Cognitively-Based Compassion Training
CBCT was designed at Emory University by one of the authors (LTN), and is a secular adaptation of techniques derived from traditional Tibetan Buddhist methods for cultivating compassion known as
lo-jong [
58]. The first term,
lo or “mind”, refers to subjectivity, and
jong refers to transformation or reorientation. The goal of this “transformation of subjectivity” is to temper egoistic self-centeredness (“self-cherishing”) toward altruism (“other-cherishing”) [
59]. Throughout CBCT, topics and meditation practices build upon one another and are designed to develop an awareness of perceptions and attitudinal biases that can result in self-preoccupation and self-centeredness, challenge unexamined attitudes and cognitions toward other people, facilitate cognitive reappraisal to understand individuals and distress within a broader perspective of the human condition, and stimulate corrective affective experiences using visualizations and imagery during guided meditations. Putatively, the process is designed to reverse, or decondition, negatively valanced thoughts, emotions, and behaviors harmful to oneself and others, and to recondition (“transform”) them into those that are more prosocial and beneficial to oneself and others. Moving from self-centeredness to compassion does not occur rapidly, however. Therefore, CBCT follows a step-by-step process toward the final goal of inclusive and engaged compassion.
Over the course of 8 weeks there will be a total of eight CBCT sessions, one per week, led by the instructor (SED) who is certified by the CBCT training program at Emory University. Participating dyads will attend the weekly CBCT classes together, which we believe will be critical to make concepts salient for both the survivor and caregiver in each dyad. Each weekly session will last for about 120 min and will begin with a brief welcome meditation. This will be followed by a didactic phase in which the instructor will articulate goals and content of the current week, followed by a group discussion facilitated by the instructor. Group discussions will center on the challenges of cancer, cancer survival, and caregiver responses. All sessions combine lecture, discussion, experiential exercises, and reflective practice. Session will end with a 20–30 min meditation guided by the instructor and specific to the topic of the week. In between weekly meetings, dyads will be encouraged to practice a minimum of 10 min per day at home, and together as a dyad if possible, using the provided audio recording.
A study coordinator will call participants once per week, to remind them to practice at home, and also to attend the next CBCT class. Our prior work suggests that participants who practice an average of 3.1 sessions per week (10 min minimum per session) tend to exhibit meaningful changes in various outcomes including depressive symptoms, self-compassion, and inflammatory markers. Home practice will be encouraged by providing dyads with printed narrative summaries of weekly lessons, as well as guided meditation audio recordings developed by the Emory CBCT program, and applied for the current trial by the CBCT instructor (SED). Each week, participants will be asked to complete a CBCT practice log to assess their home practice, and to gather information on their engagement with CBCT. The course is divided into six modules, taught across eight sessions that meet for no more than 120 min, plus time for personal practice between sessions. All sessions combine lecture, discussion, experiential exercises, and reflective practice.
Cancer health education
The cancer health education (CHE) intervention is an adaptation of the in-person attention control called Health Discussion, a protocol used previously by our group (LTN and TWWP) [
34] that incorporates select components from a telephone-based health education program also used previously by us (TAB and CS) [
60,
61]. CHE focuses on topics relevant to health and cancer for survivors and caregivers including cancer advocacy, health and cancer biology, nutrition, lifestyle interventions such as physical activity and goals for physical activity, the importance of good sleep, the impact of stress, and mental health and social support.
Over the course of 8 weeks there will be a total of eight sessions, one session per week, similar to CBCT. As with CBCT, each session will last for approximately 120 min and will include a combination of lecture, group discussion, and experiential exercises. CHE is a good control condition for a trial investigating the benefits of CBCT for several reasons. First, like CBCT, CHE involves building new social contacts while also discussing and learning new topics relevant for solid tumor cancer survivors and their caregivers. Second, also like CBCT, CHE requires individuals to travel to a central location to receive the intervention. However, unlike CBCT, CHE does not involve training around meditation, or structured discussions about compassion or kindness.