Compassion Meditation for Veterans with Posttraumatic Stress Disorder (PTSD): a Nonrandomized Study


Compassion meditation (CM) is a contemplative practice that is intended to cultivate the ability to extend and sustain compassion toward self and others. Although research documents the benefits of CM in healthy populations, its use in the context of psychopathology is largely unexamined. The purpose of this study was to refine and initially evaluate a CM protocol, Cognitively Based Compassion Training (CBCT®), for use with Veterans with PTSD. To this end, our research team developed and refined a manualized protocol, CBCT-Vet, over 4 sets of groups involving 36 Veterans. This protocol was delivered in 8–10 sessions, each lasting 90–120 min and led by a CBCT®-trained clinical psychologist. Quantitative and qualitative data were used to identify areas to be improved and to assess change that occurred during the treatment period. Based on pooled data from this series of groups, CM appears to be acceptable to Veterans with PTSD. Group participation was associated with reduced symptoms of PTSD (partial eta squared = .27) and depression (partial eta squared = .19), but causality should not be inferred given the nonrandomized design. No change was observed in additional outcomes, including positive emotion and social connectedness. The results of this open trial support additional exploration of CM as part of the recovery process for Veterans with PTSD.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA

Subscribe to journal

Immediate online access to all issues from 2019. Subscription will auto renew annually.

US$ 99

This is the net price. Taxes to be calculated in checkout.

Fig. 1
Fig. 2
Fig. 3


  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington DC: American Psychiatric Publishing.

  2. Attkisson, C. C., & Greenfield, T. K. (1994). Client satisfaction questionnaire—8 and service satisfaction scale—30. In M. E. Maruish (Ed.), The use of psychological testing for treatment planning and outcome assessment. Hillsdale: Lawrence Erlbaum Associates.

  3. Bernstein, E. M., & Putnam, F. W. (1986). Development, reliability, and validity of a dissociation scale. Journal of Nervous and Mental Disease, 174(12), 727–735.

  4. Borkovec, T. D., & Nau, S. D. (1972). Credibility of analogue therapy rationales. Journal of Behavior Therapy and Experimental Psychiatry, 3, 257–260.

  5. Bush, K., Kivlahan, D. R., McDonell, M. B., Fihn, S. D., & Bradley, K. A. (1998). The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Archives of Internal Medicine, 158, 1789–1795.

  6. Cacioppo, J. T., & Patrick, W. (2008). Loneliness: Human nature and the need for social connection. New York: W. W. Norton & Co..

  7. Cacioppo, J. T., Hughes, M. E., Waite, L. J., Hawkley, L. C., & Thisted, R. A. (2006). Loneliness as a specific risk factor for depressive symptoms: cross-sectional and longitudinal analyses. Psychological Aging, 21(1), 140–151.

  8. Clausen, A. N., Youngren, W., Sisante, J. F., Billinger, S. A., Taylor, C., & Aupperle, R. L. (2016). Combat PTSD and implicit behavioral tendencies for positive affective stimuli: a brief report. Frontiers in Psychology, 7, 758.

  9. Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale: Lawrence Erlbaum Associates.

  10. Ellis, C. C., Peterson, M., Bufford, R., & Benson, J. (2014). The importance of group cohesion in inpatient treatment of combat-related PTSD. International Journal of Group Psychotherapy, 64, 180–206.

  11. Engstrom, M., & Soderfeldt, B. (2010). Brain activation during compassion meditation: a case study. Journal of Alternative and Complementary Medicine, 16(5), 597–599.

  12. Fontana, A., & Rosenheck, R. (2010). War zone veterans returning to treatment: effects of social functioning and psychopathology. Journal of Nervous and Mental Disease, 198(10), 699–707.

  13. Fredrickson, B. L. (2001). The role of positive emotions in positive psychology. The broaden-and-build theory of positive emotions. American Psychologist, 56(3), 218–226.

  14. Fredrickson, B. L., Mancuso, R. A., Branigan, C., & Tugade, M. M. (2000). The undoing effect of positive emotions. Motivation and Emotion, 24(4), 237–258.

  15. Fredrickson, B. L., Tugade, M. M., Waugh, C. E., & Larkin, G. R. (2003). What good are positive emotions in crises? A prospective study of resilience and emotions following the terrorist attacks on the United States on September 11th, 2001. Journal of Personality and Social Psychology, 84(2), 365–376.

  16. Gable, S. L., Gonzaga, G. C., & Strachman, A. (2006). Will you be there for me when things go right? Supportive responses to positive event disclosures. Journal of Personality and Social Psychology, 91(5), 904–917.

  17. Galante, J., Bekkers, M. J., Mitchell, C., & Gallacher, J. (2016). Loving-kindness meditation effects on well-being and altruism: A mixed-methods online RCT. Applied Psychological Health and Well Being, 8(3), 322–350.

  18. Gierus, J., Mosiolek, A., Koweszko, T., Wnukiewicz, P., Kozyra, O., & Szulc, A. (2015). The Montreal Cognitive Assessment as a preliminary assessment tool in general psychiatry: validity of MoCA in psychiatric patients. General Hospital Psychiatry, 37(5), 476–480.

  19. Gilman, R., Schumm, J. A., & Chard, K. M. (2012). Hope as a change mechanism in the treatment of posttraumatic stress disorder. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 270–277.

  20. Hagerty, B. M., Williams, R. A., Coyne, J. C., & Early, M. R. (1996). Sense of belonging and indicators of social and psychological functioning. Archives of Psychiatric Nursing, 10, 235–244.

  21. Hutcherson, C. A., Seppala, E. M., & Gross, J. J. (2008). Loving-kindness meditation increases social connectedness. Emotion, 8(5), 720–724.

  22. Johnson, D. P., Penn, D. L., Fredrickson, B. L., Kring, A. M., Meyer, P. S., Catalino, L. I., & Brantley, M. (2011). A pilot study of loving-kindness meditation for the negative symptoms of schizophrenia. Schizophrenia Research, 129(2–3), 137–140.

  23. Kearney, D. J., Malte, C. A., McManua, C., Martinez, M. E., Felleman, B., & Simpson, T. L. (2013). Loving-kindness meditation for posttraumatic stress disorder: a pilot study. Journal of Traumatic Stress, 26, 426–434.

  24. Kearney, D. J., McManus, C., Malte, C. A., Martinez, M. E., Felleman, B., & Simpson, T. L. (2014). Loving-kindness meditation and the broaden-and-build theory of positive emotions among veterans with posttraumatic stress disorder. Medical Care, 52(12 Suppl 5), S32–S38.

  25. Kishon-Barash, R., Midlarsky, E., & Johnson, D. R. (1999). Altruism and the Vietnam War veteran: the relationship of helping to symptomatology. Journal of Traumatic Stress, 12(4), 655–662.

  26. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613.

  27. Lang, A. J., Strauss, J. L., Bomyea, J., Bormann, J. E., Hickman, S. D., Good, R. C., & Essex, M. (2012). The theoretical and empirical basis for meditation as an intervention for PTSD. Behavior Modification, 36, 759–786.

  28. Lee, R. M., & Robbins, S. B. (1998). The relationship between social connectedness and anxiety, self-esteem, and social identity. Journal of Counseling Psychology, 45, 338–345.

  29. Lee, R. M., Draper, M., & Lee, S. (2001). Social connectedness, dysfunctional interpersonal behaviors, and psychological distress: testing a mediator model. Journal of Counseling Psychology, 48, 310–318.

  30. Litz, B. T., & Gray, M. J. (2002). Emotional numbing in posttraumatic stress disorder: current and future research directions. Australia and New Zealand Journal of Psychiatry, 36(2), 198–204.

  31. Marshall, R. D., Turner, J. B., Lewis-Fernandez, R., Koenan, K., Neria, Y., & Dohrenwend, B. P. (2006). Symptom patterns associated with chronic PTSD in male veterans: new findings from the National Vietnam Veterans Readjustment Study. Journal of Nervous and Mental Disease, 194(4), 275–278.

  32. Mascaro, J. S., Rilling, J. K., Tenzin Negi, L., & Raison, C. L. (2013). Compassion meditation enhances empathic accuracy and related neural activity. Social Cognitive and Affective Neuroscience, 8(1), 48–55.

  33. Nasreddine, Z. S., Phillips, N. A., Bedirian, V., Charbonneau, S., Whitehead, V., Collin, I., …, Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatric Society, 53, 695–699.

  34. Negi, L. (2013). Cognitively-based compassion training manual. Retrieved from

  35. Nietlisbach, G., Maercker, A., Rössler, W., & Haker, H. (2010). Are empathic abilities impaired in posttraumatic stress disorder? Psychological Reports, 106, 832–844.

  36. Owens, G. P., Walter, K. H., Chard, K. M., & Davis, P. A. (2012). Changes in mindfulness skills and treatment response among veterans in residential PTSD treatment. Psychological Trauma: Theory, Research, Practice, and Policy, 4, 221–228.

  37. Ozer, E., Best, S., Lipsey, T., & Weiss, D. (2008). Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychological Trauma: Theory, Research, Practice and Policy, S1, 3–36.

  38. Panagioti, M., Gooding, P. A., Dunn, G., & Tarrier, N. (2011). Pathways to suicidal behavior in posttraumatic stress disorder. Journal of Traumatic Stress, 24(2), 137–145.

  39. Pietrzak, R. H., Goldstein, M. B., Malley, J. C., Rivers, A. J., & Southwick, S. M. (2010). Structure of posttraumatic stress disorder symptoms and psychosocial functioning in Veterans of Operations Enduring Freedom and Iraqi Freedom. Psychiatry Research, 178(2), 323–329.

  40. Polusny, M. A., Erbes, C. R., Thuras, P., Moran, A., Lamberty, G. J., Collins, R. C., …, Lim, K. O. (2015). Mindfulness-based stress reduction for posttraumatic stress disorder among Veterans: a randomized clinical trial. JAMA, 314(5), 456–465.

  41. Raes, F., Pommier, E., Neff, K. D., & Van Gucht, D. (2011). Construction and factorial validation of a short form of the Self-Compassion Scale. Clinical Psychology and Psychotherapy, 18(3), 250–255.

  42. Russell, J. (1980). A circumplex model of affect. Journal of Personality and Social Psychology, 39, 1161–1178.

  43. Schnurr, P. P., Lunney, C. A., Bovin, M. J., & Marx, B. P. (2009). Posttraumatic stress disorder and quality of life: extension of findings to veterans of the wars in Iraq and Afghanistan. Clinical Psychology Review, 29(8), 727–735.

  44. Sheehan, D. V., Laecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., …, Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(suppl 20), 22–33.

  45. Steenkamp, M. M., Litz, B. T., Hoge, C. W., & Marmar, C. R. (2015). Psychotherapy for military-related PTSD: a review of randomized clinical trials. JAMA, 314, 489–500.

  46. Tugade, M. M., & Fredrickson, B. L. (2004). Resilient individuals use positive emotions to bounce back from negative emotional experiences. Journal of Personality and Social Psychology, 86(2), 320–333.

  47. Weathers, F. W., Blake, D. D., Schnurr, P. P., Kaloupek, D. G., Marx, B. P., & Keane, T. M. (2013a). The Life Events Checklist for DSM-5 (LEC-5). Instrument available from the National Center for PTSD at

  48. Weathers, F. W., Litz, B. T., Keane, T. M., Palmieri, P. A., Marx, B. P., & Schnurr, P. P. (2013b). The PTSD checklist for DSM-5 (PCL-5).

  49. Weng, H. Y., Fox, A. S., Shackman, A. J., Stodola, D. E., Caldwell, J. Z., Olson, M. C., …, Davidson, R. J. (2013). Compassion training alters altruism and neural responses to suffering. Psychological Science, 24(7), 1171–1180.

  50. Zeng, X., Chiu, C. P., Wang, R., Oei, T. P., & Leung, F. Y. (2015). The effect of loving-kindness meditation on positive emotions: a meta-analytic review. Frontiers in Psychology, 6, 1693.

Download references

Author information

AJL: designed and executed the study, assisted with the treatment development, and wrote the paper. PC: conducted meditation groups and assisted with treatment development. SH: collected and analyzed qualitative data and assisted with treatment development. TH: assessed fidelity to CBCT and assisted with treatment development. SG: analyzed quantitative data and contributed to the writing of the paper. RG: acted as the research assistant and assisted with treatment development. ME: assisted with treatment development. LN: developed CBCT and assisted with treatment development.

Correspondence to Ariel J. Lang.

Ethics declarations

Conflict of Interest

Drs. Lang, Casmar, Hurst, Golshan and Essex and Ms. Good declare no conflict of interest. Dr. Negi and Mr. Harrison have a copyright for CBCT®.

Ethical Approval

IRB approval for this study was provided by the IRB of the VA San Diego Healthcare System. All procedures performed in this study involving human participants were in accordance with the ethical standards of the Institutional Review Board and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Lang, A.J., Casmar, P., Hurst, S. et al. Compassion Meditation for Veterans with Posttraumatic Stress Disorder (PTSD): a Nonrandomized Study. Mindfulness 11, 63–74 (2020).

Download citation


  • Compassion
  • Meditation
  • PTSD
  • Mindfulness