Tag Archives: Cognitive Defusion

How to deal with pop-up thought?

Basic & General, ,

“How do I stop thinking?”

“I have so much thought! I can’t stay focus!”

“How do I control my mind? I feel like I’m losing it.”

“I can’t sleep. There are so many thoughts, I can’t help it”

Just as the heart is designed to pump, the brain is designed to think, and it throws you with thoughts every 1 or 2 seconds, you can’t really control those thoughts or stop them from popping up, what can you do about them? How can you stay focused better? How can you direct attention to the here and now, to the present moment, to the things you want to do?

The answer is pretty simple… We all hear it every now and then… You might even have tried or practiced it before…

 

 

 

 

“Mindfulness”

Yes, being mindful, noticing your thought, accepting them (no judging), then bringing your attention to the present moment. How can you achieve that?

“Practice”

Yes, you need to practice, keep doing it, whenever you remember, it doesn’t just happen overnight. You can start with some simple meditation, you may learn the Benson’s relaxation method (read this). Or you can try the Leaves on the Stream here (with recordings).

Mindfulness VS Meditation

Basic & General, , ,

“What’s the difference between mindfulness and meditation?”

One of the questions I was asked a few times, and this answer below is based on my practice and understanding.

There are two types of meditation, broadly speaking. One is with focused attention. So for example, when you focus on your breathing, a word, a prayer, the candle light, you let go of anything that comes into your attention, and keep redirecting your attention to the thing that you are focusing on. (One example of this type of meditation here).

Another type of meditation, is with widen attention (awareness). It’s like you are in a stadium when no game is being played. You watch the whole space. You watch your whole experience, like an observer, or like a third party, non-judging, and not reacting. You allow things to come and go.

This second type of meditation, is a mindfulness practice! The definition(s) of mindfulness generally includes being present, being aware, non-judgemental, and acceptance (not overly reactive). When you practice Leaves on the Stream, you are mindful of what’s going on in your mind. You can of course generalise this to your daily life, and be mindful of where you are, what you do, what you think/feel etc.

You can practice mindfulness anytime anywhere. Eating, drinking, working, typing, driving, exercising, walking mindfully (i.e. staying present, being aware of what you do, and being accepting). You can’t do all that while you meditate though.

Some people might meditate while they walk, run or swim. This can be with either first (focused, narrow attention) OR second type of meditation (broaden attention). With first, you might be saying “one, two, one, two, one, two…” in your mind, or noticing your breathing in and out. With second, you will be observing your whole experience, how your muscle move, what you see, hear, sense, how you feel etc.

I’d say both are meditation, but only the second one is being mindful. I hope I’ve made it clear?! Feel free to share your views!

Watching the Mind-Train

Basic & General, , , , ,

Meditation Exercise: The Mind-Train

Following my favourite Leaves on the Stream (see here), I am introducing another mindfulness exercise. It is an eye-closed exercise (though possible to do it with eyes opened when you are familiar), so please read the instruction first.

Imagine you are standing at a railway bridge gazing down at three sets of train tracks. A slow mining train is on each set of tracks moving away from you. Each train is composed of a string of little coach/car. Seemingly endless, all three chug slowly along underneath the bridge.

Now, as you look down, imagine that the train to the left carries only ore composed of sensations, perceptions, and emotions (e.g. sounds you hear, hot sensation you feel, sweaty palms, sadness you notice, itchiness you feel etc). The middle train carries only your thoughts (your evaluations, predictions, and self-conceptualisation etc). The train on your right carries your urges to act (e.g. your pull to look away, your urge to scratch your face or stop the exercise, your efforts to change the subject). Looking down on these three tracks can be seen as a metaphor for looking at your mind.

Now, find a comfortable chair to sit in for a while in a spot where you won’t be disturbed and you can be quiet. Begin the exercise by thinking of something you’ve been struggling with lately, then close your eyes and picture the three tracks. Your job will be to stay on the bridge and gaze down at these three trains moving away from you. Take at least 3 minutes just to watch what comes up for you.

Mind train. (Forgive my very basic skills, it's not as simple in my imagination!)
Mind train. (Forgive my very basic skills, it’s not as simple in my imagination!)

本森放松法 (The Benson Relaxation Method)

Basic & General, Treatment Approaches, , ,

要素：

  • 重复单词、声音、短语、祷告词或肌肉活动(muscular activity)。
  • 被动地、忽视各种想法（这些想法无可避免地出现在脑海中），并耐心地把注意力放回到你重复的点。

方法的总结：

  1. 选择一个单词（比如“一”、“和”）、短句或祈祷词。
  2. 安静地坐在舒服的位置。
  3. 闭上眼睛。
  4. 放松肌肉，逐步地从脚到小腿、大腿、腹部、肩膀、头部和脖子。
  5. 慢慢地、自然地放松的当儿，在你呼气的时候，在心里重复你的单词、声音、短语或祷告词。
  6. 采取被动的态度。不要担心你做的好不好。当其他想法出现时，简单地对自己说“哦…”，然后轻轻地回到你的重复点。
  7. 持续十到二十分钟。
  8. 结束时不要马上站起来。继续安静地坐上一分钟左右，允许其他想法自然地回来。然后睁开眼睛，站起来之前再坐一分钟。
  9. 每天练习一到两次。适当的时间是早餐前和晚餐前。

你也可以在运动时引起放松反应。比如你在慢跑或走路时，注意你的脚在地面上的节奏-“左，右，左，右”– 当其他想法进入你的脑海，说“哦…”，然后返回“左，右，左，右” 当然，眼睛要睁着！类似地，游泳者可以专注于他们的划动、骑自行车者专注于车轮的呼呼声，舞者专注于音乐的节拍，其他也可以专注于他们的呼吸节奏。
（改编自Don Robertson的AHPC培训手册）

11分钟放松录音

Neutral Pure-O

Clinical Case Studies, Obsession & Compulsion, Treatment Approaches,

Most people know that Exposure Response Prevention (ERP) is the main intervention used for Obsessive Compulsive Disorder (OCD). So the rationale is pretty simple here, say we have a patient who is afraid of contamination (obsession) and wash his hands excessively (compulsion), we do some preparation work and can then start the ERP by exposing him to dirt without letting him to wash his hands (response prevention). This is normally done on a very gradual manner (with the patient’s consent and enough preparation work beforehand, so it is definitely not forcefully done to him). And of course in reality the OCD cases are barely as straightforward and simple as this, but this is the general principle.

With pure obsession, i.e. those without any compulsive behaviour, it’s all in their minds, things can get a bit harder, but still, it’s possible. Some commonly seen pure-O are (1) relationship obsessions (discussed in my blog else where as “morbid jealousy” which might or might not be the same condition), (2) sexual obsessions, (3) religious obsessions, (4) violent obsessions, (5) neutral obsessions.

So let’s take a recently seen man as an example here. It started once when he drove past a church, and somehow a sexual related thought popped out in his mind, he couldn’t bear himself having such “dirty” thought in a holy place, and since then, whenever he goes passed any holy places, he will suppress his mind from coming out with any “dirty thoughts”. And as we all know that our minds don’t work this way, the more you try to push some thoughts away, the more they bounce back and pop up.

ERP is possible for such pure-O cases. After the initial preparation work including psychoeducation, motivation building and mindfulness training, they are exposed to those thoughts that they have been avoiding, in those places (based on the items in the hierarchy). So it works similarly for all different types of pure obsessions, be it relationship, violent, religious or sexual (in certain cases where direct exposure is not possible, it will have to be done in imagination, and by watching videos etc).

However, how about neutral obsessions? What the patient has could be some really simple, random thoughts, which might be inconsistent, but they might be spending hours and hours thinking about these random stuff. Like a young man I saw couple months ago, who reacts to any thought his mind comes up with, e.g. “why does the universe work this way?”, “how do my ears listen and my brain comprehend what others say?” etc. I couldn’t really carry out typical ERP to him, since those are really random topics and they can be completely different every time. So I needed him to start thought defusion exercises, mindfulness meditation (then he dropped out…). I believe this is the best way for neutral pure-O, though I understand how difficult it’s to increase their motivation to keep practicing until they see the effects (did have patients in the past who were surprised by how quiet their minds can be after such exercises – and this is just a bonus, as it’s not the intention or purpose of such practices).

Do enlighten me if you have better psychological intervention for neutral pure-O. And I hope all the OCD sufferers out there will not give in to the illness!

The Benson Relaxation Method

Basic & General, ,

The essential factors:

  1. Repetition of a word, sound, phrase, prayer or muscular activity.
  2. Passively disregarding everyday thoughts (which inevitably come to mind) and patiently returning to your repetition.

The method summarised:

  1. Pick a focus word, short phrase, or prayer that is firmly rooted in your belief system
  2. Sit quietly in a comfortable position
  3. Close your eyes
  4. Relax your muscles, progressively from your feet to your calves, thighs, abdomen, shoulders, head and neck
  5. Relax slowly and naturally, and as you do, say your focus word, sound, phrase or prayer silently to yourself as you exhale
  6. Assume a passive attitude. Don’t worry about how well you’re doing. When other thoughts come to mind, simply say to yourself “oh well,” and gently return to your repetition.
  7. Continue for ten to twenty minutes.
  8. Do not stand immediately. Continue sitting quietly for a minute or so, allowing other thoughts to return. Then open your eyes and sit for another minute before rising
  9. Practice the technique once or twice daily. Good times to do so are before breakfast and before dinner.

You can also elicit the Relaxation Response while exercising. If you are jogging or walking, pay attention to the cadence of your feet on the ground – “left, right, left, right” – and when other thoughts come into your mind, say “Oh, well,” and return to “left, right, left, right.” Of course, keep your eyes open! Similarly, swimmers can pay attention to the tempo of their strokes, cyclists to the whir of the wheels, dancers to the beat of the music, others to the rhythm of their breathing.

(Adapted from the AHPC Training Manual by Don Robertson)