When Mindful Self-Compassion Turns Painful: How to Work With "Backdraft"

Physicians and other healthcare professionals naturally extend compassion to others; they want to ease suffering. This deep urge calls many into Medicine as their vocation, despite realizing that the path will be difficult. Compassion for others is part of our very nature. 

We're often uncomfortable or unfamiliar with extending this same compassion towards ourselves, though.

We may have grown up in families who valued outer achievements over inner experience. We know how to work hard, and push through pain. We've few (or no) real-world models for approaching life in any other way, or even imagining that we deserve love and compassion ourselves. While serving these up generously for others, we don't even include ourselves at the table. 

Enter an onslaught of online information about self-compassion, as if it's the answer for every ailment. Since our whole world seems to be starving for compassion, the topic's popularity makes sense. Naturally, my physician clients start investigating and using these practices. Some, however, are surprised to find that they feel worse rather than better.

How can this be?

It's actually not uncommon to experience intensified feelings of shame, unworthiness, fear, and sadness with self-compassion practice -- especially if our previous experience has been as described above. Thoughts of being a failure, or being all alone, may follow these reactions. We might think: "No one else feels this way. I'm the only one. I'm hopeless." Physical tension, body aches, deep fatigue, or GI distress can show up too. Tears or anger may pop up during meditations, for seemingly no reason. And then we may feel agitated, withdraw from others, numb out, or criticize ourselves and others. It's not at all what we thought would happen, with self-compassion practice.

What on earth is happening here?

In a nutshell, our hearts have begun to open -- maybe after being closed for years. (I have certainly been in that state!) It's the beginning of a needed healing process. The resultant pain is like when the nerves in our hands "wake up" after being out in the cold -- or we've been in an awkward position for too long. You know that "pins and needles" feeling as sensation returns? It's like that, with our human hearts. 

Another metaphor is that of "backdraft," like in the photo accompanying this post. Firefighters know that a fire can use up all the oxygen in a room, and seem to die down temporarily. But when fresh oxygen enters (like through a suddenly opened window or door) the flames can explode and rush outward. Swoosh!

Receiving self-compassion can feel likewise to our newly opening hearts. Some of us have pushed old wounds aside for years, in order to keep functioning in our work and daily lives. No time or attention has been there, for any of that. When we begin to feel loved and the door of our heart opens, the love goes in -- and the pain comes out. Another kind of "swoosh"!

It's not that self-compassion practice causes these feelings, though. We're just re-experiencing pain that's presenting to us for healing. 

Although the "backdraft" metaphor may sound scary, it's not dangerous. Our resistance to its sensations does create suffering, though. 

So, what can we do when we feel pain with self-compassion practices?

One step is to learn from firefighters. Because they understand that backdraft can happen, they enter new spaces gradually. They don't yank doors open suddenly or without thinking. Instead, they mindfully (and with precision) use their hatchets to create smaller holes into the space. Air does come in, and the flames may rise -- but the firefighters are prepared to meet and contain them. (We don't need anything as harsh as hatchets with self-compassion practice, though. We just need self-kindness, with an observant, honest, yet gentle approach.)

Simply understanding how "backdraft" applies in this context, can prepare us as we experiment with these new attitudes and practices. Realizing that backdraft is common for many people -- especially high-performing physicians! -- can help relieve our fear that we're irrevocably damaged. We're not. 

Another piece is noticing where we are emotionally, as we do this work. Are we in our comfort/safety zone, our zone of challenge (optimal for growth and learning), or our zone of overwhelm? This can change from time to time. It's important to monitor and ask ourselves what we need along the way.

The main idea is noticing when we're suffering or overwhelmed, and responding with kindness. Do we maybe need to step away, have a cup of tea, take a walk, or pet our dog? Maybe we need to take shorter periods to meditate, rather than forcing ourselves into preconceived schedules. Maybe we need to connect with our coach or a friend. Maybe it's helpful to listen to some favorite music, and to move with it.

It may help to name the strongest emotion coming up ("Ahh, that's grief," "Ohh, that's shame," etc). This engages frontal cortex rather than limbic brain alone. We can also explore the physical sensations we're noticing in our bodies, and offer soothing touch in those places. We can practice tactical breathing. (I'll post about this another time.)

You may have found still other options already that assist you. 

One last possibility I'll mention is "Soles of the Feet" meditation, which comes from my Mindful Self-Compassion Teacher Training. It helps anchor awareness in the present moment, in our body sensations -- especially when we're upset and can't seem to calm ourselves down. Here it is:

• Stand up and feel the soles of your feet on the floor. Rock forward and back a little, and side to side. Make little circles with your knees, feeling the changes of sensation in the soles of your feet. 

• When you notice your mind has wandered, just feeling the soles of your feet again.

• If you wish, you can begin to walk slowly, noticing the changing sensations in the soles of your feet. Noticing the sensation of lifting a foot, stepping forward, and the placing the foot on the floor. Doing the same with both feet as you walk. 

• As you walk, perhaps also noticing for a moment how small the surface area of your feet is, and how hard your feet work to keep your body off the ground. See if you can notice that with appreciation or gratitude. 

• When you are ready, returning to standing 

• Adapted from Singh et al, 2003

May some of these offerings help us extend compassion to ourselves, each other, our families, our teams, and our patients. These are perilous times, and every little bit matters.

Peace Begins With Me,


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