Published on Oct 16, 2014The world's leading researcher of self-compassion and founder of the Mindful Self-Compassion program considers--and rebuts--some of the main objections to treating yourself with kindness.
BG 335: Practicing with the Brain in Mind
Rick Hanson
Rick Hanson, Ph.D., is a neuropsychologist and New York Times best-selling author. His books include Hardwiring Happiness, Buddha's Brain, Just One Thing, and Mother Nurture. Founder of the Wellspring Institute for Neuroscience and Contemplative Wisdom, and on the Advisory Board of the Greater Good Science Center at UC Berkeley, he's been an invited speaker at Oxford, Stanford, and Harvard, and taught in meditation centers worldwide. He has several audio programs and his free Just One Thing newsletter has over 100,000 subscribers.
Website: RickHanson.net
A Randomized Controlled Trial of an Internal Family Systems-based Psychotherapeutic Intervention on Outcomes in Rheumatoid Arthritis: A Proof-of-Concept Study
Nancy A. Shadick, Nancy F. Sowell, Michelle L. Frits, Suzanne M. Hoffman, Shelley A. Hartz, Fran D. Booth, Martha Sweezy, Patricia R. Rogers, Rina L. Dubin, Joan C. Atkinson, Amy L. Friedman, Fernando Augusto, Christine K. Iannaccone, Anne H. Fossel, Gillian Quinn, Jing Cui, Elena Losina, and Richard C. Schwartz
ABSTRACT
Objective
To conduct a proof-of-concept randomized trial of an Internal Family Systems (IFS)
psychotherapeutic intervention on rheumatoid arthritis (RA) disease activity and psychological status.
Methods
Patients with RA were randomized to either an IFS group for 9 months (n = 39) or an education (control) group (n = 40) that received mailed materials on RA symptoms and management. The groups were evaluated every 3 months until intervention end and 1 year later. Self-assessed joint pain (RA Disease Activity Index joint score), Short Form-12 physical function score, visual analog scale for overall pain and mental health status (Beck Depression Inventory, and State Trait Anxiety Inventory) were assessed. The 28-joint Disease Activity Score-C-reactive Protein 4 was determined by rheumatologists blinded to group assignment. Treatment effects were estimated by between-group differences, and mixed model repeated measures compared trends between study arms at 9 months and 1 year after intervention end.
Results
Of 79 participants randomized, 68 completed the study assessments and 82% of the IFS group completed the protocol. Posttreatment improvements favoring the IFS group occurred in overall pain [mean treatment effects –14.9 (29.1 SD); p = 0.04], and physical function [14.6 (25.3); p = 0.04]. Posttreatment improvements were sustained 1 year later in self-assessed joint pain [–0.6 (1.1); p = 0.04], self-compassion [1.8 (2.8); p = 0.01], and depressive symptoms [–3.2 (5.0); p =0.01]. There were no sustained improvements in anxiety, self-efficacy, or disease activity.
Conclusion
An IFS-based intervention is feasible and acceptable to patients with RA and may complement medical management of the disease. Future efficacy trials are warranted.
Despite effective pharmacotherapy, many individuals with rheumatoid arthritis (RA) suffer ongoing pain and disability. Living with RA can lead to depression, anxiety, isolation, an overall impaired quality of life [1,2], and increased healthcare resource use [3]. Psychotherapeutic interventions that improve disease activity, pain-related symptoms, and psychological function would be helpful to patients living with this disease.
A number of psychobehavioral interventions have been shown to be effective in improving coping efficacy and other outcomes in patients with RA [4-11]. Cognitive behavioral interventions, in particular, have reduced pain, joint inflammation, physical disability, and depression [5,6,9,10]. The improvements are variable according to the type of intervention, tend to be most effective in newly diagnosed patients, and have limited sustainability [6,9]. For example, effect sizes (ES) for pain and disability in 2 metaanalyses of psychological interventions for RA were modest [12,13]. Also, joint inflammation and swelling were reduced by several interventions, but these results were mostly seen in patients with illness of shorter duration [13]. In a Cochrane review assessing the effectiveness of educational programs for RA, there were positive effects on disability, joint counts, patient global assessments, psychological status, and depression, but the improvements were short-lived [14]. A sustainable intervention that affects disease activity in individuals with longer-term illness could improve patients’ lives.
The Internal Family Systems (IFS) model is a rapidly emerging individual psychotherapeutic modality developed by Schwartz [15] that teaches patients to attend to and interact with their internal experience mindfully. The model actively recruits self-compassion toward an individual’s parts, conceptualized as subpersonalities that are manifested by strong feelings, judgments, or physical sensations. By fostering an internal dialogue with polarized thinking, IFS reduces emotional intensity and dysregulation; elements that have been shown to increase pain perception [16] and disease activity in RA [4,17]. IFS also uses nonjudgmental noticing and active mindfulness. Mindfulness-based interventions have been helpful in a number of painful conditions including RA [4,7,18]. To date, more than 2200 therapists worldwide have been trained in the IFS modality [19]. This technique is increasingly being used as adjunctive therapy for certain medical conditions, with anecdotal benefit reported in migraines, back pain, and multiple sclerosis. To our knowledge, our study is the first to evaluate the IFS model’s feasibility, acceptability, and potential efficacy in a randomized trial.
Tapping into Self-Compassion to Help Ease Everyday Suffering
There is never a good reason not to treat yourself with kindness and compassion.
Published on April 21, 2013 by Toni Bernhard, J.D. in Turning Straw Into Gold
Young Woman Braiding Her Hair
When I posted my last article, “8 Things I Miss as a Result of Chronic Pain and Illness,” I wasn’t planning to write a follow-up. But it became clear within hours of posting it that the piece had struck a chord with many readers. People began sharing the many losses they were feeling as the result of their health limitations. Others said they cried as they read my list because it tapped into their own feelings of deep loss.
By the end of the day, I began to feel that the piece had left some people feeling worse than they had before reading it, even though my intent was to acknowledge how things are for me in a way that I thought might help all of us accept our life as it is.
My initial idea for a follow-up was to share other people’s comments about what they miss most due to their health limitations. But my heart dictated otherwise. It said: “It’s enough for us to bear our own losses; what we need is help learning to treat ourselves with compassion over those losses.”
And so, I’ve carefully gathered fifteen quotations that I thought would help with this task. Some are from spiritual teachers; some are from philosophers and other writers; others are from people who have various self-compassion projects in the works (you can Google the names of any people you’d like to know more about). I’ve chosen several portraits by Pierre-Auguste Renoir to accompany the piece.
I hope some of these quotations will enter your heart and perhaps (as they have for me) even find themselves jotted down on scraps of paper to keep by your side.
Madame Renoir
“You are taught that there is something wrong with you and that you are imperfect. But there isn’t and you’re not.” —Cheri Huber
"Having compassion starts and ends with having compassion for all those unwanted parts of ourselves. The healing comes from letting there be room for all of this to happen: room for grief, for relief, for misery, for joy." —Pema Chödrön
“To be yourself in a world that is constantly trying to make you something else is the greatest accomplishment.” —Ralph Waldo Emerson
"Often we treat certain aspects of ourselves as junk, having no value. We try to throw parts of ourselves in the garbage. But a human being is an ecosystem, and everything in that system is of value to the whole." —Stephen Schwartz
"If your compassion does not include yourself, it is incomplete." —Jack Kornfield
"Self-compassion is approaching ourselves, our inner experience with spaciousness, with the quality of allowing, which has a quality of gentleness. Instead of our usual tendency to want to get over something, to fix it, to make it go away, the path of compassion is totally different. Compassion allows." —Robert Gonzales
“Self-acceptance is my refusal to be in an adversarial relationship to myself.” —Nathaniel Brand
Paul Meunier
“One's dignity may be assaulted, vandalized and cruelly mocked, but it can never be taken away unless it is surrendered.” —Michael J. Fox
“Be faithful to that which exists within yourself.” —André Gide
“When the heart acknowledges how much pain there is in the mind, it turns like a mother toward a frightened child.” —Stephen Levine
“You don’t want to beat yourself up for beating yourself up in the vain hope that it will somehow make you stop beating yourself up. Just as hate can’t conquer hate—but only strengthens and reinforces it—self-judgment can’t stop self-judgment. The best way to counteract self-criticism, therefore, is to understand it, have compassion for it, and then replace it with a kinder response.” —Kristin Neff
“The privilege of a lifetime is being who you are.” —Joseph Campbell
Jeanne Samary
“Simplicity, patience, and compassion are your greatest treasures. Simple in actions and thoughts, you return to the source of being. Patient with both friends and enemies, you accord with the way things are. Compassionate toward yourself, you reconcile all beings in the world.” —Lao Tzu
“It’s not your job to like me. It’s mine.” —Byron Katie
Because this piece is made up largely of quotations, I’ll take the liberty of ending it by quoting myself from my upcoming book:
“We can’t always control the world outside of us, but we can learn to control our inner world, by which I mean how we treat ourselves and how we regard ourselves. In my view, there’s never a good reason not to treat ourselves with the same kindness and compassion that we treat those who are most beloved to us, and there’s never a good reason to regard ourselves as unworthy.”© 2013 Toni Bernhard www.tonibernhard.com
I'm the author of the Nautilus Gold Medal winner How to Be Sick: A Buddhist-Inspired Guide for the Chronically Ill and their Caregivers.
My most recent book is titled How to Wake Up: A Buddhist-Inspired Guide to Navigating Joy and Sorrow (September 10, 2013 release date).
Please join me on Facebook, Twitter, Pinterest. You can also subscribe to my blog—see the choices above my picture on this page.
The Compassionate Brain, Session 6: The Power of Self-Compassion
A FREE eight-part video series, hosted by Dr. Rick Hanson, that explores effective ways to change your brain and heart and life.
(Watch or listen to the entire series by registering at http://live.soundstrue.com/compassionatebrain/.)
Session Highlights:
- An in-depth conversation with Dr. Kristin Neff, professor of human development and culture at the University of Texas, Austin and author of Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind
- How to cultivate self-compassion
- Compassion for those with special needs
The Power of Self-Compassion [ 1:04:02 ] Hide Player | Play in Popup | Download
Recorded session with Dr. Rick Hanson and Dr. Kristin Neff
Play the live session from Monday, November 12, 2012Rick Hanson, Ph.D., is a neuropsychologist and author of Buddha’s Brain: The Practical Neuroscience of Happiness, Love, and Wisdom (in 23 languages) and Just One Thing: Developing a Buddha Brain One Simple Practice at a Time (in 12 languages). Founder of the Wellspring Institute for Neuroscience and Contemplative Wisdom and Affiliate of the Greater Good Science Center at UC Berkeley, he’s been an invited speaker at Oxford, Stanford, and Harvard, and taught in meditation centers worldwide. His work has been featured on the BBC, NPR, Fox Business, Consumer Reports Health, U.S. News and World Report, and O Magazine and he has several audio programs with Sounds True. His weekly e-newsletter - Just One Thing – has over 72,000 subscribers, and suggests a simple practice each week that will bring you more joy, more fulfilling relationships, and more peace of mind and heart. If you wish, you can subscribe to Just One Thing here.
Kristin Neff: The Liberating Power of Self-Compassion
Tuesday, April 2, 2013
Tami Simon speaks with Dr. Kristin Neff, a professor of human development and culture at the University of Texas and a practitioner of Buddhist meditation. The recent book and documentary The Horse Boy (DVD) illustrate her and her family’s adventure with autism (the book is written by her husband, Rupert Isaacson).
With Sounds True, Kristin has created the audio program Self-Compassion Step-by-Step, which includes clinical evidence of the importance of self-compassion along with techniques and exercises for cultivating this pivotal quality. In this interview, Tami and Kristin talk about three pillars of self-compassion, “self-compassion breaks,” and the importance of recognizing our common humanity during difficulties that feel unique and isolating. (69 minutes)
Download
Read Transcript
* * * * *
Self-Compassion Step by Step: The Proven Power of Being Kind to Yourself
By Kristin Neff
A Six-Session Training Course for Transforming Your Relationship with Yourself
Why does it feel so natural to be compassionate and kind to those we care about-yet so hard to treat ourselves the same way? "Our culture teaches us to use self-criticism for motivation and to build self-esteem by constantly measuring ourselves against everyone else," says Dr. Kristin Neff. "We need to re-learn the essential skill of being genuinely nurturing and supportive toward ourselves." With Self-Compassion Step by Step, this groundbreaking researcher reveals the clinically proven power of self-kindness, with practical training for cultivating an enduring and unshakable sense of your fundamental human worthiness.
Self-Compassion: The Mainstay of Happiness and Well-Being
Over the past decade, an overwhelming body of research has shown self-compassion to be a master key to good psychological and physical health. Whether you wish to reduce stress, develop healthy habits for exercise or diet, unlock your creativity, or even deal with serious conditions such as depression or addiction, a strong sense of self-compassion is an essential ingredient for success. Best of all, self-compassion is a skill that can be learned. Through six sessions of teaching, Dr. Neff offers guided meditations, experiential practices, and on-the-spot techniques to help you build a strong foundation of self-compassion in your daily life.
"We often become our own worst critic because we believe it's necessary to keep ourselves motivated," says Dr. Neff, "but in fact the research shows that healthy self-compassion increases our inner drive, our resilience to setbacks, and our ability to excel at work and in every aspect of life." With Self-Compassion Step by Step, she presents a powerful training course that is both accessible and profoundly transformative-a practical approach for creating a life of greater happiness, fulfillment, and love.
HIGHLIGHTS
- Self-kindness - How actively comforting ourselves activates our physiological systems designed for soothing and safety
- Common humanity - Recognizing the imperfect nature of the shared human experience
- Mindfulness - Meeting our moments of suffering with balanced awareness rather than ignoring or exaggerating our pain
- Why we resist self-compassion - Debunking the common myths; The clinically-proven benefits of self-compassion in numerous aspects of life
- The essential difference between competitive self-esteem and true self-compassion
- The natural progression of self-compassion practice
- Guided techniques that use visualization, touch, language, and awareness to evoke states of self-compassion, and much more
Self-Compassion Project - Interview with Dr. Barbara Markway
Psychologist Barbara Markway did a 1 year self-compassion project
Published on January 25, 2013 by Alice Boyes, Ph.D. in In Practice
Dr Barbara Markway
Meet Dr Barbara Markway! She's a psychologist who did a 1 year self-compassion project.
Please tell us about your self-compassion project.
I loved Gretchen Rubin’s The Happiness Project, and I thought the idea of focusing on one thing for an entire year made a lot of sense. I chose self-compassion because I was anything but self-compassionate! I was way too hard on myself. I was perfectionistic. I equated my worth with what I accomplished. And I was battling chronic pain after neck and back surgeries that didn’t work. Trying to motivate myself with the force of a whip just wasn’t working any more.
What did you learn?
The thing that surprised me the most is how quickly I was able to become more compassionate toward myself. I looked back over my notes, and in just a month’s time, my scores on a self-compassion test had improved considerably.
Tuning in to my inner self-talk and focusing on changing what I was saying to myself really helped. I heard Dr. Kristen Neff, a leading researcher on self-compassion, speak at a workshop and she said her research showed that informal self-compassion practices were turning out to be just as helpful as the formal practices, such as meditation. I think that can give people hope—even if your self-criticism is deeply ingrained over time, you can still change, and it doesn’t have to take years.
What effects has increasing self-compassion had on your behavior, relationships etc?
I have always tended to be a big worrier, and I’ve found that I’m worrying a lot less. I’m not sure how that ties in with self-compassion, but it’s definitely something I’ve noticed. I also feel like I’m more in touch with how I’m not alone—that even when I’m going through a rough patch and it feels like I’m the only one who has ever experienced this—well, that thought goes away more quickly and transforms into a tenderness for myself and for others who may be going through a similar situation.
What's your favorite way to explain what giving yourself self-compassion is/isn't? My therapy clients often struggle to distinguish self-compassion from trying to boost their self-esteem, denying any flaws/weaknesses/mistakes or justifying/permitting poor choices.
My favorite way to explain giving yourself compassion is the analogy of how you would treat a small child. Let’s say your child is learning to walk. After a few wobbly steps, do you criticize him or her and say, “Look at you. You’re so clumsy. What’s wrong with you that you can’t walk yet.”? Of course not. You offer encouragement. You’re excited! You might even clap your hands in delight.
Now let’s say your child wants to eat candy for dinner. You set limits and say, “no” because only eating candy will likely make your child feel sick and it simply isn’t healthy. People mistakenly think that self-compassion always means saying “yes” to yourself. Sometimes it means saying “no”--but doing so with kindness. It’s important to remember that self-compassion involves nurturing and limit-setting.
What are three self-compassion techniques you plan to keep using?
1. One technique I use daily is a gentle touch on my skin (maybe touch my forearm with my other hand) while I say something reassuring to myself. The touch actually releases oxytocin and sets off a calming response in the body. I discretely do this at work when I’m stressed (at home I may give myself a big hug!)2. I often combine the self-compassionate touch with a phrase or self-compassion mantra, such as: “This is a moment of suffering; suffering is a part of life; may I be kind to myself and give myself what I need.” I have tried meditating and do it sometimes. I’m not very consistent, but I’m going to keep trying.3. I do a lot of informal mindfulness practice. I never used to take breaks—it was always work, work, work. Now I go outside and simply appreciate the beauty around me. This helps me connect with a greater good, and I end up feeling softer and gentler with myself. I have really gotten into bird watching!Oh, and one other technique I use is to write myself little “love notes” to keep in my purse. It’s usually just a few quick sentences I want to remember during the day to stay focused on self-compassion.
For someone who wants to try self-compassion, is there something easy you can suggest starting with?
I’m a big self-help book junkie, so if you can, I’d read Kristin Neff’s book on self-compassion. She also has a lot of information on her website (www.self-compassion.org) you can read and listen to for free. I’d also suggest starting by keeping a log of the things you say to yourself. Then ask yourself, “Is this how you would talk to a friend?” Remember that even subtle changes can make a big difference.
About the interviewee
Barbara Markway, Ph.D. is a psychologist and fellow blogger at Psychology Today. Her personal blog is The Self-Compassion Project. You can also find her on Facebook and Twitter.
http://www.facebook.com/theselfcompassionproject
http://twitter.com/barbmarkway
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Rick Hanson: Neurodharma of Love
Rick Hanson, PhD began meditating in 1974 and has practiced in several traditions. A neuropsychologist, writer, and teacher, he co-founded the Wellspring Institute for Neuroscience and Contemplative Wisdom (see www.WiseBrain.org) and edits the Wise Brain Bulletin. First author of Mother Nurture (Penguin, 2002), his latest book is Buddha's Brain: The Practical Neuroscience of Happiness, Love and Wisdom (with Rick Mendius, MD; Preface by Jack Kornfield, PhD and Foreword by Dan Siegel, MD). He started sitting at Spirit Rock in 1993 and recently completed a nine-year term on its Board. A graduate of the Community Dharma Leader training program, he leads a weekly meditation group in San Rafael.
2012-10-27 -- NeuroDharma of Love: Unilateral Virtue, 1:16:27
2012-10-27 -- NeuroDharma of Love: Compassion and Lovingkindness Practice, 18:07
2012-10-27 -- NeuroDharma of Love: Inner Strength, including Self Compassion Practice, 16:38
2012-10-27 -- NeuroDharma of Love: Love and the Brain , 22:45
That should be more than enough background. I had hoped to see this talk in person, but had to miss it due to work obligations, so I grateful to the AMRIG staff for recording and posting this talk.Cognitive-Based Compassion Training (CBCT)
There are doubtless many methods one could employ to enhance compassion beyond the biological level to an impartial altruism, and in fact many religious traditions contain methods for such cultivation. In our studies, we use a protocol for the cultivation of compassion developed by Geshe Lobsang Tenzin Negi, drawn from the lojong tradition of Tibetan Buddhism but rendered into secular form for use by individuals of any, or no, religious inclination. The term lojong means "mind training" or "thought transformation" and refers to a systematic practice of gradually training the mind in compassion until altruism becomes spontaneous.Lojong is based on the view that self-centered thinking and behavior cause suffering for oneself and others, while other-centered, altruistic thoughts, emotions, and behaviors ultimately benefit both oneself and others. Compassion is the heartfelt wish that others be free from suffering and the readiness to act on their behalf. It arises from a deep sense of endearment for others, coupled with empathy for and sensitivity to their pain. This empathy arises both from a sense of closeness or connectedness to others as well as a recognition of the causes of their and one’s own suffering.The CBCT program therefore aims to help practitioners progressively cultivate other-centered thoughts and behaviors while overcoming maladaptive, self-focused thoughts and behaviors by moving systematically through eight sequential steps. These are: (1) developing attention and stability of mind through focused attention training; (2) cultivating insight into the nature of mental experience; (3) cultivating self-compassion; (4) developing equanimity; (5) developing appreciation and gratitude; (6) developing affection and empathy; (7) realizing aspirational compassion; and (8) realizing active compassion. The adult CBCT program is an 8-week intervention that meets for two hours a week. Each session contains pedagogical material presented by the instructors, a guided meditation of around twenty to thirty minutes, and group discussion, with subjects being asked to meditate daily for the duration of the program using guided meditation recordings. Our team has expertise in adapting CBCT to meet the needs of diverse populations, including elementary schoolchildren, adolescents in foster care and survivors of trauma. Visit our Research page for more information about our ongoing projects.
The Science of Compassion (July 19-22, 2012, Telluride, CO) conference convenes a unique group of leading world experts in the fields of altruism, compassion, and service to present their latest research. The Science of Compassion is the first large-scale international conference of its kind dedicated to scientific inquiry into compassion.
Compassion As Scientific Inquiry
An adaptive pro-social emotion and a virtuous trait broadly condoned across humanistic and spiritual traditions, compassion has only recently gained the attention of science. The Science of Compassion: Origins, Measures and Interventions conference will provide an unprecedented opportunity for expert and aspiring researchers as well as community members to delve deeper into the science behind compassion, altruism, social connection and service.
Many of us are all too used to bashing ourselves. And it’s not surprising. In our society, we’re taught that being hard on ourselves and ashamed of everything from our actions to our looks gets results.
Self-criticism is the preferred path to success. We rarely think about showing ourselves kindness. Or even if we do, we worry that doing so is selfish, complacent or arrogant.
But research has found that self-criticism only sabotages us and produces a variety of negative consequences. For instance, according to Kristin Neff, Ph.D., associate professor in human development at the University of Texas at Austin, studies have shown that self-criticism can lead to lowered self-esteem, anxiety and depression.
Neff is the author of Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind. Self-compassion is what you’d show a loved one struggling with a similar situation. Self-compassion has been linked to greater well-being, including diminished anxiety and depression, better emotional coping skills and compassion for others.1
Specifically, according to Neff, self-compassion consists of three components:
- Self-kindness: Being kind, gentle and understanding with yourself when you’re suffering.
- Common humanity: Realizing that you’re not alone in your struggles. When we’re struggling, we tend to feel especially isolated. We think we’re the only ones to experience loss, make mistakes, feel rejected or fail. But it’s these very struggles that are part of our shared experience as humans.
- Mindfulness: Observing life as it is, without being judgmental or suppressing your thoughts and feelings.
Myths about Self-Compassion
Because beating ourselves up is so entrenched in our society, you still might be suspicious of self-compassion. Below, Neff dispels common myths that may stand in the way of people being kinder to themselves.
Myth: Self-compassion is self-pitying or egocentric.
Fact: Self-pity is being immersed in your own problems and forgetting that others struggle, too, Neff said. However, being self-compassionate is seeing things exactly as they are — no more and no less, she said. It means acknowledging that you’re suffering, while acknowledging that others have similar problems or are suffering even more. It’s putting your problems into perspective.
Myth: Self-compassion is self-indulgent.
Fact: Being self-compassionate doesn’t mean solely seeking pleasure, Neff said. It’s not shirking responsibilities or being slothful. Rather, self-compassion focuses on alleviating suffering. From this perspective, you consider whether something will hurt you in the long run, she said.
Myth: Self-criticism is an effective motivator.
Fact: There’s actually nothing motivating about criticizing yourself, Neff said, because it makes you fear failure and lose faith in yourself. Even if you do achieve great things, you’re often miserable, anyway.
It’s interesting that in other areas of our lives we understand that being harsh doesn’t work. Take the example of parenting. Decades ago, we thought that harsh punishment and criticism were effective in keeping kids in line and helping them do well, Neff said.
However, today, we know that being a supportive and encouraging parent is more beneficial. (When you’re told you’re a failure, the last thing you think you’re capable of is succeeding, or even trying.)
Self-compassion acts like a nurturing parent, she said. So even when you don’t do well, you’re still supportive and accepting of yourself. Like a kind parent, your support and love are unconditional, and you realize that it’s perfectly OK to be imperfect.
This doesn’t mean being complacent. Self-criticism tears us down; it presumes that “I am bad.” Self-compassion, however, focuses on changing the behavior that’s making you unhealthy or unhappy, Neff said.
Strategies for Self-Compassion
Being self-compassionate might seem unnatural at first. These strategies can help. This may be harder for some individuals, Neff said, particularly if you’ve experienced trauma, so it’s important to work with a therapist.
1. Consider how you’d treat someone else. The simplest thing you can do, according to Neff, is to imagine what you’d do if someone you cared about came to you after failing or getting rejected. What would you say to that person? How would you treat them?
2. Watch your language. You may be so used to criticizing yourself that you don’t even realize that you’re doing it. So it helps to pay particular attention to the words you use to speak to yourself. If you wouldn’t say the same statements to someone you care about, then you’re being self-critical, Neff said.
3. Comfort yourself with a physical gesture. Kind physical gestures have an immediate effect on our bodies, activating the soothing parasympathetic system, Neff said. Specifically, physical gestures “get you out of your head and drop you into your body,” she said, which is important since “the head loves to run away with storylines.” For instance, she suggested putting your hands over your heart or simply holding your arm. Any gesture will do.
4. Memorize a set of compassionate phrases. Whenever you find yourself saying, “I’m horrible,” it helps to have a few phrases at the ready. Pick statements that really resonate with you. Combining that with a physical gesture — like hands over your heart — is especially powerful, Neff said. She uses the following phrases:
This is a moment of suffering.5. Practice guided meditation. Meditation helps to retrain the brain, Neff said. This way, self-compassionate gestures and self-soothing become more natural. Neff includes several self-compassion meditations on her website.
Suffering is part of life.
May I be kind to myself in this moment?
May I give myself the compassion I need?
For more on this research, check out Neff’s comprehensive list of articles and chapters on self-compassion.
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Mindfulness has enjoyed a tremendous surge in popularity in the past decade, both in the popular press and in the psychotherapy literature. The practice has moved from a largely obscure Buddhist concept founded about 2,600 years ago to a mainstream psychotherapy construct today.
Advocates of mindfulness would have us believe that virtually every client and therapist would benefit from being more mindful. Among its theorized benefits are self-control, objectivity, affect tolerance, enhanced flexibility, equanimity, improved concentration and mental clarity, emotional intelligence and the ability to relate to others and one's self with kindness, acceptance and compassion.
But is mindfulness as good as advertised? This article offers an overview of the research on mindfulness and discusses its implications for practice, research and training.
Empirically supported benefits of mindfulness
The term "mindfulness" has been used to refer to a psychological state of awareness, the practices that promote this awareness, a mode of processing information and a character trait. To be consistent with most of the research reviewed in this article, we define mindfulness as a moment-to-moment awareness of one's experience without judgment. In this sense, mindfulness is a state and not a trait. While it might be promoted by certain practices or activities, such as meditation, it is not equivalent to or synonymous with them.
Several disciplines and practices can cultivate mindfulness, such as yoga, tai chi and qigong, but most of the literature has focused on mindfulness that is developed through mindfulness meditation — those self-regulation practices that focus on training attention and awareness in order to bring mental processes under greater voluntary control and thereby foster general mental well-being and development and/or specific capacities such as calmness, clarity and concentration (Walsh & Shapiro, 2006).
Researchers theorize that mindfulness meditation promotes metacognitive awareness, decreases rumination via disengagement from perseverative cognitive activities and enhances attentional capacities through gains in working memory. These cognitive gains, in turn, contribute to effective emotion-regulation strategies.
More specifically, research on mindfulness has identified these benefits:
Reduced rumination. Several studies have shown that mindfulness reduces rumination. In one study, for example, Chambers et al. (2008) asked 20 novice meditators to participate in a 10-day intensive mindfulness meditation retreat. After the retreat, the meditation group had significantly higher self-reported mindfulness and a decreased negative affect compared with a control group. They also experienced fewer depressive symptoms and less rumination. In addition, the meditators had significantly better working memory capacity and were better able to sustain attention during a performance task compared with the control group.
Stress reduction. Many studies show that practicing mindfulness reduces stress. In 2010, Hoffman et al. conducted a meta-analysis of 39 studies that explored the use of mindfulness-based stress reduction and mindfulness-based cognitive therapy. The researchers concluded that mindfulness-based therapy may be useful in altering affective and cognitive processes that underlie multiple clinical issues.
Those findings are consistent with evidence that mindfulness meditation increases positive affect and decreases anxiety and negative affect. In one study, participants randomly assigned to an eight-week mindfulness-based stress reduction group were compared with controls on self-reported measures of depression, anxiety and psychopathology, and on neural reactivity as measured by fMRI after watching sad films (Farb et al., 2010). The researchers found that the participants who experienced mindfulness-based stress reduction had significantly less anxiety, depression and somatic distress compared with the control group. In addition, the fMRI data indicated that the mindfulness group had less neural reactivity when they were exposed to the films than the control group, and they displayed distinctly different neural responses while watching the films than they did before their mindfulness training. These findings suggest that mindfulness meditation shifts people's ability to use emotion regulation strategies in a way that enables them to experience emotion selectively, and that the emotions they experience may be processed differently in the brain (Farb et al., 2010; Williams, 2010).
Boosts to working memory. Improvements to working memory appear to be another benefit of mindfulness, research finds. A 2010 study by Jha et al., for example, documented the benefits of mindfulness meditation among a military group who participated in an eight-week mindfulness training, a nonmeditating military group and a group of nonmeditating civilians. Both military groups were in a highly stressful period before deployment. The researchers found that the nonmeditating military group had decreased working memory capacity over time, whereas working memory capacity among nonmeditating civilians was stable across time. Within the meditating military group, however, working memory capacity increased with meditation practice. In addition, meditation practice was directly related to self-reported positive affect and inversely related to self-reported negative affect.
Focus. Another study examined how mindfulness meditation affected participants' ability to focus attention and suppress distracting information. The researchers compared a group of experienced mindfulness meditators with a control group that had no meditation experience. They found that the meditation group had significantly better performance on all measures of attention and had higher self-reported mindfulness. Mindfulness meditation practice and self-reported mindfulness were correlated directly with cognitive flexibility and attentional functioning (Moore and Malinowski, 2009).
Less emotional reactivity. Research also supports the notion that mindfulness meditation decreases emotional reactivity. In a study of people who had anywhere from one month to 29 years of mindfulness meditation practice, researchers found that mindfulness meditation practice helped people disengage from emotionally upsetting pictures and enabled them to focus better on a cognitive task as compared with people who saw the pictures but did not meditate (Ortner et al., 2007).
More cognitive flexibility. Another line of research suggests that in addition to helping people become less reactive, mindfulness meditation may also give them greater cognitive flexibility. One study found that people who practice mindfulness meditation appear to develop the skill of self-observation, which neurologically disengages the automatic pathways that were created by prior learning and enables present-moment input to be integrated in a new way (Siegel, 2007a). Meditation also activates the brain region associated with more adaptive responses to stressful or negative situations (Cahn & Polich, 2006; Davidson et al., 2003). Activation of this region corresponds with faster recovery to baseline after being negatively provoked (Davidson, 2000; Davidson, Jackson, & Kalin, 2000).
Relationship satisfaction. Several studies find that a person's ability to be mindful can help predict relationship satisfaction — the ability to respond well to relationship stress and the skill in communicating one's emotions to a partner. Empirical evidence suggests that mindfulness protects against the emotionally stressful effects of relationship conflict (Barnes et al., 2007), is positively associated with the ability to express oneself in various social situations (Dekeyser el al., 2008) and predicts relationship satisfaction (Barnes et al., 2007; Wachs & Cordova, 2007).
Other benefits. Mindfulness has been shown to enhance self-insight, morality, intuition and fear modulation, all functions associated with the brain's middle prefrontal lobe area. Evidence also suggests that mindfulness meditation has numerous health benefits, including increased immune functioning (Davidson et al., 2003; see Grossman, Niemann, Schmidt, & Walach, 2004 for a review of physical health benefits), improvement to well-being (Carmody & Baer, 2008) and reduction in psychological distress (Coffey & Hartman, 2008; Ostafin et al., 2006). In addition, mindfulness meditation practice appears to increase information processing speed (Moore & Malinowski, 2009), as well as decrease task effort and having thoughts that are unrelated to the task at hand (Lutz et al., 2009).
The effects of meditation on therapists and therapist trainees
While many studies have been conducted on the benefits of applying mindfulness approaches to psychotherapy clients (for reviews, see Didonna, 2009 and Baer, 2006), research on the effects of mindfulness on psychotherapists is just beginning to emerge. Specifically, research has identified these benefits for psychotherapists who practice mindfulness meditation:
Empathy. Several studies suggest that mindfulness promotes empathy. One study, for example, looked at premedical and medical students who participated in an eight-week mindfulness-based stress reduction training. It found that the mindfulness group had significantly higher self-reported empathy than a control group (Shapiro, Schwartz, & Bonner, 1998). In 2006, a qualitative study of therapists who were experienced meditators found that they believed that mindfulness meditation helped develop empathy toward clients (Aiken, 2006). Along similar lines, Wang (2007) found that therapists who were experienced mindfulness meditators scored higher on measures of self-reported empathy than therapists who did not meditate.
Compassion. Mindfulness-based stress reduction training has also been found to enhance self-compassion among health-care professionals (Shapiro, Astin, Bishop, & Cordova, 2005) and therapist trainees (Shapiro, Brown, & Biegel, 2007). In 2009, Kingsbury investigated the role of self-compassion in relation to mindfulness. Two components of mindfulness — nonjudging and nonreacting — were strongly correlated with self-compassion, as were two dimensions of empathy — taking on others' perspectives (i.e., perspective taking) and reacting to others' affective experiences with discomfort. Self-compassion fully mediated the relationship between perspective taking and mindfulness.
Counseling skills. Empirical literature demonstrates that including mindfulness interventions in psychotherapy training may help therapists develop skills that make them more effective. In a four-year qualitative study, for example, counseling students who took a 15-week course that included mindfulness meditation reported that mindfulness practice enabled them to be more attentive to the therapy process, more comfortable with silence, and more attuned with themselves and clients (Newsome, Christopher, Dahlen, & Christopher, 2006; Schure, Christopher, & Christopher, 2008). Counselors in training who have participated in similar mindfulness-based interventions have reported significant increases in self-awareness, insights about their professional identity (Birnbaum, 2008) and overall wellness (Rybak & Russell-Chapin, 1998).
Decreased stress and anxiety. Research found that premedical and medical students reported less anxiety and depressive symptoms after participating in an eight-week mindfulness-based stress reduction training compared with a waiting list control group (Shapiro et al., 1998). The control group evidenced similar gains after exposure to mindfulness-based stress reduction training. Similarly, following such training, therapist trainees have reported decreased stress, rumination and negative affect (Shapiro et al., 2007). In addition, when compared with a control group, mindfulness-based stress reduction training has been shown to decrease total mood disturbance, including stress, anxiety and fatigue in medical students (Rosenzweig, Reibel, Greeson, Brainard, & Hojat, 2003).
Better quality of life. Using qualitative and quantitative measures, nursing students reported better quality of life and a significant decrease in negative psychological symptoms following exposure to mindfulness-based stress reduction training (Bruce, Young, Turner, Vander Wal, & Linden, 2002). Evidence from a study of counselor trainees exposed to interpersonal mindfulness training suggests that such interventions can foster emotional intelligence and social connectedness, and reduce stress and anxiety (Cohen & Miller, 2009).
Similarly, in a study of Chinese college students, those students who were randomly assigned to participate in a mindfulness meditation intervention had lower depression and anxiety, as well as less fatigue, anger and stress-related cortisol compared to a control group (Tang et al., 2007). These same students had greater attention, self-regulation and immunoreactivity. Another study assessed changes in symptoms of depression, anxiety and post-traumatic stress disorder among New Orleans mental health workers following an eight-week meditation intervention that began 10 weeks after Hurricane Katrina. Although changes in depression symptoms were not found, PTSD and anxiety symptoms significantly decreased after the intervention (Waelde et al., 2008). The findings suggest that meditation may serve a buffering role for mental health workers in the wake of a disaster.
Other benefits for therapists. To date, only one study has investigated the relationship between mindfulness and counseling self-efficacy. Greason and Cashwell (2009) found that counseling self-efficacy was significantly predicted by self-reported mindfulness among masters-level interns and doctoral counseling students. In that study, attention mediated the relationship between mindfulness and self-efficacy, suggesting that mindfulness may contribute to the development of beneficial attentional processes that aid psychotherapists in training (Greason & Cashwell, 2009). Other potential benefits of mindfulness include increased patience, intentionality, gratitude and body awareness (Rothaupt & Morgan, 2007).
Outcomes of clients whose therapists meditate
While research points to the conclusion that mindfulness meditation offers numerous benefits to therapists and trainees, do these benefits translate to psychotherapy treatment outcomes?
So far, only one study suggests it does. In a study conducted in Germany, randomly assigned counselor trainees who practiced Zen meditation for nine weeks reported higher self-awareness compared with nonmeditating counselor trainees (Grepmair et al., 2007). But more important, after nine weeks of treatment, clients of trainees who meditated displayed greater reductions in overall symptoms, faster rates of change, scored higher on measures of well-being and perceived their treatment to be more effective than clients of nonmeditating trainees.
However, the results of three other studies were not as encouraging. Stanley et al. (2006) studied the relationship between trait mindfulness among 23 doctoral-level clinical psychology trainees in relation to treatment outcomes of 144 adult clients at a community clinic that used manualized, empirically supported treatments. Contrary to expectation, therapist mindfulness was inversely correlated with client outcome.
This is consistent with other findings that suggest an inverse relationship exists between therapists' mindfulness and client outcomes (Bruce, 2006; Vinca & Hayes, 2007). Other research suggests that no relationship exists between therapist mindfulness and therapy outcome (Stratton, 2006).
What might be behind these results? It could be that "more mindful" people are likely to score lower on self-reports of mindfulness because they are more accurately able to describe their "mindlessness." Conversely, people who are less mindful may not realize it and therefore may be inclined to rate themselves higher on such measures.
Overall, while the psychological and physical health benefits of mindfulness meditation are strongly supported by research, the ways in which therapists' mindfulness meditation practice and therapists' mindfulness translate to measureable outcomes in psychotherapy remain unclear. Future research is needed to examine the relations between therapists' mindfulness, therapists' regular mindfulness meditation practice and common factors known to contribute to successful treatment outcomes.
Important next steps in research
Future research holds tremendous potential for learning more about the neurophysiological processes of meditation and the benefits of long-term practice on the brain. Research on neuroplasticity may help explain the relationships among length and quality of meditation practice, developmental stages of meditators and psychotherapy outcomes. More research is needed to better understand how the benefits of meditation practice accumulate over time.
In addition, psychologists and others need to explore other ways to increase mindfulness in addition to meditation. Given that current research does not indicate that therapists' self-reported mindfulness enhances client outcomes, better measures of mindfulness may need to be developed or different research designs that do not rely on self-report measures need to be used. Garland and Gaylord (2009) have proposed that the next generation of mindfulness research encompass four domains:
1. performance-based measures of mindfulness, as opposed to self-reports of mindfulness;
2. scientific evaluation of notions espoused by Buddhist traditions;
3. neuroimaging technology to verify self-report data; and
4. changes in gene expression as a result of mindfulness. Research along these lines is likely to enhance our understanding of mindfulness and its potential benefits to psychotherapy.
Research is also needed on effective and practical means of teaching therapists mindfulness practices. Future research could investigate ways mindfulness practices and mindfulness meditation could be integrated into trainees' practicum and clinical supervision. Since mindfulness-based stress reduction has been successfully used with therapist trainees (e.g., Shapiro et al., 2007), the technique may be a simple way for therapists to integrate mindfulness practices into trainees' practicum class or group supervision. Future research questions could include: Does therapists' practice of mindfulness meditation in clinical supervision with their supervisees affect the supervisory alliance or relational skills of supervisees? Does practicing formal mindfulness meditation as a group in practicum or internship aid in group cohesion, self-care, relational skills or measurable common factors that contribute to successful psychotherapy?
Given the limited research thus far on empathy, compassion, decreased stress and reactivity, more research is needed on how mindfulness meditation practice affects these constructs and measurable counseling skills in both trainees and therapists. For example, how does mindfulness meditation practice affect empathy and compassion for mid-career or late-career therapists who are experienced at mindfulness?
Shapiro and Carlson (2009) have suggested that mindfulness meditation can also serve psychologists as a means of self-care to prevent burnout. Future research is needed on not only how the practice of mindfulness meditation helps facilitate trainee development and psychotherapy processes, but also how it can help therapists prevent burnout and other detrimental outcomes of work-related stress.
In addition, despite abundant theoretical work on ways to conceptually merge Buddhist and Western psychology to psychotherapy (e.g., Epstein, 2007, 1995), there is a lack of literature on what it looks like in session when a therapist uses mindfulness and Buddhist-oriented approaches to treat specific clinical issues.
In conclusion, mindfulness has the potential to facilitate trainee and therapists' development, as well as affect change mechanisms known to contribute to successful psychotherapy. The field of psychology could benefit from future research examining cause and effect relationships in addition to mediational models in order to better understand the benefits of mindfulness and mindfulness meditation practice.
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Daphne M. Davis, PhD, is a postdoctoral fellow at the Trauma Center at Justice Resource Institute in Brookline, Mass.
Jeffrey A. Hayes, PhD, is a professor of counseling psychology at the Pennsylvania State University department of educational psychology, counseling and special education.
