The Oxford Handbook of Compassion Science

2
OXFORD LIBRARY OF PSYCHOLOGY

AREA EDITORS:

Clinical Psychology
David H. Barlow

Cognitive Neuroscience
Kevin N. Ochsner and Stephen M. Kosslyn

Cognitive Psychology
Daniel Reisberg

Counseling Psychology
Elizabeth M. Altmaier and Jo-Ida C. Hansen

Developmental Psychology
Philip David Zelazo

Health Psychology
Howard S. Friedman

History of Psychology
David B. Baker

Methods and Measurement

Todd D. Little

Neuropsychology
Kenneth M. Adams

Organizational Psychology
Steve W. J. Kozlowski

Personality and Social Psychology

Kay Deaux and Mark Snyder

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4
The Oxford Handbook
of Compassion Science

Edited by

Emma M. Seppälä
Emiliana Simon- Thomas
Stephanie L. Brown
Monica C. Worline

5
Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of Oxford University Press in the UK and certain other countries.

Published in the United States of America by Oxford University Press

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© Oxford University Press 2017

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You must not circulate this work in any other form and you must impose this same condition on any acquirer.

Library of Congress Cataloging-in-Publication Data

Names: Seppälä, Emma, editor.
Title: The Oxford handbook of compassion science / edited by Emma M. Seppälä, Emiliana Simon-Thomas, Stephanie L. Brown, Monica C.
Worline, C. Daryl Cameron, and James R. Doty.
Description: New York, NY : Oxford University Press, [2017] | Series: Oxford library of psychology Identifiers: LCCN 2016051458 (print) |
LCCN 2017011026 (ebook) |
ISBN 9780190464684 (hardcover : alk. paper) | ISBN 9780190464691 (UPDF) | ISBN 9780190667283 (EPUB)
Subjects: LCSH: Empathy. | Compassion.
Classification: LCC BF575.E55 O94 2017 (print) | LCC BF575.E55 (ebook) | DDC 158.3—dc23
LC record available at https://lccn.loc.gov/2016051458

6
This book is gratefully dedicated to His Holiness the Dalai Lama, whose belief in both the power of compassion and empirical
research has been an inspiration to so many in the field of compassion science.

7
SHORT CONTENTS

About the Editors

Acknowledgments

Contributors

Table of Contents

Chapters

Index

8
ABOUT THE EDITORS

James R. Doty
James R. Doty is the founder and director of the Center for Compassion and Altruism Research and
Education (CCARE) at Stanford University School of Medicine. Additionally, he is a professor in the
Department of Neurosurgery at Stanford University School of Medicine. Through the center, he has
supported the development of compassion research; promoted the importance of compassion in business,
medicine, and technology; and developed a compassion intervention program (the Compassion Cultivation
Training). His research focuses on the neural bases of compassion and the impact of compassion interventions
for physical and psychological well-being. Dr. Doty is the New York Times bestselling author of Into the Magic
Shop: A Neurosurgeon’s Quest to Discover the Mysteries of the Brain and the Secrets of the Heart.

Emma M. Seppälä
Emma M. Seppälä is Science Director of the Center for Compassion and Altruism Research and
Education (CCARE) at Stanford University School of Medicine and Co-Director of the Yale College
Emotional Intelligence Project at the Yale Center for Emotional Intelligence. Her research focuses on social
connection, compassion, and well-being. She has conducted research on methods like meditation and
breathing for anxiety with students and with veterans of the war in Afghanistan and Iraq. She is a science
writer at Psychology Today and Harvard Business Review and is the author of The Happiness Track: How to
Apply the Science of Happiness to Accelerate Your Success.

Monica C. Worline
Monica C. Worline is a research scientist at Stanford University’s Center for Compassion and Altruism
Research and Education, and Executive Director of CompassionLab, the world’s leading research
“collaboratory” focused on compassion at work. Worline holds a lectureship at the Ross School of Business,
University of Michigan, and is an affiliate faculty member at the Center for Positive Organizations. She is also
the founder and CEO of EnlivenWork, an innovation organization that teaches businesses and others how to
tap into courageous thinking, compassionate leadership, and their curiosity to bring their best work to life.

Stephanie L. Brown
Stephanie L. Brown is an associate professor in the Department of Psychiatry and Behavioral Sciences at
Stony Brook University. She was the lead editor on Oxford’s edited volume entitled Moving Beyond Self-
Interest: Perspectives from Evolutionary Biology, Neuroscience, and the Social Sciences, in which she and her
colleagues advanced a new paradigm for the study of compassion and helping behavior. She is currently
investigating the physiological mechanisms that connect helping behavior to reduced mortality risk.

Emiliana Simon-Thomas
Emiliana Simon-Thomas is the Science Director at the University of California–Berkeley’s Greater Good
Science Center (GGSC). Among other initiatives, she runs the GGSC Research Fellowship program and co-

9
instructs “GG101x: The Science of Happiness,” a massive open online course that has over 450,000 students
enrolled worldwide. Simon-Thomas is trained in cognitive and affective neuroscience, and her work currently
focuses on: (1) how pro-social tendencies like compassion, generosity, and gratitude can benefit health and
well-being at individual, interpersonal, and society-wide levels; and (2) how to strengthen and assess the
impact of increasing pro-social habits within the self, families, communities, and institutions.

C. Daryl Cameron
C. Daryl Cameron is an assistant professor in the Department of Psychology and research associate in the
Rock Ethics Institute at Penn State University. His research focuses on the psychological processes involved
in empathy and moral decision-making. Much of his work examines motivational factors that shape empathic
emotions and behaviors toward others, particularly in response to large-scale crises (e.g., natural disasters,
genocides) and in inter-group situations.

10
ACKNOWLEDGMENTS

We gratefully acknowledge the dedicated and thoughtful comments and copyedits of Dr. James Kirby on a
large number of the chapters. We also are grateful for the administrative support of Dong Nguyen, Jessica
Waala, Kelly Haehnel, and Michael Juberg. Finally, we are grateful to Oxford University Press for
championing the very first Oxford Handbook of Compassion Science.

11
CONTRIBUTORS

Inbal Ben-Ami Bartal

Helen Wills Neuroscience Institute
University of California–Berkeley
Berkeley, California, USA
C. Daniel Batson
Department of Psychology
The University of Kansas
Lawrence, Kansas, USA
R. Michael Brown
Department of Psychology
Pacific Lutheran University
Tacoma, Washington, USA
Stephanie L. Brown
Department of Psychiatry
School of Medicine
Stony Brook University
Stony Brook, New York, USA
C. Daryl Cameron
Department of Psychology
Rock Ethics Institute
The Pennsylvania State University
University Park, Pennsylvania, USA
Kim Cameron
Ross Management and Organizations Department
University of Michigan
Ann Arbor, Michigan, USA
C. Sue Carter
The Kinsey Institute
Indiana University
Bloomington, Indiana, USA
Joan Y. Chiao
Department of Psychology and Interdepartmental Neuroscience Program
Northwestern University
International Cultural Neuroscience Consortium
Highland Park, Illinois, USA

12
Paul Condon
Department of Psychology
Northeastern University
Boston, Massachusetts, USA
Richard J. Davidson
Center for Healthy Minds
University of Wisconsin–Madison
Madison, Wisconsin, USA
Mark H. Davis
Department of Psychology
Eckerd College
St. Petersburg, Florida, USA
David DeSteno
Department of Psychology
Northeastern University
Boston, Massachusetts, USA
James R. Doty
The Center for Compassion and Altruism Research and Education
Department of Neurosurgery
Stanford University
Stanford, California, USA
Jane E. Dutton
Ross School of Business
University of Michigan
Ann Arbor, Michigan, USA
Nancy Eisenberg
Department of Psychology
Arizona State University
Tempe, Arizona, USA
Eve Ekman
Osher for Integrative Medicine
University of California–San Francisco
San Francisco, California, USA
Paul Ekman
Department of Psychology
University of California–San Francisco
San Francisco, California, USA
Charles R. Figley
Traumatology Institute
Tulane University

13
 New Orleans, Louisiana, USA
Kathleen Regan Figley
School of Social Work
Tulane University
New Orleans, Louisiana, USA
Lisa Flook
Center for Healthy Minds
University of Wisconsin–Madison
Madison, Wisconsin, USA
Zeno E. Franco
Department of Family Medicine
Medical College of Wisconsin
Milwaukee, Wisconsin, USA
Christopher Germer
Harvard Medical School
Cambridge, Massachusetts, USA
Dara G. Ghahremani
Semel Institute for Neuroscience and Human Behavior
University of California–Los Angeles
Los Angeles, California, USA
Paul Gilbert
The Compassionate Mind Foundation
Derby, England
Jennifer L. Goetz
Department of Psychology
Centre College
Danville, Kentucky, USA
Philippe R. Goldin
Betty Irene Moore School of Nursing
University of California–Davis
Davis, California, USA
Yotam Heineberg
The Center for Compassion and Altruism Research and Education
Stanford University
Stanford, California, USA
Shao-Hsuan Shaun Ho
Department of Psychiatry
Stony Brook University
Stony Brook, New York, USA
Hooria Jazaieri

14
 Greater Good Science Center
University of California–Berkeley
Berkeley, California, USA
Brandon G. King
Department of Psychology
Center for Mind and Brain
University of California, Davis
Davis, California, USA
James N. Kirby
The School of Psychology
The University of Queensland
Brisbane, Australia
Olga M. Klimecki
Swiss Center for Affective Sciences
Laboratory for the Study of Emotion Elicitation and Expression
Department of Psychology
University of Geneva
Geneva, Switzerland
Sara Konrath
Lilly Family School of Philanthropy
Indiana University
Indianapolis, Indiana, USA;
Institute for Social Research
University of Michigan
Ann Arbor, Michigan, USA;
Department of Psychiatry
University of Rochester Medical Center
Rochester, New York, USA
Birgit Koopmann-Holm
Psychology Department
Santa Clara University
Santa Clara, California, USA
Brooke D. Lavelle
Courage of Care Coalition
Mind and Life Institute
Oakland, California, USA
Christos Lionis
Clinic of Social and Family Medicine
University of Crete
Crete, Greece

15
Daniel Martin
Department of Management
California State University, East Bay
Hayward, California, USA;
Center for Compassion and Altruism Research and Education (CCARE)
Stanford University
Stanford, California, USA
Jennifer Mascaro
Department of Family and Preventive Medicine
Emory University School of Medicine
Atlanta, Georgia, USA
Mario Mikulincer
Ivcher School of Psychology
Interdisciplinary Center (IDC) Herzliya
Herzliya, Israel
Jake P. Moskowitz
Department of Psychology and Social Behavior
University of California–Irvine
Irvine, California, USA
Kristin Neff
Department of Educational Psychology
University of Texas at Austin
Austin, Texas, USA
Lobsang Tenzin Negi
Department of Religion
Emory University
Atlanta, Georgia, USA
Lobsang Tenzin Negi
Department of Religion
Emory University
Atlanta, Georgia, USA
Paul K. Piff
Department of Psychology and Social Behavior
University of California–Irvine
Irvine, California, USA
Eric C. Porges
Center for Cognitive Aging & Memory
Department of Clinical and Health Psychology
University of Florida, Gainesville
Gainesville, Florida, USA

16
Stephen W. Porges
Kinsey Institute
Indiana University
Bloomington, Indiana, USA
Michael J. Poulin
Department of Psychology
University at Buffalo
Buffalo, New York, USA
Charles L. Raison
Department of Psychiatry
School of Medicine and Public Health
University of Wisconsin–Madison
Madison, Wisconsin, USA
Clifford D. Saron
Center for Mind and Brain
MIND Institute
University of California, Davis
Davis, California, USA
Sarina R. Saturn
Department of Psychological Sciences
University of Portland
Portland, Oregon, USA
Brianna Schuyler
Center for Healthy Minds
University of Wisconsin–Madison
Madison, Wisconsin, USA
Emma M. Seppälä
Center for Compassion and Altruism Research and Education
Stanford University
Stanford, California, USA;
Yale Center for Emotional Intelligence
Yale University
New Haven, Connecticut, USA
Phillip R. Shaver
Department of Psychology
University of California–Davis
Davis, California, USA
Sue Shea
Clinic of Social and Family Medicine
University of Crete

17
 Crete, Greece
Emiliana Simon-Thomas
Greater Good Science Center
University of California–Berkeley
Berkeley, California, USA
Tania Singer
Department of Social Neuroscience
Max Planck Institute for Human Cognitive and Brain Science
Leipzig, Germany
Alea C. Skwara
Department of Psychology
Center for Mind and Brain
University of California, Davis
Davis, California, USA
Tracy L. Spinrad
T. Denny Sanford School of Social and Family Dynamics
Arizona State University
Tempe, Arizona, USA
James E. Swain
Department of Psychiatry and Psychology
Stony Brook University
Stony Brook, New York, USA
Jeanne L. Tsai
Department of Psychology
Stanford University
Stanford, California, USA
Erika Weisz
Department of Psychology
Stanford University
Stanford, California, USA
Helen Y. Weng
Department of Psychiatry
Osher Center for Integrative Medicine
Neuroscape, Sandler Neurosciences Institute
University of California–San Francisco
San Francisco, California, USA;
Center for Healthy Minds
University of Wisconsin–Madison
Madison, Wisconsin, USA
Monica C. Worline

18
 Center for Positive Organizations
Ross School of Business
University of Michigan
Ann Arbor, Michigan, USA;
Center for Compassion and Altruism Research and Education
Stanford University
Stanford, California, USA
Jamil Zaki
Department of Psychology
Stanford University
Stanford, California, USA
Sasha Zarins
Lilly Family School of Philanthropy
Indiana University
Indianapolis, Indiana, USA
Philip G. Zimbardo
Department of Psychology
Stanford University
Stanford, California, USA

19
TABLE OF CONTENTS

Preface
James R. Doty

Part One • Introduction

1. The Landscape of Compassion: Definitions and Scientific Approaches

Jennifer L. Goetz and Emiliana Simon-Thomas
2. Compassion in Context: Tracing the Buddhist Roots of Secular, Compassion-Based Contemplative
Programs
Brooke D. Lavelle
3. The Empathy-Altruism Hypothesis: What and So What?
C. Daniel Batson
4. Is Global Compassion Achievable?
Paul Ekman and Eve Ekman

Part Two • Developmental Approaches

5. Compassion in Children
Tracy L. Spinrad and Nancy Eisenberg
6. Parental Brain: The Crucible of Compassion
James E. Swain and S. Shaun Ho
7. Adult Attachment and Compassion: Normative and IndividualDifference Components
Mario Mikulincer and Phillip R. Shaver
8. Compassion-Focused Parenting
James N. Kirby

Part Three • Psychophysiological and Biological Approaches

9. The Compassionate Brain

Olga M. Klimecki and Tania Singer
10. Two Factors That Fuel Compassion: The Oxytocin System and the Social Experience of Moral
Elevation
Sarina Rodrigues Saturn
11. The Impact of Compassion Meditation Training on the Brain and Prosocial Behavior
Helen Y. Weng, Brianna Schuyler, and Richard J. Davidson
12. Cultural Neuroscience of Compassion and Empathy
Joan Y. Chiao
13. Compassionate Neurobiology and Health

20
 Stephanie L. Brown and R. Michael Brown
14. The Roots of Compassion: An Evolutionary and NeurobiologicalPerspective
C. Sue Carter, Inbal Ben-Ami Bartal, and Eric C. Porges
15. Vagal Pathways: Portals to Compassion
Stephen W. Porges

Part Four • Compassion Interventions

16. Empathy-Building Interventions: A Review of Existing Work and Suggestions for Future Directions
Erika Weisz and Jamil Zaki
17. Studies of Training Compassion: What Have We Learned; What RemainsUnknown?
Alea C. Skwara, Brandon G. King, and Clifford D. Saron
18. The Compassion Cultivation Training (CCT) Program
Philippe R. Goldin and Hooria Jazaieri
19. Cognitively Based Compassion Training: Gleaning Generalities fromSpecific Biological Effects
Jennifer Mascaro, Lobsang Tenzin Negi, and Charles L. Raison

Part Five • Social Psychological and Sociological Approaches

20. Compassion Collapse: Why We Are Numb to Numbers

C. Daryl Cameron
21. The Cultural Shaping of Compassion
Birgit Koopmann-Holm and Jeanne L. Tsai
22. Enhancing Compassion: Social Psychological Perspectives
Paul Condon and David DeSteno
23. Empathy, Compassion, and Social Relationships
Mark H. Davis
24. The Class–Compassion Gap: How Socioeconomic Factors InfluenceCompassion
Paul K. Piff and Jake P. Moskowitz
25. Changes Over Time in Compassion-Related Variables in the United States
Sasha Zarins and Sara Konrath
26. To Help or Not to Help: Goal Commitment and the Goodness of Compassion
Michael J. Poulin

Part Six • Clinical Approaches

27. Self-Compassion and Psychological Well-being

Kristin Neff and Christopher Germer
28. Compassion Fatigue Resilience
Charles R. Figley and Kathleen Regan Figley
29. Compassion Fears, Blocks and Resistances: An EvolutionaryInvestigation
Paul Gilbert and Jennifer Mascaro

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Part Seven • Applied Compassion

30. Organizational Compassion: Manifestations Through Organizations

Kim Cameron
31. How Leaders Shape Compassion Processes in Organizations
Monica C. Worline and Jane E. Dutton
32. The Call for Compassion in Health Care
Sue Shea and Christos Lionis
33. A Call for Compassion and Care in Education: Toward a MoreComprehensive Prosocial Framework
for the Field
Brooke D. Lavelle, Lisa Flook, and Dara G. Ghahremani
34. Heroism: Social Transformation Through Compassion in Action
Philip G. Zimbardo, Emma M. Seppälä, and Zeno E. Franco
35. Social Dominance and Leadership: The Mediational Effect of Compassion
Daniel Martin and Yotam Heineberg

Index

22
PREFACE

James R. Doty

Many have misunderstood Charles Darwin’s view of natural selection in On the Origin of Species as a
justification for the necessity of aggressive or ruthless behavior to survive. This view of natural selection as the
survival of the fittest was based on social Darwinist Herbert Spencer’s interpretation of Darwin’s theories to
justify class and race superiority. Alfred Lord Tennyson supported this description of Nature “red in tooth and
claw” in his classic poem “In Memoriam,” in 1850. It was further popularized by Thomas Aldous Huxley,
often called “Darwin’s bulldog,” who wrote a number of essays defending this gladiatorial view of natural
selection.
It is interesting to note, though, that Russian anarchist Petr Kropotkin published a rebuttal to both Spencer
and Huxley in his book, Mutual Aid: A Factor of Evolution, stating, “If we … ask Nature: ‘who are the fittest:
those who are continually at war with each other, or those who support one another?’ we at once see that
those animals which acquire habits of mutual aid are undoubtedly the fittest.” In Darwin’s later-published
Descent of Man, in 1871, he wrote, “Those communities, which included the greatest number of the most
sympathetic members would flourish best, and rear the greatest number of offspring.” Darwin further states,
“We are impelled to relieve the sufferings of another, in order that our painful feelings maybe at the same time
relieved.” Even earlier, Immanuel Kant stated, “It is a duty not to … avoid the pain of compassion, which one
may not be able to resist. For this feeling, though painful, nevertheless is one of the impulses placed in us by
nature effecting what the representation of duty might not accomplish by itself.”
Over the last three decades, the ever-growing interest in brain science has intersected with a similar
growing interest in the motivations that allow a species to survive. What has become evident, and what Kant,
Darwin, and Kropotin allude to, is that compassion, characterized by nurturing and caring behavior, is critical
to the long-term survival of many species and, most importantly perhaps, to the human species. While
empathy researchers like Daniel Batson (see Chapter 3) and Mark Davis (Chapter 23) spearheaded research
in this general area, a more pointed interest in compassion per se seemingly began as a result of a conversation
in 1992 between neuroscientist Richard Davidson and the Dalai Lama in which His Holiness expressed his
belief that meditation allowed one to increase one’s capacity for compassion. The first studies began simply as
an attempt to understand how meditation affects the brain. Over time, it was evident that such practices had
the potential to promote what is at the center of Buddhist philosophy and that of most of the world’s
religions: the cultivation of compassion. The science has further evidenced that such cultivation can have
profound positive effects on one’s physiology. These initial explorations have led to an exponential growth in
empirical research on both meditation and compassion. A new field of research has emerged from these
studies: contemplative neuroscience.
This first Handbook of Compassion Science brings together, for the first time in the form of an academic
handbook, leading researchers in the field of compassion science. The Handbook’s scientists and other scholars
explore what the motivators of compassion are, how compassionate behavior affects one’s physiology, and how

23
can compassion be cultivated.
Having grown up in poverty with a family life severely impacted by addiction, neglect, and mental illness,
for this author, the puzzle of compassion is particularly personal. The roadmap that enabled my own growth
and success fundamentally results from the compassion of others, mentors, friends, and colleagues.
Additionally, as a physician, I have personally experienced the profound effect that compassionate care can
have on the healing process. How is it, then, that our tendency toward compassion overcomes our instincts for
self-preservation?
The more I reflect on this puzzle, the less of a paradox it seems, because, as biology tells us, compassion and
its related systems of nurturing and maternal behavior completely align with the organism’s interest in self-
preservation. As our biology expanded to encompass more sophisticated social interactions, it evolved to
reward them through the release of hormones and neurotransmitters and other positive neurological and
physiological systems (see chapters by Brown and Brown, Klimecki and Singer, Porges, Carter and
Rodrigues). Presumably, these reward contingencies evolved precisely because positive social interactions
benefit us evolutionarily.
Covering multiple levels of our lives and self-concept, from the individual, to the group, to the organization
and culture, this volume gathers evidence and models of compassion that treat the subject of compassion
science with careful scientific scrutiny and concern. In this sense, this volume comprises one of the first
multidisciplinary and systematic approaches to examining compassion from multiple perspectives and frames
of reference.
An effort such as this is not merely important for an academic field, it seems of increasing concern in the
modern world. Given the conflict of culture in the modern world, can understanding the cultural levers of
compassion, as Koopman-Holm and Tsai (Chapter 21) or Chiao (Chapter 12) discuss, offer potential
recourse? Can our schools, as Lavelle et al. (Chapter 33) discuss, caregiving as Figley and Figley (Chapter 28)
of Shea and Lionis (Chapter 32) describe and understanding of development as Spinrad and Eisenberg offer
(Chapter 5) help us forge more compassionate social institutions and care-giving practices? Can we physically
or cognitively construct our daily, everyday contexts to help us expand our concern for others as Cameron
(Chapter 20), Condon and DeSteno (Chapter 22), or Weisz and Zaki (Chapter 16) describe? Finally, as
Skwara, King and Saron (Chapter 17) and Goldin and Jazaieri (Chapter 18) discuss, can we find ways to
directly cultivate compassion through direct meditation or cultivation exercises as a stable component of our
lives?
What these facets of compassion all have in common is that they may contain answers to the critical puzzle
about the proverbial conflict between compassion and self-preservation. In a world characterized by ongoing
warfare, this understanding is more important than ever. As His Holiness the Dalai Lama says, “Compassion
is no longer a luxury, but a necessity if our species is to survive.”

24
 PART 1

25
Introduction

26
 The Landscape of Compassion Definitions and Scientific Approaches

Jennifer L. Goetz and Emiliana Simon-Thomas

Abstract

How do we, as scientists, define compassion? Is it an emotional state, a motivation, a dispositional trait,
or a cultivated attitude? In this introductory chapter, we set forth a working definition for compassion,
situate compassion in the context of related terms and mental experiences, and orient readers to the key
questions addressed by the authors in this handbook. Particular attention is paid to the evolutionary
origins of compassion, the biological structures and processes implicated in compassion, the degree to
which compassion is universal and variable across cultures, and documented approaches to fostering
compassion. In closing, we explore the potential impact of training compassion on personal well-being,
the quality of relationships, organizational success, and society more broadly.

Key Words: compassion, empathy, sympathy, caregiving, emotion, motivation, attitude, trait

Many terms have been used to describe the feelings that occur in response to the suffering of others,
including empathy, empathic concern or distress, compassion, sympathy, and pity (Goetz, Keltner, & Simon-
Thomas, 2010; Batson, Ahmad, & Lishner, 2009; Hoffman, 2008; Jinpa, 2015). In addition, research points
to a variety of psychological processes involved in helping and caring for others, including accurately
recognizing their expressions, adopting their perspective or imagining how they feel, managing one’s own
feelings, and being motivated to provide care or to nurture. Our goal in this chapter is to set forth a working
definition for compassion, to situate compassion in the context of related terms and phenomena, and to orient
readers to the big questions asked and addressed by the authors in this handbook.

What Is Compassion?
Here, we offer a working definition of compassion framed as a discrete and evolved emotional experience.
From this vantage point, compassion is conceived as a state of concern for the suffering or unmet need of
another, coupled with a desire to alleviate that suffering (Goetz et al., 2010). An experience of compassion
defined this way involves several distinct components:

1. Awareness of an antecedent (i.e., suffering or need in another individual);

2. Feeling “moved”; that is, having a subjective physical experience that often involves involuntary arousal of branches of the autonomic
nervous system;
3. Appraisals of one’s own bodily feeling, social role, and abilities within the context of the suffering;
4. Judgments about the person who is suffering and the situational context; and
5. Engagement of the neural systems that drive social affiliation and caregiving, and motivate helping.

Although we see compassion as involving a patterned and specific response, we do not see the components
listed here as serial, or occurring in temporal sequence. We also do not consider the processes underlying these

27
components to be wholly independent; they probably overlap and occur in parallel, and exert bidirectional
influence upon one another in different configurations throughout life.
Our discrete emotion approach provides a promising framework for operationalizing and empirically
measuring compassion, though many researchers do not conceptualize compassion as a distinct emotion
(Ekman, 2016; Feldman Barrett, 2017). Many chapters in this handbook present critical scientific evidence
about compassion conceived differently: as a core motivation, a trait-like disposition, or a cultivated attitude.
Some also present insights drawn from non-human research in which compassion is presumed from behavior
(e.g., caregiving, consolation, and costly helping). Non-human research informs our understanding of the
evolutionary trajectory of compassion, and provides data where ethical barriers limit collection of data from
humans. All of these approaches to thinking about compassion are valid and important contributions to our
understanding of how we respond to others who are suffering. Next we explore these approaches,
disambiguate compassion from other related constructs, and note some key findings and measures from each
perspective.

Compassion as a Discrete Emotion

We conceptualize emotions as coherent and organized, yet flexible, responses to events that are shaped by
both biological and social factors. The study of compassion as a specific emotion often compares it to personal
distress or positive, social-functional states like love or pride, and has identified specific patterns associated
with its experience. Research in this area has documented the kinds and characteristics of stimuli that reliably
evoke compassion (e.g., vulnerability, undeserved suffering, unmet need), and identified the ways that people
tend to describe their subjective experience upon encountering suffering (see Batson, Chapter 3 in this
volume). Research has also documented outward behavioral patterns that communicate compassion, including
facial expressions (e.g., pursed lips, centrally scrunched oblique eyebrows; see Figure 1.1), vocal signaling (e.g.
downward-arc-toned “aaaawwwwwwww”), and postural gestures (e.g., forward lean) (Kogan et al., 2011;
Simon-Thomas, Keltner, Sauter, Sinicropi-Yao, & Abramson, 2009). As we discuss later, this research also
suggests that experiences of compassion involve measurable activation within both the sympathetic and the
parasympathetic branches of the autonomic nervous system. In the parlance of affective science, studies using
this approach are mapping out the antecedents, the mental experience, the behavioral display, and the
physiological underpinnings of compassion as a discrete emotional experience (Goetz et al., 2010).

28
Figure 1.1 Prototypical facial display during an emotional experience of compassion.

When studying compassion as a discrete emotion, it is important to note that merely exposing people to
suffering (the most common method for eliciting compassion) does not guarantee they will feel compassion.
Perceived suffering can lead to other states, including personal distress, anger, or even righteous satisfaction.
Multiple studies have tied perceived suffering to personal distress, a response in which one is more upset by
the others’ suffering than concerned for the other (Batson, 2011). This self-focused response is often referred
to as empathic distress, and a large body of research shows that it is associated with efforts to reduce one’s own
distress and tends to interfere with compassion (Eisenberg & Eggum, 2009). People may also feel indifference
to others’ suffering, as in the case of failure to notice or attend to others, or strategic suppression or reappraisal
of compassionate feelings into apathy or callousness (Cameron & Payne, 2012). As Cameron explains
(Chapter 20 in this volume), when the welfare of the suffering person(s) is deemed overwhelmingly difficult to
improve, people tend to adopt the role of “bystander,” and adjust their feelings to match this noncommittal
stance. On occasion, people may even experience pleasure in others’ suffering (i.e., schadenfreude), typically
when a suffering person is seen as enviable, overly self-serving, deserving of punishment, or otherwise morally
corrupt (Stellar, Feinberg, & Keltner, 2014; Takahashi et al., 2009). Finally, others’ suffering can elicit
expressions of rejection like disgust or anger, mostly directed at the causal factors or source of suffering (not
the sufferer), especially in contexts that are deemed poignantly unfair (e.g., innocent child casualties of war)
(Rosenberg et al., 2015). Taken together, research suggests that, while most people may feel “moved” by
suffering at first, we also assess, in part automatically and also deliberately, ourselves, the target(s), and the
context around the suffering. As is also evident in Ekman and Ekman’s analysis of global compassion (see
Chapter 4), the combination of these processes can lead to the range of experiences just described, or, in some
configurations, to compassion.
A recent advancement in research on compassion as an emotion is an understanding that it involves both
positive and negative subjective affect. In terms of social valuation and its impact on social dynamics,
compassion is considered positive, and some theorists therefore refer to compassion as a positive emotion
(Keltner & Lerner, 2010; Kok et al., 2013). However, research also shows that the moment-to-moment
experience of compassion (often called sympathy in everyday use) is either unpleasant or mixed. For example,
while people’s conceptions of compassion in English may be positive, their descriptions of how compassion
feels are associated with both unpleasant and pleasant states (Condon & Feldman Barrett, 2013). In research
comparing American and Chinese conceptions and experience of compassion, people rated sympathy and its
counterpart tóngqíng (同情) as more similar to positive emotions than to negative emotions, but again, rated
actual experiences as both emotionally pleasant and unpleasant (Goetz & Peng, 2017). People may have
unpleasant feelings, but also incorporate positive feelings related to caregiving motivation, helping, and seeing
another’s relief from suffering during an experience of compassion. Thus it seems that as a subjective
experience, compassion can involve both positive and negative affect, but as a cultural value, trait, or attitude,
it is primarily positive.

Compassion as a Motivation
A motivational perspective on compassion distinguishes the emotional experience from drive to caregive

29
and protect, and frames compassion as addressing a basic need, like hunger or self-defense. For example,
Gilbert and Mascaro (Chapter 29 in this volume) defines compassion as “a sensitivity to suffering in self and
others with a commitment to try to alleviate and prevent it.” Stephanie Brown (Chapter 13 in this volume)
posits that compassion emerges from neural circuits that support our intrinsic need to suppress self-interest
and to caregive, often in the face of threat. Caregiving motivation, supported in part by “reflexive response
circuits for instinctive motivation to provide care,” according to Swain and Ho (Chapter 6 in this volume), is
thought to be particularly strong for human parents of especially helpless infants. The caregiving motivation
approach to compassion is furthered by Mikulincer and Shaver (Chapter 7 in this volume), who (a) argue that
caregiving circuits also foster, and are dynamically shaped by, parent–infant attachment processes; and (b)
survey evidence that secure attachment is associated with greater capacity for compassion and caregiving in
adult social interactions, from romantic partners to strangers. In Chapter 8, James Kirby justifies making
compassion the guiding theme for programs to help parents maximize this core nurturing capacity.
It is helpful to distinguish the subjective emotional experience of compassion from the deeper motivation to
benefit or give care to another. This distinction allows us to explore important questions such as: Does the
subjective experience of compassion lead to motivation to help the other (as Batson argues, Chapter 3 in this
volume)? What are the facilitators and inhibitors of compassionate motivation (Gilbert and Mascaro, Chapter
29 in this volume)? Does motivation to caregive make experiences of compassion more likely (Weisz and
Zaki, Chapter 16 in this volume)?

Dispositional Compassion
Compassion, like many emotional and motivational states, can also be measured in terms of how readily it
occurs over time and across different contexts; that is, as a disposition or personality trait. Researchers have
developed various reliable and valid self-report measures to assess a person’s overall tendency to experience
compassion or endorse compassion as a core personal value (e.g., Interpersonal Reactivity Index, Davis, 1983;
Dispositional Positive Affect Scale, Shiota, Keltner, & John, 2006; Fear of Compassion Scale, Gilbert,
McEwan, Matos, & Rivis, 2011; Compassionate Love Scale, Sprecher & Fehr, 2005; and finally, the soon-
to-be-published Multidimensional Compassion Scale developed by Jazaieri, Chapter 18 in this volume). This
compassion-as-trait perspective focuses scientific inquiry on the temperamental and habitual affective,
cognitive, and motivational components of compassion that influence a person’s general likelihood of
experiencing compassion (see Spinrad and Eisenberg, Chapter 5 in this volume). For example, compassionate
children tend to score higher on measures of emotional and social well-being (Eisenberg et al., 1996), and
trait-like compassion in adults is associated with heightened empathic sensitivity (Lutz, Brefczynski-Lewis,
Johnstone, & Davidson, 2008) and greater anticipated joy from helping (Sprecher, Fehr, & Zimmerman,
2007). This perspective also provides an empirical canvas for investigating enduring biological metrics, such as
vagal flexibility (Muhtadie, Koslov, Akinola, & Mendes, 2015), genetic endowment (Rodrigues, Saslow,
Garcia, John, & Keltner, 2009), and characteristics of neural architecture or function (Keltner, Kogan, Piff, &
Saturn, 2014). Finally, a dispositional approach has identified early childhood experiences that contribute to
the development and expression of compassion, such as warm and nurturing parenting (Eisenberg,
VanSchyndel, & Hofer, 2015) and securely attached infant–caregiver relationships (Mikulincer & Shaver,
2005).

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How Is Compassion Related to Empathy?
Differentiating compassion from related or partly overlapping processes and potential precursors such as
empathy is a challenging, yet conceptually a clarifying, exercise. As Batson discusses (see Batson, Chapter 3),
empathy is an umbrella term that is used to refer to many related processes in which an individual may come to
understand, share, or feel “moved” by another’s emotional or physical state. Researchers have made
distinctions between the more cognitively complex and effortful cognitive empathy and the phylogenetically
older affective empathy (De Waal, 2008). In cognitive empathy, an individual consciously adopts another
person’s perspective and tries to understand how he or she is feeling or thinking. It is also sometimes referred
to as mentalizing (see Klimecki and Singer, Chapter 9) or perspective-taking and is the result of trying to
understand another’s feelings, and it can be measured by one’s empathic accuracy, or ability to accurately
identify the other’s emotions (Ickes, Stinson, Bissonnette, & Garcia, 1990; Levenson & Ruef, 1992; Zaki,
Weber, Bolger, & Ochsner, 2009). In affective empathy (also called emotional empathy by Klimecki and
Singer), a person experiences elements of feeling that are similar to another’s emotions. Affective empathy is
considered a more automatic process that originates in part from mimicry, in which a person mirrors another’s
expression or physical demeanor. Terms such as emotion contagion, vicarious experience, or empathic sharing have
been used to describe adopting or taking on some aspect of another’s emotional state within oneself (Klimecki
& Singer, 2011). While affective empathy may be considered a catalyst to feeling compassion, affective
empathy does not guarantee, nor is it sufficient to engender, compassion. In fact, affective empathy can easily
initiate self-focused responses like personal distress (a.k.a. “empathic distress”).
In the way we will use it here, empathy broadly involves a sensitivity to others’ feelings—feeling something
in response to their expressions, and having an understanding of what the other person is feeling and why.
With this definition, one key way that compassion is distinct from empathy, in all its variants, is in scope.
Empathy can be pan-affective; people perceive, mirror, and “catch” all kinds of emotions, including
amusement, pride, anger, or sorrow (Decety, 2012). Compassion, on the other hand, is a specific emotional
response to suffering. Secondly, empathy alone lacks a specific social urge, while compassion expressly involves
feeling concerned and wanting to do something to reduce another’s suffering.

Distinguishing Compassion from Altruism

In addition to distinguishing compassion from empathy, it is important to distinguish compassion from
behaviors it can promote, which often fall into the category of altruism. Although compassion is associated
with caregiving and helping, often at a cost to oneself, altruistic behaviors are not necessarily evidence that one
has felt compassion. Helping someone in need can also be associated with a variety of other mental states and
motivations, among them the impulse to reduce one’s own distress (Batson, Chapter 3 in this volume), the
pursuit of social recognition or status (Willer, Feinberg, Flynn, & Simpson, 2014), or attempts to mitigate
guilt or satisfy a sense of duty or obligation (Smith, Lapinski, Bresnahan, & Smith, 2013). Furthermore,
many benevolent behaviors do not specifically indicate compassion, because they do not systematically occur
in response to suffering or need. For example, feelings of love, gratitude, and moral elevation also motivate
helping and cooperative behaviors, even when need and suffering are not present (Algoe & Haidt, 2009). On
the other hand, the presence of compassion does not guarantee helping behavior (see Poulin, Chapter 26 in
this volume); a person may feel strong compassion for suffering that they cannot directly address. A clear

31
distinction between the subjective experience of compassion, the motivation to caregive, and helping behavior
allows scientists to explore the processes involved, not only in experiencing compassion, but also in translating
compassion into action.

The Science of Compassion

In addition to the diversity of conceptual approaches, the authors in this handbook take a variety of
methodological approaches to examining fundamental questions about compassion. These include exploring
the evolutionary origins of compassion—which lead directly to questions about the antecedents and situations
in which compassion occurs, the biological structures and processes by which compassion emerges, and the
degree to which compassion is universal or variable across cultures. Scientists have also collaborated closely
with expert scholars from cultural and religious traditions to study the impact of compassion and develop
programs for training compassion. Finally, researchers have sought to ask what additional outcomes may
result from enhancing compassion within our relationships, organizations, and society more broadly. Next, we
discuss these questions with the goal of directing readers to relevant chapters.

What Are the Origins of Compassion?

Since Darwin, theorists have recognized that the study of compassion should not be limited to the realm of
religious or cultural virtue. Explanations for the tendency to engage in potentially costly, dangerous, and self-
sacrificial behavior have been rooted in maternal care for vulnerable offspring (Batson et al., 2011; Hoffman,
2008; McDougall, 1908), and biological theory has revealed how care for genetically related kin could have
evolved (Hamilton, 1964). With consensus that compassion is a product of evolution, researchers have utilized
comparative research to identify similarities across biological structures, as well as behavioral response
tendencies that relate to fitness (see Carter, Bartal & Porges, Chapter 14 in this volume), providing a guiding
perspective to work towards deciphering the biological profile of human compassion (Preston, 2013).
As we discuss in depth later in this chapter, these comparative and evolutionary approaches have brought
forth key themes, such as “bottom-up” (i.e., reflexive) tendencies for compassionate responding to salient
distress (see Porges, Chapter 15 in this volume) and neonatal vulnerability (Preston, 2013), as well as the
tension and interplay between caregiving and self-protective motivations (see Brown and Brown, Chapter 13
in this volume). A biological approach has also motivated burgeoning research on genetic factors that
influence compassion (see Saturn, Chapter 10 in this volume).
Questions remain, however. One question is, How unique is the human experience of compassion?
Although recent research makes it clear that compassion relies on ancient biological structures and systems,
many of which are shared with other animals, it also suggests that compassion involves more than involuntary
emotional responses to other’s pain. For example, the perception of unmet need, distinct from the other’s state
of distress, has been called a key antecedent of compassion (Batson, Fultz, & Schoenrade, 1987). Does
perception of unmet need require an ability to imagine how the other is feeling and to understand the other’s
goals, intentions, and desires? Research on human experience has also shown that cognitively complex
attributions of responsibility and conceptions of fairness play a strong role in how much compassion is felt;
how uniquely human are these processes (Farwell & Weiner, 1996)?
Another important question is: How and why is compassion felt for non-kin, unfamiliar strangers, and even

32
other species? Are there evolutionary advantages to extending compassion beyond our offspring, or is
compassionate responding to non-kin and strangers a modern overgeneralization of a system that evolved to
respond to kin? Advances in evolutionary theory suggest that individuals gain fitness benefits by helping
others through direct and indirect reciprocity (Axelrod & Hamilton, 1981; Trivers, 1971) and through
strengthening one’s own group (Sober & Wilson, 1998). This suggests that the tendency to respond to need
in offspring was elaborated upon and later applied to individuals with whom one was likely to interact
repeatedly, individuals with whom one had a history, and individuals who were in-group members (Preston,
2013). As Davis (Chapter 23) discusses, compassion and empathy are closely linked to relationship functions.
However, conceptions of in-groups and out-groups vary from culture to culture (Markus & Kitayama, 1991),
and some cultures value helping strangers more than others do (Levine, Norenzayan, & Philbrick, 2001).
Furthermore, conceptions of fairness and punishment of unfairness (Henrich & Henrich, 2014), as well as the
role of emotion in motivating behavior, vary considerably across cultures. As Joan Chiao discusses (Chapter
12), theoretical advances recognize culture as comparable to genetics in its influence on the evolution of
human psychology and behavior (Henrich & Henrich, 2007). As we discuss in a later section, research has
only begun to examine the ways in which cultural norms influence our experience and expression of
compassion.

What Is the Biology of Compassion?

Studying the biology of compassion involves looking for markers, patterns of activity, or an overarching
biological profile that predicts, drives, or underlies compassion. This biological approach studies compassion
as a core motivation, a discrete emotional experience, and as a more general disposition, and aims to gather
evidence that the human body comes equipped to experience and behave in accordance with compassion. A
further goal for many researchers, particularly those that examine compassion training, is to understand
whether engaging the biological systems associated with compassion also confers measurable benefits to health
and well-being. Following, we explore some of the notable findings and remaining questions.

What Are the Antecedents and Moderators of Compassion?

Consistent with evolutionary accounts that suggest compassion evolved out of care for offspring, research
has identified suffering and unmet need as key antecedents of compassion. In particular, research on humans
and non-humans points to salient distress, vulnerability, and neotony as bottom-up triggers of compassion
that appear to be somewhat reflexive and involuntary. In addition, research summarized in this volume has
begun to explore contextual moderators that may up-, or down-regulate, or even block compassion (see
Gilbert and Mascaro, Chapter 29 in this volume). Inherent to some of the behavioral outcomes of compassion
is the possibility of expending resources and exposing oneself to threatening or dangerous situations. The
experience of compassion, in turn, is likely to be moderated by “cost–benefit analysis” in a given situation
(Poulin, Chapter 26 in this volume). Consistent with this logic, research points to factors that influence
compassion, including similarity and closeness to the suffering person (Condon and DeSteno, Chapter 22 in
this volume), feelings of ability and efficacy (Caprara, Vittorio, & Eisenberg, 2012), and appraisals about
morality and fairness (Weng, Schuyler and Davidson, Chapter 11 in this volume). In a specific example,
experimental work on “compassion collapse” suggests that people strategically down-regulate their own

33
feelings of compassion when they see helping as more versus less costly to self (see Cameron, Chapter 20 in
this volume). It is unknown whether this down-regulation resolves undesirable feelings tied to anticipated loss
of resources through helping, to anticipated feelings of inadequacy about not being able to help, to both, or to
something else altogether.
As a whole, what do these studies leave open? First, the mechanisms by which moderators of compassion
operate are unclear. For example, why do similar and close others elicit more compassion? One possibility is
that similarity and closeness influence the more reflexive aspects of empathy (Cheng, Chen, Lin, Chou, &
Decety, 2010), increasing the strength of feeling “moved” by suffering (i.e., affective empathy), and thus also
increasing the momentum towards compassion. Another possibility is that we deem the welfare of those we
are similar and close to as more worthy of investment, which in turn boosts the caregiving motivation
component of compassion (see Weisz and Zaki, Chapter 16 in this volume).
Second, some of the research on moderators of compassion is counterintuitive. For example, research shows
that compassion is sensitive to one’s own social class rank. Logically, one might predict that, with greater
access to resources, a person with more capacity to help others would more readily experience compassion,
since such a person can help others at a smaller relative cost. However, research summarized by Piff and
Moskowitz (Chapter 24 in this volume) shows the opposite, finding that lower social class rank (i.e., fewer
resources) predicts greater sensitivity to others’ distress and need, and more compassion. Piff’s team relates
these findings to a broaden-and-build response to stress (Fredrickson, 2004), in which people seek to build
cooperative ties and relationships in the face of stress rather than to fight or flee. Thus, questions remain
about when and why affiliative broaden-and-build strategies are invoked or prevail over avoidant or self-
protective strategies in shaping responses to perceived suffering.

Is There a Biological Profile of Compassion?

Biological research suggests that experiences of compassion involve quantifiable physiological arousal and
salience signals alongside a penchant for self-regulation via reappraisal, which together pave the way for
activating systems that motivate social affiliation and caregiving. Studies of spontaneous neural response to
vocal signals of distress suggest that the anterior insula region of the brain signals greater felt visceral response
in highly compassionate people (Lutz et al., 2008; Lutz, Greischar, Rawlings, Ricard, & Davidson, 2004;
Lutz, Greischar, Perlman, & Davidson, 2009). Increased compassion through training has been shown to
predict greater amygdala activation (the brain’s “on alert” signal) in response to compassion-eliciting images
(Desbordes et al., 2012). Anterior insula and amygdala activation are reliably associated with feeling
involuntary changes in the body (e.g., quickened heart rate or nausea) and attentional shifts towards
something important—feelings in the body and mind that, at first blush, can feel similar to personal threat or
pain—and that, unregulated, can snowball into personal distress. The reappraisal dimension of compassion,
however, appears protective of the personal-distress trajectory, as suggested by Helen Weng’s work, which
shows that engagement of the dorsolateral prefrontal cortex regions that down-regulate distress over threats or
losses increases after compassion training (Weng et al., 2013). Relatedly, Tania Singer’s team has profiled a
specific network in the brain for compassion, primarily pathways between the Ventral Tegmental
Area/Substantia Nigra and medial Orbital Frontal Cortex, that is uniquely bolstered by compassion training
exercises (see Chapter 9).

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 Further studies of what happens in the body during compassion suggest that a greater overall contribution
from the parasympathetic branch of the autonomic nervous system (ANS), both at momentary reactive (heart
rate deceleration, lower skin-conductance levels) and tonic (respiratory sinus arrhythmia) levels, is associated
with greater compassion (Eisenberg & Fabes, 1991; Stellar, Cohen, Oveis, & Keltner, 2015). As
foreshadowed by early behavioral work, compassion appears biologically contingent upon the early shift from
feeling “moved” by suffering (i.e., affective empathy) towards a state of concern towards the other, and urge to
relieve their suffering. The alternate path of personal distress, on the other hand, involves persistent
sympathetic nervous system (SNS) and hypothalamic pituitary axis (HPA) activation (e.g., adrenaline and
cortisol release), diminished parasympathetic nervous system (PNS) impact, and allocation of mental
processing resources towards self-protective motivations and behaviors. These observations evoke a key issue
raised earlier—the extent to which compassion can be considered a negative (threat-like salience signal), and
also a positive (affiliative, caregiving orientation) subjective experience, and suggest that biologically, it is a
delicate recipe of both.
A greater PNS role in the context of responding to another’s suffering, while reducing self-focused
defensive urges, is also thought to foment a host of affiliative and prosocial functions throughout the body
through pathways influenced by the vagus nerve, as evidenced by the legacy of work pioneered by Steve
Porges’s PolyVagal Theory (Chapter 15 in this volume). Within the brain, Stephanie Brown and Michael
Brown (Chapter 13 in this volume) theorizes that PNS dominance enables the hypothalamic midbrain basal
ganglia neural circuits that foster parental, as well as general social, caregiving motivation to come online
when people encounter others’ suffering. These caregiving circuits, also carefully documented by Swain and
Ho (Chapter 6 in this volume), show increased activation in people responding compassionately to images
depicting suffering (Kim et al., 2009; Simon-Thomas et al., 2012).
The appraisals and contextual attributions that influence compassion are perhaps the least well catalogued
psychologically or understood biologically; some findings from neuroscience offer promising insight, however.
For example, studies reliably implicate the dorsal lateral prefrontal cortex in self-regulation (Gross, 2002;
Ochsner et al., 2004), a known moderator of compassion. The midline cortex is thought to be involved in self-
referential and social evaluative thinking (Whitfield-Gabrieli et al., 2011), processes that overlap conceptually
with appraisal-making. Likewise, the temporal parietal junction (TPJ) reportedly supports taking the
perspective of another person (Saxe & Wexler, 2005), which is thought to be key to compassion. However,
the specific configurations of activation or connectivity associated with appraisals that foster compassion (e.g.,
self: not-under-threat, capable of helping; other: similar to me, deserving/moral) have not been specified. For
example, donating to a charitable cause has been tied to greater anatomical density of cells within the temporal
parietal junction (Morishima, Schunk, Bruhin, Ruff, & Fehr, 2012), which suggests that more biological
neural computing power for perspective-taking enhances altruism. This result alone does not, however, reveal
a particular pattern of activation within the TPJ or in conjunction with other regions that supports the specific
kinds of social appraisal (e.g., seeing another’s perspective through a trusting, moral lens) that are associated
with compassion. Future work combining careful, conceptually rigorous study design with increasingly
sophisticated neuroscience methods will aid in our understanding of the biological processes that underlie the
unique and specific combination of appraisals that affect compassion.
In a summary analysis, Dacher Keltner posits an overarching biological framework for prosocial behavior,

35
for which compassion can be considered a prototypical catalyst (Keltner et al., 2014). Keltner’s Sociocultural
Appraisals, Values, and Emotions (SAVE) framework implicates three key biological systems: (1) the
serotonergic attunement system, (2) the oxytocin social network, and (3) the dopamine reward system in
prosocial behavior, and presumably, the emotions that drive it. This framework highlights the well-known
role of serotonin in regulation of anxious and dysphoric states (Caspi, Hariri, Holmes, Uher, & Moffitt,
2010); we describe self-regulation as key to transcending personal distress in response to others’ suffering.
Sarina Saturn (Chapter 10 in this volume) describes her finding of greater accuracy of emotion-recognition in
people possessing the GG polymorphism of the rs53576 oxytocin transporter gene. Her data suggest that
noticing and understanding other peoples’ expressions, and feeling compassion towards the sad or pained
ones, come easier to some than others (Rodrigues et al., 2009). Robust evidence that helping is innately
pleasurable (Harbaugh, Mayr, & Burghart, 2007; Inagaki & Eisenberger, 2012) also supports the SAVE
framework. Specific to compassion, studies have shown that becoming more compassionate through
compassion training leads to greater engagement of neural reward circuits during compassion (Klimecki &
Singer, Chapter 9 in this volume). This reward-during-compassion signal is presumed to reflect innately
pleasurable feelings of affection and connection, as well as anticipated shared relief as a result of given support
(Klimecki, Leiberg, Lamm, & Singer, 2012).
In summary, there is a diverse and inspired field of biological science committed to discovering the systems
involved in compassion. Many researchers investigating the biological underpinnings of compassion are also
exploring whether being more compassionate confers measurable advantages to ancillary metrics in health and
well-being. The work of synthesizing these promising findings into a unified, coherent narrative is still a work
in progress, and we hope this volume provides helpful data towards this goal.

Is Compassion Universal?
Research has also begun to examine the role of culture in compassion. Like other areas in compassion
research, the findings in this area do not tell a simple story. Various cultural dimensions have been related to
compassion and prosocial behavior. Collectivism has been positively related to experiences of compassion and
sympathy (Dalsky, Gohm, Noguchi, & Shiomura, 2008; Kitayama, Mesquita, & Karasawa, 2006), but
research has also suggested that individuals from Asian cultures may be less empathically responsive and may
feel less compassion in response to others’ suffering (Atkins, Uskul, & Cooper, 2016; Cassels, Chan, &
Chung, 2010). Other research has shown that cultures that value simpatia (i.e., socio-emotional concern with
the well-being of others) show more prosocial behavior for outgroup members (Levine et al., 2001), while
cultures that value embeddedness show less helping behavior for strangers (Knafo, Schwartz, & Levine, 2009).
Chiao (Chapter 12 in this volume) suggests that the cultural dimension of “tightness–looseness” may also
contribute to social responses to social and moral deviance, thus influencing the scope of compassion. Finally,
Zarins and Konrath (Chapter 25 in this volume) present an interesting summary of changes in prosocial and
other-oriented traits and behaviors over time in the United States, and remind us that cultural differences can
be examined historically as well as regionally. Future research will need to examine whether and how these
cultural factors interact to influence compassion.
A key question in the broader literature on emotion centers on whether culture influences the experience or
expression of emotion, and this can also be applied to compassion. Koopmann-Holm and Tsai (Chapter 21 in

36
this volume) review research showing that cultural values contribute to the expression of compassion. More
work is needed to understand the impact of cultural values on when compassion is felt, how intensely it is felt,
and how and whether compassion is expressed. In addition, work can begin to examine how cultural
dimensions relate to different precursors and components of compassion, such as empathic accuracy, self-
regulation, appraisals, or caregiving motivation.

Can We Train Compassion?

Is it possible to shift the magnitude (intensity), scope (range), or overall tendency (frequency) to feel
compassion? Practitioners of 2,500-year-old Buddhist practices suggest, introspectively, yes. Stories of
transformation from adversarial to heroic roles in the community, as detailed in Zimbardo’s Heroic
Imagination Project work (Zimbardo, Seppala, and Franco, Chapter 34 in this volume) also suggest yes.
Biological evidence suggesting that compassion relies on multiple biological systems that have unique
developmental trajectories and lifetime malleability also suggests yes. From Stanford University’s Compassion
Cultivation Training (CCT) program (Goldin and Jazaieri, Chapter 18 in this volume) to the ReSource
project (Klimecki and Singer, Chapter 9 in this volume) in Leipzig, there is growing interest in understanding
the capacity for, and measurable impact of, becoming more compassionate through training.
Compassion training research teams have typically teamed up with experts of scriptures on compassion
from the Buddhist tradition (Jinpa, 2015) for conceptual and practical guidance (Desbordes & Negi, 2013).
Brooke Dodson-Lavelle (Chapter 2 in this volume) describes the influence of three Buddhist traditions in
conceptualizing compassion and the development of contemporary, secular compassion training programs. As
we discuss later, these Buddhist perspectives generously inform programs developed to train compassion
(Weng, Schuyler, and Davidson; Goldin and Jazaieri; and Skwara, King, and Saron; Chapters 11, 18, and 17
respectively) and self-compassion (Neff and Germer, Chapter 27 in this volume), as well as clinical
approaches to infusing compassion into therapeutic contexts (Gilbert & Mascaro, Chapter 29 in this volume).
Several teams have published excellent data on how compassion training affects measures of physical,
cognitive, emotional, and social function. Researchers from Emory University, working closely with Geshe
Lobsang Negi, created and evaluated the impact of an eight-week Compassion Based Cognitive Training
(CBCT), described by Jennifer Mascaro, Lobsang Negi and Charles Raison (Chapter 19 in this volume).
Focusing on biomarkers of stress, the Emory team showed that CBCT led to less anxious responding and
earlier recovery from an anticipated stressor, and in another study, that CBCT led to a healthier immune
profile in disadvantaged youth living in the foster system in Georgia (Pace et al., 2009; Pace et al., 2013;
Reddy et al., 2013). Similarly, as described by Goldin and Jazaieri (Chapter 18 in this volume) participation in
Stanford’s eight-week CCT program has been associated with increased compassion and self-compassion, a
healthier profile of emotion-regulation, and boosts to several other psychological strengths (Jazaieri et al.,
2013; Jazaieri et al., 2014). In addition, a collaborative team from Yale, Northwestern, and Harvard reported
increased neural sensitivity (i.e., salience signaled by the amygdala) to others’ suffering—which was
accompanied by a greater likelihood of helping behavior after an eight-week compassion training program
(Condon, Desbordes, Miller, & DeSteno, 2013; Desbordes et al., 2012).
Highlighting a key question within the compassion training space, “What is the optimal dosage?”
salubrious effects have also been reported for much briefer, as well as lengthier, programs. Reports of greater

37
costly helping behavior (Leiberg, Klimecki, & Singer, 2011) and activation in reward circuits of the brain have
been reported after less than one week of compassion training (Klimecki et al., 2012). Weng’s (Chapter 11 in
this volume) strengthened self-regulation findings were also related to very brief training. At the other
extreme, the Shamatha Study led by Clifford Saron and Alan Wallace examined effects of a three-month
residential retreat that included, among other contemplative exercises, practices designed to cultivate and
strengthen compassion. Shamatha retreat participation has been associated with healthier aging as indexed by
plasma telomere length, less rejection/disgusted facial expression in response to uncensored war footage, and
more adaptive “socioemotional functioning”—a custom variable computed from self-report measures of
psychosocial constructs like secure attachment and empathy (Jacobs et al., 2011; Rosenberg et al., 2015;
Sahdra et al., 2011). This work is detailed by Skwara, King, and Saron (Chapter 17 in this volume).
Another approach to compassion training has been to focus on shifting the ways that people see, think, and
feel about themselves. Drawing from themes within Buddhist traditions, Kristin Neff coined the construct of
self-compassion, published a self-compassion scale, and developed an eight-week Mindful Self-Compassion
training program (MSC). MSC training aims to help people tune into their own pain and suffering and adopt
a more humanistic, self-comforting stance (Neff, Kirkpatrick, & Rude, 2007). Neff and Germer (Chapter 27
in this volume) describes work showing that MSC training does lead to increased self-compassion, as well as
measurable benefits to other metrics of well-being (Germer & Neff, 2013).
Though the findings from research on the effects of compassion training are encouraging, there is still
mystery around precisely which aspects of the multifaceted training (Leiberg et al., 2011; Klimecki et al.,
2012; Condon et al., 2013; Desbordes et al., 2012) are most influential (e.g., mindfulness? emotional
awareness/intelligence? appraisal tendencies? social beliefs and expectations?) and for whom they stand to
work best. We also do not know whether there is an optimal sequence or quantity of training, whether it is
important to train compassion in interactive social groups, how qualified a compassion training teacher needs
to be, or if a live teacher is even necessary. As is suggested in studies of the variety of practices meant to boost
well-being, compassion training may lend itself to specific regimes tailored to individual, cultural, and
contextual characteristics (Layous, Lee, Choi, & Lyubomirsky, 2013; Lyubomirsky & Layous, 2013).

Applied Compassion
A key aspiration of science is to make discoveries that can be applied to real-world settings to improve, or at
least more accurately address the needs of, day-to-day life. Broad cultural acceptance of compassion-focused,
self-reflective practices is growing in many parts of the world—think of yoga and mindfulness. As noted
throughout this chapter, evidence from the extant research suggests that having compassion predicts improved
health, well-being, and social functioning, and these insights are filtering into popular dialogues via
dramatically increased access to and sharing of social media. Relatedly, several chapters in this volume explore
the presence, malleability, and beneficial impact of compassion at organizational levels.
One of the first sectors that comes to mind in thinking about compassion is health care. People who
provide health care for others are faced with a greater concentration of daily suffering than most, and
approaches to managing this have not been systematic. A series of key articles on “compassion fatigue” (see
Figley and Figley, Chapter 28 in this volume) suggest that being a health care provider inherently depletes a
person’s innately limited capacity for compassion, and in some veins, has reinforced a culture of explicit

38
distancing or suppression of compassion. Buddhist thought, however, suggests that compassion is
indefatigable—a perspective that Singer also shares in an article that rebrands “compassion fatigue” as
“empathic distress fatigue” (Klimecki & Singer, 2011). Sue Shea and Christos Lionis review this issue and
highlights the promise of more compassionate health care contexts (Chapter 32 in this volume).
His Holiness the Dalai Lama, leader of the Tibetan Buddhist Faith, and an unexpected but comparably
popular co-conspirator, Lady Gaga, regularly advocate greater inclusion of compassion in educational settings.
Children, in their view, hold great promise in shifting broader levels of compassion in the world, and
classrooms are an ideal place to start. Many education professionals share this view. Lavelle, Flook, and
Gharemani (Chapter 33 in this volume) catalogue the emergence of this movement and the advantages that
more compassionate educational settings enjoy.
Several chapters also explore the role of compassion in leadership and the workplace. How does compassion
in the workplace influence service, or the dynamics of performance and employee turnover, or the bottom
line? Cameron (Chapter 30 in this volume) explores different ways of thinking about a compassionate
organization, from company-wide policy and service to the collective support of colleagues, and argues that
more is better. Worline and Dutton (Chapter 31 in this volume) outline a process for imbuing organizations
with compassion, while Martin and Heineberg (Chapter 35 in this volume) discuss the qualities and “win-
win” effects of compassion on synergistic mentoring relationships between young aspiring and more
experienced senior professionals.
With more general thoughts on the potential reach of compassion, lead investigator of the famed Stanford
Prison Experiment Phil Zimbardo (Chapter 34 in this volume) offers thoughts on how to leverage
compassion towards loftier goals and behaviors—rescuing people and saving the world. Though more
exploratory in nature, these early writings will inspire the direction of future research aimed at achieving a
consensus knowledge base on the nature and potential benefits of compassion.
In conclusion, the present volume represents the near-current state of compassion science—a field that
promises gains in understanding both in the basic science of human experience and in applications of that
work to improve humankind and the world around us. The approach to compassion presented here integrates
biological and social factors from foremost experts all over the world, and therefore provides a vibrant
intellectual, as well as realistic, platform from which to move forward. Indeed, there are many remaining
questions and promising opportunities to advance the science of compassion (Lilius, Kanov, Dutton, Worline,
& Maitlis, 2011). We hope this volume serves as a catalyst for people, scientists, and experts from all walks of
life alike, to embrace, nurture, and manifest our basic human capacity for compassion, to the benefit of the
natural world and all of its inhabitants in perpetuity.

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 Compassion in Context Tracing the Buddhist Roots of Secular, Compassion-Based
Contemplative Programs

Brooke D. Lavelle

Abstract

Various conceptions of compassion are articulated in diverse Buddhist contemplative traditions. These
variations are due in part to the divergent models of mind and reality found within and across these
traditions, as well as the ways in which compassion is understood to be either supportive or necessary for
spiritual development or awakening. These diverse Buddhist models in particular have influenced the
development modern, secular mindfulness- and compassion-based contemplative programs that have
been selected for scientific study. In spite of growing interest from the scientific community in these
compassion-based contemplative programs, there is little discussion of the differences between diverse
contemplative and scientific accounts of compassion, and the implications of these differences for
research. This chapter therefore offers an overview of the ways in which compassion is variously
conceptualized in diverse Buddhist and scientific traditions.

Key Words: Compassion, mindfulness, secular mindfulness, Sustainable Compassion Training (SCT),
Cognitively-Based Compassion Training (CBCT), Compassion Cultivation Training (CCT),
contemplative theory

Compassion has been taught and practiced since the earliest period of Buddhism, yet the role of
compassion and its centrality on the path to enlightenment, as well the methods for cultivating it, have varied
across diverse Buddhist traditions. The different purposes, motivations, and practices for compassion
articulated in these Buddhist traditions have shaped the development of modern, secular, compassion-based
programs—including Cognitively-Based Compassion Training (CBCT), Compassion Cultivation Training
(CCT), and Sustainable Compassion Training (SCT)—which have been adapted for a variety of clinical and
educational settings. These modern compassion programs, in turn, also have been shaped by, and arose in
response to, their own historical-cultural context. Interest in compassion-based contemplative programs is
increasing, given their promise for enhancing health, well-being and prosociality (Condon, Desbordes, Miller,
& DeSteno, 2013; Pace et al., 2009, 2010). Yet, to date, little scholarly attention has been paid to the
differences between these methods for cultivating compassion, or to the implications that such differences
might have for research and practice. Furthermore, little attention has been paid to the differences between
Buddhist contemplative conceptualizations of compassion and modern scientific accounts.
This chapter therefore reviews the different ways compassion has been conceptualized and cultivated in
both traditional Buddhist and modern secular contemplative contexts. The goal is not to determine which
articulation of compassion is most authentic, but rather to call attention to the ways these various concepts
either limit or permit different possibilities for realizing compassion. Such an approach may deepen our

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understanding of these practices, inform more context-sensitive adaptations, and reveal new directions for
research.

Compassion in Buddhist Thought and Practice

Buddhism concerns itself with the possibility of freedom or enlightenment. Enlightenment is predicated
upon the realization of the nature of reality, yet the descriptions of that reality and the methods for realizing it
have varied across three main Buddhist traditions—namely, Theravāda, Mahāyāna, and Vajrayāna. In the next
section, I provide a brief account of these models in order to place the diverse Buddhist theories and practices
of compassion in context. It should be noted that these are general accounts that do not capture the diversity
of doctrinal distinctions found within and across these traditions; they are intended as a simple heuristic tool
to help clarify basic differences in approach and practice.

Theravāda
In early and modern Theravāda Buddhism, “suffering” is understood to arise from the mind’s attempt to
cling to the mistaken illusion of a fixed, permanent, and separate sense of self, and the feelings of attachment
and aversion that that mistaken reification generates. One attains nirvāṇa, or freedom from this suffering, by
gaining insight into the selfless, changing, or impermanent nature of experience (Gethin, 1998). The method
for realizing this insight is outlined in the Noble Eightfold Path with its emphasis on cultivating right conduct
(speech, action, and livelihood), meditation (mindfulness, concentration, and effort) and wisdom (correct view
and intention). Since wisdom or insight realizes the nature of things as they are, it, rather than compassion, is
upheld as the liberating principle on the path of liberation (Makransky, 2012).
Compassion is understood as a supportive, but not necessary, practice on the path of awakening. Methods
for cultivating compassion, which are typically included among practices for developing the apramāṇas or four
“immeasurable attitudes” of love, compassion, joy, and equanimity, are taught primarily as a means of
cultivating attention in service of wisdom or insight (Nyanamoli, 1964). Such practices, explained in texts
such as Buddhaghosa’s The Path of Purification, typically involve the extension of love or loving-kindness first
to oneself, then sequentially to a dear one, a neutral person, a difficult person, and then to all beings
everywhere. Based on this cultivation of love, one then cultivates compassion, or the wish for beings to be free
from suffering. To do this, one begins by focusing on someone who is experiencing tremendous suffering, or
by reflecting on an evildoer—such as a thief—who will be caught and subject to suffering later. After arousing
compassion through reflecting on one or both of these types of individuals, one then extends compassion to a
dear one, a neutral person, and then a difficult person. One then cultivates joy by first reflecting upon and
taking delight in the success and happiness of a dear one, then a neutral one, and so on. Finally, one cultivates
equanimity or impartiality by systematically reflecting on the premise that all beings are alike in their wish for
happiness. It is said that such practices draw one’s mind into a state of concentration and absorption with a
sense of stability and joy (Nyanamoli, 1964). Such methods for cultivating the “four immeasurables” have
influenced many modern mindfulness and Loving-Kindness Meditation (LKM) programs (see Shonin et al.,
2015, for a review). As outlined later, these programs are often distinctive in scope and style from other
compassion meditation (CM) programs.

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Mahāyāna
The Mahāyāna traditions that emerged at the beginning of the first century CE placed a greater emphasis
on the cultivation of compassion as fundamentally constitutive of the path of awakening and its result,
Buddhahood. Whereas early Buddhist traditions upheld the spiritual ideal of the arhat—one who has
achieved nirvāṇa or freedom from suffering and has thus escaped the cycles of endless rebirth—as its primary
paradigm, the Mahāyāna traditions endorsed the ideal of the bodhisattva—one who remains in samsāra and
works to attain enlightenment for the benefit of all beings—as its central paradigm (though early Buddhist
traditions acknowledged the path of the bodhisattva, it was not viewed as attainable by the vast majority of
beings). Mahāyāna traditions further distinguished themselves from earlier Buddhist traditions by postulating
different models of enlightenment and descriptions of the nature of ultimate reality. Of particular significance
is the doctrine of emptiness: whereas Theravāda practitioners cultivate insight into the nature of selflessness,
Mahāyāna practitioners aim to recognize the emptiness—or lack of intrinsic, independent, substantial reality
—of all phenomena (Pettit, 1999). To realize the emptiness of all phenomena is to collapse dualistic structures
of self and object and to recognize all beings as undivided or not ultimately separate from oneself. Mahāyāna
teachings emphasize the cultivation of bodhicitta, or the “mind of enlightenment,” and great compassion to
support the realization of emptiness. The wisdom of emptiness, in turn, further supports the practitioner’s
unconditional compassion for all beings who are caught in the cycle of suffering (Makransky, 2012). Thus
both wisdom and compassion are upheld as central principles of the bodhisattva path and of its ultimate
fruition, Buddhahood (Makransky, 2012). In other words, wisdom of emptiness frees oneself from samsara;
compassion finds skillful ways to communicate that wisdom to many others so they may find freedom.
The two most well-known methods for cultivating compassion within the Mahāyāna traditions are the
“Seven-Point Cause and Effect Method” and the practice of “Equalizing and Exchanging Oneself with
Others” (Dalai Lama, 2003, 2011; Wallace & Wallace, 1997). The Seven-Point Cause and Effect Method
begins with training in equanimity in order to help the practitioner overcome partiality and learn to see all
others as equally worthy of regard. Once a stable sense of equanimity has been developed, the practitioner
then proceeds through the Seven-Point Cause and Effect Method which involves the following seven steps:
1. Recognizing all beings as having been one’s mother or close relative in some previous lifetime, which is said to engender a state of mind
that will enable the practitioner to regard all beings as objects of affection;
2. Recollecting the kindness of others, which includes considering ways in which parents and caretakers have selflessly supported and
attended to oneself;
3. Setting the intention to repay the kindness of others;
4. Generating loving-kindness, or the wish that others be happy;
5. Cultivating compassion;
6. Generating a sense of responsibility and determination to help others relieve suffering; and
7. Making the commitment to work to become enlightened for the benefit of all beings (Gyatso, 2003; Hopkins, 2008).

The practice of “Equalizing and Exchanging Self with Others,” includes reflections on sameness of oneself
and others in their shared wish to be happy and to avoid suffering, as well as the advantages of cherishing
others and disadvantages of cherishing oneself. The practice also involves tonglen (“sending and receiving”)
meditation, in which the practitioner imagines taking on the suffering of others (receiving) and endowing
them with happiness (sending). As outlined next, these methods have had a direct influence on two modern
compassion meditation programs, including CBCT and CTC.

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Vajrayāna
The Vajrayāna or tantric traditions of Tibet emerged at the beginning of the eighth century (Pettit, 1999).
A number of these traditions built upon and further emphasized teachings of “Buddha nature,” already
present in some of the earlier traditions of Mahāyāna Buddhism. Some of these teachings on Buddha nature
assert that the mind is by nature pure and unconditioned, and that all of the qualities of awakening are
present, yet obscured, in the mind by mistaken patterns of misperception (Pettit, 1999; Makransky, 2012). In
these traditions, compassion is understood as an innate capacity of awareness that manifests when the mind is
freed from these mistaken habitual, dualistic perceptions and cognitions. Whereas some earlier Buddhist and
other Mahāyāna traditions emphasize practices for generating compassion by means of cultivation alone,
Vajrayāna traditions offer more direct methods to help practitioners realize the innateness or immanence of
enlightenment (Pettit, 1999).
There are various tantric methods that involve helping the mind learn to release its habitual, maladaptive
tendencies and the grip of so-called ordinary experience, which involves the mind’s mistaking its own reified,
narrow concepts of its world for reality. A main emphasis in practice involves “taking the result as the path”
(Pettit, 1999, p. 63), or learning to transform ordinary perceptions into pure perceptions characteristic of
enlightenment (Yeshe, 2001). One essential method involves the visualization practice of “deity yoga,” in
which the practitioner learns to dissolve they/them ordinary conception of self and others, and to arise from
this empty dimension as the manifestation of an enlightened deity. The more one becomes familiar with, and
identifies with, the qualities of the deity, the more these qualities—which are understood to be innate to or
the nature of one’s own mind—are drawn out and made manifest (Yeshe, 2001).
There are various prerequisites for engaging in tantric practice. The major prerequisites involve cultivating
renunciation (i.e., the strong desire to emerge from suffering), bodhicitta, and the view of emptiness (Yeshe,
2001). Practitioners must also gain confidence in the path and develop a strong, fervent motivation to attain
enlightenment. One key method for generating this confidence and inspiration is the tantric practice of
“refuge” and “guru yoga” found in various ngondro or preparatory practice traditions. In this style of practice,
one calls to mind a host of spiritual teachers or enlightened beings who are understood to embody compassion
and wisdom. The practitioner experiences himself/herself as deeply seen and blessed by these figures in her/his
own innate potential for enlightenment, and learns to commune and ultimately unify with these figures in
order to more deeply and stably recognize and abide in the innate, compassionate qualities of her/his own
mind (Makransky, 2012; Yeshe, 2001). The style and spirit of tantric practices, particularly their relational
emphasis and innateist rhetoric, have influenced another distinctive modern compassion meditation program
called Sustainable Compassion Training (SCT).

Buddhist Influences on Modern Contemplative Programs

These three Buddhist traditions have notably influenced the design of modern contemplative programs. In
the same way that Buddhist traditions variously conceptualized the causes of suffering and thus prescribed
various methods for overcoming that suffering, CBCT, CCT, SCT, and other mindfulness and loving-
kindness meditation programs articulate different causes of stress and outline various methods for realizing
health and well-being in secular settings. The following section provides a brief overview of the key goals and
practices of these modern programs, with a special focus on compassion-meditation programs in particular.

47
 Before outlining these modern compassion programs, it is important to again emphasize and clarify the
debate within the traditions of both Mahāyāna and Vajrayāna Buddhism concerning the nature of mind and
the means for attaining enlightenment, which has significantly framed and shaped the rhetoric and practice of
modern interventions. Briefly put, the crux of the debate hinges on whether the qualities of Buddhahood or
enlightenment are innate to one’s mind or whether they need to be created through cultivation. “Innateist”
models, which take their influence from certain Mahāyāna and Vajrayāna traditions, contend that the qualities
of awakening are present, yet are obscured or concealed by mistaken structures of cognition and reaction in
the mind. The goal of practice therefore is to eliminate, or reduce, these distorting structures by evoking the
latent power of awakening that is already available in the mind. “Constructivist” models, influenced by other
Mahāyāna traditions and early Buddhist traditions, in contrast, hold that the potential to cultivate qualities of
awakening is present in one’s mind, but that those qualities are simply generated by the process of cultivation
itself. Whereas innateist models tend to emphasize non-dual, devotional, and affective practices, constructivist
models tend to emphasize analytical contemplations.
As will become clearer, we can locate SCT on the innateist end of the spectrum of the traditional debate, in
that SCT assumes that compassion is innate and that it arises as one removes or overcomes obstacles or blocks
to compassion. It is important to note that SCT meditations do not simply aim to interrupt what impedes
compassion, the meditations draw upon—or evoke—the underlying power of compassion to help overcome its
blockers (certain mindfulness programs, like Mindfulness-Based Stress Reduction [MBSR], tend to fall on
the innateist end of the spectrum, even though they are influenced by various Buddhist traditions; Dunne,
2011; Kabat-Zinn, 2011). We can locate CBCT, CCT, and other loving-kindness programs on the
constructivist end of the spectrum, as they generally tend to assume that, while the potential for awakening
exists in everyone, the qualities of awakening—like compassion—need to be created through cultivation. To
be clear, both of these models assume that compassion needs to be cultivated to some extent. The difference
between them rests on whether the qualities of awakening are understood mainly to be created through
cultivation, or are understood to be allowed to manifest through cultivation.
This brief description of the debate is overly simplified and does not capture the subtle and important
distinctions between these so-called camps. Although these differences may seem insignificant, these
divergent approaches represent more than merely semantic distinctions. For proponents of these programs,
differences between innateist and constructivist approaches are related to different models of mind. Though
some have attempted to reconcile these approaches by suggesting that they represent different means to the
same end (e.g., compassion or enlightenment), the methods that they employ could have significant
implications for the development and realization of compassion. For example, innateist approaches tend to
employ operative metaphors that concern the discovery, realization, or revelation of compassion. The
experience of compassion tends to be evoked through poetry or through calling to mind one’s compassionate
caring figures or mentors, as well as through a rhetoric of “openness,” “receptivity,” and “letting be.”
Constructivist approaches, on the other hand, tend to employ operative metaphors that concern the
construction, development, or strengthening of compassion. Compassion is trained through investigation,
reasoning, and reflection. And although these approaches or practices are not mutually exclusive—and in fact
all modern programs described here employ elements of both camps in their training protocols—the different
theoretical frames and metaphorical strategies arguably both prime and constrain particular experiences and

48
outcomes. Thus it is worthwhile to explore potential differences between these approaches in more detail.

Modern Compassion-Based Contemplative Programs

Loving-Kindness Programs
Early and Theravada Buddhist traditions have influenced a number of modern mindfulness and loving-
kindness programs (Shonin et al., 2015). As previously mentioned, these styles of practice typically include
systematic reflections for cultivating feelings of love and extending them toward others, beginning with
oneself. Although “loving-kindness” and “compassion” are sometimes used interchangeably, there are
important distinctions between these styles of practice. Loving-kindness meditations tend to focus on
generating the wish that others be happy and have the causes of happiness. Compassion practices focus on
generating the wish for another’s freedom from suffering and place explicit emphasis on motivating the
practitioner to take responsibility for relieving others’ suffering. While some loving-kindness programs and
interventions may also include practices of compassion, or of wishing that others be free from suffering, these
programs typically tend not to teach compassion to the same degree as the programs described here. Thus
most of our attention will focus on compassion-based contemplative programs.

Cognitively-Based Compassion Training and Compassion Cultivation Training

CBCT is a secular program for training compassion developed by Lobsang Tenzin Negi in 2005, which
was first developed as a means of addressing the rising rate of depression among undergraduate students at
Emory University in Atlanta, Georgia (Negi, 2009). In subsequent years, the program was adapted for use
with healthy adults, medical professionals, elementary schoolchildren and teachers, adolescents in foster care,
incarcerated women, veterans, and survivors of trauma, as a means of promoting prosocial skills, resiliency,
health, and well-being (Ozawa-deSilva & Dodson-Lavelle, 2011; Reddy et al., 2013; Dodson-Lavelle et al.,
2015). Another related compassion-based program is the Compassion Cultivation Training Program,
developed by Thupten Jinpa and his team at Stanford University in Stanford, California, in 2007 (Jinpa,
2010). CCT has since been adapted and taught to university undergraduates, cancer survivors, veterans, and
health professionals (Jinpa, 2015). CBCT and CCT are two similar programs for cultivating compassion that
were adapted from the Tibetan Buddhist contemplative traditions outlined above.
In the CBCT model, stress and suffering are presented as arising from an excessive, maladaptive concern
with oneself, which in turn inhibits healing connections with others. Compassion is framed as an antidote to
stress and suffering. CBCT defines compassion as the heartfelt wish to alleviate others’ suffering (Ozawa-
deSilva & Negi, 2013). It is understood that compassion arises from a deep sense of affection for others,
coupled with the recognition of the causes of their suffering and the understanding that their suffering can be
alleviated. CBCT assumes that, while one is easily able to empathize with and feel compassion toward
members of one’s own family or “in-group,” one generally finds it more difficult to empathize with and feel
compassion toward strangers, members of one’s “out-group,” and especially those who have harmed or
threaten to harm one in some way. The program assumes, however, that increasing compassion for others,
including to those who have caused one harm, is a trainable skill.
In the CBCT model, compassion is taught systematically through eight ordered steps, typically over the
course of eight weeks, along with several other supportive practices (Negi, 2009; Ozawa-deSilva & Negi,

49
2013). The steps are:

1. Developing attention and stability of mind;

2. Cultivating insight into the nature of mental experience;
3. Cultivating self-compassion;
4. Developing impartiality;
5. Developing appreciation and gratitude;
6. Developing affection and empathy;
7. Generating aspirational or wishing compassion; and
8. Realizing active compassion.

The first two steps of attention and insight training are understood as a necessary foundation for more
advanced analytical practices. Basic attentional training is typically introduced through breath-focused
meditation. After cultivating a degree of stable attention, practitioners are taught to direct the focus of their
attention to thoughts, feelings and emotions in order to gain insight into their mental experience.
Cultivating self-compassion involves: (1) the recognition of the source of one’s own suffering, together with
(2) the understanding that one can change one’s mental habits, as well as (3) the commitment to change those
habits. In this third step, practitioners are invited to explore their innate desire for happiness and to reflect on
the habits of mind that either contribute to their happiness or exacerbate their stress and suffering. The
program further encourages practitioners to recognize that it is their desire to want things to be a certain way,
and their habit of mistakenly looking to external sources of happiness, that cause or exacerbate their suffering.
As the practitioner gains insight into these causes of suffering, they are instructed to recognize that these
habits can be broken and then resolve to transform those habits.
The fourth step of “impartiality” refers to specific analytical training aimed at helping practitioners
overcome bias and develop equanimity towards others. Practitioners are instructed to visualize a friend, a
stranger, and a person with whom they have difficulties, and to note the different feelings that arise as they
imagine these three individuals undergoing positive or negative experiences. Practitioners are then instructed
to reflect on the different responses they have toward these three categories of individuals, and to examine
whether there are any fixed or inherent differences between these people. After a process of reflection and
analysis, participants are encouraged to generate the intention to relate to these three categories of people with
equanimity or impartiality.
The fifth and sixth steps of developing appreciation and affection are understood as essential for fostering
one’s concern for the welfare of others. To generate appreciation, practitioners are encouraged to reflect on the
kindness and generosity of countless others, including ways in which their own very survival is dependent
upon the support of many other people. Such reflections on gratitude and interdependence are understood to
increase a sense of affection and concern for others.
As one further develops empathic concern, one becomes more acutely aware of others’ suffering. These
insights, in turn, are assumed to naturally give rise to the wish or aspiration that others be relieved of this
suffering (step 7). In this step, the practitioner is instructed to visualize and reflect upon the suffering of three
people—a loved one, a stranger, and an adversary or difficult person. One is then encouraged to recognize
how difficult it is to witness another’s suffering, and to allow one’s heart to resonate with the wish for this
person to be free from suffering. This is understood as “wishing” or “aspirational compassion.” In the eighth
and final step, participants are guided through a meditation designed to move from simply wishing others to

50
be free of unhappiness to actively committing to assistance in their pursuit of happiness and freedom from
suffering.
CBCT’s format and sequence closely follow the Seven-Point Cause and Effect Method, except that, in its
secular adaptation, it omits certain metaphysical and soteriological reflections on reincarnation and the
commitment to become enlightened for the benefit of all. CBCT also incorporates methods from Equalizing
and Exchanging Self with Others, though it emphasizes the “sending” aspect of tonglen, rather than explicitly
encouraging participants to take on the suffering of others.
CCT similarly takes its inspiration from these Buddhist methods for cultivating compassion, yet it offers a
slightly different approach compared to CBCT. In the CCT model, compassion is taught through the
following six steps, which are typically taught over the course of nine weeks. The six steps include:
1. Focusing and settling the mind;
2. Cultivating loving-kindness and compassion for a loved one;
3. Cultivating loving-kindness and compassion for oneself;
4. Cultivating compassion for others through a recognition of common humanity;
5. Cultivating compassion for all beings; and
6. Developing “active compassion” through the practice of tonglen (Jinpa, 2010; Jazaieri et al., 2013).

Despite these small differences, CBCT and CCT both employ analytical meditations and emphasize the
need to cultivate or construct compassion and its related qualities through a process of reasoning and
analytical meditation. This distinguishes these programs from other compassion-based contemplative
programs, including SCT.

Sustainable Compassion Training

Sustainable Compassion Training (SCT; formerly known as Innate Compassion Training or ICT) was
developed by John Makransky, a professor of Buddhism and comparative theology at Boston College. SCT is
a set of contemplative practices primarily designed to help practitioners realize their natural capacity for
unconditional care that empowers a strong, active compassion for others (Makransky, 2007; 2011). The SCT
program has been adapted by the Mind and Life Institute as a contemplative training for teachers and
students within its Call to Care initiative in education, which has since been adapted by the Courage of Care
Coalition (see www.courageofcare.org). SCT has also been adapted for use by health professionals, social
workers, counselors, and others in social service professions. The program has also been adapted for use in a
variety of secular and interfaith settings.
In the SCT model, adapted from Mahayana and Vajrayana Buddhist contemplative traditions, compassion
is understood as a form of love and empathic concern that involves the wish for others to be free from stress
and pain. According to this model, compassion has four aspects:
1. Loving affection, which senses all people as dear and worthy of unconditional care;
2. Empathic concern for others in their suffering;
3. A strong compassionate wish for others to be free from suffering and its causes, which brings out a compassionate will to alleviate their
suffering; and
4. Wisdom, which includes insight into our own suffering; a recognition that others are more than our limiting impressions of them; and
that suffering is not the only reality—it is embraced within a larger reality of compassionate awareness and openness that permits suffering to
heal and transform (Makransky, 2007).

SCT emphasizes the centrality of relationships in cultivating compassion, by highlighting the need for

51
practitioners to experience themselves as objects of care and compassion in order to extend care and
compassion widely to others. Put another way, the program assumes that practitioners need to be empowered
to access their potential for compassion relationally, by experiencing what it is like to be seen and loved in
their unconditional worth and human potential, as a basis to see and love others similarly. In the SCT model,
compassion is developed through three interrelated modes of care or compassion, including (1) receiving care,
(2) deep self-care, and (3) extending care.
The receiving care practices are designed to help practitioners to re-experience moments of interconnection,
warmth, affection, and inner safety. Experiencing oneself as the recipient of care is said to provide the safety
and conditions from which they are better able to welcome and see others in their potential. Practices within
this mode are also designed to address common fears, blocks, and resistances to receiving care, such as cultural
assumptions or misconceptions about receiving care as being selfish or making one weak, for example, and
also psychological challenges such as experiences of neglect.
Deep self-care practices involve helping practitioners learn to become present to feelings and emotions with
kindness and compassion, and also to learn to settle into the qualities of care available in their basic awareness.
It is understood that as practitioners learn to become more present to their own feelings, they are similarly
able to become more present to others and their feelings, and to cultivate a deeper capacity for empathic
connection to others. By learning to accept their own feelings with kindness and warmth, practitioners are
able to host others and their feelings with the same warmth, openness, and kindness.
The capacity to extend care to others is evoked through practices of receiving and deep self-care. In order to
cultivate more stable compassion, SCT also employs supportive analytical practices that help reveal the ways
in which limiting thoughts, biases, and stereotypes of self and others impede one’s natural capacity for care.
Although SCT draws on some contemplative reflections similar to those utilized in CBCT and CCT, it
considers these to be supportive of more fundamental practices that directly tap into the practitioner’s innate
potential for compassion. Such fundamental practices include devotional-style practices of recalling and “being
seen” by mentors and caring figures, as well as non-dual practices within the self-care mode designed to help
practitioners learn to “let be.” In this regard, SCT relies more on innateist models and practices for realizing
compassion drawn from various tantric and non-dual strands of Vajrayāna Buddhism (Makransky, 2007;
Thondup, 1996; Thondup, 2015).

Buddhist Contemplative and Modern Scientific Models of Compassion

The differences between these compassion-based programs have been framed largely in terms of
distinctions between various Buddhist traditions and between diverse Buddhist models of mind that have
given rise to seemingly competing styles of practice (i.e., innateist and constructivist approaches). Yet it is
important to note that while CBCT, CCT, and SCT have each been shaped by traditional Buddhist
contemplative models, they have also, in turn, been shaped for particular modern, predominantly North
American audiences. While a full exploration of the modern cultural context(s) within which these
contemporary programs have been developed is beyond the scope of this chapter, it is important to mention
that these modern interventions have been shaped in various ways by modern conceptions of individualism,
health and well-being, as well as by conceptions of “secular” space. These conceptions have implicitly and
explicitly shaped the rhetoric, goals, and practices included in each of these modern interventions. It should be

52
noted, therefore, that these modern interventions do not necessarily map or reflect so-called traditional
Buddhist contemplative models.
CBCT, CCT, SCT, and other modern contemplative interventions also have been designed and adapted
for scientific study to varying degrees. Although there is increasing interest in the potential efficacy of these
programs for enhancing health and well-being, little attention has been paid to the differences between
contemplative and scientific conceptions of compassion. Evolutionary-based scientific frameworks, for
example, propose that compassion is a natural instinct that typically emerges in response to the suffering of a
limited range of close others as well as those who are likely to reciprocate. Such views of compassion are
rooted in the notion that compassionate action is costly for the individual (for a review, see Goetz et al.,
2010). Buddhist contemplative traditions, however, suggest that practitioners have the capacity to develop
“unlimited” or “unconditional” compassion. Not only is realizing unconditional compassion possible in these
frameworks, but it is also necessary for awakening or enlightenment. These divergent contemplative and
scientific frameworks reveal different assumptions about human potential and the role of compassion in
realizing health and well-being. Such frames also limit and permit different possibilities for defining,
conceptualizing, and cultivating compassion.
In may help to point out one further distinction between traditional Buddhist and modern contemplative
programs. Whereas Buddhist contemplative models are explicitly focused on soteriological goals, the rhetoric
of contemporary secular adaptations of these models tends to emphasize therapeutic goals of enhanced health
and well-being. Though these soteriological and therapeutic goals are not necessarily mutually exclusive, such
frames shape, limit, and permit various possibilities for health, healing, and transformation. Secular frames
both implicitly and explicitly shape the goals of programs—and in so doing, are likely to influence
participants’ motivation to engage in compassion-based practices.

Implications and Future Directions

Frames matter. They affect what seems both possible and permissible, and can significantly impact the ways
in which compassion is conceptualized and cultivated. In the same way that Buddhist theoretical frames shape
and inform modern contemplative traditions, various modern cultural and scientific frames shape and limit the
content and styles of practice that are included in contemporary programs. Like the frame of a picture, frames
highlight what to attend to and what not to attend to—they lift up or make salient certain aspects of
experience or a practice while deemphasizing others.
As we have seen, the conceptualization of compassion differs across and between traditional and modern
contemplative frameworks. Similarly, notions of suffering, freedom, health, and well-being also vary. Perhaps
most importantly, the goals of the practices often differ substantially. Thus, rather than simply assessing the
validity or efficacy of compassion-based contemplative programs, we can begin to consider the implications of
these various frameworks on the development of the construct of compassion and methods for cultivating it.
Given the highly contextualized nature of practice, we should not assume that there is one universal
approach to cultivating compassion that is effective or appropriate for all individuals in all contexts. To that
end, we should take care not to assume that one model is “correct” or “authentic.” The overly simplified
descriptions of the traditional and modern contemplative frames, as well as the innateist and constructivist
debate, enable us to notice the effects of various philosophical, theoretical, and historical frames on

53
contemplative practice. It also helps us quickly map different practice styles to compare particular themes,
approaches, and tensions. As stated previously, the goal here is not to determine which tradition or practice
style is correct, but rather to call us to inquire into which different styles of practice are more efficacious for
different people with different dispositions, or at different stages on their practice paths. These are empirically
testable claims, and in my view are worth investigating. In other words, rather than searching for the most
effective style of practice in general, or assuming that all methods are in fact the same, we might more
constructively inquire into which practices work for whom and in what context and why.

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Based Compassion Training to children. Practical Matters, 4, 1–28.
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(Eds.), Compassion: Bridging Theory and Practice (pp. 416–437). Leipzig: Max Planck Institute for Human Cognitive and Brain Sciences.
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 The Empathy-Altruism Hypothesis What and So What?

C. Daniel Batson

Abstract

Do we humans ever, in any degree, care for others for their sakes and not simply for our own? The
empathy-altruism hypothesis offers an affirmative answer to this question. It claims that empathic
concern (defined as “other-oriented emotion elicited by and congruent with the perceived welfare of
another in need”) produces altruistic motivation (“a motivational state with the ultimate goal of
increasing the other’s welfare”). Research over the past 40 years testing this hypothesis against egoistic
alternatives has provided quite strong support. Empathy-induced altruistic motivation does seem to be
within the human repertoire. This empathy-induced altruism may have its biological roots in generalized
parental nurturance. Practical implications of the empathy-altruism hypothesis include both benefits and
liabilities—for the targets of empathy, for others, and for the person feeling empathic concern.
Implications of the empathy-altruism research for the content and conduct of compassion science are
suggested.

Key Words: altruism, compassion science, egoism, empathic concern, helping, parental nurturance

Think of all the time and energy we spend helping others. In addition to daily courtesies and kindnesses,
we send money to aid disaster victims halfway around the world, and to save whales. We stay up all night with
a friend who just suffered a broken relationship. We stop to comfort a lost and frightened child until his mom
appears. Sometimes the help is truly spectacular, as when Wesley Autrey jumped onto a subway track with the
train bearing down in order to save a young man who had fallen while having a seizure. Or when rescuers in
Nazi Europe risked their own lives and the lives of family members to shelter Jews.
Why do we do these things? What motivates such behavior? Is it true that “the most disinterested love is,
after all, but a kind of bargain, in which the dear love of our own selves always proposes to be the gainer some
way or other” (La Rochefoucauld, 1691, Maxim 82)? Or are we also capable of altruism?
The significance of the latter possibility depends on what you think altruism is. If, like most behavioral and
social scientists, you think of it as personally costly helping—or as helping to gain self-administered rewards
such as a warm glow or avoidance of guilt—the existence of altruism cannot be doubted. But to say we are
capable of such altruism tells us nothing we did not already know. These conceptions trivialize the centuries-
old egoism-altruism debate. In that debate, altruism refers to a motivational state with the ultimate goal of
increasing another’s welfare; egoism refers to a motivational state with the ultimate goal of increasing our own
welfare. The dominant view in Western thought has long been that our motivation is always exclusively
egoistic, as La Rochefoucauld said.

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The Empathy-Altruism Hypothesis
The empathy-altruism hypothesis takes the motivational conceptions of altruism and egoism seriously. It
states that empathic concern produces altruistic motivation, challenging the belief in universal egoism (Batson,
1987, 2011). To understand this deceptively simple hypothesis, it is necessary to be clear about what is and is
not meant by both empathic concern and altruistic motivation.

Empathic Concern
In the empathy-altruism hypothesis, empathic concern means other-oriented emotion elicited by and congruent
with the perceived welfare of a person in need. This other-oriented emotion has been called by several names
besides “empathic concern,” including compassion, tenderness, sympathy, and pity. (Note that while many people
use the term compassion to refer to a form of the emotional state I’m calling “empathic concern,” some people
use the term to refer to motivation as well as emotion, making it more equivalent to the whole empathy-
altruism hypotheses. I wish to leave the emotion-motivation link open for empirical investigation, not have it
determined in advance by definitional decree. The nature of this link is the focus of the empathy-altruism
hypothesis.) The label applied to the other-oriented emotion is not crucial. What is crucial is that the emotion
involves feeling for the other, not feeling as the other feels. Let me add four quick points of clarification.
First, when saying that the other-oriented emotion called empathic concern is “congruent with the
perceived welfare of a person in need,” I refer to a congruence of valence, not of specific content. The valence
is positive when the perceived welfare of the other is positive, and negative when the perceived welfare is
negative. So it would be congruent to feel, for example, sad or sorry for someone who is upset and afraid. Or
to feel compassion for the unconscious victim of a mugging, as did the Good Samaritan (Luke 10:33).
Second, although the term “empathy” is broad enough to include situations in which there is no perceived
need—such as when we feel empathic joy at another’s good fortune (Smith, Keating, & Stotland, 1989;
Stotland, 1969)—not all empathic emotion is hypothesized to produce altruistic motivation: only the
empathic concern felt when another is perceived to be in need. Without perceived need, there is no
motivation to increase the other’s welfare.
Third, empathic concern as defined here is not a single, discrete emotion but includes a whole constellation
of emotions. It includes feelings that people report as sympathy, compassion, softheartedness, tenderness, sorrow,
sadness, upset, distress, concern, grief, and more. Fourth, although feelings of sympathy and compassion are
inherently other-oriented, we can feel sorrow, distress, and concern that are self-oriented, as when something
bad happens directly to us. Both other-oriented and self-oriented versions of these emotions may be described
as feeling sorry or sad, upset or distressed, concerned or grieved. This breadth of usage invites confusion. The
relevant psychological distinction does not lie in the emotional label used—sad, distressed, concerned—but in
whose welfare is the focus of the emotion. Are we feeling sad, distressed, or concerned for the other, or are we
feeling this way as a result of what has befallen us (including, perhaps, the experience of seeing the other
suffer)?
In recent years the term “empathy” has been applied to a range of phenomena besides the other-oriented
emotion just described (see Batson, 2009, for a partial review). Here is a quick list:

• Knowing another’s thoughts and feelings.

• Adopting the posture or matching the neural response of another.

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 • Coming to feel as another feels.
• Feeling personal distress at witnessing another’s suffering.
• Imagining how you would think and feel in another’s place.
• Imagining how another thinks and feels.
• A general disposition (trait) to feel for others.

Each of these phenomena is distinct from the other-oriented feeling that I am calling empathic concern—or,
for short, empathy. The empathy-altruism hypothesis makes no claim that any of these other phenomena
produces altruistic motivation, except if and when they evoke empathic concern. Moreover, the hypothesis
makes no claim that any of these other phenomena is either necessary or sufficient to produce empathic
concern. As a result, to find evidence in favor of the empathy-altruism hypothesis should not be taken as
evidence that any of these other phenomena produces altruistic motivation.

Altruistic Motivation
Altruism and egoism in the egoism-altruism debate have much in common. Each refers to a motivational
state. Each is concerned with the ultimate goal of that motivational state. And, for each, the ultimate goal is
to increase someone’s welfare. These common features provide the context for highlighting the crucial
difference: Whose welfare is the ultimate goal—another person’s or our own?
“Ultimate goal” here refers to means–end relations in the psychological present, not to a metaphysical first
or final cause, and not to a biological function. An ultimate goal is an end in itself. In contrast, an instrumental
goal is a stepping stone on the way to an ultimate goal. Both instrumental and ultimate goals should be
distinguished from unintended consequences, results of an action that are not its goal. Each ultimate goal defines
a distinct goal-directed motive. Hence, altruism and egoism, which have different ultimate goals, are distinct
motives even though they can co-occur. Moreover, they are motivational states, not personal dispositions or
traits. The contrast in the egoism-altruism debate is between these motivational states—egoism and altruism
—not between types of people—egoists and altruists.
Many forms of self-benefit can be derived from helping. Some are obvious, such as when we get material
rewards or public praise, or when we escape public censure. But even when we help in the absence of external
rewards, we can still benefit. Seeing a person or animal in need may cause us to feel distress, and by relieving
the other’s distress, we relieve our own. Or when we help, we may feel good about ourselves for being kind; or
we may escape guilt and shame for failing to do what we think we should.
The empathy-altruism hypothesis does not deny that altruistically motivated helping brings self-benefits
like these. But it claims that the self-benefits of empathy-induced helping are unintended consequences rather
than the ultimate goal. Additionally, the empathy-altruism hypothesis does not claim that a person feeling
empathic concern experiences only altruistic motivation. Such a person can experience other motives arising
from other sources, including the conditions that evoke empathic concern—such as perception of the other as
in need. Nor does this hypothesis claim that empathic concern is the only source of altruistic motivation; it is
mute about other possible sources. Given that other phenomena have been called “empathy,” there can even
be other empathy-altruism hypotheses. To date, however, no other such hypotheses have been carefully tested.

Why Worry About the Motivation to Help?

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 As long as the person in need receives help, why worry about whether the underlying motivation is altruistic
or egoistic? The answer depends on our interest. If we are only interested in getting help for this person in this
situation, the nature of the motivation may not matter. But if we are interested in knowing more generally
when and where help can be expected—and how effective it is likely to be (perhaps with an eye to creating a
more caring society)—then understanding the underlying motivation is crucial. If, for example, I am
motivated to help to impress you, then when you will not know that I have helped, I will not help.
As argued by Kurt Lewin (1951), explanatory stability of human action is found in the link of a given
motive to its ultimate goal, not in behavior or consequences. Behavior is highly variable. Occurrence of a
particular behavior, including helping, depends on the strength of the motive or motives that might evoke that
behavior, as well as on (a) the strength of competing motives, (b) how the behavior relates to each of these
motives, and (c) other behavioral options available in the situation at the time. It also depends on whether the
behavior promotes an instrumental or an ultimate goal. The more directly a behavior promotes an ultimate
goal, and the more uniquely it does so among the behavioral options available, the more likely it is that the
behavior will occur. Behavior that promotes an instrumental goal can change if either (a) the causal association
between the instrumental and ultimate goal changes, or (b) behavioral pathways to the ultimate goal arise that
bypass the instrumental goal.
Yet—complicating matters—we infer motivation from behavior; specifically, from the pattern of behavior
across situations that vary in the best way to reach different possible ultimate goals. This inference has allowed
us to test the empathy-altruism hypothesis.

Current Status of the Empathy-Altruism Hypothesis

Over the past four decades, more than 35 experiments have been conducted to test the empathy-altruism
hypothesis—the hypothesis that empathic concern produces altruistic motivation—against a range of egoistic
hypotheses that claim instead that the motivation produced by empathic concern is directed toward the
ultimate goal of obtaining one or another self-benefit. As just suggested, the research strategy has been to
experimentally vary situations so we can make meaningful inferences from the pattern of behavior about the
ultimate goal of the empathy-induced motivation. (See Batson, 2011, for a comprehensive review of the
experiments.)
With remarkable consistency, results of these experiments have supported the empathy-altruism hypothesis.
The few results that initially seemed to contradict that hypothesis have not stood up to further examination.
To the best of my knowledge, there is at present no plausible egoistic explanation for the cumulative results.
This evidence has led me to tentatively conclude that the empathy-altruism hypothesis is true: Other-oriented
feeling for a person in need (empathic concern) produces motivation with the ultimate goal of removing the
empathy-inducing need (altruistic motivation). The evidence has also led me to conclude that this motivation
can be surprisingly powerful.

Antecedents of Empathic Concern

If empathic concern produces altruistic motivation, what produces empathic concern? The theory of
altruistic motivation of which the empathy-altruism hypothesis is the core specifies two key antecedents of
empathic concern: (a) perception of another as in need, and (b) intrinsic valuing of the other’s welfare (see

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Batson, 2011).
Perception of another as in need: Perceiving need involves seeing a negative discrepancy between the other’s
current state and what is desirable for the other on one or more dimensions of well-being. Dimensions of
well-being include the absence of physical pain, negative affect, anxiety, stress, danger, and disease, as well as
the presence of physical pleasure, positive affect, satisfaction, and security. Perceived needs can, of course, vary
in magnitude. The magnitude appears to be a function of three factors: (a) the number of dimensions of well-
being on which discrepancies are perceived, (b) the size of each discrepancy, and (c) the perceived importance
of each of these dimensions for the overall well-being of the person in need.
The negative discrepancy at issue concerns the well-being of the person in need, not of the person feeling
empathy. But the perception at issue is by the person feeling empathy, not by the person in need. There are
times when people perceive themselves to be in need, yet others do not. These others will not experience
empathic concern—unless they consider the person’s false perception of need itself to be a need. Alternatively,
there are times when people do not perceive themselves to be in need, yet others do. These others may well
feel empathic concern.
Intrinsic valuing of the other’s welfare: The type of valuing of another’s welfare that evokes empathic concern
is intrinsic rather than extrinsic (Allport, 1961). The other is valued in his or her own right, not for what he or
she may be able to provide. More colloquially, intrinsic valuing of another’s welfare is spoken of as caring or
loving.

How Could Empathy-Induced Altruism Have Evolved?

Extending consideration of antecedents of empathic concern back in time raises the question of how
empathy-induced altruistic motivation could have evolved. What evolutionary function might such motivation
serve? The most plausible answer seems to be that empathic concern evolved as part of the parental instinct
among higher mammals, especially humans (Batson, 2010, 2011; Bell, 2001; de Waal, 1996; Hoffman, 1981;
McDougall, 1908; Zahn-Waxler & Radke-Yarrow, 1990). If mammalian parents had not been intensely
interested in the welfare of their very vulnerable progeny, these species would have quickly died out.
No doubt, we humans have inherited key aspects of our parental instinct from ancestors we share with other
mammalian species. But in humans, this instinct is considerably less automatic and more flexible. The human
parental instinct goes well beyond nursing, providing other kinds of food, protecting, and keeping the young
close—activities that characterize parental care in most mammalian species. It includes inferences about and
anticipation of the desires and feelings of the child (“Is that a hungry cry or a wet cry?” “She won’t like the
fireworks; they’ll be too loud”). It also includes goal-directed motives and appraisal-based emotions (Scherer,
1984).
Of course, we humans do not feel empathic concern only for our own children. As long as there is no
preexisting antipathy, we can feel empathy for a wide range of others in need, including nonhumans (Batson,
Lishner, Cook, & Sawyer, 2005; Shelton & Rogers, 1981). This extension may reflect cognitive
generalization whereby we “adopt” the other as progeny, producing intrinsic valuing and, thereby, empathic
concern and altruistic motivation when the other is in need (Batson, 2011; Hoffman, 1981).
Two factors would facilitate the emergence of such generalization: (a) human cognitive capacity, including
symbolic thought and analogic reasoning; and (b) lack of evolutionary advantage in early human hunter-

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gatherer bands for strict limitation of empathic concern and parental nurturance to offspring. In these bands,
those in need were often one’s children or close kin. And survival of one’s genes was tightly tied to the welfare
even of those who were not close kin (Hrdy, 2009; Kelly, 1995; Sober & Wilson, 1998).
To the extent that the human nurturing impulse relies on appraisal-based other-oriented emotions such as
empathic concern, it should be relatively easy to generalize. In contemporary society, the prospect of such
generalization appears more plausible when you think of the emotional sensitivity and tender care typically
provided by nannies, workers in daycare centers, adoptive parents, and pet owners.
If the roots of human altruism lie in generalized parental nurturance, then altruism is woven tightly into our
nature and into the fabric of everyday life. It is neither exceptional nor unnatural, but a central feature of the
human condition. Rather than looking for altruism only in acts of extreme self-sacrifice, we should see it
manifested in our everyday experience. The empathy-altruism research indicates that it is.

Other Antecedents?
Much research has shown that the combination of perception of need and adopting an imagine-other
perspective (i.e., imagining how the person in need is thinking and feeling) can produce empathic concern.
And several individual-difference variables, including general emotionality, emotion regulation, psychopathy,
attachment style, and gender, may affect the level of empathic concern. But an imagine-other perspective and
these individual differences all seem to function as moderators of the effect of the two key antecedents of
empathic concern—need and valuing—not as additional antecedents. That is, it is unclear that any of them
affect empathic concern except through their effect on perception of need, intrinsic valuing, or both (see
Batson, 2011, for a discussion of this point).

Practical Implications
Now that we have the “what” of the empathy-altruism hypothesis before us, we can turn to the “so
what?”—the implications. I will focus first on practical implications, then briefly on the implications for
compassion science. The research on practical implications suggests that empathy-induced altruism is not an
unalloyed good. It offers benefits but also has liabilities, and we need to be aware of both. (For a more
extensive discussion and review of relevant research, again see Batson, 2011.)

Benefits of Empathy-Induced Altruism

1. More, more sensitive, and less fickle help. Perhaps the least surprising benefit is that feeling empathic
concern leads us to help the target(s) of empathy more. Even before the empathy-altruism hypothesis was
tested, there was evidence that empathic concern can increase the likelihood of helping (e.g., Coke, Batson, &
McDavis, 1978; Krebs, 1975). Now that we know empathic concern produces altruistic motivation, we have
reason to believe it can improve the quality of help as well.
Empathy-induced altruism is likely to motivate help that is more sensitive to the needs of the person for
whom empathy is felt. Egoistic goals such as gaining rewards and avoiding punishments can often be reached,
even if our help does not alleviate the needy individual’s suffering. For these goals, it is the thought that
counts. But to the degree that we are altruistically motivated, it is the other’s welfare that counts.
Experimental evidence supports this reasoning. Unlike those feeling little empathy, individuals induced to feel

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empathic concern tend to feel good after helping only if the other’s need is relieved (Batson, Dyck, Brandt,
Batson, Powell, McMaster, & Griffitt, 1988; Batson & Weeks, 1996). Highlighting sensitivity to future
consequences, Sibicky, Schroeder, and Dovidio (1995) provided evidence that empathic concern actually
reduces helping when that help, although meeting an immediate need, will be detrimental in the long-term:
Think of refusing to give a beloved child unhealthy treats.
In addition to producing more sensitive helping, altruistic motivation is also likely to be less fickle than
egoistic motives for helping. Research indicates that individuals experiencing relatively low empathy—and
hence a predominance of egoistic over altruistic motivation—are far less likely to help when either (a) they can
easily escape exposure to the need without helping, or (b) they can easily justify to themselves and others a
failure to help (Batson, Duncan, Ackerman, Buckley, & Birch, 1981; Batson et al., 1988; Toi & Batson,
1982). The practical implications of these findings are clear. Easy escape and high justification for not helping
are common characteristics of many helping situations. Amidst the blooming, buzzing confusion of everyday
life, we can almost always find a way to direct attention elsewhere or to convince ourselves that inaction is
justified. Given this, the practical potential of empathy-induced altruistic motivation looks promising indeed.
In the research just cited, individuals experiencing relatively high empathy showed no noticeable decrease in
readiness to help under conditions of easy escape, high justification, or both.
2. Less aggression. A second benefit of empathy-induced altruism is inhibition of aggression. To the degree
that feeling empathic concern for someone produces altruistic motivation to maintain or increase that person’s
welfare, it should inhibit any inclination to aggress against or harm that person. This inhibitory effect was
impressively demonstrated by Harmon-Jones, Vaughn-Scott, Mohr, Sigelman, and Harmon-Jones (2004).
They assessed the effect of empathy on anger-related left-frontal cortical electroencephalographic (EEG)
activity following an insult. As predicted by the empathy-altruism hypothesis, relative left-frontal cortical
EEG activity—which is typically increased by insult and promotes aggression (and which increased in a low-
empathy condition)—was inhibited in their high-empathy condition.
Note that empathic feelings should not inhibit all aggressive impulses, only those directed toward the target
of empathy. Indeed, it is easy to imagine empathy-induced altruistic anger and aggression, in which empathy for
Person A leads to increased anger and aggression toward Person B, if B is perceived to be a threat to A’s
welfare (Buffone & Poulin, 2014; Hoffman, 2000; Vitaglione & Barnett, 2003).
More broadly, empathy may counteract a particularly subtle and insidious form of aggression—blaming the
victims of injustice. In his classic work on the just-world hypothesis, Melvin Lerner (1980) found that
research participants were likely to derogate a person whom they perceived to be the innocent victim of
suffering. This derogation presumably served to maintain participants’ belief that people get what they deserve
and deserve what they get. Protecting belief in a just world in this way can lead to what William Ryan (1971)
called blaming the victim. Ryan suggested that we are likely to react to the victims of unjust discrimination and
oppression in our society by unconsciously blaming them. If they have less, they must be less deserving.
Derogation and blaming the victim are all-too-common alternatives to caring about the suffering of others.
These processes can lead to smug acceptance of the plight of those less fortunate as just and right. But
empathy-induced altruism may counteract this tendency. In an important follow-up to Lerner’s classic
experiments, Aderman, Brehm, and Katz (1974) found that perspective-taking instructions designed to evoke
empathy eliminated derogation of an innocent victim.

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 3. Increased cooperation and care in conflict situations. There is also evidence that empathy-induced altruistic
motivation can increase cooperation and care in conflict situations. Paradigmatic of such situations is a one-
trial Prisoner’s Dilemma. In this two-person dilemma, it is always in each person’s material best interest to
“defect” (compete), regardless of what the other person does. Theories that assume we humans are always and
exclusively self-interested—such as game theory and the theory of rational choice—predict no cooperation in
a one-trial Prisoner’s Dilemma. In contrast, the empathy-altruism hypothesis predicts that if one person in
such a dilemma is induced to feel empathy for the other, this person will experience two motives—self-
interest and empathy-induced altruism. Although self-interest is best satisfied by defecting, altruism is best
satisfied by cooperating. So the empathy-altruism hypothesis predicts that empathy should lead to increased
cooperation in a one-trial Prisoner’s Dilemma. Batson and Moran (1999) reported an experiment in which
they found precisely these results (also see Batson & Ahmad, 2001; Rumble, van Lange, & Parks, 2010).
What about real-world conflicts? Might the introduction of empathy-induced altruism be worth pursuing
there, too? Stephan and Finlay (1999) pointed out that the induction of empathy is often an explicit
component of techniques used in conflict-resolution workshops that address long-standing political conflicts,
such as between Arabs and Israelis. Workshop participants are encouraged to express their feelings—their
hopes and fears—and to actively adopt the perspective of those on the other side of the conflict (Burton, 1987;
Fisher, 1994; Kelman, 1997; Kelman & Cohen, 1986; Rouhana & Kelman, 1994). These efforts should
facilitate both perception of the other as in need and sensitivity to the other’s welfare, which should in turn
increase empathic concern.
4. Improved attitudes and action toward members of stigmatized groups. Is it possible that empathy-induced
altruism might be used to improve attitudes toward, and action on behalf of, stigmatized groups? There is
reason to think so. Batson, Polycarpou, Harmon-Jones, Imhoff, Mitchener, Bednar, Klein, and Highberger
(1997) found that inducing empathy for a member of a stigmatized group could improve attitudes toward the
group as a whole. This attitude-improvement effect has now been found for many stigmatized groups,
including people with physical disabilities, homosexuals, people with AIDS, the homeless, even convicted
murderers and drug dealers (Batson, Chang, Orr, & Rowland, 2002; Batson et al., 1997; Clore & Jeffrey,
1972; Dovidio, Johnson, Gaertner, Pearson, Saguy, & Ashburn-Nardo, 2010; Finlay & Stephan, 2000;
Vescio, Sechrist, & Paolucci, 2003). And the improved attitudes can, in turn, increase action to help the
group (Batson et al., 2002). Underscoring the broad applicability of empathy-induced attitude change,
Shelton and Rogers (1981) found that inducing empathy for whales led to more positive attitudes that were
reflected in increased intention to help save whales. Schultz (2000) found that empathy induced for animals
being harmed by pollution improved attitudes toward protecting the natural environment. Berenguer (2007)
did, too.
There are practical reasons to use empathy to improve attitudes toward and action on behalf of the
disadvantaged, downtrodden, and stigmatized of society—at least initially. The induction of empathy is likely
to be easier than trying to improve attitudes through methods such as direct intergroup contact. Novels,
movies, and documentaries show that it is relatively easy to induce empathy for a member of a stigmatized
group. Moreover, this empathy can be induced in low-cost, low-risk situations. Rather than the elaborate
arrangements often required to create direct, cooperative, personal contact, we can be led to feel empathy for a
member of a stigmatized group as we sit comfortably in our own home. Finally, empathy-inducing

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experiences can be controlled to ensure that they are positive far more readily than can live, face-to-face, direct
contact. For real-world examples of the induction of empathic concern to improve attitudes toward a
stigmatized group, see Stowe (1851/2005) and Paluck (2009). For a review of the range of programs that have
used empathy to improve such attitudes in educational settings, see Batson and Ahmad (2009).
5. Self-benefits. Shifting focus from the person in need, empathy-induced altruism may also benefit the
person who is altruistically motivated. Long-term studies of volunteers and providers of social support have
noted improved psychological and physical well-being among these help-givers (Brown, Nesse, Vinokur, &
Smith, 2003; Luks, 1991). And there is evidence that volunteers who provide personal care live longer than
non-volunteers, even after adjusting for the effect of other predictors of longevity such as physical health and
activity level (Oman, 2007). Importantly, this effect on longevity seems to be limited to those who volunteer
for other-oriented rather than self-oriented reasons (Konrath, Fuhrel-Forbis, Lou, & Brown, 2012).
Still, at this point, it is not clear that these health benefits are due to empathy-induced altruism. They
might instead be due either to the esteem-enhancement that volunteering provides, or to the feelings of
accomplishment and competence. And even if the benefits are due to empathy-induced altruism, a caution is
in order: Intentional pursuit of these health benefits may be doomed to failure. To use empathy-induced
altruism as a way to reach the ultimately self-serving ends of gaining more meaning and better health involves
a logical and psychological contradiction. As soon as benefit to the other becomes an instrumental means to
gain self-benefits, the motivation is no longer altruistic.

Liabilities of Empathy-Induced Altruism

Not all practical implications of the empathy-altruism hypothesis are positive. Along with the benefits
described, empathy-induced altruism has some serious liabilities.
1. It can cause harm. Altruistic motivation is potentially dangerous. As evolutionary biologists have long
pointed out (e.g., Dawkins, 1976), altruism may lead us to incur costs in time and money, even loss of life.
When 28-year old Lenny Skutnik was asked why he dove into the ice-strewn Potomac River to rescue a
drowning plane-crash victim, he said, “I just did what I had to do.” When first responders to the World Trade
Center on September 11th pushed forward to help trapped civilians in spite of flames, toxic gasses, and other
obvious dangers, many died. I cannot say to what extent these heroic acts were motivated by empathy-induced
altruism, but I can say that whatever motivated them put the actors squarely in harm’s way.
Not only can empathy-induced altruism be harmful to the altruistically motivated person, it can also hurt
the target. Balzac, one of our most astute observers of the human condition, graphically portrayed this irony in
his classic novel Père Goriot (Balzac, 1834/1962). Goriot’s selfless love spoiled his daughters, drove them from
him, and ultimately destroyed both them and him. Balzac’s message: Altruism may be part of human nature,
but like aggression, it must be held carefully in check lest it prove destructive. Graham Hancock made a
similar point in his scathing indictment of international aid programs in Lords of Poverty (1989).
Even when helping is clearly appropriate, empathy-induced altruism can at times make matters worse. This
is especially true when effective help requires a delicate touch. Think of surgeons: It is no accident, argued
neurophysiologist Paul MacLean (1967), that surgeons are prohibited from operating on close kin. When
operating on one’s sister rather than a stranger, deep feelings of concern and a desperate desire to relieve her
suffering may cause a normally steady hand to shake.

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 2. It can lead to paternalism. As discussed earlier, the most plausible account of the evolutionary roots of
empathy-induced altruistic motivation is that it reflects cognitive generalization of human parental
nurturance. If true, this account reveals a potentially serious liability. It suggests that people for whom
empathic concern is felt are metaphorically seen as childlike—dependent, vulnerable, and needing care—at
least in terms of their ability to address the need in question. Consistent with this possibility, research has
found that we feel greater empathic concern for more baby-faced and more vulnerable adults (Dijker, 2001;
Lishner, Batson, & Huss, 2011; Lishner, Oceja, Stocks, & Zaspel, 2008).
Sometimes, to be perceived as dependent, vulnerable, and needing care poses no problem. Most of us
happily defer to the expertise of physicians, police, firefighters, and mechanics when we need their help. But
at other times, the consequences can be tragic. Teachers and tutors can, out of genuine concern, fail to enable
students to develop the ability and confidence to solve problems themselves. They can instead foster
unnecessary dependence, low self-esteem, and a reduced sense of efficacy (Nadler, Fisher, & DePaulo, 1983).
Physical therapists, physicians, nurses, friends, and family members can do the same for patients with physical
or mental disabilities. So can social workers trying to care for the poor and disadvantaged. To see someone in
need as dependent and vulnerable may lead to a response that perpetuates if not exacerbates the problem. It
may produce paternalism.
Effective parenting requires sensitivity about when to intervene and when to stand back, as well as about
how to structure the child’s environment to foster coping, confidence, and independence. Effective help
requires much the same (Fisher, Nadler, & DePaulo, 1983). Recall the adage about teaching the hungry to
fish rather than giving them fish.
3. Not all needs evoke empathy-induced altruism. Many of the pressing social problems we face today do not
involve personal needs of the sort likely to evoke empathic concern. Such concern is felt for individuals, but
many problems are global. Think of environmental protection, nuclear disarmament, and population control.
These problems are not encountered as personal needs; they are broader and more abstract. It is difficult if not
impossible to feel empathy for an abstract concept like the environment, world population, or the planet—
although personalizing metaphors like Mother Earth may move us in that direction.
Not only is it difficult to evoke empathy for these pressing global needs, but many cannot be effectively
addressed with a personal helping response. They must be addressed in political arenas and through
institutional and bureaucratic structures. The process is long and slow. It is not a process for which emotion-
based motives, including empathy-induced altruism, are apt to be very effective (Hardin, 1977). Like other
emotions, empathic concern diminishes over time.
Empathy’s limited endurance may also undercut its ability to motivate the sustained helping efforts often
required of community-action volunteers (see Omoto & Snyder, 1995). Empathy-induced altruism may be
effective in initiating volunteer action, but other motives may need to take over if a volunteer is to continue for
the long haul.
4. It can lead to empathy avoidance. What if you do not want to be altruistically motivated? After all, altruistic
motivation can cost you. It can lead you to spend time, money, and energy on behalf of another. Awareness
that empathy produces altruism may arouse an egoistic motive to avoid feeling empathic concern and the
resulting altruistic motive. Shaw, Batson, and Todd (1994) provided evidence that this empathy-avoidance
motive is likely to arise when you are aware—before exposure to a person in need—that (a) you will be asked

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to help this person, and (b) helping will be costly (also see Cameron & Payne, 2011). Empathy avoidance
might be aroused, for example, when you see a homeless person on the street, or hear about the plight of
refugees, or see news footage of the ravages of famine. It may lead you to cross the street, close your ears,
change channels.
Empathy avoidance may also be a factor in the experience of burnout among those who work in the helping
professions (Maslach, 1982). But the conditions for empathy avoidance among helping professional do not
seem to be the ones specified by Shaw et al. (1994). Among professionals, empathy avoidance is more likely to
result from the perceived impossibility of providing effective help than from the perceived cost of helping.
Aware that limited resources (e.g., too little time) or the intractability of the need (e.g., terminal illness) makes
effective help impossible, some physicians, chronic-care nurses, therapists, counselors, and welfare case
workers may try to avoid feeling empathy in order to avoid the frustration of thwarted altruistic motivation
(López-Pérez, Ambrona, Gregory, Stocks, & Oceja, 2013: Stotland, Mathews, Sherman, Hansson, &
Richardson, 1978). They may turn their patients or clients into objects rather than people, and treat them as
such. Other professional helpers may, over time, find that their ability to feel empathic concern is exhausted,
leading to what has been called compassion fatigue. There are limits to how often one can draw from the
emotional well. (For some possible antidotes, see Halpern, 2001.)
Empathy avoidance may also occur in response to the suffering of members of the opposition in inter-group
conflicts. Whether the opposition is a rival sports team or a national, tribal, or ethnic out-group, their
suffering may be more apt to produce schadenfreude—malicious glee—than empathic concern (Cikara,
Bruneau, & Saxe, 2011; Hein, Silani, Preuschoff, Batson, & Singer, 2010).
Empathy avoidance may even have played an important, chilling role in the holocaust. Rudolf Hoess, the
commandant of Auschwitz, reported that he “stifled all softer emotions” in order to carry out his assignment:
the systematic extermination of 2.9 million people (Hoess, 1959).
5. It can produce immoral action. Perhaps the most surprising implication of the empathy-altruism hypothesis
is that empathy-induced altruism can lead to immoral action. This implication is surprising because many
people equate altruism with morality. The empathy-altruism hypothesis does not.
Often, of course, empathy-induced altruism produces action judged moral—as when it leads us to help the
needy or comfort the sick—but not always. Batson, Klein, Highberger, and Shaw (1995) found that empathy-
induced altruistic motivation can also lead people to give preferential treatment to a person for whom they feel
empathy in violation of their own moral standards of fairness (also see Blader & Rothman, 2014). Egoism,
altruism, and moral motivation are, it seems, three distinct forms of motivation, each of which can conflict
with another (see Batson, 2011, for discussion of the distinctions).
More broadly, there is evidence that empathy-induced altruism can lead to partiality in our decisions as a
society about who among the many in need will get our assistance. Several decades ago, Time magazine
essayist Walter Isaacson (1992) commented on the “photogenics” of disaster. He raised the possibility that the
decision to intervene in Somalia but not Sudan occurred because those suffering in Somalia proved more
photogenic. They evoked empathic concern and altruistic motivation in a way that those in the Sudan did not.
Isaacson reflected: “Random bursts of compassion provoked by compelling pictures may be a suitable basis for
Christmas charity drives, but are they the proper foundation for a foreign policy?” (Time, December 21, 1992;
similarly, see Bloom, 2016).

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 6. It can undermine the common good. Not only does the empathy-altruism hypothesis predict that empathy-
induced altruism can lead to immoral action, but also that it can lead us to act against the common good in a
social dilemma. A social dilemma arises when three conditions co-occur:
1. Persons have a choice about how to allocate their scarce resources (time, money, energy).
2. Regardless of what others do, to allocate the resources to the group is best for the group as a whole, but to allocate to a single individual
(oneself or another group member) is best for that individual.
3. If all allocations are to separate individuals, each individual is worse off than if all allocations are to the group.

In modern society, social dilemmas abound. They include recycling, carpooling, reducing pollution, voting,
paying taxes, contributing to public television or the local symphony—to name but a few.
Guided by the assumption of universal egoism that underlies game theory, it has generally been taken for
granted that, in a social dilemma, the only individual to whom we would allocate scarce resources is ourselves.
But the empathy-altruism hypothesis predicts that if you feel empathic concern for another member of the
group, you will be altruistically motivated to benefit that person. So, if you can allocate resources to him or
her, then rather than the two motives traditionally assumed to conflict in a social dilemma—self-interest and
the common good—three motives are in play. If, along with egoism (self-interest), the altruistic motive is
stronger than the desire to promote the common good, the latter will suffer.
How often do empathy-induced altruistic motives arise in real-world social dilemmas? It is hard to think of
a case where they do not. They arise every time we try to decide whether to spend our time or money to
benefit ourselves, the community, or another individual about whom we especially care. I may decline to
participate in a neighborhood clean-up project on Saturday, not because I want to play golf, but because my
son wants me to take him to a movie. Whalers may kill to extinction—and loggers clear-cut—not out of
personal greed but to provide for their families.
Consistent with this empathy-altruism prediction, Batson, Batson, Todd, Brummett, Shaw, and Aldeguer
(1995) found that research participants placed in a social dilemma allocated some of their resources to a
person for whom they felt empathy, reducing the overall collective good. And Oceja, Heerdink, Stocks,
Ambrona, López-Pérez, and Salgado (2014) found that, if there is reason to believe that other individuals in
the group have needs similar to the need that induced empathy, resources may be preferentially allocated to
them as well.
Highlighting a situation in which empathy-induced altruism poses an even greater threat to the common
good than does self-interested egoism, Batson, Ahmad, Yin, Bedell, Johnson, Templin, and Whiteside (1999)
found that when allocation decisions were to be made public, empathy-induced altruism reduced the common
good more than did self-interest. Why is this so? There are clear social norms and sanctions against the
pursuit of our self-interest at the expense of what is best for all: selfish and greedy are stinging epithets (Kerr,
1995). Norms and sanctions against showing concern for another person’s interests—even if doing so
diminishes the common good—are far less clear. How do whalers and loggers stand up to the public outcry
about over-depletion of natural resources? It is easy. They are not using these resources for themselves, but to
care for their families.
If altruism poses such a threat to the common good, why are there not societal sanctions against altruism
like those against egoism? Perhaps it is because society makes one or both of two assumptions: “Altruism is
always good,” or “Altruism is weak.” The empathy-altruism research provides evidence that each of these

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assumptions is wrong.

Implications for Compassion Science

In closing, let me briefly suggest some implications of the empathy-altruism research for the content and
the conduct of compassion science.

Content of Compassion Science

Concerning content, I will focus on only one question: Might compassion training based on Tibetan
Buddhism meditation practices broaden the benefits and limit the liabilities of empathy-induced altruism?
There is reason to think it might.
The practice called loving-kindness meditation seems designed to extend the range of others to whom the
meditator wishes health, happiness, and well-being—that is, the range of others whose welfare is intrinsically
valued. The strategy is to start with our love for an intrinsically cared-for other (e.g., our mother), then
gradually expand the circle of care to include acquaintances, strangers, all humans (even enemies) and,
eventually, all sentient beings. If, as I have suggested, intrinsic valuing of the other’s welfare is one of the two
necessary antecedents of empathy-induced altruism, this practice should increase the range of targets for
whom the meditator feels empathic concern when that target is in need. This should, in turn, produce
altruistic motivation to have the need removed. And so, this meditation practice should combat the liabilities
of empathy-induced altruism that arise from its natural partiality; namely, the greater likelihood that it is
experienced in response to the needs of family, friends, and in-group members.
Compassion meditation seems designed to extend the meditator’s sensitivity to the needs of a wider range of
others by increasing his or her readiness to recognize, understand, and feel for their suffering. Once again, the
strategy is to start by focusing on the needs of close others and the compassion we naturally feel for them, then
work on extending this response to a widening circle of others that eventually includes all sentient beings. If
successful, compassion meditation should increase the range of targets whose needs we perceive. It should also
increase the accuracy of that perception. And if perception of the other as in need is a necessary antecedent of
empathy-induced altruistic motivation, this practice should increase that motivation by combatting three of
the liabilities of naturally occurring empathy-induced altruism—paternalism, failure of the need of some
others to evoke empathic concern, and empathy avoidance.
If these two closely related forms of meditation have the suggested effects, the result of combining them
should be extension of empathic concern and empathy-induced altruistic motivation beyond its normal
bounds. We should see a clear increase in the range of targets for whom empathic concern is felt, which
should in turn increase the breadth and strength of altruistic motivation, thereby producing a more sensitive
behavioral response to the targets’ needs. These meditation practices should take us beyond the empathy-
induced motivational state of the empathy-altruism hypothesis to a point where altruism becomes a pervasive
aspect of character—a trait. We should see what Matthieu Ricard (2015, pp. 22–23) calls an altruistic
disposition, in which altruism becomes “a way of being.” This line of thought, which Ricard elaborates, leads to
a new research hypothesis: the expansion of empathy-induced altruism hypothesis.
Is this expansion hypothesis correct? That is, does practice of these forms of meditation in fact produce the
hypothesized effects? Like the empathy-altruism hypothesis, the expansion hypothesis is empirical even

68
though it, too, focuses on internal psychological processes that are difficult to assess—perceptions, values,
emotions, and motives. There are many impressive anecdotes, legends, secondhand reports, and testimonials
regarding the cultivation and expansion of altruism as a result of meditation. But, as with naturally occurring
altruism, such accounts cannot be taken as scientific evidence. They are only suggestive.
In recent years, researchers have gone beyond these accounts to collect some relevant empirical evidence—
the beginnings of a behavioral science of compassion. For example, there are reports that loving-kindness
meditation can (a) increase positive feelings toward a same-sex stranger (Hutcherson, Seppala, & Gross,
2008) and (b) decrease implicit inter-group bias against blacks and the homeless (Kang, Gray, & Dovidio,
2014). And there are reports that compassion-meditation training can (a) increase willingness to incur
monetary cost to compel an unfair Decider in a Dictator Game to compensate the Recipient (Weng, Fox,
Shackman, Stodola, Caldwell, Olson, Rogers, & Davidson, 2013; see Weng, Schuyler, & Davidson, Chapter
11, this volume), and (b) perhaps increase willingness to give one’s seat in the research laboratory waiting
room to a woman on crutches without being asked (Condon, Desbrodes, Miller, & DeSteno, 2013; see
Condon & DeSteno, Chapter 22, this volume—I say “perhaps” because this last effect was not statistically
reliable, only a non-significant trend).
But, although encouraging, the empirical research to date does not provide a persuasive answer to the
question of whether meditation practices extend empathic concern and empathy-induced altruistic motivation
in the ways predicted by the expansion hypothesis. Better empirical tests are needed, ones that go beyond
testing whether meditation training increases helping behavior. Like the empathy-altruism hypothesis, the
expansion hypothesis is not simply about increased helping. It is about empathic emotion and altruistic
motivation—and specifically about the extension of these beyond their normal range.
How could we get better tests of the expansion hypothesis? This question directs us to the implications of
empathy-altruism research for the conduct of research in compassion science.

Conduct of Compassion Science

The empathy-altruism research highlights two principles that compassion-science researchers may want to
follow. First, it is important to assess predicted outcomes as directly as possible. If we predict effects of
meditation practice on perception of need, or on valuing others’ welfare, or on empathic concern, or—most
crucially—on altruistic motivation, we need to assess those effects rather than something else, such as helping.
To assess helping behavior in a single situation tells us little about the nature of the underlying values,
emotions, and motives. The motivation could be egoistic, altruistic, both, or neither. Only by assessing the
pattern of helping across situations created to vary in a way that enables us to distinguish alternative
motivational possibilities can we draw meaningful inferences about motivation. Even sophisticated
neurophysiological measures fail to provide clear information about the nature of a person’s motivation—or
emotion. At least thus far, neuroimaging measures only indicate that some motivation or emotion is present,
not which. This first principle might be summarized as follows: We need to test our predictions, not proxies.
Second, when we find supportive data, we need to look for and test contrary explanations for these data.
The contrary explanations should include both methodological ones (e.g., subtle cues as to appropriate
behavior) and theoretical ones (e.g., an egoistic desire for meditators to see themselves, or be seen by others, as
altruistic). This need is especially urgent when, as is likely in compassion science, the researcher is hoping his

69
or her hypothesis is correct. Such hope creates strong pressure toward a confirmation bias—toward the
researcher’s looking for data consistent with the hypothesis and stopping there. I think we need to go two
steps further: (1) We need to actively pursue plausible contrary explanations for our results; and (2) we need to
design studies that would allow our cherished hypotheses—including the expansion hypothesis—to show
themselves to be wrong if they are. This principle can be summarized thus: We need to test for disconfirmation,
not confirmation.
Only by following these two principles are we likely to produce a science of compassion that goes beyond
preaching to the choir—that is, a science that can speak to the skeptic as well as to those already convinced of
the power of meditation practices and other forms of compassion training to expand the scope of empathy-
induced altruism.

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 Is Global Compassion Achievable?

Paul Ekman and Eve Ekman

Abstract

Two distinctions are introduced that were not previously explicit in the literature on compassion, which
might clarify what is being studied and encourage attention to forms of compassion that have been
largely ignored. The first distinction is whether the target of the compassionate behavior is proximal
(e.g., seeing someone fall down, badly scraping his or her knee) or distal (e.g., someone not directly
observed who might be injured now or in the future). Proximal is immediate, remedial if possible for the
suffering witnessed; distal prevents harm in the future from occurring. The second set of distinctions
refers to whether the compassion is empathic, involves action, or is an aspiration.

Key Words: global compassion, suffering, emotion, emotional resonance, aspirational compassion,
empathic compassion, action compassion, familial compassion, global compassion, proximal compassion,
distal compassion, impermanence

It would be a different world, a desirable world, if all of us felt global compassion, a concern to alleviate the
suffering of anyone, regardless of their nationality, language, culture, or religion (Ekman, 2015). “Global
compassion” means widening our sphere of concern beyond our familiars (e.g., family and friends) to
strangers. In the 21st century, the world is more interdependent than ever before. What we do in some
countries affects the lives of others, and what they do affects us. Think of political instability and terrorism
growing in the Middle East, creating massive migration to Europe. Consider how the very high consumption
of energy and food in Western industrialized countries decreases what is available to others elsewhere, and the
very real predicted impact of global warming on all countries. The key premise of this chapter is the
conviction that human society must move toward global compassion, if it is to help reduce and prevent
suffering on a global scale. However, in order to do so, there must be greater precision in our understanding of
compassion and suffering. Thus, this chapter has two parts. The first part will provide a typology of what
compassion and suffering entail. Providing such a framework will help improve the precision with which
compassion and suffering are studied and understood. The second part of the chapter will investigate how the
field of psychological science, specifically social, emotional, and evolutionary psychology, can help promote
global compassion. Finally, this chapter poses a number of questions that scientific research can continue to
explore, in the hope that we can better understand how to promote global compassion.

A Typology of Compassion and Suffering

Buddhist scholar Matthieu Ricard (2015) used the example of an Olympic javelin-thrower as a metaphor to
describe his theory of how much we can improve our capacity for compassion. We cannot all become Olympic

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javelin-throwers, he said, but we can all improve our ability a bit. It is our assertion that the same holds true in
our ability to build compassion on a global scale. However, with the current political and environmental
landscape showing great levels of greed, prejudice, and apathy, is global compassion achievable?
Years of developmental research indicate that newborns resonate to the cries of others, and toddlers are
naturally moved towards helping and even comforting strangers showing distress (Spinrad and Eisenberg, this
volume; Spinrad & Stifter, 2006; Warneken & Tomasello, 2007). Thus, it appears compassion is a
predisposition we are born with. However, children’s propensity to care for others depends on other factors,
such as temperamental characteristics (Spinrad and Eisenberg, this volume), the parental upbringing they have
experienced (Kirby, this volume), and the cognitive biases that develop with maturation, most notably of in-
and out-groups (Weller & Lagattuta, 2013).
Importantly, neuroscience research has also demonstrated that, with brief contemplative training,
individuals’ levels of compassionate responding and emotional resonance can also be increased (Klimecki,
Leiberg, Ricard, & Singer, 2013; Weng, Schuyler, and Davidson, this volume). Despite the promise of these
initial laboratory-based trials demonstrating increases in compassionate states, it remains unknown whether
fMRI findings translate to helping others in everyday life.
Compassion is part of a core belief system in all Abrahamic religions, Buddhism, Confucianism, and
humanism. Global compassion is a fundamental part of acting ethically and virtuously (Fowers, 2015).
However, with the growing influence of the modern world, there is a disintegration of religious activities and
identities in urban centers. Thus individuals who still engage in and identify with spiritual and religious
practice might be more prone to global compassion. Interestingly, recent studies have shown that a spiritual
identity, as opposed to religiosity, is associated with a higher degree of reported and observed compassion
compared to non-spiritual, and even religious people (Saslow, Willer, Feinberg, Piff, Clark, Keltner, &
Saturn, 2012). However, whether people who identify with religious or spiritual values bring compassion into
their everyday interactions with strangers outside of the laboratory is unknown.

Defining Compassion
There are many different definitions of compassion, yet a commonly used definition adopted by this
handbook is “sensitivity to the pain or suffering of another, coupled with a deep desire to alleviate that
suffering” (Geotz, Keltner, & Simon-Thomas, 2010). There are two key parts to this definition: the
recognition of suffering, and the response to that suffering. However, the compassion definition is still vague,
particularly when we consider who the targets of compassion are and what constitutes “suffering.” We provide
a new framework here, which details differing typologies of compassion and suffering (please see Table 4.1).
The purpose of this framework is to help provide specificity about which type of compassion and suffering is
being considered, so that we can better investigate it in scientific research.

Table 4.1 A Typology of Compassion and Suffering

Type of Compassion Target of Suffering

Empathic compassion Proximal, Explicit

Action compassion Proximal, Explicit

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Aspirational compassion Distal, Explicit, Suffering of Change

Familial compassion Proximal &Distal Family

Occasional global compassion Proximal & Distal, Explicit

Global compassion Proximal & Distal, Explicit

Non-referential compassion Explicit, Suffering of Change, Pervasive Suffering

Some definitions of compassion emphasize empathically feeling the emotions experienced by the person
who is suffering (Batson, 1991). We refer to this as empathic compassion. Feeling the emotions of a person who
is suffering can create genuine concern and caring and/or lead to feelings of empathic distress. Feeling empathic
distress is being overwhelmed by our resonance to another’s suffering, losing sight of the boundary between
ourselves and the other (Halpern, 2003). Empathic distress make compassion difficult to tolerate or even
frightening (Decety, 2011; Gilbert, McEwan, Matos, & Rivis, 2011; Singer, Seymour, O’Doherty, Stephan,
Dolan, & Frith, 2006). Another aspect of compassion is the actions that attempt to relieve physical and
emotional pain. We refer to this as action compassion, and it is related to compassionate behavior, or the second
component of the compassion definition (Goetz et al., 2010).
Most of their parents’ efforts when children are young are to alleviate immediate disappointments and
prevent future suffering. Most parents do not construe these actions as “compassionate,” although they meet
all the characteristics for familial compassion. The Dalai Lama is fond of saying that we learn compassion from
our mother, that our first experience in this world is the compassion of receiving milk from the familial
compassion shown by our mother (Dalai Lama, 1995). Global compassion can and does occur in people for
whom it is not the central organizing principle in their life, but an occasional feature. This occasional global
compassion is felt and acted upon, just not all the time. Examples are making a donation to help total strangers,
or taking off a day or part of day to support an organization (such as the Red Cross). There are many
opportunities to contribute “something” (any kind of act) to reduce the suffering of strangers without making
that the sole or central organizing principle of one’s life.
Buddhism recognizes two additional types of compassion: the first is a generalized stance of compassion,
which precedes the encounter with an individual who is suffering. This compassion is more cognitive than
emotional; it serves as a core motivation, aspiration, or intention. We refer to this as aspirational compassion.
Another form of compassion described in the Buddhist literature is non-referential compassion. Non-
referential compassion is a high-level practice that requires a decreased sense of self and ego to allow an
encompassing compassion unencumbered by distinctions between self and other. In this form of compassion,
there is no separation between having compassion for yourself and having it for others.

Defining Suffering
Compassion is generally understood to be a response to the suffering of another person. But suffering is not
simple. When most of us think about global compassion, we have in mind relieving the suffering of someone
whom we encounter in the street. If it is global compassion, perhaps it would be a response to news about a
refugee denied asylum or a terrible earthquake. All of these are what we refer to as proximal compassion,
compassion to relieve suffering in the here and now. But the type of global compassion that is required to

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lower greenhouse gases is not proximal, it is distal: we act now to avoid suffering in the future.
Distal compassion has two components: recognizing the problem that lies ahead (the distal problem),
which depends on accurate social forecasting, and willingness to engage in actions to prevent that suffering,
even if it requires some immediate sacrifices in the here and now.
In Buddhism, there are at least three types of suffering. The most obvious suffering is that due to disease or
injury, which stimulates pain sensations; included with that is mental anguish resulting from interpersonal
events, real or imagined. This is called the “suffering of suffering” or explicit suffering. This is usually a
proximal form of suffering. A second type of suffering, the suffering of change, is set up by our reification of the
self’s independent and unchanging existence and our inability to grasp impermanence; this is inherently distal,
though it could be experienced in the moment. The discomfort and unease of not getting what we want
(craving), or getting what we do not want (aversion), come from not accepting the ever-changing nature of
things, people, or situations. The third type of suffering, all-pervasive suffering, describes the basically
unsatisfactory nature of all forms of existence. This relates to our feeling that nothing is quite the way we want
it to be, and it takes the form of a mental habit of wanting things to be different.
The value of providing this typology of compassion and suffering is twofold. The first benefit is that it
encourages those who train people in, or investigate, compassion to specify which type of suffering they are
focusing on and which type of compassion they are examining or cultivating. Current research and
compassion training in the field of contemporary contemplative science focus on the cultivation of empathic
compassion and deal with the development of proximal and distal compassion for the first type of suffering
enumerated earlier: explicit suffering, from immediately observed physical or mental pain.
The second benefit of making these distinctions is that it draws attention to questions that could be
answered by further research. For example: Does action compassion always require first the experience of
empathic compassion, or might action compassion be trained directly? Do you need to first feel empathy
before you can be motivated to act to relieve the suffering of the target? Can non-referential compassion be
taught in a secular format in the way other compassion practices have been? Which type of compassion
training results in more compassion for strangers? Having clear and defined terms of compassion and suffering
allows for a greater depth and understanding of this complex construct. With greater understanding, we can
then determine how best to implement interventions to help promote and develop global compassion.

The Value of Psychological Science in Promoting Global Compassion

In this section, we review the value of psychological science in understanding how to promote global
compassion. Specifically, we will focus on the contributions of social psychology, emotion science, empathy
research, and evolutionary psychology. Collectively, knowledge gleaned in these fields helps us better
understand how and what to target when promoting global compassion.

Social Psychology and Compassion

Compassion of any kind will not occur unless the compassionate person accurately recognizes that someone
is suffering now or is likely to suffer in the future. The failure to act to prevent future suffering may be the
consequence of different events, internal and external, than the failure to act to prevent or alleviate current
suffering. Developmental and longitudinal research is needed to determine whether such compassionately

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motivated acts to prevent future harm are due to dispositional or situational factors or the combination of the
two. In some circumstances, everyone will realize that suffering is about to occur unless action is taken to
prevent an immediately impending event; for example, a safe falling from a window that will hit a pedestrian
unless the likely victim is pushed out of the way.
We do not know whether the observation of impending harm generates compassionate feelings that
precede and impel the rescuing intervention in all those who do intervene. If this is true, are those who
recognize impending harm but do not act therefore deficient in empathic resonance to the plight of others?
Might they have similar compassionate feelings but differ in risk-taking or appraisal of the likelihood of self-
risk? Or are such bystanders more generally indifferent to the suffering of others or perhaps to any emotion
shown by others? Still another possibility is that those who do not act to prevent impending harm to strangers
would do so for familiar or familial persons in danger. Thus the complexity of helping behavior in risk
situations begins to appear.
Foundational social psychology research addressed various aspects of how perception influences helping
behavior. Key findings include our perception of “in-groups” and “out-groups,” as well as how context can
shape helping behavior (Allport, 1958; Sherif & Sherif, 1969). Sherif and Sherif (1969) conducted a key study
among a group of boys attending a boys’ summer camp. Over the course of the boys’ time at camp, the
researchers made simple manipulations to the framing of activities to induce competition versus cohesion. The
boys were divided into two groups and told negative things about the “other” group, and the competition led
to anger and aggression (Sherif & Sherif, 1969). This study highlighted the malleability of perception
preceding our behavior. Stereotype threat research has followed up on this work to show how simple
manipulations to induce feelings as an outsider can lead to physiological and performance changes (Mendes,
Blascovich, Lickel, & Hunter, 2002; Mendes Reis, Sery, & Blascovich, 2003).
Another important observational study, the Good Samaritan study, pointed to the primacy of context in
predicting caring behavior. Individual seminary students were given materials to give a lecture, and a groaning
confederate was placed in their path to the lecture hall. Some were told they were late, and others had plenty
of time to reach the lecture hall (Darley & Batson, 1973). Those who were told they were late often walked
briskly past the groaning person, while the seminarians with more time were more likely to stop and help.
Their simply being in a rush changed the fate of the person needing help.
Kristin Monroe (2004) studied what she called “heroic compassion,” through individual interviews with
people who had risked their own lives to save others, including many Germans who took in Jews during the
Nazi regime. What was poignant and most powerful about this book was that the interviewees felt that they
simply had to do what they did; it was not a choice. This suggests that, for these people, risking their life was
a necessary response to the perceived threat towards others. It sounds as though these people did not
experience “out-group” feelings, and in fact had almost familial compassion towards the people they rescued,
often at great risk to their own lives and livelihood. Perceiving the target of compassion to be like us,
irrespective of external differences, has been called a “universal” orientation, one that is likely to precede a
globally compassionate approach (Phillips & Ziller, 1997).

The Science of Emotion and Compassion

In the last decade, there has been a renewed interest in the training and evaluation of compassion. Yet the

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focus on how another person’s suffering affects our own cognitive and emotional states and behavior is not
new. There is a long history of research on concepts such as empathy, emotional contagion, sympathy, and
altruism.
It is necessary to recognize that someone is suffering if one is to intervene to alleviate that suffering. Speech
content, vocal signals, and facial expressions may singly or jointly inform an observer that someone is
suffering. There is reasonably well-accepted literature supporting the existence of clear, easily recognized,
universal facial expressions of seven emotions (anger, fear, sadness, disgust, contempt, surprise, and
enjoyment); of these, the expressions of sadness are most relevant to identifying someone who is suffering
(Ekman, 1999). Both pain and anguish/sadness can be reliably distinguished from each other and from other
universal emotions, such as anger and happiness, from vocalizations and from facial expressions.
In this research, the facial and vocal expressions are studied out of context in order to determine their signal
value, independent of the specifics of any one situation. In real life, this rarely occurs. Instead, the situations in
which suffering is displayed are typically richly endowed with information that would in itself lead to the
judgment that a person in that predicament would be suffering, even if there were no clues from face, voice, or
speech. The ragged clothes and pained, limping walk of a person who has been told by police to move down
the street gives us context to feel compassion without facial or vocal expression. While the prerequisite for
distal compassion is not enabled in all people when the harm is remote and not immediate, the prerequisite
for proximal compassion—recognizing when a person is suffering—is enabled in all people, with the
exception of those afflicted with specific neurological or mental disorders.
Our emotions drive how we relate to others, to those we care about, how we treat them, love them, are
afraid of them. We are a social species; it is notable when someone lives in isolation. We need others; we are
interdependent. How we live our lives influences others, and how others lead their lives influences us. If we
believe this is true, it is just one more step toward understanding why we need global compassion. Now
consider a Western, psychological explanation for global compassion, albeit one not grounded empirically.
Ekman (1999) proposed that human beings possess an emotional alert database, comprising triggers that,
through automatic appraisals, instigate emotional impulses. The exact nature of those triggers, whether they
are scenes, scripts, or a fixed sequence of evaluations, is not germane to the issue here, but what must be
granted is that some of those triggers are universal to the human species, representing what Lazarus called the
“wisdom of the ages,” established as a result of repeated experiences over generations in our ancestral
environment. These are the unlearned triggers, such as a sudden loss of gravity triggering fear.
A more detailed description is needed to understand the emotion episode timeline, in which the emotion
alert database is nested. The timeline for an emotion begins with an automatic appraisal, as we are constantly
scanning the environment for information important to our welfare. This important information is part of the
trigger to an emotion; as stated above, these triggers are influenced by both our past personal experiences and
humans’ evolutionary past—hardwired responses that have been passed down through our genes. Our
automatic appraisal is not volitional, and to see the world without it requires highly concentrated attention.
Because appraisals can be influenced by triggers from our personal past, individuals can have dramatically
different responses to similar situations. Therefore, although emotions are universally felt and expressed, why
we become emotional and what we become emotional about are as unique as our fingerprints.
For example: You are walking down the street with a new friend, and a car passes by with the windows

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down and the radio blasting out a song. For you, this song brings up deep sadness because it was one of the
favorite songs of your brother, who died from cancer five years ago, and the song was played at his funeral.
However, the friend you are walking with did not know your brother and does not have any association with
the song. Therefore, she does not experience an emotional response. The two of you are on the same street,
hearing the same song, but due to your distinctive personal pasts, you have quite different responses. If that
car backfires, you will both have a startle and fear response, which is shared and universal.
Most triggers are learned, entering the emotional alert database as a result of various emotional experiences
over the course of one’s life. We believe (based on LeDoux’s research in 2000) that it is very difficult to erase a
learned trigger, once it has entered the emotional alert database. It can be weakened through various practices,
but it will reappear when stress seems to enliven weakened learned triggers. The question again arises whether
the volitional practice of loving-kindness and compassion practices can shift our appraisals of the world to
move closer towards a feeling that everyone is our concern; everyone is like family.

Empathy and Compassion

Empathy is a critical precursor to active compassion, which responds to proximal and distal signals of
distress. Neuroscientist James Decety provides a succinct definition of empathy that dovetails with Halpern’s
theoretical work: “The psychological construct of empathy refers to an intersubjective induction process by
which positive and negative emotions are shared, without losing sight of whose feelings belong to whom.
Empathy can lead to personal distress or to empathic concern” (Decety & Meyer, 2008, p. 1054). This
definition distinguishes three critically important points for defining empathy: (1) There is a subjective felt
experience of another’s emotions; (2) empathy does not mean losing oneself in the other person’s experience;
and (3) empathy is the precursor to feeling distress, or to caring, concern, or helping. Through the four
schematics that follow, we will review the felt experience and biological underpinnings of how empathy can
unfold. In Figure 4 we see the components of Empathy in the top left, Compassionate Empathy in the top
right, Distancing Empathy in the bottom left and Distressed Empathy in the bottom right.

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Figure 4.1 Empathy appraisal: Compassion, distance, and distress.

The diagram in Figure 4.1 illustrates the key components of empathy in temporal order. We are hardwired
for our first, and nearly automatic, emotional resonance, sometimes called “affective sharing” or “emotion
contagion” (Zaki, Weber, Bolger, & Ochsner, 2009). The key aspect of resonance is automaticity; this is the
emotional poignancy, the affective aspect of empathy.
The second component is empathy-appraisal and perspective-taking. This top-down process, less automatic
than resonance, is influenced by conscious thought. This is cognitive empathy. As shown by the arrows going
both ways in Figure 4.1, the affective resonance can be moderated by this cognitive aspect, which can in turn
influence the initial affective response.
This cognitive aspect of empathy can moderate our emotional responses to be caring, or lead us to
distancing and distress. The top-right box in Figure 4.1 shows cognitive appraisal leading to empathic concern
and enactive compassion. Enactive compassion is a term drawn from the contemplative science literature and
elaborated on in a schematic model by contemplative teacher Roshi Joan Halifax; it is similar to what we are
calling action compassion in this chapter. However, Halifax applies additional nuance to action compassion by
using the concept of an “enactive mind,” a mind that does not merely perceive the world, but is in an emergent
and contingent process of sense-making with the world and the surrounding environment (Thompson &
Stapleton, 2009). Applying this conception to compassion, compassion is not a discreet activity but part of a
process of perception and engagement (Halifax, 2014). Enactive compassion is not a blanket approach of
caring; rather, it is a nuanced response to our emotional resonance, cognitive appraisal, intention, and somatic
experience (Halifax, 2012).
The bottom-left box in Figure 4.1 represents cognitive appraisal without an intention of compassion. In
this version of empathy, automatic emotional resonance to the suffering of another person is followed by a
distancing logic towards the person for their suffering, such as a doctor feeling, “It is their fault they are sick,
they don’t take care of themselves.” This could be technically accurate, as they could be a heavy drug-abuser,

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or irresponsible with their diet despite having diabetes. This appraisal then leads to aversion, and may result in
responses of anger, blaming, avoidance, or ignoring. It is important to note here that the very same patient,
the drug-abuser, could be appraised as deserving of our enactive compassion because they are suffering—the
difference being perception, which is directly shaped by our intention and/or our feelings of efficacy and
ability. For many health professionals, not being able to help or treat a patient creates extremely difficult
feelings of inefficacy, and this inefficacy can shape our perception towards feeling aversion toward the patients
we cannot help. This aversion is a key feature of burnout, measured through questions about cynicism and
depersonalization. Burnout has been frequently cited as a cause of declining empathy among health
professionals (Picard, Catu-Pinault, Boujut, Botella, Jaury, & Zenasni, 2015).
The final box on the lower right in Figure 4.1 demonstrates what happens when we act “mindlessly”
without top-down awareness of our emotional resonance. Here, we feel the suffering of another as though it
were our own, and devolve into self-related concerns (Halpern, 2003). When we feel too distressed, we
attempt to avoid emotional resonance. Because emotional resonance occurs nearly automatically, avoidance
requires effortful, total suppression. This strategy has two downsides. One is that we miss important clinical
information that is communicated through the patient’s affect, such as fear from a patient who experienced
domestic violence, which we have not screened for. The second downside is that suppression of emotions is
effortful and physiologically taxing on our system, resulting in more, rather than less, emotional exhaustion
over time (Gross & Levenson, 1993).

Evolutionary Psychology and Compassion

Evolutionary psychology has examined the function of compassion alongside altruistic and caring behaviors.
“Reciprocal altruism” typifies a somewhat cynical, transactional view of the origins of compassion. In
reciprocal altruism, we may temporarily forfeit some of our needs for the needs of others, but this is done with
an expectation of payback. The payback is some form of reciprocation such as an in-kind favor, or earned
social status in the eyes of others for “doing good” (Simpson & Willer, 2008). This could almost be
considered a contingent compassion—kindness that is enacted with an expectation of reciprocity.
There is an additional layer involving the function of emotions, and compassion in small-group settings in
which our ancestors lived. In these groups, social cohesion was facilitated by sharing of enjoyable emotions,
and everyone was one step removed from family. These would have created the conditions for universal
familial compassion, where compassion for everyone was like compassion for family. This approach may also
sound a bit self-serving; however, it may provide some basis for an intrinsic desire to help others (Ekman,
2010).
There are three quite different positive consequences that an individual might experience after engaging in
a compassionate action (perhaps just from feeling the compassionate feelings, even if not acted upon). First is
what Ekman (2015) termed compassionate joy (CJ), a unique type of enjoyment that feels good, is consciously
felt, intrinsically rewarding, and to our knowledge, little studied to date.1 Second, and quite separate, is the
enhancement of self-image that can occur from having acted compassionately. And third is the enhancement
in how others regard the person who acts compassionately if what they do is known by others.
In 1967 and 1968, the second author of this chapter (Paul Ekman) spent time in the Southeast Highlands
of New Guinea studying a group of people—the South Fore—most of whom had little or no prior contact to

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the outside world. Based on the observations of these people (published elsewhere, Ekman, 2015), Paul
noticed how most people (as best he could tell), saw and spoke to fewer than 200 (probably closer to 100)
people in a lifetime. They lived in circumstances where they witnessed and sometimes participated in the life
course of these familiar people; a compassionate concern that would come readily for strangers was rare,
almost nonexistent. A couple of times a week, everybody in the village cooked together and ate together. The
circumstances were remarkably different from the life that we lead now in cities and towns of the industrial
world, where we see more strangers in a day than these people were likely to see in a lifetime. It is the first
author’s (Eve’s) suspicion that built within us is a compassionate concern for others, because there were few
strangers when we lived in smaller groups.

Conclusion
Paul has been considering the possibility that some people have, for inexplicable reasons, the suffering of all
people, not just family members, in their emotion alert database. Alternatively, it might be that everyone has
the suffering of all people, all strangers, in their emotional alert database, but it needs to be awakened. This
could occur by an emotionally intense event or trauma, or a national trauma such as the 9/11 terror attacks, or
an inspirational encounter with someone who has global compassion. The proposal is that everyone has the
potential, but it must be activated in most people. It is only in a minority of people that it is activated, but our
hypothesis is that the potential is there in everyone; it just needs to be activated. Within this more generous or
optimistic formulation, it is still necessary to explain why this difference exists—Why is global compassion
active from early life in some, but not most, people without some special event activating it? Is it mere chance,
inexplicable in any known terms? Or might it be something in the upbringing of these people? Only
longitudinal studies could answer that if we are not to rely on retrospective reports. Longitudinal studies
would also reveal how early in life such compassionate concern was first evident. Perhaps some genetic factors
predispose individuals to have stranger compassion? Certainly recent studies identifying genes predictive of
helping behavior suggest this may be so. It may well be a combination of genetic factors activated by specific
environmental circumstances.
Even if research were to support the role of genetics in predisposing some people toward global
compassion, it is not obvious how that finding could help those who want to increase the frequency of this
behavior. It would be helpful to discover whether there are certain life experiences that occur in most people
who exhibit global compassion, pointing toward what is required to activate a genetic predisposition, if indeed
there is such a predisposition in all people.
There are now many different approaches to cultivating compassion, many of which are being evaluated
through research. The focus is primarily on proximal compassionate feelings, much less on actions, and very
little on distal compassion. The most successful approach for cultivating global compassion may vary with the
focus, the circumstances, and the individuals addressed. We think it likely that efforts focused on actions to
prevent suffering (distal actions) will be most successful, across various people, if it occurs in late childhood
and adolescence.
Many questions remain about this burgeoning body of research into compassion. The data are not reported
in a way to determine whether increased compassion is shown by everyone or just the majority of the group
given training. And, if compassion is not evident in everyone, what might account for who responds and who

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does not? It is not known how long this meditative practice must be followed, nor whether compassion
endures after a period of time with no practice. Nor has there been study of whether contemplative practices
generate truly global compassion, toward strangers who differ in appearance, language, and culture. This
chapter offers more questions than answers, but it does offer a new typology to help understand compassion
and suffering.

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Note
1. Our hunch is that compassionate joy is a mild, not a strong, emotion, and hence, can be easily overwhelmed by the excitement obtained
when defeating someone in a game or real life. It is also possible that people who devote themselves to global compassion have a much
stronger CJ response.

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11382–11387.

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 PART 2

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Developmental Approaches

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 Compassion in Children

Tracy L. Spinrad and Nancy Eisenberg

Abstract

Developmental psychologists have been increasingly interested in studying children’s “prosocial

behavior,” defined as voluntary acts to benefit another. We begin this chapter by differentiating between
empathy, sympathy, and personal distress reactions, arguing that compassion overlaps considerably with
the construct of sympathy. Next, we focus on the normative development of children’s prosocial behavior
and children’s empathy-related responses. Our empirical work also is reviewed, highlighting the
differential associations of empathy, sympathy, and personal distress with children’s prosocial behavior.
In addition, we discuss our work examining both dispositional and socialization factors that predict
individual differences in children’s concern for others. We conclude by urging researchers to consider
nuances in compassionate behaviors, such as studying the recipients of prosocial actions and different
types of prosocial behaviors.

Key Words: development, empathy, sympathy, prosocial behavior, individual differences, emotionality,
regulation, parenting

Overview of Discipline
The developmental psychology perspective on compassion generally has focused on children’s prosocial
behavior and moral emotions. In developmental psychology, “prosocial behavior” is typically defined as
voluntary behavior intended to benefit another, such as helping, sharing, comforting, and donating
(Eisenberg, Spinrad, & Knafo-Noam, 2015). “Altruism” refers to prosocial behavior that is motivated
intrinsically rather than by the expectation of rewards or the avoidance of punishment. Of course, in work
with children (and especially young children), it is very difficult to differentiate between actions that are
motivated by internal versus external forces; thus, we often focus on the broader construct of prosocial
behavior.
Researchers have differentiated among several emotional responses thought to contribute to prosocial
behavior. One response thought to contribute to prosocial behavior is empathy, which has been defined as an
emotional experience that is the same (or nearly the same) as what another person is feeling or expected to feel
(Hoffman, 2000; see Eisenberg, Spinrad, & Knafo-Noam, 2016). For example, if a child views a sad person
and as a consequence feels sadness him-/herself, the child is experiencing empathy. Sympathy (also referred to
as “empathic concern”), is defined as an affective response that consists of feelings of sorrow or concern for
another. If a child views a sad person and feels concern towards that person, the child is experiencing
sympathy. Sympathy may often stem from empathy, but it also may stem from accessing relevant information
from memory. Goetz and colleagues (2010) defined compassion as sensitivity to the pain or suffering of

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another, coupled with a deep desire to alleviate that suffering.
Sympathy is thought to overlap considerably with the construct of compassion. Eisenberg, VanSchyndel,
and Hofer (2014) argued that both sympathy and compassion involve sympathetic concern for others.
However, sympathy might not always motivate the desire to assist another, especially in situations in which it
is difficult or impossible to assist, whereas compassion involves the desire to help another. Whether sympathy
motivates prosocial behavior probably depends on factors such as costs to the actor of assisting, opportunities
for assisting in that context (e.g., if it is possible to assist), and other situational factors (e.g., other demands
on the individual’s time). Furthermore, Goetz et al. (2010) noted that compassion may involve blends of
emotions, such as love, tenderness, caring, and warmth, that are not necessarily part of our definition of
sympathy. Thus, we typically refer to sympathy, and not compassion, in this chapter because we cannot be
sure whether the concerned feelings toward another necessarily involve the desire to help.
Another empathy-related emotional response is personal distress. Personal distress is a self-focused reaction
to another person’s negative emotion, such as a child’s feeling personally anxious and inclined to escape in the
presence of another person’s distress (Batson, 1991). Personal distress may stem from exposure to another’s
state or condition; however, it is an aversive response that includes self-focused reactions such as discomfort or
anxiety.
It is clear that it is essential to differentiate among these empathy-related responses. Scholars have
theorized that compassion (by definition), sympathy, and sometimes empathy (depending on its
operationalization) are strong motivators of prosocial behavior (Batson, 1991; Eisenberg & Fabes, 1998;
Hoffman, 2000). On the other hand, personal distress is unlikely to motivate prosocial behavior unless there is
no other way to alleviate one’s own distress (e.g., one could not escape contact with the person needing
assistance).

Compassion-Related Insights
Studies have shown that prosocial behavior and empathy-related responding emerge early in life, and they
tend to increase throughout childhood. There has been considerable interest in studying both normative
development and individual differences in children’s empathy-related responding and prosocial behavior.
Researchers have focused on the origins of prosocial behavior and empathy-related responding, with a
particular emphasis on the role of how individual characteristics and socialization factors predict the
development of empathy-related responding and prosocial behavior.

Development of Prosocial Behavior and Empathy-Related Responding

One way to gather insight into children’s prosocial behavior and empathy-related responding is to examine
its normative development. Hoffman (2000) proposed a theory regarding the development of empathy and
prosocial behavior, with young children shifting from self-concern to more empathic, other-oriented concern
over time. Specifically, Hoffman proposed that infants have not yet acquired a sense of self–other
differentiation; thus, they tend to experience self-distress in response to another’s distress, as evidenced by
their tendency to cry in response to the sound of another’s cry. Around the second year of life, Hoffman
posited that toddlers are prone to egocentric empathic distress, in which they may seek comfort for their own
distress in response to another’s distress. Hoffman further proposed that as toddlers make further cognitive

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and socio-emotional gains, they are capable of what he labeled “quasi-egocentric empathic distress” (not to be
confused with personal distress reactions). Rather than solely seeking self-comfort, toddlers may try to
comfort others, but such prosocial behavior is thought to involve giving the others what the toddlers
themselves find comforting. Hoffman argued that children’s socio-cognitive skills, such as self–other
differentiation and perspective-taking, play a key role in the emergence of prosocial behavior. In early
childhood, Hoffman argued, as socio-cognitive skills develop, children experience veridical empathic distress,
in which children’s prosocial actions reflect an understanding of the other person’s needs. With improved
cognitive and language skills, older children gain the ability to experience empathy even when the other
person is not physically present, and by late childhood, children can empathize with another’s general plight
or condition, such as responding to the impoverished.
Empirical evidence suggests that empathy and prosocial behavior emerge even earlier than Hoffman
suggested (2000). Toddlers as young as 14 to 18 months exhibit helping behavior, even with no external
rewards (Svetlovea, Nichols, & Brownell, 2010; Warneken & Tomasello, 2007; Zahn-Waxler, Schiro,
Robinson, Emde, & Schmitz, 2001), and empathic concern has been observed in late infancy (even in the first
year of life) and early toddlerhood (Davidov, Zahn-Waxler, Roth-Hanania, & Knafo, 2013; Zahn-Waxler,
Radke-Yarrow, Wagner, & Chapman, 1992). Research also suggests that rudimentary self–other
differentiation develops prior to success in mirror self-recognition tasks (see Davidov et al., 2013), which
would be consistent with the notion that empathy may develop earlier than Hoffman proposed. For example,
four-month-olds smile more and look longer at a mirror image of someone imitating them than at a mirror
image of themselves—work that suggests that infants have some self–other differentiation abilities (Rochat &
Striano, 2002). Furthermore, infants as young as three months of age prefer a helpful puppet to a non-helpful
one (Hamlin & Wynn, 2011; Hamlin, Wynn, Bloom, & Mahajan, 2011). These findings indicate that infants
have the capacity to consider others’ motives; thus, it is likely that infants have capacity for early empathy.
In addition, although toddlers are most likely to respond to another’s distress by either seeking comfort,
exhibiting sympathy, engaging in cognitive forms of empathy (e.g., hypothesis testing), or ignoring/no
response (or occasionally anger or aggression), toddlers also, albeit rarely, exhibit prosocial behavior in
response to another’s distress (Zahn-Waxler et al., 1992; Liew et al., 2011; Spinrad & Stifter, 2006; Svetlova
et al., 2010). Researchers generally have charted increases in young children’s prosocial behaviors across the
toddler and preschool years (Dunfield & Kuhlmeier, 2013; Knafo, Zahn-Waxler, Van Hulle, Robinson, &
Rhee, 2008), although children also become somewhat more selective in regard to whom they assist
(Brownell, Svetlova, & Nichols, 2009; Moore, 2009; see Hay & Cook, 2007). Prosocial behavior also
generally continues to increase in frequency across preschool and childhood (Eisenberg & Fabes, 1998).
There is limited research that has examined change in prosocial behavior in adolescence, and findings are
somewhat inconsistent. Kanacri, Pastorelli, Eisenberg, Zuffiano, and Caprara (2013) found that Italian
students’ self-reported prosocial responding (i.e., the tendency to enact prosocial behaviors) showed a
quadratic pattern, in which prosocial responding declined from age 13 to 17 and then increased until the last
assessment at age 21. On the other hand, researchers also have shown linear increases in self-reported
prosocial actions throughout adolescence (Jacobs, Vernon, & Eccles, 2004) or have shown no change in
sympathy over time (Eisenberg, Cumberland, Guthrie, Murphy, & Shepard, 2005; Taylor, Barker, Heavey, &
MicHale, 2012). Thus, more work is needed to determine the trajectories for prosocial behaviors differing in

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characteristics, such as motivation, and in different contexts.

Individual Differences in Sympathy and Prosocial Behavior

In addition to understanding the development of children’s prosocial behaviors and sympathy, there is also
an interest in understanding the origins of children’s sympathy and prosocial behavior, including potential
temperamental and socialization factors. A more thorough discussion of the origins of prosocial behavior
(including genetic, biological, and cultural factors) can be found elsewhere (see Eisenberg, Spinrad, & Knafo-
Noam, 2015; Eisenberg, Fabes, & Spinrad, 2006).

Eisenberg and Colleagues’ Research on Empathy-Related Responding and Prosocial Behavior

Relations of Empathy-Related Responding to Prosocial Behavior
As noted by theorists (Batson, 1991; Hoffman, 2000; Eisenberg, 1986), it is important to differentiate
between sympathy (empathic concern) and personal distress in response to seeing another person’s distress,
because they predict different tendencies toward prosocial behavior. Sympathy, for example, might be
expected to motivate prosocial behavior (Batson, 1991). We expect that sympathy, in many cases, is equivalent
to compassion when it motivates prosocial behavior. However, in studies of observed or reported sympathy, it
is often unclear whether the responses include prosocial motivations. Thus, we use the term “sympathy” when
referring to our work, because we cannot be sure that sympathetic responses always include the motivation to
help. Consistent with his theorizing, Batson (1991) found sympathy to be positively associated with helping
in adults.
In order to determine whether similar findings would be obtained with children, Eisenberg and colleagues
conducted a series of laboratory studies demonstrating the importance of differentiating between empathy-
related responses. In these studies, children were shown a film about other children who were injured or
otherwise distressed. Later, children had an opportunity to assist the person in the film (or someone similar)
by donating part of their payment or doing a helpful activity rather than playing with toys. Children’s facial
sympathy (e.g., eyebrows down flat and forward, relaxed face, body and head oriented forward or toward
other), and sometimes empathy (e.g., facial sadness) was positively related to their prosocial behavior
(Eisenberg, Fabes, et al., 1989, 1990; Miller, Eisenberg, Fabes, & Shell, 1996; see Eisenberg, Fabes, &
Spinrad, 2006). Children’s physiological changes, thought to be markers of sympathy (i.e., heart rate
deceleration, lower skin conductance) were also related to greater prosocial behavior (Eisenberg et al., 1989;
Eisenberg, Fabes, Miller, et al., 1990; Holmgren, Eisenberg, & Fabes, 1998).
We also have conducted observational research with much younger children. In these studies, toddlers and
young children were observed witnessing an experimenter’s feigned distress during a laboratory visit. At 30
months of age, facial measures of concerned attention (i.e., sympathy) and hypotheses testing (i.e., the child’s
attempts to label or understand the problem, thought to be an indicator of empathic concern) were positively
related to helping (Liew et al., 2011). Furthermore, sympathy at 30 months of age significantly predicted
parent-reported and observed prosocial behavior (e.g., comforting experimenter, getting parent to help) at 42
months, even after controlling for stability in the constructs (Edwards et al., 2015).
In contrast to sympathy, personal distress, because it is an aversive state, might be associated with the
motivation to make oneself feel better (Batson, 1991). Indeed, personal distress has been either unrelated or

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negatively related to children’s prosocial behavior (Eisenberg et al., 1989; Eisenberg, Fabes, Karbon, et al.,
1996; Fabes, Eisenberg, Karbon, Toyer, & Switzer, 1994). For example, higher skin conductance during a
film of injured or distressed children, a marker of personal distress, has been inversely correlated with girls’,
but not boys’, prosocial behavior (Fabes, Eisenberg, & Eisenbud, 1993).
We also have studied associations between dispositional measures of sympathy and empathy to prosocial
behavior. Using questionnaire measures of sympathy, we have found positive relations with prosocial
behaviors that involve some cost to the child, such as donating earnings to charity (Eisenberg, Miller, Shell,
McNalley, & Shea, 1991; Eisenberg, Shell, et al., 1987). In work with young children, we found that mother-
reported empathy at 24 months and the linear slope of mother-reported empathy from 24 to 54 months
positively predicted teacher-reported prosocial behavior with peers at 72/84 months (Taylor, Eisenberg,
Spinrad, Eggum, & Sulik, 2013). Thus, there is relatively consistent evidence that sympathy (and empathy, in
some cases) is positively related to prosocial behavior.
Eisenberg and colleagues also have discussed the importance of considering distinctions among prosocial
behaviors with regard to the motivation for children’s prosocial behavior (see Eisenberg, VanSchyndel, &
Spinrad, 2016). That is, because the motivations for prosocial actions are typically unclear, researchers might
find that differentiating between types of prosocial behavior (i.e., instrumental helping, sharing, or
comforting), as well as examining the context of prosocial behaviors, may provide clues about whether
prosocial behaviors are motivated by social affiliation, rewards, or sympathy (other-oriented emotions).
On one hand, prosocial behaviors may be either spontaneous or compliant. Prosocial behaviors that are
spontaneous are likely to be more other-oriented than are prosocial behaviors that are performed in response
to a request, such as sharing when asked or comforting when asked (Eisenberg & Shell, 1986; Eisenberg-Berg
& Hand, 1979; Miller et al., 1996). Spontaneous and costly prosocial behavior in preschool (i.e., sharing
objects in the child’s possession without being asked) has been positively related to a number of later measures
of prosocial responding (Eisenberg, Guthrie, Murphy, Shepard, Cumberland, & Carlo, 1999; Eisenberg,
Guthrie, et al., 2002; Eisenberg, Hofer, Sulik, & Liew, 2014), sympathy (Eisenberg, McCreath, & Ahn,
1988), as well as moral reasoning focusing on others’ needs (Eisenberg-Berg & Hand, 1979).
On the other hand, compliant prosocial behaviors in preschool (especially compliant, low-cost helping in
response to a peer’s request) have been generally unrelated to children’s later sympathy. It is likely that
children high in compliant prosocial behavior are somewhat unassertive and may lack social competence
(Eisenberg, Cameron, Tryon, & Dodez, 1981; Eisenberg et al., 1990; Eisenberg, Pasternack, Cameron, &
Tyron, 1984). Although preschoolers’ compliant costly sharing of objects or space (e.g., the swing set) was
unrelated to prosocial behavior in early adolescence, in late adolescence and early adulthood it was associated
with self-perceptions (albeit not others’ perceptions) of a prosocial orientation (Eisenberg et al., 2002;
Eisenberg et al., 2014).
Laboratory studies also have been conducted to examine children’s costly prosocial behavior (i.e., donating,
volunteering time) as opposed to less costly behaviors (i.e., helping to pick up a dropped object). We assume
that costly prosocial behaviors are unlikely to result in self-gain, and thus, such behaviors are more likely to be
motivated intrinsically than are low-cost helping behaviors. As predicted, costly prosocial behaviors have
sometimes been associated with higher sympathy and moral reasoning focusing on others’ needs, whereas low-
cost sharing/donating behaviors have been unrelated to prosocial moral reasoning or sympathy (Eisenberg &

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Shell, 1986; Eisenberg, Shell, et al., 1987). Furthermore, helping that is anonymous is not likely to be
extrinsically rewarded and, hence, is also likely to be performed for intrinsic reasons (see Eisenberg,
VanSchyndel, & Spinrad, 2016).

Origins of Empathy-Related Responding and Prosocial Behavior

Developmental researchers have been interested in the factors that predict individual differences in
children’s concern for others. In particular, we have primarily examined how children’s dispositional
emotionality and self-regulation, as well as parental socialization practices, relate to sympathy and prosocial
behavior.
Dispositional emotionality and self-regulation: Scholars have recognized the role of temperament in prosocial
behavior. Although there are other temperamental factors related to concern for others (i.e., sociability,
shyness), we focus here on children’s dispositional abilities to self-regulate as well as tendencies to experience
and/or the typical intensity of emotional experience. It is assumed that children who differ in self-regulation
and emotional responses also differ in aspects of social functioning, such as sympathy and personal distress.
Eisenberg and colleagues hypothesized that individuals who are high in self-regulation tend to experience
sympathy, rather than personal distress. We would expect that children who can regulate their own emotions
would be unlikely to become over-aroused by another’s distress. That is, children who are easily aroused and
have difficulty regulating that arousal may be more likely to experience self-focused distress reactions. We
define self-regulation as
the process of initiating, avoiding, inhibiting, maintaining, or modulating the occurrence, form, intensity, or duration of internal feeling
states, emotion-related physiology, attentional processes, motivational states, and/or the behavioral concomitants of emotion in the service
of accomplishing affect-related biological or social adaptation or achieving individual goals. (Eisenberg & Spinrad, 2004, p. 338)

Consistent with hypotheses, self-regulation has fairly consistently been related to greater sympathy
(Eisenberg, Fabes, Murphy, et al., 1996; Eisenberg, Fabes, et al, 1998; Eisenberg, Michalik, et al., 2007;
Guthrie et al., 1997; Murphy et al., 1999; Valiente et al., 2004) and prosocial behavior (Eisenberg, Fabes,
Karbon, et al., 1996). Moreover, low self-regulation sometimes predicts higher personal distress reactions
(Valiente et al., 2004).
Heart rate variability (HRV) and respiratory sinus arrhythmia (RSA) are considered physiological indices of
self-regulation. Children with higher HRV or RSA are thought to cope better (or more flexibly) with stressors
(Porges, Doussard-Roosevelt, & Malti, 1994); it is expected that these indices would be positively related to
sympathy and prosocial behavior. However, the connections of RSA (or HRV) to children’s empathy-related
responding have been somewhat inconsistent. In some work, we have found baseline RSA (or HRV) to be
related to higher levels of sympathy (Fabes et al., 1993; Liew et al., 2011), prosocial behavior (Fabes et al.,
1994), or lower personal distress (Fabes et al., 1993). We have also observed mixed results for boys’ versus
girls’ sympathy (Eisenberg, Fabes, Murphy et al., 1996); that is, physiological measures tend to primarily
predict boys’, but not girls’, sympathy. RSA suppression, which represents a readiness to respond to contextual
demands and coping with the environment (Calkins & Keane, 2004), also predicts children’s responses to
others’ distress. Specifically, RSA suppression in response to a video of crying babies was positively related to
toddlers’ helping, but not observed concerned attention (Liew et al., 2011). RSA and HRV may vary as a
function of the level of arousal, the context, and the type of response (e.g., sympathy versus empathy).
Relations between empathy-related responding and children’s dispositional emotionality also have been

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predicted. Because sympathy is an emotional experience in response to another person’s pain or distress,
people who are prone to intense emotions (particularly sadness and distress), if they can modulate their own
emotions, would be expected to be experience sympathy. On the other hand, intense negative emotions
without regulation would be expected to predict personal distress. Indeed, empirical evidence indicates that
children’s negative emotionality is negatively related to prosocial behavior (Eisenberg, Fabes, Karbon, et al.,
1996) and positively associated with personal distress reactions (Guthrie et al., 1997). Negative emotionality
or general emotional intensity also has been negatively related to sympathy, especially for boys (Eisenberg,
Fabes, Murphy, et al., 1996; Eisenberg, Fabes, Shepard, et al., 1998; see also Murphy, Shepard, Eisenberg,
Fabes, & Guthrie, 1999).
Different types of negative emotions (e.g., anger, sadness, fear) should be differentiated when examining
these predictions. Edwards and colleagues (2015), in a study of 18-, 30-, and 42-month-old children, found
that sadness and sympathy were unrelated at the youngest age. However, by 30 months of age, dispositional
sadness marginally predicted higher levels of sympathy a year later. Thus, it is possible that a greater tendency
to feel sadness fosters the early emergence of sympathy, at least as toddlers age. Moreover, young children’s
sadness may play a role in fostering sympathy through its impact on caregivers. Because sadness is likely to
elicit social support from others (Campos, Campos, & Barrett, 1989), it is possible that experiences with
caregivers mediate these relations.
We have also examined whether toddlers’ fearfulness predicted empathy-related reactions to an
experimenter’s feigned distress in the laboratory (Liew et al., 2011). Fearfulness, an emotional response that
prompts self-preservation and escape responses (Campos et al., 1989), was positively associated with personal
distress reactions, but not sympathy, concurrently at both 18 and 30 months of age.
Furthermore, one might expect that generally positive emotionality would be associated with sympathy
because children who are temperamentally positive are likely better able to be open to and respond to others’
needs. These individuals may also be more in tune with others’ emotions, better at not becoming overly
aroused by negative emotion, and more socially competent in general. Indeed, children’s positive emotionality
has been related to children’s relatively high sympathy (Eisenberg, Fabes, Murphy, et al., 1996). Preschoolers’
positive emotionality also has been associated with children’s relatively high positive empathy, a construct
designed to understand children’s happiness upon witnessing others’ good fortune (Sallquist et al., 2009).
Rather than assuming that positive emotionality promotes empathy and prosociality, it is also possible that
doing good makes one feel good. Indeed, in a series of studies, often using experimental designs, Aknin and
colleagues have shown that people who give to others exhibit more happiness than when they receive the
resources for themselves (Aknin, Barrington-Leigh, et al., 2013; Dunn, Aknin, & Norton, 2014), and these
findings have been replicated in work with young children (Aknin, Hamlin, & Dunn, 2012). There is also
evidence that adolescents’ reports of helping the family (e.g., doing chores, taking care of siblings) are related
to teenagers’ happiness and well-being (Fuligni & Telzer, 2013; Telzer & Fuligni, 2009).
It may be important to examine whether temperamental qualities are differentially related to empathy-
related responding based on the potential recipient. Spinrad and Stifter (2006) found that mother-reported
fearfulness at 10 months of age predicted personal distress to their mothers’, but not to a strangers’, distress at
18 months. Moreover, fear was positively associated with concerned attention toward both their mother and
the stranger. Thus, fearful infants may be particularly attuned to the threatening signal of others’ distress.

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 The combination of tendencies to experience negative emotions and to self-regulate is also thought to
contribute to empathy-related responding and prosocial behavior. Eisenberg and colleagues found that the
interaction of emotional intensity and self-regulation predicted children’s sympathy (Eisenberg, Fabes,
Murphy, et al., 1996), and the interaction of negative emotion and self-regulation predicted prosocial
nominations by peers (Eisenberg, Fabes, Karbon, et al., 1996). Specifically, for girls, high attention regulation
(a marker of self-regulation) was associated with high prosocial nominations, regardless of the level of negative
emotionality. On the other hand, for girls with low or moderate levels of attention regulation, there was an
inverse relation between negative emotionality and prosocial nominations. For boys, the negative association
between negative emotionality and prosocial nominations was significant only for those with moderate and
high levels of attention regulation. Boys who were low in attention regulation tended to have few prosocial
nominations, regardless of their emotionality (Eisenberg, Fabes, Karbon, et al., 1996). Eisenberg, Fabes,
Shepard, and colleagues (1998) found that two years later, for boys (but not girls) low in general emotional
intensity, sympathy also was low regardless of their level of self-regulation. However, for boys who were
average or high in general emotional intensity, sympathy was low if self-regulation was low and increased as
self-regulation increased. They also found that attention-focusing skills predicted high dispositional sympathy
only for children who were low in emotional reactivity. These findings highlight the importance of
considering both dispositional emotionality and self-regulatory skill in understanding children’s prosocial
tendencies.
Parenting. Some of our work has focused on the ways in which parental characteristics and practices are
associated with children’s empathy-related responding. Parents are likely to contribute to their children’s
empathy/sympathy and prosocial development in a number of ways, including modeling, through the quality
of their relationships with their children, discipline strategies, and emotion-related socialization practices (see
Eisenberg, Spinrad, & Knafo, 2015).
Because they are thought to foster a sense of connection to others, parental warmth, nurturance, and/or
responsiveness are believed to promote children’s sympathy and prosocial behavior. We have found evidence
to support this notion (Eisenberg, VanShyndel, & Hofer, 2015; Malti, Eisenberg, Kim, & Buchmann, 2013;
French, Eisenberg, Sallquist, Purwono, Lu, & Christ, 2013; Spinrad & Stifter, 2006; Spinrad et al., 1999).
For example, Spinrad and Stifter (2006) found that maternal sensitivity at 10 months of age predicted 18-
month-olds’ concern toward a distressed adult. Similarly, in a study of young school-aged children, maternal
positive affect and encouragement during a challenging task was positively related to children’s sympathy in
children five to seven years of age (Spinrad et al., 1999).
Parents who are sympathetic themselves are likely to model sympathy. Thus, we have examined the
association between parents’ own sympathy and children’s vicarious emotional responding. We found that
sympathetic parents had same-sex children who were helpful (Fabes, Eisenberg, & Miller, 1990) and had sons
who were relatively high on dispositional sympathy or empathy (Eisenberg, Fabes, Schaller, Carlo, & Miller,
1991). Furthermore, parents’ own sympathy was positively related to low levels of personal distress in same-
sex (but not other-sex) children (Eisenberg, Fabes, et al., 1991). Thus, when children had sympathetic
parents, they were unlikely to experience over-arousal when viewing distressing stimuli and sometimes were
more likely to experience sympathy.
In addition, parents’ own expression of emotion is thought to predict children’s vicarious emotional

96
responding, possibly by providing opportunities to see when it is acceptable to experience and display
emotions. Mothers’ negative expressivity was associated with children’s relatively lower prosocial behavior or
sympathy (Eisenberg, Liew, & Pidada, 2001; Valiente et al., 2004; Zhou et al., 2002). For example, Michalik
and colleagues (2007) found that parents’ reported negative-dominant expressivity was related to low levels of
boys’ (but not girls’) sympathy in childhood but not during adolescence. On the other hand, parents’ reported
negative emotionality was positively related to girls’ sympathy (and prosocial behavior) in adolescence, but not
childhood, suggesting that parents’ negative emotionality may heighten girls’ awareness of others’ emotions.
These findings suggest that associations of socialization to sympathy and prosocial behavior change with age,
and may be different for sons than for daughters.
We also have examined parenting practices that focus on helping children self-regulate (emotion-related
socialization practices; see Eisenberg, Cumberland, & Spinrad, 1998). Parents’ reactions to children’s negative
emotions are related to children’s empathy-related responding. In one recent study, mothers who encouraged
their 18-month-old toddlers to express their emotions had children who were relatively high in empathy at 24
months of age (Taylor et al., 2013). In another study, parents’ supportive reactions to school-aged children’s
negative emotions (e.g., encouragement of expression, problem-focused reactions) were related to comforting
a crying infant, although relations were mostly for boys (Eisenberg, Fabes, & Murphy, 1996). Specifically,
girls’ comforting was predicted by mothers’ use of moderate levels of expressive encouragement. For boys,
maternal expressive encouragement, problem-focused reactions, and emotion-focused reactions were
positively related to comforting behavior.
Another important question is whether parents should offer rewards for children’s prosocial behavior. We
found that when school-aged children were offered material rewards (i.e., such as a small prize) for prosocial
behavior, they were less likely to behave prosocially in non-reward contexts (Fabes, Fultz, Eisenberg, May-
Plumlee, & Christopher, 1989). When children receive material rewards for prosocial behavior, internal
motivation for prosocial behavior may be reduced. Thus, offering material rewards for helping, sharing, and
cooperation may undermine subsequent prosocial motivation when no rewards are offered. Recent evidence by
other researchers with much younger children also supports this notion (see Warneken & Tomesello, 2008).
Although direct effects have been found, it is also likely that the relations between parental socialization
and children’s sympathy are mediated by children’s self-regulatory capacities (see Eisenberg, Cumberland, &
Spinrad, 1998). Supporting this idea, we have found evidence that sensitive and supportive parenting predicts
higher levels of regulation/effortful control in children, even after controlling for stability in the constructs
(Spinrad et al., 2007; Eisenberg, Spinrad et al., 2010). We have shown that self-regulation mediates the link
between aspects of parenting and children’s sympathy (Eisenberg, Liew, & Padada, 2001; French et al., 2013;
Taylor, Eisenberg, & Spinrad, 2015). For example, Taylor and colleagues (2015) found that authoritative
parenting, a style of parenting characterized by age-appropriate rules and limit-setting as well as being
responsive to children’s needs, positively related to sympathy through its effect on children’s self-regulation.
Our work points to the role of parental warmth, sensitivity, and authoritative parenting in fostering
children’s sympathy and prosocial behavior (perhaps through their influence on children’s regulatory abilities).
The ways in which parents behave in response to their children’s emotions also provide a context for learning
prosocial tendencies. However, causation cannot be assumed with the existing evidence. Intervention
programs that focus on how parents could scaffold sympathy or prosocial behavior are needed.

97
Open Questions and Criticisms
The review of research here is only a brief description of the extensive body of work on children’s empathy-
related responding and prosocial behavior. The literature to date provides evidence that children’s sympathy is
positively related to prosocial behaviors. Furthermore, children’s caring for others has been consistently related
to temperamental characteristics as well as a number of parental socialization practices. Nonetheless, because
we cannot easily assess children’s motivation for prosocial behavior, there are still questions regarding whether
children’s prosocial actions are truly altruistic or compassionate or are enacted for other reasons (e.g., material
rewards, social approval).
Individuals may extend prosocial, compassionate acts towards different recipients. Identifying those who
extend compassion towards much of humanity (i.e., extensivity) rather than focusing on their own group’s
needs is an important area for research, one that has received very little attention in developmental work.
Children typically show more prosocial behavior toward friends or known peers than toward unknown or less-
liked peers (Buhrmester, Goldfarb, & Cantrell, 1992; Eisenberg & Spinrad, 2014). In a recent study, 5–13-
year-olds reported that other children feel more positive about, and more obligation to help, racial in-groups
than out-group members (Weller & Lagattuta, 2013).
It is important to understand the development and predictors of children’s extensivity of compassion. In
one early study, Eisenberg (1983) found that children believed that people should help family and friends
more than others (i.e., strangers, people from another country) or particularly disliked and stigmatized
individuals (e.g., criminals). Children tended to report less differentiation among recipients of aid with age,
and children with higher levels of moral reasoning (that is, those who may be more compassionate for all
humankind) tended to be less likely to differentiate. We believe an important area for future research is to
understand the development of extensivity and to examine potential predictors of individual differences in
children’s extensivity.
There are also gaps in the literature with regard to the ability to make causal claims regarding the origins of
prosocial behavior and sympathy. Experimental work is needed to understand age changes in prosocial
motivations and the determinants of extrinsic versus intrinsically motivated prosocial behaviors. Also,
interventions to promote compassion would be a long-term goal, and understanding the mechanisms involved
in effective interventions is a key topic for future studies.
Finally, we urge researchers to continue to consider different types of prosocial behavior (i.e., costly,
anonymous, spontaneous) in their work. Prosocial behavior across contexts, situations, and recipients can
provide clues about the motives for prosocial action. How might we understand children’s feelings of moral
obligation to help in-group and out-group members who are in need? What motivates children to engage in
costly types of prosocial behaviors? Can we expect young children to engage in prosocial behavior that is not
rewarded or is likely to be anonymous, and what predicts such moral behavior? We believe that considering
these nuances in children’s prosocial behavior, measured in diverse ways, will point to whether the behavior is
motivated by moral concerns (i.e., compassion) or other motivations such as social affiliation or another self-
oriented reward.

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 Parental Brain: The Crucible of Compassion

James E. Swain and S. Shaun Ho

Abstract

All infants rely on parenting behaviors that provide what they need to be healthy. As “compassion” can
be defined as feelings that are elicited by perceiving someone else’s suffering with a desire to help
(Goetz, Keltner, & Simon-Thomas, 2010), parenting behavior in concert with compassion towards a
child can be defined as “compassionate parenting.” A child who has received compassionate parenting
will tend to provide compassionate parenting to his or her own offspring, and possibly to unrelated
others. We postulate that compassionate parenting should have the following characteristics: (1) effective
care-giving behaviors (behavioral contingency), (2) parental emotions that are coherent and connected
with child’s emotions (emotional connection), and (3) awareness of own and other’s cognitions and
emotions and other environmental factors (reflective awareness). In this chapter, a body of literature in
neurobiological mechanisms underlying parenting is selectively reviewed in reference to the behavioral,
emotional, and cognitive aspects of compassionate parenting.

Key Words: compassionate parenting, parent–child relationships, brain imaging, fMRI, attachment,
caregiving, maternal, paternal

Connections Between Compassion and Parenting

While there are multiple theoretical accounts that may define or characterize compassion differently (Goetz
et al., 2010), there is an unequivocal consensus that all compassion-related phenomena involve perceptions
and actions in situations involving someone’s suffering or need of help. Within these situations, wherein
another’s suffering or need of help is perceived (i.e., the domain of compassion), there can be various
emotional states or feelings that are elicited by perceiving someone else’s suffering from stimuli signaling
someone’s need, distress, pain, illness, poverty, or loss. When compassion as a feeling arises, the consequences
of compassion include subjective experiences of love, sympathy, tenderness, warmth, and empathic concern for
others, and a motivation for, and possibly actual actions toward, reducing harm and providing what is needed
to others (Goetz et al., 2010).
All infants are desperately vulnerable, and to survive, they must rely on parenting behaviors that continually
provide what is needed (e.g., nurturance, warmth, and safety). Thus, it is evident that the domain of
compassion is necessarily connected with the domain of parenting a child, wherein parenting behaviors are
preceded by antecedents of perceiving an infant’s signals of need or distress—followed by the outcomes of the
development and maintenance of the infant’s life. On the other hand, the infants or children, as the recipients
of parenting behaviors after emitting signals of needs for nurturance, water, warmth, and/or safety, can
develop what is called attachment behaviors as a result of repeated trials in these situations.

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 Thus, the domain of parenting and the domain of child attachment can be considered two sides of the same
coin. This “coin” has been construed as internal representations that serve as a model to govern perceptions
and actions of an individual in a parent–child dyad in situations involving need for care (i.e., nurturance,
warmth, and safety). Thus, children’s own development of the internal attachment models that they will use
in all other close relationships throughout life critically depends on the parenting behaviors that are governed
by parental models of responding to those specific child needs, as a kind of “crucible” of social development
for behaviors elicited in the domain of compassion. We postulate that these behavior-governing parenting
models are in turn subserved by neurohormonal brain mechanisms, which probably underlie the feelings and
behaviors of compassion as well.

Key Concepts in the Science of Parenting

The development of attachment is one of the most important concepts in the science of parenting. From an
evolutionary perspective, attachment represents an innate biological system promoting proximity-seeking
between an infant and a con-specific caregiver (Bowlby, 1969, 1973). Informed by the patterns of attachment
identified in the mother–infant studies (Ainsworth & Bell, 1970; Ainsworth et al., 1978), it has been
hypothesized that all human infants attach to their caregiver, but that children manifest different patterns of
attachment, depending on the quality of the parenting they receive (Bowlby, 1977). Indeed, infants of
caregivers who were available, responsive, and sensitive to their emotional and physical needs tended to
manifest patterns of “secure attachment.” Conversely, unpredictable and/or neglectful parenting, in which
non-contingent responses to the child occurred frequently, tended to result in “insecure or disorganized
attachment” (Shaver et al., 1987). Notably, a child’s attachment model is developed specifically with a primary
caregiver, as patterns in his or her perceptions and actions in facing situations that may increase the child’s
vulnerability, when he or she is in need of nurturance, water, warmth, and safety (Waters et al., 2005).
A key concept in the science of attachment development is maternal sensitivity, which is defined as a
mother’s ability to attend and respond to her child in ways that are contingent on the infant’s needs
(Ainsworth et al., 1978). While the topography of maternal sensitivity varies substantially across parents, it
appears to be relatively stable in the same individual across time and contexts (Behrens et al., 2012; Jaffari-
Bimmel et al., 2006; Wan et al., 2013).
Furthermore, literature suggests that maternal sensitivity predicts many children’s social-emotional
outcomes—including the quality of their future intimate relationships (Bakermans-Kranenburg et al., 2003;
De Wolff & van IJzendoorn, 1997), emotional self-regulation (Eisenberg et al., 2001), social functioning
(Kochanska, 2002; Van Zeijl et al., 2006), socio-emotional development (De Wolff & van IJzendoorn, 1997),
and cognitive and language competence (Bernier et al., 2010; Tamis-LeMonda et al., 2001). In contrast, the
absence of maternal sensitivity to child signals has been linked to risk for maltreatment (Milner, 1993, 2003),
harsh parenting (Joosen et al., 2012), and parental tendencies toward punishment (Engfer & Gavranidou,
1987). Frightening and anomalous maternal behavior confers risk to children’s attachment development
(Schuengel et al., 1999; Zeanah & Gleason, 2015).
Another key concept in attachment development is parental reflective functioning, which refers to parents’
capacity to be aware of their own and their child’s feelings, desires, intentions, and thoughts in understanding
their own and their child’s behaviors (Rosenblum et al., 2008). Parental reflective functioning plays a critical

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role in a child’s secure attachment, and this effect may be mediated by parental sensitivity (Stacks et al., 2014).
We speculate that maternal or parental sensitivity is a product of all three aspects—behavioral, emotional,
and cognitive—involved in compassionate parenting. Although one may emphasize slightly more the
importance of behavioral contingency and emotional coherence in measuring maternal sensitivity, parental
reflective functioning may be deemed a key ingredient in the cognitive aspect of compassionate parenting. All
three aspects are part of recent models of parental brain function (Kim, Strathearn, & Swain, 2016; Swain &
Ho, 2017).

Three Aspects of Compassionate Parenting

Recent models suggest that parenting responses can serve as a template for understanding our caring
capacities in dealing with one another (Brown & Brown, 2015; Preston, 2013), and the science of compassion
will benefit from understanding how one’s attachment/parenting model, continually developed in one’s
lifetime, informs one’s perceptions and actions in the domain of compassion. Toward this goal, we first
attempt to characterize aspects constituting compassionate parenting, and then explore how neurobiological
mechanisms related to parenting may be influenced by variables related to those aspects.
While the domains of compassion and parenting overlap, not all parenting behaviors are compassionate.
We postulate that compassionate parenting typically has three characteristic aspects. First, behaviorally:
Compassionate parenting typically shows caregiving behaviors that are effective in providing what a child
needs, though not necessarily what he or she wants, in response to the child’s signals of physical or
psychological need, with appropriate timing and contingencies. For example, when a child signals fear, a
compassionate parenting behavior would be one that can effectively reduce the fear or increase a sense of
safety. This aspect can be referred to as behavioral contingency.
Second, emotionally: In addition to the compassion-defining features such as empathy and the desire to
alleviate the child’s distress, compassionate parenting typically features a parent’s emotions that are coherent
with the child’s and are able to enhance emotional connection between parent and child. For example, when a
child signals fear, either fear or calmness exhibited by a parent can be considered coherent and connecting
with the child’s emotion. Although the calmness expressed by the parent may not be identical with the fear
expressed by the child, calmness can be coherent with the child’s emotion if it is what a child expects to see,
and this can enhance the parent’s emotional connection with the child if it signals recognition and validation
of the child’s fear. This aspect can be referred to as emotional connection.
Third, cognitively: Compassionate parenting features parental awareness of one’s own and the child’s
cognitions and emotions and other environmental factors. The awareness is a product of valid recognition of
relevant information in the situation, and cognitive skills such as attention control, emotional regulation,
reasoning, and problem solving. This aspect can be referred to as reflective awareness.
Taken together, these behavioral, emotional, and cognitive aspects of compassionate parenting are
continually informing a parent’s models for attachment during childhood and for parenting after becoming a
parent, which will in turn shape his or her child’s attachment and parenting in the future (Figure 6.1). We
focus on the role of parenting in this chapter, as parenting a child involves regular, heated challenges for the
parent’s compassion; thus it is a kind of “crucible for compassion” for all parties involved. As understanding
the neurobiological mechanisms related to these key concepts of compassionate parenting may inform the

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science of compassion, a selected review of parental brain literature will be provided in the following section.

Figure 6.1 Behavior, Emotion and Cognition in Parental Compassion.

Neurocircuits Underlying Parenting

When a parent responds to a child, the parental brain must manage an array of complex motivations,
emotions, thoughts, and behaviors contingent on feedback from the child. Parenting requires skills in the
recognition and acknowledgment of child signals, attribution of salience and meaning, context-dependent
regulation of eye contact and voice, expression or modulation of affect, appropriate social mirroring according
to child distress, and readiness to intervene. Common parenting behaviors include picking-up, holding and
talking to their infant. Such behaviors are the result of complex neural networks involved in coordinating
perceptions and actions, regulating emotional responses (Kober et al., 2008), as well as in attention control
and executive function, as proposed in evolving models of parental brain functioning (Kim, Strathearn, &
Swain, 2016; Swain et al., 2007; Swain & Lorberbaum, 2008; Swain, 2011; Swain et al., 2011; Swain et al.,
2012).
Neurocircuits involved in human parental caregiving behaviors include the hypothalamus, midbrain,
thalamus, amygdala, dorsal striatum, ventral striatum, anterior cingulate cortex (ACC), ventromedial
prefrontal cortex (vmPFC), insula, and orbitofrontal cortex (OFC) (Swain et al., 2011). These neurocircuits
overlap with the hedonic reward neurocircuits in the dopaminergic mesolimbic pathway, including the ventral
tegmental area and nucleus accumbens (NAc) for reward signaling and also in the dopaminergic mesocortical
pathway, including the ACC, vmPFC, and OFC, for higher-order reward representation and cognitive
control (Aharon et al., 2001; Delgado et al., 2000; Melis & Argiolas, 1995; Panksepp, 1998; Stoeckel et al.,
2008; Strathearn et al., 2008). Indeed, both animal and human research (Numan & Woodside, 2010; Numan,
2014; Strathearn et al., 2009) suggest that parents’ responses to infants utilize these neurocircuits as
motivational and reward systems.
Beginning in the prepartum period, a mother’s positive feelings towards her unborn fetus, as well as her

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perception of her fetus, have been associated with greater maternal sensitivity to the infant’s signals and more
affectionate vocalizations and touch (Keller et al., 2003; Keren et al., 2003). Indeed, the initial experiences of
pleasure and activity during the early postpartum period in the maternal brain’s reward circuits when exposed
to their own infants’ cues may increase the salience of their infants’ stimuli and promote greater attention and
bond-formation to ensure continuous engagement in sensitive caregiving (Strathearn et al., 2008).
The amygdala also interacts with the reward circuit to motivate maternal behaviors. In response to infant
stimuli, infant cries and smiles activate the amygdala (Barrett et al., 2012; Seifritz et al., 2003b; Swain et al.,
2008), which has often been interpreted as a sign of emotional salience (Seifritz et al., 2003a; Lane,
Strathearn, & Kim, 2013) or positive emotion associated with attachment (Leibenluft et al., 2004). On the
other hand, in virgin rats, activation in the medial nucleus of the amygdala was associated with reduced
maternal behaviors (Morgan et al., 1999; Oxley & Fleming, 2000). Thus, while increased activation of the
amygdala in response to infant stimuli is interpreted as a more negative response to infants among typical
adults (Riem et al., 2011), in mothers, it can be associated with more positive responses to one’s own infant
(Barrett et al., 2012).

Parental Brain and Parents’ Own Attachment Models

Differences in adult attachment models are likely to be related to environment–biology interactions during
childhood (Shah et al., 2010). Consistent with the notion that a parent’s own attachment model developed in
childhood can govern his or her parenting behaviors, the activity in maternal reward circuitry (i.e., ventral
striatum), and motivation system (i.e., hypothalamus and pituitary gland), to infant facial expressions of
emotion (e.g., smiling and crying), were greater in mothers with a secure attachment model than in those
without. Indeed, using the parental bonding instrument with new mothers, correlations have been observed
between higher maternal care in childhood and larger cortical volumes, as well as responses to infant cries
(Kim et al., 2010a), suggesting biological substrates for long-term effects of maternal care on emotion-
regulation brain systems. Moreover, the activity in emotion response circuits has been positively correlated to
maternal plasma oxytocin (OT) levels during infant contact at seven months postpartum (Strathearn et al.,
2009). Interestingly, as OT is a hormone associated with breastfeeding and parent–infant bonding and brain
activity (Kim et al., 2011), maternal plasma OT levels were correlated with maternal amygdala responses
when the mothers watched their own infant’s versus standard-infant’s videos played back (Atzil et al., 2012).
In contrast, mothers with an insecure/dismissing type of attachment model show diminished OT response
to mother–infant interaction, which is associated with reduced activation in the hypothalamus and the ventral
striatum. Moreover, mothers with these attachment models also show reduced activation of the
mesocorticolimbic reward system, including the ventral striatum and vmPFC, when viewing images of their
own versus unknown infants’ faces (Strathearn et al., 2009). Furthermore, this pattern of attachment is
associated with differences in maternal behavior, including less attuned mother-to-infant vocalization at seven
months postpartum (S. Kim et al., 2014).
Together, these findings suggest that greater activity in maternal reward and motivational neurocircuitry
elicited by child signals should promote oxytocin-dependent parent–infant bonding, and parents who have
developed secure attachment model are more likely to demonstrate oxytocin-dependent parent–infant
bonding. As parent–infant bonding is presumably a key building block in the parent-child emotional

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connection, these results suggest that parental motivation and reward systems and related neural hormonal
substrates play key roles in compassionate parenting. Therefore, the receivers of compassionate parenting will
establish more emotionally coherent and connecting relationship with their own children and thus deliver
compassionate parenting to them.

Mother’s Brain Plasticity During the Early Postpartum Period

In recent years, the human parental brain has been shown to exhibit structural changes during adaptation to
the new role as a parent. Among mothers, from the first to fourth months postpartum, several brain regions
involved in maternal motivation and reward processing, including the striatum, amygdala, hypothalamus, and
substantia nigra, exhibited structural growth (Kim et al., 2010b). Structural growth has also been observed in
areas involved in processing sensory information and empathy, including the superior temporal gyrus,
thalamus, insula, and pre- and post-central gyri. Furthermore, regions associated with regulating emotions,
such as the inferior and medial frontal gyri and the ACC, also showed structural increases. Interestingly, no
neural regions showed reduction in gray matter during this time period. The evidence suggests that neural
plasticity, particularly growth, occurs in a wide range of brain regions, each serving important aspects of child
caregiving in human mothers during the first few months postpartum. Finally, the greater the observed
structural growth in the midbrain region (involved in reward and motivation), the stronger the positive
emotions a mother reported having about her baby in the third and fourth months postpartum (Kim et al.,
2010b). This finding further supports the existence of a bidirectional association between maternal experience
and neural plasticity during the first few months postpartum.

Father’s Brain Plasticity During the Early Postpartum Period

Despite receiving much less research attention, the role of the father in child development is also important
and may be conceptualized in the following domains:
1. Positive and direct engagement (e.g., play, soothing) with the child in ways that promote healthy development;
2. Parental warmth and responsiveness directed toward the child;
3. Activities that serve to monitor and make decisions on behalf of the child in order to control his/her environment;
4. Indirect care such as arranging for childcare, medical care, and contributing to home safety and environmental richness; and
5. Responsibility that includes monitoring activities to ensure that the child’s needs within the first four domains are being met (Lamb et al.,
1985; Pleck, 2010).

We speculate that these aspects of paternal behaviors are largely compassionate efforts to prevent or reduce the
child’s potential suffering.
Recently, there has been interest in the brain circuits that support fathers’ thoughts and behavior. A small
body of literature suggests that the healthy fathers’ responses to infant stimuli seem to involve many of the
same motivation and emotion response/regulation circuits as those in mothers (Swain et al., 2014b).
Furthermore, fathers’ brain responses to child pictures stimuli in medial frontal cortex were inversely related to
serum testosterone levels, suggesting that the decline in testosterone that accompanies the transition to
fatherhood may be important for augmenting empathy toward children (Mascaro et al., 2014a). In addition,
fathers’ brain responses to baby-cries in empathy regions were non-linearly related to paternal caregiving, such
that fathers with intermediate activation were most involved (Mascaro et al., 2014b). Finally, using structural
brain imaging over the several months postpartum, a recent study of fathers demonstrated apparent growth in

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the hypothalamus, amygdala, and other regions that regulate emotion, motivation, and decision making. New
fathers with more growth in these brain areas were less likely to show depressive symptoms (Kim et al., 2014).
Thus, adaptive physiological paternal brain changes seem to bear similarities to mothers’, yet important sex-
differences in parental brain function may explain and inform understanding of sex-specific parental roles,
specific risk/resilience for mental health, optimal treatment and impact on child development.

Parental Brain and Anxiety

Another perspective on parental thoughts that influence behaviors involves so-called postpartum
preoccupations that may be part of healthy maternal responses to their infants that draw them close in order
to meet the infant’s physical and psychological needs (Bowlby, 1969; Winnicott, 1956)—perhaps even
providing a reasonable explanation of why symptoms of obsessive-compulsive disorders have survived
evolution (Feygin et al., 2006). Thus, the “checking and worrying” brain circuits may overlap with those that
are hyperactive in obsessive anxiety in parents (Leckman et al., 2004). Indeed, parental anxiety peaks
immediately after childbirth and then begins to diminish during the first three to four months postpartum
(Feldman et al., 1999; Kim et al., 2013; Leckman et al., 1999). This also fits with apparent increased
responses to infant crying in postpartum anxiety circuits, including the insula, that diminish over the first four
months postpartum (Swain et al., 2014c; Swain et al., 2017a). In addition, mothers with insecure/dismissive
attachment models, which are often related to higher anxiety in situations eliciting vulnerability, showed
greater insula activation in response to seeing their own child’s sad face (Strathearn et al., 2009). Perhaps
persistently high or low activity in these anxiety-related circuits around parenting may predict
psychopathology and inform treatments.
These findings suggest that parenting-related anxiety in healthy mothers that gradually decreases during the
early period of postpartum may mark a healthy progression in compassionate parenting. While child-induced
vicarious fear and relative calmness in mothers are equally coherent with child’s emotions at the time
perceiving child’s signal of distress, the latter is more conducive than the former to effective and
compassionate parenting.

Parental Brain and Empathy

Parental empathy (the appropriate perception, experience, and response to another’s emotion) may be
especially relevant for the emotional and cognitive aspects of compassionate parenting, and perhaps for
altruistic behaviors in other social situations as well (Preston, 2013; Swain et al., 2012). Considerable brain
imaging research on empathy, largely related to the imitation of others’ emotions using stimuli such as
emotional faces, images of others in pain, or crying sounds (Fan et al., 2011), has highlighted the functional
importance of the medial PFC, precuneus/posterior cingulate cortex, temporoparietal junction, and posterior
superior temporal sulcus in cognitively simulating other people’s mental states; i.e., mentalization (Frith &
Frith, 2006; Mitchell, 2009). In addition, emotion/salience processing neurocircuits, including the anterior
insula, OFC, and amygdala, may be important for sharing emotions with others (Decety, 2015; Zaki &
Ochsner, 2012).
Maternal mentalization capacity, as measured according to mother–infant interactions, were found to be
correlated with responses to one’s own vs. another’s baby’s cry in the right frontal operculum/anterior insula

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cortex (Hipwell et al., 2015). In a different study (Ho et al., 2014), wherein a group of healthy mothers’
empathy traits were measured and they underwent a social stress task and a parenting decision-making task in
an fMRI scanner, it was found that the mothers’ trait of taking another’s perspective, a cognitive aspect of
empathy, was related to lesser cortisol stress reactivity to the social stress task. In contrast, their trait in
vicariously picking up others’ distress was related to greater stress reactivity. Moreover, during the parenting
decision-making task, the mothers’ empathic concern for others, an emotional aspect of empathy, was related
to greater responses in their ventral striatum and prefrontal areas as elicited by negative versus positive
feedback from the child. In addition, the responses to the negative versus positive feedback from the child in
these mothers’ septal area—that is, a brain area mediating prosocial motivations (Morelli et al., 2014)—were
positively related to their tendency of immersing themselves in another’s point of view. This suggests that
mothers who are more likely to think as others would may be more able to identify with their child despite the
child’s negative feedback, as they recruited more prosocial motivations mediated by the septal area (Ho et al.,
2014).

Parental Brain and Maternal Synchrony with the Child

Synchronous maternal behaviors, including coordination of gaze, touch, and vocalizations, with infants are
interpreted as more sensitive parenting behaviors and are associated with positive infant outcomes; in contrast,
intrusive maternal behaviors include lack of coordination and more directedness with the infant, and they tend
to be associated with maternal anxiety and the hypothalamic-pituitary-adrenal and stress responses (Feldman,
2007). We posit that synchronous maternal behaviors are behavioral indications of coherent and connecting
emotions, as an emotional aspect of compassionate parenting. In a brain imaging study measuring
synchronous maternal behaviors (Atzil et al., 2011), mothers at four to six months postpartum were divided
into two groups: mothers objectively rated to have high maternal synchrony and low intrusiveness scores
(synchronous mothers) vs. mothers with low synchronous scores and high intrusiveness scores (intrusive
mothers) based on observed interactions. During a neuroimaging session, mothers were presented with video
clips of their own infant and an unfamiliar infant. When intrusive and synchronous mothers were compared,
intrusive mothers showed greater responses in the amygdala to their own babies, whereas synchronous
mothers showed greater activation in the NAc. Furthermore, functional connectivity in the whole brain using
the NAc and the amygdala as seed regions was examined, and the intrusive and synchronous mothers were
compared. In synchronous mothers, activity in the NAc was correlated with activity in attention and social
information-processing regions, including the inferior frontal gyrus, the medial frontal gyrus, visual and motor
areas, and the parietal cortex. In contrast, intrusive mothers showed greater connectivity between the
amygdala and the OFC, which is characteristic of elevated anxiety. Thus, reward-related neural responses to
one’s own infant were associated with enhanced neural connectivity for attention and social information
processing, which may further support synchronous mother–infant interactions. Anxiety-related neural
responses to one’s own infant were associated with more disrupted and intrusive mother–infant interactions.
In another study, the same group of researchers demonstrated that, among mothers, plasma OT levels
correlated positively with activations in the ventral ACC, the left NAc, the inferior parietal lobule, and the
temporal and frontal gyri in response to videos of their own infants (Atzil et al., 2012). When mothers
watched videos of various mother–infant interactions, they exhibited greater neural responses in the dorsal

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ACC to videos of interactions according to how synchronous they were. Depressed mothers have lower-
synchrony interactions with their infants. (Atzil et al., 2014). Additionally, greater activation in the dorsal
ACC in response to synchronous interactions was positively associated with mothers’ own synchronous scores.
The dorsal ACC is involved in integrating affective and social processes as well as in regulating social pain
such as social rejection. Thus, greater activation in the dorsal ACC may contribute to more sensitive
processing of social cues, which may be further associated with highly synchronous behaviors among mothers
interacting with their own infants.

Parental Brain and Maternal Sensitivity

As described, maternal sensitivity is defined as a mother’s ability to attend to and respond to her child in
ways that are contingent to the infant’s needs (Ainsworth et al., 1978). We posit that maternal sensitivity is
key in compassionate parenting, and the coding of maternal sensitivity based on parent–child interaction
during videotaped free play (Feldman, 1998) may provide quantified data for the study of compassionate
parenting. Indeed, maternal responses in the right superior frontal gyrus and amygdala at two to four weeks
postpartum were predictive of maternal sensitivity at three to four months (Kim et al., 2011). In a different
study, maternal sensitivity and intrusiveness were assessed and combined with a similar baby-cry task in
mothers at 18 months postpartum (Musser et al., 2012). The study found that, when neural responses to their
own versus a control infant’s cry were examined, the observed maternal sensitivity was associated with the
superior and inferior frontal gyri. The roles of these prefrontal cortical areas suggest that maternal sensitivity
may depend on cognitive executive functions.
We posit that executive functions, including attention control, conflict resolution, working memory, and
flexible task-switching, are key to the cognitive aspect of compassionate parenting. Indeed, deficits in
attention set-shifting, spatial working memory, and a sustained attention measure have been linked with poor
maternal sensitivity to non-distressed infant cues (Gonzalez et al., 2012). Using an emotional Stroop task that
probed conflict-resolution capacity under emotional distraction, mothers with a disorganized attachment
model developed since childhood responded more slowly in trials involving stimuli of negative attachment-
related words. Furthermore, the reaction time of response to such stimulus was correlated with the number of
times that parent–child dyads were classified as a disorganized type of attachment, suggesting that the
difficulties in executive functions may affect mother–infant interactions (Atkinson et al., 2009). Greater
attention bias to infant distress cues in late pregnancy has also been associated with better scores on a parental
bonding questionnaire (Pearson et al., 2010). Attention bias to infant distress has been found to be greater in
breastfeeding mothers as compared to formula-feeding mothers of three- to six-month-old infants (Pearson et
al., 2011), which may be attributed to the presumably higher levels of OT in breastfeeding than in formula-
feeding mothers.

Parental Brain—Mechanisms of Intervention

Circuits that support social cognition, mentalization, and empathy (as discussed) among healthy mothers
are hypo-responsive to infant stimuli in mothers with insecure attachment and substance use disorders.
Specific interventions currently being delivered and refined that may benefit from brain-based analyses to
target these underlying brain mechanisms.

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 For example, parent intervention programs, such as the Circle of Security (Hoffman et al., 2006; Powell et
al., 2014), Triple P (Positive Parenting Program; Sanders et al., 2014), Video Interaction for Promoting
Positive Parenting Programme (Van Zeijl et al., 2006), ABC (Attachment and Biobehavioral Catch-Up;
Bernard et al., 2012; Bernard et al., 2013), and Mom Power (Muzik et al., 2015; Muzik et al., 2016), have
been validated according to randomized clinical trial approaches, but they lack well-developed grounding in
brain function. In the first study of its kind, mothers who were two to seven years postpartum who had
suffered at least one trauma were studied with fMRI and baby cry and empathy tasks before and after Mom
Power intervention. This intervention includes sessions devoted to improving reflective emotion response,
emotion regulation, and empathic function related to parenting. Results suggested brain correlates of the
intervention, as there were several brain areas with altered brain activity as a result of the treatment (n = 14),
controlling for time and treatment-as-usual (n = 15). In a baby-cry experiment, response to “your-baby-cry”
versus “just-listen” in the amygdala, precuneus, dorsal ACC, and dorsolateral PFC (p < 0.001, uncorrected)
was greater. Brain activity for an own-child empathy task was also increased in the dorsolateral PFC and
insula. Furthermore, brain activity that increased with treatment in both tasks was inversely related to
parenting stress (p < 0.001, uncorrected)—a serious risk factor for maternal psychopathology and adverse child
outcome (Swain et al., 2014a; Swain et al., 2017b). The findings provide preliminary evidence for neural
mechanisms for parenting intervention that may work by affecting parental brain circuits at the intersection of
emotion response as well as regulation and empathy circuits—also perhaps usefully conceptualized as the
“compassionate brain.”

Conclusion
Parenting behaviors are not only crucial for infants’ survival, but also considered to be a primary foundation
for the development of altruistic behaviors (Brown & Brown, 2015; Preston, 2013). As compassion can be
defined as an emotional and motivational state elicited by perceiving someone else’s suffering with a
motivation to help (Goetz et al., 2010), the domains of both parenting and compassion necessarily consist of
situations involving a vulnerable individual. Therefore, the sciences of compassion and parenting are
intimately overlapping and mutually informative.
Just like most, but not all, altruistic behaviors are motivated by compassion, most, but not all, parenting
behaviors are compassionate. Compassionate parenting involves parental behaviors that have characteristics of
behaviorally delivering what a child needs with appropriate contingencies (behavioral contingency), being
emotionally coherent and connecting with the child (emotional connection), and maintaining awareness of
parent and child’s psychological factors and related environments (reflective awareness).
A parent’s working model in parenting (parenting model) has its roots in the development of his or her
attachment model since childhood. Specifically, the attachment model organizes and governs the perceptions
and actions of a child when exposed to a situation that would increase the child’s vulnerability (e.g., in need of
nurturance, water, warmth, and safety). In other words, how an individual generates his or her compassion
oriented to others in need has roots in how he or she has received compassionate parenting, or (unfortunately)
the lack thereof, since childhood.
We described neurobiological mechanisms underlying parenting-related concepts, including attachment
models, parental sensitivity, empathy, and healthy parental anxiety. Notably, we also described how the

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parental brain is highly plastic from the early postpartum period. The plasticity of the brain offers great hope
for improving parents’ parenting model, as a goal of several parenting interventions, described here, and
perhaps also for promoting compassion in individuals for the benefit of humanity.
Hence, an important question that is worth asking in the science of compassion would be, What is the
brain’s plasticity in support of an individual’s compassion? Is it similar to the brain’s plasticity in support of a
parent’s parenting sensitivity? The identification of these positive conditions will inform education and
interventions for cultivating compassion. A related question is, Would the theories and practices utilized in
interventions for promoting sensitive parenting inform interventions for cultivating compassion, and vice
versa?
An apparent distinction between parenting and compassion is the scope of behaviors. While the parent–
child attachment model is specifically limited to the scope of a particular relationship between significant
others, the scope of compassion is, by definition, not limited to a specific relationship. This apparent
distinction may offer a clue for future research to search for biological mechanisms of cultivating compassion,
in which individuals may learn to treat unrelated other as if one's parent or child. Conversely, since the scope
of compassion is more general than that of parenting, a potential strategy for parenting may be to testing
whether generalized compassion training may also improve the specific nature of compassion in parenting.
There has been a significant improvement in our understanding of the human maternal brain based on a
growing number of fMRI studies with human parents and the beginnings of the brain systems at work for
compassion. However, important questions remain unanswered.
First, although most of the studies with human mothers have focused on understanding neural functions,
little work has been done regarding structural changes. Although human evidence suggests structural growth
occurs in the maternal brain (Pilyoung Kim et al., 2010b), animal evidence suggests mixed findings on
reduced neurogenesis in the hippocampus but increased synaptic density in the prefrontal cortex during the
postpartum period (Leuner et al., 2010). Furthermore, current literature suggests mixed evidence in the
direction of the anatomical and functional correlations. While training-induced increased grey matter volumes
have been associated with increased activation in the hippocampus (Hamzei et al., 2012), decreased grey
matter volumes were associated with increased activation in the amygdala among trauma-exposed individuals
(Ganzel et al., 2008). Therefore, it would be important to clarify hormone-related and experienced-based
anatomical changes and how they interact with neural functions among human mothers during the early
postpartum period, which will provide deeper understanding of the neural plasticity of the maternal brain.
Second, prospective and longitudinal studies across important transition periods for parenting are important
to map the temporal processes of neural changes in the human maternal brain. Existing findings of the human
maternal brain are based primarily on studies with women during the postpartum period or the first few years
of a child’s life. However, measures in these studies, such as maternal mood, hormones, neural activation, and
parenting behaviors, are measured cross-sectionally, providing only correlative associations that must be
interpreted with caution. Thus, causal or temporal conclusions cannot be drawn on how these factors are
related to each other. Therefore, prospective studies, particularly studying women during pregnancy and/or
even before conception with follow-up until the postpartum periods, may help determine if hormonal changes
during the pregnancy prime and enhance neural activation in response to infants during the early postpartum
period, which will be further associated with more sensitive maternal behavioral responses to infants during

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later postpartum periods. In addition, a full understanding of these biological substrates will ultimately also be
informed by genetic and epigenetic factors.
Third, negative environments such as living in poverty, being a single or teenage mother, high marital
conflict and impaired attachment are significant risk factors for psychopathology and maternal insensitivity
toward their children (Magnuson & Duncan, 2002; Sturge‐Apple et al., 2006). However, little is known
about whether such negative environments can increase risk for negative maternal outcomes through changes
in the neurobiological processes of parenting and mood regulation. This would be highly expected, given that
early-life environments are so well-established to affect gene expression in animals. Understanding these
genetic and neurological factors that are influenced by environment will be critical to determining the most
effective interventions to optimize child development. Future parental brain research must include mothers in
various at-risk environments or circumstances—each of which could pose different bio-behavioral problems
and require different solutions.
Fourth, we have discussed findings in mothers with defined psychopathology in the previous section,
including postpartum depression and substance abuse. Larger and more targeted samples may help to identify
specific neural mechanisms that are most affected in specific psychopathologies. For instance, dysfunctions in
the regulation of the emotion network may be associated with postpartum depression, whereas the
reward/motivation network may be more associated with substance abuse. Alternately, as proposed in the
National Institute of Mental Health’s Research Domain Criteria (RDoC) (Cuthbert, 2014) continuous
symptom spectra, which may overlap across defined psychopathologies, may better align with neurobiological
systems. Such specificity can be critical for developing targeted interventions and treatments that are more
effective in preventing psychopathology and improving symptoms of psychopathology that may be different
for new mothers vs. fathers as suggested by recent research (Kim et al., 2015).
Fifth, the field will benefit from continuing to move toward combining well-established paradigms known
to probe certain aspects of brain function, such as executive functions and emotion response/regulation with
naturalistic and personally salient infant information. This is especially important as it seems that brain
physiology is changing according to child stage—itself adapting to child development. Consensus on brain
imaging methodology and expectations, as we continue to examine specific links between neural
regions/networks and behaviors throughout pregnancy and the postpartum period will be important to
generate a consistent picture. Next steps may include examining whether activation in specific neural
regions/circuits such as the hippocampus and precuneus/posterior cingulate cortex, which are parts of the
neural memory circuits, change over time across pregnancy and the postpartum period, for example, verbal
recall memory declines during pregnancy and the postpartum period (Glynn, 2010). This research does raise
interesting possibilities of investigating cultural differences—at the intersection of evolutionary biology and
developmental cultural psychology—where candidate behavioral universals may be embedded in the nervous
systems of human caregivers. This could also shed light on other domains of caregiving that could be
encouraged or optimized.
Sixth, in striving to study parent-child interactions more naturally, future experiments might include both
parent and child, using forms of neuroimaging that allow for some natural movement, such as with functional
near-infrared spectroscopy (fNIRS) and electroencephalography (EEG) and virtual reality environments. This
may yield brain-based models that reflect real-life parental planning, responding and decision-making, and

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perhaps avoid neuroimaging problems in other fields that have typically been difficult to replicate or interpret,
perhaps because of not using personally tailored or particularly compelling stimuli close to reality. Along these
lines, alternate neuroimaging methods will also be needed to incorporate brain structure, resting state and
functional neural activation, and parenting behaviors. Such multimodal approaches that use machine learning
methods promise diagnostic and prognostic models for healthy maternal adaptation vs. psychopathology
(Orru et al., 2012) that may not be possible with any one method. Perhaps in the future, a routine brain-scan
—with advanced post-processing—will provide biomarkers for earlier assessment and correction of parenting
problems and capacities for compassion toward breaking trans-generational mental health problems and
healthier and more compassionate children—whose developing brains are themselves another frontier of
research.

Acknowledgments
The authors are currently supported by Stony Brook Health Sciences Center, the Brain & Behavior
Research Foundation and, University of Michigan’s Injury Center (Center for Disease Control and
Prevention U49/CE002099), Center for Human Growth and Development, Robert Wood Johnson
Foundation Health and Society Scholar Awards, and the National Institutes for Health—National Center for
Advanced Translational Sciences via the Michigan Institute for Clinical Health Research UL1TR000433.

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 Adult Attachment and Compassion Normative and Individual Difference
Components

Mario Mikulincer and Phillip R. Shaver

Abstract

According to attachment theory (Bowlby, 1973, 1982), the optimal functioning of the attachment
behavioral system and the resulting sense of security in dealing with life’s challenges and difficulties
facilitate the functioning of other behavioral systems, including the caregiving system that governs the
activation of prosocial behavior and compassionate acts of helping needy others. In this chapter, we focus
on what we have learned about the interplay of the attachment and caregiving systems and their effects
on compassion and altruism. We begin by explaining the behavioral system construct in more detail and
show how individual differences in a person’s attachment system affect the functioning of the caregiving
system. We review examples from the literature on attachment, focusing on what attachment theorists
call providing a “safe haven” for needy others. We then review studies that have shown how individual
differences in attachment affect empathy, compassion, and support provision.

Key Words: attachment, caregiving, compassion, security, prosocial behaviors, behavioral systems,
empathy, social support

Attachment theory, which concerns the effects of experiences in close relationships on patterns of thought
and behavior in subsequent relationships, provides a conceptually rich, research-generating framework for the
study of prosocial behavior in general and compassionate acts of helping needy others in particular. In his
original exposition of the theory, John Bowlby (1973, 1980, 1982, 1988) proposed that early interactions with
loving, and supportive caregivers result in the optimal functioning of what he called the attachment behavioral
system. This optimal functioning is sustained by positive mental representations of others (as trustworthy,
dependable, and well-intentioned) and a pervasive sense of security in dealing with life’s inevitable challenges
and difficulties. We (Mikulincer & Shaver, 2016) have extended Bowlby’s theory into adulthood and
proposed that the optimal functioning of the attachment system facilitates the functioning of other behavioral
systems, including the caregiving system that governs the activation of prosocial feelings and cognitions
(kindness, empathy, compassion, generosity), and underlies our predisposition to provide support and comfort
to others in times of need.
In this chapter, we focus on what we have learned about the two behavioral systems that govern support
seeking and support provision—the attachment and caregiving systems. We begin by explaining the
behavioral system construct in more detail and show how individual differences in a person’s attachment
system affect the functioning of the caregiving system. We review examples from the literature on attachment,
focusing on what attachment theorists call providing a “safe haven” for others in distress. We then review
studies that have shown how individual differences in attachment affect empathy, compassion, and support

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provision to needy others.

A Behavioral Systems Perspective on Attachment and Caregiving

In explaining human behavior, Bowlby (1973, 1980, 1982) borrowed from ethology the concept of the
behavioral system, a species-universal neural program that organizes an individual’s behavior in ways that
increase the likelihood of survival and reproductive success. Each behavioral system is organized around a
particular goal (e.g., attaining a sense of security, providing support to a needy other) and includes a set of
interchangeable, functionally equivalent behaviors that constitute the primary strategy of the system for
attaining its goal (e.g., proximity seeking, empathically understanding another person’s needs). These
behaviors are automatically “activated,” or triggered, by stimuli or situations that make a particular goal salient
(e.g., loud or unusual noises that signal danger). The behaviors are “deactivated” or “terminated” by other
stimuli or outcomes that signal attainment of the desired goal. Each behavioral system also includes cognitive
operations that facilitate goal attainment and excitatory and inhibitory neurological links with other systems.
Bowlby (1973) believed that, although behavioral systems are innate, experience shapes their parameters
and strategies in various ways, resulting in systematic individual differences. According to Bowlby, the
residues of such experiences are stored in the form of mental representations, or working models of self and
others, that guide future attempts to attain a behavioral system’s goal. With repeated use, these models become
automatic and are important sources of within-person continuity in behavioral system functioning throughout
one’s life development.

The Attachment Behavioral System

According to Bowlby (1982), the biological function of the attachment system is to protect a person
(especially during infancy and childhood, but later in life as well) from danger by assuring that he or she
maintains proximity to loving and supportive others (attachment figures). The proximal goal of the system is to
attain a subjective sense of protection or security (called “felt security” in an influential paper by Sroufe &
Waters, 1977), which normally terminates the system’s activation (Bowlby, 1982). The goal of attaining
security is made salient by perceived threats and dangers, which drive people to seek actual or symbolic
proximity to attachment figures (Bowlby, 1982). According to Ainsworth, Blehar, Waters, and Wall (1978),
during infancy, attachment-system activation includes nonverbal expressions of need and desire for proximity,
as well as observable behavior aimed at restoring and maintaining actual proximity. According to our
extension of the theory to adult attachment (Mikulincer & Shaver, 2004), the primary attachment strategies
do not necessarily involve actual proximity-seeking behavior in adulthood; they can be measured indirectly in
the form of soothing, reassuring mental representations of past experiences with supportive attachment
figures.
An abiding inner sense of attachment security (based on actual experiences) promotes general faith in other
people’s good will; a sense of being loved, esteemed, understood, and accepted by relationship partners; and
optimistic beliefs about one’s ability to handle frustration and distress. Bowlby (1988) considered attachment
security to be a mainstay of mental health and social adjustment throughout life. A host of cross-sectional and
longitudinal studies support this view (see Mikulincer & Shaver, 2016, for review).
However, when attachment figures are not reliably available, responsive, and supportive, a sense of

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attachment security is not attained, and negative working models are constructed, worries about self-
protection and lovability are heightened, and strategies of affect regulation (which Cassidy & Kobak, 1988,
called secondary attachment strategies) other than appropriate proximity seeking are adopted. Attachment
theorists (e.g., Cassidy & Kobak, 1988; Mikulincer & Shaver, 2016) emphasize two such secondary strategies:
hyperactivation and deactivation of the attachment system. Hyperactivation is manifested in energetic attempts
to gain greater proximity, support, and protection, combined with a lack of confidence that it will be provided.
Deactivation of the system involves inhibition of proximity-seeking tendencies, denial of attachment needs,
maintenance of emotional and cognitive distance from others, and compulsive reliance on oneself as the only
reliable source of comfort and protection.
When studying these secondary strategies during adolescence and adulthood, attachment researchers have
focused mainly on a person’s attachment style—the chronic pattern of relational cognitions and behaviors that
results from a particular history of attachment experiences (Fraley & Shaver, 2000). Initially, attachment
research was based on Ainsworth et al.’s (1978) three-category typology of attachment patterns in infancy
—secure, anxious, and avoidant—and on Hazan and Shaver’s (1987) conceptualization of similar adult styles in
the romantic relationship domain. Subsequent studies (e.g., Brennan, Clark, & Shaver, 1998) revealed,
however, that attachment styles are more appropriately conceptualized as regions in a two-dimensional space.
The first dimension, attachment-related avoidance, reflects the extent to which a person distrusts relationship
partners’ good will, deactivates his or her attachment system, and strives to maintain behavioral independence
and emotional distance from partners. The second dimension, attachment anxiety, reflects the degree to which
a person worries that a partner will not be available in times of need and therefore engages overzealously in
proximity seeking. People who score low on both insecurity dimensions are said to be secure or securely
attached. The two dimensions can be measured with reliable and valid self-report scales and are associated in
theoretically predictable ways with mental health, adjustment, and relationship quality (Mikulincer & Shaver,
2016).

The Caregiving Behavioral System

According to Bowlby (1982), human beings are born with a capacity to provide protection and support to
others who are either chronically dependent or temporarily in need. Bowlby (1982) claimed that these
behaviors are organized by a caregiving behavioral system that emerged over the long course of evolution
because it increased the inclusive fitness of humans by increasing the likelihood that children, siblings, and
tribe members (with whom a person shared genes) would survive to reproductive age and succeed in
producing and rearing offspring (Hamilton, 1964). According to this inclusive fitness logic, the proliferation
of a particular person’s genes depends, not only on his or her own reproductive success (based on transmitting
genes through sexual reproduction), but also on the extent to which people who share copies of one’s genes are
able to survive and reproduce.
Although the caregiving system presumably evolved primarily to increase the viability of an individual’s own
offspring and close relatives (Hamilton, 1964), it may also have been more generally adapted to respond to the
needs of other tribe members (Wilson, 2014). Today, through educational elaboration, it can be extended to
include genuine concern for anyone in need. Although most of us probably care more, and more easily, for
people to whom we are closely related, either psychologically or genetically, we can experience empathy for

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and direct caregiving efforts to all suffering human beings. Just as attachment-related motives, once they
became universally present in our psychological repertoire, can affect a wide variety of social processes,
caregiving motives can be applied more broadly than to one’s immediate genetic relatives.
Following this reasoning, we (Shaver, Mikulincer, & Shemesh-Iron, 2010) proposed that if a person’s
caregiving system develops under favorable social circumstances, then compassion, empathy, loving-kindness,
and generosity become common reactions to other people’s needs. However, if the caregiving system does not
develop under favorable circumstances, because of an absence of parental modeling, training, and support, or
because of interactions with parents that engender insecurities and worries, a developing child is likely to
become less compassionate and be less empathic with respect to other people’s needs and suffering.
According to Bowlby (1982), the goal of the caregiving system is to reduce other people’s suffering, protect
them from harm, and foster their growth and development (e.g., Collins, Guichard, Ford, & Feeney, 2006;
George & Solomon, 2008; Gillath, Shaver, & Mikulincer, 2005). That is, the caregiving system is designed to
serve two major functions: (1) meeting another person’s needs for protection and support in times of danger or
distress (which Bowlby, 1982, called “providing a safe haven”); and (2) supporting others’ exploration,
autonomy, and growth when exploration is safe and desirable (Bowlby, 1982, called this function “providing a
secure base for exploration”). From this perspective, the goal of a care seeker’s attachment system (to maintain
a safe haven and secure base) is also the aim of the care provider’s caregiving system. When a caregiver’s
behavioral system is activated by another person who needs help, the primary strategy of the system is to
perceive the needy individual’s problem accurately and provide effective help. When this help is successful, the
caregiver’s caregiving system is satisfied and, for the moment, deactivated.
According to Collins et al. (2006), the caregiving system is likely to be activated (1) when another person
seeks help in coping with danger, stress, or discomfort (safe-haven needs), or (2) when someone needs or can
use help with projects or tasks that might increase the person’s knowledge, skills, and personal development
(secure-base needs or goals). In either case, effective caregiving involves accurate empathy and empathic
concern for another person’s feelings, needs, and goals. Collins et al. (2006) described optimal caregiving in
terms of two qualities emphasized by previous attachment researchers (e.g., Ainsworth et al., 1978): sensitivity
(being attuned to, and accurately interpreting, another person’s signals of need) and responsiveness (validating
the other person’s needs, perceptions, and feelings; respecting his or her beliefs and values; and providing
useful assistance and support; Reis & Shaver, 1988).
Although Bowlby (1982) assumed that everyone is born with the potential to become an effective care
provider, effective functioning of the caregiving system depends on several factors. Effective caregiving can be
impaired by feelings, beliefs, and concerns that dampen or conflict with the motivation to help or with
sensitivity and responsiveness. It can also be impaired by deficits in social skills, fatigue, and problems in
emotion regulation that cause a caregiver to feel overwhelmed by a needy other’s pain or to wish to distance
her- or himself physically, emotionally, or cognitively from the person’s problems and distress (Collins et al.,
2006).

Interplay of the Attachment and Caregiving Systems

Bowlby (1982) noticed that activation of the attachment system can interfere with the caregiving system,
because potential caregivers may feel that obtaining safety and care for themselves is more urgent than

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providing a safe haven or secure base for others. At such times, people are likely to be so focused on their own
vulnerability that they lack the mental resources needed to attend sensitively to others’ needs. Only when a
sense of attachment security is restored can a potential caregiver perceive others to be, not only potential
sources of security and support, but also worthy human beings who themselves need and deserve sympathy
and support.
Reasoning along these lines, attachment theorists (e.g., Gillath et al., 2005; Kunce & Shaver, 1994; Shaver
et al., 2010; Shaver & Hazan, 1988) hypothesized that attachment security provides an important foundation
for optimal caregiving. Moreover, being secure implies (given the theory and supporting evidence for it; e.g.,
as reviewed in Cassidy & Shaver, 2016) that a person has witnessed, experienced, and benefited from
generous attachment figures’ effective care, which provides a model to follow when they occupy the caregiving
role. And because secure individuals are comfortable with intimacy and interdependence (Hazan & Shaver,
1987), they can allow other people to approach them for help and express feelings of vulnerability and need
(Lehman, Ellard, & Wortman, 1986). Secure individuals’ confidence concerning other people’s good will
makes it easier for them to construe others as deserving sympathy and support, and their positive model of self
allows them to feel confident about their ability to handle another person’s needs while effectively regulating
their own emotions.
Individuals with an anxious or avoidant attachment style are likely to have difficulty providing effective care
(Collins et al., 2006; George & Solomon, 2008; Shaver & Hazan, 1988). Although those who suffer from
attachment anxiety may have some of the qualities necessary for effective caregiving (e.g., willingness to
experience and express emotions and comfort with psychological intimacy and physical closeness), their
habitual focus on their own distress and unsatisfied attachment needs may siphon important mental resources
away from attending accurately and consistently to others’ needs. Moreover, their strong desire for closeness
and approval may cause them to become intrusive or overly involved, blurring the distinction between another
person’s welfare and their own. Attachment anxiety can color caregiving motives with egoistic desires for
acceptance, approval, and gratitude, which can impair sensitivity and lead to what Kunce and Shaver (1994)
called compulsive caregiving.
An avoidant person’s lack of comfort with closeness and negative working models of other people may also
interfere with optimal caregiving. Their discomfort with expressions of need and dependence may cause them
to “back away” rather than “get involved” with someone whose needs are strongly expressed. As a result,
avoidant individuals may attempt to detach themselves emotionally and physically from needy others, feel
superior to those who are vulnerable or distressed, or experience disdainful pity rather than empathic concern.
In some cases, avoidant people’s cynical or hostile attitudes and negative models of others (Mikulincer &
Shaver, 2016) may transform sympathy or compassion into schadenfreude, or gloating.
In the remainder of this chapter, we review studies that test these theoretical ideas about the interplay of
attachment and caregiving motives and processes. We particularly focus on studies that have measured
individual differences in attachment orientations in adulthood or contextually induced a sense of attachment
security in adult participants, and then assessed feelings of compassion and provision of effective support for
others in times of need. We first review studies that have examined these links within dating and marital
relationships, and then review studies that have assessed acts of compassion targeted toward suffering
strangers beyond close relationships.

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Empirical Evidence on the Attachment–Caregiving Link
Caregiving in Romantic Relationships
The first study to examine the link between attachment and caregiving within romantic relationships was
conducted by Kunce and Shaver (1994), who developed an adult Caregiving Questionnaire assessing four
main caregiving dimensions. Two correlated dimensions assess responsive caregiving—proximity maintenance
to a needy partner and sensitivity to a partner’s needs. A third dimension—controlling caregiving—measures
the extent to which the caregiver adopts a domineering, uncooperative stance and fails to respect a partner’s
ability to solve the problem at hand. The fourth dimension—compulsive caregiving—assesses over-
involvement with the partner’s pain and a tendency to experience personal neediness and distress due to over-
identification with the suffering partner.
Using this scale, several studies found that secure people exhibited the most favorable pattern of care within
dating and married couples. Compared with insecure people, secure individuals were more likely to provide
support to a needy partner and be sensitive to his or her needs, and were less likely to adopt a controlling or
compulsive caregiving orientation (e.g., Feeney & Collins, 2001; Kunce & Shaver, 1994; Millings, Walsh,
Hepper, & O’Brien, 2013; Péloquin, Brassard, Lafontaine, & Shaver, 2014). More avoidant people score
lower on proximity maintenance and sensitivity, reflecting their tendency to maintain distance from a needy
partner, and adopt a more controlling stance resembling their domineering behavior in other kinds of social
interactions (Mikulincer & Shaver, 2016). More anxious people score higher on the compulsive caregiving
scale, possibly due to their personal distress and over-involvement with a partner’s problems. These findings
were replicated in same-sex couples (Bouaziz, Lafontaine, & Gabbay, 2013), and in a 14-day diary study of
daily reports of patterns of caregiving within romantic relationships (Davila & Kashy, 2009).
Attachment orientations are also associated with care provision among adult spouses of cancer survivors.
For example, Kim and Carver (2007) found that more secure attachment (as assessed by self-report scales) was
associated with more frequent provision of emotional support to a spouse with cancer. Attachment security
was also associated with autonomous motives for providing care to a spouse with cancer, such as accepting the
need for caregiving, loving, and respecting the care recipient (Kim, Carver, Deci, & Kasser, 2008). As
expected, attachment anxiety was associated with more self-focused motives for caregiving (e.g., providing
care in order to be appraised as a worthy person). In addition, Braun et al. (2012) found that avoidant
attachment was associated with less responsive and sensitive caregiving to a spouse with cancer, whereas
anxious attachment was associated with more compulsive caregiving.
Beyond identifying insecure adults’ caregiving deficits within couple relationships, researchers have
identified the cognitive and motivational processes that explain these deficits. For example, Feeney and
Collins (2003) and Feeney, Collins, van Vleet, and Tomlinson (2013) assessed motives for providing (or not
providing) safe haven support in times of need and a secure base for exploration to a romantic partner.
Findings indicated that secure adults tended to endorse more altruistic reasons for helping (e.g., helping out of
concern for a partner or to reduce the partner’s suffering). In contrast, avoidant people reported more egoistic
reasons (e.g., to avoid a partner’s negative reactions or to receive something explicit in return), and their
reasons for not helping reflected their deactivating strategies. For example, they disliked coping with a
partner’s distress, lacked a sense of responsibility for their partner, and perceived the partner as too dependent.
Although anxiously attached adults endorsed some altruistic reasons for helping (e.g., helping out of concern

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for the partner), they also reported egoistic reasons reflecting unmet desires for closeness and security: helping
in order to gain a partner’s approval and increase the partner’s commitment.
Insecure people’s deficits in providing care to their partners have also been documented in laboratory studies
of actual caregiving behavior. In the first such study, Simpson, Rholes, and Nelligan (1992) videotaped dating
couples while the female partner waited to endure a stressful task, and trained judges then rated the male
partners’ caregiving behavior. The results supported the hypothesis that avoidant men would react to their
partner’s distress with neglect. Specifically, whereas secure men recognized their partner’s worries and
provided greater support as their partner showed higher levels of distress, men who scored high on avoidance
provided less support as their partner’s distress increased. Using a similar experimental paradigm, Simpson,
Rholes, Oriña, and Grich (2002) exposed male members of couples to a stressful procedure and found that
more avoidant female partners provided less support to their needy partner.
In another observational study, Collins and Feeney (2000) videotaped dating couples while one partner
disclosed a personal problem to the other (the “caregiver”). Caregivers scoring higher on attachment anxiety
were coded (by independent judges) as less supportive during the interaction, especially when a partner
engaged in less obvious support seeking. In contrast, secure “caregivers” tended to provide relatively high levels
of support, regardless of whether a partner’s needs were clearly expressed or not. Interestingly, attachment
insecurities were also found to bias people’s appraisals of the support they provided: anxious and avoidant
individuals evaluated their support as even less helpful than it actually was (as coded by independent judges).
In two subsequent laboratory experiments, Feeney and Collins (2001) and Collins, Ford, Guichard, and
Feeney (2005) provided a finer-grained analysis of the unique caregiving deficits of avoidant and anxious
persons. In these studies, dating couples were brought to the laboratory, and one member of the couple (the
“careseeker”) was informed that he or she would perform a stressful task—preparing and delivering a speech
that would be videotaped. The other member of the couple (the “caregiver”) was led to believe that his or her
partner was either extremely nervous (high need condition) or not at all nervous (low need condition) about
the speech task, and was given the opportunity to write a private note to the partner. In both studies, the note
served as a behavioral measure of caregiving and was rated for the degree of support it conveyed. In addition,
the caregiver’s attentiveness to the partner’s needs was assessed by counting the number of times the caregiver
checked a computer monitor for messages from the partner while the caregiver was working on a series of
puzzles (in a separate room). To assess the caregiver’s state of mind, Collins et al. (2005) added measures of
empathic feelings toward the partner, rumination about the partner’s feelings, willingness to switch tasks with
the partner, partner-focused attention (the extent to which caregivers were distracted by thoughts of the
partner while working on puzzles), and causal attributions regarding the partner’s feelings.
The studies yielded strong evidence of avoidant individuals’ hypothesized non-responsive caregiving. More
avoidant people wrote less emotionally supportive notes in both high and low need conditions, and provided
less instrumental support in the high than in the low need condition, precisely when the partner most needed
support. Moreover, avoidant participants reported less empathic feelings toward their partner, were less
willing to switch tasks with the partner, and were less distracted by thoughts about the partner while doing
puzzles.
The findings also provided clear-cut evidence of anxious caregivers’ over-involvement during the
experiment and lack of sensitivity to the partner’s needs. Specifically, anxiously attached participants were

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easily distracted by thoughts about their partner, reported relatively high levels of empathy and rumination,
but failed to write more supportive notes as partner’s needs increased. In addition, they perceived their partner
more negatively in the high need condition, due perhaps to projection of their own feelings or to the
frustration they felt when realizing that their own source of security was not as strong as they had hoped.
The detrimental effects of attachment insecurity on caregiving behavior toward a romantic partner have also
been observed when a partner is exploring new career opportunities or personal plans (an example of secure-
base support). In two observational studies of married couples interacting in a videotaped exploration activity
(e.g., discussion of one partner’s personal goals), Feeney and Trush (2010) and Feeney et al. (2013) found that
attachment insecurities reduced the provision of a secure base for a partner’s exploration and impaired the
partner’s actual exploratory behavior (as judged by external observers). Specifically, spouses’ avoidant
attachment was predictive of less availability to their partner, and spouses’ attachment anxiety was predictive
of greater interference in a partner’s explorations.
Although the reviewed findings support an attachment–caregiving link in couple relationships, the studies
have all been based on dispositional measures of attachment and cannot inform us about the causal effects of
attachment orientations. In order to provide such information, Mikulincer, Shaver, Sahdra, and Bar-On
(2013) conducted a study, in both the United States and Israel, to see if the contextual activation of the sense
of attachment security (what we call “security priming”) would improve care provision to a romantic partner
who was asked to discuss a personal problem. A second goal of the study was to examine the extent to which
security priming could overcome barriers to responsive caregiving induced by mental depletion or fatigue.
Dating couples came to the laboratory and were informed that they would be video-recorded during an
interaction in which one of them (whom we regarded as the “care-seeker”) disclosed a personal problem to the
other (the “caregiver”). Care-seekers chose and wrote about any personal problem they were willing to discuss
(except ones that involved conflict with the partner). And at the same time, caregivers were taken to another
room where they performed a Stroop color-naming task in which we manipulated mental depletion and
subliminally exposed them to either the names of security providers or the names of unfamiliar people.
Following these manipulations, couple members were videotaped while they talked about the problem that the
care-seeker wished to discuss, and then independent judges, viewing the video-recordings, coded participants’
responsiveness to their disclosing partner.
Experimentally induced attachment security was associated with greater responsiveness to the disclosing
partner. Moreover, security priming overrode the detrimental effects of mental depletion and of dispositional
avoidance on responsiveness, and it counteracted the tendency of anxious caregivers to be less responsive
following experimentally induced mental depletion. These effects were unexplained by relationship
satisfaction. Overall, the findings emphasize that attachment security facilitates effective support provision,
and that an experimental enhancement of security can counteract dispositional (insecure attachment
orientations) and situational (mental depletion) barriers to responsive and sensitive caregiving.
Subsequently, Mikulincer, Shaver, Bar-On, and Sahdra (2014) conducted two studies extending the
investigation to another barrier to caregiving, self-esteem threat, and to the provision of secure-base support
for a partner’s exploration. In Study 1, participants were randomly assigned to one of four conditions based on
self-worth threat and security priming manipulations, and external observers rated their responsiveness to a
dating partner who was disclosing a personal problem. In Study 2, participants were randomly assigned to one

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of four conditions based on mental depletion and security priming manipulations, and external observers rated
their responsiveness to a dating romantic partner who was exploring personal goals.
Findings indicate that security priming (as compared to neutral priming) caused people to be more
responsive to their romantic partner when the partner was either disclosing a personal problem (Study 1) or
exploring personal goals (Study 2). Moreover, security priming was found to override the detrimental effects
of mental depletion on the provision of secure-base support to a romantic partner who was exploring his or
her personal goals. However, priming failed to buffer the detrimental effects of a self-worth threat on the
provision of safe haven support to a distressed partner. Perhaps a self-worth threat activates negative self-
representations (a proxy of anxious attachment), thereby augmenting self-focused doubts and concerns that
distract caregivers from attending to a partner’s needs. That is, self-worth threats might act on the same
psychological mechanism acted on by security priming but in the opposite direction—augmenting rather than
reducing self-focused doubts and concerns.
Overall, the reviewed studies show that attachment insecurities interfere with caregiving in adult couple
relationships. Avoidant people’s defenses interfere with the sensitive and responsive caregiving needed by a
troubled romantic partner. Anxious people also have difficulty providing optimal care to a partner. Their
anxious self-focus combined with confusion, disorganization, and a wish that their partner would occupy the
role of “stronger and wiser” caregiver can cause their caregiving intentions to go astray. Fortunately, there is
evidence that the enhancement of attachment security can facilitate empathic caregiving to a romantic partner
and override some of the detrimental effects of contextual barriers to caregiving.

Caregiving Outside the Romantic Relationship

In this section, we review studies examining the contribution of attachment orientations to acts of
compassion targeted toward suffering strangers beyond close relationships. First, we present evidence linking
each of the two attachment dimensions (anxiety, avoidance) to global self-report measures of prosocial
reactions to other’s people needs. In this context, higher scores along the avoidance dimension have been
found to be associated with less empathic concern (e.g., Joireman, Needham, & Cummings, 2002; Lopez,
2001; Wayment, 2006), less inclination to take the perspective of a distressed person (Corcoran, &
Mallinckrodt, 2000; Joireman et al., 2002), and lowered ability to share another person’s feelings (Trusty, Ng,
& Watts, 2005). Moreover, more avoidant people are more likely to feel a sense of burden when acting
generously (Sommerfeld, 2010) and to reject a person who is disclosing personal information about his or her
suffering (Burke, Wang, & Dovidio, 2014).
With regard to attachment anxiety, studies assessing self-report measures of prosocial reactions to other’s
people needs once again suggest a pattern of over-involvement and intrusiveness during encounters with
people in distress. In particular, although Lopez (2001) found a positive association between attachment
anxiety and a measure of emotional empathy, people who scored relatively high on measures of attachment
anxiety also reported higher levels of personal distress while witnessing others’ distress (e.g., Monin, Schulz,
Feeney, & Clark, 2010; Vilchinsky, Findler, & Werner, 2010). Moreover, anxiously attached individuals score
higher on measures of unmitigated communion and pathological concern, which tap a compulsive need to
help others even when they aren’t asking for assistance, and even when the help comes at the expense of one’s
own health and legitimate needs (e.g., Bassett & Aubé, 2013; Shavit & Tolmacz, 2014).

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 The contribution of attachment to acts of compassion outside romantic relationships has been also
documented in observational studies that attempt to capture actual behavioral reactions to a suffering other.
For example, Westmaas and Silver (2001) videotaped people while they interacted with a confederate of the
experimenter whom they thought had recently been diagnosed with cancer. The authors found that both
kinds of attachment insecurity created specific impediments to effective caregiving. As expected, avoidant
participants were rated by observers as less verbally and nonverbally supportive, and as making less eye contact
during the interaction. Attachment anxiety was not associated with supportiveness, but more anxious
participants reported greater discomfort while interacting with the confederate, and were more likely to report
self-critical thoughts after the interaction. These are clear signs of emotional over-involvement and self-
related worries, which can sometimes interfere with caregiving. In another observational laboratory study,
Feeney, Cassidy, and Ramos-Marcuse (2008) also found that higher attachment security was associated with
the provision of more responsive support to an unfamiliar peer who was disclosing a personal problem and
with less self-focus during the discussion (as coded by trained observers).
Beyond examining individual differences in self-reported attachment orientations, experimental studies
have also manipulated a person’s momentary sense of attachment security (security priming) and have found
theoretically coherent effects on compassion-related feelings and behaviors toward needy people. For example,
Bartz and Lydon (2004) asked people to think about a close relationship in which they felt either secure,
anxious, or avoidant, and then assessed the implicit and explicit activation of communion-related thoughts
and behavioral tendencies (thoughts about devoting oneself to others; maintaining supportive and warm
interactions with them). Implicit activation was assessed in a word-fragment completion task (which
identified the number of word fragments completed with a communion-related word); explicit activation was
assessed with a self-report measure tapping the tendency to maintain supportive and warm interactions with
others. Contextual priming of representations of avoidant attachment led to lower levels of implicit and
explicit communion-related thoughts and tendencies than contextual priming of secure attachment.
Along the same lines, Mikulincer, Gillath, et al. (2001, Study 1) manipulated the contextual sense of
security by having participants read a story about support provided by a loving attachment figure and
examined the effects of this manipulation on self-reports of compassionate responses to others’ suffering.
Following the priming procedure, all participants read a brief story about a student whose parents had been
killed in an automobile accident, and rated how much they experienced compassion and personal distress
when thinking about the distressed student. As expected, security priming (as compared to the priming of
neutral thoughts, such as going to a grocery, or the priming of attachment-unrelated positive thoughts, such
as winning a lottery) strengthened compassion and inhibited personal distress in reaction to others’ distress.
These findings were replicated in subsequent studies (Mikulincer, Gillath, et al., 2001, Studies 2–5;
Mallinckrodt et al., 2013) and extended to the endorsement of compassion-related values, such as benevolence
—concern for close others—and universalism—concern for all humanity (Mikulincer, Gillath, et al., 2003).
Although these experimental studies support the causal link between security priming and compassion, all
of them have assessed compassion through self-report measures that can be biased by social desirability and
other motivational and cognitive tendencies. In order to deal with this critical methodological problem,
Mikulincer, Shaver, Gillath, and Nitzberg (2005) examined the effects of secure priming on the actual
decision to help or not to help a person in distress. In the first two experiments, participants watched a

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confederate while she performed a series of increasingly aversive tasks. As the study progressed, the
confederate became increasingly distracted about the aversive tasks, and the actual participant was given an
opportunity to take the distressed person’s place, in effect sacrificing self for the welfare of another. Shortly
before the scenario just described, participants were exposed to security or neutral priming either a subliminal
level (rapid presentation of the name of a specific person) or supraliminal level (asking people to recall an
interaction with a particular person). At the point of making a decision about replacing the distressed person,
participants also completed brief self-report measures of compassion and personal distress.
In both studies, dispositional avoidance was related to lower compassion and lower willingness to help the
distressed person. Dispositional attachment anxiety was related to personal distress, but not to either
compassion or willingness to help. In addition, subliminal or supraliminal priming of representations of a
security-providing figure decreased personal distress and increased participants’ compassion and willingness to
take the place of a distressed other.
In two additional studies, Mikulincer, Shaver, Gillath, and Nitzberg (2005, Studies 3–4) examined the
hypothesis that the contextual heightening of attachment security overrides egoistic motives for helping, such
as mood-enhancement and empathic joy, and results in genuinely altruistic helping. Indeed, findings indicated
that expecting to improve one’s mood by means other than helping, or expecting not to be able to share a
needy person’s joy when helped, reduced compassion and willingness to help in the neutral priming condition,
but failed to affect these emotional and behavioral reactions in the security priming condition. That is, the
contextual priming of attachment security led to heightened compassion and willingness to help, even when
there was no egoistic reason for helping. These findings fit well with our theoretical view that the sense of
attachment security reduces selfishness (defensive self-protection) and allows a person to activate his or her
caregiving behavioral system, direct attention to others’ distress, take the perspective of a distressed other, and
adopt an empathic attitude toward others’ distress. In other words, the sense of attachment security frees
people from attachment-related concerns and worries as well as from a self-oriented, needy position, and
allows them to activate the caregiving system whenever they witness the suffering of another person, while
adopting a sensitive empathic attitude towards the suffering other and experiencing a genuine desire to
alleviate that suffering.

Conclusion
In this chapter, we have shown how the attachment and caregiving systems interrelate, and how individual
differences in attachment influence caregiving of two kinds—providing a secure base for a person in distress
and providing a secure base for another’s exploration and personal development. The research findings
reported to date raise interesting applied questions: Would interventions designed to increase attachment
security cause parents, foster parents, teachers, physicians, nurses, and therapists to be more compassionate
and more effective caregivers? Should professional caregivers and foster parents be screened for attachment
security? The findings obtained thus far encourage us to pursue additional issues, such as the contribution of
secure interactions with parents during infancy and early childhood to the development of empathy,
compassion, and effective caregiving; the personality and situational factors that may interfere with the
beneficial effects of security on caregiving; and the beneficial effects of good caregiving on the functioning of a
person’s attachment system and the creation of mutually satisfying close relationships.

130
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 Compassion-Focused Parenting

James N. Kirby

Abstract

The parenting a child receives has profound long-term impacts on that child’s life. The rates of child
maltreatment globally are high. Evidence-based parenting programs have been demonstrated to have
positive impacts on improving parenting style, whilst reducing childhood social, emotional, and
behavioral problems. However, uptake in parenting interventions remains low, and governments have
been reluctant to provide evidence-based parenting on a wide scale. This chapter aims, first, to show
how the adoption of a public health approach to parenting can be considered wide-scale compassionate
action, one that will reduce rates of child maltreatment (suffering), which is also cost-effective. Second, I
argue that the next generation of evidence-based parenting programs need to be grounded in evolved,
caring motivational systems and affiliative emotion processing, which requires an understanding of the
evolved processes involved in parent–offspring caring and brain functioning. This new approach to
parenting, “compassion-focused parenting,” will be described.

Key Words: parenting style, child maltreatment, evidence-based parenting program, public health,
compassion-focused parenting, affect regulation

The parenting a child receives in the first few years of life has profound long-term effects on the life of that
child. Such long-term impacts of parenting on children affect brain development, language and social skills,
emotional regulation, empathy, mental and physical health, health-risk behavior, and their capacity to cope
with a spectrum of major life events (Beaver & Belsky, 2012; Belsky & de Haan, 2011; Cecil, Barker, Jaffee,
& Viding, 2012; Eisenberg, Spinrad & Knafo, 2015; Moffitt et al., 2011). Although we are born with a
specific genotype passed down from our parents, epigenetics and the process of methylation influences genetic
expression (Saturn, Chapter 10 this volume; Unternaehrer et al., 2012). Stressful environments, in contrast to
safe and predictable environments, increase or reduce genetic expressions in different ways as children are
developing the phenotypes that prepare them for the environmental niche in which they are growing (Belsky
& de Haan, 2011; Beaver & Belsky, 2012; Biglan, Flay, Embry, & Sandler, 2012). Therefore, there is a great
need for our communities to invest in helping parents raise their children in a family context that fosters
compassion and strengthens a prosocial phenotype, which in turn will benefit childhood physical health, as
well as mental and social well-being.
This chapter has two main aims: first, to suggest that the adoption of a public health approach to parenting
is a compassionate action, as it can help reduce the rates of child maltreatment (prevention and alleviation of
suffering); second, to demonstrate the importance of embedding the next generation of parenting
interventions in brain functioning and affiliative processing, where I will describe a new approach to parenting

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called compassion-focused parenting.

A Public Health Approach to Parenting

A Brief History of the Impact of Parenting Style
There have been over five decades of experimental clinical and developmental psychology research
classifying parenting styles and demonstrating the impact of parenting styles on child outcomes (Patterson,
2005; Sanders & Kirby, 2014). Baumrind (1966) originally classified three different styles of parenting:
authoritative (i.e., firm boundaries but flexible, responsive to child, recognizes the rights of the child),
authoritarian (i.e., controlling, non-responsive, values obedience, uses punitive practices), and permissive
parenting (i.e., not demanding, child allowed to self-regulate). Maccoby and Martin (1973), extended this
work, and classified parenting as being along the two dimensions of responsive or demanding, which resulted in
four parenting styles, authoritative (demanding and responsive), authoritarian (demanding and unresponsive),
indulgent (undemanding and responsive), and neglectful (undemanding and unresponsive). The classification of
parenting styles was an important step for the field, as it permitted developmental and parenting researchers to
examine how parenting practices influenced childhood social, emotional, and behavior outcomes.
Consistently, researchers have found that coercive parenting practices (e.g., authoritarian using punitive
practices) and lax parenting styles (e.g., neglectful, indulgent, permissive) lead to poorer child outcomes,
compared to children who receive positive parenting practices (e.g., authoritative, warm, responsive; Kaminski
et al., 2008; Nowak & Heinrichs, 2008; Sanders, Kirby, Tellegen, & Day, 2014). What is surprising, given
this knowledge, is that today smacking and corporal punishment—use of an object, such as a paddle (an
authoritarian and punitive parenting practice), are still well-used and accepted parenting practices (D’Souza,
Russell, Wood, Signal, & Elder, 2016; Klevens & Whitaker, 2007; Regalado, Sareen, Inkelas, Wissow, &
Halfon, 2004). For example, in a recent study of New Zealand parents (D’Souza et al., 2016), researchers
found that although smacking and corporal punishment had declined from 89% in 1981, it was still approved
by 40% of parents in 2013. This view is echoed in other Western countries such as the United States, where
74% reported hitting their children (Jackson et al., 1999), and 47% reported hitting very young children
(Regalado et al., 2004).
In low-income and developing nations, smacking and corporal punishment are similarly used, albeit at
higher levels. The World Health Organization estimated that violence-related child deaths were almost twice
as high in low-income countries (2.58/100,000) as in high-income countries (1.21/100,000; WHO, 2006).
For example, a study in Brazil (Bordin, Paula, Nascimento, & Duarte, 2006) aimed at estimating prevalence
rates of corporal punishment found a rate of 10.1% for severe physical punishment (e.g., choking, shaking
under two years of age, kicking, and beating) and 75.3% for non-severe physical punishment (e.g., spanking
with hand, spanking with object, twisting ear). Importantly, research shows smacking is ineffective at
changing child behavior in the long term and can negatively affect parent–child attachment, but also, a society
that views smacking as acceptable is one in which children are at considerably greater risk of being exposed to
abuse (D’Souza, Russell, Wood, Signal, & Elder, 2016; Klevens & Whitaker, 2007; Prinz, Sanders, Shapiro,
Whitaker, & Lutzker, 2009). This has led to over 40 countries (e.g., Denmark, Germany, Israel, Sweden,
Romania, etc.) introducing legislation to ban smacking and corporal punishment (United Nations, 2014).

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Child Maltreatment
The endorsement of smacking and corporal punishment puts children at risk of child maltreatment (Prinz,
2015). In the U.S. in 2014, there were 3.6 million referrals of alleged maltreatment of approximately 6.6
million children, with approximately one-fifth of children investigated being victims of abuse or neglect at a
rate of 9.4 per 1,000 children in the population (U.S. Department of Health & Human Services [DHHS],
2016). Research by Zolotor, Theodore, Coyne-Beasley, and Runyan (2007) found in a telephone household
survey that mothers self-reported physically abusive behaviors by themselves and their spouses/partners toward
their children at a rate greater than 40 times higher than the official substantiated rate of physical abuse in the
U.S. Moreover, in a study by Prinz and colleagues (2009), they found that 10% of parents self-reported using
smacking with an object on a frequent or very frequent basis, and that 49% of the parents reported relying
heavily on coercive discipline practices for child misbehavior. The World Health Organization (WHO, 2014)
has estimated that globally there are 41,000 homicide deaths of children under 15 years of age (likely to be
under-reported figure).
What is most frightening is that three key risk factors that lead to child maltreatment include, (1) the child
being under four or an adolescent, (2) the child being unwanted or failing to meet expectations of parents, or
(3) the child having special needs or crying persistently or having abnormal physical features (WHO, 2014).
And what perpetuates this vicious cycle is the parenting risk factors that lead to child maltreatment, which
include being maltreated themselves as a child, not being aware of child development milestones, having
unrealistic expectations, the use of alcohol and drugs, difficulty with bonding, and criminal and financial
difficulty (WHO, 2014). The original Adverse Childhood Experiences (ACEs) study (Felitti et al., 1998)
shed further light on the significance of the problems in home environments. ACEs include three categories:
abuse (emotional, physical, sexual), household challenges (mother treated violently, household substance abuse,
household mental illness, parental separation or divorce, incarcerated household member), and neglect
(emotional and physical). The results from this study, which included over 9,508 participants from the Kaiser
Permanente’s San Diego Health Appraisal Clinic in the U.S., found that 64% of them had been exposed to at
least one ACE as a child. Individuals who had experienced four or more ACEs had a 12-fold increased health
risk for alcoholism, drug abuse, depression, and suicide attempt. The study concluded that there was a strong
relationship between the number of ACEs experienced during childhood and multiple risk factors of several
leading causes of death in adults.
These results illustrate two key points: (1) that many children are being raised in “toxic” environments, ones
which are characterized by threat and not by compassion; and (2) the need for parents to have access to
evidence-based parenting programs to improve child outcomes. Yet the response to childhood distress appears
to be somewhat underwhelming, with few governments around the world adopting policies to offer evidence-
based parenting programs to help parents raise their children and reduce the prevalence of child maltreatment
(Prinz et al., 2009; Sanders & Kirby, 2014). One of the best pathways to help parents and protect children is
through implementing evidence-based parenting programs on a public health scale (Biglan, 2015; Klevens &
Whitaker, 2007; Prinz, 2015; Sanders & Kirby, 2014).

Evidence-Based Parenting Programs

Parenting programs provide the perfect opportunity to help promote nurturing environments. Children

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who grow up in environments characterized by a warm, supportive approach to parenting are less likely to
develop antisocial behaviors despite the impact of neighborhood deprivation, such as poverty and low
socioeconomic status (Odgers et al., 2012). There is also growing momentum among parenting and family
researchers for the need to develop nurturing environments (Biglan, 2015; Kirby, 2016; Sanders, 2012).
Nurturing environments include four key principles: (1) promote and reinforce prosocial behavior; (2)
minimize coercion, aggression, and conflict behavior; (3) reduce opportunities for problem behavior; and (4)
promote mindful, flexible pro-social values (Biglan, 2015; Biglan, Flay, Embry, & Sandler, 2012). People are
exposed to many potentially nurturing environments across the life span (e.g., school, workplace); however,
the strongest and most influential is that of the family (Biglan, 2015; Sanders, 2012), due to its direct impact
on child and adolescent development, and problems typically start to show during childhood or adolescence
(National Research Council & Institute of Medicine, 2009).
Evidence-based parenting programs (EBPPs) are programs that have been rigorously evaluated through
randomized controlled trials (RCTs) and show increased positive parenting practices (authoritative parenting
style) and reduced ineffective disciplinary practices. EBPPs produce better mental health and developmental
outcomes in children than do comparison conditions, such as care as usual, no treatment, or waiting list
control conditions (Kirby & Sanders, 2012). The United Nations and the World Health Organization
recommend EBPPs as a pathway to both preventing and treating childhood social, emotional, and behavioral
problems (UN Office on Drugs and Crime, 2009; WHO, 2009). The primary function of EBPPs is to help
reduce childhood problems by increasing parental knowledge, skills, and confidence (Sanders & Kirby, 2014).
The most empirically supported programs, such as the Incredible Years Program (Webster-Stratton, 1998),
Parent–Child Interaction Therapy (Fernandez & Eyberg, 2009), the Oregon Model of Parent Management
Training (Forgatch & Patterson, 2010), and the Triple P–Positive Parenting Program (Sanders, 2012), all
share a common theoretical basis (e.g., social learning theory) and incorporate behavioral, cognitive, and
developmental principles and concepts. For example, a meta-analytic study that included 77 published
evaluations of parent training programs identified four key components associated with larger effect sizes: (1)
teaching parenting skills related to emotional communication; (2) teaching parenting skills to interact
positively with the child; (3) teaching parents to discipline consistently; and (4) in vivo practice with the child
during the program (Kaminski et al., 2008). Numerous meta-analyses attest to the benefits that parents and
children derive (particularly children with conduct problems) when their parents learn positive parenting skills
(Comer, Chow, Chan, Cooper-Vince, & Wilson, 2013; Menting, de Castro, & Matthys, 2013). These
benefits include fewer behavioral and emotional problems in children, decreased coercive parental practices by
parents, reduced mental health problems, and less parental conflict.

Public Health Approach to Parenting: Wide-Scale Compassionate Action

EBPPs help promote nurturing family environments, which provide the conditions necessary for children
to thrive. Yet so few parents participate in EBPPs. A recent population survey of parents showed that 75% of
parents who had a child with an emotional or behavioral problem had not participated in a parenting program
(Sanders, Markie-Dadds, Rinaldis, Firman, & Baig, 2007). If greater proportions of parents engaged in
EBPPs, this would not only benefit the immediate family, but would also have a ripple effect by creating more
compassionate environments for us to live in, as it would be treating and preventing suffering on a large scale.

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This requires adopting a public health approach to parenting (Sanders & Kirby, 2014). Public health
approaches to issues such as car safety (e.g., adopting the use of seat belts in cars), smoking (e.g., restricting
smoking indoors, increasing tax), and mass shootings in Australia (e.g., gun buyback, restriction and permits
on gun ownership), have been able to prevent suffering on a large scale by reducing incidence and prevalence
rates for car injuries, rates of smoking, and number of mass shootings in Australia (Chapman, Alpers, &
Jones, 2016; US Department of Transportation, 2016; Wilson, Hayes, Biglan, & Embry, 2014). Thus, public
health approaches to issues that treat and prevent suffering can be considered synonymous to wide-scale
compassionate action.
A public health approach to parenting has the potential to reduce prevalence and incidence rates of child
maltreatment, which would be a compassionate act (Prinz, 2015; Sanders et al., 2014). There is initial support
for such an approach, with the Triple P–Positive Parenting Program (Prinz, Sanders, Shapiro, Whitaker, &
Lutzker, 2009). In a place-based randomized design population trial that spanned over two and a half years,
18 counties in South Carolina were randomly assigned to either the Triple P condition or to a care-as-usual
control group. Interventions consisted of a media and communication strategy, parenting seminars, parenting
groups, and individually delivered programs. Any parent could participate in any of the programs they wished,
depending on their need and interest. Following intervention, the Triple P counties observed significantly
lower rates of founded cases of child maltreatment (d = 1.09; 16% lower than comparison counties, slowing
the growth of cases), hospitalizations and injuries due to maltreatment (d = 1.14; 22% lower than comparison
counties), and out-of-home placements due to maltreatment (d = 1.22; 17% lower than comparison counties).
This was the first time a parenting intervention had shown positive population-level effects on child
maltreatment in a place-based randomized design. Importantly, this study targeted all parents, not just those
at risk. These results demonstrate that adopting a public health approach, and making EBPPs accessible to
everyone, reduces levels of child maltreatment. Moreover, such an approach is cost-effective, as every dollar
invested in the Triple P program yielded a $9 return in terms of reduced costs of children in the welfare
system (Aos et al., 2014).
In addition, a public health approach to parenting also has the capacity to de-stigmatize and normalize
accessing parenting support. One of the most overwhelming barriers is the stigma associated with engaging in
EBPPs (Prinz & Sanders, 2007). A real concern expressed by many parents is the shame they experience if
they enroll in an EBPP, with a belief that other parents and people will think, “They must be bad parents if
they are doing a parenting program.” This narrative is a problem, and it only serves to increase the suffering
the parents and children might be experiencing. This is where the public health approach to parenting, a
compassionate normalizing approach, becomes very powerful. The value of a population approach is that it
can benefit everyone, avoids stigmatizing anyone, and can also attract widespread citizen support (Moffitt et
al., 2011). This approach is also supported from an evolutionary perspective (Ellis et al., 2012), where there is
a growing consensus that interventions aimed at promoting more positive strategies have long-lasting effects,
as long as such interventions do not pull out only high-risk individuals, which may inadvertently confer their
status as being problematic (Ellis et al., 2012).
Importantly, although current evidence indicates the positive impact of EBPPs, intervention models can
still be improved. As our understanding of the scientific processes involved in brain development increases, so
must our models of parenting interventions (Patterson, 2005; Sanders & Kirby, 2014). Most EBPPs, as

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mentioned earlier, were developed in the 1970s, where social learning theory and behavioral approaches to
child and family functioning were the main focus in improving parenting style and child outcomes (Sanders &
Kirby, 2014). With advances in understanding evolutionary psychology, and affective neuroscience with
emotion-regulation systems, innovations in the EBPP model are warranted. Thus, the aim of the second part
of this chapter is to demonstrate how the model of EBPPs can be improved through the inclusion of
compassion, which focuses on the importance of affiliative processing to facilitate change.

Compassion-Focused Parenting
One of the most important parenting provisions, to create a safe and supportive environment for children,
is to be sensitive to the child’s needs and distress and respond appropriately. Indeed, in early childhood, the
parent is typically the only source of need fulfillment and emotion and distress regulation, as children are
vulnerable and lack the required competencies to meet those needs (Siegel & Bryson, 2011; Swain and Ho,
Chapter 6 this volume). Hence, in many ways, the various motives and competencies that underpin
compassion are crucial to the provision of safe, predictable, and secure environments for children.
Compassion has been defined in various ways (Gilbert, 2014; Goetz et al., 2010; Strauss et al., 2016). Most
theorists focus on the preparedness and wish to sensitively attend to suffering and the needs of others, and also
be prepared to do something to help reduce that suffering. In terms of a specific definition of compassion, a
common one is a sensitivity to the suffering in self and others, coupled with a commitment to alleviate or prevent it
(Gilbert, 2014; Goetz et al., 2010). Note that the prevention of suffering is important to compassionate
motivation. This is especially important for children, because a parent who is not empathetically sensitive to
the needs of their child may cause a lot of suffering. For example, there can be potential neurological damage
to the developing brain of babies who are left to cry alone regularly (Bugental, Martorell, & Barraza, 2003;
Schore, 1997), and at an extreme, unfed children tend to starve (an all too common occurrence in developing
countries; Maternal and Child Nutrition Study Group, 2013), both examples of parental neglect.
Compassion involves two key processes: (1) having a signal detection to suffering (i.e., sensitivity and
awareness), and (2) having a signal responsiveness to suffering (i.e., taking some kind of action to alleviate and
prevent suffering). Thus, compassion will involve a number of important competencies, such as knowing how
to pay attention; being emotionally moved by distress calls—that is, sympathy (rather than being uninterested
in, or irritated by it); having empathy, such as knowing that a certain type of crying might mean the baby
wants to eat, versus feeling pain, distress, or tiredness. In addition, as the child develops, the parent should
know when to remove him/her from all anxiety, in contrast to helping the child stay with and cope with that
anxiety (e.g., going to school). Thus, parents have to be able to tolerate distress and be nonjudgmental—that
is, non-condemning and non-critical (Gilbert & Mascaro, Chapter 29 this volume; Gilbert & Choden, 2013;
Siegel & Bryson, 2011). The second component of compassion requires action and skills, and providing
parents with specific evidence-based parenting training can be one effective way to help in the social,
emotional, and behavioral development of children (Kirby, 2016).
Compassion importantly includes three directions: giving compassion to others (e.g., friend, family
member), being open and responding to receiving compassion from others, and self-compassion (Gilbert,
2014; Gilbert, McEwan, Matos, & Rivis, 2010; Jazaeiri et al., 2013; Neff & Germer, 2013). Importantly, the
parenting a child receives is the first opportunity he/she has at receiving compassion from others (Mikulincer

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and Shaver, Chapter 7 this volume; Swain and Ho, Chapter 6 this volume). Compassion has been a relatively
neglected area of research within the field of parenting interventions (Kirby, 2016). This is surprising, given
that compassion helps build social relationships and connectedness through caring prosocial behavior (Gilbert,
2014; Goetz et al., 2010; Straus et al., 2016), and is essential to the development of secure attachment
relationships between parents and children, which helps facilitate emotional self-regulation and adaptive
relating styles into adulthood (Mikulincer and Shaver, Chapter 7 this volume).
Compassion-focused parenting is the combination of the strategies and principles from current EBPPs with
the principles of compassion-focused therapy (CFT). Typically, parenting interventions are “technique”-
oriented, aimed at reducing problematic behavior (Kirby, 2016), and are not grounded in the understanding of
brain function (Seigel & Bryson, 2015; Swain and Ho, Chapter 6 this volume). My premise is that many of
the techniques in EBPPs will remain the same (e.g., attention, praise), but the model of how to facilitate
positive parent–child relationships will shift to focus on evolved, caring motivational systems and affiliative
emotion processing, which require an understanding of the evolved processes involved in parent–offspring
caring and brain functioning.
This is important because children are born prepared to respond to certain kind of stimuli provided by the
parent, such as voice tone, facial expression, and physical touch (Bornstein, Suwalsky, & Beakstone, 2012;
Dunbar, 2010). These processes are conveying important information about safety and the parental
investment available to the child, and sets the physiological infrastructures for social-emotional development
(Mikulincer and Shaver, Chapter 7 this volume; Swain and Ho, Chapter 6 this volume). As Bowlby (1969)
pointed out, the provision of a secure base and safe haven offers an evolved context for child development.
Compassion is important because it brings a range of recently evolved social-intelligence competencies such as
empathy, mentalization, and self–other differentiation (Gilbert, 2014) that enables sensitive and
physiologically wise parenting. Compassion-focused parenting not only is motivated to reduce suffering and
threats in the child’s environment, but also to provide the opportunity for exploration and social, emotional,
and behavioral growth. These are facilitated when parents themselves feel secure. When parents feel
threatened and uncertain, they are more likely to engage defensively, potentially responding impulsively.
Thus, the compassion-focused parenting approach focuses on a range of social intelligence competencies,
such as empathy, distress tolerance, and clarity of the intention in one’s parenting style. Not many parents
wake up in the morning with the intention to yell at their children or smack them for misbehavior. Yet, when
parents are stressed and children misbehave, these are very common techniques parents will utilize in the
moment (Prinz, 2015; Sanders et al., 2007; Seigel & Bryson, 2011). This is typically a result of how the brain
has evolved, as our threat system is the most dominant processing system (Baumeister, Bratslavsky,
Finkenauer, & Vohs, 2001; Gilbert, Chapter 29 this volume). Importantly, this is not the parents’ fault!
Parents did not choose to design their brain in this way, one focused on threat processing. Thus, compassion-
focused parenting requires parents to understand how their brain functions, and how that will impact the
interactions, relationship, and development of their child’s social, emotional, and behavioral growth.
So at the heart of compassion-focused parenting is the relationship and connection between parent and
child, one focused on affiliative emotions. This approach requires parents to slow down and try to see what sits
behind the child’s behavior; that is, what is the function of the behavior. This perspective requires parents to
move beyond a short-term lens, one focused on immediate reductions in misbehavior, and rather take a long-

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term focus of their child’s development and their ability to self-soothe and grow to be healthy and resilient
young adults. Affiliative emotions are central in the compassion-focused parenting approach, as evidence from
developmental, neuroscience, and social-emotional research has indicated the profound effects it has on our
physiology, as well as social, emotional, and behavioral development (Mikulincer and Shaver, Chapter 7 this
volume; Porges, Chapter 15 this volume; Saturn, Chapter 10 this volume; Spinrad and Eisenberg, Chapter 5
this volume; Swain and Ho, Chapter 6 this volume).
Notably, compassion-focused parenting does not simply mean “being nice” to your children; indeed, a
compassion-focused parent will, for example, prevent a child from overeating or staying up too late, despite
protests from the child (this can take some courage). Indeed, there are many times when parenting your child
or children is not easy, and the parent can feel high levels of self-doubt, stress, and guilt about what to do in
their role as caregiver (Haslam, Patrick, & Kirby, 2015; Kirby, 2016). Thus, compassion-focused parenting
does require a number of competencies and capacities that parents range in their ability to perform (e.g.,
distress tolerance). Therefore, in order to best help our children, we must help our parents, and provide them
with the skills, knowledge, and confidence of a style of parenting that is compassion-focused, as this will help
promote well-being in children and parents, whilst preventing and alleviating suffering.

The Caring System Motive and Parenting

Parental investment in evolutionary biology and psychology is a concept that refers to “any parental
expenditure that benefits one’s offspring at a cost to the parent’s ability to invest in other components of
fitness.” Animals vary greatly in the amount of parental investment they provide; for example, sea turtles
(reptiles) provide no parental investment to their young hatchlings after they are born on sandy beaches; in
contrast, humans (mammals) provide the most significant amount, with children needing over a decade of
parental investment to ensure their safety and healthy development (Gilbert, 2014). The caring system of
humans, and indeed, mammals, is a critical system to enable infant survival. The caring system motive or
compassionate motive (Gilbert, 2014) requires parents to be sensitive to the distress signal of their offspring—
for example, for a newborn infant who could be crying (first process), and then having the capacity to move
towards that crying infant (suffering) so that the infant can be cared for through some kind of soothing
affiliative behavior, such as touch or voice tone (second process). This interaction between caregiver (parent)
and care-seeker (infant) then helps facilitate the attachment system between parent and child (see Mikulincer
and Shaver, Chapter 7 this volume; Swain and Ho, Chapter 6 this volume), and it also demonstrates how
affection and affiliative behaviors are fundamental in the affect-regulation of mammals.
Fogel, Melson, and Mistry (1986) provide an important framework to caring-nurturance and parental
investment, which helps facilitate the attachment system. This includes five important capacities: (1) an
awareness of the need to be nurturing; (2) a motivation to nurture; (3) an understanding of what is needed to be
nurturing; (4) having the capacity to express nurturing feelings; and (5) having feedback systems—that is,
having the ability to change one’s behavior depending on whether it has been successful or not (using the
previous example of the newborn infant crying, if soothing through touch or voice does not work, the parent
may need to feed the infant, as the child could have been hungry). This approach to caring and nurturing
helps create the attachment system for the child (Bowlby, 1969; Mikulincer and Shaver, Chapter 7 this
volume).

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 There are three key components to attachment: proximity seeking—that is the child’s desire to be close to an
attachment figure (typically mum or dad); secure base—the child’s having a source of security and guidance to
go out and explore and develop confidence; and safe haven—the child’s having a source of comfort when
distressed to help facilitate emotion regulation (Bowlby, 1969; Gilbert, 2014; Mikulincer and Shaver, Chapter
7 this volume). The attachment system is critical to mammalian evolution, and particularly for humans, as
affiliative emotions and relating to others (e.g., parent, family, friends, others) are potentially the most
significant in terms of affect regulation (Gilbert, this volume). Affiliative connection can include touch, facial
expression, and voice tone, among a number of other factors (Goetz et al., 2010; Porges, Chapter 15 this
volume).

Affect Regulation in Compassion-Focused Parenting

In humans, the key process to help assist with affect regulation works through affiliative and affectionate
behaviors. Polyvagal theory, outlined by Porges (Chapter 15 this volume), details how the activation of the
myelinated parasympathetic nervous system helps in the regulation of fight/flight impulses (autonomic
sympathetic nervous system), thus enabling calmness and soothing to be achieved when one is under threat,
through having close proximity to others, and receiving affiliative, caring, prosocial behavior (Davidson, 2012;
Depue & Morrone-Strupinsky, 2005; Gilbert, 2014; Goetz et al., 2010). Specific strategies such as breathing
practices, friendly voice tones, and facial and body expressions can activate the parasympathetic system, aiming
to calm and soothe the individual, which improves heart rate variability (Krygier et al., 2013). Moreover, when
the sympathetic system is activated under threat, this decreases the ability to engage higher-order cognitive
capacities such as mentalizing (e.g., theory of mind, empathizing, perspective-taking), whereas activating the
parasympathetic system helps provide a feeling of safety, which increases the ability to activate the prefrontal
cortex and enables mentalization (Klimecki et al., 2013; Thayer & Lane, 2000). Thus, the focus on activating
affiliative processing systems (e.g., parasympathetic system) assists in the regulation of affect and helps calm
individuals when they are distressed.
A key component of compassion-focused parenting is understanding emotion systems and affect regulation.
One way to consider emotions, other than individually, is to group them in terms of their evolutionary
functions. For example, we can identify a whole set of emotions whose primary functions are self-protective
and defensive and are triggered in the context of threats, but not in the context of being safe or content.
Another set of emotions is associated with rewards and acquiring resources and achievements. These functions
help direct and energize individuals to do things conducive to their well-being and obtain what they need
(e.g., food, shelter). Once these goals are acquired, however, and without threats, then emotions will be
conducive to calmness, peacefulness, and “rest and digest.” Importantly, the three types of emotional systems
need not be mutually exclusive; rather, they blend in varying degrees. This simple three-function heuristic
approach to emotions has been suggested by Gilbert (2009, 2014). Compassion-focused parenting can be
understood in terms of how parents increase conditions for the maturation of these three types of affective
functioning and how they can blend and support each other. This simple system is depicted in Figure 8.1, and
is a model informed by affective neuroscience research into the evolutionary functions of emotion (Depue &
Morrone-Strupinsky, 2005; LeDoux, 1998; Panksepp, 2010).
These three emotion-regulation systems interact. They are: (a) the threat/self-protect system, (b) the drive-

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reward system, and (c) the affiliative/soothing system. Gilbert (2014) and others (Kirby, 2016) have
emphasized how people (both children and adults) often find themselves trapped between the threat and
reward systems because of the family environments and the Western culture in which we live—a culture that
increasingly focuses on individualistic values that promote achievement and independence (see Chiao,
Chapter 12 this volume; Kasser, 2011; Park, Twenge, & Greenfield, 2014). Currently, this model of emotion
regulation has not been applied to EBPPs, despite the benefits that can be gained from understanding their
functions. For example, children receive report cards from school indicating their level of performance
compared to other children (which activates a competitive motive). If the child has performed at an “average”
or “slightly below average” level, the child can feel “anxious” about showing these results to her/his parent. If
the parent is oriented towards a threat-based approach, the parent would then respond with frustration, and
perhaps anger, in the hope that this will propel the child to study harder. This can indeed have the desired
result, with the child foregoing other activities, studying harder, and achieving better grades the following
semester. This can result in a short-term feeling of excitement and achievement for the child, which is then
reinforced by the parent. However, taking a long-term view, the child then realizes that in order to continue
to receive this type of reinforcement, he/she needs to continue to study hard, otherwise her/his parent will be
upset with her/him again (anxiety- or threat-based). So we can see an interpersonal interaction between the
parent and child of threat-drive-threat, a cycle that is internalized by the child. Consequently, such children
are learning to regulate their emotions through these two systems, which are then continued into adulthood,
and can lead to a drive of perfectionism as they strive for success. This is concerning, as when we are trapped
between the threat and reward systems (competitive motives), it can often lead to a sense of failure and high
levels of self-criticism, with an inability to self-soothe or be one’s own secure base/safe haven (Gilbert, 2014).

Figure 8.1 The interaction between the three major emotion-regulation systems. From Gilbert, The Compassionate Mind (2009), reprinted with
permission from Constable & Robinson Ltd.

If we consider children raised in family homes where they are the recipients of high levels of punitive
parenting practices, like smacking, or at its worst, child maltreatment, these children would be operating from

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their threat-based/self-protect system, as they would be scared of their parents. These situations can lead to
high levels of motive conflict for the children, as the caregivers have been the activators of threat, as opposed
to the activators of affiliative/soothing behavior. This has led some to theorize that children who live in family
environments where they receive high levels of punitive parenting and child maltreatment develop a self-
identity where they are the “cause” of the problem, and thus self-blame, as they believe that their caregiver
would not engage in threat-based punitive practices unless they truly deserved them (Gilbert, 2014). Coupled
with this is the key question, “Whom do children turn to for affiliative connection and soothing when they are
hit by their parents?” Perhaps, if the child is lucky, another family member, say a sibling or grandparent, can
help. Unfortunately, though, these children will often be left to themselves, which can reinforce a core belief
of rejection, unworthiness, and being unlovable. Moreover, threats can be activated from outside the family
home, with research by Horowitz, McKay, and Marshall (2005) finding that 50% of children from inner cities
in the U.S. show high rates of post-traumatic stress disorder symptoms, due to their exposure to community-
level stressors such as violence involving crime and weapons use. So it is critical to determine the
environments in which children are being raised, as this is going to have lifelong impacts on their ability to
regulate their affect and form attachments with others (Mikulincer and Shaver, Chapter 7 this volume).

Embedding a Compassion-Focused Parenting Approach in Evidence-Based Parenting Programs

The impact and effectiveness of EBPPs could be improved through the adoption of a compassion-focused
parenting approach. The overall aim of compassion-focused parenting is to create an internal secure-
base/safe-haven in the parent or a “compassionate mind,” so that they can respond to parenting challenges at
their compassionate best as they arise, as opposed to from a threat or defensive orientation. My prediction is
that this orientation in parents will help improve childhood social, emotional, and behavioral development.
There are many potential ways to embed a compassion-focused parenting approach in EBPPs, and I will
outline a few possible pathways.
Although parenting can be extremely rewarding, parents can also struggle with finding emotional balance,
and often parents indicate difficulties with failure, criticism, shame, and guilt concerning their perceived
parenting mistakes (Haslam, Patrick, & Kirby, 2015). Indeed, first-time mothers experience shame and
judgment from the earliest moments of motherhood (Sutherland, 2010) in connection with childbirth (Beck,
2004) and infant feeding (Thomson, Ebisch-Burton, & Flacking, 2015). For example, mothers who have
intend to breastfeed but are unable to are particularly vulnerable to shame and postnatal depression (Borra,
Iacovou, & Sevilla, 2015). Thus, judgments and criticism about parenting can occur right from the moment
we become a parent. Criticism and shame continue throughout parenting, and in a recent study, Tang,
Luyten, Casalin, and Vliegen (2016) surveyed 79 first-time parents and their children aged eight to 13
months, in a one-year longitudinal study. The study found that parental self-criticism and dependency
(maladaptive needs to be loved and cared for and fears of abandonment, at the expense of developing feelings
of autonomy and identity) were associated with increased levels of relationship stress, which in turn were
negatively related to child development. This is where a compassion-focused approach can be helpful, as CFT
was developed to directly target high levels of self-criticism and shame (Gilbert, 2014), and there is evidence
supporting the effectiveness of CFT (Kirby, 2016).
One potential pathway in applying a compassion-focused parenting approach to EBPPs is to help parents

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understand brain functioning and to try to facilitate affiliative emotional relating between parent and child.
Thus the inclusion of the three-circle model of emotion regulation in EBPPs will enable parents to
understand the function of evolved emotion systems, so that they can gain insight into “what sits behind” the
interactions with their children and parenting partners (e.g., spouse, grandparent). The benefit of including
the three-circle model is that it will also enable a de-shaming and de-blaming process to occur for parents, as
they begin to understand how they did not design their brain to function in that way (Gilbert, 2014). In so
doing, this process can start to facilitate a greater motivation for parents to take responsibility for how their
brains and affect regulation systems function in order to help their children’s social-emotional development.
A key theoretical component of EBPPs is to ensure the parents are taking care of themselves, as if the
parents’ needs are not being met, this limits their ability to meet the needs of their children (e.g., Sanders,
2012). A recent and significant finding in the parenting literature is that, although children with empathic
parents benefit significantly (i.e., experience less depression and less aggression; Chase-Lansdale, Wakschlag,
& Brooks-Gunn, 1995), this comes at a great cost for the parents. In two studies, researchers found that the
higher the reported empathy of parents towards children (Manczak, Basu, & Chen, 2015) and adolescents
(Manczak, DeLongis, & Chen, 2016), the greater the negative impact on the parents, specifically on
inflammatory markers. The authors concluded that when children suffer psychologically, empathic parents’
immune systems suffer. Thus, although parental empathy is beneficial for children, parents must also take care
of themselves. In further support, Moreira, Gouveia, Carona, Silva, and Canavarro (2014) surveyed 171
Portuguese mothers and found that high levels of stress were significantly associated with low levels of self-
compassion. Based on their findings, the authors suggested the importance of designing parenting programs
aimed at reducing parenting stress that simultaneously help parents to become more compassionate toward
themselves (Moreira et al., 2014). Therefore, a compassion-focused approach could be an avenue that could
facilitate parenting self-care so that parents can best take care of their own needs and that of their children.
I have argued that one way to help determine whether compassion-based exercises improve the impact of
EBPPs is through using micro-trial–based design studies (Kirby, 2016; Kirby & Laczko, 2017). Micro-trials
can be operationally defined as a way to test the effects of relatively brief and focused environmental
manipulations (typically in experimental conditions) designed to suppress risk mechanisms or enhance
protective mechanisms, but not to bring about full treatment or prevention effects on distal outcomes (Howe
et al., 2010). Thus, compassion-focused strategies (i.e., soothing rhythmic breathing, imagery, and loving-
kindness meditations) can be used in experimental design conditions to determine whether they influence
immediate or proximal parental and child behavior. If such experimental evidence shows that compassion-
based exercises positively influence family outcomes, there is a greater rationale to include these components
in current EBPPs.
To my knowledge, the first test of such a micro-trial–designed study for compassion-based exercises with
parents was recently conducted, which examined the impact of Loving-Kindness Meditation (LKM) for
parents of children aged two to 12 years of age (Kirby & Baldwin, 2016). LKM involves the repetition of
short phrases (e.g., “May you be safe, may you be peaceful”) towards oneself and others. A meta-analysis has
found that LKM has significant moderate effects on compassion and self-compassion, as well as decreasing
depression (Galante et al., 2014; Hoffman et al., 2011). The Kirby and Baldwin (2016) study included 61
parents who were randomly assigned to receive LKM (15-minute guided audio) or a matched control Focused

145
Imagery (FI) exercise. Participants completed measures that examined compassion, parenting and child
behavior, and parent’s emotional, cognitive, and behavioral responses to vignettes describing difficult child
behavior. Results from the study found that parents in the LKM compared to the FI group had more positive
(e.g., calm and sympathetic) and less negative emotional (e.g., frustration and anger) responses to the
situations of childhood distress. Moreover, the study found that parents who received LKM displayed higher
levels of self-compassion and motivation to show themselves compassion compared to the control group. This
study provides initial evidence for the use of LKM in a parenting context.
If compassion-based exercises are to be used with parents, it is important to assess whether parents find the
strategies acceptable. Parents and consumers can make judgments of acceptability concerning the content,
format, and modes of delivery used to implement a program, strategy, or intervention (Morawska et al., 2011).
A key reason to assess the consumer acceptability of a program, intervention, or strategy is that individuals are
more likely to access treatments and use strategies that they view as acceptable (Borrego & Pemberton, 2007),
while treatments and strategies that are perceived as unacceptable may not be accessed, regardless of their
effectiveness (Eckert & Hintze, 2000). Examining the acceptability of LKM in a parenting population was
the focus of a recent study conducted by Kirby and Baldwin (2016). The results from the study, which
included 43 parents, found that the vast majority of parents thought LKM was acceptable (81.40%) and useful
(55.81%). A key measure of acceptability is how often parents will use the strategy, and 35% of parents
reported they would complete it daily, and 60% weekly. In terms of barriers, only six people reported barriers
(14%) to LKM, with the most significant barrier being that it takes too much time to complete. These
findings suggest that, as a clinical tool, LKM may best be used in conjunction with other aspects of parenting
interventions, as suggested by Hoffman and colleagues (2011) and Kirby (2016).
Compassion can also be a way to encourage parents to stay committed to new techniques taught in EBPPs,
despite the potential difficulty of learning and implementing them. For example, research has found that self-
compassion is linked to greater motivation (Breines & Chen, 2012). In a series of experiments, Breines and
Chen (2012) randomized undergraduate participants to one of three conditions: a self-compassion condition,
a self-esteem control, or a positive distraction control. Participants were then required to respond to a personal
weakness, to a moral transgression, to studying for a test after failing it, and to a social comparison in relation
to a personal weakness. Across all experiments, the researchers found support for the hypothesis that
responding with self-compassion subsequently makes people more motivated to improve themselves and their
performance. These are some of the first experiments to demonstrate that self-compassion leads to increased
self-improvement and motivation. When applying this approach to a parenting domain, it would seem that
self-compassion might be particularly helpful, as parents can often face challenges when implementing a new
parenting strategy for the first time. A parent with a self-compassionate mindset might be more motivated to
continue to try to implement a new parenting technique, despite initial difficulties, yet this remains to be
empirically tested.

Parenting Increasing Child’s Level of Compassion

An important rationale for the inclusion of compassion-focused approach in EBPPs is the aim of raising
more compassionate children. Research has documented that children with empathic parents show more
empathy themselves (Eisenberg, Fabes, Scaller, Carlo, & Miller, 1991). In contrast, the Making Caring

146
Common Project at Harvard University surveyed 10,000 adolescents across the United States and found that
80% said that “achievement or happiness” is their top priority, compared to 20% saying “caring for others” is
their top priority (Making Caring Common, Harvard, 2014). Moreover, the study found youths were three
times more likely to agree than disagree with the statement: “My parents are prouder if I get good grades than
if I’m a caring community member.” As a result, there is an important role for parenting interventions to help
encourage compassion and caring behavior in children and adolescents, as well as school-based educational
programs, which need to be developed, applied, and evaluated.
When a child has experienced physical or emotional abuse or neglect (possibly trauma), his or her ability to
form a secure attachment with his or her caregiver has been compromised, which can have long-term
consequences for the person’s ability to regulate emotions (Gilbert, 2014). Importantly, children’s knowledge
of, expression of, and ability to regulate their emotions are moderated by the type of parenting they received
(Havighurst, Wilson, Harley, Prior, & Kehoe, 2010). Thus, parenting interventions are starting to include
modules that aim at building parents’ empathy toward children, and also responsiveness toward their
children’s negative emotions (Havighurst et al., 2010). For example, the Tuning In to Kids parenting program
(Havighurst et al., 2010) includes sessions aimed at increasing parental awareness and knowledge of emotions,
how to attend to both their child’s emotions and their own emotions, and how to use strategies to help
regulate emotions (e.g., slow breathing). The program has been evaluated in randomized controlled studies
and has been found to increase parental empathy, as well as increase emotional awareness and decrease
dismissive parenting practices (Havighurst et al., 2010). But this needs to be balanced, as increased empathy
can come at a cost for parents, and this is where compassion-based exercises could be important in EBPPs.

Future Research Areas

There is great potential for compassion to play a central role in EBPPs, but much empirical research is
required to determine its efficacy and impact on a range of important family outcomes. Such studies include
measuring compassion as an outcome of interest in EBPP evaluations. Self-report measures already exist, such
as the Fears of Compassion Scale (Gilbert, McEwan, Matos, & Rivas, 2010) and the Self-Compassion Scale
(Neff, 2003), and including these measures can also assist us in determining whether compassion acts as a
significant moderator or mediator to EBPPs, as determined by shifts in parenting style and child social,
emotional, and behavioral outcomes. Moreover, there are some parents who are non-responders to EBPPs
(Sanders et al. 2014); a potential reason for this could be due to the parents’ own fears, blockers, and
resistances (FBRs) to positive affiliative emotions and behaviors, which they are confronted with when
participating in EBPPs. Thus, an important area of research is to examine whether the inclusion of
compassion helps address these FBRs (see Gilbert, Chapter 29 this volume) and helps increase responsiveness
and maintain parents’ participation in EBPPs. Compassion may also have differential impacts on certain
parenting populations. For example, would compassion-based exercises in EBPPs have greater impact on
parents of young children or of teenagers? Or perhaps parents of children with long-standing difficulties, such
as chronic health illnesses or clinical conditions such as autism or attention-deficit/hyperactivity disorder, may
benefit most from compassion-based EBPPs. Or potentially it is parents with high levels of shame and self-
criticism who stand to benefit the most from compassion-based EBPPs.
A key future research question is to determine whether a compassion-focused approach to parenting

147
increases the efficacy of EBPPs when compared to existing interventions. In evaluations, outcomes should not
only be focused on short-term (e.g., pre-, post-, and six-month follow-up) outcomes, but also longitudinal
outcomes (5, 10, 30 years) to determine the impacts of compassion-focused parenting. Multiple sources of
assessment would be helpful to understand the effect of compassion-focused parenting, such as observation of
parent–child interactions and sibling interactions, neurological and physiological measurements (e.g., brain
imagining and biomarkers) of children and parents, as well as self-report measures.

Conclusion
To conclude, with the advances in our understanding of how the brain functions and the importance of
understanding evolved caring motivational systems and affiliative emotion processing, the next generation of
EBPPs has an exciting future. Compassion-focused parenting can help de-stigmatize and de-shame parenting
experiences, helping parents with the rewarding and at times challenging experiences that occur when raising
children. The further benefit of a compassion-focused parenting approach is the hope it will also raise
compassionate children. In summarizing, Paul Gilbert provides a poignant insight into why this area of
compassion-focused parenting is so important:
It is quite extraordinary that, given what we know about how early lives effect brain maturation and even genetic expression, we have such
limited resources dedicated to the desire for “every child to grow-up in a compassionate environment”. This failure to grasp the size and
nature of the problem of, ‘how children around the world are raised in appalling conditions’ is probably humanity’s greatest compassion
failure! (Gilbert, 2014, p. 28)

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 PART 3

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Psychophysiological and Biological Approaches

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 The Compassionate Brain

Olga M. Klimecki and Tania Singer

Abstract

This chapter focuses on the neuroscience of compassion and related social emotions such as empathy,
empathic concern, or empathic distress. First, we review neuroscientific literature on empathy and relate
empathy to similar social emotions. We then turn to neuroscientific research on caregiving and social
connection before describing cross-sectional studies on the neural signatures of compassion. To
investigate whether training of compassion can change neural functions, the neural “fingerprints” of
compassion expertise were studied in both expert and inexperienced meditators. The latter included the
comparison between functional plasticity induced by empathy for suffering as opposed to compassion
training. These studies show that compassion training changes neural functions, and that the neural
substrates related to empathy for suffering differ experientially as well as neuronally. This is in line with
the observation of distinct behavioral patterns related to feelings of empathic distress and compassion,
described towards the end of the chapter.

Key Words: Empathy, compassion, care, social connection, reward, neural substrates, empathy-for-
suffering, prosocial behavior

Empathy and Related Concepts

In order to understand each other, humans can use their ability to empathize with others; that is, to share
the emotions of others without mistaking them for their own emotions (de Vignemont & Singer, 2006). One
can thus empathize with the happiness of someone else by feeling happy, or empathize with the sadness of
someone else by feeling sad. In principle, an empathic response can elicit as much positive affect as it can elicit
negative affect. This depends on the emotion of the other person we are entering in affective resonance with.
However, in psychology and neurosciences, the vast majority of studies on empathy have so far focused on
empathic responses to the suffering of others rather than on empathic joy or resonating with pleasant
sensations experienced by another (but see Lamm, Silani, & Singer, 2015; Mobbs et al., 2009). More
specifically, empathy for suffering has so far mainly been tested by measuring brain activations when someone
is observing another person suffering emotional or physical pain (for meta-analyses, see Fan, Duncan, de
Greck, & Northoff, 2011; Lamm, Decety, & Singer, 2011). The experimental setup typically involves the
measurement of a participant’s brain activity by means of functional magnetic resonance imaging (fMRI),
while the participant is seeing pictures of painful situations such as someone cutting their hand accidentally
with a knife or slamming their hand in a car door (Jackson, Meltzoff, & Decety, 2005). Alternatively, one can
also use scenarios in which the scanned participant witnesses another person seated next to the MRI scanner
getting painful stimulation, such as electric shocks (Singer, Seymour, O’Doherty, Kaube, Dolan, & Frith,

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2004). Meta-analyses across different studies on empathy for pain from various laboratories and with different
types of paradigms have shown that witnessing the pain of others is consistently associated with increased
activations in a core network, the so-called empathy for pain network, consisting of the anterior insula (AI)
and the medial/anterior cingulate cortex (Fan, Duncan, de Greck, & Northoff, 2011; Lamm, Decety, &
Singer, 2011). Both of these regions are part of a neural network that has been proposed to process
interoceptive awareness, emotional experiences in general (Craig, 2003), as well as emotional experiences
related to pain perception in particular (Lamm & Singer, 2010; Peyron, Laurent, & Garcia-Larrea, 2000;
Rainville, 2002; Singer, Critchley, & Preuschoff, 2009). Importantly, activation of this core network elicited
when witnessing the suffering of others appears to be modulated by individual differences in trait empathy
and trial-by-trial reports of experienced negative affect and empathy (Kanske, Bockler, Trautwein, & Singer,
2015; Klimecki, Leiberg, Lamm, & Singer, 2013; Lamm et al., 2011; Singer et al., 2004). This partial overlap
between the brain regions processing the affective responses related to one’s own painful experiences and those
of others suggests that we understand other’s emotions by activating neuronal networks coding for similar
experiences within ourselves. In other words, the neural networks processing the emotions related to first-
hand pain experiences and observed painful experiences of others are shared. More recent studies using multi-
voxel pattern analyses suggest that some regions in AI code for modality-specific information related to
feeling states such as pain, disgust, or even the experience of unfairness in self and others, while other
subregions in AI code for more domain-general feelings of unpleasantness (Corradi-Dell’Acqua, Hofstetter,
& Vuilleumier, 2011; Corradi-Dell’Acqua, Tusche, Vuilleumier, & Singer, 2016). As mentioned, empathy is
not restricted to affective resonance with the suffering of others alone, and accordingly, such shared networks
for first-hand and observed experiences have also been reported in other domains of empathy, such as
empathy for smell and disgust (Jabbi, Bastiaansen, & Keysers, 2008; Wicker, Keysers, Plailly, Royet, Gallese,
& Rizzolatti, 2003), empathizing with being touched in a neutral or pleasant manner (Keysers, Wicker,
Gazzola, Anton, Fogassi, & Gallese, 2004; Lamm, Silani, & Singer, 2015), or for vicarious rewards (Mobbs
et al., 2009).
In the context of empathic responses to the suffering of another person, two basic consequences have been
distinguished in the literature (for more details, see Klimecki & Singer, 2013; and the chapter by Batson,
Chapter 3 this volume): An empathic response can turn into what some researchers call empathic distress (e.g.,
Sagi & Hoffman, 1976), and other researchers call personal distress (Davis, 1983). Empathic or personal
distress denotes the sharing of another person’s suffering almost as if what was happening to the other person
was also happening to oneself. It is a feeling accompanied by strong negative affect and the motivation to
withdraw oneself from such situations in order to reduce aversive emotional experiences. Alternatively, one
can also feel what is called empathic concern in some studies (e.g., Davis, 1983), and compassion in other studies
(e.g., Gilbert, 2010; Lutz et al., 2008), with “compassion” being defined as a sensitivity to the suffering of
another that is accompanied by the motivation to alleviate that suffering (Goetz, Keltner, & Simon-Thomas,
2010). In the next section, we will describe what is known to date about brain functions related to compassion
and related concepts such as care and social connectedness, and then focus on brain plasticity underlying
compassion training. Finally, we will examine in more detail the difference between empathy, empathic
distress, and compassion and present recent results on their respective plasticity.

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Neural Substrates of Care, Social Connection, and Reward and Their Link to Health
In order to place the implications of compassion research in context, it is useful to briefly review the neural
underpinnings of caregiving and feelings of connection and reward. With regard to caregiving behavior, a
recent review (Preston, 2013) summarized that, in rodents, offspring care relies on the activation of brain
regions that include the amygdala, the ventral tegmental area, the nucleus accumbens, and the ventral
pallidum. In humans, there is a homologous system, which also comprises the orbitofrontal cortex (OFC) and
the subgenual anterior cingulate cortex. Preston (2013) also points out that the neural activations related to
caregiving and altruism overlap to a large degree, which could indicate similar underlying neural mechanisms.
These neural networks have also been related to feelings of social connection; that is, the perception of being
cared for, valued, and loved by others (see Eisenberger & Cole, 2012, for review). It has, for instance, been
shown that activations in OFC are increased when one sees pictures of a supportive romantic partner during
physical pain experiences (Eisenberger et al., 2011) and when one is provided with supportive messages during
social exclusion (Onoda et al., 2009).
Finally, the care and social connection system also overlaps with the neural networks implicated in reward;
for instance, when receiving desired food, viewing attractive faces, or getting monetary rewards (e.g.,
O’Doherty, 2004; Schultz, 2000, for review). But note that although reward and affiliaton activate similar
brain areas, these two systems probably implicate different underlying neurotransmitter systems, as affiliation
and care have mostly been associated with neuropeptides such as oxytocin or opiads (Insel, Young, & Wang,
1997; McCall & Singer, 2012), whereas dopamine plays a crucial role in reward processing (Shultz, 2000, for
review). Importantly, social support also seems to have beneficial implications for physical health. It has thus
been proposed that the increase in brain areas related to care and reward is linked to a decrease in brain
activations implicated in threat and stress, such as dorsal anterior cingulate cortex, anterior insula, and the
periaqueductal gray, and that the active engagement in caregiving behaviors for loved ones reduces
cardiovascular arousal and mortality rates (for review, see Eisenberger & Cole, 2012). As a recent review
suggests, there is increasing evidence suggesting that the beneficial effects on health rely on hormones related
to pregnancy and offspring care, such as progesterone and oxytocin (Brown & Brown, 2015).
Taken together, there seems to be a common neural network for caring, feelings of social connection, and
altruism. Activation in this brain network also seems to have beneficial effects on health by down-regulating
threat- and stress-related reactions. Investigating this neural network in more detail could give exciting
insights into how care, affiliation, altruism, and health are linked.

Neural Substrates of Compassion

Although there are many more neuroimaging studies focusing on empathy than on compassion,
compassion-related emotions have been increasingly studied in recent years. This research area started with
cross-sectional studies on love and compassion and has been complemented by longitudinal studies on the
effects of compassion training. As compassion and love are related positive social emotions, two cross-
sectional fMRI studies on romantic and maternal love (Bartels & Zeki, 2000; and Bartels & Zeki, 2004,
respectively) offered early insights on the neural representation related to these social emotions. The
researchers measured brain activations associated with seeing pictures of romantic partners or pictures of one’s
own babies and found that both types of love activate the middle insula, the dorsal part of the anterior

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cingulate cortex, and the striatum (comprising the putamen, globus pallidus, and caudate nucleus). Activation
in the insula is typically related to social emotions and interoception (Craig, 2003; Lamm & Singer, 2010;
Singer et al., 2009), and, as already described, activations in the striatum have been linked to either
care/affiliation or reward processes.
A direct test of the neural substrates of compassion was provided in two studies that investigated the effect
of adopting a compassionate stance towards others. In one study, “unconditional love” towards pictures of
individuals with intellectual disabilities was associated with increased activations of the middle insula, the
dorsal anterior cingulate cortex, the globus pallidus, and the caudate nucleus (Beauregard, Courtemanche,
Paquette, & St-Pierre, 2009). Similarly, instructing participants to adopt a compassionate attitude towards
pictures of sad faces increased activations in the ventral striatum and the ventral tegmental area/substantia
nigra (Kim et al., 2009). The involvement of the striatum in feelings of love and social support is also
underlined by two additional studies: one study in which participants looked at a beloved person (Aron,
Fisher, Mashek, Strong, Li, & Brown, 2005), and another study in which participants saw smiling faces
(Vrticka, Andersson, Grandjean, Sander, & Vuilleumier, 2008). As these regions have been linked to
affiliation and caring and have a high density of receptors for attachment-related neuropeptides such as
oxytocin (Depue & Morrone-Strupinsky, 2005), these results suggest that feelings of compassion may involve
experiences of care and closeness that are similar to those invoked during feelings of love.

Neural Substrates of Compassion Training

Although the described cross-sectional neuroimaging studies offer exciting insights into the neural
activations associated with positive social emotions such as love, loving-kindness, and compassion, one
question remained: Can compassion training change neural activations—that is, can it induce functional
plasticity in the brain? This question is interesting for several reasons. From the perspective of basic
neuroscience, it is interesting to test whether there is evidence for functional and structural brain plasticity in
the domain of social emotions. From an applied perspective, it would be important to see how the training of
neural networks related to compassion is linked to well-being and prosocial behavior. With regard to the
malleability of the human brain, neuroscientists have been concerned with this question for more than a
century. In fact, as described by Pascual Leone and colleagues (2005), the famous neuroscientist and Nobel
Prize laureate Ramon y Cajal (1904) postulated that the acquisition of new skills should be paralleled by
changes in the brain. Over many decades, scientists studied changes in neural functions that were related to
experiences in primates and patients (Pascual-Leone, Amedi, Fregni, & Merabet, 2005). Neuroimaging
studies in healthy adults revealed that learning how to juggle induced structural changes in motor-related
areas, whereas studying for an exam induced structural changes in memory-related areas (Draganski, Gaser,
Busch, Schuierer, Bogdahn, & May, 2004; Draganski, Gaser, Kempermann, Kuhn, Winkler, Büchel, & May,
2006). These findings suggest that the acquisition of new skills is associated to structural brain plasticity in the
domains of sensory-motor as well as memory functions. An open question was whether training emotions,
such as compassion, can induce changes in the brain and whether functional (as opposed to structural) brain
plasticity can be observed in adults.
There are several ways to approach such a question. One way is to study the neural signatures of expert
meditators with thousands of hours of expertise in compassion-related meditation practices and compare them

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to the neural signatures of matched controls without any meditation expertise. Another way to approach the
question of neural plasticity is to conduct longitudinal training studies with people who are new to compassion
training and to examine how such socio-affective mental training affects brain functions. The first approach,
of studying expert meditators cross-sectionally, was adopted by Lutz and colleagues (Lutz et al., 2008), for
example. In their study, the researchers compared the neural responses of expert meditators listening to
human vocalizations of distress while in a compassionate state to those of novice meditators. The results of
this study revealed that, compared to novice meditators, expert meditators showed greater neural activity in
the middle insula.
To complement these findings, we conducted a series of longitudinal compassion training studies with
participants new to meditation. To confront participants with the suffering of others during an fMRI session,
we developed and validated the Socio-affective Video Task (SoVT, Figure 9.1; for details, see Klimecki et al.,
2013). The SoVT is based on excerpts from documentary film material depicting others’ suffering (for
instance, a women crying after an earthquake) as well as control videos depicting everyday life activities (such
as people walking or talking). The film material was taken either from archives of raw material from Swiss
television or from documentary films. To allow for repeated measurements with this stimulus material, the
SoVT consists of three parallel sets of videos that are matched on a variety of criteria, such as empathy,
valence and arousal. Each of these three video sets contains 12 videos that depict others’ suffering and 12
videos that depict everyday-life situations. The SoVT enabled us to test participants up to three times without
repeating the presentation of any one video. Using this task, we conducted a longitudinal study in which
participants were either assigned to a compassion training group or to an active control group involving
memory training (Bower, 1970). Both trainings lasted several days and were equivalent in structural aspects.
More specifically, the content of each training was introduced to participants in an evening session after the
first measurement. Then participants of both groups took part in a whole training day, which was followed by
several one-hour evening sessions. In addition, participants were encouraged to practice the training method
at home and to record the duration of their daily practice. The compassion training essentially followed the
classical loving-kindness training in which participants cultivate feelings of benevolence and kindness towards
a benefactor, themselves, a friend, a neutral person, a difficult person, and all beings. Participants visualize
these persons one after the other and cultivate wishes such as “May you be happy” and “May you be healthy”
towards the target person. As the compassion training mainly relied on silent visualizations exercised while
sitting or walking, we chose the method of loci training (Bower, 1970) for the memory training due to its
structural resemblance to the compassion training. The method of loci was used by the Greeks and Romans
and consists of memorizing items by linking them to a sequence of locations. As this training was carried out
in Zurich, Switzerland, participants first learned an imagined a route through Zurich with several locations,
such as the airport and the opera. Subsequently, participants mentally linked the items to be remembered with
each of these locations. If one was, for instance, to remember the words milk and carrot, one could imagine the
airport building being flooded by milk, and a carrot singing on the stage of the opera.
To test for changes related to compassion training, we measured participants’ brain activation as well as
their feelings in response to the videos before and after the training. To capture both positive and negatively
valenced affect as well as empathy, we asked participants to rate the degree to which they experienced
empathy, positive affect, and negative affect while watching each of the videos (see Figure 9.1). Based on

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these three questions, we could assess the change in self-reported feelings related to compassion as opposed to
memory training. Indeed, participants who underwent compassion training indicated an increase in positive
feelings after the training for both videos depicting suffering others and videos depicting people in everyday-
life situations, while no such change was present in the memory control group. Interestingly, in contrast to
typical emotion-regulation strategies that aim at the reduction of negative affect, compassion training did not
change the degree to which participants experienced negative affect. In other words, participants did not
down-regulate their negative feelings as a result of the compassion training, but rather augmented their
positive feelings. This finding extends previous research on the beneficial effect of loving-kindness training on
everyday well-being (Fredrickson, Cohn, Coffey, Pek, & Finkel, 2008). Fredrickson and colleagues reported
that after several weeks of loving-kindness training, participants reported increased well-being in daily life
(Fredrickson et al., 2008). Our results extend this finding by showing that compassion training not only
increases positive affect in response to everyday-life situations, but that it can also increase positive affect in
response to witnessing the suffering of others. The maintenance of negative affect in response to suffering
speaks to the notion that a compassionate person does not turn away from suffering, but actually relates to it
in an engaged way.

Figure 9.1 Timeline of the Socio-affective Video Task (SoVT). Participants watched videos depicting others suffering or depicting people in
everyday life activities. After each video, participants rated the degree to which they experienced empathy, positive affect, and negative affect.
(See Color Insert)
O.M. Klimecki, S. Leiberg, C. Lamm, & T. Singer, Functional Neural Plasticity and Associated Changes in Positive Affect After Compassion
Training, Cerebral Cortex, 2013, 23(7), 1552–1561, by permission of Oxford University Press.

On the neural level, compassion training, but not memory training, was associated with increased activation
in the medial OFC, the putamen and the pallidum, and the ventral tegmental area/substantia nigra (Figure
9.2a). This study was the first demonstration of changes in neural function related to the training of emotions.
These changes occurred after a relatively short training of roughly one week and were specific to brain regions
consistently implicated in affiliation and caregiving (Preston, 2013), feelings of social connection (Eisenberger
& Cole, 2012) as well as feelings of compassion and love (e.g., Bartels & Zeki, 2004; Beauregard et al., 2009;
Kim et al., 2009). This pattern of activation was also observed in two of our previous studies without a control
group and in an expert mediator immersing himself into compassionate states (Klimecki et al., 2013).
This pattern of results—a combination of sustained sharing of negative feelings with a concurrent increase

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of positive feelings associated with functional plasticity in networks related to affiliation and care—suggests
that compassion differs from traditional emotion-regulation strategies, such as distraction, suppression, or
cognitive reappraisal, as these other strategies mainly aim to reduce negative emotions. The difference
between compassion and emotion-regulation strategies was tested by Engen and Singer (2015a), in a cross-
sectional brain imaging study with long-term Buddhist meditation practitioners in which participants were
again presented with the SoVT (Klimecki et al., 2013) while being asked either to engage in classical cognitive
reappraisal strategies to regulate their emotions, or to engage in compassion meditation (Engen & Singer,
2015a). Comparing both conditions revealed that, whereas cognitive reappraisal engaged the classical fronto-
parietal control network in the brain and was most efficient in reducing negative affect, compassion activated a
similar brain network as the one in the already cited compassion training study including mOFC, striatum,
and subgenual anterior cingulate cortex (ACC, Figure 9.3). In addition, compassion increased positive affect
the most. These results confirmed that compassion can be seen as an alternative emotion-regulation strategy.
In contrast to emotion-regulation, which often involves an active down-regulation of negative affect,
compassion focuses on the active generation of positive affect and the underlying brain network related to care
and affiliation (Engen & Singer, 2015a, 2015b).

Figure 9.2 Differential effects of empathy and compassion training on functional neural plasticity. (A) Compassion training augmented
activations in the ventral tegmental area/substantia nigra (VTA, SN), the medial orbitofrontal cortex (mOFC), and the globus pallidus (GP)
and putamen (Put). (B) Empathy training (in blue) lead to increased activations in anterior insula (AI) and anterior middle cingulate cortex
(aMCC), while compassion training (in red) augmented activations in medial orbitofrontal cortex (mOFC), subgenual anterior cingulate cortex
(sgACC) and the ventral striatum/nucleus accumbens (VS, NAcc). (See Color Insert)
Reprinted from Current Biology, 24(14), Singer, T. & Klimecki, O.M., Empathy and compassion, R875–R878., Copyright (2015), with

161
permission from Elsevier.

In line with the assumption that activity in the neural network related to care and social connection can
promote health and counteract feelings of threat (Eisenberger & Cole, 2012), our data suggest that
compassion training can be seen as a novel tool to strengthen resilience and promote physical health through
the activation of a positively valenced care system.

The Different Effects of Compassion vs. Empathy-for-Suffering Training

The review of neuroscience research on empathy and compassion described here suggests that, although
both emotions are affective responses to the suffering of another being, each of these social emotions may
have rather different subjective and neuronal fingerprints. To explicitly test this hypothesis, we conducted
another longitudinal neuroimaging study, in which we aimed at differentiating between the neural and
subjective signatures elicited through empathy-for-suffering training on one hand, and compassion training
on the other, in the same individuals. Based on previous evidence showing that empathic responses to the
suffering of others were related to brain activations in dorsal parts of the anterior insula and medial anterior
cingulate cortex and associated with reported negative affect (Lamm et al., 2011), we hypothesized that
empathy-for-suffering training would increase activations in this network associated with an increase in
negative affect (Klimecki, Leiberg, Ricard, & Singer, 2014). Conversely, we expected compassion training to
augment neural activations previously observed to be related to compassion and loving-kindness and to result
in an increase in positive affect.

Figure 9.3 Reappraisal, Compassion and Empathy involve different brain activations. (A) Brain regions implicated in reappraisal (blue),
compassion (red) and empathy (orange). Empathy training (in blue) lead to increased activations in anterior insula (AI) and anterior middle
cingulate cortex (aMCC), while compassion training (in red) augmented activations in medial orbitofrontal cortex (mOFC), subgenual anterior
cingulate cortex (sgACC), globus pallidus (GP), putamen and the ventral striatum/nucleus accumbens (VS, NAcc). Reappraisal was related to
activations in dorsal anterior cingulate cortex (dACC), inferior frontal gyrus (IFG), MFG, temporal parietal junction (TPJ) (B) The effects of
compassion (yellow-orange) when used to regulate emotional reactions to negative stimuli, as compared to reappraisal (blue). Behavioral results
show that while cognitive emotion regulation relies primarily on the down-regulation of negative affect, compassion appears to both decrease

162
negative affect and increase positive affect suggesting that emotion regulation via compassion utilises different mechanisms than cognitive
emotion regulation. Here, asterisks denote significance levels of t-tests with ** corresponding to p < .01, and *** corresponding to p < .001.
Neurally, this difference is reflected in more engagement of midline and subcortical structures in compassion. Compassion, more than
reappraisal, activates subcortical structures, including ventral striatum (VS with caudate and nucleaus accumbens, NAC) and amygdala.
Critically, amygdala activation was higher in compassion than reappraisal, suggesting that active down-regulation of amygdala is not a key part
of compassion. (See Color Insert)

This study (Klimecki et al., 2014) consisted of two intervention groups: the emotion intervention group
(empathy-for-suffering and compassion training) and an active memory control group which underwent the
same type of mnemonic training as in our first compassion training study (Klimecki et al., 2013). Participants
in the affective intervention group were first trained to empathically immerse themselves in the suffering of
others and to feel the others’ suffering as if it was their own. To test whether compassion training can
counteract extensive sharing of suffering, participants were subsequently trained in compassion. Each of these
trainings lasted a full day and was followed by a series of one-hour evening sessions and practice at home.
After roughly one week dedicated to empathy-for-suffering training and the measurement of related effects,
participants were trained in compassion for another week. The control group did two weeks of memory
training. In the empathy-for-suffering training, participants imagined a series of other people and tried to feel
their suffering as if it were their own. To this end, they used sentences like “I share your pain” or “I feel your
suffering.” In order to address this aspect in the subsequent compassion training, we explicitly included the
cultivation of benevolence and kindness towards suffering others in the training sequence. The active control
group underwent memory training with a structure that was equivalent to the emotion training. However, in
the memory group, the focus was on training cognitive capacities. Both groups were tested with the SoVT and
concurrent fMRI scans prior to the first training (pre-test), after the first training (empathy for suffering or
memory), and after the second training (compassion or memory).
The results of this study revealed that empathy-for-suffering training indeed increased subjective reports of
negative affect and experienced empathy for people in the videos. These changes were observed for situations
in which participants witnessed others suffering, and for situations in which participants witnessed everyday-
life events. In other words, the excessive sharing of suffering also biased participants into perceiving normal
situations more negatively. Subsequent compassion training could counteract this effect. Compassion training
thus returned the level of negative emotional experiences to baseline and increased positive affect—again, for
everyday situations as well as for situations involving suffering. This result replicates our previous finding on
the effects of compassion training and extends this finding by showing that these effects can also be obtained
after an increase in empathy and negative affect. On the neural level, we observed for the first time functional
neural plasticity in the heretofore-mentioned “empathy for pain network”; that is, the AI and the ACC—
regions that have emerged as crucial for processing the affective component of pain (Corradi-Dell’Acqua et
al., 2011; Corradi-Dell’Acqua et al., 2016; Kanske et al., 2015; Lamm et al., 2011). Furthermore, compassion
training augmented neural activations in brain areas that we had previously observed in our other compassion
studies (Klimecki et al., 2013), namely the medial OFC and the striatum (Figure 9.2b). Together with the
behavioral findings, these results indicate that compassion is a powerful tool for strengthening positive other-
related emotions and underlying neural activations, and that in addition, compassion training can counteract
the potential detrimental effects of empathizing too much with the suffering of others, something that, if
chronically experienced in daily life, can easily lead to exhaustion and burnout (for review, see Klimecki &

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Singer, 2012; Singer & Klimecki, 2014). These findings raise exciting possibilities for developing
interventions that could help people improve their health and resilience through compassion training. In
addition, it could be important to train people to differentiate between these two social emotions and to
transform empathic reactions into compassionate responses when confronted with other people’s stress and
suffering. Based on these studies, Singer and colleagues have developed a nine-month-long compassion
training program, the ReSource Project, in which participants are taught several types of mental training
techniques in three consecutive three-month modules called Presence, Perspective, and Affect. Whereas the
training modules Presence and Perspective focus on attentional-, interoceptive-, and meta-cognitive skills, the
Affect module has a strong focus on teaching people how to distinguish empathy from compassion and how
to strength care- and affiliation-related systems through regular practice of gratitude, loving-kindness, and
compassion (for details about the ReSource project, see Singer, Kok, Bornemann, Bolz, & Bochow, 2014).

How Do Empathy and Compassion Relate to Prosocial Behavior?

Having reviewed the neuroscientific and subjective fingerprints of social emotions such as empathy,
empathic distress, and compassion and their trainability, we now turn to the question of how these social
emotions and their training link to prosocial behavior. Note that, although this question has only been
investigated in few training studies so far, the link between empathic distress and empathic concern (or
compassion) with helping behavior in adults and children was already the focus of earlier empathy research in
psychology (Eisenberg & Miller, 1987) and is also discussed in the chapter by Daniel Batson (Chapter 3 this
volume).
To test whether helping behavior can be improved by compassion training, we conducted a longitudinal
study in which we measured how several days of compassion training influence helping behavior (Leiberg,
Klimecki, & Singer, 2011). Due to the scarcity of ecologically valid and well-controlled laboratory measures of
helping behavior, we first developed the Zurich Prosocial Game (ZPG; see Figure 9.4). The ZPG is a
computerized treasure hunt game in which two players simultaneously navigate through their respective path
in a maze to reach their own treasure (which is worth real money). Gates that regularly fall on the paths along
the way can block players. These gates can only be opened with the key of a corresponding color. As keys are
scarce, there are often situations in which one player cannot advance without the help of the other player.
These situations enable us to measure helping behavior. After validating the ZPG, we employed this task in a
longitudinal study with two groups: one group of participants was trained in compassion over several days,
while the other group served as an active control group and was trained in a cognitive method for memorizing
items (Bower, 1970). Both groups played the game at baseline (prior to training) and following the training.
The data revealed that, while there was no change in helping behavior in the active memory control group, the
compassion training group increased their overall helping behavior. Interestingly, the more participants
reported having practiced compassion, the more they engaged in altruistic helping behavior—operationalized
as opening a door for another player in a situation in which this other player could not reciprocate the help.

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Figure 9.4 Screenshot of the Zurich Prosocial Game showing the two players hunting for their respective treasures. (See Color Insert)

In line with this finding, another study showed that after two weeks of compassion training, participants
used more of their monetary resources to restore the monetary equilibrium between two other players after a
norm violation in an economic game (Weng et al., 2013; see Weng, Schuyler and Davidson, Chapter 11 this
volume). The positive impact of compassion training on helping behavior is further corroborated by the
finding that compassion training was related to increased rates of helping behavior in a real-life situation
where participants had the opportunity to offer their own seat to a person in crutches (Condon, Desbordes,
Miller, & DeSteno, 2013). This effect, however, was not specific for compassion training, as it was also
observed for participants undergoing mindfulness training (Condon et al., 2013; see Condon and DeSteno,
Chapter 22 this volume). As these data show, compassion training is a powerful tool for improving helping
behavior.
Finally, a recent study from our laboratory focusing on long-term experts in compassion meditation
(McCall, Steinbeis, Ricard, & Singer, 2014) extended previous findings by showing that compassion expertise
not only has an impact on levels of helping behavior, it also affects reactions to fairness violations and norm
reinforcement. Thus, in contrast to controls, long-term compassion practitioners engaging in different types
of monetary social exchange games derived from behavioral economics showed less anger when treated
unfairly by others, and consequently showed less anger-based punishment. However, they showed a similar
amount of norm reinforcement when witnessing the unfair treatment of others, but differed from matched
controls in that they chose more often to reinstate equality by compensating victims as opposed to punishing
the perpetrators (McCall et al., 2014). These results suggest that cultivating compassion could have more
widespread effects on all kinds of social behaviors, including behavior crucial for norm reinforcement and
justice in societies.
Finally, to test whether empathic distress and compassion can have opposing influences on social behavior

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following provocation, a recent study (Klimecki, Vuilleumier, & Sander, 2016) investigated how empathy-
related traits predict behavioral reactions to provocation through unfair behavior. Due to the inherent
difficulty of studying antisocial behavior in an ecologically valid yet highly controlled laboratory setting, we
first developed and validated a new paradigm based on computerized economic and verbal interactions—the
Inequality Game (Klimecki et al., 2016). In this game, participants are first presented with the behavior of a
fair and an unfair other, and can only engage in cooperative or competitive behavior towards the other two
players in the second part of the game. More specifically, participants played two phases of an economic
interaction game with the possibility of sending messages to the other players. In the first phase of the game,
participants were in a low-power position in which the fair other player chose cooperative economic
distributions (high gains for himself and the participant) and nice messages (e.g., “You are very nice”),
whereas the unfair other player chose competitive economic distributions (high gains for himself and low
gains for the participant) and derogatory messages (e.g., “You are annoying”). Following this low-power
phase, participants were in a high-power phase in which they could also make cooperative or competitive
choices as well as select nice or derogatory feedback messages for the other players. Although participants on
average punished the unfair other and rewarded the fair other, we observed considerable inter-individual
differences in participants’ behaviors. In fact, participants could be classified as prosocial (showing
predominantly prosocial behavior to both others), sanctioning (punishing the unfair other and rewarding the
fair other), and competitive (showing aggressive behavior towards both, the unfair and even the fair other).
When we investigated how different empathy-related personality traits related to this behavior, we found that
the higher participants scored on compassion and perspective-taking, the more they showed forgiveness
behavior; i.e., cooperative and nice behavior toward the unfair other. Conversely, we observed that the more
people reported feeling empathic distress in their lives, the more aggressively they behaved towards both, the
unfair and even the fair other.
In summary, this study extends previous findings from behavioral psychology (see chapter by Batson,
Chapter 3 this volume) by showing that compassion and empathic distress are related to helping behavior and
aggressive behavior in opposing ways. Whereas compassion fosters helping behavior and forgiveness behavior,
empathic distress is related to less helping behavior and more aggressive behavior.

Conclusion: Integration and Outlook

In this chapter, we started with a summary of the neuroscientific research on empathy. We then described
the common neural substrates of care, social connection, and reward before turning to cross-sectional studies
of love and compassion. These studies revealed that compassion is associated with an increase in positive
feelings and with neural activations in a network associated with care and social connection, including the
medial OFC and the ventral striatum. Importantly, the degree of compassionate experiences is not set in
stone, but can be trained even in adults. Training compassion leads to an increase in positive affect associated
with functional plasticity in brain networks related to care and compassion. Furthermore, we discussed
evidence that compassion training can counteract potential negative effects of excessive empathy for suffering,
characterized by an increase in negative affect and underlying activation in “empathy for pain” networks. This
finding underlines the potentially beneficial role of compassion in strengthening resilience and acting as an
efficient emotion-regulation strategy that works through the up-regulation of a system of care and affiliation

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rather than through the down-regulation of negative affect described in classical emotion-regulation
strategies, such as cognitive reappraisal. Taken together, the findings that compassion training and expertise
are associated with increased levels of helping, less aggression, and behaviors of restorative justice rather than
anger or revenge-based punishment suggest exciting avenues for the development of interventions that allow
for the targeted fostering of resilience, well-being, and prosocial behavior.

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 Two Factors That Fuel Compassion The Oxytocin System and the Social
Experience of Moral Elevation

Sarina Rodrigues Saturn

Abstract

This chapter explores how inborn biology and life experiences both play a role in profiles of compassion.
The first portion focuses on oxytocin, a neuroendocrine system that is an essential part of the biological
drive to feel and express compassion for others. Both innate genetic differences and environmentally-
caused epigenetic variations of the oxytocin receptor influence how brains, bodies, and social behaviors
are driven by this hormone that facilitates caretaking. The second portion concentrates on moral
elevation, a distinct emotional state triggered by witnessing compassion. The experience of moral
elevation involves a unique pattern of neurophysiological events in the central and peripheral nervous
systems. Together, this section provides illustrations of the mind-body connections underlying of the
observations, sensations, and behaviors of compassion.

Key Words: awe, altruism, nature, nurture, autonomic, physiology, neuroscience, parasympathetic, vagal,
prefrontal

This chapter will cover two seemingly unrelated areas in my research program, but their interconnectedness
will reveal itself and illustrate how innate biology and life experiences play a role in igniting compassion
(Goetz, Keltner, & Simon-Thomas, 2010). The first topic focuses on individual differences in the oxytocin
system, the main cellular gateway for the signaling of prosocial behaviors throughout the body and the brain.
The second topic will be moral elevation, an emotional state that often arises after witnessing or hearing about
great acts of compassion.
Great fortune in advisers led me to the field of compassion research through a unique path. I completed my
doctoral dissertation in the laboratory of Joseph LeDoux where my research focus was on the synaptic events
that occur during formation of fearful memories in the amygdala, the core for emotional processing in the
brain (Rodrigues, Schafe, & LeDoux, 2004). I then was a postdoctoral researcher in the laboratory of Robert
Sapolsky, where I investigated how the release of stress hormones affects emotional circuitry in the central
nervous system (Rodrigues, LeDoux, & Sapolsky, 2009). In many circumstances, stress hormones
(glucocorticoids, epinephrine, and norepinephrine) initiate the ideal neurophysiological and behavioral events
that enable us to react to threatening situations via self-preservation instincts. They get our hearts racing, our
blood pumping, and our muscles ready to flee, fight, or freeze. However, when the stressors are severe,
chronic, uncontrollable, or unpredictable, this creates vulnerability to a massive array of mental and physical
health maladies. Undeniably, heavy doses of stress can wreak havoc on our neural, immune, cardiovascular,
and digestive systems (Sapolsky, 2004).
When performing this research on fear and the stress response, I noticed how social environments and

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genetic predispositions significantly contributed to individual differences in emotions, and mused about what
would be a natural way to blunt all the horrendous things chronic and intense negative emotions do to our
bodies and brains. This led me to the field of prosocial emotions—emotions geared toward contributing to the
welfare of other people. I then joined Dacher Keltner’s research group and gained insight and tools to bridge
prosocial psychology and neurobiology (Keltner, Kogan, Piff, & Saturn, 2014). Today I am continuing to
pursue science on the biology of prosocial emotions in my own laboratory, although much of my time and
energy now are devoted to parenting, teaching, and outreach. I am tremendously grateful for the outstanding
mentorship I have received along my winding road to this exciting and meaningful field.

Oxytocin Receptor and Implications for Compassion

Genetic Variations of the Oxytocin Receptor
Oxytocin doubles as a hormone and neurotransmitter with widespread targets throughout the body and
brain (Carter, Bartal, and Porges, Chapter 14). This nonapeptide is involved in a variety of behaviors as part
of the mammalian caregiving system. These include labor during childbirth, breastfeeding, sexual activity,
low-intensity stimulation of the skin in response to touch and stroking, food intake, parenting, and various
trust-based social interactions (Carter, 2014; Carter, 2014; Uvnäs-Moberg, Handlin, & Petersson, 2014).
Endogenous oxytocin has been shown to directly relate to a wide array of compassionate behaviors. As part
of the inbuilt nurturing system, it drives both parents’ bonding with their infants and is released during
feeding, skin-to-skin contact, eye gaze, and affectionate touch. Oxytocin is crucial for maternal behaviors and
physiology (Carter, 2014) and seems essential for both paternal and alloparental care as well (Bales, Kim,
Lewis-Reese, & Carter, 2004; Kenkel et al., 2013). While maternal care is usually essential for survival,
paternal and alloparental care enrich infant fortitude and social well-being (Apter-Levi, Zagoory-Sharon, &
Feldman, 2014; Feldman, 2012).
Oxytocin is also pivotal to the formation of long-term bonds between romantic partners (Carter, 1992,
2014; Feldman, 2012; Numan & Young). It is involved in compassionate behaviors towards one’s partner
(Snowdon et al., 2010) and fosters a variety of prosocial partner activities, such as positive exchanges,
emotional support, trust, nonverbal displays of affection, and warm touch (Gonzaga, Turner, Keltner,
Campos, & Altemus, 2006; Grewen, Girdler, Amico, & Light, 2005).
Importantly, oxytocin boosts compassionate displays between strangers as well. This includes empathy and
subsequent generosity towards strangers. Exogenous oxytocin, typically administered intranasally, can also
boost prosocial behaviors, including eye gaze, trust, in-group love, and empathic accuracy. Oxytocin also
buffers cortisol and cardiovascular responses to psychosocial stressors or otherwise difficult circumstances. In
addition, it can dampen amygdala responsivity to emotional stimuli (Domes et al., 2007), including masked
threat cues from the eyes (Kanat et al., 2015). Such a decrease in threat reactivity could enhance
compassionate behaviors in stressful social situations (for review, see Keltner et al., 2014).
However, it is important to note that sometimes exogenous oxytocin can promote unsavory social
behaviors, including gloating, envy, out-group hostility, and ethnocentrism (for review, see Keltner et al.,
2014). Furthermore, oxytocin administration can produce different results that depend on one’s attachment
style and personal history. For example, less anxiously attached individuals are more likely to remember their
mothers as caring, whereas more anxiously attached individuals are more likely to remember their mothers as

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uncaring, after a dose of oxytocin (versus placebo) (Bartz et al., 2010). Rather than serving as a ubiquitous
salve, this peptide’s influence on social processing depends on one’s context, history, and defaults.
Unlike other neuromodulators like serotonin and dopamine, which have a variety of receptor subtypes to
carry out their signaling, oxytocin just has one. It is distributed in the brain, especially in regions for social
behaviors and emotions, such as the hypothalamus and amygdala. It is also located in the medullary structures
that regulate the “vagal brake,” applying or lifting vagal input onto the heart. In addition, it is located on many
organs, including the uterus, testis, and heart. Oxytocin is released via volume transmission, as opposed to
synapse-specific communication. The receptor is a typical G-protein-coupled receptor, and when oxytocin
binds to it, it stimulates further neurotransmitter release, muscle contractions, and the activation of social
circuitry, depending on the targeted tissue (Carter, 2014; Carter, Bales, & Porges, 2005; Gimpl &
Fahrenholz, 2001).
Genetic variants of the oxytocin receptor can come about through single-nucleotide polymorphisms
(SNPs). Genetic polymorphisms are ubiquitous throughout the world, and bring about naturally occurring
diversity, from the social hierarchy of insects to the color of flower petals. In human behavior, polymorphisms
of neurochemical systems play an integral role in the diversity our social and emotional profiles. For example,
polymorphisms of the serotonin system relate to default mood tendencies, such as sensitivity to the
environment, as well as amygdala reactivity to emotionally salient stimuli. Additionally, polymorphisms of the
dopamine system relate to reward reactivity related to everything from romantic styles, to altruism, to
addictive behaviors (for review, see Keltner et al., 2014).
Due to oxytocin’s crucial role in compassionate behaviors and stress reactivity, our research group explored
how a particular SNP (rs53576) of the oxytocin receptor related to these psychological profiles. This SNP had
previously been related to maternal sensitivity (Bakermans-Kranenburg & van Ijzendoorn, 2008) and the
propensity to have autism (Jacob et al., 2007). Since exogenous and endogenous studies of oxytocin have
shown that is it related to social behaviors, we used the Interpersonal Reactivity Index (Davis, 1983), which
probes self-reported compassionate tendencies. Facets of this index include perspective-taking, such as being
able to see things from another person’s point of view; and empathic concern, such as having concern and
tenderness for the less fortunate. We discovered that this genetic variation is indeed related to how much
compassionate tendencies are self-reported by participants. We then used the Reading the Mind in the Eyes
Task (RMET; Baron-Cohen, Wheelwright, Hill, Raste, & Plumb, 2001), which involves reporting what
individual is feeling by simply looking at only the eye region of their faces. We were drawn to this task
because performance on it is improved by oxytocin administration (Domes, Heinrichs, Michel, Berger, &
Herpertz, 2007). Furthermore, individuals with autism display deficits in reading these emotions. As we
predicted, this same genetic variant of the oxytocin receptor predicted how well people performed on this task
of empathic accuracy (Rodrigues, Saslow, Garcia, John, & Keltner, 2009).
Given oxytocin’s stress-dampening effects, we then decided to look at how this polymorphism is related to
stress reactivity. First, we asked participants to report how calm or distressed they become in crises and
emergencies. We found that the same genetic group that reported more empathy and scored higher on the
RMET reported lower stress reactivity. To measure physiological stress reactivity, we administered a classic
startle paradigm where participants would view a countdown to a noxious white-noise burst presented
through headphones. Again, the same individuals who reported lower stress reactivity and higher empathy

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displayed less physiological stress reactivity during this countdown startle task (Rodrigues et al., 2009b). We
also found that this same genetic variation is related to how prosocial people are judged to be by strangers,
simply through viewing a brief silent video clip of their nonverbal behaviors when listening to their romantic
partners discuss a time of suffering in their lives (Kogan et al., 2011).
Other groups have found that this same oxytocin receptor variation is related to the volume, connectivity,
and reactivity of brain structures important for social and emotional processing. This includes a decrease in
hypothalamic volume and functional connectivity, as well as amygdala activation and coupling during
emotional tasks (Tost et al., 2010; Wang et al., 2013). Neuroimaging studies have also reported that oxytocin
genetics play a role in neural activation during empathic accuracy task (Laursen et al., 2014), positive
parenting (Michalska et al., 2014), and neural responses to viewing photograph’s of one’s child (Michalska et
al., 2014).
As is the case with many psychology studies, there are often problems with other research groups
attempting to reproduce the findings. Problems in replicability in candidate-gene studies that target the
oxytocin receptor are likely to stem from operationalization of constructs, gender, culture, and early
environment confounds (Feldman, Monakhov, Pratt, & Ebstein, 2016). For example, opposite genotype
patterns of neural activation from oxytocin treatment results from comparing males and females have been
reported (Feng et al., 2015). In addition, when comparing Western and East Asian cultures, different
associations emerge in genotype-behavior profiles related to emotional processing (Kim & Sasaki, 2014). The
social and emotional behaviors of individuals are influenced by many different internal and external factors,
and it is important to take into account the complexity of both nature and nurture when understanding the
causes of individual differences. Genetics, experiences, environments, lifestyles, and choices all contribute to
who a person becomes, and it is not possible to attribute to one gene or a single event these multifaceted
outcomes. Rather, scientific inquiry can illuminate how different factors may be significantly related to such
an intricate story of compassionate behaviors in this world. Moreover, this research emphasizes that being
consumed by personal distress can be the ultimate hindrance to compelling someone to tend to the suffering
of others.

Epigenetic Variations of the Oxytocin Receptor

We inherit our genes from our parents; therefore, the sequences coding for our genes are fixed. However,
external and environmental factors can modify how genes are activated or deactivated throughout life by
“listening” to our life experiences. This is known as epigenetics. Recent evidence of the importance of this
phenomenon for compassion has come from studies of DNA methylation of the oxytocin receptor gene
(Kumsta, Hummel, Chen, & Heinrichs 2015). These studies illustrate that adverse social experiences cause
methylation of the oxytocin receptor gene, and that this results in increased stress reactivity and lower
compassionate behaviors.
The classic prosocial studies illustrating social epigenetics were performed in animal models. They showed
that nurturing rat mothers who nurtured their offspring through ample licking and grooming produced
offspring that were calmer with lower levels of stress hormones, compared to the offspring of neglectful
mothers. Importantly, cross-fostering studies have shown that the changes in offspring are due to the quality
of maternal care, as opposed to genetic or prenatal factors (Champagne et al., 2003; Francis et al., 1999).

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More extensive studies proved that this transgenerational transmission is partly due to epigenetic
modification. High levels of maternal care are associated with marked influences in oxytocin and
glucocorticoid receptor expression, lower stress hormone levels, decreased anxiety, and better cognitive
performance. This ultimately results in nurtured offspring’s becoming nurturing parents themselves
(Champagne & Curley, 2009; Feder, Nestler, & Charney, 2009; Jensen & Champagne, 2012).
In both rats and humans, oxytocin receptor gene methylation patterns predict quality of early maternal care
(Beery, McEwen, MacIsaac, Francis, & Kobor, 2016; Unternaehrer et al., 2015). These data suggest that
nurturing experiences play an essential role in how our oxytocin receptor gene is epigenetically modified. How
such regulation of the oxytocin receptor gene is related to social behaviors in humans is a new and popular
area of investigation (Kumsta et al., 2015).
Methylation of the oxytocin receptor gene results in greater neural activity in the superior temporal and
cingulate gyri in response to social stimuli (Jack, Connelly, & Morris, 2012). Oxytocin gene methylation also
relates to brain activity in regions responsible for emotion and face perception, as well as amygdala responses
to angry and fearful faces, as well as amygdala connectivity with other brain regions with these social-
perception stimuli (Puglia, Lillard, Morris, & Connelly, 2015). In addition, it is linked to attachment style,
emotion recognition, superior temporal sulcus activity during social-cognitive tasks, and fusiform gyrus
volume (Haas et al., 2016).
Importantly, DNA methylation patterns of have been shown to be varied in a population, and they typically
result in altered transcription of the gene in both the body and brain (Aberg et al., 2013; Gregory et al., 2009).
Methylation patterns of the oxytocin receptor are related to autism spectrum disorder, which is characterized,
in varying degrees, by difficulties in social interactions and effective verbal and nonverbal communication
(Gregory et al., 2009). Greater oxytocin-receptor gene methylation has been also related to callous-
unemotional traits in older males and lower oxytocin levels (Dadds et al., 2014). Additionally, dynamic
methylation of the oxytocin receptor has been shown to occur after acute psychosocial stress (Unternaehrer et
al., 2012). Furthermore, it is related to social phobia and social interaction anxiety, increased cortisol response
to psychosocial stress, and increased amygdala responsivity to negative social words (Ziegler et al., 2015).
Intriguingly, epigenetic–genetic relationships have been found such that individuals with the genotype
associated with higher stress reactivity and lower empathy displayed higher methylation at a specific site of the
oxytocin receptor gene, and the association between depression and methylation level was moderated by
oxytocin receptor genotype (Reiner et al., 2015).
Altogether, the epigenetic research on the oxytocin receptor gene implies that our bodies and brains are
exquisitely sensitive to our social environment from a very young age, and that the biological processes that
support compassion can be influenced by our environment, particularly the nurturing or negative experiences
that we encounter interpersonally. The nascent field of social epigenetics will continue to illuminate how
compassionate experiences program our biology and the implications of such experience-dependent
modifications on compassionate behaviors from generation to generation.

Moral Elevation Through Witnessing Compassionate Action

When watching or hearing about a profound act of compassion, we often experience a distinct emotional
state called moral elevation. Moral elevation results from being deeply moved by a stranger’s performing

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compassionate acts to benefit another (Haidt, 2003). Simply observing this compassionate sensitivity to
suffering coupled with selfless actions to alleviate the suffering is enough to cause profound psychological and
physiological experiences in the witness (Figure 10.1). Here I will be discussing what happens when people see
compassion—that is, experience moral elevation as a result of other people’s compassion—which, in turn,
increases the likelihood of expressing compassion, should they come across suffering themselves.
In order to fully understand moral elevation and appreciate it as a unique entity, it is helpful to compare and
contrast it to other positive social emotional states that share some of the same flavors (Algoe & Haidt, 2009;
Keltner & Haidt, 2003). For instance, moral elevation can be distinguished the well-studied concept of
gratitude. The concept of moral emotions includes the tendency of the elicited emotion to involve stimuli that
have no direct impact on the experiencer. Moral elevation can therefore be separated from gratitude, since
gratitude is brought forth by an action that has benefited the person. Although gratitude encourages the
person towards compassionate action, this is typically executed to strengthen the relationship with the
benefactor. In contrast, moral elevation is triggered by compassionate behaviors that benefit strangers or
where no indebtedness exists. Witnessing selfless compassion arouses a broader hope for humanity and
induces a more generalized desire to help other people (Haidt, 2003).

Figure 10.1 Psychological and physiological events underlying moral elevation. (Direct and *indirect evidence)

Moral elevation can be considered part of the awe family of emotional states (Keltner & Haidt, 2003). In
general, the awe family is thought to facilitate the integration of vast and unexpected experiences into a
person’s understanding of the world. For example, we can experience awe of beauty, whether it is inspired by a
lovely sunset, gorgeous person, or breathtaking waterfall. We can also feel awe in the face of threat, when we
encounter actual or depictions of a raging fire, tsunami wave, or a massively destructive bomb. Another type
includes the awe of skill or talent, which emerges while observing a great musician, athlete, or world-changing

175
leader. In addition, awe can come from experiences of the supernatural, which can arise from self-
transcendent spiritual and religious experiences. What makes moral elevation unique among all these is that it
comes specifically from the awe of compassionate virtue. Importantly, moral elevation does not require a vast
perceptual stimulus. In fact, oftentimes it can be elicited simply by witnessing a heartfelt display of
compassion between two people.
Self-report measures, after moral-elevation induction, consistently find that this emotional state makes
people feel compassion, a desire to be a better person, a yearning to help others, a feeling of optimism about
humanity, and a love for people. In addition, people who are morally elevated report feeling hope, tenderness,
inspiration, upliftedness, and admiration (Algoe & Haidt, 2009; Freeman, Aquino, & McFerran, 2009; Piper,
Saslow, & Saturn, 2015; Schnall, Roper, & Fessler, 2010). Thus, moral elevation primes people for
compassion.
Importantly, moral elevation is a strong motivator of altruistic tendencies. For example, one key study
showed that participants in the moral elevation condition were more likely to offer their time to
uncompensated tasks to help, or relieve the burden of a third party (the experimenter). Moreover, the amount
of time these participants contributed was strikingly higher in the moral elevation condition than in
comparison conditions that induced amusement or presented a neutral experience. In addition, the time spent
assisting the experimenter correlated positively with self-reports of moral elevation, including feeling moved,
helpful, uplifted, and optimistic about humanity (Schnall et al., 2010). Witnessing virtuous behavior thus
promotes a “pay it forward” mentality so that, after observing compassionate acts, witnesses feel motivated to
be compassionate to others. Interestingly, self-affirmation of previous compassionate behavior prior to the
induction of moral elevation boosts helping behavior even more (Schnall & Roper, 2012). Furthermore, moral
elevation inspires onlookers to become mentors through improving their attitudes toward and interest in
serving in this advisor role, as well as increasing their tendency to give helpful guidance (Thomson,
Nakamura, Siegel, & Csikszentmihalyi, 2014). Therefore, moral elevation can serve as an impetus to motivate
different types of compassionate action.
In another study that sought to distinguish motivations for different prosocial behaviors, moral elevation,
but not moral outrage about a social injustice, was shown to increase charitable donations. On the other hand,
moral outrage, but not moral elevation, increases compassionate political and justice action tendencies, such as
the willingness to get involved in initiatives geared towards addressing inequities, as well as prosocial behavior
in a third-party bystander game. This suggests that moral elevation elicits very distinct compassionate
behaviors that trend towards benevolence as opposed to assertive activism (Van de Vyver & Abrams, 2015),
and therefore engages the more nurturing branches of compassionate behavior.
In addition to eliciting altruism, moral elevation has been shown to attenuate prejudice; it increases
donations from individuals high in the trait of social dominance, meaning they endorse social hierarchy in
society, to charities that benefit disadvantaged groups (Freeman et al., 2009). Furthermore, it can boost
feelings of interconnectedness between the individual and humanity, and this overlap is associated with feeling
connected to people from other racial groups (Oliver et al., 2015). Moral elevation also softens adversarial
sentiments related to sexual orientation by reducing prejudice against gay men (Lai, Haidt, & Nosek, 2013).
It would be fascinating to see how moral elevation reduces bias against other marginalized groups, who are
victims of prejudice due to religion, appearance, identity, refugee status, and more.

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 In my laboratory, I was inspired to examine the biology of moral elevation. Self-reported physiological
sensations from moral elevation include warmth in the chest, tears in the eyes, lump in the throat, and chills
(goosebumps) on the skin (Piper, Saslow, & Saturn; 2015; Schnall et al., 2010; Silvers & Haidt, 2008), bodily
responses that accompany the state of being moved and touched emotionally (Benedek & Kaernbach, 2011;
Keltner, 2009). To thoroughly document the physiology underlying moral elevation, it is prudent to look at
what is happening in both the peripheral (autonomic and somatic) and central (brain and spinal cord) nervous
systems. To guide this exploration, we focused on sections of the nervous system that have been implicated in
the kinds of experiences that are tied to moral elevation, particularly the parasympathetic branch of the
autonomic nervous system and the prefrontal cortex of the brain (Piper et al., 2015).
The autonomic nervous system, consisting of the sympathetic nervous system (SNS) and parasympathetic
nervous system (PNS), prepares the body to deal with internal and environmental stimuli (McEwen, 2012;
Porges, 2003ab; Thayer, Ahs, Fredrikson, Sollers, & Wager, 2012). One key portal of the PNS is the vagus
nerve, which plays an essential role alongside oxytocin in coordinating compassionate behaviors (Porges,
Chapter 15). The ventral vagus nerve of the PNS serves to facilitate mammalian social engagement by
controlling laryngeal and cardiac responses to social stimuli (Porges, 2003). Ventral vagus activity can be
indexed by respiratory sinus arrhythmia (RSA), a pattern of high-frequency heart rate (HR) variability
(Porges, 2007). Resting RSA levels correlate positively with socially adaptive emotion-regulation strategies
and trait social connectedness (Geisler, Kubiak, Siewert, & Weber, 2013; Kok & Fredrickson, 2010; Oveis et
al., 2009). Furthermore, RSA increases during social engagement states (Porges, 2007). Activity of the ventral
vagus, sometimes referred to as vagal tone, tends to Porges’s polyvagal theory, which posits that increases in
RSA prepare individuals for smooth, affiliative social interactions. RSA amplitude indexes functional control
of the sinoatrial pacemaker node of the heart by the projections of the ventral vagus complex. RSA is a useful
measurement as a proxy for vagal tone, as long as the experimenters are mindful of potential parameters and
confounds. One can expect these potential confounds to be greatly reduced if considering short-term RSA
fluctuations to be an index of phasic vagal cardiac control, rather than using resting RSA alone (Berntson,
Cacioppo, & Grossman, 2007; Porges, 2007).
Interestingly, moral elevation not only increases RSA, but it also increases HR (Piper et al., 2015). Thus,
this emotional state recruits both the sympathetic and parasympathetic nervous systems. Both systems are “on”
to some degree at any given moment, but typically in contrasting degrees according to the circumstances
(sympathetic for fighting, fleeing, freezing, and fainting; parasympathetic for resting and digesting).
Simultaneous acceleration of both the SNS and PNS is typically only seen under unique circumstances that
involve both profound social-engagement motivation and arousal, such as infant caretaking (Kenkel et al.,
2013), sexual activity (Carter, 1992), and emotional crying (Trimble, 2012). The observed dual autonomic
activation during moral elevation may therefore relate to increased motivation for both nurturance and
protection (Kenkel et al., 2013) and could be elicited by most elevation-inducing stimuli, which feature people
suffering followed by compassionate acts to relieve that suffering.
Parasympathetic and sympathetic reactions are peripheral results of the brain’s processing of environmental
and internal events. Specific brain regions regulate subcortical structures, such as the amygdala and
hypothalamus (Rodrigues et al., 2009a), which in turn initiate autonomic responses to support integrated
physiological states with environmental stimuli. For example, the prefrontal cortex (PFC) provides strong

177
inhibitory control over the amygdala, a key trigger of sympathetic activation and reallocation to cortical
resources (Rodrigues et al., 2009a; Thayer et al., 2012). Secondly, activation in the medial PFC (mPFC), by
way of projections to the midbrain nucleus ambiguus, is linked to regulating vagal tone and HR (Wong,
Masse, Kimmerly, Menon, & Shoemaker, 2007; Ziegler, Dahnke, Yeragani, & Bar, 2009), as well as social
processing (Amodio & Frith, 2006). It has been suggested that the aforementioned measure of vagal tone,
RSA, corresponds to the mPFC’s ability to exert rapid control over the autonomic nervous system (Thayer et
al., 2012). The study of the role of mPFC involvement during moral elevation has yielded mixed results, and
this may be due to the type of stimuli, such as using moving (Englander, Haidt, & Morris, 2012; Englander et
al., 2012) or still images (Immordino-Yang, McColl, Damasio, & Damasio, 2009). Interestingly, we observed
that moral elevation–related mPFC activation depended on the context of the stimuli (Piper et al., 2015). In
our study, we presented video stimuli that were matched for moral elevation induction and depicted stories of
compassionate strangers. Compassion for physical pain has been shown to increase mPFC activity
(Immordino-Yang et al., 2009), and we found mPFC activation for the story that involved people aiding
someone who was physically injured, but not in the story of someone helping socioeconomically disadvantaged
individuals. Therefore, the nature of the suffering observed may have an influence on this structure’s activity
during elevation. There is a lot of variability in stimuli used in moral elevation studies, although all show
compassionate acts to help others, so it would be interesting to see what pattern emerges with various moral
elevation–inducing stimuli in future research, such as witnessing others showing compassion towards the
welfare of animals or the environment. Furthermore, given the role of the amygdala in emotional evaluation
and initiating bodily events, it would be interesting to closely evaluate its involvement in specific elevation-
induction stimuli as well.
We were particularly inspired by a study that used video inductions to elicit moral elevation or amusement
in breastfeeding mothers who had brought their babies into the laboratory with them (Silvers & Haidt, 2008).
Mothers in the moral elevation condition expressed more milk than those in the amusement condition, and
were more likely to hug and kiss their babies. Morally elevated mothers also reported feeling more
touched/inspired, tears/crying, and chills/goosebumps/tingling on skin. This increase in milk letdown and
nurturing behaviors following moral elevation suggests that the hormone oxytocin may play a key role in the
body’s response to moral elevation. Many nursing mothers report milk letdown during moral elevation
anecdotally. Follow-up research goals aim to prove that this is true scientifically.
Interestingly, trait moral elevation has been successfully measured by a self-report scale, as some people are
more easily “moved” than others when witnessing compassion. One investigation (Landis et al., 2009)
evaluated a trait measure of moral elevation that asks participants how they felt when witnessing uncommon
compassionate acts. The scale presented with two factors, labeled Elevation I and Elevation II, which were
correlated with each other. Elevation I (seven items) seemed to capture more feelings of connectedness with
others using items such as, “It makes me want to thank or reward the person who did the good deed,” while
Elevation II (three items) appeared to indicate physiological reactions with items such as “I get tears in my
eyes.” Elevation I correlated positively with the extraversion, openness, and agreeableness factors of the Five-
Factor Model of Personality (McCrae & John, 1992), as well as with spiritual transcendence and altruism.
Elevation II, in contrast, correlated only with spiritual transcendence. Furthermore, Elevation I was the
strongest unique predictor of self-reported altruism, as evaluated by hierarchical regression including the Five

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Factors (openness, conscientiousness, extraversion, agreeableness, and neuroticism), spiritual transcendence,
and Elevation I as predictor variables (Landis et al., 2009). Future studies could probe how personality
differences in trait moral elevation relate to life experiences, biological predisposition, and physiological events
when witnessing compassion and consequently being moved to be compassionate.
In summary, the studies of moral elevation have shown that merely witnessing compassion prompts an
array of changes to one’s physiology and psychological state and inspires others to perform compassionate acts
in turn. This is a very effective and simple way to propel compassionate behaviors in society. As a result of this
infectiousness, it may be possible to ignite more compassion in our world by having people watch compassion
in action. Yes, compassion lives in our bodies and our brains and is indeed contagious.
Altogether, research in these two areas on oxytocin and moral elevation has shown that our compassionate
states and traits are very much affected by both our inborn tendencies and our life experiences. Studies of the
oxytocin system, including its release and genetic and epigenetic variations of the receptor, have illustrated
that compassion is “hardwired” in our DNA. Individual differences in compassionate states and traits are
related to both innate and experience-dependent differences in oxytocin signaling and the ability to cope with
psychosocial stress. Moral elevation through witnessing acts of compassion is a powerful motivator of
compassionate behavior through the physiological and psychological events it causes in the viewer.
Importantly, by experiencing prosocial behavior through witnessing and experiencing compassion, our
physiology is modified, from our autonomic physiology to the experience-dependent modification of our
oxytocin receptor gene. In an attempt to put these two stories together, the research programs of myself and
others now have plans to see how the experience of moral elevation is connected to variations in oxytocin
release and genetic and epigenetic variations of the oxytocin receptor. This is a very exciting time in the
science of compassion where transdisciplinary and multimethod approaches are being incorporated to address
how and why we experience and exercise compassion. By understanding the biological mechanisms underlying
compassionate behaviors, we can gain new insight into catalysts and obstacles to compassion in society.

179
Acknowledgments
Work on this project was supported by a grant from the National Science Foundation (NSF CAREER
Grant BCS-1151905).

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 The Impact of Compassion Meditation Training on the Brain and Prosocial
Behavior

Helen Y. Weng, Brianna Schuyler, and Richard J. Davidson

Abstract

Compassion meditation is a form of mental training that cultivates compassion towards oneself and
other people, and is thought to result in greater prosocial behavior in real-world settings. This
framework views compassion as a quality that can be trained, rather than a stable trait, and scientists
have started testing these hypotheses using neuroscientific and objective behavioral methods. How does
this internal meditative practice translate to external behavioral changes? We propose an emotion-
regulation model of compassion meditation, where responses to suffering may change through three
processes: (1) increasing empathic responses, (2) decreasing avoidance responses, and (3) increasing
compassionate responses to suffering. These altered responses to suffering may lead to behavioral
transfer, where prosocial behavior is more likely to occur, even in a non-meditative state. We summarize
the neuroscientific and behavioral literature that may provide early support for this model, and make
recommendations for future research to further test the model.

Key Words: compassion meditation, mental training, emotion regulation, neuroscience, brain imaging,
functional magnetic resonance imaging (fMRI), prosocial behavior, altruism, empathy

Recent collaboration between contemporary Western scientists and leading scholars from contemplative
traditions has focused on the claim that compassion is instrumental to well-being, and that it is a skill that can
be trained (Davidson & Harrington, 2001; Lama & Cutler, 1998; Salzberg, 1997). Furthermore, cultivation
of compassion is believed to translate into greater prosocial behavior towards human suffering when it is
encountered in the real world (Davidson & Harrington, 2001; Lama & Cutler, 1998; Salzberg, 1997). How
does this emotional transformation occur from purely internal mental training to actual changes in external
social behavior? Here, we present a body of research that has examined the impact of participation in
programs designed to strengthen compassion, largely drawn from Buddhist contemplative practices. To
objectively investigate the psychological and behavioral changes associated with compassion meditation
training, investigators have used methods of functional neuroimaging and observable prosocial behavior to
interrogate three stages from meditation to behavioral change: (1) neural states during compassion meditative
states, (2) transfer of compassionate responses to non-meditative states, and (3) behavioral transfer of
compassionate responses to increases in prosocial behavior. We integrate these findings using an emotion-
regulation framework to theorize how compassionate states during meditation practice translate to altering
compassionate responses to suffering outside of the meditation context and enhance prosocial behavior to
relieve suffering.

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Compassion Meditation
Compassion involves an emotional response that is sensitive to another’s suffering, as well as a motivational
response of wanting to relieve suffering (Goetz, Keltner, & Simon-Thomas, 2010). Compassion meditation
practices aim to cultivate compassionate responses towards people who are suffering who vary in relational
closeness to the meditator. In the compassion meditation we have studied (Weng, Fox, et al., 2013; Weng,
Fox, Hessenthaler, Stodola, & Davidson, 2015)—a secularized practice drawn from the Drikung Kagyu
tradition of Tibetan Buddhist meditation (see http://centerhealthyminds.org/well-being-tools/compassion-
training/ for audio file and script)—meditators first cultivate compassion towards targets who are closer (such
as a loved one and the self), then practice with targets who are less close (such as a stranger and a “difficult
person” with whom there may be conflict), and finally, cultivate compassion toward all living beings. This
step-wise progression can be thought of exercising compassion like a muscle, first starting with the “lightest
weight” of a loved one (for whom it is relatively easy to feel compassion) and working up to the heavier weight
of a difficult person (with whom more challenging emotions may be evoked).
For each target of compassion meditation, three steps are practiced:
1. Envisioning suffering, or imagining a time each person has suffered;
2. Mindful attention to reactions to suffering, where nonjudgmental attention is brought to sensations, thoughts, and feelings that arise in
response to envisioning suffering; and
3. Cultivating compassion, where feelings of care and concern for the target are practiced as well as a desire to relieve suffering (see Figure
11.1).

Meditators are instructed to use visualization to imagine others’ suffering (Step 1), as well as to envision a
golden light extending from their heart to the other’s heart to relieve suffering (Step 3). They are also
instructed to pay attention to internal visceral sensations (interoception), particularly around the heart, during
the meditation (Steps 1–3). They are instructed to internally repeat phrases to help cultivate compassion, such
as, “May you be free from suffering; May you experience joy and ease” (Step 3). (See other chapters in this
volume for descriptions of other methods and courses for training compassion.)

Figure 11.1 Emotion regulation model of compassion meditation. Meditators cultivate compassion for each target: a loved one, the self, a
stranger, and a difficult person (someone with whom there is conflict).

With continued practice of compassion meditation, several changes are hypothesized to occur.

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Compassionate responses cultivated during the meditation period are thought to transfer to non-meditative
states, so that when suffering is encountered in the real world, compassionate responses are more likely to
occur. Cultivation of the desire to relieve suffering is hypothesized to result in greater prosocial behavior when
suffering is encountered, even when individuals are not in a meditative state. In addition, compassionate
responses towards more relationally distant targets (e.g., a stranger, a difficult person) are thought to become
more like compassion towards more relationally close targets (e.g., loved one, the self).

An Emotion-Regulation Model of Compassion Meditation

Our group has studied compassion meditation from an emotion-regulation framework, which posits that
compassion meditation changes emotional responses to suffering to be more compassionate and promote
prosocial behavior (Lutz, Brefczynski-Lewis, Johnstone, & Davidson, 2008; Weng, Fox, et al., 2013).
Emotion regulation has been defined as “all of the conscious and nonconscious strategies we use to increase,
maintain, or decrease one or more components of an emotional response”, where the components are the
feelings, behaviors, and physiological responses that make up the emotion (Gross, 2001). We propose a
working model of how compassion meditation results in emotion regulation, where each step in compassion
meditation (i.e., envisioning suffering, mindful attention to reactions to suffering, and cultivating compassion)
impacts a different component of the emotional response to suffering in order to support subsequent prosocial
behavior (see Figure 11.1). Although the meditation described in this chapter primarily uses visual and
emotional strategies to cultivate compassion, this model acknowledges that compassionate responses to
suffering may be cultivated through both cognitive and affective means (Dahl, Lutz, & Davidson, 2015, 2016;
Engen & Singer, 2016; Weng, Fox, et al., 2013). This is consistent with psychological models where thoughts
and emotions have bidirectional influences on each other, and both can affect behavior (Beck, Rush, Shaw, &
Emery, 1987; Greenberg, 2004; Lazarus, 1991).
An emotion-regulation model of compassion meditation is outlined in Figure 11.1. Each step in
compassion meditation impacts cognitive and affective processing of stimuli of suffering to support
compassionate responses and subsequent prosocial behavior. In Step 1 of envisioning suffering (Figure 11.1,
Step 1), meditators visually imagine a time when each target has suffered, such as from physical or emotional
pain. In the case of relationally close targets (e.g., loved one and the self), this draws from memories of actual
events when suffering has occurred. In the case of relationally distant targets (e.g., stranger or difficult person),
meditators may need to imagine and construct a situation where these people may have suffered from physical
or emotional pain. We hypothesize that this step uses visual imagery to enhance initial empathic responses to
suffering, where meditators increase their understanding of others’ internal states both through affective
experience-sharing (triggered by visual and memory cues) and cognitive perspective-taking of others’ states
(Lamm, Decety, & Singer, 2011; Preston & de Waal, 2002; Zaki & Ochsner, 2012). Visualizing suffering
may be particularly important for enhancing empathic responses towards strangers and difficult people, who
are typically considered less relevant to the self and less deserving of compassion (Ashar, Andrews-Hanna,
Yarkoni, Sills, Halifax et al., 2016; Ashar, Andrews-Hanna, Dimidjian, & Wager, 2016; Chiao & Mathur,
2010; Goetz et al., 2010). This step may therefore shift unconscious appraisals of how self-relevant and
deserving of compassion each target is. We posit that enhancing empathic responses to suffering is necessary to
increase awareness of another’s suffering, but is not sufficient to result in a compassionate response and

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prosocial behavior (which the next two steps cultivate).
In Step 2 of compassion meditation, meditators bring mindful attention to reactions to suffering (Figure 11.1,
Step 2) where they practice acceptance and nonjudgmental observation of challenging thoughts, feelings, and
sensations (Halifax, 2012; Kabat-Zinn & Hanh, 2013; Salzberg, 1997) induced by empathic responses to
suffering. This acceptance-based emotion-regulation strategy (Hayes, Luoma, Bond, Masuda, & Lillis, 2006;
Kabat-Zinn & Hanh, 2013) is thought to break the cycle of ruminative thoughts and feelings that can be
triggered by negative events, if they are present. In this step it is important to regulate reactions that may
inhibit prosocial responses such as personal distress, which are negative emotions evoked by another’s
suffering (such as feeling alarmed, upset, and worried), and may result in self-focus and the desire to relieve
one’s own suffering (Batson, 1991; Batson, Fultz, & Schoenrade, 1987). Therefore, decreasing habitual
reactivity to challenging emotions in response to another’s suffering may be an important skill developed by
compassion meditation, which may inhibit avoidance behavior. Learning these skills may support
compassion-related appraisals such as perceived ability to cope with suffering (Goetz et al., 2010). We posit
that this step is neither necessary nor sufficient for compassionate responses and behavior to occur; however,
mitigating challenging emotions through mindful attention may decrease avoidance responses, and allow for
more cognitive resources to be deployed on cultivating compassionate responses (Step 3).
In Step 3 of compassion meditation (Figure 11.1, Step 3), meditators cultivate compassion towards the
targets who are suffering using visualization, emotion, and cognitive strategies (Salzberg, 1997; Weng, Fox, et
al., 2013; Weng et al., 2015). Visualization is used to imagine a golden light extending from their heart to the
other person’s heart to relieve suffering. Emotion-based strategies are used to focus on feelings of caring and
concern for the person’s well-being, and on the desire for that person’s suffering to be relieved (Batson, 1991;
Salzberg, 1997). To aid emotional awareness, meditators are instructed to pay attention to visceral sensations
in the body, particularly around the heart. Finally, cognitive strategies are used such as repeating compassion-
generating thoughts such as “May you be free from suffering.” Cultivating compassion is thought to also
strengthen compassion-related appraisals, including each target’s relevance to the self, their deservingness of
compassion, as well as the meditator’s ability to cope with suffering (Ashar et al., 2016a; Ashar et al., 2016b;
Goetz et al., 2010). Due to these emotional and cognitive changes, cultivating compassion is hypothesized to
enhance prosocial motivation and approach behavior when suffering is encountered in the real world.

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Figure 11.2 Theoretical model for compassion transfer within compassion meditation training from meditative to non-meditative states using
an affective chronometry approach. We propose that responses to suffering that impact prosocial behavior involves three components: 1)
empathic response to suffering, which signals the recognition of suffering necessary to cue subsequent prosocial responses, 2) avoidance
responses that prevent prosocial behavior (if they are present, e.g., personal distress), and 3) approach responses that promote prosocial behavior
(e.g., empathic concern). (a) Hypothetical baseline response within an untrained individual. Responses to suffering include a moderate empathic
response, large avoid response, and moderate approach response. (b) Responses to suffering during a compassion meditative state. Compared to
baseline, responses to suffering include a larger empathic response, decreased avoid response, and greater approach response. (c) Responses to
suffering after compassion training during a non-meditative state, demonstration transfer of compassion. After compassion meditation practice,
newly learned responses to suffering during a non-meditative state may fall between original baseline and meditative responses. The empathic
response is increased from baseline and lower than meditation, the avoid response is decreased from baseline and greater than meditation, and
the approach response is increased from baseline and lower than meditation.

Compassion Meditation Training: A Model of State-to-trait Changes and Behavioral Transfer

How does cultivating compassion during a meditative state (state-level change) result in greater compassion
during non-meditative states (trait-level change), and increase real-world prosocial behavior (behavioral
transfer)? Based on the state-level changes proposed during the three steps of compassion meditation in
Figure 11.1, we propose a model of how these three emotional response components may function at baseline
(before compassion meditation training), may change during meditative practice, and with continued practice
may change compassionate responses during non-meditative states (see Figure 11.2). This model is based on
principles of affective chronometry in emotion regulation (Davidson, 1998; Gross, 1998; Schuyler et al., 2012),
where each response component in compassion is conceptualized as a process that unfolds over time. Each
response component includes a rise time to peak, or the time course of the speed and intensity of the response,
and recovery time, or the time course of the response returning to baseline (due to both automatic and
controlled emotion-regulation processes) (Davidson, 1998; Schuyler et al., 2012). For simplicity, we labeled
the three response components as:
1. the empathic response, or the initial response that indicates recognition and understanding of another’s suffering and is cultivated in Step 1
of compassion meditation;
2. the avoid response, or any cognitions and emotions that lead to avoidance of suffering and are mitigated in Step 2 of compassion

188
meditation); and
3. the approach response, or any cognitions and emotions that promote compassion and prosocial behavior and are cultivated in Step 3 of
compassion meditation (Figure 11.2).

In individuals who have not received compassion training, the baseline responses to suffering may show a
moderate empathic response, a larger avoidance response, and a moderate approach response (Figure 11.2a).
During a compassion meditative state, the empathic response may be enhanced, the avoidance response may
be diminished, and the approach response may be enhanced for each target (Figure 11.2b). With continued
practice, the compassionate responses during meditative states should begin to transfer to non-meditative
states (demonstrating a form of emotional learning), which should shift the baseline responses to look more
similar to meditative responses (compassion transfer). For example, compared to the baseline response, in a
non-meditative state, the meditator may show a larger empathic response, a decreased avoidance response,
and a greater approach response (Figure 11.2c); however, we posit that these responses are not as strong as
meditative responses. Finally, after a period of training, compassionate responses during meditative and/or
non-meditative states should lead to behavioral transfer, wherein cultivated emotional responses to suffering
lead to greater prosocial behavior. The contemplative neuroscience field has started investigating components
of this framework, and our group has specifically tested the hypothesis of behavioral transfer by examining the
relationship between compassion meditative brain states and changes in prosocial behavior.

Empirical Evidence for the Emotion-Regulation Model of Compassion Meditation

In the following sections, we review and frame the behavioral and neuroscientific literature of compassion
meditation within the emotion-regulation model. We first review evidence for the behavioral transfer
hypothesis in which compassion meditation training may increase prosocial behavior towards those who are
suffering. We then review evidence that each emotional response component of compassion (empathic
responses, avoidance responses that may inhibit prosocial behavior, and approach responses that may promote
prosocial behavior) may be altered by compassion meditation training. Finally, we make recommendations for
future research to more rigorously and specifically test elements of the emotion-regulation model of
compassion meditation.

Study Design to Test the Behavioral Transfer Hypothesis in Compassion Meditation

As far as we know, our work was the first to test the prosocial behavioral transfer hypothesis using both
neural and behavioral measures. We tested whether compassion meditation training would increase prosocial
behavior, and whether individual differences in behavior were related to changes in compassionate brain
activity during a meditative state due to compassion training. We compared short-term online compassion
training (meditation steps detailed heretofore) to cognitive reappraisal training. The compassion training was
other-focused and aimed to increase empathic concern and prosocial motivation, while the reappraisal training
was self-focused and designed to decrease personal negative emotions (Ochsner & Gross, 2005; Urry et al.,
2006). (See Weng, Fox, et al., 2013, for more details, and http://centerhealthyminds.org/well-being-
tools/compassion-training/ to download trainings.)
Participants were randomized to compassion training (n = 20) or reappraisal training (n = 21), and trainings
were administered online for two weeks for 30 minutes a day. Participants were brain-scanned before and

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after the two weeks of training using an emotion-regulation paradigm, during which they were instructed to
use their trainings (employing compassion or reappraisal strategies) towards images of people suffering. To
measure altruistic behavior, we used behavioral economics methodology, which increased scientific rigor by
systematizing social interactions into monetary exchanges, and requiring actual payment based on monetary
decisions (decreasing the impact of social desirability). We designed the novel “Redistribution Game” wherein
participants first witnessed an unfair interaction between two anonymous players, and then had the
opportunity to spend personal funds to redistribute money from the unfair player to the other player. The
game was administered after training. In order to directly test the behavioral transfer hypothesis, we
investigated brain activity during compassion meditative states with individual differences in prosocial
behavior.

Compassion Meditation Training Increases Prosocial Behavioral Responses to Suffering

We first tested whether compassion training resulted in greater prosocial behavior. We found that short-
term compassion training increased redistribution behavior compared to reappraisal training (compassion
trainees spent almost twice the amount as reappraisal trainees—Weng, Fox, et al., 2013). Within the same
participants, economic paradigms that tested punishment of the unfair player and helping of the wronged
player independently found that compassion training is associated more with helping than with punishment
(Weng et al., 2015). These results demonstrated that even short-term training could result in greater prosocial
behavior outside of the training context, confirming the behavioral transfer hypothesis that internal mental
training could result in changes in external observable behavior. Interestingly, although the compassion group
reported wanting to help the people in the images (on a scale from 1 = Not at all to 9 = Very much) more than
the reappraisal group did (pre-training t 39 = 2.88, p < 0.01; post-training t 39 = 3.54, p = 0.001), and the
compassion group showed increased reported desire to help after training (paired t 19 = 3.60, p < 0.01), none
of these reports (at pre, post, or the difference score) were associated with actual altruistic redistribution
behavior (all p’s > 0.33). Therefore, although subjective reports of a desire to help are increased by employing
compassion and over time with compassion training, they are not necessarily associated with objective
measures of altruistic behavior. Subjective report may be more influenced by social desirability (or the desire to
look good to experimenters) than observable behavior, especially behavior that is costly to the participant. To
most rigorously test the behavioral transfer hypothesis of compassion meditation training, we recommend that
objective measures of prosocial behavior such as the Redistribution Game be used.
Other studies also support the hypothesis that compassion training increases observable prosocial behavior.
For example, trainees were more likely than a wait-list control group to help an injured confederate after
compassion training (Condon, Desbordes, Miller, & DeSteno, 2013; see Condon and DeSteno, this volume).
Short-term compassion training also increased costly and non-costly helping of another player in a
computerized game compared to a memory-training control group (Leiberg, Klimecki, & Singer, 2011; see
Klimecki & Singer, this volume). In another study, four weeks of compassion meditation training via
smartphone maintained the levels of charitable donations compared to decreased donations after a familiarity
intervention control group (Ashar et al., 2016a; Ashar et al., 2016b). Long-term meditators of compassion
meditation (LTMs; practitioners of the Nyingma tradition of Tibetan Buddhism who had engaged in
meditation retreat for three or more years) showed greater recompensation of a player after an unfair exchange

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compared to novices, and demonstrated less punishment towards the unfair player (McCall, Steinbeis, Ricard,
& Singer, 2014). Compassion training in children (e.g., Kindness Curriculum) may also enhance prosocial
behavior compared to a wait-list control group, where children shared more stickers with most- and least-
liked peers in their class, an unfamiliar child, and a child who was sick compared to a control group (Flook,
Goldberg, Pinger, & Davidson, 2015). These studies provide early evidence that compassion training may
exhibit behavioral transfer, where trait-level changes in compassionate responses to suffering encountered in
the real world result in observable changes in prosocial behavior.
What neural and psychological changes contributed to this increase in prosocial behavior due to compassion
training? To understand what contributes to these changes, we associated brain activity during voluntary
generation of compassion (while viewing images of human suffering) to individual differences in redistribution
behavior. We investigated whether redistribution was associated with changes in brain networks associated
with (1) enhancing empathic responses to suffering, (2) decreasing responses that could lead to avoidance such
as personal distress, and (3) increasing responses that promote prosocial behavior.

Compassion Meditation Training May Increase Empathic Responses to Suffering (Step 1)

In our work with compassion meditation novices, we found that greater redistribution behavior was
associated with increases in activation in the right inferior parietal cortex (IPC) from pre- to post-compassion
training (Weng, Fox, et al., 2013). This association between altruistic behavior and changes in IPC activation
when viewing negative images (compared to neutral) was greater in the compassion vs. reappraisal group. The
IPC is associated with an empathy network that is activated during shared representations of others’ pain
(Lamm et al., 2011), which supports the hypothesis that compassion training increases empathic responses to
others’ pain. The IPC was functionally correlated with the dorsolateral prefrontal cortex (DLPFC), which
suggests that a fronto-parietal network may be engaged to support emotion regulation to enhance empathic
responses (Vincent, Kahn, Snyder, Raichle, & Buckner, 2008). These data support the hypothesis of
behavioral transfer due to compassion meditation, where training-related changes in neural activation and
connectivity during a compassion meditative state were subsequently associated with behavioral changes that
occurred during a non-meditative state.
What may have contributed to enhanced empathic neural responses? We examined eye-tracking data to test
the hypothesis that compassion training increases visual attention to cues of suffering. We collected eye-
tracking data during the fMRI task for each trial which was 12-seconds long, and computed the percentage of
time when participants looked at emotional areas of interest (e.g., face of a woman crying) for negative vs.
neutral images (see van Reekum et al., 2007, for methodological details). In a subset of participants with high-
quality eye-tracking data (compassion n = 12, reappraisal n = 12), we found that at both pre- and post-
training, the compassion group spent more time looking at the emotional parts of negative vs. neutral images
when employing their training compared to the reappraisal group (t 22 = 2.41, p < .05) (Davidson, 2010;
Weng, 2014). Reappraisal may work to down-regulate negative emotions in part due to a behavioral strategy
of averting eye gaze from emotional portions of images (van Reekum et al., 2007). These data suggest that
compassion training may enhance visual attention to suffering, which may be one mechanism through which
empathic neural responses are enhanced.
Other studies suggest that compassion meditation training may enhance empathic neural responses to

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human suffering during both meditative and non-meditative states. During a compassion meditative state,
LTMs showed greater neural activation to sounds of human suffering in regions associated with experience-
sharing and perspective-taking (Lamm et al., 2011; Zaki & Ochsner, 2012), including the insula,
temporoparietal junction, and superior temporal sulcus, compared to novices (Lutz et al., 2008). In a non-
meditative state after eight weeks of compassion training, neural networks associated with empathic accuracy
of emotional eye expressions were longitudinally sustained, whereas they were decreased in a health discussion
control group (Mascaro, Rilling, Negi, & Raison, 2013). These regions included the inferior frontal gyrus
(IFG) and dorsomedial prefrontal cortex (dmPFC), which predicted performance in the empathic accuracy
task (Mascaro et al., 2013; see Mascaro & Raison, this volume) and are associated with experience-sharing
and mentalizing (Lamm et al., 2011; Zaki & Ochsner, 2012).
The amygdala was more highly activated in the LTMs (Lutz et al., 2008) during a compassion meditative
state, which may reflect greater salience of emotional stimuli to detect suffering (Davis & Whalen, 2001).
Similar to the finding in the LTMs, an eight-week compassion training enhanced activation in the right
amygdala in response to images of suffering compared to a mindful-attention control group during a non-
meditative state (Desbordes et al., 2012). This increase in amygdala activation was associated with functional
benefits of decreased depression scores (Desbordes et al., 2012). Although amygdala responses can be
associated with increased negative responses to negative stimuli (Ochsner & Gross, 2005; Zald, 2003), greater
amygdala activation due to compassion training may represent a functional shift where suffering is more
readily detected in order to respond prosocially. Because neural systems associated with the detection of
suffering and empathic responses were engaged after compassion training in both meditative and non-
meditative states, emotional transfer may be occurring where compassionate neural responses cultivated during
meditative states may be transferring to non-meditative states.
However, this hypothesis has not been rigorously tested in any study, and different neural systems were
engaged depending on the study and experimental paradigm.

Compassion Meditation Training May Decrease Responses That Promote Avoidance and Inhibit Prosocial
Behavior (Step 2)
For some practitioners, greater empathic responses to others’ suffering may provide an emotion-regulatory
challenge. For example, greater awareness of another’s suffering may lead to emotions that promote avoidance
and inhibit prosocial behavior, such as personal distress (Batson, 1991), and therefore requires emotion
regulation to mitigate these responses. By learning Step 2 of compassion meditation (Figure 11.1), mindful
attention to negative emotional reactions to suffering may decrease withdrawal tendencies, and allow cognitive
resources to be allocated to cultivating compassion (Step 3). Our data suggest that employing compassion is
emotionally arousing, where compassion trainees reported greater arousal (how physiologically and
psychologically activating the images are perceived to be) to both negative and neutral images compared to
reappraisal (F 1, 39 = 5.59, p < 0.05; Weng, Motzkin, Stodola, Rogers, & Davidson, 2013). In response to
images of suffering, we found a significant Group × Time interaction, where the compassion group reported
greater arousal from pre- to post-training at trend level, and the reappraisal group did not change (F 1,39 =
5.47, p < 0.05). Although at the group level, compassion training increased arousal to images of suffering,
compassion trainees who were able to decrease arousal from pre- to post-training were the most altruistic in

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the redistribution game (Weng, Fox, et al., 2013). These findings suggest that compassion trainees who are
able to regulate arousal after training may engage in an optimal level of arousal (Yerkes & Dodson, 1908),
where they may affectively engage with others’ suffering while maintaining cognitive resources to engage in
prosocial motivation and planning.
Exploratory analyses within the amygdala also suggest that compassion training may decrease negative
responses to suffering. We found that compassion trainees who were the most prosocial showed the most
decreases in a region that encompassed the amygdala, as well as the hippocampal entorhinal cortex (Weng,
Fox, et al., 2013), which are respectively implicated in emotional salience (Davis & Whalen, 2001) and social
memory (Immordino-Yang & Singh, 2011). In addition, greater DLPFC activation due to training was
correlated with decreased amygdala/hippocampal cortex activation across compassion and not reappraisal
trainees (Weng, Fox, et al., 2013), which suggests that emotion regulatory systems were used to down-
regulate activity in the amygdala. Compassion training, particularly mindful attention to reactions to suffering
(Step 2), may cultivate more balanced emotional responses to suffering.
Several studies suggest that negative responses to suffering during non-meditative states may be decreased
by compassion training. LTMs who practiced more compassion during a three-month meditation retreat
showed less facial expressions of rejection emotions when watching videos of suffering compared to a waitlist
control group (Rosenberg et al., 2015). After short-term empathy training, participants reported greater
negative affect in response to suffering, but subsequent compassion training reversed this effect and negative
affect was decreased (Klimecki, Leiberg, Ricard, & Singer, 2013). However, the effect is unclear, and it is
unknown what would happen if compassion training had been implemented first. Parametric analyses
demonstrated that decreases in negative affect after compassion training were mediated by the left
supramarginal gyrus. In another study, after four weeks of using a smartphone-based compassion training app,
participants experienced decreases in personal distress when viewing suffering due to training, and were
associated with greater donations to charity (Ashar et al., 2016a; Ashar et al., 2016b). Personal distress as well
as donation amounts were correlated with increased activity in an overlapping region of the ventromedial
prefrontal cortex (vmPFC), which has been associated with constructing emotional meaning (Roy, Shohamy,
& Wager, 2012). These findings suggest that compassion training may potentially decrease responses that
inhibit prosocial behavior (such as personal distress) in response to suffering during non-meditative states.
Because of the lack of studies examining these states during active meditation practice, it is currently unclear
whether transfer of regulating inhibitory responses occurs from meditative to non-meditative states.

Compassion Meditation Training May Increase Responses That Promote Prosocial Behavior (Step 3)
We also found neural evidence that compassion training increases prosocial behavior through emotion-
regulatory systems that enhance prosocial emotions. Greater changes in functional connectivity between the
DLPFC and the nucleus accumbens (NAcc), a region implicated in social reward (Sanfey, 2007), were found
to predict greater altruistic behavior in the compassion vs. reappraisal group (Weng, Fox, et al., 2013). This
may suggest that emotion-regulation networks were recruited to up-regulate prosocial responses to suffering,
including positive appraisals of aversive stimuli (Wager, Davidson, Hughes, Lindquist, & Ochsner, 2008),
enhancing affiliation (Depue & Morrone-Strupinsky, 2005) to people who are suffering, and increasing the
reward value (Knutson & Cooper, 2005) of the victim’s well-being. Greater DLPFC-NAcc connectivity was

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also associated with training-related decreases in reported arousal, which suggests that arousal may be
indirectly decreased by promoting affiliative emotions rather than directly down-regulating arousal (Weng,
Fox, et al., 2013).
Studies of compassion meditation training have also examined changes in prosocial responses to suffering
during meditative and non-meditative states. Participants report greater positive affect during meditative
states in LTMs (Engen & Singer, 2015), as well as non-meditative states in novices who view videos of
suffering (Klimecki et al., 2013). During a non-meditative state, LTMs report greater sympathy (a term
similar to empathic concern and compassion) towards suffering after a three-month retreat, and sympathy is
associated with facial expressions of sadness (Rosenberg et al., 2015). Neural data consistently implicate
regions associated with positive affect (Kringelbach & Berridge, 2009), affiliation (Strathearn, Fonagy,
Amico, & Montague, 2009), and reward (Haber & Knutson, 2010), including the ventral striatum, ventral
tegmental area, and the medial orbitofrontal cortex in both meditative (Engen & Singer, 2015; Klimecki,
Leiberg, Lamm, & Singer, 2012) and non-meditative states (Klimecki et al., 2013). Another study found that
training-related increases in reported tenderness (feelings of warmth and softness) when viewing suffering in a
non-meditative state were associated with greater donations to charity (Ashar et al., 2016a; Ashar et al.,
2016b), and that both tenderness and donations were correlated with increased activity in the vmPFC.
However in our own dataset, we found that changes in a non-meditative state (where participants were
instructed to simply attend to images of suffering) did not predict changes in altruistic redistribution
(unpublished data, p < 0.01 whole-brain corrected). These studies suggest that transfer of compassionate
responses from meditative states to non-meditative states may occur; however, this hypothesis has not been
directly tested in any study. Behavioral transfer may be mediated by changes in both meditative non-
meditative neural states in systems implicated in emotional meaning, emotion regulation, and reward
processing.

Summary and Recommendations for Future Research

In recent years, an emerging field has studied the neural underpinnings of the cognitive and affective neural
changes associated with compassion meditation training and resulting changes in prosocial behavior. During
compassion meditative states, networks associated with emotional salience, experience-sharing, perspective-
taking, emotion regulation, and positive affect and affiliation have been identified across studies. When
suffering is encountered in a non-meditative state after compassion training, networks associated with
empathic accuracy, emotional salience, and positive affect and affiliation are all enhanced across the studies
discussed. These findings support the hypothesis that compassion training may enhance prosocial behavior by
altering neural systems subserving response components to suffering: (1) increasing empathic neural responses,
(2) decreasing avoidance responses that inhibit prosocial behavior, and (3) increasing approach responses that
promote prosocial behavior. Furthermore, compassion transfer may occur where neural changes that occur
during active meditative states transfer to non-meditative states when suffering is encountered; however, these
hypotheses have not been directly tested. Similar networks appear to be activated during meditative and non-
meditative states of compassion, but results varied depending on the population studied, the length of
compassion training, and the fMRI paradigm.
Neural patterns representing compassionate brain states may be highly variable due to the complex

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psychological components of compassion, which may change at different rates, depending on how individuals
respond to practices. For example, some individuals may need to focus on increasing initial empathic
responses to suffering, while others may need to regulate avoidance responses and/or enhance prosocial
responses. We expect highly variable patterns of neural activation, particularly in novices, whereas long-term
practitioners may have more reliable and consistent patterns due to years of practice. Length of training may
influence the strength and detectability of changes in neural activation due to training. For example, in our
work, short-term compassion training did not produce any group-level differences in neural activation
between compassion and reappraisal training that survived whole-brain correction for multiple comparisons
(unpublished data); however, changes in activation due to training were associated with prosocial behavior,
demonstrating that individual variability in brain responses was related to meaningful behavioral outcomes
(Weng, Fox, et al., 2013). The behavioral transfer hypothesis is supported across several studies where
prosocial behavior is enhanced by compassion training, and this change in behavior is predicted by neural
activation during meditative and non-meditative states.
Future work should focus on testing more directly how compassionate neural states generated during
meditation (representing the three response components to suffering) impact compassionate neural states
during a non-meditative state, and how this subsequently increases prosocial behavior in response to suffering.
We propose methodological advances here to better investigate these processes given the complex nature of
compassion.
Understanding spatial and temporal variability of compassionate brain states: Because compassion training can
affect processing at different levels (e.g., appraisals, emotional responses and regulation, prosocial motivation),
and many tasks and populations are being studied, it is unlikely that we will identify a canonical
compassionate brain response across studies. Supporting the hypothesis that compassionate neural states are
highly variable in novices, analyses of shorter-term trainings (ranging from one day to eight weeks) often use
region-of-interest (ROI)–based approaches and find that whole-brain analyses do not yield significant results.
In addition, the development of compassionate neural states over time may not follow a linear pattern but may
develop in qualitative and quantitative shifts. The neural representation of compassion in LTMs is unlikely to
be similar to that of novices. Depending on the length and quality of their practice, people are likely to be at
different stages in ability when trying to regulate distress, enhance prosocial feelings, and stay focused on
another’s suffering. People often have mixed responses to suffering, which are unlikely to be simply
categorized as avoidant and/or prosocial, particularly if the suffering encountered is novel or involves highly
evocative stimuli. This increases the likelihood that variability exists across individuals, particularly in novices
who may not be able to consistently evoke a compassionate response. In addition, activation in one region may
have different functional significance depending on the task and population studied. For example, during
voluntary generation of compassion, LTMs show greater amygdala activation to distressing sounds (Lutz et
al., 2008), whereas in non-meditative states, novices who undergo an eight-week course also show greater
amygdala activation to negative images (Desbordes et al., 2012). However, during voluntary generation of
compassion towards a similar image set, training-related decreases in the amygdala and hippocampal
entorhinal cortex predicted greater altruistic behavior (Weng, Fox, et al., 2013). Many sources of variability
potentially exist within neural representations of compassion training both within and between individuals,
and neuroimaging methods that are able to harness and quantify this variability are needed.

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 Multivariate representation of compassionate brain states: Due to potential high variability within
compassionate brain states, as well as regions being involved in more than one process (e.g., both personal
distress and tenderness were associated with vmPFC activation in Ashar et al., 2016a), investigating neural
states in compassion training using multivariate methods may be beneficial. Techniques such as multi-voxel
pattern analysis (MVPA; Norman, Polyn, Detre, & Haxby, 2006) may be well suited to studying compassion
training because it allows for: (1) spatial variability in the way complex mind states may be represented within
individuals, which may be ideal for studying compassionate neural patterns both between and within subjects;
and (2) temporal resolution to classify dynamic fluctuations of brain states through time (at each fMRI data
time point). With this capacity, dynamic fluctuations of components of compassionate brain states (such as
the empathic response, and responses that inhibit and promote prosocial behavior) may potentially be tracked
as they wax and wane over time (Norman, Polyn, Detre, & Haxby, 2006). In MVPA, neural patterns may be
analyzed at the individual level in native space (without norming to group-level templates), which produces
individually derived metrics that can then be analyzed at the group level.
In preliminary analyses with our short-term compassion training dataset, we used classification accuracy, as
determined by MVPA, as an indirect measure of stability and distinctiveness of compassionate brain states
compared to other states (e.g., simply attending to the images). We found that compassion training
specifically increased classification accuracy of compassionate brain states from pre-training (28.5%, where
chance level is at 25%) to post-training (33.5%; t167 = 3.77, p < 0.001), and not the other three conditions. In
addition, the greater the stability and distinctiveness of compassionate brain states (as indicated by
classification accuracy), the more the participants subsequently donated their earnings to charity (rho27 = 0.51,
p = 0.005; Weng, Lewis-Peacock, Stodola, & Davidson, 2012). Other groups also suggest applying
multivariate methods to study neural representations of compassion training, such as using MVPA to examine
neural patterns within the vmPFC that distinguish personal distress from tenderness (Ashar et al., 2016a).
Affective chronometry of compassionate neural responses to suffering: Compassionate responses to suffering can
also be examined from an affective chronometry approach, examining how neural responses unfold over time
through key information-processing points (Davidson, 1998; Gross, 2001; Figure 11.2). Investigators have
examined the temporal dynamics of responses to emotional stimuli, comparing initial responses to stimuli to
later responses. For example, amygdala responses to negative images may be analyzed in terms of an initial
reactivity period compared to a later recovery period, and faster amygdala recovery (controlling for reactivity) is
associated with decreased trait neuroticism (Schuyler et al., 2012).
Because compassionate responses encompass potentially both avoidant and prosocial responses to suffering,
both frameworks can be used to examine how quickly compassion trainees can recover from stimuli of
suffering as well as sustain or increase prosocial responses. Additionally, the strength of the initial empathic
response to suffering may be enhanced through compassion training and can increase the emotional salience
of human suffering. One study of long-term compassion meditators examined temporal dynamics of the
amygdala and ventral striatum during a compassion-regulatory strategy compared to cognitive reappraisal
(Engen & Singer, 2015). Comparing compassion to reappraisal strategies, they found that activity in both the
amygdala and ventral striatum is sustained, suggesting that compassion involves greater emotional salience as
well as positive responses to suffering compared to reappraisal. Both meditative and non-meditative
compassionate responses can be examined using affective chronometry approaches.

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 Objective measures of emotion: Self-reported ratings of emotions and appraisals have provided invaluable
information about how people perceive stimuli of suffering. However, self-reported metrics are susceptible to
demand characteristics and rely on accurate introspection. More objective metrics of emotions should be
incorporated into experimental paradigms (either simultaneously measured with fMRI or outside the
scanner), such as facial electromyography (Heller, Greischar, Honor, Anderle, & Davidson, 2011), facial
action coding system (Rosenberg et al., 2015), heart rate (Lutz, Greischar, Perlman, & Davidson, 2009), and
skin conductance (Schiller et al., 2010). These data can provide additional information regarding the valence,
arousal, and type of emotions being experienced during compassion. In addition, psychophysiological data
such as eye-tracking and pupillometry can also provide information on deployment of attentional resources
and cognitive effort (Johnstone, van Reekum, Urry, Kalin, & Davidson, 2007; van Reekum et al., 2007).
Improvements in assessing prosocial behavior: Finally, the field has made strides in studying the prosocial
outcomes of compassion training by measuring observable behavior outside of the training context.
Ultimately, we want to test whether compassion training directly affects relationships, such as interactions
with family, coworkers, and larger communities. Both the quality and the quantity of these interactions
impact health and even mortality (Brown & Brown, 2015; Cohen, 2004; House, Landis, & Umberson, 1988).
Preliminary evidence suggests that loving-kindness meditation enhances perceived social connection in daily
life (Fredrickson, Cohn, Coffey, Pek, & Finkel, 2008; Kok & Fredrickson, 2010), which probably leads to
more affiliative prosocial behaviors. More efforts should be made to combine neuroimaging measures with
assessments in daily living, such as ecological momentary assessment (Shiffman, Stone, & Hufford, 2008),
video and audio recorded interactions, as well as feedback from the potential recipients of compassion
(second-person report). Compassionate behavior is not effective unless it is appropriate for the recipients of
compassion, and this is a valuable source of information to assess the quality of prosocial behavior. The field
can also draw from wisdom from the clinical psychology literature, where detailed assessments of empathic
accuracy have been developed from the motivational interviewing literature (Miller & Rollnick, 2012). Well-
designed tasks to assess prosocial (Ashar et al., 2016b) and empathic behavior (e.g., empathic accuracy in
Zaki, Weber, Bolger, & Ochsner, 2009) should be administered within the scanner to associate with real-
world assessments of prosocial behavior outside of the scanner. Dyadic interactions can be assessed inside the
scanner using hyperscanning fMRI (pairwise data-acquisition) and related to real-world social behavior such
as dyadic social network complexity (Bilek et al., 2015). Dyadic interactions can also be assessed outside of the
scanner using psychophysiological linkage (Levenson & Gottman, 1983) to associate them with
compassionate neural responses. Tasks should also be designed that can be administered longitudinally that
are less susceptible to demand characteristics, and studies should examine how long the training needs to be
for behavioral effects to be sustained. Ultimately, these neural changes and behavioral outcomes should be
related to mental and physical health outcomes of the participants (Fredrickson et al., 2008; Pace et al., 2009),
as well as the people in their social networks, to test the hypotheses that compassion training positively
influences both individual and systemic health (Davidson & Harrington, 2001; Lama & Cutler, 1998).
Targets of meditation: Studying specific targets of meditation may also be important in understanding the
compassion transfer from close others (e.g., loved one, benefactor, the self) to more distant others (e.g.,
strangers, difficult people). Compassionate responses to each target may yield psychologically and clinically
meaningful information. Compassionate responses to close others may represent a neural index of attachment

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security (Mikulincer & Shaver, 2005), and the quality of compassion evoked for close others may be associated
with the ability to feel compassion for less close targets. We also recommend that investigators specifically
study compassionate responses towards difficult people, where more complex emotions may be evoked, such
as anger, annoyance, fear, and anxiety. More time may need to be spent focused on mindful attention to
reactions to suffering, and empathy training (Klimecki et al., 2013) may be a necessary step before being able
to practice compassion. These processes would be important to understand to apply to issues such as conflict
resolution.
Finally, compassion training may be implemented to improve interactions between people of different
group memberships. Researchers found that compassion training decreased implicit biases towards
stigmatized out-group members (Kang, Gray, & Dovidio, 2013), even when those targets were not explicitly
engaged during practice. These questions provide fruitful paths for future research in the impact of
compassion training on neural and social behavioral functioning.

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Ashar, Y. K., Andrews-Hanna, J. R., Yarkoni, T., Sills, J., Halifax, J., Dimidjian, S., & Wager, T. D. (2016b). Effects of compassion
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 Cultural Neuroscience of Compassion and Empathy

Joan Y. Chiao

Abstract

“Compassion” and “empathy” refer to adaptive emotional responses to suffering in oneself and others
that recruit affective and cognitive processes. The human ability to understand the emotional experience
of others is fundamental to social cooperation, including altruism. While much of the scientific study of
compassion and empathy suggests that genes contribute to empathy and compassion, recent empirical
advances suggest gene–environment interactions, as well as cultural differences in development,
influence the experience, expression, and regulation of empathy and compassion. The goal of this
chapter is to review recent theoretical and empirical advances in the cultural neuroscience of empathy
and compassion. Implications of the cultural neuroscientific study of empathy and compassion for public
policy and population health disparities will be discussed.

Key Words: cultural neuroscience, culture-gene evolutionary theory, compassion, empathy, social
identity, universality

Human suffering represents a signal of perceived or actual experience of threats to human survival. Several
aspects of the human emotional system facilitate communication and response to the experience of human
suffering. Basic emotions, such as sadness, anger, fear, and joy, communicate the presence or absence of
natural and manmade opportunities and challenges in the environment (Darwin, 1859). Self-conscious
emotions, including shame, guilt, and pride, allow people to consciously distinguish communicative signals in
the environment as self- or other-relevant, and to guide behavior towards the alleviation of suffering,
depending on resources and one’s social role (Tracy, Robins, & Tangney, 2007). Emotions experienced as a
result of shared affective experience between one self and others, including empathic concern and personal
distress (Davis, 1983), may provide interoceptive cues of pain that can motivate a desire to alleviate the pain or
suffering of another. Cultural differences in the formation and regulation of pain affect the nature and extent
of responses to affective experiences of concern and distress. Compassion and empathy depict cultural routes
to management of pain and suffering, a fundamental human right (Brennan, Carr, & Cousins, 2007).
Compassion refers to a feeling that occurs when perceiving suffering in others, and a motivation to help
(Goetz, Keltner, & Simon-Thomas, 2010). Empathy is a sharing of another’s feelings and can be an
antecedent of altruism or helping behavior. Both compassion and empathy may lead to similar behavioral
responses; specifically, the motivation for helping another. However, compassion and empathy can differ in
the affective or feeling response to another’s suffering. Compassion involves a feeling that occurs in response
to another’s suffering, and may be a positive (e.g., love) or negative (e.g., sympathy) emotion. Empathy results
from a sensitivity to others’ emotions that are shared between oneself and others, such as a vicarious feeling of

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fear or amusement.
While the psychological and neurobiological origins of compassion and empathy are relatively well studied
(see relevant chapters in this volume: Klimecki and Singer, Weng and Davidson, Chapter 11; Koopman-
Holm and Tsai, Chapter 21), much less is understood about how culture shapes any neurobiological systems
involved in compassion and empathy. Here we adopt a “cultural neuroscience framework” to identify
theoretical and empirical approaches to the cultural neuroscience study of compassion and empathy.

Cultural Neuroscience: Understanding Human Diversity

Cultural neuroscience is an interdisciplinary science that integrates theory and methods from anthropology,
psychology, neuroscience, and genetics to study the origins of human diversity across multiple timescales
(Chiao & Ambady, 2007; Han & Northoff, 2008; Kitayama & Uskul, 2011; Park & Gutchess, 2002; Kim &
Sasaki, 2014). Neural circuits associated with a range of human capacities, including perception, cognition,
emotion, and social cognition, have been shown to behave differently as a function of cultural values, practices,
and beliefs acquired throughout the lifespan. Neurotransmitter systems regulated by specific polymorphisms,
including the serotonin transporter and oxytocin gene, modulate the degree of neural activity in response to
specific, culturally informed behavioral patterns. Epigenetic changes in gene expression show neural changes
in specific brain regions associated with social cognition, also shaped by culture (Connelly & Morris, 2015;
Jack, Connelly, & Morris, 2012; Nikolova et al., 2014; Nikolova & Hariri, 2014; Puglia et al., 2015). Shifts in
cultural identity prompted by cultural priming similarly demonstrate dynamic neural responding in social and
emotional neural systems (Harada, Li, & Chiao, 2010; Wang, Oyserman, Liu, Li, & Han, 2013). Recent
advances in cultural neuroscience have identified cultural dimensions that probably co-evolved with genes to
shape the human mind and brain (Chiao, Cheon, Pornpattananangkul, Blizinsky, & Mrazek, 2013; Cheon,
Pornpattananangkul, Blizinsky, Mrazek, & Chiao, 2013).
Research in cultural neuroscience utilizes interdisciplinary methods for understanding human diversity
(Chiao, Li, Seligman, & Turner, 2016). Empirical methods for measuring human behavior, including
qualitative (e.g., interview) and quantitative (e.g., survey) measures that assess people’s attitudes, preferences,
and beliefs provide the means to understand the scope and quality of variation in human behavior.
Neuroscience methods, including functional magnetic resonance imaging (fMRI) and event-related potentials
(ERP), allow the cultural investigation of neural structure and function with spatial and temporal precision,
respectively. Genetic analysis of functional polymorphisms enables the identification of specific behavioral and
neurogenetic associations within and across cultural groups (Chen et al., 2016; Sasaki, LeClair, West, & Kim,
2016). Fluctuations in cultural and biological expressions may be studied with distinct methodologies,
including cultural priming and DNA methylation assays (Connelly & Morris, 2016).
Several neural mechanisms have been identified as playing a key role in the creation and maintenance of
cultural values, practices, and beliefs. Imitation or mirror neurons, sometimes implicated in empathy, facilitate
the learning of cultural action, from simple gestures to complex artistic movement. Losin and colleagues
(2012; 2013) have recently shown that sociocultural identity, such as race and gender, affects the degree of
neural response when imitating similar and dissimilar others. Developmental changes in neuroplasticity also
factor into the effects of culture on the brain. Greater malleability during infancy and childhood, for instance,
facilitates rapid acquisition of cultural knowledge from the environment, which impacts perceptual and

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cognitive biases that are important for social bonding with caregivers and community (Chiao, in press). As
neuroplasticity peaks during adolescence, the maturation of the prefrontal cortex allows the neurobiological
acquisition of cognitive control and self-regulation mechanisms that support acquisition and adherence to
social and cultural norms (Choudhury, 2010). During late adulthood, when neuroplasticity plateaus, cultural
learning acquired throughout the lifespan, such as knowledge of the cultural norms of one’s social group
stored in self, others, and the community, provides the foundation for navigating the social world (Park &
Gutchess, 2002).

Culture-Gene Coevolutionary Theory of Compassion and Empathy

Culture-gene coevolutionary theory refers to the cultural and genetic-selection factors that shape human
behavior. With respect to cultural-selection factors, values of individualism and collectivism, for example, refer
to how people think about themselves in relation to others (Hofstede, 2001; Markus & Kitayama, 1991).
Individualistic cultures emphasize autonomy, freedom of speech, and thinking of oneself as independent from
others; by contrast, collectivistic cultures value connectedness, harmony, and thinking of oneself as
interdependent with others. Across 29 nations, collectivistic nations were significantly more likely to comprise
individuals carrying the short (s) allele of the serotonin transporter gene (Chiao & Blizinsky, 2010). Notably,
nations with increased population frequency of short allele carriers also demonstrated improved outcomes on
global mental health indices, such as lower prevalence of anxiety and mood disorders, presumably due, in part,
to greater cultural collectivism. These findings show the importance of cultural values as evolved buffers in
genetically susceptible populations from increased prevalence of mental health disorders.
Recently, Mrazek and colleagues (2013) investigated the cultural and genetic basis of the formation of
moral attitudes or moral justification, which play a role in the experience and expressions of empathy and
compassion, across nations. Gelfand and colleagues (2011) have shown that “tight cultures” (e.g., India,
Singapore, Turkey, Japan) are more likely to create and sustain situational constraints that restrict appropriate
behavior than “loose cultures” (e.g., Hungary, Israel, the Netherlands). People living in tight cultures are more
likely to exhibit dutiful behavior, self-regulation, self-monitoring, and a greater need for structure compared to
people living in loose cultures. Socially deviant behaviors are more likely to be sanctioned in tight cultures,
suggesting less tolerance for behaviors that are perceived to violate social or moral norms.
Given the plausible adaptive value of variability in cultural values of tightness and looseness across
geography, what genetic mechanism may facilitate the selection and maintenance of tight and loose norms
within a given society or culture? The serotonin transporter gene is a putative genetic mechanism by which
tightness–looseness is selected for within a given population. Recent evidence across 21 nations shows that
cultural tightness–looseness is correlated with frequency of the short allele of the serotonin transporter gene
(Mrazek, Chiao, Blizinsky, Lun, & Gelfand, 2013). Furthermore, genetic selection of the short allele of the
serotonin transporter gene predicts the degree of moral justifiability or intolerance for social or moral deviance
due in part to cultural selection of tight and loose social norms. These findings provide evidence for a pathway
model explaining moral attitudes as an interaction of ecological, cultural, and biological factors.
Compassion is a feeling that contributes to moral judgment and action and may vary depending on the
sociocultural context (Goetz, Keltner, & Simon-Thomas, 2010). Does the experience and expression of
compassion differ depending on experience with a tight versus a loose cultural environment? In a tight culture,

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where social actions that are considered morally justifiable in a loose culture are perceived as “socially deviant”
(e.g., “singing on a bus”), the moral intuition to feel compassion for those who perform a culturally variable
social action may be diminished. Consequently, with less felt compassion, the motivation for moral action in
response to a culturally variable social action may also be lower in a tight relative to loose culture. Another
possibility is that the psychological attributes that lead to moral behavior in a tight culture, including greater
dutifulness, self-regulation, self-monitoring, and need for structure, occupy mental processing resources that
could otherwise be allocated towards producing feelings of compassion. For instance, executive function is
considered an important psychological resource for self-regulation and self-monitoring, facilitating selection
and inhibition of cognition and behavior; similarly, compassionate practices may involve verbal strategies and
emotion regulation that also rely on executive function. In a tight culture, the reliance on executive function
for moral behavior may preclude or lessen the ability of one to elicit cognitive and affective processes
associated with compassion and empathy due to depletion of the shared psychological resource. In this
“limited resource” account of how cultural tightness–looseness affects compassion and empathy, the allocation
of psychological resources for processing social and emotional cues in oneself and others is finite, and when
cultures favor allocation of such resources towards a given set of attributes at the cost of another, cultural
variation in the frequency and quality of compassion may result. By contrast, psychological attributes
reinforced in a loose culture, such as tolerance for social deviance, may allow or encourage the recruitment of
psychological resources, including executive function, self- and other-representation, and positive affect,
necessary for feelings of compassion for self and others. Cultural reinforcement of tight and loose social norms
may constitute a process of divergent selection of attributes associated with compassion and empathy.

Universality and Cultural-Specificity of Compassion and Empathy

Traditional evolutionary accounts of compassion and empathy rely on theoretical accounts of natural
selection. Caregiving for offspring is considered one of the primary ways humans experience compassion for
others. The needs of vulnerable offspring to receive love, protection, and resources from caregivers in order to
navigate the novel challenges in the physical environment outside of the mother may serve as antecedents for
feelings of compassion in caregivers (Preston, 2013). The universal presence of compassionate behavior in
caregivers suggests a genetic mechanism for selection and reproduction of compassionate caregiving within
families. Putative genetic mechanisms of compassion and empathy include the oxytocin receptor gene, which
has been shown to vary behavioral expressions of emotional support seeking (Kim et al., 2010), empathy (Luo
et al., 2015), and emotion regulation (Kim et al., 2011), as a function of “gene–culture interaction” (Sasaki,
LeClair, West, & Kim, 2015).
While evolutionary theories of compassion and empathy may rely on theories of natural selection to explain
the selection of compassionate and empathic behavior in caregivers that are biologically transmitted and
reproduced within families, less well understood is how compassion and empathy arise in social interactions
and relationships with non-kin. Dual inheritance theory suggests that both culture and genetic selection play a
role in the shaping of compassionate behavior in humans. Cultural practices, such as meditation, that
emphasize the ritualized habit of practicing compassion represent cultural selection factors that may interact
with genetic selection to promote the transmission of compassionate behavior. The dual-inheritance theory of
compassion and empathy suggests the presence and selection of specific psychological and neurobiological

205
mechanisms that are shaped by cultural and genetic factors, including distinct experiential and physiological
processes.
Cultural differences in compassion and empathy behavior may also arise due to ecological or environmental
factors that vary across geography. Ecological theories of culture have shown that environmental pressures,
such as disease prevalence, predict selection of distinct cultural norms and practices across nations.
Individualism and collectivism as cultural norms, for example, are posited to have arisen from the historical
and contemporary prevalence of pathogens or infectious disease (Fincher et al., 2008). Similarly, tightness and
looseness as a cultural dimension may be variably selected for across geographical locations due to the presence
of different manmade and natural ecological pressures (Gelfand et al., 2011). While prior research has shown
that ecological and environmental factors lead to selection of cultural dimensions, including individualism–
collectivism and tightness–looseness, less well understood is how geographic variation of ecological and
environmental pressures affects prevalence of compassion, empathy, and altruism. One putative ecological
model of compassion is that environmental pressures, which lead to the selection of cultural dimensions,
subsequently alter geographic prevalence of compassion and cultural selection of specific sets of psychological
attributes or endophenotypes underlying compassion. Several attributes of the experience and physiology of
compassion and empathy may differ across cultures. Compassion as an emotional response to another’s
suffering involves nonverbal displays of emotion, sometimes including dynamic displays of touch. Prior
behavioral studies have shown that cultural differences exist in the recognition of compassion when perceiving
dynamic displays of compassionate touch. The cultural tendency to feel compassion and sympathy has been
previously related to interdependent or collectivistic self-construal in the United States and Japan (Uchida &
Kitayama, 2001). Compassion and sympathy for group members who are suffering are reportedly greater in
collectivistic than in individualistic cultures. People living in collectivistic cultures are also more likely to
expect helping behavior from group members than are those living in individualistic cultures; people from
individualistic cultures, on the other hand, are more likely to help members of other groups (Leung &
Iwawaki, 1988; Wong & Hong, 2005). Expressions of compassion, thus, may be more likely towards group
members within collectivistic cultures, whereas people from individualistic cultures are more likely to
communicate compassionate gestures to members of other groups. Further study is needed to determine how
interactions of environmental, cultural, and genetic factors predict variation in expressions of compassionate
behavior, including feelings and altruistic action.

Advances in the Cultural Neuroscience of Compassion and Empathy

Compassion, as a cultural practice, is commonly practiced as a form of meditation. Verbal strategies for
cultivating feelings of compassion towards oneself and others involve a type of emotion-regulation strategy,
such that a feeling of compassion for oneself and others may be cultivated by thinking of compassion-related
behaviors, such as verbal phrases. Training in meditation and compassion may emphasize the practice of
emotional up-regulation, including enhancing prosocial feelings (e.g., trust, concern, affection) towards those
suffering. Neuroimaging studies that compare compassion meditation experts to novices demonstrate that
meditation training affects neural systems involved in emotion, modulating activity with the amygdala,
mesolimbic, and insular cortices (Desbordes et al., 2012; Immordino-Yang, McColl, Damasio, & Damasio,
2009; Klimecki, Leiberg, Ricard, & Singer; 2014; Lutz et al., 2008; Weng et al., 2013). While research has

206
provided some insight into the neurobiological systems implicated in compassion as a cultural practice (see
Koopman-Holm and Tsai, chapter 21), there are fewer data pertaining to how culture, including race,
socioeconomic status, and identity, affects the psychological and neural mechanisms of compassion.

Figure 12.1 Cultural influences on neural basis of intergroup empathy (Cheon et al., 2011).

Many studies have shown that empathy for pain is subserved by a neural system that includes the midline
anterior cingulate cortex and insular cortices. Perceiving pain or harm in others elicits greater neural response
within empathic neural circuitry. The experience of vicariously feeling the pain of members of one’s own and
other groups is modulated by cultural values, such as power distance. Relative to egalitarian cultures (e.g.,
United States), in hierarchical cultures (e.g., Korea), or cultures where hierarchical social interaction is
expected or preferred, empathic neural response is greater when perceiving the pain or suffering of an in-
group member than when seeing that of an out-group member. Native Koreans living in Korea, for example,
show greater empathic neural response to the pain of other Koreans in the midst of a natural disaster within
the left temporoparietal junction (L-TPJ) than to Caucasian-Americans living in the United States (Cheon et
al., 2011, Figure 12.1). These findings indicate that the cultural dimension of power distance or social-
dominance orientation is a primary predictor of empathic response to group members (Cheon & Hong,
2016).
Cultural values of other-focusedness have also been shown to modulate neural responses during the implicit
perception of emotional pain (Cheon et al., 2013). Koreans who show greater other-focusedness also
demonstrate increased neural response with the anterior cingulate cortex (ACC) and anterior insular (AI)
cortex when viewing the emotional pain of group members. These findings indicate that people who are
routinely sensitive and attuned to other group members’ feelings recruit empathic neural circuitry when
observing their pain or suffering.
Social identity also plays an important role in how empathy for others’ pain is experienced. Being a member

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of a majority or minority group affects how people think about the pain and suffering of others. Minority
group members recruit brain regions typically associated with social cognition, such as the medial prefrontal
cortex (MPFC), when perceiving the pain of other in-group members (Mathur, Harada, Lipke, & Chiao,
2010). Notably, the degree of recruitment of MPFC response predicts altruistic motivation or the intention to
help others by donating social (e.g., time) or financial (e.g., money) resources.
Racial identification, or the degree of one’s identity with one’s cultural group, has been shown to predict
degree of neural response within cortical midline structures during intergroup empathy (Mathur, Harada, &
Chiao, 2012, Figure 12.2). African-Americans, a racial minority group in the United States, show greater
neural response within the cortical midline structures, including MPFC, ACC, and posterior cingulate cortex,
relative to Caucasian-Americans, a racial majority group, when viewing the pain or suffering of in-group
members. By contrast, Caucasian-Americans recruit brain regions associated with memory when empathizing
with the pain of different racial group members. Modulation of empathic neural circuitry as a function of
culture demonstrates the importance of “social identity,” or how closely one identifies with one’s group, in
experiencing empathy for group members, as well as suggests how group empathy may lead further to group
altruism.

Figure 12.2 Racial identification modulates cortical midline response during intergroup empathy (Mathur, Harada, & Chiao, 2012).

Culture, Compassion, and Empathy in the Developing Brain

Early in development, infants perceive and experience the compassion of their caregivers (i.e., compassion
from the other). Less is known about when infants begin to experience compassion themselves (i.e.,
compassion for their caregivers and non-kin). One of the early social and emotional abilities of infants is the
capacity to distinguish between positive and negative emotions (Nelson & De Haan, 1996), as well as to
prefer familiar (Pascalis, de Haan, & Nelson, 2002), prosocial others (Meltzoff & Decety, 2003). Cognitive
and perceptual biases that tune infant social cognition towards familiar and trustworthy others facilitate

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cultural learning and imitation from caregivers and culturally similar others. While infants are capable of
experiencing pain and suffering from birth, the absence of a continuous conscious self during infancy probably
affects the capacity to develop self- and possibly other-focused compassion.
Infantile amnesia refers to the period from infancy to early childhood when the capacity for autobiographical
or continuous self-memory is largely absent (Bauer, 2015). By the first three to four years of age, infantile
amnesia gradually declines, and a conscious experience of the self or a continuous stream of autobiographical
episodic memory becomes accessible. Wang (2006) has shown that, with the onset of autobiographical
memory, the gradual formation of a cultural notion of the self is similarly observed. In social interactions with
caregivers and parents, young children show cultural biases in how the self and others are conceptualized.
Collectivistic parents display a linguistic tendency to refer to their children in a manner that emphasizes their
social roles; in contrast, individualistic parents refer to their children in a manner that values their autonomy
from others. As the experience of compassion has been previously associated with collectivistic self-construal
by adulthood (Uchida & Kitayama, 2001), one possibility is that the developmental onset of compassion
occurs with the emergence of a cultural self. Similarly, the development of self-knowledge and a self-concept,
emotional autobiographical experiences, such as feelings of self- and other-compassion, are likely to be stored
as narratives of early childhood memories conceived with caregivers (e.g., remembering to help the poor or to
provide charity after a natural disaster) (Holland & Kensinger, 2010; Kensinger, 2009).
One of the main routes of cultural learning for infants is to imitate close others. Social actions, such as
grasping, gestures, and facial expressions, are perceived and produced by infants through imitative learning.
Mirror neuron systems present from birth encode and produce motor actions of caregivers and similar others
(Marshall & Meltzoff, 2014). The mirroring of caregivers may be the biological blueprint for the capacity to
share similar feelings vicariously, enhancing empathic experience. While preverbal infants may not be able to
readily recall or recollect autobiographical memories as an elaborate narrative, their social actions demonstrate
their proclivity to attach to caregivers through empathic response—which may be the kindling for their
compassion later on.
The presence of a neural basis of imitation from birth demonstrates the biological foundation of cultural
learning and empathy during ontogeny. As social memory and, in particular, autobiographical memory
develop during early childhood, cultural capacities for compassion may be more readily apparent and elaborate
further into adolescence. Specifically, ontogenetic foundations of cultural learning within prefrontal and motor
action regions may serve as neural precursors to compassionate feeling and action during adolescence. Given
the known role of expertise and training in the cultural acquisition of compassion in adults, it is not surprising
that the neurodevelopmental trajectory of compassion emerges later in early childhood.
The onset of the capacity for cultural and biological reproduction during adolescence coincides with the
maturation of prefrontal cortex (PFC), a brain region necessary for self- and emotion-regulation. The
emergent ability of cultural reproduction, to identify and share with close others cultural norms related to
friendship and community, during adolescence represents an important developmental milestone. Self- and
other-compassion have been shown to rely on emotion regulation, or the ability to change one’s feelings
through verbal strategies (Weng et al., 2013). Given the importance of the PFC in emotion regulation,
acquiring compassion through emotion-regulation strategies may prove more efficacious during adolescence
than in early childhood. Yet the phase of adolescence may affect the degree of self-compassion experienced,

209
due possibly to the continual tuning of cultural and biological expectations associated with maturation (Bluth
& Blanton, 2015).
One important sociocultural change during adolescence is the formation of social identity (Phinney, 1992;
Phinney & Ong, 2007). Commitment and involvement in one’s social community increases during youth, and
the benefits of social identity or a sense of belonging to one’s social group is enhanced with community
participation and heightened expectations of a higher status role for youth in one’s community. While the
relevance of compassion to health changes during adolescence with increased reliance on regulation ability, the
capacity for empathy present during infancy continues to emerge throughout childhood and into adolescence.
Evidence suggests that empathy can buffer children and adolescents from socially painful events, including
peer rejection and social discrimination. While the important social influence of peers increases during
adolescence, empathy facilitates social bonding, and friendships protect youth from interpersonal and
intergroup rejection during a critical period of social development (Masten, Morelli, & Eisenberger, 2011;
Masten, Eisenberger, Pfeifer, & Dapretto, 2010; Masten, Telzer, & Eisenberger, 2011).
As compassion is typically most studied in young adults, less well known is the role of compassion in aging.
During late adulthood, cognition and memory capacity subsequently decline; nevertheless, emotional well-
being appears relatively stable in older adults (Carstensen, 1992), and the compensatory increases on culture
and the environment aid in offsetting the deleterious effects of declining cognition during aging (Park &
Gutchess, 2002). Preventative health plays an important role in healthy aging. Self-compassion for older
adults is associated with positive responses to aging (Allen & Leary, 2013), and for those who suffer from
poorer physical health, it may provide an important emotional route to well-being (Allen, Goldwasser, &
Leary, 2012). Understanding the necessary and sufficient neurobiological mechanisms of compassion and
empathy may aid in development of cultural strategies and interventions in preventative health for youth and
the elderly alike.

Limitations and Future Directions

Recent neuroscience research on compassion has begun to reveal how culture might bias neural responses to
others’ pain and suffering; yet little is known about the mechanisms underlying compassion and empathy in
the developing brain across cultures. Similarly, the importance of cultural practice and training for the
cultivation of compassion shows the role of cultural dynamics in the socioemotional response to the pain and
suffering of others. However, little is known about how neurobiological or genetic dynamics affect the ability
to feel compassion and empathy for others due to cultural cultivation of compassion and empathy. Future
cultural neuroscience research is needed to address how cultural and epigenetic changes facilitate the
experience and expression of compassion and empathy for others. Empirical investigations into how culture
affects neurobiological mechanisms of compassion and empathy may yield novel insights into closing the gap
in population disparities of pain (Chiao & Mathur, 2016; Green et al., 2003).

Implications of a Cultural Neuroscience of Compassion and Empathy

Population Health Disparities
The human experience of pain and suffering represents approximately 10% of the global burden of disease
across low-, middle- and high income countries (LMIC) and approximately $300–$350 billion in financial

210
costs due to disability and lost productivity within the United States alone. Compassion and empathy
represent cultural interventions to pain and suffering, motivating us to respond to and alleviate pain and
suffering. While alleviating pain and suffering within the self as well as in others with cultural practices such
as meditation has been cultivated since the beginning of human history, little is known about how cultural
interventions ameliorate pain and suffering in the human mind and brain. The cultural neuroscience study of
compassion and empathy represents a novel opportunity to systematically identify biomarkers underlying pain
across cultural groups, as well as to design and promote cost-effective health interventions to reduce pain
disparities across cultures. By understanding the etiology of compassion and empathy, we gain greater insight
into achieving global health and human rights.

Public Policy
Public policy reflects the compassion of a society, expressing the principles of altruism and resource
allocation for those in need. Compassionate policies that provide aid to the poor, health care, and disaster
relief illustrate the recognition in governance for the need to alleviate suffering with equitable resource
allocation, often through community organizations and efforts (Collins, Garlington, & Cooney, 2015).
Governance across the liberal–conservative spectrum in the United States alone exhibits the economic and
institutional means by which compassion in modern political spheres may be achieved. Empirical efforts to
characterize the etiology of compassion and empathy typically emphasize the study of psychological and
physiological mechanisms within the individual. Research on the cultural neuroscience of compassion and
empathy may further illuminate the root causes and interactive mechanisms by which compassionate social
action in political and governmental organizations may ultimately lead to effective humanitarian response and
the alleviation of suffering for all.

211
Acknowledgments
Special thanks to Vani Mathur for helpful insights. Research reported in this publication was supported by
the National Institutes of Health, under award number R21NS074017-01A1. The content is solely the
responsibility of the author and does not necessarily represent the official views of the National Institutes of
Health.

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 Compassionate Neurobiology and Health

Stephanie L. Brown and R. Michael Brown

Abstract

This chapter explores the empirical roots of compassion science and the schools of thought that gave rise
to the idea that compassion may be good for health. We review the evidence that suggests that those
who help others are healthier and live longer than those who do not help others, and we highlight stress-
buffering and compassionate motivation as mechanisms for this effect. We describe emerging models
that connect compassion to physical health using neurobiology, and we review Numan’s (2006) animal
model of parental behavior as the basis for predictions about specific areas of the brain, neuropeptides,
and hormones that are hypothesized to interact to produce health benefits associated with helping
others. We conclude with a discussion of the implications of compassionate neurobiology for medical
research, mental health, and behavioral intervention.

Key Words: reciprocal altruism, altruism, kin selection, social bond, motivation, selective investment
theory, caregiving, stress-regulation

Whether human beings are capable of helping others through compassion—sympathy or concern directed
to those suffering or in need—is a question that has been subjected to long-standing philosophical and
empirical debate. In this chapter, we take it for granted that individuals are able to experience compassion,
which has been defined as a “sensitivity to the pain or suffering of another, coupled with a deep desire to
alleviate that suffering” (Goetz, Keltner, & Simon-Thomas, 2010). The nature of the experience of
compassion, however, is something that has been hotly contested, because it involves a complex set of
emotions and motivations that enable people to prioritize and help others, even at a cost to themselves (Brown
& Brown, 2006). Against a scientific norm of self-interest and psychological hedonism, the possible existence
of compassion has not been an easy pill for scientists to swallow. This is because models of human motivation
are grounded in learning theory, which suggests that positive moods and the relief of negative states guide all
of human motivation. From this vantage point, even helping and compassionate behaviors or caring feelings
are said to be reducible to the desire to feel good on some level. Models that acknowledge the existence of
caring or compassionate motivation often ignore this contradiction (e.g., Berscheid & Reiss, 1998), or if they
acknowledge it, they fail to explain how compassionate impulses can coexist alongside self-interested motives
to take advantage of others, or guard against exploitation by others (e.g., Preston, 2013). Our review examines
the history of this debate, and reviews theoretical and empirical developments that have emerged from this
perspective—developments that have created new fields, new controversies, and new mysteries.
Our chapter focuses on compassionate neurobiology, which refers to a set of neural mechanisms hypothesized
to trigger the motivation to relieve the suffering of others as well as the behaviors that relieve suffering. We

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refer to these behaviors as “helping” behaviors, and acknowledge that it is possible to help another person out
of a self-serving need to avoid guilt or gain rewards, as opposed to an other-focused concern for the welfare of
another person (i.e., compassion). Whether the motivation to help another actually produces behavior aimed at
helping others is beyond the focus of this chapter (see Poulin, this volume, for a review of theory and research
connecting compassionate motivation to helping behavior). We do, however, address the consequences of
compassionate motivation and behavior.
The emerging field of compassionate neurobiology arose, in part, from the discovery that there are health
consequences of compassion. We will review research that connects the behavior of helping others to better
health for the helper. We highlight evidence suggesting that these health benefits are restricted to helping
behaviors that emerge out of a compassionate, inherently other-focused, motive. The possibility that there are
health benefits associated with compassionate behavior may be an important avenue to pursue because it
potentially explains the mystery of why people who are in social relationships live longer than people who are
socially isolated (Brown, Nesse, Vinkur, & Smith, 2003). Before describing this work, we review evolutionary
theories that gave rise to the idea that compassionate behaviors are beneficial for health, evidence that
connects helping behavior and compassionate motives to improved health, and neurobiological mechanisms
hypothesized to connect compassionate behavior with physical health. We conclude with a discussion of the
implications of compassionate neurobiology for medical research, mental health, and behavioral intervention.

Evolutionary Frameworks
The aid which we feel impelled to give to the helpless is mainly an incidental result of the instinct of sympathy, which was originally
acquired as part of the social instincts, but subsequently rendered … more tender and widely diffused. Nor could we check our
sympathy, if so urged by hard reason, without deterioration in the noblest part of our nature. (Darwin, 1871, p. 873)

The origins of scientific interest in compassion trace back to Darwin (1871/1872) who considered the “social
instincts” of sympathy and love to be products of natural selection and to have evolved from parental and filial
“affections.” He described how facial gestures such as smiling, and the desire for touch that accompanies
“tender feelings,” can abruptly shift in response to threat. He viewed maternal love as the basis for the most
compassionate feelings, as well as the most formidable ones, as when a mother must protect and defend her
offspring.
Although the seeds for a science of compassion were sown by Darwin, it was Peter Kropotkin (1902) who
formally highlighted the importance of compassion in natural selection. Kropotkin observed that the harsh
natural environment should have favored cooperation and compassionate acts between individuals. He
described these ideas in his book Mutual Aid, in which he argued that selection pressures favoring cooperation
should theoretically be more powerful than selection pressures favoring competition. Kropotkin’s observations
came in response to Thomas Huxley (1899), who described ongoing competition between people as reflecting
a struggle for existence in which only the strong prevail and the weak perish. As Huxley wrote: “The animal
world is on about the same level as a gladiator’s show … the strongest, the swiftest, and the cunningest live to
fight another day” (pp. 199–200).
Kropotkin’s response to Huxley’s interpretation of Darwin was to travel in search of intra-species warfare.
His quest led to this conclusion: “I failed to find—although I was eagerly looking for it—that bitter struggle
for the means of existence, among animals belonging to the same species….” As Kropotkin (1902) writes (p.
1), summarizing and quoting from Darwin in The Descent of Man,

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 He [Darwin] pointed out how, in numberless animal societies, the struggle between separate individuals for the means of existence
disappears, how struggle is replaced by cooperation … in such cases the fittest are not the physically strongest, nor the cunningest, but those
who learn to combine, strong and weak alike…. “Those communities [quoting from Darwin] … which included the greatest number of the
most sympathetic members would flourish best, and rear the greatest number of offspring” (Darwin, 1871, 2nd ed., p. 163). (Kropotkin,
1902, p. 1)

Despite the best efforts of Kropotkin, a formal science of compassion would remain dormant and elusive until
the end of the 20th century. Huxley’s view dominated definitions of survival of the “fittest,” serving as not
only the scientific paradigm for theories of evolution, but also the basis for social Darwinist political agendas
that saw winners and losers as natural products of the competition for survival. Social Darwinism, especially in
the late 19th and early 20th centuries, reified the notion that social competition is the essence of human
nature, providing a “scientific” justification for racism, classicism, and the oppression of workers by the
industrial elite.
Against this backdrop, evolutionary theorists scrambled to understand and explain the prevalence of helping
behavior among humans: If survival and reproduction are the keys to fitness, how could altruistic emotions
and behaviors, which impose fitness costs, possibly have evolved? The most compelling resolution of this
evolutionary paradox to date has been termed inclusive fitness theory, described most elegantly by William
Hamilton. Hamilton (1964) demonstrated mathematically that the reproductive costs of helping others could
be offset if the help was directed selectively to close genetic relatives. In this circumstance, copies of the
helper’s genes, carried by genetically related recipients, would survive, even if the helper did not. Hamilton
argued that the concept of “fitness” should be expanded to characterize, not just the survival and reproduction
of the self, but also the reproduction of genes one shares with others; hence the term inclusive fitness. Put
differently, helping behaviors that occur at a cost to the helper can still be selected by nature if the behavior
benefits close biological relatives (kin), thus leading to the reproduction of common genes—kin selection.
Of course, the observation that, in humans, helping behavior is pervasive among individuals who are not
genetically related poses a challenge to inclusive fitness explanations of helping behavior. Robert Trivers
(1971) resolved this issue by advancing the concept of reciprocal altruism, arguing that natural selection would
favor altruism directed toward genetically unrelated individuals as long as they reciprocated at some point in
the future. The theory assumes there will be opportunities for reciprocation, as well as mechanisms for
detecting potential cheaters (non-reciprocators).
These two mid-level evolutionary theories of altruism—kin selection and reciprocal altruism—are generally
accepted and well-respected accounts of how it can be adaptive to help others (e.g., Axelrod, 1984; Axelrod &
Hamilton, 1981; Burnstein, Crandall, & Kitayama, 1994; Trivers, 1985). However, together they do not
explain the frequency of unreciprocated helping behavior in humans that occurs between genetically unrelated
individuals, or how individuals overcome self-interested motivation in order to help another person (Brown &
Brown, 2006; Sober & Wilson, 1998). Attempts to fill in these gaps have included a scaffolding of derivatives
of reciprocal altruism theory, which are premised on the idea that the costs of helping behavior are offset by
the benefits that are eventually returned to the helper, or to the group (see Brown & Brown, 2006, for a
review).

Motivation: The Missing Link

Gene-centric evolutionary theories (as opposed to models that posit return benefits to the group)
traditionally have ignored motivational mechanisms that might give rise to altruistic behavior (de Waal,

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2008).1 But the issue of motivation is crucial to understanding how altruistic responding can occur effectively,
efficiently, and repeatedly, especially when the fitness costs of behaving prosocially (e.g., exploitation, threats
to survival) are high. As de Waal describes, evolutionary biologists have neglected to address the motivational
issue, yet they have nevertheless “hijacked” motivational terminology, giving the misleading impression that
individuals are motivated (consciously or unconsciously) to help others out of a selfish desire to compete or
survive or reproduce. As de Waal notes, extrinsic motives, the deliberate weighing of the costs and benefits of
helping another, take too much time, so are ill-suited to account for the evolution of helping behavior, which
requires immediate responding to the needs of others.

Selective Investment Theory

To help address this theoretical vacuum, we advanced an evolutionary theory that highlights the role of
other-focused motivation (e.g., love, connection, compassion, empathic concern) in producing helping
behavior (S. Brown & R. Brown, 2006; R. Brown & S. Brown, 2006). We refer to this other-focused
motivational system as a “social bond,” the purpose of which is to motivate individuals to invest in other
people, especially those in need, over the long term. Selective investment theory does not tether helping
behavior to return benefits or group benefits. The theory does, however, assume that individuals are able to
recognize states of fitness interdependence: situations in which the reproductive (fitness-related) fates of two or
more individuals are intertwined. According to the theory, social bonds emerge from these situations. As we
will describe next, states of fitness interdependence discourage exploitation of helping behavior motivated by
the bond.

Fitness Interdependence
Evolutionary fates can become linked to create fitness interdependence in various ways. Selective investment
theory describes two types of interdependence: shared genes and mutual need. Fitness interdependence based
on shared genes refers to a circumstance in which the reproductive success of one person will pass on the genes
of the other person, and vice versa. Fitness interdependence based on mutual need refers to circumstances in
which individuals share reproductive goals even though they do not share genes. Romantic partners, for
example, can have their evolutionary fates linked by the potential to raise a common offspring—which will
unite the reproductive outcomes for both. Long-standing neighbors, coworkers, or individuals in groups (e.g.,
soldiers, team members, countries, ideologies) can also have their evolutionary fates linked by circumstance—
especially if there is a salient benefit or threat affecting all equally.
When evolutionary fates are shared through interdependence, there is a positive correlation in fitness-
related outcomes—so that when the welfare of one person increases, it directly increases the welfare of the
other. This can occur along two dimensions—the extent of the need/dependence on the other, and the
equality of that dependence. Strangers on an airplane, for example, have the potential for fitness
interdependence because the environment creates a shared, equivalent survival outcome—however, there is no
dependence unless there is a threat posed, such as mechanical failure or severe weather that endanger
occupants of the airplane.

Minimizing the Threat of Exploitation

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 What is critical about fitness interdependence is that it is uniquely equipped to counter selection pressures
for exploitation, a risk to the reproductive fitness of those who sacrifice to help others. What do we mean by
this? Evolutionary theories of helping behavior have been plagued by the problem of exploitation. This is
because helping behavior leaves the door open to those who will take help from others but not give in return.
It is easy to imagine how quickly “takers” would survive and reproduce, at the expense of “helpers,” because
they are able to use other people (i.e., “helpers”) to meet their own survival needs. This poses a challenge to
evolutionary theories of altruism that need to explain how genes for altruism can evolve amidst shark-infested
pools of potential cheaters.
The problem of exploitation may be addressed reasonably if individuals are able to identify (and selectively
cooperate with) kin and reciprocal altruists; but the problem is increased exponentially by introducing other-
focused motivational states such as love, empathy, compassion, or the “social bond.” The “social bond,” as
defined within selective investment theory, is hypothesized to be a motivational mechanism for suppressing self-
interest, over the long-term, at a high cost to the self, and even in the absence of reciprocity. Such a
mechanism would be a highly prized target for someone willing to cheat—ensuring substantial, material
benefit for a cheater over the long term. States of fitness interdependence, however, insure against this
possibility, because a positive correlation in reproductive outcomes creates a circumstance in which any
attempts to exploit the helpers would have been just as lethal to cheaters as to those exploited. Hence,
exploitation could not have been selected for under these circumstances. We are collectively aware of this
general prohibition against cheating when we suggest that individuals be careful to avoid “biting the hand that
feeds you.” Thus, fitness, for everyone, is maximized when individuals are able to recognize states of fitness
interdependence and avoid exploitation in those instances.

Social Bonds
According to selective investment theory, “cues” for fitness interdependence constitute a safety signal that
permits an other-focused orientation (empathy, love, connection). The perception of interdependence
provides an evolutionarily realistic basis for establishing social bonds that, in turn, drive costly, long-term
helping behavior. The physiological substrate of the “safety” signal may well be the vagus nerve (see Porges,
this volume), allowing for social engagement and approach orientation in general, but also “other-focused”
motivation in particular. Because of the stranglehold that exploitation threats are likely to pose to other-
focused motivation (i.e., discouraging other-focused motivation), we hypothesized that the initial activation of
this system begins with detecting authentic cues for vulnerability or need in others (who are not in a position
to pose an exploitation risk; Brown & Brown, 2015; Preston, 2013). We have referred to this basic system
that orients to the needs of others as a caregiving system. The caregiving system accommodates either short-
term, single instances of helping those in need, or longer-term, reliable, high-cost helping behaviors, such as
parenting or caring for a sick or disabled loved one. According to selective investment theory, the latter case
requires more than “cues” for vulnerability or fitness interdependence. Costly, long-term investment in
another person requires an overarching emotion-regulating mechanism (i.e., the social bond) that minimizes
and resolves motivational conflict between self and others. More specifically, we view the social bond as a
dynamic memory complex with cognitive, neurohormonal, and affective features—associated with feelings of
unconditional love and connection. Hypothesized neurophysiological substrates of the motivational

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architecture of bonds include neurohormones such as oxytocin (see Carter, this volume), which facilitates the
emergence of social bonds, the inhibition of fight-or-flight responses to personally threatening situations, and
the onset of parental and other forms of helping behaviors (S. Brown & R. Brown, 2006). As mentioned
above, the considerable threats of exploitation led us to propose that states of fitness interdependence are a
necessary precursor to the development of the social bond. Once the bond is formed, however, fitness
interdependence is no longer necessary for the maintenance of the bond or for helping behavior, as in the case
of giving up time and resources to care for a loved one who is terminally ill, even if the loved one is not a
biological relative.

Stakeholder Theory
About the same time that we were developing selective investment theory, a behavioral ecologist, Gil
Roberts (2005), was independently formulating a very similar account of the evolution of altruism—stakeholder
theory. His theory is mathematically identical to the fitness interdependence component of selective investment
theory. Through mathematical modeling, Roberts demonstrated that helping behaviors based on rules of
shared evolutionary fates (interdependence) can overtake a population of cheaters, or populations of tit-for-tat
cooperators. Although Roberts did not address instances of long-term helping or social bonds, his theory of
interdependence, like our own, identifies the underlying evolutionary logic that unites kin selection and
reciprocal altruism. As Roberts describes, helping based on interdependence subsumes both kin selection and
reciprocity in describing circumstances in which helping behavior could have enhanced reproductive success.
A linkage in the reproductive outcomes of non-reciprocators, non-relatives, and even strangers protects
against the potential costs of exploitation, and ensures that these costs are offset by the advantages of
cooperation. Importantly, both stakeholder theory and selective investment theory find the origins of cooperation
and altruism in parental care (see Preston, 2013), thereby reversing the theoretical landscape in favor of the
groundwork laid by Kropotkin, asking, not how compassion might have evolved from selfishness, but rather,
how selfishness evolves from compassion (R. Brown & S. Brown, 2006).

Motivation Within Social Relationships

There is nearly universal agreement that human motivation is often selfish, characterized by impulses to
seek pleasure and avoid pain. What is in question is whether humans are also capable of other-focused,
compassionate feelings that lead to helping behavior and cooperation. Although the implications of
evolutionary insights now suggest that the answer is “yes” to this question, this answer emerged only gradually,
and ironically, from the work of early motivational theorists, such as Freud (1856–1939) and Hull (1884–
1952) who probably would have answered “no.”
Freud and Hull tethered motivation to the satisfaction of basic needs. As learning theory and behaviorism
came to dominate the field of psychology in the 1930s and 1940s (Hull, 1943; Skinner, 1938), the construct
of motivation was described in terms of reinforcement and punishment—the strengthening (or weakening) of
responses by pairing them with pleasurable (or aversive) stimuli. According to learning theory, prosocial
motivation and behavior in close relationships could be understood in terms of secondary (conditioned)
reinforcement. Secondary reinforcement is a process whereby an initially neutral stimulus (e.g., the sound of a
bell) can strengthen a response by virtue of the fact that the stimulus has been paired with a “primary”

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reinforcer, a stimulus that can strengthen a response because it is naturally pleasurable (e.g., food), or naturally
relieves an aversive state (e.g., pain reduction). For example, according to learning theory (Dollard & Miller,
1950), an infant’s emotional attachment to her mother is best understood as a response to a conditioned
stimulus, learned through both classical and operant conditioning. The focal point of this learning is the
feeding situation, as was the case in Freud’s characterization of infant attachment. Through nursing, infants
learn to associate Mother (a neutral stimulus initially) with the reduction of hunger (an unconditioned
pleasurable response). In effect, this promotes a “secondary drive,” motivating the infant to want to be close to
Mother even when she is not feeding. In operant conditioning terms, the mother becomes a conditioned (or
secondary) reinforcer for the infant’s behavior. Although learning theory and Freudian psychoanalysis are
generally considered strange bedfellows, both theories agree on the concept of secondary motivation as an
explanation of prosocial emotions and behavior.
John Bowlby (1907–1990), a psychoanalyst, challenged the idea of thinking of love objects as secondary
reinforcers (1958/1969), based, in part, on the work of Harry and Margaret Harlow with rhesus monkeys.
The Harlows’ work argued against the idea that feeding was the centerpiece of love, and showed that there
was something unique about the infant–mother bond that could not be reduced to secondary reinforcement
(Harlow, 1958). Moreover, the Harlows were able to demonstrate, across a variety of experiments, that
maternal deprivation created serious social and physical problems for the infant, despite the fact that the
infant’s primary (biological) needs were met (Harlow & Zimmerman, 1959). Both the Harlows and Bowlby
concluded that the motivation to stay close to a caregiver or an attachment figure does not hinge on the
reduction of primary drives such as hunger, but instead reflects a unique (attachment) motivational system,
shaped by evolutionary forces that enhance the infant’s protection and security.

The Caregiving System

Bowlby recognized that, complementary to an attachment behavioral system, evolution should have also
favored a system that motivates parents and other caregivers to provide security and protection to their infants.
He termed this motivational system a “caregiving behavioral system,” a suite of cognitions, emotions, and
motivations that compel a parent or caregiver to nurture and care for its young (Bowlby, 1969). According to
Bowlby, infant attachment experiences with a caregiver shape a “working model” of social relationships that
influences the caregiving behavioral system as an adult. If an infant’s needs are reliably met by a caregiver, then
the infant will internalize a “working model” of secure relationships, and this model will ultimately direct her
own caregiving motivation and behavior as an adult.
Bowlby and his colleagues paid considerably more attention to the “attachment” side of the equation than
to the caregiving side (Cassidy, 1999). Indeed, the “caregiving system” was largely ignored or neglected in
favor of studies examining how differences in infant attachment experiences create different types of
attachment working models, especially those based on security (Mikulincer & Shaver, 2003). Although there
are now various ways to categorize and organize infant attachment histories, the bulk of the attachment
literature remains focused on the effects of infant attachment experiences on attachment style or orientation
(secure, insecure), and on the behavioral, cognitive, and social effects of secure and insecure attachments on
the developing child. Only within the past two decades have there been systematic attempts to understand and
explore (1) how attachment bonds influence adult caregiving and compassion (Mikulincer and Shaver, this

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volume; Mikulincer, Shaver, Gillath, & Nitzberg, 2005); and (2) how the caregiving system works (S., Brown
& R. Brown, 2006; Brown, Brown, & Preston, 2012; Brown & Brown, 2015; Collins, Ford, Guichard, Kane,
& Feeney, 2010; George & Solomon, 2008; Preston, 2013; Solomon & George, 2011).

How Does the Caregiving System Work?

Our own recent effort to describe the neurobiology of the caregiving system stemmed from a larger body of
work in health psychology that had stumbled upon a critical connection between social relationships and
mortality. It appeared that people in close relationships live longer than people who are socially isolated.
Harlow’s social-deprivation experiments with monkeys, together with observations of socially deprived human
children in institutional settings (e.g., Goldfarb, 1945; Spitz, 1945, 1946), were among the first to raise the
possibility that critical aspects of social relationships had profound effects on the health and well-being of
relationship partners—ostensibly through effects on physiology. It would turn out that the health effects of
social relationships could be traced back to “other-focused” motivation and helping behavior. However, the
process of connecting helping behavior to health was not straightforward; rather, it emerged as a novel
hypothesis stemming from a mystery—one brought to light by a pioneering article in Science (House, Landis,
& Umberson, 1988). After reviewing experimental non-human work and correlational, large-scale studies in
humans, House et al. concluded that the health benefits of social relationships were as powerful as the health
effects of smoking, drinking, and exercise; however, the field of health psychology was blind with respect to
how and why social relationships may be protective.
After publication of this seminal piece, scientists responded positively to the challenge to discover how
social relationships protect health by testing the idea that it is the support received from others that improves
health and increases the life span—i.e., the “social support” hypothesis. Unfortunately, tests of this hypothesis
led to contradictory results. Sometimes receiving support was beneficial, but there were as many null findings,
and some showed that people receiving support had a higher risk of mortality than those not receiving support
(Brown et al., 2003).2 A meta-analysis of the link between receiving social support and health outcomes
revealed that, although receiving support was predictive of better relationship satisfaction, the presumed
association of receiving support and physical health was not reliable or generalizable (Smith et al., 1994). In
2001, House reiterated his thesis that, although we know that social isolation kills, we do not yet know how
and why (House, 2001).

A Novel Hypothesis Connecting Close Relationships to Physical Health

In an effort to address the mystery of how social relationships promote health, we used selective investment
theory to hypothesize that the health benefits of social relationships reside in the contribution made to
relationship partners—helping behavior—as opposed to the support received from the partner. The first direct
test of this hypothesis was supportive, demonstrating a 30–60% reduction in mortality risk among helpers
relative to non-helpers (Brown, Nesse, Vinokur, & Smith, 2003). Our own attempts to replicate these
findings were successful (Brown et al., 2009a; Brown, Brown, House, & Smith, 2008), as were independent
attempts (Brown, Consedine, & Magai, 2005; Roth et al., 2013). There is now a growing area of research
demonstrating that helping in the form of providing social support, caregiving for an ill family member, and
volunteering are often associated with better health and mental health outcomes for the helper (see Brown &

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Brown, 2015, a for recent review).

The Mystery Remains

Despite these findings, mechanisms for understanding precisely how helping behavior is related to physical
health are poorly understood. This “gap” in our knowledge led us to begin to study the neurobiology of
helping behavior, with the goal of identifying potential bridges that would link “helping” neurophysiology to
factors that could influence longevity. We were drawn to so-called mammalian caregiving models, which can
be used to connect helping behavior to both (1) evolved neural circuitry and hormones underlying parental
behavior (e.g., Brown, Brown, & Preston, 2012; Preston, 2013; Brown & Brown, 2015); and (2) the
physiology of stress regulation and immune function (S. Brown & R. Brown, 2006; Brown & Brown, 2015;
Brown, Brown, & Preston, 2012; Eisenberger, 2013). Our own model (described hereinafter) was heavily
influenced by work with rodents on maternal caregiving (e.g., Numan, 2006) and by selective investment
theory (S. Brown & R. Brown, 2006).

Mammalian Models of Maternal Care

Mammalian models of the human caregiving system are grounded in animal research investigating neural
pathways that underlie maternal behavior. These models have been developed in rodents, but attempts to
generalize to non-mothers, including males, juveniles, and other species such as sheep and birds, have also
been successful (Numan, 2006). Together, these models highlight the role of the medial pre-optic area of the
hypothalamus (mPOA) in directing (motivating) parental behaviors, such as pup retrieval, nest-building, and
predator defense. This discovery was based in part on the fact that damage to the mPOA (or closely related
ventral bed of the strial terminals) disrupts parental behavior, but that it does not disrupt any other behaviors
that are under control of the hypothalamus, such as locomotion, temperature regulation, and feeding. On the
other hand, reward regions in the brain that are also part of the caregiving circuit do not appear to be
necessary for maternal behavior to occur, as damage to these areas (e.g., nucleus accumbens) does not
necessarily disrupt maternal behavior.

Our Model of the Caregiving System

Our model (Brown, Brown, & Preston, 2012; Brown & Brown, 2015—see Figure 13.1) depicts a
neurobiological model of the caregiving system that is grounded in both selective investment theory and
Numan’s (2006) model of maternal care. We have hypothesized that, when the threat of exploitation is low,
helping behavior in humans occurs via increased activation of the mPOA. In light of the existence of oxytocin
(OT) receptors throughout the caregiving neural circuit (i.e., amygdala, hypothalamus, nucleus accumbens),
we and others (e.g., Numan, 2006) have hypothesized further that OT increases the binding potential (the
salience) of this brain region.
Theoretically, OT enables the regulation of fear and avoidance motives, which might otherwise interfere
with helping behavior. Indeed, evidence suggests that OT plays an important role in stress regulation (Carter,
1998). Stronger activation of the mPOA tends to suppress fear and avoidance motivation—that is, it
interrupts the sympathetic stress response. According to Numan (2006), the mPOA interferes with stress-
responding by inhibiting the anterior hypothalamic nucleus and/or sending inhibitory signals to the

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periaqueductal gray, neural interconnections between the forebrain and the lower brain stem. In this way, the
caregiving circuit, primed by OT, is well positioned to interrupt stress (i.e., accelerate recovery from stress). In
fact, signals from the amygdala—olfactory and non-olfactory cues—trigger mPOA activation in the first place
(Numan, 2006). We have theorized that this occurs because need in others should trigger the arousal system
to motivate a helping response (Brown & Brown, 2015).

Figure 13.1 Caregiving system model of hypothesized links between prosocial behavior and physical health (Brown & Brown 2015).

A more controversial pathway by which the mPOA is hypothesized to motivate helping behavior is through
the approach circuit. This is controversial, because animal models disagree on whether the mPOA influences
motor programs for helping via reward centers in the brain. Specifically, there is consensus that the mPOA
activates the nucleus accumbens—a brain region known for dopamine release and triggering reward centers—
which, in turn, signals the ventral pallidum (a motor region) to engage a helping response. However, there is
some disagreement over how this is accomplished. Some models (e.g., Preston, 2013) suggest that the mPOA
stimulates the nucleus accumbens, which, in turn, releases dopamine that activates reward centers and
approach motivation and behavior. In effect, helping is motivated by anticipating the rewarding consequences
of rescuing those who may be in need of help, such as mothers’ anticipating pleasurable physical and social
contact contingent on retrieving their offspring. Alternatively, helping behavior may be driven by mPOA
inhibition of the nucleus accumbens (Brown & Brown, 2012; Numan, 2006). Because the nucleus accumbens
normally inhibits the ventral pallidum, and the ventral pallidum normally initiates programs for motoric
caregiving responses, the mPOA’s inhibitory effect on the nucleus accumbens may result in disinhibition
(facilitation) of helping responses. On a behavioral level, inhibition of the nucleus accumbens suppresses
anticipation of reward, thereby enabling the ventral pallidum’s activation of helping behavior. This neural
scenario dovetails nicely with the idea that decisions to direct costly help to others, of necessity, require
inhibition of competing self-interested responses (S. Brown & R. Brown, 2006; Sober & Wilson, 1998).
On the surface, this controversy may appear tangential or unnecessarily technical. However, it is pivotal in
determining whether and how helping behavior can occur in the absence of reward. Our own model
hypothesizes that reward-inhibition neural circuitry is a necessary component of the caregiving neural circuit.
Otherwise, reinforcement motives would be sufficient to explain all instances of helping behavior. We have
argued that such motives are insufficient precursors to helping others because they start and stop with the
reward value from helping—such a mechanism would leave others in need, especially children, without the

224
necessary care. Despite the disagreements over the role of reward neural circuitry, there is consensus among
models (i.e., Brown, Brown, & Preston, 2012; Preston, 2013; Brown & Brown, 2015) that stress-regulation is
critical for activating a helping response. Moreover, these models also similarly posit cortical input from the
orbital frontal cortex (mOFC) and the subgenual anterior cingulated cortex (ACC), as top-down regulators of
compassionate or empathic (i.e., caregiving) responses (Brown, Brown, & Preston, 2012; Preston, 2013).

Significance of Stress-Regulation
If stress-regulation is critical for activating helping behavior, then any reduction of stress that accompanies
helping others may produce health benefits for the helper, potentially resulting in a longer life span. The
significance of stress-regulation cannot be overstated. Studies show that prolonged activation of the stress
response can undermine regulation of the immune system (McEwen, 2007). In essence, individuals who are
consistently exposed to stressors in the environment can develop a reduced sensitivity to cortisol, the stress
hormone that would normally regulate and turn off the immune response. Insensitivity to cortisol exposes the
individual to a toxic immune environment, and triggers the development of chronic inflammation (Jenny,
2012), contributing to disease (e.g., cancer, heart and lung disease, Alzheimer’s disease, diabetes) and elevated
risk of mortality (Heron, 2016). It stands to reason that mechanisms that regulate stress may well enhance
immune system functioning, producing dividends for health, well-being, and longevity.

Empirical Tests of the Brown, Brown, & Preston (2012) Caregiving System Model
Results from prospective studies are consistent with the possibility that the caregiving system benefits
health via stress regulation. A reanalysis of the data from the Brown et al. (2003) study of helping revealed a
30% relative increase in mortality risk for each stressful life event encountered, but only for individuals who did
not help others in the prior year. Among helpers, there was no association between stress and mortality risk
(Poulin, Brown, Dillard, & Smith, 2013). These findings suggest that the harmful effects of exposure to stress
can be reduced for individuals who help others. A similar pattern of results was also obtained for the
relationship between helping behavior and depressive symptoms that accompany bereavement. Among
individuals who had lost a spouse, helping behavior decreased depressive symptoms over time, but only for
those with a heightened grief (stress) response (Brown, Brown, House, & Smith, 2008).
Evidence that the mental and physical health benefits associated with helping are due to motives associated
with caregiving, as opposed to other reasons for helping (e.g., seeking pleasure, avoiding pain), comes from
longitudinal studies of older adults. Among older adult volunteers, for instance, the type of motive for
volunteering (other-focused versus self-focused) determined whether there were mortality benefits associated
with volunteering (Konrath, Fuhrel-Forbis, Lou, & Brown, 2011). Specifically, individuals who stated that
they volunteered for reasons such as social connection and caring about others (other-focus) showed reduced
mortality risk relative to non-volunteers; individuals who stated that they volunteered for reasons such as
learning more about themselves (self-focus) did not differ from non-volunteers in their mortality risk.
In a direct test of selective investment theory, Alzheimer’s caregivers who participated in a study of their
helping behaviors showed higher levels of positive emotions associated with their helping behavior if they felt
interdependent with the recipient (Poulin et al., 2010). In other words, it was interdependence (i.e., feelings
of needing the recipient as much as the recipient is in need) that determined whether helping behaviors

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produced positive emotional states. This finding suggests that the consequences of helping behavior are
tethered to the caring feelings or social connections between individuals.

Are There Other Avenues for Helping-Related Health Benefits?

Although empirical tests of our caregiving system model have been supportive, the model relies heavily on
the central importance of stress-regulation as a mechanism linking helping behavior to improved physical
health. This hypothesis is based on both the neural arrangement of the mPOA with the sympathetic stress
response, and the involvement of neurotransmitters such as OT in regulating stress. However, as we reported
in our 2015 review article (Brown & Brown, 2015), the relationship of OT to stress-regulation is complex and
involves other candidate hormones that also have the potential to play a role in longevity and well-being. Next
we describe the possible avenues by which OT may augment health-related benefits associated with helping
behavior.

Oxytocin
Since the late 1980s, OT has been considered to be the neuroendocrine basis of social bonds, especially
child–parent and romantic attachments (Carter, 1998). This conclusion was inescapable after repeated
demonstrations that experimental injections of OT created partner preferences that were enduring across time
and contexts in many different species of social mammals. OT has also been experimentally linked to the
onset, but not to the maintenance of, parental and other forms of prosocial behavior (see S. Brown & R.
Brown, 2006). Together, this work implicates OT as a neurotransmitter that creates or initiates long-term
changes in the brain that facilitate motivational states, such as compassion, that trigger self-sacrifice (reviewed
in S. Brown & R. Brown, 2006).
Consistent with our model linking activation of the caregiving system to stress-regulation, OT has stress-
regulating capabilities. For example, OT has been shown to decrease blood-pressure and the stress hormone
cortisol (Uvnäs-Moberg, 1997, 1998a, 1998b), reduce adrenocorticotrophic hormone (ACTH) (Parker et al.,
2005), and decrease the functional coupling in the brain between two regions involved in the stress response—
the amygdala and the periaqueductal gray (Kirsch et al., 2005). Note, however, that OT has a paradoxical
relationship to stress, potentiating fear responses under some circumstances (Grillon et al., 2013; Striepens et
al., 2012), and increasing ACTH (Gibbs, 1986; Link et al., 1992) and heart-rate and blood pressure (Richard
et al., 1991).
A similar paradox has been shown between OT and the stress-regulating hormone progesterone (Childs et
al., 2010). At high doses, OT has been shown to decrease progesterone. However, at low doses, OT has been
shown to trigger the release of progesterone (Barrett & Wathes, 1990; Berndtson et al., 1996; Chandrasekher
& Fortune, 1990; Miyamoto & Schams, 1991; Tan et al.,1982a, 1982b). This complex relationship between
OT and stress-regulation suggests that, at the very least, OT is not universally beneficial for stress-regulation,
inviting the possibility that other hormones, such as progesterone, could also play a role in linking helping
behavior to physical health.

Progesterone
We were intrigued by OT’s relationship to progesterone because progesterone plays a role in maintaining

226
physiological homeostasis (Bitzer, 2009), including promoting immune system regulation (Jain et al., 2004;
Tamura et al., 2011). Although it has been primarily studied for its role in reproduction, as a female sex
hormone, evidence suggests that it is released in both males and females in the central nervous system.
Progesterone increases in both men and women following exposure to a social affiliation induction
(Schultheiss, Wirth, & Stanton, 2004); it increases in women following a closeness induction (Brown et al.,
2009b), and its metabolites restore hypothalamic-pituitary-adrenal (HPA) axis function after stress (Childs, et
al., 2010). Evidence that progesterone may play a role in compassion comes from a study of social closeness in
which progesterone levels predicted participants’ self-reported willingness to risk their lives for their partner
(Brown et al., 2009b).
The possibility that both OT and progesterone are involved in the development of social bonds, the
initiation of “other-focused” motivation and behavior, and stress-regulation led us to hypothesize that helping
behavior increases longevity and well-being, in part, through interactions between OT and progesterone. We
are currently testing this possibility, and thus far, our preliminary studies have shown that when people help
someone they care about, there is a strong, positive correlation between OT and progesterone (Brown et al.,
2016).

Social Rejection and Stress-Augmentation: Eisenberger’s 2015 Mammalian Caregiving Model

A complementary model of the possible links between compassion and health focuses on threats to social
connection, especially non-compassionate behaviors typical of social rejection (Eisenberger & Lieberman,
2004). The similarities between the physical pain network and the psychological stress reaction to social
rejection have been used to predict that social relationships and compassion benefit health by preventing
exposure to significant levels of stress upon experiencing rejection by others (Inagaki & Eisenberger, 2016).
Although not directly focused on compassion per se, the model is grounded in mammalian caregiving and
describes the severe threats and reproductive consequences for individuals who feel rejected within their social
relationships. A similar point has been made about the link between feelings of loneliness and physical health
(Cacioppo & Patrick, 2008)—notably, that social relationships are protective because they reduce exposure to
the stress-augmenting features of social isolation and loneliness.
Together these models underscore the importance of social connection and compassion for stress-regulation
and physical health because they suggest that it is the isolated and/or socially rejected person who will
experience a stress response that is virtually indistinguishable from physical pain. Thus, these individuals will
have greater exposure to a prolonged stress response, and hence the sequela of disruptions to immune function
that can lead to disease and death.

Implications of Compassionate Neurobiology for Health and Well-being

The possibility that social connections and compassion have the power to alter stress-regulation in ways
that are healthy offers promising new directions for medical research, including knowledge of disease
pathways, studies of mental health, and the development of behavioral health interventions.

Disease Pathways
Models of chronic inflammation tied to dysregulated immune function are now being used to understand

227
the causes and accelerators of the most lethal forms of disease, including cancer, heart disease, and lung
disease. Chronic inflammation models may also help us better understand senescence, through the
accumulation of insults to homeostatic balance of the immune system (Weinert & Timiras, 2003). There is an
intriguing theory of the development of lethal forms of cancer that illustrates the central and critical
importance of maintaining immune system balance. Specifically, interleukin-6 (Il-6), a proinflammatory
cytokine, is recruited when there is injury or damage to a cell, which mobilizes stem cells to repair the damage.
The delicate nature of stem cell repair requires many signals coming from the immune system to be turned
off. Il-6 sends a signal to turn off aspects of the immune response to protect the generation of new tissue.
Unfortunately, in the case of lethal cancer, this can lead to overgrowth of a tumor, which triggers even greater
release of Il-6 to repair damaged tissues. This lethal feedback loop is thought to be one of the reasons that
cancer is so difficult to treat. Experimental interruption of this loop results in substantially reduced tumor size
and lowered mortality risk (Korkaya, Liu, & Wicha, 2011; Korkaya et al., 2012).
Models of compassionate neurobiology may provide insights into natural ways of interrupting the
development of lethal forms of cancer, and possibly other diseases that are influenced by chronic
inflammation. To the extent that compassionate motivation and behavior interrupt stress, they naturally
protect against developing a resistance to cortisol, which maintains the integrity of the hormonal system that
regulates immune function. Furthermore, our own caregiving system model highlights the possibility that
progesterone is released in response to OT and mPOA activation. Progesterone regulates physiological
homeostasis in the body and is related to particular cytokines in ways that may protect against oxidative stress,
including inhibiting Il-6 (Brown & Brown, 2015).

Mental Health
On a behavioral level, models of compassionate neurobiology underscore the importance of social
relationships, social connection, feelings of acceptance, social approval, and making a contribution to others.
These models are explicit with respect to the social behaviors that should regulate psychological stress, as well
as the types of behaviors that can augment stress in others, such as social rejection and evaluation (Eisenberger
& Lieberman, 2004). At a physiological level, the regulation of stress through hormones such as OT and
progesterone may yield psychological and mental health benefits as well as physical health benefits.
Progesterone and its metabolites are known for restoring gamma-aminobutyric acid (GABA) tone to the
HPA stress response following a stressor. For this reason, compassionate behaviors that are accompanied by
changes or increases in progesterone may improve an individual’s resilience to stressful life events and internal
states that may give rise to mental health problems.

Behavioral Interventions
Models of compassionate neurobiology suggest that low-cost, noninvasive ways to improve resilience to
stress and disease can come from activities or opportunities that involve helping someone who is familiar or
close. Efforts to adopt the perspective of companions, to build social connections, to inhibit communications
of rejection or isolation to relationship partners, and to find ways to meet the needs of relationship partners
could be avenues for maintaining the homeostatic balance of internal systems we use to combat stressful life
events, disease, and injury. And these interventions may go further than improving the physical and mental

228
health of individuals and communities. Increasing an individual’s sense of social connection and contribution
may also benefit academic performance, stimulate creative pursuits, and contribute to career success.

Conclusion
Although the study of compassionate neurobiology is in its infancy, this new field may pave the way for a
better understanding of how social connections can be protective. As new technologies emerge for testing
subtle and nuanced predictions from competing explanations, we will begin to learn more about noninvasive
ways to fight disease and improve mental health. And taking center stage in this new research direction is
compassion. As this volume brings to light, compassion may be a bridge connecting and integrating diverse
fields within and across science and medicine (e.g., social genetics, Cole, this volume). Although Kropotkin
may have been ahead of his time, his ideas, together with technologies that permit us to explore the
architecture of the brain, may be teaching us the true power of his compassionate, paradigmatic view of
human nature.

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Notes
1. Some multi-level selection theories have considered motivation (Sober & Wilson, 1998), but these theories typically rest on the highly
controversial assumption that the prime targets of natural selection are groups, not genes. However, influential mainstream evolutionary
biologists have questioned the idea that selection between groups can be a strong evolutionary force (Williams, 1966; Maynard Smith,
1976), mainly because between-group selection must overcome within-group tendencies to exploit altruists. Moreover, group selection
accounts tend to be imprecise in their specification of what constitutes a “group” (Pinker, 2012), and less parsimonious than gene-centric
theories. At the same time, group selection accounts make no unique predictions about the evolution of altruism (West et al., 2007).
2. And this makes sense conceptually because people receiving support can be sicker, or can feel dependent or like a burden to others, which
has been shown to be associated with higher levels of anxiety and even suicidal behavior (see Brown et al., 2003, for a discussion of this
issue).

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 The Roots of Compassion An Evolutionary and Neurobiological Perspective

C. Sue Carter, Inbal Ben-Ami Bartal, and Eric C. Porges

Abstract

Compassion for others and social support have survival value and health benefits. Although compassion
is sometimes considered uniquely human, critical components of compassion have been described in
nonhuman mammals. Studies originally conducted in social mammals and now in humans have
implicated neuropeptide hormones, especially oxytocin, in social cognition, a sense of safety, and the
capacity of sociality to permit compassionate responses. In contrast, the related peptide vasopressin and
its receptor may be necessary for forming selective relationships and for the apparently paradoxical effects
of oxytocin, which can include increases in fear and avoidance. Oxytocin and vasopressin may contribute
to sex differences in compassion. Furthermore, among the processes through which oxytocin and
vasopressin influence behavior and health are complex effects on the autonomic nervous system.
Knowledge of the mechanisms underlying the benefits of compassion offers new insights into the
healing power of positive social behaviors and social support.

Key Words: compassion, helping behavior, oxytocin, vasopressin, autonomic nervous system, sex
differences, evolution, neurobiology

Overview
This chapter reviews neurobiological mechanisms implicated in compassion through the lens of evolution.
While defense behaviors are typically viewed as having a critical role in survival and reproduction, the
evolutionary benefits of prosocial behaviors, including compassion for the suffering of others, are not as widely
recognized. Yet prosociality is a primary component of social behavior among many species, and it has many
advantages for groups and individuals. A sense of caring for others can have beneficial emotional, intellectual,
and health consequences. Groups in which individuals act for the benefit of others are more likely to thrive.
These effects may extend from the individual to society in general, and knowledge of these systems holds
relevance for the survival of our species.
Compassion is sometimes considered uniquely human (Adolphs, 2006). Indeed, humans have complex
cognitive processes and the ability to take the perspective of others (Lamm et al., 2008; Decety & Porges,
2011). Embedded in these processes is a sophisticated capacity for compassion, including witnessing or
attempting to alleviate the pain of others. However, components of compassion also exist in nonhuman
species, and research in other mammals helps us understand the neurobiological substrates of compassion.
Here, we conceptualize compassion as an effective mechanism to motivate helping behavior in humans, and
argue that a simple form of compassion may drive helping in other species as well. As evidence of the
universality of positive social behaviors that resemble compassion, we provide a specific case of helping

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behavior in rats.
Recent evidence suggests that mammalian neuropeptides, including oxytocin and the related peptide
vasopressin, play a central role in the capacity for and expression of social traits and emotions. Primitive
molecules that are essential to life on earth are used and reused in many biological contexts, ranging from the
union of hormones with receptors, through to complex societal and cultural practices. Understanding the
neurobiology of oxytocin and vasopressin and their receptors also may help refine and more accurately predict
individual differences in the outcome of attempts to study or enhance compassion.

Definitions of Compassion
Compassion is defined in this volume as “sensitivity to the pain or suffering of another, coupled with a deep
desire to alleviate that suffering” (Goetz, Keltner, & Simon-Thomas, 2010). If compassion is operationally
defined to include contingent social responses to emotional expressions of pain, fear, or hunger (such as
isolation calls and hunger cries), then components of these, such as approach, consolation, and helping
behaviors, are detected in the repertoire of many vertebrates, ranging from primates to rodents.
Compassion and the related concept of empathy are usually presented as psychological constructs,
describing feelings, expressions, and behaviors that enable individuals to recognize, perceive, and respond
appropriately to the emotional states of others. There is now a converging agreement that compassion and
empathy involve complex socio-emotional competencies. For example, empathy encompasses different
components, including empathic arousal and empathic concern (Decety et al., 2012). Empathic arousal, which
refers to the unconscious contagious sharing of affect, is the first building block of empathy to appear during
ontogeny (Decety & Michalska, 2010; Michalska et al., 2013; Roth-Hanania et al., 2011). In turn, individual
levels of compassion and empathy may be associated with individual differences in arousal experienced while
viewing others in physical distress. It is also possible to use a combination of psychophysiological and
behavioral measures to differentiate constructs such as arousal and concern from each other. In the analysis of
compassion, issues and techniques similar to those studied in empathy may apply.

Social Behaviors, Including Compassion, Are Evolved Traits

The powerful consequences of the presence or absence of others are seen as shaping forces in evolution.
Social interactions and within-species interdependence are universal components of life on earth. Even single-
cell bacteria are more reproductively successful in the presence of others of their own species. The
sophisticated expression of, or full experience of, compassion depends on cognitive processes and cortical
capacities that are unique to humans. However, behaviors resembling compassion, empathy, and consolation
have been described in other social species as diverse as bonobo chimpanzees (Preston & de Waal, 2002),
domestic rats (Ben-Ami et al., 2011), and prairie voles (Burkett et al., 2016).
The basic neurobiological elements necessary for compassion, and other forms of sociality, exist in some
rudimentary form in many species. The neocortex, which varies widely among species and individuals, is not
the sole source of social cognition. Processes that rely on the more conserved brainstem and autonomic
nervous system are essential to prosociality. Furthermore, the affective experiences associated with positive
sociality and helping may be major motivators of rewards for prosocial behaviors in non-human animals.

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Mammalian Reproduction as an Evolutionary Prototype for Compassion
As mammals evolved, they became increasingly dependent on social cues and social support from others,
usually of their own species. Social behaviors allowed mammals to more safely eat, digest, sleep, mate, and
care for their dependent young. The processes that led to the evolution of mammalian social engagement and
communication, and in some species compassion, were associated with the evolution of the neurobiology of
the central and autonomic nervous systems (Porges, 2011; Porges, this volume).
The neural substrates of emotions are shared across many species (MacLean, 1990). These same systems
are involved in various aspects of reproduction, including social contacts and preferences, sexual behavior, and
the basic biology of motherhood. Young altricial mammals depend on their mothers for prenatal and postnatal
nourishment. The postnatal interaction between mother and infant involves highly conserved patterns of
physiology and behavior that may serve as prototypes for mammalian sociality. The circuits involved offer the
potential for selective responding to individuals of the species, such as a mother to her offspring, which
probably did not exist in the reptilian ancestors of modern mammals. Furthermore, most humans not only are
attracted to babies in general, but also may become quickly and selectively emotionally bonded to their own
baby. Behavioral and emotional selectivity, which are essential to social bonds and mothering, also may be in
some cases features of human compassion.

Helping Behavior in Nonhuman Animals

Prosocial actions meant to benefit others are adaptive and are found across multiple taxa and species. As
specific evidence of the evolved nature of the response to distress in others, we offer the following examples.
For instance, research shows that ants will help other ants by releasing them from a foot-snare (Nowbahari et
al., 2009). Chimps will help a human experimenter retrieve an object that is out of reach (Warneken &
Tomasello, 2006), and demonstrate targeted helping (Yamamoto et al., 2012). Bonobos show consolation
behavior in response to signs of distress from others (Clay & de Waal, 2013). Elephants (Lee et al., 2016) and
hyenas (Owens & Owens, 1984) show non-parental care of young. Bats share food with disabled conspecifics,
despite little chance of receiving anything in return (Wilkinson, 1984). Ravens delay eating in order to alert
others to the location of food (Heinrich & Marzluff, 1995). Many other instances of helping, communal
nesting, and allomothering have been documented (Ben-Ami et al., 2014; Dugatkin, 1997).
In humans as well as other mammals, an affective response to another’s distress can motivate prosocial
behavior. Humans and other mammals can experience the pain and distress of others as aversive. This
affective experience is a crucial component of helping to motivate the desire to end the distress of others.
Affective resonance, particularly the transfer of distress between individuals, exists in many nonhuman
animals, and can be thought of as a basic form of empathic arousal. As described later, a growing body of
evidence points to shared biological elements for compassionate arousal in human and rodents, including
homologous brain regions, and the autonomic and endocrine mechanisms (Panksepp & Panksepp, 2013).
Moreover, as in humans, the expression of helping behavior in rodents is higher in females and stronger for
familiar others versus strangers (Decety et al., 2016). Thus, it is not unreasonable to posit that emotional
arousal experienced in response to another’s distress can motivate animals to help a conspecific.
Helping behavior has been demonstrated in laboratory rodents. For example, rats will refrain from pressing
a lever that shocks a conspecific, press a lever to relieve a rat dangling in midair, reciprocate food sharing,

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prefer mutual reward to selfish reward, and release a cage mate trapped inside a restrainer in a paradigm
termed the “helping behavior test” (Decety et al., 2016). For this test, rats are exposed to a trapped conspecific
for daily, one-hour sessions. The restrainer has a door that could be opened from the outside, by the observer
rat alone. The trapped rats are not in physical pain and are able to turn around inside the restrainer, yet they
typically try to escape the restrainer and appear to experience distress. The free rats exposed to a trapped
conspecific demonstrate a movement pattern consisting of repeated approaches to the trapped rat, touching
the trapped rat with their snout through holes in the restrainer, digging and biting at the restrainer, and
attempting to reach the trapped rat. When tested with trapped cage mates, rats were motivated to end the
distress of the trapped cage mate, and learned to open the restrainer in about five sessions. The behavior may
first occur accidentally, but it becomes intentional, as is evidenced by the use of a consistent method for
opening the restrainer, with short latency, and a delay in the freezing initially caused by the door falling over.
The opener rats also manifested increased activity in the minutes following door-opening, and often urinated
on the restrainer door, an apparent expression of dominance. Once rats learned how to open the restrainer,
they did so quickly and intentionally in following sessions. This suggests that door-opening is reinforcing.
Rats do not open an empty restrainer or one containing a toy rat, indicating that the presence of the trapped
rat, rather than the restrainer itself, is the motivator for door-opening.
Rodents are highly social animals, and, like humans, rats find social interaction rewarding; thus a possible
motivation for releasing the trapped rat is to gain social contact. To test this hypothesis, the researchers
checked to determine whether rats would still help a cage mate if contact after door-opening was prevented.
They found that contact was not necessary for the helping behavior observed in this paradigm. When rats
were released into a separate arena after door-opening, helping continued for a period of several months, until
testing had to be interrupted. Only by removing the trapped rat could door-opening behavior be extinguished.
Furthermore, when helping was pitted against access to chocolate chips, rats demonstrated helping behavior
and on the majority of trials, shared the chocolate with the trapped rat.
While arousal, possibly a negative affective response to another’s distress, is a critical component for rats’
helping behavior (Ben-Ami et al., 2016), it is possible that helping is rewarding for the rats, not merely
because it extinguishes a negative stimulus. Other social behaviors in rodents have been shown to be
dependent on brain regions involved in reward (Dolen et al., 2013; Gunaydin et al., 2014).
These experiments show that rats find releasing a trapped cage mate a rewarding act, and that they are
motivated to repeatedly help, intentionally and quickly, over many days, with no previous training, external
reward, or observable benefit to themselves. Yet all of these experiments were conducted on cage mate pairs,
who were highly familiar with each other and returned to the same cage following testing. The researchers
wanted to know how rats would interact with strangers, and others who were different from them.
One of the most defining aspects of motivated helping in humans is the bias for in-group members. We are
more motivated to help others from our own group. There is not much known about the biological basis for
this behavior. To test how helpful rats would be in different social situations, the experimenters tested rats
with trapped strangers, and found that rats were as helpful to strangers as they were to cage mates. Yet these
rats were all from the same Sprague-Dawley strain, meaning they are nearly genetically identical. So, the next
experiment tested rats with cage mates and strangers of a different strain, the black-caped Long-Evans rats.
While rats were motivated to release cage mates and strangers of their own strain, they did not open the

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restrainer for rats from another strain, with whom they were unfamiliar. But cage mates, rats who were housed
with a rat of the other strain, treated that rat as they did their own strain (Ben-Ami et al., 2014). Importantly,
rats then generalized this behavior, releasing strangers of the other strain. This shows that prosocial
motivation is flexible in rats and can be modified by social experience.
The finding that rats can learn to help others of another strain was encouraging and led to the idea that
prosocial motivation is actually determined by social experience, not genetic relatedness, as is sometimes
posited. To test if there is an inherent biological imperative to help genetically similar others, rat pups were
cross-fostered to mothers from another strain at birth, and raised to adulthood never meeting members of
their own strain. If rats possess some hard-wired knowledge of genetic similarity to others, they would be
expected to help others of their own strain as adults, even lacking any social experience with their strain. Yet,
when the fostered rats were tested with trapped strangers of their own strain as adults, they failed to release
them. They preferred instead to help their adoptive strain. From this surprising finding, we learn that the
biological identity has no power to induce prosocial motivation in rats; rather, it is the positive social
experience acquired with other animals that leads them to help those they know, and their group members. It
is important to note that prosocial motivation and identity are not one and the same. Rats are capable of
distinguishing the different strains, as is evidenced by their capacity to generalize to one strain and not the
other.
In conclusion, as has been demonstrated for humans and other animals, prosocial motivation in rats
depends on the social context. Social animals, including rats, demonstrate social memory and are able to
distinguish between individual conspecifics. The social classification of conspecifics, as familiar others or in-
group members, determines the affective response to their distress and prosocial motivation (Ben-Ami et al.,
2014).
Studies of this kind leave no doubt that nonhuman animals, as well as most humans, can sense and respond
to the emotions or experiences of others. It is interesting to consider whether these experiences are truly
homologous to those that humans describe or experience as compassion or empathy. Homology among these
experiences may be examined, in part, by understanding the evolution of, and biological mechanisms
underlying, these behaviors.

Oxytocin and Vasopressin: Building Blocks for Sociality and Bonding

Research on the evolved origins of compassion, and also empathy, has directed attention toward the
neuropeptides, especially oxytocin and vasopressin. These molecular and genetic building blocks for sociality
predate the evolution of modern vertebrates by an estimated 700 million years (Acher et al., 1995). Both
oxytocin and vasopressin evolved from a single peptide, vasotocin, thought to have primary functions in water
balance. Highly chemically reactive elements, such as the sulfur bonds found in oxytocin and vasopressin, give
these molecules exceptionally broad functions. The chemistry of the amino acids that compose oxytocin and
vasopressin allow them to be attracted to and attach to each other and to other substrates, including
compounds in blood and specific receptors in tissues throughout the brain and body (Martin, Davis, & Carter,
unpublished data). Thus, the metaphor of “bonding” extends from the simple to the complex, and from
molecules to molar components of behavior.
Molecules generated by ancient genes related to oxytocin and vasopressin have been implicated in social and

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sexual behavior in the tiny hermaphroditic nematode C. elegans (Garrison et al., 2012), although “sociality” in
worms is not likely to involve emotional states that correspond to human social experiences. Studies in
invertebrates suggest the broad involvement of neuropeptides in sociality across many unrelated species and
supports the primitive nature of these processes.
Oxytocin is particularly important to mammals because it facilitates mammalian sexual behavior, birth,
lactation, maternal behaviors, and social bonds (Marlin et al., 2015; Beery et al., 2016; Carter et al., 1995).
Oxytocin facilitates the birth process through powerful muscle contractions. Concurrently, oxytocin protects
the fetal nervous system during the stress of birth (Tyzio et al., 2006). Oxytocin also facilitates milk ejection
and thus lactation. Lactation and postnatal nurture, in turn, allow the birth of comparatively immature
infants. Milk also contains hormones and regulatory factors and facilitates postnatal intellectual development
in offspring. Oxytocin and vasopressin may be especially important in early life, but they also act across the
lifespan to integrate various processes such as social bonding, emotional feelings and responses, and the
functions of the autonomic nervous system. Oxytocin, in particular, seems a likely component of various forms
of prosociality, including compassion.
The actions of oxytocin and vasopressin depend on the availability of their receptors. Individual and species
differences in peptide receptors probably play an important role in individual differences in sociality and social
communication. Thus, as the capacity to assess both peptides and their receptors increases, we will gain a
deeper understanding of the role of oxytocin and vasopressin in the behavioral states and responses necessary
for individual differences in compassion.
Oxytocin sits at the center of a neuroendocrine network that coordinates social behaviors and concurrent
responses to various stressors, generally acting to regulate reactivity to stressors (Carter & Altemus, 1997;
Carter, 1998). Oxytocin tends to decrease fear and anxiety and to increase tolerance for stressful stimuli.
Oxytocin may protect the vulnerable mammalian nervous system from regressing into the primitive states,
such as the “reptile-like” freezing pattern, which is based on lower brainstem activity, with an associated
shutdown of higher neural processes. Mammals—with their comparatively large cortexes and a corresponding
need for high levels of oxygen—cannot endure long periods of hypoxia. Thus, the capacity of oxytocin to
protect against shutting-down processes, including hypoxia, is fundamental to survival. At the same time,
oxytocin appears to encourage various forms of sociality (Carter, 2014), especially those, such as mothering
and sexual behavior, that require intimacy and immobility without fear (Porges, 1998). Oxytocin acts on
pathways that include both the central and autonomic nervous systems, and may even allow neural systems
that were previously involved in defensive functions or basic metabolic processes to be coopted for prosocial
actions. For example, in compassionate states, the presence of oxytocin might reduce emotional and
autonomic over-reactivity, thus permitting individuals to witness the suffering of others without necessarily
experiencing high levels of personal distress. Thus, oxytocin may permit compassion while maintaining the
capacity of the observer to engage in helping behaviors or other adaptive responses.
When oxytocin is released, it works in conjunction with vasopressin. Vasopressin is structurally similar to
oxytocin, differing by only two of nine amino acids. Vasopressin has important physiological functions in the
regulation of water balance, blood pressure, and autonomic functions. Behaviorally, vasopressin is most often
implicated in active protective or defensive behaviors, including territoriality and aggression, and is probably
critical to the selective sociality that characterizes social bonds (Carter, 1998). The actions of vasopressin may

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allow selective engagement and selective forms of compassion that require active responses. Alternatively,
stimulation of the vasopressin receptor might act to inhibit compassion toward strangers.
Whether vasopressin plays a direct role in compassion remains to be explored. However, because of the
structural similarity of the oxytocin and vasopressin molecules, these peptides can potentially influence each
other’s receptors. The functions of oxytocin and vasopressin are often—but not always—in opposite
directions. While chronic exposure to oxytocin tends to reduce behavioral and autonomic reactivity to stressful
experiences, in contrast, vasopressin is associated with arousal, mobilization, and vigilance. Vasopressin also
plays a role in social behaviors and has adaptive functions in the regulation of the hypothalamic-pituitary-
adrenal (HPA) axis, especially in the face of behavioral and physiological stressors.
Dynamic interactions between oxytocin and vasopressin are important to the approach and avoidance
components of sociality. In men, intranasal oxytocin facilitates “trust” behavior, as measured in a computer
game (Kosfeld et al., 2005), and the ability to detect subtle cues from pictures of eyes (Lischke et al., 2012). A
growing literature suggests that many aspects of sociality, including the salience of social cues (Shamay-
Tsoory & Abu-Akel, 2016), can be modulated by these peptides. In this manner, peptides may have direct
and indirect effects on compassion.

Receptor Dynamics Can Help Explain the Behavioral Actions of Oxytocin and Vasopressin
Oxytocin and vasopressin are synthesized in, and are particularly abundant in, the hypothalamus, but to
function, they often must reach distant receptors, including those in the cortex and in lower brain stem areas
and other systems responsible for autonomic functions. Oxytocin was historically assumed to have only one
receptor. The oxytocin peptide uses the same receptor for many functions throughout the body, including the
nervous system, reproductive tract, and immune and digestive systems. Oxytocin receptors throughout the
body, such as the heart or digestive system, also play a role in providing oxygen and energy needed for many
adaptive functions; these in turn are necessary for responding to and helping others. This feature of oxytocin
may allow coordinated effects on behavior and physiology. These properties of oxytocin also can play a role in
the integration of behavioral and emotional responses in the face of challenges to others (Grinevich et al.,
2016).
Vasopressin has three subtypes of receptors. Of these, the V1a receptor is abundant in the brain and
cardiovascular system, and it is implicated in various kinds of social and defensive behaviors, as well as blood
pressure and local fluid regulation. A second vasopressin receptor, V1b, plays a role in the regulation of
pituitary responses to stress and may affect aggression and maternal defense (Bayerl et al., 2015). The V2
vasopressin receptor is found in the kidney and plays a critical role in water balance. In comparison to
oxytocin, vasopressin is thought to be the more primitive molecule, with homeostatic effects that integrate
behavior with the physical environment. But both molecules probably have been coopted for many adaptive
functions.
The distributions of oxytocin and vasopressin and their receptors vary across species, from voles to primates
(Witt et al., 1991; Freeman et al., 2014), and in humans are likely to be highly heritable. However, the
expression of these peptide receptors also can be regulated epigenetically (Gregory et al., 2009), allowing
experience to modulate the availability of receptors for these peptides and thus increase or decrease their
capacity to affect adaptive responses across the lifespan.

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 The behavioral effects of oxytocin and vasopressin are the result of actions on both the oxytocin and
vasopressin receptors, and these effects may be sexually dimorphic (Carter, 2007; Albers, 2015). Variations in
the gene for the oxytocin receptor (OXTR) and vasopressin receptors have been repeatedly associated with
social behaviors. Beginning with early studies conducted in autism, genetic variation in the OXTR gene was
associated with social deficits (Jacob et al., 2007), a finding that was replicated in studies of tendencies toward
empathy, and now a broad range of social behaviors (Feldman et al., 2016). Among these studies in autism
and other conditions, it is common to find genetic variations that may be indexed by single-nucleotide
polymorphisms (SNPs) in the gene for the oxytocin receptor (for example, rs53576) (Rodrigues et al., 2009).
This is only one example, since variations in the OXTR gene also have been related to behavioral outcomes.
The interpretation of these studies is complicated by the fact that most studies are small and methodologies
are extremely variable. Furthermore, the gender of the subject showing compassion, and to which compassion
is directed, can interact with genetic variations in the OXTR, even when oxytocin is administered as an
intranasal spray (Palgi et al., 2016).
In spite of these concerns, as these studies have accumulated, some patterns are emerging. For example,
individuals who are very sensitive to the social environment may have a particular genetic pattern of SNPs in
the OXTR, while those who are less sensitive may have a different genetic background in oxytocin pathways.
Our ongoing research in prairie voles supports the hypothesis that epigenetic changes, due to early life
experiences, such as exposure to differential parenting or trauma, could play a role in individual differences in
these peptide receptors (Carter et al., 2009; Bartz et al., 2015), and thus in the actions of oxytocin and
vasopressin. Therefore, variations in the capacity for compassion can be supported by a variety of mechanisms,
including, but not limited to, individual differences in oxytocin and vasopressin and their receptors.

The Autonomic Nervous System is Critical for the Social and Emotional Functions of Oxytocin
and Vasopressin
The autonomic nervous system is a bidirectional system, including sensory and motor components, and
plays a critical role in both the expression and experience of emotional states. In a general sense, responses and
adaptations in the autonomic nervous system are fundamental to the processes that underlie compassion,
including affective experience, emotional expression, facial gestures, vocal communication, and contingent
social behaviors. Refined neural pathways support the needs of mammalian communication and selective
sociality.
Brain stem structures involved in the regulation of autonomic state are sentries of visceral states and
feelings, and they can convey defensive signals, including emotional cues, to the periphery. The brain stem
also provides a portal through which sensory information related to peripheral sensations, including social
cues, contributes to the general activation of higher brain structures, including the cortex. Thus, visceral
regulation can be mediated by brain stem systems that control the heart and gut and also can convey sensory
information to the brain stem. Brain stem structures, in turn, transmit information to brain regions, including
cortical regions, that regulate the autonomic state (Critchley et al., 2004).
The mammalian nervous system must be able to sense danger and transition quickly between positive social
behaviors, such as those seen in parenting, and responses to life-threat. The neural circuits for self-defense
regulate fight/flight behaviors and, in more extreme situations, freezing or shutdown responses. These

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behavioral strategies are supported by the brain stem and a complex bidirectional network of autonomic
nerves, which coordinates behavioral demands with physiological and visceral processes, including heart rate,
respiration, and metabolism.
Compassion may be described as a “gut feeling.” Visceral sensations, in turn, represent the communication
between visceral organs (e.g., heart and gut) and the brain stem, through the autonomic nervous system.
However, the emotional feelings associated with compassion may overcome states of fear and promote social
communication and engagement.
What we experience as states, emotions, and behavioral traits in ourselves, and what we perceive in others,
require activity in archaic brain stem and autonomic processes, which predate and may override the activities
of the modern cortex. Basic to survival is the capacity to react to challenges or stressors and maintain visceral
homeostatic states necessary for vital processes, such as oxygenation of tissues and the supply of nutrients to
the body. For these reasons, the neural circuits involved in regulating social interactions, and feelings such as
compassion, would be expected to overlap with autonomic processes regulating visceral homeostasis.

The Parasympathetic Nervous System and Vagus Nerve are Central to Sociality
Of particular importance to emotional regulation and social engagement is the vagus (10th cranial nerve)
(Porges, 2011; Porges, this volume). The mammalian version of the parasympathetic system includes both a
dorsal vagal motor process (which is ancient and found throughout vertebrates) and a newer ventral vagal
efferent (also motor) pathway, of particular importance to mammalian social communication. This vagal
system has a major role in parasympathetic function, and both afferent and efferent vagal pathways regulate
social engagement and social communication. The ventral vagal pathway provides a neuroanatomical and
neurophysiological link between the brain stem regulation of the striated muscles of the face and the
regulation of the autonomic nervous system (Porges, this volume). The parasympathetic nervous system and
the autonomic processes that it regulates are necessary to support physiological states and feelings such as
those necessary for compassion.
Oxytocin and vasopressin receptors are abundant both centrally and on peripheral organs that are
innervated by the vagus, such as the cardiovascular, digestive, and immune systems, thus regulating both
motor and sensory processes. Visceral feedback from these systems may be experienced as either positive or
negative emotions. These experiences are filtered through central nervous system pathways that contain
receptors for both oxytocin and vasopressin. Thus, the visceral nervous system—regulated in part by oxytocin
and vasopressin—has a plausible role in various emotions, including those associated with compassion.

The Autonomic Processes and Ancient Brain Systems May Take Precedence Over Cognition
When we examine human constructs such as compassion in existing life forms, we are seeing the expression
of neural and biochemical processes that played a major role in the successful evolution of mammals, and
eventually the human species (Carter, 2014). As we attempt to deconstruct emotions or feelings, including
compassion, it is helpful to be aware that our nervous system is largely wired from the “bottom up.” A rational
desire to show or experience compassion may be preempted by processes associated with self-preservation or
survival. However, higher brain structures and manipulations of state, such as those involved in contemplative
practices, can modulate lower brain stem functions. For example, meditation and breathing exercises may

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allow a shift from fear or anger to states more compatible with compassion (Porges, this volume).
Critical to understanding concepts such as compassion is an awareness of the capacity of the nervous system
to detect and evaluate the positive and negative features of the social environment. Thus, the processes that
regulate approach or avoidance are basic to sociality in general. Sensory, autonomic, emotional, and motor
systems can be primed to allow an individual to detect and interpret the features of social cues, and then to
respond with appropriate motor and autonomic reactions. All of these are sensitive to peptides, including
oxytocin and vasopressin. For example, the capacity of peptides such as oxytocin to dampen emotional
reactivity could be critical to the ability of an individual to reduce over-arousal or defensive behaviors, and
show compassion in the face of suffering in others.

The Comparative Neurobiology of Positive Sociality

One approach to understanding the neural mechanisms underlying prosocial behaviors, and substrates for
compassion, has been to examine interspecies differences in sociality among mammals (Carter et al., 1995).
Socially monogamous rodents, such as prairie voles, are especially sensitive to their social environment and
offer a useful model for understanding the neuroendocrine mechanisms that enable positive social experiences.
Studies of social bond formation in prairie voles have been particularly helpful for understanding the effects of
oxytocin. The importance of social interactions can be understood in part by examining the consequences of
placing animals in social isolation. For example, prolonged isolation is associated with increases in oxytocin in
females. Elevated oxytocin in this context may be protective against the negative consequences of isolation. It
is possible that this increase in oxytocin would, in turn, increase tendencies toward subsequent sociality. There
also is evidence that opioids and dopamine, probably through interactions with oxytocin and vasopressin,
influence social behavior and specifically social bonds (Aragona et al., 2006). Social interactions have powerful
effects on reward systems, possibly contributing to the emotional effects associated with compassionate
responses. Based on the well-documented actions of these molecules, this same suite of hormones and
neurotransmitters also may influence the detection of, or response to, the pain or suffering in others, while
reinforcing the rewarding feelings associated with helping others.
Prairie voles also have a human-like autonomic nervous system, characterized by high levels of vagal
efferent activity through the myelinated, ventral vagal pathways that regulate the heart. Highly social
mammals like prairie voles serve as models for understanding the role of the autonomic nervous system and
visceral reactions in social behavior. Consistent with this expectation, in prairie voles, social isolation produces
profound reductions in vagal control of the heart, increases in sympathetic arousal, and a reduced capacity to
recover after a stressor. Oxytocin injections can reverse the cardiac effects of isolation (Grippo et al., 2009).
Behavioral responses of prairie voles to the distress of others have been documented. These behavioral
responses were prevented by blocking oxytocin receptors, thus implicating oxytocin in what could be argued is
a form of “compassion” or empathy (Burkett et al., 2016).
Oxytocin and vasopressin receptors are found in many limbic structures, including the extended amygdala,
the bed nucleus of the stria terminalis (BNST), and the lateral septum. The amygdala and its connections
serve a role in the integration of reactions to various kinds of sensory stimuli, including approach and
avoidance. In human males, intranasal administration of oxytocin inhibited the activity of the amygdala and
altered downstream connections to brain stem structures involved in the regulation of the autonomic nervous

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system. Vasopressin, acting centrally (in areas including the medial amygdala, BNST, and lateral septum),
may elevate vigilance and defensiveness, possibly serving in some cases as an antagonist to the effects of
oxytocin (Albers, 2015). Behaviors mediated by the central amygdala may mediate stimulus-specific fear,
while the BNST has been implicated in experiences related to anxiety. Other peptides, including
corticotrophin-releasing factor (CRF), released during “stressful” experiences may be anxiogenic, acting in the
extended amygdala, including the BNST, to up-regulate responses to dangerous or threatening cues. At least
some of the fear-associated or defensive actions of CRF or vasopressin can be counteracted by oxytocin. Thus,
oxytocin may have the capacity to reduce fear and calm the sympathetic responses to stressful stimuli.

Sex Differences in Compassion

Sex differences in the actions of oxytocin and the related peptide, vasopressin, are likely to be critical to
gender differences in compassion. For example, exogenous oxytocin (given intranasally) can reduce neural
activation in the amygdala in men, while in women, the same treatment facilitated activation of the amygdala
(Domes et al., 2007). Social stimuli, such as those from an infant, also have neural and behavioral effects that
differ between the sexes (Feng et al., 2015a; Feng et al., 2015b). The actions of exogenous vasopressin also are
sexually dimorphic (Thompson et al., 2006).
Sex differences in the capacity for or expression of sociality provide hints to the neurobiology of
compassion. Females are typically described as more empathic than males (Chakrabarti & Baron-Cohen,
2006). Sex steroids may be involved in this sex difference. Blood levels of oxytocin and vasopressin often do
not differ between the sexes. However, both oxytocin and vasopressin are regulated somewhat differently in
males and females, possibly due to hormonally dependent differences in both the peptides and their receptors.
Of particular relevance to social behavior is evidence that the hypothalamic synthesis of vasopressin is
androgen-dependent, in a neural pathway that involves the medial amygdala, BNST, and lateral septum
(Albers, 2015). This neural axis is critical to defensive and aggressive behavior, and vasopressin increases in
this pathway following developmental exposure to androgens. Peptides acting in this axis, especially on the
lateral septum, may create sexually dimorphic vulnerabilities in the capacity to regulate defensive strategies and
sensitivity to social cues, which are building blocks for the capacity for compassion. Working in concert,
oxytocin and vasopressin allow sexually dimorphic responses to emotionally contradictory tasks, such as
forming social bonds or showing compassion, while also permitting rapid behavioral and autonomic reactions,
including defensive behaviors or aggression. These and other findings predict sex differences in the substrates
for compassion. For example, females in general may be more capable than males of appreciating the suffering
of others.
Elevations in oxytocin during periods of isolation also may be sexually dimorphic. In human females,
increases in oxytocin were associated with “gaps in social relationships” (Taylor et al., 2006). The significance
of isolation-related elevations in oxytocin remains to be empirically determined, but it is likely that oxytocin is
a component of a homeostatic, coping process that helps mammals deal with isolation or other stressful
experiences. Such responses could also facilitate preparedness for social engagement, a function that might be
especially adaptive in females, who may be less able than males to cope with the physical challenges of being
alone. In the context of personal safety, the release of oxytocin could encourage social interactions, such as
those associated with detecting and responding with compassion to the emotions or experiences of others.

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 Vasopressin, because of its androgen-dependent occurrence in the extended amygdala and lateral septum,
also is a prime candidate for a role in explaining sex differences in social behaviors (Carter, 2007). For
example, males and females may experience or respond to compassion-eliciting stimuli using sexually
dimorphic neural pathways.
Oxytocin is a likely mediator of compassion, especially if the behavioral reactions involve immobilization
without fear and down-regulation of emotional reactivity or aggression, which are essential to several forms of
sociality (Porges, 1998). Alternatively, vasopressin might be implicated in situations where a more active or
mobilized strategy is required for an adaptive response. Sex differences in the availability or actions of oxytocin
and vasopressin and their receptors are important candidates for mediators of sex differences in compassion.
However, it is important to keep in mind the fact that these peptide systems can be tuned by experience in
early life and also across the lifespan. This tuning process also can be sexually dimorphic, but it introduces
additional opportunities for individual variation in compassion across the lifespan. Thus, we could speculate
that individual variations in androgens or vasopressin might allow greater variation in the capacity for
compassion in males than in females.

Sources of Individual Differences: An Example From Humans

As the study of compassion and related forms of sociality matures, researchers are increasingly exploring
individual differences and measuring biologically relevant outcomes. For example, in one series of studies,
college-aged men viewed a mixed martial arts (MMA) video, in which fighters inflict and experience high
levels of distress and pain. A series of responses to this MMA video was examined, including the relationship
between levels of dispositional empathy, subjective arousal, parasympathetic or vagal status (measured by
respiratory sinus arrhythmia; RSA), sympathetic arousal (measured by electrodermal activity), and salivary
testosterone (Porges et al., 2015). In a second study, 18–35-year-old men were separated according to whether
they carried the rs53576 G or A variant of the OXTR (Smith et al., 2014). Individuals with OXTR variant
rs53576 GG, compared to A allele carriers, showed increased levels of subjective and sympathetic arousal in
response to viewing pain in others. GG homozygotes for this gene also expressed greater levels of empathic
concern. These findings support the importance of oxytocin receptor variation in emotional and physiological
reactions to response to pain experienced by others. Participants with lower parasympathetic activity
responded to watching MMA with greater increases in testosterone, suggesting that high parasympathetic
tone dampens testosterone reactivity and defensive responding. Findings from this and related studies suggest
that individuals with higher baseline vagal tone may be less vulnerable to behavioral and physiological
reactivity when confronted with violence. Conversely, low vagal tone is a risk factor for social and emotional
regulatory disorders. Individuals with low baseline levels of vagal tone and a concurrent increase in
testosterone may be at risk for antisocial and aggressive behaviors, with less capacity to show compassion,
especially in the face of emotionally provocative experiences.
The absence of buffering from the parasympathetic nervous system would leave some individuals vulnerable
to emotional over-reactivity, either in the face of personal threat or while viewing pain or suffering in others.
Especially under conditions of threat or danger, retraction of the “vagal brake” would leave a relative
dominance of sympathetic activity; under these conditions, the capacity for compassion might be
compromised (Porges, 2011; Porges this volume). In peptide-sensitive individuals (such as those with variant

245
rs53576 GG), especially under conditions of chronic stress, we would hypothesize that oxytocin (through its
effects on the brain or autonomic nervous system) could dampen sympathetic and emotional over-reactivity.
Whether specific variants in the OXTR or factors regulating the expression of the oxytocin receptor are
directly regulating vagal activity remains to be examined.

The “Dark Side of Compassion”: Do Interactions Between Oxytocin and Vasopressin Influence
Responses to Pain or Distress in Others?
The mechanisms through which peptides, including oxytocin, affect behavior have only begun to be
considered. However, several recent studies have focused on what has been described as the “dark side” of
compassion and also oxytocin. Individuals with high levels of concern for the distress of others may—under
some circumstances—elect to punish those who are causing the distress. For example, the tendency of humans
to report “in-group” preferences and cooperation, and “out-group” exclusion, increased after treatments with
exogenous oxytocin (De Dreu & Kret, 2016).
Both oxytocin and vasopressin are probably involved in the capacity to detect and respond to the emotions
of others. However, the emotional responses associated with feeling the pain of others are complex (Bartz et
al., 2015; Shamay-Tsoory & Abu-Akel, 2016). For example, feeling the distress of others can lead to attempts
to protect those being harmed, or to inflict retribution on those who threaten loved ones. The willingness to
experience pain or even death to protect others can contribute to suicidal terrorism and war. This complexity
remains poorly understood. For this and other reasons, attempts to use hormones, such as oxytocin, as
prophylactic treatments must be approached with caution (Harris & Carter, 2013). However, a deeper
understanding of the naturally occurring mechanisms that foster compassion might be facilitated by
understanding factors that acutely or chronically enhance the functions of the parasympathetic and oxytocin
systems.

Does Variation in Peptide Receptors Explain Species or Individual Differences in Social

Behavior?
Explanations for behavioral actions of oxytocin alone are not sufficient to explain the role of oxytocin in
social behavior. Evidence for this comes from animal models in which it is possible to inject a peptide and
concurrently inactivate or block specific types of receptors. For example, in hamsters, injections of oxytocin
can induce flank marking, a form of social communication, through actions on the vasopressin V1a receptor;
these effects of oxytocin were seen even when the oxytocin receptor was blocked, but not when the vasopressin
V1a receptor was unavailable (Song et al., 2014). These and comparable studies in other species leave little
question that oxytocin and vasopressin engage in “cross-talk” at the level of their receptors (Albers, 2015).
Oxytocin and vasopressin may stimulate, and in some cases may directly block, the actions of each other at the
receptor level, creating a dynamic system capable of quickly responding to either positive or negative contexts.
Further complicating the translational significance of the role of peptides in human behavior is the ongoing
controversy regarding whether the distribution of the oxytocin receptors in Old World primate nervous
systems is similar to, or perhaps rather different from, those found in rodents. Oxytocin receptors in primates
may not be abundant in limbic system sites predicted by research in rodents; however, oxytocin receptors have
been identified in brain regions that also contain high concentrations of cholinergic processes (Freeman et al.,
2014). This finding supports the hypothesis that the behavioral actions of oxytocin, especially those related to

246
emotion regulation, may be mediated by effects on the autonomic nervous system. The autonomic nervous
system, in turn, is regulated in part by acetylcholine, which in turn regulates various inhibitory processes. The
capacity to inhibit fear, while feeling the suffering of others, is likely to be involved in the capacity for
compassion.
Vasopressin V1a receptors are abundant throughout the primate brain. As in rodents, at least some of the
effects seen following exogenous treatments with oxytocin in humans and other primates may be due to effects
on the V1a receptor.
These kinds of dynamic interactions and the complex regulation of peptide receptors preclude a simple
interpretation of the actions of oxytocin and vasopressin. However, hundreds of published studies continue to
support the importance of the oxytocin and vasopressin molecules in human behavior, including studies of
social behaviors relevant to compassion (reviewed by Bartz et al., 2015; Shamay-Tsoory & Abu-Akel, 2016;
Feldman et al., 2016).
Variations in genes for both the oxytocin receptor and vasopressin V1a receptors also may moderate the
tendency to direct or experience aggression. These relationships probably depend on a variety of intervening
variables, including the strength of a relationship with the target for either compassion or retribution (Buffone
& Poulin, 2014). For example, one SNP of the OXTR (rs53576 GG) is associated with sensitivity to
environmental context and specifically associated with empathy, while carriers of the A allele of this SNP
seem less sensitive, or even insensitive, to the social environment (Rodrigues et al., 2009; Smith et al., 2014;
Feng et al., 2015a; Feldman et al., 2016).
The capacity of oxytocin to affect the vasopressin receptor (Albers, 2015) must be considered in the
interpretation of these findings. The behavioral phenotype elicited by vasopressin (or compounds that
stimulate the vasopressin receptors) would seem to be a candidate for the defensive behaviors or mobilized
responses to threat that are seen in these situations. Conversely, vasopressin might interfere with the capacity
for compassion or, alternatively, heighten the tendency toward defense of loved ones who are in distress.
As with other functions of oxytocin and vasopressin, it is unlikely that any single peptide is acting alone to
influence emotional reactivity, including those responses that may appear as socially defensive or parochial. In
addition, genetic and epigenetic indicators of the status of the oxytocin or vasopressin receptors need to be
considered in studies of compassion. For example, blood levels of oxytocin predict brain activation, especially
in men and in areas of the prefrontal cortex that have previously been implicated in social sensitivity
(Lancaster et al., 2015).
A deeper understanding of the neurobiology and receptor dynamics of oxytocin and vasopressin is
particularly important if these hormones are to be administered clinically (Harris & Carter, 2013). Based on
the evolved biology of these systems, individual differences are expected. The genetics of the receptors for
these peptides seems to be especially variable. Oxytocin and vasopressin and their targets throughout the body
also are targets for epigenetic “tuning,” allowing modifications of emotional systems by individual experiences.

Can Knowledge of the Neurobiology of Oxytocin and Vasopressin Be Used to Facilitate

Compassion?
The most commonly reported consequences of exogenous oxytocin are the enhancement of positive social
behaviors and a tendency to improve behavioral responses in various psychopathologies (MacDonald & Feifel,

247
2013). There is, however, evidence that treatments with exogenous oxytocin can have negative consequences,
especially in genetically vulnerable individuals and in psychological contexts associated with threat or fear
(Bartz et al., 2015; De Dreu & Kret, 2016). Men and women may respond differently to what appears to be
the same experience. Based on behavioral studies, it has been proposed that these paradoxical effects occur
because oxytocin enhances social salience, although mechanisms for this have not been fully articulated
(Shamay-Tsoory & Abu-Akel, 2016). At the neuroendocrine level of analysis, we must consider the
possibility that the capacity of oxytocin to stimulate vasopressin receptors helps explain individual or
situational differences in the response to exogenous hormones. Individual differences in sensitivity are to be
expected, based at least in part on variations in receptors, and these could be genetic and epigenetic in origin.
Developmental experiences may be critical to tuning receptor expression and binding. Clues to the origins
of individual differences in physiology and behavior can be detected by measurements of hormones in blood,
saliva, and other bodily fluids (Carter, 2007). In addition, individual differences in receptors can be indexed
through genetic and epigenetic markers. These can be combined with functional imaging and other
psychophysiological techniques with, in some cases, an excellent capacity to predict behavior (Porges et al.,
2015; Lancaster et al., 2015). A more complete sense of individual responses is possible when measures are
taken at several levels of analysis. This work is promising, but still at early stages of development.
Finally, it is increasingly evident that the autonomic nervous system is integral to emotional and social
experiences. The autonomic nervous system, and especially patterns of vagal activity, provide indices of
individual differences and context-dependent effects of peptides (Bartz et al., 2015). In the face of challenge,
knowledge of the resting status of the autonomic nervous system also is capable of predicting later reactions to
social stimuli (Porges et al., 2015; Porges, 2011; Porges, this volume). Both oxytocin and vasopressin affect
emotional states and traits, in part through autonomic and visceral reactions. Thus, measures of autonomic
processes may provide a noninvasive window into the interactive neuroendocrine systems that respond to
social cues, providing substrates for the capacity for compassion.

Conclusion
The desire to help others can be elicited by stimuli such as witnessing pain in others. For some, but not all,
individuals, these kinds of stimuli have an inherent capacity to induce an autonomic and neural sense of
distress, but also a sense of connection. These experiences also may release oxytocin or be sensitive to
endogenous oxytocin (Kenkel et al., 2013; Mascaro et al., 2014).
A context of emotional safety also may be relevant to the complex consequences of attempts to use
hormones, including oxytocin, to directly influence human social behavior. For example, in healthy
individuals, oxytocin may increase a sense of safety. However, there is some evidence that the effects of
oxytocin vary according to the emotional history of the individual. Individuals with a history of neglect, abuse,
or trauma, and for whom a sense of safety is difficult to achieve, may be at particular risk for adverse reactions
following treatment with oxytocin, possibly through the capacity of oxytocin to stimulate the vasopressin
receptors (Albers, 2015).
Emotional and visceral states influence how we feel about and react to others, and thus our capacity for
compassion. Awareness of factors that regulate emotional responses and feeling leads us to a deeper
understanding of the evolved neurobiology of compassion. Selective social behaviors can facilitate survival and

248
reproduction, promoting safety and a sense of emotional security. Sociality is essential to human existence,
and it is likely that the neural substrates and hormonal conditions that permit compassion are shared with
those that enable other forms of sociality, including willingness to approach or “trust” others, and sensitivity to
the emotions or suffering of others. Sensitivity to social cues is one element of compassion. Neural systems,
including autonomic functions, that rely on brain stem neuropeptides, such as oxytocin and vasopressin, are
plausible candidates in the moderation of these systems.
The strategy of investigating social behaviors by examining the neural systems that rely on oxytocin and
vasopressin increasingly has been extended to the level of genetic and epigenetic analysis. For example,
individual differences in the genetics and epigenetics of oxytocin and vasopressin receptors have been linked to
autistic traits (Jacob et al., 2007), as well as to individual and sex differences in sociality (Feldman et al., 2016)
and perceptions of social stimuli (Puglia et al., 2015). Individual or sex differences in the genetics of oxytocin
and vasopressin also are associated with individual differences in the capacity for compassion. However, the
biological substrates of safety are interwoven with those for defense and reactions to threat or danger. Thus,
manipulations of these systems must be done with caution and in a context of safety (Harris & Carter, 2013).
Ideally, such studies will also be conducted with knowledge of individual and gender variations in autonomic
function, of other concurrent hormonal processes, and of the sensitivity or expression of receptors that are
affected (Smith et al., 2014; Porges et al., 2015).

249
Acknowledgments
We are grateful to many colleagues whose work is described here, and especially Stephen W. Porges for his
conceptual and editorial input into this chapter. We also thank Emma Seppälä, Emiliana Simon-Thomas,
and Stephanie Brown for their thoughtful editorial comments. The completion of this chapter was sponsored
in part by the National Institutes of Health (P01 HD 075750).

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 Vagal Pathways Portals to Compassion

Stephen W. Porges

Abstract

In this chapter, contemplative practices are conceptualized as methods that function as neural exercises
enhancing vagal regulation of the autonomic nervous system. The model presented proposes that specific
voluntary behaviors (e.g., breath, vocalizations, and posture), which characterize ancient rituals and form
the core of contemplative practices, can trigger a physiological state mediated by vagal pathways that
fosters health and optimizes subjective experiences. The model emphasizes that, in order for the positive
benefits of contemplative practices to be experienced, the rituals associated with contemplative practices
(e.g., chants, prayers, meditation, and dance) must be performed in a context defined by physical features
that are calming and soothing and promote feelings of safety.

Key Words: compassion, contemplative neuroscience, ancient rituals, autonomic nervous system,
polyvagal theory, vagal brake, social engagement system, dissolution, neuroception

As contemplative neuroscience emerges as a discipline, research is being conducted to identify the neural
pathways that contribute to compassion. Paralleling these scientific explorations, clinicians in mental health
disciplines are developing interventions designed to enhance compassion of others and self (Gilbert, 2009).
Limiting these investigations and applications is the lack of a consensus definition of compassion. This
ambiguity limits both scientific investigations of the neural pathways determining compassion and the
evaluation of compassion-based therapies.
Definitions of compassion and the tools used to assess compassion vary within the literature (see Strauss et
al., 2016). Compassion has been viewed as an action, a feeling, an emotion, a motivation, and a temperament.
Although common themes may be extracted from the literature, no assessment tool conforms to the standards
commonly employed in scientific research (Strauss et al., 2016). Without a consensus definition, researchers
investigating compassion lack a toolkit that would foster scientific inquiry, and clinicians lack a metric to
assess the outcome of compassion-based therapies.
In contrast to the frequent definitions of compassion as a psychological construct, this chapter proposes that
compassion is an emergent process dependent on one’s neurophysiological state. Consistent with this
perspective, compassion cannot be investigated as a voluntary behavior or a psychological process independent
of the physiological state. Thus, compassion cannot be taught through classic rules of learning, nor can it be
indexed by specific neurophysiological processes, behavioral actions, or subjective experiences independent of
the bidirectional communication between peripheral physiological state and brain function. In the proposed
model of compassion, physiological state functions as an intervening variable between the person who is
suffering and the responses to the person, which are manifested as the subjective experiences and behavioral

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actions that form operational definitions of compassion.
This chapter proposes that a physiological state mediated via vagal pathways is a necessary, but not
sufficient, condition for an individual to experience compassion. The vagus is a cranial nerve, which provides
the major bidirectional (motor and sensory) communication between the brain and the body. The vagus is a
major component of the parasympathetic branch of the autonomic nervous system. Functionally, specific vagal
motor pathways are able to inhibit the reactivity of the sympathetic branch of the autonomic nervous system,
while vagal sensory pathways provide a major surveillance portal between the body and the brain. I propose a
model that emphasizes the dependence of compassion on a vagal-mediated state that supports feelings of
safety, which enable feeling one’s own bodily responses at a given time, while acknowledging the bodily
experiences of another person. The emphasis on shifting physiological state via vagal mechanisms to
experience compassion is consistent with the historic use of rituals in contemplative training.
Since compassion depends on a vagal-mediated physiological state, it may be separated from other
subjective experiences that have a different physiological substrate. For example, although empathy is
frequently assumed to be interchangeable with compassion, the physiological state associated with empathy
may differ from the physiological state associated with compassion. Empathy is frequently operationally
defined as feeling someone else’s pain or negative emotion (e.g., Decety & Ickes, 2009). If we deconstruct
empathy from a neurobiological perspective, empathy should be associated with the activation of the
sympathetic nervous system. This would occur because the autonomic response to pain is characterized by a
withdrawal of vagal influences and an activation of the sympathetic nervous system. Thus, from a
neurobiological perspective, compassion is not equivalent to empathy, given that compassion engages vagal
pathways.
If compassion is associated with a calm vagal state, it would promote a physiological state associated with
“safety of self” that projects calmness and acceptance towards the other. Functionally, the vagal pathways are a
major component of a branch of the autonomic nervous system, historically labeled the parasympathetic nervous
system. A linguistic cue for the function of the parasympathetic system is in the use of “para” in its name. Para
is derived from the ancient Greek παρά meaning “contrary” or “against.” Thus, the parasympathetic nervous
system, as suggested by its name, provides an implicit understanding of the containment of the defensive
reactivity associated with the sympathetic nervous system. Consistent with this view of the containment of
defensive reactions, the critical portal to express compassion would be dependent on the capacity to recruit the
vagal pathways that actively inhibit sympathetic reactivity and promote a calm physiological state that projects
safety and acceptance to others.
The physiological state mediated by vagal pathways is not equivalent to compassion. Rather, it is a state
that promotes or facilitates feelings of safety, positive feelings towards others (e.g., Stellar et al., 2015),
connectedness, and the potential to respect both the suffering and joy of others (e.g., Kok & Fredrickson,
2010).
It is through the vagal inhibition of the neurophysiological defenses (hypothalamic-pituitary-adrenal–
sympathetic responses) that the vagal state functionally contains the behavioral and physiological reactivity to
suffering. This containment provides opportunities to witness without judgment and to subsequently be
helpful in alleviating the suffering of self or other. Brain-imaging studies attempting to distinguish between
empathy and compassion are consistent with the proposed state differences associated with empathy and

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compassion. Klimecki et al. (2014) suggest that the excessive sharing of others’ negative emotions (i.e.,
empathy) may be maladaptive, and that compassion training dampens empathic distress and strengthens
resilience. Similarly, it has been suggested that empathy involves resonating with or mirroring another’s
emotion in neurophysiological, peripheral physiological, and behavioral domains (for an overview, see Decety
& Ickes, 2009).
A cornerstone to compassion is respecting the individual’s capacity to experience their own pain. By
respecting the individual’s capacity to experience pain, compassion functionally allows the individual to have
their experiences “witnessed” by another without hurting the other, by empathically sharing their pain and
activating the defensive sympathetic nervous system in the other. This allows the pain to be expressed without
fear of negative evaluation or the potential shame that emerges from evaluation. Compassion allows and
respects the other’s right to “own” their experiences. This respect of the other in itself contributes to the
healing process by empowering the other and not subjugating or diminishing the value of the person’s
experiences of pain or loss. Compassion functionally allows one who has lost or is suffering not to be defensive
about the loss and not to experience shame for the loss. If we attempt to fix the problem without successfully
expressing compassion, the intervention will disrupt the individual’s process of expression by triggering
behavioral and physiological defense strategies associated with a shift in physiological state, which is
characterized by a withdrawal of vagal influences and activation of the sympathetic nervous system. Thus,
compassion relies on a “neural” platform that enables an individual to maintain and express a physiological
state of safety when confronted with the pain and suffering of others.

Vagal States Are Intertwined with the History of Contemplative Practices

Throughout the history of humanity, rituals such as chants, prayers, meditation, dance, and posture have
provided the behavioral platform for contemplative practices. A careful investigation of many rituals results in
the discovery that the rituals are functional exercises of vagal pathways (see Table 15.1). Although chants,
prayers, and meditation have been incorporated into formal religions, the function of these rituals may be
different from that of the narratives upon which religions were based. The narratives are attempts to fulfill the
human need to create meaning out of uncertainty and to understand the unknowable mysteries of the human
experience in a dynamically changing and challenging world. While this assumption may be consistent with
the history of the narratives that form the corpus of formalized religions, the function of rituals may be more
closely related to health and personal subjective feelings of connectedness to others, and to a deity.
The documented positive effects of meditation on mental and physical health (Bohlmeijer et al., 2010;
Chiesa & Serretti, 2009; Davidson et al., 2003) have stimulated an interest in contemplative practices as
health-related interventions such as mindfulness-based stress reduction (e.g., Kabat-Zinn, 2003). Science is
now interfacing with insights derived from historical and often ancient contemplative practices. The
accumulated knowledge suggests that meditative practices, not only lead to a different perspective of reality
that fosters a connectedness with others expressed through feelings of compassion, but also may have positive
influences on health. These observations have led to a new discipline of contemplative neuroscience that
attempts to document the shift in neural regulation that occurs during contemplative practices such as
meditation.

Table 15.1 The Physiology of Rituals

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Ritual Vagal Mechanism

Chants Laryngeal nerves Pharyngeal nerves Respiration (long exhalation and deep abdominal
(vocalizations) inhalation enhance vagal “brake”)

Meditation Respiration (long exhalation and deep abdominal inhalation enhance the vagal “brake”)
(breath)

Prayer (posture) Carotid baroreceptors (vagal contribution to blood pressure regulation)

Contemplative neuroscience has focused on documenting the mechanisms through which meditation
“heals.” Thus, contemplative neuroscience assumes directional causality in which mental processes can
influence and potentially optimize bodily function. This “top-down” model emphasizes mind in the mind–
body relationship and assumes that “thought” is the driving force through which meditation functions
effectively. Functionally, the research has emphasized the investigation of mind–brain relationships through
imaging and electrophysiological studies of brain circuits of expert meditators (e.g., Lutz et al., 2013). Within
contemplative neuroscience, investigations of the influences of meditation on the neural regulation of visceral
organs have not been emphasized.
The predominant model within contemplative neuroscience, including the study of neural pathways
associated with compassion, assumes a directional causality in which mental activity drives brain function.
Although this directional causality has been reliably documented (i.e., mental processes reliably influence
neural activity), the model is limited because it does not incorporate two intervening variables that may
mediate the effectiveness and efficiency of contemplative practices. First, the model does not acknowledge the
influence of context on the nervous system. Second, the model does not acknowledge the influence of
peripheral physiological state on brain function. Without detailed attention to these two variables, the
functional impact of contemplative practices on mental and physical health will be unpredictable. In addition,
the efficiency of contemplative practices in increasing a sense of connectedness and an ability to express
compassion may be compromised.
This chapter presents a model in which contemplative practices are conceptualized as methods that require,
as a prerequisite, enhanced vagal regulation of biobehavioral states. Functionally, by enhancing vagal
regulation, these methods efficiently promote health and may enable expansive subjective experiences related
to compassion and a universal connectedness. The model proposes that specific voluntary behaviors (e.g.,
breath, vocalization, and posture), which characterize ancient rituals and form the core of contemplative
practices, have the potential to trigger a physiological state that fosters health and enables subjective
experiences that have been the objective of contemplative practices.
The model emphasizes that two well-defined and sequential antecedent conditions are necessary for the
beneficial properties of contemplative practices to be experienced. First, the environment in which
contemplative practices are performed needs to have physical features that are calming and soothing. Across
history and cultures, contemplative practices have been performed in quiet and safe environments. There are
specific neurophysiological reasons for this consistency. To survive, humans needed to identify danger and
therefore detect environments and others who were either safe or dangerous. Thus, the human nervous system
needed to be sensitive to features that define physical spaces, which may either trigger or dampen defensive

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physiological reactivity. Second, rituals of chants, prayers, meditation, dance, and posture provide potent
stimuli to our nervous system to “exercise” the vagal pathways. These pathways down-regulate defense and
promote states of calmness and stillness.
In a safe environment, when a person no longer needs to be vigilant in anticipation of danger, the nervous
system tends to shift into a qualitatively and measurably different physiological “safe” state. This “safe” state
may function as a “neural” catalyst for subjective feelings of social connectedness and compassion. Without the
appropriate contextual cues of safety, and without the body shifting into a “safe” physiological state, attempts
at contemplative practices may be ineffective, and may even promote defensive feelings focused on self-
survival that promote hypervigilance and hyper-reactivity. Consistent with this premise, via personal
communications, clinicians treating veterans with post-traumatic stress disorder (PTSD) have reported
situations in which mindfulness techniques have triggered defensiveness.

Polyvagal Theory: Deconstructing Ancient Rituals from a Polyvagal Perspective

Polyvagal theory (Porges, 1995, 2011) explains how rituals associated with contemplative practices
contribute to bodily feelings of safety, trust, and connectedness. Polyvagal theory holds that cues of risk and
safety, which are continuously monitored by the nervous system, promote either states of safety and calmness
or states of vigilance toward sources of potential threat and defense. The theory assumes that mammals are on
the search for safety, which, when obtained, facilitates health and social connectedness. The theory explains
how the rituals associated with contemplative practices trigger physiological states that calm neural defense
systems and promote feelings of safety that may lead to expressing and feeling compassion.
The human nervous system provides two paths to trigger the neural mechanisms capable of down-
regulating defensiveness to enable states of calmness that support health and connectedness. One path is
passive and does not require conscious awareness (see the section on neuroception in this chapter), while the
other requires conscious volitional behaviors that trigger specific neural mechanisms that, in turn, change
one’s physiological state. Spontaneous positive social behavior expressed in facial expressions and vocal
intonation is dependent on the former, and optimal outcomes of contemplative practices such as meditation
and chants are dependent on the latter. Features of voice (i.e., prosody—intonation of voice) and facial
expression, which characterize the interactions of positive social behavior, provide potent cues to the nervous
system that down-regulate defense circuits. In contrast to the passive pathway of calming through affiliative
social engagement, contemplative training is usually conducted within the context of a “spiritual” space (e.g.,
quite space with calming music) that triggers the passive pathway to promote the physiological state associated
with feeling safe. Once in a safe state, the individual is instructed to perform voluntary behaviors such as
breathing, posture shifts, and vocalizations that functionally exercise the vagal circuit and that further
promote, reinforce, and strengthen states of calmness. These voluntary behaviors, which we observe as rituals,
directly tap into and engage vagal circuits that efficiently manipulate one’s physiological state. This enables
rituals to function as neural exercises of vagal pathways.

The Role of the Vagus in Bidirectional Communication

During the phylogenetic transition from ancient reptiles to mammals, the autonomic nervous system
changed. In the ancient reptiles, the autonomic nervous system regulated bodily organs via two subsystems:

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the sympathetic nervous system and the parasympathetic nervous system. Modern reptiles share these global
features. The sympathetic nervous system provided the neural pathways for visceral changes that support
defensive fight and flight behaviors. This physiological adjustment to support mobilization for self-
preservation was associated with increases in heart rate and an inhibition of digestive process, which required
suppression of parasympathetic (i.e., vagal) influences to the heart and the gut.
In ancient reptiles, the parasympathetic nervous system complemented the function of the sympathetic
nervous system by providing reciprocal influences on visceral organs. The reptilian parasympathetic nervous
system served two primary adaptive functions: (1) when not recruited as a defense system, it supported
processes of health, growth, and restoration; and (2) when recruited as a defense system, it reduced metabolic
activity by dampening heart rate and respiration, enabling the “immobilized” reptiles to appear inanimate to
potential predators (i.e., a “freeze” response). When not under threat, the sympathetic and parasympathetic
branches of the autonomic nervous system in reptiles function reciprocally (and frequently antagonistically) to
simultaneously innervate the visceral organs that support bodily functions. This synergy between the two
branches of the autonomic nervous systems in support of health (not defense) is maintained in mammals, but
only when mammals are safe. In this safe state, the potential of the autonomic nervous system’s being
recruited in support of defense is greatly reduced.
Most of the neural pathways of the parasympathetic nervous system travel through the vagus nerve. The
vagus is a large cranial nerve that originates in the brain stem and connects visceral organs throughout the
body with the brain. In contrast to the nerves that emerge from the spinal cord, the vagus connects the brain
directly to bodily organs. The vagus contains both motor fibers to influence the function of visceral organs and
sensory fibers to provide the brain with continuous information about the status of these organs. The flow of
information between body and brain informs specific brain circuits that regulate target organs. Bidirectional
communication provides a neural basis for a mind–body science, or a brain–body medicine, by providing
plausible portals of intervention to correct brain dysfunction via peripheral vagal stimulation (e.g., vagal nerve
stimulation for epilepsy, depression, and PTSD) and plausible explanations for exacerbation of clinical
symptoms by psychological stressors, such as stress-related episodes of irritable bowel syndrome. In addition,
bidirectional communication between the brain and specific visceral organs provides an anatomical basis for
historical concepts of the optimal balance among physiological systems, such as Walter Cannon’s homeostasis
(Cannon, 1932) and Claude Bernard’s internal milieu (Bernard, 1872).

Polyvagal Theory: Overview

Polyvagal theory is a reconceptualization of how autonomic state and behavior interface. The theory
emphasizes a hierarchical relationship among components of the autonomic nervous system that evolved to
support adaptive behaviors in response to the particular environmental features of safety, danger, and life
threat (Porges, 2011). The theory is named “polyvagal” to emphasize that there are two vagal circuits: an
ancient vagal circuit associated with defense (the freeze response) and a phylogenetically newer circuit related
to feeling safe and displaying spontaneous affiliative social behavior. The theory articulates two defense
systems: (1) the commonly known “fight-or-flight” system that is associated with activation of the
sympathetic nervous system, and (2) a less-known system of immobilization and dissociation that is associated
with activation of a phylogenetically more ancient vagal pathway.

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 The polyvagal theory describes the neural mechanisms through which physiological states communicate the
experience of safety and contribute to an individual’s capacity: (a) to feel safe and spontaneously approach or
engage cooperatively with others, (b) to feel threatened and recruit defensive strategies; or (c) to become
socially invisible by feigning death. The theory articulates how each of three phylogenetic stages, in the
development of the vertebrate autonomic nervous system, is associated with a distinct and measurable
autonomic subsystem. In humans, each of these three subsystems becomes activated and is expressed
physiologically under specific conditions (Porges, 2009). The three autonomic subsystems are phylogenetically
ordered and behaviorally linked to three general adaptive domains of behavior: (a) social communication (e.g.,
facial expression, vocalization, listening); (b) defensive strategies associated with mobilization (e.g., fight-or-
flight behaviors); and (c) defensive immobilization (e.g., feigning death, vasovagal syncope, behavioral
shutdown, and dissociation). Based on their phylogenetic emergence during the evolution of the vertebrate
autonomic nervous system, these neuroanatomically based subsystems form a response hierarchy.
The polyvagal theory emphasizes the distinct roles of two distinct vagal motor pathways identified in the
mammalian autonomic nervous system. The vagus conveys (and monitors) the primary parasympathetic
influence to the viscera. Most of the neural fibers in the vagus are sensory (approximately 80%). However,
most interest has been directed to the motor fibers that regulate the visceral organs, including the heart and
the gut. Of these motor fibers, approximately only 15% are myelinated (i.e., approximately 3% of the total
vagal fibers). Myelin, a fatty coating over the neural fiber, enables faster and more tightly regulated neural
control circuits. The myelinated vagal pathway to the heart is a rapidly responding component of a neural
feedback system, involving the brain and heart, which rapidly adjusts the heart rate to meet challenges.
Humans, as well as other mammals, have two functionally distinct vagal circuits. One vagal circuit is
phylogenetically older and unmyelinated. It originates in a brainstem area called the dorsal motor nucleus of the
vagus. The other vagal circuit is uniquely mammalian and myelinated. The myelinated vagal circuit originates
in a brain stem area called the nucleus ambiguus. The phylogenetically older unmyelinated vagal motor
pathways are shared with most vertebrates, and, in mammals, when not recruited as a defense system, these
pathways function to support health, growth, and restoration via neural regulation of subdiaphragmatic organs
(i.e., internal organs below the diaphragm). The phylogenetically “newer” myelinated vagal motor pathways,
which are observed in mammals, regulate the supradiaphragmatic organs (e.g., heart and lungs). This newer
vagal circuit slows the heart rate and supports states of calmness. It is this newer vagal circuit that both
mediates the physiological state necessary for compassion and is functionally exercised during rituals
associated with contemplative practices.

Vagal Brake: A Mechanism to Contain Emotional Reactivity

When mammals evolved, the primary vagal regulation of the heart shifted from the unmyelinated pathways
originating in the dorsal motor nucleus of the vagus to include myelinated pathways originating in the nucleus
ambiguus. The myelinated vagus provided a mechanism to rapidly and efficiently regulate visceral organs to
foster calm prosocial behaviors and psychological and physical health. For example, the myelinated vagus
functions as an active efficient brake (see Porges et al., 1996), in which rapid inhibition and disinhibition of
vagal tone to the heart can rapidly calm or mobilize an individual. Moreover, the myelinated vagus actively
counteracts the sympathetic nervous system’s influences on the heart and dampens hypothalamic-pituitary-

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adrenal (HPA) axis activity (see Porges, 2001). The vagal brake can modulate visceral state, especially the
sympathetic nervous system reactions that frequently accompany empathy. Functionally, regulation of the
vagal brake keeps autonomic reactivity from moving into a range that supports defensive behaviors. Thus, the
vagal brake enables the individual to rapidly engage and disengage with objects and other individuals, while
maintaining a physiological resource that is capable of promoting self-soothing behaviors and calm states.
Ancient rituals, employing breathing, posture, and vocalizations, actively recruit and exercise the vagal brake
to down-regulate defensive biases and to enhance positive engagement of others with feelings of compassion.

The Face–Heart Connection: The Emergence of the Social Engagement System

When the individual feels safe, two important features are expressed. First, the bodily state is regulated in
an efficient manner to promote growth and restoration (e.g., visceral homeostasis). This is accomplished
through an increase in the influence of myelinated vagal motor pathways on the cardiac pacemaker (sino-atrial
node) to slow heart rate and inhibit the fight-or-flight mechanisms of the sympathetic nervous system. In
addition, the myelinated vagal pathways dampen the stress response system of the HPA axis (e.g., cortisol)
and reduce inflammation by modulating immune reactions (e.g., cytokines). Second, through the process of
evolution, the brain stem nuclei that regulate the myelinated vagus became integrated with the nuclei that
regulate the muscles of the face and head via special visceral efferent (motor) pathways. These emergent
changes in neuroanatomy provide a face–heart connection in which there are mutual interactions between the
vagal influences to the heart and the neural regulation of the striated muscles of the face and head. The
phylogenetically novel face–heart connection provided mammals with an ability to convey their physiological
state via facial expression and prosody (intonation of voice), enabling facial expression and voice to calm
physiological state (Porges, 2011; Porges & Lewis, 2010; Stewart et al., 2013).
The face–heart connection enables mammals to detect whether a conspecific is in a calm physiological state
and “safe” to approach, or is in a highly mobilized and reactive physiological state during which engagement
would be dangerous. The face–heart connection concurrently enables an individual to signal “safety” through
patterns of facial expression and vocal intonation, and potentially calm an agitated conspecific to form a social
relationship. When the newer mammalian vagus is optimally functioning in social interactions (i.e., inhibiting
and containing the sympathetic excitation that promotes fight-or-flight behaviors), emotions are well
regulated, vocal prosody is rich, and the autonomic state supports calm, spontaneous social engagement
behaviors. The face–heart system is bidirectional, with the newer myelinated vagal circuit influencing social
interactions and positive social interactions influencing vagal functions to optimize health, dampen stress-
related physiological states, and support growth and restoration. Social communication and the ability to co-
regulate another, via reciprocal social engagement systems, leads to a sense of connectedness, which is a defining
feature of the human experience.
Polyvagal theory proposes that physiological state is a fundamental part, and not a correlate, of emotion and
mood. The theory emphasizes a bidirectional link between brain and viscera, which would explain both how
thoughts can change our physiology, and how our physiological state influences our thoughts. Thus, the
initiation of contemplative practices is dependent on physiological state, and through the mental process
defining contemplative practices, it influences our physiological state. As individuals change their facial
expressions, the intonation of their voices, the pattern in which they are breathing, and their posture, they are

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also changing their physiology, primarily through manipulating the function of the myelinated vagus to the
heart.
Regulating the physiological state through the myelinated vagus is an implicit underlying principle of
contemplative practices. However, contemplative practices, by directly exercising the vagal regulation of state,
coopt the need for social interactions to reflexively calm the practitioner (see section on neuroception) and
expand the sense of connectedness from a proximal social network to an unbounded sense of oneness.
Neurophysiologically, the rituals involved in contemplative practices elicit the same neural circuits that evolved
with mammals to signal safety. Through our phylogenetic history, these signals were usually emitted by the
mother to calm her vulnerable infant. Thus, the metaphor of the mother calming the child is
neurophysiologically embedded in contemplative training and practices and is frequently used in various
spiritual narratives.
As we learn more about the face–heart connection, we are informed that contemplative practices may
recruit this system to obtain states of calmness. This is initially accomplished sequentially, first through the
passive pathway detecting features of safety in the context in which contemplative practices are typically
experienced, and then through a voluntary pathway (i.e., neural exercises) that uses efficient and reliable
behavioral manipulations (e.g., breathing, vocalization, posture) that we know as rituals.

The Social Engagement System: A System That Expresses and Acknowledges Emotion
The phylogenic origin of the behaviors associated with the social engagement system is intertwined with the
phylogeny of the autonomic nervous system. As the muscles of the face and head emerged as social
engagement structures, a new component of the autonomic nervous system (i.e., a myelinated vagus) evolved
that was regulated by the nucleus ambiguus. This convergence of neural mechanisms produced an integrated
social engagement system with synergistic behavioral (i.e., somatomotor) and visceral components, as well as
interactions among ingestion, state regulation, and social engagement processes. The neural pathways
originating in several cranial nerves that regulate the striated muscles of the face and head (i.e., special visceral
efferent pathways) and the myelinated vagal fibers formed the neural substrate of the social engagement
system (see Porges, 1998, 2001, 2003a).
As illustrated in Figure 15.1, the somatomotor component includes the neural structures involved in social
and emotional behaviors. Special visceral efferent nerves innervate striated muscles, which regulate the
structures derived during embryology from the ancient gill arches (Truex & Carpenter, 1969). The social
engagement system has a control component in the cortex (i.e., upper motor neurons) that regulates brain
stem nuclei (i.e., lower motor neurons) to control eyelid opening (i.e., looking), facial muscles (e.g., emotional
expression), middle ear muscles (e.g., extracting human voice from background noise), muscles of mastication
(e.g., ingestion), laryngeal and pharyngeal muscles (e.g., prosody and intonation), and head-turning muscles
(e.g., social gesture and orientation). Collectively, these muscles function both as determinants of engagement
with the social environment and as filters that limit social stimuli. The neural pathway involved in raising the
eyelids (i.e., facial nerve) also tenses the stapedius muscle in the middle ear, which facilitates hearing human
voice. Thus, the neural mechanisms for making eye contact are shared with those needed to listen to human
voice. As a cluster, poor eye gaze, difficulties with extracting the human voice from background sounds,
blunted facial expression, minimal head gestures, limited vocal prosody, and poor state regulation are common

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features of individuals with autism and other psychiatric disorders.

Figure 15.1 The Social Engagement System. The social engagement system consists of a somatomotor component (i.e., special visceral efferent
pathways that regulate the striated muscles of the face and head) and a visceromotor component (i.e., the myelinated vagus that regulates the
heart and bronchi). Solid blocks indicate the somatomotor component. Dashed blocks indicate the visceromotor component.

Afferents from the target organs of the social engagement system, including the muscles of the face and
head, provide potent input to the source nuclei in the brain stem regulating both the visceral and somatic
components of the social engagement system. Thus, activation of the somatomotor component (e.g., listening,
ingestion, lifting eyelids) could trigger visceral changes that would support social engagement, while
modulation of the visceral state, depending on whether there is an increase or decrease in the influence of the
myelinated vagal efferents on the sino-atrial node (i.e., increasing or decreasing the influence of the vagal
brake), would either promote or impede social engagement behaviors. For example, stimulating the visceral
states that promote mobilization (i.e., fight-or-flight behaviors) will impede the ability to express social
engagement behaviors.

Contemplative Practices and the Social Engagement System

The pathways defining the social engagement system enable many of the processes associated with
contemplative practices (e.g., listening, chanting, breathing, shifting posture during prayer, and facial
expressivity) to influence one’s physiological state via a myelinated branch of the vagus. The passive pathway
recruits the social engagement system (including the myelinated ventral vagus) through the cues of safety, such
as a quiet environment and the presentation of prosodic vocalizations (e.g., chants) in the frequency band that
would overlap with the vocal signals of safety that a mother uses to signal safety to her infant. In male-
dominated religious practices, where females are not available to provide the vocal signals of safety, female-
like voices are produced by boy choirs and, historically, by castrato soloists to promote feelings of spirituality.
Shifts in breathing patterns are perhaps the most accessible potent manipulations of the output of the

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myelinated vagus. Research documents that respiration gates the influence of the vagus on the heart (see
Eckberg, 2003). The vagal inhibition of the heart’s pacemaker is potentiated during exhalation and dampened
during inhalation. Thus, both the duration of exhalation and the inhalation/exhalation ratio are critical in
manipulating the functional “calming” of the vagus on the heart. Rituals such as chants require extending the
duration of the exhalation relative to the inhalation. Moreover, as the phrases of the chants become longer,
the parameters of breathing spontaneously adjust to provide a sufficient volume of air, and breathing
movements expand from the chest towards the abdomen. With abdominal or belly breathing, the diaphragm
is actively pushed downward. This action stimulates vagal afferents, which functionally influence the vagal
outflow to the heart. As described in Table 15.1, the manipulation of breathing during chants and meditation
provides a potent mechanism to regulate vagal efferent activity. Thus, in these rituals, breathing strategies
optimize and exercise the vagal influence on the heart.
Chants and other forms of vocalizations are frequent features of contemplative practices. These processes
not only require active manipulation of breathing, but also recruit additional components of the social
engagement system. For example, chants require the production and the monitoring of sounds while
regulating one’s breath. The modulation of vocalizations requires the active involvement of neural regulation
of laryngeal and pharyngeal muscles (see Figure 15.1) to change pitch and to regulate resonance. Breath is
critical, since the acoustic features of vocalizations are a product of a controlled expiration, which passes air at
a sufficient velocity across structures in the larynx to produce sounds.
Successful social communication via vocalizations requires rapid adjustments in both the production and
detection of vocalizations. This process requires a complex feedback loop that informs brain areas of acoustic
properties conveying cues of safety or danger (see neuroception section). The cues result in dynamic
adjustments in the transfer function of middle ear structures via cranial nerves to enhance or dampen the
loudness of sounds within the frequency band in which social communication occurs. Without sufficient
neural tone to the middle ear muscles, the sounds of human vocalizations will be lost in the low-frequency
background noise that characterizes our environment.
Virtually all the neural pathways involved in the social engagement system (see Figure 15.1) are recruited
and coordinated while chanting. This would include the regulation of muscles of the mouth, face, neck,
middle ear, larynx, and pharynx. Thus, chanting may provide an efficient “active pathway” to recruit and
exercise several features of the social engagement system, while promoting a calm state through the
myelinated ventral vagal pathway.
Rituals often involve voluntary posture shifts. Posture shifts influence blood pressure receptors known as
baroreceptors. Baroreceptors send signals to the brainstem that will either increase heart rate by down-
regulating vagal efferent output (and often stimulate sympathetic output), or decrease heart rate by increasing
vagal efferent output. Manipulating posture functions as an efficient voluntary method to shift one’s
physiological state, often enabling a visceral feeling of activation (due to a transitory withdrawal of the
myelinated ventral vagus) that is rapidly followed by calming (due to a reengagement of the myelinated ventral
vagus).
Functionally, rituals provide a complementary alternative to social engagement behaviors, an opportunity to
use voluntary behaviors to regulate and exercise several neural pathways involved in the social engagement
system. As an individual becomes more proficient with the rituals, the autonomic nervous system becomes

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more resilient and exhibits a greater capacity to down-regulate defense and to support states that promote
health, social behavior, and compassion.
Consistent with the polyvagal theory, effective contemplative practices can only occur during states
experienced as safe. Only in safe states are neurobiological defense strategies inhibited and emotional
reactivity contained. Thus, a key to successful contemplative training would be to conduct contemplative
exercises in an environment that supports feelings of safety. This step is mediated through the “passive”
pathway, which simultaneously down-regulates the involuntary defense subsystems and potentiates the
physiological state associated with the evolutionarily newer social engagement system. Functionally, during
contemplative training, the rituals involving breath, posture, and vocalizations provide, through an active
pathway, “neural” exercises of circuits involving structures described in the social engagement system. As these
neural exercises enhance the efficiency and reliability of the neural pathways inhibiting defense systems, the
individual acquires greater access to feelings of safety, openness, and connectedness, which are explored during
contemplative practices and are antecedent states for compassion.
The processes and mechanisms involved in exercising the “active” pathway have been explained. To
understand how the “passive” pathway is recruited, it is necessary to understand two additional features of the
polyvagal theory: dissolution and neuroception. First, through the process of “dissolution” (see Dissolution
section), the theory describes autonomic reactivity as a phylogenetically organized response hierarchy in which
evolutionarily newer circuits inhibit older circuits. Dissolution explains how specific autonomic states can
support either defensive or calm behaviors. Moreover, the autonomic state that supports calm behavior also
has the capacity to actively down-regulate reactivity and defense. Thus, it is insufficient for an individual solely
to abstain from defensive behaviors. The individual must also be in an autonomic state that is incompatible
with defensive behaviors. Second, through the process of “neuroception” (see Neuroception section), context
can influence one’s autonomic state. Neuroception is a complex neural process that evaluates risk in the
environment independently of cognitive awareness. Neuroception detects risk from sensory patterns in the
environment and reflexively shifts a person’s autonomic state to support either defense or safe interactions.
Neuroception provides the clues to understanding how the passive pathway is elicited. Dissolution provides an
understanding of the emergent hierarchical relationship among the components of the autonomic nervous
system that are related to resilience and vulnerability.

Dissolution
The three circuits defined by the polyvagal theory are organized and respond to challenges in a
phylogenetically determined hierarchy consistent with the Jacksonian principle of dissolution. Jackson
proposed that in the brain, higher (i.e., phylogenetically newer) neural circuits inhibit lower (i.e.,
phylogenetically older) neural circuits and “when the higher are suddenly rendered functionless, the lower rise
in activity” (Jackson, 1882, p. 412). Although Jackson proposed dissolution to explain changes in brain
function due to damage and illness, polyvagal theory proposes a similar phylogenetically ordered hierarchical
model to describe the sequence of autonomic response strategies to challenges.
The human nervous system, like that of other mammals, evolved not solely to survive in safe environments,
but also to promote survival in dangerous and life-threatening contexts. To accomplish this adaptive
flexibility, the mammalian autonomic nervous system, in addition to the myelinated vagal pathway that is

264
integrated into the social engagement system, retained two more primitive neural circuits to regulate defensive
strategies (i.e., fight–flight and death-feigning behaviors). It is important to note that social behavior, social
communication, and visceral homeostasis are incompatible with the neurophysiological states that support
defense. Thus, via evolution, the human nervous system retains three neural circuits, consistent with the
Jacksonian principle of dissolution, that are in a phylogenetically organized hierarchy. In this hierarchy of
adaptive responses, the newest circuit is used first; if that circuit fails to provide safety, the older circuits are
recruited sequentially. From a contemplative practice perspective, it is necessary to recruit the phylogenetically
newest circuit that down-regulates defense and involves the social engagement system and the myelinated
vagus.
As we have described, via the active pathway, rituals exercise the integrated social engagement system,
including the myelinated vagus. However, before rituals can function as efficient neural exercises, the
individual must be in a calm and safe physiological state. Only in this state is the active pathway available and
not in conflict with adaptive defense reactions. Thus, an understanding of how to regulate the passive pathway
to maintain a calm physiological state is the initial and most critical step leading to subjective experiences
related to compassion and a universal connectedness. Neuroception provides the insight into the mechanisms
that enable or disable the passive pathway.

Neuroception
To effectively switch from defensive to social engagement strategies, the mammalian nervous system needs
to perform two important adaptive tasks: (1) assess risk, and (2) if the environment is safe, inhibit the more
primitive limbic structures involved in fight, flight, or immobilization (e.g., death-feigning) behaviors. Any
stimulus that has the potential for signaling cues of safety also has the potential to recruit an evolutionarily
more advanced neural circuit that promotes calm behavioral states and supports the prosocial behaviors of the
social engagement system.
The nervous system, through the processing of sensory information from the environment and from the
viscera, continuously evaluates risk. Polyvagal theory proposes that the neural evaluation of risk does not
require conscious awareness but functions through neural circuits that are shared with our phylogenetic
ancestors. Thus, the term neuroception (Porges, 2003b, 2004) was introduced to emphasize a neural process,
distinct from perception, that is capable of distinguishing environmental (and visceral) features that are safe,
dangerous, or life-threatening. In safe environments, our autonomic state is adaptively regulated to dampen
sympathetic activation and to protect the oxygen-dependent central nervous system, especially the cortex,
from the metabolically conservative reactions of the dorsal vagal complex (e.g., fainting).
Neuroception mediates both the expression and the disruption of positive social behavior, emotion
regulation, and visceral homeostasis (Porges, 2004, 2007). Neuroception might be triggered by feature
detectors involving areas of temporal cortex that communicate with the central nucleus of the amygdala and
the periaqueductal gray, since limbic reactivity is modulated by temporal cortex responses to biological
movements, including voices, faces, and hand gestures (Ghazanfar et al., 2005; Pelphrey et al., 2005).
Embedded in the construct of neuroception is the capacity of the nervous system to react to the “intention” of
these movements and sounds. Neuroception functionally decodes and interprets the assumed goal of
movements and sounds of animate and inanimate objects. This process occurs without our awareness.

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Although we are often unaware of the stimuli that trigger different neuroceptive responses, we are aware of
our body’s reactions. Thus, the neuroception of familiar individuals and individuals with appropriately
prosodic voices and warm, expressive faces translates into a positive social interaction promoting a sense of
safety.
In most situations, the “passive pathway” is activated during social interactions by identifiable social
engagement features, including prosodic vocalizations, gestures, and facial expressions. However, within the
proposed model, the passive pathway is recruited via exposure to the physical characteristics of the context in
which contemplative training will occur. History helps us identify and describe optimal contexts.
Contemplative training and practice often occur in structures with physical features that functionally remove
background sounds. This contextual feature is similar to silent retreats, in which the passive triggering of
“safety” is shifted from social interactions to context. In the silent retreat, the removal of distracters, including
the inhibition of potential social engagement via voice, enables the body to move from either a state of
hypervigilance or a state of reciprocal interaction to a state of calmness.
Historically, structures subjectively experienced as safe were often constructed with heavy, durable materials
such as stone (e.g., ancient temples). The fortress attribute supports contemplative practices through two
domains: (1) protection from others when in the physically vulnerable state associated with contemplative
practices; and (2) reduction of sensory cues of danger by attenuating low-frequency sounds associated with
predators, and limiting distracting visual cues. In addition, the stone surfaces provided an acoustic
environment in which vocalizations could be heard without effort and the acoustic characteristics were
enhanced by echoes that might resonate with parts of the body. As vocalizations became ritual chants (e.g.,
Gregorian and Buddhist chants) the harmonics of the chants would echo through the space, and the acoustic
energy would be interpreted as spiritual and healing. Physical features of these sanctuaries promote, through a
passive pathway, feelings of safety and were often the contexts in which contemplative practices were taught
and expressed. Thus, contemplative practices, to be functional and to have positive outcomes, must be
conducted during physiological states in which the autonomic nervous system is not supporting defense and in
a context that does not elicit a neuroception of danger or life threat.

Regulating Autonomic State Through Passive and Active Pathways

Within polyvagal theory, social safety depends on recruiting the ventral vagal pathways to foster a calm
physiological state and maintain physiological and behavioral resilience. Consistent with compassion-focused
therapy (Gilbert, 2009), the recruitment of a social safety system is a prerequisite for experiencing or
expressing compassion. Neuroception describes the “passive” pathway to recruit this state. Neuroception is the
initial step to feeling safe in a safe environment. A neuroception of safety shifts our biobehavioral state by
increasing the influence of both the ventral vagus of the heart and the special visceral efferent pathways
regulating the striated muscles of the face and head described in the social engagement system.
To experience a state of safety, the contextual cues in the environment have to elicit, via neuroception, the
ventral vagal pathways that actively down-regulate autonomic defense systems mediated by the sympathetic
nervous system and the dorsal vagus. Feeling safe requires two complementary features. First, states of
hypervigilance are reduced by removing cues of distraction and potential predators. In general, the focus is on
auditory and visual cues, since our nervous system is hardwired to interpret the intentionality of movements

266
and sounds. Low-frequency sounds are hardwired cues of predators and potential life threats. High-frequency
sounds are also hardwired cues of danger (see Porges & Lewis, 2010). Since our nervous system continuously
attempts to interpret the intention of movements, removal of visual distracters enables individuals to shift
from hypervigilance to calmness.
Removal of cues of danger is not sufficient for everyone to feel safe. Some people experience a quiet space as
restful and spiritual, while others become anxious and hypervigilant. To insure a neuroception of safety, the
individual must process additional sensory features in the environment. This is most reliably accomplished
through the use of acoustic stimulation that is modulated in the frequency band of a mother’s lullaby.
Functionally, humans are hardwired to be calmed by the modulation of the human voice (Porges & Lewis,
2010).
The acoustic features for calming infants are universal and have been repurposed by classical composers in
music (Porges, 2008). Composers implicitly understood that they could lull the audience into a state of safety
(i.e., via neuroception) by constructing melodic themes that duplicated the vocal range of a mother soothing
her infant, while limiting the contribution of instruments that contributed low-frequency sounds. The
acoustical structure of liturgical vocal music follows a similar convention by minimizing low-frequency sounds
and emphasizing voices in the range of the nurturing mother calming her infant.
A large pipe organ, generating low-frequency tones, triggers a feeling of awe, not safety. The low tones of
an organ have acoustical features that overlap with our hardwired reactions of immobilization in the face of a
predator. Thus, loud, low tones from a pipe organ could potentially disrupt the passive pathway and interfere
with the state of safety required to experience compassion and a connectedness with another. However, the
presentation of low-frequency tones within a confined environment may trigger a sense of submission that
could be associated with psychological feelings of surrendering to a deity.
Once the passive pathway effectively shifts our physiological state, the second step can be initiated. The
second step, exercising the vagal brake, recruits the “active” (voluntary) pathway through rituals requiring
manipulations of breath, posture, and vocalizations. These manipulations of the vagal brake exercise the
inhibitory influence of the vagus on the heart as an efficient calming mechanism. Neurophysiologically, the
vagus functions as a brake on the heart’s pacemaker, resulting in the heart beating at a rate substantially slower
than the intrinsic rate of the pacemaker.
Breathing is an efficient and easily accessible voluntary behavior to systematically reduce and increase the
influence of the vagus on the heart. More than a hundred years ago, Hering (1910) reported that the cardio-
inhibitory vagal pathways had a respiratory rhythm that reflected the dynamic adjustment of the vagal control
of the heart. Further articulation of this phenomenon was summarized as a “respiratory gate” by Eckberg
(2003), who emphasized the enhancement of the vagal influences on the heart during exhalation, and the
dampening of vagal influences on the heart during inhalation. Many rituals require breathing pattern shifts.
Perhaps the most obvious are chants and other forms of vocalizations, which manipulate the respiratory gate
by expanding the duration of exhalation and reducing the duration of inspiration. Other rituals involving
prayer and meditation may also influence vagal regulation through posture shifts, which trigger baroreceptors
(blood pressure receptors) to adjust blood flow to the brain. This process involves systematic changes in vagal
regulation of the heart to avoid dizziness and fainting (e.g., vasovagal syncope).
As described in Table 15.2, polyvagal theory explains how the manipulation of vagal pathways is involved in

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the foundational processes upon which contemplative training and practice are based. These processes require
two pathways (passive and active) to regulate the autonomic state and lead to a physiological state, which
would enable feelings of safety and compassion to be felt and expressed. Involving the two pathways to
regulate the physiological state is a prerequisite for effective contemplative practices (e.g., meditation). The
two pathways function sequentially. Thus, once one is in a physiological state that supports feelings of safety,
successful training would result in a resilient autonomic nervous system that would acknowledge, without
mirroring, the emotional reactivity and pain often expressed by those who are suffering.

Table 15.2 Steps to Compassion

Step Polyvagal Process

1. Experience safe context (recruit • Neuroception of safety
passive pathway)
• Remove predator cues
• Add acoustic cues of a loving mother
2. Perform rituals (recruit active • Exercise vagal brake to enhance autonomic flexibility and resilience
pathway)

3. Contemplative training (e.g., • Mental exercises involving brain functions that are dependent on
meditation)
maintaining “ventral” vagal state
4. Experiencing compassion and a • Emergent property of higher brain processes, while maintaining a “ventral”
sense of oneness
vagal state

If the passive pathway does not enable the person to be in a calm ventral vagal state, then the active
pathway, rather than being an enabler of compassion, may trigger defensiveness. If an individual engages in
the active pathway in a vulnerable physiological state (during either down-regulated ventral vagal influences or
up-regulated sympathetic influences), then exercising the vagal brake may create a transitory state of
vulnerability. This would occur when the “neural exercises” associated with the active pathway withdraw the
vagal brake (e.g., during inspiration while meditating or chanting) and trigger a sympathetic excitation
sufficient to support fight/flight behaviors.

Conclusion
In this chapter, a multistep sequential model is proposed that would optimize the effects of contemplative
training leading to a greater capacity to feel and express compassion. The model includes:
1. A “passive” pathway that is elicited by feeling safe in an environment that provides sensory cues that, via neuroception, down-regulate
defense;
2. An “active” pathway that is implemented via voluntary behaviors (i.e., neural exercises of the vagal brake) capable of establishing a “calm”
neural platform (i.e., ventral vagal state) that would functionally optimize contemplative practices;
3. Extensive contemplative training; and
4. The emergent properties of contemplative practices, including the capacity to experience and express compassion.

The objective of this chapter is to propose that the capacity to experience and express compassion depends
on a physiological state mediated by myelinated vagal pathways originating in the brain stem. Thus, within
this model, the capacity to experience and express compassion is predicated on successful implementation of
antecedent steps that recruit and exercise the vagal brake. Underlying this objective are several plausible

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assumptions and testable hypotheses:
1. Autonomic state is critical to experiencing and expressing compassion;
2. The “passive” pathway, through neuroception, can recruit ventral vagal pathways and features of the social engagement system to shift
autonomic state sufficiently to facilitate the effectiveness of rituals, as neural exercises, in enhancing autonomic regulation;
3. The “active” pathway, through the efficient use of rituals, exercises vagal regulation of autonomic state to optimize health and resilience;
and
4. The efficient use of rituals promotes a physiological state in which the outcomes of contemplative training are optimized.

Thus, an appreciation of the physiological state as an important prerequisite for compassion may result in
more efficient and positive outcomes of practices, including compassion-focused therapy; leading to enhanced
compassion.

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 PART 4

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Compassion Interventions

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 Empathy-Building Interventions A Review of Existing Work and Suggestions for
Future Directions

Erika Weisz and Jamil Zaki

Abstract

A major question in the study of empathy—the capacity to share and understand others’ internal states—
is whether it can be increased. Scientists have designed a number of effective interventions through
which to build empathy, especially in cases where it typically wanes. Here we review these efforts, which
often focus on either enhancing individuals’ skills in experiencing empathy or expressing empathy to
others. We then propose a novel approach to intervention based on a motivated account of empathy: not
only teaching people how to empathize, but also encouraging them to want to empathize. Research
traditions from social psychology offer several ways of increasing empathic motivation, which can
complement existing work and broaden the palette of applied scientists seeking to help people develop
their capacities to care for and understand others.

Key Words: interventions, empathy, self-oriented interventions, group-based interventions, situation-

based interventions

More than any other species on earth, humans vicariously experience others’ thoughts and feelings.
Empathy—the capacity for one person (a perceiver) to share and understand internal states of someone else (a
target)—is a social bridge that allows us to connect with one another. It also drives many crucial downstream
outcomes, including individual well-being (Davis, 1983; Mehrabian, 1996; Wei, Liao, Ku, & Shaffer, 2011)
and prosocial behavior (Batson & Shaw, 1991).
Yet, for all its benefits, empathy is not a universal response; it predictably fails under certain conditions
(Zaki & Cikara, 2015). For instance, people experience reductions or even reversals in empathy during
conflict (Brewer, 1999; Hein, Silani, Preuschoff, Batson, & Singer, 2010; Sherif, 1936) and when interacting
with dissimilar others (Chiao & Mathur, 2010; Mitchell, Macrae, & Banaji, 2006; Singer, Seymour, &
O’Doherty, 2006; Xu, Zuo, Wang, & Han, 2009). In other cases, an individual’s experience or even their
profession reliably diminishes empathy. For example, doctors sometimes fail to correctly understand the depth
of their patients’ suffering (Decety, Yang, & Cheng, 2010; Marquié et al., 2003), diminishing well-being in
both patients (Hojat et al., 2011) and physicians (Krasner et al., 2009). Sources of empathic failure can
compound each other. For instance, empathy impairments among medical professionals are exacerbated when
interacting with black patients (Goyal, Kuppermann, Cleary, Teach, & Chamberlain, 2015; Trawalter,
Hoffman, & Waytz, 2012). These empathy failures and their devastating consequences generate an important
question: Is it possible to build empathy through intervention? To answer this question, we must first consider
the nature of empathy. Is empathy a fixed capacity, or is it a skill that can be developed over time?
Individual differences in empathic tendencies register on a number of indices, suggesting that empathy may

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be a stable trait. First, people differ in reports of how much empathy they feel for a target (Davis, 1983;
Eisenberg & Miller, 1987; Mehrabian, Young, & Sato, 1988). They also differ in their tendencies to convey
empathy in facial expressions (Lundqvist & Dimberg, 1995; Sonnby-Borgström, Jönsson, & Svensson, 2003),
in their empathy-related brain activity (Hooker, Verosky, Germine, Knight, & D’Esposito, 2010; Marsh et
al., 2008; Singer et al., 2006), and in their capacities to offer help when confronted with others’ distress (Davis
et al., 1999; Hein et al., 2010).
Other evidence challenges this notion, however, demonstrating that empathy is highly sensitive to
situational forces. For example, though some studies find that women are more empathic than men, a closer
examination shows that this difference only manifests under certain contextual constraints (like when
empathy-relevant gender expectations are made salient) (Ickes, Gesn, & Graham, 2000). Clever
manipulations of situational features reduce these differences (Klein & Hodges, 2001; Thomas & Maio,
2008), supporting the idea that empathy is susceptible to change across contexts. In many cases, individual
differences are only weak indicators of empathy and related behavior. Sometimes situational factors (e.g.,
limited time) change the likelihood that someone will empathize (Shaw, Batson, & Todd, 1994) and predict
helping behavior better than trait indices of empathy (Darley & Batson, 1973).
These findings align with a malleable view of empathy; though there is evidence for variability in
individuals’ trait empathy, inconsistent responding across situations suggests that empathy can be developed.
In an effort to further investigate the flexibility of empathy, researchers have endeavored to change it through
intervention.

Empathy and Compassion

Empathy encompasses at least three related, but distinct, subprocesses. Mentalizing refers to the ability to
draw inferences about a target’s thoughts and feelings (Davis, 1983). Experience sharing refers to the process by
which someone vicariously experiences another person’s emotional state (Hatfield, Cacioppo, & Rapson,
1993). Finally, empathic concern captures a perceiver’s desire to alleviate a target’s distress (Batson, 2009).
Though behaviorally and physiologically dissociable, the three subcomponents are deeply intertwined and
interactive (Zaki & Ochsner, 2012). For example, exercises in perspective-taking can elicit increases in
empathic concern (Batson et al., 1997; Batson, Turk, Shaw, & Klein, 1995).
Compassion, on the other hand, is the capacity to perceive and desire to alleviate others’ suffering (Goetz,
Keltner, & Simon-Thomas, 2010). Features of empathy (particularly the empathic concern subprocess) bear
great resemblance to compassion; both qualities feature an understanding of another person’s emotional states,
coupled with a desire to help. However, though they probably share evolutionary roots, empathy and
compassion are conceptually distinct constructs (Zaki, 2014). Compassion entails recognizing specific negative
emotional states (like pain) and subsequently experiencing an urge to help; empathy involves sharing and
understanding a range of emotions, both positive and negative. Empathy also involves both an understanding
and a sharing of someone else’s feelings, whereas compassion may not require a perceiver to vicariously share
another person’s feelings. Later in this chapter, we offer a framework of motivated empathy intended to
complement existing empathy interventions. Though here we address interventions specifically designed at
bolstering empathy, it should be noted that our motive-based framework could be similarly applied to
compassion-related interventions, because both involve engagement with others’ emotions (Zaki, 2014).

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 Given the interplay of mentalizing, experience sharing, and empathic concern (and because there are
relatively few empathy training studies), in this chapter we will review interventions aimed at increasing any of
these three empathic subcomponents. We will start by reviewing empathy-building efforts, then suggest a
novel framework for constructing empathy interventions. Crucially, we will differentiate between two
categories of interventions; first, we will review existing interventions, which typically aim to bolster people’s
empathic ability. We will then explore a novel, theory-driven approach for instead building people’s
motivation to empathize, and describe applications of motive-based empathy interventions.

A Review of Existing Interventions

Many empathy interventions focus on developing people’s ability to empathize by targeting their capacity to
experience empathy or expressing empathy to others. Experience-based interventions feature tasks that
encourage “tuning in” to targets’ internal states. Expression-based interventions help perceivers more effectively
convey empathy for a target.
Experience-based interventions often offer perceivers an opportunity to take a target’s perspective, through
either imagining themselves in the target’s position or considering a target’s internal states. These two
approaches build empathy for targets by providing a deeper understanding of their thoughts and feelings.
Some interventions use role-play techniques to build empathy through simulating a target’s experience.
Allowing perceivers to see the world through the target’s perspective facilitates better understanding of their
internal states, in turn cultivating empathy for them. In one such project, medical students were admitted to
stay overnight in a hospital to experience hospitalization from a patient’s perspective. The students who
participated expressed greater interest in improving the doctor–patient relationships, suggesting that this role-
play exercise worked in evoking sympathy for patients (Wilkes, Milgrom, & Hoffman, 2002).
Bunn and Terpstra (2009) used a novel experiential technique for medical students during their psychiatry
rotation. Students underwent an auditory hallucination simulation while completing a battery of cognitive
tasks in an effort to understand patients’ experiences during neuropsychological testing. Participating students
later had higher scores on a self-report measure of empathy for individuals with mental illness (Bunn &
Terpstra, 2009). Similar methods have been used to increase empathy among adolescents for their peers
(Jacobs, 1977), among sex offenders for assault victims (Webster, Bowers, Mann, & Marshall, 2005), and
among college students for the disabled (Clore & Jeffery, 1972) (see Table 16.1 for a selection of empathy-
building interventions, and for a more thorough review of existing empathy interventions see Davis &
Begovic, 2014).
Other perspective-taking techniques explicitly instruct perceivers to consider a target’s internal states. In
one study, perceivers were asked to imagine the life and feelings of a target who was a member of a
stigmatized group. This intervention increased positive evaluations, both for the stigmatized targets and for
other members of the stigmatized group (Batson et al., 1997). In a study using a similar paradigm, imagining
the thoughts and feelings of a heroin addict led participants to allocate more money to an addiction treatment
agency, suggesting that these interventions also elicit positive downstream effects of helping behavior (Batson,
Chang, Orr, & Rowland, 2002).
Researchers also use vignettes, videos, stories, and letters to deliver similar information about targets’
perspectives. These techniques are often used to promote empathy for out-group members. One study found

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that white students who watched a video documenting white privilege and institutional racism showed an
increase in empathy and racial awareness (Soble, Spanierman, & Liao, 2011). In another study, Arab
participants read and responded to a letter written by a Jewish mother whose son had been killed in a terrorist
attack. Participants experienced more empathy and less hostility towards Israelis after the letter-writing
activity (Shechtman & Tanus, 2006). Similar effects emerge following first-hand contact between groups.
Inter-group contact diminishes prejudice and hostility (Pettigrew & Tropp, 2006) by increasing perspective-
taking and empathy toward out-group members (Pettigrew & Tropp, 2008).
Some interventions designed to foster compassion or empathic concern use techniques like meditation to
increase understanding of and caring for others. Such “compassion training” has induced changes in
psychological (Jazaieri et al., 2015), physiological (Klimecki, Leiberg, Lamm, & Singer, 2013; Weng, Fox,
Shackman, & Stodola, 2013), and behavioral (Condon, Desbordes, Miller, & DeSteno, 2013; Leiberg,
Klimecki, & Singer, 2011) responses to others’ distress. Through role-play, media presentations, first-hand
contact, and compassion meditation, experiential interventions build empathy by giving perceivers a deeper
understanding of targets’ experiences.
Expression-based interventions teach participants to recognize targets’ internal states and respond
appropriately. They are often implemented in cases where a perceiver fails to identify others’ distress, or when
a perceiver is impaired in conveying empathy for a target. Expression interventions are often used among
medical professionals, often enhancing doctors’ empathic displays. Empathic displays (e.g., wincing at others’
pain) serve communicative purposes, informing a target that the perceiver understands and shares their
suffering (Bavelas, Black, Lemery, & Mullett, 1986). Given that the doctor–patient relationship is a context
where showing empathy can improve relations, communication skills training programs are popular
techniques among this population (Back et al., 2007; Bonvicini et al., 2009).1
Riess and colleagues developed a program specifically for physicians that featured a scientific justification
for being empathic with patients. In their paradigm, physicians watched videos of difficult interactions
between doctors and patients. The videos displayed the doctor and patient’s physiological responses (e.g.,
skin-conductance fluctuations) on a portion of the screen during the conversation, providing information
about the ameliorative effects of sharing affect with patients. Consistent with the researchers’ expectations, the
training improved doctors’ recognition of facial expressions and their evaluation scores on a patient satisfaction
measure (Riess, Kelley, Bailey, Dunn, & Phillips, 2012).

Table 16.1 Summary of Experience-Based and Expression-Based Interventions

Study Participants Type Training Outcome

Batson et Female college Experiential Asked to imagine life More positive attitudes towards
al. (1997) students and feelings of members of stigmatized group
stigmatized targets
(AIDS patient, homeless
person, murderer)

Batson et College students Experiential Asked to imagine life Prosocial action on behalf of
al. (2002) and feelings of stigmatized group

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 stigmatized target (drug
dealer)

Bunn & Medical students Experiential Audio hallucination Higher score on Jefferson Scale
Terpstra simulation during of Physician Empathy
(2009) neuropsychological
testing

Condon et Adults Experiential Attended meditation Increased rates of helping a

al. (2013) classes led by Tibetan suffering individual
Buddhist lama for 8
weeks

Clore & College students Experiential College students Improved attitudes towards
Jeffery travelled around campus disabled people
(1972) in wheel chair

Jacobs Adolescents Experiential Students role-play No changes in empathy

(1977) adolescent interpersonal measures
interactions

Jazaieri et Adults Experiential Participants attended Compassion training increased

al. (2015) classes on compassion- mindfulness and happiness,
focused meditation and which was related to increased
engaged in daily home caring for others
meditation

Klimecki Adults Experiential Attended 1-day course of Increased positive affect in

et al. loving kindness response to distress, and
(2013) mediation increased activity in brain
regions supporting affiliation
and positive affect

Shechtman Arab students Experiential Multi-session Increased empathy and reduced

& Tanus intervention including hostility toward Israelis
(2006) reading a letter from a
Jewish mother

Soble et al. College students Experiential Video intervention Increased empathy and racial
(2011) documenting awareness
institutional racism

Webster et Sex offenders Experiential Sex offenders complete Improved recognition of

al. (2005) role-play paradigms consequences for victims

Wilkes et Medical students Experiential Medical students Students endorse interest in

al. (2002) admitted to stay improving hospital conditions

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 overnight in hospital

Weng et Adults Experiential Participants listened to Compassion meditation

al. (2013) 30-minute audio increased altruistic behavior and
recordings featuring activity in brain regions
compassion meditation supporting social cognition and
emotion regulation

Archer & College students Expressive Emotion recognition and Improved peer relationship
Kagan empathic responding rating scores and performance
(1973) on affect sensitivity scale.

Back et al. Oncology fellows Expressive Communication training Improved in communication

(2007) workshop skills, including empathic verbal
skills

Bonvicini Physicians Expressive Communication training Training increased physicians’

et al. workshop global empathy and empathy
(2009) expressions during patient
interactions

Dadds et Children with Expressive Emotion recognition Improvements in affective

al. (2012) behavioral/emotional training empathy and conduct problems
problems in kids with high
callous/unemotional traits

Golan & Adults with Expressive Computer-based training Improvements on similar

Baron- Asperger syndrome in recognizing emotions emotion recognition tasks (but
Cohen in faces and voices not dissimilar tasks)
(2006)

Riess et al. Otolaryngology Expressive Empathy-relational skills Improved knowledge of

(2012) residents training focused on neurobiology of empathy, self-
underlying neurobiology reported capacity to empathize,
of empathy and patient satisfaction

In order to convey an empathic response, a perceiver must first recognize a target’s distress. Therefore, some
expression-based interventions focus on enhancing a perceiver’s emotion-recognition ability. Such training
techniques are often used among people who exhibit impaired empathic responding due to impaired ability to
read others’ communicative gestures. People with autism, for example, struggle to understand others’
expressions and mental states. Through systematic training in expression identification, individuals with
autism can improve their emotion-recognition abilities (e.g., Golan & Baron-Cohen, 2006). A similar
emotion-recognition paradigm was implemented among aggressive adolescents. Adolescents with higher
levels of callous/unemotional traits benefitted most from this emotion-recognition training, and displayed
significant improvements in affective empathy following the intervention (Dadds, Cauchi, Wimalaweera,

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Hawes, & Brennan, 2012).

Summary of Interventions
Existing empathy interventions can be broadly categorized as enhancing the experience or the expression of
empathy. Using a variety of techniques including role-play, perspective-taking, and information sharing,
experiential interventions increase one’s internal feeling of empathy. Expression interventions, on the other
hand, change a person’s external display of empathy by teaching perceivers to recognize and respond to
targets’ distress. It should be noted that this characterization of existing work serves only to better categorize
the most popular methods of existing studies; this is not an exhaustive review of all related work; therefore,
this categorization functions only to orient the reader to important features of previous interventions.

Accounting for Empathic Motives

Existing interventions are effective in changing empathy; a recent review suggests that interventions can
alter people’s capacity to feel empathy and their ability to show empathy, and can even elicit downstream
effects of empathy like altruistic helping behavior (van Berkhout & Malouff, 2015). Given their utility, one
may wonder whether these interventions would be effective if applied to novel situations. The answer is
probably “yes,” but only under specific conditions. These interventions are likely to work in situations where
perceivers are able to empathize (i.e., they can recognize others’ emotions and have the means to respond
accordingly) and are ready to empathize (there are no factors discouraging empathy for the target). But is this
the case across all perceiver–target relationships? Unfortunately it is not; people frequently fail to empathize
with particular targets not because they are unable to do so, but rather because they are unwilling to empathize
(Zaki, 2014; Zaki & Cikara, 2015).
In particular, empathy—like many other psychological phenomena (Dweck & Leggett, 1988; Kahneman &
Tversky, 1979; Kunda, 1990; Lewin, 1952)—reflects the interplay of approach motives, which drive people
toward empathizing, and avoidance motives, which drive people away from empathizing. Avoidance motives
include cases in which people expect empathy to be costly (Cameron & Payne, 2011; Pancer, Mcmullen,
Kabatoff, Johnson, & Pond, 1979; Shaw et al., 1994) or painful (Davis et al., 1999; for an in-depth discussion
of compassion avoidance motives, see chapter by Paul Gilbert and Jennifer Mascaro in this handbook). People
also experience empathic avoidance motives when empathy conflicts with their goals; for instance, during
competition. To wit, a linebacker who feels the pain of the person he tackles would probably be worse at his
job. Evidence suggests that people in such contexts avoid empathy, including under darker contexts, such as
executioners downplaying or ignoring the suffering of death row inmates (Osofsky, Bandura, & Zimbardo,
2005).
Empathy-inducing techniques like perspective-taking can even backfire when applied in particular contexts.
In competitive interactions, for example, perspective-taking manipulations increase the likelihood that one
will behave selfishly (Epley, Caruso, & Bazerman, 2006). Perceiving distress in competitive interactions often
elicits counter-empathic emotions like schadenfreude (Cikara & Fiske, 2011; Lanzetta & Englis, 1989;
Yamada, Lamm, & Decety, 2011). Considering the mind of another person may be a “relational amplifier,”
facilitating prosocial interactions in cooperative contexts but dishonesty or deceitfulness in competitive
contexts (Pierce, Kilduff, Galinsky, & Sivanathan, 2013). Such empathic failures do not result from a lack of

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ability to empathize; rather, they reflect a lack of motivation to empathize. Such empathic failures are often
the most pernicious (e.g., bullying, inter-group conflict) and are arguably the cases in which empathy is
needed most.
What does this mean for existing interventions? Despite their success, effects of existing interventions may
be unnecessarily constrained due to an incomplete depiction of forces impacting empathy. These studies and
their findings imply a direct link between perceiving distress and responding empathically; empathy is
“triggered” when a perceiver is able to detect someone else’s pain. But this theory does not account for the
many cases where empathy breaks down for motivational reasons. An intervention that changes experience or
expression of empathy while simultaneously accounting for empathic motives could be even more effective
than changing experience and expression alone. By pairing existing techniques with complementary motive-
based approaches, we are positioned to expand our scope of influence and correct multiple varieties of
“empathy gaps,” including both ability-based and motive-based failures.

Social Psychology and Brief Interventions

Social psychology offers a theoretical foundation for developing motive-based empathy interventions. With
an acute understanding of the system of forces governing certain actions, small motive adjustments can elicit
big behavioral changes (Yeager & Walton, 2011).
Brief social-psychological interventions derive their success from disrupting cycles of behavior at crucial
points. Consider an intervention designed to improve achievement in school: Teaching students that poor
performance reflects a lack of effort (not a lack of ability) may encourage them to exert more effort on
subsequent tasks, which in turn produces improvements in performance (Dweck & Leggett, 1988). Assuming
that people act under the influence of interacting forces, strategically tweaking elements of these systems of
motives produces enduring behavioral changes (Lewin, 1943). Brief interventions influence a person’s
behavior over time, changing an individual and in turn changing their environment (Walton, 2014).
Social-psychological interventions could be adapted to build empathy in at least three ways: by changing
views of the self, by changing perceived social norms, and by shifting people’s construal of particular empathy-
evoking situations. Through targeting the motives that bear on empathy, interventionists may be able to
preserve empathy in contexts where it is known to fail.2

Self-Oriented Interventions
Work by Carol Dweck and colleagues illustrates the degree to which our beliefs influence our behavior.
Dweck differentiated two types of mindsets, or beliefs about the nature of a phenomenon, which predict
people’s behavior in challenging contexts. Individuals with fixed mindsets about intelligence believe that
intelligence is a stable quantity that does not change, whereas individuals with growth mindsets about
intelligence believe that intelligence can be developed with effort (Dweck & Leggett, 1988).
These implicit theories about the nature of psychological phenomena extend beyond the domain of
intelligence and have implications for other areas of social cognition, including beliefs about personality and
interpersonal functioning (Chiu & Dweck, 1997; Erdley, Cain, Loomis, Dumas-Hines, & Dweck, 1997).
Interventions targeting beliefs about psychological phenomena have been tremendously effective in improving
people’s academic performance (Blackwell, Trzesniewski, & Dweck, 2007), their resilience to academic failure

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(Wilson & Linville, 1982), and their behavior following social rejection (Yeager et al., 2011).
Drawing from these motive-based interventions, subsequent work has targeted people’s lay theories of
empathy to shape their motives and behavior. In a 2014 study, Schumann and colleagues found growth
mindsets about empathy (whether measured across people or induced experimentally) predicted greater
empathic effort in challenging situations (e.g., when interacting with a target from a social out-group).
Interventions seeking to improve empathic effort—especially in contexts when empathy can break down—
could approach behavior change by targeting beliefs about empathy’s malleability (Schumann, Zaki, &
Dweck, 2014).
Lay theories also predict people’s resilience in the face of failure. Returning to the example of intelligence,
individuals with growth mindsets about intelligence are more likely to attribute failure to a lack of effort. They
are often motivated to persevere after failure, applying greater effort and in turn developing intelligence.
People with fixed mindsets about intelligence attribute failure to a lack of ability. Fixed mindsets about
intelligence steer people away from contexts in which they expect to fail, since failure jeopardizes their views
of their own intelligence (Elliott & Dweck, 1988; Hong, Dweck, Lin, & Wan, 1999).
Mindsets could similarly influence attributions of empathic failures. When people fail to empathize, they
may conclude that they are unable to empathize or that they are not empathic people. Instead, teaching people
that empathy failures can be overcome with increased effort (i.e., inducing a growth mindset about empathy)
could make them resilient to empathic failures and encourage them to exert more effort empathizing in these
contexts.
Interventions designed to teach people that empathy is malleable and can be developed can build their
motivation to empathize, change their interpretation of empathic failure, and ultimately increase their
willingness to connect to others, even when it is challenging.

Group-Based Interventions
Group dynamics shape empathic behavior. In-group members are often favored over out-group members, a
phenomenon referred to as inter-group bias (Brewer, 1979; Tajfel, 1982). This propensity carries over to
empathic behavior, and people generally show blunted affective responses to people from an out-group
(Cikara, Bruneau, & Saxe, 2011). Intervention techniques that change perceptions of group boundaries may
be useful in reducing group-based empathy biases. The Common Group Identity Model (Gaertner &
Dovidio, 1977) suggests that the boundaries defining groups are flexible; extending a conception of an in-
group to be more inclusive (e.g., Americans instead of New Yorkers) reduces inter-group tension.
Applications of this model highlight its potential to change inter-group relations. In a 2005 study of
helping behavior, Levine and colleagues examined the malleability of in-group preference by changing
people’s perceptions of group boundaries. When cues of in-group membership were narrow (based on shared
support of one particular soccer team), participants were less likely to help a person wearing another team’s
jersey (an out-group member). But by changing cues of in-group membership to be more inclusive (defining
in-group membership as “soccer fans” rather than “Manchester United fans”), the group-based difference is
attenuated, and help is offered to those who were previously regarded as out-group members (Levine, Prosser,
Evans, & Reicher, 2005).
Similarly, altering inter-group interactions can change perceptions of group boundaries and reduce inter-

281
group bias. Introducing shared goals to groups in conflict reduces tension and increases positive inter-group
interactions (Sherif, 1958). Subsequent studies have also “overridden” existing group boundaries by offering
salient cues of alternative group membership. Biased processing of racial out-group members’ faces, for
example, is reduced by the introduction of shared group membership in a minimal groups paradigm (van
Bavel, Packer, & Cunningham, 2008). If group-based behavior is determined by in-group boundaries, and
such boundaries are flexible, then scientists may elicit motivational and behavioral changes in empathy by
broadening people’s views of in-group membership.
In addition to changing the structure of a group to encourage empathy, changing a group’s values could
similarly alter empathic behavior. A long tradition of research demonstrates that people willingly adjust their
beliefs and behavior to match others around them (Asch, 1956; Sherif, 1936). This effect is amplified in group
contexts; to preserve a sense of group membership and belongingness, people even endorse beliefs that they
think their in-group holds (Prentice & Miller, 1993). Under the scrutiny of their in-group, people may be
motivated to avoid empathy for out-group members if it means deviating from the perceived group norms.
Norms convey powerful messages about how group members typically think and behave (Cialdini, 2003;
Sherif, 1936). People are sensitive to these messages and often act in ways consistent with apparent norms
(Cialdini, Reno, & Kallgren, 1990). Given that group norms are so closely linked to group membership,
shifting norms could be a useful avenue for changing individual members’ attitudes and values.
In instances of empathic failures resulting from inter-group tension, it may be especially important to
understand the existing group norms, how they are perpetuated, and how they can be modified. Introducing
norms at initial stages of group formation may be particularly fruitful. For example, if one wanted to increase
empathy on a college campus, it would be wise to take new members (i.e., college freshman) and teach them
that they are entering an environment where empathy is valued and regularly practiced in the community
(Nook, Ong, Morelli, Mitchell, & Zaki, 2016; Tarrant, Dazeley, & Cottom, 2009).
Beliefs about the nature of groups and the people that compose them have tremendous implications for an
individual’s behavior. Changing a group’s structure (by altering group boundaries) or shifting a group’s values
(by adjusting salient norms) can produce long-term changes in people’s social functioning and empathic
behavior.

Situation-Based Interventions
A third approach to intervention is changing people’s perception of empathy-inducing situations. Just as
perceiver and target’s individual attributes shape empathy, characteristics of the contexts in which dyadic
interactions occur are also deeply influential. Interventions should be sensitive to cues embedded in situations,
and they could work to adjust situational signals to promote empathy. This could be achieved by shaping
situations to feature cues illustrating the goal-relevance of empathy, perhaps highlighting how empathy (1)
can help people feel good and (2) can help people satisfy the demands of their important social roles.
Emphasizing the personal benefits of empathy could encourage empathic engagement. Empathy changes as
a function of people’s beliefs, and it often breaks down when a perceiver expects it to be painful or impose a
monetary cost. Fortunately, these beliefs are amenable to change, and adjusting people’s perspective on the
costs of empathy changes empathic behavior. In one study, informing participants that prosocial helping
imposed only a low cost (i.e., helping the target would not be time-consuming) made them more likely to

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empathize with a person in need (Shaw et al., 1994).
Addressing people’s concerns about the affective costs of empathy (i.e., whether they’ll feel bad after
empathizing) could produce a similar outcome. When people expect that empathy will be painful (imposing
an “emotional cost”), they are more likely to avoid it (Davis et al., 1999). By shaping people’s expectations
about the emotional outcomes of empathy, we may be able to encourage them to empathize even when they
expect it to be painful.
Interventions could similarly highlight the affective benefits of empathy. Predictions of affective outcomes
(like vicariously feeling another person’s happiness) powerfully influence behavior and can be harnessed for
prosocial purposes; in one study, people’s expectations of positive emotions conferred by volunteering
predicted their subsequent volunteering behavior (Barraza, 2011). One could similarly emphasize the benefits
of empathy (like its positive influence on psychological and physical health) in creating an intervention to
increase empathic engagement.
Finally, people may be more likely to empathize when they see its goal relevance. Showing people how
empathy may facilitate their existing goals (for example, fulfilling the duties of their important roles) makes
empathizing personally significant to them. Previous interventions have modified situations to signal task
significance to increase certain behavior. In an intervention looking at the influence of task significance on
performance, lifeguards who read stories about other lifeguards rescuing swimmers volunteered to work more
hours and were rated as more helpful by guests than lifeguards who read stories about how they could
personally gain skills or knowledge from the job (Grant, 2008). In a similar study, doctors washed their hands
more when reminded of the benefits hand-hygiene had for their patients (Grant & Hofmann, 2011).
In professions like these, where one’s identity is derived from relational connections to others people,
highlighting the role-relevant aspects of a novel action encouraged participants to change their behavior.
Tailoring experimental messages to emphasize aspects of the behavior that were consistent with the lifeguards’
and doctors’ identities produced more robust behavior change than emphasizing the personal benefits of the
same behavior.
When empathy is relevant to one’s important roles and aspects of one’s identity, it may manifest more
readily than it otherwise would have. For example, when gender value cues are made salient, women
outperform men on tests of empathic accuracy. When the task was presented as relevant to their role as a
female, the researchers suspected, women were more motivated to do well on the task and outperformed men
in an effort to behave consistently with their roles as women (Klein & Hodges, 2001). Interventions that
connect empathy to meaningful aspects of a person’s identity (like occupational or social roles) stand to
produce enduring effects on a person’s empathic motivation.

Limitations
Despite the promise of this model for building empathy, there are limitations of a motive-based approach
(and of empathy interventions more generally). Motive-based interventions are likely to fail in contexts where
competing avoidance motives overpower approach motives. There are many situations in which an individual
has the ability to empathize, but lacks the desire to empathize (e.g., when empathy is expected to be painful or
costly, or during competitive or hostile interactions). In the face of these powerful motives to avoid empathy,
interventions designed to bolster approach-motives are likely to fail (Prentice & Miller, 2013). In constructing

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a motive-based empathy intervention, it is therefore crucial to consider the entire range of motives influencing
a perceiver-target. A wise researcher may recognize, for example, that a small reduction in avoidance motives
could yield greater outcomes than a large increase in approach motives.
Furthermore, it is important to consider contexts in which any attempt to develop empathy (motive-based
or otherwise) could potentially do more harm than good. Several studies explore the counter-intuitive
antisocial effects of perspective-taking (for a review and theoretical exploration, see Vorauer, 2013). In some
cases, perspective-taking can aggravate existing tensions between perceivers and targets (Paluck, 2007), or
increase the likelihood that a perceiver will seek to harm a target (Okimoto & Wenzel, 2011). Of course,
perspective-taking and subsequent behavior are influenced by context. For example, a study finding that
perspective-taking increased negative attitudes toward an out-group emphasized that this was a feature of a
power imbalance between the two groups (Bruneau & Saxe, 2012). Given that the effects of perspective-
taking are highly sensitive to perceiver–target dynamics and the larger context, it is important for researchers
to consider these factors in constructing interventions.

Conclusion
Psychologists have generated a number of interventions that successfully build empathy. In addition to their
promise in addressing empathic “failures,” these interventions highlight the malleability of empathy overall.
The lion’s share of existing interventions focuses on building empathic skills through exposing people to
empathy-inducing cues, and teaching them to take others’ perspective, or to better express empathy. Although
these approaches have been successful, interventions could also benefit from adopting a complementary,
motive-based approach that targets the underlying forces governing empathy. By altering empathic motives
through changing perceptions of the self or views of a group, or interpretation of situational cues, new types of
interventions stand to make even more impactful change on people’s ability and tendency to consider, share,
and care about each other’s experiences.

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Notes
1. It’s possible that developing empathy expression simultaneously changes people’s experience of empathy. In one intervention, nurses trained
in empathic responding (e.g., listening and adding to a patient’s statement) later reported feeling greater empathy for their patients (Herbek
& Yammarino, 1990). Consistent with literature on power-embodiment (Carney, Cuddy, & Yap, 2010), perhaps adopting an empathic
disposition changes people’s expression of empathy and their internal experience of empathy.
2. In this section, we organize social psychological interventions into three categories: Self-Oriented Interventions, Group-Based
Interventions, and Situation-Based Interventions. This taxonomy is used to highlight similarities and differences between existing social-
psychological interventions and the motives they alter. However, many social-psychological interventions may stretch across these categories
and could appeal to multiple motives simultaneously. This categorization should therefore be regarded as an organizational heuristic, not an
exhaustive characterization of all motives addressed by these interventions.

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 Studies of Training Compassion What Have We Learned; What Remains
Unknown?

Alea C. Skwara, Brandon G. King, and Clifford D. Saron

Abstract

Recent years have seen a growth of interest in contemplative approaches to cultivating compassionate
responses to suffering. This chapter draws on contemporary research from cognitive, affective, and social
psychology to provide an introduction to the field of compassion training. We consider what constitutes
compassion training and offer a summary of current meditation-based approaches. We then provide an
overview of the empirical evidence for a relationship between compassion training and changes in
socioemotional processes, prosocial behavior, and physiological stress responses to the perception of
others’ suffering. We further address challenges in interpreting data from these studies, considering
potential training-related mechanisms of change and how compassion-relevant processes might develop
over time. Lastly, we conclude by outlining key theoretical challenges for future research.

Key Words: meditation, compassion, training, contemplative practice, responses to suffering, emotion

We live in a world that is increasingly interconnected—through our economic and trade systems, our
environmental policies, ease of travel and communication, and global media reach. This confluence of factors
places humans in an unprecedented situation wherein we are ever more aware of the suffering occurring
around the world. We can immerse ourselves in the stories of refugees through virtual reality, view personal
cellphone videos of war, and watch cities crumble in earthquakes and tsunamis or reel from terrorist attacks.
We cannot escape the evidence of how our consumption choices affect the lives of countless other species.
This increased global exposure to the suffering of others presents us with a challenge: we can—in despair—
become disillusioned and overwhelmed by our own powerlessness in its wake, or we can focus on building
capacities that allow us to engage with this onslaught skillfully and adaptively. Increasing our capacity for
compassion is one such way to alter how we engage with suffering.
Contemplative traditions have long been concerned with questions of human suffering and the
development of compassion (e.g., Salzberg, 2004; Wallace, 1999). More recently, researchers and clinicians in
Western psychological traditions have incorporated aspects of these contemplative traditions into their
evolving understanding of compassion. The potential for drawing on contemplative traditions—particularly
meditation practices—to train compassion has been of special interest. While this area of research is rapidly
growing, the field is still in its infancy and many core questions remain unanswered. This chapter will explore
some of what we know, and what we do not, about the training of compassion using contemplative
approaches.
First, we consider what constitutes compassion training and offer an overview of current research
approaches to investigating the training of compassion. Next, we provide an introductory overview of the

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empirical evidence for the relationship between compassion training and compassion-relevant processes in
psychological research contexts, with a consideration of how these processes might develop over time and a
focus on addressing challenges of interpretation. Lastly, we outline two core issues with which the field has yet
to grapple: characterizing subtle forms of suffering, and the possibility of compassion without action.

What Constitutes Compassion Training?

Approaches to studying the training of compassion within the psychological literature can be usefully
divided into: (1) studies of expert or adept meditators with extensive training in compassion meditation
practices (who are often compared to novice meditators on experimental outcomes of interest), and (2)
longitudinal studies of individuals undergoing compassion-training interventions. Although the interventions
described in this chapter and the accompanying Handbook section are all classified as “compassion training,”
extant training programs vary on a range of factors—perhaps most notably in the length and intensity of
training and the pedagogical and design components they include. While many studies of compassion training
emphasize procedural aspects of specific meditation techniques, these programs generally also include lectures,
discussion, and the social support of a group of individuals working towards a common goal. The existence of
these multiple facets of training frequently complicates interpretations of the potential mechanisms underlying
any observed effects. Furthermore, for novice or beginning practitioners, the experience of undergoing such
programs presumably differs greatly from the life experience of expert meditators (most frequently Buddhist
monks).
Although the focus of this chapter is on training programs that incorporate compassion-based meditation
practices oriented towards developing compassion for others, it is important to note that there are training
approaches aimed at enhancing empathy and compassion that do not include meditation (see Weisz & Zaki,
Chapter 16 in this volume for examples), programs that emphasize other types of meditation without an
explicit focus on compassion (e.g., mindfulness-based stress reduction; Kabat-Zinn, 1990), and programs that
include meditation but primarily focus on cultivating compassion for one’s self (e.g., Mindful Self-
Compassion; Albertson, Neff, & Dill-Shackleford, 2015; Neff & Germer, 2013; see also Neff & Germer,
Chapter 27 in this volume), each of which might presumably influence the development of compassion-
relevant processes (Kabat-Zinn, 2011). Finally, although our focus here is on compassion training methods
drawn primarily from Buddhist traditions, the teaching of compassion appears across varied religious and
secular humanist traditions (for an example from Christianity, see Rogers, 2015; for an example from secular
humanism, see Becker, 2012, and other articles in that journal issue), and there exist interventions based on
these traditions (e.g., gratitude; see Bono & McCullough, 2006; Gulliford, Morgan, & Kristjánsson, 2013, for
reviews) that share considerable conceptual overlap with Buddhist-derived compassion-training programs.
In this section, we overview current approaches to studying Buddhist-derived compassion-training
programs by examining two primary dimensions on which such trainings commonly vary: (1) the length and
intensity of training, and (2) the multiple training components (e.g., instructional, ethical, motivational) that
comprise these programs. For illustration, we provide exemplars of several classes of studies that have been
conducted; specific results will be discussed in the “Survey of Compassion Training Outcomes” section of this
chapter.

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Length and Intensity of Training
Many early studies on the training of compassion attempted to capitalize on the experience gained over a
lifetime of practice by studying expert meditators (typically Tibetan Buddhist monks) as compared to novice
or beginning meditators (e.g., Engen & Singer, 2015b; Lutz, Brefczynski-Lewis, Johnstone, & Davidson,
2008; Lutz, Greischar, Perlman, & Davidson, 2009). Although these studies do not take a directed-
intervention approach, they do offer insight into changes in compassion-related processes that may be
cultivated through extensive training.
Other studies have employed either long-term and/or intensive training (e.g., full-time, daily practice),
tracking participants over the course of a given training program. The ReSource Project, for example, is a
study on the effects of contemplative training on cognitive-affective regulation and psychosocial functioning
that was conducted over the course of one year (Lumma, Kok, & Singer, 2015; Singer et al., 2016). The
intervention included three intensive three-day retreats, which occurred at the beginning of each of three
consecutive 13-week training modules; between these brief retreats, participants went about their typical day-
to-day lives while practicing daily at-home meditation and attending weekly meditation groups. Another
study, The Shamatha Project, was conducted by our laboratory in 2007 (with ongoing follow-up data
collected through 2014), and was designed as a multi-method study on the cognitive, affective, and
neurobiological effects of intensive meditation training in a formal retreat setting. Participants lived onsite at
Shambhala Mountain Center, a remote retreat center in Colorado, and meditated approximately six to eight
hours per day over the course of a three-month training period (e.g., Jacobs et al., 2013; MacLean et al., 2010;
Rosenberg et al., 2015). Intensive and long-term designs such as these provide a higher “dosage” of training
elements and thus are ostensibly more likely to yield measurable effects of training. Because of this high dose,
intensive training also increases the likelihood of obtaining measurable differences between interstitial
assessment points (e.g., from the onset to the midpoint of a given training period).
In contrast to such intensive designs, the vast majority of intervention studies have employed non-intensive
training protocols (i.e., typically less than one hour of practice per day; up to several hours of instruction per
week), often six to nine weeks in length. The most prominent programs of this type incorporate Buddhist
meditation practices that are adapted for non-religious contexts. Of the training programs that explicitly focus
on compassion, the two most studied are Compassion Cultivation Training (CCT; Jinpa, 2010) and
Cognitively-Based Compassion Training (CBCT; Ozawa-de Silva et al., 2012). Other compassion-focused
studies employ training protocols of similar lengths that include many of the same training elements as
standardized programs such as CCT or CBCT, but are customized to specific populations or study aims (e.g.,
Condon, Desbordes, Miller, & DeSteno, 2013). There has also been recent growth in the availability of
online tools and applications (apps) for training mindfulness and compassion. Headspace
(www.headspace.com), one such mindfulness training tool developed by Andy Puddicombe and his
colleagues, was recently used as the training method in a study investigating the effects of mindfulness
training on prosocial behavior (Lim, Condon, & DeSteno, 2015).
Currently, there is not a large enough body of work on intensive or long-term training to allow us to draw
clear conclusions regarding the effects of different training lengths and intensities. As such, in the remainder
of this chapter, we will collectively review findings from expert meditators, intensive interventions, and non-
intensive interventions. While this approach allows for a general overview of the state of knowledge, it may

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also gloss over potentially important variables that differ across training methods and with varying levels of
participant meditation expertise.

Training Components
Compassion interventions often consist of multiple training components. Common features include group
meditation practice, individual meditation practice, didactic instruction, group discussion, individual writing
or reflection, and an organizing ethical framework (e.g., Jinpa, 2010; Ozawa-de Silva et al., 2012; Singer et al.,
2016). In addition, individuals may differ widely in their personal motivations for undertaking a particular
training or practice. In the absence of studies explicitly controlling for these multiple components, it is
impossible to determine their separate, additive, or interacting influences on commonly measured outcomes:
any or all of these components may contribute substantively to observed training-related changes. Notably,
while most training studies measuring compassion-relevant outcomes include an explicit focus on compassion,
it is not clear that this emphasis is an essential element of effective compassion training. Studies that employ
training either primarily (e.g., Rosenberg et al., 2015) or exclusively (e.g., mindfulness group in Condon et al.,
2013; Lim et al., 2015) centered on attention-training or mindfulness practices have reported changes in
responses to suffering as a function of training. However, such focused attention and mindfulness training
may include compassion-relevant themes. For instance, while the primary training focus of the Rosenberg et
al. (Shamatha Project) study was intensive practice of focused-attention meditation, participants engaged in
supportive practice of meditations centered on beneficial aspirations for themselves and others, explicitly
including compassion, for approximately 45 minutes each day. This “supportive” practice time is generally
comparable to the total time dedicated to contemplative practice in many non-intensive compassion-training
programs. In the case of the Condon et al. (2013) and Lim et al. (2015) studies, which included training
programs that exclusively focused on mindfulness practice, both reported improvements in prosocial behavior.
These findings suggest the somewhat counter-intuitive possibility that an explicit emphasis on compassion
need not be an essential component of programs that nevertheless result in measureable changes in
engagement with suffering and prosocial responding. In all of these studies, there are likely to be additional
unknown contributions of ethical frameworks (whether provided by teachers, traditional texts, or brought in
by participants) that may account in part for observed training-related effects.

What Is the Relationship Between Compassion Training and Compassion?

A core assumption of compassion-training programs is the idea that compassion can, indeed, be trained.
Early evidence from studies employing compassion-training programs has provided support for the general
efficacy of compassion training in enhancing compassion, but many questions regarding specific outcomes and
precise mechanisms of change remain unanswered. As other chapters in this volume provide extensive reviews
of specific compassion-training programs and studies, we offer here a brief survey of the compassion training
literature in, non-clinical settings. We first outline compassion-relevant findings from studies employing
compassion-training programs and studies of expert meditators. We next offer a theoretical discussion of
potential mechanisms of change involved in such training programs. Finally, we point out several key
challenges in interpreting findings from studies of compassion training.

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Survey of Compassion Training Outcomes
Compassion has been broadly defined throughout this volume as an affective response to the perception of
another’s suffering that motivates the desire to relieve that suffering (Goetz, Keltner, & Simon-Thomas,
2010). The intentional development of this motivation may be supported by inquiry into the nature and
causes of suffering—both in one’s self and in others—the understanding of which can inform a grounded and
situationally appropriate response (e.g., Gilbert, 2015; Halifax, 2012). From a cognitive and social psychology
perspective, there are a multitude of component processes that underlie compassionate behaviors and
motivational states (Batson, Ahmad, & Lishner, 2009; Zaki, 2014; Zaki & Ochsner, 2012), many of which
may be influenced and developed by compassion training (e.g., Ashar et al., 2016). In this section, we discuss
key findings from the compassion training literature across several compassion-relevant domains, including
affect, stress physiology, recognition of emotion and responsiveness to suffering, aversion and related social-
evaluative processes, and prosocial behavior.

AFFECT AND COMPASSION

The relationship between feeling states, their regulation, and compassion training is complex. Although
extensive research has been conducted on compassion and related processes outside of the Buddhist-informed
perspective offered here (see Batson, Chapter 3, and Weisz & Zaki, Chapter 16 in this volume; Singer &
Klimecki, 2014), there remain gaps in our understanding. One such gap relates to the precise role of emotion
in the generation of a compassionate response to suffering. For example, while emotion regulation is probably
critical in the generation of compassionate responses (e.g., Decety & Jackson, 2006; Eisenberg, 2000), the
over-regulation of affect can be prosocially maladaptive, reducing prosocial engagement with witnessed
suffering (e.g., Dovidio & Gaertner, 1991). In two studies, Cameron and Payne (2011) found that two groups
of participants—those who were naturally skilled at regulating their emotions and those who were instructed
to actively down-regulate their emotions—showed reductions in reported compassion as the number of
individual suffering victims increased in salient descriptions of suffering in others. Participants who were
unskilled at emotion regulation, or who were instructed to simply “experience” their emotions during the task,
did not demonstrate a concomitant decrease in compassion (for more on motivational influences on
compassion, see Cameron, Chapter 20 in this volume). The emotion regulation strategy employed when
witnessing suffering also appears to matter: reliance on suppression as an emotion regulation technique has
been linked to reduced empathic concern and willingness to engage in helping behaviors, whereas engaging in
reappraisal does not seem to carry these same consequences (Lebowitz & Dovidio, 2015).
Within the compassion training literature, CCT has been reported to enhance self-reported feelings of
compassion towards one’s self and others (Jazaieri et al., 2013), to increase self-reported mindfulness and
happiness, and to reduce self-reported worry and emotional suppression in adults (Jazaieri et al., 2014; see
Goldin & Jazaieri, Chapter 18 in this volume for a review of studies employing CCT). Despite the
improvements in self-reported mindfulness and happiness, and the decreased worry reported in Jazaieri et al.
(2014), the training did not result in observed changes in self-reported perceived stress; the authors
interpreted this reduction in worry absent changes in perceived stress as indicative of improved adaptive coping
following CCT. In adolescents, a Buddhist compassion training based on the New Kadampa Tradition
(Gyatso, 2003; Lopez, 1998) evidenced similar decreases in self-reported worry, as well as improvements in

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the environmental mastery and personal growth facets of self-reported well-being (Ryff & Keyes, 1995), but
showed no changes in self-reported positive affect (Bach & Guse, 2015). The authors of this study suggest
that these reported changes in well-being may reflect a change in personal perspective—that happiness can be
achieved through cultivating benevolent states of mind, particularly in situations where external events cannot
be easily controlled. Compassion training may also alter an individual’s perspective on what constitutes
happiness and what is valuable in life (Ricard, 2008), such that psychological well-being is no longer primarily
grounded in hedonic states or pleasant experiences but rather in the ability to live a meaningful life (Ryan &
Deci, 2001). This change in perspective may in turn increase individuals’ sense of efficacy in regulating their
own emotional states. Together, these findings support the view that compassion training may influence how
one relates to potentially negative or distressing events, such that events may be framed as less aversive or
overwhelming.

BIOMARKERS OF STRESS AND INFLAMMATION

If compassion training influences how individuals report that they cope with stress and challenging
experiences, one might expect to see these changes mirrored in the domain of stress physiology. Across a
series of studies, CBCT has been found to reduce markers of stress and inflammation in undergraduate
students (Pace et al., 2009; Pace et al., 2010), and inflammation in adolescents in the foster care system (Pace
et al., 2013). In the former studies, greater time spent practicing meditation at home over the course of
CBCT was associated with a reduction in deleterious biological markers. However, a later study on a larger
sample of adults conducted by this same group failed to replicate any of these outcomes and found no effect of
CBCT on any relevant behavioral or biological measures (unpublished data; see Mascaro, Negi, & Raison,
Chapter 19 in this volume for further discussion). This highlights the potential variability in psychobiological
responses to compassion training, and the need for replication studies and the careful consideration of
differences in contextual factors between studies (e.g., Van Bavel, Mende-Siedlecki, Brady, & Reinero, 2016).

RECOGNITION OF EMOTION AND RESPONSIVENESS TO SUFFERING

Expert meditators—Tibetan Buddhist monks with a range of 10,000–50,000 lifetime hours of meditation
experience in a tradition strongly emphasizing compassion (e.g., Jinpa, 2015; Dalai Lama & Ekman, 2008)—
demonstrate increased pupil dilation and activation in the insula and cingulate cortex (Lutz et al., 2008), and
increased coupling between cardiac rate and BOLD (blood-oxygen-level-dependent) activity in the
somatosensory cortex (Lutz et al., 2009) in response to sounds of suffering as compared to novice meditators.
These findings suggest increased responsiveness to signals of suffering in others. Consistent with these
findings, novices trained in CBCT have demonstrated improved empathic accuracy as measured by the ability
to infer what emotion an individual is feeling from a picture of only their eyes (Mascaro, Rilling, Negi, &
Raison, 2012). This improvement in empathic accuracy was accompanied by increased activation in the
inferior frontal gyrus and dorsomedial prefrontal cortex, brain regions previously associated with theory of
mind (for more on this study, see Mascaro et al., Chapter 19 in this volume). In a separate study employing
CBCT, training participants demonstrated a trend-level increase in activation in the amygdala to negative
images from the International Affective Picture Set (IAPS; Lang, Bradley, & Cuthbert, 2008), which was
significantly correlated with decreases in depression scores (Desbordes et al., 2012). While the amygdala has

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long been associated with negative affect and fear-relevant processing, it is more broadly implicated in salience
detection and general affect processing (Janak & Tye, 2015). Other researchers have also observed increased
amygdala activation during the generation of compassion, as compared to cognitive reappraisal, in expert
meditators viewing film clips of individuals in distress (Engen & Singer, 2015b). Experts in this same study
also demonstrated greater activation in the ventral striatum and medial orbitofrontal cortex (part of a network
implicated in positive affect and reward processing), as well as the mid-insula (interpreted as supporting
feelings of affiliation), and had greater self-reported positive affect when asked to generate compassion while
viewing the films of distress, as compared to when they were asked to view these films in a neutral “watch”
condition or to engage in cognitive reappraisal of the films (see also Klimecki & Singer, Chapter 9 in this
volume).
Together, these findings suggest that compassion training may enhance perceptual accuracy and alter the
salience of social-emotional stimuli, and that these changes may be supported by identifiable differences in
associated neural activity following training. Both shorter-term interventions (e.g., CCT, CBCT) and long-
term expertise appear to enhance emotional responsiveness to depictions of others’ emotional states. One
possibility proposed by Engen and Singer (2015b) is that enhanced responsiveness related to compassion
training may have a protective effect, mitigating empathic distress and burnout by increasing positive affect in
the face of emotional challenge. It will be important for researchers to unpack the specific functional or
informational qualities of increased positive affect. For example, positive feelings associated with the active
deployment of compassion in the face of suffering need to be dissociated from states of self-congratulation for
feeling compassion for others or engaging in helping behavior.
It is important to note that physiological responses often demonstrate complex or nonlinear relationships
with outcomes of emotional experience and behavior. For example, while higher levels of cardiac vagal activity
—an indirect measure of parasympathetic nervous system activity (see Porges, S. W., Chapter 15 in this
volume)—are associated with positive affect and have been shown to predict higher levels of self-reported
compassion (Stellar, 2013; Stellar, Cohen, Oveis, & Keltner, 2015), cardiac vagal activity has also been
demonstrated to show an inverted U-shaped relationship with prosociality, suggesting that very high levels of
vagal activity may be associated with reduced prosocial responding (Kogan et al., 2014). As another example,
post-training increases in functional connectivity between the dorsolateral prefrontal cortex and the nucleus
accumbens have been linked to increases in altruistic behavior in participants who underwent compassion
training, but to decreases in altruistic behavior in participants who underwent reappraisal training (Weng et
al., 2013). Thus, interpretation of physiological data absent of accompanying experiential or behavioral
measures may be uninformative or even misleading.

AVERSIVE RESPONDING AND SOCIAL-EVALUATIVE PROCESSES

It is likely that increased responsiveness to the suffering of others is subserved by decreased aversion to
those who are suffering (see Weng, Schuyler, & Davidson, Chapter 11 in this volume), and that this is a core
capacity trained by compassion interventions. Supporting this possibility, several studies have reported
reductions in aversive responses to suffering in others, or to stigmatized groups following training (e.g., Kang,
Gray, & Dovidio, 2014; Kemeny et al., 2012; Rosenberg et al., 2015).
As part of the Shamatha Project, participants were asked to watch emotionally evocative film clips of

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human suffering before and after an intensive meditation retreat (Rosenberg et al., 2015). Participants’ facial
expressions were unobtrusively recorded and subsequently coded using the Facial Action Coding System
(Hager, Ekman, & Friesen, 2002) to identify expressions of emotion, including sadness, as well as aversive
emotional expressions (i.e., anger, contempt, and disgust) termed “rejection emotions.” Expressions of
rejection emotions were conceptualized as indicating aversion or defensiveness towards the graphic depictions
of suffering contained in the films. After a three-month focused-attention (shamatha; Wallace, 2006)
meditation retreat, training participants were more likely to show facial expressions of sadness in response to
depictions of suffering than matched waitlist-controls. Training participants also displayed fewer instances of
facial expressions of rejection emotions. Importantly, in the training group, self-reported experiences of
sympathy—but not of sadness or distress—in response to the post-training film were positively related to
facial expressions of sadness, and were negatively related to facial displays of rejection emotions. These
findings suggest that intensive meditation training that includes both shamatha (concentrated attention) and
“four immeasurables” (beneficial aspirations: loving-kindness, compassion, empathetic joy, and equanimity)
practices promotes engagement with the suffering of others. It also appears that training reduces defensive
responding to suffering, which was operationalized as reduced expression of rejection emotions. It is
important to note that while Shamatha Project participants did practice compassion meditation (~45
minutes/day across all four immeasurables practices), the core practice of the retreat was shamatha meditation,
which aims to develop stability of attention (e.g. MacLean et al., 2010, Sahdra et al., 2011, Zanesco et al.,
2013, Zanesco et al., 2016). Overall, these findings highlight the need for continued research into the direct
or indirect consequences of attention-based training on the development of compassionate responses to
suffering.
In a related finding, when compared to waitlist controls, participants trained in Cultivating Emotional
Balance (CEB—a training program that includes compassion-focused and contemplative elements)
demonstrated faster implicit access to compassion-related concepts in a lexical decision task after subliminal
exposure to images depicting suffering, even when these images included elements designed to elicit feelings
of disgust (Kemeny et al., 2012). For suffering images that did not include an element of disgust, participants
appeared to take more time to access disgust-related concepts in a lexical decision task than did controls. This
finding once again points to a possible decrease in aversive reactions to suffering following compassion-
relevant training.
Sometimes, resistance to feeling or enacting compassion may stem not from aversion to suffering itself, but
from an aversion to the individual who is suffering. Hence another core aim of compassion training is to
broaden the circle of individuals toward whom we may respond compassionately. We tend to feel more
compassion for those we perceive as being similar to ourselves, and experimental manipulations of perceptions
of similarity have been shown to increase feelings of compassion and prosocial behavior towards others
(DeSteno, 2015). On the other hand, individuals frequently feel less concern for, or even celebrate, the
suffering of members of a social out-group (e.g., Cikara, Bruneau, & Saxe, 2011). In line with this premise,
Kang et al. (2014) reported that training in loving-kindness meditation (a practice that aims to enhance
feelings of affective care and well-wishing towards others) was related to decreased implicit bias against
stigmatized groups. After training, a group of participants who were randomly assigned to a loving-kindness
meditation training demonstrated significant reductions in implicit bias (Greenwald & Banaji, 1995) as

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measured by the Implicit Association Test (Greenwald, Nosek, & Banaji, 2003) against both Blacks and
homeless people (two commonly stigmatized groups), as compared to controls. Participants’ explicit attitudes
(i.e., what they say about their beliefs and feelings), however, did not change. These findings suggest that
training in loving-kindness meditation influenced implicit reactions to stigmatized groups, which the authors
suggest may result from increased feelings of connectedness towards others.
Taken together, the findings reviewed in this section suggest that compassion-related training may decrease
aversive responses to witnessing suffering, as well as widen the scope of individuals towards whom one may
experience compassion.

PROSOCIAL BEHAVIOR

In the previous section, we considered evidence suggesting that compassion training may adaptively
modulate social-evaluative processes that presumably underlie enactment of compassionate responses in the
face of suffering. Here we consider a key question in evaluating the training of compassion: Do changes in
emotional experience and reactivity to suffering translate into changes in overt helping behavior (see also
“behavioral transfer” in Weng et al., Chapter 11 in this volume)? One common method of testing prosocial
behavior in a laboratory setting is through the use of economic games. In two independent studies, both (1)
long-term meditators (individuals with over 40,000 hours of lifetime practice hours; McCall, Steinbeis,
Ricard, & Singer, 2014) and (2) novices trained using a two-week home-based compassion intervention
(Weng et al., 2013) offered more money to compensate victims of unfair treatment in an economic game than
did controls. In the study by McCall et al. (2014), when expert meditators were themselves the victims of
unfair treatment, they punished the player who had treated them unfairly with less severity than did controls.
However, when others were the victims of unfair treatment, the expert meditators’ punishment of players who
had behaved unfairly was equal to that of the controls, suggesting a stronger motivation to enforce fair
treatment of others than of themselves. Despite equal ratings of perceived unfairness as compared to controls,
experts also reported experiencing less anger at the unfair behavior (McCall et al., 2014). These findings
support the idea that both short- and long-term compassion training may encourage altruistic action to relieve
witnessed inequity.
In one of the few studies of real-world, ecologically valid helping behavior, Condon and colleagues (2013)
found that participants who underwent an eight-week non-intensive training program in either mindfulness
or compassion meditation were significantly more likely to offer their seat to a confederate in apparent
suffering (grimacing on crutches), as compared to waitlist controls who received no training (see also Condon
& DeSteno, Chapter 22 in this volume). However, the type of meditation training (mindfulness or
compassion) had no significant effect on the probability of helping: both groups were equally likely to offer
their seat. The findings from this study were recently replicated (though with lower reported effect sizes)
using a mobile app-based mindfulness intervention (Headspace) as the training program, when compared to
an active control condition based on cognitive skills training (Lim et al., 2015). Thus, the willingness to offer
one’s seat may not be a compassion training–specific effect, but rather a more generalized effect of
contemplative training. One possibility is that skillful, experienced teachers may implicitly communicate and
foster ethical views that uphold compassion as an important personal value, even in non–compassion-specific
trainings. To this point, while Headspace is presented as a mindfulness training application, the platform’s

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primary teacher, former Buddhist monk Andy Puddicombe, has stated: “I never teach meditation in
isolation…. I always teach View, Meditation, and Action. You can’t teach the View without altruism”
(Widdicombe, 2015, http://www.newyorker.com/magazine/2015/07/06/the-higher-life). This quote
emphasizes the inadequacy of referring to classes of training types by using the non-qualified terms
“compassion” or “mindfulness,” as each class of training will nearly always contain aspects of the other. It
should also be noted that, even in the context of the presumably small personal sacrifice of giving up one’s
seat, these trainings did not result in universal altruism: in the in-person meditation-trained groups, 51% of
participants failed to give up their seat (compared to 84% of controls), while in the Headspace study, 63%
failed to give up their seat (compared to 86% of active controls). Nonetheless, the demonstration of increased
incidence of helping behaviors in real-world situations following training is noteworthy (for more on these
studies, see Condon & DeSteno, Chapter 22 in this volume). Future studies should consider issues of
situational factors (such as resource availability or social-evaluative processes) on real-world helping behavior.

SUMMARY

As a whole, the studies surveyed indicate that compassion-based (and in some cases attention- or
mindfulness-based) training may sensitize participants to the suffering of others and increase the tendency to
experience compassion or sympathy, as opposed to emotions such as disgust or anger, in response to the
perceived suffering of others. Furthermore, it appears that training may reduce aversion in the form of
automatic bias against stigmatized groups. In terms of prosocial action, findings suggest that both long-term
and shorter-term compassion training may increase the tendency to respond altruistically in the context of
economic games played in the laboratory and in ecologically valid situations, though data here are sparse.

Mechanisms of Change
So how might directed and deliberate training in compassion change one’s behavioral, cognitive, or
psychological reactions to suffering in the world? This is a truly open question. As discussed, compassion-
training programs are comprised of a variety of design elements, all of which may influence observed or
reported changes in compassionate responding. To date, few studies have attempted to disambiguate these
potential mechanisms of change; thus any discussion of such mechanisms is largely theoretical. Nevertheless,
we will address several potential pathways through which compassion training may influence real-world
compassionate responses, with the goal of motivating future research and encouraging greater delineation of
component processes. First, we discuss potential ways in which various types of meditation may influence
compassion-relevant processes. We then suggest how broad training elements unrelated to meditation style or
practice may function to support training-related changes. It is important to note that in none of these cases
do we suggest a one-to-one or linear relationship of change between any specific outcome measure and
element of training. Rather, we point to a range of influences and training factors that, together, may
contribute to observed changes in a dynamic, contextually dependent manner.

MEDITATION

All trainings reviewed in this chapter include elements of guided or silent meditation practice. In many
modern psychological accounts, meditation training is often conceptualized as facilitating a process of mental

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development that can enhance attentional stability and the ability to self-regulate affect and behavior through
the application of attention and awareness to various domains of experience (Lutz, Slagter, Dunne, &
Davidson, 2008; Lutz et al., 2009; Rosenberg et al., 2015; Sahdra et al., 2011). The process through which
meditation may influence real-world responses to suffering is unknown and has largely gone uncharacterized.
However, the extent to which meditation practice facilitates trait-like changes in cognition or behavior
presumably depends on a confluence of cognitive-affective capacities developed through a given meditation
practice. These domains include the cognitive operations and ethical commitments embedded in the
meditation instructions; the personal motivations of the practitioner; the relationship between practitioner and
teacher (whether in person or via digital media); the sociocultural context in which the training is offered, and
resulting alterations in perception, attitudes, or response tendencies; and well-being resulting from continued
engagement in the practice. The same meditation techniques delivered by different teachers or in differing
contexts may hold divergent effects on a given group of individuals, who are also likely to exhibit considerable
inter-individual differences in motivation, socio-emotional function, and baseline capacities for compassionate
responses. While recognizing the importance of contextual and individual differences, it is possible that
meditation training may generally increase the tendency to respond with compassion, both by influencing the
desire to care for others, and by improving cognitive-affective capacities that enhance the ability to enact these
motivational tendencies.
Some meditation practices (e.g., compassion, loving-kindness) focus explicitly on the development of care
and concern for oneself and others. These practices often aim to “systematically [alter] the content of thoughts
and emotions” (Dahl, Lutz, & Davidson, 2015, p. 518) by cultivating specific affective and motivational states
and traits that increase positive feelings and actions towards others. One interesting possibility is that
meditation practices of this class may support compassion by fostering a sense of connectedness between
oneself and others (Trautwein, Naranjo, & Schmidt, 2014). Indeed, feelings of connectedness and closeness to
others appear to increase prosocial behavior. For instance, feeling close to an individual (Beckes, Coan, &
Hasselmo, 2013) or having been to the location of a natural disaster before it has occurred (Zagefka, Noor, &
Brown, 2013) have both been linked to increased altruistic behavior. It is also possible that compassion-based
trainings support a shift in the perceived importance of attuning to suffering in one’s life, the connection
between suffering and personal happiness, and one’s own causal agency in creating or alleviating that suffering
(Ozawa-de Silva et al., 2012).
Other meditation practices purport to strengthen the practitioner’s ability to regulate, direct, and reorient
attention (Dahl et al., 2015; Lutz, Jha, Dunne, & Saron, 2015). Supporting this assertion, our lab has
reported that Shamatha Project participants who underwent intensive training in attention-based meditation
demonstrated improved perceptual discrimination (MacLean et al., 2010), attentional stability (MacLean et
al., 2010), and response inhibition (Sahdra et al., 2011) following a three-month intensive training period. If
and how such increases in attentional stability and cognitive-regulatory capacity support changes in
situationally-appropriate affective responding is another open question. In the Shamatha Project, training-
related improvements in response inhibition were linked to greater self-reported socioemotional and
psychological functioning (Sahdra et al., 2011). These same participants also demonstrated greater
engagement with, and less defensiveness to, film depictions of suffering (Rosenberg et al., 2015).
Overall, these data suggest that training in a variety of contemplative practices may influence

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socioemotional outcomes. Interpretation of the effects of specific meditation techniques is complicated by the
lack of data on the effects of teachers (independent of the type of meditation taught) in modeling
compassionate and altruistic motivations, either directly or indirectly, through their actions, word choice, style
of interpersonal interaction, and teaching instructions. Thus, while specific cognitive capacities trained
through mindfulness or focused-attention practices probably influence socioemotional functioning, the role of
the teacher in imparting the value of a compassionate attitude toward suffering may constitute an important,
and under-studied, element of compassion training.
Other pathways through which meditation practice may influence real-world compassionate responding
include the activation of secure attachment primes (Mikulincer & Shaver, 2005; Mikulincer, Shaver, Gillath,
& Nitzberg, 2005; Shaver, Lavy, Saron, & Mikulincer, 2007), reducing experiential avoidance of distress
(Chiesa, Anselmi, & Serretti, 2014), strengthening meta-awareness (Dahl et al., 2015; Lutz et al., 2015), and
increasing the salience of signs of suffering in others (Lutz et al., 2008). Current evidence for these
hypothesized pathways is sparse; we believe that future work designed to elucidate specific pathways to change
is essential for the field’s continued growth.

NON-CONTEMPLATIVE TRAINING ELEMENTS

Other elements that influence compassion-related training outcomes may operate relatively independently
of the specific meditation techniques or practices being taught. These include the grounding of the training in
an ethical worldview, personal preferences and motivations for practice, and social factors such as interaction
with a respected teacher and identification with a group of like-minded individuals.
Individuals come to meditation practice with different intentions and motivations, which presumably
influence the course of an individual’s development during training. For example, an individual who engages
in meditation practice with the goal of reducing ruminative thought might place a different emphasis on the
development of compassion than does an individual who arrives with the goal of feeling more connected to
others. Individuals also have personal preferences, which may influence their enjoyment of, responsiveness
towards, and commitment to the training program. Indeed, different patterns of neural activity in response to
painful stimuli before training in CBCT have been found to predict subsequent time spent practicing
mindfulness and compassion meditation during training (Mascaro, Rilling, Negi, & Raison, 2013). Thus, it
may be important to consider preexisting differences in evaluating the outcomes of meditation interventions,
or in tailoring interventions to specific populations.
Compassion-training programs often include teaching and instruction in ethics. Though the lessons and
exercises in CCT and CBCT are presented within a primarily secular framework, many of the key concepts
and core practices are drawn from Buddhist traditions, and both programs were developed under the guidance
of Buddhist teachers and scholars Geshe Thupten Jinpa and Geshe Lobsang Tenzin Negi, respectively. Other
interventions may occur within more explicitly religious contexts. The Shamatha Project, for example, was
conducted at a Buddhist retreat center environment under the guidance of Buddhist-trained meditation
teacher (B. Alan Wallace). Nevertheless, even within the explicitly Buddhist context of the Shamatha Project,
participants varied in their personal religious beliefs and adherence to Buddhist worldviews; the contribution
of these individual differences to our reported outcomes, however, is presently unknown. This is but one
example of the multiple layers of complexity inherent in many studies of training compassion. Thus, while

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very little research has been conducted on the influence of intention, motivation, and belief within meditation
training, we believe that this is an essential area for future work. In the Shamatha Project, we are examining
this issue through qualitative analysis of practitioners’ worldviews, goals, and approach to life via thematic
coding of interviews collected both during and after training. The goal is to visualize and quantify qualitative
shifts in participants’ reports using network analytic methods for statistical integration with empirical
laboratory findings (Pokorny et al., accepted).
The social interactions with teachers and fellow trainees inherent in many compassion-based trainings may
also play an important role in supporting observed training effects. Importantly, studies employing an active
control intervention designed to account for some of these social factors have failed to find differences in
outcomes between mindfulness training and control interventions on a variety of self-report and physiological
variables (MacCoon et al., 2012; Rosenkranz et al., 2013). It will be crucial for future studies to examine
whether compassion-relevant outcomes are similarly sensitive to non-specific effects of the training context. In
addition to effects of social support, it may also be important to consider the influence of teacher-specific
effects on training outcomes. For example, in the earlier reviewed Condon et al. (2013) study—which found
no differences in prosocial behavior following training in mindfulness or compassion meditation—both
training programs were taught by an experienced Tibetan Buddhist lama who has extensive compassion
meditation experience. It is possible that the experience of interacting with a teacher who embodies
compassionate behavior may serve, in itself, as a catalyst for the development of compassion. The influence of
teacher-specific factors, independent of delivered content or training materials, is an important consideration
for future research.

SUMMARY

Compassion training may influence compassion-related outcomes through a range of hypothesized

pathways, including increased motivation and capacity to respond to others in need, development or
reorganization of one’s ethical priorities, and renewed social support and guidance from others. There are
currently few studies that enable researchers to distinguish the effects of these different training elements, and
as such, mechanistic explanations of training effects lack clear empirical support. Future study designs that
allow for mechanistic hypotheses, that or that derive testable models of predicted results (e.g., Ashar et al.,
2016), will be essential for the development of the field. However, we believe it is also healthy to question a
core motivating assumption often encountered in the training literature: that researchers should seek to
identify primary “active ingredients” that directly correspond to the development of isolatable cognitive or
affective capacities. At this stage, the available evidence from mindfulness and compassion-training programs
is suggestive of a complex, variable, and contextually-dependent developmental process in which acquired
skills may generalize to various domains and are supported by multiple interrelated processes. The extant work
in this area consists mainly of heuristic outlines and theoretical sketches of how such a dynamic, interactive
process may function (e.g., Halifax, 2012), and directed theoretical development is needed.

Issues in the Interpretation of Training Outcomes

There is a range of issues complicating the interpretation of compassion training-related outcomes. Key
challenges include the generalization of findings from assessments of expert meditators to non-expert

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populations, the general lack of rigorous active control interventions (particularly for multi-week, in-person
trainings such as CBCT and CCT), the possible dissociation between feelings of compassion and knowledge
of appropriate action, and the complexity of drawing inferences from multi-method studies incorporating
neuroimaging, self-reported experience, and measured behavior. We will discuss each of these in turn.

EXPERT MEDITATORS

Many of the key insights in this field—and as cited in this chapter—are based on data collected from expert
meditators, often male Tibetan Buddhist monks, who have a day-to-day experience that differs profoundly
from that of the novice meditators often used as control comparisons in these studies. Such experts may also
have a very different ethical framework and motivation for their meditation practice (Santideva, 1997) than is
typically presented in secularized short-term interventions, or that may motivate novices to participate in a
study (such as remuneration or academic credit). Beyond these motivational and cultural differences,
additional issues include understanding and following delivered instructions, and managing the effort required
to engage in specified practices, all of which are likely to change and evolve with acquired expertise. Experts
also generally have extensive training in a range of meditation techniques, not just those specifically aimed at
cultivating compassion. Thus, observed effects cannot be attributed to training in any specific practice, but are
presumably due to a constellation of factors, including specific meditation training, scholastic knowledge,
worldview, and life experience.

ACTIVE CONTROL INTERVENTIONS

There is a need for implementation of rigorous, active control interventions within the meditation training
literature at large (Davidson & Kaszniak, 2015). Many studies have employed matched waitlist control
conditions (e.g., Rosenberg et al., 2015), which are designed to control for general population-level factors
such as demographics, the motivation to practice and engage in meditation, and quantification of simple
“practice” effects of repeated experimental testing in longitudinal designs. Nevertheless, when such studies
report changes in outcomes following an intervention, it is often difficult to attribute these observed changes
to specific training elements of interest (e.g., compassion meditation). Rather, such changes may be influenced
by a confluence of multiple training elements, or other factors largely unrelated to training, such as demand
characteristics. To this end, researchers at the University of Wisconsin–Madison have developed the Health
Enhancement Program (HEP), an active control intervention for the evaluation of mindfulness-based stress
reduction (MBSR; Kabat-Zinn, 1990). In studies comparing these two programs, no differences were found
in self-reported emotional experience in a thermal pain task (MacCoon et al., 2012) or in cortisol rise in
response to an acute social stressor (Rosenkranz et al., 2013) between HEP and MBSR. These findings
highlight the importance of accounting for aspects of meditation-based interventions that are unrelated to the
dissemination of teachings on specific techniques, such as the presence of a compassionate teacher, social
support, and relevant didactic information.

COMPASSION AND APPROPRIATE ACTION

The ability to select an appropriate behavioral response to a given situation may be dissociated from the
capacity to generate compassionate feelings or to feel motivated to help others. In situations where one has the

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intention to respond compassionately, the successful deployment of an appropriate response requires an
understanding of the dynamics of the situational context, knowledge of the potential outcome of different
actions, and a felt capacity to cope with the situation (Halifax, 2012). To our knowledge, no studies have
examined the effects of compassion training on the ability to determine appropriate action when witnessing
others in need of help or aid, or how such behavioral action is moderated by training expertise and individual
differences in psychological traits or affective profiles. Further complicating this question, behavioral
manifestations of compassionate responses may look quite different depending on the situational or
interpersonal context. For example, skillful and compassionate parenting may at times require gentle
nurturance or flexible guidance, and at other times require stern words or the setting of firm limits.
Determining what constitutes a compassionate response in which situation is a formidable challenge.

BRAIN, EXPERIENCE, AND BEHAVIOR

Many studies rely on brain imaging data combined with self-report measures to assess training efficacy.
While it can be useful to look to neural mechanisms to understand the neurobiological mechanisms of
compassion development, this approach can lead to unclear inferences regarding the processes underlying
training-related change. For instance, in a study of compassion training versus reappraisal training, Weng et
al. (2013) observed similar patterns of neural connectivity between the dorsolateral prefrontal cortex and the
nucleus accumbens following training in both intervention groups. However, in the compassion training
group, increased connectivity predicted greater altruistic redistribution of funds in an economic game, whereas
in the reappraisal group, increased connectivity between these regions predicted less redistribution of funds.
The fact that the same pattern of change in measured connectivity was related to divergent changes in
behavior between training groups highlights the complex relationship between training, brain activity, and
behavior. Continued efforts to integrate experiential accounts and behavioral measures will strengthen our
understanding of the development and experience of compassion, and how these may vary across individuals
and contexts.

Summary
In this section, we have reviewed evidence that compassion training may influence participants’ attitudes
toward difficult emotions, enhance socio-emotional processing, reduce aversion to suffering and to
stigmatized others, and support prosocial behaviors. While acknowledging that evidence for specific
mechanisms is sparse, we discussed potential pathways for training-related changes, and pointed to key issues
in the interpretation of such data, including the joint consideration of relevant experiential and behavioral
information.

What Is the Trajectory of Compassion Training?

The training of compassion can be conceptualized as a developmental process: changes in compassion-
relevant processes occur over time, and they are deepened and strengthened with acquired expertise. The
shape of the associated developmental curves likely varies between component processes, and between
individuals. For the sake of illustration, consider a hypothetical training trajectory with the following
attributes:

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 1. The cognitive effort required to respond compassionately to suffering has a linear, negative slope, with the highest effort demonstrated in
novices and the lowest in experts;
2. The affective/motivational salience of suffering follows an independent, positive exponential curve, quickly increasing with expertise and
then leveling out over time; and
3. Personal distress to suffering has an inverted U-shaped curve, in which distress first rapidly increases, peaks with moderate levels of
training, and then decreases at higher levels of expertise.

In this imagined scenario, the specification of component developmental curves—and any interactions
between them—would aid researchers in generating hypotheses about the experience of compassion and
predictions for compassion-relevant outcome measures at different points in training. Despite the potential
utility of such curves, there are very few studies that attempt to model developmental trajectories. Importantly,
when considering the trajectory of compassion training, this conceptual approach can inform research and
theory at several different timescales: the trajectory within a single session (of meditation or of performing a
laboratory task), the trajectory across a set training period (such as a course of CCT or CBCT), and the
trajectory across a lifetime of practice. Here, we will consider the potential utility of each of these timescales in
generating research questions.

Trajectory Across a Single Session

There is extremely limited knowledge regarding the time-course of the recruitment of select cognitive and
affective processes within a given session of compassion meditation or within a compassion-relevant task (for
an example, see Engen & Singer, 2015b). In studies employing brain imaging techniques, neural activity is
typically averaged across an entire task block or meditation period, thus information on temporal dynamics is
lost. However, time-course analyses of compassion-related processes may offer deeper insights into how these
processes unfold. For example, analysis of the time-course of compassion-based emotion regulation in expert
meditators has demonstrated activation in brain regions implicated in reward and social connection before the
onset of distressing films, suggesting that participants were upregulating their positive affect prior to
presentation of the challenging stimuli (Engen & Singer, 2015b). By considering within-session temporal
dynamics in this manner, it becomes possible to disambiguate competing hypotheses that hold differing
implications for our understanding of compassion—in this case, the hypotheses of anticipatory up-regulation
versus positive affective responses to stimuli designed to elicit distress. This example demonstrates the utility of
considering the time course of compassion in elucidating supporting processes and in the interpretation of
relevant data. For a more in-depth discussion of the importance of within-session temporal dynamics, and
potential methodologies for implementing such analyses, see Weng et al., Chapter 11 in this volume.

Trajectory Across Training

In addition to single sessions of practice, one can consider trajectories across the course of multiple sessions
of an intervention. Intervention studies typically employ two measurement points: pre-training and post-
training. While pre- to post-training change can be informative, it provides little insight into how processes
develop during training. This remains a largely unexplored area of inquiry. Returning to the conceptual
illustration of a developmental curve of training presented in the introduction to this section, the length of
training and timing of assessment points within a given training program will place training outcome
measurements at different points of this hypothetical curve. Where these measurements are placed relative to

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a given individual’s underlying developmental trajectory will, in turn, almost certainly influence the magnitude
and direction of reported effects. As discussed in our hypothetical example, a developmental training
trajectory could vary across different elements of training, and these varying curves and their interactions could
have differential effects on outcome measures. Exemplifying the utility of this approach, Lumma et al. (2015)
examined longitudinal changes in heart rate (HR), high frequency heart rate variability (HF-HRV),
participants’ reports of how much they liked the training, and perceived effort across different meditation
styles within the ReSource Project. This year-long training was divided into three counterbalanced three-
month training modules. In each module a different meditation practice was taught: mindfulness of breathing,
observing thoughts, and loving-kindness. Analyses revealed that, over the course of the year-long training,
ratings of enjoyment of any given practice increased, and perceived effort decreased. Although HR during
meditation practice increased over the course of the year-long training, this was only true for the three months
of loving-kindness meditation and three months of observing-thoughts meditation; HR did not increase over
the three months of breathing meditation. Similarly, HF-HRV significantly decreased over the course of the
year-long training; however, when the year-long training period was analyzed according to the specific three-
month training modules, this decrease was significant only for the loving-kindness and observing-thoughts
meditation styles. This pattern of effects supports the notion that trajectories of training may indeed differ
across training elements (in this case, per meditation type, but also presumably across processes related to
attention, emotion regulation, cognitive control, etc.; see Dahl, Lutz, & Davidson, 2016; Engen & Singer,
2015a) and outcome measures.

Trajectory Across a Lifetime

The development of compassion does not end at the cessation of formal training—individuals continue to
integrate and apply the views, motivations, and capacities developed during training into their ongoing life
experiences. Despite this, few studies track participants beyond the conclusion of formal training programs,
and therefore little is known about how individuals integrate observed training effects into their daily lives.
Much more thought is needed on this issue, as researchers begin to characterize the conceptual dividing line
between active training and daily life, and undertake longitudinal studies with measures of compassionate
behavior that are optimized for real-world contexts. Measures with clear real-world implications, such as
dyadic interactions with close others, second-person reports, or measures of community involvement, may be
useful for more fully understanding the development of compassion after formal training and, ultimately,
across an individual’s lifetime.

A Note on State Versus Trait Effects

In contrast to our emphasis on the developmental characteristics of compassion training, even a few
minutes of loving-kindness meditation has been shown to induce increased feelings of social connectedness
and positivity toward strangers (Hutcherson, Seppala, & Gross, 2008). Likewise, a one-day training in loving-
kindness meditation has been shown to increase self-reported positive affect and empathy, as well as
associated neural activity in response to distressing videos (Klimecki, Leiberg, Lamm, & Singer, 2012), and to
increase helping behavior in a prosocial game (Leiberg, Klimecki, & Singer, 2011). The concept of training as
we have framed it suggests that a skill or ability is developed and honed over time; however, these shorter

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interventions, which lack such an extended developmental trajectory, nevertheless seem to affect compassion-
relevant measures. Further contributing to this apparent contrast are issues of measuring and conceptualizing
changes in state-like versus trait-like capacities over time. A very short intervention manipulating situational
or contextual factors may be sufficient to induce a state-level change, whereas longer-term or intensive
trainings may be more likely to influence trait-like tendencies, which in turn influence situational responding.
Practices and interventions at both of these levels of analysis have been shown to influence compassionate
responses. Among the situational or contextual factors that can influence compassionate responding are the
number of suffering victims (Cameron & Payne, 2011), explanations ascribed to the cause of suffering (Gill,
Andreychik, & Getty, 2013), perceptions of agency (Akitsuki & Decety, 2009), and societal factors such as
ongoing cultural conflict (Bruneau, Dufour, & Saxe, 2012). Trait-like contributors may include formative
early life experiences such as the development of attachment security (Mikulincer & Shaver, 2005; Mikulincer
& Shaver, Chapter 7 in this volume). Both trait-level and contextual factors critically contribute to any real-
world response to suffering: as one encounters suffering, one’s capacity to experience and generate compassion
meets situationally specific factors, which dynamically alter the expression of compassion in a given moment
(see Condon & DeSteno, Chapter 22 in this volume).

Conclusion: Compassion Without Action and Subtle Forms of Suffering

In this chapter, we have offered an overview of current approaches to training compassion and what
research on these approaches suggests about the development of compassion and the trajectory of compassion
training. In this final section, we address two key issues that present significant research challenges, but are
highly relevant to daily life outcomes: the role of compassion when nothing immediate can be done to relieve
another’s suffering; and manifestations of suffering that are common to the human experience, yet are
frequently overlooked in research on compassion.
We are frequently exposed to suffering in others that we cannot immediately act to alleviate, such as media
depictions of war, genocide, starvation, and natural disasters. What, in these situations, constitutes an
appropriate response? When the scale of suffering exceeds our perception of our own resources to relieve it, we
tend to experience “compassion collapse” (Cameron & Payne, 2011). So how can we respond compassionately
when we witness suffering that is far afield and out of our locus of control? In these cases, we would argue that
self-care becomes a critical act of compassion. In the moment that we empathize with suffering that we
cannot possibly relieve, and feel our own powerlessness in the face of others’ pain, our own suffering and
distress may increase. Thus, recognizing our own suffering and taking measures to acknowledge, engage with,
and care for that pain is itself an act of compassion. In this conceptualization, compassionate regard for
oneself becomes can become an important aspect of well-being (see Neff & Germer, Chapter 27 in this
volume).
Related to this question, representations of suffering presented in psychological studies of compassion tend
to depict obvious physical (mutilation, starvation) or emotional (sadness, distress) pain, or instances of social
unfairness (often through economic games). While undeniably salient, these forms of suffering are not fully
representative of the range of suffering we often encounter in our daily lives. It is possible that different kinds
of suffering and the varying contexts in which they occur may induce heterogeneous affective and motivational
states and demand unique or tailored behavioral responses, all of which may still be considered

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“compassionate” (Ekman, 2014). In other words, suffering does not always present in obvious forms. A range
of affective and motivational states can lead to a given compassionate response, with the behavioral
manifestation of that response often dependent on the situational context. Thus, the appropriate response to
perceived suffering may be quite different, depending on a given situation, and it may be difficult to
operationalize these responses in reductionist or simplified terms. The field of contemplative science would
benefit from the development of theoretical models that attempt to characterize compassion along multiple
experiential and psychological dimensions. A recent work outlining such a phenomenological classification of
mindfulness and related processes (Lutz et al., 2015) could serve as a useful guide in developing a similar
framework for organizing compassion-based practices.
From the Buddhist perspective, a central form of suffering is the suffering of change—all life situations and
circumstances, no matter how satisfying, are transitory (Patrul, 1998). From this perspective, our basic
biological and psychological nature perpetuates a cycle of meeting needs only to then have to meet other
needs: “I am hungry, and so I eat”; “I ate, so now I am tired”; “I am tired, so now I must rest”; and so on.
Thus, an approach to life that emphasizes only hedonic aspects of well-being (attaining pleasure and avoiding
pain; e.g., Ryan & Deci, 2001) may result in a never-ending quest to fulfill these needs. Paradoxically, training
in mindful, compassionate self-regard may enable one to savor the pleasurable aspects of these momentary
experiences, without attaching one’s sense of well-being to the pleasant target or object. With repeated
practice, this decoupling of well-being from momentary experiences of pleasure or pain may promote the
development of an understanding of one’s own agency in creating the conditions for happiness, which is
ultimately more consistent with a eudaimonic view of well-being (Bach & Guse, 2015; Ryan & Deci, 2001).
The cultivation of compassion toward suffering resulting from the transitory nature of experience represents
an unstudied, but potentially widely applicable, domain of inquiry. This may be particularly relevant for
individuals in modern societies with assured access to basic necessities (food, water, shelter, and physical
safety). Subtle forms of suffering often go unnoticed, as they are pervasive daily conditions of even the most
materially well-off individuals. For example, from the contemplative perspective, meditation-based trainings
that foster awareness of this inevitable cascade of small daily losses or changes in hedonic state (e.g., the last
bite of a delicious meal, the end of a good book) may provide a gateway towards a deeper understanding that
one’s primary external sources of comfort and well-being, such as loved ones, employment, health, or
longevity, are also of a transient nature. Building a framework for how to relate to suffering in familiar,
seemingly less consequential, life domains may, in turn, provide the experiential basis for compassionate
responses to other, more apparent forms of suffering such as physical pain or the loss of a loved one. This may
ultimately extend further to more extreme kinds of suffering—such as violence, war, or famine—even if one
has no familiarity with such conditions. The understanding that everyone experiences suffering, however
subtle, may spark a sense of commonality in which to ground compassion and, bit by bit, extend it to
individuals whose lives, experiences, and manifestations of suffering may be quite different from our own.
Thus, understanding these more subtle but inescapable types of suffering may be important in working
towards global compassion (see Ekman & Ekman, Chapter 4 in this volume), and in moving from idealized
to enacted compassion (e.g., Raiche, 2016).

308
309
Acknowledgments
The authors wish to acknowledge the members of the Saron Lab for their support and helpful discussions
regarding the ideas in this chapter. We thank Anthony Zanesco and Quinn Conklin for trenchant and helpful
comments on previous manuscript drafts and Rayna Saron for proofing. Preparation of this chapter was
supported by funds from The John Templeton Foundation Grant 39970, Hershey Family Foundation, and an
anonymous donor.

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 The Compassion Cultivation Training (CCT) Program

Philippe R. Goldin and Hooria Jazaieri

Abstract

Compassion is a powerful feature of human experience and is a key component of individual,

interpersonal, organizational and societal well-being. It is a fundamental skill that can be trained.
Cultivating compassion may contribute to sustained well-being in individuals, groups, and organizations.
There is now a growing scientific and clinical interest in understanding how compassion can be
cultivated, and a need to examine what psychological processes are modulated by compassion training
programs. The goal of this chapter is to briefly define the complex concept of compassion, describe the
structure and content of the compassion cultivation training (CCT) program designed at Stanford
University, and then share some of the empirical findings of research on CCT in community samples.

Key Words: compassion, meditation, mechanisms, treatment outcome, mind-wandering moderators,

training

Compassion is a powerful feature of human experience and is a key component of individual, interpersonal,
organizational, and societal well-being. However, understanding what it means, unpacking the components of
compassion and discovering how to cultivate it, and determining how to study compassion are complex
considerations. Training individuals in compassion has been a major part of many different contemplative
traditions for thousands of years. Recently, there has been an upswing of interest in scientific and clinical
communities which is resulting in a powerful exploration of how compassion is defined, trained, measured,
and implemented in various clinical, organizational, and community settings. For example, clinical scientists
are deeply interested in examining how compassion impacts emotional experience, emotion regulation, and
psychological flexibility (e.g., Fredrickson et al., 2008; Jazaieri et al., 2014; Leiberg, Klimecki, & Singer,
2011). More broadly, there is great potential for integrating compassion training into educational, community,
organizational, and clinical settings as a tool to enhance and sustain mental and physical health (e.g.,
Hofmann et al., 2015; Hofmann, Grossman, & Hinton, 2011; Johnson et al., 2011; Kearney et al., 2013). To
make evidence-based decisions on how best to inculcate compassion, we need to examine the outcomes
produced by different types of compassion training and to elucidate the underlying psychological mechanisms
of change. Thus, there is great excitement and promise in learning how, for whom, and why compassion
training may be beneficial to individuals and society. In this chapter we briefly define compassion, introduce
the compassion cultivation training (CCT) program designed at Stanford University, and share some of the
empirical findings of research on CCT.

Defining Compassion

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 Compassion is a complex concept that has been defined in several ways (see Goetz, Keltner, & Simon-
Thomas, 2010). From our perspective, compassion is an orientation that recognizes suffering. It includes a
fearless motivation to understand and alleviate the causes and conditions that give rise to suffering in oneself,
others, and society. It is important to note that compassion arises within a rich context that includes the
development of ethics, concentration, insight, and personal commitment. These are qualities or factors that
are important to keep in mind as we develop and test different compassion training programs.
Definitions of compassion will, obviously, be influenced by the historical period and cultural influences that
shape thinking about human potential and development of human capacities. Here, we propose a definition
that characterizes compassion as a multidimensional mental state with four key interacting components (Jinpa,
2010; Jinpa & Weiss, 2013). These four components contribute to the ontology (definitional constituents)
and phenomenology (lived experiential features) of compassion.
1. Compassion involves an awareness of suffering (cognitive component). Awareness entails many cognitive processes, including focused
attention on another person, taking the perspective of another person, recognizing their suffering (e.g., distress, pain, angst, confusion,
discontent, disequilibrium, and so forth), and holding that suffering in unwavering focused attention and working-memory for some period of
time. This awareness varies in intensity, is nonjudgmental, and embraces rather than avoids.
2. Compassion involves a caring and tender concern related to being emotionally moved by suffering (affective component). This arises from a
willingness to experience a softening of the heart, emotional resonance with others, and empathic concern for others. A deep emotional
experience is not required, but it may occur as a result of the cognitive component.
3. Compassion includes a genuine wish to see the relief of that suffering and, more specifically, a modification of the causes and conditions that
give rise to suffering (intentional component).
4. Compassion includes a responsiveness or readiness to take action in some way to relieve that suffering (motivational for altruistic behavioral
activation). We propose that these four components provide a structure that can serve as basis for training compassion, assessing individual
differences in levels of compassion, and refining compassion training programs.

Preliminary empirical evidence supports the use of these four components of compassion and their subsequent
measurement (Jazaieri et al., in preparation).
Given the complexity of compassion, there are likely to be multiple individual differences in biological and
psychological factors that influence how well developed each of these four components is in an individual and
that arguably moderate the effects of compassion training. The specification of additional psychological and
biological factors that characterize compassion remains to be elucidated in future research studies.
In summary, here, we propose a conceptual framework that defines compassion as a complex interaction of
cognitive, affective, intentional, and motivational components that orient the mind to suffering in different
contexts and that may give rise to cooperative and altruistic behavior (Jinpa, 2010; Jinpa & Weiss, 2013).

The Compassion Cultivation Training Program

The Compassion Cultivation Training (CCT) program was developed as a comprehensive compassion
training program by Thupten Jinpa, with contributions from a multidisciplinary team of psychologists,
neuroscientists, and contemplative scholars at Stanford University. The program trains a series of techniques
for mental and emotional well-being and is designed to cultivate the qualities of compassion, empathy, and
kindness for oneself, loved ones, difficult people, and all beings. While the program was heavily influenced by
contemplative practices from the Indo-Tibetan Buddhist traditions, special care has been taken to ensure that
the practices presented in CCT are nondenominational and secular. The intention behind this decision is to
make CCT as acceptable to as many communities and individuals as possible. More specifically, the intention

315
is to share compassion training techniques in a manner that highlights the practices and supports inner
experience directly. CCT is built on the understanding that compassion is fundamental to our basic nature as
human beings and is part of our everyday experience of being human (Jinpa, 2015).

General Background and Structure of Compassion Cultivation Training

The standard CCT program is taught in eight or nine weeks (an optional introductory session followed by
eight weekly sessions, each two hours in length). While CCT has been taught in groups as small as five and as
large as 35, we suggest that it be taught in groups of 20–30 to allow for adequate teaching and debriefing of
practices. However, the optimal size will depend on the individual instructor and his/her ability to regulate
group dynamics. The key is to create an environment that supports learning, communication, and direct
experience. In terms of the target population, CCT was originally designed for community-dwelling adults.
However, offering CCT to specific groups such as chronic pain patients (e.g., Chapin et al., 2014), parents,
cancer patients, teachers, health care providers, and so forth, represents a natural evolution and extension of
CCT to samples of individuals who may especially benefit from focused practices to cultivate compassion for
themselves and others. CCT does not have prerequisites to participate; thus recruitment is open to all
individuals, including those with no prior meditation practice or retreat experience. However, future empirical
studies of CCT will probably elucidate whether specific participant and instructor features predict better CCT
outcomes.
Participants are informed that the CCT program builds both didactically and experientially in a sequential
manner over two months. This is important to emphasize, as participants may experience discouragement or
distress when initially learning compassion practices. Thus an understanding of the longer-term arc of the
CCT program might mitigate shorter-term difficulties. Participants are encouraged to establish a daily home
practice starting with 15 minutes per day initially, and later building up to 25–35 minutes per day. The goal is
build familiarity and momentum with the variety of practices and pattern of responses to the practices. To
support home practice, participants are given CDs or access to MP3s of the audiotaped meditations to guide
their practice each week. In addition to the formal daily guided sitting mediation practices, weekly homework
in CCT also includes informal practices. The goal of the informal practices is to help the participant integrate
the didactic lessons and formal meditation practices from that particular week into one’s personal and
professional life. For example, during step 5 (described later), when participants are cultivating compassion for
others, informal practice may include journaling on the benefits to oneself of broadening one’s compassion, or
observing any challenges to compassion in everyday life—noticing people, situations, or conditions where one
feels resistance, difficulty, or limits to cultivating compassion for others. Thus, multiple methods are used to
scaffold the learning of compassion during CCT.
Because each week builds upon the prior weeks’ content, participants are told that if they have any
predetermined scheduling conflicts that will prevent them from attending the CCT course regularly, or if they
are unable to allot sufficient time to the homework practices, it is best to hold off on taking the course until
they are able to attend consistently and keep up with homework practices. Thus far, preliminary research on
CCT has suggested that there is a dose-response, whereby the amount of guided formal meditation practice
during CCT is associated with better outcomes (Jazaieri et al., 2013; Jazaieri et al., 2015; Jazaieri et al., 2014).
Unlike other compassion training programs (e.g., Gilbert, 2010), participants in CCT are specifically

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cautioned that this program is not intended to treat any specific psychopathology and is not intended to
replace psychotherapy. In fact, participants are told that CCT may bring up a variety of reactions such as
negative emotions and memories, and participants are assessed for and encouraged to seek outside professional
help during the course of CCT should the need arise.
Each CCT class follows a similar structure while reinforcing prior learning and introducing new content.
The class structure consists of:
1. a brief introductory guided meditation practice;
2. homework check-in both in small groups of two or three participants, followed by a larger group discussion;
3. introduction to the specific step of the week (described later) with pedagogical instruction and active group discussion;
4. interactive exercises designed to generate feelings of open-heartedness and connection to others through reading poetry or reflecting on
inspiring stories;
5. a longer guided meditation on the specific step of the week, followed by a group debrief and discussion;
6. assignment of new homework consisting of both informal and formal practices for the week; and
7. a brief closing activity.

There is a short break of 10–15 minutes midway through the two-hour class. This class structure is
important for both the instructor and the course participant, as it provides regularity and clarity. The function
of homework is to help encourage participants to integrate the principles of compassion into their lives and
interactions outside of the class. Ideally, over time, there is increasing alignment and fluidity between
intrapersonal experience and interpersonal expression of compassion. Each instructor may also include
inspiring stories relevant to the theme of the particular step of the week. This allows instructors to enliven the
class and highlight how compassionate action already exists in the world. CCT classes also include some basic
psychological education pertaining to the dynamic interactions between thoughts, emotions, and feelings, and
their relationship to one’s well-being.
One important aspect of the CCT program includes partner and small-group sharing each week. In these
exercises, participants are given specific instructions on how to practice compassionate listening, which is
rooted in the scientific understanding of empathy (e.g., focused attention, eye contact, body language,
perspective taking, nonjudgmental attitudes, and receiving vs. advice-giving). For example, during the week
on “common humanity,” participants get into pairs, and one participant begins by sharing with their exercise
partner something that he or she has experienced with the practice over the last week. Topics can include
things that are going well, or things that the person is having difficulty with, or is disappointed about. While
the participant is sharing his or her experience with the partner, the other person (the listener) looks at the
exercise partner and gives the other person his or her fully present, attentive, and engaged presence. Once the
partner has concluded, in response to everything that is shared, the listener simply says “Thank you.” Then the
roles are switched and the process is repeated. This time the one who spoke earlier takes the role of a listener
and simply says “Thank you” in response to the other’s sharing of their experiences with the practices over the
last week. At the end of the exercise, the two partners discuss how the practice was for them—both from the
perspective of the person sharing and the perspective of the person listening. Course after course, these small-
group and partner exercises are reported as being some of the most impactful experiences of the CCT
program. These partnered exercises allow for the experience of compassion in action in a simple, powerful,
and meaningful manner.

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The Six Steps of Compassion Cultivation Training
The content of CCT consists of six steps (see Table 18.1) through which participants progress over the
course of the program (Jinpa, 2010; Jinpa & Weiss, 2013). Step 1 involves settling and focusing the mind, which
is considered to be a basic skill essential for any form of mental reflection. For example, participants start with
a preliminary “cleansing breath” exercise consisting of deep, diaphragmatic breaths. Subsequent breathing
practices include silent mental counting of breath inhalation-exhalation cycles and resting the mind on the
awareness of the movement of one’s breath. Participants are encouraged to observe thoughts and emotions in
a dispassionate, purely observational manner, a basic element of mindfulness practice and part of the
psychoeducation on noticing the habitual patterns of our mental content. The overarching theme is fostering
mental awareness as a foundation for all subsequent meditation practices. The breathing practices precede
each of the compassion-focused meditations throughout the CCT course.

Table 18.1 The Six Steps of the Compassion Cultivation Training (CCT) Course

Session Step Main Content

1 1 Introduction to the course and to settling and focusing the mind

2* 1 Settling and focusing the mind

3 2 Loving-kindness and compassion for a loved one

4 3a Compassion for oneself

5 3b Loving-kindness for oneself

6 4 Embracing shared common humanity and developing appreciation of others

7 5 Cultivating compassion for others

8 6 Active compassion practice (tonglen)

9 Integrated daily compassion cultivation practice (steps 1–6)

* When the course is taught in an eight-week format session, 2 is dropped.

In step 2, participants practice loving-kindness and compassion for a loved one. This involves connecting with
the natural ability within each person to feel care, love, and compassion for another person. Throughout
CCT, participants are encouraged to cultivate feelings of warmth, tenderness, concern, and connectedness,
and to notice the embodied sensations that co-arise with these feelings. We begin with a loved one because it
can be easier for most participants to extend feelings of warmth, tenderness, concern, and connectedness to
this loved person before pivoting and extending the field of view to include oneself, acquaintances, and
adversaries.
In step 3, participants learn to cultivate loving-kindness and compassion towards oneself. This practice can be
challenging for some participants. Thus, these practices are spread out over two weeks to provide ample time
to lean into this experience slowly. Participants are trained to cultivate compassion for themselves by gradually
generating attitudes of self-acceptance, non-judgment, and tenderness towards themselves (step 3a). Next,
participants practice loving-kindness towards themselves, which includes focusing on the qualities of warmth,

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appreciation, joy, and gratitude (step 3b). Together, this processes composes Step 3, which is considered to be
a critical (and challenging) step, as it is important to genuinely connect with one’s own feelings, needs, and
experiences, and engender loving-kindness and compassion toward oneself.
Step 4 shifts to establishing the basis for compassion towards others. Two key elements are emphasized for
generating genuine compassion towards others. First, common humanity, or the recognition of the similarity
of the fundamental needs and aspirations between oneself and others, involves the recognition of the shared
human desire for happiness and freedom from suffering. Common humanity, or this “just like me”
perspective, is considered to be essential for empathy; i.e., the ability to take the perspective of another. In
CCT, compassion towards others is cultivated progressively, from easier to more challenging targets. This is
done explicitly to scaffold the cultivation of compassion. The sequence of training begins with a loved one,
then a neutral person, a difficult person, in-group, and out-group, and eventually extending to all living
beings. This sequence optimizes the depth and stability of compassion. The goal is to cultivate a universal
compassion that encompasses all beings. This serves as a basis for cultivation of the second insight; namely, an
appreciation of the de facto interconnectedness of all beings. For example, participants recognize and
acknowledge how they depend on countless others for basic survival (e.g., food and shelter) and for their
personal well-being (e.g., safety and education). In this regard, participants are encouraged to generate
feelings of gratitude towards others known and unknown who have supported them both directly and
indirectly. This insight overrides the overlearned habitual tendency to perceive and treat others as separate,
independent, and disconnected beings. Instead, a more refined perspective is generated that understands the
vast and profoundly interconnected nature of all beings. This discernment engenders an expansive compassion
that gives rise to a universal sense of belonging, an interdependence of self and others, and a willingness to
take action to alleviate pain, confusion, and suffering in the world.
Step 5 extends the prior step by cultivating compassion towards all beings. As in step 4, here, participants
focus on a loved one, a neutral person, and a difficult person, and finally expand their circle of compassion and
concern to include all humanity. It is through this recognition that participants understand that, just as they
do, all others also wish to experience happiness and freedom from suffering. Thus others also are deserving of
happiness and freedom from suffering. Participants cultivate the mentality that the whole world depends on
giving and receiving kindness and compassion. It helps participants feel part of something larger and can help
put one’s life in perspective with the world.
The sixth step of CCT is referred to as active compassion practice. In this step, participants are generating the
wish to do something about the suffering of others. A formal sitting practice that is introduced in this part of
the course comes from a Tibetan practice called tonglen, or “giving and receiving.” In this practice, participants
visualize taking away the suffering (including destructive thoughts and behaviors) of others, and then visualize
offering to others whatever will bring ease and peace of mind, happiness, well-being, and freedom from
suffering. This is an advanced type of compassion practice that builds on everything that came before. Tonglen
requires self-confidence, great mental and emotional stability, and willingness to let go of self-interests and
instead focus on promoting the well-being of others.
In the last CCT class, the instructor introduces a final practice that is considered an integration of the six
steps into a single unified compassion meditation practice. This integrated practice progresses through settling
and focusing the mind, loving-kindness and compassion for a loved one, loving-kindness and self-compassion,

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establishing the basis for compassion towards others, cultivating compassion towards others, and active
compassion or tonglen practice. The goal is to provide participants with a single integrated meditation that
they can implement as a daily practice after the course has concluded. While not exhaustive of all the different
methods for training, CCT offers a comprehensive, logical set of meditation practices that aim to cultivate a
solid personal foundation in compassion.

Compassion Cultivation Training Instructors

CCT courses are taught by a certified teacher (for a directory of certified CCT teachers, please visit
http://ccare.stanford.edu/education/cct-directory). Although not as common, in some circumstances and
conditions, having a co-facilitator (who is also a certified CCT teacher) is an appropriate accommodation for
the course. Instructor qualifications for the CCT program include having one’s own formal meditation
practice spanning a variety of compassion practices, and having experience teaching meditation practices.
Advanced training in psychology is highly recommended, though not required. Applicants for the CCT
teacher training program are selected from an international pool of professionals from a variety of
backgrounds and industries who wish to deepen their ability to share the science, philosophy, and practice of
compassion. Qualified applicants participate in a year-long teacher-training program followed by a period of
supervised teaching of CCT by a senior CCT instructor through the Center for Compassion and Altruism
Research and Education (CCARE) at Stanford University.
In addition to retreats where meditation practice is emphasized, the year-long CCT teacher-training
program consists of several academic courses, including the Science of Compassion and Philosophical
Perspectives on Compassion. While in the teacher-training program, the teachers in training have access to a
detailed CCT instructor manual (Jinpa, 2010), from which they teach during their period of supervised
teaching and beyond. Following the year-long teacher-training program and during the period of supervised
teaching, the instructor in training audiotapes and videotapes each class (recordings are submitted for
certification consideration), meets periodically with the senior teacher supervising their course, meets for
consultation with other teachers in training, and solicits formal, written feedback from all participants in their
courses at least twice during their CCT class (these course evaluations and feedback from the course
participants are also submitted as part of determining teacher certification).

Empirical Investigations of Compassion Cultivation Training

Given the increasing interest in the effects of compassion training, it is critical to develop an empirical
understanding of how compassion training works, for whom it works, and what the outcomes of such training
are. We have conducted studies to begin answering these questions. We conducted a controlled trial in which
a community sample of adults were randomized to either nine weeks of CCT or a waitlist control group that
received CCT only after completing nine weeks of no training. Our first question was to determine whether
CCT produced changes in different types of compassion. Self-reported responses from participants indicated
that CCT produced significant increases in their compassion for others, and decreases in fear of compassion
for others, for themselves, and of being the object of compassion from others (Jazaieri et al., 2013).
Importantly, CCT participants showed that they were committed to the program and dedicated, on average,
95 minutes per week to formal, audiotaped, guided meditation practice at home. While the number of at-

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home formal guided meditation sessions per week remained steady throughout the nine weeks of CCT, the
number of informal spontaneous (i.e., unguided) compassion practices continued to increase during the nine-
week CCT course. An important question that the field of contemplative science has been grappling with is
whether the amount of home practice matters in terms of compassion and other CCT-related outcomes. We
conducted an analysis to test this question and found a meditation dose response. Specifically, increases in
home meditation practice predicted several CCT-related changes, including decreases in worry, emotional
suppression, and mind-wandering to unpleasant topics, and increases in compassion for others (Jazaieri et al.,
2014; Jazaieri et al., 2016).
We also wanted to know whether CCT produces changes in other factors that are important for mental
flexibility, interpersonal effectiveness, and compassionate behavioral engagement in the world. CCT resulted
in significant changes in emotion experience (increases in positive affect and decreases in negative affect and
perceived stress), emotion regulation (increases in cognitive reappraisal and acceptance, decreases in suppression
of emotion), and cognitive regulation (increases in mindfulness skills, decreases in mind wandering and
negative rumination) (Jazaieri et al., 2015; Jazaieri et al., 2014). With regards to mind wandering, prior to
CCT, participants reported mind wandering about 59.1% of the time, a rate higher than what has been
reported in general community samples (46.9%; Killingsworth & Gilbert, 2010). However, following CCT,
we observed a reduction in the tendency for the mind to wander, particularly to unpleasant thoughts. We have
also found a significant reduction in the number of self-reported psychiatric symptoms on the Symptom-
Checklist-27 (Hardt et al., 2004) in this adult community sample (Jazaieri et al., 2014), which raises the
question of whether, and how, and for whom CCT might be useful as an adjunct to current clinical
interventions for patients with psychiatric problems such mood and anxiety disorders.
We were also interested in examining whether intrapersonal changes were related to interpersonal changes.
We tested this in multiple ways. CCT resulted in significant decreases in anticipatory anxiety and anxiety
during social interactions. This is important because an implicit goal of compassion training in general and
CCT specifically is the transfer from internal commitment and skill-building to compassionate engagement in
the world. We further tested the impact of CCT on empathic concern for others by using a set of provocative
video clips showing adults describing personally painful social situations in which they suffered a loss of
dignity (Goldin et al., in preparation). We presented several such video clips to participants before and again
after CCT, along with several probes of emotion awareness and empathic concern for others. The results were
robust and indicated a very clear pattern. CCT produced significant decreases in specific maladaptive form of
emotion-regulation called expressive suppression. This refers to suppressing one’s own emotional expression
such that others would not be able to discern one’s current emotional state. Regression analysis found that
pre-to-post-CCT decreases in expressive suppression significantly predicted CCT-related increases in the
participant’s detection of their own and the videotaped person’s emotional state, as well as increases in the
participant’s levels of caring, willingness to help, and amount of time offered to the videotaped person. These
findings emphasize the impact of CCT on emotional awareness and interpersonal caring.
Our next question focused on whether CCT produced any meaningful change in caring behavior (Jazaieri
et al., 2016). To examine this question, we implemented daily experience sampling methods that included
assessment every day for one week prior, nine weeks during, and one week after CCT. This entailed
automated assessment twice a day for each CCT participant via smartphones at random times, once in the

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morning and once in the evening. To facilitate understanding, we provided participants with a list of examples
of self and other caring behaviors (see list of behaviors in Jazaieri et al., 2015) one week before starting CCT.
We asked several questions regarding affect, meditation practice, and caring behaviors at each automated
assessment. The findings indicated that, over nine weeks of CCT, participants varied significantly in their
week-to-week levels of caring behaviors toward themselves (e.g., “Refrained from criticizing myself”; “Asked
for help from others when I needed such help”; “Let myself rest and relax”). Engaging in caring behaviors
probably reflects changes produced by specific components of CCT during training. In contrast, over time
there was a small but significant increase in the tendency to engage in caring behaviors focused on others (e.g.,
“Did a favor for someone”; “Volunteered time to someone else”; “Gave someone a compliment”). This
asymmetry reflects an observation that occurs frequently during CCT (and in other contemplative training)—
that generating loving-kindness and compassion focused on others is easier, perhaps more intuitive, than
generating loving-kindness and compassion toward oneself. This inequality in caring behavior is a very
important issue in contemplative training and clinical intervention work. However, when we then asked
whether daily meditation practice influenced caring behavior, our analyses elucidated a very promising pattern.
Averaged across all the daily experience samples over nine weeks, whether or not a person had done
meditation practice at home on that day influenced the frequency of caring behaviors significantly.
Specifically, when a person had practiced meditation that day, the probability of an other-focused caring
behavior increased by 3.5 times. This was an expected finding, as increasing other-focused caring behavior is
an explicit goal of CCT. Surprisingly, we found that prior meditation that day increased the probability of
self-caring behaviors by 6.5 times, suggesting an even stronger link than was evident with other-focused
caring behavior. Furthermore, when we analyzed the influence of self and other caring behaviors on each
other, we found a non-directional positive relationship: if someone did a self-care behavior, then that person
was 9.3 times as likely to do an other-care behavior (or vice versa). These findings are very promising;
however, they need to be replicated in a different sample with a variety of other CCT instructors before we
can be fully confident that they are reliable, reproducible, and meaningful.
One more important research question was focused on identifying specific features or characteristics that
participants have prior to starting CCT that predicts CCT-related changes (Goldin et al., in preparation).
The moderator analyses we conducted determined that gender influenced self-compassion. When examining
pre-to-post-CCT changes, compared to females, males demonstrated significantly greater decreases in fear of
self-compassion. Even though everyone showed improvement in self-compassion, men benefitted even more
than women. One explanation for the gender moderation of self-compassion is that at baseline, prior to CCT,
compared to men, women have higher levels of compassion for themselves and for others. Thus, there is more
room for men to improve with CCT. Gender was also associated with other CCT-outcomes: women (vs.
men) experienced greater self-esteem and satisfaction with life, as well as fewer depression symptoms and
social-interaction anxiety. Prior experience with meditation retreats, regular meditation practice, and regular
yoga practice at baseline each predicted greater improvement in compassion for self and for others. These
moderator findings are provocative in that they make us reflect on who benefits from CCT and in what
domains. How would we modify specific components of CCT to better serve people with different
characteristics and prior life experiences? Is there a way to modify CCT to amplify its impact in men and
women, respectively? Or is compassion training really gender-blind? Furthermore, what type and “dose” of

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prior yoga and meditation practice might be optimal to enhance the effectiveness of CCT? The data suggest
stronger benefits in women (vs. men) for symptoms of depression and anxiety, self-esteem, and life
satisfaction, but for how long are these benefits sustained after CCT is done? Clearly, these findings are very
promising and suggest that CCT may have robust beneficial effects in adult community samples. However,
they need to be replicated in multiple groups with a variety of other CCT instructors before we can be fully
confident that they are reproducible, valid, and meaningful.

Conclusion
Compassion’s time has come, and the future for CCT is bright. CCT has been offered in a variety of
organizations and settings, including Stanford University (e.g., for continuing education, undergraduates,
school of business, medical school), University of California–Berkeley, University of California–Davis,
Google, nonprofit organizations, outpatient cancer clinics, inpatient healthcare settings and hospitals, and
even in the United States Department of Veterans Affairs, both to healthcare providers and to U.S. veterans
suffering from post-traumatic stress disorder (PTSD).
Beyond the field of clinical science, the importance of compassion and its empirical study have begun to
emerge in the fields of business (e.g., Allred, Mallozzi, Matsui, & Raia, 1997; Molinsky, Grant, & Margolis,
2012), education (e.g., Wear & Zarconi, 2008), health care (e.g., Papadopoulos & Ali, 2015), and beyond.
There is tremendous interest and potential in the scientific examination of compassion training. However,
much more research needs to be done to address many pertinent issues. Who is most likely to benefit from
compassion training? What are the specific characteristics that make a person more or less ready to learn
compassion meditation? Might there be one or several optimal sequences of contemplative training; for
example, beginning with mindfulness meditation for some period, short-term meditation retreats, and then
compassion meditation training? While there are specific meditation practices and programs that focus on
compassion for self or for others, we currently know very little about how these two facets of compassion (self
versus other) change over time with different training. Furthermore, with the introduction of online training
courses and resources, we need to determine the person-specific variables and class context features that
determine whether someone is best suited for individual vs. group and in-person vs. online training
experiences. While there is preliminary evidence for the potential for integrating compassion practices as
adjunct components of current clinical interventions (e.g., Linehan, 2014) or as stand-alone interventions
(e.g., Gilbert, 2010), we need studies that investigate which practices may facilitate changes in clinical
symptoms and functioning in different populations (e.g., major depression, anxiety disorders, caregiver
burnout, and so forth). Given that so much suffering and discontent arises in the workplace, we need
controlled studies that empirically test how compassion practices affect teams embedded in different types of
organizations.
Finally, compassion may be an important part of social justice. Specifically, more studies are need that
examine multileveled social hierarchies and how compassion training influences the interactions between
different levels of society (e.g., privileged versus under-represented groups; high versus low political power in
groups; wealthy versus poor). In summary, the promise for a scientific understanding and practical integration
of compassion practices is clear. However, there is need for more refined research to understand how best to
train individuals, teams, and organizations in compassion skills and how best to support sustained

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development of compassion.

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 Cognitively Based Compassion Training Gleaning Generalities from Specific
Biological Effects

Jennifer Mascaro, Lobsang Tenzin Negi, and Charles L. Raison

Abstract

Recent research has examined the beneficial impact of kindness-based meditation practices, including
cognitively-based compassion training (CBCT). Here we provide a theoretical and practical account of
CBCT and review the emerging evidence that it affects the brain and body in ways that are relevant for
health. Initial research demonstrated that CBCT alters immune function and stress physiology, and
augments empathy as well as the neural activity supporting it. More recent studies indicate that CBCT
is differentially effective, depending on the population that practices. We suggest directions for future
research to best examine the apparently complex effects of CBCT on health and well-being.

Key Words: compassion, empathy, empathic accuracy, immune system, inflammation, interleukin, c-
reactive protein, fMRI, oxytocin

Over the last 25 years, research on meditation has advanced in domains both clinical and basic, motivated
by the intuition that contemplative practices are effective interventions for alleviating psychopathology and
increasing well-being and resilience. In addition, it is increasingly appreciated that contemplative practices
may be used as tools to help scientists understand the human brain, body, and brain–body connections. While
much of this research has been on mindful attention practices, more recently researchers have turned their
attention to kindness-based practices, frequently to address the question, “Can kindness be trained?”
Increasingly, the answer appears to be “yes” (Fredrickson et al., 2008; Hutcherson et al., 2008).
This chapter will focus on a body of research that asks a related question, which is, “Are kindness-based
practices good for us?” Elsewhere, we and others have reviewed the physiological and neurobiological effects
of the emerging family of kindness-based contemplative practices (Galante et al., 2014; Mascaro et al., 2015);
here we offer a different perspective, examining with granularity the biological effects of a single, arguably
unique contemplative practice, CBCT® (Cognitively-Based Compassion Training) (Ozawa-de Silva & Dodson-
Lavelle, 2011). To this end, we will begin with a theoretical and practical account of CBCT.
Given the theoretical underpinnings and the particulars of the practice, we will ask how we would expect
CBCT to affect a practitioner’s body. Next, we will review the growing body of research regarding how
learning and engagement with CBCT alter the brain and body. What emerges is a conundrum, in which
CBCT appears to be differentially effective, depending on the population that practices. We will try to make
sense of this apparent complexity. Finally, we will discuss the need for future research that will further advance
investigations of CBCT and other contemplative practices more broadly, especially for clinical populations
that may have the most to gain from the training.

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Cognitively Based Compassion Training: Theory and Practice
CBCT draws heavily from the eleventh-century Tibetan Buddhist lojong (“mind training”) tradition, which
itself is deeply rooted in the seminal works of eighth-century Tibetan Buddhist Shantideva. Geshe Thupten
Jinpa, one of the rare eminent scholars trained in both the Tibetan monastic tradition and in Western
religious studies, identifies the defining features of lojong as an analytical and didactic approach designed to
reorient the practitioner’s perspective on his or her relationship with others, and ultimately to develop and
cultivate an altruistic mind (Jinpa et al., 2014). Ozawa-de Silva and Dodson-Lavelle (2011) have argued that
it is this analytical approach that makes CBCT unique among related contemplative practices. In contrast to
popularized applications of mindfulness that often emphasize open, nonjudgmental awareness, it is through
an analytical process and active reorientation of thoughts, values, and relationships that empathy and
compassion are cultivated in CBCT (Ozawa-de Silva & Dodson-Lavelle, 2011). In contrast to other
compassion training programs such as compassion cultivation training (CCT) (Jazaieri et al., 2013) and
compassionate mind training (CMT) (Gilbert & Procter, 2006) that were developed either completely by, or in
collaboration with, clinical psychologists, CBCT emerges principally from the Buddhist tradition, with little
initial input from Western clinicians.
From this theoretical background, CBCT adapts standard lojong processes in two important ways in its
operationalization for inexperienced and secular populations. First, the program is presented in non-religious
terms; thus, all discussions of soteriological or existential themes (e.g. the attainment of Buddhahood, karma)
are omitted. Second, rather than immediately commencing with compassion-specific techniques, CBCT
begins with an introduction to foundational practices aimed at entraining attention. Specifically, it begins with
one week of concentrative (i.e., shamatha) practice, often entailing awareness of breath. The second module
introduces an open-presence practice, in which the attention is expanded from the single point of the breath
to an awareness of mental contents more widely. While these techniques are generally considered advanced in
the Tibetan spiritual tradition, they are often practiced in conjunction with compassion practices and are
thought to be essential for establishing the focus and awareness necessary to engage in analytical practices
(HHDL, 2001; Wallace, 2001). CBCT instruction unfolds in the following sequence and with the following
goals:
Module 1: Developing Attention and Stability of Mind: The foundation for the practice is the cultivation
of a basic degree of refined attention and mental stability.
Module 2: Cultivating Insight into the Nature of Mental Experience: The stabilized mind is then
employed to gain insight into the nature of the inner world of thoughts, feelings, emotions, and reactions.
Module 3: Cultivating Self-Compassion: The practitioner observes his or her innate aspirations for
happiness and well-being as well as those for freedom from unhappiness and dissatisfactions (for example,
which mental states contribute to fulfillment and which ones prevent it). The participant then makes a
determination to dispel toxic mental and emotional states that promote unhappiness.
Module 4: Developing Equanimity: People tend to hold fast to categories of friends, enemies, and strangers
and to react unevenly to people, based on those categories, with over-attachment, indifference, or dislike. By
examining these categories closely, the participant comes to understand their superficiality and learns to relate
to people from the deeper perspective that everyone is alike in wanting to be happy and to avoid unhappiness.
Module 5: Developing Appreciation and Gratitude for Others: Although people view themselves as

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independent, self-sufficient actors, the truth is that no one can thrive or even survive without the support of
countless others. When the participant realizes interdependence with others and the many benefits others
offer every day, the participant develops appreciation and gratitude for them.
Module 6: Developing Affection and Empathy: Deeper contemplation and insight into the ways in which
myriad benefits are derived from countless others, along with awareness that this kindness should by rights be
repaid, enables the participant to relate to others with a deeper sense of connectedness and affection. By
relating to others with a profound sense of affection and endearment, the participant is able to empathize
deeply with them. The participant cannot then bear to see others suffer any misfortune and rejoices in their
happiness.
Module 7: Realizing Wishing and Aspirational Compassion: Enhanced empathy for others, coupled with
intimate awareness of their suffering and its causes, naturally gives rise to compassion: the wish for others to
be free from suffering and its conditions.
Module 8: Realizing Active Compassion for Others: In the final step, the participant is guided through a
meditation designed to move from simply wishing others to be free of unhappiness to actively committing to
assist in their pursuit of happiness and freedom from suffering.

Active Ingredients
Since our focus here is to document the biological effects of CBCT, it is worth speculating on the “active
ingredients” of the training in order to better situate existing empirical data (Table 19.1). To our eye, there are
several. First, it is possible that any effects arise because of the mindful and attention components that are
practiced at the outset. The research is unequivocal at this point that mindful attention is impactful,
particularly for improving anxiety and depression (Goyal et al., 2014). However, as will be reviewed in what
follows, studies directly comparing CBCT with mindfulness have revealed distinct effects of both (Desbordes
et al., 2012b; Desbordes et al., 2014). Thus, if CBCT confers benefits by altering mindful attention, its
impact is likely to be in addition to, not reducible to, the impact of the first two modules.

Table 19.1 CBCT Modules and Related Hypothesized “Active Ingredients”

Module Aim Hypothesized Active Ingredient(s)

1 Developing Attention and Stability of Mind Mindfulness

2 Cultivating Insight into the Nature of Mental

Experience

3 Cultivating Self-Compassion Cultivation of a growth or mastery

mindset

4 Developing Equanimity Development of affection and gratitude

5 Developing Appreciation and Gratitude for Others

6 Developing Affection and Empathy

7 Realizing Wishing and Aspirational Compassion Compassion

8 Realizing Active Compassion for Others

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 A second possible active ingredient is the cultivation of self-compassion. While Module 3 can be easily
misunderstood as something akin to self-esteem or to other self-compassion programs (Neff, 2003), the
CBCT teachings and practices begin by facilitating critical inquiry into the practitioners’ own deep-rooted
desire to be free from suffering. This is followed by the reflection on their innate ability to cultivate and shape
their mind in a manner that influences the day-to-day quality of their mental experience. Importantly, a recent
line of research shows that individual differences in the belief that empathy can be shaped and developed
predict an individual’s propensity to empathize in difficult situations (Schumann et al., 2014). More broadly,
research on motivation and perseverance suggests that a growth or mastery mindset, such as that which is the
goal of module 3, may be optimal in a wide variety of socio-cognitive domains broadly related to learning
(Dweck & Leggett, 1988). By empowering practitioners with the understanding that their own levels of
empathy and compassion are traits that can be cultivated, CBCT may promote a growth mindset that alters a
practitioner’s habitual engagement with their world, including the way the body (for example, the immune
system) engages with the world.
A third possible active ingredient is the generation of deep affection and gratitude for others; the goal of
modules 4 through 6. A large corpus of research now attests to the positive effect that gratitude has on health
(Hill et al., 2013) and well-being (Emmons & McCullough, 2003; Wood et al., 2010), and as a buffer against
stress and depression (Wood et al., 2008). Moreover, gratitude and affection promote patterns of
interpersonal connection that combat chronic social isolation, a state shown in many studies to bias an
individual’s immune system toward a fast-acting innate immune response, characterized by deleterious pro-
inflammatory signaling (Cole, 2009). Furthermore, recent research shows that eudaimonic well-being has a
demonstrable effect on pro-inflammatory immune processes (Fredrickson et al., 2013) and may even protect
individuals from the otherwise deleterious effects of loneliness (Cole et al., 2015). By cultivating a sense of
shared humanity and ever widening the practitioner’s in-group, CBCT may influence the practitioner to
interpret their world as safe and interconnected, thereby optimally shaping their immune system’s response.
If CBCT does affect pro-inflammatory immune function, recent research in psycho-neuro-immunology
suggests that we should take a more dynamic view of its effects. That is, recent work shows that, not only do
chronic isolation and loneliness enhance signaling in the deleterious pro-inflammatory immune system, but
also that increased inflammation further increases feelings of isolation and enhanced amygdala responses to
threatening social stimuli (Inagaki et al., 2012), as well as depression (Musselman et al., 2001). Taken
together, these studies reveal a powerful cycle whereby isolation and depression enhance inflammation, which
then further enhances subjective isolation and may decrease empathy and compassion (Cusi et al., 2011).
The optimistic outlook on this negative cycle is that compassion practices may provide relief from the cycle
by augmenting both subjective feelings of social connectivity as well as the underlying biological systems that
support these feelings, which in turn may attenuate inflammation and related depression. CBCT, then, may
increase compassion in part by reducing the practitioner’s own suffering, thereby fostering interconnectedness
and exposing compassionate inclinations.
A final ingredient that may do the “work” of CBCT is the cultivation of the active, aspirational compassion
that culminates the program. Research attests to the salutary effects of compassion: for example, compassion
may do the bulk of the work in the link between religiosity and the related psychological well-being (Steffen

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& Masters, 2005). Additionally, multiple disparate lines of research, from investigations of altruistic giving
(Moll et al., 2006), to studies of adopting a compassionate stance when viewing others’ suffering (Kim et al.,
2009; Morelli et al., 2012), to research on human parental caregiving (Mascaro et al., 2013a; Rilling, 2013), to
research on the appetitive drive to nurture offspring in animal models (Numan & Stolzenberg, 2009),
implicate the mesolimbic dopamine system in active compassion (see Weng, Schuyler, and Davidson, Chapter
11 and Klimecki and Singer, Chapter 9, in the current text). This raises the intriguing possibility that this
neural system is altered by CBCT, essentially enhancing the reward and motivation practitioners feel toward
others.

State of the Science

Effects on the Body
With these promising ideas in mind, we started a program of research to examine the effects of CBCT on
stress physiology and immune function. In our first study (Pace et al., 2009b), we randomized medically and
psychiatrically healthy college freshmen either to a six-week CBCT program or to an active control condition
(a health-education group), and then had them participate in a standardized laboratory psychosocial stressor
(Trier Social Stress Test [TSST]). Prior to and throughout the stressor, we collected blood samples to assay
cortisol and pro-inflammatory molecules. Counter to our initial expectations, there was no effect of group
assignment on cortisol response to the TSST. However, we found an interesting association between the
amount of time spent practicing CBCT (within the compassion group) and cortisol responses. Participants
who engaged in substantial “at home” practice had their cortisol levels return to pre-stressor baseline levels
significantly faster than individuals with minimal practice time during the study. Importantly, CBCT practice
did not alter the initial cortisol response to the stressor. These results suggested to us that CBCT may
preserve appropriate acute stress responses, while attenuating non-adaptive prolonged stress responses once
the stressor has passed—the type of rumination that has been shown in many studies to increase the risk for
anger and a number of psychiatric and medical illnesses (Nolen-Hoeksema, 2000).
Similar to the cortisol findings, no between-group differences were seen in innate immune inflammatory
cytokine responses (i.e., plasma interleukin [IL]-6) to the TSST. However, within the CBCT group, the
amount of time spent doing CBCT practices was strongly associated with IL-6 responses to the TSST (Pace
et al., 2009a; Pace et al., 2010a). Specifically, participants who engaged in more time practicing produced less
IL-6 in response to the stressor than did those with lower levels of practice. The picture that emerged from
these data was that increased practice time was associated with reduced autonomic nervous system (ANS)
responses to the TSST, which in turn, predicted lower IL-6 levels after the stressor (unpublished data).
Participants who practiced more had less acute ANS activation in response to the stressor, and these reduced
immediate responses were strongly correlated with reduced plasma concentrations of IL-6 90 minutes after
the stressor. Together, these findings suggest that the practice of CBCT may have reduced the level of stress
perceived by individuals exposed to the TSST, as indexed by reduced autonomic reactivity, which in turn led
to reductions in inflammation, all consistent with multiple lines of evidence suggesting that autonomic
responses to stress play an important role in modulating inflammation (Bierhaus et al., 2006).
While these initial findings were encouraging, it remained unknown whether these effects of CBCT on
autonomic, neuroendocrine, and immune responses to social stress would be apparent in other age groups, or

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in populations with medical or psychiatric illness. A follow-up study examined the effects of CBCT on a
population that suffers significantly high levels of inflammatory activity: children exposed to early-life
adversity. Adolescents (n = 71) in the Georgia State Foster Care system were randomized either to six weeks
of CBCT or to a wait-list condition. Consistent with the first study, CBCT practice time across the six-week
training period was associated with reductions in resting-state inflammation, as indexed by salivary
concentrations of the acute phase reactant, c-reactive protein (CRP) (Pace et al., 2013). These findings are
especially encouraging, given that levels of CRP were high in this population at the start of the study,
consistent with the high rate of early-life trauma in children placed in foster care in the United States, and
consistent with replicated associations between early-life adversity and elevated CRP (Danese et al., 2008).
Whether these meditation-induced reductions in inflammation would persist after training and/or translate to
long-term protection against illness is one of the most important unanswered questions in the arena of
compassion and endocrinology/immunology.

Effects on the Brain

If CBCT alters immune function and stress physiology, brain function should mediate these effects.
Among the first to examine this possibility, Desbordes and colleagues conducted a longitudinal investigation
of CBCT in healthy adults naïve to meditation. Participants underwent functional magnetic resonance
imaging (fMRI) prior to being randomized to either CBCT, mindful attention meditation, or a health
discussion control group. Following these interventions, the fMRI assessment was repeated. The investigators
found that, for individuals randomized to CBCT, but not for those randomized to attention meditation,
meditation practice time predicted increased amygdala activation in response to empathy-inducing stimuli,
though the effect was only marginally statistically significant (Desbordes et al., 2012). In the context of
empathy, the amygdala is thought to play an important role in detecting the salience of, and learning about,
social information based on sensory cues (Blair, 2008), and it may be critically involved in the affective
dimension of empathy (Hurlemann et al., 2010). Importantly, the increased amygdala activation observed in
the CBCT group was associated with reduced self-reported symptoms of depression across the study period
(Desbordes et al., 2012). While it is important to note that this was not a clinically depressed population,
given the association between inflammation and depression, this finding is consistent with earlier studies
reporting that CBCT reduces inflammatory biomarkers, both at rest and in response to psychosocial stress
(Pace et al., 2009a; Pace et al., 2013), and with other studies showing that compassion-based practices lead to
decreased symptoms of depression (Gilbert & Procter, 2006). Moreover, it supports the idea that a key active
ingredient in CBCT is the amelioration of depression symptoms and attendant activity of the innate immune
response, essentially unmasking the underlying empathy and compassion that were impaired by the
individual’s own suffering. The finding of an association between increased amygdala activity and reduced
depression in the context of CBCT may seem surprising, given significant evidence that antidepressant
medications have an opposite (i.e., dampening) effect on amygdala activation (Sheline et al., 2001). If
confirmed in future studies, the findings by Desbordes et al. (2012) may suggest that depression can be
reduced, either by damping down emotional reactions to the sufferings of others, or by actually increasing
these reactions, but in a way that is felt to be empowering and that produces positive—not negative—affect.
Although these musings await scientific exploration, it should be noted that the increased amygdala reactivity

330
observed in the Desbordes study in novice CBCT practitioners has also been observed in extremely advanced
long-term meditators (Lutz et al., 2008), most of whom actively engaged in compassion-based practices.
In addition to neural systems related to stress and depression, a second study examined whether CBCT
alters the neurobiology that supports prosocial states like empathy and compassion. Using a longitudinal
design similar to that of Desbordes and colleagues, we found that those randomized to CBCT, compared to a
health education control group, had enhanced scores on an empathic accuracy task (Baron-Cohen et al., 1997;
Baron-Cohen et al., 2001) that involved judging others’ mental states based on impoverished images of the
face (Mascaro et al., 2012). Participants completed the empathic accuracy task in the fMRI scanner (known as
“Reading the Mind in the Eyes Test” [RMET]), and increased scores were related to increased neural activity
in several regions of the brain important for social cognition. First, improved scores were related to
augmentation of activity in the inferior frontal gyrus (IFG), a hub in the putative mirror neuron system that
appears to be integral for inferring others’ mental states based on their facial expressions (Carr et al., 2003;
Caspers et al., 2010; Dapretto, 2006). While it is unclear why CBCT augmented IFG activity, other studies
have shown that motivation modulates the putative mirror system (for example, Cheng et al., 2007), and it
may be that CBCT heightened participants’ motivation to take the perspective of others.
Improvements in empathic accuracy on the RMET were also related to a CBCT-related increase in activity
of the dorsomedial prefrontal cortex (dmPFC), a region that is important for thinking about others’ mental
states (Lieberman, 2007). Activity in the dmPFC is thought to be related to relatively controlled, reflective
perspective-taking, so the implication of this study is that CBCT augmented this more cognitive component
of empathy, and as a result, enhanced practitioners’ ability to accurately report on the mental states of others
(Mascaro et al., 2012).
Sometimes negative results are as important as positive, and this is one of those instances. The findings
presented here might be interpreted as demand characteristics, in which the results are best explained by
participants’ implicit and/or explicit beliefs about the experiment’s purpose, which subsequently shape their
behavior. However, this possibility is arguably mitigated because this same participant population also
completed an “empathy for pain” task in which they viewed video clips of others receiving painful shocks
(Lamm et al., 2010), based on the hypothesis that CBCT would enhance neural activity related to empathy or
compassion. We did not find that CBCT altered neural activity in regions known to be important for
simulating the affective pain response or for compassion (Mascaro et al., 2013b), suggesting to us that the
effects of CBCT on the brain are both specific and not likely to be explained by expectation bias. In sum, the
research to date suggests that CBCT may target the amygdala, inferior frontal gyrus, and the dmPFC, areas of
the brain important for perceptual/motor and cognitive aspects of empathy. Regions of the brain important
for simulating the sensory or affective experience of pain thus far appear unaltered by CBCT training.

A Final Cautionary Note

Our initial work on the impact of CBCT on inflammatory responses to psychosocial stress garnered
sufficient interest to result in our research group’s receiving grant funding to conduct a very large replication
study of the anti-inflammatory effects of CBCT, and moreover, to compare CBCT with mindfulness
meditation as well as a health discussion group. These results await publication, but early analyses suggest that
none of the interventions affected any relevant behavioral or biological measure. Thus, enthusiasm over

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positive findings presented for previous studies must be tempered by the fact that in a far larger trial, these
potential CBCT benefits were not replicated. As will be elaborated here, it is possible that these negative
results reveal important nuances in how CBCT affects the brain and body.

Conundrums, Unanswered Questions, and Future Research

In short, research reviewed here suggests that CBCT has the capacity to buffer practitioners against
heightened pro-inflammatory and prolonged cortisol responses to psychosocial stress, and it may reduce
resting-state levels of peripheral inflammation in high-risk adolescents with evidence of chronically
heightened innate immune activity, perhaps secondary to the now-well-established capacity of early-life
adversity to program inflammatory pathways to be “hot” across the lifespan. Furthermore, CBCT impacts
neural activity in response to empathy stimuli, enhancing activity in the amygdala, inferior frontal gyrus, and
dmPFC, while improving empathic accuracy. An obvious next step is to examine whether these apparent
effects in the body and brain are related. That is, are changes in immune function and stress physiology related
to central nervous system changes, and if so, how? Related, it will be important to examine whether changes
in compassion mediate alterations in immune function and stress physiology. This review also highlights
several challenges for future research on CBCT, which will be elaborated later in this chapter.

Negative Findings
The most obvious puzzle—the negative findings from our larger study with adults—is also the most critical.
Too often in meditation research, negative findings are not pursued, and while to our knowledge no formal
statistical analyses on publication bias have been conducted, recent meta-analyses suggest that bias is a
problem in the study of meditation (Goyal et al., 2014). Researchers in the field of contemplative research,
who are often personally committed to the practice of meditation, should be especially mindful to guard
against the “file drawer” effect, in which negative findings are not published (and instead relegated to a filing
cabinet), thus falsely inflating the appearance of an effect. In the case of CBCT, we suspect that the mixed
findings may indicate a more nuanced and theoretically interesting state of affairs (future questions
summarized in Box 19.1). At the simplest level, it is important to remember that just because a contemplative
practice can do something, it doesn’t mean that it will do so in any given population, and this may be true for
any of a number of reasons.

Youth and Plasticity

Remarkably, the most consistent positive findings in CBCT research come from studies of adolescents,
college-aged and younger. The mean ages for the positive effects on the immune system are 18.5 (Pace et al.,
2009b) and 14.7 (Pace et al., 2013), whereas the mean age for the more recent study that does not find effects
of CBCT on inflammation is 33.9. Given repeated observations that early-life depression predicts the
subsequent development of many modern diseases in which inflammation is known to play a role (Raison et
al., 2010), CBCT’s effectiveness for adolescent populations may be particularly important. If age really does
moderate the efficacy of CBCT, what explains it? It may be that heightened neuroplasticity renders CBCT
especially potent during this time. Related, one or more of the putative active ingredients of CBCT may be
more malleable during late adolescence and early adulthood. Younger adults also have more reactive ANSs.

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Given our findings of an association between reductions in ANS responses to stress and subsequent reductions
in inflammatory cytokines, it may be that an important mechanism of action for CBCT is more available to
younger individuals. Or, perhaps CBCT resonates better with a younger population. If this is the case, we
might expect practice time and attendance to be relatively higher in younger populations. Similarly,
comparing self-reported post-CBCT efficacy ratings across future studies would be fruitful, to test the
hypothesis that CBCT better resonates with younger practitioners.

Box 19.1 Future Questions Related to CBCT (Cognitively-Based Compassion Training)

Future Questions
1. Which of the putative active ingredients do the “work” of CBCT?

2. Do changes in compassion mediate CBCT-related alterations in immune function and stress physiology?

3. How do baseline personality and physiology influence CBCT training?

4. Is the oxytocin system augmented by CBCT training?

5. Is CBCT more impactful for certain-aged practitioners?

Moderators of Cognitively Based Compassion Training’s Impact

There is, as yet, not enough consistent research on CBCT to conduct the aforementioned fine-grained
meta-analyses, but the notion that CBCT may resonate more with specific populations points to a broader
question that will be crucial for the field of compassion science and for research on CBCT more specifically.
That is, a critical factor for understanding the effects of compassion training and meditation more broadly,
and one that is under-examined, is the likelihood that underlying personality and biological profiles shape the
way a novice embarks on a contemplative compassion practice such as CBCT, and in turn, moderate the
biological outcomes of practice. Here again, the research on CBCT is mixed. While one study found no
association between responses to a TSST administered prior to CBCT training and the subject’s subsequent
amount of meditation practice (Pace et al., 2010b), two other studies now suggest that baseline levels of
compassion and empathy-related brain activity are positively correlated with practice time (Mascaro et al.,
2016; Mascaro et al., 2013b). The critical implication of these findings, and one that will be particularly
important for CBCT training in clinical populations, is that CBCT may be most difficult, or least resonant,
for those who may benefit from it the most. An associated question is whether practitioners’ religiosity or
spiritual beliefs impact their engagement with CBCT, which may be particularly important given CBCT’s
Buddhist origins and lack of secularized, clinical influence relative to other compassion programs.
Related is the idea that practitioner goals impact meditation outcomes, and research on mindfulness has
benefited from the attention paid to the intentions of the practitioner (Shapiro et al., 2006). For example, one
study has shown that Vipassana practitioners’ goals influenced the outcome of their practice (Shapiro, 1992).
Of note, our own research with CBCT is not consistent with the findings from Vipassana and mindfulness
(Mascaro, 2011), as the effects of CBCT on brain function were not moderated by practitioner goals, and it
may be that practitioner intentions and goals are more influential for particular contemplative practices.

Practice Time

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 Another question for CBCT that is highlighted here is the importance of practice: Is it enough to hear the
didactic teachings on CBCT content during class, or is it necessary to spend time “on the cushion?” While
some studies reviewed here indicate that the biological effects of CBCT are related to practice time
(Desbordes et al., 2012; Pace et al., 2013; Pace et al., 2009b), other studies did not find a relationship between
outcomes and practice time (Mascaro et al., 2012). These seemingly discrepant findings may indicate that
practice time more directly mediates particular outcomes or is more important for particular populations. The
question of the underlying mechanisms by which a contemplative practice confers its effects is resonating
within the field of contemplative science more broadly, and recent study designs have begun to empirically
examine the importance of practice time versus didactic class time (e.g., Jha et al., 2015) and can serve as a
model for future investigations of CBCT.

A Word About Oxytocin

Given the rapidly burgeoning literature suggesting that the oxytocin (OT) system plays an important role in
empathy, we predict that the effects of CBCT are mediated—to at least some degree—by alterations in this
system. This intuition is bolstered by oxytocin’s role as a widely acting neuromodulator (Carter, 2014), which
might provide a parsimonious explanation for the multitude of effects of CBCT on stress physiology, immune
function, and social cognition. Multiple studies indicate that empathic accuracy performance on the RMET is
influenced by the OT system, either by administration of OT (Domes et al., 2007; Guastella et al., 2010) or
by polymorphisms in the OT receptor (Rodrigues et al., 2009). In addition, OT administration impacts
responses to psychosocial stress (TSST) in ways similar to changes observed with CBCT (Pace et al., 2009b).
Interestingly, the fact that another study shows that OT administration has no effect on neural responses to
an “empathy for pain” task (Singer et al., 2008) in a way similar to the lack of efficacy for CBCT in the same
empathy task suggests that OT may play an important role in both the effects—and lack of effects—that we
have observed for CBCT.
Alterations to the OT system could include increased circulating levels of the neuropeptide, an increased
density of receptors, or both; however, to date, there is no evidence that CBCT, or any contemplative practice
to our knowledge, alters the OT system. This probably reflects methodological difficulties, as central nervous
system (CNS) levels of OT are notoriously difficult to assay, and plasma measures may not accurately reflect
OT levels affecting the brain and behavior (Kagerbauer et al., 2013). Early trials are underway in the attempt
to development a positron emission tomography (PET) radioligand for OT (Baribeau & Anagnostou, 2015;
Smith et al., 2013), and if these innovations are suitable for human use, it would revolutionize research on
oxytocin and allow contemplative researchers to more directly test currently elusive hypotheses.

Conclusion
Research on CBCT is in its infancy, but it is impelled by both the promise and the puzzles apparent in the
early findings. This review indicates that CBCT alters immune function and stress physiology, as well as the
neurobiology supporting empathy and social connectedness. As the field of compassion science advances, so,
too, will the rigorous mechanistic testing of specific practices such as CBCT, especially for clinical populations
typified by empathy impairment. Future work will bridge these mechanistic examinations with behavioral and
psychological assessments to best understand how CBCT affects the well-being of practitioners.

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 PART 5

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Social Psychological and Sociological Approaches

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 Compassion Collapse Why We Are Numb to Numbers

C. Daryl Cameron

Abstract

In the current chapter, I will discuss a phenomenon known as “compassion collapse”: people tend to feel
and act less compassionately for multiple suffering victims than for a single suffering victim. This
phenomenon contradicts many people’s expectations about how they would and should respond to
situations in which the most victims are suffering, as in natural disasters and genocides. Precisely when it
seems to be needed the most, compassion is felt the least. In the chapter, I describe studies documenting
the effect, and compare two explanations of why compassion collapse occurs: one that focuses on basic
capacity limitations on compassion, and another that focuses on motivational factors that lead people to
strategically avoid compassion. I close by discussing open questions and future directions for study on
this phenomenon.

Key Words: compassion, altruism, empathy, motivation, emotion regulation, prosocial

In the summer of 2015, two news stories powerfully gripped public awareness. People learned about the
death of Cecil the Lion, a popular African lion that was lured out if its preserve and killed by an American
hunter. Public outrage spread quickly, inspiring calls for justice and greater attention to animal rights. Yet
thousands of animals are killed for sport annually, eliciting a weak response in contrast. Later in the summer,
the world saw a devastating image of a Syrian boy who had drowned trying to escape persecution in his home
country. The image was shocking and elicited strong outcries of support and compassion from around the
world. Yet the thousands of Syrian refugees who are suffering or who have been killed fail to elicit the same
kind of strong sympathetic response. When faced with a single identifiable victim, compassion seems quite
potent; when faced with a collective, compassion seems to wane.
This example illustrates a phenomenon known as compassion collapse: as the number of victims in a crisis
increases, compassionate emotion and behavior decreases. This effect is surprising for two reasons. First, it
contradicts our expectations about how we would respond in such situations: namely, that compassion would
increase in a linear fashion with numbers. Second, for many of us it contradicts our expectations about how we
should respond, given the irreducible value of each human life. In this chapter, I will describe studies
documenting the effect, and compare two competing explanations of why this effect occurs: one that focuses
on basic capacity limitations on compassion, and another that focuses on motivational factors that lead people
to strategically avoid compassion. I will close by discussing open questions and future directions for study on
this phenomenon.
In this chapter, I use the definition of compassion provided by Goetz and colleagues (2010): “the feeling
that arises in witnessing another’s suffering that motivates a desire to help.” Compassion is distinct from

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experience-sharing, a facet of empathy that involves feeling the same internal states as others, and from
perspective-taking, a facet of empathy that involves actively attempting to understand the thoughts and
feelings of others (Decety & Cowell, 2014). As a discrete emotion, I define compassion as a mental state built
from core affect—i.e., how good/bad and excited/calm you are currently feeling in relation to your
environment (Russell, 2003)—and conceptual knowledge about compassion accrued through life experiences
and cultural norms (see Birgit-Koopman and Tsai, Chapter 21, this volume). As such, compassion is not
identical to positive affect, a point I will return to later. Finally, compassion as an emotion is separate from
“compassionate behavior” such as donation. Given that behaviors can be multiply determined by different
emotions, motivations, and affective states (see Batson, Chapter 3, this volume), and the variable relationships
between specific emotions and specific behaviors (Cameron, Lindquist, & Gray, 2015), it is important to
separate emotion and behavior effects.

What Is Compassion Collapse?

Compassion is an emotion of care: it is elicited by the perception of harm to others, and it motivates actions
to reduce suffering. When more harm and suffering is present, as when more victims are involved, it seems
reasonable to expect that compassion will increase. A single identifiable victim, such as a crying child, can pull
our heartstrings quite well—so if there are four such children, then surely I will feel more compassion proportional to
those in need. This pattern is what people predict when asked to forecast how they would respond to a crisis
(Dunn & Ashton-James, 2008), and it is what people endorse as the normatively appropriate way to respond
(Dickert et al., 2015). Yet many studies have revealed precisely the opposite pattern: that as the number of
victims in a crisis increases, compassionate emotion and behavior decreases. Compassion appears to break
down exactly when it is needed the most.
In one of the early demonstrations of this effect, Kogut and Ritov (2005) presented participants with either
one or eight children in need of medical aid, and varied the amount of identifying information provided about
the children. They found that willingness to contribute money was lower for groups than for individuals, and
in follow-up studies, they found that this effect was mediated by reduced self-reports of distress for the group
of children. In these studies, ratings of distress were lower for groups than individuals, but ratings of
compassion did not differ and were uncorrelated with willingness to donate. This effect also occurs when
comparing one victim with “statistical victims” (e.g., thousands of victims described without identifying
information such as names; Friedrich & McGuire, 2010; Small, Loewenstein, & Slovic, 2007).
This effect is not limited to the laboratory, but also occurs for compassionate behavior in the real world. A
study by Galak, Small, and Stephen (2011) examined donation behavior on the microlending site Kiva.org, on
which people can request loans for various needs. Galak and colleagues (2011) compared the amount of
donation, and time to fulfill microlending requests, for profiles with images depicting individuals (vs. groups).
Consistent with compassion collapse findings in laboratory settings, donations were lower for group profiles
than for individual profiles, and it took longer to fulfill group requests than it did to fulfill individual requests.
In another applied example, Slovic and colleagues (2017) found that after publication of the iconic
photograph of a drowned Syrian boy, Aylan Kurdi, there was a short-term increase in Google searches about
the Syrian refugee crisis, and in donations to the Red Cross.
This effect is not limited to humanitarian crises, but also extends to perceptions of other groups such as

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corporations. Recent work finds that people are less likely to feel sympathy for corporations than for
individuals, because people are less likely to assign corporations experiential mental states such as pain and
emotion (Rai & Diermeier, 2015). The effect also extends to perceptions of harm. Research on the “scope-
severity paradox” finds that when an action harms more people (compared to fewer people)—for instance,
when a tainted food is not recalled and makes 20 (vs. two) people sick—it is perceived as less harmful, and the
transgressor is assigned less punishment (Nordgren & McDonnell, 2011).
Importantly, compassion collapse is distinct from “the identifiable victim effect.” Prior work finds that
identifying information for a victim—such as picture, name, and age—increases empathy and compassion
(e.g., Genevsky et al., 2013; Small & Loewenstein, 2003). Comparisons between single and statistical victims
confound number of victims with the presence of identifying information. Thus, more recent studies of
compassion collapse attempt to remove this confound by comparing one identified victim against multiple
identified victims, and find that increased number of victims causes compassion collapse (Cameron & Payne,
2011; Dickert, Kleber, Peters, & Slovic, 2011; Dickert & Slovic, 2009; Dickert, Sagara, & Slovic, 2011;
Markowitz, Slovic, Västfjäll, & Hodges, 2013; Rubaltelli & Agnoli, 2012; Smith, Faro, & Burson, 2013).

Why Does Compassion Collapse Occur?

The robustness and social importance of compassion collapse have led many to develop explanations for
why the effect emerges. Compassion for all of humanity is one of the central tenets of Buddhist thought, but
the foregoing results suggest that achieving such “global compassion” may be difficult, and may even be
impossible (see Ekman & Ekman, Chapter 4). Knowing whether compassion collapse is a basic glitch in
compassionate experience—or instead, due to a motivated choice to avoid compassion—is critically important
for understanding human potential to solve large-scale global problems.
According to one prominent account, compassion collapse occurs because compassion is like a fossil fuel: a
limited-capacity resource that cannot be extended indefinitely (Slovic, 2007). According to an alternative
account, what appears to be a capacity limit on compassion may actually be the result of a motivated strategy
to avoid costs of compassion (Cameron & Payne, 2011). Next, I summarize each approach, before concluding
that a motivational approach is ultimately more supported by the evidence and in keeping with the broader
body of work within compassion science.

The Capacity Explanation

According to one prominent explanation of compassion collapse, compassion is innumerate because of basic
limitations on the emotion itself (Slovic, 2007). As put by Västfjäll et al. (2014), “Our capacity to feel
sympathy for people in need appears limited, and this form of compassion fatigue can lead to apathy and
inaction.” This view is captured by other writers who have discussed the limits of empathy, such as Bloom
(2013): “Yet it is impossible to empathize with seven billion strangers, or to feel toward someone you’ve never
met the degree of concern you feel for a child, a friend, or a lover. Our best hope for the future is not to get
people to think of all humanity as family—that’s impossible.”
This capacity limit is thought to result from two factors: imagery and attention. In comparison to
collectives, individual victims are cognitively represented with greater vividness and coherence, which then
elicits stronger emotional reactions (Hamilton & Sherman, 1996). With multiple victims, on the other hand,

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where a person’s finite capacity for attention and imagery must be spread thinly across everyone, their mental
representation of the victims would be blurry and fragmented and, in turn, arouse less compassion. Support
for this perspective comes from recent work finding that construing multiple victims as a single entity can
reverse compassion collapse (Smith, Faro, & Burson, 2013). Smith and colleagues (2013) had participants
read about either one victim, six unconnected victims, or six victims who were part of the same family—thus
leading them to be perceived as a single entity. Six unconnected victims were rated as less positive and
received less donation compared to the one victim, but there was no such difference for six connected victims.
The second factor is attention: the presence of multiple victims may divide attention from any single victim,
attenuating the emotional response for any single victim (Dickert & Slovic, 2009). In one study, Dickert and
Slovic (2009) had participants make sympathy judgments over repeated trials about a child target who was
either presented alone, or while flanked with seven other children. Sympathy was reduced on multiple-victim
trials compared to single-victim trials, suggesting that attention may be a second mechanism generating a
capacity limit on compassion.
These limits on imagery and attention are thought to be fixed constraints on how much compassion people
can feel. Small, Loewenstein, and Slovic (2007) had participants read about either single victims or statistical
victims, and they also manipulated participants to be in either a deliberative or an affective mindset. Rather
than bolstering donations for large numbers of victims, deliberation reduced donation for single victims. Such
effects have led proponents of the capacity account to claim that individuals cannot do much to combat this
bias: rather, handling large-scale global problems will require coordinated institutional efforts rather than
individuals’ moral emotions (Slovic, 2007; Bloom, 2013). As put by some prominent researchers on this topic,
this “arithmetic of compassion” is a fixed capacity limit, such that we are “psychologically wired to help only
one person at a time” (Slovic & Slovic, 2015).

The Motivational Explanation

Another possibility is that the collapse of compassion is the result of a motivated choice to avoid
compassion due to anticipated costs (Cameron, Inzlicht, & Cunningham, 2015; Cameron & Rapier, 2017).
As mentioned earlier, people anticipate feeling more empathy and compassion as the number of victims
increases. This affective forecast may create concerns about the costs of compassion. Some costs may involve
material expense: people might expect that helping multiple victims will be more expensive, or be a less
efficacious expenditure (i.e., “a drop in the bucket”). Costs may also be psychological, as people might be
concerned that compassion for mass suffering will be emotionally exhausting and overwhelming (Cameron,
Harris, & Payne, 2016). There may also be aversion to the particular victims involved, if they are from
stigmatized groups. Of course, there may also be psychological benefits to compassion in these situations, such
as upholding one’s moral self-image, attaining a warm glow from helping or aspiring to help, and building
social capital and managing one’s reputation in the eyes of others. From a motivational perspective (see also
Gilbert & Mascaro, Chapter 29; Weisz & Zaki, Chapter 16), whether people choose to feel compassion or
not will depend on how they balance these competing goals within compassion-evoking situations. Past work
on empathy avoidance (Dovidio et al., 1991; Hodges & Biswas-Diener, 2007; Shaw et al., 1994) and
instrumental emotion regulation (Tamir, Mitchell, & Gross, 2008; Tamir, 2009) finds that people regulate
their emotions strategically, based on how useful these emotions seem like they will be for goal pursuit.

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Compassion collapse may change, depending on what people want to feel.
In previous work, I have tested this motivated emotion-regulation account of compassion collapse.
According to this motivational account, compassion collapse should only emerge under predictable conditions:
only when people are motivated to avoid compassion for multiple victims, and only when they engage in
emotion-regulation processes to reduce compassion for multiple victims. Testing this hypothesis requires
experimentally manipulating both factors, to see if doing so changes compassionate outcomes. According to
the capacity explanation of compassion collapse, manipulating motivation and emotion regulation should not
influence compassion collapse. Importantly, most studies of compassion collapse do not manipulate
motivational variables, preventing disconfirmation of the capacity-limit account (for more on the need for
disconfirmatory testing in compassion science, see Batson, Chapter 3, this volume).
In one study, we manipulated whether people expected compassion to have a financial cost. In a pre-test,
we established that people expected helping eight child refugees from the Darfur region of Sudan would be
more financially costly than helping a single child refugee. Because most studies of compassion collapse
explicitly request a financial donation, it may be that this leads people to strategically avoid compassion
because of the anticipated higher cost. It could be that this aversion to higher cost is about stinginess (i.e.,
protecting personal resources) or about simply not having enough to make a difference. We had people read
about either one or eight child refugees in Darfur, and gave half of participants the expectation that they
would be asked to make a financial donation later on in the experiment. When people expected to be asked to
donate, there was a non-significant trend of more compassion for one than for eight victims; but when this
expectation was not imposed, the pattern reversed, with more compassion for eight victims than for one
victim. Put another way, removing the prosocial expectation and self-efficacy challenges altogether made
participants less concerned about being concerned.
In follow-up studies, we held motivation constant and focused on emotion regulation. Even if people want
to avoid compassion for multiple victims, they should only be able to implement this strategy if they can
skillfully regulate their emotions. In a second experiment, participants read about one, four, or eight victims,
and rated how much distress they felt over the course of one minute. We also assessed emotion-regulation
ability using the Difficulties in Emotion Regulation Scale (Gratz & Roemer, 2004), a self-report measure in
which people assess how well they can control their emotions. Results revealed that distress was reduced for
higher numbers of victims, but only among participants who could skillfully regulate their emotions,
suggesting that emotion regulation is necessary for the effect.
In a third experiment, we built on the previous study by experimentally manipulating cognitive reappraisal.
Participants read about either one or eight child refugees as previously, and were told either to experience their
emotions without trying to control them, or to engage in reappraisal by thinking about the situation in such a
way that it would reduce their emotions. Replicating the findings for emotion-regulation ability, compassion
collapse only emerged when people were instructed to regulate their emotions. When people were told to
experience their emotions without trying to control them, this regulatory process was inhibited, and
compassion collapse did not emerge. Supporting a motivated emotion-regulation account, compassion
collapse only emerged when people were motivated and able to regulate their emotions.
Other work supports a motivational account of compassion collapse—even work that has been framed as
supporting a capacity explanation. For instance, Markowitz and colleagues (2013) find that compassion

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collapse between one and many endangered animals only occurs for people who do not self-identify as
environmentalists. The authors explain this effect as a result of environmentalists’ having greater knowledge
about environmental issues. Another explanation is motivational: when environmentalists consider the
suffering of many animals, they feel a need to uphold their moral principles by feeling more compassion,
despite emotional or material costs. Similarly, recent evidence (Kogut, Slovic, & Västfjäll, 2015) finds that
compassion collapse varies with collectivist beliefs: whereas compassion collapse emerges in individualistic
countries and among participants with stronger individualistic beliefs, the effect does not emerge in collectivist
countries and among participants with stronger collectivist beliefs. Although this effect could be due to
differences in how individualists and collectivists cognitively represent individuals vs. groups, this moderation
pattern may also represent different moral values motivating collectivists to care more about the suffering of
groups relative to individuals.
Another example comes from the study described earlier: describing a collective of victims as a unified
group removes compassion collapse (Smith et al., 2013). Although this could be due to changes in cognitive
representation, it could also be due to changes in perceived costs of compassion. Helping a disconnected set of
individuals may seem to cost more than helping members of a cohesive group, who may be able to rely on
each for support. Finally, a third example comes from research on attachment: people who display an anxious
attachment style—being chronically nervous about social interactions—are more likely to show compassion
for identified than for non-identified single victims (Kogut & Kogut, 2013). From a motivational perspective,
people who are anxiously attached may be more sensitive to emotional costs of helping an unidentified, and
thus uncertain, target—or the peril of being seen as ineffective, having been in a position to help—which
could explain diminished compassion.
More work needs to be done to test the competing hypotheses of the capacity and motivation accounts of
compassion collapse. First, it is worth testing where the boundaries of motivated choice might reside. In the
foregoing studies, the contrast was between a single victim and a handful of victims, in keeping with original
studies of the effect (Kogut & Ritov, 2005) and to ensure that the presence of identifiable information was not
confounded with number of victims. Would motivational factors shape whether people feel more compassion
for one victim than for 1,000 victims, or 10,000 victims? This question remains untested. Second, it is worth
testing other motivations that might accentuate compassion collapse. Perhaps the most immediate motivation
worth testing is emotional cost: thinking about the suffering of more victims may create concerns about
emotional exhaustion and burnout. Independent of financial cost, the emotional cost of mass suffering may
take a toll. Removing expected emotional costs may reverse compassion collapse.
Future research should examine the representational assumptions inherent in the capacity explanation of
compassion collapse. Do people actually feel like the details of multiple victims are “fuzzier” and more
superficial than the details of single victims? If given sufficient opportunity and time to sequentially read about
multiple victims of a shooting, for instance, people may be able to encode each victim’s suffering with the
same detail. Multiple victims may require switching of attention between each victim, but it may be that by
encoding the suffering of a group of victims in terms of particular individuals, any representational deficits
might be removed.
What should we take away from these results, in what they imply for global compassion and the potential
for compassion to assist in large-scale global problems such as natural disasters, climate change, and war? One

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take-home message is that change is possible: unlike the claims of capacity accounts, the motivational account
suggests that people can choose to feel more compassion for mass suffering. Although on one hand it might be
seen as disheartening that people often choose to avoid compassion in these instances, on the other hand it
can be read as positive that people can change if their motivations change. If individuals can expand the scope
of their compassion, then institutional change may not be the only answer. It’s not that you can’t feel
compassion for mass suffering: it may be that you just don’t want to.
Of course, it may be that both motivation and capacity can play a role in compassion collapse. In order to
recognize mass suffering, one must attend to the situation, and there may be limits on how much information
can reside in our conscious attention or be held in working memory at any given moment, and on how much
information can be remembered about a suffering event. However, there are strategies that people can use to
increase the scope of what they attend to and are conscious of, such as by “chunking” information into more
easily processed units. Although it may be incredibly difficult to cognitively represent the individual suffering
of 10,000 distinct victims, the weight of 10,000 victims as generalized from the suffering of five or six victims
may be attainable, depending on motivations to deploy this cognitive maneuver. Indeed, research on
compassion and bias suggests that inducing compassion for a single victim can generalize to positive attitudes
toward the group that victim belongs to (Batson et al., 1997), suggesting that such transition of compassion
from single individuals to groups may be feasible, depending on how people are motivated to process
information.

Open Questions and Future Directions

Thus far, I have summarized evidence suggesting that, in at least some cases, compassion collapse may be
explained by motivational factors, rather than basic capacity limitations on how much compassion people are
able to feel. Next, I discuss three open questions: (1) What is the causal locus and mechanism of compassion
collapse? (2) What are the contextual boundaries of compassion collapse? (3) What motivational interventions
can counteract compassion collapse?

What Is the Causal Locus and Mechanism of Compassion Collapse?

First, there are open questions about which affective and emotional experiences are involved in compassion
collapse. Is the effect about compassion, distress, or affect in general? Is it stronger for emotion or for
behavior? Some studies find the effect on empathic distress (Kogut & Ritov, 2005; Cameron & Payne, 2011),
whereas others find the effect on compassion (Dickert & Slovic, 2009) or donation (Galak et al., 2011). More
recently, studies have suggested that “compassion fade” involves decreases in positive affect (Genevsky et al.,
2013; Västfjäll et al., 2014). Although all of these states are likely to be involved in compassionate contexts,
these are distinct responses that should not be treated interchangeably.
Consider the distinction between compassion and positive affect. Recently, Västfjäll and colleagues (2014)
found that self-report and physiological measures of positive affect decreased with increasing numbers of
victims, and labeled this effect “compassion fade.” This finding builds on earlier work showing that identified
(vs. non-identified) single victims elicit stronger amounts of positive arousal, which predicts greater donation
(Genevsky et al., 2013). Yet affect is not identical to emotion: discrete emotions such as compassion involve
not just affect, but also conceptual knowledge that is used to make sense of affect as a discrete experience

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(Cameron et al., 2015). Moreover, it is debatable whether compassion involves positive affect: although
people’s abstract prototypes of compassion appear to be positive, experimentally induced compassion is
sometimes experienced as negative (Condon & Barrett, 2013).
Clarifying this issue also requires distinguishing anticipated from experienced emotions. According to
Vastfjall et al. (2014), the motivational account of compassion collapse claims that: “as the number of lives in
need of help increases, people experience negative affect and attempt to regulate these negative feelings by
turning their attention away from the problem.” This description of the motivational explanation is incorrect.
The claim is not about experienced emotions in helping situations. Rather, it is about anticipated emotions.
In mass suffering contexts, people predict that they will feel more emotion, and it this anticipated emotion—
rather than experienced emotion—that triggers defensive emotion regulation. Of course, more work is needed
to specify which emotional states are being forecast. It is likely that many people do not finely differentiate
compassion from distress or other affective states when forecasting how they will feel in empathic situations.
Supporting this claim, Shaw and colleagues (1994) found that people did not differentiate between
compassion, distress, and sadness when forecasting emotional responses to helping.
Future work should expand on this point to examine how shifting affective forecasts in helping situations
changes empathy avoidance. For instance, would encouraging people to make emotionally specific forecasts of
compassion, vs. distress, lead to changes in empathy avoidance and compassion collapse? If compassion is
perceived as positive and uplifting, whereas distress is perceived as negative and exhausting, this might change
how people choose to regulate their emotions (Klimecki, Leiberg, Ricard, & Singer, 2013). Related to this,
anticipating empathic joy in response to the relief of suffering tied to compassion-motivated caregiving
behavior might sustain a compassionate approach.
In addition to clarifying the role of anticipated vs. experienced emotions, future work should examine
emotion-regulatory mechanisms that mediate the compassion collapse effect. Prior work found that
compassion collapse varies as a function of emotion-regulation skill and a cognitive reappraisal manipulation
(Cameron & Payne, 2011). To build on this work, studies should measure spontaneous engagement in
emotion-regulation strategies, such as attentional distraction and situation selection. For instance, studies
could use eye-tracking to examine where people fix their gaze when confronted with single or multiple
victims. Participants engaging in motivated emotion regulation may be more likely to proactively avert their
gaze, to forestall compassion. Similarly, studies could present participants with a choice between learning
about one victim or multiple victims. To the degree that compassion for multiple victims is expected to be
costly, participants should be less likely to enter into or approach situations in which multiple victims will be
presented. Indeed, this last strategy is perhaps most analogous to what occurs in everyday life, when people
can easily choose to toss a UNICEF envelope in the trash or change the channel from a humanitarian aid
commercial. In recent work, our lab finds that people exhibit a strong preference to avoid empathy in free
choice measures, and that this is associated with perceptions of empathy as costly and inefficacious (Cameron,
Hutcherson, Ferguson, Scheffer, & Inzlicht, 2016; future work could readily adapt this paradigm to examine
compassion collapse).
Finally, additional work should specify distinct targets of emotion regulation, and in particular, anticipatory
vs. experienced emotions. When people anticipate high cost or threat, they may down-regulate experienced
compassion for multiple victims, creating compassion collapse. By contrast, people could down-regulate the

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anticipatory emotions felt when forecasting multiple victims, and doing so may facilitate the experience of
compassion for multiple victims, eliminating compassion collapse.

What Are the Contextual Boundaries of Compassion Collapse?

There are open questions about how compassion collapse varies across different contexts and populations.
Typically, studies focus on events such as natural disasters and genocides, with less attention paid to relevant
differences between these contexts. Some contexts involve sudden departures from the status quo, such as
hurricanes and tsunamis, whereas others involve chronic suffering, such as genocides and war. Some evidence
finds that, for identified victims, compassion is stronger for sudden than for chronic events; this pattern
reverses for statistical victims (Small, 2010). Future work should experimentally cross numbers of victims with
types of disaster event (natural disaster, genocide) to see if the effect amplifies or weakens depending on
context. Research on dyadic morality (Gray, Young, & Waytz, 2012) suggests that it is easier to feel the plight
of victims when salient agents are involved—from this account, it might be expected that feeling compassion
for large numbers in genocides may be easier because moral villains are salient.
Similarly, studies should examine how inter-group factors shape compassion collapse. Much prior work
finds that empathy and compassion are reduced for out-groups (Cikara, Bruneau, & Saxe, 2011). Most
research on compassion collapse involves out-group victims and does not explicitly manipulate group
similarity. A limited amount of work has examined how intergroup considerations shape compassion collapse.
Kogut and Ritov (2007) found that people contributed more money to help a single in-group patient than
multiple in-group victims, with no differences in donation for one vs. many out-group victims. More recent
work provides conflicting evidence (Ritov & Kogut, 2011): under conditions of inter-group threat, identified
out-group targets elicit more sympathy and donation than unidentified out-group targets. These papers
explained their findings as being due to how in-group and out-group targets are cognitively represented as a
function of social distance.
However, another possibility is that motivational considerations can shape inter-group compassion. A
meta-analysis of racial biases in helping behavior indicates that such biases are most evident when there is a
race-neutral justification available for not providing help, such as high personal cost or low efficacy of helping
(Saucier, Miller, & Doucet, 2005). Mass suffering contexts may provide such opportunities for rationalization
—people anticipate that helping multiple victims will be more financially costly (Cameron & Payne, 2011),
and less efficacious (Västfjäll et al., 2015). Moreover, race-related motivations, such as motivation to control
prejudice and aversive racism, may accentuate the perceived costs of helping multiple victims. According to
this prediction, compassion collapse should be stronger for out-group victims than for in-group victims,
because the costs of compassion are highest for multiple out-group victims.

What Motivational Interventions Can Counteract Compassion Collapse?

A third important area of research involves motivational interventions to counteract compassion collapse.
The motivated emotion-regulation perspective makes the unique prediction that such interventions will be
able to either undermine or reverse compassion collapse, by reducing avoidance motives and increasing
approach motives (see Weisz & Zaki, Chapter 16 in this volume).
One approach is to target generalized motivations to approach, rather than avoid compassion. A growing

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body of work in psychology and neuroscience has drawn upon mindfulness meditation practices (see Condon
and DeSteno, Chapter 22, this volume). Recent evidence suggests that eight-week interventions in
mindfulness meditation and compassion meditation can increase costly prosocial behaviors such as bystander
intervention (Condon et al., 2013), whereas other studies find that short-term compassion interventions can
increase prosocial behavior (Klimecki et al., 2013; Weng et al., 2013).
Although more work needs to be done to uncover mechanisms of these effects, such interventions may
discourage compassion collapse. It is likely that the relationship between meditation practice and compassion
collapse will depend on the type of meditation in question. Mindfulness meditation encourages paying
attention to the present moment, as well as the acceptance of negative experiences (Bishop et al., 2004). Such
practice may lead people to become more aware of anticipated emotions in mass suffering contexts and to be
less afraid of the consequences of compassion. On the other hand, compassion-focused meditation encourages
up-regulation of compassion. Such explicit generation of compassion may then be usefully extended outward
from the self to single victims and to all of humanity (Klimecki et al., 2014). Both approaches should enable
people to increase compassion for mass suffering, and whether one or the other strategy is best for reversing
compassion collapse may depend on an individual’s emotional dispositions and salient motivations.
By contrast to these long-term interventions, other approaches could use short-term motivation
manipulations to counteract compassion collapse. One approach would to be activate moral goals or the moral
self-concept prior to presentations of mass suffering. Activating the goal to be a moral person may override
competing goals to avoid financial or material cost, and make people think twice about down-regulating
compassion. A related approach would be to change perceived social norms about compassion (Tarrant et al.,
2009). If people are led to believe that an in-group they identify with values compassion, then presenting a
situation in which more compassion is optimal may lead people to exert more effort to feel compassion (for
related discussion, see Weisz & Zaki, Chapter 16, this volume). A third approach would be to increase
people’s perceptions of effectiveness and impact—if people are led to believe that helping will make a
difference and not be a drop in the bucket, they may exert greater effort to feel and act compassionately
toward multiple victims.
Another approach would be to examine ideological factors that might matter for compassion collapse.
People who are high in socioeconomic status (SES) tend to feel less compassion for others compared to those
low in socioeconomic status, possibly because they have less need to rely on others for survival (for discussion,
see Piff and Moskowitz, Chapter 24, this volume). To date, no studies have examined SES in the context of
compassion collapse, but competing predictions could be derived. On one hand, people high in SES might
perceive compassion for others as threatening because it risks over-dependence from others. So if there are
more victims suffering in a crisis, where risks of entanglement are greatest, then compassion should be
correspondingly lower. By contrast, people low in SES should be more attuned to the suffering of more
individuals because they place a greater value on helping others. Yet the reverse hypothesis may also hold.
Given that people low in SES are generally more compassionate, they may be most at risk for emotional costs
of compassion—i.e., of being emotionally exhausted and overwhelmed by the suffering of large numbers—and
so may be more likely to show compassion collapse. By contrast, people high in SES may not feel as
emotionally threatened, and may actually value the opportunity to engage in utilitarian behaviors that benefit a
larger collective (Côté, Piff, & Willer, 2013). More work should examine how this ideological factor, along

349
with others, can either amplify or diminish compassion collapse. In addition, certain organizational contexts—
such as business and medicine—may present consuming daily activities, obligations, and norms that
structurally stifle compassion for others.
A final approach is to change people’s lay theories and expectations about compassion. Prior work finds that
people who are dispositionally high in compassion are more likely to enter into compassion-inducing
situations, because they have more positive expectations about what will occur (Davis et al., 1999). Other
work finds that encouraging people to think about empathy as a skill that can be incrementally improved, as
opposed to a fixed personality trait, leads people to exert more effort to feel empathy in challenging situations
(Schumann, Zaki, & Dweck, 2014). A similar manipulation could be applied to counteract compassion
collapse. Would leading people to believe that compassion has a capacity limit, and that it is fundamentally
unresponsive to mass suffering—a message conveyed by many writers (Bloom, 2013; Slovic, 2007)—actually
create a self-fulfilling prophecy, leading people to disengage individual efforts to engage in global compassion?
What about telling them that compassion is a choice, or that compassion is indefatigable and untiring?
Discussion of compassion collapse intersects with the related topic of compassion fatigue and caregiver
burnout in clinical and health contexts. Findings of compassion fatigue suggest that there are emotional costs
of compassion, which arise from engaging in repeated care over a long period of time (e.g., among nurses,
social workers, primary caregivers, and social justice advocates). Although such individuals are likely to be very
motivated to feel compassion based on their chosen career, they still experience distress from repeated care
over time. Compassion fatigue often involves helping a single victim over time, or single victims in sequence,
which seems distinct from single-shot compassion collapse scenarios that contrast compassion for single vs.
multiple victims simultaneously. If compassion collapse scenarios were revised to involve sequential helping of
single victims over time, this would more closely approximate the contexts in which compassion fatigue is
observed. The same motivational logic is likely to play a role: as the material or psychological costs of helping
more and more individual victims accrue, there should be a greater likelihood of defensively regulating
emotions to avoid these costs.
Finally, it is worth asking whether compassion collapse might be adaptive for some people, in some
contexts. Although compassion and prosocial behavior can have a number of positive physical and mental
health benefits, the benefits accrued from helping might be limited to helping a small number of individuals.
There could be a decline in the personal utility of helping as the number of victims increases, and with
corresponding rises in material and psychological costs. Given that it is unlikely that people had the
opportunity to help large numbers of victims over evolutionary time, it stands to reason that personal benefits
of helping may be most readily apparent for helping smaller numbers. With the advent of social media and
other forms of globalized communication, however, people have the opportunity to help collectives of victims
in ways that transcend biological inheritance, and it remains to be seen whether distinct functional benefits
might result from helping collectives. For instance, if people anticipate empathic joy from helping a single
victim, but then multiply that anticipated joy when helping a collective, this may amplify the emotional
rewards of helping and reinforce future pro-social behavior. Moreover, it may be that the abstraction entailed
by helping larger numbers, vs. the more immersive helping that is usually involved with individual victims and
can produce compassion fatigue, may allow for a more psychologically distanced compassion that is ultimately
more sustainable over the long term.

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Conclusion
Compassion collapse is the tendency to feel more compassion, and act more compassionately, for a single
victim than for a large number of victims. This phenomenon is robust in the laboratory and manifests in
everyday life. It can be seen in public responses to natural disaster, genocide, climate change, and epidemics,
and has a direct impact on how we relate to the biggest problems that the world faces. Some have suggested
that there is nothing we can do about this failure of global compassion: that we simply cannot feel compassion
for large numbers, that compassion has a limited capacity. In this chapter, I have argued that the scope of
compassion is, at least to some extent, under our individual control, depending on what we want to feel. We
can choose to expand or contract our bounds of compassion, once we appraise what the costs and benefits of
compassion are in a given context. If compassion is a choice, then we can motivate change.

351
Acknowledgments
I thank Paul Condon and Emiliana Simon-Thomas for helpful comments on an earlier version of this
chapter, and Eliana Hadjiandreou for assistance with references.

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 The Cultural Shaping of Compassion

Birgit Koopmann-Holm and Jeanne L. Tsai

Abstract

In this chapter, we first review the existing literature on cross-cultural studies on compassion. While
cultural similarities exist, we demonstrate cultural differences in the conception, experience, and
expression of compassion. Then we present our own work on the cultural shaping of compassion by
introducing Affect Valuation Theory (e.g., Tsai, Knutson, & Fung, 2006), our theoretical framework.
We show how the desire to avoid feeling negative partly explains cultural differences in
conceptualizations and expressions of compassion. Specifically, the more people want to avoid feeling
negative, the more they focus on the positive (e.g., comforting memories) than the negative (e.g., the
pain of someone’s death) when responding to others’ suffering, and the more they regard responses as
helpful that focus on the positive (vs. negative). Finally, we discuss implications of our work for
counseling, health care, and public service settings, as well as for interventions that aim to promote
compassion.

Key Words: culture, compassion, sympathy, affect valuation theory, emotion, American, German

In The Descent of Man, and Selection in Relation to Sex, Charles Darwin described the feeling of concern
about another person’s suffering (i.e., compassion), as a basic human instinct that composed the “noblest part
of our nature” (Darwin, 1871, p. 162). While increasing research suggests that experiences of compassion are
associated with greater psychological well-being and prosocial behavior (e.g., Allred, Mallozzi, Matsui, &
Raia, 1997; Condon & DeSteno, 2011; Hofmann, Grossman, & Hinton, 2011; Neff, Hsieh, & Dejitterat,
2005; Neff, Kirkpatrick, & Rude, 2007; Pace et al., 2009), most of this research has focused on Western
samples. As a result, we still know relatively little about the role that culture plays in the conception,
experience, and expression of compassion, which has implications for which aspects of compassion are “basic”
and “instinctual” (Wuthnow, 2012, p. 306). In line with the other chapters in this Handbook, we define
“compassion” as sensitivity to the pain or suffering of another person, coupled with a deep desire to alleviate
that suffering (Goetz, Keltner, & Simon-Thomas, 2010). However, because previous researchers have used
other terms (e.g., “sympathy,” “empathy,” “altruism”) to refer to states and behaviors that overlap with and are
related to compassion, we refer to studies that focus on these states as well. In this chapter, we review the
existing cross-cultural research on compassion and then describe our own work in the area. But first, we
describe what we mean by “culture.”

What Is Culture?
By “culture,” we refer to socially transmitted and historically derived ideas that are instantiated in shared

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practices, products, and institutions (Kroeber & Kluckhohn, 1952). Cultural ideas provide individuals with a
framework for how to be a good person (Shweder, 1991), and by engaging in this framework, individuals
recreate this framework for others (Markus & Kitayama, 2010). This process is called “the mutual constitution
of cultures and selves” (Markus & Kitayama, 2010) or the “culture cycle” (Markus & Conner, 2013). For
example, women’s magazines contain advertisements with models that reflect the beauty ideals of the
advertisers. Readers of these magazines may at least to some degree consciously or unconsciously internalize
these beauty ideals. Consequently, they may try to emulate these ideals by purchasing clothes and other
products that reflect the ideals. Furthermore, readers may consciously or unconsciously use these ideals when
judging the beauty of others.
Culture not only shapes ideals of beauty, but also ideals of emotion (Markus & Kitayama, 2010). The
“cultural construction” approach to emotion (Boiger & Mesquita, 2012) argues that people’s cultural contexts
shape their emotions by providing a framework for interpreting each emotional episode. For example, in a
cultural context like the United States, in which people are encouraged to influence others, excitement,
enthusiasm, and other high-arousal positive states are viewed as desirable, in part because being excited helps
individuals change their environments to be consistent with their desires, beliefs, and preferences (Tsai,
Knutson, & Fung, 2006; Tsai, Miao, Seppala, Fung, & Yeung, 2007). Thus, in many U.S. contexts, people
are encouraged to show and express their excitement and enthusiasm, and people who show these states are
rated more positively (Sims & Tsai, 2015). In contrast, in East Asian contexts, in which people are
encouraged to adjust to others, calm, peacefulness, and other low-arousal positive states are viewed as desirable
in part because being calm helps individuals attend to their environments and ultimately change their own
desires, beliefs, and preferences to be consistent with those of others. Thus, in many East Asian contexts,
people are encouraged to show and express their calm and peacefulness, and people who show these states are
rated more positively (Tsai, Blevins, Bencharit, Chim, Yeung, & Fung, under review). Consequently,
experiences and expressions of excitement may mean something different in East Asian vs. U.S. contexts.
In this chapter, we argue that cultures shape different aspects of compassion (for a discussion of different
factors that might bring about cultural differences in compassion, see Chiao, Chapter 12 this volume). More
specifically, we propose that culture may shape how people conceptualize compassion (i.e., which feelings,
thoughts, and behaviors people view as being compassionate/helpful), experience compassion (i.e., how people
feel when they see others suffering), and express compassion (i.e., what people do when they see others
suffering), as illustrated in Figure 21.1. Here we focus on the specific case in which cultural differences in
views of negative affect shape how individuals conceptualize and express compassion. At the end of the
chapter, we discuss the implications of these cultural differences for cross-cultural counseling, health care, and
public service.

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Figure 21.1 The cultural shaping of compassion through views of negative affect.

What Do We Know About Compassion Across Cultures?

First we will review existing cross-cultural studies of the conception, experience, and expression of
compassion and related states, which demonstrate cultural similarities and differences.

Conception
Across different cultures, people conceive of compassion and other related states (e.g., sympathy, empathy)
as emotional (e.g., Shaver, Murdaya, & Fraley, 2001). At the same time, cultures also appear to differ in what
is construed as being compassionate. For instance, most Western concepts of compassion assume that people
should feel the most compassion for people whom they can identify with (Batson, O’Quin, Fultz, Vanderplas,
& Isen, 1983), whose perspectives they can share (Toi & Batson, 1982), and whom they feel similar to
(Batson, Duncan, Ackerman, Buckley, & Birch, 1981; Batson, Fultz, & Schoenrade, 1987). In contrast,
Buddhist conceptions of compassion assume that everyone and everything is interconnected (Dalai Lama,
1997), and therefore, people should be able to feel compassion towards all beings, including adversaries and
transgressors.
Differences in the conceptualization of compassion and related states have been demonstrated between
independent and interdependent cultural contexts. For instance, Kitayama and Markus (2000) found that
feelings of social engagement like sympathy (being concerned and feeling sorry about someone’s suffering) are
more strongly associated with feeling good in Japanese than in American samples. In another set of studies
(Davis, 1980; Siu & Shek, 2005), participants completed a commonly used measure to assess trait empathy
(i.e., the ability to identify, share, and understand another’s emotions) (Interpersonal Reactivity Index [IRI];
Davis, 1980). For English speakers, four aspects of empathy emerged (fantasy [the tendency to imagine the
feelings of fictitious characters], perspective-taking [the tendency to adopt another’s point of view], empathic
concern [the tendency to experience feelings of concern and sympathy for others], and personal distress [the
tendency to feel anxiety when others are suffering]; Davis, 1980). While fantasy and personal distress also
emerged for Chinese speakers, perspective-taking and empathic concern comprised one factor, suggesting less
of a distinction between cognitive and emotional aspects of empathy for Chinese speakers (Siu & Shek, 2005).
Similarly, another study examined the factor structure of the IRI in a Chilean sample (Fernández, Dufey, &
Kramp, 2011) and found no correlation between perspective-taking and personal distress for male

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participants. Together, these data suggest that the distinction between cognitive and emotional aspects of
empathy may vary within cultures.
Cultures also vary in what they regard as “altruistic” (i.e., as an act of helping someone for his/her sake
while disregarding one’s own needs). For instance, while helping others is generally regarded as a moral act in
the United States and India, for Americans, a spontaneous act of helping is associated with more altruistic
motivation than a reciprocal act of helping. For Hindu Indians, however, altruistic motivation is associated
with both types of helping behavior to similar degrees (Miller & Bersoff, 1994). Together, these studies
suggest that culture may shape people’s conceptions of compassion and other related states.

Experience
Several studies suggest that the elicitors of sympathy are similar across cultures: people feel sympathy for
others who suffer for reasons that are beyond their control (e.g., Zhang, Xia, & Li, 2007). In German, Israeli,
Indonesian, and Malaysian contexts, children expressed sympathy (e.g., they lifted their inner eyebrows and
spoke in a soft voice) for targets who are sad because they have lost a treasured toy (Trommsdorff,
Friedlmeier, & Mayer, 2007). Moreover, feeling sympathy seems to have similar consequences across cultures.
For instance, in North American and Brazilian children, feeling sympathy led to greater reports of helping
behavior (e.g., giving money to a stranger in need) (Eisenberg, Zhou, & Koller, 2001).
Empathy for another person’s pain has been linked to specific patterns of brain activity across different
cultures (e.g., similar patterns of brain activation in the left inferior frontal cortex and the left insula; de Greck
et al., 2012; C. Jiang, Varnum, Hou, & Han, 2014). Differences, however, have also been observed (e.g., de
Greck et al., 2012; C. Jiang et al., 2014) (for a description of cultural neuroscience, see Chiao, Chapter 12 this
volume). For example, whereas Chinese participants showed a pattern of brain activity suggesting that they
were regulating their emotions when empathizing with a familiar angry target, German participants showed a
pattern of brain activity suggesting that they were assuming the perspective of the angry target (de Greck et
al., 2012). Furthermore, compared to European American participants, Korean participants, who value social
hierarchy more than European Americans, showed a greater empathic neural response in the left
temporoparietal junction for in-group compared to out-group members experiencing emotional pain (Cheon
et al., 2011; see also Chiao, Chapter 12 this volume).
The experiential consequences of empathy also appear to differ across cultures. For instance, J. Park,
Haslam, Kashima, and Norasakkunkit (2015) found that while empathy reduces the focus on oneself in Japan,
it does not in Australia. More specifically, they examined the self-humanizing bias, which is the bias to see
oneself as more human than other people on average. After recalling having empathized with someone else,
Japanese were less likely than Australians to show the self-humanizing bias. In other words, experiencing
empathy resulted in the Japanese focusing less on themselves and seeing human attributes in others more than
it did for the Australians (J. Park et al., 2015).
Findings from another set of studies (Atkins, Uskul, & Cooper, 2016) revealed that British participants
showed more empathic concern than East Asian participants, whereas East Asian participants showed more
empathic accuracy (the skill to correctly identify other people’s feelings and thoughts) than British participants
when witnessing others’ social pain. One possible explanation for the findings regarding empathic accuracy is
that more empathic concern among British participants might have interfered with empathic accuracy, as

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emotions can interfere with cognitive tasks (Atkins et al., 2016). Alternatively, it could be that empathy is
more other-focused among East Asians, so they are first just trying to understand how the other person is
feeling before showing empathic concern. The findings regarding empathic concern are consistent with other
findings that Western adolescents and young adults reported more empathic concern when confronted with
someone’s suffering than did East Asian adolescents and young adults (Cassels, Chan, Chung, & Birch, 2010;
Trommsdorff, 1995).
Finally, because cultural ideas can be instantiated in practices (Kroeber & Kluckhohn, 1952), other studies
examined culture in terms of cultural or religious practices like meditation. These studies demonstrated
increased empathy (Lutz, Brefczynski-Lewis, Johnstone, & Davidson, 2008; Shapiro, Schwartz, & Bonner,
1998), social connectedness (Hutcherson, Seppala, & Gross, 2008), as well as hope and optimism for another
(Koopmann-Holm, Sze, & Tsai, in preparation) for individuals who meditate. Together, these studies suggest
that while the elicitors of compassion and related states may be similar, various aspects of the experience of
compassion may differ across cultures.

Expression
Relatively less research has focused on the expression of compassion and related states. One study found
that sympathetic touches can be distinguished from other emotional touches. Hertenstein and colleagues
(Hertenstein, Keltner, App, Bulleit, & Jaskolka, 2006) asked participants in the United States and Spain to
touch other participants’ arms in ways that communicated specific emotions, without seeing or talking to each
other. Using a forced-choice response format, participants in the U.S. and Spain were able to differentiate
sympathetic touches (patting followed by stroking) from angry, afraid, disgusted, surprised, loving, and
grateful ones.
Other studies suggest that certain cultural ideas and practices increase the likelihood that people will
express compassion. For example, engaging in meditation appears to increase expressions of compassion (e.g.,
Condon, Desbordes, Miller, & DeSteno, 2013; Kemeny et al., 2012; Leiberg, Klimecki, & Singer, 2011;
Weng et al., 2013). Condon and colleagues (2013) found that participants who were randomly assigned to an
eight-week meditation course (versus a no-intervention control group) were more likely to offer their chair to
a person on crutches.
In perhaps one of the largest cross-national studies of expressions of compassion, Levine, Norenzayan, and
Philbrick (2001) examined how people in 23 nations around the world responded to situations in which
strangers needed help (e.g., a person who has dropped a pen, a person with a hurt leg, a blind person who is
trying to cross the street). People from nations with a tradition of simpatia (the tendency of being concerned
about other’s well-being and of fostering harmony in relationships, which is highly valued in Latino culture),
such as Brazil and Costa Rica, were more likely to help others in these situations than people from nations
without a tradition of simpatia such Singapore and Malaysia (Levine et al., 2001).
In that study, people from poorer nations (e.g., Malawi and India) were also more likely to help others than
those from wealthier nations such as the Netherlands and the United States. These findings are consistent
with work by Stellar, Manzo, Kraus, and Keltner (2012) demonstrating that within the United States,
individuals of lower socioeconomic status reported feeling more compassionate towards a peer undergoing a
stressful job interview than did those of higher socioeconomic status. These social class differences and

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differences between poorer and wealthier nations are likely also due to culture: Compared to higher
socioeconomic contexts, lower socioeconomic contexts endorse more “interdependent” models of self, which
encourage individuals to be more sensitive and responsive to the needs of others (Snibbe & Markus, 2005).
One main limitation of the study by Levine et al. (2001), however, is that it assumes that the expressions of
compassion are similar across cultures. For instance, Levine et al. (2001) assumed that helping a blind person
cross the street is a compassionate act. Again, this might depend on how individualistic or collectivistic the
culture is. In cultures that promote independence (individualistic cultures), helping a blind person across the
street may undermine that person’s sense of autonomy and control. Thus, in these cultures, the compassionate
act might be to first assess whether the blind person needs and wants help. In the next section, we describe
our own work, which examines how cultural differences in views of negative emotion influence what
constitutes an expression of compassion.

Affect Valuation Theory: Cultural Differences in Avoided Negative Affect

Verweinen lasst die Nächte mich,
Solang ich weinen mag.
[Let me pass the nights in tears,
As long as I want to cry.]
(Johann Wolfgang von Goethe, 1749–1832; Goethe, 1827, p. 316)

Be still, sad heart! And cease repining;

Behind the clouds is the sun still shining.
(Henry Wadsworth Longfellow, 1807–1882; Longfellow, 1842, p. 112)

Most people want to feel more positive than negative states, and want to feel more positive and less
negative than they actually feel. And yet, people vary in the specific positive states that they want to feel (e.g.,
Tsai et al., 2006), as well as in their desire to avoid negative emotions (Koopmann-Holm & Tsai, 2014).
Affect valuation theory (AVT) incorporates this variation into models of affect and emotion. Although most
of our research has focused on cultural and individual variation in the affective states that people ideally want
to feel (their “ideal affect”) (e.g., D. Jiang, Fung, Sims, Tsai, & Zhang, 2015; Koopmann-Holm, Sze, Ochs,
& Tsai, 2013; B. Park, Tsai, Chim, Blevins, & Knutson, 2016; Sims & Tsai, 2015; Tsai, 2007; Tsai et al.,
2016; Tsai et al., 2006; Tsai, Louie, Chen, & Uchida, 2007; Tsai, Miao, & Seppala, 2007; Tsai, Miao,
Seppala, et al., 2007), our recent research demonstrates that the premises of AVT also extend to the affective
states that people want to avoid feeling (“avoided affect”) (Koopmann-Holm & Tsai, 2014). In this chapter,
we will primarily focus on this new research, but we will discuss how compassion might be influenced by ideal
affect at the end of this chapter.
The first premise of AVT postulates that how people actually feel (their “actual affect”) often differs from
how they ideally want to feel (their “ideal affect”) and how they want to avoid feeling (their “avoided affect”).
As mentioned above, most people want to avoid feeling negative states. Of course, there may be specific
situations in which avoided affect includes positive states. For example, people might try to avoid being too
excited about a possible opportunity in order to minimize their disappointment if that opportunity does not
arise. However, in Western contexts like the United States and Germany, people want to avoid negative more

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than positive affective states (Koopmann-Holm & Tsai, 2014). While there may be times when people cannot
avoid feeling these negative states, people are often successful at not feeling the states they want to avoid states
(Koopmann-Holm & Tsai, 2014). Moreover, structural equation modeling demonstrates that actual, ideal,
and avoided negative affect are distinct constructs in the U.S. and Germany (Koopmann-Holm & Tsai,
2014). In other words, actually feeling negative states, ideally wanting to feel negative states, and wanting to
avoid feeling negative states are separate aspects of our emotional lives.
The second premise of AVT predicts that culture shapes ideal and avoided affect more than it does actual
affect, whereas temperament shapes actual affect more than it does ideal and avoided affect. Rozin (2003) and
Shweder (2003) argue that cultural factors shape what people view as desirable—good, moral, and virtuous;
and by extension, what they view as undesirable—bad, immoral, and sinful. Similarly, AVT predicts that
cultural factors should shape what affective states people view as desirable and undesirable. Although cultural
factors also shape what affective states people actually feel (Kitayama, Markus, & Kurokawa, 2000; Mesquita
& Markus, 2004), decades of empirical research suggest that, across cultures, actual affect is primarily shaped
by people’s temperament (Costa & McCrae, 1980; David, Green, Martin, & Suls, 1997; Diener & Lucas,
1999; Gross, Sutton, & Ketelaar, 1998; Lykken & Tellegen, 1996; McCrae, Costa, & Yik, 1996; Rusting &
Larsen, 1997; Schimmack, Radhakrishnan, Oishi, Dzokoto, & Ahadi, 2002; Tsai et al., 2006), as well as their
regulatory abilities and immediate circumstances (e.g., Gross, 1998). In support of this prediction, across three
studies, we observed that, on average, European Americans wanted to avoid feeling negative states more than
Germans did. Thus, although most people want to avoid negative states, there are cultural differences in the
degree to which people want to avoid feeling negative. In contrast, cultural differences in actual negative affect
were not as strong or reliable across studies (Koopmann-Holm & Tsai, 2014).

American–German Differences in Avoided Negative Affect

These observed differences in avoided negative affect are supported by historical accounts and personal
anecdotes. For instance, in American Cool, historian Peter Stearns states that, in American society, “fear and
anger had no positive function … ; rather than being directed, they were to be avoided as fully as possible”
(Stearns, 1994, p. 96). In Against Happiness, Wilson describes the first American settlers as extremely
optimistic people who avoided sadness by moving to the “Promised Land”: “They thought that they would on
the American shore discover true happiness and put most sadness to rout” (Wilson, 2008, p. 11). Similarly,
McAdams describes the key feature of contemporary American identity as “the transformation of personal
suffering into positive-affective life scenes that serve to redeem and justify one’s life” (McAdams, 2004, p. 96),
as reflected in American storytelling, which characteristically has positive endings. Indeed, in Bright-Sided,
Ehrenreich (2009) describes how she was scolded, reprimanded, and told to seek professional help by other
breast cancer patients when she expressed her anger and anxiety about her diagnosis. As suggested by
Ehrenreich’s experiences, Held and Bohart describe how American culture views “negativity, complaining,
pessimism” as sinful (Held & Bohart, 2002, p. 961).
In contrast, in his book Ein Jahr Hölle [One Year of Hell], Michael Lesch, a German actor, describes his
battle with cancer as “horrible,” and full of anxiety, horror, and shock (Lesch, 2008). Indeed, German culture
is often described as being melancholic and pessimistic, as the terms Weltschmerz and Angst suggest (Clair,
2005; Gelfert, 2005). This is reflected by the Sturm und Drang (“storm and drive”) movement in German

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literature and music in the eighteenth century, which was characterized by the free expression of extreme
positive and negative emotions. In this movement, negative emotions were not only accepted, but also
glorified.
Previous empirical work supports these historical, ethnographic, and personal accounts of American-
German differences as well. For instance, German scholar Hedderich (1999) conducted semi-structured
interviews with American and German employees, who had spent at least six months in the other country. He
asked them about differences between the cultures and concluded that, compared to Germans, Americans
resist talking about their failures, indirectly referring to them as “items for improvement” (Hedderich, 1999, p.
161), and instead praise each other for their achievements. In line with this, Friday (1989) compared German
and American discussion styles among colleagues within one corporation, and found that Germans were more
likely to be forceful compared to Americans. Similarly, Koopmann-Holm and Matsumoto (2011) found
differences in emotional display rules, with German display rules allowing the expression of anger and sadness
more than American display rules. Together, these findings support our findings that people in American
contexts want to avoid negative states more than do people in German contexts.
Where might these cultural differences stem from? American culture endorses a “frontier spirit” (i.e.,
achieving one’s goals, influencing one’s circumstances, overcoming nature) more than German culture does
(Koopmann-Holm & Tsai, 2014). Early American settlers went to the New World to escape their negative
circumstances and improve their lives, and as a result, they may have created a culture in which individuals
want to avoid the negative. In contrast, the ancestors of today’s Europeans stayed in their homeland and had
to adjust to their negative life circumstances. These individuals may have created a culture that endorses
greater acceptance of the negative. Indeed, we observed that because American culture endorses frontier spirit
values (i.e., valuing achievement over nature) more than German culture does, Americans want to avoid
negative emotions more than their German counterparts do (Koopmann-Holm & Tsai, 2014, Study 3).

Implications for Compassion

The third premise of AVT is that people’s desire to avoid negative states drives their behavior. In their
control-theory of behavior, Carver and Scheier (1998) argue that most behaviors are directed towards goals or
away from anti-goals, and are regulated by discrepancy-reducing or discrepancy-enlarging feedback systems,
respectively. Whereas discrepancy-reducing systems bring organisms closer to their goals, discrepancy-
enlarging processes move organisms farther from their “anti-goals.” We propose that avoided negative affect
acts like an “anti-goal”; therefore, people act in ways that actively distance them from the negative states they
want to avoid. For instance, the more someone wants to avoid negative affect, the more likely that person may
be to avert the gaze from someone who is suffering (e.g., a homeless person asking for money) for fear that the
person who is suffering may make them feel bad. Some preliminary data support this prediction: when
presented with one image that could either be perceived as a suffering face, a laughing face, or both, the more
participants wanted to avoid feeling negative affect, the more likely they were to report seeing only the
laughing face (Koopmann-Holm, Bartel, Bin Meshar, & Yang, in preparation). These findings suggest that
cultural differences in avoided negative affect may have consequences for the experience of compassion. For
instance, because people must perceive another’s suffering before they can experience compassion, it is possible
that the more individuals want to avoid negative affect, the less likely they may be to put themselves in

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situations in which they might observe the suffering of another person. The less likely people are to see other
people’s suffering, the fewer opportunities they have to experience compassion.

Figure 21.2 Depiction of a prototypical American (left) and German (right) sympathy card.

Furthermore, avoided negative affect may play a role in how people express their sympathy or compassion
for another. In cultures that encourage people to avoid negative states more, people may find responses that
focus more on the positive and less on the negative as more helpful and compassionate. However, in cultures
that encourage people to avoid negative states less, people may find responses that acknowledge the negative
more and focus on the positive less to be more helpful and compassionate. To test this hypothesis, we
compared the emotional content of a representative sample of American and German sympathy cards sold in
American and German card stores. We examined these cultural products because they are specifically
designed as a way of responding to others’ suffering. In both the United States and Germany, people send
sympathy cards to show their concern and compassion to others. Supporting our hypothesis, we found that
American cards contained more positive words, more living images, fewer negative words, and fewer dying
images than did German cards (see Figures 21.2 and 21.3):
To further test our hypotheses regarding culture, compassion, and avoided negative affect, we asked
European American and German participants to imagine that the father of one of their acquaintances had just
died, and that their acquaintance was very sad. We then presented them with three pairs of sympathy cards.
Each pair contained one card that focused more on the negative (e.g., “A severe loss … take time to grieve”)
and one card that focused more on the positive (e.g., “Remembering … let time heal your soul”). As
predicted, Americans felt less comfortable sending sympathy cards that contained primarily negative content
than Germans did, and these differences were mediated by cultural differences in avoided negative affect.
Whereas 72% of Germans chose at least one negative card from the three pairs presented, only 37% of
European Americans did (Koopmann-Holm & Tsai, 2014).

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Figure 21.3 Frequency of negative words and positive words (percentage of total words that are negative or positive) in American and German
sympathy cards.

Because these data were correlational, we conducted another study in which we used an experimental design
to examine whether the tendency to want to avoid negative affect more caused greater choice of positive versus
negative cards (Koopmann-Holm & Tsai, 2014, Study 4). American and German participants were randomly
assigned to either “avoid negative affect” or “approach negative affect” conditions. In the “avoid negative
affect” condition, participants were told to push a joystick away from themselves when they saw a negative (vs.
neutral) image on a computer screen. In the “approach negative affect” condition, participants were told to
pull a joystick towards themselves when they saw a negative (vs. neutral) image on a computer screen.
Afterwards, they were presented with the scenario in which they had to choose a card to send to someone who
had just lost a loved one. Overall, participants in the “avoid negative affect” condition preferred sympathy
cards with positive content more (and cards with negative content less) than those in the “approach negative
affect” condition. These findings suggest that differences in avoided negative affect at least partially drive
different responses to suffering.
Do the same differences emerge when people are suffering themselves? To answer this question, we asked
participants to “Please imagine that one of your loved ones just died…. Imagine that you just received a
sympathy card from one of your acquaintances.” We then presented participants with two pairs of different
sympathy cards. As described above, there was one negative and one positive card for each pair. We then
asked participants to report how comforting and helpful they found each card. As predicted, Americans rated
the negative cards as less comforting and helpful than did Germans. When asked which type of card they
would rather receive, only 16% of European Americans chose at least one out of two negative cards, whereas
38% of Germans chose at least one out of two negative cards. Again, these cultural differences were partly due
to differences in the desire to avoid negative states: the more individuals wanted to avoid negative states, the
less comforting and helpful they found the negative cards (Koopmann-Holm, Bruchmann, Pearson, Oduye,
Mann, & Fuchs, in preparation).
Together, these findings suggest that people express compassion differently across cultures, and people
differ in which compassionate responses they view as helpful.

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Implications for Counseling, Health Care, Public Service, and Intervention
Our work suggests that behaviors that are regarded as compassionate in one culture may not be in another.
Focusing on the positive may seem superficial in a German context, whereas focusing on the negative may
seem discouraging and even morbid in an American context. Furthermore, our findings suggest that
American dominant models of compassion and empathy might not apply in German contexts and other
contexts in which people want to avoid negative affect less. Indeed, the two most famous models explaining
compassionate responding, the empathy-altruism hypothesis by Batson and colleagues (1981, 1983; 1991) and
the negative state relief model by Cialdini and colleagues (1973), assume that people do not want to feel
negative emotions. The empathy-altruism hypothesis suggests that the more distress people feel when seeing
someone suffer, the less they help, because people do not want to feel that distress. Because Americans want to
avoid feeling negative more than Germans, actually feeling negative/distressed might interfere with helping
more for Americans than Germans. The negative state relief model suggests that when someone is distressed
because another person is suffering, this distress leads to more helping behavior, because people want to
improve their own mood (i.e., reduce their distress) by helping someone else. While Americans might help
others to reduce their own distress, Germans might be less inclined to reduce their own distress, because they
are more accepting of negative emotion. Thus, the motivation to reduce one’s own distress might be less
relevant in German contexts for compassionate responses to occur.
Our findings provide just one example of how culture might shape the expression of compassion.
Understanding cultural differences in compassion is important for several reasons. First, understanding
cultural differences in compassion may be critical to developing effective cross-cultural counseling (Chung &
Bemak, 2002). For instance, grief and trauma counseling is often organized and provided internationally, but
it is often ineffective because it does not take into account the culture of the people being counseled (Watters,
2010). Even among Western clinical therapies, some may be more effective than others, depending on how
much individuals want to avoid negative emotion. For instance, Sigmund Freud, the father of psychoanalysis,
was Austrian and thus influenced by German culture. Therefore, the assumption that suppressing and
avoiding negative emotions impairs functioning, and that one needs to release, accept, and talk about one’s
negative emotions as a “cure,” might reflect the German acceptance of negative emotion. In contrast, Aaron
Beck, the father of cognitive therapy, was American. The assumption in cognitive therapy that one needs to
repair one’s negative mood (i.e., make it positive) might reflect the American desire to avoid negative
emotion. Indeed, contrary to psychoanalytic thought, repressive coping (i.e., ignoring or suppressing negative
thoughts and feelings) leads to better mental and physical health after the loss of a loved one in an American
sample (Coifman, Bonanno, Ray, & Gross, 2007), perhaps because it is consistent with the American value
placed on avoiding negative emotion. Thus, understanding cultural and individual differences in avoided
negative affect might inform therapists and other health providers how best to respond to another’s suffering.
While some might prefer to “pass the nights in tears, as long as [they] want to cry” as described by Goethe
(1827, p. 316), others might prefer their heart to “cease repining [because] behind the clouds is the sun still
shining” as described by Longfellow (1842, p. 112).
Knowing about cultural differences in compassion may be important not just for counseling settings, but
also for health care and public service, where compassion can lead to better outcomes (Amador, Flynn, &
Betancourt, 2015). For example, in our increasingly multicultural world, it is important for clinicians to know

365
how to compassionately convey the diagnosis of a terminal illness to patients and their families. Furthermore,
an awareness of cultural differences in compassion in educational settings is important for advising students
from various cultural backgrounds and might be an important aspect of “ethnocultural empathy” (Wang et al.,
2003), or understanding the perspective of an ethnically different person.
Understanding cultural and individual differences in expressions of compassion is also critical to
interventions that aim to promote compassion, empathy, sympathy, and altruism in different cultures. For
instance, previous studies have demonstrated that meditation increases compassion (e.g., Condon et al., 2013;
Kemeny et al., 2012; Leiberg et al., 2011; Weng et al., 2013); however, none of the studies have examined
whether the findings hold across different ethnic and cultural groups. Indeed, Layous, Lee, Choi, and
Lyubomirsky (2013) demonstrated that specific happiness interventions do not seem to be similarly effective
in North American and South Korean contexts. In addition to studying the effectiveness of interventions in
different cultural contexts, researchers should include measures of compassion that reflect cultural differences
in the conception, experience, and expression of compassion.

Limitations and Future Research

Our studies have some limitations that should be addressed in future research. First, we examined how
avoided negative affect shapes hypothetical responses to the suffering of an acquaintance; future studies should
examine whether these findings generalize to actual negative events. For example, we are currently
investigating what types of cards are considered most helpful by recently bereaved individuals, as well as how
people respond to posts of actual suffering on Twitter. Future studies should also examine responses to other
individuals (e.g., the suffering of a family member or friend) and responses to different types of suffering (e.g.,
having AIDS or cancer, occupational or marital difficulties).
Second, we have only begun to examine cultural differences in compassion and related states using
American (mainly European American) and German samples. Interestingly, these are two cultures that are
often lumped together as “individualistic and Western.” Future studies should examine expressions of
sympathy and compassion in other cultural contexts as well (e.g., Gaines & Farmer, 1986; Grossmann &
Kross, 2010).
Third, it would be important to examine how these cultural differences in compassion affect compassion
fatigue. Are people more susceptible to fatigue when they want to avoid negative affect? Our data suggest that
the desire to want to avoid feeling negative may lead to feeling even more negative when exposed to negative
stimuli (see Koopmann-Holm & Tsai, 2014, p. 1109). Therefore, it is possible that people who want to avoid
feeling negative more might show earlier and/or greater signs of compassion fatigue than people who want to
avoid feeling negative less. Future research should test this prediction.
Furthermore, future studies should also examine how ideal affect (the affective states people ideally want to
feel; Tsai et al., 2006) might shape compassion. As mentioned above, we have found that American culture
values excitement states more and calm states less than many East Asian contexts do (Tsai et al., 2006). To
the degree that compassionate responses involve positive emotion, people from cultures that value excitement
states more might find excited responses to be more compassionate, whereas people from cultures that value
calm states more might find calm responses to be more compassionate.
Another important point that future research should address is how compassion should be measured across

366
but also within cultural contexts. Should we focus our efforts on examining how people respond to someone
they relate and feel similar to as suggested by Western concepts of compassion (Batson et al., 1981; Batson et
al., 1987)? Or should we include a Buddhist perspective on compassion (Dalai Lama, 1997), which
emphasizes the interconnectedness of all beings and therefore encourages compassion towards everyone,
including transgressors and adversaries? We argue for the importance of alternative measures of compassion in
order to understand this construct from a cross-cultural perspective (Koopmann-Holm, Sze, et al., in
preparation). In addition to including the dimension of extensivity (the quality of including everyone, not just
in-group members, but also transgressors and adversaries) to compassion, it will also be important to examine
compassion from a more collectivist viewpoint as well. For example, group solidarity includes compassionate
acts not necessarily stemming from an individual’s emotion and appraisals, but rather from a collective social
identity (M. Gaborit, personal communication, February 19, 2016). Stavrova and Schlösser (2015) define
solidarity as “behaviors that are driven by a sense of shared identity with the disadvantaged and are directed at
improving their conditions” (Stavrova & Schlösser, 2015, p. 2), which is very much in line with the definition
of compassion in this Handbook.
Finally, our work has focused on the cultural shaping of the conceptualizations and expressions of
compassion. More research is needed to examine how these differences shape the experience of compassion.
Our findings suggest that compassion is expressed differently, depending on the degree to which people want
to avoid feeling negative emotions. Because compassion is expressed differently, based on the “cultural
construction” view of emotion (Boiger & Mesquita, 2012), it is possible that compassion is also experienced
differently. Previous studies suggest that cultural differences exist in how people experience empathy and
altruistic motivation (de Greck et al., 2012; Miller & Bersoff, 1994; Siu & Shek, 2005). Our research suggests
that people who want to avoid feeling negative may actually feel more negative when exposed to negative
images (see Koopmann-Holm & Tsai, 2014, p. 1109). However, people who want to avoid feeling negative
focus more on the positive when responding to someone’s suffering. This might make them actually feel more
positively when seeing someone suffer compared to people who don’t want to avoid feeling negative. For
example, when people who want to avoid feeling negative see someone else’s suffering, they focus on the
positive more and thus construe the situation differently than people who want to avoid the negative less.
They might focus on the good times a grieving person had with a deceased loved one, which might lead to an
experience of a “warm glow” when feeling compassionate. For individuals wanting to avoid feeling negative
less, they might focus on the pain the person feels as a result of having lost a loved one, which might lead to
feeling this pain when feeling compassion. Future research needs to test this prediction and should also
examine whether feeling more negative while feeling compassionate erases the positive feelings of compassion
(e.g., the “warm glow”), or whether the positive and negative feelings coexist.
Importantly, previous research has documented clear cultural similarities in compassion. In fact, the core
tendency to relate to others and respond to others’ suffering might very well be universal, as Darwin suggests
(Darwin, 1871). Even though we find cultural differences in how people respond to someone’s suffering in
European American and German contexts and in what they regard as helpful, sympathy cards are readily
available in both cultures. This suggests that sending a sympathy card to express one’s compassion occurs
frequently enough for these cultural products to exist, suggesting cultural similarities in compassion. However,
our work demonstrates that the motivations that follow this initial emotional tendency to be compassionate

367
and to want to help (i.e., whether people focus on the positive or negative) are shaped by culture.
In conclusion, although Darwin might have been correct in proposing that the tendency to feel compassion
is basic and instinctual, it is clear that there are differences across cultures in the conception, experience, and
expression of compassion. Here we demonstrate that cultural differences in the degree to which people want
to avoid negative emotions predicts how people respond to others’ suffering as well as people’s preferences for
how they would like others to respond to their own suffering (i.e., what they regard as most helpful and
compassionate). The more people want to avoid negative affect, the more they focus on the positive (vs.
negative) when responding to others’ suffering, and the more they want others to focus on the positive (vs.
negative) when expressing compassion toward their own suffering. Our hope is that in the future, increasing
research will reveal the other ways in which culture shapes the conception, experience, and expression of
compassion.

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 Enhancing Compassion Social Psychological Perspectives

Paul Condon and David DeSteno

Abstract

Historically, social psychologists are known for demonstrating the power of situations to reduce
compassionate impulses and prosocial behavior. The simple presence of other people, for example, can
decrease the rates at which people act to help others. Yet more recent findings also point to the power of
situations to evoke other-oriented emotional states that increase intentions and actions to help others
and build relationships. In this chapter, we review the current social psychological literature on
compassion and its role in shaping moral decision-making and relationship formation. We then turn to
the burgeoning field of contemplative science and demonstrate the role of meditation practices in
shaping prosocial character. In the end, this literature suggests that humans are amenable to situational
forces that tip the scales in favor of compassionate responding. Moreover, such behaviors can be
increased through simple, readily available meditation-based exercises.

Key Words: emotion, prosocial behavior, moral decision-making, meditation, mindfulness, social
psychology

Social psychology’s contribution to the study of compassion begins with notorious examples of human
failures to act compassionately. The early years of experimental social psychology were infamous for
demonstrating the power of situations to hinder compassionate responses to the needs of others. The murder
of Kitty Genovese in 1964, allegedly witnessed by 38 unresponsive onlookers, sparked public and academic
interest in the situational forces that cause onlookers to ignore the plights of others.1 Experimental research
later confirmed that the presence of nonresponsive onlookers typically led to a reduction in helping behavior,
called “the bystander effect” (Darley & Latané, 1968; Fischer et al., 2011; Latané & Nida, 1981). Further
research demonstrated that situations can reduce prosocial responding even among those who have dedicated
their lives to values such as compassion. In a widely cited study, seminary students under time pressure to
reach a destination and deliver a lecture related to generosity and compassion were less likely to help an actor
portraying a homeless man, compared with students who were not under time pressure (Darley & Batson,
1973). Stanley Milgram’s research on obedience demonstrated the overwhelming tendency of people to obey
authorities, even when authorities encouraged them to harm others, thereby overriding any impulse for
compassionate action (Milgram, 1963). Our academic field blossomed by focusing on situations that
prevented compassionate action toward those in need. Fortunately, social psychologists later uncovered
situational factors that also enhance compassion.
The dawn of the 1980s witnessed a shift toward a focus on emotional or affective states that facilitate
prosocial responding, which yielded two key insights about compassion. First, social psychologists

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demonstrated that other-oriented emotional states promoted helping behavior aimed to alleviate another’s
suffering. This work, usually employing the term “empathic concern” as opposed to “compassion,” composed
much of the social psychological literature on helping behavior in the late twentieth century (Batson, 1991,
2011; Eisenberg & Miller, 1987). Across numerous experimental settings, experiences of compassion for
another increased the probability of costly helping, independent of other self-interested motivations, including
desires to (1) reduce one’s own aversive, empathic arousal; (2) avoid social punishment and self-criticism for
failing to help; and (3) gain social rewards or self-approbation for helping (Batson, 1991, 2011). Moreover,
these other-oriented experiences had unique predictive validity compared with experiences of empathic
distress. Compassion or empathic concern therefore appeared to represent a unique emotional state in which
an onlooker feels for another, rather than feeling as another, combined with the desire to alleviate another’s
suffering (Batson, 1991, 2011). This perspective resonates with modern conceptualizations of compassion in
social psychology, which define compassion as an affective state that promotes costly helping behavior in
response to the suffering of others (Goetz, Keltner, & Simon-Thomas, 2010).
The second key contribution from social psychology centered on findings that compassion-based emotional
responses are modulated by subtle situational cues. The perceived characteristics of a target, for example, can
have a dramatic impact on the likelihood that an onlooker will feel compassion and act to help. The degree to
which an onlooker perceives a sense of similarity with another predicts helping behavior beyond empathic
concern (Cialdini, Brown, Lewis, Luce, & Neuberg, 1997). These results coincide with findings that people
provide more help and resources to members of an in-group (Tajfel & Turner, 1979). Thus, compassion-
related states can be tuned up or down depending on the subtle cues that signal a sense of similarity or oneness
(Penner, Dovidio, Piliavin, & Schroeder, 2005). The implications are central to this volume: social
psychologists can use situational factors and training programs to enhance compassionate states and prosocial
behaviors.
In the remainder of this chapter, we review social psychological research that demonstrates why compassion
is fundamental to human social living, and examine ways to enhance it. In particular, we organize our review
around the two key contributions just described. First, we will examine social psychological literature on
compassion-based emotional experiences that impact prosocial decisions. Second, we will examine ways to
enhance compassion, including situational cues and meditation-based training programs. We conclude by
raising open questions and recommending future research.

Compassion as a Moral Force

A fundamental problem of human social living concerns the development of cooperative social relationships
and communities. Emotion theorists have long considered the role of emotional states in shaping decisions
and behaviors that build long-term relationships (e.g., Frank, 1988). For social beings, navigating the social
terrain is just as key to survival as is navigating the physical terrain (e.g., avoiding predators, securing food). In
this perspective, emotions are functional—they motivate people to behave in ways that solve problems of
adaptive importance. Emotional states, such as gratitude, love, and compassion, should function to encourage
a person to behave in ways that facilitate relationships in the long run, even if behaviors carry a cost in the
short term (DeSteno, 2009; Frank, 1988). Compassion is an affective state that has clear implications for
prosocial behavior, caregiving, and relationship formation across the lifespan (Batson, 1991, 2011; Goetz et

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al., 2010). Yet compassion appears to function as more than a simple motivator of prosocial behavior—it
appears to serve as an affective state that mitigates harm in the world and extends our willingness to help
others.
The status of compassion as a moral emotion capable of driving intuitive judgments and behavior beyond
simple helping responses, such as decisions to forgive or punish another carries high interest across disciplines.
Goetz et al. (2010) suggested that compassion, like other moral emotions, may act as a moral intuition with
the motivation to remedy unjustified harm and increase individual freedom and rights. Similarly, Singer and
Steinbeis (2009) suggest that compassion-based motivations for cooperation and punishment, in contrast to
fairness-based motivations, can counteract the desire for revenge and subsequent downward escalations into
iterative noncooperation or violence. To the extent that punishment violates kindness and concern for
another’s well-being, it follows that a compassionate emotional response should indeed reduce punitive
tendencies.
Theorists suggest that compassion stems from the need to provide care to vulnerable and weak offspring
(Goetz, Keltner, & Simon-Thomas, 2010; Mikulincer & Shaver, 2005). However, like other phenomena that
result from natural selection, compassion may act as a spandrel that occasionally affects interactions beyond
the conditions that led to its emergence; in this case, those with non-kin (Sober, 2002). Compassion may
thereby function to alter moral decisions that favor relationships outside of familial bonds (Goetz et al., 2010).
These principles provide theoretical support compassion as a fundamental capacity of the human emotional
repertoire. In this section, we review evidence demonstrating that compassion supports relationships by
motivating decisions and moral behaviors beyond those tied to direct prosocial helping (see Batson, in this
Handbook, for a review of research the relationship between compassion and helping behavior).
Compassionate motives have been demonstrated to predict the development of novel relationships. Crocker
and colleagues have studied the experiences of first-semester college freshman who were randomly assigned a
roommate and demonstrated that people who care about the well-being of others (i.e., those motivated by
“compassionate goals”) were more likely to satisfy their own and others’ needs compared with those who were
motivated by self-interest (i.e., “self-image goals”) (see Crocker & Canevello, 2012, for review). Whereas
pursuing self-esteem can have various short- and long-term costs, including a reduced sense of relatedness and
increased anxiety and depression, caring for the well-being of others indirectly promotes one’s own well-being
through the building of social capital (Crocker & Canevello, 2008). Based on longitudinal data that tracked
college freshman over their first semester, Crocker and Canevello found that those who maintained
compassionate goals, compared with those who prioritized self-image goals, provided more support to others
in the context of new relationships. Furthermore, the individuals who simultaneously endorsed high
compassionate goals and low self-image goals reported receiving greater social support and greater
interpersonal trust from friends and significant others. Thus, compassionate dispositions appeared to support
the development of emerging relationships. These findings also suggest a positive impact of compassion on
overall well-being: compassionate goals predicted downstream psychological well-being as indicated by self-
reported feelings of trust, closeness, and reduced loneliness and interpersonal conflict (Crocker & Canevello,
2008).
The effects of compassion on the development of cooperative relationships may also extend to larger groups
beyond dyadic relationships. Empirical evidence supports the notion that cooperative groups accumulate the

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largest amounts of resources over time compared with groups that engage in punitive action. Using simulated
economic exchanges, Dreber and colleagues demonstrated that groups that refrain from punitive action reap
greater communal gains than do groups characterized by punitive behavior (Dreber, Rand, Fudenberg, &
Nowak, 2008). In short, cooperation, rather than punishment, promotes a flourishing community. It is
therefore of great value to identify the factors that might promote cooperation despite uncertainty about
potential losses of resources in the short run. In this vein, our laboratory has taken an interest in the potential
of compassion to motivate prosocial behavior and forgiveness toward those who have committed social
violations or transgressions.
Initial investigations of the impact of compassion on moral decision-making have produced evidence that
compassion can promote a reduction in punishment directed at individuals who commit a transgression, even
in cases where the transgression occurs against a third party and no forgiveness is sought (Condon &
DeSteno, 2011). Using an orchestrated scenario, we had participants witness a confederate (i.e., an actor)
cheat on a task to win money. Participants later had the opportunity to punish the transgressor by deciding
the amount of hot sauce he would be forced to consume (cf. Lieberman, Solomon, Greenberg, & McGregor,
1999). Some participants were also exposed to the intense sadness of a nearby female confederate. As
expected, the experience of compassion in response to the female confederate’s sadness mediated a reduction
in the amount of hot sauce administered to the transgressor. Compassion may therefore function as an
effective mechanism for reducing escalations of violence. Although unpunished transgressions could prove
costly, the avoidance of aggressive action can result in less psychological stress and greater hedonic well-being
in the long run (Bushman, 2002; Carlsmith, Wilson, & Gilbert, 2008), suggesting that compassionate action
even toward transgressors may prove adaptive.
An emerging question concerns the manner in which compassion promotes cooperative behavior in
contexts that involve moral violations. The motivation to reduce suffering would probably lead individuals to
endorse policies and values that protect the rights of others (Goetz et al., 2010). In turn, it is likely that
compassion would motivate an individual to correct the actions of a transgressor with the ultimate aim to
reduce collective suffering, albeit in a non-violent manner that minimizes the transgressor’s suffering. This
interpretation remains speculative, however, and awaits empirical investigation. Furthermore, although we
have demonstrated compassion’s ability to reduce punishment when the distress of a victim is causally
dissociated from the act of a transgressor, it remains an open question whether the same relationship would
hold true when a victim’s suffering is due to the actions of a transgressor. In such cases, the level of distress
observed, and therefore the level of compassion felt, might co-vary tightly with the level of animosity directed
at the cause of the suffering (i.e., the transgressor). In such cases, it is possible that the influence of elevated
compassion might be associated with desires to punish the source of the distress (e.g., Meyers, Lynn, &
Arbuthnot, 2002; Keller & Pfattheicher, 2013). Recent work on contemplative practice (which we will review
in greater detail later) has shown that compassion training can increase behavior meant to punish a
transgressor when the punishment would benefit a victim (Weng et al., 2013). Yet it remained unclear if the
actions were motivated by the desire to punish the transgressor or help the victim. Follow-up work revealed
that, given a choice, participants who received compassion training were more likely to give resources to help a
victim, but were not more likely to punish a transgressor (Weng et al., 2015). Depending upon which
mechanisms underlie compassion’s influence, the exact nature of the interplay of these forces is difficult to

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predict. In sum, compassion supports the development of novel relationships and communal interest, in part
by encouraging people to forego short-term benefits for themselves. The question of how to foster
compassionate emotional states and behaviors is therefore critical.

Enhancing Compassion
Evidence that accumulated over the past two decades painted a picture of human beings as capable of
prosocial emotional states that encourage behaviors that favor the interests of a relationship over the long-
term, even if such behaviors incur short-term costs (e.g., time, resources) for the self. These findings suggest
the possibility of using social psychological approaches to enhance compassionate emotional states and
prosocial action. In this respect, two key themes have recently emerged: first, the possibility of increasing
compassion through chronic training of the mind, and second, the possibility of facilitating compassion
through subtle, situational cues that modulate how the mind responds to others.

Social Psychological Investigations of Meditation

Scientists have been conducting empirical investigations of meditation for many decades, beginning as early
as the 1930s (see Houshmand, Harrington, Saron, & Davidson, 2002). Most early scientific investigations of
meditation focused on the health and cognitive benefits generated from repeated practice over a sustained
period of time. Empirical studies demonstrated that various forms of meditation practice generated enhanced
brain activity in attention-relevant brain regions and networks (Cahn & Polich, 2006; Fox et al., 2014; Holzel
et al., 2012; Vago & Silbersweig, 2012), enhanced cognitive performance (Slagter, Lutz, Greischar,
Nieuwenhuis, & Davidson, 2009), and enhanced mental and physical health (Grossman, Niemann, Schmidt,
& Walach, 2004; Hofmann, Sawyer, Witt, & Oh, 2010). Perhaps surprisingly, however, little of this early
work examined the ability of meditation to enhance social or relational outcomes.
The focus on basic cognitive skills can be attributed in part to the assumption among scientists that
meditation practices primarily targeted basic cognitive processes (see Davidson, 2010, for a review). In fact,
the most ubiquitous form of Buddhist meditation (i.e., śamatha) is aimed at improving concentration (Lutz,
Dunne, & Davidson, 2007). Moreover, the primary figures who initiated Buddhist–scientist dialogues were
biologists and neuroscientists who had great interest in mind–brain correspondence and subjective experience
(e.g., Hayward & Varela, 1992; Varela, Thompson, & Rosch, 1992). This likely accounted for an expansion
of empirical research on the effects of meditation on the neural correlates of cognitive activity. Nevertheless,
Buddhist meditation and related practices are also aimed at altering cognitive and emotional states to support
the development of virtuous mental states and behavior that counteract the causes of suffering (i.e., greed,
hatred, and delusion; Gethin, 1998).
Several scientific papers have highlighted the potential role of meditation in cultivating positive
interpersonal outcomes (Brown, Ryan, & Creswell, 2007; Ekman, Davidson, Ricard, & Wallace, 2005; Lutz
et al., 2007; Vago & Silbersweig, 2012). Brown and colleagues (Brown et al., 2007), for example, asserted that
the quality of attention and awareness developed via mindfulness meditation should increase attentiveness, not
only to one’s own internal state, but also to others’ thoughts, emotions, and well-being, and therefore increase
the capacity for communication and reduce destructive behaviors. Yet the early empirical research has been
limited in quantity and in its ability to make strong assertions about the causal efficacy of meditation for

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promoting virtuous mental states and behavior qualities. Many studies relied on self-report or measurements
of neural activity removed from the contexts of everyday life. As such, the early literature was limited in its
ability to make causal claims about the role of meditation in promoting virtuous outcomes. The past five years,
however, have witnessed a growth in empirical research aimed to address this lacuna in knowledge.
Many empirical examinations of meditation have examined the impact of mindfulness, loving-kindness,
and compassion training on self-reported positive emotions, social connectedness, and compassion. In one
notable line of research, Fredrickson and colleagues (Fredrickson, Cohn, Coffey, Pek, & Finkel, 2008; Kok et
al., 2013) examined the influence of a six-week training program in loving-kindness meditation (LKM) on
daily experiences of positive emotions and post-training outcomes related to cognitive, psychological, physical,
and social resources. They demonstrated that participants completing LKM, compared with those assigned to
a wait-list control (WLC), reported increased positive emotion (e.g., amusement, awe, contentment,
gratitude, hope, interest, joy, love, and pride) throughout the training (Fredrickson et al., 2008; Kok et al.,
2013). Furthermore, increases in positive emotion accounted for increases in a variety of personal resources,
including self-reported positive relations with others and perceived social connection (Fredrickson et al., 2008;
Kok et al., 2013). Several further studies examining the effects of compassion and/or loving-kindness
training have produced similar increases in self-reported compassion and related prosocial qualities (Jazaieri
et al., 2013; Neff & Germer, 2013; Sahdra et al., 2011; Wallmark, Safarzadeh, Daukantaitė, & Maddux,
2013). These studies provided initial evidence that various forms of meditation increased qualities such as
empathy, compassion, and positive interpersonal functioning.
Yet there remained uncertainty regarding claims of meditation and prosocial, virtuous outcomes, largely due
to reliance on self-report methods. People generally have limited access to the processes underlying conscious
experience (Nisbett & Wilson, 1977). Beliefs or heuristics about emotional states and the self can influence
retrospective and general ratings of past emotional states (Barrett, 1997; Robinson & Clore, 2002a, 2002b).
Men and women, for example, rate themselves differently when using aggregate measures that are influenced
by gender role knowledge, but not when they are reporting on momentary states (Barrett, Robin,
Pietromonaco, & Eyssell, 1998; Robinson, Johnson, & Shields, 1998). The methods used in the literature on
meditation and prosocial outcomes suffered a similar limitation: participants were generally asked to provide
global ratings of compassion and related qualities before and after a six- to eight-week course. These scales
require the participant to summarize a variety of experiences (e.g., over the past 24 hours, week, month, or
one’s lifetime) and aggregate them to make a global judgment about their general affective state or social
behavior. These global judgments are typically driven by stereotypical information about emotions (i.e., beliefs
about emotions) rather than precise information about emotional instances or episodes themselves (Robinson
& Clore, 2002a, 2002b).
Concerns about self-report methods are particularly salient in meditation studies. People participating in
studies that offer training in meditation are probably motivated to report that meditation was effective. As
several contemplative scientists have recognized, self-report measures concerning meditation-related qualities,
such as mindfulness, are likely to conflate achievement with aspiration (Grossman & Van Dam, 2011).
Despite these concerns, the initial studies described earlier helped establish a research focus on the ethical and
moral qualities that emerge from training in contemplative practice. Measures that move beyond retrospective
self-report will be critical for testing whether meditation promotes virtuous outcomes. In accordance with this

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view, Lutz et al. (2007) called for research that examines how meditation affects behavior outside of the
laboratory and basic mental functions in everyday life. This perspective echoes the message from social
psychologists who have called for the use of field research and real-world behavior throughout psychology
(Baumeister, Vohs, & Funder, 2007; Cialdini, 2009).
Studies to date have measured behaviors indirectly related to compassion and the reduction of another’s
suffering. Measures used to assess prosocial behavior, for example, include implicit categorization of social
stimuli as a measure of social affiliation (Hutcherson, Seppala, & Gross, 2008; Kang, Gray, & Dovidio,
2014); nonverbal behaviors indicating affiliation, interest, or a lack of hostility (Kemeny et al., 2012); or
economic generosity in computer-based video games and transactions (Leiberg, Klimecki, & Singer, 2011;
Weng et al., 2013). A brief seven-minute LKM practice in the laboratory, for example, has been shown to
affect explicit and implicit positive social evaluations of neutral others even after very brief practice (e.g.,
Hutcherson et al., 2008), thus providing evidence for potential links between meditation and interpersonal
harmony. Research in this direction has also shown that LKM reduces implicit prejudice toward different
social groups (Kang et al., 2014). These studies are encouraging and suggest the role that meditation might
play in promoting positive social behaviors and relationships.
A number of researchers, including our colleagues in the present volume, investigated the impact of
meditation on neural reactivity to the suffering of others (see chapter 9 by Singer and Klimecki; chapter 11 by
Weng and Davidson). Several independent groups have demonstrated that compassion-based meditation—a
technique similar to, but distinct from LKM—increased people’s empathic responses to others’ suffering
(Klimecki, Leiberg, Ricard, & Singer, 2014; Lutz, Brefczynski-Lewis, Johnstone, & Davidson, 2008;
Mascaro, Rilling, Tenzin Negi, & Raison, 2013). Moreover, this increased empathic response has been shown
to predict subsequent prosocial acts. As one example, loving-kindness–based training increased economic
generosity in computer-based transactions, which were predicted by mediation-induced changes in neural
reactivity to others’ suffering (Weng et al., 2013).
Even as scientists have begun to examine the effects of meditation on prosocial behavior, the conclusions
that could be drawn with respect to compassion were limited by designs that lack real-time person-to-person
interactions centered on suffering. Prior studies utilized meditators’ behavior in computer-based economic
games requiring economic generosity or cooperation (e.g., Leiberg, Klimecki, & Singer, 2011; Weng et al.,
2013, 2015) to assess altruistic action. Such methods, while suggesting that meditation may increase
generalized prosocial responding, do not directly gauge responses meant to mitigate the suffering of others.
Social psychology stands to make critical contributions through methods that assess behavior in real time.
In an effort to link meditation to compassionate responses to the suffering of others directly, we constructed
a paradigm designed to reduce demand by unobtrusively measuring behaviors outside of a laboratory. We
utilized confederates (i.e., actors and actress feigning participation in research studies) to expose participants
to the suffering of another individual outside the laboratory. All confederates remained blind to the
hypotheses of a given experiment and to each participant’s experimental condition. Prior to the participant’s
arrival, two female confederates sat in a designated waiting area with three chairs. Upon arriving at the waiting
area, the participant sat in the last remaining chair. After the participant had been sitting for one minute, a
third female confederate, who played the role of the “sufferer,” appeared around the corner with crutches and
a large walking boot. The sufferer, who visibly winced while walking, stopped just as she arrived at the chairs.

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She then looked at her cell phone, audibly sighed in discomfort, and leaned back against a wall.
To assess compassionate responding, we measured whether the true participant offered his or her seat to
the sufferer to relieve her pain. One of the sitting confederates surreptitiously notified the experimenter, who
was waiting out of sight, via text message whether the participant offered the seat to the sufferer. If two
minutes passed and the participant had not given up his or her seat, the trial was ended and coded as a non-
helping response. The experimenter then entered the waiting area, greeted the participant, and escorted him
or her to the laboratory to complete a series of unrelated measures. Of greatest import, this scenario
constitutes a classic “bystander” situation, in which the presence of unresponsive others typically leads to a
reduction in helping (Darley & Latané, 1968; Fischer et al., 2011).
Our initial research demonstrated that eight weeks of training in either compassion- or mindfulness-based
meditation significantly enhanced the likelihood that individuals would offer their seat to relieve the pain of
the suffering confederate (50%), compared with those in a wait-list control (15%) (Condon, Desbordes,
Miller, & DeSteno, 2013). This enhanced compassionate response occurred even within the context of a
bystander situation in which others ignore the person’s suffering (Darley & Latané, 1968). Importantly, the
mindfulness-based training group did not include any explicit discussions of compassion or features of
compassion training. Those completing compassion- and mindfulness-training were equally likely to provide
help, suggesting that discussions of compassion that occurred within the compassion course were not entirely
responsible for producing enhanced compassionate action.
Together, these results provided initial confidence that compassion and mindfulness-mediation can
enhance compassionate responding beyond the influence of demand characteristics and participant
expectations. Yet much like other studies in the literature on meditation, the nature of our design required
that one group (i.e., meditators) come together for repeated classes, thereby creating a context that afforded
interaction with other individuals participating in the study. The wait-list group had no such possibility of
interacting with others due to participation in a structured class. The experience of repeated interactions with
fellow participants in a meditation course may have produced social consequences that could account for
increased levels of helping behavior relative to a wait-list control (e.g., increased social resources). To rule out
this possibility, we obtained a measure of the number of people whom participants interacted with on a
regular basis before and after training, using the Social Network Index (Cohen, Doyle, Skoner, Rabin, &
Gwaltney, 1997). Participants indicated the number of regular social contacts they interacted with by listing
the initials of each individual they interacted with at least once every two weeks across a range of social
categories (e.g., roommates, co-workers, family, friends, acquaintances). If the meditation classes increased social
capital, we would expect to find that those in the meditation group reported an increase in their number of
relationships at post-testing, relative to the wait-list group. Yet participants in the meditation group did not
experience a growth in their social network as a function of participating in an organized class. Thus, increases
in social capital as a result of participating in a group activity are unlikely to account for our central finding.
Nevertheless, we employed an active control group in subsequent research to address this limitation directly.
Given that many individuals will not have easy access to meditation courses taught in person by expert
practitioners or other certified teachers, we designed a subsequent experiment to examine the ability of
meditation training delivered via mobile devices to produce a similar increase in compassionate action (Lim,
Condon, & Desteno, 2015). If so, the scalability of using meditation as a compassion intervention would

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appear promising, as individuals could practice at their convenience during daily life simply through utilizing a
smartphone. Indeed, Weng et al. (2013) utilized specially created audio segments supplied as compact discs or
audio files as a primary tool for training in compassion meditation with good success. However, the use of
such techniques to enhance behaviors directly targeting the relief of suffering within a face-to-face
interpersonal context remained to be explored.
We utilized a framework similar to that of our previous work (Condon et al., 2013), in which participants
would take part in a brief course of meditation or not, and then be exposed to a situation that confronted them
with the opportunity to relieve the pain of another. Although similar in structure to our previous work, this
experiment possessed three key differences. The first involved the use of an active control group. Given that
the simple act of regular engagement in a task (as opposed to being assigned to a waiting list for a meditation
course) might itself produce affective or motivational changes, control participants in the present experiment
took part in a memory and cognitive skills training program. The second difference involved the use of a
smartphone-based method of instruction (for both the meditation and control courses of instruction). In our
previous work, an adept Buddhist instructor had delivered meditation instruction; here, meditation
instructions were provided through the commercially available Headspace platform, which was designed by an
individual with Buddhist monastic training. Finally, the current research focused solely on mindfulness
meditation as opposed to compassion meditation. Compassion training specifically emphasizes the
importance of examining the feelings of others and wishing for their freedom from suffering, and as such, it
raises the possibility that effects on prosocial behavior could stem from demand characteristics. Here, we only
examined the effects of mindfulness meditation on prosocial action, removed from concerns involving
demand.
As before, those completing mindfulness training demonstrated an increased rate of compassionate
responding to a confederate in need (37%) compared with those in the active control group (14%). Of
additional importance, the relative level of compassionate action in the active control group matched that of
the wait-list control group (16%) from our earlier work, suggesting that the 23% increase in helping among
meditating participants represented an increase from baseline (i.e., as opposed to stemming from the active
control training’s somehow producing a decrease in what would have been the normative level of
compassionate responding).
These findings are notable for several reasons. First, they serve as a robust replication of our initial findings
demonstrating that brief engagement in mindfulness meditation enhances compassionate behavior (Condon
et al., 2013). These findings also point to the potential scalability of meditation as a technique for building a
more compassionate society. As is clearly evident, many individuals do not have the luxury of access to, or
time to regularly attend, meditation training sessions with certified instructors. The ability to access expert
guidance using web- and mobile-based technology at little cost would greatly facilitate engagement in
contemplative practice by any interested individuals. Moreover, the potential for the spread of prosocial
behavior would be strengthened, not only by the increased numbers of individuals demonstrating increased
compassionate motivations, but also by a “pay-it-forward” effect among recipients of their kindness. As our
past work has shown, grateful beneficiaries of aid evidence a marked increase in their own likelihood to
subsequently extend help to others, even if these others are complete strangers (Bartlett & DeSteno, 2006;
DeSteno, Bartlett, Baumann, Williams, & Dickens, 2010).

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Enhancing Compassion Through Subtle Situational Cues
Social psychologists have investigated a variety of non-meditation based techniques that may also prove
effective for enhancing compassion. In particular, manipulations of subtle situational cues within an
environment can alter the likelihood that an onlooker will come to the aid of another person in need.
Experimental research indicates that increases in feelings of similarity (Valdesolo & Desteno, 2011) and
security (Mikulincer, Shaver, Gillath, & Nitzberg, 2005) enhance compassion and helping behavior. In both
lines of research, subtle cues were sufficient to increase feelings of compassion and downstream helping
behavior. In work from our laboratory, a simple manipulation of motor synchrony resulted in magnified
feelings of similarity to a stranger, which subsequently mediated the feeling of compassion for the stranger’s
plight and behaviors meant to assist him (Valdesolo & DeSteno, 2011). Mikulincer and colleagues (also see
chapter by Mikulincer and colleagues, this volume) likewise demonstrated that subtle manipulations of felt
security increased compassionate responding to the others’ suffering (Mikulincer et al., 2005). Participants in
these studies viewed subliminal primes of the names of secure attachment figures (e.g., the name a person who
had provided care and responsiveness in times of need, such as the participant’s mother, a close friend, or
other relationship partner) and later reported greater willingness to help a woman in need, compared with
participants who viewed subliminal primes of neutral content.
Interventions that incorporate these factors may stand as potential targets for interventions that do not
involve meditation-based training. It is interesting to note a potential common element that may tie some of
these relatively nascent findings together. The goal of many meditative techniques is to foster a state of
equanimity—a state in which the social categories typically used to separate people are broken down
(Desbordes et al., 2015). Such a state, by definition, increases the similarity seen between individuals. In turn,
the ability of subtle similarity manipulation to increase compassion may represent an efficient mechanism to
achieve similar benefits that come from more chronic training of the mind. This view is supported by work
showing that inductions of compassion enhance feelings of similarity to others (Oveis, Horberg, & Keltner,
2010), thereby suggesting a possible reciprocal interaction between the relevant mechanisms. A sense of
increased similarity to another individual, of course, stands as a marker that this individual is likely to be more
willing to repay the favor by providing subsequent aid in the future (de Waal, 2008). Importantly, increasing a
sense of similarity and oneness appears to be a viable route to extending compassion and interpersonal
harmony beyond one’s in-group (Dovidio et al., 1997; Dovidio, Gaertner, & Kawakami, 2003). For example,
Dovidio and colleagues found that the bias to help in-group members more than out-group members could be
reduced by leading participants to recategorize two groups as one. Moreover, initial evidence has
demonstrated the ability of meditation practices to alter categorization and implicit attitudes toward different
social groups (Kang et al., 2014; Lueke & Gibson, 2015).

Questions and Criticisms

We believe three major questions mark the agenda for future research on enhancing compassion. First, as
the field matures, it will be important to examine possible contextual factors that predict the degree to which
meditation increases compassionate outcomes (e.g., social context, practice settings). The next wave of
investigation should aim to understand the exact mechanisms associated with mindfulness- and compassion-
based training that may underlie their enhancement of prosocial behavior. Second, researchers should

381
prioritize investigations of individual susceptibility to compassion-based enhancements via meditation
training. Finally, we believe it fruitful to investigate meditation practice and situational cues as factors that can
help overcome “compassion fatigue” (see Figley and Figley, this volume) and the collapse of compassion in
which people are more likely to help a smaller number of victims compared with larger groups (cf. Cameron
& Payne, 2011). We discuss each in turn.
Our research demonstrated that mindfulness- and compassion-based meditation increases the likelihood of
prosocial responding. Of particular interest for future work is the possibility that mindfulness and
compassion-based meditation might increase compassionate outcomes via different mechanisms. Whereas
compassion meditation might increase compassionate behaviors through empathic processes and prosocial
emotion, mindfulness-meditation might increase compassionate behaviors through a number of plausible
mechanisms, including increased attention to all stimuli (MacLean et al., 2010), a reduction of self-related
affective biases (Hölzel, Lazar, et al., 2011; Vago & Silbersweig, 2012), or increases in executive functioning
(Sahdra et al., 2011). Future work should prioritize examination of practice-specific mediators of enhanced
compassionate behavior. Such investigations will aid us in determining whether different practices are more or
less effective for promoting compassionate outcomes for specific populations.
The second question for future research centers on integrating social psychological and personality
psychology approaches to compassion and prosocial behavior. From one perspective, situational forces (e.g.,
feelings of similarity or security) can modulate compassion. From a second perspective, chronic dispositions
(e.g., dispositional compassion) can modulate experiences of compassion. These competing perspectives
parallel a long-running debate between social and personality psychologists regarding the predictively validity
of personality traits or dispositions since the late 1960s. Whereas social psychologists favored explanations
that attributed human behavior to situational forces, personality psychologists argued that dispositions or traits
explained behavior. Walter Mischel (1968) wrote a landmark book that critiqued the trait approach, arguing
that traits only account for a limited amount of variance in behavior. Although the two fields have been
marked by division since that time, most personality and social psychologists generally take an interactionist
perspective in which personality factors and situations interact to produce behavior (Donnellan, Lucas, &
Fleeson, 2009).
Research on compassion and prosocial behavior appears to coincide with the interactionist perspective:
situations affect compassionate responding to the needs of others, but contextual variables and differences
between people can impact compassionate behavior meant to reduce the suffering of others. In this vein, our
laboratory has demonstrated that greater severity of past adversity predicts higher levels of empathic processes
and dispositional compassion. Moreover, these chronic variables predicted the intensity of affective states of
compassion and subsequent actions meant to aid those in need when exposed to another’s suffering (Lim &
DeSteno, 2016). Thus, compassionate states drive prosocial action, but its emergence can be a function of the
interaction between situational and chronic variables. We encourage investigators to take an interactionist
approach in future work.
Finally, an unresolved puzzle in this area of inquiry concerns the degree to which compassion is sustainable.
Many scholars have described the tendency to experience “compassion fatigue” through which repeated
instances of caregiving can give rise to empathic distress (e.g., Figley, 2002; see Figley and Figley, this volume;
see also Klimecki & Singer, 2012). In a similar vein, Cameron and colleagues (see Cameron, this volume;

382
Cameron & Payne, 2011) have demonstrated that people down-regulate experiences of compassion when they
anticipate a request for help from a large number of people, compared with a smaller number. In a similar
vein, people are more likely to care and provide help for a specific, identified individual than for a large group
of unidentified victims (Jenni & Loewenstein, 1997; Small & Loewenstein, 2003). Although speculative, the
present review suggests that meditation-based practices may provide a viable route to overcoming these
barriers to large-scale and sustainable compassion. Indeed, as our colleagues in this volume have
demonstrated, contemplative practices have been shown to increase the ability to experience compassionate
mental states, rather than empathic distress, when presented with another’s suffering (e.g., Klimecki, Leiberg,
Ricard, & Singer, 2014). It remains to be investigated whether such training would prevent burnout in
contexts that require long-term care or helping a large number of people in need. Although humans are
susceptible to situational forces that lead to the ignorance of others’ suffering, humans are also readily
amenable to situational forces that tip the scales in favor of compassionate responding. Moreover, such
behaviors can be increased through simple, readily available exercises such as mindfulness- and compassion-
based meditation. The doors are open for future investigations to build on this work toward a more
compassionate society.

383
Note
1. At the time, and for many years following, the historical record shows, there were reports that 38 onlookers in a busy, metropolitan setting
witnessed the murder of Ms. Genovese but failed to come to her assistance. The case of Ms. Genovese has recently been reconstructed, with
some authors suggesting that there is no evidence that 38 onlookers directly observed the incident (Manning, Levine, & Collins, 2007).
Nevertheless, the original reports of the event were an impetus for academic interest in situational influences on prosocial behavior (Batson,
2012).

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 Empathy, Compassion, and Social Relationships

Mark H. Davis

Abstract

Empathy is widely recognized to have multiple facets, both affective and cognitive. This chapter reviews
evidence regarding the effect on social relationships of two of these facets: compassion and perspective-
taking. The focus is on three domains: smooth social functioning/relationship quality, social support,
and responses to partner transgression. Evidence indicates that perspective-taking is consistently related
to measures of relationship quality, including global relationship satisfaction and interpersonal hostility.
In contrast, compassion displays weaker and less consistent associations. A similar pattern is found for
social support; perspective-taking has a consistent beneficial effect on the provision of various types of
relationship support; the effects of compassion are weaker. A different pattern emerges for reactions to
partner transgression. By far the strongest predictor of forgiveness is experiencing compassion for the
transgressor. Finally, the limited evidence from studies examining these issues cross-culturally suggests
that these patterns hold in non-American samples as well.

Key Words: empathy, sympathy, perspective-taking, compassion, social support, relationship

satisfaction, hostility, forgiveness

The idea that social intercourse is significantly influenced by the capacity for empathy is certainly not new.
Centuries ago, Smith (1759/1976) and Spencer (1870) both argued that important social consequences flow
from our tendency to “sympathize” with others’ experiences—that is, to share a “fellow feeling” with them.
Later theorists with a decidedly more cognitive view of empathy (e.g., Mead 1934; Piaget 1932) have also
held that possessing such a capacity improves social life. What both approaches have in common is the
recognition that empathy in some guise is necessary to help us deal with the fundamental obstacle in social
life: namely, other people. Over the past four decades, the role of empathy within social relationships has been
examined in a variety of ways. This chapter will review some of this evidence in an attempt to answer two
questions: (1) What are the most consistent associations between empathy and social functioning? and (2)
How consistent are these associations across cultures?
However, given this volume’s focus on compassion, it is necessary to offer some explanation of the
relationship between empathy and compassion. In short, it is my belief that the best way to define empathy is
broadly and inclusively—as a set of constructs all having to do with the responses of one individual to the
experiences of another. Compassion is one of these constructs, and an especially important one. Thus,
research on empathy’s role in social relationships has frequently examined the effect of compassion, though
rarely referring to it by that name.

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What Is Empathy?
Attempts to define empathy have a long and convoluted history. Over the years, it has been conceived of as
a cognitive process (e.g., Wispé, 1986), as an accurate understanding of another (e.g., Dymond, 1950), as a
sharing of emotional states with a target (e.g., Hoffman, 1984), and as the specific emotional response of
sympathy (e.g., Batson, 1991). Previously, I offered a model designed to organize all of these approaches into a
comprehensive treatment of the empathy process; Figure 23.1 contains a somewhat revised and updated
version of this model (Davis, 2006). In contrast to much previous work, the spirit of this model is deliberately
inclusive, designed to emphasize the connections between these constructs. Thus, empathy is broadly defined
as a set of constructs having to do with the responses of one individual to the experiences of another. These
constructs specifically include both the processes taking place within the observer and the affective and non-
affective outcomes that result from those processes. Based on this definition, the model conceives of the typical
empathy “episode” as consisting of an observer’s being exposed in some fashion to a target, after which some
response by the observer—cognitive, affective, motivational, and/or behavioral—occurs. Four related
constructs can be identified within this prototypical episode: antecedents, which refer to characteristics of the
observer, target, or situation; processes, which refer to the particular mechanisms by which empathic outcomes
are produced; intrapersonal outcomes, which refer to cognitive, affective, and motivational responses produced
in the observer that are not necessarily manifested in overt behavior; and interpersonal outcomes, which refer to
behavioral responses directed toward the target. Behaviors that influence one’s social relationships—for better
or worse—represent an important category of interpersonal outcomes.

Antecedents
THE PERSON

All observers bring to an episode certain characteristics that have the potential to influence both processes
and outcomes. Most important for the purposes of this chapter are individual differences in personality.
Various measures have been developed over the years to assess the dispositional tendency to engage in
empathy-related processes such as perspective-taking (e.g., Davis, 1980; Hogan, 1969) or to experience
empathy-related affective responses (e.g., Davis, 1980; Mehrabian & Epstein, 1972). Of special note here are
two individual differences that are likely to influence interpersonal behavior: the tendency to take the
perspective of other people, and the tendency to experience feelings of sympathy for a person in distress.

Figure 23.1 Organizational model of empathy.

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THE SITUATION

All responses to another person, whether cognitive or affective, emerge from some specific situational
context, and these contexts vary along certain dimensions. One such dimension is the strength of the situation,
defined as its power to evoke an emotional response from observers. For example, a situation that includes a
clear display of negative emotion by a weak or helpless target is particularly able to engender powerful observer
emotions and would be classified as a “strong” situation. In contrast, situations lacking such evocative
emotional cues would be characterized as relatively weak. A second situational feature is the degree of similarity
between the observer and the target. (Actually, of course, similarity is a joint function of both the target and
the observer, but for the sake of convenience, it is considered here.)

Processes
The model’s second major construct consists of the specific processes that generate empathic outcomes in
the observer. Based on the work of Hoffman (1984) and Eisenberg (Eisenberg, Shea, Carlo, & Knight, 1991),
the model identifies three broad classes of empathy-related processes, chiefly distinguished from one another
by the degree of cognitive effort and sophistication required for their operation. In a sense, it is potentially
misleading to characterize these processes as either “cognitive” or “affective.” It is the outcomes of these
processes that can be more clearly identified in this way, and each process is capable of producing both
cognitive and affective outcomes. However, given the clear differences in the levels of cognitive sophistication
required for their operation, it seems reasonable to use this dimension to describe these three broad classes.

NONCOGNITIVE PROCESSES

Some processes that lead to empathic outcomes require very little cognitive activity. The apparently innate
tendency for newborns to cry in response to hearing others cry, which Hoffman (1984) refers to as the primary
circular reaction, is one example. Another noncognitive process is motor mimicry, the tendency for observers
automatically and unconsciously to imitate the target. Early conceptions of mimicry viewed it as a somewhat
deliberate strategy for “feeling into” the other, but more recent approaches (e.g., Hatfield, Cacioppo, &
Rapson, 1994; Hoffman, 1984; van Baaren, Decety, Dijksterhuis, van der Lie, & Leeuwen, 2009) have
treated it as a relatively automatic, largely noncognitive process.

SIMPLE COGNITIVE PROCESSES

In contrast to the noncognitive processes, other processes require at least a rudimentary cognitive ability on
the part of the observer. Classical conditioning is an example; if an observer has previously perceived affective
cues in others while experiencing that same affect (perhaps because both observer and target are
simultaneously exposed to the same unpleasant stimulus), then the affective cues of targets may come to evoke
that emotional state. For example, if a beloved childhood pet dies and two siblings are both saddened to the
point of tears, the emotional state experienced by one sibling (sadness) may become associated with the sight
of distress cues in the other sibling. In the future, seeing such cues in other people may evoke such feelings of
sadness. Similar processes of comparably modest sophistication—direct association (Hoffman, 1984) and
labeling (Eisenberg et al., 1991)—have also been proposed. For instance, an observer may know that certain
situations (like college graduations) usually produce happiness. Witnessing someone graduate may lead to the

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inference that the person is happy, regardless of other cues that may be present.

ADVANCED COGNITIVE PROCESSES

Finally, some processes require rather advanced kinds of cognitive activity. One example is what Hoffman
refers to as language-mediated association, in which the observer’s reaction to the target’s plight is produced by
activating language-based cognitive networks that trigger associations with the observer’s own feelings or
experiences. A target who says “I’ve been laid off” may display no obvious facial or vocal cues indicating
distress, but an observer may respond empathically because personal relevant memories are activated by the
target’s words. Eisenberg et al.’s (1991) elaborated cognitive networks and Karniol’s (1986) rule-transformation
model describe similar processes. The most advanced process, however, and the one that has received the most
empirical attention, is perspective-taking: the attempts by one individual to understand another by imagining
the other’s perspective. It is typically conceived of as an effortful process, involving both the suppression of
one’s own egocentric perspective on events and the active entertaining of someone else’s.

Intrapersonal Outcomes
The model’s third major construct consists of intrapersonal outcomes—the cognitive, affective, and
motivational responses of the observer that result from exposure to the target. These outcomes are thought to
result primarily from the various processes identified at the previous stage in the model.

COGNITIVE OUTCOMES

One cognitive outcome is interpersonal accuracy, the successful estimation of other people’s thoughts,
feelings, and characteristics (e.g., Dymond, 1950; Ickes, 1997). More recently, perspective-taking has been
linked to changes in the cognitive representations that perceivers form of targets—in particular, the degree to
which these representations resemble the cognitive representations of the self (Davis, Conklin, Smith, &
Luce, 1996; Galinsky & Moskowitz, 2000). Davis et al. (1996), for example, had observers rate themselves
and a target on a lengthy adjective checklist. Those receiving perspective-taking instructions subsequently
rated the target as possessing a greater proportion of traits that they had earlier ascribed to themselves—in
essence, a greater merging of the cognitive representations of self and other.

AFFECTIVE OUTCOMES

This category, affective outcomes, consists of the emotional reactions experienced by an observer in
response to the observed experiences of the target, and it is further subdivided into two forms: parallel and
reactive outcomes. A parallel emotion may in a sense be considered the prototypical affective response: an
actual reproduction in an observer of the target’s feelings. This sort of emotional “matching” has been the
focus of several historical approaches (Spencer, 1870; McDougall, 1908) and some contemporary ones
(Eisenberg & Strayer, 1987). Reactive emotions, on the other hand, are defined as affective reactions to the
experiences of others that differ from the observed affect. They are so named because they are empathic
reactions to another’s state rather than a simple reproduction of that state in the observer. One response clearly
falling into this category is the feeling of compassion for others referred to variously as sympathy (Wispé,
1986), empathy (Batson, 1991), and empathic concern (Davis, 1983).

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MOTIVATIONAL OUTCOMES

A third category of intrapersonal outcomes, somewhat related to the second, encompasses the motivational
states produced in the observer by empathy-related processes. For example, forgiveness is often conceptualized
as a transformation of motivation toward a transgressing partner, in which desires for revenge are reduced and
desires for reconciliation are increased (Kelley, Holmes, Kerr, Reis, Rusbult, & Van Lange, 2003;
McCullough, Worthington, & Rachal, 1997). More generally, empathic processes have also been linked to
increased motivation to value the other’s outcomes (Batson, Turk, Shaw, & Klein, 1995)—that is, to value the
general happiness and welfare of another person.

Interpersonal Outcomes
The final construct in the model consists of interpersonal outcomes, defined as behaviors directed toward a
target that result from prior exposure to that target. The outcome that has attracted the most attention from
empathy theorists and researchers is prosocial behavior; both cognitive and affective facets of empathy have
long been thought to contribute to the likelihood of observers’ offering help to needy targets. Aggressive
behavior has also been linked theoretically to empathy-related processes and dispositions, with the expectation
that empathy will be negatively associated with aggressive actions. A final interpersonal outcome—and the
one this chapter will be concerned with—are the behaviors that occur within social relationships.
There are, of course, various ways in which empathy-related processes and intrapersonal outcomes might
play a role in social relationships. Some of these might result from empathy contributing to “pro-relationship”
behaviors such as helping, generosity, and collaboration; others might result from empathy inhibiting “anti-
relationship” behaviors such as conflict, rudeness, and selfishness. In addition, empathy may have an effect on
relationships because of its role in routine day-to-day relationship maintenance, but it may also play a role at
critically important times when the relationship faces much more serious threats, such as those posed by
serious partner misbehavior. Research addressing each of these possibilities will be described in this chapter.

Empathy and Compassion: A Very Brief Overview

Where does compassion fit into this model? I believe that compassion—defined as sensitivity to the pain or
suffering of another, coupled with a deep desire to alleviate that suffering (Goetz, Keltner, & Simon-Thomas,
2010)—aligns almost perfectly with the construct typically referred to in empathy research as empathic concern.
Empathic concern is an emotional response to another person that is characterized by tender feelings of
concern and sympathy for that person (“sensitivity to the pain or suffering of another”). Considerable evidence
indicates that such feelings are frequently accompanied by the valuing of the target’s welfare, and an increased
likelihood of offering help, even if such help is costly (“deep desire to alleviate that suffering”). For these
reasons, I believe that investigations of empathic concern can, by and large, be considered investigations of
compassion. Research has sometimes treated empathic concern as a transient emotional state and sometimes
as a stable personality trait; this chapter will review both types of research.
In addition, compassion is related somewhat less directly to another major empathy construct: perspective-
taking. Perspective-taking is a sophisticated cognitive process that may influence social relationships through
pathways that have nothing to do with compassion (e.g., accurate perceptions of one’s partner). However, and
importantly, perspective-taking can be seen as relevant to compassion. A considerable body of research has

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documented the link between taking the perspective of another person and experiencing feelings of empathic
concern for that person (see Davis, 1994, for a review of this literature). Thus, the cognitive form of empathy,
in addition to any non-affective outcomes it may produce, will often contribute substantially to feelings of
compassion as well.

What Are the Associations Between Empathy/Compassion and Social Functioning?

Given the many ways in which empathy has been conceptualized, it will come as no surprise to learn that
the hypothesized relations between empathy and social functioning have taken many different forms. A wide
variety of possible links between empathy and social behavior has been suggested over the years, including
possible effects on prosocial behavior (Batson, 1991; also Chapter 3), aggression (Miller & Eisenberg, 1988),
attributions for the behavior of social partners (Bradbury & Fincham, 1990), social support (Verhofstadt,
Buysse, Ickes, Davis, & Devoldre, 2008), forgiveness for partner transgressions (McCullough et al., 1998),
behavioral synchrony during interactions (Chartrand & Bargh, 1999), and self-disclosure (Davis & Kraus,
1991). A full review of this literature is beyond the scope of this chapter. Instead, I will focus on three
domains: smooth social functioning/relationship quality, social support, and responses to partner
transgression.

Smooth Social Functioning/ Relationship Quality

One way empathy may influence social life is by providing a mechanism for smoothing out its rough edges.
Given the robust self-interest with which all of us are imbued, social life contains plentiful opportunities for
interpersonal friction. Compassion for our social partners, and a willingness to entertain their points of view,
can counteract such friction.

GLOBAL SATISFACTION

One straightforward way of assessing social functioning is by measuring overall relationship satisfaction.
While such satisfaction is undoubtedly influenced by many factors, it seems likely that relationship quality will
be higher for more empathic participants. Attempts to link empathy to such overall satisfaction have routinely
used dispositional measures of empathy, and the evidence suggests that such measures are reliably associated
with global satisfaction.
Franzoi, Davis, and Young (1985) had both members of romantic couples complete questionnaires that
included measures of dispositional perspective-taking (the Perspective Taking [PT] scale from the
Interpersonal Reactivity Index [IRI]) and satisfaction with the relationship. Males’ satisfaction with the
relationship was significantly and positively associated with their own PT scores and with the PT scores of
their partner; females’ satisfaction was similarly associated with their own PT scores, but not with the scores of
their partner. In a somewhat similar investigation, however, Fincham and Bradbury (1989) found conflicting
results. As part of a larger study, perspective-taking (PT scale) and marital satisfaction were assessed for both
members of married couples. Husbands’ satisfaction was significantly and positively related to their own PT
scores, but not their wives’; wives’ satisfaction was unrelated to PT scores of either spouse.
Long and Andrews (1990) examined this issue in a more comprehensive fashion. Both spouses completed a
questionnaire that included a measure of marital adjustment (essentially, satisfaction with the marriage) and

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three perspective-taking scales: (1) the PT scale, (2) a scale assessing one’s tendency to specifically adopt the
perspective of one’s marital partner (rather than people in general), and (3) a measure of the respondents’
perceptions of their partners’ perspective-taking tendency. Analyses were conducted in which one spouse’s (A’s)
satisfaction was predicted by the other spouse’s (B’s) general PT, by partner-specific PT, and by A’s
perceptions of B’s PT. For both husbands and wives, marital adjustment was significantly associated with all
three perspective-taking indices. However, perceptions of one’s partner’s perspective-taking displayed the
strongest association with one’s marital adjustment; perceiving one’s partner to be high in perspective-taking
tendency was associated with better adjustment. The partner’s self-reported tendency to role-take within the
relationship was similarly, albeit less strongly, associated. Unexpectedly, however, once the effects of these two
variables were statistically accounted for, partner’s general perspective-taking was actually negatively associated
with one’s marital adjustment.
Levesque, Lafontaine, Caron, Flesch, and Bjornson (2014) also assessed partner-specific PT and Empathic
Concern (EC), self-reported coping strategies to partner distress, and relationship satisfaction. Using a sample
of Canadian heterosexual couples, they found that for both men and women, having greater feelings of
empathic concern for their partners was strongly associated with their own levels of satisfaction; in contrast,
partner-specific PT was not related to satisfaction.
Rusbult, Verette, Whitney, Slovik, and Lipkus (1991), in a larger investigation examining accommodation
in close relationships (to be described in more detail later), had individual participants (not couples) complete
measures of relationship satisfaction, general perspective-taking (PT scale), a measure of partner-specific
perspective-taking similar to the measure used by Long and Andrews, and a measure of dispositional
empathic concern (the IRI’s EC scale). Multiple regression analyses revealed that partner-specific perspective-
taking was significantly and positively related to one’s own satisfaction, while general perspective-taking and
empathic concern were not. Thus, the greater one’s tendency to entertain the specific perspective of one’s
romantic partner, the greater one’s own satisfaction.
This issue has also been examined in non-romantic relationships, almost entirely with children and
adolescent populations. Smith and Rose (2011), using same-sex friendship dyads in middle school, examined
the influence of several variables on friendship quality. For this review, we may focus our attention on their
measure of “social perspective-taking,” which consisted of six items from the IRI’s PT scale, and 13 items
from the Empathy Quotient (EQ; Baron-Cohen & Wheelwright, 2004). All of the items were revised to
specifically measure the tendency to engage in perspective-taking within the particular relationship. Such
dyad-specific PT was significantly and positively related to the measure of friendship quality; the more that
individual dyad members engaged in perspective-taking, the more positively they perceived their relationship.
Chow, Ruhl, and Buhrmester (2013) used the Actor–Partner Interdependence Model (APIM) to examine
tenth-graders in same-sex friend dyads. Empathy was measured by means of the IRI’s PT and EC scales, but
instead of treating them as separate constructs, Chow et al. combined them into a single empathy measure. As
expected, empathy was positively associated with friendship closeness (which seems a reasonable indicator of
satisfaction) and negatively related to friendship discord. Clark and Ladd (2000) examined the
“socioemotional orientation” of five-year-olds, measured by means of teacher ratings of the degree to which
the children expressed concern for others in distress and offered help or comfort. These ratings were
substantially correlated with teacher ratings of the quality of the children’s friendships.

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 Taken as a whole, the results of these studies reveal an interesting pattern. A tendency to take the specific
perspective of one’s relationship partner was consistently positively associated with one’s own satisfaction and
that of one’s partner. Measures of global perspective-taking, on the other hand, tended to display similar but
weaker associations. This pattern highlights the value of assessing dispositional empathy in a way that is most
appropriate to the social context in question—when the context is a particular relationship, then a measure of
empathic tendencies specific to that relationship is likely to be most useful. Empathic concern was not always
included in these investigations; when it was, its effects were similar to those of perspective-taking, but tended
to be weaker.

POPULARITY/SOCIAL SKILLS

Another way to measure social competence is through indices of popularity and social skillfulness. Such an
approach has been taken primarily in studies of children and adolescents, often within a school context. For
example, Eisenberg, Fabes, Murphy, Karbon, Smith, and Maszk (1996) examined dispositional sympathy in
second-graders using a measure composed of items specifically measuring feelings of compassion for others, as
well as some items from Bryant’s (1982) scale that seemed most likely to capture feelings of sympathy. Scores
on this measure of dispositional compassion were associated with greater social skill (as rated by the teacher)
and popularity with peers (as rated by the peers). Similarly, in the Clark and Ladd (2000) study described
earlier, children’s socioemotional orientation (essentially compassion) was associated with number of friends
(mutual friendship nominations) and peer acceptance (as rated by peers).

HOSTILITY AND CONFLICT

A third way to assess the smoothness of social functioning is by directly assessing the level of hostile or
aggressive behavior. Theoretically, empathy might be associated with lower levels of hostility for two broad
reasons. First, observers’ emotional responses to the distress of others may lessen their likelihood of aggressing
against those others. Thus, victim distress can produce compassion in perpetrator-observers, and this may
then lead the observer to stop or reduce the aggression. The second way in which empathy might reduce the
occurrence of hostile and aggressive actions is through the process of perspective-taking. That is, adopting the
point of view of a person who acts in a potentially provocative way may lead to a more tolerant and
understanding perception of that person’s actions; such tolerance can consequently reduce the likelihood that
retaliation will occur.
One method for evaluating the general proposition that empathy will be related to interpersonal hostility is
to examine the association between individual difference measures of these two constructs. Davis (1994)
reported data from a sample of college students who completed the IRI and two widely used measures of
dispositional hostility: the Buss-Durkee (Buss & Durkee, 1957) and Cook-Medley (Cook & Medley, 1954)
hostility scales. A series of multiple regression analyses was carried out in which the IRI scales served as
predictor variables, and the various hostility measures served as dependent variables. Among males, PT scores
were significantly associated with the most global measures of hostility—the Buss-Durkee and Cook-Medley
total scores; for females, only EC had a significant effect on any global measure (the Cook-Medley measure).
More interesting is the pattern found when IRI scores were used to predict the separate sub-scales making up
the Buss-Durkee total score. Dispositional empathy was associated with antagonistic hostility—the tendency

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to be physically and verbally hostile to others—but the pattern varied for men and women. Women displayed
significant negative associations between measures of antagonistic hostility and dispositional empathic
concern, while men did not; men displayed a negative association between antagonistic hostility and
dispositional perspective-taking, while women did not.
Another way to examine empathy’s contribution to hostility is by considering actual behavior, either
observed or self-reported. Such efforts have focused largely on dispositional PT. For example, Davis and
Kraus (1991) reported, in two samples of adolescent and pre-adolescent boys, a significant negative correlation
between dispositional PT and their self-reported number of fights and arguments over the previous two years.
Sessa (1996), in an investigation of nursing teams, found that teams with higher mean scores on measures of
dispositional perspective-taking tended to perceive their group as having less “people-oriented” conflict (which
is especially damaging) and more “task-oriented” conflict (which is less damaging). In two investigations
(Richardson, Hammock, Smith, Gardner, & Signo, 1994; Richardson, Green, & Lago, 1998), Richardson
examined the link between dispositional PT and actual verbal aggression in a laboratory setting and found
evidence that high perspective-takers were less likely to retaliate against opponents who had mildly provoked
them.
Empathy’s role in affecting hostility toward important social partners has also received attention. Loudin,
Loukas, and Robinson (2003) had college students complete the PT and EC scales of the IRI as well as a
measure of relational aggression, defined as “harming others through purposeful manipulation of and damage
to interpersonal relationships” (p. 431). For instance, deliberately excluding someone from a group would be
an example of such aggression. Regression analyses revealed that dispositional PT was significantly and
negatively associated with relational aggression, and that this relationship held for both men and women. In
contrast, dispositional EC had such a relationship with aggression only for men.
Péloquin, Lafontaine, and Brassard (2011) conducted a study using both members of Canadian cohabiting
couples. Each member of the couple completed partner-specific versions of the PT and EC scales, as well as a
measure of psychological aggression assessing the frequency with which they had committed a variety of
hostile acts that did not involve physical aggression (e.g., demeaning one’s partner verbally; destroying one of
his/her possessions). Similar to the Loudin et al. (2003) study, taking the partner’s perspective was found to be
significantly and negatively associated with committing psychologically aggressive acts toward that partner,
and this relationship was found for both men and women. Partner-specific EC was associated with lower
aggression, but only among women.
Finally, research with younger populations has also supported the link between empathy and interpersonal
conflict. The Clark and Ladd (2000) study of five-year-olds described earlier found that children’s
dispositional compassion was negatively associated with level of conflict with peers, as rated by their teachers.
Similarly, in the Chow et al. (2013) investigation of friendship dyads in tenth-graders, the combined PT/EC
empathy measure was significantly related to effective conflict management, which was in turn negatively
associated with discord in the friendship.
Taken as a whole, the very clear pattern that emerges from research in this area is that dispositional PT is
the most consistent and reliable influence on hostility/aggression, no matter how such aggression is
operationally defined. Other facets of empathy also play a role, but their effects are often moderated by other
variables—most notably gender—and often not in consistent ways. As a consequence, the evidence seems

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substantially stronger for the second theoretical mechanism by which empathy and aggression may be linked;
it appears that aggression is most reliably inhibited, not by the potential perpetrator’s affective responses, but
by the more cognitive process of trying to apprehend the other’s point of view.

NON-U.S. EVIDENCE

Several investigations conducted outside the United States have examined the association between empathy
and overall relationship satisfaction. Two of them focused on friendships in adolescent populations. Soenens,
Duriez, Vansteenkiste, and Goossens (2007) examined Belgian adolescents and found that both the PT scale
and the EC scale were associated with the self-reported quality of the relationship with their best friends.
However, when both forms of empathy were included in a structural equation model, the effect of EC
dropped to nonsignificance, while the effect of PT remained. In a similar vein, Wölfer, Cortina, and Baumert
(2012) studied the relationship between empathy and embeddedness in one’s social network in a group of
German seventh-graders. Empathy was assessed in the same way used by Chow et al. (2013), by combining
the IRI’s PT and EC scales. Embeddedness was measured by having all members of a class make friendship
nominations; the greater the number of nominations made and received, the more embedded in the social
network one is said to be. Greater empathy was associated with greater embeddedness.
Other studies have focused on romantic relationship satisfaction. In two studies primarily devoted to the
topic of forgiveness in Italian married couples, Fincham, Paleari, and Regalia (2002) and Paleari, Regalia, and
Fincham (2005) assessed the amount of compassion felt toward one’s spouse after that spouse’s most recent
relationship offense, and the overall level of relationship quality. In both investigations, the amount of
compassion felt by husbands was significantly correlated with relationship satisfaction; for wives, those
correlations were weaker and less reliable. Using a sample of Korean teachers, Chung (2014) found that trait
empathy was significantly associated with marital satisfaction for both husbands and wives. The empathy
measure was a Korean version of Mehrabian and Epstein’s (1972) measure of emotional empathy, which
includes items measuring compassion, but also general emotionality and emotional contagion. Finally, in a
study directly comparing American and Chinese undergraduate students, Lin and Rusbult (1995) found that
relationship satisfaction was associated with a measure of partner-specific PT.
Studies outside the United States have also examined the link between dispositional empathy and aggressive
behavior. In an investigation of Dutch boys and girls, deKemp, Overbeek, de Wied, Engels, and Scholte
(2007) assessed emotional empathy using a questionnaire developed by Bryant (1982), and assessed aggressive
behavior toward other people by means of an eight-item self-report instrument measuring aggressive actions
over the previous six months. For both boys and girls, dispositional emotional empathy was significantly
negatively associated with aggression. Gini, Albiero, Benelli, and Altoè (2007) also examined aggressive
behavior in a sample of youth, in this case Italian adolescents attending a middle school. Dispositional
empathy was measured with an Italian version of the IRI. Aggressive behavior was assessed through a peer-
nomination process in which the students were asked to nominate classmates who initiated or contributed to
bullying other students. Both dispositional PT and EC were associated with lower levels of aggression;
however, this pattern was only significant for males.

Social Support

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 Another domain in which empathy may play a meaningful role is social support, broadly defined as the kind
of everyday assistance that we provide to one another (Pasch & Bradbury, 1998). Social support is considered
a key element of relationship maintenance and marital well-being (Bradbury, Fincham, & Beach, 2000;
Bradbury & Karney, 2004), and greater support from the partner is associated with greater marital satisfaction
(Cramer, 2004; Pasch & Bradbury, 1998; Pasch, Bradbury, & Sullivan, 1997).
It is also possible to distinguish among different types of support. In particular, researchers have identified
both positive and negative forms of support provision (Pasch, Harris, Sullivan, & Bradbury, 2004). Two
different positive forms can be distinguished; namely, emotional and instrumental support provision.
Emotional support provision is aimed at the management of emotions; reassuring one’s spouse, or providing
encouragement, would be examples of such support. In contrast, instrumental support attempts to deal
directly with the problem; when providing such aid, one might offer specific suggestions, give helpful advice,
or provide access to information regarding the problem. In contrast to these two forms of positive support,
examples of negative support provision would include criticizing or blaming the spouse, expressing negative
affect at the spouse, and minimizing the problem (Bradbury & Pasch, 1994; Cohen, Gottlieb, & Underwood,
2000). Of course, in a very real sense, such responses do not constitute support at all. However, they usually
occur in response to a support-seeker’s implicit or explicit appear for help, and are often intended by the
support-provider as legitimate forms of aid.
Empathy might be expected to influence social support for two reasons. First, perspective-taking might
allow an individual to understand when a partner requires support and to accurately determine the form it
should take. Second, feelings of compassion for the partner might serve a motivational function, leading the
person to more readily offer help. In both cases, the effect of empathy should be beneficial. Instrumental and
emotional support should be associated with higher levels of perspective-taking and compassion; in general,
the opposite pattern should be found for negative support. To a considerable degree, this is indeed the pattern
that has been found, although there are exceptions as well.
Two early investigations by Davis and Oathout (1987; 1992) can be seen as examining this issue, although
the research was not explicitly framed as an investigation of social support. In both studies, college students in
romantic relationships completed the IRI, and they also reported on how frequently they displayed certain
specific behaviors toward their partners; a number of those behaviors can be considered forms of social
support. It was found that, for both men and women, dispositional EC was positively associated with a cluster
of behaviors that included being supportive, generous, and loving toward one’s partner. Dispositional PT, for
both men and women, was inversely related to what can be considered negative social support: a cluster of
behaviors including being critical, nagging, rude, and dominating.
In recent years, a much more concerted effort to examine empathy’s role in social support has been made.
Using various ways to assess social support, a team of Belgian researchers has documented the ways in which
empathy is related to marital support. One set of studies focused on self-reports of social support and their
relationship with dispositional empathy. Devoldre, Davis, Verhofstadt, and Buysse (2010) carried out two
studies to examine this question. In the first, they asked female college students to complete a measure
assessing the degree to which they provided emotional, instrumental, and negative support to their romantic
partners; in the second study, they asked the same questions of both members of a sample of married couples.
In each study, the participants also completed a Dutch version of the IRI. Overall, each of the three forms of

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dispositional empathy displayed significant associations with support provision. The most consistent effects
may be summarized as follows: (1) dispositional perspective-taking was associated with providing more
instrumental support; (2) dispositional perspective-taking was associated with providing less negative support;
and (3) dispositional personal distress was associated with providing more negative support.
Devoldre, Verhofstadt, Davis, and Buysse (2013) addressed the same question but used a different
technique for assessing support. Rather than relying on global self-reports of their behavior in the
relationship, Devoldre et al. presented participants with a series of hypothetical scenarios in which they were
to imagine their romantic partners’ experiencing some form of stress; they were then asked to choose their
likeliest response from a set of possible options. Some options reflected instrumental support, some emotional,
and some negative. In addition, each of those types of support appeared in two forms—either directive or
non-directive. This distinction has to do with the degree to which the support provider respects the autonomy
of the support recipient. Directive forms of support largely consist of explicitly telling the support recipient
what to do; thus, they tend to impose some particular coping response. Non-directive support does not take
this form, and allows the recipient to determine his or her own response. For example, a non-directive form of
emotional support might be to listen attentively and sympathetically to your partner; a directive form of
emotional support might be to tell the partner that s/he needs to have more confidence.
Using a convenience sample of Belgian adults who were married or cohabiting with their partners,
Devoldre et al. found that dispositional PT was associated with choosing more instrumental support
responses, and dispositional EC was associated with choosing more emotional support responses.
Interestingly, however, this only held true for the non-directive forms of these types of support. Dispositional
empathy displayed no relationship with directive support. Thus, empathy in this study was only related to the
form of support that explicitly recognizes the other person’s autonomy; empathy was not related at all to
support that ignores the other’s point of view.
The social support research described thus far has employed the IRI to provide measures of perspective-
taking, empathic concern, and on occasion, personal distress. At least one study, however, has examined the
association of dispositional empathy and social support using partner-specific versions of these scales. The
Levesque et al. (2014) investigation described earlier employed such partner-specific scales and a measure they
termed “dyadic coping,” which assesses the ways in which people report dealing with a partner’s stress (sample
item: “I take on things that my partner would normally do in order to help him/her out.”). Thus, it seems
plausible to consider this a measure of social support as well. For both men and women, partner-specific PT
and EC were related to their reported levels of support. In fact, the size of the associations (correlations
ranging from .43 to .58) was considerably greater than the associations found using the global IRI scales.

NON-U.S. EVIDENCE

Evidence for a link between empathy and social support in non-U.S. samples is considerable. In fact, much
of the social support research described here was conducted in Belgium using a Dutch-language version of the
IRI. Thus, somewhat oddly, most of the research on empathy and social support has been conducted using
translations of the IRI rather than the original English version. In addition to the research already described,
Kaźmierczak and Davis (2013) examined the link between dispositional empathy and social support in a larger
investigation of over 700 Polish married couples. Dispositional empathy was assessed with a Polish variant of

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the IRI, in which only three of the original IRI scales were represented: Perspective-Taking, Empathic
Concern, and Personal Distress. Social support was measured by using items from the Communication in
Marriage Questionnaire (Kaźmierczak & Plopa, 2005) to create indices of instrumental, emotional, and
negative support. A pattern generally consistent with the Belgian research was found, with dispositional
empathy modestly but significantly associated with social support in the expected ways. Perspective-taking
was associated with offering more instrumental and emotional support and less negative support; EC was
associated with offering more instrumental and emotional support; PD was associated with offering less
instrumental and more negative support.
Finally, Paleari, Tagliabue, and Lanz (2011) investigated the link between empathy and social support
using an ambitious approach based on the Social Relations Model (SRM). All of the members of 117 Italian
families participated, and they completed two measures: first, each member reported on the degree of social
support they received from each of the other family members; second, each one also completed a dyadic PT
measure in which they reported the degree to which they attempted to understand the perspective of each of
the other family members. SRM analyses revealed that for each possible family relationship (mother–father;
mother–child; father–child; child–child) there was a significant and positive association between empathy and
perceived support. That is, the more that any family member attempted to take the perspective of another
family member, the more supportive the first family member was perceived to be by the second.
In sum, the overall pattern that emerges from the social support research supports two broad conclusions.
First, dispositional empathy generally displays a positive influence on social support; it tends on average to be
associated with providing more of the useful forms of support (emotional, instrumental) and less of the non-
useful, negative form. Second, the aspect of empathy that displays the most consistent effect on social support
is perspective-taking. Every one of the investigations reviewed here found some association between
perspective-taking and at least one form of social support.

Responses to Partner Transgression

A final domain of social life in which empathy plays an important role has to do with perhaps the most
emotionally fraught of relationship events: transgressions by one’s partner that pose some kind of threat to the
relationship. Such threats can be fairly mild—what we may think of as garden-variety relationship
transgressions—or they may be quite serious indeed, involving partner misbehavior of the most hurtful and
damaging type. In either case, empathy can play a role in shaping the kind of response one makes to such
transgressions.

ACCOMMODATION

One influential approach to understanding responses to the less serious type of threats can be seen in
Rusbult’s work on accommodation (Rusbult et al., 1991). Rusbult et al. assume that when one partner in a
close relationship behaves badly, whether through omission (e.g., forgetting an anniversary) or commission
(e.g., yelling at their spouse), the primitive, unprocessed impulse of the other partner is typically to retaliate.
Thus, destructive acts by one partner generally produce an impulse toward retaliation in the other. In many
instances, however, such retaliation never takes place; instead, the wronged party inhibits the immediate
destructive impulse and instead acts in a constructive fashion, perhaps ignoring the transgression or treating it

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as only a minor annoyance. Rusbult et al. (1991) term this constructive reaction accommodation.
To demonstrate this phenomenon, Rusbult et al. presented subjects with a series of hypothetical destructive
acts that could be committed by one’s partner (e.g., ignoring you, criticizing you), and asked them to report
their most likely response to such acts. The tendency to make accommodating responses was most powerfully
influenced by the subjects’ commitment to the relationship—those more committed to the relationship were
more likely to accommodate. Above and beyond the effect of commitment, however, a greater self-reported
tendency to take the partner’s perspective was also associated with greater accommodation; in contrast,
dispositional empathic concern had no such effect.
Arriaga and Rusbult (1998) later conducted a multi-study investigation of perspective-taking’s role in
fostering accommodation. In the first study, both husbands and wives completed a measure of
accommodation modeled after the one used by Rusbult et al. (1991); they also completed a partner-specific
version of the IRI’s PT scale. Such partner-specific PT was significantly and consistently related to making
more accommodating responses. In three additional studies, undergraduate college students were asked to
imagine scenarios in which their romantic partners had transgressed in some way (e.g., unexpectedly canceling
dinner plans you have made) and were asked to indicate their likeliest responses. Partner PT was measured
much as in the first study; in addition, a PT manipulation was used to prompt participants to consider (or not)
the partner’s likely perspective on the hypothetical events. Manipulated PT was modestly associated with
more accommodating responses, and partner PT was again strongly associated with such responses.

FORGIVENESS

Moving beyond the relatively common everyday disappointments that our partners provide, there are more
serious offenses and betrayals that pose more dramatic threats to the relationship. In such cases, the key
response from the wronged party is, not the simple forbearance reflected in accommodative responses, but a
more fundamental willingness to forgive the guilty party. The past quarter-century has seen an increasing
amount of attention paid to this important interpersonal phenomenon (e.g., Enright, Gassin, & Wu, 1992;
McCullough, Pargament, & Thoresen, 2000). Although a variety of definitions have been advanced, one
influential approach is that of McCullough et al. (1997), who define forgiveness as a set of motivational
changes characterized by lowered desires to retaliate against and maintain estrangement from an offending
relationship partner, and a heightened desire for conciliation. Thus, forgiveness at its heart is a set of changes
in the motivations of the offended party.
What is empathy’s role in all this? McCullough et al. (1997) have proposed a highly influential model that
identifies compassion for the transgressor (which they term “empathy”) as the most important cause of
forgiveness following a transgression. Only to the extent that the wronged party feels compassion (perhaps as
a result of an apology by the transgressor) does s/he experience a motivational change such that “in place of
the motivations for revenge and … estrangement, the increase in caring for the offending partner increases the
offended partner’s motivation to pursue conciliatory courses of action” (McCullough et al, 1997, p. 323).
Considerable evidence supports this model. For example, in a pair of investigations, McCullough et al.
(1997) found that feelings of compassion, as hypothesized, were associated with greater forgiveness for an
individual who had previously transgressed against them; moreover, forgiveness was then associated with less
avoidance and greater conciliation. McCullough et al. (1998; Study 4) reported similar findings in an

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investigation that examined two distinct behavioral responses to being wronged by another: avoidance and
revenge. Feelings of compassion for the transgressor were associated with decreased motivation for both
behaviors. In a pair of longitudinal studies, McCullough, Fincham, and Tsang (2003) repeatedly queried
individuals for weeks after they had suffered an interpersonal transgression. In both studies, empathy at the
time of the transgression was significantly related to immediate forgiveness, but it was much less likely to
predict additional forgiveness over time. Thus, it may be that compassion has its greatest effect on the
motivation to forgive in the immediate aftermath of another’s misbehavior.
In an interesting line of research, Witvliet and colleagues have examined the effect on empathy and
forgiveness of two specific cognitive strategies: compassionate reappraisal and emotional suppression. For
example, Witvliet, Mohr, Hinman, and Knoll (2015) had participants recall and then ruminate about a past
real-life offense in which another person had acted in a hurtful way toward them. Some participants were
guided through compassionate reappraisal instructions in which they were to think of the offender as a
“human being” who had acted badly, and to try to wish for this person to undergo a positive transformation.
Other participants were guided through emotional suppression instructions in which they were urged to not
become emotional and to not display any negative emotions they might experience. Engaging in
compassionate reappraisal led to greater empathy for the offender and greater forgiveness than did emotional
suppression.
The fast-growing literature on forgiveness has prompted meta-analytic examinations of this work, and two
such analyses have examined evidence for the correlates of interpersonal forgiveness. Fehr, Gelfand, and Nag
(2010) analyzed the results from 175 studies and over 25,000 participants to evaluate the evidence for the
situational and dispositional correlates of forgiveness. As part of this effort, they considered three facets of
empathy: trait PT, trait EC, and state EC (compassion). The trait variables exhibited relatively modest but
reliable associations with forgiveness (dispositional PT, mean r = .17; dispositional EC, mean r = .11). In
contrast, state levels of compassion were strongly related to forgiveness (mean r = .53). In fact, state
compassion displayed the strongest association with forgiveness of any of the variables included in the meta-
analyses.
Riek and Mania (2011) conducted a similar meta-analysis based on 158 samples from 103 articles and
papers. As in the Fehr et al. (2010) analysis, Riek and Mania examined both state and trait EC; however, they
apparently combined investigations of both state and trait PT within a single category. However, the overall
pattern of results was very similar to Fehr et al.’s. The strongest association with forgiveness was found for
state EC (r = .50), with trait EC (r = .24) and PT (r = .25) displaying smaller but nevertheless reliable effects
as well. As in the Fehr et al. analysis, state EC displayed the highest association with forgiveness of all the
variables under consideration.

NON-US EVIDENCE

A number of investigations have examined the relationship between empathy and forgiveness using non-
U.S. populations. In particular, a research team including pair of Italian psychologists published several studies
that have examined the empathy–forgiveness link. Fincham et al. (2002) asked husbands and wives from
Italian married couples to vividly imagine their partners engaging in several different negative behaviors. After
each one, they then indicated how much they would forgive the spouse and how much emotional empathy

401
(essentially empathic concern) they would feel. Substantial positive correlations between compassion and
forgiveness were found for both husbands and wives. Paleari et al. (2005) conducted a longitudinal study of
Italian married couples in which husbands and wives were asked to identify the most serious offense
committed by their spouse during the previous six months, and then indicated how much compassion they felt
toward the spouse and the degree to which they had forgiven the spouse. At both time points, greater
compassion was associated with greater forgiveness. Using a different measure of forgiveness, Paleari, Regalia,
and Fincham (2009) obtained similar results. Finally, Paleari, Regalia, and Fincham (2003) found a similar
association between empathy and forgiveness when Italian adolescents were asked to imagine problematic
behavior by parents; the greater the amount of compassion they reported, the greater the degree of forgiveness
for the parental misbehavior.
Several investigations have examined the empathy–forgiveness association in non-Western, more
collectivist cultures. Mellor, Fung, and Binti Mamat (2012) had Malaysian undergraduate students complete
the IRI and a measure of trait forgiveness—the Transgression-Related Interpersonal Motivations Inventory-
12 (TRIM12; McCullough et al., 1998). Mellor et al. speculated that the association found between
dispositional empathy and forgiveness in individualist Western cultures might be weaker, or even nonexistent,
in more collectivist ones. Their logic was that, in collectivist cultures, the societal emphasis on social harmony
might override the influence of individual personality traits. Interestingly, however, they also predicted that
dispositional perspective-taking would be more strongly associated with forgiveness than would dispositional
empathic concern. Overall, both PT and EC were significantly positively related to forgiveness. Among men,
PT had a somewhat stronger relationship than EC with one aspect of forgiveness (revenge-seeking); however,
the difference was not statistically significant. For women, there was essentially no difference at all in the
strength of the correlations. Thus, the relationship between dispositional empathy and forgiveness in this
Malaysian sample was very similar to that found in Western populations. Similar results have also been
reported with Indian (Baghel & Pradhan, 2014) and Korean (Chung, 2014) populations, using measures of
trait empathy that assessed a general tendency to experience affective responses to others rather than
compassion specifically.
Finally, Merolla, Zhang, and Sun (2012) examined the relationship between empathy and forgiveness using
data from both individualistic (American) and collectivist (Chinese) cultures. However, they did so in a way
that was somewhat different from the other forgiveness investigations described thus far. Merolla et al. were
interested specifically in forgiveness communication—how wronged parties convey to the offender that
forgiveness has taken place. Using undergraduate samples from the United States and from China, Merolla
and colleagues had their participants identify a hurtful act committed by a friend or romantic partner, and for
which they had forgiven the offender. They were then asked to respond to a number of questions about that
transgression, including a measure of state empathic concern toward the offender, and a measure of empathic
communication. The latter measure taps three ways in which the offended party might convey forgiveness:
directly (e.g., “I told them I forgive them”), non-expressively (“I forgave them but said nothing to him or her
about it”), and conditionally (“I told him or her I would forgive him or her only if things changed”). Contrary
to predictions, empathy had almost no significant association with any form of forgiveness for either sample.
In retrospect, however, this pattern is perhaps not that surprising. The forgiveness communication measure
assesses how people convey forgiveness after it has already occurred; in contrast, virtually all of the other

402
forgiveness research reviewed here is concerned with predicting whether or not forgiveness will occur at all.
Thus, while the evidence is clear that empathy is a robust predictor of forgiveness for a misbehaving social
partner, it may prove to be a weak predictor of how that forgiveness is or is not conveyed. Unfortunately, this
methodological difference makes the Merolla et al. study of somewhat limited value in understanding cultural
differences in forgiveness per se.

Conclusion
This selective review of the literature on empathy and social functioning provides strong evidence for two
general conclusions, and suggestive evidence for a third. First and foremost, it is clear that empathy, in all of
its shapes and forms, has strong and reliable effects on a number of indices of social functioning. Dispositional
forms of empathy are associated with greater relationship satisfaction, greater popularity, lower levels of
conflict and aggression, higher levels of effective support-provision, greater tolerance for partner misbehavior,
and a greater willingness to forgive. State levels of compassion are consistently associated with social support-
provision and are especially strongly related to forgiveness; they are also associated, in a somewhat more
complex fashion, with relationship satisfaction. Thus, in a variety of ways, both large and small, empathy
tends to enhance the quality of social relationships. Second, the evidence to date suggests that empathy’s
influence on social relationships is consistent across cultures. More work is necessary, of course, but at present
it does not appear that the evidence of such associations is limited to the United States, or perhaps to Western
cultures in general.
Finally, the pattern of results suggests something interesting about how empathy tends to operate. For most
of the indices of social functioning that were considered in this review, it was the cognitive aspect of empathy
that generally played the larger role. Relationship satisfaction and hostility/aggression were most consistently
associated with measures of perspective-taking (although popularity was consistently related to empathic
concern). Similarly, slightly more consistent influences on social support provision were found for
dispositional perspective-taking, which increased the likelihood of instrumental support, while diminishing
the likelihood of negative support. The research on accommodative responses to relatively minor partner
misbehavior displayed this pattern as well; taking partners’ perspectives was consistently associated with more
constructive responses to their malfeasance.
The exception to this pattern, and it is a striking one, is the research on forgiveness. When partners have
committed serious transgressions, the facet of empathy that is most strongly and consistently associated with
forgiveness is state empathic concern. In contrast to every other index of social functioning, when it comes to
forgiveness, it is the emotional facet of empathy—specifically feelings of compassion—that is by far the most
potent factor. Thus, an intriguing dynamic is apparent with regard to empathy’s role in social life. For the
day-in, day-out maintenance of social relationships—understanding one’s partner, offering the proper
support, and avoiding the commission of bad behaviors—it is generally the willingness and ability to
understand the partner’s psychological point of view that is important. However, when relationships are most
in jeopardy due to a serious transgression by one of the partners, it is the emotional response of compassion
for the offender that largely determines whether or not the offense will be forgiven.
This pattern may result from the particular nature of forgiveness, which can be thought of as a kind of
relationship “alchemy”—when we are faced with betrayal, it transforms the powerful immediate retaliatory

403
response into to a more benign and benevolent one. Understanding the partner’s point of view may contribute
to this transformation, but it seems to require more than mere understanding. What is required for this kind
of transformation is the emotionally fueled power of a positive affective orientation toward the transgressor.
What is required, in short, is a compassionate response of sufficient strength to turn relationship lead into
gold.

Future Directions
One useful direction for future research on compassion’s role in social relations will be an increased
attention to the mechanisms by which compassion’s effects are realized. In terms of the organizational
empathy model (Figure 23.1), it seems useful to focus on the second and third stages of the model: empathy-
related processes and intrapersonal outcomes. Many likely candidates present themselves. For example, the
role of cognitive processes (e.g., perspective-taking) and outcomes (e.g., attributional explanations for the
partner’s behavior) is likely to be large. There is considerable evidence that the way we explain our partners’
actions is influential in generating subsequent emotional responses and relationship behaviors (Bradbury &
Fincham, 1990; Fletcher & Fincham, 2013). It seems highly likely that compassion will to some degree be
created by such attributions; it is easier to feel compassion for partners when we do not hold them entirely
responsible for bad outcomes. In turn, compassion probably shapes later attributions; it is easier to hold
partners blameless when we are genuinely feeling sympathy and concern.
Another approach likely to be useful will be to ensure that measures of key constructs are tailored to the
particular relationship in question. A common pattern in the research examining relationship satisfaction was
that “generic” measures of dispositional perspective-taking and empathic concern were less strongly related to
outcome variables than were partner-specific versions of the same constructs. This makes sense, of course,
given the large literature suggesting the importance of specificity-matching when assessing the magnitude of
attitude–behavior correlations (e.g., Fishbein & Ajzen, 1975; Eagly & Chakin, 1993) and the association
between trait measures and overt behavior (e.g., Epstein, 1979; Ajzen, 1988). Thus, partner-specific empathy
measures clearly seem to be the preferred form of empathy measurement whenever possible. The very strong
effects of state levels of compassion on forgiveness might also result in part from a higher degree of variable
specificity; the measures used in such research routinely assess compassion for, and forgiveness of, one
particular person—the transgressor.
Finally, there would be much value in examining these issues in non-Western cultures. Although there is a
reasonable amount of non-U.S. evidence now available, the vast majority of it was conducted in Western
countries, and especially in Europe. Very few studies have been carried out in non-Western, more clearly
collectivist societies, and there is an almost complete absence of investigations directly comparing Western
and non-Western populations. The non-U.S. evidence reviewed here suggests that similar associations with
relationship outcomes are found outside the United States. It is still an open question, however, how similar
the findings will be when more clearly different cultures are compared.

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 The Class–Compassion Gap How Socioeconomic Factors Influence Compassion

Paul K. Piff and Jake P. Moskowitz

Abstract

Who is more likely to experience compassion: someone who is rich or someone who is poor? In this
chapter, we review how psychological science can shed light on this question. We argue that social class
differences in objective material resources (e.g., income) and corresponding subjective perceptions of
rank produce self- versus other-oriented patterns of social cognition and behavior among upper- and
lower-class individuals, respectively. Extending this framework to the domain of compassion, empirical
studies find that individuals from lower social class backgrounds are more prone to feelings of
compassion and more likely to behave in ways that are compassionate, including sharing with, caring for,
and helping others, relative to individuals from higher social class backgrounds. We describe boundary
conditions and mitigating factors to the class–compassion gap, and conclude by outlining important
questions and lines of inquiry to guide future research.

Key Words: social class, socioeconomic status, SES, compassion, empathy, prosocial behavior,
generosity

In 2014, a group called OckTV posted a video online of what it described as a “social experiment”
(MoeAndET, 2014). In the video, different young men approached strangers in New York City who were
eating pizza and claimed to be hungry before asking them if they would share a slice. The men are repeatedly
turned down, sometimes quite hostilely, until finally one individual, who is ostensibly homeless, shares a slice.
The video’s message is simple: Whereas those who were better off declined to help the person in need, it was
the homeless person with so little to give who readily offered help.
The video has its limitations––for instance, the homeless man had earlier been given some pizza slices––but
it quickly went viral (it has been viewed over 30 million times as of this writing). The video generated
considerable controversy online as comments poured in from people offering their opinions. Some
commenters reflected on how they would respond if asked for food by a stranger. Others agreed with the
video’s conclusions and observed that individuals in more impoverished circumstances tend to be more
compassionate and more giving. Others countered that people work hard for what they have, and that those
with less tend to be less hardworking, reliant on others, even mean and harmful to society. The video had
clearly struck a nerve.
The interest in compassion, and whether it varies as a function of one’s socioeconomic position in society, is
not new. For centuries, scholars and lay people alike have debated the role that social class may play in shaping
the propensity to care for others (e.g., Marx, 1977/1867; Plato, 1987/380 b.c.e.). Distinct lines of reasoning
point in competing directions. On one hand, in many cultures there is a principle of noblesse oblige, stating that

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those with more resources should assist those who have less (Pratto, Sidanius, Stallworth, & Malle, 1994),
and there are notable examples of wealthy individuals behaving in charitable ways. This indicates that higher
social class may enhance one’s propensity to care for others. On the other hand, there are myriad religious
teachings; folk stories, such as those surrounding Mammon (an evil deity representing riches and money); and
widely held stereotypes that extol the poor and admonish the rich (e.g., Fiske, Cuddy, Glick, & Xu, 2002; see
also Pew Research Center, 2012)––all of which indicate that higher social class may impair compassion.
Guided by mounting interest in how social class influences people’s thoughts, feelings, and actions,
psychological research is providing unique insights into this long-contested question: Do upper- and lower-
class individuals diverge with respect to compassion? We review this emerging research in the current chapter.
In the first section of the chapter, we summarize prior theorizing and research on social class to provide a
theoretical framework for understanding its influences upon compassion. In broad strokes, we argue that
elevated resources and rank among upper-class individuals produce an internal, self-oriented focus: social-
cognitive and behavioral tendencies characterized by greater attention to one’s internal states and goals. By
contrast, reduced resources and rank among lower-class individuals give rise to an external, other-oriented
focus: social-cognitive and behavioral tendencies characterized by heightened focus on the external social
environment and other individuals within it.
In the chapter’s second section, we extend this theoretical framework to the domain of compassion. Guided
by prior theorizing and research in this area, we conceptualize compassion as an affective state characterized
by concern for those who suffer or are vulnerable and a motivation to enhance the welfare of others (e.g.,
Goetz, Keltner, & Simon-Thomas, 2010; Oveis, Horberg, & Keltner, 2010). We review research suggesting
that basic class differences in how people orient to their social worlds manifest in divergent experiences of
compassion, such that individuals from lower social class backgrounds are more prone to feelings of
compassion than individuals from upper social class backgrounds. We also broaden our analysis beyond
compassion as an affective state to the behavioral domain, and describe research finding class differences in
compassionate actions that reflect a relative concern (or disregard) for the welfare of others, including
prosociality––tendencies to share, care, and assist. The third and final section of this chapter outlines
important questions and lines of inquiry to guide future research, and it explores possible boundary conditions
and mitigating factors (perspective-taking, contact, and utilitarianism).

The Emerging Psychology of Social Class

People fold into hierarchies of different kinds based on a number of different dimensions of social life,
including physical dominance, attractiveness, competence, prestige, power, and social class (or socioeconomic
status). Paralleling prior theorizing, we see social class as reflecting, in part, the objective material resources
(e.g., wealth) an individual possesses, which, in turn, evoke inferences and perceptions of one’s own subjective
social class rank vis-à-vis others (see also Kraus, Piff, & Keltner, 2011). As such, an individual’s social class
identity comprises both objective resources and corresponding perceptions of social-class rank. A person’s
material resources are most commonly indexed using “objective” characteristics, such as financial wealth or
income, educational attainment, or occupational prestige (Oakes & Rossi, 2003); whereas subjective
assessments ask individuals to self-identify as belonging to a particular social class category (e.g., “lower class,”
“middle class”) or to rank themselves relative to others in terms of income, education, and occupational

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prestige (e.g., Adler, Epel, Castellazzo, & Ickovics, 2000; Kraus, Piff, Mendoza-Denton, Rheinschmidt, &
Keltner, 2012; Piff, 2014). Critically, subjective social-class rank is statistically related to objective resources
but contributes to the health and life outcomes of individuals independently of their objective resources. For
example, relative to objective measures of social class (e.g., education, income), subjective social-class rank
more strongly predicts self-rated health and physiological health outcomes such as body-fat distribution (e.g.,
Adler et al., 2000). These results underscore the importance of perceptions of social-class rank to the
experience of social class and its associated outcomes.
Disparities in resources and perceived rank among upper- and lower-class individuals lead them to develop
unique mindsets and perceive, interpret, and react to various situations differently. Abundant resources and
elevated rank afford individuals from upper-class backgrounds increased freedom and control (Kraus, Piff, &
Keltner, 2009), and their lives are relatively protected from external influences, threat, or unpredictability
(Johnson & Krueger, 2005). Upper-class individuals also experience increased geographic and upward social
mobility (Chetty, Hendren, Kline, Saez, & Turner, 2014), improved physical and mental health (Adler et al.,
2000), and more choices in their personal and professional lives (Stephens, Markus, & Townsend, 2007).
Moreover, upper-class environments are more likely to emphasize individuality and value personal
accomplishments and talents (Kohn, 1963; Lareau, 2002). This confluence of increased freedom and control,
greater independence, and reduced reliance on others shifts upper-class individuals in an individualistic
direction, giving rise to self-focused patterns of social cognition and behavior—heightened focus on the
individual, independent self (Kraus et al., 2012; Piff, Kraus, Côté, Cheng, & Keltner, 2010).
The environments and life outcomes of lower-class individuals contrast with those of upper-class
individuals, both objectively and in terms of subjective construal. Lower-class individuals experience greater
threats and environmental unpredictability (e.g., economic instability, more dangerous neighborhoods, poorly
funded schools; Evans, Gonnella, Marcynyszyn, Gentile, & Salpekar, 2005; Gallo & Matthews, 2003), and
they have limited resources to overcome these challenges. Given their more threatening environments, relative
lack of material resources, reduced rank, and decreased personal control, lower-class individuals engage in a
variety of adaptive social-cognitive responses. One such response is a heightened vigilance to the social
environment, which can help increase detection of potential threats and heighten attentiveness to others in the
social environment (Chen & Matthews, 2001; Kraus et al., 2009). A second strategy for coping with stressful
and threatening environments is to engage in affiliative behaviors that build cooperative networks of reciprocal
aid, to help withstand challenges and overcome obstacles (e.g., Bowlby, 1978; Piff, Stancato, Martinez, Kraus,
& Keltner, 2012; Taylor, 2006). According to this theorizing, lower-class individuals engage in tend-and-
befriend responses, which promote other-focused patterns of social cognition and behavior––greater focus on
the needs of others and more compassionate responses to suffering.
In sum, we propose that greater independence and reduced reliance on others lead upper-class individuals
to be more focused on their internal states and goals and less sensitive to the needs of others. By contrast, due
to their increased vigilance to the social environment and their greater investment in the development of
supportive, interdependent bonds, lower-class individuals exhibit increased attentiveness, awareness, and
concern toward others. There are, in turn, numerous empirical demonstrations of class differences in
attentiveness to others, which set the stage for our discussion of how social class influences compassion.

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Social Class and Attentiveness to Others
An emerging literature in psychology documents divergent patterns of sociality among individuals from
different social class groups. Using a variety of methods and measures across student, online, nationally
representative, and international samples, studies find that upper-class individuals are more focused on and
prioritizing of the self, whereas lower-class individuals are more focused on the states and needs of others (for
a review, see Kraus et al., 2012; Piff, Stancato, & Horberg, 2016). Higher social class, assessed both
objectively (e.g., in terms of parental education) and subjectively (e.g., as one’s perceived socioeconomic rank
in society), is associated with increased narcissism and psychological entitlement––psychological traits
characterized by an increased sense of self-importance and deservingness vis-à-vis others (Cai, Kwan, &
Sedikides, 2012; Foster, Campbell, & Twenge, 2003; Piff, 2014). In a representative sample of close to 3,000
American adults, a composite of annual household income, assets, education, and occupational prestige was
negatively associated with agreeableness—a key factor of personality comprising traits reflecting compassion,
cooperation, and trust (Chapman, Fiscella, Kawachi, & Duberstein, 2010). In other work, lower-class
individuals (as indexed by level of education) reported having more close social relationships, increased levels
of socially engaged emotions (e.g., friendliness, guilt), and decreased levels of socially disengaged emotions
(e.g., pride, anger) compared to upper-class individuals (Na et al., 2010).
Individuals from lower-class backgrounds are more likely to spend time with family members, engage in the
caretaking of others, and have stronger extended-family ties (Argyle, 1994; Lareau, 2002). In one
investigation, lower-class students (assessed in terms of parental educational attainment) were nearly twice as
likely to report having interdependent motives for attending college (e.g., helping their families, giving back to
their communities) than higher-class students (Stephens, Fryberg, Markus, Johnson, & Covarrubias, 2012).
Studies of social interactions reveal similar class differences in behavior. In a study of videotaped interactions
with strangers, upper-class individuals (as indexed by parental education and household income) exhibited
reduced social engagement (e.g., less frequent eye contact, fewer head nods) and greater disengagement-
related behaviors, such as doodling on a questionnaire or fiddling with nearby objects, relative to their lower-
class peers (Kraus & Keltner, 2009).
Class differences in attentiveness to others are further evidenced by studies of empathy––which broadly
refers to processes through which people focus on and relate to the internal states of others (Zaki & Ochsner,
2012). One such process is empathic accuracy, or the ability to correctly infer the thoughts and emotions of
others (Ickes, Stinson, Bissonnette, & Garcia, 1990), which is integral to the experience of compassion.
Research finds that individuals with higher social class are less empathically accurate than their lower-class
counterparts. In one study, Kraus and colleagues (2010) found that, independent of the effects of gender and
agreeableness (factors related to empathic accuracy), participants with a four-year college degree performed
significantly worse on a test of their ability to accurately identify emotions in photographs of human faces
(Kraus, Côté, & Keltner, 2010). In another study, participants with lower subjective socioeconomic status
(SES) more accurately inferred the emotional states of their partners following a mock job interview, even
after controlling for numerous other covariates (e.g., the effects of actor/partner gender, ethnicity, and
agreeableness). In a follow-up experiment, participants made to feel higher in subjective SES––by comparing
themselves to someone at the very bottom of the socioeconomic ladder––were less effective at estimating the
emotional states of individuals based on images of the eye-region of the face (“Reading the Mind in the Eyes”

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test; Baron-Cohen, Wheelwright, Hill, Raste, & Plumb, 2001), relative to participants made to feel lower in
subjective status––who had compared themselves to someone at the very top of the socioeconomic ladder. In
addition to an objective indicator of higher social class standing (education), mere perceptions of relatively
higher social class standing––even those triggered via moment-to-moment social comparison processes––seem
to dampen empathic accuracy (Kraus, Côté, & Keltner, 2010). That an objective resource measure and a
subjective social class rank-based manipulation similarly predicted empathic accuracy suggests that objective
social class and subjective social class rank both influence class-based psychological outcomes. More broadly,
these results highlight the importance of the social context in shifting the experience of subjective social-class
rank and class-based patterns of emotion––a point we will return to in our discussion.
Neural imaging studies further underscore the link between lower social class and increased empathy.
Research indicates that the mentalizing neural network––a set of brain regions that includes the dorsomedial
prefrontal cortex and posterior cingulate cortex and is implicated in tasks that require understanding the
mental states of others (Frith & Frith, 2006; Lieberman, 2010; Mitchell, 2009; Zaki, Weber, Bolger,
Ochsner, 2009)––is more active in lower-class individuals. In one investigation, students with lower subjective
SES experienced greater activation of the mentalizing neural network while reading a fictional first-person
narrative of a student describing their thoughts and feelings about the beginning of a new college quarter
(Muscatell et al., 2012). In a similar vein, Varnum and colleagues (2015) studied patterns of fronto-central P2
activation––a neural marker of empathy––among upper- and lower-class individuals in response to images of
others in pain (Varnum, Blais, Hampton, & Brewer, 2015). A composite of income, highest parental
education, and subjective SES was negatively related to fronto-central P2 activation, indicating that higher
social class was linked to diminished neural empathic responses toward the suffering of others.
The research we have reviewed highlights an intriguing pattern in the literature: lower social class is
associated with increased interdependence, greater other-focus, and heightened empathic responding.
Although “empathy,” which generally refers to the vicarious experiences of another’s emotions, is
differentiable from “compassion”––a specific emotion triggered by another’s suffering and that motivates
desires to help (Goetz et al., 2010)––these findings indicate that social class may underlie differential
experiences of compassion.

Social Class Differences in Compassion

In a major review, Goetz, Simon-Thomas, and Keltner (2010) define compassion as a “feeling that arises in
witnessing another’s suffering and that motivates a subsequent desire to help” (Goetz et al., 2010). According
to this conceptualization, compassion is an internal affective state, not an attitude or general behavioral
response, and although it is conceptually and experientially related to feelings of sympathy, empathy, or pity––
all of which can arise in response to the suffering of others––it is distinguishable from these insofar as it
entails a further desire to help improve the experience of the suffering individual (see also Gilbert, 2015).
Certain individuating processes that enhance attention to the individual self or are otherwise inimical to
interdependence exert a powerful influence on compassion and compassion-related states. For example,
interdependent self-construal and collectivism (i.e., viewing oneself as part of a whole) have been positively
related to experiences of compassion and sympathy in both American and Japanese samples (Dalsky, Gohm,
Noguchi, & Shiomura, 2008; Uchida & Kitayama, 2001). Moreover, individuals who are more self-focused,

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narcissistic, or self-enhancing show reduced empathic tendencies and perspective taking (Watson, Grisham,
Trotter, & Biderman, 1984; Eysenck, 1981). Insofar as upper-class individuals are more self-focused, less
attentive to others, and less empathetic, they should also experience less compassion.
Research on social power is also relevant to our discussion of possible class differences in compassion.
Although social class and “power”––which refers to asymmetrical control over resources in social
relationships––are conceptually and empirically distinct (e.g., Kraus et al., 2012), higher social class, by being
associated with greater material resources, might increase people’s psychological feelings of powerfulness,
which studies have linked to reduced compassionate responses. In one study, participants with increased
feelings of power, as measured through the Sense of Power scale (e.g., “In my relationships with others, I can
get others to do what I want”; Anderson & Galinsky, 2006), reported feeling less compassion than their low-
power counterparts after listening to a lab partner describe a recent event that had “caused them a great deal of
emotional suffering and pain” (van Kleef et al., 2008). These findings link feelings of powerlessness to
increased compassionate responding and indicate that lower-class individuals (who may feel less powerful)
may be more compassionate than their upper-class counterparts.

Direct Evidence Linking Social Class to Experiences of Compassion

The research we have reviewed on social class, attentiveness to others, and empathy, as well as the findings
we have described on individual-level determinants of compassion (e.g., interdependence, power), indicate
that social class may influence responses to others’ suffering. Select studies to date have specifically examined
the association between social class and compassion, and their findings yield limited but suggestive evidence in
support of the claim that lower-class individuals are more prone to compassion than their upper-class
counterparts.
Stellar, Manzo, Kraus, and Keltner (2012) conducted one of the most pertinent investigations in this realm,
testing across multiple studies the specific association between social class and compassion. In an initial study,
participants were asked to indicate their current level of social class (e.g., “lower class,” “middle class”) and
complete the Dispositional Positive Emotion Scale (DPES), a well-validated measure of an individual’s
propensity (or trait-like tendency) to experience several distinct positive emotions, such as love, awe, pride,
and, critically, compassion (Shiota, Keltner, & John, 2006). In this measure, participants indicate their
agreement with a variety of statements that reference core appraisals and experiences of each target emotion.
Five items index compassion, capturing such things as attentiveness to others in need of help (“I often notice
people who need help”) and the motivation to act on their behalf (“When I see someone hurt or in need, I feel
a powerful urge to take care of them”). Individuals who categorized themselves as higher in social class
reported experiencing less compassion than individuals categorizing themselves as lower in social class, and
this trend remained significant when controlling for relevant covariates (gender, ethnicity, and spirituality).
Further analyses revealed no significant correlations between social class and any of the six other positive
emotions captured by DPES (joy, contentment, pride, love, amusement, and awe), suggesting that lower-class
individuals’ increased compassion was not attributable to a tendency to report increased positive emotion in
general.
In addition to assessing self-reported tendencies to experience compassion in daily life, Stellar and
colleagues (2012) measured people’s emotional reactions in a specific situation to an individual who is

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suffering or otherwise vulnerable––conditions that are both central to the experience of compassion as well as
ideal for its study (Goetz et al., 2010). In one follow-up study, participants viewed two 2.5-minute videos: a
neutral-emotion video explaining the construction of a patio (which provided a baseline condition for
comparison purposes), and a compassion-inducing video depicting the experiences of children with cancer and
their families as they cope with the challenges of chemotherapy. After each video, participants were asked to
report how much they experienced feeling “compassion/sympathy,” as well as several other emotions (e.g.,
happy, inspired) while watching the video. The videos were separated by a five-minute resting period, and
heart rate was measured throughout using ECG, allowing the researchers to examine whether heart rate
deceleration––a physiological reaction associated with orienting toward and engaging with others (Eisenberg
et al., 1989)––would vary by social class alongside self-reported compassion. Paralleling the results of their
first study, but this time with an objective resource-based measure of social class (family income and parental
education), lower-class participants reported greater overall increases in compassion from the neutral video to
the compassion-inducing video than upper-class participants did. A similar pattern was observed in the heart
rate deceleration of participants: lower-class individuals exhibited greater levels of heart rate deceleration from
the neutral video to the compassion-inducing video than upper-class participants did.
In a final study by Stellar and colleagues that yielded complementary evidence (Stellar et al., 2012, Study 3),
participants engaged in a competitive mock job interview. The experimenter interviewed study participants in
pairs as they sat across from each other for a hypothetical psychology laboratory manager position.
Participants were told that the best interviewees would receive a cash prize. After the interview, participants
rated both their and their partners’ experience of a set of 20 positive and negative emotions, including
compassion, during the job interview. Consistent with the authors’ predictions, and paralleling the results
from their prior two studies, lower-class participants (assessed in terms of family income and parental
education) reported feeling more compassion for their partner, even when controlling for a number of other
factors, including gender, ethnicity, and partners’ social class. The study further revealed one mechanism
underlying class differences in compassion, and it harks back to our earlier discussion of class differences in
attentiveness to others. Specifically, lower-class individuals perceived greater distress in their partners during
the mock interview, an admittedly stressful and anxiety-provoking task, which statistically mediated their
increased compassion. In sum, increased compassion among lower-class individuals is attributable, in part, to
their increased attentiveness to others’ suffering.
A separate investigation by Côté, Piff, and Willer (2013) mirrored the findings of Stellar et al. (2012). The
central question in the work of Côté and colleagues was whether upper- and lower-class individuals would be
differentially utilitarian in their moral decision-making––specifically, are there social class differences in
people’s willingness to commit a smaller harm in the service of the greater good? Across several studies, the
researchers found that upper-class participants behaved in a more utilitarian fashion: they were more willing
to harm one person in order to maximize gains for the group.
Most pertinent to our review is why these class differences in utilitarian decision-making emerged in the
first place. The researchers hypothesized that upper-class individuals would make more utilitarian judgments
because they feel less compassion for those harmed by this type of judgment than lower-class individuals. In
one representative study, the researchers examined class differences in feelings of compassion for the losing
player of a virtual economic game (Côté et al., 2013, Study 2). Study participants were told that they had been

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chosen to play the role of the “decider” and could choose to take money from a designated online player (“lose
member”) in order to maximize monetary gains for the other group members. Following the game,
participants reported how much compassion, sympathy, and other empathic emotions they felt for the losing
member––whose economic well-being would have been directly impacted. Consistent with their predictions,
and even when accounting for several other factors (gender, age, ethnicity, religiosity, and political
orientation), higher-income participants reported reduced feelings of compassion for the losing player, relative
to their lower-income counterparts, and these class differences in compassion accounted for the association
between social class and utilitarian judgment.
In a follow-up study, Côté et al. (2013) tested whether class differences in compassion are attributable more
generally to class differences in emotional reactivity—for example, it may be the case that lower-class
individuals are simply more reactive to any emotion-eliciting stimulus regardless of its content or valence. To
investigate this possibility, the researchers presented participants with sets of images that elicited either pride
(e.g., pictures of U.S. national landmarks), amusement (e.g., pictures of laughing monkeys), or compassion
(e.g., pictures of helplessness, vulnerability). After viewing the slides, participants reported their felt level of
each emotion, confirming that the manipulations were successful in eliciting their respective target emotion.
As expected, lower-income participants reported greater compassion in response to viewing images of others
suffering than upper-income participants, but no income differences emerged in response to images eliciting
pride or amusement––suggestive evidence that higher social class is specifically associated with reduced
reactivity to stimuli that elicit compassion.
These initial findings indicate that social class shapes people’s levels of compassion and are consistent with
the claim that individuals from lower-class backgrounds experience greater compassion than individuals from
upper-class backgrounds. Across both objective resource-based measures (e.g., income) and subjective rank-
based measures, lower-class individuals report experiencing more compassion in daily life, as well as respond
with greater compassion––as assessed via self-reports and compassion-related peripheral physiology––when
confronting the suffering of others. Moreover, these class differences in compassion are not reducible to
factors that may co-vary with social class (e.g., ethnicity, political orientation, religiosity), nor are they
attributable to more general class differences in emotional responding. The stronger compassionate
responding of lower-class individuals, we have theorized, may strengthen social connections that can
subsequently help them cope with their more threatening and resource-poor environments.

How Social Class Influences Compassionate Action: Sharing, Caring, and Assisting
As part of the growing scientific interest in understanding the psychological effects of social class,
investigators have explored how social class influences not only people’s thoughts and feelings, but also their
behavioral responses toward others in the social environment (for a review, see Kraus et al., 2012; Piff et al.,
2016). Investigations in this realm have documented numerous class differences in prosocial behavior––
tendencies to share, care, and assist (Keltner, Kogan, Piff, & Saturn, 2014)––both in the context of a specific
behavioral response initiated by the perception of need, as well as in terms of more diffuse or cooperative
forms of helping (e.g., helping an anonymous target who is not identified as suffering or being in a state of
dire need).
In describing research on class differences in compassionate actions that reflect a relative concern (or

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disregard) for the concerns of others, we do not mean to suggest that compassion and prosocial behavior are
one and the same; indeed, there is reason to differentiate them. First and foremost, we have conceptualized
compassion as a specific subjective feeling state that is triggered by the suffering of others and that motivates
desires to help, which parallels prior treatments of the construct (e.g., Gilbert, 2015; Goetz et al., 2010). As
such, compassion is distinct from a general benevolent response to others regardless of suffering. Second,
although feelings of compassion can trigger subsequent helping behavior, compassion and helping are not
reducible to one another: compassion does not always translate to helping behavior––for example, when the
costs of helping are deemed too high (Keltner et al., 2014; see also Cameron & Payne, 2011; and Cameron
D., this volume); and helping behavior can be motivated by various states besides compassion, including
gratitude (e.g., Bartlett & DeSteno, 2006), moral elevation (Schnall, Roper, & Fessler, 2010), and awe (Piff,
Dietze, Feinberg, Stancato, & Keltner, 2015).
Notwithstanding these important distinctions, there is a strong theoretical and empirical overlap between
compassion as an affective state and compassionate acts, such as helping and generosity (Gilbert, 2015),
underscoring the relevance of research on class differences in prosociality to our review of class and
compassion. Importantly, the motivation to alleviate suffering is a defining feature of compassion (Goetz et
al., 2010). Although this motivation can be expressed in a variety of acts, among the most well-documented is
that of helping behavior. Consistent with this notion, research finds that individuals with increased propensity
to feelings of compassion display greater levels of prosociality. For example, in a nationwide representative
sample of adults, individuals who reported experiencing greater compassion behaved in a more generous
fashion toward an anonymous study partner, even after accounting for the effects of other positive prosocial
emotions (e.g., love; Piff et al., 2015; see also Batson, 1998; Batson & Shaw, 1991). To the extent that lower-
class individuals are more attentive to the needs of others than their upper-class counterparts, as we have
argued and as prior research documents, they should not only be more likely to feel compassion, but also to
behave in ways that are compassionate, by prioritizing the needs and concerns of others.
Nationwide surveys of charitable giving in America frequently find what is referred to as a “giving gap”:
lower-income households often give a larger percentage of their annual incomes to charity than upper-income
households do (Gipple & Gose, 2012; Greve, 2009; James & Sharpe, 2007; Johnston, 2005; Independent
Sector, 2001). For example, in a large-scale analysis conducted by the Chronicle of Philanthropy of IRS
charitable giving records, individuals with yearly incomes of $50,000–$75,000 donated an average of 7.6% of
their discretionary income to charity, whereas those with yearly incomes above $100,000 contributed 4.2% of
their discretionary income to charity (Gipple & Gose, 2012; however, for a different perspective, see
Korndörfer, Egloff, & Schmukle, 2015). These patterns suggest, somewhat provocatively, that those with less
may at times be more giving.
Laboratory studies in which the opportunity to respond prosocially was an observed reaction to another
individual, often in conditions of anonymity, yield corroborating results. In one study using the Dictator
Game, a well-validated measure of generosity in which participants split points between themselves and an
anonymous other (e.g., Forsythe, Horowitz, Savin, & Sefton, 1994), individuals lower in subjective SES
donated more credits––which would later be exchanged for cash––to their partner than did individuals higher
in subjective SES (Piff et al., 2010, Study 1). In another experiment, individuals made to feel relatively lower
in social class rank, by comparing themselves to someone at the very top of the socioeconomic ladder,

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endorsed increased charitable donations, relative to individuals primed to feel relatively higher in social class
rank, by comparing themselves to someone at the very bottom of the social ladder (Piff et al., 2010, Study 2).
This study simultaneously revealed an independent effect of objective social class: lower-income individuals
were also more charitable than upper-income individuals, even when adjusting for the effects of manipulated
social class rank. These results indicate that alongside objective social class, subjective perceptions of relative
social class rank––even as triggered via fleeting social comparisons––can alter compassionate behavior.
There is some initial evidence that class-related differences in giving may generalize to diverse measures of
social class and generosity (e.g., Kirkpatrick, Delton, de Wit, & Robertson, 2015), and perhaps to even
different age groups and cultural contexts (e.g., Chen, Zhu, & Chen, 2013; Kirkpatrick, Delton, de Wit, &
Robertson, 2015; Miller, Kahle, & Hastings, 2015). In one study in this realm, researchers observed the
giving patterns of preschool children whose families varied in terms of wealth. Children from lower-income
families acted more altruistically than children from wealthier families, donating a greater number of prize
tokens to anonymous sick children (Miller et al., 2015). Despite this preliminary evidence, the question of
how social class differences in prosociality manifest across different populations and cultural contexts is an
important, and largely open, extension of the research we have reviewed.
Whereas lower-class individuals may be more prosocial, research finds that upper-class individuals are more
likely to behave in ways that harm others or are otherwise unethical for self-gain (for a review, see Piff et al.,
2016). In one relevant line of work (Piff, Stancato, Côté, Mendoza-Denton, & Keltner, 2012), individuals
higher in subjective SES were more likely to endorse various unethical behaviors, such as accepting bribes or
deceiving others, and were more likely to cheat in a game in order to increase their chances of winning a cash
prize. In two field studies that were also a part of this investigation, drivers with more expensive vehicles (a
real-world proxy for wealth) were more likely to cut off other drivers at a four-way intersection, and to fail to
yield for a pedestrian––actually a study confederate––waiting to cross at a crosswalk, actions that are not only
unlawful but that also reflect a disregard for the concerns of others (see also Blanco et al., 2008; Dubois,
Rucker, & Galinsky, 2015; Johns & Slemrod, 2010; Konigsberg, MacGregor, Johnson, Massey, & Daubman,
2013; Lyons et al., 2012; Wang & Murnighan, 2014).
What are the mechanisms underlying these class differences in prosocial behavior? Piff and colleagues
(2010, Study 4) conducted an experiment that underscores compassion as one potent driver of class-related
differences in prosociality. Piff and colleagues theorized that class differences in sensitivity to the welfare of
others and feelings of compassion might explain why lower-class individuals engage in more prosocial
behavior than upper-class individuals do. They proceeded to test this question in the context of giving
participants the opportunity to help a person in distress.
Study participants were randomly assigned to one of two experimental conditions. In the control condition,
participants viewed a video of two actors talking quietly to one another in a courtroom; this video was
designed to elicit a neutral emotional response. In the compassion-induction condition, participants watched a
video on child poverty, which elicited compassion by showing images of suffering and vulnerability. Shortly
after the video, a supposed lab partner––actually a confederate in the experiment––rushed into the lab,
apologized for being late, and asked whether she could still participate, all the while displaying classic
nonverbal signs of distress (e.g., widening of the eyes, brow movements up and in; Eisenberg et al., 1989;
Gross & Levenson, 1993). The partner was seated in an adjacent room, and then, ostensibly to make up for

418
lost time due to the partner’s late arrival, participants were asked to help divide a list of tasks, each with a
specified time requirement, between themselves and their partner. The total duration of the chosen tasks
served as a behavioral measure of helping: the more minutes participants volunteered to help their distressed
partner in the study, the more helpful they were being.
Piff and colleagues predicted that if lower-class individuals are, by default, more prone to feelings of
compassion and subsequent prosocial behavior, then they should exhibit high helping in both the compassion
and neutral conditions. On the other hand, upper-class individuals, who by default exhibit reduced
compassion and prosocial behavior, should exhibit high helping in the compassion condition but not in the
neutral condition. In other words, if class differences in prosociality are rooted, in part, in class differences in
compassion, then inducing in upper-class participants increased feelings of compassion should cause them to
be just as helpful as their lower-class counterparts.
Consistent with predictions, lower-income participants in the neutral condition were found to help their
partners to a greater extent than higher-income participants, mirroring past findings showing reduced
prosociality among higher-class individuals. However, experimentally inducing compassion via a brief video
about child poverty caused these class differences in helping behavior to disappear: inducing compassion
caused upper-income participants to exhibit levels of helping behavior that matched their lower-income
peers’. These findings help underscore two important points. First, they indicate that class-based differences
in prosociality may be attributable, at least in part, to class differences in baseline levels of compassion.
Second, these results indicate that class-based divergences in compassionate behavior are not immutable, but
rather sensitive to even brief reminders of the needs of others and “nudges” of compassion.
This research indicates that class differences in compassionate behavior parallel the class differences in
feelings of compassion we described earlier. Relative to upper-class individuals, lower-class individuals exhibit
increased tendencies to share with, care for, and help others, tendencies that arise, in part, out of their
increased attentiveness to others and baseline levels of compassion. Importantly, when upper-class individuals
are induced to feel compassion (for instance, via reminders of the suffering of others), they may become as
prosocial as lower-class individuals. Class differences in compassionate action, it would seem, do not arise
from a diminished capacity but rather from a reduced default tendency toward compassion among upper-class
individuals. What, then, determines when and where compassion on the part of the upper class will emerge?
What factors may help promote it? We turn to these questions in our final section.

Open Questions and Future Directions in Research on Social Class and Compassion
In this chapter, we have described an emerging pattern in the study of compassion––upper-class individuals
display less compassion than their lower-class counterparts do (Côté et al., 2013; Piff et al., 2010; Stellar et al.,
2012). Though provocative, the research we have described is also preliminary, and many important questions
remain. For example, do these effects extend to extremes of wealth and poverty and other instantiations of
compassion? And might class differences in compassion vary as a function of who is suffering––for example,
whether the person is rich or poor?
One central question concerns the origins of class differences in compassion, and in particular what aspects
of social class underlie these divergences. We have argued that “social class” comprises both objective resources
and subjective social-class rank, and that together these two components produce an internal, self-oriented

419
focus among upper-class individuals, and an external, other-oriented focus among lower-class individuals––
broad social-cognitive divergences that extend to class differences in compassion. We have reviewed research
indicating that subjective perceptions of relative class rank, and even context-specific social comparisons that
shift these perceptions, are associated with compassionate responding in ways that parallel more objective,
resource-based measures of social class. These findings suggest that class differences in compassion are very
likely to be multiply determined, originating from a confluence of cultural, environmental, and social-
cognitive factors tied to objective characteristics of social class as well as subjective perceptions of social class
rank.
It will be important to build on these findings by examining what aspects of the class-compassion gap are
relatively enduring or stable, versus shaped by the social context. For example, structural features of upper-
class environments, such as relative independence from others and increased autonomy, may provide fewer
opportunities for social interaction and reduced experiences with tending to the needs of others, both of which
may attenuate compassion. Compassion may also be less normative in upper-class contexts, which could
decrease the social value of compassion among individuals who identify as upper class (e.g., Lareau, 2002).
Future research should delineate to what extent relatively enduring features of higher social class, including
cultural values, identity, and autonomy, shape chronically lower feelings of compassion (e.g., Snibbe &
Markus, 2005; Stephens et al., 2007).
Compassion is also influenced by perceptions of social-class rank, which, as we have discussed, can shift as a
function of the social context and situation-specific perceptions of relative standing. This cautions researchers
against drawing firm conclusions about class differences in compassion as essential or categorical; rather, class
patterns of compassion are heavily influenced by contextual and situational factors. Perceptions of higher
social class rank may be more chronically activated among individuals with increased objective resources (e.g.,
greater wealth, higher education; Kraus et al., 2012), which could shape habituated responses to the social
environment. At the same time, social contexts––and social comparisons––that induce perceptions of
relatively lower social class rank can increase compassionate responding, even among individuals who are
objectively wealthy (e.g., Piff et al., 2010).
Future investigations should seek to better understand the pathways through which perceptions of relatively
decreased social class rank might independently increase compassion. Social rank is a fundamental means by
which people navigate the social realm, and it determines the individual’s privileged access to valued resources
(e.g., reproductive partners; Keltner, van Kleef, Chen, & Kraus, 2008). We argue that perceptions of one’s
own relatively lower-class rank (even those that arise in situ) trigger a heightened vigilance of the social
context and an other-focused social orientation, which are well-documented and adaptive strategies of lower-
rank individuals navigating more unstable environments (e.g., Kraus et al., 2009; Piff et al., 2010), both of
which may increase compassion. We posit that the effects of perceived social class rank are parallel to, but
distinguishable from, those of other rank-based processes that seem to similarly shift patterns of self- versus
other-focus, such as power (e.g., Guinote & Vescio, 2010) or winning in a competition (Schurr & Ritov,
2016)––an intriguing direction for research.
The mutability of class differences in compassion is further underscored by research we have described
finding that compassionate, prosocial action among upper-class individuals is responsive to psychological
intervention, such as brief reminders of the needs of others (e.g., Piff et al., 2010). These findings cast further

420
doubt on the notion that class differences in compassion reflect a reduced capacity for compassion among the
upper class. Rather, upper- and lower-class individuals may have differential motivations surrounding
compassion. One possibility is that upper-class individuals regulate or even avoid compassion, because they
expect that compassion inhibits self-relevant goals, whereas lower-class individuals may place more value on
compassion because they believe it advances their goals. Research on social power lends credence to this
motivational perspective, finding that high-power individuals may engage in emotion-regulation in response
to others’ suffering, thereby reducing their overall feelings of compassion (van Kleef et al., 2008). In the
future, studies should examine whether upper- and lower-class individuals hold differing motivations
surrounding compassion, and whether altering these motivations––for instance, by priming the relative
benefits versus costs of compassion––can lead to downstream shifts in compassionate responding.
One notable implication of the patterns we have described is that the people perhaps best positioned to care
for others—due to their elevated rank and resources—are seemingly the least likely to do so. Upper-class
individuals’ reduced compassion for the plight of others may exacerbate class divides in a socioeconomic
climate already rife with inequality (e.g., Saez & Zucman, 2014). What, then, can be done to alter this trend?
We discuss three promising factors—perspective-taking, contact, and utilitarianism—that point toward
important future directions and possible interventions.
One route to compassion involves transforming self-focus into perspective-taking. As we have seen, upper-
class individuals are more self-focused and less attentive to others in the social environment. Reduced
tendencies to see the world through others’ eyes may signify that upper-class individuals, at the level of basic
perception, are less cognizant of the suffering of others, even when confronted directly by it. Social
psychological research has shown that taking another’s perspective––for example, by imagining how she is
thinking and feeling––enhances empathy and compassion (e.g., Coke, Batson, & McDavis, 1978; Eisenberg
& Miller, 1987; Underwood & Moore, 1982). To the extent that upper-class individuals hold the view that
perspective-taking confers a disadvantage, a possibility we alluded to before, one effective strategy may be to
tie perspective-taking to preexisting values of self-interest, thereby harnessing the very self-interest that would
otherwise mitigate perspective-taking and compassion. Future investigations could identify effective
interventions to increase chronic perspective-taking among upper-class individuals, such as through explicit
training programs (e.g., compassion training; Jazaieri et al., 2016).
A related second avenue to increasing upper-class compassion involves inter-group contact. People tend to
surround themselves with those of similar class backgrounds; consequently, affluent individuals living in
comfortable environments may be less frequently confronted with the suffering of others. This could
undermine their feelings of personal efficacy when encountering suffering––in a sense, not knowing how to
respond. Moreover, affluent individuals may be more likely to categorize individuals who are suffering as
dissimilar to themselves (or as belonging to an out-group), perceptions that can hamper compassionate
responding (e.g., Cikara, Bruneau, Van Bavel, & Saxe, 2014; Tarrant, Dazeley, & Cotton, 2009). One way to
short-circuit these mitigating factors is through prolonged, interdependent contact with socioeconomically
diverse others (e.g., Aronson & Patnoe, 2011). Increased personal contact with those of lower social classes
might help upper-class individuals build skills for effectively responding to the suffering of others, enhance
their feelings of closeness and understanding, and broaden their definition of the in-group to include those
who are less socioeconomically advantaged. An interesting direction for research in this vein would be to test

421
whether experimentally induced cross-class contact can increase compassion across social class boundaries
(e.g., Page-Gould, Mendoza-Denton, & Tropp, 2008).
A final route to compassion involves harnessing the utilitarian proclivities of upper-class individuals. We
have described studies finding that when making certain moral decisions, upper-class individuals are
significantly more likely to prioritize the needs of the many over the few; they strive to maximize the greatest
good for the greatest number of people (Côté et al., 2013). Given that previous research has tested class
differences in compassion toward specific individuals who are suffering, it may be that upper-class individuals
dampen their feelings of compassion in these instances because they deem them less utilitarian. Following this
lead, upper-class individuals may be most inclined to respond with compassion to issues that they believe
negatively affect a large number of people, such as instances of collective or mass suffering. Future
investigations could examine whether framing instances of suffering in more collective ways––for example, by
underscoring how one individual’s suffering implicates many others––can boost compassion among upper-
class individuals. In sum, upper-class compassion may be facilitated through processes that link compassion to
utilitarianism.

Conclusion
People have made the case that our culture today is experiencing a compassion deficit. Over the past 50
years, people have become more individualistic, more self-focused, less connected to others, and less
empathetic (e.g., Twenge, Campbell, & Freeman, 2012), all trends that could signify societal declines in
compassion. It is perhaps partly for this reason that, in recent years, scientific interest in compassion, and the
factors that promote it, has surged. In this chapter, we have reviewed findings indicating that a person’s
propensity toward compassion is tied to her/his social class, such that increased social class is frequently
associated with less compassionate responding. We have outlined some of the possible psychological factors
underlying these associations, and described certain psychological, situational, and structural factors that could
mitigate them. Future research should build on these initial insights to better our understanding of the class-
compassion gap and, in turn, how it may be bridged.

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 Changes Over Time in Compassion-Related Variables in the United States

Sasha Zarins and Sara Konrath

Abstract

Compassion, or empathic concern, is an emotional response to another’s suffering, coupled with the
desire to take action to alleviate that suffering. Throughout history, older generations have been critical
of younger generations, often arguing that they are more self-focused than previous generations.
However, it is important to examine actual data with respect to changes over time in such variables.
Without doing so, we risk spreading potentially harmful and inaccurate stereotypes about young
Americans. The goal of this chapter is to review research examining changes over time in compassion-
related variables in the United States. Research suggests that compassion-related variables have indeed
been declining over time, while self-focused variables have been increasing. However, we will also
discuss counter-arguments and counter-evidence, and present possible implications of this research.

Key Words: compassion, empathic concern, temporal changes, social change, other-focus, self-focus

Overview
Young adults in the United States today have a bad reputation. A glance of the headlines in the early 2010s
finds news articles accusing so-called millennials of being coddled (Lukianoff & Haidt, 2015), whiny (Proud,
2015), and lazy, entitled narcissists (Stein, 2013). However, in light of the perennial human tendency for older
people to be critical of the younger generation (Eibach & Libby, 2009), it is important to examine actual data
with respect to changes over time in such variables. Without doing so, we risk spreading potentially harmful
and inaccurate stereotypes about young Americans.
In this chapter, we will review research examining changes over time in compassion-related variables in the
United States. Are there historical trends of decreasing compassion and increasing self-focus in the United
States? The results of our comprehensive review indeed suggest that compassion-related variables have been
declining over time, while self-focused variables have been increasing. Parallel changes in technology and
media, among other potential explanations, may help us better understand the broader cultural context in
which these changes were occurring. We will also review possible implications of this research, and discuss
counter-arguments and counter-evidence. We conclude with some suggestions for future directions.

What Is Compassion?
The study of compassion and compassion-related concepts is wrought with definitional issues. The terms
compassion, empathy, and sympathy are often used interchangeably. Although they are closely related concepts,
each term represents a distinct construct. Compassion is an awareness that another person is in pain or
suffering, coupled with wanting to do something to alleviate that suffering (Goetz, Keltner, & Simon-

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Thomas, 2010). Empathy, on the other hand, is often defined as both an emotional and a cognitive construct.
Empathic concern, the emotional component, refers to other-oriented feelings of care and concern for the
suffering of others. To make things more confusing, empathic concern is sometimes referred to as sympathy
(Lennon & Eisenberg, 1987), but sympathy is also sometimes used to refer to feelings of pity (Gerdes, 2011).
Feelings of empathic concern often motivate the desire to do something to alleviate others’ suffering (Batson,
2011). Given this, there is much overlap between the construct of empathic concern and compassion in that
they are both emotional responses to others’ suffering that motivate altruistic prosocial action. Perspective-
taking, or cognitive empathy, involves imagining other people’s points of view (Davis, 1983). In itself,
perspective-taking need not be prosocial. Indeed, it is possible for people to use perspective-taking skills to
manipulate others and get what they want from them (Epley, Caruso, & Bazerman, 2006). Many scholars see
compassion (or empathic concern) to be one of two possible reactions to seeing someone in distress or need;
the other response is the more self-focused response of personal distress, which is sometimes confusingly called
empathic distress (Davis, 1983; Singer & Klimecki, 2014).
In this chapter, we will review changes over time in compassion-related traits, such as those mentioned, but
also compassion-related behaviors. Prosocial behavior is any action intended to benefit another person (Batson
& Powell, 2003). Prosocial behaviors can be motivated by altruism, which is the desire to benefit others, but
they can also be motivated by egoism, which is the desire to benefit oneself (Batson & Powell, 2003). Both
cognitive and emotional empathy are associated with more prosocial behaviors (Batson, 2011; Eisenberg &
Miller, 1987; Underwood & Moore, 1982).

Different Meanings of Different Methods

Before reviewing the changes over time in compassion-related variables, we will explain the different
methodologies used in this literature. This is important to understand in order to make appropriate
conclusions about the findings. We organized our chapter according to the strength of the potential evidence
about generational changes (also called cohort effects), ranging from weaker (cross-sectional) to stronger
(repeated surveys with age held constant, or cross-temporal meta-analyses).

SINGLE TIME-POINT CROSS-SECTIONAL SURVEYS

The weakest evidence for cohort effects comes from cross-sectional surveys, which rely on correlational data
in which people of different age groups are asked questions or take standardized tests at a single time point.
These results are often erroneously discussed in terms of generational or birth cohort effects. This can be
misleading, because with this type of data, taken from a single time point, it is impossible to determine if any
results are due to natural developmental changes that occur as people age (development effects) or because of
generational changes that affect the mindset of a group of individuals (cohort effects), or both combined. Birth
cohorts (or generations) are defined as people born within a specified range of years who experienced similar
significant events and social norms based on the time period in which they were raised (Stewart & Healy,
1989; Twenge, 2000). Four commonly used generations are: the Silent Generation (born 1925–1945), Baby
Boomers (born 1946–1964), Generation X (born 1965–1979), and Millennials (born 1980–2000; Howe &
Strauss, 2009). Yet there is debate over whether the use of arbitrary generational cutoffs makes sense
(Twenge, 2014). Overall, results from single time-point cross-sectional surveys must be interpreted with

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caution.

TRENDS IN CULTURAL PRODUCTS

Cultural products include books, songs, political speeches, greeting cards, art, and other such artifacts
(Morling & Lamoreaux, 2008). These do not represent direct measures of traits or attitudes of individuals, but
instead assess more indirect societal trends related to compassion. One strength of using cultural products is
that they are often available even before certain standardized measures. For example, Google Ngram makes it
possible to search millions of digitized books from 1800 onward (Michel et al., 2011), enabling us to examine
the frequency of word usage across this relatively long time period.

CROSS-TEMPORAL META-ANALYSES

The method of cross-temporal meta-analyses involves collecting data on traits or other standardized
measures from published or unpublished sources, and then examining changes over time in these measures.
Since the cross-temporal meta-analysis method holds age constant, it can determine changes over time across
different cohorts. For example, it can compare dispositional empathy scores of 20-year-old college students in
the 1980s to empathy scores of 20-year-old college students from the 1990s and 2000s. However clever this
method, these studies are often limited by the samples they use; nearly all of them rely on college student
samples, since these are the participants most widely used by psychology researchers. Therefore, the results of
these studies cannot be generalized to less affluent and more diverse groups in the United States. Another
problem with this method is that it relies on standardized scales, and thus can only go back as far as the point
at which they were developed. Often this only reveals window of psychological change in a relatively brief
period (e.g., the 1970s to the present day), rather than a longer time period.

MULTI-YEAR SURVEYS

There are some large, nationally representative datasets that have asked questions related to compassion on
a regular (annual or biannual) basis for many years. These surveys either sample the entire U.S. population
(e.g., the General Social Survey), or they sample a specific age group (e.g., high school students in the
Monitoring the Future Study). In any case, examining temporal changes in these surveys is a legitimate way of
understanding societal-level psychological changes on variables of interest. One strength of these surveys is
that since they draw on nationally representative samples, the results can be generalized to the United States
as a whole rather than a certain subset of the population.

Changes Over Time in Other-Focused Variables

We first discuss changes over time in other-focused personality traits, attitudes, behaviors, and cultural
indicators.

Other-Focused Traits
SINGLE TIME-POINT CROSS-SECTIONAL SURVEYS

In a 2015 survey conducted by NBC News, 62% of 2,650 American adults said that they believe that kids
today are less kind than kids in the past (Raymond, 2015). However, very little can be determined from a
single survey taken at a single time point. For example, we cannot tell if a similar percentage of adults in the

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1990s and 1970s would have expressed the same sentiment. Indeed, throughout most of human history, older
people have had concerns about the moral character of the youth. As a case in point, in 700 bce, Hesiod, a
Greek poet, wrote: “Men will dishonor their parents as they grow quickly old, and will carp at them, chiding
them with bitter words, hard-hearted they, not knowing the fear of the gods. They will not repay their aged
parents the cost of their nurture, for might shall be their right.” The sentiments expressed in this quote seem
quite contemporary, yet examples such as these have occurred throughout written history (Eibach & Libby,
2009). This speaks to the importance of carefully documenting actual changes over time in a society, using
empirical approaches.

CROSS-TEMPORAL META-ANALYSES

Given the previously defined relationship between empathy and compassion, we first examine changes in
empathy over time. A cross-temporal meta-analysis that examined changes over time in American college
students’ dispositional empathy found declines in empathic concern (emotional empathy) and perspective-
taking (cognitive empathy) scores between 1979 and 2009 (Konrath, O’Brien, & Hsing, 2010). These
declines were most pronounced after the year 2000.
Next, adult attachment styles involve how people connect with and relate to others (Bartholomew &
Horowitz, 1991). Secure feelings of attachment between the self and others provide a foundation for
compassion, while insecure attachment interferes with one’s ability to feel compassion (Diehl, Elnick,
Bourbeau, & Labouvie-Vief, 1998; Mikulincer & Shaver, 2005). A cross-temporal meta-analysis of adult
attachment styles found that the proportion of American college students reporting a secure attachment style
declined between 1988 and 2011 (Konrath, Chopik, Hsing, & O’Brien, 2014).

Other-Focused Attitudes and Values

MULTI-YEAR SURVEYS

Moral reasoning is the degree to which individuals conform to moral rules because of consequences to
themselves, others, and society (Kohlberg, 1976). Lower-level moral reasoning focuses on avoiding negative
consequences for oneself (e.g., punishment), whereas considering consequences to other individuals is seen as
more advanced moral reasoning. Yet, the highest level considers consequences to society at large. Moral
reasoning is related to compassion because higher levels of moral reasoning are present in more empathic
adolescents (Eisenberg-Berg & Mussen, 1978; Hoffman, 2001). One multi-year study found that moral
reasoning levels decreased over time from 1979 to 2005 (Thoma & Bebeau, 2008).
Both the Monitoring the Future Study and the American Freshman Survey include items that tap into
concern for others. Between 1966 and 2009, high school seniors and first-year college students were less likely
to express empathy for out-groups, less likely to want a job that helps others (e.g., social worker), and less
likely to say they would eat differently if it meant more food for the hungry (Twenge, Campbell, & Freeman,
2012). Such lower levels of concern for others imply difficulty with compassion towards others.
Next, trust involves holding positive expectations of others (Rotter, 1971). More trusting people also tend
to be more empathic (Nadler & Liviatan, 2006), so changes in trust over time could be seen as signaling
changes in a positive focus on others, with implications for compassionate responses toward them. Trust in
others declined from 1976 to 2012 in adults (General Social Survey) and declined from 1972 to 2012 in high

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school seniors (Monitoring the Future Study; Twenge, Campbell, & Carter, 2014).

Other-Focused Behaviors
SINGLE TIME-POINT CROSS-SECTIONAL SURVEYS

The Corporation for National and Community Service (CNCS) found that, in 2014, American millennials
reported the lowest rate of volunteering (21.7%), and Generation X had the highest rate (29.4%). Baby
boomers (27.2%) and older adults (24.0%) were in the middle (CNCS, 2015). However, without comparing
these results across several time periods, we cannot tease apart developmental from cohort effects.

MULTI-YEAR SURVEYS

Charitable donations involve freely giving money to nonprofit organizations or individuals in need (Bekkers,
2005). Although motivations for charitable giving can be self-focused or other-focused, because charitable
giving benefits others, we consider it an other-focused behavior. Indeed, more empathic people are more likely
to engage in charitable giving (Bekkers, 2006).
Between 1966 and 2009, the Monitoring the Future Study found that high school seniors were significantly
less likely to say that they would donate to charity in the future (Twenge, Campbell, & Freeman, 2012).
However, this is not a very strong measure of charitable giving, because it is based on self-reported future
expectations. Giving USA annually collects and analyzes tax data, economic indicators, and demographics
from more reliable sources like the Internal Revenue Service, the Philanthropy Panel Study, and the Census
Bureau (Giving USA Foundation, 2015). Between 1974 and 2014, the total dollar amount of charitable
donations by individuals increased significantly, even when adjusted for inflation. However, giving has
remained flat at around 2% of disposable income across this same time period. Because of the overall increase
in charitable donations, one might conclude that Americans are becoming more generous. However, they are
not donating a higher proportion of their disposable income, which casts doubt on this assumption. In
addition, since charitable donations do not necessarily indicate altruistic motivations, increasing total
charitable donations do not necessarily imply increased compassion in the United States.
Volunteering is another formal prosocial behavior that involves freely giving time to nonprofit organizations
(Wilson, 2000). Several multi-year studies have examined volunteering rates over time:

• Between 1984 and 1997, ABC News/Washington Post surveys found that the percentage of Americans
who volunteered in the past year increased from 44% to 58% (reported in [Ladd, 1999]).
• Between 1977 and 1995, Gallup/Princeton polls found that the percentage of Americans reporting
involvement in social service work increased from 26% to 54% (reported in [Ladd, 1999]).
• Between 1989 and 2007, the CNCS found that the rate of volunteering increased across all age groups,
with the largest increase among teens (CNCS, 2007).
• Between 1966 and 2009, the Monitoring the Future Study and the American Freshman Survey found
that high school seniors and first-year college students were more likely to have participated in volunteer work
over time (Twenge, Campbell, & Freeman, 2012).
• However, between 2003 and 2013, Giving USA found that volunteering rates steadily declined over time
(Giving USA Foundation, 2015).

Overall, it appears that volunteering was increasing from the middle of the twentieth century to the first

430
decade of the twenty-first century, but it may have declined in later years. As with charitable donations,
volunteering does not necessarily imply altruistic motivations. Although more empathetic people behave more
prosocially, including donating to charity (Bekkers, 2006) and volunteering (Bekkers, 2005; Penner, 2002),
people volunteer for many reasons (Clary & Snyder, 1999). For example, more narcissistic people often help
for strategic or selfish reasons rather than for altruistic reasons (Konrath, Ho, & Zarins, 2016). Thus, a rise in
volunteering rates over time does not necessarily imply increased compassion over time. Overall, we must
consider these behavioral changes within the larger context of changes in traits, attitudes, and values.
Furthermore, a study used the lost letter paradigm to measure changes over time in helping behavior. The
lost letter paradigm measures the return rate of addressed, stamped envelopes that are “lost” in public locations
(Milgram, Mann, & Harter, 1965). In this study, fewer letters were returned in 2011 (49.46%) than in 2001
(58.68%) in the United States. However, this decrease in helping behavior did not occur in Canada, where
return rates were similar in 2001 (53.59%) and 2011 (51.40%) (Hampton, 2016).
Beyond helping, volunteering, and charitable donations, people engage in society in a number of ways.
People who are more actively engaged in society and politics (e.g., more likely to vote) score higher in
empathic concern (Bekkers, 2005). The Monitoring the Future Study and the American Freshman Survey
found that, between 1966 and 2009, there was a decrease in civic engagement and social capital among young
Americans (Twenge, Campbell, & Freeman, 2012). Millennials were less likely to think about social
problems, have an interest in government, vote, write to a public official, participate in a demonstration, give
money to political causes, or take action to help the environment, compared to prior generations of young
Americans (Twenge, Campbell, & Freeman, 2012). The only exception to this trend is that millennials were
more likely to discuss politics over this time period compared to those from Generation X (Twenge,
Campbell, & Freeman, 2012). Overall, this lower civic engagement could have implications for compassion
toward others who are from different backgrounds.
So far, we have discussed changes in general engagement with society, but we also see changes at a more
personal/relational level. More socially connected people have more friends and people to discuss important
topics with (McPherson, Smith-Lovin, & Brashears, 2006). One multi-year study using the General Social
Survey found that the number of people with whom Americans discussed important topics decreased from an
average of 2.94 other people in 1985 to an average of 2.08 other people in 2004 (McPherson et al., 2006).
However, across the same time period, Americans were more likely to discuss important matters with their
spouse (McPherson et al., 2006). Since empathy enhances, and can also be enhanced by, social connections
with others (Watt, 2005), it is likely that declines in the number of intimate others over time could have
implications for people’s compassion toward others.
Taken together, the trends we report in this section align with more in-depth prior scholarship
documenting declines in trust in others, social connections, and political, civic, and religious participation in
the second half of the twentieth century (Putnam, 2001).

Other-Focused Cultural Indicators

Cultural products can vary in their degrees of relative individualism (independence) versus collectivism
(interdependence; Morling & Lamoreaux, 2008). The more other-focused aspect, collectivism, involves seeing
oneself as part of an interconnected group with others (Markus & Kitayama, 1991). As such, people who are

431
more collectivist also tend to be more empathic (Realo & Luik, 2002). Focusing on oneself in relation to
others might make it easier for individuals to be compassionate towards others.
There have been declines in interdependent/collectivist words and phrases in American books, from 1960
and 2008 (Twenge, Campbell, & Gentile, 2012b) and from 1860 and 2006 (Grossmann & Varnum, 2015).1
In addition, the use of the term “self-control” in American books decreased from 1900 to 2000 (Konrath &
Anderson, 2011), and first-person plural pronouns (e.g., “we”) became less common between 1960 and 2008
(Twenge, Campbell, & Gentile, 2013). Parallel changes have been found when examining other-focused
words in songs. For example, one study found that the number of other-focused words, social interaction
words, and positive emotion words all declined in popular songs from 1980 to 2007 (DeWall, Pond Jr.,
Campbell, & Twenge, 2011). Finally, another study found decreases in the use of words that indicate other-
interest (e.g., mentions of friends) in U.S. presidential State of the Union speeches between 1790 and 2012
(Chopik, Joshi, & Konrath, 2014).2

Summary of Other-Focused Results

There have been changes at the individual, family, and societal levels in a number of other-focused
variables. In general, there have been significant decreases in other-focused traits, attitudes, values, and
behaviors. Cultural indicators also point to a trend toward decreased collectivism in American society (see
Table 25.1 for a detailed summary). Given these decreases in empathy, secure attachment, moral reasoning,
concern for others, and trust, coupled with cultural trends away from collectivist values, we can begin to piece
together a clearer picture of the overall trends in compassion-related variables. Even in light of the
inconsistent behavioral evidence around volunteering and charitable giving, other behavioral measures indicate
a decrease in other-focused behaviors (e.g., civic engagement and social connections). Decreases in these
traits, attitudes, and values are likely to make it more difficult for recent generations of American college
students to be compassionate.

Table 25.1 Summary of Prior Research on Temporal Trends in Compassion-Related Variables

Variable Change over Time Participants Study Measure/Survey Citation

time period type

Other-focused traits

Perceptions of kids’ Respondents None N = 2,650 Single NBC News (Raymond,

empathy believe kids specified adults time- Season of 2015)
today have (nationally point Kindness Poll
less empathy representative) cross-
than kids in sectional
previous survey
generations

Dispositional empathy Empathic 1979– N = 13,737 Cross- Interpersonal (Konrath et

concern and 2009 college temporal Reactivity Index al., 2010)
perspective- students in 72 meta- (Davis, 1983)

432
 taking studies analysis
declined

Adult attachment style Secure 1988– N = 25,243 Cross- Relationship (Konrath et

attachment 2011 college temporal Questionnaire al., 2014)
declined, students in 94 meta- (Bartholomew &
dismissing studies analysis Horowitz, 1991)
attachment
increased

Other-focused attitudes and values

Moral development Moral 1979– N = 15,115 Multi- Defining Issues (Thoma &
reasoning 2006 college and year Test (Rest, 1990) Bebeau,
levels graduate survey 2008)
declined students

Attitudes toward Concern for 1966– MtF1: N = Multi- Monitoring the (Twenge,
others others 2009 463,753 high year Future & Campbell, &
declined school students survey American Freeman,
(nationally Freshman Survey 2012)
representative);
AF2: N = 8.7
million college
students
(nationally
representative)

Trust in others Trust in 1972– GSS3: N = Multi- General Social (Twenge et

others 2012 37,493 adults year Survey & al., 2014)
declined (nationally survey Monitoring the
representative); Future
MtF: N =
101,633 high
school students
(nationally
representative)

Other-focused behavioral indicators

Volunteering American 2014 ~100,000 Single Volunteer (CNCS,

millennials adults each time- supplement of the 2015)
reported the month point Current
lowest levels (nationally survey Population Survey
of representative)

433
 volunteering
(21.7%) and
Generation X
had the
highest rate
(29.4%). Baby
boomers
(27.2%) and
older adults
(24.0%) were
in the middle

Charitable giving Intent to 1966– MtF: N = Multi- Monitoring the (Twenge,

donate to 2009 463,753 high year Future Campbell, &
charity school students survey Freeman,
decreased (nationally 2012)
representative)

Charitable giving Total 1974– All US citizens Multi- Giving USA (Giving USA
charitable 2014 who filed taxes year Foundation,
giving survey 2015)
increased, but
giving as a
proportion of
GDP and of
disposable
income
remained
around 2%

Volunteering Rates of 1966– MtF: N = Multi- Monitoring the (Twenge,

volunteering 2009 463,753 high year Future & Campbell, &
and expected school students survey American Freeman,
future (nationally Freshman Survey 2012)
volunteering representative);
increased AF: N = 8.7
million college
students
(nationally
representative)

Volunteering Volunteering 1974– ~100,000 Multi- Volunteer (CNCS,

434
 increased 2007 adults each year supplement of the 2007)
month survey Current
(nationally Population Survey
representative)

Volunteering Volunteering 1977– Number of Multi- ABC (Ladd, 1999)

increased 1997 participants year News/Washington
not given4 survey Post Poll (1984–
1997) & Gallup
and Princeton
Survey Research
Associates Poll
(1977–1995)

Volunteering Volunteering 2003– ~100,000 Multi- Giving USA – (Giving USA

declined 2013 adults each year Volunteer Foundation,
month survey supplement of the 2015)
(nationally Current
representative) Population Survey

Helping behavior In the United 2001– United States: Multi- Lost-letter (Hampton,
States, the 2011 2001: 2,161 year paradigm 2016)
number of letters 2011: measure (Milgram et al.,
letters 2,210 letters 1965)
returned Canada: 2001:
declined 1,560 letters
2011: 1,535
letters

Civic engagement Civic 1966– MtF: N = Multi- Monitoring the (Twenge,

engagement 2009 463,753 high year Future & Campbell, &
declined school students survey American Freeman,
(nationally Freshman Survey 2012)
representative);
AF: N = 8.7
million college
students
(nationally
representative)

Religious Attendance at 1976– N = 11.2 Multi- Monitoring the (Twenge,

participation religious 2013 million high year Future, Exline, et al.,
services and school and survey Monitoring the 2015)

435
 religious students Future 8th & 10th
affiliation (nationally grade surveys, &
declined representative); American
AF: N = 8.7 Freshman Survey
million college
students
(nationally
representative)

Social connectedness Adults 1985– ~1,100 Multi- General Social (McPherson

reported 2004 households per year Survey et al., 2006)
fewer year (nationally survey
confidants representative)
with whom
they discussed
important
matters

Other-focused cultural indicators

Collectivist/communal Use of 1860– American Cultural Google Ngrams (Grossmann

words communal 2006 fiction and products & Varnum,
words and 1960– nonfiction 2015;
phrases 2008 books Twenge,
decreased Campbell, et
al., 2012b)

“Self-control” Use of the 1900– English- Cultural Google Ngrams (Konrath &
word “self- 2000 language books products Anderson,
control” 2011)
decreased

Pronoun use Use of first- 1960– American Cultural Google Ngrams (Twenge,
person plural 2008 fiction and products Campbell, et
pronouns nonfiction al., 2013)
(indicating books
collectivist
values)
decreased

Song lyrics Use of other- 1980– Top ten US Cultural Song lyrics (DeWall et
focused 2007 songs of each products al., 2011)
words, words year
related to

436
 social
interactions,
and positive
emotion
words
decreased

State of the Union Use of other- 1970– 226 State of Cultural State of the Union (Chopik et
person 2012 the Union products Addresses al., 2014)
pronouns and Addresses
mentions of
friends
decreased

Self-focused traits

Narcissism Narcissism 1979– N = 49,818 Cross- Narcissistic (Twenge &

increased 2008 college temporal Personality Index Foster, 2010;
students in 107 meta- (Raskin & Hall, Twenge et
studies analysis 1979) al., 2008)

Narcissism Narcissism 1994– N = 4,152 Multi- Narcissistic (Twenge &

increased 2009 University of year Personality Index Foster, 2010)
within a South survey (Raskin & Hall,
single college Alabama 1979)
campus introductory
psychology
students

Self-esteem Self-esteem 1968– N = 65,965 Cross- Rosenberg Self- (Twenge &

increased in 1994 students in 199 temporal Esteem Scale Campbell,
college samples meta- (Rosenberg, 1965) 2001)
students analysis

Self-esteem Self-esteem 1965– N = 39,353 Cross- Coopersmith Self- (Twenge &

decreased in 1993 students in 156 temporal Esteem Inventory Campbell,
children from samples meta- (Coopersmith, 2001)
1965 to 1979 analysis 1967)
then
increased
from 1980 to
1993

Self-esteem Self-esteem 1988– N = 77,522 Cross- Rosenberg Self- (Gentile et

increased 2008 middle school, temporal Esteem Scale al., 2010)

437
 high school, meta- (Rosenberg, 1965)
and college analysis
students in 264
samples

Ambition Adolescents’ 1976– Ns range from Multi- Monitoring the (Reynolds,

ambition has 2000 1,946 (2000) year Future Stewart,
increased to 3,295 survey MacDonald,
(1978); high & Sischo,
school seniors 2006)
from 125 high
schools each
year (nationally
representative)

Narcissism Narcissism ~1990– N = 933 Multi- California (Stewart &

has increased 2008 college year Personality Index Bernhardt,
students and survey (Gough, 1956) 2010)
graduate
students

Agentic traits Self-ratings 1966– N = 6.5 million Multi- American (Twenge,

on agentic 2009 college year Freshman Survey Campbell, et
traits students survey al., 2012a)
increased

Self-focused attitudes and values

Desired job (1) Value of 1976, N = 16,507 Multi- Monitoring the (Twenge,
characteristics intrinsic and 1991, high school year Future Campbell, et
social rewards
(intrinsic vs. extrinsic 2006 students survey al., 2010)
decreased
rewards) (2) Value of
leisure
rewards
increased
(3) Value of
extrinsic
rewards
increased
from 1976 to
1991 then
decreased
slightly from
1991 to 2006,
but increased
overall
between 1976

438
 and 2006
(4) No
differences in
value of
altruistic
rewards

Life goals (intrinsic Intrinsic life 1966– MtF: N = Multi- Monitoring the (Twenge,
vs. extrinsic goals) goals 2010 463,753 high year Future & Campbell, &
decreased and school students survey American Freeman,
extrinsic life (nationally Freshman Survey 2012)
goals representative);
increased AF: N = 8.7
million college
students
(nationally
representative);
182
undergraduate
college
students from
San Diego
State
University

Self-focused cultural indicators

Individualistic words Use of 1860– American Cultural Google Ngrams (Grossmann

individualistic 2006 fiction and products & Varnum,
words and 1960– nonfiction 2015;
phrases 2008 books Twenge,
increased Campbell, et
al., 2012b)

“Self-esteem” Use of the 1900– English- Cultural Google Ngrams (Konrath &
word “self- 2000 language books products Anderson,
esteem” 2011)
increased

Pronoun use Use of first- 1960– American Cultural Google Ngrams (Twenge,
person 2008 fiction and products Campbell, et
singular and nonfiction al., 2013)
second- books
person

439
 pronouns
(indicating
individualistic
values)
increased

Song lyrics Use of self- 1980– Top ten US Cultural Song lyrics (DeWall et
focused words 2007 songs of each products al., 2011)
and antisocial year
words and
phrases
increased

State of the Union Use of first- 1970– 226 State of Cultural State of the Union (Chopik et
person 2012 the Union products Addresses al., 2014)
pronouns Addresses
(singular and
plural) and
mentions of
family
increased

Baby names Preference for 1880– All US citizens Historical Social Security (Grossmann
unique baby 2012 who have a data Administration & Varnum,
names 1880– Social Security baby name 2015;
increased 2007 card database Twenge,
Abebe, et al.,
2010)

Household size (1) Frequency of (1) 1880– All US citizens Historical US Census & the (Grossmann
single-child 2012 data American & Varnum,
families (2) 1880–
Community 2015)
relative to 2012
multi-child (3) 1880– Survey;
families 2012 government
increased (4) 1860–
records from the
(2) Frequency of 2012
single- (5) 1900– National Center
generation 2009 for Health
households
Statistics at the
relative to
multi-
US Department of
generation Health and
households
Human Services
increased
(3) Percentage of

440
 adults and
older adults
living alone
increased
(4) Average
family size
decreased
(5) Divorce rates
relative to
marriage rates
increased

Counterevidence

Loneliness Loneliness 1978– N = 13,041 Cross- UCLA Loneliness (Clark et al.,

declined 2009 college temporal Scale (Russell, 2014)
students in 48 meta- 1996)
samples analysis

Loneliness Loneliness 1991– N = 385,153 Multi- Monitoring the (Clark et al.,

declined 2012 high school year Future 2014)
students survey
(nationally
representative)

Time spent alone Time spent 1979– 143,593 people Multi- Human coding of (Hampton et
alone in 2010 were coded in year time-lapsed film al., 2015)
public spaces four public measure and video
declined, spaces
while time
spent in
groups in
public spaces
increased

Bullying (1) School- 1992– N~160,000 Multi- National Crime (Finkelhor,

related violent 2011 youth age 12– year Victimization 2014)
victimizations
18 each year survey Survey
declined
(2) Bullying and
peer
victimization
declined

Bullying (1) Physical 1991– N~12,000– Multi- Youth Risk (Finkelhor,

fighting and 2011 17,000 high year Behaviors Survey 2014)
fighting on
school students survey
school
each year

441
 property
declined
(2) No significant
changes in
bullying
between 2009
and 2011
nationally
(3) School
bullying
declined in
Massachusetts

Bullying Students 1998– N~4,500 6th– Multi- Health Behavior (Finkelhor,

reporting 2010 10th grade year in School-Age 2014)
being a students each survey Children Study
perpetrator or year
a victim of
bullying
declined

Bullying Exposure to 1991– N~2,500 high Multi- Monitoring the (Finkelhor,

threat of 2010 school seniors year Future 2014)
interpersonal from 125 high survey
injury at schools each
school year
declined,
except among
students who
reported
being
victimized

Bullying Pushing, 1995– 6th, 9th, 12th Multi- Minnesota Survey (Finkelhor,
grabbing, and 2010 graders (N not year on Bullying 2014)
shoving on reported) survey
school
property
declined

Bullying Physical 2006, N~4,500 Multi- National Survey of (Finkelhor,

intimidation, 2009, children each year Children Exposed 2014)
emotional 2011 year survey to Violence
victimization,
and peer and

442
 sibling assault
declined

Bullying (1) Online 2000, N = 4,561 Multi- Youth Internet (Jones et al.,
harassment, 2005, youth age 10– year Safety Survey 2013)
driven by
2010 17 who use the survey
direct online
harassment Internet
increased
(2) Distressing
harassment
increased
proportional
to the increase
in overall
harassment
(3) Repeated
harassment by
the same
person
increased. (4)
Bullying
perpetration
increased

Tolerance Tolerance for 1972– N = 35,048 Multi- General Social (Twenge,

others with 2012 adults year Survey Carter, et al.,
controversial (nationally survey 2015)
beliefs and representative)
lifestyles
increased

Narcissism No change in 1982– N = 26,867 Multi- Narcissistic (Trzesniewski

narcissism 2007 college year Personality Index et al., 2008)
over time students at the survey (Raskin & Hall,
University of 1979)
California
(Davis, Santa
Cruz, and
Berkeley)

Self-enhancement No change in 1976– N = 410,527 Multi- University of (Trzesniewski

self- 2006 high school year California et al., 2008)
enhancement seniors and survey introductory
over time college psychology testing
students at the sessions,
University of Monitoring the

443
 California Future
(Davis, Santa
Cruz, and
Berkeley)

Narcissism No change in 1996– N = 30,073 Multi- Narcissistic (Donnellan et

narcissism 2008 college year Personality Index al., 2009)
over time students at the survey (Raskin & Hall,
University of 1979)
California
(Davis and
Berkeley)
1
Monitoring the Future
2 The American Freshman

3 General Social Survey

Changes Over Time in Self-Focused Variables

We next review changes over time in more self-focused personality traits, attitudes, and cultural indicators.

Self-Focused Traits
CROSS-TEMPORAL META-ANALYSES

Narcissism is a personality trait involving excessively positive self-views, in combination with low empathy
(Watson, Grisham, Trotter, & Biderman, 1984). A cross-temporal meta-analysis found that narcissism
significantly increased in American college students between 1979 and 2006 (Twenge, Konrath, Foster, Keith
Campbell, & Bushman, 2008), and continued to rise between 2006 and 2008 (Twenge & Foster, 2010).
Narcissism was even found to be increasing between 1994 and 2006 on a single college campus (Twenge &
Foster, 2010). Since narcissism by definition includes low empathy, it is possible that young adults with an
increasing self-focus might find it difficult to have compassion for others.
Next, self-esteem measures how positively or negatively people view themselves (Rosenberg, 1965). People
who score higher in self-esteem also tend to score higher in narcissism (Watson, Little, Sawrie, & Biderman,
1992). The main difference between them is that it is possible to have high self-esteem and care about others,
but narcissistic people have high self-esteem and also devalue others (Campbell, Rudich, & Sedikides, 2002).
A cross-temporal meta-analysis found that self-esteem increased from 1968 to 1994 in college students, but it
had a more complex pattern in elementary and junior high school students: decreasing from 1965 to 1979,
then increasing from 1980 to 1993 (Twenge & Campbell, 2001). A second cross-temporal meta-analysis
found that it increased in middle-school, high-school, and college students between 1988 and 2008 (Gentile,
Twenge, & Campbell, 2010). Because self-esteem is correlated with narcissism (Watson et al., 1992), this
increase in self-esteem could indicate that younger generations are becoming less compassionate over time.
However, given that it is possible to have high self-esteem and care about others (Campbell et al., 2002), it is
also possible that changes in self-esteem are not indicative of changes in compassion.

444
MULTI-YEAR SURVEYS

In addition to the cross-temporal meta-analyses discussed above, a multi-year study compared

undergraduate and graduate students in 2004–2008 to undergraduates before 1990 and found a significant
increase on the narcissism measures of the California Psychological Inventory (Gough, 1956; Stewart &
Bernhardt, 2010). However, caution must be used in interpreting this study, because the comparison groups
differed.
Agentic traits focus on the self (e.g., ambition, competence) while communal traits focus on others (e.g.,
cooperativeness, understanding of others; Abele & Wojciszke, 2007). People with higher levels of empathy
also tend to have fewer agentic traits (Davis, 1983). Between 1966 and 2009, there was an increase in agentic
traits among first-year college students taking the American Freshman Survey (Twenge, Campbell, &
Gentile, 2012a). This suggests that there was a rise in self-focused traits across this time period, with potential
implications for compassion toward others.

Self-Focused Attitudes and Values

MULTI-YEAR SURVEYS

Intrinsic motivation involves doing things because they are interesting or enjoyable, and extrinsic motivation
involves doing things for external rewards (Ryan & Deci, 2000). People who are intrinsically motivated also
tend to have a more prosocial personality (Finkelstien, 2009). The Monitoring the Future Study includes
questions about desired job rewards in future employment. The value placed on more self-focused job rewards
(e.g., leisure rewards such as vacation time and extrinsic rewards such as prestige) increased in high school
students between 1976 and 2006, while the value placed on less self-focused rewards (e.g., intrinsic rewards
such as having an interesting job and social rewards such as making friends) decreased across this time period
(Twenge, Campbell, Hoffman, & Lance, 2010). However, the desire for altruistic rewards did not change over
time (Twenge, Campbell, et al., 2010).
Another study examined changes in general life goals in the Monitoring the Future Study and the
American Freshman Survey. These can be more intrinsic/other-focused, such as making a contribution to
society; or more extrinsic/self-focused, such as being financially well-off. Students’ intrinsic life goals
decreased between 1966 and 2009, while their extrinsic life goals increased across that same time period
(Twenge, Campbell, & Freeman, 2012). Given that people who are intrinsically motivated also tend to have a
more prosocial personality (Finkelstien, 2009), it is possible that the decreases in intrinsic rewards and
increases in extrinsic rewards have implications for compassion-related responses.

Self-Focused Cultural Indicators

Individualism (independence) involves seeing oneself as separate and unique from others and valuing one’s
own goals and desires above others’ (Markus & Kitayama, 1991). Focusing on the self probably makes it more
difficult for individuals to be compassionate towards others (Wiehe, 2004). Researchers have examined
indicators of individualism in American cultural products over time.
There have been increases in individualistic/independent words and phrases in American books, from 1960
to 2008 (Twenge, Campbell, et al., 2012b) and from 1860 to 2006 (Grossmann & Varnum, 2015). In
addition, the use of the term “self-esteem” in American books increased from 1900 to 2000 (Konrath &

445
Anderson, 2011), and first-person singular (e.g., “I”) and second-person pronouns (e.g., “you”) became more
common between 1960 and 2008 (Twenge, Campbell, et al., 2013). Parallel changes were again observed
when examining self-focused words in songs, with an increase in the number of self-focused and antisocial
words in song lyrics from 1980 to 2007 (DeWall et al., 2011). Finally, another study found increases in the
use of words that indicate self-interest (e.g., first-person pronouns) in U.S. presidential State of the Union
speeches between 1790 and 2012 (Chopik et al., 2014).
However, there are other cultural indicators of individualism besides words or phrases. The Social Security
Administration (SSA) maintains a database of first names given to babies each year since 1879 (SSA, 2015).
Overall, American parents were significantly more likely to give their baby a unique name between 1880 and
2012,3 with the pattern most pronounced after 1950 (Grossmann & Varnum, 2015; Twenge, Abebe, et al.,
2010). Other changes at the household and family level follow similar patterns. For example, research based
on U.S. Census data finds that the frequency of single-child families, single-generation households, and adults
living alone has increased, while the average family size has decreased since 1860 (Grossmann & Varnum,
2015). Finally, according to governmental records, divorce rates have increased significantly since 1900
(Grossmann & Varnum, 2015).

Summary of Results
There have been changes at the individual, family, and societal level in a number of self-focused variables.
In general, there have been significant increases in self-focused traits, attitudes, values, and behaviors. Cultural
indicators also point to a trend toward increased individualism in American society (see Table 25.1 for a
detailed summary). Given these increases in narcissism, self-esteem, agentic traits, and extrinsic motivations
and goals, coupled with cultural trends toward individualistic values, we can further clarify the overall trends in
compassion-related variables. Increases in these traits, attitudes, and values indicate that people are becoming
more self-focused and may be less likely to be compassionate.

Potential Explanations
Together, the bulk of the evidence suggests broad cultural shifts toward a decreased focus on others and an
increased focus on the self, in the years leading to the first decade of the twenty-first century. How and why
might such cultural changes occur? There are two theoretical frameworks that we draw on when making sense
of these results (see Figure 25.1).

Ecological Models
First, Bronfenbrenner’s (1977) theory on the ecology of human development provides a framework from
which we can view these changes over time. It points to the complexity of trying to pinpoint specific causes
when there are many simultaneous changes occurring in society at a variety of different levels. Ecological
models encompass multiple levels of analysis, beginning with the individual-level microsystem, which includes
one’s immediate day-to-day environments. Microsystems include individuals themselves, along with their
families and close friends, nested within physical contexts like homes, schools, churches, workplaces, and
neighborhoods. The mesosystem includes the relationships between a person’s microsystems, such as the
interactions between family members, friends, and school. The exosystem includes larger social structures that

446
influence the individual’s microsystems, such as the government, mass media, and the economy. Finally, the
macrosystem refers to overarching cultural values such as capitalism, individualism, and inequality tolerance.
Contemporary adaptations of this theoretical framework, such as Harrison et al.’s (2011) Six-C’s model might
be especially fruitful in better understanding reasons for changes over time in compassion-related variables.
These theoretical frameworks can be helpful in understanding the dynamic and reciprocal changes that
occur across different ecological levels. Although we cannot clearly determine whether parallel changes that
have occurred at each of the ecological levels have directly influenced changes over time in compassion-related
variables, we can use ecological frameworks to organize the evidence for plausible causal factors.
For example, work on dispositional empathy finds that parenting, which is part of the microsystem, can
influence children’s empathy levels (Fortuna & Knafo, 2014). If we found evidence of corresponding changes
over time in parenting styles, this would be suggestive of one potential cause of declining compassion. Other
research finds that exposure to prosocial media can lead to increases in empathy and prosocial behavior
(Coyne & Smith, 2014), and that mobile phones can both disrupt and enhance social connections and
empathy (Davis et al., 2016). The seismic shifts in the media landscape with the introduction, rapid adoption,
and increasing dependence upon the Internet and mobile phones (Centers for Disease Control & Prevention
[CDC], 2012; Jones, Mitchell, & Finkelhor, 2013), especially among younger Americans (Lenhart, Purcell,
Smith, & Zickuhr, 2010), suggest a plausible causal role at broader ecological levels (i.e. exosystem). Similarly,
changes in compassion-related variables have coincided with dramatic rises other broader ecological variables
such as income inequality (Atkinson & Bourguignon, 2014; Heathcote, Perri, & Violante, 2010; Piketty,
2014) and declines in religious participation in the United States since the 1950s (Grant, 2008; Putnam,
2001; Twenge, Exline, Grubbs, Sastry, & Campbell, 2015).

Figure 25.1 Theoretical frameworks.

It goes beyond the scope of this chapter to systematically review all evidence at each of these levels of
analysis, but doing so in future research could help us isolate which ecological levels are most likely to respond
to interventions. However, it should be noted that these different levels probably mutually affect each other,
so fixating on only one particular causal factor (e.g., social media) is not likely to be productive.

Theory of Social Change and Human Development

In her theory of social change and human development, Greenfield (2009) argues that changes in societal-
level sociodemographic conditions such as urbanization, relative wealth, or average education levels can lead to
cultural shifts such as those reviewed in this chapter. There are some conceptual overlaps between ecological
models and Greenfield’s theorizing (see Figure 25.1), with the main difference between them being that the
latter is clearer about the direction of causality. Greenfield contends that changes in sociodemographic

447
conditions (e.g., urbanization) can change core cultural values such as individualism, which in turn can change
learning environments such as child care practices or school environments. Learning environments then
influence human development, including both cognitive development (e.g., attention to detail, abstract
thinking) and social development (e.g., prosocial behaviors).
Greenfield posits that sociodemographic changes shift on a continuum between Gemeinshaft and
Gesellschaft. Gemeinshaft, the German word for community, is used to describe rural, small-scale communities
with relatively low technology and education. These communities are generally poor, self-contained, and
homogeneous. In contrast, Gesellschaft, the German word for society, is used to describe large, complex, urban
societies with more access to technology and education. These societies are generally wealthier, more diverse,
and have more contact with the outside world. When these sociodemographic factors shift in either direction,
the developmental variables are also likely to shift in the same direction. For example, a society that is
becoming more urban is likely to later become more individualistic. This in turn could lead to more
formalized education through child care centers and formal school systems. Finally, these changes can lead to
more abstract thinking and less interdependent social relationships. However, shifts from Gemeinshaft
towards Gesellschaft have become more common as the world becomes more urban, wealthy, high tech, and
highly educated (Greenfield, 2009).

Summary
Overall, it is difficult to establish a specific answer to the question of why individual-level traits and values
and broader cultural-level indicators have appeared to shift towards an increased self-focus and a decreased
other-focus up until the early part of the twenty-first century. However, there are two key theoretical
frameworks that can help increase our understanding of this question.

Counter-Evidence
So far, we have presented evidence for a decline in compassion-related traits, values, and cultural indicators
in the United States, but it is also important to present evidence that does not fit this pattern.

CROSS-TEMPORAL META-ANALYSES

Loneliness is the perception of social and/or emotional isolation (Weiss, 1973), and high-empathy people
tend to be less lonely (Beadle, Brown, Keady, Tranel, & Paradiso, 2012; Davis, 1983). In a cross-temporal
meta-analysis of the UCLA Loneliness scale (Russell, 1996; Russell, Peplau, & Ferguson, 1978), loneliness
actually declined between 1978 and 2009 (Clark, Loxton, & Tobin, 2014). This may be because technological
advances have made it increasingly easier to connect with close others, even as our close social network sizes
are diminishing over time (McPherson et al., 2006).

MULTI-YEAR SURVEYS

Similarly, in the Monitoring the Future Study, high school seniors reported lower levels of loneliness
between 1991 and 2012 (Clark et al., 2014). Again, corresponding changes in technology may help explain
this apparent paradox.
In a study that compared time-lapse film of public spaces in 1979 and 1980 to videos of the same public
spaces from 2008 to 2010, fewer people spent time alone, and more people spent time in groups between 2008

448
and 2010 than in 1979 and 1980. In addition, mobile phones were used more often in spaces where people are
more likely to walk alone (Hampton, Goulet, & Albanesius, 2015).
In terms of compassion-related traits, there are at least two studies that contradict the finding that
narcissism has increased in college students (Twenge & Foster, 2010). In one, there was no evidence that
narcissism has increased between 1982 and 2007 (Donnellan, Trzesniewski, & Robins, 2009; Trzesniewski,
Donnellan, & Robins, 2008). There was also no evidence that self-enhancement increased in high school
seniors between 1976 and 2006 (Trzesniewski et al., 2008). However, the authors used different methods to
analyze and interpret the data than are typically used in studies examining changes over time.
As for compassion-related attitudes, tolerance is an indicator of how accepting people are of controversial
views or lifestyles (Twenge, Carter, & Campbell, 2015). People who are higher in emotional empathy also
tend to be significantly more tolerant of others who are different or stigmatized, but slightly less tolerant of
individuals who are intolerant of others (Butrus & Witenberg, 2013). The General Social Survey includes
questions about tolerance for many different kinds of people. There was a significant increase in tolerance for
people with controversial views or lifestyles between 1972 and 2012 (Twenge, Carter, et al., 2015). Increases
in tolerance for controversial lifestyles such as homosexuality were especially large, while tolerance for
controversial views such as racism did not increase very much over time (Twenge, Carter, et al., 2015).
Increasing tolerance for others might indicate more compassion for others. However, tolerance at its basic
level involves a respect for uniqueness and difference, and therefore it can also be an expression of
individualism. Compassion goes much deeper than simply tolerating others, by loving, accepting, and caring
for them.
Shifting to compassion-related behaviors: bullying occurs when one person repeatedly says or does
something with the intention of hurting another person (Craig, 1998; Nansel et al., 2001). Bullies tend to be
low in emotional empathy (Jolliffe & Farrington, 2006). There have been numerous surveys that have asked
middle and high school students about bullying behavior. Overall, as can be seen in Table 25.1, while some
types of bullying are increasing (e.g., online harassment; Finkelhor, 2014), rates of bullying perpetration and
victimization in general decreased between 1991 and 2011 (Finkelhor, 2014). This might be because of
increased awareness and interventions around bullying. Television, movies, and books frequently introduce
issues of bullying, and schools often teach about the negative consequences of bullying. Perhaps these direct
appeals to decrease bullying, and policies that enforce consequences in the presence of bullying, partially
explain the apparent decreases in bullying between 1991 and 2011.

Conclusion and Future Directions

Throughout this chapter, we have presented evidence for declining focus on other people and an increasing
focus on the self. While there is some evidence that does not fit this overall trend, such as decreasing rates of
bullying and loneliness and increasing tolerance for controversial views, nearly all of the evidence confirms this
shift from other-focus to self-focus (see Table 25.1).

Implications
Being caring and concerned for others is often seen as a key moral virtue with intrinsic value in itself, but it
also has some important implications. Other-focused traits (e.g., empathic concern, compassion) and

449
behaviors (e.g., prosocial behavior) are associated with benefits both for the self and for others. In terms of
personal benefits, compassionate traits and behaviors are associated with higher well-being, including lower
anxiety and stress, and better physical health (Konrath, 2014, 2016; Konrath & Brown, 2013; Seppala,
Rossomando, & Doty, 2013). In terms of interpersonal benefits, compassionate traits and behaviors are
associated with more frequent and numerous social connections, and closer and more satisfying interpersonal
relationships (Crocker & Canevello, 2008; Konrath, 2016; Konrath & Grynberg, 2016). Given the potential
benefits of compassion and prosocial behavior to both the self and others, changes in these traits and behaviors
over time would be likely to have important implications for individuals and social relationships. In turn,
ecological and developmental theories of cultural change suggest that changes in core social connections
between people can have broader societal implications.

Limitations and Future Directions

All of the research presented in this review is from the United States, since most of the current research has
been conducted there. Although there is some research from other countries that we did not cover (e.g.,
Billstedt et al., 2016; Blanchflower & Oswald, 2004; Lindfors, Solantaus, & Rimpelä, 2012), there is
generally very little cross-cultural research. Of particular interest would be changes over time within more
collectivist cultures. Future reviews should examine to what extent these changes are occurring across cultures,
and what factors might influence such changes. Similarly, although some of the research examined changes
since the late 1700s and early 1800s, most of the research is limited to approximately 1970 to 2010. There
needs to be more research examining longer periods of time. Finally, most of the cross-temporal meta-
analyses presented covered very specific populations, usually college students. Many of the nationally
representative surveys involved high school or college students. Future research should continue to focus on
nationally representative groups to the extent that the data are available.

Conclusion
At the beginning of this chapter, we defined compassion as an awareness that another person is in pain or
suffering, coupled with wanting to do something to alleviate that suffering (Goetz et al., 2010). Overall, the
bulk of the evidence suggests that compassion-related variables have been declining over time, while self-
focused variables have been simultaneously increasing. The implications are potentially troubling if these
trends continue well into the twenty-first century.

450
Notes
1. These two studies used very different methods of determining collectivist and individualistic words. In the first study, a list of 20
individualistic words and 20 individualistic phrases were created by asking a sample of American adults to generate individualistic words,
then asking a second sample of American adults rate how individualistic the words were. The same procedure was used to generate the list
of individualistic phrases (Twenge, Campbell, et al., 2012b). In the second study, researchers built lists of individualistic words and phrases
using common scales of individualism to create a lists based on the view of cultural psychologists (Grossmann & Varnum, 2015). Despite
the different methods used to determine collectivist and individualistic words and phrases, both studies found similar changes over time in
American books.
2. It should be noted that this study and the study examining pronoun use in American books classified pronouns differently. In this study
examining State of the Union addresses, plural first-person pronouns (e.g., “we”) were classified as self-oriented, while the study examining
American books classified plural first-person pronouns as other-oriented. Similarly, this study classified other-person (or second-person)
pronouns (e.g., “you”) as other-oriented, while the previous study classified them as self-oriented.
3. One study focused on the percentage of children receiving the 20 most popular names for their gender (Grossmann & Varnum, 2015),
while the other study examined the percentage of babies who received the most popular name, or one of the 10, 25, or 50 most popular
names for the year they were born (Twenge, Abebe, & Campbell, 2010).
4. ABC News/Washington Post Polls typically sample ~1,000 adults for each poll (nationally representative), and Gallup/Princeton Survey
Research Associates polls typically sample ~1,500 adults for each poll (nationally representative).

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 To Help or Not to Help Goal Commitment and the Goodness of Compassion

Michael J. Poulin

Abstract

Why does compassion appear to have disparate associations with helping, emotions, and well-being?
One possibility is that, while compassion always elicits a desire to help others, it only sometimes leads to
commitment to that goal. Drawing on the action-phase model of goal pursuit, I propose that
compassion has the most beneficial outcomes for those in need and for potential helpers in the presence
of factors that drive commitment to helping goals. Among those factors are implementation intentions
with respect to helping goals, readily perceived means for helping, and perceiving that one has passed a
point of no return (a.k.a. a “Rubicon”) with respect to helping goals. Research on this model may reveal
with more specificity compassion’s true role in social life.

Key Words: compassion, goal commitment, helping goals, action-phase model, mindsets,
implementation intentions, self-protection, Rubicon

Compassion, an emotional response to the suffering of others, appears to have disparate associations with
helping, short-term emotions, and long-term well-being. That is, although compassion is a well-known
predictor of helping (Haidt, 2003; Batson & Shaw, 1991; Goetz, Keltner, & Simon-Thomas, 2010;
McCullough, Kilpatrick, Emmons, & Larson, 2001), feelings of compassion do not guarantee action. In
addition, while compassion is sometimes depicted as aversive and linked to distress (e.g., van Kleef et al.,
2008), compassion has also been conceptualized as non-aversive and distinct from distress (Batson, Early, &
Salvarani, 1997; Oveis, Horberg, & Keltner, 2010). And while compassion—or at least compassionate
behaviors—has been shown to predict favorable outcomes for health and well-being (e.g., Cosley, McCoy,
Saslow, & Epel, 2010; Poulin, 2014; Steffen & Masters, 2005), in some cases, compassion appears to predict
negative health outcomes (McNulty & Fincham, 2012; Monin, Schulz, & Feeney, 2014; Rothschild, 2006).
While some of the disparity in these effects of compassion is undoubtedly due to differences in terminology
and measurement, some of this disparity may also be explained by the fact that the connection between
situations that evoke compassion and the motivation to help others is somewhat ambiguous. Goetz and
colleagues (2010) provide an excellent definition of compassion, stating that it is “the feeling that arises in
witnessing another’s suffering and that motivates a subsequent desire to help,” (emphasis added), but even in
this definition, there is ambiguity. How strong is the desire to help that accompanies compassion? Is the
desire to help the only desire present alongside compassion, or could it overlap with other desires as well? Is
there a difference between a desire to help and a decision to help?
In this chapter, I suggest that much of the ambiguity about the effects of compassion on helping, short-
term emotions, and long-term well-being stems from the fact that there is a difference between having a

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desire, or goal, to help another person and actually committing to that goal. Drawing on research on mindset
theory and the action-phase model of goal pursuit (Gollwitzer, 1990; Gollwitzer & Bayer, 1999; Gollwitzer,
Fujita, & Oettingen, 2004), I argue that the effects of compassion-evoking situations on these outcomes may
be different depending on whether a person merely has the goal to help another person—which is one goal
among many—or commits to a helping goal. That is, it may not be possible to understand the effects of
compassion without also understanding the effects of goal commitment.

The Action-Phase Model of Goal Pursuit

In any given moment, a person’s actions can be described as being motivated by a collection of goals at
varying levels of specificity (Ach, 1935; Cantor, 2003; Carver & Scheier, 2001; Pervin, 1982). Imagine, for
example, a woman named Rose, who is currently eating lunch with a friend. We can surmise that Rose is
satisfying the goals to reduce her hunger and to have a pleasant social interaction. We can also speculate—
depending on what she is eating—that Rose might be pursuing the goal to enjoy something tasty, or possibly
the goal to maintain her physical health.
By describing Rose’s behavior in this way, we illustrate the fact that behavior is responsive to goals.
However, by starting with a behavior Rose is already engaged in, we are missing another important part of
goal pursuit: Rose’s decision to engage in this behavior. Often, though not always, engaging in behavior
requires first selecting which of one’s many goals are worth pursuing in a given moment (Brandtstädter, &
Rothermund, 2002; Carstensen, 2006; Heckhausen, Wrosch, & Schulz, 2010). This process can be
challenging and cognitively intensive—especially since it is rarely possible for a person to pursue all of their
goals at once, as goals are often in competition with or opposed to one another. To continue with the example
of Rose, she was fortunate to find a way to pursue both physiological (reducing hunger) and social (time with
her friend) goals all at once. But in the process, she may to a certain extent have had to decide between
pursuing the goal to enjoy something tasty and the goal to improve her physical health. For example, Rose
may love French fries but may also be highly invested in reducing her blood pressure, and she may therefore
believe that the fat, salt, and carbohydrates they contain pose a threat to her health. In deciding whether to
order fries or not, Rose fundamentally has to decide which of those goals—taste or health—she is going to
commit to pursuing. Once she makes that decision, she can act on it, with the burden of the decision process
behind her.
What Rose’s scenario illustrates is the action-phase (or Rubicon) model of goal pursuit (Gollwitzer, 1990;
Gollwitzer & Bayer, 1999; Gollwitzer, Fujita, & Oettingen, 2004). In this model, pursuing goals can occur by
way of two radically distinct phases of cognition, affect, and action. The first phase, in which a person is
considering which of their goals to prioritize and act on, is called the motivational or deliberative phase. The
second phase, in which a person has committed to a goal (or set of non-competing goals) and is putting it into
action, is called the volitional or implemental phase (Gollwitzer, Heckhausen, & Steller, 1990). These are
separated by the decision to act on a particular goal—a point referred to as the Rubicon (see Figure 26.1), as
crossing this point marks a dramatic departure and a “point of no return,” as did Julius Caesar’s crossing of the
Rubicon River on his way to conquer Rome. Reviewing the features of each phase of goal pursuit reveals the
aptness of this metaphor.

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The Deliberative Phase
A person enters the deliberative phase when a situation makes multiple mutually exclusive courses of action
possible, and the person is motivated to decide among valued goals. Examples of such situations are quite
varied, potentially including large-impact life decisions such as choosing a college major or a romantic partner,
smaller momentary decisions such as what to order on a menu, or (of importance to this chapter) whether or
not to help a person in need. Before a decision is made, a person making a choice is faced with the challenge
of determining what course of action will pay off the most in the long run, in terms of well-being or another
criterion of adaptiveness (Heckhausen et al., 2010). This means that each course of action must be evaluated
in terms of (a) the importance of one’s valued goals that are relevant to the decision, and (b) whether the
action is likely to be successful, thereby aiding in pursuit of those goals.
By definition, such decision points make multiple, sometimes conflicting, goals salient (Puca, 2001; Taylor
& Gollwitzer, 1995). I will discuss how this plays out in an example of a compassion-evoking situation
shortly; but first, let us consider the somewhat simpler case of Rose’s perusal of menu choices. In this example,
her goals to eat good-tasting food and to manage her blood pressure are both present. And to the extent that
these goals are in conflict, that conflict is also made salient by the need to make a decision. In Rose’s case, the
possibility of ordering French fries presents this conflict. The requirement to make a decision and the
presence of conflict, in turn, promote the need for (relatively) rational thinking (Armor & Taylor, 2003; Puca,
2001; Taylor & Gollwitzer, 1995), as Rose must weigh (a) the relative importance of eating something she
loves versus the importance of promoting her health, and (b) how much ordering fries will contribute to—or
detract from—both of these goals. In the presence of goal conflict, deliberating is often accompanied by
distress and anxiety (Armor & Taylor, 2003; Cantor, Acker, & Cook-Flannagan, 1992; Cantor & Blanton,
1996; Carver & Scheier, 1990), as a person faces the fact that making a choice requires a sacrifice with respect
to one or more valued goals. In sum, the deliberative phase can be characterized by (1) the presence of
multiple, potentially conflicting, valued goals, (2) relatively rational deliberation about the value of those goals
and the implications of one’s choice for them, and (3) distress and anxiety about conflict among goals.

Figure 26.1 The Rubicon model of action phases.

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The Implemental Phase
Depending on the goal in question, the deliberative phase can last for only a brief moment or for an
extended period of time from minutes, to weeks, to years (Heckhausen et al., 2010). Indeed, if a person is
under cognitive load or otherwise not inclined to seriously entertain multiple goals, implicit attitudes may
guide goal selection, and a person may skip deliberation altogether (Fazio, 1990; Olson & Fazio, 2008).
However, assuming one does “select,” “decide on,” or “commit to” a course of action (these phrases can be
used interchangeably), the deliberative phase ends and one enters the implemental phase: a person crosses the
decisional Rubicon. This language may seem dramatic, but that is arguably appropriate, because the
psychological features of the implemental phase are substantially different from those of the deliberative
phase. Assuming Rose does make a decision—in this case, perhaps she decides to order the fries after all—her
thoughts and feelings are likely to shift in ways that facilitate pursuit of the goal she has chosen.
First, and most obvious, in selecting a course of action, she no longer is actively considering the pursuit of
multiple conflicting goals—she is now pursuing only one: her goal to eat something she enjoys. In doing so,
her cognitions about each of the goals that were in conflict are likely to shift to support the decision she has
made. While previously Rose had been weighing the importance of each goal and the relevance of her menu
choice for satisfying each of those goals, her perceptions of those dimensions will align with the action she has
chosen. With respect to her goal to eat something she enjoys, she is likely to enhance the perceived
importance of that goal (Heckhausen et al., 2010)—for example, by reminding herself how important it is to
her to have small indulgences in her life. In other words, she will increase her perception that the goal she has
chosen to pursue is important to her happiness and well-being.
She will also probably increase her belief that eating the fries will satisfy that goal (Brandstätter, Giesinger,
Job, & Frank, 2015; Gollwitzer & Kinney, 1989; Heckhausen et al., 2010), perhaps by reminding herself of
just how much she loves French fries, specifically, and heightening her anticipation of the perceived emotional
rewards she will receive from eating them. By contrast, her perceptions will probably shift in the opposite
direction for the goal she has chosen not to pursue—that is, the goal to maintain her health or well-being. She
may, for example, denigrate the importance of that goal (Achtziger, Gollwitzer, & Sheeran, 2008;
Heckhausen et al., 2010; Köpetz, Faber, Fishbach, & Kruglanski, 2011)—at least in the short term—by
reminding herself of how many other things she does to support her health (e.g., exercising), thereby
justifying setting aside the goal in this instance.
Rose may also dismiss the impact of her chosen course of action on her health goals, perhaps by focusing on
worse things she could have ordered (“at least it wasn’t the nachos”). In other words, the effect of choosing a
goal for action leads to a set of positive illusions (Armor & Taylor, 2003; Taylor & Gollwitzer, 1995) about
the value and effectiveness of the chosen course of action versus the non-chosen course of action. In support of
positive illusions, these cognitions bolster Rose’s feelings of satisfaction and well-being (Armor & Taylor,
2003; Taylor & Gollwitzer, 1995), facilitating a generally pleasant state of mind. In sum, the implemental
phase of action truly is the opposite of the deliberative phase in that it is characterized by (1) a focus on a
chosen valued goal, not on potentially conflicting goals; (2) relatively biased cognitions about the value of
those goals and the implications of one’s choice for them; and (3) feelings of well-being.

Driving the Shift from Deliberation to Implementation

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 What causes a person to cross the Rubicon from the deliberative to the implemental phase? Making a
decision and crossing the Rubicon is arguably easy when the value of one goal under consideration greatly
outweighs the others, or when pursuit of only one goal is feasible. But when these attributes are closely
matched, as is arguably the case in Rose’s example or in many other types of decisions, other factors come into
play. First and foremost, people are most likely to act on a given goal if they have formulated plans about how
and under what conditions they will act—that is, if they have developed implementation intentions with respect
to that goal (Gollwitzer, 1993, 1999; Gollwitzer & Sheeran, 2006; Oettingen, Hoig, & Gollwitzer, 2000).
Thus, Rose will be more likely to order the fries if she has already thought about the barrier they pose to her
health goals and decided that even if such concerns arise, she will set them aside and order what she really
wants. (Of course, the opposite also applies: if she had formulated implementation intentions with respect to
her health goals, she would think about the temptation the fries would pose and decide that even in the face of
that temptation, she will order a healthier alternative.)
Even in the absence of pre-established implementation intentions, however, several subtle features of a
person or situation can determine whether a person continues to deliberate or selects a course of action. First,
the presence of clear steps to goal pursuit facilitates goal selection (Jin, Huang, & Zhang, 2013). For example,
if Rose has already decided to order a sandwich when she is deliberating over the fries, she is more likely to
commit to ordering them if the menu gives her the option of choosing them as a side dish than if she has to
take the initiative to locate them elsewhere on the menu. Second, the presence of multiple means of pursuing
a goal increases the likelihood of selecting the corresponding action (Etkin & Ratner, 2012; Kruglanski,
Pierro, & Sheveland, 2011). Thus, if the restaurant offers a number of ways to customize her fries after she
orders them (e.g., different dipping sauces), Rose is more likely to commit to ordering them. It is important to
note that this is different from having a plethora of possible goals to choose from—for example, multiple
choices of fries to order—which may actually have the opposite effect on goal commitment and satisfaction
with her choice (Inbar, Botti, & Hanko, 2011; Iyengar & Lepper, 2000; Shah & Wolford, 2007). Third, the
perception that one has already inadvertently crossed a Rubicon may be sufficient to lead to goal commitment
(Gu, Botti, & Faro, 2013; Zhao, Lee, & Soman, 2012). For example, if Rose orders the sandwich while she is
still deliberating about the fries, but then discovers that the sandwich comes with fries by default, she may be
more likely to commit to having the fries—even if she has the option to substitute a different side order.
Likewise, if Rose’s friend orders the fries, that example may also make ordering fries seem like a foregone
conclusion. Finally, it is possible that being in a deliberative or implemental mindset about another, unrelated,
decision can push a person closer to or further from goal commitment (Gollwitzer & Bayer, 1999; Gollwitzer,
Fujita, & Oettingen, 2004; Heckhausen & Gollwitzer, 1987; Henderson, de Liver, & Gollwitzer, 2008). If
Rose and her friend are having an in-depth conversation about whether the friend should leave her current job
or not, with a consideration of the pros and cons of each course of action, Rose may well have greater trouble
deciding whether to get the fries than if the two friends have instead reached the end of that discussion and
have just decided on a course of action. In sum, crossing the Rubicon from the deliberative to the implemental
phase—with all of the cognitive and affective shifts that entails—can be influenced by many factors that are
not directly relevant to the decision itself.

An Action-Phase Model of Compassion

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 Witnessing the suffering of a person in need evokes a desire, or goal, to help alleviate that person’s
suffering, particularly when that person is valued in some way and helping that person is feasible (Goetz et al.,
2010). However, this desire is itself frequently in tension with other valued goals. Helping another person
almost always entails some degree of cost to the self, whether in terms of time, effort, money, or relationship
risks (e.g., rejection or conflict). For that reason, the desire to help is almost always accompanied by the desire
to avoid threats to the self and one’s own resources (Batson, Duncan, Ackerman, Buckley, & Birch, 1981).
For this reason, I suggest that until a person commits to the goal to alleviate another’s suffering, situations
that elicit compassion may have complex and unclear effects on helping behavior and a potential helper’s well-
being. In other words, the correlates of compassion differ between the deliberative versus implemental phases
of helping. Compassion and the desire to help may be different from many other goals, however, in that
committing to the goal to alleviate another’s suffering involves setting aside a competing goal that frequently
stands in the way of well-being: the desire to avoid threats to the self.

Compassion in the Deliberative Phase

The conditions that give rise to feelings of compassion make multiple courses of action possible. Most
notably, witnessing the suffering of a valued other offers a person the option of expending time, effort, and/or
resources to provide help, thus acting on a goal to alleviate the other’s suffering—but it also offers the
possibility of preserving one’s lot by not helping, thus conserving time, effort, and/or resources for oneself. For
example, it is possible to imagine Rose having to make a decision, not about lunch, but about whether or not
to help a friend. Suppose Rose’s friend Amy has recently lost her mother, and is now grieving. One day as
Rose is finishing her shift at the grocery store where she works, she thinks about Amy and feels for her—that
is, to be more specific, Rose feels compassion for Amy. It occurs to Rose that she knows that Amy will be
home, so perhaps now would be a good time to go over and spend time with Amy. Amy has previously said
that having company helps relieve the pain, and Rose certainly has the time available. On the other hand, as
Rose considers going over to Amy’s house, she feels a tremor of anxiety, because Rose worries that seeing her
friend in distress might be too painful, and also because thinking about Amy’s situation leads to painful
thoughts about what it will be like when Rose’s own mother dies. Thus, Rose is feeling uncertain—should she
go to Amy’s house or not?—and this uncertainty itself is distressing. Perhaps, Rose thinks, she will go to
Amy’s house another time.
In short, conditions are ripe for Rose to experience compassion, but they are ripe for other feelings, as well,
since Rose is in the deliberative phase of the goal to alleviate Amy’s suffering. It is important to note that this
is different from failing to experience compassion in the first place. Goetz and colleagues (2010) specify that
compassion occurs if a set of conditions are in place: if there is a suffering other, especially one whose
outcomes matter for the self; if one does not desire for that person to suffer; if the suffering other deserves
help; and if one has the resources to help. Rose’s situation meets all of Goetz’s and colleagues’ (2010) criteria:
Amy is suffering; because Amy is a friend, Amy’s outcomes are relevant for Rose; Rose does not want Amy to
suffer; Amy, being a friend, deserves help; and Rose has the relevant resource of time to provide help. So Rose
does indeed feel something in response to Amy’s suffering, and those feelings are leading to a desire to help
Amy. This situation gives rise to other desires as well, however. In particular, it gives rise to Rose’s desire to
avoid threats to her own emotional well-being. Together, these desires make it difficult to know how, or

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when, Rose will act. Will she decide to go to Amy’s house or not? And if not, will she make this decision
palatable to herself by believing that she will go visit Amy “another time”—a point in time that Rose half-
realizes could all too easily become “never?”
While Rose’s situation is just one example of a way in which compassion may exist alongside the goal to
avoid threats in the deliberative phase, several pieces of evidence suggest that this is frequently, if not always,
the case. For example, witnessing the suffering of others often leads to distress and the desire to escape a
potential helping situation, even without providing help (e.g., Batson et al., 1981). More recent evidence
suggests that people are actually motivated to avoid feeling compassion when doing so may be impossible or
may present large costs to the self (e.g., Cameron & Payne, 2011; 2012). In addition, models of the
neurocircuitry underlying the processes involved when providing assistance to others suggest that doing so
entails the activation of networks for both social approach and self-preservation (Brown & Brown, 2006;
Brown & Brown, 2015; Brown, Brown, & Preston, 2011). Moreover, it is worth noting that a prominent
model of interpersonal functioning, Murray and Holmes’s (2009) risk-regulation model, suggests that the
opportunity to connect with another person always automatically activates self-protection concerns—concerns
that must be addressed in order to act on connection goals. In the context of close relationships, self-
protection goals most often mean avoiding rejection. In the context of goals to help others more broadly, from
close others to strangers, these concerns may encompass those concerns, as well as others such as those in
Rose’s example, including distress over another’s plight, the possibility of that distress becoming one’s own,
and anxiety over the potential loss of time, money, or (while not in Rose’s case) physical safety.
In sum, compassion may entail the desire to help, but in the absence of a decision to help, that desire exists
uneasily alongside other desires, most notably the desire to avoid threats to the self. Batson (1997) had a
similar insight when describing the role of empathic concern, an emotional state akin to compassion, in
helping behavior:
The empathy-altruism hypothesis makes no claim that empathic concern per se influences helping; it claims that empathy evokes altruistic
motivation. Altruistic motivation does not necessarily lead to helping behavior. Whether it does is determined by the result of a hedonic
calculus in which the costs and benefits of various possible ways to reach the altruistic goal are considered in the context of other motives
present at the time, some of which may have been evoked by perception of the same need situation that evoked the empathy. Depending
on the relative strength of the conflicting motives and on the behavioral options available, an altruistically motivated individual may help,
let someone else help, or do nothing at all. (Batson, 1997, p. 520)

While this insight is indeed important, I argue that it refers specifically to the role of compassion/empathic
concern in the deliberative phase, before a person commits to a helping goal. Could compassion function quite
differently once a person crosses the Rubicon with respect to helping? That is, what role does compassion play
when the desire to help becomes a commitment to help?

Compassion in the Implemental Phase

The logic of the action-phase model of goal pursuit suggests that once a person has crossed the Rubicon
and committed to the goal to alleviate another’s suffering, their thoughts and feelings should change fairly
dramatically compared to when they were still deliberating over whether to help or not (see Figure 26.2).
Before reviewing what the implemental phase of compassion might look like, however, it is important to
consider why a person might cross that Rubicon in the first place. One simple and obvious answer is that a
person might choose to help if the goal to alleviate another’s suffering is overwhelmingly more important than
threat-avoidance goals in a given case. For example, if Rose’s best friend were very ill and needed a bone

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marrow transplant and Rose were an eligible donor, it is likely that Rose’s feelings of compassion for her
friend would lead to commitment to donating. This is because even though doing so would impose real costs
on Rose, her friend’s need, and thus the value of helping, would be much greater. This may also characterize
heroic or reflexive helping, where people spring into action apparently with no deliberation at all. Another
situation that would lead straightforwardly to goal commitment to alleviate another’s suffering would be if
helping goals were not in conflict with threat-avoidance goals. For example, if Rose had a sick friend who
asked Rose to pick up medication from a store where Rose was already planning to go, compassion for the
friend would almost certainly lead Rose to commit to this practically cost-free course of action.
Where the links between compassion and commitment to alleviating another’s suffering become less certain
are in situations in which other-focused goals and threat-avoidance goals are of similar importance or
achievability. When Rose is considering visiting her grieving friend Amy, the value of her visit is in tension
with her concerns over the emotional costs of confronting her friend’s distress and parental loss. In this
circumstance, other factors may determine whether Rose does or does not cross the Rubicon into
commitment to compassion-driven helping goals. For example, it is possible that Rose has formulated
implementation intentions with respect to visiting Amy. That is, she may have realized in advance that she
would be tempted to avoid going and decided that even in the face of such temptations, she would prioritize
her goal to help and support her friend. It is important to note that implementation intentions do not need to
be specific to a particular course of action, as is the case with Rose’s intention to visit Amy. Rose could also
commit more generally to the goal to alleviate Amy’s suffering however she can, and remain attentive to future
opportunities to take action. Thus, it is possible to remain in the implemental phase of compassion with
respect to others’ suffering even when there is not an immediate or obvious way to help.

Figure 26.2 The Rubicon model of action phases, applied to compassion.

Even in the absence of implementation intentions, relatively subtle situational influences may determine
whether or not Rose commits to compassion-driven helping goals. For example, given that the presence of
clear steps for goal pursuit influence goal commitment, Rose may be more likely to commit to helping Amy if

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she already knows how to get to Amy’s house from work, versus if she would have to look up that
information. In addition, given that having multiple possible means to attain a goal facilitates goal
commitment, Rose may be more likely to commit to helping if she can readily think of multiple ways she
could help Amy during her visit, such as talking to Amy, cooking a meal for her, or merely sitting quietly with
her. Moreover, since perceiving that one has (inadvertently) crossed a Rubicon towards a goal promotes goal
commitment, Rose would probably be more likely to commit to helping Amy if she thinks about Amy’s
situation as she is incidentally driving on Amy’s street, or if a friend is also on her way to Amy’s house and will
be expecting Rose—both yielding the sense that she has already committed to visiting Amy. Finally, given
that already being in an implemental mindset facilitates commitment to salient goals, Rose may be more likely
to commit to helping Amy if she has just made several purchasing decisions for the grocery store when she
thinks about the possibility of visiting Amy than if those unrelated decisions are still up in the air.
However helping goal commitment occurs, for Rose or for anyone who has made the decision to alleviate
another’s suffering, what should compassion in the implemental phase look like? First, by selecting that goal
as the focus of action, the importance and attainability of that goal should become enhanced in order to
sustain goal pursuit. Once Rose decides to help by going to visit Amy, she will probably come to believe that
doing so is more important than Rose thought it was before the decision, that it will feel more rewarding than
she thought it would before (cf. Inagaki & Eisenberger, 2012), and she should also believe that her help will
be more effective than she previously believed. In addition, the burden of uncertainty should be alleviated,
since Rose has decisively chosen to act on the goal to alleviate Amy’s suffering, not on her threat-avoidance
oriented goals. Of course, this implies that Rose will come to believe that her threat-avoidance goals are less
important than they were before she made the decision. Avoiding emotional discomfort should feel like a less
compelling motivation once the competing alternative of visiting Amy has been selected. In other words, Rose
will disengage from her threat-avoidance goals, at least for the moment, in order to prioritize helping Amy.
There is another, less immediately obvious, psychological feature of committing to a helping goal.
Disengagement from threat-avoidance goals, which often stand in the way of pursuing helping goals, may
reduce stress and anxiety more generally. Threat-avoidance goals entail the desire to avoid an array of
potential threats or losses (Jonas et al., 2014; Meleshko & Alden, 1993), whether that takes the form of
avoiding the loss of money, avoiding emotional discomfort, or avoiding any other noxious experience. And
avoidance-related motivations are associated with anxiety, decreased well-being, and poorer performance,
particularly in the long term, but also in short-term interactions (Elliot & Thrash, 2002; Roskes, Elliot, & De
Dreu, 2014). Disengagement from threat-avoidance goals in the service of commitment to helping goals may
thus alleviate anxiety and distress, even from sources unrelated to the helping task. In other words, once Rose
commits to the goal to help Amy, she may experience reduced self-focused anxiety and distress stemming
from other aspects of her life, such as her job, her family, personal setbacks, and so on. In other words,
commitment to helping goals may serve as a stress buffer.

Evidence for an Action-Phase Model of Compassion

So far, I have argued that situations that evoke compassion may have differing implications for behavior and
well-being before versus after commitment to the goal to alleviate another’s suffering. If this is the case, it
should be possible to find evidence consistent with this model in the existing literature on compassion and

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related phenomena. To date, I know of no research that directly tests the proposition that commitment to a
helping goal moderates the effects of compassion on key outcomes. However, several sets of findings from my
own research and from that of others are broadly consistent with this model and provide indirect evidence that
I hope will spur further research.

Effects of Self-Focused Goals on Other-Focused Goals

First, consistent with the proposition that the goal to alleviate another’s suffering is in tension with threat-
avoidance goals, and that commitment to other-focused goals requires reduction of threat-avoidance goals,
there is evidence that satisfying threat-avoidance goals facilitates acting on compassion-driven helping goals.
Attachment theory (Ainsworth, Blehar, Waters, & Wall, 1978; Bowlby, 1969; Brennan, Clark, & Shaver,
1998) posits that strong and stable bonds with close others, including parents, romantic partners, and close
friends, promote feelings of safety and security. These feelings, or felt security, in turn, facilitate engaging in
novel social interactions and buffer people against possible concerns about rejection or threat. Mikulincer,
Gillath, and colleagues have found that both experimental manipulations and dispositional predictors of
attachment security predict greater levels of empathy, compassion, and helping behavior (Gillath et al., 2005;
Mikulincer, Shaver, Gillath, & Nitzberg, 2005). This suggests that fulfilling threat-avoidance goals facilitates
commitment to other-focused goals.
Satisfying threat-avoidance goals may not be the only way to reduce their interference with compassion-
directed helping goals. Instead, diminishing the importance or centrality of the individual self (an approach
similar to “decentering”; cf. Bernstein et al., 2015) may also facilitate acting on compassion-driven helping
goals. Piff and colleagues have recently found that the emotion of awe facilitates prosocial behavior, and that it
does so in part by inducing feelings of a “small self”—that is, a feeling that one’s own concerns are diminished
relative to those of others or a collective (Piff, Dietze, Feinberg, Stancato, & Keltner, 2015). In sum, these
studies suggest that helping goals can exist in tension with threat-avoidance goals, and that diminishing the
relevance or importance of threat-avoidance goals may help people cross the Rubicon and commit to helping
goals.

Effects of Other-Focused Goals on Self-Focused Goals

If the goal to alleviate others’ suffering frequently exists in tension with threat-avoidance goals, then does
commitment to other-focused goals lead individuals to disengage from threat-avoidance goals? Recent
research in our laboratory is consistent with this possibility in that it suggests that prioritizing the feelings of a
suffering close other leads to diminished focus on the self and its concerns. Building on Batson’s (1991, 2011)
classic research on empathy, we use perspective-taking instructions to ask participants to either focus on the
feelings of a suffering other or not. By acting on these instructions, participants commit to the goal to
prioritize the suffering other’s feelings, bypassing the deliberation they might experience if they encountered a
suffering other without any such explicit instructions. By the logic of an action-phase model of compassion,
this should lead them to disengage from self-focused goals such as threat avoidance. Our results are consistent
with this prediction.
For example, we recently obtained evidence that prioritizing the feelings of a suffering other leads to less
awareness of self-protective aspects of the self-concept (DeLury, Buffone, Ministero, & Poulin, 2016).

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Research on the self-concept has found that there is a difference between what people see as their core, most
valued traits, or the true self, and the characteristics of the self that people are most comfortable sharing with
the world—the public self (Bargh, McKenna, & Fitzsimons, 2002; Schlegel & Hicks, 2011; Schlegel, Hicks,
Arndt, & King, 2009). Because people want to protect the true self against possible rejection or threat, the
public self exists, in a sense, as a manifestation of threat-avoidance impulses. Given that this is true, if a focus
on another person’s suffering reduces threat-avoidance goals, we predicted that prioritizing the feelings of a
suffering other would diminish the salience of the public self.
In order to examine this, my colleagues and I had participants (N = 158) come to the lab and select a list of
traits that participants felt fit their true selves and their public selves, respectively. Then, later in the laboratory
session, these participants came back, and some of them were told to think about a time a close other was in
need, and to focus on that person’s feelings (i.e., engage in perspective taking) or not. Other participants
engaged in one of three control tasks designed to rule out competing explanations for the effects of
prioritizing the feelings of another, including mere distraction or social connection. These tasks included
imagining how the participant would feel in the other’s position, extending compassion to the self for a
personal need, and merely writing a note to a friend. Next, participants engaged in a lexical decision task on
the computer in which they had to decide as quickly as possible whether strings of letters on the screen were
words or not. Some of the words participants viewed were words they had chosen as describing themselves,
and some were not; and some of the self-descriptive words were true-self words, and some were public-self
words. We found that participants instructed to focus on a suffering other took longer to respond to public-
self words, but not to true-self words, indicating that focusing on a suffering other made the public self, linked
to threat-avoidance concerns, less accessible (see Figure 26.3).

Figure 26.3 Response times (latencies, in milliseconds) to public-self and true-self words.

The desire to avoid threats does not just influence patterns of self-related cognitions, it also influences stress
physiology (Blascovich & Mendes, 2000; Seery, 2013). Our lab has found that prioritizing the feelings of a
suffering other reduces psychological stress as indexed by cardiovascular physiology (Buffone et al., 2017).
Specifically, we had participants come to the lab and read a story used in a great deal of empathy research (for
reviews, see Batson, 1991; 2011) about a fellow student named “Katie Banks.” Katie (an actually fictional

466
person) had lost her parents in a car crash and was struggling to take care of her two younger siblings. We
randomly assigned participants (N = 212) to either focus on Katie’s feelings, to imagine themselves in Katie’s
position, or to remain objective. Then we asked participants to deliver a speech, recorded on video and
supposedly to be shown to Katie later, in which they gave Katie advice about her situation. While they gave
the speech, participants were connected to equipment that allowed us to measure participants’ degree of
physiological threat, assessed as constriction of peripheral blood vessels (Blascovich & Mendes, 2000; Seery,
2013). We found that participants instructed to focus on Katie’s feelings experienced lower levels of threat as
compared to participants in the other two conditions (see Figure 26.4). In other words, thinking about Katie
instead of themselves or being objective appeared to result in decreased concerns over threat avoidance.
Further evidence of the stress-buffering role of commitment to alleviating another’s suffering may come
from the growing literature on helping behavior and well-being. Engaging in helping or volunteering predicts
better physical and mental health over time, as well as decreased risk of mortality—that is, a longer life span
(e.g., Brown, Brown, House, & Smith, 2008; Brown, Nesse, Vinokur, & Smith, 2003; Brown et al., 2009;
Konrath, Fuhrel-Forbis, Lou, & Brown, 2011; Poulin, 2014; Poulin et al., 2013; O’Reilly, Connolly, Rosato,
& Patterson, 2008; see Post, 2007, for an overview). Moreover, experimentally manipulating prosocial
behavior—versus either neutral behavior or kindness directed towards the self—leads to increased positive
affect and psychological flourishing, as well as decreased negative affect (Nelson, Layous, Cole, &
Lyubomirsky, 2016). Similarly, participants induced to spend money on others experienced lower blood
pressure than those induced to spend money on themselves (Whillans, Dunn, Sandstrom, Dickerson, &
Madden, 2016). The precise mechanisms by which prosocial behavior may yield such psychological and
physiological health benefits are currently unknown, but it is possible that engaging in helping behavior
reflects commitment to the goal to alleviate another’s suffering. Such a commitment might lead to increased
perception of the likely emotional rewards of engaging in relevant behaviors (cf. Inagaki & Eisenberger,
2012), as well as simultaneous disengagement from threat-avoidance goals, thus reducing stress. While this
interpretation of the literature is speculative, a few other findings with respect to helping behavior and well-
being are consistent with this model. First, consistent with the idea that helping behavior reduces threat-
avoidance impulses and thus reduces stress, helping behavior and compassion appear to promote longevity and
emotional well-being specifically by reducing the impact of stressful events (Cosley et al., 2010; Poulin et al.,
2013; Raposa, Laws, & Ansell, 2016). Second, in keeping with the idea that it is specifically commitment to
alleviating others’ suffering that reduces threat-related concerns, research on helping and health indicates that
the benefits of helping depend on a person’s motivations. People can volunteer or engage in helping behavior
for a variety of reasons, some of which align more closely with threat avoidance than others do. For example,
people may volunteer because of a requirement for work or school, they may do so to gain valuable skills or
expertise, or even for social status. But it appears that only people who volunteer for prosocial reasons gain
longevity benefits from volunteering (Konrath et al., 2011). Moreover, the stress-buffering effects of helping
are only present among those who believe other people are good and valuable (Poulin, 2014). These findings
suggest that caring about the welfare of others—which may conflict with avoiding threats to the self—is more
important than merely going through the motions of helping.

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Figure 26.4 Means of the cardiovascular threat reactivity by condition. Higher scores on the challenge/threat index represent greater relative
challenge, while lower scores reflect greater relative threat, with zero representing the sample mean.

Effects of a Deliberative Mindset on Helping-Goal Commitment

If focusing on a suffering other’s feelings diminishes threat-avoidance because it entails some degree of
commitment to the goal to alleviate another’s suffering, then the effects of this manipulation should only work
when goal commitment is likely. That is, many of the effects of perspective taking should only be present
when participants can readily cross from the deliberative into the implemental phase with respect to helping
goals. As reviewed before, one factor that can influence this is whether an individual is already in a deliberative
or implemental mindset with respect to other goals. So if a person is already in a deliberative mindset,
focusing on the feelings of a suffering other should be less likely to yield commitment to helping goals than if
a person is not in a deliberative mindset. Our lab has recently examined this idea, testing the prediction that
inducing a deliberative mindset would undermine the effects of focusing on another’s suffering on helping
behavior (Ministero, Poulin, Buffone, & DeLury, 2016).
To do so, we had people (N = 240) come to the lab and told them we were interested in their responses to
current events. And specifically (using a cover story and materials developed by Cameron & Payne, 2011), we
wanted to assess their responses to the crisis in the Darfur region of Sudan. But first, we randomly assigned
half of participants to a deliberative-thinking condition and another half to a neutral control condition. To do
so, we had participants unscramble sentences—either sentences having to do with rational deliberation or not
(cf. Gervais & Norenzayan, 2012). For example, in the deliberative thinking condition, participants could be
presented with the words “numbers, gyrate, carefully, analyze, the,” which the participants would then turn
into the sentence “Analyze the numbers carefully” (participants were told they would need to drop one word).
By contrast, in the neutral condition, participants might see the words “high, the, flies, wet, plane,” which
would yield the sentence “The plane flies high.” After participants solved five of these sentences corresponding
to their condition, we showed them pictures of suffering children in Darfur, and while participants were
looking at those pictures, half of the people were asked to think about the feelings of the children, while the
other half were given no such instructions. After this, participants were asked if they would be willing to make
a donation to the Red Cross on behalf of the victims. Our results showed that thinking about the feelings of
the suffering children elicited donations in the neutral control (no deliberation) condition, but such a focus
failed to elicit donations in the deliberation condition (see Figure 26.5). In other words, rational deliberation
eliminated the effects of a focus on another’s suffering on helping behavior. This finding adds context to prior
research showing that deliberation tends to undermine prosocial behavior in general (Christov-Moore &

468
Iacoboni, 2016; Christov-Moore, Sugiyama, Grigaityte, & Iacoboni, 2016; Fermin et al., 2016; Rand,
Greene, & Nowak, 2012), and provides further evidence that, in order for compassion-evoking situations to
lead to action, people must find a way around or through the deliberative phase of helping-goal pursuit to the
biased, implemental phase.

Figure 26.5 Effects of other focus on donating in the presence versus absence of deliberation.

Implications of an Action-Phase Model of Compassion

In this chapter, I have emphasized the importance of the distinction between merely having a desire or goal
to help, which is inherently a part of compassion, and committing to such a goal, which may require the
presence of additional factors beyond compassion. That is, I have tried to make the case that compassion can
exist in different phases of pursuing the goal to alleviate another’s suffering—the deliberative versus the
implemental phase—and that the effects of compassion-evoking situations on both helping behavior and
(potential) helper well-being differ in these two phases. Specifically, in the deliberative phase, such situations
may elicit helping goals but not necessarily helping behavior, and may lead to distress as people confront
threat-avoidance concerns and uncertainty about whether to help. In contrast, in the implemental phase,
situations that evoke compassion may yield increased commitment to helping, and increased helping behavior,
as well as decreased stress and threat-related concerns. If this model of compassion is accurate, I believe it has
two sets of practical and theoretical implications. Specifically, I believe this model can help shed light on the
effects of compassion as well as the related, but seemingly distinct effects of helping behavior on well-being,
while providing directions for future research in each of these areas.
First and foremost, an action-phase model of compassion can clarify under which conditions compassion-
evoking situations produce helping behavior and specific patterns of feelings in potential helpers. As I have
reviewed, the links between compassion and helping behavior are far from absolute. Compassion may predict

469
helping, but it does not inevitably produce helping behavior. The links between compassion-evoking
situations and other feelings in potential helpers are also unclear. Are these feelings pleasant and desirable, or
are they aversive and something that people strive to avoid? An action-phase model of compassion would
suggest that, when conditions are such that a person is in the deliberative phase with respect to the goal to
alleviate another’s suffering, situations that evoke compassion may be unlikely to lead to helping behavior and
may be associated with uncertainty, distress, and anxiety. In contrast, when conditions lead a person to cross
the Rubicon and commit to the goal to alleviate another’s suffering, putting them in the implemental phase,
compassion-evoking situations may yield both helping behavior and reduced feelings of threat-related
concern.
In particular, I would predict that people’s feelings are mostly aversive and helping is unlikely in situations
in which the goal to alleviate another’s suffering is perceived as of similar importance to threat-avoidance
goals, and when there are no factors to nudge a person across the Rubicon and commit to the other-focused
goal. As a reminder, those factors include the presence of implementation intentions, having a clear path to
helping-goal implementation, the presence of multiple means of helping-goal implementation, a perception of
having crossed the Rubicon, or already being in an implemental mindset. In contrast, compassion may be
especially more likely, and to lead to helping, either when helping goals are clearly more important than
threat-avoidance goals or when commitment-enhancing factors are present.
These predictions are ripe for empirical testing, and research may also reveal other factors that facilitate or
inhibit commitment to goals to alleviate others’ suffering. For example, making a person’s moral identity
salient (cf. Reed, Kay, Finnel, Aquino, & Levy, 2016) may function as a signal that one has already crossed
the Rubicon with respect to other-focused motivation in a potential helping situation. Testing commitment-
enhancing—or -inhibiting—factors could contribute to a richer theoretical action-phase model of
compassion. Such a model could also contribute to research in a more applied vein. For example, if the
combination of compassion and commitment most strongly predicts helping behavior, this could suggest new
interventions to promote volunteering or charitable engagement. Much prior work in promoting prosocial
behavior has focused on increasing the value of helping goals for individuals, either through incentives or
through appeals to norm-based motivations (for a review, see Stukas, Snyder, & Clary, 2016). However, an
action-phase model of compassion would suggest that attention to suffering plus commitment-promoting
factors such as implementation intentions may also be effective, as might interventions designed to decrease
threat-avoidance motivations. Indeed, the practice of compassion training (e.g., Jinpa, 2016) already includes
implementation intentions as one component. In addition, if compassion has differing implications for well-
being in the presence versus absence of helping-goal commitment, that could lead to better understanding of
and interventions for experiences such as compassion fatigue, burnout, or caregiver burden.
Second, an action-phase model of compassion may provide a new mechanism by which helping behavior
may appear to foster physical and mental health. Previous researchers studying helping behavior and well-
being have proposed many possible mechanisms by which engaging in prosocial behavior could be beneficial.
Among these mechanisms are increased self-esteem; increased feelings of meaning, purpose, or control;
alleviation of negative affect; or increased social contact (for reviews of these, see Post, 2007); or biological
mechanisms associated with the caregiving behavioral system (Brown & Brown, 2006; Brown & Brown,
2015; Brown, Brown, & Preston, 2011). However, an action-phase model of compassion suggests another

470
possibility: merely committing to the goal to alleviate another’s suffering may lead to disengagement from
threat-related concerns, thus leading to stress reduction. That is, entering the implemental phase of pursuing
the goal to alleviate another’s suffering in and of itself may yield benefits for mental and physical health,
completely independent of the effects of helping behavior, per se. Future studies could test this prediction
using an array of techniques, including cardiovascular assessment of stress or threat versus approach
physiology (cf. Buffone et al., 2017; Stellar, Cohen, Oveis, & Keltner, 2015). This is not to say that helping
behavior does not have its own effects on helpers’ well-being; it could easily be the case that both helping-goal
commitment and helping behavior have unique, or synergistic, benefits.
The idea that commitment to other-focused goals could lead to improved helper well-being, independent
of helping behavior, has not been tested, but it could be a very interesting target for future research. Again, if
this mechanism functions as the action-phase model of compassion predicts it does, this could also make
commitment to other-focused goals a useful tool in improving the well-being of those experiencing stress—
including, but not limited to, those providing care for others.

Conclusion
Compassion leads to a desire to help suffering others, but that desire does not necessarily lead to
commitment, especially since the desire to help is frequently in tension with the desire to protect oneself. An
action-phase model of compassion suggests that situations that evoke compassion have differing effects on
helping behavior and on potential helpers’ well-being before versus after commitment to helping goals. This
model is broadly consistent with prior research on helping behavior, helps to make sense of conflicting or
unclear findings in research on compassion, and suggests new directions for research in the future. Applying
an action-phase model to compassion may help unlock compassion’s true role in social life.

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 PART 6

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Clinical Approaches

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 Self-Compassion and Psychological Well-being

Kristin Neff and Christopher Germer

Abstract

Self-compassion involves being touched by and open to one’s own suffering, not avoiding or
disconnecting from it, generating the desire to alleviate one’s suffering and to heal oneself with kindness.
Self-compassion also involves offering nonjudgmental understanding to one’s pain, inadequacies, and
failures, so that one’s experience is seen as part of the larger human experience. This chapter will provide
an overview of theory and research on self-compassion and its link to psychological well-being, which is
the goal of clinical practice. It will discuss what self-compassion is and what it is not (e.g., a form of
weakness, selfishness, etc.), and provide empirical evidence to support these distinctions. Finally, it will
discuss methods that have been developed to teach individuals how to be more self-compassionate in
their daily lives, some clinical implications of self-compassion training, and future directions for research.

Key Words: self-compassion, self-kindness, common humanity, mindfulness, therapeutic intervention

What Is Self-Compassion?
To better understand what is intended by the term self-compassion, it is helpful to first consider what it
means to feel compassion for others, a concept many of us are more familiar with. Compassion involves
sensitivity to the experience of suffering, coupled with a deep desire to alleviate that suffering (Goertz,
Keltner, & Simon-Thomas, 2010). This means opening one’s awareness to the pain of others, without
avoiding or disconnecting from it, allowing feelings of kindness towards others and a desire to ameliorate their
suffering to emerge (Wispe, 1991). Compassion also involves understanding the shared human condition,
fragile and imperfect as it is, as well as willingness to extend that understanding to others when they fail or
make mistakes. Instead of looking away or rolling up your window when you pull up next to that homeless
man at a stoplight, for example, you pause and take a moment to reflect on how difficult things are for him.
By stepping out of your usual frame of reference and placing yourself in his position, you start to see him as an
actual human being who is in pain. Once this happens, your heart cannot help but resonate with his;
compassion literally means “to suffer with” (Lewis & Short, 1879). Rather than trying to tune him out, you
might discover that his situation has emotionally moved you, compelling you to help ease his pain in some
way.
Self-compassion is simply compassion directed inward. Just as we can feel compassion for the suffering of
others, we can extend compassion towards ourselves when we experience suffering, regardless of whether the
suffering resulted from external circumstances or our own mistakes, failures and personal inadequacies. Self-
compassion, therefore, involves being touched by and open to one’s own suffering, not avoiding or
disconnecting from it, generating the desire to alleviate one’s suffering and to heal oneself with kindness. Self-

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compassion also involves offering nonjudgmental understanding to one’s pain, inadequacies, and failures, so
that one’s experience is seen as part of the larger human experience.

The Three Facets of Self-Compassion

Drawing on the writings of various Buddhist teachers (e.g., Salzberg, 1997), Neff (2003b) has
operationalized self-compassion as consisting of three main elements: kindness, a sense of common humanity,
and mindfulness. These components combine and interact to create a self-compassionate frame of mind. Self-
compassion is relevant when considering personal inadequacies, mistakes, and failures, as well as when
confronting painful life situations that are outside of our control.

SELF-KINDNESS

Western culture puts great emphasis on being kind to our friends, family, and neighbors who are struggling.
Not so, when it comes to ourselves. When we make a mistake or fail in some way, we may be more likely to
beat ourselves up than to put a supportive arm around our own shoulder. This tendency towards self-criticism
is particularly prevalent among those of us who live with anxiety disorders and depression (Blatt, 1995). And
even when our problems stem from forces beyond our control, such as an accident or traumatic event, we
often focus more on fixing the problem than on calming and comforting ourselves (Austenfeld & Stanton,
2004). Western culture often sends the message that strong individuals should be like John Wayne—stoic and
silent toward their own suffering. Unfortunately, these attitudes rob us of one of our most powerful coping
mechanisms when dealing with the difficulties of life—the ability to comfort ourselves when we are hurting
and in need of care.
Self-kindness refers to the tendency to be supportive and sympathetic toward ourselves when noticing
personal shortcomings, as opposed to harshly judging ourselves. It entails relating to our mistakes and failings
with tolerance and understanding and recognizing that perfection is unattainable. Self-compassion is
expressed in internal dialogues that are benevolent and encouraging rather than cruel or disparaging. Instead
of berating ourselves for being inadequate, we offer ourselves warmth and unconditional acceptance. Instead
of getting fixated in a problem-solving mode and ignoring our own suffering, we pause to emotionally comfort
ourselves when confronting painful situations. With self-kindness, we make a peace offering of warmth,
gentleness, and sympathy from ourselves to ourselves so that true healing can occur.

COMMON HUMANITY

All humans are flawed works-in-progress; everyone fails, makes mistakes, and engages in dysfunctional
behavior. All of us reach for things we cannot have, and have to remain in the presence of difficult experiences
that we desperately want to avoid. Just as the Buddha realized, some 2,600 years ago, we all suffer
(Makransky, 2012). Often, however, we feel isolated and cut off from others when considering our struggles
and personal shortcomings, irrationally reacting as if failure and pain were aberrations. This is not a logical
process, but a kind of tunnel vision in which we lose sight of the larger human picture and focus primarily on
our own seemingly feeble and worthless selves. Similarly, when things go wrong in our external lives through
no fault of our own, we often assume that other people are having an easier time of it; that our own situation
is abnormal or unfair. We feel cut off and separate from other people who are presumably leading “normal,”

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happy lives. This egocentric response resembles “the personal fable” commonly observed among adolescents—
the belief that one’s personal experience is unique and unrelated to that of others (Lapsley, FitzGerald, Rice,
& Jackson, 1989). It still lives on in adulthood, however, especially in terms of how we relate to our own
suffering.
With self-compassion, however, we take the stance of a compassionate “other” toward ourselves. Through
this act of perspective-taking, our outlook becomes broader and more inclusive, recognizing that life’s
challenges and personal failures are simply part of being human. Self-compassion helps us feel more
connected and less isolated when we are in pain. More than that, it helps put our own situation into context.
Perhaps a situation that seemed like the end of the world at first—being fired from a job, for instance—
doesn’t seem quite so terrible when we consider that other people have lost their homes or their loved ones.
Remembering the shared nature of suffering not only makes us feel less isolated, it also reminds us things
could be worse.
Recognition of common humanity also reframes what it means to be a self. When we condemn ourselves
for our inadequacies, we are assuming that there is in fact a separate, clearly bounded entity called “me” that
can be pinpointed and blamed for failing. But is this really true? We always exist in a present-moment
context, and the range of our behavioral responses is informed by our individual history (Hayes, 1984). Let’s
say you criticize yourself for having an anger issue. What are the causes and conditions that led you to be so
angry? Perhaps inborn genetics plays a role. But did you choose your genes before entering this world? Or
maybe you grew up in a conflict-filled household in which shouting and anger were the only ways to be heard.
But did you choose for your family to be this way? If we closely examine our “personal” failings, it soon
becomes clear that they are not entirely personal. We are the expression of millions of prior circumstances that
have all come together to shape us in the present moment. Our economic and social background, our past
associations and relationships, our family history, our genetics—all have had a profound role in creating the
person we are today (Krueger, South, Johnson, & Iacono, 2008; Riemann, Angleitner, & Strelau, 1997;
Triandis & Suh, 2002). And thus we can have more acceptance and understanding for why we are not the
perfect people we want to be.

MINDFULNESS

Mindfulness involves being aware of present-moment experience in a clear and balanced manner (Brown &
Ryan, 2003). Mindful acceptance involves being “experientially open” to the reality of the present moment,
allowing thoughts, emotions, and sensations to enter our awareness without judgment, avoidance, or
repression (Bishop et al., 2004). Why is mindfulness an essential component of self-compassion? First, it is
necessary to recognize that you are suffering in order to give yourself compassion. While it might seem that
suffering is obvious, many people do not acknowledge the extent of their own pain, especially when that pain
stems from their own self-criticism. Or when confronted with life challenges, people often get so absorbed by
the process of trying to fix their problems that they do not pause to consider how much they are struggling in
the moment. While the tendency to suppress or ignore pain is very human, an avoidant style of coping with
negative emotions can lead to dysfunctional and ultimately ineffective strategies such as substance misuse,
binge-eating, or social withdrawal (Holahan & Moos, 1987). Mindfulness counters the tendency to avoid
painful thoughts and emotions, allowing us to bear witness to our experience, even when it is unpleasant.

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 At the same time, being mindful means that we do not become “overidentified” (Neff, 2003b) with negative
thoughts or feelings so that we are caught up and swept away by our aversive reactions (Bishop et al., 2004).
This type of rumination narrows our focus and exaggerates negative implications for self-worth (Nolen-
Hoeksema, 1991). Not only did I fail, “I AM A FAILURE.” Not only am I disappointed, “MY LIFE IS
DISAPPOINTING.” Over-identification means that we define ourselves in terms of our behaviors, reifying
them as definitive and permanent. When we observe our pain mindfully, however, new behaviors become
possible. Like a clear, still pool without ripples, mindfulness mirrors what is occurring without distortion,
allowing us to take a wiser and more objective perspective on ourselves and our lives.

Research on Self-Compassion
Thus far, the large majority of research examining the link between self-compassion and well-being has
been conducted using the Self-Compassion Scale (SCS; Neff, 2003a), which assesses trait levels of self-
compassion. The SCS was developed to explicitly represent the thoughts, emotions, and behaviors associated
with the various components of self-compassion. It includes items that measure how often people respond to
feelings of inadequacy or suffering with self-kindness (e.g., “I try to be loving towards myself when I’m feeling
emotional pain”), self-judgment (e.g., “I’m disapproving and judgmental about my own flaws and
inadequacies”), common humanity (e.g., “I try to see my failings as part of the human condition”), isolation
(e.g., “When I think about my inadequacies it tends to make me feel more separate and cut off from the rest
of the world”), mindfulness (e.g., “When something painful happens I try to take a balanced view of the
situation”), and over-identification (e.g., “When I’m feeling down I tend to obsess and fixate on everything
that’s wrong”). Responses are given on a 5-point scale from “Almost Never” to “Almost Always.” Items
representing uncompassionate responses to suffering are reverse-coded so that higher scores represent a lower
frequency of these responses. Means are then calculated for each subscale, and a grand mean is calculated that
represents an overall measure of self-compassion. Thus, the SCS can be used as an overall measure of self-
compassion. Alternatively, the six subscales of the SCS can be examined separately.
There has been some controversy over whether or not the factor structure of SCS generalizes across
populations (e.g., Costa et al., 2015; Williams, Dalgleish, Karl, & Kuyken, 2014), and whether an overall self-
compassion score can be reliably used. However, recent research using bifactor analyses suggests that an
overall self-compassion factor explains at least 90% of item variance across student, community, meditator,
and clinical populations (Neff, Whittaker, & Karl, 2017), providing support for the use of a total SCS score to
represent overall trait levels of self-compassion.
Studies suggest that trait levels of self-compassion are linked to well-being (Zessin, Dickhauser, &
Garbade, 2015). For instance, higher scores on the SCS have been associated with greater levels of happiness,
optimism, life satisfaction, body appreciation, perceived competence, and motivation (Hollis-Walker &
Colosimo, 2011; Neff, Hsieh, & Dejitthirat, 2005; Neff, Pisitsungkagarn, & Hsieh, 2008; Neff, Rude, &
Kirkpatrick, 2007); as well as lower levels of depression, anxiety, stress, rumination, body shame, and fear of
failure (Daye, Webb, & Jafari, 2014; Finlay-Jones, Rees, & Kane, 2015; Neff, Hseih, & Dejitthirat, 2005;
Raes, 2010). Higher scores on the SCS have also been associated with healthier physiological responses to
stress (Breines, Thoma, et al., 2014; Breines, Toole, et al., 2014; Friis et al., 2015).
Increasingly, however, researchers are starting to use other methods to examine the link between self-

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compassion and well-being such as mood inductions (e.g., Breines, & Chen, 2012); behavioral observations
(Sbarra, Smith, & Mehl, 2012), short-term interventions (e.g., Smeets, Neff, Alberts, & Peters, 2014) and
longer-term interventions (e.g., Neff & Germer, 2013). Findings using non-self-report methodologies tend to
converge with findings obtained with the SCS. For instance, self-compassion interventions have been found
to increase optimism, happiness, life satisfaction, self-efficacy, and body appreciation; to decrease rumination,
depression, anxiety, stress, and body shame (Albertson et al., 2014; Neff & Germer, 2013; Shapira &
Mongrain, 2010; Smeets et al., 2014); and to positively impact physiological responses to stress (Arch et al.,
2014). Similarly, experimental studies designed to induce a self-compassionate mood (e.g., responding to
writing prompts that foster self-kindness, common humanity, and mindfulness in response to suffering) have
been shown to increase positive affect and motivation and also decrease negative emotions such as anxiety,
shame, and depression (Breines & Chen, 2012; Diedrich et al., 2014; Johnson & O’Brien, 2013; Leary et al.,
2007; Odou & Brinker, 2014).
Summing up an increasingly large body of research, a consistent finding in the literature is that self-
compassion is inversely associated with psychopathology. In fact, a recent meta-analysis (MacBeth & Gumley,
2012) found a large effect size when examining the link between self-compassion and negative states such as
depression and anxiety across 20 studies. Of course, a key feature of self-compassion is lower levels of self-
criticism, and self-criticism is known to be an important predictor of anxiety and depression (Blatt, 1995).
However, self-compassion is still a negative predictor of anxiety and depression when controlling for self-
criticism and negative affect (Neff, 2003a; Neff, Kirkpatrick, & Rude, 2007). Greater self-compassion is also
linked with less rumination, perfectionism, and fear of failure (Neff, 2003a; Neff, Hsieh, & Dejitterat, 2005).
The resilience self-compassion offers against negative states of mind may be related to the finding that giving
compassion to oneself tends to decrease cortisol and increase heart-rate variability (associated with the ability
to self-soothe when stressed; Rockliff, Gilbert, McEwan, Lightman, & Glover, 2008).
Self-compassion appears to facilitate coping by moderating people’s reactions to negative events. In an
elegant series of experimental studies, Leary et al. (2007) asked undergraduates to recall unpleasant events;
imagine hypothetical situations about failure, loss, and humiliation; perform an embarrassing task; and
disclose personal information to another person who gave them ambivalent feedback. Results indicated that
individuals who were higher in trait self-compassion demonstrated less extreme reactions, less negative
emotions, more accepting thoughts, and a greater tendency to put their problems into perspective, while at the
same time acknowledging their own responsibility, than individuals who were lower in self-compassion.
While self-compassion appears to loosen the grip of negativity, it is important to remember that self-
compassion does not eliminate or push away negative emotions altogether. In fact, more self-compassionate
individuals are less likely to suppress unwanted thoughts and emotions than are those with less self-
compassion (Neff, 2003a), and are more likely to acknowledge and validate the importance of their emotions
(Leary et al., 2007; Neff, Hseih, & Dejitterat, 2005). In one study, for instance, Neff et al. (2007) gave
participants a mock job interview that asked them to “describe their greatest weakness.” The results indicated
that levels of self-compassion were unrelated to how many negative self-descriptors people used when
describing their weaknesses. However, more self-compassionate people were less likely to develop anxiety as a
result of the interview. Also, individuals with greater self-compassion tended to use language that indicated
connection rather than isolation when writing about their weakness. For example, they used fewer first-

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person-singular pronouns such as “I,” in favor of first-person-plural pronouns such as “we,” and made more
social references to friends, family, and others. These findings suggests that self-compassion may decrease
maladaptive emotional reactions because weaknesses feel less threatening when considered in the light of the
shared human experience.
Research suggests that self-compassion is associated with a number of positive psychological strengths. For
instance, people higher in trait self-compassion report feeling happier than do those with lower levels (Hollis-
Walker & Colosimo, 2011; Neff, Rude, & Kirkpatrick, 2007; Shapira & Mongrain, 2010; Smeets et al.,
2014). They also display higher levels of optimism, gratitude, and positive affect more generally (Breen,
Kashdan, Lenser, & Fincham, 2010; Neff, Rude, & Kirkpatrick, 2007). Self-compassion has also been linked
to emotional intelligence, wisdom, personal initiative, curiosity, intellectual flexibility, life satisfaction, and
feelings of social connectedness—which are all important components of a meaningful life (Heffernan,
Griffin, McNulty, & Fitzpatrick, 2010; Martin, Staggers, & Anderson, 2011; Neff, 2003a; Neff, Rude, &
Kirkpatrick, 2007). In addition, the trait of self-compassion has been associated with feelings of autonomy,
competence, relatedness, and self-determination (Magnus, Kowalski, & McHugh, 2010; Neff, 2003a),
suggesting that self-compassion helps meet the basic psychological needs that Ryan and Deci (2001) argue are
fundamental to eudaimonic well-being.
In order to better understand why self-compassion generates such a positive mind-state at the same time
that it ameliorates negative mind-states, it is useful to think of the three components of self-compassion in
terms of loving, connected, presence (kindness, connectedness, and mindfulness). When we hold our pain in
“loving connected presence,” we simultaneously generate positive emotions while lessening our negative
emotions through self-soothing.
Of course, many people have misgivings about self-compassion that get in the way of their actually
adopting this mindset. In fact, many people are afraid of being self-compassionate because they believe it will
harm them in some way (Gilbert, McEwan, Matos, & Rivis, 2011). Fortunately, there is now enough research
evidence to suggest that these misgivings are actually misconceptions, false beliefs and understandings of what
self-compassion really entails. We will address these misgivings one by one.

Misgivings About Self-Compassion

SELF-COMPASSION IS WEAK

Self-compassion is for sissies, isn’t it? a hearts and flowers approach to life that will make us soft. In fact,
psychologists are discovering that self-compassion is a powerful source of coping and resilience. For instance,
Sbarra et al. (2012) found that self-compassion was key in helping people adjust after divorce. Researchers
asked divorcing adults to complete a four-minute stream-of-consciousness recording about their separation
experience, and independent judges rated how self-compassionate their dialogues were. Those who displayed
greater self-compassion when talking about their breakup not only evidenced better psychological adjustment
at the time, but this effect persisted over nine months. Self-compassion also appears to aid adjustment to
university life. Undergraduates with higher levels of self-compassion experienced less psychological distress
when confronted with academic pressure and social difficulties (Kyeong, 2013) and also had fewer feelings of
homesickness during their first semester at college (Terry, Leary, & Mehta, 2013).
Research indicates that self-compassion is also an important tool for successfully coping with a variety of

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health problems. For instance, individuals with more self-compassion have been shown to maintain more
emotional balance, function better in daily life, and subjectively perceive less pain as a result of chronic pain
(Costa & Pinto-Gouveia, 2011; Wren et al., 2012). Self-compassion has also been linked to resilience in
adults with spina bifida (Hayter & Dorstyn, 2013), breast cancer (Przezdziecki et al., 2013), and positive HIV
status (Brion, Leary, & Drabkin, 2014). Self-compassion may also be an important protective factor for post-
traumatic stress disorder (PTSD) (Thompson & Waltz, 2008). For instance, the level of self-compassion
displayed by combat veterans returning from Iraq or Afghanistan was a better predictor of PTSD
symptomology than the level of combat exposure itself (Hiraoka et al., 2015). Similarly, the self-compassion
levels of parents of autistic children predicted how much stress they experienced better than the severity of
their child’s autism (Neff & Faso, 2014). It is not just what you face in life that matters, it is how you treat
yourself when life gets tough that seems to determine our ability to get through difficulties.

SELF-COMPASSION IS LAZY

Perhaps the biggest block to self-compassion is the belief that it will undermine our motivation. In fact,
research suggests that some people actually fear having self-compassion because they think it will undermine
their efforts to reach their goals (Gilbert et al., 2011). But is this true? A good analogy can be found in how
good parents motivate their children. Would a compassionate father ruthlessly criticize his son when he
messes up, telling him he is a hopeless failure? Of course not. Instead, he would reassure his child that it is
only human to make mistakes, and offer whatever support his son needed to help him do his best. The child
will be much more motivated to try to attain his goals in life when he can count on his father’s encouragement
and acceptance when he fails, rather than being belittled and labeled as unworthy.
It seems easy to see this when thinking about healthy parenting, but it is not so easy to apply this same logic
to ourselves. We are deeply attached to our self-criticism, and at some level we probably think the pain is
helpful. To the extent that self-criticism does work as a motivator, it is because we are driven by the desire to
avoid self-judgment when we fail. But if we know that failure will be met with a barrage of self-criticism,
sometimes it can be too frightening to even try. With self-compassion, however, we strive to achieve for a very
different reason—because we care. You might say that the motivation of self-compassion arises from love,
while the motivation of self-criticism arises from fear. If we truly care about ourselves, we will do things to
help ourselves be happy, such as taking on challenging new projects or learning new skills. And because self-
compassion gives us the safety needed to acknowledge our weaknesses, we will be in a better position to
change them for the better.
There is ample empirical evidence to support the idea that self-compassion enhances rather than
undermines motivation. For instance, while self-compassion is negatively related to perfectionism, it has no
association with the level of performance standards adopted for the self (Neff, 2003a). Self-compassionate
people aim just as high, but they also recognize and accept that they cannot always reach their goals. People
with higher levels of self-compassion have been found to have less motivational anxiety and to engage in fewer
self-handicapping behaviors such as procrastination than those with lower levels (Sirois, 2014; Williams,
Stark, & Foster, 2008).
In a series of four experimental studies, Breines and Chen (2012) used mood inductions to engender
feelings of self-compassion for personal weaknesses, failures, and past moral transgressions. When compared

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to a self-esteem induction (e.g., “Think about your positive qualities”) or a positive mood distractor (e.g.,
“Think about a hobby you enjoy”), a self-compassion induction (e.g., “Express kindness and understanding”)
resulted in more motivation to change for the better, try harder to learn, and repair past harms and avoid
repeating past mistakes. More self-compassionate people have been found to have less fear of failure (Neff,
Hsieh, & Dejitthirat, 2005), but when they do fail, they are more likely to try again (Neely, Schallert,
Mohammed, Roberts, & Chen, 2009).

SELF-COMPASSION MEANS BEING SELF-INDULGENT

Doesn’t being kind to yourself mean giving yourself whatever you want? No. Self-compassion is concerned
with the alleviation of suffering. Self-indulgence, on the other hand, involves giving oneself short-term
pleasure at the cost of long-term harm. A compassionate mother would not give her daughter endless bowls of
ice cream and let her skip school whenever she wanted. That would be indulgent. Instead, a compassionate
mother tells her child to do her homework and eat her vegetables. Self-compassion avoids self-indulgent
behavior because it leads to harm in the long run, and well-being often requires denying immediate
gratification.
Research suggests that self-compassion is linked to healthier living. For instance, the trait of self-
compassion appears to be an important feature of healthy aging (Allen, Goldwasser, & Leary, 2012; Allen &
Leary, 2013; Terry & Leary, 2011), and a recent meta-analysis indicates that self-compassion is associated
with a variety of health-related behaviors (Sirois, Kitner, & Hirsch, 2015). Kelly, Zuroff, Foa, and Gilbert
(2009) examined whether self-compassion could help people stop or reduce smoking. Individuals trained to
feel compassionate about the difficulties of giving up smoking reduced their smoking to a greater extent than
did those trained to reflect upon and monitor their smoking. The self-compassion intervention was especially
effective among those who were highly self-critical or resistant to change. Other research suggests that
increasing self-compassion helps alcohol-dependent individuals reduce their alcohol use (Brooks, Kay-
Lambkin, Bowman, & Childs, 2012). Women with more self-compassion have been found to be more
intrinsically motivated to exercise, and their goals for exercising were related to health rather than ego-
concerns (Magnus et al., 2010; Mosewich, Kowalski, Sabiston, Sedgwick, & Tracy, 2011).
In addition to behavioral changes, self-compassion may enhance health directly by strengthening the
immune function. A recent study by Brienes et al. (2014) found that individuals with higher levels of self-
compassion displayed better immune function when exposed to a standard laboratory-based stressor (the Trier
Social Stress Test). Moreover, self-compassion predicted immune response even when controlling for self-
esteem and depression levels. This basic finding was replicated in a group of people who underwent brief self-
compassion training (Arch et al., 2014). Thus, self-compassion appears to enhance both physical and mental
well-being.

SELF-COMPASSION IS NARCISSISTIC

But isn’t self-compassion just a tired rehash of self-esteem, a way of believing we are better than others?
Many people fear that this is the case. There is an important distinction between self-compassion and self-
esteem, however. “Self-esteem” refers to the degree to which we evaluate ourselves positively. There is general
consensus that self-esteem is essential for good mental health, while the lack of self-esteem undermines well-

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being by fostering depression, anxiety, and other pathologies (Leary, 1999). There are potential problems with
high self-esteem, however—not in terms of having it, but in terms of getting and keeping it (Crocker & Park,
2004). In American culture, high self-esteem requires standing out in a crowd—being special and above
average (Heine, Lehman, Markus, & Kitayama, 1999). It is often based on comparisons with others and is
contingent upon success (Harter, 1999). The self-esteem movement in the United States has also been linked
to an epidemic of narcissism among college undergraduates (Twenge & Campbell, 2009). In contrast, self-
compassion is not based on positive judgments or evaluations—it is a way of relating to ourselves. It is easier
to achieve self-compassion than self-esteem, given that it only requires that we acknowledge our limitations
with kindness, rather than changing our self-evaluations from negative to positive. We have self-compassion
because we are human beings, not because we are special or above average. This means that we do not have to
feel better than others to feel good about ourselves. Self-compassion also offers more emotional stability than
self-esteem because it is always available—in good times and bad.
Research suggests that, while self-compassion yields similar mental health benefits as self-esteem, it does
not have the same pitfalls in terms of social comparison or contingency on successful performance. In a survey
involving a large community sample in the Netherlands (Neff & Vonk, 2009), for instance, trait self-
compassion was associated with more stability in feelings of state self-worth (how valuable one feels in the
moment) over an eight-month period (assessed 12 different times) than did global levels of trait self-esteem.
This was related to the fact that self-compassion was found to have a weaker link with a sense of self-worth
that was contingent on things like physical attractiveness or successful performances than self-esteem did.
Results indicated that trait self-compassion was associated with lower levels of social comparison, public self-
consciousness, self-rumination, anger, and close-mindedness than self-esteem was. Also, self-esteem had a
robust association with narcissism, while self-compassion had no association with narcissism. These findings
suggest that, in contrast to those with high self-esteem, self-compassionate people are less focused on
evaluating themselves, feeling superior to others, worrying about whether or not others are evaluating them,
defending their viewpoints, or angrily reacting against those who disagree with them.
Leary et al. (2007) compared self-compassion and self-esteem using a mood induction. Participants were
instructed to recall a previous failure, rejection, or loss that made them feel bad about themselves, and were
then asked a series of questions that assessed their feelings about the event. Participants responded to prompts
to write about what happened with self-compassion (e.g., “Reflect on the event with kindness, a sense of
common humanity, and mindfulness”), or in a way that bolstered their self-esteem (“Write about your positive
characteristics and interpret the event in a way that makes you feel better about yourself”). Participants who
received the self-compassion instructions reported less negative emotions when thinking about the past event
than those in the self-esteem condition. They also took more personal responsibility for the event than those
in the self-esteem condition did, suggesting that self-compassion does not lead to “letting oneself off the
hook.”
In another study (Leary et al., 2007), participants were asked to make a videotape that would introduce and
describe themselves. They were then told that someone would watch their tape and give them feedback in
terms of how warm, friendly, intelligent, likeable, and mature they appeared (the feedback was given by a
study confederate). Half the participants received positive feedback; the other half, neutral feedback.
Participants who were higher in trait self-compassion were relatively unflustered regardless of whether the

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feedback was positive or neutral, and were willing to say the feedback was based on their own personality
either way. People with high levels of self-esteem, however, tended to get upset when they received neutral
feedback (“What, I’m just average?”). They were also more likely to deny that the neutral feedback was due to
their own personality but rather ascribed it to factors such as the observer’s mood. This suggests that self-
compassion better enables people to accept who they are regardless of the degree of praise they receive from
others.

SELF-COMPASSION IS SELFISH

Is this true? In fact, by treating ourselves in the same way that we treat those we care about, it appears that
we become more connected to others, not less. Whereas continual self-criticism leads to ruminative self-focus
(Lyubomirsky, Tucker, Caldwell, & Berg, 1999; Nolen-Hoeksema, 2000), positive emotions such as self-
kindness engender a sense of social connectedness (Fredrickson, 2001; Hutcherson, Seppala, & Gross, 2008).
It is also important to remember that self-compassion is very different from self-pity. While self-pity
emphasizes egocentric feelings of separation and exaggerates the extent of personal distress, self-compassion
allows us to see the related experiences of self and other without distortion. Moreover, recognition of our
common humanity helps us put our own situation into better perspective.
There is research evidence that self-compassion benefits interpersonal relationships. In a study of
heterosexual couples (Neff & Beretvas, 2013), individuals who were more self-compassionate were described
by their partners as being more emotionally connected, accepting, and autonomy-supporting, while being less
detached, controlling, and verbally or physically aggressive than those with less self-compassion. Self-
compassion was also associated with greater relationship satisfaction and attachment security. When people
give themselves care and support, they appear to have more emotional resources available to give to their
partners. Research has found that college students with higher levels of self-compassion tend to have more
compassionate goals in relationships with friends and roommates, meaning that they tend to provide social
support and encourage interpersonal trust (Crocker & Canevello, 2008). Other research (Yarnell & Neff,
2013) has found that individuals with greater self-compassion were more likely to report compromising in
conflict situations with mothers, fathers, and romantic partners, while those with less self-compassion tended
to subordinate their needs to those of others. This pattern makes sense, given that people with higher levels of
self-compassion say they tend to be as kind to themselves as to others, but people with lower levels of self-
compassion say they tend to be kinder to others than to themselves (Neff, 2003a). Finally, self-compassion has
been associated with the tendency to apologize and repair past relationship harms (Breines & Chen, 2012;
Howell, Dopko, Turowski, & Buro, 2011), thereby facilitating harmony within relationships.
An interesting question concerns whether or not self-compassionate people are more compassionate
towards others in general. Some evidence suggests that self-compassion stimulates parts of the brain
associated with other-focused compassion. Using functional magnetic resonance imaging (fMRI) technology,
Longe et al. (2009) found that instructing individuals to be self-compassionate simulated neuronal activity
similar to that evoked by empathy for others. This finding suggests that the tendency to respond to suffering
with caring concern is a process broadly applicable to the self and others. However, the link between
compassion for self and others is not completely straightforward, and it varies somewhat according to age and
life experiences.

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 Neff and Pommier (2013) examined the link between self-compassion and other-focused concern among
college undergraduates, an older community sample, and individuals practicing Buddhist meditation. In all
three groups, people with higher levels of self-compassion were less likely to experience personal distress; i.e.,
they were more able to confront others’ suffering without being overwhelmed. In addition, self-compassion
was significantly associated with forgiveness. Forgiving others requires understanding the vast web of causes
and conditions that lead people to act as they do. The ability to forgive and accept one’s flawed humanity,
therefore, appears to also apply to others. Self-compassion was significantly but weakly (r < .30) linked to
compassion for others, empathetic concern, and altruism among the community and Buddhist samples. This
association is probably not so robust as might be expected because of the fact that most people report being
much kinder to others than to themselves (Neff, 2003a), attenuating the association. Interestingly, there was
no link found between self-compassion and other-focused concern (i.e., compassion, empathetic concern, and
altruism) among undergraduates, even though their levels of self-compassion and other-focused concern were
the same as that of community adults. The lack of association between concern for self and others may be due
to the fact that young adults often struggle to recognize the shared aspects of their life experience,
overestimating their distinctiveness from others (Lapsley, FitzGerald, Rice, & Jackson, 1989). Their beliefs
about why they are deserving of care and why others are deserving of care are therefore likely to be poorly
integrated. The link between self-compassion and other-focused concern was strongest among meditators,
which may be the result of practices like loving-kindness meditation that simultaneously cultivate compassion
for self and others (Hofmann, Grossman, & Hinton, 2011).
While there are many people in the world who are compassionate to others but not to themselves, it is
difficult to sustain this way of being without burning out. Research indicates that the trait of self-compassion
is linked to less compassion fatigue among counselors, and greater “compassion satisfaction”—the positive
feelings experienced from one’s work such as feeling energized, happy, and grateful for being able to make a
difference in the world (Newsome, Waldo, & Gruszka, 2012; Shapiro, Brown, & Biegel, 2007). Similarly,
Barnard and Curry (2012) found that clergy who were more self-compassionate were less likely to suffer from
burnout from attending to the needs of their parishioners, and they were also more satisfied with their roles in
the ministry. In a study of health care professionals, Shapiro, Astin, Bishop, and Cordova (2005) found that
mindfulness training increased participants’ self-compassion, which in turn predicted reductions in their stress
levels. Thus, giving oneself compassion appears to provide the emotional resources needed to care for others.

Can Self-Compassion Be Taught?

Research suggests that self-compassion is not just a preexisting personality trait—training in self-
compassion can also result in enhanced psychological well-being. There are several studies indicating that
relatively brief training in self-compassion can be highly effective. For instance, Smeets et al. (2014) developed
a three-week self-compassion intervention for college students. The intervention involved a combination of
discussion, self-compassion practices such as putting one’s hand on one’s heart in times of distress, and various
exercises such as focusing on identifying the inner critic and finding compassionate ways to motivate the self.
At the end of the intervention, students in the experimental condition showed significantly greater increases
in self-compassion, mindfulness, optimism, and self-efficacy, and decreases in rumination in comparison to a
time-management control group. Shapira and Mongrain (2010) examined the impact of a self-compassionate

488
letter-writing intervention, which involved writing a paragraph about a recent difficulty in a kind,
understanding way, as a good friend would do. After seven days of letter writing, they found that this activity
not only decreased depression levels for three months, but it also increased happiness levels for six months.
Similarly, Albertson, Neff, and Dill-Shackleford (2014) conducted a study among women with body image
concerns that involved their listening to guided self-compassion meditations on the Internet for three weeks.
They found that the intervention produced significant decreases in body dissatisfaction, body shame, and
contingent self-worth based on their appearance, as well as increases in self-compassion and body appreciation
compared to a waitlist control group. All gains were maintained for three months. These results indicate that
even brief self-compassion interventions can be effective in teaching self-compassion skills and enhancing
well-being.
Self-compassion can also be enhanced through longer-term interventions. For example, enhanced self-
compassion appears to be an important outcome of mindfulness-based interventions such as Mindfulness-
Based Stress Reduction (MBSR) and Acceptance and Commitment Therapy (Yadavaia, Hayes, & Vilardaga,
2014). Shapiro et al. (2005) found that health care professionals who took an MBSR program reported
significantly increased self-compassion and reduced stress levels compared to a waitlist control group. They
also found that increases in self-compassion mediated the reductions in stress associated with the program.
The authors developed a program to teach self-compassion skills to the general population, called Mindful
Self-Compassion (MSC; Neff & Germer, 2013). In this program (described in detail later), participants meet
for about 2.5 hours once a week for eight weeks, and also attend a half-day silent meditation retreat. The
MSC program teaches a variety of meditations (e.g., loving-kindness, affectionate breathing) and informal
practices for use in daily life (e.g., soothing touch, self-compassionate letter writing). Self-compassion is
evoked during the classes using experiential exercises, and home practices are taught in order help participants
develop the habit of self-compassion. While the course primarily focuses on building the skill of self-
compassion, many of its meditations and exercises are focused on using self-compassion as a means of
sustaining and expanding compassion for others, given that the two mutually support each other. Participants
are encouraged to practice these techniques for a total of 40 minutes per day, either in formal sitting
meditation or informally throughout the day.
A typical MSC group typically consists of 10–25 participants and, depending on the size of the group, one
or two teachers. Since group participants are likely to encounter uncomfortable emotions, it is recommended
that at least one teacher be a trained mental health professional. MSC co-leaders teach by modeling—by
embodying compassion and self-compassion. Teachers also encourage participants to support one another on
the path to self-compassion by sharing their own experiences in a safe, confidential, respectful atmosphere.
The purpose of the course is to develop the inner resource of self-compassion that enables individuals to safely
engage difficulties as they arise in their lives.
Neff and Germer (2013) conducted a randomized controlled study of the MSC program that compared
outcomes for a treatment group (N = 24; 78% female; M age = 51.21) to a waitlist control group (N = 27; 82%
female; M age = 49.11). Compared to controls, MSC participants demonstrated a significant increase in self-
compassion, mindfulness, compassion for others, and life satisfaction, while decreasing in depression, anxiety,
stress, and emotional avoidance. All gains in outcomes were maintained at six months and one-year follow-up.

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Clinical Implications
Self-compassion appears to be a key mechanism of action in the effectiveness of mindfulness-based
therapeutic interventions (Baer, 2010), including Mindfulness-Based Cognitive Therapy (MBCT; Kuyken et
al., 2010). For instance, Kuyken et al. (2010) compared the effect of MBCT to maintenance antidepressants
on relapse in depressive symptoms. They found that increases in mindfulness and self-compassion following
MBCT participation mediated the link between MBCT and depressive symptoms at 15-month follow-up.
They also found that MBCT reduced the link between cognitive reactivity (i.e., the tendency to react to sad
emotions with depressive thinking styles) and depressive relapse, and that increased self-compassion (but not
mindfulness) mediated this association. This suggests that self-compassion may be an important key to
changing habitual thought patterns so that depressive episodes are not re-triggered.
Similarly, following short-term psychodynamic treatment, higher levels of self-compassion predicted
decreases in anxiety, shame, and guilt and increases in sadness, anger, and closeness (Schanche, 2011). In the
same study, increases in self-compassion predicted fewer psychiatric symptoms and interpersonal problems.
Because self-compassion is predicated upon connecting with difficult emotions without self-judgment, it
appears to lead to healthier psychological functioning.
Research shows that people who lack self-compassion are more likely to have critical mothers, come from
dysfunctional families, and display insecure attachment patterns than self-compassionate people are (Neff &
McGeehee, 2010; Wei, Liao, Ku, & Shaffer, 2011). Childhood emotional abuse is associated with lower self-
compassion, and individuals with low self-compassion experience more emotional distress and are more likely
to abuse alcohol or make a serious suicide attempt (Tanaka et al., 2011; Vettese, Dyer, Li, & Wekerle, 2011).
Research indicates that self-compassion mediates the relationship between childhood maltreatment and later
emotional dysregulation, meaning that abused individuals with higher levels of self-compassion are better able
to cope with upsetting events (Vettese, Dyer, Li, & Wekerle, 2011). This relationship holds even after
accounting for history of maltreatment, current distress level, or substance abuse, suggesting that self-
compassion is an important resiliency factor for those traumatized as children.
Early trauma such as childhood neglect or abuse is more likely to lead to self-criticism and shame because
those people did not receive sufficient warmth, soothing, and affection in childhood (Gilbert & Proctor,
2006). Paul Gilbert and colleagues developed a new treatment model based on self-compassion called
Compassion Focused Therapy (CFT; Gilbert, 2009, 2010). Gilbert notes that survivors of childhood
maltreatment can readily identify their maladaptive thought patterns (“I’m unlovable”) and provide alternative
self-statements (“Some people love me”), but they do not necessarily find the process emotionally reassuring.
Therefore, the goal of CFT is to “warm up the conversation” (personal communication, 2011). CFT
techniques include mindfulness training, visualizations, compassionate cognitive responding, and engaging in
self-compassionate overt behaviors and habits. In a pilot study of the compassionate mind training, a
structured program based on CFT, hospital day-treatment patients struggling with shame and self-criticism
showed significant decreases in depression, self-attacking, shame, and feelings of inferiority (Gilbert &
Procter, 2006). CFT is currently being used to treat eating disorders, anxiety disorders, bipolar disorders,
psychosis, and other forms of suffering, with apparent success (Braehler et al., 2013; Gilbert, 2010).
In light of consistent evidence that self-compassion is inversely associated with psychopathology, especially
anxiety and depression (MacBeth & Gumley, 2012), efforts to enhance self-compassion in therapy are clearly

490
warranted. It appears that self-compassion may be cultivated either through a compassionate therapeutic
relationship or by instructing clients to practice self-compassion exercises (Desmond, 2016; Germer, 2012;
Germer & Neff, 2013). Self-compassion also holds promise as an inner resource that mitigates caregiver
fatigue (Finley-Jones, Rees, & Kane, 2015).

Future Directions
While research on self-compassion is growing quickly, there are still many things we do not know about the
consequences of treating oneself kindly that should be explored in future research. For instance, are there any
hidden disadvantages to practicing self-compassion? To date, there is only one published research article
identifying any downsides to self-compassion, and only in a particular population in a particular context—men
in romantic relationships who are low in conscientiousness. In a series of studies, Baker and McNulty (2011)
found that among men low in conscientiousness, self-compassion was associated with less motivation to
correct interpersonal mistakes and engage in constructive problem-solving behaviors in romantic relationships.
Note that, for women, self-compassion had a positive impact on their relationship behavior regardless of their
level of conscientiousness. The authors interpret their findings to mean that the motivation to repair mistakes
in relationships is unrelated to self-compassion and is due to some other cause—being conscientious (in the
case of men) or for cultural and/or biological reasons (in the case of women). Of course, it may also be that
unconscientious men simply lack clarity about their own thoughts and actions, and that they tended to use the
idea of being kind to themselves as a cover for bad behavior. Regardless, it will be important in future research
to determine for whom and when the idea of self-compassion may be misused or even harmful in some way.
We also know very little about group differences in self-compassion. A recent meta-analysis (Yarnell et al.,
2015) found that self-compassion increases with age, and that women tend to be less self-compassionate than
men. The effect sizes are quite small, however, and the reasons underlying these differences are unclear. It
could be that at earlier ages, individuals are less accepting of themselves as they strive to find their place in the
world, while with maturity, people tend to accept their imperfections with more equanimity. The gender
difference might be due to the fact females tend to be more self-critical and to have a more ruminative coping
style than males do (Leadbeater, Kuperminc, Blatt, & Hertzog, 1999; Nolen-Hoeksema, 1987), or else to
feminine gender-role norms emphasizing self-sacrifice and meeting the needs of others (Ruble & Martin,
1998). Clearly, there is more to be understood about how age and gender differences develop.
Similarly, there has been very little research on cross-cultural differences in self-compassion. For instance, is
the lack of self-compassion primarily a Western problem? Neff, Pisitsungkagarn, and Hseih (2008) examined
self-compassion levels in Thailand, Taiwan, and the United States, and found self-compassion was highest in
Thailand and lowest in Taiwan, with the United States falling in between. This may be because Thais are
strongly influenced by Buddhism, and the value of compassion is emphasized in parenting practices and
everyday interactions in Thailand. In contrast, the Taiwanese are more influenced by Confucianism, with
shame and self-criticism emphasized as a means of parental and social control. Perhaps Americans had more
moderate levels of self-compassion due to the mixed messages American cultures gives in terms of positive
self-regard (e.g., a strong emphasis on self-esteem but also an isolating, competitive ethos). In fact, Americans
had significantly higher levels of self-esteem than the other two groups did. In all three cultures, however,
greater self-compassion significantly predicted less depression and greater life-satisfaction, suggesting that

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there may be universal benefits to self-compassion despite cultural differences in its prevalence. Still, a great
deal more research will be needed to understand the role that culture plays in the development of self-
compassion, including within cultural differences based on race or class. (See Chapters 21 and 24 for a
discussion of the role of culture and class in the expression of compassion for others).
The extent to which mindfulness and self-compassion differ is also unclear and needs more research to be
fully understood. While mindfulness is a component of self-compassion, it is likely that the added feelings of
warmth and interconnectedness affect both physiological and psychological functioning in important ways.
An important area for future research will also be to determine if, how, when, and for whom mindfulness and
self-compassion training should be combined. Intuitively, it would seem optimal to learn mindfulness before
self-compassion, given that mindfulness is needed for compassion. However, people suffering from severe
shame or self-criticism might need to first cultivate self-compassion in order to have the sense of emotional
safety needed to mindfully open themselves to their pain. Similarly, should people learn to be self-
compassionate before taking training programs aimed at developing compassion for others (such as the
Compassion Cultivation Training program, see Chapter 18), or afterward? It is likely that the answers to such
questions will depend on a variety of factors such early history, habitual tendencies toward self-criticism, and
the motivation to learn mindfulness, self-compassion, or compassion for others in the first place.
Finally, the development of empirically supported self-compassion interventions for specific clinical
conditions is indicated. For example, since self-compassion appears to mediate the relationship of mindfulness
training to recurrent depression (Kuyken, et al., 2010), how might specialized training in self-compassion
enhance outcomes for depressed people? And when applying self-compassion to the treatment of childhood
trauma, what special adaptations might be needed to insure safe and effective treatment? In general, since
mindfulness has become mainstream in clinical practice, and self-compassion is a key mechanism of
mindfulness, interventions specifically designed to enhance self-compassion appear to have considerable
potential.

Conclusion
Research increasingly suggests that the degree to which one treats oneself with care and compassion plays
an important role in psychological health. While the majority of research on self-compassion has been
correlational, meaning that the direction of causality cannot be assumed, the increasing convergence of
findings on the benefits of self-compassion using non-self-report methodologies is beginning to provide more
confidence in the conclusion that self-compassion is a powerful way to enhance intrapersonal and
interpersonal well-being. When we are mindful of our suffering and respond to it with kindness, remembering
that suffering is part of the shared human condition, it appears that we are able to better cope with life’s
struggles. Adopting a loving, connected, and balanced mind state seems to reduce psychopathology while
simultaneously enhancing joy and meaning in life. And by combining acceptance of our present-moment
experience with the compassionate desire to be happy and free from suffering, we maximize our ability to heal
and reach our full potential.
More research is needed to confirm these conclusions, but perhaps the best way to investigate whether or
not self-compassion enhances well-being is to try it for oneself. Increasingly, individuals are adopting a
scientist-practitioner model in which first-person and third-person perspectives are integrated (Lane &

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Corrie, 2007), a process that can yield unique insights into how the human psyche operates. Ultimately, it is
the experience of self-compassion and direct observation of what happens when we treat ourselves as an inner
ally rather than an inner enemy that is most likely to convince skeptics of its benefits.

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 Compassion Fatigue Resilience

Charles R. Figley and Kathleen Regan Figley

Abstract

Drawing on more than 48 years of experience working with compassionate people who were suffering,
the authors discuss and illustrate the useful applications of the new Compassion Fatigue Resilience
Model. Briefly reviewing the relevant research and theoretical literature, they point to the common
findings that human service workers frequently forget about their own workplace comforts and are often
unaware of the heavy price they pay in giving service to others. Several case studies illustrate what
prompts efforts to build compassion fatigue resilience, and the life improvements that result when these
efforts are successful. These improvements not only enhance the quality of human services by the
workers; attention to their mental health needs leads to better worker health and morale, and sense of
mutual support that extends their careers.

Key Words: compassion, fatigue, compassion fatigue, self-harm, stress, resilience, compassion fatigue
resilience, prevention

According to the U.S. Bureau of Labor Statistics (2014), healthcare practitioners and technical fields were
approximately 6% of the American work force. Add to this the nearly 2% who are engaged in community and
social services. Today across the United States, thousands of human services workers are helping suffering
people. This chapter is about their welfare, or more specifically, their compassion satisfaction, compassion
fatigue, and the resources needed to be resilient.1
The delivery of human services requires a special kind of professional who follows the ethical and treatment
standards of their specialty and is able to establish an effective working relationship with the patient (Hersong,
Hogland, Monsen, & Havik, 2001; Horvath & Symonds, 1991). Human service workers must be able to gain
the trust and support of their patients to help develop a treatment plan and work toward the agreed-upon
goals. This process is highly complex and requires adaptation, creativity, and especially empathy and rapport
with the patient (Scilleppi, Teed, & Torres, 2000). A professional who understands the needs and style of the
patient will quickly establish good connections with her or him and help the client reach their goals. For
nurses focusing on patients’ care, Abendroth and Figley (2014) note it is critical to simultaneously focus on
their own welfare and boundaries. Otherwise, nurses will migrate toward the welfare of others, despite the
boundaries.
Figley (1995a) defines compassion fatigue as the formal caregiver’s reduced capacity or interest in being
empathic or “bearing the suffering of clients,” and as “the natural consequent behaviors and emotions resulting
from knowing about a traumatizing event experienced or suffered by a person” (p. 7; see also Figley, 2002a,
2002b). Compassion fatigue (CF) is the manifestation of succumbing to the demands of client care over self-

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care of those who provide the care of clients as a professional. CF is the fatigue from dispensing compassion,
day after day, year after year. Thus, CF is a hazard associated primarily with the clinical setting and with first-
responders to trauma.
Professionals are expected to be compassionate and empathic every day. What if they begin to run short of
compassion? What if their work becomes toxic to their health or interferes with their professional judgment?
We will consider these questions through the lens of the Compassion Fatigue Resilience Model (CFRM).
The model is composed of 13 empirically derived variables that together predict who will develop CF and
who will be resilient to it, under similar circumstances. After defining relevant terms and concepts and
introducing CFRM, we examine fundamental questions that arise within the professional self-care movement
and offer some potential solutions. In addressing these questions, we offer an explanation for the mechanism
that accounts for how professionals develop and become free of CF by focusing on building their resilience; a
habit of self-care and mindfulness through an effective Compassion Stress Management/Resilience plan.
Along the way, we will use specific case studies to enrich the phenomenological, or experiential,
understanding of CF and the resilience that is its antidote.

Case Study #1: Sasha Wilkinson, MSW

“I think I have compassion fatigue,” Sasha [a composite of four people] said in an email. “But I think I am
on my way to getting better.” She had read my book (Figley, 2002a) on the topic and wanted to focus her
doctoral research on this phenomenon. She had met me briefly at a workshop I gave in the 1990s on the topic.
As it turned out, Sasha started working as a hospice social worker out of graduate school. She was impressed
with the local hospice. She believed that the entire staff did their best to make the final months of her dear
grandmother’s life as comfortable as possible. During her first weeks, Sasha was providing assistance to the
four other social workers and was learning her job. Everyone who worked there seemed very professional and
caring. She had a passion for helping others, and she found that the job fit her well. Even with some shift
work, she thrived in the position and steadily improved during the first 10 years.
Death was, she had discovered, “nothing to fear.” Then, two weeks from her tenth anniversary at the
hospice, an incident occurred that shocked her and forced her to question her abilities as a helper. I learned
over several exchanges and a phone call that, despite her best efforts, the husband of one of her patients
admitted to assisting in his wife’s suicide. He was charged with murder. An aging man in his eighties was in
jail for murdering his wife.
Sasha had worked with the couple for three weeks and thought she knew them and their needs. The patient
was dying of terminal cancer, and hospice was providing the care that would make the wife’s natural death
more comfortable for her and, in turn, her family. But over and over, the husband, a physician, complained
that she was hardly ever awake; that he was gradually losing his wife due to “over-medication.” The wife
explicitly asked her husband to help her end her life, a mercy killing. He did.
Sasha was devastated by the news. Talking it over with other staff was not helpful. She sensed that they
may have somehow blamed her for not knowing what was going on and stopping it. This was despite the fact
that she’d had less contact with the couple than others who had counseled the couple. Sasha’s sleep was not as
restful. She avoided friends out of a concern that they would ask her why she was upset. She did not want to
relive the event. Sasha was able to get a similar job in the next city. She believed a fresh start would help. She

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had become overly cautious about client risks, especially suicide. She found that she was more reactive and less
sure of herself in working with colleagues as well as with her patients. This continued for three years.
Sasha rarely missed work, but it was not as satisfying as it once was. There was distance between her and
other staff members, until she attended a stress management workshop. She found that having the ability to
effectively manage her stress through a simple breathing exercise and practicing yoga made her more willing to
face her fears and eventually talk with her minister. Gradually she began to appreciate working with dying
patients again and not fearing client suicides. She then became interested in talking with others about her own
experiences and was able to transform her experiences from something to fear into lessons she had learned and
could share with others.
Sasha’s traumatic experiences as a human service provider are not unusual. Physician-assisted suicide is
most common among cancer patients (Vann der Mass, van der Wal, & Haverkate, et al., 1996). Nor was her
particular workplace environment exceptionally stressful, but the “compassion stress,” the demand to act
compassionately in the face of loss, like any other stress, comes with the job; and too much pain might end her
career. We will now identify and define some important concepts and variables useful in explaining Sasha’s
experiences.

Definitions
Compassion
As defined by Goetz, Keltner and Simon-Thomas (2010), compassion is the “sensitivity to the pain or
suffering of another, coupled with a deep desire to alleviate that suffering.” It is safe to say that compassion is
a requirement for all human service providers. The ability of these providers to understand and help those in
need depends on their compassion, empathic abilities, and performance (Figley, 2002b). This means that they
are acutely sensitive to the pain and suffering of their clients. This painful information and the connected
emotions will remain with these providers beyond their face-to-face meetings with clients. Practitioner
compassion combines this sensitivity to the clients’ suffering with the passionate focus on helping to alleviate
the suffering.
A factor that makes practitioner compassion unique is that this dedication to the sensitivity to the pain or
suffering of others often springs from deeply held values and a commitment to the highest standards of
professional and ethical practice. To be compassionate is to be effective in assessing and helping the suffering.
For example, the physician ethic of “First, do no harm” implies that workers care for themselves to ensure
quality, ethical services: that is, the concept of “First, do no self harm” (Figley, Huggard, & Rees, 2013).

Stress
The term stress was originally defined as (Selye, 1936) as “the non-specific response of the body to any
demand for change.” Selye was able to determine that there were endless demands for change (stressors), but
that laboratory animals, despite being subjected to many types of demands (e.g., noxious physical and
emotional stimuli such as blaring noises or lights or temperature changes) all exhibited the same physiological
reactions: persistent stress could cause medical and emotional breakdowns. He helped shift the focus from
pathogens as being solely accountable for disease to include environmental factors such as stressors. Post-
traumatic stress disorder (PTSD), for example, as stipulated by the most recent Diagnostic and Statistical

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Manual of Mental Disorders Version 5 (DSM-5; APA, 2013) diagnostic criteria for PTSD include:

1. A history of exposure to a traumatic event that meets specific stipulations

2. Symptoms from each of four symptom clusters—intrusion symptom cluster
3. Avoidance symptom cluster
4. Negative alterations in cognitions and mood
5. Alterations in arousal and reactivity symptoms
6. Duration of symptoms
7. Assessment of functioning
8. Only symptoms not attributable to a co-occurring substance abuse or co-occurring medical condition

There is also a delayed expression of symptoms and dissociative subtype of PTSD. Secondary traumatic
stress (STS) and traumatic stress are examples of stress. Traumatic stress is the demand to act that is
experienced by those in harm’s way. STS is the demand to act to understand and help those in harm’s way;
indirect exposure to trauma through experiencing compassion and empathy for the suffering.

Fatigue
Defined for our purposes as a noun, fatigue means weariness from bodily or mental exertion. It is a state of
being exhausted with the ability to recover and spring back. In the context of the field of physiology, fatigue
means a temporary diminution of the irritability or functioning of organs, tissues, or cells after excessive
exertion or stimulation (Dictionary.com).

Compassion Fatigue (CF)

CF is caused by an unchecked buildup of compassion (secondary traumatic) stress. This buildup of
secondary stress resulting from day after day of feeling cumulative stressors from delivering human services to
suffering clients. This buildup of the emotional residue of energy from exposure to client suffering takes a toll
of the practitioner. Moreover, the toll increases with more stressors from the memories of past trauma, the
overexposure to the suffering, and life’s unexpected stressors.

Resilience
Resilience is defined for our purposes as the ability of a human service worker to spring back into their old
selves following a work-related incident or any highly stressful event or setback. Resilience is the indicator of
numerous human resources that, together, enable the worker to overcome challenges, including the emotional
upset from providing direct client services. How well a worker bounces back from being attacked by a patient,
for example, or having to give heartbreaking news to a family member of a client, is an indication of the
worker’s resilience. The popularity of the concept of resilience was influenced by the thinking of George
Bonanno (2004). He asserts that, as a field of study, psychology has underestimated the human capacity to
thrive even after extremely aversive events. He calls for a paradigm shift from a deficit model of
psychopathology and viewing clients by their diagnosis; a shift to a more neutral or positive approaches that
focus on health, wellness, rehabilitation, and resilience.
Most recently, Hobfoll, Stevens, and Zalta (2015) suggested that the concept of resilience is critical to
understanding the entire stress reduction and management process. Bonanno, Romero, and Klein (2015)
delineated several key elements emerging from the literature that would guide stress resilience research. These

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include, for example, not only quantifying resilience at the individual level of functioning, but quantifying
stress at the familial and community levels. This has been attempted in the context of disaster capacity and
functioning markers (Ferrira & Figley, 2015).

Compassion Fatigue Resilience

More specific to the current discussion, compassion fatigue resilience is the spectrum of resources available to
the human service worker, varying from very low resilience to very high resilience. High resilience would
include optimization and self-nurturance through self-care, detachment, sense of satisfaction, and social support,
which are considered the resilience or “protective” factors. This form of resilience offers adaptation and coping
as well as resistance to STS. As a result, the trauma-exposed person can develop into a confident, caring,
competent, and efficient worker and social being. CF resilience is reached when one’s compassion core (empathy
for client, self, and colleagues) is honed and built (Harrison & Westwood, 2009). It results in an exquisite
form of empathy that is protective and invigorating. Thus, the focus is on the protective factors such as self-
compassion that increase CF resilience.
This focus on quantifying resilience is consistent with our CFRM. Though the model focuses on the
individual, it takes into account the systemic and community implications by calculating individual
vulnerability to the distress experienced by human service providers that may lead to poor performance, and
the overall resilience of the community the providers serve.

The Compassion Fatigue Model

The CFRM is a potentially useful theoretical tool for predicting who will become vulnerable to burnout,
CF, and vicarious trauma. CFRM applies to all human service workers, a category that includes social
workers, psychologists, nurses, and physicians; all provide human services in direct contact with the clients to
help improve their lives (Woodside & McClam, 2011). The model represents the current understanding of
the primary risk factors for developing CF. At the same time, the model is a road map for helping those
helping the traumatized, for it links risk factors with associated protective factors that practitioners can
cultivate to increase their CF resilience. The CFRM presented here improves upon earlier versions (Figley,
1995), a reflection of increased experimental research and theoretical contemplation. The original CF model
was developed to account for the variance in CF and revised later to focus on treatment (Figley, 2002a).
Figure 28.1 (Figley & Ludnick, in press, 2016) explains both the causes and the antidotes for CF. The
diagram suggests that the variables that are more amenable to lowering and managing STS are the four boxes
encased in dotted lines that offset the impact of CF (self-care, detachment, sense of satisfaction, and social
support). In contrast, four variables add to elevations in STS and a lower CFR score. Empathic response
requires the practitioner to experience empathy and compassion for the client under the practitioner’s care.
According to the model, a practitioner with high CF resilience has the ability to withstand considerable
distress of others; whereas the practitioner with low CF resilience experiences symptoms of distress and
distraction associated with CF and has difficulty witnessing another’s suffering.
Considered from left to right, the model starts with the importance of the empathic response, as noted
earlier. To generate the proper empathic responses requires the human service provider to be willing and able
to work directly with the suffering clients with sufficient empathic ability and concern.

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 This model accounts for how and when compassion stress leads to CF, and the role of resilience simply
follows the model. Specifically, the four variables that together account for the quantity of compassion stress
—(1) empathic response-related stress; (2) trauma memory–related stress, (3) overexposure to trauma-related
stress, and (4) stressful life events–related stress—are modulated and potentially counterbalanced by the seven
CF protective factors. The challenge, then, is to apply the right empathic response for the appropriate client at
the right time. This combination of skill and empathy represents the art (rather than the science) of
counseling and helping others (Figley, 1989). Each of the four sectors and 11 variables will be considered in
more detail later.

Figure 28.1 The Compassion Fatigue Resilience Model.

Exposure to Suffering
The exposure factor is to the degree to which the workers interact directly with suffering clients who seek
their services (Figley, 1995). Karademas (2009) noted that exposure to suffering is the first pathway to
compassion stress. Those who avoid or minimize trauma caseloads reduce their risk (protective factor). Those
who work with people who are suffering experience impaired cognitions directly and through decrease in
positive mood. It seems that an “in vivo” exposure to human suffering activates a cognitive and emotional
reaction, which affects evaluations about self and personal well-being (Karademas, 2009). The case example
provides an example of how human service workers can develop tunnel vision, ignoring all else but their job in
dealing with suffering, sometimes even forgetting to breathe.

Empathic Concern
In this context of what accounts for effective interpersonal response toward suffering clients, empathic
concern (Davis, 1983) is defined as the worker’s explicit, high level of compassion and interest in helping

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clients meet their goals as needed. Schroeder, Dovidio, Sibicky, Matthews, and Allen (1988) found in an
experiment with subjects exposed to strangers in distress (not clients) that concern about another person’s
distress rather than about one’s own emotional state can be the primary motivation for helping. Empathy is
the primary mechanism of appropriate response to suffering, both as a person and as a professional.
Because of this innate and universal importance, empathy is therefore a very significant pathway to STS.
Specifically, without empathy generally and one’s empathic concern specifically, no secondary stress would be
generated, because there is insufficient emotional resonance or connection between humans.

Empathic Ability
Empathic ability refers to a person’s ability and proclivity to recognize suffering in others (Batson, 1990;
Figley, 2002c); to adapt to and understand another person’s position, emotions, needs, and pain, which
enables service providers to enact just the right empathic response required. Empathy and empathic concern
have the ability to both protect and harm (Salston & Figley, 2003). Empathic ability or accuracy is fully
engaging with the client through understanding the client’s pain and suffering. These accurate, raw data are
critical for accurately assessing and determining the best treatment plan to enable the client to recover and to
recognize when recovery happens (Figley, 2002c).
Those who work with the traumatized recognize that being a healer is a huge responsibility. Empathic
ability enables the healer to effectively read emotions of the traumatized client and anticipate and respond to
their special sensitivities, such as being susceptible to re-traumatization, and thus to avoid doing harm by the
very treatment designed to undo harm (e.g., iatrogenic impacts) (Boscarino et al., 2004). Attending to the
special needs of the traumatized in delivering all types of services is consistent with trauma-informed care
(Hopper, Bassuk, & Olivet, 2010) that is emerging nationally and internationally in all aspects of human
services, with special attention to empathy-centered service-delivery goals.

Empathic Response
The empathic response by a caregiver to a client is a response that is informed by the caregiver’s empathic
ability when exposed to the suffering at a high level of concern for the client. It is a caring response that is the
precisely correct response to the client to effectively help the suffering client. The empathic response requires
establishing and maintaining the trust and sense of safety of the suffering client, and it is the key ingredient in
all effective human services. A meta-analysis (Greenberg et al., 2003) found a statistically and clinically
significant relationship between empathy and positive therapeutic outcomes.
Also, the empathic response is the key pathway for experiencing compassion stress and, with time, CF.
Human beings are strongly motivated to be connected to others (Batson, 1990). Empathic response is the
quality of responding, of making an effort to meet a client with empathy, insight, and caring (Figley, 1995c).
The empathic response is informed by empathic concern and empathic ability. When providing an empathic
response, the worker is projected into the distressed client’s position, even experiencing their fear or suffering.
Over time, constant empathic responses can have a numbing effect on workers and elicit compassion stress
(Figley, 1995c).

Compassion Stress

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 Compassion stress is the demand to be compassionate as perceived by the human service worker. The level
and chronicity (how long it is sustained without relief) of stress is directly associated with the level of CF
resilience. The risk factors increase stress and lower CF resilience, and the protective factors reduce the stress
and increase resilience. These risk factors are noted later.

Traumatic Memories (Risk Factor)

The concept of traumatic memories is defined here as memories of past traumatic events that remain linked
to triggers (reminders) and often lead to a cascade of negative images and accompanying unwanted emotions.
These are markers, symptoms that are critical to an accurate assessment or diagnosis and the subsequent
treatment plan. Traumatic memories of practitioners are no different from those of (their) clients. Our
traumatic memories—both as clients and as practitioners—have an impact on our functioning. Traumatic
memories are the person’s own trauma recollections that could take the form of the practitioner’s personal
trauma history or traumatic memories from previous client dealings (Figley, 2002c). These memories have the
potential to be reactivated and to cause further distress, anxiety, or depression.

Prolonged Exposure to Suffering

A sense of prolonged exposure in this context means “an ongoing sense of responsibility for the care of the
sufferer and the suffering, over a protracted period of time … associated with a lack of relief from the burden
of responsibility, and the inability to reduce the compassion stress” (Figley, 2011, p. 253). This constant
exposure and repeated empathic engagement leave behind harmful cumulative emotional energy that includes
self-doubt about one’s competence as a practitioner, and other doubts and stress reactions. If left unchecked,
this cumulative emotional pain and negative energy can wreak havoc with the affected person, be they client
or caregiver (Radey & Figley, 2007).

Other Life Demands

This term refers to the stressors from outside work that sometime invade one’s work life, such as changing
jobs, moving, and other changes of schedule and status, including divorce and the death of a child or spouse
(Holmes & Rahe, 1967). These are life situations that demand attention and can temporarily disrupt
functioning (Figley, 2002a). Unexpected changes in routine/schedule and managing demanding
responsibilities—such as financial difficulties, changes in social status, illness, and added obligations—could
add strain. Certain life changes, however, in combination with the other variables in the model, affect
compassion stress (Figley, 1995) and subsequently CF. To the over-extended person, an unexpected minor
event can seem catastrophic and insurmountable, whereas it would hardly cause a stir in a prospering
individual.

Self-Care
Self-care is defined as the successful thoughts and actions that result in improving or maintaining one’s
good physical and mental health, and a general sense of personal comfort. Alternatively, Gantz (1990, p. 2),
noted a panel of 15 experts in self-care were unable to reach consensus on a definition but were able to agree
on four characteristics of self-care. Among other things, these characteristic included self-care: (a) being

505
situation- and culture-specific; (b) having the capacity to act and to make choices; (c) being influenced by
knowledge, skills, values, motivation, locus of control, and efficacy; and, (d) focusing on aspects of healthcare
under individual control (as opposed to social policy and legislation). For human service providers, the
optimum self-care program would enhance overall resilience because of the overlap of characteristics
associated with resilience and self-care (Barnett, Baker, Elman, & Schoener, 2007). Both are ways of defining
the readiness of a person to adapt to any situation and cope with any new stressor.
To be more effective, human service providers must balance work stress and self-care (Figley, 2002a).
While attending to heavy client caseloads, they frequently fail to perform the basics of self-care, which
include, for example, (1) effectively monitoring nutrition and drink; (2) managing to experience good sleep
and rest; (3) maintaining access to social support; (4) regularly experiencing a sense of joy in life; and (5)
regularly engaging in some form of physical exercise. Effective self-care enhances resilience generally and CF
resilience in particular, as argued in this chapter. Moreover, self-care is associated with post-traumatic growth
(Tedeshi & Calhoun, 1996). It is not surprising that Kulkarni, Bell, Hartman, and Herman-Smith (2013)
found that greater time invested in self-care was unequivocally associated with lower levels of stress. They
concluded that commitment to self-care held a lot of protective potential against STS. Similarly, Newsome,
Waldo, and Gruszka (2012) found that poor self-care can lead to poor performance and difficulty adapting to
setbacks.

Detachment
Viewed from the perspective of a human service worker, having detachment means being able to take a
mental and physical break from the work—especially the most troubling and difficult parts. Because it serves
as a resource for the worker in modulating the level of work stress for maximum performance, we support the
early view of Figley (1985) that detachment is a protective factor. Sonnentag and Fritz (2014) and colleagues
have found that recovery from work, a form of purposeful detachment (from work during off-hours) is
important in lowering job stress. Not everyone shares the same ability and motivation to detach, but it is often
included in a comprehensive self-care plan.
Research on the role of professional disengagement from traumatic materials had been quite sparse until
recently (cf. Sonnentag, Arbeus, Mahn, & Fritz, 2014). Recent evidence was found that those suffering from
PTSD often have difficulty disengaging from the trauma memories (cf. Aupperle, Melrose, Stein, & Paulus,
2011). The practitioner also has difficulty disengaging from trauma memories. This inability to disengage
from traumatic materials often hinders the individual from attending to aspects such as family, friends,
positive emotions, and pleasurable activities, which in turn perpetuates the emotional numbness and
depressive symptoms so often seen in the aftermath of trauma exposure.

Social Support
The concept and variables of social support have been studied for a generation. In 1985, more than 30 years
ago, Kessler, Price, and Wortman published “Social factors in psychopathology: Stress, social support, and
coping processes” for the Annual Review of Psychology for that year. They cited the pioneering work of
Dohrenwend and Dohrenwend (1974), who started the interest in social support in the context of coping with
stress.

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 Social support is among five protective factors that enhance compassion stress resilience and lower CF
(Figley, 2002b). Some have argued that social support represents the essence of being human. Hirsch (1980)
suggested that social support was the perceived support one receives if, in times of need, you seek out and
succeed in acquiring emotional support, advice, tangible aid, companionship, and encouragement and was the
basis of the frequently used Purdue Social Support Scale (Figley, 1989). Eriksson, Vande Kemp, Gorsuch,
Hoke, and Foy (2001) found social support to significantly determine psychological adjustment in
international relief personnel after trauma exposure or hearing about traumatic events. Social support acted as
a buffer, especially in the workers with high levels of trauma exposure. Lerias and Byrne (2003) asserted that
social support is a crucial factor in bolstering one’s ability to deal with trauma exposure.

Compassion Satisfaction
The term compassion satisfaction emerged from the work of Beth Stamm (2009). She found that practitioner
scores on their ProQOL Survey (measure of CF) indicated that, among others, compassion satisfaction was a
protective factor associated with lower levels of STS that leads to CF. Stamm originally defined compassion
satisfaction as the pleasure you derive from being able to do your work well. These pleasant thoughts are
associated with hope and a sense of accomplishment. In the first case study presented here, Sasha derived
thrilling satisfaction from most of her clients, including her first clients in her clinical placement in graduate
school. Much of her satisfaction was derived from her believing in the worth and abilities of her clients
enabled by her care. This was why she felt so baffled and guilty after the assisted suicide event; that she had
somehow failed in her duties. Next, we introduce you to Chaplain Bob Gomez, our second case study whose
experience is quite different from Sasha’s.

Case Study #2: Bob Gomez, MS, CPC

Bob Gomez joined the U.S. Army as a captain in 2002 after he completed his master’s degree in religious
studies. He learned to be an Army chaplain on the job. He had finished his undergraduate degree and went
immediately into his master’s of science program in chaplaincy with no practice experience, other than a brief
internship. He was not concerned: His focus was on God’s guidance. Bob was soon promoted to major and
responsible for supervising five Army chaplains in his Army battalion at Ft. Hood. Then they were deployed
to Iraq. His sense of inadequacy increased as he worked with the chaplains who were older and more
experienced than he. He found out that his education was inadequate and interpreted his professional failures
as his failing God.
As it turned out, Chaplain Bob was not very adept at reading people. He was far more comfortable with
books than with people. He struggled in his clinical chaplaincy internship. He had difficulty accurately
summarizing the feelings and positions of his clients because he lacked empathic ability, as noted by his
supervisors. “Bob was more of a thinker than a talker,” one observed. However, his day to day work required
little therapeutic skill until their battalion began to be struck by Iraqi insurgents, which required additional
troops. This placed considerable pressure on the chaplains, and for a short time, it forced Chaplain Bob to
provide chaplain services to the men in his unit. All three of these (soldier) clients were experiencing a fear
response from different stressors for different reasons that were puzzling to Bob. In the evenings, Bob
obsessed over the situations of the clients he had seen that day. He was unable to sleep soundly. The next day

507
he was tired and wary of another day of new clients and their spiritual and clinical challenges. There was no
one particular soldier that led Bob to experience compassion stress and it was no one symptom. It was, as he
explained it, “a numb feeling”; a sense of hopelessness in being able to help, and an inability to answer the call
for help effectively.
Applying the CFRM to Bob’s case, he was not interested in working in direct practice because he was not
sure how to help; nor did he want to make the effort. As a result, he found himself caring much less. He
justified this shift by saying he was not much of a “people person.” Because Bob did not engage clients by
being either empathic or especially compassionate in a feeling kind of way, he was not vulnerable to
compassion stress that would lead to CF. He was initially numb and he put aside his feelings and those of his
clients and supervisee chaplains.
Bob was different than Sasha in other ways. His social support was good enough. His compassion
satisfaction was near zero, but he was not disappointed, nor did he expect that compassion would bring him
satisfaction in the first place. Bob was a master at depersonalization and compartmentalization. His stress level
was at the moderate level most of the day because he knew how to isolate himself from others and their needs.
He tried to appear compassionate. He derived little satisfaction from delivery of human services because of
some bad experiences in his clinical training. His clients had reported dissatisfaction with his lack of
compassion to his supervisor but with no suggestions for improvement. He did not have CF, because he
seldom turned on his compassion. It came on from time to time, accompanied with bouts of uncertainty and
stress.

The Compassion Fatigue Resilience Model in Action

Mindful of the differences evident in the cases of Sasha and Bob, we now more closely examine the
CFRM’s 12 variables associated with CF resilience in light of their case studies. In the case of Sasha the social
worker, she has always had empathic ability: It was one of the reasons she knew she was a good social worker.
Although she had some bad days, she looked forward to going to work every day to face suffering and sad
patients and their families, and she had the requisite empathic concern. Her empathy enabled her to hear
what patients and family members said to her and to formulate almost effortlessly the right empathic
responses through her kind and caring ways.
The empathic response directly affects the level of compassion stress because the worker is expected to take
in information about the patient and their family that is disturbing. Thus Sasha’s exposure to human suffering
activated a cognitive and emotional reaction, which affected her evaluations about herself and her personal
well-being.
Compassion stress can be exacerbated or diminished by other variables, in addition to the empathic
response, including prolonged exposure to suffering, other life demands, and traumatic memories. In Sasha’s
case, she took insufficient breaks during the day and often skipped lunch or ate with colleagues who would
talk about work, removing the rest that might have mitigated her high stress. She tended to take short
vacations and experienced considerable life demands other than work. Personal matters taxed Sasha further. In
contrast, Chaplain Bob had few distractions in Iraq. He had his “room,” a portion of a tent, his assignments,
and a considerable amount of free time.
According to the model, the opposite of risk factors are four protective factors that reduce the compassion

508
stress and enhance resilience: self-care, detachment, compassion satisfaction, and social support. Sasha was
fortunate in knowing about and practicing self-care. She learned how to develop and maintain a self-care plan
that included good nutrition, a reasonable and sustainable exercise program, and a wide variety of interests and
activities that were relaxing and that helped her avoid thinking about work. She learned in her initial years as a
social worker to compartmentalize and detach from work as needed to provide the breaks from the grind and
to become revitalized, especially after work hours. Sasha drew great satisfaction from working with the dying
and their families, and she won numerous awards from her employer and field as well as dozens of letters of
appreciation from surviving family members. Finally, Sasha had considerable social support both at work and
at home and turned to her trusted others for encouragement, companionship, advice, and inspiration.

Toward a Mechanism Accounting for Compassion Stress and Resilience

Human service delivery of an empathic response requires workers to think deeply about their clients; to
reach the right decision about how best to approach, help, and complete work with each new patient. There is
considerable guidance available from employee training, supervision, and peer coaching to enable a worker to
adhere to standards of practice in the assessment, treatment, and recording of data for each patient. There is
little or no guidance in self-care and thriving the human services demands. In order to perform important
human services, the worker must have the ability to empathize and be compassionate in thought and behavior
toward the customers and their families. Thus, poor empathic responses are bad for customers and their
families. At the same time, what may account for poor empathic responses may also be protective against high
compassion stress and fatigue.
Three factors that account for poor empathic responses are the worker’s (1) low empathic ability (negates
any negative impact of formulating and delivering a useful empathic response); (2) avoidance of the
traumatized (and thus not being exposed to the emotionality and suffering); and (3) lack of interest in serving
the traumatized (and therefore not applying empathy toward the traumatized).
On the other hand, these same indicators can serve as protective factors against high compassion stress and
fatigue. After all, there is little or no emotional incentive to become upset about clients if the healthcare
worker does not empathically engage with them. Bob is a good example of such a worker. As his clinical skills
emerged from additional training and experience, he began to recognize that client criticism in the past was
more hurtful than he had admitted. His sense of burnout and ambivalence about working with the suffering
eventually went away.
To survive as a social worker, Sasha needed the protective factors suggested in the model in Figure 28.1:
social support, self-care, detachment, and compassion satisfaction. Bob, however, expended little energy
regarding his empathy because it amounted to such a small part of his persona. He was better than Sasha at
self-care. He had an excellent ability to detach in part to provide better self-care. He derived little satisfaction
from delivery of human services because of some bad experiences (feedback from clients). This may be why he
had never sought out direct practice experiences. He learned early in his graduate education and training that
being empathic with people did not come easily to him and was not appreciated by the client when delivered.

Prevention of Compassion Fatigue

The first step in lowering compassion stress and, thus, preventing CF is to recognize the signs and

509
symptoms of CF. Workers need to be mindful of the presence of numbing, startle response, intrusive
thoughts, nightmares, insomnia, anxiety, and avoidance of situations (citation?). Conscientious monitoring of
both the worker’s work environment and personal life needs to be implemented to address the buildup and
continuation of CF (Bride & Figley, 2009).
The next step is to develop a plan for lowering or eliminating the symptoms. As noted in the model, the
lower the compassion stress levels, the lower the prospects of developing CF. Moreover, human service
workers who have experienced the consequences of compassion stress may take some degree of comfort from
the fact that this form of stress is not an indication of some pathological weakness or disease or personal
failing. Rather, the symptoms are a call for action by leadership and workers, and a natural consequence of
providing care for traumatized individuals.
Preventing CF means increasing the worker’s resilience. Increasing their resilience means, among other
things, attending to the variables that can increase resilience, consistent with the description of the mechanism
of CF resilience. Resilience to CF and other work-related, unwanted distress markers demands a combination
of skills, aspirational mantras, level of compassion satisfaction, and CFR, along with post-traumatic growth
(Tedeshi, & Calhoun, 1996) and self compassion (Neff, 2003), as noted elsewhere in this volume. It is the
combination of capabilities that enables the compassionate to also be extremely competent and effective at
what they do in working with the traumatized. Designing programs that facilitate the development of CF
resilience in all those who work with the traumatized enables trauma workers to thrive in the face of
emotionally toxic stressors.
Compassion stress is preventable, highly responsive to treatment, and oftentimes needs very little effort to
be ameliorated (Figley & Figley, 2001; Figley, 2011). The CFRM suggests that compassion stress can be
effectively monitored and lowered to prevent CF by boosting the known protective factors and reducing the
risk factors, and therefore, elevating resilience. No study has specifically tested this assertion. There is,
however, considerable research on the positive impact of social support, across a spectrum of measures, for
enhancing the sense of well-being and life satisfaction and personal comfort (cf. Hirsch & Barton, 2011). The
studies that helped build and verify this model helped pave the way to understanding resilience, and especially
CF resilience. The first step, however, in testing and being guided by the model in any community not yet
studied, is to calibrate the measures of variables to fit the culture.
This chapter is about compassion for the compassionate. In hearing the story of Sasha and Bob, you might
wonder about them and the quality of care they dispense. They represent tens of thousands of workers in the
U.S. and many more throughout the world. They represent real people engaging in the emotions of dozens of
people, sometimes many more than that, per week. Through their efforts and sense of purpose and ethics,
they are dispensing kindness and compassion. And we are all the better for it.

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Note
1. We explain these terms more fully in the Definitions section.

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 Compassion Fears, Blocks and Resistances An Evolutionary Investigation

Paul Gilbert and Jennifer Mascaro

Abstract

While there is increasing research on the benefits and facilitators of compassion, as with all motives,
there are inhibitors. This chapter will not cover the benefits of compassion, explored in other chapters,
but instead considers its inhibitors: the fears, blocks, and resistances (FBRs) to compassion and their
evolutionary and psychosocial origins. We begin with an explication of a model for compassion, and
show how compassion rests on discrete components and competencies that can be differentially
inhibited. Next, we utilize Ernst Mayr’s (1961) classic heuristic to understand compassion inhibition;
namely, the “ultimate” and “proximate” analysis. We conclude with an exploration of the antidotes to
these inhibitors. Greater research into the nature of compassion inhibitors and insights on how to
address them could increase the use of compassion in different domains of life.

Key Words: compassion, prosocial, facilitators, inhibitors, fears, blocks, resistances

The benefits of prosocial and compassionate behavior have been extolled for many thousands of years in the
contemplative and spiritual traditions (Leighton, 2003; Plante, 2015; Ricard, 2015). In the last 30 years or so,
there has been increasing scientific exploration of the facilitators and benefits of prosocial behavior, including
compassion cultivation for oneself and others (Klimecki, Leiberg, Ricard, & Singer, 2014; Keltner, Kogan,
Piff, & Saturn, 2014; Kogan et al., 2014; Music, 2014; Ricard, 2015; Singer & Bolz, 2012; Weng et al., 2013;
Mascaro et al., 2012) and as a psychotherapy (Braehler et al., 2013; Germer & Siegel, 2012; Gilbert, 2010;
Hoffmann, Grossman, & Hinton, 2011; Kirby & Gilbert, 2017; Leaviss & Uttley, 2015). There is also
increasing evidence that the evolution of our capacities for prosocial affiliation, caring, and compassion drove
the evolution of some of our recent human social intelligence and competencies (Spikins, 2015). Indeed, the
evolved value of helping others had many advantages, including infant survival, survival of helpful relatives and
allies, and signaling self as a desirable friend, sexual partner, and cooperative ally (Brown & Brown, 2015;
Geary, 2000; Gilbert, 1989, 2009; Goetz, Keltner, & Simon-Thomas, 2010; Spikins, 2015). There is general
agreement that our potential for compassion is rooted in the evolution of caring motivational processes
(Brown & Brown, 2015; Gilbert, 1989/2016; Mayseless, 2016), is shaped in childhood (Mikulincer & Shaver,
2017; Narvaez, 2017) and forms a basis for moral and ethical thinking and behavior later in life (Music, 2014;
Narvaez, 2017). There is also increasing science on the epigenetic’s of compassion and prosocial behaviour and
how early life experiences can influence prosocial motivation and behaviour (Conway & Slavich, 2017).
Caring and prosocial motives, like all motives, need to be targeted and will have inhibitors as well as
facilitators. For example, we are less likely to be compassionate when relating to: non-kin, people we don’t like
or want as a friend, people we find unattractive and undesirable, and when we would rather compete than

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cooperate (Loewenstein & Small, 2007). The motives to harm, steal, cheat, neglect, and benefit oneself at
others’ expense are obvious compassion inhibitors (Gilbert, 2005). This chapter will not cover the benefits of
compassion, explored in other chapters, but instead considers the inhibitors of compassion, relating to fears,
blocks, and resistances (FBRs) (Gilbert, McEwan, Catarino, & Baião, 2014; Gilbert, McEwan, Gibbons,
Chotai, Duarte, & Matos, 2013; Gilbert, McEwan, Matos, & Rivis, 2011; Goetz et al., 2010; Loewenstein &
Small, 2007; Plante, 2015).
To this end, we will begin with an explication of a model for compassion (see Gilbert, 2015a, 2017a;
Strauss, Taylor, Gu, et al., 2016, for discussions on its definition). Critically for the present chapter, we show
how compassion rests on discrete components and competencies that can be differentially inhibited. Next, we
will utilize Ernst Mayr’s (1961) classic heuristic to understand compassion inhibition; namely, the “ultimate”
and “proximate” analysis. Insight into the possible ultimate causes of compassion limitation and inhibition are
derived from consideration of phylogeny and the long-term effects of natural selection. Proximate causes are
related to ontogeny and local, contextual constraints and challenges. After considering each, we conclude with
an exploration of the antidotes to these inhibitors, suggesting that both societal and individual interventions
can reduce inhibitors of compassion.
FBRs of compassion are many—for example, basic disliking; fear of being seen as behaving inappropriately
in helping in public spaces, known as the “bystander effect” (Fischer, Krueger, Greitemeyer, et al., 2011); fears
that compassion is a weakness or self-indulgence; expectations that one’s compassionate efforts will be
incompetent, unhelpful, rejected, or shamed; fears of becoming too upset (personal distress) or swamped by
the needs of the others (Vitaliano et al., 2003); fear that one’s compassion will be seen as manipulative or self-
interested. Blocks are not necessarily based on fears but can be linked to environmental contingencies. For
example, hospitals that are overwhelmed with bureaucracies and staff shortages may significantly block staff’s
capacity to function as compassionately as they would like (Brown et al., 2014). In the Buddhist traditions,
ignorance and lack of insight into the temporary and illusory nature of the self are key blocks to compassion
(Leighton, 2003). Resistances arise when people could be, but simply don’t want to be, compassionate—they
want to resist compassion. For example, they may be more focused on competitive self-advantage, wanting to
hold onto their resources rather than share them, as can be common for some people in power (Keltner,
2016). Certain personalities (Furnham, Richards, & Paulhus, 2013; Ho, Sidanius, Kteily, et al., 2015)
vengefulness, from personal arguments or tribal conflicts can inhibit compassion (Goetz et al., 2010; see later
in this chapter). Sometimes resistance can be rooted in deep fears (of “the other,” for example).The use of
psychological defenses such as dissociation, repression, and denial (Dalenberg, & Paulson, 2009) can also
affect our compassion for others, the openness to the compassion from others and self compassion (see
following).

A Model of Compassion: Components and Competencies

To explore FBRs in relation to compassion, we articulate the components and competencies of compassion. This
is because FBRs can be rooted in different components of compassion. There are currently multiple
definitions for, and models of, compassion (Gilbert, 2017a,b; Strauss et al., 2016). Goetz et al. (2010) define
compassion in emotional terms as “the feeling that arises in witnessing another’s suffering and that motivates a
subsequent desire to help” (p. 351). In the Bodhichitta ideal of Mahayana Buddhism, compassion is centered

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on the motivation and the “heartfelt wish for all sentient beings to be free of suffering and the causes of
suffering” (Dalai Lama, 1995; Ricard, 2015, personal communication; Tsering, 2008). Nuances aside, any
motivation (be it sexual, competitive, or caring) will give rise to appropriate attentional focus, with emotions
that guide actions, and in humans, ways of reasoning, planning, anticipating, and thinking. Some
contemporary scholars argue that compassion has two key components: affect or emotion related to caring for
another who suffers, coupled with a motivation to relieve the suffering (Halifax, 2012; Singer & Klimecki,
2014). Others argue that emotions are important, but not necessary to act compassionately, and indeed, if we
only rely on emotion, then compassion may be limited (Loewenstein & Small, 2007). Attention and
intention, however, are key, because if we do not notice signals of suffering, or lack caring intentions then
nothing else may follow. So with these two components in mind, this chapter uses a relatively common
definition of compassion as “a sensitivity to suffering in self and others with a commitment to try to alleviate
and prevent it” (Gilbert, 2017a; Gilbert & Choden, 2013).

Sensitivity and Engagement with Suffering

Especially important to caring and compassion are competencies for being motivated to pay attention and
respond to distress calls and needs. More specifically, these are competencies of:
1. Recognizing the other as an object for caring rather than as a source of food, sex, threat, or indifference. Indeed, MacLean (1985) notes
that the caring brain must evolve mechanisms that prevent parents from treating the kids as just another meal!
2. Kin recognition and closeness rather than fight, flight, or avoidance when in close proximity (Bell, 2001; Carter, 2014; Porges, 2007);
3. Paying attention in a particular way to the needs of the other (e.g., infant);
4. Discriminating among different kinds of signals emitted by the other (e.g., infant crying vs. laughing); and
5. Selecting appropriate responses (feeding the hungry infant, soothing the distressed, seeking and retrieving [rescuing] the lost; Gilbert,
1989/2016). Even crocodiles can hear the calls of their hatchlings and carry them in their mouths to the water. Crucially, they don’t carry just
any hatchling, only their own. So (kin-focused) distress sensitivity has very ancient origins.

Actions to Alleviate and Prevent Suffering

Mammalian caregiving was selected from adaptations for distress-call responsiveness, coupled with
approach behavior (to the infant) rather than avoidance (Bowlby, 1969; Porges, 2007). With the evolution of
this ‘turn towards and approach distress’ system, more recent evolutionary changes are thought to involve
higher-level distress awareness and processing competencies that are dependent on prefrontal cortex (Brown
& Brown, 2015). These can include provisioning, recognizing, and addressing different needs; wanting to see
the other (e.g., offspring) flourish, and understanding what is required for that flourishing to occur (Geary,
2000; Rilling, 2013). Bowlby (1969) emphasized social and psychological needs such as providing the infant
with a secure base and safe haven, which offer the optimal context for psychological development. Also,
compassion addresses the causes of suffering and seeks prevention (Ricard, 2015). Thus, addressing the needs
of others is key, because if those needs are not met (e.g., basic food, protection and comfort), suffering will
arise. This is why any definition of compassion should also include the concept of prevention of suffering, not
just moment-by-moment relief of it. Indeed, in Buddhism, the cultivation of the compassionate self
(bodhisattva) is to prevent future suffering (Leighton, 2003). There is now increasing evidence that the more
compassion we experience early in life the easier it is for us to develop it for others as we mature (Gillath,
Shaver, & Mikulincer, 2005; Mikulincer & Shaver, 2017; Narvaez, 2017).

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The Two Aspects of Compassion: Engagement and Action
Taking that definition and concept of compassion, rooted in mammalian evolutionary history (with its
investing strategies of protecting and care-provisioning; Mayseless, 2016), there are two basic psychological
processes underpinning this motivational system and its compassionate protégé. The first are the
competencies we need in order to be able to be alerted to, attend, notice, engage with, and tolerate suffering,
rather than turn from, run away or dissociate from it. The second process is taking appropriate action. These
can be depicted as a series of interactive processes that have evolved over millions of years, as shown in the
inner and outer rings of Figure 29.1 (Gilbert, 2009, 2015, 2017b; Gilbert & Choden, 2013). Each of these
twelve competencies as depicted in figure 29.1 can have a number of FBRs.

THE FIRST COMPETENCE OF COMPASSION—ENGAGEMENT

Stated briefly, the inner circle of Figure 29.1 addresses the first psychology of engaging with suffering. As
in any motivation system, evolutionary processes select for inner mechanisms that lead an organism to want
to, or feel urged to, behave in a certain way in the presence of certain stimuli. In other words, motives are
sensitive to certain signals, which trigger physiological patterns and behaviors. These will be briefly elaborated.
The initial competencies of compassion facilitate movement towards and engagement with
suffering/distress. For space reasons, we are unable to give detailed reviews of each competency, and these
have been described elsewhere (Gilbert, 2009, 2010, 2014, 2017b). However, stated briefly, compassion, as
the definition implies, is rooted in a motivation to help and care. Once attention is directed to the distress
signal (i.e., sensitivity), it triggers some physiological response; that is, an animal is moved/altered by signals
of distress/suffering toward taking actions. This is typically regarded as sympathy (Eisenberg, Van Schyndel, &
Hofer, 2015). As Eisenberg et al. (2015) make clear, sympathetic emotions are usually ones of distress or
alarm, which may or may not match the feelings experienced by the other. Indeed, it is the distressing,
sympathetic feelings associated with opening to the distress of others that can make feeling compassion an
unpleasant emotional experience (Condon & Barrett, 2013). In fact, sadness, anxiety, or even anger can be
triggers for compassionate actions but also inhibitors (Gilbert, 2009). Anxiety-triggered compassionate
behavior may arise when we see a child in danger and rush into the burning house to save him/her. Anger can
arise when we see injustice, and indeed, when compassion calls for moral courage, individuals who are able to
experience and tolerate feelings of anger are more likely to behave compassionately for the welfare of others
than those who avoid anger feelings (Halmburger, Baumert, & Schmitt, 2015).

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Figure 29.1 The two psychologies of compassion.
Adapted from P. Gilbert (2009), The Compassionate Mind. With kind permission, Constable & Robinson.

It follows, therefore, that such feelings have to be tolerated rather than avoided or closed down, thus
making distress tolerance a central compassion competency. Importantly, when working clinically, one can find
individuals who cannot tolerate painful or threatening feelings including ones of sadness and grief and thus
become fearfully resistant to compassion (Gilbert, 2010). Soeng (2007) notes that many Western explorations
of Buddhist concepts often fail to highlight the importance of the tolerance of grief and sadness for the
inherent suffering of life as a core competency for developing genuine compassion. Eisenberg et al. (2015)
note, too, that sympathetic distress (labeled “personal distress”) may be so great that people turn away from
suffering, use denial defenses (“It’s not really as bad as it seems; not really happening”), give up (“There is
nothing I can do about it”), dissociate (block out from noticing), use justification (“it is too complex. They
deserve to suffer”), or act simply to try to quell our own distress. Sometimes the pain in another reminds us of
(unprocessed) pain in ourselves that we don’t want to face and would rather get away from. All these are
obvious FBRs for compassion that begin in the first flush of connecting with suffering. Importantly,
Rosenberg et al. (2015) have shown that intense compassion meditation training increases our willingness to
tolerate sadness.
The ability to tolerate the various feelings that arise when we engage with suffering helps us develop insight
into the nature and sources of suffering. This is to have empathy (Zaki, 2014), which here loosely includes
competencies for emotional contagion/attunement and forms of mentalizing (Fonagy, Gergely, Jurist, &
Target, 2002), theory of mind, and intersubjectivity (Cortina & Liotti, 2010). Empathy has become a very
tricky concept with various definitions, but two core features researchers agree on are: (1) the degree of
emotional “contagion,” where we feel the same or similar emotions to the other, linked with mirror neurons;
and (2) perspective-taking that allows us to have cognitive insights into the experience of the other (Decety &
Cowell, 2014). Emotional contagion and attunement can be automatic, whereas perspective-taking is more
deliberate and reflective, since it involves choosing to actually imagine what another person may be feeling and

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why. Perspective-taking links to mentalization, whereby we try to understand the motives as well as the
emotions of people. Lastly is non-judgement, which is the ability to allow and accept the process of
compassion without criticizing or condemning.
The origins of empathy probably did not lie in caring but in avoiding distress in others since such signals
might indicate risk of injury, disease or predation (Panksepp & Panksepp, 2013). As a competency it is easier
to use it with people we like, know and understand than people we don’t. In addition, empathy is not always
used for good intentions. For example, psychopaths have some forms of empathy that will enable them to
manipulate others (Meffert, Gazzola, den Boer, Bartels, & Keysers, 2013), empathic interrogators and
torturers are probably ‘better’ than non empathic ones; and empathy for victims can reduce empathy for
perpetrators and stimulate vengeance (Loewenstein, & Small, 2007). So there are many areas of life where
empathy is not linked to compassion (Zaki, & Cikara, 2015).

THE SECOND COMPETENCE OF COMPASSION—RESPONSE/ACTION

In regard to the second aspect of compassion, taking action, first our attention is now not so much on the
actual suffering as on the pathway out of it. So, for example, once doctors have grasped the nature of the
patient’s difficulty, they then focus on what they need to do; e.g., attending to what painkilling drugs to use.
They may run various imagined scenarios in their minds that are supported by discernment, wisdom, and
reasoning on what best to do. These draw on and utilize empathic competencies and acquired knowledge. We
are more likely to feel inhibited in taking action if we don’t know what to do. In the Buddhist traditions, once
we gain insight into the nature of suffering (the Four Noble Truths), then attention turns to its relief via
training the mind (Tsering, 2008). Compassionate behavior can be of various types. One is soothing, calming,
validating, and (sometimes) affectionate, but another type can be taking actions/doing things, such as
performing surgery, running into a burning house to save someone, encouraging others to do things they may
be frightened to do (as in psychotherapy), or “standing up” and confronting injustice. Stellar and Keltner
(2017) have reviewed the evidence that we physiologically respond to distress and suffering differently
according to the actions that are required; for example whether we are going to be soothing and consoling or
active and rescuing. In regard to prevention, all kinds of mind and body training and “wisdom-seeking” come
into play. So feelings will vary with contexts for action. Although there are many different triggers of
compassion, working with a “calm and insightful mind” that allows us to bring our reflective wisdom to bear
on situations is a common focus of compassion training. This is not only to help us stay “in the moment,” but
over time to create the physiological conditions that help us orientate ourselves to a future of commitment to a
compassionate self-identity (Gilbert & Choden, 2013; Ricard, 2015; Singer & Bolz, 2012). So compassionate
intention is to be backed up with commitment to acquire wisdom for action.

Summary
This section explored the nature of compassion and its competencies. Each of compassion’s competencies
can have FBRs associated with it, linked to a range of interacting factors, such as genetic; neural and,
hormonal processes along with personality traits; meta-cognitive beliefs and social contexts and rearing
practices (Conway & Slavich, 2017; Narvaez, 2017). The more we understand these inhibitors of compassion,
the more we will be able to address them in order to promote prosocial and compassionate motives and

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actions in personal, social and political life. The next section considers more deeply the origins of these FBRs
that arise from evolutionary motivational systems and play out in the human brain relatively automatically,
with little insight or awareness of their effects on our minds, in different person–context interactions.

Inhibitors of Compassion
Ultimate Explanations for Compassion Inhibition
Since Darwin (1888) discussed sympathy and helpfulness, evolutionary theories have questioned how such
behavior for helping others could have evolved (Mayseless, 2016). The basic view is that evolution is primarily
a competitive process whereby genes build individuals capable of competing for resources and who are highly
self and kin-focused to advance survival and reproduction (gene replication). According to this view, these
processes give rise to the both helpful and dark sides of our nature, with the later being such as predation
nepotism aggressiveness, vengeance, callousness tribalism and greed. Although we now know that caring and
helpfulness promote the replication of certain gene clusters, our potential for caring exists alongside potentials
for intense self-focused competitiveness and hostility to others (Barrett, Dunbar, & Lycett, 2002; Buss, 2014).
Moreover, evolutionary theorists highlight the different domains of competition such as parent–infant
competition (Geary, 2000), intra- and inter-sexual competition, and group competition; and it is in these
domains that conflicts typically inhibit compassion (Buss, 2014).
Hence, there is a range of motives, phenotypic strategies, and personality traits that are highly non-
compassionate and very self-focused. One group of them has been identified and labeled as the Dark Triad:
Machiavellianism, narcissism, and psychopathy (Furnham, et al., 2013). Another is ruthless (competitive)
ambition (Tang-Smith et al., 2014; Zuroff, Fournier, Pattall, & Leybman, 2010). Yet another is social
dominance orientation (Ho et al., 2015), These various patterns are over-represented in the higher echelons of
business and government and share a common attribute—callousness—an obvious opposite of compassion
(Furnham et al., 2013). These individuals appear to lack (or chronically inhibit) the motivation for caring, but
they can still be competent empathizers (Meffert et al., 2013). These can also be seen as dimensional traits
rather than categories that can vary not only between people but also within a person according to context and
mood states; most of us are capable of acting callously at times.

THE COSTS OF CARING

In any analysis of ultimate explanations an obvious but important limitation on caring and compassion, is
that it is often a costly resource to dispense. So over the phylogenetic long term, it could only evolve in
contexts that support gene replication (Bell, 2001; Burnstein et al.,1994; Preston, 2013). For example, it is
well known that we are far more compassionate to people we are related to than to those we are not (few give
the same resources to the starving children in need as to their own kin networks of offspring, cousins,
nephews, and nieces who are probably not that much in need, or might even be wealthy). We are more likely
to be compassionate to people we know and like than to those we don’t; to people we believe have similar
values to us than to those we see as different (Goetz et al., 2010; Loewenstein & Small, 2007).
So kin relationships and alliances and friendships are natural boundaries around compassion. Those deemed
out-groups, and in particular those we see as different and hostile, are less easy to feel compassion for
(Loewenstein & Small, 2007). We neither want to respond to their distress calls nor want to provide the

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resources that would help them to flourish. Indeed, recent work on the hormone oxytocin has shown that,
while it can increase empathic, affiliative, and compassionate behavior towards kin, friends and ingroup
members, it can increase aggressiveness to out-group members and also, in women, towards potential threats
to their children (Mayseless, 2016). This again highlights the fact that compassion is sensitive to context and
its targets (Loewenstein & Small, 2007).
In addition to the direct costs, compassion and caring can struggle in a number of role-linked conditions.
These include: when caring is felt to be obligatory in some way; when the needs of the other exceed the
resources available, or what one wants to put into caring; when one is unsure or confused about what to do;
and when there is a lack of social support. These conditions in caring roles lead to stress and can be
detrimental to health (Vitaliano et al., 2003). In fact, rates of depression in carers of people with chronic
conditions like dementia, are between 30–50% (Schultz & Williamson, 1991; Pagel, Becker, & Coppel,
1985). Molyneux, McCarthy, McEniff, Cryan, and Conroy (2008) found high levels of depression in primary
carers of people attending psychogeriatric clinics in a community setting. Furthermore, Baumgarten et al.
(1992) found significantly higher levels of depression and physical symptoms in those caring for someone with
dementia than in those caring for an individual with a physical illness. In a study of shame, guilt, and
entrapment in dementia carers, Martin, Gilbert, McEwan, and Irons (2006) found that these were
significantly related to depression. Indeed, feeling “trapped” in a caring role can create severe conflicts between
wanting to care but feeling resentful of the impact on one’s own life, and then feeling ashamed and guilty
about one’s resentment.
We should be cautious of concepts like ‘compassion or empathy fatigue’ however because studies of mental
health problems in caregivers have revealed that burnout and fatigue can be due to a lack of social support;
grief over the loss of the person who existed before the illness; difficulties in coping with changes in behaviors
such as demandingness, physical needs, or aggression in the one cared for; fears of caring inadequately;
financial worries; and others (Molyneux et al., 2008). Importantly, therefore, it need not be the components of
empathy or compassion itself that cause so-called compassion fatigue (as some suggest), but other issues
around the strain in the caring role. Brown, Crawford, Gilbert, Gilbert, and Gale (2014) explored clinicians’
experiences of compassion on acute psychiatric units. All had insights into the basic nature of compassion and
a wish to provide compassionate care to their patients, but what caused problems and fatigue was contextual:
staff shortages, bureaucracy, severe time limitations on caring roles, staff downgrading for cost savings,
constant management reorganizations, lack of support if things went wrong, and uncertainties about the
future.
One of the most obvious caring roles is of course the parental role, and here again, we see individuals differ
in their abilities to provide compassionate care to their children (Koren-Karie, Oppenheim, Dolev, Sher, &
Etzion-Carasso, 2002). There are many contextual and (family and personal) historical factors that create the
context for inhibited compassion towards children. Parents who themselves have a history of neglect and
abuse, are unsupported, and have mental health problems and learning difficulties are particularly at risk of
inhibited compassion (Mikulincer & Shaver, 2017; Narvaez, 2017). It is quite extraordinary that, given what
we know about how early lives affect brain maturation and even genetic expression (Slavich & Cole, 2013), we
have such limited resources dedicated to the desire for “every child to grow up in a compassionate
environment.” This failure to grasp the size and nature of the problem of “how children around the world are

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raised in appalling conditions” is probably humanity’s greatest compassion failure (Gilbert, 2009; Van der
Kolt, 2014).

SOCIAL COMPETITION

In addition to the direct and indirect costs of compassion, there are many instances when compassion is at
direct odds with another core innate motive: to compete. Indeed, there is now neurophysiological evidence
that self-focused competition (e.g., pride) operates through different brain systems than caring (Simon-
Thomas, Godzik, Castle, Antonenko, Ponz, Kogan, & Keltner, 2011). Social, interpersonal competition
covers various domains of interactions (e.g., parent–offspring, sexual, resource acquisition and holding etc.).
Much of human evolution occurred in small, nomadic, kin-based groups, where resources were low and
sharing and mutual support (rather than excessive self-focused competitiveness) were essential for survival
(Hrdy, 2009; Spikins, 2015). However, the advent of agriculture brought stationary settlements with
increasingly large group sizes and the capacity to create surplus, which reinvigorated (earlier evolved motives
for) competitive conflict over resources, and kin-linked status (mostly male) hierarchies. To make a long story
short, the advantages of self- and kin-focused competition became more salient in these environments.
Indeed, as wealth has increased, self-focused competitiveness has also increased, with a detriment to
community and prosocial compassionate values (James, 2007). Galbraith (1987, 1992) and Twenge,
Campbell, and Freeman (2012) note that in relatively poor communities, people may pool resources together,
but with increasing wealth, individuals start opting out, are less orientated to share, and more orientated to
accumulate—they want to buy their own homes, have private health service and education, and not contribute
much to the common good. Economists are also increasingly concerned that unbridled and unregulated
capitalism and competitiveness are corrupting many of our prosocial values and moral ways of working.
Indeed, in many areas, working life has become more stressful, with people expected to work longer hours in
the pursuit of efficiency and profit (Hutton, 2015; Sachs, 2012).

INHIBITION OF COMPASSION FROM INCREASED POWER AND STATUS

One of the consequences or indeed aims of competitive behavior is to increase status, power, and therefore
control over the resources conducive to survival and reproduction. It might be thought that as people acquire
more resources, control, or status, they would be more inclined to be generous and compassionate. Tragically,
the evidence is the opposite (Keltner, 2016). There is now growing evidence that, as people become more
powerful in their social groups, they actually become less empathic, less sensitive to the suffering of others,
and less compassionate (James, 2007; Keltner, 2016; Van Kleef, Overis, Lowe, LouKogan, Goetz, & Keltner,
2008). Although there are obvious philanthropic exceptions, Piff (2014) has shown that increasing wealth
often goes with an increasing narcissistic sense of entitlement and less orientation to sharing. To put it
another way, increasing wealth can advantage dark Triad and hubristic type strategies at the potential expense
of altruistic ones. Indeed, the wealthy elite of nearly all cultures throughout history have behaved this way—
holding and accumulating rather than sharing.
In modern societies opportunities for accumulation stimulate desires for holding onto one’s personal
resources and may be more adaptive than giving them away; certainly one’s kin will do better. This goes some
way to explaining how vast disparities of wealth between the haves, have-nots and have-lots, arise that don’t

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seem to cause moral concerns to those who hold them, and indeed the wealthy go out of their way to justify
their wealth and privilege (Sachs, 2012; Van Kleef et al., 2008). Basically, we’ve created cultures that are very
different from the small, hunter gatherer social niche that helped turn basic mammalian caring into
compassion competencies and interests. Although many individuals are highly motivated to enter the caring
professions, such teachers, clinicians, and police, we struggle with a fair distribution of resources because we
are accumulators—wanting the best houses, education, and health care for ourselves and our families
(Galbraith, 1992). One might fairly argue that some of this is proximate, cultural and contextual, but the
point here is that when contexts allow, what can emerge is not warmhearted sharing but more ancient
resource competition and holding. In fact, it is difficult to think of any civilization that has had a fair and
equal distribution of wealth despite the desires of communism.
Competition can take diverse forms. For example, while humans can and do compete aggressively they also
compete for social attractiveness—to be chosen, to be wanted, and to be esteemed for various advantageous
roles such as sexual partners, friends, or employees. Indeed, competing to create positive impressions in the
minds of others has driven social intelligence (Gilbert, 1992, 1998, 2007; Gilbert, Price, & Allan, 1995).

Table 29.1 Strategies for Gaining and Maintaining Rank-Status in Social Roles

Strategy Aggression Attractiveness

Tactics used Coercive Threatening Authoritarian Showing talent Show competence

Affiliative

Outcome To be obeyed To be reckoned with To be To be valued To be chosen To be freely

desired submitted to given to

Purpose of To inhibit others To stimulate fear To inspire, attract others To stimulate

strategy positive affect

From Gilbert and McGuire, 1998

Hence, as many have suggested (Buss, 2014), caring altruism and compassion may have evolved, not only
from the benefits of caring for kin or reciprocation, but also because it also creates (beneficial) positive
emotions about oneself in the mind of others, that ’one will be a helpful and reliable partner’; and such
impressions and reputations carry major benefits for the self (Gilbert, 2009).’ Table 29.1 depicts examples of
these two different strategies of competition, one based on aggression, and one based on attractiveness.
As noted shortly, different motives and strategies compete with each other within us (Huang & Bargh,
2014; Ornstein, 1986). So, for example, one of the major ‘competitions’ between our own different motives is
whether to turn towards the suffering of others, share with them, and take an interest in their well-being, or
be much more self-focused, seeking to accumulate and defend resources (don’t share), focusing on our own
self advantage and how to protect it. These different motives affect what we pay attention to, the kinds of
things that give us joy or fear, and how we allocate resources to different behaviors (e.g., advancing our
careers). As the costs of helping increases and a threatened self-interest is activated, so potential for
compassion can decrease (Loewenstein & Small, 2007).
Evidence for this battle between self- or other-focus comes from a long history of research revealing that

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competitive self-focus inhibits compassion and helping (Darley & Batson, 1973; Music, 2014). It also comes
from research on modern education. Recently the Harvard Graduate School of Education (2014) reported on
a survey of 10,000 middle and high school children from 33 diverse schools exploring their motivations for
self-focused competitive achievement versus fairness and helping others. They bring attention to the fact that
self-focused happiness and achievement are rated much higher as personal values than concern for others, and
this differential has been accentuated over the last 20 years. They indicate that both parents and schools have
been rewarding and emphasizing self-focused competitiveness and personal achievement over prosocial
behavior. This report highlights the way in which our increasing cultivation of self-focused competitiveness
can significantly suppress/inhibit concern for others and compassionate engagement (Narvaez, 2017).
Self- versus other-focus is also related to different outcomes. In a series of studies, Crocker and Canevello
(2008) explored the impact of two different motivational styles, compassion-focused and self-focused goals,
on the social relationships and well-being of students. Compassion goals were measured by the degree to
which students tried to be “helpful to others, have compassion for their mistakes, avoid doing things that were
hurtful.” Self-image goals were marked by desires to have “one’s positive qualities noticed, get people to see
you are right, avoid being rejected, avoid having weaknesses or having mistakes revealed.” Self-focused
motivations were associated with feeling more lonely, confused, disconnected, and isolated, and with poorer
well-being and increased depression. Despite the fact that Western societies teach people to be self-focused,
striving, and competitive, there is increasing evidence that, actually, prosocial friendships, caring,
compassionate and cooperative goals are more conducive to well-being (Brown & Brown, 2015; Keltner et al.,
2014; Ricard, 2015; Singer & Bolz, 2012).

INTRA- AND INTER-SEXUAL COMPETITION AS A COMPASSION INHIBITOR

Having looked at competitiveness in general, we can now focus on a more nuanced approach locating the
competitive motives themselves in survival and reproductive strategies. The point here is to indicate how
different types of survival and reproductive strategy will give rise to different types of inhibitors of compassion.
Evolutionary biologists have highlighted the fact that opportunities to breed and reproduce often involve
complex competitive interactions between members of the same sex (intra-sexual) and opposite sex (inter-
sexual); (Barrett et al., 2002; Buss, 2014). Male reproductive strategies of competing for resources can be
affiliative, or use high-risk/high-gain strategies, involving hostile competition with conflicts for status, power,
resources, and sex. In order for animals to live within groups, hierarchies also evolve with a range of
submissive behaviors, which can minimize the degree or risk of injury that can arise from such conflicts
(Gilbert, 2000). However, subordinate status can take its toll on the subordinate’s health (Sapolsky, 2005),
and our tendencies for submissiveness and compliance with authorities can enable extraordinary cruelties
(Kelman & Hamiltion, 1989; Milgram, 1974; Zimbardo, 2016) including ones perpetrated by religions
(Garcia, 2015).
The degree of aggressiveness used to acquire status/power is linked to personality traits, but also to culture
and context. For example, studies of baboons show two different leadership styles, with some dominant males
being affiliative but others being aggressive (Sapolsky, 1990). Gilbert and McGuire (1998) noted how low-
serotonin monkeys tend to pick fights, are unpredictable, and basically try to create social environments of
anxiety, demanding displays of submissiveness and inhibition of challenge to their authority. In other words,

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the strategy of hostile dominance creates fear and submissiveness in those around them in order for that
strategy to prosper. In contrast, higher-serotonin males are more affiliative and likely to generate affiliative
ways to obtain and maintain status.
Increasing research indicates that when the self-focused and aggressive types of male sexual reproductive
strategies are able to operate in and dominate group contexts, there is a focus on threat, intimidation, fear, and
anxiety, with subordinates wanting to hide, please, and conform to the will of the dominant male (Shackelford
& Goetz, 2012). Group-wise, there is a focus on control and territorial acquisition—resources and wealth
flow upwards to the higher ranks, and indeed, the higher ranks use their wealth to maintain their position,
sometimes to extraordinary extents, including hiding and cheating on tax payments (Sachs, 2012). There is a
focus on sexual control with an interest particularly in regulating female sexuality, all of which can mitigate
against compassion.
Females also compete with each other for resources and sexual access. Like men, they can be affiliative and
cooperative, but also hostile to each other (Buss & Dreden, 1990). Their tactics are more those of shunning
and ridicule than of physical intimidation (Stockley & Campbell, 2013). In addition, wives, sisters and
mothers have enticed their husbands, sons and male relatives to behave in aggressive, dominant ways against
competitors (Gay, 1995). So both genders have ways of denigrating and harming their competitors (Buss &
Dreden, 1990; Shackelford & Goetz, 2012)
Whereas intra-sexual competition relates to the conflicts between individuals of the same sex, inter-sexual
competition arises between the sexes and is created by the divergent interests of individuals of different sexes.
Competing to be attractive to sexual partners (so that one is chosen/accepted as a sexual partner) leads to
whole array of “attracting” displays both physically and as a resource holder (Buss, 2014). Indeed physical
attractiveness carries many benefits beyond being desired as a sexual partner, but also in terms of employment,
alliances, being forgiven and receiving compassionate aid, a phenomena Ectoff (1999) called ‘The Survival of
the Prettiest’. Being an attractive (e.g., helpful and altruistic) mate choice and ally may also have supported the
evolution of altruism and compassion (Goetz et al., 2010) However, tragically, sexual motives and strategies
can be highly coercive in a number of different species, where each gender tries to impose its reproductive
interests on the other. This is not uncommon in humans and will of course inhibit compassion. The history of
the lack of attention to the suppression, subordination, exploitation, and suffering of women is an powerful
and tragic example of compassion inhibition (see the shocking WHO report on domestic violence; Garcia-
Moreno Jansen, Ellsberg, Heise, & Watts, 2006). So one has to keep in mind, in “whose interest is it” that
these social contexts and belief systems be maintained?

CRUELTY

Another ultimate and innate source for FBRs to compassion is cruelty, and the deliberate causing of
suffering to another, (Abbott, 1993; Gilbert, 2005; Gilbert & Gilbert, 2015; Glover, 1999; Nell, 2006; Plante,
2015; Taylor, 2009). As noted, removing and suppressing competitors is one source of the desire to harm
others; however, other evolved mechanisms for cruelty have been suggested. Nell (2006) offers a fascinating
analysis that one route to human cruelty (the antithesis of compassion) could have evolved with hunting and
killing prey, because killing to eat requires the predator to completely turn off any “concern” or inhibitory
response to the distress calls from the pain they’re causing with killing. Indeed, prey are usually in high states

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of “distress signaling” as they are being eaten and killed. Sometimes it takes a lion nearly an hour to kill a
buffalo, and hyenas rip the flesh from their prey as they are running, which generates shrieks of terror (Nell,
2006). Chimpanzees kill and eat other monkeys, and again have to completely inhibit caring responses to the
distress of the monkey being killed.
Certainly as meat eaters, humans have treated, and still treat, animals, especially those we want to eat, with
intense cruelty (and not just factory farming). It is possible that some of the mechanisms (and there will be
many others) that turn off sensitivity to distress are rooted in the evolution of hunting and predator behavior.
These mechanisms may simply have been co-opted and used for later evolved inter-group violence, enabling
cruelty to others.

Summary
This section has explored how natural selection may have shaped the human propensity to focus
compassion on some individuals but withhold it from others and be cruel and hostile to yet others. The most
common evolutionary explanation is that compassion is expensive, in terms of energy and resource expenditure
(Burnstein et al., 1994; Buss, 2014). In addition, we may not wish to respond to some distress signals if they
signal danger e.g., disease or risk of harm to self (Panksepp & Panksepp, 2013); looking after somebody with
severe paranoia, drug and alcohol problems, or Ebola might pose a challenge. Caring for others can also have
mental health costs (Vitaliano et al., 2003). All these make it selectively focused on kin and alliances and
‘relatively safe others’.
Another explanation emerges from intra- and inter-sexual competition, which may place compassion at
odds with gender linked reproductive strategies. Not only dispositions for gender violence and exploitation but
the quality of parental investment has its roots here. Indeed the extent to which individuals are self-focused at
the expense of others in terms of their sexual and resource competition means that natural selection has
shaped many opposing motivations (Huang & Bargh, 2014).
In regard to evolved inner mechanisms that may actually turn off empathy and sensitivity to suffering (Zaki
& Cikara, 2015), these could be linked to the threats and costs of caring but also have evolved from predatory
tendencies that helped human ancestors fulfill dietary requirements, and necessitated the ability to bring about
and willfully observe the suffering of another suffering being (Nell, 2006). Since evolution adapts already
existent mechanisms for other uses (Buss, 2014), our potential for cruelty may have multiple sources. With
these ultimate explanations in mind, we can better consider the proximate, local, cultural and contextual
causes, for compassion inhibitors.

Proximate Inhibitors (FBRs) of Compassion

Linking Ultimate and Proximate Explanations
In order to achieve their goals, genes that code for strategies (and their motive systems) create social
contexts that enable them to prosper and reproduce themselves. Just as bacteria try to create the conditions in
the gut for them to survive and reproduce, even affecting the dietary preferences of their hosts, so strategies
produce behaviors that will influence, not only the mind of their host, but also those around the host; to create
states in the minds of others to enable those strategies to flourish. These states of mind are the purview of our
proximate analysis of compassion FBRs.

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 So, for example, aggressive strategies seek to create social contexts of fear and submission in the minds of
others. In addition, they will create social discourses fueling beliefs that support the use of aggressive rather
than cooperative strategies (e.g., “It’s a harsh jungle of dog eat dog world out there; we’ve all got to toughen
up”; “Life is threatening so you need to look after yourself and your own”). These are not uncommon beliefs,
but if identified with, they will obviously influence a whole range of behaviors of those they infect (Perry et al.,
2013). In contrast, affiliative/altruistic strategies seek to stimulate cooperative motives in the minds of others
and thus, caring environments with a sense of safeness, trust, and openness in conspecifics. In other words,
different strategies seek to create very different states of minds in the minds they interact with. Within any
population, these different strategies (e.g., investing vs. cheating, aggressive vs. affiliative; tribal vs open) will
be competing for expression, to influence the minds of others, and ultimately replication. These obviously are
not black and white or either/or and can operate to various degrees in different people at different times in
different contexts—and within any one individual, they will be in conflict (Huang & Bargh, 2014). However,
our point is that evolved social strategies are phenotypes for creating dynamic, reciprocal, social dances that
can facilitate compassion discourses or close them down. In what follows, we analyze the more proximate, and
local contextual, causes of compassion inhibition related to how people situate themselves in their social
contexts.

Inhibition of Compassion From Shame

One of the most important social and personal judgements that can impact on a whole range of behaviours,
including ethical, moral and compassionate, is shame. Shame is a defensive response to being criticized,
ridiculed, or rejected by others (Gilbert, 1998). Shame can be focused on our own negative self-evaluations;
feeling personally inferior, inadequate, with flaws, or having made mistakes or taken bad actions (called
internal shame). Moreover, people can treat themselves with mild self-criticism all the way through to self-
persecution and self-hatred. These are major inhibitors to self-compassion, self-acceptance and self-
forgiveness While internal shame can be internally focused, the experience of shame often begins in the
outside world form from the negative evaluations and actions of others We experience others as seeing oneself
as inadequate, flawed, undesirable, unattractive or bad in some way; we feel ashamed, diminished or belittled,
in the eyes and minds of others (called external shame) (Gilbert, 1998, 2007). It is a major competitive loss of
social standing with potentially serious implications for confident social engagement and securing helpful
relationships. Note too that the desire to shame and disgrace others is, of course, different to wishing to be
compassionate to them.
Extensive work by Tangney and her colleagues have shown many times, that far from supporting moral
emotions, shame is much more likely to be linked to avoidance of responsibility, anger, concealment,
aggression, vulnerability to criminal and immoral behavior, depression and paranoia (e.g., see Stuewig,
Tangney, Kendall, Folk, Meyer, & Dearing, 2014; Tangney, Stuewig, & Mashek, 2007).
Because shame is about threats to our social identity (and thus social competitive ability and our
attractiveness rating), we can fear the potential to be shamed and thus rejected or even attacked. Moreover, to
avoid being shamed (e.g., as a coward or disloyal) we can be enticed into complying with behaviors that may
be detrimental to ourselves and others (see Gilbert, 1998, 2007). Kelman and Hamiliton (1989) referred to
these a ‘crimes of obedience’. There are also tragic examples were cultures create conditions for shame that

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create enormous suffering e.g., chineses foot binding (Mao, 2007) and sanction the most horrific punishments
for relatively minor misdemeanours (Abbott, 1993).
Part of the “bystander effect” is linked to social presentation and shame avoidance. Tice and Baumeister
(1985) found that macho self-images in men could inhibit helping if helping was seen to undermine (or
shame) their macho self-image. Indeed, culturally scripted “macho” images of masculinity “to be tough,
fearless, and in control of one’s emotions” are more common when cultures seek to create men who are
competitive with each other, the ecology is dangerous, and tribal conflicts require men to take risks and fight
(Gilmore, 1990). Compassion values, such as peacekeeping, sharing, and gentleness, are perceived very
differently in benevolent and cooperative environments (Gilmore, 1990).
People who are fearful of interpersonal closeness and compassion can believe that ’if you really knew me or
what went on in my mind, you wouldn’t think I deserve compassion (Pauley & McPherson, 2010). Indeed,
the link between internal and external shame is one of the major blocks to being able to receive compassion
from others or oneself (Gilbert, 2007, 2010; Gilbert et al., 2011). Actually, probably all humans have some
degree of fear of their internal fantasies’ being revealed! Individuals who come from abusive environments
where others who should have been protective and kind were hurtful, and where they’ve often been told they
were unlovable or bad in some way, can fear the intersubjectivity and closeness that comes with the opening to
another. They have the motto that “if you get close to me, you will see the bad in me; if I get close to you, I
will see the bad in you.” There can be a basic mistrust of what happens in close or sharing relationships. The
bottom line is that fear of shame can inhibit compassion, and also suppress moral courage and a preparedness
to fight against injustice and uncompassionate behaviors. Shame can stop us from reaching out to others and
stop us from receiving compassion as well as giving it (Gilbert, 2017b).
While shame has a self-focused, competitive motivational system as its root, guilt, in contrast, is focused on
harm-avoidance and has a caring motivation as its root. Guilt is therefore associated with different emotions,
such as sadness and remorse for wrongdoing, and it is far more likely to be associated with compassion
(Gilbert, 2009, 2017b); Tangney et al., 2007). Clearly, then, we can’t shame people into feeling compassion,
but facilitating guilt or regret is associated with compassion, because it involves a sensitivity to suffering in the
other in a way that shame does not (Gilbert, 2017b).

Inhibition of Compassion From Power and Status

The phenomenology of status hierarchies and leader-follower relationships are made possible by the
dynamics of species-topic sexual and resource competition. Importantly though, the influence of leaders on
their followers is both a response to but also provides social contexts that prime compassion facilitation or
inhibition. The importance of leaders and their personality was also inadvertently revealed in a fascinating
study by Sapolsky & Share, (2004). A group of monkeys they had been observing began to feed from local
rubbish dumps, with the dominants getting the biggest share. When a tuberculosis outbreak occurred, the
dominant males were most likely to contract the disease and die. With these males gone, the social texture of
the group changed, including increased grooming and affiliation, and less aggression and stress among males.
The more peaceful and egalitarian culture lasted for many years, even as new baboons moved into to the
troop. Indeed, groups can be violent or peaceful according to their leaders (the influence of Gandhi in India
and Nelson Mandela in South Africa being core examples of how transitions of power were achieved

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peacefully rather than through violent conflict).
Gaining power can result in hubris changes in personality (Garrard, & Robinson, 2015). Leaders caught in
the self inflations of power can have poor judgement and promote non-compassionate values (Jakovljević,
2011). The stress and threats that are associated with high profile modern leadership may partly select certain
personalities and also increase the risk of hubris as a defence against personal uncertainty and vulnerability
(Lindholm, 1993; Owen, 2008; 2012).
The importance of leaders for good or bad group actions are revealed by studies like those of Green, Glaser,
and Rich (1998). They looked at the historical records for the link between unfavorable economic conditions
(e.g., high unemployment) and hate crimes (lynching and beatings) directed at minorities. Current wisdom
had it that with increases in relative poverty, envy and frustration build up, leading to increases in hate crime.
But this link proved weak. Green et al. (1998) believed that an important factor in the rise of hate crimes is
the emergence of leaders and power elites that direct and orchestrate violence for their own ends or reasons.
Lindholm (1993) and Gay (1995) concluded the same. Certainly, in many conflicts around the world today,
violence is orchestrated by power elites, while those who are actually engaged in the combat can suffer
intensely (Kelman & Hamilton, 1989; Pratto, Sidanius, Stallworth, & Malle, 1994). In fact it is surprisingly
easy to entice people to behave aggressively and harmfully to others (Zimbardo, 2006).
Gay (1995) outlines how political rhetoric can easily stimulate audiences into fear, and from fear, hatred of
the outsider, and if not hatred, then certainly a sense of superiority or entitlement which suppress compassion
motives and competencies. Indeed, the stronger the in-group ties, the greater a sense of needing to protect
them, and hence increased hostility to outsiders (Gay, 1995). One of the tragedies of the Balkan and indeed
many other wars such as the Rwandan wars was the way in which ethnically different people, who had
previously been compassionate and friendly neighbors, were so easily enticed by their leaders to turn on each
other in rather horrific ways under the banner of a “nation state.” It is recognized that commonly this is the
impact of a group of aggressive, nationalistic males (Ingnatiff, 1999). For many centuries powerful political
messages have sought to create “fear of the outsider” and a sense ‘of threat to one’s way of life’ to win votes and
followers. Modern Western politicians and sections of the media are no different, sadly.
Leaders are looked to in order to maintain group identity, cohesion, and protection, not to loosen it
(Linholm, 1993). In 1974, Stanley Milgram published his classic and well-known set of experiments showing
that it takes rather little authority to entice people to behave cruelly (obedience to leaders) to others. Indeed,
seeking to appease and ingratiate oneself with cruel leaders and comply with group norms and values
underpins a lot of human atrocities (Kelman & Hamilton, 1989; Zimbardo, 2006). The way submissive and
appeasing behavior can suppress compassion can show up in unexpected ways. For example, although a
number of studies have revealed that compassion is linked to the personality traits of agreeableness and
conscientiousness, Bègue, Beauvois, Courbet et al. (2015) showed that these two traits are also associated with
conformity, not wanting to cause trouble, and obedience in a Milgram-type experiment.
We should also note that while religions can often offer comfort and moral direction they can also be
sources of exceptional violence and seek to reach into the most intimate areas of peoples’ lives including their
control over their own reproductive strategies (Garcia, 2015). So some religions have been highly tribal,
aggressive, controlling, male dominated and very non-compassionate, even whilst proclaiming compassion sits
at their heart.

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Inhibition of Compassion from Threats
FBRs to compassion are clearly linked to the perceptions of threats. Although compassion is about
sensitivity to distress, it is important to keep in mind that distress-sensitivity first began as a threat/warning
signal triggering flight and avoidance from the one distressed (Panksepp & Panksepp, 2013). Hence, much
may depend on what kind of distress is occurring, in what context, and who is the distressed (Goetz et al.,
2010). An example awareness of distress that acts as a warning signal and triggers fear can inhibit caring and
may trigger avoidance rather than approach. One of the most important tasks of life is to recognize and deal
with threats to self and kin relationships, quickly and efficiently. This means that our threat system is our
most dominant processing system. It can be quickly aroused, is highly sensitive to classical conditioning,
creates attentional biases, has the capacity to easily suppress positive (and affiliative) affect, and stimulates
defensive emotions such as anxiety, anger, and disgust, which can suppress compassion. This has been seen as
an innate negativity bias or “bad is stronger than good,” as suggested by Baumeister, Bratslavsky, Finkenauer,
and Vohs (2001).
The more we see the world as a dangerous place, requiring a focus on vigilance to threat and self-
protection, the more conservative and less focused on cooperative and compassionate actions of sharing
resources we are (Janoff-Bulman, 2009). A meta-analysis by Perry, Sibley, and Duckitt (2013) revealed two
different ideological types of belief linked to threat sensitivity that impacted on cooperative and compassionate
values: (1) The world is a dangerous place where good people are constantly threatened by bad; (2) this is a
competitive place, a jungle, characterized by an amoral, ruthless struggle and competitiveness; a dog eat dog
world and to prosper one has to adopt or cope with those tactics. Interestingly, research on the fears of
compassion scale suggest that fears of compassion for others are not that highly correlated with fears of being
open to compassion or self-compassion (Gilbert et al., 2011, 2013, 2014). Indeed, currently there is no
evidence that individuals holding such an ideology are less self-compassionate. Other common blocks to
compassion include different types of envy or holding contemptuous views of others (Gilbert, 2010).
In addition, physiological states of threat and stress interfere with compassion processing and direct
attention to the need to look after oneself rather than others, as well as closing down frontal cortical and
empathic systems (Porges, 2007). Moreover, a whole range of mental health problems, including depression
and paranoia that increase rumination and self-focus, are associated with fears of compassion (Gilbert et al.,
2011).

The Role of Motivational Conflicts as Compassion Inhibitors

Earlier, we introduced the idea of motivational conflicts as an ultimate explanation of compassion FBRs.
These conflicts evolved with a kind of “cost–benefit” analysis played out over evolutionary time (Buss, 2014;
Gilbert, 1989/2016; Huang & Bargh, 2014). Crucially, though, these different strategies and motivational
potentials are competing within individuals for expression, and personal history and context plays a large role
in what gets cultivated and played out (Huang & Bargh, 2014; Narvaez, 2017). For example, anger and rage
can be FBRs of compassion, for obvious reasons, but they can inhibit self-compassion and self-acceptance
when people believe that compassion is about having to get “rid of these feelings,” as opposed to developing
the courage and compassion to tolerate and work with them. Other context-specific motivation contexts will
be discussed in turn.

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 Conflicts that can impact compassion can also be in the domain of values, including ethics (Music, 2014).
For example, Batson, Klein, Highberger, and Shaw (1995) indicated that an ethic of justice may conflict with
an ethic of compassion. In addition, the nature of one’s morality may impact on compassion. Furthermore, the
ability to give empathic, skillful compassion may depend on the ability to, or inhibition of, the ability to
receive it (Hermanto & Zuroff, 2016), and some people try to behave compassionately to be liked rather than
from genuine empathy (Catarino, Sousa, Ceresatto, Moore, & Gilbert, 2014).

Inter-Group Conflicts—Tribalism
It is clear that tribalism is partly an ultimate process, that many species are tribal including killing
individuals from unrelated groups, and humans too can be intensely tribal. Tribalism and tribal wars and its
slavery has accounted for immense suffering not to mention huge resources spent on armaments (Van Vugt,
& Park, 2009). As noted above, tribalism is easily stimulated by leaders’ appeals to inter-group conflicts, for
example to the fears purity-disgust and contamination, harmfulness or resource loss. Here, the other is seen as
“alien and contaminating us.” Hitler described the Jews, for example, as “a disease and vermin” (Glover,
1999). Once this psychology of “contamination and disease” catches hold, then the desire to “seek out,
eradicate, and exterminate”—the archetypal approach to disease—can dominate the way we think about and
treat others, and compassion takes an obvious back seat (Gay, 1995; Gilbert, 2005). There can also be the fear
of “invasion” and being swamped or taken over—typical in the rhetoric against immigrants and refugees, who
are often treated poorly and certainly without much compassion.
Rooted in the evolutionary psychology of tribalism is the concept of group-focused social dominance. Sidanius
and Pratto (2004) argue that “Most forms of group conflict and oppression (e.g., racism, ethnocentrism,
sexism, nationalism, classism, and regionalism) can be regarded as different manifestations of the same basic
human predisposition to form group-based social hierarchy” (p. 319). Martin et al. (2014) explored measures
of the fears of compassion and social dominance traits and showed social dominance and justifying inequality
was associated with a fear of all forms of compassion. So, one of the important roles that group-focused, social
identities and communication networks can do is provide narratives to legitimize inequalities (e.g., to see
others as less deserving, or inferior in some way), and create fears and terrors around differences and legitimize
cruelties. For those on the receiving end of the cruelties of others, there will of course be a sense of
humiliation, resentment, and desire for retaliation.

Enjoyment of Suffering
It’s not just hunting/feeding, threat, protection, or vengeance that power sadism and cruelty, but actual
enjoyment. There is a word in German, Schadenfreude, which is “taking pleasure in the misfortune and
suffering of others” (Leach, Spears, Branscombe, & Dossje, 2003), the exact opposite of compassion. Indeed,
humans can enjoy vengeance (Leach et al., 2003). Much storytelling, and of course, popular media, is based on
the idea of seeing the “good guys” take violent vengeance on “the bad guys.” The more we empathise with the
victims, the more we may want vengeance. Sometimes the more violent and cruel the punishment on the
(really) nasty/bad guys, the more it is enjoyed. It is not cruelty we condemn, but who uses it and for what
reason. It’s not surprising that there are evolutionary grounds for the value of retaliation, because it acts as a
deterrent, but humans can take it to extremes. Cruelty and the motives to torture and cause pain are

530
commonly directed toward individuals who are considered threats, enemies, or outsiders who threaten the
social order, or vengeance is used simply as punishment. Beliefs and depictions of hell are fueled by such
themes. Concepts of a loving compassionate God coexisting with hell are not uncommon, even though they
are incompatible.
Ideas that torture can be used in the service of caring and protecting one’s own group and country are also
common. Even powerful countries like America have used torture, as a recent Senate report notes (Senate
Select Committee on Intelligence, 2015).
But our fascination with cruelty and sadism arises even in the absence of these issues and can be simply for
excitement and entertainment. Indeed, for 700 years, the Roman games were a prominent feature of Roman
life. Today our entertainments have become increasingly violent and sadistic (harking back to the Romans—
e.g., Game of Thrones). So there are important research questions on the source of our fascination with the
sadistic and cruel and its impact on compassion.

Summary
Here we explored the proximate mechanisms of compassion inhibition, considering some of the immediate
contextual and interpersonal features that may underpin FBRs. We noted that the induction of shame and
guilt have potent, though differential, effects on compassion. The induction of a power, resource or status
differentials and feelings of threat also have clear inhibitory impacts on compassion for the suffering of others.
Finally, we categorized several disparate motivations, such as vengeance and cruelty, into a category of states
that are triggered is specific contexts and, crucially, are mutually exclusive of compassion. Understanding of
these proximate causes of FBRs allows for a greater understanding of the potential antidotes to compassion
inhibition. There are of course, many other personal, proximate sources of compassion inhibition such as the
impact of early life experiences and family environment. These are explored in more detail in the therapeutic
literature (Gilbert, 2014).

Addressing the Inhibitors

As noted at the beginning of this chapter, there is now a large range of skills trainings and therapies
focusing on the development of affiliation, empathy, caring, prosocial behavior, altruism, and compassion
(Kirby & Gilbert, 2017). However, given that all motives have facilitators and inhibitors, and much work on
compassion to date has been on facilitators, this chapter has sought to explore the inhibitors. Inhibitors are
linked to evolved motives and strategies for social competition, and are sensitive to cultural shaping and
interpersonal processes. Crucially we know that cultural, social, school and family contexts can play huge roles
in what motivational systems are cultivated and mature within us and prosocial motives flourish within
particular kinds of cultural and social context (Cortina, & Liotti, 2010; Mikulincer & Shaver, 2017; Narvaez,
2017). Indeed, because of neuroplasticity, neurogenesis, and epigenetics, and the enormous power of social
contexts that shape us, including genetic expression (epigenetics), with wisdom and caution we can address
these inhibitors. In one of the few studies of its kind to explore reducing inhibitors, Jazaieri et al. (2013) found
that specific compassion training reduced the fears of compassion across three domains of compassion:
compassion for others, receiving compassion from others, and self-compassion. In a recent study,
compassionate self-training also significantly reduced such fears of compassion (Matos, Durate, Durate, et al.,

531
in press). A greater focus on FBRs to compassion cultivation can also be instigated in schools and
organizations (Harvard Graduate School of Education, 2014; Murphy, 2016; Welford & Langmead, 2014).
Working to identify and reduce narcissistic, competitive self-interest and promote ethical and compassionate
values and behaviours throughout all infrastructures of society is the challenge for the future (Narvaez, 2017;
Sachs, 2012). Importantly too, we know that prosocial and compassionate behavior are subject to epigenetic
regulation and understanding the early life experiences that can promote robust physiological architectures for
compassion is important (Conway & Slavich, 2017).

Mindful Forgiveness
As noted, evolution is partly driven through conflicts of interest, which can generate hostile and rejecting
behaviors and emotions. Helping people recognize the ease with which conflicts can arise (by virtue of our
evolved brains), and how to compassionately engage with conflicts of interests, can help soften inhibitors
(Matos et al., in press). When we feel other people have hurt or injured us, we might typically have feelings of
vengeance. The antithesis of vengeance is forgiveness. There are different motives that can underpin
forgiveness (Worthington, O’Conor, Berry, Harp, Murray, & Yi, 2005). One is the recognition that
forgiveness and letting go of one’s anger enable a certain kind of inner peacefulness. Another form of
forgiveness arises when we see deeply into the causes of suffering and how so much is linked to the way we
have evolved—a deep understanding that this is not our fault, but is our responsibility to counteract.

Conclusion
The key theme of this chapter is that compassion is an evolved motivational system that is part of a menu of
inner motives. It operates as an inner potential along with many others, such as: harm-avoidance (threat), self-
focused competitiveness, tribalism, sex, and power-seeking. All are rooted in evolutionary strategies that
evolved for genetic survival and replication. As such, they give rise to different motivational systems that
organize attention, emotion, reasoning and behavior in quite different ways. We have known for a long time
that within social groups, and also within our own heads, there are major conflicts of interest between
different competencies, motives, and emotions. Many of the inhibitors of compassion have to do with the
process of this (within and between individuals) motivational competition.
Thus, we can acknowledge that as a potentially profoundly compassionate species, we also have highly self-
interested competencies and are capable of horrendous greed and cruelty and neglect of the suffering of others;
we have a terrorizing dark side that human history has seen far too often. Compassion, then, requires a the
courage to see the true causes of, and engage with, suffering related to the social contexts and cultures we have
created, inhabit, and support. We can recognise that cultural beliefs reflect deeper evolved strategies that are
constantly competing with each other both intra-personally and interpersonally. Leaders influence what
emotions, motives, and values are stimulated within their followers. Personal beliefs, the touchstones of the
cognitive approaches to therapy, are commonly reflections of cultural narratives that propagate certain kinds of
strategies (self-focused versus prosocial and sharing) that advantage specific individuals, following specific
strategies. Thinking about compassion as a form of courage can be set against the view that compassion is about
kindness, softness, and gentleness. Those are ways of being compassionate but are not compassion itself. So
there are very good reasons why compassion runs up against powerful inhibitors all the time. Hence,

532
understanding the facilitators and inhibitors of compassion at both ultimate and proximate levels of
explanation will support further research on how to identify and nullify the inhibitors of compassion, at both
the individual and cultural levels. This is a challenge for the future of compassion research.

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 PART 7

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Applied Compassion

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 Organizational Compassion Manifestations Through Organizations

Kim Cameron

Abstract

In this chapter, we discuss compassion as experienced and expressed at the organization level of analysis.
Shifting to this collective level suggests that the definition of compassion needs to be expanded to
include two additional attributes: (1) the active demonstration of compassion through the organization
and its members; and (2) actions motivated by inherent virtuousness rather than the acquisition of a
reward. The chapter describes empirical studies in organizational settings in which the relationship
between virtuousness and desired organizational outcomes is examined. Compassion by itself is seldom a
singular predictor of organizational performance, but in combination with other virtues, it has profound
effects. The chapter provides a theoretical rationale for why compassion has a significant impact on
organizational performance. Three explanatory mechanisms are identified for why compassion predicts
effectiveness. The chapter concludes by highlighting some fundamental principles that are needed to
expand our understanding of compassion and its effects in organizations.

Key Words: compassion, organizational compassion, virtue, virtuousness, organizational culture,

organizational performance, positivity

In this chapter, we discuss compassion as experienced and expressed at the organization level of analysis.
Shifting to this collective level suggests that the definition of compassion needs to be expanded slightly from
that proposed by Goetz, Keltner, and Simon-Thomas (2010) to include two additional attributes: (1) the
active demonstration of compassion through the organization and its members; and (2) actions motivated by
inherent virtuousness rather than the acquisition of recognition or reward. Examples of organizations
demonstrating compassion are provided to illustrate these attributes.
The chapter describes empirical studies in organizational settings in which the relationship between
virtuousness (including collective compassion) and desired organizational outcomes is examined. Compassion
by itself is seldom a singular predictor of organizational performance, but in combination with other virtues, it
has been found to have profound effects.
Finally, we provide a theoretical rationale for why compassion has a significant impact on organizational
performance. Three explanatory mechanisms are identified for why compassion predicts effectiveness. The
chapter concludes by highlighting some foundation stones that are needed to expand our understanding of
compassion and its effects in organizations.

Organizational Compassion
Compassion, as defined in this volume, is “sensitivity to the pain or suffering of another, coupled with a deep

541
desire to alleviate that suffering” (Goetz, Keltner, & Simon-Thomas, 2010). As we consider compassion at
the organization level of analysis, the concept takes on additional attributes. Kanov et al. (2004, p. 810)
described organization-level compassion as a dynamic and relational process. It not only involves empathic
feelings and desires to alleviate suffering, but also involves assisting or responding in ways that attempt to
relieve suffering. “Organizational compassion exists when members of a system collectively notice, feel, and
respond to pain experienced by members of that system.” Compassion becomes organizational, rather than
individual, when it is legitimized within an organizational context and propagated among organization
members. It extends beyond mere emotional contagion to include collective action.
Organizations may develop cultures of compassion, but organizational culture, by definition, involves
implicit, unrecognized assumptions and values. Most of us, for example, did not wake up this morning
making a conscious decision to speak our native language. We are not aware that we do until we encounter
someone who does not—or when our basic assumptions are challenged or highlighted by another person.
Organizational culture is almost entirely implicit (Schein, 2010; Cameron & Quinn, 2011). Similarly,
compassionate cultures in organizations are made manifest when opportunities arise for collective action or
when the collective compassionate inclinations are tested.
Dutton, Worline, Frost, and Lilius (2007, p. 60) indicated that organizational compassion occurs “when
individuals in organizations collectively notice, feel, and respond to human pain in a coordinated way.”
Coordination among individuals is a key mechanism that activates organizational compassion, so that
responding to pain or suffering is synchronized among individuals through values, practices, and routines.
Compassion in organizations involves not only sensitivity to suffering and a desire to respond, but also a
coordinated response aimed at assisting or supporting others in coping with the pain or distress that they
experience.
When three foreign graduate students at a Midwestern business school suffered the loss of all their
possessions in an apartment fire just before final exam week, the organization they belonged to demonstrated
collective compassion. Not only were empathetic feelings and desires expressed by members of the business
school community, but the organization itself demonstrated coordinated compassion in a variety of ways.
Fellow students voluntarily organized a clothing drive to replace the victims’ apparel as well as basic
necessities. The business school provided free housing in an executive residence for a period of time while the
students took final exams and secured permanent housing. Classmates shared course notes, reading materials,
and computers so that the students could take their final exams. The school’s dean personally led an effort to
collect funds for the students by writing a personal check in a full faculty-staff meeting (Dutton et al., 2007).
The key to organization-level compassion was a coordinated response to the suffering of others. It extended
beyond the mere feelings, desires, or intentions of individuals when they witnessed distress or pain.
Coordinated action was required.

Varieties of Compassion Through Organizations

Compassionate action by organizations may take a variety of forms, but not all collective action in response
to suffering can be defined as “organizational compassion.” For example, corporate social responsibility
initiatives undertaken by organizations may or may not be examples of true compassion. A few examples may
illustrate this distinction.

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 A culture of compassion may go unnoticed until given voice by leaders as an outcome of unexpected events
or crises. Empathic feelings, inclinations to assist, or prosocial motives may exist in the organization, but they
often become organizational in scope only when activated by leaders.
For example, Jim Mallozzi, newly appointed chief executive officer of U.S-based Prudential Real Estate
and Relocation Company, spent his first year in office articulating and reinforcing the values of compassionate
care for fellow employees as well as for Prudential’s customers. “We help people at the most vulnerable times
in their lives. This is who we are” (Cameron & Plews, 2012, p. 101). One manifestation (and test) of this
compassionate culture is illustrated by the following event. Mallozzi recounted it thus:
About 18 months ago, I was visiting our London operations meeting with a variety of clients. British Petroleum (BP) is one of our clients
in Europe, not a client here in the United States. I met with some of their HR [human resources] folks and introduced myself as the new
CEO. I talked about Positive Organizational Scholarship and how we were trying to change the culture of our company. I said that we
wanted to engage them and learn from them. It was a great meeting. Then, about three or four weeks later, the Deep Water Horizon oil
spill occurred with the unfortunate loss of a dozen or so lives and one of the largest environmental spills in history. You could read and see
on TV that the folks at BP were being blasted in the U.S. and throughout the global press regarding their reaction times, what they were
doing, what they were not doing, and so forth. The folks at BP were feeling pretty bad about all this. So were we at my firm. I called up the
senior HR person whom I knew, and I said,
“Listen, I can see what’s going on in the States. I’m sorry that this is happening for you. I understand you’re trying to move a lot of
people into the Gulf area to deal with this crisis. I know you have vendors there probably helping you, but we are a relocation company. I
would like to offer the services of our company to you, free of charge, for the duration of the crisis.”
He said, “Why would you make such an offer?”
“The very simple answer is that we all have a responsibility for what’s going on in the Gulf. We all need to try to help in ways large and
small. This is the best way that I can think of to help you. It’s a sincere offer. If you’d like to take us up on it, great, if you don’t, that’s fine.
I certainly understand.”
About two days later I got a call back from the senior executives at BP. They said, “Well, first off, thank you so much for calling. There
have been a number of vendors with whom we currently do business throughout the world. Many have called offering their services. You
were the only one that offered to do it free of charge. We probably won’t take you up on the offer, but we very much appreciate the
gesture.”
I said, “That’s fine. If you change your mind, we’re happy to do whatever we can to help. Again we’re all responsible here, and we just
want to be helpful.” (Cameron & Plews, 2012, p. 103)

Whereas it was Mallozzi who expressed compassion on behalf of his organization, this offer represented
several thousand employees who were willing and ready to collectively demonstrate their compassion not only
toward Prudential customers but toward unrelated constituencies as well. Mallozzi’s offer was neither a shock
nor a surprise to the organization because the virtue of compassion had been institutionalized as part of the
organization’s culture.1
Another example occurred in the U.S. airline industry in 2001. The terrorist attack on September 11th
exacted a tremendous toll on the U.S. airline industry. People stopped flying, especially short-haul routes,
fearing that airlines were a prime target for terrorists. Ridership fell an average of 20%, and all the airline
companies were forced to downsize. Although Southwest Airlines incurred a larger financial loss than the
industry average due to its reliance on short-haul flights, the CEO of Southwest reflected a uniquely
compassionate culture in the organization. Despite losing millions of dollars per day, and despite the fact that
the entire industry had downsized, CEO Jim Parker articulated an alternative, compassionate response:
Clearly we can’t continue to do this indefinitely, but we are willing to suffer some damage, even to our stock price, to protect the jobs of our
people…. Nothing kills your company’s culture like layoffs. Nobody has ever been furloughed [at Southwest], and that is unprecedented in
the airline industry. It’s been a huge strength of ours. It’s certainly helped us negotiate our union contracts. One of the union leaders came
in to negotiate one time and he said, “We know we don’t need to talk with you about job security.” We could have furloughed at various
times and been more profitable, but I always thought that was short-sighted. You want to show your people that you value them, and
you’re not going to hurt them just to get a little more money in the short term. Not furloughing people breeds loyalty. It breeds a sense of
security. It breeds a sense of trust. (Gittell, Cameron, Likm, & Rivas, 2006, p. 318)

This crisis, in other words, allowed Southwest’s compassionate culture to become transparent. The test the
organization faced was whether it would respond compassionately when serious economic pressures advocated

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the opposite response.2
Other kinds of compassionate activities are also quite common. Tsui (2013) highlighted a variety of
examples in her Academy of Management presidential address after pointing out that 90% of Fortune 500
companies sponsor some form of volunteer program. For example, Disney has supported more than 6 million
hours of volunteer service over the last two decades, and last year directly compensated more than a half a
million hours of employee time to support literacy, hunger and homelessness relief, health care, family
services, and the environment.
OfficeMax, after learning that the average public school teacher spends $1000 of her or his personal funds
for classroom supplies, began in 2007 to place collection boxes in each of its 900 stores to gather office
supplies to be donated to local teachers. Food Gatherers, an organization founded in Ann Arbor, Michigan,
daily collects food from restaurants, hotels, cafeterias, and schools that would normally be discarded but is still
edible and sanitary. The food is donated to homeless shelters and social service organizations that feed the
under-served poor or homeless.
These kinds of activities in organizations are frequently referred to as “corporate social responsibility”
(CSR), and they have become quite widespread in the last several decades, especially in the United States.
Organizational compassion, however, may or may not be equated with CSR, inasmuch as one important
characteristic of compassion is that it represents virtuous actions. Virtuousness, by definition, is its own
reward. It is a good in and of itself. It is not motivated by a desire to receive a reciprocal benefit but merely to
alleviate suffering.
Organizations have frequently been found, however, to engage in CSR for instrumental, financial, or
reputational gain (Bollier, 1996). Some researchers have reported that CSR is typically initiated in order to
acquire a reputational advantage for the firm or as a result of a reciprocal arrangement (Batson, Klein,
Highberger, & Shaw, 1995; Fry, Keim, & Meiners, 1982; Moore & Richardson, 1988; Piliavin & Charng,
1990). Exchange, reciprocity, and self-serving motives are not indicative of organizational compassion,
inasmuch as compassion, at its core, is virtuous. This additional criterion associated with organizational
compassion is discussed in the next section.

Compassion as Virtuousness
Nussbaum (1996) argued that compassion lies at the core of what it means to be human. All major
religions, moral philosophers, and social theorists have valued compassion as an indication of virtue in human
beings. That is, compassion is universally accepted as being much better than its absence (e.g., unfeeling) or its
reverse (e.g., contempt). Compassion is a core virtue listed in citations of universal strengths and virtues
(Peterson & Seligman, 2004), and evolutionary theories of human development now place compassion as a
central force in human survival and flourishing (Goetz et al., 2010). Compassion, in other words, is a core
element in virtuousness.
Virtue has roots in the Latin word virtus, meaning strength or excellence. Anciently, Plato and Aristotle
equated virtuousness with eudaimonia, or the ultimate condition of happiness and flourishing in human
beings. Virtuousness represents the best of the human condition, the most ennobling of behaviors and
outcomes, the excellence and essence of humankind, and the highest aspirations of human beings (Cameron
& Caza, 2013; Comte-Sponville, 2001; Huta, 2013; MacIntyre, 1984; Tjeltveit, 2003). According to

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economist Adam Smith (1976/1790) and sociologist Georg Simmel (1950), virtuousness is the basis upon
which all societies and economies flourish, since it is synonymous with the internalization of moral rules that
produces social harmony (Baumeister & Exline, 1999). Virtuousness in societies provides the integral
elements of good citizenship (White, 1996), reciprocity (Simmel, 1950), and stability (Smith, 1976/1790)
needed to ensure societal longevity. In the original Greek, arête (virtuousness) was recognized as being
demonstrated at both the individual and the collective levels (Schudt, 2000), so virtuousness may be typical of
persons or of organizations.
Organizational virtuousness can be thought of in two ways—virtuousness in organizations and virtuousness
through organizations. “Virtuousness in organizations” refers to the behavior of individuals in organizational
settings that helps other people flourish as human beings (Tjeltveit, 2003). The manifestation and
consequences of individual virtues, such as compassion, hope, gratitude, wisdom, forgiveness, and courage,
have been studied quite extensively by positive psychologists. This form of virtuousness may be expressed by
individuals in work settings, but it is not necessarily a coordinated and collective effort.
“Virtuousness through organizations” refers to coordinated and collective action that fosters and perpetuates
moral excellence and people’s highest aspirations. This includes actions that would not be possible for
individuals to achieve by acting alone. Virtuousness in this sense is often representative of an organizational
culture where the impulse to seek human flourishing is a common factor that guides decisions (Cameron,
2008). It is compassion through organizations that is the primary focus of this chapter.

Tonic and Phasic Virtues

One more nuance is also important to recognize regarding the definition of organizational compassion. It is
based on the fact that a single virtue seldom occurs in isolation. Both empirically (as discussed later) and
experientially, single virtues tend not to occur independently of other virtues. When compassion is
experienced, for example, it mostly occurs in concert with other virtues such as kindness, charity, generosity,
gratitude, and love (Cameron, Mora, Leutscher, & Calarco, 2011; Dutton, Workman, & Hardin, 2014;
Peterson & Seligman, 2004). This is one reason why we use the term virtuousness when describing the
category into which compassion fits.
Virtues, in addition, can be described as being either tonic or phasic in character. Tonic virtues refer to
general dispositions that individuals or organizations possess that are oriented toward the benefit of humanity.
A consistent striving for excellence, eudaimonism, and the common good regardless of circumstances
represents tonic virtuousness (Arjoon, 2000). Tonic virtues are cultural in that they constitute normative
assumptions about what “should be,” or what is “good,” so they influence espoused values and promote
specific behaviors (Schein, 2010). Examples of tonic virtues include humility, generosity, kindness, integrity,
and love. They can be possessed and reflected regardless of circumstances.
Phasic virtues, on the other hand, occur only in certain circumstances. For example, forgiveness is only
demonstrated when an offense has been experienced, harm has been done, or pain has been caused. Forgiving
someone when no injury has occurred makes little sense.
Compassion is an example of a phasic virtue in that is it demonstrated and experienced only under
conditions of suffering or travail. Whereas forgiveness and compassion may become part of the enduring
character of an individual or of the culture of an organization—that is, an organization can develop a

545
compassionate culture so that it is inclined to notice, feel, and demonstrate compassion—compassion is
mostly recognized and demonstrated in the presence of pain and discomfort. It is conditional or phasic. This
distinction is important because when we discuss empirical studies of organizational compassion in the next
section, the predictive power of phasic and tonic virtues is different (Bright, Cameron, & Caza, 2006).

The Effects of Compassion on Organizational Performance

Most research on compassion has been conducted at the individual or dyadic level of analysis. Studies have
focused primarily on the emotions, reactions, and relationships that occur in individuals or in relationships
between two people—one who is suffering and one who is experiencing or acting with compassion. This
research has shown that people who feel compassion demonstrate higher levels of helping behavior, moral
reasoning, connectedness, and stronger interpersonal relationships, as well as less depression, reduced
moodiness, and less mental illness (Cassell, 2002). They also are rated as better leaders and as more intelligent
by others (Melwani, Mueller, & Overbeck, 2012). Recipients of care, support, or assistance that is motivated
by compassion tend to recover physically from injury or illness (Brody, 1992) and emotionally from grief
(Bento, 1994) more quickly and thoroughly, and show enhanced commitment, self-esteem, self-efficacy,
prosocial identity, and a sense of dignity than others (Dutton, Workman, & Hardin, 2014).
On the other hand, a potential downside of individual compassion in organizational settings has been
proposed by Kanov et al. (2004). These authors argued that demonstrations of compassion in organizations
may be time- and energy-consuming so that, over time, compassion may actually diminish performance. That
is, compassion may deflect resources and consume energy and time away from more centrally important
activities. George (2013) made a similar point in arguing that compassion is antithetical to capitalistic motives
and outcomes. Compassion in organizational contexts, she proposed, may produce more negative effects than
the positive outcomes typical of individual-level or dyadic-level compassion.
These proposed differences in effects at the individual, dyadic, and organizational levels of analysis
highlight the need to empirically examine organizational compassion and its impacts. Whereas the number of
empirical studies focusing on organizational compassion is limited, a few studies do highlight the effects of
collective compassion in the workplace.

Compassion Across Industries

One set of studies examined a sample of 18 organizations representing 16 different industries. Industries
included retail, manufacturing, steel, automotive, public relations, transportation, business consulting, health
care, power generation, and social services (Cameron, Bright, & Caza, 2004; Bright, Cameron, & Caza,
2006). All but two of these organizations were downsizing or had recently downsized, so the likelihood of
suffering in those organizations was high. Downsizing almost always results in harm and distress in
organizations, with a resulting deterioration in survivors’ performance (Cameron, 1998; Cameron, Kim, &
Whetten, 1987).3
A survey instrument was developed to assess the presence of organizational virtuousness in these
organizations. Thirty-two different virtues were included, based on previous instruments and from reviews of
the literature on universal virtues (e.g., Peterson & Seligman, 2004; Sandage & Hill, 2001). The survey was
distributed to 1,437 employees across functions and hierarchical levels in these 18 organizations. The number

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of respondents in each organization ranged from 11 to 96. Items measured collective virtuousness
implemented at the organization level rather than individual actions. Examples of items on the survey
included: “Acts of compassion are common in this organization”; “Kindness and benevolence are expected of
everyone in this organization”; “Employees are inclined to forgive one another’s mistakes.”
In one study (Cameron, Bright, & Caza, 2004), the effect of virtuousness on organizational performance
was examined, and objective indicators of performance (e.g., profitability, productivity, employee turnover,
customer retention) as well as subjective outcomes (e.g., innovation, quality, morale) were included in the
analyses. Overall organizational virtuousness produced statistically significant (p < .001) effects in both
objective and subjective performance, and it predicted between 15% and 18% of the variance in the outcomes.
The virtue of compassion alone was predictive at the p < .05 level. That is, organizations demonstrating high
levels of virtuousness, including compassion, performed significantly better on objective and subjective
outcomes than did other organizations. These results do not support the liabilities of compassion in
organizations that were proposed by Kanov et al. (2004) and George (2013).

Compassion Amidst Downsizing

In another study using the same instrument (Bright, Cameron, & Caza, 2006), the focus was on the
deleterious effects of downsizing on the organizations’ performance. In previous investigations (Cameron,
Kim, & Whetten, 1987; Cameron, 1994; Freeman & Cameron, 1993; Cameron, 1998), downsizing had been
found to be associated with 12 negative, dysfunctional outcomes that appear almost universally in
organizations that chose to eliminate jobs and lay off workers.4 These twelve factors led almost universally to
deteriorating organizational performance.
In this particular study, tonic virtues loaded together on one factor (e.g., kindness, generosity, integrity,
humility) and phasic virtues (e.g., forgiveness, compassion, courage) loaded together on another factor.
Whereas both tonic and phasic virtues were inversely related to the deleterious effects of downsizing, phasic
virtues (i.e., compassion) were more powerful predictors. That is, organizations characterized by higher levels
of compassion and forgiveness were much less likely to experience the 12 negative attributes associated with
downsizing than were other firms. These results also confirmed that when virtuousness exists in organizations,
organizational performance increases. Innovation, customer retention, profitability, quality, and less employee
turnover were all positively associated with virtuousness.

Compassion in Financial Services and Health Care

Two additional studies—one conducted in 40 business units in the financial services industry and a second
conducted in 29 nursing units in the healthcare industry—provided further insight into the role of
organizational compassion in affecting organizational performance (Cameron, Mora, Leutscher, & Calarco,
2011). The financial services industry was selected because organizational compassion and virtuousness are not
often associated with this sector, which is stereotypically dominated by a profit motive above all else. Nursing,
on the other hand, is stereotypically concerned with compassionate care and human service.
A unique instrument was developed for investigating organizational virtuousness, consisting of 114 Likert-
type items representing virtuous practices at the organizational level of analysis. Examples of items are: “We
treat each other with respect.” “We trust one another.” “We help people who are facing difficulty.” “We

547
genuinely care about each other.” “We do not blame one other when mistakes are made.”
An exploratory factor analysis revealed six factors that explained the variance in employee responses, and
these factors were used to predict organizational effectiveness in both industry sectors. The factors were
labeled as Caring and Kindness, Compassionate Support, Forgiveness, Inspiration and Transcendence,
Meaning and Meaningfulness, and Respect, Integrity, and Gratitude.
Compassionate support was measured at the organization level by the following items, possessing a
Cronbach alpha reliability coefficient of .95:

We help people who are facing difficulty.

We are there for fellow employees who are struggling.
We provide emotional support to each other.
We show compassion for each other.
We show kindness to one another.

In order to investigate causal relationships in both organizational sectors, measures were taken at year 1 and at
year 2, and a change score was computed to determine whether improvement in virtuousness and compassion
had occurred over time. The various outcome measures were assessed with a one-year lag from the
virtuousness assessments to ensure causal directionality.
In the financial service organizations, improvement in virtuous practices was significantly associated with
financial performance, work climate, turnover, and senior executive evaluations of effectiveness. Financial
service organizations that improved in their virtuousness over a two-year period of time produced significantly
more revenues, a better work climate, less employee turnover, and more customer retention than organizations
that did not improve. Figure 30.1 summarizes these results.
In an industry in which virtuousness traditionally carries little importance and in which financial
considerations predominate, organizational performance was significantly improved by the implementation of
virtuous practices.5 Compassion as a single dimension was not independently predictive of these outcomes but
only in combination with the other virtues.
In the study of the health care sector using the same instrument, improvement in positive practices was also
investigated over a two-year period of time. Again, lagged assessments were taken of multiple outcome
variables, and two-year change scores were used as predictors. Figure 30.2 summarizes the results.

548
Figure 30.1 Effects of virtuousness of organizational outcomes in financial services (Cameron, Mora, Leutscher, & Calarco, 2011).

Figure 30.2 Effects of virtuousness on outcomes in healthcare organizations (Cameron et al., 2011).

Virtuous practices at the organizational level predicted improvements in employee turnover, patient
satisfaction, organizational climate, employee participation in the organization, quality of care, managerial
support, and resource adequacy. The specific positive practices that emerged as most predictive in the nursing
unit study were those associated with the development and support of human capital—including compassion,
respect, integrity, gratitude, forgiveness, inspiration, and meaningful work. Compassion by itself was
moderately predictive of the outcomes, but again, it was a much more powerful predictor in conjunction with
other virtuous practices. Figure 30.3 reports the double-digit improvement over the two-year period on the
various outcomes.
It is important to note that, by definition, virtuous practices do not need to produce traditionally pursued

549
organizational outcomes in order to be of worth. An increase in profitability, for example, is not the criterion
for determining the value of compassion in organizations. Virtuousness is inherently valued because it is
eudaimonic. It is universally the highest aspiration for human beings (Aristotle, Metaphysics XII, p. 3).
Instrumental outcomes are not the relevant criteria for determining the extent to which virtuousness should be
pursued in organizations. Nevertheless, virtuous practices—including the demonstration of compassion—do
have an effect on the outcomes for which leaders and managers are held accountable. Institutionalized
virtuousness, including compassion, has been shown to help organizations achieve significantly elevated levels
of performance on desired outcomes (Cameron et al., 2004; Cameron et al., 2011; Gittell et al., 2006).

Explanations for Why Compassion Affects Performance

There are at least three explanations for why compassion and other virtuous practices can elevate
organizational performance—amplifying effects, buffering effects, and heliotropic effects (Cameron, Mora,
Leutscher, & Calarco, 2011). This discussion focuses primarily on virtuousness, not compassion exclusively,
although, as mentioned before, compassion tends to overlap with other virtuous behaviors and can be
considered a core indicator of virtuousness.

Figure 30.3 Percent improvement over a two-year period in health care organizations (Cameron et al., 2011).

Amplifying Effects
Virtuous practices provide an amplifying effect because of their association with positive emotions and with
social capital (Cameron, Bright, & Caza, 2004). Several authors have reported that exposure to virtuousness
produces positive emotions in individuals, which, in turn, leads to elevation in individual performance in
organizations (Fredrickson, 1998; Seligman, 2002; Fineman, 1996; Staw, Sutton, & Pellod, 1994; Kok, &
Fredrickson, 2010). When organization members observe compassion, experience gratitude, or witness
forgiveness, for example, a mutually reinforcing cycle begins. They feel compelled to behave with compassion,
gratitude, or forgiveness, thus magnifying or amplifying the experience of virtuousness. Fredrickson (2003, p.
173) reported that “elevation increases the likelihood that a witness to good deeds will soon become the doer
of good deeds, then elevation sets up the possibility for some sort of upward spiral … and organizations are
transformed into more compassionate and harmonious places.”
This effect is well documented in the social networks literature (Christakis & Fowler, 2009). Staw and

550
Barsade (1993) found that positive emotions produce improved cognitive functioning, better decision-making,
and more effective interpersonal relationships among organization members. Employees experiencing positive
emotions are more helpful to customers, more creative, and more attentive and respectful to one another
(George 1998; Sharot, Riccardi, Raio, & Phelps, 2007).
A second reason for the amplifying effects of virtuousness in organizations is their association with social
capital formation (Coleman, 1998; Baker, 2000). “Social capital” in organizations refers to the relationships
among individuals through which information, influence, and resources flow (Adler & Kwon, 2002; Leana &
Van Buren, 1999; Nahapiet & Ghoshal, 1998). Several researchers have reported that when employees
observe displays of virtuousness among fellow employees—for example, compassion, kindness, generosity, or
caring—the results are enhanced liking, commitment, participation, trust, and collaboration, all of which may
contribute to organizational performance (Podsakoff, MacKensie, Paine, & Bachrach, 2000; Koys, 2001;
Walz & Niehoff, 2000). These enhanced relationships serve as the social capital upon which organizational
performance is built. They form a reserve of resources that facilitates effectiveness.
The Gittell, Cameron, Lim, and Rivas (2006) study discussed before identified this reserve of social
relationships as the key predictor of airline company recovery after the September 11th attacks. Airline
companies displaying the most virtuous practices in coping with the September 11th crisis emerged with the
strongest financial performance over the next five years. Organizational performance is likely to be enhanced,
therefore, because amplifying virtuous practices foster more social capital, better organizational climate, better
coordination and decision-making, and better care of customers and fellow employees.

Buffering Effects
Virtuous practices also buffer the organization from the negative effects of trauma or distress by enhancing
resiliency, solidarity, and a sense of efficacy (Masten & Hubbard, Gest, Tellegen, Garmezy, & Ramirez, 1999;
Weick, Sutcliffe, & Obstfeld, 1999). Seligman and Csikszentmihalyi (2000) pointed out that the development
of virtuous practices serves as a buffer against dysfunction and illness at the individual and group levels of
analysis. They reported that compassion, courage, forgiveness, integrity, and optimism, for example, prevent
psychological distress, addiction, and dysfunctional behavior (Seligman, Schulman, DeRubeis, & Hollon,
1999).
At the group and organization levels, virtuous practices enhance their ability to absorb threat and trauma
and to bounce back from adversity (Dutton, Frost, Worline, Lilius, & Kanov, 2002; Wildavsky, 1991),
including absorbing work-related stress (Cohen, 2003; Kaplan, 2003; Kiecolt-Glaser, 2003) and healing from
traumatic events (Powley & Cameron, 2007). Virtuous practices serve as a source of resilience and “toughness”
(Dienstbier & Zillig, 2002); in other words, in helping to preserve social capital and collective efficacy
(Sutcliffe & Vogus, 2003), and in strengthening, replenishing, and limbering organizations (Worline et al.,
2003). They serve as buffering agents that protect and inoculate organizations, permitting them to bounce
back from misfortune and to avoid deteriorating performance. The research reported earlier by Bright,
Cameron, and Caza (2006), which investigated organizations engaged in downsizing, demonstrates the
resilience and recovery that virtuous organizations experienced.

Heliotropic Effects

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 Virtuous practices also possess attributes consistent with heliotropism (Drexelius, 1627, 1862). The
heliotropic effect is the attraction of all living systems toward light and away from dark, toward positive
energy and away from negative energy (the sun is the source of positive energy in nature), or toward that
which is life-giving and away from that which is life-depleting (Smith & Baker, 1960; D’Amato & Jagoda,
1962; Mrosovsky & Kingsmill, 1985). Every living system has an inherent inclination toward positive, life-
enhancing forces and away from negative, life-diminishing forces. Organizations characterized by virtuous
practices foster positive energy among their members, and positive energy produces elevated performance
(Erhardt-Siebold, 1937; Dutton, 2003; Cameron, 2012).
Several explanations have been proposed for why heliotropic tendencies exist in human beings and their
systems. Erdelyi (1974) explained positive biases as a product of individual cognitive development. Perceptual
defense mechanisms (e.g., denial, displacement) emerge to counteract the effects of negative information, so
inclinations toward positivity develop in the brain. In brain-scan research, Sharot, Riccardi, Raio, and Phelps
(2007, p. 102) found that the human brain tends toward optimistic and positive orientations in its natural
state, and that more areas of the brain activate when positive and optimistic images are processed compared to
negative or pessimistic images.
Unkelbach et al. (2008) reported a series of studies showing that the human brain processes positive
information faster and more accurately than negative information, so human productivity and performance are
elevated by the positive more than the negative. Learning theorists (e.g., Skinner, 1965) explain positive biases
as being associated with reinforcement. Activities that are positively reinforcing are repeated, while activities
that are punishing or unpleasant are extinguished. In a study by Hamlin (2013), infants from three to eight
months old were involved in experiments in which they could choose a helpful, compassionate hand puppet to
play with, or a puppet that was depicted as unhelpful and non-virtuous. Overwhelmingly, infants preferred the
puppets that were compassionate. The study concluded that even in pre-language infants, an inherent
tendency exists to prefer virtuousness and compassion.
Organizationally, heliotropic tendencies in social processes can be explained by the basic motivation in
social systems to organize (Merton, 1968; Weick, 1999). Simply stated, organizing occurs in order to benefit
the collective, so human organizations, at their core, are intended to facilitate positive benefits. The
eudaimonic tendency in human beings leads people toward helping or contributing behaviors (Krebs, 1987),
and when others observe these behaviors, they feel compelled to join with and build upon those contributions
(Sethi & Nicholson, 2001).
Gouldner (1960) proposed that role modeling and social norm formation create a tendency toward the
positive. Virtuous social processes are more likely to survive and flourish over the long run than negative social
processes, because they are functional for the group. Collectives survive when they rely on positive norms, and
these norms are a direct product of demonstrated virtuous practices. Evolutionarily, the dysfunctional effects
of non-virtuous practices cause them to eventually become extinguished (Seppala & Cameron, 2015).
In sum, at least three explanations find grounding in the literature for why virtuousness and compassion in
organizations are predictive of higher performance. Cognitively, emotionally, behaviorally, physiologically,
and socially, evidence suggests that human systems naturally prefer exposure to virtuousness, so it is expected
that organizational performance will be enhanced by virtuous practices and demonstrations of compassion.

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Exceptions
Of course, it is important to keep in mind that “All sunshine makes a desert.” That is, a constant or
exclusive focus on virtue may have detrimental effects in organizations. Baumeister and colleagues (2001)
highlighted this fact in their paper entitled “Bad Is Stronger Than Good.” They pointed out that negative
events usually overpower positive events and compassionate tendencies. For example, negative feedback has
more emotional impact on people than positive feedback (Coleman, Jussim, & Abraham, 1987), and the
effects of negative information and negative events take longer to wear off than the effects of positive
information or pleasant events (Brickman, Coates, & Jason-Bulman (1978). A single traumatic experience
(e.g., abuse, violence) can overcome the effects of many positive events, but a single positive event does not
usually overcome the effects of a single traumatic negative event (Laumann, Gagon, Michael, & Michaels,
1994; Laumann, Paik, & Rosen, 1999). Negative events usually get priority in organizations, therefore, and it
often requires conscious effort on the part of organization members, and/or a compassionate organizational
culture, to give priority to coordinated compassionate responses in organizations.

Questions, Issues, and Future Research on Organizational Compassion

Despite the increasing attention being paid to compassion research, the entire field of study associated with
organizational compassion is still very much in the toddler stage of development. The field is still building a
foundation both theoretically and empirically. Among the foundation stones that need to be put into place
are:

• A precise definition: At the organizational level of analysis, in spite of the definition proposed in this
chapter, a consensual and precise definition of compassion still needs to be developed. Research thus far has
only scratched the surface in examining the various indicators and attributes of compassion in organizations.
A putative definition and an empirically valid measurement instrument are necessary for the foundation to be
built.
• Empirical underpinnings: Far too few rigorous empirical studies have examined compassion at the
organization level of analysis. Its measurement, its impact, and its relationship to various organizational
dynamics such as incentive systems, engagement, culture, and leadership are examples of this largely
unexamined territory. The relationship of compassion—and similar phasic virtues—to various kinds of
organizational outcomes such as productivity, quality, customer loyalty, revenue generation, and innovation
are mostly unidentified, barring the few studies mentioned here.
• Dimensions: In one set of empirical studies reported earlier, organizational compassion was found to be a
phasic virtue rather than a tonic virtue. However, like all virtues, organizational compassion is likely to be
multidimensional. The conditions under which compassion has independent effects, the extent to which it
occurs in the presence of certain virtues but not others, and the extent to which compassion can be observed as
an independent state, are all unexplored questions. The clusters of virtues that occur in combination with
compassion are still unexplored.
• Organizational contexts: Different types and levels of suffering, pain, grief, sadness, and discomfort occur
in organizations. Still unexamined is the extent to which compassion has different manifestations in different
circumstances and different effects in different kinds of organizations. The multidimensionality and multiple
expressions of compassion in organizations have yet to be investigated, as have the effects of compassion on

553
different organizational outcomes.

Compassion fatigue occurs when compassionate actions are not acknowledged or reciprocated (Adams,
Boscarino, & Figley, 2006), or when the requirements for demonstrating compassion are overwhelming. (For
example, an overabundance of newspaper reports of suffering and tragedy has been reported to lead to
compassion fatigue; Dart Center, 2008; see also Cameron, “Compassion Collapse,” this volume). The extent
to which expressions of compassion are inappropriate in some organizational settings is still unknown, and the
limits of compassion and its effects in organizations have not been explored.

• Ethnocentrism: One criticism of positive organizational scholarship and positive psychology is that they
represent a culturally biased point of view. They are accused of superimposing a Western value set on others.
Different cultures and ethnicities may not value compassion in the same way that it is espoused and studied in
the United States (see Koopmann-Holm and Tsai, this volume). We still know relatively little about how this
virtue of compassion is expressed and how it affects organizational performance in multiple cultural and
geographic contexts.
• Organizational reinforcement: The mechanisms by which organizations best foster and facilitate
compassion, and the extent to which generalized incentives or strategies are available to organizations, are still
to be determined. If organizational compassion has positive impacts on desired outcomes—as the evidence to
date suggests that it does—too little is known about how leaders and organizations can enable more
compassion at the organizational level of analysis.

Conclusion
In this chapter, we have identified two additional definitional attributes of compassion when it is
considered at the organizational level of analysis. In addition to “sensitivity to the pain or suffering of another,
coupled with a deep desire to alleviate that suffering,” actively assisting or responding to suffering is necessary
for compassion to be detected at the organization level of analysis. Action is the evidence that compassion
exists as part of the organization’s culture.
In addition, compassion is a virtue, and as such, it is inherently valuable, even if no beneficial outcomes are
detected. Virtuousness, in Aristotle’s terms, is a good of “first intent”—worthwhile for its own sake.
Compassion is demonstrated regardless of any expectation of recognition or reward.
Moreover, compassion is seldom demonstrated independently in organizations. Both empirically and
experientially, compassion usually occurs in the presence of other virtues such as kindness, charity, generosity,
gratitude, and love. These virtues may have different effects in different types of conditions when suffering,
grief, or pain is being experienced.
A few research studies that examined compassion at the organizational level of analysis found that
significant positive effects were produced when virtuousness improved over time in organizations. Findings
revealed that organizational performance improves when compassion and virtuousness improve. Because most
research has occurred at the individual and dyadic level of analysis, however, much remains to be done to draw
precise and well-supported conclusions regarding compassion in organizations.

554
555
Notes
1. More explanation of this incident and how this organization’s compassionate culture was developed is available in Cameron and Plews
(2012).
2. Southwest Airlines, parenthetically, is the only airline not to suffer a single losing quarter since September 11th, 2001, and its financial
return has exceeded the industry average by a factor of 4. Importantly, it has exceeded the financial return of airline companies that did not
demonstrate collective compassion by a factor of 8. (See Gittell, Cameron, Lim, & Rivas, 2006, for a more thorough explanation of the
factors that accounted for Southwest’s financial performance.)
3. A survey of research on downsizing and job loss over the previous two decades found an association between job loss and significant
deterioration in workplace trust, personal security, depression, perceptions of justice, social relationships, commitment, and loyalty, extra-
role behavior, family relationships, workgroup support, and prosocial acts (Cooper, Pandey, & Quick, 2012). Downsizing organizations,
therefore, provide an ideal context in which to study the effects of organizational compassion.
4. The 12 dysfunctional factors almost universally associated with downsizing in organizations are: Centralization: Decision-making is pulled
toward the top of the organization. Less power is shared. Short-term, crisis mentality: Long-term planning is neglected. Slack resources are
used up. First-learned, habitual responses predominate. Threat-rigidity response occurs. Loss of innovativeness: Trial-and-error learning is
curtailed. There is less tolerance for risk and failure associated with creative activity. Resistance to change: Fear, uncertainty, and potential loss
leads to conservatism, “hunkering-down,” and a protectionist stance. Decreasing morale: Infighting and a “mean mood” permeate the
organization. Politicized environment: Special-interest groups organize and become more vocal. The climate becomes politicized. Loss of
loyalty: Commitment to the organization and to other employees deteriorates as perceptions of injustice, secretiveness, and unclear priorities
emerge. Loss of trust: Leaders lose the confidence of subordinates, and distrust of one another, the future, and the organization increases
among members. Increasing conflict: Fewer resources result in internal competition and fighting for a smaller pie. Goal displacement occurs
as acquiring resources replaces striving for outcomes. Restricted communication: Only good news is passed upward. Information is not widely
shared because of fear and distrust. Lack of teamwork: Individualism and disconnectedness make teamwork difficult. Individuals are not
inclined to share, sacrifice for one another, or act benevolently. Leadership anemia: Leaders are scapegoated, priorities are unclear, a siege
mentality prevails, and the best leaders tend to exit (Cameron, Kim, & Whetten, 1987; Cameron, 1994).
5. For examples of the virtuous practices that produced these positive results, see Cameron and Plews (2012) and Cameron and Vanette
(2009).

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 How Leaders Shape Compassion Processes in Organizations

Monica C. Worline and Jane E. Dutton

Abstract

This chapter focuses on how leaders matter for the expression of compassion in organizations. Leaders
are imbued with both instrumental and symbolic power to shape individual and organizational responses
to suffering. To understand how leaders impact a system’s compassionate responses, we focus on
leadership moves, defined as actions taken by leaders in relation to those who are suffering and/or those
who are seeking to alleviate suffering. We identify twelve leadership moves and offer a theoretical view
of how these twelve leaders’ moves impact the way emergent compassion processes unfold. We focus
particularly on the importance of (1) how leadership moves shape the expression of suffering; (2) how
leaders draw attention to pain; (3) how leaders feel and express emotion; and (4) how they frame and
narrate suffering. This review illuminates the variety of ways that leaders matter and invites further
research into new questions about compassion and leadership.

Key Words: leadership, emotion, sensemaking, role modeling, suffering at work

Work organizations play a pivotal role in both creating and alleviating suffering (Frost, 1999). In
contemporary life, workplaces are the terrain where many people spend the majority of their waking hours.
Work is often a crucial locus of identity for people (Ashforth & Mael, 1989), as well as a source of purpose,
accomplishment, growth, and thriving (Sonenshein, Dutton, Grant, Spreitzer, & Sutcliffe, 2013). On the
other hand, the absence of work can be a significant source of economic suffering for people and communities
(e.g., Arulampalam, 2001; Wilson, 1996). The absence of work also causes mental and emotional pain that
flows from a loss of identity, purpose, dignity, and meaningful engagement with others (Driver, 2007; Paul &
Moser, 2009; Wilson, 1996).
In many instances of suffering, organizational boundaries become blurry. People bring suffering created at
home to work, to school, to church, and to community organizations. Our interdependence with each other in
getting work done makes it clear that we don’t “check our suffering at the door.” Likewise, suffering created in
organizations also marches back home with people. The flow of suffering into and out of work contexts makes
it important to understand, not just the individual science of compassion, but also how organizational leaders,
cultures, structures, and practices shape the ability and willingness of organizational members to respond to
suffering that crosses the semipermeable membrane between work and home (Lilius, Worline, Dutton,
Kanov, & Maitlis, 2011). In this chapter, we focus particularly on leaders, who are imbued with the
instrumental and symbolic power to shape individual and organizational responses to the presence of suffering
in workplaces. Further, we focus on the actions and interactions leaders take—their “moves”—to unpack the
process by which leaders influence an organization’s compassionate responses to suffering.

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 To understand the process of leading in ways that draw out compassion in a system, we emphasize the
importance of understanding how leaders’ moves impact a system’s compassionate responses. In line with this
goal, we adopt a social-interaction view of leadership, where “leadership” is defined, not as individualistic,
hierarchical, or one-directional, but rather as “repeated leading-following interactions” (DeRue, 2011, p. 126).
In this view, leadership is constituted through interactions between people in context. Leaders can influence
compassion in organizations through their interactions with people, as well as through the ways they shape
the work context. This definition assumes that leaders and followers co-construct relations, identities, and
resources that create patterns at the collective level, and that is what we refer to as leadership (DeRue, 2011).

Compassion as a Process in Organizations

This chapter provides a view of compassion that is distinctly organizational. It builds on physiological and
psychological research summarized and reviewed by other chapters in this handbook, but it also draws from
the interdisciplinary science of organizational studies, which sits at the intersection of organizational behavior,
sociology, psychology, economics, and organizational theory. While many readers familiar with the
psychology of compassion will recognize the kinds of processes proposed here, organizational theory may be
less familiar, with its strong ties to social structures, social processes, and collective outcomes (Scott & Davis,
2007; Hatch & Cunliffe, 2012). It is important to keep this level of theory in the foreground in order to
understand the contextually embedded relationship between leadership and compassion. Accordingly, we
integrate psychological and sociological approaches to compassion—expanding the psychological definition of
compassion slightly to incorporate four social processes that are essential to compassion in organizations.
Some of the four-part-process view that we adopt is evident in this volume’s definition of compassion as “a
feeling that arises in witnessing another’s suffering and that motivates a subsequent desire to help” (Goetz,
Keltner, & Simon-Thomas, 2010, p. 351). Dutton, Workman, and Hardin (2014), unpacking compassion as
an organizational process, elaborate that this definition entails attention to and noticing of suffering, as well as
interpreting or making sense of suffering in context, and these two processes inform the feeling that arises, as
well as the motivation and the actions that are taken in response to suffering. We add the Dutton, Workman,
and Hardin (2014) depiction of compassion as a social process to the account of compassion as an individual
emotion. We therefore define compassion as a four-part process that includes (1) attention to suffering, (2)
“sensemaking” about suffering, (3) felt empathic concern, and (4) action to alleviate suffering. This rendering
of compassion as a four-part social process is depicted in Figure 31.1, adapted from Dutton, Workman, and
Hardin’s (2014) review. It depicts essential aspects of compassion as a social process to help us map how
aspects of organizations, including leadership, affect the process.
We will also unpack leaders’ impacts on the compassion process in organizations in four steps that
correspond to this process view. First, we ask how leaders structure attention or inattention to suffering.
Second, we focus on how leaders shape the meaning of suffering. Third, we emphasize how leaders impact
feelings of empathic concern as part of a process of compassion. And fourth, we emphasize that, in
organizations, compassion comprises actions aimed to alleviate suffering, and leaders influence this critical
phase of the compassion process as well.

Understanding Compassion as a Process

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 A process view of compassion necessarily moves us beyond an individualistic understanding, helping us see
compassion as it unfolds between people in context. We will briefly discuss this understanding of compassion
for those who are more familiar with an individual definition, using Figure 31.1 as a guide.
Point A of Figure 31.1 calls attention to how suffering emerges inside an organizational context in what
Lilius and colleagues (Lilius, Worline, Maitlis, Kanov, Dutton, & Frost, 2008) refer to as “pain triggers.” Pain
triggers include suffering originating from work itself, such as being punished or belittled for an error, as well
as situations arising from life outside of work. Point A of Figure 31.1 also makes it clear that episodes of
suffering launch an emergent process of organizing, where each subsequent aspect of the process is unique to
that instance of suffering.
Point B of Figure 31.1 emphasizes that suffering can be expressed in a variety of ways, and the expression of
suffering is crucial to how the process unfolds. Organizational members must notice and make sense of
expressed suffering in order for compassion to emerge. People’s willingness and ability to express suffering in
organizations hinges on many factors, including personal worries about upsetting others (Goodrum, 2008),
role expectations for professionalism (Atkins & Parker, 2012), relational closeness (Clark, 1987), norms for
emotional expression (Elfenbein, 2007), and many others, including leadership (see Dutton et al., 2014). We
focus directly on leaders and the effect of leaders on the compassion process (for other organizational aspects
and impacts of compassion, see Cameron, Chapter 30, this volume).

Figure 31.1 Essential aspects of compassion as a social process in organizations.

Adapted from Dutton, Workman, & Hardin (2014), Compassion at work. Annual Review of Organizational Psychology & Organizational
Behavior, 1, 277–304.

Point C of Figure 31.1 emphasizes the important and central role of sensemaking or meaning-making in
the unfolding of compassion as a social process. In organizations, each aspect of the compassion process
hinges on the meaning that people make of what is happening. When people in organizations make sense of
suffering in ways that suggest it is unprofessional or illegitimate (e.g., Goodrum, 2008; Simpson, Clegg, &
Pitsis, 2014a), compassion can be blocked. While we might wish that all expressions of suffering would be
greeted with compassion, research shows that the “appraisals” or meaningful accounts people make of
suffering feed directly into their feelings of empathy and willingness to act with compassion (Atkins & Parker,
2012; Goetz et al., 2010). Later, we discuss the important role of leaders in shaping these appraisals and

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collective sensemaking in relation to suffering in ways that can foster greater compassion.
Point D of Figure 31.1 emphasizes that it is possible for suffering to be ignored in organizations. The
context shapes what people attend to in powerful ways. Research indicates that attentional load, time
pressures, and performance demands all influence whether or not suffering is noticed, even by those who are
individually likely to act with compassion (e.g., Chugh, 2004; Darley & Batson, 1973). In one well-known
social psychology study, participants who were recruited from a seminary school were asked to prepare and
deliver an impromptu three- to five-minute speech on the topic of “The Good Samaritan,” a Biblical parable
related to helping strangers. In one study condition, participants and were told that they were late and had to
hurry to the room where the speech would be given. As part of the research design, all participants walked
through an alley to get to the room where they would give their speech. In the alley was a person slumped in a
doorway who coughed and groaned as the participant walked by. The victim, actually a confederate in the
study, recorded the degree of a subject’s helping. Of the people who were told to hurry, only 10% stopped to
help, even though they were hurrying to give a speech about the Good Samaritan (Darley & Batson, 1973).
Work organizations are full of time and performance pressures that preoccupy people and hinder their ability
to notice the state of others.
Point E of Figure 31.1 emphasizes that attention and meaning-making related to suffering affects the
likelihood of felt empathic concern. Felt empathic concern is a primary component of the compassion process,
and it is important in motivating compassionate action, as demonstrated by scholars such as Batson (2014).
Here we simply point out that contextual factors are crucial in shaping the link between noticing suffering and
feeling empathic concern. For instance, toxic work relationships can sour people toward one another in ways
that lead them to feel indifference rather than concern toward one another’s pain (Frost, 2003; Scandura,
1998). In some work organizations, which value independence and self-reliance rather than interdependence
and mutual regard, people treat suffering from job stress and burnout with criticism rather than compassion
(e.g., Meyerson, 1994). Widespread incivility in the workplace can lead members of organizations to disregard
indicators of pain or feel distress rather than empathic concern toward suffering (Frost 2003; Pearson &
Porath, 2009). With regard to felt empathic concern and compassionate action, as we will show, leaders are an
important source of modeling how to feel and how to act.
Point F of Figure 31.1 shows that all of these factors in the process contribute to the overall likelihood and
shape of compassionate actions in organizations. Compassionate actions are highly diverse, ranging from
something as seemingly minor as extending a supportive hand on a shoulder, to something as seemingly major
as a large financial donation (Lilius et al., 2008). Even seemingly small acts that demonstrate social and
emotional support in organizations are often perceived as significant, so the impact ascribed to these actions
cannot be determined in advance or easily captured by outsiders (Lilius et al., 2008).
Point G of Figure 31.1 draws attention to the variety of outcomes of the unfolding process. Some of these
outcomes are material resources, such as when co-workers donate money or other goods to alleviate suffering.
Others are psychological resources such as social and emotional support for coping and recovery. Still others
are meaning-based resources such as a different view of oneself at work or co-workers (Lilius et al., 2008).
Giving, receiving, or witnessing compassion in an organization also generates resources for the organization,
such as greater emotional attachment and commitment to the organization (Lilius et al., 2008; Grant,
Dutton, & Rosso, 2008).

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 Figure 31.1 may make the compassion process appear overly linear, but the prevalence of double-headed
arrows indicates the possibility of many feedback loops and different patterns. Seeing compassion as a social
process reminds us that demonstrating compassion is rarely a solo act. Depending on the type of suffering that
emerges in an organizational context, the response often involves many people and the mobilization of several
groups, networks, and roles (Dutton, Worline, Frost, & Lilius, 2006). As this process unfolds, leaders are
important at each step. For the remainder of the chapter, we will focus on how leaders influence the process as
it unfolds and how the actions of leaders can amplify or diminish compassion in organizations through this
process.

Why Focus on Leaders?

We know that leaders play a central role in shaping compassion as it unfolds in organizations (Frost, 1999;
2003). Because of their pivotal importance, leadership messages and actions can have outsized impacts. This
may be particularly true in times of distress, when we look to leaders for hope and vision, as well as to manage
our frustration and anxiety, as captured by leadership scholar Heifetz (1994):
In times of distress, we turn to authority. To the breaking point, we place our hopes and frustrations upon those whose presumed
knowledge, wisdom, and skill show the promise of fulfillment. Authorities serve as repositories for our worries and aspirations, holding
them, if they can, in exchange for the powers we give them. (p. 69)

Research on the particular effects of leaders on compassion in organizations is still in its early stages. Few
studies employ rigorous research designs to investigate the relationship between leadership and compassion.
Leaders’ willingness, ability, and skill in relation to suffering and compassion—while noted as essential to
building greater cultures or climates of compassion—is still little investigated and not well understood.
In the absence of a large field of established findings, we hope to shape future research and draw out fruitful
questions by building on the theoretical framework of compassion as a social process described before. We
present a high-level, theoretically based view of leadership moves that shape the process of compassion in
organizations. We define leadership moves, in keeping with Goffman (1981), as actions taken in relation to
others—these are behaviors that constitute interpersonal interactions. Leadership moves related to compassion
are actions taken by leaders in relation to others who are suffering and/or actions taken by leaders in relation
to people who are seeking to alleviate suffering in the organization. For instance, someone in a formal
leadership role giving a speech that draws attention to compassion being mobilized in an organization is
making a leadership move related to compassion because it amplifies or enhances the attention to suffering and
the actions being taken to alleviate suffering.
Theorizing about moves is common in organizational studies, building on a sociological view of interactions
that comprise social structures. Moves are a form of practical knowing-in-action (Dutton, Ashford, O’Neill,
& Lawrence, 2001; Pentland, 1992), or micro-acts of a routine (Grodal, Nelson, & Siino, 2015; Pentland &
Rueter, 1994). Moves are interpersonal actions that fuel common organizational patterns. In relation to
compassion, leaders’ moves show us the ways that people in positions of influence can use knowing-in-action
to influence whether and how compassion is enacted. A focus on leaders’ moves emphasizes social process and
leading-following interactions, helping to avoid seeing leadership as overly individualistic or conflating it with
hierarchy (DeRue & Ashford, 2010). From this point of view, a leadership move related to compassion is
never isolated to the person acting, but is part of a process in which multiple people are attending,
interpreting, feeling, and acting in ways that shape compassion in the organization (Deal & Peterson, 1994;

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DeRue, 2011).
Writing about how leaders shape schools, Peterson and Deal (1998) note that all leadership moves shape an
organization’s culture:
The role of … leaders in the crafting of cultures is pervasive…. Their words, their nonverbal messages, their actions [we would add: their
emotions], and their accomplishments all shape culture. They are models, potters, poets, actors, and healers. They are historians and
anthropologists. They are visionaries and dreamers. (p. 30)

In similar fashion, we see that a wide variety of leaders’ moves shape compassion as a social process in
organizations and cultures. Their influence is pervasive in shaping whether and how compassion is expressed,
and this influence is crafted through moves that range from subtle to dramatic.

Leaders’ Moves that Influence Compassion in Organizations

To integrate leadership research with the extant research on compassion as a social process, we developed
Figure 31.2 as an elaboration of Figure 31.1. We will use Figure 31.2 as a map for the remainder of the
chapter. This depiction highlights the multiple moves that leaders can make to influence the process. While
some of these moves may be overlapping in their impact, we separate each to identify how distinct moves
relate to each aspect of the four-part process of compassion in organizations. By isolating twelve types of
leaders’ moves and showing how they are related to each of the elements of the compassion process, we hope
to foster appreciation and understanding of the depth and breadth of leaders’ influence. This mapping of
leaders’ moves onto the compassion process makes a distinctive contribution to both leadership and
compassion research, opens new questions for exploration, and reveals both theoretical and practical
implications.

Creating Space: Leaders’ Moves That Draw Out the Expression of Suffering in Order to Foster Compassion
Leaders are essential in creating “organizational spaces” in which people can engage in existential meaning-
making in relation to suffering (Driver, 2007; Dutton, Frost, Worline, Lilius, & Kanov, 2002; Sosik, 2000).
We point out two compassionate leadership moves in relation to suffering: move #1 creating dedicated space
for the expression of suffering, and move #2 creating felt presence. Each of these leader moves impacts the
expression of suffering in organizations, and in so doing, creates the path by which compassion will or will not
unfold.

MOVE 1: LEADERS CREATE SPACE FOR THE EXPRESSION OF MEMBERS’ SUFFERING

In one organization we studied, a change effort to implement a new shared services unit created conditions
in which several people all over the organization feared for their jobs. Others whose jobs were saved, but
stripped of meaning or valued relationships, mourned a sense of loss of a valued identity. The leader heard
about these concerns and sources of pain. He assembled focus groups to make space for the expression of
concerns. After allowing space for the expression of this form of pain, he also created space for brainstorming
about ways to ease the pain. This leader intentionally created space for people to express their suffering at
work, which was a necessary and important step in creating a more compassionate organizational response.
Suffering represents distress that goes beyond physical and emotional pain, threatening our sense of
integrity or intactness (Cassell, 1999), and threatening disconnection and alienation from the deepest and
most fundamental aspects of ourselves or meaning in our lives (Coulehan, 2013; Frankl, 1959). Applied in

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organizations, suffering has been defined as “enduring, inevitable, or unavoidable loss, distress, pain, or injury”
(Pollock & Sands, 1997, p. 173), and it can arise from institutional or organizational failures and disasters
(e.g., Wicks, 2001); exposure to trauma as part of the work activities (e.g., Tehrani, 1998); violence in the
organization or workplace (e.g., McClure & Werther, 1997; Johnson & Indvik, 1996); aggression, hostility,
and incivility from organizational members, customers, and suppliers (e.g., Pearson & Porath, 2009);
demands for change (e.g., Driver, 2002); and collective dysfunctions or neuroses (e.g., Kets de Vries, 1991).
With so many sources of suffering in organizations, these spaces are also suffused with opportunities for
people to uncover meaning by expressing suffering in community with others (Dutton et al., 2002).
Colleagues often offer trusting, authentic, and caring relationships in which to work with the suffering if
people feel that there is a space dedicated for this purpose (e.g., Jaworski, 1996; Mollner, 1992). Leaders’
willingness to convene a community of caring colleagues and make space for the expression of suffering is one
important move that amplifies people’s willingness and ability to express suffering in organizations and to
respond with compassion.

MOVE 2: CREATING FELT PRESENCE

Leaders’ ability and willingness to share their own suffering is another way that they create space for the
expression of suffering. A leader’s capacity to be present with suffering is a less-appreciated but highly
impactful move that matters for fostering compassion in organizations. After tragedies and losses, for instance,
leaders who make space to express their own loss and sorrow and to be present with followers have a dramatic
impact on the sense of compassion in their organizations. Dutton and colleagues (2002) describe a market
research firm in which a senior executive died suddenly. The grieving CEO personally visited each member of
his 20-person management team to deliver the news, “going house to house to share in each person’s sorrow”
(p. 58). When leaders fail to acknowledge or express their own suffering, the silence often leaves
organizational members uncertain about how to handle difficult issues or helpless to know what to do to
respond to one another and those in pain (Dutton et al., 2002).

Figure 31.2 Leadership moves shape compassion as a social process in organizations.

Adapted from Dutton, Workman, & Hardin (2014), Compassion at work. Annual Review of Organizational Psychology & Organizational
Behavior, 1, 277–304.

Senge and colleagues (2005) refer to “presence” as a core capacity of leaders who create change in systems,

566
referring to presence in relation to time (conscious and aware in the moment), orientation toward others (deep
listening and openness beyond preconceptions), and forces beyond one’s control (letting go of old identities,
sensing movement or evolution, participating in a larger field). This multidimensional understanding of
presence offers links to the power of spiritual and wisdom traditions from around the world, as well as tapping
into possibilities for shifts in groups and organizations (Senge, Scharmer, Jaworski, & Flowers, 2005). As a
form of felt physical or psychological co-location, emotional openness, and participation in something larger
than the self, this move of creating felt presence is a palpable experience (Hallowell, 1999).
Some scholars claim that organizations are spaces of authority, in which participants are socialized to accept
meaning that others create for them, particularly others in positions of power (Gemmill & Oakley, 1992).
Leadership presence can break down barriers created by power or status differences and emphasize equality
and similarity through showing the ability listen and engage with one who is suffering (Frost, 1999; 2003). In
a study of women who experienced miscarriages or stillbirths, Hazen (2003) found that the space for
meaning-making granted by co-workers mattered in whether or not the experience of suffering made work
more or less meaningful (see also Hazen, 2008). Those whose suffering was greeted with clichéd responses
that imposed meaning on them (e.g., “You are young; you have time to have another child”) experienced what
the researchers called “disenfranchised grief” and did not experience suffering as a source of meaningful
engagement with colleagues. As a result, work became less compassionate and meaningful. Alternatively,
women who were greeted by colleagues, including supervisors and leaders, who simply listened and engaged in
being what Hazen (2003, p. 163) described as “witnesses … to the mother’s story of what happened” were
able to use their experiences of suffering to ultimately see their work as more meaningful and to develop more
compassion in their work lives over the long term. Overall, managers’, supervisors’, and leaders’ capacities to
engage as witnesses to the story of what happened in people’s suffering create a form of felt presence that
imbues the expression of suffering with meaning and offers the workplace as a space of growth in relation to
suffering.

SUMMARY

Table 31.1 summarizes the leadership moves discussed in this section (moves 1 & 2). By creating space for
the expression of suffering, leaders open up or close down people’s willingness to be with one another as a
community in the midst of suffering (Dutton et al., 2002). By creating felt presence with those who are
suffering, a leader shifts toward participating in ways that are larger than the self, helping develop a sense of
oneness, wholeness, open-heartedness, or grace that invites transformation of suffering (Senge et al., 2005).
These moves are referenced in Point 1 of Figure 31.2, which shows that creating space for the expression of
suffering and creating felt presence are fundamental to shaping compassion as a social process in
organizations. If these moves are absent, it will be less likely that compassion is expressed, because it will be
more difficult for people in the organization to notice, make meaning, feel and act in ways that coordinate and
mobilize helpful action in response to suffering. On the other hand, when these moves are done with skill by
leaders, compassion in organizations becomes more likely because it becomes far easier for many people in the
organization to notice, make meaning, feel, and act in ways that alleviate suffering.

Leaders Direct Attention in Organizations

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 What leaders pay attention to matters in organizations. In part, this is because they can direct resources
toward issues that garner their attention. In addition, others are likely to pay attention to issues leaders focus
on. How leaders shape and direct their own and other people’s attention in regard to suffering can
dramatically shape the compassion process. Here we articulate three leadership moves related to attention: In
move 3, leaders can counter the attentional effects of power that inhibit their ability to notice others’ full
human state, fostering greater compassion. In move 4, leaders can explicitly direct attention to suffering and
compassion in their organizations. In move 5, leaders can influence practices and routines that affect whether
and how suffering and compassion are regularly given attention by many members of the organization.

Table 31.1 Summary of Leaders’ Moves That Shape Compassion as a Social Process in Organizations

Leadership Move Elaboration of the Move

Moves that influence the expression of suffering: These moves open up or close down people’s willingness to
express suffering in the organization and therefore open up space for compassion in organizations.

Move 1: Making space Leaders’ actions that invite members to express suffering in a caring community as
for the expression of well as leaders’ willingness to display and to express their own suffering as part of
suffering creating a compassionate organization

Move 2: Creating felt Leaders’ actions that convey presence with suffering through physical and
presence psychological co-location, emotional openness, and participation in something
larger than the self

Moves that influence attention: These moves open up or close down people’s attention to suffering in the
organization and expand (or fail to expand) the capacity of the organization to respond with compassion.

Move 3: Countering the Leaders’ actions that restore mindful or conscious attention to the full human state
effects of power on of others in the organization, in order to enable noticing of suffering and counter
attention to suffering the inattention that often comes with power and status

Move 4: Directing Leaders’ actions that draw attention to suffering and the need for or value of
attention of others to compassion, often through the use of public communication or symbols
suffering and
compassion

Move 5: Infusing Leaders’ actions that influence organizational routines such as hiring, problem
attention to suffering solving, planning, and decision making such that they draw sustained attention to
into routines compassion and aid in alleviating suffering

Moves that influence sensemaking: These moves open up or close down people’s interpretations of suffering
and compassion by making them relevant, impacting who seems deserving or worthy of compassion, and
shaping the extent to which people believe it is within their purview to act with compassion.

Move 6: Legitimizing Leaders’ actions that help others interpret suffering and compassion as relevant to
suffering and the goals of the organization, appropriate and normal within the organization, and
compassion worthy of resources

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Move 7: Sense-giving Leaders’ actions that frame and give sense to experiences of suffering and
through rituals and compassion by inviting people to participate in collective stories and rituals
stories

Moves that impact emotion: These moves open up or close down the feeling of empathic concern between
members of the organization through processes of emotional contagion and their impact on emotional
culture.

Move 8: Shaping Leaders’ actions that serve as salient, focal stimuli for emotion contagion,
followers’ emotions particularly felt empathic concern that becomes contagious
through contagion

Move 9: Shaping the Leaders’ actions that influence the felt vitality, mutuality, and positive regard that
quality of connections characterize high-quality connections between people in the organization by
demonstrating respectful engagement, trust, and helping

Move 10: Shaping the Leaders’ actions that demonstrate cultural assumptions about how people should
emotional culture feel in the organization, including showing empathic concern, care, and affection
for others as part of work

Moves that impact action: These moves open up or close down compassionate action and the resource
generation that allows organizations to effectively direct a variety of resources toward the alleviation of
suffering.

Move 11: Modeling Leaders’ actions that provide a model or blueprint for actions that alleviate
compassionate action suffering, encouraging followers to emulate the leaders’ actions

Move 12: Catalyzing Leaders’ actions that catalyze an array of material, financial, social, psychological,
resources to alleviate and emotional resources and encourage others to emulate actions that direct
suffering resources toward alleviating suffering

MOVE 3: COUNTERING THE EFFECTS OF POWER ON ATTENTION

Renowned coach Joe Paterno led the football organization at Pennsylvania State University for many years,
apparently while close assistants were engaged in abusive behavior toward young people. When this abuse
came to light, it was difficult for members of the public to understand how such a beloved and celebrated
leader could have overlooked such suffering (Heffernan, 2011). Unfortunately, leaders often fall victim to
forms of “willful blindness” (Heffernan, 2011), ignoring evidence of suffering, overlooking unethical conduct
that causes suffering, or failing to give their attention to the full humanity of those around them. Social
psychology research shows us that leaders may have difficulty attending to suffering because one of the effects
of power is to make people less sensitive to the states of others in lower-power positions (Fiske, 1993).
These tendencies of people in power to overlook suffering and become insensitive to less powerful people
raise the specter of a darker side of compassion at work (Simpson, Clegg, & Pitsis, 2014b; Simpson, Clegg,
Lopes, Cunha, Rego, & Pitsis, 2014). To counter these tendencies, leaders need to be on the watch for
suffering and for potential abuses in organizations, especially ones that claim a mantle of compassion
(Simpson, Clegg, Lopes, Cunha, Rego, & Pitsis, 2014). Bazerman (2014) equates becoming a good leader

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with becoming “a first class noticer; … someone with a good eye, especially for human behavior” (p. 181).
Becoming aware of suffering requires singling out certain cues from the flow of ongoing experience (Dutton
et al., 2014). Cues associated with suffering are often ambiguous, especially when people strive to stifle their
suffering. For leaders, cues may be ambiguous because people often attempt to keep their suffering out of the
eye of authority. Leaders can foster greater attention to suffering and compassion in their organizations by
developing and listening to their intuitions about the state of others, engaging in active listening, and seeking
out additional information (Way, 2010). Unfortunately, time pressures and the pace of work for leaders may
keep them from engaging in this kind of attention, which requires effortful thinking and conscious
deliberation (Chugh, 2004). In order to counter this, leaders can ask managers, project leaders, and members
of their teams to help make suffering obvious and directly in their line of sight. One organization we studied
had a policy of notifying its top leaders of significant suffering in the lives of employees within 48 hours,
bringing more suffering to the conscious attention of leaders in a systematic manner that they were less likely
to overlook.
Research supports the power of this leadership move as well. Fiske (1993) shows that holding and
endorsing explicit values related to humanity and egalitarianism can shift the attention of those in power
toward greater compassion. Fiske (1993) also illuminates the power of self-concepts for leaders, such as being
fair-minded or caring, and suggests that recalling these self-concepts and values can reduce the effects of
power on attention. The growing emphasis on mindfulness and contemplation for leaders and leadership
development (e.g., Boyatzis & McKee, 2005; Jinpa, 2015) suggests that these types of interventions can also
help leaders notice more suffering and give greater attention to compassion in their organizations.

MOVE 4: DIRECTING OTHERS’ ATTENTION TO SUFFERING AND COMPASSION

In organizations, leaders are not just people, they are symbols (Pfeffer, 1977). According to a well-known
theory about symbolic leadership, leaders come to symbolize the human capacity to control our own destiny in
the midst of a confusing and complex world (Czarniawska-Joerges & Wolff, 1991). As organizations grow
larger, more complex, and more global, this symbolic aspect of leadership becomes more and more important.
Media coverage, corporate videos, and social media communications from leaders offer a stage upon which
these symbolic performances play out to direct attention toward what leaders want to emphasize (Ocasio,
2011).
The chief executive officer of LinkedIn, Jeff Weiner, used his position as the top executive in this global
firm to publish an essay on the organization’s social media platform entitled “Managing Compassionately”
(Weiner, 2012). In this public statement, Weiner writes:
Of all the management principles I have adopted over the years, either through direct experience or learning from others, there is one I
aspire to live by more than any other. I say “aspire” because as much as I’d like to do it consistently and without fail, given the natural ebb
and flow of day-to-day operations and challenges, and the subsequent range of responses that follow, I find this particular principle harder
to practice consistently than others. That principle is managing compassionately. (Weiner, 2012, para. 1)

Since the appearance of his essay on LinkedIn, Weiner has been invited to speak at large public conferences
about his philosophy of compassionate management and how he practices it in his work. He has also served as
the subject of other writers’ essays about the rise of compassionate management (e.g., Felony, 2015; Fryer,
2013). While he cannot be physically present with employees who are spread across 30 countries, Weiner uses
his symbolic position and the stage that comes with leadership to direct others’ attention toward compassion.

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 When leaders emphasize compassion as part of their symbolic power, this invites middle-level managers
and others in positions of lower-level leadership to engage in a process that some researchers have called
“authoring compassion.” Authoring compassion is defined as a process where middle-level leaders in an
organization invoke the symbolic power of compassion expressed by higher-level leaders (Brummans, Hwang,
& Cheong, 2013). In this way, this symbolic leadership move helps spread compassion throughout a large and
complex organization, even when people are widely geographically and temporally distributed, as described by
Brummans, Hwang, and Cheong (2013) in a study of a global spiritual leader and the management of her
organization:
What may strike any newcomer to Tzu Chi is how omnipresent Master Cheng Yen is, even though she mainly resides in Hualien. When
entering Tzu Chi buildings, the charismatic nun can be seen on posters and photos, on book covers and pamphlets, in Da Ai television
programs on TV sets overhanging hallways; and most importantly, her voice can be heard everywhere, as if it were filling the organization
throughout. (Brummans, Hwang, & Cheong, 2013, p. 356)

Similar to Jeff Weiner’s leadership move, Master Cheng’s symbolic leadership moves keep employees’
attention focused on compassion, even when she cannot be physically present with followers who are spread
across the globe.

MOVE 5: INFUSING ATTENTION TO SUFFERING INTO PRACTICES AND ROUTINES

We posit that leaders can explicitly foster attention to suffering and compassion in their organizations by
influencing routines and regular work practices such as problem solving, decision making, and planning. In a
study of a billing department that created extraordinarily high performance, as well as a distinctive and
effective capability for compassion (Lilius, Kanov, et al., 2011), we found that the unit leader infused attention
to the suffering of coworkers into her organization by using collective decision-making practices such as
workload decisions. She also explicitly drew attention to compassion as part of how she organized the hiring
routine and interview format and questions. This leader deployed this leadership move to infuse daily
workflow planning meetings with attention to the condition of co-workers, such that in a daily meeting, the
unit engaged in discussion of who needed help and how to allocate it well.
This move operates at a more macro level than some others we have described, influencing the compassion
process by shaping the organizational practices. Scholars who write about an attention-based view of
organizations assert that organizational-level outcomes such as adaptation or strategic success follow from the
way that attention is allocated across the organization (Ocasio, 1997; 2011). Leaders therefore must use all the
tools at their disposal to direct attention in ways that create a focus of time, energy, and effort on a selected set
of action repertoires that are important for the organization (Ocasio, 1997). Organizational scholars refer to
this collective capacity to pay attention to selected actions as “attentional engagement,” defined as an
organization’s “intentional, sustained allocation of cognitive resources to guide problem solving, planning,
sensemaking, and decision making” (Ocasio, 2011, p. 1288). We suggest that this move helps leaders direct
the attentional engagement of their organizations toward compassion.
We return to Jeff Weiner’s example at LinkedIn to demonstrate how his emphasis on compassionate
management has infused attention to compassion into the organization’s everyday work practices. A case study
that focused on how interns are recruited and hired at LinkedIn (Dutton & Reed, 2014) documents a hiring
routine that is informed by how candidates respond to an instance of employee suffering. The human resource
leader who developed this hiring practice links his efforts to develop compassionate hiring routines to

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Wiener’s valuing of compassion. This leadership move shifts a routine that many people participate in to
include attention to compassion.

SUMMARY

Table 31.1 summarizes the three leadership moves described in this section. Point 2 in Figure 31.2 depicts
how these leadership moves related to attention are likely to affect the overall compassion process by shaping
what people notice as part of their work environment. Three insights emerge from considering these
attention-based leadership moves. First, what leaders attend to is shaped by their position in the social system.
Accordingly, leaders must make an effort to counter the effects of status and power on their ability to attend
to the full humanness of those in lower-status or lesser-power positions. Second, the symbolic power of
leaders enables them to direct others’ attention to suffering and compassion in ways that can dramatically
increase compassion in organizations. And third, leaders’ influence is often infused into routines and practices
that shape the attentional engagement of the whole organization, and thus attention gets directed to
compassion as a priority in daily work.

Leaders Influence the Sense People Make of Organizational Events

The idea of sensemaking figures prominently in the model of compassion as a social process, connecting
each aspect of the compassion process, as shown in Figure 31.2. This concept is linked to the idea of
“appraisals” that figures into individual responses to suffering (Atkins & Parker, 2012; Goetz, Keltner, &
Simon-Thomas, 2010). Organizational scholars posit that the organizational context and organizational
interactions figure prominently into the creation of meaning, and as such, the creation of meaning is not only
an individual-level but also a collective-level process—suffusing every aspect of organizational life (Smircich &
Morgan, 1982). Sensemaking is a theory that explains the process by which people exert effort to understand
or impute meaning to events, issues, or situations that are ambiguous, contradictory, or confusing, and how
organizations influence this effort to impute meaning (Weick, 1995; Maitlis & Christiansen, 2014). Smircich
and Morgan (1982) point out that leaders are critical for sensemaking, as leaders help make the world sensible
to organizational members.
From this perspective, organizational members “surrender their power to interpret and define reality to
others” in leadership positions, and leadership roles formalize and institutionalize the leader’s right to define
the nature of experience (Smircich & Morgan, 1982). Some scholars refer to leaders’ engagement in this
process as “sensegiving,” defined as an attempt to “influence the sensemaking and meaning construction of
others toward a preferred redefinition of organizational reality” (Gioia & Chittipeddi, 1991, p. 442). Through
sensegiving, leaders’ shape, not only organizational members’ attention (which overlaps with what was
discussed above), but also their feeling, and action (Maitlis & Lawrence, 2007). While direct research on how
leaders make sense of suffering and compassion is limited, we draw on theories of sensemaking and
sensegiving to articulate two leadership moves that shape compassion in organizations by how they mold
people’s sense of reality. In move 6, leaders influence the interpretations of suffering and compassion as
relevant and legitimate in the organizational context. In move 7, leaders give sense to suffering through their
use of narrative vision, rituals, and stories.

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MOVE 6: LEGITIMIZING SUFFERING AND COMPASSION AS PART OF THE ORGANIZATION’S WORK

The extent to which someone interprets that another person deserves compassion dramatically impacts their
willingness to feel empathy and act with compassion (Atkins & Parker, 2012; Goetz, Keltner, & Simon-
Thomas, 2010). In organizations, people’s deservingness or the worthiness of responding to suffering is often
contested or unclear. Leaders can foster compassion in organizations by making suffering look worthy of our
compassion. They can also provide followers with a sense that it is legitimate and valuable within the purview
of their work to act with compassion. We saw a vivid example of this in one leader’s communication about a
stigmatized form of suffering that impacts organizations of many kinds: suicide. Here is an excerpt of a
message this leader sent to the entire university community upon the suicide of a student. Pay particular
attention to the moves in this leadership communication that convey deservingness and legitimate compassion
as part of the work of the university community:
You likely heard that, last weekend, we lost a … student, a young man who tragically took his own life…. Suicide is not easy for many of us
to talk about. You may not want to even read further. I ask that you do, for the well-being of us all.
As uncomfortable as the topic may be, it is truly amazing how many of our lives have been or will be touched by suicide and the mental
distress and disease that underlies it: family, friends … suicide is endemic among those in the typical college-age group…. We feel this pain
year in and year out. Can we change that?
My life has been affected, having lost a college-age son to this epidemic. Our reluctance to talk about such topics—suicide, depression,
other mental distress and disease—was, I concluded, part of what can make ailments like depression the deadly diseases that they can be.
Because of the stigma surrounded such topics, people do not bring the manifestations of a usually VERY treatable problem to the attention
of others. In my layman`s view, our brains are very powerful and, mental ailments can use that awesome brainpower, reinforced by fear of
stigmas, to hide their very existence from the person with the ailment. Dire consequences can then result.
So, I took a vow, no matter how personally painful it was, to never be too embarrassed or afraid to talk about these subjects. Or, about my
son.
That is step one and I encourage you to consider joining me in that vow: break the stigma surrounding these topics by being willing to
discuss them just as you would any other ailment to which we beautifully complex human beings are sometimes vulnerable (personal
communication, reprinted with permission).

In this campus-wide communication, the leader’s move to give sense to the suffering and compassion makes
this suicide relevant to the entire community and the goals of the university. The leader’s move hopes to shift
followers’ appraisals of suicide, which may be greeted with scorn or fear, and conveys instead a sense of
empathic concern and an opportunity to act with compassion toward one another as “beautifully complex
human beings.”
The leader’s message goes on to emphasize what members of the university can do, beyond being willing to
feel empathic concern for mental illness among those in the community. In extending the message by
enumerating possible actions, the leader’s sensegiving also shapes the appraisals of members about whether
they have any capacity to alleviate this suffering, emphasizing resources to take action. Research demonstrates
that when we interpret that we can act to address suffering, compassion is more likely (see Atkins & Parker,
2012; Goetz et al., 2010; Lazarus & Folkman, 1984).
Simpson and colleagues (2014a) point out that not all compassionate action is legitimate in organizations,
so leadership moves can help enhance the legitimacy of compassionate actions. When suffering and
compassion are interpreted as legitimate, they are seen by many in the organization as appropriate and normal
elements of a person’s experience. Thus, when a leader emphasizes the appropriateness of addressing suffering
like suicide, the suffering and the compassionate action to alleviate that suffering take on more legitimacy
throughout the organization. Organizational research emphasizes three types of appraisals that can help
leaders legitimize suffering and compassion (Atkins & Parker, 2012):
1. Appraisals of the goal-relevance of the suffering in the organization—i.e., is it in the scope of my work to address this suffering?

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 2. Appraisals of the deservingness of the suffering—i.e., are the people suffering worthy of my concern? and
3. Appraisals of the degree to which organization members believe they can bring about desired outcomes—i.e., is there something I can do
from my position in this workplace?

We see all three of these types of appraisals in the university president’s communication, which is part of
what makes it such a strong message in support of compassion in his organization.
When leaders make sense of reality in ways that consistently emphasize the legitimacy of responding to
suffering with compassion, and offer appraisals that support acting with compassion, as this university
president did, this move amplifies the likelihood that people across the organization will feel empathic
concern and act with compassion.

MOVE 7: GIVING SENSE TO SUFFERING IN RITUALS AND STORIES

We expect leaders to synthesize information and use it to create an overarching vision that others can adopt
and use to guide their actions (Gioia & Chittipeddi, 1991). Leaders can help people throughout an
organization make sense of suffering and act with compassion by incorporating compassion into their
overarching vision and their stories of success. In our study of an organizational response to members who lost
everything in a fire, we saw the power of a leader who engaged in storytelling about the suffering and linked it
to an overall vision for the organization as a caring community that “takes care of its own” (Dutton et al.,
2006). This sensegiving move by the leader tied the suffering engendered by the fire to the vision of the
community as a whole, activating collective empathy and spawning coordinated compassionate action.
Leaders’ moves in relation to conveying an overarching vision that fosters compassion often take the form of a
story or a narrative, as in this case. Stories like these “frame” experience and help members of the organization
understand what is more or less important in ways that guide future organizational actions (Fiss & Zajac,
2006; Smircich & Morgan, 1982).
When we point to organizational culture, we often point to a leader’s role in rituals. Rituals are essential in
cultures because they reinforce assumptions about the nature of the organization, the emotion-display rules in
operation, and the behavioral scripts that guide how people treat each other (Trice & Beyer, 1993). Rituals are
also important and impactful moments for sensegiving (Maitlis & Lawrence, 2007). In one study, we
witnessed a ritual by a leader upon the death of an employee’s family member. This leader asked the entire
organization to join in a circle of silence. This ritual invited members of the organization to participate in a
compassionate response to loss and reinforced the value of compassionate community. This leadership move
offers a clear example of how leaders can deploy rituals in the service of enhancing the organization’s
compassion.

SUMMARY

Table 31.1 summarizes two leadership moves that are important to sensemaking during the compassion
process. Point 3 of Figure 31.2 depicts how these two leadership moves are central in shaping the compassion
process because they impact collective attention, feeling, and action. Two insights emerge from articulating
these two leadership moves. First, through both words and actions, leaders actively shape others’
interpretations of reality. These interpretations can amplify compassion in organizations by making suffering
and compassion seem more relevant and legitimate. A second insight is that leaders’ moves can harness the
power of ritual to affirm and catalyze compassion in cultural rituals. These rituals reinforce cultural

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assumptions, and leaders can shape the rituals in ways that give meaning to suffering and invite people to
participate in the compassion process in new ways.

Leaders Shape the Context for Empathic Concern

While cognitive and rational views have dominated organization theory, attention to emotion in organizing
has exploded over the past two decades, with evidence showing that emotion is intrinsic to the social ordering
of activity (Elfenbein, 2007; Keltner & Haidt, 1999). Leadership research also shows a growing emphasis on
the centrality of emotion, particularly theories that emphasize charisma and transformational qualities of
leaders (e.g., Bass, 1985; House, 1977; Conger & Kanungo, 1998), as well as those that emphasize the
importance of the relationship between leaders and followers (e.g., Uhl-Bien, 2006). In fact, differences in the
use of emotion and emotion-based influence distinguish between what has been called “transactional” or
“exchange-based” leadership and “transformational” leadership (House, Woycke, & Fodor, 1988). Here, we
articulate three leadership moves that are related to emotion because they impact the likelihood that an
organization’s members will feel empathic concern in response to suffering. In move 8, leaders shape emotion
through contagion processes. In move 9, leaders influence the quality of emotion in the organization’s culture
through their impact on connections between people. In move 10, leaders’ moves affect the emotional climate.

MOVE 8: SHAPING FOLLOWERS’ EMOTIONS THROUGH CONTAGION

Leaders’ own empathic concern for members’ suffering is contagious. When leaders model moral emotions
such as empathy, their modeling influences followers to be more empathetic (Zhu, Riggio, Avolio, & Sosik,
2011). In the study of a highly compassionate hospital billing unit referenced before, we found that the
leader’s emotional display of empathic concern for strain in the lives of her employees was central to fostering
the empathic concern of co-workers in the unit (Worline & Boik, 2006). In one example, Sarah, the leader,
expressed concern for an employee going through a divorce who was under increasingly visible emotional and
financial strain. Catching Sarah’s contagious empathic concern, co-workers also expressed concern, rallied to
help by buying some extra groceries, created a handmade card to express emotional support, and even
collaborated to raise money that would help her buy gas to get to and from work during an especially stressful
period. Sarah explained her implicit theory of leaders’ moves that involve expressing empathic concern:
Understand that there are a lot of influences on your employees’ lives outside of work that impact their ability to perform each and every
day. Then be understanding. They will have off days. It’s ok once in a while. (Worline & Boik, 2006, p. 120)

Social psychologists interested in emotions also show the powerful social influence of emotional contagion—the
ability to shape one another’s feelings in a kind of interpersonal emotional dance. Opportunities for contagion
abound in organizations (Elfenbein, 2007), and emotional contagion generally supports social coordination
(Hatfield, Cacioppo, & Rapson, 1994; Keltner & Kring, 1998). Power has an important amplifying impact on
emotional contagion, with leaders serving as salient and focal emotional stimuli in groups (Sy, Cote, &
Saavedra, 2005). That’s why Sarah was such a powerful source of contagion of empathic concern in her unit.
Likewise, leaders are sometimes less constrained by emotional display rules or expression norms, and greater
emotional expressiveness also increases emotional contagion (Totterdell, Kellett, Teuchmann, & Briner,1998).
Sarah did not feel constrained to hold back her concern, which freed others to feel and express their concern
as well. Across studies, researchers conclude that powerful people disproportionately sway the direction of

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social interactions (Anderson, Keltner, & John, 2003; van Kleef, Oveis, van der Löwe, LuoKogan, Goetz, &
Keltner, 2008), making leaders’ emotions highly contagious.
Examples of emotional contagion are common in descriptions of leaders who inspire others. Goleman and
Boyatzis (2008), emphasizing the importance of emotional intelligence for leaders, describe Herb Kelleher,
cofounder and former CEO of Southwest Airlines, spreading contagious positive emotion: “He shook hands
with customers as he told them how much he appreciated their business, hugged employees as he thanked
them for their good work. And he got back exactly what he gave” (p. 4). Leaders’ positive emotions may be
particularly potent in creating emotional contagion that feeds compassion because some evidence shows that
leaders’ expressions of positive emotions bolster organizational citizenship behaviors or prosocial extra-role
efforts such as volunteering, helping others, and supporting the organization (Johnson, 2008).

MOVE 9: ENHANCING THE QUALITY OF CONNECTIONS BETWEEN PEOPLE

High-quality connections are defined as moments of felt vitality, positive regard, and mutual engagement
(Dutton, 2003). Compassion researchers have theorized that more high-quality connections between co-
workers generally increase the likelihood that an organization’s members will feel empathic concern when
another member is suffering (Dutton et al., 2014). Leaders can shape compassion in their organizations by
fostering more high-quality connections. Sarah, the leader described before, is an example of someone who
shaped the quality of connections between people and thereby shaped the likelihood of empathic concern in
her organization. She deliberately attempted to dress and speak in ways that were familiar to her employees,
not setting herself apart. She engaged interpersonally with them in ways that exuded positive regard for each
unique individual. She also emphasized trust and creating respectful interactions as essential to the work
environment, drawing out empathy. While articulating her leadership practices that helped foster compassion
in her unit, Sarah emphasized this aspect of leading:
Every employee who works with you is the same as you … human. There may be different levels of hierarchy within your corporation, but
when all the layers are peeled back, we are all the same. So treat every one of the employees you work with as you expect to be treated. This
is vital to gain respect and loyalty. (Worline & Boik, 2006, p. 118)

We posit that leaders’ moves that enhance the quality of connections between people will amplify compassion
in the organization, because other researchers also demonstrate that relational action such as respectful
engagement, trusting, and helping create an organization where people are more attuned to one another, feel
greater psychological safety, and care more about one another’s well-being (Dutton, 2003; Carmeli, Dutton,
& Hardin, 2015; Hasu & Lehtonen, 2014). Researchers who investigate ethical leadership emphasize the
importance of caring and supportive relationships with followers (Brown & Treviño, 2006). Likewise, theories
of authentic transformational leadership propose the impact of leaders largely through the quality of
relationships between leaders and followers (Bass & Steidlmeier, 1999; Sosik, 2005). While the quality of
relationships between leaders and followers is likely to affect many aspects of the compassion process, and in
this sense, these leaders’ moves have overlapping effects, here we emphasize the importance of the quality of
connections for the likelihood of widespread feelings of empathic concern as part of the collective compassion
process.

MOVE 10: SHAPING EMOTIONAL CULTURE AND CLIMATE

“Organizational culture” refers to “a pattern of shared basic assumptions learned by a group as it solved its

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problems of external adaptation and internal integration” (Schein, 2010, p. 18). This pattern will be taught to
new members as “the correct way to perceive, think, and feel” (Schein, 2010, p. 18). In this way,
organizational culture matters greatly to the expression of compassion. Compassionate leadership will take
different forms in different organizational cultures. Leaders also shape cultures (Schein, 2010). We posit that
leaders’ moves can shape the emotional culture for compassion.
One instance comes from Pat Christen, former president and CEO of HopeLab, a technology think-tank
in Silicon Valley. Pat wrote a thank-you letter to members of her organization that exemplifies how leaders
reinforce a culture of compassion, or what some have called companionate love (Barsade & O’Neill, 2014). In
the excerpt of this letter, pay particular attention to how this leader conveys compassion and love for the ways
that members of the organization have responded to suffering and adversity:
When I turned to look at each one of you, table-by-table, I was swamped with memories, not of your accomplishments, but even more
significantly of times when we struggled as individuals, as teams, in community….
Some of these struggles are quite public and the challenges and setbacks are well known to us all. Some are deeply personal and private.
At the time we endured them, they precipitated feelings of exasperation, anger, shame, annoyance, sadness, amusement, even joy. My point
now is not to enumerate that list for you; indeed many of those stories are not mine to share publicly. My point here is to tell you that it is
that list that moved me most deeply.
That is the list that demonstrates our deepest commitment to ourselves and to community. This struggle to persevere in the face of deep
challenge and adversity is not always pretty. We are a mess at times as we navigate our shortcomings, our losses, and those places where we
do not live up to our highest aspirations. But what I want you to know is that I was simply overcome by and in awe of what you have done
—each of you—to persevere, to be better, to try again, to pick yourselves up, to wade back into the fray, to not give up on yourselves, on
one another, on our work, on our community, on our world (personal communication, shared with permission).

In Pat’s celebration of her organization, her words as a leader not only display empathic concern (move 8) and
influence people to engage in higher-quality connections (move 9), they also serve to shape an enduring
emotional culture of love that is capable of embracing errors, struggles, and suffering with compassion.
Recent organizational research supports the importance of emotional aspects of culture (Barsade & O’Neill,
2014). This research draws out the impact leaders have on creating an emotional culture in which people can
feel empathic concern for the suffering of others. Barsade and O’Neill (2014) define a “culture of
companionate love” as one in which “showing caring, tenderness, and affection for people at work is a natural
part of what being at work means” (p. 555). We often look to leaders to see the norms for caring, tenderness,
and affection in organizations.

SUMMARY

Table 31.1 summarizes the three moves we have articulated in relation to emotion and felt empathic
concern as part of the compassion process. They are also depicted in Point 4 of Figure 31.2, which shows how
leaders’ moves that influence felt empathic concern continue to shape the way the compassion process unfolds
or fails to unfold. Elaborating these moves gives insight into the ways that leaders’ actions shape the emotions
of followers. Compassion can be hindered when leaders fail to engage in moves that create contagious
empathic concern. Compassion is advanced by shaping the emotional culture toward companionate love and
cultivating high-quality connections between leaders and members. When leaders like Sarah or Pat, who are
described here, use these moves to create contagious empathic concern and shape a culture of affection and
care, such moves leave a lasting trace on the entire organization’s likelihood to respond to suffering with
compassion.

Leaders Are Powerful Models for Action

577
 Perhaps one of the oldest and most well-established ideas about the importance of leaders is that they
provide examples for others to follow (Burns, 1978). The theory of transformational leadership rests on
assumptions that leaders are capable of creating transformation in those around them by first shifting
themselves and by behaving in ways that others can emulate (Burns, 1978; Quinn & Quinn, 2009). While we
have already given a number of examples of leaders serving as models for compassionate action, here we
emphasize two leaders’ moves related to action and modeling. In move 11, we focus on how leaders’ actions
provide a blueprint for others’ actions through emulation of leaders as a model for action. In move 12, we
emphasize how leaders’ moves model ways to catalyze resources that can be directed toward the alleviation of
suffering.

MOVE 11: MODELING COMPASSIONATE ACTION

Research on ethical leadership demonstrates that social learning—seeing leaders act ethically—affects
followers’ ethics (Brown, Treviño, & Harrison, 2005; Mayer, Kuenzi, Greenbaum, Bardes, & Salvador,
2009). Popular books on ethical and moral leadership also emphasize the power of modeling empathy or
compassion. Sinek’s (2014) Leaders Eat Last is an examination of the lessons of military leadership for civilian
leaders and managers. He concludes that people who accomplish extraordinary feats in the military do so by
drawing on empathy that is in large part sustained by leaders who model it.
A vivid example of many of the leadership moves we have described here, including modeling
compassionate action, comes from an account of the response of Reuters to the terrorist attacks in the United
States on September 11, 2001 (documented in a case by Dutton, Pasick, & Quinn, 2002a, 2002b). Reuters
provided services that were essential to the operation of the U.S. Treasury Market as well as valuable financial
information services and global news. In the attack on the World Trade Center, Reuters lost several
employees. They also experienced the destruction of a significant data center and the loss of crucial
infrastructure that connected them to their clients. Phil Lynch was serving as president of Reuters America on
that day. After watching the World Trade Center towers burning, he knew that he would need to establish a
command center for the crisis. Converting the Reuters boardroom into a hub for handling the response,
Lynch and his executive team set and reiterated priorities that guided their actions: “People first, then
customers, then the business” (Dutton et al., 2002a, p. 5). This is an example of move 4, directing attention to
suffering, as well as move 7, giving sense to an ambiguous situation in ways that make compassion more likely.
Phil Lynch and his team issued regular updates about the crisis, employees’ safety, and activities to help the
recovery, emphasizing again and again those three priorities. Theories of adaptive leadership (e.g., Heifetz,
1994) emphasize behaviors of leaders and how those behaviors provide a model that helps mobilize, motivate,
orient, and focus the attention of others in the organization in order to adapt to difficult challenges,
particularly staying calm, focused, and present in the midst of adversity or suffering. Lynch exhibited this form
of adaptive leadership modeling as he encouraged Reuters’ employees globally to do whatever it took to restore
personal capacity and get customers up and running. On global teleconferences dedicated to answering
questions, Phil Lynch responded openly about what leaders were feeling, as well as the steps Reuters was
taking. This offers an example of move 1, creating space for the expression of suffering, as well as move 8,
displaying empathic concern that was contagious to followers.
Phil Lynch gave a directive for people interacting with the families of those who were missing: “It’s all

578
about the families. Just remember, it’s all about them.” Reuters’ employees who witnessed Phil Lynch meeting
with the mother of an employee who had died were moved by his presence, and additional stories of support
and caring were unearthed and shared. This offers an example of move 2, creating felt presence, as well as
move 10, shaping an emotional culture toward love and concern. Theories of authentic leadership (e.g.,
George, 2003) emphasize compassionate action as essential to demonstrating authenticity as a leader,
demonstrating “heart” through actions that model sensitivity to others and willingness to aid them.
One employee described Phil Lynch as an overall model of compassionate action this way: “Watching Phil
Lynch get so involved with the families—so quickly—with their personal lives, bringing them in, comforting
them, involved with their personal pain—I saw the heart—not just the company, not just technology and lines
—I saw the heart of the company in him responding to the families” (p. 8). This is an example of what we
mean by modeling. This form of modeling is evident in theories of servant leadership, where leaders put
followers first and show empathy in action to emphasize that followers and followers’ concerns are a priority
for the leader (Liden, Panaccio, Mueser, Hu, & Wayne, 2014). As demonstrated by this follower’s quote,
“Phil Lynch’s actions model a compassionate response in ways that shift the likelihood of many in the
organization to engage suffering with compassion.”

MOVE 12: CATALYZING RESOURCES

Researchers often focus on leaders as points of leverage in an organization because they control access to
important resources such as time, money, and connections with others. How and when leaders unlock access
to resources is important in helping to alleviate suffering. Leaders’ moves that direct resources toward
compassion are also symbolically important by illustrating values in action (Podolny, Khurana, & Hill-Popper,
2004) or reinforcing cultural assumptions that people and relationships matter (Schein, 2010). We saw this in
Phil Lynch’s response to the terrorist attacks. Lynch catalyzed resources such as comfort and emotional
support for the families of employees who had died. He also catalyzed resources for a memorial service that
brought the families together with Reuters’ employees. He helped catalyze resources for counseling services,
authorized town hall meetings for people to come together to share and hear stories and ask questions, and
poured resources into rebuilding the operations of the lost data center. Because of the resources he helped
catalyze, Reuters employees installed an astounding $200,000 of equipment within four days. These moves to
catalyze resources allowed Reuters to meet the human needs, the client needs, and the business needs that
restored the backbone for financial trading and economic stability in the United States.
Research in organization theory shifts the view of resources from a focus on fixed entities, such as money,
toward dynamic value that is created by resources-in-use (Feldman, 2004). This view broadens the definition
of “resources,” shedding light on resources created in interaction, such as trust, respect, or legitimacy
(Feldman, 2004). Feldman and Worline (2011) illustrate resourcing theory with the example of a pile of paper
money, which is valuable in one way when it is burned to create warmth, but valuable in a very different way
when used for exchange. Drawing on resourcing theory, we posit that leadership moves have the power to
catalyze resources such as attention, empathy, legitimacy, social and emotional support, collective identity,
shared meaning, and discretionary effort, and to put these resources to use in the service of compassion. Again
this move may overlap with some of the moves previously discussed, as when leaders catalyze attention or
emotion, but here we articulate it separately to emphasize the enormous importance of resourcing in

579
alleviating suffering.
Sometimes leadership moves that catalyze resources are prompted by episodes of suffering that catch an
organization by surprise, like a crisis, a disaster, or an unexpected illness or injury, as was the case for Phil
Lynch. Adaptive leadership (Heifetz, 1994; Heifetz, Grashow, & Linsky, 2009) theories suggest that one of
the most important roles of leaders in times of surprise is to identify adaptive challenges and to mobilize
resources to meet them. Surprises offer leaders the opportunity to see holes in the organization’s safety net and
to mobilize resources that make rapid response to suffering more reliable over time. John Chambers, former
CEO of Cisco Systems, approved the institutionalization of a rapid response team for employee disasters after
Cisco employees became seriously ill in parts of the world where advanced medical care was not readily
available to them. Whenever Chambers found through a surprise that the organization was unable to respond
to suffering in appropriate ways, he catalyzed new policies and procedures to ensure that Cisco could respond
to suffering with compassion in the future.

SUMMARY

Table 31.1 summarizes two moves related to modeling and leaders’ actions. Points 5 and 6 of Figure 31.2
depict these moves and their influence on the compassion process. By articulating these as distinct leaders’
moves, we gain insight into the fact that leaders’ instrumental actions matter for compassion in organizations
(Antonakis & House, 2014). When actions model compassion, they serve as a blueprint for followers’ actions
(Bass & Avolio, 1990). And when leaders’ instrumental actions serve to change an organizational policy or
implement a practice that creates compassion, these resources-in-use also inspire others to emulate the action
and direct additional resources toward alleviating suffering.

HOW LEADERS SHAPE COMPASSION PROCESSES IN ORGANIZATIONS

Table 31.1 summarizes all twelve of the leadership moves we have identified from this review of the
leadership literature as it relates to compassion in organizations. Figure 31.2 depicts compassion as a process
and makes clear the points at which different leaders’ moves impact the way the process unfolds. Together,
the table and the figures clearly show a variety of effects leaders have on the unfolding of compassion in
organizations. Ranging from how leaders act to how they feel and express emotion, from how they frame and
narrate suffering to what they attend to, and from how they use their presence to how they create a space for
the expression of suffering, obviously leaders matter.
When we look at dramatic or extreme cases, such as the Reuters response to the terrorist attacks, we can see
how these moves are intertwined with one another and build on one another over time. When leaders offer
their own very human regard for the humanness of others, and when this human-to-human regard and
presence becomes the centerpiece of attention, feeling, communication, and action, organizations literally
come alive with compassion. One Reuters employee described it this way: “It was so human. It was not about
do we have to check our financial services? It was about ‘Where are our people?’ People, then clients, then the
business. It made me proud to work here. I gained more of a sense of respect for the company, and I have
been here for a very long time” (Dutton et al., 2002b, p. 3).
In the past several years, compassion has become a more mainstream topic for research in organization and
management disciplines. In 2010, a worldwide gathering of business scholars at the Academy of Management

580
was dedicated to compassion and care in organizations (see also Tsui, 2013), along with issues of top journals
dedicated to these topics (e.g., Rynes, Bartunek, Dutton, & Margolis, 2012). As compassion grows in viability
for research attention, it likewise grows in viability for leaders’ attention. Visible leaders and thought leaders in
successful organizations, such as Jeff Weiner or Simon Sinek, bring new power to dialogue about compassion
and its role in business. Increasing dehumanization of work and employee disengagement add urgency to
compassion as a leadership concern.
This review shows that research on leadership and compassion is still in its early stages. However,
identifying leadership moves that matter creates a call for research that tests the power and impact of these
moves to shape compassion and alleviate suffering. We hope that many researchers will join in investigating
how leaders contribute to enlivening their followers’ humanity. This call opens a window into a new reality in
which the world’s organizations, while pursuing their day-to-day missions of commerce, innovation, or service
delivery, simultaneously hold the possibility to become some of the world’s most powerful vessels for
compassion.

581
Acknowledgments
Thanks to Brad Owens, Ned Wellman, and members of the CompassionLab for their assistance with an
earlier draft of this chapter.

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 The Call for Compassion in Health Care

Sue Shea and Christos Lionis

Abstract

The concept of compassion applies to a number of situations and deserves to play a major role in health
care. Within this chapter, we discuss the importance of compassionate care within both the hospital and
primary healthcare settings, with a view to identifying ways of improving quality of care. We then
discuss the importance of addressing compassion and health with regard to specific societal conditions
such as during times of austerity, and towards vulnerable individuals such as the homeless who might
experience specific health and social needs. Finally, we address factors that may hinder or promote
compassion, before considering how compassion can be sustained in the longer term, and the extent to
which the concept may be effectively incorporated in teaching and training programs.

Key Words: compassion, health care, hospitals, specific conditions, primary care, austerity,
homelessness, organizational factors, teaching/training

The ideal of combining clinical competence with compassion has been a central feature of the practice of medicine
throughout history. Hippocrates is credited with the terms philanthropia (love of humanity) and philotechnica
(love of technical skill or art) to describe this pairing.
Anandarajah and Rosemand, 2014, p. 17

Frequently referred to as sensitivity to the pain or suffering of another, coupled with a deep desire to
alleviate that suffering (Goetz, Keltner & Simon-Thomas, 2010), the concept of compassion applies to a
number of situations, and equally, it deserves to play a major role in health care. Kindness and compassion are
two core human values that are important in society, and aside from other moral values are the foundation of
social and personal relationships (Crowther, Wilson, Horton, & Lloyd-Williams, 2013). According to the
United Kingdom (UK) Care Quality Commission (CQC), compassion is a hard-to-describe facet of health
care, but it may be viewed as how care is given through relationships based on empathy, respect, and dignity.
It can be described as intelligent kindness and is central to how people perceive their care
(http://www.cqc.org.uk/content/compassionate-care). Likewise, it has been observed that certain
characteristics that are commonly used in association with compassion in regard to caring and nursing include:
sensitivity, empathy, kindness, a person-centered approach, the relationship, involvement—working with
patients and carers, empowerment, knowing the person, understanding how people are feeling, being
nonjudgmental, listening, responding, taking responsibility, and advocating (Schofield, Concept Analysis—
Compassion in Nursing,
https://www2.rcn.org.uk/__data/assets/pdf_file/0011/445817/Research2012Mo16.pdf—accessed July 2015).
However, attitudes, cultures of care, organizational issues, and communication skills of staff members involved

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in direct care and support have been criticized, and identified as priority areas for improvement (Crowther et
al., 2013).
Following a number of media reports that have highlighted and emphasized how compassion towards the
patient seems to have decreased in health care, a prominent focus on compassion in health care has now
emerged. In 2008, the UK National Health Service (NHS) confederation noted that, despite the increasing
scope and sophistication of health care, it still fails the patient at a fundamental level, and that care and
compassion should be the basics of care delivery. Inspired by this observation and other reports regarding
alarming gaps in the humanity of care offered, the authors of this chapter organized a multidisciplinary
symposium at Greenwich University in 2011 to address the important issue of compassion in health care
(Shea, Wynyard, West, & Lionis, 2011). The symposium attracted a wide audience (including patient
representatives) from various backgrounds, with a shared interest in moving forward with the “science and art”
of compassion in health care. The event proved to be an uplifting experience, and it was highly evident, that
despite distressing media reports, that attendees were united in the belief that compassion constitutes an
important issue in health care.
Scientific research investigating compassion is a rapidly developing field, and it is potentially crucial to the
healthcare setting. Evidence suggests that compassion can help prompt a faster recovery from acute illness,
enhance the management of chronic illness, and help relieve anxiety, whilst benefits have also been reported in
studies that show that kindness and touch alter the heart rhythm and brain function in both the person
providing compassion and the person receiving it (Fogarty, Curbow, Wingard, McDonnell, & Summerfield,
1999; Shaltout, Toozer, Rosenberger, & Kemper, 2012). A compassionate approach to interacting with others
and oneself is also believed to alter the brain’s response to stress and assist in increasing pain-tolerance
(Youngson, 2012). Although further research investing the specific impacts of compassion is still required, it
would appear that a compassionate approach can benefit all concerned—both the recipient and the receiver.
The purpose and aims of this chapter are to discuss the importance of compassionate care within the
healthcare setting, in order to find ways to improve the quality of care. We also refer to the importance of
compassion during times of austerity, and for vulnerable individuals such as the homeless, who might
experience ill health or difficulties accessing health care due to circumstances beyond their control.
Furthermore, the chapter takes into account factors that may hinder or promote compassion, and describes
how the virtue of compassion may be sustained in the longer term.

Compassion Competence in Health Care

The Hospital Setting
When an individual is hospitalized or reliant on hospital services, they are often in a most vulnerable
situation and may be totally dependent on those around them. An environment of fear and anxiety may
dominate the hospitalized patient. It seems logical then, that in addition to providing technical expertise,
treating a patient with kindness, empathy, and compassion may ease the burden, offer the reassurance that the
patient needs, and ensure that the patient’s experience is less traumatic and more accommodating. Likewise,
enhanced communication between a compassionate caregiver and a patient can help develop trust, resulting in
increased shared information about symptoms and concerns, which, in turn, may yield a more accurate
understanding and diagnosis (Mannion, 2014).

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 Despite the potential benefits of a compassionate approach, we are aware from recent reports that such an
approach is not always forthcoming. Concerns regarding failures in humanity in health care were escalated
further in the United Kingdom, following the publication of the Francis Report (2013). The report was
released after an inquiry into the devastating events surrounding the care of patients at Mid-Staffordshire
Hospital in the U.K. This report attracted international attention by demonstrating that, for many patients,
even the most basic elements of care were neglected, including toileting, hygiene, nutrition, dignity, and pain
relief. Staff morale was reported as low, and although many did their best in difficult circumstances, others
showed a disturbing lack of compassion towards their patients.
Responding to the Francis Report and similar reports of severe lack of care at Winterbourne View private
hospital in South Gloucestershire, U.K., the UK National Health Service Commissioning Board stated that:
The health, care and support system provides people with often good and often excellent service. But this is not universal. There is poor
care, sometimes very poor. As professionals and care staff, we are as shocked by the failings at Mid Staffordshire and Winterbourne View
as the public are. Such poor care is a betrayal of what we all stand for. (NHS Commissioning Board, 2012, p. 7)

In addition, a further report by Keogh (2013) drew attention to the quality of care and treatment provided by
14 hospital trusts in England, whilst a northeast London hospital was found to have a “catalogue of failings”
during unannounced inspections by the UK CQC (2013). It would appear that similar problems occur at a
global level; for example, in the U.S. healthcare systems, various problems have also been reported, including,
“escalating costs, medical errors, inconsistent results and, according to a new national survey, a lack of
compassion” (Nauert, 2015, p. 1).
At a seminar held in June 2012, at Green Templeton College, University of Oxford, a group of nurse
leaders, health policymakers, healthcare researchers, and clinicians met to debate and develop an action plan
around integrating the Fundamentals of Care (FOC) into the patient-centered care agenda. At the seminar, it
was acknowledged that, despite significant improvements in delivering more compassionate and patient-
centered care, there were still many challenges that existed concerning meeting the basic needs of many
vulnerable patients, which was thought to be due to a range of complex factors. A number of health system
initiatives to improve patient care were discussed at the seminar, including: regulation of care; preparation and
training of nurses; ways that factors such as dignity, compassion, and kindness can be promoted in health
systems; and the use of techniques such as hourly rounding, patient involvement in systems redesign, and a
number of other innovations. The FOC framework emerged from the meeting, consisting of three core
dimensions: (1) statements about the nature of the relationship between the nurse and the patient within the
care encounter; (2) the way the nurse and the patient negotiate and integrate the actual meeting of the FOC;
and (3) the system requirements that are needed to support the forming of the relationship and the safe
delivery of the fundamentals of care (Kitson, Conroy, Kuluski, Locock, & Lyons, 2013).
Likewise, at the Chief Nursing Officer’s (CNO) conference held in the United Kingdom in December
2012, attempts were made to address problems with regard to failings in care, through the launch of
“Compassion in Practice” (Cummings & Bennett, 2012). The values and behaviors of this three-year plan led
to calls for every nurse, midwife, and member of the care team to implement what is known as the “6 Cs”—
Care, Compassion, Competence, Communication, Courage, Commitment—into practice and, furthermore,
into all areas of health, public health, and social care services.
In 2014, Bramley and Matiti undertook a qualitative study with a sample of 10 patients in a large U.K.

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teaching hospital. The purpose of the study was to understand how patients experience compassion within
nursing care and to explore their perceptions of developing compassionate nurses. Three themes emerged
from the data: (1) what is compassion: knowing me and giving me your time; (2) understanding the impact of
compassion: how it feels in my shoes; (2) being more compassionate: communication and the essence of
nursing. From this study, the authors concluded that compassion from nursing staff is broadly aligned with
actions of care, and that this can often take time. However, some believed that this element of time need only
be fleeting to establish a compassionate connection.
The components of compassion may include many virtues, such as kindness, empathy, sympathy, respect,
attention to basic needs, and attention to dignity. But the concept of compassion as a whole may differ from
its individual component values. In 2010, Jocelyn Cornwell, director of the Point of Care Program at the
Kings Fund, suggested that compassion in its totality differs from other values in that it goes beyond just
“feeling” something for another person, and implies some kind of action and effort as a result of the desire to
“do” something for another. Thus, the unique quality of the concept of compassion in comparison to the
many individual values contained within it is that it involves taking some kind of “action,” even though this
action could be something quite small; for example, noticing when a patient is in pain, offering kind words
and reassurance, and providing comfort.
Indeed, a UK Department of Health Report (2009) states that, in providing compassionate care: “we
respond with humanity and kindness to each person’s pain, distress, anxiety or need. We search for the things
we can do, however small, to give comfort and relieve suffering…” (Department of Health, 2009, p. 12).
Taking compassion as a concept involving action, giving attention to basic needs is perhaps an essential
starting point for a compassionate approach to patient care within the healthcare setting. With a focus on
hospital care, attention to basic needs often includes, but is not restricted to, the following areas of concern:
dignity/privacy, clothing, food and diet, hygiene, pain relief, comfort, communication, ensuring items are
within reach of the patient, focusing on the individuality of the patient. In addition, care should be delivered
with the important aspects of cultural awareness and cultural competency in mind, as a patient’s values and
perceptions about health care might be different from our own. It would appear that patient care can be
enhanced if healthcare professionals take into account the background, culture, and values of the patient
(Papadopoulos, 2011).

Specific Conditions
A predominant factor that is likely to feature in many clinical conditions is that of pain. In a study by
Chapin et al. (2014), the emergence of anger in patients was viewed as a predictor of chronic pain outcomes,
suggesting that treatments that target anger may be useful within the context of chronic pain. These authors
proceeded with a pilot study of a nine-week group compassion-meditation cultivation intervention in chronic
pain to investigate its effect on pain severity, anger, pain acceptance, and pain-related interference. In
addition, the study aimed to describe observer ratings provided by patients’ significant others, and secondary
effects of the intervention. The results of this study indicated that patients had significantly reduced pain
severity, reduced anger, and increased pain acceptance at post-treatment compared to treatment baseline.
Qualitative data from significant others corroborated patient reports for reductions in pain severity and anger.
Because of the effect of compassion meditation on decreasing anger and increasing self-compassion and

590
interpersonal compassion, it may be particularly beneficial for individuals with chronic pain.
In addition, research highlights the need to consider specific conditions and the individual needs of the
patient and their family/carers. Cancer patients, for example, may expect detailed but user-friendly
information about their treatment and access to additional support for both themselves and their families.
Studies have indicated that clinician empathy towards cancer patients is related to higher patient satisfaction
and less distress, and also that the spiritual needs of patients should be met, to reduce the risk of depression,
and to enhance a sense of spiritual meaning (Lelorain, Bredart, Dolbeault, & Sultan, 2012; Pearce, Coan,
Herndon, Koenig, & Aberneth, 2012). A study by Thorne et al. (2014) reports on the importance of
understanding how cancer patients’ communication needs and preferences change across the course of their
illness trajectory. Their findings suggest that in relation to each phase of their cancer care trajectory, patients
should identify tension points and contextual challenges impinging on what they feel constitutes helpful and
unhelpful patient–provider communication.
In the case of patients with dementia, such individuals are likely to experience confusion, and small acts of
kindness and understanding may make their experience better. The perceptions and needs of the
families/carers of such patients should also be taken into consideration, and as identified in a qualitative study
by Crowther, Wilson, Horton, and Lloyd-Williams (2013) that investigated experiences of carers of patients
with dementia, examples of excellent care were sometimes found to exist alongside examples of very poor care.
Furthermore, in a qualitative study designed to examine carers’ views and experiences of patient care for
people with dementia, it was reported that, although carers appreciated many aspects of the care provided,
communication and engagement of family carers was still perceived as insufficient (Spencer, Foster,
Whittamore, Goldberg, & Harwood, 2013). Taking into consideration that international policy indicates that
acute care for people with dementia should be informed by the principles of person-centered care, and that
interventions should be designed to sustain their personhood, Clissett, Porock, Harwood, and Gladman
(2013) explored whether current approaches were performing to their full potential at enhancing personhood
in adults with dementia. The findings indicated that healthcare professionals in acute settings were not
engaging in all opportunities to sustain personhood for people with dementia, and there is a need for the
concept of person-centered care to be valued at the level of both the individual and the organization (Clissett
et al., 2013).
Compassion is particularly applicable for patients approaching the end of their life, whereby palliative care
represents an important approach in assisting with the relief of symptoms, and providing psychological, social,
and spiritual support to patients and their families/carers. But how can we fully understand the needs and
thoughts of patients reaching the end of the human life cycle? Death is something very personal and
individual, particularly at the final stages; thus compassion towards the dying patient is essential to relieve
suffering and to try to make their exit from this world as pain-free and comfortable as possible (Shea, 2014).
Sampson, Burn, and Richard (2011) suggest that models to improve end-of-life care need to consider the
large range of settings, as well as cultural and staff factors, while being mindful of what works best for whom
and in what circumstances. An earlier qualitative study, by Singer, Martin, and Kelner (1999), which aimed at
obtaining perceptions of patients regarding end-of-life care, identified five domains of quality end-of-life care:
(1) receiving adequate pain and symptom management; (2) avoiding inappropriate prolongation of dying; (3)
achieving a sense of control; (4) relieving burden; and (5) strengthening relationships with loved ones. In

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addition, Herbert, Moore, and Rooney (2011) emphasized that the need for better understanding of end-of-
life care has never been greater than in today’s healthcare climate, and that compassionate end-of-life care that
is appropriate and in accordance with the patient’s wishes is essential.
A further example of the importance of a compassionate approach to patient care emerges when
considering patients treated in intensive care units (ICUs), and the importance of effective communication
with their families. A prospective cohort study performed in four ICUs of a university hospital in Germany
revealed that, although families reported high satisfaction with intensive care, there was room for
improvement regarding how ICU staff communicated with families and provided emotional support
(Schwarzkopf et al., 2013).
Effective communication and information provided to patients and their carers could be particularly
important in cases where the patient may be confused and suffering from delirium. The issue of delirium is
common in the ICU (Brummel & Girard, 2013), and manifestations of delirium can be extremely upsetting
to patients, patients’ families, and nursing staff (Balas et al., 2012). As Balas et al. point out, an appropriate
and compassionate management strategy may reduce the suffering and adverse outcomes associated with
delirium and improve relationships between nurses, patients, and patients’ family members.
Box 32.1 represents a real-life example (included with permission), where better communication between
ICU staff and the patient and his family could have helped to relieve anxiety and fear.

Box 32.1 Delirium in the ICU Unit—Neil, United Kingdom

After nine hours on the operating table and 48 hours in an induced coma, I became conscious. What
happened next was very unusual:
… I was wheeled onto a stage with another young man in a bed next to me. They were filming us. I looked over and a severe looking female
junior doctor seemed to be in charge of the production. There was a sinister undercurrent flowing here….
… After the bizarre filming session, I was moved to an odd house, outside the main hospital. An Asian man looked after me, and did his best to
reassure me that I had not been involved in any film or trial, although I did not believe him….
… The following night was even worse. I was in a house of horrors for the whole interminable time. Lying on the floor, they taunted me. I was
convinced that they were either trying to drive me mad, or kill me….

I finally made it out of intensive care and high dependency wards, and back to the general surgical ward. It
was good to feel that I was making progress, but there were always the hallucinations to remind me that
things were not altogether normal yet:
There were the purple spotted fish shapes which drifted across the ward, and of course the plethora of big hairy spiders which lived just under the
ceiling tiles. I could see their legs writhing around, but never their bodies.

As I recovered, the delusions gradually subsided. However, the memory of the bizarre experiences still
persists, nearly two years later. It was also an upsetting experience for friends and family who visited me.
When my partner asked the nurses what was wrong with me—had I suffered brain damage?—she was
given no satisfactory explanation. At no time before or after my operation had anyone warned me of the
possibility that I might have disturbing delusions and hallucinations. I believe this would have been useful
information to have, and that it may have helped me cope better with the horror and fear that I experienced
during my stay. From a technical perspective, the care that I received was a medical miracle, but there was
no support on this issue of delirium for either myself or my family.

Considering the example in Box 32.1, we can see how a compassionate approach and reassurance from the

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hospital staff, together with attention to basic needs, may help alleviate the burden that certain patients face.
Whilst technological expertise is undoubtedly crucial, particularly under certain circumstances,
communication, understanding, information, choices, individualized care, pain relief, and attention to spiritual
needs all constitute examples of attending to basic care needs based on individual clinical conditions, to the
benefit of both patients and their families/carers.
There is a close relationship between person-centered care and compassion. According to a definition by
the Institute of Medicine (IOM), patient-centered care is an approach that offers care according to the
patient’s wishes, preferences, and needs (Institute of Medicine, 2001). Patients anticipate being treated with
compassion, respect, and dignity. This underlines the need for a focus on compassion in relation to patient or
better person-centered care. As such, provision of compassion should be considered as an essential skill for
healthcare practitioners in order to aid effective communication. Compassionate care could also be combined
with spiritual care and motivational interviewing in order to move towards a more patient-centered approach.
It is not only members of the public who find themselves in the situation of being a vulnerable patient or an
anxious relative. The example that follows demonstrates that healthcare professionals themselves can be
equally vulnerable when a lack of compassion is evident. The following account has been shared through a
previous publication authored by the individual referred to in Box 32.2.
The personal reflection in Box 32.2 reminds us of how important a compassionate approach can be, and
how a lack of compassion can lead to great distress. The absence of communication and lack of “bravery” from
Professor Sweeney’s colleagues led him to suffer much more than he should have done, and to encounter
feelings of great despair and hopelessness.

Box 32.2 Professor Keiran Sweeney

Professor Sweeney was known for his clinical excellence and devotion to compassionate care, and for
applying ideas from philosophy, arts, and social science to honor patients above their diseases. When
Professor Sweeney became ill with malignant mesothelioma at age 57, his colleagues were too afraid to tell
him of the diagnosis. This lack of communication led to his finding out his diagnosis himself, when he
accessed his own medical records whilst having lunch one day. Before his death, Professor Sweeney
published his own experiences as a patient, in which he speaks of the “lack of bravery” of the medical team
treating him, and whilst speaking of their faultless technical expertise, he refers to a severe lack of relational
aspects of care:
In the care I have received, the transactions have been timely and technically impeccable. But the relational aspects of care lacked strong
leadership and at key moments were characterised by a hesitation to be brave. What I have always feared in illness was anonymity,
being packaged, losing control, not being able to say “this is who I am.” In the end, one is left alone, here, in the kingdom of the sick.
—Sweeney, Toy, and Cornwell (2009, p. 512)

The Primary Care Setting

Much of the literature surrounding compassion has focused on the hospital setting. However, applying the
concept of compassion in health care is equally important within primary care settings. Taylor (1997) refers to
the “resuscitation” of the personal doctor, stating that “general practice without compassion is as therapeutic
as air without oxygen” (p. 521), and as such, compassion is a necessary value for general practitioners (GPs).

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 Traditionally, family medicine was intended to encompass the treatment of a patient based on personal
knowledge of the person, and taking into consideration the patient’s biological/psychological needs, within the
context of knowledge of his/her family/community. The concept of “compassion” can be viewed as a crucial
aspect of general practice; indeed, as Barry and Edgman-Levitan (2012) state, “Caring and compassion were
once often the only ‘treatment’ available to clinicians” (p. 780).
The GP is often the first point of contact for the patient, and GPs deal with a wide range of consultations
and offer a broad spectrum of care (Allen et al., 2002). GPs deal with a number of conditions and are often
responsible for dealing with the needs of elderly patients and playing a role in end-of-life care. GPs also play a
vital role in dealing with the management of long-term conditions (LTCs), which are considered important
determinants of quality of life. Chew-Graham et al. (2013) conducted a qualitative study focusing on ways in
which the Quality and Outcomes Framework (QOF) informs the consultation, highlighting tensions between
patient-centered consulting and QOF-informed LTC management. The results from the study indicated that
patients often passively present themselves to the practitioner for scrutiny, but they often leave the
consultation with unmet biomedical, informational, and emotional needs. These authors conclude that routine
review consultations in primary care often focus on the biomedical agenda set by QOF, where the practitioner
is the expert, and the patient agenda is often unheard.
Shared decision making should form an important part of general practice, but patients may be left
confused and unsure about how their problems are being managed and how to understand the range of
treatment options available to them. Thus, sensitivity to the patient is an important factor, as are effective
communication and a patient-centered approach. As such, Stevenson (2012) argues that patient-centered care
exerts a positive influence on health outcomes and is especially applicable in general practice, providing an
efficacious and compassionate response to suffering.
Recently, attention has been drawn to the importance of a patient-centered care approach across a number
of organizations. For example, in both Europe (World Organization of National Colleges, Academies and
Academic Associations of General Practitioners/Family Physicians (WONCA, 2002) and the United States
(American Academy of Family Physicians [AAFP], American Academy of Pediatrics [AAP], American
College of Physicians [ACP], American Osteopathic Association [AOA], 2007), statements have been
provided regarding patient-centeredness as a key determinant of effective primary care.
In the U.S., the patient-centered Medical Home (a model of care that aims to transform the delivery of
comprehensive primary care to children, adolescents, and adults) delivered four fundamental components of
this approach, where coordination, comprehensiveness, continuity, and quality of care are included. In
Europe, the National Health Services Research Institute of the Netherlands (NIVEL)—also a World Health
Organization (WHO) collaborating center—has developed instruments for the monitoring of the quality of
primary care and to assess the level of its integration into primary care provision
(http://www.nivel.nl/en/european-health-care-systems). Under the support of this institute, Kringos et al.
(2013) identified that strong primary care consists of seven core dimensions. These include three for the
structure of primary care (primary care governance, economic conditions of primary care, and primary care
workforce development), and four for the primary care process (accessibility of primary care,
comprehensiveness of primary care, continuity of primary care, and coordination of primary care). However,
recent reports regarding the quality of primary care services across different European settings have shown a

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high variation in service quality (Schäfer et al., 2015), with countries affected by the austerity period, such as
Greece, needing to undertake certain measures to improve their current situation.
Although compassion is frequently included in position papers, compassionate care is not considered as an
independent component of the patient-centered care approaches, either in the U.S. or Europe (Lionis &
Shea, 2012; AAFP, AAP, ACP, and AOA, 2007). Frampton, Guastello, and Lepore (2013) have noted that
the IOM definition lacks a specific emphasis on compassion. This observation is made on the basis of the
experiences of Planetree in the U.S., a not-for-profit organization that partners with healthcare establishments
to drive adoption of patient-centered care principles and practices by connecting healthcare professionals with
the perspectives of patients and family members (www.planetree.org). Thus, it would appear that the current
debate on patient-centered care lacks practical approaches for embedding compassion in healthcare delivery
and organizational culture in order to meet patients’ needs, desires, and expectations with regard to “empathic
and respectful human interactions” (Frampton et al., 2013).
In a study by Tarrant, Windridge, Boulton, Baker, and Freeman (2003) designed to examine perceptions of
care in general practice, care providers felt that compassion was important from the initial stage of entering
the reception room, stating that this is the first step towards the doctor, and if this experience is off-putting,
patients may adopt a defensive attitude when they see the doctor. However, the concept of compassion may
not be explicit within the World Organization of Family Doctors (WONCA) definition, and perhaps the
extent to which compassionate care should be introduced as a key competency is an issue for discussion
(Lionis & Shea, 2014). Within the European definition of general practice/family medicine, WONCA
Europe defines eleven characteristics of the discipline, and lists six competencies for the general practitioner:
(1) primary care management, (2) person-centered care, (3) specific problem-solving skills, (4) a
comprehensive approach, (5) community orientation, and (6) a holistic approach (WONCA Europe, 2002).
However, this approach remains vague in its formulation. The “holistic approach” competency, which
includes the ability to use a bio-psycho-social model taking into account cultural and existential dimensions,
also created some confusion for European delegates when they were asked to consider the inclusion of this
competency into national vocational training programs (Lionis, Allen, Sapouna, Alegakis, & Svab, 2008).
Perhaps what is needed is the inclusion of a competency relating to compassionate care (Lionis & Shea,
2012). This could help further extend the holistic approach, it would seem to be closely related to the
competence of patient-centered care, and it is an issue that residency programs could address.
There is a growing interest in the concept of compassion within primary care, as reflected in the activities of
certain European organizations, including the Royal College of General Practitioners (RCGP). The RCGP
organized a one-day conference to address this issue and to discuss and debate the challenges faced in
providing compassionate primary health care. The conference addressed a number of issues, including
practitioner altruism, patient engagement and empowerment, and patient safety and health outcomes.
In the United Kingdom, the CQC (2013) has announced that GPs will be rated for their compassion and
values, and CQC inspectors will interview GPs and their patients to measure how caring and compassionate
individual practices are. However, there is a danger of introducing such measures and increasing the burden
on GPs, possibly leading to further cases of burnout. Thus, compassion towards GPs themselves, and across
the primary care team involved in family medicine, is also an important issue if compassion towards the
patient is going to be sustainable. As such, the recent RCGP conference also addressed the issue of GP

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burnout that has been recognized as a growing issue in the U.K., as evidenced by a survey conducted among
1,800 GPs by the College of Medicine, Pulse, and RCGP (Pulse, 2013). As noted by Fortney, Luchterhand,
Zakletskaia, Zgierska, and Rakel (2013), burnout, attrition, and low work satisfaction of primary care
physicians are growing concerns, and these can have a negative influence on health care. In a recent
uncontrolled pilot study, Fortney et al. (2013) concluded that participating in an abbreviated mindfulness-
training course adapted for primary care clinicians was associated with reductions in indicators of job burnout,
depression, anxiety, and stress. Thus, modified mindfulness training could be a time-efficient tool to help
support clinician health and well-being, which may have implications for patient care.
General practice/family medicine is generally a key focus of any current healthcare reform, and quality-of-
care improvement currently involves discussion in relation to the new roles of GPs. General practice is a
discipline that deals with complexity and may be utilized by healthcare systems in different ways, but,
although GPs are expected to offer person-oriented and integrated care, the conditions and settings within
which they operate may not always be supportive. We are reminded that, over time, advances in medical
science have provided new options, and although these can often improve health outcomes, they may also
inadvertently distance physicians from their patients.
As mentioned previously, a close relationship exists between person-centered care and compassion. Thus,
we may assume that compassion can incorporate other concepts frequently utilized in general practice, such as
patient-centeredness and empathy. And, as Professor Haslam (2015) reminds us, “there is ‘extraordinary
potential for blending the best of evidence-based medicine with real patient centeredness … and it takes every
single person involved in health care—from Governments all the way through to the frontline—to remember
this” (p. 3). Box 32.3 has been included in order to clarify the potential of compassion in clinical cases, as
observed within the primary care setting.
In the primary care setting, people often visit or are referred to such services with invisible or hidden
healthcare problems, such as intra-familiar violence. By expressing empathy and compassion, the primary care
practitioner can ensure that the patient feels reassured and safe, by creating a friendly environment and
motivating him/her in disclosing key issues of life and personal happiness that might have a major impact on
health. Referral of adolescents to primary care practitioners, either by other care services or by the families
themselves, is key, and it is an important source for the recognition of unseen health and behavioral problems.
Thus, in the example displayed in Box 32.3, adopting a compassionate approach and paying attention to
mental health issues, in addition to dealing with physical factors, could play a crucial role.

Compassionate Health Care Within Specific Societal Conditions

Beyond presenting with conditions, entering a hospital, or seeking advice from a GP, the health of an
individual may be affected by circumstances that might be beyond their control. Under these circumstances,
health needs might differ, resources might be limited, and access to care might be difficult. At such times,
compassion is perhaps most crucial, but it might be difficult to deliver. We briefly discuss two examples as
follows.

Box 32.3 Observation in a Primary Care Setting During Austerity

Female, 16 years old, referred to the Primary Health Care unit of the Municipality of Heraklion by a

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 social worker due to limited insurance program for the second time:

• Ethnic background: Greek-Romanian

• Family background and living conditions: Parents divorced, never met her father, facing financial
problems, living with her mother, two younger siblings living in Romania, one sister living in a
children’s charity organisation
• Reason for visit: Fainted, weight loss, and vaccination check
• Symptoms: fatigue, dizziness, insomnia, anorexia
• Health habits: Smoking, alcohol abuse, drug abuse (eight-month cessation)
• Personal medical history: three-month anorexia reported, seven-month insomnia, emotional disorders
• Family medical history: No other diseases reported
• Clinical examination and blood examination performed

Austerity/Financial Crisis—The Example of Greece

Karanicolos (2010) draws our attention to how the financial crisis in Europe has posed major threats and
opportunities to health. Countries affected in Europe, such as Greece, Spain, and Portugal, have experienced
a growth in strain on their healthcare systems, and a rise in suicides and outbreaks of infectious diseases. An
extreme example of austerity is evidenced in Greece, which Kentikelenis et al. (2014) refer to as “mounting
evidence of a Greek public health tragedy”(p. 748). During recent years, Greece has experienced an austerity
period that has severely affected its spending on healthcare services and the populations. There has been a
great impact on access to healthcare services and drug supply (Karatzanis et al., 2012; Karamanoli, 2012),
while a great proportion of the Greek population is not receiving continuous and personalized care. According
to research by Kentikelenis, Karanikolos, Reeves, McKee, and Stuckler (2014), hospital budget cuts have
resulted in increased workloads for staff and a growth in waiting lists, whilst rural areas have encountered
particular difficulties with shortages of medicines and medical equipment. Mental health has also worsened
considerably since the beginning of the financial crisis in Greece (Kondilis, Ierodiakonou, Gavana,
Giannakopoulos, & Benos, 2013). In an editorial published in The Lancet, (2015), it was noted that we should
not forget that the crisis in Greece is not only economic but also about health. Furthermore, the editorial
draws attention to the fact that many Greeks who have lost their jobs have also lost their health insurance.
The editorial concludes by expressing hope that “a humane response to Greece’s economic recovery, whatever
that might be, can be realized to ease the health crisis facing the country’s 11 million people” (p. 104). The
key here perhaps lies in the word “humane,” wherein perhaps a more compassionate approach is needed.
Although the political parties in Greece agree that efforts to strengthen primary care are essential, the
efforts undertaken during the recent years still seem to be ineffective (Kousoulis, Angelopoulou, & Lionis,
2013). In Greece, teamwork and multidisciplinary work are also still lacking in both the public and private
healthcare sector, and continuity, comprehensiveness, and coordination require many efforts for improvement
(Schafer et al., 2015). Multi-morbidity, frailty, and self-management issues that are subject to the benefits of
compassionate care are currently under debate within the international setting, but these are still not included
in the present agenda for general practice/family medicine in Greece, even within the austerity period (Lionis,
2015). In view of this, it seems that the effects of austerity measures on human life and the individuals

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affected should be carefully analyzed, and those affected (including healthcare professionals themselves), need
to be treated with compassion, empathy, altruism, and understanding.
Utilizing Greece as an example, we can see that such countries could be facing a true humanitarian crises,
and a compassionate approach could be key to recovery. However, certain measures have been put in place by
healthcare professionals in Greece, who demonstrated their own compassionate approach by initiating
volunteer-run health clinics to help to ease the burden and to assist Greeks who have lost their jobs and
associated healthcare plans (Kremer & Badawi, 2013).
It would seem that the problems that Greece (and other affected countries) face could benefit from a
compassionate approach at an international level. Understanding and taking into account elements regarding
the culture and structure of Greece, and the pressures that many Greeks currently face could aid in the
country’s recovery.

Homelessness
Sometimes related to economic difficulties is the issue of homelessness. It may be difficult to categorize a
homeless person, and the reasons that a person becomes homeless vary considerably; however, homelessness is
a widespread problem, and more so in times of economic crisis. In addition to the various problems that this
vulnerable population faces, assistance with primary, secondary, and mental healthcare access is a crucial issue.
Many homeless people encounter mental or physical health problems, and in some cases they experience
both. In addition, drug and alcohol abuse is also common amongst homeless people. However, access to the
appropriate health services for these people can be difficult, and there are many reasons why such difficulties
might arise. According to the RCGP (2013), these reasons include: more immediate needs such as food and
shelter, poor staff attitudes, fear of being judged, etc., which might be particularly problematic when
attempting to access general practice.
It is reported by the Queen’s Nursing Institute (QNI) that individuals who sleep in impoverished
conditions experience rates of physical health problems two or three times greater than the general population
does. Such people also encounter significantly higher rates of respiratory disorders, skin and dental problems,
musculoskeletal problems, and sexually transmitted diseases, and many have multiple health problems. QNI
also drew attention to findings of the prevalence of chronic chest and breathing problems being twice as bad
as the general population. Furthermore, homeless people have considerably worse health-related quality of life
than the general population, and many problems in relation to anxiety and depression are reported (Sun,
Irestig, Burstrom, Beijer, & Burstrom, 2012). However, despite the strong body of evidence that there are
significantly higher rates of mental health problems in populations of homeless adults, and that unusually high
rates of psychosis are a feature (QNI, 2012), access to mental healthcare services may prove difficult.
Due to the problems incurred in gaining access to services, often the one place that homeless people feel
that they can go to receive treatment is the Accident and Emergency service (A&E). Use of A&E services is
high among this population, and according to the charity “Crisis” (2005), homeless people are more likely to
use A&E services if an untreated problem requires immediate attention, or if they are unable to access a GP.
Tending to the problems faced by homeless people requires an approach that is compassionate, and activated
at a community level, with the recognition of the problems, high vulnerability, and social exclusion that these
people face. Homelessness is an issue where compassion plays a major role (Limebury & Shea, 2015). When

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assisting homeless people, we should perhaps consider the statement by Cole-King and Gilbert (2014) that a
nonjudgemental approach is required, whereby we are not “judging a person’s pain or distress, but simply
accepting and validating their experience” (p. 72). Adopting such an approach may help us better understand
the needs of this vulnerable group and assist in removal of the stigma that is often attached to homelessness.
As such, a compassionate approach applies not only to the healthcare setting, but also to the needs of
vulnerable groups who may have specific health and social requirements.

Obstacles to Compassion in Health Care

For most health professionals, compassion, empathy, and respect are core values and viewed as integral to
their caring role (Mannion, 2014). However, for the compassionate approach to succeed, it is important to
consider the healthcare setting as a whole, including organizational factors. Team work, healthcare
professional self-care and understanding, and a compassionate approach between healthcare professionals
towards each other may all contribute to the overall patient and healthcare provider experience. Healthcare
professionals are often under strain from a number of pressures, including large amounts of paperwork and
lack of time, and as burnout and compassion fatigue are growing issues, it is important that healthcare
professionals receive adequate support. Without such support, it may become difficult for them to adequately
express compassion towards their patients.
A study conducted by Bogossian, Winters-Chang, and Tuckett (2014) aimed at exploring nurses’
perceptions of the nature of nursing work and whether that was a factor that contributed to attrition from the
profession. The study discovered that nurses’ motivation and satisfaction with work are being greatly tested.
Bogossian et al. (2014) concluded that there is tension between the core concepts (compassion and care) of
nursing and a system of work that actively precludes nurses from being able to exhibit these virtues and fails to
reward them. Bogossian et al. further suggest that issues such as workload, shift work, violence, and financial
remuneration are seen as drivers of attrition and need to be addressed.
So, is it possible for a compassionate individual to remain compassionate if operating in a non-
compassionate organization? We know from the Mid-Staffordshire experience that morale at the Trust was
low, and whilst many staff did their best in difficult circumstances, others showed a disturbing lack of
compassion towards patients. This may lead us to consider the importance of factors such as time, lack of
teamwork and communication, and the structure of the organization in general, which may all lead to a
decrease in compassion. Thus the organization itself needs to demonstrate compassion as a whole, towards all
staff and patients. This in turn might help ease the pressure on healthcare professionals and reduce the
incidence of burnout.
With the growing demands healthcare professionals are expected to meet, such as increased paperwork and
the number of targets, Fotaki (2015) suggests that proposals to incentivize compassion should be geared
towards promoting prosocial behavior rather than imposing a new set of burdens and target measures. Thus, it
would be an unsatisfactory measure to introduce additional burdens, if we are to take the well-being of
healthcare providers into consideration. This suggestion was included in an editorial by Fotaki (2015), which
addressed the question, “Why and how is compassion necessary to provide good healthcare?” In responding to
this editorial, Lionis (2015) suggests that a culture change that places the patient at the heart of all decision-
making procedures relevant to his/her health seems to be a key issue. This can perhaps be achieved by

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involving patients in issues relevant to the quality of care services and safety, both basic components of a
patient-centered approach. Additionally, Shea (2015) suggests that such procedures require feedback and
evaluation, and the development of measures via the utilization of a theoretical framework for understanding
barriers to care, and for understanding “what goes right” and “what goes wrong” within the healthcare setting.
According to Lown, McIntosh, Gaines, McGuinn, and Hatem (2016), compassion should be consistently
offered by healthcare professionals to patients, families, staff, and one another. However, compassion without
collaboration may result in uncoordinated care. In a paper by Hojat (2009), it is stated that, “empathy in the
context of clinical care can lead to positive patient outcomes including greater patient satisfaction and
compliance, lower rates of malpractice litigation, lower cost of medical care, and lower rate of medical errors.
Also, health professionals’ wellbeing is associated with higher empathy” (p. 412).
Kearsley and Youngson (2012) suggest that the characteristics of personal compassion may be extrapolated
to the concept of organizational compassion. They discuss the fact that little discussion has taken place on
how healthcare organizations might best integrate aspects of individual compassion to create an organization
with compassion as a core value. Three characteristics of a “compassionate hospital” were defined by these
authors as (1) the presence of a healing environment, (2) a sense of connection among people, and (3) a sense
of purpose and identity. They further suggest how a “top-down” focus on compassion as a core value by
clinical leaders could maximize the compassion of healthcare workers and reduce the suffering expressed
and/or experienced by healthcare workers and patients in today’s healthcare facilities.
Although health care practitioners are often thought to need more compassion, this tends to blame the
problem on individual practitioners rather than focusing on the overall design of care and healthcare
organizations (Crawford, Brown, Kvangarsnes, & Gilbert, 2014). Crawford et al. (2014) conducted an
investigation of the tension between individual and organizational responses to contemporary demands for
compassionate interactions in health care, using the terms compassion, care, and design in a search of literature
published from 2000 through to mid-2013. They found that there is a relatively large literature on compassion
in health care, where authors discuss the value of imbuing a variety of aspects of health services with
compassion, but that this is in contrast to the lack of attention given to how organizational structures and
processes might inform compassion. Crawford and colleagues discuss how making the clinic more welcoming
for patients and promoting bidirectional compassion and compassion-formation in nursing education can be
part of an overall approach to the design of compassionate care. They further discuss a number of ways in
which compassion can be enhanced through training and educational and organizational design.
In 2010, Cosley, McCoy, Saslow, and Epel conducted a study to investigate how compassion for others
might moderate physiological stress reactions. In this study, the authors examined the role of compassion and
social support in reducing blood pressure reactivity. Assessing for a link between compassion and social
support, the researchers suggested that practitioners in receipt of social support may be more compassionate,
and that this in turn leads to a decrease in their own blood pressure. Thus, those who are more compassionate
may also be benefited by the support that they themselves receive, particularly during stressful situations.
A paper by Seppala, Hutcherson, Nguyen, Doty, and Gross (2014) raised the important question as to
“what practical steps can be taken to increase compassion, thereby benefitting both provider well-being and
patient care?” (p. 1). In a study designed to investigate the relative effectiveness of a short, 10-minute session
of loving-kindness meditation to increase compassion and positive affect, the authors found that loving-

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kindness meditation improves well-being and feelings of connection over and above other positive-affect
inductions. The authors suggest that loving-kindness meditation may provide a viable, practical, and time-
effective solution for preventing burnout and promoting resilience in healthcare providers and for improving
quality of care in patients (Seppala et al., 2014).
In order to reintroduce compassion into the U.S. healthcare system, the Schwartz Center for
Compassionate Healthcare (www.theschwartzcenter.org) has developed what is known as the “Schwartz
Center Rounds.” These rounds are designed for staff to come together once a month to discuss the nonclinical
aspects of their work, including emotional and social challenges. Likewise, the Schwartz Center Rounds are
currently being piloted by the Point of Care program in the United Kingdom. Typically, during the Rounds, a
patient’s case is presented by the team responsible for him or her. The themes that emerge are then discussed
and guided by a facilitator. Quite often, the issues raised include caring for difficult patients and their families.
The Rounds have been running for 15 years in the United States, and in 2009, the Point of Care Program in
the U.K. signed an agreement to pilot the rounds in the United Kingdom (Goodrich, 2012).
According to the Schwartz Centre, compassionate care is not separate from other kinds of care, nor is it
reserved for the end of life; it is fundamental to all patient–caregiver relationships and interactions. Without
it, care may be technically excellent but depersonalized, and it cannot address the unique cultures, concerns,
distress, and suffering of patients and their families. To foster a more compassionate healthcare system, the
Schwartz Centre are calling on all who believe in the importance of compassion and compassionate health
care to support and endorse a set of commitments, which they believe would go a long way toward making
compassion a priority in healthcare systems. These include: Commitment to Compassionate Healthcare
Leadership; Commitment to Teach Compassion; Commitment to Value and Reward Compassion;
Commitment to Support Caregivers; Commitment to Involve, Educate, and Learn from Patients and
Families; Commitment to Build Compassion into Healthcare Delivery; and Commitment to Deepen Our
Understanding of Compassion (www.theschwartcentre.org).
Stress, depression, and burnout can be common in doctors and nurses, making them more self-critical and
less compassionate towards themselves, rendering it harder to show compassion towards their patients. Thus,
compassion not only should be concerned with the interaction between healthcare professionals and patients,
but also should extend to interactions, connections, and communication across the entire organization—
including policy makers and managerial staff.

Increasing Compassion in Health Care

So far, we have discussed the importance of a compassionate approach in different healthcare settings. We
have also considered potential barriers to compassionate care, such as time, fatigue, and organizational factors
that might prevent compassion from being evident within practice. Following the symposium held at
Greenwich University in 2011 (Shea et al., 2011), we asked participants for their views on how compassion
might be sustained in the longer term. The participants responded with suggestions such as: introducing
refresher courses on compassion,; providing positive messages to staff, and asking patients for their views and
experiences, and their suggestions on what could be done better. A key question that is often asked is, can
compassion be taught? As such, our participants also discussed various aspects in relation to teaching and
assessing compassion, such as the process of lifelong learning and the need to encourage suitable role models.

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The process of learning was considered just as important as the method of teaching. Owing to the scientific
nature of medical training, it was considered possible that students are taught “not to be” compassionate. On
the latter point, early work by Becker, Geer, Hughes, and Strauss (1961) suggested that values in health care
may be “taught out of” medical students during their training. Thus, it is possible that the scientific nature of
nurse/medical training may lead to a decrease in compassion.
Chochinov (2007) reports that compassion can be achieved through various channels, and it may be
cultivated by exposure to the humanities, social sciences, and arts. Such a multidisciplinary approach can offer
an insight into the human condition and the pathos that accompanies illness. Likewise, Haslam (2015)
suggests that “indeed empathy is a trainable quality if we cultivate the habit of self-reflection, and learn from
humanities such as literature, film, theatre, poetry which will help us imagine the lives of others” (p. 2).
Debate as to whether or not compassion can be taught has existed for some time, and as far back as 1983,
Pence (1983) raised this question in a well-cited essay, utilizing the differing views of ancient philosophers.
Pence drew on the opinions of Socrates (who claimed that virtues cannot be taught) and Protagoras (who
claimed that everyone teaches virtues), concluding that compassion can be taught if medical education systems
reward this virtue alongside other medical virtues, thus ensuring its sustainability. There are various
indications that compassion can be taught, or that it can at least be brought to the forefront and encouraged in
both medical/nursing students and practicing healthcare professionals. One such example comes from the
Leadership in Compassionate Care Program (LCCP), developed as a joint program of research between
Edinburgh Napier University and NHS Lothian (Adamson & Smith, 2014). The developers realized that a
good starting point in learning how to provide compassionate care is recognizing that “we don’t always know
what patients want … and we should consistently check out what is important to them” (p. 236). The
program aims to embed compassionate nursing within clinical practice and preregistration nursing education.
The structure of the LCCP involves: simulated practice to teach students to assess acutely ill patients,
encouraging them to focus on the person as an individual and to identify what is important to them at that
moment; using actors to play the role of patients whereby students are asked to listen to patient stories, and
the emerging themes are utilized to inform changes to the nursing program; involving student participation in
sessions creating collages of what compassionate care would look like for them as a patient. Feedback from the
LCCP program has demonstrated that students enjoy participating in the program, and listening to actor-
patient stories helps them understand how patients feel. Such stories help them reflect on their own practice
and experiences. In addition, students find the development of collages and visual images a stimulating
exercise (Adamson & Smith, 2014). The following section summarizes our own experiences of developing and
delivering courses in compassionate care.

University of Crete Medical Faculty, Crete, Greece

In 2010, a course was developed on the island of Crete for delivery to first-year medical students (Lionis,
Shea, & Markaki, 2011). The course aimed to enable students to recognize basic human feelings and needs in
themselves and their colleagues, identify the need for compassionate care in individual patients, and focus on
the patient as a “whole” person and understand the issues faced by patients and their families. The structure of
the course involved introductory and interactive sessions, interactive workshops, clinical workshops, and the
use of videos and other learning materials.

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 The course attracted high interest from students, with most of them reporting that it had greatly improved
their understanding of compassion and alerted them to the fact that compassion is very relevant in healthcare
settings. Many of the students felt that the course would have a great effect on their future practice. The
course is still being offered and continues to attract a lot of student interest.

Ygia Hospital, Limassol, Cyprus

In 2015, a course was developed in Cyprus consisting of six modules, lasting six hours each, delivered over a
time-scale of a few months. The authors of this chapter participated in the development and teaching of two
of the six-hour modules, which were delivered to nurses, doctors, and administrative staff at a private hospital
in Limassol, Cyprus. The goal of the training was to provide a practical framework for developing compassion
for oneself and others by enhancing and deepening the qualities of compassion, empathy, kindness, self-
awareness, self-reflection, interpersonal conflict resolution, communication, and compassionate care skills. A
number of activities were included throughout the course, including lectures, role-play, case studies, videos,
and discussion topics. Evaluation of the course demonstrated that, although some participants felt that the
six-hour sessions were slightly too long, a majority of them expressed very high levels of satisfaction and
reported enjoying the positive experience that the course provided. Of further interest, the involvement of
managerial and administrative staff as participants throughout enabled them to actively participate in the
learning experience, alongside frontline staff.
In conclusion, it appears that compassion can be taught or assisted in its sustainability through short courses
or inclusion in medical curricula, but such training should involve all in the healthcare team to draw attention
to the importance of the concept and gain an understanding of its impact. Thus, if training or education on
the topic of compassion can be extended to include all of those involved in the healthcare setting, this may
help ensure a compassionate approach, not only towards patients, but also towards other members of the
healthcare team. Ongoing training, reflective learning, learning by experience, role-modelling, and innovative
teaching methods may all help sustain the virtue of compassion in the longer term.

Conclusion
Compassion is a rapidly developing field within the scientific literature, and although technical ability and
skills are essential in health care, the important role of a compassionate approach should not be overlooked.
In this chapter, we have looked at the role of compassion within various settings and situations, including
the hospital setting and primary care setting, and when maintaining awareness of the needs of specific patient
groups. In addition, we have looked at the role of compassion at the society level in terms of the effects of
austerity measures on health care, and the specific health and social requirements of the homeless. Finally, we
have reported on potential barriers to compassionate care, and described how the concept may be incorporated
in teaching and training programs.
It is encouraging that many initiatives are in place to incorporate compassion within health care, and that
many are united in the recognizing the importance of this issue. It is important to maintain this momentum
and to appreciate that healthcare professionals themselves face many obligations and targets, the pressure of
which could be partially overcome by a critical understanding of the needs of all involved in the healthcare
setting. Investigations into what works best for whom and under what circumstances, by the development of

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explanatory theoretical frameworks, could benefit patients, family members, carers, and healthcare
professionals. In addition, attention to the needs of specific vulnerable groups such as the homeless and those
affected by austerity could help reduce the risk of increased physical and mental health problems. Scientific
research, and further development of the evidence of the physiological effects of compassion on both the
recipient and the receiver, may help ensure that the role of compassion in health care is not lost. Finally, we
argue for the importance of introducing compassionate care training both at an undergraduate level and
throughout professional practice, for all of those working in/wanting to pursue a career within the healthcare
setting; and furthermore, that such training should extend to administrative and managerial staff as well. We
should remember, of course, that there are also examples of very good and excellent care within our healthcare
settings, and observing examples of “what goes right” as well as examples of “what goes wrong” could prove to
be a helpful learning tool.

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 A Call for Compassion and Care in Education Toward a More Comprehensive
Prosocial Framework for the Field

Brooke D. Lavelle, Lisa Flook, and Dara G. Ghahremani

Abstract

Students are challenged by stressors that negatively impact their physical health and well-being as well as
their ability to thrive in school. Many educators have mobilized to address these issues, as mounting
evidence suggests that enhancing the social, emotional, cultural, and ethical aspects of schooling
improves student well-being. These movements have stirred a variety of prosocial education initiatives—
including Social and Emotional Learning (SEL) and mindfulness-based programs—which have been
shown to make a positive impact. Yet in spite of this growing interest in prosocial education, these
movements have proceeded largely independently of one another and without a comprehensive
theoretical model of prosocial development. In this chapter, we review the evidence of compassion-based
interventions and offer a compassion-based framework as an organizing principle for the field that may
help integrate diverse prosocial approaches and help educators respond most effectively to needs of our
school communities.

Key Words: prosocial, prosocial education, social and emotional learning, SEL, mindfulness,
compassion, school climate, moral education

Many educators in recent years have strengthened their calls for a systems-wide approach to education that
fosters development of prosocial behavior, such as cooperation, sharing, and empathic behavior, among
students. For some, this call reflects a desire to reclaim a more holistic vision of education that fosters
students’ ethical development and civic engagement; for others, this call reflects a push to create the
conditions necessary to improve students’ academic performance and to prepare them for today’s job market
(Brown, Corrigan, & Higgins-D’Alessandro, 2012). Though these perspectives reveal different points of view
regarding the primary goals of education, both perspectives are aligned by a common concern for students’
physical and mental well-being.
Students are vulnerable to a range of factors that can negatively affect their physical and mental well-being,
as well as their ability to succeed and thrive in school. An increase in mental health problems (Jaffee,
Harrington, Cohen, & Moffitt, 2005; Romano, Tremblay, Vitaro, Zoccolillo, & Pagani, 2001) has coincided
with higher reported rates of bullying and aggression (Swearer, Espelage, Vaillancourt, & Hymel, 2010).
Students are increasingly engaging in high-risk behaviors, such as unprotected sex (Kann et al., 2014), and
student engagement in the classroom has declined, while dropout rates have increased (Battin-Pearson et al.,
2000; Klem & Connell, 2004).
Students in inner-city settings are particularly prone to experiencing and witnessing trauma and violence
(Hammack, Richards, Luo, Edlynn, & Roy, 2004). In some inner-city schools, 26–30% of students have

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witnessed someone getting killed by stabbing or shooting (Bell & Jenkins, 1993). Compared to the general
population, children of low socio-economic status (SES) are more than twice as likely to experience domestic
violence and abuse (Fantuzzo, Boruch, Beriama, Atkins, & Marcus, 1997). Many studies indicate that
exposure to violent and traumatic experience negatively impacts mental health (Gorman-Smith & Tolan,
2003; Kliewer, Lepore, Oskin, & Johnson, 1998; Lynch & Cicchetti, 1998; Schwab-Stone et al., 1995),
cognitive and neural function (Carrion, Garrett, Menon, Weems, & Reiss, 2008; Saltzman, Weems, &
Carrion, 2006; Villarreal & King, 2001), and physical health (De Bellis et al., 1994; Robles, Glaser, &
Kiecolt-Glaser, 2005; Wright & Steinbach, 2001), and it increases the likelihood of substance abuse
(Liebschutz et al., 2002).
Students from high SES backgrounds are also at risk of having mental health issues. The surge of suicides
in an affluent, high-achieving district in Northern California highlights the potential toll of academic and
social pressures that students face. This incident is now the subject of a rare Centers for Disease Control
(CDC) investigation by its Epidemiological Assistance unit, which typically responds to infectious disease
outbreaks (Noguchi, 2016), indicating the gravity of the situation.
Over the last several decades, various programs have been developed to address a number of these issues, as
mounting evidence suggests that enhancing the social, emotional, cultural, and ethical aspects of schooling
improves student achievement and well-being (Brown et al., 2012; Wentzel, Battle, Russell, & Looney,
2010). Many of these interdisciplinary educational initiatives have been launched in the name of “prosocial
education,” a broad, umbrella term that refers to diverse approaches, including character education, service
learning, civic and moral education, cooperative learning, social and emotional learning, and transformational
teaching.
Yet, despite the growing enthusiasm and evidence-base for prosocial education programs (e.g., Durlak et
al., 2011; Brown et al., 2012), a commonly agreed upon framework for prosocial education remains to be
established. “Prosocial education” is variably and loosely defined across a host of programs and disciplines,
many of which rest on different and, at times, competing methodologies and competing theoretical
frameworks. Some, for example, emphasize the role of prosocial education in supporting academic
performance, which can be interpreted by others as instrumentalizing (i.e., using it as a means to achieve a
singular goal of boosting academic performance), and not in line with a more holistic vision of education and
prosocial development. Although a number of prosocial programs have been effective in a variety of
educational settings, these approaches have existed largely independently of one another, and often without a
clear, thorough definition of prosociality (Brown et al., 2012). The field of education has also largely
proceeded without a comprehensive theoretical model of prosocial development and lacks clear, systematic
methodologies for fostering prosocial capacities at individual, relational, and social levels.
In parallel with the growing interest in prosocial development, interest in compassion-based practices has
grown, as research has suggested that contemplative-based compassion training may have a demonstrable
effect on health and well-being (Pace et al., 2009), prosocial skills (Mascaro, Rilling, Negi, & Raison, 2012),
and altruistic helping behavior (Cohen, 2012; Weng et al., 2013). To date, work on compassion-focused
interventions has existed outside of the purview of the field of education; however, there have been some
programs recently adapted for use in school settings (Dodson-Lavelle, Makransky, & Seigle, 2015; Ozawa-de
Silva & Dodson-Lavelle, 2011). Movements within prosocial education that focus on character and moral

609
education highlight the need to develop skills like empathy, compassion, and altruism. However, systematic
methodologies for cultivating compassion (beyond cognitive reflections or the promotion of core ethical
values; e.g., Ruiz & Vallejos, 1999) are lacking within such movements, which are disconnected from the
growing scientific literature on empathy and compassion.
Given the promise of this early work in education, we believe the field of education would benefit from a
more explicit focus on such contemplative-based methodologies for cultivating compassion. In turn, scholars,
researchers, and interventionists interested in compassion-based programming and its application in schools
may benefit from engaging with experts in the field of prosocial education who have experience designing and
implementing initiatives at the educational systems level. Furthermore, compassion—and possibly the broader
term “care,” which we understand to encompass both compassion and love—may be useful constructs with
which researchers and practitioners might organize and systematize related interventions and research
programs that currently fall under the broad rubric of “prosocial education.” To be clear, this is not to suggest
that the way forward is to develop a simple compassion intervention for education, for that would be too
narrow a focus. Rather, a skillful way forward may be for educators, contemplative teachers and researchers,
and others (e.g., educational, developmental, and moral psychologists) to coordinate a line of research into the
best practices for training compassion in developmentally appropriate ways in educational settings. A
compassion-focused framework could also help bring leaders in the field of developmental, evolutionary, and
social psychology into more direct conversation with education researchers and practitioners.
The development of a comprehensive, compassion-focused framework will require multi-year
interdisciplinary collaboration, theoretical development, research, and prototyping. Given the current state of
the field, our goal in this chapter is to offer a preliminary set of suggestions for why and how we might
develop a compassion-focused framework for education that integrates and advances various “prosocial”
education programs in interventions. We begin by briefly reviewing the evidence for the impact of compassion
training on well-being and suggest ways in which compassion training might help attenuate or reduce a
number of the challenges faced by educational communities. We will then briefly review research on several
related prosocial education programs, which suggests that the capacities and skills of compassion can be
trained in various school settings. Next, we will suggest ways in which compassion-based interventions and
prosocial programs might mutually benefit from integration, while also pointing out possible areas of
challenge. Finally, we suggest lines of inquiry and research for the field as a whole.

The Science of Compassion

Compassion can be defined as sensitivity to another’s pain coupled with the desire or motivation to alleviate
that pain or suffering (Goetz, Keltner, & Simon-Thomas, 2010). It is the counterpart to love or the wish for
another’s well-being. Compassion includes several components or building blocks, including loving affection,
which sees others as worthy of care; empathic concern for others through sensing and recognizing their
suffering; a strong wish for all beings to be free from suffering, and a sense of responsibility to help others; and
wisdom or insight, which includes insight into one’s own suffering as well as recognition that others are more
than our ideas or limited impressions of them (Makransky, 2012; Makransky, Das, & Osgood, 2007; Ozawa-
de Silva & Negi, 2013).
Research suggests that the seeds of prosocial capacities—such as compassion—are present from an early age

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(Hepach, Vaish, & Tomasello, 2012; Kärtner, Keller, & Chaudhary, 2010; Sloane, Baillargeon, & Premack,
2012). Infants, for example, show preferences for those who help rather than hinder another from attaining a
goal (Hamlin, Wynn, & Bloom, 2007). Toddlers are also able to display spontaneous helping behavior, and
they can do so without the expectation or anticipation of any personal reward or reciprocation (Warneken &
Tomasello, 2007). These action-based prosocial behaviors emerge early, followed by development of an
understanding of others’ emotions from less overt cues over the course of the second year of life (Svetlova,
Nichols, & Brownell, 2010). Children show expressions of concern and provide comfort to those who are in
distress (Zahn-Waxler, Radke-Yarrow, Wagner, & Chapman, 1992).
Despite the presence of these prosocial qualities, children do not always respond with care or kindness
toward others. Instead, with developmental growth, children show differential treatment toward others
depending upon their relationship with those others. By elementary-school age, children begin to show
preferential treatment of in-group members, with exclusionary treatment of others in the out-group (Fehr,
Bernhard, & Rockenbach, 2008). As cognitive capacities mature, the possibility for complex thinking and
reasoning develops, but this does not guarantee greater cultivation of prosocial tendencies and extending care.
As a result, there is a need for intentionally cultivating and widening our circles of care to foster conditions for
compassion to arise consistently throughout development and across circumstances.
Various systematic methods for cultivating compassion—including sustainable compassion training (SCT;
see D. Lavelle, this volume), cognitively based compassion training (CBCT; see Mascaro, Nego and Raison,
this volume), cultivating compassion training (CCT; see Goldin and Jazaieri, this volume), and compassionate
mind training (CMT; see Gilbert, this volume) among others—have been employed in many clinical and
nonclinical settings. Research suggests that these types of compassion training programs may enhance
prosocial behavior (Condon, Desbordes, Miller, & DeSteno, 2013), attenuate mood disorders (Leaviss &
Uttley, 2015), and reduce inflammatory reactivity (Pace et al., 2009). In addition, previous research on CBCT
has shown that college students who were taught and practiced CBCT displayed reduced emotional upset in
response to psychosocial stress (Pace et al., 2009; Pace et al., 2010).
Different models of compassion training draw from various contemplative and psychological traditions.
Each model assumes, to varying degrees, that individuals have the capacity for compassion and care, and that
these qualities can be trained and stabilized over time. Furthermore, these models also suggest that a person’s
natural capacities for compassion and care can be strengthened and extended to include those beyond one’s so-
called in-group. Although the sequence of training and the training methodologies themselves differ among
these programs, they all include training, to some degree, of the following capacities: attention, affection,
empathy, insight, distress tolerance, and courage. They also include an emphasis on cultivating the motivation
to care for others, and the possibility, again to varying degrees, that the capacities for compassion and care can
be cultivated and extended to others regardless of so-called in-group or out-group status. Overall, the specific
capacities that compassion training aims to develop are clearly important for achieving the broad-range goals
of prosocial education stated before.

Current Approaches to Compassion in Education

Although there is relatively little empirical research on contemplative interventions for youth, many of the
extant programs and studies have focused on mindfulness-based interventions for use in educational settings

611
(see Meiklejohn et al., 2012; Zenner, Herrnleben-Kurz, & Walach, 2013, for examples). In part, this is based
on the view that mindfulness-based trainings are supportive of fundamental social and emotional skills,
including self-regulatory skills such as attention and emotion regulation, and prosocial dispositions like
empathy and perspective-taking (Davidson et al., 2012).

Mindfulness-Based Interventions
The Kindness Curriculum, for example, developed at the University of Wisconsin–Madison, provides
mindfulness training as a basis for building on and leading into kindness practices for children ages four to six
years. In the eight-week course, which provides three 20–30-minute lessons each week, mindfulness is
introduced through basic activities that help children develop their awareness of inner and outer experience.
Children then learn to cultivate awareness of, and attention to, the changing nature of experience (including
emotions), and how emotions impact their interactions with peers and others. Next, students are taught and
practice ways to work with difficult emotions. Throughout the curriculum, positive qualities (such as
gratitude, generosity, and compassion), and an understanding of the interconnectedness of all things in the
world, are cultivated.
The curriculum is progressive and incorporates children’s literature, music, and movement in order to teach
and stabilize concepts related to kindness and compassion. The curriculum has been offered in a variety of
settings, including Head Start (a federally funded program in the United States to bolster children’s early
development), public school classrooms, and a university campus preschool. Results from initial research on
the Kindness Curriculum indicate improvements in preschoolers’ prosocial behavior, as well as academic
performance (Flook, Goldberg, Pinger, & Davidson, 2015).
There are still relatively few studies with children, but studies like the one by Flook and colleagues (2015)
show promise for mindfulness and related training with children as early as preschool, extending through high
school. Results of mindfulness-based interventions with elementary-age students demonstrate that such
programs may be effective in improving executive function (Flook et al., 2010) and academic performance
(Flook et al., 2015; Schonert-Reichl et al., 2015). Research on other mindfulness-based programs for youth
suggest that training may be effective in reducing test anxiety (Napoli, Krech, & Holley, 2005) and
psychological symptoms (Broderick & Metz, 2009; Mendelson, Tandon, O’Brennan, Leaf, & Ialongo, 2010).
Practices have also been introduced in clinical settings for children with anxiety (Semple, Reid, & Miller,
2005), as part of outpatient treatment for teenagers (Biegel, Brown, Shapiro, & Schubert, 2009), and for
youth living with HIV (Sibinga et al., 2008). Although further investigation is needed, preliminary evidence
suggests that mindfulness-based programs can be adapted in developmentally appropriate ways, and they can
offer students methods for self-care and cultivating prosocial qualities like empathy and kindness. Programs
like these may further provide a foundation to build on and directly address the cultivation of compassion.

Compassion-Based Interventions
To date, only a few contemplative-based programs with an explicit focus on compassion have been adapted
for use in educational settings, including SCT and CBCT (Dodson-Lavelle et al., 2015; Ozawa-de Silva &
Dodson-Lavelle, 2011), which we describe briefly later in this chapter. As mentioned, each of these programs
assumes that human beings have the natural capacity for compassion and that this capacity can be further

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strengthened through systematic training. More recently, CMT—a program adapted from compassion-
focused therapy (CFT)—has also been adapted for educational settings. SCT, CBCT, and CMT all build on
some of the components taught in mindfulness-based programs we just outlined, and they consider
mindfulness to be a supportive capacity necessary for cultivating compassion.
Although research on and development of compassion-based interventions for education is still in its early
stages, we believe this work holds promise. It is important to point out, however, that enthusiasm for
contemplative-based programs in education has outpaced research studies that provide evidence-based
support. Next, we briefly describe some of these new programs before considering further possible directions
for adaptation and application, integration with other prosocial models, and directions for research.

Sustainable Compassion Training (SCT)

The basic principle of SCT aligns with Nel Noddings’s “ethic of care” principle: to be one caring is to be
one cared for (Noddings, 1984, 1992). SCT draws out the relational dimension of care by helping educators
and students recognize that one needs to learn to receive care—to be held in unconditional positive regard—in
order to be empowered to extend this same caring attitude toward others. This relational dimension of care is
critical for providing a sense of safety, self-worth, and appreciation of others, all of which are necessary for
cultivating compassion and ethical sensitivity (Varela, 1999). When students feel safe and secure, they are less
likely to form rigid boundaries between themselves and others. They are more likely to remain open to and
empathize with others, and thereby, are better able to feel concern for and respond compassionately to others.
Thus, ethical sensitivity is grounded in an openness to life, rooted in a sense of safety and loving relationship.
To address these relational dimensions of cultivating compassion, SCT is organized by three modes of care:
receiving care, deep self-care, and extending care. Each mode provides psycho-educational material, intra- and
interpersonal skills training, and contemplative and somatic practice (Dodson-Lavelle et al., 2015). SCT was
the contemplative basis for the Mind and Life Institute’s Call to Care Initiative (www.mindandlife.org/care;
see also http://courageofcare.org). Launched in 2013, Call to Care was designed by an interdisciplinary team
of educators, contemplatives, and psychologists as an educational framework to help educators, students, and
the larger school community to develop deeper capacities for care and compassion through training in these
three modes. The program involved a year-long professional development program coupled with a year-long
curriculum-implementation support process for kindergarten through twelfth-grade (K-12) teachers (~5–18
years of age). The aim was to help teachers nurture their caring capacities for the benefit of their own health
and well-being, and to help them embody and model these skills in the classroom. In this way, educators are
better equipped to create safe, supportive classroom environments, and to effectively teach students these same
skills. Call to Care has been piloted in over 30 schools in the United States, as well as in a number of schools
in Israel, Norway, Bhutan, and Vietnam. The work is now being carried forward by the Courage of Care
Coalition and has expanded to include a more explicit focus on equity and systems-change.

Cognitively Based Compassion Training (CBCT)

The CBCT model for training compassion (see Mascaro, Negi, and Raison, this volume), draws from the
lojong, or “mind training,” tradition of Tibetan Buddhism (Ozawa-de Silva & Negi, 2013), but it has been
adapted for use in a variety of secular settings. CBCT views compassion as a trainable skill that is developed

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through the cultivation of:
1. Attention and stability of mind;
2. Insight into the nature of mental experience;
3. Self-compassion;
4. Impartiality;
5. Appreciation and gratitude;
6. Affection and empathy;
7. Aspirational compassion; and
8. Active compassion.

As with other compassion-training programs, CBCT assumes that human beings have a natural capacity
for compassion, but that this compassion is often limited to one’s own in-group or kin. The program also
assumes that this capacity can be strengthened and that one can learn to extend compassion to all people,
including those in one’s out-group, as well as those who may have caused one harm. The program is
cognitively based, in that it relies on analytical meditations that encourage participants to gain insight into the
ways they relate to others in sometimes biased, hostile, and limiting ways. These insights are then deepened
through repeated reflection and practice until they transform the ways in which one relates to and treats others
(Ozawa-de Silva & Dodson-Lavelle, 2011; Ozawa-de Silva & Negi, 2013). The program has been piloted
with students four to 11 years of age in private and charter schools in the Atlanta, Georgia, area.

Compassionate Mind Training (CMT) for Education

Recently, practitioners have begun adapting Compassionate Mind Training (CMT) for educational settings
(Welford & Langmead, 2015). CMT, which is adapted from Paul Gilbert’s CFT, is an approach to
cultivating compassion that draws on evolutionary and attachment theory, and integrates methods from
cognitive-behavioral therapy and Buddhist psychology. CMT offers principle-driven methods for cultivating
compassion. It emphasizes the need for compassionate self-understanding through learning of ways in which
humans are designed and shaped by various evolutionary and sociological processes. This compassionate view
of oneself provides a basis from which one can develop a compassionate mind and address shame, self-
criticism, and other blocks to compassion (Gilbert, McEwan, Matos, & Rivis, 2011). The training focuses on
helping participants recognize the ways that they are largely driven by their “threat system,” and it offers
methods for helping them activate their “affiliative” or “soothing system” in response to threat. Although
research in this area is still in its infancy, preliminary anecdotal data suggest that school-based applications of
CMT may increase staff well-being and parental engagement and decrease disruptive student behavior
(Welford & Langmead, 2015).

Contemplative, Compassion-Based Programs in Context: Including the Whole School and Child
Although there is far more research to be done in this area, we believe the aforementioned compassion-
based and other contemplative interventions offer promise to the field of education. As mentioned, we believe
these programs build from and incorporate a number of key social and emotional learning skills, and that
greater benefit may arise with more robust integration of these programs with other prosocial education
programs; including, for example, those that focus on school climate and/or involve somatic interventions
(e.g., yoga).

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Somatic Interventions
As mentioned at the beginning of this chapter, toxic levels of stress and trauma are all too prevalent in
classrooms. Because of their deleterious physiological effects and disruption of cognitive and emotional
capacities, researchers and interventionists have begun to focus more on body-based interventions to restore
autonomic balance than on interventions that focus primarily on cognitive strategies. Such bottom-up
interventions include yoga, breathwork, rhythmicity approaches (e.g., EMDR), and biofeedback. Many of
these have been shown to increase heart rate variability and reduce symptoms of PTSD (Sack, Lempa,
Steinmetz, Lamprecht, & Hofmann, 2008; Seppala et al., 2014; Zucker, Samuelson, Muench, Greenberg, &
Gevirtz, 2009). Moreover, school yoga programs have been shown to reduce tension and anxiety in students
(5–18 years old) (Ferreira-Vorkapic et al., 2015). Other programs have examined yoga-based training for
elementary school students, finding decreased rumination, intrusive thoughts, and emotional arousal in
response to stress (Mendelson et al., 2010). Similarly, middle and high school programs, like the Youth
Empowerment Seminar (YES! For Schools), that combine social and emotional learning (SEL)-like
education with a focus on controlled breathing (based on yoga-based breathing techniques) have been shown
to reduce impulsive behavior (Ghahremani et al., 2013) and increase emotional empathy (Ghahremani, Oh,
Rana, Agrawal, & Dean, under review) in high school students.

School Climate
Programs that address school climate and culture recognize that the best learning emerges in the context of
safe, caring relationships. Advocates for school climate programs highlight four factors that shape climate and
culture: safety, relationships, teaching and learning, and the institutional environment (Cohen, 2012). A
positive school climate provides its members with a sense of connection to each other and to the school itself
(Orpinas & Horne, 2009). Such environments help teachers find meaning in their work and to recognize their
role, not only in the classroom, but also in the larger community (Battistich, Solomon, Watson, & Schaps,
1997).

Professional Development for Educators

Research shows that school-based programs are most successful when implemented school-wide and also
engage students outside of school (e.g., in their homes and in after-school programs) (Bond & Hauf, 2004).
Successful implementation also depends on school leadership, parent and community involvement, and
professional development support for educators (Bryk, Sebring, Allensworth, Easton, & Luppescu, 2010;
Durlak & DuPre, 2008). Teacher development is critical, as research has also shown that teachers with weak
social and emotional skills may actually hinder their own students’ social and emotional development (Reyes,
Brackett, Rivers, Elbertson, & Salovey, 2012). In the same way that student learning is predicated by safe,
secure, caring relationships, educators’ own development depends upon safe, trusting peer and professional
relationships (Jones, Bouffard, & Weissbourd, 2013). Teachers’ social and emotional development is also
related to sustainability: teachers without adequate prosocial training are at a higher risk for burnout as they
struggle to deal effectively with the general stressors of teaching (Jennings & Greenberg, 2009).
Emerging empirical research that has been conducted on mindfulness training for educators using a
randomized controlled design, and it points to improvements across a range of measures, including reduced

615
stress and burnout, increased mindfulness, improved attention, and more effective organization of classroom
time (Flook, Goldberg, Pinger, Bonus, & Davidson, 2013; Jennings, Frank, Snowberg, Coccia, & Greenberg,
2013; Kemeny et al., 2012; Roeser et al., 2013). These are factors that, in turn, are linked with quality of the
classroom environment, interactions with students, and effective instructional practices (Jennings &
Greenberg, 2009). The potential for synergistic effects of pairing training for educators and students is a
promising avenue for further investigation.

Toward an Integrated, Compassion-Based Framework for Prosocial Education

Although the potential benefits of integrating compassion-based contemplative frameworks with existing
prosocial education interventions is promising, research remains to be done to establish the efficacy of these
programs, and further development is required to determine a more comprehensive framework for
compassion-focused training and learning in educational settings. To this end, a clear reframing of
prosociality is needed that includes well-defined standards for cultivating compassion across the course of
child development. Moreover, more sophisticated theoretical frameworks and predictions for the various
methodologies employed in educational programs need to be established.
This latter point holds not only for the field of educational studies, but also for any researcher or
practitioner interested in understanding compassion and the effects of various training methodologies. The
aforementioned compassion-based programs, for example, each rest on different theoretical models and thus
prescribe different practice methodologies for enhancing compassion. In turn, these compassion programs
differ from a number of common mindfulness programs (which also reflect diversity of theory and practice).
A compassion-focused framework would need to adopt a more ecological, systems-based view of education.
In order to promote the development of the individual to the fullest extent possible, contemplative-based
interventions must consider and address ways in which contemplative training may need to be adapted within
particular contexts. We thus need to consider, not only the role of context, but also which programs or
combinations of programs work best for which children, and at what optimal developmental stage or
sequence. Researchers and program developers, therefore, can learn from one another, as well as from
communities of students, parents, and educators, in order to better understand the methods that work best for
individuals and communities in various contexts. With so many approaches and methodologies, research can
serve to help guide curricular decisions and support understanding for whom, how much, and when specific
types of training may be most helpful.
Pressing questions include: How can compassion and related qualities best be woven into the school day,
integrated with other subject matter, and progressively built upon just as other academic subjects are
reinforced and tailored across year levels? How can the wide array of approaches best be integrated with one
another and other prosocial education programs? How can these programs be adapted in culturally and
contextually sensitive ways?

Challenges, Opportunities, and Future Directions

Developing a more comprehensive framework for education is not without its challenges. This work calls
for an integration of multidisciplinary fields of study and practice—each with its own diverse sets of
definitions, methodologies, and standards of research and practice. Assessing the effectiveness of such

616
programs and models at the systems or ecological levels will also be challenging.
Opening the dialogue on compassion may also highlight unnamed assumptions or potential biases.
Compassion programs tend to avoid instrumental language such as “managing” or “controlling” emotions or
behavior for social or academic ends. They tend to focus on drawing out and deepening underlying capacities
for love, compassion, and affection, rather than trying to problem-solve or manage behavior. Adopting this
unconditional caring stance, as opposed to the language of self-regulation, for example, may be at odds with
prosocial programs focused explicitly on enhancing academic success or regulating or controlling student
behavior.
Thus, the call for a more integrated framework brings to the surface the disparate visions and goals of
education held by researchers, practitioners, community leaders, policy makers, and other stakeholders.
Integrating a compassion-based approach into education permits a bolder vision for the purposes and goals of
education, and allows for a more sophisticated perspective on the innate prosociality of people. While
compassion-based educational initiatives can be integrated into and enrich programming that is focused
primarily on enhancing students’ academic achievement and performance, opportunities to do so may be
limited unless traditional initiatives embrace more holistic approaches.
Although many prosocial education programs are interested in enhancing the social and emotional
development of students and teachers, they have generally tended to underemphasize the potential to develop
qualities of unconditional care and compassion. The low priority placed on compassion may be partly due to
educational policies that drive attention towards academic achievement and performance on high-stakes
testing. While prosocial education programs may help promote aspects of learning, a compassion-based
framework goes beyond this singular focus by encompassing a broader, more integrated vision for education.
Such a framework emphasizes nurturing the whole child to cultivate a deep-rooted concern for and
commitment to the welfare of others, with an appreciation for the interdependent global community.
Compassion and care are vital for the growth of children, both inside and outside of the school setting. The
depth of these qualities may be unfamiliar and seemingly at odds with school environments strained by high
levels of stress related to trauma and pressures around academic performance. However, it is these very
conditions that underscore the necessity of a broader view that incorporates compassion and the concern for
all children in our education systems. If we are to realize the fuller potential of education and humanity, the
field of education will need to reclaim a bolder, more inclusive vision that recognizes, values, and nurtures
compassion.

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 Heroism Social Transformation Through Compassion in Action

Philip G. Zimbardo, Emma M. Seppälä, and Zeno E. Franco

Abstract

Heroism as an important factor in social transformation, and enacted compassion can fundamentally
change individual and societal level outcomes. Although some of our prior work has distinguished
heroism from altruism, compassion can be viewed as a central element in many heroic acts. Here we
assert that one definition of heroism is compassionate action at the risk of personal sacrifice. We also
suggest that training compassionate self-sacrifice is possible, through programs like the Heroic
Imagination Project and other similar training efforts. Two pilot studies based on this idea are
summarized. The first examines gang desistance programs that focus on replacing these activities with
compassionately driven, prosocial ones. However, these actions can put former gang members at
considerable personal risk. The second study examines transitions in Palestinians and Israelis who have
turned away from war and are focusing on reconciliation, but at the cost of compromised relationships
with family members and friends.

Key Words: heroism, compassion, moral courage, social transformation, gang desistance, Palestinian–
Israeli conflict, personal sacrifice, risk, heroic imagination

Heroes, in the classical tradition, are viewed as rare and unique individuals who do not seem to “walk on
mortal soil.” Traditionally, heroism is considered a rare phenomenon—despite its being based on compassion,
which we know is innate. The concept of the hero is one we associate with legends and stories of exceptional
and noble people carrying out extraordinary deeds for some great cause: these heroes are usually military
generals, religious martyrs, or political heroes. Agamemnon and Achilles have been our Western models of
male warrior heroes, as were the Samurai warriors in Japan. Traditional heroes are almost always male, though
there are some notable exceptions (e.g., Joan of Arc). Across traditions, the traditional perspective implies that
heroism is a highly unusual human phenomenon.
Over time, the military, religious, and political heroes of the past have been replaced in public discourse by
social heroes who engaged in long-term efforts for causes that changed the course of history. Gandhi, Nelson
Mandela, Martin Luther King, and Mother Teresa are a few of the notable exemplars. Their life work created
a fundamentally different future for entire social groups or nations, altering global dialogue along the way
(Allison & Goethals, 2015). In addition, our research is demonstrating that heroism is not always innate, but
may emerge through life experiences. Heroism often emerges through a transformative process whereby,
through an identity shift, a person begins to actively devote himself or herself to the social good.

Heroism

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 Although heroism can sometimes emerge out of duty more than compassion (e.g., military duty), the type
of heroism discussed here can be broadly defined as compassionate action at the risk of personal sacrifice to
effectuate positive social change. Heroism represents the ideal of citizens transforming civic virtue into the
highest form of civic action, accepting either physical peril or social sacrifice in the process (Franco et al.,
2011). Compassion and empathy are the emotional and cognitive mental precursors essential to fueling this
moral courage. But actually taking compassionate action, when it involves danger to one’s self, is heroism.
Heroism is essential to effect social change. Heroes put their best selves forward for the good of humanity
by opposing evil, acting as a shield for others in harm’s way, and promoting goodness in all its forms (Franco
& Zimbardo, 2016; Kinsella et al., 2015). As such, they inspire others by providing a model of noble civic
action.
Heroism can be formally defined as:
A social activity: (a) in service to others in need—be it a person, group, or community, or in defense of socially sanctioned ideals, or a new
social standard; (b) engaged in voluntarily (even in military contexts, heroism remains an act that goes beyond actions required by military
duty); (c) with recognition of possible personal risks/costs, (i.e., not entered into blindly or blithely, recalling the 1913 Webster’s definition
that stated, “not from ignorance or inconsiderate levity”); (d) in which the actor is willing to accept anticipated sacrifice, and (e) without
external gain anticipated at the time of the act. (Franco et al., 2011, p. 101)

There are two types of heroism. Heroism can take the form of “reflective proactivity” involving planned and
deliberate action, like Operation Underground Railroad, a nonprofit that stages elaborate scenarios to rescue
children from sex trafficking. Another example of this category of heroism is the one hero of the Abu Ghraib
military scandal in 2004—an ordinary army reservist, Joe Darby. He provided a superior officer a CD with
hundreds of digital images of his fellow service members degrading and abusing Iraqi prisoners they were
supposed to protect. Darby was also an example of proactive heroism because he knew that his colleagues—
some of whom were friends with those he served alongside in a combat zone—would be given dishonorable
discharges and that these friends would seek revenge on him. The military had to place Darby, his wife, and
mother into protective custody for three years, after which he received the heroic honor he deserved.
The second category of heroism can be termed “emergent or impulsive reactivity.” A study of accounts of
actions taken by Carnegie Hero Medal recipients, for example, suggests that the recipients responded
intuitively and automatically to a dangerous situation; that is, without prior emotional or much cognitive
deliberation (Rand & Epstein, 2014). Such actions are part of training for the military and first responders:
learning to respond immediately with maximum impact to situations perceived as endangering the lives of
others. An example of emergent or impulsive reactivity is the case of three unarmed American soldiers on
leave who counter-attacked a well-armed terrorist on a French train, risking their lives, but in doing so
preventing a major disaster (Thompson, 2015).
In this chapter, we advance the principle that heroism is neither rare nor extraordinary, because the seeds of
heroism exist in everyone and, like compassion, heroism can be systematically trained for the advancement of
the social good. It is important to note that the use of the terms hero and heroic action are always social
attributions (Franco, Blau, & Zimbardo, 2011). Someone other than the actor confers these descriptors on the
hero and their deed. For an act to be deemed heroic and for its agent to be called a hero, social consensus
about the significance and meaningful consequence of an act must exist. A Palestinian suicide bomber who is
killed in the act of murdering innocent Jewish civilians is given heroic status in Palestine, but demonic status
in Israel, for example. Similarly, some people may construe such hostile aggressors either as heroic freedom

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fighters or as cowardly agents of terrorism, depending on who is conferring the attribution. Similarly, the
coordinated terrorist attacks in many Parisian venues in November of 2015, murdering and wounding
hundreds of innocent victims, may be deemed heroic by ISIS (Islamic State in Iraq and Syria) followers.
Therefore, we can assert that definitions of heroism are always culture-bound and time-bound. For example,
to this day, children in remote villages of Turkey enjoy puppeteers enacting the legend of Alexander the
Great. In the towns where his command posts were set up and his soldiers intermarried with villagers,
Alexander is a great hero; however in towns that were just conquered on his relentless quest to rule the known
world, Alexander is portrayed as a great villain, even a thousand years after his death.
Because heroism is believed to be rare, it has not received substantial attention in the scientific literature.
For example, absent from any traditional psychology textbook are the twin terms of hero and heroism, although
some figures who can be viewed through a heroic lens are sometimes mentioned in the context of altruism.
The same is true in the relatively newer field of positive psychology, where compassion and empathy are
presented as the most significant human virtues, yet without any mention of heroism as the highest civic
virtue (in our view).

The Banality of Heroism

However, heroism is not as exceptional as one might think. A national survey found that 20% of Americans
reported acting heroically at some time in their lives (Zimbardo, Breckenridge, & Moghaddam, 2013). Franco
and Zimbardo (2007) have even advanced the notion of the “banality of heroism” as an opposing parallel to
Hannah Arendt’s (Arendt & Kroh, 1964) popular notion of the “banality of evil.” Just as ordinary people often
commit evil deeds, so, too, are the most heroic deeds. In certain situations, it is ordinary people who perform
extraordinary acts. The view of heroism we are advancing here is that of ordinary heroism; and, as we will
argue, its potential exists within anyone and, as we have shown, it can be inspired, taught, and trained.
Though economists have long argued that our primary motivator is self-interest rather than altruism, let
alone heroism, a growing body of evidence documented in this handbook and elsewhere suggests that, at our
core, both animals and human beings have the seeds of heroism within them, even at a cost to themselves.
Studies on helping behavior with chimpanzees, and human infants too young to have learned the rules of
politeness, suggest that both toddlers and chimpanzees spontaneously engage in helpful behavior when
confronted with another individual who needs help—and that they even overcome obstacles to do so,
sometimes incurring a cost themselves (Warneken, Hare, Melis, Hanus, & Tomasello, 2007; Warneken &
Tomasello, 2006). Research has shown that even rats will do what is required to alleviate another rat’s
suffering, going out of their way to help it out of its quandary (Bartal, Decety, & Mason, 2011).
Some have argued that the act of helping others is intrinsically selfish, driven at some level by reward or
personal pleasure. This is the position taken by Robert Cialdini (Cialdini, 1987, 1997) in his famous
disagreement and classic social psychology debate with Daniel Batson’s “empathy-altruism hypothesis” (who
proposed that helping others is motivated by empathetic concern; Batson, 1987). However, a study with
infants showed that their distress at another’s suffering is appeased by observing relief of that suffering—
whether or not the infant was directly involved in that helping (Hepach, Vaish, & Tomasello, 2012). In other
words, they helped out of intrinsic motivation rather than for an expected reward. Infants’ pupil diameters (a
measure of attention) decreased both when they helped and when they saw someone else helping, suggesting

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that their arousal decreased because another person’s suffering was relieved, and not because of the pleasure
they received by personally helping.
Other studies have found that even in adults and older children, the first and most automatic impulse when
confronted with the opportunity to help or benefit others is to do so (Rand, Greene, & Nowak, 2013). In an
economic game (i.e., public goods game), when participants were given equal amounts of resources to either
keep for themselves or share with others, they were more likely to contribute when they were given very little
time to think about the decision. One of the many reasons why adults do not always act on their instinct to
help, however, is that they often stop themselves from acting on that impulse because of the “norm of self-
interest.” They stop themselves from helping for fear that someone could misinterpret their helping hand as a
self-interested action (Miller, 1999). In other words, it can be asserted that the act of helping others—even at
a cost to oneself—exists as a natural and even automatic tendency in both animals and humans.

The Difference Between Compassion and Heroism

Compassion, as defined throughout this handbook, is the felt response to perceiving suffering that involves
an authentic desire to help (Goetz, Keltner, & Simon-Thomas, 2010). As such, it often leads to altruistic
actions. Staub (1991) defined heroism as an extreme version of compassion, yet as we have argued,
compassion is not equivalent to heroism (Franco, Blau, & Zimbardo, 2011). There are several key factors that
differentiate heroism and compassion. For one, someone’s compassion does not always imply that a person
will behave heroically in situations that call for heroic action. Heroism by definition involves real, meaningful
risk, which could result in serious physical or social injury. While many forms of compassion incur little to no
serious personal risk—for example, giving blood or donating money—heroism by definition involves a
potential physical cost (risking one’s life by running into a burning house or diving into a river to save lives) or
a social cost (risking one’s career and livelihood by whistleblowing at a pharmaceutical company to report
fraudulent research activity). While compassionate action is often accompanied by some period of
deliberation, heroism often involves an instantaneous response despite risk of injury or even self-sacrifice
(Franco, Blau, & Zimbardo, 2011). Finally, heroism can at times not involve compassion at all. Heroism can,
for example, stem entirely from a sense of duty (e.g., military duty).

Heroes as Social Transformation Agents

As described, in our time and age, the heroism of today is mostly social heroism. We define social heroism
as “a social activity: (a) in service to others in need—be it a person, group, or community, or in defense of
socially sanctioned ideals, or new social standard” (Franco & Zimbardo, 2011). This new social standard is
inherently about transformation: the movement from slavery to desegregation, from homophobia to legalized
gay marriage, from women being chattel to the women’s suffrage movement, etc. All of these movements
deeply challenged the social status quo, leveraging individual compassion for the individual pain experienced
by the oppressed. Social transformation as one of the fundamental tasks of social heroes is deeply tied into the
ideas of social justice. Drawing on the work of Prilleltensky (Prilleltensky & Huygens, 2014), we argue that
heroism is an enactment of mercy or preservation of dignity (Franco & Zimbardo, 2016). In many cases
individuals and leaders acted on their compassion for social groups in ways that incurred profound personal
risk.

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 Social heroism can, in some cases, also involve tremendous psychological risk. In some cases it involves
personal transformation (e.g., gang members become anti-gang activists) and can be, not only physically risky
(violent retaliation), but also psychologically risky as it entails adopting an entirely new identity (Franco &
Zimbardo, 2016). Letting go of a comfortable, but no longer useful, identity requires immense courage not
available to all.

Inspiring and Training Heroism

We know that individuals can become more compassionate thanks to directed compassion training. As
discussed in other chapters of this handbook, we know that compassion meditation training, for example, can
increase prosocial affect and behavior (e.g., Condon, Desbordes, Miller, & DeSteno, 2013; Leiberg, Klimecki,
& Singer, 2011). Recent studies are focusing on also developing and cultivating heroism in various ways.
The two pilot studies discussed here exemplify how heroes can emerge from noxious situations and become
models for others who then, in turn, emulate them. The first study focused on “gang bangers” in cities in the
state of California, in the United States. The respondents were long-term gang members who had committed
murders or even led gangs but who had, for various reasons, decided not only to quit their gang but also to
work actively to prevent gang-recruitment activities. These individuals are heroes because, by cutting off a
gang’s supply of money and staff, they endangered themselves by becoming their former gang’s target.
Nevertheless, they persisted in their new livelihoods.
Our research program (Berger & Zimbardo, 2012), along with other research, illustrated in a video
documentary (Heineberg, Zimbardo, & Berger, 2015), attempts to elucidate the process of “gang desistance”
(voluntarily quitting gangs) among core gang members in the San Francisco and Los Angeles areas. We then
outlined the pathways from violent antisocial conduct to prosocial behavior. Forty ex-gang members, 80%
males and 20% females, were identified as core gang-members based on self-report. Each underwent extensive
semi-structured interviews tracking their development from childhood into gang initiation, their level of
involvement in the gang, desistance from the gang, and finally, involvement in gang prevention or
community-enhancement organizations. Clinical graduate students from Palo Alto University, who had
completed a course in client interviewing, conducted these interviews in safe places.
Utilizing theoretically informed systematic qualitative analysis, a generic common pattern of gang
desistance (dis-identification) was identified. The desistance pathways include the following four
transformations: pragmatic, developmental, spiritual, and sociocultural. Separating the push factors—that is,
negative events that pushed them out of gangs—from the pull factors—that is, the circumstances that
encouraged them to start a more productive, safer life, three dominant response categories emerged within
each factor. The three response categories for push factors are: (a) being personally hurt (or friends and family
hurt) by gang (85%); (b) experiencing incarceration and criminal justice threat (82%), and (c) feeling burned
out by the stressful gang lifestyle (38%). The comparable big three pull factors are: (a) family responsibilities
(32%), (b) religious reawakening (30%), and (c) parenthood (30%).
The research team also interviewed Palestinians and Israelis who were once victims of and perpetrators of
the Israeli–Palestinian strife, but who now no longer sought revenge but instead were promoters of
reconciliation. The personal cost they incurred for this form of heroism, contrary to the norm, was rejection
from their families. The interview data from these two dozen interviewee “transformers” (i.e., they

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transformed hostile motives into compassion and reconciliation) highlight early childhood family patterns, as
well as some personality and situational variables. The main personality traits are having an internal rather
than an external locus of control, being optimistic, and being goal-directed. Among key situational
experiences that moved these individuals to become transformers are: experiencing major traumatic events,
being a bystander to the abuse and degradation of a rival or enemy, having personal contact with a rival or
enemy, and being exposed to influential role models and different sources of non-hostile information. The six
main categories of underlying processes leading to transformation are: (a) humanizing of the other, (b)
reformulating one’s self identity, (c) emotional awakening, (d) reconnecting to one’s roots, (e) dealing with
one’s guilt and making amends, and (f) discovering spirituality anew.
Given that we now have a clearer understanding of factors that contribute to heroism within these two
populations (gang members in the U.S., and Israelis and Palestinians in the Middle East), we can begin to
create programs that promote these factors—thereby cultivating heroism.

Creating Everyday Heroes via the Heroic Imagination Project

The Heroic Imagination Project (HIP) is a San Francisco-based nonprofit foundation that aspires to
change the nature of our educational system and create a more compassionate and courageous world for the
new generation of youth who are training to be “everyday heroes.” The lessons help people make morally
courageous decisions in challenging situations in their personal lives. The goal of each HIP training session is
that each person trained becomes a “social change agent” who is ready and willing to stand up, speak out, and
take wise and effective actions that can make a difference in creating a better world for everyone. HIP
envisions a world where every school child is a hero in training. School children learn how to take heroic action
against injustice of all kinds—bullying, prejudice, and unjust authority—and also to transform bystander
apathy in emergency situations into wise and effective “upstander” helping actions.
This plan is realized in several ways, first through in-class training sessions with teachers and students, and
eventually through online trainings and programs for parents and the general public. The curriculum is
organized around detailed lessons centered upon dynamic topics in social and cognitive psychology such as
transforming passive bystanders (Latane & Darley, 1970) into active heroes, converting fixed mindsets into
growth mindsets (Dweck & Legget, 1988), changing prejudice and discrimination (Allport, 1979) into
understanding and acceptance, among other themes under the umbrella of Understanding Human Nature
(Adler, 1927). These lessons are made dynamic by integrating a series of provocative videos, which stimulate
small group discussions. The second way that daily deeds of everyday heroism are promoted is via the HIP
website, which includes social fitness weekly exercises (www.heroicImagination.org). See also The Lucifer
Effect, Chapter 16 (Zimbardo, 2007) for ways to resist powerful negative situational forces, as well as a
comprehensive taxonomy of heroism.
This programmatic approach to creating and inspiring ordinary people to do extraordinary daily deeds of
caring and helping is now implemented in both American and European schools. The educational program is
now in many California and Oregon community colleges where their honor society students—Psi Betas—are
teaching it in local high schools. The California State University system is developing a new Science
Technology Engineering & Mathmatics (STEM)- Heroes education program in conjunction with HIP.
After trainings in Budapest, Warsaw, and Palermo, the HIP educational lessons are now integrated in a

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thousand high schools throughout Hungary, hundreds in Poland, and many in Sicily. New programs are
emerging in Geelong, Australia; Tehran, Iran; Bali, Indonesia;, and soon in London, United Kingdom, and
Jakarata, Indonesia, Prague, Czech Republic, and more in the works. The impact of these programs is
empirically assessed in each venue to measure their efficacy in changing attitudes, values, and behavioral
intentions of the students involved, as well as to obtain feedback from the teachers. Finally, this program has
also been tailored to fit corporate and organizational settings to broaden its reach.
While the future goal is to adapt these lessons to work well with middle and primary school youth, we
should mention a complementary program that has been designed entirely to take young school children on
classic hero journeys. Matt Langdon’s Hero Construction Company has been developed both in Australia and
the United States, and has been proving its effectiveness over the past decade in many primary school
programs.

Conclusion
During a public dialog held at Stanford University in October of 2010, His Holiness the Dalai Lama—one
of the greatest proponents of compassion today—and Philip Zimbardo discussed that compassion alone is not
sufficient to combat the evils of the world. Individuals who are perpetuating extreme harm in our society (e.g.,
drug peddlers, human traffickers, terrorists) must be actively opposed. In this sense, compassion needs to be
socially engaged and not simply a personal process and internal attribute. Ideally, compassion should be
transformed into the social action of heroism. The Dalai Lama accepted this extension of compassion into
socially oriented heroic action.
Research suggests that witnessing someone helping another person creates a state of “elevation” in the
onlooker (Algoe & Haidt, 2009). Beneficent social actions that others observe can create an inspired, prosocial
ripple effect; elevation inspires onlookers to help others—and this phenomenon may be the force behind a
chain reaction of giving. Research on elevation in a corporate setting shows that corporate leaders who engage
in self-sacrificing behavior—thereby eliciting elevation in their employees—have employees who are more
committed and more willing to help other co-workers (Vianello, Galliani, & Haidt, 2010). We advance the
proposition that heroism is contagious: acts of generosity and kindness beget more generosity in a chain
reaction of “goodness going forward” (Fowler & Christakis, 2010).
The role of heroic leadership involves inspiring others to take risks that they could not have imagined
engaging in before—not just generosity—but engaging in profoundly altruistic and helpful acts. If we think
about Martin Luther King, Jr., there were many, many people who were inspired to use their physical bodies
in support of his cause. There were countless heroes in his movement, and it could not have been
accomplished without both heroic leadership at the top and the anonymous heroic actions of the inspired
followers of the movement, some of which resulted in bodily harm, incarceration and even death.
By training individuals to become heroes, we can effectuate change at a larger societal level. Just as we
oppose harm not only at the level of individual agents but also at the situational and systemic levels, we can
actively promote heroism through programming that inspires, encourages, and trains people of all ages and
backgrounds to learn how to be wise and effective everyday heroes through small daily deeds that contribute to
the social good. We hope heroic acts and the people who engage in them will be widely celebrated in every
society. These people form essential links among us; they forge our human connection. Perpetrators of harm

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must be countered, and eventually overcome by the greater good in the collective hearts and the personal
heroic resolve of every man and woman, and in all of our children.
In a sense, we are giving psychology away to the general public in a readily useful educational and inspiring
format that is designed to enhance the quality of individual lives as well as engender positive societal changes
globally.

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 Social Dominance and Leadership The Mediational Effect of Compassion

Daniel Martin and Yotam Heineberg

Abstract

Leadership is usually a mandatory component of business education. Here we used the model of
transformational leadership, and operationalized leadership consistently with the Values in Action
Leadership scale. Social dominance orientation is a hierarchical belief-system that attributes social rank,
ranging from high to low. Business students have been found to have higher levels of Social Dominance
Orientation (SDO. Accordingly, 371 working business students were sampled to establish the
relationship between SDO and transformational leadership capacity. The mediational impact of
compassion was assessed. This study found high levels of competitive and hierarchical world
conceptualization was significantly and sometimes strongly negatively linked to these constructs (Martin
et al., 2014). We also discuss preliminary results of an interpersonal compassion-based intervention. The
research suggests the opportunity to broaden psychological well-being of employees with impactful
interventions, since negative behaviors within an institution can raise healthcare costs and lower job
performance.

Key Words: compassion, leadership, social dominance orientation, fear of compassion

Compassion and Leadership

Leadership has been described in a broad and diverse set of terms for thousands of years. Appreciation of
compassion and compassionate leadership reflects a move from a more hierarchical “top-down” model of
leadership to a more egalitarian and caring model. This requires some basic knowledge of the leadership
literature. While there are innumerable leadership models, development programs, and efforts to provide
insights into the complex series of behaviors, cognitions, and attitudes of leaders, we will focus on two theories
that provide a potential underpinning for our approach to compassionate leadership and its measurement.
There are various definitions of compassion. In their important paper, “Compassion: An evolutionary analysis
and empirical review,” Goetz, Keltner, and Simon-Thomas (2010) suggest that “compassion is the feeling that
arises in witnessing another’s suffering and that motivates a subsequent desire to help.” While we are aligned
with this definition, we feel an action component is needed, too. Organizational behavioral psychology models
define compassion as noticing another’s suffering, empathically feeling the person’s pain, and acting to ease the
suffering (Dutton et al., 2006; Kanov et al., 2004). Given these cognitive, affective, and behavioral definitions,
we will show that this framework links well with both the transformational and positive approaches to
leadership we will discuss here.

Transformational Leadership

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 While leadership has been approached from many angles, transformational leaders use their influence to ask
followers to consider the good of the others, organization, or society (Bass, 1985). Transformational
leadership reflects meaningful and creative exchange between leaders and followers to facilitate vision-driven
change in people and organizations (Bass, 1985). Unlike more traditional models of leadership,
transformational leaders facilitate followers’ problem-solving, while developing employees so that they are
better prepared to address future problems (Bass, Avolio, Jung, & Berson, 2003), thus potentially enabling
them to become leaders themselves. Empirical evidence supports the relationship between transformational
leadership and performance (Avolio, 1999; Bass, 1998; Bass et al., 2003).
Results of several meta-analyses support the linkage between transformational leadership and performance
(DeGroot, Kiker, & Cross, 2000; Lowe, Kroeck, & Sivasubramaniam, 1996). Transformational leadership
has been viewed as having a potentially high level of charismatic components in leaders; it also brings an
assumption that employee intellectual stimulation and individualized consideration will develop the employee
along with the organization. Values are critical to the dissemination and linkage to the vision of the leader.
Benevolence and self-direction are consistently the most important values across cultures (Schwartz & Bardi,
2001). This critical insight gives us the opportunity to link compassion to transformational leadership via
awareness of employee and organizational needs (i.e., awareness of suffering), feeling empathy (i.e.,
recognizing sympathetic feelings), and taking action to solve the problem at hand (i.e., action).

Positive Leadership
While there have been innumerable conceptualizations of leadership, the more recent concept of positive
leadership applies principles from positive psychology and positive organizational scholarship, focusing on:
1. Positively deviant performance, or an emphasis on moving from normalcy to excellence in organizations and individuals;
2. An orientation toward strengths rather than weaknesses in all aspects of orientation (e.g., communication, attitudes, and efforts); and
3. A consistent emphasis on the norms of positivity that are evident on a daily basis, but are often glossed over, given our negative biases
(Cameron, 2008).

Cameron (2008) identifies four strategies to manifest and develop positive leadership, which are supported
through the leadership literature, including: (1) cultivation of a positive climate, (2) developing and
maintaining positive relationships, (3) establishing positive communication, as well as (4) ensuring clear and
positive meaning.
Given that the narrative of positive leadership is consistent with the compassion literature in its links with
intra/interpersonal, group, team, and organizational and community well-being, we have operationalized
leadership in the current study consistently with the Values in Action Leadership scale (Peterson & Seligman,
2004). This framework outlines components of positive leadership—encouraging the group leader to be
productive and complete tasks while maintaining good relations within the group, organizing group activities,
and ensuring task completion. Any and/or all of these components have the potential to advance well-being at
the intra/interpersonal and organizational level. Given the relationship between transformational leadership
concerns for both leader and follower, high-performance leadership and team development, the necessity of
building high-quality relationships, and the requirements to respond with flexibility, we would anticipate
negative relationships between high levels of social dominance orientation (SDO; see later in chapter) and
positive leadership (Cameron, 2008).

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Social Dominance Orientation
SDO is an individual’s level of “basic ruthlessness and a view of the world as a competitive, dog-eat-dog
environment of winners and losers” (Sidanius et. al, 2012), coupled with an in-group’s desire to be superior to
out-groups (Pratto, Sidanius, Stallworth, & Malle, 1994). SDO theorists posit that there is a fundamental
human desire to maintain group-based social hierarchy—such as cultural, racial, and ethnic groups—(Levin &
Sidanius, 1999), despite the possible negative effects for the individual (Pratto et al., 1994; Sidanius & Pratto,
1993). Those who score high in SDO measures want high social status and economic status (Pratto,
Stallworth, Sidanius, & Siers, 1997; Sidanius & Pratto, 1999), and are tougher minded, less other-concerned,
less warm and sympathetic, compared with people lower in SDO (Duckitt, 2001; Heaven & Bucci, 2001;
Lippa & Arad, 1999; Pratto et al., 1994).
High-SDOs prefer to be dominant in normal relationships, and are immoral (Georgesen & Harris 2006),
lacking in empathy (Duriez 2004) and benevolence (Cohrs, Moschner et al., 2005), scoring high in
Machiavellianism and psychoticism (Altemeyer 1998; Heaven & Bucci 2001). There are potentially vast
sociopolitical ramifications for leadership of high SDO individuals. The ecological impact of high SDO
individuals who seek social, political, and economic status at all costs (Duriez & Van Hiel 2002; Duriez, Van
Hiel, & Kossowska 2005; Pratto et al., 1997; Sidanius & Pratto 1999); strive for leadership positions
(Altemeyer 2003, 165); and are willing to use unethical means such as exploitation to achieve social or
political gain (Son-Hing et al. 2007), have profoundly disturbing consequences for the organizations,
communities, and countries they will lead.
High scorers on SDO scales prefer disharmony to egalitarianism: those who score higher on the SDO scale
show higher preferences for war, national hegemony, and international disharmony and inequality (Heaven et
al., 2006, p. 605). Dominant leaders have more sensitive stress responses and may use force and hierarchy-
legitimizing myths (Georgesen & Harris 2006) when their standing is threatened.

Social Dominance Orientation, Leadership, and Workplace Distress

Given that leadership has a cascading impact on organizations, the established negative relationship
between high SDO and a host of positive leadership constructs is an extremely important building block in
our understanding of problematic organizational functioning. When leaders demonstrate higher levels of
SDO, the relationships between subordinates may be undemocratic and possibly abusive (Shao, Resick, &
Hargis, 2011). Individuals with higher SDO can motivate interpersonal deviance, and this is indirectly related
to interpersonal citizenship (Shao, Resick, & Hargis, 2011). Supervisors with higher levels of SDO will be
more likely to use “hard power” tactics with employees, like showing disapproval and reminding employees
that the supervisor is in the position to help the subordinate with promotion (Aiello, Pratto, & Pierro, 2013).
Increasing demands in the workplace contribute to distress, which in turn leads to workplace burnout
(Demerouti, Bakker, Nachreiner, & Schaufelfi, 2001; Demerouti, Bakker, De Jonge, Janssen, & Schaufeli,
2001). When employees experience uncertainty, conflicts in the workplace, and one harmful or hazardous
experience, they are more likely to have absences (Böckerman & Laukkanen, 2010) or actively seek
employment elsewhere (Böckerman & Ilmakunnas, 2008). High SDO–oriented organizations may generate a
culture that is unsupportive and lacking in empathy, which may perpetuate the cycles of stress, depression, and
anxiety for members within the organization.

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Business Education and Support for Hierarchical Systems
Frank, Gilovich, and Regan (1993) established the relationship between studying economics and self-
interested attitudes and behaviors. Sidanius et al. (1991) found in longitudinal studies that certain business
majors attract students who have proclivity and favoritism towards hierarchical systems. Researchers have
found the influence of disciplinary culture in the ethical and moral concepts acquired in organizations (Ringov
& Zollo, 2007), which include social and economic disparities often presented in business curricula. The
exposure to information that demonstrates the benefits of a business education, income advantages after
graduation, and the social prestige certain schools provide can also influence students to support hierarchical
systems (Frank et al., 1993). For students, an environment that is conducive to the reinforcement and
justification of ideologies and conventions can inveterate these beliefs (Jost, Blount, Pfeffer, & Hunyady,
2003).

Social Dominance Orientation, Fields of Study, and Employment Selection

SDO has been found to relate to the desire for and use of power (Altemeyer, 1998). Individuals with high
levels of SDO may select careers or positions that will maintain social inequality (Pratto, Stallworth, Sidanius,
& Siers, 1997); have an affinity towards higher-status social groups and have more negative attitudes toward
lower social status groups (Levin & Sidanius, 1999); and will have an aversion towards diverse groups
(Umphress, Smith-Crowe, Brief, Dietz, & Watkins, 2000). These individuals will seek positions that are
“hierarchy enhancing” (Pratto, Stallworth, Sidanius, & Siers, 1997). Persons with low levels of SDO will
select careers that are more equitable or hierarchy-attenuating (Pratto, Stallworth, Sidanius, & Siers, 1997).
Hierarchy-attenuating organizations tend to have philosophies that are more democratic (Pratto, Stallworth,
Sidanius, & Siers, 1997).
Sidanius et al. (1991) studied consensual or shared racial attitudes and compared them to career choices of
college students (N = 5,655). Their research found that business and law students (or those in “power” fields
of study) expressed higher levels of consensual racism when compared to students in social science or
humanities fields of study (Sidanius et al., 1991). Additionally, students in “power” fields of study also
expressed lower levels of consensual racism if they had less education in their specific field of study (Van Laar,
Sidanius, Rabinowitz, & Sinclair, 1999).
Researchers have also found that SDO predicts sociopolitical connections between participant location of
employment and hierarchical belief systems (Sidanius et al., 1991; Van Laar, Sidanius, Rabinowitz, &
Sinclair, 1999). The high SDO employment institutions in the Sidanius studies (cited previously) were
hierarchy-enhancing with an inequitable belief system that lacked democratic principles. Moreover, these
institutions were assorted into non–mutually exclusive categories: institutional selection, differential attrition,
self-selection, differential reward, and institutional socialization (Sidanius et al., 1991). The studies on SDO
suggest that workplace environments may vary on levels of compassion and empathy, which may be mediated
by system justification or economic systems justification (ESJ).

Compassion and Organizational Outcomes

Compassion is multidimensional, covering a broad range of affective, cognitive, and behavioral constructs,
and it is expressed through a wide range of behaviors that can be observed at the individual and group level.

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At least three elements of compassion have been established: noticing another’s suffering, empathically feeling
the person’s pain, and acting to ease the suffering (Dutton et al., 2006; Kanov et al., 2004). Importantly,
compassion goes beyond empathy to include actual helping behavior, regardless of whether or not the action
achieves the goal of ameliorating suffering (Kanov et al., 2004; Reich, 1989). The impact of not being
compassionate is becoming clear in management literature. For example, when managers do not express
compassion when conducting layoffs or pay cuts, employees are more likely to file wrongful termination
lawsuits (Lind et al. 2000) and engage in workplace deviance (Greenberg 1990). On the other hand,
employees are less likely to leave their jobs if the employer/leader is prosocial (Barsade & Gibson 2003).
Pertinent to organizations, compassion is related to prosocial behavior (Brief & Motowidlo 1986) and
organizational citizenship behavior (Smith et al., 1983). Emotional social support has been defined as
“talking, listening, and expressing concern or empathy” (Zellars & Perrewe, 2001, p. 459), and it has been
shown to facilitate interpersonal relationships. Compassion is a response to organizational strife and pain,
which can both occur within the organization and be brought in from factors outside the organization.
Compassionate responses often extend far beyond empathic conversations, and they can entail significant
allocations of material and instrument resources directed toward persons in pain (Dutton et al. 2006). There
are several types of compassion, ranging from compassion for others to compassion for oneself.

Compassion for Self

Self-compassion and global self-esteem are highly correlated, although self-compassion has a host of
additional benefits above and beyond self-esteem (Neff & Vonk, 2009). For example, self-compassionate
people tend to have higher resilience and are better able to cope with failure, as they tend to be driven by a
desire to learn (Neff et al. 2005). While compassion is the wish to relieve those who are suffering in a kind
and nonjudgmental way, self-compassion takes that idea and turns it toward oneself (Neff, 2003). Given our
positive operationalization of leadership, we anticipate high scores of SDO will be related to low scores on
leadership measures, positively mediated by self-compassion.

Compassion for Others

Grant (2008) defined compassion as having three components: “1) empathy or understanding the feelings
of others, 2) caring for the other person, and 3) willingness to act in response to the person’s feelings” (p. 77).
Being compassionate toward others has many health benefits, such as lower systolic and diastolic blood
pressure and lower cortisol (Cosley et al., 2010). Cohen and Wills (1985) suggest that compassion may serve
as a buffer against stress. In our study, we used the Santa Clara Brief Compassion Scale to assess compassion
toward others, including strangers. Given our positive operationalization of leadership, we anticipate high
scores of SDO will be related to low scores on leadership measures, positively mediated by compassion for
others.

Fear of Compassion from Others

Although compassion has been shown to have positive effects (Gilbert et al., 2010), there are some who
fear it. This is extremely problematic from an evolutionary standpoint, as affiliative emotions help us regulate
threats and social isolation (Depue & Morrone-Strupinsky 2005). The fear of receiving compassion can have a

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direct effect on one’s heart rate, for example. Rockliff et al. (2008) showed that people who were highly self-
critical experience a reduction in heart rate variability in the face of a threat response, whereas those who were
classified as low self-critics had an increase in their heart rate variability. Given our positive operationalization
of leadership, we anticipate high scores of SDO will be related to low scores on leadership measures, positively
mediated by reductions in fear of compassion for others.

Fear of Compassion for Others

There are others who believe showing compassion is a sign of weakness. Gilbert et al. (2010) reported
McLaughlin and colleagues’ (2003) findings that some individuals feel that if one is compassionate toward
another, one will be taken advantage of. We hypothesize that individuals who have high levels of SDO also
have a high fear of compassion for others because they discriminate against out-group members more than do
those who have low levels of SDO (Pratto et al., 1994), and exhibit uncompassionate behaviors to out-group
members (Gilbert et al., 2010). Given our positive operationalization of leadership, we anticipate high scores
of SDO will be related to low scores on leadership measures, positively mediated by fears of compassion for
others.

Fear of Compassion for Self

As noted, there are many benefits to being self-compassionate, including resilience and motivation;
however, some people mistakenly see self-compassion as a weakness (Gilbert & Procter, 2006). People who
are low in self-compassion can also feel that they do not deserve to receive compassion from themselves.
Gilbert et al. (2010) explained that the lack of self-compassion may be at times due to harsh or abusive
backgrounds. SDO theory would expect those who score high on measures of SDO to score higher on fear of
compassion for self, given the potentially attenuating effects of compassion on social hierarchies. Given our
positive operationalization of leadership, we anticipate high scores of SDO will be related to low scores on
leadership measures, positively mediated by fears of compassion for self.

Figure 35.1 SDO mediated by ESJ by each of the compassion variables.* * Hypotheses 1a and 1b propose a positive relationship between SDO,
compassion/self-compassion, and leadership. Hypotheses 1c, 1d, and 1e propose a negative relationship between SDO, leadership, and the fears
of compassion scales.

Hypotheses
As a result of this background literature, our specific hypotheses for our study are listed as follows:

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 1. The relationship between SDO and transformational leadership will be mediated by individual levels of compassion along each of the
following domains (see Figure 35.1):
a. Compassion for others
b. Self-compassion
c. Fear of compassion for others
d. Fear of compassion from others
e. Fear of compassion for self

Methods
Participants
The present study sample (n = 371) were graduate and undergraduate students from a medium-sized
western U.S. university. Extra credit was offered to students for participating in the study as part of a course
during winter/spring of 2014. To combat fatigue, the measures were administered through an online survey
package at three time points throughout the quarter. Participation was voluntary for students in Business
Administration disciplines. Descriptive statistics for participants are presented in Table 35.1.

Table 35.1 Descriptive Statistics for Participants

Frequency Percent

Ethnicity Asian 189 50.9

Latino/a 59 15.9

Black 22 5.9

Mixed 24 6.5

White 72 19.4

Total 366 98.7

Missing System 5 1.3

Total 371 100.0

Sex

Valid Female 222

Male 149

Total 371

Instruments
Social Dominance Orientation
To assess for social dominance, the Social Dominance Orientation Scale was utilized (SDOS; Pratto et al.,
1994). The SDOS is a 16-item instrument that measures preference of an individual to preserve social
hierarchies, as they exist presently.

Positive Leadership

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 To assess for propensity towards transformational leadership, the Values in Action Leadership Scale was
used (VIA). The VIA Leadership Scale is a seven-item measure that assesses leadership ability.

Compassion for Others

To assess compassion for others, the Santa Clara Brief Compassion Scale was employed (SCBCS; Hwang,
Plante, & Lackey, 2008). The SCBCS is a five-item scale that identifies an individual’s level of compassion
for others, specifically one’s propensity towards prosocial behavior.

Self-compassion
To assess for self-compassion, the Self-Compassion Scale was used (Neff, 2003). The SCS is a 12-item
scale that measures how an individual responds to him- or herself during times of stress.

Fear of Compassion for Others, From Others, and for Self

To assess for fear of compassion for others, from others, and for self, the Fear of Compassion Scales were
employed (FCS; Gilbert, McEwan, Matos, & Rivis, 2011). The FCS are a group of three scales that measure
the compassion one gives to others, the compassion that one experiences coming from others, and the
compassion one has towards him- or herself when having done something wrong.

Results
To establish the relationship between individual differences in SDO, leadership, and various components of
compassion, we examined the correlations between these constructs (see Table 35.2).
The directionality of the scaling in four of the five compassion scales used in this research needs to be
considered for interpretation. Given that high scores on the self-compassion scale signify less self-
compassionate behavior, and higher scores on the three fear of compassion scales signify more fearfulness, we
can interpret the correlations as follows.
Leadership scores were significantly negatively correlated with SDO and the three fears of compassion
scales. This is consistent with the theoretical underpinnings of positive leadership and the relative impact of
SDO and fears of compassion on interpersonal skills. Also theoretically consistent is the significant positive
correlation between compassion and positive leadership. These findings suggest that the higher an individual
scores on positive leadership, the less the preferences of SDO will be manifested, the more compassion for
others will be expressed; and the individual will show less fear of expressing compassion for others, receiving
compassion from others, and expressing kindness and compassion toward oneself. This could also suggest that
individual preference for the preservation of social hierarchies is inversely related to desire to engage in
transformational leadership; namely, inspirational motivation, idealized influence, intellectual stimulation, and
individualized consideration.
Scores on the measure of SDO were significantly negatively correlated with compassion, consistent with
theoretical expectations and previous research (Martin & Heineberg, 2014). SDO was significantly negatively
correlated with fear of expressing compassion for others, fear of receiving compassion from others, and fear of
expressing compassion toward oneself. This finding suggests that the higher one scores on the SDO scale, the
less compassion one might show for others, and such people will be more fearful of expressing compassion for

637
others and themselves as well as being more fearful of receiving compassion from others.

Table 35.2 Correlations Between SDO, Leadership, and Measures of Compassion

1 2 3 4 5 6

Leadership 1

Social Dominance –.329** 1

Compassion for Others .390** –.335** 1

Self-Compassion .026 .031 .170** 1

Fear of Compassion for Others –.182** .261** –.063 .382** 1

Fear of Compassion from Others –.400** .356** –.124* .305** .570** 1

Fear of Compassion for Self –.398** .402** –.164** .225** .417** .767**
*
Correlation is significant at the 0.05 level (2-tailed).
** Correlation is significant at the 0.01 level (2-tailed).

Given the similarity of the questions in the compassion measures we used, coupled with the finding that all
other measures of compassion correlated significantly with SDO, we were surprised to find that the Neff Self-
Compassion measure did not. Consistent with the theoretical concept, self-compassion correlated
significantly with both fear of receiving compassion from others and fear of expressing kindness and
compassion toward oneself. This finding suggests that the two constructs are tapping into similar elements of
acceptance of compassion toward oneself (from others and self).
Of note is the lack of significant correlation between the Neff Self-Compassion Scale in any of the other
measures in the current research besides the measure of compassion for others. Though the scale is used
frequently, previous research using the scale had suffered similar results (Martin & Heineberg, 2014), and it
may reflect either the multidimensionality in the construct or required reification of the scale/s.
To establish the mediating effects of compassion between SDO and Leadership, mediational models were
used to test our hypotheses (see Figure 35.1). Through the first mediation model, the mediational impact of
compassion for others between SDO and transformational leadership was established. In Step 1 of the
mediation model, the regression of SDO on transformational leadership scores, ignoring the mediator, was
significant: b = – .318, t(371) = –6.70, p = .000. Step 2 showed that the regression of the SDO scores on the
mediator, compassion for others, was also significant: b = –.3923, t(371) = –6.82, p = .000. Step 3 of the
mediation process showed that the mediator (compassion for others), controlling for SDO scores, was also
significant: b = .2596, t(371) = 6.35, p = .000. Step 4 of the analyses revealed that, controlling for the mediator
(compassion for others), SDO scores were a significant predictor of transformational leadership scores: b =
–.2161, t(371) = –4.51, p = .000. A Sobel test was conducted and did find mediation in the model (z = –4.62,
p = .000). The mediational analysis did support hypothesis 1a: The relationship between SDO and
transformational leadership was mediated by individual levels of compassion for others.
Through the second mediation model, the mediational impact of self-compassion between SDO and
transformational leadership was not established. In Step 1 of the mediation model, the regression of SDO on

638
transformational leadership, ignoring the mediator, was significant: b = –.3180, t(371) = –6.70, p = .000. Step
2 showed that the regression of the SDO scores on the mediator, transformational leadership, was not
significant: b = .0238, t(371) = .6047, p = .546. Step 3 of the mediation process showed that the mediator
(self-compassion), controlling for the SDO scores, was not significant: b = .0462, t(371) = .7371, p = .462.
Step 4 of the analyses revealed that, controlling for the mediator (self-compassion), SDO scores were a
significant predictor of transformational leadership: b = –.3191, t(371) = –6.71, p = .000. A Sobel test was
conducted and did not find mediation in the model (z = .323, p = .747). The mediational analysis did not
support hypothesis 1b: The relationship between SDO and transformational leadership was not mediated by
individual levels of self-compassion.
Through the third mediation model, the mediational impact of fear of compassion for others between SDO
and transformational leadership was not established. In Step 1 of the mediation model, the regression of SDO
on transformational leadership, ignoring the mediator, was significant: b = –.3180, t(371) = –6.70, p = .000.
Step 2 showed that the regression of the SDO scores on the mediator (fear of compassion for others), was also
significant: b = .3008, t(371) = 5.20, p = .000. Step 3 of the mediation process showed that the mediator (fear
of compassion for others), controlling for the SDO scores, was significant: b = –.0864, t(371) = –2.03, p =
.043. Step 4 of the analyses revealed that, controlling for the mediator (fear of compassion for others), SDO
scores were still a significant predictor of depression: b = –.2920, t(371) = –5.96, p = .000. A Sobel test was
conducted and did not find mediation in the model (z = –1.86, p = .06). The mediational analysis did not
support hypothesis 1c: The relationship between SDO and transformational leadership was not mediated by
fear of compassion for others.
Through the fourth mediation model, the mediational impact of fear of compassion from others between
SDO and transformational leadership was established. In Step 1 of the mediation model, the regression of
SDO on transformational leadership, ignoring the mediator, was significant: b = –.3180, t(371) = –6.70, p =
.000. Step 2 showed that the regression of the SDO scores on the mediator, fear of compassion from others,
was significant: b = .4138, t(371) = 7.32, p = .000. Step 3 of the mediation process showed that the mediator
(fear of compassion from others), controlling for the SDO scores, was significant: b = –.2688, t(371) = –6.50,
p = .000. Step 4 of the analyses revealed that, controlling for the mediator (fear of compassion from others),
SDO scores were still a significant predictor of transformational leadership: b = –.2067, t(371) = –4.30, p =
.000. A Sobel test was conducted and found mediation in the model (z = –4.83, p = .000). The mediational
analysis supported hypothesis 1d: The relationship between SDO and transformational leadership was
mediated by individual levels of fear of compassion from others.
Through the fifth mediation model, the mediational impact of fear of compassion for self between SDO
and transformational leadership was established. In Step 1 of the mediation model, the regression of SDO on
transformational leadership, ignoring the mediator, was significant: b = –.3180, t(371) = –6.70, p = .000. Step
2 showed that the regression of the SDO scores on the mediator, fear of compassion for self, was also
significant: b = .5110, t(371) = 8.44, p = .000. Step 3 of the mediation process showed that the mediator (fear
of compassion for self), controlling for the SDO scores, was significant: b = –.2407, t(371) = –6.19, p = .000.
Step 4 of the analyses revealed that, controlling for the mediator (fear of compassion for self), SDO scores
were still a significant predictor of transformational leadership: b = –.1949, t(371) = –3.94, p = .0001. A Sobel
test was conducted and found mediation in the model (z = –4.97, p = .000). The mediational analysis

639
supported hypothesis 2e: The relationship between SDO and transformational leadership was mediated by
individual levels of fear of compassion for self.

Discussion
Correlations
Leadership scores were significantly negatively correlated with SDO and fear of compassion from others
and for self. Given the positive relationship with compassion for others and leadership, this finding suggests
that this could be a powerful tool for self-awareness in leaders (and a crucial component of leadership
development is awareness and development of acceptance of compassion in three directions: towards others,
from others, and towards self). Consistent with theoretical underpinnings of positive leadership, the high
levels of fears of compassion may have detrimental impacts on the interpersonal skills of leaders, modeling
inappropriate behavior across the organization.
Also theoretically consistent is the significant positive correlation between compassion and positive
leadership. When taken with the above findings, this suggests that the higher an individual score on positive
leadership, the less the preferences of SDO will be manifested; more compassion for others will be expressed,
and less fearfulness of expressing compassion for others, receiving compassion from others, and expressing
care and compassion toward oneself. While counterintuitive in the “dog-eat-dog world” of enterprise (Martin
& Heineberg, 2014), the emerging picture is clear: Leadership benefits (as do employees) from diminished
levels of SDO via compassionate awareness and behavior. Ongoing research (Martin, Heineberg, Bok, &
Kelman, in progress) suggests strong and significant links between high levels of SDO, lack of compassion,
and high levels of fear of compassion with the constructs of stress, anxiety, and depression. SDO is inversely
related to positive leadership, namely inspirational motivation, idealized influence, intellectual stimulation,
and individualized consideration.
Scores on the measure of SDO were significantly negatively correlated with compassion, consistent with
theoretical expectations and previous research (Martin & Heineberg, 2014). SDO was significantly negatively
correlated with fear of expressing compassion for others, fear of receiving compassion from others, and fear of
expressing compassion toward oneself. This finding suggests that the higher one scores on the SDO scale, the
less compassion one might show for others, and one will be more fearful of expressing compassion for others
and self, as well as being more fearful of receiving compassion from others.

Mediational Analyses
Contrary to our expectations, self-compassion did not mediate the relationship between SDO and positive
leadership. This lack of a mediational role for self-compassion seems to be illustrative of the potential new
measure of self-compassion. Additionally, the lack of a meditational role of self-compassion may be a function
of the nature of leadership in that it is focused on the leader’s relationship with the other and not necessarily
an intrapersonal capacity. As such, we would expect that transformational leadership capacity would be
impacted more by compassion in the context of the other over the self. While further replication is necessary
to corroborate this claim, our study seems to provide initial support for this premise.
Consistent with our hypotheses, the relationship between SDO and positive leadership was mediated by
compassion for others. As SDO is thought to be predictive of potentially negative interpersonal/group

640
relationships, compassion for others seems to facilitate positive and beneficial social interactions. As such, this
finding seems to suggest that a higher level of compassion for others is the key ingredient in the relationship
between SDO and the values of leading positively.
Consistent with our hypotheses, a mediational role was found between fear of compassion from others and
for self in the relationship between SDO and positive leadership. However, fear of compassion for others did
not mediate the relationship between these constructs. While SDO is thought to be predictive of potentially
negative interpersonal/group relationships, fears of compassion seem to prevent leaders from accessing the
very tools they need to receive and offer assistance in the execution of organizational requirements. As such,
this finding seems to suggest that lower levels of compassion for others might lead to high levels of positive
leadership.

Training and Education

The data outlined in this chapter suggest a need for intervention programs that facilitate the increase of
compassion for others and a reduction in fears of compassion from others, for others, and for self. Such
outcomes are also likely to result in increased overall well-being, as well as increased positive leadership. A
program entitled CST (Compassion Skills Training), which we (Martin & Heineberg, 2014) recently piloted
and currently utilize in hospitals and universities, is showing promise in doing just that. By integrating
psychoeducational materials focused on dimensions of positive leadership and compassion and well-being
through peer discussions, we found statistically significant differences in the aforementioned domains. While
further replication and controlled studies will be needed to establish the proven efficacy of our model, we
believe this pilot acts as initial proof for feasibility of compassion training for leaders. Our data suggest that,
while work in the environment of leadership is a dire need, there is sufficient space for optimism since
budding evidence suggests that in fact we can do something about this, and contribute to positive shifts in
compassion, well-being, and leadership capacities in workplace environments.
Conceptually, teaching and learning about how to be more or less compassionate as a positive leader is not
very difficult. However, establishing evidence that the training and education has been fruitful/impactful for
participants, as well as developing the willingness and ability to be more positive, seems to be a daunting task.
Over the past months we have been working to establish a model that might facilitate this.
In our proposed model, participants are exposed to cutting-edge, evidence-based literature on well-being
and compassion, and are asked to engage with meaningful experiential growth-oriented peer-to-peer
discussions on the topics. The program relies on a rich fund of evidence-based literature that has been adapted
to fit the online peer-to-peer format of the program, and the needs of the specific population with whom we
intend to work. This is not a clinical program, and it is not psychotherapy. Rather, lessons in this program are
presented in the format of a psychoeducational class with the intention of increasing intellectual
understanding of topic matters, as well as one’s sense of resilience, empathy, and compassion towards self and
others.
Compassion skills training begins with a pre-training assessment, followed by eight sessions consisting of
an approximately one-hour reading, followed by a one-hour dyadic interaction conveniently scheduled at the
discretion of the two participants using compassion development skills protocols. The training ends with a
post-training assessment. In total, 16 hours’ worth of training occurs, with web-based participation evidence

641
and outcomes provided by participants.
In previous applications of the CST with working student population, significant effects were found in pre-
/post-test measures:
1. A paired-samples t-test was conducted to compare pre-/post-tests of the Santa Clara Brief Compassion Scale. There was a significant
difference in the scores for the pretest (M = 3.67, SD = .85 and posttest (M = 3.92, SD = .85); t(–2.17) = 77, p = .03.
2. A paired-samples t-test was conducted to compare pre/posttests of the Subjective Happiness Scale. There was a significant difference in
the scores for the pretest (M = 3.36, SD=.56 and posttest (M = 3.37, SD =.72); t(–4.49) = 77, p = .00.
3. A paired-samples t-test was conducted to compare pre/posttests of the Values in Action Leadership Scale. There was a significant
difference in the scores for the pretest (M = 3.32, SD = .58 and posttest (M = 3.80, SD = .66); t(–4.74) = 77, p = .00.
4. A paired-samples t-test was conducted to compare pre/posttests of the Acceptance and Action Scale. There was a significant difference in
the scores for the pretest (M = 2.86, SD = .58 and posttest (M = 3.80, SD = .70); t(–4.17) = 77, p = .00.
5. A paired-samples t-test was conducted to compare pre/posttests of the Fear of Offering Compassion to Others Scale. There was a
significant difference in the scores for the pretest (M = 3.31, SD = .76 and posttest (M = 3.10, SD = .73); t(2.67) = 77, p = .00.

While data collection is ongoing in multiple environments, industries, and occupations, we anticipate similar
responses from ongoing studies with various populations, and with potentially more significant results, as
pilots have been executed with working business students (undergraduate and graduate) who are not
vocationally motivated to consider the intra- and interpersonal criticality of compassion in meeting personal,
social, and organizational needs.

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INDEX

Note: Page numbers followed by f and t indicate figures and tables, respectively. n indicates an endnote, and b
indicates boxed material.

A
ABC (Attachment and Biobehavioral Catch-up), 71–72
ABC News/Washington Post Polls, 337t, 349n4
Abu Ghraib military scandal, 488
Acceptance and Commitment Therapy, 379
Accident and Emergency service (A&E), use by homeless people, 466
Accommodation, of partner transgression in relationship, 308–309
Accuracy
empathic. See Empathic accuracy
interpersonal, 300f, 301
Action
appropriate, determination of, compassion training and, 229–230
compassion and, 238, 401, 403
compassionate. See also Heroism
leaders’ modeling of, 444t, 451–452
social class and, 323–325
in compassionate health care, 459
heroism and, 488
organizational compassion and, 437f, 438
legitimizing, 441f, 443t, 447–448
in organizations, leaders’ role in, 441f, 444t, 451–453
Action compassion, 42, 42t, 46
Action-phase model
of compassion, 357–360, 359f
evidence for, 360–363
implications of, 363–365
of goal pursuit, 354–357, 355f
Actor-Partner Interdependence Model (APIM), 303–304
Adaptive coping, CCT and, 222–223
Adler, A., Understanding Human Nature, 491
Adolescent(s)
compassion and caring behavior in
interventions to encourage, 101
neurodevelopment and, 153
compassion training for, outcomes, 223
empathy in, 153–154
immune function, CBCT and, 223, 251, 253
personal fable of, 372
prosocial behavior in, 55
self-compassion in, 153
social identity of, 153
Adverse Childhood Experiences (ACEs), 93
Affect. See also Emotion(s)

645
 actual, 277
avoided, 277
American–German differences in, 277–278, 279f
compassion training and, 222–223
ideal, 277, 281–282
negative
avoiding, cultural differences in, 277–278, 279f
compassion training and, 140
positive
and compassion, distinction between, 266
compassion training and, 223–224
regulation of
attachment and, 97
in compassion-focused parenting, 97–99
Affection, development of, in CBCT, 22, 248, 249t, 250
Affective chronometry, 136
of compassionate neural responses to suffering, 142–143
Affective sharing, 46
Affect valuation theory (AVT), 277–280
Affiliative/altruistic strategies, 409
lower class and, 319
Agentic traits, temporal trends in, in U.S., 339t, 344
Aggression, 300f, 302
altruistic, empathy-induced, 32
empathic distress and, 117–118
empathy/compassion and, 304–306
non-U.S. evidence, 306
inhibition of, empathy-induced altruism and, 31–32
relational, 305
in students, 475
Aggressive strategies, 406, 406t, 408–409
Aging. See also Older adults
compassion in, 154
Agreeableness, 411
Airline(s). See also Southwest Airlines
recovery after September11th attacks, 428
Alcohol use, self-compassion and, 376
Alexander the Great, 488
Altruism, 44, 332. See also Empathy-altruism hypothesis
and compassion, differentiation of, 6
cultural differences in, 275
definition of, 27, 53
empathy-induced, 30
benefits of, 31–33
evolution of, 30–31, 34
expansion of, 37
liabilities of, 33–36
evolutionary theories of, 161–162
moral elevation and, 126
neuroscience of, 110
reciprocal, 47, 161, 163
Altruistic disposition, 36

646
Altruistic motivation, 28–29
Ambition, temporal trends in, in U.S., 339t, 344
American Freshman Survey, 333–335, 336t–340t, 344
Americans, and Germans, differences in avoided negative affect, 277–278, 279f
Amygdala, 8, 11, 127, 251–252
activity
CBCT and, 223, 251–253
meditation and, 251–252
in caregiving, 166
compassion training and, 139, 151
in parenting, 67–72, 110
and social behavior, 180–181
in stress response, 166, 168
Ancient rituals. See Ritual(s)
Anger, 46f, 47
altruistic, empathy-induced, 32
chronic pain and, 460
and compassionate behavior, 402, 411
with others’ suffering, 4–5
Angst, 278
Animals. See also specific animal
attitudes toward, empathy-induced altruism and, 33
cruelty to, 408
nonhuman, helping behavior in, 175–176
Antecedents
of compassion, 4, 8, 150
of empathic concern, 30, 300, 300f
Anterior cingulate cortex
in caregiving, 167
in compassion, 111, 113–114, 115f
in empathy, 110, 151–152
in parenting, 67–72, 110
Ants, helping behavior in, 175
Anxiety
attachment, 81
and caregiving, 82–83
and caregiving in romantic relationships, 83–85
and caregiving to strangers, 85–87
CCT and, 243
and compassionate behavior, 402
homelessness and, 466
in hospitalized patient, 458
in illness, compassion and, 458
neurobiology of, 180–181
parenting-related, neurophysiology of, 69–70
postpartum, 69–70
self-compassion and, inverse association of, 374, 381
Appeasement behavior, 407, 411
Applied compassion, 11–12
Appraisal making, 9, 46, 46f
Appreciation
development of, in CBCT, 21–22

647
 for others, development of, in CBCT, 248, 249t
Approach motives, and empathy, 210
Approach response
compassion mediation and, 136–137, 136f, 141
hormones mediating, 178
neurobiology of, 180
Arête, 424
Arhat, 18
Aspirational compassion, 42t, 43
in CBCT, 22
Association(s)
direct, 300f, 301
language-mediated, 300f, 301
Attachment, 5–6, 401
adult, 79–81
link to caregiving, empirical evidence for, 83–87
temporal trends in, in U.S., 333, 336t
anxious, 80, 122
and caregiving, 82–83
avoidant, 80
and caregiving, 82–83
and caregiving, to strangers, 85–87
caring system and, 97
and child’s level of compassion, 101
components of, 97
infant
and adult caregiving/compassion, 164
theories of, 163–164
insecure/disorganized, 66, 164, 333
parenting and, 65–66
parents’ own models of, and compassionate parenting, 68
science of, 66
secure, 66, 80–81, 95, 164, 333
contextual heightening of, and empathic response, 87
and optimal caregiving, 82–83
working models of, in infants, 164
Attachment anxiety, 81–87
Attachment behavioral system, 79–81
and caregiving behavioral system, interplay of, 82–83
deactivation of, 80
hyperactivation of, 80
primary attachment strategies and, 80
secondary attachment strategies and, 80
and security, 80
Attachment figures, 80
Attachment-related avoidance, 81
Attachment style, 80–81
Attachment theory, 79
Attention
and compassion, 400–401, 403
and compassion collapse, 263
development of, in CBCT, 21–22

648
 and organizational compassion, 437f, 438
to suffering, in organizations, leadership moves and, 441f, 442–446, 443t
visual, to suffering, compassion training and, 139
Attentional engagement, 446
Attitudes
other-focused, temporal trends in, in U.S., 333–334, 336t
self-focused, temporal trends in, in U.S., 340t, 344–345
Attractiveness
physical, 407
as strategy, 406, 406t
Austerity, primary care in setting of, 465–466, 465b
Authoring compassion, 445
Autism
child’s, parents’ adjustment to, self-compassion and, 375
oxytocin gene and, 124, 178, 184
Autonomic nervous system, 4, 9, 190
activity, CBCT and, 251, 253
and affect regulation, 97
evolution of, 192–193
moral elevation and, 126–127
response hierarchy of, 193–194
response to stress, Cognitively Based Compassion Training and, 251
and social behavior, 180, 184
and socioemotional functions of oxytocin and vasopressin, 179–180, 184
subsystems of, 193–194
and visceral homeostasis, 179, 194
Autrey, Wesley, 27
Aversion, 46f, 47
Aversive responding, compassion training and, 224–225
Avoidance, 46f, 47
attachment-related, 81
compassion mediation and, 136–137, 136f, 139
as coping style, 373
dispositional
and caregiving in romantic relationships, 83–85
and caregiving to strangers, 85–87
hormones mediating, 178
neurobiology of, 180
threat system and, 358–360, 364, 411
Avoidance motives, and empathy, 210
Awe, emotional states associated with, 125

B
Baboons, intra- and inter-sexual competition in, 407
Baby Boomers
definition of, 332
volunteering by, 334, 336t
Baby names, temporal trends in, in U.S., 341t, 345, 349n3
Balzac, H. de, Père Goriot, 33
Baroreceptors, 197
Bats, helping behavior in, 175
Batson, Daniel, xxi. See also Empathy-altruism hypothesis
Beauty, cultural construction of, 273–274

649
Beck, Aaron, 281
Behavior. See also Helping/helping behavior; Prosocial behavior; Social behavior
anti-relationship, 302
appeasement, 407, 411
caring, CCT and, 243
compassionate, 4, 403
compassion training and, 230
control theory of, 278
cooperative, compassion and, 288–289
motivation and, 29
other-focused, temporal trends in, in U.S., 334–335, 336t–338t
perception and, 44
personality and, 295
pro-relationship, 302
situational factors and, 295
submissive, 407, 411
traits and, 295
Behavioral contingency, in compassionate parenting, 67, 67f, 72
Behavioral system(s), 79–83. See also Attachment behavioral system; Caregiving behavioral system
primary strategy of, 80
working models of self and others in, 80
Behavioral transfer, compassion mediation and, 137–138
Behaviorism, 163. See also Conditioning
Biofeedback, in schools, 480
Biology, xxii. See also Neurobiology
of compassion, 8–10
Blaming the victim, 32, 46f, 47
Blocks. See also Fears, blockers, and resistances (FBRs)
definition of, 400
Bodhicitta, 19
Bodhisattva, 18–19, 401
Bonobos, helping behavior in, 175
Books, American
collectivist words in, temporal trends in, 335, 338t, 348n1
individualistic word use in, temporal trends in, 340t, 345, 348n1
Bowlby, John, 79–82, 96, 164, 401
Brain. See also Neurocircuits
activity
CBCT and, 223
empathy and, 275
meditation and, 289
bidirectional communication and, 193
Cognitively Based Compassion Training and, 251–252
and compassion, 8–9
compassionate states
multivariate representation of, 142
spatial and temporal variability in, 142
compassion training and, 8–9, 110, 139, 230
culture–gene coevolution with, 148
developing, culture, compassion, and empathy in, 152–154
functions
and compassion-focused parenting, 99

650
 related to compassion, 110
imaging. See Neuroimaging
infant, parental neglect and, 95
maternal
future research areas, 72–73
plasticity in postpartum period, 68–69
prospective studies of, 73
structural changes in, 73
parental, 67–72
interventions and, 71–72
and parenting-related anxiety, 69–70
paternal, plasticity in postpartum period, 69
plasticity
and acquisition of new skills, 112
and compassion, 72
compassion training and, 110–114, 116
culture and, 148
parental, in postpartum period, 68–69, 72
positive/optimistic orientation of, 429
pregnancy and, 73–74
response to signals of suffering, 223
stress response, compassion and, 458
structures, and modulation of compassion, 179–180
threat system in, 96
Brain stem
and social engagement system, 195–196
and socioemotional function, 179
and visceral regulation, 179
Breastfeeding, moral elevation and, 127
Breath, neurophysiology of, 191, 191t, 195, 197
Breathwork, in schools, 480
British Petroleum (BP), 422–423
Bronfenbrenner, U., ecological theory of human development, 345–346, 346f
Buddhahood, 18–20
Buddhism, 10–12, 17, 36, 43, 228, 400
compassion in, 18–20, 275, 282, 400. See also Global compassion
and compassion training, 220
and contemplative model of compassion, 20–21, 24
and distress tolerance, 402
Drikung Kagyu tradition of, 134
four immeasurables of, 18, 224
Mahāyāna, 18–20, 23, 400
meditation in, 289
mind training tradition of, 248, 479
and modern contemplative programs, 20–21, 24
New Kadampa Tradition, 223
Noble Eightfold Path of, 18
and self-compassion, 381
suffering in, 43
tantric practice, 19–20
Theravāda, 18, 21
Vajrayāna, 18–20, 23–24

651
Bullying
among students, 475
definition of, 347
temporal trends in, in U.S., 342t–343t, 347–348
Burnout, 34–35, 47, 295
in health care professionals, 466–467
in primary care practitioners, 464
protection against, self-compassion and, 379
Business education, and support for hierarchical systems, 497
Bystander effect, 287, 292, 400, 409
Bystander role, 4

C
6 Cs, of health care, 459
California Personality Index, 339t
California Psychological Inventory, 344
Callousness, 404
Call to Care, 23, 479
Cancer, immune function and, 169
Cancer patient(s), care for, compassion in, 460
Cancer survivors, caregiving by adult spouses of, attachment and, 83
Capitalism, 405, 425
Care. See also Self-care
extending, in SCT model, 23
receiving, in SCT model, 23
relational dimension of, 479
Caregiving, 6. See also Parenting
brain circuits of, 9
compulsive, 82–83
controlling, 83
deficits
in anxious persons, 83–87
in avoidant persons, 83–87
evolution of, 401, 403–404
impairment of, 82
link to adult attachment, empirical evidence for, 83–87
mammalian, 401
neural substrates of, 110–111
optimal, 81–82
responsive, 83
in romantic relationships, 83–85
to strangers, 85–87
Caregiving behavioral system, 81–82
and attachment behavioral system, interplay of, 82–83
extension of, 81
Caregiving motivation, 5, 8
Caregiving Questionnaire, 83
Caregiving system, 79, 162–164
mammalian models of, 165
mechanism of action of, 164–165
neurobiological model of, 165–167, 166f
empirical tests of, 167
Care Quality Commission (CQC; U.K.), 457, 459, 464

652
Caring, 30
context and, 44
costs of, 404–405
evolution of, 399
Caring behavior, CCT and, 243
Caring role, costs of, 404
Caring system motive, and parenting, 96–97
Caudate nucleus, in compassion, 111
Cause(s)
proximate, 400
ultimate, 400
Chambers, John, 452
Chanting, neurophysiology of, 197, 199
Charitable giving
compassion training and, 140
social class and, 323–324
temporal trends in, in U.S., 334–335
Chief Nursing Officer’s (CNO) conference (U.K.), 459
Child(ren)
compassionate, 53–63
compassion-focused parenting and, 95–96, 102
empathic parents and, 101
future research areas, 60
interventions to encourage, 101
compassion-focused parenting and, 95–96, 102
corporal punishment of, 92
dispositional emotionality, and sympathy, 57–58
emergence of compassion in, 477
empathy in, 153–154
from inner cities, community violence and, 99
prosociality in, social class and, 324
self-regulation, and sympathy, 57–60
smacking of, 92
socioemotional orientation of, effects of, 304
temperament of, and sympathy, 57–58
Child deaths
by homicide, global statistic, 92
violence-related, 92
Child development
compassion-focused parenting and, 96
father’s role in, 69
and prosocial behavior, 477
social-emotional, compassion and, 96
Childhood experiences, 6, 401, 405
and self-compassion, 380
Child maltreatment, 92–94, 98–99
risk factors for, 92–93
and self-compassion, 380
Chimpanzees, helping behavior in, 175, 489
Christen, Pat, 450
Christianity, and compassion training, 220
Cingulate cortex, in compassion, 223

653
Circle of Security, 71
Cisco Systems, 452
Civic engagement, temporal trends in, in U.S., 335, 338t
Class. See Social class
Cognitive generalization, and evolution of empathy-induced altruism, 30–31, 34
Cognitively Based Compassion Training (CBCT), 17, 19–22, 221, 228, 477–480
active ingredients of, 249–250, 249t
anti-inflammatory effects of, 223, 250–252
differential effects in different populations, 253
effects
on body, 223, 250–251
on brain, 251–252
moderators of, 253–254
practice time and, 254
future research areas, 253, 253b
modules of, 248–249, 249t
outcomes, 223–224
and oxytocin system, 254–255
practice of, 248–249
science and, 24
theoretical basis of, 248
Cognitive networks, elaborated, 300f, 301
Cognitive performance, meditation and, 289
Cognitive reappraisal, 113–114, 137, 222–223, 230
and compassion collapse, 264–267
Cognitive regulation, CCT and, 242–243
Cognitive representations, of self and other, 300f, 301–302
Cognitive therapy, 281
Cohort effects, 332
Collectivism, 10, 148–149
and compassion, 321
and compassion collapse, 265
and cultural shaping of compassion, 282
ecological and environmental factors and, 150
and empathy–forgiveness association, 310–311
and expression of compassion, 150
and parenting, 153
temporal trends in, in U.S., 335, 338t
College students
adjustment to college, self-compassion and, 375
American
other-focused variables in, changes over time, 333–344, 336t–339t
self-focused variables in, changes over time, 339t–341t, 344–345
empathy-building interventions for, 207, 208t
Common good, and empathy-induced altruism, 35–36
Common Group Identity Model, 211
Communal traits, temporal trends in, in U.S., 339t, 344
Community, and society, 346–347
Compassion
action-phase model of. See Action-phase model
active
in CBCT, 22

654
 in CCT, 22
affective component of, 238
and altruism, differentiation of, 6
assessment of, 189
behavioral patterns of, 4
in Buddhist thought and practice. See Buddhism
capacity limit on, 263
cognitive component of, 238
vs. compassionate behavior, 262
and compassion training, relationship between, 222–226
competencies of, 95–96, 174, 400–403
components of, 3–4, 95, 238, 400–401, 477, 498
conception of, cultural shaping of, 274–275, 274f
contingent, 47
cross-cultural studies of, 274–277
as cultivated attitude, 4
cultivation of. See Cultivation of compassion
cultural neuroscience study of, 148–154
cultural shaping of, 274, 274f
as cultural value, 5
definition of, 3–4, 28, 42, 53, 95, 110, 133, 147, 174, 189, 222, 237–238, 273, 288, 320, 331, 353, 371, 389, 400, 421, 436, 457, 477, 498
in CBCT, 21
development of, 152–153
in CBCT, 249–250, 249t
directions of, 95
dispositional, 5–6, 295
and distress, 353
dyadic, 425
ecological model of, 150
as emotion, 4–5, 262, 288
and emotions, 353
and empathy, 6, 45–47, 190, 206, 261–262, 299
and engagement, 401–403
enhancement of, 289–294. See also Cultivation of compassion; Training, compassion
future research areas, 294–296
practice-specific mediators of, 295
social psychological approaches to, 289–294
subtle situational cues and, 294
evolution of, 174
experience of
cross-cultural considerations in, 282
cultural shaping of, 274–276, 274f
positive vs. negative in, 282–283
expression of
avoided negative affect and, 278–280, 279f
cultural shaping of, 274, 274f, 276–280, 279f
functions of, 190–191, 288
global. See Global compassion
as gut feeling, 179
in health care. See Health care
and helping, 353, 364
individual, 425

655
 in organizational settings, 425
individual-level determinants of, 321
inhibitors of. See Inhibition/inhibitors, of compassion
intentional component of, 238
leadership and, 495. See also Leadership
mammalian reproduction as evolutionary prototype for, 174–175
measurement of, 101
cross-cultural considerations in, 282
modern scientific model of, 24
as moral force, 288–290
as motivation, 4–5
motivational component of, 238
neural substrates of, 111
in nonhuman species, 173
for others, 498
assessment of, 500
and relationship between leadership and social dominance orientation, 503
to others, 95
physiology of, 190, 468
and positive affect, distinction between, 266
psychologies of, 402f
receiving, 95
and response/action, 401, 403
science of. See Science of compassion
in SCT model, 23–24
sex differences in, neurobiology of, 181
similarity/closeness and, 8
situational cues and, 288
social class differences in, 320–325
and social functioning, 303–311
as social process in organizations, 436–439, 437f
sociocultural context and, 149
and survival of species, xxi
sustainability of, 295
as trait, 4–6
typology of, 42–43, 42t
universality and cultural specificity of, 150
and vagal-mediated physiology, 190
and well-being, 353
in Western thought, 274–275
without action, 232
Compassionate joy (CJ), 47, 48n1
Compassionate Love Scale, 5
Compassionate mind training (CMT), 248, 477
for education, 479–480
Compassionate neurobiology
and behavioral interventions, 169
definition of, 159
and disease pathways, 169
future research areas, 184–185
and mental health, 169
Compassionate parenting. See Parenting

656
Compassion Based Cognitive Training (CBCT), 11
Compassion collapse, 8, 232, 295
as adaptive response, 269
capacity explanation for, 263
causal locus of, 266–267
causes of, 261, 263–266
contextual boundaries of, 267–268
counteracting, motivational interventions for, 268–269
definition of, 261–262
examples of, 261
expectations and, 269
vs. identifiable victim effect, 262
ideological factors and, 268
intergroup factors and, 267–268
laboratory studies of, 262
mechanism of, 266–267
motivational explanation for, 263–266
real-world studies of, 262
scope-severity paradox and, 262
socioeconomic status and, 268
Compassion core, and compassion fatigue resilience, 390
Compassion Cultivation Training (CCT), 10–11, 17, 19–23, 221, 228, 237–245, 248, 477
background of, 238
class structure, 239
empirical investigations of, 242–244
future research areas, 244–245
homework, 239–240
instructors, 242
outcomes, 222–224
gender differences in, 244
participants in, 239, 242
characteristics of, and CCT-related changes, 243–244
partner and small group sharing in, 240
practice of, 238–240
science and, 24
six steps of, 240–242, 240t
theoretical basis of, 238
Compassion fade, 266
Compassion fatigue (CF), 12, 35, 269, 295
antidotes for (protective factors), 390–391
causes of, 390, 404–405
culture and, 281
definition of, 387, 389
in healthcare professionals, 466–467
in organizations, future research on, 430
prevention of, 295, 396
protection against, self-compassion and, 379
risk factors for, 390
Compassion fatigue resilience
definition of, 390
genesis of, 395–396
Compassion Fatigue Resilience Model (CFRM), 388, 390–394, 391f

657
 applications of, 395
case studies, 388, 394–395
Compassion-focused therapy (CFT), 95–96, 99, 199–201, 380–381
Compassion in Practice, 459
Compassion meditation (CM), 18, 20, 36–37, 490
and behavioral change, study methods, 133
and behavioral transfer, 137–138
and compassionate responses, 268
future research on, 295
mechanism of effect, 295
emotion-regulation model of, 134–136, 134f
empirical evidence for, 137–140
future research areas, 141–144
in management of chronic pain, 460
practice of, 133–134
response components, 134, 134f
and state-to-trait changes, 136–137
steps in, 134, 134f
strategies used in, 134, 134f
targets of, future research on, 143–144
Compassion satisfaction, 387
benefits of, 394
definition of, 394
for human service workers, 395
self-compassion and, 379
Compassion Skills Training (CST), 503–504
Compassion stress, 388, 390–391, 391f, 392
genesis of, 395–396
prevention of, 396
risk factors for, 395
Compassion transfer, compassion mediation and, 137
Competition, 403–404
and empathy avoidance, 210
and human nature, 160–161
inter-sexual, as compassion inhibitor, 407–408
intra-sexual, as compassion inhibitor, 407–408
and natural selection, 160
self-focused, 405–407
social, 405
strategies for, 406, 406t
Compulsive caregiving, 82–83
Concern, 28
Conditioning
classical, 300f, 301
operant, 163
Conflict resolution, 32
interpersonal, empathy/compassion and, 304–306
Confucianism, and self-compassion, 381
Connections, high-quality
among co-workers, 449
definition of, 449
leadership moves and, 449–450

658
Conscientiousness, 411
Constructivist models, 20–21
Consumer acceptability, of treatments and strategies, 100
Contact
inter-group, and empathy building, 207
social, cross-class, and social class differences in compassion, 327
Contemplative neuroscience, xxi, 189
directional causality in, 191
Contemplative practices
active pathway and, 192, 199–201
benefits of, 191–192
environment for, 192, 199
neurophysiology of, 191, 191t, 195
passive pathway and, 192, 197–201
and social engagement system, 196–198
and vagal mechanisms, 191–192, 191t, 195
Contemplative programs, modern
Buddhism and, 20–21, 24
compassion-based, 21–24
Cooperation
in conflict situation, empathy-induced altruism and, 32
origins of, 160, 163
Cooperative behavior, compassion and, 288–289
Coopersmith Self-Esteem Inventory, 339t
Corporate social responsibility (CSR), 423–424
Corporations, compassion collapse and, 262
Cortex, 9
and social engagement system, 195–196
Corticotropin-releasing factor, 180–181
Cortisol, 167–169
response to stress, Cognitively Based Compassion Training and, 250–251
Costs
of caring, 404–405
of compassion, 404–405
and compassion collapse, 263–268
of empathy, 212
and parental empathy toward children, 100
and prosocial behavior in children, 56–57
Counseling, cultural shaping of compassion and, 280–281
Courage, compassion as form of, 414
Courage of Care Coalition, 23, 479
C-reactive protein, buffering of, by Cognitively Based Compassion Training, 251
Cruelty, 287, 408, 411–412
Cultivating Emotional Balance (CEB), 224–225
Cultivation of compassion, xxi–xxii, 48, 469. See also Compassion Cultivation Training (CCT)
in Buddhist thought and practice, 18–19, 401
in compassion meditation, 134, 134f, 135–136
and education, 476
Cultural indicators
other-focused, temporal trends in, in U.S., 335, 338t–339t
self-focused, temporal trends in, in U.S., 340t–341t, 345
Cultural neuroscience, 147–154, 275

659
 advances in, 151–152
definition of, 148
future research areas, 154
implications of, 154
research in, 148
scope of, 148
Cultural priming, 148
Cultural products, and historical trends in compassion-related variables in U.S., 332
Cultural reproduction, 153
Culture
affect valuation theory and, 277
and compassion, 10, 150, 273
future research areas, 281–282
in health care, 459–460
and compassion-related variables, temporal trends in, future research on, 348
definition of, 273–274
ecological theories of, 150
and emotions, 10
and empathy, 150
tightness and looseness
and compassion and empathy, 149
geography and, 150
Culture cycle, 273–274
Culture–gene coevolutionary theory
of compassion and empathy, 148–149
definition of, 148
Culture of companionate love, 450
Current Population Survey, volunteer supplement of, 336t–337t

D
Dalai Lama, xxi, 12, 42–43, 492
Darby, Joe, 488
Dark Triad, 404–405
Darwin, Charles, xxi, 160, 273, 282, 403
Davidson, Richard, xxi
Davis, Mark, xxi
Deep Water Horizon oil spill, 422–423
Defense(s), and compassion, 400, 402
Defining Issues Test, 336t
Deity yoga, 19
Delirium, in ICU patient, compassionate care for, 461, 461b
Dementia, patients with
care for, compassion in, 460
carers of, compassion for, 460
personhood of, 460
Denial, and compassion, 400, 402
Depression
amelioration, by CBCT, 251–252
in carers, 404
counteracting, helping behavior and, 167
homelessness and, 466
inflammation and, 251
postpartum, 71, 73

660
 self-compassion and, inverse association of, 374, 380–381
self-compassion interventions for, future research on, 382
Derogation, of innocent victims, 32
Detachment
and compassion fatigue resilience, 390
in Compassion Fatigue Resilience Model, 391f, 393, 395
Development. See also Child development
human
Bronfenbrenner’s ecological theory of, 345–346, 346f
Greenfield’s theory of, 346–347, 346f
Developmental psychology, 53
Development effects, 332
Dictator Game, 324
Direct association, 300f, 301
Disease, compassionate neurobiology and, 169
Disgust, with others’ suffering, 4–5
Disney, 423
Dispositional Positive Affect Scale, 5
Dispositional Positive Emotion Scale (DPES), 321
Dissociation
and compassion, 400
defensive, 193
Dissolution
Jacksonian principle of, 198
in polyvagal theory, 198
Distal compassion, 43, 45
Distancing empathy, 46f, 47
Distress, 28. See also Empathic distress; Personal distress
workplace, social dominance orientation of leaders and, 497
Distress tolerance, 402
Divorce
adjustment to, self-compassion and, 375
temporal trends in, in U.S., 345
DNA methylation, 148
of oxytocin receptor gene, social and emotional effects of, 124
Domestic violence, 408
Dopamine, 9, 67
in active compassion, 250
and helping behavior, 166
and reward processing, 111
and social behavior, 180
Dorsal motor nucleus, of vagus, 194
Downsizing, and organizational performance, 425–426, 431n3–431n4
Dual inheritance theory, of compassion and empathy, 150
Dyadic coping, 308
Dying patients, care for, compassion in, 460–461

E
Ecological model(s)
of compassion, 150
exosystem in, 345–346, 346f
macrosystem in, 345–346, 346f
mesosystem in, 345, 346f

661
 microsystem in, 345–346, 346f
Ecological theory(ies)
Bronfenbrenner’s, of human development, 345–346, 346f
of culture, 150
Economic systems. See also Capitalism
justification of, 497–498
Education, 12. See also Medical education
compassion-focused framework for, 476–477. See also Prosocial education
challenges for, 481–482
future research areas, 481–482
opportunities with, 482
compassion in
compassion-based interventions and, 478–480
mindfulness-based interventions and, 478
and cultivation of compassion, 476
goals of, 475
prosocial, 476–477
somatic interventions in, 480
Educators
mindfulness training for, 481
professional development for, 481
Egoism
altruism and, 27–28. See also Empathy-altruism hypothesis
definition of, 27, 332
and empathy-induced altruism, 35–36
and prosocial behavior, 332
Ehrenreich, B., Bright-Sided, 278
Elephants, helping behavior in, 175
Elevation, moral. See Moral elevation
Emory University. See Cognitively-Based Compassion Training (CBCT)
Emotion(s), 4–5
affiliative, and compassion-focused parenting, 96–97
anticipated vs. experienced, and compassion collpase, 266–267
vs. behavior, 262
and compassion, 238, 400
compassion training and, 222–223
cultural construction of, 274
and empathic concern, 28
empathy-related, 53–54
evolutionary functions of, 97–98, 147
experience of, CCT and, 242
facial expressions and, 45
moral, 125, 288
negative, 5
and children’s empathy-related responding, 57–58
resilience against, self-compassion and, 374–375
neurobiology of, 174
objective measures of, 143
in organizations, leaders’ role in, 441f, 443t
other-oriented, 28
parallel, 300f, 302
parents’ modeling of, and children’s empathy-related responding, 59

662
 positive, 5
amplifying effects, 428
and children’s empathy-related responding, 57–58
individual propensity for, measurement of, 321
loving-kindness meditation and, 290
prosocial, 122
compassion training and, 140
reactive, 300f, 302
recognition of
biology of, 9
compassion training and, 223–224
empathy-building interventions and, 208t, 209, 209t
rejection, 140, 224
self-conscious, 147
self-oriented, 28
short-term, compassion and, 353–354
three-function heuristic approach to, 97–98, 98f, 99
timeline for, 45
triggers for, 45
visceral nervous system and, 179
Emotional alert database, 45, 48
Emotional connection, in compassionate parenting, 67, 67f, 72
Emotional contagion, 6, 44, 46, 402
in organizations, 441f, 443t, 449
Emotional resonance, 46, 46f
Emotional support, 306–308
organizational compassion and, 438, 498
Emotion regulation, 151, 153. See also Affect, regulation of; Compassion meditation (CM), emotion-regulation model of
brain networks of, 113–114
CCT and, 242–243
and compassion collapse, 264–267
compassion training and, 222–223
definition of, 135
Emotion-regulation systems, 98, 98f
affiliative/soothing, 98–99
and compassion-focused parenting, 99
drive-reward, 98
insecure attachment and, 101
threat/self-protect, 98–99
Empathic ability
in Compassion Fatigue Resilience Model, 391–392, 391f
interventions for, 206–209
experience-based, 206–207, 208t, 209, 213n1
expression-based, 206–209, 208t–209t, 213n1
Empathic accuracy, 6
CBCT and, 223, 252
cross-cultural studies of, 276
neural networks in, 139
social class and, 320
Empathic arousal, 174
in nonhuman animals, 175
Empathic compassion, 42, 42t

663
Empathic concern, 3, 110, 116, 147, 174, 287–288, 302
antecedents of, 30, 300, 300f
and compassion, 302
overlap of, 332
in Compassion Fatigue Resilience Model, 391, 391f
cross-cultural studies of, 276
definition of, 28, 206, 302, 331
emotions and, 28
felt, and organizational compassion, 437f, 438, 441f, 443t, 448–451
and foregiveness of partner transgression in relationship, 310–311
and social support, 307–308
and sympathy, differentiation of, 332
Empathic distress, 3–4, 6, 42, 46f, 47, 110, 116–118, 332. See also Personal distress
Empathic distress fatigue, 12
Empathic joy, 109
Empathic response
in Compassion Fatigue Resilience Model, 390–391, 391f, 392, 395
compassion mediation and, 134–139, 134f
in infants, 153
Empathic sharing, 6
Empathy, 3, 44, 402
in adolescents, 153–154
affective, 6, 8–9, 300–301
altruism produced by, 30
evolution of, 30–31, 34
antecedents of, 30, 300, 300f
avoidance of, 210
benefits of, interventions emphasizing, 212
in children, 153–154
cognitive, 6, 46, 46f, 299–303. See also Perspective-taking
cultural differences in, 275
and social functioning, 311–312
and compassion, 6, 45–47, 190, 206, 261–262, 299
components of, 174
context and, 206
cultural differences in, 275
cultural neuroscience study of, 148–154
definition of, 6, 28, 46, 109, 147, 205, 299–300, 331
development of, 54–55
in CBCT, 248–250, 249t
dispositional
context and, 304
and hostility, 305
and social support, 306–308
temporal trends in, in U.S., 333, 336t
emotional, 6
cultural differences in, 275
ethnocultural, 281
expectations and, 269
experience of, cross-cultural studies of, 275–276
failures of, 205, 210
mindsets and, 211

664
 gender and, 206
and goal relevance, 212–213
intergroup, neural basis of, culture and, 151, 151f
interpersonal outcomes of, 300f, 302
intrapersonal outcomes of, 300f, 301–302
limits of, 263
motive-based framework for, 206, 209–210
interventions oriented to, 211–213
limitations of, 213
neurophysiology of, 70, 109–110, 190
not linked to compassion, 403
organizational model of, 300, 300f
future research areas, 312
for pain, 109–110, 116, 190–191, 252, 254
culture and, 151–152
neural systems and, 151–152
parental, neurophysiology of, 70
person and, 300, 300f
physiology of, 190
positive, in children, 58
processes of, 206, 300–301, 300f
cognitive, 300–301, 300f
noncognitive, 300–301, 300f
and prosocial behavior, 53
similarity/closeness and, 8
situational factors and, 206, 212–213, 300, 300f
and social functioning, 303–311
in social relationships, 299
for suffering, 109
as trainable, 469
as trait, 205–206
universality and cultural specificity of, 150
younger people’s, older people’s perceptions of, temporal trends in, in U.S., 331, 333, 336t
Empathy-altruism hypothesis, 27–31, 280, 358, 489
current status of, 29–30
experimental tests of, 29–30
Empathy-appraisal, 46, 46f
Empathy avoidance, 34–35
Empathy-related responding, in children
age-related changes in, 57–59
origins of, 57–60
parenting and, 58–60
and prosocial behavior, 55–57
sex differences in, 58–59
Emptiness, doctrine of, in Buddhist thought, 18–19
Enactive compassion, 46, 46f
End-of-life care, compassion in, 460–461
Engagement. See also Social engagement system
attentional, 446
civic, temporal trends in, in U.S., 335, 338t
compassion and, 401–403
England, hospital care in, 458–459

665
Enlightenment, Buddhist, 18–20
Environment
childhood, long-term effects of, 99
and gene expression, 73, 91
neurological effects of, 73
nurturing, characteristics of, 93
Epigenetics, 148, 413
definition of, 124
of oxytocin receptor, 124, 178, 184
Equalizing and Exchanging Oneself with Others, 19, 22
Equanamity
in Buddhist thought and practice, 18–19
development of, in CBCT, 21–22, 248–250, 249t
Ethic of care, 479
Ethics, and compassion, 412
Eudaimonism, 425, 427
Event-related potentials, 148
Evidence-based parenting programs (EBPPs), 93–94
compassion-focused parenting approach in, 99–101
efficacy of, compassion-focused parenting and, 102
future research areas, 101–102
parents who are nonresponders to, 101
positive effects of, 94–95
Evolution, 8. See also Culture–gene coevolutionary theory
of altruism, 161–162
attachment and, 97
of autonomic nervous system, 192–193
of caregiving, 401, 403–404
of caring, 399
and compassion, 150, 403–404, 413
of compassion, 174
of competition, 160–161, 403–404
of cruelty, 408
of empathy-induced altruism, 30–31, 34
gene-centric theories of, 161, 170n1
and group selection, 161, 170n1
of helping behavior, 161–162
of oxytocin, 176
of parasympathetic nervous system, 193
of prosocial behavior, 160–161, 173–174, 399
of social behavior, 81, 174–175
of sympathetic nervous system, 193
of vasopressin, 176
Evolutionary psychology, 47
Exercise, self-compassion and, 376
Exosystem, in ecological models, 345–346, 346f
Expansion of empathy-induced altruism hypothesis, 37
Experience-sharing, 206, 262
in compassion meditation, 134f, 135
Expert meditators, and compassion training, 220, 229
Exploitation, threat of, minimizing, 162
Expressive suppression, 222

666
 CCT and, 243
Extensivity, of compassion
development of, 60
future research areas, 60

F
Face–heart connection, 194–195
Facial expression, 4, 4f, 45
and neurophysiology, 192
responses to, compassion training and, 224
Familial compassion, 42–43, 42t, 47
Family
as nurturing environment, 93
structure, temporal trends in, in U.S., 341t, 345
Family medicine
compassion in, 462–464
European definition of, 463–464
Father, brain plasticity in postpartum period, 69
Fatigue. See also Compassion fatigue
definition of, 389
Fear(s)
of compassion, 411–412
reducing, 413
of compassion for others, 499
assessment of, 500
and relationship between leadership and social dominance orientation, 503
of compassion for self, 499
assessment of, 500
and relationship between leadership and social dominance orientation, 503
of compassion from others, 498–499
assessment of, 500
and relationship between leadership and social dominance orientation, 503
definition of, 400
in hospitalized patient, 458
of outsiders, 410
Fearfulness, in children, and empathy-related responding, 58
Fear of Compassion Scales (FCS), 5, 500
Fears, blockers, and resistances (FBRs), 400. See also Inhibition/inhibitors, of compassion
and evidence-based parenting programs, 101–102
Fears of Compassion Scale, 101
Felt security, 80
Females. See also Gender differences
and competition, 407
Fight-or-flight, 193–194
Financial crises, primary care in setting of, 465–466, 465b
Financial services industry, compassion in, 426–427, 427f
Fitness
in evolutionary theory, 160–161
inclusive, 81, 161
Fitness interdependence, 161–162. See also Stakeholder theory
Food Gatherers, 423
Forgiveness, 288, 300f, 302
communication of, 311

667
 definition of, 309
empathy/compassion and, 309–312
in non-U.S. populations, 310–311
mindful, 413
of partner transgression in relationship, 309–311
as phasic virtue, 425
self-compassion and, 378
Frames, and contemplative practice, 24–25
Francis Report, 458
Freud, Sigmund, 163–164, 280
Functional magnetic resonance imaging (fMRI), 148
and compassionate brain states, 143
empathy studies, 109–110
maternal mentalization studies, 70, 72
studies of romantic and maternal love, 111
Fundamentals of Care (FOC), 459

G
Gallup/Princeton Survey Research, 337t, 349n4
Game theory, 35
Gang desistance, 490
Gang members, former, as heroes, 490
Gemeinshaft, 346–347
Gender differences
in CCT-related changes, 244
in compassion, neurobiology of, 181
and empathy, 206
in empathy and interpersonal hostility, 305–306
in empathy/compassion and forgiveness, in non-U.S. populations, 310–311
in self-compassion, future research on, 381
Gene(s)
and evolution, 161, 170n1
expression, 91
shared, and fitness interdependence, 162
Gene–culture interaction, 150
General practice. See Family medicine
General practitioners (GPs)
burnout in, 464
compassion in, 462–464
Generational effects, and historical trends in compassion-related variables in U.S., 332
Generation X
civic engagement in, 335
definition of, 332
volunteering by, 334, 336t
Generosity, class differences in, 323–324
Genetics, 148–150, 184
at-risk environment and, 73, 91
and global compassion, 48
of oxytocin receptor, 122–124, 178, 182, 184
Genovese, Kitty, 287, 296n1
Germans, and Americans, differences in avoided negative affect, 277–278, 279f
Gesellschaft, 346–347
Giving USA, 334, 337t

668
Global compassion, 45, 48, 263
cultivation of, 48
definition of, 41
genetic predisposition and, 48
occasional, 42t, 43
promotion of, psychological science and, 43–48
Globus pallidus, in compassion, 111, 114f
Goal(s)
helping, commitment to, 358–360
deliberative mindset and, 362–363
future rersearch areas, 364
future research on, 365
instrumental, 29
other-focused, effects on self-focused goals, 361–362
self-focused, effects on other-focused goals, 360–361
self-protection, 358
threat-avoidance, 358–360, 411
factors affecting, 364
ultimate, 29
Goal pursuit, action-phase (Rubicon) model of, 354–357, 355f
Goal relevance, empathy and, 212–213
God, 412
Good Samaritan, 28, 44, 438
Google Ngram, 332, 338t, 340t
Gratitude, for others, development of, in CBCT, 248, 249t, 250
Greece, austerity/financial crisis in, and health care, 465–466, 465b
Grief, 28
counteracting, helping behavior and, 167
tolerance of, 402
Group dynamics, and empathy-building interventions, 211–212
Group-focused social dominance, 412
Group norms, and empathy-building interventions, 212
Guilt, 410
Guru yoga, 20

H
Hamilton, W., 161
Hancock, Graham, Lords of Poverty, 33
Happiness
compassion training and, 223
hedonic vs. eudaimonic well-being and, 233
Harlow, H. and M., 164
Harm
empathy-induced altruism and, 33
scope-severity paradox and, 262
Hate crime, 410
Headspace, 221, 225–226
Health. See also Mental health
Cognitively Based Compassion Training and, 250–251
compassion and, 11, 17, 24, 160, 353, 364–365, 498
compassionate brain and, 112–114
empathy-induced altruism and, 33
helping behavior and, 165, 364–365

669
 oxytocin in, 167–168
meditation and, 289
population disparities in, cultural neuroscience and, 154
social relationships and, 164–165
social support and, 111, 164–165, 170n2
Health Behavior in School-Age Children Study, 342t
Health care, 12
in austerity/financial crisis, 465–466, 465b
compassionate, design of, 467–468
compassion in, 457
and action, 459
components of, 459
definition of, 459
future research areas, 470
increasing, 468–470
obstacles to, 466–468
physiological effects of, 458
societal conditions and, 464–466
cultural shaping of compassion and, 280–281
homelessness and, 466
hospital-based, compassion in, 458–460
humanity in, failures in, 458
patient-centered
and compassion, 464, 467
IOM definition of, 462–463
in primary care, 463
person-centered
and compassion, 462, 464
for dementia patients, 460
in primary care setting, compassion in, 462–464
Health care organizations
compassionate, 467–468
compassion in, 427, 427f–428f
non-compassionate, 467
Healthcare practitioners. See Healthcare professionals; Human service workers
Healthcare professionals. See also Human service workers
compassionate approach to each other, 466
compassionate care for, 462, 462b
and declining empathy, 47
and distancing empathy, 47
empathy-building interventions for, 207–209, 208t, 213n1
loving-kindness meditation for, 468
Mindfulness-Based Stress Reduction (MBSR) for, 379
self-care by, 466
self-compassion and, 379
support for, 466–467
well-being of, compassion and, 468
Health Enhancement Program (HEP), 229
Health problems, adjustment to, self-compassion and, 375
Health-related behaviors, self-compassion and, 376
Heart rate
compassion training and, 231

670
 moral elevation and, 127
Heart rate variability
compassion training and, 231
fear of compassion and, 499
moral elevation and, 126–127
Heliotropism
definition of, 429
virtuousness and, 429–430
Hell, 412
Helping/helping behavior, 6, 159–160
in chimpanzees, 175, 489
class differences in, 323–325
and compassion, differences between, 323, 364
compassion training and, 116–118, 225–226
cultural differences in, 275–276
enhancement of, subtle situational cues and, 294
and exploitation, 162
health benefits of, to provider, 165, 167, 364–365
oxytocin and, 167–168
in infants, 477, 489
and kin slection, 161
likelihood of, empathy-induced altruism and, 31
motivation and, 29, 166
motivations for, 323
neurobiology of, 165, 175
in nonhuman animals, 175–176, 489
other-oriented emotional states and, 287–288
in rats, 175–176, 489
real-world, 225–226
reliability of, empathy-induced altruism and, 31
self-benefit of, 29, 165, 362
sensitivity of, empathy-induced altruism and, 31
temporal trends in, in U.S., 335, 337t
in toddlers, 477
and well-being, 29, 165, 362
witnessing, elevation caused by, 124–128, 125f, 492
Helping behavior test, for rats, 175
Heroes
everyday, 491
social, 487, 490, 492
as social transformation agents, 490
traditional, 487
Heroic compassion, 44
Heroic Imagination Project (HIP), 10, 491–492
Heroism
and action, 488
attention in scientific literature, lack of, 488–489
banality of, 489
and compassion, difference between, 489–490
as contagious, 492
culture-bound, 488
definition of, 487–488

671
 emergence of, 487
inspiring, 490–491
proactive (reflective), 488
reactive (emergent or impulsive), 488
social consensus and, 488
time-bound, 488
traditional perspective on, 487
training, 490–491
types of, 488
Hesiod, 333
Hierarchical systems, support for, business education and, 497
Historical trends, in compassion-related variables in U.S., 331–348
assessment methods, 332–333
cross-temporal meta-analysis of, 332–333
multi-year surveys and, 333
single time-point cross-sectional surveys of, 332
and trends in cultural products, 332
Hoess, Rudolf, 35
Homelessness, and health care, 466
HopeLab, 450
Hormones. See also specific hormone
and social traits and emotions, 173–174
Hospital(s)
compassionate, 467
health care in, compassion in, 458–460
Hostility, empathy/compassion and, 304–306
Household size, temporal trends in, in U.S., 341t, 345
Hubris, leaders and, 410–411
Hull, C., 163
Humanity, common, recognition of, 372–373
in Self-Compassion Scale, 373
Human service workers
characteristics of, 387
compassion in, 389
self-care for, 393
Huxley, Thomas Aldous, xxi, 160
Hypothalamic-pituitary axis (HPA), 9, 169, 177–178, 194
Hypothalamus, 127
medial pre-optic area
and caregiving system, 165–166
and parental behavior, 165
in parenting, 67

I
Identity
cultural, and group empathy, 152, 152f
meaningful aspects of, and empathy, 212–213
racial, and group empathy, 152, 152f
social
of adolescents, 153
and group empathy, 152
sociocultural, and neural response, 148
work as locus of, 435

672
Illness
acute, recovery from, compassion and, 458
adjustment to, self-compassion and, 375
chronic, management of, compassion in, 458
Imagery, and compassion collapse, 263
Immobilization
defensive, 193
reptilian, 193
Immoral action, empathy-induced altruism and, 35
Immune function
and cancer, 169
Cognitively Based Compassion Training and, 250–251, 253
compassion and, 250–251
self-compassion and, 376–377
stress regulation and, 167
Impartiality, development of, in CBCT, 21–22
Implicit Association Test, 225
Inclusive fitness, 81, 161
Income equality, and compassion, temporal trends in, in U.S., 346
Incredible Years Program, 93
Indifference, to others’ suffering, 4
Individualism, 148–149
in American cultural products, temporal trends in, 340t, 345
definition of, 345
ecological and environmental factors and, 150
and expression of compassion, 150
and parenting, 153
Inequality Game, 117–118
Infant(s)
attachment in, 163–164
compassion and, 152–153
empathy in, 54–55
maternal response to, neurocircuitry of, 68
moral judgment in, 429
social cognition in, 152–153
Infantile amnesia, 153
Inferior frontal gyrus, activity
CBCT and, 223, 252–253
and empathic accuracy, 139
Inferior parietal cortex, in compassion, 138
Inflammation
chronic, and disease, 169
compassion training and, 223
stress regulation and, 167
In-group(s). See also Proximity
and compassion, 21, 44, 176, 211–212, 267–268, 288
in children, 60
and empathy, 151–152
Inhibition/inhibitors, of compassion, 399–400
addressing, 413
proximate, 408–413
ultimate, 402–408

673
Innate Compassion Training (ICT). See Sustainable Compassion Training (SCT)
Innateist models, 20–21, 23–24
Insight training, in CBCT, 21–22
Institute of Medicine, definition of patient-centered care, 462–463
Instrumental support, 306–308
Insula
anterior, 8, 110, 152
in compassion, 111, 139, 223
compassion training and, 151
in empathy, 151
in parenting, 67
Intelligent kindness, 457
Intensive Care Unit (ICU), patients in, compassionate care for, 461, 461b
Intention, and compassion, 400
Interactionist approach, to prosocial behavior, 295
Interdependence, social, and compassion, 321
Inter-group bias, 211
Interleukin- 6, and cancer, 169
Interoception, 110
Interpersonal Reactivity Index (IRI), 5, 123
dispositional empathy measurement, 336t
Empathic Concern (EC) score
and relationship satisfaction, 304–306
and social support, 307–308
Personal Distress (PD) score, and social support, 308
Perspective Taking (PT) score
and accommodation of partner transgression in relationship, 309
and relationship satisfaction, 303–306
and social support, 307–308
Interpersonal relationships. See also Relationship(s); Romantic relationships
mistakes in, motivation to repair, 381
self-compassion and, 378
Intervention(s). See also Cognitively-Based Compassion Training (CBCT); Compassion Cultivation Training (CCT); Training
behavioral, compassionate neurobiology and, 169
cultural shaping of compassion and, 281
for empathic ability, 206–209
empathy-building, 206–209
group-based, 211–212
self-oriented, 211
situation-based, 212–213
social psychology and, 210, 213n2
Invertebrates, sociality in, 177
Isolation
health effects of, 160
and mortality, 164–165
in Self-Compassion Scale, 373
social, protection against, compassion and, 250
and social behavior, 180
stress caused by, 168–169
Israelis, as social transformers in Israeli-Palestinian strife, 490–491

J
Jinpa, Geshe Thupten, 228, 238, 248

674
Jinpa, Thupten, 21
Joy
in Buddhist thought and practice, 18
cultivation of, 18
Just-world hypothesis, 32

K
Kant, Immanuel, xxi
Kelleher, Herb, 449
Kindness, 457. See also Self-kindness
in health care, 458
intelligent, 457
Kindness Curriculum, 478
King, Martin Luther, Jr., 492
Kin relationships. See Proximity
Kin selection, 161, 163. See also Inclusive fitness
Kropotkin, P., xxi, 160, 163
Kurdi, Aylan, 262

L
Labeling, 300f, 301
Lady Gaga, 12
Langdon, M., Hero Construction Company, 491–492
La Rochefoucauld, F., 27
Leader(s)
organizational
and compassion processes in organizations, 441f, 443t–444t, 453
felt presence of, 440–442, 441f
as models for compassionate action, 444t, 451–453
self-concepts, power of, 444
Leadership, 12, 410–411
adaptive, 444t, 451–452
authentic, 452
compassion and, 495
definition of, 436
heroic, 492
and organizational compassion, 439
positive, 496
assessment of, 500
compassion training and, 503–504
and social dominance orientation, 496–497
social dominance orientation and
individual differences in, various components of compassion mediating, 499–504, 501t
negative correlations between, 502–503
social-interaction view of, 436
symbolic, 445
transactional, 448
transformational, 448, 495–496
and performance, 496
social dominance orientation and, mediation of, 499, 499f
Leadership in Compassionate Care Program (LCCP), 469
Leadership moves
and attention to suffering, 441f, 442–446, 443t

675
 definition of, 439
and organizational compassion, 439–446, 441f, 443t–444t
and organizational culture, 439
related to compassion, 439
Learning theory, 159, 163–164
Lesch, M., Ein Jahr Hölle (One Year of Hell), 278
Lewin, Kurt, 29
Life demands, and compassion fatigue, 392–393
Life goals, temporal trends in, in U.S., 340t, 344–345
LinkedIn, 445–446
Loci training, 112
Lojong, 248, 479
Loneliness
protection against, compassion and, 250
stress caused by, 168–169
temporal trends in, in U.S., 341t, 347
Longevity
help-giving and, 33
social factors and, 164–165
Long-term care
burnout in, 295
compassion in, 462
Lost letter paradigm, 335, 337t
Love
in Buddhist thought and practice, 18
cultivation of, 18
neural substrates of, 111
Loving, 30
Loving-kindness meditation (LKM), 18, 20–21, 36–37, 227
acceptability of, in parenting population, 100
and attitudes toward stigmatized groups, 225
benefits of, 113
effect on parenting practices, 100
for healthcare professionals, 468
and interpersonal functioning, 225, 290–291
outcomes, 231–232
and positive emotions, 290
and prosocial qualities, 290–291
Lynch, Phil, 451–452

M
Machiavellianism, 404, 496
Macho role, 409
Macrosystem, in ecological models, 345–346, 346f
Making Caring Common Project, 101
Makransky, John, 23
Males. See also Gender differences
and aggressive nationalism, 410
and competition, 407
Mallozzi, Jim, 422–423
Marital satisfaction
empathy/compassion and, 303–304
social support and, 306

676
Master Cheng Yen, 445
Maternal care
mammalian models of, 165, 174
neurobiology of, 174
oxytocin receptor and, 124
variations, and development, 124
Maternal sensitivity, 66
and compassionate parenting, 71
neurocircuits in, 71
Mayr, Ernst, 400
Medical education
and compassion, 469–470
empathy-building interventions in, 207, 208t
Medical Home, 463
Medicine, clinical competence and compassion in, 457
Meditation, xxi. See also Compassion meditation (CM); Expert meditators; Loving-kindness meditation (LKM); Mindfulness meditation;
Tonglen meditation
attention-based, 224, 227
and attitudes toward different social groups, 294
breath-focused, 22
Buddhist, 289
and compassionate responses, 276
compassion-based, 227
and compassion training, 226–227
and empathy building, 207
and experience of compassion, 276
and expression of compassion, 276
in modern contemplative programs, 21–23
and neural reactivity, 292
outcomes, self-report methods and, 291
and positive interpersonal outcomes, 289–291
and real-world compassionate responses, 226–227
scientific investigations of, 289
shamatha, 224
social psychological investigations of, 289–294
targets of, future research on, 143–144
and virtuous mental states, 289–290
Memory
autobiographical, development of, 153
neurocircuitry of, in pregnancy and postpartum, 74
Mental experience, of compassion, 4
Mental health
among students, 475–476
austerity/financial crisis and, 465
compassion and, 364–365
compassionate neurobiology and, 169
helping behavior and, 165, 167, 364–365
homelessness and, 466
meditation and, 289
Mentalizing, 6, 206
and empathy, 403
Mesolimbic system, compassion training and, 151

677
Mesosystem, in ecological models, 345, 346f
Microsystem, in ecological models, 345–346, 346f
Micro-trials
for compassion-based exercises with parents, 100
definition of, 100
Midbrain, in parenting, 67
Mid-Staffordshire Hospital (U.K.), 458, 467
Milgram, S., research on obediance, 287, 411
Millenials
civic engagement in, 335
definition of, 332
volunteering by, 334, 336t
Mimicry, 6, 300f, 301
Mind
in Buddhist thought, 18–20
constructivist models and, 20–21
culture–gene coevolution with, 148
enactive, 46
innateist models and, 20–21
models of, 20
Mind and Life Institute, 23
Mindfulness, 18, 20
in Cognitively Based Compassion Training, 248–250, 249t
and self-compassion, 373
future research on, 381–382
in Self-Compassion Scale, 373
Mindfulness-Based Cognitive Therapy (MBCT), 380
Mindfulness-Based Stress Reduction (MBSR), 20, 379
Mindfulness meditation
and compassionate behavior, 292–294
and compassionate responses, 268
future research on, 295
mechanism of effect, 295
outcomes with, 289–290
Mindfulness training
in education, 478
for educators, 481
for primary care practitioners, 464
Mindful Self-Compassion (MSC) training, 11, 220, 379–380
Mindset(s), 354
deliberative, effects on helping-goal commitment, 362–363
and empathic failures, 211
fixed, 211
growth, 211
development of, in CBCT, 248–250, 249t
mastery, development of, in CBCT, 248–250, 249t
Mind training, tradition, of Buddhism, 248, 479
Mind wandering. See Cognitive regulation
Minnesota Survey on Bullying, 342t
Mirror neurons, 148, 153, 252
Mobile phones, and social connections, 346
Moderators, of compassion, 8

678
Mom Power, 71–72
Monitoring the Future Study, 333–335, 336t–342t, 344, 347
Moral attitudes, cultural and genetic basis of, 149
Moral development, temporal trends in, in U.S., 333, 336t
Moral elevation
biology/physiology of, 125f, 126–127
trait, 128
from witnessing compassion, 124–128, 125f, 492
Morality, and compassion, 412
Moral motivation, and empathy-induced altruism, 35
Moral reasoning
and compassion, 333
definition of, 333
temporal trends in, in U.S., 333–334, 336t
Mother
at-risk environment and, 73
brain plasticity in postpartum period, 68–69
empathy in, neurocircuitry of, 70
parenting-related anxiety in, 69–70
psychopathology in, and parenting, 71, 73
synchrony with child, neurocircuitry of, 70–71
Motivation
and altruism, 161
and behavior, 29, 161
and compassion, 238, 400
compassion-based, 288
and compassion collapse, 263–266
compassion training and, 222–223
and empathy, 206
extrinsic, definition of, 344
and helping, 29, 159–160, 401–402
intrinsic, definition of, 344
other-focused, 161–163
prosocial, 399
in rats, 176
self-compassion and, 101, 375–376, 499
in social relationships, 163–164
Motivational conflicts, and inhibition of compassion, 411–412
Motor mimicry, 300f, 301
Moves, 439. See also Leadership moves
Multidimensional Compassion Scale, 5

N
Narcissism, 404
temporal trends in, in U.S., 339t, 343t, 344, 347
Narcissistic Personality Index, 339t, 343t
National Crinme Victimization Survey, 342t
National Health Services Research Institute of the Netherlands (NIVEL), and quality of primary care, 463
National Survey of Children Exposed to Violence, 343t
Natural selection, xxi, 150, 160
NBC News, Season of Kindness Poll, 333, 336t
Need(s), 401
attention to, in health care, 459

679
 global, and empathy-induced altruism, 34
mutual, and fitness interdependence, 162
perceived, 28, 30–31
magnitude of, 30
unmet, 8
Negi, Lobsang Tenzin, 21, 228
Neural network(s)
and compassion, 179–180
compassion training and, 112–116, 139, 223–224, 230–231
in empathy, 70, 109–110, 275
social class and, 320
in empathy for pain, 109–110
empathy-for-suffering training and, 114–116
in moral elevation, 125f, 126–127
shared, for firsthand and observed experiences, 110
and socioemotional function, 179
Neural reactivity, meditation and, 292
Neurobiology. See also Compassionate neurobiology
of avoidance, 180
of caregiving system, 165–167, 166f
comparative, of social behavior, 180–181
of emotion, 174
of gender differences in compassion, 181
of helping behavior, 165, 175
of maternal care, 174
of prosocial behavior, 174
of reproduction, 174
of safety, 184
of sociality, in prairie voles, 180–181
of socioemotional functioning, 179–180, 184
Neuroception, in polyvagal theory, 198–200
Neurocircuits
at-risk environment and, 73
and caregiving, 9
eand intergroup empathy, 151–152, 151f
and maternal synchrony with child, 70–71
memory-related, in pregnancy and postpartum, 74
and parenting, 67–72
and reward, 9–10, 67–68, 110–111, 141, 166
Neuroimaging. See also Functional magnetic resonance imaging (fMRI)
maternal–child synchrony study, 70
parental brain and empathy study, 70
studies of compassion, 111
studies of memory/learning, 112
studies of parent–child interactions, 74
Neuroscience, 8–9. See also Cultural neuroscience
of parenting, 67–72
Ngondro, 20
Nirvāna, 18
Noblesse oblige, 317
Nonhuman research, 4
Non-referential compassion, 42t, 43

680
Nucleus accumbens
and compassion, 140, 224
and helping behavior, 166
in parenting, 67–71, 110
Nucleus ambiguus, 194
Nurses. See also Healthcare professionals; Human service workers
attrition among, 467
training of, and compassion, 469
Nursing. See also Health care
compassion in, 457, 459
work in, qualitative evaluation of, 467

O
Obediance, Milgram’s research on, 287, 411
OckTV video, 317
OfficeMax, 423
Older adults
self-compassion in, 154
volunteering by, 334, 336t
Operation Underground Railroad, 488
Opiates, in affiliation and care, 111
Opioids, and social behavior, 180
Orbitofrontal cortex
in caregiving, 167
medial, in compassion, 113–114, 114f, 118, 141, 223
in parenting, 67–72, 110
in social connection, 110
Oregon Model of Parent Management Training, 93
Organization(s). See also Health care organizations
compassionate, 12
downsizing, 425–426, 431n3–431n4
hierarchy-attenuating, 497
hierarchy-supporting, 497–498
rituals and stories in, and giving sense to suffering, 441f, 443t, 448
social capital in, 428
suffering in, 435
Organizational compassion. See also Health care organizations
across industries, 425–426
amplifying effects, 428
attributes of, 421
buffering effects, 428–429
contexts for, future research on, 430
as coordinated response, 422
cross-cultural comparisons, future research on, 431
definition of, 421–422
future research on, 430
detrimental effects of, 430
dimensions of, future research on, 430
and downsizing, 425–426, 431n3–431n4, 498
empirical underpinnings of, future research on, 430
four parts of, 436, 437f
future research areas, 430–431
heliotropic effects, 429–430

681
 leadership moves and, 439–446, 441f, 443t–444t, 453
leaders’ role in, 435–436, 439
legitimizing, leaders’ role in, 441f, 443t, 447–448
and organizational performance, 421, 425–430
organizational reinforcement of, future research on, 431
and prosocial behavior, 498
and resource allocation, 444t, 452, 498
as social process, 436–439, 437f
varieties of, 422–424
Organizational culture, 448
definition of, 422, 450
emotional, leaders’ role in, 441f, 443t, 450
leadership moves and, 439, 441f, 443t, 448–449
and organizational compassion, 422
social dominance orientation and, 496–497
Organizational theory, 436
Outcomes
affective, 300f, 302
cognitive, 300f, 301–302
interpersonal, 300f
intrapersonal, 300f, 301–302
motivational, 300f, 302
organizational compassion and, 437f, 438, 446, 498
other’s, valuing, 300f, 302
Out-group(s), and compassion, 21, 44, 211, 225, 267–268, 404
Over-identification, 373
in Self-Compassion Scale, 373
Oxytocin, 9, 121–124, 148, 169, 404
actions of, 177
sex differences in, 181
in affiliation and care, 111, 122, 177
behavioral effects of, receptor dynamics and, 178–179, 182–183
CBCT and, 254–255
and compassion, 122, 128, 180, 182
and compassionate parenting, 68, 71, 122
and emotional processing, factors affecting, 122–123
evolution of, 176
exogenous, effects of, 183–184
and health-related benefits of helping behavior, 167–168
physiological functions of, 122, 254
physiology of, 122
and progesterone levels, 168
in romantic partnerships, 122
and social bonds, 163
and social processing, factors affecting, 122–123
and social traits and emotions, 173–174, 176–177
socioemotional functions of, autonomic nervous system and, 179–180, 184
and stress response, 122, 165–166, 168, 177, 180–181, 254
and vasopressin, interactions of, 177–178, 181–183
and visceral nervous system, 179
Oxytocin receptor(s), 150, 177
and behavioral effects of oxytocin, 178–179, 182

682
 epigenetic variations of, 124, 178, 184
gene methylation, social and emotional effects of, 124
genetic variations of, 122–124, 178, 182, 184
in primates, 183
in rodents, 183

P
Pain. See also Empathy, for pain
brain responses to, 109–110
chronic, management of, compassion in, 460
Pain triggers, and suffering in organizational contexts, 436, 437f
Palestinians, as social transformers in Israeli-Palestinian strife, 490–491
Pallidum, ventral
and helping behavior, 166
in parenting, 110
Parasympathetic nervous system (PNS), 9, 190, 224
and affect regulation, 97, 182
evolution of, 193
moral elevation and, 126–127
and sociality, 179, 182
Parental instinct
and evolution of empathy-induced altruism, 30–31, 34
human, 30
Parental investment, 96–97
Parental reflective functioning, and attachment, 66
Parental sensitivity, and attachment, 66
Parent–Child Interaction Therapy, 93
Parent–infant attachment, 5, 65–66
Parenting, 6, 405. See also Evidence-based parenting programs (EBPPs); Father; Mother
and altruism, 163
anxiety related to, parental brain and, 69–70
caring system motive and, 96–97
and children’s empathy-related responding, 58–60
and compassion, connections between, 58–60, 65–66
compassionate, 346
characteristics of, 66–67, 72
future research areas, 72–74
interventions and, 71–72
and parents’ own models of parenting, 68, 72
compassion-focused, 91, 95–101
affect regulation in, 97–99
benefits of, 102
competencies of, 95–96
definition of, 95–96
in evidence-based parenting programs, 99–101
future research areas, 102
and cooperation, 163
criticism and, 99
cultural bias and, 153
long-term effects on children, 6, 58–60, 91
neurocircuits involved in, 67–72
public health approach to, 91–95
as wide-scale compassionate action, 94–95

683
 punitive, effects of, 98–99
and risk factors for child maltreatment, 93
science of, 66
self-compassion and, 98–101
shame and, 99
Parenting style(s)
authoritarian, 92
authoritative, 92
classification of, 92
coercive, and child outcomes, 92
demanding, 92
effects of, 92
indulgent, 92
lax, and child outcomes, 92
neglectful, 92
permissive, 92
responsive, 92
Parents. See also Father; Mother
caring for themselves, 99–100
compassion-based exercises with, 100
empathy toward children, costs to parents, 100
stress on, programs to reduce, 100
Paternalism, empathy-induced altruism and, 34
Patient care, imporvement, health system initiatives for, 459
Perceived suffering, 4–5, 44–45
Perception
and behavior, 44
and empathy, 47
Periaqueductal gray, in stress response, 168
Personal distress, 6, 54, 110, 147, 230, 332, 402. See also Empathic distress
compassion training and, 140
neuroscience of, 8–9
perceived suffering and, 4–5
Personality
and behavior, 295
and empathy, 300
Perspective-taking, 6, 46, 46f, 262, 300–301, 332
and accommodation of partner transgression in relationship, 309
antisocial effects of, 210, 213
and compassion, 302–303
in compassion meditation, 134f, 135
and empathy, 402–403
and empathy building, 207
and foregiveness of partner transgression in relationship, 310–311
and hostility/aggression, 305–306
non-U.S. evidence, 306
and relationship satisfaction, 303–304, 306
and self-compassion, 372
and social class differences in compassion, 326–327
and social support, 307–308
Philanthropia, 457
Philotechnica, 457

684
Photogenics of disaster, 35
Physicians. See Healthcare practitioners; Healthcare professionals; Human service workers
Physiology. See also Neurobiology
of compassion, 190
compassionate behavior and, xxi–xxii, 4
compassion training and, 231
of empathy, 190
of moral elevation, 125f, 126–127
of oxytocin, 122
of ritual, 191, 191t, 197–198, 200–201
Pity, 3, 28
Planetree, 463
Point of Care Program (U.K.), and Schwartz Center Rounds, 468
Polyvagal theory, 9, 97, 192–194, 200–201, 201t
dissolution in, 198
neuroception in, 198–200
Popularity, empathy/compassion and, 304
Posterior cingulate cortex, in empathy, 152
Postpartum period
anxiety in, 69–70
parental brain plasticity in, 68–69, 72
Postpartum preoccupations, 69
Post-traumatic stress disorder (PTSD)
diagnostic criteria for, 389
protection against, self-compassion and, 375
Postural gestures, 4
Posture, neurophysiology of, 191, 191t, 195
Power
and attention to suffering in organizations, 443t, 444
and inhibition of compassion, 405–407, 410–411
social, and compassion, 321, 326
social dominance orientation and, 497
Power distance, and intergroup empathy, 151
Prairie voles
epigenetic changes in, 178
neurobiology of sociality in, 180–181
Prefrontal cortex, 8–9, 401
activity, CBCT and, 223
and compassion, 153
dorsolateral
and compassion, 138, 224
compassion training and, 140
dorsomedial
activity, CBCT and, 252–253
and empathic accuracy, 139
medial
in empathy, 152
moral elevation and, 127
in parenting, 67–72
Pregnancy, brain changes in, 73–74
Prejudice, amelioration by moral elevation, 126
Primary care

685
 compassion in, 462–464
core dimensions of, 463
and hidden or invisible healthcare problems, 464
Primary circular reaction, 300f, 301
Prisoner’s dilemma, 32
Progesterone, 111, 169
in compassion, 168
release, oxytocin and, 168
Pronoun use, Americans’, temporal trends in, 335, 338t, 341t, 345, 348n2
ProQOL Survey, 394
Prosocial behavior, 300f, 302
assessment, improvements in, 143
benefits of, 399
biology of, 9
in children, 53
costly vs. less costly, 56–57
development of, 54–55
empathy-related responding and, 55–57
individual differences in, 55
motivations and, 56, 60
origins of, 57–60
spontaneous vs. compliant, 56
class differences in, 323–325
compassion and, 17, 116–118
compassion meditation training and, 137–138
compassion training and, 225–226
culture and, 10
definition of, 332
deliberative mindset and, 362–363
in developmental psychology, 53
development of, 54–55, 477
emergence of, in young humans, 477
empathy and, 116–118
evolution of, 173, 399
facilitators of, 399
interactionist approach to, 295
measurement of, 291–292
meditation and, 291–293
moral elevation and, 124–128
motivators of, 53–54
neurobiology of, 174
in nonhuman species, 174
organizational compassion and, 498
situational factors and, 287
spread of, 294
Prosocial education, 476–477
future research areas, 481–482
integrated compassion-based framework for, 481
Proximal compassion, 43, 45, 48
Proximity, and compassion, 401, 404
Proximity seeking, and attachment, 97
Prudential Real Estate and Relocation Company, 422–423

686
Psychologists. See Human service workers
Psychopathy, 404, 496
Psychosis, homelessness and, 466
Public health
and parenting, 91–95
and wide-scale compassionate action, 94–95
Public policy, cultural neuroscience and, 154
Public service, cultural shaping of compassion and, 281
Puddicombe, Andy, 226
Punishment, 412
compassion and, 288–289
Purdue Social Support Scale, 393–394
Putamen, in compassion, 113, 114f

Q
Quality and Outcomes Framework (QOF), 462–463

R
Racism
and compassion collapse, 267–268
consensual, in college students, and fields of study, 497–498
Ramon y Cajal, S., 112
Rats
helping behavior in, 175–176, 489
maternal care in
and development, 124
oxytocin receptor and, 124
prosocial motivation in, 176
social behavior in, 175–176
Ravens, helping behavior in, 175
Reading the Mind in the Eyes Task, oxytocin and, 123
Reality, ultimate, in Buddhist thought, 18–19
Reappraisal. See also Cognitive reappraisal
in compassion, 8–9
Redistribution Game, 137–138
Reflective awareness, in compassionate parenting, 67, 67f, 72
Refuge, tantric practice of, 20
Reinforcement, secondary (conditioned), 163–164
Relationship(s). See also Romantic relationships; Social relationship(s)
compassion and, 288
future research areas, 312
non-U.S. evidence, 306, 308, 310–312
interpersonal
mistakes in, motivation to repair, 381
self-compassion and, 378
partner transgression in
accommodation and, 308–309
forgiveness for, 309–311
perspective-taking and, 309
responses to, empathy/compassion and, 308–311
quality, empathy/compassion and, 303–306
Relationship Questionnaire, 336t
Relationship satisfaction

687
 empathy/compassion and, 303–304
non-U.S. evidence, 306
future research areas, 312
Religion, and compassion, 42
Religious participation, temporal trends in, in U.S., 335, 338t, 346
Repression, and compassion, 400
Reproduction
mammalian, as evolutionary prototype for compassion, 174–175
neurobiology of, 174
Reproductive strategy(ies), 407–408
Resilience. See also Compassion fatigue resilience; Compassion Fatigue Resilience Model (CFRM)
definition of, 389–390
genesis of, 395–396
increasing, in human service workers, 396
quantification of, 390
self-compassion and, 498–499
virtuous practices and, 429
Resistance(s). See also Fears, blockers, and resistances (FBRs)
definition of, 400
ReSource Project, 10, 116, 220, 231
Resources, organizational, and compassionate action, 444t, 452, 498
Respiratory sinus arrhythmia (RSA)
moral elevation and, 126–127
and vagal status, 182
Response, compassion and, 401, 403
Responsiveness, of care provider, 82
Restorative justice, compassion and, 117–118
Reuters America, 451–453
Reward circuits, neural, 9–10, 67–68, 110–111, 166–167
and compassion, 141
and parenting, 165
Rewards
absence of, and helping behavior, 166
altruistic, desire for, temporal trends in, in U.S., 340t, 344
extrinsic, desire for, temporal trends in, in U.S., 340t, 344
intrinsic, desire for, temporal trends in, in U.S., 340t, 344
leisure, desire for, temporal trends in, in U.S., 340t, 344
social, desire for, temporal trends in, in U.S., 340t, 344
and social behavior in rats, 175–176
Rhythmicity approaches, in schools, 480
Ricard, Matthieu, 36–37, 41
Risk-regression model, of interpersonal functioning, 358
Ritual(s)
functions of, 197–198
physiology of, 191, 191t, 197–198, 200–201
polyvagal theory and, 192, 200–201, 201t
Roberts, G., 163
Rodents. See also Rats
helping behavior in, 175
Romantic relationships
caregiving in, 83–85
mistakes in, motivation to repair, 381

688
 oxytocin in, 122
satisfaction in, empathy/compassion and, 303–304, 306
Rosenberg Self-Esteem Scale, 339t
Royal College of General Practitioners (RCGP), and compassionate primary care, 464
Rubicon model, of goal pursuit, 354–357, 355f
Rule-transformation model, 301

S
Sadism, 412
Sadness, 28
and compassionate behavior, 402
dispositional, in children, and empathy-related responding, 57–58
tolerance of, 402
Safe haven, 401
and attachment, 79, 81–83, 96–97
Safety
fortress attribute and, 199
neurobiology of, 184, 190, 192–194
polyvagal theory and, 192
vocal signals of, 196–197, 200
Samsāra, 18–19
Santa Clara Brief Compassion Scale (SCBCS), 498, 500
Satisfaction. See also Compassion satisfaction; Relationship satisfaction
sense of, and compassion fatigue resilience, 390
Schadenfreude, 4, 35, 82, 210, 412
School climate, programs addressing, 480
Schwartz Center for Compassionate Healthcare, 468
Schwartz Center Rounds, 468
Science of compassion, 6–7, 12
conduct of, empathy-induced altruism and, 37–38
content of, empathy-induced altruism and, 36–37
origins of, 160
Scope-severity paradox, 262
Secondary traumatic stress (STS), 389
pathways to, 390–391, 391f
protection against, 393–394
Secular humanism, and compassion training, 220
Secure base, 401
and attachment, 81, 83, 96–97
Security
attachment and, 80
and caregiving
in romantic relationships, 83–85
to strangers, 85–87
contextual heightening of, and empathic response, 87
felt, 80, 360
Security priming
and caregiving
in romantic relationships, 84–85
to strangers, 86
and compassion, causal link between, 86–87
Selective investment theory, 161–163, 165, 167
Self, true vs. public, 361

689
Self-benefits, empathy-induced altruism and, 33
Self-care
characteristics of, 393
and compassion fatigue resilience, 390
for human service workers, 393, 395
and post-traumatic growth, 393
in SCT, 23
Self-compassion, 10–11, 95, 232, 411, 498
in adolescence, 153
age-related changes in, future research on, 381
and anxiety, inverse association of, 374, 381
assessment of, 500
benefits of, 374–375, 380–381, 498–499
CCT-related changes in, 244
childhood experiences and, 380
clinical implications, 380–381
and compassion fatigue resilience, 390
and coping, 374–375
cross-cultural differences in, future research on, 381
cultivation of
in CBCT, 21–22
in Cognitively Based Compassion Training, 248–250, 249t
definition of, 371
and depression, inverse association of, 374, 380–381
disadvantage of, 381
and eudaimonic well-being, 375
fear of, 499
and forgiveness, 378
future research areas, 381–382
gender differences in, future research on, 381
group differences in, future research on, 381
and healthier living, 376
and immune function, 376–377
induction of, 374, 376
inhibitors of, 409
and interpersonal relationships, 378
interventions, 374, 379
for specific clinical conditions, future research on, 382
lower, risk factors for, 380, 499
misgivings about, 375–379, 499
and motivation, 101, 375–376, 499
in older adults, 154
and other-focused compassion, 378–379
and parenting, 98–101
power of, 375
and psychological stengths, 375
and psychopathology, inverse association of, 374, 381
and relationship between leadership and social dominance orientation, 503
research on, 373–375
and resilience against negative emotions, 374–375
and self-esteem, differentiation of, 377, 498
and self-improvement, 101

690
 vs. self-pity, 378
and self-worth, 377–378
three facets of, 372–373
training in, 379–380. See also Mindful Self-Compassion (MSC) training
trait levels of
and Self-Compassion Scale score, 373
and well-being, 374
and well-being, 374–375, 382
Self-Compassion Scale (SCS), 101, 373–374, 500–501
Self-concept, development of, 153
Self-control [term], Americans’ use of, temporal trends in, 335, 338t
Self-criticism, 372, 376, 378, 409, 499
and psychopathology, association of, 374
Self-enhancement, temporal trends in, in U.S., 343t, 347
Self-esteem, 498
cross-cultural differences in, future research on, 381
and self-compassion, differentiation of, 377, 498
threat to, and caregiving, in romantic relationships, 85
Self-esteem [term], use of, temporal trends in, in U.S., 339t–340t, 344–345
Self-humanizing bias, 275–276
Self-interest, norm of, 489
Self-judgment, in Self-Compassion Scale, 373
Self-kindness
definition of, 372
in self-compassion, 372
in Self-Compassion Scale, 373
Self–other differentiation, 54–55
Self-pity, vs. self-compassion, 378
Self-preservation, xxii
Self-regulation, 9, 11
in children, and empathy-related responding, 57–60
physiological indices of, 57
Self-report measures, 5
Self-worth, self-compassion and, 377–378
Sensegiving, 446
Sensemaking
and organizational compassion, 437f, 438, 441f, 443t, 446–448
in organizations, leadership moves and, 441f, 443t
Sensitivity, of care provider, 82
Septum, lateral, and social behavior, 181
Serotonin, 9
Serotonin transporter, 148–149
Seven-Point Cause and Effect Method, 19, 22
Sexual competition, 407–408
Shamatha Project, 220–221, 224, 227
Shamatha Study, 11
Shambhala Mountain Center, 221
Shame, 99
external, 409
and inhibition of compassion, 409–410
internal, 409
Shantideva, 248

691
Silent Generation, definition of, 332
Similarity. See also Proximity
and empathy, 225, 300
to other, feelings of, and compassionate behavior, 294
Simpatia, 276
Six-C’s model, 346
Skutnik, Lenny, 33
Smoking cessation, self-compassion and, 376
Social and emotional learning, and compassion in education, 478–480
Social behavior
comparative neurobiology of, 180–181
empathy and, 303
evolution of, 81, 174–175
genetic evolution of, 81
mammalian, evolution of, 174–175
in rats, 175–176
sex differences in, neurobiology of, 181
Social bond(s), 161–163, 174–175
neurohormones and, 168
Social capital
in organizations, 428
temporal trends in, in U.S., 335
Social change, Greenfield’s theory of, 346–347, 346f
Social class. See also Socioeconomic status
and attentiveness to others, 318–320
and charitable giving, 323–324
and compassion, 8, 317–318, 320–325
differences in, 325–326
direct evidence linking, 321–323
future research areas, 325–327
motivations and, 326
mutability/sustainability of, 325–326
social context and, 325–326
and compassionate action, 323–325
and empathic accuracy, 320
lower
characteristics of, 319
psychological traits associated with, 319
and social behavior, 319–320
and objective resources, 318
psychology of, 318–320
and subjective rank, 318, 320
effects on compassion, 324, 326
upper
characteristics of, 318–319
psychological traits associated with, 319
and social behavior, 319–320
Social communication, 193, 196–197
Social connection
compassion and, 250
ecological variables and, 346
neural substrates of, 110–111

692
 temporal trends in, in U.S., 335, 338t
Social Darwinism, 160–161
Social dilemma
conditions for, 35
and empathy-induced altruism, 35–36
Social Dominance Orientation Scale (SDOS), 500
Social dominance orientation (SDO), 496–497
assessment of, 500
and compassion, negative correlations between, 502–503
group-focused, 412
high scorers
career choices of, 497–498
characteristics of, 496–497
fields of study selected by, 497–498
as leaders, 497
individual differences in, and leadership, various components of compassion mediating, 499–504, 501t
and intergroup empathy, 151
and leadership, negative correlations between, 502–503
and transformational leadership, mediation of, 499, 499f
Social engagement system, 194–196, 196f
contemplative practices and, 196–198
Social-evaluative processes, compassion training and, 224–225
Social functioning
compassion and, 11, 303–311
empathy and, 303–312
future research areas, 312
smooth, empathy/compassion and, 303–306
Sociality, in invertebrates, 177
Social justice
compassion and, 244–245
compassion training and, 117
Social psychology, 44, 210, 287
and brief interventions, 210
concept of compassion in, 288
and empathy-building interventions, 210, 213n2
Social rejection, stress reaction to, 168–169
Social relationship(s)
empathy-related processes and, 300f, 302
and health, 164–165, 168–169
and helping behavior, 167
motivation in, 163–164
Social skills, empathy/compassion and, 304
Social support
and compassion fatigue resilience, 390
in Compassion Fatigue Resilience Model, 391f, 393–394
definition of, 308
emotional vs. instrumental, 306–308
empathy/compassion and, 306–308
non-U.S. evidence, 308
and health, 164–165, 170n2
for human service workers, 395
organizational compassion and, 438, 498

693
 physiological effects of, 468
positive vs. negative, 306–307
Social transformation, heroes and, 490
Social workers. See Human service workers
Society, and community, 346–347
Socio-affective Video Task (SoVT), 112–113, 113f
Socio-cognitive skills, in children, 54–55
Sociocultural Appraisals, Values, and Emotions (SAVE), 9–10
Sociodemographic variables, changes in, Greenfield’s theory of, 346–347, 346f
Socioeconomic status. See also Social class
and compassion, 317
and compassionate responses, 268
and compassion collapse, 268
and expression of compassion, 276
and vulnerabilities of students, 476
Socioemotional functioning, 11
neurobiology of, 179–180, 184
Solidarity, 282
Somatosensory cortex, in compassion, 223
Song lyrics, American
other-focused, temporal trends in, 335, 338t
self-focused, temporal trends in, 341t, 345
Sorrow, 28
South Fore people (New Guinea), 47
Southwest Airlines, 449
compassionate culture of, 423
financial performance of, 431n2
Spencer, Herbert, xxi
Spirituality, and compassion, 42
Stakeholder theory, 163
Stanford Prison Experiment, 12
Stanford University. See Compassion Cultivation Training (CCT)
State(s)
altruism as, 36
compassion training and, 231–232
motivational, 29
State of the Union speeches
other-interest in, temporal trends in, 335, 339t
self-interest in, temporal trends in, 341t, 345
Status, and inhibition of compassion, 405–407, 410–411
Stearns, P., American Cool, 278
Stigmatized groups, attitudes toward
compassion training and, 144
empathy-induced altruism and, 32–33
loving-kindness meditation and, 225
Strategy(ies), 408
aggressive, 406, 406t, 408–409
attractiveness as, 406, 406t
social, 406, 406t, 408–409
Stress. See also Compassion stress; Post-traumatic stress disorder (PTSD)
adverse effects of, 121
biomarkers of, compassion training and, 223

694
 broaden-and-build response to, 8
buffering of
by Cognitively Based Compassion Training, 250–251
by helping, 362
compassion as antidote to, 21
definition of, 389
in illness, compassion and, 458
and mortality risk, 167
parents’, programs to reduce, 100
physiological effects of, 165–168, 361–362, 362f, 389, 468
compassion training and, 223
regulation of
importance of, 167
oxytocin in, 122, 165–166, 168, 177, 181, 254
social rejection and, 168–169
traumatic, 389. See also Secondary traumatic stress (STS)
Stress hormones, 121
Stress reduction
and health, 167
mindfulness-based, 220, 229
Stria terminalis, bed nucleus of, and social behavior, 180–181
Striatum
in compassion, 111, 113, 118, 223
dorsal, in parenting, 67
in feelings of love and social support, 111
ventral
in compassion, 118, 141
in parenting, 67
Student(s). See also College students
dropout rates, 475
exposure to violence, 475–476
high-risk behaviors among, 475
socioeconomic status of, and vulnerabilities, 476
suicide in, 476
vulnerabilities of, 475–476
well-being of, factors affecting, 475–476
Submissive behavior, 407, 411
Substance use disorder, maternal, 71, 73
Substantia nigra, in compassion, 111, 113–114
Suffering, 8. See also Perceived suffering
affective/motivational salience of, 230
all-pervasive, 42t, 43
appraisals of, and organizational compassion, 437f, 438, 441f, 443t, 446–448
awareness of, and compassion, 238
brain responses to, 109–110
in Buddhist thought, 43, 372, 403
of change, 42t, 43, 233
compassion as antidote to, 21–22
current, alleviation of, 44
definition of, 43, 440
engagement with, 400–403
enjoyment of, 412

695
 envisioning, in compassion meditation, 134, 134f, 135
explicit, 42t, 43
exposure to, in Compassion Fatigue Resilience Model, 391, 391f
expression of, in organizations, 436, 437f
leadership moves that affect, 440–442, 441f, 443t
future, prevention of, 44
global exposure to, 219
legitimizing, in organizations, 441f, 443t, 447–448
mass, and compassion, 265–266. See also Compassion collapse
neural sensitivity to, 11
organizational boundaries and, 435
in organizational contexts, 435–436, 437f
prevention of, 401
prolonged exposure to, in Compassion Fatigue Resilience Model, 391f, 392
reactions to, mindful attention to, in compassion meditation, 134, 134f, 135
responsiveness to
compassion training and, 223–224
factors affecting, 231–232
sensitivity to, 400–401
shared nature of, 372
signal detection to, 95
signal responsiveness to, 95
signals of, 44–45
subtle forms of, 232–233
typology of, 42–43, 42t
Suicide
physician-assisted, 388
in students, 476
Superior temporal sulcus, in compassion, 139
Survival of the fittest, xxi
Sustainable Compassion Training (SCT), 17, 20, 23–24, 477–479
science and, 24
Sweeney, Keiran, 462, 462b
Sympathetic nervous system (SNS), 9
and affect regulation, 97
evolution of, 193
moral elevation and, 126–127
Sympathy, 3, 5, 28, 44, 300, 302, 401–402
in children
individual differences in, 55
and prosocial behavior, 56
and compassion, overlap of, 53–54
cultural differences in, 275
definition of, 53, 332
parents’ modeling of, and children’s empathy-related responding, 59
and prosocial behavior, 53–55
Sympathy cards
American–German differences in, 279–280, 279f
and compassion, 282
Sympatia, 10

T
Temporal parietal junction (TPJ), 9

696
 in compassion, 139
in empathy, 151
Tenderness, 28
Tennyson, Alfred Lord, xxi
Thalamus, in parenting, 67
Threats
avoidance, 358–360, 364, 411
and inhibition of compassion, 411
Tightness–looseness, 10
Time
and changes in compassion-related variables in U.S., 331–348
spent alone, temporal trends in, in U.S., 342t, 347
Toddler(s)
empathy in, 54–55
prosocial behavior in, 54–55
Tolerance, temporal trends in, in U.S., 343t, 347
Tonglen meditation, 19, 22, 241
Tóngqíng, 5
Torture, 412
Touch
compassionate, culture and, 150
emotional, discrimination among, 276
in health care, 458
sympathetic, 276
Training. See also Compassionate mind training (CMT)
compassion, 10–11, 151, 207, 237, 403, 413, 477. See also Cognitively Based Compassion Training (CBCT); Compassion Based Cognitive
Training (CBCT); Compassion Cultivation Training (CCT); Compassion meditation (CM); Sustainable Compassion Training (SCT)
active control interventions and, 228–229
approaches to, 220
and appropriate action, 229–230
attention-based, 221, 224–226
benefits of, 477–478
brain and, 8–9, 110
Buddhist-derived, 220, 228
characteristics of, 220–222
and compassion, relationship between, 222–226
components of, 221–222
contemplative approaches, 219, 221, 226–227
context, and training effects, 228
vs. emotion-regulation strategies, 113–114
expert meditators and, 220, 229
future research areas, 228, 233, 244–245
length and intensity of, 220–221
mechanisms of change with, 226–229
mindfulness-based, 221, 226
models of, 478
multiple facets of, 220
neural and subjective effects, 114–116
neural responses to, 112–114
neuroscience of, 10, 111–114
non-contemplative elements, and outcomes, 227–228
novice/beginning meditators and, 220

697
 online tools and applications for, 220. See also Headspace
outcomes, 221–226
and positive leadership, 503–504
and prosocial behavior, 292–294
results interpretation, issues in, 229–230
social interactions in, and training effects, 228
and state vs. trait effects, 231–232
teacher-specific effects in, 228
trajectory of, 230–231
variations in, 220
emotion-recognition, 208t, 209, 209t
empathy-for-suffering, neural and subjective effects, 114–116
heroism, 490–491
kindness, 247
meditation, 151
in self-compassion, 379–380. See also Mindful Self-Compassion (MSC) training
Trait(s)
agentic, temporal trends in, in U.S., 339t, 344
altruism as, 36
and behavior, 295
communal, temporal trends in, in U.S., 339t, 344
compassion as, 4–6
compassion training and, 231–232
motivational, 29
other-focused, temporal trends in, in U.S., 333
self-focused, temporal trends in, in U.S., 339t, 344
Trauma
childhood
and self-compassion, 380
self-compassion interventions for, future research on, 382
students’ exposure to, 475–476
Trauma-informed care, 392
Traumatic memories, in Compassion Fatigue Resilience Model, 391f, 392
Tribalism, 412
Triggers, emotional, 45
Triple P (Positive Parenting Program), 71, 93–94
Trust
definition of, 334
temporal trends in, in U.S., 334, 336t
Tuning In to Kids, 101
Tzu Chi, 445

U
UCLA Loneliness Scale, 341t, 347
Unintended consequences, 29
United States
compassion-related variables in
decline in, counter-evidence to, 341t–343t, 347–348
ecological variables and, 345–346
future research areas, 348
historical trends in, 331–348. See also Historical trends
General Social Survey in, 334–335, 336t, 338t, 343t, 347
healthcare systems, problems in, 459

698
 multi-year surveys in, 333
Universal orientation, 44
University of Crete Medical Facility (Crete), 469
Upset, 28
Utilitarian decision-making
class differences in, 322, 327
and compassion, 327

V
Vagal activity
cardiac, 194–195, 224
isolation and, 180
and compassion, 190
moral elevation and, 126–127
rituals and, 191, 191t
and social behavior, 179–180, 182
Vagal brake, 194
Vagal circuits, 194
Vagal tone, 127, 182
Vagus nerve, 9, 179, 190, 193
in bidirectional communication, 193
dorsal motor nucleus of, 194
Values
group dynamics and, 212
other-focused, temporal trends in, in U.S., 333–334
self-focused, temporal trends in, in U.S., 340t, 344–345
Values in Action (VIA) Leadership Scale, 496, 500
Valuing, intrinsic, 30–31, 36
Vasopressin
actions of, 177
sex differences in, 181
behavioral effects of, receptor dynamics and, 178–179, 182–183
in compassion, 181
evolution of, 176
and oxytocin, interactions of, 177–178, 181–183
and social behavior, 180
and social traits and emotions, 173–174, 177–178
socioemotional functions of, autonomic nervous system and, 179–180, 184
and visceral nervous system, 179
Vasopressin receptor, 177–178
and behavioral effects of vasopressin, 178–179
in primates, 183
Vasotocin, 176
Vengeance, 412–413
Ventral tegmental area, 67
in compassion, 111, 113–114, 114f, 141
in parenting, 110
Vicarious experience, 6
Victim(s)
blaming, 32
compassion for, type of disaster and, 267
identifiable, and compassion collapse, 262
innocent, derogation of, 32

699
 number of, and compassion collapse, 261–262
statistical, and compassion collapse, 262, 267
suffering of, and punishment of transgressor, 288–289
as unified group, and compassion collapse, 263, 265
Video Interaction for Promoting Positive Parenting Programme, 71–72
Violence
power elites and, 410
students’ exposure to, 475–476
Virtue(s)
phasic, 425
tonic, 424–425
Virtuousness, 424
compassion as, 424
organizational, 424
measurement instrument for, 426
and organizational performance, 426–427
amplifying effects, 428
buffering effects, 428–429
exceptions to, 430
heliotropic effects, 429–430
in organizations, 424
through organizations, 424
Visceral nervous system, 194
and emotions, 179
Vocalization, neurophysiology of, 191, 191t, 192, 195–197, 200
Vocal signaling, 4, 44–45, 196–197, 200
Volunteerism
benefits of, 362
motivations for, 334, 362
and health benefits, 167
temporal trends in, in U.S., 334–335, 336t–337t
Volunteer programs, organizational sponsorship of, 423

W
Wealth, and inhibition of compassion, 405–406
Weiner, Jeff, 445–446
Welfare, other’s, intrinsic valuing of, 30–31, 36
Well-being
compassion and, 11, 17, 24, 288
compassion training and, 223, 503–504
dimensions of, 30
empathy-induced altruism and, 33
eudaimonic view of, 233
hedonic, 233
helping behavior and, 362
long-term, compassion and, 353–354
self-compassion and, 374–375, 382
of students, factors affecting, 475–476
Weltschmerz, 278
Whales, attitudes toward, empathy-induced altruism and, 33
Wilson, E. G., Against Happiness, 278
Winterbourne View, 458
Wisdom, in Buddhist thought and practice, 19

700
Wishing compassion. See Aspirational compassion
Women, suppression of, 408
Work
absence of, effects of, 435
as context for suffering, 435–436
as locus of identity, 435
Workplace, 12
social dominance orientation and, 497–498
Workplace distress, social dominance orientation of leaders and, 497
World Organization of Family Doctors (WONCA), definition of general practice/family medicine, 463–464

Y
Ygia Hospital (Limassol, Cyprus), 469–470
Yoga, in schools, 480
Youth Empowerment Seminar (YES! For Schools), 480
Youth Internet Safety Survey, 343t
Youth Risk Behaviors Survey, 342t

Z
Zimbardo, P., The Lucifer Effect, 491
Zurich Prosocial Game (ZPG), 116, 117f

701