The Current and Future Role of Heart Rate Variability for Assessing and Training Compassion

“For example, trait self-compassion, measured by the Self-Compassion Scale (37) was found to be correlated to resting HRV and an increase in parasympathetic nervous system tone (43).”

“Indeed, there are times when high sympathetic tone is desired, for example, when helping to target states of helplessness (14).”

“Each of these approaches have been examined in randomized controlled trials, with early findings indicating compassion-based interventions are a promising intervention to help increase well-being and reduce suffering (28).”

“Furthermore, in CFT a focus of intervention is to help improve safeness for the client, and although this is hypothesized to generally be associated with higher HRV, it may also help a client feel empowered and give them confidence to challenge themselves, which could be linked to a higher resting sympathetic tone.”

“The assessment methods used in compassion training relies predominantly on self-report measures, such as the Self-Compassion Scale (37), and a recent review that critically examined the assessment measures for compassion concluded that self-report questionnaires assessing compassion have serious psychometric weaknesse…”

“Polyvagal theory, outlined by Porges (14), details how the activation of the myelinated parasympathetic nervous system helps in the regulation of the fight/flight response (autonomic sympathetic nervous system), thus enabling calmness and soothing to be achieved through having close proximity to others, giving/receivi…”

“To date, there have been several cross-sectional studies demonstrating lower levels of HRV in conditions, such as depression (39), anxiety (40), rumination (41), and self-criticism (42).”

“A time domain measure of HRV (root mean square successive differences) were obtained using HRV Analysis Software (48).”

“Another study (46) found compassion meditation increased positive emotions and HRV, and that effect moderated by baseline vagal tone.”

“Practicing compassion also has an impact on neurophysiology due to neuroplasticity (27), with a recent study showing that it has significant impacts on HRV (Matos et al.”

“Moreover, children with higher heart rate deceleration during evocative films showed increased subsequent compassionate behavior (20).”

“Interestingly, children with higher baseline HRV were rated by teachers and parents as more helpful and more able to regulate their emotions than those with lower HRV (21) and showed increased self-reports of sympathy, both dispositionally and in response to distress-inducing films (22).”

“Compassion training improves general well-being and social relationships (33, 34), with increasing evidence of its effectiveness as a psychotherapy (11, 35, 36).”

“There is now considerable evidence that being the giver and recipient of caring behaviors, particularly compassion, has a range of health benefits (29, 30) and can affect genetic expression (31, 32).”

“In this study, HRV was derived by inter-beat interval time series of electrocardiography and CMetx software (44).”

“To date, there have been several cross-sectional studies demonstrating lower levels of HRV in conditions, such as depression (39), anxiety (40), rumination (41), and self-criticism (42).”

“Compassion-focused therapy is notably different to the other interventions, as the theoretical underpinning is based on an evolutionary model that links to physiology (11).”

“Many species, such as fish, turtles, and other egg-laying reptiles produce large numbers of young ones, who need to disperse rapidly afterbirth to avoid predation, including, at times, from their own parents (1).”

“The inhibition of heart rate through the activity of the parasympathetic nervous system has shown to be linked to the orienting response and sustained outward attention, which constitute a core action tendency of compassion (17).”

“Compassion training improves general well-being and social relationships (33, 34), with increasing evidence of its effectiveness as a psychotherapy (11, 35, 36).”

“Specific strategies, such as breathing practices, friendly voice tones, and facial and body expressions, can activate the parasympathetic system, aiming to calm and soothe the individual, which improves HRV (25).”

“Interestingly, children with higher baseline HRV were rated by teachers and parents as more helpful and more able to regulate their emotions than those with lower HRV (21) and showed increased self-reports of sympathy, both dispositionally and in response to distress-inducing films (22).”

“A second study (45) including 105 undergraduate college women (Mean age = 19.”

“Compassion training improves general well-being and social relationships (33, 34), with increasing evidence of its effectiveness as a psychotherapy (11, 35, 36).”

“Increased HRV in adults has been found to be specifically connected to the emotional state of compassion and not to positive affect in general (23), supporting the correlation between vagal activity and state-like episodes of compassion.”

“, sensitivity and awareness of distress) and (2) having a behavior–output repertoire that allows appropriate responsiveness to suffering (i.”

“Consistently, compassion-evoking stimuli (videos of other’s suffering) have shown to generate vagally mediated heart rate deceleration in children (18) and in adults, whose self-reports of sympathy and compassion were positively related to heart rate deceleration (19).”

“Recent technologies aimed at providing biofeedback in order to increase HRV are also showing promise (50), although researchers are suggesting that technologies used to increase HRV are potentially more effective when combined with mindfulness or compassion-based techniques (50).”

“Consistently, compassion-evoking stimuli (videos of other’s suffering) have shown to generate vagally mediated heart rate deceleration in children (18) and in adults, whose self-reports of sympathy and compassion were positively related to heart rate deceleration (19).”

“One way to better focus future research in compassion science is via evolutionary insights into its origins and functioning situated within its neurophysiological architecture (4, 5, 10, 11).”

“Along with compassion there are many human motives including self-protection (harm-avoidance), sexual (finding a mate and reproducing), and caring-based motives (5, 12, 13).”

“Along with compassion there are many human motives including self-protection (harm-avoidance), sexual (finding a mate and reproducing), and caring-based motives (5, 12, 13).”

“For example, trait self-compassion, measured by the Self-Compassion Scale (37) was found to be correlated to resting HRV and an increase in parasympathetic nervous system tone (43).”

“(47) found that compassionate self-talk increased HRV and soothing positive affect, and that the effects on both physiological and self-report measures were amplified when participants were asked to repeat the phrases in front of a mirror.”

“There is now considerable evidence that being the giver and recipient of caring behaviors, particularly compassion, has a range of health benefits (29, 30) and can affect genetic expression (31, 32).”

“Moreover, recent findings (24) have shown that increases in vagally mediated HRV induced by Transcranial Direct Current Stimulation over the left temporal lobe, topographically close to the left insular cortex, was associated with increases in soothing positive affect: a feeling of perceived safeness and warmth which…”

“To date, there have been several cross-sectional studies demonstrating lower levels of HRV in conditions, such as depression (39), anxiety (40), rumination (41), and self-criticism (42).”

“CFT is notably different from the other interventions, as the theoretical underpinning also includes a combination of evolutionary psychology, attachment theory, and social mentality theory (Gilbert, 2014; Kirby, Doty, Petrocchi, & Gilbert, 2017).”

“More recently, a meta-analysis found compassion-based interventions led to benefits for both self-reported compassion (Cohen’s d = 0.55) and selfcompassion (d = 0.70) and mental health outcomes such as depression (d = 0.64), anxiety (d = 0.49), and well-being (d = 0.51) (Kirby et al. 2017b).”

“Indeed, there is good evidence that compassion training changes a range of physiological systems [68] including the immune and cardiovascular system, and areas in the frontal cortex due to neuroplasticity (see [108] for reviews).”

“Physiologically, CMT practices aim to stimulate the parasympathetic system, and are thought to correspond to adaptive HRV (Kirby et al. 2017).”

“Thus, fears of compassion inhibit one’s ability to activate compassion across the three flows which negatively affects physiological and psychological health and wellbeing [86].”

“Compassionate interventions, such as the use of soothing voice tones and breathing, reduce the fight/flight response, decelerate heartbeat and facilitate parasympathetic rest and restoration (Kirby et al., 2017).”

“Furthermore, the present study aimed to explore the impact of the CMT-T on heart rate variability (HRV), an indicator of vagal regulatory activity and a physiological marker of a person’s ability to flexibly respond to environmental challenges and regulate emotional responses [56, 75], which has been proposed as a pri…”

“(2008) along with various other studies show that engagement in self-compassion exercises is positively associated with HRV (Kirby et al., 2017).”

“As a result, the three-factor structure CMAS Compassion and Self-Compassion Scales was confirmed and represent common targets of compassion-based interventions (Kirby, 2016; Kirby et al., 2017c), and therefore we believe the structure of the CMAS is theoretically sound.”

“Related to this, it has been reported that compassion-based practices can directly increase HRV and potentially other biological, physiological, and neurophysiological measures, such as cortisol [30].”

“The research field is dominated by self-report measures of compassion with few objective measures [40].”

“For the purpose of this study we selected RMSSD as a measure of HRV because it is used to estimate the shortterm component of HRV (Malik et al., 1996) and a recent review of self-compassion intervention studies found that this is one of the most frequently used measure (Kirby et al., 2017).”

“Recent work has shown that heart rate variability (HRV) is an important physical and mental health indicator (Kirby et al., 2017).”

“Evidence suggests that interventions including compassion training effectively promote subjective well-being (Kirby, 2017; Kirby et al., 2017b).”

“, 2017), and improve heart rate variability (Kirby et al., 2017).”

“…helping individuals develop self-reassurance and self-compassionate capabilities may help buffer against the pervasive effects of shame and self-criticism in a number of physical and mental health conditions (Kirby et al., 2017a), including eating and body image-problems (Steindl et al., 2017).”

“In future, it would be useful to analyse a triangulation of SOCS and non-self-reporting measures, such as heart rate variability (Halamová et al., 2019; Kirby et al., 2017), electromyography (Koróníová, Halamová, & Džongová, 2020), eye-tracking (Strnádelová et al.”

“In this way the therapy seeks to change not only437 psychological processes but physiological ones too (Kirby et al., 2017).”

“Continued regulation of the soothing system helped to engage the parasympathetic nervous system in times of emotional distress 94,95,137 , and interventions aimed at cultivating compassion increased self-compassion and soothing affect, and improved state and trait heart-rate variability 97,138,139 .”

“Other examples include the use of artificial intelligence to recognize the emotional load of text-based diary inputs [57] and the use of sensor-based technologies to track biomarkers related to emotional arousal [58].”

“Nurturing self-compassion in your practice There are number of systematic reviews and increasing meta-analytic evidence supporting the efficacy of compassion focused approaches for a range of populations and mental health difficulties (Craig et al., 2020; Kirby et al., 2017b).”

“Participants then engaged in an exercise called soothing rhythm breathing which is linked to accessing and developing the parasympathetic nervous system (which has been found, amongst other things, to be related to threat regulation and social connection - see [21]).”

“Compared to the conventional use of self-report only measures, incorporating HRV into the outcome assessment provides researchers with more robust evidence toward the effectiveness of such practices on psychosocial health and well-being (Kirby et al., 2017).”

“The importance of compassion as a protective factor of health (Gilbert et al. 2011) has led to the creation of different psychotherapeutic interventions based on it to promote mental health (Kirby 2017; Kirby et al. 2017a).”

“Compas-sionate interventions – such as the use of soothing voice tones and breathing techniques – reduce the fight/flight response, decelerate heartbeat, and facilitate parasympathetic rest and restoration (Crone et al., 2024; Kirby et al., 2017).”

“Burgeoning evidence has consistently pointed to a variety of benefits from intentionally developing compassion for oneself and others (e.g. Gilbert, 2017; Kirby et al., 2017a; Seppälä et al., 2017).”

“For instance, a randomized control trial of compassion-focused therapy showed that those who engaged in mindfulness and compassion showed increases in resting baseline RSA compared to the control group (Kirby et al., 2017).”

“Heart-rate variability (HRV) is an indicator of variation in the beat-to-beat R-wave complex [1] and is a reputed marker of parasympathetic nervous system (PSNS) response [2,3].”

“…training on heart rate variability (HRV), where the introduction of various compassion-oriented exercises has resulted in greater HRV. High HRV (relative to baseline) is associated with activation of the parasympathetic (rest, soothe, and digest) nervous system (Gilbert, 2014; Kirby et al., 2017).”

“, to be sensitive to the suffering of the self and others, allied with the wisdom, strength and commitment to prevent and/or alleviate that suffering), CFT has been shown to increase the capacity for emotion regulation as well as to have a positive impact in the stimulation and development of the soothing system (18,…”

“As discussed, a better understanding of behavioral, social, and emotional factors that contribute to HRV will provide evidence for its utility as an outcome measure, a potential method for manipulating behavioral and emotional states, and an index for understanding the integration of autonomic regulation and emotional…”

“Candidate mechanisms might also include heart rate variability (Kirby et al., 2017), improved social connection or belonging (Kok et al., 2013), fear of negative and positive evaluation (Morrison et al., 2024), and emotion regulation (Finlay-Jones, 2017).”

“Being compassionate regulated our autonomic nervous system (Kirby, 2017; Kirby et al., 2017), while self-compassion promoted self-regulation through the reduction in symptoms of anxiety, depression, and maladaptive perfectionistic tendencies (Woodfin et al.”

“…affect and affiliation, feelings of relaxation and safety, self-compassion, compassion for others and from others (e.g., Gilbert & Procter, 2006; Klimecki et al., 2013; Leaviss & Uttley, 2015; Matos et al., 2017; Petrocchi et al., 2017), life satisfaction and well-being (e.g., Barnard & Curry,…”

“This soothing system plays a crucial role in regulating distress and feeling socially safe and connected (Kirby et al., 2017a).”

“In addition, heart rate variability has been proposed as a useful way to measure compassion training outcome 64 .”

“lower heart rate, higher respiratory sinus arrhythmia, and higher heart rate variability [51, 52] that, in turn, are linked with a lower risk for hypertension [53, 54].”

“Higher vmHRV may as such represent the physiological signature of a trait-like compassionate responding (Kirby et al., 2017).”

“Sherwell and Kirby ( 2024 ) and Kirby et al. ( 2017 ) summa - rized the evidence that HRV and compassion are intimately 1 3”

“…is often communicated through compassion, employing interventions such as soothing voice tones and controlled breathing can reduce the fight-or-flight response (e.g., reduce the heartbeat), facilitate parasympathetic rest and repair, and subsequently promote psychophysiological well-being [16,17].”

“Over thousands of years, this system has evolved among mammals to sense distress in their young and work to alleviate it (Kirby, Doty, et al., 2017).”

“…on psychological distress in people with PD [17], pointing to a potential benefit of CMT in PD. Recent studies have confirmed that CMT is effective in activating the soothing affect system which is connected with parasympathetic nervous system activity influencing heart rate variability (HRV) [18].”

“Autonomic function is evaluated as HRV, a primary outcome in intervention research exploring the efficacy of approaches promoting feeling safe and socially connected.(69) HPA axis and immune response associated with HRVare evaluated as cortisol, C-reactive protein, and proinflammatory cytokines.”

“Overall, evidence has shown that these interventions are effective in improving empathy and compassion towards oneself and others (Brito-Pons et al., 2018) and decreasing anxiety and depressive symptoms (Kirby et al., 2017a).”