Compassion: A Promising Emerging Approach in Cardiovascular Health?

Cardiovascular diseases and mental health are closely and complexly linked, influenced by biopsychosocial and behavioural interactions. Yet current therapeutic approaches often remain compartmentalized: on one hand, strictly medical interventions targeting the physical aspects of disease and, on the other, psychological interventions focused on mental health. This dichotomy can limit treatment effectiveness, especially in situations where body and mind interact in an interconnected and dynamic way.

A large body of research suggests that psychological health plays a significant role in long-term cardiovascular health. Conditions such as anxiety, depression, chronic stress, and sleep disorders—unfortunately common—are associated not only with an increased risk of developing cardiovascular disease, but also with poorer prognosis and significantly reduced life expectancy. For example, several epidemiological studies have reported that mood disorders such as severe and persistent mental illnesses—including major depressive disorder and bipolar disorder—can reduce life expectancy by nearly 10 years [1].

Depressive and anxious states can affect cardiovascular health through direct mechanisms, such as chronic activation of stress axes—particularly the hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system (ANS)—or indirectly by undermining the adoption and maintenance of healthy behaviours like physical activity and balanced nutrition.

Despite this reality, few therapeutic models integrate these interdependent dimensions to effectively transform an individual’s relationship to their symptoms by incorporating, for instance, mindfulness practices and emotional regulation tools.

Emerging approaches based on mindfulness, compassion, and self-compassion offer a promising perspective, as they simultaneously address both psychological and cardiovascular dimensions.

This article will briefly review these approaches and place emphasis on compassion, since studies have shown that:

• A lack of compassion is associated with greater carotid atherosclerosis and high blood pressure.
• Compassion training is possible and yields positive results for both psychological and metabolic health (e.g. diabetes).

Mindfulness: A Common Thread in These Therapeutic Approaches

Mindfulness is defined as a conscious and attentive awareness of the present moment, encompassing both internal experiences (sensations, thoughts, emotions, motivations) and external stimuli (environmental cues such as sounds, objects, and events). This practice emphasizes observing experiences without judgment, with a sense of kind curiosity. According to Kabat-Zinn (1990), mindfulness is “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally” [2].

Mindfulness training typically involves practical techniques like meditation, body scans, and mindful breathing. These exercises help individuals enhance their capacity to remain present (a meditative state) while decreasing emotional reactivity to everyday stressors.

Several therapeutic interventions have been developed to incorporate mindfulness into clinical practice. Among them:

• MBSR (Mindfulness-Based Stress Reduction): Developed by Jon Kabat-Zinn, this program aims to reduce stress and improve emotional regulation through meditative practices, mindful movement, and group discussions.
• MBCT (Mindfulness-Based Cognitive Therapy): An adaptation of MBSR, MBCT is specifically designed to prevent depressive relapse by combining mindfulness techniques with cognitive therapy.
• DBT (Dialectical Behaviour Therapy): Developed by Marsha Linehan, DBT uses mindfulness to help regulate emotions, particularly in individuals with personality disorders or self-destructive behaviours.
• ACT (Acceptance and Commitment Therapy): This approach emphasizes accepting difficult experiences while actively engaging in actions aligned with personal values.

While these interventions vary in goals and contexts, mindfulness remains a core therapeutic tool.

Compassion: Definition and Distinction from Mindfulness

Compassion is an emotional and intentional response to suffering—whether our own or that of others. It involves several key dimensions [3]:

1. Awareness of suffering;
2. Emotional concern in response to this suffering;
3. A desire to alleviate it;
4. A motivation to take action.

Compassion goes beyond mindfulness by including actions and intentions aimed at relieving suffering.

Suffering may be physical, psychological, or social, and can take many forms: difficult emotions, physical discomfort, anxiety, pain, isolation, rejection, etc.

What about self-compassion? This occurs when our compassionate attention is directed inward. Self-compassion differs from mindfulness by focusing more on the sufferer, adding a proactive and kind intention.

In short:

• Mindfulness centres attention on the experience.
• Self-compassion centres attention on the experiencer.

Aspect	Mindfulness	Self-compassion
Principal target	The present-moment experience	One’s own suffering
Intention	Non-judgmental observation	Active reduction of self-criticism; supporting oneself in difficult times
Tools	Meditation, body scans, breathing exercises	Compassionate dialogue, self-soothing exercises, meditation

Current Compassion-Based Interventions

Like mindfulness-based therapies, compassion-focused approaches integrate specific techniques and strategies to cultivate and strengthen this capacity:

• Mindful Self-Compassion (MSC): Developed by Kristin Neff and Christopher Germer, this intervention combines mindfulness, common humanity, and kindness to reduce internal suffering. It reduces rumination and over-identification (believing our thoughts are facts), feelings of isolation, and self-criticism. Although it emphasizes self-compassion, studies show it also increases compassion for others. Exercises include breath awareness, guided meditations, introspective writing, and mental imagery.
• Compassion-Focused Therapy (CFT): Founded by Paul Gilbert, this biopsychosocial therapy is inspired by evolutionary psychology, cognitive-behavioural therapy, attachment theory, and an understanding of motivational systems. It focuses on developing compassion (toward oneself, others, and receiving compassion) using tools such as imagery exercises, soothing breathing, expressive writing, and Gestalt techniques. Originally, this therapy was intended for patients resistant to standard treatments and overwhelmed by shame and/or self-criticism.

These approaches are used in self-care, individual, and group psychotherapy.

Workshops and Group Training in MSC or CFT: These programs allow participants to experiment with practical tools such as self-support strategies, gratitude practices, visualization, and meaning-making. In MSC specifically, additional techniques include compassionate self-touch (self-hugs) and reframing of self-critical internal dialogue. CFT has developed a group training program known as Compassionate Mind Training (CMT).

Compassion: A Lever for Cardiovascular Health

Compassion may represent a promising integrative approach for the prevention and management of cardiovascular diseases due to its influence on biological mechanisms involved in disease development, its positive effect on the adoption of healthier behaviours, and its modulation of chronic stress.

Effect on Atherosclerosis Development:
One study found an association between individuals’ level of self-compassion and reductions in early markers of cardiovascular disease, such as carotid intima-media thickness (CIMT), a key indicator of atherosclerosis. For example, a study of 197 women aged 45–67 found that higher levels of self-compassion were associated with lower CIMT values [4]. This relationship persisted even after adjusting for physical activity, insulin resistance, symptoms of depression and anxiety, and sociodemographic factors. These results suggest that self-compassion may act as a form of primary prevention by delaying the development of cardiovascular disease before clinical symptoms appear.

Effect on Blood Pressure:
A 31-year longitudinal study involving around 2,000 people (the Young Finns Study) suggests that compassion could significantly influence blood pressure regulation [5]. Individuals with no family history of hypertension and high levels of compassion had lower systolic and diastolic blood pressure and a reduced risk of developing hypertension.

Compassion-Based Interventions: Favourable Impacts on Diabetes and Mental Health

Effect on Diabetes:
Self-compassion training also appears effective in managing diabetes, a major cardiovascular risk factor. In the Kindness Matters randomized controlled trial involving 110 diabetic patients, an 8-week Mindful Self-Compassion (MSC) program significantly reduced HbA1c levels (a marker of chronic hyperglycemia) by nearly 1%—an effect greater than that achieved with some hypoglycemic drugs like DPP4 inhibitors (e.g. sitagliptin) and SGLT2 inhibitors (e.g. empagliflozin), which lower HbA1c by 0.5%–0.7% [6].

The 2025 American Diabetes Association Practice Guidelines now recommend implementing a combination of educational, behavioural, and psychological multidisciplinary interventions to improve diabetes and depression management. These guidelines highlight that mindfulness-based approaches are valuable therapeutic tools for diabetic patients suffering from depression.

Effect on Mental Health:
A meta-analysis of 21 randomized clinical trials (N=1,285) found that compassion-based interventions—including Compassion-Focused Therapy (CFT), Mindful Self-Compassion (MSC), and other compassion cultivation programs—led to significant improvements in key mental health domains: well-being, depression, anxiety, and psychological distress [7].

A systematic review of CFT suggests its applicability in various contexts, including depression, anxiety, eating disorders, PTSD, and chronic physical conditions such as breast cancer, HIV, and psoriasis [8]. These interventions have shown promising outcomes in reducing psychological symptoms and improving self-compassion and emotional regulation. Similarly, a review of 20 clinical studies in patients with chronic illnesses found consistent reductions in anxiety and depression, along with marked improvements in emotional regulation and acceptance of their condition [9]. Another review of 15 studies with 1,190 participants suffering from chronic diseases highlighted a significant increase in self-compassion, with medium to large effect sizes, accompanied by a strong reduction in depression [10].

A recent meta-analysis of 15 clinical trials on compassion-based therapy (CBT—inspired by CFT) in individuals with mental health disorders found notable improvements in self-compassion, self-reassurance, and management of self-criticism, along with reductions in fear of self-compassion and depressive symptoms [11]. These findings emphasize the potential of compassion training programs such as CMT (Compassionate Mind Training) to improve emotional well-being, attachment, and resilience. Overall, these practical approaches appear to enhance psychological resilience, positioning compassion as a central lever for optimal mental health [12][13].

Hypotheses on the Mechanisms of Action of Compassion

How can compassion help control diabetes and blood pressure and slow the development of atherosclerosis?

Chronic stress, through allostatic load, is a major driver of cardiovascular disease [14]. Compassion may play a key role in mitigating harmful effects by promoting better emotional regulation and reducing the physiological toll of stress. These effects include reduced inflammation (e.g. lower IL-6 cytokine levels), the activation of the parasympathetic nervous system (reflected in improved heart rate variability), and a more balanced HPA (hypothalamic-pituitary-adrenal) axis and cortisol response—impacting blood pressure and gluconeogenesis, among other processes.

For instance, one study showed that individuals with higher levels of self-compassion had better baseline heart rate variability (HRV), a sign of healthier autonomic nervous system function [15]. Similarly, a brief self-compassion exercise was found to lower heart rate through parasympathetic activation [16].

CFT has also demonstrated benefits for HRV:

• A 12-week group CFT intervention improved HRV in participants who also showed significant increases in self-compassion [17].
• A randomized controlled trial involving teachers found that an 8-week compassion training program significantly improved HRV compared to a waitlist control group [18].
• Participants with bipolar disorder who completed a 12-module CFT program experienced improved HRV [19], and the development of compassion through CFT was associated with an increase in parasympathetic response, measured via HRV [20].

Overall, these results suggest that CFT can positively impact cardiovascular health by improving HRV, a key indicator of autonomic and cardiovascular function.

However, conflicting results regarding HRV have also been observed, likely due to individual variability in initial responses to compassion. Some individuals may initially experience the activation of their fear system when confronted with their own suffering—before benefiting from the soothing effects of self-compassion [21]. Researchers emphasize the importance of nuanced approaches to better understand these mechanisms, taking into account the wide range of emotional and physiological responses to self-compassion.

Another explanation is that self-compassion plays a key role in adopting and maintaining healthy behaviours. Some studies show that it also improves treatment adherence and encourages proactive behaviour—even in challenging socioeconomic contexts [22–26].

Toward Integrated Models of Care: Moving Beyond the Mind-Body Divide

The traditional separation between mind and body in healthcare models is a major barrier to truly comprehensive care. This dichotomy—often inherited from classical biomedical thinking—overlooks the complex and dynamic interactions between the biological, psychological, and social dimensions of disease. Compassion-centred approaches offer a unique opportunity to rethink this paradigm by integrating these dimensions within a unified biopsychosocial perspective. These practices can be taught and learned, and have demonstrated both their impact and practical applicability.

Conclusion

Compassion stands out as a holistic approach that positively influences the biopsychosocial mechanisms involved in cardiovascular disease. These effects alone highlight the importance of increased attention to integrating compassion-based interventions into cardiovascular prevention and treatment strategies.

Nonetheless, further research, including large-scale randomized controlled trials involving populations with cardiovascular issues, is essential to confirm these findings and deepen our understanding of underlying mechanisms.

References

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