Compassion - Bridging Practice and Science - page 238

low circulating concentrations of cortisol[22].
So would training people to be more compassionate lower cortisol activity, as one would predict from the
ability of oxytocin to reduce cortisol, or would it increase cortisol activity, as one would predict from the finding
that low cortisol levels are associated with lack of empathy? Although no definitive answer can be given at this
point, data from our group provide intriguing clues, and suggest that the answer is “neither”[23],[24],[14].We
taught a 6-week compassion-based training program, the CBCT program (see for more detail about CBCT
Box IIIandChapter 1) to medically and psychiatrically healthy college freshmen and had them participate in a
standardized laboratory psychosocial stressor (Trier Social Stress Test [TSST]) either before or after six
weeks of meditation training. While we found no effect of compassion meditation training per se on cortisol
responses to the TSST when compared to an active control condition (a health education group), we found an
intriguing association between amount of meditation practice within the compassion group and cortisol
responses. Participants who engaged in significant “at home” practice had no reduction in how much cortisol
increased in response to the stressor, but had their cortisol levels return to the pre-stressor baseline
significantly faster than individuals with minimal practice time during the study (Figure 3). These results
suggest to us that compassion training may preserve appropriate acute stress responses, while at the same
time attenuating non-adaptive prolonged stress responses once the stressor has passed, the type of “chewing
on things” that has been shown in many studies to increase the risk of depression, anger and a number of
medical illnesses[25].
Compassion, Endocrinology and the Immune System
We have already discussed the fact that endocrine hormones implicated in compassion, especially oxytocin
and cortisol, have profound effects on central nervous system functioning. These hormones also powerfully
impact immune function in complex ways (see againFigure 2)that are likely of direct relevance to health, and
that may explain a curious recent finding that directly links empathy to infectious disease outcome. In a large
randomized trial, patients with colds who experienced their doctors as more empathic during a clinical visit
recovered from their illness more rapidly, and had less severe symptoms, than those who experienced their
doctors as less empathic[26]. Interestingly, patients who experienced their doctors as more empathic also had
higher nasal wash levels of the important immune molecule interleukin (IL)-8, raising the possibility that the
experience of empathy might impact immune functioning in ways that promote health. These findings support
and extend earlier data that people with high levels of social support were less likely to develop colds when
experimentally exposed to viruses in nasal spray[27].
In addition to potentially optimizing immune function in the face of pathogen exposure, a number of
social/emotional factors related to compassion have been shown to impact immune functioning in ways known
to affect both mental and physical health. To understand these findings it is important to know that the
mammalian immune system has two large interacting subsystems: a fast acting and non-specific one that is
often referred to as innate immunity and is characterized by inflammation, and a slow acting and specific
system often referred to as acquired immunity that is characterized by T cell activity and the production of
antibodies that clear pathogens from the body. Overwhelming evidence demonstrates that many aspects of
the modern world conspire to increase chronic inflammation even in the absence of any evidence of ongoing
infection[28].This chronic increase in inflammation has, in turn, been associated with the development of a
number of psychiatric diseases, including major depression, bipolar disorder and schizophrenia, as well as
many physical conditions including cardiovascular disease, diabetes, cancer and dementia. Importantly, both
acute and chronic psychosocial stress has been shown to promote increases in chronic inflammation, with
these effects being stronger in individuals with histories of early life adversity (e.g., trauma, neglect) than in
others[29],[30].Together these findings raise the possibility that activation of inflammation may be one
pathway by which social stress promotes depression. These findings may also help account for the repeated
observation that depression earlier in life predicts the subsequent development of many modern diseases in
which inflammation is known to play a role[31].
In this context, recent findings regarding the effect of compassion meditation on inflammatory responses to a
psychosocial stressor (the TSST) are especially relevant. In the same population of college freshmen
described above, we found that – much as with cortisol – although no effect was seen for randomization to
compassion meditation per se, within the compassion group amount of time spent practicing during the study
was strongly associated with inflammatory responses to the TSST[23],[24] ,[14].Specifically, those who
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