Self-Compassion for Healing Physical Symptoms: Migraines, Chronic Pain & Mind-Body Medicine with Leah Samaha and Dr. John Stracks
Video: Watch the full session here → https://www.youtube.com/watch?v=CbKZ6jS12lI
Dr. Stracks: Hello, I'm Dr. John Stracks. I'm a physician in Chicago who focuses on the reduction and elimination of physical symptoms using mind-body medicine. If you'd like to learn more about working with me or our staff, you can visit our website at cormendihealth.com.
I'm here today with Leah Samaha, an educator who got her first migraine at age 28, which then developed into debilitating daily headaches and migraines. She has worked with me and a number of other practitioners, individually and in classes and groups, and has been able to significantly reduce her symptoms. Leah, you may recognize that we did a recording with her and a couple of her contemporaries that we published in a different video, which you can find on our YouTube page.
Along the way, she has learned a lot about self-compassion and mindfulness meditation, so much so that she's developed a course on self-compassion that she'll be teaching with us. Today we're going to talk about self-compassion: what it is and how it's useful for healing physical symptoms. Leah, welcome, and thanks for being here.
Leah Samaha: Hey, Dr. Stracks, thanks for having me.
Leah's Story: From Migraines to Chronic Daily Headaches
Dr. Stracks: As I said, you and I have talked at length on camera about your physical symptoms, so we won't totally repeat that. But could you give a brief version, just so people watching have a sense of what happened, where you've been, and where you are now?
Leah: I was thinking about this earlier. There's no way to tell the story briefly, but let's make it brief.
When I was 28 years old, never having had a history of headaches, I had my first migraine. It came on pretty quickly and lasted for 24 hours. A friend said, "Hey, take some Tylenol," so I popped a couple, and it disappeared. Then a week later I had my second migraine, and it didn't go away for roughly five years.
At the start of my symptoms I had truly debilitating headaches. I was noise sensitive and in excruciating pain, and that led to muscle tightness and pain throughout my body. I spent the first couple of years bouncing around to a lot of different headache specialists and neurologists, working in a very Western medical, one-size-fits-all approach. I took a lot of pills, tried a lot of different medications and treatments to ease the symptoms.
The Biofeedback "Aha Moment"
Leah: Around year three I had a really big flare-up, and I was in a chronic pain clinic for the second time. This was an aha moment in my journey, because they said, "All right, we're going to try something different. We're going to try biofeedback therapy." You're familiar with it, Dr. Stracks, and maybe some people watching have heard of it.
They welcomed me into a room, put me in a very comfy La-Z-Boy, and hooked me up to a bunch of different monitors: a temperature gauge, and a monitor on my finger to measure my stress response and heart rate. As I sat there, we watched all of these biometrics on a screen, and the woman very kindly prompted me to take some deeper breaths to see how that might lower my stress levels and my heart rate.
What I noticed is that I had a chattering voice in my mind. Every time it was saying something like, "This will never work. You will never get better. You're in so much pain. Nope, don't trust this woman, and don't trust yourself." I could see my cortisol level spike, and I could see my pain increase in my body. I had this aha moment: yes, my physical symptoms were something I absolutely felt in my body, and the critical chatter in my head was continuing to exacerbate my symptoms.
Dr. Stracks: If you're anything like me, self-compassion was a totally new concept. After I became a physician, I had pain issues, and people have heard about those, but the whole idea of self-criticism and self-compassion was something I had to learn about as a professional before I could start to apply it to myself. So you learned about it earlier than some people might, starting with that particular moment.
Leah: Yes, and in some ways I'm so grateful. The program allowed me to work with a psychologist at the time who introduced me to the idea of self-compassion, and I became hooked. I thought, "Oh, this is fascinating. There's some way I can be on my side. I don't have to change the situation I'm in, but I can have a different way of relating to it." That started my inquiry into learning all I could about self-compassion and figuring out how to build that capacity in myself.
That was before I met you. We've now known each other, I think, about four years.
Dr. Stracks: It's been a while. I've been able to see you gradually improve to the point where the headaches have mostly gone away. It's not that they're never there, but they're significantly reduced from where they once were.
Leah: Correct. It's been almost a year and a half now since I've regularly had headaches, and when I do, they come and they pass. Even in telling the story of what my pain used to be like, it's a little like reading a chapter book of someone else's life that was mine at some point. There's been tremendous relief.
Dr. Stracks: It's nice that you and I were talking about that recently, that it's starting to feel like a different time and a different place, and not where you are anymore, which is great.
How Leah Learned Self-Compassion
Dr. Stracks: So, going back to self-compassion, which is the point of being here today: what it is and how people can use it. You had this moment where you recognized the chatter was there. What did you do then to learn more?
Leah: From there I became really fascinated with learning all I could about compassion and self-compassion. The psychologists at the chronic pain clinic recommended reading Kristin Neff's book Self-Compassion, so that was my first foray into it. Kristin Neff is a researcher who has done tremendous work gathering data from all different types of research, really compiling an understanding of what self-compassion is and what practices help cultivate it.
Then, on my own, I started looking for other places that would help me cultivate it. That involved changing the type of therapy I was in to one really focused on compassion, and it grew into my interest in mindfulness meditation and cultivating compassion within a meditation practice.
Dr. Stracks: How did that change you on a day-to-day basis? What kinds of things did you learn that were helpful, and how did you go from thinking of yourself as quite critical to being less so?
Leah: The first step was just bringing awareness to the fact that I had this very critical part of my mind. I don't think I had recognized that it was quite ruthless, quite insistent, and quite mean. The things going on in my mind were never things I would say to any of my friends, and yet it was a constant chatter. When I was able to bring awareness to it, I could hear something that had been at a really low volume for a very long time. That was the first step: realizing, "Oh wow, there is a dialogue going on."
From there, it was very hard for me to cultivate compassion for myself. So it started with considering other people in my life who were compassionate figures and imagining what they might say to me. I began to surround myself with compassionate voices, whether through podcasts, people who embodied that, or writing from a compassionate voice. The thing I love about self-compassion is that there are a myriad of ways to cultivate it. For me it was helpful to imagine it as someone else first. It was almost too hard to see myself as a compassionate person, so I started with those figures.
Dr. Stracks: Do you have any moments you can remember where you recognized you were doing it differently than you once did?
Leah: There's a moment right now. Right before Dr. Stracks and I hopped on camera, he said hello, and in my newness to Zoom I said hello too early. We had this moment of laughter, but I was also a little embarrassed. In that exact moment I thought, "Oh, of course, Leah. You hopped in a little too early. It's not a big deal. Lots of people do this, especially when they're recording, because it makes everyone a little nervous. No big deal." That's a recent moment, but it's a reminder that this is a capacity I've started to build, and it's becoming more second nature.
Dr. Stracks's Story: "We Don't Talk Like That Around Here Anymore"
Dr. Stracks: It's fun to see that. A personal story I tell pretty regularly is that this was a new concept to me. At some point I thought, "Oh, really? Not everybody is that mean to themselves in their mind?" I was learning about this and doing a series of trainings in Minneapolis, where, interestingly, our daughter goes to school, as you and I were talking about before we got on. I was going up to Minneapolis every month or two for the training.
I had a training coming up, and I happened to look at my schedule at the clinic. I was working at the hospital at the time, and I had a full schedule the day I was supposed to be in Minneapolis. I immediately started to blame my staff: "I told you guys to clear my schedule!" Then I turned it on myself: "Gosh, professionals don't do this. You're never going to be a successful doctor if you can't even keep track of your schedule."
I had learned enough that in my mind I said, "Wait, wait, wait. We don't talk like that around here anymore. That's not acceptable." I was able to shut it down in a way that I hadn't previously, and as soon as I did, it was easy to figure out what to do. But until that voice stopped, I was at the mercy of feeling like I was flagellating myself, and there was nothing I could do to solve the situation. So it's awareness, then practice, and then moments like that start to pop up for people.
Self-Compassion Is a Practice
Leah: Absolutely, and that's been my experience. The word you brought up, "practice," is helpful to name. As soon as I learned about self-compassion I thought, "Great, of course I want to be on my own side. It's not a hard concept." I would love for that to be the habit of my mind, but it wasn't. For many reasons I had developed a very critical habit of mind, and it has taken time to develop something different. It takes an intentional practice of being kinder, being more sensitive to my own suffering, and being more on my side.
The reason I'm so excited to share these practices is that I truly think they work. I have my own experience as an experiment, and there's so much research out there now showing that, because of neuroplasticity and what we know about the ability of our brains to change, we can actually change the internal monologue of our experience, which is amazing.
Dr. Stracks: Absolutely. When we talk about the negative voice we start with, I tell people it's not there by accident. It's not a voice in our head that developed to drive us crazy. For a lot of people, that voice and that criticism was super helpful when we were young, a very adaptive strategy. Sometimes it was super important, maybe even lifesaving. Now we're in different places than we once were, so we can do it differently. But it's helpful to recognize that this is not a character flaw. For a lot of people it was a survival strategy that got them through difficult times.
Formal Training in Mindfulness and Compassion
Dr. Stracks: So at some point you decided to get more formal training. How did you move from reading about it and practicing to deciding you wanted to take courses?
Leah: During my chronic pain story I became passionate about somatic practices like yoga. I did yoga teacher trainings, and that was a big part of my life. Through that I became much more interested in meditation, and I had been working with a meditation teacher for a while, Jessica Dixon, who has been on Hope for Healing. She urged me to look into a training she had been part of and told me how life-changing it was for her.
As a teacher and an educator, I'm passionate about being able to teach things outside of what I do in K-12 schooling. I applied to a two-year mindfulness meditation teacher training program with Jack Kornfield and Tara Brach, which I started back in 2020. Now that I think about it, it feels like a bit of a time warp. It's been an incredibly robust and fulfilling experience to move from being a receiver of a lot of these practices to someone who helps facilitate and offer them to other people.
Dr. Stracks: And as part of the training you've been part of classes, and you've also taught or co-taught classes already, is that correct?
Leah: Yes. I've taught introductions to mindfulness meditation, and I've taught classes specifically for people who experience chronic pain and chronic illness, tailoring a lot of the meditation, mindfulness, and compassion practices to that specific experience. It's been a really rich and rewarding time.
What Are Self-Criticism and Self-Compassion?
Dr. Stracks: Some of the people listening are old pros at this, and some are wondering, "What negative voice? Self-criticism? What are we talking about?" How would you explain self-criticism and self-compassion to people who don't know very much about it?
Leah: Let's try it. I'd invite you to think to yourself right now: who is someone who embodies compassion? Someone who is on your side, who is supportive, who is both a champion and willing to give you real-talk advice at times, but not in a critical way, more like a supportive coach. Does someone come to mind for you?
Dr. Stracks: My wife, Lisa.
Leah: Right. We can all look out in the world and see these people, whether they're public figures or personal ones in our lives. I define self-compassion as a time when we're sensitive to our suffering and we are on our own side. Kristin Neff has done a lot of research into this. There's a tender side and a fierce side of self-compassion: a tenderness and warmth toward the suffering we experience, and a fierce, Mama Bear ability to stand up for oneself. Both components are really helpful to think about in terms of what self-compassion is.
The Three Components of Self-Compassion
Dr. Stracks: If people are trying to sort through how to start, how do they begin to pull away that critical voice and replace it with something different?
Leah: There are three components of self-compassion that Kristin Neff teaches, and I think they're really helpful for thinking about this as systematic skill building. When we're learning something new, it can be helpful to break it down.
The first is mindfulness, or awareness: bringing awareness to the fact that there is this critical response.
The second is common humanity: being able to stop and say, "Oh, this is actually an experience everyone has." Like the anecdote you shared about not clearing your schedule: we all make mistakes, we all forget to double-check our calendars, and in my case, I said hi before I should have on this recording. This is a common experience.
The last is kindness: learning and practicing being kind to ourselves. That might mean forgiving ourselves for making mistakes because we're human and that's what we do. Or it might be kindness in a more fierce way: "You can be supportive and be on your side, and maybe try the thing you've been a little nervous about doing."
Dr. Stracks: All three of those are such an important part of the experience. I know Kristin Neff has this amazing story where she's on an airplane with her son, who is autistic, and he has kind of freaked out on the airplane. He starts running up and down the aisles and screaming, and the pilots are threatening to turn the plane around. She finally grabs him and corrals him, and starts berating herself: "I'm a terrible parent. You're going to make this plane turn around, and everybody's going to be late getting to San Francisco."
Then she has this thought: "Wait a minute. I'm Kristin Neff. I wrote the book on self-compassion." She takes some breaths and calms herself down, and recognizes that this is a moment of suffering. It's not fun to have everybody on the plane staring at you, and she's not the only person who has ever had a child freak out on a plane. It wasn't the first time it happened, and it won't be the last. As she starts to regulate herself, she recognizes that her son is starting to regulate as well. Everybody calms down, and the plane continues on to San Francisco. It's amazing what that recognition can do, the mindful nature of it and, like you said, the common humanity of it. Kristin Neff, who literally wrote the book on self-compassion, has these moments too. We all do. It's part of the human experience.
Leah: Yes. The common humanity piece has been, for me, one of the most powerful. It's why it's so powerful to learn self-compassion in groups and talk about it in groups. We can look around and hear from other people, "Oh, you too? You also missed an appointment? You also said this critical thing to yourself? You're also still working up the courage to start this creative endeavor?" Through that common humanity we can take a breath and realize, "Being a human is hard, and we're usually trying the best we can with the tools we have." At least for me, that's such a great relief.
How Self-Criticism Affects Physical Symptoms and Chronic Pain
Dr. Stracks: A lot of people here have physical symptoms and are working on them psychologically, as you and I have, and we both teach. What are your thoughts on how self-criticism translates into physical symptoms? Or, looked at the other way, how does learning self-compassion help us heal physically?
Leah: Do you remember the phrase you may have heard as a kid: "Sticks and stones will break my bones, but words will never hurt me"? Based on what I've read, that's just not true. Research shows that physical pain and emotional pain light up similar places in the brain and body. When I learned that, it was revolutionary and totally radical to me. It meant that even though words seem ephemeral, if they're a constant soundtrack in my mind, my body is actually activating a threat response because it feels under attack. If I'm feeling under attack, my cortisol levels skyrocket, I'm tense, I'm guarded, and that creates additional pain and tension in my body.
That was one of the most compelling reasons for me, because self-compassion had sometimes felt like a "soft skill." Then I saw the bridge to the actual physiological response: the critical part of my mind triggers more pain.
Dr. Stracks: Absolutely. If pain is about feeling safe versus feeling in danger, there are few things more dangerous than telling ourselves that we're terrible people, that we've done something wrong, or that we're never going to stick with anything. It just goes on and on for people. If you think about where the danger is coming from, that's such a huge reservoir of danger for people.
Leah: And this is one of the most powerful things about self-compassion: we can start to cultivate that safety in ourselves. It's hard, and it takes time and effort, but we can do it. That has been an amazing source of hope for me.
A Guided Self-Compassion Break Exercise
Dr. Stracks: You have an exercise for us to try out, is that correct?
Leah: I do.
Dr. Stracks: Go for it.
Leah: Am I going to be the subject?
Dr. Stracks: Let's all do it together.
Leah: I don't know about you, but it's midday on a Friday. It might be nice to take a moment to pause and bring some kindness to ourselves.
I invite you to close your eyes if you're comfortable, or leave them open if that's more comfortable, and take a moment to settle into your body. Start by feeling your feet and whatever surface they're touching, then feel the top of your head, and allow your attention to fill the space between your feet and your head and everything in between.
We'll take a couple of deeper breaths to activate some of that soothing nervous system response. Breathe in, and on the exhale, allow it to extend. After a few more of these longer breaths, I'll invite you to bring in a moment from this week where you might have been harsh with yourself. On a scale of zero to ten, don't pick something that's a nine or ten. Pick something that's a one, two, or three: a moment where maybe you made a mistake at work, maybe you cut someone off, maybe you said something to a partner that you regretted later.
Bring that moment to mind, and watch it as if it's on a little camera right in front of you. You might notice any of the emotions or thoughts that came from the situation, maybe "I can't believe you did this again. You left the dishes out." Notice where there are moments of embarrassment or anger.
Then, bringing your name to yourself, say: "That was really hard. Mistakes are part of life. This is something everyone experiences. How can I be kind to myself in this moment?"
I'll invite you to repeat those phrases, saying your name to yourself, whispering it in your mind: "Hey, this is really hard right now. Suffering is a part of life. It's something we all experience. What do I need? How can I be kind to myself right now?"
To that question, there might be words that come to mind, or maybe an action. Maybe I need a cup of tea, or a quick break outside, or I just need to say, "Hey, it's okay. Next time I'm going to try something different," or "It's okay to make mistakes." As you offer yourself some of this kindness, check in with your body and notice how that feels. What does it feel like to receive some care?
To close out this practice, take a deep breath in, exhale through the mouth, and allow your eyes to flutter open.
Dr. Stracks: Thank you.
Leah: Absolutely. What was it like for you?
Dr. Stracks: It really slowed things down. My breathing got a lot more regular, and the compassion toward myself felt really good, and really different from where I can get to sometimes, quickly, when I'm upset about something. That reflection of "Yeah, I'm trying hard, this is part of the human experience" really softened my overall experience. I really like that. Thank you.
Leah: Absolutely.
Inside the Self-Compassion Class at Cormendi Health
Dr. Stracks: That's a fairly common self-compassion break that we teach when we're starting to teach people about self-compassion. You're teaching a seven-and-a-half-hour class over five weeks, so that's a lot of time on self-compassion. What else goes into a class like that? What can people expect to get from attending?
Leah: I'm really excited about this class because we're going to approach self-compassion from a couple of different facets. We'll think about it as a concept, but we'll also bring it to our bodies, our emotions, our thoughts, and our actions, and think about how we can apply it to different parts of our experience.
The classes will be structured with a short teaching, some storytelling (I love telling stories), and then experiential practices, a little like this one, and we'll get a chance to debrief together and hear about other people's experiences. We'll also do other things, from journal writing to working with self-compassionate thoughts. We'll probably create some characters of our critical selves as a way to relate to them differently, and try other types of meditations or reflective practices.
I'm excited because there are a lot of different ways in, so if one thing doesn't fit for you, that's okay. What I love about your work, Dr. Stracks, is that you often talk about a tool belt, or a toolkit. For some people meditation will really stick, and for others expressive writing will be really powerful. The goal is to offer many different approaches to cultivating self-compassion and let folks try them on and say, "Here's what I'd like to incorporate more frequently," and notice which ones aren't sticking right now.
Dr. Stracks: That sounds really good, and I'm super excited to have this as part of our organization. Eight, nine, ten years ago, a number of my patients took a self-compassion class from a provider in California. This was pre-COVID, before a lot of things were on Zoom, but they did it remotely. Jessica was one of them, I think. They still talk about it a decade later, about what their experience was like. What have your experiences been in some of these classes? What do you think people might feel as they go through not just a five-minute exercise, but a series of 90-minute classes over a month or so?
Leah: One thing that's powerful about a series of classes is that we can start to get a sense of change, from where we start in class one to the final class, class five. We can really see it as a skill being built. If I wanted to learn piano or speak Japanese, I'd have to practice. I'm not going to be able to show up and just speak a different language. The joy of a class is that there's some group accountability, which is really nice: every week it's on my calendar, and I get a chance to practice my fluency in self-compassion. We also get to hear stories throughout the class of where we're starting to see this pop up more in our lives.
There will be informal practices that people can try in their day-to-day lives, and more formal practices, knowing that building those habits takes some dedicated effort. If you're anything like me, I always need a team any time I'm going to try something new. I'm usually more motivated when I get to do it with other people.
Dr. Stracks: I like the ideas that Kristin Neff, Tara Brach, Jack Kornfield, you, and Jessica have taught over time, which is that self-compassion is a skill. A lot of people listening know they can be critical and know they should be more compassionate. One of the great developments over these 10 to 15 years is that we've learned what really helps, what we can teach, and what people can practice that makes a big difference. So I'm super excited that you're available to help with that.
Leah: I'm really excited about it as well.
Dr. Stracks: Anything else people should know about you, self-compassion, or classes coming up?
Leah: Two other things come to mind. One is that a lot of people think self-compassion is mushy. I just want to say: no, it's really hard. It can be really strong and fierce, and developing it takes a lot of strength. If that's a reservation, I completely understand it. Bring it to the class. I love skepticism and questions. The second is that humor is a really important piece of this for me. Sometimes this stuff can feel quite serious, and it is, because it's important, but we're going to bring some lightness. Hopefully this time together will feel fun and enjoyable even as we're learning something new.
Closing
Dr. Stracks: Great. We'll end there for now. Thank you, Leah, so much for taking the time to be here and for sharing your experience and your insights. I know how much people appreciate hearing what other people have experienced and what they've learned along the way.
Leah: Happy to.
Dr. Stracks: For those of you listening, if you want more information about Leah's self-compassion class or about working with us here at Cormendi Health, you can visit our website at cormendihealth.com, and we'll get back to you with all the information you need.
Thank you, as always, to everybody who's been here and listening. Every time we record a webinar, I'm reminded how blessed and touched I am to be part of this community of people who are working so hard on this brave, creative, and cutting-edge way of healing. Thank you so much. I hope everybody has a good day, stay safe, and take care.
Dr. John Stracks practices mind-body medicine via telehealth nationally and internationally. To learn more about working with Dr. Stracks or the Cormendi Health team, visit cormendihealth.com. You can find more interviews on the Cormendi Health YouTube page.