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Buddhist-Derived Loving-Kindness and Compassion Meditation for the Treatment of Psychopathology: a Systematic Review

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Mindfulness DOI 10.1007/s12671-014-0368-1 ORIGINAL PAPER Buddhist-Derived Loving-Kindness and Compassion Meditation for the Treatment of Psychopathology: a Systematic Review Edo Shonin & William Van Gordon & Angelo Compare & Masood Zangeneh & Mark D. Griffiths # Springer Science+Business Media New York 2014 Abstract Although clinical interest has predominantly fo- approach is recommended whereby issues encountered during cused on mindfulness meditation, interest into the clinical the (ongoing) operationalization of mindfulness interventions utility of Buddhist-derived loving-kindness meditation are duly considered. In particular, there is a need to establish (LKM) and compassion meditation (CM) is also growing. accurate working definitions for LKM and CM. This paper follows the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines and provides Keywords Loving-kindness meditation . Compassion an evaluative systematic review of LKM and CM intervention meditation . Mindfulness . Psychopathology . studies. Five electronic academic databases were systemati- Buddhist-derived interventions cally searched to identify all intervention studies assessing changes in the symptom severity of Diagnostic and Statistical Manual of Mental Disorders (text revision fourth edition) Axis I disorders in clinical samples and/or known Introduction concomitants thereof in subclinical/healthy samples. The comprehensive database search yielded 342 papers and 20 Buddhist-derived meditation practices are increasingly being studies (comprising a total of 1,312 participants) were eligible employed in the treatment of psychopathology. Throughout for inclusion. The Quality Assessment Tool for Quantitative the last two decades, clinical interest has predominantly fo- Studies was then used to assess study quality. Participants cused on mindfulness meditation, and specific mindfulness demonstrated significant improvements across five interventional approaches are increasingly being advocated psychopathology-relevant outcome domains: (i) positive and and/or employed in the treatment of psychiatric disorders negative affect, (ii) psychological distress, (iii) positive think- (see, for example, American Psychiatric Association (2010) ing, (iv) interpersonal relations, and (v) empathic accuracy. It and National Institute for Health and Clinical Excellence is concluded that LKM and CM interventions may have utility (NICE) (2009) practice guidelines for the treatment of depres- for treating a variety of psychopathologies. However, to over- sion). However, in the last 10 years, there has also been a come obstacles to clinical integration, a lessons-learned growth of interest into the clinical utility of other Buddhist meditative techniques (Shonin et al. 2014a). Of particular significance are novel interventions that integrate meditative E. Shonin (*) : W. Van Gordon : M. D. Griffiths techniques known as loving-kindness meditation (LKM) Psychology Division, Nottingham Trent University, and compassion meditation (CM). Studies of LKM and CM Nottinghamshire, UK NG1 4BU interventions have demonstrated a broad range of e-mail: [email protected] psychopathology-related salutary outcomes that include im- A. Compare provements in the following (for example): (i) schizophrenia Faculty of Human and Social Sciences, University of Bergamo, symptomatology (Johnson et al. 2011); (ii) positive and neg- Bergamo, Italy ative affect (May et al. 2012); (iii) depression, anxiety, and stress (Van Gordon et al. 2013); (iv) anger regulation (Carson M. Zangeneh Factor-Inwentash, Faculty of Social Work, University of Toronto, et al. 2005); (v) personal resources (Fredrickson et al. 2008); Toronto, ON, Canada (vi) the accuracy and encoding of social-relevant stimuli Mindfulness (Mascaro et al. 2013a, b); and (vii) affective processing ultimate aim (for a discussion of the different types of suffer- (Desbordes et al. 2012). ing in Buddhism, see Van Gordon et al. 2014b). Buddhist CM is described in the psychological literature as the practitioners who adopt and act upon such an attitude are meditative development of affective empathy as part of the known as bodhisattvas (for more a detailed description of visceral sharing of others’ suffering (Shamay-Tsoory 2011). bodhichitta and the bodhisattva’s way of life, see Shantideva LKM is more concerned with the meditative cultivation of a 1997). According to Shonin et al. (2014c), dedicating one’s feeling of love for all beings (Lee et al. 2012). Depending on life (and future lives) to alleviating the suffering of others whether they are practising LKM or CM, the meditation represents a “win-win” scenario because it not only helps practitioner first establishes themselves in meditative absorp- other beings both materially and spiritually but it also causes tion and then intentionally directs either compassionate (CM) the meditation practitioner to assume a humble demeanour or altruistic/loving (LKM) feelings towards a specific individ- that is essential for (i) dismantling attachment to the “self,” ual, group of individuals (which can also include sentient and (ii) acquiring spiritual wisdom (for a discussion of the beings in general), and/or situation, and has conviction that meaning of wisdom in Buddhism, see Shonin et al. 2014a). they are tangibly enhancing the well-being of the person or According to Buddhist thought, the wisdom deficit or igno- persons concerned (Shonin et al. 2014c). Although CM and rance that arises from being attached to an inherently existing LKM interventions in clinical contexts are typically delivered self is the underlying cause of all forms of suffering, including using a secular format (i.e., without the explicit use of the entire spectrum of psychological disorders (Shonin et al. Buddhist terminology), the manner in which CM and LKM 2014a). techniques are operationalized in clinical settings is still rea- One of the most common CM/LKM techniques employed sonably closely aligned with the traditional Buddhist model. in clinical settings derives from the Tibetan lojong (meaning mind training) Buddhist teachings (Shonin et al. 2014c). The Buddhist Construction of Loving-Kindness and Compassion lojong teachings are practiced within each of the four primary Tibetan Buddhist traditions (i.e., the Nyingma, Gelug, Kagyu, Within Buddhism, loving-kindness (Sanskrit, maitrī)isde- and Sakya) and include instructions on a meditation technique fined as the wish for all sentient beings to have happiness and known as tonglen (meaning giving and taking or sending and its causes (Bodhi 1994). Compassion (Sanskrit, karunā)is receiving). Tonglen involves synchronizing the visualization defined as the wish for all sentient beings to be free from practice of taking others’ suffering (i.e., compassion) and giv- suffering and its causes. In conjunction with “joy” (Sanskrit, ing one’s own happiness (i.e., loving-kindness) with the in- muditā) and “equanimity” (Sanskrit, upeksā), loving-kindness breath and out-breath, respectively (Sogyal Rinpoche 1998). In and compassion make up what are collectively known as the this manner and according to Buddhist theory, the regular “four immeasurable attitudes” (Sanskrit, catvāri process of breathing in and out becomes spiritually productive brahmaviharas). Although in Buddhist meditation the four and functions as a meditative referent that facilitates the main- immeasurable attitudes are often generated and then emanated tenance of meditative and altruistic/compassionate awareness to other sentient beings one at a time, each attitude is deeply throughout daily activities (Shonin et al. 2014c). connected to, and reliant upon, the others. For example, the As elucidated above, compassion and loving-kindness help immeasurable attitude of joy highlights the Buddhist view that to foster spiritual wisdom, but their effective cultivation is also genuine loving-kindness and compassion can only develop in dependent upon it. In other words, compassion and loving- amindthatis“well-soaked” in meditative bliss, and that has kindness facilitate wisdom acquisition and wisdom in-turn transmuted both gross and subtle forms of ego-attachment facilitates the development of compassion and loving- (Khyentse 2007). Likewise, given the objective is to distribute kindness (Dalai Lama 2001). This spiritual wisdom or insight loving-kindness and/or compassion in equal and unlimited that develops in conjunction with compassion and loving- measures to all sentient beings, the immeasurable attitude of kindness is believed to play a vital role in bringing the med- equanimity emphasizes the need for total impartiality in one’s itation practitioner to the understanding that while compassion regard for others (for a detailed discussion of the four immea- and loving-kindness arise from the wish for others to have surable attitudes, see Nanamoli 1979). happiness and be free of suffering, the prospect of an individ- While the practices of compassion and loving-kindness are ual permanently eliminating the suffering of another individ- integral to all Buddhist traditions, this is particularly the case ual is a fundamental impossibility (Van Gordon et al. 2014b). in Mahayana Buddhist schools (Shonin et al. 2014c). One of Indeed, Buddhism asserts that individuals must take respon- the fundamental principles of Mahayana Buddhism is the sibility for their own spiritual development and that an en- concept of bodhichitta. Bodhichitta is a Sanskrit word that lightened or saintly being can only play a supporting/guiding
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