Erik van den Brink MD, psychiatrist/psychotherapist & mindfulness trainer Frits Koster, vipassana meditation teacher & mindfulness trainer

Center for Integrative Psychiatry, Lentis, Groningen, The Netherlands

CMRP’S 2015 CONFERENCE WORKSHOP 3rd JULY 2015

Mindfulness-Based Compassionate Living

Disclosure

• None commercial, apart from a tiny interest as authors of the MBCL book

• A strong commitment to find ways to relieve suffering and empower self-healing capacity

Content

• What is (self-)compassion and why train it? • Research? • Themes and practices of MBCL? • Taste of some exercises

• With a brain, body and emotions and a socially developed self, that were not our choice.

• In a life full of tragedies: threat, loss, illness, decay, death.

• A lot of what we experience is neither our design, nor our fault.

• Compassion starts with the recognition of this inevitable suffering.

Paul Gilbert (2009):

Here we are, all in the same boat…

What is Compassion?

• ‘Compassion’ is defined as… the capacity to be sensitive to the suffering of ourselves and others and the willingness to relieve and prevent it

(Gilbert, 2014)

• A natural human capacity inherent in all of us but

often not very well developed. • The aim of compassion training is to develop and

deepen it.

Why training in Compassion?

• Ancient Wisdom Compassion as a gateway to happiness.

• Evolution and Attachment Theory Highly sensitive brain for internal and external kindness increases survival chance.

• Neuroscience Specific areas of the brain active with kindness and compassion.

• Research General and clinical populations.

Self-compassion correlates positively with... (Barnard & Curry 2011; Hofmann e.a. 2011; MacBeth & Gumley, 2012; Neff, 2012)

• More psychological well-being & life fulfillment • More emotional intelligence & positive emotions • Healthier coping with adverse events

(academic failure, trauma, divorce, chronic pain)

• Healthier lifestyle (diet, exercise, less smoking)

• More social connectedness, empathy, altruism, forgiveness

Compassion Training Programmes

• CMT: Compassionate Mind Training Gilbert & Procter 2006

• LKM: Loving-Kindness Meditation Fredrickson et al. 2008

• CBCT: Cognitive-Based Compassion Training Pace et al. 2009

• CCT: Compassion Cultivation Training Jazaieri et al. 2013

• MSC: Mindful Self-Compassion Neff & Germer 2012

• MBCL: Mindfulness-Based Compassionate Living Van den Brink & Koster 2012

For graduates of a basic mindfulness course: MBCT, MBSR, ACT

Transdiagnostic programme of 9 sessions 2,5 hr; 1hr daily practice

Interventionstudies RCT’s • LKM: increase in positive emotions, experiencing meaning, social

support; decrease in depressive symptoms and physical complaints Frederickson e.a. 2008

• CBCT: positive effect on immune function, neuro-endocrine and behavioral response to stress Pace e.a. 2009

• CCT: increase in happiness, decrease in worry and emotional suppression Jazaieri e.a., 2013, 2014

• MSC: increase in mindfulness, compassion self/others, social connectedness,well-being and happiness; decrease in depression, anxiety, stress and avoidance of unpleasant thoughts and feelings

Neff & Germer 2012 • CFT: pts with schizophrenia: better clinical functioning; increase in

compassion correlated with decrease in depressive symptoms and experience of social exclusion Braehler e.a. 2012

Brainresearch

Compassion meditation experienced > beginners: • More gamma-activity and synchronicity on EEG Lutz e.a. 2004

• More activity in areas associated with empathy and emotion regulation on fMRI; stronger response to others in distress Lutz e.a. 2008

Brief Compassion Training compared to active controls: Weng e.a. 2013; Klimecki e.a., 2013a, 2013b

• Activates circuits associated with positive emotions • Counteracts effect of empathic distress • Increases generosity

High and low roads to compassion Goleman 2006

LOW • Attachment behavior Vrticka & Vuilleumier 2012

• Soothing breathing rhythm Gilbert 2010

• Vagal tone (HR Variability) Porges 2007; Kok & Fredrickson 2010

• Oxytocin Olff et al. 2013

HIGH • Mindfulness and loving kindness practice • Compassionate imagery and skills training High and low roads reinforce each other in an upward spiral Kok et al. 2013

Language, imagery, looking forward & backward, fantasizing,

ruminating, conceptualizing, mentalizing, self & other

Territory, agression,

hunting, sex

The evolved brain MacLean 1990

Care, attachment, play, social behavior,

rivalry and rank

The more care and protection are needed, the less ‘instinctive’ the brain and the more learning capacity.

The more social the species, the thicker the cortex.

From ME-first to WE-first

Compassion as ‘flow’

Other Self

Self Self

Self Other

Don’t kill the messenger!

EMOTIONS… Are useful messengers that tell us whether we

move in the right direction (of survival!) Inform us when we experience:

• Threat - safety • Failure - success • Social isolation - connectedness

Emotion & Motivation: 3 Basic Systems • THREAT SYSTEM self protection & safety Focus narrow (‘sticks’) Avoiding Fight, flight, freeze

• DRIVE SYSTEM reward & resources Focus narrow (‘carrots’) Approaching Grab & gobble

• SOOTHING SYSTEM social bonding & safeness Focus wide (internal & external, self & other) Attaching Rest & digest

SOOTHING SYSTEM content, safe, connected

DRIVE SYSTEM pleasure, excitement, vitality

THREAT SYSTEM anger, anxiety, disgust

Reward focused

Wanting, striving, achieving, consuming

Activating

Affiliative focused safeness seeking

Kind and caring

Calming, soothing

Threat focused, safety seeking

Fight, flight, freeze

Activating/ inhibiting

PARASYMP.

SYMP.

Dopamine

Oxytocin Endorphins

HPA axis

Van den Brink & Koster, 2012

adapted from Gilbert, 2009

Affiliative focused

safeness seeking

Kind and caring Calming, soothing

Threat focused, safety seeking

Fight, flight, freeze

Activating/ inhibiting

SOOTHING SYSTEM content, safe, connected

Reward focused

Wanting, striving, achieving, consuming

Activating

SYMPATHICUS PARASYMP.

THREAT SYSTEM anger, anxiety, disgust

DRIVE SYSTEM pleasure, excitement, vitality

Van den Brink & Koster, 2012

adapted from Gilbert, 2009

Reward focused

Wanting, striving, achieving, consuming

Activating

DRIVE SYSTEM pleasure, excitement, vitality

SOOTHING SYSTEM content, safe, connected

Threat focused, safety seeking

Fight, flight, freeze

Activating/ Inhibiting

THREAT SYSTEM anger, anxiety, disgust

SYMPATHICUS PARASYMP. Affiliative focused

safeness seeking

Kind and caring Calming, soothing

Van den Brink & Koster, 2012

adapted from Gilbert, 2009

OLD & NEW BRAIN REACTIONS TO THREAT

SELF-COMPASSION:

FIGHT SELF-CRITICISM • SELF-KINDNESS

FLIGHT SELF-ISOLATION • COMMON HUMANITY

FREEZE

OVER- IDENTIFICATION

• MINDFULNESS

THREAT PHYSICAL PSYCHOLOGICAL

Germer 2009 Neff 2003

TEND & BEFRIEND Taylor 2006

SELF-COMPASSION MANTRA NEFF 2011

• This is a moment of suffering (mindfulness)

• Suffering is a part of life

(common humanity) • May I be kind to myself here and now

(self-kindness)

ACCEPTANCE OF PAIN: 5 STAGES Germer 2009

1. Aversion – resistance, avoidance, rumination 2. Curiosity – turning toward discomfort with interest 3. Tolerance – safely enduring 4. Allowing – letting feelings come and go 5. Friendship – embracing, seeing hidden value

First we need to accept, then we can change.

Carl Rogers

In our pain we find our values.

Steven Hayes

Eating

Sexual stimulus

Shaming, blaming, punishing

LIMBIC SYSTEM

Saliva Gastric juice Arousal Stress reaction

Fearful, depressed

Care, Kindness

Relaxation response Calm, content

Gilbert 2009

Shame Self-

criticism

Meal Compassion

Sex

INNER BULLY

INNER HELPER

Social mentalities Gilbert, 2000

OLD BRAIN Emotions Reactive Short route

• Threat system • Drive system • Soothing system

NEW BRAIN Imagery/thinking/reasoning Responsive Long route

• Threat mind • Competitive mind • Compassionate mind

↔

Evolved social patterns supporting survival in groups. Blueprints for society that structure the human mind.

dominance/power, obedience/submission, rivalry/rank, giving/receiving care

Thinking Reasoning

Behaviour

Emotions Motivation

Attention

Imagery Fantasy

Model for (self)therapy

These elements form the structure of an inner pattern, mode, mentality or schema

Gilbert 2010

Judging risk safe/unsafe

Avoiding, resisting

Emotions Motivation

Focus on danger

Doom and gloom

THREAT MODE

Self protection Aversion, fear, anger

Behaviour Imagery

Attention Reasoning

Van den Brink & Koster, 2015 Adapted from Gilbert, 2010

Judging rank, comparing

Achieving, rivalry

Emotions Motivation

Focus on reward

Success and fame

COMPETITION MODE

Self enrichment, improving status Desire, envy

Behaviour Imagery

Attention Reasoning

Van den Brink & Koster, 2015 Adapted from Gilbert, 2010

Non-judging, allowing

Accepting, befriending

Emotions Motivation

Needs of self and others

Peaceful connection and safeness

CARING MODE

Social bonding, well-being

Calm, content

Behaviour Imagery

Attention Reasoning

Van den Brink & Koster, 2015 Adapted from Gilbert, 2010

Being socially sensitive

How the New Brain can work against us...

The Inner Bully grows on self-conscious emotions

such as shame & guilt

You’re no good!

Ideal Self

Actual Self

You must do better!

Self-criticism

by the inner bully Self-correction

by the inner helper

Self-esteem Self-compassion

• Competitive mind • Survival of the fittest • Feeling superior-inferior

(narcissism) • Dependant of others • I have to prove myself • Less wellbeing

• Compassionate mind • Survival of the nurtured • Intrinsic self-worth

(common humanity) • Independant of others • It’s okay to make mistakes • More wellbeing Neff & Vonk, 2009

Recognising INNER PATTERNS or SCHEMAS Germer, 2009; Young et al. 2003

Mindful noting and naming liberates from over-identification. Practising self-compassion heals associated pain.

Not-Good-Enough

Outcast

Mrs/Mr Bottling up

Everyone- Abandons-Me

Short Fuse

Ugly Duckling

Loner

Mrs/Mr Suspicious

Mommy’s Child

Pessimist

Attention Freak

Mrs/Mr Helpless Helpaholic

Little Prosecutor

Misfortune Teller

Control Freak

Loser Adaptor

Centre-of-the- Universe

… perhaps you can change your relationship with them.

Outcast Mrs/Mr

Bottling up

Mommy’s child

Everyone-Abandons-Me

Short-fuse

Adaptor

Not-Good-Enough Attention Freak

Centre-of-the-Universe

MisfortuneTeller

Pessimist Little Prosecutor

Loser

Ugly Duckling

Mrs/Mr Suspicious

Helpaholic Mrs/Mr

Helpless Control Freak

Loner

If you cannot change your patterns…

Compassion Distress tolerance

Sensitivity

Sensory

Sympathy

Empathy Non-judgement

Care for wellbeing

Emotions Behavior

Reasoning Attention

Imagery

THE CIRCLE OF COMPASSION

SKILLS-TRAINING

ATTRIBUTES

warmth ca lmness

k indness p layfu lness Gilbert 2009

SUGGESTIONS FOR HOME PRACTICE FORMAL

• nourishing the soothing system, e.g. soothing breathing rhythm • kindness meditation - self & others (metta light) • compassionate breathing - self & others (tonglen light) • safe place / compassionate companion / compassion mode • compassionately dealing with resistance / desire / inner patterns • compassionate letter writing / forgiveness • taking in the good / equanimity INFORMAL breathing spaces with kindness and compassion; self-compassion mantra; calendar exercises

Loving-kindness practice (Metta light)

Self… Benefactor… Dear person… Neutral person… Difficult person… Groups… All beings… ALTERNATIVE:

Compassionate breathing (Tonglen light)

In breath: May I / you / we / all…

feel safe... feel healthy... feel happy… feel at ease…

Out breath:

Backdraft

Germer 2009

Particularly in persons with insecure attachment/ trauma/ neglect, practising kindness may trigger the threat system rather than calming it.

The fear of compassion

Gilbert 2010

The impermanent self • Over-identification: survival strategy of

threat and drive modes. • Our relationship with images of ourselves and others can

be rigid or flexible and a source of pain or joy (just like relationships with real persons).

• From which part in ourselves do we look at which part in ourselves or the other?

• De-identification (defusion from self-as-content) can be liberating.

Compassion practice: looking from a wider care-giving part to a care-needing part.

Common humanity

We all wish for happiness; nobody wishes to suffer. Dalai Lama

Suffering and imperfection are part of life. We do not need to approve of harmful behaviour, nonetheless we can wish the person who misbehaved happiness and freedom from suffering. PRACTISING FORGIVENESS Forgiving ourselves; asking forgiveness; forgiving others

Four Friends for Life ‘Illimitables’ (Brahmaviharas) • Not limited by ego-perspective • Do not exclude anyone • Can be practised without limit.

Compassion Loving kindness Sympathetic joy Equanimity

What contributes to happiness? POSITIVE PSYCHOLOGY (Seligman 1998)

• The Pleasant Life • The Engaged Life • The Meaningful Life

PRACTICES • Savouring

– Taking in the good (Pleasure Walk) – Revisiting the good

• Gratitude • The silver lining • Core values

What motivates us in daily life? Practical Ethics

• Are we motivated by threat, drive or soothing systems?

• What are the consequences of our thoughts, speech and behaviour?

• Practical ethics: as much wholesome and as little unwholesome effects as possible for as many involved as possible.

• Ethical decisions come from a compassionate mind (not from threat or competitive minds).

Compassion a natural (self) healing capacity

‘I call this transformation ‘healing towards the human condition’ and for me, it’s the deepest healing of all… If you allow life in without resistance or clinging, you can be healthy and whole, no matter what kind of injury or disease process you may be living with.’

Vidyamala Burch, 2010

No mud… no lotus

With gratitude for your attention and … compassion

www.mbcl.org www.compassionateliving.info

MBCL TRAINING COURSES – ENGLISH SPOKEN

by Erik van den Brink and/or Frits Koster

In the UK, organised by Compassionate Wellbeing, see www.compassionatewellbeing.co.uk.

− Fri 21 - Sun 23 August 2015 Foundation Course, King’s College, London − Fri 11 - Sun 13 December 2015 Foundation Course, Crowne Plaza, Edinburgh − Mon 9 - Wed 11 May 2016 MBCL Teacher Training, module 1, Midlands − Mon 26 - Wed 28 Sep. 2016 MBCL Teacher Training, module 2, Midlands

In Ireland, Dublin, organised by Institute for Mindfulness-Based Approaches, see www.institute-for-mindfulness.eu.

− Fri 27 - Sun 29 November 2015 Foundation Course − Fri 11 – Sun 13 March 2016 MBCL Teacher Training, module 1

In Norway, near Oslo, organised by Institute for Mindfulness-Based Approaches, see www.institute-for-mindfulness.eu.

− Fri 17 - Sun 19 June 2016 Foundation Course − Fri 27 – Sun 29 January 2017 Foundation Course − Fri 28 – Sun 30 April 2017 MBCL Teacher Training, module 1 − Fri 8 – Sun 10 September 2017 MBCL Teacher Training, module 2

See also

www.compassionateliving.info

&

www.mbcl.org

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SESSION

1 2

3 4

5 6

7

8 THEMES

Three Emotion

Reg

ulation

Systems

Why

(no

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(self-) co

mpa

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Multi-laye

red brain

‘The

des

ign is not

our fault’;

Threa

t, drive &

soothing

sys

tems

and their ba

lanc

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How

to nou

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soothing

sys

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Stress Rea

ctions

&

Self-Compassion

Self-criticism

vs

kind

ness

; Self-isolation vs

co

mmon

hum

anity

; Ove

r-iden

tification

vs m

indfulne

ss

Ten

d & Befrie

nd

Using

Imag

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Bac

kdraft

Inner Patterns

Threa

t, co

mpe

titive &

carin

g mod

es

Fun

ction of th

e Inne

r Bully and

se

lf-co

nsciou

s em

otions

(sh

ame,

shyn

ess, guilt)

Malad

aptiv

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hema’s

Compassion

Mode

Attributes

& skills

of com

pass

ion

Cultiv

ating an

Inne

r Helper

Doing

‘As-if’

Self & Others

Self-tran

scen

dent

& relationa

l qu

alities

of

compa

ssion

Ove

r- & de-

iden

tification

Kindn

ess to

othe

rs

Common

Human

ity

Fou

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Lov

ing Kindn

ess

Com

pass

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Sym

pathetic Joy

Equ

anim

ity

Wha

t con

tributes

to

happ

ines

s?

S I L E N T P R A C T I C E S E S S I O N

Compassion in

Daily Life

Motivation:

Wha

t mov

es us:

threat, d

rive or

care?

Practical Ethics

Hea

ling Power

of

Compassion

Eva

luation

How

to

continue

?

FORMAL

PRACTICES

Safe Place

Three

Circ

les

Soo

thing Breathing

Rhy

thm

Soo

thing throug

h the

Sen

ses

Pleas

ure Walk

Com

pass

iona

tely

dealing with

Res

istanc

e Com

pass

iona

te

Com

panion

Com

pass

iona

tely

dealing with

Des

ire

Com

pass

iona

tely

dealing with

Inne

r Patterns

Embo

dying

Com

pass

ion

Kindn

ess for the

Bod

y Walking

& M

oving

with

kindn

ess

Com

pass

iona

te

Lette

r Writing

Com

pass

iona

te

Breathing

Forgive

ness

: forgiving on

eself

Tak

ing in th

e Goo

d

Sav

ourin

g Gratitud

e Silver Lining

Core Value

s

Equ

anim

ity

Disco

verin

g Com

pass

ion for

Self a

nd O

thers in

Daily Life

Preve

ntion Plan

Com

pass

iona

te

Bod

ysca

n

Strea

m of

Awaren

ess

LOVING

KINDNESS

Self

Self

Ben

efac

tor

Dea

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n Neu

tral Perso

n

Difficult Perso

n Group

s

All Being

s

Foc

us on

Equ

anim

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---

cont. -

--

INFORMAL

Breathing

Spa

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ith

Kindn

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Breathing

Spa

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with

Com

pass

ion

Self-Com

pass

ion

Man

tra

---

cont. -

--

---

cont. -

--

---

cont. -

--

---

con

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--

---

con

t. -

--

---

cont. -

--

CALENDAR

Soo

thing sy

stem

Threa

t sys

tem

Driv

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stem

Inne

r bu

lly

Inne

r he

lper

Rec

eiving

co

mpa

ssion

Giving

compa

ssion