A Pilot Study and Randomized Controlled Trial of the Mindful Self-Compassion Program

A Pilot Study and Randomized Controlled Trial of the Mindful
Self-Compassion Program
Kristin D. Neff 1 and Christopher K. Germer 2
1 University of Texas at Austin
2 Harvard Medical School
Objectives: The aim of these two studies was to evaluate the effectiveness of the Mindful
Self-Compassion (MSC) program, an 8-week workshop designed to train people to be more self-
compassionate. Methods: Study 1 was a pilot study that examined change scores in self-
compassion, mindfulness, and various wellbeing outcomes among community adults (N = 21; mean
[M] age = 51.26, 95% female). Study 2 was a randomized controlled trial that compared a treatment
group (N = 25; M age = 51.21; 78% female) with a waitlist control group (N = 27; M age = 49.11;
82% female). Results: Study 1 found significant pre/post gains in self-compassion, mindfulness,
and various wellbeing outcomes. Study 2 found that compared with the control group, intervention par-
ticipants reported significantly larger increases in self-compassion, mindfulness, and wellbeing. Gains
were maintained at 6-month and 1-year follow-ups. Conclusions: The MSC program appears to
be effective at enhancing self-compassion, mindfulness, and wellbeing. C© 2012 Wiley Periodicals,
Inc. J. Clin. Psychol. 00:1–17, 2012.
Keywords: self-compassion; mindfulness; compassion; intervention; well-being; meditation
The past two decades have seen an explosion of research into the benefits of mindfulness, a
quality of attention that has traditionally been cultivated in Buddhist meditation (Goldstein &
Kornfield, 1987). According to the definition offered by Bishop et al. (2004), mindfulness has
two main elements: paying attention to one’s present moment experience as it is happening,
and relating to this experience with a curious, open, accepting stance. There is ample evidence
that mindfulness has positive psychological effects, including increased subjective wellbeing,
reduced negative symptomology and emotional reactivity, and improved behavioral regulation
(see Keng, Smoski, & Robins, 2011 for a review). Another construct stemming from Buddhist
psychology that is now getting research attention due to its strong link to psychological health is
self-compassion (Brach, 2003; Salzberg, 1997). Similar to definitions of compassion for others
(Goetz, Keltner, & Simon-Thomas, 2010; Wispe, 1991), Neff (2003a, 2003b) proposes that self-
compassion involves being touched by one’s own suffering, generating the desire to alleviate
one’s suffering and treat oneself with understanding and concern. Self-compassion is relevant
to all personal experiences of suffering, including perceived inadequacies, failures, and painful
life situations more generally. Self-compassion comprises three interacting components: self-
kindness versus self-judgment, a sense of common humanity versus isolation, and mindfulness
versus over-identification when confronting painful self-relevant thoughts and emotions.
Self-kindness refers to the tendency to be caring and understanding with oneself rather than
being harshly critical. When noticing some disliked aspect of one’s personality, for example, the
tone of language used to acknowledge the shortcoming is kind and supportive. Rather than
attacking and berating oneself for not being “good enough,” the self is offered warmth and
unconditional acceptance (even though particular behaviors may be identified as unproductive
and in need of change). Similarly, when life circumstances are stressful, instead of immediately
trying to control or fix the problem, a self-compassionate response might entail pausing first to
offer oneself soothing and comfort.
We would like to acknowledge Susan Pollak for her assistance in conducting this study.
Please address correspondence to: Kristin D. Neff, Department of Educational Psychology, University of
Texas at Austin, 1 University Station, Austin, 78712. E-mail: [e-mail]
JOURNAL OF CLINICAL PSYCHOLOGY, Vol. 00(00), 1–17 (2012) C© 2012 Wiley Periodicals, Inc.
Published online in Wiley Online Library (wileyonlinelibrary.com/journal/jclp). DOI: 10.1002/jclp.21923

2 Journal of Clinical Psychology, xxxx 2012
The sense of common humanity in self-compassion involves recognizing that all humans are
imperfect, that all people fail, make mistakes, and have serious life challenges. Self-compassion
connects one’s own flawed condition to the shared human condition, so that features of the
self are considered from a broad, inclusive perspective. Often, however, when people notice
something about themselves or their lives that they do not like, they feel “this should not be
happening,” that something has gone wrong. When failures and disappointments are experienced
as an aberration not shared by the rest of humankind, people may feel isolated from others who
are presumably leading “normal” happy lives.
Mindfulness in the context of self-compassion involves being aware of one’s painful experi-
ences in a balanced way that neither ignores nor ruminates on disliked aspects of oneself or one’s
life. It is necessary to be mindfully aware of personal suffering to be able to extend compassion
towards the self. At the same time, it is important to pay attention in a grounded way that
prevents being carried away by the storyline driving the suffering, a process that Neff (2003b)
has termed “over-identification.” This type of rumination narrows one’s focus and exaggerates
implications for self-worth.
Although mindfulness is required to experience self-compassion, it is important to recognize
that the two constructs are not exactly the same. First, the type of mindfulness entailed in
self-compassion is narrower in scope than mindfulness more generally. The mindfulness com-
ponent of self-compassion refers to balanced awareness of the negative thoughts and feelings
involved in personal suffering. Mindfulness in general refers to the ability to pay attention to
any experience—positive, negative, or neutral—with acceptance and equanimity. Another dis-
tinction between mindfulness and self-compassion lies in their respective targets (Germer, 2009).
Mindfulness tends to focus on one’s internal experience (sensations, emotions, thoughts) rather
than oneself as the experiencer. For example, in the case of lower back pain, mindful awareness
might be directed at the changing pain sensations, perhaps noting a stabbing, burning quality,
whereas self-compassion would be aimed at the person who is suffering from back pain. Self-
compassion emphasizes soothing and comforting the “self” when distressing experiences arise,
remembering that such experiences are part of being human.
Research indicates that individuals who are self-compassionate demonstrate better psycho-
logical health than those who lack self-compassion. For instance, greater self-compassion has
consistently been found to predict lower levels of anxiety and depression (see Neff, 2012, for a
review), which may be related to the finding that self-compassion tends to decrease cortisol and
increase heart-rate variability (associated with the ability to self-soothe when stressed; Rockliff,
Gilbert, McEwan, Lightman, & Glover, 2008). Greater self-compassion is also linked with less
rumination, perfectionism, and fear of failure (Neff, 2003a; Neff, Hsieh, & Dejitterat, 2005). At
the same time, self-compassionate people are less likely to suppress unwanted thoughts and are
more willing to acknowledge their negative emotions as valid and important (Leary et al., 2007;
Neff, 2003a).
Self-compassion is associated with positive psychological strengths such as happiness, op-
timism, wisdom, curiosity and exploration, personal initiative, and emotional intelligence
(Heffernan, Griffin, McNulty, & Fitzpatrick, 2010; Hollis-Walker & Colosimo, 2011; Neff,
Rude, & Kirkpatrick, 2007). Another strength of being self-compassionate is the ability to cope
effectively with life stressors such as academic failure (Neff, Hseih, & Dejitthirat, 2005), divorce
(Sbarra, Smith, & Mehl, 2012), childhood maltreatment (Vettese, Dyer, Li, & Wekerle, 2011), or
chronic pain (Costa & Pinto-Gouveia, 2011). Self-compassionate individuals have been found
to have improved relationship functioning (Neff & Beretvas, 2012; Yarnell & Neff, in press),
and also report more empathetic concern, altruism, perspective taking, and forgiveness (Neff
& Pommier, 2012). Self-compassion also promotes health-related behaviors such as sticking to
one’s diet (Adams & Leary, 2007), reducing smoking (Kelly, Zuroff, Foa, & Gilbert, 2009), seek-
ing medical treatment when needed (Terry & Leary, 2011), and exercising (Magnus, Kowalski,
& McHugh, 2010).
As the scientific literature supporting the beneficial nature of self-compassion expands, psy-
chologists are becoming increasingly interested in ways to enhance self-compassion. Training
in mindfulness is one important way to increase self-compassion, given that mindfulness is a
prerequisite to self-compassion and is one of its constituent components. The most widespread

A Pilot and Randomized Trial of MSC Program 3
mindfulness training program is mindfulness-based stress reduction (MBSR), an experiential
learning course that includes eight weekly group sessions, a half-day retreat, and a core curricu-
lum of formal and informal mindfulness meditation practices (Kabat-Zinn, 1982). Mindfulness-
based cognitive therapy (MBCT) is also an increasingly popular variant on MBSR that has
been adapted for clinical use, particularly for the treatment of depression (Segal, Teasdale, &
Williams, 2002). Meta-analytic reviews indicate that MBSR and MBCT lead to significant im-
provements in physical and psychological functioning in a wide range of populations (Chiesa
& Serretti, 2009; Grossman, Niemann, Schmidt, & Walach, 2004; Hofmann, Sawyer, Witt, &
Oh, 2010). There is also growing evidence that participation in MBSR and MBCT increases
self-compassion (Birnie, Speca, Carlson, 2010; Kuyken et al., 2010; Lee & Bang, 2010; Rimes &
Wingrove, 2011; Shapiro, Astin, Bishop, & Cordova, 2005; Shapiro, Brown, & Biegel, 2007).
In fact, some researchers have proposed that self-compassion may be a key mechanism by
which mindfulness-based interventions improve wellbeing (Baer, 2010; H ̈olzel et al., 2011).
In support of this idea, Shapiro, Astin, Bishop, and Cordova (2005) found that health care
professionals who took an MBSR program reported significantly increased self-compassion
and reduced stress compared to a waitlist control group, and that self-compassion mediated the
reductions in stress associated with the program. Similarly, Kuyken et al. (2010) examined the
effect of MBCT compared with maintenance antidepressants on relapse in depression, and found
that increases in mindfulness and self-compassion both mediated the link between MBCT and
depressive symptoms at 15-month follow-up. They also found that increased self-compassion
(but not mindfulness) reduced the link between cognitive reactivity and depressive relapse.
Although mindfulness-based interventions can increase self-compassion, these programs de-
vote relatively little time explicitly teaching skills of self-compassion and focus primarily on
teaching techniques to enhance mindfulness. This suggests that an intervention program specif-
ically targeting the development of self-compassion would be useful to maximize its benefits.
Paul Gilbert and colleagues have developed a general therapeutic approach designed to
enhance self-compassion called compassion-focused therapy (CFT; Gilbert, 2010). Gilbert and
Proctor (2009) note that therapy patients can often identify their maladaptive thought patterns
(“I’m unlovable”) and provide alternative self-statements (“I know for sure that some people
love me”), but they do not necessarily find the process emotionally reassuring. Therefore, the
goal of CFT is to help patients develop a sense of warmth and emotional responsiveness toward
themselves as they engage in the therapeutic process. CFT accomplishes this through a variety
of exercises including visualization, cultivating self-kindness through language, and by engaging
in self-compassionate behaviors and habits. In a pilot study of the compassionate mind training
(CMT, a group therapy approach based on CFT; Gilbert & Irons, 2005), hospital day treatment
patients struggling with shame and self-criticism showed significant decreases in depression, self-
attacking, shame, and feelings of inferiority (Gilbert & Procter, 2006). CFT is currently being
used to treat eating disorders, bipolar disorder, depression, shame, and other psychological
conditions (Gilbert, 2010; Goss & Allan, 2010; Kelly, Zuroff, & Shapira, 2009; Lowens, 2010).
CFT is a therapy approach designed for use with clinical patients, but interventions that enhance
psychological resilience in both clinical and nonclinical populations are also worth developing.
For the reasons given above, we developed a program specifically to enhance self-compassion
called Mindful Self-Compassion (MSC). MSC may be considered a “hybrid” program applicable
to both the general public and to some clinical populations. The term “mindful” is included in
the name of the MSC program because it teaches basic mindfulness skills, which–as discussed
above–are crucial to the ability to give oneself compassion. The structure of MSC is modeled on
MBSR, with participants meeting for 2 or 2 1/2 hours once a week over the course of 8 weeks,
and also meeting for a half-day meditation retreat. Note that the MSC program mainly focuses
on helping participants to develop self-compassion, and includes mindfulness as a secondary
emphasis (only one session in the 8-week course is exclusively devoted to teaching mindfulness
skills). This suggests that the MSC program is complementary to MBSR or MBCT, which are
able to devote more time to developing a deep and comprehensive understanding of mindfulness.
MSC teaches both formal (sitting meditation) and informal (during daily life) self-compassion
practices. There are experiential exercises and discussion periods in each MSC session in addition
to homework assignments to help participants learn how to be kinder to themselves. The goal

4 Journal of Clinical Psychology, xxxx 2012
is to provide participants with a variety of tools to increase self-compassion, which they can
integrate into their lives according to what works best for them. The program also teaches general
skills of loving-kindness, which is a type of friendly benevolence given to oneself in everyday
situations (compassion is mainly relevant for situations involving emotional distress). MSC is
considered a resource-building course rather than group therapy, but because self-compassion is
primarily aimed at emotional suffering, the MSC program always has two leaders, one of whom
is a trained therapist for situations in which a participant requires the attention of a clinician.
Because the concept of self-compassion is new for many people, especially those who tend to
be very self-critical, the starting point of the MSC program is explaining what self-compassion
is and why it is necessary for wellbeing. The program makes it clear how judging oneself when
things go wrong tends to exacerbate emotional pain, while self-compassion helps to alleviate that
pain. MSC includes research evidence where appropriate, presenting it in an easy-to-understand
manner. For instance, one of the strongest barriers to self-compassion is the belief that self-
compassion is self-indulgent or that it will undermine personal motivation (Gilbert, McEwan,
Matos, & Rivis, 2011). In the program, it is explained why this is not the case, citing research
which demonstrates that self-compassion is associated with intrinsic motivation and greater
personal initiative to make needed changes in one’s life (Neff, 2003a; Neff, Rude, & Kirkpatrick,
2007). Because self-compassionate people do not berate themselves when they fail, they are less
afraid of failure and more able to take on new challenges (Neff, Hseih, & Dejitterat, 2007). MSC
teaches participants how to motivate themselves as they would a caring friend, by providing
encouragement and support rather than punishment and condemnation.
At the beginning of the program a distinction is also made between self-compassion and
self-esteem, as many struggles with self-judgment are actually struggles with self-esteem. Self-
esteem is often based on self-enhancement and downward social comparisons and can lead
to prejudice, ego-defensive anger, and narcissism (Crocker & Park, 2004; Twenge & Campell,
2005). It can also be unstable, rising and falling depending on one’s latest success or failure
(Crocker, Luhtanen, Cooper, 7 Bouvrette, 2003). In contrast, self-compassion provides kindness
and understanding in the face of life’s disappointments, does not require feeling “above average”
or superior, and provides emotional stability when confronting failure or personal inadequacies.
Study 1
In order to explore whether participation in the MSC program would increase self-compassion,
mindfulness, and wellbeing, we first conducted a pilot study to determine if the program improved
outcomes. We gave participants a battery of self-report measures before and after the program to
determine outcome change. Based on the research literature reviewed above, we hypothesized that
participants would report higher levels of self-compassion, mindfulness, social connectedness,
happiness, and life satisfaction, as well as lower levels of depression, anxiety, and stress. Finally,
we examined whether gains in self-compassion and mindfulness would be maintained after a
6-month period.
Method
Participants. Study participants were recruited from the greater Boston area via an-
nouncements on the Internet, referrals by local area therapists and meditation teachers, and
e-mail notifications from the yoga studio in which the MSC training was held. Individuals who
signed up for the research study received a substantially reduced fee for the training program.
A total of 23 people took the course, but two did not complete all the poststudy measures so
21 participants were finally included. Participants were 95% female, 87% Caucasian, and had a
mean age of 51.26 (standard deviation [SD] = 11.28). The large majority (81%) of participants
reported having prior meditation experience.
Measures. Baseline and postintervention measures were completed online 2 weeks before
and after the program. Measures of self-compassion and mindfulness were also given 6 months