Mindfulness: understanding and application

Mindfulness:  understanding and application

Contents

Introduction

Attention

Mindfulness application

Suffering

Emotions, attention and suffering

Emotions, beliefs and not paying attention

The present moment and contentment

Summary

Introduction

Mindfulness is paying attention in the present moment without judgement or evaluation.

Attention is what we focus on.  You might think of it like a beam of light that we use to play on a certain part of the world to light it up and experience it. So, of the many sounds, sights, physical feelings, smells, tastes and thoughts that we could focus on, our attention is what we choose out of these to get our attention.

So, when we are mindful we are paying attention to what is happening in the present moment. That might be a sensation of something, how it feels, smells, sounds, tastes, and looks.  Alternatively, it might be noticing that we are having a thought.  Noticing that I am thinking happens in the present, when you think the contents of the thought it takes us away from the present as we think about what might happen in the future, or has happened or should be happening.

Mindfulness is a practice of paying attention to the present moment without judgement or evaluation.  The practice of mindfulness might be either something you do that you make time for e.g. a breathing meditation or something you incorporate into your day, e.g. eating mindfully.

However, you practice, you can never find that you can always be mindful rather you will be distracted through your attention wandering. Whilst practice can reduce your attention wandering but you will never stop it. Mindfulness is like sleep, you can’t make it happen naturally but rather you can set up the best circumstances for it to arise in.

Attention

We have the ability to pay attention to different things, we can pay attention to our current experiences, e.g.  how our body feels or what someone else is doing. We can also think about the past, the future, or judge how the present is or should be.

When we pay attention to things it has an effect. If I pay attention to my sensations, it can allow me to experience more of them: e.g. when eating I might notice more taste sensations, or as I watch the sky I might notice more things I can see. If I pay attention to my thoughts, then I will experience what I’m thinking about. So, if I think about my holidays, where I went and what I did, I will imagine the holiday again and have some of the feelings I had when I was on holiday.

What we pay attention to therefore creates our experience of the world and will also determine what we learn about the world.  Two people in the same space can be having completely different experience due to where they are putting their attention.

We can both influence where we have attention on the world and it can work automatically. As I sit in my study, I can think that I want to find my glasses, so I then use my attention to focus on different parts of the room to find them.  Alternatively, I can passively experience the room and my attention goes where it wants.

The automatic pilotness of our attention, seems to be directed by what’s important to us at any one time. If you are very hungry and you walk through a town your attention will be drawn to food, or if you have a powerful emotion, say anxiety, then your attention will be drawn to scary things. It would seem that this is helpful to us as your attention is in some ways pointing out things that it thinks might help us, food when hungry, scary things when we feel we need to protect ourselves from when we are feeling anxious.

Summary

So, to summarise attention is our focussing on parts of the world. It can be operated by choice or automatically, and the automatic seems to be in service of what is currently important to us. What we focus on produces effects in that it can increase the quality of our experience of where we put our attention on.

Mindfulness application

Mindfulness enhances our ability to pay attention to the present moment which can be incredibly handy in a number of ways.

Suffering

Let me firstly distinguish between pain and suffering. Pain we can understand as when something happens, and it causes an unpleasant feeling, something hurts, or we feel momentarily an unpleasant emotion. We could liken pain to what animals feel. Suffering then is the unpleasant feelings we can feel about pain. Imagine then if you stub your toe, you initially feel pain, then you tell yourself how stupid you were to stub your toe, and you feel bad about that, you then tell yourself how bad this pain is and how you can stand it, and you feel bad about that. These secondary unpleasant feelings we can describe as suffering, which can be thought of the distress we have about having pain. This can be pain we currently have, have had or could have.

Suffering comes then from thinking about the past or the future or how the present should be different. So, we might think about how bad the things are that have happened to us, or we might think about how things might go wrong in the future. As we pay attention to these thoughts, we have an experience of these things happening, so we don’t feel so good.  

Emotions, attention and suffering

When we experience powerful emotions, they affect how we think, perceive, remember and imagine. When we are very sad we think about sad things that are happening, have happened and could happen. Powerful emotions then will control where we put our attention. As our attention focuses on sad things then the effect is to create more sad feelings as we re-experience sad things that have happened, experience sad things that could happen. By practicing mindfulness, we increase our paying attention to the present which can reduce our suffering by not focussing on distressing things that could but may not happen, or have happened but are no longer happening.

Emotions, beliefs and not paying attention

As much as paying attention to things has effects not paying attention to things has effects too. We can very consciously try to not pay attention to things we don’t like. This forms part of our avoiding it or escaping from it.  The things we might actively not pay attention to might be things we find unpleasant in the world or indeed in ourselves like some emotions and physical feelings.

So, we might be scared of spiders, we might avoid looking at them, being near them and at the first opportunity escape from them so they are no longer something that we might think about, or might touch us.  We might not pay attention to something unpleasant we need to do like pay a bill. Alternatively, we might want to avoid a feeling like say anxiety. If we feel anxious we may really want to get rid of the feeling, so we try to avoid putting our attention on it, by say distracting ourselves. Likewise we might do the same for physical feelings such as pain.

There is an effect out of not paying attention to unpleasant things in that it can maintain the unpleasantness of the thing. Taking the pain\suffering distinction, suffering being the extra distress we have about have pain.  As we try to avoid engagement with an unpleasant thing and to turn our attention away from it then it would seem that we can maintain our beliefs about the awfulness of the unpleasant thing.

How mindfulness then can help with this is that through staying in the present moment you can find out what the unpleasant thing is actually like as opposed to what you fear it is like. So you can sit with a spider and as you look at it and describe it, it can lose the awfulness that it has had, you can see an insect going about its life in a body that helps it do that. As you sit with anxiety, you can notice the physical feelings of an alarm system going off in your body and whilst it may not be pleasant, in just sitting with them rather than struggling and failing to get rid of it will make it more tolerable.  

The present moment and contentment

Paul Gilbert understood there to be 3 emotional regulation systems which is both a simplification and useful in the same measure.

1.       A drive\resource seeking system

2.       A fear\threat system

3.       A soothing\contentment system

The drive system is where we seek to achieve things, get things that are important to us. When we do we receive dopamine in our body and feel happy.

The fear system deals with threats to our well-being, here adrenaline\cortisol is used to activate our fight and flight system to protect ourselves.

The soothing\contentment system deals with our feelings of safety, belonging and contentment. It’s uses oxytocin to activate our rest and digest system.

Distress seems to be caused when there is an imbalance between these systems. If the drive system is too dominant, then nothing will ever be good enough, there will be low enjoyment and there will be a continual pressured chasing of your tail. Life will be stressful without joy, as soon as you succeed in getting something you want something more. It will be quite similar to the life of a drug addict where you continually seek the next high, as you chase the next dopamine hit of achievement.

If the threat system is too dominant, then this might impact on your drive system, as you will fear what will happen and spend significant energy trying to protect yourself but getting no pleasure from achievement, or joy from enjoying what you have.

Whilst the soothing\contentment system could be dominant it is rare that this is the case.

Mindfulness activates the soothing\contentment system as it pays attention to how things currently are.  The drive system wants to get things so focuses on the future and how to get three. The threat system generally focuses on possible threat from the future and how to prevent them. So, with mindfulness then we can enhance the rest and digest system and the enjoyment and contentment of how things are at present.

Summary

Mindfulness can

·         reduce suffering by returning our attention to the present and therefore away from styles of thinking that can cause suffering

·         reduce suffering by paying more attention to unpleasant things that are happening in the present

·         increase contentment and enjoyment by activating the soothing\contentment system

·         increase our ability to choose where to put our attention: sometimes in can be helpful to pay attention to the past, the future, or how the present should be. Being mindful allows us to choose as opposed to doing this automatically

Thinking about meaning (Presentation to PWPs at an IAPT service by Step 3 CBT clinician)

Thinking aboutmeaningv1 from Rob Thomson

Contents
Theory 1
Mental health essence 1
Meaning’s base medium 2
Language 2
Attention 2
Drivers of attention 3
Attentional effects 3
Thought 3
Thought types 4
Speech Characters 4
Practice 5
Meaning is core to mental health 5
Meaning is held in thoughts\perception 6
Thoughts can be dynamic\passive 6
Thoughts are communication 7
Communication can be between different characters 7
Attentional Focus 7

Theory

Mental health essence

Meaning is key to mental health.  This is not because it defines a mental health disorder in the way that the meaning of a swollen liver defines cirrhosis but rather because meaning creates it.

Mental health disorders are considered to be disorders of cognition, emotion or behaviour, a sense of something not being functional in one of these three areas. However there is no essential aspect of any of them that defines a mental health disorder. Rather it is meaning plus state of cognition\emotion\behaviour that defines a disorder.

If you are sad and have little interest in doing things but have just lost your loved family in a freak accident then this could be understood as grieving.  If you have suffered no recent loss then you could be understood as having the mental disorder of depression.

If you have thoughts of wanting to push people under trains, then you could think of this of as an unpleasant thought. If you think it’s a sign that you want to then it can provoke anxiety and you will be afraid of your thoughts and your behaviour around train stations.  This could lead thinking you have a mental disorder of OCD. 

If you always want to make sure you arrange your room in a certain way then you could understand this as superstitious or if you think there’s something abnormal about it, then you could consider it OCD.

It is how we interpret events that generate emotions and our meaningful desires that drive behaviour that likewise produces emotions. Meaning is the key to emotions and behaviours and consequently mental health.

Meaning’s base medium

The base medium of meaning is language, but it is also held in behaviour and perception. Behaviour carries meaning historically through the things we create or in the present through my gestures and actions.  So we are linguistically taught to push the pedals to move the bicycle, then we do it, then we don’t need language to do this as we understand pushing pedals as that which moves bicycles.

Perception carries meaning as our experiencing of the world with our 5 senses is done meaningfully: there is the squirrel that runs up the tree, next to the river in the park where I walk today.  When we were small we were taught the meaning of things in our perception, that’s a cat in front of you, that’s a mat etc. After having been taught it we no longer use language in perception. So whilst meaning is held in behaviour and perception it is only done so in so far it is describable and made meaningful by language.

Language

Language enables communication through a speaking and a listening. This communication is originally between people and can also be between parts of yourself when used in thought. Language as speech then becomes an act, so you might congratulate, or criticise and therefore has a purpose and an effect from both the speaker and the listener.

Language as a meaning bearer also enables creation\demarcation of the world and can thus enable an understanding and a satisfaction of our desires. As much as I the world is understood in certain ways, therefore it enables me to satisfy my desires.  As I understand woods as scary then I can satisfy my desires to stay safe by staying away from woods.  It can also be said that language can create the world as well and then be used to satisfy our desires. The word happiness points at a certain state of humans (thoughts, emotions, behaviours, physiology). People then strive to achieve it and are distress when they don’t. The word happiness, the label that attempts to define a human state, creates a part of the world that then people have desires for.

Attention

We perceive in so far as we orient ourselves in a certain way to the world. There are also different way in which we can perceive, long focus, short, narrow angle, broad, repeatedly perceiving the same type of thing. This can leave our attention have a certain style.

We can orient ourselves to external or internal events. If internal it can be focussed on a thought about the past, present or future.

When our attention is on something then we may build a sequence of actions on top of it. So I see the kettle and boil it to make tea, or I start thinking about how I am going to spend my time this weekend.  So we can see the initial act of attention, then a volitional building on top of action.

Our experience, our life is constructed out of perception and the attentional style we have.

Drivers of attention

The attention that we give the world can be said to be driven by different forces.

Firstly our general mood or disposition. If angry our attention is on more things that cohere with this emotion. If hungry we would see more things to eat, and get mistake more impression for signs of food.

Secondly our belief system. If we believe that human relationships are generally competitive with winners and losers, then we will see more instances of this, as opposed to different ways of being.

Thirdly our previous experiences as with our beliefs, we will be more sensitive to things that we have experienced before. So if a child has manipulative parents, then when someone acts differently to them, gives them something, then they might not interpret this as a kind gesture as they have had very little experience of this.

Fourthly it can be a deliberate strategy. If I am frightened of being sick then I may be on the lookout anything that could cause this, i.e. out of date food, people being ill etc. In this instance attention is motivated as a safety strategy.

Attentional effects

As you orient yourself to the world, take a perspective and understand it in certain ways. This has certain effects:

1.       Beliefs

a.       If you repeatedly understand the world in certain ways, it confirms this belief. So if you are continually trying to protect yourself from illness, your belief in the probability of being ill increases, the awfulness increases as you are thinking about it so much and experiencing to some small extent the effects of it as you imagine it.

2.       Physiology

a.       If you pay attention to a bump, then the effects of it increase. It feels more painful as the pain is on your mind more. It seems these effects might be because the meaning you give to it is unpleasant, which might make you struggle with it, e.g. tense your muscles, or scratch it.

3.       Emotions

a.       If you pay attention to an unpleasant emotion, then you can enhance unpleasant emotions as you are perceiving the emotion to be unwanted, unfair, something you can’t stand, this meaningful act of perception in turn produces more emotions, which will keep the original emotion going.

Thought

Thought can be described as constructed out of language or image.

The language part of thought can be thought either as speech or desire satisfaction.  Speech is seen between two parts of you and can be an act that has an effect, for instance self-criticism.  Desire satisfaction can run from the initial demarcation\understanding of the world so that you know what is there, and what you want, through problem solving to ensure you get what you want.

Image based thinking, is more emotional and more action based. Perception is the basis for image based thinking and this we do in so far as we aim to get our needs met in the world, we act and react. As I talked about earlier perception is meaningful and its meaning is within language.

Thought types

Thoughts that happen to us, pop into our head without our asking, let’s call them passive thoughts. There are also thoughts that we actively have, let’s call them dynamic, for instance when you plan what to do next weekend. Dynamic thoughts are streams of purposive thought, they are acts we choose.  For instance with meta thoughts, then if you have the first passive thought  “we could have a car accident” the Meta thought would be that thoughts true, then you feel anxious, and have other thoughts about how to keep yourself safe.

If would seem that every set of dynamic thoughts is preceded by a passive thought that just comes to us.

Passive thoughts seem to relate to:

1.       Our current concerns

2.       Our perceptions

3.       Out associations

4.       Fantasy thoughts

Our current concerns. If you are planning your wedding, you may well find many thoughts about weddings popping into your head unbidden.

Our perceptions. If you are in the supermarket and see carrots in someone’s shopping basket you may think about carrots. If you feel your stomach gurgle you may think about food. You generally only have a thought about things that are significant to you, it’s only the things that jump out that seem to merit a thought.

Our associations, you may have an association from the event you have just experienced, be it external perception or an internal event. So a smell might be associated with a family holiday and  you remember it, or the sight of bread you might associate with pack lunches and then the thought of what’s in your child’s packed lunch comes into your head.

Fantasy thoughts have two aspects, one the horrifying for instance, what if I stabbed my partner, the other the jubilant, what if I won the lottery.

Speech Characters

The dynamic act of speech that happens in thought is dialogic, that is there is a speaker and there is a listener. Thus as you think in speech, one part of you is talking to another part of you. As with any conversation the speaker has motives in speaking, and aimed for outcomes, the listener has outcomes and will respond back to the speaker. The learning theory of CBT shows us that our beliefs and behaviours are learnt from experience.  So as we see a type of speech in thought then we might ask where this was learnt. This can lead to some significant people in the person’s life who have influenced this way of thinking. As much as there can be key influence in a type of speech, we can also characterise the type of speech, so you might get the doubter, the show off, the policeman etc. Characterising the internal speech in this way, can also allow you to see the behaviours and values that go with this character, so that when they are activated which parts they are responsible for.

Practice

1. Meaning is core to mental health
2. Meaning is held in thoughts\perception
3. Thoughts can be dynamic\passive
4. Thoughts are communication
5. Communication can be between different characters
6. Attentional focus

Meaning is core to mental health

1.       It’s not what happens to us that causes mental health problems but how we understand it.

2.       Thoughts aren’t facts but beliefs.

3.       There are many different ways to look at the same event.

It’s not what happens to us that causes mental health problems but how we understand it.

The beginning of treatment seems to be to get a relationship between how I think and the emotions that I have.  This means that events don’t cause emotions and therefore I have more control over my emotions that I thought I had.

A powerful way to show this is if you can find an event that has happened to your client and other people they know and then you can notice the same event and different reaction. For instance a significant event bad or good that happens to a group (family, friends, school, sports team etc.). If this isn’t available, then you can do it with imagination. Ask your client to imagine you are in a different emotional/cognitive/behavioural state, how would you understand the event and then how what emotion would that provoke. This then provides a range of emotional response, which relate to how people think about the situation and demonstrates its not the situation that caused the emotion.

Thoughts aren’t facts but beliefs.

To look at thoughts as not being facts, you can generally ask someone if they have ever been wrong about anything. I have had someone who has said no, in that case, you can ask them one of the following:

1.       Have your beliefs changed over time?

2.       Have you thought someone thought something but found out later this was wrong?

3.       How do you understand what ideas to adopt as your own, as there are a lot that get offered from the media for what’s good and bad. This will lead to them saying evidence is the criteria used, which then gives us the position that I believe what I have evidence for, so for anything I believe I should have good evidence for it, which shows that the best we have is a belief we have good evidence for and we should change that when we have contradictory evidence.

There are many different ways to look at the same event.

There are many different ways to look at the same event. Take an everyday event like its raining. What are the different types of thought and emotions you might have about it? What happens if you have strong emotions, how does that change it. How do you think about it if you’ve been working hard, or going out a lot, how does that change what you think?  So if you change the context for the client, they interpret differently, if you make them older\younger they interpret differently. If you ask what about different people again you get a different interpretation.

If the only thing a client takes away from your work is an understanding the relationship between thoughts and emotions and that thoughts aren’t facts and there are different ways to look at things, I’d say you’ve done a good job

Meaning is held in thoughts\perception

Clients can when asked to say what they were thinking to help us understand a strong emotion, say they don’t know. It can be helpful here to know that meaning is perceptual so that you aim to elucidate the meaning of the scenario, which can then explain the emotion.  So as you’re feeling angry what is the situation like (describe perception). Of this what is it that made you angry (link meaning to emotion). If the client reports no current meaningful link between the perception and the emotion, for instance, my anger is related to there being so many people about, but I don’t understand why being jostled would make me angry, then the emotion may be created by association or memory. In this case then you would need to be asking what was the first time you remember being angry because of a lot of people, or if that doesn’t yield a meaningful answer then to ask what was the time when you got angriest when there were a lot of people about.

Thoughts can be dynamic\passive

A lot of mental distress can be caused by confusing these two categories. Some thoughts we receive as events, some cognitive activity we choose for a reason. People with OCD think the intrusive thoughts they receive as events means they have chosen them, so it means something bad about them, this then cause’s anxiety which they then try to manage.  People who worry a lot or ruminate don’t think they can control it, they consider either what they do because who they are, or that you can’t stop these things.

You can demonstrate that thoughts can be mental events with a client by asking them not to think of anything for 30 seconds and every time they do think of something to put their hand up.

Dynamic thoughts you can ask the client to think of an elephant, or to think about what they will do over the weekend.

It can be helpful in terms of psychoeducation for clients to realise the two different types of thought, some we choose, some we receive.

The treatment with passive thoughts is to learn how we react to them:

1.       What is our Meta thought? Do we believe the received thought? Monitoring the thought and noticing what the meta thought is can help

2.       Do we attach to the thought, i.e. pay attention to it and build thoughts and behaviours on top of it. Again firstly monitor it, then secondly practise detaching from thoughts with the skills learn from a breathing meditation or informal mindfulness practice.

If people have troubling passive thoughts, then the psychoeducation of what can increase these can help

1.       Giving thoughts attention increases them

2.       My current concerns increase these thoughts.

So

1.       Cognitively

a.       Thought suppression will increase thoughts

2.       Behaviourally

a.       Safety behaviours will increase the feared thoughts

Thoughts are communication

Clinically it can be useful for clients to notice that a thought communicates from one part of themselves to the other. Speech communicates between people, as you think then you get communication from parts of you. So as you criticise yourself, there is the critic and the criticised.

The first movement with clients can be to pull out the two sides of the communication to understand what each side is trying to do and how they feel. So the critic might be trying to improve performance, or to keep safe. The criticised might feel sad and that they can’t do anything right.  Opening this up allows the client to understand more about why they act and its effects so they can evaluate it.

Once the two sides have been highlighted, then you can ask about origins. Have there been any relationships where you have learnt to behave like this? This then allows another level of evaluation by the client. Whilst their current behaviour might be integrated and justified, when it first started it wouldn’t have been. So what was it like, how did it make you feel, how would you prefer to have been acted towards?

Again in a similar tack you can ask if you would behave like you do to yourself to another.

Communication can be between different characters

As much as you have identified the type of communication, sometimes it can help clients name this part of themselves, as it may relate to a collection of ways of thinking and acting.  So to name one part of them, the policeman, can collect all the times when they make themselves or others obey the law, and punish them if they don’t.   This can be helpful in terms of firstly distancing themselves from their thoughts and behaviours by noticing when they do something, which allows them to take different choices.  Secondly it provides a way to understand themselves, a framework. Thirdly if they start monitoring when they see the policemen, they can start to see how dominating it is. If they identify other characters, they can also then start seeing how marginalised some of the quieter voices are.

Again through creating a character can allow clients to then start relating it to all the people, or significant persons who have contributed to its formation. They can then ask at point of origin what they thought of these people\person, how it made them feel when they acted to them in this way.

Attentional Focus

Psychoeducation

Physiological effects of attentional focus: get client to say how their hand feels, then get them to pay attention to it for 2 mins

Cognitive effects of attentional focus: Ask them how many pigeons they saw on the way in. Then ask them how many they think they would see if they believed there was a deadly strain of pigeon flu

Emotional effects of attentional focus: Decide on a type of emotion to work with, take the current temperature of that emotion, get them to remember in vivid detail an event that had provoked that emotion in the past

Treatment

Mindfulness: breathing meditation, pay attention to the breath, and whenever you notice your attention has wandered then gently move it back to your breath. Rationale strengthens the attentional switching muscle. 

Cognitive: When you have a strong emotion notice what thought helps explain it. Then write what are the strong influences on why you think like this at the moment. Rationale look for cognitive bias.

Wells Attentional training from Overcoming Health anxiety:

The aim here is to only pay attention to what is asked, treat all other as noise and if you are distracted return to what you have been asked. Collect three different sounds in three different locations. You should do this daily for 4 weeks.

1.       Focus your gaze on one spot on the wall and keep it there

2.       Slow switch

a.       For 5 minutes pay attention to one sound for 30 seconds then move to another different sound work around your list

3.       Fast Switch

a.       For 5 minutes pay attention to one sound for 30 seconds then move to another different sound work around your list

4.       All zones

a.       For 2 minutes hold your awareness on all nine sounds and see how many you can hear at the same time