Neuroscience, compassion, and the heart of Acceptance and Commitment Therapy Reno 2010 Benjamin Schoendorff MSc

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 compassion Conceptual issues Identify 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-reference Negative emotions Positive emotions Reward 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-reference Negative emotions Positive emotions Reward learning Clinically what have we learned? My therapy’s good because it 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 tennis Are Federer’s right arm muscles the source of his killer forehand? What if we could train the exact same muscle structure and activation patterns in a non tennis player ?

Training the activation What if I could train this muscle through biofeedback (and no tennis experience)… Will this make a better player? Or this?...

Discriminating the good player This? The physical shape of the activation?

Discriminating the good player Or 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 compassion with 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 mind Built into human language Judging, comparing, finding wanting, self and others No compassion without self- compassion…

Self-compassion 1.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 perspective Making room for difficult thoughts and feelings Moving in valued directions, as ‘the person I’d like to be’

At last some data! Anxiety and Mindfulness self-help book study RCT vs waitlist 109 vs % 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 study RCT vs waitlist 109 vs % in tx Mediators 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 interesting From 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