Self-Compassion, Self Care and Persisting Pain

“It sounds like you need to start looking after yourself…”

Somewhere along your pain journey, perhaps in response to the emotional aspects of living with pain, you may have been encouraged to practice “self-care”. Maybe you’ve been given suggestions for relaxing activities like walking, meditation, or making “me time”.

Self-care can be a great tool to combat the feelings of shame, self-criticism, and self-blame that are common among people with chronic pain. There is immense value in making time for things that bring you joy and relaxation when you’re experiencing these hard, but very common, feelings.

However, too often self-care becomes just another item to check off your to-do list. It can feel like one more thing you’re not getting done, and instead of helping with feelings of self-blame and guilt, it can add to them.

This is where self-compassion comes in.

Self-Care and Self Compassion

While self-care and self-compassion sound similar, they can mean different things to different people. Self-care is often interpreted as an act, whereas self-compassion includes a feeling and attitude that goes along with the act, within the context of a situation.

Self-compassion includes having a clear, non-judgmental, awareness of your needs. It includes having the courage, kindness, and love to meet those needs. And it may also include asking for support when needed.

If you can imagine self-care that comes from a place self-compassion, you can see it’s an ongoing process and way of life, not just a list of activities to check off.

Sure, self-care may include the things commonly suggested: rest, social connection, physical activity, time in nature, boundary setting, or meditation. But these activities aren’t always ‘self-care activities’, they are just activities.

They become compassionate self-care practices when you choose how and when to do them, respecting your time and needs in the process.

For example, it’s late in the evening and you are feeling overwhelmed because you still need to walk the dog,  do the stack of dishes on the counter and make school lunches for tomorrow. You are exhausted and in pain and think that self-care in this moment would be to soak in the bath. This attempt at “self-care” may leave you feeling more stressed if you lie in your bubbles brooding about everything you have to do when you get out.

Better self-care in this moment might be asking your kids or partner to help with the dishes or lunch prep while you get some fresh air and take the dog out for a leisurely but shorter walk, stopping to rest at a nearby park bench, as you realize that relaxing outdoors in nature, in solitude, is something you haven’t had all day, and would better serve you in the moment.

Or maybe you need to pull up a chair and direct the lunch-making from the corner of the kitchen, recognizing your need to rest while still ensuring that the job gets done.

It’s also possible the bath would be the best choice for you in the moment. Maybe you can return to the tasks post-bath feeling less pain, more grounded and with more energy. Or maybe you decide that going to bed early is best and getting up earlier to complete the tasks is a better choice at this time. The point is, it will be different for everyone. And the only way you’ll know what’s the best thing for you in the moment, is to be compassionately aware of your needs.

Self-Compassion is NOT weakness

Sometimes we’re hard on ourselves because of the cultural misconception that shame, or “tough-love” can be a motivator to change.

Maybe you worry that if you extend self-compassion, you’ll become complacent and give up trying to change your situation? The opposite effect was seen in studies of college students, which found that the students were actually more likely to change their behavior, or try again after making a mistake, if they practiced self-compassion rather than self-criticism.

Self-compassionate behaviour and practices have also been shown to have specific benefits for people living with persisting pain.

In one study, researchers found that people who exhibit behaviour traits of self compassion also had feelings of more control over their pain situation and decreased fear and worry about their pain. Research also suggests that these traits of self-compassion are associated with reduced levels of depression, anxiety and stress in people with persistent pain.

There is also preliminary evidence that practicing self-compassion can reduce anger, pain intensity and psychological distress in people with persistent pain and I propose that there is great value in including self-compassion practices as part of an individual’s pain care plan.

The Three-part Self-Compassion Puzzle

Dr. Kristin Neff, a researcher and Associate Professor at the University of Texas at Austin, breaks down self-compassion into these three elements:

1. Mindfulness: Being fully present helps us be aware that we are struggling and experiencing a challenging moment. Understandably, we want to fix, avoid or resist the pain, discomfort or unpleasant feeling, and make it go away. However, if we are unaware or unwilling to accept we are in a moment of struggle to begin with, it can leave us feeling more frustrated or critical and create more resistance towards any changes we desire. Being aware without judging is the first step to change and the first step in extending compassion.
   
2. Common Humanity: Pain is a common human experience, as are feelings of shame, self-criticism, and anger. Everyone experiences these things to some degree. They make us human. Being in pain can be isolating. Hearing stories from people who are facing similar struggles can help you feel more connected and self-compassionate with what you’ve been going through on your journey. It can help you see that having pain isn’t a failure on your part,you did nothing wrong, and you’re not alone.
   
3. Kindness: This element of self-compassion is about extending comfort, support and a sense of love towards yourself, amidst the suffering. The way this is done will be different for each person.

These three components reveal many different things that you can do to help cultivate self-compassion in your life. You’ll find these in the action steps.

Action Steps

Take the first steps to change your critical self-talk

It’s challenging to cultivate self-compassion when your critical inner voice won’t give you a break. Make friends with your inner critic and turn down the volume on that inner voice with this useful writing exercise from Dr. Kristin Neff.

Stay Connected to Others, and to Yourself

Finding a supportive community to talk about your current experience can be an enormous help. While there are many different online support groups, sometimes people in pain report that certain groups can make them feel worse for a variety of reasons. Ensure you feel the group is meeting your needs and you feel connected, supportive, respected, hopeful and inspired.

PainBC has an online forum that is a good example of an online support group.

You can stay connected to people in your local community through social activity groups, church, or group classes like gentle yoga, tai chi or other mindful movement practices.

Reading and listening to stories of others’ pain experiences can also help you to feel less alone in the challenging experience of pain. Try Pain Heroes by Alison Sim, My Cuppa Jo blog by Joletta Belton, and The Patient Voice webinar by Keith Meldrum, as a start.

Explore ways that help you feel connected to yourself. For some, it may be journaling, creative art, listening to your favourite music, prayer, or spending time in nature, with loved ones or with people who make you laugh and feel alive.

Explore Mindfulness Practices Each Day

Mindfulness is a practice in which you consciously pay attention to something on purpose. You could bring your present awareness to scan your body and how you feel, in this moment. Notice any physical sensations. Notice any areas of discomfort and also any areas of ease. Notice how you’re breathing. What is your current emotional state? How do you feel energetically? Do you notice the thoughts passing through your mind?

Other parts of mindfulness practice involve paying attention to the environment around you, noticing yourself and the world without elaborative stories. Just notice: colours, shapes, aromas, sounds, tastes, or sensations like the breeze or warm sunshine on the skin or the earth under the feet.

There is no ‘good or bad’ or ‘right or wrong’ to just noticing. Mindfulness is simply observing and being fully present with what is happening in the present moment.

Like all new activities, mindfulness takes practice and repetition to become skillful at it. To begin with, you can try a daily practice of noticing things in yourself and your environment that draw your attention, and observe them with loving-kindness.

Yes, even the hard stuff – pain, frustration and worry.

Meditation is one way to hone your mental awareness skills – Insight Timer is a useful, free app that can help.

Incorporating a moment of mindfulness into a daily activity you already do, like eating, brushing your teeth, bathing, or going to the bathroom can be convenient ways to find time to bring mindfulness into your day. Many people enjoy the ‘Toilet Meditation’!

Practicing mindfulness can make decisions about self-care easier and more effective, as you’re practicing attuning your awareness to what you truly need. This mindful attention brings much more clarity and insight into your decision making, based on your awareness of yourself and the environment around you.

Treat yourself like you treat others

Sometimes it feels easier to extend love and kindness to someone else, rather than to yourself.

If you find this is the case, you can practice the feeling of kindness by thinking about someone you love dearly. It may be a family member, a friend or even a pet.

If you knew they were going through what you’re going through, what would you say to them? Now, apply that same kindness to yourself, however you’re feeling in the present moment.

Try this letter-writing activity from the Center for Mindful Self-Compassion to help you discover your compassionate, encouraging voice towards yourself.

Learn More

Do you struggle with shame? Many people with pain do. This video from Brene Brown shines a light on this dark topic that silently affects so many.

Visit self-compassion.org, the home of Self-Compassion researcher Dr. Kristin Neff for self-evaluations and helpful resources.

Read “Approaching Low Back Pain with Self-Compassion” from the Center for Mindful Self-Compassion.

Try this brief Self-Compassion Practice for a Person in Pain.

Listen to “The Art of Self-Compassion” on the Healing Pain Podcast.

Try these audio self-compassion meditations from Dr. Chris Germer.

Geek out with the complete version of The Self-Compassion Scale by Dr. Kristin Neff.

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SPECIAL EDITING THANKS to our hardworking writer Jenn Johnson for her help organizing and planning the early drafts of this post *hugs*