{"paper_id":"4ccf22aa-c3cc-4def-8b9c-68140aef6b8a","body_text":"Learning together when feeling alone: The experience of parents with chronically ill children in a self-compassion program | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Learning together when feeling alone: The experience of parents with chronically ill children in a self-compassion program Phoebe Franco, Marissa Knox, Lauren Gulbas, Krista Gregory This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4769435/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Objectives Parents of children with chronic illnesses face unique stressors that put them at risk for mental health disorders, such as anxiety, stress, and depression. In the U.S., 20% of families care for a child with a chronic health condition. Because self-compassion is a protective factor for parents against distress, this study examined the processes through which parents may become open to attending a self-compassion-based support program and acquiring self-compassion skills. Methods Eight parents who attended a six-week self-compassion training were interviewed about their experiences during the program. Responses were analyzed using thematic analysis. Results Parents were motivated to attend the program because they were open to change and trusted the program would be valuable. Learning self-compassion involved developing a kinder relationship with themselves and embracing their common humanity, which helped them recognize the existing strengths they have had to develop in order to care for their children. They also experienced greater emotional acceptance and reported learning self-compassion had impacted the quality of care they provided for their children. Conclusions Results demonstrate the importance of acquiring trust from potential participants and combining social support (which can reduce feelings of isolation) with evidence-based training. Findings also provide insight for future researchers to examine the mechanisms of engagement in a program and to better understand the processes through which self-compassion supports positive mental health outcomes for parents of chronically ill children. self-compassion intervention chronic illness children parents Figures Figure 1 Introduction In the U.S., 20% of families have a child with a chronic health condition [ 1 ]. Chronic illness refers to a wide spectrum of symptoms and encompasses rare diseases (defined as existing in less than 1 in 200,000 people) as well as more common conditions such as cystic fibrosis and Down syndrome [ 2 , 3 ]. Across this spectrum, parents of chronically ill children experience unique caregiving roles. In addition to their typical parenting duties, such parents are likely to frequent hospitals and/or clinics, constraining their time and financial resources [ 3 ]. Doctor appointments and hospital visits also require emotional reserves to make medical decisions and interact with the healthcare system, adding to the general stress of parenting ​[ 4 ]. Several studies have indicated that the unique circumstances and challenges associated with parenting a chronically ill child result in higher rates of psychological distress than parents of healthy children [ 4 , 5 , 6 , 7 ]. Due to the constant demands of their caregiving roles, more parents of chronically ill children meet clinical levels of burnout than parents of healthy children [ 6 ]. Cohn et al.’s 2020 meta-analysis of 26 studies found that parents of children with chronic illness experience depression and anxiety at significantly higher rates than parents of healthy children [ 5 ]. These parents are more likely to experience negative emotions and psychopathology, including frustration, isolation, guilt, anxiety, depression, chronic sorrow, and burnout [ 8 , 9 , 10 , 11 ]. Additionally, parents have reported feeling frustrated at the lack of answers or treatments for their children’s condition and isolated from others who do not share their experiences, especially if their children have rare, misdiagnosed, or undiagnosed illnesses [ 2 , 12 ]​. The coping strategies that parents of chronically ill children use can exacerbate or mitigate their levels of distress and negative emotions [ 13 , 14 ]. A systematic review of 11 studies found adaptive coping strategies predicted parental quality of life for parents caring for a child with a disability or chronic illness [ 15 ]. In one study, parents who experienced higher levels of anxiety and uncertainty and used coping strategies such as denial and self-blame during their child’s hospital stay were more likely to experience post-traumatic stress symptoms three months after their child was discharged [ 16 ]. In contrast, a recent review of qualitative studies about parents with children with chronic kidney disease found that coping strategies that emphasize interpersonal support helped to lessen parental distress [ 17 ]. The authors note that while personal coping strategies are important, interpersonal coping strategies can help to assuage the emotional and social isolation that many parents with chronically ill children face. These research findings suggest that the strategies parents utilize to respond to their distressing experiences can influence their own mental health outcomes over time. Mindfulness and self-compassion interventions are promising options for helping parents cope with the stress and other difficult emotions they experience in their caregiving roles, which may, in turn, impact their children. The term mindfulness has been operationalized by Bishop et al.as the self-regulation of attention with an orientation of curiosity, openness, and acceptance of one’s experience [ 18 ]. This type of attention to one’s inner experience can reduce the impact of psychological distress and help individuals respond more skillfully to their environment, their relationships, and their own experiences [ 19 , 20 ]. Self-compassion is related to mindfulness and refers to treating oneself like a good friend when experiencing painful emotions and thoughts. Neff conceptualizes the construct as involving three interrelated parts: mindfulness (paying attention to one’s experience), common humanity (understanding you are not alone), and self-kindness (actively supporting oneself) [ 21 ]. Each of the three components has an opposing pair: over-identification (in contrast to mindfulness), isolation (in contrast to common humanity), and self-judgment (in contrast to self-kindness). Self-compassion differs from mindfulness in that it involves active self-soothing with kind words and behaviors compared to only observing one’s experience [ 22 ]. Parents’ mindfulness and tendency to relate kindly to themselves with self-compassion are related to their experience of psychological distress. Gouveia et al. found parents with higher levels of mindfulness and self-compassion reported higher levels of mindful parenting (attending to their child with presence, compassion, and acceptance) [ 23 ]. In turn, these parents reported lower levels of parenting stress. Another study revealed that among a sample of depressed parents, self-compassion predicted fewer distressed reactions to children’s emotions and less criticism of their children [ 24 ]. A number of studies have examined how relating to oneself compassionately can protect parents of children with special needs. For parents of children with autism, higher self-compassion levels predict higher well-being levels and is a stronger predictor of mental health than even the child’s level of symptom severity [ 25 ]. Chan et al. also found self-compassion to mediate the negative relationship between post-traumatic growth and depression, anxiety, and stress in a sample of Chinese caregivers of children with Autism [ 26 ]. These studies demonstrate how coping skills are a crucial component of maintaining parents’ mental health outcomes as they manage the numerous stressors that accompany caring for children with special needs. They also suggest that the self-compassion parents build in the process of overcoming traumatic events can protect them from many negative mental health outcomes. Given its potential to help mitigate parents’ feelings of isolation and to provide tools for managing the stress, anxiety, sorrow, and exhaustion associated with caring full-time for a chronically ill child, mindfulness and self-compassion training is an important avenue for intervention research for this population. As they are often the primary caregivers and central hub for their child’s care, maintaining parents’ emotional well-being is crucial for supporting the quality of their children’s care and for helping children adaptively adjust to their chronic illness. While many of these interventions have demonstrated effectiveness in improving parent and child outcomes, the ways in which parents learn mindfulness and self-compassion are poorly understood [ 27 , 28 , 29 ]. In addition, parents of children with chronic illnesses may have unique needs and outcomes in these interventions. For instance, across 29 studies, parents of children with rare diseases most commonly reported needing more social support in the form of support groups, family and friends, and other adults who did not provide medical care to their child, especially other parents of children with similar conditions [ 2 ]. Other areas of opportunity to provide for these parents include informational, emotional, spiritual, and practical support. It is imperative that researchers explore how parents may develop mindfulness and self-compassion to clarify the factors and mechanisms that support parent engagement and sustained skill use. This is particularly pertinent in this unique population of parents who have chronically ill children, given the extensive difficulties they may encounter. To this end, this pilot qualitative study focused on exploring the process of learning mindfulness and self-compassion among parents of chronically ill children. In this study, parents participated in a six-week, six-hour adaptation of a mindful self-compassion program for healthcare professionals. The six-week training was previously found to be effective at improving healthcare professionals’ levels of self-compassion, compassion to others, compassion satisfaction, personal accomplishment, and decreasing their levels of depression, anxiety, stress, and symptoms of burnout in a sample of healthcare professionals [ 30 , 31 , 32 ]. After a need was identified for parents of chronically ill children to learn skills related to mindfulness and self-compassion, the curriculum was offered to parents seeking treatment for their children at a large pediatric hospital and a local outpatient clinic serving patients with complex medical conditions in the Southwest. In this paper, we examine the qualitative data gathered with parents after they completed the program, exploring three main research questions: 1) what motivated parents to attend the training; 2) what was their experience like during the training; and 3) how did the training affect them after it was over? Methods Procedure The present study was approved by the University of Texas at Austin’s Institutional Review Board Study. The study was performed in accordance with the ethical standards outlined in the Belmont Repor. Parents were recruited through the sponsoring hospital’s connection with area organizations working with children with complex medical needs. Flyers were emailed to the sponsoring organizations to distribute to the parents they served. Through marketing and word-of-mouth referrals, parents volunteered to participate in one of the two groups offered (one in the Fall of 2018 and one in the Spring of 2019). In total, 20 parents attended the intervention. Description of the Intervention In the six-week adaptation of the Mindful Self-Compassion program, practices were selected that could be easily utilized while working or caregiving, in contrast to long, sitting meditations that would require quiet time away from a child or patient (see Table 1 ) [ 32 ]. Throughout the curriculum, participants were provided examples of how to apply the practices taught in the course to their everyday lives. During the program, child care was available on-site with an experienced caregiver of children with special needs. Table 1 Self-Compassion for Healthcare Communities practices by week Week One: What is Self-Compassion? Exercises: How Do I Treat a Friend?; Hand Gestures; Self-Compassion Bracelets Week Two: Practicing Self-Compassion Exercises: Soothing Touch; Self-Compassion Break; S.T.O.P; Soles of the Feet Week Three: Discovering Your Compassionate Voice Exercise: Motivating Ourselves with Compassion Week Four: Self-Compassion and Resilience Exercise: Strategies for Meeting Difficult Emotions Week Five: Self-Compassion and Burnout Exercise: Compassion with Equanimity Week Six: Making it Count Exercise: Setting an Intention; Self-Compassion Stone Note: From Authors (2022) Description of Participants Eight of the 20 parents who attended the intervention agreed to take part in a qualitative interview 5 to 11 months after the completion of the course. Informed consent was obtained from all individual participants included in the study. Two of the parents were married to each other. The majority of parents identified as white, with at least some college education, and lived in households with six-figure incomes. Two were male. They ranged in age between 41 and 56, with an average age of 46. Their children’s illnesses were rare, undiagnosed, and/or required a full-time level of care. Data Collection Using semi-structured interviews, the authors asked a series of questions to understand parents’ experiences while attending the training program and its influence on their lives after the course was over. Our process involved a team of researchers meeting to develop interview questions based on what we wanted to know about the parents. The main categories of questions were 1) the primary challenges of parenting a chronically ill child; 2) motivation to attend the six-week program; 3) experience during the program; and 4) the effect of the training on the parents’ lives. The first and second authors interviewed eight parents and then transcribed the audio using the software Temi. Completed transcripts were checked for accuracy while listening to the audio. The interviews ranged from twenty-one minutes to one hour, and the average length was thirty-four minutes. Data Analysis Using a thematic approach, the first author coded the interview for themes related to the relevant questions by open-coding each individual interview first and then by cross-referencing codes between interviews [ 33 ]. Similar codes were grouped into categories, and similar categories were united under primary themes. From this, the first author wrote a composite summary description of each theme and the ways in which the theme manifested across the qualitative interviews. The second author reviewed and evaluated this summary, and during a team meeting, the team finalized the list of themes and their definitions through consensus. Following a process outlined by Sobo (2009), we organized themes into a visual framework through an iterative team process that entailed working across both coded text and individual interview transcripts to illustrate and contextualize the process through which self-compassion was learned [ 34 ]. During team meetings, we revised the framework to ensure it accurately described the experiences of participants in the dataset. Rigor & Trustworthiness We implemented the following strategies outlined by Guest and colleagues (2012) to support the credibility and dependability of our study findings [ 33 ]. As a team, we discussed how our respective fields of study (anthropology, psychology, and social work), previous experiences, and identities potentially shaped interpretations of the data. To support this work, we engaged in a process of member checking to share our emergent findings and interpretations of the data and elicit feedback from our participants. During the process of member checking, all participants supported our analysis of the data, and no new themes were discovered during this process, supporting the credibility of our findings. Dependability was facilitated by using multiple team members to develop the interview guide questions. After the interviews, the research team debriefed to ensure consistency in data collection procedures and the use of the interview guide. Results Figure 1 organizes nine themes (openness to change; trust in the program; motivation to learn self-compassion; integration into daily life; kinder relationship to self; common humanity; repositories of strength; caring for child; and emotional acceptance) to illustrate the process through which parents of chronically ill children learn self-compassion (see Fig. 1 ). The figure is not intended to imply a causal connection but rather to describe the experiences of parents in the training program. The figure suggests that learning self-compassion begins with openness, trust, and motivation, as these elements contributed to and sustained parent engagement in the program and the learning process. From this, several elements interacted synergistically to promote the internalization of self-compassion. Through reflective exercises and discussions, the program helped parents develop a kinder relationship with themselves and an understanding of their common humanity in general and with other parents of children with chronic illness. The process of learning self-compassion also helped them identify the existing repositories of strength they developed as parents. Parents practiced integrating self-compassion into their daily lives in several ways, reinforcing what they had learned in the training. Through learning and integrating self-compassion, they developed emotional acceptance of their experiences parenting a chronically ill child and reoriented their parenting practices to support compassion toward self and others. The Motivation to Learn Self-Compassion Learning self-compassion begins with the cultivation of a motivation to learn. Our results suggest that two factors facilitate a capacity to learn: (1) being open to change, and (2) having trust in the program. Many parents in the program reflected that although they did not know what to expect from the course, they recognized they needed help and were curious and willing to try new strategies for coping. P1 explained, “I feel like we’ve identified as parents more [than others] that we need help.” P2 described being always on the lookout for more support services: “I’m kind of just always willing to give things a try and just see how it goes.” Notably, the most common reason people were motivated to attend the course was because they trusted people associated with the program. A number of parents were associated in some way with the hospital or parent support group sponsoring the program and expected these organizations to provide a program worthy of their time and attention. P3 explained that she had become familiar with Kristin Neff’s work on self-compassion through an outpatient program and trusted that a course associated with her name would be valuable. P4 contrasted her experience during the six-week program with another support group she had attended that caused her to feel more anxious after listening to other parents’ difficult stories. During the six-week program, she explained, “I felt there was a process you were going to lead us through. There was leadership, and the program was based on something. [It] wasn’t just a free for all.” Developing a Kinder Relationship to the Self Learning self-compassion involves developing a kinder relationship to the self. Parents described self-compassion as being kind to themselves in the form of loving themselves, going easy on themselves, being gentle with themselves, forgiving themselves, and taking care of themselves. Parents practiced being kind to themselves in their internal monologue or self-talk. Several reflected on becoming more aware of the harsh words they use with themselves since taking the course. P2 described how she has “definitely cut way down on the negative self-talk, like, ‘What are you doing? You stink. You're just failing.’” Because she was more conscious of the harsh words that emerge in difficult situations with her daughter, she has started countering them with statements like, “You're doing the best you can…it may or may not be enough…but maybe next time it will feel different or better.” Other parents described the effect of using kinder language toward themselves to decrease their perception of social threat, alleviate emotional exhaustion, and cultivate more hope over their situation. P4 explained, “I really believe the words that you use in your self-talk make a huge difference in your outlook on life.” When she feels exhausted from taking care of her son, she is more prone to negative self-talk and hopelessness. She reflected, “You’ve got to find some ways to be less spent all the time. And I think just that kind of self-talk makes the difference in your, if not the physical energy, then the emotional and mental energy that you have for ongoing care.” Embracing a Common Humanity The experience of attending a self-compassion program with other parents of chronically ill children helped participants directly experience their common humanity and feel less alone. P2 explained, “We probably spend 90% of our time feeling like we're the only people going through something like this.” Every parent that was interviewed cited the opportunity to be in a room with other parents of chronically ill children as one of the high points of the program. P5 described feeling relieved from hearing other parents’ stories: “That validation of our experiences are so similar. I’m not crazy.” P6 similarly said that it helped to be with other people who implicitly understood “what you're going through…and they are there to support you through it. And to me, that was huge because one, it shows you that you're not alone and or that you're never going to be alone.” P3 and P4 each described how the concept of common humanity allowed them to feel more connected to and compassionate towards others. P3, who had been introduced to self-compassion before participating in the training, explained that the course “further [drove] home and helped integrate the knowledge of self-compassion, the core tenants of these are experiences that everybody else has. These feelings are human and universal.” P4 described how the phrase “common humanity” has remained with her even several months after participating in the course. She explained that she thinks about it “multiple times a week. And it helps me feel calmer in some stressful situations, and it helps me feel more compassionate towards other people.” Drawing on Repositories of Strength Learning self-compassion helped parents face the unique challenges of parenting a child with chronic illness. Parents consistently described caring for their chronically ill child as all-consuming of their mental and physical resources. For many parents, the amount of time required to care for their child was equivalent to a full-time job, involving keeping their children physically comfortable and emotionally well and balancing the time needed for doctor’s appointments with work, other family responsibilities, and personal interests. In addition to the time she spends caring for her son, P4 noted the challenge of maintaining an identity outside of “mother of a chronically ill child” because much of her day-to-day routine is related to caring for her son, including her volunteer activities. Several parents discussed the challenge of maintaining the mental and physical reserves to care for their children, given the considerable time, effort, and attention required. P3 described the difficulty of replenishing her physical and mental energy in contrast to understanding how to care for her child on an intellectual level. As P3 explained: When it comes to managing a chronic, lifelong, life-altering, and potentially life-threatening illness...the biggest challenge is the internal fortitude to keep coming back over and over and bringing new resolve and new energy and fighting spirit. While learning self-compassion did not eradicate the challenges parents faced, the program did help them identify and access internal resources of support. P3 explained how she has redirected her skills as a mother toward relating to herself, countering the other more critical voices that have developed throughout her lifespan: The mother version that lives in me for my children is my best self. When I think of my highest, greatest, wisest mind, that’s who it is. Part of [becoming self-compassionate] was figuring out how to utilize that resource, that existing repository of strength. But in a way that could be more self-directed and essentially replace some of those other [voices]--the voice of my actual mother, the voice of societal expectations of what a mom should be, the patriarchy—take your pick—judgment voice, achievement voice and all of these other voices that are very powerful, are very well established and are in many ways completely not useful to actually being productive and having emotional reserves. Integrating Self-Compassion into Daily Life Parents applied several strategies to integrate self-compassion into their daily lives, including teaching others and daily practices. Many parents stated that they have shared their experience and training with others (e.g., their children, their colleagues, and other parents they know). They were moved to share what they learned with others, which aided their internalization of the skills of self-compassion and made the impact of the training ripple out beyond the initial training group itself. P3 said that sharing what she learned has helped her better integrate self-compassion into her life and her relationships with others. “The best way to learn things is to teach it. And I think [the course] gave me really good vocabulary, and it gave a lot of opportunities to either model it for other people or utilize it more tangibly in conversations.” P2 and P6 shared with other parents the mindset that it is okay to give themselves a break. “I try to enlighten other parents that don't know about it. To be like, give yourself a break,” P2 noted. P6 similarly explained that when she talks to people about what she’s learned, she explains, “it’s not about pride. It’s okay to ask for help. It’s okay to lean on someone.” Teaching others may have emerged frequently because, as parents, our participants recognize how the tools they learned can help their children. Both P4 and P1 explained sharing the techniques they learned in class with their children. P4 reported that she had shared the “self-soothing mantras or behaviors” with her non-special needs daughters who struggle, like her, with anxiety and insomnia. She explained how she guides them to “take deep breaths, focus on what you’re doing right now, you don’t have to worry about next week.” Similarly, P1 has shared meditation strategies with her special needs adult daughter, who has struggled with symptoms of anxiety and post-traumatic stress in her assisted living facility: “She gets really nervous and anxious and...so I'm like, okay, where do you feel it?” In her role as a healthcare professional, P1 has also shared these tools with her patients. She explained them as a “little toolbox” she can tell patients about to provide “something else to hope for.” In addition to teaching others, daily practice helped parents incorporate self-compassion into their everyday lives. This way of practicing self-compassion corresponds to a handout in the first session called “Self-Compassion in Daily Life,” which helps participants discover the behaviors they are already enacting that are soothing or enjoyable to them. P6 explained: “[the course] made me stop and breathe and smell the flowers and actually smell the flowers and not just walk past them and go, Oh, look at those pretty flowers. You know, I'll look at them later, and later never comes.” P4 similarly described how slowing down to notice and enjoy what she is doing, even a mundane task like washing her hands, helps to soothe her: I noticed when I'll be washing my hands...and I'll actually physically have my body turned away. Like, I'm onto the next thing already…I'm just washing my hands, but in my mind and even in my body, I'm ready to run off to do the next thing. And so I don't criticize myself. I'm like, ‘wash your hands right now. That's all you have to do is wash your hands right now.’ The class helped me think of that. That also is a soothing behavior. Other ways participants described practicing mindfulness included newfound permission to take breaks from their children or participate in activities they enjoyed (like taking a walk or driving the scenic route home). Parents also described taking deep breaths throughout their day and connecting with their self-compassion stone. The latter is a stone given to participants at the end of the course as a visual reminder of what they learned. They are also instructed to practice mindfulness with the stone by paying attention to how it feels and looks. P7 explained: “the pebble helps you relax…I can just sit in my car and rub it and just relax, close my eyes. Don't even worry…” P8 also said that he keeps his rock at his desk as a reminder throughout his day that everything is “going to be okay.” The Benefits of Learning Self-Compassion Emotional Acceptance Learning self-compassion helped parents to accept their emotions more readily, rather than avoid their difficult feelings. P6 and P7 explained that they had a tendency to “bottle” up their feelings before taking the course, invoking the idea that emotional pressure could build, only to explode at a later time if not released properly. P7 described the pressure to be “superman” in his family, the one who takes care of his daughters and wife when they are hurting. After taking the course, he said, “I could share my feelings and I could let go of stuff and not just keep it bottled in.” Accepting their difficult emotions has allowed parents to release pressure on their emotional valves more slowly so that they will not feel overwhelmed at a later time. P5 explained: “Before [the course], I would push through a really, really hard thing to get to the other side and then process it afterward. And maybe after the class, it was more of being able to do it in the moment as it was happening.” P3 described the skill of noticing her emotions as “bringing things to a surface level where I can sort of interrogate them more intelligently rather than just being ruled unknowingly…I don't have to wait until I go to therapy for my therapist to say, well, it sounds like you were really grieving being away from your babies this week.” Parents explained that emotional acceptance helped them continue to learn and cultivate self-compassion, motivating them to speak kindly to themselves, participate in enjoyable activities without guilt, and practice mindful presence to more fully appreciate life and relax. Moreover, emotional acceptance was helpful for parents navigating the healthcare system and the frustration of not having answers for a rare or undiagnosed illness. P6 explained that before the course, “I didn't realize that it was okay to feel angry…about the unanswered questions. I would ask a ton of questions and not get answers, or I would get pushed away...Just knowing that it's ok to have those emotions, but at the same time, learning how to process those emotions.” Caring for Child Parents also discussed the influence of their practice on caring for their children. They noted that practicing self-compassion has reinforced the importance of providing loving attention to their children. Self-compassion practices have helped them feel more energized to care for their children and to navigate difficult interactions more skillfully. P3 explained how she recognizes that “what my children need most from me is just my physical presence in their life. Did they get that loving attention? I think that [self-compassion] is a further affirmation of that...[For] most of life, just showing up is the major part of the game.” Because her son requires constant care, P4 described how her self-compassion practice would inevitably affect him: Everything that I do where I can practice self-compassion—that’s going to relate back to him. If I am less stressed [or] emotionally spent, then that's got to communicate itself to him. Whether it's me just remembering to tickle him and hug him and kiss him, or to be more aware of what might improve his quality of life. To just bring fresher energy to his care. P8 explained how the course has helped him be more skillful in responding to the difficult emotions that can arise while providing care to his son. “[I’m] a little bit more tolerant when I get frustrated. Because [my son] can write and sometimes he doesn't want to write with me. So sometimes I get frustrated with that ... So it’s helped me handle that frustration a bit better than I had in the past. [To] walk away or something like that and just let him have his space. I have my space and then we'll come back and try again a little bit later.” Discussion Parents were motivated to learn self-compassion in a 6-hour training because they were open to experiencing change and because they trusted the program would be a valuable use of their time. The process of learning self-compassion for these parents involved developing a kinder relationship to themselves in their self-talk and behaviors as well as embracing their common humanity, particularly with other parents of chronically ill children. As part of learning to be self-compassionate, parents came to recognize the existing strengths they have had to develop to care for their children. Parents experienced greater emotional acceptance and reported learning self-compassion had enhanced the quality of care they provided for their children. Our findings suggest two important components of providing programs for parents of chronically ill children: peer support and practical tools. As Coffey’s 2006 metasynthesis of studies examining the experience of parenting children with chronic illness found, the complex responsibility of parenting a chronically ill child can create a feeling of isolation [ 35 ]. Peer support groups for parents with similar experiences can be a “bridge to the outside world” in which they experience camaraderie and a shared understanding of their unique circumstances [ 35 ]. Including a peer support component in educational programs can help parents access the inherent benefits of connecting with others in similar situations and develop an understanding of their common humanity. However, parents in our study also appreciated that the program was “based on something” (i.e., evidence-based skill development) rather than being a “free for all” discussion group. It is possible that peer support groups could intensify individual distress if tools for addressing empathic resonance and distress experienced during conversations about parenting difficulties are not included [ 36 ]. In the process of learning self-compassion, parents discussed using new strategies for speaking to and caring for themselves. They did so in ways that do not necessarily add to their task list, demonstrating the benefit of self-compassion as a self-care tool for exceptionally busy people. For example, parents discussed how changing their internal monologue to be more kind towards themselves helped them to feel less exhausted and to experience more positive emotions, such as hope. They also reported savoring their experiences of smelling flowers and washing their hands. These small, daily tweaks to their self-talk and relationship to their moment-to-moment experience may grow into a protective buffer against stress, depression, and other forms of distress. Indeed, previous research has found that parents who attend interventions with a self-compassion component experience significantly lower depression, anxiety, and stress from before to after the intervention [ 37 ]. Other research has found self-compassion to be a protective factor against parenting stress among parents whose children are autistic [ 25 ]. Learning self-compassion may target some of the coping challenges of parenting a child with chronic illness, such as experiential avoidance. As an outcome of learning self-compassion, parents found they were able to accept their emotional experiences of frustration and anger in medical situations and avoid having their difficult emotions build up over time. Jackson et al.’s 2015 systematic review found avoidance, disengagement, and denial to be associated with lower maternal mental health among parents of children with heart disease [ 38 ]. Parents of children with chronic illness are also significantly more likely to experience burnout, stress, anxiety, and depression if they have a tendency to cope by avoiding their experience [ 39 ]. Self-compassion may be associated with reduced parental distress by providing skills that facilitate processing difficult emotions rather than using strategies that can exacerbate parents’ stress response. The reflections of our participants suggest the benefits of being more self-compassionate (e.g., being more energized, attentive, and patient) may improve the relationship between child and parent. Previous studies have found parents’ self-compassion to be associated with mindful parenting behaviors, such as listening to one’s child with their full attention [ 40 ]. Mothers who are more self-compassionate are less likely to make critical comments towards their children [ 25 ]. Future quantitative and qualitative studies should explore how parenting actions may change as they become more compassionate toward themselves. Parenting interventions that involve self-compassion can be viewed as a strengths-based approach to supporting parents of children with chronic illness, in contrast to deficit approaches that view parents’ coping skills and behaviors as in need of fixing. By enhancing their ability to recognize their existing capacity as parents and identify additional skills for coping, self-compassion can support parents in their growth and development of the strengths needed to care for themselves and their children. Implications These preliminary, exploratory findings, alongside a large body of research evidence demonstrating the positive association between self-compassion and mental health, suggest that self-compassion education could be one promising way to support parents of chronically ill children. Because self-compassion tools can be applied immediately, in the midst of caring for one’s child or while doing other tasks, they may be particularly relevant for overloaded parents who do not have time to step away from their caregiving duties to care for themselves. Additionally, parents in our study indicated they needed to trust that an educational offering would be a valuable use of their scarce time. Before implementing a training program, organizations should consider how they will demonstrate the trustworthiness of their offering through advertising and word-of-mouth referrals. Parents also indicated the combined benefits of meeting with other parents who shared similar experiences and learning practical tools that could help them manage their distress. For instance, programs that provide only peer support to parents should consider including useful tools that can help them manage their distress. Alternatively, programs focused only on educational support should consider providing opportunities for parents to share similar experiences to cultivate their common humanity. Since a regularly scheduled training over a series of weeks is not feasible for every parent with a chronically ill child to attend, creative ways to introduce parents to self-compassion concepts and techniques should be considered. For instance, self-compassion tools could be offered to parents in one-on-one encounters with social workers or in a peer support group setting. Infographics about self-compassion techniques could be placed in hospitals, doctors’ offices, and other places parents might frequent. Clinicians who support parents and their children could be trained to facilitate brief self-compassion interventions or to provide one-on-one support with self-compassion tools. While implementing self-compassion education, evaluation data should be collected to understand the degree to which self-compassion content is acceptable and feasible for parents from a variety of backgrounds and to understand how to improve the content to meet the specific needs of parents whose children are chronically ill. Limitations We developed a model for learning self-compassion using a rigorous approach to qualitative research and analysis. However, given the exploratory nature of our pilot study, additional research is warranted to further refine and test our model. Importantly, the small sample size limits the generalizability of our study findings. Participants in the study were demographically homogenous: the majority were white, female, and college-educated. The two men who attended the training both participated in an interview, and each mentioned the need for further support of fathers specifically. It is our hope that additional revisions are made to our model through research with more diverse samples of participants across intersectional identities, including race, gender, and class. Such research will support critical discussions and advance understandings of the ways in which self-compassion is perceived, learned, and implemented in the challenges that parents confront in everyday life. Declarations Competing Interests PF and MK facilitated the intervention described in this study. Author Contribution PF and MK collected the interview data and wrote the main manuscript text. LG prepared the figure and contributed to all sections of the manuscript text. KG helped with data collection and contributed to sections of the manuscript. All authors reviewed the manuscript. Acknowledgements Thanks to Natasha Iqbal for providing editing support on this paper. Thanks also to the parents who offered their valuable time to share their insights and experiences about the program with us. Data Availability The data that support the findings of this study are not available publicly to protect the privacy and confidentiality of participants. Sections of the data, such as de-identified direct quotes, may be requested from the authors upon reasonable request. References Ghandour, R. M., Hirai, A. H., & Kenney, M. K. Children and Youth With Special Health Care Needs: A Profile. Pediatrics. 2002; https://doi.org/10.1542/peds.2021-056150d ​Pelentsov, L. J., Laws, T. A., & Esterman, A. J. The supportive care needs of parents caring for a child with a rare disease: A scoping review. Disability and Health Journal. 2015; https://doi.org/10.1016/j.dhjo.2015.03.009 ​Vonneilich, N., Lüdecke, D., & Kofahl, C. The impact of care on family and health-related quality of life of parents with chronically ill and disabled children. Disability and Rehabilitation. 2016; https://doi.org/10.3109/09638288.2015.1060267 ​Pinquart, M., & Kauser, R. Do the associations of parenting styles with behavior problems and academic achievement vary by culture? Cultural Diversity & Ethnic Minority Psychology. 2018;. https://doi.org/10.1037/CDP0000149 ​Cohn, L. N., Pechlivanoglou, P., Lee, Y., Mahant, S., Orkin, J., Marson, A., & Cohen, E. Health Outcomes of Parents of Children with Chronic Illness: A Systematic Review and Meta-Analysis. The Journal of Pediatrics. 2020; https://doi.org/10.1016/J.JPEDS.2019.10.068 ​Lindström, C., Åman, J., & Norberg, A. Increased prevalence of burnout symptoms in parents of chronically ill children. Acta Paediatrica (Oslo, Norway:1992). 2010; https://doi.org/10.1111/J.1651-2227.2009.01586.X ​Muscara, F., McCarthy, M. C., Woolf, C., Hearps, S. J. C., Burke, K., & Anderson, V. A. Early psychological reactions in parents of children with a life threatening illness within a pediatric hospital setting. European Psychiatry. 2015; https://doi.org/10.1016/J.EURPSY.2014.12.008 Alkan, F., Sertcelik, T., Yalln Sapmaz, S., Eser, E., & Coskun, S. Responses of mothers of children with CHD: quality of life, anxiety and depression, parental attitudes, family functionality. Cardiology in the Young. 2017; https://doi.org/10.1017/S1047951117001184 Ashkani, H., Dehbozorgi, Gh. R., & Tahamtan, A. Depression among parents of children with chronic and disabling disease. Iranian Journal of Medical Science. 2004. ​Batchelor, L. L., & Duke, G. Chronic sorrow in families with chronically ill children. Pediatric Nursing. 2019; https://doi.org/10.1097/00000446-200205000-00036 Khanna, A. K., Prabhakaran, A., Patel, P., Ganjiwale, J. D., & Nimbalkar, S. M. Social, psychological and financial burden on caregivers of children with chronic illness: A cross-sectional study. Indian Journal of Pediatrics. 2015; https://doi.org/10.1007/s12098-015-1762-y ​Gibson, C. H. The process of empowerment in mothers of chronically ill children. Journal of Advanced Nursing . 1995. ​Doupnik, S. K., Hill, D., Palakshappa, D., Worsley, D., Bae, H., Shaik, A., Qiu, M. K., Marsac, M., & Feudtner, C. Parent coping support interventions during acute pediatric hospitalizations: A meta-analysis. Pediatrics . 2017; https://doi.org/10.1542/PEDS.2016-4171/38313 ​Law, E., Fisher, E., Eccleston, C., & Palermo, T. M. Psychological interventions for parents of children and adolescents with chronic illness. Cochrane Database of Systematic Reviews . 2019; https://doi.org/10.1002/14651858.CD009660.PUB4/MEDIA/CDSR/CD009660/IMAGE_N/NCD009660-CMP-017.02.SVG Fairfax, A., Brehaut, J., Colman, I., Sikora, L., Kazakova, A., Chakraborty, P., & Potter, B. K. A systematic review of the association between coping strategies and quality of life among caregivers of children with chronic illness and/or disability. BMC Pediatrics . 2019 ; https://doi.org/10.1186/S12887-019-1587-3/TABLES/5 Franck, L. S., Wray, J., Gay, C., Dearmun, A. K., Lee, K., & Cooper, B. A. Predictors of parent post-traumatic stress symptoms after child hospitalization on general pediatric wards: A prospective cohort study. International Journal of Nursing Studies. 2015; https://doi.org/10.1016/j.ijnurstu.2014.06.011 Ong, Z. H., Ng, C. H., Tok, P. L., Kiew, M. J. X., Huso, Y., Shorey, S., & Ng, Y. P. M. Sources of Distress Experienced by Parents of Children with Chronic Kidney Disease on Dialysis: A Qualitative Systematic Review. Journal of Pediatric Nursing . 2021; https://doi.org/10.1016/J.PEDN.2020.10.018 ​Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., Segal, Z. V., Abbey, S., Speca, M., Velting, D., & Devins, G. Mindfulness: A proposed operational definition. Clinical Psychology: Science and Practice. 2004; https://doi.org/10.1093/clipsy/bph077 ​Chambers, R., Gullone, E., & Allen, N. B. Mindful emotion regulation: An integrative review. Clinical Psychology Review . 2009; https://doi.org/10.1016/j.cpr.2009.06.005 ​Han, A. Effects of mindfulness-and acceptance-based interventions on quality of life, coping, cognition, and mindfulness of people with multiple sclerosis: A systematic review and meta-analysis. 2021; https://doi.org/10.1080/13548506.2021.1894345 Neff, K. D. Self-Compassion: Theory, method, research, and intervention. Annual Review of Psychology . 2023. Neff, K. D. Development and validation of a scale to measure self-compassion. Self and Identity . 2003. Gouveia, M. J., Carona, C., Canavarro, M. C., & Moreira, H. Self-compassion and dispositional mindfulness are associated with parenting styles and parenting stress: The mediating role of mindful parenting. Mindfulness . 2016; https://doi.org/10.1007/s12671-016-0507-y ​Psychogiou, L., Legge, K., Parry, E., Mann, J., Nath, S., Ford, T., & Kuyken, W. 2016; https://doi.org/10.1007/S12671-016-0528-6 Neff, K. D., & Faso, D. J. Self-compassion and well-being in parents of children with autism. Mindfulness. 2014;. https://doi.org/10.1007/s12671-014-0359-2 Chan BSM, Deng J, Li Y, et al. The role of self-compassion in the relationship between post-traumatic growth and psychological distress in caregivers of children with autism. J Child Fam Stud. 2020; doi: 10.1007/s10826-019-01694-0 ​​Bazzano, A., Wolfe, C., Zylowska, L., Wang, S., Schuster, E., Barrett, C., & Lehrer, D. Mindfulness Based Stress Reduction (MBSR) for Parents and Caregivers of Individuals with Developmental Disabilities: A Community-Based Approach. Journal of Child and Family Studies . 2015; https://doi.org/10.1007/s10826-013-9836-9 ​Burgdorf, V., Szabó, M., & Abbott, M. J. The effect of mindfulness interventions for parents on parenting stress and youth psychological outcomes: A systematic review and meta-analysis. Frontiers in Psychology . 2019; https://doi.org/10.3389/FPSYG.2019.01336/BIBTEX Cachia, R. L., Anderson, A., & Moore, D. W. Mindfulness, Stress and Well-Being in Parents of Children with Autism Spectrum Disorder: A Systematic Review. Journal of Child and Family Studies . 2016;. https://doi.org/10.1007/s10826-015-0193-8 Authors. (2020). Authors. (2021). Authors. (2022). ​​Guest, G., M.MacQueen, K., & E.Namey, E. Applied Thematic Analysis. Applied Thematic Analysis . 2012; https://doi.org/10.4135/9781483384436 ​Sobo, E. J. Culture and Meaning in Health Services Research: A Practical Field. Culture and Meaning in Health Services Research: A Practical Field . 2016; https://doi.org/10.4324/9781315430935/ CULTURE-MEANING-HEALTH-SERVICES-RESEARCH-ELISA-SOBO Coffey, J. S. Parenting a child with chronic illness: A metasythesis. Pediatric Nursing, 2006. ​Hurst, I. Parents’ evaluations of a support program in a newborn intensive care nursery. Journal of Perinatal and Neonatal Nursing . 2006; https://doi.org/10.1097/JPN.0000000000000546 ​Jefferson, F. A., Shires, A., & Mcaloon, J. Parenting Self-compassion: a Systematic Review and Meta-analysis . https://doi.org/10.1007/s12671-020-01401-x Jackson, A., Frydenber, E., Lian, R. P.-T., Higgins, R. O., & Murphy, B. M. Familial impact and coping with child heart disease: A systematic review. Pediatric Cardiology. 2015 ; https://doi.org/10.1007/s00246-015-1121-9 Sairanen, E., Lappalainen, P., & Hiltunen, A. Psychological inflexibility explains distress in parents whose children have chronic conditions. PLoS ONE . 2018; https://doi.org/10.1371/JOURNAL.PONE.0201155 ​Lathren, C. R., Rao, S. S., Park, J., & Bluth, K. Self-Compassion and Current Close Interpersonal Relationships: a Scoping Literature Review. Mindfulness. 2021; https://doi.org/10.1007/S12671-020-01566-5 Additional Declarations Competing interest reported. PF and MK facilitated the intervention described in this study. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 22 Aug, 2024 Reviews received at journal 21 Aug, 2024 Reviewers agreed at journal 21 Aug, 2024 Reviews received at journal 20 Aug, 2024 Reviewers agreed at journal 01 Aug, 2024 Reviewers invited by journal 30 Jul, 2024 Editor assigned by journal 25 Jul, 2024 Submission checks completed at journal 25 Jul, 2024 First submitted to journal 19 Jul, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-4769435\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":342847117,\"identity\":\"8a78bd57-3472-4cd7-8db2-0527a4d70a6d\",\"order_by\":0,\"name\":\"Phoebe Franco\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABD0lEQVRIiWNgGAWjYBAC+xkMDMxAOgGIGR9AxBgb8GoxuIHQwmxAshY2CaIcZnC7+eDjggqGBH7p9msVP/7YyZnzH258XMBgky/vgF2L/ZxjycYzzjAkSM45U3azty3Z2HJGYrPxDIY0y40HcNgikWMmzdvGkGBwIyftBm/DgcQNNxjbpHkYDhsY4vASUIv5b95/EC2Ff/4cqN9w/iBBLWbMvA0gLenHmHnYDiQYHEiEaJHH5X2JtGTpGcckEiRn5DBLy7YlG264AfQLj0GagQFOLckHPxfU2NTzS6Q//Pjmj528wfnjDx/zVNgYyONwGBSAYoQH2Vgg2+AAXi0gwP4AlU/AllEwCkbBKBg5AADEv1m20vdb5gAAAABJRU5ErkJggg==\",\"orcid\":\"\",\"institution\":\"Dell Children's Medical Center of Central Texas\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Phoebe\",\"middleName\":\"\",\"lastName\":\"Franco\",\"suffix\":\"\"},{\"id\":342847118,\"identity\":\"90cc4190-0a0b-4910-af9d-0e2845f19a62\",\"order_by\":1,\"name\":\"Marissa Knox\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The University of Texas at Austin\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Marissa\",\"middleName\":\"\",\"lastName\":\"Knox\",\"suffix\":\"\"},{\"id\":342847119,\"identity\":\"ada311a0-6f28-46dc-be41-7048907793d1\",\"order_by\":2,\"name\":\"Lauren Gulbas\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"The University of Texas at Austin\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Lauren\",\"middleName\":\"\",\"lastName\":\"Gulbas\",\"suffix\":\"\"},{\"id\":342847120,\"identity\":\"317fe0f9-4539-46e8-8538-de3a528da676\",\"order_by\":3,\"name\":\"Krista Gregory\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Dell Children's Medical Center of Central Texas\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Krista\",\"middleName\":\"\",\"lastName\":\"Gregory\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-07-19 19:12:57\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-4769435/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-4769435/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":63407020,\"identity\":\"a28b24dd-ef6b-4999-b743-a17abe569f0d\",\"added_by\":\"auto\",\"created_at\":\"2024-08-27 21:48:45\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":19264,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003e\\u003cem\\u003eProcess of Learning Self-Compassion\\u003c/em\\u003e\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"floatimage1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4769435/v1/a54aa51e8019b1cba2e2a64a.png\"},{\"id\":63407021,\"identity\":\"5e96838e-0802-4585-a54e-bd18ca0cd2d7\",\"added_by\":\"auto\",\"created_at\":\"2024-08-27 21:48:50\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":522472,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4769435/v1/3ba854c0-a51a-4c76-ad22-ebe94d2f6cc4.pdf\"}],\"financialInterests\":\"Competing interest reported. PF and MK facilitated the intervention described in this study.\",\"formattedTitle\":\"Learning together when feeling alone: The experience of parents with chronically ill children in a self-compassion program\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eIn the U.S., 20% of families have a child with a chronic health condition [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. Chronic illness refers to a wide spectrum of symptoms and encompasses rare diseases (defined as existing in less than 1 in 200,000 people) as well as more common conditions such as cystic fibrosis and Down syndrome [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. Across this spectrum, parents of chronically ill children experience unique caregiving roles. In addition to their typical parenting duties, such parents are likely to frequent hospitals and/or clinics, constraining their time and financial resources [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. Doctor appointments and hospital visits also require emotional reserves to make medical decisions and interact with the healthcare system, adding to the general stress of parenting ​[\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eSeveral studies have indicated that the unique circumstances and challenges associated with parenting a chronically ill child result in higher rates of psychological distress than parents of healthy children [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. Due to the constant demands of their caregiving roles, more parents of chronically ill children meet clinical levels of burnout than parents of healthy children [\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. Cohn et al.\\u0026rsquo;s 2020 meta-analysis of 26 studies found that parents of children with chronic illness experience depression and anxiety at significantly higher rates than parents of healthy children [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e]. These parents are more likely to experience negative emotions and psychopathology, including frustration, isolation, guilt, anxiety, depression, chronic sorrow, and burnout [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e]. Additionally, parents have reported feeling frustrated at the lack of answers or treatments for their children\\u0026rsquo;s condition and isolated from others who do not share their experiences, especially if their children have rare, misdiagnosed, or undiagnosed illnesses [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]​.\\u003c/p\\u003e \\u003cp\\u003eThe coping strategies that parents of chronically ill children use can exacerbate or mitigate their levels of distress and negative emotions [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. A systematic review of 11 studies found adaptive coping strategies predicted parental quality of life for parents caring for a child with a disability or chronic illness [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. In one study, parents who experienced higher levels of anxiety and uncertainty and used coping strategies such as denial and self-blame during their child\\u0026rsquo;s hospital stay were more likely to experience post-traumatic stress symptoms three months after their child was discharged [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. In contrast, a recent review of qualitative studies about parents with children with chronic kidney disease found that coping strategies that emphasize interpersonal support helped to lessen parental distress [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e]. The authors note that while personal coping strategies are important, interpersonal coping strategies can help to assuage the emotional and social isolation that many parents with chronically ill children face. These research findings suggest that the strategies parents utilize to respond to their distressing experiences can influence their own mental health outcomes over time.\\u003c/p\\u003e \\u003cp\\u003eMindfulness and self-compassion interventions are promising options for helping parents cope with the stress and other difficult emotions they experience in their caregiving roles, which may, in turn, impact their children. The term mindfulness has been operationalized by Bishop et al.as the self-regulation of attention with an orientation of curiosity, openness, and acceptance of one\\u0026rsquo;s experience [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e]. This type of attention to one\\u0026rsquo;s inner experience can reduce the impact of psychological distress and help individuals respond more skillfully to their environment, their relationships, and their own experiences [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. Self-compassion is related to mindfulness and refers to treating oneself like a good friend when experiencing painful emotions and thoughts. Neff conceptualizes the construct as involving three interrelated parts: mindfulness (paying attention to one\\u0026rsquo;s experience), common humanity (understanding you are not alone), and self-kindness (actively supporting oneself) [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]. Each of the three components has an opposing pair: over-identification (in contrast to mindfulness), isolation (in contrast to common humanity), and self-judgment (in contrast to self-kindness). Self-compassion differs from mindfulness in that it involves active self-soothing with kind words and behaviors compared to only observing one\\u0026rsquo;s experience [\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eParents\\u0026rsquo; mindfulness and tendency to relate kindly to themselves with self-compassion are related to their experience of psychological distress. Gouveia et al. found parents with higher levels of mindfulness and self-compassion reported higher levels of mindful parenting (attending to their child with presence, compassion, and acceptance) [\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e]. In turn, these parents reported lower levels of parenting stress. Another study revealed that among a sample of depressed parents, self-compassion predicted fewer distressed reactions to children\\u0026rsquo;s emotions and less criticism of their children [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003e A number of studies have examined how relating to oneself compassionately can protect parents of children with special needs. For parents of children with autism, higher self-compassion levels predict higher well-being levels and is a stronger predictor of mental health than even the child\\u0026rsquo;s level of symptom severity [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. Chan et al. also found self-compassion to mediate the negative relationship between post-traumatic growth and depression, anxiety, and stress in a sample of Chinese caregivers of children with Autism [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]. These studies demonstrate how coping skills are a crucial component of maintaining parents\\u0026rsquo; mental health outcomes as they manage the numerous stressors that accompany caring for children with special needs. They also suggest that the self-compassion parents build in the process of overcoming traumatic events can protect them from many negative mental health outcomes.\\u003c/p\\u003e \\u003cp\\u003eGiven its potential to help mitigate parents\\u0026rsquo; feelings of isolation and to provide tools for managing the stress, anxiety, sorrow, and exhaustion associated with caring full-time for a chronically ill child, mindfulness and self-compassion training is an important avenue for intervention research for this population. As they are often the primary caregivers and central hub for their child\\u0026rsquo;s care, maintaining parents\\u0026rsquo; emotional well-being is crucial for supporting the quality of their children\\u0026rsquo;s care and for helping children adaptively adjust to their chronic illness. While many of these interventions have demonstrated effectiveness in improving parent and child outcomes, the ways in which parents learn mindfulness and self-compassion are poorly understood [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e]. In addition, parents of children with chronic illnesses may have unique needs and outcomes in these interventions. For instance, across 29 studies, parents of children with rare diseases most commonly reported needing more social support in the form of support groups, family and friends, and other adults who did not provide medical care to their child, especially other parents of children with similar conditions [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. Other areas of opportunity to provide for these parents include informational, emotional, spiritual, and practical support. It is imperative that researchers explore how parents may develop mindfulness and self-compassion to clarify the factors and mechanisms that support parent engagement and sustained skill use. This is particularly pertinent in this unique population of parents who have chronically ill children, given the extensive difficulties they may encounter.\\u003c/p\\u003e \\u003cp\\u003eTo this end, this pilot qualitative study focused on exploring the process of learning mindfulness and self-compassion among parents of chronically ill children. In this study, parents participated in a six-week, six-hour adaptation of a mindful self-compassion program for healthcare professionals. The six-week training was previously found to be effective at improving healthcare professionals\\u0026rsquo; levels of self-compassion, compassion to others, compassion satisfaction, personal accomplishment, and decreasing their levels of depression, anxiety, stress, and symptoms of burnout in a sample of healthcare professionals [\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]. After a need was identified for parents of chronically ill children to learn skills related to mindfulness and self-compassion, the curriculum was offered to parents seeking treatment for their children at a large pediatric hospital and a local outpatient clinic serving patients with complex medical conditions in the Southwest. In this paper, we examine the qualitative data gathered with parents after they completed the program, exploring three main research questions: 1) what motivated parents to attend the training; 2) what was their experience like during the training; and 3) how did the training affect them after it was over?\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eProcedure\\u003c/h2\\u003e \\u003cp\\u003e The present study was approved by the University of Texas at Austin\\u0026rsquo;s Institutional Review Board Study. The study was performed in accordance with the ethical standards outlined in the Belmont Repor. Parents were recruited through the sponsoring hospital\\u0026rsquo;s connection with area organizations working with children with complex medical needs. Flyers were emailed to the sponsoring organizations to distribute to the parents they served. Through marketing and word-of-mouth referrals, parents volunteered to participate in one of the two groups offered (one in the Fall of 2018 and one in the Spring of 2019). In total, 20 parents attended the intervention.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eDescription of the Intervention\\u003c/h2\\u003e \\u003cp\\u003eIn the six-week adaptation of the Mindful Self-Compassion program, practices were selected that could be easily utilized while working or caregiving, in contrast to long, sitting meditations that would require quiet time away from a child or patient (see Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e) [\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e]. Throughout the curriculum, participants were provided examples of how to apply the practices taught in the course to their everyday lives. During the program, child care was available on-site with an experienced caregiver of children with special needs.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eSelf-Compassion for Healthcare Communities practices by week\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"2\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWeek One: What is Self-Compassion?\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eExercises: How Do I Treat a Friend?; Hand Gestures; Self-Compassion Bracelets\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWeek Two: Practicing Self-Compassion\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eExercises: Soothing Touch; Self-Compassion Break; S.T.O.P; Soles of the Feet\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWeek Three: Discovering Your Compassionate Voice\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eExercise: Motivating Ourselves with Compassion\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWeek Four: Self-Compassion and Resilience\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eExercise: Strategies for Meeting Difficult Emotions\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWeek Five: Self-Compassion and Burnout\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eExercise: Compassion with Equanimity\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWeek Six: Making it Count\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eExercise: Setting an Intention; Self-Compassion Stone\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003cp\\u003eNote: From Authors (2022)\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eDescription of Participants\\u003c/h2\\u003e \\u003cp\\u003eEight of the 20 parents who attended the intervention agreed to take part in a qualitative interview 5 to 11 months after the completion of the course. Informed consent was obtained from all individual participants included in the study. Two of the parents were married to each other. The majority of parents identified as white, with at least some college education, and lived in households with six-figure incomes. Two were male. They ranged in age between 41 and 56, with an average age of 46. Their children\\u0026rsquo;s illnesses were rare, undiagnosed, and/or required a full-time level of care.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eData Collection\\u003c/h2\\u003e \\u003cp\\u003eUsing semi-structured interviews, the authors asked a series of questions to understand parents\\u0026rsquo; experiences while attending the training program and its influence on their lives after the course was over. Our process involved a team of researchers meeting to develop interview questions based on what we wanted to know about the parents. The main categories of questions were 1) the primary challenges of parenting a chronically ill child; 2) motivation to attend the six-week program; 3) experience during the program; and 4) the effect of the training on the parents\\u0026rsquo; lives. The first and second authors interviewed eight parents and then transcribed the audio using the software Temi. Completed transcripts were checked for accuracy while listening to the audio. The interviews ranged from twenty-one minutes to one hour, and the average length was thirty-four minutes.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eData Analysis\\u003c/h2\\u003e \\u003cp\\u003eUsing a thematic approach, the first author coded the interview for themes related to the relevant questions by open-coding each individual interview first and then by cross-referencing codes between interviews [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e]. Similar codes were grouped into categories, and similar categories were united under primary themes. From this, the first author wrote a composite summary description of each theme and the ways in which the theme manifested across the qualitative interviews. The second author reviewed and evaluated this summary, and during a team meeting, the team finalized the list of themes and their definitions through consensus. Following a process outlined by Sobo (2009), we organized themes into a visual framework through an iterative team process that entailed working across both coded text and individual interview transcripts to illustrate and contextualize the process through which self-compassion was learned [\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e]. During team meetings, we revised the framework to ensure it accurately described the experiences of participants in the dataset.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eRigor \\u0026amp; Trustworthiness\\u003c/h2\\u003e \\u003cp\\u003eWe implemented the following strategies outlined by Guest and colleagues (2012) to support the credibility and dependability of our study findings [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e]. As a team, we discussed how our respective fields of study (anthropology, psychology, and social work), previous experiences, and identities potentially shaped interpretations of the data. To support this work, we engaged in a process of member checking to share our emergent findings and interpretations of the data and elicit feedback from our participants. During the process of member checking, all participants supported our analysis of the data, and no new themes were discovered during this process, supporting the credibility of our findings. Dependability was facilitated by using multiple team members to develop the interview guide questions. After the interviews, the research team debriefed to ensure consistency in data collection procedures and the use of the interview guide.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eFigure \\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e organizes nine themes (openness to change; trust in the program; motivation to learn self-compassion; integration into daily life; kinder relationship to self; common humanity; repositories of strength; caring for child; and emotional acceptance) to illustrate the process through which parents of chronically ill children learn self-compassion (see Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e). The figure is not intended to imply a causal connection but rather to describe the experiences of parents in the training program. The figure suggests that learning self-compassion begins with openness, trust, and motivation, as these elements contributed to and sustained parent engagement in the program and the learning process. From this, several elements interacted synergistically to promote the internalization of self-compassion. Through reflective exercises and discussions, the program helped parents develop a kinder relationship with themselves and an understanding of their common humanity in general and with other parents of children with chronic illness. The process of learning self-compassion also helped them identify the existing repositories of strength they developed as parents. Parents practiced integrating self-compassion into their daily lives in several ways, reinforcing what they had learned in the training. Through learning and integrating self-compassion, they developed emotional acceptance of their experiences parenting a chronically ill child and reoriented their parenting practices to support compassion toward self and others.\\u003c/p\\u003e \\u003cp\\u003e \\u003c/p\\u003e \\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eThe Motivation to Learn Self-Compassion\\u003c/h2\\u003e \\u003cp\\u003eLearning self-compassion begins with the cultivation of a motivation to learn. Our results suggest that two factors facilitate a capacity to learn: (1) being open to change, and (2) having trust in the program. Many parents in the program reflected that although they did not know what to expect from the course, they recognized they needed help and were curious and willing to try new strategies for coping. P1 explained, \\u0026ldquo;I feel like we\\u0026rsquo;ve identified as parents more [than others] that we need help.\\u0026rdquo; P2 described being always on the lookout for more support services: \\u0026ldquo;I\\u0026rsquo;m kind of just always willing to give things a try and just see how it goes.\\u0026rdquo;\\u003c/p\\u003e \\u003cp\\u003eNotably, the most common reason people were motivated to attend the course was because they trusted people associated with the program. A number of parents were associated in some way with the hospital or parent support group sponsoring the program and expected these organizations to provide a program worthy of their time and attention. P3 explained that she had become familiar with Kristin Neff\\u0026rsquo;s work on self-compassion through an outpatient program and trusted that a course associated with her name would be valuable. P4 contrasted her experience during the six-week program with another support group she had attended that caused her to feel more anxious after listening to other parents\\u0026rsquo; difficult stories. During the six-week program, she explained, \\u0026ldquo;I felt there was a process you were going to lead us through. There was leadership, and the program was based on something. [It] wasn\\u0026rsquo;t just a free for all.\\u0026rdquo;\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eDeveloping a Kinder Relationship to the Self\\u003c/h2\\u003e \\u003cp\\u003eLearning self-compassion involves developing a kinder relationship to the self. Parents described self-compassion as being kind to themselves in the form of loving themselves, going easy on themselves, being gentle with themselves, forgiving themselves, and taking care of themselves. Parents practiced being kind to themselves in their internal monologue or self-talk. Several reflected on becoming more aware of the harsh words they use with themselves since taking the course. P2 described how she has \\u0026ldquo;definitely cut way down on the negative self-talk, like, \\u0026lsquo;What are you doing? You stink. You're just failing.\\u0026rsquo;\\u0026rdquo; Because she was more conscious of the harsh words that emerge in difficult situations with her daughter, she has started countering them with statements like, \\u0026ldquo;You're doing the best you can\\u0026hellip;it may or may not be enough\\u0026hellip;but maybe next time it will feel different or better.\\u0026rdquo;\\u003c/p\\u003e \\u003cp\\u003eOther parents described the effect of using kinder language toward themselves to decrease their perception of social threat, alleviate emotional exhaustion, and cultivate more hope over their situation. P4 explained, \\u0026ldquo;I really believe the words that you use in your self-talk make a huge difference in your outlook on life.\\u0026rdquo; When she feels exhausted from taking care of her son, she is more prone to negative self-talk and hopelessness. She reflected, \\u0026ldquo;You\\u0026rsquo;ve got to find some ways to be less spent all the time. And I think just that kind of self-talk makes the difference in your, if not the physical energy, then the emotional and mental energy that you have for ongoing care.\\u0026rdquo;\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eEmbracing a Common Humanity\\u003c/h2\\u003e \\u003cp\\u003eThe experience of attending a self-compassion program with other parents of chronically ill children helped participants directly experience their common humanity and feel less alone. P2 explained, \\u0026ldquo;We probably spend 90% of our time feeling like we're the only people going through something like this.\\u0026rdquo; Every parent that was interviewed cited the opportunity to be in a room with other parents of chronically ill children as one of the high points of the program. P5 described feeling relieved from hearing other parents\\u0026rsquo; stories: \\u0026ldquo;That validation of our experiences are so similar. I\\u0026rsquo;m not crazy.\\u0026rdquo; P6 similarly said that it helped to be with other people who implicitly understood \\u0026ldquo;what you're going through\\u0026hellip;and they are there to support you through it. And to me, that was huge because one, it shows you that you're not alone and or that you're never going to be alone.\\u0026rdquo;\\u003c/p\\u003e \\u003cp\\u003eP3 and P4 each described how the concept of common humanity allowed them to feel more connected to and compassionate towards others. P3, who had been introduced to self-compassion before participating in the training, explained that the course \\u0026ldquo;further [drove] home and helped integrate the knowledge of self-compassion, the core tenants of these are experiences that everybody else has. These feelings are human and universal.\\u0026rdquo; P4 described how the phrase \\u0026ldquo;common humanity\\u0026rdquo; has remained with her even several months after participating in the course. She explained that she thinks about it \\u0026ldquo;multiple times a week. And it helps me feel calmer in some stressful situations, and it helps me feel more compassionate towards other people.\\u0026rdquo;\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eDrawing on Repositories of Strength\\u003c/h2\\u003e \\u003cp\\u003eLearning self-compassion helped parents face the unique challenges of parenting a child with chronic illness. Parents consistently described caring for their chronically ill child as all-consuming of their mental and physical resources. For many parents, the amount of time required to care for their child was equivalent to a full-time job, involving keeping their children physically comfortable and emotionally well and balancing the time needed for doctor\\u0026rsquo;s appointments with work, other family responsibilities, and personal interests. In addition to the time she spends caring for her son, P4 noted the challenge of maintaining an identity outside of \\u0026ldquo;mother of a chronically ill child\\u0026rdquo; because much of her day-to-day routine is related to caring for her son, including her volunteer activities.\\u003c/p\\u003e \\u003cp\\u003eSeveral parents discussed the challenge of maintaining the mental and physical reserves to care for their children, given the considerable time, effort, and attention required. P3 described the difficulty of replenishing her physical and mental energy in contrast to understanding how to care for her child on an intellectual level. As P3 explained:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eWhen it comes to managing a chronic, lifelong, life-altering, and potentially life-threatening illness...the biggest challenge is the internal fortitude to keep coming back over and over and bringing new resolve and new energy and fighting spirit.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003e While learning self-compassion did not eradicate the challenges parents faced, the program did help them identify and access internal resources of support. P3 explained how she has redirected her skills as a mother toward relating to herself, countering the other more critical voices that have developed throughout her lifespan:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eThe mother version that lives in me for my children is my best self. When I think of my highest, greatest, wisest mind, that\\u0026rsquo;s who it is. Part of [becoming self-compassionate] was figuring out how to utilize that resource, that existing repository of strength. But in a way that could be more self-directed and essentially replace some of those other [voices]--the voice of my actual mother, the voice of societal expectations of what a mom should be, the patriarchy\\u0026mdash;take your pick\\u0026mdash;judgment voice, achievement voice and all of these other voices that are very powerful, are very well established and are in many ways completely not useful to actually being productive and having emotional reserves.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eIntegrating Self-Compassion into Daily Life\\u003c/h2\\u003e \\u003cp\\u003eParents applied several strategies to integrate self-compassion into their daily lives, including teaching others and daily practices. Many parents stated that they have shared their experience and training with others (e.g., their children, their colleagues, and other parents they know). They were moved to share what they learned with others, which aided their internalization of the skills of self-compassion and made the impact of the training ripple out beyond the initial training group itself. P3 said that sharing what she learned has helped her better integrate self-compassion into her life and her relationships with others. \\u0026ldquo;The best way to learn things is to teach it. And I think [the course] gave me really good vocabulary, and it gave a lot of opportunities to either model it for other people or utilize it more tangibly in conversations.\\u0026rdquo; P2 and P6 shared with other parents the mindset that it is okay to give themselves a break. \\u0026ldquo;I try to enlighten other parents that don't know about it. To be like, give yourself a break,\\u0026rdquo; P2 noted. P6 similarly explained that when she talks to people about what she\\u0026rsquo;s learned, she explains, \\u0026ldquo;it\\u0026rsquo;s not about pride. It\\u0026rsquo;s okay to ask for help. It\\u0026rsquo;s okay to lean on someone.\\u0026rdquo;\\u003c/p\\u003e \\u003cp\\u003eTeaching others may have emerged frequently because, as parents, our participants recognize how the tools they learned can help their children. Both P4 and P1 explained sharing the techniques they learned in class with their children. P4 reported that she had shared the \\u0026ldquo;self-soothing mantras or behaviors\\u0026rdquo; with her non-special needs daughters who struggle, like her, with anxiety and insomnia. She explained how she guides them to \\u0026ldquo;take deep breaths, focus on what you\\u0026rsquo;re doing right now, you don\\u0026rsquo;t have to worry about next week.\\u0026rdquo; Similarly, P1 has shared meditation strategies with her special needs adult daughter, who has struggled with symptoms of anxiety and post-traumatic stress in her assisted living facility: \\u0026ldquo;She gets really nervous and anxious and...so I'm like, okay, where do you feel it?\\u0026rdquo; In her role as a healthcare professional, P1 has also shared these tools with her patients. She explained them as a \\u0026ldquo;little toolbox\\u0026rdquo; she can tell patients about to provide \\u0026ldquo;something else to hope for.\\u0026rdquo;\\u003c/p\\u003e \\u003cp\\u003eIn addition to teaching others, daily practice helped parents incorporate self-compassion into their everyday lives. This way of practicing self-compassion corresponds to a handout in the first session called \\u0026ldquo;Self-Compassion in Daily Life,\\u0026rdquo; which helps participants discover the behaviors they are already enacting that are soothing or enjoyable to them. P6 explained: \\u0026ldquo;[the course] made me stop and breathe and smell the flowers and actually smell the flowers and not just walk past them and go, Oh, look at those pretty flowers. You know, I'll look at them later, and later never comes.\\u0026rdquo; P4 similarly described how slowing down to notice and enjoy what she is doing, even a mundane task like washing her hands, helps to soothe her:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eI noticed when I'll be washing my hands...and I'll actually physically have my body turned away. Like, I'm onto the next thing already\\u0026hellip;I'm just washing my hands, but in my mind and even in my body, I'm ready to run off to do the next thing. And so I don't criticize myself. I'm like, \\u0026lsquo;wash your hands right now. That's all you have to do is wash your hands right now.\\u0026rsquo; The class helped me think of that. That also is a soothing behavior.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003e Other ways participants described practicing mindfulness included newfound permission to take breaks from their children or participate in activities they enjoyed (like taking a walk or driving the scenic route home). Parents also described taking deep breaths throughout their day and connecting with their self-compassion stone. The latter is a stone given to participants at the end of the course as a visual reminder of what they learned. They are also instructed to practice mindfulness with the stone by paying attention to how it feels and looks. P7 explained: \\u0026ldquo;the pebble helps you relax\\u0026hellip;I can just sit in my car and rub it and just relax, close my eyes. Don't even worry\\u0026hellip;\\u0026rdquo; P8 also said that he keeps his rock at his desk as a reminder throughout his day that everything is \\u0026ldquo;going to be okay.\\u0026rdquo;\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eThe Benefits of Learning Self-Compassion\\u003c/h2\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section3\\\"\\u003e \\u003ch2\\u003eEmotional Acceptance\\u003c/h2\\u003e \\u003cp\\u003eLearning self-compassion helped parents to accept their emotions more readily, rather than avoid their difficult feelings. P6 and P7 explained that they had a tendency to \\u0026ldquo;bottle\\u0026rdquo; up their feelings before taking the course, invoking the idea that emotional pressure could build, only to explode at a later time if not released properly. P7 described the pressure to be \\u0026ldquo;superman\\u0026rdquo; in his family, the one who takes care of his daughters and wife when they are hurting. After taking the course, he said, \\u0026ldquo;I could share my feelings and I could let go of stuff and not just keep it bottled in.\\u0026rdquo;\\u003c/p\\u003e \\u003cp\\u003eAccepting their difficult emotions has allowed parents to release pressure on their emotional valves more slowly so that they will not feel overwhelmed at a later time. P5 explained: \\u0026ldquo;Before [the course], I would push through a really, really hard thing to get to the other side and then process it afterward. And maybe after the class, it was more of being able to do it in the moment as it was happening.\\u0026rdquo; P3 described the skill of noticing her emotions as \\u0026ldquo;bringing things to a surface level where I can sort of interrogate them more intelligently rather than just being ruled unknowingly\\u0026hellip;I don't have to wait until I go to therapy for my therapist to say, well, it sounds like you were really grieving being away from your babies this week.\\u0026rdquo;\\u003c/p\\u003e \\u003cp\\u003eParents explained that emotional acceptance helped them continue to learn and cultivate self-compassion, motivating them to speak kindly to themselves, participate in enjoyable activities without guilt, and practice mindful presence to more fully appreciate life and relax. Moreover, emotional acceptance was helpful for parents navigating the healthcare system and the frustration of not having answers for a rare or undiagnosed illness. P6 explained that before the course, \\u0026ldquo;I didn't realize that it was okay to feel angry\\u0026hellip;about the unanswered questions. I would ask a ton of questions and not get answers, or I would get pushed away...Just knowing that it's ok to have those emotions, but at the same time, learning how to process those emotions.\\u0026rdquo;\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec17\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eCaring for Child\\u003c/h2\\u003e \\u003cp\\u003eParents also discussed the influence of their practice on caring for their children. They noted that practicing self-compassion has reinforced the importance of providing loving attention to their children. Self-compassion practices have helped them feel more energized to care for their children and to navigate difficult interactions more skillfully. P3 explained how she recognizes that \\u0026ldquo;what my children need most from me is just my physical presence in their life. Did they get that loving attention? I think that [self-compassion] is a further affirmation of that...[For] most of life, just showing up is the major part of the game.\\u0026rdquo;\\u003c/p\\u003e \\u003cp\\u003eBecause her son requires constant care, P4 described how her self-compassion practice would inevitably affect him:\\u003cdiv class=\\\"BlockQuote\\\"\\u003e\\u003cp\\u003eEverything that I do where I can practice self-compassion\\u0026mdash;that\\u0026rsquo;s going to relate back to him. If I am less stressed [or] emotionally spent, then that's got to communicate itself to him. Whether it's me just remembering to tickle him and hug him and kiss him, or to be more aware of what might improve his quality of life. To just bring fresher energy to his care.\\u003c/p\\u003e\\u003c/div\\u003e\\u003c/p\\u003e \\u003cp\\u003eP8 explained how the course has helped him be more skillful in responding to the difficult emotions that can arise while providing care to his son. \\u0026ldquo;[I\\u0026rsquo;m] a little bit more tolerant when I get frustrated. Because [my son] can write and sometimes he doesn't want to write with me. So sometimes I get frustrated with that ... So it\\u0026rsquo;s helped me handle that frustration a bit better than I had in the past. [To] walk away or something like that and just let him have his space. I have my space and then we'll come back and try again a little bit later.\\u0026rdquo;\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eParents were motivated to learn self-compassion in a 6-hour training because they were open to experiencing change and because they trusted the program would be a valuable use of their time. The process of learning self-compassion for these parents involved developing a kinder relationship to themselves in their self-talk and behaviors as well as embracing their common humanity, particularly with other parents of chronically ill children. As part of learning to be self-compassionate, parents came to recognize the existing strengths they have had to develop to care for their children. Parents experienced greater emotional acceptance and reported learning self-compassion had enhanced the quality of care they provided for their children.\\u003c/p\\u003e \\u003cp\\u003e Our findings suggest two important components of providing programs for parents of chronically ill children: peer support and practical tools. As Coffey\\u0026rsquo;s 2006 metasynthesis of studies examining the experience of parenting children with chronic illness found, the complex responsibility of parenting a chronically ill child can create a feeling of isolation [\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]. Peer support groups for parents with similar experiences can be a \\u0026ldquo;bridge to the outside world\\u0026rdquo; in which they experience camaraderie and a shared understanding of their unique circumstances [\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e]. Including a peer support component in educational programs can help parents access the inherent benefits of connecting with others in similar situations and develop an understanding of their common humanity. However, parents in our study also appreciated that the program was \\u0026ldquo;based on something\\u0026rdquo; (i.e., evidence-based skill development) rather than being a \\u0026ldquo;free for all\\u0026rdquo; discussion group. It is possible that peer support groups could intensify individual distress if tools for addressing empathic resonance and distress experienced during conversations about parenting difficulties are not included [\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003e In the process of learning self-compassion, parents discussed using new strategies for speaking to and caring for themselves. They did so in ways that do not necessarily add to their task list, demonstrating the benefit of self-compassion as a self-care tool for exceptionally busy people. For example, parents discussed how changing their internal monologue to be more kind towards themselves helped them to feel less exhausted and to experience more positive emotions, such as hope. They also reported savoring their experiences of smelling flowers and washing their hands. These small, daily tweaks to their self-talk and relationship to their moment-to-moment experience may grow into a protective buffer against stress, depression, and other forms of distress. Indeed, previous research has found that parents who attend interventions with a self-compassion component experience significantly lower depression, anxiety, and stress from before to after the intervention [\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e]. Other research has found self-compassion to be a protective factor against parenting stress among parents whose children are autistic [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eLearning self-compassion may target some of the coping challenges of parenting a child with chronic illness, such as experiential avoidance. As an outcome of learning self-compassion, parents found they were able to accept their emotional experiences of frustration and anger in medical situations and avoid having their difficult emotions build up over time. Jackson et al.\\u0026rsquo;s 2015 systematic review found avoidance, disengagement, and denial to be associated with lower maternal mental health among parents of children with heart disease [\\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e]. Parents of children with chronic illness are also significantly more likely to experience burnout, stress, anxiety, and depression if they have a tendency to cope by avoiding their experience [\\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]. Self-compassion may be associated with reduced parental distress by providing skills that facilitate processing difficult emotions rather than using strategies that can exacerbate parents\\u0026rsquo; stress response.\\u003c/p\\u003e \\u003cp\\u003eThe reflections of our participants suggest the benefits of being more self-compassionate (e.g., being more energized, attentive, and patient) may improve the relationship between child and parent. Previous studies have found parents\\u0026rsquo; self-compassion to be associated with mindful parenting behaviors, such as listening to one\\u0026rsquo;s child with their full attention [\\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e]. Mothers who are more self-compassionate are less likely to make critical comments towards their children [\\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e]. Future quantitative and qualitative studies should explore how parenting actions may change as they become more compassionate toward themselves.\\u003c/p\\u003e \\u003cp\\u003e Parenting interventions that involve self-compassion can be viewed as a strengths-based approach to supporting parents of children with chronic illness, in contrast to deficit approaches that view parents\\u0026rsquo; coping skills and behaviors as in need of fixing. By enhancing their ability to recognize their existing capacity as parents and identify additional skills for coping, self-compassion can support parents in their growth and development of the strengths needed to care for themselves and their children.\\u003c/p\\u003e \\u003cp\\u003eImplications\\u003c/p\\u003e \\u003cp\\u003e These preliminary, exploratory findings, alongside a large body of research evidence demonstrating the positive association between self-compassion and mental health, suggest that self-compassion education could be one promising way to support parents of chronically ill children. Because self-compassion tools can be applied immediately, in the midst of caring for one\\u0026rsquo;s child or while doing other tasks, they may be particularly relevant for overloaded parents who do not have time to step away from their caregiving duties to care for themselves.\\u003c/p\\u003e \\u003cp\\u003eAdditionally, parents in our study indicated they needed to trust that an educational offering would be a valuable use of their scarce time. Before implementing a training program, organizations should consider how they will demonstrate the trustworthiness of their offering through advertising and word-of-mouth referrals. Parents also indicated the combined benefits of meeting with other parents who shared similar experiences and learning practical tools that could help them manage their distress. For instance, programs that provide only peer support to parents should consider including useful tools that can help them manage their distress. Alternatively, programs focused only on educational support should consider providing opportunities for parents to share similar experiences to cultivate their common humanity.\\u003c/p\\u003e \\u003cp\\u003e Since a regularly scheduled training over a series of weeks is not feasible for every parent with a chronically ill child to attend, creative ways to introduce parents to self-compassion concepts and techniques should be considered. For instance, self-compassion tools could be offered to parents in one-on-one encounters with social workers or in a peer support group setting. Infographics about self-compassion techniques could be placed in hospitals, doctors\\u0026rsquo; offices, and other places parents might frequent. Clinicians who support parents and their children could be trained to facilitate brief self-compassion interventions or to provide one-on-one support with self-compassion tools. While implementing self-compassion education, evaluation data should be collected to understand the degree to which self-compassion content is acceptable and feasible for parents from a variety of backgrounds and to understand how to improve the content to meet the specific needs of parents whose children are chronically ill.\\u003c/p\\u003e \\u003cp\\u003eLimitations\\u003c/p\\u003e \\u003cp\\u003eWe developed a model for learning self-compassion using a rigorous approach to qualitative research and analysis. However, given the exploratory nature of our pilot study, additional research is warranted to further refine and test our model. Importantly, the small sample size limits the generalizability of our study findings. Participants in the study were demographically homogenous: the majority were white, female, and college-educated. The two men who attended the training both participated in an interview, and each mentioned the need for further support of fathers specifically. It is our hope that additional revisions are made to our model through research with more diverse samples of participants across intersectional identities, including race, gender, and class. Such research will support critical discussions and advance understandings of the ways in which self-compassion is perceived, learned, and implemented in the challenges that parents confront in everyday life.\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003ch2\\u003eCompeting Interests\\u003c/strong\\u003e\\u003cp\\u003ePF and MK facilitated the intervention described in this study.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003ePF and MK collected the interview data and wrote the main manuscript text. LG prepared the figure and contributed to all sections of the manuscript text. KG helped with data collection and contributed to sections of the manuscript. All authors reviewed the manuscript.\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgements\\u003c/h2\\u003e \\u003cp\\u003eThanks to Natasha Iqbal for providing editing support on this paper. Thanks also to the parents who offered their valuable time to share their insights and experiences about the program with us.\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003eThe data that support the findings of this study are not available publicly to protect the privacy and confidentiality of participants. Sections of the data, such as de-identified direct quotes, may be requested from the authors upon reasonable request.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eGhandour, R. M., Hirai, A. H., \\u0026amp; Kenney, M. K. Children and Youth With Special Health Care Needs: A Profile. 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Pediatric Nursing, 2006.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003e​Hurst, I. Parents\\u0026rsquo; evaluations of a support program in a newborn intensive care nursery. \\u003cem\\u003eJournal of Perinatal and Neonatal Nursing\\u003c/em\\u003e. 2006; \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1097/JPN.0000000000000546\\u003c/span\\u003e\\u003cspan address=\\\"10.1097/JPN.0000000000000546\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003e​Jefferson, F. 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Familial impact and coping with child heart disease: A systematic review. \\u003cem\\u003ePediatric Cardiology. 2015\\u003c/em\\u003e; \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1007/s00246-015-1121-9\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s00246-015-1121-9\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSairanen, E., Lappalainen, P., \\u0026amp; Hiltunen, A. Psychological inflexibility explains distress in parents whose children have chronic conditions. \\u003cem\\u003ePLoS ONE\\u003c/em\\u003e. 2018; \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1371/JOURNAL.PONE.0201155\\u003c/span\\u003e\\u003cspan address=\\\"10.1371/JOURNAL.PONE.0201155\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003e​Lathren, C. R., Rao, S. S., Park, J., \\u0026amp; Bluth, K. Self-Compassion and Current Close Interpersonal Relationships: a Scoping Literature Review. \\u003cem\\u003eMindfulness.\\u003c/em\\u003e 2021; \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://doi.org/10.1007/S12671-020-01566-5\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/S12671-020-01566-5\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":true,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"discover-psychology\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"discpsy\",\"sideBox\":\"Learn more about [Discover Psychology](https://www.springer.com/44202)\",\"snPcode\":\"\",\"submissionUrl\":\"\",\"title\":\"Discover Psychology\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Discover Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"self-compassion, intervention, chronic illness, children, parents\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-4769435/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-4769435/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eObjectives\\u003c/h2\\u003e \\u003cp\\u003e Parents of children with chronic illnesses face unique stressors that put them at risk for mental health disorders, such as anxiety, stress, and depression. In the U.S., 20% of families care for a child with a chronic health condition. Because self-compassion is a protective factor for parents against distress, this study examined the processes through which parents may become open to attending a self-compassion-based support program and acquiring self-compassion skills.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eEight parents who attended a six-week self-compassion training were interviewed about their experiences during the program. Responses were analyzed using thematic analysis.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003e Parents were motivated to attend the program because they were open to change and trusted the program would be valuable. Learning self-compassion involved developing a kinder relationship with themselves and embracing their common humanity, which helped them recognize the existing strengths they have had to develop in order to care for their children. They also experienced greater emotional acceptance and reported learning self-compassion had impacted the quality of care they provided for their children.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003eResults demonstrate the importance of acquiring trust from potential participants and combining social support (which can reduce feelings of isolation) with evidence-based training. Findings also provide insight for future researchers to examine the mechanisms of engagement in a program and to better understand the processes through which self-compassion supports positive mental health outcomes for parents of chronically ill children.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Learning together when feeling alone: The experience of parents with chronically ill children in a self-compassion program\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-08-27 21:48:41\",\"doi\":\"10.21203/rs.3.rs-4769435/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2024-08-22T05:43:36+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2024-08-21T18:56:10+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"175317236184878032234860569167957302893\",\"date\":\"2024-08-21T18:13:45+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2024-08-20T17:24:08+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"227512804492702703116789421743830669988\",\"date\":\"2024-08-01T13:33:57+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2024-07-30T12:10:48+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2024-07-25T12:23:25+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2024-07-25T12:21:03+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"Discover Psychology\",\"date\":\"2024-07-19T19:11:40+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"discover-psychology\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"discpsy\",\"sideBox\":\"Learn more about [Discover Psychology](https://www.springer.com/44202)\",\"snPcode\":\"\",\"submissionUrl\":\"\",\"title\":\"Discover Psychology\",\"twitterHandle\":\"\",\"acdcEnabled\":true,\"dfaEnabled\":true,\"editorialSystem\":\"stoa\",\"reportingPortfolio\":\"Discover Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"7b88969c-137c-4dca-acb9-746cd0e7a567\",\"owner\":[],\"postedDate\":\"August 27th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-11-04T05:53:42+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-08-27 21:48:41\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-4769435\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-4769435\",\"identity\":\"rs-4769435\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}