Psychologist Hamilton Fairfax on OCD & Mindfulness

An Interview with Psychologist Hamilton Fairfax

Hamilton Fairfax, Ph.D. is consultant counseling psychologist in the National Health Service (NHS) in the UK. He has developed Adaptation-based Process Therapy (APT), an integrative group-based approach for complex clients, especially those with a personality disorder diagnosis and another medical condition. His work also focuses on the benefits of mindfulness for those with OCD.

Preeti Kota:  Hi, everyone. Thank you for joining this installment of the Seattle Psychiatrist Interview Series. I’m Preeti Kota, a research intern Seattle Anxiety Specialists. We are Seattle-based psychiatry, psychology, and psychotherapy practice specializing in anxiety disorders.

I'd like to welcome with us psychologist, Dr. Hamilton Fairfax who joins us from England today. Dr. Fairfax was a recipient of 2014 Society’s Professional Practice Board’s Award for Practitioner of the Year for his development of innovative therapeutic techniques when working with clients with complex needs. He specializes in adaptation-based process therapy, APT, an integrative group-based approach for complex clients and OCD. Before we get started today, can you let our listeners know a little bit more about you and what made you interested in becoming a psychologist as well as in mindfulness and OCD?

Hamilton Fairfax:  Yeah, of course. Thank you for inviting me.

So, I'm Hamilton. I'm a consultant counseling psychologist in the NHS, the National Health Service, which in the UK is a publicly funded health care system. And I'm working in Devon, which is in the far west end of England. And I'm in charge of psychology and psychological therapies for adults, secondary mental health care clients and that's people who've got severe enduring difficulties.

What's the next bit? Oh, it's why did I want to become a psychologist? Yeah. Good question. I started off doing theology and philosophy and classics and I suppose probably because I'm very bad at philosophy, I got a bit frustrated that it was all really interesting, but I wanted some practical ways of helping people and I think that was my interest all the way along was trying to find ways of trying to be helpful to people and I haven't got many other skills to do so and I ended up being a psychologist and that's still debatable in terms of the skills thing as well.

In terms of mindfulness, I was probably first introduced to it as a concept about 20-odd years ago through DBT and I pursued it from there. And the main focus on OCD is in the work that we were doing. We see anybody here with a complex, any diagnosis of complex care. And in that particular team I was working at the moment, at that time there was a really, really long waiting list and a lot of people with OCD. So, it was a case of how can we see people with the resources we have? And that led to, I'd be thinking as well about limited thoughts and mindfulness and just seemed like let's give it a go for an OCD group, mindfulness based.

Preeti Kota:  Great. So, just to begin generally, what is OCD?

Hamilton Fairfax:  Really difficult question there, isn't it? I guess traditionally, that would be seen as part of an anxiety disorder. I think it's a bit more than that. So, I suppose OCD is the idea of sort of a compulsive need to perform some behavioral or thinking rituals to help neutralize, prevent, or manage really distressing, intrusive thoughts in somebody's mind. And I guess it's on a continuum as well that I feel is about most mental health difficulties, that it's on the continuum, it's dimensional, we've all got a bit of something that it gets more and more extreme. And what OCD really is is awful. It's really, really life bothering and distressing for people. And I think the World Health Organization's still have it high on their worst conditions to have. So, OCD and it's worse because can be completely debilitating for people.

Preeti Kota:  Mm-hmm. Yeah, definitely. Why do you think many clients failed to engage or complete treatment for OCD when using the techniques of cognitive behavioral therapy or exposure and response prevention? Also, if you want to go into what those are generally.

Hamilton Fairfax:  Yeah, sure. So, it's a really good point, isn't it? Because I think they have some studies certainly in the UK saying that sometimes people weren't diagnosed with OCD for up to 15 years from their first presentation because there is something quite shameful that people can feel about OCD. Logically, they know this isn't the case, but they just feel compelled to do it. So, there's something often very shameful about that.

Also, when you start to tell people about exposure and response prevention. So, that is developing a series of graded ways of confronting your fear, that could be really scary. So, if you really think that something really bad could happen if I don't wash my hands 50 times and someone comes along, "Right, the treatment we're going to give you is we're going to make you stop washing hands 50 times and we're going to do it week after week after week in slow steps," it could be really, really off-putting for people to do that. So, there's a lot of fear and I think some people perhaps have read about things and they think, "Oh, no. I've got worries about contamination. I'll have to stick my hand down the toilet." They see these kind of videos out there. So, I think there's something about education in that as well.

And it's a really, really hard condition to treat. So, people won't tell people in huge details about what their thoughts are. Sometimes these thoughts and behaviors are really embarrassing for them. Sometimes they're really shameful and sometimes they're really scary. So, if you've got intrusive thoughts, for example, about being a pedophile, telling people that can have some really difficult consequences and people will respond differently to you. So, that's very, very difficult.

And I guess what we know from people with OCD is often, say, they'll present maybe the top of an iceberg of their difficulties and it would be for the therapist to really, really drill down into what's really going underneath that. And that takes time that you need to build a relationship, not just necessarily steam in with the behavioral side of things. So, it takes time to build that trust. And if you don't address the core, the roots, you might change certain behaviors but they could substitute different behaviors, which happens a lot from the evidence. Sometimes it can be 50, 60% of people relapsing or having a different kind of OCD. I think those are some of the reasons why it can be difficult.

Preeti Kota:  Hmm. Is one in particular CBT or ERP more effective or ...

Hamilton Fairfax:  If so, in the UK we have something called NICE, which is the National Institute for Clinical Health and Excellence. So, that's basically an organization that looks at the RCT forms of research and recommends treatment on that for the more common mental health conditions. So, they would argue that cognitive behavioral therapy with exposure and response prevention would be the best way of treating that. But, of course, the more complex people become, the more you need a bit more sophistication.

Preeti Kota:  Hmm. Yeah, definitely. What about mindfulness do you think makes it an effective solution for OCD?

Hamilton Fairfax:  Yeah. I think there's several things that helpful. One, I mean, it's incredibly portable. I think there's a book on mindfulness, isn't it? I think they're called “Wherever You Go, There You Are” in the sense that if you're being mindful, your body and who you are is always around. So, there's something you can practice and try out wherever you are in the world. I think, as well, I got particularly interested in cognitive mechanism suggested behind OCD called thought-action-fusion. And that's the idea that to have the thought is exactly the same as if you've done the behavior. And there were two types of thought-action-fusion. One's called moral thought-action-fusion, which is, if I have a thought that I'm a pedophile, what kind of person does that make me? I must be that evil person. And then it sets off.

So, the thought is just as bad as being that thing and there's a likelihood thought-action-fusion. If I keep thinking about the plane could crash, it could crash. So, I need to do something about it. It's almost like I'm making it crash. So, this way of the thought-action-fusion is really awful because it really starts that behavioral response automatically. So, I think something good about mindfulness is it begins to start to have a break between that thought-action-fusion. It begins to say, "Hang on, hang on. Okay. Yeah. That happens, but let's just stop and try and get that meta mindful position and try and break that link between thought-action-fusion."

Preeti Kota:  Do you think it's also ... Sorry.

Hamilton Fairfax:  It's also ... Sorry. Go ahead.

Preeti Kota:  Do you think thought-action-fusion is something that we have as an automatic bias or something we develop?

Hamilton Fairfax:  Good question. I'm guessing it's both. I think it has a function as well but that, over time, you feel more... I suppose it depends on the nature of the thoughts, as well, behind it if something is so horrific, either morally- or likelihood-wise, it might become more an ingrained pattern. Good question, though. It's difficult one to answer, but I think it's probably down to individuals-

Preeti Kota:  Yeah.

Hamilton Fairfax:  ... and what happened.

Preeti Kota:  And I'm sorry.

Hamilton Fairfax:  Yeah, yeah. No worries. I think also what's useful about mindfulness and the treatment of OCD is that it really helps engage in a behavior. So, for example, if you think checking the door loads of times is going to help prevent something happen. If you do it mindfully, if you mindfully check the door, you have to say, "Okay, I'm going to mindfully do this. I'm going to observe myself moving the handle and feeling what the metal feels. Oh, I'm surprised. Oh no, no, bring it back to that task." It really makes that person engage in that behavior. So, you're going to be obsessed with mindfully in a sort of paradoxical way. That helps because what we know about OCD, the way that it affects certain brain areas, but also anxiety and distress in general, is it hits our executive functions and our memories. So, it's very hard to do that.

So, when you begin to doubt yourself. "Oh, did I do it 15 times? Actually, no. I do remember really moving the handle." So, you get this whole sensory as well as to format memories as it lays down the links, which makes it more, "Okay. Maybe I didn't ... No, I don't need to go back and check, because I do remember doing it." So, it has that utility as well.

Preeti Kota:  Yeah. Are there specific types of mindfulness that are more beneficial than others, such as meditation over yoga?

Hamilton Fairfax:  I guess they are different practices. So, yoga obviously would be more physical-based. And I suppose the, it's the intention behind what you're doing it. I mean, there's different kinds of traditions in mindfulness and there's loving kindness meditation as well. But I guess they're doing different things in some way. So, I would always say, "Whatever kind of mindfulness you are doing, what's the intention behind doing it?" I mean, to be mindful is not to be relaxed. Far from it, often. You're really sort of immersed in the experience of feeling, "Oh, my god. What's all this about?"

So, it's not a relaxation technique at all. And the same with yoga. It embodies you, which is really important. That's what mindfulness can do as well. Embody you, but I guess with yoga there's an explicit meaning behind the practice.

Preeti Kota:  Can you elaborate on what you mean behind the intention of doing the practices?

Hamilton Fairfax:  Yeah. So, I'm thinking, well, and a poor example, some people will think, "Okay, so mindfulness is about being relaxed," and it isn't, but if your intention is, "I'll do this and I'll feel more capable of managing my distress or getting out there in the world," that's a bit difficult because mindfulness, I guess, personally for me, I don't feel is a set of skills. I think it's a way of being and that's a very different way to approach it. So, I think that's what I mean by the intention.

So, if we set the intention in treating OCD with mindfulness in the sense that, "Okay, what I'd like you to do is just really be aware of when you touch the desk 10 times. I really want you to feel it. I want you to notice." So, you're really actually priming the person about why you're doing what you're doing. You're being really explicit. "Okay." And then you'll say, "What will happen is we'll do this. Your mind will wander. You'll feel racy. You will have those in compulsive thoughts. That's alright. All I want you to do is practice bringing your head back and forth to that sensation." So, it's something again there about why you're doing what you're doing. I think that's what I mean by intention.

Preeti Kota:  Okay. In treating OCD, is mindfulness best suited as in addition to traditional therapy, in addition to medication or involving both?

Hamilton Fairfax:  I would say it depends completely on the person. How I've used it is all of the above. Most people I see will be on medication and they'll need more than just mindfulness practice. It needs to be contained within a wider psychological formulation. So, I'd say complete depends on the individual. I think I'd go back to intention again, but if you're wanting to talk to people about mindfulness in a therapeutic way, it needs to be part of a formulation that's explicit and co-constructive and like, "We're doing this because, and this is what I'd like you to ..." So, I think it depends on the person. I wouldn't separate it.

Preeti Kota:  So, when you're deciding based on the individual, is that related to the severity of the OCD or ...

Hamilton Fairfax:  In terms of medication, yes. So, sometimes medication can be helpful, sometimes it can't. I think I don't I'd ever just do be mindfulness, use mindfulness with somebody, but it would need to be part of the ... I wouldn't say as adjunct. I just say it's part of the therapeutic process.

Preeti Kota:  Okay. How long do the techniques of mindfulness last after completing a mindfulness program? Is it something you have to continue practicing often?

Hamilton Fairfax:  Well, you see, this is where we're bad practitioners in the NHS, because often we don't do follow-ups. But, actually, some of our groups, we did manage to do that. I can't remember if there's a paper written on it, but I think it was 12 months we did, certainly six months. And mindfulness people continue to feel better. When we asked them what was the thing they found most helpful in the group, which was cognitive behavioral as well as ERP and mindfulness, it was mindfulness. So, they carried on practicing the mindfulness.

In terms of what do you have to do? Yes, you do have to keep doing it because it gives you that authenticity. If you're asking someone to sit with their thoughts and manage that meta and the struggle of not getting it right, whatever that means. You need to have your own experience of doing that. It doesn't have to be... Sorry.

Preeti Kota:  Oh, no. You continue.

Hamilton Fairfax:  No. No. I was going to say it doesn't have to be wedded to any particular religious belief or whatever, but you do need to have that authenticity. So, you know what it's like to struggle.

Preeti Kota:  Is it the thing that … casually or something like dedicate time to each day?

Hamilton Fairfax:  I'm sorry. I lost you there over the Atlantic. I couldn't quite hear that.

Preeti Kota:  It's okay. Is mindfulness something that becomes more of an automatic habit or a scale or is it something that you have to dedicate time explicitly to practice each day?

Hamilton Fairfax:  Right. See this is why, depends on who you are as a person and what you need to do to remind yourself to do it. So, I'm very bad, because I suspect as a practitioner I need to be reminded to do these things. I need to have a commitment to do it, not me. I have to do it for an hour or anything like that. But there's also something, back with our client, it's very portable. You can do mindfulness. You find a form of mindfulness practice that suits you. For example, I quite like mindful walking, just really sort of noticing what it means to walk, which can make you feel really unbalanced.

But, so, I think it does take a commitment to actually doing it on an ongoing way. Does it become automatic? I think we're human beings, we resist these things and sometimes they become more familiar and sometimes they don't. Just depends where we are, but it does take a commitment.

Preeti Kota:  Okay. Do mindfulness and OCD affect similar brain areas neurologically?

Hamilton Fairfax:  Tricky and this is where I'll probably get in trouble with all my neuroscience colleagues. I'm not a neuroscientist, but what I'm aware of is that I think what mindfulness does in some of the studies I've seen, it certainly helps, I think it's thick in some of the prefrontal cortex. And I think it's been linked with a lot of the regulation of the limbic system and small amygdalas, I think. So, that would.

And with what we know of OCD, we know, again, the prefrontal cortex, the caudate nucleus, and the singlets are all sort of implicated, particularly that sort of relationship between the frontal cortex and the basal ganglia and the caudate nucleus. That sort of idea that here's the front bit that says here's our choice decision-making and here's the sort of more movement-y bit and that sort of error checking bit that gets skewed in OCD. That's a terrible, terrible neurological description. But anyway, so what I think that mindfulness does is that I think it calms down the reactivity of the system. So, I don't think it necessarily targets brain areas as such. Perhaps it just helps reduce the energy in those certain areas.

Preeti Kota:  Okay. So, I mean this might be too neurological of a question, but it doesn't really rewire the brain. It kind of just-

Hamilton Fairfax:  Well, I think that's interesting because if you go with... I mean, yeah, neuroplasticity I don't but I think, absolutely, because if you do something enough times you are going to rewire that kind of connection. So, absolutely. But I think that's true of any of our experiences. So, yes, I'm sure, I think therapy does help to do that kind of neuroplasticity change.

Preeti Kota:  And that's probably most likely in the prefrontal cortex that does that?

Hamilton Fairfax:  Again, I think you need someone who's much better qualified than me to do that. But, I guess, I think about brain functioning in terms of systems and yeah, across regions, but also systems. I don't know if it's just in the prefrontal because I guess you got the temporal lobes with the memory and all sorts of things. So, I think it might be more diffuse than that. I think that's what mindfulness might do as well. I think it's probably diffuse neural. But again, talking to someone who knows what they're on about.

Preeti Kota:  Okay. Is there a genetic basis for OCD, and also, is there a genetic basis for the ease of practicing mindfulness? Does it come automatically to someone more than another person?

Hamilton Fairfax:  Yeah. The best I've ever come across. I mean, you haven't looked at it for ages, was that 50/50 in terms of genetic bias of OCD. It might be slightly more than that.

It also means, yeah, on that continuum of OCD, we've got tick disorders, we've got neurological things, we've got other things. So, I think it's in maybe about 50/50. In terms of genetic for practicing mindfulness. I guess it's more about personality and temperament than genetics for being why to do it, I guess. I mean, that's a hard one. That's back to the nature/nurture. So, I don't know about that. But what we do know about mindfulness it’s been practiced for thousands of years in cultures across societies and across cultures. So, everyone can do it. Yeah. So, I don't really know about a genetic thing. I wouldn't have thought so but we're animals as well.

Preeti Kota:  Mm-hmm. Are there certain personalities that you were referring to personality-wise, that it depends? Are there certain path personalities you think are better at mindfulness?

Hamilton Fairfax:  Just on my experience and sort of just in gut feeling, I guess again, it's those people who are openness to experience who are sort of perhaps slightly more extroverted. You don't need to do that. But openness to experience that are willing to give things a go that are psychologically minded, that can make connections between things, that like to do new things. I suspect they'll probably be more willing to engage. But that certainly doesn't mean that people who are more reserved or more introverted can't do it.

Preeti Kota:  Yeah, I would actually expect people who are more introvert to be better because they're already kind of in tune or with themselves I guess.

Hamilton Fairfax:  Or a perception of themselves. And I guess that's the thing that we do with the mindfulness is are you introverted or someone called you... I mean, it could be. You could be absolutely right. There's something about that almost as diagnosis of introverted or extroverted but you probably could unpack through mindfulness.

Preeti Kota:  Mm-hmm. Yeah, definitely. Does mindfulness involve dissociation in that it practices separating the self from sensory experiences?

Hamilton Fairfax:  No, I don't think so at all. I think it's quite the reverse. I think it is about engaging with sensory experiences, either very explicitly, such as smell this coffee literally, or smell these. We did an exercise in one of these groups which was smelling Quavers, which in this country, is an incredibly fragrant, almost sick-making crisp that smells very strongly of cheese. So, we thought, "Fantastic. We're doing Quavers, not raisins," because they're far too traditional. But to do that, we were asking people to really engage with this Quaver. So, it felt funny and it really strongly smelled. So, they had to engage with that crisp and having all these thoughts going on and actually nobody really wanted to eat it, because the more you engage with it, the smell took over.

So, that's just an example I think of... It's not. It's about immersing yourself in the experience but having that step back that observes. It's not dissociative. It's an observing mind, it's an observing way of being. So, you need to know all these kind of things and it asks you to be in your body, because if you're sitting there thinking, "Oh, god, I didn't know my stomach felt like that when I'm having this thought." Okay, just observe it. Just hold on to it. Carry on with what you're doing. So, I think it really invites you to be far more embodied. And you can use mindfulness with psychosis as well. I know some can be quite worried about that, but there's some really good evidence of mindfulness in psychosis.

Preeti Kota:  Hmm. Can you just elaborate on the differences between mindfulness and disassociation, because I feel like mindfulness also involves kind of taking perspective, but I don't know much about dissociation.

Hamilton Fairfax:  Dissociation are often a highly understandable and effective way to deal with trauma. But what you're doing in dissociation is literally cutting off from an experience. You're putting your head somewhere else out of that environment. Whilst you're being mindful, you are engaging yourself in that environment. Yes, you're trying to have a meta-perspective to observe it, but you are fully immersed.

Preeti Kota:  Okay.

Hamilton Fairfax:  You're fully present, well dissociation to cut off.

Preeti Kota:  Okay. And then, do certain emotions or situations increase one's tendency to urge surf or act impulsively? And if you want to generally go over what urge surfing is as a concept.

Hamilton Fairfax:  Yeah. Well, I think it takes me back to my DBT days. So, this idea that you'll be flooded with, it's about emotional regulation often. So, you'll be flooded with feelings that just takes you to certain kinds of ways. And how mindfulness and DBT with certain other ways as well is to sort of stop and say, "Yeah, here's that flood of emotions. You can surf the wave, you don't have to be swamped under it."

So, mindfulness is a way of sitting back, setting the board on the wave as opposed to drowning under it. And in terms of acting impulsive, I guess that's what we're trying. That's the antidote that you're surfing it, you're riding it, you're not ignoring it, you're being aware that you feel pissed off or angry or whatever it is, but you're not letting it take you over.

Preeti Kota:  Okay.

Hamilton Fairfax:  And in certain situations do that, I think anything that's traumatic will do that. In terms of the emotion dysregulation. So, if you ask somebody who might have been diagnosed with personality disorder, which I prefer to say, "Complex trauma," there's lots of hardwiring for your environment where you are going to be highly sensitive to certain environments that you might feel abandoned, rejected, or under assault. And that could trigger you instantly into that sort of emotional overload, that storm of affect.

Preeti Kota:  Okay. How long does the emotions of trauma affect the tendency to urge surf?

Hamilton Fairfax:  How does it ... Go on. Say that again?

Preeti Kota:  How long do the emotions of traumatic situations affect one's tendency to urge surf?

Hamilton Fairfax:  How long? I guess it really depends on the situation and what's happening. If, for example, someone is self-harming and that's been what they've done before and we know that the positive thing of self-harming is that the cutting helps express a feeling, helps regulate an emotion, what we're wanting to do is try and change that behavior differently. So, it will depend, again, on the individual. It'll depend again on the context. In terms of a timescale, it's difficult. If that's how you've had to manage your life to survive for decades, it's going to be an instant thing.

Preeti Kota:  Okay. And then, for cases not directly relating to trauma, are there daily emotions or more common emotions that trigger urge surfing or impulsivity?

Hamilton Fairfax:  So, yeah. I mean I think anything that's ... There's small-t trauma, not necessarily sexual abuse and all the rest of, but small-t traumas, things that sort of interfere with our quality of life will lead to arousal of affect. And again, it is going be dependent on the person, what triggers you in that way. And again, the triggering is not necessarily always extreme. So, we're talking about I suppose the fight/flight's freeze way of understanding situations and how that relates to your emotions.

Preeti Kota:  So, it doesn't necessarily have to be negative emotions in terms of arousal, it can also be positive?

Hamilton Fairfax:  Sorry. I missed the first part.

Preeti Kota:  So, it doesn't necessarily have to be negative emotions just in terms of arousal. It could also be positive emotions that ...

Hamilton Fairfax:  Absolutely. Absolutely. If you're a big sport fan or a music fan, you know can really be easily taken over impulsively in the moment and sometimes do things you wish you hadn't or whatever or just be in a different place. Absolutely. So, it's just all mindfulness and I suppose other techniques is other ways of therapy is just trying to rebalance.

Preeti Kota:  Okay. Just also getting on a little bit of a tangent. For positive emotions, since it feels very good to be very happy, how would one be motivated to practice mindfulness to kind of tame those kinds of emotions? Because I feel like more … some people with maybe bipolar, with before you have something might not want to do that.

Hamilton Fairfax:  Yeah. I heard most of that I think, but tell me if I haven't answer your question properly. So, something here about how do you convince people with really high positive emotions that they want to stop doing that and try and be it more balanced?

Preeti Kota:  Yes.

Hamilton Fairfax:  Really ridiculous. Particularly people with bipolar disorder, cyclothymia and often when you meet the people that actually miss those high states, because there's something really addictive about not caring and just being happy in the moment. But I suppose what you need to do, again, is to look at the consequences of behaviors and they can often be really, really bad and they can often influence the bipolar shift the other way sometimes.

So, I think what it is, again, it's all about balance. It's not about destroying those high states. It's building relationships therapeutically with that person and saying, "Look, we want you to be in control of your feelings. That doesn't mean you have to be a robot. So, it doesn't mean you have to do these kind of things." But, like with OCD, we all have it a bit, but when it interferes with the quality of our lives, then it becomes a problem. And that's all we'll be saying to our bipolar people as well, I guess. These things, these emotional states interfere with the quality of your life and the quality of other people's lives. So, that's why we just need to bring this down a bit.

Preeti Kota:  What about-

Hamilton Fairfax:  Sorry, go ahead.

Preeti Kota:  It's okay. What about for people with OCD who just experienced such a high level of satisfaction from performing certain behaviors that they're just not motivated to practice mindfulness, to kind of change those behaviors even though it's affecting their life?

Hamilton Fairfax:  If someone doesn't want to change their behaviors, nothing we can do about that. But I'm guessing the fact that they've come in to talk about it would be some chink of saying, "Something's not okay here." I don't know if I fully answered that question. What was the first part of that?

Preeti Kota:  I think it was how people with OCD could be motivated to resist the satisfaction they get from performing the compulsive behaviors.

Hamilton Fairfax:  Yeah, okay. Yeah. That's an interesting one. I guess the people I tend to see aren't satisfied. It's all they're far from it. So, although there's a sort of, "I've done this. Things are okay." They're not happy because it's controlled their lives for 20 odd years or longer. So, there's a sense of satisfaction, but it becomes something really, really very toxic and they're there because this isn't okay. Or they can live with it, but no one around them can. So, that's a chink in as well. Or they don't want their children to pick up their behavior. There's some knowledge, there's some awareness that they don't want anyone else to have what they're doing.

Preeti Kota:  Okay. And then you're talking about the spectrum of OCD before, how some cases are very extreme and some are mild. So, on that spectrum, I guess what range can mindfulness help with, even mild is there?

Hamilton Fairfax:  Oh, yeah. You see how massively optimistic. I think you can help in all presentations because, again, it's about, the formulation, it's about the intention behind it. It's a very helpful way to get into exposure and response prevention in a certain way. Because the first thing you're doing is I'm gluing thoughts and saying, "Look, all I'm going to ask you to do is spend 30 seconds just sitting with that." So, it's a way of inducting people. So, I think you can work at any level of extremists and we've certainly had people, the OCD groups who were really intensive OCD units in the UK, real lifelong people, 40, 50 years plus of OCD. Had some lady who was so concerned about contamination that she would unscrew her floorboards throughout the house and clean the screws every single day. So, it's really quite extreme things and people benefitted from that.

Preeti Kota:  Mm-hmm. That's great to hear. So, what advice do you have for beginners trying to get into mindfulness?

Hamilton Fairfax:  Don't be put off and don't think you have to be a guru or anything like that at all. You don't have to be Buddhist. You can be. Don't have to be. It's just the way of being and the idea about being a beginner is what we all are. Because it's not about failing or succeeding, it's just noticing and being kind to yourself. So, please, please, please be kind to yourself. We're all beginners. There's a path of mindfulness practice, which is seeing as if for the first time, and that's a really good reminder because we become automatic with our perceptions. And so, if you all begin it, great. You're doing it. It's not about pass or fail. It's just about practice and just noticing what's happening.

Preeti Kota:  And do you also have advice for when someone with OCD relapses or even just someone without OCD trying to practice mindfulness but struggling and they're just harsh on themselves and they get kind of demotivated or unmotivated?

Hamilton Fairfax:  Really kind of compassionate. And also this is a good thing about having your own practice. It's just say, "Me, too. It's a bugger, isn't it? It's really difficult." And so, then you sit with them and think, "Okay, so what were you trying to do?" Well maybe they got into thinking, "I must be mindful, I must be mindful this time and this time. Well, I'm not doing my mindfulness." And just trying to work out what's getting in the way. And sometimes it just might be they've got really busy lives. So, just sort of stop and be compassionate and find out what's happening.

I guess one thing with OCD, I did notice with mindfulness is we saw one gentleman who had really, really severe mindfulness, was in several inpatient units, specifically for OCD. And what we noticed with him, I think he was able to say eventually, is that, when he was given instructions like CBT or whatever, he would internalize them as a ritual.

So, with the mindfulness, when we were talking about wise mind and the rest of it, it became an obsessive ritual. So, he would say things like, "Right, I'm doing my mind," while he wasn't being mindful. So, there's something to watch in that as well, just to make sure that people are doing, and that's why it has to be experiential and talking about the practice.

Preeti Kota:  Yeah, definitely.

Oh. Lastly, is there anything else you would like to share with our listeners or any final words of advice?

Hamilton Fairfax:  Yeah, this is for people with OCD and people treating OCD. Yeah, I just have enormous amount of hope. As I said, in these groups and I haven't run them all. Other people run them as well. People with 60 year histories of OCD, people who have had their life controlled by it - it can change. And you can tell your therapist anything. They're really unlikely to be flustered. Even if it's something you're really, really fearful of, we're here to help you. But it's the massive amount of hope that there can be change in OCD or any mental health difficulty.

Preeti Kota:  Great. I love that. We ended on a very optimistic note. Well, thank you so much for being here.

Hamilton Fairfax:  No problem.

Preeti Kota:  I definitely learned a lot and it was great to have you.

Hamilton Fairfax:  Thank you very much for inviting me.

Preeti Kota:  Of course. Bye.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.

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Editor: Jennifer (Ghahari) Smith, Ph.D.

Psychologist Mark Leary on Self-Compassion

An Interview with Psychologist Mark Leary

Dr. Mark Leary is a Professor Emeritus of Psychology and Neuroscience at Duke University, and specializes in social and personality psychology.

Maya Hsu: Hi, my name is Maya, and I'm a research intern here at Seattle Anxiety Specialists. Today I am joined by Dr. Mark Leary, who is a professor emeritus of psychology and neuroscience at Duke University. He has made significant contributions to the fields of social and personality psychology, and he has also authored an article titled Self-Compassion and Reactions to Unpleasant Self-Relevant Events: the Implications of Treating Oneself Kindly, which is how I found Dr. Leary. Dr. Leary, would you like to introduce yourself and share how you became interested in social psychology and self-compassion?

Mark Leary: I've been interested in topics involving self-reflection, that is thinking about yourself, for a long time because the quality of our lives and our emotions and our behavior are affected by how we think of ourselves. And traditionally, psychologists have thought of that in terms of self-esteem. But more recently, in the last 20 years, the topic of self-compassion has become hot. And I just sort of tagged onto it and began to do work with my research team on self-compassion.

The difference is that self-esteem has to do with how you evaluate yourself. Do you evaluate yourself positively or negatively? How good do you feel about yourself? So everybody's familiar with the topic of self-esteem. Self-compassion is not a self-evaluation. It's how you treat yourself. Do you treat yourself well, with kindness and caring and understanding, when you have problems in life? I often like to describe it as compassion directed toward yourself.

Think about how you treat other people you care about when they're having problems and they're struggling and they're unhappy and they're anxious and they're depressed. You treat them with care and empathy and concern. The irony is that many of us, when we hit problems, we treat ourselves very badly. We're really mean to ourselves and critical to ourselves. We beat ourselves up in our own heads. And so self-compassion is an attempt to try to lower the degree to which people are mean to themselves and increase the degree to which they treat themselves better, treat themselves kindly and with concern.

Maya Hsu:  Great. Thank you so much. You answered my first two questions of what is self-compassion. It's self-kindness. And how does it differ from self-esteem, which is more of a self-evaluation. Which got me thinking, is it possible to have one without the other? Is it possible to have self-compassion without self-esteem?

Mark Leary: Absolutely. Think about it in terms of having compassion for another person. You can have a lot of care and compassion for somebody that you don't evaluate positively. Right? You might even dislike them, but you might be compassionate and try to help them and make them feel better and reduce their problems. A person with low self-esteem can do that to themselves. For the time being, maybe they don't evaluate themselves all that well, but that doesn't mean they have to be mean to themselves. They can treat themselves kindly. I also think there are some people with high self-esteem who treat themselves horribly in their own heads. They're very self-critical. They beat themselves up a lot. They evaluate themselves positively. They have high self-esteem. But they're not very self-compassionate. So these are two very distinct things. They are correlated because the more favorably people perceive themselves, the better they tend to treat themselves. But there's no necessary relationship there. You can have one without the other.

Maya Hsu: Okay. And I know this is true for me and a lot of people that I talk to in my life. Why is it easier to access compassion for others than ourselves?

Mark Leary: That is a really good question. I've been puzzled with that in my own life. It's occurred to me sometimes that if I talked to other people as meanly as I talk to myself in my own head, if I was as critical to them as I am to myself, I'd probably be arrested. I'd be sued for harassment. We harass ourselves in our own heads. And it is a puzzle because in many ways the average person cuts themselves a lot of breaks. There's a lot of research showing that we are nice to ourselves in some ways. But when it comes to self-criticism and catastrophizing and beating ourselves up, some of us are just not very nice to ourselves, and I don't have a good answer for exactly why that is. My hunch is it's because if we treated other people the way we treat ourselves in our own mind, we wouldn't have any friends. Our romantic partners would leave us. Nobody would want to interact with us. They'd say, "You're horrible. You treat me awfully." Some of us treat ourselves in exactly that way, but we can't leave ourselves. We're stuck with the person who is mistreating us, which is us.

Maya Hsu: Yeah. I wonder if part of the advantage of being self-critical is that it can act as a motivator for us to improve or work on certain qualities within ourselves. Is it possible to have that self-motivation without the self-criticism? Is it possible to have self-compassion and still be driven to work on oneself?

Mark Leary: I absolutely think so. And I want to make a distinction because you ask a question I've been asked many, many times, because the idea of self-compassion suggests to some people that we just should always be nice to ourselves, only say pleasant things to ourselves, never be negative, never be self-critical. That is not true. There are times that we have to evaluate ourselves negatively. That helps us regulate our behavior. So there's nothing, truly nothing wrong with negative self-evaluations, as long as they're accurate. If I mess up, if I fail or I make a mistake or I engage in a bad behavior or hurt somebody, it makes sense that I have to say, "I was wrong about that. I shouldn't have done that."

So negative self-evaluations are okay. Where they're not okay is when they are inaccurate. And so many people have self-judgments that are just far more negative than they really should be. So you want to have an accurate self-judgment. But the worst thing is that when you have a self-judgment, the question is, how hard do you need to be on yourself? How hard do you need to beat yourself up? And again, if you think about applying judgment to other people, if someone else has done something wrong... Let's say you're a parent and you're interacting with a child. It's perfectly okay to say, "You shouldn't have done that. That was a bad thing to do." But how badly do you need to scream at the child?

Well, the same question can be raised in your own head. Yes, it's okay to say, "Boy, I messed that up," or "I've got this problem I have to solve," "I lose my temper too much," whatever it happens to be. But how mean do I need to be to myself? And my guess is that most of us don't need to be nearly as critical and nearly as mean to ourselves as we are in order to stay motivated, because that negative evaluation is motivating at times. I've talked to many highly achieving people who just insist that their success is based on how badly they treat themselves when they fail. And I can see the truth in that to an extent. But I always ask them, "Okay, I agree with that. But how bad do you have to treat yourself? Isn't it enough just to know that you messed up and that you need to do better, or do you need to lie awake at night and feel badly about it?"

Maya Hsu: Yeah. It sounds like you're making a very clear distinction here between negative self-evaluation and meanness, because you can have one without the other.

Mark Leary: Yes. That's right. That's exactly right.

Maya Hsu: And you can acknowledge that you might have done something imperfectly or you might have harmed somebody without reprimanding yourself to the point where you feel awful.

Mark Leary:  Yes. And there's a couple of other considerations there. When you do something badly or something's going wrong or you're afraid of something that's going to happen, it's okay to think about that in a very concrete and specific way that focuses on the actual problem, the failure, the mistake, the bad behavior, the threatening event, to think about that very narrowly about, "Well, what can I do about this? What's going on here? How do I solve this problem?" The problem is many of us over-generalize from that thing, from that failure. Yes, I failed this test. But the thing I say to myself is, "God, I'm stupid. I'm always going to be a failure. I'll never amount to anything." You've taken one specific thing and you've blown it up, or you're rejected.

Yeah, we all have rejections. And yeah, that hurts, and it's a problem to be solved. But it's one thing to say “I was rejected.” It's even one thing to say, "I didn't behave as I should have in this relationship." It's another thing to say, "I am a horrible person who will never be loved by anybody." We over-generalize. So as we evaluate ourselves negatively, it's very helpful to keep those evaluations really focused and specific.

It's also important just to be able to solve the problem. I can solve the problem of doing badly on this particular test or taking care of one bad habit. I don't know how I would solve the problem of just being a loser or a failure in all areas of life or a horrible person. Those are just so global, there's no way to begin to solve the difficulty that started the whole problem.

So I think people need to be very attentive to how they talk to themselves in their minds because it makes their life worse. It creates negative emotions in ways that aren't beneficial. It's okay to have unfavorable evaluations if it helps you correct a problem, it helps motivate you. That's fine. But so much of this is not helpful. It just makes us miserable.

Maya Hsu: Yeah. I think you touched on a really important piece there, which is the accuracy of that self-evaluation and self-reflection. And I definitely have engaged in that globalized, fatalistic thinking where you do one thing imperfectly, and it's like, "Well, I suck at everything now."

Mark Leary:  And we all do. The challenges are the people who just get stuck in that mode of reacting to their problems, and those are the ones that really need to think about how do we deal with this in the long run.

Maya Hsu:  Right, because it can be very cyclical. And you can then enter into confirmation bias where then you expect yourself to do that in the next situation, and then it's just a self-perpetuating cycle.

Mark Leary:  Yes. Let me add one other thing. So far we've been talking about not being mean to yourself when you have problems, when you've done bad things or bad things have happened, to be less mean. But the other part of self-compassion is to actually be nice to yourself, do pleasant things for yourself. So often when we have problems, particularly if we feel like we have caused the problems, it's almost like we feel like we ought to punish ourselves and push ourselves harder and hold our feet to the fire. But that might be the time to be nice to yourself. And again, if you think of a friend who's really struggling, sometimes we'll say something like, "Hey, let's take the evening and go have dinner. Hey, let's talk. What do you want to do that would be fun? You had a bad day." We don't do that. When we have a bad day, that's when we push ourselves the most sometimes.

 This really dawned on me. I had a graduate student who was working on this. In fact, she's one of the co-authors on that article that you mentioned at the beginning. She went away one weekend to visit her grandparents. They were in their 80s, I think. And like all older people, they were starting to suffer some cognitive issues. Their memories weren't as good. They were clearly physically more frail and had health problems. But she came back very impressed by the difference in how her grandfather and her grandmother coped with those problems.

Her grandfather was a poster child for low self-compassion. He fussed and ranted about his memory is getting so bad, and he would criticize himself and, "I'm not strong enough to go out and mow the yard without stopping now. I just hate getting old, and I can't do anything anymore. I'm worthless." Her grandmother was a poster child for high self-compassion. What she said was, "Yeah, I've got good days and bad days. But when I'm having problems and my joints are hurting and I can't get around much, that's when I treat myself particularly well. I'll fix myself a cup of tea and watch the birds in the yard, and I won't try to push myself to get the housework done." And it was such a striking difference. And it wasn't just that the grandmother wasn't being mean to herself. She was actually treating herself more nicely.

And this student went on... they gave her the idea for her dissertation. She did three studies of self-compassion in older people, people 65 to 95 years old that we recruited as participants. And consistently, the ones who treated themselves more nicely, who were higher in self-compassion, were psychologically doing better. They were less anxious. They were less depressed. They were more healthy. It's the same kind of finding we find anytime we study self-compassion. You get positive psychological and physical outcomes. But it was particularly striking when I thought about it in terms of aging. And that was 20 years ago. I'm kind of more conscious about the psychology of aging now than I was 20 years ago when we first did that research. But I can understand the importance of self-compassion in that context.

Maya Hsu:  Yeah. That's an important point that it's not the absence of meanness, but it is the presence, the addition of self-kindness. And I like the anecdote. Thank you for sharing that. It reminds me of family members who berate themselves when they gain weight and that kind of thing, when they could access self-compassion and do something kind for themselves, which ties into the previous point of not having that motivator. I think that self-criticism is like, "Well, if I'm kind to myself after I've gained weight, then I'll just gain more weight."

Mark Leary:  Yes. But then again, that person who's gained weight and is unhappy with it knows they don't want to be overweight. They already have a motivator. They know they'll feel better and they'll look better and be happier. Do they need to go through their entire life until they lose weight beating themselves up? And the answer is no, probably not.

Maya Hsu:  Right. You touched on some of the positive effects that can accompany self-compassion, like better health and psychological well-being. How does that work? How does it moderate the effects of more negative events?

Mark Leary:  It does a couple of things. One is that it takes away that extra layer of negative self-evaluation and self-criticism. The average person thinks that their reactions to events are reactions to the events themselves in the world. So I have an experience or I do something and I feel bad about it, but that's sort of like a natural reaction. That's partly true. But so much of our reaction has to do with how we think about it and perceive it and think about ourselves and talk to ourselves. So self-compassion takes away that extra layer of negative emotion that occurs when you berate yourself, when you don't treat yourself nicely.

The way I often explain it to people is when you have a problem, you really do have a problem. Whatever that problem is, whether it's your weight or a bad habit or you failed or you were rejected, you have a problem. Why make that any worse than it already is? But we all do that. I do that. I don't want anybody to get the idea that I'm always self-compassionate. I'm not. I'm more self-compassionate than I was before I started studying this. I absolutely am. But still I have a problem, and now I'm going to make that problem worse just by how I talk to myself about it. So self-compassion takes away that extra layer of negative emotion, and I think that's why people high in self-compassion are happier. They are more satisfied with their lives. They rate themselves higher in serenity, even. Why? They don't pile the extra stuff on there. It doesn't make their problems go away, but it changes their reaction.

In one study we did with university students, at the end of the semester, we asked them, "What was the worst thing that happened to you this semester?" And we got a whole range of things, from very trivial things like "I lost my chemistry book" or something, to very serious, traumatic, life-changing events. But regardless of what we asked them— this worst thing that happened to you, how upsetting was it and how disruptive to your life was it?— And what we found is the students higher in self-compassion said that the worst thing that happened to them was less upsetting and less disruptive to their life. And they had the same kinds of problems. We thought maybe people high in self-compassion somehow have fewer problems. But we analyzed the content of the problems. That wasn't it. It was the fact they were not adding the extra emotional baggage on top of the original problem. Whether it was a lost book or a traumatic event, they weren't adding to the trauma of the situation through how they were talking to themselves.

So the big thing that self-compassion does is it takes away that extra layer of stuff. And then to the extent that you can treat yourself more nicely, it can actually make you feel better. When we're having a problem and a friend treats us nicely and takes us out to dinner, it doesn't solve our problem, but it does enhance our positive feelings because now we're doing something nice. So self-compassion just corrects for the fact that we don't treat ourselves as nicely as we should.

Maya Hsu:  So to clarify, it strips away the globalization thinking and the self-judgment and just kind of the inaccurate thoughts and the meanness. And that is what leads to improved health and improved cognition and better physiological benefits.

Mark Leary:  As a very general statement, that's true. I wouldn't quite say it strips them away because that sounds like they're never there anymore, but it reduces them to where they're not as much of a problem.

When it comes to health, there's some interesting research trying to understand why it is that people higher in self-compassion do show better physical health. They have fewer symptoms, and they just seem to be better... They have fewer stress reactions physiologically. We know that stress makes people unhealthy. There seem to be two processes by which self-compassion improves physical health. One is it reduces the negative emotions and stress. And we know that negative emotions and stress undermine health, interferes with the immune system, so it reduces the stress and unhappiness. But also, people higher in self-compassion take better care of themselves. If you think about that, when you care about somebody, when you're concerned with their wellbeing, you treat them better. And you would tell a loved one if they're doing something unhealthy, "Maybe you need to stop eating all that junk food, or, "Maybe you need to go and get a flu shot," or whatever it is. I think people higher in self-compassion are more likely to do that.

In the study of the older people I mentioned a moment ago, we found that participants higher in self-compassion were more likely to take daily multivitamins, even, which is really interesting. If you care about yourself and your own wellbeing enough, it not only leads you to treat yourself well and not beat yourself up, but you take better care of yourself physically.

Maya Hsu:  That's so interesting. It sounds like there's a certain sense of empowerment that you have to embody. You have to kind of step up to the plate and take ownership of yourself and be willing to treat yourself kindly, which takes effort if you've been treating yourself poorly your whole life, to take your multivitamins.

Mark Leary:  I've never thought of it that way, but that sounds accurate. For those of us, myself included, who were never particularly self-compassionate, it does take effort. It takes a change of habits to do that. I think some people somehow grew up just naturally being nicer to themselves, and I envy those people because they don't quite have these struggles. I have talked to people who just are kind of puzzled. They say, "Why would anybody be meaner to themselves than they need to be? I've never done that." And that amazes me. That's great though.

Maya Hsu:  In your years of studying this, what have you seen are the biggest barriers to people sort of shifting into a more self-compassionate mindset?

Mark Leary:  I think the biggest one is something we've sort of talked about indirectly, and that is, people are afraid that if they're too nice to themselves, they'll turn into slackers. Because it does sound like if you're not careful that self-compassion is something where no matter what happens, you go, "Well, that's okay. No, I'm fine. Oh, I did this horrible thing. Well, that's okay. Everybody does horrible things." But that's not what it is. You still take your behavior seriously. You just don't add that extra layer.

And there are some studies that show among university students, higher self-compassion students take more responsibility for their bad behaviors. Like after failing a test, students higher in self-compassion take more personal responsibility and then work harder before the next test. And that might seem counterintuitive because it sort of sounds like if you're nice to yourself after you fail, that's sort of like you're taking yourself off the hook. Why would you go ahead and work really hard? And I think it's because if I don't beat myself up, I'm not adding a lot more negative emotion to the whole situation of failing that would lead me to avoid the whole thing. If I'm really, really mean to myself, my life is a wreck when I fail, and I just sort of tune out. And I say, "Well, there's nothing I can do about this." And I pull back, and I over-globalize and I can't fix this problem. But if I can accurately say, "No, I didn't do very well on this, and I'm not going to make a big deal out of it, but I'm going to do better in the future," it actually increases students' motivation.

So I want to encourage anybody who says, "I'm afraid to be self-compassionate because I'll turn into a loser or a bad person, who just will do anything and not worry about it.” That is not what happens. When you're compassionate towards someone else, and they have done something bad or they have failed, you don't tell them, "Hey, that's okay that you failed. Don't worry about it. Don't try to improve." You would never say that. Or if they did a bad moral behavior, you don’t say, "Well, that's fine. That's okay. You stole the money. Who cares?" You don't do that. And we don't do that to ourselves. We know how we're supposed to act. We don't cut ourselves that much slack.

Maya Hsu:  Yeah. It does seem a bit surprising at first that people with self-compassion after failing a test would work harder and achieve higher the next time. But it does make sense when you break it down because when you do layer on all the judgments and it becomes this insurmountable task, then it would definitely make sense that people would just give up.

Mark Leary:  Yeah. That's right.

Maya Hsu:  Yeah. Let's see. How might someone journal self-compassionately for anxiety management, or just use self-compassion for anxiety specifically?

Mark Leary:  There are writing exercises out there, including journaling exercises that help promote self-compassion. And I think what those kinds of exercises are useful for are two things. One is,  if a person wants to change unhealthy habits... And low self-compassion is just an unhealthy habit. It's changeable. It's just a pattern that we get into in how we think about ourselves and think about the bad things that happen to us. The only way to change a bad habit is to begin to really monitor yourself for cases in which you do it to understand, when do I do this thing? Why do I do it? What form does it take? And journaling, in which you analyze your day in terms of how you talk to yourself about the things that happened, particularly after a bad event, I think is really beneficial in terms of just opening people's eyes to how much they really do this. And that's the first step. So journaling is beneficial just in terms of alerting people, putting them in touch with how they're talking to themselves.

The second thing then is you can begin to journal in ways that promote your own self-compassion, or do writing exercises of other kinds. There are exercises out there, for example, where people are told to give themselves advice about a problem the way they would give that advice to somebody they really cared about, with kindness and concern and compassion. In fact, write it in the third person. You're writing it to yourself as if you were somebody else. And that's often eye-opening to people to realize that “the advice that I would give somebody else for how to deal with this is very different than the advice I've been giving myself in my own mind that's making me so miserable.”

So there are ways to begin to give yourself advice. If there are personal characteristics that a person has, they dislike a lot, and that's making them beat themselves up for whether it's academic or intellectual or personality problems or social problems, you can do the same sort of thing. What would you say to someone else who had these characteristics, somebody you cared about? How would you talk to them about these shortcomings that you think you have? And again, you wouldn't deny them to somebody you cared about when they realize they're having problems in school or something like that. But you would talk to them about it in a proactive, healthy, somewhat positive way.

I would recommend to any listeners who want to try different kinds of exercises, whether they're writing exercises or exercises that you do just in the course of everyday life, there's a website, self-compassion.org, self-compassion hyphenated.org. This is the website of Kristin Neff, N-E-F-F, who started the study of self-compassion in psychological research about 20 years ago. If you go back through the research literature on self-compassion, you can't find the term in psychology until Kristin's groundbreaking work. She developed the idea, developed a scale to measure it. And she's got a fantastic website at self-compassion.org that has, last time I looked, a couple of dozen exercises and lectures, little lectures, five minutes up to 20 minutes, along with a number of different exercises for people who want to begin to explore, how do they promote their own self-compassion a little bit more. Kristen's great at doing this stuff. She's been doing self-compassion workshops around the country for years now, and she can give you a lot better advice about how to deal with low self-compassion than I can. Self-compassion.org.

Maya Hsu:  Awesome. Thank you. Okay. And can people acquire trait self-compassion, or is it only possible to acquire state self-compassion over time?

Mark Leary:  Okay. Let me define those terms for your listeners first. When psychologists talk about people's characteristics, they often make a distinction between a trait. And a trait is a general tendency. So there are some people who have a general tendency to be low in self-compassion. We would say that's trait low self-compassion. There are other people who have a tendency to be high in self-compassion, high in trait self-compassion. It doesn't mean they're always that way, but if you look at them over a period of time, across different situations, yeah, we lean in one direction or the other. State self-compassion refers to how self-compassionate am I behaving at this moment. In this particular situation at this particular time, am I treating myself with self-compassion?

And there's obviously a relationship. People high in trait self-compassion are people who engage in state self-compassion more frequently. But there are some people... And I would put myself here. I think I have emerged as a person high in trait self-compassion after working on this, but I still can be really low in state self-compassion. Sometimes I just lose it over that stupid thing I did because I'm an idiot and a loser, and I don't know that I'll ever amount to anything. The thoughts just start running.

So the question is, can you change? In a state way, it's not all that difficult now and then to catch ourselves. In that moment, we can say, "I'm not going to engage in this low self-compassion stuff. I'm going to treat myself nicely." That is not all that difficult to do from time to time. The bigger question is, can a person who generally does not treat themselves well, a person low in trait self-compassion, ever become high? The answer is absolutely yes.

People just need to realize, again, this is a habit. We all have habits, and we can change habits, including unhealthy and bad habits. This is a way of thinking that some of us have developed— who knows how. There's not much research on this. By the way our parents talked to us, perhaps, the way people taught us to think about our problems and mistakes and bad behaviors along the way. Maybe some of us just drifted into it, started not being very nice to ourselves. But regardless of where it came from, we can always change bad habits by beginning to monitor them, by doing exercises, by accepting the fact that we're going to fail at this from time to time.

You're never going to be always high in self-compassion. There's nobody on the face of the earth who never criticizes themselves unnecessarily or beats themselves up. That's fine. What I tell people is what you really want to do is just reduce this a little bit. It takes the edge off of life if you can just reduce your negative self views, your beating yourself up, not being nice to yourself, by even 15 or 20%, for example, your life will improve.

So yes, this is changeable. And again, I'll refer people to Kristin's website as a good way to start to really understand self-compassion, to monitor how they're treating themselves, and then to start taking steps through exercises to try to become more self-compassionate.

Maya Hsu: I think that's very encouraging to think of it as a habit that can be changed and worked on through practice. Is there anything else that you would recommend for our listeners about self-compassion just broadly?

Mark Leary:  There are probably some people listening who right now are beating themselves up for not being sufficiently self-compassionate, because I do that sometimes. It creeps in through the back door, low self-compassion and this meanness that we have for ourselves sometimes. So just cut yourself a break. Accept the problem a little bit more. It doesn't mean they're not problems.

I always want to make the point as well, sometimes if you're not careful, what sounds like high self-compassion is trying to tell yourself you don't have problems. It's like it's positive thinking. Self-compassion is not positive thinking. I'm not a big fan of positive thinking, in fact. I am a fan of accurate thinking because being too positive can create almost as many problems as being too negative. So it's not just telling yourself happy stories. It's not just being optimistic about the future for no reason. It's not building up your self-esteem artificially. It's not telling yourself that you can do anything you put your mind to, because that's not true. All it is, is not making your life worse by treating yourself badly. It's not just positive thinking. It's accurate thinking and not being mean to yourself. And when you look at it that way, it shouldn't be that hard. We're nice to other people. We have a lot of experience being nice to people. Why can't we be that nice to ourselves? That's what self-compassion is about.

Maya Hsu:  That made me think of one last question I want to ask you. With failing a test and with gaining weight, those kinds of measures are more objective. But with the situations that are a bit more ambiguous, maybe social situations where people might feel like they failed, but it's hard to know for sure, how does one access accuracy in those situations?

Mark Leary:  Wow. That is a really, really, really good question because we all know that there are times in which we misinterpret what has just happened in the situation, whether it's a social situation or a romantic situation, or it's just me working in my yard and I mess up something and cut down the wrong tree. What happened there? And I don't know. I think the best thing is just to be aware of the fact that the beliefs we have about ourselves and our behaviors and the causes of what happens to us are partial and sometimes incorrect. They certainly don't feel that way. We believe that we understand what has happened to us and why it's happened. And we have to go on those beliefs. We just can't sit and say, "I don't know why anything happens."

We do infer things correctly sometimes. I just encourage people not to take their judgments and their beliefs about themselves too seriously as if they're completely accurate, because everybody knows they're not. Everybody could think of times in which they misjudged a situation or they misjudged themselves. One question you could ask yourself is, “how sure am I that this was my fault?” And there's often a little bit of ambiguity there. So there's no good answer to your question in terms of how do we increase our accuracy except to be open to the possibility that we're sometimes inaccurate and be able to live with that.

Some people would be paralyzed by uncertainty. How do I know what to do? I don't know who I am or why I did this or what happened to me. That's not it. You have to go ahead and make behavioral decisions, but just don't be too certain that you think that this social event went badly and everybody thought you were an idiot. Was that true? Maybe not. We know that people sometimes overestimate negative situations. Our threat detection system is on high alert. And all animals are made that way. They're more likely to treat something that's not dangerous as something that's threatening and risky than they are to treat something that's dangerous as safe. And we do that throughout life, throughout our jobs and our social lives and our family lives and our academic lives. We put a negative reading on things. And that's adaptive because it makes sure we don't miss anything bad, but it also is a downside because it makes us react to things as if they're bad that aren't really.

Maya Hsu:  Yeah. So there are some situations where it's kind of ambiguous and unclear, and that's something we have to accept. And it sounds like what you're saying is that in those situations, the best thing we can do is just be on alert for inaccurate thoughts and judgments and just to not engage in those. And then what's left is kind of the more accurate ambiguous truth.

Mark Leary:  You said that better and more concisely than I did. Very good.

Maya Hsu:  Collaboration. A collaborative effort. Well, thank you so much for joining us today, Dr. Mark Leary.

Mark Leary:  Well Maya, thank you very much. I've enjoyed it. I hope it's been helpful.

Maya Hsu:  Definitely. It was wonderful to have you.

Mark Leary:  Thanks.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.

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Editor: Jennifer (Ghahari) Smith, Ph.D.

Rev. Tim Burnett on Mindfulness-Based Stress Reduction

An interview with Reverend Tim Burnett

Rev. Tim Burnett is Executive Director, Founder, and guiding teacher at Mindfulness Northwest.

Jennifer Ghahari:  Thanks for joining us today. I'm Dr. Jennifer Ghahari, research director at Seattle Anxiety Specialists. I'd like to welcome with us, Reverend Tim Burnett, executive director, founder, and guiding teacher at Mindfulness Northwest. Tim has been a teacher of mindfulness-based stress reduction since 2010 and a mediator since 1986. Before we get started, can you let us know a little bit more about yourself and what made you interested in mindfulness?

Tim Burnett:  Sure. Yeah. I stumbled into Buddhist meditation as a young man, and I found it helpful. I didn't really have language for it. I was a bit shy about it. I didn't really tell my friends. I was going quietly off to the Zen center early in the morning on my way to college classes and so on. And then, I relocated and just by happenstance ended up helping to form a group that became a Buddhist center. And meanwhile... The practice of it, somehow it met some need that I couldn't meet any other way, stabilizing, soothing, provided some sense of purpose and meaning that I needed. But I always saw it as specialized unusual thing and a little weird that not that many people would be into this kind of thing. But I was. So, okay, what the heck? In the meantime, my career was just going left and right and center and not really landing anywhere. I was a field scientist for a while. I became an elementary school teacher. I worked in technology. And nothing was really quite landing.

And then I started in about... I don't know... 2007 or 2008 to notice mindfulness starting to show up on the media more. And of course, now, it's a lot more than then. And a friend of mine was involved in a project at the Seattle VA Hospital to bring mindfulness-based stress reduction training to veterans with PTSD, Gulf War Syndrome and some pretty serious conditions. And I somehow got involved in that for a little while and started teaching these classes and found a lot of resonance with what I had personally been experiencing in Zen Buddhism, but delivered in contemporary language, really accessible to people who probably would never walk through the doors of the Zen Center.

And, I was amazed just how much it seemed to help people and starting with this group of vets. A few of them were actually Vietnam veterans and suffering from the effects of PTSD and the trauma of the wars for 40, 50 years. And here they were in the second or third class that I was somehow facilitating and reporting lots of shifts and changes and feeling excited, feeling positive, understanding emotions a little differently, and sleeping better. Yeah. So, I was hooked from there. And then I got curious, could I do more than just one project?

So I started an institute like the Paul Simon song says. It was the right place, the right time and the right level of persistence, started getting institutional interests from county government and medical schools and university, and then started offering community classes. And it just unfolded from there. So, now there is 11 people on staff, some of them part-time. And we are about a half a million-dollar organization, non-profit, fee-for-service, with some donor support. And we've been offering these trainings to thousands of people up and down the Puget Sound region, and now, of course, online. So yeah, that's how that came to be.

On a good day, I take a little step back and I'm amazed. Like wow, how could this even be happening? It's such a new field, but it's been increasingly accepted. One thing I've noticed over the years is the people who come have shifted from an earlier attitude, which was like, "Well, this is a little weird. But maybe, okay, I'll try it. Ya know, I'm stressed." Now people are like, "I know I need this. How do you do it? I don't know how to meditate. How do you do this?"

So it's interesting, at least within some segments of American society now, it's just understood in a way it wasn't before that stress is harmful and we can't just push through all the time. We need some other tools, other attitudes, other ways of being. So, yeah, it's been really exciting. Yeah.

Jennifer Ghahari:  Great! So, can you explain what the mindfulness space is and how is mindfulness important to one's life?

Tim Burnett:  Well, mindfulness is a term that just helps to point at an ordinary thing that we do all the time, but we do it pretty automatically, which is that we're navigating in a really complex, perceptual, biophysical, psychological field all the time, right? And moments are happening. Moment after moment is happening. And somehow, we're selecting which moments to pay attention to, which is attention itself. We're responding to them in certain ways. We're influenced by our history, conditioning and culture in certain ways. But, we're so busy often, and often lost in some conceptual stuff that we add to everything, kind of lost in our heads, that we miss a lot of opportunities to see things a little more clearly, to respond to things a little more creatively, to be more aware of the felt sense of what's happening moment to moment, and whether we're adding to our own stress with habituated patterns or whether we're finding different ways to cope that are more adaptive to the current situation.

Like one quotation we like that describes the space as it was a good question, is a quotation attributed to Viktor Frankl. And the quote is, "Between stimulus and response, there's a space. In that space is our power to choose our response. And in our choice is our growth and our freedom." So, it's dialing it way down, and we're... Of course, that's where we are. We're always happening now. But our mind is about, "How am I going to deal with it this time? Do I have time to get the kids after work? Oh my God, did I remember that?" Right? So, there's a way that our incredible minds, which can construct past and future, useful, but also, we get lost there, and we lose track of what's happening now. And we live in an autopilot mostly by habit.

And so, yeah, we talk a lot in our mindfulness courses about how all these things are useful; I’m not saying otherwise. We need habits. That's how we assemble a bunch of tasks and do things without thinking about it too much, right? But, when life becomes all habit and becomes all anxiety and depression, what are we missing, and the mindfulness trainings help us feel that space that he's talking about in that quotation. "Oh, maybe it's not, maybe it's this? Oh, wait. Okay. I can do it this way. Wow." And often there's quite a bit of relief from stress, from anxiety, from certain conditions that lead to depression through just being more present. And there's some interesting science around how people when their minds wander less, they tend to be happier. They tend to be more resilient, more engaged.

So, yeah. It's just like putting some more of the focus on the process of living because we have so much training and education in the content and skills and stuff to do, and then all this societal pressure to buy more stuff and do more trainings and get more-busy, right?

Jennifer Ghahari:  Right.

Tim Burnett:  So, mindfulness involves remembering that there's a brake pedal down there too. And even though the gas pedal gets stuck down, we can tap the brakes and say, "Oh." So that's what we mean by space in mindfulness.

Jennifer Ghahari:  You had mentioned that you're trained in Zen Buddhism. And, a few weeks ago, I had a chance to interview the Venerable Thubten Chodron of Sravasti Abbey in Washington state. And we spoke about meditation, anxiety. And, I see that there seems to be some type of connection between Buddhism and stress reduction. And can you explain what that connection is?

Tim Burnett:  Sure. And that's great that you got to speak with her. She's a real leader in that world.

Jennifer Ghahari:  Yeah. She's great.

Tim Burnett:  Yeah, amazing person. Well, what we're now calling mindfulness is a coming together of several different strands. And one of those strands are the understandings from traditional Buddhist meditation about the value of this present-centered awareness and a whole set of tools that help people to park that busy mind and reengage with what's happening now. And so that's modern mindfulness has married that with positive psychology, looked for support for it from neuroscience, sprinkled in some poetry to soften and connect people in the way that great literature and arts can do. Some philosophy. And so, yeah, it's just that Buddhism is one of the deep roots of it.

What's nice is that Buddhism actually is a religion in addition to having all the elements that we're speaking about here. And so, mindfulness is presented in a contemporary non-religious way so you don't have to worry about what you think about Buddhas or bodhisattva or rebirth or anything like that. It's about, yeah, well, there's some support from a deep tradition. People have been trying stuff like this for thousands of years. And we're doing it in a way that we feel is applicable and relevant to modern society. So, yeah, we use language like attention, stress, planning, worrying, returning to the present, just ordinary language for an ordinary thing. But, it's also in a way not ordinary because when we really engage more fully in our lives, we remember in a deep way how amazing it is to be alive.

How amazing that this organism can do all the things it can do. So, Buddhism has that enthusiasm for the incredible potential of human life. But Buddhism expresses it in a certain socio-religious context and we express it in a more everyday context. Like, “Yeah, life can be hard.” We got to really recognize that and feel that, which is really coaching with what Buddhism calls the first noble truth, that condition life has this element of suffering and stress. But then, where we go with that in modern mindfulness is, and we can really feel and understand and experience that it's also wonderful to be alive - even with pain, even with anxiety, or even with depression. There's a joy there that we can access.

So, yeah. I don't know. I feel like they're roommates from different cultures or something like that.

Jennifer Ghahari:  Yeah. That's definitely. So, at Mindfulness Northwest, you teach mindfulness-based stress reduction. So, what is that exactly? And how is it practiced?

Tim Burnett:  Sure. Yeah. We offer mindfulness-based stress reduction and then a whole suite of classes that are in that same kind of modality. So, mindfulness-based stress reduction and the acronym often gets used MBSR, that pops up a lot, it's an eight-week course on mindful awareness and stress resilience with everyday components like bringing mindfulness to perception, bringing mindfulness to communication, bringing mindfulness to understanding of stress reactivity works, and bringing some of the science of stress reactivity forward in a way that we can use for ourselves. And what mindfulness... Excuse me. There we go. I failed to silence my phone. The first thing I told people to do in mindfulness class. (laughs)

So anyway, that class was actually created by one of the pioneers in this work, a fellow named Jon Kabat-Zinn in the late 1970s, really early. And, it's remained pretty consistent from his original vision. But what I've done and with my colleagues at Mindfulness Northwest is that's a wonderful course we offered multiple times a quarter to the communities... When there's not a pandemic... in communities from Bellingham to Olympia, and also online. But we realized that that's a pretty big commitment. It's an eight-week course. It's a long evening, eight weeks in a row, and there's a Saturday session too. So, we really have a lot of hands-on time to do these practices deeply. And not everyone has time for that. So, we also have a shorter five-week version of that that's oriented towards healthcare professionals called Mindfulness for Healthcare Professionals.

We have two-week introductory workshops. We have two- and four-hour topical workshops. So, we started with that framework and brought out different pieces of it to make it more accessible. And we also offer a second eight-week course called Mindful Self-Compassion, which builds on that sense of the power of present-centered awareness to also cultivate more kindness and more emotional understanding. So that's also a wonderful course. We offer that every quarter as well. So, it's a whole suite of programming and it's... The MBSR, mindfulness-based stress reduction course is like the granddaddy of the program, but we have gone beyond that.

Jennifer Ghahari:  Oh. So, can you tell the audience what's something that they might learn in an MBSR course?

Tim Burnett:  Mm-hmm (affirmative). Yeah. You might be surprised to learn that even though the things that are happening in life can be stressful, there's all kind of little ways that we can take a stressful thing and make it worse. And that, we can actually notice that with some simple mindfulness tools and switch it and turn that down and respond differently. And actually, here's another area of little bit of Buddhist crossover, I often quote as Buddhist story, which is worth telling, it's pretty brief.

Jennifer Ghahari:  Yeah!

Tim Burnett:  Yeah, great, which has the Buddha recommended and we do too in mindfulness that life does include inevitably difficulties and trying to pretend it doesn't serve us, right? There's a certain kind of approach orientation we needed to show up in life. And the Buddha told the students that when life hits you with one of those difficult moments, it's like you're hit by a dart or an arrow. And it’s painful, right? Whether you stub your toe or your boss yells at you, or somebody cuts you off, these are painful moments. Or you feel really anxious and worried, these are painful moment.

So the Buddha recommended learning to just really show up and feel and experience those directly. Sometimes, you've experienced them directly and feel them. They just pass on again. They don't always stick in the same way we think they do. But then he said, and here's where I'm getting to the point is, "But then we have an incredible propensity as human beings to then throw a second dart at ourselves." Why did that happen? That shouldn't have happened. Whose fault, is it? Is it my fault? Is it their fault? They should know better. This should be set up differently. This should be organized better.

And what we're doing there is we're taking something that may be difficult, maybe it's a mild difficulty, and we amplify it, and we make it worse. So, we have a way that we generate our own stress. And, it's hard to be aware of that when we're just moving so fast. So, one of the things people experience in the MBSR course is, here's a framework and a lot of community support. We really work together as a group and a support from a teacher to slow down and notice what really happens. What really happens when I get a grouchy email from such and so. If I'm in next minute like “ahhhh!” writing an angry reply, what does that do to me? I already knew it didn't solve the problem with her, but what does it do to me?

And so we learned to take a breath. We learned some body awareness skills that help us to be more in touch with how I'm feeling, which is a little different thing from the story. “She sent me an angry email. She sucks” is different from, “My stomach's tight. My face is scrunched. I'm angry.” And that noticing of the experience below the storyline can be so liberating. It can help us get back into that space that the quotation is talking about. Here's a stimulus. That email I perceive as nasty and here's a moment to notice, "Okay. This got something. (breathes out) How do I respond? And here's my response." And maybe I do it differently this time or maybe they have it patterned so strong, I do it anyway. But at least I know I did it. So, it's that growth of awareness that really is, I think the mediator of the stress reduction of this work. It's just we notice better what we're doing.

Jennifer Ghahari:  Right. “Taking a pause,” it sounds like.

Tim Burnett:  Right. Exactly. We have a whole suite of ways that we strengthen our natural ability to take a pause that we forget how to do when we're so busy.

Jennifer Ghahari:  Great. So, what is mindful self-compassion?

Tim Burnett:  Mindful Self-Compassion is another eight-week course, very similar structure, eight evening or afternoon courses, and then a day session to practice the hands-on skills. It was created by a pair of psychologists named Kristin Neff and Christopher Germer. It's a more recent thing that created somewhere around 2000 or so. And they were really interested in how do people treat themselves that most of us are conditioned to be very good at serving others, helping others, paying attention to others, kind to others. But if we really tune in using these tools of mindfulness to our own self talk, our own behavior towards ourselves, we're often quite hard on ourselves. And so, they developed psychological measures of self-compassion, and found that it's pretty low. And that, based, again, on a mix of Buddhism and psychology, that they could devise practices, exercises, including psychodynamic and psychoeducational exercises to help us understand our emotions and our pattern that we can just learn to be nicer to ourselves. And that there are a lot of benefits from that. And they aren't just self-focused benefits.

Then, we're actually able to be kind and compassionate to others in a more sustainable way. There's a way that our helping is often exhausting because we're not really that aware of what we're doing. It's also another habituated thing. So yeah, in both classes, the MBSR and MSC, mindfulness-based stress reduction and mindfulness self-compassion, they involve a lot of reflection, a lot of conversations, a lot of exercises, where we're doing something a little differently with their mind. Some of them are rooted in meditation. Some of them are other modes. And they just help us take a fresh look at, “Who am I and how do I work?” And are there areas where I can make some little shifts. And oftentimes, people discover over time a little shift leads to a big change. I'm curious if that's been your experience supporting people with anxiety too?

Jennifer Ghahari:  Yeah, definitely. Like you said, just learning different habits and working on them, one habit leads to another. And then, there are vast improvements that happen over time.

Tim Burnett:  Yeah. Yeah. Exactly. Another thing that's neat about these courses is their group interventions. So, they're a little a more affordable, a little more accessible. And as I'm sure you do too, we're trying to provide skills and practices that people can continue well beyond the course, well beyond the intervention so that they really can have this as a lifelong support. And most people that we... We don't do very systematic follow up, but the bits of follow up we've managed to do, most people do continue. Most people, if they find it helpful, they keep doing this stuff and it helps them.

Jennifer Ghahari:  You had mentioned about how groups can be helpful. Are there any other benefits to doing this or any pros or cons to doing this type of class in a group as opposed to one-on-one?

Tim Burnett:  Well, yeah. The advantage of it and the disadvantage of it is you have to be pretty vulnerable because this work is inherently so personal so you have the wonderful safety when there's a strong therapeutic relationship in a one-on-one intervention. And so, we really work hard and I think do usually pretty well creating a little model learning community in our classes. We talk in the first weeks about ways to be safe together, how to hold confidentiality. We are especially careful about not giving people advice or trying to fix them, that each of us is here on our own journey. And then the incredible advantage there is if you're with a group of people who are able to be vulnerable and open about their situation, then there's so much learning from each other. And yeah, one example I will never forget as I was working with the veterans at the Seattle VA Hospital, and there were several with pretty extreme physical complaints. And so, they were talking about how painful every day was. But they were trying to apply mindfulness and it was helping them.

And four weeks in this, one fellow, but I don't think he really spoken before said, "You know, I've got severe depression. And I've been listening to you guys with all your back pain. I don't have back pain. And you know, if you can really get into this mindfulness thing, and if you can stick with it with all that pain, I can stick with it too with my heart, with my sad, my dark moods and my depression and how upset I am all the time. I can stick with this. And I can feel that it's helping me."

Jennifer Ghahari:  Wow.

Tim Burnett:  Yeah. So, there's a way people with different challenges and different conditions can offer each other a really genuine kind of modeling and organic support. And sometimes specific really helpful ideas like, "Oh, I'm not giving advice. But I've learned to navigate this aspect of my crazy mind in this way." And someone else say, "Oh! I never thought of that." So, yeah, there's a lot of lateral learning and community learning. But yeah, the challenge and the joy of that is that we have to be pretty open and create an environment where that's safe to do. And usually that works fine. Sometimes people realize it's too much for them and we try to be really graceful and supportive. And from the get-go we say, "This is not for everybody. This is not for everybody."

Many, many people have been benefited from this lots of different ways. And there's good scientific evidence as well. But, a few weeks in you might realize this is too much and that's fine. We give them a refund and some of them on their way with love. And, “Maybe later” right now. So yeah, it has been really a core thing from the beginning that it's not just a group, but also a heterogeneous group, people with lots of different backgrounds and conditions. And I'm happy in Seattle, especially we've got more and more diversity in our classes. So, I think we're also, in some small way, part of the bigger conversation about the tremendous diversity that we need to acknowledge and understand and own in a stratified society.

Jennifer Ghahari:  Well, the fact that it's heterogeneous, I think there are differences. But the fact that you feel that you're not suffering alone will help too, right? Like you said, especially for the veterans, they were all suffering in slightly different ways, but all feeling that they had some type of shared community, helps.

Tim Burnett:  Exactly. Exactly. That's well said. Yeah. But there's a way when we think, “It's just me” the stress and the fear and the anxiety, or whatever it is for us is so amplified like an echo chamber. And there's an aspect of self-compassion that they called common humanity, which is what you're saying is so powerful, the sense of common humanity. We all, even... And I try to be as straight and vulnerable as I can be. I mean, I'm overall pretty privileged and have had a pretty protected life. I had to work hard and everything. But, I suffer, you suffer, everybody suffers. And so, if we really can feel that in a genuine way where it's not just words, but it's like we're really sharing from the heart, then, yeah, it's such a relief.

And you can watch people in the room, their shoulders drop, their faces relax, they're, "Oh. It's okay to be this way, huh? Wow." Yeah. And you wouldn't think that because we're so programmed to think in terms of problems and solutions, right? That's not a solution exactly. But it changes the whole perception of the problem, which is a solution. So, it's funny.

Jennifer Ghahari:  Well, right. Great. So do you have any other advice or recommendations for our listeners or anything else that you'd like to share?

Tim Burnett:  Yeah. I mean, if this stuff interests you, I just really want to encourage you to try it. And there's so many different levels of trying it that are available now. There are all the meditation supporting apps out there. You can try there. And nobody has to know. I was so shy and private about this when I started. So, I relate to that, and wouldn't want to show up in a big center or a class until you know what it is. So yeah, you can try a meditation app. And Mindfulness Northwest and other groups, we offer introductory workshops. So, it's less of a commitment. Or maybe something about this just rings your bell and you want to jump in and go for it; we welcome that too. Even our eight-week classes are designed for people who are new to this. We walk you through step-by-step.

So, yeah. If you haven't tried it, it's just a little different way of being in your own skin. And it's still you. It's not like you're taking on some weird thing from somewhere else. But it's a support for... I don't know... remembering who you are in a certain way, pausing and reconnecting, rebooting if a computer metaphor works. So, yeah. I just recommend giving it a try. I always tell people, like I said before, it may not be for you. But how would you know, unless you tried it?

And it's very experiential. That's the other thing. This is not thinking our way out of our problems. It's about doing something different with body and mind, but then, opens up some new possibilities. So, it's, yeah, stuff you have to try. It's like just thinking about a restaurant menu doesn't taste like food, and watching ski videos doesn't make you a great skier, although it might help. You have to actually get out there and do it to find out what it is.

Jennifer Ghahari:  This is something that anybody can do, right? I think maybe some people might be hesitant to thinking that, "All right, if I'm Christian or Jewish or Hindu, maybe I shouldn't be doing this?" But it's something that anybody can do, right? Because mean you're prescribing to a certain religion.

Tim Burnett:  Yeah. There's no beliefs or anything like that required. Yeah. It's very... The word secular isn't quite right, but it's not hinged on any particular belief system. And it's all about like try this and see for yourself. But, since it's a little different than what we usually do, you need a little support and structure and guidance to actually even try it. So, you got to get in there and try it. But then, yeah. It's available to everybody. When we work with people sometimes who have some pretty challenging internal conditions, like social anxiety disorder or severe depression, they reach out to us and we support them in trying it out. If it doesn't work, it doesn't work. But, I've had people with those kinds of conditions, both find it incredibly helpful, like a whole new life. And also, tried it out and say, "You know what? Too much." That's fine too. Maybe it's just not the right time.

Jennifer Ghahari:  Mm-hmm (affirmative). You won't know until you try.

Tim Burnett:  Exactly. Exactly. Yeah.

Jennifer Ghahari:  Well, Tim, thank you so much for joining us and being part of this project. And we look forward to hopefully speaking with you again in the future. And, thank you again.

Tim Burnett:  Thanks a lot, Jennifer. What a pleasure to talk to you about this.

Jennifer Ghahari:  Great. Thank you.

Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.

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Editor: Jennifer (Ghahari) Smith, Ph.D.