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

The Journey and Experiences of Female Hispanic Nurse Leaders

OBJECTIVE

This study aimed to understand the experience of female Hispanic nurses in formal leadership roles.

BACKGROUND

Research has identified that a diverse nursing leadership workforce is essential to providing optimal patient care. Little is known about the phenomenon of minority nurse leaders, particularly female Hispanic nurses in leadership roles.

METHODS

Ricoeur's hermeneutic phenomenology guided the interviews of 15 female Hispanic nurses in leadership roles.

RESULTS

Three themes were generated that described the environment in which leaders lived: family, culture, and healthcare organization. Four phenomenological themes were identified: weaving my life fabric, my inner dialogue, weight on my shoulders, and paving the way.

CONCLUSION

The study findings highlight the importance of a diverse and inclusive nursing leadership workforce. By proactively addressing equal opportunities, reducing barriers to career advancement, and developing strategies to support and encourage minority nurses, organizations and communities can recruit and retain qualified underrepresented minority nurse leaders.

Compassionate mind training for people with Parkinson's disease: A pilot study and predictors of response

INTRODUCTION

People with Parkinson's disease (PD) often present with disabling neuropsychiatric symptoms. Compassionate mind training (CMT) is a psychological approach effective in reducing stress and promoting psychological well-being. Heart rate variability (HRV), a measure reflecting sympathovagal balance, has been associated with psychological well-being and a compassionate attitude.

AIM

To assess the feasibility and effectiveness of CMT in enhancing the quality of life and psychological well-being in PD patients. Additionally, we evaluated HRV as a physiomarker for assessing the CMT outcomes.

METHODS

Twenty-four PD patients participated in the study. A 6-week online CMT intervention was delivered on a weekly basis. At baseline and post-intervention patients completed questionnaires assessing depression, anxiety and quality of life. In a subsample of 11 patients, HRV was measured at baseline and post-intervention in three conditions: at rest, during stress and after 3 min of deep breathing.

RESULTS

The attendance rate was 94.3%. Quality of life and perceived stigma improved post-intervention as compared with baseline (p = 0.02 and p = 0.03 for PD Questionnaire-39 total score and Stigma subscore, respectively). After CMT, patients presented better physiological regulation to stress, as measured by higher HRV as compared with baseline (p = 0.005). Notably, patients who were more resilient to stress at baseline (less decrease in HRV during stress) experienced a more substantial reduction in anxiety and depression following CMT.

CONCLUSIONS

CMT is feasible and can improve quality of life and stigma in PD patients. HRV emerges as a promising physiomarker for predicting and measuring the outcomes of psychological interventions in PD.

Physiological response to self-compassion versus relaxation in a clinical population

BACKGROUND

Compassion-focused imagery (CFI) can be an effective emotion-regulation technique but can create threat-focused responses in some individuals. However, these findings have been based on tasks involving receiving compassion from others.

AIMS

This study sought to compare responses CFI involving self-compassion to relaxation and a control task, and to see whether any threat-responses to self-compassion and relaxation decrease with practice.

METHOD

25 participants with depression/anxiety symptoms and high self-criticism and/or low self-compassion engaged in three tasks (control task, relaxation imagery, and CFI) at three or four separate testing sessions, every three days. Heart-rate variability (HRV) was used to explore group-level differences between tasks. Additionally, we identified how many individuals showed a clinically significant change in HRV in response to compassion (compared to baseline) and how many showed such a change during relaxation (compared to baseline).

RESULTS

During session 1, more individuals had a clinically significant increase in HRV in response to CFI (56%) than in response to relaxation (44%), and fewer had a clinically significant decrease in HRV during CFI (16%) than during relaxation (28%). Comparing the group as a whole, no significant differences between tasks were seen. Repeated sessions led to fewer positive responses to CFI, perhaps reflecting habituation/boredom.

CONCLUSIONS

These preliminary findings suggest that in high self-critics (those most likely to find self-compassion difficult), self-compassionate imagery is no more challenging than standard relaxation tasks. For both compassion and relaxation, some individuals respond positively and others negatively. For those who are not benefiting, practice alone is not sufficient to improve response. Effects may differ for other compassion tasks.

TRIAL REGISTRATION

Trial number: NCT04647318.

Concurrent TMS-EEG and EEG reveal neuroplastic and oscillatory changes associated with self-compassion and negative emotions

Background/Objective

Self-compassion has a consensual relevance for overall mental health, but its mechanisms remain unknown. Using intermittent theta burst stimulation (iTBS) and concurrent transcranial magnetic stimulation-electroencephalography (TMS-EEG), this study investigated the causal relationship of the dorsolateral prefrontal cortex (DLPFC) with self-compassion and explored the changes in neuroplasticity and neural dynamics.

Method

Thirty-two healthy participants received iTBS or sham stimulation over the DLPFC, before and after which they were instructed to either use self-compassionate strategies or to be rejected in the context of social rejection and to report the level of self-compassion or negative affect. TMS-evoked potentials were evaluated as novel neuroplastic techniques with N45, P60, N100, and P180.

Results

iTBS uniquely decreased P180 amplitude measured with TMS-EEG whereby sham stimulation had no effect on neuroplasticity. In line with neuroplasticity changes, iTBS enhanced a widespread gamma band power and coherence, which correlated consistently with increased engagement in self-compassion. Meanwhile, iTBS demonstrated opposite effects on theta activity dependent on the social contexts whereby self-compassion decreased and social rejection enhanced it respectively. This unique effect of iTBS on theta activity was also supplemented by the enhancement of theta band coherence following iTBS.

Conclusions

We found a causal relationship between DLPFC and self-compassion. We also provide evidence to indicate widespread gamma activity and connectivity to correlate with self-compassion as well as the critical role of the DLPFC in modulating theta activity and negative emotions.

A bioelectronic route to compassion: Rationale and study protocol for combining transcutaneous vagus nerve stimulation (tVNS) with compassionate mental imagery

BACKGROUND

The vagus nerve (VN) is a neural nexus between the brain and body, enabling bidirectional regulation of mental functioning and peripheral physiology. Some limited correlational findings suggest an association between VN activation and a particular form of self-regulation: compassionate responding. Interventions that are geared towards strengthening self-compassion in particular, can serve as an antidote to toxic shame and self-criticism and improve psychological health.

OBJECTIVE

We describe a protocol for examining the role of VN activation on 'state' self-compassion, self-criticism, and related outcomes. By combining transcutaneous vagus nerve stimulation (tVNS) with a brief imagery-based self-compassion intervention, we aim to preliminarily test additivity versus synergy between these distinct bottom-up and top-down methods for putatively regulating vagal activity. We also test whether the effects of VN stimulation accumulate with daily stimulation and daily compassionate imagery practice.

METHODS

Using a randomized 2 x 2 factorial (stimulation x imagery condition) design, healthy volunteers (n = 120) receive active (tragus) or sham (earlobe) tVNS plus standardized (audio-recorded) self-compassionate or sham mental imagery instructions. These interventions are delivered in a university-based psychological laboratory in two sessions, one week apart, as well as being self-administered between sessions by participants at home. Pre-stimulation, peri-stimulation and post-imagery measures of state self-compassion, self-criticism and related self-report outcomes are assessed in two lab sessions, separated by a week (Days 1 and 8). Heart rate variability is used as a physiological metric of vagal activity and an eye-tracking task assesses attentional bias to compassionate faces during the two lab sessions. On Days 2-7, participants continue their randomly assigned stimulation and imagery tasks at home, and complete state measures at the end of each remote session.

DISCUSSION

Demonstrating modulation of compassionate responding using tVNS would support a causal link between VN activation and compassion. This would provide a basis for future studies of bioelectronic approaches to augmenting therapeutic contemplative techniques.

CLINICAL TRIALS REGISTRATION

ClinicalTrials.gov, Identifier: NCT05441774 (Date: July 1st 2022).

OSF REGISTRATION

https://osf.io/4t9ha.

Emotion-Focused Mobile App for Promoting Self-Compassion, Self-Protection, and Self-Criticism

The COVID-19 pandemic has changed our daily lives and restricted access to traditional psychological interventions. Hence there is an immediate and growing demand for accessible and scalable mental health solutions. Emotion-focused training for self-compassion and self-protection was developed and distributed using mobile phone technologies, and its effectiveness was tested. The available research sample consisted of 97 participants with a mean age of 26.06 years and a standard deviation of 10.53. Participants using the mobile app underwent a 14-day program aimed at reducing self-criticism while increasing self-compassion and self-protection. Pre- and post-measurements were collected. The results showed a statistically significant medium effect on self-compassion, self-criticism, and self-protection performance and a significant small effect on self-protection distress. The finding that a 14-day mobile app was able to foster well-being in the form of self-compassion, self-protection, and self-criticism is promising. It indicates the potential for individuals to obtain help through the use of remote tools such as MHapps for a fraction of the usual cost, at their own pace, and without other restrictions.

Self-Compassion and Its Association With Ruminative Tendencies and Vagally Mediated Heart Rate Variability in Recurrent Major Depression

Background

Recurrent Major Depressive Disorder (MDD) is one of the most disabling mental disorders in modern society. Prior research has shown that self-compassion protects against ruminative tendencies, a key feature of recurrent MDD. In addition, self-compassion has been found to be positively related to higher psychophysiological flexibility (indexed by a higher vagally mediated heart rate variability; vmHRV) in young, healthy adults. To our knowledge, there is a lack of studies on how self-compassion relates to vmHRV in patients with recurrent MDD. The aim of the current study was to investigate whether higher self-compassion would associate with (1) lower ruminative tendencies and (2) higher vmHRV in a sample of adults with recurrent MDD.

Methods

We included a sample of 63 patients (46 females) between 20 and 71 years old (M = 40.24, SD = 12.8) with a history of three or more depressive episodes. They filled out the Self-Compassion Scale (SCS), Beck Depression Inventory (BDI), and Rumination Rating Scale (RRS). ECG (used to derive vmHRV) was acquired while resting and the square root of the mean squared differences of successive RR interval values (RMSSD) was calculated as measure of vmHRV.

Results

As hypothesized, self-compassion was associated with lower ruminative tendencies. However, self-compassion was not associated with level of vmHRV. Several confounding variables were controlled for in the statistical analyses, and higher age predicted lower vmHRV across all statistical analyses.

Conclusion

The results confirmed our hypothesis that higher self-compassion would be associated with lower ruminative tendencies in recurrent MDD. Contrary to our expectation, we did not find that the tendency to be more self-compassionate was associated with higher vmHRV. As such, higher self-compassion seems to relate with a lower tendency to ruminate about past mistakes and events but does not seem to relate to a flexible autonomic stress response (as indexed by higher vmHRV). Other potential explanatory factors for lower vmHRV in recurrent MDD is suggested as focus for exploration in future studies.

At the heart of change: Differences in young offenders' HRV patterns after the delivery of the PSYCHOPATHY.COMP program

INTRODUCTION

Literature has pointed the need for intervention programs specifically tailored to target the treatment needs of young offenders, as well as the need to test the efficacy of such programs through physiological indexes of emotion regulation (e.g., heart rate variability; HRV), complementing self-reports typically used as outcome measures. The PSYCHOPATHY.COMP is a 20-session individual intervention program based on Compassion Focused Therapy aiming to reduce psychopathic traits and disruptive behavior among young offenders through the development of a compassionate motivation, while stimulating the soothing system as a strategy to improve emotion regulation. Previous research with young offenders has shown decreases in vagally mediated HRV (vmHRV) when the soothing system is activated. This physiological pattern seems to mirror threat-like responses that contrast with relaxed states.

METHODS

To test the efficacy of the PSYCHOPATHY.COMP, a clinical trial was implemented encompassing a treatment (n = 56) and a control group (n = 53). Treatment participants attended the PSYCHOPATHY.COMP, while controls received the Treatment As Usual (TAU) delivered in Portuguese juvenile detention facilities. HRV data was collected throughout a standardized procedure (encompassing resting, reactivity and recovery phases) specifically designed to trigger the soothing system. Participants were assessed at pre-treatment, post-treatment and 6-months follow-up.

RESULTS

Although treatment participants continued to process the soothing system as unpleasant (with decreased vmHRV), they seem to become able to adaptively recover from the stimuli without avoiding it or resorting to maladaptive coping strategies. The physiological pattern was in line with participants' decreases in difficulties in emotion regulation across the assessment periods. In contrast, controls seemed to have actively employed coping strategies associated with increases in vmHRV not only when the soothing system was triggered, but also when recovering from the stimuli. Congruently, for controls, increases in difficulties in emotion regulation were found, with increases in the lack of emotional clarity across the assessment periods.

DISCUSSION

Findings offer new evidence for the efficacy of the PSYCHOPATHY.COMP program in improving emotion regulation in young offenders, assessed through both self-report and physiological measures. Additionally, findings support the assessment of the autonomic balance as a treatment efficacy index in future research, targeting the rehabilitation of these youth.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov, identifier NCT03971682.

HRV patterns associated with different affect regulation systems: Sex differences in adolescents

Evolutionary perspectives of human behavior propose the existence of three emotion regulation systems (i.e., threat, drive and soothing systems). An unbalanced functioning of the systems represents greater risk for emotion dysregulation and psychopathology. In recent years, heart rate variability (HRV) has been reported as an accurate index of emotion regulation, and although adolescence is characterized by multiple neurophysiological, psychological and social changes, there is no study exploring the HRV patterns of each emotion regulation system in this developmental stage. In Study 1, a standardized procedure (SP) aiming to elicit the three different systems was developed and validated by experts (n = 14) and community adolescents (n = 31). In study 2, differences in HRV patterns across the three emotion regulation systems and across sex, were investigated in a sample of community adolescents (n = 155; 70 males), aged between 14 and 18 years old. Results showed that the threat and drive systems were associated with decreases in HRV, while the soothing system was associated with decreased heart rate. Sex differences were found for the activation of the threat system: while males maintained a decreasing trend in HRV indexes, from resting to recovery, females did not show a decrease in HRV during the activation of this system. Overall, physiological correlates of each specific emotion regulation system corroborate the theoretical assumptions. Moreover, a SP able to trigger each system independently while measuring physiological data is now available and can be used in future research.

Nonsuicidal Self-Injury Is Associated With Attenuated Interoceptive Responses to Self-Critical Rumination

Nonsuicidal self-injury (NSSI) is a prevalent and dangerous behavior. Those with a history of NSSI often report high levels of self-critical rumination (SCR), a form of negatively valenced introspective self-referential processing. It is plausible that this overly analytical style of relating to the self might hinder the ability to process interoceptive signals, thereby increasing the capacity to engage in behaviors that cause bodily harm. Two studies investigated whether trait or state SCR influenced aspects of interoception in those with and without a history of NSSI. In Study 1 (N = 180), irrespective of NSSI history, trait SCR was associated with finding attending to the heartbeat unpleasant. However, no associations were observed for interoceptive confidence, or metacognitive insight into their interoceptive abilities (confidence-accuracy correspondence). Trait SCR was associated with having higher interoceptive accuracy, but only in those without a history of NSSI. In Study 2 (N = 98), irrespective of NSSI history, state self-criticism led to a more negative interoceptive valence, and reduced participants' metacognitive insight. In those without a history of NSSI, state self-criticism also increased interoceptive accuracy-an effect attenuated in those with NSSI. These findings suggest that those with NSSI are characterized by a blunted interoceptive response to negatively valenced self-focused attention.

Compassion Is Not a Benzo: Distinctive Associations of Heart Rate Variability With Its Empathic and Action Components

Recent studies have linked compassion with higher vagally mediated heart rate variability (vmHRV), a measure of parasympathetic activity, and meta-analytic 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 that (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 in positive affect, whereas video 2 was characterized by an increase in anger, a parallel decrease in 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.

Integrating Breathing Techniques Into Psychotherapy to Improve HRV: Which Approach Is Best?

Introduction

Approaches to improve heart rate variability and reduce stress such as breathing retraining are more frequently being integrated into psychotherapy but little research on their effectiveness has been done to date. Specifically, no studies to date have directly compared using a breathing pacer at 6 breaths per minute with compassion focused soothing rhythm breathing.

Current Study

In this randomized controlled experiment, 6 breaths per minute breathing using a pacer was compared with compassion focused soothing rhythm breathing, with a nature video being used as a control group condition.

Methods

Heart rate variability (HRV) measures were assessed via electrocardiogram (ECG) and respiration belt, and an automated blood pressure machine was used to measure systolic diastolic blood pressure, and heart rate (HR). A total of 96 participants were randomized into the three conditions. Following a 5-min baseline, participants engaged in either 6 breath per minute breathing, soothing rhythm breathing, or watched a nature video for 10 min. To induce a stressful state, participants then wrote for 5 min about a time they felt intensely self-critical. Participants then wrote for 5 min about a time they felt self-compassionate, and the experiment ended with a 10-min recovery period.

Results

Conditions did not significantly differ at baseline. Overall, HRV, as measured by standard deviation of NN intervals (SDNN), low frequency HRV (LF HRV), and LF/HF ratio, increased during the intervention period, decreased during self-critical writing, and then returned to baseline levels during the recovery period. High frequency HRV (HF HRV) was not impacted by any of the interventions. The participants in the 6 breath per minute pacer condition were unable to consistently breathe at that rate and averaged about 12 breaths per minute. Time by Condition analyses revealed that both the 6 breaths per minute pacer and soothing breathing rhythm conditions lead to significantly higher SDNN than the nature video condition during breathing practice but there were no significant differences between conditions in response to the self-critical and self-compassionate writing or recovery periods. The 6 breath per minute pacer condition demonstrated a higher LF HRV and LF/HF ratio than the soothing rhythm breathing condition, and both intervention conditions had a higher LF HRV and LF/HF ratio than the nature video.

Conclusions

Although the 6 breath per minute pacer condition participants were not able to breath consistently at the low pace, both the participants attempting to breathe at 6 breaths per minute as well as those in the soothing rhythm breathing condition effectively increased HR variability as measured by SDNN, and attempting to breathe at 6 breaths per minute led to the highest LF HRV and LF/HF ratio. Both breathing approaches impacted HRV more than watching a relaxing nature video and can potentially be used as key adjuncts in psychotherapy to aid in regulating physiological functioning, although it appears that consistent breathing practice would be needed.

Ways of Knowing Compassion: How Do We Come to Know, Understand, and Measure Compassion When We See It?

Over the last decade, empirical research on compassion has burgeoned in the biomedical, clinical, translational, and foundational sciences. Increasingly sophisticated understandings and measures of compassion continue to emerge from the abundance of multidisciplinary and cross-disciplinary studies. Naturally, the diversity of research methods and theoretical frameworks employed presents a significant challenge to consensus and synthesis of this knowledge. To bring the empirical findings of separate and sometimes siloed disciplines into conversation with one another requires an examination of their disparate assumptions about what compassion is and how it can be known. Here, we present an integrated theoretical review of methodologies used in the empirical study of compassion. Our goal is to highlight the distinguishing features of each of these ways of knowing compassion, as well as the strengths and limitations of applying them to specific research questions. We hope this will provide useful tools for selecting methods that are tailored to explicit objectives (methods matching), taking advantage of methodological complementarity across disciplines (methods mixing), and incorporating the empirical study of compassion into fields in which it may be missing.

Demystifying the mirror taboo: A neurocognitive model of viewing self in the mirror

Research has consistently demonstrated that viewing one's body in a mirror after an amputation or other perceived or visible body disfigurements can be a traumatic experience. Mirror viewing or mirroring is a taboo subject, which may be the reason this trauma has not been previously detected or acknowledged. Traumatic mirror viewing may lead to mirror discomfort, mirror avoidance, and a host of psychosocial concerns, including post-traumatic stress. As mirroring is complex, four qualitative mirror viewing studies, embodiment concepts, polyvagal theory, and memory theories were used to develop a model. In this article, foundational knowledge that led to the development of the model is shared. A neurocognitive model of mirror viewing is offered together with implications for nursing research, practice, and education.

Psychometric properties of the German version of the fears of compassion scales

The cultivation of compassion is associated with beneficial effects on physical and psychological health, satisfaction with life and social relationships. However, some individuals, especially those high in psychopathological symptoms or those with particular disorders such as borderline personality disorder (BPD) may demonstrate pronounced fears of engagement in compassionate experiences or behaviours. Furthermore, fears of compassion have been found to impede progress in psychotherapy. The 38-item fears of compassion scales (FCS) is a self-report questionnaire for measuring trait levels of fears of compassion (a) one receives from others (FCFO), (b) one feels towards others (FCTO) and (c) one feels for oneself (self-compassion; FSC). The FCS is an internationally used instrument of proven validity and reliability in both clinical and nonclinical samples. In the present study, a German translation of the FCS including its three subscales was provided, and the psychometric properties were examined in 430 participants from four different samples: (a) a sample from the general population; (b) a mixed sample of psychiatric residential and outpatients; (c) a clinical sample of residential and outpatients with a primary diagnosis of BPD and (d) a sample of healthy control participants. Internal consistencies were excellent for the German version of the FSC and acceptable to excellent for its subscales. Correlations with established measures of mental health demonstrate its validity. Additionally, the German FCS discriminates significantly between individuals from the general population and patients, thus supporting its specificity. The German FCS is suitable to detect potential obstacles in cultivating compassion in psychotherapeutic treatments and beyond.

Physiological fractals: visual and statistical evidence across timescales and experimental states

A marker of engaging in compassion meditation and related processes is an increase in heart-rate variability (HRV), typically interpreted as a marker of parasympathetic nervous system response. While insightful, open questions remain. For example, which timescale is best to examine the effects of meditation and related practices on HRV? Furthermore, how might advanced time-series analyses--such as stationarity--be able to examine dynamic changes in the mean and variance of the HRV signal across time? Here we apply such methods to previously published data, which measured HRV pre- and post- a two-week compassionate mind training (CMT) intervention. Inspection of these data reveals that a visualization of HRV correlations across resting and compassion meditation states, pre- and post-two-week training, is retained across numerous recording timescales. Here, the fractal-like nature of our data indicates that the accuracy of representing HRV data can exist across timescales, albeit with greater or lesser granularity. Interestingly, inspection of the HRV signal at Time 2 compassion meditation versus Time 1 revealed a more highly correlated (i.e. potentially more stable) signal. We followed up these results with tests of stationarity, which revealed Time 2 had a less stochastic (variable) signal than Time 1, and a measure of distance in the time series, which showed that Time 2 had less of an average difference between rest and meditation than at Time 1. Our results provide novel assessment of visual and statistical markers of HRV change across distinct experimental states.

Compassion-focused therapy for trauma in people with intellectual disabilities: A conceptual review

Trauma exposure and post-traumatic stress disorder are more prevalent in people with intellectual disabilities (PWID) than in the general population, yet the evidence base for trauma interventions in this population is sparse. Compassion-focused therapy (CFT) may be particularly well-suited to PWID for a number of reasons, including its adaptability to different developmental levels. PWID are more likely to have issues with self-relating (e.g. shame and self-criticism) and attachment than the general population, two issues that are compounded by trauma and which CFT explicitly seeks to address. Furthermore, compassion-focused approaches emphasize cultivating a sense of safeness while empowering people to make behavioural changes; this is particularly pertinent to PWID who have been traumatized and may feel unsafe and disempowered. An overview of CFT and its application to trauma are given, as well as some case studies using CFT with PWID.

Neurophysiological and behavioural markers of compassion

The scientific study of compassion is burgeoning, however the putative neurophysiological markers of programs which actively train distress tolerance, such as Compassionate Mind Training (CMT), are less well known. Herein we offer an integrative, multi-method approach which investigated CMT at neural, physiological, self-report, and behavioural levels. Specifically, this study first assessed participants' neural responses when confronted with disappointments (e.g., rejection, failure) using two fundamental self-regulatory styles, self-criticism and self-reassurance. Second, participant's heart-rate variability (HRV) - a marker of parasympathetic nervous system response - was assessed during compassion training, pre- and post- a two-week self-directed engagement period. We identified neural networks associated with threat are reduced when practicing compassion, and heightened when being self-critical. In addition, cultivating compassion was associated with increased parasympathetic response as measured by an increase in HRV, versus the resting-state. Critically, cultivating compassion was able to shift a subset of clinically-at risk participants to one of increased parasympathetic response. Further, those who began the trial with lower resting HRV also engaged more in the intervention, possibly as they derived more benefits, both self-report and physiologically, from engagement in compassion.

Explicit and Implicit Responses of Seeing Own vs. Others' Emotions: An Electromyographic Study on the Neurophysiological and Cognitive Basis of the Self-Mirroring Technique

Facial mimicry is described by embodied cognition theories as a human mirror system-based neural mechanism underpinning emotion recognition. This could play a critical role in the Self-Mirroring Technique (SMT), a method used in psychotherapy to foster patients’ emotion recognition by showing them a video of their own face recorded during an emotionally salient moment. However, dissociation in facial mimicry during the perception of own and others’ emotions has not been investigated so far. In the present study, we measured electromyographic (EMG) activity from three facial muscles, namely, the zygomaticus major (ZM), the corrugator supercilii (CS), and the levator labii superioris (LLS) while participants were presented with video clips depicting their own face or other unknown faces expressing anger, happiness, sadness, disgust, fear, or a neutral emotion. The results showed that processing self vs. other expressions differently modulated emotion perception at the explicit and implicit muscular levels. Participants were significantly less accurate in recognizing their own vs. others’ neutral expressions and rated fearful, disgusted, and neutral expressions as more arousing in the self condition than in the other condition. Even facial EMG evidenced different activations for self vs. other facial expressions. Increased activation of the ZM muscle was found in the self condition compared to the other condition for anger and disgust. Activation of the CS muscle was lower for self than for others’ expressions during processing a happy, sad, fearful, or neutral emotion. Finally, the LLS muscle showed increased activation in the self condition compared to the other condition for sad and fearful expressions but increased activation in the other condition compared to the self condition for happy and neutral expressions. Taken together, our complex pattern of results suggests a dissociation at both the explicit and implicit levels in emotional processing of self vs. other emotions that, in the light of the Emotion in Context view, suggests that STM effectiveness is primarily due to a contextual–interpretative process that occurs before that facial mimicry takes place.

Is Dispositional Self-Compassion Associated With Psychophysiological Flexibility Beyond Mindfulness? An Exploratory Pilot Study

BACKGROUND

Dispositional mindfulness and self-compassion are shown to associate with less self-reported emotional distress. However, previous studies have indicated that dispositional self-compassion may be an even more important buffer against such distress than dispositional mindfulness. To our knowledge, no study has yet disentangled the relationship between dispositional self-compassion and mindfulness and level of psychophysiological flexibility as measured with vagally mediated heart rate variability (vmHRV). The aim was thus to provide a first exploratory effort to expand previous research relying on self-report measures by including a psychophysiological measure indicative of emotional stress reactivity.

METHODS

Fifty-three university students filled out the "Five Facet Mindfulness Questionnaire" (FFMQ) and the "Self-Compassion Scale" (SCS), and their heart rate was measured during a 5 min resting electrocardiogram. Linear hierarchical regression analyses were conducted to examine the common and unique variance explained by the total scores of the FFMQ and the SCS on level of resting vmHRV.

RESULTS

Higher SCS total scores associated significantly with higher levels of vmHRV also when controlling for the FFMQ total scores. The SCS uniquely explained 7% of the vmHRV. The FFMQ total scores did not associate with level of vmHRV.

CONCLUSION

These results offer preliminary support that dispositional self-compassion associates with better psychophysiological regulation of emotional arousal above and beyond mindfulness.

Investigating the Influence and a Potential Mechanism of Self-Compassion on Experimental Pain: Evidence From a Compassionate Self-Talk Protocol and Heart Rate Variability

Previous studies have indicated a positive relationship between self-compassion and psychological and emotional well-being in chronic pain populations. However, evidence on the role and mechanisms of self-compassion in pain perception is largely limited. The current study was designed to investigate the effects and a potential mechanism of self-compassion on experimental pain. Thirty healthy participants underwent a compassionate self-talk protocol, which was followed by cold pain exposure during which high-frequency heart rate variability (HF-HRV) was evaluated. The compassionate self-talk protocol successfully generated compassionate statements among the participants. Our behavioral data showed lower pain ratings in the self-compassion compared to the control condition. Moreover, self-compassion manipulation resulted in higher HF-HRV during pain, which was associated with lower pain ratings. We present interesting findings that a short period of compassionate self-talk may decrease experimental pain as well as mechanistic evidence surrounding bodily control over pain-related arousal indicated by HF-HRV. PERSPECTIVE: This study presents the first line of evidence that a short period of compassionate self-talk may be sufficient to reduce experimental pain. We also demonstrate increased bodily control as a potential mechanism underlying this effect.

The social brain and heart rate variability: Implications for psychotherapy

PURPOSE

Humans evolved within the mammalian line as a highly social species. Indeed, sociality has been a major driver of human social intelligence. From birth, social relationships have emotional and self-regulating properties and operate through different body systems. This paper will explore how heart rate variability (HRV), an index of the vagal regulation of the heart and a central element of the physiological underpinnings of sociality, is related to mental health problems, with important implications for psychotherapy.

METHODS

We conducted a narrative review of the literature on the bi-directional links between prosocial motivations, HRV, and psychophysiological functioning.

RESULTS

HRV is associated not only with the ability to downregulate physiological arousal, but also with a variety of psychological and behavioural variables which are usually the target of psychotherapeutic interventions. A modern neurovisceral integration model can be employed to explain the complex intercorrelation between HRV and psychophysiological functioning. In particular, the link between HRV, the experience of inter- and intrapersonal safeness, and the inhibitory function of the prefrontal cortex will be explored in the context of prosocial motives, such as compassion, that alleviate and help prevent mental health difficulties.

CONCLUSIONS

Our knowledge of the social brain and its physiological underpinnings might influence important elements of a therapeutic intervention, from the initial assessment of patient's difficulties to the evaluation of therapy outcomes.

PRACTITIONER POINTS

Social relationships have emotional and self-regulating properties. The experience of inter- and intrapersonal safeness is connected to prosocial motives, such as compassion, and the inhibitory function of the prefrontal cortex. Social relationships and compassion influence different body systems, such as the vagus nerve. Many forms of psychopathology represent the activation of evolved, defensive strategies especially in contexts where there are few stimuli indicating safeness and social support. Heart rate variability predicts psychotherapy outcome.

Randomised controlled trial of the new short-term online emotion focused training for self-compassion and self-protection in a nonclinical sample

The Emotion Focused Training for Self-Compassion and Self-Protection (EFT-SCP) is an intervention developed to increase skills of self-compassion and protective anger with the aim to decrease self-criticism. This novel intervention was developed on the basis of the latest findings on self-criticism from Emotion-focused therapy and previous programs cultivating compassion (namely Compassion Mind Training and Mindful Self-Compassion Program). According to existing research, simply cultivating self-compassion is not always sufficient in reducing self-criticism. Therefore, the EFT-SCP was designed to build self-compassion whilst developing protective anger to combat self-criticism. Our goal was to investigate the efficacy of this new, short-term, online EFT-SCP program in a non-clinical population. A randomized control trial was conducted with pre- and post-intervention measurements and two-month follow-up of self-compassion and self-criticism/reassurance. Convenience sampling was used to recruit participants through a snowballing technique on social media. A total of 123 participants were randomly allocated to the EFT-SCP intervention or to a control condition. The intervention group were instructed through emails to complete an EFT-SCP task every day for 14 consecutive days. The control group did not complete any tasks. Out of 123 participants, 31 from intervention group and 20 from control group completed all measurements. There was a significant effect of the EFT-SCP on increasing self-compassion and self-reassurance scores as reported at two-month follow-up. The EFT-SCP was also effective at reducing self-uncompassionate responding and self-criticism (specifically Hated self) with changes evident at two months post-intervention. These findings are encouraging and suggest that interventions designed to enhance self-compassion and decrease self-criticism can be delivered to broader populations without the direct contact with mental health professionals.

Autonomic and Brain Morphological Predictors of Stress Resilience

Stressful life events are an important cause of psychopathology. Humans exposed to aversive or stressful experiences show considerable inter-individual heterogeneity in their responses. However, the majority does not develop stress-related psychiatric disorders. The dynamic processes encompassing positive and functional adaptation in the face of significant adversity have been broadly defined as resilience. Traditionally, the assessment of resilience has been confined to self-report measures, both within the general community and putative high-risk populations. Although this approach has value, it is highly susceptible to subjective bias and may not capture the dynamic nature of resilience, as underlying construct. Recognizing the obvious benefits of more objective measures of resilience, research in the field has just started investigating the predictive value of several potential biological markers. This review provides an overview of theoretical views and empirical evidence suggesting that individual differences in heart rate variability (HRV), a surrogate index of resting cardiac vagal outflow, may underlie different levels of resilience toward the development of stress-related psychiatric disorders. Following this line of thought, recent studies describing associations between regional brain morphometric characteristics and resting state vagally-mediated HRV are summarized. Existing studies suggest that the structural morphology of the anterior cingulated cortex (ACC), particularly its cortical thickness, is implicated in the expression of individual differences in HRV. These findings are discussed in light of emerging structural neuroimaging research, linking morphological characteristics of the ACC to psychological traits ascribed to a high-resilient profile and abnormal structural integrity of the ACC to the psychophysiological expression of stress-related mental health consequences. We conclude that a multidisciplinary approach integrating brain structural imaging with HRV monitoring could offer novel perspectives about brain-body pathways in resilience and adaptation to psychological stress.

Brain-heart interaction in perseverative cognition

The move from the concept of homeostasis to that of allostasis has led reactivity stress research to widen the object of its investigation: from the brief physiological response that occurs when one is facing a stressor to what happens when one is anticipating or recovering from a stressor. A paradigmatic example is represented by perseverative cognition, during which human beings react "as if" they were constantly facing a concrete stressor. The core idea behind this review is that the cognitive inflexibility that characterizes perseverative cognition is reflected in both our body (by increased autonomic nervous system rigidity assessed by heart rate variability; HRV) and our brain (by reduced prefrontal-amygdala functional connectivity). This is a review of studies conducted in different settings (laboratory, daily life), populations (healthy, major depression, generalized anxiety), location (United States, Europe), and age groups (children, adults) that consistently replicated the association between autonomic, subjective, and behavioral measures of cognitive inflexibility during perseverative cognition. Moreover, compelling neuroimaging data suggest that HRV reduction from pre- to post-induction of perseverative cognition is associated with both structural and functional brain abnormalities reflecting impaired prefrontal inhibitory control over subcortical structures (e.g., diminished prefrontal-amygdala functional connectivity). The integration of neuroscience techniques with clinical autonomic research has advanced our understanding of the neurobiology of brain-heart interaction during perseverative cognition, potentially yielding to more effective treatment packages. This is clinically relevant if one considers that perseverative cognition is a pervasive transdiagnostic factor that carries prognostic risk for both psychological and somatic health.

Factorial structure and construct validity of an Italian version of the Fears of Compassion Scales: A study on non-clinical subjects

OBJECTIVES

This study was aimed at investigating the factorial structure and the construct validity of the Italian translation of the Fears of Compassion (FC) Scales in a non-clinical sample (i.e., Fear of Compassion From Others [FCFO], Fear of Compassion Towards Others [FCTO] and Fear of Self-Compassion [FSC]). An exploratory factor analysis was conducted on all the items to investigate the dimensionality of the FC scales. To assess construct validity, correlations between the FC scales and a series of construct-related measures were analysed.

DESIGN/METHODS

After being translated into Italian using a back-translation procedure, the questionnaire was administered to a community sample of 298 participants (82 males) with a mean age of 24.31 (SD = 8.75), along with self-report measures of psychopathological symptoms, attachment style, self-esteem, satisfaction with life and altruistic behaviour. A behavioural test of altruism was also administered in a subsample of 40 subjects.

RESULTS

Thirteen of 38 items did not show adequate psychometric characteristics and thus were removed. The remaining 25 items showed a clear 3-factor solution which explained 48% of the variance. FC Scales were significantly correlated with all the construct-related scales administered in the expected direction, with higher effect sizes for FCFO and FSC than FCTO.

CONCLUSIONS

Although 13 items were removed, results confirmed the expected three factor solution for the Italian translation of FC scales, and provided new evidence for their construct validity. In this vein, an interesting pattern of correlations emerged with psychiatric symptoms and prosocial behaviour, indicating that FCFO and FSC are more powerful correlates of psychopathology and altruism with respect to FCTO.

PRACTITIONER POINTS

Fears of Compassion Scales have been increasingly used in clinical and research settings. The reduced Italian version of the FCS developed in this study is a valid and parsimonious instrument. Fears of receiving compassion from others and from ourselves are more powerful predictors of psychopathological symptoms than fear of giving compassion to others. Fears of Compassion Scales were correlated with both a self-report and a behavioural measure of altruism.

The Current and Future Role of Heart Rate Variability for Assessing and Training Compassion

The evolution of mammalian caregiving involving hormones, such as oxytocin, vasopressin, and the myelinated vagal nerve as part of the ventral parasympathetic system, enables humans to connect, co-regulate each other’s emotions and create prosociality. Compassion-based interventions draw upon a number of specific exercises and strategies to stimulate these physiological processes and create conditions of “interpersonal safeness,” thereby helping people engage with, alleviate, and prevent suffering. Hence, compassion-based approaches are connected with our evolved caring motivation and attachment and our general affiliative systems that help regulate distress. Physiologically, they are connected to activity of the vagus nerve and corresponding adaptive heart rate variability (HRV). HRV is an important physiological marker for overall health, and the body–mind connection. Therefore, there is significant value of training compassion to increase HRV and training HRV to facilitate compassion. Despite the significance of compassion in alleviating and preventing suffering, there remain difficulties in its precise assessment. HRV offers a useful form of measurement to assess and train compassion. Specific examples of what exercises can facilitate HRV and how to measure HRV will be described. This paper argues that the field of compassion science needs to move toward including HRV as a primary outcome measure in its future assessment and training, due to its connection to vagal regulatory activity, and its link to overall health and well-being.