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Open Access 20-01-2024 | ORIGINAL PAPER

A Brief Compassion Focused Therapy Intervention Can Increase Moral Expansiveness: A Randomized Controlled Trial

Auteurs: James N. Kirby, April Hoang, Charlie R. Crimston

Gepubliceerd in: Mindfulness | Uitgave 2/2024

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Abstract

Objectives

This study investigated whether training in compassion can broaden individuals’ moral circles. In total, 102 participants, including 87 females, took part in a brief seminar on Compassion Focused Therapy (CFT), which is a psychological intervention aimed at cultivating greater levels of compassion.

Method

Participants were randomized to either the CFT intervention (n = 48) or waitlist control group (n = 54). Participant levels of moral expansiveness (moral concern for human, non-human animals, and environmental entities) were measured at pre-intervention, 2 weeks post-intervention, and the CFT group again at 3-month follow-up.

Results

At 2 weeks post-intervention, participants in the CFT group compared to control had significantly increased total moral expansiveness, as well as increases specifically for family and revered sub-groups. At 3-month follow-up, these outcomes improved, with reported moral concern for all sub-groups significantly increasing, including out-groups, stigmatized members of society, animals, plants, and the environment.

Conclusions

The results show promise for how we can expand the boundaries of our moral concern through compassion focused interventions.

Preregistration

The study was preregistered on the Open Science Framework (https://​osf.​io/​z3c9f).
Opmerkingen

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Author Statement

We have submitted two papers using the same sample from the same randomized controlled trial that looked at two different domains. One domain being moral expansiveness, which we examined in this paper. The other paper examined the domain of parenting. Both were pre-registered, with the parenting study pre-registered on the Australia and New Zealand Clinical Trials Registry and this study being registered on the Open Science Framework. All materials, measures, and data are available on the Open Science Framework (https://​osf.​io/​z3c9f). We report on data from the Compassionate Action and Engagement Scale in both papers, but all other measures are different.
Our moral circle, a demarcation of who is worthy of our moral concern and who is not, typically takes shape in a fairly predictable way (Singer 1981; Crimston et al., 2016). We prioritise our family and ingroup, and care much less about those different or distant from us, or for those who have violated social norms. There are important evolutionary reasons for this, given our in-groups tend to be based on genetic and psychological kinship networks (Krebs, 2015), meaning our moral concern is not always evenly dispensed among diverse entities and we tend to favour those in-group ties. Despite this, however, there are moments when our moral priorities may shift. For example, at times of crisis (e.g., natural disasters, humanitarian disasters, pandemics, war), particularly when we have a window into the suffering of others, we may feel a drive to extend concern to those who may typically sit outside of our moral periphery. In these instances, tragedy can be an intervention that powerfully unleashes acts of compassion and moral concern for others (Zaki, 2020), and facilitates the fading away of our more restrictive boundaries. How is this so? A growing body of research has been focused on identifying individual traits and contextual pressures that can predict a more morally expansiveness mindset (Crimston et al., 2016, 2021).
Moral expansiveness includes two key components, (1) how we deem other living entities worthy of our concern, and (2) our perceived personal responsibility to support and protect that position (Crimston et al., 2016). Moral expansiveness can be applied to a diverse range of entities, including humans (e.g., families, strangers) to non-humans (e.g., chimpanzees) and to elements of the natural environment (e.g., plants, ecosystems). Moral expansiveness is different to moral reasoning or moral thinking, with the latter approaches being concerned with how people decide what is morally right in specific situations (Graham et al., 2011), whereas moral expansiveness refers to the number of different and varied entities we consider worthy of our moral concern and treatment. We vary in our moral expansiveness towards these entities, with some having a restricted or narrow mindset, and others having wider mindset, with research finding that a morally expansive mindset predicts prosocial thinking and behavior in adults (Crimston et al., 2016, 2018a) and children (Neldner et al., 2018). To date, research has found that empathy is one of the strongest and reliable predictors to an increased morally expansive mindset (Crimston et al., 2016, 2018a).
Moral expansiveness is also connected to compassion. Compassion is a complex prosocial motive, defined as, “the sensitivity to suffering in self and others, with a commitment to try and alleviate or prevent it” (Gilbert, 2014, p. 19). Unlike empathy, which is a cognitive social process which includes understanding another’s emotions (affective empathy) and perspectives (cognitive empathy; Decety & Cowell, 2014), compassion requires both engaging in suffering and the motivation to reduce that suffering (Decety & Cowell, 2014; Spinrad & Eisenberg, 2017). Despite empathy’s associations with prosocial behavior (Zaki, 2014), our empathic motivations can be biased towards in-groups and those that are similar to oneself (Bloom, 2019). In addition, they can also be used for other motivations, such as competitive self-interest (Loewenstein & Small, 2007). Recent research has also found we most often empathize with positive states (e.g., happiness) rather than negative (Depow et al., 2021). In contrast, the primary function of compassion is to address suffering (Gilbert, 2019). Thus, if identifying mindsets and/or traits tied to the expansion of moral concern, compassion may be the key driver of moral concern towards those in need and in unlocking a morally expansive mindset. Moreover, compassion aims to extend our concern to all sentient beings (e.g., humans, animals), including those we dislike (Kirby et al., 2022), and those from different groups and backgrounds (Gilbert, 2021; Ricard, 2015), and extend our compassion to other living forms such as the environment (e.g., plants). As such, the constructs of compassion and moral expansiveness are conceptually (and empirically; see Crimston et al., 2021) connected.
Research is beginning to examine the ties between compassion, empathy, and moral expansiveness directly. Crimston et al. (2021) found across three studies that empathy and mindfulness were significantly associated with moral expansiveness, but crucially, neither remained a significant predictor once compassion and fears of compassion (i.e., the avoidance or fear response individuals can have towards compassion; Gilbert et al., 2011) were considered. Framed another way, both compassion and fears of compassion predicted significant unique variance in moral expansiveness after more established predictors of moral concern were taken into account (i.e., empathy). These results align with Gilbert’s (2019) approach used in Compassion Focused Therapy (CFT), where he conceptualizes compassion as a motivation and competencies such as mindfulness and empathy can be used to help inform and guide the enactment of the compassionate motivation. Indeed, researchers in secular mindfulness-based approaches are beginning to argue for the introduction of compassion as a key component in mindfulness-based approaches to help promote prosocial behavior (Berry et al., 2020). Critically, research has found that compassion focused interventions can significantly reduce fears of compassion (Matos et al., 2017; Carter et al., 2023), which offers a promising pathway to help grow one’s moral circle. Moreover, given contextual factors can shift how we prioritize others (e.g., inequality; Kirkland et al., 2023), it is equally encouraging to know that interventions might be able to strengthen the resolve of our moral expansiveness during times of hardship, difficulty, or challenge (Gilbert, 2021).
The most direct research examining the links between compassion and morality was by Breines and Chen (2012), who examined self-compassion and past moral transgressions. In this study, 91 participants were asked to recall and write about a past moral transgression (e.g., infidelity, academic misconduct, betrayal of trust, and hurting someone they cared about), in which they experienced feelings of guilt, remorse or regret. The participants were then assigned to a self-compassion (reflect on the event in a compassionate perspective), self-esteem (describe your positive qualities), or a positive distraction control condition (write about a hobby they enjoyed). Results indicated that participants in the self-compassion condition were significantly more motivated to make amends and avoid repeating the transgression in the future compared to both the self-esteem and positive distraction condition. This promising experimental work indicates the potential for self-compassion to facilitate moral growth; however, the targets of this were specific (i.e., past victims of transgressions), and it is unclear whether self-compassion may lead to a general broadening of our moral circles.
Compassion, by definition (Gilbert, 2014), includes both self and others, but it remains unclear whether self-compassion is associated with a morally expansive mindset. Buddhist views suggest that developing compassion towards the self ultimately contributes to being compassionate towards others (Dalai Lama, 1995). Indeed, central to Buddhist teachings is the wish for all sentient beings to be free from suffering and the causes of suffering (Dalai Lama, 1995). Although, self-compassion has numerous benefits at the intrapersonal level (e.g., better individual mental health and wellbeing; Mey et al., 2023), recent work is indicating self-compassion can also have benefits at interpersonal level. For example, Neff and Pommier (2013) found that self-compassion is associated with greater other-focused concern, and Welp and Brown (2014) found that self-compassion predicted greater helping intentions towards a hypothetical person. Randomized controlled trials of self-compassion focused interventions, such as the Mindful Self-Compassion program, have also found that cultivating self-compassion also increased compassion for others at post-intervention compared to a control group (Germer & Neff, 2019). Self-compassion often includes the concept that one is part of common humanity (Neff, 2022), and it could be that identifying as part of a wider common humanity may connect self-compassion to judgments of moral concern for others. Thus, compassion-based interventions, which include practices of self-compassion and compassion towards others, may increase moral concern of others.
Past research has theorized about potential individual difference and contextual factors that might shape moral expansiveness (Crimston et al., 2018b), but no prior work has established if interventions can lead to an increase in moral expansiveness. Rather, tangentially related past work has examined if moral education training leads to improved moral judgment (Schlaefli et al., 1985). However, moral judgment is concerned with how people decide what is morally right in a specific situation, which is different to moral expansiveness (the scope of entities—human, non-human animal, and environmental—deemed worth of moral concern and treatment). Moreover, moral education programs in the 1980s tended to rely heavily on Kohlberg’s theory of morality and required 3–12 weeks of intervention for moral judgment to improve (Schlaefli et al., 1985).
An alternative approach to increasing moral expansiveness could be through compassion training. One such intervention model is Compassion Focused Therapy (CFT), which aims to cultivate compassion to improve intrapersonal and interpersonal wellbeing (Gilbert, 2014; Matos et al., 2022; Kirby & Petrocchi, 2023). CFT is a biopsychosocial, contextual, and evolutionary informed approach to therapy (Gilbert, 2019), and the model has been distilled into a series of different delivery formats, which are commonly skills-based, and these are typically referred to as Compassionate Mind Training (CMT) programs. To date, there have been several randomized controlled trials (RCTs) of CFT, with some as brief as a 2-hr seminar (e.g., Matos et al., 2017), and others spanning eight weekly sessions (Irons & Heriot-Maitland, 2020). One study by Matos et al. (2017) used an RCT design with 93 participants, who were randomized to either a brief 2-hr seminar on compassion focused training or a waitlist control group. After the 2-hr seminar, the participants had an additional 2 weeks to practice the exercises introduced in the seminar. At 2 weeks post-intervention, compared to the control group, participants in the compassion intervention had improved levels of compassion and self-compassion, as well as improved levels of wellbeing.
A core aim in the brief 2-hr compassion focused intervention is to develop a person’s compassionate-self (Matos et al., 2017; Kirby et al., 2017). Specifically, the individual is asked to imagine what it would be like for them to be a deeply compassionate person, imagining how this would influence how they would relate to others, as well as to themselves. Previous research has found this practice alone when practiced over a 2-week period can reduce fears of compassion, and also improve physiology, specifically heart rate variability (Kim et al., 2020a, 2020b). An important component of the compassion-self practice is how it is embodied. Embodiment refers to the way in which the individual perceives they have acted and become their imagined compassionate-self. Matos et al. (2018) examined how perceived embodiment and perceived helpfulness of the compassionate-self practice explained outcomes at post-intervention, finding that the more the compassionate-self was embodied and experienced as being helpful, the better the outcomes for compassion, self-compassion, and wellbeing at post-intervention. Given the links between compassion and self-compassion and the other-focused concern, as well as the prior work establishing a links between compassion and moral expansiveness (Crimston et al., 2021), we expected that CFT might offer a compelling avenue to facilitate a more morally expansive mindset.
The central aim of this study is to build on this foundational work of CFT and to examine the efficacy of CFT at increasing moral expansiveness using an RCT design. This study was part of a larger project focused on parents to determine whether CFT could increase levels of compassion, self-compassion, and moral expansiveness. The CFT intervention was specifically focused only on cultivating compassion for others and for self, with no content on parenting strategies or on morality. We predicted that, compared to the control group, CFT at post-intervention would have increased total moral expansiveness (H1). In addition, we explored whether there would be significant increases in individual moral expansiveness sub-groups, including family, ingroup, outgroup, revered, stigmatized, villains, animals, plants, and environment. We also predicted these changes will continue to improve at three-month follow-up for the intervention condition (H2). Finally, we also predicted that compassion change scores (for self and for others), as well as compassionate embodiment and helpfulness should explain changes to moral expansiveness (H3).

Method

Participants

The aim of this study was to help increase compassion for parents; thus, the criteria for the study included, (1) had at least one child, and (2) be able to attend one of the pre-organized compassion training seminar times. As detailed in the flow chart in Fig. 1, 191 participants were assessed according to this eligibility (checking the participant had at least one child and could attend a pre-organized compassion training seminar time), with 89 participants being excluded, as they declined to participate, or provided unspecified various reasons. This left 102 participants who were randomized to either the CFT intervention (n = 48) or waitlist control group (n = 54). The demographics of the sample are provided in Table 1, with most participants being female (n = 87), with an average age of 38.31 years (SD = 5.10).
Table 1
Demographic characteristics of the sample
Characteristic
Intervention
Waitlist-control
Frequency or mean
% or SD
Frequency or mean
% or SD
Sex
  Male
10.00
76.20
4.00
7.41
  Female
37.00
23.00
50.00
92.59
Age
38.29 (5.22)
 
38.41 (5.04)
 
Education
  Highschool
2.00
4.17
3.00
5.56
  Tertiary or TAFE course
23.00
47.92
17.00
31.48
  Post graduate degree
23.00
47.92
34.00
62.96
Employment
  Full-time
17.00
35.42
13.00
24.07
  Part-time
11.00
22.92
24.00
44.44
  Casual
4.00
8.33
6.00
11.11
  Employed but on maternity leave
0.00
0.00
3.00
5.56
  Full-time student
4.00
8.33
2.00
3.70
  Unemployed and looking for work
2.00
4.17
1.00
1.85
  Not in paid employment
10.00
20.83
5.00
9.26
Household type
  Original
39.00
81.25
47.00
87.04
  Step-family
2.00
4.17
0.00
0.00
  Sole family
6.00
12.50
6.00
11.11
  Other
1.00
2.08
1.00
1.85
Relationship status
  Single
3.00
6.25
1.00
1.85
  Married/defacto
41.00
85.42
48.00
88.89
  Separated/divorced
4.00
8.33
4.00
7.41
  Widow/widower
0.00
0.00
1.00
1.85
Number of children
  1.00
11.00
22.92
12.00
22.22
  2.00
31.00
64.58
32.00
59.26
  > 2
6.00
12.50
9.00
16.67
Child sex
  Male
20.00
41.67
31.00
57.41
  Female
27.00
56.25
23.00
42.59
Child age
5.17 (2.08)
 
5.23 (2.08)
 
SD, standard deviation. The accumulate percentage might not equal to 100% due to missing data

Procedure

The study was an RCT that used a mixed 2 (condition: intervention vs. waitlist-control) × 2 (time: pre-intervention [Time 1] vs. post-intervention [Time 2]) design. This study formed part of a larger intervention trial aimed at improving compassion for parents. Both studies used the same CFT intervention, which was designed to enhance compassion for self and for others. This study was separately pre-registered on the Open Science Framework, and the data are also stored and available (https://​osf.​io/​z3c9f). While no prior research has examined CFT effects on moral expansiveness, significant moderate effects of CFT have been found for compassion. Therefore, assuming a small to moderate effect on moral expansiveness, an a priori power calculation using G*Power (Faul et al., 2007) estimated that 102 total participants are required to detect medium effect size (d = 0.50) with 80% power and 5% type I error rate. The study received ethics approval from the University of Queensland in Australia with ethics clearance number: #2018000136.
After collecting informed consent from participants, they were then randomly allocated to either the CFT intervention group or a waitlist control group using a computer-generated number sequence. The CFT seminar is a 2-h intervention aimed to cultivate compassion for self and others. The intervention included psychoeducation about compassion according to a Compassion Focused Therapy approach, as well as psychoeducation focused on core CFT concepts such as “tricky brain” and “not your fault” (Gilbert, 2014; Matos et al., 2017). The CFT intervention included didactic presentation, group discussion, and experiential practices of seven specific exercises within the seminar, (1) body posture, (2) friendly voice tone and facial expression, (3) soothing rhythm breathing, (4) mindfulness, (5) cultivating the compassionate-self, (6) compassion for others, and (7) compassion for self. All of these practices are designed to help cultivate the compassionate motivation, which according to CFT requires activation of the body, to help stimulate its physiology, as well as specific compassion visualisations to help imagine enacting as one’s compassionate-self (Matos et al., 2017; Kirby & Petrocchi, 2023). All seminars were delivered by the lead author, who is a clinical psychologist. Participants received a workbook which contained the exercises. An email with a weblink to the recorded guided audio tracks that were used in the CFT seminar was also sent to participants so that they could continue to practice the exercises. Participants were encouraged to practice the exercises during the 2-week period and to bring compassion into their life whenever they needed it, particularly during moments of difficulty. All tracks used in the interventions are available on the Open Science Framework: https://​osf.​io/​z3c9f.

Measures

Demographic Characteristics

Demographic information was self-reported via an online questionnaire at pre-assessment collecting data on age, sex, number of children, education, relationship status, child age, and child sex.

Moral Expansiveness Scale

The Moral Expansiveness Scale (MES; Crimston et al., 2016) was used to assess scope of moral concern for other entities. Each participant’s MES score was calculated based on the placement of 30 target entities within four graded boundaries of concern (inner circle = 3, outer circle = 2, fringes = 1, outside = 0). Hence, the aggregate MES score across the 30 entities could vary from 0 to 90, with higher scores indicating greater moral expansiveness. As in prior research, the 30 items formed an MES scale with strong internal consistency (ω = 0.91). The entity groups and their McDonald’s omega reliability estimate included family/friends (e.g., partner; ω = 0.94), ingroup (e.g., co-worker; ω = 0.91), outgroup (e.g., member of opposing political party; ω = 0.90), revered (e.g., charity worker; ω = 0.95), stigmatized (e.g., refugee; ω = 0.89), villains (e.g., murderer; ω = 0.95), animals high-sentient (e.g., chimpanzee; ω = 0.90), animals low-sentient (e.g., chicken; ω = 0.91), plants (e.g., apple tree; ω = 0.90), environment (e.g., coral reef; ω = 0.95).

Compassion

The Compassionate Engagement and Action Scales (Gilbert et al., 2017) has three subscales, one to assess self-compassion, a second to assess compassion to others, and a third to assess compassion from others. All scales include an engagement (e.g., “I notice and am sensitive to distress in others when it arises”) and action (e.g., “I think about and come up with helpful ways for them to cope with their distress”) subscale. All items are rated on a 10-point Likert scale (1 = Never to 10 = Always). Internal consistencies ranged from good to excellent: Engagement (self ω = 0.73; to others ω = 0.88; from others ω = 0.89) and Action (self ω = 0. 90; to others ω = 0.89; from others ω = 0.90).

Embodiment

The scale asked the following seven items in relation to their embodiment of the compassionate-self (Matos et al., 2017): frequency (“How often did you act as your compassionate self?”, “How often did you feel as your compassionate self?”) both rated on a 10-point scale (1 = Never to 10 = A lot of the time); power (“How powerful were your compassionate feelings?”) rated on a 10-point scale (1 = Not powerful at all to 10 = Very powerful); easiness (“How easy was it to act as your compassionate self?”, “How easy was it to feel as your compassionate self?”) rated on a 10-point scale (1 = Not easy at all to 10 = Very easy); duration (“How long did your compassionate feelings last?”) rated on a 10-point scale (1 = Fleeting to 10 = Most of the day); soothing effect (“How comforting were your compassionate feelings?”) rated on a 10-point (1 = Not comforting at all to 10 = Very comforting); and impact of acting as the CS (“How was the impact of your compassionate actions?”) rated on a 10-point scale (1 = Very negative to 10 = Very positive). A total embodiment score was computed by summing the dimensions frequency, easiness, power, duration, soothing effect, and impact. McDonald’s omega reliability estimate of 0.90 found in this study indicates that the scale is reliable as a measure of Embodiment.

Perceived Helpfulness

Perceived helpfulness was assessed on how useful the participants found the compassionate-self practice (“How helpful did you find the compassionate-self practice?”) and was measured using 1 item on a 5-point scale: Unhelpful, Not very helpful, Neither helpful nor unhelpful, Quite helpful, Very helpful.

Data Analyses

Analysis of missing data indicated overall 12.45% of missing values. Little’s test showed data missing completely at random (MCAR) with p-value greater than 0.05 (χ2 (46,844) = 120.50, p = 1.00). Missing values were then estimated using the expectation–maximization (EM) method. Preliminary assumption testing indicated signs of sphericity and homogeneity violation in variables. Robust ANOVA methods were thus adopted and handled with R package WRS2 (Mair & Wilcox, 2020) to calculate intervention effectiveness. Robust ANOVA methods with WRS2 provide a solution free from all the critical model assumptions (Mair & Wilcox, 2020). Effect size of change was calculated using the explanatory measure of effect size d (Wilcox & Tian, 2011). Values of d = 0.20, 0.50, and 0.80 correspond to small, medium, and large effect sizes.

Results

Short-Term Effects (H1)

Moral Expansiveness

Robust ANOVA indicated a significant time × condition effect for the MES total score F(1,50.83) = 8.00, p = 0.01. Post hoc analysis showed significant improvement of the MES total score from Time 1 (M = 55.50, SD = 17.30) to Time 2 (M = 61.00, SD = 15.04) within the intervention group but not the waitlist control group, t(29) = 2.91, p < 0.01. Among different entities, Family, Revered, and Villains were the three MES sub-groups that had significant time × condition effects. Follow-up analyses showed that the MES score of the intervention group increased significantly from Time 1 to Time 2 for Family (t(29) = 3.12, p < 0.01) and Revered (t(29) = 2.81, p < 0.01) while no change was observed within the waitlist control group. For Villains, no significant change in MES score was observed within the intervention group from Time 1 to Time 2; however, there was a drop within the waitlist control group from Time 1 to Time 2. All short-term results are found in Table 2.
Table 2
Short-term intervention effectiveness
Variables
Intervention
(n = 48)
Waitlist
(n = 50)
F
df
p
T1-T2
Time 1
Time 2
Time 1
Time 2
   
d [95% CI]
M (SD)
M (SD)
M (SD)
M (SD)
MES total score
55.50 (17.30)
61.00 (15.40)
56.90 (15.90)
55.60 (17.30)
7.59
1, 54.83
0.01
0.11 [0.00–0.31]
MES Family
9.54 (1.37)
10.10 (1.47)
9.63 (1.22)
9.65 (1.26)
9.49
1, 35.47
0.00
0.10 [0.00–0.29]
MES Ingroup
6.85 (1.80)
7.42 (1.69)
6.83 (1.71)
7.04 (1.85)
1.95
1, 56.98
0.16
0.12 [0.00–0.34]
MES Outgroup
5.21 (2.29)
5.88 (2.03)
5.37 (2.36)
5.24 (2.29)
3.44
1, 57.82
0.07
0.11 [0.00–0.32]
MES Revered
5.50 (2.03)
6.29 (1.80)
5.91 (1.91)
5.63 (2.13)
10.66
1, 57.29
0.00
0.07 [0.00–0.26]
MES Stigmatized
6.21 (2.18)
6.79 (1.86)
6.18 (1.86)
6.24 (2.10)
0.90
1, 57.58
0.34
0.14 [0.00–0.34]
MES Villains
2.33 (2.29)
2.92 (2.39)
2.59 (2.13)
2.26 (2.21)
6.19
1, 54.49
0.02
0.05 [0.00–0.25]
MES Animals high-sentient
5.21 (2.39)
5.44 (2.18)
5.44 (2.11)
5.15 (2.35)
2.94
1, 56.43
0.09
0.05 [0.00–0.27]
MES Animals low-sentient
4.90 (2.41)
5.38 (2.05)
4.89 (2.15)
4.56 (2.37)
2.32
1, 54.22
0.13
0.17 [0.00–0.37]
MES Plants
4.04 (2.41)
5.04 (2.22)
4.20 (2.41)
4.33 (2.36)
2.31
1, 54.63
0.13
0.14 [0.00–0.35]
MES Environment
5.69 (2.31)
5.75 (2.28)
5.82 (2.43)
5.52 (2.26)
0.53
1, 57.81
0.47
0.05 [0.00–0.26]
Self-compassion Engagement
34.00 (7.16)
37.90 (9.21)
33.70 (8.33)
34.20 (9.04)
4.17
1, 57.89
0.05
0.08 [0.00–0.30]
Self-compassion Action
21.00 (6.78)
25.80 (7.50)
20.70 (7.07)
22.00 (7.64)
8.52
1, 57.92
0.01
0.14 [0.00–0.33]
Compassion To others Engagement
42.20 (8.70)
43.00 (8.95)
41.80 (11.10)
42.10 (10.60)
0.56
1, 49.87
0.46
0.02 [0.00–0.26]
Compassion To others Action
30.70 (5.27)
31.20 (5.69)
29.80 (7.46)
29.20 (6.70)
2.23
1, 53.73
0.14
0.10 [0.00–0.31]
Compassion From Others Engagement
32.80 (9.79)
35.90 (11.20)
31.80 (10.30)
33.40 (11.20)
0.09
1, 56.05
0.76
0.02 [0.00–0.24]
Compassion From Others Action
24.40 (7.41)
26.40 (8.16)
23.40 (7.50)
23.90 (7.11)
0.74
1, 52.64
0.39
0.07 [0.00–0.31]

Compassion

Among all the CEAS subscales, the interaction effect of time × condition was found to be significant for the self-compassion-action (F(1,57.92) = 8.52, p = 0.01) but not others. The CEAS-Self-Compassion Action score of the intervention group increased significantly from M = 21.0 (SD = 6.78) at pre-intervention to M = 25.80 (SD = 7.05) post-intervention (t(29) = 5.05, p < 0.01). No significant change was observed in the waitlist control group. Effect size of change was d = 0.14 (0.00–0.33).

Long-Term Effects (H2)

The long-term effect analysis was conducted using only data from the intervention group, as no control waitlist data was available.

Moral Expansiveness

Robust one-way repeated measures ANOVA suggested long-term effects of the compassion focused intervention on MES scores within the intervention group. The total MES score increased from M = 55.50 (SD = 17.30) at Time 1 to M = 74.33 (SD = 14.56) at Time 3 (t(29) = 7.99, p < 0.01). The main effect of time was also significant across all 10 MES entity groups (Table 3). Among the 10 entity groups, family is the group that saw the largest MES increase across the intervention from M = 9.54, SD = 1.37 at Time 1 to M = 11.65 (SD = 1.04) at Time 3 (t(29) = 9.55, p < 0.01). While still significant, environment in contrast saw the lowest increase, M = 5.69 (SD = 2.31) to M = 7.54 (SD = 2.23), t(29) = 4.05, p < 0.01.
Table 3
Long-term changes
 
Intervention (n = 48)
Effect of Time
Time 1
Time 3
t
df
p
M (SD)
M (SD)
MES total score
55.50 (17.30)
74.33 (14.56)
8.00
29
0.00
MES Family
9.54 (1.37)
11.65 (1.04)
9.55
29
0.00
MES Ingroup
6.85 (1.80)
8.75 (1.66)
5.35
29
0.00
MES Outgroup
5.21 (2.29)
7.62 (2.07)
7.12
29
0.00
MES Revered
5.50 (2.03)
7.83 (2.09)
5.51
29
0.00
MES Stigmatized
6.21 (2.18)
8.44 (2.03)
5.42
29
0.00
MES Villains
2.33 (2.29)
5.00 (2.39)
5.64
29
0.00
MES Animals high-sentient
5.21 (2.39)
7.15 (2.00)
4.53
29
0.00
MES Animals low-sentient
4.90 (2.41)
7.12 (1.93)
5.76
29
0.00
MES Plants
4.04 (2.41)
6.75 (1.81)
5.91
29
0.00
MES Environment
5.69 (2.31)
7.54 (2.23)
4.05
29
0.00
Self-compassion Engagement
34.00 (7.16)
38.10 (8.79)
3.07
29
0.00
Self-compassion Action
21.00 (6.78)
28.10 (6.31)
7.58
29
0.00
To others Engagement
42.20 (8.70)
45.10 (9.10)
3.04
29
0.01
To others Action
30.70 (5.27)
31.40 (5.43)
0.91
29
0.37
From others Engagement
32.80 (9.79)
35.60 (10.30)
1.33
29
0.19
From others Action
24.40 (7.41)
27.20 (6.90)
2.41
29
0.02

Compassion

Regarding compassion engagement and action scales, the intervention group’s Self-Compassion-Action score continued to show significant growth from M = 21.00 (SD = 6.78) at pre-intervention to M = 25.80 (SD = 7.50) at post-intervention, and (M = 28.10, SD = 6.31) at follow-up (t(29) = 7.58, p < 0.01). At follow-up, an increase of Self-Compassion Engagement and Compassion to others was also evident in the intervention group. The Self-Compassion Engagement score of the intervention group increased from M = 34.00 (SD = 7.16) prior to the compassion focused intervention to M = 38.10 (SD = 8.79) at follow-up. It was also noticed that the Compassion From Other Action score increased significantly from pre-intervention to follow-up from M = 24.40 (SD = 7.41) to M = 27.20 (SD = 6.90), t(29) = 2.41, p = 0.02 (Table 3).

Changes in Moral Expansiveness (H3)

To examine the contribution of change in compassion and compassionate embodiment and helpfulness in predicting changes to moral expansiveness, multiple regression was conducted. Demographic variables (age and gender) and MES score pre-intervention were controlled before compassionate embodiment, compassionate helpfulness and changes in compassion score between Time 1 and Time 2 were entered into the model. The associations between variables are presented in Table 4; multiple regression results are presented in Table 5.
Table 4
Correlations between variables
 
1
2
3
4
5
6
7
8
9
10
11
MES score Time 3
           
Gender
 − 0.04
          
Age
0.25
0.06
  
 + 
      
Compassionate Embodiment Time 2
0.37*
 − 0.25
 − 0.01
        
Compassionate Helpfulness Time 2
0.56***
 − 0.27
0.07
0.61
       
MES score Time 1
0.39*
 − 0.18
0.04
0.23
0.18
      
Compassion To Others—Engagement change score
 − 0.19
 − 0.10
 − 0.16
0.16
0.11
0.12
     
Compassion To Others—Action change score
 − 0.03
 − 0.05
 − 0.04
0.35
0.37
 − 0.04
0.59
    
Self-Compassion—Engagement change score
0.04
 − 0.25
 − 0.15
0.26
0.37
 − 0.03
 − 0.03
0.03
   
Self-Compassion—Action change score
 − 0.06
 − 0.20
0.04
0.11
0.19
0.00
0.31
0.12
0.39***
  
Compassion From Others—Engagement change score
0.07
 − 0.22
0.01
0.32
0.41
0.16
0.43
0.42
0.33*
0.37*
 
Compassion From Others—Action change score
 − 0.01
 − 0.35
0.05
0.21
0.37
 − 0.06
0.32
0.46
0.39***
0.39***
0.72
*Significant at p > 0.05, ***significant at p > 0.001
Table 5
Predictors of moral expansiveness at Time 3
Predictors
B
S.E
 
p
Gender
3.28
5.02
0.65
0.52
Age
2.76
2.41
1.15
0.26
Compassionate Embodiment Time 2
2.22
3.05
0.73
0.47
Compassionate Helpfulness Time 2
9.41
3.06
3.08
0.00
MES score Time 1
3.05
3.48
0.88
0.39
Compassion To Others—Engagement change score
 − 2.48
3.09
0.80
0.43
Compassion To Others—Action change score
 − 2.07
3.25
0.64
0.53
Self-Compassion—Engagement change score
 − 1.47
2.51
0.58
0.57
Self-Compassion—Action change score
 − 0.05
1.91
0.03
0.98
Compassion From Others—Engagement change score
 − 1.88
2.96
0.63
0.53
Compassion From Others—Action change score
 − 0.54
3.20
0.17
0.87
Model
F(11,27) = 2.41, p < 0.05; \(\Delta\) R2 = 0.29
In total, the model accounted for 29% of the variance in MES scores at follow-up. Among all the variables, only compassionate helpfulness at post-intervention significantly predicted MES scores at follow-up. Changes in compassion did not significantly predict long-term MES outcomes.

Discussion

The aim of this RCT was to determine whether a brief 2-hr Compassion Focused Therapy seminar could help increase moral expansiveness, compassion, and self-compassion. Based on our results, our hypotheses were partially supported. For the first time, we found evidence that overall moral expansiveness can be increased via a psychological intervention. At the sub-group level, when compared to the control group, we found significant increases in moral expansiveness towards family/friends (e.g., partner), as well as revered individuals (e.g., charity worker) after the compassion focused intervention (2 weeks post CFT). Although there was a significant interaction for villains (e.g., murderer), this was due to the significant drop in the control group at post-intervention. The CFT intervention was delivered to parents; thus, it is unsurprising that family as an entity group experienced a significant increase, as participants were motivated to increase their levels of compassion for family. The increase in moral concern to villains appears to indicate that CFT was effective in helping increase moral expansiveness to entities traditionally deemed as less of a moral priority (Crimston et al., 2016, 2018a).
At 3-month follow-up after the intervention, we found these positive findings improved. Specifically, participants reported significantly increased overall moral expansiveness, as well as increased moral concern towards all entity sub-groups contained in the MES (family, ingroup, revered, stigmatized, outgroup, high-sentience animals, low-sentience animals, environment, plants, and villains). Finally, in terms of whether embodiment, helpfulness, compassion, and self-compassion change scores predicted greater moral expansiveness, only perceived helpfulness of the compassionate-self exercise emerged as a significant predictor. This finding was partially contrary to predictions, as previous work has found that embodiment does lead to increases in compassion scores (Matos et al., 2017), but this did not translate to predicting changes identified in moral expansiveness.
The current findings are in line with prior work demonstrating a robust link between compassion and moral expansiveness (Crimston et al., 2021). However, this is the first time that any intervention (or psychological manipulation) has been tested and found to increase moral expansiveness. Past work has theorized about a range of factors that might lead to increased (or reduced) moral expansiveness (Crimston et al., 2018a), though no prior research has provided causal evidence of the malleability of moral expansiveness, with the current findings highlighting the promise of CFT as a light touch intervention.
There are several important implications from this research. First, compassion towards others did not change at post-intervention; however, self-compassion did significantly improve. This finding suggests that self-compassion might be the key factor leading to a more expansive moral mindset. However, the change scores did not predict moral expansiveness at Time 3, rather only the helpfulness of the compassionate-self exercise emerged as a significant predictor. The compassionate-self exercise involves asking participants to imagine what it would be like for them to be a deeply compassionate person, imagining how this would influence how they would relate to others, as well as to themselves. Experiencing the compassionate-self exercise as helpful appears to be the major driver to a morally expansive mindset over the longer term. Indeed, experiencing the compassionate-self as helpful may indicate that enacting compassion in everyday life is possibly more important than meditating or thinking about being compassionate. Future work can examine what factors act as facilitators and barriers to developing a sense of the compassionate-self being helpful. For example, self-efficacy could be a core factor leading to perceived helpfulness of the practice. Second, it appears self-compassion and compassion are both linked to moral expansiveness, and further work can continue to examine the interpersonal benefits of both. For example, the role of common humanity, which is central in self-compassion might be an important driver to morally expansive mindsets, and future research could include a measure of that to determine its importance. Third, the benefit of a brief 2-hr seminar seems to be realized after a longer period of time, in this instance a 3-month follow-up period. It could be that learning, practising, and experiencing CFT practices take time, and 2 weeks post-intervention is simply too early to measure outcomes of moral expansiveness towards more distal targets like plants, animals, and the environment. Finally, we focused on compassion predicting moral expansiveness, but it is possible that those who are more morally expansiveness are also more compassionate. Thus, potentially increasing moral expansiveness might lead to increased compassion. However, there are no known interventions that directly target morally expansiveness. The only possibility we could imagine was whether a psychoeducation intervention on moral expansiveness might increase it. Our view is that morally expansive mindsets are an outcome, which individual differences factors such as empathy and compassion can predict. Moreover, these constructs are malleable, and interventions can increase them, which gives hope in increasing moral expansiveness.

Limitations and Future Directions

There are some important limitations to the current research. First, we were unable to measure the objective dosage of the intervention, specifically, how frequently participants listened to the guided audio meditations during the 2-week period following the CFT seminar. Assessing for dosage as a moderating variable would provide further insights into the impact CFT can have on outcomes, and also provide insights into those more likely to use the meditations compared to those who did not. Previous research by Matos et al. (2018) did collect data on self-reported practice over a 1-week period, offering options such as “never”, “1–2 times”, “3–4 times”, “5–6 times”, or “7 or more times per week”. We recommend future research includes at least some measure of practice frequency (e.g., self-report, objective measure). In addition, although our analyses examined between (groups) and within (time) change, our results were based on summed scores of a group, as such there could be individual difference factors that we did not account for in our analytical approach. A further limitation of the current research was the control group was a waitlist control rather than an active control condition, such as a mindfulness-based intervention. In future research, we recommend the use of an active control group. Moreover, we did not collect 3-month follow-up data from the control group due to restraints with funding, future research should include control group follow-up data to ensure the improvements we found are not due simply to time or another possible factor not controlled. Our participants were middle-class, highly educated, and predominantly female, as a result the generalizability of the findings to other populations is limited. The compassion focused intervention was targeted towards parents and did not include any training or psychoeducation in morality or concepts related to morality. It could be that introducing concepts of morality and applying the compassion training exercises specifically to concepts of morality might further increase the effectiveness of the intervention. Indeed, in future work, participants could be asked to embody their compassionate-self and imagine acting compassionate towards the specific entities included within the Moral Expansiveness Scale.
A final consideration for future research is to use physiological measurements, such as heart rate variability, to gauge the influence HRV is having on moral expansiveness, but also how compassion practices are improving HRV. Meta-analytic research has found a significant moderate effect size between compassion and HRV (Di Bello et al., 2020), and brief CFT practices can improve baseline HRV (Kim et al., 2020a, 2020b; Matos et al., 2017). No research has directly linked HRV to moral expansiveness, but research has found that those with lower HRV are quicker to judge and assign blame (León et al., 2009). It could be that CFT improves HRV, which also leads to individuals having increase moral expansiveness towards others.
The current research provides the first evidence of an intervention leading to an increase in moral expansiveness, and crucially, highlights the potential malleability of our moral boundaries. In addition, it provides further evidence of the robust links between compassion and moral expansiveness, and the vital role that compassion, and compassion interventions, can play in expanding our moral outlooks. In a rapidly changing and uncertain world where we face constant threats such as pandemics, wars, rising inequality, and the looming impacts of climate change, identifying concrete strategies to increase our compassion and expand our moral circles seems a most essential endeavour.

Declarations

Ethics Approval

The study received ethics approval from the University of Queensland in Australia with ethics clearance number: #2018000136.
Participants informed consent was collected via an online computer website, where the participant read an information sheet and consent form and then by clicking the next button consented to participating in the study.

Conflict of Interest

The authors declare no competing interests.

Artificial Intelligence Statement

AI was not used.
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://​creativecommons.​org/​licenses/​by/​4.​0/​.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Author Statement

We have submitted two papers using the same sample from the same randomized controlled trial that looked at two different domains. One domain being moral expansiveness, which we examined in this paper. The other paper examined the domain of parenting. Both were pre-registered, with the parenting study pre-registered on the Australia and New Zealand Clinical Trials Registry and this study being registered on the Open Science Framework. All materials, measures, and data are available on the Open Science Framework (https://​osf.​io/​z3c9f). We report on data from the Compassionate Action and Engagement Scale in both papers, but all other measures are different.
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Metagegevens
Titel
A Brief Compassion Focused Therapy Intervention Can Increase Moral Expansiveness: A Randomized Controlled Trial
Auteurs
James N. Kirby
April Hoang
Charlie R. Crimston
Publicatiedatum
20-01-2024
Uitgeverij
Springer US
Gepubliceerd in
Mindfulness / Uitgave 2/2024
Print ISSN: 1868-8527
Elektronisch ISSN: 1868-8535
DOI
https://doi.org/10.1007/s12671-023-02300-7

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