An unfortunate side effect of the biological revolution of psychiatry is in perceiving emotional discomfort as undesirable or bad, something we shouldn’t feel, something that can be medicated away. And while medications can be life-saving and necessary with severely disabling conditions such as psychosis, mania, depression, and debilitating anxiety, to name a few, perhaps we’ve taken a troublesome short-cut along the way. I worry that mental health may now be seen as the absence of mental pain, flat-lining on happy, or no emotions at all, rather than the ability to live a bumpy, personally meaningful life, despite the pain that goes with it.
How much of our mental suffering is created from our attempts to avoid discomfort, rather than realizing that we can actually allow and tolerate our difficult experiences?
Psychology has developed an equation for anxiety. Anxiety is our perception that bad stuff will happen over our ability to handle it. Often we focus on the probability of the threat, problem-solving to prevent it or telling ourselves that it’s really not that likely, as a way to manage our anxiety. But when there are real threats in life, and real painful emotions that feel threatening in themselves, the solution is in how we actually can cope when thing go wrong.
Brene Brown, author and researcher at the University of Houston, praises vulnerability, struggle and adversity. She describes hope as something learned from struggle. She speaks not only of learning to live wholeheartedly despite adversity, but living wholeheartedly because of coping with adversity. If we don’t experience anything threatening, we can’t learn that we actually can cope. Or as Thich Nhat Hanh, the Vietnamese Buddhist monk and revered teacher says, “Without the mud, you cannot grow the lotus flower.”
Following this philosophy, Christine Padesky, psychologist and cofounder of The Center for Cognitive Therapy in California, has recently developed a technique called the "Assertive Defense of Self" for people experiencing social anxiety. Rather than trying to reduce the threats of painful events from happening, she teaches people to manage social anxiety through coping when pain inevitably does happen. In a workshop, she illustrated her method with an account of her client who was paralyzed by a fear of public judgment for how she looked. Rather than convincing her that she’s overestimating the threat, she had this client put on the most outrageous outfit she could fashion and then go fishing for insults at the mall. She invited the threat in. Then she practiced facing the feared criticism and coping with it.
Many forms of therapy have evolved in this direction. We often think that change needs to come from the inside first. Once we feel better inside, more motivated, or upbeat, we will go for a run. Or once we feel more confident, we will ask a coworker over for dinner. We call this working from the inside-out. However we can also work from the outside in. That is, even if we don’t feel like it and we push ourselves to go for a run, we can feel better and more energetic because we ran. Or because we asked the coworker over for dinner, we now feel more confident after enjoying a fun night of company.
Traditional Cognitive Behavior Therapy is increasingly emphasizing this outside-in "behavioral" part through a strategy Marsha Linehan, founder of Dialectical Behavioral Therapy, effectively summarizes with the term "Opposite Action." In our more primitive limbic system of our brains, our emotions are hard-wired not only to communicate to ourselves and others, but to propel action, and fast. In most situations, these emotionally-driven behaviors are extremely helpful for us (e.g. if you see a tiger, fear tells you to flee; if you lose a loved one, sadness guides you to stay home from work and seek support). But sometimes, our emotions get short-circuited in patterns that no longer serve us. So fear pushes us to flee from everything, sadness to withdraw from the activities that would help us feel better, and shame to hide so we never get a chance to connect and recover.
These urges to avoid at all costs can make our lives very small: when we avoid undesirable emotions, we end up losing out on all the enlivening ones too. That’s when we need to invite the higher level of our brain, the prefrontal cortex, in to reflect: are these emotions pushing us in a helpful direction? Are they allowing us to live the full life we would like to live? If the answer is no, Opposite Action has our prefrontal cortex (the high road of the brain) override our limbic system (the low road), pushing us to act the opposite of how we feel, even if means actually feeling the uncomfortable emotion in the moment. This all boils down to gently acknowledging and allowing the difficult emotion, while continuing to move in a helpful long-term direction (e.g. gradually approaching fears or continuing to engage with others and activities despite sadness or shame).
Opposite Action also includes changing your body language to be consistent with coping well. For example, Amy Cuddy, a social psychologist from Harvard Business School, presented her research on the potency of Power Poses. She showed that engaging in winning body postures in stressful situations, ones that make you look big and confident, actually improved internal confidence and external performance. She concluded that you can learnt to cope with threats by “Faking it until you become it.”
David Barlow, a prolific author, professor at Boston University, and leader within the field of managing emotional disorders, and Bruno Cayoun, developer and director of the Mindfulness-Integrated Cognitive Behavioral Therapy Institute in Hobart, Australia, further add to this strategy. They both argue that our focus of work doesn’t even need to be on actually coping through situations we find most stressful in the real world. Rather, we can build a greater tolerance to our emotional reactions themselves. Although differing in specific techniques, they teach us to learn to cope with challenging emotions through building tolerance to the actual feelings within our bodies. Whether practicing this by hyperventilating or imagining stressful situations that bring on panic, they teach exercises to build awareness and acceptance to our day-to-day difficult reactions in the body. In this way, we learn to cope. We then can muddle through any stressful and painful experiences, regardless of the external cause, without retreating when our bodies protest.
While lecturing on "How to Make Stress Your Friend," Kelly Mcgonigal, a health psychologist at Stanford University, surprised many with her research showing that stress itself is not bad for you. She compared people who learnt to tolerate and embrace the body sensations that go with stress (e.g. coping with interpretations like, “My heart is racing because my body is energized to meet this challenge”) with people who were less tolerant or avoidant of our stress responses (e.g. “Uh oh, my heart is racing, this must be dangerous or bad”). She showed that stress is only related to illness and death in those people who thought that feeling stressed was bad for them. Those who were tolerant and accepting of feeling stressed had no side effects from stress itself.
Now welcome in the mindfulness movement: a hip teenager in the therapy world and pop culture, yet a wise elder in its 2,500 years of history with Buddhism. With mindfulness, we don’t try to change our experience; we change how we relate to these experiences. We learn to cultivate awareness and acceptance of both our inner and outer experiences in life, even the unwanted ones. We open the door to the messiness, the chaos, the pain. Borrowing from Rumi, the thirteen century Sufi mystic and poet’s words, as so many mindfulness teachers do, “The dark thought, the shame, the malice, meet them at the door laughing, and invite them in.”
This mindful approach weaves together flawlessly with the science of emotions. Neuroscientists describe the course of emotions as a wave, lasting approximately ninety seconds. I don’t know about you, but my emotions last a tad longer, specifically the ones I don’t like. So what happens? Our natural reaction to difficult feelings is to push them away, and fast. Or we cling to them, ruminating, convinced that we will be able to problem-solve our way out of them, fueling the fire. In this way, the Buddha described our pain and suffering as being hit by two arrows. The first arrow, the inevitable pain of life, whether a difficult event, thought or feeling, is shot at us; we have little control over this. But then we shoot a second arrow at ourselves with our own reaction to the pain, amplifying and prolonging it. The suffering from the refusal or pushing away of this pain, the "it shouldn’t be here," the "I can’t stand this," but also the blaming, the ruminating, the "why me?" the "it’s always been this way and always going to be this way" stories: these are the parts we add. To put it simply: pain is inevitable; suffering is optional.
Mindfulness encourages a new way of being with our experiences, especially the uncomfortable ones. Anchored to the present moment for support, we hold our pain gently, with kindness and curiosity, rather than dwelling on or denying it. When a student asked the spiritual leader of the Tibetan people, His Holiness the 14th Dalai Lama, if he experiences anger, he answered, “Well yes, of course.” Questioned further on what to do with the anger, he stated, “I watch it arise, and I watch it pass.” As Joseph Goldstein, American meditation teacher and co-founder of the Insight Meditation Society, explains, “You can’t stop the waves, but you can learn to surf.”
The essential ingredient to this practice is the way we relate to our experiences: one of gentleness and compassion. Compassion has always been at the core of mindfulness teaching. Without compassion, we wouldn’t have a safe space to turn towards and acknowledge our pain. Without compassion, bare awareness of our pain would be masochistic. We are not only asking ourselves to be aware of what is going on within ourselves right now, but also “How can I hold this with kindness?”
Kristen Neff, a professor and researcher at the University of Texas, and Christopher Germer, psychologist and clinical instructor at Harvard, have shown that participating in compassion training courses can improve our coping with difficult emotions and experiences. As Brene Brown explains, “Compassion is not a virtue—it is a commitment. It’s not something we have or don’t have—it’s something we choose to practice.” And as Neff and Germer have proved with their research, it’s something that can be learned.
Jon Kabat Zinn, American author and founder of the Mindfulness-based Stress Reduction program, summarizes this mindful approach as “Full Catastrophe Living.” We can’t stop the wild and painful catastrophes of life, but we can learn to cope.