Care, by itself, brings thoughts of warmth, compassion, and doing right by the people who need your help. As an employment Sector, it sees life or death stakes placed on a chronically undervalued staff, working under stringent budgets in high pressure working environments.
What, then, can we learn from the fields of trauma research and community support in caring for those carers?
Dr Dianne Wepa of Charles Darwin University joins us again with colleagues Professor Mary Steen from Curtin University and Dr Lisa Di Lemma from Liverpool Hope University to talk about self care and self compassion as tools for improving public health.
As a note, this episode includes discussions of workplace bullying and medical trauma. Listener discretion is advised.
Read the original research: https://doi.org/10.2174/18743501-V15-E221020-2022-39
Listen to Dr Wepa's previous episodes:
Care, by itself, brings thoughts of warmth, compassion, and doing right by the people who need your help. As an employment Sector, it sees life or death stakes placed on a chronically undervalued staff, working under stringent budgets in high pressure working environments.
What, then, can we learn from the fields of trauma research and community support in caring for those carers?
Dr Dianne Wepa of Charles Darwin University joins us again with colleagues Professor Mary Steen from Curtin University and Dr Lisa Di Lemma from Liverpool Hope University to talk about self care and self compassion as tools for improving public health.
As a note, this episode includes discussions of workplace bullying and medical trauma. Listener discretion is advised.
Read the original research: https://doi.org/10.2174/18743501-V15-E221020-2022-39
Listen to Dr Wepa's previous episodes:
00:00:08 Will Mountford
Hello, I’m Will. Welcome to research pod. There is something about the care sector as a field of employment that always rings a little paradoxical. On the one hand, care as a verb, adjective or noun brings thoughts of warmth.
00:00:22 Will Mountford
Compassion doing right by the people who need.
00:00:24 Will Mountford
To help as a sector, it seems some of the toughest work that people can perform in physical or emotional labour all tallied up under stringent budgets, high pressure working environments and literally life or death stakes placed on chronically undervalued staff.
00:00:41 Will Mountford
What then can we learn from the fields of trauma research and community support in caring for those carers?
00:00:47 Will Mountford
Doctor Diane Wepa at Charles Darwin University joins us again with colleagues Professor Mary Steen from [[ Update : Curtin University ]] and Doctor Lisa di Lemma from Liverpool Hope University to talk about self-care and self compassion as tools for improving public health from supporting remote communities during the height of the pandemic, to providing relief to health care staff and veterans.
00:01:08 Will Mountford
needing their own healing today.
00:01:10 Will Mountford
As a note, this episode includes discussions of workplace bullying and medical trauma. Listener discretion is advised.
00:01:23 Will Mountford
And joining me for this episode, Doctor Lisa dilemma, Doctor Diane Wepa, and Professor Mary Steen. Hello to you all.
00:01:28 All
Hello will.
00:01:29 Prof Mary Steen
Hello and thank you for inviting me to this podcast. I'm going to introduce this podcast with my own definition of what I believe self compassion is and self compassion is having the ability to care for yourself by being aware of your feelings and accepting these when experiencing.
00:01:48 Prof Mary Steen
Difficult life problems and or work change.
00:01:51 Prof Mary Steen
Changes and that does fit in with Paul Gilbert's statement. He sees it as a basic kindness with a deep awareness of the suffering of oneself and other living things, coupled with the wish and effort to relieve it. OK, now, Christine Neff and Chris Germer have done a lot of work in this area. They're.
00:02:02
Cool.
00:02:12 Prof Mary Steen
Pioneers over in the States and in the early 2000s, they looked at the benefits of self compassion. It's not a new concept. It's been in Buddhist philosophy.
00:02:23 Prof Mary Steen
And their self-care sort of meditation practices for about 2500 years. But their psychologist, and they could see the benefits of self compassion for the general population at large. Now they discuss what self compassion is and they have put together 3.
00:02:42 Prof Mary Steen
Components. Each of these with a positive and a negative.
00:02:47 Prof Mary Steen
So for example, self kindness versus self judgment, common humanity versus isolation and mindfulness versus overidentification. So it's really changing that the basically being kind to yourself, because often we are our own worst enemy.
00:03:07 Prof Mary Steen
If you have a look at how you feel when you maybe do a task or something happens in your life, and remember in life we all will suffer. You have to show the same kindness that you would give to a friend.
00:03:20 Prof Mary Steen
And or a work colleague. And we often don't, and we judge ourselves and we are our a self critic. So it's really to actually realize that be aware of that and actually give yourself kindness. Common humanity is like the shared experience because when we are suffering in life, we believe we are the only.
00:03:40 Prof Mary Steen
Won.
00:03:41 Prof Mary Steen
And we ruminate and we catastrophize. But this is not the case. And mindfulness is really to take that pause, take some time out, and be the in the here and now. We do always look at the past and ruminate far too much. Then we worry about the future. But we don't often just live.
00:04:02 Prof Mary Steen
In the here and now.
00:04:04 Dr Lisa di Lemma
And I think it's quite nice how all these aspects, as you say, they're not reading new elements. They're also part of what we use in clinical psychology counseling as techniques that we use during therapy. So as you mentioned before, exactly they're not new concepts, but they're seen as a new kind of construct.
00:04:25 Dr Lisa di Lemma
In fact, cell compassion is seen as an adaptive emotional regulation strategy that has shown throughout different reviews on different subgroups of the population, including veterans, for example.
00:04:38 Dr Lisa di Lemma
How actually it can improve both physical health and mental health?
00:04:43 Dr Lisa di Lemma
So examples are especially effective for psychopathology, such as post traumatic stress that we know we can see often in veterans populations.
00:04:55 Will Mountford
To ground what you've said about this being, nothing new in psychological terms and nothing new in philosophical terms to center things in a very 2023 sense, could I ask you to compare a little bit about self compassion?
00:05:07 Will Mountford
To chronic stressors such as a couple of years of pandemic related response and lockdowns and everything happening in the world generally with some of the acute responses, Lisa you mentioned there post traumatic stress disorder which can come down to a single inciting moment or could be something a bit more accumulative.
00:05:28 Will Mountford
You see that there's different approaches or different suitability for self compassion. well-being this mindfulness thinking in the long term or as the immediate response to a trauma.
00:05:40 Dr Lisa di Lemma
Research shows that the definitely different approaches, so I just mentioned post traumatic stress that actually shows improvement against depression, anxiety, improved sleep, so a great amount of breadth of research really.
00:05:55 Prof Mary Steen
And building on to that world, because you did say the philosophical underpinnings, which obviously is the Buddhist philosophy, it's that taking time out, taking time for yourself. I'm just writing up a paper on a research study where I'm looking at caring for the car.
00:06:12 Prof Mary Steen
Because as you mentioned, the pandemic was, you know, Pandemic 1919 really did affect the world globally. But not only people been in lockdown, but the actual carers that were on the frontline that had to give the care and some actually lost their own lives as well.
00:06:32 Prof Mary Steen
And it's actually slowing down and giving permission to give care for yourself. We're not often good at that. And this study I'm doing a key message has just come out because I'm analysing the data.
00:06:44 Prof Mary Steen
That even though we're aware of self-care, some strategies and skills, because we are carers, nurses and midwives, we're not often very good at doing it for ourselves and we have to be reminded. So I have just LED and we have just looked at our educational workshops and 55 nurses and midwives.
00:07:04 Prof Mary Steen
Attended, we followed them up and we followed them up later again a second time at 6 to 8 weeks and what they're saying is that it actually decreased their anxiety and stress.
00:07:17 Prof Mary Steen
Mood was similar, so we have to be cautious about reporting that, but from this evidence they said they definitely need the reminders and they suggested that this should become part of continual professional development. It should be mandated at least annually.
00:07:36 Dr Lisa di Lemma
I think there's also a study that was published in 2010 from Miller and colleagues.
00:07:42 Dr Lisa di Lemma
That actually looks at, for example, social worker clinicians and proves that self compassion is a unique and significant predictor for both personal and professional self-care and practices related to self-care.
00:07:59 Prof Mary Steen
And that's interesting, because the nurses and midwives fed back about there.
00:08:04 Prof Mary Steen
Personal stresses at home with family, with relationships, with even financial issues, because you know, everybody is under pressure. I think the whole world at the moment when you look at society and different nations and that could.
00:08:20 Prof Mary Steen
Pulled with workplace stressors, we've they were saying about shortage of staff, long shift patterns, no breaks. You know, it's the accumulation of those stressors that actually can lead to poor mental health and illness. And they said that by being reminded.
00:08:41 Prof Mary Steen
To practice self compassion sort of strategies. For example meditation. Taking some time out, you know, but I'll be OK, alright. I've not got this right but.
00:08:52 Prof Mary Steen
It will pass. I will go through it, enabled them. It was like a buffer to prevent it escalating, perhaps to compassion fatigue and also burnout.
00:09:04 Will Mountford
To come back to something that Mary you mentioned that we have the the Western psychology perspective, there's the Buddhist perspective and Diane, something that we've mentioned in a couple of past podcasts is the indigenous married perspective, indigenous Aboriginal Australian perspectives on well-being and pandemic response natural disasters.
00:09:24 Will Mountford
Could I ask you to kind of put that in more of a, you know, to fill out that global view of how self compassion mindfulness manifests in different cultures and different attitudes to community and personal health?
00:09:37 Dr Dianne Wepa
Yes, Mary and I have done some work in that space as well with the Aboriginal woman, which I think she could probably add to, but definitely in New Zealand we do have a term called Aroha AROHA and that's a wonderful word because it can mean love and it can actually mean.
00:09:57 Dr Dianne Wepa
Sympathy or?
00:09:58 Dr Dianne Wepa
The fee and when it's used in a sentence, you can say that you are showing Adora or even kindness for a person. So I think yeah, a lot of the indigenous cultures do have basically one word. That means a lot of things. And I think when you have the, say, the English.
00:10:18 Dr Dianne Wepa
Language is very much noun driven and there's lots of defining of words, so you know you would say sympathy, empathy.
00:10:27 Dr Dianne Wepa
Caring, compassion and so a lot of indigenous cultures, the language is verb.
00:10:33 Dr Dianne Wepa
Verb focus. So it's what are we doing with the words? And so I've been doing a bit of work around that. The concept weed entity, which I've talked about before, which is different to identity. So the collective orientation around Wellness and self compassion is very strong and the.
00:10:51 Dr Dianne Wepa
Whom are we? And us is quite dominant in indigenous cultures language. It's very few would use the word I. So I think that lends itself to what's been said in this podcast, which Mary I think, can expand on in terms of how do we do that in the workplace and doing some behavioural activation. I know Mary and I did a bit of work on that, like developing a tool.
00:11:12 Dr Dianne Wepa
Where people can actually be encouraged to take those moments to.
00:11:18 Dr Dianne Wepa
Demonstrate self compassion, which is what we just talked about. You do need reminders and in the field of social work that I come from, we have the model of clinical supervision or professional supervision which I know midwives have as well. So I think having the workplace support you to actually in work time take a pause and meet with someone.
00:11:38 Dr Dianne Wepa
To talk about the stress of what's happening in the workplace during work time is 1 method to help mitigate these stress and burnout that people would take home.
00:11:51 Dr Dianne Wepa
Into their home lives, but definitely I think there's a lot we can learn from indigenous cultures. Mary, do you want to add to that?
00:11:57 Prof Mary Steen
Yeah. And one of my PhD students in SA, we've been doing some work with the women's prison in Adelaide and we've been running groups and we've put a program together, Mother's matter and obviously as a component of that self-care has come up and we have introduced self compassion.
00:12:17 Prof Mary Steen
In a way of forgiveness and the clear message that, yes, she might have made a mistake, but that does not necessarily make you a bad person.
00:12:26 Prof Mary Steen
And that acceptance and to move forward, you know what's happened prior it's over. We have to move forward now we're here and now and to give and to give and these some strategies and in that women's prison population over 30% I think it was about 33% were.
00:12:46 Prof Mary Steen
From Aboriginal or Torres Strait Island background, so you got your and then we had migrant women as well. And women with learning disabilities that really have not ever, ever had any kind of kind.
00:12:59 Prof Mary Steen
Us, in fact, a few of the women actually admitted that they did a crime to go back into prison because they felt safer.
00:13:08 Prof Mary Steen
So you know you have to put things in perspective here that we were teaching them that it's OK to feel like this, that things in life are out of your control and you can suffer. But you can actually develop some positive and some good coping strategies.
00:13:25 Prof Mary Steen
Not you know, where they might have had access to alcohol or even drugs, but actually to do meditation, to believe in themselves and to give themselves kindness and to forgive themselves. What we found was it was very helpful to do that. And I think Lisa can build on this because with the veterans.
00:13:46 Prof Mary Steen
She mentioned post traumatic Stress disorder, which obviously a lot of these women will be suffering from as well, but also the guilt related trauma. Do you want to come in, Lisa, and, you know, discuss how it was affected for guilt related trauma.
00:14:02 Dr Lisa di Lemma
Yeah. So in the systematic review, actually a scoping review we published just prior to the pandemic, we found that it was obviously had an effect in various sickle cell. So methodology, but in particular PTSD, trauma, guilt related and as well.
00:14:22 Dr Lisa di Lemma
Improving physical aspects. Physical health such as sleep.
00:14:26 Dr Lisa di Lemma
But the main aspect was exactly anything that was related to trauma, not only lived exactly during their service, but as well. Maybe when they left service, so really focuses on like a breadth of different.
00:14:46 Dr Lisa di Lemma
Aspects and one thing actually that came out that was quite surprising because prior research did show effects.
00:14:53 Dr Lisa di Lemma
In with alcohol substance uses, so improve in self compassion. But in our review for a veteran population we saw that actually schizophrenia and alcohol and substance abuse was not actually an aspect that showed improvement with.
00:15:13 Dr Lisa di Lemma
The self.
00:15:14 Dr Lisa di Lemma
Passion. So there are aspects that obviously show a better improvement than others. So self compassion shows a protective role, in particular for trauma related psychopathology, including guilt. But as well, it shows not an effect, at least in veteran population, from our current reviews, which again was published in 2000.
00:15:35 Dr Lisa di Lemma
And 20. So if there's other research.
00:15:40 Dr Lisa di Lemma
That it's been published recently, that's not included currently, but it did show that it only affected it mostly covered and protected against trauma related psychopathology, and it also included the aspect of acceptability and feasibility of this improvement in training for self.
00:16:01 Dr Lisa di Lemma
Passion in this population and it showed an interesting aspect was how it actually improved, showed better improvement if you involve the family and the social network around the.
00:16:14 Dr Lisa di Lemma
Patterns, which is something that actually not many studies have looked into, and so there's this breadth of research, the future research there that should be investigating this aspect because it links nicely as well with the concept of self compassion being inclusive and non judgmental of yourself.
00:16:34 Dr Lisa di Lemma
But also of others. And so it showed exactly stronger effects if you included the social network of the around the veteran. I'm not sure if that's the case as well, maybe and then maybe you would know if that's the case as well. In other research that you conducted.
00:16:52 Prof Mary Steen
Yes, we have talking about families, Lisa. We have done a review of the influence of self compassion education for parents, myself, Diane and Sweet Hoffman and Lois McKellar. We had a look at the research and we found ten studies that actually addressed this and interestingly enough.
00:17:13 Prof Mary Steen
It was parents that had children with additional needs, so you can imagine parenting is one of the most challenging roles.
00:17:22 Prof Mary Steen
I speak from personal experience and I think we all can hear and people that are listening. It's not easy, is there? There's no such thing as a perfect parent, but we're good enough, aren't we? That's what I always say to the mothers and fathers that I do sessions with. And in this review that we found, when they learn how to give themselves compassion. Take that time.
00:17:42 Prof Mary Steen
Now they could cope better and their anxiety and stress reduced so we could see a pattern. So we believe that if it works with parents that have children with additional needs, which is the research that's showing, then you know, on a balance of probability, it's going to work with parents in general. And this is an area that we're going to take.
00:18:02 Prof Mary Steen
Further, and do further research and introduce self compassion education and part of the antenatal sort of education during pregnancy, but then follow it through postnatally cause this is where a lot of parents are saying they're struggling. Mental health is increasing and so I think it's an area that we can actually identify.
00:18:23 Prof Mary Steen
Do you want to build on that Diane?
00:18:26 Dr Dianne Wepa
I'm thinking of the work that our Masters student Sophie did Sophia with, working with the fathers, and how they were trying to work out how to use self compassion with their young babies. Wasn't it? With that were in the NICU and the intensive care unit.
00:18:44 Prof Mary Steen
Yeah, that was in the women and Children's Hospital.
00:18:46 Prof Mary Steen
In Adelaide, will and what she looked at is there's a lot of evidence around skin to skin contact. You know, when mammals remember, we have to give that loving kindness, that warmth, that depth. But obviously in Australia it's been termed kangaroo care.
00:19:04 Prof Mary Steen
And so it's very acceptable, which is quite nice. Now often we focus on the mothers, and rightly so, because the mother is giving the care. However, sometimes the mothers might not be available. She might have had her traumatic birth experience being not feeling very well. She might have had a caesarean section. So the next best person is the father.
00:19:24 Prof Mary Steen
Now these babies obviously were either premature or they were growth restricted or there were some issue why they had to be in the neonatal intensive care centre. That's what a niku is. And so the fathers were taught how to actually give the kangaroo.
00:19:42 Prof Mary Steen
Care. And it was amazing. They all calmed. Oxytocin was released. It was absolutely amazing. And there's other studies showing that cortisol levels go down and and you know, and that really leads to that. We should be kind, that it takes a village to bring a child up. And yes, Lisa, like you said.
00:19:59
The.
00:20:04 Prof Mary Steen
We really need to look at the support of people like veterans, for example, parents, the aloe parents, the grandparents, other people that maybe some societies do better than the Western world. You know that we have become a little bit isolated.
00:20:20 Prof Mary Steen
You know, because of work, we move away. Have we got the family support? Do we give that kindness and this probably really showed, like you mentioned the COVID-19 pandemic where we did become isolated, didn't we? Yes, we could zoom and talk like we're, you know, speaking today. But nothing really that face to face. And that human contact.
00:20:42 Prof Mary Steen
You know, and often one of the self compassion strategies is touch. I know when I'm having a difficult time at work and it is you know, because we're all under pressure with shortages, even midwifery educators and researchers with.
00:20:56 Prof Mary Steen
Of staff, but I take a pause. As Diane mentioned earlier, I put both hands over my heart and I think I'm OK.
00:21:04 Prof Mary Steen
This will pass. I'm OK. I need time to take out. And it's interesting. When I went to Brazil, I was the only one working all the time at my desk. I kid you not, will. And having a sandwich and a coffee as if I can't, do you know, really bad habits to be.
00:21:20 Prof Mary Steen
Quite.
00:21:20 Prof Mary Steen
Honest and yet my Brazilian colleagues know Mary.
00:21:24 Prof Mary Steen
We go for lunch, we down tools, we take time out.
00:21:29 Prof Mary Steen
And we have a nice lunch and then we come back, refresh. We have a little walk. We have some fresh air. We appreciate the environment. Each others company, our support of each other and then we will assure you that you will be more productive and guess what will they were right.
00:21:49 Prof Mary Steen
So I had to unlearn some bad behaviours. I don't know if Lisa and Diane want to build on that.
00:21:56 Dr Lisa di Lemma
Yeah, I was gonna just link nicely there with what you were saying related to COVID. So I'm writing currently a paper. It's not on self compassion really, but it does link nicely because it's looking actually at the relationship. It's a qualitative study looking at the relationship between increased use of drinking.
00:22:16 Dr Lisa di Lemma
Basically, alcohol during COVID and perceive stress in students.
00:22:22 Dr Lisa di Lemma
And from the quotes of the students we that we analyze, we see that social interaction and the lack and the absence of them actually was one of the main stressor, including obviously the issues with the challenges they encouraged during moving from face to face teaching.
00:22:41 Dr Lisa di Lemma
To online teaching and actually it showed that one of another stressor that they mentioned was uncertainty. The uncertainty about the whole situation and how that would plan now and affect as well the relationships in the future.
00:22:55 Dr Lisa di Lemma
And it does link nicely with self compassion because obviously due to the breadth of research showing improvements in well-being in general, we see how the students have a narrative in, in this study that we run, we're at the minute writing up how actually that could have helped.
00:23:15 Dr Lisa di Lemma
Having a bit of self compassion acknowledging the situation.
00:23:20 Dr Lisa di Lemma
That it's temporary and would have definitely helped their benefits. But social interaction exactly was one of exactly the main stressor that came out during the pandemic, at least in the studies we, and it's actually lined with a breadth of research again in of COVID and loneliness, and increases in mental health issues.
00:23:41 Dr Lisa di Lemma
During the the.
00:23:43 Prof Mary Steen
Diane, you mentioned in your first podcast the well-being and resilience about the five ways to well-being, which obviously is being embedded and adopted throughout the NHS in the United Kingdom. And I think that links into what Lisa's saying and actually self compassion. You can use the five ways.
00:24:03 Prof Mary Steen
To well-being, they're a little bit entwined, aren't there? And I you did talk about this, didn't you?
00:24:08 Dr Dianne Wepa
Diane. Yes. Yes, I definitely did. And I think coming back to the, the cultural perspective is that I think when you have a a strong sense of community, the five ways to well-being.
00:24:19 Dr Dianne Wepa
A more fluid and I think you would do all of those actions with another person because that seems to be the orientation of some cultural groups and I think that's important. And I was just wanting to loop back to what you were saying, Mary, about the the study we've done with the fathers with Niku, I thought it was a really important take away.
00:24:39 Dr Dianne Wepa
Message for the listeners, especially if they are providers of health where the father felt he was neither a patient or a visitor.
00:24:48 Dr Dianne Wepa
And I think that's something to think about in terms of well-being, how?
00:24:54 Dr Dianne Wepa
We treat people that we provide services to where we may inadvertently have them feel like they actually don't belong to the health system, and especially for fathers. I think there's some work still to be done because they're an underserved group in terms of being part of the health system, especially when they're, you know, they've got a very unwell baby.
00:25:13 Dr Lisa di Lemma
Yeah, the focus is always on the mother, but actually the mother, they're one of usually the pillars of support next to the new family and the the new mothers. And, you know, other mothers. So there should be more research in the area, I agree.
00:25:29 Prof Mary Steen
Yeah, that paper has been well cited, and it was far as encounters with maternity care will. And you know, we have to hold our hands up. We didn't consider him and the NHS is good at looking after patients and visitors. He's neither is the partner and parent.
00:25:49 Prof Mary Steen
And so he's in this interstitial space. So how do we give the care? And often even just by calling him his name often, we'll say dad, dad. Well, could we take the time to actually find out his name? He's the other parent and say the mother has had a cesarean section or an instrumental birth or not.
00:26:09 Prof Mary Steen
Well, he can actually, you know, be like I said, the next person to give that care and remember healthcare settings, yes, we're all busy. But what is our core business? Our core business is to give care. However, if we do not care for ourselves like I'm going back to the caring for carers, how can we care for us?
00:26:31 Prof Mary Steen
What we're showing in this latest research is that when we actually do take time out for ourselves, we actually then improve our relationships with our working colleagues, because often some places unfortunately, like lots of different organizations, it can be bullying. There is.
00:26:50 Prof Mary Steen
You know, work being undertaken at the moment around that. So we we need to address that that how we work with our colleagues.
00:26:58 Prof Mary Steen
Leaks and that kindness, so self compassion and compassion for others are entwined. So if you're compassionate for yourself, then you're more likely to be able to be compassionate for others, and that ultimately it will improve the care that patients and parents get in general.
00:27:25 Will Mountford
There's one question here that I'd like to address we've mentioned of.
00:27:30 Will Mountford
That self-care self compassion. It can be a tool for yourself, and I wonder, could you tell me more about self-care, not just as a tool, but benefiting from other health tools, not just other counselling and other therapy, but also mobile health tools. Some of the app research that's going on about how you know, technology tools can supplement.
00:27:50 Will Mountford
If not face to FaceTime and self compassion, but.
00:27:54 Will Mountford
Deliver it to where it might not otherwise be deliverable in traditional health interventions.
00:27:59 Dr Lisa di Lemma
Yeah. So there's a breadth in general of that of research. Uh, like my background is mostly in addiction. So my PhD was looking at actually improving a cost effective tool for reducing hazard drinking in people that are not substance dependent, but, you know, drink over the recommended.
00:28:20 Dr Lisa di Lemma
Guidelines and obviously the the use of this technology helped multiple ways. One, they're cheaper to run.
00:28:28 Dr Lisa di Lemma
Secondly, they reach widely, you know internationally. And if you think about specific settings and contexts, if you just think about COVID, they can support during situations such as social isolation and restrictions that have been during lockdowns that we seen.
00:28:48 Dr Lisa di Lemma
And they already started looking at this also for self compassion that they show to be effective in improving self compassion, improving well-being and reducing stress. However, obviously because they're sort of just in the development in study.
00:29:05 Dr Lisa di Lemma
We need more of those randomized control trials in order, because obviously the research is just at its beginning. It's more pilot studies on small subgroups of the population with small sample sizes. So obviously there still needs to be further research just to show how cost effective.
00:29:25 Dr Lisa di Lemma
These are, however, there is is definitely showing that direction of positive effects that you can improve self compassion with the use of these apps and online tools.
00:29:39 Dr Dianne Wepa
And just to add to that too, and then I'll take it back to Mary, as in the other podcast, how I talked about the research I'm doing, reviewing the suicide prevention apps and I reviewed with the team 10,000 apps and none of them were Co designed with the end user in mind. And so I think when we do look at digital solutions.
00:29:59 Dr Dianne Wepa
They have to be quite critical and I think not take them on face value because the literature, sorry, there's a huge drop off rate of people engaging with the app. So there's actually.
00:30:09 Dr Dianne Wepa
You know, quality review or even an ethical review around the governance of these apps in the in the privacy, you know, conditions when people do sign up for them. And basically the take away message is that any of these sort of clinically focused apps do need to be with a psychologist or, you know, a mental health practitioner.
00:30:29 Dr Dianne Wepa
Whereas if people use them on on their own, I think as long as people know that's at the lower end of the continuum, if you like to help with the self-care and self compassion. So we would need to look at how that is staged throughout the continuum, because if there are people in that acute phase of unwellness with their mental health.
00:30:48 Dr Dianne Wepa
They are really should be working in tandem with the health professional and Mary, I was just going to look back, you know, the work we did on behavioral activation. Sorry, I might have the term wrong a while ago and where I was piloting the questionnaire on things that you were having me pretending to be a client.
00:31:09 Dr Dianne Wepa
And identifying certain activities that I would go away and then come back and report to you on.
00:31:16 Dr Dianne Wepa
And whether I had done those and rating them, I don't know if you remember that that would be something worth following.
00:31:21 Prof Mary Steen
Up. Yes, that's an area that we are looking at around for post Natal depression at the moment, mood monitoring and behavioral activation. So behavioral activation basically is sort of self-care activities, but I think we need a hybrid approach that some face to face.
00:31:39 Prof Mary Steen
Because digital health is.
00:31:41 Prof Mary Steen
Expanding and I know the last podcast you and jabin was talking all about digital health, but I think we have to be cautious as well. I now and it was after my Brazilian experience, I actually turn off my phone. I have a thing, my son, obviously the younger ones always show you, don't they? I have to ask my son sometimes to sort.
00:32:01 Prof Mary Steen
My phone out for me and I bet I'm not the only one that has to do that in my age bracket, but he he turns it off do not disturb.
00:32:10 Prof Mary Steen
It's still difficult. I'm not saying that I'm perfect and that I actually, you know, take that prompt every time. Sometimes I cheat because we all the mobile phone is like an extension of your hand. Now is it not? But I make sure I try and take time out. And sometimes you have to detox and have to get out into the environment.
00:32:30 Prof Mary Steen
You know, to make you see yourself feel better. So when we talked about before, those actual reminders, now when we did the workshops, we even did the self compassion education workshops in the hospitals in the study sites. Even then it was difficult to get clinicians out of practice.
00:32:48 Prof Mary Steen
Because obviously service comes first and continual professional development might be a second priority. There is a need to have the option of online sort of education around self compassion, but it's kind of changing the culture that it's nice to listen to. Maybe some meditation music or some apps that are out there.
00:33:08 Prof Mary Steen
And people that can't maybe afford a subscription, like for example, you could use insight timer. I often go on there and listen to John Sadiq. He calms me.
00:33:19 Prof Mary Steen
Lisa Copler she really does a good session on the self critic because you have to deal with the self criticism before you can move forward to give yourself compassion. So there is a real need there and it's what fits for one might not actually fit for another. When you have self compassion strategies and skills.
00:33:39 Prof Mary Steen
Like a lot of people might be able to stay calm and meditate, but that might not be for a very hyperactive person, or somebody that might not be the case. Mindfulness walking.
00:33:51 Prof Mary Steen
Might be the better way to actually give yourself that self compassion. So it's looking at a range of strategies and skills for a variation of people within the societies.
00:34:03 Will Mountford
Others leads on to a question that I flagged in the outline and a general.
00:34:07 Will Mountford
Concern that I have.
00:34:08 Will Mountford
When thinking of self compassion and self-care as a marketable trend, I know that.
00:34:14 Will Mountford
Coloring in books are not going to fix what I've got going on, so picking up something for 399 from WH Smith to Shade in, there's bigger problems that need addressing. There's much broader approaches to tackle. Where do you see the commercialization of some of those?
00:34:30 Will Mountford
Not exactly tools and behaviors, but some of the attitudes towards tools and behaviors such as coloring in or going for a walk. How does that fit within approaches to self-care? Compassion. Is it useful to have? Does it detract from any of the core messages and core takeaways from actually doing some?
00:34:49 Will Mountford
Section.
00:34:50 Will Mountford
Of any worries from a professional sense.
00:34:52 Will Mountford
In that regard.
00:34:53 Prof Mary Steen
I think you have to look at the population at large and some people cannot express themselves and so art therapy you you really touching on art therapy there aren't you as self-care strategy. Some people might like to draw. Some people like writing narrative, sort of therapy works for some.
00:35:13 Prof Mary Steen
I like to write.
00:35:15 Prof Mary Steen
And then that's it's like a way of me reflecting, I mean, health professionals have done reflective practice for a long time and it helps us to move forward when say things haven't gone so well in practice. And this happens, it's the real world. Sometimes we have to reflect and learn.
00:35:35 Prof Mary Steen
And then we can move forward. So I think there's an area there and maybe men and women look at things differently. I mean, I know my dad, his time out is watching sport, even though he's a Yorkshireman, you will laugh. Will he will pay the sky subscription, which is a lot of.
00:35:52 Prof Mary Steen
Me, but it's worth it for him. You know. He's balanced that. Where's my mum? Likes to watch the Strictly Come Dancing. So have they're separate. And that leads me into older people. We've just completed the review on older people and we've identified 10 studies where giving them self compassion and learning some skills and time out.
00:36:12 Prof Mary Steen
Has helped the older generation to cope with ailments that they have to live with now because of the aging process. Maybe it might be terminal and and it's really helped them to move forward. And maybe there's been unresolved conflict in their.
00:36:29 Prof Mary Steen
Lives that they start to forgive and to forgive themselves. So we're actually looking at that target population at the moment and that actually fits in with the NHS long term plan to actually give this care and the community and what dianne's talking about in many indigenous populations.
00:36:49 Prof Mary Steen
I think the Western world needs to revisit the power of the village and that community, and I've just been reading. When we look at Japan.
00:36:59 Prof Mary Steen
And they believe in the icky guy. I don't know if you've heard of your icky guy, and I thought, wow, how powerful that is. And they lived to be in their hundreds, don't they? With the movement, with that shared belonging approach, you know, they belong. They connect, they eat well. And I think we just need to go back to basics.
00:37:20 Prof Mary Steen
And look at how we engage in those social interactions that Diane and Lisa have been talking about in this podcast.
00:37:30 Dr Dianne Wepa
Going back to the military and the veterans, they have an interesting way to, I guess, debrief on the field. Say there, you know, the middle of a war. And it's called after action review. And I found that really interesting and they're like commanding officer. Would, you know, do a huddle after some sort of event. And they would say no.
00:37:50 Dr Dianne Wepa
F's and no B's, no fault and no blame. And you would have this after action review and I think that's such a wonderful way. So I think there are examples of that sense of community and that was with the American military. You might want to expand on that list.
00:38:08 Dr Lisa di Lemma
It's also been amplified. It's also been adapted in other situations, such as a big emergency crisis, as a first way of debriefing, let's say if you think about Manchester bombing and the people there, or if you think about big natural disasters, so they use that kind initially.
00:38:29 Dr Lisa di Lemma
Briefing that exactly servicemen use after big operational tours or operation specific actions that it's been now applied because obviously it shows really effective first step.
00:38:44 Dr Lisa di Lemma
This is obviously it's a a brief kind of term of outcome. So obviously for longer term outcomes, there needs to be some kind of add-on treatment. However, as a first measure to obviously reduce stress and deal with the situation, it's been now showing improvement and it's been now adapted in multiple.
00:39:05 Dr Lisa di Lemma
Critical.
00:39:06 Dr Lisa di Lemma
Traumatic situations from environmental catastrophe to ward zones and actually adding to that what you said, Mary, about aging and what we call now social prescribing kind of social prescribing treatment. We actually did a review looking at and actually no, it was more an evaluation of services.
00:39:28 Dr Lisa di Lemma
So there are unforeseen covenant fund actually funded quite a lot of these social prescribing from exactly working on fly fishing working on.
00:39:39 Dr Lisa di Lemma
Wood or maybe going for walks in nature, or more social just the groups and they show the fact and improving elderly veterans, isolation, loneliness, but as well-being in general and this aging veterans fund in fact had such a successful some of not.
00:39:59 Dr Lisa di Lemma
All of them, but most of some of these treatments that were funded are now actually being continued and they're not only focusing, as you mentioned as.
00:40:08 Dr Lisa di Lemma
Or maybe walks or more specific treatment, but they focus also on learning skills, for example, as you mentioned before, the being elderly veterans. So we're looking at population that usually over 6075 actually the the main ages is, is and they.
00:40:29 Dr Lisa di Lemma
One of the treatment was actually to improve their social interactions and improve their skills. They've been taught by peers ex veterans or so younger veterans or ex servicemen, leavers that have to maybe exit for injuries.
00:40:45 Dr Lisa di Lemma
Early they got trained in using for example, iPads or FaceTime. These kind of tools to help them get engaged with maybe friends and family that live abroad or they met years ago and it just really shows like an improvement in well-being and social isolation and decreasing loneliness.
00:41:06 Dr Lisa di Lemma
And so then this goes back to what you mentioned about in previous postcard at Tech and Health. Obviously we have a breadth there of you know possibilities. However we do need to be critical of their use as you mentioned before because most of these actually are always.
00:41:26 Dr Lisa di Lemma
Looked at being used with treatment as usual or with current treatments with other aspects, so obviously we're not looking at just using the tech on its own. This kind of online in.
00:41:40 Dr Lisa di Lemma
Interventions and most of these online intervention also look at, as you say, engagement is essential. So if you have a big dropout rate and the user doesn't engage with them from the beginning apps or online intervention, that includes usually reminders of engaging and actually.
00:42:00 Dr Lisa di Lemma
Show a higher grader success in improving, for example as well. So self compassion as its own, but other other aspects as well, depending what they're looking for. So I just wanted to add that to what you mentioned before.
00:42:16 Prof Mary Steen
That actually leads into wisdom. The knowing when you look at societies and you look at caring for others and the, you know, from an anthropological perspective and when we were doing the research in the women's prison with Aboriginal and Torres Straits Women, they wanted their elders or their aunties, and we used the elders.
00:42:36 Prof Mary Steen
You know, when we were doing this research to meet the cultural sort of needs and the cultural safety aspect.
00:42:42 Prof Mary Steen
Alex and they really want back, which is traditional and it might be called something different in other societies. The Yarning it's when they come together, the community and the yarn. Actually my mother's eyes, she calls it Kelly when she gets all her sisters together and you know the kettles put on, let's take that time out.
00:43:02 Prof Mary Steen
And obviously in Yorkshire we have a nice cup of tea will and it works, doesn't it? Because he's taking time out. You're taking that pause that you actually need. What's one thing I mentioned here when you just reminded me maybe with the veterans?
00:43:17 Prof Mary Steen
There and it could be to some extent the parents and even the elderly people. And like I mentioned, that they might have unresolved conflict and the women in prison, the stigma and shame around maybe things that have happened in our lives, personally or professionally, that we have to accept that and deal and maybe move forward.
00:43:39 Prof Mary Steen
That the self.
00:43:40 Prof Mary Steen
Passion helps you to do that, but also, like we said, the reminders but to be aware because remember the Buddhist philosophy underpins this. Now the Buddhists believe in the four noble truths suffering, cause sensation and the pathway out and the Western world. We don't really want to look at suffering. We try to avoid it.
00:44:00 Prof Mary Steen
But you cannot avoid it because it fits with the three inevitables that the Buddhists talk about, which is aging illness.
00:44:08 Prof Mary Steen
In death. So if we put these into our background and our philosophies, when we actually give care and we connect with people, we will have much more of that. Knowing that knowledge and wisdom that many societies do, you know as well the wise man and the wise woman. So I just believe we can all benefit from self.
00:44:28 Prof Mary Steen
Compassion.
00:44:33 Will Mountford
The final question, what future work do you have going on that anyone listening to this might look forward to either reading about soon. If there's anything that you'd like to direct people to as a project or as a paper, and there's the systematic review, and if people are listening to this and getting to the end and they want to know more, where should they head to? What?
00:44:55 Will Mountford
Resources can we provide to them?
00:44:57 Prof Mary Steen
I mean, there is a specific website that Christine Neff and her colleagues have set up. So if you actually Google self compassion, you will come and she has put together that put together like a range of studies because evidence is emerging. But when you, you know, so I would go there to look at sort of self compassion. There is books out there.
00:45:18 Prof Mary Steen
Obviously, to help you with self compassion as well, we're actually just about to submit a couple of papers because obviously we look at the evidence first.
00:45:28 Prof Mary Steen
Then we justify why we undertake the study and then we'll go on to do further research. Now it's only the last two decades, but yes, it is emerging. And yes, Lisa did say many are feasibility studies or pilot studies, but collectively they come together. Now we did do a scope and review because often when you don't know about a subject, you would do a scoping.
00:45:50 Prof Mary Steen
Review and we use the jbi sort of frameworks which helps and that's nationally if you want to look up the jbi sort of tools to help you do any kind of reviews. I find them really help.
00:46:02 Prof Mary Steen
Full and then from the scoping review, now we're doing a systematic review. So you would follow on with an integrated review or a systematic review. And what we're trying to do is yes, we're trying to put accumulate the evidence together because separately it would be classed as weak evidence, but collectively you're actually strengthening the evidence to put forward.
00:46:23 Prof Mary Steen
Now we've been doing a lot of studies with different target populations, and the findings seem.
00:46:28 Prof Mary Steen
Miller sort of benefits for self compassion. So what I want to stress is look at the overall evidence and.
00:46:39 Prof Mary Steen
Quantitative evidence? Yes, we say systematic reviews are one a evidence when you're looking at the hierarchy of evidence. Randomized controlled trials 1B, but they're only good to answer questions about effectiveness and efficacy.
00:46:52 Prof Mary Steen
Say. However, what about acceptability? You need both. You need the qualitative data and then you can do like for example we have just done a mixed method. So we will try and triangulate or we will integrate the evidence together. So one informs the other and supports. Then you have better.
00:47:13 Prof Mary Steen
Evidence to support the use and benefit of self compassion for everyone really. Like we said, we've been looking at different target populations. We want to take this work forward and we will do so.
00:47:27 Prof Mary Steen
And really, looking at our students, I've been looking at the carers for the carers, but when I look at the actual students, they are struggling as well, aren't they? So that might be. I think Lisa mentioned that I think that's another target population that we need to address.
00:47:44 Will Mountford
Diane, anything that they like to lead people towards, we're going to put links to these in the show notes and episodes. We'll be linking back to the other interviews that you've done as well.
00:47:52 Dr Dianne Wepa
The in press at the moment the article and the Alternative Indigenous Journal should be out in December, and that's the findings I had with the rural and remote indigenous populations in New Zealand that found that during and after the pandemic, what was it that kept them together and you kept them motivated?
00:48:12 Dr Dianne Wepa
To be able to access their healthcare needs when they were in such dire sort of situations and it keeps coming through again and again and again, is that collective sense of identity and I think.
00:48:25 Dr Dianne Wepa
When we look at natural disasters around the world, or even wars and pandemics, what seems to be resonating with people is when there's a strong sense of community. The response is is better. You know, people are able to organize themselves more and be able to find resource and work with the resilience within the community.
00:48:46 Dr Dianne Wepa
That's not saying government shouldn't be doing things, but you do find that with people showing self compassion to themselves and others. And if it's part of the DNA, if you like of that community, then.
00:48:59 Dr Dianne Wepa
The response is actually more positive in terms of any sort of catastrophic event. So I think it has value right through the continuum from individual situations through to healthcare, through to environmental disasters as well.
00:49:14 Prof Mary Steen
And I think looking out when you said like in the workplace managers, I mean I'm a line manager, we sometimes have to make very difficult decisions, but we can do what's been now termed wise compassion.
00:49:27 Prof Mary Steen
But obviously we have to care for ourselves before we can care for others ourselves.
00:49:32 Prof Mary Steen
And you know the tasks and the operational work that we have to do, but Kings College in London have been looking at wise compassion that yes, we have to make some very difficult decisions, but we can do it you mainly you know, most people leave their jobs because they don't feel valued or it's the way they've been.
00:49:51 Prof Mary Steen
Beated, isn't it by the boss? So I think there's an element of further research to look at how we can wisely use compassion to be in kind of management roles as well that you know, so it goes right, as Diane said, from the individual to our colleagues.
00:50:11 Prof Mary Steen
To the collective sort of perspective that self compassion underpins compassion and we can obviously care for ourselves and others throughout society and throughout, you know, the globe.
00:50:26 Will Mountford
Well, one question that I've put to Diane and the other episodes, and it might be different for each one. So it'll be interesting to hear, Mary, your perspective.
00:50:33 Will Mountford
To think of who was going to listen to this episode and what they should take from it in either the patient sense, the practitioner sense, or maybe even to like the policy sense. If anyone listening to this is at that higher echelon of being able to implement change or direct research or have some real influence and power.
00:50:52 Will Mountford
At those three different levels of personal impact, professional impact and policy impact, who should listen to this and what should they take from it? If there was any, you know, unifying message to wrap up everything that we spent the last hour discussing?
00:51:09 Prof Mary Steen
I think that we all matter and I think you personally, but obviously professionally and policy at policy level that we will all gain some freeing from listening to this podcast because right we mentioned earlier in the podcast, we all need reminders.
00:51:28 Prof Mary Steen
We live, you know, in a very in the 21st century, in a capitalist driven world, we have to take the pause. And I thought COVID-19 pandemic actually increase the awareness of that because it was unprecedented times, wasn't it for us to, you know, continue.
00:51:47 Prof Mary Steen
And I think it was when your Prime Minister, Diane Jacinda, said, what's the point in having all this economical value to society if you have an ill society?
00:51:57 Prof Mary Steen
So I think we need to go back to basics and care for the community and we've talked throughout this podcast about the benefits of them, social connections.
00:52:09 Prof Mary Steen
But not just personally, but also in the work colleague they talked about the veterans and out that support of each other in in life, because life can be very challenging.
00:52:21 Dr Dianne Wepa
And in the last podcast I talked about the launch of England's suicide prevention strategy and what I really liked about that strategy is it talks about a whole of systems approach and suicide prevention is everyone's business through the schools, right through to, you know, dealing with people in an administrative way. So I think they're.
00:52:43 Dr Dianne Wepa
To take a leaf out of that, now that I see, see in England the the governments sort of realising you can't silo approaches when it comes to mental well-being in our health. And so I really do like that approach. It's everyone's business and that's just.
00:52:59 Dr Dianne Wepa
What I think yeah, we are saying in this podcast today is that take away message, it's not someone elses. It's starts with us.
00:53:08 Will Mountford
In that case, Diane. Mary. Lisa, thank you so much for your time today. And speaking with us across all.
00:53:13 Will Mountford
Of these podcasts.
00:53:14 Prof Mary Steen
Thank you. Goodbye. Thank you, will.