As the current COVID-19 pandemic rages on, physicians are facing increasing risk of stress and burnout. Various conditions have been linked to the onset of physician burnout: repeated exposure to patients’ pain and suffering; shouldering the burden of responsibility to help patients; limited control over patient outcomes; frustration in navigating the health care system; the intensity and duration of work; and the lack of sufficient emotional and psychological skills to cope with ongoing stressors.
A crucial issue related to physician burnout that is gaining more attention is self-compassion, i.e., extending the same compassion to yourself as you would give to others. In fact, it’s been argued that genuine compassion for others first requires compassion for oneself. Top
Compassion is often confused with empathy and these terms are used interchangeably. However, there are important distinctions. Empathy relates to an awareness of another’s experience, both their cognitive and emotional states. Compassion relates specifically to contexts of suffering and the alleviation of it; in other words, take action. One’s empathy in response to others’ suffering could be a source of distress and inaction, if it is not accompanied by a compassionate wish to act. This has been supported by research on functional neural plasticity using fMRI. Multiple studies suggest that increasing compassion may reflect a novel way to overcome empathic distress and strengthen resilience. Excessive empathy can indeed cause compassion fatigue and distance clinicians from their patients, whereas compassion is better understood as a potential therapeutic intervention for such fatigue.
A growing body of literature on self-compassion highlights its benefits to clinicians’ well-being and its potential to enhance care for patients. Compassion and self-compassion are skills that must be cultivated and practised regularly. For example, compassion training with medical students can significantly improve resiliency, wellness, and happiness, while decreasing worry and emotional suppression. Self-compassion may also serve as a protective factor against stress-induced inflammation and inflammation-related disease. As such, self-compassion may act as a positive emotional counter to the negative aspects of stress and burnout. Top
Dr. Kristin Neff,1,2 who has studied the processes and benefits of self-compassion extensively, has developed a set of practices to enhance compassion skills. She identifies three core components: self-kindness, common humanity, and mindfulness.
Self-kindness refers to extending the same kind of support and encouragement to ourselves as we would toward others we care about. Some physician cultural patterns lend themselves to harsh self-criticism, self-judgement, feelings of inadequacy, focus on shortcomings, and self-berating. Self-kindness counters these tendencies. Instead of attacking and berating ourselves for being less than perfect, we can offer ourselves warmth and unconditional acceptance. When external life circumstances are challenging and feel too difficult to bear, we can engage in active soothing to comfort ourselves — much like a parent may extend to their child or a loved one, who is suffering. Top
Unfortunately, self-kindness is not a culturally valued response, particularly among physicians, who are often taught to be stoic and silent in their own suffering. Self-kindness requires us to understand our foibles and failures instead of condemning them. It entails clearly seeing the extent to which we harm ourselves through relentless self-criticism. The next time you catch yourself in self-criticism, try giving yourself a gentle hug, or simply holding or stroking your own hand or arm. These kinds of simple embraces have been shown to make suffering more bearable and even release oxytocin — the neurochemical involved in the calming reflex.
Common humanity refers to the sense of interconnectedness we feel with others. All humans are flawed works-in-progress, everyone fails, makes mistakes, and experiences hardship in life. Connecting to our common humanity honours the unavoidable fact that life entails suffering for everyone, without exception. When things go wrong or not the way we expected them to go, we often think we are at fault. We forget that this is perfectly normal and natural. In addition, physicians often isolate themselves when they are struggling. Instead of reaching out for support, they will often blame themselves for not being able to cope better with stress. Top
Remembering that pain and failure are part of the shared human experience and normalizing that allows us to feel more connected with others. Tapping into our common humanity is a reminder that there are forces beyond our control. It requires accepting what you can change and having the wisdom to let go of what you cannot change or directly impact. Dr. Neff suggests that, when we find ourselves suffering or feeling disconnected from others, we repeat the following phrases to ourselves: “We all make mistakes. We all fail. This is part of the human experience. May I be safe, may I be peaceful, may I be kind to myself. May I accept myself as I am.” 2
Mindfulness involves being aware of moment-to-moment experience in a clear and balanced manner. It means being open to the reality of the present moment, allowing all thoughts, emotions, and sensations to enter awareness without resistance or avoidance. Often, when we are stressed or challenged, we get so caught up with problem-solving that we don’t pause and consider just how difficult the moment is for us. However, when we mindfully observe our condition, we can acknowledge the struggle and suffering without contributing to it, thus allowing us to adopt a more constructive and objective perspective on ourselves and the situation. In fact, being mindful is the first step toward self-compassion.
A useful way to develop mindfulness is to practice noticing. Take a few moments throughout the day to make a mental note of the thoughts, emotions, and sensations that arise in the moment. At first, try to do this for about two minutes, starting with observing your breath, then noticing any thoughts that arise, feelings, or body sensations without getting wrapped up in them. This noticing practice has been shown to be effective in dealing with challenging situations by reducing stress, and it can be used in any situation.