Compassion — At the Core of Social Work: A New Science Emerges
By Dan Orzech
Social Work Today
Vol. 6 No. 2 P. 20

Does research on the brain’s response to compassion have positive implications for deepening client connections and preventing compassion fatigue?

“My religion,” the Dalai Lama once remarked, “is kindness.” Whether we use the Dalai Lama’s term for it or call it compassion, empathy, emotional warmth, prosocial behavior, or altruism, this universal human trait is an essential part of social work practice.

Nevertheless, compassion isn’t necessarily well understood. In recent years, a growing number of researchers—some of them in unexpected disciplines such as neuroscience—have focused on the subject, shedding new light on our fundamental nature as social beings, as well as the role compassion plays in the helping professions.

At the University of Wisconsin-Madison, neuroscientist Richard Davidson, PhD, is using electroencephalograms and functional MRIs to study the brains of colleagues of the Dalai Lama—Buddhist monks with decades of meditation experience—as well as those of ordinary people to build an unexpected picture of compassion and the human brain.

When Davidson showed people a picture of an injured baby, for example, and asked them to wish the child to be free of suffering, their brains showed a burst of activity in parts of the prefrontal cortex associated with positive emotions. Other brain regions involved in emotion, such as the amygdala and the insula, also showed higher levels of activity.

Davidson also played the monks a brief recording of a woman screaming. “What we find, remarkably,” he told a recent conference of scientists and meditators, “is a decrease in an area of the brain that is specifically associated with the self. This is an area of the brain that gets activated when people think about themselves. If you give a person an adjective, and you ask them, does this adjective describe you, that area of the brain becomes very active.”

Surprisingly, one of the brain regions that shows the most activation when people are in a state of compassion is the striatum, a brain region associated with motor activity.

After speaking with the monks, however, Davidson realized that the compassion meditation may be training them to be “utterly prepared” to act. “It’s a kind of state of heightened preparation,” he says.

Davidson has also found that monks engaged in a form of meditation known as loving-kindness meditation, which invokes feelings of unconditional compassion for all creatures, produce a specific pattern of synchronized electrical activity known as gamma waves. Beginner meditators doing the same meditation produced a much weaker gamma signal.

This suggests that not only can compassion be learned, Davidson says, but that the brain changes in response to doing so. That’s in tune with a concept that is receiving growing acceptance in the neurosciences: neuroplasticity, or the idea that the brain can change in response to experience and training. “Positive qualities like happiness and compassion,” says Davidson, are not fixed characteristics. “We are not indelibly fixed in our current state, but rather, these are characteristics that can be transformed.”

The Seat of Compassion: The Vagus Nerve?
While Davidson focuses on the regions of the brain involved in compassion, Dacher Keltner, PhD, believes that the seat of compassion may just lie somewhere else: the vagus nerve.

Keltner is a professor of psychology at the University of California, Berkeley, and coeditor of Greater Good, a magazine about prosocial behavior such as compassion and forgiveness. For the past several years, he has been examining the novel hypothesis that the vagus nerve—a bundle of nerves that emerges out of the brain stem and wanders throughout the body, connecting to the lungs, heart, and digestive system, among other areas—is related to prosocial behavior such as caring for others and connecting with other people.

The vagus nerve is considered part of the parasympathetic branch of the autonomic nervous system. That means it’s involved in relaxation and calming the body down—the opposite of the “fight or flight” arousal for which the sympathetic branch of the autonomic nervous system is responsible.

Medicine has traditionally focused on the vagus nerve’s role in controlling things such as breathing, heart rate, kidney function, and digestion. But researchers lately have experimented with stimulating the vagus nerve to treat epilepsy as well as drug-resistant cases of clinical depression (see sidebar). Keltner has been exploring the idea that the vagus nerve—which is unique to mammals—is part of an attachment response. Mammals, he says, “attach to their offspring, and the vagus nerve helps us do that.”

Researchers have already found that children with high levels of vagal activity are more resilient, can better handle stress, and get along better with peers than children with lower vagal tone.

In his laboratory, Keltner has found that the level of activity in people’s vagus nerve correlates with how warm and friendly they are to other people. Interestingly, it also correlates with how likely they are to report having had a spiritual experience during a six-month follow-up period.

And, says Keltner, vagal tone is correlated with how much compassion people feel when they’re presented with slides showing people in distress, such as starving children or people who are wincing or showing a facial expression of suffering.

Among other things, Keltner is interested in the implications of these findings for human evolution.

“Much of the scientific research so far on emotions,” he says, “has focused on negative emotions like anger, fear, or disgust”—what Keltner calls the “fight or flight” emotions.

“We tend to assume,” says Keltner, “that evolution produced just these fight/flight tendencies, but it may have also produced a biologically based tendency to be good to other people and to sacrifice self-interest. Evolutionary thought is increasingly arising at the position that the defining characteristic of human evolution is our sociality. We are constantly cooperating, constantly doing things in interdependent fashion, and constantly embedded in relationships. From an evolutionary perspective, that suggests that we should have a set of emotions that help us do that work.”

Compassion in Action
While Buddhist monks may develop a deep sense of compassion through years of disciplined meditation practice, the same techniques can also be useful in clinical practice.

Myra Weiss, DSW, is a social worker in New York City who teaches Mindfulness-Based Stress Reduction, an approach to meditation and yoga originally developed by Jon Kabat-Zinn at the University of Massachusetts Medical School. As part of her classes, Weiss teaches her students the same loving-kindness meditation practiced by the monks in Davidson’s laboratory.

She also applies it in her own therapy practice. Your compassion, she says, “connects you [to your client]. And compassion, or unconditional acceptance, is understanding that people are the only place they could be at the moment considering how their life has gone until now.”

Weiss brings a sense of compassion not only to her clients, but to herself. It begins the moment she meets a client for the first time. “I try to monitor what’s happening for me, as well as what’s going on for this person, even as we walk into the room,” she says. “Is the person feeling shame or feeling anxious? How is that touching me, and what’s my response to it?”

The ability to have compassion for oneself is essential for her clients as well, Weiss says. “A question that always comes up for me as the case goes on is how much self-compassion has the client allowed himself or herself. Learning to allow oneself compassion is an important part of therapy,” she says.

But compassion, Weiss says, “must also be balanced with wisdom.” In her work with cases that involved domestic violence and child abuse, for example, compassion and empathy were essential, but so were limit setting and challenging. “There was challenging with caring,” she says, “but there was challenging.”

Just Listening
Sometimes compassion takes the form of simply listening. Bruce Lackie, DSW, PhD, is a Philadelphia therapist who frequently works with trauma victims in his clinical practice. A few weeks after Hurricane Katrina devastated the city of New Orleans and surrounding areas, Lackie headed for Louisiana, where he found himself working alongside a group of medical volunteers from Israel as they gave people tetanus and hepatitis vaccinations.

“One of the doctors asked me to just stand at the door and talk to people as they came in,” Lackie says, “because as she was giving them their shots, she would ask them how they were doing, and people would just break down and start crying.”

These were people who had lost everything: homes, businesses, and pets. Their whole world had, overnight, been changed beyond recognition, in ways that are hard for us to imagine, says Lackie. A number of them were fisherman whose families had fished in the area for generations. Not only was the world they were familiar with above ground gone, “but everything they’d learned from childhood on about where the fish were, where the structures in the water to avoid were, where the underwater wrecks were—all that had changed,” he says.

And there was little Lackie could do except listen.

“My role was just as a witness. In the few moments I had with people, I was not going to bring any great therapeutic intervention to anybody,” Lackie says. “With a few people, I did suggest that once they got settled they try to hook up with somebody to talk about the experience. But at that early stage, you don’t really do debriefing, because people are still in shock.”

Many people Lackie encountered in Louisiana had faced the terrible choice of having to abandon their pets or not being rescued. “They couldn’t take the animals on the boats or the buses,” he says. “There was a sense of absolute helplessness.”

Those are the sorts of dilemmas Lackie helps people work with in his clinical practice. At the core of trauma are “impossible choices or impossible dilemmas that get frozen and stuck away,” he says. “The job of a trauma therapist is to delicately unfold the layers that protect the person from their own impossible dilemmas.”

With post-traumatic stress disorder (PTSD), he says, “there’s hyper-vigilance, there’s hyper-arousal, but there’s also avoidance. You avoid the things that are so painful that you can’t bear to be there. The therapist’s job is to make it safe for the person to revisit the places where they least want to go.”

To make it possible for that to take place, compassion is essential. “The therapist must be able to stay present with the sadness and helplessness, and have the compassion to not impose anything on the client,” says Lackie. That’s one reason Lackie likes working with Eye Movement Desensitization and Reprocessing. “It’s self-directed,” he says, “so you’re not imposing anything.”

The trauma therapist’s compassion, says Lackie, helps allow the person “to feel compassion for the frozen part of the self that’s still stuck in that impossible situation.”

The Cost of Caring
But therapists and others who help people in distress face a risk in doing this work: absorbing the trauma of those they are helping and become traumatized themselves. This secondary trauma, or compassion fatigue, can look at lot like PTSD, says Charles Figley, PhD, a professor of social work at Florida State University, and author of the book Compassion Fatigue.

One sign that people in the helping professions are experiencing compassion fatigue, says Figley, is if they start losing their sense of humor. They can also have “flashbacks about their patients, as well as dreams about the experiences related to them by their patients. They find themselves attempting to push away those experiences and not think about them, but yet they come back.”

As a result, people experiencing compassion fatigue tend to lose their enthusiasm about their work and even come to dread it. Compassion fatigue, however, is not the same as burnout. “You can be satisfied with your job, with your supervisor, with your pay,” says Figley, “and still experience compassion fatigue.”

While the notion of compassion fatigue seems to be common sense, “the concept of secondary traumatic stress reactions, or compassion fatigue, hasn’t been around for a long time,” says Figley. “We haven’t really thought about the idea that we are vulnerable to being traumatized ourselves when we work with a traumatized population.”

Figley recently finished a study on social workers in New York City following 9/11, which demonstrated that those who worked with traumatized people were more likely to show signs of trauma than those who didn’t work with traumatized people. What’s more, Figley found that the greater the exposure to client’s trauma, the higher the level of compassion fatigue.

The problem, Figley believes, is not only that social workers can easily neglect their own needs, leaving them vulnerable to compassion fatigue, but that they are not being trained to attend to their own needs, he says.

The social work profession—and social work educators—“need to take this seriously,” says Figley, “or we’re going to lose the most sensitive and caring people.”

— Dan Orzech is a Philadelphia-based freelance writer and editor of “Mindfulness Update,” a newsletter for mindfulness-based stress reduction practitioners.

Vagus Nerve Stimulation Therapy
Vagus nerve stimulation (VNS) therapy involves implanting a small pacemaker-like device under the skin in the chest area that sends mild pulses to the brain via the vagus nerve in the neck. A thin, thread-like wire, attached to the generator, runs under the skin to the left vagus nerve. The vagus nerve, one of the 12 cranial nerves, serves as the body’s “information highway” connecting the brain to many major organs. Several studies have shown that VNS therapy may modulate neurotransmitters such as serotonin and norepinephrine thought to be involved in mood regulation.

VNS therapy was approved in July 2005 by the FDA as a long-term adjunctive treatment for patients aged 18 and older with major depression who have not had an adequate response to four or more adequate antidepressant treatments. VNS therapy was approved for the treatment of pharmacoresistant epilepsy in 1997 and is now the first treatment specifically studied and approved for treatment-resistant depression (TRD).

In clinical studies of VNS therapy, more than one half of the patients who had experienced an average of 25 years of major depressive disorder and multiple treatment trials realized some clinical benefit, approximately 40% of the patients had at least a 50% improvement in their depression, and one of six were depression free after one year and two years of treatment with VNS therapy. Patients also reported significant improvements in quality-of-life areas, such as vitality, mental health, emotional well-being, and social functioning.

“Patients with TRD clearly need additional treatment options. The availability of VNS therapy is an important new option for people who, until now, have not had access to a long-term treatment for controlling depressive symptoms,” says John P. O’Reardon, MD, assistant professor of psychiatry at the University of Pennsylvania School of Medicine and director of Penn’s Treatment Resistant Depression Clinic. “It is especially important to know that clinical study results indicate that patients achieve increasing benefits from VNS therapy over time and that the improvement appears to sustain well. Additionally, VNS therapy is quite tolerable, and side effects typically diminish over time,” says O’Reardon.

— Source: University of Pennsylvania Health System