A Systematic Review and Meta-analysis of the Effects of Meditation on Empathy, Compassion, and Prosocial Behaviors

May combine two claims.

Meditation-based interventions improve stress, anxiety, depression, quality of life, and emotion regulation across a range of psychiatric and medical populations.

“The results of several systematic reviews and meta-analyses of mindfulness-based interventions suggest that these treatments significantly improve stress, anxiety, depression, quality of life, and emotion regulation across a range of psychiatric and medical populations (Bohlmeijer, Prenger, Taal, & Cuijpers, 2010; Eberth & Sedlmeier, 2012; Gotink et al., 2015; Hofmann, Sawyer, Witt, & Oh, 2010; Kh”

• cites Bohlmeijer, Prenger, Taal, & Cuijpers, 2010 sourceNot checked — no full text of the source
• cites Eberth & Sedlmeier, 2012 sourceNot checked — no full text of the source
• cites Gotink et al., 2015 sourcePartly supported

  The Discussion’s summary of main results (page not available) reports significant improvements in depression, anxiety, stress, and quality of life after MBSR or MBCT in patients with medical conditions and psychological disorders. The cited paper does not report a significant improvement in emotion regulation as an outcome; its Results instead mention increased metacognitive awareness of negative thoughts and feelings. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

May combine two claims.

LKM improves depression, mindfulness, compassion, self-compassion, and positive affect.

“a recent meta-analysis found that LKM indeed improves depression, mindfulness, compassion, self-compassion, and positive affect (Galante, Galante, Bekkers, & Gallacher, 2014).”

• cites Galante, Galante, Bekkers, & Gallacher, 2014 sourcePartly supported

  The Abstract and Conclusions report reduced depression and increased mindfulness, compassion, and self-compassion versus passive controls, plus increased positive emotions versus progressive relaxation. But these are findings for kindness-based meditation as a group of practices, not specifically for LKM; the citing sentence also omits the differing comparators. The Effects of the intervention section reports mixed or nonsignificant results against some active controls. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

May combine two claims.

In studies with follow-up assessments, one found maintained gains at 5-months post-intervention and the other found no significant improvements post-intervention or at follow-up.

“In studies with follow-up assessments, one found maintained gains at 5-months post-intervention (Kemeny et al., 2012) and the other found no significant improvements post-intervention or at follow-up (Poehlmann-Tynan et al., 2016).”

• cites Kemeny et al., 2012 sourceSupported
• cites Poehlmann-Tynan et al., 2016Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim. May combine two claims.

Empathy and compassion are related but distinct prosocial emotions that consist of cognitive and affective components and can be learned with practice.

“Although there are varying definitions of empathy and compassion, they are often considered related but distinct pro-social emotions that consist of cognitive and affective components and can be learned with practice (Bibeau, Dionne, & Leblanc, 2016; Goetz, Keltner, & Simon-Thomas, 2010).”

• cites Bibeau, Dionne, & Leblanc, 2016 sourceNot checked — no full text of the source
• cites Goetz, Keltner, & Simon-Thomas, 2010 sourcePartly supported

  The Critical Summary of Alternatives (page unavailable) distinguishes compassion from empathic distress and describes compassion as involving appraisals and feelings. It also says loving-kindness meditation may cultivate a lasting disposition toward compassion. These passages do not establish that empathy itself can be learned with practice or that both empathy and compassion have the claimed cognitive and affective components. (LLM, conf=0.84)

  Experimental — accuracy not yet measured

May combine two claims.

Oxytocin plays a role in both relaxation and secure attachment physiology and is associated with greater pro-social behaviors.

“Oxytocin plays a role in both relaxation and secure attachment physiology and is also associated with greater pro-social behaviors (e.g., improved face expression recognition, enhanced encoding of positive social memories; Isgett, Algoe, Boulton, Way, & Fredrickson, 2016; Mascaro et al, 2015; Strathearn, Fonagy, Amico, & Montague, 2009).”

• cites Isgett, Algoe, Boulton, Way, & Fredrickson, 2016 sourcePartly supported

  The Introduction (page unavailable) describes oxytocin as implicated in sociality, and the Discussion (page unavailable) links it to altruistic behavior, attention to positive faces, and constructive behavior during couple conflict. Those passages support the broad social-behavior association, but they do not establish a role in relaxation or secure-attachment physiology, improved facial-expression recognition, or enhanced encoding of positive social memories. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites Mascaro et al, 2015 sourcePartly supported

  The Neuromodulatory Backdrop section links oxytocin to prosocial behaviors and to vagal activity and reduced sympathetic responses to stress, which supports the prosocial and relaxation-related parts of the claim. It does not discuss secure attachment physiology or the specific examples of facial-expression recognition and positive social-memory encoding. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites Strathearn, Fonagy, Amico, & Montague, 2009 sourcePartly supported

  The Discussion (page unavailable) reports higher oxytocin levels in securely attached mothers after interacting with their infants and suggests a role in attachment and social behavior. The Introduction (page unavailable) describes improved facial-expression recognition, social memory, and trust in trials of intranasal oxytocin. Our copy does not establish a role for oxytocin in relaxation. (LLM, conf=0.86)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Emotion regulation is thought to play a role in the effects of LKM on pro-social outcomes.

“and emotion regulation is thought to play a role in the effects of LKM on pro-social outcomes (Mascaro et al., 2015).”

• cites Mascaro et al., 2015 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Individuals must be able to tolerate the distress they feel in response to another's suffering in order to effectively enact helping behaviors.

“Theoretical conceptualizations of compassion emphasize that individuals must be able to tolerate the distress they feel in response to another’s suffering in order to effectively enact helping behaviors (Strauss et al., 2016).”

• cites Strauss et al., 2016 sourcePartly supported

  Section 1.1 describes distress tolerance as a component of several conceptualizations of compassion and says overwhelming personal distress may hinder the ability to help. The claim’s categorical “must” is stronger than the review’s qualified account. (LLM, conf=0.85)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Empathy (affect-sharing) may increase personal distress and reduce pro-social behavior.

“Empathy (affect-sharing) may increase personal distress and reduce pro-social behavior”

• cites Klimecki et al., 2014 sourceSupported
• cites Singer & Klimecki, 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Compassion (affect-sharing with motivation to help) may strengthen personal resources and promote positive outcomes.

“while compassion (affect-sharing with motivation to help) may strengthen personal resources and promote positive outcomes (e.g., Klimecki et al., 2014; Singer & Klimecki, 2014).”

• cites Klimecki et al., 2014 sourcePartly supported

  The Introduction says compassion is concern for others’ suffering associated with motivation to help, and describes it as a promising way to strengthen personal resources. The Discussion reports increased positive affect after compassion training. However, the paper characterizes sharing others’ painful feelings as empathy, which it distinguishes from compassion; it does not support the parenthetical definition of compassion as affect-sharing. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites Singer & Klimecki, 2014Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Other previous studies have found some differences in emotional outcomes across meditation types.

“other previous studies have found some differences in emotional outcomes across meditation types (Zeng et al., 2015).”

• cites Zeng et al., 2015 sourceSupported

May combine two claims.

A total of 18 studies provided sufficient data on self-reported outcomes for meta-analysis, allowing 19 comparisons.

“A total of 18 studies provided sufficient data on self-reported outcomes for meta-analysis. These studies allowed for 19 comparisons because one study used two control groups.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Most studies (n = 22) were conducted in non-clinical adult populations.

“Most studies (n = 22) were conducted in non-clinical adult populations using a primarily LKM or CM intervention (n = 10) or both mindfulness and LKM combined (n = 8).”

May combine two claims.

Greater meditation compliance led to decreased anxiety, which led to greater empathy.

“Shapiro et al. (1998) found that greater meditation compliance led to decreased anxiety, which led to greater empathy.”

• cites Shapiro et al., 1998 sourceNot checked — no full text of the source

May combine two claims.

A total of 11 studies provided sufficient data on observable outcomes for meta-analysis with 12 comparisons available.

“A total of 11 studies provided sufficient data on observable outcomes for meta-analysis with 12 comparisons available (see Figure 3).”

May combine two claims.

Studies showed lower risk of bias in selective reporting (24 low risk) but higher risk in baseline imbalance (4 high risk), participant blinding, incomplete outcome data, and differential attrition (3 high risk each).

“In general, studies showed lower risk of bias in terms of selective reporting of outcome measures (24 low risk), but higher risk of bias in terms of baseline imbalance (4 high risk), participant blinding, incomplete outcome data, and differential attrition (3 high risk each; see Figure 2).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims. The quote only partly states this claim.

Most studies used a primarily LKM or CM intervention (n = 10) or both mindfulness and LKM combined (n = 8).

“Most studies (n = 22) were conducted in non-clinical adult populations using a primarily LKM or CM intervention (n = 10) or both mindfulness and LKM combined (n = 8).”

May combine two claims.

Increases in mindfulness and self-compassion, and decreases in stress, were significantly correlated with increases in empathy.

“One study also found that increases in mindfulness and self-compassion, and decreases in stress, were significantly correlated with increases in empathy (Wallmark et al., 2013).”

• cites Wallmark et al., 2013 sourceNot checked — no full text of the source

May combine two claims.

Eleven studies showed a low risk of bias, 12 showed a medium risk, and 3 showed high risk.

“Eleven studies showed a low risk of bias, 12 showed a medium risk, and 3 showed high risk (Tables 1 and 2).”

Classified as probably not a substantial claim. May combine two claims.

The literature search yielded 479 results, and after exclusions, 26 studies met eligibility criteria.

“Our search yielded 479 results. After excluding duplicates (n = 282), unpublished manuscripts (n = 18), non-RCTs (n = 52), non-meditation interventions (n = 18), and studies that did not quantitatively measure pro-social outcomes (n = 43) or only measured self-focused compassion (n = 40), there were 26 studies that met our eligibility criteria.”

May combine two claims.

Loving kindness meditation led to improvements in positive emotions, which led to improvements in social connectedness, which led to improvements in vagal tone.

“Kok et al. (2013) tested more complex structural models and found that loving kindness meditation led to improvements in positive emotions, which led to improvements in social connectedness, which led to improvements in vagal tone.”

• cites Kok et al., 2013 sourceNot checked — no full text of the source

May combine two claims.

Almost all (7 out of 8) studies examined the relationship between amount of home practice/meditation adherence and prosocial outcomes; 5 found greater meditation practice correlated with greater prosocial outcomes and 2 found no significant correlation.

“Almost all (7 out of 8) examined the relationship between amount of home practice/meditation adherence and pro-social outcomes: 5 found that greater meditation practice was correlated with greater pro-social outcomes (Jazaieri et al., 2013; Keefe, 1979; Rosenberg et al., 2015; Velásquez et al., 2015; Wallmark et al., 2013) and 2 found no significant correlation (Kemeny et la., 2012; Mascaro et al.”

• cites Jazaieri et al., 2013Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Keefe, 1979 sourceNot checked — no full text of the source
• cites Rosenberg et al., 2015 sourceNot checked — no full text of the source

May combine two claims.

Effects for observable outcomes were somewhat stronger and more consistent than results for self-reported outcomes, though both showed significant improvements in the meta-analysis.

“Effects for observable outcomes (e.g., real-world helping behavior, facial expressions) were somewhat stronger and more consistent than results for self-reported outcomes, though both showed significant improvements in the meta-analysis.”

May combine two claims.

Meta-analysis results indicated that meditation training had a small-medium and significant effect on both subjective and objective prosocial outcomes, similar across studies with active and inactive control groups.

“Meta-analysis results indicated that meditation training had a small-medium and significant effect on both subjective and objective pro-social outcomes, which was similar across studies with active and inactive control groups if not slightly higher among those with active controls.”

• AssumptionRests on an assumption: The outcome measures used across included studies validly capture empathy, compassion, and prosocial behavior.

May combine two claims.

Many studies were low-risk, with only 3 studies showing a high risk of bias and no clear differences in outcomes based on risk of bias.

“Many studies were low-risk, with only 3 studies showing a high risk of bias and there were no clear differences in outcomes based on risk of bias.”

Classified as probably not a substantial claim.

Two independent reviewers assessed risk of bias for each included study according to Cochrane Collaboration guidelines.

“Two independent reviewers (CML and NS) assessed risk of bias for each included study according to Cochrane Collaboration guidelines (Higgins & Green, 2008).”

• cites Higgins & Green, 2008 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Heterogeneity of included studies was examined using the i-squared statistic and Q test to determine a fixed or random effects meta-analysis model.

“We examined heterogeneity of the included studies based on the i-squared statistic and Q test to determine a fixed or random effects meta-analysis model according to the results (i-squared < 40% for fixed effects; Higgins & Green, 2008).”

• cites Higgins & Green, 2008 sourceNot checked — no full text of the source

May combine two claims.

Engaging in prosocial behavior is associated with greater happiness, psychological well-being, indices of physiological health, better physical functioning, better interpersonal relationships, and decreased morbidity in medical populations.

“Indeed, a large body of research demonstrates that engaging in pro-social behavior is associated with greater happiness and psychological well-being, indices of physiological health (e.g., increased heart rate variability, immune function, telomere length, genetic expression), better physical functioning, better interpersonal relationships, and decreased morbidity in medical populations (Dunn, Akn”

• cites Dunn, Aknin, & Norton, 2008 sourceNot checked — no full text of the source
• cites Hoge et al., 2013 sourceNot checked — no full text of the source
• cites Ironson, 2007 sourceNot checked — no full text of the source

May combine two claims.

Greater empathy leads to greater compassion, and greater compassion leads to greater prosocial behavior.

“Research supports the idea that greater empathy leads to greater compassion, and greater compassion leads to greater pro-social behavior (Lim & DeSteno, 2016).”

• cites Lim & DeSteno, 2016 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

For studies that included two control groups, two comparisons were conducted and the total N was divided by 2 to avoid over-estimation.

“For studies that included two control groups, we conducted two comparisons and divided the total N by 2 to avoid over-estimation of the study.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Authors did not contact authors to obtain missing data in order to prevent bias introduced by selective responding of authors.

“We did not contact authors to obtain missing data in order to prevent bias introduced by selective responding of authors.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Compassion meditation promotes prosocial outcomes in psychotherapists.

“A narrative review also suggested that compassion meditation promotes pro-social outcomes in psychotherapists (Bibeau et al., 2016).”

• cites Bibeau et al., 2016 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Publication bias was assessed by funnel plot and the fail-safe N.

“Publication bias was also assessed by funnel plot and the fail-safe N.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

One reviewer extracted data for meta-analysis and a second independent reviewer verified the results, with no discrepancies noted.

“One reviewer (CML) extracted data for meta-analysis and a second independent reviewer (RS) verified the results, with no discrepancies noted.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Two independent reviewers extracted data from each study and discussed results to ensure agreement, with discrepancies resolved through discussion with the senior author.

“Two independent reviewers (CML and NS) extracted data from each study and discussed results to ensure agreement. Any discrepancies were resolved through discussion with the senior author (GY).”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

Improving these pro-social outcomes has the potential to promote important societal changes needed today.

“Improving these pro-social outcomes has the potential to promote important societal changes needed today.”

May combine two claims.

Potential emotional mechanisms include an increased sense of social-emotional connectedness with others, increased positive affect, decreased stress and negative affect, and greater trait mindfulness and self-compassion.

“Potential emotional mechanisms include an increased sense of social-emotional connectedness with others (Ashar et al., 2016; Kok et al., 2013), increased positive affect (Hutcherson et al., 2008; Kok et al., 2013), decreased stress and negative affect (Kang et al., 2014; Oman et al., 2010; Shapiro et al., 1998), and greater trait mindfulness and self-compassion (Wallmark et al., 2013).”

• cites Ashar et al., 2016 sourceNot checked — no full text of the source
• cites Kok et al., 2013 sourceNot checked — no full text of the source
• cites Hutcherson et al., 2008 sourceNot checked — no full text of the source

• AssumptionRests on an assumption: The mechanisms identified in the included studies are causal mechanisms by which meditation improves prosocial outcomes.

Probably not a substantial claim: may not pass S3 (load-bearing).

In the current systematic review, limitations include heterogeneity in the interventions.

“limitations include heterogeneity in the interventions”

Probably not a substantial claim: may not pass S2 (checkable).

These results advance the scientific understanding of meditation for health outcomes.

“Nonetheless, these results advance the scientific understanding of meditation for health outcomes”

May combine two claims.

Samples were primarily female and White.

“primarily female and White”

Probably not a substantial claim: may not pass S3 (load-bearing).

The role of oxytocin in social behavior is complex and not necessarily pro-social, depending on individual difference characteristics (e.g., gender, psychopathology).

“Recent theories highlight that the role of oxytocin in social behavior is complex and not necessarily pro-social, depending on individual difference characteristics (e.g., gender, psychopathology; Shamay-Tsoory & Abu-Akel, 2016).”

• cites Shamay-Tsoory & Abu-Akel, 2016 sourceNot checked — no full text of the source

May combine two claims.

These mechanisms are consistent with research demonstrating that mindfulness-based interventions increase trait mindfulness, as trait mindfulness is likely to promote real-time awareness of others' suffering.

“These mechanisms are also consistent with research demonstrating that mindfulness-based interventions increase trait mindfulness (Quaglia, Braun, Freeman, McDaniel, & Brown, 2016), as trait mindfulness is likely to promote real-time awareness of others’ suffering”

• cites Quaglia, Braun, Freeman, McDaniel, & Brown, 2016 sourceNot checked — no full text of the source

• AssumptionRests on an assumption: The mechanisms identified in the included studies are causal mechanisms by which meditation improves prosocial outcomes.

May combine two claims.

Some studies directly tested self-focused emotional mechanisms as mediators of meditation training on prosocial outcomes and found significant indirect effects, suggesting that meditation leads to improvements in individuals' own socio-emotional functioning and, thereby, improvements in prosocial outcomes.

“Some studies directly tested self-focused emotional mechanisms as mediators of meditation training on pro-social outcomes and found significant indirect effects, suggesting that meditation leads to improvements in individuals own socio-emotional functioning and, thereby, improvements in pro-social outcomes (Ashar et al., 2016; Hutcherson et al., 2008; Kang et al., 2014; Kok et al., 2013; Shapiro”

• cites Ashar et al., 2016 sourceNot checked — no full text of the source
• cites Hutcherson et al., 2008 sourceNot checked — no full text of the source
• cites Kang et al., 2014 sourceNot checked — no full text of the source

• AssumptionRests on an assumption: The mechanisms identified in the included studies are causal mechanisms by which meditation improves prosocial outcomes.

May combine two claims.

These limitations may have biased the results and limits generalizability.

“which may have biased the results and limits generalizability.”

May combine two claims.

Distress tolerance is a well-established risk factor for emotional disorders that influences emotion regulation strategies (i.e., low levels of distress tolerance motivate maladaptive avoidance).

“Distress tolerance, an individual difference variable defined as the ability to withstand negative affective states (Simons & Gaher, 2005), is a well-established risk factor for emotional disorders that influences emotion regulation strategies (i.e., low levels of distress tolerance motivate maladaptive avoidance).”

• cites Simons & Gaher, 2005 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Some research suggests empathy and compassion may have different utility for the person giving versus receiving help, particularly when empathizing with another's suffering.

“It is also worth noting that some research suggests empathy and compassion may have different utility for the person giving versus receiving help, particularly when empathizing with another’s suffering.”

May combine two claims.

Many studies used active control groups and objective behavioral outcomes.

“Many studies used active control groups and objective behavioral outcomes”

May combine two claims.

The same physiological processes that characterize the relaxation response occur in the context of secure attachment and mother-child dyads, which provide a foundation for compassion.

“The same physiological processes that characterize the relaxation response have been shown to occur in the context of secure attachment and mother-child dyads, which provide a foundation for compassion (Fricchione, 2011; Hill-Soderlund et al, 2008; Mikulincer, Shaver, Gillath, & Nitzberg, 2005; Oosterman, De Schipper, Fisher, Dozier, & Schuengel, 2010).”

• cites Fricchione, 2011 sourceNot checked — no full text of the source
• cites Hill-Soderlund et al, 2008 sourceNot checked — no full text of the source
• cites Mikulincer, Shaver, Gillath, & Nitzberg, 2005 sourceNot checked — no full text of the source

May combine two claims.

Meditation interventions, particularly mindfulness meditation, significantly increase distress tolerance and improve emotion regulation.

“Meditation interventions, particularly mindfulness meditation, have been shown to significantly increase distress tolerance and improve emotion regulation (Lotan, Tanay, & Bernstein, 2013; Chambers, Gullone, & Allen, 2009)”

• cites Lotan, Tanay, & Bernstein, 2013 sourceNot checked — no full text of the source
• cites Chambers, Gullone, & Allen, 2009 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

Meditation interventions (e.g., MBSR, MBCT) could provide additional benefits beyond reduced emotional distress.

“Clinicians and meditation teachers should be aware that meditation interventions (e.g., MBSR, MBCT) could provide additional benefits beyond reduced emotional distress.”