The uncertainties of the modern medical profession, and of the wider world, mean it can feel harder to be compassionate than usual. But our desire to do so - and the need for compassion - is probably greater than ever.

This is where understanding of the science and benefits of compassion can help us. Taking some inspiration from international research (see Stephen Trzeciak and Anthony Mazzarelli and Kristin Neff), here are six fundamental considerations when it comes to compassion.

1. Acknowledge your inherent capacity for compassion

Compassion is a universal human instinct, rather than a quality that some have and others don't. It runs deeply in health professionals' veins but there are also real barriers to compassion, including work overload, competing demands and the magnitude of suffering we see.

Nonetheless, we can strengthen our capacity to be compassionate, which benefits us as well as those around us.

Actions:

Know your inherent capacity for compassion.
Acknowledge that compassion is a skillset that can be cultivated.

2. Aim for compassion over empathy

Empathy and compassion aren't the same, although they're often used interchangeably.

Empathy is feeling someone's emotions, appreciating their perspective and mirroring their feelings.

On the other hand, compassion is feeling for someone's pain or suffering, accompanied by an authentic desire to help, without a consuming need to do so.

Think of it as a three-legged stool: a compassion 'seat' supported by hope, courage and confidence.

The challenges that we as health professionals face daily can overwhelm our ability to be compassionate. Unchecked, this can be replaced by feelings of helplessness or hopelessness, dread or despair. These feelings are not wrong; they simply serve as emotional GPS signals, alerting us to the need orientate ourselves back to compassion.

Actions:

Check in with yourself to maintain the stability of your 'compassion stool'.
Take steps to develop a sensitive 'stabilising reflex' when you find yourself out of balance. How do we do this?

3. Dispel the myth that compassion feels warm and fuzzy

We need to be clear what compassion does and doesn't feel like. In a research study that asked people what compassion left like, many described it as calm, relaxed and pleasant. Yet when the participants listened to stories that elicited their compassion, what they actually felt was rather different.

Compassion generates paradoxical but complementary emotions - such as sadness and gratitude, tenderness and guilt, anxiety and a sense of being energised. This is because compassion is an unfolding process of opposites. It starts with a stress (sympathetic) response to the distress we are witnessing, followed by a balancing (para-sympathetic) response that generates a feeling of calm.

The extent to which we can feel compassion depends on our ability to hold these two opposites within us. We are activated and energised, but also feel more "grounded." A third stage then unfolds with the release of neuro-hormones, promoting empathy, care-giving and satisfaction from helping others.

Actions:

Take comfort from knowing that you can't feel compassion without initial feelings of distress.
Take long deep breaths to boost the calming effects that will unfold.
Be nourished by "compassion satisfaction" and watch for excessive emotional distress.

4. Stay 'in' compassion and 'out' of emotional distress

Real compassion is sustaining rather than self-sacrificing. It benefits both the recipient and the giver, measurably improving the physiological and psychological health of both parties.

But if we expend emotional energy to the point of exhaustion, compassion is replaced by a self-focused response to our own distressing feelings. Left unchecked, our physical and mental health suffer and we risk illness, despair or burnout.

How can we guard against this? Awareness and acknowledgement of the risks are key starting points, together with rest and recreation. Compassion training for health professions also confers demonstrable benefit to clinicians as well as their patients.

Actions:

Consider compassion training tailored to health professions.
The next time someone's suffering feels distressing to you, try this: focus on thinking kind and positive thoughts towards them, wishing for their situation to improve. Notice if you feel calmer and more compassionate and if they do too.

5. Recognise compassion as a therapeutic intervention.

"Even when compassion 'can't make a difference', it makes a difference." Stephen Trzeciak and Anthony Mazzarelli: Compassionomics

Health professionals can find 'unfixable' situations challenging, having a strong desire to relieve other people's distress and also their own. It can be hard to resist offering solutions or launching into giving information, but neither option provides the compassion that's actually needed.

What do recipients perceive as compassionate? Cues include open body posture, attentive eye contact, and encouraging gestures and sounds. When asked what cues convey the opposite of compassion, responses invariably include talking instead of attentive listening.

Actions:

Beware; the "pity face" and voice are not perceived as compassionate
Likewise 'object manipulation' - something like fiddling with your pen detracts from the compassion conveyed.
Even keeping your phone in view creates an 'attentional drain', reducing the perception of compassion.
Talk less. Listen more.
Check your intention. When you're motivated by self-gain, benefits to both parties disappear.

6. Practice self-compassion

While it can be hard to be as compassionate to others as we'd like in these difficult times, it can feel even harder to find compassion for ourselves - perhaps because self-compassion can be confused as self-centred, self-indulgent, self-pitying or simply selfish.

Or it may be because self-compassion requires us to 'step back' from our own pain or suffering rather than being immersed in it, so we can offer ourselves compassion.

Take time to cultivate self-compassion. Formal self-compassion training has therapeutic effects on our brains and bodies, and enhances our resilience.

Actions:

When you are distressed, notice and name your feelings.
Acknowledge and accept how you feel. This helps difficult feelings feel less overwhelming or wrong and allows them to pass more quickly.
See yourself as one of many who are in the same boat - "just like me"; you'll feel less alone.

You might also like to read our five tips for responding to uncertainty for you and your team and tips for managing conversations at a challenging time.

This article first appeared on medicalmediation.org.uk and has been edited for publication.

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