Be Resilient: Self-Compassion in Health Care

A scholarly apologetics for the use of mindful practices in the general population and healthcare.  

By Dr. Kim ByrdRider, PT 

Be Resilient 

Self-Compassion in Health Care 

What is self-compassion? 

According to psychology professor Dr. Kristin Neff, self-compassion is “extending compassion to one’s self in instances of perceived inadequacy, failure, or general suffering. Three main components: (a) self-kindness- being kind and understanding towards oneself in instances of pain or failure rather than being harshly self-critical, (b) common humanity-perceiving one’s experiences as part of the larger human experience rather than seeing them as a separating and isolating and (c) mindfulness- holding painful thoughts and feelings in balanced awareness rather than over-identifying with them” (Neff, 2003).  

What does Self-compassion do? 

1. Increases: self-esteem, successful aging, general well-being, life satisfaction, functioning, resilience and emotion regulation. 

1. Decreases: depression, fear of failure, anxiousness, fear of rejection, negative affect, self-pity, catastrophizing, resignation, emotional problems and PTSD symptom severity.  

(Allen & Leary, 2010; Leary, Tate, Adams, Allen, & Hancock, 2007; Neff, 2003b; Neff, Kirkpatrick, & Rude, 2007; Scolglio, 2015) 

Why do healthcare patients need to practice self-compassion? 

Patient Problems: 

• People often ignore doctors’ recommendations, fume about the inconvenience of being incapacitated, and blame themselves for the illness or injury (Putnam, Finney, Barkley, & Bonner, 1994). 

• People’s attention is derailed by judgmental, defensive, or otherwise non-self-compassionate thoughts (Greeson & Brantley, 2009; Shapiro & Schwartz, 1999). 

What are the advantages for healthcare workers? 

Healthcare worker issues in the research literature:  

• Identification of the erosion of compassion as a significant factor of a decrease in patient care in recent healthcare inquiries (American Medical Association, 2001; Institute of Medicine, 2004; Francis, 2013; MacLean, 2014; Willis, 2015). 

• Healthcare worker burnout 

Healthcare worker recommendations in research literature… 

• Education: self-compassion, emotional intelligence, and mindfulness training should be incorporated into medical students’ curricula and programs that promote healthcare providers’ well-being (Patsiopoulos & Buchanan, 2011; Senyuva et al., 2014; Olson et al., 2015; Kemper et al., 2015; Beaumont et al., 2016). 

• Self-compassion practices for the healthcare workers and care givers: findings suggest that an 8-week yoga and compassion meditation program can improve the quality of life, vitality, attention, and self-compassion of caregivers (Marcelo, 2017). 

Solution. 

Self-compassion + Emotion-regulation (which increases with increased self-compassion) = Self-Regulation  

Self-regulation= Resilience 

(Scolglio, 2015) 

Defining terms: 

1. Self-Compassion: self-kindness, common humanity and mindfulness  

Self-compassion… 

• Links one to greater knowledge and clarity about one’s own limitations because individuals do not have to hide their shortcomings from themselves in order to maintain a positive self-image. Unlike self-esteem, self-compassion is not contingent on performance evaluations, clarity and accuracy of self-appraisals (Baumeister, Heatherton, & Tice, 1993). 

• Maybe especially useful as a means of countering negative self-attitudes in self-concept domains where self-improvement is difficult or impossible (Scolglio, 2015). 

• Self-compassion may facilitate healthy behavior by helping people to monitor their health goals with less distraction and defensiveness, consider their situation with equanimity, disengage from goals that are not in their best interests, seek medical help when needed, adhere to treatment recommendations, and regulate negative affect (Baumeister, Bratslavsky, Muraven, & Tice, 1998).  

1. Emotion regulation 

• People who are high in self-compassion do not suppress their emotional reactions. They experience negative events in a more mindful, less reactive manner. Because they experience less negative affect, they do not deplete self-regulatory resources trying to manage their emotions. As a result, their resources are available for other self-regulatory tasks, including adhering to medical regimens, instituting positive behavioral changes, or monitoring their progress toward health goals (Baumeister, Bratslavsky, Muraven, & Tice, 1998; Schmeichel, 2007, Neff et al., 2007). 

• Self-compassion should also aid in emotional regulation when dealing with disease, illness, and injury (Baumeister, 1996). 

• Self-compassion is a useful emotional regulation strategy, in which painful or distressing feelings are not avoided but are instead held in awareness with kindness, understanding, and a sense of shared humanity. Thus, negative emotions are transformed into a more positive feeling state, allowing for clearer apprehension of one’s immediate situation. This allows one to adopt actions that change oneself and/or the environment in appropriate and effective ways (Folkman & Moskowitz, 2000; Isen, 2000). 

1. Self-Regulation (self-compassion + emotion-regulation) produces… 

• More effective selection of health goals, goal progress monitoring, engagement in behaviors to reach their goals, including seeking medical treatment and adhering to treatment recommendations (Baumeister, 1996). 

• Elimination of impediments that can arise when people’s attention is derailed by judgmental, defensive, or otherwise non-self-compassionate thoughts. (Greeson & Brantley, 2009; Shapiro & Schwartz, 1999). 

Note:  Increasing Self-esteem DOES NOT increase Self-regulation: 

1. Attempts to raise self-esteem are often ineffective in general (Swann, 1990).  

1. Boosting individuals’ self-esteem may inadvertently foster self-centeredness and a sense of superiority (Damon, 1995). Raising self-esteem is often attempted by giving individuals indiscriminate praise or encouraging positive self-affirmations (Hewitt, 1998). 

1. Unrealistic praise is also dangerous in that it does not acknowledge that individuals may have patterns of behavior that need to be changed because they are unproductive, unhealthy or harmful (Damon, 1995). High self-esteem appears to be linked to narcissistic tendencies, egoistic illusions, adopting inappropriate goals that are beyond performance capabilities and self-regulation failure (Baumeister, Heatherton, & Tice, 1993). 

1. Even though self-esteem does not improve self-regulation, self-compassion can improve self-esteem (Baumeister, Heatherton, & Tice, 1993). 

• Successful self-regulation requires people to attend to and evaluate their behavior and health on an ongoing basis. Mindfulness (one of the three components of self-compassion) identified by Neff (2003b), may play a role in the attentional component of self-regulation (Shapiro & Schwartz, 1999). People who are mindful pay attention to their experiences in a non-judgmental, and accepting manner (Terry, 2011). Mindfulness qualities promote self-regulation. (Greeson & Brantley, 2009; Shapiro & Schwartz, 1999). 

1. Resilience 

• The capacity to recover quickly from difficulties; toughness.  

• Resilience requires self-regulation. 

How do people become self-compassionate? 

Practice 

For Self-compassion practices go to http://selfcompassion.org/, click on Practices. The url is phycology professor, Dr. Kristen Neff’s site. She wrote two of the reference articles and the self-compassion definition in this paper. 

References 

Allen, A. B., Goldwasser, E., & Leary, M. R. (2010). Self-compassion and well-being in the elderly. Manuscript under review. Durham, NC: Duke University.  

Allen, A. B., & Leary, M. R. (2010). Self-compassion, stress, and coping. Social and Personality Psychology Compass, 4(2), 107–118. 

American Medical Association. Code of Medical Ethics: Principle 1 2001. Retrieved 26 October 2016 from http://www.ama-assn.org/ama/pub/physician-resources/medical-ethics/code-medical-ethics/principles-medical-ethics.page 

Baumeister, R. F., Heatherton, T. F., & Tice, D. M. (1993). When ego threats lead to selfregulation failure: Negative consequences of high self-esteem. Journal of Personality and Social Psychology, 64, 141–156. 

Baumeister, R. F., & Heatherton, T. F. (1996). Self-regulation failure: An overview. Psychological Inquiry, 7, 1–15. 

Baumeister, R. F., Bratslavsky, E., Muraven, M., & Tice, D. M. (1998). Ego depletion: Is the active self a limited resource? Journal of Personality and Social Psychology, 74, 1252– 1265. 

Beaumont, E., Irons, C., Rayner, G., & Dagnall, N. (2016b). Does compassion focused therapy training for health care educators and providers increase self-compassion and reduce self-persecution and self-criticism?Journal of Continuing Education in the Health Professions, 36(1), 4–10. 

Dowd, J., Jung, M. (2017).  Self-compassion directly and indirectly predicts dietary adherence and quality of life among adults with celiac disease. Appetite, 113;1, 293-300. 

Kemper, K.J., Mo, X., & Khayat, R. (2015). Are mindfulness and self-compassion associated with sleep and resilience in health professionals? Journal of Alternative and Complementary Medicine, 21(8), 496–503.  

Folkman, S., & Moskowitz, J. T. (2000). Stress, positive emotion, and coping. Current Directions in Psychological Science, 9(4), 115–118. 

Francis, R. (2013). Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. London: The Stationery Office. 

Greeson, J., & Brantley, J. (2009). Mindfulness and anxiety disorders: Developing a wise relationship with the inner experience of fear. In F. Didonna (Ed.), Clinical handbook of mindfulness (pp. 171–188). New York, NY: Springer. 

Hewitt, J. P. (1998). The myth of self-esteem: Finding happiness and solving problems in America. New York: St. Martin’s. 

Institute of Medicine (2004). Improving medical education: Enhancing the behavioral and social science content of medical school curricula. Washington, DC: National Academies Press. 

Leary, M. R., Tate, E. B., Adams, C. E., Allen, A. B., & Hancock, J. (2007). Self-compassion and reactions to unpleasant events: The implications of treating oneself kindly. Journal of Personality and Social Psychology, 92, 887–904. 

MacLean, R. (2014). The Vale of Leven Hospital Inquiry. Retrieved 5 August 2016 from www.valeoflevenhospitalinquiry.org. 

Marcel, D., Kozasa, E., Afonso, R., Galduroz, J., Leite, J. (2015). Yoga and compassion meditation program improve quality of life and self-compassion in family caregivers of Alzheimer's disease patients: A randomized controlled trial. Geriatrics Gerontology, Int; 17: 85–91. 

Neff, K. D. (2003b). The development and validation of a scale to measure self-compassion. Self and Identity, 2, 223–250. 

Neff, K. D., Kirkpatrick, K., & Rude, S. S. (2007). Self-compassion and its link to adaptive psychological functioning. Journal of Research in Personality, 41, 139–154. 

Olson, K., Kemper, K.J., & Mahan, J.D. (2015). What factors promote resilience and protect against burnout in first-year pediatric and medicine-pediatric residents? Journal of Evidence-Based Complementary & Alternative Medicine, 20(3), 192–198. 

Patsiopoulos, A.T., & Buchanan, M.J. (2011). The practice of self-compassion in counseling: A narrative inquiry. Professional Psychology: Research and Practice, 42, 301–307.  

Putnam, D. E., Finney, J. W., Barkley, P. L., & Bonner, M. J. (1994). Enhancing commitment improves adherence to a medical regimen. Journal of Consulting and Clinical Psychology, 62, 191–194. 

Schmeichel, B. J. (2007). Attention control, memory updating, and emotion regulation temporarily reduce the capacity for executive control. Journal of Experimental Psychology: General, 136, 241–255. 

Scoglio, A., Rudat, D., Garvert, D., Jamolowski, M., Jackson, C., Herman, J. (2015). Self-compassiona and responses to trauma: the role of emotion regulation. Journal of Interpersonal Violence, 1-21. 

Senyuva, E., Kaya, H., Isik, B., & Bodur, G. (2014). Relationship between self-compassion and emotional intelligence in nursing students. International Journal of Nursing Practice, 20, 588–596.  

Sinclair, S., Kondejewski, J., Raffin-Bouchal, S., King-Shier, K., Singh, P. (2017).  Can Self-Compassion Promote Healthcare Provider Well-Being and Compassionate Care to Others? Results of a Systematic Review. Health and well-being, 9 (2), 168-206. 

Shapiro, S. L., & Schwartz, G. E. R. (1999). Intentional systematic mindfulness: An integrative model for self-regulation and health. Advances in Mind-Body Medicine, 15, 128–134. 

Swann, W. B. (1990). To be adored or to be known?: The interplay of self-enhancement and self-verification. In E. T. Higgins & R. M. Sorrento (Eds.), Handbook of motivation and cognition: Foundations of social behavior, Vol. 2 (pp. 408–448). New York: Guilford. 

Terry, L., Leary, M. (2011).  Self-compassion, self-regulation, and health. Self and identity, 10 (3), 352-262. 

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