therapy

Mindful of mindfulness

pnrj cognitive science, personal , , , , , , , , , , , , , , , ,

Sep 25 JDN 2459848

I have always had trouble with mindfulness meditation.

On the one hand, I find it extremely difficult to do: if there is one thing my mind is good at, it’s wandering. (I think in addition to my autism spectrum disorder, I may also have a smidgen of ADHD. I meet some of the criteria at least.) And it feels a little too close to a lot of practices that are obviously mumbo-jumbo nonsense, like reiki, qigong, and reflexology.

On the other hand, mindfulness meditation has been empirically shown to have large beneficial effects in study after study after study. It helps with not only depression, but also chronic pain. It even seems to improve immune function. The empirical data is really quite clear at this point. The real question is how it does all this.

And I am, above all, an empiricist. I bow before the data. So, when my new therapist directed me to an app that’s supposed to train me to do mindfulness meditation, I resolved that I would in fact give it a try.

Honestly, as of writing this, I’ve been using it less than a week; it’s probably too soon to make a good evaluation. But I did have some prior experience with mindfulness, so this was more like getting back into it rather than starting from scratch. And, well, I think it might actually be working. I feel a bit better than I did when I started.

If it is working, it doesn’t seem to me that the mechanism is greater focus or mental control. I don’t think I’ve really had time to meaningfully improve those skills, and to be honest, I have a long way to go there. The pre-recorded voice samples keep telling me it’s okay if my mind wanders, but I doubt the app developers planned for how much my mind can wander. When they suggest I try to notice each wandering thought, I feel like saying, “Do you want the complete stack trace, or just the final output? Because if I wrote down each terminal branch alone, my list would say something like ‘fusion reactors, ice skating, Napoleon’.”

I think some of the benefit is simply parasympathetic activation, that is, being more relaxed. I am, and have always been, astonishingly bad at relaxing. It’s not that I lack positive emotions: I can enjoy, I can be excited. Nor am I incapable of low-arousal emotions: I can get bored, I can be lethargic. I can also experience emotions that are negative and high-arousal: I can be despondent or outraged. But I have great difficulty reaching emotional states which are simultaneously positive and low-arousal, i.e. states of calm and relaxation. (See here for more on the valence/arousal model of emotional states.) To some extent I think this is due to innate personality: I am high in both Conscientiousness and Neuroticism, which basically amounts to being “high-strung“. But mindfulness has taught me that it’s also trainable, to some extent; I can get better at relaxing, and I already have.

And even more than that, I think the most important effect has been reminding and encouraging me to practice self-compassion. I am an intensely compassionate person, toward other people; but toward myself, I am brutal, demanding, unforgiving, even cruel. My internal monologue says terrible things to me that I wouldnever say to anyone else. (Or at least, not to anyone else who wasn’t a mass murderer or something. I wouldn’t feel particularly bad about saying “You are a failure, you are broken, you are worthless, you are unworthy of love” to, say, Josef Stalin. And yes, these are in fact things my internal monologue has said to me.) Whenever I am unable to master a task I consider important, my automatic reaction is to denigrate myself for failing; I think the greatest benefit I am getting from practicing meditation is being encouraged to fight that impulse. That is, the most important value added by the meditation app has not been in telling me how to focus on my own breathing, but in reminding me to forgive myself when I do it poorly.

If this is right (as I said, it’s probably too soon to say), then we may at last be able to explain why meditation is simultaneously so weird and tied to obvious mumbo-jumbo on the one hand, and also so effective on the other. The actual function of meditation is to be a difficult cognitive task which doesn’t require outside support.

And then the benefit actually comes from doing this task, getting slowly better at it—feeling that sense of progress—and also from learning to forgive yourself when you do it badly. The task probably could have been anything: Find paths through mazes. Fill out Sudoku grids. Solve integrals. But these things are hard to do without outside resources: It’s basically impossible to draw a maze without solving it in the process. Generating a Sudoku grid with a unique solution is at least as hard as solving one (which is NP-complete). By the time you know a given function is even integrable over elementary functions, you’ve basically integrated it. But focusing on your breath? That you can do anywhere, anytime. And the difficulty of controlling all your wandering thoughts may be less a bug than a feature: It’s precisely because the task is so difficult that you will have reason to practice forgiving yourself for failure.

The arbitrariness of the task itself is how you can get a proliferation of different meditation techniques, and a wide variety of mythologies and superstitions surrounding them all, but still have them all be about equally effective in the end. Because it was never really about the task at all. It’s about getting better and failing gracefully.

It probably also helps that meditation is relaxing. Solving integrals might not actually work as well as focusing on your breath, even if you had a textbook handy full of integrals to solve. Breathing deeply is calming; integration by parts isn’t. But lots of things are calming, and some things may be calming to one person but not to another.

It is possible that there is yet some other benefit to be had directly via mindfulness itself. If there is, it will surely have more to do with anterior cingulate activation than realignment of qi. But such a particular benefit isn’t necessary to explain the effectiveness of meditation, and indeed would be hard-pressed to explain why so many different kinds of meditation all seem to work about as well.

Because it was never about what you’re doing—it was always about how.

What’s wrong with “should”?

pnrj cognitive science, ethics, personal , , , , , , , , , ,

Nov 8 JDN 2459162

I have been a patient in cognitive behavioral therapy (CBT) for many years now. The central premise that thoughts can influence emotions is well-founded, and the results of CBT are empirically well supported.

One of the central concepts in CBT is cognitive distortions: There are certain systematic patterns in how we tend to think, which often results in beliefs and emotions that are disproportionate with reality.

Most of the cognitive distortions CBT deals with make sense to me—and I am well aware that my mind applies them frequently: All-or-nothing, jumping to conclusions, overgeneralization, magnification and minimization, mental filtering, discounting the positive, personalization, emotional reasoning, and labeling are all clearly distorted modes of thinking that nevertheless are extremely common.

But there’s one “distortion” on CBT lists that always bothers me: “should statements”.

Listen to this definition of what is allegedly a cognitive distortion:

Another particularly damaging distortion is the tendency to make “should” statements. Should statements are statements that you make to yourself about what you “should” do, what you “ought” to do, or what you “must” do. They can also be applied to others, imposing a set of expectations that will likely not be met.

When we hang on too tightly to our “should” statements about ourselves, the result is often guilt that we cannot live up to them. When we cling to our “should” statements about others, we are generally disappointed by their failure to meet our expectations, leading to anger and resentment.

So any time we use “should”, “ought”, or “must”, we are guilty of distorted thinking? In other words, all of ethics is a cognitive distortion? The entire concept of obligation is a symptom of a mental disorder?

Different sources on CBT will define “should statements” differently, and sometimes they offer a more nuanced definition that doesn’t have such extreme implications:

Individuals thinking in ‘shoulds’, ‘oughts; or ‘musts’ have an ironclad view of how they and others ‘should’ and ‘ought’ to be. These rigid views or rules can generate feels of anger, frustration, resentment, disappointment and guilt if not followed.

Example: You don’t like playing tennis but take lessons as you feel you ‘should’, and that you ‘shouldn’t’ make so many mistakes on the court, and that your coach ‘ought to’ be stricter on you. You also feel that you ‘must’ please him by trying harder.

This is particularly problematic, I think, because of the All-or-Nothing distortion which does genuinely seem to be common among people with depression: Unless you are very clear from the start about where to draw the line, our minds will leap to saying that all statements involving the word “should” are wrong.

I think what therapists are trying to capture with this concept is something like having unrealistic expectations, or focusing too much on what could or should have happened instead of dealing with the actual situation you are in. But many seem to be unable to articulate that clearly, and instead end up asserting that entire concept of moral obligation is a cognitive distortion.

There may be a deeper error here as well: The way we study mental illness doesn’t involve enough comparison with the control group. Psychologists are accustomed to asking the question, “How do people with depression think?”; but they are not accustomed to asking the question, “How do people with depression think compared to people who don’t?” If you want to establish that A causes B, it’s not enough to show that those with B have A; you must also show that those who don’t have B also don’t have A.

This is an extreme example for illustration, but suppose someone became convinced that depression is caused by having a liver. They studied a bunch of people with depression, and found that they all had livers; hypothesis confirmed! Clearly, we need to remove the livers, and that will cure the depression.

The best example I can find of a study that actually asked that question compared nursing students and found that cognitive distortions explain about 20% of the variance in depression. This is a significant amount—but still leaves a lot unexplained. And most of the research on depression doesn’t even seem to think to compare against people without depression.

My impression is that some cognitive distortions are genuinely more common among people with depression—but not all of them. There is an ongoing controversy over what’s called the depressive realism effect, which is the finding that in at least some circumstances the beliefs of people with mild depression seem to be more accurate than the beliefs of people with no depression at all. The result is controversial both because it seems to threaten the paradigm that depression is caused by distortions, and because it seems to be very dependent on context; sometimes depression makes people more accurate in their beliefs, other times it makes them less accurate.

Overall, I am inclined to think that most people have a variety of cognitive distortions, but we only tend to notice when those distortions begin causing distress—such when are they involved in depression. Human thinking in general seems to be a muddled mess of heuristics, and the wonder is that we function as well as we do.

Does this mean that we should stop trying to remove cognitive distortions? Not at all. Distorted thinking can be harmful even if it doesn’t cause you distress: The obvious example is a fanatical religious or political belief that leads you to harm others. And indeed, recognizing and challenging cognitive distortions is a highly effective treatment for depression.

Actually I created a simple cognitive distortion worksheet based on the TEAM-CBT approach developed by David Burns that has helped me a great deal in a remarkably short time. You can download the worksheet yourself and try it out. Start with a blank page and write down as many negative thoughts as you can, and then pick 3-5 that seem particularly extreme or unlikely. Then make a copy of the cognitive distortion worksheet for each of those thoughts and follow through it step by step. Particularly do not ignore the step “This thought shows the following good things about me and my core values:”; that often feels the strangest, but it’s a critical part of what makes the TEAM-CBT approach better than conventional CBT.

So yes, we should try to challenge our cognitive distortions. But the mere fact that a thought is distressing doesn’t imply that it is wrong, and giving up on the entire concept of “should” and “ought” is throwing out a lot of babies with that bathwater.

We should be careful about labeling any thoughts that depressed people have as cognitive distortions—and “should statements” is a clear example where many psychologists have overreached in what they characterize as a distortion.

Creativity and mental illness

pnrj cognitive science , , , , , , , , , , , , ,

Dec 1 JDN 2458819

There is some truth to the stereotype that artistic people are crazy. Mental illnesses, particularly bipolar disorder, are overrepresented among artists, writers, and musicians. Creative people score highly on literally all five of the Big Five personality traits: They are higher in Openness, higher in Conscientiousness, higher in Extraversion (that one actually surprised me), higher in Agreeableness, and higher in Neuroticism. Creative people just have more personality, it seems.

But in fact mental illness is not as overrepresented among creative people as most people think, and the highest probability of being a successful artist occurs when you have close relatives with mental illness, but are not yourself mentally ill. Those with mental illness actually tend to be most creative when their symptoms are in remission. This suggests that the apparent link between creativity and mental illness may actually increase over time, as treatments improve and remission becomes easier.

One possible source of the link is that artistic expression may be a form of self-medication: Art therapy does seem to have some promise in treating a variety of mental disorders (though it is not nearly as effective as therapy and medication). And that wouldn’t explain why family history of mental illness is actually a better predictor of creativity than mental illness itself.

My guess is that in order to be creative, you need to think differently than other people. You need to see the world in a way that others do not see it. Mental illness is surely not the only way to do that, but it’s definitely one way.

But creativity also requires basic functioning: If you are totally crippled by a mental illness, you’re not going to be very creative. So the people who are most creative have just enough craziness to think differently, but not so much that it takes over their lives.

This might even help explain how mental illness persisted in our population, despite its obvious survival disadvantages. It could be some form of heterozygote advantage.

The classic example of heterozygote advantage is sickle-cell anemia: If you have no copies of the sickle-cell gene, you’re normal. If you have two copies, you have sickle-cell anemia, which is very bad. But if you have only one copy, you’re healthy—and you’re resistant to malaria. Thus, high risk of malaria—as we certainly had, living in central Africa—creates a selection pressure that keeps sickle-cell genes in the population, even though having two copies is much worse than having none at all.

Mental illness might function something like this. I suspect it’s far more complicated than sickle-cell anemia, which is literally just two alleles of a single gene; but the overall process may be similar. If having just a little bit of bipolar disorder or schizophrenia makes you see the world differently than other people and makes you more creative, there are lots of reasons why that might improve the survival of your genes: There are the obvious problem-solving benefits, but also the simple fact that artists are sexy.

The downside of such “weird-thinking” genes is that they can go too far and make you mentally ill, perhaps if you have too many copies of them, or if you face an environmental trigger that sets them off. Sometimes the reason you see the world differently than everyone else is that you’re just seeing it wrong. But if the benefits of creativity are high enough—and they surely are—this could offset the risks, in an evolutionary sense.

But one thing is quite clear: If you are mentally ill, don’t avoid treatment for fear it will damage your creativity. Quite the opposite: A mental illness that is well treated and in remission is the optimal state for creativity. Go seek treatment, so that your creativity may blossom.