Chapter 3: Building and Sustaining Self-Compassion and Self-Care

“First cultivate love toward yourself” The Dalai Lama

“Love thy neighbor as yourself” Mark 12:31

It might seem odd to put a section on self-compassion before discussions on compassion towards others, and when I first outlined this book, this section was going to be towards the end of the book. However, I quickly came to the realization that if we do not have compassion for ourselves, it is difficult to have compassion towards others. The quote “Love thy neighbor as yourself” from the Christian Bible teaches us that if we do not love ourselves, we will have difficulties loving others. It also teaches us to view the common humanity in all of us.

The Dalai Lama wrote that, “Compassion for others must be cultivated on the basis of self-respect, not out of guilt or feelings of unworthiness.” (Lama & Chodron, 2017; p. 160). When we have self-respect, we take care of ourselves, and tend to our emotional and physical well-being. Feeling worthy means cultivating a non-judgmental attitude towards our own mistakes, misdeeds and shortcomings. When we judge ourselves harshly for our mistakes, chide ourselves for our missteps or misdeeds, or entertain thoughts that we are not worthy of being loved, it is easier to have these same thoughts and emotions towards others. Additionally, on a purely biological level, when we feel judgmental towards ourselves, when we feel unworthy, we are inhibiting the soothing and self-contentment system in our bodies, which dampens our ability to feel compassion towards others.

Kristin Neff, a researcher who studies self-compassion says that just as compassion requires us to recognize and move towards suffering, self-compassion involves:

being touched by and open to one’s own suffering, not avoiding or disconnecting from it, generating the desire to alleviate one’s suffering and to heal oneself with kindness. Self-compassion also involves offering nonjudgmental understanding to one’s pain, inadequacies, and failures, so that one’s experience is seen as part of the larger human experience. (Neff & Germer, 2017; p. 371)

Cultivating self-compassion is different than ego-centrism or narcissism, which are conditions where people put themselves first with no regard for others. Ego-centric or narcissistic people rarely recognize their own foibles and may not have a desire to engage with their own suffering. Additionally, self-compassion is also different from self-esteem in that it involves a realistic understanding of one’s own flaws and foibles (without excessive judgement). Self-compassion allows us to feel disappointed with our shortcomings while at the same time giving ourselves unconditional love and encouragement to do better in the future.

In Chapter 1, I discussed research that has demonstrated that when we feel compassion towards others, we activate neurochemicals that reduce our own stress. Not surprisingly, self-compassion has the same healthful benefits! One study found that practicing self-compassion can be beneficial to cardiovascular health (Thurston et al., 2021). Other studies have found a link between self-compassion and other measures of physical health, including lower levels of insomnia and more self-care behaviors (Phillips & Hine, 2021).

Self-compassion can also be protective against professional burnout. A research study that followed pediatric residents for three years found that participants who had higher levels of self-compassion had lower levels of burnout (Kemper et al., 2020). In this study, pediatric residents who had higher levels of self-compassion also rated higher on their ability to provide compassionate care, and demonstrated higher levels of empathic concern. Finally, research indicates that caregivers who have been trained in self-compassion are less likely to experience compassion fatigue, and that people who deliberately work to improve their self-compassion have increased resilience, and become more open-minded and more openhearted (Neff, 2011).

Kristine Neff (2012) has identified three components of self-compassion: kindness towards ourselves, recognition of a common humanity and mindfulness (Neff, 2011). The three components are not discrete steps along the path to self-compassion, nor do they have to be accomplished in any given order. You might begin a journey to self-compassion by practicing self-kindness. Another time when you are in need of self-compassion you might begin by reminding yourself of your common humanity and that you are not alone in your suffering. Mindfulness can also be the entry point to practicing self-compassion as mindful awareness can make us aware of our own suffering.

In the following sections, I will briefly discuss the three components of self-compassion and will offer exercises to help you increase your own self-compassion. I will conclude the chapter by briefly discussing self-care, and how that ties into the concepts of compassion and self-compassion. This chapter is designed to introduce the concept of self-compassion, and you may find you want to explore this concept further. At the end of the chapter, I will provide a list of resources that I have found useful.

Recognition of Common Humanity

In the previous chapters we explored how recognizing that all humans have similar emotions, that all humans experience suffering during their lifetimes, and that evoking feelings of lovingkindness towards all can help us act with compassion in the face of this suffering. It turns out that a recognition of our common humanity can help us face our own suffering with self-compassion. While everyone has different responses to suffering, some of us – myself included- tend to feel alone with our suffering. We may have been taught to suppress negative emotions. We may have been raised in cultures where we were instructed to “keep a stiff upper lip.” We may have been cared for by adults who had low distress tolerance and were unwilling or unable to deal with our suffering. They may have told us that “boys don’t cry”, or “big girls don’t cry.” We might have been exposed to messages that encourage us to “look for the silver lining” or to otherwise keep a positive, cheerful outlook. These well-intentioned instructions, which were designed to help us feel better, or at the very least to carry on despite the inevitable hardships of life, may have had the unintended consequence of actually making things worse. These messages make it difficult for us to acknowledge our own suffering, and if we do not acknowledge that we are suffering, it is difficult if not impossible to alleviate our own suffering.

When we have been told that we need to be strong in the face of suffering and hardship, we may feel alone and isolated when faced with a big life challenge such as a divorce, an illness (especially a mental illness), or a job loss. Even little challenges can make us feel alone, such as being unable to get out of a mental funk, continuing to beat ourselves up about a mistake we made, or if we just can’t seem to feel happy when everyone else is enjoying themselves. This feeling of aloneness may make us feel like a failure or that we are unworthy of being helped, especially when society sends us messages that grit and resilience will get us through life. Connecting with the realization that everybody endures hardship, suffering, emotional and physical pain many times during the course of a lifetime can help us feel less alone and is an important step towards accessing self-compassion and ultimately healing.

As a nurse, you are aware that all humans experience suffering, hardship, pain and other difficulties in life. Sometimes life is just plain hard! However, as a nurse, you may be primed to be the helper, the giver of care and compassion, rather than the recipient of these. Sadly, the suicide rate among nurses in the United States is significantly higher than that of the general population (Davis et al., 2021), which to me indicates that there is a lot of work that needs to be done to address the mental health of nurses. Taking care of the mental health of caregivers is doubly important because people who are experiencing clinical depression or another form of mental illness can have a neuro-endocrine system that is out of balance. Their bodies may be unable to produce the hormones associated with caring, which will make it doubly hard for them to cope with suffering. Therefore it is vitally important that nurses and other caregivers have access to high quality mental health services.

While recognition that life is hard and all humans suffer at times can be depressing, this recognition can also be liberating. When we recognize that everyone suffers, we might feel more connected to others. Recognition that other people have made it through challenges that are similar to the ones we are facing can also be inspiring and can give us the strength to go on. This is the role that support groups play and is also the reason that we are drawn to stories of perseverance.

Feeling connected also triggers feelings of lovingkindness, which will then stimulate the neuro-endocrine pathways that are associated with soothing and contentment. As I discussed in Chapter 1, these chemicals also stimulate our reward centers, which ultimately helps us feel better about ourselves. Compassion and self-compassion are inexorably linked via the neurochemical pathways in our brain – which explains why it is difficult to feel compassionate towards others if you cannot feel compassionate towards yourself.

In the previous chapters, we explored the concept of suffering. This discussion was focused on the suffering of others, in the context of compassion. Dr. Neff offers the following description of suffering as it relates to our own suffering:

Suffering stems from a single source – comparing our reality to our ideals. When reality matches our wants and desires, we’re happy and satisfied. When reality doesn’t match our wants and desires, we suffer. (Neff, 2011)

This passage highlights the fact that major life events (e.g. illness, death, monetary issues) can cause suffering, but we can also suffer when our expectations do not match our experience, and we can even experience suffering when pleasant experiences end (such as the end of a vacation). Difficult or boring shifts at work, rainy days on our vacation, new shoes that give us blisters, are all examples of minor life events that can cause suffering.

We also suffer when we do not live up to our own standards. When we are cross with our children, when we get a lower grade on a test than we expected, or when we cannot quite master a new skill. In our professional practice most of us strive for perfection, and feel bad when we even make a small mistake like forgetting to bring a patient a pitcher of water. However, because we are human, we will make mistakes. This is why we have created systems and routines (for example the 5 Rights of Medical Administration) to help us minimize mistakes, and to help us avoid big costly mistakes. Nevertheless, mistakes will happen. Recognition of a common humanity, and that all people make mistakes at some point in their lives will not only help us generate self-compassion, but it will also aid us in generating compassion for others. Furthermore, when we examine our mistakes and shortcomings with self-compassion, and in a mindful manner, we are more likely to learn from them.

The following exercise is a form of the loving-kindness meditation and is designed to help you utilize the recognition that all people experience hardship and suffering as a starting point to self-compassion.

EXERCISE: Exploring Our Common Humanity in the Context of Self-compassion

You can do this exercise in a group, or alone. First think of a hardship, challenge or illness that you have experienced that is also similar to one that a friend or family member has experienced. Perhaps you and your daughter both experience migraines. Perhaps you and your best friend from high school both have struggled with weight control, and you are hard on yourselves when yet another diet doesn’t succeed.

1. Start by taking some deep breaths and finding your anchor. Do a quick body scan, notice any sensations in your body – is there anywhere that is tight? Achy? Was this the result of thinking about your difficult experience, or was this present before? Send some softening energy to the tight spots, and some soothing energy to anything that is achy.

2. Next turn your attention to your emotions. Where there any emotions that were triggered by thinking about the hardship or struggle that you and your friend or family member both share? Just notice and name these emotions.

3. Now focus your thoughts on your friend or family member. You are aware they have similar struggles as you do. What conversations have you had with them about these issues? How are their emotions and physical reactions similar to yours? Where do they differ? Does the suffering you have in common create a bond between you, or distance (or both?)?

4. Next - as you think about your friend or family member and their suffering, imagine them surrounded by healing energy. Then imagine them turning towards you and inviting you into this circle of healing energy. Keep a curious and open mind – notice any feelings that arise as they offer to share the circle of healing that you created.

5. Next, imagine that your friend or family member leaves, and you are alone in the circle of healing energy. Sit with this for a moment. This is self-compassion. If it is difficult for you to experience this healing, loving energy, invite your family member or friend back into the circle.

6. Finally close the exercise with a version of the lovingkindness mantra or prayer. Please feel free to adapt the words to suit your style, keeping the intention the same:

Just like me (insert name here) has hardship and suffering.

Just like me (insert name) deserves to be free from hardship and suffering.

May we both find healing and strength.

May we both be healthy.

May we both be happy.

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Self-kindness

According to Kristin Neff, the second component of self-compassion is self-kindness, or the ability to soothe, comfort and forgive ourselves when we experience suffering, hardship, or when we make a mistake. When we practice self-kindness, we activate the same soothing and contentment systems that are activated when we care for another person. In the previous exercise, I initially invited you to explore feelings of common humanity – the realization that everyone encounters difficulties and hardships. You then imagined offering kindness to another person, and then extending that same kindness to yourself. Since this was a mental exercise, not real life, you may or may not have triggered the release of oxytocin, which if you will recall is one of the hormones that facilitates love and attachment. If you had actually been engaged in an act of kindness towards another person, or towards yourself, you probably stimulated the release of oxytocin.

As discussed in Chapter 1, research indicates that oxytocin is released when we feel compassion towards others, and it is also released during moments of self-compassion and self-kindness (Wang et al., 2019). Since oxytocin is beneficial to our health and well-being - it lowers blood pressure and can help reduce other physiological symptoms of stress – self-kindness and self-compassion are health-promoting activities (Brown & Brown, 2017).

Unfortunately, self-kindness is not a skill that most of us learned. As I discussed previously, many of us were taught to be tough, resilient, and self-critical when life got hard. As infants and toddlers, we may have engaged in self-soothing behaviors such as thumb sucking while holding a blanket, hugging a stuffed animal or other comforting soft toy, or sucking on our hair (which is what I did). At some point we were instructed to leave these “childish” behaviors behind, but we were never taught how to engage in alternative, more mature self-soothing behaviors.

We also may have been taught concepts of self-esteem, which is distinct from self-compassion. When we have high self-esteem, we think well of ourselves, we honor what we do, what we can achieve, how we look, or what we own. Self-affirmation activates the reward seeking neural pathways in our brains, which temporarily inhibit the compassion and self-soothing pathways (Cascio, 2016). It is healthy to have a strong appreciation for ourselves, however, we need to realize that at times we will make mistakes, we will not accomplish our goals, or we will experience hard times. In these situations, our self-esteem may take a hit, and we can become despondent. This is when we need to activate self-compassion and self-kindness.

So, how does one offer themselves kindness and self-comfort? Positive self-talk is one way. However, Dr. Neff, in her book Self-Compassion says that when faced with genuine suffering or distress, this may not helpful. Instead, Dr. Neff suggests that self-kindness starts with an acknowledgement of distress or suffering. Recognizing that we are suffering can be a powerful act of self-compassion, and the first step to taking action to alleviate suffering.

This is a small example, but, like many people, I sometimes have problems with intense emotions (such as anger or irritability) when I am hungry, but do not recognize that hunger is the source of these emotions. Because of these difficult emotions, I might start feeling bad about myself. For example, if I am bicycling and have used up all my energy stores I can find myself thinking negative thoughts such as “you are so slow,” or “you are in horrible shape,” or “when will this ride be over?” The once pleasurable bike ride is now a miserable experience because I am hungry! In these moments, self-kindness starts with an acknowledgement of suffering. Once I acknowledge that I am suffering because I am hungry or thirsty, I can take a break to eat, drink some water, and rest. Then when I resume my bike ride, I find I do so much better!

Self-kindness may involve a physical act of self-care, such as eating, resting or doing something that is fun. It can also involve a small act of physical self-soothing, such as giving ourselves a hug, gently rubbing or massaging our arms or shoulders, gently rocking, or even placing your thumb in the palm of the opposite hand (this mimics holding the hand of another person). I invite you to experiment with different ways of physical comforting yourself to figure out what works for you. While it may feel weird to give yourself a hug, it actually sends a powerful message to your body that thoughts alone may not. Finally, because some of these self-soothing acts are not normalized behaviors in our culture, you may develop different self-soothing techniques for when you are alone versus when you are out in public spaces.

If physical acts of self-kindness just seem weird to you, there are other things you can do! Self-kindness also involves talking to ourselves (aloud, in writing, or silently) in a kind and supportive manner. To get started, imagine what a supportive friend, family member or trusted elder would say to us to help us through a difficult time. In the exercise below, (Self-compassion when we make a mistake) I will offer an example of this. We may also develop a short prayer or mantra that we can use during difficult times. Dr. Neff (2011) has created the following self-compassion mantra:

This is a moment of suffering.

Suffering is part of life.

May I be kind to myself in this moment.

May I give myself the compassion I need. (p. 119)

Dr. Neff also suggests that you can personalize this mantra. Use whatever words resonate with you. You may even turn it into a prayer. The important thing is to acknowledge your suffering or distress, contextualize it as something that happens to everyone (which gets you in touch with our common humanity), say something that is soothing or expresses self-concern, and close with an intention to engage with yourself compassionately. Writing a letter to yourself, as if you were writing to a friend who is experiencing a hard time is another way you can engage the self-soothing system (Gilbert, 2013).

A self-kindness mantra or prayer is different than positive self-affirmation. Examples of self-affirmation are, “I am beautiful”, “I am smart,” “I am enough,” or “I am strong.” While self-affirmation can be important to help motivate us to achieve goals, or to remind ourselves that we do not need to conform to society’s unrealistic expectations (especially around body size and physical appearance), as I mentioned above, it stimulates different pathways in our brain and may not serve as an antidote to suffering. You may find that self-affirmation and self-kindness are tools that you use at different times in your life to help you get through whatever difficulties you encounter. In the next exercise, I will invite you to develop a self-kindness mantra or prayer.

EXERCISE: Practicing self-kindness:

In this exercise I invite you to play with some phrases and/or physical movements that you can use when you need a little self-kindness and self-compassion. This is an exercise that is best done by yourself, but I invite you to share your experiences with self-kindness and self-compassion with your study group, if you have one. In particular you might want to share any awkwardness or resistance you felt when engaging in self-compassionate thoughts and self-soothing behaviors.

1. Find a quiet place and take a few minutes to settle your thoughts and find your anchor. Take three or four cleansing breaths – breath in through your nose with mouth closed, then breathe forcefully out through your mouth. Imagine “stale” air leaving your lungs and “fresh” air entering. Set your intention by saying something like: “This is a moment of self-compassion. I am open and curious to explore self-compassion and self-kindness.”

2. Start by thinking of a time in the recent past when you experienced a minor irritation, stressor or physical discomfort. Perhaps you were running late to an appointment and you could feel your blood pressure rising, or perhaps you had a headache, but had to go to work anyway, or maybe you burned a batch of cookies. Don’t start out with a big event – you will have plenty of opportunities to practice self-compassion in the future with big events – the goal of this exercise is to find some self-soothing mechanisms that work for you.

3. As you remember the stressful or difficult event, first try some physical self-soothing. Give yourself a hug, gently stroke your upper arms or clasp your hands together as if you are holding your own hand. You might also try drawing gentle circles in the palm of one hand with the thumb of another. Experiment with different physical movements until you find one that feels comfortable and comforting to you. Perhaps gently rocking back and forth helps to calm you. (Rocking is a very soothing activity – it is how we soothe babies, and it is how many people with autism self-soothe.) Also take note of any gesture or movement that makes you feel self-conscious, embarrassed or feels awkward.

4. Next experiment with a self-compassion mantra or prayer. You can try the example from Kristine Neff, or you can come up with your own.

This is a moment of suffering.

Suffering is part of life.

May I be kind to myself in this moment.

May I give myself the compassion I need. (Neff, 2011, p. 119)

The actual words you use do not matter too much. However, you should try to include the following components: 1. an acknowledgement of your suffering; 2. A reminder that suffering is a part of the human condition; 3. an expression of self-concern and self-soothing; and 4. A reminder of your intention to treat yourself with kindness and self-compassion.

5. Write your mantra or prayer down so you do not have to re-create it in the future. If you are so inclined, you might use calligraphy or some other form of decorative lettering and illustration to make the phrase special. The point of having a phrase you can say to yourself is that it is something you can do at anytime, anywhere, to give yourself a little kindness when you are experiencing suffering or hardship.

If you are reading this book with a friend, or a group of people, consider sharing your phrases with each other, or helping each other out if one of you feels stuck and can’t find the right words to use.

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Personally, I have found using a self-compassionate mantra to be very helpful when I am overwhelmed with a difficult emotion like anxiety. One event that consistently triggers my anxiety is airplane travel. I am not afraid of flying – it is just the thought of all of the steps before the plane goes off that causes anxiety – getting to the airport, parking the car, checking the luggage, going through security, finding the gate, boarding the plane. In fact, as I am typing this, and thinking of past experiences, I feel a bit anxious. Paradoxically my anxiety dissipates as soon as I am seated on the plane and it takes off! I have tried getting to the airport super early (which drives my husband crazy!), positive self-talk, breathing exercises, but nothing has really worked to alleviate my anxiety.

In the past I would silently judge myself for not being calm, and for being unable to relieve my irrational anxiety. However, after learning about self-compassion, I decided it was time to try a new technique to calm myself on the way to the airport. This time, as I was in the car on the way to the airport and my anxiety level started to rise, I silently had the following conversation with myself: “I notice you are anxious. It doesn’t feel good. It’s okay, everyone gets anxious at times. This is your anxiety trigger. I wish for you to have peace. I wish for you to be safe. I wish for you to be free from suffering.” As my anxiety ebbed and flowed, I would repeat, “I wish for you to have peace. I wish for you to be free of suffering.” In this instance, I found it helpful to use the second person “you” when addressing myself. Sometimes that is the best way to give yourself compassion, other times you may wish to use the first person “I”.

While changing my self-talk and offering myself compassion was not a magic bullet that made my anxiety go away, it did lessen it. It also allowed me to step outside of myself and acknowledge that while this anxiety is irrational (I have never missed a plane in my life), it is something I may always have to live with. I now have the perspective that going to the airport may always be a stressful event for me, and as long as the stress does not prevent me from flying, it is a moment of suffering that I will just continue to soldier through.

Sustaining Self-compassion when We Have Made a Mistake: Shame versus Guilt

Learning to face mistakes and missteps with self-kindness is a difficult skill. While it is important for our personal and professional growth that we learn from our mistakes, it is not helpful to feel intense shame when we make a mistake. Both shame and guilt are emotions that most humans experience when they have made a mistake, when they hurt someone’s feelings, when they have violated their own or society’s norms, or even when they have fallen short of their own expectations (e.g. not getting a good grade on a paper).

Brene Brown (2012) writes that shame involves feeling that we are flawed because we failed, or did something wrong. Shaming ourselves leads us away from self-love and self-compassion. Likewise, shaming others inhibits compassion and can also impede learning (I will discuss this more in Chapter 7). In contrast, Brown’s research indicates that guilt is a helpful emotion. She describes guilt as a psychological discomfort that allows us to acknowledge we failed to live up to our own standards. To alleviate this discomfort, we might explore how we could have handled the situation differently, and we might vow to do better in the future. This is where learning and growing occurs. To borrow from Brene Brown’s work, another way of explaining the difference between shame and guilt is:

• Shame: I did something bad, therefore I am bad. AND You did something bad, therefore you are a bad person.
• Guilt: I did not live up to my standards. I am human and I can fail, but I am not inherently a bad person. I can learn from my mistakes and am worthy of self-compassion. AND You did not live up to standards or expectations. However, you are not inherently a bad person, you are worthy of compassion. You can learn from your mistakes.

Shame can lead to rumination, which is when we fall back into the same thought patterns over and over again. In other words, when we ruminate on a situation or event, we think about it in the same way, without getting additional insights or figuring out a way to move on. Rumination is detrimental to our psychological health and does not promote learning and growth. In contrast, when we critically examine why we made a mistake, or why and how we failed to live up to our expectations in an atmosphere of self-kindness and forgiveness, we actively promote psychological healing and growth.

I will admit, it is sometimes easier to write about self-kindness and forgiveness towards our shortcomings that it is to enact these qualities. This is because of our conditioning. Many of us have had experiences where negative reinforcement and negative motivation were used as teaching or coaching techniques. You might have had a teacher who told you that unless you work harder, you will never amount to anything. Or a coach that made your whole team do push-ups because you did not do the drill with the right amount of effort. Experiences like these teach us to be hard on ourselves. Most likely, your parents and teachers had your best interests in mind – they wanted you to grow and learn and did not want you to be satisfied with poor performance or to refuse to take responsibility for learning from mistakes. They may have felt that shaming and blaming were the best way to discipline and motivate you.

I want to emphasize that I am not advocating for a nonchalant attitude towards mistakes or shortcomings. If you mess up, it is human to feel guilt, or perhaps embarrassment. (Even dogs seem to feel guilt when they do something, like chew up the couch, that they know they should not have). Like I alluded to above, guilt and embarrassment are difficult emotions that signal that we messed up. They are positive when they trigger introspection, learning and growth. The following exercise is designed to help you use these triggers to self-compassionately and honestly face your mistakes, and to learn and grow from them.

EXERCISE: Self-compassion When We Have Made a Mistake or Failed to Live up to Our Expectations

The goals of this exercise are to cultivate self-compassion and forgiveness for your personal failings or mistakes, and to develop strategies to help you learn from them. In order to avoid overwhelming feelings of shame, or to avoid getting caught up in rumination and recrimination, first try this exercise with a minor mistake or mishap in mind. This will keep you from being overwhelmed with emotions and will help you process the experience better. When you have more practice with this exercise, you can use it to help you process larger shortcomings, failures, or mistakes. You can either do this exercise mentally, or write it in a journal, whichever works best for you. If you are working through this book others, you might do this exercise alone, then discuss how it went.

1. First think of a time when you made a little mistake or failed to live up to your standards. Perhaps you yelled at your child when they got a bad grade, instead of comforting them. Perhaps you promised a patient you would bring them fresh water, or a warm blanket, but forgot. Or maybe you watched TV instead of studying for a test, and then did not get the grade you would have liked on the test.

2. Now take some deep breaths and find your anchor. Do a quick scan of your body, mind and feelings. What are you feeling? Name your emotions. Notice any tendency to self-blame, or to give yourself excuses for the mistake (which can be a way of deflecting ownership of the mistake). Notice any physical sensations that are present in your body. Acknowledge any emotions, thoughts or sensations that are not pleasant. Acknowledge any suffering you may be experiencing at this moment as you recall this experience. You might say, “this is a moment of suffering.”

3. Now bring your focus back to your breath and your anchor. Imagine that a co-worker, a friend, a child, or a family member made this mistake. They feel bad and are unable to make themselves feel better about it. What might you say to comfort them? You can try out a phrase like, “I see that you made a mistake, and you now feel bad about it. Please know that we are all human and we all make mistakes sometimes. I know you are a good person, and that you will learn from this experience.” If this person were with you at this moment, what physical act of comfort would you offer them? Would you hug them? Or gently touch their arm? Or just sit with them quietly?

4. Now bring your attention back to yourself. Practice saying the same words that you said in your mind to your friend or family member to yourself. If you cannot envision that, imagine that your friend is saying those words to you. Imagine that they are offering you some physical comforting – a hug, a gentle touch, or a smile.

5. If you have been able to feel some kindness towards yourself for making the mistake, now explore the scenario that you thought about. What contributed to the mishap? Is there anything that you might have done to prevent it? Or was it just a case of being in the wrong place at the wrong time? What might you do in the future to prevent this from happening again? I also encourage you think of all the times you were in a similar situation and handled it well. What was different about that scenario? It might take a while to figure out what you need to learn from this incident, and it’s okay to come back to it – as long as you are not caught in a cycle of self-blame and rumination.

6. Now, gently bring your attention back to your breath and your anchor. End the exercise with a recognition that all humans make mistakes, and that you are human and you make mistakes, and that you sometimes fall short of your own expectations and the expectations of other people. You might say to yourself something like:

I am human. Like all humans, I sometime make a mistake or fail to live up to my expectations.

When I did XXX, I made a mistake or I failed to live up to my expectations.

I forgive myself for this mistake.

I am learning from this experience and am becoming the person I strive to be.

7. It might be helpful to perform an act of self-care or self-love after doing this exercise. Perhaps go for a walk, pet an animal, take a bath, or watch a funny TV show. Do something that will put you in a positive frame of mind, especially if you are having a hard time letting go of difficult emotions that the exercise brought out. Note – this is not the same as distracting yourself, you have processed the event, (or at least started to process it), and now it is time to move on.

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If you are having a hard time processing a mistake, or if you keep thinking about it, you might need to do the exercise I presented above more than once. Or it might be useful to talk it out with a trusted friend, co-worker, spiritual advisor or counselor. When I worked as a staff nurse, I would often talk about mistakes I made with my co-workers (they did the same with me). We would process why they happened, and help each other feel better about them, and would come up with ways (usually changes at the unit level) to prevent future errors or near misses.

As you worked through the above exercise, you may have encountered some resistance when you got to the part where I invited you to forgive yourself. If you grew up with overly critical parents, teachers or other grown-ups who did not help you find emotionally healthy ways of dealing with your shortcomings, you may find it difficult to practice self-compassion when you make a mistake. If you find yourself continually beating yourself up for shortcomings, falling into shame reactions (e.g. thinking “I am a bad person), or if you struggle with perfectionism, and the exercises I suggested here do not help, you may need to work with a therapist to process your past and to learn how to activate self-compassion and self-kindness.

Mindfulness and Self-compassion

In Chapter 2, we explored how mindful awareness relates to compassion. Mindfulness is also a component of self-compassion. Mindful awareness helps us tune into moments of suffering and helps us focus on our emotional and physical responses to suffering, a first step in healing. If you are like me, you may have had moments when you felt off kilter and did not realize it or could not figure out why. Perhaps in those moments you acted unkindly towards another person. Perhaps you over-ate some comfort food or engaged in another type of unproductive coping mechanism. It is probable that the source of your suffering was an everyday, relatively minor irritant that did not even register in your conscious mind. Or perhaps it was the build-up of a lot of minor irritants. Perhaps someone cut you off in traffic. Perhaps worries about work or school were percolating in your subconscious. Maybe you were just bone tired from too many long shifts. Or perhaps you experienced a series of micro-aggressions.

When I worked evening shift, the following scenario was all too common. I would work late, either because I had a rough night and had to finish charting, or because someone on night shift called in sick and I had to stay over to cover their shift. The next day, I would try to sleep in, but my children would make noise and wake me up. Then I would be cross at them and at my husband for not keeping them quiet. My children would be cross because I was not available to spend time with them, and everyone would have a bad day. In hindsight, I wish I had been more mindful of what was going on and been able to honestly discuss the situation with my family. Offering compassion to my children and husband, and self-compassion to myself probably would have resolved some of the tension we all experienced when my work intruded into my family time. Now that my children are grown, we have had some good discussions about how difficult it was for them when I had to work overtime and holidays. It was also difficult for me to miss out on these important evens! I now know that I was doing the best I could at the time with the skills and tools I had. It is my hope that this book, and the exercises in it helps you navigate some of these difficulties that nurses face with grace, kindness, compassion and self-compassion.

Cultivating mindfulness and being aware of how stress affects our body by manifesting as muscle pains or headaches (thus increasing our suffering) can help us live healthier lives. When we are distressed or in a difficult situation, many of us try to suppress our emotions in order to get through the day. In some ways, this is a useful skill. It enables us to keep on going and to take care of ourselves and dependents even in the face of major life traumas such as death in the family or a divorce. In our professional lives, being able to keep moving in the face of trauma enables us to do our jobs and care for our patients. However, this useful skill can also lead to a closing down of our emotions. If we learn to ignore our difficult emotions, we also can dull our more pleasant emotions. Emotional numbness may be a symptom of burnout, and requires our immediate attention. Practicing mindful awareness of our emotional and physical state can help us learn to recognize when we are experiencing difficulties and can help us develop the tools to work things out, or to take time to just rest, when it is safe and appropriate to do so. Later in this chapter, I will discuss self-care – which is a critical component of dealing with stressful events.

Earlier in this chapter, I mentioned the concept of rumination, which is excessive thinking about a given event. Our brains are constantly thinking, it is what they are designed to do. Sometimes we are not even aware of what we are thinking! If you are like me, and like most people, at times we will find ourselves replaying a given scenario over and over again. In her book, Rising Strong, Brene Brown discusses the human tendency to create stories in our minds about events. These stories may not be reflective of what the other people who were present were thinking, feeling, or intending, but they become very real to us. When we become mindful that we are ruminating and creating elaborate stories about what really happened (and perhaps also creating revenge fantasies), we can stop the rumination process before it gets out of hand. Mindfulness can give us the space to decide how to act from a place of compassion for the other person as well as from a place of self-compassion for ourselves.

One of the components of mindfulness is cultivation of non-judgmental awareness. As nurses, you probably know that you should take care of your patients without judging them. I will discuss this more in Chapter 4. It is also important to learn how to take care of ourselves without judgement. When I learned that I was judging myself for feeling anxious about getting to the plane on time, and that this self-judgement was actually increasing my anxiety, I was able to work towards letting go of self-judgement. In this case, the story I was telling myself was that my anxiety was out of hand because I had not practiced stress reduction techniques enough, or in the right way, and that I was a weak person. When I became attuned to this story and accepted that anxiety can be a result of the way our brains are wired, and of our past conditioning, and it is really not our fault that we feel anxious sometimes, I stopped judging myself. Subsequently, I found that my anxiety was easier to tolerate. Now in situations that trigger anxiety, I greet it like I would a chatty neighbor or co-worker – the one who wants to tell you the same story over and over again. Instead of trying to ignore my anxiety, I meet it head on with a thought like, “Here comes that anxiety again. I survived it before, I’ll survive it again.” And then I carry on getting to the airport on time!

EXERCISE: Mindful Awareness of Self-judgement

One of the keys to practicing self-compassion is to let go of self-judgement. As I discussed in the personal example I gave about feeling anxious about getting to the airport, for the longest time I was not aware that I was judging myself for having these feelings, and that this judgement was actually making the anxiety worse! You can do this exercise in one of two ways.

• You may have already recognized a recurring pattern of thinking, feeling or behaving that you have been trying to change. Because you have been working on this issue for some time, you may also be judging or berating yourself for not being able to change. Bring this issue to mind as you work through the exercise.
• If you have not identified an issue that triggers self-judgment and lack of self-compassion, the goal of this exercise might be to see if there is a recurring situation in which you could be more self-compassionate. Perhaps, like me, there is a situation where you are so focused on trying to change your behavior or emotion, that you do not realize that you are also feeling negative about your inability to change.

1. Begin the exercise with a brief moment of centering. Find your anchor and use your breathing to focus your attention. Create an intention to be curious and to practice self-kindness. You might think something like, “May I be open to learning about myself. May I be kind to myself in the process.”

2. You may either do this exercise mentally, or by writing your thoughts in a journal. Thinking of the issue that you brought to mind, ask yourself any, or all, of the following questions. Also feel free to think of your own questions, as long as they are curious and non-judgmental:

• What seems to be the trigger for these behaviors, thoughts or feelings? Is there something from my past or the way I was raised that triggers self-judgement?
• I can’t stop thinking about this issue, and I keep playing it over and over again in my mind – why is it so important or bothersome? What do I need to do to get past ruminating about it?
• I have noticed that when (a given event) happens, I usually feel (a given difficult emotion). Why are the two linked? And if I can’t change my feelings, or the situation, what can I change about the way I think about it?
• How might approaching the situation with self-compassion and self-kindness change it? What would that look like? What would I think or do differently?

3. If at any time during this exercise you find yourself in a state of self-judgement or self-recrimination, let that thought go by bringing your attention to your heart region (you may even put your hand on your heart). Repeat to yourself, “May I be kind to myself.” You can either end the exercise at this point, with a decision to explore it later, or once you have let go of self-judgement, you can continue your exploration.

4. Close the exercise with some cleansing breaths and give yourself some gratitude for taking the time to learn how to practice self-compassion rather than self-judgement. You may want to end with a self-compassion mantra or prayer:

Like all beings, I wish to be safe, happy and healthy.

May I practice self-compassion and self-kindness as I continue to grow and learn.

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Self-care: The physical Manifestation of Self-compassion

I want to begin this section by acknowledging that you probably already know the benefits of self-care. We are inundated with messages to take care of ourselves (the messages usually seem to be aimed at women and mothers), while at the same the world seems to make it hard for us to take the time, or find the resources, to do so. Perhaps you have set, and broken, resolutions to exercise more, to eat better, to get more sleep, to have more fun. Perhaps this is an area in which you sit in judgement of yourself because you have been unable to fulfill your goal of taking care of yourself. If so, please understand that I, and probably everyone who is reading this book, has had a similar experience. If you have been unable to practice the type of self-care you feel you need, this is an area where you might want to practice some self-compassion and let go of self-judgement.

When I was a staff nurse in an in-patient oncology unit, management decided that instructing nurses to engage in self-care was the answer to burnout. For a few years, during our annual evaluation we had to discuss what we were doing to take care of ourselves. At the same time, the pressures at work were slowly increasing. We had frequent mandatory overtime, had problems getting adequate breaks during most shifts, and really struggled to meet the needs of our patients who seemed to be sicker than ever before. Furthermore, many of us were also taking care of aging parents, children, or sick friends outside of work. However, if we took too much time off to care for our families, we could be reprimanded for excessive use of sick leave. The mixed messages made it seem like it was our fault if we experienced burnout, and also made it clear that our organization was not going to change the way it did business in order to improve the well-being of nurses.

Even though nurses get the message that self-care and time with family and friends is important, we need to recognize all the ways our organizations, and the societies in which we live, conspire to make it difficult for us to care for ourselves. This realization alone may help you let go of self-judgement when you are unable to practice self-care! In Chapters 5 and 6 I will discuss how we can create more compassionate workplaces - that is where the real change needs to happen. In this section I want to invite you to explore your self-care needs, what might be blocking your ability to take care of yourself, and to think of ways you might bring a little more self-care into your life. This is an excellent topic to explore with friends or co-workers, as you might create little communities that can allow for this self-care to happen.

It is very common for caring people, like most nurses are, to put the needs of others before themselves. However, neither extreme concern for others, nor extreme self-love are healthy (Pembroke, 2016). Instead cultivating a middle path is essential. In her article on self-care, Pembroke suggests that prayer, quiet contemplation, and meditation are all ways a nurse can learn to walk this middle path. The Christian philosopher, Thomas Aquinas also says that “(a) healthy self-love is an essential component of Christian living; (b) we must have love for our body as a gift from God; (c) concern for one’s own good is integral to virtue or moral self-transcendence.” (In Ryan, 2010; p. 161). Likewise, Islamic teachings emphasize the need for followers to nurture their spiritual, physical, mental and social health (Marzband & Zakavi, 2017).

The benefits of exercise, sleep, proper nutrition and stress reduction activities have been well-documented, and there are a lot of articles and books on how you can take care of your physical and mental health. As health care providers you probably already know what humans need to do to maintain health and prevent illness. We just need to find the time, and support to take care of ourselves!

In this section I am inviting you to work through two exercises. In the first one, I invite you to to explore your unmet self-care needs, and to identify barriers in the outside world that prevent you from taking care of yourself. In this exercise I also invite you to develop a plan to overcome one of these barriers. The second exercise is designed to be a moment of self-care, a moment to appreciate yourself and to offer yourself a little love! The first exercise is a great one to do with a group, this group may even become a self-care support group! The second exercise is really designed to be done on your own.

EXERCISE: Building and Sustaining a Self-Care Practice: Identifying your Self-Care Needs and Preferences

If you are like most people (including myself), you have limited time in the day to practice self-care. This is activity is designed to help you prioritize the time you have for self-care. The intent of the exercise is to help you identify the self-care practices that bring you the most joy, and decrease your stress, and to identify the practices you engage in because you feel you “should”. You may already have a list of “shoulds” when it comes to self-care. I should be eating more vegetables. I should be exercising more. I should be sleeping more. The point of the exercise is not to add to this list, but to help you determine what self-care activities bring you joy, and which ones add to your stress.

When self-care is viewed from a lens of “I should be doing this,” it loses some of its ability to provide us comfort. That being said, eating a small portion of comfort food may be an act of self-care, but mindlessly eating comfort food to the point of feeling ill, or becoming unhealthy, is not self-care. This is where mindful awareness of our actions comes in.

This exercise is based on one from The Mindful Self-Compassion Workbook by Kristin Neff and Christopher Germer (2018). You can do it on your own, or with a study group. This exercise is designed to be a written self-reflection rather than a meditation, therefore, a journal or something to write on (or type on) might be helpful.

Reflecting on the following broad categories of self-care activities, list what you currently engage in. Rate whether it brings you joy or feels like work. Some of the activities that feel like work – like going to the gym – may be activities you want to keep, just acknowledge that they do not recharge you like other ones that bring you joy – like having coffee with a friend – does.

Then think of some self-care activities in this category that you might like to engage in. They do not have to be ones that will become a part of your everyday life but might be an occasional self-care activity (like a weekend away with friends) or a one-time event (like visiting an art museum).

As you do this exercise, I invite you to celebrate what you already do to take care of your body, your spirit, and your psyche, and to find time to do a bit more of what brings you joy so you can recharge as you continue to build and sustain a compassionate and self-compassionate approach to work and life.

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EXCERCISE: Practicing a Moment of Self-Care

This exercise is designed to be a brief moment of self-care – a meditation or prayer on acknowledging your needs and giving yourself permission to take care of them. It is my hope that this exercise gives you some ideas about how to fit such moments into your busy life. It should take about 5-15 minutes, perhaps even less if you feel pressed for time.

1. First find a comfortable position. You can do this exercise seated or lying down. You could even do it standing or walking!

2. Take a few deep breaths, and either with your eyes closed or open, do a quick body scan, starting with your feet. Notice any areas of tightness, pain, discomfort, or fatigue. Ask yourself what small act you can do to address this tightness, pain, discomfort, or fatigue. For example, if your feet are sore, perhaps they need to be rubbed. If they are tired, maybe they just need to be propped up for a few minutes. Maybe your whole body is tired. Perhaps you need a micro-nap. Or maybe you just realized you are thirsty or hungry. Whatever it is that you notice, take a few minutes to address it. For some of you this might be the extent of this exercise!

3. If you do not need to move to address your self-care needs, continue with the exercise. You might have noticed several parts of your body that need attention, but you do not have time to address them all. If that is the case you could try sending them some energy in the form of light, or gently massage the area if you can. If a part of your body needs rest, but you cannot take a long rest break at the moment, think of a color that is soothing and restful to you, and imagine this color surrounding that part.

If you identify that you feel sluggish but need to wake up, imagine some energetic color entering your body. Then you might go get a caffeinated beverage! As long as we do not overdo caffeine, or drink it at times when it will keep us awake, it can be beneficial by increasing our ability to stay alert. Additionally, something as simple as drinking a cup of coffee or tea can be an act of self-care – especially when we do so with a feeling of gratitude and appreciation.

Another small act of self-care that you can do is to engage in gentle movement. Movement can help alleviate tight muscles, can be calming, or can energize us. Stretching, doing one yoga pose, dancing to a song, singing a song, jumping up and down – whatever movement brings you joy and meets your need at that moment – is self-care. Sometimes if I have been sitting too long, but do not have time to take a walk, I will go up and down the steps a few times(either at home or in my workplace).

If you need psychological or spiritual self-care – a short prayer, meditation might be what you need. Or perhaps you need to read an inspiring short story, or an inspirational quote. If you need relational care – text a friend! If you feel being creative will rejuvenate you – you might doodle for a few minutes, or play one song on a musical instrument. The point is to find one small self-care activity you can do in the limited amount of time that you have.

4. Close the exercise with a moment of gratitude and appreciation that you found the time to do a small act of kindness for your body, your mind, your psyche, and for yourself. Know that it was enough for the moment. From time to time during your busy day, see if you can find time to pause and take stock of what you can do at that moment that would benefit your health and well-being.

5. If you are doing these exercises with a group, I invite you to share with each other what you did for your small act of self-care. As a group you can help each other brainstorm ways to get your self-care needs met, especially in the context of work. If you identify elements of the workplace that are getting in the way of your health and well-being, perhaps you can also figure out ways to overcome these obstacles.

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Now that you have had an experience with a brief moment of self-care, I invite you to make this part of your daily routine. Finding a whole day to spend in a spa is great, but since that is a rare event for most of us, figure out what you can do with just 10 or 15 minutes. One staff nurse that I worked with would routinely arrive at work 15-20 minutes early. She spent that time quietly reading in her car. Another co-worker would arrive at work early so she could go to the park near the hospital and feed the pigeons.

As I suggested in the exercise, another way to incorporate self-care into your day without too much effort is to take time to appreciate your coffee break or your meal break – either at home or at work (I am aware that breaks are rare for many nurses while they are at work!). Spend the time it takes you to drink a cup of tea, coffee, or water and eat a nourishing snack in mindful contemplation. Or, just spend a few seconds feeling a sense of gratitude for the food or drink and appreciating the nourishment it will give you. It is difficult for most of us to eat mindfully and to savor our food, and you may find you can just focus on one or two bites, but not the whole meal. Well, every little bit counts!

On days when I absolutely have no time to take care of myself, and when even meals felt rushed, I might take some moments when I was alone to close my eyes and focus on some deep breaths. Sometimes, even a short break like that can help relieve my stress and can re-set my mood. However, if it doesn’t, I know that at least I tried!

Conclusion

In this chapter I discussed the components of self-compassion. You probably realized the significant overlaps between self-compassion and compassion for others, and I hope you realized that when you strengthen your self-compassion you increased your ability to be compassionate towards others, and vice-versa. While I closed the chapter with a discussion of self-care, I want to emphasize that self-care (and self-compassion) alone are not the panacea for issues such as burnout, compassion fatigue and secondary traumatic stress (which I discuss in Chapter 8). Systemic changes are needed to improve working conditions for nurses. These changes will free us to provide better, and more compassionate, care for our patients, and will decrease our need for self-care after every working shift.

In the first chapters of this book, I introduced the topics of compassion, mindfulness, and self-compassion. If you want to explore any of these topics in more depth, I invite you to check out the list of resources that I have provided throughout Chapters 1 through 3. In the next part of the book, I will discuss how you can apply the concepts I have discussed here in your patient care, in your interactions with colleagues, in your leadership practice, and as an educator as you build and sustain a compassionate nursing practice. Even if you are not currently in a formal position of leadership or education, I invite you to look at these chapters, as every nurse has an informal leadership role, and every nurse at some point in their career will find themselves precepting a student nurse, orienting a new nurse, or educating a patient or their family.

Key takeaways from Chapter 3

• When we learn how to engage with our own moments of suffering with self-compassion, we improve our ability to respond to others with compassion.
• There are three main components of self-compassion: kindness towards ourselves, recognition of a common humanity, and mindfulness. All three of these components can be nurtured and strengthened through practice.
• It is important to learn how to respond with self-compassion when we make a mistake or fail to live up to our own expectations. This prevents us from responding with shame, with self-judgement, and helps us learn and grow.
• Taking care of our physical, mental, spiritual, social and creative needs is a form of self-compassion. While it may not be possible to find large blocks of time for self-care, it is possible to integrate small moments of self-care into most days.

Further reading

Brown, B. (2010). The Gifts of Imperfection. Center City, MN: Hazelden

Brown, B. (2015). Rising Strong. New York: Spiegel & Grau

Germer, C. (2009). The Mindful Path to Self-Compassion. New York: The Guilford Press.

Neff, K. (2011). Self-Compassion: The Proven Power of Being Kind to Yourself. New York: William Morrow.

Neff, K. & Germer, G. (2018). The Mindful Self-Compassion Workbook. New York: The Guildford Press

Silberstein-Tirch, L. (2019) How to Be Nice to Yourself: The Everyday Guide to Self Compassion. San Antonio, TX: Althea Press

References

Brown, B. (2012). Daring greatly: How the courage to be vulnerable transfomrs the way we live, love, parent and lead. Avery.

Brown, S. L., & Brown, R. M. (2017). Compassionate neurobiology and health. In E. M. Seppala, E. Simon-Thomas, S. L. Brown, M. Worline, C. D. Cameron, & J. R. Doty (Eds.), The Oxford handbook of compassion science (pp. 159-173). Oxford University Press.

Davis, M. A., Cher, B. A. Y., Friese, C. R., & Bynum, J. P. W. (2021). Association of US nurse and physician occupation with risk of suicide. JAMA Psychiatry, 78(6), 651. https://doi.org/10.1001/jamapsychiatry.2021.0154

Gilbert, P. (2013). The Compassionate Mind. Robinson.

Kemper, K. J., Schwartz, A., Wilson, P. M., Mahan, J. D., Schubert, C. J., Staples, B. B., McClafferty, H., Serwint, J. R., & Batra, M. (2020). Burnout in pediatric residents: Three years of national survey data. Pediatrics, 145(1), e20191030. https://doi.org/10.1542/peds.2019-1030

Marzband, R., & Zakavi, A. A. (2017). A concept analysis of self-care based on Islamic aources. International Journal of Nursing Knowledge, 28(3), 153-158. https://doi.org/10.1111/2047-3095.12126

McNamee, R. (2005). Regression modelling and other methods to control confounding. Occupational and Environmental Medicine, 62(7), 500-506.

Neff, K. (2011). Self-Compassion. Harper Collins.

Neff, K., & Germer, C. (2017). Self-compassion and psychological well-being. In E. M. Seppala, E. Simon-Thomas, S. L. Brown, M. Worline, C. D. Cameron, & J. R. Doty (Eds.), The Oxford handbook of compassion science (pp. 371-385). Oxford University Press.

Pembroke, N. (2016). Contributions from Christian ethics and Buddhist philosophy to the management of compassion fatigue in nurses. Nursing & Health Sciences, 18(1), 120-124. https://doi.org/10.1111/nhs.12252

Phillips, W. J., & Hine, D. W. (2021). Self-compassion, physical health, and health behaviour: A meta-analysis. Health Psychology Review, 15(1), 113-139. https://doi.org/10.1080/17437199.2019.1705872

Ryan, T. (2010). Aquinas on compassion: Has he Ssomething to offer today? Irish Theological Quarterly, 75(2), 157-174. https://doi.org/10.1177/0021140009360496

The Dalai Lama, & Chodron, T. (2017). Approaching the Buddhist path. Wisdom Publications.

Thurston, R. C., Fritz, M. M., Chang, Y., Barinas Mitchell, E., & Maki, P. M. (2021). Self-compassion and subclinical cardiovascular disease among midlife women. Health Psychology, 40(11), 747-753. https://doi.org/10.1037/hea0001137

Wang, Y., Fan, L., Zhu, Y., Yang, J., Wang, C., Gu, L., Zhong, S., Huang, Y., Xie, X., Zhou, H., Luo, S., & Wu, X. (2019). Neurogenetic mechanisms of self-compassionate mindfulness: The role of oxytocin-receptor genes. Mindfulness, 10(9), 1792-1802. https://doi.org/10.1007/s12671-019-01141-7