Neuroscience, compassion, and the heart of Acceptance and Commitment Therapy

Reno 2010

Benjamin Schoendorff MSc benjamin.schoendorff@gmail.com

Compassion (Wikipedia)(from Latin: "co-suffering") is a virtue — one

in which the emotional capacities of empathy and sympathy (for the suffering of others) are regarded as a cornerstone of greater social interconnectedness and humanism

Functional definition?define compassion by its consequences

Neuroscience and compassionConceptual issuesIdentify the neural signature of

compassion?Possible functions:

Train compassion in novel ways (neurofeedback)

Discriminate ‘real’ vs ‘false’ compassion?…

What if what determines compassion are its social functions ?

The trap…

How can I even be talking about this…What do I really know about

compassion ?Who am I to speak of

compassion ?.....

Here comes the judging mind…

Worse trap yet…

How can I even speak of neuroscience and compassion ?

I’m incompetent and in about 5 seconds, they’ll all realize what an idiot I am!

Self-referenceNegative emotionsPositive emotionsReward learning

Meanwhile at the neuro level…

Here’s my mPFC when I form judgments about myself (freely derived from Overwalle 2009)

I’ll bet my brain images and animations will make them think I know my stuff!

I’m an incompetent fool and I’m so nervous I’ll never get to the end of this talk

Self-referenceNegative emotionsPositive emotionsReward learning

Clinically what have we learned?

My therapy’s good becauseit lights up the right areas…Hey what if I could train

activation in these regions?

I have these two metaphors…The brain as a muscle, compassion as tennisAre Federer’s right arm muscles the source

of his killer forehand?What if we could train the

exact same musclestructure andactivation patternsin a non tennis player ?

Training the activationWhat if I could train this muscle through

biofeedback (and no tennis experience)…

Will this make a better player? Or this?...

Discriminating the good playerThis?

The physical shape of the activation?

Discriminating the good playerOr this ?

The act in context (as socially defined AARR)

What of compassion?Does it look more like this ?...

Compassion as meditation

Form or function?Personal or

interactive practice?

For social pain produces more activation in regions

involved in homeostatic regulation : ACC, AI, HT

For physical pain produces more activation in regions

related to the musculoskeletal system : PI, LPC (inc SMG) SPL

In the brain, compassion…

(Innordinno-Yang et al. 2009)

And in our lives…Does it look more like this ?

But can you have compassionwith no social interaction?

=compassion?

✚

Limits of compassion

Necessary to connect and make room

Perhaps not enough to make

progress

Barriers to compassion

ACT / RFT perspective :Part of the normal functions of the

mindBuilt into human languageJudging, comparing, finding

wanting, self and othersNo compassion without self-

compassion…

Self-compassion1. Self-kindness – being kind and understanding

toward oneself in instances of pain or failure (acceptance) rather than being harshly self-critical (defusion)

2. Common humanity – perceiving one's experiences as part of the larger human experience rather than seeing them as separating and isolating (perspective taking)

3. Mindfulness – holding painful thoughts and feelings in balanced awareness (present moment, acceptance) rather than over-identifying with them (defusion) (Neff 2003)

Toward compassion

No genuine compassion without self-compassion… these are two sides of the same coin

To train the repertoire, therapists must have it

Compassionately making room for their own suffering and fully feeling their wish to alleviate suffering

Compassion, acceptance and defusion

Training compassion toward the judgmental self talk

Defusing from self and other judgments

Taking perspectiveMaking room for difficult thoughts and

feelingsMoving in valued directions, as ‘the

person I’d like to be’

At last some data!

Anxiety and Mindfulness self-help book studyRCT vs waitlist 109 vs 187 50% in tx

BAI from (d =.71) BDI (d=.89) Penn State worry (d = .72) Fear of fear (d = .67) Social anxiety (d =.43)

Process measures: MAAS (d = .55) increase from low up to average WBSI (d = .44) cut off of 53. From 58 to 47 d = .44 BAFT (John’s lab measure) (d = 1.17) from 80 to 45 (cutoff at 51). AAQ9 (d = .81) from clinical to normal SCS (Neff’s Self-Compassion scale) : (d = 1.29 ) QOLI (d = .71) from below 0 to 1.5

Better yet some mediational data!Anxiety and Mindfulness self-help book studyRCT vs waitlist 109 vs 187 50% in txMediators for:For BAI : suppression and

fusion were the significant mediators

For BDI : AAQ, self-compassion, WBSI and fusion (but not mindfulness as per MAAS)

For QOL flexibility, self-compassion, defusion.

Conclusion

Compassion lies at the heart of the ACT model

Brain pictures are interestingFrom a clinical point of view:

compassion and self compassion are still more usefully seen functionally and in terms of trainable behavioral repertoire rather than brain activation patterns