Relationships, Mindfulness & Neuroplasticity

Relationships, Mindfulness & Neuroplasticity

Getting Unstuck

 

We are social beings, and our brains are wired to see ourselves in relation to everyone we meet.  Our social relationships can have many forms, and are continuously assessed and revised, even if we aren’t aware of it.      

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Here we go again
Sometimes we notice that we have become stuck, again, in a familiar but unsatisfying pattern of relating with others. 

We may have experienced, with certain people at certain times, a simple authenticity where connection is easy and satisfying.  But somehow this ease is elusive, and instead we are often caught up in semi-conscious reactive patterns, and snap out of it only to find ourselves on familiar dead-end roads, not quite knowing how we got there.

Social Automaticity: Bound by History
The quality of our relationships with others is strongly influenced by the habitual, automatic responses that we have learned – these responses are rapidly generated, moment by moment, as the result of our past experiences. Once triggered, habitual responses play without much awareness, offering little chance for course correction or registering changing details. So even as an interaction is taking place, we can find ourselves stuck in a familiar, uncomfortable place (disconnected, defensive, dismissive, misunderstood, ignored, feeling ungenuine or embarrassed, too exposed, etc.), not quite sure how it has happened, again.

Filtered Experience: What’s between me and the world 
Our histories also affect our expectations about how others will receive us and behave toward us. These expectations can actually influence our perceptions – filtering them so that we are biased toward seeing things that confirm our expectations. This causes us to lose important information – not noticing or misinterpreting a small smile, losing the subtle details of experience in a tangle of memory and strategies.

“You talk to me as if from a distance

and I reply with impressions chosen from another time.”

– Brian Eno: By this river

Habits are good: Habits are bad
Our brains are well equipped to learn from experience, and our experience in the world shapes our knowledge, expectations and responses. Many responses become habitual – automatic – and fall beneath the level of conventional awareness. They just play out – and many automatic responses serve us well. For example, as we walk in the street we are seldom aware of the constant scanning of the sidewalk and the muscular adjustments that allow us to make our way without incident. Those processes have become automatic – though it is possible to bring them to awareness through deliberate placement of attention.  Mindfulness training is a way to have greater flexibility and attentional control, so that we can be more aware of the details of our experience, and aware of our tendency to respond in habitual ways.  Mindfulness brings about changes that are experientially obvious, and, as has been abundantly reported in recent years, also can be identified in measures of brain function.

Mindfulness of the other
Social habits can be hard to uncover, as they operate when “the pressure is on” – that is, in the midst of social interactions, when it can feel like the stakes are high.  For this reason, a therapy group made up of people interested in developing social mindfulness skills can be a powerful way to bring these unhelpful social habits to awareness, in a safe space.  It is a practical way to move toward more satisfying and genuine relationships with others.   As we accumulate new, more direct, experience of other people, we learn to welcome the freshness that is possible in each encounter.  We make friends with our habitual tendencies, and they stop being obstacles to simple direct connection with others.  I offer groups with this focus – you can find out more here.

 

 

 

 

 

 

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The language of instruction
Thoughts in development for a book (Springer Publishing, 2016) on mindfulness in mental health practice.

Feel the sensations of the breath.  If you notice that you’re not feeling the breath, feel the breath, right away.  The breath is always happening, right now.”

The clinician’s use of language in describing the technique and leading mindfulness practice in the therapy session is very important, as it is becomes internalized and used by the client. I have found it helpful to simplify the language used in providing instruction. My comments here do not represent my opinion about what is correct, but rather what I have found to be useful when working with a broad range of clients with different conditions, characteristics and levels of function.  This very simplified view of instruction language has been inspired by teachings of Dzogchen, which is truly virtuosic in its nonconceptuality (e.g., see T. U. Rinpoche et al.,1994).

     In particular, I have found it extremely helpful to keep to language that minimizes any call to exertion, imagery, or abstract conceptualization, as it is easy for these to become “hooks” for obsessiveness and anxiety. For example, a commonly heard instruction is “return (or come back) to the breath.” This gives an impression of the client having gone somewhere and needing to travel back – an image that I believe tends to unhelpfully and inaccurately solidify the “realness” of thoughts. This may seem a fine point, but in my view it is an entirely unnecessary complication that can interact negatively with clinical vulnerabilities. Words like “concentrate on” or “focus on the breath” are evocative of special effort (and thus opportunities for failure), and are best avoided: I find that clients are all too ready to turn mindfulness practice into a strenuous and exhausting activity. Even talk about “placing attention,” which is useful in didactic explanation, is too abstract and conceptual for use at the point of instruction, and is best avoided when leading practice. Another unnecessary piece of imagery is “let go of the thought” – why introduce this idea of physicality? In fact one need not engage in the operation of letting go of anything – one need only feel the breath. Instead of all these possibilities, I simply and consistently say “feel the breath”.

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Rinpoche, T. U., Kunsang, E. P., & Schmidt, M. B. (1994). As It Is, Volume 2. Rangjung Yeshe Publications. Retrieved from https://books.google.com/books?id=23OQ9ozpYgsC&pgis=1

13996394-el-tiro-de-marchita-flor-de-loto-sobre-fondo-oscuroThe Problem with Mindfulness
Thoughts in development for a book (Springer Publishing, 2016) on mindfulness in mental health treatment.

Mindfulness training can lead to significant, persistent, and very welcome changes in how people experience their mental life – bringing about more accurate perceptions and responses, access to greater warmth and connectedness, as well as more effective action.  As with any intervention, it can misfire.

Mindfulness training must be used carefully in a clinical context.  Contrary to popular misconceptions mindfulness is not a tranquilizer: in its traditional form, mindfulness practice is intended to be disruptive and destabilizing of the status quo – the status quo being, generally, the domination of experience by a tangle of thoughts about past and future. There are two main classes of problems that can occur as people take on a mindfulness practice: those that occur when the instructions are not used accurately, and those that occur when instructions are used accurately.

Feel the sensations of the breath.  If you notice that you’re not feeling the breath, feel the breath, right away.  The breath is always happening, right now.”

 

When the instructions are not followed
It is typical for people to hear the simple instructions for mindfulness, and rather than follow them, engage instead in their own particular variety of neurotic exertion, which may include excessive strain, self-criticism, performance anxiety, feeling incompetent or overwhelmed.  At the beginning, this tendency should be expected and addressed in careful communication and assessment, so that people can be protected from ‘mindfulness practice’ that is really a session of intensified and sometimes painful neuroticism. When this tendency is pronounced, a variety of methods may be used.  For example, short practice periods during therapy sessions are recommended, giving opportunity for communication and reinforcement of the precision of technique, before sending people off to practice alone at home.

When the instructions are followed
It is important to remember that mindfulness has the intended effect of disrupting habitual patterns of mind, and this may include patterns of coping and self-soothing. Most people who appear for clinical treatment have a hard-won repertoire of coping and soothing strategies, which may operate with or without awareness. These may not be well designed, but they generally do contribute to stability and a sense of control. I have found it remarkable that many people, including those who experience great distress in their daily lives, have naturally discovered elements of mindfulness practice and make use of them in their coping and self-regulation.  However, most people have other coping and soothing methods based on mental routines that are quite vulnerable to disruption by mindfulness training. It is important to monitor people in session while they begin to practice, particularly those suffering from severe anxiety, obsessiveness, or trauma. When mindfulness instructions are followed with precision, unexpected troubles may come to awareness as layer upon layer of distraction dissolve.

 

Applications of Neuroscience and Mindfulness

in Processing, Modifying and Integrating Memories

 

 

When memories are recalled and become present in one’s mind, they are subject to modification through “mixing” with the information that is also present in current experience. Convincing evidence of this process of memory modification and reconsolidation has been identified in laboratory studies1, specifically in the context of aversive, fearful memories. Though one can only cautiously generalize from experimental data to every-day life, evidence suggests that this process of “mixing” and reconsolidation is an ordinary and commonplace consequence of memory recall. The degree to which memories may be modified in any instance of recall is likely to be both constrained and variable, however the mental health clinician should be on notice that this process is likely to occur in treatment sessions when memories are explored.

     Obviously, this process has the potential of positive therapeutic impact, particularly in the case of traumatic memories that may be recalled in a safe therapeutic context. It may, in fact, underlie some of the efficacy of existing experiential treatments. However the specific characteristics of reconsolidation make it reasonable to suppose that mindfulness techniques can play an important role in this process. Mindfulness involves training in attentional flexibility, which supports a grounding in present experience and disrupts habitual cognitive and emotional reactivity. Specifically, integration of mindfulness techniques in the client/clinician alliance can promote a reliable orientation to current experience during the session. In this way the client can be aware of being present, in relationship with the clinician, and in the absence of the original danger, as well as being aware of the problematic memories being recalled and explored. Mindfulness can thereby provide a practical means by which a beneficial “mix” may be brought about and reconsolidated, though this is of course dependent on the quality of the client/clinician relationship and the ability of the clinician to collaborate in holding a safe place with the client. In my experience, many clients can acquire a mindfulness practice that can facilitate treatment in this way.
Reconsolidation of Human Memory: Brain Mechanisms and Clinical Relevance. Schwabe L, Nader K, Pruessner JC. Biol Psychiatry. 2014 Mar 15. pii: S0006-3223(14)00161-9. doi: 10.1016/j.biopsych.2014.03.008.

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 How did I get here?

The naturally healthy adaptable mind
We all have innate, adaptive, beneficial abilities to think and remember, love and care for self and others, learn from our experience, solve problems, avoid danger, prepare for the future, find friends and lovers, experience the full range of our vivid sensations and emotions, and move toward satisfying and enriching goals.

Getting stuck in unhelpful and unhealthy patterns
There also are times when these adaptive abilities misfire and become distorted. This may be in response to powerful adversities (acute loss, abuse, problems with health and security), but often the causes are not so clear-cut. We naturally adjust and try to cope, but sometimes problems persist or increase, andwe feel unable to right ourselves and our circumstances. Our time and energy can be wasted in repetitive, unproductive thoughts and worries, poor communication, isolation, painful feelings about events long past, loss of motivation and pleasure in life. We can develop unhealthy patterns of thought and behavior that may bring short-term relief but lead to long-term problems. These unhelpful responses can become habitual, sometimes invisible, until they flare up and we feel the need to make a change and move forward in a healthier way.

Getting unstuck: Methods for rediscovering natural health
My goal is to help people rediscover and cultivate their natural capacities for clarity, flexibility and well-being – these capacities are already built-in. In response to the special characteristics and conditions of each individual, my treatment methods integrate cognitive, behavioral, psychodynamic and mindful approaches to bring awareness, warmth, and effective clarity of mind to the challenges and opportunities of everyday life.

Agency in Mental Health Treatment

New York Times article by Prof. Joseph LeDoux describes some of my experience with the application of neuroscience findings in the treatment of anxiety.  Here I expand on some of the points mentioned there.

The article describes neuroscience findings about the importance of agency in learning how to be safe and productive, and in regulating emotional state.

Agency is the sense that one’s actions have impact on the world and that one can influence one’s own mental and emotional state.  This can be impaired by severe symptoms of anxiety, depression, addiction, trauma, and other conditions, where instead one may have the experience of being a passive sufferer of uncontrollable events, moods and emotions.

The importance of agency, or mastery, in mental health treatment is not a novel idea.  However, the findings described by Dr. LeDoux, which is the most recent publication in a line of research that began in his lab in 2000 with the work of  Dr. Karim Nader and colleagues,  highlight the dynamic properties of agency, and its position as an evolved, adaptive feature with clear impact on the behavioral and emotional outcome of fearful experiences.

Inspired in part by this research,  I have found it useful to use cognitive, behavioral, and mindfulness techniques to reinforce the client’s sense of agency in the course of treatment.

Mindfulness techniques have many potential benefits, but one of the most immediate is the strengthening of agency that results from a person’s deliberate use of simple techniques that have a readily experienced, and welcome, effect on mental and emotional state. Though, in the short-term, these effects are generally transient, they nonetheless can provide significant new experiences of one’s ability to regulate mental and emotional state. With this preparation, people develop a greater ability to address problematic habits, responses, and patterns of mind and behavior.

An essential element of learning mindfulness is the training of attention – cultivating an ability to notice how one’s attention can be captured and held by mental events that have an intense emotional charge, and an ability to deliberately place attention on physical sensation as a way to orient to the present moment and displace maladaptive thoughts and emotions from present experience.  This has many potential benefits, including a gradual recalibration of the exaggerated emotional charge of troublesome thoughts.  But even at the beginning of training, this process of attentional control through mindfulness can provide a vivid and convincing experience of how it is possible to have an impact on experience through the deliberate use of simple techniques, even on a “bad day.”