Have Yourself a Mindful Christmas

Christmas time can be a challenging time for many people. For those navigating difficult family dynamics, those who are grieving lost loved ones or for those who are experiencing Christmas away from family and friends it can be a lonely time of year. On the other hand, Christmas can be an extremely fun, connecting and positive time of year as well. And as our complex brains can show us, we can have a whole mix of emotions going on both positive and negative.

Here are a few mindfulness and compassion-based ideas to try this Christmas:

  1. Food – humans have a nervous system and brain that evolved for living in the Pleistocene epoch, when food (especially of the nature served at Christmas) was not plentiful. It is believed that our ancestors used to have to gorge on food when it was available and then would starve and live off their fat supplies at other times. Therefore, in order to manage our food intake, we are working against our evolved nature. Also, many of us may use food to self soothe at times when interpersonal and emotional charges run high. We need to be kind with ourselves at this time. Acknowledge that we may not want to overeat, this can be our goal, but have compassion if we don’t always manage it. The other thing is whatever we do eat, to try and eat it slowly and mindfully, really paying attention to the flavours, textures, smells etc of the food and our internal feelings of pleasure and enjoyment. We tend to find if we slow down and eat mindfully it is more difficult to ignore the signals from our body telling us when to stop. It also means we are not just eating for the sake of it. We are really taking it in and appreciating it, we are savouring the experience and can feel gratitude.
  2. Interpersonal – try the STOP technique and the self-compassion break if you have difficult family dynamics to manage. Take some deep breaths, slow down, label and describe your emotional experience and then focus on the communication so you can listen and talk in a mindful and compassionate way. Balance the skills of being assertive and setting boundaries with perspective taking and the ability to see other people’s points of view. If you need to create space and take some time to yourself to engage your soothing system, then look after yourself.
  3. Compassion and kindness – focus on giving. This is consistently shown to be both good for the people you are giving to and for ourselves. We are a social species and we are designed to connect and live in groups. Our attachment system has a soothing component. Engage this through a focus on giving during this time. Giving time, giving attention, giving physical assistance, giving emotional support and of course giving presents!
  4. Mindful movement – make some time for mindful movement. If it is difficult to do your usual fitness routines can you at least go for a long walk. Can you do some yoga or gentle stretching. It may be worth spending more time relaxing with your family. But humans really are designed to move, especially if we are consuming large amounts of food, can you notice any feelings of resistance towards moving, accept with friendliness and take these feelings and thoughts with you as you go and exercise. Even 10 minutes is helpful.
  5. Self-compassion – this can be a bitter sweet time of year. The pain of losses can be present for many of us. There can be an expectation to enjoy this ‘most wonderful time of the year’. Can we allow space for painful emotions? Inquire into whether they are giving you important information about how you are living your life and what you are engaging in and your plans for the coming year. If the emotions don’t seem to have useful information that can help you make positive changes can you allow them to be in the background as you build happiness through behaviour. Can you bring mindful acceptance and self-compassion to painful emotions and continued to be present with the people you love, doing meaningful activities.
  6. Be playful – can you reconnect with the friendly playful spirit that you may have experienced as a child at Christmas time. Can you joke around with your family and friends, play and have fun. You can even start to engage in these activities if you feel shame, sadness, anxiety or other challenging emotions. Can you let these be in the background and in the foreground is your present moment experience of fun?

May we all be happy, healthy, safe and peaceful this Christmas!

Bullet Ants, Vision Quests and Mental Health Recovery as an Endurance Event

The Sateré-Mawé tribe of the northern region of the Amazonas in South America have a sacred ritual for young warriors that is quite unique. They have to prove their worth to the tribe by remaining in a calm state whilst suffering agonising pain. The tribe sow sedated bullet ants (named as their sting is said to be as painful as being shot) into gloves made of leaves. Boys as young as twelve have their hands placed into the gloves. As the ants awaken, they are stung for five minutes or longer. The ant’s toxins interfere with their nervous system and the venom continues acting for hours after being removed. The young warriors endure pain & paralysis, disorientation and hallucinations in these hours that follow. They need to go through this herculean ordeal twenty times to earn the respect of the tribe and be recognised as full warriors. Their only distraction during the ceremony is the tribe’s ceremonial song and dance!

Tests of endurance are perhaps as old as humankind. Vision quests, Sundance’s and land diving have given rise to the modern triathlon, iron man and ultra-marathons. I think that some days during mental health recovery are like endurance tests. When you wake to your intense symptoms and they persist till you attempt to sleep, it is somewhat like an endurance test. But one you have not chosen to take part in and often won’t gain the respect of your tribe. However, we can use the same tools that endurance athletes use to go through this process. Tools like breathing and relaxing, motivational and instructional self-talk (especially with a kind and compassionate tone) and mindful attentional training. We can use attentional control skills and develop our ability to accept pain in the service of moving towards our valued goals in life. Runners will often focus out into their environment rather than be drawn into the intoxicating feelings of exhaustion. The Sateré-Mawé focus intently onto the rhythmic music and dancing. We can find our own ceremonial drums.

A focus on values and goals can help us in this difficult place. Athletes will remind themselves of their goals, the time or position they are hoping for, why they are running and their team that are supporting them. This can help them to dig deeper and persist. Humans are a deeply social animal. We can draw on strength and support from our team, the crowds and supporters. Even in a vision quest the lone adventurer has the intention to pass through the trial so they can come back stronger and wiser for the tribe. There is fascinating research demonstrating that people anticipate mountains to be less steep when they are with a friend or group. Find your support network and tribe.

I’ve had days in the past when waves of panic or depersonalization were my constant companion. When the heavy weight of depression held me like the burning lactic acid climbing that first mountain or when repetitive rumination and obsessive thoughts felt like an enemy hunting me through the forest. And at those times it was helpful to frame it like a hero’s journey, rite of passage or endurance test. To constantly accept the anxiety and return my attention to the conversation I was having, or the activity I was doing, and to ensure I had a kind compassionate inner coach with me all day in my self-talk. To come back to my values and goals each hour to check I was moving towards what I cared about rather than running from what I feared. And I think at these times when we are facing our shadow, we train our new brains to regulate our old brains at a much deeper level. A simplified model is our pre-frontal cortex is getting stronger and more able to calm our limbic system, even when we are in our fight, flight or freeze response.

If we have days during recovery when we feel good then that’s great, we can savour and enjoy that. But if during the recovery marathon we have days that are dominated by anxiety & depersonalization, depression, obsessions & compulsions, then this is a chance to practice acceptance and following our valued direction in life – like weight training for our brain. On these days we are competing in the endurance race of recovery, if we can gently and patiently keep going, we are laying the synaptic pathways for freedom and a deeper happiness. It’s tough but we can build these skills over time. You may need the help of a professional skilled in the journey of recovery, just as a coach is an essential part of a physical fitness team. You will almost certainly need a training buddy or group – humans can’t do many things without the tribe. But with practice you can get there. So maybe think of the Sateré-Mawé when you are next having a tough day of suffering and maybe this concept might help you through it. There is a light at the end of the tunnel, the only way is through, whilst using whatever tools support you best.

Savouring the Present Moment: Mindfulness of Pleasure, Enjoyment and Happiness

The most beautiful thing we can experience is the mysterious. It is the source of all true art and science. He to whom this emotion is a stranger, who can no longer pause to wonder and stand rapt in awe, is as good as dead: his eyes are closed.’ Albert Einstein, My World View (from a collection of philosophies of notable figures in 1931)

 

Savouring and mindfulness are two distinct but related cousins. One enduring definition of mindfulness, penned by Jon Kabat-Zin, is ‘Mindfulness means paying attention in a particular way: on purpose, in the present moment, and nonjudgmentally’. So, in theory, mindfulness meets pain and pleasure with the same openness, or range of acceptance. Whereas savouring is selectively attending to what is pleasant, enjoyable, satisfying etc in the present moment, and allowing our attention to ‘dance’ between what we are enjoying and how we are feeling. It could be argued that mindfulness meets a beautiful view, pain, a busy London underground carriage all with the same receptive attention. Whereas savouring is going to be easiest with the beautiful view and more difficult (but not impossible) in the other situations. Mindfulness deepens and supports savouring, and often it leads to it. Some researchers believe these concepts naturally overlap and that this was reflected in its historical roots in Buddhism.

Fred Bryant and Joseph Veroff have led much of the important psychological research on savouring, including exploring the emotional and physiological benefits. Their distinction with mindfulness is ‘when people savour, they too are mindful of their experience, but their attention does not remain totally open to incoming or internal stimuli. Instead, the savouring process involves a more restrictive focus on internal and external stimuli associated with positive affect’. They also distinguish two types of savouring where you can attend to the sensory pleasure and the experience without thinking. Or you can engage more cognitive processes, thinking thoughts that deepen the sense of savouring. Other methods they suggest for deepening savouring include: Sharing your good feelings with others; taking a mental photograph; congratulating yourself; sharpening your sensory perceptions (a forte of mindfulness); shout it from the rooftops (i.e. express it with your voice, body and expression); comparing the outcome to something worse; getting absorbed in the moment; expressing gratitude; reducing killjoy thinking; and reminding yourself of how quickly time flies.

Barbara Fredrickson parses savouring into the categories of memories from the past, experiences in the present and anticipatory savouring for the future (there is some overlap with positive constructive daydreaming). She advises to ‘Narrate your experience with a gentle inner voice that truly appreciates what’s unfolding before you. Notice the small details.’ She also encourages a light touch to this process, as excessive effort can decrease savouring as can attempting to hold onto something slipping through your fingertips.

Another positive psychology researcher, Sonja Lyubomirsky, states that ‘researchers define savouring as any thoughts or behaviours capable of generating, intensifying, and prolonging enjoyment’. It’s clear that savouring and gratitude are closely related, expressing gratitude can deepen savouring. And savouring and flow (being deeply engaged in activities where attentional absorption begins to happen) also overlap to some extent. Savouring differs from flow in that there is a stepping outside of the experience to notice the pleasure, whereas flow involves complete absorption, so that it is only after the experience we are aware it was enjoyable. We can savour how good we feel after flow, but savouring flow would reduce absorption. A great way to enhance savouring is sharing with loved ones, reflecting on our positive experiences and talking and enjoying them together. This is something people often do very naturally, but when humans are experiencing psychological distress it can be a behaviour that drops away as we isolate ourselves and the brains negativity bias limits savouring.

Here are some ideas and tips to help savour positive experiences:

  1. Choose something enjoyable, anything from a pleasant memory, completing a task, a delicious meal, time with a good friend. This can be a memory, something you are doing in the present or a future anticipated enjoyable activity.
  2. Relax and allow your mind to settle in the present moment. Maybe take a couple of deep soothing breaths to slow yourself down.
  3. Now attend to the pleasant sensory experience of whatever you are doing or visualising and thinking about. As your awareness settles in, allow your mind to dance back and forth between pleasant feelings in your body and the activity, experience or memory.
  4. You can gently narrate this to enhance it the experience (as Fredrickson advises), similar to loving kindness meditation practice where you use a phrase to deepen your connection with a feeling, you can say ‘this feels so good, that looks so beautiful, I feel amazing etc’.
  5. Like many of the practices your mind may resist this. Brains like to stick with patterns and they can look for threats in both environments and our own minds. Sometimes happiness can be threatening to a mind that is not so used to it. Also, if we have not had these experiences reinforced through our life, or put another way, we weren’t well taught to savour things in our childhood then it can be tricky at first. In a depressed state positive emotion can be threatening. Therefore, be gentle, start with small practices especially if you are experiencing low mood, depression or anxiety.

If this is difficult then savour for a short time and do this a few times a day. Let this develop and build over time and its totally fine for ‘negative’ emotions and thoughts to be in the background as you savour. You are aiming to have more of your attention on the pleasant experience and feelings, which are often very subtle, and you are accepting any negative feelings or thoughts. Accept any doubtful thoughts, self-criticism or worry etc and gently keep bringing your attention back to savouring. At first the difficult emotions may be stronger than the subtle notes of pleasure. But just like wine tasting we can develop and refine our affective palette and attention. Some days it might feel the most natural thing and you don’t really need to use any effort to savour – this might be happening naturally. Other days it might be arduous and take discipline to bring your mind back to savouring, but often at those times its when we need savouring, gratitude and flow the most.

If savouring is proving tricky then focus on engagement and absorption in your chosen activity. Pick something you enjoy, or enjoyed in the past and give 15 mins to concentrate and attend to what you are doing (noticing and accepting any resistance from your mind and returning to the activity). Then savour the affects of having been absorbed (to greater or lesser extent) in the valued activity.

Bringing savouring together with painful emotions is a step that is often taught in many psychotherapy models. When you bring the strength of an internal resource to meet the pain from the past it can help us to process the memories. We draw on inner or outer resources to soothe the pain of the past. This is something Rick Hanson talks about with eloquence and clarity in his books including the brilliant Resilient. Give savouring some time to develop and let me know how you get on.

Take a Walk on the Grateful Side – The Gratitude Walk

As the great stoic philosopher Epictetus said:

 ‘He is a wise man who does not grieve for the things which he has not, but rejoices for those which he has

Epictetus spent his youth as a slave in Rome. He was crippled on the journey to Rome and lay below deck on the ship for days, controlling his reaction to the pain. He lived alone for much of his life with few possessions. It’s not exactly the life you might think would give rise to an appreciation of the power of gratitude. However, Epictetus practiced a philosophy that held that all you could really control in life was your rational mind and what it focused on.

Gratitude has been demonstrated to improve the frequency of positive emotions (even amongst people with chronic illness), reduce physical health symptoms like headaches, improve sleep and even enhance interpersonal relationships (Lyubomirsky 2007). It is a practice closely related to mindfulness, in the brilliant Mindfulness Finding Peace in a Frantic world they talk about having the quality of ‘appreciative attention’. Mindfulness helps us to have the attentional skills to apply and focus on gratitude, especially when we are in difficult circumstances.

A practice for cultivating gratitude which I enjoy regularly when I walk my dog is ‘The Gratitude Walk’ (of course the walking can be replaced with any appropriate movement or it can be done sitting if movement is an issue):

  1. Begin with 2-5minutes of mindful walking. You can bring your awareness to the sensations of walking, or your breath or you can open your awareness to your sensory experience of sight, sound, feeling, smell, taste etc
  2. Start to reflect on different things in your life which you feel grateful for and (using any language that works for you) say silently in your mind ‘I’m grateful for x’
  3. Categories for gratitude could be relationships, resources, opportunities, abilities, hobbies, work, a (relatively) healthy body and mind etc. You can also express gratitude for the things you see around you like nature or the people you are with
  4. Expand this out so that you reflect on something you are grateful for and then deepen this by expressing why you are grateful for it. For example, ‘I am grateful for my dog, because he is always pleased to see me and keeps me regularly walking in nature
  5. Let your awareness ‘dance’ between the thoughts of gratitude and any pleasant feelings in your body like the feeling of gratitude, warmth, openness, relaxation, joy etc in the heart, face and whole body
  6. If your mind drifts away notice and return. If your mind resists the practice with judgement, doubt, self-attack, inner critic etc then see if you can notice this in a kind and accepting way and gently keep bringing your attention back to expressing gratitude. Let the doubt be in the background. We have the capacity to experience different emotions at the same time, we can have gratitude whilst feeling anxious, depressed, obsessing etc. Let the other thoughts and feelings be in the background of your awareness and gratitude takes centre stage
  7. Continue for 10-20 minutes or as long as feels right
  8. Try to find different things to be grateful for each time you practice, including different things that have happened through your day. This trains our attention to be searching for positive occurrences throughout the day

Our brains have evolved a negativity bias that prepares us to search for threats in our environment. It made more sense for our ancestors to spot the dangers of their environment (like Lions, Tigers and Hyena’s) than it did to continuously savour the beauty of their world. So, our baseline state can often be one when the brain defaults to searching for danger. Gratitude is a wonderful practice to offset this and to prime our minds to take in the good. People often struggle with gratitude, especially if they are experiencing low mood. When this happens, a person suffering from depression can end up denigrating themselves for ‘failing’ at another thing. This is where we gently use our mindful acceptance skills to allow these thoughts to be there whilst we place our attention on the gratitude practice. We can experience gratitude even in the midst of emotional or physical pain. So, start gently, maybe just writing down three things for which you feel grateful for or spending two minutes through the day to reflect on gratitude.

The other thing people struggle with is what gratitude means in a world full of social injustice. But it’s important to reflect that gratitude can be a complementary practice to support us in working to create a better world. We can resource ourselves to help others with gratitude and reduce the chance of burn out. Even people in very difficult situations have found benefits with gratitude. For example, Shawn Achor did research with cancer patients, African farmers that had lost their land and homeless people and found they all benefited from the practice of gratitude for their well-being.

So why not try Epictetus’s approach and experience the ‘freedom of being the master of yourself’ by cultivating an attitude of gratitude. Take a walk on the grateful side.

The Dialectics of Being Lost at Sea – Differences between Acceptance and Distraction

Marsha Linehan developed Dialectical Behaviour Therapy as a way to help treat the most suicidal patients. Having lived through this wretched place in her own life, she was deeply empathic in her quest to aid these people. These patients had been traditionally shipwrecked, as Emily Dickinson so beautifully put it  without ‘even a Report of Land’. The clinical psychologyfield had been at a loss when it came to the controversial and highly stigmatised diagnoses of borderline personality disorder that Linehan decided to target. Linehan drew upon the philosophical perspective of dialectics (balancing opposites) in order to develop this behaviour therapy. She balanced the concept of acceptance with change, when working with the emotional storms her patients were experiencing. Sometimes people needed to learn emotional regulation techniques that could contain and shift their emotional overwhelm. Other times they needed to learn ‘radical acceptance’ in order to get back to a ‘wise’ way of living. Both of the strategies that are the focus of this post – acceptance and distraction – are found in DBT.

I am a huge fan of the Acceptance and Commitment Therapy (ACT) principle of acceptance and committed actions in service of your valued direction in life. This can seem similar to distraction as an emotional regulation strategy, but there are subtle differences. As Rob Wilson puts it the difference is all about intention. Distraction is a strategy to escape painful thoughts and feelings. Acceptance and valued actions lets the thoughts and feelings be there, whilst you engage with meaningful activities and relationships.

I’m with Marsha Linehan in her view that distraction can be a useful tool at specific times. There are people that have such severe emotional regulation problems that acceptance is a step too far in the beginning. Prof Paul Gilbert once described someone he was working with, that smashed her head through a window when asked to accept her feelings because she was so distressed! For some people their emotional thermostat is too sensitive for acceptance in the beginning. This is why DBT uses skilful distraction as part of the emotional regulation and distress tolerance modules.

Distraction can be enhanced by using the skills from positive psychology concept of flow. We can ensure a task is challenging and requires skill which is balanced to our ability; we concentrate in an ‘effortless’ way and there are clear goals with immediate feedback. We can pick more complex tasks like sports, creative pursuits or complex intellectual challenges. We can also try to speed up an activity so we are just at the edge of our abilities. We can pick activities that naturally grab our attention like books, movies or music we enjoy. There is clearly a place for this and DBT demonstrates the effectiveness of this side of the dialectic.

However, distraction has its limitations. It doesn’t always work, there can be levels of emotional distress that mean we can’t get absorbed in activities. Sometimes distractions work for a period of time but when we finish the distracting activity the emotional distress can come back even stronger. We can’t always perform at the high level of intensity needed for absorbing distraction, and we might not deal with the underlying problems in our lives or relationships which are feeding or causing the distress. Acceptance and committed action is another powerful option, that with practice can be a more flexible psychological tool. It can still lead to states of flow, but it really supports us when our mental health disrupts our ability to concentrate or engage with what we are doing.

To describe this approach I like David Veale’s metaphor that this acceptance approach is like walking along a pavement next to a busy road. The difficult thoughts and emotions are like cars on the road. If we try to flag them down or stop them we are likely to experience all kinds of problems. But if we focus on the pavement we are walking on, who we are walking with and what activities we are doing, we may notice the cars on the road but we let them go past while focusing on the meaningful activities we are doing on our path. It takes time to develop this skill, but like any complex task we can build our ability with practice.

Lost in Oblivion – An Exploration of Adverse Meditation Experiences

(Please note this is a long blog post in order for me to do this subject justice. It’s likely to be of most interest if you have experienced adverse meditative affects)

Meditation is not all spa music, oxytocin, sandalwood and light! There can be stages that are like arduous rights of passage. A shamanic vision quest. There might be underlying mental health pathologies that mean that practice, or at least intense practice might be unwise. Yet in the west mindfulness has been marketed as a panacea (although it is already facing a backlash in the press like and also). But traditional practices are well aware of these potential challenges. For a start, many schools of meditation aim at ‘deconstructing the sense of self’ and ‘realizing emptiness’ which clearly are not the same as relaxation and improving corporate performance. Take for example a classic manual from the meditative world: 

At the peak of insight knowledge of dissolution, one clearly realizes that mental and physical phenomena vanished in the past, are vanishing in the present, and will also vanish in the future. As a result, conditioned phenomena begin to appear fearful. At this point insight knowledge of fear arises’ (Mahasi Sayadaw, Manual of Insight). This is followed by the insight knowledge of danger when ‘conditioned phenomena’ will be experienced as ‘unpleasant, detestable, and harsh’. This is from one of the traditional Burmese teachers that the modern mindfulness movement has in part grown out of (Zen and Vipassana being Jon Kabat-Zinn’s main practices before developing MBSR).

The brilliant Neuroscientist and Zen practitioner James Austin describes in Zen and the brain, Makyo, which is the Zen traditions version of side effects of meditation. He states Makyo is ‘what can happen when the brain opens up the barriers which would otherwise separate its states of waking, sleeping and dreaming’. And ‘intensive meditative concentration for weeks or months invariably yields visual or auditory aberrations, hallucinations, or unusual somatic experiences’. In Zen training, students are taught to disregard Makyo and to continue with the practice no matter what happens.

In Tibetan Buddhist traditions, this category of experiences is known as Nyams and can mean everything from visions, psychological distress, physical pain, paranoia and terror. There are a number of famous western Tibetan teachers who have talked about intense adverse experiences after doing the traditional 3-year retreats that are part of the Tibetan path. From shamanic practices to the pragmatic dharma of modern ‘hardcore practitioners’ you find the equivalent stages in almost every spiritual practice involving contemplative practices. In their highly engaging book ‘The Science of Meditation’ Daniel Goleman and Richard Davidson state ‘dark nights are not unique to vipassana; most every meditative tradition warns about them. In Judaism, for example, Kabbalistic texts caution that contemplative methods are best reserved for middle age, lest an unformed ego fall apart’. There are even studies that show long term practioners can experience many of the same ‘symptoms’ as depersonalization disorder (DPD) but without the negative affective (emotional) tone.

The brilliant Neuroscientist Willoughby Britton of Brown University has been leading pioneering work in this field in the Varieties of Contemplative Experience Study (VCE). Britton began researching solely on the positive side of mindfulness for wellbeing, but after directly experiencing patients suffering from severe adverse effects she started to look at this area. Supportive of mindfulness, Britton is keen that it is not framed as a panacea and the nuance of these powerful practices are understood (as they are rolled out en masse as mental health interventions). She interviewed long term meditators including expert teachers from a wide range of practices (Zen, Theravada, Tibetan). Her team found that there was a huge range of experiences both cognitive and somatic and the emotional valence ‘ranged from very positive to very negative, and the associated level of distress and functional impairment ranged from minimal and transient to severe and enduring’. She receives multiple phone calls a week from meditators experiencing issues and has set up a support group and in the beginning of her work she even had long term severely impaired meditators staying in her house to recover.

On top of this there are endless accounts of seemingly ‘high level’ teachers who end up doing unforgiveable things, that speak of mental health difficulties. Some of this element is explored in the Buddha Pill, in which Dr Miguel Farias and Catherine Wikholm examine this aspect in detail and other shadow sides of meditation. I think this is a book that is worth all meditation teachers having a look at in order to gain a mature view of their art. It attempts to give a balanced assessment on what meditation can and cannot do for mental health and life at large. They have a chapter examining the ‘dark night of the soul’ and interestingly they note that the Diagnostic and Statistical Manual of Mental Disorders has had a clause noting mental health problems, such as depersonalization, may arise as a temporary result of spiritual practices. Working with Dr Farias there is a meditation group in the UK headed by Damcho Pamo who experienced her own psychosis and mania after attending a Zen retreat, and now seeks to support others. There website speaks of some of the potential adverse effects in a balanced and supportive way.

Now clearly as a mindfulness teacher, I am a fan of mindfulness, but I am keen that we take a sensible approach to how we use it for improving mental health. It is not a panacea. Much like physical exercise not everyone can start training for a marathon right away or compete in crossfit. Some people may carry injuries that need physiotherapy first and for some people they might have to adapt their physical training to match their genetic body type and vulnerabilities. I think this is a useful analogue for intensive meditation practice. Briefly my own story with adverse effects includes experiencing anxiety, panic, OCD, depression and depersonalization from a young age (many of my earliest memories were panic attacks). Some of these challenges definitely brought me to practice Zen and Qigong twenty years ago in an attempt to heal myself. And as I practiced through the years I learned tools that helped me manage my anxiety (although it wasn’t till I had CBT that the pieces came together to help me).

Many of the earlier years in practice I would experience intense emotions, pain from long sits and other adverse experiences and I got pretty good at sitting with these. I did a number of silent retreats which I practiced intensely through each day from waking to sleeping for 9 days. I would do extra sits, sit through part of the night and engage in ‘strong determination sitting’ which for someone with early onset arthritis meant a lot of knee and back pain. For many years’ depersonalization had not been a major feature of my mental health challenges, then after a retreat for the following months I was trying to sit as much as I could and practice through the day, then I had an intense adverse experience. I had levels of primal terror I had never experienced before, sensory alteration, existential anxiety, strange somatic experiences, depression, depersonalization more intense than I had ever experienced and many other symptoms. This period coincided with other intense life trials like the intensity of psychotherapy training, a number of bereavements and life choices so I believe it was a combination of causes following a lot of intense practice.

Ultimately this experience was positive in that it made me look deeply at my life, how I was practicing and what was meaningful to me. From an acceptance and commitment frame I was far away from many of my values, isolated and practicing meditation excessively. It also increased my empathy for those suffering from intense mental health disorders. It helped me refine my understanding of using mindfulness to help recovery from mental health issues, and how to adapt the practice for anxiety disorders and other mental health problems. Interestingly I’ve had no students have these types of experiences in 8 years of teaching. Occasionally I have had someone experience a heightening of stress in the beginning of mindfulness practice, normally when they are living a stressed and busy life in London. However, I think the intensity of my experience followed about 15 years of disciplined practice (practicing many hours a day), a number of retreats and a number of months of attempting continuous practice through much of my daily life. As I write this its obvious how out of balance and obsessive my approach had gotten.

Here are some suggestions based off my own experience. The first being to consult a trained mental health professional (ideally one that knows this territory) if you are experiencing difficulties:

  • Significantly reduce your practice time. I would advise anyone experiencing adverse effects to slow down their practice, and significantly reduce the time spent sitting. Even cut the practice down to 5 minutes or 3 minutes or take a break from practice. If you do decide to keep going, then make sure you are working with an advanced meditation teacher who understands this process. For example, for the teacher training at Spirit Rock – head teacher Jack Kornfield makes all teachers do training in the trauma therapy approach Somatic Experiencing. But honestly, I would say don’t continue on retreats or intense practice if you are having adverse effects. Get back into your life and make your practice a smaller supporting part of it.
  • See a professional, ideally a therapist skilled in this area and often they will be a trauma therapist trained in modalities like Somatic Trauma Therapy, Sensorimotor Therapy or Somatic Experiencing. David Treleaven book Trauma Sensitive Mindfulness is a brilliant resource here (and a must for anyone teaching Mindfulness or Meditation). Also, Babette Rothchild’s The Body Remembers part 2 has excellent guidance on how to adapt mindfulness for individuals who have experienced trauma. She suggests the areas of high risk with MBSR training being: ‘the rigidity of program structure and task instructions; the inward focus of mindfulness targets; the length of practice sessions; postural positions for practice and the possibility of relaxation-induced anxiety for people with PTSD, anxiety or panic disorders’. She recommends more agency and control for the student to adapt the practice, placing focus on the ‘exteroceptors’ of sight, hearing, taste, touch and smell. PTSD sufferers are often overwhelmed by their ‘interoceptor’ sensations when focusing inside their bodies, she even suggests potentially switching back and forth between the focus from inside to outside the practitioner (which I found useful myself). The portions, pacing and positions are important with recommendations to engage in mini practices, adjusting to postures which don’t trigger sufferers (lying down or sitting still can trigger freezing in PTSD) and promoting practitioner agency.
  • Focus on life goals and values. The teachings from Acceptance and Commitment Therapy particularly focusing on value-based actions is really useful here. We can use our meditative skills to accept difficulties and then focus out into the world and engage with life. Don’t spend long periods of time focusing deeply on your symptoms in an attempt to ‘see their impermanence’. There are certain experiences that may just be too much, and you are better to use acceptance and then read a good book or speak to a friend. Can you build acceptance towards your symptoms of depression, anxiety, DPD etc and engage in a meaningful life? Here we use the skills of meditation to direct our attention out in the world.
  • Reduce self-focus. Linked to this is the negative impact of excessive self-focus found in many mental health issues. Intense meditation practice can potentially exacerbate this and the more we can train our focus out into the world the better. Many Cognitive Behavioural Therapy experts emphasise training this external focus. Particularly I got a lot from David Veale and Rob Wilson’s work on reducing self-focus, their books such as Manage Your Mood and Overcoming Health Anxiety have a lot of useful techniques for dealing with adverse effects linked to excessive self-focus. Techniques such as attentional training and situational attentional refocusing
  • Try some different meditative approaches – if the breath feels uncomfortable and panicky then you could switch to different anchors for example physical sensation of sitting, sounds, gently staring at a rock or candle. If closing your eyes seems destabilising then you can open your eyes. You could try visualisation practice and imagery like Compassion Focused Therapy imagery. You could even use thinking to describe the image in compassion focused or safe place imagery thus engaging the language centres of your brain whilst meditating which I think can be helpful. You could use an app on your phone to lead you in breathing exercises as engaging with an external source can be useful. Loving Kindness practice might be a better choice right now (although people do have adverse effects from this practice), I found switching to this practice is shorter doses was particularly helpful.
  • Rotate between meditation and thinking. It’s important to have both approaches online, in fact there can be an overlap between intense meditation practice which quietens the default mode network (often described as a beneficial quietening but more nuanced in reality) and symptoms of dissociation. Sit for a while, say 10 minutes and then either let your mind wander or actively think about things. Maybe switch back and forth between meditating and thinking. This can help your brain move more easily from a quiet default mode to a more active one. Another approach I found useful was to sit for a while and then read a fiction book or watch a tv show. This is similar to Babette Rothschild suggestion of switching between an internal focus and an outside focus (mentioned above) but also engages the language centres of the brain. Linked to this is using affect labelling which I mentioned in previous blogs. I particularly think compassionate thinking is brilliant here. The brilliant Scott Barry Kaufman has written a lot about the (highly relative to this point) concept of positive constructive daydreaming.
  • Working with a blank mind. To build on the above step, a lot of people who experience adverse effects and depersonalization, experience having a blank mind – but not in a positive way. It’s like the anxiety response has shut down thinking (similar to a trauma response), or thoughts are so vague and nebulous that you can’t really find them (these experiences can be reported as positive things in meditation, but for many people they can be terrifying). In this case it can be helpful to re-cultivate the ability to think. Sub-vocalising or even saying thoughts gently can help, reading books as slow as you need to in order to engage and possibly reading out loud. I particularly like the concept from compassion focused therapy technique of compassionate thinking, or Barbara Fredrickson’s concept of narrating your day in a kind way. Just building acceptance of your mind and how you are feeling whilst engaging in thinking about your current task can be so powerful here.
  • Working with relaxation induced anxiety. When I began practicing qigong and meditation many years ago I experienced a lot of relaxation induced anxiety. Through many years of practice and exposure this reduced, although I would still occasionally experience it when I did long sits or got into deeper states of relaxation and concentration. When I experienced some adverse effects I found Prof Paul Gilbert’s advice from his brilliant book Overcoming Depression really useful. He describes for people who find either breathing or relaxing to invoke anxiety, that it can be a useful practice to do slow soothing breathing and progressive relaxing whilst doing another activity. This can be something more physical like walking or gardening, or a relaxing soothing activity like having a bath. You can even squeeze a ball and have your focus on touch and the breath and relaxation in the background. Additionally, alternating between tension and relaxation as per progressive relaxation can be useful, and practicing yoga that might actually strengthen, solidify and tense your muscles.
  • Movement can be incredibly powerful. For example Hans Burgschmidt, as told in Jeff Warren’s brilliant article (worth checking out Jeff’s other work as well) various types of physical practice were key to Hans recovery. The most ideal thing is if we can engage in a group-based activity, in nature which we find engaging and physical challenging. Too much time on our own spent exercising might not be the ideal practice here. I think it’s great to do a combination of slower more meditative practices and also more intense exercise (cardio and strength training). Exercise is such a great support to our mental health.
  • Practice Gratitude and other more ‘cognitive’ practices. This means engaging meditative practices which actively keep our thinking and conceptual faculties on line. Sometimes the non-conceptual awareness of meditation is not what you need for robust mental health. This is where gratitude and savouring practices from positive psychology come in handy. We do a meditative practice when we actively reflect on the details of the different things in our life we feel grateful for, and we also tune into the feeling of gratitude in our body and hearts. In savouring we can cognitively reflect on what we are enjoying in the moment and subvocalize phrases that reflect this like ‘this feels good, I love doing x/y/z’ whilst savouring the pleasant aspects of our present moment experience. Also, the visualisation and imagery practices as found in Compassion Focused Therapy might be useful here.
  • Reading novels and enjoyable literature, and engagement in enjoyable hobbies. I found that in my difficult periods I was compulsively reading a lot of books on meditation, philosophy, psychology and consciousness science etc. For now, it would be worth putting down these books, stop listening to podcasts on these topics and step away from the YouTube dharma talk! If we focus on this it can continue to send the brain signals that we are trying to solve this uncertainty (around existence, the self, life, our symptoms etc) and it will keep the anxiety going that feeds the depersonalization. By all means you will be able to get back to reading and studying this material, but ideally in a more balanced and less compulsive way. For now reading enjoyable novels, engaging in artistic pursuits, learning a musical instrument, listening to enjoyable audio books might all be a better choice for your tired brain.
  • Join your community, and find connection. As is the case with many aspects of mental health, human connection is a key part of recovery. We are wired to connect and often people experience adverse effects in meditation when they may be isolated and lacking meaningful connections. I think that retreat practice can be a brilliant way to build mindfulness skills but often adverse effects occur in the retreat setting. Most retreat centres screen for mental health issues, but the silence and hours of intense practice are not the right approach for everyone. Be honest with yourself as to whether this is the right choice for you. Even the famous podcaster Tim Ferris experienced adverse effects on retreat, which he reports to be ultimately healing and leading in a positive direction, but were intense none the less. So, make sure you are connected and in community to support your practice. Join a group, especially one with teachers who are familiar and experienced in working with adverse effects. Maybe you would be better to practice being in the moment with awareness whilst listening and talking to a friend rather than sitting in silence. This was undoubtedly a part of what led to my experiences. In Jeffrey Young’s schema therapy, there is the concept of the detached protector mode that patients can experience. People who have experienced attachment trauma in childhood, learn to withdraw and depend on themselves. Experiences like DPD are often a part of this mode, in order to break this pattern, we might need to push against this isolated protector and connect with others. This could be part of a mindfulness practice, to engage in mindful and compassionate connection with others.
  • Be kind to yourself, don’t just sit through emotional adversity. As with a lot of my approach to mental health, self-compassion sits at the heart of it. There are many teachers who will just advise students to sit through any intense experience and develop mindfulness with it. You have brilliant teachers like Mingyur Rinpoche and Joseph Goldstein who both talk about using anxiety their own anxiety and panic to develop mindfulness, sitting and observing it closely. This is not always appropriate advice for everyone as demonstrated in some of the accounts I have linked to and in the trauma work of Treleaven and Rothschild. In my own experience I had levels of anxiety that I sat with, it was not uncommon for me to sit for an hour or longer with anxiety watching my body and mind and building acceptance. But then I hit levels which were far too overwhelming for me to sit with, the more I sat the more they would be the dominant emotion throughout the day and would intensify and disrupt my functioning – making me experience more intense levels of depersonalization and depression. What was better was to accept these emotions and then actively pursue meaningful activities in the world with people I care about, using meditation to focus out into the world rather than into myself. Teachers who advise this approach may not have experienced trauma, may not be prone to depersonalization and may have a very different brain to you. More sitting is not always better. Sometimes it can be better to use your meditation skills to accept challenging emotions and bring your focus to reading a good book, art or music or talking to a friend. Don’t spend a lot of time observing difficult thoughts and feelings (it’s easy to get tangled with old memories, or to amplify the fear through somatosensory amplification) instead label and passively disengage and then place your attention on something positive and meaningful to you.
  • Exposure and response prevention can be useful. It’s worth getting professional help with is aspect. If you have existential rumination/ocd alongside your issues it might be helpful. From talking with others and reading accounts of adverse effects there can be a connection to existential rumination typical of obsessive-compulsive disorder. This was the case for my own experiences. This is often pertinent in depersonalization disorder as described in the brilliant Overcoming Depersonalization Disorder by Katharine Donnelly  and Fugen Neziroglu (a book that I think is a must for anyone suffering from adverse effects along with Elaine Hunter’s DPD Book). Exposure was even a path of great meditation masters like Ajahn Chah meditating in charnel grounds and exposing themselves to existential fear.

Sometimes these existential ruminations are what keep the adverse effects going. There is excessive self-focus and checking of how we feel, intense reading of meditation literature or videos that discuss whether the self is real, whether we have agency, is life ultimately suffering etc all tangle together to feed the DPD. When the meditator is not practicing they might be ruminating on deep existential questions that have not been answered by anyone, that might cause terror and anxiety which further feed the issues. Sitting under this may be fears about losing ones mind, living an unhappy life or brain disease leading to death. As with other forms of OCD exposure and response prevention can be key here. For example, you can write out and read through an exposure script that runs through the worst-case scenario ultimately leading to mental breakdown, misery or death (Donnelly and Neziroglu’s book is an excellent guide on how to do this step). It can also be good to write exposure cards or to agree with these thoughts and expose yourself to them in the moment as per this excellent article by CBT expert Fred Penzel.

Then the response prevention means you use your meditative skills to accept the initial obsessional thought and then do not engage in the rumination of trying to solve these unsolvable mysteries of life. For this step, what has seemingly caused the issue is the tool to get out of it, i.e. the attentional skills developed through meditation. This is not to say that there is not a place to ponder life’s mysteries but generally people doing this are able to shut off their thoughts after some time of pondering, or these thoughts don’t cause intense anxiety or depression typical of DPD. You will be able to come back to pondering these questions and reading from time to time but for now it would be wise to reduce or stop any compulsive ruminating or reading on this topic.

I think adverse effects can be caused for a variety of reasons. They might be as simple as you are living a stressful life and its only when you sit still you notice how stressed and anxious you are. It might indicate that you have a trauma history, that might not be known to you, and that this might be resurfacing (this can be healing when it is done at the right pacing with a professional). They might be natural effects of deep and intense practice as have been described through the ages, and depending on how you frame them and how ‘robust’ your sense of self is, you might move safely between these ‘no-self’ states and daily life. They might also relate to individual genetic makeup and brains. For example, in the DPD world a lot of people are triggered through taking drugs. And this demonstrates how different brains can react to different stimulus, as many people take drugs without experiencing DPD, it could be the same with intense meditation practice. It could reflect other underlying mental health issues, or your vulnerabilities from your childhood attachment histories. Clearly it is a complex topic and I’m sure the work of scientists like Britton will begin to shed light on the nuances so that everyone can benefit from the positives of meditation at the right ‘dose’ and pacing. Some people never experience this territory, others do for brief periods without major impact to their lives, but some people do get stuck in these modes for long periods of time. Hopefully especially the latter group will benefit from ideas in this post. Feel free to contact me if you have any queries about adverse effects as a result of meditation practice.

Getting Your Five a Day of TLC

I am a big fan of the short mindfulness practices that you can integrate into your day. Exercises like the STOP practice, the 3 minute breathing space and the self-compassion break. I often say to participants in our 8-week courses to try to get your ‘five a day’ of these short mini-mindfulness practices. A lot of people struggle to keep a consistent daily practice and these short practices can still strengthen your abilities in mindfulness, even if you are struggling to sit for 10 or 20 minutes daily.

You can link these practices with simple daily tasks like brushing your teeth, showering, having a cup of tea, waiting for your computer to turn on, queuing (a particular favourite of us Brits) or travelling on a busy commuter’s train. They are also a useful way to prepare for a stressful event, you can do the STOP practice before a difficult meeting, presentation or conversation. They can also be used to help manage stress throughout the day. Try to get your five a day of mini mindfulness practices (like you would your fruit and veg) and see if it is useful for you.

My own version of a mini mindfulness practice is TLC. I think the name is useful to give a sense that this practice is your way of being kind and supportive to yourself. Here are the stages:

  1. Take a deep relaxed breath– this can be one breath or as many as you need. You can use a soothing breathing rhythm. Check out a lot of information about the power of breathing at Emma Seppala’s brilliant website
  2. Label what’s happening in your emotions and thoughts. For example, silently say to yourself ‘I’m feeling stressed, I feel tension in my chest, my heart rate is up and my thoughts are catastrophising’ and then bring your attention back to what you are doing. Matthew Lieberman’s brilliant work has shown the power of affect (emotional) labelling
  3. Compassion, give yourself compassionate self-talk and behaviour. Use a gentle compassionate coping statement like ‘this is painful, but I can handle this’ and make sure your next steps reflect compassion and kindness to yourself in the long run.

So why not give it a try and see if you can get your ‘five a day’ of mini mindfulness practices like TLC. You can set reminders on your phone, you can put reminders in your house or you can link it with behavioural habits you already have like brushing your teeth. Give yourself some TLC today!

Behavioural Activation Part 6 – A Tool for the Future and a Promethean Act of Will

William James (1842 – 1910), the philosopher and pioneer of American psychology (teaching the first psychology course in the USA at Harvard) suffered bouts of depression throughout his life. At times they took what he described as a ‘Promethean Act of Will’ to overcome this ‘crisis of meaning’. BA is a tool that you can use for the rest of your life. At times it will be easy, for some people at times, it will require James’ Promethean Act of Will.

You may have times when you use BA more formally and write down an hour by hour daily plan. Other times you might use the principles to ensure you are giving yourself a balance of pleasant and mastery focused activities. You may completely forget about BA at times and then decide to come back to it if you notice changes in your mood.

These last two points are considerations for the future:

9. Prepare for lapses – Unfortunately for most people with anxiety or mood disorders there are likely to be lapses. When life throws new pain and losses at you, stress levels rise, or we stop looking after ourselves so well, then old brain pathways can resurface. Be ready for this and restart what worked as soon as you notice any signs of a lapse. Start planning BA and use your other tools as soon as you can. This was one of the key ideas of MBCT, the ability to detect the early warning signs of depression using mindfulness and to start to take care of ourselves early with BA.

10. Connect and get help – I have mentioned already that a number of these steps work better with friends or in groups. However, we have to watch for the tendency to ruminate out loud with another person. Can we instead put our attention on what they are saying, on their life? Can we do shared activities together rather than talk about our depression? It can be useful to talk to a professional therapist or a close friend or family member. But if it seems like we are going over the same unsolvable loops out loud, then try to switch into a problem-solving mode of what actions you are going to take, or observe and accept the thoughts whilst taking action with the other people.

Again, it’s worth noting that indigenous communities with lower levels of depression tend to spend almost every hour of the day with their friends and family. As they say in Dialectical Behavioural Therapy we need to do opposite action to what the emotion is telling us. So, try to connect with others and face to face connection is always best! Our blood pressure lowers and our heart rate variability improves when we are with friends, its how our nervous systems have evolved!

It can be really disheartening if we experience a lapse or a relapse in our symptoms. It can be important to contact our therapist right away or to connect with our support networks. Depression can resurface but if we continue to practice what worked and to open up with acceptance to these feelings and pursue meaningful activities, then we can recover again. As we develop these skills in a lapse, we actually become more confident that we know what to do next time. Each time we experience these difficult emotions and develop the ability to focus on meaningful goal-directed actions with the people we love (willingly carrying these emotions on our backs), our confidence grows. We get stronger through these promethean trials, much like a right of passage. I hope you have found this series useful and feel free to share any thoughts or questions in the comments below.

Behavioural Activation Part 5 – Lets Get Physical – Activate Through Activity

If you look at many high functioning people who have experienced depression, you often find exercise is part of their recovery. The likes of Tim Ferris, Stephen Fry and world class endurance athlete Christopher Bergland all have credited exercise to helping them maintain and improve their mental health (if you do a little more research online you’ll find the list is extensive). Exercise has been found to have comparable effects to anti-depressant medication in a number of studies. Not to mention the fact that there are all of the additional health benefits of exercise.

But what if you can’t get off the couch, out of bed or think clearly enough to exercise? We all find it difficult to exercise at times, imagine how difficult it is when you are suffering from major depression and you can barely move. I have experienced this dark place myself and it feels like an Olympian feat to simply get moving! But we do have some agency in the painful abyss of depression. We can strengthen the ability to make healthy choices whilst carrying these Atlas-like emotions on our backs. This is where scheduling physical activity in your BA schedule can be so helpful and having the support of friends and family to get you moving. Here are a few other ideas that might help:

7. Start small and build up – Walking is a really useful tool here. The key is to start with a really small and gentle amount. This might even be walking round your house for 2 minutes. Then moving onto a 5-minute brisk walk, then 10 minutes round the block and upwards. Also try integrating exercise with things, you have to do in your day – like commuting, shopping or visiting friends.

Exercising with other people is even more powerful and if you get out in nature as well then you have the coup de gras. It can be beneficial to do a mixture of relaxing and slow exercise like yoga & tai chi and also more intense aerobic exercise & weight lifting. This combination can have a really positive impact on our mental health.

8.What if it’s boring – A lot of people find exercise boring, even when they are feeling well, so (as always) be kind and self-compassionate. If exercise is boring then you might not have found the right fit. What did you use to enjoy before depression? Think back to when you were a kid (a useful tool for filling your BA schedule more generally) and what games, sports, outdoor activities did you use to enjoy and can you add them back in? Connect with other people in groups. Get an exercise buddy to help motivate you. Sometimes (as long as we have the all clear from our doctor) boredom can be a sign that we are not pushing ourselves hard enough. We might need a bit more sweat to access the pleasant rewards of exercise. Its also important to congratulate yourself in your head for achieving your goal when you finish your exercise. Many people don’t do this last step and often berate themselves and go straight into negative rumination after exercise.

Can we use exercise to train our focus and concentration, either through mindfulness of movement and breath or even by listening to music or a favourite podcast? Every time our mind drifts away we notice and come back. Sometimes people use exercise as a time to ruminate, engage in self-criticism or to worry. Can we notice and accept these thoughts and bring our minds back to the present moment? You can use encouraging self-talk to help you as we have talked about in the previous articles. Just like an endurance athlete encourages themselves internally and thinks of their goals.

Some theorists suggest that the stress of living a modern life, far from what we evolved for in the Pleistocene epoch, is one cause of the rise in depression. Indigenous cultures that report much lower levels of depression tend to get 4 hours + of exercise a day (just by going about their day and living their lives) and middle aged and older individuals are built like Olympic athletes! Can we reclaim a bit of this indigenous antidepressant lifestyle by building more exercise into our lives? Alongside exercise, a healthy diet and sleep are incredibly important ways to take care of ourselves and build into our behavioural activation. We will look at these topics in future articles.

Let me know your favourite ways to activate yourself through exercise below?

Behavioural Activation Part 4 – Actions Speak Louder Than Thoughts and Emotions

Our feelings have evolved to hijack our attention, behaviour and motivational systems. At times this can be incredibly useful, even lifesaving. But there are times when the better-safe-than-sorry ‘smoke detectors’ in our brain produce feelings that drive behaviours that don’t help us! There is a level of sadness which can be useful in helping us to pause and reflect, to feel love and compassion or to appreciate the bitter-sweet flavours of our life’s banquet. But there is a level of sadness that pushes us into a numbness or painful states of depression that induce shutdown and social isolation. The pain can be unbearable, there are even common neural correlates in the brain between depression and pain. These agonising feelings can place real barriers to behavioural activation. Often, we need to do the opposite to what our feelings are telling us. We need to get up and exercise when our beds call soporifically to our exhaustion. We need to contact and connect with our friends when every impulse in us is saying to avoid them and retreat back to the cave. We have covered a number of useful tools for working with painful emotions in part 3 of this series, but here are two more ideas to put in the mix:

5. Fake it till you make it – as Mark Freeman says ‘focus on changing actions, not thoughts and feelings’. It’s much better to do your chosen BA actions focusing on what you are doing and trying as best as you can not to monitor how you feel. Excessive self-focus is a large part of the problem. Can you aim to have far more of your focus out on the world and the people you are with? You may very well feel awful when you first start BA, but can you improve your ability to function and concentrate whilst these difficult thoughts and feelings are in the background? Can that be your aim, rather than aiming to feel better?

It is likely it has taken months and years to build to this point of your depression. It might well take some time to break the patterns that led to it, so it’s far better to focus on achieving your goals and concentrating out into the world rather than whether or not you are feeling better. Do the activities you used to enjoy, or new activities that reflect your values even if you don’t feel like it. Having experienced depression, anxiety, depersonalisation and OCD myself, I know how difficult this is, but if we progress gradually then we can get better at changing actions with the heavy thoughts and feelings in the background.

6. Parallel emotions – Another useful concept that I found in the work of a number of expert’s (Mark Freeman ,Reid Wilson, Leslie Greenberg) is the concept that you can have emotions in parallel. There is space for depression and gratitude, anxiety and savouring. In fact, Greenberg (leading researcher and expert on Emotion Focused Therapy) has found that to transform painful emotions they need to be activated alongside positive emotions. Can you learn to accept or tolerate the emotion whilst your concentration is on something enjoyable or satisfying? We really can train this skill of concentrating on gratitude, savouring and flow even when our concentration feels weakened by depression. I found flow to be particularly useful here as we just need to (i) focus (ii) have goals with clear feedback, and (iii) have a balance between our skill and the challenge (not too easy or too hard).

The key is not to battle with our painful emotions. We can use different tools to help us tolerate and then accept our pain but we need to try and develop them alongside our pain, not to battle with it. You might also find my article the acceptance spectrum useful for ideas on managing challenging emotions.