Daily Compassion (Guest Blog)

This was a guest blog that I wrote for the brilliant 365 Days of Compassion Blog

It’s early February and you can’t quite fathom that you are breaking all your New Year’s resolutions. You are a month in and you are already overeating, missing the gym, drinking a glass of wine, the house is a mess, you’re berating yourself with a harsh inner voice and you’ve just had a needless argument with your spouse (insert relevant New Year’s resolution here)! We’ve all been there. The 12th of January is called quitters day for a reason. Our new positive behaviour has not persisted even through January. If this happens for eating less chocolate then what hope is there for having 365 days of compassion!

There is a cultural narrative that people don’t stick to their resolutions. It’s even a cliché to say new year new me. But behaviour change and psychology expert John Norcross tells us that actually 40% of resolvers are successful at 6 months. The critical window is maintaining the behaviour for 90 days to modify a habit. This includes really sticky addictions. The difference between the people who achieve this, is that they utilise their slips to renew their motivation to change. The average number of slips in the first 30 days is 6 and incredibly the number of slips does not predict whether someone will accomplish their goal. Compassion is a motivation as Paul Gilbert says, and is reflected in behaviour that we can cultivate and update. So even if compassion is not a strong character trait for us, it is a skill on a spectrum that we can develop. There is hope!

Because of our tricky brains, compassion and kindness can be difficult behaviours to modify. The following is some of the key barriers I have experienced teaching compassion and in my own mental health history:

• I can be kind and compassionate to other people, my friends and family, but not myself.This seems to be the most common barrier to compassion that I come across in my teaching. If we have internalised a strong critical voice in our childhood; if we have been abandoned or neglected; if we have not had our core needs for safety security and love met; then this critic can develop. It can take time to push into this barrier and to acclimatise to self-compassion. We can start with this focus on others and gently over time move it towards ourselves.

Self-compassion is weak, I won’t get anything done if I let myself off the hook. It can seem like our greatest achievements coincide with an inner voice berating us to keep going. But often this is correlation and not causation. We can motivate and instruct ourselves in a kind and supportive way. Like a good coach or teacher, we can be firm but kind and accepting at the same time. Compassion like many of the best things in life is imbued with paradox. Paul Gilbert often uses the analogy of two schools we are choosing between to send our children. One is shaming, criticising and attacking to get the kids to study. The other is firm but kind, supportive and compassionate. Why do we keep sending ourselves to the cruel and shaming school?

I’m not worthy and don’t deserve compassion. This is linked to shame, where we think or feel a global sense of not being good enough. This is closely connected to the first point. It was one of the key reasons that Paul Gilbert developed CFT. Because it is very difficult to engage in psychotherapy if we feel shame and hopelessness to our core. Like rocks in a pond we will keep sinking to the depth of our shame if we don’t engage with this at the root. It can be so useful to engage with a kind, supportive and affiliative therapist if we are struggling with shame. Often people with this barrier may describe a belief that everyone deserves kindness. But their felt sense is that they are not included in this group. The compassion practices (like the inner critic work) can be so useful here. Sometimes we need to move through rage and sadness in order to shift the shame to self-compassion and acceptance.

I can’t do compassion it doesn’t feel safe. If we have grown up with environments where those who cared for us were also punishing, cruel, neglectful or abusive then we have an inbuilt distrust of closeness and warmth. There are even studies showing some people who have experienced this pattern, release more oxytocin (often called the love or cuddle hormone) in conflict than in closeness. This distrust was adaptive in our childhood, but now it does not serve us and our need for safety and connection. This is an area where a therapeutic relationship built on empathy, attunement, congruence and validation can be so critical.

My mind is too crazy to be compassionate. If we are struggling with mental health challenges like anxiety, panic, OCD, depression and impulsivity then compassion can feel like a real workout for the mind at first. There may be doubt, self-attack, worry, intrusive thoughts, panic and other painful emotions as we begin to develop compassion. If we are depressed, we may feel nothing at all or we may feel shame and contempt. This ‘backdraft’ as Kirstin Neff calls it, can make people give up on compassion. But remember that compassion is a motivation and intention which may or may not come with feelings of love – think of the fireman running into a burning building, who is more likely to feel focused and fearful than warmth, peace and friendliness. It is a skill rather than a binary quality. We can develop it like learning a musical instrument.

There are other variations on these barriers, but these are some of the common ones I have experienced in myself and others in teaching. In terms of working with these and sticking to your resolution for 365 days, here are 6 tools that I have found useful:

1.Short practices many times – there is a principle in Tibetan Buddhism that states ‘short moments, many times.’ I think this can be incredibly useful. Gradual exposure is a principal that is highly effective in treating anxiety disorders. But this principle can also be used when positive emotions feel threatening. As stated above this can be because our soothing and reward systems have not been up-regulated and welcomed in our early attachments. Or our threat response might be directly connected with positive emotions. So, we can gradually expose ourselves to compassion in short practices, many times so that they become more natural and secure.

2.Narrate your day in a kind accepting way – our self-talk is such a useful tool for cultivating compassion. It might be worth taking note of how often the critical voice shows up throughout your day. For some this might be a clear and familiar inner voice. For others it might be more subtle thoughts and imagery or a felt sense of shame in the body. After you have spent a few hours or a day noticing this, see if you can gently bring in – a parallel and supportive voice. It doesn’t need to battle with the critic, and it should be focused on acceptance and kindness towards yourself. Overtime more of your attention is on the kind internal voice and eventually it starts to show up automatically when you drop a pile of plates! Engage your compassionate inner coach as Mary Welford brilliantly puts it.

3.Focus on behaviour and the thoughts and feelings will follow – often our behaviour is the aspect of our experience we have most agency over. Set goals for your day and week that manifest compassion and kindness for yourself and others. Take a bath, call a friend, walk in nature, give yourself the evening off, reduce procrastination thinking of yourself in the long run. Connect with another person who has this value and compassionate goals. Focus on your core needs for safety, connection, creativity or freedom together.

4.Be compassionate to our resistance and build compassion in parallel – if our mind throws up the critic, the catastrophiser, panic, shame etc try to meet this with compassionate attention, thinking and imagery. Send your loving kindness to these vulnerable parts and modes of our tricky brains. Compassion can be built alongside fear, shame, depression etc. Can we hold these emotions with compassion and steadfastly continue to be kind to ourselves and others? Just like in meditation – when our mind drifts away from the object we gently and kindly bring it back. We do the same if we lose touch with compassion throughout the day. In the beginning or during times of stress we may need to do this many times in a minute.

5.Join a compassionate group, community or find a compassion buddy – humans can’t survive well on their own. Our soothing system is built to activate in the presence of kind and supportive friends and family. Our ancestors spent almost all their waking day in the company of others. So, try to connect with a compassionate community or buddy to build these skills together. A virtual community like the 365 Days of Compassion can support you in this.

Why don’t we turn our slips into renewed motivation and keep coming back to compassion for 365 days?

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.

Behavioural Activation Part 2 – Why You Need More than Common Sense

As I wrote in part 1 BA is a common-sense approach to mental health. The problem is when you are in the depths of depression and anxiety the logical common-sense part of your brain is inhibited. You also struggle to hold on to the positive experiences in this state. In fact, at times your brain actively seems to resist them. Professor Richard Davidson elucidated this in his brilliant bookThe Emotional Life of your Brain’. Davidson describes that in comparison studies, depressed patients report the same level of positive emotion in response to pleasant stimuli. The difference is in the half life of these positive emotions. In the control group these positive emotions increased as the subjects reflected and savoured the experience, whereas, in the depressed individuals the positive emotions dropped away sharply. This was reflected in the brain region related to reward and pleasure, the nucleus accumbens. The ‘notes’ of pleasure in the brains of depressed patients were trailing off far quicker than in healthy controls. I think anyone who has experienced depression will relate to this, there are moments of happiness and pleasure, but these are often followed by even deeper lows as you lament for what slipped through your fingers. Sometimes these highs are so subtle that they even go unregistered, so the depressed person is tricked into believing there is only the darkness.

There is also the lack of motivation or the paralysis of fear to deal with. You literally can’t get yourself to think, move or act in a positive way. You might even know what will help you but your body doesn’t seem to move or your overwhelming thoughts convince you that nothing will help or you don’t deserve recovery.

Many theorists posit that depression has an evolved function. In the days of our ancestors this mood state would induce you to go back to the cave to rest and avoid danger. Or it might mean that you kept a lower status in the group so that the dominant members of the tribe would not attack you. Is it perhaps a mechanism that in smaller dose’s can be beneficial, but is not designed for our modern world? Is depression triggered by an overactive physiological response to the everyday stresses of modern life? These theories make sense to me. Perhaps we can use them to help us be kind with our harsh inner critics and cut ourselves some slack. After all, it is not our fault that we have tricky brains.

So, what can you do when you are depressed and want to utilise BA? As MBCT states ‘In depression, we have to do something before we are able to want to do it’. Over the next series of blogs, I’m going to describe 10 tools that have helped me. Needless to say, it will always be most effective to do BA under the guidance of a trained professional.

 

  1. Divide and conquer – The science of procrastination has a lot of transferable tools here (see Prof Timothy Psychl brilliant book for more details). Divide every task up into smaller and smaller chunks, until it seems possible. At the extreme end of the scale, getting out of bed and going downstairs for breakfast could be divided into multiple steps, each one being focused on in turn. Start small in terms of changes, with one or two new items added to your schedule a day (or week). Start with the simpler tasks and build up to anything more challenging.

 

  1. Put it down on paper – As discussed in the first article, BA is typically recorded hour by hour on paper. It really helps to write the plan down and focus on each hour rather than the potentially overwhelming full day or week. Generate and write down your list of pleasure and mastery activities that reflect your values and goals.

 

These first two points work in partnership. Putting our plans down on paper helps us to divide and conquer. But what happens when your thoughts and feelings resist this process? We will take a look at tools to work with our tricky minds in the next article.

Behavioural Activation Part 1 – A Common Sense Approach to Mental Health Your Gran Would Agree With

I think the best psychotherapy and well being programmes have common sense overflowing from each practice, intervention or tool. Would your Gran have told you to do this when you were a child? Did the Greeks, Stoics and indigenous cultures do these things either consciously or as part of ‘the Good Life’? If the answer is an unequivocal yes then it’s definitely worth exploring. Behavioural Activation (BA) is certainly one of these common-sense tools. When we feel depressed or anxious we tend to isolate ourselves, stop doing things that make life meaningful and ruminate on our suffering. BA teaches us to challenge this by doing the opposite, making a list of varied activities to nourish our brains and recover our moods. Its not easy when you are depressed but it makes sense.

Mindfulness Based Cognitive Therapy (MBCT) was primarily developed for maintaining recovery from depression. Its creators had previously been experts in Cognitive Therapy and mixed elements of this with mindfulness in MBCT. One aspect was BA and they titled the session that focuses on it ‘How Can I Best Take Care of Myself’ to reflect the compassion embodied in Jon Kabat-Zinn’s original formulation of Mindfulness Based Stress Reduction.

BA came from the behavioural tradition of psychology, and holds that depression stems from a lack of positive environmental factors and/or too many punishing factors. There are different varying approaches to BA, often they start with an analysis of how you are spending your time hour by hour each day. How do these activities impact your emotions and moods? Then identifying positive experiences to add in and negative experiences to remove. This is followed with tracking the impact on your mood of increasing these positive steps and reducing negative factors. In MBCT we identify positive events by two categories: pleasure activities and mastery activities. Pleasure activities are inherently rewarding and involve enjoyment like talking with a close friend, eating nourishing food, listening to beautiful music etc. Mastery exercises give us a sense of satisfaction through mastery of our environment, like tidying our house, planning our monthly spending etc. Of course, there can be some overlap between pleasure and mastery, but it is good to schedule a balance of these activities.

It sounds very simple, but this can be a herculean task when you are depressed. When the weighted shirt of depression is on you, it can be a huge task just getting out of bed. You can’t think straight, your own mind is attacking you with the weapons of doubt, self-criticism and meaninglessness. So how can you use BA to move through the quicksand of depression or the paralysis of anxiety? In the next article I will explore some ideas that have helped me when using BA to work with my own anxiety and depression.