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?

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.

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 3 – The Internal Saboteur

Its official – there are parts of us that are not in our own corner. In the clasp of depression this can show up as an internal voice or feeling that sabotages our efforts to make positive changes. It might be that heavy thick feeling of pain or it might be the voice telling you that ‘this isn’t working and you’ll never recover’. Many modern approaches to psychotherapy see the brain as made up of different systems or competing parts. In evolutionary psychology this model is called the modular mind. It’s even reflected in our language when we say ‘part of me wanted to do x’ or ‘I’m in two minds about y’. We even see it explored in literature like Dr Jekyll and Mr Hyde. Unfortunately, this layered network of different evolutionary stages can overreact, misfire or even turn on ourselves as the inner critic. These competing parts can have a large role in depression. So, what do we do to cope with this internal sabotage?

3. Talk to your self – I’ve mentioned the power of compassionate self-talk before on the blog. Just think of an endurance athlete and what they say to themselves in their heads to push through the pain and focus on their goals. In many ways this is a close replica of the depressed person. It is often an endurance event to get through the day. Use self-talk to both help concentration and motivation.

Emergency service drivers are taught to narrate their driving to help them concentrate when they are sleep deprived. You can do the same here: gently and kindly narrate what you are doing. Narrate each step and congratulate yourself when you achieve each step. Be the compassionate coach that Mary Welford describes.

There are studies that show that using self-talk can enhance your abilities in many areas, even finding lost items. So, use this skill to help you function when you are struggling. You can slow down the self-talk if you are struggling to concentrate, you can even talk to yourself out loud if you are in the right place for that. Its highly likely you will have the negative inner critic voice there as well, aim to have these voices running in parallel (rather than competing). Can you listen to your own positive, compassionate self-talk while the critic continues in the background? Can you focus more attention on the kind voice than the critic? It’s a skill that can be trained so it is unlikely to produce miracles right away, but give it time. You are strengthening this skill each time you try.

4. Dealing with rumination/negative thoughts – its widely acknowledged that negative ruminations feed depression. They will come up as you do BA. As in the point above try to let them be there as you focus on your kind self-talk and the actions you are taking. You might try to use the 3-minute breathing space from MBCT. Or you can label what you are feeling and remind yourself of your values (for example to be happy and health, to support and love others, to enjoy life etc).

Can you try to accept your negative thoughts and not fuel them with further rumination? Instead keep bringing your attention back to what you are doing and focusing on your goals. This is just like meditation; in the beginning of practice you need to keep returning your focus to your breath, until eventually you can stay focused on the breath while your negative thoughts float past in the background. The spotlight of attention is on what you are doing. The volume is turned up on thoughts that aid performance and the critic is turned down.

Also, choose some activities that help you break negative rumination cycles. Have an enjoyable and engaging book to hand, using the language systems of our brains can help to quieten the rumination cycles. Play fun computer games, do puzzles or sudoku, do sports, talk to people about things other than your ruminations. Even better, do activities outdoors with other people.

 

Why not give these tools a try and let me know what you think?

We will cover some tools in the next article which focus particularly on the emotional feelings that can challenge the BA process.