Wednesday, October 14, 2015

Bipolar in Focus - On Empathy and Bipolar Disorder

The bipolar brain and empathy is yet another long overdue topic I'm finally getting to (for reasons I'll divulge in a moment). 

To be clear, I am not saying that empathy is unique to bipolar brains. The capacity for empathy is an integral human capacity. All people are capable of feelings of empathy (with the exception, it'd appear, of certain psychopaths and sociopaths but that is a very deep and difficult subject I best leave to address some day in my neuroscience blog)

So while empathy is of course not unique to bipolar people, I'm going to begin my argument that bipolar brains struggle with empathy in ways that many or most people do not. But fear not, non-bipolar mentally suffering peeps, I will address how you struggle with empathy as well and there will be much for any highly empathetic person to take away from today's piece.   

Regular readers will by now know (I hope) that I study various fields of neuroscience and human behaviour. I have also put an enormous amount of effort into exploring and understanding the symptoms (in the clinical sense), the real life mental and physical experiences people live with, all and any aspect of bipolar, schizophrenia, depression and anxiety and the unique and challenging worlds we live in. I take what I learn (from my own mental experience phenomenon and that of others) and then seek to understand the neuroscience of what is involved. It's a lot of work, but it's a work I am both highly motivated and driven to do and a work that I find deeply, deeply gratifying. I then attempt to digest what I learn and turn it into essays that I hope will help readers to understand and better cope with their own struggles. 

I strike many chords because I am attempting to play many tunes. I get private messages and emails from people all over the world responding to one of my posts or another, many with questions wanting to know more or looking for better understanding of their personal struggles. As I write very openly about my own disorders, conditions and struggles, many people feel a connection with me that they'd not get from a professional mental health worker (be it a psychiatrist, therapist and so on within the system).

As such, yesterday I got a private message from a male suffering from bipolar who's been impacted by his condition to the point of having to go on a disability pension and about my age. In other words, someone quite a bit like me. He had some very specific things he was struggling with about which he wanted to know more about my own personal thoughts. 

With his permission, I'm going to share some of what he wrote to me (anonymously of course) because a) I think he expressed very well what many of us struggle with, b) he asked some very good questions and c) connecting with a fellow sufferer often helps me springboard into very useful posts most of us sufferers can I identify with and learn from. 

He wrote (in part):

I feel disturbed by a great many things regarding the state of the world.  If I had to label them, I'd call them 'unnecessary injustices'.  Everything from a greed-driven wealth disparity to power-driven class wars to the needless loss of life (e.g., 21,000 people die every day in a world where there already exists enough food to feed everyone -- wtf is up with that?).

Granting that my emotional volatility may be at least partly due to some bipolar dynamics, I believe that part of my volatility is simply a consequence of compassion.  Many of the issues that disturb me aren't even issues that affect me personally -- at least, not directly.

So my question to you is this:  is it possible that the desire to be 'happy' may, at least in part, be a denial of all the injustice and pain in the world?  I mean, how can a person find genuine inner peace when they're aware of such vast corruption in government, and such unnecessary loss of life due to a lack of resources that already exist, etc.?

I can't seem to do this.  Frankly, I'm not convinced that it's a "can't" issue (for me) as much as  "won't".  And though I wouldn't say that I'm consciously stubborn about such a position, what I find is that even when I'm successful at attaining some sense of peace and happiness, I can't for long hold onto it because there's no getting away from the overwhelming brokenness all around the world.

<private information withheld> ... that I again slipped into the same rut of not being able (or willing?) to escape the 'rut' of negativity all around me.

 I think many of you will be feeling a very big "Bingo!" and identifying very much with all of what the reader is experiencing and feeling. And let me just say that over the years of my own bipolar states, and growing worse all that time (up until recently when I began to better cope with it all within myself), that I struggled deeply and painfully with all of what the reader wrote above.

Now, if you'll allow me, let me try to begin to address what the reader articulated so well. 

When I started this whole quest for better understanding every aspect of the major psychiatric and mood disorders at the beginning of 2013 (almost three years ago already!), I explored every avenue I could. Early on, I placed ads looking for bipolar and schizophrenic people who'd be willing to share their experiences with me. The best respondent was a man in his mid-forties who had struggled mightily his whole life with bipolar and ADHD named "John". He was very, very well informed and articulate and very open to sharing all he knew. I spent a very memorable (and enjoyable) long afternoon listening to him tell me his remarkable story and what he'd learned from the one psychiatrist who specialized in bipolar disorder and who'd finally and truly helped him. He shared with me some very, very useful insights. 

One thing that he told me particularly lit up some light bulbs within me in understanding my own struggles and is precisely the topic at hand for today's post. 

John's own research into bipolar disorder and what he'd learned from that one excellent psychiatrist is that bipolars tend to be unusually highly empathetic people. As well, we can often have very, very strong senses of justice and fairness and as such react acutely and intensely to any perceived (this is a very important distinction) injustice or unfairness. He also said bipolars will feel intensely driven or impelled to do something about it (which can account for some of our impulsive violent tendencies). 

This, as you can see, is very much in tune with what the reader who contacted me wrote above about his own mental anguish and struggles.

As I said, this meeting with "John" was early on in my own big research/study push and this gave me an enormous amount to think on and look into further. I especially wanted to know and understand better the neuronal basis for this and why we reacted so intensely to social injustice and unfairness and suffer so from it all. 

I'm only going to be able to scratch the surface of this topic today (every topic I raise and write about is like this!) but I'll start to outline what empathy is and why some of us suffer for it so deeply. 

Empathy, to put it very briefly, is "the experience of understanding another person's condition from their perspective". While we now know this ability is not unique to humans, the human mind has an capacity to experience empathetic feelings over a broader spectrum. And some of us suffer from it much more than most people. 

I am not going to get into the science of this today, but it is now known that empathy and pain regions and circuits in the brain are closely linked together. From an evolutionary development stance, this makes perfect sense. Small amounts of pain can create stronger memories (we'll examine this much deeper when we learn more about Post Traumatic Stress Disorder, its symptoms and what creates it in the brain) and thus better identifying with others' experiences and pain helps us learn better survival through others' experiences. That shot of pain we feel when we witness the pain of another helps sear that memory into us in order to help us avoid a similar fate. Experiencing the pain of others also impels us to help that other person and not stand idly by. 

So in our evolutionary past, empathy and empathetic pain was critical for humans (and our primate cousins, along with some other higher intelligence mammals and even some bird species) to learn stronger survival techniques and how to better work together to ward off threats. Empathetic abilities are common to all social mammals. 

But, as I've argued in my essay 
Evolution, Life and Why Our Brains Developed the Way They Are, human evolution took place over millions of years and for conditions that in no way, shape or form resemble today's living conditions. We spent most of our evolutionary development living in small groups or clans and our empathetic capacities thus developed not only for those closest to us, but for very small groups. It is part of my argument that the human brain has not kept pace with the incredibly fast pace of human social and cultural development of the past half century or so and that part of our modern suffering is due in part to our brains not being able to keep up with the pace of the enormous and fast paced human cultural and societal change that has taken place since the Industrial Revolution and especially in the last several decades of the post WW II years.

As well, like any human capacity, the capacity for empathy is not equal among us and there's a whole range and spectrum for how it's experienced, for whom and how strongly. I'm going to leave aside any judgement of those who experience empathy less than we do and I'd ask that you do the same. We gain nothing from judging others and I'd prefer to focus on understanding our own experiences and why we suffer. Suffice to say for now then that there is a class of people we'll call "highly empathetic people". Just as how any human mental capacity can be stronger in some than others - be it mathematics, artistic, athletic, language and so on - some of us are endowed with far greater capacity for empathy. 

It's more than that, however. Not only are some of us more strongly endowed with the capacity for empathy, we also more acutely develop and feel emotional pain of all kinds. We suffer the hurt of life much deeper and longer than most; we experience heartbreak more intensely, we suffer rejection more deeply and painfully, we miss people we love and care about more intensely, we suffer loss more intensely; the list is long. Combine these highly developed emotional  pain circuits with a higher than average ability to empathize with others' hardships, pain and suffering and we thus feel their pain more intensely. 

Take these high capacities for empathy and emotional pain and then look at how the news of the world and its suffering is piped into our lives 24/7 through media of all kinds, and you have a recipe for acute and chronic emotional suffering on a massive scale. It is seemingly inescapable. In my 
series on the stress response system when we look deeper into emotional pain of all kinds and how this keeps our stress response system locked on, we will see that this has very serious mental and physical health consequences.

For it's more than even just experiencing the pain of others. Looking back at the evolutionary basis for empathetic pain, this pain triggers our stress response system to do something about it. In our past, this would have been restricted to those immediately around us. Our ancestors would see a family or clan or tribe member suffering in some way, and their stress response system would activate just as it was themselves experiencing the threat and a course of action would be clear (help fend off some sort of attack, for example). This is a critical part of how and why empathy developed - to not only trigger our own "fight or flight" stress responses to save ourselves, but to save or help others as well. It's designed to make us take action for the sake of the greater good (which actually aides our own chances of survival). 

As humans developed higher organized and sophisticated social structures and in much larger and diverse numbers, this capacity for empathy and action also became more sophisticated and began to respond to non-physical threats and include threats to our well being and that of others from what we now term as "social injustices" or "class injustices" and all the unfairness involved. We therefore might be driven to fight against it (hence class wars or even civil wars on the scale of the Russian Revolution) or to flee it (which accounts for no small part of the history of human migration).

And herein lies a great deal of the trouble with our modern selves. For the vast, vast majority of pain and suffering and death and social injustice we now bear witness to, we have no capacity at all to either fight it of flee it. Yet we cannot block it out. Or as the reader wrote, "there's no getting away from the overwhelming brokenness all around the world". 

Now, as we evolved the capacity for empathy and experiencing empathetic pain, we also evolved the capacity to block it out when it becomes overwhelming for in the strictest terms of how life works it is not an evolutionary benefit to emotionally break down from overwhelm and not be able to continue on. 

And this is what I was looking at in my piece 
Broken Ego Defenses - how some of us lack the essential capacity to block out what can damage us emotionally and not only will we get pummeled by the pain of our own suffering, we'll get pummeled by the pain of so much of the world around us. I spent a great deal of time studying the whys of suicide and at one point spent several days reading suicide notes (compiled by a suicide prevention organization, they numbered in the hundreds and went back to the middle of the 18th century) and this suffering "the pain of the world's injustices" was a very common theme. To put that briefly and bluntly, this overwhelming emotional pain can kill us.

Back to bipolar and empathetic suffering. Why is it that bipolars tend to suffer more? A number of reasons. 

One, bipolar people are generally far above average in emotional intensity and not only that, across the entire emotional spectrum. We tend to experience all emotions at the extreme edges of intensity. This is one of the key factors in creating a bipolar mind that can go from the highest highs to the lowest lows. 

As well, bipolar people also tend to be very driven, very compelled to take action, and not just any action, but great action. We tend to be very driven to find solutions and act in big ways. If we happen to be high on the human empathy spectrum, this will set us up for a lot of pain and suffering if we are unable to do anything or if our actions don't get results. 

Now this does not mean that you have to be bipolar to live with this kind of empathetic suffering. Through this blog and in my own explorations of human experience, I come across a lot of people suffering to some degree from depression and/or anxiety. And in talking with them and probing their mental experiences, virtually every one would rate very high on the "empath scale". 

Is there anything we can do about it? 

I believe there is. In fact, I doubt very much I'd be alive if I did not learn how to deal with my own suffering in this regard and develop stronger "ego defenses" to better protect me from this kind of empathetic pain. 

For further reading on empathy - and a bit of a look into the "dark side of empathy" - and some insight how to reduce empathetic suffering, please see the follow up piece 
Taming the Polar Bears in Focus - Taming Empathy

For now though, I hope I have given you an at least somewhat better understanding of what you're feeling and why. I hope also to let you feel that you are not alone and that there is actually nothing inherently "wrong" with you. You are simply human, perhaps more so than others. I want you to feel that you are an important and vital part of the world.

Mostly, however, I want to open a door in your mind to the belief that you needn't suffer so. To answer the writer's question above, yes; "to be 'happy' may, at least in part, be a denial of all the injustice and pain in the world". But by that, I do not mean you turn your back coldly to the suffering in the world. We just have to get you to learn better how to a) block out what you cannot solve and b) better channel your highly empathetic mind to better use. I hope to nudge you towards the belief that is possible to be a caring, compassionate and empathetic human being and not suffer so much for being so.

I want you to feel hope that there is a better way to be that great and wonderful You. 

Sunday, October 4, 2015

An Introduction to Mindfulness Meditation Cognitive Behaviour Therapy

As I do some rewriting and additions to this piece three and a half years after first writing it in the fall of 2015 and have put more and more distance between my present self and the self that went through the worst of what many consider to be the most difficult to deal with psychiatric disorder (bipolar type I) and, it turns out, Chronic Traumatic Encepholapathy  (from about a dozen concussions earlier in life), along with major anxiety disorder and borderline personality disorder along with being homeless through a Canadian winter, I can look back with some added perspective as to how I not only managed to get through all of that but actually continue to handle my mental outlooks, moods, mental states, cognitive abilities, abilities to handle life's difficulties and so on in a much improved fashion. 

I have to be clear that one does not - at least at my age and for how long my brain has been a "bipolar brain" (and all the rest) - simply "stop" being bipolar. Chronic Traumatic Encepholapathy is an (as yet) incurable degenerative brain disease that doesn't exactly go away on its own either. All the potential forces those can give rise to (and they infamously powerful) are and will always be there, they always must be managed. A bipolar brain (the real ones, not the tragically misdiagnosed ones) and one with CTE is always going to be prone to certain reactions to life's stress and stressful events. It is never going to be easy to manage. There is always going to be potential for being blown way off the rails by life events and stressors outside of one's control. This is true of all long term disorders. 

Reflecting back, there was certainly no one magic bullet or even strategy that made 
the difference in learning to better manage the horrors and intense emotions and reactions my mind could produce so I need to think hard on what exactly made the biggest differences (aside from the basics of my Positive Difference Making Fundamentals). 

In various previous posts, I've talked some about thoughts and the power they have over us and while there is certainly more than just thoughts involved with major psychiatric disorders, there's no denying that how our thoughts are generated, what thoughts we have, and the directions our thoughts will steer our minds and lives is a very significant factor driving mental states and moods. 

Aside from thoughts are our "instinctive" reactions to life events, triggers, others' words and actions towards us and so on but even many of our own reactions arise out of our own thoughts, mental models and ingrained thought processes. (I'm going to have to leave reactions for a future post, and it is when we begin to study our reactions and how and why we react certain ways that understanding just how very autonomous our subconscious 
"zombie programs" are will really come to the fore).

And of course tied to both our reactions and thoughts are 
our emotions

So I'm going to go ahead and declare that it's a pretty safe bet that in rearranging my mind, moods, reactions, impulses and so on to create a more mentally stable, emotionally resilient and healthy me, learning to deal with my thoughts ranks pretty close to the top of the list of how I turned so many things around. 

Now, if someone had told me during the worst of my mental states that it was "just thoughts", I'd have been the first to freak out and scream "this is more than just thoughts!!". And my experience at the time was that it certainly seemed to me much more than "just thoughts". It felt for all the world that I was in the grips of something very, very powerful (and in a very real sense, I was). However, as I learned more and more about the neuroscience of thoughts and the power of thoughts and how thoughts could cascade into 
creating the stress and anxiety and resultant stress response system spikes that were causing my worst melt downs, I had to begin to admit to myself and come to accept that so much of what was driving my mental states was thoughts and their power (and I think I'll need several more key posts to further convince you the readers of the power your thoughts have over you), the question became how to control them. 

Thoughts, as I'm sure many of you who battle mental health disorders are aware, don't just go away because we ask them to. If only it were so simple. Thoughts are all generated by specific brain regions and networks (neuronal groups and the wiring networks that connect them, something I introduced in 
Chapter One - Neuroanatomy 101 and in this post introducing neuroplasticity) and it is part of our disorders that these "brain loops" (as I like to call them) become too dominant and ingrained in our overall brain functioning. 

Changing our thoughts, therefore, means changing brain regions and brain wiring, something that is known not to be easy. I liken it to a professional golfer trying to change his golf swing, even someone as great as Tiger Woods. To learn the new swing they have to also learn to "forget" the old swing for it is the old swing (which they are changing because it is now producing poor results) that will just naturally and automatically come back when they step up to a ball and initiate a swing. And they have to "overwrite" the old swing with a lot of conscious effort and repetition of the new swing. It's difficult because it requires breaking down old wiring networks and building new ones (this is what neuroplasticity is all about, folks). Even for a great athlete with top notch coaching it takes a great amount of work.

And it is exactly the same with thoughts, emotions, reactions and behaviours that could arise from those; like breaking any old habit we no longer want and building new habits, it takes a lot of conscious effort to be aware of what is now undesired, what we want to replace it with, and the efforts to implement and ingrain the new habit. 

The trouble with something like thoughts or emotions is that they have been so much a part of us, and likely so much a dominating part of us, we're hardly aware that they're even there, much less how much power they have over us and the damage they are doing to us. And we're almost certainly not aware that they don't have to be there and dominate our minds and lives so much.

As I've said numerous times previously in this blog, I stopped at nothing and investigated everything in looking at how to recognize and deal with mental health disorders of all kinds. As well, I attended and took part in several kinds of therapy and group therapy (including being introduced to the very excellent 
Core Program (1)) so in several different ways and through several different sources and at different levels, I came to understand Cognitive Behaviour Therapy and mindfulness meditation and somehow, though I no longer precisely recall how, the subject of this post - Mindfulness Meditation Cognitive Behaviour Therapy.

Mindfulness Meditation Cognitive Behaviour Therapy (or mindfulness based cognitive behaviour therapy) has got to be one of the most cumbersome, unwieldy and syllable laden expressions ever devised to describe something that's actually more straight forward than would seem. So before we get too far, we'd better unpack just what exactly all that means. 

I was actually practicing this before I came across the term, read what it was about and realized, "oh, that's what I've been doing" but understanding better what I'd already been doing did help me to improve my practice of it. I'll get to how we're going to approach the practice of <deep breath> mindfulness meditation behaviour therapy in a minute but first let's break it down and remove some of the mystery and what I'm going to assume is a bit of an intimidation factor.

Mindfulness Meditation has its roots - of course - in meditation, a mind training practice that itself originated in Hinduism and Buddhism healing and spiritual practices nearly 2,500 years ago. Mindfulness meditation - to quote:

relies on techniques of mental training that suggest non-judgmental awareness of here-and-now mental or somatosensory* experience positively influences accurateness of perception and acceptance of one's own life experiences. The mindful practitioner thus amalgamates a focused attention component with a non-judgmental attitude of openness and receptivity when trying to pay attention to and non-reactively monitor the content of present-moment experience. 

[* "somatosensory" is a term which in this context distinguishes physical experience from mental experience]

Cognitive behaviour therapy is a form of long standing and often very successful psychotherapy that arose out of combining the principles of cognitive and behaviour therapies. Cognitive refers to our thoughts and mental patterns, and behaviours to our reactions to life around us or the actions we habitually take. CBT is designed to help us work through our thoughts, behaviours/actions, and feelings (emotions) and to understand their relations to each other within us. Its goal is to help us gain more control over all three aspects and to hopefully build more optimal thoughts, behaviours (or actions/reactions) and emotions that are more adaptive to our life situations. It is designed to bring these all into more harmony within us - which, I can assure you, can go a long ways in settling down a great deal of the inner turmoil and conflict we experience and which has such an unsettling effect on our overall mental states and peace of mind.

This illustrates what we were looking at above - how our thoughts, feelings/emotions and behaviours/reactions all tie together. I early on recognized the benefits of CBT, however the trouble was that I in no way could afford a one on one therapist skilled in teaching and applying CBT. Group therapy can be effective but the problem is finding a good group that is affordable and within convenient distance of where one lives. 

For the vast majority of those suffering mental health disorders, finding therapy of any kind, let alone therapy that is personalized and effective is extremely challenging, if not downright impossible. 

Which is the situation I faced - I not only could not find therapists trained and able to deal with my complicated and difficult case (2), in no way could I have afforded it even if I could (though again, I did find some groups at various times which were beneficial in some way or another at the times). 

So what to do?

I very early on in my race to discover ways to manage or overcome mental health disorders starting at the beginning of 2013 began to come across many ties between the study of the brain and meditation, chiefly that meditative practices could change the brain in very important and positive ways. As I started looking more into meditation, I came across the concept of mindfulness meditation. As I was already studying the neuroscience of consciousness and various means of "altering" consciousness, I grasped the fundamentals of mindfulness meditation quite quickly but at the same time I could see and sense this gulf between how "normal" practitioners practiced it and how we peeps with poor mental health could utilize it. This is a beef with me with meditation and yoga; two very useful practices made overly complicated, too advanced and difficult for the majority of people to gain from. 

So setting aside all what you may have read or learned elsewhere about mindfulness meditation, I'm just going to get to how I combined mindfulness meditation and CBT and further, how I learned to do them on my own without too much complication and difficulty.

To better understand how I approach mindfulness I'm going to ask that we have another brief look at consciousness. Regular readers will recall that we looked at consciousness in the previous posts An Introduction to Meditation and On Consciousness, Thoughts and Meditation. In those posts I likened consciousness to our computer screens and speakers and just as those peripherals display only a small portion of what your computer is capable of (through its own programs, memory stored and what it can bring in through the Internet) for you to work on at any one time, consciousness is like a "screen" or "working plate" created by our brains at any one time out of all of what our brains are capable of producing through our senses, our brains' programming and the vast amounts of memory stored there. 

It is also necessary to recall that our brains often, or maybe always, don't give us much choice of what is put up on our "awareness plates" or consciousness. It is also necessary to recall that our brains keep vast amounts of inner activities outside our conscious awareness (and thus we're not aware of what's causing so many of our behaviours that are driving us batty and which we'd like to change). 

So we're going to learn how to better manage our "conscious plates" or "conscious computer screens and speakers" and we're going to do that with mindfulness meditation, or at least my version of it. And with mindfulness meditation, we're going to tie it in to CBT and thus learn how to better manage our thoughts, behaviours, and feelings/emotions. 

I must tell you up front that this is no small task. I said above that I learned how to do it without too much complication and difficulty but by that I mean the actual practice of it needn't be complicated or difficult. This does not mean, however, that the mental work we must do is easy. We need to be aware of that and understand that it's not going to be easy because if we do that, we are less likely to become discouraged when we find that it can be tough. We are far better able to cope with difficulty (generally) if we know up front what to expect and how to deal with it (and we'll be learning techniques and the belief that we can deal with it). 

Now, without further ado, here we go. 

In the four years since first writing this I have done a great deal more study into consciousness of the human mind and subjective conscious experience (a good deal under the direct tutelage of renowned consciousness authority Bernard Baars), I have come to think of mindfulness meditative CBT differently, especially the "cognitive behaviour therapy" part. I think of it more now as "consciousness behaviour therapy" as it is our conscious experience that we must change and work on. 

As for what we have to do, I use it as a time set aside to specifically examine my thoughts, feelings and ongoing events in my life. I also think of it as a way to let my mind to slowly wake up in the morning in ways that I am paying close attention to. 

Mindfulness CBT takes a certain amount of bravery when you have the sort of thoughts that come with psychiatric disorders like bipolar and suicidal depression so let's keep that in mind as well. And with that in mind, lets just go ahead and give ourselves permission to be brave, to believe that we can do this, even if for only a short period of time each day. And like other forms of meditation, it is quite alright to do it only for short periods of time to begin with. I certainly started out with short periods but after I began to make some noticeable headway, I found I could stretch out the time I did mindfulness CBT longer and longer. 

I'm a morning person so in the beginning I tended to do mine first thing in the morning when everything was quiet and we do want quiet, undisturbed time to do this (and I realize what a challenge this is for many, especially for the parents out there among you). Since then (early 2014, about five years ago at the time of this rewrite) it's become a more natural thought process and I can apply it almost anywhere at any time. For you to start though, let's assume though that we can find some quiet time. 

Now, here's what we're going to do - and this is the scary part - we're going to allow all and any thoughts to come into our consciousness. But - and just for this period of mindfulness CBT - we're not going to judge them, we're not going to try push any aside; we're going to allow them to come in. But because we put ourselves in a brave state of mind and we're in a safe quiet place, this is going to be okay, if only for a short period of time. 

If you're like I was (and can still sometimes be), you're going to have an enormous number of possibly very disturbing thoughts vying for attention. But we're not going to pay attention to any particular thoughts just yet. And we're going to think of our mind like our computer screen metaphor and our thoughts as things that are popping up on that screen. 

As we saw above, the point of CBT is to learn how to examine and deal with our thoughts, behaviours and feelings (along with core beliefs and values), but today we're going to look at and just focus on thoughts, though we're also going to start examining the emotions that can come with our thoughts. Our minds can produce a lot of thoughts, in our cases often of the nuclear grade negative variety, so obviously dealing with our thoughts is an overwhelming and frightening sounding proposition. But again, we're going to give ourselves permission to be brave about this. And we're going to start to learn the concept that whatever our thoughts are, they are just thoughts. This will be very hard for many of you (and it certainly was for me) but again, for just this brief period of mindfulness CBT, that's how we're going to think of them. 

Now - and here's the important part - we cannot deal with all our thoughts at once; this is a big part of what drives us crazy, after all. So what we're going to do is to now begin to pay more mindful attention to our thoughts. We're going to lie here quietly and just sort of see what thoughts are going on.

They'll be swirling around, each trying to push the other aside. Or as one reader referred to it in a comment at the end of the post 
talking about bipolar and empathy (and empathy in general), the "blender in my head".  Through this tornado of thoughts, some are going to start to be more dominant. So what we're going to do is pay attention to the dominant ones and we're going to choose just one or two. 

Now, if I can get you to imagine your mind as being like that computer screen metaphor of ours, this is what we're going to do. You're going to imagine that our thoughts are like the tabs and various programs on your computer screen and that you have a mouse in your hand. Now, with that mouse, you're going to start "clicking" the "X" on the "tabs and programs" of thoughts to "close" the thoughts and feelings we don't want to look at just now.

So we've chosen a thought or two we want to examine more closely and all the others we're going to "close" in our mind, just like closing tabs, browsers, photo images or whatever else we might have open on our computer screen at any one time so that we can focus on just a few things without other distractions or bogging down the computer speed. 

This will not be easy at first. Like pop-up ads, many of these unwanted thoughts and images are going to pop up again again and again as soon as we close them. But for this period of Mindfulness CBT we're going to be persistent, just stick with it and mentally just  keep "clicking" on them and visualize them disappearing from your inner screen. 

I'll ask you to just imagine that for a few moments - clicking on unwanted pop-ups and tabs and so on and closing them. Now imagine doing that with thoughts in your mind and having the same power to close them.

Now, let's focus on the few thoughts we've chosen (and here's where general meditative practice begins to pay off - when we chose to focus on one or a few things and disregard others, those others will begin to naturally fade into the background). These thoughts we chose could be about anything - anything. They might be how we think of ourselves, our bodies, our situations. They might be about our jobs and money. They might be about our future. They are undoubtedly scary and worrisome. But, for this time at least, we're not going to feel afraid of them. 

I'll also ask at this time to please bear in mind that this takes practice and the first attempts will probably not go well. And that is perfectly one hundred percent okay and normal and I'll ask as well that you give yourself permission to forgive yourself if you don't nail it on your first try. 

Okay, so now we have a thought or two to examine and we're going to start questioning the ones we've chosen. There's quite a process for this, and I'm going to have to write a separate column for how this works, but I want for now to start with this idea and process of questioning our thoughts. I want to start with the idea and process of questioning whether these thoughts really have to be there at all, I want to start with the idea and process of questioning the very truth of these thoughts and ideas that are plaguing our minds and lives. 

As an example, let's start with a very common one - that we're ugly, we're bad people and nobody wants to be around us and that everyone hates us. For this time, during our mindfulness CBT session, we're going to challenge the truth of these thoughts. 

This will be very, very hard for many of you. For these thoughts have been so much a part of our inner landscape that they have become an "undeniable truth". Furthermore - and this is a "buggy" way the human brain works - when we get a "truth" like this in our minds, our brains will actively search for "evidence" to support these "truths". But for now we're going to question that. 

And to do this, I want you to actually question them. Try it! Just ask yourself, "Hhmmm, is that really true?" And of course your mind will immediately leap to provide all kinds of "evidence" that of course it's true. But we're going to be very stubborn here. We're going to keep pushing back on these thoughts and "evidence". Let's start with something easy like "nobody likes us". Really?? Nobody?? Nobody?? Not a single solitary person on the whole planet likes us? Seven billion people on the planet and not a single one likes us? Really?? 

Now, if we start questioning this and asking if this is really true, we may well find that it's not. If we start thinking through it, we may find that it's not as true as we thought. Now it may be true that we may not exactly be popular, but we'll find that it's not exactly true that "nobody" likes us. 

So we'll just go ahead and focus for a few moments on thinking of people who like us, or who don't mind us too much or even, to start with, who don't "hate" us. It might only be one. It might be five. It could be any number. What we want is to see evidence that counters our "belief" that "nobody" likes us. 

Now, as we examine the truths of our thoughts, it's also important to learn acceptance of some of our more unpleasant thoughts and truths behind them and - AND - to take ownership for them. Very, very, very important. For when we learn to take ownership of something, we give ourselves the power to do something about it. And if we have that power, we can change it. 

So now that we have identified a thought we don't like, and furthermore the basis for that thought and what's true and not true about the basis for it, let's try to think of some simple daily courses of action for what we can do about it. If we are troubled by feeling, or perceiving, that we are not popular, what are some daily actions we can do to change that? (I'll let you think on this for yourself, as exploring this will quickly stretch the boundaries of this post too far). Just remember the formula above in that thoughts and supporting behaviours must be in alignment so we must create better behaviours that will support our better thoughts and better thoughts to create our better behaviours. 

We can also use this time as an opportunity to start working on black or white thinking and the belief that everything has to be painted in stark either/or colours such as someone either "likes" us or "hates" us. We can start to think that maybe there are all kinds of shades or that there are different aspects to how people feel about us. Maybe they like us in this way but not so much in that way. 

We can start to question the black and white thinking about our very selves. Are we really "bad" people or maybe we're just bad sometimes? Maybe we're not "bad" but just do bad things sometimes.We can start to separate "us" from our behaviour (a classic therapy technique).

And so it will go as we look through and examine our thoughts and feelings about and reactions to our mental states and experiences of the world around us. 

We're not going to turn around our thoughts, feelings about any one aspect of ourselves or our reactions to the world around us in one session but we're going to start chipping away these long held "truths" about ourselves, these thoughts and ideas about ourselves that we are just convinced are "self-evident". As well, we're going to start learning more about 
common cognitive distortions and working through those.

And more importantly, we're going to start establishing the habit of creating the time and mental space to work on mindfulness meditation CBT. Way back when I wrote out my positive difference making fundamentals, I wrote that I worked on creating better habits. This is one of those. This was perhaps the most important new habit I created. 

For as I've written before, if we don't learn to work on our thoughts, to change our thoughts, we will be their bitch; they will mess us up.

So, before I go, a brief recap of what makes up mindfulness meditation CBT:

Mindfulness: This simply means paying mindful attention to what we are doing and in the case here, paying mindful attention to our thoughts.

Meditation: This is a tool we use to channel our focus on to specific things. Practicing simple meditative techniques like those in 
an introduction to meditation. We use it in practicing mindfulness in the sense of to what we are mindfully paying attention. 

Cognitive Behaviour Therapy: These are methods and tools for changing our thoughts and behaviours. It is generally done with a therapist working with you - and this is great if you can find one who's good (not a given) - but we're going to start learning how to do it on our own. 

Method: set aside periods of time each day that are quiet and you will not be disturbed to allow yourself to mindfully examine the thoughts and beliefs that are predominant at any one time. Learn to question the truth and validity of these thoughts and beliefs. Learn to reframe them. This time of mindfulness CBT can be just a few minutes to start, up to half an hour, an hour or more. 

Lastly, I want to remind that this is not easy work. But then again, nothing worthwhile doing is going to be easy. Now pay attention to that word "worthwhile". Many of us will have issues with this idea of "worth" and being "worthwhile", for one of our dominating thoughts and ideas are probably that we're not "worth it". 

It is now been five years since I created this program for myself and started regularly practicing it. In that time it has become an ingrained natural habit, a default mechanism that kicks in after I go through a difficult life or mental (and often both at once, of course). It is this process that is always the core to bringing myself around and moving forward as positively as possible. And this is the ultimate goal with a practice like this - make it a daily habit that comes to you naturally. Further mastery comes from more consciously deliberate sessions of examining our core values, beliefs and goals and making sure our thoughts, behaviours and emotions are in alignment with those. 

So here's a little bit of homework for you today. Practice believing that you are worth the work. Yes. You are worth it. Yes. You. Are. 

(1) While I'd come to see the Core Program as an excellent resource, unfortunately the facilitator I had leading the 8 week therapy program was very poor and I gained little from it at the time. That said, many of the things I'd learned I'd later see I'd begun to subconsciously use, so I think being exposed to it despite the poor facilitator made a difference in the long run.

(2) At one point from the fall of 2012 into the spring of 2013 I was extremely fortunate to work for free with a therapist who specialized in suicidal danger through the University of British Columbia's psychology program (the sessions and the relationship with that therapist in training ended, however, with the end of that school term). Though I'd been told I was welcome to register for free therapy again the following fall, when I tried to do so I was told that because my case was so difficult they did not feel comfortable having me see any of their therapists.