By Angela McCasland, LCSW, OSW-C 

As oncology social workers, we stand alongside our patients and bear witness to the suffering caused by cancer. We often use phrases such as “give yourself grace” or “take things one day at a time,” which offer little guidance on exactly what that means. By utilizing Acceptance and Commitment Therapy (ACT) in relation to self-compassion, we can provide a more strategic way for patients to put self-compassion into practice.  

There is a constant theme of self-compassion throughout ACT. The aim of ACT is to create a meaningful life through committed actions while accepting the pain that inevitability goes with it (Harris, 2009). Similarly, self-compassion suggests that being kind to ourselves inwardly allows us to cope with the pain of life without becoming derailed by it (Neff & Germer, 2022).  

The six core therapeutic processes of ACT can all be traced back to three components of self-compassion: mindfulness, kindness, and common humanity. For example, in ACT, contacting the present moment, cognitive defusion (detaching from our thoughts, images, and memories rather than getting caught up in them) and acceptance are all aspects of mindfulness (Harris, 2009). Values and committed action are aspects of kindness and self-as-context/flexible perspective taking are aspects of common humanity.  

So, how do we effectively utilize self-compassion through an ACT lens with our patients? Put simply, when practicing self-compassion, we acknowledge the pain/suffering and respond with compassion/kindness. Easy enough, right? According to Harris (2009), self-compassion exercises can be brief and there’s room for flexibility. They don’t have to involve long, formal meditative style interventions.  

There are a range of self-compassion activities to choose from but the simplest form is through non-judgmental self-talk via acknowledgment. 

• Patient Kindly Acknowledges Pain:
  “This is really painful.” “This is really difficult.” “This hurts.” “I’m noticing sadness.” “This is a moment of suffering.”
  We want the patient to express an emotion that resonates, or they can use a more general word such as pain or hurt. 

• Follow up with a kind statement:
  “May I be kind to myself in this moment.” “May I treat myself with kindness.” “Be easy on yourself.”
  These are a few examples but ultimately, we want this statement to be coming from the patient’s inner voice.  

We can think of this self-talk as a mantra that the patient can fall back on during difficult times. Also, keep in mind, not everyone identifies with the term self-compassion. Feel free to adapt your approach in a way that resonates with each individual patient. I typically fall back on a four-tiered approach: 

1. Acknowledging the painful emotion  
2. Opening up to the emotion  
3. Kind self-touch 
4. Use of self-kindness statement  

During my interactions with patients, this usually sounds something like:  

1. As you’re sharing this with me, what emotion is coming up? 
2. Is there a place in your body where you’re feeling this emotion most? 
3. I wonder if we can give ourselves some extra support here. Can we hold the emotion with some compassion/kindness? Imagine that your hands are holding warm, comforting and supportive energy. Now, place your hands on the area of your body where you feel the emotion most, or you can simply place a hand on your heart, or use both hands, placing one on the belly and one on the heart. How does it feel to hold yourself in this way or what are you noticing as you do that? 
4. As we soften up to this pain or this emotion, is there something kind you can say to yourself in this moment? Some examples: “This is a moment of pain, may I be kind to myself” “I’m noticing/Here is/This is (enter emotion), Be easy on yourself” etc.  
5. What was that like for you? Would you be able to experiment with this more at home? I say “experiment” because sometimes it may work, and sometimes it may not and that’s okay!  

We want to keep in mind that many of us have been living with our internal self-critic for a long time. It’s possible you will encounter patients that have difficulty expressing compassion towards themselves. In cases like these, we want to be sure to validate how strong our self-critic or challenging thoughts/emotions can be. I’ve also found it helpful to introduce the skill of Taking the Perspective of a Loved One. If someone you loved and felt endearment towards was going through this same situation, what would you tell them? The message would likely be a kind one. Isn’t it interesting how we can nurture and be kind to others in moments of suffering, however, have difficulty doing that for ourselves?      

Overall, patients have reported that their distress decreases after being guided through this simple exercise. Offering support is key in our role and within that role, we also want to empower patients to support themselves. Self-compassion strategies through the ACT lens generally transform a validating pat on the back into a practical tool that patients can utilize to self-soothe throughout treatment.  

If you’d like to connect to discuss self-compassion approaches more or would like to share what has worked for you, please email me at Angela.McCasland@usoncology.com.  

References

Neff, K. D. & Germer, C. (2022). The role of self-compassion in psychotherapy.  World Psychiatry, 21 (1), 58-59. https://self-compassion.org/wp-content/uploads/2022/01/World-Psychiatry_February-2022-Neff-Germer.pdf 

Harris, R. (2009). ACT made simple. New Harbinger Publication, Inc.