By Ellen Feldman, MD
Altru Health System, Grand Forks, ND
Dr. Feldman reports no financial relationships relevant to this field of study.
• Cognitively Based Compassion Training (CBCT), a meditation-based intervention using mindfulness and focused on building compassion and empathy, was administered to groups of volunteer parents for a total of 20 hours over eight to 10 weeks. In all, 39 volunteer parents of children aged 9 months to 5 years were randomized into either the intervention (n = 25) or wait list control group (n = 14).
• The goal of the study was to determine if CBCT in parents was associated with decreased level of stress in children as measured by hair cortisol concentration (HCC), and/or with a decrease in parental levels of stress, self-compassion, and mindfulness.
• Parental CBCT was associated with a significant decrease in HCC in children (P = 0.041), but there was no clear association with changes in parental HCC or other measures of parental stress, self-compassion, or mindfulness.
SYNOPSIS: The authors of this small, randomized, controlled trial found that Cognitively Based Compassion Training, a group-based technique taught to parents, was associated with decreased hair level of cortisol (a marker of decreased stress) in children whose parents completed this training.
SOURCE: Poehlmann-Tynan J, Engbretson A, Vigna AB, et al. Cognitively Based Compassion Training for parents reduces cortisol in infants and young children. Infant Ment Health J 2020;41:126-144.
“We cannot always build the future for our youth, but we can build our youth for the future.” — Franklin D. Roosevelt
Mindfulness is a powerful, teachable therapeutic technique useful for a variety of health outcomes, including stress reduction and overall improvement of well-being and health. Mindfulness-based stress reduction (MBSR) is one of the most widely studied, structured mindfulness-based programs. Jon Kabat-Zinn, the founder of MBSR, defines mindfulness as the “awareness that arises through paying attention, on purpose, in the present moment, non-judgmentally.”1-3
While MBSR practitioners use mindfulness techniques to assist with regulation of intense mood states, Cognitively Based Compassion Training (CBCT) takes a different slant. Both techniques rely on the development of mindfulness and consequent self-awareness, but CBCT aims to use self-awareness to foster compassion and empathy. First developed for use in combating depression in college students, CBCT has shown promise in studies involving many other populations.4 Poehlmann-Tynan et al noted that CBCT has not been studied in parents. Postulating that strengthening compassion and empathy could decrease the stress of parenting, they decided to investigate whether this technique could help with parental mindfulness, self-compassion, stress, and/or child stress levels.
Initially, 28 parents of children aged 9 months to 5 years were randomized to an intervention group (n = 14) and a wait list control group (n = 14). After the initial cohort completed a course of CBCT, the wait list group, along with 11 new parents, were invited to participate in a second cohort group. Thus, 39 patients overall participated in the study, with 25 receiving active intervention. Most of the volunteer participants were married, associated with an early childcare center at a teaching university, highly educated, and came from higher socioeconomic backgrounds.
CBCT was administered for a total of 20 hours over eight to 10 weeks (depending on the cohort). Hair samples and self-administered questionnaires were collected pre- and post-intervention. The following standardized tests were completed and scored based on the responses to the questionnaires:
- Calgary Symptoms of Stress Inventory (perceived symptoms of stress)
- Parenting Daily Hassles Scale (perceived parenting stress)
- Self-Compassion Scale (parental self-compassion)
- Five Facet Mindfulness Questionnaire (parental mindfulness).
Post-intervention scores on each standardized scale showed no evidence of a significant change in the intervention group or in the control group. Post-intervention hair cortisol concentration (HCC) in parents increased mildly in both the intervention and control groups, without any evidence of a significant intervention effect. However, there was a significant difference in child HCC post intervention. Children of parents who received CBCT showed a pooled mean decrease in cortisol concentration of -143.26 pg/mg, whereas children of parents in the control group showed a pooled mean increase in cortisol concentration of 102.56 pg/mg; P = 0.041.
It is important to realize this was a preliminary study with only a small number of participants from homogeneous backgrounds. Clearly, a more diverse pool of subjects would help determine if results can be generalized. Additionally, although HCC and the relation to stress in adults is well-documented, it is a relatively new concept for children and needs more research to establish clear norms in this demographic.5 We do know that prolonged elevation of cortisol in childhood is linked with exposure to adverse childhood events. Additionally, we know that cortisol elevation over time may adversely affect hippocampal functioning and result in long-lasting difficulties with memory, learning, and regulation of mood. Prolonged elevation of cortisol can inhibit the immune system and elevate glucose, leading to inflammation in multiple areas.6 This study by Poehlmann-Tynan et al points to a possible pathway to prevent or reverse elevation of cortisol via parenting techniques, providing a promising avenue for future research.
The results bring up many intriguing ideas for the primary care physician or pediatrician working with young children. It is notable that the parents in this study were healthy volunteers and not a group with specific
parenting problems or health concerns. Not all parents in this position will be motivated or have time to participate in group therapy to enhance skills. In addition, CBCT may not be readily available or easily affordable in many communities.
However, a provider is on solid ground telling parents there is suggestive evidence that enhancing parental empathy and compassion can help decrease stress in young children. In fact, there may be multiple ways for parents to gain these skills — this study looked at only one intervention. These results also serve to remind the provider to consider not only the health needs of the identified patient, but the intertwined needs of children and caregivers. This unique perspective allows more robust interventions that can affect wellness for the entire family.
- Davis DM, Hayes JA. What are the benefits of mindfulness? A practice review of psychotherapy-related research. Monitor on Psychology 2012;43:64. https://www.apa.org/monitor/2012/07-08/ce-corner
- Sharma M, Rush SE. Mindfulness-based stress reduction as a stress management intervention for healthy individuals: A systematic review.
J Evid Based Complementary Altern Med 2014;19:271-286.
- Mindful. Jon Kabat-Zinn: Defining Mindfulness. Published Jan. 11, 2017. https://www.mindful.org/jon-kabat-zinn-defining-mindfulness/
- Mascaro JS, Kelley S, Darcher A, et al. Meditation buffers medical student compassion from the deleterious effects of depression. The Journal of Positive Psychology 2016;13:133-142.
- Bates R, Salsberry P, Ford J. Measuring stress in young children using hair cortisol: The state of the science. Biol Res Nurs 2017;19:499-510.
- Barnes AJ, Anthony BJ, Karatekin C, et al. Identifying adverse childhood experiences in pediatrics to prevent chronic health conditions. Pediatr Res 2020;87:362-370.