Imagine you are a college student, sitting in your Biology class, when your Emergency Medical Services (EMS) radio blares. You gather your belongings and hastily leave class — attempting to not cause too much of a distraction. You meet your partner at your truck outside the building to learn that the call is high acuity: a cardiac arrest. With lights flashing and sirens blaring, together you race to the dispatched location. Cardiac monitor, medications, and advanced airway measures in hand, you calmly but diligently proceed to the location – determined to save a life. You are the first ones to arrive on scene. You knock on the door announcing yourself and then enter. Limp on the couch, blue and cold, no pulse and with obvious signs of death you find your classmate. Your bag drops. Your heart sinks. Yet, there is no time to feel. Beside him. you see his parents, screeching, crying, on their knees. You crouch down, hold their hand, and inform them that their child has passed away. “We regret to inform you that your son has passed away. We are so sorry for your loss.”They fall into your arms. You hold them till the police and other agencies arrive. You give a report and fill out paperwork. And then you return to class. 

On many campuses across North America, collegiate EMS organizations (CBEMS) provide emergent prehospital care to their communities. The anecdote above is from a call I experienced working as an Advanced Emergency Medical Technician (EMT) for my university’s collegiate EMS organization. Many collegiate student EMT providers can recount difficult experiences of responding to one’s peers, ranging from alcohol intoxication, anaphylaxis, overdoses, traumas, and more. EMTs are typically faced with significant physical and psychological stressors, with frequent exposure to traumatic events, with little to no closure. CBEMS providers must balance an already grueling profession with the demands and rigor of a college education.  Current coping mechanisms generally used by prehospital providers largely center around repression of feelings, dark humor, peer communication, and avoidance (Alexander & Klein, 2001). These are not the most beneficial are actually correlated with more psychological problems (Brown et al., 2002). Thus, methods that mitigate traumatic stress symptomatology and serve as proactive measures are needed and essential for both provider and patient safety. Preventative measures for this group are even more necessitated due to their significant potential benefit, given that this population is only at the forefront of their careers.

Mindfulness and contemplative practices have exploded in the past few decades and research has followed. These may be particularly beneficial among these burdened populations. CBCT (Cognitively-Based Compassion Training) presents a experimentally tested framework for mindfulness. CBCT is derived from the Indo-Tibetan Buddhist lojong (Tib: བློ་སྦྱོང་, Wylie: blo sbyong) or mind-training tradition and was adapted to be accessible to those of any or no faith tradition. As is evident in its’ name CBCT is a “cognitive” or “analytical” style of meditation that combines exercises for stabilizing attention with contemplation of aphorisms, visualizations, self-inquiry, and related meditative exercises for cultivating and reinforcing compassion. It has experimentally been shown to decrease depression, loneliness, and stress-induced inflammation while increasing compassion, empathy, and hopefulness(Pace et al. 2012) (Dodds et al. 2015)(Lang et al. 2019)(LoParo et al. 2018)(Reddy et al. 2013).

CBCT was developed by Lobsang Tenzin Negi, Ph.D., a Associate Teaching Professor in the Department of Religion, former monk, and co-founder and executive director of the Center for Contemplative Sciences and Compassion-Based Ethics (CCSCBE) at Emory University. The goal of CBCT is to challenge and examine feelings and actions towards others with the goal of generation spontaneous empathy and compassion for oneself and others (Pace et al. 2012). CCSCBE focuses on educating the heart and mind through innovative research frameworks. The center reflects Emory’s collaborations with His Holiness the Dalai Lama since 1998. 

CBCT has been a catalyst for positive change across various groups, spanning veterans, medical students, and hospital chaplains. With this momentum, there is a compelling prospect that it will play a pivotal role in elevating conditions for collegiate EMTs, their patients, and beyond.

“You may want to analytically meditate on how you might have contributed in some way to the situation that made you angry. And while the midst of anger, your tendency is to perceive the person who harmed you as 100% bad. But deeper analysis will make you realize that every human being is composed of both positive and negative characteristics, and you can try to get a more realistic view of the person, thereby diluting the anger harbored against the person.” — Dalai Lama

Alexander, D. A., and S. Klein. 2001. “Ambulance Personnel and Critical Incidents: Impact of Accident and Emergency Work on Mental Health and Emotional Well-Being.” The British Journal of Psychiatry: The Journal of Mental Science 178 (1): 76–81. https://doi.org/10.1192/bjp.178.1.76.

Brown, Jill, Gerry Mulhern, and Stephen Joseph. 2002. “Incident-Related Stressors, Locus of Control, Coping, and Psychological Distress among Firefighters in Northern Ireland.” Journal of Traumatic Stress 15: 161–68. https://doi.org/10.1023/A:1014816309959.

Dodds, Sally E., Thaddeus W. W. Pace, Melanie L. Bell, Mallorie Fiero, Lobsang Tenzin Negi, Charles L. Raison, and Karen L. Weihs. 2015. “Feasibility of Cognitively-Based Compassion Training (CBCT) for Breast Cancer Survivors: A Randomized, Wait List Controlled Pilot Study.” Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer 23 (12): 3599–3608. https://doi.org/10.1007/s00520-015-2888-1.

Lang, Ariel J., Anne L. Malaktaris, Pollyanna Casmar, Selena A. Baca, Shahrokh Golshan, Timothy Harrison, and Lobsang Negi. 2019. “Compassion Meditation for Posttraumatic Stress Disorder in Veterans: A Randomized Proof of Concept Study.” Journal of Traumatic Stress 32 (2): 299–309. https://doi.org/10.1002/jts.22397.

LoParo, Devon, Sallie A. Mack, Bobbi Patterson, Lobsang Tenzin Negi, and Nadine J. Kaslow. 2018. “The Efficacy of Cognitively-Based Compassion Training for African American Suicide Attempters.” Mindfulness 9 (6): 1941–54. https://doi.org/10.1007/s12671-018-0940-1.

Pace, T., L. Negi, B. Donaldson-Lavelle, B. Ozawa-de Silva, S. Reddy, S. Cole, L. Craighead, and C. Raison. 2012. “P02.119. Cognitively-Based Compassion Training Reduces Peripheral Inflammation in Adolescents in Foster Care with High Rates of Early Life Adversity.” BMC Complementary and Alternative Medicine 12 (1): P175. https://doi.org/10.1186/1472-6882-12-S1-P175.

Reddy, Sheethal D., Lobsang Tenzin Negi, Brooke Dodson-Lavelle, Brendan Ozawa-de Silva, Thaddeus W. W. Pace, Steve P. Cole, Charles L. Raison, and Linda W. Craighead. 2013. “Cognitive-Based Compassion Training: A Promising Prevention Strategy for At-Risk Adolescents.” Journal of Child and Family Studies 22 (2): 219–30. https://doi.org/10.1007/s10826-012-9571-7.