Loving ourselves points us to capacities of resilience, compassion, and understanding within that are simply part of being alive.

Sharon Salzberg,

The Force of Kindness

 

Medicine is a competitive profession with lots of pressures and risks, making it hard to feel good about yourself. It is easy to feel like a failure if you don’t achieve your high goals or when your efforts fall short of alleviating a patient’s suffering. One way to address these pressures is by improving your resilience, emotional intelligence, and overall well-being with a self-compassion training.

Self-compassion does not mean feeling sorry for yourself and it is not self-pity. It means developing a nurturing relationship with yourself foremost. Similarly, self-compassion is not a sign of weakness. It implies being your own guardian, best friend and healer instead of critic.

Self-compassion is a concept whose popularity has surged in the past decade due to its being a major factor for physical and emotional health. It is defined as “a healthy way of relating to oneself in times of suffering, whether suffering is caused by failure, perceived inadequacy, or general life difficulties.” Considering the high rates of burnout among medical professional and the overall stress levels in that field, we recommend employing the research-based techniques, developed by Dr. Kristin Neff at University of Austin, Texas in combination with the use of self-care products that can enhance their positive effects.

Dr. Neff and her colleagues have provided evidence that high self-compassion is positively linked with well-being in a variety of domains: psychological health, emotional intelligence, self-concept, body image, motivation, interpersonal functioning, and markers of sympathetic nervous system activity after stress. On the other hand, low self-compassion is linked to psychopathology including outcomes such as depression, anxiety, and stress, as well as risk factors for psychopathology such as self-criticism, rumination, and thought suppression.

Compassion for Others as a Fundamental Component of the Medical Profession

Having compassion for oneself is really no different than having compassion for others. Think about what the experience of compassion feels like. First, to have compassion for others you must notice that they are suffering. If you ignore the anguish of a patient, you can’t feel compassion for how difficult his or her experience is. Second, compassion involves feeling moved by others’ suffering so that your heart responds to their pain by offering understanding and kindness to them. When this occurs, you feel warmth, caring, and the desire to help the suffering person in some way. Imagine that you integrate this into the framework of your daily experience at work. Wouldn’t that be the secret to being a great clinician?

How can you do that? By increasing your self-compassion. This involves acting positively towards yourself when you are having a difficult time, fail, or notice something you don’t like about yourself. Instead of just ignoring your pain with a “stiff upper lip” mentality, you stop to tell yourself “this is really difficult right now,” how can I comfort and care for myself in this moment? Instead of mercilessly judging and criticizing yourself for various inadequacies or shortcomings, self-compassion means you are kind and understanding when confronted with personal failings.

The Psychology of Self-Compassion

 

When we criticize ourselves, just like when we experience stress, we activate the body’s threat-defense system (our reptilian brain). It is automatic and easily triggered. Although this system was adaptive in our evolutionary past when we had to escape physical danger, it is detrimental to our health in the contemporary world where such dangers are rare. Spiked cortisol and adrenaline levels can damage our body and psyche in multiple ways, especially when chronic. For that reason, self-criticism, although often neglected, can be a serious cause for poor health. It puts us in a situation where we are both the attacker and the attacked.

Luckily, we are more than reptiles. We have a mammalian brain too, with a care system designed to allow for a long period of keeping infants safe. When the care system is activated, oxytocin (the love hormone) and endorphins (feel-good hormones) are released, which helps reduce stress and increases feelings of safety and security. A soothing touch is one way to activate the care system. Another is through positive self-talk (self-compassion). Compassion (and SC) is linked to the mammalian care system and can trigger it immediately. In addition, self-compassion helps to offset the stress (threat) response. When we experience stress and the threat response is on, we turn on ourselves in a triple negative reaction. We fight ourselves (self-criticism), we flee from others (isolation), or we freeze (rumination). 

When we practice self-compassion, we are deactivating the threat-defense system and activating the care system. In one study, for instance, researchers asked participants to imagine receiving compassion and feeling it in their bodies. Every minute they were told things like “Allow yourself to feel that you are the recipient of great compassion; allow yourself to feel the loving-kindness that is there for you.” It was found that the participants given these instructions had lower cortisol levels after the imagery than those in the control group. Participants also demonstrated increased heart-rate variability afterward. The safer people feel, the more open and flexible they can be in response to their environment, and this is reflected in how much their heart rate varies in response to stimuli. So you could say that when they gave themselves compassion, participants' hearts actually opened and became less defensive.

In sum, when we practice SC, we deactivate the stress response and activate the relaxation response through the care system. These dual benefits of stress reduction and improved well-being are appealing to all medical professionals and come with little time commitment and cost.

Compassion Fatigue in the Medical profession

When we care for others who are suffering, the process of empathic resonance means that we feel their distress as our own. When we witness someone else in pain, the pain centers of our own brains become active. Empathic distress can be hard to bear, so it's natural to try to block it out or make it go away as we would any other pain, but the constant struggle can be draining and lead to caregiver fatigue and burnout.

How do we know we've reached the point of burnout? Usually there are signs such as being distracted, angry or irritated, restless, or avoidant of others, having trouble sleeping, or experiencing distressing and intrusive thoughts. Compassion fatigue is not a sign of weakness, but a sign of caring. In fact, the more caregivers are capable of empathic resonance (which is what often draws people into professions), the more vulnerable they may be to caregiver fatigue.

Empathy is an accurate understanding of the patient's world as seen from the side. To sense their private world as if it were your own. If we just resonate with the suffering of others without having the emotional resources to hold it, we will become exhausted and suffer from compassion fatigue. Compassion entails a sense of tenderness and care that embraces the suffering of others rather than struggling with it. Empathy says, “I feel you.” Compassion says, “I hold you.” Compassion is a positive emotion, an energizing emotion. One research study trained people for several days to experience compassion and then showed them a short film depicting others' suffering. The films activated distinctly different brain networks, and only compassion training activated networks associated with positive emotions.

It is crucial that we give ourselves compassion when experiencing empathic pain. As well told whenever we fly, when there is a drop in cabin m pressure, we need to put on our own oxygen mask first, before we help others. Some medical professionals may believe they should only be concerned with the needs of others and are often self-critical because they think they aren't giving enough. However, if you don't meet your own emotional needs by giving yourself compassion, you will become depleted and less able to give.

Importantly, when you calm and soothe your own mind, the person you're caring for will also feel calmed and soothed through her own empathetic resonance. In other words when we cultivate peace within, we help all those we're in contact with achieve the same.

Self-Compassion Scale

To gauge your self-compassion, answer these questions, based on Kristin Neff’s Self-Compassion Scale:

Do you try to be patient and tolerant toward aspects of your personality you don’t like?

When something painful happens, do you try to take a balanced view of the issue?

Do you remind yourself that everybody has flaws and that you are not alone?

Do you give yourself the care you need?

Yes answers indicate that you’re high in self-compassion, and you probably recover quickly from most stresses. Now try these questions:

When you fail at something important to you, do you berate yourself? Do you become consumed by feelings of inadequacy?

Are you judgmental about your flaws?

Do you feel isolated and alone, separate from other people?

If you’ve answered yes to these, it’s a sign that you struggle to feel compassionate toward yourself. Self-compassion is a skill you can develop. And it’s a skill that will help you develop a resilient response to your negative thoughts. When people who are high in self-compassion have a flood of negative thoughts and feelings, they do things differently from the rest of us. They don’t criticize themselves for having faults. They can observe their negative thoughts without getting swept up in them. This means that they don’t have to push away negative feelings; they just let those feelings happen and then fade. This kind attitude has positive effects on their health. People high in self-compassion react to stress with lower levels of stress hormones and they have less anxiety and depression.

SourcesSelf-Compassion: The Proven Power of Being Kind to Yourself, Kristin Neff; The Mindful Self-Compassion Workbook, Kristin Neff and Christopher Germer.

Kristin Neff, PhD is an Associate Professor of Human Development and Culture, Educational Psychology Department, University of Texas at Austin. Dr. Neff is the most prominent scholar in the field of self-compassion. Her book, Self-Compassion, was published by William Morrow in April, 2011 and is a best-seller on Amazon. 

Christopher Germer, PhD is a clinical psychologist and lecturer on psychiatry (part-time) at Harvard Medical School. He is a co-developer of the Mindful Self-Compassion (MSC) program, author of The Mindful Path to Self-Compassion, co-author of The Mindful Self-Compassion Workbook, and (forthcoming) Teaching the Mindful Self-Compassion Program and co-editor of Mindfulness and Psychotherapy, and Wisdom and Compassion in Psychotherapy.  Dr. Germer is a founding faculty member of the Institute for Meditation and Psychotherapy as well as the Center for Mindfulness and Compassion, Cambridge Health Alliance, Harvard Medical School. He teaches and leads workshops internationally on mindfulness and compassion, and has a private practice in Arlington, Massachusetts, USA specializing in mindfulness and compassion-based psychotherapy.