Learning Compassion and Meditation: A Mixed-Methods Analysis of the Experience of Novice Meditators

A randomized controlled trial of a compassion-centered spiritual health intervention to improve hospital inpatient outcomes

BACKGROUND

Inpatient medical settings lack evidence-based spiritually integrated interventions to address patient care needs within a pluralistic religious landscape. To address this gap, CCSH™ (Compassion-Centered Spiritual Health) was developed to leverage the skillsets of healthcare chaplains to improve patient outcomes through spiritual consultation. Here, we report the results of a randomized, wait-list controlled, pre-registered (NCT03529812) study that evaluated the impact of CCSH on patient-reported depression and explored putative mediators of CCSH's effects.

METHOD

Chaplain residents were randomized to be trained in CCSH as part of their clinical pastoral education (CPE) residency in the fall (n =  8) or spring semester (n =  8). After fall training, all residents provided spiritual consultations with hospitalized patients (n =  119; n =  54 seen by CCSH-trained chaplains). Those not yet trained to deliver CCSH provided a traditional consult. Patients' pre-consult distress was measured using the National Comprehensive Cancer Network Distress Thermometer, and post-consult depression was measured using the Hospital Anxiety and Depression Scale (HADS). Consults were audio-recorded and transcribed verbatim, and we conducted linguistic analyses using LIWC 2015 software to quantify chaplain linguistic behavior.

RESULTS

Patients seen by CCSH-trained chaplains had lower post-consult depression scores (M =  4.10, SD =  5.04) than patients who were seen by wait-listed chaplains (M =  6.12, SD =  5.08), after adjusting for pre-consult distress (p = .048). There was also a significant relationship between post-consult depression and chaplain LIWC clout scores (r =  -0.24, p = .017), a linguistic measure thought to reflect the expressive confidence and other-oriented focus of the speaker. An exploratory mediation model revealed an indirect effect of CCSH on patient depression through chaplain clout language b =  -0.11 (90% CI, -.257, -.003).

IMPLICATIONS

These data suggest that CCSH decreases patient depression among inpatients, in part due to CCSH-trained chaplains' use of more inclusive, confident, and other-oriented language. We connect these findings with current understandings of effective clinical linguistic behavior and reflect on what this work may mean for integrated spiritual health care.

Hospital Chaplain Burnout, Depression, and Well-Being during the COVID-19 Pandemic

Healthcare personnel experienced unprecedented stressors and risk factors for burnout, anxiety, and depression during the COVID-19 pandemic. This may have been particularly true for spiritual health clinicians (SHCs), also referred to as healthcare chaplains. We administered a daily pulse survey that allowed SHCs to self-report burnout, depression, and well-being, administered every weekday for the first year of the pandemic. We used a series of linear regression models to evaluate whether burnout, depression, and well-being were associated with local COVID-19 rates in the chaplains' hospital system (COVID-19 admissions, hospital deaths from COVID-19, and COVID-19 ICU census). We also compared SHC weekly rates with national averages acquired by the U.S. Census Bureau's Household Pulse Survey (HPS) data during the same timeframe. Of the 840 daily entries from 32 SHCs, 90.0% indicated no symptoms of burnout and 97.1% were below the cutoff for depression. There was no statistically significant relationship between any of the COVID-19 predictors and burnout, depression, or well-being. Mean national PHQ-2 scores were consistently higher than our sample's biweekly means. Understanding why SHCs were largely protected against burnout and depression may help in addressing the epidemic of burnout among healthcare providers and for preparedness for future healthcare crises.

Energizing compassion: using music and community focus to stimulate compassion drive and sense of connectedness

Objectives

The last 20 years have seen considerable research on the nature and biopsychosocial impacts of compassion training on self and others. This training is usually focused on calming and slowing the mind and body and on individual imagery practices and mantras. This study explored the effects of three variations: 1. The impact of using energizing music to generate activation and "drive" for compassion; 2. To focus on imagining "breathing in and breathing out a white light or mist of compassion" to bring compassion to the world; and 3. While listening to energizing music, participants were guided to imagining connecting to the compassion (Sangha) community, imagining oneself as linking with others as part of communities seeking to help the world.

Methods

From approximately 1,600 members of the Compassionate Mind discussion list, participants were invited to take part in a new energizing focused self-practice study. The study involved listening to recorded guidance on the evolutionary model of compassion and the need to address the potentially harmful side of our nature. This was followed by a 4 1/2-min tonglen-informed guided practice of breathing in and breathing out compassion accompanied by energizing music. Forty-three participants completed several self-report scales measuring compassion orientation, wellbeing, social safeness, and positive affect before and following 2 weeks of practice. Participant experiences were recorded from 6 open explorative questions.

Results

Self-report measures taken before and following 2 weeks of practice revealed significant increases in self-compassion, compassion to others, openness to compassion from others, activated positive affect, safe positive affect, social safeness, and wellbeing, with the largest effect size relating to compassion for the self (d = -0.76). In addition, qualitative data revealed that the participants had experienced the practice as energizing, inspiring, and felt socially connected and that it had significant impacts on other aspects of their lives. Some participants noted that engaging with suffering also stimulated sadness.

Conclusion

This study found that pairing energizing music with breathing practices and specific compassion visualizations, focusing on the desire to bring compassion to the world and be part of a compassionate community, was well-accepted and had a range of significant positive impacts. This study indicates the potential value of exploring energizing in comparison to the more standard soothing and settling practices as ways of stimulating the biopsychosocial processes of compassion.