What is self-compassion as an eater and how can it support people experiencing cancer? Stephanie Meyers, MS, RD, LDN is joined by Ellen, a patient, and Patricia Arcari, PhD, RN, AHN-BC, program manager for meditation programs at the Zakim Center at Dana-Farber.

[THEME MUSIC]

STEPHANIE MEYERS: Hi and welcome to Eating with Cancer, a podcast about how food and eating experiences are impacted by cancer. Where we sit down to candid conversations and explore integrative approaches to finding joy with food. I'm your host, Stephanie Meyers, registered dietitian and nutrition manager in the Zakim Center for Integrative Therapies and Healthy Living at Dana-Farber Cancer Institute in Boston. And I am honored to have with me today,Ellen, a Dana-Farber patient whose story speaks directly to the heart of how important self-compassion can be during a cancer experience.

And Patti Arcari, a nurse with a Ph.D in mindfulness and 30 years of experience teaching and researching in this field. So thank you both for being with me today. So our theme for today is self-compassion. Self-compassion specifically as an eater. What is that, first of all? And how can it support you during a cancer journey? Now, Ellen, you and I have had a long, long relationship talking about this together and in a really deep and powerful way that's been very moving to me as a health care provider.

And I know that self-compassion is something you practice. So I'd like to sort of just invite you first to share for you what it means. What is self-compassion, how do you define it in your own words?

ELLEN: Well, thanks, Stephanie. It's nice to be able to be here and talk about this. I'm still kind of a neophyte when it comes to self-compassion [laughs]. I've been practicing it since the summer, and I consider myself kind of a work in progress. So my definition, too, is a work in progress. But basically what it's meant for me is the ability to kind of silence my inner critic. I have a very loud inner critic, and it made me start to think about the way that I spoke to myself that I would never tolerate in a friend.

I would never be friendly with someone who spoke to me the way that my inner voice spoke to me. So it's turning down the inner critic, and finding the ability to understand myself and meet myself where I am. And acknowledge it and forgive the stumbles… and almost become an inner coach, which has been far more motivating. But it's been tough breaking years and years of, of having this voice say to you, you know, “you blew it,” or whatever it is in the eating journey. So it's really becoming kind of your inner coach or friend.

STEPHANIE MEYERS: Yeah. I love the way you describe it as sort of this ally that you can be for yourself on the inside. Patty, I'd love to have you sort of offer as well from your perspective as a researcher and a clinician and an instructor. How do you define self-compassion? What do you teach people about what it is?

PATTY ARCARI: Well, the wonderful thing about self-compassion is that now we have over a decade of research to really describe for folks what it means. There have been over 1600 research studies, believe it or not, over the course of the past decade, really identifying what this concept is all about. And it's so cool, Ellen, because you defined the three core factors that two researchers, specifically Kristin Neff and Chris Germer, who are the ones who really brought this into the mainstream, you defined those three factors!

The first that you talked about was just having the awareness that you were doing this to yourself, in terms of the voice, right? And so the first factor in self-compassion is mindful awareness. It's hearing that voice, it’s knowing that it's happening, because until you see it and hear it, you can't do anything about it. It just sort of washes over us, right? So the first factor in self-compassion, as identified by factor analysis and research, is the ability to be mindful of the voices versus over-identifying with them and saying, “Yeah, that's me, I'm bad,” or “Yeah, I really messed up.”

Okay. So, mindfulness is the first factor. And then the second one that you described is the ability to be kind to ourselves, to hear the voices, to understand that it's happening, but to just give ourselves a break and know that so much of that chatter that we're identifying with, that's not who we are. That's actually distorted and irrational and not real. So to hear it and then be kind.

And then the third factor – it's kind of cool, we were talking about this earlier – is a sense of common humanity, meaning that we understand that we're all going through this in some way, shape, or form together, right? Whether it's perfectionism around having to do the perfect podcast, or eat the perfect diet, or be the perfect parent, we have to understand that all human beings in this culture are experiencing these critics telling them that they're not good enough. And so to understand that we're doing it all together helps us feel less isolated.

So those are the three factors. But the way that Kristin Neff presents it feels a little bit more human for me. I hold on to this for myself. She calls it “loving, connected presence.” That's what self-compassion is: loving, connected presence. And her research has shown that people who have this sense of love and connection and presence, they actually engage in healthier behaviors like eating right and exercising, or drinking less.

And they're more motivated to participate in these health behaviors. And it's not that, you know, “I'm giving myself a break, so I'm not going to work as hard.” In fact, people who have self-compassion do have really high standards of what they want in their lives. It's just that they don't beat themselves up as much when they experience the inevitable – less than what they had set their goals to be.

STEPHANIE MEYERS: So true, Patty. In my experience, working with patients over the years. In particularly, in the realm of food and eating, right, you can have a lot of really great intentions and a lot of really specific goals. And then life just unfolds as it does, and things don't always work out exactly how you planned. And how you talk to yourself about that is a very big predictor of how well you will do going forward, carrying on, continuing to feel like even trying, right?

And I loved what you said about not over-identifying with the message, right? Understanding that there's a sort of universal experience that we have as humans. And that you're not the only one, and that there's a way for you to actually relate to yourself that is far more peaceful, inspiring. And actually that that is a skill you can build. That is something you can practice. You know, Ellen you and I talked about this when you first started to… When you first heard the term self-compassion, there was a bit of cynicism, right? And I think that that for me, same! I was like, “Well, that sounds, you know, nice for me to be kind of friendly with myself.” But really… I wonder if you'd say a bit about that. When you first heard about self-compassion, like what you thought of it, what you felt about it?

ELLEN: Well, I honestly did a complete inner eyeroll. I was thinking, “Oh, boy, here we go. You know, another way to excuse your behavior and, you know, it's okay that you ate the chocolate cake. You didn't eat two chocolate cakes.” And I just saw it as a weight. And also it seemed, for lack of a better word, a little squishy to me. I couldn't see myself getting up in the morning and giving myself a hug and saying, “You're just the best ever.” And so… but I was open to the possibility of learning more about it.I just, I just went in with kind of a “we’ll see” attitude about it.

STEPHANIE MEYERS: Beautiful. And to know you and know your story and the ways that you have actually applied self-compassion in very real and practical terms, that is the part that, really, I hope our listeners can take away. You know, if you're listening and you're thinking to yourself, “I don't know…” just like what Ellen said, “Is it really going to be this squishy?” What a great adjective to describe, so this notion that “Eh, I don't know if this is for me.” If that's how you're feeling right now as a listener, hang with us, because I really want for you to hear how Ellen has used self-compassion as a sort of gift.

So, Ellen, one of the stories that you told me, it's a very poignant example. In fact, it gives me chills. I'd love for you to tell us about one time even that you found self-compassion to be so very helpful for you in the midst of your cancer journey.

ELLEN: Well, I have to say that it was a very painful event that happened with a provider. But I was diagnosed with breast cancer in 2019 and having had cancer in my family, with my husband, I'm very, very sensitive to any changes.

And I'm very vulnerable to anything that's going on. So in November of this year, I had experienced some symptoms that really caused me some anxiety. So I went to see a provider and she examined me and ordered some tests. And then she kind of looked at my chart and made eye contact and said, “You know, really the biggest problem that you have and possibly what brought this on and will cause a reoccurrence is your BMI.” And basically that is the determinant that really kind of set this all in motion. And I cannot tell you, having gone in feeling very vulnerable, but then hearing those words was absolutely soul-crushing. And it made me feel like I did this to myself. I did this to my family. The fact that my BMI is higher than I want it to be caused this. I'm responsible.

And I went home and literally could not put anything in my mouth for two days. I thought I poisoned or brought this incredible angst on everyone through what I was eating. And everything, everything, everything, that I had learned and educated myself on and all the movement that I had incorporated and the good nutrition was for naught. I really, I went down the rabbit hole of self-blame.

STEPHANIE MEYERS: And I, you know, it's hard to even imagine trying to give words to what you just said, Ellen. That, that feeling you had of sitting in a room with a provider seeking help and then feeling so, so low, right?

ELLEN: It was awful.

STEPHANIE MEYERS: Yeah. Yeah. Yeah, Patty?

PATTY ARCARI: I just think what comes up is the tremendous suffering that you were experiencing as a result of those words. And so from that place of feeling that deep suffering, that shining the light on it through just acknowledging it can be some sort of a step along the way to be able to bring yourself into this space of accepting and loving and allowing the suffering to be there, but then letting it melt as they say. Letting the suffering melt away in the bright light of that love for yourself, of that kindness to yourself. That your inner wisdom told you was necessary because what you were hearing is not who you were, right?

STEPHANIE MEYERS: In fact, Ellen! That's, Patty, that’s such beautiful language to give to this. What you were hearing, those moments of being told something awful… How did you use self-compassion, Ellen, in that moment and beyond to help you move and recover from that moment?

ELLEN: Well, I have to say, it took a couple of days, and I really went back to… the inner critic really rode roughshod over everything for a couple days. And then I kind of stopped and I said “Wait a minute. This provider doesn't really know me beyond my diagnosis. And my BMI is just one line on my life resumé. She doesn't know what I've been through, who I am, what I'm doing. And if her words were in fact, true, it would mean that no one with a normal BMI would have cancer. And everyone with a BMI that was above normal would have cancer.

So the self-compassion, and to Patti's point earlier, was the rational side that came through and said, “Wait a minute, brakes on this. And you didn't cause this. This happened to you. You can make a change. Make positive progress in your life. And this doesn't have to be your story, just based on this BMI comment of this provider.” And the self-compassion kind of met me where I was. And what I really like about it is… the inner critic, the comment on weight is, is a backwards looking comment.

It's blaming something that happened in the past, and the self-compassion is forward-looking and saying “This is where you are. And these are the steps that you're taking to be positive. Let's move forward, however imperfectly, we're going to move forward.” And it really it made me feel so much better about myself and my forward-looking journey. And it kind of made those comments fade.

STEPHANIE MEYERS: Yeah. Well, Ellen, I mean, it is… it is beautiful. And I just want to acknowledge that, as Patty said earlier, the suffering and also your fortitude from coming from that most… the depths of your inner kindness toward yourself, to recognize that there was a way… not that you could brush this off… to really actually sit with it, that feeling, and then move through it with a very skillful approach of saying to yourself, “I know how to practice self-compassion. I know how to say to myself, I am more than my weight. I know how to say to myself, I'm aware of what I put into my body.” The things you said. “I am pursuing knowledge, I am taking steps, I am doing things.” Those things are all truths that came from you being able to practice self-compassion for yourself in the middle of a really hard moment.

I also want to… yeah, Patty?

PATTY ARCARI: I don't want to take away from that train of thought. But another thing that you, in other words, you mentioned that was so important and so helpful, Ellen, is the word understanding that I'm imperfect, right? I'm not perfect. And I think that when we hold on to this sense that we've got to do everything right and be everything right, we're moving away from sort of our essential nature, right? And so to just put out there that, “I'm not perfect, and that's just the way… a true reflection of who I am without expecting that I'm going to be perfect, right? That that's the goal that I should be reaching for… because it's not!” And to just accept that in the moment.

STEPHANIE MEYERS: I mean, Patty, I couldn't agree more. If you were going to take any truth about food and eating... There is – let me just offer from my perspective – there is no such thing as a perfect eating pattern. There's no such thing. That doesn't exist. If you are perpetually in pursuit of that, you… please come to the table of self-compassion! Please, please do! Because this is the thing. It's not only about what others might say to us, right? It's also the kinds of things we say to ourselves about food and eating. And it's… you know, 25 years of being a registered dietitian and nutritionist, I think a lot of my job is helping people contend with some of the narrative they have in their own mind about food and eating.

You know, “I'm so lazy about food. I need to control myself. If I could just get back on track...” If those are the kinds of phrases, thoughts, and feelings kicking around in your being, I just want to, again, with the support of both Ellen and Patty, is the way we're lifting this topic of self-compassion up today. This is actually a very specific way you can begin to work with that internal messaging and find some relief. Find some ease. Find, literally find, some joy and pleasure and satisfaction, which is actually how we're meant to feel with food.

And I was thinking about that, actually, Ellen, there was something you said once upon a time. I love it. It's about the eggs on the floor quote. Can you just…

ELLEN: Oh! [laughs]

STEPHANIE MEYERS: You said this to me once about food and eating. In some way, you had been feeling bad about your own eating, and then you had this thought. And this self-compassion phrase, I felt like it was really a self-compassion phrase. And I am wondering if you can share it with our listeners because it's so powerful, I think.

ELLEN: Well, I was going to say, I think what self-compassion has done is… it's narrowed the bandwidth of bad eating patterns. For example, before, if I had something or overindulged, I would say, “Oh, you've blown it. Now you have to wait till Monday to start again. You have to wait until the first of the month. Well, you've already blown lunch, so dinner you might as well... You know, you failed at this, so let's start tomorrow or whatever.” So the analogy was if you drop an egg you don't throw down the other 11. You clean it up. You say, “Well, it was one egg. I stumbled. I wasn't perfect. I did something that I regret, but I'm not going to throw away the rest of the time that I have. If I overindulged at lunch, I'm going to have a salad for dinner.” And it's not, it's not giving up. It's not giving yourself permission to throw the other 11 down.

STEPHANIE MEYERS: Yeah. Yeah.

PATTY ARCARI: I love that!

STEPHANIE MEYERS: Isn’t it so great? So I want to, I want to have us transition to takeaways for listeners. You know, people for whom self-compassion this podcast might have been the first time they've ever heard that term. And they might feel a little curious, a little skeptical. Whatever your experience is, it's fine by us. But what I'd like to have us each think about is, what steps would you recommend someone take if they were curious about self-compassion and how it might be helpful for them? Patty, would you like to get us started with some ideas of things that, examples of things people can try or do?

PATTY ARCARI: Well, I always go back to the practice itself, right? To the practice of meditation that allows us to get to that space where we can open, and see, and feel all of these very basic qualities that we've been talking about over the past half hour, right? When you are sitting in practice and you can feel, literally feel, this sense of suffering that's a part of your life because of something that you want to change, right? That direct experience of the suffering becomes a way to then say, “Okay, I'm motivated because I don't want to feel this way anymore. So I'm going to do… I'm going to commit myself to this practice so that I can try to let go of this suffering piece.” And so then that brings you to the question that brings you to the seat that allows you to say, “Alright, I'm going to try this for maybe 10 minutes to see how it feels.”

And I don't know about you, Ellen, when you when you first let yourself sit with a self-compassion meditation, just opening to it and saying, let me try it for 10 minutes. And then once you have the direct experience of what it feels like to truly have a sense of love and care for yourself, that opens you up to trying a little bit more, and a little bit more, and a little bit more. But the only way to really get a sense for what this is, is to have your own direct experience. Both of why you want to do it, because it doesn’t feel good to suffer, but then how much better it feels when you can just sit and be in that space of love and presence and connection with all, right?

So it's a matter of going from what you don't want, right? The suffering piece. Into what you do want, which is to feel worth it. I don't know if you guys are old enough to remember. Remember that L’Oréal commercial phrase?

STEPHANIE MEYERS: Yes!

ELLEN: Yes!

PATTY ARCARI: I'm worth it, right? Yes! I'm worth feeling this sense of peace, feeling this sense of love, feeling this like, “I am okay. And my meditation brings me into direct contact with that piece that is okay and not just okay, but loving and kind.”

STEPHANIE MEYERS: Yeah, so Patty, hearing you say it, I'm picturing like sort of sample sizes. Small little bites of things that are… You're starting small to get a taste and flavor of what self-compassion may be like for you, and how the benefits may show up for you.

PATTY: Yes!

STEPHANIE MEYERS: And that's actually a perfectly wonderful place to begin. Ellen, was there anything else you wanted to add in terms of like, thinking about how you can start?

ELLEN: Well, I was going to say, it really for me, too, was the realization that the other way wasn't working so well

So why not be open to trying this,and being a goal setter? Just putting on the mindset of, you know, being kind to myself. And whether it's life's journey or a cancer journey, it is unpredictable and it is not a straight line. And to be able to say to yourself, you know, “It's okay, I'm going to meet you where you are, and you're not going to quit and you're not going to give up, and here's what we're going to do moving forward,” is so much healthier and takes up such… you know, it freed up time for me because I wasn't beating myself up. I was coaching myself and encouraging myself and moving forward. And it was a nice feeling. But it takes practice. It takes time, and like I said, you have setbacks where your critic jumps out again, but it's okay. That's all part of the process and that's part of the forgiveness and the stumbling and getting back up.

STEPHANIE MEYERS: Ellen, I know we're nearing the end of time, but I just want to have our listeners understand that not only are you coming at this from the perspective of being a patient yourself, but you have experience as being a care partner.

ELLEN: Yes.

STEPHANIE MEYERS: I know that self-compassion wasn’t part of your lived experience at the time that you were caring for your husband through his cancer journey. But I just wondered if you could speak now for just even a moment to the people listening who are the loved ones, the support system, the friends, the family surrounding the person with cancer. What do you feel could come from self-compassion in that role?

ELLEN: I would say that being a caregiver, in terms of perfectionism, is even harder than being a cancer patient because you are so emotionally invested in bringing the best to this person, that when you fall short, it is a huge, huge mental hurdle. Because you want to be the best you can be for this person and the family, and what you have to encounter and carry is so very heavy that it can't be done perfectly.

And because you're human, there are days where you're tired or crabby or normal, and you're asking yourself to be superhuman. And so if I had had this tool when I was going through it, I think I would have been a lot kinder to myself. And I think I would have been able to, again, meet myself where I was and encourage myself versus, you know, really focusing on where I felt that I had been lacking.

STEPHANIE MEYERS: Ellen, thank you. Thank you so much for sharing. It's just so powerful to hear how this this concept, I'm calling it, of self-compassion. But it's really a practice, a daily practice, a way to strengthen your moment-to-moment existence, kindness toward yourself. And just again, for our listeners, who are interested, who are curious, who are wondering, where can I learn more? How can I find out more? You know, there's a workbook, Mindful Self-Compassion, Kristin Neff wrote with Christopher Germer, which is a great place to start. You can practice self-compassion on the website of Sharon Salzberg or Jack Kornfield with guided meditations. You can also join us at MyZakim. It's the platform where we deliver and host live and on-demand programs that are open to everyone.

So mindfulness meditation is a program you can find on MyZakim, Dana-Farber's integrative medicine website. And also, of course, we have additional classes and programs for Dana-Farber patients specifically. But for people who are interested and want to learn more, please visit us at myzakim.dana-farber.org. And I'd like to just again, thank you, Ellen and Patty, so very much for sharing your wisdom and insights today.

And thanks to each person listening right now. May your moments with food be nourishing, full of ease, and true satisfaction. I'm Stephanie Meyers with the Zakim Center at Dana-Farber Cancer Institute. And until next time, be well.

[THEME MUSIC]