Speaker 1 · 0:04Welcome everyone. I'm really looking forward to today and today's guest. We have Willoughby Britton to talk about identifying and managing the adverse effects of mindfulness meditation. For those of you not familiar with her, she's a clinical psychologist, an associate professor of psychiatry and human behavior at Brown University Medical School, and the director of Brown's Clinical and Effective Neuroscience Laboratory. Her clinical neuroscience research investigates the effects of contemplative practices on the brain and the body in the treatment of mood disorders, trauma, and other emotional disturbances. She is especially interested in practice-specific effects, individual differences, and moderators of treatment outcome. Or in other words, which practices are best or worst suited for which types of people or conditions and why. Dr. Britton is the founder of Cheetah House, a nonprofit organization that provides support for meditators who are experiencing meditation-related difficulties and meditation safety trainings to providers and organizations. Willoughby, it's an honor to have you. Thank you so much for joining us.
Speaker 2 · 1:33I'm going to take you through some practice modifications, trauma informed practice modifications, and kind of give you an indicator of like what would be gas, like increasing intensity, and what would be break, meaning like slowing things down. And it's not that gas is bad and break is good. It's just like you want to go for the optimal level, which could be really different for different people at different times. And so you want to just be able to have gas and break. It's a good way to drive. I find that a lot of the sort of unhelpful messages come from a particular fallacy, which is called the no pain, no gain fallacy. This idea that worsening is to be expected and is a positive sign that the therapy is working. So this is a very popular idea, and there is very little empirical data to support it. Less than 10% of deteriorations result in positive treatment response. So people, very few people who get worse actually does it tend out to be a really good thing. And instead, people who have really positive experiences with treatment, that's what predicts treatment response, is actually having really positive experiences, not negative ones. And third, monitoring and addressing, i.e., intervening on when deteriorations will increase the efficacy and decrease treatment failure. So actually, I was also taught to, you know, just, you know, don't intervene, non-fixing, don't try to, don't try to make anything better, um, just accept it. And the data suggests that, you know, under certain circumstances, intervening is actually better than just letting it play out. And here are some quote, these are very common slogans, ones that I've used a million times that I'm now learning from meditators that they can be very unhelpful. Things like turning towards a difficult. It's sometimes good to turn towards the difficult, but it's like the U-shape curve. Like you can overdo that. If you're always turning towards a difficult, then you can actually develop a negative bias in your attention. Um, same thing with leaning into your sharp points. It's like, okay, that's sometimes a good thing, especially if you're kind of avoidant, but if you tend to sort of fixate on the negative, like learning how to do some positive things is also helpful. Um, the only way forward is through another, again, a sort of no pain, no gain fallacy. So more just notice it. Um, a lot of people describe this as feeling like just deal with it, kind of a dismissal or not feeling heard. Suffering is caused by resistance, or the other the idea that if you're having, if you're suffering, then it's your fault because you're resisting. And then if you feel it 100%, then it will release. And I was taught this way, I've said this a million times, but you know, we're seeing some new models now that actually like, you know, resistance can actually be seen as a form of inner wisdom. Um, and Willem Kaiken, from um, who's you know, one of the ambassadors of MBCT, um, now uses a term that he calls protective awareness. And Trish Migari uses the word behavioral compassion. So those are new ways of appraising or languaging the choice to opt out of something or not do something or say no, um, or you know, something to honor that feeling of like your own boundaries. Just in general, like these are the subtle messages that often limit choice. You know, the idea that like saying yes, confronting, facing, accepting, you know, turning towards, um, not judging, that's all like good. And everything else is bad. Like saying no is avoidance, resisting, turning away, and being reactive, you know, kind of like the gas turn, you know, going forward, turning on the gas is good and the break is bad. And I think that like it's much more nuanced than that. Um, and we can, we we often send these signals and we can, and we there's a lot of ways to talk differently that can give it a little bit more choice, like behavioral compassion and protective awareness. And so another metaphor that this actually comes from John Cabot Zinn is the metaphor of the chrysalis and the, you know, the caterpillar turning into the butterfly. Um, and he says that, like, you know, transformation and healing happen in their own time, and that any effort to force it or speed it up will cause damage and prevent transformation. And that our job as teachers and meditators is to support the transformation and to help the caterpillar or the meditator get in touch with the intrinsic needs of the organism. So that gets me into practice modifications. And to go back to this metaphor of gas or break, which was a metaphor that came up a lot in the varieties of contemplative experience study. Um, and this is a quote from uh a recent paper that we have on worldviews that's impressed right now. Um and the meditator says, if there was a question of gas or break, it was always almost always gas. If there was a problem, it would be like more gas, step on the gas, more. You'll burn through that. Um, so this was a very common kind of idea, this sort of striving idea. Um and we also interviewed 30 teachers along with the 60 meditators. And the teachers were like, Yeah, this idea right here is a big problem. Um, and so they said many teachers were in agreement, um, but there was a widespread idea that more is better and more is not better. Um, so if you think about you know the definition of the inverted U-shape curve, more is not better. So in the social domain, increasing the intensity would be to do things in isolation and not talk. If you want to decrease the intensity, add social interaction. Social interaction is very calming, very regulating to us, usually. Um, kinesthetic. So immobility, being very still increases the intensity. Adding movement, walking, or yoga decreases intensity. The visual system, closing the eyes or fixing the gaze, gas. Opening the eyes or moving your eyes around, um, that can be a way of regulating. The attention, having a very, very narrow, tight aperture that will increase your brain activation, dopamine, norepinephrine, arousal. Um, you want things to calm down, widen your aperture of your attention. Durations should be pretty obvious. The more longer duration is going to increase the intensity. Um, you want to take it down a notch, lower the dose, take shorter meditations and take breaks. Um, and then in terms of where your focus is, internal body focus will increase um your arousal through somatosensory amplification. Um, and if you want to downregulate that, just look to external objects outside of the body. And importantly, this is not a formula. So I hope none of you are writing any of that down. This is not a formula. This is just a basic starting place. And you always want to, you always want to check with the the client. So, like, try this, but what happened? You know, and for me, like this is what happens. And for other people, some people get really amped up on concentration practice, some people will fall asleep. So it's really, you really got to check with the client. The next sections on contraindications, these are the things you know that you really should watch out for somatic focus, immobility, and then some other things that I've noticed along the way. So somatic focus, this is something that David brings up a lot. If you focus to have too much body awareness, you can develop anxiety, panic, pain, headaches, and flashbacks. When I trained in MBCT, and this is still in some of the MBCT manuals, this was the instructions to work through the most difficult emotions, put your all of your attention in the most intense body sensations. So all of your attention in the most intense body sensations. So that's how I was taught from a trauma-informed uh perspective, this is not a good idea. And David calls this the somatic focus paradox. Um, that basically, you know, if trauma lives in the body, focusing on the body can basically just bring attention to the trauma. And if you think about it, whether it's trauma or just anxiety, like your body, you know, like parts of your body holds certain emotions, um, bringing attention there is probably not going to be calming. So this is an example of the somatic focus paradox from a monk that was in the Varieties Project. So he says, as I began to explore sensations as a direct experience, contraction or heat, whenever I would turn my attention towards them, an overwhelming sense of dread and panic would overwhelm me. And I found it very difficult to sustain my attention on them because I would be so flooded with fear, exhaustion, panic, and confusion. So somehow these strong emotional states and mental states were connected with my attempt to consciously connect to the sensation of this knot in the back of my leg. So that was very baffling because up to the point, meditation has been very validating. Okay, so what can we do about somatic focus? Like so many of our practices are, you know, focusing on the breath in the belly or the body scan. So, how how do we get around that? So, here are some ideas that come from somatic experiencing, titration and pendulation. So the idea is to basically imagine that that bullseye is like the knot. You know, there's like a there's a the centerpiece, the yellow is where it's the tightest and most intense, and then it kind of goes out from there and is a little bit less intense. So the idea here is to start with a resource. So start with something, you know, in your peripheral vision, it could be a flower, just something that that tends to, you know, be calming and start there. And you spend like, you know, 90% of your moments with the resource. And then when you feel like ready and resourced, then you can make a kind of a flyby, like an airplane, with one moment, you know, so a 90-10 ratio and just touching into the edge of that, of that area. So instead of putting 100% of your attention in the middle, you just dip into it. And then if that and then you then you spend nine more moments with the resource. And if that seems okay, then you can increase it, you know, to an 80-20 split. And if that seems okay, then you can maybe move the flyby a little closer to the center. So we're still we're still touching into the difficulty. We're still turning into, you know, leaning into our sharp points, but in a controlled way that's very systematic so that the person, you know, only goes when they're ready, when it's right, when they feel resourced, much safer. Another thing that I've learned is about the choice of anchor when it comes to, so this is back to the idea that breath awareness can be problematic. So in the study where there was a focused attention group, um, we had six anchors. So we had three breath anchors and three non-breath anchors. So we had breath in the nose, breath in the belly, and breath in the chest, and then hands, feed, and sound. And then we basically ran the program and got data from them afterwards. Um, and basically what we found was is that when we asked people to, we asked people to choose a favorite anchor. And when we got the data back, basically the majority of people chose non-breath anchors. And when we asked them why they didn't choose the breath, they said it because it made them anxious. Um, and specifically, it was the one in the midline of the body. And so a slight caveat to, you know, stay out of the body if you have trauma or, you know, body focus is bad, or, you know, it's certain parts of the body, especially the hands and feet, are often fine because that's not really an emotional, those areas don't tend to carry emotions. But the midline of the body where a lot of the emotions live, that tends to be a much more um anxiety-producing place. So be careful of those places. And if you if you offer them as uh objects of meditation, just give them other options. Um, and so I know in the mindfulness center, everybody uses our six anchors meditation instead of the usual sitting meditation, which was basically used to be just breath awareness. Now they use six anchors so that people can use the breath if it's good for them, but they also have non-breath anchors as an option if needed. Um, another friend of mine, Norman Farb, he did a similar study and he found that when given the choice, more than half of people chose an anchor other than the breath. And in this case, they were given images or phrases. And he found that interestingly, that the physiological response, so whether you uh were had a stress response or a stress reduction, it physiologically depended on the person anchor interaction. So if the person was given their preferred anchor, they their physiological uh activation got calmer. And if they were given an anchor that they did not prefer, then their physiology went up. So most important thing is let people choose their anchor. They know better than you do what's good for them. Okay, immobility. Immobility, if you think about meditation, most people think we're sitting extremely still, like basically immobile. And I know for a lot of people, like when you go into a meditation class and you don't know what to expect and everyone's meditating, you're like terrified to move. And some in some centers actually like there's all you know these strong determination sits where you're literally like told not to move. So not moving can be a thing in meditation. However, if you have a trauma history, not moving and being immobile can itself induce a freeze response. It is a freeze response. And so it can basically induce dissociation on its own, just being immobile. So if you're working with a group where you think that there might be some trauma, and that's pretty much everyone, I always give permission to move, give people like options to sit and just say, like, I didn't say not to move, it's okay to move. Um, and it doesn't have to be like moving huge like yoga moves. It could just be like permission to move your eyes. You know, that's enough to break up the freeze. And if you find that somebody looks paralyzed and frozen, you can actually just have them move their eyes. And that's actually a way to get out of the freeze. So introducing movement, allowing movement, giving people choice. So at Cheetah House, we've been seeing a lot of problems from apps or programs that teach no-self teachings, um, which are sort of metaphysical or ethical teachings that say that the self is an illusion or it's problematic. And that advocating for yourself in any way is ego. And the practices might look something like asking who is observing this or where is the observer or who am I, things like that. Um, we've seen a lot of mostly young guys, 18 to 25. I don't know why, but particular, there's one particular app that they like that does this, developing um dissociative sort of syndromes from this. So just be uh aware. And I know that when I did my MBSR training, um, we were told, you know, to avoid personal pronouns for this reason. It was like, you know, we didn't want to introduce a self. And we were told to use, you know, the foot and the body rather than my body. Um and that's how we taught the body scan. And then when I did my trauma training, it was the complete opposite. So we were taught to like touch ourselves and say, like, you know, my foot, Willow's foot, actually use the word my and the name. And so, because in trauma, often the self is very fragmented, and and being able to say my and and the name, like actually can help bring people back together. You know, some people might need a little, you know, less self. And some people might need a little more. And so you get to decide, or they get to decide even better, which one to listen to. So those are just some options that you have. Just a couple more thoughts about diversity and just the the issue of like sort of a person-centered approach. The basic idea is just, you know, promoting autonomy and empowerment. And that means giving people choices and options and control. It's not just trauma survivors that have problems advocating for themselves. It's well, probably all of us, but definitely people in any kind of, you know, disempowered position, which is really, if you're in a class and there's a teacher, you're already, you know, being a student is already a disempowered position. So I would say that everyone has a hard time advocating for their needs and just giving choice to everyone is just a basic trauma-informed modification. Here's another quote. This is actually from a mindfulness program participant at a school. So this is a mindfulness program that was taught during school hours by the teacher of like the actual school teacher. The teacher was giving instructions about how to pay attention to the breath. Start by counting the outbreath in sets of five. It was very specific and directive, like this is the correct way to do it. I have a history of sexual abuse, and all of that came flooding back. I was trapped with no exit, no options, and someone else in charge of me. I felt panic, then helpless, then just disdissociated, which is what I did then too. I did not tell the teacher. So I read this. This is actually a very recent scenario. This happened like in the last year. But just to say that, you know, the way that we teach meditation or that we have taught meditation isn't working. And we, and a lot of times we don't know that. Like this is pretty standard, basic, you know, this particular teacher has been teaching this exact same way for like 20 years, and he still doesn't know that there's a problem. So we really need that safe channel of feedback to understand that, like, just because things have been done a certain way for a long time doesn't mean that they're okay. Um, we can still do better. So here are some other ways to give some choices related to practice. Giving people the choice to engage with the practice or not. Even if you drove two hours to come to meditation class, like, do you want to meditate now? Is this what you really need? Um, or maybe you need to go for a walk or something else. Um, repeated permission to pause and opt out and modify and titrate. It's not enough to just say at the beginning of class, like, you know, repeatedly throughout the meditation. And giving, you know, maybe even defining mindfulness as self-awareness informed self-care. So using mindfulness as deciding what mindfulness practice to do. And then here's some other ideas in terms of what I what I do is using myself as an example. And so I might say, like, oh, I have a really bad headache today. I'm I'm not gonna do the concentration practice. I'm gonna, I'm gonna skip it. I'm gonna go out into the hall and do yoga because that's better when I have headaches. Um, so I get to be the one to be the mod to make the modifications and do something different than the rest and sort of embody that deviation. Um and then people have, oh, I'm allowed to do that. I can, I can, I can make decisions like that. The other thing that I do a lot is I I co-teach with people. One, it's easier just to have somebody cover you if you're sick, but two, like to have somebody who's really different than you and like just somebody I had I taught with this one guy who he was actually a monk, and he, you know, he loves certain practices that I didn't like and like I like certain other practices. And so we would kind of like share our disagreement, and then people are like, oh, we can choose. We get to have opinions about this, like people are different. So that can be a really fun way to just embody choice. Um, and then other ways to to think about, you know, diversity really is about power and authority and using a kind of interpersonal mindfulness to be aware of how that's playing out in certain spaces. You know, one way to think about like boundaries is like, you know, what are the spatial locations when people walk into a class? Like, are the cushions already arranged in a circle? Like it's already pre-decided for them that they're gonna sit, you know, shoulder to shoulder with somebody else. Like, do they have to make eye contact with people or do they have, you know, do they have a choice? Similarly on Zoom, um, there's lots of cool stuff you can do on Zoom. So you can you can turn your camera off. You can also like push your chair back. Some people will be like, wait, come back, you know, and other people are like, Oh, thank God she's farther away. And so no, you can just play with that, like a whole class you can spend just doing that, and you'll notice that people are really different, and that just playing with the distance um on your screen can make a huge difference. Um, you can also play with the volume, turning it up and turning it down. And so the amount of eye contact, you can play with that and just learning how people can titrate their own arousal in a group setting, because often it's a group setting and the implicit social pressure that gets us into trouble. We often sell ourselves out and we attend to the expectations of others rather than our own needs. So it's really important to practice that in a group setting where these social pressures are present. So teach breath awareness, teach lots of, you know, teach all the different things, but give them choices. Like, I mean, you if yoga's done a really good job in this. Like, I remember when I first started doing yoga, like this is how you do the practices. And then like I came back like, you know, 20 years later, and it was like there were like five variables, variations of each thing. You're like, if you well, if you can't, if your hips are tight, then you do it this way and put your foot here, and like, same idea. Like we're gonna do concentration practice, but you're gonna get six options for an anchor. And then once they have lots of different practices, then then you can say, like, okay, we're gonna do a practice now, you get to choose. Yeah, you know, and if you need to do a movement practice, like we're gonna go in the hall and do a movement practice. So I think just giving people options is, you know, because you really don't like everybody wants to know like what's the safe practice and what's the good one and what's the bad one. And like it just isn't doesn't work that way because it's like, you know, every time I give those modifications, everybody takes them too seriously. And I'm like, you know, it might be the complete opposite for someone else. Like, you know, every time I every time I say, like, you know, be careful of breath awareness. There are people like, well, I have a trauma history and I love breath awareness. It's my favorite. So, you know, you really just have to just just keep asking the person, like, how is that for you? And you're allowed to change. Additional resources. David Trilevin's trauma-sensitive mindfulness. He has an awesome website, all sorts of cool stuff, courses, webinars, all sorts of things. If you want the 20-hour version of this talk, it does exist. You can get it on the Cheetah House website. It's also accompanied by a meditation safety toolbox, which is all kinds of best practices from all different mindfulness groups all over the world. And it's actually even translated into a couple different languages. And then there's also Cheetah House. So if you ever have a meditation client that is developing problems and you're not sure what to do, you can always send them to Cheetah House. So we have research-based information, we have a bibliography of different research studies, we have educational videos, we do teacher trainings, we have on-demand trainings, we have live webinars, and then for any meditator in distress, we have one-on-one peer support, we have four different support groups, we service 98 countries. In 2020, we had 20,000 visitors. So, whatever it is, we can handle it. So if you didn't learn anything in the whole rest of this talk, here's a resource that you can send people if you feel like they're having meditation-related challenges that you're not sure how to handle.
Speaker 1 · 26:42Thank you so much. It's an honor to have you. I see being able to identify and manage the adverse effects of mindfulness as one of our top, say, pillars of our training. It's something that's very important for mindfulness teachers to be aware of. And this research and practice, I think, continually evolves, and you're at the forefront of it. And so I just want to thank you for being here and teaching us all so that we can better help the people who we want to help. And so, Willoughby, thank you so much for giving us more tools and understanding to help us to help those people in ways that are more and more compassionate and with more and more wisdom. So, thank you so much for everything, Willoughby.
