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EXPERT COMMENTARY
Compassion vs empathy
By Dr David Rakel
“When a person feels accepted for who they are and what they do – no matter how unhealthy – it allows them the
freedom to consider change rather than needing to defend against it.”
T
his quote by Steve
Berg-Smith is true
for treating oth-
ers and ourselves. This
study of type 1 and 2
diabetics showed that an
8-week mindfulness and
self-compassion course
reduced depression, diabe-
tes-associated stress, and
HbA
1c
levels by almost 1%
3 months after enrolment
in this 8-week course com-
pared with a “usual care”
control group.
Diabetes is associated with self-critical thoughts such as, “I need to eat
better, exercisemore, and lose weight.” This can lead to distress, depression,
and worsening diabetic control. Compassion training has been associated
with lower cortisol, increased heart rate variability, decreased IL-6 (inflam-
mation), decreased stress, and lower HbA
1c
levels. Compassion training
also stimulates oxytocin (the love hormone) and natural endorphins.
What is compassion training?
Two main ingredients of the compassion training provided in this
study were self-kindness (rather than self-criticism) and common hu-
manity (rather than isolation). This second point is a key difference
between empathy and compassion. Practicing empathy can lead to
empathy distress or empathy fatigue because the training requires that
we feel the suffering of another person where the two people involved
are separate: me and you. Compassion training on the other hand
teaches a common humanity, where two people are more one than
separate. When I support you through your suffering, I support myself
because we are both part of the same humanity (compassion) vs I feel
your suffering (heavy) and I am going to help you through it (empathy).
This may sound like psychological and philosophical babble, but
there is promising evidence to back this up.
In 2014, Klamicki and colleagues showed study participants videos
of human suffering before and after empathy training (“I feel your
pain”) and compassion training (loving-kindness training, for self and
others). The researchers looked at positive and negative affect and
functional MRI after participants watched videos of human suffering.
Negative affect worsened after empathy training and then improved
after compassion training. Positive affect changed little after empathy
training but went up significantly after compassion training. Functional
MRI of the brains of these study participants showed that compassion
training activated the centres associate with love, reward, and affiliation.
Those activated with empathy were associated with pain.
2
Self-acceptance and kindness not only improves depression, coping,
and diabetic control but can also reduce clinician burnout if we see our
work as a service to all humanity in which we are an intricate part.
References
1. Berg-Smith S. Heart of behavior change: Client-centered education. 2015;
www.
doh.wa.gov/portals/1/Documents/8100/HeartOfBehaviorChange.pdf
. Accessed
July 4, 2016.
2. Klimecki OM, Leiberg S, Ricard M, Singer T.
Soc Cogn Affect Neurosci
2014;9:873–879.
Dr David Rakel is Associate Professor at
the Department of Family Medicine and
Director at the University of Wisconsin
Integrative Medicine, University of Wisconsin
School of Medicine and Public Health.
Self-acceptance
and kindness not
only improves
depression, coping,
and diabetic
control but can
also reduce
clinician burnout.
JOURNAL SCAN
Prevalence of diabetic retinopathy in newly diagnosed type 2 diabetes
Diabetologia
Take-home message
•
In this observational population-based study, researchers investigated the prevalence of diabetic
retinopathy (DR) at the time of diagnosis of type 2 diabetes. Of the 14,948 participants inves-
tigated, 347 had newly diagnosed type 2 diabetes detected during the screening. Based on
fundus photographs, researchers observed that 13% of participants with newly diagnosed type
2 diabetes had DR. The majority of DR in these participants was mild non-proliferative (12%), but
0.6% of participants had moderate DR and 0.3% had proliferative DR.
•
Up to 13% of individuals with type 2 diabetes have DR at the time of diagnosis, underscoring the
importance of diabetes screening.
Abstract
AIMS/HYPOTHESIS
Individuals with type 2 diabetes
mellitus may experience an asymptomatic period
of hyperglycaemia, and complications may already
be present at the time of diagnosis. We aimed to
determine the prevalence of diabetic retinopathy in
patients with newly diagnosed (screening-detected)
type 2 diabetes.
METHODS
The Gutenberg Health Study is a popu-
lation-based study with 15,010 participants aged
between 35 and 74 years. We determined the
weighted prevalence of diabetic retinopathy by as-
sessing fundus photographs. Screening-detected
type 2 diabetes was defined as an HbA1c concen-
tration of 6.5% (47.5 mmol/mol) or more, no medical
diagnosis of diabetes and no intake of insulin or oral
glucose-lowering agents.
RESULTS
Of 14,948 participants, 1377 (9.2%) had
diabetes mellitus. Of these, 347 (25.2%) had newly
diagnosed type 2 diabetes detected by the screen-
ing. Overall, the weighted prevalence of screening-
detected type 2 diabetes was 2.1%. Fundus photos
were evaluable for 285 (82.1%) participants with
newly diagnosed diabetes. The weighted preva-
lence of diabetic retinopathy in screening-detected
type 2 diabetes was 13.0%; 12% of participants had a
mild non-proliferative diabetic retinopathy and 0.6%
had a moderate non-proliferative diabetic retinopa-
thy. Diabetic retinopathy was proliferative in 0.3%.
No cases of severe non-proliferative diabetic retin-
opathy or diabetic maculopathy were found. Thirty
(14.9%) of 202 and six (7.2%) of 83 individuals with
and without concomitant arterial hypertension, re-
spectively, had diabetic retinopathy (OR 2.54, 95%
CI 1.06–7.14). Visual acuity did not differ between
individuals with and without diabetic retinopathy.
CONCLUSIONS/INTERPRETATION
In this large European
study, the prevalence of diabetic retinopathy in
screening-detected type 2 diabetes was 13%. Only
a very small proportion of participants with detected
diabetic retinopathy needed treatment.
Prevalence of diabetic retinopathy in screening-
detected diabetes mellitus:
RESULTS
from the
Gutenberg Health Study (GHS)
.
Diabetologia
2016 Jun 17;[Epub ahead of print], Ponto KA,
Koenig J, Peto T, et al.
Mindful self-compassion
intervention improves
depression, distress,
and HbA1c in people
with diabetes
Diabetes Care
Take-home message
•
This randomised controlled trial evalu-
ated the effect of an 8-week mindful
self-compassion program on depression,
diabetes-related distress, and HbA
1c
in
patients with type 1 or type 2 diabetes
mellitus. The results revealed that par-
ticipants in the program had significantly
fewer depressive symptoms, reduced
distress, and improved HbA
1c
during the
study period and at follow-up.
•
This study suggests that promoting self-
compassion improves overall emotional
well-being as well as specific metabolic
markers in diabetic patients.
Abstract
OBJECTIVE
Mood difficulties are common
among patients with diabetes and are linked
to poor blood glucose control and increased
complications. Evidence on psychological
treatments that improve both mood and meta-
bolic outcomes is limited. Greater self-compas-
sion predicts better mental and physical health
in both healthy and chronically ill populations.
Thus, the purpose of this randomised con-
trolled trial (RCT) was to evaluate the effects
of self-compassion training on mood and meta-
bolic outcomes among patients with diabetes.
RESEARCH DESIGN AND METHODS
This RCT
tested the effects of a standardised 8-week
mindful self-compassion (MSC) program (n =
32) relative to a wait-list control condition (n
= 31) among patients with type 1 and type 2
diabetes. Measures of self-compassion, de-
pressive symptoms, diabetes-specific distress,
and HbA
1c
were taken at baseline (preinter-
vention), at week 8 (postintervention), and at
3-month follow-up.
RESULTS
Repeated-measures ANOVA using
intention to treat showed that MSC training
increased self-compassion and produced
statistically and clinically significant reduc-
tions in depression and diabetes distress in
the intervention group, with results maintained
at 3-month follow-up. MSC participants also
averaged a clinically and statistically meaning-
ful decrease in HbA
1c
between baseline and
follow-up of > 10 mmol/mol (nearly 1%). There
were no overall changes for the wait-list con-
trol group.
CONCLUSIONS
This initial report suggests that
learning to be kinder to oneself (rather than
being harshly self-critical) may have both emo-
tional and metabolic benefits among patients
with diabetes.
Kindness matters: A randomised controlled
trial of a mindful self-compassion interven-
tion improves depression, distress, and
HbA
1c
among patients with diabetes.
Diabe-
tes Care
2016 Jun 22;[Epub ahead of print],
Friis AM, Johnson MH, Cutfield RG, et al.
DIABETES
VOL. 1 • No. 2 • 2016
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