A growing body of evidence has highlighted the significance of self-compassion for understanding health trajectories and outcomes. Defined as taking a kind, non-judgmental, connected, and mindful stance towards oneself during times of failure and difficulty [1], self-compassion has been linked to a number of consequential health-related outcomes that underscore its relevance for public health. Self-compassion is associated with lower levels of self-reported stress in medical and non-medical populations [2, 3], and attenuated unhealthy physiological responses to stress [4,5,6]. Evidence also supports the role of self-compassion for a variety of important health behaviours including exercise and healthy eating [7,8,9], sleep hygiene [10, 11], smoking cessation [12], self-care in medical populations [13], and medical adherence [14, 15]. Importantly lower stress and healthy emotion regulation have been identified as key explanatory pathways for the links to health behaviours [9, 14]. Given evidence supporting the protective role of self-compassion for reducing stress and for promoting health behaviours, and the known contributions of stress and health behaviours to physical health status [16], it is therefore reasonable to expect that self-compassion would be associated with better physical health. Yet to date, few studies have examined self-compassion in relation to physical health status.
Self-compassion has been conceptualized as including six key components organized along three bipolar dimensions [1], each of which can have benefits for health. Self-kindness versus self-judgement refers to responding to perceived inadequacy or difficulties with understanding, patience, and acceptance, rather than with harsh self-criticism. This response can defuse rather than perpetuate negative emotions and promote self-acceptance, which can down-regulate stress and thus be protective for health. Common humanity versus isolation refers to the recognition that all people are imperfect, make mistakes, and experience failure, rather than experiencing one’s shortcomings as unique or special, and thus feeling isolated by this egocentric perspective. By taking this broader and more connected perspective, self-compassionate people can more easily view their struggles in general, and with health issues and health behaviour changes in particular, as being part of the human condition. This can reduce the barriers to seeking help when in times of need [2, 3], and potentially improve health. Lastly, mindfulness refers to being aware of one’s current emotional states and suffering without becoming over-identified with the negative feelings that arise after failure or during struggles. This balanced mindset can minimize rumination over such failures and challenges including those that inevitably arise while trying to improve or manage one’s health. This in turn can free up self-regulation resources to support performance of behaviours to promote good health [17]. Together, these six components of self-compassion are proposed to operate in distinct and synergistic ways to promote a healthier way of responding to the inevitable failures and challenges of life [18], and thereby promote good health.
A burgeoning body of research supports the theoretical links between self-compassion and various factors that influence physical health. For example, self-compassion has been linked to lower levels of self-reported stress [3, 19], and to physiological markers indicating lower stress [4, 5]. With respect to the latter, research has found that self-compassionate individuals have lower sympathetic nervous system activation and reduced inflammatory response following exposure to a stressor [4,5,6], and higher heart rate variability, an index of parasympathetic influence on the heart that reflects greater ability to return to a resting state following acute stress [6, 20]. Evidence also indicates that self-compassion is associated with the practice of important health-promoting behaviours, such as exercise and diet, which are known to be modifiable risk factors for disease [21], and medical adherence, a key behaviour for health maintenance and disease prevention [22]. In a meta-analysis of 15 samples (N = 3252) self-compassion was positively associated with an index reflecting more frequent practice of a variety of health-promoting behaviours, including healthy eating and regular exercise [9]. Self-compassion has also found to be associated with better medical adherence across five medical samples including individuals with fibromyalgia, cancer, chronic fatigue syndrome [14], and better self-management behaviours in Type II diabetes [13]. Consistent with the theorized links between self-compassion and health, lower levels of negative affect and stress were found to explain in part why self-compassion people engaged in better health-promoting and health management behaviours, respectively [9, 14].
Despite the growing evidence base linking self-compassion to factors associated with better health, there is far less research on how self-compassion is linked to overall physical health. Self-rated health (SRH) is one reliable measure of overall physical health that is known to predict a number of objective measures of health status, including morbidity and mortality, health behaviours, serum high-sensitivity C-reactive protein, and cortisol responses to stress, even after accounting for other confounding factors [23,24,25,26,27]. SRH is captured via a single statement asking respondents to rate their health from poor to excellent, most commonly on a 5-point rating scale. A key distinction between SRH and other measures of physical health is that it is proposed to be a “summary statement about the way in which numerous aspects of health, both subjective and objective, are combined within the perceptual framework of the individual respondent” [28], p., 92. Importantly, numerous studies provide evidence that SRH is not only associated with current health status but also a predictor of future health (see Benyamin [29] for a review).
To date there have been few studies examining the link between self-compassion and SRH. Using composite measures of physical health that included the single item SRH, three studies have found that self-compassion was linked to better physical health among adult samples [7, 8, 30]. However, one study using an undergraduate sample found a small but significant negative association between self-compassion and a composite measure of physical health that included the global SRH item [31]. However, in each of these studies, factors known to attenuate or amplify perceptions of health were not accounted for. Given this, and the limited research to date, further research on how self-compassion relates to SRH with more diverse samples is warranted.
One potentially useful model for understanding why self-compassionate people may report better SRH is the Cognitive Process Model of SRH [23]. According to this model, answering the question of “How do you rate your current health?” involves an active cognitive process of reflection and self-assessment that necessarily takes places within a contextual framework that includes socio-cultural and individual differences. In particular, it highlights the role of personality as well as positive and negative affective states. Fig. 1 presents an operational model of the contextual factors that contribute to the process of evaluating one’s current physical health status as suggested by the Cognitive Process Model of SRH [23]. This multi-stage process begins with considering the relevant cultural and personal-historical information that can contribute to one’s health, including existing medical diagnoses and functional status, symptoms experienced, genetic risk factors, and biological sex. Of particular relevance for understanding how self-compassion relates to SRH, the next stage in the evaluation process involves appraising and summarizing this initial evaluation within the context of individual differences in positive and negative dispositions, age, previous health status, depression, health expectations and experiences. Together the evaluations from these processes inform the overall self-rating of health [23].
From the lens of the Cognitive Process model, there are several reasons to expect that self-compassion is associated with better SRH. Self-compassion reflects a way of relating to oneself in a positive manner when dealing with personal challenges and failures [1]. In this respect self-compassion is akin to other cognitive reappraisal processes that aim to reframe a situation to change the way it is emotionally responded to (Gross, 1998). Indeed, research has found that self-compassionate people tend to use cognitive reappraisal emotion regulation strategies to help reduce their negative mood [11, 32]. In the context of health challenges, self-compassionate people may therefore perceive their health status in a more positive light by being less critical of any health issues, viewing their health issues as part of the human condition, and reflecting on their health in a balanced rather than over-identified manner. Taken together the appraisals that self-compassionate people make towards their health suggest that they may evaluate their health status favorably. In addition, because SRH has strong associations with objective measures of health status [6, 23, 27], and self-compassion is associated with objective indicators of better health [4, 5], self-compassionate people may report better SRH in part because they experience fewer health symptoms, and thus have relatively better health compared to those with similar health profiles.
Although it is tempting to conclude that the link between self-compassion and SRH is due to the health protective nature of self-compassion as a positive quality, the high levels of positive affect and low levels of negative affect that characterize self-compassion [33] could also attenuate attention to physical states and symptoms and in this way result in higher ratings of SRH [34]. The Cognitive Process model posits that individual differences in positive and negative personality traits play a key role in shaping the evaluations that inform SRH, because levels of positive and negative affect, respectively, are known to attenuate or inflate attention to physical states and symptoms [35]. For example, personality traits linked to positive mood, such as conscientiousness and extraversion predict higher SRH, whereas traits linked to negative mood, such as neuroticism and self-critical perfectionism, are associated with lower SRH [35,36,37,38,39]. Following this line of reasoning, it is therefore important to control for positive and negative affect when understanding the extent to which self-compassion is associated with SRH.
Using the Cognitive Process Model of SRH [23] as a guiding framework, the aim of the current study was to address the limitations and inconclusive findings of previous research by providing a comprehensive analysis of whether self-compassion was associated with SRH across a large range of samples. In addition, the unique contribution of self-compassion to SRH was evaluated by controlling for positive and negative affect among a subset of samples that included a measure of positive and negative affect. Consistent with previous research indicating that self-compassion is associated with markers of good physical health [4, 6], it was hypothesised self-compassion would be positively associated with SRH. Self-compassion was further expected to be associated with lower levels of negative affect and higher levels of positive affect, as has been found in previous research [9, 33, 40]. Because the Cognitive Process model posits that SRH is determined by appraisals of current and past health that are based on objective health status, it was expected that self-compassion would remain significantly associated with SRH after accounting for the contributions of positive and negative affect to reflect the idea that self-compassion is linked to better overall health.
The first hypothesis was tested across a set of twenty-six samples including participants with a diverse range of health statuses, and the other hypotheses were tested among a subset of 13 samples from the 26 samples for which there were measures of positive and negative affect. For all sets of analyses, the associations were statistically meta-analyzed to estimate the magnitude of the effects (i.e., unadjusted and adjusted effects). This approach is recommended when findings are inconclusive and/or conflicting to help build a cumulative evidence base [41]. Summarising the associations this way also permitted a probing, through moderator analyses, of the contextual factors of health status (i.e., student, community adult, or medical sample), age and sex as suggested by the Cognitive Process Model [23], that might attenuate or amplify the magnitude of the proposed associations across different samples. Because research indicates that self-compassion may be particularly beneficial for health among individuals who have existing health problems [42], it was expected that the effects garnered from the chronic illness samples would be the largest relative to the community adult and student samples. The influence of sex and age on the associations of self-compassion with SRH were also examined in moderator analyses as both have been found to moderate the link between personality and health [23, 43].