possession by the mind, in clear and vivid form, of one out of what seem several simultaneously
possible objects or trains of thought. Focalization, concentration of consciousness are of its
essence. It implies withdrawal from some things in order to deal effectively with others”
Attention entails the allocation of mental processing resources to an object. Attention can be
focused, selective, sustained, alternating, dispersed or divided. It can also be panoramic, where
the attentional ground is inclusive, reflective and non-judgmental.
One cannot quite imagine compassion being present without attention being stable, whether
attention is focused or panoramic. In order to recognize suffering in others or oneself, one must
have cultivated attentional balance, where attention is at least focused and sustained or panoramic
and inclusive. The ability to perceive in an unfiltered way the nature of suffering and also one’s own
responses to suffering requires attentional balance. Stable attention is sustaining, vivid and
effortless; it is non-judgmental, non-reactive, not contracting in relation to unpleasant phenomena
and not clinging to a desired outcome. Attention also makes it possible for cognitive processing to
be grounded; cognitive control is needed for attention to be balanced, so that the attentional field is
not disturbed by assumptions, judgment and reactivity.
Balanced attention can make accessible an unambiguous perception of reality, and in the case of
compassion, an unbiased perception of suffering. Recent research has shown that the attentional
training that entails a component of mindfulness meditation results in decreased susceptibility to
the effects of emotionally arousing events upon task performance. This suggests that attentional
balance enhances one’s ability to perceive reality non-judgmentally, including the reality of
suffering
This ability is essential for compassion to be present when caring for those who are
suffering from catastrophic illness and when giving compassion-based attention to family members
and colleagues who are distressed around issues related to suffering, dying and death.
The A/A Axis and Affective Balance
The second domain in the A/A Axis is the emotional or affective domain. For clinicians, kindness
and equanimity are essential affective processes associated with compassion. Kindness is
characterized by a dispositional tenderness towards others combined with genuine concern.
Equanimity is a process of stability or mental balance that is characterized by mental composure
and an acceptance of the present moment. These two qualities are essential for clinicians who
care for the dying. Equanimity also supports empathy, another affective feature frequently
associated with the priming of compassion. Empathy is affective attunement with another. Affective
attunement, often associated with compassion, might or might not elicit kindness, depending on
the psychological makeup of the experiencer or the capacity of the experiencer to regulate her or
his arousal level and maintain equanimity
In the case of the latter situation, emotion regulation
and attentional and affective balance are essential. These conditions, when engaged, can lead to
compassion. Recent research has indicated that affective balance, compassion and other prosocial
emotions can stabilize and broaden the attentional base and allow one to be more resourceful and
have the capacity to make clearer discernments and decisions. Negative emotions, such as anger
and fear, seem to narrow the attentional base and color perception, making discernment
challenging
. In addition to kindness and equanimity, altruism, empathy, sympathetic joy,
gratefulness and a long list of mental processes associated with positive psychology and
prosociality can be fostered. Like attention, these seem to be trainable processes of mind. These
prosocial processes can be greater or lesser features associated with the emergence of
compassion. Whatever affective features are engaged, balance and regulation of these faculties is
essential for compassion to be primed. There is no question that affective balance, combined with
attentional balance, or equanimity, is critical to clinician well-being and resilience. The end-of-life
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