Abstract
It is important to note that in addition to empathic distress, feelings of empathy can give rise to a second, more positive emotion: compassion (“co-passion”). This is a sense of warmth and concern toward the person who is hurting that is coupled with a strong desire to improve his outcome. Visualize a young child in the hospital with an upset and anxious mother. She can hardly bear to be near her sick son. Instead, she avoids intimate contact with him, pacing back and forth in the hall as she awaits word from the doctor. 1 Now imagine that same child, but this time his mother sits at his bedside, holding his hand and comforting him with her gentle, loving words. It's easy to see which scenario is more soothing and helpful to the child—which conveys empathic distress and which conveys compassion.
Compassion is the antidote to empathic distress. It implies, I may not be able to fix your suffering, but I can simply be with you as we both turn toward its cause and walk to a better place together. This is the feeling of interconnection in which two individuals are joined in the same process, and it is an effective helping strategy. Indeed, research shows that individuals who feel and express compassion are able to give more than those who rely on empathy alone. 2
The good news is that scientists have now also proven that being compassionate not only helps the person in need, but also benefits the caregiver emotionally as well as physically. 3 The positive emotions that arise from feeling compassion elevate immune function as compared with anger, which depresses it. These feelings engage the neuroplasticity of the brain by activating the prefrontal cortex and ventral striatum, regions that are also stimulated by social connection, maternal affiliation, and romantic love. This brain activity helps reverse the negative emotions associated with burnout, thus strengthening resilience. 4
Indeed, recently, researchers at the University of Buffalo showed that caring for others enhances a caregiver's health. The act of volunteering protects people from stressful events in their lives, and this in turn has a positive effect on the long-term survival rates and the distress levels of the volunteers. Interestingly, this stress-buffering effect worked only for individuals who had positive views of others and were not cynical. 5 I believe that oxytocin plays a role in the longevity of these volunteers. It increases when people connect and drives them to build social relationships while reducing inflammation and protecting the heart.
Another fascinating study published in 2014 explored the potentially beneficial effects within the brains of people who give support to loved ones. In this experiment, twenty romantically attached couples completed an fMRI session in which the female partner underwent a scan while her partner stood just outside the scanner and received unpleasant electric shocks. The women were provided with one of two coping mechanisms. Either they were to squeeze a stress ball when the shocks were administered to their loved one, or they held his hand and thought about sending love and support. The stress ball did not change the women's brains at all. However, in those women who offered caring and intention, the reward-related region called the ventral striatum, the same area activated by compassion and maternal behavior, lit up. There was also less activity in the amygdala, the structure that responds to fear. 6
This is a great example of how opening and engaging the source of suffering can create a biology that builds courage, hope, and resilience, establishing a catalyst for the connection. Offering love and support can also be a form of self-care—as people turn the same intent upon themselves. These studies teach us that compassion produces intention for others, and in so doing, it's also the best way to reduce one's own stress.
Other researchers looked at how compassion enhances health by comparing immune reactions of three groups of subjects. The first group generated caring and compassionate emotions by one of two methods: watching a video of Mother Teresa ministering to the sick and dying or shifting their attention to the area around their hearts (where most people experience positive emotions) and meditating on loving and compassionate emotions within themselves. The second group generated angry and frustrating thoughts either by recalling difficult incidents from their own lives or watching specially edited, disturbing clips of war scenes. A third group acted as controls. The researchers found that those who meditated on compassionate emotions produced a significantly stronger and longer immune response (as measured by the infection- fighting antibody IgA in their saliva) than the study participants who focused on anger and frustration or who did no visualizations at all. 3
Curing is linear and goes in one direction from the caregiver to the patient. However, as we've seen, a healing connection is circular. In the process of healing another, people also heal themselves. When individuals reach out with compassion, they're not serving someone other than themselves—they're serving one interconnected process that includes themselves. It becomes increasingly clear that in order to help others, caregivers must first start with being compassionate toward themselves.
I believe that the best way to do this is to engage in compassionate mindfulness meditation. This activity derives from Buddhist contemplative practices. It reinforces inner calmness, a strong mind, and the courageous determination to help someone who is suffering. 3 Fortunately, it can be learned and is a valuable part of a caregiver's armamentarium. Engaging in this meditation is also associated with many health benefits for the caregiver including a reduction in inflammation. This lessens the risk of many chronic diseases 7 —such as diabetes, 8 cancer, and Alzheimer's—that are dependent on inflammation for their progression. Research has established that people who practice compassionate mindfulness meditation have down regulated the genes that promote inflammation with less interleukin-6 (a marker of inflammation) circulating in their blood. 9,10
Another excellent avenue to expand compassion is the loving-kindness meditation. This exercise evokes compassion, kindness, and acceptance toward oneself and others. Practitioners send out feelings of loving kindness in expanding circles first for themselves and then to people near and far. Research comparing empathy to compassion showed that people experience more positive affect with compassion training. 4 During this meditation, individuals activate regions of the brain that light up with love and pleasure and produce more oxytocin. As they feel and express love, they experience less burnout. It is hard to be irritable and impatient when one is connected to oneself and others in this loving way.