational system, which facilitates one’s openness and motivation [58,66,116].
Taken together these results and the specificity of the target population, this study provides
evidence for the effectiveness of the CMT-T in reducing teachers’ fears, blocks and resistances
to compassion (for self, for others and from others) while also facilitating their motivation, dis-
tress tolerance and commitment to be compassionate towards themselves and others, along
with developing the attributes and practicing the competencies of self-compassion and com-
passion for others. Therefore, the CMT-T may contribute to attenuating the barriers to com-
passion and strengthening teachers’ compassionate mind and abilities, including greater self-
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 24 / 36
compassion, openness to receiving compassion and support from others, and motivation and
competencies to establish more compassionate relationships, particularly in the school envi-
ronment (e.g., colleagues, staff, pupils).
One of the central aims of CMT-T is to promote both overall and professional wellbeing,
which in the current study were assessed through types of positive affect, linked to feelings of
relaxation and calmness, feelings of safeness and contentment, and energised positive emo-
tions (e.g., excited, energised, enthusiastic), and through teachers’ satisfaction with their pro-
fessional life. Group comparisons revealed that the CMT-T group significantly increased safe,
relaxed and activated positive affect from pre- to post-intervention, with large effect sizes.
Stepped wedge analyses further substantiated these findings and revealed that, at post-inter-
vention, WLC participants who completed the CMT-T presented incremented levels of feel-
ings of safeness and relaxation (with large effect sizes) and of vitality/activation (medium effect
sizes). These results are in line with our hypotheses and with preceding research that reported
increases in positive affect, particularly in feelings of safeness, contentment, and relaxation,
after a CMT intervention in community samples [66,67]. Conversely to these previous studies
where no changes were found in activated positive affect, interestingly, the CMT-T produced
enhanced energizing positive emotions (e.g., excitement, vitality and enthusiasm) hypothe-
sized to be related to the drive system, in addition to heightened positive emotions of safeness,
contentment, calmness and relaxation, hypothesized to be related to the soothing system [58,
116]. These findings support the CFT framework regarding the beneficial impact of fostering
compassion and reducing its inhibitors on cultivating types of positive affect linked to the
affiliative and care-giving mentalities [58,116]. Moreover, it may be that the specificity of the
setting where CMT-T was implemented facilitates the promotion of a different type of active
positive emotions related to the drive resource-seeking system [58,116]. This may be related
to the fact that teachers tend to suffer from burnout and exhaustion [4], which may be reflected
in a dampening of this energizing positive affect prior to the intervention. Hence, the fact that
CMT-T is applied to their professional lives and within the school context may encourage an
adaptive stimulation of the drive resource-seeking system and foster this type of positive ener-
gizing emotions which, balanced by the promotion of feelings of safeness and relaxation, may
be crucial to professional performance and wellbeing. In fact, this hypothesis seems to be fur-
ther supported by the results using a new measure assessing emotional climate at work (i.e.,
the activation of the safeness, drive and threat affect systems) in a subsample of teachers. These
participants exhibited significant increases in positive emotions linked to soothing/safeness
and drive/vitality at work from pre-to-post CMT-T, representing medium to large effect sizes.
Regarding teachers’ satisfaction with professional life, no significant changes were found in the
CMT-T group. However, stepped wedge analyses revealed significant increases between base-
line (T1) and post-intervention (T3) in the WLC participants who received the CMT-T
(medium effect size). Of note, in the group comparison analyses, the WLC group presented a
significant increase in satisfaction with professional life from T1 to T2. However, at baseline,
these participants had lower scores in satisfaction with professional life than the CMT-T
group, and this increase put both groups at a similar level at T2. As a whole, these results con-
cerning the valuable effects of CMT-T on overall and professional wellbeing extend previous
studies using earlier versions of CMT-T that did not assess these indicators [32,87] and find-
ings from research using CFT as guided self-help in the general population that demonstrated
improvements in wellbeing at post-intervention [79].
Alongside the cultivation of positive emotions and wellbeing, the CMT-T also aims to target
and reduce suffering and psychological distress. Although no significant interaction effects
were found for outcome measures of psychological distress, within-group comparisons
revealed that teachers in the CMT-T group demonstrated significantly decreased anxiety and
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 25 / 36
depression symptoms (with medium and large effect sizes, respectively). Furthermore, stepped
wedge analyses showed that, at post-intervention, WLC participants who completed the
CMT-T presented decreased burnout, depression, anxiety and stress, all corresponding to
large effect sizes. In relation to the WLC participants, a significant decrease in burnout and
anxiety symptoms was found between baseline and post-intervention (medium effect sizes),
even though their post-intervention scores were still higher than the CMT-T group baseline
scores. This may be attributable to a ceiling effect given that at baseline, the WLC participants
scored significantly higher than the CMT-T group in burnout and depression (small effect
sizes). These findings partially corroborate our hypotheses, hinting at the potential benefits of
the CMT-T in helping teachers diminish burnout and psychological distress. These results add
to the CMT-T pilot study, which had already documented a decrease in psychopathological
indicators at post-intervention but failed to find significant changes in burnout [87]. They also
expand upon Maratos et al. [32] feasibility study, where thematic analyses pointed to the posi-
tive impact of CMT on dealing with emotional difficulties, although quantitative analyses did
not find significant changes. Our findings are also in line with previous studies in community
samples [66,67] and other professionals [i.e., firefighters, 72] which attested the positive
impacts of CMT and CFT in psychopathological indicators.
The present study also aimed to explore the impact of the CMT-T on heart rate variability
(HRV), an indicator of vagal regulatory activity and a physiological marker of a person’s ability
to flexibly respond to environmental challenges and regulate emotional responses [40,50,75],
which has been proposed as a primary measure to assess and train compassion [44,56]. Results
showed that HRV significantly increased in the CMT-T group from baseline (T1) to post-
intervention (T2). This suggests that, as previously found [67], CMT-T may produce an
increase in vagal tone which is associated not only with the ability to downregulate physiologi-
cal arousal, but also with the experience of inter- and intrapersonal safeness, and the inhibitory
function of the prefrontal cortex with resulting greater capacity for emotion regulation [123],
metacognitive awareness, and empathy. Relevantly, higher vagal tone has also been associated
with better physical health: better glucose regulation, better HPA axis function, reduced
inflammation, reduced risk for cardiovascular disease, and all-cause mortality [40]. However,
surprisingly, the WLC group also demonstrated an increase in HRV (even though non-signifi-
cant) from T1 to T2, which might be one of the reasons why the time x group interaction effect
test did not reach statistical significance. These findings differ from previous investigations
where only the intervention group showed significant changes in HRV [67]. One of the possi-
ble explanations of this result could be the beneficial effects of the CMT-T intervention not
only on the group undertaking the intervention but also on the whole school climate. In fact, it
is possible that the WLC participants have been positively impacted by the expectation of
receiving a compassion focused intervention, or by believing that they work for and belong to
an institution that promotes such initiatives that show interest and care for their psychological
needs. Indeed, perceived positive organizational climate has been shown to be related to heart
rate variability [124,125]. Given the study design where teachers were randomised within
their school into the CMT-T and WLC groups, it is also possible that WLC participants already
started benefitting from the increased compassion the intervention group was developing as a
result of the intervention. This alludes to the intriguing possibility that interventions leading to
increased compassion related variables and physiological regulation in a group might poten-
tially have a positive impact on other groups in the same institution, virtually initiating an
upward spiral [126].
A psychological process that might play a role in how participants responded to the CMT-T
is self-criticism. Self-criticism is a transdiagnostic and major vulnerability factor to mental
health difficulties and poor wellbeing [127], being linked to a variety of adverse interpersonal
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 26 / 36
(e.g., submissive behaviour, aggression) and intrapersonal (e.g., shame, rumination, worry,
poor emotion regulation skills) factors in nonclinical populations [128,129]. Importantly, self-
criticism is known to influence the impact of compassion and self-compassion in wellbeing
[67,88]. In the current study, and contrarily to our hypothesis, no significant interaction
effects of the CMT-T were found on self-criticism. Although previous research using CMT in
community samples [66,67,79] and other professional groups [e.g., psychotherapy students,
73, healthcare educators and professionals, 68,69] found changes in self-criticism, similar
results to ours were reported in the pilot studies of CMT for teachers in Portugal [CMT-T; 87]
and the UK [32]. Despite in the refined version of the CMT-T, implemented in the present
study, self-criticism having been addressed throughout the sessions and specifically on module
5, the decreasing trend in self-criticism levels that could be observed in the CMT-T group did
not reach statistical significance. Future iterations of the CMT-T should seek to clarify these
findings and explore whether this resistance to change in self-criticism is attributable to the
specificity of the target population and whether it is replicable in other samples of teachers. A
possible aspect that could be adjusted in the CMT-T is exchanging the order of the modules so
that the functional analysis of self-criticism and strategies to use the compassionate self to
work with it (module 5 in the CMT-T) come earlier in the intervention.
Considering previous research emphasising that individual differences in self-criticism
influence the impact of compassion-based interventions in general [8890], and of the CMT-T
in particular [87], we examined the role of self-criticism on the effects of the CMT-T interven-
tion. When controlling for baseline self-criticism, a significant interaction (time x self-criti-
cism) effect was found, and significant effects of the intervention (time x group) effects
emerged in compassion for self and for others, self-compassion and compassion to others
motivation and action, fears of compassion for self and for others, relaxed and activated posi-
tive affect, and satisfaction with professional life. These findings highlight that self-criticism
seems to impact how teachers respond to CMT-T, playing a role in how the intervention oper-
ates in developing teachers’ abilities to be compassionate towards themselves and others, thus
promoting their wellbeing and reducing psychological distress. In addition, when comparing
changes between baseline and post-intervention in high and low self-critics of the CMT-T
group, results showed that the high self-critics significantly improved compassion for self, self-
compassion motivation and action, compassion to others motivation and action, and positive
emotions of safeness, relaxation and activation, and decreased fears of compassion for self and
for others, self-criticism and depression and anxiety symptoms. On the other hand, the low
self-critics revealed significant increases in self-compassion and compassion to others motiva-
tions and actions, and in positive emotions (safeness, relaxation and activation), in addition to
significant decreases in fears of compassion for others. All differences corresponded to
medium to large effect sizes. Hence, high self-critics seem to benefit the most from the CMT-T
revealing significant or greater reductions in fears of compassion, self-criticism, depression
and anxiety, and improvements in self-compassion and compassion to others, and in positive
emotions linked to safeness, relaxation and vitality, after the intervention compared to low
self-critics. Indeed, the magnitude of improvement in anxiety and self-criticism was greater in
the high self-critic participants. The current study extends the findings of the CMT-T pilot
study [87], where self-criticism was found to influence the intervention effects on self-compas-
sion, satisfaction with professional life and burnout. Our results underline the importance of
addressing and working with self-criticism throughout a CMT intervention to facilitate
changes in compassion, wellbeing and psychological distress. Future research implementing
and testing the CMT-T or other CMT interventions should take into account these findings,
in particular, considering specifically working with self-criticism ahead in the intervention
whilst also targeting it across the sessions.
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 27 / 36
Importantly, in line with our hypothesis, the improvements seen in the CMT-T group and
WLC group participants who received the intervention were largely maintained at three
months follow-up, with the exception of self-compassion and compassion to others motiva-
tions and actions, which diminished. This reduction at follow-up might somehow be expected,
given that the CMAS assesses one’s desire, reasons, and need for compassion to others and for
oneself [108]. This means that if participants improvements in the flows of compassion were
maintained from post-intervention to follow-up, then their perception of the need and motiva-
tion to continue to enhance their self-compassion and compassion to others might have faded
away. However, only a longer follow-up period would allow us to confirm this hypothesis.
Alternatively, it may be that an ongoing independent practice of CMT is needed to maintain
its benefits on levels of self-compassion and compassion to others motivation and action, as
typically encouraged by CMT practitioners. These results affirming the stability of the changes
after the CMT-T add to prior studies using earlier versions of the CMT-T [32,87] and are
aligned with Irons and Heriot-Maitland (2020), who found a maintenance of CMT induced
changes at three months follow-up in the general public, and with Sommers-Spikerman et al.
[79] who described a retainment or amplification of the improvements after a guided self-help
CFT in a community sample at three- and nine-months follow-up.
Taken together, our findings offer empirical support for the feasibility and effectiveness of
the CMT-T on promoting teachers’ self-compassion and compassion for others, and overall
and professional wellbeing, strengthening their physiological self-regulation via increased HRV,
in addition to reducing their resistances to compassion and psychological distress. Specifically,
the CMT-T seems to promote a shift from threat-focused competitive motives to more compas-
sion affiliative focused ones in relation to both oneself and to others, in the sense that it lightens
teachers’ fears and resistances to compassion whilst also enabling the development of their com-
passion abilities, motives and actions towards themselves and others. This may improve how
teachers regulate their emotions and cope with the multiple challenges they encounter in their
personal and professional lives that cause psychological distress [namely those related to com-
petitive pressures focused on the self or others, achievement focus, performance evaluation,
heavy workloads, pupils’ behavioural problems, 5, 36, 130]. The impact of the cultivation of
such socio-emotional competencies and compassion motives seems to be reflected in teachers’
increased levels of safeness, relaxation and vitality positive emotions, and satisfaction with pro-
fessional life, alongside decreased psychological distress symptoms found at post-CMT-T. The
increased sense of intra- and inter-personal safeness promoted by the CMT-T was also reflected
in the increased resting HRV reported by the participants in the experimental group.
As a whole, results from the current study highlight the utility and importance of imple-
menting compassion-focused interventions in educational settings. The CMT-T may not only
help teachers develop socio-emotional competencies for mental health and wellbeing but also
contribute to cultivating a compassionate, prosocial and resilient culture in school settings.
Therefore, the CMT-T might respond to key international guidelines for sustainable develop-
ment prioritising the promotion of health and wellbeing, the cultivation of peaceful, resilient
and inclusive societies, and the assurance of inclusive and equitable quality education for all
[2]. At the same time, the CMT-T is aligned with national recommendations as it might help
to achieve the goal of enhancing social-emotional competencies and health literacy in educa-
tional settings to foster health and wellbeing [81,82].
Limitations and future research
Despite the encouraging findings, the present study encloses some limitations that should be
taken into consideration and addressed in future studies. First, due to the current trial design,
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 28 / 36
participants could not be blinded to condition allocation, which may increase the risk of selec-
tion biases. Second, owing to the use of a waitlist control group, it is not possible to rule out
the influence of nonspecific factors [131]. Third, because some of the CMT-T and WLC group
participants were from the same school, potential contamination effects might have occurred.
Fourth, the uneven gender distribution and overrepresentation of female teachers in our sam-
ple limit the generalizability of the findings. Fifth, although the use of a large sample and a ran-
domised controlled stepped wedge design is a major strength of our study, effect sizes tend to
be overestimated in RCT’s with waitlist-controlled designs, which may thus constraint the
conclusiveness of our findings [132,133]. Sixth, the control group remained on the waiting-
list and did not receive another psychological intervention, and this limits conclusions on the
effectiveness of the CMT-T over other interventions tailored for the same target population
(e.g., CARE for teachers, CASEL). Additional trials with active comparison groups are neces-
sary to provide more robust evidence of the efficacy of the CMT-T in comparison to other psy-
chological interventions for teachers. Seventh, while teachers were instructed to practice the
CMT exercises daily in-between each session and at-home practice as discussed at the begin-
ning of each session, qualitative data regarding home-based practices were not analysed in the
current study. Additionally, only a subsample of participants underwent the HRV assessment,
which may thus limit the conclusiveness of our findings.
Furthermore, in light of past research indicating that practice frequency [32], practice
helpfulness and the embodiment of the compassionate self may be crucial in promoting
changes in a CMT intervention [74], it seems fruitful to investigate the role of these practice
indicators on the effectiveness of the CMT-T. Previous studies have pointed to the mediating
role of compassion and fears of compassion as key processes of change mediating the impact
of CMT in teachers [87] and in general community samples [134], and thus future research
should explore the processes that mediate changes from pre to post-intervention using the
refined version of CMT-T. Future research is also warranted to shed further light on whether
implementing the CMT-T on teachers would directly impact the quality of their relationships
with pupils/parents or indirectly impact on pupils’ wellbeing, prosocial qualities, and academic
performance. It is worth noting that the current study is part of a larger ongoing project, the
Compassion in Schools Research Initiative, which aims at employing a systemic whole school
approach, where the entire school community is involved (i.e., school boards, teachers, non-
teaching staff, pupils and parents), and that aims at implementing tailored CMT programs to
all educational agents and the pupils. Future studies resulting from this project will allow us to
test the effectiveness of this whole-school approach. In fact, prior studies using CMT in organi-
sational settings [e.g., mental health care services, 71] have emphasised the importance of
adopting compassion approaches at all levels of an organisation. Finally, the low cost to deliver
and usefulness of the CMT-T seems promising, and future work should continue to assess its
effectiveness and promote its dissemination in other settings/countries, to establish the scal-
ability of this intervention.
Conclusion
The findings suggest that the CMT-T is a feasible and effective intervention to promote teach-
ers’ self-compassion and compassion for others, their overall and professional wellbeing,
psychophysiological self-regulation, as well as to reduce their psychological distress. In sum,
CMT-T may not only enhance teachers’ wellbeing and reduce distress, thereby reducing indi-
vidual suffering and relieving a substantial socioeconomic burden on society, but also contrib-
ute to creating safe, compassionate, collaborative, encouraging, and resilient educational
environments for the benefit of all.
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 29 / 36
Supporting information
S1 File. CONSORT checklist.
(DOC)
Acknowledgments
The authors would like to thank the educational institutions that collaborated with this project
and the teachers for their kind participation.
Author Contributions
Conceptualization: Marcela Matos, Isabel Albuquerque, Ana Galhardo, Marina Cunha, Mar-
garida Pedroso Lima, Lara Palmeira, Paul Gilbert.
Data curation: Marcela Matos, Isabel Albuquerque, Nicola Petrocchi.
Formal analysis: Marcela Matos, Ana Galhardo, Lara Palmeira, Nicola Petrocchi, Kirsten
McEwan.
Funding acquisition: Marcela Matos, Frances A. Maratos, Paul Gilbert.
Investigation: Marcela Matos, Isabel Albuquerque, Ana Galhardo, Marina Cunha, Margarida
Pedroso Lima, Lara Palmeira.
Methodology: Marcela Matos, Isabel Albuquerque, Ana Galhardo, Marina Cunha, Margarida
Pedroso Lima, Lara Palmeira.
Project administration: Marcela Matos, Isabel Albuquerque.
Resources: Marcela Matos, Isabel Albuquerque, Frances A. Maratos, Paul Gilbert.
Supervision: Marcela Matos, Paul Gilbert.
Writing – original draft: Marcela Matos, Isabel Albuquerque, Ana Galhardo, Lara Palmeira,
Nicola Petrocchi, Kirsten McEwan.
Writing – review & editing: Marcela Matos, Ana Galhardo, Marina Cunha, Margarida Ped-
roso Lima, Lara Palmeira, Nicola Petrocchi, Kirsten McEwan, Frances A. Maratos, Paul
Gilbert.
References
1. World Health Organization. (2013). Mental health action plan 2013–2020 [Internet]. Geneva: World
Health Organization; [cited 2021 Sept 10]. Available from: https://apps.who.int/iris/handle/10665/
89966
2. UN General Assembly [Internet]. New York (NY): Transforming our world: the 2030 Agenda for Sus-
tainable Development, 21 October 2015, A/RES/70/1, available at: https://www.refworld.org/docid/
57b6e3e44.html [accessed 9 September 2021]
3. Jennings PA, DeMauro AA, Mischenko PP. Where are we now? Where are we going? Preparing our
students for an uncertain future. In: Jennings PA, DeMauro AA, Mischenko PP, editors. The Mindful
School. Transforming School Culture through Mindfulness and Compassion. New York (NY): Guild-
ford Press; 2019. p. 3–13.
4. Gray C, Wilcox G, Nordstokke D. Teacher mental health, school climate, inclusive education and stu-
dent learning: A review. Can Psychol. 2017; 58(3):203–210. https://doi.org/10.1037/cap0000117
5. Varela RC, della Santa R, Silveira H, Coimbra de Matos A, Rolo D, Areosa J. Inque
´rito nacional sobre
as condic¸ões de vida e trabalho na educac¸ão em Portugal (INCVTE). Jornal da FENPROF. 2018
[cited 2021 Sept 10]. Available from: https://www.fenprof.pt/?aba=39&cat=667
6. Skaalvik EM, Skaalvik S. Job satisfaction, stress and coping strategies in the teaching profession-
What do teachers say? Int Educ Stud. 2015; 8(3):181–192.
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 30 / 36
7. Jennings PA, Greenberg MT. The prosocial classroom: Teacher social and emotional competence in
relation to student and classroom outcomes. Rev Educ Res. 2009; 79(1):491–525. https://doi.org/10.
3102/0034654308325693
8. Betoret FD. Self-efficacy, school resources, job stressors and burnout among Spanish primary and
secondary school teachers: a structural equation approach. Educ Psychol (Lond). 2009; 29(1):45–68.
https://doi.org/10.1080/01443410802459234
9. McCallum F, Price D. Graham A, Morrison A. Teacher well-being: A review of the literature. Hawthorn
(Australia): The Association of Independent Schools of New South Wales Limited; 2017 Oct 11.
Available
10. Naghieh A, Montgomery P, Bonell CP, Thompson M, Aber JL. (). Organisational interventions for
improving wellbeing and reducing work-related stress in teachers. Cochrane Database Syst Rev.
2015;(4). https://doi.org/10.1002/14651858.CD010306.pub2 PMID: 25851427
11. Stansfeld SA, Rasul FR, Head J, Singleton N. Occupation and mental health in a national UK survey.
Soc Psychiatry Psychiatr Epidemiol. 2011; 46(2):101–110. https://doi.org/10.1007/s00127-009-0173-
7PMID: 20033130
12. Education Support. Teacher Well-being Index. London (UK): Education Support; 2020. Available
from: https://www.educationsupportpartnership.org.uk/sites/default/files/resources/teacher_
wellbeing_index_2018.pdf [Last accessed 05.03.2020].
13. NASUWT. (2016). The Big Question 2016: An opinion survey of teachers and school leaders. Avail-
able from: https://www.nasuwt.org.uk/uploads/assets/uploaded/7649b810-30c7-4e93-
986b363487926b1d.pdf
14. Sapolsky MR. Why zebras don’t get ulcers, 3rd ed. New York (NY): Holt Paperback; 2004.
15. Heinrichs M, Baumgartner T, Kirschbaum C, Ehlert U. Social support and oxytocin interact to suppress
cortisol and subjective responses to psychological stress. Biol Psychiatry. 2003; 54:1389–1398.
https://doi.org/10.1016/s0006-3223(03)00465-7 PMID: 14675803
16. Alyamani RAS, Murgatroyd C. Epigenetic programming by early-life stress. Prog Mol Biol Transl Sci.
2018; 157:133–150. https://doi.org/10.1016/bs.pmbts.2018.01.004 PMID: 29933948
17. Ein-Dor T, Verbeke WJ, Mokry M, Vrtička P. Epigenetic modification of the oxytocin and glucocorticoid
receptor genes is linked to attachment avoidance in young adults. Attach Hum Dev. 2018; 20(4):439–
454. https://doi.org/10.1080/14616734.2018.1446451 PMID: 29513137
18. Hoglund WLG, Klingle KE, Hosan NE. Classroom risks and resources: Teacher burnout, classroom
quality and children’s adjustment in high needs elementary schools. J Sch Psychol. 2015; 53(5):337–
357. https://doi.org/10.1016/j.jsp.2015.06.002 PMID: 26407833
19. Harding S, Morris R, Gunnell D, Ford T, Hollingworth W, Tilling K, et al. Is teachers’ mental health and
wellbeing associated with students’ mental health and wellbeing? J Affect Disord. 2019; 253:460–466.
https://doi.org/10.1016/j.jad.2018.08.080 PMID: 30189355
20. Kidger J, Araya R, Donovan J, Gunnell D. The effect of the school environment on the emotional health
of adolescents: a systematic review. Pediatrics. 2012; 129(5):925–949. https://doi.org/10.1542/peds.
2011-2248 PMID: 22473374
21. Plenty S, O
¨stberg V, Almquist YB, Augustine L, Modin B. Psychosocial working conditions: An analy-
sis of emotional symptoms and conduct problems amongst adolescent students. J Adolesc. 2014; 37
(4):407–417. https://doi.org/10.1016/j.adolescence.2014.03.008 PMID: 24793388
22. Oberle E, Schonert-Reichl KA. Stress contagion in the classroom? The link between classroom
teacher burnout and morning cortisol in elementary school students. Soc Sci Med. 2016; 159:30–37.
https://doi.org/10.1016/j.socscimed.2016.04.031 PMID: 27156042
23. McLean L, Connor CM. Depressive symptoms in third-grade teachers: Relations to classroom quality
and student achievement. Child Dev. 2015; 86(3):945–954. https://doi.org/10.1111/cdev.12344 PMID:
25676719
24. OECD iLibrary [Internet]. Paris: OCDE; 2021. Positive, high-achieving students?: What schools and
teachers can do; [cited 2021 September 9]. Available from: https://doi.org/10.1787/3b9551db-en
25. Frenzel AC, Goetz T, Lu¨dtke O, Pekrun R, Sutton RE. Emotional transmission in the classroom:
Exploring the relationship between teacher and student enjoyment. J Educ Psychol. 2009; 101
(3):705–716. https://doi.org/10.1037/a0014695
26. Kunter M, Tsai YM, Klusmann U, Brunner M, Krauss S, Baumert J. Students’ and mathematics teach-
ers’ perceptions of teacher enthusiasm and instruction. Learn Instr. 2008; 18(5):468–482. https://doi.
org/10.1016/j.learninstruc.2008.06.008
27. Cefai C, Bartolo PA, Cavioni V, Downes P. (2018). Strengthening Social and Emotional Education as
a core curricular area across the EU. A review of the international evidence. Publications Office of the
European Union. https://doi.org/10.2766/664439
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 31 / 36
28. Viac C, Fraser P. Teachers’ well-being: A framework for data collection and analysis. OECD Education
Working Papers [Internet]. 2020 [cited 2021 Sept 10]; 213. Available from https://doi.org/10.1787/
c36fc9d3-en2020
29. Becker JC, Hartwich L, Haslam SA. Neoliberalism can reduce well-being by promoting a sense of
social disconnection, competition, and loneliness. Br J Soc Psychol. 2021; 60(3):947–965. https://doi.
org/10.1111/bjso.12438 PMID: 33416201
30. Galton M, MacBeth J. Teachers under pressure. London: Sage Publications Ltd; 2008.
31. Curran T, Hill AP. Perfectionism is increasing over time: A meta-analysis of birth cohort differences
from 1989 to 2016. Psychol Bull. 2019; 145(4):410–429. https://doi.org/10.1037/bul0000138 PMID:
29283599
32. Maratos FA, Montague J, Ashra H, Welford M, Wood, Barnes C, et al. Evaluation of a Compassionate
Mind Training intervention with school teachers and support staff. Mindfulness. 2019;10:2245–2258.
https://doi.org/10.1007/s12671-019-01185-9
33. Rodway C, Tham SG, Ibrahim S, Turnbull P, Windfuhr K, Shaw J, et al. Suicide in children and young
people in England: a consecutive case series. Lancet Psychiatry. 2016; 3(8):751–759. https://doi.org/
10.1016/S2215-0366(16)30094-3 PMID: 27236279
34. Wetherall K, Robb KA, O’Connor RC. Social rank theory of depression: A systematic review of self-
perceptions of social rank and their relationship with depressive symptoms and suicide risk. J Affect
Disord. 2019; 246:30–39. https://doi.org/10.1016/j.jad.2018.12.045 PMID: 30594043
35. Cunha M, Matos M, Faria D, Zagalo S. (2012). Shame memories and psychopathology in adoles-
cence: The mediator effect of shame. Rev Int Psicol Ter Psicol. 2012; 12(2):203–218.
36. Gilbert P, Matos M, Wood W, Maratos F. The compassionate mind and the conflicts between compet-
ing and caring: Implications for educating young minds. In: Coles MI, Gent B, editors. Education for
survival: The pedagogy of compassion. Sterling (VA): Trentham Books; 2020. p. 44–76.
37. Basran J, Pires C, Matos M, McEwan K, Gilbert P. Styles of leadership, fears of compassion, and com-
peting to avoid inferiority. Front Psychol. 2019; 9:2460. https://doi.org/10.3389/fpsyg.2018.02460
PMID: 30723443
38. Coles MI. Towards the compassionate school. From golden rule to golden thread. Sterling (VA): Tren-
tham Books; 2015.
39. Carter S, Bartal IB, Porges E. The roots of compassion: an evolutionary and neurobiological perspec-
tive. In: Seppa
¨la
¨EM, Simon-Thomas E, Brown SL, Worline MC, Cameron CD, Doty JR, editors. The
Oxford handbook of compassion science. Oxford: Oxford University Press; 2017. p. 178–188.
40. Petrocchi N, Cheli S. The social brain and heart rate variability: implications for psychotherapy. Clin
Psychol Psychother. 2019; 9:208–223. https://doi.org/10.1111/papt.12224 PMID: 30891894
41. Gilbert P. Explorations into the nature and function of compassion. Curr Opin Psychol. 2019; 28:108–
114. https://doi.org/10.1016/j.copsyc.2018.12.002 PMID: 30639833
42. Gilbert P, Choden. Mindful compassion. London: Constable Robinson; 2013.
43. Crocker J, Canevello A. Consequences of self-image and compassionate goals. In: Devine PG, Plant
A, editors. Advances in experimental social psychology. Amsterdam: Elsevier; 2012. p. 229–277.
44. Di Bello M, Carnevali L, Petrocchi N, Thayer JF, Gilbert P, Ottaviani C. (2020). The compassionate
vagus: A meta-analysis on the connection between compassion and heart rate variability. Neurosci
Biobehav Rev. 2020; 116:21–30. https://doi.org/10.1016/j.neubiorev.2020.06.016 PMID: 32554001
45. Keltner D, Kogan A, Piff PK, Saturn SR. The sociocultural appraisals, values, and emotions (SAVE)
framework of prosociality: Core processes from gene to meme. Annu Rev Psychol. 2014; 65:425–460.
https://doi.org/10.1146/annurev-psych-010213-115054 PMID: 24405363
46. MacBeth A, Gumley A. Exploring compassion: A meta-analysis of the association between self-com-
passion and psychopathology. Clin Psychol Rev. 2012; 32(6): 545–552. https://doi.org/10.1016/j.cpr.
2012.06.003 PMID: 22796446
47. Seppa
¨la
¨EM, Simon-Thomas S, Brown SL, Worline MC, Cameron CD, Doty JR. The Oxford handbook
of compassion science. Oxford: Oxford University Press; 2017.
48. Fredrickson BL, Grewen KM, Coffey KA, Algoe SB, Firestine AM, Arevalo JM, et al. A functional geno-
mic perspective on human well-being. Proceedings of the National Academy of Sciences of the United
States of America. 2013;110:13684–13689. https://doi.org/10.1073/pnas.1305419110
49. Wang Y, Fan L, Zhu Y, Yang J, Wang C, Gu L, et al. Neurogenetic mechanisms of self-compassionate
mindfulness: The role of oxytocin-receptor genes. Mindfulness. 2019; 10:1792–1802. https://doi.org/
10.1007/s12671-019-01141-7
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 32 / 36
50. Di Bello M, Ottaviani C, Petrocch N. Compassion is not a benzo: Distinctive associations of heart rate
variability with its empathic and action components. Front Neurosci. 2021; https://doi.org/10.3389/
fnins.2021.617443 PMID: 33776635
51. Kirby JN. Compassion interventions: The programmes, the evidence, and implications for research
and practice. Psychol Psychother: Theory Res Pract. 2017; 90:432–455. https://doi.org/10.1111/papt
52. Kirschner H, Kuyken W, Wright K, Roberts H, Brejcha C, Karl A. Soothing your heart and feeling con-
nected: A new experimental paradigm to study the benefits of self-compassion. Clin Psychol Sci,
2019; 7(3):545–565. https://doi.org/10.1177/2167702618812438 PMID: 32655984
53. Kim JJ, Parker SL, Doty JR, Cunnington R, Gilbert P, Kirby JN. Neurophysiological and behavioural
markers of compassion. Sci Rep. 2020; 10(1):1–9. https://doi.org/10.1038/s41598-019-56847-4
PMID: 31913322
54. Singer T, Engert V. It matters what you practice: Differential training effects on subjective experience,
behavior, brain and body in the ReSource Project. Curr Opin Psychiatry. 2019; 28:151–158. https://
doi.org/10.1016/j.copsyc.2018.12.005 PMID: 30684917
55. Goleman D, Davidson RJ. Altered traits: Science reveals how meditation changes your mind, brain,
and body. New York (NY): Penguin; 2017.
56. Kirby JN, Doty JR, Petrocchi N, Gilbert P. The current and future role of heart rate variability for
assessing and training compassion. Front Public Health. 2017; 5:40. https://doi.org/10.3389/fpubh.
2017.00040 PMID: 28337432
57. Leaviss J, Uttley L. Psychotherapeutic benefits of compassion-focused therapy: An early systematic
review. Psychol Med. 2015; 45:927–945. https://doi.org/10.1017/S0033291714002141 PMID:
25215860
58. Gilbert P. The origins and nature of compassion focused therapy. Br J Clin Psychol. 2014; 53(1):6–41.
https://doi.org/10.1111/bjc.12043 PMID: 24588760
59. Kirby J, Gilbert P. The emergence of the compassion focused therapies. In: Gilbert P, editor Compas-
sion: Concepts, research and applications. London: Routledge; 2017.p. 258–285
60. Gilbert P. Compassion focused therapy: Distinctive features. London: Routledge; 2010.
61. Gilbert P. Compassion: From its evolution to a psychotherapy. Front Psychol. 2020; 11:3123. https://
doi.org/10.3389/fpsyg.2020.586161 PMID: 33362650
62. Craig C, Hiskey S, Spector A. Compassion focused therapy: a systematic review of its effectiveness
and acceptability in clinical populations. Expert Rev Neurother. 2020; 20(4):385–400. https://doi.org/
10.1080/14737175.2020.1746184 PMID: 32196399
63. Kirby JN, Tellegen CL, Steindl SR. A meta-analysis of compassion-based interventions: Current state
of knowledge and future directions. Behav Ther. 2017; 48: 778–792. https://doi.org/10.1016/j.beth.
2017.06.003 PMID: 29029675
64. Porges SW. The polyvagal perspective. Biol Psychol. 2007; 74(2):116–143. https://doi.org/10.1016/j.
biopsycho.2006.06.009 PMID: 17049418
65. Irons C, Beaumont E. The compassionate mind workbook: A step-by-step guide to developing your
compassionate self. Cave Junction (OR): Robinson; 2017.
66. Irons C, Heriot-Maitland C. Compassionate Mind Training: An 8-week group for the general public.
Psychol Psychother: Theory Res Pract. 2020. https://doi.org/10.1111/papt.12320 PMID: 33222375
67. Matos M, Duarte C, Duarte J, Pinto-Gouveia J, Petrocchi N, Basran J, et al. Psychological and physio-
logical effects of compassionate mind training: A pilot randomised controlled study. Mindfulness.
2017; 8(6):1699–1712. https://doi.org/10.1007/s12671-017-0745-7
68. Beaumont E, Irons C, Rayner G, Dagnall N. Does Compassion-Focused Therapy training for health
care educators and providers increase self-compassion and reduce self-persecution and self-criti-
cism? J Contin Educ Health Prof. 2016; 36(1):4–10. https://doi.org/10.1097/CEH.0000000000000023
PMID: 26954239
69. Beaumont EA, Bell T, McAndrew SL, Fairhurst HL. The impact of Compassionate Mind Training on
qualified health professionals undertaking a Compassion Focused Therapy module. Couns Psy-
chother Res. 2021; 00:1–13. https://doi.org/10.1002/capr.12396
70. Beaumont E, Martin CJH. Heightening levels of compassion towards self and others through use of
compassionate mind training. Br J Midwifery. 2016; 24(11):777–786. https://doi.org/10.12968/bjom.
2016.24.11.777
71. McEwan K, Minou L, Moore H, Gilbert P. Engaging with distress: Training in the compassionate
approach. J Psychiatr Ment Health Nurs. 2020; 27(6):718–727. https://doi.org/10.1111/jpm.12630
PMID: 32187418
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 33 / 36
72. Beaumont E, Durkin M, McAndrew S, Martin C. Using compassion focused therapy as an adjunct to
trauma-focused CBT for fire service personnel suffering with trauma-related symptoms. Cogn Behav
Therap. 2016;9. https://doi.org/10.1017/S1754470X16000209
73. Beaumont E, Rayner G, Durkin M, Bowling G. The effects of Compassionate Mind Training on student
psychotherapists. J Ment Health Train Educ Pract. 2017; 12(5):300–312. https://doi.org/10.1108/
JMHTEP-06-2016-0030
74. Matos M, Duarte C, Duarte J, Gilbert P, Pinto-Gouveia J. How one experiences and embodies com-
passionate mind training influences its effectiveness. Mindfulness. 2018; 9(4):1224–1235. https://doi.
org/10.1007/s12671-017-0864-1
75. Park G, Thayer JF. From the heart to the mind: cardiac vagal tone modulates top-down and bottom-up
visual perception and attention to emotional stimuli. Front Psychol. 2014; 5:278. https://doi.org/10.
3389/fpsyg.2014.00278 PMID: 24817853
76. Petrocchi N, Ottaviani C, Couyoumdjian A. Compassion at the mirror: Exposure to a mirror increases
the efficacy of a self-compassion manipulation in enhancing soothing positive affect and heart rate var-
iability. J Posit Psychol. 2016;1–12. https://doi.org/10.1080/17439760.2014.994223 PMID: 26640507
77. Stellar JE, Cohen A, Oveis C, Keltner D. Affective and physiological responses to the suffering of oth-
ers: Compassion and vagal activity. J Pers Soc Psychol. 2015; 108(4):572–585. https://doi.org/10.
1037/pspi0000010 PMID: 25621856
78. Svendsen JL, Osnes B, Binder PE, Dundas I, Visted E. Nordby H, et al. Trait self-compassion reflects
emotional flexibility through an association with high vagally mediated heart rate variability. Mindful-
ness. 2016; 7(5):1103–1113. https://doi.org/10.1007/s12671-016-0549-1 PMID: 27642372
79. Sommers-Spijkerman MPJ, Trompetter HR, Schreurs KMG, Bohlmeijer ET. Compassion-focused
therapy as guided self-help for enhancing public mental health: A randomized controlled trial. J Consult
Clin Psychol. 2018; 86(2):101–115. https://doi.org/10.1037/ccp0000268 PMID: 29265836
80. Welford M, Langmead K. Compassion-based initiatives in educational settings. Educ Child Psychol.
2015; 32(1):71–80. Available from: https://www.researchgate.net/profile/Mary-Welford-2/publication/
320584562_Compassion-based_initiatives_in_educational_settings/links/
59eefef64585152de64db43a/Compassion-based-initiatives-in-educational-settings.pdf
81. Monteiro R, Ucha L, Alvarez T, Milagre C, Neves MJ, Silva M, et al. Estrate
´gia nacional de educac¸ão
para a cidadania [Internet]. Lisbon: XXI Governo Constitucional: 2017 Sept [cited 2021 Sept]. Avail-
able from: https://www.dge.mec.pt/sites/default/files/Projetos_Curriculares/Aprendizagens_
Essenciais/estrategia_cidadania.pdf
82. Direc¸ão Geral de Educac¸ão and DGS Direc¸ão Geral da Sau
´de. Referencial de Educac¸ão para a
Sau
´de. Lisbon (Portugal): Direc¸ão-Geral da Educac¸ão and Direc¸ão-Geral da Sau
´de; 2017. Available
from: https://www.dge.mec.pt/sites/default/files/Esaude/referencial_educacao_saude_vf_junho2017.
pdf
83. Hanh, Weare K. Happy teachers change the world. Berkeley (CA): Parallax Press; 2017.
84. Hwang YS, Bartlett B, Greben M, Hand K. A systematic review of mindfulness interventions for in-ser-
vice teachers: A tool to enhance teacher wellbeing and performance. Teach Teach Educ. 2017;
64:26–42. https://doi.org/10.1016/j.tate.2017.01.015
85. Zarate K, Maggin DM, Passmore A. Meta-analysis of mindfulness training on teacher well-being. Psy-
chol Sch. 2019; 56(10):1700–1715. https://doi.org/10.1002/pits.223
86. Maratos FA, Gilbert T, Gilbert P. Improving well-being in higher education: Adopting a compassionate
approach. In: Gibbs P, Jameson J, Elwick A, editors. Values of the university in a time of uncertainty.
Cham: Springer; 2019, p. 261–259.
87. Matos M, Palmeira L, Albuquerque I, Cunha M, Pedroso Lima M, Galhardo A, et al. Building compas-
sionate schools: Pilot study of a Compassionate Mind Training intervention to promote teachers’ well-
being. Mindfulness. 2021. https://doi.org/10.1007/s12671-021-01778-3
88. Duarte J, McEwan K, Barnes C, Gilbert P, Maratos FA. Do therapeutic imagery practices affect physio-
logical and emotional indicators of threat in high self-critics? Psychol. Psychother: Theory Res Pract.
2015; 88(3):270–284. https://doi.org/10.1111/papt.12043 PMID: 25347984
89. Longe O, Maratos FA, Gilbert P, Evans G, Volker F, Rockliff H, et al. Having a word with yourself: Neu-
ral correlates of self-criticism and self-reassurance. NeuroImage. 2010; 49(2):1849–1856. https://doi.
org/10.1016/j.neuroimage.2009.09.019 PMID: 19770047
90. Rockliff H, Karl A, McEwan K, Gilbert J, Matos M, Gilbert P. Effects of intranasal oxytocin on compas-
sion focused imagery. Emotion. 2011; 11(6):1388–1396. https://doi.org/10.1037/a0023861 PMID:
21707149
91. Maratos FA, Matos M, Albuquerque I, Wood W, Palmeira L, Cunha M, et al. Exploring the international
utility of progressing Compassionate Mind Training in school settings: A comparison of implementation
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 34 / 36
effectiveness of the same curricula in the UK and Portugal. Psychol Educ Rev. 2020; 44(2):73–82.
https://doi.org/10545/625433
92. Hemming K, Haines TP, Chilton PJ, Girling AJ, Lilford RJ. The stepped wedge cluster randomised
trial: rationale, design, analysis, and reporting. BMJ. 2015;350. https://doi.org/10.1136/bmj.h391
PMID: 25662947
93. Gilbert P, Catarino F, Duarte C, Matos M, Kolts R, Stubbs J, et al. The development of compassionate
engagement and action scales for self and others. J Compassionate Health Care. 2017; 4(1):4. https://
doi.org/10.1186/s40639-017-0033-3
94. Schulz K F, Altman D G, Moher D. CONSORT 2010 statement: Updated guidelines for reporting paral-
lel group randomized trials. Journal of Clin Epidem. 2010; 63:834–840. https://doi.org/http%3A//dx.
doi.org/10.1016/j.jclinepi.2010.02.005 PMID: 20346629
95. APA Publications and Communications Board Working Group on Journal Article Reporting Standards.
Reporting standards for research in psychology: Why do we need them? What might they be? Ameri-
can Psychologist. 2008; 63:839–851. http://dx.doi.org/10.1037/0003-066X.63.9
96. Bowen DJ, Kreuter M, Spring B, Cofta-Woerpel L, Linnan L, Weiner D, et al. How we design feasibility
studies. Am J Prev Med. 2009; 36(5):452–457. https://doi.org/10.1016/j.amepre.2009.02.002 PMID:
19362699
97. Gilbert P, McEwan K, Mitra R, Franks L, Richter A, Rockliff H. Feeling safe and content: A specific
affect regulation system? Relationship to depression, anxiety, stress, and self-criticism. J Posit Psy-
chol. 2008; 3(3):182–191. https://doi.org/10.1080/17439760801999461
98. Pinto-Gouveia Jose
´; Dinis Alexandra; Matos Marcela. Types of Positive Affect Scale. [Portuguese
translation] Unpublished manuscript. 2008.
99. Diener ED, Emmons RA, Larsen RJ, Griffin S. The satisfaction with life scale. J Pers Assess. 1985; 49
(1):71–75. https://doi.org/10.1207/s15327752jpa4901_13 PMID: 16367493
100. Albuquerque I, Palmeira L, Lima MP, Cunha M, Galhardo A, Matos M. Measuring the satisfaction with
professional life of teachers: Psychometric validation in a Portuguese sample. Forthcoming 2021.
101. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression
Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther.
1995; 33(3):335–343. https://doi.org/10.1016/0005-7967(94)00075-u PMID: 7726811
102. Pais-Ribeiro JL, Honrado A, Leal I. Contribuic¸ão para o estudo da adaptac¸ão portuguesa das escalas
de ansiedade, depressão e stress (EADS) de 21 itens de Lovibond e Lovibond. Psicologia, Sau
´de &
Doenc¸as. 2004; 5(2):229–239. https://doi.org/10216/6910/2/81876.pdf
103. Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and
21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample.
Psychol Assess. 1998; 10(2): 176–181. https://doi.org/10.1037/1040-3590.10.2.176
104. Armon G, Shirom A, Melamed S. The Big Five personality factors as predictors of changes across
time in burnout and its facets. J Pers. 2012; 80(2):403–427. https://doi.org/10.1111/j.1467-6494.2011.
00731.x PMID: 21449937
105. Gomes AR. Medida de “Burnout” de Shirom-Melamed (MBSM). Unpublished technical report 2012.
Escola de Psicologia, Universidade do Minho.
106. Baganha C, Gomes AR, Esteves A. Stresse ocupacional, avaliac¸ão cognitiva, burnout e comprometi-
mento laboral na aviac¸ão civil. Psicologia, Sau
´de & Doenc¸as, 17; 2:164–179. http://dx.doi.org/10.
15309/16psd170212. 2016
107. Matos M, Pinto-Gouveia J, Duarte C, Duarte J. Compassionate Engagement and Action Scales for
self and others. [Portuguese translation] Unpublished manuscript. 2015.
108. Steindl SR, Tellegen CL, Filus A, Seppala E, Doty JR, Kirby JN. The Compassion Motivation and
Action Scales: a self-report measure of compassionate and self-compassionate behaviours. Aust Psy-
chol. 2021. https://doi.org/10.1080/00050067.2021.1893110
109. Matos M, Gonc¸alves E, Palmeira L, Melo I, Steindl S, & Gomes A. Advancing the Assessment of Com-
passion: Psychometric Study of the Compassion Motivation and Action Scales in a Portuguese Sam-
ple. Curr Psychol. 2021.https://doi.org/10.1007/s12144-021-02311-4
110. Gilbert P, McEwan K, Matos M, Rivis A. Fears of compassion: Development of three self-report mea-
sures. Psychol Psychother: Theory Res Pract. 2011; 84:239–255. https://doi.org/10.1348/
147608310X526511 PMID: 22903867
111. Matos M, Pinto-Gouveia J, Duarte J, Simões D. The Fears of Compassion Scales. [Portuguese trans-
lation] Unpublished manuscript. 2016.
112. Gilbert P, Clarke M, Hempel S, Miles JN, Irons C. Criticizing and reassuring oneself: An exploration of
forms, styles and reasons in female students. Brit J of Clin Psych. 2004; 43(Pt 1):31–50. https://doi.
org/10.1348/014466504772812959 PMID: 15005905
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 35 / 36
113. Castilho P, Pinto-Gouveia J, Duarte J. Exploring self-criticism: Confirmatory factor analysis of the
FSCRS in clinical and non-clinical samples. Clin Psychol Psychother. 2015; 22(2):153–164. https://
doi.org/10.1002/cpp.1881 PMID: 24307461
114. Halamova
´J, Kanovsky
´M, Kupeli N, Gilbert P, Troop N, Zuroff D, et al. The factor structure of the
forms of self-criticising, attacking & self-reassuring scale in thirteen distinct populations. J Psycho-
pathol Behav Assess. 2018; 40(4):736–751. https://doi.org/10.1007/s10862-018-9686-2 PMID:
30459486
115. Albuquerque I, Matos M, Galhardo A, Cunha M, Palmeira L, Lima M, et al. The Emotional Climate in
Organizations Scales: Psychometric properties and factor structure. Unpublished manuscript. 2021.
116. Gilbert P. The compassionate mind: A new approach to facing the challenges of life. London: Consta-
ble Robinson; 2009.
117. Tarvainen MP, Niskanen JP, Lipponen JA, Ranta-Aho PO, Karjalainen PA. Kubios HRV—heart rate
variability analysis software. Comput Methods Programs Biomed. 2014; 113(1):210–220. https://doi.
org/10.1016/j.cmpb.2013.07.024 PMID: 24054542
118. Malik M. Heart rate variability. Standards of measurement, physiological interpretation, and clinical
use. Task Force of the European Society of Cardiology and the North American Society of Pacing and
Electrophysiology. Eur Heart J .1996; 17:354–381. PMID: 8737210
119. Kline RB. Principles and practice of structural equation modelling, 2nd ed. New York (NY): Guilford
Press. 2005
120. Field A. Discovering statistics using IBM SPSS statistics. Thousand Oaks (CA): Sage Publications;
2013.
121. Tabachnick B, Fidell L. Using multivariate statistics. London: Pearson Education, Inc; 2007.
122. Neff KD. The development and validation of a scale to measure self-compassion. Self and Identity.
2003; 2(3):223–250. https://doi.org/10.1080/15298860309027 PMID: 26979311
123. Mather M, Thayer J. How heart rate variability affects emotion regulation brain networks. Curr Opin
Behav Sci. 2018; 19:98–104. https://doi.org/10.1016/j.cobeha.2017.12.017 PMID: 29333483
124. Elovainio M, Kivima
¨ki M, Puttonen S, Lindholm H, Pohjonen T, Sinervo T. Organizational injustice and
impaired cardiovascular regulation among female employees. Occup Environ Med. 2006; 63(2):41–
144. org.jerome.stjohns.edu/10.1136/oem.2005.019737
125. Herr RM, Bosch JA, van Vianen AEM, Jarczok MN, Thayer JF, Li J. Organizational justice is related to
heart rate variability in white-collar workers, but not in blue-collar workers—Findings from a cross-sec-
tional study. Ann Behav Med. 2015; 49(3):434–448. https://doi.org/10.1007/s12160-014-9669-9
PMID: 25472852
126. Fredrickson BL, Joiner T. Positive emotions trigger upward spirals toward emotional well-being. Psy-
chol Sci. 2002; 13(2):172. https://doi.org/10.1111/1467-9280.00431 PMID: 11934003
127. Werner AM, Tibubos AN, Rohrmann S, Reiss N. The clinical trait self-criticism and its relation to psy-
chopathology: A systematic review—Update. J Affect Disord. 2019; 246:530–547. https://doi.org/10.
1016/j.jad.2018.12.069 PMID: 30599378
128. Pinto-Gouveia J, Castilho P, Matos M, Xavier A. Centrality of shame memories and psychopathology:
The mediation effect of self-criticism. Clin Psychol (New York). 2013; 20:323–334. https://doi.org/10.
1111/cpsp.12044
129. Cavalcanti LG, Steindl SR, Matos M, Boschen MJ. Fears of compassion magnify the effects of rumina-
tion and worry on the relationship between self-criticism and depression. Curr Psychol. 2021. 1–15. D.
oi: https://doi.org/10.1007/s12144-021-01510-3
130. OFSTED [Internet]. Manchester: OFSTED; 2019. Teacher well-being at work in schools and further
education providers; [cited 2021 September 9]. Available from: https://assets.publishing.service.gov.
uk/government/uploads/system/uploads/attachment_data/file/819314/Teacher_well-being_report_
110719F.pdf
131. Mohr DC, Spring B, Freedland KE, Beckner V, Arean P, Hollon SD, et al. The selection and design of
control conditions for randomized controlled trials of psychological interventions. Psychother Psycho-
som. 2009; 78:275–284. https://doi.org/10.1159/000228248 PMID: 19602916
132. Cuijpers P, Cristea IA, Karyotaki E, Reijnders M, Huibers MJH. How effective are cognitive behavior
therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World
Psychiatry. 2016; 15:245–258. https://doi.org/10.1002/wps.20346 PMID: 27717254
133. Kazdin AE. Treatment as usual and routine care in research and clinical practice. Clin Psychol Rev.
2015; 42:168–178. https://doi.org/10.1016/j.cpr.2015.08.006 PMID: 26431668
134. Matos M, Duarte C, Duarte J, Pinto-Gouveia J, Petrocchi N, Gilbert P. Cultivating the compassionate
self: An exploration of the mechanisms of change in compassionate mind training. Mindfulness. 2021.
https://doi.org/10.1007/s12671-021-01717-2
PLOS ONE
Compassionate Mind Training for Teachers
PLOS ONE | https://doi.org/10.1371/journal.pone.0263480 March 1, 2022 36 / 36
... However, it is important to note that there are only a limited number of RCT studies (e.g., Arimitsu, 2016;Tung, 2020) conducted so far, to support the use of these compassion-based interventions (Kirby, 2016;Matos et al., 2017aMatos et al., , 2022a. Furthermore, literature exploring compassion-based interventions also seem to be at an infancy stage (Kirby, 2016), with the need for more rigorous trials to explore the efficacy of compassion-based interventions across clinical and non-clinical samples from a range of diverse backgrounds. ...
... To the authors' knowledge, this was the first crosscultural study to explore the efficacy of CMT in an Asian sample. Online CMT studies are distinctly scarce (Halamova et al., 2020) and there is also a dearth of cross-cultural CMT studies (Maratos et al., 2019(Maratos et al., , 2020Matos et al., 2021Matos et al., , 2022a. Additionally, the use of an online CMT was particularly appropriate due to the current climate of the COVID-19 pandemic for both Sri Lankan and UK participants (Halder, 2020;Wang et al., 2020). ...
... In addition, although most participants dropped out before completing the CMT, those who completed the feedback questions indicated that they found the CMT useful, easy to access, and that they would recommend the CMT to others. This suggests that the CMT is a feasible practice for the public, which was also demonstrated in previous cross-cultural studies (Maratos et al., 2020;Matos et al., 2021Matos et al., , 2022a. The following sections will discuss the implications of the results in more detail. ...
Thesis
The concept and benefits of practicing compassion have been recognised and discussed in the contemplative traditions for thousands of years. However, it is within the last two to three decades, that research and psychotherapy have shown an increased interest in integrating compassion for addressing mental health difficulties and increased well-being. Although heavily influenced by Buddhist philosophy and Eastern traditions, compassion related studies and interventions are mostly developed and applied in the Western communities. In fact, compassion-based studies are particularly scarce in the Asian context. Therefore, whilst briefly outlining the theories and existing compassion-based interventions, this thesis explored the cross-cultural applicability of compassion-based interventions in the Asian communities. A rigorous qualitative investigation discussed that compassion is a culturally embraced concept in Sri Lanka, a Buddhist influenced, collectivistic Asian community, and discussed the challenges Sri Lankan participants (n = 10) experience when practicing compassion. Participants discussed that showing compassion to others was easier than showing compassion to themselves, whilst religion, society, and upbringing influenced these experiences. To understand whether these compassionate experiences are similar across cultures, a cross-sectional quantitative study was conducted among Sri Lankan (n = 149) and UK (n = 300) participants. This study indicated that some similarities (e.g., compassion to and from others, depression, anxiety) and some differences (e.g., self-compassion and self-reassurance, fears of compassion and external shame were higher in the Sri Lankan group, and social safeness was higher in the UK group) existed in the levels of compassion, and facilitators and inhibitors of compassion across the two samples. Therefore, it was important to note that the impact of compassion-based interventions might have cross-cultural differences. To test this, a longitudinal Compassionate Mind Training was implemented among Sri Lankan (n = 21) and UK participants (n = 73), which produced promising results towards increasing compassion for the self and others, along with significant reductions in distress and improvements in well-being in participants across both countries. Thus, this thesis suggests that although research is limited in exploring the cross-cultural applicability of compassion, compassion-based interventions can be used effectively in the Asian communities.
... CMT is a programme of contemplative, imaginal and body-based practices that can also be used in non-clinical populations to help people cultivate compassion [1,4,[11][12][13][14]. CMT programmes have helped boost wellbeing and levels of compassion in a variety of populations including healthcare educators and providers [15,16], teachers and support staff in schools [17][18][19], healthcare professionals enrolled on a CFT module [13], trainee therapists [20,21], and the general public [22,23]. ...
... According to Gilbert compassion is: "a sensitivity to suffering in self and others, with a commitment to try to alleviate and prevent it" (p. 19) [4]. The qualities and skills of compassion can be taught and aim to help people cultivate a compassionate mind. ...
Article
Full-text available
Self-guided, smartphone apps may be helpful in reducing symptoms associated with psychological distress and may boost wellbeing, and levels of compassion. To our knowledge this is the first study to examine the impact a 28-day app based on Compassion Focused Therapy and Compassionate Mind Training has on participant’s levels of compassion, wellbeing, and self-criticism. The Self-Compassion App includes exercises, meditations, quotes, a daily wisdom, and audios, all of which aim to help individuals develop compassion for themselves, experience compassion from others, and be more compassionate to other people. The aim of the study was to explore participants’ experiences of the app, including ease of use, preferred sessions, barriers, as well as perceived impact on well-being, self-compassion, and self-criticism. Nine members of staff and eight students from The University of Salford took part in two focus groups; one for staff and one for students approximately four-six weeks after use of the app. The analysis highlighted eight themes: (1) Thinking of my experiences differently (2) Soothing the threat: Managing the three systems (3) Stop, reflect, and befriend the self-critic (4) Looking after me: The therapist within (5) Fears, Blocks, and Resistances (6) Looking back at the good things in life (7) Gender of Therapist (8) An ap(p)t App. Following use of the app, participants reported that they were more supportive of themselves, connected with their compassionate self, befriended their inner critic, experienced gratitude, and in times of personal struggles, reminded themselves that the present moment was an opportunity for compassion to be applied. The COVID-19 pandemic had, and continues to have, a negative impact on the mental health of many people. Therefore considering interventions that utilise technology with the aim of boosting wellbeing, levels of compassion, and reducing self-criticism is imperative.
... A recent study showed that teachers who received an 8-week compassionate mind training program (CMT-T) improved their self-compassion ability and compassion for other skills. As a result, the authors pointed out that following the training, the teachers had developed a more kind, caring toward themselves and a nonjudgmental attitude toward their suffering, as well as a greater motivation to act compassionately to alleviate the other people's suffering [124]. The conjunct effect on self-and other-oriented compassion is particularly interesting. ...
Article
Full-text available
Several studies on helping professionals showed the protective role of compassion among colleagues and leaders. Despite this, studies on well-being factors at school, both preventive and protective, usually focus on teachers’ personal resources and study compassion in the teacher–student relationship. This study explores the role of received compassion at work on teachers’ life satisfaction while considering perceived school collective performance and burnout conditions as mediators in this link. One hundred and eighty-six Italian teachers (female = 85.4%, mean age = 48.5, SD = 9.46) completed a questionnaire on received compassion at work, perceived school collective performance, burnout, and life satisfaction. Through a structural equation model (χ2(21) = 30.716, p = 0.08, CFI = 0.989, TLI = 0.981, RMSEA = 0.050 (90% CI = 0.000–0.080, p = 0.465), SRMR = 0.038), it emerged that only perceived school collective performance mediated the association between received compassion and life satisfaction. To the best of our knowledge, few studies have addressed the role of compassion received from colleagues and supervisors at school and its effect on teachers’ work-related beliefs and personal well-being.
... Particularly, empathy, compassion, and cooperation are linked to psychological well-being in adolescents [18,19] and adults [20]. Additionally, compassion-based interventions have benefits for both intra-and interpersonal relationships and seem to promote not only compassion but also self-regulation abilities in diverse populations and settings [21], including in the school context [15,16,22]. Despite its beneficial results, programs that complement SEL with compassionate components are still scarce in young populations or educational settings. ...
Article
Full-text available
The use of serious games may be an appealing and complementary way to motivate curriculum-based social and emotional learning (SEL); still, investigation into this potential usefulness is scarce. This study aims to address the usefulness of serious games within the program ‘Me and Us of Emotions’. Specifically, we analyzed the differences in children’s satisfaction in sessions that did or did not use serious games as a complement to the intervention, explored the contribution of using serious games to the global satisfaction with the program, and explored children’s qualitative feedback regarding the sessions. The participants were 232 children (122 boys and 110 girls) aged between 8 and 12 years old (M = 9.09, SD = 0.80). The measures were based on the subjective appraisals of the sessions made by the participating children, including quantitative and qualitative assessments of the degree of satisfaction of the participants. The results showed that there were similar levels of satisfaction with the sessions that did or did not use serious games as a complement to the program. However, only satisfaction with the sessions that used serious games (and not satisfaction with the sessions that did not use them) contributed significantly to explaining both the enjoyment of the activities and the interest in the subjects. Satisfaction with serious games was significantly and positively associated with fun, easiness, ability to understand the session, and ability to cope with emotions. Qualitative analysis showed three main themes, namely: positive aspects, negative aspects, and opportunities for improvement of the program. Overall, these results indicate that children’s satisfaction with the ‘Me and Us of Emotions’ program is related to serious games, suggesting the relevance of using this complementary tool more often when intervening with younger generations.
Article
Full-text available
Objetivo: Verificar quais são as estratégias utilizadas pelos professores de ensino médio para o enfrentamento de situações estressoras, no processo de ensino-aprendizagem. Metodologia: Trata-se de uma revisão integrativa da literatura. As bases de dados utilizadas para busca da literatura foram MEDLINE, PsycoINFO, COCHRANE library, CINAHL, e Web of Science. Resultados: Foram selecionados 13 estudos, onde oito deles utilizaram o delineamento transversal, dois longitudinais e três eram estudos de intervenção. Os artigos foram agrupados em duas categorias: avaliação de programas de gerenciamento do estresse e mecanismos de enfrentamento utilizados pelos professores. Os estudos mostraram que, após a aplicação de programas de gerenciamento do estresse, houve uma redução do nível de estresse e aumento na utilização de estratégias de enfrentamento do mesmo. Dentre essas estratégias, estavam a realização de atividades de lazer, prática de atividades físicas, caminhadas com animais de estimação, convívio com familiares e amigos, a capacidade de controlar as tarefas de trabalho, evitar acúmulo de atividades e entender que essas nem sempre sairão perfeitas. Além disso, foram citadas estratégias de enfrentamento disfuncionais, em que os professores apresentavam desengajamento comportamental, negação, distração, sentimento de culpa, uso de substâncias, e técnicas de respiração, a fim de controlar o estresse. Conclusão: Os professores recorrem às estratégias para o enfrentamento de situações estressoras, sendo elas focadas no problema, na emoção, relacionamento, enfrentamento disfuncional e as de foco evitativo. Os programas de gerenciamento do estresse mostraram-se eficientes no auxílio aos professores no enfrentamento dos desafios impostos pela profissão.
Article
Purpose: Practising compassion increases well-being and reduces depression, anxiety, and psychological distress among clinical and non-clinical populations. There is a rapid increase in compassion-based interventions within the past two decades. However, the reviews are limited to predominantly Western cultures. Therefore, this meta-analysis aimed to evaluate the literature attempting to promote and increase compassion in Asian communities. Method: Eight randomised controlled trials (RCTs) conducted between 2016 to 2021 were included in the meta-analysis with data from 1012 participants across Thailand, Japan, China and Hong Kong. Effect sizes were calculated to test the efficacy of the compassion-based interventions on the self-compassion outcome. Intervention efficacy was tested by comparing the intervention groups against control groups (wait-list control and active control groups) at pre- and post-interventions. Results: Significant between-group differences in change scores were found on self-report measures of self-compassion with large effect sizes in interventions with wait-list control groups (d = .86) and small effect sizes in interventions with active-control groups (d = .19). Conclusions: Although compassion-based interventions are heterogeneous in nature and limited in scope, there is promising evidence of improving self-compassion in Asian communities. This supports for the cross-cultural applicability of compassion-based interventions. However, research within the Asian context is limited and at an infancy stage, signifying the importance of conducting further compassion-based interventions in clinical and non-clinical groups living in the Asian communities.
Chapter
There is growing evidence that the cultivation of compassion focused motives and emotions has profound effects on mental health and wellbeing. This chapter outlines the importance of embedding compassion in school and educational settings for pupils/students, those who teach them, and for the contextual organisation of education. Compassion based initiatives (CBIs) guide staff and pupils to understand the nature of their own minds, and that of others. This is in particular respect to managing emotions and the adverse effects of the competitive nature of education, which can lead to mental health issues in pupils and teachers. This chapter explores theory and research as to the nature of compassion as both a personal and social process and reviews the utility of specifically developed compassionate initiatives for teachers, HE students and school-aged pupils. The chapter culminates in offering practical advice and guidance for cultivating a compassionate school ethos and includes the recommendation of specific exercises and practices taken from CBI curricula.
Chapter
There is growing evidence that the cultivation of compassion focused motives and emotions has profound effects on mental health and well-being. This chapter outlines the importance of embedding compassion in school and educational settings for pupils/students, those who teach them, and for the contextual organisation of education. Compassion-based initiatives (CBIs) guide staff and pupils to understand the nature of their own minds, and that of others. This is in particular respect to managing emotions and the adverse effects of the competitive nature of education, which can lead to mental health issues in pupils and teachers. This chapter explores theory and research as to the nature of compassion as both a personal and social process and reviews the utility of specifically developed compassionate initiatives for teachers, Higher Education students and school-aged pupils. The chapter culminates in offering practical advice and guidance for cultivating a compassionate school ethos and includes the recommendation of specific exercises and practices taken from CBI curricula.
Article
Full-text available
Objectives Mounting research has supported the beneficial effects of compassion-based interventions for improving psychosocial and physiological well-being and mental health. Teachers present a high risk of professional stress, which negatively impacts their mental health and professional performance. It is crucial to make compassion cultivation a focus in educational settings, supporting teachers in coping with the school context’s challenges, and promoting their mental well-being. This study aims to test the feasibility of the Compassionate Mind Training programme for Teachers (CMT-T), as well as to preliminary explore possible mechanisms of change. Methods Participants were 31 teachers from one public school in the centre region of Portugal, who underwent the CMT-T, a six-module Compassionate Mind Training group intervention for teachers. Feasibility was assessed in six domains (acceptability, implementation, practicality, adaptation, integration, and preliminary effectiveness), using self-reports, overall programme assessment, attrition, attendance, and home practice. Using a pre-post within-subject design, changes were assessed in self-reported psychological distress, burnout, well-being, compassion, and self-criticism. Mediation analysis for repeated measures designs was used to explore mechanisms of change. Results The CMT-T was feasible in all the six domains. Participants revealed significant decreases in depression, stress, and fears of compassion to others, as well as significant increases in compassion to others, self-compassion, and compassion to others’ motivations and actions after the CMT-T intervention. When self-criticism was controlled, decreases in burnout and increases in satisfaction with professional life, and self-compassion, were also found. Fears of compassion for others mediated the impact of CMT-T on teachers’ burnout, and self-compassion mediated the intervention effect on psychological well-being. Conclusions This pilot study provides evidence that CMT-T is feasible and may be effective in promoting teachers’ compassionate motivations, attributes, and actions towards others and themselves and improving their mental health and well-being. These promising findings warrant further investigation within a randomized controlled trial.
Article
Full-text available
Objectives The current study aimed to examine the mechanisms of change that mediate the impact of a compassionate mind training (CMT) intervention, in particular, whether changes in compassion, fears of compassion and heart rate variability (HRV) would mediate the effects of a brief CMT intervention on psychological vulnerability factors, mental health indicators and positive affect. Methods Using a longitudinal design, general population participants were randomly assigned to one of the two conditions: compassionate mind training (n = 56) and wait list control (n = 37). Participants in the CMT condition attended a psychoeducation session and practiced a set of core CMT exercises for 2 weeks. Self-report measures of compassion, fears of compassion, self-criticism, shame, depression, stress and positive affect were completed, and HRV was assessed at pre- and post-intervention. Results Mediation analyses revealed that increases in compassion for self and from others and reductions in fears of compassion for self, for others and from others mediated the effects of CMT on self-criticism and shame. In depression and stress, compassion for the self and from others and fears of compassion for the self emerged as significant mediators. Compassion for the self and from others and fears of compassion for self and from others significantly mediated the effect of CMT in safe affect. Compassion for the self, fears of compassion for self and for others and HRV mediated changes in relaxed affect. Conclusions Cultivating a compassionate mind/self-identity through the core components of CMT may stimulate vagal regulatory activity and positively impact one’s ability to experience and be open to compassion, and thus promote emotion regulation, well-being and mental health.
Article
Full-text available
Compassion can be defined as a sensitivity to suffering, both in the self and others, with a motivation and commitment to alleviate and prevent this suffering. Mounting research has documented the countless benefits of compassion-based interventions. The Compassion Motivation and Action Scales (CMAS) were designed to assess motivation and action as core components of compassion and self-compassion, and to allow the measurement of changes in compassionate action over time. This study aims to examine the factor structure and psychometric characteristics of the CMAS in the Portuguese population and further expand its original study by exploring its test–retest reliability and responsiveness to change. Factor structure, internal consistency and construct validity of the Compassion for Others and Self-Compassion Scales of the CMAS were examined in 516 adult participants recruited from the general community. Test–retest reliability and responsiveness to change were tested in a sample of 112 participants enrolled in a Compassion Mind Training for Teachers (CMT-T) program as part of a larger intervention trial. Exploratory and confirmatory factor analysis results confirmed the original structure of the instrument, composed by three subscales (intention, distress tolerance and action), both for the Compassion for Others scale (12 items) and the Self-Compassion scale (18 items). The CMAS revealed good internal consistency, adequate construct validity, temporal stability and sensitivity to change. Therefore, the CMAS seems to constitute a valid and reliable instrument for the assessment of compassionate and self-compassionate motivation and action, which can be used as both a research and clinical tool.
Article
Full-text available
Compassion Focused Therapy (CFT) and Compassionate Mind Training (CMT) aim to help people cultivate compassion for self and others. To date, there is little evidence exploring the effects CMT has on those engaged in or embarking on a career in the helping professions. Interventions that encourage self‐reflection and self‐practice may help practitioners cultivate self‐compassion, leading to the promotion of self‐care. To explore the impact CMT has on students’ levels of self‐compassion and self‐criticism, and on their work as healthcare practitioners/counsellors/psychotherapists. This was a mixed‐methods study (N = 15). Pre‐ and post‐quantitative data were collected via three questionnaires: The Self‐Compassion Scale‐SF, the Forms of Self‐Criticising/Self‐Attacking and Self‐Reassuring Scale and the Functions of Self‐Criticising/Self‐Attacking Scale. Qualitative data were collected via diaries and a focus group to portray the impact training had on students. Results revealed a statistically significant increase in self‐compassion post‐training and a statistically significant increase in scores on the reassured self subscale. Statistically significant reductions in self‐correction scores and inadequate self scores were observed post‐training. There was no statistical significant difference post‐training on the hated self or self‐persecution subscales. Themes identified from the weekly diaries included the following: the benefits of compassion; when compassion arises; and difficulties and opportunities. Themes identified by the focus group data included the following: self‐reflection and self‐practice; finding balance; and critical self and compassionate self. Incorporating interventions into education programmes that help student’s foster compassion may help them cultivate a compassionate mindset and learn to be kinder to self.
Article
Full-text available
There is a well-established relationship between self-criticism and depression. This cross-sectional study investigated the roles that rumination, worry, and fears of compassion for self and from others play in this relationship. Undergraduate students and community participants (N = 417; 68% female; mean age 21.42 years [SD = 6.45]) completed online self-report questionnaires measuring self-criticism, depression, rumination, worry, and fears of self-compassion and receiving compassion from others. It was hypothesized that self-criticism would predict depression, partially mediated by rumination and worry, and moderated by fears of compassion for self and from others. The indirect effects of self-criticism on depression through rumination and worry were found to be conditional on levels of fears of compassion for self and from others. Fears of compassion for self and from others magnified the impact of self-criticism on rumination and rumination on depression; and fears of compassion from others magnified the impact of self-criticism on worry. These findings suggest that having high fears of compassion for self and from others potentiates the effect of self-criticism and repetitive negative thinking on depression. Fears of compassion from others and for oneself should be assessed and addressed alongside phenomena such as self-criticism and rumination when working with depression.
Article
Full-text available
Recent studies have linked compassion with higher vagally-mediated heart rate variability (vmHRV), a measure of parasympathetic activity, and metanalytic evidence confirmed significant and positive associations. Compassion, however, is not to be confused with soothing positive emotions: in order to engage in actions aimed to alleviate (self or others) suffering, the pain should resonate, and empathic sensitivity should be experienced first. The present study examined the association between vmHRV and the empathic sensitivity and action components of trait and state compassion. To do so, several dispositional questionnaires were administered and two videos inducing empathic sensitivity (video 1) and compassionate actions (video 2) were shown, while the ECG was continuously recorded, and momentary affect was assessed. Results showed i) scores on subscales assessing the empathic component of trait compassion were inversely related to resting vmHRV; ii) vmHRV decreased after video 1 but significantly increased after video 2. As to momentary affect, video 1 was accompanied with an increase in sadness and a decrease of positive affect, whereas video 2 was characterized by an increase in anger, a parallel decrease of sadness, and an increase (although non-significant) in positive affect. Overall, present findings support the notion that it is simplistic to link compassion with higher vmHRV. Compassion encompasses increased sensitivity to emotional pain, which is naturally associated with lower vmHRV, and action to alleviate others’ suffering, which is ultimately associated with increased vmHRV. The importance of adopting a nuanced perspective on the complex physiological regulation that underlies compassionate responding to suffering is discussed.
Article
Full-text available
Neoliberalism has become the dominant ideology in many parts of the world. Yet there is little empirical research on its psychological impact. On the basis of a social identity approach to health, we hypothesize that, by increasing competition and by reducing people's sense of connection to others, neoliberalism can increase loneliness and compromise our well-being. Study 1 (N = 246) shows that the more neoliberal people perceive society to be, the worse their well-being, and that this relationship is mediated via loneliness. In two experiments, we showed that exposure to neoliberal ideology increases loneliness (Study 2, N = 204) and, through this, decreases well-being (Study 3, N = 173). In Study 4 (N = 303), we found that exposure to neoliberal ideology increased loneliness and decreased well-being by reducing people's sense of connection to others and by increasing perceptions of being in competition with others. In Study 4, the effect of neoliberalism on well-being was evident for liberals only. We discuss the potential impact of neoliberalism on different social groups in society.
Article
Full-text available
The concept, benefits and recommendations for the cultivation of compassion have been recognized in the contemplative traditions for thousands of years. In the last 30 years or so, the study of compassion has revealed it to have major physiological and psychological effects influencing well-being, addressing mental health difficulties, and promoting prosocial behavior. This paper outlines an evolution informed biopsychosocial, multicomponent model to caring behavior and its derivative “compassion” that underpins newer approaches to psychotherapy. The paper explores the origins of caring motives and the nature and biopsychosocial functions of caring-attachment behavior. These include providing a secure base (sources of protection, validation, encouragement and guidance) and safe haven (source of soothing and comfort) for offspring along with physiological regulating functions, which are also central for compassion focused therapy. Second, it suggests that it is the way recent human cognitive competencies give rise to different types of “mind awareness” and “knowing intentionality” that transform basic caring motives into potentials for compassion. While we can care for our gardens and treasured objects, the concept of compassion is only used for sentient beings who can “suffer.” As psychotherapy addresses mental suffering, cultivating the motives and competencies of compassion to self and others can be a central focus for psychotherapy.
Article
Objective: While motivation and action are core components of compassion and self-compassion, no other measure thoroughly assesses these aspects, or offers a measure of change in compassionate action over time. In a novel application of the language of motivation and action described in motivational interviewing theory and research, this study developed the Compassion Motivation and Action Scales (CMAS), and examined its psychometric characteristics. Method: A sample of 621 participants was recruited to conduct exploratory and confirmatory factor analyses on the CMAS for both Compassion and Self-Compassion Scales. Results: The analyses supported a factor structure of the CMAS of three subscales, Intention, Distress Tolerance, and Action, for Compassion (12-items) and Self-Compassion (18-items) Scales. The confirmatory factor analysis supported stability of the factor structures of the CMAS scales. Psychometric evaluation revealed that the CMAS scales had good internal consistency, and satisfactory construct and concurrent validity with other psychometrically valid measures of compassion and mental health. Conclusion: The CMAS offers a brief, user friendly, public domain measure of compassionate and self-compassionate motivation and action, which was psychometrically strong. Potential uses of the measure as both a research and clinical tool, and implications for further research, are discussed. Key Points What is already known about this topic: • Motivation and action are core components of compassion and self-compassion, however, no other measure thoroughly assesses these aspects, or offers a measure of change in compassionate action over time. • Motivational Interviewing is a theoretical and evidence-based model describing the language of motivation and action, and offers a novel framework for assessing these components in compassion and self-compassion • Developing a questionnaire assessing compassion motivation and action, as well as changes in compassionate action over time, will be an important development for both clinical and research applications. What this paper adds: • This study is the first to draw on a sophisticated and well-established model of motivation and action, and apply it to assessing these components in compassion and self-compassion, to develop the Compassion Motivation and Action Scales (CMAS). • The factor analysis of the two scales, CMAS Compassion Scale (12-items) and CMAS Self-Compassion Scale (18-items), revealed three factors: Intention, Distress Tolerance, and Action. • The resultant CMAS scales and factors were psychometrically strong, and the scales may be used to assess motivation and action at intake, and as a repeated assessment of change in compassionate and self-compassionate action across an intervention.
Article
Objectives: There is an increasing interest in how compassion training, and in particular, the cultivation of self-compassion may be an important component in the reduction of distress and promotion of well-being. Compassion Focused Therapy (CFT) has shown promising results in this area, with positive outcome studies in a wide range of mental health problems. However, following the successful development of short mindfulness-based programmes (e.g., Mindfulness-based Stress Reduction and Mindfulness-based Cognitive Therapy) and compassion/self-compassion programmes (e.g., Mindful Self-Compassion) that can be accessed by the general public, we were keen to develop and research an 8-week Compassionate Mind Training (CMT) course, based on the CFT model. Design: Within-subjects pre-to-post-group comparison. Methods: Following an 8-week CMT groups, participants in the general population (n = 55) completed pre- and post-measures (with 22 of these also providing 3-month follow-up data) on self-compassion, compassion for others, compassion from others, attachment, self-criticism, positive emotion, well-being, and distress. Results: Significant increases in compassion, self-reassurance, social rank, positive emotions, and well-being were found, alongside reductions in self-criticism, attachment anxiety, and distress. Changes were maintained at 3-month follow-up. Change scores indicated the importance of increases in self-compassion and reductions in self-criticism in overall improvements in well-being and psychological distress. Conclusions: Findings offer preliminary support for the usefulness of group CMT in community samples. Practitioner points: Compassionate Mind Training (CMT) groups appear to be applicable and beneficial in community samples. CMT psychoeducation and practices appear to bring positive changes to a variety of psychological processes, including attachment, self-criticism, self-compassion, well-being, and distress. Further studies are required to investigate whether the mechanisms through which CMT is beneficial.