The Integration of Compassion-Based Theory with ......–Paul Gilbert: “ Deep awareness of the...

The Integration of Compassion-Based Theory with Biofeedback Treatment

Urszula Klich, Ph.D.

Shepherd Pain Institute

Atlanta, Georgia

(678) 310-8228

(Urszula Klich, 2014)

Overview

Introduction Experience with complex medical problems

Unique considerations

Compassion and Meditation Protocols Meditation, and compassion protocols

How does biofeedback fit in

Teaching Breath for Life Case study

Compassion fatigue

Personal Practice

Global Compassion Movement The What, Why, and How

Charter for compassion


Bringing Compassion into Biofeedback Treatment

Biofeedback practitioners are in a prime position to bridge the gap of technology and wellbeing


What is Compassion?

• Definitions– Latin: “suffer with”– Merriam Webster: “sympathetic consciousness of others’ distress together

with a desire to alleviate it”– Paul Gilbert: “ Deep awareness of the suffering of oneself and other living

beings, coupled with the wish and effort to alleviate it” – Kristen Neff: Common humanity, kindness, and mindfulness

• Components– The common experience and interdependence– Historically strong associations with doing something to help


Why Compassion?

• Technology, consumerism, has radically changed how we live our lives, relate to others, and understand ourselves. It has become, not only de-centering, but rather dehumanizing.

• This generation: self centered or self preserving?

The bottom line:

People are starving for effective ways to live more consciously


Biofeedback, Mindfulness & Compassion: The Overlap

Biofeedback Entrain successive changes in performance Goal is to train self-awareness & skill

Mindfulness-Based Meditation Awareness Non-Judgement Acceptance

Compassion Use of awareness of self and other, interconnected and empathy


Mindfulness-Based Meditation

Growing scientific research

Reduction in negative mood states

Reduction in perceived pain

Increased immune response

Activation of left prefrontal cortex

Reduced thickening of amygdala


Compassion as a variable?

• Self-compassion has been found to be a major factor in the therapeutic benefit of mindfulness-based techniques

• Compassion mitigated stress reduction for health care professionals taking MBSR (Shapiro et al., 2005)

• Increased self-compassion reduced the correlation between cognitive reactivity and depression (Kuyken et al., 2010)


Meditation and Compassion Protocols

• Mindfulness Based:

– MBSR (Jon Kabat-Zinn, 1991)

– MBCT (Zindel Segal, Mark Williams, John Teasdale, 2002)

• Compassion Based:

– CBCT (Geshe Lobsang Tenzin)

– CFT (Paul Gilbert, 2010)

– MSC-(Kristin Neff and Chris Germer, 2012)

– Loving-Kindness (Sharon Salzberg, 1995)


CBCT Research

Lutz, Brefczynski foundCompassion meditation increases concern for others and enhances processing of emotion and response to distress (sounds of distress of others)The state of loving-kindness and compassion is described as an “unconditional readiness and availability to help living beings.”

Davidson et al. (2003) found left-sided anterior activation associated with happiness and increased antibody titers to a flu vaccine, translating into a stronger immune system response to vaccine.

Larose et al. (2010) found reduced perceived stress and burnout, nonsig trend in improvement in absenteeism and turnover , in a Heartmath transforming stress curriculum, 6hr training (4hr & 2hr f/u). N=83 (69%completed both training.)

Kupferschmidt, K. (2013). Tania Singer studies compassion and empathy, concentrating on kindness. Empathy does not imply we have the same emotions as others.


CBCT ongoing Research

Current Projects

CBCT in the community- Berkley 3rd round

Medical areas such as dermatology, autism

Children, woman’s center camp

Schools

Woman’s prison


Metta/Loving Kindness PracticeAbout “relearning loveliness”

The budStands for all things,Even for those things that don’t flower, For everything flowers, from within, of self blessing,Though sometimes it is necessaryto reteach a thing its loveliness,To put a hand on the brow Of the flower,And retell it in words and in touch,It is lovelyUntil it flowers again from within, of self-blessing

-Galway Kinnell


Metta/Loving Kindness Practice

• May I accept my pain, without thinking it makes me bad or wrong.• May I remember my consciousness is much vaster than this body.• May all those who have helped me be safe, be happy, be peaceful.• May all beings everywhere be safe, be happy, be peaceful.• May my love for myself and others flow boundlessly.• May the power of loving-kindness sustain me.• May I open to the unknown, like a bird flying free.• May I be free of danger, may I be peaceful.• May I be peaceful and happy, at ease in body and mind.• May I be free from anger, fear and worry.• May I live and die in ease.• May I accept my anger, fear and sadness, knowing that my vast

heart is not limited by them. (Reprinted with permission, Salzberg, 2008)


Compassion fits with Core Objectives of MBB

• Increase somatosensory awareness of bodily sensations/ feelings/thoughts

• Increase awareness of choice in responding to situations

• Relapse prevention for mood difficulty

• Promote acceptance of change in bodily functioning

• Facilitate integration of all aspects of the physical, cognitive, and emotional being


Bringing Compassion into the Treatment room

• Language– “Isn't it interesting”– Open to loving-kindness statements

• Emphasis – Understanding the journey– Use experiential learning to understand other’s struggles

• Homework– Assessment: Neff Self-Compassion Inventory– Physical and emotional discomfort is accompanied by

thoughts, which in turn often increase the discomfort– Observing gut and reactions to self-talk along with

biofeedback-driven goals will likely lead to more effective treatment outcome


Cultivation of Compassionate Attitude

• Acceptance• Non-judgment• Non-attachment • Beginner's Mind• Letting Go• Patience: compassion for self and others• Observation• Kindness• Noting of common experience• Interdependence


Compassion Fatigue: Signs Avoidance of activities or people

Self-doubt of ability to help

Secretly wishing clients don’t show up!

Irritability, anxiety, depression, or lassitude

Resenting co-workers or other people

Missing meetings or forgetting ordinary tasks

In short, not attending to those things you claim are your priorities

Decline in relationships, job performance or satisfaction,

Redirecting clients from emotional material to avoid your distress

Conflict about how much to work and when to call it a day

Thoughts of quitting or changing career


Compassion Fatigue: Contributing Factors Nature of the Work

Case load and type: Stress and pace of environment Perceived level of support by other colleagues or employers Dwindling resources- client’s needs vs system availability

Nature of the Client Clients often project intense negative feelings onto us They can be demanding and never satisfied Litigious Working with stress emotions

Nature of the Helper Work Satisfaction Healthy coping strategies Current life stressors Self and mental health, awareness


Compassion Fatigue to Compassion Growth

• Assess– Neff (2003) Self-Compassion Inventory

– Monitor fatigue and resilience- “Provider Resilience”

• Address– Self-Care VS Other-care balance

– Engage Self-Compassion Exercises

RELAX, RELATE, RELEASE


Simple Starting Points Incorporate during temperature checks

Quieting reflex

Hourly 3- second diaphragmatic breath break

Compassionate self-talk

Mindfulness of self-judgment in everyday tasks

How would I treat a friend with this issue

How would ____ treat themselves

In a sense get to the “yoga” of self care


Compassion Growth

Love your enemies video

http://www.youtube.com/watch?v=L0HhHLHLHaA


http://www.youtube.com/watch?v=L0HhHLHLHaA

Global Compassion Movement-What?

• Karen Armstrong (2008) was awarded the TED Prize for her work which allowed her to carry out her wish for a better world through starting the Charter for Compassion.

• The mission is to foster cultures of compassion locally and globally through diverse initiatives—education, cities, business, religious and spiritual communities, and the arts.


Global Compassion Movement- Why?

• Why Compassion

– Secular

– The heart of all

spiritual, religious,

and ethical practices


Can we track/map compassion?

http://charterforcompassion.org


http://charterforcompassion.org/

Charter for Compassion- Status

• Over 100,000 people have signed the charter

• 12 universities signed, 20 in process

• 40 cities have signed the charter for compassion

• 232 cities in 39 countries are actively organizing to become compassionate cities

• Close to 900 partners in several sectors (business, education, environment, healthcare, peace, religion, science, research, and soon to be announced in arts).

• Botswana- The world's first country to sign 12/12/3http://charterforcompassion.org


http://charterforcompassion.org/

Overall Goal

Help Yourself,

Help Patients&

Help Patients Help Themselves

And keep breathing…


Recommended Reading


Recommended Websites

http://www.compassion-training.org

http://www.compassionatemind.co.uk

http://www.self-compassion.org

http://www.mindfulselfcompassion.org

http://www.ronaldalexander.com/pdf/books/bookCh3.pdf

https://www.MyMindfulWayOfLife.com


http://www.compassionatemind.co.uk/

http://www.compassionatemind.co.uk/

http://www.self-compassion.org/

http://www.mindfulselfcompassion.org/

https://www.mymindfulwayoflife/

https://www.mymindfulwayoflife/

ReferencesAlexander, R. (2009). Wise Mind Open Mind: Finding Purpose and Meaning in

Times of Crisis, Loss & Change. New Harbinger Publications

Carlson, L. E. (2012). "Mindfulness-based interventions for physical conditions: A narrative

review evaluating levels of evidence." ISRN Psychiatry 2012: 21.

Chiesa, A., & Malinowski, P. (2011). Mindfulness-Based Approaches : Are They All the Same ?

Ã, 67(Mm), 404–425. doi:10.1002/jclp.20776

Davidson, R. J., Kabat-Zinn, J., Schumacher, J., Rosenkranz, M., Muller, D., Santorelli, S. F.,

Urbanowski, F., et al. (2003). Alterations in brain and immune function produced by

mindfulness meditation. Psychosomatic medicine, 65(4), 564–70. Retrieved from

http://www.ncbi.nlm.nih.gov/pubmed/12883106

Desbordes, G., Negi, L. T., Pace, T. W. W., Wallace, B. A., Raison, C. L., & Schwartz, E. L.

(2012). Effects of mindful-attention and compassion meditation training on amygdala

response to emotional stimuli in an ordinary, non-meditative state. Frontiers in human

neuroscience, 6, 292. doi:10.3389/fnhum.2012.00292

Epstein, M. (1998). Going to Pieces Without Falling Apart. New York: Broadway Books.

Grossman, P., L. Kappos, H. Gensincke, M. D’Sousa, D. C. Mohr I. K. Penner, and C. Steiner.

(2010). MS quality of life, depression, and fatigue improve after mindfulness training: a

randomized trial. Neurology 75(13): 1141–49.


ReferencesFehr, B. and Sprecher, S. (2009) Compassionate Love: Conceptual, Measurement, and Relational

Issues, in The Science of Compassionate Love: Theory, Research, and Applications (eds B.

Fehr, S. Sprecher and L. G. Underwood), Wiley-Blackwell, Oxford, UK.

doi: 10.1002/9781444303070.ch2

Germer, C. K. (2009). The mindful path to self-compassion: Freeing yourself from destructive

thoughts and emotions.New York: Guilford Press.

Gilbert, P. (2009). The compassionate mind. London: Constable.

Holzel, B. K., J. Carmodyy,M. Vangel, C. Congleton, S. M. Yerramsetti, T. Gard, and S. W. Lazar,

2011. Mindfulness practice leads to increases in regional gray matter density. Psychiatry

Research Neuroimaging 191(1): 36–43.

Kabat-Zinn, J. (1990). Full catastrophe living: Using the wisdom of your body and mind to face

stress, pain and illness. New York: Delacorte.

Kabat-Zinn, J. (2011). Some reflections on the origins of MBSR, skillful means, and the trouble

with maps. Contemporary Buddhism, 12(1), 281–306. doi:10.1080/14639947.2011.564844

Khazan, I. Z. (2013). The clinical handbook of biofeedback: A step-by-step guide for training and

practice with mindfulness. John Wiley & Sons.

King, M., Welch, W. M., Bacon, J. (2013, August 22). Dramatic 911 call in Ga. school shooting

incident released. USA Today. Retrieved from http://www.usatoday.com/story/news/nation/

2013/08/21/decatur-georgia-michael-brandon-hill-school-shooting/2680407/


ReferencesKlatt, M. D., Buckworth, J., & Malarkey, W. B. (2009). Effects of low-dose mindfulness-based

stress reduction (MBSR-ld) on working adults. Health education & behavior : the official

publication of the Society for Public Health Education, 36(3), 601–14.

doi:10.1177/1090198108317627

Kupferschmidt, K. (2013). Neuroscience. Concentrating on kindness. Science (New York, N.Y.),

341(6152), 1336–9. doi:10.1126/science.341.6152.1336

Lang, A. J., Strauss, J. L., Bomyea, J., Bormann, J. E., Hickman, S. D., Good, R. C., & Essex, M.

(2012). The Theoretical and Empirical Basis for Meditation as an Intervention for PTSD.

Behavior Modification.

LaRose, A., Danhauer, S. C., Feldman, J., Evans, G. W., & Kemper, K. J. (2010). Brief stress-

reduction training in an academic health center. Journal of alternative and complementary

medicine (New York, N.Y.), 16(9), 935–6. doi:10.1089/acm.2010.0338

Lutz, A., Brefczynski-Lewis, J., Johnstone, T., & Davidson, R. J. (2008). Regulation of the neural

circuitry of emotion by compassion meditation: effects of meditative expertise. PloS one,

3(3), e1897. doi:10.1371/journal.pone.0001897

K. D. Neff, “Test how self-compassionate you are,” in Self-Compassion, 2009, http://www.self-

compassion.org/test-your-self-compassion-level.html.

Negi, L.T (n.d.) A Manual for Cognitively-Based Compassion Training. Unpublished Manuscript.

Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation

of a short form of the Self-Compassion Scale. Clinical Psychology & Psychotherapy. 18,

250-255.


ReferencesReiner, K., Tibi, L., & Lipsitz, J. D. (2013). Do Mindfulness‐Based Interventions

Reduce Pain Intensity? A Critical Review of the Literature. Pain Medicine, 14(2), 230-242.

Salzberg, S. (2008). The Kindness Handbook: A Practical Companion (p. 208). Sounds True, Incorporated.

Saunders, N. (2013). Beyond Civility: Growing compassionate Love in Communities. YMCA.

Schwartz, M. S., & Andrasik, F. (2003). Evaluating research in clinical biofeedback. In F. Andrasik & M. S. Schwartz (Eds.), Biofeedback A practitioners guide 3rd ed.(pp. 867-880). Guilford Press.

Shapiro, S.L., Carlson, L.E. et al. (2006). Mechanisms of Mindfulness. Journal of Clinical Psychology, 62 (3): 373-386.

Sherman, R. A. (2012). Pain: Assessment & Intervention From a PsychophysiologicalPerspective (2nd ed., p. 412). Association for Applied Psychophysiology and Biofeedback.

Singer, T. (2013). Concentrating on Kindness. Science, 341(September), 1336–1339.Zaichkowsky, Kamen. (1978). Biofeedback and Meditation: Effects on Muscle Tension

and Locus of Control. Perceptual Motor Skills, June(46), 955–958.


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