An intervention study examining the effectiveness of loving kindness meditation in reducing depressive symptoms: Compassionate coping as a mediator?
Main Article Content
Abstract
Aim: To explore whether the LKM intervention has the potential to decrease depression and increase self-compassion. Self-compassionate coping was examined as a mediating variable.
Methods: A sample of 57 university students underwent a pretest-posttest design. Self-compassion was measured with the Self-Compassion Scale, depression with the Patient Health Questionnaire – 9, and self-compassionate coping was assessed using the Self-Compassionate Coping Measure. Participants completed all measures at both pre and posttest. Between both measurement moments there were 12 days in which participants followed either the LKM or a control exercise daily. Repeated measures ANOVAs and a simple mediation analysis were performed.
Results: Over time, both groups decreased in their depression and increased in their self-compassion scores. Assignment to the LKM condition did not result in significantly higher self-compassion scores compared to control. We found a significant effect of LKM for depressive symptoms only when controlling for successfully completed homework exercises. Self-Compassionate coping did not emerge as significant mediator in our statistical analysis.
Conclusion: The results indicate a mixed picture regarding the efficacy of LKM in reducing depression and increasing self-compassion. Both conditions were possibly too similar and involved helpful elements. Further research into the antidepressant utility of LKM is warranted to understand the exact mechanisms of action.
Article Details

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
References
- Neff KD. Self-Compassion: An Alternative Conceptualization of a Healthy Attitude Toward Oneself. Self and Identity, 2003a, 2(2): 85-101. https://doi.org/10.1080/15298860309032
- Carvalho SA, Trindade IA, Gillanders D, et al. Self-Compassion and Depressive Symptoms in Chronic Pain (CP): A 1-Year Longitudinal Study. Mindfulness, 2020, 11(3): 709-719. https://doi.org/10.1007/s12671-019-01292-7
- Zeller M, Yuval K, Nitzan-Assayag Y, et al. Self-Compassion in Recovery Following Potentially Traumatic Stress: Longitudinal Study of At-Risk Youth. Journal of Abnormal Child Psychology, 2015, 43(4): 645-653. https://doi.org/10.1007/s10802-014-9937-y
- Bluth K and Neff KD. New frontiers in understanding the benefits of self-compassion. Self and Identity, 2018, 17(6): 605-608. https://doi.org/10.1080/15298868.2018.1508494
- MacBeth A and Gumley A. Exploring compassion: A meta-analysis of the association between self-compassion and psychopathology. Clinical Psychology Review, 2012, 32(6): 545-552. https://doi.org/10.1016/j.cpr.2012.06.003
- Greenberg PE, Fournier AA, Sisitsky T, et al. The Economic Burden of Adults with Major Depressive Disorder in the United States (2010 and 2018). PharmacoEconomics, 2021, 39(6): 653-665. https://doi.org/10.1007/s40273-021-01019-4
- Egan SJ, Rees CS, Delalande J, et al. A Review of Self-Compassion as an Active Ingredient in the Prevention and Treatment of Anxiety and Depression in Young People. Administration and Policy in Mental Health and Mental Health Services Research, 2022, 49: 385-403. https://doi.org/10.1007/s10488-021-01170-2
- Marsh IC, Chan SWY and Macbeth A. Self-compassion and Psychological Distress in Adolescents -— a Meta-analysis. Mindfulness, 2018, 9: 1011-1027. https://doi.org/https://doi.org/10.1007/s12671-017-0850-7
- Zessin U, Dickh O and Garbade S. The Relationship Between Self-Compassion and Well-Being: A Meta-Analysis. Applied Psychology: Health and Well-Being, 2015, 7(3): 340-364. https://doi.org/10.1111/aphw.12051
- Bluth K, Gaylord SA, Campo RA, et al. Making Friends with Yourself: A Mixed Methods Pilot Study of a Mindful Self-Compassion Program for Adolescents. Mindfulness, 2016, 7(2): 479-492. https://doi.org/10.1007/s12671-015-0476-6
- Dundas I, Binder PE, Hansen TGB, et al. Does a short self-compassion intervention for students increase healthy self-regulation? A randomized control trial. Scandinavian Journal of Psychology, 2017, 58(5): 443-450. https://doi.org/10.1111/sjop.12385
- Neff KD and Germer CK. A Pilot Study and Randomized Controlled Trial of the Mindful Self-Compassion Program. Journal of Clinical Psychology, 2013, 69(1): 28-44. https://doi.org/10.1002/jclp.21923
- Rodgers RF, Donovan E, Cousineau T, et al. BodiMojo: Efficacy of a Mobile-Based Intervention in Improving Body Image and Self-Compassion among Adolescents. Journal of Youth and Adolescence, 2018, 47(7): 1363-1372. https://doi.org/10.1007/s10964-017-0804-3
- Kendler KS, Thornton LM and Gardner CO. Genetic risk, number of previous depressive episodes, and stressful life events in predicting onset of major depression. American Journal of Psychiatry, 2001, 158(4): 582-586. https://doi.org/10.1176/appi.ajp.158.4.582
- Solomon DA, Keller MB, Leon AC, et al. Multiple recurrences of major depressive disorder. American Journal of Psychiatry, 2000, 157(2): 229-233. https://doi.org/10.1176/appi.ajp.157.2.229
- Johnson DP, Penn DL, Fredrickson BL, et al. A pilot study of loving-kindness meditation for the negative symptoms of schizophrenia. Schizophrenia Research, 2011, 129(2-3): 137-140. https://doi.org/10.1016/j.schres.2011.02.015
- Van Gordon W, Shonin E, Sumich A, et al. Meditation Awareness Training (MAT) for Psychological Well-Being in a Sub-Clinical Sample of University Students: A Controlled Pilot Study. Mindfulness, 2014, 5(4): 381-391. https://doi.org/10.1007/s12671-012-0191-5
- May CJ, Weyker JR, Spengel SK, et al. Tracking Longitudinal Changes in Affect and Mindfulness Caused by Concentration and Loving-kindness Meditation with Hierarchical Linear Modeling. Mindfulness, 2014, 5(3): 249-258. https://doi.org/10.1007/s12671-012-0172-8
- Carson JW, Keefe FJ, Lynch TR, et al. Loving-Kindness Meditation for Chronic Low Back Pain: Results From a Pilot Trial. Journal of Holistic Nursing, 2005, 23(3): 287-304. https://doi.org/10.1177/0898010105277651
- Galante J, Galante I, Bekkers MJ, et al. Effect of kindness-based meditation on health and well-being: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 2014, 82(6): 1101-1114. https://doi.org/10.1037/a0037249
- Shonin E, Van Gordon W, Compare A, et al. Buddhist-Derived Loving-Kindness and Compassion Meditation for the Treatment of Psychopathology: a Systematic Review. Mindfulness, 2015, 6(5): 1161-1180. https://doi.org/10.1007/s12671-014-0368-1
- Bodhi B. The Noble Eightfold Path: The Way to the End of Suffering, 2006.
- Shahar B, Szepsenwol O, Zilcha-Mano S, et al. A Wait-List Randomized Controlled Trial of Loving-Kindness Meditation Programme for Self-Criticism. Clinical Psychology and Psychotherapy, 2015, 22(4): 346-356. https://doi.org/10.1002/cpp.1893
- Weibel DT, McClintock AS and Anderson T. Does Loving-Kindness Meditation Reduce Anxiety? Results from a Randomized Controlled Trial. Mindfulness, 2017, 8(3): 565-571. https://doi.org/10.1007/s12671-016-0630-9
- Kirby JN and Laczko D. A Randomized Micro-Trial of a Loving-Kindness Meditation for Young Adults Living at Home with their Parents. Journal of Child and Family Studies, 2017, 26(7): 1888-1899. https://doi.org/10.1007/s10826-017-0692-x
- Uchino BN, Bowen K, Grey RGK, et al. Loving-Kindness Meditation Improves Relationship Negativity and Psychological Well-Being: A Pilot Study. Psychology, 2016, 7(1): 6-11. https://doi.org/10.4236/psych.2016.71002
- Totzeck C, Teismann T, Hofmann SG, et al. Loving-Kindness Meditation Promotes Mental Health in University Students. Mindfulness, 2020, 11(7): 1623-1631. https://doi.org/10.1007/s12671-020-01375-w
- Denckla CA, Consedine NS and Bornstein RF. Self-compassion mediates the link between dependency and depressive symptomatology in college students. Self and Identity, 2017, 16(4): 373-383. https://doi.org/10.1080/15298868.2016.1264464
- Mehr KE and Adams AC. Self-Compassion as a Mediator of Maladaptive Perfectionism and Depressive Symptoms in College Students. Journal of College Student Psychotherapy, 2016, 30(2): 132-145. https://doi.org/10.1080/87568225.2016.1140991
- Krieger T, Altenstein D, Baettig I, et al. Self-Compassion in Depression: Associations With Depressive Symptoms, Rumination, and Avoidance in Depressed Outpatients. Behavior Therapy, 2013, 44(3): 501-513. https://doi.org/10.1016/j.beth.2013.04.004
- Ehret AM, Joormann J and Berking M. Examining risk and resilience factors for depression: The role of self-criticism and self-compassion. Cognition and Emotion, 2015, 29(8): 1496-1504. https://doi.org/10.1080/02699931.2014.992394
- Krieger T, Berger T and Holtforth M. The relationship of self-compassion and depression: Cross-lagged panel analyses in depressed patients after outpatient therapy. Journal of Affective Disorders, 2016, 202: 39-45. https://doi.org/10.1016/j.jad.2016.05.032
- Johnson EA and O'Brien KA. Self-compassion soothes the savage ego-threat system: Effects on negative affect, shame, rumination, and depressive symptoms. Journal of Social and Clinical Psychology, 2013, 32(9): 939-963. https://doi.org/10.1521/jscp.2013.32.9.939
- Mascaro JS, Darcher A, Negi LT, et al. The neural mediators of kindness-based meditation: A theoretical model. Frontiers in Psychology, 2015, 6: 1-12. https://doi.org/10.3389/fpsyg.2015.00109
- Bakker AM, Cox DW, Hubley AM, et al. Emotion Regulation as a Mediator of Self-Compassion and Depressive Symptoms in Recurrent Depression. Mindfulness, 2019, 10(6): 1169-1180. https://doi.org/10.1007/s12671-018-1072-3
- Diedrich A, Burger J, Kirchner M, et al. Adaptive emotion regulation mediates the relationship between self-compassion and depression in individuals with unipolar depression. Psychology and Psychotherapy: Theory, Research and Practice, 2017, 90(3): 247-263. https://doi.org/10.1111/papt.12107
- Zhang H, Watson-Singleton NN, Pollard SE, et al. Self-Criticism and Depressive Symptoms: Mediating Role of Self-Compassion. Omega (United States), 2019, 80(2): 202-223. https://doi.org/10.1177/0030222817729609
- Garnefski N and Kraaij V. The Self-Compassionate Coping Measure 4 items): Psychometric features and relationships with depression and anxiety in adults. Advances in Health and Behavior, 2019, 2(2): 75-78. https://doi.org/10.25082/ahb.2019.02.001
- Raes F, Pommier E, Neff KD, et al. Construction and factorial validation of a short form of the Self-Compassion Scale. Clinical Psychology & Psychotherapy, 2011, 18(3): 250-255. https://doi.org/10.1002/cpp.702
- Neff KD. The Development and Validation of a Scale to Measure Self-Compassion. Self and Identity, 2003b, 2(3): 223-250. https://doi.org/10.1080/15298860309027
- Kroenke K, Spitzer RL and Williams J. The PHQ-9 Validity of a Brief Depression Severity Measure. Journal of General Internal Medicine, 2001, 16(9): 606-613. https://doi.org/10.1046/j1525-14972001016009606x
- Love J, Selker R, Verhagen J, et al. Software to sharpen your stats. Aps Observer, 2015, 28(3): 27-29.
- Al-Refae M, Al-Refae A, Munroe M, et al. A Self-Compassion and Mindfulness-Based Cognitive Mobile Intervention Serene) for Depression, Anxiety, and Stress: Promoting Adaptive Emotional Regulation and Wisdom. Frontiers in Psychology, 2021, 12: 1-18. https://doi.org/10.3389/fpsyg.2021.648087
- Fredrickson BL, Boulton AJ, Firestine AM, et al. Positive Emotion Correlates of Meditation Practice: a Comparison of Mindfulness Meditation and Loving-Kindness Meditation. Mindfulness, 2017, 8(6): 1623-1633. https://doi.org/10.1007/s12671-017-0735-9
- Zeng X, Chiu CPK, Wang R, et al. The effect of loving-kindness meditation on positive emotions: A meta-analytic review. Frontiers in Psychology, 2015, 6: 1-14. https://doi.org/10.3389/fpsyg.2015.01693
- Suárez N, Regueiro B, Estévez I, et al. Individual precursors of student homework behavioral engagement: The role of intrinsic motivation, perceived homework utility and homework attitude. Frontiers in Psychology, 2019, 10: 1-10. https://doi.org/10.3389/fpsyg.2019.00941
- Deci EL, Koestner R and Ryan RM. A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychological Bulletin, 1999, 125(6): 627-668. https://doi.org/10.1037//0033-2909.125.6.627
- Robiner WN. Enhancing adherence in clinical research. Contemporary Clinical Trials, 2005, 26(1): 59-77. https://doi.org/10.1016/j.cct.2004.11.015
- Sheiner LB and Rubin DB. Intention-to-treat analysis and the goals of clinical trials. Clinical Pharmacology and Therapeutics, 1995, 57(1): 6-15. https://doi.org/10.1016/0009-9236(95)90260-0
- Gilbert P, McEwan K, Matos M, et al. Fears of compassion: Development of three self-report measures. Psychology and Psychotherapy: Theory, Research and Practice, 2011, 84(3): 239-255. https://doi.org/10.1348/147608310X526511
- Gilbert P. Fears of Compassion in a Depressed Population Implication for Psychotherapy. Journal of Depression and Anxiety, 2014, S2: 1. https://doi.org/10.4172/2167-1044.s2-003
- Zeng X, Wei J, Oei T P, et al. The Self-Compassion Scale is Not Validated in a Buddhist Sample. Journal of Religion and Health, 2016, 55(6): 1996-2009. https://doi.org/10.1007/s10943-016-0205-z
- Mantzios M, Tariq A, Altaf M, et al. Loving-Kindness Colouring and Loving-Kindness Meditation: Exploring the Effectiveness of Non-Meditative and Meditative Practices on State Mindfulness and Anxiety. Journal of Creativity in Mental Health, 2022, 17(3): 305-312. https://doi.org/10.1080/15401383.2021.1884159