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There are several ways women can build self-compassion to adopt a kinder, less self-critical attitude to the self.
Australian women are more likely to be admitted to hospital for treatment of a depressive disorder during midlife than at any other age. Experts and clinicians alike often wrongly assume that any increased risk of depression observed in midlife is due to the hormonal changes of menopause. In fact, although findings are mixed, a number of longitudinal studies have found no association between sex-steroid concentrations and risk of depressive symptoms or disorders at midlife.
Most midlife women do not develop clinically significant depressive symptoms or a depressive disorder. Rather than assuming that all women are at risk, there is an urgent need to understand individual differences, and identify modifiable resilience factors that might protect them from developing depression over the midlife years. In our recent study, we tracked depressive symptom severity of 272 Australian midlife women aged 40–60 years over a five-year period and were interested in whether one potential resilience factor, namely self-compassion, could be protective. We found that higher levels of baseline self-compassion did indeed predict fewer depressive symptoms measured five years later.
What is self-compassion?
Self-compassion is an emotional and cognitive orientation towards the self that involves extending the same kindness that you would have for a good friend towards yourself in your thoughts, emotions and behaviours. The opposite of self-compassion is self-criticism, where you treat yourself harshly as if you were your own worst enemy. Self-compassion becomes salient during moments of physical or emotional distress, such as the experience of sickness, pain, stress or even grief or a divorce.
Our recent research has found that self-compassion is a powerful predictor of adjustment to physical symptoms, including menopausal hot flushes, and it is a key ingredient of good mental health. Self-compassion entails responding to life’s hardships with an attitude of acceptance (mindfulness), self-kindness and an appreciation of common humanity – that pain is a part of life, something that unites rather than isolates us as human beings.
For example, in the midst of a hot flush (a moment of physical suffering) someone high on self-compassion may respond with gentleness and acceptance (“this is a moment of heat, may I be kind to myself”) whereas a woman low on self-compassion is more likely to resist and/or be self-critical (“I can’t cope; this is yet another reminder that I am past my prime”).
Why do midlife women need self-compassion?
Women typically have slightly lower levels of self-compassion than men. At midlife, women often experience a lot of life changes and challenges. To navigate these changes, research has found that self-compassion becomes increasingly relevant to mental health. It has been found to act as a stronger predictor of mental health in midlife compared with earlier adulthood. With age, there are often more stressors and life complexities and, therefore, more opportunities to practise self-compassion.
For example, women usually go through the menopause transition at midlife. The menopause transition is caused by ovarian ageing and involves irregular menstrual cycles culminating in the cessation of the menses. The menopause transition and early postmenopause can involve a range of troublesome symptoms where self-compassion is relevant – the most common and bothersome of which are hot flushes (called “night sweats” when occurring nocturnally), which can last over nine years in some cases.
But menopause doesn’t happen in a vacuum. At midlife, self-care can drop to the bottom of women’s ever-growing priority list, and this has repercussions for mental and physical health. Midlife is typically a vibrant yet stressful life phase. Women have often gained seniority at work, which is empowering yet potentially stressful. They also often juggle multiple caregiving responsibilities to growing children and ageing parents.
We investigated the benefits of self-compassion for women in midlife and found that self-compassion appeared to have a protective effect, reducing the likelihood that a woman would go on to develop depressive symptoms. We think that this may be because women who adopt a kinder attitude towards themselves and the stress they experience are better able to cope with those challenges.
A strength of the study is the longitudinal study design. Many studies have found that self-compassion is strongly associated with good mental health, including reduced rates of psychiatric morbidity and higher levels of happiness. But much prior work is based on cross-sectional study designs. In our study, we were able to control for baseline depression and, therefore, tease apart the unique effect of self-compassion on future mental health.
We also found that self-compassion may play a role in predicting low anxiety and also better sleep quality among women experiencing menopausal hot flushes. Up to 60% of midlife women may experience poor sleep, sometimes in association with night sweats. We found that that self-compassion is a significant predictor of self-reported sleep quality in our community sample of midlife women experiencing relatively poor sleep and vasomotor symptoms. In this study it appeared to be self-critical or cold attitudes towards the self that played the major role in explaining poor sleep quality.
Taken together, our findings show that self-compassion can be seen as a type of insurance policy, that (alongside other factors) helps safeguard women’s mental health over the midlife years.
As clinicians, how can we best support our patients to build self-compassion?
We take the view that self-compassion is a learnable skill, so it may be that training in self-compassion can reduce the risk of future depression and improve the way women cope with menopausal symptoms and manage their sleep. There are a number of ways to build self-compassion, ranging from structured psychotherapeutic self-compassion-based interventions to general encouragement from clinicians to adopt a kinder, less self-critical attitude to the self (here).
Some physicians may fear that encouraging patient self-compassion might enable unhealthy behaviours, but in fact the opposite is true. An attitude of self-compassion is much like that of a good running coach. A good coach wouldn’t berate you if you fell over and sprained your ankle. Instead, they would support you to rebuild strength after a fall. In the same way, self-compassion acts as a source of self-motivation that is available as a form of self-support in moments when life goes off plan.
Mindfulness approaches have gained considerable currency in recent years and many of these include some aspects of self-compassion. Mindfulness practice can be safely recommended to many patients and may be accessible to women in regional and remote areas through online programs.
Finally, we should also not overlook the importance of broader societal change that challenges the negative stereotypes that women may internalise about menopause and later life, which can contribute to self-critical attitudes towards the self.
Dr Lydia Brown is a Senior Lecturer in Clinical Psychology at the University of Melbourne.
Kiira Gavralas is a Clinical Psychologist at Barwon Health who undertook this research as part of her Master of Clinical Psychology training.
Associate Professor Christina Bryant is an academic Clinical Psychologist and an Honorary Principal Fellow at the University of Melbourne.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policy of the AMA, the MJA or InSight+ unless so stated.
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