Tag Archives: compassion

Brain/Mind: Forever Lovers

I write for several mental health and psychology journals and blogs. Every month, I field questions that may be relevant to several people and their interests. Recently, I was asked to differentiate between sympathy, empathy, and compassion, and their significance. While there is overlap, the empirical data and clinical experience indicate differences among these concepts.

In addition, I have been exploring the concept of Empath, which is somewhat different, and does not yet have sufficient research. As you know, I believe in the combination of clinical, empirical, cultural competence, and lived experience, so it’s an intriguing area for further study.
*Empathy means that you feel what a person is feeling.
*Sympathy means you can understand what the person is feeling.
*Compassion is the willingness to relieve the suffering of another. It is an active process of wanting to help others.

Empathy
When you are viscerally feeling what another person feels, you are experiencing empathy. Thanks to your brain’s “mirror neurons,” a concept still under neural investigation, empathy may arise when you witness someone in pain. For example, if you saw someone in distress, you may feel awful. This has even been witnessed in infancy, such as babies and toddlers who may start crying if they see or hear another child in tears.
Several interesting developmental psychology studies in Finland and Denmark have shown that empathy can be taught from an early age, as an active skill and strategy, so ‘baby, you were born with it,’ is not necessarily the only scenario. Just think about the possibilities of teaching empathy as an active life strategy and the possibilities for what that would mean across the world.
For more info: Why We Should Teach Empathy

Sympathy
It can be tricky to differentiate sympathy and empathy. The main difference? When you are sympathetic, you are not experiencing another’s feeling. Instead, you are able to understand the content of what the person is feeling. For example, if someone’s loved one has passed away, you may not be able to feel that person’s experience. However, you can understand that your friend is sad. This includes societal norms of grief and loss.

Compassion
Compassion kicks empathy and sympathy to the level of activity. When you are compassionate, you feel the pain of another (i.e., empathy) or you recognize that the person is in pain (i.e., sympathy), and then you do what you can to to alleviate the person’s suffering. It is the basis of volunteering, community service, mentoring, and helping others.
At its Latin roots, compassion means “to suffer with.” When you’re compassionate, you’re not running away from suffering, you’re not feeling overwhelmed by suffering, and you’re not pretending the suffering doesn’t exist. When you are practicing compassion, you can stay present with suffering, actively.

Dr. Thupten Jinpa, was the Dalai Lama’s principal English translator and author of the training known as Compassion Cultivation Training (CCT).  Jinpa posits that compassion, trained in neural science, is a four-step process:
-Awareness of suffering
-Sympathetic concern related to being emotionally moved by suffering
-Wishing to see the relief of that suffering
-Responsiveness or readiness to help relieve that suffering through behavioral activity and reaching out.
For more info: Compassion Institute

Empath
I posit one additional concept, that does not yet have sufficient Cognitive/Neural research data. I call it the mind meld, or empath. It’s being with someone in the mindful moment or experience, and has been anecdotally described in indigenous cultures and spiritual practice. Think of Diana, from Star Trek; or the conduit described by the Iroquois, and dogs who stare into your eyes, which they do not do with any other species, except their beloved humans.

Also read:
The Neuropsychology of Dog Love

When I began my neuroscience studies, the epitome of writing and research was represented by neurologist, Dr. Eric Kandel. Many chapters in his landmark textbook ended with: this is all we know, and how much we still need to learn about brain functioning. Still true.I enjoy your neuropsychology questions and comments. And I love that people are interested in the brain/mind connection. They are forever spouses.

More info:
Mental Health and Empathy
The Science of Compassion
The Neuropsychology of Self Compassion

How Can I Be More Self-Compassionate?

A frequent discussion with patients is how to be kinder… To oneself.
According to clinical psychology research, self-compassion includes three major components: self-kindness, mindfulness, and connection with humanity. Scientifically, self-compassion promotes well-being, decreases depression and anxiety, and can be a buffer during difficult times.
See The Neuropsychology of Self-Compassion.

Become aware of your inner critic. The Ping.
When you notice your self critical thoughts like “I am a failure”, “I am such an idiot” or “No one likes me”. Pause and intervene with thought stopping (picture a stop sign) and replace it with another thought. Another method that my clients have found to be helpful is what I call ‘the ping’. Wear a stretchy style bracelet and ping it on your wrist when you find yourself being mean to you. It’s a quick reminder that this is an automatic thought. Self- denigrating thoughts can become internalized and require mindful vigilance to address them.
See Why Self-Compassion is More Important Than Self-Esteem

What would you say to a dear friend if you heard them saying these things aloud? The No-Trash-Talking.
If you heard someone you care about beating themselves up, you would likely tell them to be kinder. You would remind them that they did their best and help them remember what makes them special. Just as you wouldn’t let somebody else trash talk your bestie, being mean to yourself is not helpful.
See 13 Ways to Practice Non Compassion

Take a self-compassion break. The Timeout.
I also call this the reboot. When a laptop is glitching, you shut down everything and reboot. When people feel like they are in a downward spiral, stop everything and take a break. Use affectionate breathing, loving kindness meditation, or the self-hug as strategies to show yourself compassion.
See On the Power of the Self-Hug

Realize your suffering is a part of collective pain: Dukkha.
In Eastern thought, understanding that suffering is a part of common humanity versus your own isolated experience may help put things into perspective and to feel more connected. Pain makes people feel alone. Understand that although you may feel you are the only one suffering, you are not. Suffering is a part of the human range of experience and brings us closer to the bigger world.
See The Science of Compassion

Mindfulness. The self-scan.
Mindfulness is a receptive mind state where one observes thoughts and feelings as they are without suppressing or denying them. This state helps you become mindful of both positive and negative emotions and keep it in a balanced perspective. This can be combined with journaling, if desired. Writing how you feel in the moment from a stream of consciousness (no editing) perspective has been linked to a decrease in depressive or negative thoughts in numerous studies.
See Restorative Writing and Mental-Health

Kindness to others: Giving.
Community work and volunteering is strongly linked to an increase in positive mood. Somehow the act of helping others boosts us along with them. There are fewer things that are a bigger win-win.
Also see The Kindness of Strangers

How To Support

Saying the right words or finding specific ways to help are some of the most important things you can do when someone you care about is struggling.

Ideas to consider might include:
1. “Thank you for all you do for me/us, but now is a time to take care of yourself as well.”

When someone is going through a difficult experience, they might not be able to justify a much-needed break. Help them by letting them know that you’d like to take over some responsibilities while they tend to their needs. For example, you can order food for them, ask if you can return phone calls or make appointments, or even just check-in daily with somebody going through a hard time. It can make a big difference.

If you’re far away from a loved one, and can’t be there in person, consider sending a care package with food or some of their favorite things, in addition to a personal message of support.

2. Remind your person of something kind they did for you.
They have probably been there for you when you were going through hard times. Remind them of this when they’re in the same boat. They’ll be happy to know they made you feel better. More importantly, hearing about how they helped you may make them feel a little bit better.

3. “I’m proud of you.”
These are powerful words.

Depending on the nature of your relationship with, there’s a good chance this important person would love to hear that you’re proud of the way they are dealing with a painful experience.

4. “My job is to make your life easier right now. This is how I’m going to do it. Does that work?”
People need to support each other when one is in pain. However, if you only ask a loved one “How can I help?” when they are struggling, they might not actually let you know. Instead, offer to make their life easier during this painful time in specific ways.

What to Say to a Friend Experiencing Hard Times. Friends aren’t just people we share fun times with. They’re also the people we may turn to when life is difficult. If you know a friend would like to hear from you right now, get in touch to share one of these messages:

5. “I hate that you’re going through this, but I know that you’ve got this. How can I best support you? “
People want to know their friends don’t just like them but admire them as well. Tell a friend going through a tough time that you know they have the strength to overcome it.

6. “You’ve got a lot on your plate. Can we set a time to chat every week?”
You can suggest a specific time each week when they can call you to vent. Some of my patients tell me this gives them an area to vent, cry, and be able to process their week.

7. “Remember when you were there for me? It’s my turn to do the same for you.”
Most friends going through hard times often feel better when someone reminds them that they’ve been a big help in the past. It’s easier to except help when you realize that you are not a victim, and that you have been strong in the past.

Let your friend know you want to support them by reminding her of a specific time when they did the same for you. This will boost your friend’s odds of actually accepting your offer to help.

8. “You’re my best friend. Helping in any way I can is my top priority right now. Please believe that.”

What to Say to an Acquaintance or Colleague Who’s Going Through a Rough Patch

When I had a beloved dog who passed away, I had colleagues at work who pulled together to help me with all of the vet appointments when I had to take time off.

9. “Here’s how we’re going to take care of your work while you’re away.”
A colleague going through a rough patch may need to take a step back from work for a period of time to address other needs. This may be true if your colleague is in mourning, struggling with illness, or dealing with a life challenge that consumes a lot of their time.

Your colleague might stress about work and wonder who will be handling all the responsibilities until they get back. You can help your colleague in a very big way by coordinating with supervisors and coworkers to divvy up responsibilities. Get in touch and show your colleague you have work responsibilities under control.

10. “If you need a reference, networking help, anything like that at all, let me know. Happy to help!”
There’s a chance you might be able to help by serving as a reference or introducing your colleague to others in your industry. Offering to help in these key practical ways could make your colleague feel cared for.

Read more on the importance of compassion The Science of Compassion.

What I Learned

I was recently interviewed for a piece on mental health for VerywellMind about things I have learned from the pandemic.

The question was:
As both one who is living through this and helping others live through this, what are the lessons that most come to mind for you?

Seven things I learned from the Pandemic
1. There was no ‘Normal.’
We say, I wish we could return to normal, I miss the old days. When will things go back?
The old days weren’t so great. We have seen businesses go under, people who were barely getting by already go over the precipice, huge upticks in mental health and substance abuse problems, how separated and isolated people feel, and how difficult it is to ask for and receive support. I believe The greatest lesson of these times is the absolute necessity for a paradigm shift. The concept of a paradigm shift, originally based in physics, refers to a major change in the worldview, concepts, and practices of how something works or is accomplished. Recently, people have sometimes referred to it in employment terms as the Pivot.  Why return to a supposed normal that never worked, completely fell apart under duress, neglected the vulnerable, and is certainly not equipped to address any future challenges?

2. Nothing is more important than connection.
People have deeply hungered for love, touch, intimacy, and affection during these difficult times. It is an essential part of being human. Those who felt most isolated suffered the most challenges to their mental health. I recently wrote a piece about loneliness as a marker of danger to mental and physical health. A recent study equated deep-rooted loneliness as the equivalent of smoking chronically, with regard to the impact on longevity and wellness.

It’s literally a killer.

3. Mindfulness matters.
Groundhog Day happens. Over and over again, I have heard people say they have lost track of time. ’It feels like it’s going by so slowly, and yet so quickly’. Each day can feel the same. Learning mindfulness strategies anchors our perception of reality. We cannot live in a blur, and it’s very easy to succumb to that. Before we know it, it’s September 2021. Also see this helpful post on a mindfulness practice.

4. Pain cannot be avoided.
We can numb our feelings of fear, resentment, anxiety, grief, and terrifying uncertainty. They are still there. How to cope without being overwhelmed requires numerous strategies. I was sent a photograph from a recent trash recycling day in DC, where house after house was lined up with dozens of empty bottles; liquor, wine, beer, soft drinks. Our pain is honorable and a marker of experience. It’s not going to go away just because we want to anesthetize.

5. Looking after your health is absolutely essential.
Health care that is consistent in the middle of chaos is one of the hardest things to do. When you’re just trying to juggle bills, care for children and family, deal with virtual learning, work from home, metabolize constant health alerts and daily fears, confront financial hardship and job changes, and combat isolation and ennui, survival needs take over. Self-care often goes on the back burner. And yet, it is the absolute foundation.

6. It takes community.
In previous work, I have referred to the pandemic as the ultimate #compassionproject. In short, thinking about ourselves and our immediate circle has never worked, is not working now, and will not work in the future. Only if we pull together with our amazing range of strengths, talents, skills, and vulnerabilities, are we going to make it through.

7. Creativity can thrive under fire
I have seen innovation, creativity, flexing, and hustle like never before. In line with number six, above, I have seen projects large and small making the world a better place. Resolve, Love, and Hardwork are unbeatable.

Superhero Therapy and Mental Health

When we think of Superman, all sorts of powers come to mind: flight, heat vision, near-complete invulnerability. But we may overlook his greatest characteristic: compassion. He chooses not to harm. Superman’s greatest power is his compassion. Throughout every successful iteration of the character that one virtue remains constant: he is an extremely powerful and endlessly resourceful being motivated by bottomless reservoirs of compassion to help people in whatever way he can. He experiences great distress when he is not able to aid someone in pain or peril.

The beauty of superhero stories, for me, is that they invite us to identify with the superhero, to imagine ourselves with their burdens and challenges, but also with their capabilities. Superhero stories are prevalent in some of the therapy work that I do. The characteristics of well known and loved heroes, and villains, are often catalysts for deeply personal disclosures and discussions by patients. For example, following the release of Black Panther, many of my patients were split about their favorite character in the movie, Killmonger or T’Challa. I call this Superhero Therapy: incorporating the characteristics of Superheroes into evidence-based therapy (CBT, Mindfulness, etc.).

The compassion of Superman and mental health
Dr. Steve Cole, a medical researcher at UCLA, conducted a study in 2012 assessing the characteristics of ‘very happy people’ and the possible relation to physical health. They found that people who were happy because they lived for pleasure or fun (sometimes also know as “hedonic happiness”) had high inflammation levels but that, on the other hand, people who were happy because they lived a life of purpose or meaning had low inflammation levels. Inflammation is implicated in a host of chronic illnesses, including cancer, heart disease, and obesity. A life of meaning and purpose is one focused less on satisfying oneself and more on others. Compassion is strongly associated with longevity and good health. 

Another way in which a compassionate lifestyle may improve longevity is it protect us against stress. A large study by the Department of Psychology at the University at Buffalo found that stress did not predict mortality in those who helped others, but that it did in those who did not. In addition, people who practiced a more compassionate lifestyle, including volunteering and community service, had significantly lower rates of anxiety and depression.

Finally, compassion may boost well-being by increasing a sense of connection to others. A number of studies have shown that lack of social connection is a greater detriment to health than obesity, smoking, and high blood pressure. Social connection strengthens our immune system (research by Steve Cole showed that the same genes impacted by social connection also code for immune function and inflammation), helps us recover from disease faster, and may even lengthen our life.

The compassion of Superman can be a useful metaphor in psychotherapy, where people are often struggling with difficult questions:

Are they doing or accomplishing enough?
How are they going to manage restraint and impulse control and still have a voice?
How are they going to be there for others and self-care at the same time?

10 tips to support home medication management for seniors

Many people I care for are also caring for their elders. I know it can be rewarding, but challenging, personally and professionally. I worked at ManorCare assisted living for two years, and the residents taught me a lot. A long-term friend and colleague works with adult protective services. Health issues are important. Most of all:

Compassion goes a long way.  Because we’re all going to be there.

Some strategies
1. Gather all medications, vitamins, OTC meds, and supplements into one location. If they’re all stored in different locations, it’s easy to lose track of the prescribed medication, vitamins, over-the-counter medication, or supplements that are being taken.

For example, some older adults might keep certain pills in the kitchen, some on their bedside table, and others in the bathroom medicine cabinet. It’s especially important to include over-the-counter medications because they could still cause reactions when combined with prescription medications.

A good habit is to gather everything into one place.
That way, you can see exactly what is being taken, make sure similar prescriptions aren’t being prescribed for the same health condition, and know when to dispose of expired medications.

To stay organized and increase medication safety, keep all their current pill bottles and packages in a clear plastic storage bin. That ensures everything stays together. Use a separate bin for former or medicines that are only used occasionally. It’s very easy to mix everything together.

2. Make sure medication is stored properly.
In general, medication should be kept in a cool and dry place.
That means the bathroom cabinet isn’t a good place to keep meds – moisture and heat can affect drugs. Medications should also be kept safely away from children or pets. Dogs and cats will swallow pills that they find on the floor. Some of these medications may even taste good to them, making them even more dangerous.

3. Create and maintain an up-to-date medication list.
To prevent negative drug interactions, It’s essential to know exactly what medications your older adult is taking. That’s why it’s so important to always have an up-to-date list of their medications, vitamins, supplements, and over-the-counter medications.

Be sure to record:
Names of each prescription medication, over-the-counter medication, vitamins, and supplements
How often each item is taken
What dosage of each item is used
The healthcare provider who prescribed each prescription medication
The purpose of each item and/or symptoms it’s supposed to treat
Whether each item is for short-term or long-term use
This list should be given to the patient, a family member, and a caregiver.

4. Pre-sort medications for the week
Staying organized is essential to good medication management for seniors. Using a pill organizer allows you to help your older adult pre-sort their medications for the week.
The best type of pill organizer for your older adult is one with enough compartments for every dose they’ll need throughout the day.

If any pills need to be split, it may be best to do this ahead of time and include those halves in the pill organizer compartments.

5. Make it a team project. Many seniors are resistant to medication, and feel that they are being forced to take them. If it becomes an interactive activity, there is less resistance.

6. Take photographs of the actual medicine bottles, the pillbox, and each pill so you can see what it looks like.

7. Have a checklist with you that your senior also has, so they can go through and check off which ones they have taken. You can make this a daily routine with them, a.m. and p.m. it’s like being there.

8. Follow each medication time with a reward. They could eat some candy (if allowed medically), take a nap, watch a favorite show, read a novel or magazine, etc.

9. Some Hacks For Getting Someone To Take Their Medication
-Speak to their Doctor: Their PCP or NP may have a solution for you based on the patient’s individual needs. Perhaps there is a way to minimize the number of pills they must take, change certain dosages, switch to a different formula, etc.

-Use your resources: At times, I’ve had to put on my Dr. voice and call the patient, because they would not listen to their child or regular caregiver, who were there for them on a daily basis. Support groups for caregivers can also be helpful for sharing and receiving support.

-Create a calm environment: A less stressful environment may help an older adult relax enough to do something uncomfortable but necessary.

-Crush pills into food: Crushing medication into applesauce, pudding, yogurt, or other foods may make it more pleasant to consume. Please sure to ask a pharmacist before doing this, since certain pills become less effective when crushed.

-Do it together: Taking your own vitamins or medicine at the same time can make the entire experience more enjoyable, as if you two are health “buddies”.

-Set up medication management devices: If your loved one is independent, help them set up alarms, reminder, pill organizers or dispensers, daily checklists, etc.

-Remain calm: Don’t force it. If it’s not happening, try again in 10 minutes. Sometimes, they just need to breathe, calm down, and/or be in a different mind state. Don’t give up if it’s a bad day. Or a bad hour.

10. Stick to a Routine. This can do wonders for getting a senior to cooperate, especially one struggling with dementia. Does your senior know what time to go to bed, eat lunch, feed the cat, take out the trash? Eventually, a regular schedule may make it so normal there is no resistance to medication at all.

The Science of Compassion

In my doctoral studies, I had the honor of working on a research study on conjugal bereavement with Dr. Dacher Keltner. Dr. Keltner, in addition to prolific work in a wide range of areas, has developed the science of compassion and empathy into a multidisciplinary field. In short, the study I co-authored found that in a study of individuals who had lost a long-term partner, and who ultimately showed greater psychological health over a five-year span after the loss, were those who received ongoing empathy and social support in response to their vulnerability, as the primary variable related to mental health and adjustment.

(Bonanno, G. A., Siddique, H. I., Keltner, D., & Horowitz, M. J. (1996). Correlates and consequences of dispositional repression and self-deception following the loss of a spouse. The Catholic University of America, Washington, DC).

Dr. Keltner runs a compassion-based research studies program at UC Berkeley. He writes prolifically about the importance of compassion for psychological health, social justice, and even the survival of our species.

Compassion literally means “to suffer together.” Among emotion researchers, it is defined as the feeling that arises when you are confronted with another’s suffering and feel motivated to relieve that suffering.

Compassion is not the same as empathy or altruism, though the concepts are related. While empathy refers more generally to our ability to take the perspective of and feel the emotions of another person, compassion is when those feelings and thoughts include the desire to help. Altruism, in turn, is the kind, selfless behavior often prompted by feelings of compassion, though one can feel compassion without acting on it, and altruism isn’t always motivated by compassion.

While cynics may dismiss compassion as touchy-feely or new age-y, neuropsychologists have started to map the biological basis of compassion, suggesting a deeper evolutionary purpose. This research has shown that when we feel compassion, our heart rate slows down, we secrete the “bonding hormone” oxytocin, and regions of the brain linked to empathy, caregiving, and feelings of pleasure light up, which often results in our wanting to care for other people.

Compassion makes us feel good: Compassionate action activates pleasure circuits in the brain, and compassion training programs, even very brief ones, strengthen brain circuits for pleasure and reward and lead to lasting increases in self-reported happiness.

Being compassionate—tuning in to other people in a kind and loving manner—can reduce risk of heart disease by boosting the positive effects of the Vagus Nerve, which helps to slow our heart rate. A recent study found that people who have a greater level of empathy live 9 to 10 years longer than others, controlling for other factors. 

One compassion training program at Stanford has found that it makes people more resilient to stress; it lowers stress hormones in the blood and saliva and strengthens the immune response. Compassion training may also help us worry less and be more open to our own and others’ negative emotions. In short, people who are more compassionate tend to be less avoidant of the range of emotions.

Compassion could improve our mental health: One research review found that practicing compassion meditation improved participants’ emotional life, positive thinking, relationships, and empathy. Brain scans during loving-kindness meditation, which directs compassion toward suffering, suggest that, on average, compassionate people are happier.

Practicing compassion could make us more altruistic. In turn, it may also help us overcome empathic distress and become more resilient in the face of others’ suffering. Too often, we hear people say, I can’t watch the news because it’s just too much for me. Instead, the practice of compassion makes people more able to tolerate the pain of others, and yet provide support.

Compassion helps make caring parents: Brain scans show that when people experience compassion, their brains activate in neural systems known to support parental nurturance and other caregiving behaviors.

Compassion helps us be better friends and partners: Compassionate people are more optimistic, forgiving, and supportive when communicating with others.

Compassion helps make better doctors: Medical students who train in compassion feel less depressed and lonely, and avoid the typical declines in compassion that sometimes happen during medical school.

Employees who receive more compassion in their workplace see themselves, their co-workers, and their organization in a more positive light, report feeling more positive emotions like joy and contentment, and are more committed to their jobs. A compassionate workplace culture is linked to less burnout, greater teamwork, and higher job satisfaction.

Compassionate people are more socially adept, making them less vulnerable to loneliness; loneliness has been shown to cause stress and harm the immune system.

Compassion is contagious. According to Dr. Keltner’s “the greater good project”, based out of UC Berkeley, compassionate behavior rubs off on other people.

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