Non-verbal communication of compassion: measuring psychophysiologic effects

Kathi J Kemper, Hossam A Shaltout, Kathi J Kemper, Hossam A Shaltout

Abstract

Background: Calm, compassionate clinicians comfort others. To evaluate the direct psychophysiologic benefits of non-verbal communication of compassion (NVCC), it is important to minimize the effect of subjects' expectation. This preliminary study was designed to a) test the feasibility of two strategies for maintaining subject blinding to non-verbal communication of compassion (NVCC), and b) determine whether blinded subjects would experience psychophysiologic effects from NVCC.

Methods: Subjects were healthy volunteers who were told the study was evaluating the effect of time and touch on the autonomic nervous system. The practitioner had more than 10 years' experience with loving-kindness meditation (LKM), a form of NVCC. Subjects completed 10-point visual analog scales (VAS) for stress, relaxation, and peacefulness before and after LKM. To assess physiologic effects, practitioners and subjects wore cardiorespiratory monitors to assess respiratory rate (RR), heart rate (HR) and heart rate variability (HRV) throughout the 4 10-minute study periods: Baseline (both practitioner and subjects read neutral material); non-tactile-LKM (subjects read while the practitioner practiced LKM while pretending to read); tactile-LKM (subjects rested while the practitioner practiced LKM while lightly touching the subject on arms, shoulders, hands, feet, and legs); Post-Intervention Rest (subjects rested; the practitioner read). To assess blinding, subjects were asked after the interventions what the practitioner was doing during each period (reading, touch, or something else).

Results: Subjects' mean age was 43.6 years; all were women. Blinding was maintained and the practitioner was able to maintain meditation for both tactile and non-tactile LKM interventions as reflected in significantly reduced RR. Despite blinding, subjects' VAS scores improved from baseline to post-intervention for stress (5.5 vs. 2.2), relaxation (3.8 vs. 8.8) and peacefulness (3.8 vs. 9.0, P < 0.05 for all comparisons). Subjects also had significant reductions in RR (P < 0.0001) and improved HRV (P < 0.05) with both tactile and non-tactile LKM.

Conclusion: It is possible to test the effects of LKM with tactile and non-tactile blinding strategies; even with blinding in this small preliminary study, subjects reported significant improvements in well-being which were reflected in objective physiologic measures of autonomic activity. Extending compassion is not only good care; it may also be good medicine.

Trial registration number: US National ClinicalTrials.gov registration number, NCT01428674.

Figures

Figure 1
Figure 1
Study Visit. LKM- Lovingkindness meditation VAS- visual analog scales for stress, relaxation, peacefulness NVCC - Non-verbal communication of compassion.
Figure 2
Figure 2
Average RR for Practitioner (blue) and Subjects (red) during Non-tactile NVCC over 10 minute intervention (40 15 second averages). Correlation, r = 0.55, P < 0.001.

References

    1. Lane RD, Waldstein SR, Chesney MA, Jennings JR, Lovallo WR, Kozel PJ, Rose RM, Drossman DA, Schneiderman N, Thayer JF, Cameron OG. The rebirth of neuroscience in psychosomatic medicine, Part I: historical context, methods, and relevant basic science. Psychosom Med. 2009;71:117–134. doi: 10.1097/PSY.0b013e31819783be.
    1. Ong LM, de Haes JC, Hoos AM, Lammes FB. Doctor-patient communication: a review of the literature. Soc Sci Med. 1995;40:903–918. doi: 10.1016/0277-9536(94)00155-M.
    1. Richmond VP, McCroskey JC, Hickson ML. Allyn and Bacon. 7 2001. Nonverbal Behavior in Interpersonal Relations.
    1. Cevasco AM. Effects of the therapist's nonverbal behavior on participation and affect of individuals with Alzheimer's disease during group music therapy sessions. J Music Ther. 2010;47:282–299.
    1. Street RL, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician-patient communication to health outcomes. Patient Educ Couns. 2009;74:295–301. doi: 10.1016/j.pec.2008.11.015.
    1. Campenni CE, Crawley EJ, Meier ME. Role of suggestion in odor-induced mood change. Psychol Rep. 2004;94:1127–1136.
    1. Goffaux P, Redmond WJ, Rainville P, Marchand S. Descending analgesia--when the spine echoes what the brain expects. Pain. 2007;130:137–143. doi: 10.1016/j.pain.2006.11.011.
    1. Kong J, Kaptchuk TJ, Polich G, Kirsch I, Vangel M, Zyloney C, Rosen B, Gollub RL. An fMRI study on the interaction and dissociation between expectation of pain relief and acupuncture treatment. Neuroimage. 2009;47:1066–1076. doi: 10.1016/j.neuroimage.2009.05.087.
    1. Kong J, Kaptchuk TJ, Polich G, Kirsch I, Vangel M, Zyloney C, Rosen B, Gollub R. Expectancy and treatment interactions: a dissociation between acupuncture analgesia and expectancy evoked placebo analgesia. Neuroimage. 2009;45:940–949. doi: 10.1016/j.neuroimage.2008.12.025.
    1. Kong J, Gollub RL, Rosman IS, Webb JM, Vangel MG, Kirsch I, Kaptchuk TJ. Brain activity associated with expectancy-enhanced placebo analgesia as measured by functional magnetic resonance imaging. J Neurosci. 2006;26:381–388. doi: 10.1523/JNEUROSCI.3556-05.2006.
    1. Moerman DE, Jonas WB. Toward a research agenda on placebo. Adv Mind Body Med. 2000;16:33–46.
    1. Neumann M, Edelhauser F, Kreps GL, Scheffer C, Lutz G, Tauschel D, Visser A. Can patient-provider interaction increase the effectiveness of medical treatment or even substitute it?--an exploration on why and how to study the specific effect of the provider. Patient Educ Couns. 2010;80:307–314. doi: 10.1016/j.pec.2010.07.020.
    1. Moerman D. Doctors and patients: the role of clinicians in the placebo effect. Adv Mind Body Med. 2003;19:14–22.
    1. Sibinga EM, Kemper KJ. Complementary, holistic, and integrative medicine: meditation practices for pediatric health. Pediatr Rev. 2010;31:e91–e103. doi: 10.1542/pir.31-12-e91.
    1. Baron Short E, Kose S, Mu Q, Borckardt J, Newberg A, George MS, Kozel FA. Regional Brain Activation During Meditation Shows Time and Practice Effects: An Exploratory FMRI Study. Evid Based Complement Alternat Med. 2007.
    1. Holzel BK, Ott U, Gard T, Hempel H, Weygandt M, Morgen K, Vaitl D. Investigation of mindfulness meditation practitioners with voxel-based morphometry. Soc Cogn Affect Neurosci. 2008;3:55–61.
    1. Luders E, Toga AW, Lepore N, Gaser C. The underlying anatomical correlates of long-term meditation: larger hippocampal and frontal volumes of gray matter. Neuroimage. 2009;45:672–678. doi: 10.1016/j.neuroimage.2008.12.061.
    1. Engstrom M, Pihlsgard J, Lundberg P, Soderfeldt B. Functional magnetic resonance imaging of hippocampal activation during silent mantra meditation. J Altern Complement Med. 2010;16:1253–1258. doi: 10.1089/acm.2009.0706.
    1. Engstrom M, Soderfeldt B. Brain activation during compassion meditation: a case study. J Altern Complement Med. 2010;16:597–599. doi: 10.1089/acm.2009.0309.
    1. Kemper KJ, Fletcher NB, Hamilton CA, McLean TW. Impact of healing touch on pediatric oncology outpatients: pilot study. J Soc Integr Oncol. 2009;7:12–18.
    1. Kemper KJ, Hamilton C, Atkinson M. Heart Rate Variability: Impact of Differences in Outlier Identification and Management Strategies on Common Measures in Three Clinical Populations. Pediatr Res. 2007.
    1. Kemper KJ, Hamilton CA, McLean TW, Lovato J. Impact of music on pediatric oncology outpatients. Pediatr Res. 2008;64:105–109. doi: 10.1203/PDR.0b013e318174e6fb.
    1. Kemper KWCR, Yard B, Cohen DG, McLean T, Atkinson M. Heart rate variability in pediatric patients with leukemia: a brief report. J Cancer Int Med. 2004;2:137–143.
    1. Tang R, Tegeler C, Larrimore D, Cowgill S, Kemper KJ. Improving the Well-Being of Nursing Leaders Through Healing Touch Training. J Altern Complement Med. 2010;16:837–841. doi: 10.1089/acm.2009.0558.
    1. Travis F. Autonomic and EEG patterns distinguish transcending from other experiences during Transcendental Meditation practice. Int J Psychophysiol. 2001;42:1–9. doi: 10.1016/S0167-8760(01)00143-X.
    1. Lutz A, Brefczynski-Lewis J, Johnstone T, Davidson RJ. Regulation of the neural circuitry of emotion by compassion meditation: effects of meditative expertise. PLoS One. 2008;3:e1897. doi: 10.1371/journal.pone.0001897.
    1. Hutcherson CA, Seppala EM, Gross JJ. Loving-kindness meditation increases social connectedness. Emotion. 2008;8:720–724.
    1. Barnhofer T, Chittka T, Nightingale H, Visser C, Crane C. State Effects of Two Forms of Meditation on Prefrontal EEG Asymmetry in Previously Depressed Individuals. Mindfulness (N Y) 2010;1:21–27.
    1. Carson JW, Keefe FJ, Lynch TR, Carson KM, Goli V, Fras AM, Thorp SR. Loving-kindness meditation for chronic low back pain: results from a pilot trial. J Holist Nurs. 2005;23:287–304. doi: 10.1177/0898010105277651.
    1. Fredrickson BL, Cohn MA, Coffey KA, Pek J, Finkel SM. Open hearts build lives: positive emotions, induced through loving-kindness meditation, build consequential personal resources. J Pers Soc Psychol. 2008;95:1045–1062.
    1. Feldman G, Greeson J, Senville J. Differential effects of mindful breathing, progressive muscle relaxation, and loving-kindness meditation on decentering and negative reactions to repetitive thoughts. Behav Res Ther. 2010;48:1002–1011. doi: 10.1016/j.brat.2010.06.006.
    1. Lutz A, Greischar LL, Perlman DM, Davidson RJ. BOLD signal in insula is differentially related to cardiac function during compassion meditation in experts vs. novices. Neuroimage. 2009;47:1038–1046. doi: 10.1016/j.neuroimage.2009.04.081.
    1. Tloczynski J, Santucci A, Astor-Stetson E. Perception of visual illusions by novice and longer-term meditators. Percept Mot Skills. 2000;91:1021–1026.
    1. Morse DR, Martin JS, Furst ML, Dubin LL. A physiological and subjective evaluation of meditation, hypnosis, and relaxation. Psychosom Med. 1977;39:304–324.
    1. Ditto B, Eclache M, Goldman N. Short-term autonomic and cardiovascular effects of mindfulness body scan meditation. Ann Behav Med. 2006;32:227–234. doi: 10.1207/s15324796abm3203_9.
    1. Peng CK, Henry IC, Mietus JE, Hausdorff JM, Khalsa G, Benson H, Goldberger AL. Heart rate dynamics during three forms of meditation. Int J Cardiol. 2004;95:19–27. doi: 10.1016/j.ijcard.2003.02.006.
    1. Peng CK, Mietus JE, Liu Y, Khalsa G, Douglas PS, Benson H, Goldberger AL. Exaggerated heart rate oscillations during two meditation techniques. Int J Cardiol. 1999;70:101–107. doi: 10.1016/S0167-5273(99)00066-2.
    1. Peressutti C, Martin-Gonzalez JM, J MG-M, Mesa D. Heart rate dynamics in different levels of Zen meditation. Int J Cardiol. 2010;145:142–146. doi: 10.1016/j.ijcard.2009.06.058.
    1. Telles S, Nagarathna R, Nagendra HR. Autonomic changes while mentally repeating two syllables--one meaningful and the other neutral. Indian J Physiol Pharmacol. 1998;42:57–63.
    1. Wu SD, Lo PC. Cardiorespiratory phase synchronization during normal rest and inward-attention meditation. Int J Cardiol. 2010;141:325–328. doi: 10.1016/j.ijcard.2008.11.137.
    1. Bartoli A, Bystrzycka E, Guz A, Jain SK, Noble MI, Trenchard D. Studies of the pulmonary vagal control of central respiratory rhythm in the absence of breathing movements. J Physiol. 1973;230:449–465.
    1. LaFramboise WA, Woodrum DE, Guthrie RD. Influence of vagal activity on the neonatal ventilatory response to hypoxemia. Pediatr Res. 1985;19:903–907. doi: 10.1203/00006450-198509000-00006.
    1. Gotoh S, Sun G, Kagawa M, Matsui T. A novel stress monitoring method through stress-induced respiratory alterations: non-contact measurement of respiratory V(T)/T(I) alterations induced by stressful sound using a 10 GHz microwave radar. Journal of medical engineering & technology. 2011.
    1. Costanzo LS. Philadelphia: Lippincott, Williams, and Wilkins. 5 2010. BRS Physiology.
    1. Stein PK, Bosner MS, Kleiger RE, Conger BM. Heart rate variability: a measure of cardiac autonomic tone. Am Heart J. 1994;127:1376–1381. doi: 10.1016/0002-8703(94)90059-0.
    1. Heart rate variability. standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93:1043–1065.
    1. Sgoifo A, de Boer SF, Westenbroek C, Maes FW, Beldhuis H, Suzuki T, Koolhaas JM. Incidence of arrhythmias and heart rate variability in wild-type rats exposed to social stress. Am J Physiol. 1997;273:H1754–1760.
    1. Laitinen T, Hartikainen J, Niskanen L, Geelen G, Lansimies E. Sympathovagal balance is major determinant of short-term blood pressure variability in healthy subjects. Am J Physiol. 1999;276:H1245–1252.
    1. Travis F, Olson T, Egenes T, Gupta HK. Physiological patterns during practice of the Transcendental Meditation technique compared with patterns while reading Sanskrit and a modern language. Int J Neurosci. 2001;109:71–80. doi: 10.3109/00207450108986526.
    1. Wu SD, Lo PC. Inward-attention meditation increases parasympathetic activity: a study based on heart rate variability. Biomed Res. 2008;29:245–250. doi: 10.2220/biomedres.29.245.
    1. Sibinga EM, Kemper KJ. Complementary, holistic, and integrative medicine: meditation practices for pediatric health. Pediatr Rev. 2010;31:e91–103. doi: 10.1542/pir.31-12-e91.
    1. Yu X, Fumoto M, Nakatani Y, Sekiyama T, Kikuchi H, Seki Y, Sato-Suzuki I, Arita H. Activation of the anterior prefrontal cortex and serotonergic system is associated with improvements in mood and EEG changes induced by Zen meditation practice in novices. Int J Psychophysiol. 2011.
    1. Pace TW, Negi LT, Adame DD, Cole SP, Sivilli TI, Brown TD, Issa MJ, Raison CL. Effect of compassion meditation on neuroendocrine, innate immune and behavioral responses to psychosocial stress. Psychoneuroendocrinology. 2009;34:87–98. doi: 10.1016/j.psyneuen.2008.08.011.
    1. Benedetti F, Lanotte M, Lopiano L, Colloca L. When words are painful: unraveling the mechanisms of the nocebo effect. Neuroscience. 2007;147:260–271. doi: 10.1016/j.neuroscience.2007.02.020.
    1. Critchley HD. Psychophysiology of neural, cognitive and affective integration: fMRI and autonomic indicants. Int J Psychophysiol. 2009;73:88–94. doi: 10.1016/j.ijpsycho.2009.01.012.
    1. de Vignemont F, Singer T. The empathic brain: how, when and why? Trends Cogn Sci. 2006;10:435–441. doi: 10.1016/j.tics.2006.08.008.
    1. Nummenmaa L, Hirvonen J, Parkkola R, Hietanen JK. Is emotional contagion special? An fMRI study on neural systems for affective and cognitive empathy. Neuroimage. 2008;43:571–580. doi: 10.1016/j.neuroimage.2008.08.014.
    1. Parkinson B, Simons G. Affecting others: social appraisal and emotion contagion in everyday decision making. Pers Soc Psychol Bull. 2009;35:1071–1084. doi: 10.1177/0146167209336611.
    1. Cattaneo L, Rizzolatti G. The mirror neuron system. Arch Neurol. 2009;66:557–560. doi: 10.1001/archneurol.2009.41.
    1. Bastiaansen JA, Thioux M, Keysers C. Evidence for mirror systems in emotions. Philos Trans R Soc Lond B Biol Sci. 2009;364:2391–2404. doi: 10.1098/rstb.2009.0058.
    1. Leslie KR, Johnson-Frey SH, Grafton ST. Functional imaging of face and hand imitation: towards a motor theory of empathy. Neuroimage. 2004;21:601–607. doi: 10.1016/j.neuroimage.2003.09.038.
    1. Singer T, Seymour B, O'Doherty J, Kaube H, Dolan RJ, Frith CD. Empathy for pain involves the affective but not sensory components of pain. Science. 2004;303:1157–1162. doi: 10.1126/science.1093535.
    1. Preston SD, de Waal FB. Empathy: Its ultimate and proximate bases. Behav Brain Sci. 2002;25:1–20. discussion 20-71.
    1. Harris JC. Social neuroscience, empathy, brain integration, and neurodevelopmental disorders. Physiol Behav. 2003;79:525–531. doi: 10.1016/S0031-9384(03)00158-6.
    1. Le Bel RM, Pineda JA, Sharma A. Motor-auditory-visual integration: The role of the human mirror neuron system in communication and communication disorders. J Commun Disord. 2009;42:299–304. doi: 10.1016/j.jcomdis.2009.03.011.
    1. Yang TT, Simmons AN, Matthews SC, Tapert SF, Bischoff-Grethe A, Frank GK, Arce E, Paulus MP. Increased amygdala activation is related to heart rate during emotion processing in adolescent subjects. Neurosci Lett. 2007;428:109–114. doi: 10.1016/j.neulet.2007.09.039.
    1. Sauter DA, Eisner F, Ekman P, Scott SK. Cross-cultural recognition of basic emotions through nonverbal emotional vocalizations. Proc Natl Acad Sci USA. 2010;107:2408–2412. doi: 10.1073/pnas.0908239106.
    1. Baird AD, Scheffer IE, Wilson SJ. Mirror neuron system involvement in empathy: A critical look at the evidence. Soc Neurosci. 2011. pp. 1–9.
    1. Hooker CI, Verosky SC, Germine LT, Knight RT, D'Esposito M. Neural activity during social signal perception correlates with self-reported empathy. Brain Res. 2010;1308:100–113.
    1. Travis F, Shear J. Focused attention, open monitoring and automatic self-transcending: Categories to organize meditations from Vedic, Buddhist and Chinese traditions. Conscious Cogn. 2010;19:1110–1118. doi: 10.1016/j.concog.2010.01.007.
    1. Bernardi L, Sleight P, Bandinelli G, Cencetti S, Fattorini L, Wdowczyc-Szulc J, Lagi A. Effect of rosary prayer and yoga mantras on autonomic cardiovascular rhythms: comparative study. Bmj. 2001;323:1446–1449. doi: 10.1136/bmj.323.7327.1446.
    1. Brefczynski-Lewis JA, Lutz A, Schaefer HS, Levinson DB, Davidson RJ. Neural correlates of attentional expertise in long-term meditation practitioners. Proc Natl Acad Sci USA. 2007;104:11483–11488. doi: 10.1073/pnas.0606552104.
    1. Kaul P, Passafiume J, Sargent CR, O'Hara BF. Meditation acutely improves psychomotor vigilance, and may decrease sleep need. Behav Brain Funct. 2010;6:47.
    1. Wenck LS, Leu PW, D'Amato RC. Evaluating the efficacy of a biofeedback intervention to reduce children's anxiety. J Clin Psychol. 1996;52:469–473. doi: 10.1002/(SICI)1097-4679(199607)52:4<469::AID-JCLP13>;2-E.
    1. Astin JA. Mind-body therapies for the management of pain. Clin J Pain. 2004;20:27–32. doi: 10.1097/00002508-200401000-00006.

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