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Compassion: Conceptualisations, Research, and Use in Psychotherapy

By Paul Gilbert (Ed.)

New York: Routledge, 2005. 403 pp.

ISBN 1-58391-982-1 (hardcover) $90.00

ISBN 1-58391-983-X (paperback) $34.95

Reviewed by Paul T. P. Wong

In a post-9/11 world that desperately needs compassion as an antidote to terrorism and suffering, Compassion: Conceptualisations, Research, and Use in Psychotherapy is a timely and groundbreaking publication on the psychology of compassion. The book consists of two parts. Part 1 covers themes of conceptualization and research. Part 2 focuses on compassion as a healing process in psychotherapy. All the contributors are well published in their respective fields and have something significant to say. I thoroughly enjoyed reading this volume and believe it will be an invaluable resource for researchers and clinicians.

Gilbert, with his trademark erudition and creative scholarship, provides a sweeping survey of the vast domain of compassion from different perspectives. Although this book was not designed to compare Eastern and Western conceptions of compassion, cultural differences remain a prominent theme. Buddhism is another recurrent theme that runs through most of the chapters. For me, the greatest contribution of this volume is the integration of the Buddhist concept and practice of compassion with Western psychology and psychotherapy.

In this review, in addition to a running commentary on the contents of the book, I intend to clarify some of the fundamental concepts of Buddhism and compassion and describe mature positive psychology as informed by Buddhist humanistic–existential psychology. These considerations will enable us to better understand Compassion and evaluate its contributions to integrating Western psychology with Buddhism.

The Nature of Compassion

Compassion is a multilayered, dense construct that overlaps various other constructs such as loving-kindness, empathy, attachment, care giving, and prosocial behavior. Compassion emerges from a vast constellation of factors such as genes, culture, early childhood experiences, motives, thoughts, and behavior. Given the complexity of this construct, it is understandable that different theories have been developed to illuminate the nature of compassion.

Different Theories of Compassion

Gilbert (Chapter 2) proposes a biopsychosocial model of compassion. He considers compassion an emergent property of the mind, resulting from complex and dynamic interactions of many processes (i.e., biological, social, cultural, and psychological). More specifically, Gilbert’s (1989) social mentality theory provides the mechanisms for compassion through developing roles such as caring–giving. The theory predicts that social rank mentality will decrease compassion, because it is about social power and striving for personal success. Because social rank mentality is the product of a competitive, materialistic, and individualistic culture, can we cultivate compassion without transforming the culture?

Sheila Wang (Chapter 3) explicitly links Buddhist conceptualization of mind with neuroscience. She correctly recognizes that compassion is a process that can operate on different levels. From the perspective of evolution theory, she proposes that there are two major adaptive physiological and emotional systems: an individualistic “self-preservative” system and a prosocial “species-preservative” system. The former is more likely to operate when the circumstances are perceived as threatening, whereas the latter is more likely to be predominant in safe environments. In other words, people are less likely to be generous and kind and are more likely to be self-centered in high-stake situations of cut-throat competition.

I propose that when a situation is perceived as threatening to the entire family or community, then the species-preservative system should kick in, because it is based on a more inclusive sense of self. It also seems logical that any effort to cultivate the Buddhist concept of interconnectedness should facilitate the development of species-preservative system and altruism. In the long run, evolution will favor cooperation and compassion among members of the human species.

The other chapters in Part 1 focus on specific aspects of social psychological mechanisms. Gillath, Shaver, and Mikulincer (Chapter 4) extend Bowlby’s (1969) attachment theory to the development of prosocial behavior and compassion. Bierhoff (Chapter 5) focuses on the importance of social learning in the development of self-identity and prosocial personality. Compassion is both a motivation for being helpful and an aspect of prosocial personality. Worthington, O’Connor, Berry, Sharp, Murray, and Yi (Chapter 6) bring out the dialectic nature of compassion, focusing on how to be compassionate in the context of betrayals and conflicts. They explore the role of forgiveness and reconciliation because of our fundamental need for each other.

Different Functions of Compassion

Part 1 presents a comprehensive picture of the many functions compassion serves. As a motivation, it involves the desire to help others and to provide relief to those who are suffering. Compassion moves people toward care giving and prosocial behaviors. As an emotion, it involves feelings of concern and sympathy. Gilbert (Chapter 2) points out that the caring- giving social mentality, which underlies compassion, includes caring, empathy, and sympathy. Sheila Wang (Chapter 3) writes, “Compassion is the feeling that arises from the realization of the deeper reality that we are all connected, we are all one” (p. 104). Compassion is also linked to positive affect (Davidson, 2002).

As an adaptive process, according to Wang (Chapter 3), compassion is evolution’s way to reduce high mortality rates of young people in hostile circumstances:

This bond of attachment is the psychological and physiological template for all other relationships… . As a result, we have the unique opportunity to think beyond the self, to recognize that we co-create experience in both self and others. Compassion facilitates the ability to co-create states that are safe and allows us to move out of the self-protective and self- preservative systems. (p. 111)

As a cognitive activity, compassion involves understanding the needs of the person in need of help and reflecting on one’s own thoughts (Gilbert, Chapter 2). As an attitude, it is one facet of compassionate self-identity or personality (Bierhoff, Chapter 5). As a prosocial behavior, it can be acquired through social learning, reinforcement, and early secure attachment. As a social skill, compassion is learned when we are children, but we may have to relearn it when we forget it in the midst of fighting to get ahead (Worthington et al., Chapter 6). Gilbert (Chapter 2) also emphasizes that compassion is a spiritual virtue and a healing process.

The Practice of Compassion

Part 2 presents different ways of practicing compassion and incorporating it into psychotherapy. Leahy (Chapter 7) focuses on the importance of validating all emotions, including sadness, anger, shame, and envy. Validation is an expression of compassion and unconditional positive regard. Validation grants patients the “permission” and “safety” necessary to experience these feelings and understand the meanings behind them.

This sounds like an integration of person-centered counseling and emotion-focused therapy. This is the only chapter that emphasizes the emotional aspect of compassion. Rinpoche and Mullen (Chapter 8) focus on cultivating a compassionate attitude by the use of imagery or deities. For example, one can visualize and meditate on the Bodhisattva of Compassion as a focus of universal compassion. Unlike other authors, Rinpoche and Mullen do not simply use meditation as a skill or technique, because they realized the need for attitude change and inner transformation through the experience of meditation.

The next few chapters involve different ways of compassionate mindfulness training.

Allen and Knight (Chapter 9) apply such training to treat depression. Gilbert and Iron (Chapter 10) use it to deal with psychological problems related to critical inner voices. It involves teaching people to pay full attention to the contents of their thoughts and feelings “in an attitude of acceptance and loving-kindness” (Marlatt & Kristeller, 1999, p. 70).

Both Lee (Chapter 11) and Hackmann (Chapter 12) use case studies to illustrate the use of the imagery and compassionate mind training in dealing with posttraumatic stress disorder and anxiety disorders. Lee focuses on training as an opportunity to experience feelings of warmth and soothing for the self. Hackmann emphasizes the need for empowerment and compassionate engagement in working through imagery of certain memories.

The last chapter, by Bates, explores compassion in a group cognitive therapy context. In this complex and dynamic situation, compassion helps create a sense of safety and facilitates openness. A kind and compassionate way of relating to self and others encourages tolerance for imperfection and facilitates personal growth. This sounds very Rogerian, and I am not sure in what fundamental way compassion is different from unconditional positive regard. I wish that the book would have ended with a concluding chapter that focused on synthesis and self- reflection.

Buddhism and Compassion

Because Buddhism permeates every chapter of this book, it is important that we have some basic understanding of Buddhism and Buddhist teaching on compassion. This will allow us to better appreciate as well as critique Gilbert’s efforts to integrate Buddhism with psychology.

In his book An Open Heart: Practicing Compassion in Everyday Life, the Dalai Lama (2001) wrote:

What is compassion? Compassion is the wish that others be free of suffering. It is by means of compassion that we aspire to attain enlightenment. It is compassion that inspires us to engage in the virtuous practices that lead to Buddhahood. We must therefore devote ourselves to developing compassion. (p. 91)

Several important concepts are packed into this brief statement; these concepts will become clearer as we review basic concepts of Buddhism later. The Dalai Lama further pointed out that just as compassion is the desire to free all sentient beings from suffering, loving- kindness is the desire to bring happiness to all people. Both compassion and loving-kindness derive from understanding the four noble truths.

The Four Noble Truths

What initiates the process of compassion is the realization of the first noble truth of Dukkha—all human existence is marked by suffering, affliction, and vexation. Even the most successful and fortunate people are still vulnerable to suffering, because of the impermanence of possessions, relationships, and life itself. To understand and accept the bleak reality of human suffering naturally leads to compassion and loving-kindness.

To foster compassion, we need to understand the second noble truth of Tanha—our suffering comes from craving and ignorance. We experience frustration, vexation, and all sorts of mental suffering when we become too attached to self and the world. Striving to meet our selfish needs and worldly desires only increases our misery and decreases our compassion. We cannot be compassionate toward others when we are consumed by blind ambition and dominated by concerns abut social status. Once we recognize that our human bondage is caused by our craving and distorted view of reality, we begin to understand the third noble truth of Nirvana—liberty from Dukkha. We become aware that the way to be free from suffering is not by changing circumstances but by changing ourselves—by changing our fundamental views and assumptions about reality and letting go of our attachment to self and others.

How do we implement the Buddhist way? The fourth noble truth of Magga (the Eightfold Path) prescribes the method for attaining Nirvana. This method consists of eight spiritual practices or disciplines, which include Right Mindfulness and Right Meditation.

To be effective, Right Mindfulness and Right Meditation need to be an essential part of daily living. Right Mindfulness emphasizes that we need to be fully responsible for, and aware of, our speech, thoughts, feelings, and activities and their impact on others every moment of the day. We also need to be mindful of the conditions and opportunities that present themselves moment to moment. This kind of reflective, disciplined inner life will transform us by freeing us from critical and troublesome inner voices and enabling us to become aware of our true nature.

Right Meditation is a focused way to develop mindfulness. It is the practice of focusing on our bodily sensations, breathing, imagery, feelings, and thoughts. We simply feel, observe, and experience thoughts as they emerge, without judging, analyzing, or trying to control them. There is an immediacy and intimacy that results from fully experiencing reality moment to moment. Mindful meditation sharpens our focus and deepens our understanding. Mindful meditation also facilitates compassion, because it develops awareness and enlightenment regarding the meaning of suffering, the impermanence and emptiness of life, and our essential self.

I hope that this brief introduction to the four noble truths helps us understand why the Dalai Lama (2001) emphasized that we attain enlightenment by way of compassion, and we cultivate compassion by way of enlightenment. From the Buddhist standpoint, efforts to cultivate compassion apart from enlightenment can achieve superficial and short-lived benefits. However, when we attain enlightenment and realize our inner transformation, then we will naturally radiate compassion to all people, because it has become part of our nature or character

Buddhist Teaching of Mind

Gilbert considers compassion as the emergent property of the mind. But what is the mind? Kapleau (1989) pointed out that if you ask where the mind is, Westerners would point to their heads whereas most Japanese would point to the heart. From the Buddhist perspective, the mind is more than the seat of intellect; it stands for total awareness of our true nature, our essential self.

Mindful meditation involves more than the cognitive processes of perceiving our sensation, feelings, and thoughts. It also involves a deeper or higher level of consciousness, which does not have its equivalent in cognitive psychology. Metacognition comes close, but still cannot capture the kind of higher mental activity described by Levine (2000):

You are not your mind. The essential you is more anterior, capable of observing the mind’s activities and, it would appear, of changing those activities. This anterior process, as we suggested in earlier chapters, is also capable of calming the mind and of assessing the beliefs held by the mind. It is that anterior process that constitutes the essential self. (p. 60)

Later Levin wrote:

Buddha-nature is said to be inherent in all humans, waiting to be realized. It may be interpreted as that anterior, ideal, essential self: The more it is realized, the more we move along the path toward super maturity. As we gradually calm the mind by transforming our passions, and gradually deepen our understanding, this Buddha-nature, this essential self, is said to be more and more revealed. (pp. 60–61)

Buddhism teaches that we open the mind’s eye to enlightenment and open up our hearts to compassion. Mind and heart are often used interchangeably, because they both refer to a deeper experience or total awareness of realizing our essential self—the Buddha-nature inherent in all of us. At this level, our distorted view of self as a separate individual entity is replaced by an enlightened view of the true or essential self. Thus, to be liberated from suffering and become a compassionate human being, two things need to happen: One needs to (a) understand and transform our distorted thinking and self-centered craving and (b) grasp and realize the Buddha-nature or the illuminating mind. In short, the inner transformation needs to go deeper than mere cognitive activities—it needs to touch the essential self or our true nature.

Buddhist Concepts of Self and Compassion

What is the enlightened self? Why is this essential to compassion? Sheila Wang (Chapter 3) is correct in pointing out that we need to have an expanded sense of self to understand and practice compassion. But Buddhism goes still further and it envisions the state of “no-self.”

According to Chan (or Zen, in Japanese) Master Sheng-yen (2001), there are three levels of the self: small self, universal self, and no-self. The small self is represented by the distorted sense of self that results from interactions with the external environment and other people. It is the product of the constant process of comparing, evaluating, and judging. Chan practice begins with establishing a clear and strong sense of the small self, with its strengths and limitations.

At the next stage, our sense of self is enlarged so that it becomes interconnected with all humanity. This universal self takes on an unchanging, eternal nature and represents our true nature or essential self:

In dhyana and samadhi, as well as in other spiritual practices, one can have a sense of experiencing an absolute and unchanging spiritual self. At such times it seems as though all of existence moves while one’s true nature remains still, as if one’s own essence is the basis for, or, indeed, is everything else. (p. 27)

However, there is still some attachment even in the universal self. To attain complete liberation, we need to let go of all attachments. This will require that we realize the state of no- self:

With no-self, there are no attachments. It does not mean that everything ceases to exist once you attain liberation. After liberation, wisdom and merit continue to exist. Likewise, after a no-self experience, life goes on and there are still things to do. However, in order to get to no-self, one must start from the beginning, and that means developing a strong sense of small self. (p. 27)

Ego often gets in the way of cooperation and compassion. Buddhism deals with problems related to ego by cultivating the three stages of self. Kapleau (1989) pointed out thatThe notion of an ego, that is, awareness of oneself as a discrete individuality, is an illusion. It arises

The notion of an ego, that is, awareness of oneself as a discrete individuality, is an illusion. It arises because, misled by our bifurcating intellect (the sixth sense) into postulating the dualism of “myself” and “not-myself,” we are led to think and act as though we were a separated entity confronted by a world external to us. (p. 402)

It is difficult to understand how psychotherapy can cultivate compassion through mindful meditation without addressing problems related to ego.

Mindful Meditation Versus Psychotherapy

Gilbert (Chapters 1 and 2) recognizes that Western psychotherapy is based on specific skills derived from some theoretical formulation. He also correctly recognizes that compassion is a healing process rather than a clinical skill. Furthermore, he acknowledges the importance of personal experience and development of the therapist. That is why it seems puzzling that most chapters in Part 2 simply incorporate mindful meditation training as a skill in the context of cognitive–behavioral therapy. To fully integrate Buddhist compassion into therapy, one needs to pay more attention to the larger issues of enlightenment and compassion discussed earlier.

I propose that the main difference between mindful meditation and Western psychotherapy is found in the difference between macro- and micro-approaches to behavioral change. The macro-approach emphasizes universal issues that are relevant to all people regardless of their circumstances; such issues are related to human existence, human needs, worldviews, and core values. The micro-approach emphasizes local issues specific to certain individuals and certain problem areas, such as a person’s marital problems or traumatic experiences. Mindful meditation favors the macro-approach, whereas psychotherapy favors the micro-approach: “Chan does not address specific psychological problems and their causes. Chan masters will rarely analyze a personal situation” (Shengyen, 2001, p. 234). This is how Master Sheng-yen (2001) compared and contrasted Chan meditation with Western psychotherapy:

The goal of Chan is to eliminate ignorance and vexation, to see into one’s intrinsic nature, and to realize bodhi-mind. The goal of psychotherapy is to eliminate or alleviate a person’s internal conflicts, confusion, contradictions, sense of helplessness, etc. Thus, Chan and psychotherapy are similar in that they address issues of the mind and that their goals are to help people become clearer and more stable. The difference is in the degree of clarity. Psychology does not speak of intrinsic nature and spiritual awakening; it tries to help a person become more stable and to understand and deal with his or her problems. (p. 233)

Master Sheng-yen (2001) freely admitted that he was not a psychologist and did not understand Western psychotherapy in depth, but his point is well taken. In teaching counseling theories, I frequently criticize cognitive-behavioral therapy as focusing too much on the leaves and forgetting the forest. Most of the chapters in Part 2 of Compassion have the same tendencies—they focus on specific cognitive and behavioral disorders without addressing the larger picture. I have also advocated a two-pronged approach to dealing with individual client’s specific problems and the larger existential and spiritual issues. True integration between Buddhism and psychotherapy needs to take a similar two-pronged approach. This calls for transformation or enlightenment of the mind rather than just cognitive restructuring of a situation. Such transformation must begin with the therapist, because from the Buddhist perspective, the therapist is the therapy by virtue of who he or she is rather than what he or she does.

What Is Mature Positive Psychology?

Mature positive psychology is rooted in the history of human cruelty and forged in the crucible of human suffering. It is mature because it has endured thousands of years of pains and afflictions and discovered the wisdoms necessary to transcend those adversities that are beyond one’s control. This brand of mature positive psychology can also be called “Asian positive psychology” or “positive existential psychology,” because it is heavily influenced by the Asian humanistic–existential thoughts of Buddhism, Taoism, and Confucianism. For example, Levine (2000)’s The Positive Psychology of Buddhism and Yoga: Paths to Mature Happiness emphasized the deep experience of inner peace, fulfillment, and wisdom in the valley of death and tears.

In the last few years, I have spoken to many university students and professional groups in Asia. I have repeatedly encountered people who told me that American positive psychology does not resonate with the suffering masses who live in a world very different from the United States, where people live in peace and security, have control over their own lives, and expect good things to happen to them. My Asian audiences often presented cases of individuals whose lives were controlled by external forces, who had more than their share of tragedies, and who experienced more bad things than good things in their everyday lives.

Furthermore, the professionals working in the palliative care settings or with severely handicapped patients talked about individuals who seemed utterly hopeless and had no reason to live. My take-home message from these speaking tours is that suffering people embrace mature positive psychology much more readily than a positive psychology shaped by an American, optimistic, can-do attitude.

Compassion further contributes to the development of mature positive psychology, which appeals to all people from East and West who desire to be free from suffering and enjoy a life of fulfillment regardless of their life circumstances. Based on Gilbert’s book, a unified theory of mature positive psychology needs to have the characteristics outlined in the below subsections.

It Is Dialectic Rather Than Dichotic

Mature positive psychology affirms the co-existence of good and evil, love and hate, hope and despair. It does not differentiate between positive psychology and negative psychology. Instead, it underscores the necessity to integrate and synthesize both positive and negative experiences. In fact, the positive psychology of compassion is near impossible without the reality of human suffering; courage has no meaning without fear; and forgiveness is shallow without deeply felt hurt. From an evolution perspective, Sheila Wang (Chapter 3) emphasizes that the species-preservative system was developed in response to the high death rates of children in a hostile environment. The entire Buddhist system of enlightenment and compassion was developed as a solution to unavoidable human suffering. It would be difficult to develop compassion through mindful meditation without understanding the profound reality of death and suffering.

It Is Collectivistic Rather Than Individualistic

Asian culture’s collectivistic orientation affects many aspects of cognitive processes (Nisbett, 2003). Western culture, on the other hand, has an individualistic orientation and fosters a social ranking mentality (Gilbert, Chapter 2). That is why, in the West, people are more concerned about individual success than being compassionate toward others. There are important implications for both orientations. Gilbert reports that “Groups that value individualist materialism increase striving, create segregated communities and have elevated rates of crime and mental ill-health (Kasser, 2002)” (p. 61). He also notes that “Group societies that value caring and the welfare of others and seek equity have lower rates of crime and various forms of illness (Arrindell, Steptoe, & Wardle, 2003)” (p. 62).

Mature positive psychology goes beyond individuals. It emphasizes the need to engage and transform culture in order to relieve all sentient beings from suffering and bring them happiness. For example, we need to address problems of poverty and inequality: “It would be interesting to see what might happen if psychological science put compassion at the center of its efforts to improve the well-being of humanity, and focused rather less on the need for personal achievement goals” (p. 63).

Gilbert (Chapter 2) needs to be applauded for his humanistic vision. He writes:

In this chapter, I have tried to widen our focus beyond the domain of individual psychology, for, as many suggest, ecologies, group processes and leadership-follower psychology all need to be understood if we are to work towards great compassion in the world. (p. 64)

It Is Holistic and Integrative Rather Than Ethnocentric

For positive psychology to progress and meet the needs of suffering masses around the globe, it has to integrate approaches from different cultures on an equal footing, as Rinpoche and Mullen (Chapter 8) demonstrate. We cannot simply use the Western individualistic and positivist framework as the standard and try to incorporate a few skills and concepts into the Western system, as several contributors in Compassion do. To develop a truly unified general theory of mature positive psychology, we need to recognize the validity of other research methods and other approaches to the philosophy of science.

Finally, a mature positive psychology would demand more attention to existential and spiritual issues. Although the present volume emphasizes compassion as a healing process, most of the chapters focus on biological and cognitive sciences without taking seriously the roles of spirituality, even though Buddhism is a major spiritual tradition. We need a mature positive psychology of compassion with both heart and soul.


The above critiques are really minor and are intended to show the future directions of integrating West and East in the psychology of compassion. For the time being, Gilbert’s Compassion is a landmark publication. It represents a courageous and visionary endeavor to produce an edited volume that integrates Buddhism with scientific psychology. I am sure Gilbert must be fully aware of the pitfalls and challenges associated with such a complex undertaking.

The book has succeeded in major ways by bringing some of the powerful concepts and practices of Buddhism into the inner circles of Western psychology. I hope that more psychologists will follow his examples. American psychology can be greatly enriched by ideas and contributions from other cultures. Humanity can benefit when psychology becomes more inclusive and integrative. I highly recommend this book to anyone interested in research and applications of compassion, international psychology, and mature positive psychology.


  1. Bowlby, J. (1969). Attachment and loss: Vol. 1. Attachment. New York, NY: Basic Books.
  2. Chan, Master Sheng-yen (2001). Zen wisdom: Conversations on Buddhism. Elmhurst, NY: Dharma Drum.
  3. Dalai, Lama (2001). An open heart: Practicing compassion in everyday life. New York, NY: Back Bay Books.
  4. Davidson, R. (2002). Toward a biology of positive affect and compassion. In R. Davidson & A. Harrington (Eds.), Visions of compassion: Western scientists and Tibetan Buddhists examine human nature (pp. 107-130). New York, NY: Oxford University Press.
  5. Gilbert, P. (1989). Human nature and suffering. Hove, UK: Erlbaum.
  6. Kapleau, R. P. (1989). The three pillars of Zen: Teaching, practice, and enlightenment. New York, NY: Anchor Books.
  7. Levine, M. (2000). The positive psychology of Buddhism and yoga: Paths to a mature happiness. Mahwah, NJ: Erlbaum.
  8. Marlatt, A. G., & Kristeller, J. L. (1999). Mindfulness and meditation. In W. R. Miller (Ed.), Integrating spirituality into treatment: Resources for practitioners (pp. 67–84). Washington, DC: American Psychological Association.
  9. Nisbett, R. (2003). The geography of thought: How Asians and Westerners think differently… and why. New York, NY: Free Press.


Wong, P. T. P. (2006). The nature and practice of compassion: Integrating Western and Eastern positive psychologies [Review of the book Compassion: Conceptualizations, research, and use in psychotherapy]. PsycCRITIQUES, 51(25). doi:10.1037/a0002884