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.

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.

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.

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.