Helping clients to get back in charge of their lives, with the confidence, calmness & self-sufficiency to flourish.

J.P. Noble Award

Back in June I attended the annual conference of the National Society for Hypnosis, Psychotherapy & Mindfulness, and was very surprised, and also very honoured to find a dissertation I had submitted to the National College of Hypnosis & Psychotherapy had won the J.P. Noble Award for 2017. The dissertation was titled 'Working with Mindfulness & Hypnosis in Psychotherapy; a challenge and an opportunity', and covered the ways in which mindfulness can inform, integrate with, or work as an adjunct to psychotherapy, and also the similarities, differences and tensions that exist between hypnosis and mindfulness in a psychotherapeutic setting.

A blog post on this subject is probably long overdue, especially as I am increasing finding clients become confused around the similarities of their experiences in mindfulness meditation practices and in self-hypnosis. This is not particularly surprising, as both states tend to be characterised by coming to rest, and turning our attention inwards. However, there is a fundamental difference too: Mindfulness involves an intentional awareness of our present moment experience; we turn towards our experience, however, in hypnosis, we tend to disconnect from some aspects of our present moment experience and become absorbed instead by internal images, or imagined sensations and experiences, or perhaps we visit past or future moments, rather than the present. Quite a substantial difference!

Mindfulness and the Control Agenda.

Recently, I was delighted to be invited to lead a themed mindfulness sitting for a group in St. Albans, just outside London. I decided to work with the theme of the ‘control agenda’, and afterwards I thought it might be worth sharing this with a wider audience here, as it’s a subject that doesn’t seem to get discussed very often.

Before looking at the ways we get caught up in trying to control our thoughts, feelings and situations, let’s consider an important aspect of mindfulness meditation practices: They are a powerful way of learning how our minds work. This quote from Gilbert & Choden’s Mindful Compassion (New Harbinger, 2014) illustrates this point rather well:

“Mindfulness meditation actually means ‘becoming familiar with’ and ‘getting to know’ the mind, and the way we do this is through open attention and observation. This point cannot be over-emphasised.”

From this perspective, we can begin to see the distractions we encounter in mindfulness practice as the rich and fertile soil from which our mindfulness skills develop; as a way in which we can become more familiar with our minds. However, all too often we see distractions, such as a restless mind, as being a problem. We become frustrated, or self-critical: ‘I should be better at this, I’ve read all those books, listened to all those meditations, why can’t I stop my mind from wandering? Maybe I’m just no good at this.” When this happens, the challenge is to recognise that we’ve become caught up in a control agenda; we want to control our mind, to stop it from distracting us, and to make it become quiet, thus allowing us to maintain a rigid attention. Once we recognise that this is happening, we can identify this as another aspect of the way our minds work, and learn from it. So welcome the distraction, it really is a valuable part of our practice, rather than a failure, a problem or a difficulty. Learn to notice the patterns of distractions created by the mind and body, and also the subsequent reaction to them.

Sometimes we can also find a control agenda creeping into the way that we engage with our mindfulness practice, and this has the potential to be quite destructive to our long-term practice, so it’s worth looking at more closely. This most often occurs when we attempt to control our internal experience, such as by relaxing, or when we turn away from our experience, such as by distracting ourselves.

Let’s start by considering relaxation. Mindfulness meditations often produce relaxation in the meditator, however, this is not the intention when practicing mindfulness, it’s merely a by-product. And there’s no guarantee it will always occur; for example, if you’re sitting in meditation and difficult thoughts keep arising, you’re unlikely to find it relaxing. But if you’re seeking to relax, then on such occasions you’re likely to think something’s gone wrong, your favourite relaxation technique is no longer working… and if this keeps happening, you may even stop practicing. The fact is, there are hundreds of relaxation techniques to try – but mindfulness meditation is not one of them. When engaged in a mindfulness meditation our intention is to be present, and turn towards our experience in an open, curious and non-judgemental way – this can be difficult when we’re preoccupied with trying to relax, and thus to alter our experience, rather than turning towards it. Of course, there’s nothing wrong with becoming relaxed when meditating, but when we seek to do so, we’re no longer practicing mindfulness, and instead we’ve turned it into yet another relaxation technique.

It’s also worth considering that relaxation techniques work best when we’re essentially safe, in fairly non-challenging situations, and not too distressed. Under conditions when we don’t feel safe, are deeply distressed and in a challenging situation, relaxation techniques may fail to work. Ironically, it’s actually the skills and psychological flexibility that we cultivate in mindfulness practice that are most likely to help us to cope at such times.

So, following on from this, let’s also consider those kinds of circumstances when we might unintentionally use our practice as a distraction technique to avoid the present moment, rather than turn towards it. Sometimes these situations can be quite hard to recognise, but let’s take the example of someone who really doesn’t like their daily commute by train, so they decide to use the time to meditate. And let’s say they discover they are able to meditate on the train, and begin to do this on a daily basis. On the one hand this seems like a great idea: This was ‘down’ time they weren’t going to be using to do anything else, so it really helps them to fit their practice into their day. But on the other hand, when we look a little closer, we can see they’re also using their practice to avoid their experience, to turn away from it, to not be present. This is really the opposite of a mindful approach, and instead the meditation has just become another control strategy. Perhaps the clearest way to spot this is to look at the motivation to practice at that particular time or location; is it to avoid being present?

To be clear, none of the above is meant to be interpreted as a set of rules, but simply as food for thought. Most often people move away from practicing mindfulness by slipping into intending to practice relaxation or distraction: There is nothing inherently wrong with avoiding or controlling our experience, and nothing wrong with using relaxation or distraction techniques, but they are quite different to mindfulness.

Mindfulness involves turning towards our experience in the present, with openness and curiosity. When practiced in this way mindfulness offers an extraordinary opportunity to learn how our minds work. To keep in touch with this, when practicing, it can be helpful to begin by connecting with our intention in the practice (being present, observing the breath, etc.), and also connecting with our motivation to practice, and doing this can help to expose those times that we’ve begun to move away from mindfulness and towards relaxation or distraction.

Anxiety UK therapy outcomes for 2016

Anxiety UK have published figures for therapy outcomes in 2016, measured using the IAPT method for calculating recovery, reliable improvement and reliable recovery.

Out of 221 planned completions, 67% of clients recovered, 87% reliably improved and 67% reliably recovered.
This compares very favourably to the national IAPT outcomes for 2015/16 which were 46.3% recovered, 62.2% reliably improved and 44% reliable recovery.
Just to be clear, these figures relate to all forms of therapy provided through Anxiety UK's approved therapist schemes, working with CBT or hypnotherapy. I think they show the quality of the service and support that Anxiety UK are able to offer their members through the scheme.

For any one who is curious, the IAPT method for calculating recovery, reliable improvement and reliable recovery is as follows:

A referral is classed as ‘recovered’ if the client has finished a course of treatment and moved from caseness* to not being at caseness by the end of the referral.

A referral is deemed to have shown reliable improvement if it shows a decrease in one or both assessment scores that surpass the measurement error, (for GAD7 assessment this is 4, for PHQ9 it is 6).

Reliable improvement and recovery can be combined to create an overall measure of reliable recovery where both a change from caseness to not caseness during the course of the referral and which show reliable improvement.

*Caseness is the term used to describe a referral that scores highly enough on measures of depression and anxiety to be classed as a clinical case.

More information on the use of IAPT services can be found in this report.

Some thoughts on why stopping smoking can be challenging.

Many people successfully stop smoking in October, thanks to the Stoptober campaign, but unfortunately some find themselves struggling in the following months. To help anyone in this position, I’m offering a 20% reduction in the ‘Single Session’ protocol I provide, and this will be available to anyone until the end of 2016.

So this seems like a good time to share a few thoughts on why stopping smoking can seem so difficult:

We often use phrases like 'being in two minds' about something, or having 'mixed feelings' when we're struggling to take action in some way. These phrases are really useful in describing the situation people find themselves in when they're experiencing difficulty in stopping smoking. One part of them wants to smoke, (otherwise they simply wouldn’t be smoking), whilst another part of them clearly wants to stop. We could call one part the ‘smoker’s mind’ and let’s call the other part the ‘smoke-free mind’. It’s between these ‘two minds’ that the struggle starts; an internal struggle between two seemingly different parts of our mind. 

This is never a comfortable place to be, and the stress and anxiety that can be felt at such times will often cause a smoker to crave a cigarette, but this craving is mostly a craving to reduce anxiety, rather than a physical craving for a drug. Of course it is possible to reduce anxiety or stress in a number of ways, but if we haven't correctly identified what we’re feeling, we may just misinterpret it as a craving for nicotine and thus a sign of the 'addictive power' of nicotine. This will then be followed by another thought from the ‘smoker’s mind’, along the lines of how ‘impossible’ it is to fight such a powerful ‘addiction’, leading to more stress and anxiety, which fuels further cravings... it’s no wonder stopping can be so difficult for many people. 

Part of the problem is that we tend to identify our thoughts - our internal dialogue - as ourselves, and also as factual. The discovery that ‘we are not our thoughts’ is a powerful and liberating lesson, whether it comes from mindfulness meditation, cognitive behavioural therapy, or anywhere else. Equally, learning that our thoughts are not necessarily facts, but opinions, can transform our experience of them, and of our lives. Finally, and equally empowering, is an awareness that thoughts and cravings are transient, and will pass out of our consciousness just as easily as they came into it.

Without this knowledge, it’s all too easy to listen to the ‘smoker’s mind’, without identifying it as such, just accepting it, and following what it is saying. For example, the ‘smoke-free mind’ may be congratulating you on how well you’ve done by not smoking all morning - and how easy it seemed to be. But then the ‘smoker’s mind’ continues, in the same voice, telling you how much you deserve a reward for that achievement... how it’s OK to have one cigarette at lunchtime... how it’ll be much easier to quit completely in a week or two, after cutting down a little… Now the craving has been lit, and before too long the anxiety is rising, and perhaps another attempt to quit will soon become an attempt to cut down. And unfortunately that will bring a sense of failure, and the ‘smoker’s mind’ will soon be telling the story of how impossible it is to quit, which becomes a justification for continuing to smoke. It can seem as if the ‘smoker’s mind’ is always looking for an excuse to fail, as proof that it can’t be ignored.

So how does hypnotherapy help? Well, there are several different ways of describing this, but in essence it strengthens the part of the mind that wants to stop, making it easier to keep on top of the part that wants to smoke. Considered in this way, its obviously best to use hypnosis as an aid to stopping, when you’re really wanting to stop - that is, when the part of you that wants to stop is big enough to have a chance.

Another way of understanding this is to consider a simplified model of what is happening in the brain during hypnosis: There is a shift towards more activity in the brain's right hemisphere, which is more closely involved in emotion, intuition, imagery, metaphor and 'the big picture' - as opposed to the logical, rational, and detail-focussed left hemisphere. Whilst logical, rational conscious processes are important, they do not easily modify emotions, and this is rarely more obvious than in the case of the drive to smoke. We can think rationally and logically about how harmful, expensive and unacceptable smoking is, but it doesn’t seem to help much in many cases. What really needs to be ‘re-educated’ is the emotional drive, the right hemisphere, not the logical thinking left. And this is where hypnosis has the potential to help. It certainly doesn’t help by ‘controlling your mind’ and ‘forcing’ you to stop! 

Difficult decisions, challenging choices.

In our lives we’re presented with a constant stream of choices that require us to make decisions, thankfully most of them are not too difficult: Should I take the bus to work, or should I walk? Perhaps we have a preference to walk, as we’re trying to lose weight or keep fit, making it an easy choice, or perhaps it’s raining, which may make it an equally obvious choice.

As a result, it’s not surprising that we come to think of decisions as having one choice that is ultimately right, and one that is ultimately wrong, and we apply this kind of logic to all choices that we’re presented with. In fact, if life was this simple we’d all become quite robotic, as we follow logic and reason every step of the way. But difficult decisions present us with a different situation, one where the simple right/wrong, yes/no logic doesn’t apply, yet we so often fail to see that this is the case. Why?

Much of the time, a decision is difficult because it doesn’t have an obvious ‘right’ answer, and yet, whilst we might already realise this, we continue to review the options, think through the outcomes, and become frustrated by our inability to find the ‘right’ answer, even though we already know it does not exist! No wonder we so often feel we’re driving ourselves crazy in the process, as we endlessly think through our options, changing our mind again and again.

In such moments in can be helpful to recognise that the choice we’re considering doesn’t have a right/wrong answer, it simply has two different answers, each of which is right or wrong in similar measures. Perhaps both offer us the potential to be happy with the outcome of our choice, but in different ways. Let’s say the choice is between continuing to follow a career path as an employee or setting up a business of our own. In fact, each may offer a similar potential for future success, satisfaction and happiness: We just need to be comfortable enough to become the person that is better suited to the outcome we choose. In a sense, we go on to create the reason to have made that choice, after we’ve made the choice. In reality, this is a really empowering moment, one when we get to look inside ourselves for the reason and logic behind a choice, rather than searching outside.

In this way, we can come to see difficult decisions as those moments when we actually get to write the story of our life, rather than just drifting from one easy choice to the next.

Another reason we can find it so difficult to make the right decision is something psychologists call ‘affective forecasting’ - predicting how our emotional state will be in the future. But that’ll become the subject of another post…