The effect of brief compassionate imagery on empathy following severe head injury

Background: Loss of empathy is part of the personality change commonly observed following head injury. In a preliminary study that attempted to increase empathy after head injury, O’Neill and McMillan (2012) found a non-significant trend towards increased self-compassion using a brief compassionate imagery intervention. Aims: This study explores whether modifications to the design used by O’Neill and McMillan will result in a positive change in empathy and/or compassion in a severe head injury sample. Methods: Participants were randomised to a 50-minute compassionate focused imagery (CFI) or relaxation imagery (RI) control condition. Self-report of empathy, compassion, relaxation and anxiety, a wordsearch task designed to detect information processing bias and heart rate variability changes (HRV) were the dependent variables. Pre-intervention Fears of Compassion (FoC) scores were treated as a covariate. Results: Differences post-intervention were not significant between CFI and RI conditions. No correlations between outcome change and HRV change were found. No correlations between outcome change and FoC were found. Data from both conditions combined revealed a non-significant trend towards increased empathy post-intervention. This change was not reflected in HRV outcomes. Conclusion: Evidence to support the use of brief compassionate imagery for people with head injury was not found. Smaller than predicted between group effect sizes suggest that the study may be underpowered, and hence conclusions are tentative. A more intensive intervention programme in studies with a larger sample size is recommended