self compassion exercise Archives - Gail Gazelle MD, MCC

Excerpt from the forthcoming Mindful MD. 6 Ways Mindfulness Restores Your Autonomy and Cures Healthcare Burnout

Our Most Important Patient: Ourselves

As physicians, we learn to be very critical of ourselves. Our training focuses much more on deficits than strengths. We see the attending physician sneer at a med student or another resident when they miss one item on a broad differential diagnosis of a rare symptom or finding. We are subjected to ‘pimping’ where we are asked a series of ever more demanding questions, only so we can be shamed when we can’t answer one correctly. The incessant ratings, rankings, and comparisons of training leave us comparing ourselves to our peers and focusing on where we’re coming up short.

Additionally, we learn to put others first and to always be there for our patients, no matter the time of day, and no matter how fatigued and drained we might be. While this altruism is laudable, we don’t learn how to apply that same nurturance to ourselves.

All of this leaves us looking to others to affirm our worth. In the words of mindfulness educator Sharon Salzberg: ”When we experience inner impoverishment, love for another too easily becomes hunger: for reassurance, for acclaim, for affirmation of worth.”

With self-compassion, we’re shifting the lens from outward caring to inward. We are including ourselves in the group of people who receive care, love, forgiveness, and attention.

While this is not what most of us in medicine learn, we can.

This makes me think of a coaching client who I’ll call Ayesha, who came to me because she was forever behind in her charting. In fact, when we first met, she had over 200 unfinished charts in the queue. A forty-two-year-old family physician, Ayesha loved taking care of patients but did not love getting their notes done. Moreover, when we looked at her experience charting, it turned out that no sooner did she log into the electronic record than she found herself besieged by inner chastising voices: What’s wrong with you anyway? You’re so lazy. Everyone else is so much better at this than you are. You’ve always been slower than others. I don’t even know why you bother trying.

These voices cut through her, rapidly plummeting her mood and leaving her feeling heavy and defeated. Whatever motivation she might have had to get her charts done rapidly disappeared, and the next thing she knew, she was checking Facebook, stopping to file her nails, and going over the family shopping list. Anything but facing this mean bullying voice that stood between her and getting her charts done.

I knew that we needed to bolster her ability to be kinder to herself, to say things to herself that buoyed her up rather than taking her down. But when I mentioned the concept of self-compassion to her, she looked surprised. “Isn’t that what we bring to our patients? They’re the ones who are sick. Why would I need to be compassionate to myself?”

This is something I hear from many of the physicians I coach. Additionally, many believe that self-compassion will breed self-pity; that it is self-centered and means they will wallow in themselves—basically, sit around all day complaining and eating bon-bons. But when you stop and think about it, isn’t it self-centered to be focused on ourselves and all of our perceived faults?

Interestingly, when we are kinder to ourselves, there’s often a sense of expansiveness. We are actually less stingy in the compassion we offer to others. Even the scarcity that comes from identifying as the special one on the team lessens, replaced by an abundance mindset that allows greater compassion for others.

As Ayesha began to build her muscle of self-compassion, she noticed something shifting in her level of motivation. Instead of sitting at her computer procrastinating, typing a few words, and then checking social media, she now found herself better able to get the charts done. In being kinder to herself, she moved into a greater level of efficacy and efficiency. No longer under the thumb of the inner critic, her fear of inner censure abated, and she was much more able to get her work done. Slowly, slowly, slowly, and then all at once (how mindfulness progress typically works), Ayesha was able to put her inner critic aside.

When Ayesha first started utilizing self-compassion, she said that it felt artificial. “I didn’t believe any of it! In fact, it seemed like a complete farce. But I kept at it. And now, I certainly don’t fully believe it 100 percent, but I am starting to believe it a little bit. Maybe that will continue to grow.”

In her next coaching session, Ayesha reported that “In some ways it’s subtle, but I notice that I’m much more content at the end of each day. I have more emotional energy to get the work done. I am also noticing that I’ve been much more patient with my sixteen-year-old son, and I’m less reactive with him. As I develop more compassion for myself, I seem to have more for others as well.”

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Perhaps this brief passage from Mindful MD can help you see ways you are being overly harsh with yourself. Perhaps it can help you see why kindness to yourself is actually the antidote for procrastination and inefficiency.

As you go through your week, see if you can replace inner criticism with a dose of mindful self-compassion. I’d love to hear how it goes!

In this post, we look at self-compassion mindfulness, definition, exercises, and explore self-compassion vs self-esteem.

Demystifying Mindfulness (A 12-part Mindfulness in Medicine Series)

Demystifying Mindfulness is a mini-crash course designed to help you navigate the sometimes muddy waters surrounding mindfulness, one of the simplest ways to positively impact a physician’s career. In this post, we’ll look at self-compassion, using a real-life case study to delve into this important topic.

Dear Dr. Gazelle,
“I’ve been struggling with fatigue and overwork. I’m teetering on the edge of burnout. Recently, I nearly missed a key diagnosis in one of my patients – can’t believe what an idiot I am. I know that none of my partners would have missed this. I feel like I’m an embarrassment as a physician. I’m not sure I really have what it takes and I’m thinking it might be best if I just call it quits. If I do continue, clearly, I need to work harder so this never happens again. One of my friends suggested that I be more compassionate with myself but that seems crazy to me. If I don’t push myself, how will I ever improve? Self-compassion seems like the last thing I need. My job is to give compassion to my patients. Why would I need to direct it to myself?”

Thanks so much for writing, Dr. C. I understand your concerns about self-compassion and perhaps I can clarify why it’s important.

Before I do, though, I’m noticing that you’re being fairly harsh with yourself. If a colleague told you about a near-miss like you’re describing, I’m wondering what you’d say to them. Would you use the kind of language you’re directing toward yourself or would your tone be more compassionate? Most physicians are good at directing compassion toward others but much less good at giving it to themselves. We often see self-compassion as soft, weak, self-indulgent, unnecessary, and downright selfish. But, is it?

Self-Compassion Mindfulness Definition

To understand self-compassion mindfulness, consider the harsh self-criticism that most of us don’t think twice about directing toward ourselves. We can typically find fault with our actions, words, and behavior, and physical appearance, whether it’s for something we did yesterday or something from the past. We may even spend time berating ourselves for things we said or did decades earlier.

Self-compassion mindfulness involves treating oneself in the same way we would treat a good friend. Kristin Neff, the leading self-compassion researcher, defines self-compassion as having three components: mindfulness, self-kindness, and awareness of the shared humanity that we are all a part of. When we utilize mindfulness, we have an awareness that suffering is occurring, and that we’re the ones suffering.

We can identify the blame or shame we often experience when something goes wrong, and turn our attention to the fact that what we’re experiencing is difficult. Once we’re aware of our suffering, rather than attacking or beating ourselves up for our imagined inadequacy, we can offer ourselves kindness, concern, and care. And with the third component, shared humanity, we acknowledge the unavoidable fact that life involves suffering for everyone, without exception.

We can trick ourselves into believing that things are “supposed” to go well and that something is wrong when they don’t. In reality, we all make mistakes, and we all experience hardships of one sort or another. With a sense of shared humanity, we can remind ourselves that whatever suffering we’re experiencing is simply part of life. In the case of Dr. C, we can see that rather than being a personal deficit, anguish around a diagnosis nearly missed is a part of the shared experience of most physicians.

Is Self-Compassion a Sign of Weakness? Self Compassion VS Self Esteem

It’s common for people to see self-compassion and self-care as unnecessary indulgences that are only meant for the weak. In reality, self-compassion can be a powerful tool for coping with difficult situations, one that increases our personal resilience. Self-compassion, when practiced as part of our mindful approach to life, actually helps us when we go through significant challenges or crises.

In a study of 100 people recently separated from their spouses, researchers had participants record their thoughts and feelings about their separation experiences. They evaluated language, differentiating between comments such as “I don’t know how I managed to ruin my marriage. It was all my fault.” versus ones like “Looking back, you have to take the best out of it and move on from there. Just forgive yourself and your ex for everything you both did or didn’t do.” Controlling for initial levels of self-esteem, optimism, and depression, the researchers found that participants who displayed more self-compassion regarding the breakup evidenced better psychological adjustment in the immediate term, and for the next nine months.

Is Self-Compassion Selfish?

This is a commonly held belief. In healthcare, we spend our days being compassionate to our patients. If we exclude ourselves from that same kindness and care, we can create a real sense of separation from others. If I treat you kindly and myself harshly, I’m treating you as worthy of compassion and myself as not. Doing this regularly creates a dynamic that fosters a state of deprivation for clinicians, and it’s one that can contribute to burnout. And we know that burnout fuels a lack of empathy for our patients and can be a major contributor to medical error. With self-compassion, we’re simply including ourselves in the circle of humanity deserving of compassion, and making it easier to perform the important and demanding work that we do. In reality, the practice of self-compassion is actually the opposite of selfish.

I encourage you to see for yourself: spend a workday replacing self-criticism with kinder self-talk and see whether you’re more or less compassionate when you get home to your family.

Will Self-Compassion Mindfulness Make Me Complacent?

The belief that self-compassion will undermine our motivation to improve is a common misconception. Many of us believe that if we don’t criticize ourselves for failing to live up to our standards, we’ll become slothful and unmotivated. In fact, though, harsh self-criticism has been found to undermine motivation.

Let’s try a brief experiment: Think of something on your to-do list that you’ve been procrastinating about and haven’t felt motivated to move forward with. Spend 30 seconds now telling yourself how you believe your own inadequacy is to blame for the fact that you haven’t completed the task: you’re lazy, you don’t have the right skills, others are better equipped to get it done. You can even tell yourself that you’ll never get it done! Now, rate your level of motivation to get the task done on a 0 to 10 scale where 0 is completely unmotivated and 10 is “let me at it!”

Now, spend the next 30 seconds telling yourself all the ways you are perfectly situated to get the task done. Tell yourself that you have the right skills, that you’re good at this kind of thing, and that you’re always up for a challenge. Now, re-rate your level of motivation. Did your level go down? Stay the same? Go up? I think you see the point here.

In the physicians I coach, I see this same phenomenon over and over – capable clinicians whipping themselves with self-criticism. And not being able to move forward until they shift the inner dialogue to a more compassionate tone.

Building Self-Compassion Exercise

Developing greater compassion for ourselves is similar to going to the gym to build skeletal muscle. It takes practice and repetition, and it is hard! Patterns of self-criticism can be well ingrained and require effort to reshape. Here are three self-compassion exercises that can build your self-compassion musculature:

Pay attention to your patterns of self-criticism. Most of us have a loud inner critic that is so well established that we hardly notice it. As always, this act of mindfulness is the first step. Take note of every time you experience a self-critical thought. Next, consider what you’d say to a good friend in the same situation. Try replacing your self-critical message with this message and see how this feels.
Set a daily intention to be kinder to yourself. Every morning write this out or tell someone that this is your plan. You may not do it every moment, but by setting an intention it’s likely that you’ll cultivate this habit.
Take what Dr. Neff refers to as a self-compassion break. The next time you’re upset about something you perceive that you have done wrong, stop and take three slow deep breaths. Then, place your right hand over the area of your heart and say the following:

“This is a moment of suffering. Suffering is part of life. It’s normal and expected that I will suffer in this way. May I be kind to myself in this moment, give myself the compassion I need and deserve, forgive myself in whatever ways will help me, learn to accept myself as I am, care for myself just as I would a loved one in need, be patient with myself.” Consider other things that you might say to express kindness to yourself.

Try these steps the next time you’re feeling critical of something you have said or done. Self-compassion is often the first step to self-improvement. But don’t believe me, try it for yourself. Let me know what you find.

Self-Compassion: An Elixir for Physician Burnout