Mindfulness and Well Being

Mindfulness is a really hot topic right now. You can’t go anywhere in the real world or online without someone using this buzz word.

But what is mindfulness, in its essence, and why is it so important for well-being, mental health, and effective therapy?

At its core, mindfulness is a simply paying attention in a curious, non-judgmental way to the way that things are, both within us around us. A mindful form of attention does not come from a place of judgement about the way things should be, but instead stays firmly rooted in noticing how things actually are in this moment.

So that is what mindfulness is.

But why is developing the ability to pay attention in this particular way so helpful? There is a huge list of reasons that this is the case, but I will list what I believe to be three of the most important reasons, as they relate to therapy.

1)   Mindful awareness, because it is anchored in the present moment, offers a very effective antidote to anxiety and depression. Anxiety is all about moving into the future, into terrible things that almost never happen. Depression is a lot about ruminating on the past, fixating on our past failures and rejections, playing these images over and over again in our minds. Mindfulness, because it returns our awareness to the present moment, wakes us up from our mental time travel to the past or future, and it therefore offers a natural relief from the suffering of anxiety and depression.

2)  We always experience the world of our senses in the present moment. Therefore, cultivating a mindful form of attention tends to make our sensual experiences richer, more engrossing, and more interesting. This helps to add richness and texture to our lives.

3)  Lastly, and most perhaps importantly for experiential therapy, we always experience our bodies and therefore our emotions in the present. This means that developing mindful awareness greatly deepens our abilities to fully experience, understand, express, and regulate our emotions. These are invaluable skills in general, but especially helpful for the progress of therapy. 

In other posts I will talk in more detail about mindfulness, how it is useful in therapy, and some ways you can help yourself to develop it.

Attachment Styles

In this blog post I want to introduce you to something called attachment theory. It has a central role in how I often practice psychotherapy.

The most basic idea of attachment theory is that human beings are deeply and inherently social. This means that our need to belong is only slightly less important than eating and drinking, and in some cases more so. This theory also says that our need to feel deeply connected to at least one other human being is not something that we grow out of in adulthood, but rather something that remains a basic existential need through out our lives. According to attachment theory, when we know that there is at least one person who has our back, this provides us with what attachment theory guru John Bowlby called “a secure base”. From this secure base we are more able to venture out into the world and explore, to grow, because we know that we will always have that person to return to when we need them.

Attachment theory also suggests that the attachment related experiences we have when we are children have very strong impacts in how we relate to emotional closeness and for how we go about trying to meet our attachment needs. In line with this idea, people tend to have one of four primary attachment “styles”.

Many people have a primarily “secure” attachment style. These are people who are able to tolerate both a healthy degree of closeness and a healthy degree of distance in their primary relationships. This allows them to bond successfully with their significant other, while at the same time not becoming overwhelmed by anxiety when distance or conflict temporarily appear in that relationship, as they occasionally do in any healthy relationship.

A significant minority of people tend to primarily demonstrate what is called a “preoccupied” attachment style. For these people closeness and proximity feel good and reassuring, but any distance or tension in their primary attachment relationship is very anxiety provoking. As a result, it is common for people with this attachment style to aggressively pursue their significant other for reassurance whenever some normal tension or distance appears in the relationship. Unfortunately, it is also very common that the intensity of this pressure for reassurance can inadvertently cause the partner to feel overwhelmed and to back further away, which causes the preoccupied partner to become even more anxious and therefore to pursue more, etc etc. In this way, a destructive pursue-withdraw pattern can come to dominate the relationship.

Another significant minority of people tend to primarily demonstrate what is called an “avoidant” attachment style. For these people distance and less emotional intensity feel comfortable, while closeness and intimacy can feel overwhelming. For someone with a primarily avoidant attachment style the anxiety that they feel in response to emotional intimacy can make it very difficult for them to allow themselves to be vulnerable enough with their partners to allow a secure base to truly form between them. People whose attachment style is strongly avoidant often end up feeling deeply alone, because the very thing that they need in order to feel safe in the world (close connection with another person) is also something that they find strongly threatening.

And finally, some people primarily demonstrate what is called a “disorganized” attachment style. For these people both closeness and distance from their significant other can cause strong anxiety at different times. Therefore, depending on the particular situation, people with this attachment style end up alternating between avoiding closeness when it is being offered, and over striving for closeness when it isn't available. As a result, relationships can become a source of confusion and overwhelm for people with this primary attachment style.

Now that I have laid them all out, there are a couple of things that I want to say about these four attachment styles.

The first is that each one makes perfect sense as a way of coping with a particular kind of environment growing up. Coming to understand your own primary attachment style and the ways in which it made sense as a response to your world growing up can offer strong feelings of relief and self compassion, and a stronger feeling of “making sense” to yourself. If we worked together, developing a compassionate understanding of the development of your primary attachment style is something we would likely do together.

The second, and the more important thing, is that attachment styles can be changed, or at least be made to become more flexible and functional. In fact for many of my clients this is one of the central goals that we work on together.

In my work it is a common and wonderfully satisfying outcome to watch one my clients become more flexible in their primary attachment style. For example, when a client with a predominantly preoccupied attachment style learns to regulate the anxiety of separation well enough that they no longer cause conflict in their relationships through excessive reassurance seeking. Or when a client with with a predominantly avoidant attachment style learns how to be more emotionally vulnerable with their loved one, even though this is still scary thing for them. Or when a client with a predominantly disorganized style learns how to do both of these things, so that their relationships can become less confusing, less conflict ridden, and more satisfying.

So, if you do end up working with me it is likely that we will talk together about what we believe your predominant attachment style is, about the ways in which it developed, about how it currently serves you, and about how you can learn to change it in those areas where it no longer does serve you.

Inside Out

If you haven't seen the movie Inside Out yet I would recommend you give it watch. It is not only a typically engaging, fun movie from Pixar. It is also a really accessible introduction to emotions and how they function.

If you don't already know, the movie is about adolescent girl who moves from a small town to a new city with her family. In the process of moving she loses connection with their social support network and falls into a depression. The movie operates in two different worlds. One of these worlds is common to most movies, one in which we see the story from the perspective of the girl and her family as they go through this challenge together. However, in the film's other world, we see inside the girl's brain/ mind. The world of her mind primarily involves the interplay between four sub-selves, each representing a different core emotion: joy, sadness, anger, and disgust.

I think Inside Out does a really good job of demonstrating a couple of things.

The first thing is how it so vividly illustrates demonstrates that what appears to be a person's singular “self” , is actually emerging through the continual interaction of multiple sub selves. (if you haven't done so already I invite you to read my blog post on this topic). This idea, not just as a useful metaphor but as a neurologically grounded reality, is very central to how I do therapy. So I love the way that Inside Out was able to present this idea and such accessible fun way.

The second thing that I really like about Inside Out is how effectively it illustrates that each of the core emotions, even the painful ones, provide vitally important, adaptive information when they are listened to appropriately. The key illustration of this idea in Inside Out comes in a scene (Spoiler alert!) where the girl is mourning the loss of her childhood. The three main characters in this scene are Joy, Sadness, and a character representing the girl's fading childhood self. Through much of the film, Joy is the primary emotional sub self. She is the one who is working hard to keep sadness, anger and disgust regulated so she can help move the girl forward and out of her depression. This is adaptive for most of the film. However, in this key scene Joy and Sadness meet the  character symbolizing childhood, who is grieving for being “grown out of”  by the girl. Joy thinks the right thing to do is to “cheer up” the grieving character. This of course does not work. Only when Sadness connects with the grieving character and empathizes with him, is the grieving character able to move through his grief and return to forward action. Joy has great trouble understanding how Sadness was able to help in a way that she herself, despite all of her wonderful positive energy, was not. Gradually Joy, and the audience, come to vividly see that Sadness is not just a “problem to be managed”, but is a vital resource that allows us to take the time we need to recognize and process  losses when this proves necessary. On another level this scene also clearly differentiates sadness from depression, with the forward moving quality of adaptive sadness compared to the flat and despairing quality of the girl's depression ( I invite you to check of my earlier blog post on the differences between sadness and depression).

So I really do encourage you to rent Inside Out if you haven't seen it. Not only will it be a fun movie, you may end up learning a few valuable things about yourself, and about ideas that are central to effective psychotherapy.

Mindful walks in nature

As I have let you know in several previous blog posts, I have been a meditator for years. But I recently discovered a new way of bringing mindfulness into my life that has been a wonderful discovery for me. I'd like to share it with you in this blog post, in the hopes that it might also prove to be a valuable practice for you.

Historically my meditation practice has involved various kinds of traditional sitting meditation, things like following the breath or metta, a form of compassion enhancing meditation.

About a year ago I the decided to try something new. A friend of mine who is also meditator and I went for walk in the UBC endowment lands. It was lovely to be with my friend and to chat about what had been going on in our lives since we last met. However, at a certain point in the walk I realized that, as much as I was enjoying being with my friend, a part of me was also wanting to more fully appreciate the feeling of being immersed in nature. Because I knew that my friend was also a dedicated meditator I spontaneously decided to ask her if she wanted to spend a half an hour of our precious time together doing “mindful nature walking”. To my delight she said that had actually been thinking the same thing!

So for the next half an hour we stayed together but stopped chatting and instead focused our full awareness on the sensual experience of being in the forest. I occasionally shifted my awareness from: the physical feeling of walking on the springy path; to my visual awareness of all the lovely colours of green around me; to the equally lovely sounds of nature that were surrounding us. As with any form of meditation, whenever I noticed that my attention had shifted from what I was focusing on I would note that, and then gently return my awareness to the object of attention.

Both my friend and I remarked afterwards had deeply revitalizing and refreshing this experience had been. I have always found the experience of walking in nature to be deeply refreshing, especially in the forests of the Lower Mainland. But somehow doing so mindfully, even just for 30 minutes, strongly enhanced the feelings of restoration that I received from this.

So in the last year I have made a commitment to trying to do mindful nature walks, sometimes with friends and sometimes on my own, at least a couple of times a month. I have found this to be a really wonderful way of lowering my stress levels and of feeling more connected to something greater then myself.

So the next time you find yourself out in the lovely nature that surrounds us I invite you to give mindful walking a try, even for 10 minutes. I hope that it will offer you the same benefits that I have received from this practice.

Why we avoid fully feeling positive emotions

It will probably not surprise you when I say that avoidance is often at the very center of psychological suffering. It will also probably not surprise you when I say that this avoidance is often an avoidance of experiencing what are generally thought of as “negative” emotions, such as fear or shame.

For example, it is well understood that social withdrawal is one of the most common pathways into a depressive episode. As our mood starts to go down, and we start to feel less positive about ourselves, it is very common to have the impulse to begin socially avoiding. What are we really avoiding here? In my mind, we are ultimately avoiding the feelings of social discomfort and awkwardness that come from being around others when we're not feeling very confident, interesting, or attractive. But this very avoidance of spending social time with other people, especially people who care about us, further lessens our sense of self worth,which further deepens our depression, which further increases our impulse to avoid socially. And so on and so on. In this way the original impulse to avoid socially when our mood first starts to drop can be clearly seen as playing a key role in how depression deepens over time.

On the other hand, it might be surprise you to learn that psychological researchers have recently begun learning that the avoidance of positive emotions may also be an important pathway into psychological suffering.

Why would this be? Why would anyone avoid “positive” feelings such as joy or excitement in the same way that they might avoid “negative” feelings of fear or pain?

Research into this area is fairly new so the answers are still emerging. But I'd like to talk about what I believe to be among the most important reasons for this kind of avoidance, a reason that I see again and again in my practice.

This reason is based on having had a history of your mood dropping into a pit. If we are at a neutral middle-of-the-road emotional place when we fall, once again, into one of these pits then we have less far to fall, compared to if we were letting ourselves feel really good when the rug gets pulled out from under us. Not only have we now had a further, more painful drop, but we are now also left with the terrible experience of feeling stupid; stupid that we got our hopes up when we were happy, allowing ourselves to believe that this time it would be different, that this time the rug would not get pulled out from under us.

In other words, it often seems that we avoid allowing ourselves to feel really good as a kind of “insurance policy”, a bracing against the inevitable drop in mood that we always quietly fear is coming. Not only can this help to lessen the “inevitable” drop, it also gives us a feeling of at least some control over our experience.

Seen from this perspective, avoiding the full experience of strong positive emotions doesn't seem quite so crazy. It is actually a coping strategy that, like all coping strategies, makes a kind of sense in its own way.

However, the costs strategy are profound. By not allowing ourselves to tolerate the full experience of positive emotions, like joy and excitement, we are robbing ourselves of the full richness of living.

An equally important cost occurs at the neural level. When positive experiences are fully felt and embraced, this allows them to be much more deeply encoded as episodic memories at a neural level. Therefore, when we avoid fully sensing into our positive emotions we greatly lessen our ability establish rich neural networks that are based on memories of ourselves as being happy, competent, and lovable. And, ultimately, these are the very neural networks that we need to in order to remain resilient in the face of hardship and stress, and thereby to avoid falling into the pit of depression when life inevitably does get hard.

One of the reasons why I wanted to write this blog post is to send a message to those readers who relate to this idea of avoiding positive emotions: this strategy is not crazy or even unusual. And in doing this, my hope is that these readers will begin offering themselves patient compassion as they set out to build their tolerance for fully feeling positive emotions.

So the next time someone tells you that they love you, or that you notice how good it feels to see a beautiful sunset, instead of shutting those positive experiences down internally, and then feeling crazy for having done so, I invite you to try doing something different altogether. Instead, I invite you to allow yourself to actually experience the physical sensations of joy or happiness for just a second longer than you normally would. And then the next week, to increase your window of tolerance just a second more. And so on and so on, until eventually you are able to fully relish in these experiences for their entire wave of naturally arising and falling away, without any longer needing to interfere with this process.

And if we we do end up working together then this skill, this ability to tolerate the actual embodied experience of positive emotions, is something that we may well end up working on together.

Feeling Shame About Having Anxiety

Many of the people that I work with experience distressing levels of worry and anxiety. In this blog post I want to write less about the anxiety and worry itself, and instead about what can be even more debilitating: feelings of shame about having these problems with anxiety.

It is very common that my clients tell me that the hardest part about their anxiety or worry is the feeling that, because they're smart and they logically know that the things that they worry about are unlikely to ever actually happen, the fact that they continue worrying anyway must mean that there is something essentially crazy or broken about them.

In my experience this sense of feeling “crazy” for getting so worried and anxious is as much a barrier to positive change as the anxiety itself. Why is this the case? I think that there are two key reasons.

The first is that this kind of shame can stop us from reaching out for help. If we live with a fear that tackling our anxiety head on could lead to the terrifying and hopeless confirmation that we are indeed essentially broken after all, then it makes sense that we would want to avoid this possibility by tackling our “irrational” anxiety with a therapist.

A second reason is that these kinds of feelings of shame for having an anxiety problem can lessen our ability to recover in a patient, self compassionate way. If we feel that we are weak,defective, or self indulgent for “allowing” anxiety get the best or us (rather than simply living with form of suffering that tens of millions of other people around the world also live with, a problem that has nothing to do with how smart or strong we are) then this can really lessen our sense that we actually deserve to work on these problems. Most people in this situation would never have these kinds of doubts or internal barriers if they we were working to overcome some some kind of medical condition, a condition that they didn't blame themselves for having.

So I hope that this blog post will help you to understand why I believe that developing self compassion (the ultimate antidote to shame) for having an anxiety challenge is often one of the most important steps in the road to recovery for my clients who struggle with anxiety and worry.

Mindfulness and Messy Socks

I will always remember the first time that I heard about meditation. I was about 7. My older sister had just signed up for a meditation class at the local community centre. Every night she would disappear into her closet for about twenty minutes after supper. After a few night of watching her disappear in there I became deeply curious. What could she possibly be doing in her closet all of that time? When I asked, she said that she was “meditating”.  I, of course, has no idea what that was ( I was 7). So I asked “what’s mediating?”. She explained that she went into her closet, sat on a pillow, and allowed her thoughts to go down a stream. And she pretty much left it at that (as any 12 year old sister might).

I was left completely confused. How did you “get your thoughts to go into a stream?” How did the stream get into the closet in the first place? Yet, somehow, despite my confusion, I was instantly fascinated by the idea of mediation. Intuitively, it somehow seemed that by sitting in a closet alone and meditating, one might be able to unlock profound mysteries of the human mind.

I will also never forget the first time I was taught to mediate. It was in Toronto, where I lived during my early twenties. There was a Korean Zen Buddhist temple around the corner from me . I would finally have a chance to explore my life long desire to mediate, and to thereby to begin unlocking the profound mysteries of the human mind!

On the day of the first class, I was so lost in thought about the profound experiences that I was surely about to have that I forgot the time. So, despite living around the corner, I needed to rush to the temple in order to make it to the class on time. I came rushing into the building, took off my shoes, and threw my socks into the corner. At that moment, a young monk approached me, picked up my mangled socks, handed them to me, and said, “As you enter the temple please do so mindfully. Please fold your socks neatly and place them next to your shoes.” I attempted this process three of four times before I finally slowed down enough to do it in a way that met his approval. Only then did he show me to the room where the class was taking place. I had no idea why he had made such a big fuss about something as silly as my socks. I was interested in unlocking profound mysteries of my mind, not learning how to fold my socks. I felt a wave of resentment toward him, decided that he must be some kind of junior monk who didn’t know what he was doing yet, and  rushed into the class.

I have now been mediating for over 20 years. I have read widely on the topic. I have completed a PhD dissertation that has helped me to understand how mindfulness operates at the level of the brain. ( In future blog posts I will write about some of the fascinating things I learned on this topic). But when I really ask myself what mindfulness actually is,  I very often come back to those two early experiences. I have found that mindfulness truly does have the capacity to illuminate the deepest mysteries of my mind, just as I intuited it might when I was a young child. But I have also found that it doesn’t do this by helping me to understand some abstract set of ideas. Instead, it does this by helping me to achieve the profound benefits of waking up to my own life. If I had been able to truly accept the monk’s invitation, I may have had a key insight much earlier then I eventually did. Namely, that so much of the suffering in my life stemmed from the fact that I was always late and that I was always lost in thoughts about some big idea that made me miss whatever (and whoever) I was actually experiencing in the present moment. However, the monk was also offering me something even more important then the opportunity to develop these powerful insights. By inviting me to slow down, to fully notice what I was doing in the present moment, and then to do only that one thing, he was also offering me a practical way out of much of the suffering that the mind creates.

Inspired by these experiences in my own life, mindfulness has  become a key part of how I work with clients. With some clients this involves offering formal meditation instruction. With other clients the role of mindfulness is more implicit, simply involving my encouraging of a joint appreciation of the present moment as it unfolds during our time together.

Sadness versus Depression

It is understandably common for people to mix up sadness and depression. Unfortunately, this confusion is often one of the things that has been causing people a lot of suffering by the time they come to work with me.

The reason that sadness and depression are so easy to mix up is that feeling blue is (almost always) common to both. And the reason that it's so important to be able to learn how to distinguish these two experiences is that we need to respond to them in opposite ways.

As a core emotion, sadness has a very important evolutionary role to play. Like all core emotions sadness provides us with invaluable information about what is important to us in our lives, and then produces an action tendency that helps us respond to our situation in the most appropriate way (for more on core emotions and what they are see my video on Emotions in AEDP on the resources page). The theme of sadness is around loss/damage to the self or to something that we value. Therefore, the action tendency of sadness leads us to take some time out from life to soothe ourselves, and also to reach out for comfort and soothing from others.

So, for example, imagine that there was a big promotion at work that you really hoping for and you didn't get it. The feelings of sadness that would come afterwards would actually be a healthy sign that you just lost something that really mattered to you. So if you miss the promotion it would be healthy to follow the action tendency of sadness and, for example, spend the next weekend on the couch feeling down, watching movies and/or calling a friend to share your feelings with them. The key with sadness is to listen to it and express it (without becoming overwhelmed by it). Avoiding or repressing healthy, albeit painful, feelings of sadness makes it harder to treat ourselves with compassion, to let go of unattainable goals, and finally, to find a path toward new goals that we can achieve. In fact, over-controlling a healthy sadness can actually lead to depression.

On the other hand, depression is much more then just sadness. It is a whole cluster of experiences which together are a sign that your system has become dysregulated and out of whack. Feelings of sadness are only one feature of depression, along with a cluster of other symptoms including: loss of interest in things; problems with sleep; changes in appetite; concentration problems; lowered sex drive; fatigue; feeling worthless; sluggishness or restlessness; and thoughts about death or, at times, thoughts of suicide.

Not all of these symptoms need to be there in order for depression to be present, but at least some of them do, and of these sadness is perhaps the most common symptom we experience when we become depressed.

However, unlike with “pure” sadness, it is  not in your interest to listen to depression. Depression will always tell you to avoid engaging fully in life and/or will tell you to socially isolate. The more we listen to depression, the more we end up leading lives that are empty, lonely, and depressing. So this leads to more depression, and a very powerful cycle can be created that becomes like a vortex which pulls us in. A “pure” sadness will lessen over time, while a depression that has tricked us into listening to it does just the opposite, it becomes more and more intense.

This is why we need to do exactly the opposite with depression than with sadness; we need to not listen to the depression and instead re-engage with life in a self compassionate manner that will actually work. This approach, often  involving SMART Goal setting (see my blog post on this topic) involves returning to engagement with life at a tolerable pace, where you're not asking yourself to do more than you can manage but you're also no longer allowing depression to get you to do too little.

The ability to sense or taste the difference between sadness and depression is a skill. And sometimes we might need help figuring out which is really going on. It can be very difficult sometimes to tease out the difference between these two things, especially when we are feeling down. Getting help with understanding what's really going on, deciding if it's more of a sadness based experience or a depression based experience, is one of the vital roles that psychologist or other qualified mental health practitioner can play. And once in counseling, learning how to taste the difference between these things for themselves becomes a very important goal for many clients in therapy.

Once therapy has helped people learn how to sense for themselves the difference between healthy sadness and depression, this is a very valuable skill that they can then use to keep themselves healthy for the rest of their lives.

THINKING OF OURSELVES AS MADE UP OF MULTIPLE SUB-SELVES

From the time that we are  brought into this world were taught  to think of ourselves as a unitary being. I am a person named "Douglas".   In a common sense way this is true,of course  It is also very useful and practical to think of ourselves a a single entity. For example, it is way easier to order  a coffee at Starbucks if we just give our name when they ask, rather then explaining that we are in fact " a complex, emerging  being made up of multiple subselves".  

 But when it comes to psychotherapy, especially  experiential psychotherapy like AEDP, being too rigidly attached to the idea of ourselves as a unitary being can actually  sometimes be counter-productive. I say this because my years of experience as a therapist have  led me to the firm conviction that, in  a very real way, we actually are “an integrated overall being made up of multiple subselves”.  

One of the clearest examples of this idea comes from witnessing client after client exhibiting a split between a more rational, conceptual part of themselves and a more embodied, emotional part of themselves. Inevitably these two subselves see the world in a very different ways. The more rational part is often the "goal setter" or the "driver" who has all sorts of very clear ideas of how things "should" be and what you "should" be able to achieve. The more emotional part often ends up feeling oppressed and pushed around by the rational part, because he or she is the one who actually has to actually bear the deep emotional costs of facing fears and/or continually  failing to achieve unrealistic expectations.  

One of the most striking things that I have learned over time is that psychological wellness does not involve sacrificing either of these parts. Each has so much of value to offer us. Without the rational part it would be really hard to navigate in the world or to move toward long-term goals. But without the more emotional self it would be difficult  to really know what we actually wanted to set as goals in the first place, or to move toward those goals in a sustainable, self-compassionate way.  

Rather then getting rid of either of these sub-selves, the key seems to lie in getting them to respect each other and to listen to each others' points of view, even though those points of view will always be different (because their perspective on the world will always be different). In short, the more the relationship between these two sub-selves contained within a single person comes to look like a healthy intimate relationship between two seperate people, the healthier and more resilient people seem to become.  

This idea of the self as made up of sub-selves can seem a little weird or flakey to many people at first.  But I have seen  healing the realtionship between these two main subselves become a key element in so many successful  therapies, including one of my own, that I have now strong faith in this model. Given my faith in this perspective, it is  a relief that, over my years of reading, I have found that this perspective is  actually very consistent with both Buddhist psychology and with neuroscience research.

 This perspective does not make sense to all of my clients I work with. If that is the case, then that is, of course, perfectly fine. It is not essential to adopt this perspective in order to have a successful course of experiential therapy. But for those clients  who are open to exploring themselves as comprised of seperate but realted sub-selves, this can often offer a very helpful path toward healing.