Peer-Reviewed CCARE Articles

Bayley, P.J., Schulz-Heik, R.J., Tang, J.S., Mathersul, D.C., Avery, T., Wong, M., Zeitzer, J.M., Rosen, C.S., Burn, A.S., Hernandez, B., Lazzeroni, L.C., & Seppälä, E.M. (2022). Randomised clinical non-inferiority trial of breathing-based meditation and cognitive processing therapy for symptoms of posttraumatic stress disorder in military veterans. BMJ Open. doi:10.1136/bmjopen-2021-056609

Post-traumatic stress disorder (PTSD) is a debilitating condition that can develop after exposure to a traumatic event. Symptoms include re-experiencing, avoidance, negative alterations in cognition and mood, and increased arousal and reactivity. The lifetime prevalence of PTSD is estimated at 24.5% in veteran populations. Veterans Affairs (VA)/Department of Defense (DoD) clinical practice guidelines recommend evidence-based, trauma-focused therapies including prolonged exposure therapy, cognitive processing therapy (CPT) and eye movement desensitisation and reprocessing as first-line treatments for PTSD. These therapies typically show large effect sizes (>1.0). However, up to two-thirds of individuals retain a PTSD diagnosis post treatment and dropout is a significant problem. Other treatments are urgently needed, and there are compelling reasons for considering complementary and integrative health (CIH) modalities such as yoga and meditation.

CIH interventions can be effective, less stigmatising and are popular. However, a review of the literature reveals several limitations: small–medium effect sizes and methodological concerns regarding controls, small sample sizes, randomisation, blinding and reporting. More high-quality, well-controlled studies are needed.

Mathersul, D.C., Tang, J.S., Schulz-Heik, R.J., Avery, T.J., Seppala, E.M., & Bayley, P.J. (2019). Study protocol for a non-inferiority randomised controlled trial of SKY breathing meditation versus cognitive processing therapy for PTSD among veterans. BMJ. doi: 10.1136/bmjopen-2018-027150

Post-traumatic stress disorder (PTSD) is a debilitating, highly prevalent condition. Current clinical practice guidelines recommend trauma-focused psychotherapy (eg, cognitive processing therapy; CPT) as the first-line treatment for PTSD. However, while these treatments show clinically meaningful symptom improvement, the majority of those who begin treatment retain a diagnosis of PTSD post-treatment. Perhaps for this reason, many individuals with PTSD have sought more holistic, mind–body, complementary and integrative health (CIH) interventions. However, there remains a paucity of high-quality, active controlled efficacy studies of CIH interventions for PTSD, which precludes their formal recommendation.

Scarlet, J., Altmeyer, N., Knier, S., & Harpin, R. E. (2017). The effects of Compassion Cultivation Training (CCT) on health-care workers. Clinical Psychologist, 21, 116–124. doi:10.1111 /cp.12130

The main objective of this pilot study was to investigate the effects of the Compassion Cultivation Training (CCT) on various aspects of burnout and job satisfaction in health-care workers. Specifically, this study sought to investigate whether CCT reduces work-related burnout, interpersonal conflict, as well as increases of mindfulness, compassion toward the self, fears of compassion, and job satisfaction scores.

Jazaieri, H., McGonigal, K., Lee, I. A., Jinpa, T., Doty, J. R., Gross, J. J., & Goldin, P. R. (2017). Altering the trajectory of affect and affect regulation: The impact of compassion training. Mindfulness. Advance online publication. doi: 10.1007/s12671-017-0773-3

Investigators examined the effects of a compassion training program on affect and affect regulation by implementing a 9-week compassion cultivation training (CCT) program and analyzing four affective states (anxiety, calm, fatigue, alertness) as well as the desire and capability to regulate them. Daily trajectories showed a general decrease in anxiety and an increase in calmness, likely due to participants tending to choose acceptance of the affective experience, regardless of whether they were negative or positive. At the same time, participants also reported more capability in meeting their goals for affective regulation. Over the course of the training program, participants reported greater acceptance in the face of stress and/or anxiety.  Implications for the effects of compassion training programs on affective regulation and self-efficacy are discussed.

Seppala, E. M., Simon-Thomas, E., Brown, S. L., Worline, M. C., Cameron, C. D., & Doty, J. R. (2017). The Oxford Handbook of Compassion Science. Oxford University Press. doi: 10.1093/oxfordhb/9780190464684.001.0001

The first of its kind, this handbook is dedicated to the rapidly growing, evidence-based literature on compassion, altruism, and empathy. Contributed by experts and organized by themes, each chapter presents a multidisciplinary and systematic approach to include basic and clinical research as well as grounded theories and multiple perspectives to understanding the neurobiological, developmental, evolutionary, social, and clinical applications of compassion science. Bridging gaps among multiple disciplines, this handbook will serve as a valuable reference to further build upon and understand the foundation of compassion science to guide basic and applied research.

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Genevsky, A., & Knutson, B. (2015). Neural affective mechanisms predict market-level microlending. Psychological Science, 26(9), 1411-1422. doi:10.1177/0956797615588467

Researchers investigate the neural mechanisms in which microloans receive approval based on the elicitation of positive affect by applicant’s photographs in two separate studies: one internet and the other a neuroimaging study. The internet study showed that positive affect in applicant photographs promoted loan success. The neuroimaging study further extended the internet findings by showing lender’s active regions in the brain where positive emotions are closely associated with, the nucleus accumbens, as well as self-reported positive affect by lenders who approved loans for those applicants who had high ratings of eliciting positive emotions. Implications for the role of affective neuroscience in microlending success and market-level behaviors are discussed.

Jazaieri, H., Lee, I. A., McGonigal, K., Jinpa, T., Doty, J. R., Gross, J. J., & Goldin, P. (2015). A wandering mind is a less caring mind: Daily experience sampling during compassion meditation training. Journal of Positive Psychology. doi:10.1080/17439760.2015.1025418 

The effects of the Compassion Cultivation Training (CCT) program, a 9-week, twice daily compassion meditation, was found to reduce mind wandering towards neutral thoughts and increased caring behaviors for oneself. Further path analysis indicated that compassion meditation was associated with reduced mind wandering for unpleasant thoughts and increased mind wandering to pleasant thoughts, and that both were associated with increased caring behavior for oneself and others. This is the first known study to lend partial support that formal compassion training reduces mind wandering while increasing caring behavior not only for oneself but also for others.

Neff, K. D., & Seppala, E. M. (2016). Compassion, well-being, and the hypoegoic self. In K. W. Brown & M. Leary (Eds.), Oxford Handbook of Hypo-egoic Phenomena. Theory and Research on the Quiet Ego (pp. 189-202). Oxford University Press.

Seppala, E. M., Hutcherson, C. A., Nguyen, D. T. H., Doty, J. R., & Gross, J. J. (2014). Loving-kindness meditation: A tool to improve healthcare provider compassion, resilience, and patient care. Journal of Compassionate Healthcare. doi:10.1186/s40639-014-0005-9

Stress and burnout is prevalent in the healthcare industry. Numerous research focused on reducing these strains on healthcare professionals can be time-consuming and intensive. Thus, this study sought to investigate the effectiveness of a short, 10- minute compassion-inducing intervention, lovingkindness meditation (LKM), to attempt to address this obvious disconnected need for a short, non-intensive, and effective intervention. LKM was compared to a positive affect induction (self-focus) and a neutral control condition. Ten minutes of LKM showed increased explicit as well as implicit levels of well-being and feelings of social connection to others and decreased focus on the self. Implications for decreasing burnout and improving patient care is discussed.

Martin, D., Seppala, E., Heineberg, Y., Rossomando, T., Doty, J., Zimbardo, P., Shiue, T.-T., Berger, R., & Zhou, Y. Y. (2015). Multiple facets of compassion: The impact of social dominance orientation and economic systems justification. Journal of Business Ethics, 129(1), 237-249. doi:10.1007/s10551-014-2157-0

Social Dominance Orientation (SDO) is a hierarchical worldview that ascribes people to social rankings and is often found in high levels among business school students. To establish the relationship between individual differences in compassion, SDO, and free ESJ (Economic Systems Justification), partial correlations were run controlling for social desirability to response bias. As anticipated, a significant correlation between ESJ and SDO was established. Significant correlations between SDO and low levels of Self-Compassion supported the hypotheses that those with higher levels of SDO have lower levels of self-compassion.