Erik van den Brink MD, psychiatrist/psychotherapist & mindfulness trainer Frits Koster, vipassana meditation teacher & mindfulness trainer
Center for Integrative Psychiatry, Lentis, Groningen, The Netherlands
CMRP’S 2015 CONFERENCE WORKSHOP 3rd JULY 2015
Mindfulness-Based Compassionate Living
Disclosure
• None commercial, apart from a tiny interest as authors of the MBCL book
• A strong commitment to find ways to relieve suffering and empower self-healing capacity
Content
• What is (self-)compassion and why train it? • Research? • Themes and practices of MBCL? • Taste of some exercises
• With a brain, body and emotions and a socially developed self, that were not our choice.
• In a life full of tragedies: threat, loss, illness, decay, death.
• A lot of what we experience is neither our design, nor our fault.
• Compassion starts with the recognition of this inevitable suffering.
Paul Gilbert (2009):
Here we are, all in the same boat…
What is Compassion?
• ‘Compassion’ is defined as… the capacity to be sensitive to the suffering of ourselves and others and the willingness to relieve and prevent it
(Gilbert, 2014)
• A natural human capacity inherent in all of us but
often not very well developed. • The aim of compassion training is to develop and
deepen it.
Why training in Compassion?
• Ancient Wisdom Compassion as a gateway to happiness.
• Evolution and Attachment Theory Highly sensitive brain for internal and external kindness increases survival chance.
• Neuroscience Specific areas of the brain active with kindness and compassion.
• Research General and clinical populations.
Self-compassion correlates positively with... (Barnard & Curry 2011; Hofmann e.a. 2011; MacBeth & Gumley, 2012; Neff, 2012)
• More psychological well-being & life fulfillment • More emotional intelligence & positive emotions • Healthier coping with adverse events
(academic failure, trauma, divorce, chronic pain)
• Healthier lifestyle (diet, exercise, less smoking)
• More social connectedness, empathy, altruism, forgiveness
Compassion Training Programmes
• CMT: Compassionate Mind Training Gilbert & Procter 2006
• LKM: Loving-Kindness Meditation Fredrickson et al. 2008
• CBCT: Cognitive-Based Compassion Training Pace et al. 2009
• CCT: Compassion Cultivation Training Jazaieri et al. 2013
• MSC: Mindful Self-Compassion Neff & Germer 2012
• MBCL: Mindfulness-Based Compassionate Living Van den Brink & Koster 2012
For graduates of a basic mindfulness course: MBCT, MBSR, ACT
Transdiagnostic programme of 9 sessions 2,5 hr; 1hr daily practice
Interventionstudies RCT’s • LKM: increase in positive emotions, experiencing meaning, social
support; decrease in depressive symptoms and physical complaints Frederickson e.a. 2008
• CBCT: positive effect on immune function, neuro-endocrine and behavioral response to stress Pace e.a. 2009
• CCT: increase in happiness, decrease in worry and emotional suppression Jazaieri e.a., 2013, 2014
• MSC: increase in mindfulness, compassion self/others, social connectedness,well-being and happiness; decrease in depression, anxiety, stress and avoidance of unpleasant thoughts and feelings
Neff & Germer 2012 • CFT: pts with schizophrenia: better clinical functioning; increase in
compassion correlated with decrease in depressive symptoms and experience of social exclusion Braehler e.a. 2012
Brainresearch
Compassion meditation experienced > beginners: • More gamma-activity and synchronicity on EEG Lutz e.a. 2004
• More activity in areas associated with empathy and emotion regulation on fMRI; stronger response to others in distress Lutz e.a. 2008
Brief Compassion Training compared to active controls: Weng e.a. 2013; Klimecki e.a., 2013a, 2013b
• Activates circuits associated with positive emotions • Counteracts effect of empathic distress • Increases generosity
High and low roads to compassion Goleman 2006
LOW • Attachment behavior Vrticka & Vuilleumier 2012
• Soothing breathing rhythm Gilbert 2010
• Vagal tone (HR Variability) Porges 2007; Kok & Fredrickson 2010
• Oxytocin Olff et al. 2013
HIGH • Mindfulness and loving kindness practice • Compassionate imagery and skills training High and low roads reinforce each other in an upward spiral Kok et al. 2013
Language, imagery, looking forward & backward, fantasizing,
ruminating, conceptualizing, mentalizing, self & other
Territory, agression,
hunting, sex
The evolved brain MacLean 1990
Care, attachment, play, social behavior,
rivalry and rank
The more care and protection are needed, the less ‘instinctive’ the brain and the more learning capacity.
The more social the species, the thicker the cortex.
From ME-first to WE-first
Don’t kill the messenger!
EMOTIONS… Are useful messengers that tell us whether we
move in the right direction (of survival!) Inform us when we experience:
• Threat - safety • Failure - success • Social isolation - connectedness
Emotion & Motivation: 3 Basic Systems • THREAT SYSTEM self protection & safety Focus narrow (‘sticks’) Avoiding Fight, flight, freeze
• DRIVE SYSTEM reward & resources Focus narrow (‘carrots’) Approaching Grab & gobble
• SOOTHING SYSTEM social bonding & safeness Focus wide (internal & external, self & other) Attaching Rest & digest
SOOTHING SYSTEM content, safe, connected
DRIVE SYSTEM pleasure, excitement, vitality
THREAT SYSTEM anger, anxiety, disgust
Reward focused
Wanting, striving, achieving, consuming
Activating
Affiliative focused safeness seeking
Kind and caring
Calming, soothing
Threat focused, safety seeking
Fight, flight, freeze
Activating/ inhibiting
PARASYMP.
SYMP.
Dopamine
Oxytocin Endorphins
HPA axis
Van den Brink & Koster, 2012
adapted from Gilbert, 2009
Affiliative focused
safeness seeking
Kind and caring Calming, soothing
Threat focused, safety seeking
Fight, flight, freeze
Activating/ inhibiting
SOOTHING SYSTEM content, safe, connected
Reward focused
Wanting, striving, achieving, consuming
Activating
SYMPATHICUS PARASYMP.
THREAT SYSTEM anger, anxiety, disgust
DRIVE SYSTEM pleasure, excitement, vitality
Van den Brink & Koster, 2012
adapted from Gilbert, 2009
Reward focused
Wanting, striving, achieving, consuming
Activating
DRIVE SYSTEM pleasure, excitement, vitality
SOOTHING SYSTEM content, safe, connected
Threat focused, safety seeking
Fight, flight, freeze
Activating/ Inhibiting
THREAT SYSTEM anger, anxiety, disgust
SYMPATHICUS PARASYMP. Affiliative focused
safeness seeking
Kind and caring Calming, soothing
Van den Brink & Koster, 2012
adapted from Gilbert, 2009
OLD & NEW BRAIN REACTIONS TO THREAT
SELF-COMPASSION:
FIGHT SELF-CRITICISM • SELF-KINDNESS
FLIGHT SELF-ISOLATION • COMMON HUMANITY
FREEZE
OVER- IDENTIFICATION
• MINDFULNESS
THREAT PHYSICAL PSYCHOLOGICAL
Germer 2009 Neff 2003
TEND & BEFRIEND Taylor 2006
SELF-COMPASSION MANTRA NEFF 2011
• This is a moment of suffering (mindfulness)
• Suffering is a part of life
(common humanity) • May I be kind to myself here and now
(self-kindness)
ACCEPTANCE OF PAIN: 5 STAGES Germer 2009
1. Aversion – resistance, avoidance, rumination 2. Curiosity – turning toward discomfort with interest 3. Tolerance – safely enduring 4. Allowing – letting feelings come and go 5. Friendship – embracing, seeing hidden value
First we need to accept, then we can change.
Carl Rogers
In our pain we find our values.
Steven Hayes
Eating
Sexual stimulus
Shaming, blaming, punishing
LIMBIC SYSTEM
Saliva Gastric juice Arousal Stress reaction
Fearful, depressed
Care, Kindness
Relaxation response Calm, content
Gilbert 2009
Shame Self-
criticism
Meal Compassion
Sex
INNER BULLY
INNER HELPER
Social mentalities Gilbert, 2000
OLD BRAIN Emotions Reactive Short route
• Threat system • Drive system • Soothing system
NEW BRAIN Imagery/thinking/reasoning Responsive Long route
• Threat mind • Competitive mind • Compassionate mind
↔
Evolved social patterns supporting survival in groups. Blueprints for society that structure the human mind.
dominance/power, obedience/submission, rivalry/rank, giving/receiving care
Thinking Reasoning
Behaviour
Emotions Motivation
Attention
Imagery Fantasy
Model for (self)therapy
These elements form the structure of an inner pattern, mode, mentality or schema
Gilbert 2010
Judging risk safe/unsafe
Avoiding, resisting
Emotions Motivation
Focus on danger
Doom and gloom
THREAT MODE
Self protection Aversion, fear, anger
Behaviour Imagery
Attention Reasoning
Van den Brink & Koster, 2015 Adapted from Gilbert, 2010
Judging rank, comparing
Achieving, rivalry
Emotions Motivation
Focus on reward
Success and fame
COMPETITION MODE
Self enrichment, improving status Desire, envy
Behaviour Imagery
Attention Reasoning
Van den Brink & Koster, 2015 Adapted from Gilbert, 2010
Non-judging, allowing
Accepting, befriending
Emotions Motivation
Needs of self and others
Peaceful connection and safeness
CARING MODE
Social bonding, well-being
Calm, content
Behaviour Imagery
Attention Reasoning
Van den Brink & Koster, 2015 Adapted from Gilbert, 2010
How the New Brain can work against us...
The Inner Bully grows on self-conscious emotions
such as shame & guilt
You’re no good!
Ideal Self
Actual Self
You must do better!
Self-esteem Self-compassion
• Competitive mind • Survival of the fittest • Feeling superior-inferior
(narcissism) • Dependant of others • I have to prove myself • Less wellbeing
• Compassionate mind • Survival of the nurtured • Intrinsic self-worth
(common humanity) • Independant of others • It’s okay to make mistakes • More wellbeing Neff & Vonk, 2009
Recognising INNER PATTERNS or SCHEMAS Germer, 2009; Young et al. 2003
Mindful noting and naming liberates from over-identification. Practising self-compassion heals associated pain.
Not-Good-Enough
Outcast
Mrs/Mr Bottling up
Everyone- Abandons-Me
Short Fuse
Ugly Duckling
Loner
Mrs/Mr Suspicious
Mommy’s Child
Pessimist
Attention Freak
Mrs/Mr Helpless Helpaholic
Little Prosecutor
Misfortune Teller
Control Freak
Loser Adaptor
Centre-of-the- Universe
… perhaps you can change your relationship with them.
Outcast Mrs/Mr
Bottling up
Mommy’s child
Everyone-Abandons-Me
Short-fuse
Adaptor
Not-Good-Enough Attention Freak
Centre-of-the-Universe
MisfortuneTeller
Pessimist Little Prosecutor
Loser
Ugly Duckling
Mrs/Mr Suspicious
Helpaholic Mrs/Mr
Helpless Control Freak
Loner
If you cannot change your patterns…
Compassion Distress tolerance
Sensitivity
Sensory
Sympathy
Empathy Non-judgement
Care for wellbeing
Emotions Behavior
Reasoning Attention
Imagery
THE CIRCLE OF COMPASSION
SKILLS-TRAINING
ATTRIBUTES
warmth ca lmness
k indness p layfu lness Gilbert 2009
SUGGESTIONS FOR HOME PRACTICE FORMAL
• nourishing the soothing system, e.g. soothing breathing rhythm • kindness meditation - self & others (metta light) • compassionate breathing - self & others (tonglen light) • safe place / compassionate companion / compassion mode • compassionately dealing with resistance / desire / inner patterns • compassionate letter writing / forgiveness • taking in the good / equanimity INFORMAL breathing spaces with kindness and compassion; self-compassion mantra; calendar exercises
Loving-kindness practice (Metta light)
Self… Benefactor… Dear person… Neutral person… Difficult person… Groups… All beings… ALTERNATIVE:
Compassionate breathing (Tonglen light)
In breath: May I / you / we / all…
feel safe... feel healthy... feel happy… feel at ease…
Out breath:
Backdraft
Germer 2009
Particularly in persons with insecure attachment/ trauma/ neglect, practising kindness may trigger the threat system rather than calming it.
The fear of compassion
Gilbert 2010
The impermanent self • Over-identification: survival strategy of
threat and drive modes. • Our relationship with images of ourselves and others can
be rigid or flexible and a source of pain or joy (just like relationships with real persons).
• From which part in ourselves do we look at which part in ourselves or the other?
• De-identification (defusion from self-as-content) can be liberating.
Compassion practice: looking from a wider care-giving part to a care-needing part.
Common humanity
We all wish for happiness; nobody wishes to suffer. Dalai Lama
Suffering and imperfection are part of life. We do not need to approve of harmful behaviour, nonetheless we can wish the person who misbehaved happiness and freedom from suffering. PRACTISING FORGIVENESS Forgiving ourselves; asking forgiveness; forgiving others
Four Friends for Life ‘Illimitables’ (Brahmaviharas) • Not limited by ego-perspective • Do not exclude anyone • Can be practised without limit.
Compassion Loving kindness Sympathetic joy Equanimity
What contributes to happiness? POSITIVE PSYCHOLOGY (Seligman 1998)
• The Pleasant Life • The Engaged Life • The Meaningful Life
PRACTICES • Savouring
– Taking in the good (Pleasure Walk) – Revisiting the good
• Gratitude • The silver lining • Core values
What motivates us in daily life? Practical Ethics
• Are we motivated by threat, drive or soothing systems?
• What are the consequences of our thoughts, speech and behaviour?
• Practical ethics: as much wholesome and as little unwholesome effects as possible for as many involved as possible.
• Ethical decisions come from a compassionate mind (not from threat or competitive minds).
Compassion a natural (self) healing capacity
‘I call this transformation ‘healing towards the human condition’ and for me, it’s the deepest healing of all… If you allow life in without resistance or clinging, you can be healthy and whole, no matter what kind of injury or disease process you may be living with.’
Vidyamala Burch, 2010
MBCL TRAINING COURSES – ENGLISH SPOKEN
by Erik van den Brink and/or Frits Koster
In the UK, organised by Compassionate Wellbeing, see www.compassionatewellbeing.co.uk.
− Fri 21 - Sun 23 August 2015 Foundation Course, King’s College, London − Fri 11 - Sun 13 December 2015 Foundation Course, Crowne Plaza, Edinburgh − Mon 9 - Wed 11 May 2016 MBCL Teacher Training, module 1, Midlands − Mon 26 - Wed 28 Sep. 2016 MBCL Teacher Training, module 2, Midlands
In Ireland, Dublin, organised by Institute for Mindfulness-Based Approaches, see www.institute-for-mindfulness.eu.
− Fri 27 - Sun 29 November 2015 Foundation Course − Fri 11 – Sun 13 March 2016 MBCL Teacher Training, module 1
In Norway, near Oslo, organised by Institute for Mindfulness-Based Approaches, see www.institute-for-mindfulness.eu.
− Fri 17 - Sun 19 June 2016 Foundation Course − Fri 27 – Sun 29 January 2017 Foundation Course − Fri 28 – Sun 30 April 2017 MBCL Teacher Training, module 1 − Fri 8 – Sun 10 September 2017 MBCL Teacher Training, module 2
See also
www.compassionateliving.info
&
www.mbcl.org
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01
5
SESSION
1 2
3 4
5 6
7
8 THEMES
Three Emotion
Reg
ulation
Systems
Why
(no
t) practice
(self-) co
mpa
ssion?
Multi-laye
red brain
‘The
des
ign is not
our fault’;
Threa
t, drive &
soothing
sys
tems
and their ba
lanc
e
How
to nou
rish the
soothing
sys
tem?
Stress Rea
ctions
&
Self-Compassion
Self-criticism
vs
kind
ness
; Self-isolation vs
co
mmon
hum
anity
; Ove
r-iden
tification
vs m
indfulne
ss
Ten
d & Befrie
nd
Using
Imag
ery
Bac
kdraft
Inner Patterns
Threa
t, co
mpe
titive &
carin
g mod
es
Fun
ction of th
e Inne
r Bully and
se
lf-co
nsciou
s em
otions
(sh
ame,
shyn
ess, guilt)
Malad
aptiv
e sc
hema’s
Compassion
Mode
Attributes
& skills
of com
pass
ion
Cultiv
ating an
Inne
r Helper
Doing
‘As-if’
Self & Others
Self-tran
scen
dent
& relationa
l qu
alities
of
compa
ssion
Ove
r- & de-
iden
tification
Kindn
ess to
othe
rs
Common
Human
ity
Fou
r Frie
nds for Life
Lov
ing Kindn
ess
Com
pass
ion
Sym
pathetic Joy
Equ
anim
ity
Wha
t con
tributes
to
happ
ines
s?
S I L E N T P R A C T I C E S E S S I O N
Compassion in
Daily Life
Motivation:
Wha
t mov
es us:
threat, d
rive or
care?
Practical Ethics
Hea
ling Power
of
Compassion
Eva
luation
How
to
continue
?
FORMAL
PRACTICES
Safe Place
Three
Circ
les
Soo
thing Breathing
Rhy
thm
Soo
thing throug
h the
Sen
ses
Pleas
ure Walk
Com
pass
iona
tely
dealing with
Res
istanc
e Com
pass
iona
te
Com
panion
Com
pass
iona
tely
dealing with
Des
ire
Com
pass
iona
tely
dealing with
Inne
r Patterns
Embo
dying
Com
pass
ion
Kindn
ess for the
Bod
y Walking
& M
oving
with
kindn
ess
Com
pass
iona
te
Lette
r Writing
Com
pass
iona
te
Breathing
Forgive
ness
: forgiving on
eself
Tak
ing in th
e Goo
d
Sav
ourin
g Gratitud
e Silver Lining
Core Value
s
Equ
anim
ity
Disco
verin
g Com
pass
ion for
Self a
nd O
thers in
Daily Life
Preve
ntion Plan
Com
pass
iona
te
Bod
ysca
n
Strea
m of
Awaren
ess
LOVING
KINDNESS
Self
Self
Ben
efac
tor
Dea
r Perso
n Neu
tral Perso
n
Difficult Perso
n Group
s
All Being
s
Foc
us on
Equ
anim
ity
---
cont. -
--
INFORMAL
Breathing
Spa
ce w
ith
Kindn
ess
Breathing
Spa
ce
with
Com
pass
ion
Self-Com
pass
ion
Man
tra
---
cont. -
--
---
cont. -
--
---
cont. -
--
---
con
t. -
--
---
con
t. -
--
---
cont. -
--
CALENDAR
Soo
thing sy
stem
Threa
t sys
tem
Driv
e sy
stem
Inne
r bu
lly
Inne
r he
lper
Rec
eiving
co
mpa
ssion
Giving
compa
ssion