... the current system for bringing promising biomedical research to the bedside is operating at an obsolete level of efficiency, causing great delay, and consequently resulting in the loss of many lives. - Roger Rosenberg (JAMA 2003;289:1305-6)
Yesterday evening was the fifth session of this 12 evening training course. I wrote about the fourth session last week. As usual, this evening, the material we were due to cover was described in a dozen Powerpoint slides which the participants received as a handout. See slides 1-6, Powerpoint or slides 1-6, PDF and slides 7-12, Powerpoint or slides 7-12, PDF.
We began with the main Autogenic Training relaxation/meditation which we'll be practising over this week - the "Breath" exercise. The eight participants then paired up to talk about how their various intentions had gone over the last week. We then reconvened as a full group and went round checking in on how things had been going. Although I had hoped to get round this check-in fairly quickly as there was much material to cover in the evening, I also emphasised that if there were important issues that had come up during the previous week they would take precedence. Balancing time given responding to "what comes up" with time given to pre-prepared course material is sometimes a challenge.
And two or three quite important points did emerge. One of them is the issue of what to do when a practice session is hard & upsetting - when one's mind is busy & distressed even though one is aiming to settle and hoping to find peace. There isn't a single "correct" response here. Three that are all perfectly reasonable are a.) Simply see one's situation as similar to a learner driver finding the traffic too busy for their current level of skill. It's fine at this stage of the training course to take a break and try the Autogenic practice again later when one is feeling a bit more settled. b.) A related response is to acknowledge that we're learning a cluster of methods in this "Life skills" course. Sometimes an alternative technique may be better. Problem-solving, taking physical exercise, talking with a friend, and practising therapeutic writing are all perfectly reasonable alternative strategies when one is feeling distressed. It's good to have a cluster of methods one can use and to get more skilful at knowing what to use when. c.) A third possible response - which we discussed at some depth this evening (the fifth session of the course) - is to sit with the difficulty & distress. I said that often relaxation/meditation practice is lovely, peaceful, quietening and joyful. Sometimes it isn't. I talked about my experience on meditation retreats with my knees giving me agony, or at the dentist choosing to work with difficult sensations rather than having an injection. So often our reactions to challenging experiences - the "wrapping paper" of responses we put around the experience - these reactions can easily become as much or more of a problem than the initial experience itself. "Mindfulness" may well involve "just being with what is", with openness and kindness, letting the feelings, thoughts, and sensations come into our consciousness and flow on out. I explained that it is fine - at this stage of the training - to take a break from the occasional practice session that is this difficult, but it is likely to be helpful occasionally to practise "sitting with difficulties". So, I said, I might be sitting and my ear starts to itch strongly. It's fine simply to scratch it, but it is also interesting and helpful to realise that I don't have to scratch the itch. I can simply accept the itch and be with it. Good to have this choice. Good to practise being with these experiences more without "running away", to develop a strength of being able to just be with difficulties without adding the "wrapping paper" of the "It shouldn't be this way, it's so awful, it will never get better" style responses.
Challenging. I had given them the "Bus driver metaphor" handout this evening. I've blogged too about my own use of these ideas in "Ways of coping: theory & personal experience". I talked about David Barlow's work and the need to be cautious about forms of avoidance and give real thought to desensitising or confronting inappropriate avoidance at whatever level - behavioural, interpersonal, emotional, somatic and cognitive. I talked too about some of the more recent application of these ideas for chronic pain sufferers - and the similarities to living with other types of difficult symptoms. This will be material it's useful to revisit further into the course. Next week, for example, I plan to run the first Autogenic practice with a radio turned on behind the group - challenging us all to relax/be mindful under more difficult circumstances.
This discussion on mindfulness and avoidance overlapped into a deeper discussion on worry & rumination. I'd given them a six-miniatures-to-the-page Powerpoint handout on "Worry, anxiety & tension" as well as "Rumination & worry scale" that they could use to track their tendency to worry and/or ruminate over the following week if they suspected that this is a problem for them.
This lead on to looking at what we pay attention to - illustrated in slide 8 of the overall 12 slide Powerpoint handout for this evening. I used the Garden of Eden story to illustrate this. Human beings - more than other animals - are able to imagine and plan for multiple possible future circumstances. We can also remember, think over, and learn from what happened in the past. This ability to "time travel" and "possibility travel" in our minds is something that can be very helpful - and could certainly be something that promoted adaptation during our evolution. However this "apple from the Tree of Knowledge" also comes at a price. We can worry endlessly about the many things that might go wrong, or ruminate round & round about what happened in the past. We may spend less & less time in the present - in coming to our senses, to our relationships, to being in this extraordinary, marvellous natural world, with this extraordinary, priceless gift of being alive. Knowledge can come at this price, a kind of "being cast out of the Garden". And it's fascinating that the story goes in Matthew's gospel "Verily I say unto you, Except ye be converted, and become as little children, ye shall not enter into the kingdom of heaven." I personally am not a member of any religion, but there seems a deep truth here. I know how easily I can go right through a day, very busily, very effectively, but it's as though I'm skating across the surface of life. It's as though I'm in danger of getting to the end of my life and remembering that I've got a lot done, but forgotten the grace I've often illustrated through Mary Oliver's precious poem, "The summer day" with it's final lines:
I don't know exactly what a prayer is.
I do know how to pay attention, how to fall down
into the grass, how to kneel down in the grass,
how to be idle and blessed, how to stroll through the fields,
which is what I have been doing all day.
Tell me, what else should I have done?
Doesn't everything die at last, and too soon?
Tell me, what is it you plan to do
with your one wild and precious life?
Several handouts from the "Wellbeing & calming skills" page of this website are relevant to these points - including "Attention, focus & time", "Savouring, mindfulness & flow", and the section on "Gratitude & appreciation": "Gratitude & appreciation record", "Suggestions" and "Miniatures" - this is a delightfully simple and potentially very helpful happiness-boosting intervention. The miniatures can be printed out as a six slide to a page Powerpoint handout providing background information. The suggestions sheet explains how to do the exercise, and the record sheet is filled in as one follows these instructions. I believe humans (and many other animals) tend to take fairly static aspects of their environment for granted. I suspect this has adaptive survival advantages in hunter-gatherer environments. Part of the cost is the hedonic treadmill where we rapidly take for granted precious every day facts - our ability to function, our relationships, the beauty of nature, the taste of food, so many things. As has been said "We tend to only notice the really important things in life when they're gone." This gratitude noting exercise readjusts the thermostat of our appreciation. It will probably then slide back and may benefit from being readjusted by doing this exercise for a week every month or some other regular reminder.
Besides these explorations of "mind noise" and reminding ourselves to notice & appreciate more, we also touched on issues around sleep - see the handouts & points made on the "Sleep, ADHD & fatigue" page of this website. And to keep a degree of focus on diet too, they received handouts on "A healthy breakfast - the best start to your day" and "Pack a healthy lunch". As usual I highlighted that all of us can benefit from continuing to work with the Autogenics, exercise, and diet. Other aspects like charting rumination & worry, or working more seriously on ideas around sleep, will be highly relevant for some course participants but not particularly important for others. I asked everyone to look at what mix is likely to be a realistic and personally relevant challenge for this coming week. They all had the usual "Reflection & intention sheets" and "Practice records" .
For next week's details, see "Life skills ... session 6".