It’s like Riding a Bike – the Practice of Happiness

Happiness is a lot like riding a bicycle, if you think and concentrate too hard on each process, you are likely to start to wobble and ultimately fall. You have to be gentle and feel your way into the process, and then reduce analysis, rumination and questioning as you are gliding along – or bombing down steep mountain trails! And yet you have to practice. Some people are naturals and others struggle. This can relate to genetics, early attachments, life experiences and more. I love this topic, as I have had my own struggles with happiness over the years linked to my own mental health challenges and have observed this being a common pattern for people I have worked with. For people experiencing both anxiety and mood disorders happiness can be tricky. Working with clients with varying mental health challenges (like OCD, generalized anxiety disorder, panic, depersonalization disorder and depression) I have seen many ways that difficulties with happiness seem to play out. It may be really hard to let yourself enjoy life. We might struggle to ride our bike. We might need to start with stabilisers or a helping push.

A few examples of how these barriers to happiness might look include:

  • Depression is characterised by numbness and anhedonia or an inability to experience positive emotions. Thought processes play out like the self-attacking inner critic ‘I don’t deserve happiness’ or existential barriers like ‘this won’t last anyway, what’s the point, life is short’. For other people it’s more felt sense based: strong feeling barriers like numbness and psychological pain block the small sparks of positive emotion. Professor Richard Davidson’s work showed that depressed people do activate their brains reward system in the presence of positive experiences, it’s just that it does not stay activated and soon fades. In people without depression the reward centre lights up and burns brightly long after a positive event ends. There are brain based barriers to the reward and motivation to experience happiness. People may struggle to have the attention or cognitive capacity to concentrate on things enough to enjoy them.
  • If we take psychiatric medication (which I think has its place in recovery especially in acute phases of mental health challenges) we may find our emotional range is blunted so that we feel fewer positive feelings. Meds can take away the extreme pain of negative emotions but they can also flatten out happiness and positive emotions.  
  • In anxiety disorders people often have anxiety triggered when they start to feel anxious and experience less positive emotions as anxiety increases. If the cognitive process of worry is a stronger component (rather than felt sense anxiety) then people may worry happiness won’t last, that they don’t deserve happiness, they won’t achieve things by making time for happiness, they need to think about others and worry if they relax and enjoy something, they won’t be able to spot danger. Or it might be the sensations and felt sense of anxiety is the barrier. The gnawing feeling in the pit of your stomach or your pounding heart makes it hard to enjoy the moment. I used to experience panic attacks when sitting back to enjoy some music. I would experience nausea, beating heart, tunnel vision, depersonalization and other perceptual changes of anxiety ‘amping’ up as I tried to enjoy a new album.
  • In OCD people may have obsessive concerns about safety and threat that simply don’t allow much space for happiness. If people have obsessive existential thoughts they may ruminate and question around life, meaning, happiness, reality etc and these obsessions may block the ability to relax into pleasure and joy. OCD often targets the things we care about the most, so if we value enjoying life, intrusive thoughts or sensations may threaten to distract and ruin our happiness indefinitely.
  • In depersonalization disorder our attention may be so hijacked by feelings of unreality in ourselves or the world that it becomes difficult to engage in experiences that bring pleasure and happiness. Happiness may feel remote and distant or a concept that itself feels unreal.
  • In trauma our current reality may be so hijacked by past traumatic events that we can’t experience pleasure and may be immersed in panic, psychological or emotional flashbacks or depression. It can feel like there is no time to enjoy experiences when we are in survival mode.
  • Clearly there are other ways this could play out in other psychological disorders like manic depression where the highs, hijack pleasant states so that we may not even feel present to enjoy them, or the pain of the lows overpower the highs. We may not be able to enjoy simple and relaxed pleasure that doesn’t measure up to the euphoric states. Positive emotions are ‘too highly’ up regulated and our behaviour risks relationships or our own safety. Addictions hi-jack the reward system and dampen its effects over time, we go from enjoying our drug of choice to needing it to stop deep psychological and physical suffering. Or we might have perceptual disturbances in psychosis etc that mean it is so difficult to connect with the present moment and experience happiness.

These are just a few examples. The human brain is so complex this could play out in many other ways. It seems that an element of difficulty with happiness manifests in many, if not all, mental health challenges. Others have written about this and arguably positive psychology has attempted to work directly with this challenge. Mark Freeman talks about the most challenging exposure being to enjoy life, Shala Nicely talks about emotional compulsions that might block happiness and in Miriam Akhtar’s excellent book ‘Positive Psychology for Overcoming Depression’ she talks about how she used to question ‘but am I happy’ in the presence of pleasant experiences and this intellectual process would rob her of her happiness. My mind would create barriers to happiness in different ways. For example, I would ruminate existentially about things like happiness ‘what is it and am I feeling it’, I would feel anxiety and depersonalization activated in the presence of happiness or my depression would overshadow it with pain and numbness or throw up questions about the futility of happiness. At one point my partner joked with me that I was ‘serious about happiness’.

To work with this, I have found that standing facing into the storm has been key. Like with anxiety treatment, exposure to what we fear the most, without doing compulsions to remove the uncertainty and anxiety has been so useful. Learning to accept uncertainty and not answer questions my brain throws at me around happiness; accepting painful emotions; and focusing on pleasant experiences have all become practices and skills I have developed (and continue developing) over time. Practice being happy. Schedule positive events, make time for savouring and gratitude and when your own unique mind tries its method to control happiness, remove uncertainty, spot threats , question it etc then notice and accept this and then engage back into the present moment. If there is a tiny portion of positive emotion, gratitude or engagement then lean into and cultivate your connection with it.  Connect with other people and savour together. We learn to ride our bike with others, often more skilled than ourselves. Be kind and gentle with yourself, the practice of happiness is closely linked to self-compassion. As Rick Hanson say’s ‘take in the good’ and ‘marinate’ in a positive experience long enough for it to form lasting neural changes in your brain.

Another interesting point is that we often think we can’t experience positive mental and emotional processes in the presence of pain. But in reality, we can. Normally the pain overshadows and eclipses the positive experiences but with practice we can feel gratitude, meaning, engagement and joy in the presence of psychological or physical pain.

Just like physical fitness this takes practice. Especially if you are not one of the naturally happy folks. You might need a little longer with the stabilisers on the bike or with someone running alongside you. But we can all get better at riding our bikes and then we never really forget it even if we get a little rusty.

Why not plan three pleasant events for the next couple of days and engage deeply in them no matter what stress, depression or fear is in the background?

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?

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.

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 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 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.

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.