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Monday, February 25, 2013

Mindfulness Concept #3: Awareness of the Sensory World Around You

As I work with clients to get them out of their (sometimes seemingly endless) rumination about the past and the future, I sometimes ask them, "How soft is your chair?"  My chairs in my office are reasonable comfortable and soft, albeit somewhat worn from years and years of patients sitting in them.  The answer is invariably something like, "It's fine."  I then follow up with, "How's the room temperature?"  And again, the answer is usually something like, "It's okay."  And so on.  "Are you hungry, or are you satisfied right now?" I may ask.  Sometimes my patient is aware of hunger, sometimes not.

Why do I do this?  To point out that in the instant they are assessing the softness of the chair, the warmth or coolness of the room, and the state of hunger or satiety, they are no imaginary monsters stalking them.  There is no monster from the past making them feel guilty for what they have done or not done ("should statements" or reverse fortune telling).  There is no monster from the future about what might happen (catastrophizing).  There are only the awareness of the present. 

This is sometimes referred to as "getting off of autopilot."  Sometimes, a mindfulness approach by Dr. Jon Kabat Zinn is just to help someone eat one raisin with full awareness--without being on autopilot.

I had mentioned in a previous blog one of the techniques I use to heighten my sensory awareness.  I ask myself, what would I paint in the scene before me?  As I look around my study right now, I can ask myself that question.  Is it the cluttered stack of mail in front of me?  Probably not.  I look at the Poinsettia slightly past its prime.  Would I paint it?  Not in the state that it is in, but then I notice the lovely redness in some of the leaves.  I had totally overlooked that when I walked in the room and when I started typing!  At the moment, I find no clear subject, but I also realize that with just a little rearranging, there are actually many possible subjects.  I am also aware of the many little pieces of art, none of which are expensive, but all of which have some interest in them.  With just a slight rotation of the Poinsettia and a leaf fallen on the desk below it, maybe it would made a good painting after all.

Why is this important?  Because there is a tendency for us to go on autopilot.  We have so many things.  We work hard for a life of many things, and then we ignore them.   We continue striving.  And striving is good in some ways.  But I do not believe that it is good for us when we only strive to have more, but cannot take the time to appreciate what we then have. 

Our senses are a way out of our mindless striving.  Why do I refer to it as "mindless" striving?  It is mindless because we are often on autopilot.  And it is mindless to acquire things just so that we can ignore them.  It is mindless to strive without having a good reason to strive.  It is mindless to strive but then not enjoy the fruits of our labors.

In a previous blog, I referred to the thin tropical island of the present.  In that world, our senses help us to get in touch with the physical reality around us.  When we are looking, we can really look at the present.  When we are listening, we can really hear the present.  When we touch something, we can really feel it.  Or taste it, or smell it.  And when we are doing that then are almost always in the present and out of the clutches of the real or imagined demons of the past and future.

Sunday, February 24, 2013

Mindfulness Concept #2: Self Compassion

Principle 2.  Self Compassion

Thias, again, can be thought of as the flip side of cognitive therapy.  In cognitive therapy we try to reduce or even get rid of should statements.  Shoulds are often directed towards the self in a very self-punitive way.  We might say to ourselves, "I should have done better," "I should have studied more," etc. 

Consider this quote from Karen Horney regarding the "tyranny of the shoulds."  She described the attitudes of someone whose thinking is dominated by such thoughts:

 “He should be the utmost of honesty, generosity, considerateness, justice, dignity, courage, unselfishness.  He should be the perfect lover, husband, teacher.  He should be able to endure everything, should like everybody, should love his parents, his wife, his country; or, he should not be attached to anything or anybody, nothing should matter to him, he should never feel hurt, and he should always be serene and unruffled.  He should always enjoy life; or, he should be above pleasure and enjoyment.  He should be spontaneous; he should always control his feelings.  He should know, understand, and foresee everything.  He should be able to solve every problem of his own, or of others, in no time.  He should be able to overcome every difficulty of his as soon as he sees it.  He should never be tired or fall ill.  He should always be able to find a job.  He should be able to do things in one hour which can only be done in two to three hours.”

I have worked with people for years to eliminate the unnessary "shoulds" from their lives because they are unnecessary and because they usually cause feelings of tension, guilt, or inadequacy.  I like the concept of self-compassion because it works on the same issue but phrases it in a positive way.  Getting rid of unnecessary shoulds can be a step in self-compassion.

Some people are able to be compassionate towards others but not towards themselves.  We all make mistakes.  Sometimes they are big mistakes.  Sometimes we can make amends for what we have done, and sometimes we can't.  Either way,  we need to learn self-compassion.  We all engage in negative mental behaviors, such as ruminating, focusing on faults, etc.  We need self-compassion for those behaviors, too.  For people who are good only at compassion toward others, it may seem odd, peculiar, or even immoral to have compassion toward oneself.  It need not be. 

I'm not talking about murder here.  I'm talking about the tendency to be harsh on ourselves for unhealthy behaviors.  It might even be for something our therapist asked us not to do.  For example, I may suggest that someone try to eliminate the word "should" from their vocabulary.  For many patients, the next step is that they are telling themselves that they "shouldn't" use the word "should."  See the vicious cycle?  There is no vicious cycle with self-compassion.

Some might argue that self-compassion means that we will tolerate negative behaviors in ourselves.  That need not be true.  If I am aware that I am procrastinating, I can work on new ways to overcome that without beating myself with shoulds.  I can accept that this is a problem that I have had--for whatever reason--and at the same time be determined to move forward into a more healthy behavior.

Sometimes in the past, I have demonstrated metaphorically an attitude of calm self-compassion with a black rock on my table next to my chair.  I pretend that the black rock is a negative thought or negative behavior.  I proceed to slap the rock, as one metaphor for how people beat themselves up for their undesirable thoughts and behaviors.  Then I demonstrate nonverbally another approach.  I pick up the rock (the negative behavior) with the least amount of force and energy possible, and gradually set it aside out of my sight.  Behaviors can be set aside without energizing them further with self-blame.  And self-blame often does energize our negative thoughts and behaviors and make them worse.

Tuesday, February 19, 2013

Mindfulness Concept #1: Living in the Present

In my last blog, I wrote about following up cognitive therapy coping with mindfulness techniques.  Mindfulness is actually a collection of concepts centered around one or two major ideas. 

I have come to see that mindfulness concepts are the opposite side of the coin from cognitive therapy.  In cognitive therapy, the point is to clear away negative concepts.  In mindfulness, there is an emphasis on the positive.  However, they are just flip sides of the same coin.

Concept #1.  Living in the present.  Many of the people whom I work with are spending much of their mental energy living in the past or the future, and not in a positive way.  By living in the present, we are usually focusing on positive experiences, not negative ones.  Many of the negative thoughts we have are imagined, or even irrational.  This is something I have written about a lot.

There are some exceptions to this, and perhaps by exploring the exceptions I can clarify the importance of the being in the present.

My rule for myself is to spend most of my time right now, here in the current time.  But one exception I would make for myself would be to allow 1% of my time, or less, for worst case scenario thinking.  Why?  Well, if I am making a preflight inspection of the airplane which I rent, and there is a screw missing, it is really useful to imagine the worst that can happen.  If I decide that it is not a problem, then I fly.  However, if I can imagine any worst case scenario that would lead to a crash, then I check with a mechanic, or I don't fly.  If I am investing money, I think of the worst case scenario as well as what gains could come of it.   Perhaps, it would be good for people to imagine some worst case scenarios before going to Las Vegas.

However, it is usually a mistake to spend more than 1% of our lives thinking about the worst case scenario because (a) it usually doesn't come true, and (b) it can start us into an anxiety spiral.  By spiral, I mean a self-perpetuating cycle of negative thinking, leading to anxiety, which leads to more negative thinking, which leads to more anxiety, etc.  I am referring here to the the "anxiety spasm."

Usually, the present is a fairly good place to be.  Usually, we are in a relatively comfortable environment.  Usually,we are not too hungry.  Usually, there is no danger or threat to us.  By living in the present we are not subjecting ourselves to the bad feelings associated with past mistakes or with potential future catastrophes.

Another exception to thinking about the future is that there is a part of the future which I would label the "creative future."  This is thinking about the positive things we can do.  It involves a positive, creative aspect of our mental functioning.  While I suppose in excess it could lead to too much fantasy thinking, it is an important part of our lives to think about all of the wonderful things we could accomplish and created but which have not yet been done.

What about thinking about the past?  I would apply somewhat of the same rule.  There is some value in thinking over the past.  Could I have done something better?  Did I perhaps hurt someone's feelings unintentionally?  What can I learn from it?  But I would again probably apply the one percent rule here.  There is probably not much more "juice" that can be squeezed out of the past beyond 1% of our time.  I like to squeeze lemons into my water for an easy lemonade at a meal.  There is definitely only so much you can squeeze out of a slice of lemon.  After that you are wasting your time.  There is only so much usable "juice" one can get from mulling over the past.

So that leaves us in the present.  When I am working with a client on mindfulness techniques, I ask them to focus on the surroundings in my office.  Is the chair comfortable?  Is the temperature in the room comfortable?  Do they feel hungry or satisfied?  (They usually feel satisfied.)  The point is that in that place, at that time, in that situation, there is nothing to be upset about.  The only thing to be upset about is something outside of that room and place, which is something either in their past or in their future.  But this doesn't only apply to the psychologist's office, it is often true at home, too.  One statement which can be useful is the following, "At this time, in this place, there is nothing for me to worry about."

One image I have come up with is a thin strand of island about a hundred feet wide, in the middle of the ocean.  On that thin island is a hammock, coconut trees, sweet drinks, adequate shade, and so on.  On either side of the island, about a hundred feet into the water is a whirlpool (think anxiety spiral).  On the left side, is the whirlpool spiral of the past, which can suck a person down and cause them to drown.  This is the "shoulds" and reverse fortune telling about the past which lead to depression.  Thoughts in that whirlpool focus on the past and begin with "If only I had," or "I should have..." 

On the right side is the whirlpool spiral of fortune telling and catastrophizing about the future, which can also cause a person to drown.  This is worst case scenario thinking which is triggering anxiety, which in turn triggers more negative thinking, and so on.  Thoughts in this whirlpool usually begin with "What if...?"

But in the middle of the two, on the island, if we choose to lay in the hammock, and enjoy the shade, we can enjoy the "good life" of the present.

Now, I suspect that some readers would say, "If we only live in the present and enjoy it, we don't really accomplish anything." There is some truth to that. A little anxiety can motivate us. Creative thinking about the future can produce some excitement and tension about wanting to reach that future. However, if we live too much in the future, then even when we get there, we don't enjoy it. Thinking about "When I have children...", "When I get a job...", or "When I retire..." can all be legitimate events to look forward to. But if we can't enjoy the present NOW, we may not be able to enjoy the present THEN.

The island strand is only a metaphor. I am not trying to imply that we need to take it easy all of the time. Not at all. If the metaphor bothers you, think about there being a scientific laboratory just up the island a little ways, or an arts and crafts room, or a work out room. The point is that living in the strand of the present rather than the past or present usually makes us most productive.

Because one of my hobbies is oil painting, I have a technique which works for me that helps me to really appreciate the present.  I look around me, no matter where I am, and imagine how it could be made into an oil painting by a really excellent artist.  I have seen intriguing and/or attractive paintings of every type of scene imaginable, including broken down buildings and rusty signs.  By imagining the painting that could be produced from the scene I am looking at, I am able to enjoy my surroundings even more.  It helps me to not only be in the present, but also to enjoy the present.

Monday, February 11, 2013

After Cognitive Therapy--Then What? Mindfulness and Letting Go

Much of what I have published on my website (handouts, blog, and podcasts) has dealt with cognitive therapy.  From time to time, patients have asked me, "After the four column technique, what do I do then?"

That question has tended to puzzle me.  I would generally say something like, "Once you have challenged the negative thoughts, then most of the work has been done."

I think I understand my clients' questions better now, and I think I have a better answer than the one I used to give.

The key to handling stress is, I believe, a sequence of cognitive therapy, problem solving, and mindfulness.

1.  Cognitive therapy.  This involves hitting the most irrational thoughts head on.  When something negative has happened, we may tend to catastrophize.  Or we may gravitate towards another type of negative thinking, such as mind reading, all or nothing thinking, etc.  The first step is to use all the cognitive therapy techniques (and mainly the four column technique) to dismantle the irrational negative thoughts.

2.  Problem solving.  After the cognitive work is done, take time (about 30 minutes or so) to consider all your problem solving options.  What can be done about the problem?  Which of the available options do you want to try?  Consider page 20 in

3.  Put the problem on the shelf and let go.  Once you have chosen an option to try and fix the problem, then you may be able to implement it immediately.  Or you may have to wait until you have the opportunity to actually do something abou it.  You may have to wait until the next time you see your boss.  Or you may have to wait until the parent teacher conference.  Or you may be able to do something right now.  If so, you may want to do something immediately.  Either way, once you have done what you can do for that moment, let go.

There is no advantage to constant ruminating and worrying.  If you try to do the four column technique 24 hours a day, or if you try to problem solve 24 hours a day, what do you gain?  Probably very little.  If you ruminate about the problem 24 hours a day, what do you have to lose?  Probably a lot.  You will probably become more depressed and/or anxious.

I realize that putting a problem on the shelf is not always easy.  We want to ruminate.  Our mind wants to zoom in, laser like.  We want to fix things RIGHT NOW.  However, after we have taken action (or after we have decided how we are going to take action) there is no advantage in continuing to think about it.

How do we let go of the problem and our negative thoughts?  I will be writing another blog entry on that point.  The answer is in the techniques offered by mindfulness treatment of depression and anxiety.  These techniques help us to let go, rather than being embroiled by and consumed by our emotions.

To summarize, here is the technique in summary:

(For those of you who remember the four column technique)

Column 1:  The triggering event.
Column 2:  The automatic negative thought
Column 3:  The feeling generated by the ANT.
Column 4:  Challenging the ANT.
Column 5:  Identifying problem solving options available to us. 
Column 6:  This could be a blank column, because it can involve a nonverbal appreciation of the world rather than being stuck in a series of thoughts.  Or it could involve answering the question: "What are my senses experiencing right now?"  There is no way to explain this column here in this one blog.  That will have to come later after I have written several postings on mindfulness.  After that, I will take a stab at coming up with some specific steps or questions for Column 6.