Self Compassion and Brain Injury

Kyla Pearce, CBIS, RYT-200, MPH, PhD Senior Director of Programs and Research, LoveYourBrain Foundation

Imagine you’re experiencing intense pain from chronic headaches. If you’re practicing self-compassion, you’re able to notice your pain and say something to yourself like, “I understand there’s a lot of pain right now. You’re not alone. I know you’re doing the best you can. I’m here for you.” But without self-compassion, your narrative would be something more like, “I can’t believe I’m in so much pain. Why won’t this pain go away? No one understands. I can’t do anything right.”

How does it feel for you to read these different approaches? The truth is, we all intuitively know that meeting difficulty with warmth and care matters, but most of us have never learned how to approach our own pain in this way.

Brain injury comes with wide ranging psychological, physical, behavioral, and cognitive impacts, often leading to isolation and difficulty adjusting to the person they are now. And, while the risk of developing depression and anxiety increases substantially, access to evidence-based therapy is limited (Sharma et al., 2015).

In the past few decades, a growing body of research has shown that self-compassion interventions can improve a variety of health outcomes common among brain injury survivors, including anxiety, depression, rumination, self-criticism, and stress. Neuroscience shows us that compassion increases activity in the areas of the brain involved in dopamine and oxytocin release, and thus enhances positive emotions in response to adverse situations.

Self-compassion means to treat oneself with warmth and understanding in difficult times and recognize that making mistakes is part of being human. According to Kristin Neff, PhD, a leading researcher on this topic, there are three main pillars of self-compassion:

• Mindfulness – To pay attention to our present experience non-judgmentally. When we’re being self-compassionate, we must first turn towards our own difficulties instead of avoiding them. We bring our attention inwards to acknowledge our feelings, thoughts, and sensations with open-heartedness and curiosity. This is in contrast to how we often approach our difficulties, where we so easily fall into patterns of blame, self-pity, and judgment, or run away from them altogether.
• Self-Kindness – This refers to your inner voice, which might sound more like an inner critic. When you’re practicing self-compassion, you treat yourself the way you treat someone you respect and appreciate – with gentleness, kindness, and care. Instead of criticizing yourself each time you mess up or feel inadequate, you acknowledge, “I’m human and make mistakes. What can I learn from this?”
• Common Humanity – Common humanity reminds us that we’re not the only ones struggling. This contrasts what typically happens, where our difficulties leave us feeling further isolated and that no one understands what we’re going through. Yet, we all have something in common – we’re all struggling in some way, and we all wish to find peace. Ultimately, our suffering connects each of us even more deeply to what it means to be human.

Several studies specifically within brain injury have begun to explore the benefits of self-compassion for improving psychological health and self-coping. For example, a study of 12 people with ABI participated in group Compassionate Focused Therapy (CFT) as part of their neurorehabilitation. Compassionate Focused Therapy is a type of psychotherapy that aims to help people develop kinder thinking habits. In this study, self-reported pre-post data and qualitative interviews revealed improvements in anxiety, depression, and ability to self-soothe. Participants perceived that CFT gave them tools to effectively manage continued psychological difficulties, like shame and self-criticism, which have been found to undermine adjusting to life after brain injury.

Acceptance and Commitment Therapy is another evidence-based intervention that integrates self-compassion as a key strategy for psychological health after trauma. It’s rooted in the “four A’s” framework: Acknowledge, Allow, Accommodate, and Appreciate, and has been successfully adapted to address common cognitive impacts of TBI using visual materials, experiential activities, and repetition. In this randomized controlled trial, 93 individuals with mild-moderate TBI participated in either an eight-week ACT program or an active control group. The results showed participants in the ACT intervention experienced significantly greater reduction in psychological distress on the Brief Symptom Inventory and improvements in psychological flexibility.

In summary, self-compassion can support people with brain injury to:

• Better self-regulate by acknowledging what’s happening in the moment without over-identifying with it. This skill is critical for emotional regulation and managing depression and anxiety, since it offers more perspective to work with thoughts, feelings, and behaviors that can undermine mental health.

TIP: Try acknowledging, “I understand there’s a lot of pain right now,” instead of being overwhelmed by “I can’t believe I’m in so much pain.”

• Improve psychological adjustment by using kinder self-talk to interrupt self-criticism, self-compassion doesn’t mean that we get rid of negative thoughts (as much as we may want to!), instead we notice them and then gently shift our attention to more helpful thoughts as best we can.

TIP: Try encouraging yourself like, “I know you’re doing the best you can. I’m here for you,” instead of being self-critical, “I can’t do anything right.”

• Counteract isolation by remembering that they’re part of a larger community of people who also struggle. This is important because isolation is one of the primary predictors of depression and suicide among the brain injury community.

TIP: Try reminding yourself, “You’re not alone,” instead of, “No one understands.”

Moreover, research also suggests self-compassion reduces symptoms of posttraumatic stress disorder (PTSD), which occurs more often after TBI. PTSD encompasses three symptom categories (arousal, avoidance, intrusions), which closely correspond to the stress response (fight–flight–freeze) and to our reactions to internal stress (self-criticism, self-isolation, and self-absorption). Self-kindness can have a calming effect on autonomic nervous system hyperarousal, common humanity is an antidote to shame, and mindfulness allows us to disentangle from intrusive memories and feelings (Germer and Kneff).

Ultimately, more research is needed to continue to understand the effectiveness and optimal design timing of self-compassion interventions following brain injury. In the meantime, accessing resources specific to the brain injury community is a helpful starting point:

• Practice meditation that emphasizes mindfulness and kindness. “Loving kindness meditation” has been shown to increase positive emotions, feelings of purpose in life and social support, and to decrease illness symptoms (Fredrickson et al. 2008) and stress-linked immune responses (Pace et al. 2009).
• Explore a range of self-compassion meditation and self-inquiry practices, including a Self- Compassion Break.
• Sign up for free programs for the brain injury community that offer guidance in self-compassion.