Mindfulness Practice

I recently posted on Instagram about my mindfulness practice, and have had a couple of followers ask that I talk more about it. What better way than a blog post?

I should start this off by saying that I am not a licensed health-care professional. I do identify as a mental health advocate, though, based on my own personal experiences with my own and loved ones’ mental health.

After hitting the lowest of lows of my major depressive episode a little over a year ago, I started intensive therapy that involved meeting three times a week in a group therapy setting. The curriculum of these sessions was based on Dialectical Behavior Therapy (DBT). The goal of this form of therapy is to provide individuals with concrete skills to manage painful emotions and conflict in relationships. There are four overarching components of DBT: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness.

But what really is DBT?

Four components of Dialectical Behavioral Therapy - mindfulness, emotion regulation, distress tolerance and interpersonal effectiveness.

DBT is a cognitive-behavioral treatment that was developed by Dr. Marsha Linehan in the 1980s to treat individuals with borderline personality disorder. It is now become an effective treatment for depression, eating disorders, substance abuse, bipolar disorder, and PTSD. As Psychology Today states, “DBT is influenced by the philosophical perspective of dialectics: balancing opposites. The therapist consistently works with the individual to find ways to hold two seemingly opposite perspectives at once, promoting balance and avoiding black and white—the all-or-nothing styles of thinking. In service of this balance, DBT promotes a both-and rather than an either-or outlook. The dialectic at the heart of DBT is acceptance and change.”

The way that I would explain this is that I can have an emotion driven, “irrational thought,” but also can identify it as such. Think about how sometimes you can give your friend advice that you can’t give yourself. Even though I know the thought is irrational, it still causes me emotional distress.

Today I’m going to talk about mindfulness, and in the coming weeks will explore the other components of DBT. So – here we go!

What is mindfulness?

Diana sitting looking over a cliff!

At its core, mindfulness is about being present and self-aware. To take it a step further, it is doing those things without being judgemental, without overthinking, and without invalidating your own experience in any way. Mindfulness is acceptance.

In the world we live in today, we really don’t spend a lot of time being mindfully present. We tend to disconnect from our actual experience to either live through someone vicariously on instagram, or just engage with our own thoughts rather than reality. Now, according to DBT theory, there are three states of mind that are in at varying times: emotional mind, logical mind, and lastly wise mind being the ideal state of mind. Wise mind is the combination of emotional and logical mind.

We use logical mind when we are doing concrete tasks, like math or putting together furniture from Ikea. Emotional mind, unsurprisingly, is the state of mind in which we feel our emotions and act from our emotional state. So things like acting out of anger or just plainly being impulsive.

Wise mind is somewhere in the middle. In wise mind, we are aware of our feelings in a non-judgemental way (mindfulness) and act in a way that is cognizant of our emotions and goals.

Chart of wise mind!

So what are the core skills of mindfulness?

Observe

Observe your thoughts, emotions and feelings without trying to change them. Recognize how you are responding to an event, and allow yourself to feel what you are feeling.

Describe

journal with pen

Whether just to yourself in your head, or using pen to paper – describe your experience. What physical manifestations did you experience? Rapid heart rate, crying, chest tightness? Where were you when this happened? What was the prompting thought? How did that thought make you feel? By describing in great detail your experience, you are able to show yourself a bit of empathy as well as later have a more firm grasp on your emotional response. Remind yourself here that feelings and thoughts are not facts (wise mind).

You might feel alone for example, but if you sit down and truly think about it there are people and support services that you can reach out to.

Participate

Be present. Experience things with all five of your senses. All the emotions to pass, and then engage with the present moment. This sounds easier than it really is, but that’s where a couple of techniques come into play.

Being more mindful

Being mindful involves being non-judgemental, practicing one-mindfulness, and being effective. Below are a couple of specific exercises to strengthen your practice of these things.

Body Scan

This is one of my personal favorites as it is very meditative, and engages your whole body. A typical body scan runs through each part of the body starting with the toes and working upwards. You pay attention to how each part of the body feels, focus your breathing to that area, and imagine the muscles of that area relaxing. Just search “body scan meditation” on YouTube and you will find many options. Below is one of my favorites. A body scan can be done at any time of day, but as it is really relaxing – it is most commonly practiced before sleep. This practice has really helped me with my insomnia.

One Mindfully

Identify situations in your life where you are trying to do multiple things at one time. For me, my biggest problem area is mornings. I try to do my hair and makeup, pick out an outfit, maybe change the load of my laundry, make my lunch and make my breakfast all at the same time. Doing so is usually chaotic and just anxiety-provoking.

You may find that you also do this after work. Many times I come home and look at my apartment and realize all the things I need to do: make dinner, empty the dishwasher, fold my laundry, take the trash out… And I enter a fury of doing all things at once.

Another situation you may do this is when hanging out with loved ones. Now that most of us have smartphones, we feel the need to constantly to attend to the information that we have access to.

One mindfully means concentrating on one thing at a time, and completely experience it by engaging all of your senses. When you are eating, eat. When you are walking, walk. When you are worrying, worry. When you are remembering, remember. Observe and listen quietly, and then reflect on your experience afterwards. Below are a couple of things that you can do one mindfully. One of my favorites is making coffee. My therapist taught me to approach it like it’s a scientific experiment – which really helped me to think of how to approach one-mindfulness. I really honed in on my observation skills.

  • watch rain falling
  • watch a campfire
  • listen to music
  • fold your laundry
  • make your dinner
  • make your coffee 🙂
  • listen to a loud clock
  • listen to the sound of the wind
  • pick a place in your home, or a chair that will be your “worry space,” when ever you are worried about something, sit there and worry. Observe how you feel for 30 minutes, then allow yourself to go about the rest of your day.
  • go for a walk to a park. sit, close your eyes, and try to identify 3-4 sounds you can hear. Can you identify from what direction they came from? Try to make out 2-3 smells from the air. Do those smells remind you of anything? Reflect.

Mindful Creating

Remember play-doh? Well go get you some play-doh. It is one of my favorite mindfulness mediums. Sit and play, create. Focus on how it feels and what it reminds you of. You can also practice mindful creating doing any sort of activity or craft that you like. I find crocheting to also be a super mindful activity.

Play a mindfulness game

I have an excellent support system, and sometimes when I’m in a bad place I just really need to be around people. There are a couple of games that we used in play in my group session that are really fun. They are mindfulness games because they require a lot of attention. Here are some examples:

  • Categories – pick a category and list as many items from that category as possible.
  • The alphabet game – pick a category and go around circle (or back and forth) listing items from that category starting with A-Z. So for fruit it would go, Apple, Banana, Cantaloupe…etc.
  • Play catch! You can also integrate playing catch to either of the games above. Throw a ball back and forth while you name items.
  • Play 20 questions with a friend
  • Play Jenga or complete a puzzle

Half-Smile

This exercise can feel a bit weird, but it has been shown to improve mood. But basically, sit in a chair or somewhere comfortable. Take a couple of deep breaths. Close your eyes if you wish. As you continue to breathe, make a small smile with your lips. Then relax your face. Continue to alternate and notice whether your emotions begin to change as you communicate feelings of acceptance to your brain.

Go forth, and live mindfully!

Dog practicing mindfulness

I hope that this post has been moderately helpful. I would love to hear about your experiences with some of these exercises. Lookout for future posts on DBT techniques.

Mental Illness, Stigma, and the Dangers of Not Getting Help

So I’ve been putting this one off. And even as I sit here and begin to write I feel uneasy. Even though I am very open about my mental health, I still experience internally imposed and externally received stigma. I fully believe that it is part of what makes me who I am. Yet, I know it can make people uncomfortable and cause them to trust you less. And sometimes others even dismiss you as just being, “crazy.” This is the first blog about my mental health (cue the deep breathing exercises).

I myself had a very public major depressive episode, and eventual break. I know this still colors the perceptions that those around me have of me. And I still experience blame. There are people who say it is my fault and that I could have controlled it if I wanted to. I know that much of this stems from ignorance and lack of knowledge. But what I honestly must say to those people is, “kindly, fuck you.”

In this post I argue that my expletives are warranted. I know what can happen when you ignore your mental health – when hide that you are in pain. Today I’m not going to present you with my full story. Instead I will discuss the dangers of not getting help and the hindering role stigma plays in that process.  

Stigma & Unconscious Bias

A CDC study found that 57% of adults believed that people were caring and sympathetic to persons with mental illness. But, only 25% of adults suffering from mental illness believed that people were caring and sympathetic towards them. Something called the Dunning-Kruger effect could explain this gap. This is the cognitive bias where people who are incompetent at something are not able to recognize their own incompetence.

As humans, I think we would all like to say we are caring to people who have a mental illness. But unfortunately, there is a deeply ingrained, unconscious bias at play. Take the following example. In the media, people are reduced to just being, “mentally ill” far too often. Instead, they should more respectfully be referred to as a, “person with a mental illness.”

By calling someone “mentally ill, you are not acknowledging that they are a person and not just that mental illness. That is a manifestation of bias. How often have you seen a news story about a, “mentally ill” person who has committed a crime? And how often do you independently associate mental illness with other behaviors that you would identify as “bad?”

A Single Story

Photo of Chimananda Ngozi Adichie with a quote that reads, "The problem with stereotypes is not that they are untrue, but that they are incomplete. They make one story become the only story."

Let me tell you about a concept called the “single story,” created by author Chimamanda Ngozi Adichie. She uses this term to describe the overly simplistic, often stereotypical, perceptions that we form about individuals, groups, or countries. A lot of her work serves to complicate and disrupt the single stories that many people have about Africa. I think that there are also many single stories that people have about those who live with mental illness.

Let’s do an exercise. Picture a person with depression. How would you describe them? How do you know that they’re depressed? What type of person do you think that they are?

You can keep the answers to yourself, but I hope that you see a bit of what I’m getting at. I had a single story of mental illness, and because of that story, and the stigma I saw associated with it, I did not get help for almost ten years. Let me tell you why.

I was “high functioning.” I was always an “A” student, overly-involved in extracurriculars, and friends with a wide variety of people. Out of college I had a stable job, paid my bills, and was involved in my community. But I was living all this time with almost no quality of life. Six out of seven of the days of the week having thoughts of death and self-harm. This does not mean that I did not have happy moments, but that the pain I was experiencing kept me from truly valuing those moments.

So I hid what I was going through. On the one hand, I didn’t look or act like what I thought people with depression looked like. On the other hand, I didn’t want to make the important people in my life feel unvalued because of my lack of interest and extreme pain. And being in a family in which others suffered from mental illness, I didn’t want to add to any heartbreak. At one point early on I did seek help, but continued to minimize my symptoms to my doctor and to the people I cared about. I didn’t want to put my life on hold and I didn’t want to scare anyone.

The stigma of having a mental illness and stigma of taking the necessary time to treat one kept me from doing so. I didn’t see myself as sick enough to get help and I didn’t want to change what people thought of me. Eventually, I sunk into a major depressive episode. An episode that lasted over a year and a half, and that culminated with me self-harming.

Effects of Delaying Treatment

The longer that one waits to treat their mental illness, the more complicated it becomes and the harder it becomes to treat. Various preclinical studies have shown that delaying treatment of mental illness can cause untreated disorders to become more frequent, spontaneous, severe, and resistant to treatment.

Additionally, a single disorder will most likely progress to more complex comorbid disorders that are harder to treat. You will most likely begin to experience chronic physical problems such as insomnia, gastrointestinal issues, and even chemical changes to your brain and other organs.

Outside of affecting one’s health, leaving a mental illness untreated is correlated to school and job failure and early, unstable, and sometimes violent marriages. At the extreme, some experience bankruptcy or homelessness. Further, there is an increased risk of substance abuse, incarceration, accidents, and suicide.

For those with major depressive disorder, like myself, only 35% are treated within a year of first developing symptoms. For others it can take 4 years or more. Going over a decade without treatment has left me with a lot more challenges to overcome. In addition to Generalized Anxiety Disorder, I also battle PTSD, and now have been classified as having medically-resistant depression as a result of long-term chemical changes in my brain.

Creating Conversation

This isn’t meant to scare anyone, but rather underscore that both stigma and lack of conversation are detrimental to those with mental illness. By othering those who have a mental illness, we push them into a state of fear when it comes to talking about and seeking help for what they are going through. If we can make mental health a part of everyday conversation, then we will create an environment that empowers people to take care of themselves and supports them throughout that process.

Personally, I did not start to get better until I independently made the decision myself to get the real help that I needed. I sometimes think that if our culture was more open and inclusive of people with mental health issues, that I would have sought help sooner. That I would have saved myself years of being numb. But I also had to come to terms with the fact that depression was going to be a companion to me for the rest of my life. It is something that I need to work each day to address. And with that I’ve slowly started to become less ashamed. I wouldn’t be who I am today without my depression.

Irish musician Niall Breslin said something about his depression that resonates with me. Breslin said: “It’s always given me an edge, over everybody else. I truly believe it’s given me an edge, because with depression, nothing can be as bad as that day when you’re stuck in your bed and you can’t get up, and you cannot look at anybody in the eye. So that’s how it’s given me an edge.”

Getting Help

If you are struggling with any kind of emotional distress or mental illness and need to seek help, please utilize one of the resources below:

Psychology Today – Find A Therapist, Counselor – https://www.psychologytoday.com/us/therapists

National Suicide Prevention Hotline – 1-800-273-8255

National Alliance on Mental Illness Helpline – 1-800-950-NAMI (6264) or info@nami.org