#139 - Kristin Neff, Ph.D.: The power of self-compassion

1. 0:00 – 3:30

   Intro

   1. PAPeter Attia0:01

      [intro music] Hey everyone, welcome to "The Drive" podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, full stop, and we've assembled a great team of analysts to make this happen. If you enjoy this podcast, we've created a membership program that brings you far more in-depth content if you wanna take your knowledge of this space to the next level. At the end of this episode, I'll explain what those benefits are, or if you wanna learn more now, head over to peterattiamd.com/subscribe. Now, without further delay, here's today's episode. [upbeat music] My guest this week is Kristin Neff. Kristin's an Associate Professor of Educational Psychology at the University of Texas here in Austin. She's the author of the book, "Self-Compassion: The Proven Power of Being Kind to Yourself." She's widely regarded as one of the world's leading experts on self-compassion, being the first one to truly operationally define and measure this construct basically over the past decade. Now, in addition to her research into self-compassion, she's also developed an eight-week program to teach self-compassion skills in daily life. She co-created this with her colleague, Dr. Chris Germer. It's called the Mindfulness Self-Compassion, MSC. I stumbled upon Kristin's work in my own search for better understanding self-compassion. This is something that came up for me personally as an area that needed enormous improvement. And in doing so, I realized I wanted to speak with her, reached out to her, and obviously, uh, the rest is history. In this episode, we talk about her own journey towards the discovery of self-compassion, which somewhat coincided with her discovery of, of mindfulness. And you'll see in this podcast, it's actually quite interesting, and it takes me until the very end of the podcast to truly appreciate the distinction between mindfulness and a practice of mindfulness in meditation. And, and so if you're listening to this and you're an astute listener of podcasts where either meditation has been discussed or the concepts of mindfulness have been put forth, pay close attention, and hopefully you won't make the same mistake I will. But basically, Kristin arrives at this conclusion that, you know, when she's going through a difficult time in her life, the best approach is to take a compassionate approach to herself, and that experience personally then basically shapes the remainder of her professional career. And she does a great job here contrasting self-compassion from self-esteem and self-pity. Uh, and I think this is a very important thing. We get into sort of some of the concerns that people have with self-compassion, you know, "Hey, will this reduce my output or my productivity or my competitiveness?" And I think you'll see that frankly, by the end of this, this is a very nascent field. Much of what we talk about here is not hard science. There are a lot of things here that we, we are speculating on. But I think what nobody will speculate on if they've put any of this into practice is that you feel better, and ultimately, that's probably the metric that matters more than anything else. So with that said, please enjoy my conversation with Dr. Kristin Neff. [upbeat music] Hey, Kristin. Thank you

2. 3:30 – 9:45

   The life crisis that turned Kristin to mindfulness and self-compassion

   1. PAPeter Attia3:30

      so much for making time today. I know you're super busy, and we're gonna talk a lot about what it is that keeps you busy. I've wanted to speak with you for probably about four or five months now since I started to become interested in your work and the broader topic of self-compassion. But I think to understand how you came to study it, we have to understand more about you and what it is that sort of brought you on that journey. So I sort of know little bits of your story, but I kinda wanna go back a little bit further, maybe even starting in college. What did you study in college, and what piqued your curiosity?

   2. KNKristin Neff4:07

      Okay. So actually, as an undergraduate, I was very much into issues of kind of culture and how culture impacts reasoning. I took a three-part series in cultural anthropology, and I just fell in love with the topic, thinking of how culture and the larger cultural context may influence the way we think about the world and think about moral topics. And so I went to UC Berkeley to study with a moral developmental scholar named Elliot Turiel, who was just amazing. And I was, again, researching. I was really interested in things like how people balance concerns with autonomy and connectedness. It was a theme actually that's run through my entire research career. Kind of you think about how they c- balance concerns with self and other, and I started getting interested in that in terms of moral reasoning, how people resolve moral conflicts, especially between self and other. I did my dissertation research in India looking at, I think it was called Reasoning About Rights and Responsibilities in the Context of Indian Family Life. [chuckles] So basically, I became interested in how, especially how gender hierarchy in a very traditional place like India impacted how people resolved conflicts between their personal needs and their others' needs. Some people had said that India is a duty-based culture, and it's all about meeting the needs of others, whereas the United States is a rights-based culture, and it's all about meeting our own needs. I thought, well, is that really true? I mean, what about gender? It seems like with a lot of gender hierarchy that, yes, women really need to do their duty and meet their husband's needs, but husbands have a lot of rights to do what they want. So you can't really separate out power and gender and culture from the way people think about things. And by the way, I did find that. I found that they emphasize duties for wives and rights for husband, but the Indian women were like, "But that's not fair. We'll do it 'cause we have to, but we don't like it. It's not fair." Kind of showing the kind of- Also that we aren't totally dictated to by our culture, that we're individuals who can reason and, and decide, "Actually, that's not fair. I think that should change." While I was in India, I started... Basically, I talk about it a lot in my book, but while I was in India, my life fell apart, basically. I had been married, and it was kind of a-- I'll go ahead and say it right here 'cause we're, we're talking. What had happened was I left my husband for another man, which is something that I was a very moral person. I never, ever thought I would be in that situation, but it happened. So I left my husband for another man who was supposed to join me in India, and he didn't. [chuckles] And basically, so the whole thing fell apart, and I came back to Berkeley. And actually, when I came back, talk about trauma, he was, he had brain cancer, and he died within a year, the man I left my husband for, who didn't leave his partner or her. And so basically, I was a mess. I was feeling a lot of shame. It was very traumatic. I consider myself a very moral, honest person, and the fact that I got myself in that situation kind of was just really upsetting to me that I had allowed myself to get in that situation. Plus, the fact that it really, it [chuckles] didn't work out so well, right? So he didn't come, and the guy I left my husband for ended up dying of cancer within a year. My husband, who I'd been divorced when I got back, hated me, and I was just a basket case, basically. And so I thought I would learn mindfulness meditation because I'd heard that mindfulness was good for stress and trauma and all this stuff, which I was going through. So I, I started learning about Buddhism as a way to kind of help me through what I was going through.

   3. PAPeter Attia7:46

      What kind of support network did you have at this time? So I'm trying to picture this. So you... How long were you in India?

   4. KNKristin Neff7:51

      Uh, a year. I was in India for a year.

   5. PAPeter Attia7:54

      And so you come back, and you're in the process of writing your dissertation now, I assume?

   6. KNKristin Neff7:59

      Yes, I wrote up my dissertation.

   7. PAPeter Attia8:01

      What type of interaction you're having with your girlfriends? Are they consoling you? Do you feel isolated and-

   8. KNKristin Neff8:07

      I had a very good support network, and actually, believe it or not, I had actually met the man who was going to be my second husband when I was in India. He came as well, which helped. It was very soap opera-ish, Peter. [laughs] It was like "Days of Our Lives," right? It was kind of the script of a soap opera, all these elements that came together. I had support, but I knew I really needed something to help me deal with everything I'd been going through, and I was always a spiritual person. My mother had books by, like, Indian gurus. Ram Dass' "Be Here Now" was on my coffee table, which is partly what drew me to India, to be totally honest. I also thought that I might find some spiritual awakening there. Didn't actually happen in India. It happened when I got back, but nonetheless, I was always kind of drawn to those alternate ways of thinking about the world, so it was kind of a natural for me to start meditation.

   9. PAPeter Attia8:59

      And what drew you to a mindfulness form of meditation? There are other forms, of course, and especially being in India, certainly the birthplace of transcendental meditation or other things.

   10. KNKristin Neff9:11

       To be totally honest, it was because this meditation group, which was a Thich Nhat Hanh group, a group that followed the teachings of the Zen master Thich Nhat Hanh, it was right down the street from me, so it was kind of happenstance. The one thing that I kind of liked about Buddhism, I didn't know a lot about it, but I knew enough to know that it was more scientifically grounded. The thing about Buddhism is it's more like a science of the mind. There's not a lot of belief systems. You don't have to believe in reincarnation. You don't have to believe in a god or gods, just basically a way of understanding the mind. And because I was a scientist

3. 9:45 – 17:15

   How mindful self-compassion relieved Kristin’s feelings of self-judgement, and the psychology that says we all have the capacity for self-compassion

   1. KNKristin Neff9:45

      getting my Ph.D., that also drew me. And then plus, I'd just been hearing good things about mindfulness meditation. But really, thank goodness it was a Thich Nhat Hanh group because Thich Nhat Hanh is one of the Buddhist teachers that talks a lot about self-compassion, more than a lot of other teachers do. Others do, but that's, like, a big theme of Thich Nhat Hanh. And so the very first night I went, the woman leading the group talked about self-compassion. If I had gone to a transcendental meditation group or some other group, it may have been, I don't know, Shambhala or some other type of meditation, they might not have talked about self-compassion. It may have just been about quieting the mind, stilling the mind, observing the mind. Not the group I went to. She talked a lot about self-compassion, and it had an immediate impact on me. I mean, literally, when I got home the first night, I thought, "Wow." [chuckles] I had never even thought about being actively kind and supportive to myself. I wasn't a particularly harsh self-critic. You might think that I was. I actually wasn't. I was kind of like an average self-critic, but I was feeling a lot of shame about everything I'd gone through and the kind of soap opera that had become my life. When I just started being actively kind and supportive to myself, I started speaking to myself in a way like, "Hey, Kristin, I know you're hurting. This is really hard. It's understandable. There's a lot of reasons for how things unfolded the way they did. Um, you know, I'm here for you." I started really just... I did it silently, but speaking to myself as if I was speaking to a friend, and it really was like finding a superpower I didn't even know I had. It was almost immediate, the impact it had on me. Now, mindfulness meditation took a lot longer to figure out. It's a more subtle practice. Then I did learn to meditate, and I went on many retreats. But self-compassion, and probably because I have fairly secure attachment with my parents, it wasn't very difficult for me to learn, and I got it almost immediately. But I did have to practice applying it to my life.

   2. PAPeter Attia11:40

      Now, how do you go to the point where you are able to sort of say to yourself in compassionate ways the things that you're saying without first being aware of what the default voice is that's probably happening subconsciously? Is that necessary? 'Cause to me, that's the harder part, is I think we'll discuss later, most of us have some level, and some more than others, of being incredibly critical. The real challenge is how subconscious that critical voice is and how we're not aware of it. So were you even aware at that point of how degrading you could be to yourself or how demeaning you could be?

   3. KNKristin Neff12:20

      I think you're right that some of these things are less conscious than others. Like I say, I actually wasn't a particularly harsh self-critic. It was more that I was just lost in the... I mean, I was feeling shame, and so you might say there was self-criticism, but it wasn't an entrenched pattern for me.

   4. PAPeter Attia12:39

      How were your behaviors? 'Cause I guess that to me is one of the telltale signs. You come back from India, you're probably at that point mostly sitting in your apartment and much of your work is analyzing data and writing. But how did that shame manifest itself as an outward manifestation of whatever the inner voice was saying? Were you in any way depressed or anxious or anything like that?

   5. KNKristin Neff13:01

      I think I was feeling discombobulated. [chuckles] That's probably the best word I can use to describe it. I didn't get into a deep depression. I also had a lot of stuff going on in my life at the same time. So again, I was also starting a new relationship, which kind of made it more complicated. It also gave me, you might say, some support. But I've always been psychologically oriented, kind of interested in my internal landscape. I could be aware of the feelings of guilt and shame. For me, the biggest shameful thing was I've always identified as being a very honest person, and the fact that I did that was just, it was really hard for me because it just goes against my self-concept, the fact that I got myself in that situation. I understand it, how it could happen, but it was really hard for me. I started noticing these thoughts about my self-concept. What does this mean about the type of person I am? And that was really helped by starting Buddhism, because Buddhism is all about understanding this sense of self that causes suffering, this sense of identification with the separate self, the kind of thoughts of, "I am this type of person," or, "I am that type of person." Did it take a long time to notice that? It certainly got better as I got more deep into it. Especially as you go deeper into meditation, you can start to see even more subtle layers of self-judgment. But it wasn't necessary to get there before I could start seeing the benefits of self-compassion. So it deepened over time. A lot of people are just blown away by the simple thing of putting your hand on your heart and saying something kind and supportive to yourself. Here's the thing, Peter. I really believe in parts psychology. I've used internal family systems therapy as I used that type of therapy for many years.

   6. PAPeter Attia14:47

      That's Dick Schwartz, right?

   7. KNKristin Neff14:48

      Dick Schwartz's model where we have different parts of ourself, and I really do believe we have different parts of ourself.

   8. PAPeter Attia14:54

      Can you explain to folks a little bit about what Dick's work is?

   9. KNKristin Neff14:57

      So the idea is we have different parts of ourselves that all kind of play a role, and he, it's a terrible name, he called it internal family systems, but basically the idea is we have different parts of ourself that kind of form a family, interact like a family, but it's on the inside and not just outside. And so we have a part of ourselves that may be self-critical, maybe feel shame. We also have a part of ourself that maybe wants to defend against the wounds of the shamed part of ourselves and maybe is really angry at others or gets really busy. You know, we have different parts that have a different function. The function of all the parts ultimately is safety. It's kind of survival. That's kind of how these operate. So there's a part that defends our ego as a form of survival. There's a part that defends against those feelings of shame, but there's also a compassionate part of ourselves I really believe that all of us have, and that compassionate part of ourselves typically gets exercised when we're relating to others, people we care about, maybe our children or our good friends or other people we're close to. We also have the compassionate part of ourselves. So I don't think it's the case that you need to totally uncover the, all the self-critical parts of ourselves before we can activate the self-compassionate part. It's there. We actually are already pretty familiar with it as it relates to other people. So I think what happened is I was able to activate that self-compassionate part. I was able to see, wow, this really makes a difference. If you take that self-compassionate part and aim it inward as opposed to outward, it almost immediately changes the landscape, also the physiological as well as the mental landscape. You're actually moving from the threat defense mode to the attachment system mode. You're kind of priming your own attachment security when you tap into the compassionate part of yourself. So for me, it got better over time. It went more deep over time. I was able to uncover more layers, more hidden selves full of shame or inadequacy related to my father and all the stories that you unpack in therapy. But it was easier than I thought it was. That's the thing that surprised me over my career. It's actually easier than you might think to help people get in touch with their compassionate self, because for many, many people, that compassionate self is very, very well-practiced. It's an expert just aimed at others. So you don't have to create something totally new that's not there. That's the

4. 17:15 – 20:15

   Peter’s history of self-criticism and his personal practice of self-compassion

   1. KNKristin Neff17:15

      useful thing about it.

   2. PAPeter Attia17:16

      Yeah. I have a friend who, in sort of helping me think about this, so unlike you, I'm probably naturally much more self-critical. You sort of describe yourself as probably in the middle, kind of normal. I would be an Olympic level self-critic, including actually audibly. I mean, I could literally... You'd think I was a crazy person at times 'cause I could literally speak in a voice like this to myself in a incredibly harsh and critical way. So a friend of mine, Rick Elias, who has been on this podcast and who I consider not just a friend, but kind of a, a life mentor, said, "I want you to practice something, which is when you're in that moment and you're about to have that discussion with yourself, I want you to picture that the same events occurred that are upsetting you, but now it wasn't you that did it, it was one of your close friends that did it." How would you console him? This is interesting. It was, for me, a process of five months of doing this. But for example, I'll give you... So there's two things I do almost every day. I either shoot my bow and arrow or drive my race car simulator. Now, those are two seemingly nonsensical activities, but unfortunately, they both have become barometers of self-worth. So when they don't go well, the inner self-directed hatred is enormous, and it results in anger and tantrums and outbursts and feelings of total worthlessness when they don't go well. So instead, what I started doing, and I literally did this every single day for five months, is after every single episode of doing one of those activities, which meant every single day, I would take my phone out and I would speak into the recorder as though it were my friend who had that bad experience. And I would say, I would use my name. So I'd say, "Hey, Peter, I know you just had a really bad day shooting and you couldn't hit the broad side of a barn if your life depended on it. But doesn't mean you're bad. It just means that you had a bad day at archery today, but you're still a great dad, and you're gonna get another chance to come out here and do this tomorrow. And there are probably reasons for it today. You might not even know why you didn't shoot poorly, but blah, blah, blah, blah, blah." I would send text that message to my therapist every single day as a form of accountability. It really was amazing how much it deescalated me. It was actually very quick. It used to be at the point where driving or shooting poorly could ruin my day, and it got to the point where within about three minutes, I had forgotten about it.

   3. KNKristin Neff19:57

      Yeah. That's the power of self-compassion. And again, it's because you already had that part developed. It'd have been one thing if you hadn't had any experience your whole life of how to be compassionate or supportive to someone. But you'd spent many, many years developing that skill, probably with your kids or your friends. So you just needed to

5. 20:15 – 26:15

   The problem with prioritizing self-esteem over self-compassion, and how self-compassion produces a more stable version of self-worth

   1. KNKristin Neff20:15

      access that part of yourself which you weren't accessing before. And that's why I found, to get back to kind of in terms of for myself, that's why I was just blown away by how useful it was. And then, so I started getting interested in Buddhism and the whole idea of self-concept. What is this thing we call a self anyway? And it really made a lot of sense to me, this way of understanding how this sense of separate self and ego and separation leads to suffering. And so I thought, well, maybe I wanna kind of pivot, and I didn't pivot totally away, but pivot away from moral reasoning and get into understanding self-concept, how the development of our self-concept impacts things. So I did my postdoc with Susan Harter, who's studying self-concept development. She was also studying autonomy and connectedness, so it was a natural fit. So I've been studying autonomy and connectedness and moral reasoning, and she was studying autonomy and connectedness and relationships. Your self-concept, are you other-focused? Are you self-focused? Are you both? So it was an absolutely natural fit for me to go work with her and do my postdoc. But she was also one of the country's leading self-esteem researchers, and she had done research along with others showing that self-esteem is not necessarily a good thing. It's good to like yourself as opposed to hate yourself, but the ways we get our self-esteem can be very, very problematic. You know, a lot of social comparison. It's contingent, like for you, if you shoot the bullseye, you feel good about yourself. If you miss it, you hate yourself. I mean, that's not very stable. It's very contingent. It's unstable. So it was when I was finding out more about self-esteem, and I was just kind of questioning the whole self-esteem thing anyway through my Buddhist practice, and what is this thing we call an ego and that we invest so much in that we have to judge it positively and it can't be negative at all. And then it was just a natural to think, "Wow, I think self-compassion is a lot more helpful than self-esteem." When I was working with Susan, I was developing all my ideas about that, and then eventually I came to show that empirically when I got to UT Austin.

   2. PAPeter Attia22:16

      When you sort of take a broad lens at human psychology, when did this idea of self-esteem become something that was really pushed? I mean, certainly as long as I can remember as a kid, I mean, this is what was talked about all day, every day. The table was pounded. Kids that don't have high self-esteem do drugs and whatever sort of... But that couldn't have been the narrative forever. Was there somebody that was a champion for this school of thinking or?

   3. KNKristin Neff22:43

      Well, it's interesting because if you actually look at the founding American psychology, William James, who was writing early 1900s, 19th century, he wrote about self-esteem, and he actually identified contingent self-esteem. He defined self-esteem as perceptions of competence in domains of importance. In other words, being good at those things in life that are important to you. Like, you could probably care less if you're bad at hockey if you don't play hockey, but you do care if you're bad at archery because you care about archery. That's kind of the way self-esteem works. We need to be good at those things in life that we value. So he was actually talking about it way back then, but then it didn't really take off in psychology. Then they started going into psychoanalysis and then in, into behaviorism. And it was probably people like Rosenberg, oh, I blanking on his first name, who created the Rosenberg Self-Esteem Scale. That was probably one of the big factors, creation of good measures of self-esteem, because people could say, "Wow, when people score higher on the self-esteem scale, they're less depressed, they're less anxious, they're happier." And then that kind of started kicking the ball rolling of noticing, and it is true, people with higher self-esteem have better mental health than people with low self-esteem. But the problems is, is all the unhealthy ways they get to that high self-esteem, [chuckles] like feeling better than others, bullying others. We know that the reason kids in middle school start to bully others is to have high self-esteem 'cause they wanna feel good about themselves in comparison.

   4. PAPeter Attia24:13

      How do we compare and contrast narcissism with self-esteem or other negative traits? 'Cause self-esteem by itself doesn't really sound to be negatively valenced, but a lot of those other traits do.

   5. KNKristin Neff24:25

      There's nothing wrong with self-esteem, and in fact, there's a pretty strong correlation between self-compassion and self-esteem. If you're self-compassionate, you have higher self-esteem and you have less self-hate, so they're linked. But the healthy form of self-esteem is what they call unconditional self-esteem. You feel worthy, not because you're good at something that you value. You feel worthy just because you're a human being, an intrinsic sense of self-worth, and that's the type of self-esteem that self-compassion gives you. If you look at them head-to-head, like compare my self-compassion measure against a self-esteem measure, you'll find that it's self-compassion that explains stability of self-worth over time. You know, in other words, it doesn't go up and down as much because it's less contingent on outcomes, on a good day and on a bad day.

   6. PAPeter Attia25:13

      So just to make sure I understand that, there's some discordance between self-esteem and self-compassion. A person with self-compassion generally has self-esteem, but not everybody with self-esteem has self-compassion.

   7. KNKristin Neff25:26

      Yes, exactly. It's hard to tease them apart, but for instance, if you have self-esteem because you're a narcissist, you probably won't have higher self-compassion. You won't have lower self-compassion either because that would have to say that people who aren't compassionate, who hate themselves, have higher narcissism, so they're completely orthogonal. When you put them all together in a regression equation, you control for self-esteem and self-compassion, and narcissism is the outcome. It actually came out as 0.0 correlation, totally orthogonal between self-compassion and narcissism, where self-esteem, I forget what it was. I think it was a moderate correlation. I'd have to look again. It's not that self-esteem is bad. We want to feel worthy. It's really why we feel worthy, how we feel worthy that's important.

   8. PAPeter Attia26:11

      I think viscerally it makes so much sense using, like

6. 26:15 – 31:45

   An argument for self-compassion over self-criticism for optimizing performance

   1. PAPeter Attia26:15

      I said, the trivial example of do you shoot well or not? If your self-worth is dependent on performance, you're doomed to fail at some point.

   2. KNKristin Neff26:24

      Right, and then when you do fail, what do you do? And so people criticize themselves, thinking it's gonna improve their performance, and by the way, it does kind of work. It has to be admitted, many people have gotten through med school or law school through harsh self-criticism, so it's not like it doesn't work at all. But it works with a lot of negative side effects, like, uh, performance anxiety is a big one. So if you have a lot of anxiety because you're slamming yourself, you're beating yourself up, next time you have some big test or something, you're really worried about doing well because you know if you don't and you've gotten the negative reinforcement of beating yourself up, so it makes you more anxious, which actually undermines your performance. It can make you more disconnected from others if you're really invested in doing better than other people, and that can lead to, like, little interpersonal behaviors that actually aren't good at creating closeness and connection. It kind of works. There's a lot of problems with it, and self-compassion works better. What we know in the research is constructive criticism is more effective than harsh criticism, and we know that. Of course, we know that. You still want criticism. You wanna know where you went wrong and how you could improve. It's not like, "Oh, that's fine." If you're a professional archer saying, "Oh, well, just had a bad day," that's not gonna help you, and that's not gonna help you achieve your goals, which means it's actually not ultimately loving. If you're a professional archer, you want to do your best because that's related to your happiness and well-being, but what's gonna help you do your best? Constructive criticism that says, "Okay, well, here's what didn't work. When you did it this way, this didn't work. Why don't we try it this way? I believe in you. You've got my support. I'm here for you." That type of constructive voice is actually more effective. Yes, a coach that says, "You're crap. You better do better," it kinda works. It doesn't work as well as constructive criticism, and we know that.

   3. PAPeter Attia28:13

      Because obviously that's one of the concerns that anybody would have going down this path of self-compassion. If, if somebody had spoken to me when I was in high school or college and said, "Look, we're gonna work on you not beating yourself up," I would've said, "No way. I'm not willing to give up my edge in exchange for feeling better in the moment."

   4. KNKristin Neff28:35

      Right, which is ironic because it actually doesn't give you an edge. It actually is not nearly as effective. It gives you more of an edge if you have constructive criticism than destructive criticism, and again, study after study shows that.

   5. PAPeter Attia28:48

      Yeah, so walk me through some of the, the social or psychological experiments that can test that hypothesis.

   6. KNKristin Neff28:55

      Research has come out of UC Berkeley which shows, a lot of research shows that self-compassion is not only more effective than self-criticism, which kind of occurs naturally, but also is more effective than self-esteem as a motivator. So just as an example of one type of study, they had UC Berkeley undergraduates. They had them all fail a vocabulary test. They took, like, the hardest items from the SAT. They had the students take the test, and everyone failed because it was a really hard test. They split up the students into three groups. One group, they gave instructions to be self-compassionate about the failure. "It was a really hard test. Try not to beat yourself up about it. Just, you know, try to be kind and supportive to yourself about failing this test." The other group, they gave the self-esteem instruction. They said, "Don't worry about it. You got into Berkeley. You know you're smart." Kinda gave them a self-esteem boost. And the other group, they didn't give any instructions, which meant they were probably self-critical. They didn't encourage the students to be self-critical. That'd be kind of unethical. They just didn't say anything. What they did is they said, "You're gonna take the test again. You've got some free time to study for the exam." They, they had materials they could study for the vocabulary test. "Just kind of let us know when you're done and you're ready to take the exam." And what they foundfound was that people who were told to be self-compassionate about the failure studied longer and harder than the other two groups. And how long people studied was related to how well they did on the next exam.

   7. PAPeter Attia30:26

      I mean, what would be another interesting group as a fourth group would be a group that was berated and told-

   8. KNKristin Neff30:32

      You're crap

   9. PAPeter Attia30:33

      ... yeah, like, "You guys got into Berkeley and you still flunked this test?"

   10. KNKristin Neff30:37

       Yeah, yeah.

   11. PAPeter Attia30:37

       "That's pathetic." I'd be curious to know if that was positive or negative in terms of reinforcing additional study.

   12. KNKristin Neff30:44

       Yeah, I guess kind of unethical to do that. It'd be very hard to do a study [laughs] like that. You can't actually insult subjects in a experiment like that because it's considered psychologically damaging.

   13. PAPeter Attia30:55

       Let's pause for a moment on that. The IRB won't let you say to an undergraduate something like that, whereas think about what was done 40 and 50 years ago with some of the famous psychology experiments down at Stanford.

   14. KNKristin Neff31:07

       That's why they've changed the IRB. And actually, Peter, do you know what you, you have to use as an insult? The feedback you use is you did average.

   15. PAPeter Attia31:13

       [laughs]

   16. KNKristin Neff31:14

       That's considered an insult. If you tell people their score was average, it's considered an insult. There's lots of research like that, that basically... So what happens is when you're self-compassionate about a failure, first of all, it allows you to learn more from the failure. I mean, it's such a truism. Failure is our best teacher. But if you're full of shame and you're just really mad at yourself, you don't actually have the presence of mind to look objectively and say, "Huh, where did I go wrong? How could I do better next time?" But self-compassion support actually does

7. 31:45 – 36:45

   How and when to introduce self-compassion to children

   1. KNKristin Neff31:45

      give you that presence of mind to be able to learn from your experiences. And so self-compassion leads to what they call growth mindset, where you actually learn from your mistakes as opposed to a fixed mindset, which means you just think you're stupid or smart, one or the other.

   2. PAPeter Attia31:58

      How soon in a child's development can these patterns be set?

   3. KNKristin Neff32:05

      We don't have a lot of data with kids. Partly that's because we don't have a good way to measure self-compassion in children. There are a few scales. Actually just came out the scale for youth. It can be used for younger kids. Uh, brand new. It came out, like, last year. It hasn't been used much. We don't have a lot of data on this, but I suspect that about age seven or eight, once kids have learned about friendship and they have, like Piaget would call, two-way thinking, you can understand reciprocity, they understand concepts of fairness, they understand kind of that back and forth. They can take the perspective of another. Um, to be self-compassionate, you have to take the perspective of another towards yourself. And also, by the way, self-criticism doesn't really kick in until later on in development, partly because of that, because children are just kind of, like, happy and they have a positivity bias, and they tend to think they're great unless their parents tell them the exact opposite. Kind of... It's called one-way thinking. They're all one or the other. I would assume two-way thinking would have to kick in, which would be about age seven or eight. So there are some good books out there, and you can find them on my website if you, if you wanna get the reference, to kind of teach kids when they learn about friendship, that they should also be their own best friend. Learn about what it means to be a good friend. They should also learn to be a good friend to themselves. And I suspect that's probably the best time to start introducing these concepts. And then adolescents, once you start getting metacognition and you get more abstract thinking, it's even more appropriate because that's when really the self-concept formation starts kicking in. What kind of person am I? And then you can start having conversations with teenagers. They actually do understand issues like, do you really want your sense of self-worth to be contingent on being pretty enough or having people like you or being smart enough? They have enough abstract thinking skills to be able to understand something like self-compassion.

   4. PAPeter Attia34:02

      Now, some would argue that we're sort of in the midst of a social experiment for which the outcome might not be known for decades, which is a group of kids that are growing up in a world where comparison is at a level that you or I couldn't imagine. You and I grew up... So I'll speak for myself, but I didn't have a clue outside of my neighborhood. There was nothing. I mean, even looking at the TV was very abstract. Not like I knew anybody that lived out of the borough of the city that I lived in. And you barely watched TV. There was no way to sense what was happening. And of course, today, that couldn't be further from the truth. So you spoke earlier about ego being so entwined in self compar- sorry, in comparison to others, that you would argue that we are in an environment today where the potential for that comparison, that ranking, is so high. So it would seem to me that self-compassion is more important today than potentially it ever has been.

   5. KNKristin Neff35:05

      I hear what you're saying. I, I think it certainly is frightening. On the other hand, I don't know a lot about it. My son doesn't use social media. I don't use social media. I'm like a dinosaur. My book has a Facebook account, but I don't. So it's a whole other world, and I know I'm not really part of it, and my son's not part of it either. But I do, from friends who have teenage kids, I do hear this. On the other hand, it seems like that the younger generation is more open-minded than past generations, that it may be because they've got the ability to know so many different stories. Like, in some ways, when we were growing up, probably a little older than you, but still, it was like there was a few sitcoms on, and everyone watched All in the Family or MASH or whatever it was. I'm probably dating myself [laughs] . You were probably, like, seven when those came out. But nonetheless, there were certain sitcoms that everyone watched, and that was kind of the unique frame of reference, shared frames of reference, at least in cultures like the United States. But now people, they can get the point of view of, like, so many diverse points of view, depending on what they like, what they're interested in. I haven't seen any data Well, that's not quite true. There is some data showing that suicide rates are up and stress is up. I just don't know. I, I think the jury's out. I think the jury's out. I think in some ways social media can be used... For instance, if you're part of the LGBTQ community, you have access to people like you in a way that you wouldn't have had 20 years ago. And in that sense, social media could be a positive thing. It can make you feel less isolated and more connected to others. On the other hand, if you're just looking at Instagram and followers, maybe

8. 36:45 – 40:00

   Learning her son had autism—a personal story of how Kristin used mindfulness and self-compassion

   1. KNKristin Neff36:45

      not. So I think I just don't know what to think about it. It's scary though, I, I admit it [laughs] . It's really scary. We don't know.

   2. PAPeter Attia36:51

      That's an interesting point. Now, you mentioned your son does not use social media. Your son has autism, correct?

   3. KNKristin Neff36:57

      Yes.

   4. PAPeter Attia36:57

      He's how old now?

   5. KNKristin Neff36:58

      He is 18. And by the way, he just got his driver's license. I can't even tell you how proud he is and how proud I am of him that he just got his driver's license. It is like independence is just around the corner. He's a sophomore in high school. He was delayed because we homeschooled him. We started him a little bit back so that he could catch up academically, but yeah, he's doing really well, really well.

   6. PAPeter Attia37:24

      You probably start to figure out that something is not exactly, quote unquote, "normal" when your son is two or three years old?

   7. KNKristin Neff37:33

      I knew earlier because I was trained as a developmental psychologist, and I knew something was up. But there's a myth that autistic children don't make eye contact. They make eye contact a little less frequently, but a lot of them make a lot of eye contact, especially with their parents, and I literally used to joke with his father, "Ha, well, at least we know it's not autism. Look at that eye contact." But then it turned out it was autism. Well, he's actually an extroverted... There are extroverted autists. He's an extroverted autist.

   8. PAPeter Attia38:02

      So what did you notice? And when the diagnosis finally came, how did you start to process that, and how did your training in self-compassion serve you?

   9. KNKristin Neff38:11

      I started noticing because he was delayed in language development. Actually, delayed pointing is one of the biggest indicators of some sort of delay, and he was just using the echolalia, just the repeating of the words, and kind of the repetitive behaviors. Um, but he was very social. I had the stereotype that autistic kids, they weren't loving, they weren't affectionate, they didn't make eye contact, which wasn't him at all. But then once I realized that a lot of autists are extroverted [laughs] and social, I realized, "Oh yeah, he's got it." And then, and we had the official diagnosis. It was devastating. It was devastating. The first feeling, quite honestly, is one of disappointment. It just has to be kind of owned. This isn't what I imagined being a parent would be like. I imagined something different, these long, in-depth philosophical conversations about life, and actually we're starting to finally have those [laughs] but it took a lot longer than I thought it would. He wasn't potty trained until he was five, which is really, really hard. He would tantrum a lot well past the terrible twos, and so I was disappointed. I was overwhelmed. It wasn't the plan I had signed up for. And so my self-compassion and my mindfulness practice both together, and they really can't be separated. Mindfulness is a necessary ingredient to self-compassion. The day after he got his diagnosis, I went on a meditation retreat, and I just sat there on my cushion and I cried. What I did was I allowed every single emotion to come up. You're supposed to feel disappointed because I love my son more than anything else in the world. I didn't say, "Okay, this emotion's allowed and that emotion isn't allowed." [laughs] I just let any emotion I had to come up, feelings of grief, feelings of disappointment, feelings of fear. And not only was I allowed myself to be with them without suppressing them

9. 40:00 – 49:30

   Self-compassion for cases of childhood trauma, PTSD, and overcoming a “fear of compassion”

   1. KNKristin Neff40:00

      or fighting them, the thing that made the biggest difference for me is I actively gave myself support because of them. "This is really hard, Kristin. I know you're disappointed. I know you're frightened. It's gonna be okay. I'm here for you. I'm so sorry that you're having struggling, but care about you." I treated myself just like I would treat a good friend who had a similar situation. What I found, and over and over again, the more I could give myself compassion for my son's autism, the better parent I was to him, and the more I could accept him. The more I could accept my own difficult feelings about his autism, the more I could actually accept his autism. Whereas if I had fought them and suppressed them or said, "I'm not supposed to feel this way," or, "I'm not gonna allow myself to feel this way," I think it would have created a tension that would have actually made it more difficult to accept him for who he was.

   2. PAPeter Attia40:50

      And when you were going through this process, did your husband mirror you in that practice, or did he sort of have his own way of doing this, so you were kind of in this journey of you were supporting him and he was maybe delayed? And what was that dynamic like?

   3. KNKristin Neff41:09

      A bit of both. He had kind of his own way of dealing with things. He's much more of a doer and did... Wrote this book called The Horse Boy, and he thought of, "How can I make this into an adventure?" That's kind of his way of dealing with things. If life throws you lemons, how am I gonna make lemonade? Which is a little different than my way of doing it [laughs] . And so he made-- had this whole adventure and we took our son to Mongolia, and he wrote a bestselling book and a documentary about it, and he really tried to look on the positive side of it. There's really value to that as well, a different approach than what I took. Mine's kind of more like, how do I hold the pain with love? And his was like... He actually, I think he has a line in his book, "When life gives you lemons, why stop at lemonade? Make a margarita." Very much his way of dealing with things. And by the way, we aren't together anymore, just so you know. We split up about nine years ago.

   4. PAPeter Attia41:59

      There was a point in that documentary, by the way-

   5. KNKristin Neff42:02

      Oh, so you did see it?

   6. PAPeter Attia42:03

      Yes, yes, I did. It's very powerful. It's at least represented in the documentary that Rowan basically didn't make a sound... Maybe I'm misremembering this, but it was only when he first encountered the horse that he sort of came to life. Am I remembering that correctly?

   7. KNKristin Neff42:22

      It was the first time he did a complete sentence. So before he'd repeat words, might be like food he liked back then, might be bottle or water or muffin or something like that. He would repeat the words, but it's the first time when he got on Betsy, and I actually wasn't there when it happened, so I'm assuming it's true [laughs] . He said, "He's a nice horse." Betsy's actually female, but, "He's a nice horse," first time he was on the back of the horse. And I did see a change. So there's some research that suggests on horses, it's actually, they think it may have to do with the cerebellum because when you continually have to find and re-find your balance, it influences the cerebellum, which helps brain integration. And one of the things that's happening with autism is a lack of brain integration because overgrowth of white ma-matter. You probably know all this about autism, lack of adequate pruning. It's hard to get cross-brain communication in autistic kids, which is one of the reasons you get kind of hyper-specialization and fixations. There's a really good scientific reason to think why things like being on a horse, finding and re-finding the balance would help cross-brain communication, which might allow for things like language. And also, it was just a lot of fun. Basically learned to speak on horseback. It was pretty amazing.

   8. PAPeter Attia43:34

      Remind me how old Rowan was when you guys did this trip.

   9. KNKristin Neff43:37

      About five, between five and six.

   10. PAPeter Attia43:39

       And you obviously alluded to kind of these outbursts, right? I mean, children with autism obviously can have remarkable outbursts.

   11. KNKristin Neff43:48

       Yeah, they get overwhelmed. My son likes to tell me, "Autistic children, they don't tantrum because they're trying to get their way. They do it just because they get overwhelmed, and it's just a natural reaction, but they don't do it to manipulate." So it's interesting, which I think is very true.

   12. PAPeter Attia44:05

       So where does self-compassion come into trauma? You alluded to it very briefly up front, but there's also some literature for formal diagnoses of PTSD, isn't there?

   13. KNKristin Neff44:16

       Oh, in terms of self-compassion?

   14. PAPeter Attia44:18

       Yes.

   15. KNKristin Neff44:19

       It's not so much that self-compassion aids in the diagnosis of PTSD. There's a lot of research actually on self-compassion and trauma. So there's kind of two parts to that research. One is that people with early childhood trauma, so sexual, emotional, physical abuse, it actually hinders the ability to be self-compassionate as an adult, and that's mainly because of the attachment system. So if you have secure attachment, it means you think you're kind of valuable, you're worthy, and your needs are worth being met. If you had secure attachment with your parents and your parents treated you like you were worthy and they met your needs consistently, then when you're an adult, it's easier to think that I'm worthy and I'm gonna meet my needs because I'm worthy of having my needs met. If you have insecure attachment, then you may not think that your needs are worthy of being met. And if your parents were actually harshly critical or actually abusive, what can happen is the system that's supposed to make you feel safe, the attachment system, gets fused with feelings of fear because these people who are your only source of safety and comfort in life are also terrifying you. And then so what happens is everything gets kind of jumbled up and mixed in. And for some people, actually, it can be frightening to give themselves compassion. Paul Gilbert talks about this. He calls it fear of self-compassion because basically when you're activating the attachment system, which is supposed to make you feel safe, it actually makes you unsafe. And so some people, when they start opening their hearts with self-compassion, they have memories, traumatic memories come up, or, like, just this voice in their head saying, "You're crap. You're worthless," or maybe some memories of kind of some sort of abuse. It's harder to be self-compassionate if you have a trauma history. But having said that, self-compassion is one of the best ways to deal with early childhood trauma because what you're doing is you're, like, re-parenting yourself. So maybe the program is, "Okay, you're worthless. You aren't worthy of care." But if you actually intentionally give yourself compassion for those feelings which are so hard, "Wow, it's really hard to feel that I'm worthless. These feelings of shame, they're really difficult. How can I learn to relate to the pain of the trauma with some kindness?" It's not like cognitive behavioral therapy where you work directly with rewriting those negative schemas. I mean, that's also useful. It has its role for sure. What you're really doing is learning how to hold the pain, any pain, with this kind, supportive stance. And so when you do that, there's actually some research showing you can get what they call earned secure attachment as an adult. You can actually learn to have a secure attachment schema through self-compassion. Maybe your parents didn't meet your needs consistently, but you can learn to meet your own needs consistently when you're frightened or you need help or you need support in some way. It is harder, the road's bumpier, and it usually really helps to have a good therapist help you unpack all of this. Once people can do it, there's lots of research, especially with compassion-focused therapy created by Paul Gilbert, which is specifically designed for people with early trauma. Th- There's different ways you have to approach it, and the way in is a little different. It has to go slower, and things are a little different, but it actually is remarkably effective, and you can get people who are able to heal from early trauma through self-compassion. And so there's research showing this. If you look at trauma that's not caused by early childhood, for instance, there's a lot of work with combat veterans. So combat veterans who moved to Iraq or Afghanistan who experienced a lot of combat trauma, what they found is those veterans who are more self-compassionate toward themselves about what they had experienced, they were less likely to develop post-traumatic stress syndrome. And so in a way, post-traumatic stress syndrome is when, you know, the trauma kind of almost gets locked in your body and you keep re-experiencing the trauma because you can't process it. And so self-compassion towards the trauma helps you process it so it doesn't get kind of, you might say, locked into place through post-traumatic stress syndrome.

   16. PAPeter Attia48:13

       Yeah, which really makes so much sense when you look at the incredible success that the organization MAPS has had in testing MDMA in people with PTSD because MDMA is the ultimate compassion molecule. So it basically takes a slight amount of compassion you might have and it just amplifies it tremendously, and that's presumably why people in as few as two or three sessions can have otherwise debilitating PTSD rectified.

   17. KNKristin Neff48:45

       I think there's only one study that did show that MDMA increased self-compassion, but there isn't a lot. I think there's a huge, what we'll see starting, there's a huge boom already in looking at psychedelics, MDMA, mushrooms, because what they do is they give you an experience of basically love and connectedness. And I think, as you say, one of the reasons probably that it works is by increasing both self-compassion and a sense of connectedness. The two are actually, they go hand in hand. I wouldn't be surprised if we find that that's kind of the active ingredient of how it works, is to increase self-compassion, increase mindfulness, and increase connectedness. The three components of self-compassion are self-kindness, mindfulness, and common humanity or kind of

10. 49:30 – 52:30

    The relationship between self-compassion and physical health

    1. KNKristin Neff49:30

       the sense of connectedness, and the three really do go hand in hand. They operate as a system.

    2. PAPeter Attia49:35

       What's the relationship between those and physical health?

    3. KNKristin Neff49:39

       So there is an emerging literature that shows that self-compassion is linked to better physical health. It's kind of a small to medium correlation maybe. I think, like, there was a meta-analysis that found .28, .30, so significant, not mind-blowing, but still there with physical symptoms, at least self-reports of, like, colds, aches, pains, physical symptoms. A lot of research, actually, Fucius here was one of the big research in this area, and she finds that it's linked to better physical health. There's also research showing this is probably why it's linked to physical health, is it operates through the nervous system. So self-compassion, and this is done either looking at self-report of self-compassion or by, like, enhancing the self-compassionate mood. You can have people think of something they're dealing with and write to themselves a paragraph being mindful, kind of accepting of what's happening, remembering that they aren't alone, common humanity, and being kind to themselves like they would be to a friend. If you induce the three components of self-compassion, what we find is, first of all, it reduces sympathetic activity, things like inflammation, things like, uh, cortisol levels, and also increases heart rate variability, which is the main marker we have of parasympathetic activity. And it's probably by changing the nervous system reaction that it influences physical health because, of course, what your body's doing, how reactive it is, is linked to how healthy you are. Also, immune function. It's linked to better immune function.

    4. PAPeter Attia51:05

       It actually seems to me like I wouldn't be surprised if a greater body of literature emerges from this, because I think it sounds so cliché to say that the mind and the body are related.

    5. KNKristin Neff51:18

       But they are.

    6. PAPeter Attia51:19

       They clearly are, and I think anybody who's tried to help people in one of those dimensions and not been able to help the other is pretty aware of that focus. And, and certainly I interviewed Bob Sapolsky some time ago, and I think his work in stress is just so interesting. And stress is really, to me, kind of just one other piece of this vector. So I'm excited to hear that we're becoming more aware of this because obviously the lens I kind of come at all these things through is longevity, and longevity isn't just living longer, it's living better. And that, for me, I think, was the turning point in coming to accept the value of this, was even if figuring out a way to become more self-compassionate didn't make you live one day longer-

    7. KNKristin Neff52:06

       It increases telomere length though, so it probably does

    8. PAPeter Attia52:08

       [laughs] But even if it didn't, the impact it would have on the quality of your life alone would be worth it. And I think in the final analysis, quality of life matters more than length of life, and there's no reason you can't strive for both. The old joke about lifelong caloric restriction is it will increase your lifespan

11. 52:30 – 55:45

    Distinguishing between self-compassion and self-pity, and the three necessary components self-compassion

    1. PAPeter Attia52:30

       and you'll know it, or something to that effect. It'll feel like it. You'll live longer and it'll sure feel like it 'cause you're so miserable. So to me, that's kind of a big part of it. I wanna kind of go back to tease out a little bit more of the nuance in this because one could easily misconstrue self-compassion for self-pity. How do you distinguish these?

    2. KNKristin Neff52:49

       We need the three components of self-compassion. Just self-kindness or self-love, it could be a self-focused state, that I'm just poor me and I feel sorry for myself. What's the difference between pity and compassion? How do you know, and what's the difference between when someone pities you or someone has compassion for you? If you think about it, we like one and we don't like the other.

    3. PAPeter Attia53:13

       Well, that's a good question. I mean, pity feels condescending, I suppose.

    4. KNKristin Neff53:17

       Exactly. The separation. You're looking down. It's the separation. Compassion is, "Hey, I've been there, man." It's shared. And that is the whole difference between compassion and pity. And that's why in my measurement, in my construct of self-compassion, we need to include the sense of common humanity. I name it common humanity. I actually wanted to call it interdependence or interbeing. It's kind of like going beyond the separate self, but I knew that that'd be kind of a hard term for most people to get their head around, but that's really what it's pointing to. When you have self-compassion, you recognize that everyone's imperfect, everyone leads an imperfect life. Suffering, failure, hardship, this is part of the shared human condition. And also, if you really go deeply enough with it, you also realize that what I experience is not separated from what you experience. It's all part of these interdependent causes and conditions co-arising, and the idea that you can really separate yourself out of the larger whole in some ways is an illusion. You don't have to go that deeply with it, but that's ultimately where it's pointing. But if you didn't have that sense of Connectedness in the experience of suffering, it may turn into self-pity. That's why that part has to be there. Also mindfulness. So self-pity isn't very mindful. Self-pity tends to exaggerate, it tends to catastrophize. "Poor me, this is like the worst thing ever," kind of very self-focused. Mindfulness kind of has more equanimity. It's more of a balanced state of mind and see things as they, it is. It's just the little things where we do see importance. It doesn't like say, "Carry on," that type of thing. Like, "I'm not gonna focus on the fact that this is hard. I'm just gonna pretend it's not there." That doesn't help. But on the other hand, catastrophizing doesn't help either. And the mindfulness component partly comes from the inherent perspective that comes from self-compassion. Ironically, it's interesting to think about this, but because we are used to giving compassion to others, whenever we give ourselves compassion, there's like an inherent sense of perspective there because we're treating ourselves as we would treat another. We aren't lost in our drama. We're like stepping outside of ourselves, and that perspective, which actually leads... It's, it's not exactly the same t- as mindfulness, but they're very related. It actually gives us more perspective and balance in terms of how we relate to our own situation. From my point of view, all three need to be there to be self-compassionate, and actually psychometrically, if you look at psychometric analyses

12. 55:45 – 58:45

    Why self-criticism comes from a desire to be safe, the circular pattern of self-judgment, and self-compassion as the ultimate motivator

    1. KNKristin Neff55:45

       of the self-compassion scale, they all operate as a system, and all three change simultaneously. So they really do operate as a system.

    2. PAPeter Attia55:55

       Now, one of the things that anybody who starts to practice this becomes aware of is when you fall short of it, depending on how harsh a critic you are in the first place, you can easily fall into a pattern of self-judgment.

    3. KNKristin Neff56:09

       Right. Beating yourself up for beating yourself up.

    4. PAPeter Attia56:12

       It's the double bang.

    5. KNKristin Neff56:13

       Yeah.

    6. PAPeter Attia56:13

       So what advice do you have for folks who want to begin this practice to pull themselves out of that spiral?

    7. KNKristin Neff56:21

       Well, I think it's really helpful to know why we criticize ourselves. We criticize ourselves because we care. The reason we criticize ourselves is because we want to be well, we want to do our best, we want to be safe, we want people to love us, to support us, because we're afraid that if we don't do well, maybe we're gonna harm other people or we're gonna harm ourselves. Bad things are gonna happen to us if we don't do well, and good things are gonna happen to us, we believe, if we do do well. And so it all comes from the, a basic sense of safety. We don't need to beat ourselves up for beating ourselves up. We need to have compassion for the reasons we beat ourself up, which comes with a very natural desire to be safe. And once you recognize that, it's like, "Oh, okay, that's just me trying to be safe. Well, actually, there's a more effective way to help myself feel safe, and that is by giving myself compassion for what's just happened." When we teach people, especially self-compassionate motivation, if you wanna help people move from motivating themselves with criticism to a more kind of constructive criticism, more compassionate motivation, if you leave out that step of having compassion and even gratitude to our inner critic for trying to keep ourselves safe, it actually doesn't work. And I think why that is is because that part of ourselves, the self-critical part, is really scared for its life in many ways. [laughs] It's like from that, that point of view, it's like, "Life will end if I fail," or, "Life will end if I make this mistake," or, "Life will end if I'm not a good archer," whatever, you know? It's not a really rational part of ourselves. It's just like an emotional reaction. And so if we just skip over that part and say, "Hey, shut up. I don't wanna listen to you. I wanna listen to my compassionate part," that part of us gets even more scared. "Life's gonna end, and you aren't listening to me. Listen, listen, listen, life's gonna end." It's like it shouts even louder if we don't listen to it. But if we listen to it and say, "Hey, okay, I see you're worried. You're worried about my safety. Thank you so much. I hear you. Trust me, I'll do everything I can to keep myself safe," once you do that, then it's much easier for the more compassionate part of ourselves to try to motivate a change. It also wants to keep us safe, also wants to do our best, also wants us to change unhealthy behaviors, but does it not because it's afraid that we'll be inadequate, but just because it cares. It's a much more effective and sustainable voice of motivation.

13. 58:45 – 1:01:45

    Potential role of a self-compassion practice for addiction and other maladaptive behaviors

    1. PAPeter Attia58:45

       I think that's a really interesting point. I'm glad you brought it up because I don't think I've appreciated that nuance. You do have to acknowledge... A- again, this maybe comes back to maybe not so much Dick Schwartz's model, but other models of essentially us having wounded children within us, adaptive children within us, functional adults, et cetera. You can't ignore anyone's voice inside.

    2. KNKristin Neff59:12

       That's right, and the idea is just integration. We want integration, and we want to learn. Part of what your inner critic is telling you may be useful, but you just wanna glean what's useful, and what's useful is probably about, "Hmm, where did you go wrong? What could you do better next time?" It's not useful to say, "You're worthless," or, "You're a bad person." I mean, what are you gonna do with that, right? It's not helpful. But you don't wanna shut down that voice at all. But you don't want it dominating things either because it's a very one-sided, very kind of immature, not very wise part of yourself that just is freaking out, basically. [laughs]

    3. PAPeter Attia59:46

       I have no doubt that there is a very strong correlation between... And it would really be a reciprocal correlation or an inverse correlation between high levels of self-compassion and low levels of maladaptive behaviors such as addictions. I wouldn't dispute that for a second. What I'm curious about is how much is causative. In other words, is there any evidence that we could use self-compassion as an intervention to treat at least partially maladaptive behaviors, gambling, substance addiction, things like that?

    4. KNKristin Neff1:00:21

       I wish there were more research on self-compassion and addiction. There is a little bit of intervention research, I believe. Actually, trying to think Is there a randomized controlled trial with addiction as the outcome with the intervention? There may not be. I think it's more cross-sectional research that shows they're negatively correlated, and of course, we don't know causality in that case. There is some research showing that one of the things when AA is successful, it appears that one of the reasons it may be successful is because it increases self-compassion. By the way, I think it depends what group you belong to. I've had people who've gone through AA that said it was all about shame, and others say it was all about self-compassion, so I think it [chuckles] definitely varies depending on what group you go to. I would be willing to bet money that you would find that. I don't think we're quite there yet. And in terms of the two-way causality, for instance, if you're really addicted, it may make it harder for you to be self-compassionate. Once you come off the substance, it may be easier to be more self-compassionate. So all these things are always kind of bidirectional.

    5. PAPeter Attia1:01:26

       And how easy is this? I mean, I think as we sort of think and look to the future of using self-compassion as an intervention. So if you think about the easiest interventions are drugs. Here's a pill. The treatment group gets a placebo pill. The intervention group gets an active pill. All you have to do is take this one pill once a day, and we'll

14. 1:01:45 – 1:04:45

    Clinical applications and practical uses of self-compassion

    1. PAPeter Attia1:01:45

       figure out if it lowered your blood pressure or your cholesterol. Well, when you start to get into now we're going to test whether mindfulness-based meditation is beneficial or self-compassion is beneficial, it becomes more complicated. How challenging is it from a clinical research standpoint to package the practice that you've spent the better part of 20 years refining in yourself, writing about, but then taking it into a clinical setting with a group of subjects and being able to blind them, being able to randomize them, and then blind researchers who are gonna measure outcomes based on obviously the differences in behaviors?

    2. KNKristin Neff1:02:23

       We have developed the Mindful Self-Compassion Training Program, which actually isn't designed for clinical populations but can be adapted for clinical populations, and there's also Compassion Focused Therapy, which is similar, that is designed for clinical populations. And there have been randomized controlled trials of both with a waitlist control, which isn't as good as an active control, where you just put people in peer support. You might get similar findings, and I actually expect you might get similar findings from a peer support group. It's actually not that difficult. I think we definitely have the tools in place right now to do the research. I'm not doing that research 'cause I'm more focused on developing the interventions. I really hope people do. Also, I don't think it has to be reinventing the wheel. I think adding some explicit self-compassion to preexisting interventions that we know work is probably the way to go. There's more than just self-compassion. Self-compassion isn't everything. I think including mindfulness interventions. I have to say, personally, my feeling is although mindfulness training naturally increases self-compassion, it makes it stronger if you make it explicit, if you give people explicit tools they can use to practice self-compassion that's not meditation. Because when you're, like, in the supermarket and you have some thought or something happens, you aren't gonna sit down and meditate in that moment, but you can put your hand on your heart and say something supportive to yourself. It's very portable. It's very scalable. And also, the research shows it doesn't require meditation to learn it, which also makes it more accessible to a lot more people. I love meditation, but it's just a lot of people aren't gonna meditate. That's just the reality, but self-compassion is easier. It's more portable. It's more scalable. I personally think if we started looking at does adding explicit self-compassion into these interventions strengthen it, I suspect you'd find it does. We aren't quite there yet.

    3. PAPeter Attia1:04:14

       I think you're right, by the way. I think that's exactly the way to go about doing it, is you take interventions that are already known to have some efficacy, and you layer this on. Because I think as your story explains, this is a relatively straightforward intervention to teach somebody, and the results can happen quite quickly. I mean, if someone who's as harsh a self-critic as I am can, in a period of months, with a little bit of daily practice, with something tangible, 'cause it's tangible to practice, I'm quite excited about it in the sense that I,

15. 1:04:45 – 1:08:40

    Why you don’t need to meditate to learn mindfulness and self-compassion

    1. PAPeter Attia1:04:45

       I think there's a pretty big opportunity there. I wanna go just into this m- the mindfulness component a little bit because you've made this point now several times, which is, look, mindfulness is not a necessary component of self-compassion, but a re-

    2. KNKristin Neff1:04:57

       No, it is a necessary component of self-compassion.

    3. PAPeter Attia1:05:00

       Oh, it is? Okay, so I misunderstood. Maybe I misunderstood. I thought a mindfulness-based meditation practice is what I really mean. Is that necessary?

    4. KNKristin Neff1:05:08

       You don't need to meditate to be mindful. So meditation is probably the most tried and true way to increase mindfulness. Most mindfulness training programs base their techniques on meditation, but being mindful is just kind of being aware. Whenever you're aware that you're suffering, you're being mindful of your suffering, especially when you're aware in a certain way, when you're aware, not like freaking out aware, but you're aware like, "Okay, this is what's happening." So mindfulness itself, you can't have self-compassion without some degree of mindfulness. But our research shows, we did a randomized controlled trial, the Mindful Self-Compassion Program, and we found that practice was linked to gains in self-compassion, but it didn't matter whether that practice was sitting down and doing self-compassion meditations, uh, the program has many, or it was just simple things like taking a self-compassion break in the middle of your day, and you notice you're suffering, giving yourself kindness and support like you'd show to a good friend. It didn't matter how you practiced. So meditation isn't necessary, but mindfulness is. And you can also learn mindfulness without meditation. It's just a little tricky because mindfulness is kind of vague and abstract. It's hard to get your hands around it, so meditation helps.

    5. PAPeter Attia1:06:19

       Do you think an analogy to make this point would be that having strong legs is necessary for walking up a hill? One way to do that is just to walk up a hill. Another way to do it is actually go to the gym every day, lift weights, and walk up the hill, where the actual m- mindfulness meditation is the going to the gym. It's doing the very concentrated, focused exercise. Technically, you don't have to do it to still do well, but you're, in the long run, maybe gonna do better.

    6. KNKristin Neff1:06:48

       Yeah. So we don't know. We don't have data in the long run what's better. I mean, meditation we know is tried and true. It can change your neuronal pathways. Meditation is good. I believe in meditation. I'm a meditator. I think it's a little unfortunate that so much emphasis has been placed on meditation because not everyone's gonna meditate. Not everyone wants to meditate. Some people don't have time to meditate. It doesn't appeal to them. Again, I do think self-compassion is more scalable. You can have someone... So for instance, we just did a training program for healthcare workers working at a pediatric hospital. Six weeks of training, one hour a week, just done at lunch, very s- minimal training. We did not give them any homework they had to do outside of the class 'cause they didn't have time. They were, you know, stressed out healthcare professionals. We didn't give them any meditation. But we said, "On the job, whenever you notice you're stressed or you're sad or have something difficult happen," we gave them certain practices they could use to deal with it. We did give some informal mindfulness practices, like feel the soles of your feet. You know, come back to the present moment. We did things like the self-compassion break, put your hand on your heart, and help people develop phrases that work for them to remind them of the three components of self-compassion. And they got a lot out of it. They didn't have to meditate. After we taught the program, a lot of them said, "Actually, maybe I'll take the full program and learn how to meditate." [laughs] You know what I mean? So yeah. So maybe they'll go on to meditate after learning some self-compassion. And actually, there's some research that shows it helps you stick with the meditation practice if you have self-compassion, 'cause meditation's hard. But I don't think it's the only way forward, and I do think... I just think unfortunately in our culture, there's a way in which it seems kind of foreign to people. I think there's a lot of blocks to meditation that aren't there with self-compassion.

    7. PAPeter Attia1:08:39

       But it's

16. 1:08:40 – 1:11:45

    Kristin’s personal meditation practice

    1. PAPeter Attia1:08:40

       obviously stuck for you. You've gone on several retreats it sounds like.

    2. KNKristin Neff1:08:43

       Yeah, 40 retreats. I don't go on retreats nearly as much as I used to. First of all, the pandemic and just my life getting so busy, but I still meditate, yeah.

    3. PAPeter Attia1:08:52

       What is it for you that has kept meditation as sort of part of your daily routine?

    4. KNKristin Neff1:08:59

       Well, the meditation, the reason it's useful, 'cause what meditation basically is, is just it's a really focused time. You aren't doing anything else. You're kind of reducing sensory input. Um, I actually usually meditate in bed. It's not quite as good as doing it on the cushion, but it, it's still pretty good, and it's kind of more doable [laughs] for me, right? So I'll do it early in the morning or late at night.

    5. PAPeter Attia1:09:20

       You don't fall asleep doing that?

    6. KNKristin Neff1:09:22

       Sometimes I do, but sometimes I don't. Like, if I do it when I'm really awake, if I wake up at 3:00 in the morning, let's say my mind's racing, then it's a really good time to do it, and it actually will help me fall asleep. I'll be honest. The quality of the meditation is not quite as good as when I sit on my cushion, but at least I do it, whereas sometimes I just find I don't have time. Yeah, so meditation is helpful, first of all, because what happens when you meditate is you get into a certain brain state. Basically what happens is your default mode network quiets, and so your brain state changes, and it's easier for you to see clearly. It's easier for you to pay attention. There's less chatter in the brain, and that's very helpful. Yeah. So meditation is great. But I just don't want people to think that unless they meditate, they can't learn this skill. So for instance, there was one study that just had people, kind of like you, instead of texting themselves kindness, they wrote a compassionate letter to themselves with the three components, mindfulness, common humanity, and kindness. Once a day for seven days, one week, and it reduced depression for three months and increased happiness for six months. That's doable. Anyone could do that. You don't have to learn how to meditate to do that, and it still helps you.

    7. PAPeter Attia1:10:33

       Does your son have a practice around this? It sounds like he's quite aware.

    8. KNKristin Neff1:10:37

       He's finally coming around to self-compassion, but he fought it tooth and nail for years. I mean, just really recently, like the last few months he's come around to it. He used to say, "Don't give me that self-compassion stuff, Mommy." 'Cause he didn't want to accept the pain. He wanted to fight the pain. He didn't want to accept imperfection. He was, like, just clinging on tooth and nail, you know, to... He wanted the pain to go away. He didn't want imperfection to be there. He was, like, in full-on resistance. But he could articulate it. And I would kind of think, "Okay. Well, good luck with that one." What can I do? Like, you can try to fight the pain. Unfortunately, I know it's not gonna help, but people have to come to that conclusion themselves. But now finally he's starting to see the value of being kind to himself and see the value of just kind of understanding that, yeah, he's gotta accept imperfection. He said to me the other day, he said, "Imperfection is like spicy food. You know, if everything was perfect, all our meals would be bland. You know, we need some variety. We need some spice to our life." That, he came up with that himself.

    9. PAPeter Attia1:11:39

       That's kind of amazing.

    10. KNKristin Neff1:11:41

        Yeah, it is. And he's finally getting there. He's 18 now, and he's really

17. 1:11:45 – 1:16:40

    Resources for learning self-compassion

    1. KNKristin Neff1:11:45

       getting kind of to the next level of self-reflection and stuff. So he's a little behind, but he's definitely getting there.

    2. PAPeter Attia1:11:52

       You have a workbook that's based on your book, correct?

    3. KNKristin Neff1:11:55

       The Mindful Self-Compassion Workbook is basically the Mindful Self-Compassion Program, which I co-developed with Chris Germer. We met back in 2008. We're partners, and we've created this program. We've got the Center for Mindful Self-Compassion. We have teacher training. We have adaptations. It's its own thing. Chris and I, it was totally us together that created this program, and the workbook is the eight-week program in workbook format. So you basically take yourself through the program.

    4. PAPeter Attia1:12:24

       Yeah, I mean, to me, that seems like a really logical place for somebody to start if listening to this podcast has got them interested and at least piqued some amount of curiosity around this idea. It's a very structured way to go through this. It's not the way I did it, but I've looked through the book and I thought, "Boy, this is a really nice way to be guided through something." I would certainly make a plug for that. You can just get it on Amazon. It's easy to, you know

    5. KNKristin Neff1:12:51

       It's like $10. Yeah. If you want to actually train in self-compassion, it's an empirically supported program. There are randomized controlled trials. It's very carefully sequenced. We refined the program over years and years and years and what worked and what didn't work. I'm pretty confident in the efficacy of the program. But if you want like more personal stories, then you could probably go with my first book, Self-Compassion, or Chris Germer's book, The Mindful Path to Self-Compassion. Some people don't like workbooks. They like more like the stories. And so that would be my favorite book.

    6. PAPeter Attia1:13:24

       Well, Kristin, this has been a really interesting discussion and I'm really a huge believer in this, in this work that you're doing. And you've also lived it too. You've had these ups and downs and these challenges that have, I think kind of allowed you to sort of roll with things that are hard.

    7. KNKristin Neff1:13:39

       I had a lot to be self-compassionate about. That's for sure. [laughs]

    8. PAPeter Attia1:13:42

       Well, I look forward to meeting you in person at some point when this pandemic rolls over.

    9. KNKristin Neff1:13:47

       Yeah.

    10. PAPeter Attia1:13:47

        And again, thanks so much for your time today.

    11. KNKristin Neff1:13:50

        Thank you. It was lovely.

    12. PAPeter Attia1:13:52

        Thank you for listening to this week's episode of The Drive. If you're interested in diving deeper into any topics we discuss, we've created a membership program that allows us to bring you more in-depth, exclusive content without relying on paid ads. It's our goal to ensure members get back much more than the price of the subscription. Now to that end, membership benefits include a bunch of things. One, totally kickass comprehensive podcast show notes that detail every topic, paper, person, thing we discuss on each episode. The word on the street is nobody's show notes rival these. Monthly AMA episodes or Ask Me Anything episodes, hearing these episodes completely. Access to our private podcast feed that allows you to hear everything without having to listen to spiels like this. The Qualies, which are a super short podcast that we release every Tuesday through Friday, highlighting the best questions, topics, and tactics discussed on previous episodes of The Drive. This is a great way to catch up on previous episodes without having to go back and necessarily listen to every one. Steep discounts on products that I believe in, but for which I'm not getting paid to endorse. And a whole bunch of other benefits that we continue to trickle in as time goes on. If you want to learn more and access these member only benefits, you can head over to peterattiamd.com/subscribe. You can find me on Twitter, Instagram, and Facebook, all with the ID PeterAttiaMD. You can also leave us a review on Apple Podcast or whatever podcast player you listen on. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. Finally, I take conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit peterattiamd.com/about where I keep an up-to-date and active list of such companies. [outro music]

Episode duration: 1:16:40