Reframing Distressing Thoughts, Self-Compassion and other Mind-Body Techniques

on the Cancer Journey

Dr. Rob Rutledge, OncologistAssociate Professor, Dalhousie University

HealingandCancer.org

Podcast Content

• Complete Cancer Care• Mind-Body and Body-Mind Connection• Stress and relaxation• Mindfulness and meditation• Reframing distressing thoughts• The power of self-compassion• Taking in the good

Benefits of Psychological Well-Being

• Being happy is valuable• Your family and friends will be happier• Get through treatment more easily

– Able to fight off infections more• Fewer complications and medical problems• You will function better, think more clearly• Improve survival? Cure?

Complete Cancer Care(Integrative medicine)

• Understanding what’s happening to you• Getting the best from the medical system• Empowering the body

– Exercise, diet, reasonable weight, sleep• Working with the mind

– Stress reduction– Relaxation / meditation– Reframing difficult thoughts– Working with emotions

• Nurturing a spiritual view

The Mind-Body and Body-Mind connection

• The nervous system includes the ‘body’– Enteric (gut) nervous system – The nerves around the heart

• Relaxing the body will settle the mind– Eg. for insomniacs

• Exercise! Exercise! Exercise

• The POWER POSE!!

Main points on Stress• Stress is associated with many ‘positives’

• Reframing stress as enhancing to our lives improves brain function

• Short mindset interventions can have long-lasting benefits

Stress is most likely to be harmful when 3 things are true:

1 – You feel inadequate to it

2– It isolates you from others, and

3 – It feels utterly meaningless and against your will

• Creates ‘Threat’ physiology

The Stress Response Curve

Thanks to Dr. Rick Hanson

Buddha’s Brain and Hardwiring Happiness

Your Brain: A Product of Evolution• ~ 4+ billion years of earth• 3.5 billion years of life• 650 million years of multi-celled organisms• 600 million years of nervous system• ~ 200 million years of mammals• ~ 60 million years of primates• ~ 6 million years ago: last common ancestor with chimpanzees, our closest

relative among the “great apes”• 2.5 million years of tool-making (starting with brains 1/3 our size)

– ~ 150,000 years of homo sapiens– ~ 50,000 years of modern humans– ~ 6000 years of blue, green, hazel eyes• Living in tribes of 100-150, competing for food, tribal warfare

Evolutionary History

The Triune Brain

Three Motivational and Self-Regulatory Systems

• Avoid Harms:– Predators, natural hazards, aggression, pain– Primary need, tends to trump all others

• Approach Rewards:– Food, shelter, mating, pleasure– Mammals: rich emotions and sustained pursuit

• Attach to Others:– Bonding, language, empathy, cooperation, love– Taps older Avoiding and Approaching networks

Each system can draw on the other two for its ends.

Pain network: Dorsal anterior cingulate cortex (dACC), insula (Ins), somatosensory cortex (SSC), thalamus (Thal), and periaqueductal gray (PAG). Reward network: Ventral tegmental area (VTA), ventral striatum (VS), ventromedial prefrontal cortex (VMPFC), and amygdala (Amyg). K. Sutliff, in Lieberman & Eisenberger, 2009, Science, 323:890-891

Stressor Perception Stress

Many pathways to STRESS!!!• Real threat to your life

– Jumping out of way of a runaway car

• Perceived threat to your life– Worrying about the test results

• Ego/Social threats– Argument over who does more housework– Public speaking (threat of being ostracized)

• Fear of the unknown– Financial– Relationships

Neurophysiology of long-term stress

• A traumatic event triggers a profound stress reaction

• Body /mind compensate to survive the event

• Core belief maintains a perception of danger

• Non-threatening triggers prime the stress reaction on an ongoing basis

• The body ‘stores’ the stress reaction

PHYSICAL EFFECTS OF LONG-TERM STRESS

• ALL SYSTEMS

• Diabetes, hypertension, heart disease

• Mutes the normal stress reaction

• Susceptible to infection

• Chronic fatigue syndrome

• Inflammatory disease

• Damage our brain

HOW DO YOU EXPERIENCE STRESS?

• What are your triggers ?

• What happens in your body?

• What emotions do you feel?

• What happens to your thinking?

• What thoughts do you have?– What do you say about yourself?– How do you label other people/situations?

TIME TO DE-STRESS• Press the ‘pause’ button

• Be very curious about the physical sensations

• Four slow breaths into the abdomen

• Reassure yourself with wisdom and kindness

Pause and Plan response• Monitoring for body sensations, thoughts and emotions – that you’re

about to do something you will regret later

• Starts with a perception of internal conflict

• This physiology will slow you down– Decrease heart rate, BP, breathing, other systems– Calmer but not too sedate

• Time to reflect and make a good decision

Resetting the stress-o-meter• The Stress-o-meter is your baseline state of relaxation / stress

• You can lower your baseline through meditation / relaxation practice

Stress levels over time

Thanks again to Kelly McGonigal, PhD, Stanford Professor

Reframing stress as enhancing

• Social Stress Test– Eg. Columbia business students giving persuasive speech

• Reframed ‘stress reaction’ as helpful

• DHEA promotes learning during stressful situations

Oxytocin• Cuddle hormone

• Released during stress reaction

• Drives pro-social behaviour– Tend and befriend

• Decreases inflammation, opens up heart blood vessels, promotes regeneration of heart cells

Neurotransmitters released in stress

• Oxytocin – Social caregiving system

• Dopamine – reward system– Increases optimism, dampens fears– Primes the brain for physical action -won’t freeze

• Seritonin – attunement system– Enhances perception, intuition, self-control– Understanding what’s needed, biggest impact

“Challenge” physiology and peak performance

• Still feel stress - AND

• Feel anxious, excited, energized, enthusiastic, confident, …

Other Interventions to reframe stress

• “I am calm” vs “I am excited”

• Fixed mindset vs Growth mindset– Opportunity to grow, learn, become stronger

Corporate World InterventionCrum et al, Stanford

1 – Acknowledge the stress– Notice the sensations / thoughts

2 – Welcome the stress– Something that you care about is at stake– Why does it matter? What is the priority

3 – Make use of the energy of stress

Feeling Better by Examining and Changing

Your Thoughts

With Mindfulness Awareness & Kindness(based on David Byrne’s Feeling Good)

You can change your mind• You can change the way you think and look at things

• You can change your underlying beliefs and thought patterns

• These will change how you see your self, your life, others, the world

• This will change how you feel, emotions, moods, outlook, attitude and productivity

Situation: Step 1 Step 2 Step 3

Mindful of Distressing Thoughts

Awareness and Inquiry Kind & Rational Response• Acknowledge the

difficulty with kindness• Look at the situation

from another perspective

• Encourage yourself: I can…

Situation: Eat 3 pieces of cheesecake for dessert

Mindful of Distressing Thoughts

Awareness and Inquiry Kind & Rational Response

Situation: Eat 3 pieces of cheesecake for dessert

Mindful of Distressing Thoughts

I can’t believe I did that. I’m such a loser. I’ll never follow a healthy diet. It’s no use. I should just give up now!

Awareness and Inquiry Kind & Rational Response

Situation: Eat 3 pieces of cheesecake for dessert

Mindful of Distressing Thoughts

I can’t believe I did that. I’m such a loser. I’ll never follow a healthy diet. It’s no use. I should just give up now!

Awareness and Inquiry

1. What emotions follow from this way of thinking?

2. How does my body feel?

3. Is this a helpful or harmful thought?

4. Exaggerated, irrational?

Kind & Rational Response

Situation: Eat 3 pieces of cheesecake for dessert

Mindful of Distressing Thoughts

I can’t believe I did that. I’m such a loser. I’ll never follow a healthy diet. It’s no use. I should just give up now!

Awareness and Inquiry

1. What emotions follow from this way of thinking?

2. How does my body feel?

3. Is this a helpful or harmful thought?

4. Exaggerated, irrational?

Kind & Rational Response

Ahh. This is frustrating and disappointing. Relapses are to be expected. No one is perfect. I can learn from this and do better next time.

Situation: Tired and needs ride…Mindful of Distressing Thoughts

Awareness and Inquiry Kind & Rational Response

Situation: Tired and needs ride…Mindful of Distressing Thoughts

I hate asking for help. I’m the friggin one that takes care of everyone else. I can’t bear needing their help. I’ll handle this myself.

Awareness and Inquiry

1. What emotions follow from this way of thinking?

2. How does my body feel?

3. Is this a helpful or harmful thought?

4. Exaggerated, irrational?

Kind & Rational Response

Situation: Tired and needs ride…Mindful of Distressing Thoughts

I hate asking for help. I’m the friggin one that takes care of everyone else. I can’t bear needing their help. I’ll handle this myself.

Awareness and Inquiry

1. What emotions follow from this way of thinking?

2. How does my body feel?

3. Is this a helpful or harmful thought?

4. Exaggerated, irrational?

Kind & Rational Response

It is scary but maybe now it is my time to receive and be open to the love compassion of friends and family. (Spiritual lesson, a circle of giving and receiving).

Mindful of Distressing Thoughts

They say you are supposed to stay positive but I feel awful, angry, helpless, filled with despair, I’m afraid I am making it worse.

Awareness and Inquiry Kind & Rational Response

Mindful of Distressing Thoughts

They say you are supposed to stay positive but I feel awful, angry, helpless, filled with despair, I’m afraid I am making it worse.

Awareness and Inquiry

1. What emotions follow from this way of thinking?

2. How does my body feel?

3. Is this a helpful or harmful thought?

4. Exaggerated, irrational?

Kind & Rational Response

Mindful of Distressing Thoughts

They say you are supposed to stay positive but I feel awful, angry, helpless, filled with despair, I’m afraid I am making it worse.

Awareness and Inquiry

1. What emotions follow from this way of thinking?

2. How does my body feel?

3. Is this a helpful or harmful thought?

4. Exaggerated, irrational?

Kind & Rational Response

It’s natural to have strong and negative feelings. I am learning to comfort myself and ask for reassurance from others. I can work with my state of mind and that helps.

Self-Compassion Kristen Neff, PhD

Self-compassion linked to multi-levels of well-being

• Decreased anxiety, depression, stress, mal-adaptive behavior, shame, poor body image

• Increased happiness, satisfaction, gratitude, optimism, appreciate body

• Healthier habits – exercising, eating well, getting better medical care

• Greater coping, resilience, adaption

• Partners rate them as more giving, understanding, better communication

• Self-compassion training can decrease depression, anxiety, stress, and emotional avoidance

Self-Compassion.org• With self-compassion, we give ourselves the same kindness and care we'd

give to a good friend. Three elements:

1- Noticing the person suffering

2 - Feeling moved by others’ suffering so that your heart responds to their pain

3 - Realizing that suffering, failure, and imperfection is part of the shared human experience.

What Self-compassion is not• Self-pity

• Self-indulgence

• Self-esteem

Self-Kindness vs Self-Judgment• Treating self with care and understanding rather than harsh judgment

• Actively soothing and comforting oneself

• Desire to alleviate suffering (any pain or emotional discomfort – large or small)

Common Humanity vs Isolation• Seeing own experience as part of larger human experience ie not isolating

• Recognizing that life is imperfect (us too!)

Mindfulness vs Over-Identification• Allows us to ‘be’ with painful feelings as they are

• Versus getting caught up in our thoughts and beliefs about ourselves

Self-compassion linked to motivation

• Less fear of failure, more likely to try again and persist in efforts after failure

• More personal responsibility and motivation to repair past mistakes

Taking in the Good

Self-directed neuroplasticity

You can use your mind to change your brain to change your mind for the better

Growing Inner Strengths

Inner strengths are grown mainly from positive mental states that are turned into positive neural traits.

Change in neural structure and function (learning, memory) involves activation and installation.

We grow inner strengths by internalizing positive experiences of them and their related factors.

Inner Strengths Include• Capabilities (e.g., mindfulness, insight, emotional intelligence, resilience,

executive functions, impulse control)

• Positive emotions (e.g., gratitude, self-worth, love, self-compassion, secure attachment, gladness, awe, serenity)

• Attitudes (e.g., openness, determination, optimism, confidence, approach orientation, tolerance, self-respect)

• Somatic inclinations (e.g., vitality, relaxation, grit, helpfulness)

• Virtues (e.g., wisdom, patience, energy, generosity, restraint)

What inner strength would you like to build?

• Or what are you struggling with – and think of the antidote state?

Inner Strengths Are Built From Brain Structure

The Brain’s Negativity Bias• As our ancestors evolved, avoiding “sticks” was more important for

survival than getting “carrots.”

• Negative stimuli:– More attention and processing– Greater motivational focus: loss aversion

• Preferential encoding in implicit memory: – We learn faster from pain than pleasure.– Negative interactions: more impactful than positive– Easy to create learned helplessness, hard to undo– Rapid sensitization to negative through cortisol

Velcro for Bad, Teflon for Good

A Major Result of the Negativity Bias:Threat Reactivity

• Two mistakes:– Thinking there is a tiger in the bushes when there isn’t one.– Thinking there is no tiger in the bushes when there is one.

• We evolved to make the first mistake a hundred times to avoid making the second mistake even once.

• This evolutionary tendency is intensified by temperament, personal history, culture, and politics.

• Threat reactivity affects individuals, couples, families, organizations, nations, and the world as a whole.

Need activation and instillation of the positive!

Without this installation, there is no change in the brain - no useful learning, no healing, no growth.

Positive activation without installation is pleasant, but has no lasting value.

Meanwhile, negative mental states are being preferentially installed into neural structure.

The Negativity Bias

Learning to Take in the Good

Inner Strengths Include• Capabilities (e.g., mindfulness, insight, emotional intelligence,

resilience, executive functions, impulse control)

• Positive emotions (e.g., gratitude, self-worth, love, self-compassion, secure attachment, gladness, awe, serenity)

• Attitudes (e.g., openness, determination, optimism, confidence, approach orientation, tolerance, self-respect)

• Somatic inclinations (e.g., vitality, relaxation, grit, helpfulness)

• Virtues (e.g., wisdom, patience, energy, generosity, restraint)

Have a Good Experience

Enrich It

Absorb It

TheWellnessChallenge.org

Includes 9 weekly ‘Skills for Wellness’ Podcasts to help you become

healthier and happier

Dr. Rob Rutledge, OncologistAssociate Professor of Medicine

HealingandCancer.org

Canadian Cancer Survivor Network Contact Info

Canadian Cancer Survivor Network1750 Courtwood Crescent, Suite 210Ottawa, ON K2C 2B5Telephone / Téléphone : 613-898-1871E-mail jmanthorne@survivornet.ca or mforrest@survivornet.ca Web site www.survivornet.caBlog: http://jackiemanthornescancerblog.blogspot.com/Twitter: @survivornetcaFacebook: www.facebook.com/CanadianSurvivorNet Pinterest: http://pinterest.com/survivornetwork/** www.TheWellnessChallenge.org **