Thursday, August 20, 2009

Changing my mind: slightly all-over-the-shop thoughts about brain plasticity, excessive worry, and mindfulness

For many years I have pictured my condition/illness/neurosis (whatever you want to call it) as a small child constantly tugging at my sleeve and demanding care, attention and protection. Of course, I’m not Robinson Crusoe in seeing myself this way – inner child therapy suggests that we all have a needy child inside us that we need to listen to, love and support.

What I’m trying to do more actively these days is actually learn to manage this child, look after it, but also keep it in line. And to do this I’m finding myself viewing my brain as a pliable thing that I can manipulate.

I know this sounds a bit negative and mechanistic so let me explain. Ever since I read The Brain That Changes Itself by Norman Doidge, a book that reveals some of the latest research into just how plastic and changeable our brains actually are, I’ve been pondering how disempowered I’ve always felt about handling my chronic anxiety and panic.

These feelings of disempowerment have only increased over the last four years or so, since I gave up therapy and decided once and for all that my body couldn’t handle antidepressants. During this time I have done a few empowering things – I learned how to control my breathing and still practise abdominal breathing when stressed; I did a short group therapy course for social anxiety sufferers; and I bought a mindfulness book and CD, and still do a mindfulness session with the CD about four times a week.

I also try to practise mindfulness (staying in the present; being aware of my surroundings and sensory experiences; noting but not judging thoughts) but I’m not strict about letting the thoughts go – more on that later.

These are all good things, but with my wayward brain they’re simply not enough!

The Brain That Changes itself was an incredibly affirming book. I’m the sort of person who needs constant affirmation, and exterior, visible proof that something is working. I think that’s one reason I’m finding it hard to make further necessary changes like starting meditation – there’s no-one there to say ‘I can see that’s making a difference’, no machine I can hook up to that will show my altered brainwaves after a meditation session.

But Doidge’s book, even if it can’t make my brainwaves visible to me, has been making me see my brain as something fluid, something that I can change, something that’s constantly affected by what I think, do, and tell myself.

So I don’t want to manipulate it in a way that denies my reality (‘I am now a multimillionaire with a swish New York apartment and a cottage in the south of France’). I just need to give it a bit of discipline. When I think of manipulating my brain, I’m actually thinking of a process more like, say, massaging sore muscles into shape or, conversely, exercising slack muscles.

Some examples. I can fall prey to obsessive thoughts sometimes, and while I don’t class myself as having OCD (I have enough problems!) I found the section on OCD in Doidge’s book very helpful. (It’s also useful for anyone who worries excessively.)

When you have an obsessive thought that won’t go away, you do two things: you refuse to focus on the content of the thought, and tell yourself the actual content is not the problem, but the obsessive thinking is; and then you do something pleasurable to distract yourself.

It’s so simple, and yet, if you do it over and over, determinedly, you’re actually changing your brain, creating positive new circuits and connections. What a fantastic idea!

Of course, it’s hard work, and takes perseverance. And it doesn’t mean you actually eliminate the old mental habits. Instead, you create new, competing circuits.

This part of the book was quite tantalising, because the book as a whole doesn’t include a lot of practical suggestions for dealing with anxiety and so on.

But it does suggest how important self-talk is in general, something I’ve been working on in a separate but related area, my social anxiety. Every time I go into a scary social situation, I now tell myself I’m safe. I tell myself I’m doing well. I talk sense to myself. I guess this is a very basic form of cognitive behavioural therapy, which seeks to identify and challenge irrational thoughts.

The book also offers a concrete way of thinking about those more esoteric habits that are hard to introduce, such as meditation, progressive relaxation or mindfulness in daily life. These practices are not simply good in the abstract; over time they’ll produce new neural connections and new mental habits.

When I think about it, meditation (even if it’s not specifically mindfulness meditation) and progressive relaxation (where you progressively tense and relax all the major muscles in the body) are related to mindfulness, if not forms of it, because they’re both about being in and experiencing the present moment.

But mindfulness actually seems to clash a bit with the good self-talk and the anti-worry treatment described in Doidge’s book.

Mindfulness is quite interesting in relation to the general kind of brain manipulation I’m discussing. If I adopt it along with my anti-worry strategy I’m at once attempting to take control (by introducing a new practice that will alter my mind for the better, and striving to stay in the moment) and let go (by not trying to control or judge feelings, behaviours, thoughts but simply observing them; by letting life be the way it is).

This is consistent with Doidge’s suggestion of not buying into the content of the thought. But it contradicts the idea that I should challenge my thoughts, either in relation to persistent obsessions and worries, or specific anxieties like social anxiety. According to mindfulness practice, I should simply note thoughts, not buy into them as fact, and let them go.

Perhaps this apparent contradiction doesn’t matter – perhaps the main thing is to have a grab bag of tools one can use? Oh dear, I can feel a worry coming on …

If anyone has any suggestions about reconciling mindfulness with CBT and the treatment of obsessive thoughts that I’ve briefly sketched, I’d be glad to hear them!

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