I am currently working with my friend Michaela (Ki) James on the delivery of a new Mindfulness Based Healthy Living course. Key focuses of this course are self-compassion and healthy eating habits. Last week in the course we explored the obesogenic environment and the evolved human condition and concluded that we are in a fight with our biology to eat healthily in the modern world, ie. unhealthy eating habits are not our fault! This means we don’t need to blame ourselves and instead we can offer ourselves kindness and care in the face of challenging habitual patterns, ie. self-compassion. We contemplated our obstacles to moving towards a healthy lifestyle with compassion and rejoiced in the strengths and supports that we already we have in place to support us in addressing challenging habitual patterns. Our intention is to move in the direction of a healthy lifestyle.
Therefore, I was interested in exploring the evidence base for self-compassion training in relation to eating behaviours. I have looked at systematic reviews and meta-analyses to get an overview.
Braun et al (2016) is a systematic literature review of how self-compassion relates to body image and problematic eating habits. They describes that self-compassion is based on the recognition that suffering, failure and inadequacy are part of the human condition, and that all people, including ourselves, are worthy of compassion. They describe how some studies suggest that self-compassion practice improves health behaviours by transforming negative emotions into positive ones. This is consistent with research that compassion training activates neural circuitry associated with positive emotion and affiliation. They also suggest that self-compassion might be helpful at inducing self-soothing and non-reactivity during unpleasant emotional experiences.
Braun et al, looked at 28 studies and found self-compassion to be linked to lower levels of problematic eating habits and to be protective against poor body image and problematic eating. It suggests that self-compassion may directly decrease problematic eating outcomes. It may also reduce the occurrence of or interrupt risk factors leading to problematic eating outcomes, by boosting protective factors such as body appreciation, emotional tolerance or flexibility around body image, which have been found to improve intuitive eating and reduce binge eating.
Braun et al, suggest simultaneous training in self-compassion and mindful eating, which are both key components of our new Mindfulness Based Healthy Living course.
Steindl et al (2017) is a qualitative review of the use of Compassion Focussed Therapy (CFT) for eating disorders. CFT draws on evolutionary science, psychological science and neuroscience. This paper defines self-compassion as approaching oneself with kindness and acceptance, especially in the face of one’s own personal distress or disappointments. It describes how people suffering with eating, body-image and weight concerns tend to have high levels of self-criticism, self-directed hostility and shame. CFT was specifically developed to support clients with high levels of self-criticism, self-directed hostility and shame.
A version of CFT, called CFT-E has been developed to treat eating disorders. It aims to support people in understanding the links between their eating and their emotions, in developing empathy for themselves and their problems around eating, in developing some wisdom around the challenges of recovery, in developing the motivation to care for themselves and so a commitment to engage in recovery, and in developing the confidence and courage needed to offer understanding, support, advice and encouragement to themselves and others in their CFT-E groups (Steindl et al, 2017). CFT shows promising results for adults with a diagnosed eating disorder and the paper speculates that the approach may also be applicable to people with obesity.
Some of the reviews, Braun et al (2016) and Steindl et al (2017), describe how some people experience a fear response to self-compassion. Therefore, care needs to be taken when training course participants in self-compassion.
Rahimi-Ardabili (2018) is a systematic review of the efficacy of interventions that aim to increase self-compassion on nutrition habits, eating behaviours, body weight and body image. It looked at six studies and found that self-compassion can be beneficial for weight loss, nutrition behaviours, eating behaviours and body image. The studies had the aim of increasing self-compassion and assessed at least one of the following: nutrition habits, such as energy intake; eating behaviours, such as binge eating; body weight or BMI; or body image. All the studies indicated beneficial effects of self-compassion in healthy, normal weight or overweight people on factors such as weight loss and reduced body dissatisfaction. The results are consistent with the theory that self-compassion can alleviate barriers to healthy weight management, through improving emotional regulation, reducing self-critical thoughts, decreasing stress and increasing acceptance and psychological wellbeing. However, the number of studies was low and most of the studies had serious methodological limitations, in particular most of the studies included only women.
Turk et al (2020) is a systematic review and meta-analysis exploring if self-compassion is relevant to the pathology and treatment of eating and body image concerns. This study considered 59 previous quantitative, English language, peer reviewed studies, which used a self-compassion questionnaire and also measured eating or body image. It found that higher self-compassion was associated with lower eating pathology, reduced body-image concerns and greater positive body image with medium to strong effect sizes. It also found that self-compassion interventions for eating pathology and body image were effective and concludes that self-compassion appears to be an adaptive emotion regulation strategy in relation to eating disorders and body image concerns. Study limitations included that the studies were in English language and so may under-represent non-Western cultures and that they mainly included college age women.
Therefore, it seems that there is quite good evidence that self-compassion can help with problems of unhealthy eating behaviours and body image.
Written by Heather Regan-Addis
Heather Regan-Addis is a Founder Member and Director of the Mindfulness Association.
Heather delivers training for the Mindfulness Association on our two Post Graduate Master’s degree courses as well as on our regular courses in Mindfulness, Compassion, Insight and on our Teacher training programmes.
References:
Braun et al, 2016 – https://www.sciencedirect.com/science/article/pii/S1740144516301000
Rahimi-Ardabili et al, 2018 – https://link.springer.com/article/10.1007/s12671-017-0804-0
Steindl et al, 2017 – https://www.tandfonline.com/doi/abs/10.1111/cp.12126
Turk et al, 2020 – https://www.sciencedirect.com/science/article/pii/S0272735820300441
