Motivation and emotion/Book/2022/Compassion
What is compassion, what are its pros and cons, and how can it be fostered?
Overview[edit | edit source]
There is much debate as to what compassion means, what the advantages and disadvantages of showing compassion are, and how compassion can be fostered. In this chapter, compassion is defined as an emotion expressed in reaction to the suffering or low well-being of others (Nussbaum, 2003). People are compelled to show compassion or withhold it based on the perceived seriousness of a situation (Nussbaum, 2003). The more serious a situation, such as the death of a loved one, the more likely an individual is to show compassion (Nussbaum, 2003). According to Charles Darwin, compassion is said to have evolutionary origins in primates (Gilbert, 2020). Primates that had the largest number of sympathetic individuals thrived and reproduced the most offspring (Gilbert, 2020). There are also evolutionary benefits of compassion in humans, with prosocial behaviour studies finding that being motivated to care, and showing self and radical compassion has benefits on physiological, psychological and social processes (Gilbert, 2015). SEVERAL AREAS OF THE BRAIN ARE ACTIVATED THROUGH COMPASSION etc. (brief).
The pros of showing compassion outweigh the cons when compassion is exercised in the right circumstances. The literature has shown that compassion can foster healing, compassion satisfaction, emotional connections and shared positive emotions (Dutton et al., 2014). However, when compassion is not exercised correctly (see case study 2), moral distress and compassion fatigue can occur (Dunn, 2019; Nussbaum, 2003; Sabo, 2014). There are many ways of fostering compassion to ensure that it is exercised at the appropriate times. These include mindful self-compassion, cognitively based compassion training, and compassion cultivation training (Cole et al., 2012; Germer & Neff, 2019; Kirby, 2017).
What is compassion?[edit | edit source]
There are many definitions of compassion, with the main ones stemming from Richard Lazarus and Jennifer Goetz et al. What Lazarus' and Goetz' definitions have in common is that compassion involves being affected by another person's suffering, having the desire to help them, and taking action to help them (Baer et al., 2016). In this chapter, we will be referring to a more detailed definition of compassion. As mentioned in the overview, compassion is an emotion expressed in reaction to the suffering or low well-being of others (Nussbaum, 2003). It involves making a judgement, known as the judgement of seriousness, that someone is not coping well and that the situation is serious (Nussbaum, 2003). Therefore, compassion is not felt for people who lose insignificant items, such as a pair of socks or a hairbrush (see case study 1).
There are two main types of compassion:
Radical compassion, otherwise known as compassion for others, involves showing compassion to other people, through acknowledging their pain and coming up with a solution to relieve it (Cherry, 2021).
Self-compassion involves showing compassion to yourself in suffering and perceived inadequacy (Cherry, 2021). In Kathryn Stockett's novel 'The Help,' which was later adapted into a film, an African-American nanny whispers to the little girl she is babysitting: "You is kind, you is smart, you is important" (2009, p. 443). This was a simple, yet caring way to encourage self-compassion in this young girl.
What is the difference between compassion and empathy?
People can often become confused between the terms compassion and empathy. Empathy involves feeling what others are feeling and desiring to help them (Zimmer, 2019). Compassion involves a deep concern for others, a desire to help, AND taking action to help the person (Zimmer, 2019). While empathy and compassion both involve sharing the feelings of others and desiring to help them, compassion also involves taking action to help them (Zimmer, 2019).
Case Study 1:
|The following case study demonstrates the judgement we make when choosing whether to show compassion based on the seriousness of a person's suffering.
Case Study: Samantha is feeling down because she has lost her scrunchie. Samantha has other scrunchies that she can use and her lost scrunchie has no personal significance to her. Samantha's roommate, Alice, evaluates the situation and decides that although Samantha is upset, she is not seriously affected. Therefore, Alice shows understanding of the loss but chooses not to show compassion.
Compassion theories[edit | edit source]
There are many theories surrounding why people show compassion, with the main ones being the emancipatory theory of compassion, the theory of compassion energy, and the theoretical model of self-compassion. These theories centre around nursing occupations, but are applicable to many occupations and everyday situations.
The emancipatory theory of compassion[edit | edit source]
Dr. Jane Georges coined the emancipatory theory of compassion, believing that suffering is universal, and can therefore be relieved through showing compassion (Constantinides & Georges, 2022). Georges viewed compassion as going further than having good thoughts or being kind (Constantinides, 2019). She believed it was an active consciousness that involved being mindful of others and having a tendency to connect with them (Constantinides, 2019). In her theory of compassion, Georges identifies several key characteristics of compassionate behaviour:
- Acknowledging the uniqueness and spirituality of others
- A willingness to understand
- An ability to genuinely listen
Mindfulness in particular can be used to establish meaning and thoughtfulness in reaction to human needs (Constantinides, 2019). As a nurse theorist, Georges also believed that nurses have the ethical responsibility to advocate for social justice and human rights (Constantinides, 2019). However, nurses, whether conscious of their actions or not, can create surroundings where suffering is sustained due to a lack of compassion (Constantinides & Georges, 2022). As a way of rectifying this, Georges proposes a Buddhist perspective of reflecting on one's own suffering and the suffering of others and how best to alleviate it (Constantinides, 2019).
The theory of compassion energy[edit | edit source]
Compassion energy was proposed by Martha Rogers based on her Science of Unitary Beings and Caring Science theories work (Dunn, 2019). Martha's theory involves caregivers or nurses who have a desire to provide compassionate care by intentionally getting to know the person they are caring for through being there for them and nurturing them (Dunn, 2019). When nurses and carers engage in a nurturing way with patients, they become energized and focused on meeting the needs of their patients (Dunn, 2019). This energy is referred to as compassion satisfaction and it results in positive outcomes for both the carer and the patient (Dunn, 2019). Compassion then becomes the driving force or energizer for caring (Dunn, 2019). However, compassion energy fades when a nurse or caregiver distances themselves from a patient in an attempt to protect themselves from the experiences of the patient (Dunn, 2019). This places the nurse or caregiver at risk for compassion fatigue, as they are no longer experiencing compassion satisfaction (Dunn, 2019). Martha believes it is key for nurses and carers to maintain compassion, not only for the health of their patients, but also for their own health (Dunn, 2019).
Theoretical model of self-compassion[edit | edit source]
This model was proposed by Kristin Neff and involved self-compassion consisting of three groups of contrasting components: emotional responsivity, attention to personal suffering, and cognitive understanding (Neff et al., 2020). Emotional response is made up of self-kindness vs. self-judgement, attention to personal suffering is composed of mindfulness vs. overidentification and cognitive understanding consists of isolation vs. common humanity (Neff et al., 2020). These contrasting components interconnect as a system and can be measured individually or all together to make a total score (Neff et al., 2020). This is called the Self-Compassion Scale. The Self-Compassion Scale comprises of 80 items, with 11-15 items in each subscale (Neff et al., 2020). These items comprise the six compassion components (kindness, indifference, mindfulness, separation, common humanity, and disengagement) (Neff et al., 2020). When completing the scale, one would indicate from 1 (almost never) to 5 (almost always) how frequently they felt or behaved in a certain way, according to the statement presented (see Table 1).
A sample of the Self-Compassion Scale Questions (adapted from Neff et al., 2020).
|Kindness||If I see someone going through a difficult time, I try to be caring toward that person.|
|Kindness||I like to be there for others in times of difficulty.|
|Common Humanity||It’s important to recognize that all people have weaknesses and no one’s perfect.|
|Common Humanity||Suffering is just a part of the common human experience.|
|Mindfulness||I notice when people are upset, even if they don’t say anything.|
|Mindfulness||I tend to listen patiently when people tell me their problems.|
|Indifference||I don’t concern myself with other people’s problems.|
|Indifference||When others are feeling troubled, I usually let someone else attend to them.|
|Separation||I can’t really connect with other people when they’re suffering.|
|Separation||I don’t feel emotionally connected to people in pain.|
|Disengagement||I don’t think much about the concerns of others.|
|Disengagement||I try to avoid people who are experiencing a lot of pain.|
What is compassion?
What are the pros of compassion?[edit | edit source]
There are many pros of exercising compassion, and they are said to outweigh the cons if compassion is exercised in the right situations. When compassion is exercised in inappropriate situations, such as during a non-serious situation, moral distress can occur. This concept will be discussed later in the chapter.
Healing[edit | edit source]
When an individual shows compassion, the receiver often experiences feelings of healing (Dutton et al., 2014). This healing is not only psychological (such as healing from grief), but can also be physiological (healing from illness or harm) (Dutton et al., 2014). Compassion can help reduce anxiety, and increase positive emotions such as gratitude (Dutton et al., 2014). Attachment theorists suggest that experiencing compassion from another person can reactivate the receivers attachment system and stimulate the healing process (Gilbert, 2018). Research surrounding attachment has found mammals sympathetic and parasympathetic nervous systems have modified over time (Gilbert, 2018). This has allowed mammals to form close relationships and recognise the importance of compassionate behaviour in soothing and decrease perceived threat (Gilbert, 2018). Soothing and healing from threatening situations occurs when oxytocin is released, generating feelings of trust and affiliation (Gilbert, 2018).
Self-compassion can also have healing effects in difficult situations or when experiencing challenging emotions (Gilbert, 2018). People who have experienced bullying, abuse and neglect often deal with trauma through feeling ashamed or criticizing themselves (Gilbert, 2018). By exercising self-compassion, often through compassion-focused therapy, individuals can heal from their past trauma and learn to be kind to themselves (Gilbert, 2018). Compassion-focused therapy targets a person's social safeness/soothing system, as people who find it hard to exercise self-compassion find it hard to access this system (Gilbert, 2018). These people also experience a heightened threat protection/drive system due to feeling shameful and self critical (Gilbert, 2018).
Compassion satisfaction[edit | edit source]
Compassion satisfaction occurs when a person continuously shows compassion to others, and experiences a deep sense of satisfaction due to being kind and understanding (Dutton et al., 2014). As well as satisfaction, an individual can also experience an improved prosocial identity, where they view themselves as caring (Dutton et al., 2014). Stamm and Figley developed a Compassion Fatigue/Satisfaction Self-Test (CFS) to measure levels of compassion satisfaction and fatigue (Stamm, 2002). The test contained 66 questions measuring an individuals happiness levels, life satisfaction, ability to cope with traumatic events, levels of compassion, and their ability to help others (Stamm, 2002). Participants would use a Likert Scale to rate themselves either a 0 (never), 1 (rarely), 2 (a few times), 3 (somewhat often), 4 (often) or 5 (very often) (Stamm, 2002). Participants were instructed to mark an x next to certain questions which measued compassion satisfaction (Stamm, 2002). If participants scored 118 or above, they were said to have an extremely high potential for compassion satisfaction (Stamm, 2002). Scores from 117-100 were considered high potential, scores from 99-82 were considered good potential, scores from 81-64 were considered modest potential, and scores below 63 were considered low potential (Stamm, 2002). However, it is important to note that due to this scale being a self-report measure, there is likely to be response biases such as social desirability bias, where a participant will answer in a way that makes them look desirable (e.g. scoring themselves high on positive traits such as happiness).
[edit | edit source]
Research suggests that compassion connects people psychologically and generates a stronger emotional connection (Dutton et al., 2014). This stronger connection may be due to the fact that compassion generates trust (Dutton et al., 2014). Alternatively, if an individual consistently shows compassion to another person, but does not receive it in return, this may result in status differences or relational inequalities (Dutton et al., 2014).
Compassion also generates shared positive emotions such as gratefulness and joy (Dutton et al., 2014). Compassion has also been found to improve collaboration in the workplace (Dutton et al., 2014). Shared emotions and connectedness can also increase mindfulness (Neff, 2003). Mindfulness generates an increased awareness of one's emotions, as well as the emotions of others which can help in developing compassion (Neff, 2003). Mindfulness also reduces the chance of criticism and increases understanding of other's situations (Neff, 2003). Abraham Maslow believed in the importance of mindfulness and assisting people to acknowledge their suffering as a key motivator for growth (Neff, 2003). He believes we have a fear of knowing ourselves, our thoughts, feelings, impulses and memories in order to protect our self-esteem (Neff, 2003). However, by encouraging others to show self-compassion during suffering allows them to increase their self-understanding (Neff, 2003). This generates 'B-perception' which is a forgiving, loving acceptance of oneself (Neff, 2003).
What are the cons of compassion?[edit | edit source]
If compassion is exercised in the wrong situations, moral distress and compassion fatigue can occur. Fortunately, there are ways of reducing the chance of moral distress or compassion fatigue, mainly through compassion training which teaches an individual when it is appropriate to show compassion and how to be more compassionate towards oneself and others.
|Note: We need to have a balance of providing compassion, but also receiving compassion ourselves to mitigate the cons of displaying compassion.|
Moral distress[edit | edit source]
Moral distress occurs when someone is considering showing compassion, but is unable to take the right action, does not effectively relieve others' suffering, or experiences secondary trauma or impairment resulting from extensive exposure to another person's suffering (Dutton et al., 2014). Moral distress can also occur when an individual shows compassion in a situation that does not require compassion, or when an individual withholds compassion when it is needed (Nussbaum, 2003). In this situation, the person has wrongly determined the judgement of seriousness, placing great importance on the wrong situations and not enough importance on significant situations (Nussbaum, 2003).
Moral distress is particularly prominent in healthcare occupations, especially nursing (Whitehead et al., 2014). A study by Whitehead et al., 2014 used the Moral Distress Scale-Revised (MDS-R) to measure moral distress in healthcare professionals. The MDS-R consists of 21 items measuring moral distress and uses a Likert Scale from 0-4 based on how often a situation occurs and how distressing the situation is when it happens (Whitehead et al., 2014). These scores are multiplied, then added to generate a total score from 0-336, where 0 suggests no moral distress and 336 suggests high moral distress (Whitehead et al., 2014). Nurses and direct care providers scored the highest on perceived moral distress (Whitehead et al., 2014).
Morley and colleagues (2021) conducted a literature review and found that the main interventions for minimizing moral distress included education programs, supervised discussions, consultations with a specialist, self-reflection and journaling. This shows that through understanding the roots of moral distress, interventions can be put in place to minimize the risk of mental distress. These interventions can also help with managing existing moral distress.
Case Study 2:
|The following case study demonstrates the moral distress felt when too much importance is placed on situations that don't require compassion.
Case Study: Samantha has lost another item, this time it is her earing. The earing has no personal significance to her, as it is a standard sleeper, which can easily be replaced. Alice, again, evaluates the situation and decides that because Samantha became so distraught when Alice did not provide compassion last time, she would show compassion to Samantha this time. However, Alice experiences moral distress, as the situation is not serious and the loss of a trivial item does not require the expression of compassion.
Compassion fatigue[edit | edit source]
Compassion fatigue is described as actions or emotions resulting from hearing about a traumatic event and feeling stressed due to wanting to or actually helping the person who is suffering (Sabo, 2014). Compassion fatigue is common in the healthcare profession, particularly among nurses (Dunn, 2019). Nurses who are highly empathetic are at a greater risk of developing compassion fatigue (Sabo, 2014).
The stress-process framework is the main theoretical model relating to compassion fatigue (Sabo, 2014). The model consists of empathic ability, empathic response, and residual compassion stress (Sabo, 2014). The model comprises a series of events, where care providers are first exposed to a patients suffering (Sabo, 2014). Care providers then experience empathic concern and ability, resulting in an empathic response, which may lead to compassion stress (Sabo, 2014). Those more at risk of developing compassion fatigue experienced ongoing exposure to hardships, memories that generated an emotional reaction, or sudden life disturbances (Sabo, 2014).
There are strategies that can reduce the chance of compassion fatigue, or help to reduce the effects (Nolte et al., 2017). Family or peer support was key, particularly for nurses, in preventing compassion fatigue (Nolte et al., 2017). A supportive workplace is also key in reducing the chance of compassion fatigue (Nolte et al., 2017). Setting boundaries with patients or clients helps to preserve the healthcare worker and debriefing after tough cases can help in reducing the chance of compassion fatigue (Nolte et al., 2017). Self-care, such as exercising, also reduced the chance of compassion fatigue, as well as increased knowledge about what compassion fatigue is (Nolte et al., 2017). If these strategies were implemented in high stress work environments, compassion fatigue would likely decrease.
What are the pros of compassion?
What are the cons of compassion?
How can compassion be fostered?[edit | edit source]
There are ways we can foster compassion, mainly through compassion training. There have been many types of effective compassion training and therapy programs, with the most effective ones being mindful self-compassion, cognitively-based compassion training and compassion-focused therapy.
Mindful self-compassion[edit | edit source]
Mindful self-compassion (MSC) was developed by Kristin Neff and Chris Germer and combines mindfulness and compassion training as well as psychotherapy and personal development training (Germer & Neff, 2019). Mindfulness training is necessary, as it allows an individual to detect when they are suffering so they can show themselves kindness (Germer & Neff, 2019). It is also necessary to stabilize one's awareness of the confronting emotions triggered during self-compassion therapy (Germer & Neff, 2019). These confronting emotions are associated with times in a person's life where they did not receive compassion (Germer & Neff, 2019). Mindful self-compassion takes a therapeutic approach in addressing these old wounds with a new approach: mindfulness and self-compassion (Germer & Neff, 2019). Self-compassion training has roots in Buddhism and is necessary, as we often need to show loving awareness towards ourselves before we apply this to our experiences (Germer & Neff, 2019).
A standard MSC group is made up of 10-25 participants with 1-2 teachers in a classroom setting (Germer & Neff, 2019). Overall, eight sessions are run, usually just under three hours long with a four hour silent treatment (Germer & Neff, 2019). These sessions are run by a mental health professional, with participants learning mindfulness and self-compassion through meditation, educational talks, videos, exercises, discussions, informal practices and poetry (Germer & Neff, 2019). The principles of self-compassion training are also taught, to allow for participants to continue their progress after the program has ended (Germer & Neff, 2019). Teachers are encouraged to model self-compassion and a culture of kindness to their students, and an inquiry takes place after the program, where each student meets with the teacher and shares their experiences (Germer & Neff, 2019). Each of the eight sessions is designed to build on the existing one (as seen below):
- Discovering mindful self-compassion: An introduction to each other and to self-compassion (Germer & Neff, 2019). Informal practices that can be carried out during the week are given (Germer & Neff, 2019).
- Practicing mindfulness: Mindfulness practices are taught and awareness of resistance and backdraft (where kind words can allow old hurt to resurface) is generated (Germer & Neff, 2019).
- Practicing loving-kindness: The concept of loving-kindness is introduced, as it is less challenging than self-compassion (Germer & Neff, 2019). Trust and safety in a group is developed (Germer & Neff, 2019).
- Discovering your compassionate voice: Focuses on turning loving-kindness into self-compassion and decreasing self-criticism (Germer & Neff, 2019).
- Living deeply: Develops compassionate listening skills and cultivates an individuals core values (Germer & Neff, 2019).
- Retreat: Four hours of silence period, where students can apply the learned practices to their thoughts that arise during the silence (Germer & Neff, 2019). New practices such as compassionate walking and appreciating nature in a mindful way (Germer & Neff, 2019).
- Exploring challenging relationships: Practicing how to deal with relational anger, caregiver fatigue, and forgiveness (Germer & Neff, 2019).
- Embracing your life: Brief focus on positive psychology concepts such as gratitude and self-awareness (Germer & Neff, 2019). Students then review what they have been taught and their key takeaways (Germer & Neff, 2019).
Cognitively-based compassion training[edit | edit source]
Lobsang Tenzin Negi coined the term cognitively-based compassion training (CBCT) (Cole et al., 2012). CBCT is a form of contemplative practice, where an individual is encouraged to view others with love, kindness, empathy and compassion (Cole et al., 2012). CBCT was originally designed for undergraduate university students cultivate emotional resilience (Kirby, 2016). CBCT builds on mindfulness techniques and uses various cognitive restructuring and affect fostering techniques (Cole et al., 2012). The long term aim of CBCT is to generate a calmness of mind, which accepts and understands others (Cole et al., 2012).
- Topics for CBCT (8)
Compassion-focused therapy[edit | edit source]
- Gilbert 2018
Conclusion[edit | edit source]
- Answer the question in the sub-title (based on psychological theory and research)
- Answer the focus questions
- Summarize the content covered
- Communicate the practical, take-home messages
See also[edit | edit source]
- Compassion (Wikipedia)
- Compassion Training (Book chapter, 2020)
- What Matters/Compassion (Book chapter, 2021)
References[edit | edit source]
Cherry, K. (2021, November 1). What is compassion? Verywell Mind. https://www.verywellmind.com/what-is-compassion-5207366
Cole, S. P., Craighead, L. W., Dodson-Lavelle, B., Ozawa-de Silva, B., Pace, T. W. W., Raison, C. L., Reddy, S. D., & Tenzin Negi, L. (2012). Cognitive-based compassion training: a promising prevention strategy for at-risk adolescents. Journal of Child and Family Studies, 22, 219–230. https://doi.org/10.1007/s10826-012-9571-7
Constantinides, S. M., & Georges, J. M. (2022). To a centrality of compassion: operationalizing the emancipatory theory of compassion. Advances in Nursing Science, 45(2), 114–126. https://doi.org/10.1146/annurev-orgpsych-031413-091221
Constantinides, S. M. (2019). Compassionate knowing: building a concept grounded in watson’s theory of caring science. Nursing Science Quarterly, 32(3), 219–225. doi:10.1177/0894318419845386
Dunn, D. J. (2013, April). The theory of compassion energy. Beginnings Magazine, 1–4. https://www.researchgate.net/publication/261753858_The_Theory_of_Compassion_Energy
Dutton, J. E., Hardin, A. E., & Workman, K. M. (2014). Compassion at work. The Annual Review of Organizational Psychology and Organizational Behavior, 1, 277–304. https://doi.org/10.1146/annurev-orgpsych-031413-091221
Germer, C., & Neff, K. (2019). Mindful self-compassion (MSC). In I. Itvzan (Ed.), The handbook of mindfulness-based programs: every established intervention, from medicine to education (pp. 357–367). London: Routledge.
Gilbert, P. (2015).The evolution and social dynamics of compassion. Social and Personality Psychology Compass, 9(6), 239–254. https://doi.org/10.1111/spc3.12176
Gilbert, P. (2018).
Gilbert, P. (2020). Compassion: from its evolution to a psychotherapy. Frontiers in Psychology, 11, 1–31. doi: 10.3389/fpsyg.2020.586161.
Kathryn, S. (2009). Aibileen Chapter 34. In K. Stockett (Ed.), The Help (p. 443). The Penguin Group.
Neff, K. D., Pommier, E., & Tóth-Király, I. (2020).The development and validation of the compassion scale. Assessment, 27(1), 21–39. doi:10.1177/1073191119874108
Nussbaum, M. C. (2003). Compassion and terror. International Justice, 132(1), 10–26. https://www.jstor.org/stable/20027819
Sabo, B. (2011). Reflecting on the concept of compassion fatigue. The Online Journal of Issues in Nursing, 16(1), 1. https://doi.org/10.3912/OJIN.Vol16No01Man01
[edit | edit source]
- What is the difference between empathy and compassion? Chip Zimmer (YouTube)