Self – Compassion in Inflammatory Bowel Disease

It’s easy to like ourselves when things are going well in our lives. We feel competent, friendly, smart, and energetic. We get out of the house, do things we love, go to work or school, and often feel like we have achieved something in our day.

When we’re struggling with Inflammatory Bowel Disease, especially in a flare, the symptoms can take their toll on both our physical and psychological well-being. When we are sick, fatigued, or even spending long days in hospital, taking long periods off work/school, unable to engage in activities we enjoy or even spend time with people that we love. We are often unable to fulfill tasks that give us a sense of achievement when we’re well – even showering or self–hygiene can be impossible some days! These experiences can in turn fuel self-blame and other negative self-evaluations about not being able to meet personal and others’ expectations and create a downward spiral of poor well-being. People living with IBD can sometimes see themselves as useless, broken, stuck, or even unlovable as a result of their condition. Our self-esteem, and sometimes even our self - worth can plummet.

A growing evidence base suggests that self-compassion is an important quality to help manage the stress and behavior-related issues that can compromise chronic illness care.

What is Self–compassion?

Dr. Kristin Neff, a prominent researcher in the area, defined self-compassion as “taking a kind, accepting, and non-judgmental stance towards oneself in times of failure or difficulty”, self-compassion is associated with several indicators of adjustment, including resilience in times of difficulty. While it may be difficult to be compassionate towards ourselves when we are in an IBD flare, research has shown that practicing self-compassion may be especially beneficial for those with chronic health conditions. Self–compassion is associated with reducing stress, improving illness self-management skills and health-promoting behaviors, changing one’s relationship with illness-related shame and self-blame, and boosting resilience.

Through decades of research, Dr. Neff outlined three key features that comprise self-compassion: self-kindness, common humanity, and mindfulness.

Self-kindness

Living with IBD offers a constant temptation to self-blame. When illness flares, we may blame ourselves for getting sick. “If only I took better care of myself . . . “ “Why did I overdo it at work last week?” “If I can’t calm my stress levels, then it’s no wonder my disease is active.” Sound familiar? And then there is the further self-criticism about all the things we can’t do when we feel sick. “My house is a mess.” “I’m behind on my work; I’m so stupid.” “Nobody would want to be around me; I’m just a negative, lazy lump on the sofa.”

What if we try something different and treat ourselves with kindness? We can do this by talking to ourselves like we would a friend or a loved one. So for example, instead of chastising ourselves when we are in a flare, we could try to understand it. “I feel so blah when I’m sick, and that’s okay. I can’t expect myself to be energetic and cheerful when I’m hurting.” Or “I do tend to overdo things in a way that can make symptoms worse. Sometimes I just so want to be ‘normal’ that I forget that I have IBD. I’ll try to take better care of myself in the future, but I can feel empathy for the part of myself that wants to do everything.” What would it be like to talk to yourself in this way?

Remember: Self–kindness often does not come naturally to us. It can feel uncomfortable or even a bit weird to begin with. Try not to criticize yourself for not mastering self-kindness right away! This is a process that can be tricky to begin with and generally becomes more natural with lots of practice. So when your inner voice tells you that you’re horrible at self-kindness, just notice it and say, “I’m a work in progress, and I’m practicing something hard.”

Common Humanity

Research has found that another important component in developing self-compassion is maintaining a belief that painful experiences are part of the human condition and that we are not isolated in our suffering.

While we know that pain and loss are part of every person’s life, it can be easy to forget this when we are in the throes of our own suffering. The loneliness of isolation of living with IBD can bring up many difficult thoughts such as “Why me?” “ No one understands what I going through”. These thoughts can further isolate a person and can be one of the most painful experiences associated with chronic illness.

This idea of common humanity refers to seeing our struggles as core components of what makes us human, rather than as personal failings that separate and isolate us from other people. We can all imagine that “everyone else is doing better than I am!” (which, unfortunately, we have often been conditioned to do). These thoughts can begin that spiral into low self–esteem or self-worth that increases risk for mental health distress.

When we live with IBD it can be helpful to remember that struggling in life doesn’t mean there is something wrong with you. It means you are human!

Mindfulness

Finally, self-compassion is cultivated by attention to mindfulness. Mindfulness is essentially an awareness of the present moment; noticing your emotional state, thoughts, and what is happening in the now rather than becoming sucked in and spiraling with them. Importantly, mindfulness does not mean ignoring, getting rid of, or denying our uncomfortable feelings. On the contrary, it’s important that we pay attention to them. What mindfulness practices is becoming aware of and not getting stuck in those feelings.

When sadness overtakes you, for example, allow yourself to feel the sadness, perhaps as an ache in your chest or a lump in your throat. Say to yourself “Here is sadness. It is OK to be sad, it is part of being human and eventually it will pass.” We try not to blame ourselves for feeling sad or cling to the belief that sadness will last forever. We simply sit with it and breathe, allowing it to come and go.

So, how do you get started with Self–compassion?

We know that self-compassion is linked to lower stress levels, increased resilience, and adaptive coping. We know that it’s been positively shown to improve well-being in people living with chronic illnesses including IBD.

Here’s the thing: Self-compassion is not something we pull out when we’re ill and forget about during our relatively good periods. Rather, it’s a way of being that radically changes how we see ourselves at all times and in all dimensions of our lives, not only through our condition. We want to be practicing it every day so that when the going gets really tough we will have it in our toolbox to draw upon.

Here are examples of some small changes that can have large effects.

Self-kindness: Find a self-kindness mantra that you can pull out when you start to blame or self–criticize. For example; “Nobody’s perfect.” “All will be well.” “This too shall pass.” “I’m only human.” “I’m choosing to give myself a break.”

Common humanity: Find small ways to experience connection with the people around you. Connect with a friend you haven’t seen in a while. Make small talk with the check-out person at the café or shop. Smile at someone when out for a walk. Let that car out in front of you. Practice empathy for others, trying to understand what it may be like to be in their shoes. Notice how we all suffer and that is ok.

Mindfulness: Practice meditation – which can even be as short as 1 minute. The good news is that it’s not too difficult to work meditation in our daily lives, as smartphone apps and websites offer a variety of short and lengthier guided meditations. Headspace, Calm, and Smiling Mind are examples of Meditation Apps. There is also plenty of free meditations on YouTube or Spotify – just search “guided meditation”

There are specific Self – Compassion meditations on Dr. Kirsten Neff’s website https://self-compassion.org/category/exercises/#guided-meditations

If that feels like too much, simply take a few deep, intentional breaths when you think of it, noticing with pleasure the air moving in and out of your lungs. Take a moment to notice what it is like to be present in the moment.

When it comes to self–compassion, little steps can take us a long way. Remember, it can be hard to begin with and especially difficult when you are sick, but by showing ourselves some kindness, we can improve our physical and mental well-being.

What is one way you can practice Self–compassion today?

Take care,

Aideen Stack

Health Psychologist