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

Investigating the effects and efficacy of self-compassion intervention on generalized anxiety disorders

BACKGROUND

Generalized anxiety disorder (GAD) is the least successfully treated anxiety disorder. This clinical trial investigated the effects and efficacy of a novel self-compassion intervention in GAD.

METHODS

A total of 75 GAD patients were assigned to a self-compassion intervention group (n = 25), a mindfulness intervention group (n = 25), or a treat-as-usual group (n = 25). Patients in the two active groups received eight intervention sessions in two weeks in addition to usual treatment i.e., pharmacotherapy. Primary outcomes were anxiety and worry, assessed at pre-intervention, post-intervention, and three-month follow-up. Secondary outcomes included depression, sleep, as well as self-compassion and mindfulness.

RESULTS

Both the self-compassion and mindfulness intervention induced a more rapid decrease in anxiety and depression than pharmacological treatment alone with excellent response and remission rate. Self-compassion intervention also induced a more rapid improvement in sleep quality compared to mindfulness intervention and pharmacological treatment alone. We also presented a mechanism for the self-compassion intervention in which decreased anxiety led to improvement in sleep quality. There was also a higher pleasure, acceptance, and willingness to re-attend in the self-compassion compared to the mindfulness intervention.

LIMITATIONS

This study was single blinded and nonrandomized which may bring risks of bias.

CONCLUSIONS

Overall, we provided novel evidence that self-compassion intervention is an alternative psychotherapy for GAD with excellent response and acceptability.

Compassion Focused Therapy for Groups: Transdiagnostic Treatment for Turbulent Times

The concept of compassion has a centuries-long history as a pillar of philosophical and religious discourse as a response to human suffering. More recently, Paul Gilbert, the founder of Compassion Focused Therapy (CFT) has explained compassion evolutionarily as a willingness to enter human suffering and a commitment to alleviating it. In the face of increased (and increasing) suffering in the world, compassion shows promise as both a societal and an individual intervention. In the following article, we discuss the background and theory of CFT, the empirical evidence for CFT delivered in a group therapy format, and present a standardized protocol. We then present an illustrative clinical vignette and discuss the current clinical and research limitations. We call for continued research to expand our understanding of CFT as well as its potential reach, and conclude by recommending CFT as an evidence-based group treatment that is particularly appropriate for the current global climate.

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.

The Me and the Us of Emotions: a cluster-randomized controlled trial of the feasibility and efficacy of a compassion-based social-emotional learning program for children

There are well-established benefits of social and emotional learning (SEL) programs for children within educational contexts. Combining social-emotional skills and compassion abilities has been seldomly done, and it may be valuable at individual and societal levels, for resilient, empathetic, and inclusive societies. This study explored the feasibility and efficacy of a program designed to promote socioemotional and compassion skills in children attending the 3rd and 4th grades, by using in-class dynamics complemented with serious games. This program, named "The Me and the Us of Emotions," is part of the Gulbenkian Knowledge Academies 2020 and consists of 10 group sessions embedded in the school curriculum. Using a cluster-randomized controlled trial design, school classes were allocated to intervention (classes, n = 8; children, n = 163) and control groups (classes, n = 6; children, n = 132). During the program, facilitators assessed adherence to the sessions' plan, attendance, dosage (i.e., how many sessions were delivered), and participant responsiveness. Children completed self-report measures of social-emotional skills and emotional climate at pre-, post-intervention, 3-month, and 6-month follow-ups. Results indicate that the program is feasible, with high adherence, high attendance rate, and participant responsiveness. Results also indicate empathy, soothing, and drive feelings to change from pre-intervention to all other assessment moments, for the intervention group only. Moreover, cooperation and threat changed over time for participants in both the control and the intervention groups. The current study offers empirical support for the feasibility and utility of a compassion-based social-emotional learning program on promoting children's empathy, and emotions of soothing and vitality in the school context. Thus, these findings contribute to recent research on the potential added value of compassion practices within an SEL program.

Differential reduction of psychological distress by three different types of meditation-based mental training programs: A randomized clinical trial

Objective

There is little knowledge about which types of meditation-based training are effective for alleviating which facets of psychological distress. We investigated shared and specific effects of three meditation-based training programs on distress.

Method

332 healthy adults were assigned to a retest control cohort or to one of three 3-month mental training cohorts including: the cultivation of mindfulness-based attention (Presence), socio-affective skills such as compassion (Affect), or metacognitive skills such as perspective taking (Perspective). A battery of 68 self-reported distress measures was collected. Data were analyzed using machine learning methods, identifying the cohort allocation based on distress change scores.

Results

Supporting only specific and not shared alleviation effects, the classifiers identified significantly above chance Presence from Affect and Affect from Perspective, but they did not identify the training cohorts from the retest cohorts.

Conclusions

The classifiers revealed stable module-associated distress change profiles, which could help to precisely choose meditation-based interventions to target individuals' specific distress patterns.

The integrative process promoted by EMDR in dissociative disorders: neurobiological mechanisms, psychometric tools, and intervention efficacy on the psychological impact of the COVID-19 pandemic

Dissociative disorders (DDs) are characterized by a discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, bodily representation, motor control, and action. The life-threatening coronavirus disease 2019 (COVID-19) pandemic has been identified as a potentially traumatic event and may produce a wide range of mental health problems, such as depression, anxiety disorders, sleep disorders, and DD, stemming from pandemic-related events, such as sickness, isolation, losing loved ones, and fear for one's life. In our conceptual analysis, we introduce the contribution of the structural dissociation of personality (SDP) theory and polyvagal theory to the conceptualization of the COVID-19 pandemic-triggered DD and the importance of assessing perceived safety in DD through neurophysiologically informed psychometric tools. In addition, we analyzed the contribution of eye movement desensitization and reprocessing (EMDR) to the treatment of the COVID-19 pandemic-triggered DD and suggest possible neurobiological mechanisms of action of the EMDR. In particular, we propose that, through slow eye movements, the EMDR may promote an initial non-rapid-eye-movement sleep stage 1-like activity, a subsequent access to a slow-wave sleep activity, and an oxytocinergic neurotransmission that, in turn, may foster the functional coupling between paraventricular nucleus and both sympathetic and parasympathetic cardioinhibitory nuclei. Neurophysiologically informed psychometric tools for safety evaluation in DDs are discussed. Furthermore, clinical and public health implications are considered, combining the EMDR, SDP theory, and polyvagal conceptualizations in light of the potential dissociative symptomatology triggered by the COVID-19 pandemic.

Empathy, sympathy, and altruism-An evident triad based on compassion. A theoretical model for caring

BACKGROUND

Based on existing confusion and a suggested contradiction regarding empathy and compassion in relation to caring science as well as in clinical health care.

AIM

The aim of the study was to find a knowledge base for the development of clinical caring science for, empathy, sympathy altruism, and compassion and their mutual relationship.

DESIGN

A theoretical paper.

RESULTS

The text discusses the different concepts separately, considering their history, research, obstacles, and bias and then brings them together in a concept model. The conclusion shows that empathy, sympathy, and altruism have no contradictions. Instead, they together form an evident triad based on compassion. Compassion is a prerequisite and a basis for the others to work. In clinical application, empathy is metaphorically a quality coming from the head, sympathy from the heart and altruism from the hand, merged in an attitude of compassion as a motif to care. The paper also reflects on the possibilities to increase and develop a compassionate mood and capacity by education and training.

Athletes' self-compassion and emotional resilience to failure: the mediating role of vagal reactivity

Whether athletes' self-compassion predicts their emotional resilience to failure has yet to be empirically tested. Moreover, as an important physiological process of stress regulation, vagal reactivity is a plausible physiological mechanism for this relationship. Through a laboratory-based observational study of 90 college athletes, this research explores the influence of athletes' trait self-compassion on their emotional resilience when recalling failure, and examines whether vagal reactivity plays a mediating role. The results show that self-compassion did not significantly predict athletes' positive emotions but did significantly predict better recovery from negative emotions after recalling failure events. Furthermore, vagal reactivity was a significant mediator between self-compassion and recovery from 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.

Compassion Focused Group Therapy for People With a Diagnosis of Bipolar Affective Disorder: A Feasibility Study

Background

Compassion focused therapy (CFT) is an evolutionary informed, biopsychosocial approach to mental health problems and therapy. It suggests that evolved motives (e.g., for caring, cooperating, competing) are major sources for the organisation of psychophysiological processes which underpin mental health problems. Hence, evolved motives can be targets for psychotherapy. People with certain types of depression are psychophysiologically orientated towards social competition and concerned with social status and social rank. These can give rise to down rank-focused forms of social comparison, sense of inferiority, worthlessness, lowered confidence, submissive behaviour, shame proneness and self-criticism. People with bipolar disorders also experience elevated aspects of competitiveness and up rank status evaluation. These shift processing to a sense of superiority, elevated confidence, energised behaviour, positive affect and social dominance. This is the first study to explore the feasibility of a 12 module CFT group, tailored to helping people with a diagnosis of bipolar disorder understand the impact of evolved competitive, status-regulating motivation on their mental states and the value of cultivating caring and compassion motives and their psychophysiological regulators.

Methods

Six participants with a history of bipolar disorder took part in a CFT group consisting of 12 modules (over 25 sessions) as co-collaborators to explore their personal experiences of CFT and potential processes of change. Assessment of change was measured via self-report, heart rate variability (HRV) and focus groups over three time points.

Results

Although changes in self-report scales between participants and across time were uneven, four of the six participants consistently showed improvements across the majority of self-report measures. Heart rate variability measures revealed significant improvement over the course of the therapy. Qualitative data from three focus groups revealed participants found CFT gave them helpful insight into: how evolution has given rise to a number of difficult problems for emotion regulation (called tricky brain) which is not one's fault; an evolutionary understanding of the nature of bipolar disorders; development of a compassionate mind and practices of compassion focused visualisations, styles of thinking and behaviours; addressing issues of self-criticism; and building a sense of a compassionate identity as a means of coping with life difficulties. These impacted their emotional regulation and social relationships.

Conclusion

Although small, the study provides evidence of feasibility, acceptability and engagement with CFT. Focus group analysis revealed that participants were able to switch from competitive focused to compassion focused processing with consequent improvements in mental states and social behaviour. Participants indicated a journey over time from 'intellectually' understanding the process of building a compassionate mind to experiencing a more embodied sense of compassion that had significant impacts on their orientation to (and working with) the psychophysiological processes of bipolar disorder.

Nurturing compassion in schools: A randomized controlled trial of the effectiveness of a Compassionate Mind Training program for teachers

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.

Integrating top-down and bottom-up requirements in eHealth development: The case of a mobile self-compassion intervention for people with newly diagnosed cancer (Preprint)

Background

Objective

Methods

Results

Conclusions

Secure Attachment Representation in Adolescence Buffers Heart-Rate Reactivity in Response to Attachment-Related Stressors

To date, we know very little about the effects of the differences in attachment classifications on the physiological correlates of stress regulation in adolescent age groups. The present study examined for the first time heart rate (HR) and heart rate variability (HRV) during an attachment interview in adolescents. HR and HRV data were collected during a baseline assessment as well as during the administration of the Adult Attachment Projective Picture System (AAP) in a community-based sample of 56 adolescents (26 females and 30 males, mean age = 16.05 years [SD = 1.10]). We additionally used the Adult Attachment Interview (AAI) in 50% of our sample to test the convergent validity. Adolescents with a secure attachment representation showed a higher HRV from baseline to the AAP interview compared to those with an insecure-dismissing (Ds) and the unresolved group. A comparison between the two insecure attachment groups showed no significant difference related to HR and HRV. Cohen’s Kappa (κ = 0.81) revealed an almost perfect agreement between the AAP and the AAI for the four-group classification. Our results indicate that adolescents with a secure attachment representation are more capable of dealing with attachment-related distress which is represented in higher HRV during an attachment interview.

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.

The role of social connection on the experience of COVID-19 related post-traumatic growth and stress

BACKGROUND

Historically social connection has been an important way through which humans have coped with large-scale threatening events. In the context of the COVID-19 pandemic, lockdowns have deprived people of major sources of social support and coping, with others representing threats. Hence, a major stressor during the pandemic has been a sense of social disconnection and loneliness. This study explores how people's experience of compassion and feeling socially safe and connected, in contrast to feeling socially disconnected, lonely and fearful of compassion, effects the impact of perceived threat of COVID-19 on post-traumatic growth and post-traumatic stress.

METHODS

Adult participants from the general population (N = 4057) across 21 countries worldwide, completed self-report measures of social connection (compassion for self, from others, for others; social safeness), social disconnection (fears of compassion for self, from others, for others; loneliness), perceived threat of COVID-19, post-traumatic growth and traumatic stress.

RESULTS

Perceived threat of COVID-19 predicted increased post-traumatic growth and traumatic stress. Social connection (compassion and social safeness) predicted higher post-traumatic growth and traumatic stress, whereas social disconnection (fears of compassion and loneliness) predicted increased traumatic symptoms only. Social connection heightened the impact of perceived threat of COVID-19 on post-traumatic growth, while social disconnection weakened this impact. Social disconnection magnified the impact of the perceived threat of COVID-19 on traumatic stress. These effects were consistent across all countries.

CONCLUSIONS

Social connection is key to how people adapt and cope with the worldwide COVID-19 crisis and may facilitate post-traumatic growth in the context of the threat experienced during the pandemic. In contrast, social disconnection increases vulnerability to develop post-traumatic stress in this threatening context. Public health and Government organizations could implement interventions to foster compassion and feelings of social safeness and reduce experiences of social disconnection, thus promoting growth, resilience and mental wellbeing during and following the pandemic.

Compassionate Mind Training: An 8-week group for the general public

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.

A Systematic Review of Respiratory Sinus Arrhythmia in Romantic Relationships

Respiratory sinus arrhythmia (RSA), an index of the parasympathetic nervous system, has recently gained attention as a physiological component of regulatory processes, social connectedness, and health. Within the context of romantic relationships, studies have operationalized and conceptualized RSA in disparate ways, obscuring a clear pattern of findings. This systematic review synthesizes the rapidly developing literature and clarifies the role of RSA in romantic relationships. We evaluate support for three conceptual hypotheses: (1) resting baseline RSA is associated with better quality relationships; (2) phasic RSA is reflective of changes in threat and connection during couple interactions; and (3) physiological linkage in RSA between romantic partners relates to positive or negative relationship functioning depending on the nature of the linkage (e.g., in-phase vs. antiphase). We identified 26 empirical studies that tested associations between RSA and an index of romantic relationships (i.e., relationship satisfaction). Our findings show that higher RSA is not uniformly "good" for relationships. Higher resting baseline RSA was contemporaneously associated with better quality relationships, yet higher baseline RSA was also unexpectedly associated with relationship violence. Short-term decreases in RSA were found during relationship conflict, though the opposite-phasic increases in RSA during positive romantic partner interactions-was not found due to mixed empirical support. As expected, evidence for RSA linkage was found, though the connection between linkage and relationship functioning depends on the context in which it was measured. We discuss methodological limitations and directions for future research.

Fears of compassion magnify the harmful effects of threat of COVID-19 on mental health and social safeness across 21 countries

Background

The COVID‐19 pandemic is a massive global health crisis with damaging consequences to mental health and social relationships. Exploring factors that may heighten or buffer the risk of mental health problems in this context is thus critical. Whilst compassion may be a protective factor, in contrast fears of compassion increase vulnerability to psychosocial distress and may amplify the impact of the pandemic on mental health. This study explores the magnifying effects of fears of compassion on the impact of perceived threat of COVID‐19 on depression, anxiety and stress, and social safeness.

Methods

Adult participants from the general population (N = 4057) were recruited across 21 countries worldwide, and completed self‐report measures of perceived threat of COVID‐19, fears of compassion (for self, from others, for others), depression, anxiety, stress and social safeness.

Results

Perceived threat of COVID‐19 predicted increased depression, anxiety and stress. The three flows of fears of compassion predicted higher levels of depression, anxiety and stress and lower social safeness. All fears of compassion moderated (heightened) the impact of perceived threat of COVID‐19 on psychological distress. Only fears of compassion from others moderated the effects of likelihood of contracting COVID‐19 on social safeness. These effects were consistent across all countries.

Conclusions

Fears of compassion have a universal magnifying effect on the damaging impact of the COVID‐19 pandemic on mental health and social safeness. Compassion focused interventions and communications could be implemented to reduce resistances to compassion and promote mental wellbeing during and following the pandemic.

The Compassionate Kitbag: A creative and integrative approach to compassion-focused therapy

PURPOSE

This paper outlines the concept of the 'Compassionate Kitbag', a novel multi-sensory-based means of helping draw together the various elements of compassionate mind training and processes within compassion-focused therapy (CFT), to help clients cultivate and facilitate their capacities for compassion. Building on the work of Lucre and Corten (2013, Psychology and Psychotherapy: Theory, Research and Practice, 86, 387), this is the first published work exploring this concept and the theoretical underpinnings, with a specific focus on how this can be used to support people with attachment and relational trauma.

METHODS

A narrative review of the literature on multi-sensory stimulation in facilitating people's capacities for compassion was conducted, coupled with a review of the literature of the use of non-human and transitional objects as explained by attachment theory and the broader scientific research underpinning the CFT model.

RESULTS

Clinical examples of how to use the Compassionate Kitbag to help stimulate compassionate therapeutic processes demonstrate the benefits of and how to begin utilizing this approach in compassion-focused work with clients with complex needs.

CONCLUSIONS

The Compassionate Kitbag's potential therapeutic value lies in offering multifarious creative and tangible means of accessing compassion to a wide range of individuals whom are typically fearful of, blocked, and/or resistant to compassion. Further research into the wider application of the concept of the Compassionate Kitbag is needed.

PRACTITIONER POINTS

Many patients with ruptured and/or traumatized early attachment relationships can find more traditional talking therapies difficult to access. Compassion-focused therapy (CFT) can offer an evolutionary-based understanding of interpersonal difficulties which can be helpful for such patients. Creatively harnessing and utilizing multi-sensory and non-linguistic social signals in CFT is key to exercising the care-giving and care-receiving social mentalities that facilitate compassionate flow. There is considerable evidence to support the use of a multi-sensory component to the therapeutic work to help patients cultivate and facilitate their capacities for compassion. The Compassionate Kitbag can be a way of supporting patients to create concrete representations of compassion in the context of the compassionate mind training component of the therapeutic work. Some of these objects can become transitional objects which can aid the therapeutic work.

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.

Effectiveness of compassion-focused therapy on self-criticism of the women applying for divorce

INTRODUCTION

Making decision for separation from the spouse is one of the crises which are followed by unpleasant feelings such as self-criticism in the people. The purpose of the present study was to investigate the effectiveness of compassion-focused therapy (CFT) on self-criticism of the women applying for divorce.

MATERIALS AND METHODS

The research design was quasi-experimental with pretest, posttest, and control group type. The population included all the women applying for divorce who referred to an intervention-in-crisis center under the supervision of the organization of well-being in the city of Tehran in 2019. It had the convenient sampling method where the subjects were accommodated into two groups of fifteen women both in the experimental and control groups. The present study had the convenient nonrandom sampling method and the statistical population included 30 women from whom 15 women were accommodated into experimental group and so were 15 in the control group. Sampling method was in available, nonrandom type wherein 15 women were accommodated in the experimental group and so were 15 women in the control group. The experimental group participated in eight 90-min sessions of CFT and the control group did not receive any intervention. Before and after practical experimental administration, both the groups were assessed through self-criticism questionnaire by Smart et al. (2016). The statistical method used in the data analysis was ANCOVA.

RESULTS

The results showed that at the error level of 0.5, after controlling the effect of pretest scores as a covariance factor, the mean of the experimental group was significantly lower than the mean of the control group, which shows that CFT approach has been effective in reducing self-criticism.

CONCLUSION

As a result, CFT approach can help the people who face the crisis of making decision for divorce and self-criticism to be able to confront this issue effectively and achieve mental health.

Psychological and Physiological Effects of the Mindful Lovingkindness Compassion Program on Highly Self-Critical University Students in South Korea

Objectives

Self-critical behavior is especially relevant for university students who face academic and non-academic stressors, leading to negative outcomes such as mental distress and psychopathologies. To address this behavior, mindfulness and compassion are important factors to decrease self-criticism and ensure positive outcomes. This study examined the psychological and physiological effects of an intervention, the Mindful Lovingkindness Compassion Program (MLCP), on highly self-critical university students in South Korea.

Methods

Thirty-eight university students with a high level of self-criticism were assigned to an MLCP group (n = 18) or waitlist (WL) group (n = 20). Self-report measures of self-criticism, self-reassurance, psychological distress, and other mental health variables were completed, and the physiological measure of heart rate variability (HRV) was conducted before and after the intervention with both groups. In addition, 1- and 3-month follow-up assessments were conducted using self-report measurements.

Results

Compared to the WL group, participants in the MLCP group experienced significantly greater reductions in self-criticism and psychological distress, and a greater increase in self-reassurance, mental health, and HRV. The improvements in the self-report measures were maintained when assessed 1 and 3 months later.

Conclusions

MLCP could be a promising intervention for alleviating self-criticism and increasing self-reassurance among self-critical individuals.

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.

Impact of a 12-Week Group-Based Compassion Focused Therapy Intervention on Heart Rate Variability

Heart rate variability (HRV) is considered an index of self-regulatory capacity, and trait compassion predicts healthy HRV and self-regulation. Compassion focused psychotherapy interventions have been shown to increase levels of compassion in the general population but no studies to date have examined if these interventions also increase HRV in a distressed clinical sample. The present study examined whether a 12-week compassion focused therapy intervention administered in group format would improve resting HRV and impact HRV reactivity during self-critical writing and self-compassion writing tasks administered before and after the intervention. A total of 31 participants in a university counseling center completed the intervention and HRV assessments. Resting HRV did not significantly change over the course of the intervention in the overall sample. Only those who showed a reliable increase in self-compassion also had a significant increase in resting HRV post-intervention. Additionally, the self-critical writing task was associated with a significant decrease in HRV, with HRV staying low during self-compassionate writing and then significantly increasing during recovery. Reliable change in self-compassion predicted increased HRV reactivity to self-critical and self-compassion writing tasks following the intervention, indicating greater engagement with the task. Findings support the idea that increased self-compassion increases HRV reactivity and potentially strengthens ability to engage with difficult emotions in psychotherapy.

Attachment and compassion-threat: Influence of a secure attachment-prime

OBJECTIVES

The present paper proposed and tested a methodology for reducing individual's threat response to compassion-imagery, by increasing their levels of state attachment-security.

DESIGN

A total of 68 University students (63% female, mean age = 25) completed an experimental study, where they were randomly assigned to either a 10-min attachment-prime (to enhance attachment-security) or an interpersonal skills module (control condition).

METHODS

Participants completed a compassion-focused imagery exercise before and after the manipulation, to determine the effects of the attachment-prime. To measure the effects of the manipulation on individual's threat response, heart rate variability data were collected at baseline and during both compassion exercises.

RESULTS

As predicted, individuals who reported higher levels of anxious and avoidant attachment styles were more likely to display a threat response (decreases in heart rate variability), to the first compassion-focused imagery. After receiving an attachment-prime, heart rate variability increased suggesting that individual's experienced greater self-soothing responses and decreased threat responses to the second compassion-focused imagery.

CONCLUSIONS

The present findings suggest that individuals with insecure attachments are likely to require additional support increasing their attachment-security, before they can successfully engage in compassion-based exercises or therapies.

PRACTITIONER POINTS

Compassion-based exercises may result in fear and consequently avoidance in some populations of individuals. Threat responses to compassion can be reduced by using attachment-based techniques. Research findings will help inform and broaden the clinical applicability of compassion-based therapies.

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.

Attachment styles modulate neural markers of threat and imagery when engaging in self-criticism

Attachment styles hold important downstream consequences for mental health through their contribution to the emergence of self-criticism. To date, no work has extended our understanding of the influence of attachment styles on self-criticism at a neurobiological level. Herein we investigate the relationship between self-reported attachment styles and neural markers of self-criticism using fMRI. A correlation network analysis revealed lingual gyrus activation during self-criticism, a marker of visual mental imagery, correlated with amygdala activity (threat response). It also identified that secure attachment positively correlated with lingual gyrus activation, whilst avoidant attachment was negatively correlated with lingual gyrus activation. Further, at greater levels of amygdala response, more securely attached individuals showed greater lingual gyrus activation, and more avoidantly attached individuals showed less lingual gyrus activation. Our data provide the first evidence that attachment mechanisms may modulate threat responses and mental imagery when engaging in self-criticism, which have important clinical and broader social implications.

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.

Does Compassion Predict Blood Pressure and Hypertension? The Modifying Role of Familial Risk for Hypertension

Background

This study investigated (i) whether compassion is associated with blood pressure or hypertension in adulthood and (ii) whether familial risk for hypertension modifies these associations.

Method

The participants (N = 1112–1293) came from the prospective Young Finns Study. Parental hypertension was assessed in 1983–2007; participants’ blood pressure in 2001, 2007, and 2011; hypertension in 2007 and 2011 (participants were aged 30–49 years in 2007–2011); and compassion in 2001.

Results

High compassion predicted lower levels of diastolic and systolic blood pressure in adulthood. Additionally, high compassion was related to lower risk for hypertension in adulthood among individuals with no familial risk for hypertension (independently of age, sex, participants’ and their parents’ socioeconomic factors, and participants’ health behaviors). Compassion was not related to hypertension in adulthood among individuals with familial risk for hypertension.

Conclusion

High compassion predicts lower diastolic and systolic blood pressure in adulthood. Moreover, high compassion may protect against hypertension among individuals without familial risk for hypertension. As our sample consisted of comparatively young participants, our findings provide novel implications for especially early-onset hypertension.

Electronic supplementary material

The online version of this article (10.1007/s12529-020-09886-5) contains supplementary material, which is available to authorized users.

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.

Effect of adding a compassion-focused intervention on emotion, eating and weight outcomes in a commercial weight management programme

This study examined whether adding a compassion-focused light touch digital intervention into a commercial multicomponent weight management programme improved eating behaviour, self-evaluation and weight-related outcomes. The compassion intervention significantly reduced binge eating symptomatology and dropout, and improved psychological adjustment and self-evaluation, but did not affect weight outcomes. Compassion, self-reassurance and reductions in shame and self-criticism mediated the effect of the intervention on reductions of binge eating symptomatology. Negative self-evaluation, binge eating symptomatology, susceptibility to hunger and eating guilt were significant predictors of dropout. Findings suggest that compassion-based digital tools may help participants better manage binge eating symptomatology and self-evaluation in weight management interventions.

The neurophysiological basis of compassion: An fMRI meta-analysis of compassion and its related neural processes

Theoretical and neurophysiological investigations into compassion are burgeoning, yet the putative neural mechanisms which underpin such processes are less well understood. Therefore, we have conducted an Activation-Likelihood Estimate meta-analysis in order to ascertain the shared neural processes consistently identified as relevant to compassion. Our analysis of sixteen fMRI studies revealed activation across seven broad regions, with the largest peaks localized to the Periaqueductal Grey, Anterior Insula, Anterior Cingulate, and Inferior Frontal Gyrus. Overall, we identified a tendency for studies to operationalize compassion in one of three ways, as driven either 'top-down', 'bottom-up', or modified by target context. We failed to identify regions purportedly common to compassion such as the DLPFC, OFC, and Amygdala, possibly due to a small number of studies which used Loving-Kindness meditation. We argue future research in compassion science continue a multi-modal approach to examine links between neural activity and actual prosocial behavior, and recommend the application of fMRI paradigms on compassion with clinically diagnosed populations to parallel current trends in psychotherapy such as Compassion Focused Therapy.

Self-reassurance, not self-esteem, serves as a buffer between self-criticism and depressive symptoms

OBJECTIVES

Several studies suggest that self-criticism and self-reassurance operate through different mechanisms and might interact with each other. This study examined the hypothesis that self-reassurance serves as a buffer between self-criticism and depressive symptoms in a way that self-esteem, which is rooted in a different motivational system, may not.

DESIGN

We hypothesized that self-criticism would be correlated with high levels of depressive symptoms, but that this association would be weaker at higher levels of self-reassurance abilities. We also hypothesized that self-esteem, a self-relating process based on feeling able and competent to achieve life goals, would not buffer the relationship between self-criticism and depression.

METHODS

Self-criticism, self-reassurance, depressive symptoms, and self-esteem were assessed in a sample of 419 participants (66% females; M_age  = 33.40, SD = 11.13).

RESULTS

At higher levels of self-reassurance, the relationship between self-criticism and depressive symptoms became non-significant, supporting the buffering hypothesis of self-reassurance. Despite the high correlation between self-esteem and self-reassurance, self-esteem did not moderate the relationship between self-criticism and depressive symptoms.

CONCLUSIONS

Results support the growing evidence that not all positive self-relating processes exert the same protective function against psychopathological consequences of self-criticism. Implications for psychotherapy and the validity of using compassion-focused interventions with clients with self-critical issues are discussed.

PRACTITIONER POINTS

Self-reassurance and self-criticism are distinct processes and they should not be considered positive and negative variations of a single dimension Different types of positive self-relating do not show the same correlation with depressive symptoms. The ability to be self-reassuring protects against the psychopathological correlates of self-criticism while having high self-esteem does not. Compassion-focused interventions are promising avenues to help clients counteract the negative impact of self-criticism on mood.

Psychological and physiological effects of emotion focused training for self-compassion and self-protection

Emotion Focused Training for Self-Compassion and Self-Protection (EFT-SCP) is a novel intervention developed on the basis of the latest findings on self-criticism from Emotion-focused therapy and existing programs designed to cultivate compassion. EFTSCP is designed to encourage participants to cultivate self-compassion and protective anger as a way of reducing selfcriticism. Our goal was to investigate the effect of this group-based intervention on self-criticism, self-protection, and self-compassion. A total of 73 students were assigned to the EFT-SCP intervention (n=19), no-treatment control (n=34) or to an active control group (n=20). The intervention group met weekly for 1.5 hours and were instructed to incorporate EFT-SCP tasks into their daily life for 12 weeks. Whilst the no-treatment group did not undergo an intervention, the active control group completed an adapted expressive writing task once a week. In addition to the assessment of heart rate variability during imagery tasks, participants also completed self-reported measures of self-compassion and self-criticism before and after the intervention. Compared with both control groups, the intervention group showed a significant increase in heart rate variability following EFT-SCP (during self-critical imagery, P=.049; probability of superiority was .63, and during self-compassionate imagery P=.007; probability of superiority was .62, both effect sizes were medium) and significant decreases in selfcriticism (Hated Self P=.017; .34 and Inadequate Self P<.001; .33) and self-uncompassionate responding (P<.001; .39). All three effect sizes were small. Participating in EFT-SCP had a positive effect on psychological and physiological outcomes.

Treating hoarding disorder with compassion-focused therapy: A pilot study examining treatment feasibility, acceptability, and exploring treatment effects

OBJECTIVES

Hoarding disorder (HD) was recognized as a psychiatric disorder in 2013. Existing literature suggests room for improvement in its treatment. The current pilot study aimed to provide an initial evaluation on the potential of compassion-focused therapy (CFT) as an intervention for HD, with the primary aim being assessing its feasibility and acceptability, and the secondary being evaluating its effects.

DESIGN

Both CFT and a second round of the current standard of treatment and cognitive behavioural therapy (CBT) were investigated in the current study as follow-up treatment options for individuals who had completed CBT but were still significantly symptomatic.

METHODS

Forty eligible individuals were enrolled (20 in each treatment). Treatment feasibility and acceptability were assessed by quantitative and qualitative measures. To explore treatment effects, HD symptom severity, HD-related dysfunctions, and their underlying mechanisms were assessed pre-treatment and post-treatment.

RESULTS

Retention rates were 72% for CFT and 37% for CBT. All participants and 79% of the participants rated CFT and CBT, respectively, as good or excellent. After receiving CFT as a follow-up treatment, HD symptom severity dropped below the cut-off point for clinically significant HD for 77% of the treatment completers, and 62% achieved clinically significant reduction in symptom severity. In contrast, after completing a second course of CBT, 23% had HD symptom severity dropped below the cut-off threshold, and 29% achieved clinically significant symptom reduction.

CONCLUSIONS

The current study showed satisfactory feasibility and acceptability of CFT. Moreover, it also found promising effects of CFT in addressing hoarding-related mechanisms that may not have been sufficiently addressed by CBT. The results suggest promising potential of CFT as a treatment for HD. Further investigation on this intervention is needed.

PRACTITIONER POINTS

CFT may be a promising treatment option, particularly for those who do not respond well to CBT. Improving emotion regulation and negative self-perception by applying CFT interventions may help relieve hoarding symptoms. Generalization of the findings should be applied with caution given the small convenience sample of the current study. Statistical comparison on treatment effect measures between CFT and CBT as follow-up treatments was not available due to small sample size. Therefore, the comparative conclusions based on this pilot study should be made with caution.

Building an integrative science for psychotherapy for the 21st century: Preface and introduction

Psychotherapy is plagued with fragmentation of models, theories, and interventions. The future of psychotherapy requires an integrative framework rooted in the expanding science of psychology, neuroscience, and social contextualism. The papers in this special issue address these challenges for psychotherapy, ranging from explorations of the implications of epigenetics, evolutionary functional analysis, interpersonal neurobiology, the importance of social relationships as physiological regulators, through to the challenges of ethnic diversities and the growing digital technologies. PRACTITIONER POINTS: As therapists, we should be aware of the challenges posed by the proliferating 'schools of therapy' and consider commonalities rooted in a scientific understanding of the mind. The science of understanding the causes, alleviation, and prevention of mental health problems is increasingly multidimensional taking into consideration the interactions between biological, psychological and social processes and in the process dissolving the boundaries between different schools of psychotherapy.

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.

Psychotherapy for the 21st century: An integrative, evolutionary, contextual, biopsychosocial approach

Fragmentation of processes and interventions plague the psychotherapies (Gilbert & Kirby, ). Part of the problem is that we have not agreed on a framework that could be the basis for integrating knowledge and the scientific enquiry of processes and interventions. This paper outlines an approach that brings together a variety of different disciplines in the service of consilience (Wilson, , Consilience: The unity of knowledge, Vintage, New York, NY; Siegel, ). It presents the importance of an evolutionary framework for understanding the proclivities and dispositions for mental suffering and antisocial behaviour, and how they are choreographed in different sociodevelopmental contexts. Building on earlier models (Gilbert, , Human nature and suffering, Routledge, London, UK; Gilbert, , Clin. Psychol. Psychother., 2, 135; Gilbert, , Br. J. Med. Psychol., 71, 353; Gilbert, , Case formulation in cognitive behaviour therapy: The treatment of challenging cases, Wiley, Chichester, UK, pp. 50-89) the call is for an integrative, evolutionary, contextual, biopsychosocial approach to psychology and psychotherapy. PRACTITIONER POINTS: Evolutionary functional analysis is part of an evolutionary, contextual, biopsychosocial approach to mental health that can serve as a scientific platform for the future developments of psychotherapy. Therapist skills and training will increasing need to focus on the multidimensional textures of mental states especially the context-social-body linkages. Therapies of the future will also focus more on the moral aspects of therapy and address the need to promote prosocial and ethical behaviour to self and others.