COMPASSION IS THE cornerstone of healthcare work. It is a fundamental component of the care provided by healthcare workers, coupled with devotion and hope against disease and despair.

On a typical day, tending to the physical and emotional needs of others involves risks of emotional exhaustion and burnout. In the depths of a global pandemic, these risks are significantly heightened.

While many adjust to working from home or not working at all, frontline workers have a range of adjustments to make. The demands on the compassion and energy of healthcare workers are greater and the possibility of experiencing ‘compassion fatigue’ as a result of vicarious trauma is amplified in what can only be described as a traumatic event. 

How does trauma manifest?

Having consulted with nurses working in hospitals and ICU units in the UK and Ireland, it’s apparent that this may manifest in a range of ways, from extreme emotional responses (‘‘Why can’t I control my emotions?’) to no emotional response at all (‘Why don’t I cry? Am I desensitised? Am I numb?’).

Intrusive thoughts, those thoughts that almost feel ‘stuck’ in your mind, and images may interfere with sleep or rest periods and chronic stress may increase cortisol levels and compromise the immune system at a time when it is most in demand.

Frustration may surface (‘I wouldn’t need to be hailed a hero if we were just provided with adequate equipment’, ‘How can my friends complain about being bored?’) as frontline workers are forced to separate from loved ones in times when they need them the most. Ultimately, compassion reservoirs may be running low. 

When it comes to alleviating this stress in times of crisis, self-care is a buzz word whose components certainly offer some promise of relief, but research has shown that even more crucial to maintaining wellbeing is the emotional state of self-compassion.

If compassion involves the motivation to relieve the suffering of others, self-compassion is that same attitude directed inward, particularly in the face of perceived inadequacy, failure or general suffering.

Pioneering self-compassion researcher Dr Kristen Neff has identified three main components to self-compassion, all of which have been linked to increased psychological well-being, resilience and mental health:

• Self-kindness entails meeting difficulties with warmth and caring toward ourselves, approaching these experiences with a more flexible and understanding stance (‘I did what I could under the circumstances’).

• Common humanity recognises the shared human nature of suffering and imperfections (‘I’m not the first person to feel this way’), rather than feeling ‘abnormal’ or alone.

• Mindfulness in this context refers to the ability to be open to and acknowledge painful experience rather than suppressing it, with a non-reactive, balanced awareness (‘this all feels overwhelming’).

Taken together, these three components are in fact the precise opposite of a common instinctive reaction to distress – self-criticism, self-isolation and self-absorption. 

Striving for ‘success’

One of the barriers to cultivating self-compassion is the misconception that self-criticism is a good thing and that pushing ourselves hard is required for success (‘I could have done better’).

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In this vein, self-compassion may be dismissed and viewed as weakness, complacency or even selfishness. However, there is some research showing that self-criticism diminishes resilience in the face of suffering, reduces our capacity for compassion and is a risk factor for depression.

Self-compassion, on the other hand, can be a powerful agent of change, fostering resilience, optimism and physical health, even serving as a protective factor against stress-induced inflammation and disease.

Acting from a compassionate stance takes one out of threat response mode, allowing the executive functions of the brain to come back online and enable more effective, creative and deliberate decisions and responses. Fundamentally, self-compassion is vital in order to maintain compassion for others; caring for others requires caring for oneself.

Importantly, self-compassion is learnable and can be trained. Below are some tips and links to resources from key self-compassion researchers that may help you to begin to cultivate a self-compassionate attitude in this crisis and create a space to place oneself as the object of care and concern:

• Become more aware of your emotions at this time, meeting them with acceptance and acknowledgement, allowing them to be felt and processed.

• Refrain from self-judgement or criticism, try to recognise when the inner critic is active and catch these thoughts and become aware of them.

• Expect and accept a range of emotional and physical responses to this situation, from heightened sensitivity or irritability to fatigue.

• Ask yourself how you would respond to a friend who was having a similar thought or experience to you. What would they need to hear? How would you convey compassion and understanding to them?

• Take each day at a time, trying to be present in the here and now as much as possible, particularly during moments of rest and leisure.

• Have patience with yourself, recognise your limits and set boundaries with others.

• Engage only in things that bring you a sense of comfort at this time – ensure your free time is spent fulfilling your own individual needs and avoid comparison with others.

Resources: Kristen Neff is widely regarded as a global expert on self-compassion. The Compassionate Mind Foundation also does great work in this area, as does the Center for Mindful Compassion in the US. Louise Boland has a Masters degree in the Psychology of Mental Health. She currently works in a rehabilitation centre with clients recovering from addictions.