Cognitively Based Compassion Training May Help Ease Stress

Jamie DePolo: Hello. Thanks for listening. Today's guest is Dr. Thaddeus Pace, associate professor of nursing at the University of Arizona. His research looks at stress in cancer survivors and ways to ease that stress, for both people with a history of cancer and their partners. He joins us to discuss his research on how a specific type of guided meditation, called Cognitively Based Compassion Training, can help people with a history of breast cancer, as well as their partners. Dr. Pace, welcome to the podcast.

Dr. Thaddeus Pace: Thank you, Jamie. It's wonderful to be here with you today. I want to thank you and everyone at Breastcancer.org for the opportunity.

Jamie DePolo: We're very excited to talk to you because, obviously, stress is a huge thing for anybody who's been diagnosed with any type of cancer. And I wanted to ask you, before we get into your specific research, there are some studies that show that when someone feels stress, it causes physical changes in their body, and from my understanding, your research is kind of working on that. So, could you talk a little bit about that? Explain that for us.

Dr. Thaddeus Pace: Sure. No, I'd be happy to. You know, stress can cause all sorts of physical changes in our bodies, from increased heart rate and blood pressure to, you know, changes in stress hormones, like cortisol and adrenaline. So, we're all familiar with those sorts of things. Interestingly, stress can also turn up inflammation and change the way the immune system works.

And sometimes we have a personal sense of how that's maybe the case when we're more likely to experience symptoms of a cold when we're experiencing a lot of stress. But inflammation is a known, normal part of the stress response, just like cortisol is. But that stress can sometimes become harmful, like cortisol can become harmful. The inflammation with stress can become harmful, too. And then we also know that stress can change the way that cortisol and inflammation may interact with one another, and I've been interested in that interplay in the past, as well.

Jamie DePolo: Okay. Why are those things important for somebody who's been diagnosed with breast cancer? I mean, obviously, I'm thinking it affects the immune system and how that might respond, but are there other things?

Dr. Thaddeus Pace: Yeah. So, you know, first of all, I want to say that stress is something that we all have personal experiences, as in multiple experiences with, over the course of our lives. It's a...stress is a human thing that we all encounter, right? And when we're stressed out, we feel like we're having a hard time keeping up or a hard time coping with situations, right?

But for people who have a history of breast cancer, stress is perhaps especially powerful as an experience, including the stress responses that come along with experiencing the powerful stress of being diagnosed with breast cancer. Because the stress responses that we can have, ultimately, we hope that our stress responses are adaptive. You know, they're supposed to help us to cope with the challenges that we have, but when a source of stress is really intense or the source of stress keeps going on and on and on for a long period of time, that chronic stress can lead to the response changes.

Things like cortisol and inflammation, that can go from being beneficial, to helping us cope, to actually being somewhat harmful in helping us move forward in the healthiest way that we possibly can. So, that's why research has focused, over the last, you know, I'd say couple decades, if not a bit more, on understanding how stress is important for women with a history of breast cancer and also the responses that go along with that stress.

Things like cortisol, but also inflammation are maybe a part of, you know, the negative aspects of the experience of breast cancer, the diagnosis and the treatment, as well. We know that some of the aspects of the stress response, you know, perhaps most prominently, inflammation, can...can have an impact on the way the brain works to change the way we feel. Change the way we may feel a little bit more anxious or especially a little bit more depressed, fatigued, those kinds of things. So, understanding these aspects of the stress response, we think, can tell us a lot about how to best approach helping people who are dealing with the really enormous stress of being diagnosed and then treated with breast cancer and then going through all of the other changes in life that...that also occur.

Jamie DePolo: Okay. Okay. Thank you. So, why did you decide to study Cognitively Based Compassion Training in people with a history of breast cancer? I mean, I know that there are a lot of different types of meditation out there. So, how did you sort of focus in on that particular style, if that's the right word?

Dr. Thaddeus Pace: Yeah. It's a really great question because there are other styles out there. I think it's one point to make first, that not all meditations are the same, right? There are many different traditions and styles. Probably the one that people think about the most is mindfulness meditation, where the goal is to develop a new capacity or improve one's capacity to be present, non-judgmental, and in the present moment and to have those qualities with you, not just while you're practicing mindfulness meditation, but in between practice sessions, as well.

It's sort of like, you know, you want to develop a strength, maybe from exercising regularly, that you benefit from in between exercise sessions at the gym or going out for walks, that kind of thing. So, compassion meditation, or the particular style or particular program that we study called Cognitively Based Compassion Training, is quite a bit different than mindfulness.

There are some similarities between, you know, Cognitively Based Compassion Training, or CBCT, as I'll call it for short, and mindfulness, but the similarities are small, and the differences, I would say, are quite large.

So, really, CBCT is all about developing compassion for the self and others in ways that are unique compared to, certainly, other meditation styles. And we wanted to study this particular approach/style of meditation, Cognitively Based Compassion Training, or CBCT, because it not only helps to decrease things like stress, anxiety, and depression in people in general.

But CBCT and other compassion meditations are really intended to help people develop a sense of interconnections with other people and how people ...as people were all more similar to each other than not, in terms of all wanting to be happy and free of suffering. And when we do that, we appreciate these connections we have with other people. You know, the research with people who have been treated for breast cancer or have a history of breast cancer, you know, suggests that folks don't just experience stress and anxiety and depression, but they also often feel socially isolated from the people around them, even when they have people around them. So, practicing a compassion meditation, we think, may help connect people or feel more connected with others around them, and that's really one of the big reasons why, originally, we started to study Cognitively Based Compassion Training, CBCT, for women with a history of breast cancer, and this was years and years ago.

Jamie DePolo: Okay. Okay. Thank you. Well, that's very interesting because, you know, as you talked about mindfulness meditation...and I'm not going to claim to be an expert in meditation at all, but I've dabbled, and it is very inner focused. You know, it's you and your thoughts, or you're trying to get rid of your thoughts and empty your thoughts. But the way you've described the compassion-based meditation, it sounds more like you're thinking about other people? Am I understanding that correctly?

Dr. Thaddeus Pace: Yes. Yes. I think you're understanding that almost perfectly. So, when you are meditating on particular ideas in compassion meditations, including Cognitively Based Compassion Training, you are focusing your cognitions on understanding how you're connected with others around you and how you may or may not have such a healthy level of self-compassion for yourself, especially in those sort of social settings, you know?

My Tibetan Buddhist colleagues and my religion scholar colleagues who developed CBCT remind me that, you know, Western people often have not the healthiest compassion for themselves. You know, they're hard...we're hard on ourselves, in general. And this meditation is not just about understanding those connections with others by way of meditation and making that sort of sense of connection a really true part of yourself, but also developing a healthy compassion for the self, that self-compassion is key.

Jamie DePolo: Oh, that's very interesting. So, is that why you decided to include partners or loved ones in your research? Because if people are meditating on them, it kind of makes sense to include them, I guess.

Dr. Thaddeus Pace: Yeah. Yeah. That is an awesome question and really is the one that we've been thinking about for many years and has brought us to where we are at now and some of the research we're trying to do. So, when you're...when you're learning a compassion meditation, like Cognitively Based Compassion Training, you meditate on the idea of appreciating someone who's close and dear to you.

So, people who are in your family, who have cared for you, who you have cared for, will be sort of the focus in many of the activities that you do over the course of...of learning compassion meditations. But there's an additional reason why we want to have them a part of our efforts with compassion meditation for women with a history of breast cancer. And that is because, you know, in separate research, including research that's been done by some of my really close colleagues here at the University of Arizona, including a nurse scientist named Terry Badger, suggested that people with a history of cancer are not individuals that are, you know, units going through the world.

They obviously have these powerful connections with other people, right? Those interconnections between people with a history of cancer and their supportive partners, as we...we refer to them...and supportive partners can be family members, so spouses, you know, adult children, parents, even close friends, right, are there throughout the experience of cancer, often every step of the way, helping to care for us.

And you know how that connection between people with a history of cancer and those supportive partners really matter. Such that when a, you know, person with a history of cancer is having a really good day and has, you know, really...a really strong, positive affect, you know, or really bright emotions, that tends to interconnect with the supportive partner over time by way of these interconnections that my colleagues here at the University of Arizona and others have identified.

Likewise, the inverse is true, too. When people with a history of cancer are experiencing distress, things like depression and anxiety, those same sorts of feelings can be conveyed by way of these interconnections to supportive partners. And then, you know, you can actually flip things around, too, if supportive partners are experiencing distress, you know, a bit of anxiety, over time, that is shared with...you know, with a loved one who has a history of cancer, such that, you know, the two individuals are...are really tied together, right? In fact, the technical term that the science uses is interdependence. There is this interdependence between supportive partners and people with a history of cancer. That matters. I mean, the word interdependence, for many of us, doesn't have a good connotation, right?

So, you know, I prefer to usually think of it as interconnections, interconnections that really matter. So, if we are trying to promote well-being in someone with a history of cancer and we know that these interconnections are important, right? And we know that they exist, too, and we want to try to take advantage of these interconnections to promote well-being, to decrease distress, to promote the positive aspects of well-being for people with a history of cancer, why not bring along or include supportive partners in that?

Because that's one way to improve the experience for the person with a history of cancer, as well as the experiences and the well-being of the supportive partner, as well. Who, by the way, of course, as we all know, supportive partners often experience distress along the cancer journey, as well, and are really worthy and in need of programs to make them better, as well.

Jamie DePolo: Absolutely. Absolutely. Yes. Thank you. So, I want to ask about your specific project, which I believe is called SUPORT – S-U-P-O-R-T --  which, if I'm right, stands for Survivors and Partners Online Research Together, and that's your project. So, how does it work? What are you doing? Can people still join it? I mean, I know it's online, so, I mean, that's pretty cool for all our listeners. Because I know sometimes when I talk to people and they're in...you know, they're researchers in New York, so somebody who's listening in Florida is like, no, well, I can't do that. But this sounds so interesting and fascinating that it's virtual and people can do it wherever.

Dr. Thaddeus Pace: Yeah. You got it. So, the SUPORT project is...I mean, I think the first thing to mention about it is that it is an online project, 100% online project, that is really available to people with a history of breast cancer and their supportive partners across the United States. And really, the lower 48, and we limit it to folks who are in the lower 48 because, you know, we have four time zones across which we can work, which is doable, as opposed to, unfortunately, including Hawaii and...I guess even Alaska would make for too many time zones, because we do have to bring people together once a week over the course of eight weeks over Zoom.

We're using Zoom in the project to take part in either Cognitively Based Compassion Training classes or a health education program that we're also studying at the same time. And so, we're really...yeah, we're limiting things to the lower 48, but it is an online research program that, you know, has assessments before and after related to psychological distress and measures of relationship quality, as well as the chance to collect saliva, your own saliva, at home over the course of...

Jamie DePolo: Who could pass that up?

Dr. Thaddeus Pace: Right? Right? So, understand that stress hormone in ourselves, although we won't have numbers right away. So, I want to caution folks about that. But we will be happy to share cortisol information as we finally get it. But yeah, so, the project is...it's online, and it's really just getting started in its first year of about four, or maybe a bit more than four years. And we will have two to maybe three sessions per year when we're bringing women with a history of breast cancer and their supportive partners together with certified instructors online, as well as other women with a history of breast cancer and their supportive partners in sort of a group-like setting.

So, you're on Zoom with others and learning from a certified instructor who has training and lots of experience in working with women with a history of breast cancer as well as partners. And then when you're learning the meditation with other people, you also get to kind of compare experiences. And we know from a lot of prior work that you know, having those shared experiences as you learn helps with your learning process as well. And so, yeah, we're just getting started, and there'll be many opportunities for folks to take part over the next several years, if they would like to.

Jamie DePolo: Oh, that's great, and I can include the link to your website when we publish the podcast, if people are interested, so they could still go to that link, and then I believe there's a form they can fill out if they're interested and you kind of ask them for information and assess whether it's a good fit?

Dr. Thaddeus Pace: Exactly. Exactly. So, yeah, folks can go to that link, or if you Google SUPORT Project Arizona, as in the University of Arizona...and it's SUPORT with only one P. So, S-U-P-O-R-T, not two Ps. You should find your way to our webpage, as well.

Jamie DePolo: Okay. Excellent. And I'm assuming the goal is to reduce stress. I mean, that would be the main goal. You're checking people before they go through this program. Check them after, but you know, everybody always has, as the scientists say, secondary end points. So, are you looking for other things besides stress reduction?

Dr. Thaddeus Pace: Yeah. That's a great question. So, we are interested in, you know, psychological distress, first and foremost. And psychological distress really is the combination of anxiety and depression, depression features. But our secondary outcomes that we think may be important for, you know, mediating the effect, or possibly moderating, the effect of Cognitively Based Compassion Training for women with a history of breast cancer and their supportive partners are things like relationship quality, relationship function. So, we have some questions related to those things, as well, which are...which we suspect, based on the science that's been done as well as some of the research that we've done before, may be important for understanding how this compassion meditation may be good for women with a history of breast cancer and their partners. It's a great question.

Jamie DePolo: Okay. Great. And I'm wondering, too, it sounds like the project is going on for four years. If somebody is interested and would like to take part, are they in the project for four years? Or is...are you going to have kind of...I don't know if this is the right term, but kind of rolling classes? Like somebody does this for a year and then you have a new group? Or how does that work?

Dr. Thaddeus Pace: Yeah. No, that is a great question, and thanks for asking about that, because it lets me clarify. Really, when you begin...when you begin with a SUPORT Project, your involvement will be for, you know, about the eight weeks when you're...when you're actually learning Cognitively Based Compassion Training or the health education program, if you're randomized to that.

And then I should also point out that we have one part of the study where women with a history of breast cancer learn Cognitively Based Compassion Training by themselves, not with their partners, and then the partners will have the opportunity to learn Cognitively Based Compassion Training a little bit after...after those first eight weeks. But there are those eight weeks, and then there are several follow-ups afterward to explore distress and relationship aspects that go out for about six months in the end.

So, your participation will be for about six months or so when all is said and done. But most of the activity is there in the first eight weeks when you're actually attending the online classes once a week, and those, at least initially, will be on Saturdays. Either Saturday mornings, late mornings, or Saturday afternoons, depending on where you are across the country, across the United States. And it's okay to miss one class or maybe even two. I should point that out. Sometimes folks have busy schedules and they know something is coming up. We do approach Cognitively Based Compassion Training and the health education, for that matter...

Jamie DePolo: With compassion.

Dr. Thaddeus Pace: Yeah. Right, and we gear them so we can catch you up if you have to miss one week, and that's okay. Obviously, the goal should be to try to make it for the majority of the classes over the course of the eight-week period when it's running. And then, you know, after the eight weeks are...have concluded, we...we encourage people to continue their practice of compassion meditation, and we hope that we do, right, because the goal...the goal...the ultimate goal of Cognitively Based Compassion Training, whether you're a woman with a history of breast cancer or supportive partner or just anyone else, right, is to, you know, really begin a lifelong practice of compassion meditation to help you have a really good sense of self-compassion as well as a...you know, feelings of connections to others that can really matter for how you feel going through the world day in and day out, right? That's what we are hoping for here in anyone who begins this compassion meditation.

Jamie DePolo: Okay. That all sounds fascinating. I'm wondering, too, what if somebody has been diagnosed, they don't think they have anyone? And I know, like, a lot of people think they are isolated. Maybe their partner...they don't have a partner, their partner has passed away. I guess I'm trying to decide, like, you know, everybody must have one friend that, perhaps, they could ask, too, and that qualifies, as well, right? I'm just trying to think if somebody says, oh, well, I don't have a partner. You know, I don't...my parents aren't here. I don't have any kids. I don't have any siblings. You know, can they still take part?

Dr. Thaddeus Pace: They may be able to. The way we set the SUPORT Project up, at least on this go-around, is for women with a history of breast cancer and a supportive partner to take part in the study, and the supportive partner, by the...by the way the study is written, by the way the study is set up, needs to be someone that lives together with the person with a history of breast cancer.

So, that is one inherent limitation in what we're trying to do now. We're hoping that that won't be an impediment for a huge number of women. But we realize, and by way of some past experience, that it will be, unfortunately. You know, the science, the science of trying to understand how women with a history of breast cancer and their supportive partners are interconnected has sort of pushed us to, at least for the time being, work with, you know, pairs of individuals who are likely to have a pretty close connection.

In the past, we have...we've studied compassion meditation and other well-being programs that included supportive partners who could be close friends, who maybe lived across town, and you know, the person with a history of cancer maybe didn't see every day or maybe not even every week, but a really good friend. And you know, as much as having that sort of supportive partner along is very important, the science is suggesting to us that when you include...when we include partners, at least in research, we may find, or we have sort of found, in the past, greater benefits for a person with a history of cancer when a partner comes along who they are very close to. And so that's why, in the current study, we are focusing on supportive partners who live with the person with the history of breast cancer. That being said, though, if someone is really interested in beginning a meditation practice, hopefully a, especially a compassion meditation practice, and they don't qualify for the study, we will, we will work hard to connect everyone with local resources or programs that can be done online, you know, maybe from anywhere, because they're...they are now out there, including with Cognitively Based Compassion Training.

And so, folks who may not qualify for the study because of supportive...not having a supportive partner they live with can still begin this, can still begin compassion meditation if they would like to. And we want to be 100% supportive of that, and we will be. So, thanks for asking about that.

Jamie DePolo: Oh, that's great. You must have read my mind, because that was going to be my...my last question, was what if somebody doesn't qualify, but is interested? So, they could still go to your SUPORT, S-O-P-O-R-T, Project website and learn about compassion-based training. And would they need to contact you to get some information about resources just if they wanted to do it on their own, or do you have that right on your website?

Dr. Thaddeus Pace: We currently do not have it right on our website, because we're working to get people excited about participating in the study. But we do have our contact information on our website, you know, our email address and our telephone number. And if someone knows...if someone realizes, after taking a look at our study webpage that lists off, you know, the requirements to take part, but they wouldn't be a good fit, by all means, definitely contact us either by phone or by that email address, and we will...we'll get back to them with some good options, which we do have ready to share pretty much at a moment's notice. We try to get back to our calls, you know, within about 24 hours, because we want to keep the enthusiasm that people have rolling along, and so, yeah, that's a really good question.

Jamie DePolo: Excellent. Dr. Pace, thank you so much. This has been so interesting, and I really can't wait to hear what the results of your study are. We'll have to have you back in three or four years when...after you've gathered everything and analyzed it all. Thank you so much.

Dr. Thaddeus Pace: You bet, Jamie. That sounds wonderful to come back some day, and thank you again for having me on today. I really appreciate it.