Mindfulness in Turbulent Times
In the past few months I have witnessed tremendous increases in anxiety, irritability, depression, and fear about what’s happening in our country and the world, in my mindfulness students and therapy clients (as well as among friends, family, neighbors and most everyone I interact with). At the same time, I’ve heard more people questioning the value of mindfulness practice in these crazy, chaotic times.
How can we make sense of the current political climate in the U.S., and particularly the constant assault on our Democratic institutions and dedicated public servants, from a mindfulness perspective? And more importantly, how can mindfulness help us to manage the anxiety we’re feeling? Here are some thoughts:
1) Mindfulness is not an escape from reality, but rather an embracing of reality that offers true refuge, as the American Buddhist teacher Tara Brach’s book of the same name explains. It gives us a solid ground to stand on, unlike the false refuge of our various addictive behaviors and ways we all have of numbing ourselves or checking out. When we are truly mindful, we can see clearly what is happening, without getting overwhelmed, and we’re less likely to be fooled by those who seek to manipulate our emotions.
2) When we learn to stop, take a breath, and observe what’s happening, both around us and within us, before we act/speak, then we begin to see the full range of choices available in how we respond, to any situation we face. We can choose our response carefully, rather than act/speak reactively. This is a fundamental freedom that no one can take from us, as Viktor Frankl, the Austrian psychiatrist and concentration camp survivor, said so eloquently in his book, Man’s Search for Meaning. Mindfulness practice teaches us response-ability.
3) Mindfulness asks nothing more, and nothing less, of us than deep and honest self-reflection. While the guiding principles of mindfulness are fairly simple, it is not easy to practice, because it requires that we acknowledge all of our thoughts, emotions, actions, and reactions, even the ones we’re not so proud of. It holds us accountable for our words and deeds, asking that we speak wisely, and choose skillful action, in ways that are not harmful to ourselves or others. In other words, the opposite of what’s been playing out in the political arena over the past months!
4) Mindfulness increases our capacity to tolerate strong negative emotions and difficult situations. Another of my favorite American Buddhist teachers, Pema Chodron, says, in her book When Things Fall Apart, that things are always falling apart and coming back together again, that much of our suffering comes from our resistance to this inevitable process of change, and that “the healing comes from letting there be room for all of this to happen: room for grief, for relief, for misery, for joy.”
5) There are two opposing forces in the universe, chaos and rigidity. We can see rigidity in how the current occupant of the White House tries to impose his will on others: that’s authoritarianism. We can see chaos in the impulsive and cruel actions of his unelected hatchet man: that’s nihilism. Neither extreme is good. And all of humanity’s struggles can be understood as a quest to find balance between these two forces, both in the world and within our own minds. Dan Siegel, the interpersonal neurobiologist, discusses these ideas in his book, Mindsight. Mindfulness meditation practice can lead us to that balance, a “middle way.”
6) Finally, Mindfulness invites us to acknowledge our common humanity, to recognize the fundamental truth that most people want the same things – to be able to take care of themselves and their loved ones, to have financial security, to enjoy basic rights and freedoms, and to be happy. As the television producer Norman Lear used to say, “I am just another version of you.” When we look for the common humanity in each other, we build bridges to understanding and compassion, rather than building walls and more hatred.
In closing I would like to offer a couple of mindfulness practices for these challenging times. The first one is called The Mountain Meditation, adapted from the Mindfulness-Based Relapse Prevention curriculum, and originally published by Jon Kabat-Zinn in his book, Wherever You Go, There You Are. The second one is a brief practice, borrowed from my colleague Renee Burgard, LCSW, called the Mindful Self-Compassion Break. Both can be found on this website, on the Guided Meditation audio files page. Password is “patience”.
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Burnout in the Helping Professions
“There’s no shame in taking a step back to focus on self-care.” As I was saying this to one of my clients recently, it hit me: if I truly believe that, then I need to practice what I preach! It was obvious to me that my client was suffering from burnout, due to the demands of her job as a mental health professional as well as her family caregiver responsibilities, and equally obvious that she absolutely deserved to set some boundaries, ask for help, and take a break to recharge her batteries. And yet, even though I was beginning to see signs of burnout in myself, it was a real struggle to acknowledge this, and give myself the same permission to step back.
This is the dilemma that many of us in the helping professions face: if you’re a nurse, doctor, psychotherapist, social worker, or teacher, you may have received training to recognize the signs of burnout, and you may know what to tell your patients, clients, or colleagues to do to relieve it. In fact, you might spend your days counseling others to take a step back, set some boundaries, reach out for help, and get some rest. But when it comes to you, you’re far more likely to tell yourself to just push through the exhaustion, and ignore the growing cynicism and feeling of detachment from the work that you used to love.
So what exactly is burnout? The World Health Organization (WHO) defines burnout as “a syndrome resulting from chronic work-related stress, with symptoms characterized by feelings of energy depletion or exhaustion; increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job; and reduced professional efficacy.”[1] It is not a medical condition or mental disorder.
Christina Maslach, professor emerita of psychology at UC Berkeley and co-author of the Maslach Burnout Inventory (MBI), describes burnout as “feelings of exhaustion, inefficiency and cynicism, defined by a detachment from work and a lost sense of meaning.”[2] Developed in 1981, the MBI was the first instrument to measure burnout, and remains widely used today.
Are people in the helping professions more likely to experience burnout? According to recent surveys [3,4], burnout seems to be growing among workers across occupations, fueled by COVID-19 pandemic-related trends in working from home, remote schooling for children, and staffing shortages. But healthcare workers and educators have been hit the hardest, and even prior to the pandemic, these occupations have historically been most impacted by burnout. To understand why, we can examine the traits of people who are most vulnerable to burnout, but even more importantly, we need to look at the characteristics of jobs that burn people out.
Burnout doesn’t happen to slackers, but rather to those who are the most conscientious and hardest working, and who regard their work as a calling.[5] The traits of people who are most vulnerable to burnout include:
- Being a helper, by nature or occupation;
- Scoring high on conscientiousness and agreeableness (Big Five Personality test);
- Taking pride in one’s work ethic and dedication;
- When the going gets tough, they don’t quit, they just work harder; and
- They believe that asking for help is a sign of weakness.
Do any of those ring true for you?
Burnout is caused by chronic and excessive job-related stress, not by any deficiency in the individual. The characteristics of occupations that have highest rates of burnout include:
- Involving the provision of direct services to people in the areas of health, mental health, and primary education;
- Responsibilities are loosely or vaguely defined, additional responsibilities are constantly being added;
- Success is difficult to measure, there’s never an endpoint or goal post;
- Rewards are intangible, few, or fleeting;
- Job demands exceed what is humanly possible, given time and resource constraints.
Therefore, it is increasingly difficult to do the job well, or meet the needs of those you are supposed to serve. Does this sound like your job?
How do you know if you’re suffering from burnout? In my experience, these are the key signs:
- You’re more impatient or irritable than usual;
- You don’t feel well-rested after a night’s sleep;
- You’ve stopped doing activities that normally bring you pleasure or involve self-care;
- You find yourself saying or thinking more often, “I just don’t care” about your job; and
- You don’t feel ready to go back to work after your regular days off.
You may also find yourself getting more and more behind on routine work and household tasks, and thinking more often about quitting, changing jobs, or retirement.
A key point: burnout is not the same as depression. Because there is a significant overlap of symptoms, those who are suffering from burnout may believe, or may be told, that they’re clinically depressed, however, the causes of burnout are different, and so is the treatment. (Of course, it’s possible to have both burnout and clinical depression, in which case you will need to address both conditions.)
What is the treatment for burnout? Ideally, a signficant amount of time off work. For some people, a couple of weeks might be enough, for others, a month to a year may be needed. Of course, this is not possible or realistic for many people, so then you will need to implement these self-care tasks while continuing to work:
- Start with setting some boundaries. Learn to say “no,” or “not now,” and let go of any non-essential tasks;
- Ask for help from colleagues, or delegate if you can;
- Prioritize getting more sleep and exercise, eating healthier, and reaching out to family and friends for social connection;
- Change your attitude or approach to work. Become willing to be “good enough” rather than “great;” commit to leaving work on time, or if you work from home, create boundaries to separate work from home and family life;
- Take some time to review your life goals, and what gives you a sense of meaning and purpose. If it’s not your job anymore, then begin to explore other options.
- Finally, I highly recommend seeking out a psychotherapist to assist you in this process.
When I saw my client again, she seemed a bit happier, and reported that she had set some limits with the family members who had been most demanding of her time. She’d also resumed her exercise routine, was making plans for a trip with friends, and was actively looking for a job that was less direct-service oriented. And how did I address my own incipient burnout? I have decided to take a break from teaching mindfulness classes, even though I love doing so, to give myself more time for rest, relaxation, exercise, and visits with friends and family.
Notes:
1. Burnout an “occupational phenomenon”: International Classification of Diseases WHO. 28 May 2019. Referenced in Wikipedia page on occupational burnout.
2. Christina Maslach, quoted in Zuckerman, C (2021, April 30) How to Beat Burnout without Quitting Your Job. NYT online, retrieved March 28 2022.
3. Survey by Robert Half Int’l, referenced in Maurer, J. (2020, December 16) Remote Employees Are Working Longer Than Before. Retrieved from SHRM HR Today, online ed.
4. Threlkeld, K. (2021, March 11) Employee Burnout Report: Covid-19’s Impact and 3 Strategies to Curb It. Retrieved from Indeed.com.
5. From “The Exhaustion Funnel,” handout from my MBCT course.
Calming the Anxious Mind
We are living in turbulent times. If you are paying attention at all, it’s hard not to feel anxious about the state of the world we live in and the fate of humanity. While violence, war, and natural disasters have occurred throughout human history, we seem to be experiencing them today with a new level of intensity – from the effects of climate change to the rise in terrorist activity – while our leaders and politicians seem more concerned with their own approval ratings than providing actual leadership.
We also live in a “500-channel universe,” a world of seemingly infinite possibilities for distraction. Distraction is a common coping strategy against anxious thoughts or worries, but when we are bombarded by TV and radio programming that aims to offend and shock, advertising that urges us to spend money we don’t have in a never-ending quest for happiness, and the constant stream of bad news, our nervous system gets stressed, and may become overloaded.
The pace of daily life has sped up, to a speed that may actually exceed the brain’s ability to process and respond to our experience in an effective way. When I was growing up, we were promised that technology would make our lives easier, and give us more leisure time (remember “The Jetsons”?) Instead, we have less free time, with our cell phones, laptops, and tablets keeping us connected to the office and to everyone we know 24/7, even while we’re supposed to be sleeping or on vacation. This lack of down time adds to our stress and anxiety.
Anxiety and worry are normal human emotions, emanating from the part of our brain that houses our survival instincts. (Read what Rick Hanson, PhD says about the brain’s “negativity bias.”) Anxiety can be passed down in families, both as a genetic predisposition and as learned behavior. Everyone experiences anxiety at times, though some people are more sensitive to it, while others are anxious all the time. Anxiety is one of the most common reasons that people take medication (or use alcohol, drugs, or food to “numb out”). So what are some healthy ways to relieve anxiety, and calm the anxious mind?
One way is to “unplug”: see if you can turn off your devices when you’re eating and sleeping, and leave them at home while you enjoy a walk in nature. Stop watching the news on TV before bedtime, and read a book instead. Can you go for a whole day without checking email or texting? Finding ways to reduce the amount of stimulation to your brain may lower your anxiety level.
Another way is to challenge your assumptions and thoughts about whatever is making you anxious. If you’re prone to playing the “worst case scenario” game in your head, you may be scaring yourself, and making things worse than they actually are. The gold standard of anxiety treatment is Cognitive-Behavioral Therapy (CBT), which teaches you to change how you feel by changing your thoughts and behaviors. Check out this new CBT workbook: The Road to Calm
Because we experience anxiety in the physical body, as well as in our minds, Mindfulness-Based Cognitive Therapy (MBCT), a newer variation of CBT, incorporates meditation and yoga practices. As a CBT practitioner for over 25 years, and an MBCT practitioner for the last seven, I’ve found that mindfulness and meditation practice improve the efficacy of CBT, and are also stand-alone practices that can be very helpful to manage anxiety and relieve its effects.
At its most basic level, mindfulness invites us to wake up to the present moment, and notice that we’re breathing – “I’m awake and alive, right now.” While this might not strike you as a reason to rejoice, if you stop to think about it, that we breathe automatically is truly amazing. Mindfulness is about stepping out of autopilot mode, and using the breath and body to ground us in the present. However, if you’re experiencing anxiety, this can get dicey.
A typical mindfulness meditation practice is to focus on the breath. Many people find that this promotes relaxation and calmness, but if you are prone to anxiety, focusing on your breath can actually make you more anxious. You might notice that your breathing is kind of shallow, or a bit rapid, so you try to take a deep breath or slow your breathing down, but then the harder you try the more it seems to speed up, until it feels like you can’t breathe at all! Has that ever happened to you?
And did you then conclude “meditation is not for me?” The problem here is that bringing conscious awareness to automatic processes in the mind and body, while beneficial for most people, can backfire for anxious people, who are already hyper-focused on things that other people don’t even notice, like their breathing, heart rate, and worrisome thoughts. But if you give up on mindfulness and meditation so soon, you don’t give your mind and body a chance to reap the benefits, which are signficant. Herein lies the paradox of mindfulness.
Whether it’s your breath, or your life, if you start with wanting things to be different than they are, you create more stress and anxiety for yourself. Mindfulness invites you to just observe what is, without judgment or worry, and without needing things to be different. If you can do that, then change may come, often effortlessly. You might try this brief breath meditation:
Still not sure about meditation? Perhaps some mindful movement, like Yoga, Tai Chi, or Qi Gong, can help. One of my favorite forms of mindful movement is walking meditation, where we focus our attention on the sensations involved in walking, slowly and intentionally, just being present with our experience without needing to go anywhere. Walking this way, we find there’s actually a lot to notice, so we’re not just focused on the breath, and this, plus the gentle, rhythmic movements of our body, can help to calm the anxious mind. If you’d like to try walking meditation, here are some instructions:
A Ladder and a Map: Tools for Emotion Regulation
I recently had the opportunity, due to the pandemic, to attend a virtual version of an annual conference for psychotherapists that is usually held in Washington D.C. One of the webinars I attended, by Deb Dana, LCSW, offered some simple and practical tools to use with clients, based on a not-so-simple to explain theory, the Polyvagal Theory. The first tool is a ladder; the second, a map, or a series of maps.
Polyvagal Theory was developed by Dr Stephen Porges, and even though I’ve read his book and listened to several talks he’s given, I still have trouble clearly explaining it. In a nutshell, it merges evolutionary neurobiology with attachment theory to describe the mechanisms behind a hierarchy of human responses to perceived threats. These responses include one most of us are familiar with, the “Fight or Flight mechanism,” as well as a “Freeze” response. Porges’ theory helps us understand how emotional regulation is a function of interpersonal connection, how trauma disrupts those connections, and most importantly, how people can regain emotional equilibrium after being dysregulated by a threat or trauma.
Before I get to the ladder and the map, a little background. If you studied human anatomy in school, you learned that our autonomic nervous system (ANS) has two branches, the sympathetic (SNS) and the parasympathetic (PNS). The SNS governs movement, doing, while the PNS governs resting, being. The “fight or flight” response is generated by the SNS, while the PNS leads us to “rest and digest.” In a healthy functioning ANS, the two branches work in harmony. The sympathetic branch acts like the accelerator on a car, while the parasympathetic branch acts like the brake. Simple, right?
Here’s where it gets more complicated. The term polyvagal comes from the vagus nerve, which is a large nerve that connects the brain with the major organs of the body – lungs, heart, stomach – as well as the face, eyes and ears. The vagus nerve is like “command central” for the PNS. A key discovery of Porges was that there are two pathways of parasympathetic response, one of which causes the “freeze” response, when a person becomes immobilized in the face of a threat or trauma. The other pathway has an opposite response, leading to social engagement and connection. The immobilization response is a more primitive protective mechanism that all mammals have. The social engagement response is a more evolutionarily advanced mechanism, which only some mammals (dogs, cats, horses, elephants) and all humans have.
These two pathways are called Dorsal Vagal and Ventral Vagal. In the Dorsal Vagal response, the organism moves to shut down, in an attempt to save itself (think of how a mouse might feign death to escape from a cat, who loses interest when it stops moving). A person in this state may feel numb, disconnected, lost, abandoned, invisible, hopeless, and despairing. The Ventral Vagal response, in contrast, moves the organism to connect to self and others. A person in this state may feel alive, energized, tuned in, resourceful, flexible, and hopeful. Can you recall experiencing either, or both of these states?
The ladder is a visual representation of the range of responses to a perceived threat, from immobilization (Dorsal Vagal) at the bottom, to social engagement (Ventral Vagal) at the top, with the sympathetic responses that mobilize us (Fight or Flight) in the middle. The ladder is a tool that allows you to locate where your own response lies, to identify how dysregulated you are, and to see that it’s possible to climb out of immobilization into mobilization, and from there into engagement and connection. Most likely, you will need help to do this.
Polyvagal Theory recognizes that all of these responses are adaptive survival mechanisms that often operate below the level of conscious awareness. We don’t choose to fight, flee, or freeze, so there’s no reason to get down on ourselves when we do. The good news is that once we can come to understand what’s happening, we can learn how to move out of that automatic reaction into a more regulated state.
Connectedness is actually a biological imperative. People are inherently social beings, and our nature is to interact and form relationships with others. And it is within those interpersonal relationships that we learn to regulate our emotions. Think about how a baby cries when it is hungry, tired, or has a soiled diaper, and how its mother-caregiver offers comfort through a soothing voice, facial expression, and physical touch. These are instinctive responses that bring mother and child into “co-regulation” of their physical and emotional states, an equilibrium. As adults, we still want and need to experience co-regulation with others. When we do, we feel safe, at ease, relaxed, content. We can face challenges and function effectively in the world.
Trauma and other threats to our safety and well-being disrupt this natural drive to connect, and interfere with an individual’s ability to seek and experience co-regulation. The fight or flight responses, and especially the Dorsal Vagal collapse, are coping mechanisms designed to keep us alive, but they aren’t intended to be long-term modes of functioning. And they block us from establishing the connections we need to co-regulate and regain emotional equilibrium. The dilemma is, how can we engage and connect with others when we don’t feel safe?
This is where the map comes in. In Deb Dana’s process, therapist and client co-create a map or series of maps to first name and describe where the person may be on the ladder, and then identify the steps that will move them toward connection and social engagement. For example, if they are immobilized in a Dorsal Vagal collapse, the first steps may include establishing a sense of safety by doing grounding exercises, and to offer themselves some kind words of comfort and soothing gestures. The maps include both things the person can do on their own, and things they can do that involve others, for example, text a friend, accept a hug, or go for a walk in a park where there are other people around.
If you would like to learn more about the Polyvagal Theory, there are many YouTube videos with Stephen Porges, and a TED talk by his son Seth Porges. To learn more about Deb Dana’s approach to restoring emotional equilibrium, I recommend her new book, and podcast, “Befriending Your Nervous System.” And if you would like to work directly with a therapist to learn how you can use the ladder and maps for yourself, please contact me!
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