1. A Program of Emory University www.tibet.emory.edu/cbct

2. Cognitively-Based Compassion Training (CBCT) June 6, 2014 Timothy Harrison, Associate Director Emory-Tibet Partnership, Emory University

3. Emory-Tibet Partnership -- a cross-cultural exchange -- Emory-Tibet Science Initiative (ETSI) Cognitively-Based Compassion Training (CBCT) Lobsang Negi, PhD Director of ETP

4. Emory-Tibet Partnership -- a cross-cultural exchange -- Emory-Tibet Science Initiative (ETSI)

5. OVERVIEW What is compassion? Benefits of compassion Can we cultivate compassion? CBCT Protocol CBCT Research Cognitively-Based Compassion Training

6. com·pas·sion the desire to relieve others from suffering or misfortune synonyms: sympathy, empathy, fellow feeling, care, concern, solicitude, pity, sensitivity, warmth, love, tenderness, mercy, leniency, tolerance, kindness, humanity, charity What is Compassion?

7. Peter and Linda Biehl Amy Biehl What is Compassion?

9. Easy Nofomela Ntobeko Peni

10. What is Compassion? The Amy Biehl Foundation Gugulethu, South Africa

11. For most people, to “act what they think” requires that first they have to un-bundle themselves from all sorts of encumbrances, most of which are self-imposed, others of which are not. The longer you spend in life the more encumbered you get. What Linda and I have discovered is that when somebody who is important to you is suddenly stripped away from you, then the conventional encumbrances tend not to matter. The moment that we accepted the reality of Amy's death, and reflected on the reason for it … it really stripped away everything that could possibly have encumbered us. -- Peter Biehl, Amy’s father What is Compassion?

12. 20 th Anniversary Memorial 2013

13. Benefits of Compassion Compassion and love are not mere luxuries. As the source both of inner and external peace, they are fundamental to the continued survival of our species. They are the source of all spiritual qualities: of forgiveness, tolerance, and all the virtues. Moreover, they are the very thing that gives meaning to our activities and makes them constructive. If we seek happiness for others, we should practice compassion; and if we seek happiness for ourselves, we should also practice compassion! – The Dalai Lama, Beyond Religion

14. Compassionate action (e.g., giving to charity) activates pleasure circuits in the brain Increases self-reported happiness. Can reduce risk of heart disease by boosting Vagus Nerve activity Lowers stress hormones and strengthens the immune response. Less rumination about what has gone wrong or might go wrong Activates neural systems that support parental nurturance. More optimistic and supportive in communication style Decreases vindictiveness toward others. Benefits of Compassion (source: Greater Good Science Center, UC-Berkeley)

15. Employees who receive more compassion in their workplace see themselves, their coworkers, and their organization in a more positive light, report more positive emotions like joy and contentment, and are more committed to their jobs. Societies that take care of their most vulnerable members, assist other nations in need, and have children who perform more acts of kindness, are the happier ones. Compassionate people are more socially adept and less vulnerable to loneliness, which causes stress and harms the immune system. Supports commitment to moral principles. Benefits of Compassion (source: Greater Good Science Center, UC-Berkeley)

16. Helping behavior, along with other types of social interaction, is associated with positive health outcomes, including reduced mortality. The present research indicates that helping valued others predicts reduced mortality specifically because it buffers the association between stress and mortality. To our knowledge, this is the first study to find evidence for a stress- buffering mechanism for explaining the beneficial association of prosocial behavior with mortality. Poulin et al. | Peer Reviewed | Research and Practice September 2013, Vol 103, No. 9 | American Journal of Public Health Benefits of Compassion

17. Can we cultivate compassion? “The Two Wolves of the Heart” - Cherokee Nation Folk Tale

18. Can we cultivate compassion? As man advances in civilization, as small tribes join with large tribes, the simplest reason will tell each individual that he ought to extend his social instincts and sympathies to all the members of the same nation, though personally unknown to him. This point being, once reached, there is only an artificial barrier to prevent his sympathies extending to the men of all nations and races… Our sympathies becoming more tender and more widely diffused, until they are extended to all sentient beings. – Charles Darwin, Descent of Man

19. So when Jesus says “Love your enemies,” he is setting forth a profound and ultimately inescapable admonition. Have we not come to such an impasse in the modern world that we must love our enemies– or else? The chain reaction of evil – hate begetting hate, wars producing wars – must be broken, or we shall be plunged into the dark abyss of annihilation. - Dr. Martin Luther King, Jr. Strength to Love Can we cultivate compassion?

21. Cognitively-Based Compassion Training a specific approach to developing compassion Developed as a protocol for research at Emory University. Drawn from the ancient lojong (“mind training”) tradition of Tibet and rendered into secular form. Begins by tapping into the biologically-given potential for compassion in all of us. Makes deliberate effort to expand our compassionate capacity beyond the limits of in-group/out-group bias. Intentionally develops our receptivity to suffering and intensifies our desire to help others, allowing this response to be more natural and spontaneous in our everyday lives.

22. Progressive Components of CBCT 1. Attentional Stability 2. Self-Compassion 3. Cultivating Impartiality 4. Developing Appreciation and Empathy 5. Strengthening Compassion

23. Why, in a country that consumes 25% of the world’s resources (the U.S.), is there an epidemic of loneliness, depression, and anxiety? Why do so many in the West who have all of their basic needs met still feel impoverished? While some politicians might answer, “It’s the economy, stupid,” based on scientific evidence, a better answer is, “It’s the lack compassion, stupid.” -- James Doty, MD, Professor of Neurosurgery at Stanford University, and Director of the Center for Compassion and Altruism Research (CCARE) Compassion Research

24. Emory University School of Medicine CBCT Pilot Study – Fall 2014 -10 week CBCT course for 2 nd year medical students -Presented in mentored groups, randomized to 50% of the students, with booster classes in Spring 2015 -Compassion App in development to promote “stickiness” -Investigators: Andrew H. Miller, MD, Prof. of Psychiatry, Jennifer Mascaro, PhD, Anthropology Dean Christian P. Larsen, MD, DPhil Associate Dean Ira K. Schwartz, MD Executive Associate Dean J. William Eley, MD, MPH

25. Stress is the body’s response to a perceived threat. In the case of psycho-social threats, the stress is in response to aversive cognitive appraisals which can create a prolonged elevation of the immune system response and chronic inflammation correlated with many modern epidemics – heart disease, diabetes, asthma, and even cancer and depression. Compassion and Stress Our real enemies are not those who oppose us. Our real enemies are the anger and hatred we feel toward those people. -- Charles Raison, MD, Dept. of Psychiatry, University of Arizona

26. Trier Social Stress Test (TSST)

27. Benefits: Effects of CBCT on biochemical stress responses Pace et al. Psychoneuroendocrinol 2009;34:87-98; Pace et al. Psychoneuroendocrinol 2010; 35: 310-15

28. Desbordes, Negi, et al., Frontiers in Human Neuroscience, 2012 Differential effects of mindful-attention training vs. compassion training Amygdala response Before After Depression score Mindful-Attention Training * Compassion Training Before After

29. CBCT Group Control Group Benefits of Compassion Training: Empathic Accuracy IFG Brain Activation and Reading the Mind in the Eyes Mascaro et al. SCAN 2013; 8(1):48-55. * * p < 0.05

30. Reading the Mind in the Eyes Test

33. CBCT Group Control Group Benefits of Compassion Training: Empathic Accuracy IFG Brain Activation and Reading the Mind in the Eyes Mascaro et al. SCAN 2013; 8(1):48-55. * * p < 0.05

34. CBCT for At-risk Adolescents in Foster Care We have no shortage of programs for kids in care, but they are all focused on changing external circumstances. We need a program that brings about inner change, and I feel that Emory’s compassion program is exactly what our children need. B.J. Walker Commissioner, GA Division of Human Services, 2009 Helped youth transform relationships with caregivers, teachers and peers Encouraged concrete changes in their behavior

35. Lower inflammation and greater hope in foster care adolescents who practiced CBCT more Pace, Negi, Dodson-Lavelle, Ozawa-de Silva, Reddy, Cole, Danese, Craighead & Raison (in press). Psychoneuroendocrinology, July 2, 2012 higher inflammation lower inflammation less hope more hope saliva C-reactive protein controlling for baseline change in Children’s Hope Scale Score from before to after training Reddy, Negi, Dodson-Lavelle, Ozawa-de Silva, Pace, Cole, Raison, Craighead (in press) Journal Child Family Studies, February 21, 2012 high CBCT practice* low CBCT practice* high CBCT practice* low CBCT practice* * below or above median practice sessions

36. CBCT for Elementary School Children At first, I was a bit worried about whether or not we could teach these concepts to very young children, but their creativity and ability to grasp these teachings completely blew my mind. Brooke Dodson-Lavelle, CBCT Instructor Brendan and Brooke with children in elementary school classroom

37. CBCT(N=26) MINDFULNESS (N=27) % children with peer friendships Only children who learn CBCT add significantly more friends to their social network (p=.005) Only children who learn CBCT add significantly more peer (same-class) friendships (p=.019) % of children who add friends Social Circles Task (Children Ages 7-10) Antonucci et al., 1998 (Dodson-Lavelle, Robbins, Ozawa-de Silva, Pace, Negi, Raison, Rochat, in preparation.)

38. CBCT Research implications to date: – decreases stress responses – enhances well-being – improves mood – improves interpersonal skills, such as empathy – improves number and consistency of friendships – can be implemented at elementary and higher education levels

39. Current Research Projects - 2014 Nurses at the Neonatal Intensive Care Unit, Children’s Healthcare of Atlanta - Egleston Post-Traumatic Stress Disorder Victims, Atlanta VA Medical Center AIDS Patients, Grady Health - Ponce de Leon Center Breast Cancer Survivors, U. of Arizona - Tuscon Pre-School Parents, U. of Wisconsin - Madison Elementary Public School Teachers, International Community School, Decatur, GA Students, Emory University School of Medicine

40. Progressive Components of CBCT 1. Attentional Stability 2. Self-Compassion 3. Cultivating Impartiality 4. Developing Appreciation and Empathy 5. Strengthening Compassion

42. me

48. In a real sense all life is inter-related. All men are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly. - Dr. Martin Luther King, Jr. Interdependence

49. A human being is part of the whole called by us “universe,” a part limited in time and space. We experience ourselves, our thoughts and feelings, as something separate from the rest. A kind of optical delusion of consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest to us. Our task must be to free ourselves from the prison by widening our circle of compassion to embrace all living creatures and the whole of nature in its beauty. The true value of a human being is determined by the measure and the sense in which they have obtained liberation from the self. We shall require a substantially new manner of thinking if humanity is to survive. – Albert Einstein

50. we

51. A Program of Emory University www.tibet.emory.edu/cbct