Ann Quinlan-Colwell, PhD, APN
In this third of a series of writings about compassion and pain management, this article focuses on self-compassion. The premise is that it is essential for health care providers to have compassion for self as the foundation to empathically and compassionately care for patients, while promoting compassionate satisfaction and preventing compassion fatigue.
Self-compassion is connecting care and support for self during times of personal suffering (Neff & Knox, 2017). Since compassion is being aware of the pain of another person without judgment and a desire to alleviate pain, self compassion is focusing that non-judgmental perception to appreciate self pain with a desire to alleviate it (Veneziani, Fuochi, & Voci, 2017). Germer (2009, p. 33-34) explains self-compassion as “simply giving the same kindness to ourselves (during suffering) that we would give to others.”
Neff identified three essential components of self-compassion as being “self-kindness versus self-judgment, common humanity versus isolation, and mindfulness versus overidentification” (2016, p. 1). Similarly, Reyes (2012) noted that being aware of other people, being kind to oneself (i.e. self-kindness) particularly when suffering, being mindful and being wise are attributes of self-compassion. See table 1 for characteristics of self-kindness as described by Reyes.
Characteristics of Self-kindness (from Reves, D. 2012)
- Treating self kindly when suffering
- Replacing self-criticism with caring and understanding
- Accepting own faults
- Releasing regrets and disappointments
- Giving up illusions about what might have been
- Forgiving self
- Accepting responsibility
- Avoiding guild
- Restraining from punishing self
Contrary to being selfish, compassion for self is essential for developing sincere compassion toward patients and others (Dalai Lama, 2003). It is “a useful regulation strategy in which painful feelings are not avoided but are instead held in awareness with kindness, understanding, and a sense of shared humanity” (Costa & Pinto‐Gouveia, 2013, 1580). Unlike narcissism, self-compassion is considered to be a healthy self-care element that is not associated with egotism, enhancement of self-image or excessively positive self-evaluations (Veneziani, Fuochi, & Voci, 2017). In fact, the authors of an interesting study reported that individuals with greater self-compassion had less acceptance of their own moral transgressions (Wang, Chen, Poon, Teng, & Jin, 2017).
Although research of the concept is limited, self-compassion is associated with lower levels of anxiety and depression (Costa & Pinto‐Gouveia, 2013). Self-compassion is associated positively with health-related quality of life which was demonstrated among people living with multiple sclerosis (Nery-Hurwit, Yun, & Ebbeck, 2018). Conversely the absence of self-compassion is associated with unhealthy behaviors. Self-compassion is reported to be inversely correlated with disordered eating (Maraldo, Zhou, Dowling, & Vander Wal, 2016). The researchers of a recent study reported an inverse relationship between self-compassion and developing substance use disorder (Phelps, Paniagua, Willcockson, & Potter, 2018).
Consider the pain management clinical situation in which a clinician is working with a patient to manage pain with a multimodal approach using acetaminophen, gabapentinoids and opioids. The patient overdoses on the gabapentinoids and opioids in addition to some benzodiazepines received from another provider who also prescribed other opioids. The pain management clinician who never developed self-compassion is devasted by the news and berates self for not checking the prescription drug monitoring database (PDMP). The clinician does not forgive self and ruminates about this situation becoming increasingly depressed and anxious. Eventually this very talented and compassionate clinician leaves pain management entirely.
The situation described could have a very different outcome if the clinician cultivated self-compassion. With self-compassion the clinician could review the situation, acknowledge the omission of not checking the PDMP and grieve the patient. Yet with self-compassion the clinician can experience remorse and regret while also knowing that there was no intent to harm the patient. With self-compassion the clinician can understand that time constraints and a lack of appreciation for the importance of the PDMP information led to not checking. With self-compassion the clinician can forgive self and vow to assiduously check the PDMP whenever prescribing opioids, thus becoming a more responsible pain management clinician for thousands of patients. With an understanding and cultivation of self-compassion, this talented clinician is also able to be appropriately compassionate for people living in pain and guide patients toward self-compassion.
Costa, J., & Pinto‐Gouveia, J. (2013). Experiential avoidance and self‐compassion in chronic pain. Journal of Applied Social Psychology, 43(8), 1578-1591.
Dalai Lama. (2003). Transforming the Mind: Teachings on Generating Compassion. London, Thorsons, Hammersmith.
Germer, C. (2009). The mindful path to self-compassion: Freeing yourself from destructive thoughts and emotions. Guilford Press.
Maraldo, T. M., Zhou, W., Dowling, J., & Vander Wal, J. S. (2016). Replication and extension of the dual pathway model of disordered eating: The role of fear of negative evaluation, suggestibility, rumination, and self-compassion. Eating Behaviors, 23, 187-194.
Neff, K. (2016). Self-compassion. Mindfulness in Positive Psychology: The Science of Meditation and Wellbeing, Encyclopedia of Personality and Individual Differences. 37, 1-8.
Neff, K. D., & Knox, M. C. (2017). Self-compassion. V. Zeigler-Hill, TK Shackelford (eds.), Encyclopedia of Personality and Individual Differences, 1–8. DOI 10.1007/978-3-319-28099-8_1159-1.
Nery-Hurwit, M., Yun, J., & Ebbeck, V. (2018). Examining the roles of self-compassion and resilience on health-related quality of life for individuals with Multiple Sclerosis. Disability and Health Journal, 11(2), 256-261.
Phelps, C. L., Paniagua, S. M., Willcockson, I. U., & Potter, J. S. (2018). The relationship between self-compassion and the risk for substance use disorder. Drug and Alcohol Dependence, 183, 78-81.
Reyes, D. (2012). Self-compassion: A concept analysis. Journal of Holistic Nursing, 30(2), 81-89.
Veneziani, C. A., Fuochi, G., & Voci, A. (2017). Self-compassion as a healthy attitude toward the self: Factorial and construct validity in an Italian sample. Personality and Individual Differences, 119, 60-68.
Wang, X., Chen, Z., Poon, K. T., Teng, F., & Jin, S. (2017). Self-compassion decreases acceptance of own immoral behaviors. Personality and Individual Differences, 106, 329-333.