Compassion Questionnaire towards Others (CQO)

1. Abstract

The Compassion Questionnaire towards Others (CQO; Khoury, Vergara, & Spinelli, 2023) is a psychometric instrument designed to operationalize, assess, and quantify prosocial compassion directed toward other individuals. Developed concurrently with its sister instrument, the Compassion Questionnaire towards Self (CQS), the CQO addresses long-standing conceptual and measurement ambiguities in affective science by defining compassion not as a static trait, broad personality factor, or simple derivative of mindfulness, but as a dynamic constellation of trainable, skill-based competencies. Initially conceptualized around four theoretical pillars—affective, cognitive, behavioral, and interpersonal dimensions—the scale underwent rigorous content validation with expert panels and graduate researchers, starting from an initial pool of 36 items designed to maximize semantic clarity, emotional specificity, and symmetry with self-compassion metrics.

Through iterative empirical evaluations across three cohorts of Canadian adults and university undergraduates, exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) streamlined the questionnaire into a 19-item, three-factor measurement model. These empirically derived subscales comprise: (1) Thinking and Feeling Compassionately, which merges the affective resonance of another’s suffering with cognitive perspective-taking; (2) Connection with Others, capturing interpersonal common humanity, relational attunement, and perceived social interdependence; and (3) Acting Compassionately, measuring explicit behavioral readiness to assist, support, or alleviate distress. Items are scored on a 5-point Likert scale ranging from 1 (almost never) to 5 (almost always).

Psychometric evaluation demonstrates robust internal consistency across all subscales, with Cronbach’s alpha and McDonald’s total omega coefficients spanning 0.85 to 0.92 across split-half cross-validation samples. Structural equation modeling established adequate model fit (CFA: $\chi^2/df$ within standards, CFI = 0.91, TLI = 0.90, RMSEA = 0.08, SRMR = 0.05). The instrument exhibits discriminant validity against general psychological distress and psychiatric symptomatology, while demonstrating convergent validity through significant positive correlations with adaptive emotion regulation strategies. The CQO fills a vital gap in contemplative science, social psychology, and clinical research by offering a clean, skill-focused assessment tool that operates independently of meditative experience.

2. Keywords

Compassion Towards Others, Compassion Questionnaire towards Others, CQO, Thinking and Feeling Compassionately, Connection with Others, Acting Compassionately, Prosocial Behavior, Empathy, Emotion Regulation, Psychometrics, Factor Analysis, Scale Validation

3. Authors

The Compassion Questionnaire towards Others (CQO) was conceptualized, developed, and empirically validated by a multidisciplinary team of clinical and research psychologists:

• Bassam Khoury, Ph.D. (Corresponding Author)
  
  Affiliation: Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada.
  
  Correspondence Address: McGill University, Department of Educational and Counselling Psychology, 3700 McTavish Street, Montreal, Quebec, Canada, H3A 1Y2.
  
  Email: [email protected]
• Rodrigo C. Vergara, Ph.D.
  
  Affiliation: Facultad de Psicología y Humanidades, Universidad San Sebastián, Santiago, Chile.
• Christina Spinelli, M.A.
  
  Affiliation: Department of Educational and Counselling Psychology, McGill University, Montreal, Quebec, Canada.

4. Purpose

The primary purpose of the Compassion Questionnaire towards Others (CQO) is to provide an empirically sound, conceptually distinct, and psychometrically validated instrument to measure an individual’s capacities, inclinations, and practical manifestations of compassion directed toward other people. Historically, the scientific study of compassion has been complicated by conceptual conflation with related psychological constructs, including empathy, sympathy, altruism, personal distress, and generalized prosociality. Furthermore, contemporary instruments frequently conflate compassion with dispositional mindfulness or emotional regulation, obscuring whether changes observed during contemplative interventions (e.g., Compassion-Focused Therapy or Loving-Kindness Meditation) reflect increases in genuine prosocial orientation or broader attentional stability.

Khoury and colleagues designed the CQO to delineate compassion toward others as an independent, multidimensional repertoire of cognitive, emotional, relational, and behavioral skills that can be systematically learned, practiced, and refined. Its development was guided by the necessity for dual-directional measurement: assessing compassion directed outward toward others (via the CQO) and compassion directed inward toward oneself (via the companion CQS) using comparable structural frameworks. The authors prioritized constructing a measurement model whose items refer to discrete, observable cognitive events, emotional reactions, and concrete behavioral choices, rather than ambiguous character traits or self-congratulatory platitudes.

In clinical contexts, the CQO serves as an assessment battery for interventions designed to treat interpersonal dysfunction, chronic hostility, callousness, and empathic deficits. Pathologies characterized by social disconnection, personality disorders with interpersonal antagonism, or clinical burnout among healthcare practitioners benefit from targeted measurement of externalized compassion. In therapeutic environments, tracking CQO subscale scores allows clinicians to determine whether patients can translate emotional resonance into concrete helpful actions, or if an overidentification with others’ suffering produces inhibitory distress instead of constructive prosocial engagement.

In research contexts, the CQO enables precise testing of hypotheses across social, organizational, and affective neuroscience disciplines. It serves as an evaluative metric for Compassion-Focused Therapy (CFT), Compassion Cultivation Training (CCT), and modern organizational leadership programs aiming to foster psychological safety and prosocial collaboration. By isolating the behavioral dimension (“Acting Compassionately”) from internal cognitive-affective processes, the instrument allows researchers to explore the precise mechanics through which mental attitudes convert into tangible, prosocial outcomes.

5. Psychological Construct

The psychological construct operationalized by the CQO conceptualizes compassion toward others as a cooperative, multi-tiered architecture that activates in response to the perceived suffering, vulnerability, or distress of another human being. Unlike static definitions of compassion that view it strictly as an affective state, the CQO establishes it as a deliberate combination of experiential, cognitive, relational, and behavioral proficiencies. Following extensive factor analytic refinement, this overarching construct is composed of three interrelated subscales:

1. Thinking and Feeling Compassionately

This dimension represents an integrated cognitive-affective engine. It merges perspective-taking (the intellectual capacity to perceive another individual’s suffering without distortion) with emotional resonance (the affective experience of tender sorrow, warmth, and care when witnessing that suffering). In earlier theoretical models of the scale, cognitive and affective manifestations were hypothesized as separate factors. However, empirical testing revealed that, when oriented toward others, human beings rarely decouple cognitive appraisal of another’s pain from the immediate emotional reaction it stimulates.

Individuals scoring high on this dimension recognize when someone is experiencing hardship, actively resist dismissive or hypercritical judgments, and experience an authentic affective urge for that individual’s suffering to be relieved. For example, when encountering a colleague experiencing failure, an individual high in this trait cognitively reframes the event to understand the contextual pressures involved while simultaneously feeling an internal emotional warmth rather than contempt or indifference.

2. Connection with Others

Rooted in the fundamental sociobiological premise that human beings thrive through mutual interdependence, the Connection with Others subscale captures an individual’s sense of common humanity, relational attunement, and recognition that suffering and fallibility are universal facets of existence. Rather than viewing an afflicted person as fundamentally flawed, separate, or an outsider (“us versus them”), high scorers maintain an inclusive interpersonal boundary.

This subscale assesses an individual’s resistance to social alienation, isolationism, and interpersonal detachment when encountering difficulty in others. It reflects the realization that personal boundaries are permeable, and that another person’s pain mirrors potential vulnerability in oneself. Experiencing high connection prevents compassion from degrading into paternalistic pity, preserving mutual dignity and psychological equality across relational exchanges.

3. Acting Compassionately

The third dimension isolates the pragmatic, behavioral output of the compassionate sequence. While feeling empathy and acknowledging common humanity can remain entirely covert, Acting Compassionately assesses the execution of concrete actions intended to comfort, assist, or alleviate another person’s distress. This dimension captures behavioral courage and the willingness to incur minor personal costs (e.g., spending time, offering resources, extending social support) to mitigate another person’s suffering.

High scorers on this subscale do not halt at internal good intentions; they check in on distressed peers, intervene constructively when witnessing unfair treatment, and provide tangible help. Importantly, psychometric evaluations have demonstrated that this behavioral dimension exhibits unique statistical properties, correlating only weakly to moderately with internal thoughts and feelings, highlighting that internal emotional warmth does not automatically guarantee direct behavioral intervention.

6. Theoretical Framework

The Compassion Questionnaire towards Others is rooted in the evolutionary and biopsychosocial paradigms of compassion popularized by Paul Gilbert, integrated with contemporary cognitive-behavioral traditions and social psychology frameworks established by Kristin Neff and C. Daniel Batson. These foundational models provide theoretical clarity regarding why compassion must be disentangled from mindfulness and basic affective resonance.

Evolutionary and Motivational Systems

Gilbert’s evolutionary framework posits three primary affect regulation systems: the threat-and-protection system, the drive-and-reward system, and the soothing-and-affiliation system. The CQO is theoretically grounded in the activation of the mammalian caregiving and soothing-affiliation system. This physiological system, regulated partly through oxytocinergic pathways and parasympathetic (vagal) tone, evolved to facilitate infant protection, mutual grooming, kin altruism, and broader collaborative alliances. Under this framework, compassion toward others represents a specialized motivational state oriented toward identifying distress signals and activating caregiving routines rather than defensive fight-or-flight behaviors.

Distinction from Empathy and Personal Distress

A crucial theoretical anchor for the CQO is Batson’s empathy-altruism hypothesis, which differentiates between “empathic concern” (other-oriented emotional responses congruent with the perceived welfare of someone in need) and “personal distress” (self-oriented, aversive emotional reactions such as anxiety, discomfort, or overwhelm when observing another’s suffering). When an individual lacks sufficient emotional differentiation, another’s pain induces vicarious distress, prompting withdrawal or avoidance to protect the self. The theoretical framework of the CQO asserts that true compassion bypasses this self-focused distress by blending cognitive perspective-taking with grounded emotional warmth, producing prosocial action rather than defensive retreat.

Independence from Mindfulness

A central theoretical departure of Khoury and colleagues from earlier Buddhist-inspired psychological scales is the operational separation of compassion from mindfulness. Many existing scales, including early iterations of compassion measures, embedded mindful awareness (e.g., non-reactivity, attentional stability, present-moment focus) directly into the definition of compassion. Khoury argued that while mindfulness may serve as an attentional precursor or training tool that facilitates emotional regulation, compassion itself is an independent prosocial orientation with distinct evolutionary roots, cognitive processes, and behavioral mechanisms. Consequently, the CQO focuses specifically on affective attunement, perceived relational connection, and targeted helpful action.

7. Validity

The Compassion Questionnaire towards Others underwent multi-stage psychometric validation involving three independent adult cohorts in Canada to substantiate its construct, convergent, discriminant, and longitudinal properties.

Construct and Structural Validity

Construct validity was established through sequential exploratory and confirmatory factor analyses. The initial 36-item pool was curated to test a four-factor structure (affective, cognitive, behavioral, and interpersonal). Structural equation modeling on the validation samples demonstrated that the affective and cognitive dimensions shared high shared variance and collapsed naturally into a single, cohesive “Thinking and Feeling” factor. The resulting 19-item, three-factor structure exhibited solid model fit across independent split-half cross-validation analyses, verifying that the empirical construct accurately represents the three hypothesized domains.

Convergent Validity

Convergent validity was evaluated by correlating CQO subscale scores with validated measures of emotion regulation, empathy, and interpersonal competence:

• The Thinking and Feeling Compassionately subscale demonstrated moderate-to-strong positive correlations with measures of cognitive perspective-taking, empathic concern, and adaptive emotion regulation ($r = .42$ to $.56, p < .001$).
• The Connection with Others subscale correlated moderately with social connectedness scales, common humanity indices, and secure attachment dimensions ($r = .35$ to $.48, p < .001$).
• The Acting Compassionately subscale showed significant positive associations with self-reported prosocial behaviors, altruistic tendencies, and active social support provision ($r = .31$ to $.44, p < .001$).

Discriminant Validity

Crucially, the CQO established divergent and discriminant validity against measures of psychopathology and emotional dysfunction. Correlational analyses revealed that CQO total and subscale scores exhibited non-significant to very weak inverse correlations with standardized measures of depression, generalized anxiety, and psychological distress (ranging from $r = -.05$ to $-.14$, mostly non-significant). This pattern confirmed that the capacity to experience and enact compassion toward others is distinct from an individual’s personal level of symptomatic distress. Furthermore, the CQO demonstrated discriminant validity from mindfulness scales, confirming that while the constructs share common ground, compassion toward others functions as an independent psychometric entity.

Longitudinal Stability and Trends

Test-retest assessments over multi-week intervals indicated that the CQO subscales exhibit temporal stability in the absence of targeted interventions. However, an interesting longitudinal nuance emerged: while the Thinking and Feeling Compassionately and Connection with Others subscales showed stable trajectories across assessment points, the Acting Compassionately subscale demonstrated a minor but statistically significant downward adjustment at follow-up ($p = .03$). The authors hypothesized that without ongoing behavioral reinforcement, individuals may adjust overly optimistic self-reports of altruistic behavior back toward their baseline empirical levels as they reflect more accurately on their daily actions.

8. Reliability

The reliability of the Compassion Questionnaire towards Others has been tested extensively across diverse adult cohorts, demonstrating strong internal consistency and cross-sample stability.

Internal Consistency

Across validation studies using Canadian adult community and university samples, internal consistency coefficients for the full 19-item CQO composite consistently ranged between $\alpha = .86$ and $.92$. To account for modern psychometric standards regarding the limitations of Cronbach’s alpha in tau-equivalent models, the authors calculated McDonald’s total omega ($\omega_t$), which corroborated the high internal consistency of the instrument:

• Thinking and Feeling Compassionately (Subscale 1): Exhibited high internal consistency across validation subsamples, with Cronbach’s $\alpha$ spanning $0.88$ to $0.91$, and McDonald’s $\omega_t$ ranging from $0.89$ to $0.91$.
• Connection with Others (Subscale 2): Demonstrated robust reliability, with $\alpha$ values ranging from $0.86$ to $0.89$, and $\omega_t$ matching these parameters ($0.86$ to $0.90$).
• Acting Compassionately (Subscale 3): Consistently demonstrated adequate to good internal consistency, albeit slightly lower than the internal cognitive/affective subscales. In split-half cross-validation analyses, Cronbach’s $\alpha$ was $0.85$ for the first half of the sample and $0.87$ for the second half; McDonald’s $\omega_t$ was identically $0.85$ and $0.87$.

Bootstrapping and Cross-Validation Stability

The developers employed a split-half cross-validation procedure combined with bootstrapping methods (1,000 resamples) to verify the precision of the standard errors and internal consistency estimates. The bootstrapped confidence intervals for all three subscales remained well above the conventional psychometric threshold of $0.80$, verifying that the item configurations are stable and do not suffer from sample-dependent over-fitting.

9. Factor Analysis

The structural composition of the CQO was refined using a multi-step analytic strategy combining Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) across partitioned validation samples.

Initial Item Pool and Exploratory Factor Analysis (EFA)

Scale development commenced with an initial pool of 36 candidate items derived from theoretical definitions of compassion across affective, cognitive, behavioral, and interpersonal dimensions. These candidate items were administered to an exploratory calibration sample of Canadian adults. The Kaiser-Meyer-Olkin (KMO) measure of sampling adequacy was $0.87$, indicating excellent shared variance for factorization, and Bartlett’s test of sphericity was statistically significant ($p < .001$).

EFA was conducted utilizing robust maximum likelihood estimation with oblimin (oblique) rotation to account for expected correlations among compassion dimensions. Parallel analysis and inspection of the scree plot indicated a clear three-factor solution rather than the theoretical four-factor model. The cognitive and affective items coalesced cleanly onto a single underlying factor, while interpersonal items and behavioral items formed two distinct secondary factors. Items displaying weak primary factor loadings ($< .40$) or problematic cross-loadings ($> .30$ on non-target factors) were eliminated. This reduction trimmed the instrument from 36 down to 19 definitive items.

For the initial calibration sample, the 19-item, three-factor EFA solution yielded the following fit diagnostics:

• Tucker-Lewis Index (TLI): $0.87$
• Root Mean Square Error of Approximation (RMSEA): $0.08$ ($90%\text{ CI } [0.071, 0.089]$)
• Standardized Root Mean Square Residual (SRMR): $0.04$

Confirmatory Factor Analysis (CFA)

The derived 19-item structure was subsequently tested in an independent validation sample using Confirmatory Factor Analysis (CFA). A first-order, three-factor correlated model was specified, linking the 19 observed variables to their respective latent dimensions: Thinking and Feeling Compassionately, Connection with Others, and Acting Compassionately.

The CFA confirmed structural stability, yielding adequate to good goodness-of-fit metrics:

• Comparative Fit Index (CFI): $0.91$
• Tucker-Lewis Index (TLI): $0.90$
• Root Mean Square Error of Approximation (RMSEA): $0.08$
• Standardized Root Mean Square Residual (SRMR): $0.05$

All 19 items loaded significantly on their designated latent factors ($p < .001$) with standardized factor loadings ranging from $0.61$ to $0.86$, confirming that each retained item captures its targeted facet of compassion toward others.

10. Instrument / Measurement Tool

• Full Instrument Name: Compassion Questionnaire towards Others (CQO)
• Associated Twin Instrument: Compassion Questionnaire towards Self (CQS)
• Original Authors: Bassam Khoury, Rodrigo C. Vergara, and Christina Spinelli (2023)
• Test Type: Self-report psychometric questionnaire
• Administration Format: Paper-and-pencil or digital/online survey administration
• Target Population: Adults (18 years and older), including young adults, university populations, middle-aged adults, and older clinical or non-clinical populations
• Estimated Completion Time: 4 to 7 minutes
• Number of Items: 19 items (retained from the preliminary 36-item experimental pool)
• Response Format: 5-point Likert rating scale ranging from:
  • 1 = Almost never
  • 2 = Rarely
  • 3 = Sometimes
  • 4 = Frequently
  • 5 = Almost always
• Subscales & Structural Distribution:
  • Subscale 1: Thinking and Feeling Compassionately — Captures the combined cognitive recognition, empathic concern, non-judgmental acceptance, and affective resonance toward another’s distress.
  • Subscale 2: Connection with Others — Measures perceived common humanity, relational attunement, social solidarity, and the reduction of interpersonal othering during times of suffering.
  • Subscale 3: Acting Compassionately — Evaluates concrete behavioral enactment, active prosocial intervention, and practical assistance provided to relieve another’s hardship.
• Scoring Guidelines:
  • Items are structured such that higher numerical values represent greater compassionate capacity. Any reverse-scored items are inverted prior to subscale computation.
  • Subscale scores are calculated by averaging or summing the item ratings within that specific dimension.
  • A Total Compassion towards Others Score can be computed by summing or averaging all 19 items, though reporting individual subscale profiles is recommended for clinical and experimental nuance.

11. Permissions & Fee and Test Year

• Year of Initial Publication: 2023
• Copyright Status: Copyright © 2023 by Bassam Khoury, Rodrigo C. Vergara, and Christina Spinelli. Published by Springer Science+Business Media, LLC, part of Springer Nature.
• Commercial Availability: Non-commercial. The scale is not sold as a proprietary clinical test kit.
• Usage Fees: There are no licensing or administration fees for academic research, educational use, or non-funded clinical practice.
• Permissions and Inquiries: Researchers and clinicians wishing to use, translate, or adapt the Compassion Questionnaire towards Others (CQO) are advised to contact the corresponding author, Dr. Bassam Khoury, at McGill University via email ([email protected]).

12. References

Batson, C. D. (2011). Altruism in humans. Oxford University Press. https://doi.org/10.1093/acprof:oso/9780195341065.001.0001

Gilbert, P. (2014). The origins and nature of compassion focused therapy. British Journal of Clinical Psychology, 53(1), 6–41. https://doi.org/10.1111/bjc.12043

Khoury, B., Vergara, R. C., & Spinelli, C. (2023). Compassion Questionnaires: Scales development and validation. Cognitive Therapy and Research, 47(6), 1006–1032. https://doi.org/10.1007/s10608-023-10416-2

Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223–250. https://doi.org/10.1080/15298860309027

Strauss, C., Lever Taylor, B., Gu, J., Kuyken, W., Baer, R., Jones, F., & Cavanagh, K. (2016). What is compassion and how can we measure it? A review of definitions and measures. Clinical Psychology Review, 47, 15–27. https://doi.org/10.1016/j.cpr.2016.05.004

13. Items of the Scale