How Self-Compassion Helps with Anxiety

Anxiety can be a loud voice in your head telling you that something bad is going to happen.   Your heart rate starts to quicken, your thoughts speed up, and you feel a knot in your stomach. At times, you might feel disconnected from yourself or the world around you.

Moments in which you are experiencing anxiety can be quite uncomfortable. They can also be an opportunity to practice relating to yourself with self-compassion.

What is Self-Compassion?

Self-compassion has three parts:

  1. Self-kindness (instead of self-judgment)
    Self-kindness involves opening up to your experience in the present moment, whether feelings of joy or sadness, and acknowledging your experience with warmth and love.
  2. Common humanity (instead of isolation)
    Self-compassion includes an acknowledgement that suffering is a normal part of being a human being. Often we feel alone or isolated in our suffering, but it is actually what connects us to others.
  3. Mindfulness (instead of over-identifying)
    Mindfulness involves observing thoughts and feelings, rather than identifying asthoughts and feelings. There is a difference between noticing the content of your thinking (e.g., “I’m having the thought that something bad is going to happen”) and taking your thoughts at face value and buying into the content of your thinking (e.g., “Something badis going to happen”).

One important study found that more self-compassion is associated with less symptoms of anxiety and depression. This does not mean that people engaging in self-compassion do not feel anxious or sad sometimes. They certainly do, as do all of us. However, welcoming rather than criticizing experiences of anxiety allows us to let go of struggling with anxiety, helping us let go of harsh judgments of ourselves and our experiences.

One of the great things about self-compassion exercises is that they can be practiced at any time. You can feel incredibly sad, anxious, or frustrated with yourself, and begin to build a habit of self-compassion.

How Do I Practice Self-Compassion?

Dr. Kristin Neff is probably the world’s leading expert on self-compassion and one of the key exercises she teaches is something called the “Self-Compassion Break.”

The exercise is done when you are in the midst of a situation that is causing your suffering or you are feeling something like anxiety, frustration, sadness, or any other painful emotion. You can use this exercise during any moment where you are having a hard time. The basic instructions include three steps:

  1. Acknowledge the pain or discomfort that you are feeling. You might say, “This is a moment of suffering.”
  2. Acknowledge your connectedness to others. You could say, “Suffering is a part of life.”
  3. Put your hands over your heart and say, “May I be kind to myself.”

If you want to hear an audio version, you can listen to it here. For a more detailed description of the exercise, see here. Once you practice the exercise a few times, you’ll find you can do it quite quickly whenever you need it.


Relating to your anxiety with self-compassion can help you make space for it, allowing it to be, rather than getting caught in a prolonged game of “anxiety tug-of-war.” Through self-compassion–through learning to relate to yourself and your experiences with kindness and compassion–you can learn to let go of internal struggles and connect more fully with the world around you.

For more self-compassion meditations or exercises, you can visit Dr. Neff’s resources or resources compiled by Portland Psychotherapy.

Click here to learn more about Anxiety Treatment at Portland Psychotherapy

Self-Help for Anxiety in an International Sample

Since I saw him present on some preliminary results at a conference 6 years ago, I’ve been following with interest University of Albany – SUNY professor John Forsyth’s, PhD, research on his self-help book, The Mindfulness and Acceptance Workbook for Anxiety. (The Workbook was recently published in a 2nd edition but the research is on the 1st edition.)

The Workbook is based on Acceptance and Commitment Therapy (ACT) principles, and it is designed to treat a wide range of anxiety-related problems (it’s “transdiagnostic”).

Self-help books have great potential to help people who don’t have access to or don’t want to pursue psychotherapy. Unfortunately, self-help books are rarely based on well-researched treatments, let alone studied themselves as standalone treatment. Dr. Forsyth and his co-author Dr. Georg Eifert have been working very hard to make their book an exception.

The Most Recent Study

In the most recent published study, Dr. Forsyth’s lab gave out copies of the Workbook to a large (503 people!) international sample—mostly American, with people from the UK, Canada, Australia, New Zealand, and other countries. Participants either received a copy immediately, or they were assigned to a 12-week waiting period before receiving a copy. They completed questionnaires before receiving the book and 12-months later, with follow-up assessment at 6 and 9 months. All waitlist participants received a copy after 12-weeks and completed the same post-treatment and follow-up measures.

Contrary to research studies of self-help books that may include regular phone consultation or other forms of therapist/researcher contact, Dr. Forsyth’s lab deliberately chose to not offer guidance for participants using the Workbook in order to examine how useful it was in the way it would normally be used.

What They Found

The sample included people with generalized anxiety disorder, OCD, major depressive disorder, panic disorder, obsessive-compulsive disorder, social anxiety disorder, and posttraumatic stress disorder, among other conditions.

Participants in both conditions showed improvements in anxiety, depression, worry, quality of life, mindfulness, and self-compassion after using the book, and some continued to show improvement at the 6 and 9-month follow-ups. As a comparison sample, people on the waitlist did not show significant improvement until after receiving and working through the Workbook.

What was really interesting is that some of the improvements in scores on the measures were comparable to studies that involved individual ACT treatment delivered by therapists.

Summary

Dr. Forsyth’s recent publication offers further evidence that The Mindfulness and Acceptance Workbook for Anxiety is a helpful, cost effective treatment option for people struggling with a variety of anxiety-related problems. In my work as an anxiety specialist, I recommend this book more than any other because of the strong research support behind it—and because it offers a number of useful worksheets and recordings.

Here’s a link if you want to check out the 2nd edition of The Mindfulness and Acceptance Workbook for Anxiety.

If you or some you know is struggling with anxiety-related problems, please check out the Portland Psychotherapy Anxiety Clinic.

Evaluating Self Help: The Mindfulness & Acceptance Workbook for Anxiety

There’s no shortage of self-help books on the market. There is, however, a paucity of research on whether those self-help books are actually helpful to the people who use them. In an ideal world, every self-help book would be submitted to scientific scrutiny to determine if people actually benefit from using them. Unfortunately, this happens only rarely.

Even a self-help book that is based on well-researched cognitive behavioral principles and written by leaders in the field is not guaranteed to be effective.  For example, one recent study found that college students with greater rumination exhibited more depressive symptoms after using Greenberger & Padesky’s Mind over Mood, a well-respected cognitive behavioral self-help book for depression. These findings suggest that evidence-based psychotherapy interventions don’t always translate into effective self-guided techniques that people can use on their own, and in some instances can actually be harmful.

The Mindfulness & Acceptance Workbook for Anxiety

Over 5 years ago, I wrote a few blogs posts about Forsyth & Eifert’s The Mindfulness & Acceptance Workbook for Anxiety in 2 prior blogs for which I used to contribute. The first, on my blog Scientific Mindfulness, reported on pre-publication research I heard about at a conference. (Unfortunately, it appears the other post has been taken down.) The first author of the workbook, SUNY-Albany professor John Forsyth, PhD, conducted 2 studies on his ACT-based self-help book. He gave copies of the book to people for free, and had them complete online self-report measures at various intervals.

Dr. Forsyth recently posted a summary of this research on his personal blog in anticipation of the upcoming 2nd edition of The Mindfulness & Acceptance Workbook for Anxiety that will be released April 1, 2016. One paragraph in his blog post caught my attention:

Reductions in anxiety and fear did not happen by going after anxiety and fear directly. It was just the opposite. By first focusing on the skills needed to live a more valued life, readers then experienced a decline in their anxiety, fears, and depression, and ultimate improvements in their lives. This is an important message––one that supports the approach we offer in this workbook.

The workbook emphasizes ACT skills to help people engage in meaningful living, and it appears that those skills—rather than interventions aimed at alleviating anxiety and worry—appear the most effective.  Said another way, the findings suggest that people using the workbook improved more from doing things that were important to them than from any particular technique. This is quite profound, if you think about it, and very different from how many people approach anxiety. Attempting to directly suppress or control anxiety-related thoughts and feelings can often backfire.

Because it’s one of the rare self-help books that has been researched specifically as a self-help book, I find myself recommending The Mindfulness & Acceptance Workbook for Anxiety more than any other self-help books, and I was excited to hear there’s an updated edition coming out. I encourage readers to check it out.

Anxiety Treatment at Portland Psychotherapy

CNN Article on Religious-Themed OCD (aka Scrupulosity)

CNN featured a nice article on a lesser known subtype of obsessive-compulsive disorder (OCD)–Scrupulosity. This involves religious-themed obsessions, such as fear of blaspheming, fear of going to hell, or a sense that you are inherently bad. Rates of OCD are no higher in more orthodox religious communities, but rates of scrupulosity are, which provides an interesting illustration of how history and environment can influence the particular form that OCD takes.

The article quotes well-known OCD expert Jonathan Abramowitz, PhD, a professor at the University of North Carolina-Chapel Hill.

From the article:

“Scrupulosity often involves a lot of checking, Abramowitz said. Patients experience distress around the idea that they may have done something wrong or improper, so they may consult the Bible or religious authority figures often to see if they’re doing things right. Consulting people and books isn’t pathological, but in scrupulosity the behavior of checking is excessive compared to other religious people.”

I’m glad to see scrupulosity getting national press, as many people don’t understand it and aren’t aware that it’s an expression of OCD. Click here to read the article.

Anxiety Treatment at Portland Psychotherapy

A Yale Graduate Student’s Account of Her Struggle to Find Effective Treatment for OCD

At Portland Psychotherapy, we are passionate about offering evidence-based treatment and promoting training in effective treatments to other professionals. I recently came across this opinion piece by a Yale graduate student recounting her struggles to find effective treatment for obsessive-compulsive disorder (OCD).

I think this article offers both a good description of some of the things someone with OCD struggles with, and it illustrates the unfortunate barriers many people face in receiving effective treatment–even in an instutuion such as Yale, and by someone who has educated herself about the type of treatment she needs. She writes:

“Despite knowing exactly what treatment to ask for, it took nearly a year to receive what I hope will be acceptable care at Yale Health.” 

You can read the full article here.

I’d like to thank the Association for Behavioral and Cognitive Therapies for bringing this article to my attention.

Anxiety Treatment at Portland Psychotherapy

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