Psychology
2012. Vol.3, Special Issue, 80 5-809
Published Online September 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.329122
Depression, Guilt, and Tibetan Buddhism
Lynn E. O’Connor1*, Jack W. Berry2, David J. Stiver3, Rachna K. Rangan1,4
1The Wright Institute, Berkeley, USA
2Samford University, Birmingham, USA
3Graduate Theological Union, Berkeley, USA
4The Wright Institute, Berkeley, USA
Received July 1st, 2012; revised August 2nd, 2012; accepted September 4th, 2012
Depression appears to be somewhat epidemic in the modern world. In prior empirical studies we found
depression significantly associated with empathy-based guilt, empathic distress, and an overly active or
misattributing moral system. In this study, we compared 98 Buddhists, who were primarily Tibetan medi-
tation practitioners to 438 non-Buddhist, non-practicing community adults on a measure of depression
along with measures of maladaptive guilt, empathic distress, anxiety and altruism. Our findings demon-
strated that practitioners were significantly lower in depression, pathogenic guilt, anxiety, and empathic
distress, and significantly higher on agreeableness, conscientiousness, openness to experience and com-
passionate altruism directed towards strangers. Intensity of practice significantly correlated with positive
outcomes. In addition, we found that within the population of Tibetan Buddhist practitioners, those who
endorsed the statement that the goal of meditation was other-focused (for the benefit of all sentient beings)
were significantly lower in depression, empathic distress, and anxiety, and significantly higher in cogni-
tive empathy (perspective-taking) compared to practitioners whose goal of meditation was self-focused.
Keywords: Depression; Resilience; Meditation; Religion; Compassion
Introduction
After two decades of studying depression and its relationship
to empathy based guilt associated with pathogenic cognitions,
empathic distress, and both compassionate and pathological
altruism, we became interested in examining the experience of
Tibetan Buddhists who appear to be resilient and less vulner-
able to depression and PTSD. After suffering serious trauma in
Tibet, including imprisonment and torture, followed by a
stressful escape over the Himalaya, often on foot, and immigra-
tion to Nepal and/or India, the Tibetan Buddhists seem to arrive
in their new country with minimal symptoms of depression or
PTSD. Prior studies have indicated that refugees who have
escaped countries where they were imprisoned and/or tortured
were likely to exhibit high rates of Post Traumatic Stress Dis-
order (PTSD) and depression (Mollica et al., 2001; Hollifield et
al., 2002). In addition, it has been suggested by cross-cultural
experts that immigration itself is strongly associated with epi-
sodes of major d epressive disorde rs (Breslau et al., 2011). There-
fore, clearly there may be something different about the prac-
tice of Tibetan Buddhism, explaining this contrast.
Tibetan Buddhists have been described as exhibiting protect-
tive factors in various studies, in terms of reactions to stress,
and a general psychological wellbeing, skill at emotion regula-
tion, and low levels of depression and anxiety (Sachs et al.,
2008). Studies by Holtz, 1998 and Keller et al., 2006 indicate
that unlike many other political torture survivors, Tibetans in
exile appear relatively resilient and optimistic. Both Sachs et al.,
2008 and Keller et al., 2006 hypothesized that something about
the Tibetan Buddhist religion, either specific beliefs or prac-
tices or both, may serve as a protective factor against vulner-
ability to psychological distress particularly depression, PTSD,
and anxiety.
It has also been suggested that this resilient response to
traumatic conditions may be attributed to protective factors
associated with specific Tibetan Buddhist beliefs; for example
Watkins & Cheung (1995) have suggested that the habitual
tendency to see oneself as having suffered less than others, re-
gardless of circumstances may contribute to this positive out-
come. In addition, other beliefs that are an integral part of the
religion may play an important role. For example, Tibetan
Buddhists believe in Karma, whereby prior actions—including
actions in past lives—lead to events, something over which a
person has no control in terms of the past. Karma is, however,
changeable, in accord with a person’s current actions of “body,
speech and mind.” In this world-view, a better future may be
predicted if a person is an active practitioner. The meditation
practices commonly used have thus been empirically associated
with psychological wellbeing and low levels of depression in
general (Marchand, 2012).
Lutz, Brefczynski-Lewis, Johnstone & Davison, 2008 and
Lutz, Slagter, Dunne & Davidson, 2008 have performed fMRI
and EEG studies with experienced Tibetan Buddhist meditators
and shown that experienced Tibetan Buddhist mediators record
powerful gamma wave activity that is rarely—if ever—detected
in non-meditators. These Gamma waves are brain waves oscil-
lating at roughly 40 cycles per second, indicating intensely
focused thought. In addition, it is also reported that the medita-
tors enjoy unusual levels of positive emotions and states of
brain activity indicating a greater level of neural communica-
tion than is ordinary (Jang et al., 2011; Rubik, 2011).
In our prior studies, initially derived from clinical experience,
we focused on the relationship between depression and empa-
thy-based guilt, pathogenic beliefs, empathic distress, and both
*Corresponding author.

L. E. O’CONNOR ET AL.
pathogenic and compassionate altruism. In clinical cases, the
strong correlation between guilt and depression is well known
and guilt is included in the formal criteria for major depressive
disorder. We particularly focused on survivor guilt broadly
defined, (referring to a fear of harming others by surpassing
them, sometimes conscious but often outside of conscious
awareness) and omnipotent responsibility guilt, or feeling re-
sponsible for other’s happiness even when one has no power to
change another’s situation for better or worse and had no re-
sponsibility for their problems to begin with. These types of
guilt are associated with “imaginary crimes,” that is thinking
one has harmed someone by committing a crime that essentially
never happened (Weiss, 1993). While empathy-based guilt is to
some extent universal, from our clinical experience we hy-
pothesized that both survivor guilt and omnipotent responsibil-
ity guilt would be significantly associated with depression, and
in many studies these hypotheses were supported (O’Connor et
al., 1999, 2002, 2011).
Green S, Lambon Ralph MA, Moll J, Deakin JF, Zahn R.
(2012) have used functional MRI to study the brains of people
with a history of major depression and a control group of peo-
ple who never had depression and found that when compared to
those in the control group, people with a history of depression
showed different responses in brain regions associated with
guilt (i.e., the subgenual region of the brain) and knowledge of
acceptable social behavior (i.e., the anterior temporal lobe). In
particular, they have found that in people with a history of de-
pression the anterior temporal lobe and the subgenual region of
the brain do not connect as strongly as they do in people
who’ve never been diagnosed with depression and that this
“decoupling” only occurs when people prone to depression feel
guilty or blame themselves, but not when they feel angry or
blame others. These finding could implicate that the “decoup-
ling” observed in the depressed people could reflect the lack of
access to details of about what exactly was inappropriate about
their behavior when feeling guilty and as a consequence they
extend guilt to things they are not responsible for and feeling
inappropriate guilt and support the role for self-blame and guilt
might play in depression.
Finding what appears to be a protection from vulnerability to
anxiety and depression in practitioners of Tibetan Buddhism
may have clinical implications. In a religious tradition largely
focused on “others” with rituals carried out routinely and spe-
cifically “for the benefit of all sentient beings” one might expect to
find higher levels of empathy, empathic distress, empathy-
based guilt and subsequently, depression. On the other hand, it
seemed equally possible that factors as briefly described above,
such as a belief in Karma, or a c onviction that others are sufferi ng
more than oneself, in conjunction with a more general belief
system grounded in compassion and altruism towards others,
beyond friends and close family, the kind of empathy-based
guilt we found associated with depression might be minimized.
This study was designed to investigate the associations be-
tween depression, anxiety, empathic distress, empathy-based
guilt, and both pathological and compassionate altruism in a
population of Tibetan Buddhist meditation practitioners, and
compare it to a normal non-practicing religiously varied popu-
lation in the United States.
Method
Participants
Two samples were collected for this study. One sample in-
cluded 98 practitioners of Tibetan Buddhist contemplation
(70.4% female) who were recruited through advertisements on
Tibetan Buddhist listservs connected to the Foundation for the
Preservation of the Mahayana Tradition (FPMT) in the United
States. Practitioner ages ranged from 18 to 83 years (M = 44.2,
SD = 16.4). The types of Buddhist contemplation practices
reported were 31.6 percent Mahayana, 19.4 percent Vajrayana,
8.3 percent Pure Land, and 40.8 percent Other, a combination
of traditions, or non-response. Most participants were European
American (68.4%); other ethnic identifications included Asian
American/Pacific Islanders (8.2%), Latin American (5.1%), Afri-
can American (2.0%), and 16.3 percent other ethnicities, mixed,
or non-responses. The sample was generally highly educated,
with 16.4 percent of participants having a doctoral degree, 29.6
percent a masters degree, 18.4 percent a bachelors degree, 26.4
percent with some college education at an undergraduate or
graduate level, and the remaining 9 percent with a high school
education or non-response.
The other sample, which served as a comparison group, in-
cluded 438 adult participants (83% female) recruited through
advertisements on Craigslist. Of 450 initial participants, 12 who
identified as Buddhists were excluded from the sample. Par-
ticipant ages ranged from 18 to 72 years (M = 30.5, SD = 11.1).
Ethnic identities were as follows: European American (51%),
Asian American/Pacific Islanders (15.3%), Latin American
(3%), African American (2.3%), and 28.4 percent other ethnici-
ties, mixed, or non-responses. Education levels of participants
were as follows: 3.3 percent had doctoral degrees, 14 percent
masters degrees, 32.6 bachelors degrees, 39.7 percent with
some college education at an undergraduate or graduate level,
and the remaining 10.4 percent with a high school education or
less or non-response.
Instruments
The Center for Epidemiologic Studies Depression Scale
(CESD; Radloff, 1977) is a widely-used 20-item self-report in-
strument that assesses symptoms associated with depression.
Items are scored on a 4-point scale to indicate how often symp-
toms are experienced in the preceding week. Scores range from
0 to 60. Higher scores indicate higher levels of depression.
Alpha coefficients have ranged from .84 to .90 (Radloff, 1977).
The Interpersonal Guilt Questionnaire-67 (IGQ-67; O’Con-
nor, Berry, Weiss, Bush & Sampson, 1997) is a 67-item meas-
ure, using Likert-type scales, to assess empathy-based guilt.
Three subscales were used in this study. Survivor Guilt is char-
acterized by the belief that being successful or happy will make
others feel inadequate simply by comparison (e.g., “It makes
me very uncomfortable to receive better treatment than the
people I am with”). Separation Guilt is characterized by the
belief that if a person separates from, leads his or her own life,
or differs from loved ones in some way, he or she will cause
loved ones to suffer (e.g. “I am reluctant to express an opinion
that is different from the opinions held by my family or
friends”). Omnipotent Responsibility Guilt is characterized by
the belief that one is responsible for the happiness and well-
being of others (e.g. “I often find myself doing what someone
else wants me to do, rather than doing what I would most en-
joy”). Internal consistencies (Cronbach’s alpha coefficients) for
the subscales have ranged from .76 to .85 for Survivor/Outdo-
ing Guilt, from .84 to .89 for Self-Hate, from .71 to .83 for
Omnipotent Responsibility Guilt, and from .73 to .83 for Sepa-
806

L. E. O’CONNOR ET AL.
ration Guilt (O’Connor et al., 1997; O’Connor et al., 1999). The
construct validity of the IGQ-67 has been established through
correlations with other measures of guilt and psychopathology
(O’Connor et al., 1997; O’Connor et al., 1999).
Compassionate Altruism Scale (CAS; O’Connor, Berry, Cris-
ostomo, & Yi, 2005). The CAS is a 45-item instrument, derived
from a measure of social support (Vaux, Riedel, & Stewart,
1987). Instead of measuring how much social support a person
received, the CAS measures how much support someone tends
to extend to others. Respondents indicate how frequently they
perform acts of altruism for family members, friends, and
strangers in a variety of social situations. Items from thisques-
tionnaire include how often the participant “gave money for an
indefinite amount of time” and “helped them think about a
problem.”
The Interpersonal Reactivity Index (IRI; Davis, 1980) is a
28-item self-report instrument measuring four distinct catego-
ries of empathy: Perspective taking (the ability to identify with,
or understand cognitively the situation experienced by another
person); Empathic Concern (the degree of concern or compas-
sion a person tends to feel on witnessing difficult or unpleasant
experiences occurring to another person); Personal Distress (the
degree of anxiety or distress a person is likely to feel upon wit-
nessing difficulties experienced by another person); and Em-
pathic Fantasy (the tendency to identify with fictional charac-
ters in novels, films, and plays). Davis (1983) reported internal
consistencies of the IRI subscales ranging from .71 to .77.
The Big Five Inventory (BFI; John, Donahue, and Kentle,
1992) is a 44-item measure of the Big-Five personality factors:
neuroticism, extraversion, agreeableness, conscientiousness, and
openness to experience. Short phrases are rated on a 5-point
Likert-type scale according to how descriptive the phrases are
of the respondent. John et al. (1992) reported internal consis-
tencies for the subscales ranging from .75 to .88. Peer-peer and
peer-self correlations ranged from .21 for agreeableness to .63
for extraversion. Further evidence of construct validity is pro-
vided by John, Naumann, and Soto (2008).
Procedure
Subjects were directed to the study by way of a link provided
in the online announcements, where they first read the intro-
ductory letter which outlined the anonymous nature of the study,
and after which they indicated agreement to participation. From
there they went to the study itself, which consisted of the stan-
dardized instruments and a demographic questionnaire that in-
cluded questions about their meditation practices. The questions
about the meditation practice included items such as “how long
have you been practicing”; “what is the duration of practice
during each session” and “what is the main goal for meditation”.
After completing the survey, they submitted their data, which
came into the EPARG server via FileMaker Pro, was then fed
into Excel, and from there, was translated into an SPSS file for
analysis.
Results
Independent-samples t-tests were used to compare the Ti-
betan Buddhist practitioners to the non-practitioner comparison
group on psychological outcome variables (empathy, empathy-
based guilt, altruism, depression, and the Big Five personality
factors). The results are presented in the Table 1.
The practitioners were significantly lower on omnipotent re-
sponsibility guilt, empathic distress, and depression. On the Big
Five personality factors, the practitioners were significantly
higher on agreeableness, conscientiousness, and openness to
experience, and they were significantly lower in neuroticism;
there was no significant group difference in extraversion. Al-
though the Buddhists did not differ from the comparison group
on altruism towards family and friends, they were significantly
higher in altruism toward strangers .
Within the Tibetan Buddhist practitioner sample, we assessed
the relationships between specific practice variables and psy-
chological outcomes. The practice variables were frequency of
meditation, duration of sessions, practice intensity (frequency X
duration), and how long the participant has been meditating.
Because the practice variables were ordered categories, we
calculated Spearmen rank correlations between these practice
variables and psychological outcome variables. The correla-
tions are presented in Table 2.
Measures reflecting frequency and intensity of Tibetan
meditation practice tended to be significantly associated with
lower psychological distress, including lower depression, neu-
roticism, empathic distress, and omnipotent responsibility guilt.
These practice variables were positively associated with per-
spective-taking and conscientiousness, but there were no sig-
nificant associations with the altruism scales. Similar associa-
tions were found with number of years meditating.
We also examined whether the practitioners’ goals of medi-
tation were related to psychological outcomes. Participant goals
were classified as either other-focused (where the goals was for
“the benefit of all sentient beings”; n = 37) or self-focused
(which included goals such as relaxation, health benefits,
enlightenment, to be more positive, or to get out of samsara; n
= 39). Independent-samples t-tests were used to compare
Table 1.
Tibetan Buddhist meditation practitioners versus non-practitioners on
psychological outcomes.
Buddhists Non-Buddhists
M SD M SD t
Guilt
Survivor Guilt 70.4 8.2 68.4 11.2 1.68
Separation Guilt 36.8 7.5 37.6 8.8 –.75
Omnipotent Guilt 45.2 7.5 47.6 8.0 –2.68**
Empathy
Perspective-Taking 26.1 4.2 25.3 4.9 1.39
Empathic Concern 28.2 3.7 27.9 4.2 .81
Empathic Distress 15.2 4.8 17.2 5.3 –3.38***
Altruism
Altruism t o Family 174.1 29.2 170.2 32.0 1.08
Altruism to F riends171.0 26.4 173.9 28.1 –.91
Altruism t o Str angers111.9 33.1 91.9 31.9 5.40***
Depression (CESD)13.2 10.6 21.7 13.2 –4.83***
Personality
Extraversion 26.3 6.4 25.6 7.1 .93
Agreeableness 35.4 5.5 33.4 5.6 3.03**
Conscientiousness 34.4 6.1 31.3 6.5 4.27***
Neuroticism 20.7 6.0 25.4 6.7 –6.20***
Openness 41.0 6.5 39.4 6.1 2.34*
Note: *p < .05, **p < .01, ***p < .001.

L. E. O’CONNOR ET AL.
Table 2.
Correlations between psychological outcomes and meditation practices
among Tibetan Buddhist practitioners.
Frequency of
Meditation Duration of Sessions Practice Intensity How Long Meditating
Guilt
Survivor Guilt –.09 .03 –.05 .06
Separation Guilt –.05 –.26* –.15 –.17
Omnipotent Guilt –.30* –.19 –.26* –.28*
Empathy
Perspective-Taking .26* .26* .32* .35**
Empathic Concern .05 .02 .07 –.02
Empathic Distress –.39** –.30* –.43** –.28*
Altruism
Altruism t o F amily .03 -.05 -.0 5 –.17
Altruism t o F riends .03 -.11 -.05 –.16
Altruism t o S trangers .14 .01 .09 .13
Depression (CESD) –.44** –.33* –.45** –.24*
Personality
Extraversion .11 .21 .09 .02
Agreeableness .14 .15 .18 .14
Conscientiousness .23 .37** .32* .26*
Neuroticism –.35** –.28* –.36** –.22
Openness .20 .31* .28* .20
Note: *p < .05, **p < .01.
participants with these two classes of goals on all psychological
outcomes. Results are provided in Table 3.
Compared to practitioners whose goal of meditation was
self-focused, those whose goals were other-focused were sig-
nificantly lower in depression, empathic distress, and neuroti-
cism, and they were significantly higher in perspective-taking;
their lower omnipotence guilt closely approached significance
(p = .053). There were no significant group differences on the
altruism scales.
Discussion
These results support the hypothesis that people who are
practicing Tibetan Buddhist meditation tend to experience less
depression, anxiety, empathic distress, and empathy-based guilt,
that is specifically guilt that occurs when someone is unrealis-
tically worried about harming others by surpassing them, or
otherwise blaming themselves for problems of others for which
the guilt-ridden person has neither the power to bring on nor the
power to alleviate. This type of “omnipotent guilt” involves
faulty cognitions and particularly those connected to attribu-
tions for harm. The finding that Tibetan Buddhist practitioners
are significantly less depressed and less irrationally responsible
and self-blaming may be the result of better affect regulation,
secondary to meditation practice, or it may be the result of be-
liefs embedded in the religion. Future research may illuminate
this further.
The finding that practicing Tibetan Buddhist meditators
demonstrate greater altruism towards strangers may be particu-
Table 3.
Goal of meditation practice and psychological outcomes.
Self-Focused Other-Focused
M SD M SD
t
Guilt
Survivor Guilt 70.47.6 70.7 7.8 –.16
Separation Guilt 37.38.6 35.4 6.7 1.07
Omnipotent Guilt 45.86.5 42.7 7.0 1.97
Empathy
Perspective-Taking 25.34.3 27.4 4.0 –2.02*
Empathic Concern 28. 43.7 28.8 3.6 .93
Empathic Distress 16.04.9 13.5 3.7 2.39*
Altruism
Altruism t o Family 171.632.5 175.3 26.8 –.51
Altruism t o Fri ends 169.926.7 175.3 26.9 –.11
Altruism to S trangers110.229.6 119.7 33.2 –1.24
Depression (CESD) 15.112.7 9.9 7.3 2.10*
Personality
Extraversion 26.46.6 26.7 6.5 –.21
Agreeableness 35.25.4 36.5 5.1 –1.06
Conscientiousness 35.05.7 35.9 5.9 –.67
Neuroticism 22.26.1 18.2 5.2 –2.92**
Openness 39.77.9 42.3 5.5 -1.55
Note: *p < .05, **p < .01, ***p < .001.
larly important in these times in which we are rapidly becoming
a global family. Neuroscientists such as Davidson and col-
leagues have studied the meditation practices of Tibetan Monks
in the past decade providing increasing evidence for the posi-
tive effects of Buddhist contemplative practices on the emotion
regulation. In support of this hypothesis, this study finds that
the intensity of mediation is significantly associated with lower
depression, a nxiety, pathologica l guilt and empathy-distress and
with higher conscientiousness, cognitive empathy (empathic
perspective-taking) and altruism to strangers. These findings
may be in part explained by the Buddhist worldview that we are
all impermanent and interdependent and therefore we may be
excluded from the possibility of omnipotent responsibility for
things we can’t control or even necessary influence. In this
view, if we assume that no one is entirely permanent or inde-
pendent and that everyone is interdependent leads to the belief
that no one can be liberated until everyone is liberated, and this
provides a strong motivation to liberate all sentient beings from
suffering without taking on unrealistic and irrational beliefs
associated with the causal attributions often seen associated
with pathological guilt an d altruism.
The Mahayana Buddhists are trained to believe that to be
successful, to achieve happiness and wellbeing in this life and
in future lifetimes, the ultimate goal is to become a Bodhisattva,
a person for whom liberating all sentient beings takes prece-
dence over liberating the self. In this regard, this study finds
that most Tibetan Buddhist practitioners chose the goal of me-
diation “for the benefit of all sentient beings”. There is however
a subset of the Tibetan Buddhist practitioners in this study who
chose other responses as being the most important goal for
mediation. We found that level or intensity of meditation cor-
related with positive outcomes, and that practitioners whose
goal was other-focused (i.e. more in-sync with Bodhisattva
beliefs) appear to derive more benefits in terms of positive
well-being. While we don’t yet know the role that conscious
808

L. E. O’CONNOR ET AL.
beliefs or meditation intensity may play in determining the
results found in this study, the differences found within the
Tibetan Buddhist sample in terms of levels of meditative prac-
tice, suggests that the practice itself may provide the explana-
tion we seek, above and perhaps independent of the consciously
expressed beliefs held within the religion.
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