What is Self-Compassion and why is it so important?

Self-compassion has been studied in various contexts in a wide range of populations and is linked with positive mental health consistently.

Increased self-compassion is linked to less stress, depression, and anxiety (1) Kristen Neff describes it as “a practice in which we learn to be a good friend to ourselves when we need it most – to become an inner ally rather than an inner enemy (2).”

It is “being open to and moved by one’s own suffering, experiencing feelings of caring and kindness toward oneself, taking an understanding, nonjudgmental attitude toward one’s inadequacies and failures, and recognizing that one’s experience is part of the common human experience”(3). People who are high in self-compassion treat themselves with kindness and concern when they experience negative events (4).

I have observed, including with myself, that when you live with a chronic illness like Ehlers-Danlos Syndrome, chronic fatigue (and PEM), or POTs, we tend to be the hardest on ourselves. We tend to be harsh with our self-talk and often carry guilt and blame for living with this condition. There was a recent discussion in The Zebra Club app about experiencing flare-ups in pain and fatigue. Many of the participants felt guilty or blamed themselves for the flare-up.

I have also been guilty of comparing myself to others, beating myself up for not being able to do what my peers are able to do. Finding self-compassion has been a real game-changer for me and how I relate to myself and my EDS. It can be a hard concept to accept when you have been prone to a harsh approach with yourself, but with practice it becomes easier and a welcome ally.

The opposite of self-compassion is self-criticism.

The opposite of self-compassion is perhaps self-criticism. According to Paul Gilbert, self-criticism causes us to tap into the body’s “threat defense system” and can contribute to a defense response in the body characterized by cortisol and adrenaline release. As Kristen Neff says, “with self-criticism, we are both the attacker and the attacked (2).”

Self-compassion tends to be slightly (though statistically significantly) lower in women than men. This is attributed to the finding that women are more self-critical than men and tend to focus on the negative aspects of themselves more (5).

The ratio of women to men with a hypermobility syndrome is also higher, so we may be seeing these lower rates of self-compassion in the hypermobility community more too. I would suggest living with a chronic condition is hard enough already. People living with a chronic illness could really benefit from self-compassion to help manage the stress and anxiety often associated with living with these conditions.

The Neuroscience of Self-Compassion

According to Psychotherapist and repeat The Zebra Club visitor Kim Clayden, Self-compassion involves treating oneself with kindness and understanding in times of difficulty. The relationship between our thoughts and our bodies is complex and interconnected. The way we think directly impacts the way we feel physically as well as emotionally. Here are some examples she provided of what happens in the brain when we practice self-compassion:

• Insula Activation: The insula, a brain region involved in emotional awareness, is affected by self-compassion. Studies suggest that self-compassion may enhance emotional regulation by influencing the functioning of the insula (5).
• Prefrontal Cortex Activation: Mindful self-compassion practices have been shown to increase activity in the prefrontal cortex, a region associated with emotional regulation, decision-making, and perspective-taking (6).
• Amygdala Regulation: Self-compassion has been associated with decreased activation of the amygdala, a region linked to the processing of stress and negative emotions. This suggests that practicing self-compassion may help regulate emotional responses (7).
• Default Mode Network (DMN): Self-compassion practices have been associated with alterations in the DMN, a network involved in self-referential thinking. This may contribute to a more positive and less self-critical internal dialogue (7).

Self-compassion can have a measurable impact on the nervous system

Another study found that brief self-compassion training impacted physical markers of sympathetic nervous system response (8). University undergraduate women were grouped into a placebo group, a no-intervention group, and then a group that received self-compassion recordings. These were meditations that focused on cultivating kindness and acceptance towards self and a little towards others. The participants then had to participate in a stress test that involved “an interview-style presentation, followed by a surprise mental arithmetic test, in front of an interview panel who do not provide feedback or encouragement (9).”

Researchers found that in response to the stress test, the group that received self-compassion training before the test had lower levels of alpha-amylase in their saliva. This is a marker of sympathetic (Fight or Flight) nervous system activation. Meaning that in the group that simply listened to self-compassion meditations, the sympathetic fight-or-flight response wasn’t as strong.

The self-compassion group also had a more stable heart rate variability following the stress test compared to the two control groups which both had lower heart rate variability. The researchers correlated this ability to maintain a higher HRV as having greater attentiveness and a better ability to regulate their emotions. Notably, while anxiety scores increased in all groups in response to the stress test, it increased less in the self-compassion group.

Resting vagally mediated heart rate variability (vmHRV) is an indicator of the interplay between the parasympathetic (rest and digest) and the sympathetic (fight or flight) nervous system. Higher heart rate variablilty – or the variability in beat to beat (not the heart rate itself) is associated with a predominantly parasympathetic state (10).

In another study, a group of students were assessed using questionnaires to determine their level of mindfulness and self-compassion. Researchers found higher vmHRV was associated with higher scores of self-compassion (they took calculated this in a way to take mindfulness out of the picture and just assess self-compassion). This was a pilot study done in an attempt to tease out mindfulness from self-compassion (10). Self-compassion seems to directly have an impact on the parasympathetic nervous system! While this study focused on “dispositional self-compassion” (which means they ranked higher on a self-compassion assessment), self-compassion can be learned. We will discuss this further.

Self-compassion and chronic pain

A systematic review of the impact of self-compassion interventions analyzed 7 different studies. All of the studies took different approaches to implementing self-compassion interventions and measuring the effect. This made it difficult to draw clear conclusions. What this review was able to conclude was that across all of these studies, learning self-compassion benefits people with chronic pain (11).

As we often mention, meditation can impact pain. We would like to note that self-compassion can be another tool in the pain relief toolbox. Preliminary research has shown that using loving kindness and compassion-based meditation can reduce pain severity, change the impact of pain, and reduce distress from pain (12)

One small study on people with migraines found that after a 20-minute loving kindness meditation, participants self-reported a decrease in pain by an average of 33% and a decrease in emotional tension by an average of 43% (13).

Self-Compassion Exercises with Kim Clayden

How can we improve our mindset?

Improving self-compassion involves cultivating a mindset of kindness and understanding toward oneself, especially in times of difficulty or failure. Here are some practical steps to enhance self-compassion:

• Mindfulness Practices:
  • Engage in mindfulness meditation or other mindfulness practices. Mindfulness helps you become aware of your thoughts and emotions without judgment, fostering a non-reactive and compassionate attitude.
• Self-Kindness Language:
  • Monitor your inner dialogue. Replace self-critical thoughts with kind and supportive language. Treat yourself with the same kindness you would offer to a friend facing a similar situation. It can be useful to ask, ‘What would I say to my best friend if they were in the same situation as me?’
    • I recently recorded a Heart Meditation on The Zebra Club app which is designed to promote self-kindness and compassion to ourselves.
• Common Humanity:
  • Recognise that everyone faces challenges and makes mistakes. Understand that imperfection is a shared human experience. Feeling connected to others in this way can diminish feelings of isolation and self-judgment.
• Write a Self-Compassion Letter:
  • Write a letter to yourself as if you were writing to a friend who is struggling. Acknowledge your challenges, express understanding, and offer words of encouragement and support. Read the letter when you need a self-compassion boost.
• Mindful Self-Compassion Practices:
  • Explore mindful self-compassion exercises developed by researchers like Kristin Neff and Christopher Germer. These may include guided meditations, exercises, and reflections designed to enhance self-compassion.
• Set Realistic Expectations:
  • Set realistic and achievable goals. Be kind to yourself when things don’t go as planned. Understand that setbacks and mistakes are part of the learning and growth process.
• Self-Care:
  • Prioritise self-care activities that bring you joy and relaxation. This can include activities like exercise, reading, spending time in nature, or engaging in hobbies. Taking care of your physical and mental well-being contributes to self-compassion.
• Gratitude:
  • Practice gratitude by reflecting on positive aspects of your life. Focusing on what you are grateful for can shift your perspective and contribute to a more compassionate mindset.
    • We have a gratitude meditation on The Zebra Club app to gently guide you through a gratitude practice.
• Seek Support:
  • Reach out to friends, family, or a mental health professional for support. Sharing your struggles with others can provide a sense of connection and understanding.
• Learn from Mistakes:
  • View mistakes and failures as opportunities for learning and growth rather than as reasons for self-condemnation. Embrace a growth mindset and recognise that everyone makes mistakes on the path to improvement.

Remember that developing self-compassion is an ongoing process, and it takes time and practice. Be patient with yourself and celebrate the progress you make along the way, however big or small.

We would like to thank Kim Clayden HPD, DfSFH, MNCH, AfSFH (reg) CHNC (reg), for her contributions to this post. Kim is a psychotherapist and hypnotherapist who specializes in pain and long-term health conditions. You can find more about Kim here.

Literature Review/Research by Catherine Nation, MSc, PhD

WORKS CITED

1. Neff and Knox (2017) Self-Compassion Encyclopedia of Personality and Individual Differences,DOI 10.1007/978-3-319-28099-8_1159-1
2. Neff and Germer (2018) The Mindful Self-Compassion Workbook. Guilford Press.
3. Neff, K. (2003a). Self-Compassion: An Alternative Conceptualization of a Healthy Attitude toward Oneself. Self and Identity, 2, 85-101.
4. Allen and Leary (2010) Self-compassion, Stress, and Coping. Soc Personal Psychol Compass.
5. Neff, K. (2011) Self-Compassion, Self Esteem, and Well-Being. Soc Personal Psychol Compass.
6. Longe et al (2010) Having a word with yourself: Neural correlates of self-criticism and self-reassurance. NeuroImage.
7. Kim et al (2020) Neurophysiological and behavioural markers of compassion. Scientific Reports.
8. Arch et al (2014) Self-compassion training modulates alpha-amylase, heart rate variability, and subjective responses to social evaluative threat in women. Psychoneuroendocrinology.
9. Allen et al (2016) The Trier Social Stress Test: Principles and practice. Neurobiol Stress.