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.

Worry vs. Problem Solving

Worry is one of the most common problems that brings clients in to work with me.

So what is worry?

Worry is triggered when our minds jump into the future and imagine bad outcomes, even if these outcomes are very unlikely. For example, imagine that you have to prepare and give a big talk for work. If you are a worrier, you will probably start noticing that scary mental images start “popping” into your mind, such as images of everyone in the room looking really bored, walking out, or being disrespectful.

The next step in worry occurs when we respond to the original mental image by trying to figure out ways that we can stop these feared outcomes from happening. I will prepare a lot. I will make sure to have well organized notes.

On the surface this kind of mental preparation seems quite helpful. The problem is that the anxious mind will immediately start thinking of reasons that these coping plans won't work. But what if I prepare hard and I still find that I haven't prepared enough? ...But what if I forget to take my notes with me?

So now we have a whole bunch of new problems to mentally solve. Okay I 'll leave my notes on the kitchen counter to remind me to take them. Again, this seems reasonable, except now your anxious mind will immediately produce an image of you being so stressed out that you walk right past your counter and forgetting your notes. And on and on it goes. Possible solution; possible problem with that solution. Until all of these different scenarios begin to spiral and multiply. Its exhausting.

On the other hand there's problem-solving. It starts in a similar way. We have a problem: we have a big presentation to give and we aren't fully prepared yet. But unlike with worry (which we tend to do while we are doing other things like shopping for groceries, watching TV, having a conversation with our partner etc etc) we decide that we are going to engage in problem solving as an activity unto itself. Another difference is that, unlike worry, we do problem solving on paper. This may sound a little unnecessary at first. But I am amazed at how important this is, because getting the problem out on paper makes it more concrete and tangible. And this helps us to stay on track and not to spin off into outer space the way that we do when we are worrying.

Once we define a problem on paper the next step is to brainstorm alternative actions that we might be able to take to solve it. For example we could set ourselves a plan of certain number of hours of preparation for the talk, we could lay our notes on the counter the night before, we could make a plan to go over the presentation in a mock rehearsal with some colleagues in advance etc etc. Once we have generated a reasonable number of alternatives, we go through the pros and cons of each one. And then we select one or a handful of these to try. And in another key difference from worry; we then actually put these strategies into place instead of staying stuck in mentally “planning”. And finally, we evaluate how well the chosen strategies worked so we can decide what to do next.

By learning to problem solve instead of worry, we end up solving the solvable problems in our lives sooner, more effectively, and with much less suffering along the way. Even more importantly, over time this strategy can help us begin to trust more deeply that even when bad things do happen, or even when the coping strategies that we try out at first don't work, we are much stronger and more able to cope then anxiety wants us to believe.

If worry is something that you struggle with in your life and you do end up working with me there's a good chance that I will end up presenting these ideas again and inviting you to experiment, with my guidance and support, in using the power of problem-solving to overcome the very real suffering that worry can help to create.

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.

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.

The Transformative Power of Effective Goal Setting

In this blog entry I want to write a little bit about setting effective goals.

This might not sound like a very sexy topic . But in my experience, both as a therapist and as a person, it's one of the most important topics around.

By setting goals I don't mean so much what particular goals we set (although this is also very important) but the process we use to set goals. This topic is passionate for me, and very closely connected to a story that I'd like to share.

About 15 years ago, when I was first beginning to train as a therapist, I had the opportunity to be a student co-leader in two consecutive cognitive behavioral therapy (CBT) groups for depression. SMART goal setting was one of the basic interventions used in this group program. When I first looked at the manual, I remember thinking to myself “Oh this goal setting stuff, it's so basic. I already know this stuff and so does everyone else. So why are we wasting valuable time on a skill that everyone already know?”

All these years later I couldn't see effective goal setting any more differently. To me now, effective SMART goal setting is a very potent mix of mindfulness, self compassion, and commitment. Let me explain why I say this.

The process of SMART goal setting requires you to do a number of things. The first is to decide what it is that you want to change in your life, for example to get into better shape. The second, in the spirit of friendly curiosity (which is the essence of mindfulness), is to simply notice and record how you have been doing in the chosen area in the last week or so. And the third is to set goals for the coming week from a self compassionate stance which accepts that whatever you discovered during the recording phase is what you are able to do at this particular point in our life and then starts setting goals from there (as opposed to the more familiar, judgemental stance in which we set goals instead based on what we think we she really “should” be able to do).

This sounds very simple and as a concept it is. I just explained it in 100 words or so. But in practice I have come to see that for many people this process is actually remarkably difficult. And I have come to believe that this difficulty is largley because of one thing, a defecit of self compassion.

As I led the first CBT group all those years ago I began to notice that the group seemed to break more or less into two separate subgroups.

There was a subgroup who allowed themselves to simply note what they seemed to be capable of doing, no matter how simple that was, started from there. For example, someone in this sub-group might say something like this to themselves “ I've always been an athlete. Before I got depressed a year ago I used to get to the the gym at least 4 days a week. But since I've been really depressed my monitoring tells me that in the last week I have done no exercise at all. I'm going to really give this SMART approach a try. I'm going to start where I am. This week I will go to the gym and ride an exercise bike for 10 minutes. I'll see how that goes and then take it one step at a time after that.” People who did this would usually get to the gym and achieve their goal because they were starting from a place of self compassion. As a result, they would feel a sense of success. This feeling of success would fuel them to set a slightly higher goal for the second week, of spending perhaps 15 minutes at the gym. Over time, this feeling of success would create a positive cycle, so that often by the end of the 8 weeks they had fully recovered from their depression, and had also armed themselves with a powerful tool to stop depression from coming back.

On the other hand, the second subgroup never really bought into the self compassionate stance that SMART goal setting  requires. They would tend to say something like this to themselves at the beginning of the group “I'm an athlete. A year ago I went to the gym 4 days a week. I haven't been to the gym at all in the last 6 months. So I'm going to “cut myself a break”. I will “only” make myself get to gym three times this week instead of four.” These people tended to get to the gym maybe once, like the people in the first sub-group. But rather than feeling a sense of success around this very real accomplishment they would instead feel like failures. This would lower their motivation for the second week. Often they would respond to this by getting even harder on themselves and say something like “Well I failed to get there 3 times last week so I'm really going to push myself and get there 4 times this week”. Which of coure they wouldn't. So while members of the the more self compassionate sub- group had a gradual but accelerating upward spiral, these people tended to stay pretty much where they were when started, continuing to set unrealistic goals and then punishing themselves as faliures.

I was so struck by what I had observed that, despite my intial skepticism, during the second CBT group I decided to set goals alongside the group members. I had recently been diagnosed with Type 2 diabetes. I was about 40 pounds overweight and was very unhealthy. I had been telling myself for years that I “should” get to the gym four times a week, without getting there hardly at all. So during my first week co-leading the new group I set a very different goal: walking around my neighborhood for 10 minutes, twice during the week. By the end of the group I was running for 20 minutes, four times a week. I had lost 10 pounds and was well on my way to losing another 40. I have kept (most of) that weight off for all of these of these years, and even more importantly, I have much more energy then I did when I was 30. These are accomplishments that I'm really proud of.

So , if we end up working together, I hope you'll understand if I end up talking excitedly about SMART goal setting with you, because I've seen the the power of this apparently simple approach to help transform people's lives. Including my own.