Self-care: The gift that keeps on giving

Despite wide use and growing popularity, the term “self-care” continues to be misunderstood. On the one hand, the wellness benefits of self-care seem obvious — so we should make it a priority. However, to many, self-care may seem like just “one extra task” that is difficult to schedule into our already overly busy lives.

Furthermore, while self-care is encouraged by health care providers, not all of corporate America has championed self-care in meaningful ways. Plus, for many of us, giving  care seems more important than receiving care. But could helping ourselves actually help others?

To gain clarity, we spoke with Jacob Towery, MD, psychiatrist, author and adjunct clinical instructor in the Department of Psychiatry and Behavioral Sciences at Stanford University.

What exactly is self-care?

Towery defines self-care as any act or habit that promotes sanity, rejuvenation and/or joy. Because of the broad scope of human diversity, many activities fall into this category.

In The Anti-Depressant Book (2016), he defines the “three pillars of self-care” as:

  1. Getting adequate sleep (7-8 hours for most adults)
  2. Engaging in vigorous physical activity multiple times per week
  3. Developing a daily meditation practice

“I find these to be the most effective self-care practices for mental health,” says Towery. However, he also encourages taking time to do whatever it is one enjoys — such as reading, watching a movie, spending time with loved ones, or even scheduling a vacation.

When people think of self-care, they often think of relaxation. According to Towery, this is a common misconception. “Self-care can also include scheduling things that one is excited about, like going to a concert or going out with friends. It is a widely encompassing term covering most things that people experience as exciting, rejuvenating, relaxing or pleasurable.” In fewer words, self-care is taking time for doing what it is you want to do.

What does science say about those who practice self care versus those who don’t?

“I don’t know if there is good evidence as to self-care being beneficial “in general,” states Towery, referencing a 2010 review that examined the range of different experiences that may result from engaging in various self-care activities. “For example, we know that people who are sleep-deprived are at more risk for getting sick, are more irritable, are more prone to depression, and find it harder to concentrate. On the other hand, people with adequate sleep consistently tend to be happier and have better concentration and stronger immune systems in general.” Many studies support this finding, including a 2003 review examining the physical and mental effects of sleep deprivation.

Towery elaborates: “We also know that people who get vigorous physical exercise multiple days per week tend to have healthier bodies, less anxiety and depression, tend to live longer and have fewer physical illnesses than people who are sedentary — who have more heart disease, depression, and tend to not live as long.” This topic has also been studied in depth, including a 2006 literature review on the health benefits of physical activity.

“I’m pretty excited about the growing body of evidence on meditation,” states Towery, referencing a  2014 meta analysis showing that consistent meditation can reduce levels of depression, anxiety, and pain.

In addition to the research supporting Towery’s “three pillars,” he also emphasizes the importance of human connection. “Spending quality time with others in person, as opposed to online or through the phone, can also be of benefit,” states Towery. There is growing research on this topic, including a 2010 meta-analytic review showing people who spend more time in the company of others tend to live longer and have other health benefits.

With such busy schedules, many can barely get the essentials done. How can we add self-care without adding extra stress (i.e., “another thing to do”)?

Towery agrees that many of us struggle with prioritizing self-care, especially in this geographic area where there is so much emphasis on productivity and working long hours. “There is even some social cachet around bragging about how busy we are,” explains Towery. However, he believes that how we spend our time comes down to priorities: “If our priorities are working as many hours as possible, we can do that. We can cheat ourselves on sleep, skimp on exercise and meditation and spend more hours in the office.” Will that make you perform better at work? “Not necessarily,” he concludes. “I don’t think our brains are designed to sit and work for 10-12 hours straight.” He references Tim Ferris’s book, The 4-Hour Work Week, which encourages being efficient with your time rather than working more hours.

“I know many people who put their phones on airplane mode to get rid of distractions — and when they work, they do one thing at a time and are incredibly productive. If you do that even a few hours a day, you will likely get higher quality work done than if you multitask and are only  semi-productive at work all day. Plus, you will likely have more time left over for self-care, and as a result you will become happier and more focused.”

Towery admits that not everyone has that luxury. “Some people are locked into something; but most of us have more choice in the matter than we may think.”

Towery also acknowledges the popular use of social media, which he notes is not  fulfilling for most people. He encourages cutting back on social media and other mindless activities while prioritizing more fulfilling and intentional activities.

For many, self-care is coupled with guilt. How can I overcome this so I actually enjoy the activity?

As a cognitive behavioral therapist (CBT), Towery spends much of his time teaching people the idea that thoughts determine feelings. “Many people think it’s the events in our lives that affect how we feel, but it is actually the way we think of the events in our lives that affect our emotions. So, if we tell ourselves, ‘If I take 10 minutes for myself, I am a selfish person,’ we’re not going to want to do it. If we tell ourselves the thought, ‘If I take a lunch break, that means I am lazy,’ we’re not going to do it. Most of us don’t want to think of ourselves as lazy or selfish.”

According to Towery, we can change our thoughts. “Our thoughts are not facts. They are potentially malleable secretions of the brain.”

One of the things he does in his practice is to help people consider that you can do self-care without thinking of yourself as selfish or lazy. “I think one of the reasons we’re here is to enjoy our lives as best we can. So, if you’re engaging in self-care, you’re doing what we’re here for.” Towery makes it a priority to enjoy his life, and encourages others to do the same.

“It really depends on what you tell yourself — and guilt, in this case, is optional. There are some things we should feel guilty about: If you purposefully harm others, you should feel guilty. If you sleep for eight hours, you don’t need to feel guilty. You can tell yourself that self-care will help you to become a more compassionate, kind and patient person, benefiting both you and the people around you. Again, guilt in this case is optional, depending on what you tell yourself.”

Towery notes that this may require training — essentially, rewiring the brain. So don’t be surprised if you have to repeat this new thought over and over again to essentially break the old pattern of thinking and form a new thought process that is more conducive to health and well-being. Some people may experience so much guilt around self-care that they seek professional help to reduce these feelings of guilt or shame.

Are there specific groups of people who need self-care more than others?

Towery claims, “Human beings as a whole need self-care.” However, he identifies several groups that would strongly benefit from self-care, particularly those who take care of others. Professionally, this includes social workers, doctors, nurses, teachers, therapists and others who professionally care for other people. “For this group of people, self-care is particularly important because there is so much time spent devoted to others, which can lead to burnout and resentment.”

According to Towery, people who are not professional caretakers, but who are just wired to be “other-centered,” can also benefit greatly from self care. “A phenomenon I’ve seen more and more recently is that people who are brought up to be very other-centered — e.g., who don’t take time for themselves — can become resentful toward the people in their lives who are not caring for them as they would like. Learning to make self-care more of a routine and a priority can lead to less upset and resentment.”

Additionally, Towery identifies “self-described workaholics” as a population that can really benefit from self-care. “Especially here in Silicon Valley, it’s easy to get caught up in the rush of 70-80 hour workweeks, and that can feel normal if other people are doing it; however, it’s really not sustainable. Such work-heavy schedules lead to taking shortcuts with things like sleep, diet, not meditating, not spending time with others … and people can run themselves ragged.”

Towery concludes that if you self-identify as a “workaholic” or personal or professional caretaker, and you rarely consider finding time for self-care, you should reconsider your time priorities: self-care may bring you more ease, productivity and joy.

What are some practical strategies I can start with?

Towery refers to Time Magazine’s  2018 special edition, The Power of Habits. “For some people, changing multiple habits at the same time works really well. You kind of do a life overhaul and dive in all at once. I’ve had patients where we’ve changed multiple things at once with success. For many others, picking one habit at a time and really solidifying that for 1-3 months before moving on to something else works better.”

Towery comes back to the “three pillars of self care” — sleep, meditation and exercise, which he believes to be the most important for mental health. He encourages readers to develop a habit they are confident they will be successful in, no matter how small. “Meditation can be a great starting point, since it requires the least amount of time,” says Towery. “Even if it’s just a few minutes a day, that’s a great starting point.” Towery uses the Headspace meditation app regularly, and often recommends it to patients. He also created a free Youtube meditation video to help people get started.

“Once you’ve got meditation firmly under your belt, you can move onto something like getting adequate sleep. To make this a reality, you may need to make some practical changes such as setting an alarm to turn off electronics or to begin getting ready for bed. If you have meditation and sleep under your belt, you may want to step up your vigorous physical exercise. It’s hard; I struggle with exercising as much as I want, so I sympathize with how challenging it can be to exercise in a busy life. But most people find that if they exercise vigorously in the morning, they feel happier, more energized, more calm and productive.”

Towery assures us that any self-care is better than no self-care, even if it’s just a few minutes a day. So, start where you can.

What is one takeaway message you would like to leave us with?

Towery participated in Stanford’s Compassion Cultivation Training, an eight-week course he found life-changing. He would recommend this course to anyone:

“One of the messages I took with me is that being compassionate to others is wonderful, but self-compassion is incredibly important, too.” He emphasizes that the more we prioritize compassion for ourselves, the more we can be available to be compassionate, patient and kind toward others. “It doesn’t have to be someone winning and someone losing. If you prioritize self-care, other people in your life can also benefit from you being happier, kinder and more patient. It is not a zero sum game. Everyone can win.”

Mia Primeau
November 2019