Varför behöver jag mindfulness?

Mindfulness har blivit ett riktigt modeord och kommer i alla dess former. Jag brukar bli lite anti just alla sådana trender och måste erkänna att jag kämpade med Mindfulness också i början. Inte minst för att det presenteras som en universallösning på nästan vad som helst. Samtidigt har det ju fått mig att undra just varför det presenteras som svaret på allt.

Mindfulness är en version av meditationer som utövats inom Buddhismen väldigt länge och handlar om att träna vårt sinne och hjärna. Mental träning med andra ord. Varför behöver vi träna vår hjärna då? För mig föll inte det på plats förrän jag fick chans att fördjupa mig i evolutionspsykologi. Då insåg jag att vi utrustats med en ganska knepig hjärna som ställer till det en hel del för oss och att mycket av det som gör det svårt är automatiska processer som utvecklats evolutionärt för att säkra vår överlevnad. Sättet vi kan styra över dessa automatiska processerna är genom att medvetandegöra dem och det är genom vårt medvetande som vi kan skapa större kontroll över oss själva och vårt inre liv. Det här kräver dock träning.

På samma sätt som vi går till gymmet för att träna våra muskler fungerar medvetandet som en muskel som behöver hållas i trim. Ju mer vi tränar ju lättare det går. Lång tids regelbunden träning bygger också upp en förmåga som vi kan luta oss emot även när vi tränar mindre.

Vad handlar detta om då?

Jo, vår organism är fokuserad på överlevnad. Det innebär att både kropp och hjärna prioriterar det. Samtidigt har vårt samhälle förändrats oerhört fort på bara några århundranden och vår hjärna har inte hunnit med. När du blir stressad så drar automatiska överlevnadsprocesser igång i hjärnan på samma sätt som de gjort i årtusenden. Vad som är annorlunda är vad som stressar oss. Förr var det hot mot vår överlevnad såsom vilda djur eller andra folkstammar som attackerar. Idag är det snarare fyllda mejlboxar, renoveringsprojekt och fyllda agendor som stressar. Hjärnan reagerar dock på samma sätt. Vi kan inte designa om hjärnan men vi kan jobba med vårt medvetande och det är här mindfulness handlar om.

Vad är mindfulness?

Mindfulness är medveten närvaro, eller härvaro som ett bättre ord. När vi utövar mindfulness så förankrar vi vårt medvetande i nuet. När vi övar på det kan vi välja ett specifikt ankare såsom vår andning eller hur något känns i handen. Då tränar vi en hjärna som ständigt bombaderas med impulser till att parkeras i nuet. Så istället för en hjärna som tänker på det som hänt eller som det som ska hända så ger vi oss en chans att landa i det som är just nu och ta in det till fullo. För överhettade hjärnor ger det en välbehövlig paus.

Mindfulness känns obehagligt

Då och då möter jag personer som upplever det här med att träna sig på att vara i nuet som obehagligt. Jag kan själv känna det ibland. För hjärnans överlevnadsprocesser driver på oss att hela tiden vara uppmärksamma och vaksamma på vad som kan hända. Att stanna upp och bara vara i nuet däremot kan gå helt emot hjärnans automatiska impulser, särskilt om vi är riktigt stressade. Det är det som gör det knepigt. För det går emot vad som känns rätt. Både kropp och hjärna ger signaler på att skynda på, inte stanna upp, jobba vidare så att vi kommer bort från det som är hotfullt. Men dagens samhälle är inte den typen av hot som vi ska komma bort ifrån.

Så vad händer när vi landar i nuet och i kroppen?

Jo, vi kan bli varse om saker som vi inte var innan som vi också kan uppleva som hotfullt. Vi kan plötsligt bli uppmärksamma på hur trötta vi är eller att vi känner oss ledsna och ensamma. Det är inte alltid insikter som vi vill ha. Särskilt om strategin att skynda vidare är väl befäst i oss. Jag är t.ex. en person som klarat mig genom livet genom att helt ignorera vad kroppen signalerat till mig, vilket har inneburit att båda stänga av fysiska upplevelser och känslor. Att då stanna upp och lyssna in mig själv blev att helt plötsligt möta så mycket som jag inte ville möta.

Kan Mindfulness bota allt?

Nej, Mindfulness är ingen universalmedicin. Forskning visar att träna sig i mindfulness kan minska symptomen på depression, ångest och kronisk smärta. Det finns många fler forskningsstudier som visat effekt på en rad andra åkommor men som fortfarande inte är tillräckligt välgjorda för att man ska kunna veta vad det är som orsakar positiva resultat. Det flera studier visar är att regelbunden mental träning leder till förändringar i hjärnan och framförallt minskad aktivitet i amygdala, den delen av hjärnan som främst aktiverar de automatiska överlevnadsprocesserna. Det skulle tyda på att Mindfulness hjälper oss att vara mindre reaktiva över lag, inte bara när vi övar. Precis som gymträningen bygger muskler som gör oss starka i en rad andra sammanhang verkar Mindfulness fungera på liknande sätt.

Ofta möter jag ambitiösa människor som vill lära sig bli mer effektiva och maxa sin potential. De blir ofta besvikna när jag istället försöker lära dem att göra saker långsammare och med mer närvaro. Men det är precis så Buddhistmunkarna utövar Mindfulness. Långsamt och medvetet. Och tvärtemot vad vår hjärna säger oss så blir vi mer effektiva när vi gör det. Vi glömmer inte lika lätt. Vi kan ta in fler perspektiv. Jobba med mer komplexitet. Och dagens samhälle kräver egentligen att vi kan ta oss an ganska komplexa processer och kunna tänka i många led. Och för att kunna göra det med dagens hjärna behöver vi alltså sakta ner och tillåta närvaro och reflektion. Precis tvärtemot de impulser vår hjärna sänder ut till oss.

Referenser:

https://news.harvard.edu/gazette/story/2018/04/harvard-researchers-study-how-mindfulness-may-change-the-brain-in-depressed-patients/

Treating highly sensitive persons

I led a workshop the other day on self-criticism and got the intruiging questions whether I thought that highly-sensitive persons were more likely to be self-critical than others. I forced me to once more dive into the scientific evidence around highly sensitive persons or HSP.

HSP is a person who seem to experience sensations more intensely than others be it emotions, sounds, touch or light. Want to know if you are HSP? - take the test here. The traits, that is found in roughly 20% of the population, has been quite debated, especially due to lack of scientific evidence. Recently I heard that there is testing indicating if you have a more easily triggered nervous system which got me thinking about the phenomena that psychologist Elaine Aron has described as HSP. In my clinical practice I've also met people who seem to just experience things a bit more intensely than others.

So what do we know so far? Seems like there is actually scientific evidence that HSPs process and experience things a bit differently. A recent study shows that HSP brains responds to dopamine differently.

Dopamine is the brain's reward chemical. It's what makes you "want" to do certain things, and then feel a sense of victory or happiness when you do them.


Further more a 2014 study with functional brain imaging research found that HSPs had consistently higher levels of activity in key parts of the brain related to social and emotional processing. This higher level of activity kicked in even in tests involving strangers, showcasing HSPs' ability to extend compassion to people they don't personally know. (The effect was still highest with loved ones, however). The study also show that the attention and awareness when interacting with others is heightened for HSPs which could explain why HSPs sometimes find that kind of interaction overwhelming. Other brain studies show that HSPs emotional activation in the brain is higher than non-HSPs. A HSP’s brain is wired differently and the nervous system is highly sensitive with a lower threshold for action (2). This hyper-excitability contributes to increased emotional reactivity, a lower threshold for sensory information (e.g. bothered by noise, or too much light), and increased awareness of subtleties (e.g. quick to notice odors).'

When reading this I realised how well Compassion focused therapy responds to these difficulties as we practice how to downregulate the sympathetic nervous system and activating the calming parasympathetic nervous system. We also work with understanding and regulating emotions.
I hope there will be more studies in this area that can shed more light on the phenomena and hopefully also explore the link with self-criticism.


Read more

Aron, E.N., Aron, A., Jagiellowicz, J., 2012. Sensory processing sensitivity: a review in the light of the evolution of biological responsivity. Pers. Soc. Psychol. Rev.16 (3), 262–282.


Pluess, M., Boniwell, I., 2015. Sensory-processing sensitivity predicts treatment response to a school-Based depression prevention program evidence of vantage sensitivity. Pers. Ind. Differ. 82, 40–45.


Homberg, J.R., Schubert, D. Asan, E. & Aron, E.N. (2016). Sensory porcessing sensitivity and serotonin gene variance: Insights into mechanisms shaping environmental sensitivity. Neuroscience and Biobehavioral Reviews. 71, 472-483.

Responding to the self-critic

It is a common belief that working with your self-critic means that we are supposed to get rid of it. Some methods would actually promote this but it can be a tricky thing to do. One of the reasons is that we often find that the self-critical side of us has purpose and meaning and we harbour a fear of what will happen if we were to rid it completely. In Compassion focused therapy we work with trying to uncover what the function of the self-critic is to us. Understanding the purpose it has, and has had, in our lives is an important step in responding to it with Compassion.

So am I self-critical? Yes! Over the years I've gotten to know my self-criticism pretty well and it has changed tone and shape but it is still there. At times when I'm stressed or tired the little voice will appear in me and judge me and compare me to others, just as it does for everyone else.

What has changed?
I learned an alternative in Compassionate responding that work as a counterbalance to the criticism. I've also found acceptance for the role the critic has had in my life and I have a greater understanding of why it shows up at times. Its protective role in my life is clearer to me now and I have more Compassion to it as a life strategy. One  of the most helpful things was to learn to separate the critical voice from myself. That in turn helped me to distinguish between helpful self-correction and less helpful judgement and criticism. When I realised that we need self-correction and that it is "allowed" to make mistakes and then correct them something really clicked with me.

Compassionate self-correction means focusing on the future. "Given that this has happend what change do I want for the future to help me?" "Is there something I need to learn or develop?" I use this a lot in my every day life when things don't turn out the way I want them to. It helps me to move forward instead of getting caught in guilt and shame. Compassionate self-correction also means taking responsibilty for your mistakes or if you've hurt someone. By adopting a compassionate approach it is possible to hold both the other persons hurt and your own hurt withouth it causing a conflict. It allows for me to do so without comparing or judging my hurt as greater than the others.

My colleage helped me with that so beautifully one day when I was upset over an argument I had had with my husband. She asked what my hurt was; what my suffering was, and I told her. Then she asked what I thought my husbands hurt might be and what his suffering was. The questions forced me to move out of my comparing mind and into a more empathic mind and when doing so I lost the will to hold on to my anger. When I could see that he was hurting just as much as me then I was able to look at the conflict from the outside rather than from an angry place. I often come back to these questions now when I work and when I get stuck with different things. When I identify my own hurt and then turn my gaze towards the hurt of others with an self-correcting approach I find I am more likely to actually take ownership rather than get stuck in a shaming and blaming game that we so often get stuck in when we are absorbed by our own emotions.

The importance of slowing down

I've been struggling so much with this particular aspect in my life - slowing down... In the therapy room I often encourage my clients to take on some kind of meditative practise as a way of slowing down both the mind and body in a far too fast-paced world. Things become blurry when we move with speed and we do need to let the dust settle in order to see the world clearer.

And it might come as a surprise that I've struggled with this since I speak so fondly about it. Slowing down is not something that comes naturally to me (or to most people) and I have used speed as a measure to avoid difficult emotions. Eventhough I have learned how to deal with difficult emotions the impulse to speed up still comes up even for me and slowing down is rarely my first impulse.

When I started training in Compassion focused therapy slowing down was one of the first things we were taught. Things happen when we start pacing ourselves also in the therapy room. It allows for that outside perspective we often need. It allows us to see the world from above in a way we just can't while we're constantly running around or feeding our mind.

Nowadays I've built pacing down into my daily routine. If I'm lucky I get to start the day with a short yoga session. Throughout the day, I take little micro meditations either with the help of the app called Pause or Calm. The Pause app is brilliant because it helps you to center and focus, literally, since it asks you to focus on a dot on the screen. I use that when I am very wound up and really need help to calm down. The Calm app has a number of different programmes and you can choose a particular meditation or can choose a programme. I've made my way through the self-to-self series which is about how we relate to ourselves and how we can meet ourselves with more Compassion and understanding. I've just started the programme meditating on emotions hoping it can give me some inspiration I can use with my clients.

The most common experience amongst the people I meet is the idea that meditation needs to be perfect. No,  in fact there are two ideas. One is that it needs to be perfect and that our mind should never wander. Yet, this is the default set up of our brain. It is constantly on, even when we sleep. The other idea I meet is the idea that meditation is about emptying the mind from thoughts and not think at all. Now, for me that sounds really scary! Imagine the emptiness and loneliness connected to an empty mind. I have at brief moments experienced something that could be labelled as emptiness - a moment of deep reflection where time passes without me noticing it. The difference though is that my mind was active even then. When I first started trying to meditate I struggled in particular with this idea of emptying your mind and I never found striving for that helpful. A third idea I meet is the idea that meditation should be pleasant. It can be pleasant at times and the brain normally enjoys a moment of slowing yet it is not the purpose. The way meditative practises are used in Compassion focused therapy is to help us work through difficult issues. Yet, sometimes I've met very experienced yogis who have used it as a way of getting away from difficult emotions and thought. In my opinion this is not what it should be used for but rather to improve our innate psychological functioning.

So even if you feel a bit of resistance towards slowing down, because it is not what our brain wants when we are wounded up, stick to it. Explore your resistance. There might be a new aspect of yourself to discover!

Navigating Swedish health care system as an expat

This week I've for different reasons realised how incredible challenging it can be to navigate the Swedish health care system as an expat. Having said that it is a challenge even if you are a Swede. Even for me who has a good idea of how it works I find it daunting to say the least.

So how to go about it if you need help with mental health issues?
Health care is divided into primary care and specialist care. The primary care is suppose to function as the portal into the specialist care (in reality it more often become the bottle neck). So if you have mental health issues you should first enlist with a 'vårdcentral' and get an appointment with a GP. The GP can then refer you onto a specialist unit if that is what you need. The GP can also write you a referral for therapy if that is what you need. There are two types of referrals, one for short-term therapy (6-10 sessions) and one for long-term therapy (15-20 sessions). You need to choose who to see from a list of accredited therapists and inform your GP. They will then send the referral to that therapist. The therapy sessions are funded by the healthcare system and will cost you 160 SEK/ session.

Can I see you based on a referral from my GP?
No, I do not take referrals out of principle. I am all for therapy being widely available but the system has been shaped so that the system determines how many sessions you should have and what kind of treatment you should have. I do not find that ethical. Also, once you've used you number of sessions then you cannot get a new referral for another year. On a positive note you don't have to get a referral to see me and I normally can see you within a couple of weeks time. Check my website for available appointments.

I have medication that needs to be monitored by a psychiatrist
There are two ways to go about that. One is to go the route through the healthcare system and start with your GP and get referred into the specialist care/psychiatric care. There are benefits and downsides with this depending on your mental health status. You can also choose to go privately to a psychiatrist that is affiliated with the healthcare system. I used to have a psychiatrist I cooperated with and am currently trying to set up a cooperation with someone new.

I urgently need help
For urgent mental health issues you need to contact the psychiatric emergency. Psychiatric emergency Malmö. Psychiatric emergency in Lund. 

I am looking for a private alternative
Most private health care providers are still affiliated with the public system and so the difference between private and public health care providers is quite limited. There is no big difference between going to a private vårdcentral and a public one.

If you have a private health insurance you might be able to get quicker and easier access through a special CAPIO clinic that only serves patients for insurance companies:
https://capio.se/narsjukvard/skane/malmo-stortorget/vard-och-halsa/specialistlakare/allmanmedicin/

I cannot get an appointment with my vårdcentral
Unfortunately the entire Region is understaffed with GPs and so it can sometimes be a nightmare to get an appointment with GP which is often the way access point to further health care. You can now also get appointments with an online doctor instead for certain conditions. You can get quick and easy access if you have a Mobile bank ID. Here are links to the major ones:
www.kry.se
www.mindoktor.se
www.doktor24.se

I want to see a doctor in English
While it is impossible to go through medical school in Sweden without knowing English (as much of the literature is in English) not everyone feels confident to speak English. Make sure you inquire about an english-speaking doctor when making the appointment.

Funding therapy
Many home insurances grant their clients 8-10 sessions of psychotherapy and most of the times you only need to provide the receipts. Some international insurances have the same policy but with some you need to get pre-approval. Check what the rules are for you insurance.

Some Swedish employers offer their employees "friskvårdsbidrag" psychotherapy is not covered under those rules but stress treatment is so in certain cases you can get a contribution from your employer to cover your sessions. You will need receipts stating it is stress treatment however.

Compassion in practise

Many clients ask for exercises they can do between sessions. Experiencing and embodying compassion is an importat feature of the therapy and I always encourage my clients to work some form of self-practice between the sessions. It can look very differently but I was myself helped, in my self-practise, by having audio meditations I could follow. My mind tends to wander off very easily and unless I keep it tethered by either a yoga position and someone's voice I find it hard to stay with the practise.

The Compassionate Mind Foundation in the UK has released a number of different meditiative practises tailored towards working with Compassion. I warmly recommend you to try them and just notice what happens. What comes up? Sometimes it is not what we expect, sometimes it can help us get in touch with blocks and fear. So keep an open mind and just allow what comes to come.

https://soundcloud.com/compassionatemind

Learning about loneliness

Last week I went for Advanced CFT-training in Stockholm together with prof. Paul Gilbert. He talked a lot of loneliness and its central role in what human suffering.

It is no coincidence that we react strongly to loneliness, after all we are pack animals. Eventhough we live in societies where you can manage pretty much on your own our wiring in the brain is still that of  a tribe member. Without good connections and a tribe in the back we die.

The training days got me thinking about loneliness and the role it has played in my life. I recognise that loneliness is not only at the core of many of my clients struggles but also at the core of my own. It makes me wonder if my choice of occupation also was to address that feeling. Because let's be honest, therapy is one of the most intimate moments with a stranger we can have. Rarely are we so close and so in tuned to each other with someone we don't really know.

Over the weekend I have been reflecting a lot on what this loneliness has made me do, besides chosing my current occuptation or self-revealing in a blog like this. ;) I could see very clearly that loneliness has been like a shadow following me around for most of my life and it has ironically caused me to withdraw.

What Paul Gilbert explained is that emotions sometimes become fused together and in my case my loneliness is fused with shame. Any sign of loneliness is a sign of me being wrong, in essence. We often define shame as "I am wrong" rather than Guilt which would be "I do wrong". Shame is a powerful emotion and it often causes us to withdraw. So during the past couple of days I've been faced with this insight that loneliness and shame walk hand in hand for me. I am completely perplexed by it and yet it makes so much sense when I look back at both my personal and professional life. It is deeply problematic though because loneliness can be cured by connection but I hold myself back out of shame.

I also realised that this governs many other emotions in me but especially anger. As showing anger could lead to a rupture in the relationship and that would ultimately mean I would be alone and in addition be a bad person. This is of course not conscious thinking in me nor in clients. It is rather a description of deep emotional processes within us. Therapy can help us uncover this and reveal underlying motivations that come with these processes.

And as I have now uncovered this loneliness and shame, it has given me new motivation to actually work with that feeling of shame and adress the sense of loneliness.