Tag Archives: Mindfulness

Ruminating: The Mental Health Killer


I teach a course on psychopathology. Each week we consider a different family of problems. We explore anxiety disorders, mood disorders (depression, mania), and anger/explosive disorders in the first few weeks in the class. Later on, we look at eating disorders, addictions, trauma, and psychosis.

While each of the presentations of problems vary widely from each other, there is ONE symptom that almost every person with a mental health problem experiences–repetitive, negative thought patterns. Rumination.

The content of the repetitive thoughts may change depending on the type of problem (i.e., anxious fears, depressive negative thoughts, illicit urges, fears of weight gain, hypervigilance, irritability, etc.) but the heart of the problem in most mental health challenges are negative thought patterns leading to an experience of either impulsivity or paralysis. These patterns can look like obsessional worries about germs (triggering ruminative “why” questions as to the root causes of the obsessions). The pattern can look like repeated negative self-attributions for perceived mistakes. Whatever the pattern, the person finds it difficult to break out of the negative thoughts and attempts at distractions seem futile since the thought or feeling returns in seconds to minutes.

Is there anything that helps?

Yes, there are things that you can do to reduce the “noise” level of these repetitive thoughts. It is important, however, to remember two important factors

  • patterns in place for years or decades are harder to change. Give yourself the grace to fail as you work to change them.
  • As with pain management, the goal should not be the complete elimination of negative thoughts and feelings. Realistically, anxious people will have some anxiety. Depressed people will feel darker thoughts. Addicts will have greater temptations. But lest you give up before you start, this does not mean that you must always suffer as you do now.

Consider the following three steps as a plan of action to address the problem of rumination.

  1. Build a solid foundation of health. Every house needs a foundation if it is going to  last. Your mental health foundation starts with your physical body: Exercise, diet, and sleep. Did you know that daily exercise, getting a good 8 hours of sleep each night, and eating a diet rich in protein supports good mental health and may even prevent re-occurrence of prior problems? Will this solve all your problems. No! But failing to get good sleep and eat a balanced diet of proteins will exacerbate your problems. Sleep is especially needed. The lack of it will multiply your problem. Of course, getting sleep is difficult when you are worrying or depressed. Thus, work to develop a different bed-time routine. Shut off your electronics, do mindless activities like Sudoku, develop rituals that help promote sleep. If you are having trouble with this or your diet or exercise, find a trusted person to review your situation. And avoid all/nothing thinking that often leaves us paralyzed when we can’t reach our goals. On this point, read the next step.
  2. Prepare for change by accepting your struggle. What, I thought this was helping me out of my struggle? Acceptance is the beginning of change. Consider this examples. You struggle with intrusive negative thoughts about your belly. You don’t like how it looks. You’ve tried dieting and exercise, but still it is flabby. Every time you look at yourself, every time your hand rests on your belly, you hear (and feel) that negative narrative. The first step in change is to accept the body you have and to find ways to like it, even love it. Sounds impossible but it is necessary to accept all your parts. This does not mean that you won’t continue to exercise and eat well. Marsha Linehan suggests that one part of change is to accept the problem as it is. In her Dialectical Behavior Therapy model she speaks of choosing willingness over willfulness. Willingness opposes the response “I can’t stand this belly” by saying, “my belly is not as I would like but it is not all of who I am.” “I can’t stand it…” becomes a willful and yet paralyzing response. Whereas acceptance acknowledges the reality and chooses goals that are within one’s power to achieve (e.g., healthy eating choices). Acceptance is not giving up but preparing for realistic change.
  3.  Start to move. Consider these action steps as the beginning movements you undertake in a long process towards the goal:
    1. “So what?” Our ruminations are often filled with interpretations and assumptions. There are times we can challenge them by attacking the veracity of the assumptions. But we can also ask, “so what?” So what if I have OCD? So what if have to fight every day to stay sober? So what if I have to manage my schedule so as to not trigger a bipolar episode? Challenge the worst thing that you are afraid of.
    2. Develop a counter narrative. Rumination is a narrative. Begin by writing and rehearsing a counter narrative. It won’t have much power at first compared to your internalized rumination but it will gain power over time. Work to refine it. Choose to repeat it as often as you see the trigger for the rumination. Make sure your counter narrative doesn’t include self-debasing or invalidating comments. If you have trouble writing one, use Scripture passages that speak of God’s narrative, through Christ, for you. Be encouraged that developing alternative storylines has shown capacity to alter chronic nightmares. If nightmares can be changed, then even more thoughts and feelings during the day.
    3. Practice being present. Much of our lives are run on auto-pilot. When we are in that mode, it is easy to fall into rumination. Work to stay present, to be mindful and attuned to your surroundings. Notice ruminations but let them slide on out of view and bring yourself back to the present. Use your senses that God gave you to enjoy the world he made. Smells, sounds, sights, taste, and touch all give you means to enjoy that world. Start practicing staying in tune with it, a few minutes at a time and build your capacity as you go.

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Mindfulness post over at www.biblical.edu


The faculty blog at Biblical Seminary has posted one of mine about mindfulness from a Christian perspective. Actually, it is a call to develop a theology of mindfulness–or what I prefer to call watchfulness. While you are there, check out some of the other postings by my colleagues.

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Guest post on mindfulness


I have a post this am on the Society of Christian Psychology’s blog regarding the topic of mindfulness. I’ve written more here on the topic but you can go here to see my comments on the makings of a Christian Psychology version of mindfulness.

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End of semester thoughts


Looking at a stack of papers I need to grade and yet not feeling the energy to do so. Late night classes take more out of me than I care to admit. My physiology class ended with student presentations and a look at bipolar disorder. As we concluded the class, I asked them to remember that,

  1. Even with all the advances in neuroscience, we must humbly admit we still know little how we are fearfully and wonderfully made.
  2. It is good for counselors to keep learning about the body and at the same time hold what they know lightly. Tomorrow may bring evidence to the contrary
  3. Yet, what we know about the body can be helpful. We ought not to look down upon our ignorance but remember that doctors do not always explain or walk with patients
  4. There are great medical interventions available, but (and that but shouldn’t diminish what I said before it),
  5. Over and over we saw that the basics (maintaining balance in life, self-care, mindfulness) are so important to health, perspective, etc. No, they aren’t magic interventions. Yes, they pay-off over time rather than immediately.

On this last point I am pondering a bit and so let me be hyperbolic. Most people who come to see me for paid counseling come because they think (naively) I have some expertise that will shed light on their situation and a solution to their problems. They want me to do something. Why else pay that kind of money? And yet much of what I have to offer isn’t rocket science. Beyond a few fun techniques, what I have to offer is a listening ear, a willingness to walk with the other person in their travail, and encouragement to keep going back to the basics. Most people like the first two but balk at the last one. Why do we balk at going back to the basics? Two reasons: (1) we want something that will fix the problem NOW, and (2) we’ve tried the basics and they didn’t seem to work (see reason 1).

Examples of what I mean.

  • If you are a parent and you go to a counselor to deal with your young child’s behavior problem. More than likely, you will get some counselor telling you to use some reinforcement strategies. And what do many parents say? “I tried that and it didn’t work.” Chances are they did try it and either they didn’t keep at it or they didn’t realize they were doing something that reinforced the wrong thing, or they had a misguided view of what success should look like
  • A couple is struggling with fighting. They go to the counselor who encourages them to return to the basics of respectful talk. Usually, they will feel like they have already tried it–and it didn’t work. Chances are… You get the picture.

In physiology, we see that care for the body includes mindful meditation (My friend and former professor says a substitute word would be “watchfulness”) on the world as God sees it, developing and maintaining good circadian rhythms, watching food intake, exercise, maintaining healthy relationships and social supports. In every mental illness, these things are shown to decrease the severity of symptoms and delay relapse.

Here’s the problem: we forget the basics and because they don’t give immediate results, we go searching for other fast-acting mechanisms. For example, I want to feel safe. Instead of engaging in centering prayer over the long haul, I fall prey to the temptation to act in such a way to avoid all possible danger–thereby increasing my fears of danger.

If I don’t exercise (and I don’t much) I rarely get immediate feedback that my body is falling apart. If I don’t eat right, I don’t immediately gain 10 pounds. If I don’t pray, I don’t immediately get embittered. So, I assume that these basics aren’t all that important. Or, I know they are important but since they don’t pay off now, I don’t do them. I only do what demands I do it to avoid a crisis.

How do we stay on track with the basics? We need another person(s) willing to keep us on a short leash. As a kid I ran because I had a friend who was going to wonder where I was. As a doctoral student, I played basketball at 6 am because my peers would  ask me where I was. I lost some weight a couple of years ago because my wife and I worked together. Notice that the social accountability is a key facet to help us build the disciplines long enough to see that the pay off is more than can be delivered by an exciting new technique.

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Stress & Christian mindfulness, part 2


In the last post I reviewed some simple definitions of mindfulness, including some of the Buddhist ideas behind a version of mindfulness. In this post I want to consider how mindfulness, when reconsidered in the light of Christian thought, can be a valuable part of counseling practice.

A thought about mindfulness and the brain

Let me detour to one more thought about biology and mindfulness. What happens in the brain when a person is practicing mindfulness? Thought and feeling patterns result in neural activity in the brain (or is it the other way around?). Repeated neural activity creates stronger connections between neurons (increased synaptic activity and denser connections with neurons in the same neighborhood. Repeated activity leads to greater blood flow and activation in particular regions of the brain. Neuroscientists call this neuroplasticity.

Thus affective and cognitive patterns can indeed change your brain. Think about this. What patterns of thought do you engage in on a repetitive basis? Do you have a habit of fantasizing? Mulling over bitter or jealous thoughts? While some of these may come naturally to you, what you do with them may actually change or strengthen neural connections in the brain–for better or for worse.

Is mindfulness healthy or relativistic?

Mindfulness, no matter whether you take a religious, consciousness, or relational approach to it, includes the stepping back from shoulds, oughts, and other judgments. One might think that this would be dangerous for Christians. Within Christianity, there are rights and wrongs, truth and lie, righteousness and unrighteousness. The Bible is, among other things, the single guide for Christians to determine how to live for God. SO, it begs the question whether Christians should be wary of anything that seems to let go of shoulds and oughts?

Another view of shoulds and oughts

In my experience, those suffering from anxiety and depression suffer from a disorder of judgments. They are flooded by shoulds and oughts. Their self-talk does not seem to come from the Lord but are already laced with prejudice. “You should have been more vigilant against danger AND you weren’t. You’re a failure.” “You shouldn’t be rebellious BUT you are always a screw-up.” “I shouldn’t have to suffer this way AND God must not care for me.” Notice that most of these forms of judgment are careful consideration of the facts and experiences but well-formed opinions that may be based on only a smidgen of the actual events in their present circumstances.  Notice that these forms of ruminative thinking come in disguise as careful, logical thinking. They are not. What they are narratives–well-practiced narratives–that have an already formed conclusion that we repeat regardless of the actual facts of our lives.

Mindfulness, then, is stepping back from these narratives. Mindfulness is a practiced discipline of just noticing and describing events so as to process them more carefully instead of automatically repeated a script or mantra. Mindfulness provides the opportunity to discover “what is” rather than compound suffering by focusing on what we just assume. Consider Dan Siegel (The Mindful Brain, p. 77)

When the mind grasps onto preconceived ideas it creates a tension within the mind between what is and what “should be.” This tension creates stress and leads to suffering.”

While I’m sure I would vigorously disagree with Siegel on what a preconceived idea is, on what can be healthy “should be’s”, and much more, he has a point worth considering. Have you ever engaged in a fantasy conflictual conversation with someone you are about to meet. You play out yourself winning, being mistreated, standing up for what is right, and so on. Notice how such conversations aren’t useful. They only increase your level of stress because your brain responds to the inner drama as if it were really happening, when it has yet to happen. In this way, Siegel is right. We create tension that leads to suffering.

Using mindfulness in Christian Counseling

I’m running out of room here and won’t be able to do justice, in this post, to the most practical part of mindfulness. [Isn’t that just like us academics. We spend all our time pointing out problems but we never solve anything!]. Mindful practice may include time practicing being present in one’s surroundings. The counselor may encourage clients to take in their surroundings. While many thoughts may race through the brain, the mindful person may choose to not follow them but “drink in” the creation beauty around them–things growing, art, or anything that is a delight to the senses. This form of discipline must be practiced in de-stressed times so that it will be available during a crisis–just like a basketball player practices free-throws over and over so as to make the shot when there is only 1 second left on the clock.

Such work is the work of taking every thought captive. and resting (a la Psalms 131) without grasping after things “too wonderful” for us.

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Stress & Christian mindfulness, part 1


I’ve written about mindfulness in the past and based on numbers of folks coming to my blog looking for information about Christianity and mindfulness, I thought I might write just a bit more here. My intention is to write in two parts. Part 1 will cover some basics about stress and the idea of mindfulness. Part 2 will explore how Christian counselors might think critically about the topic and consider its use in their practice.

If this is not a term you are familiar with, you may wish to explore the goodly number of books in your local store discussing the topic. Why the interest? There is clear evidence that mindfulness has positive health benefits by reducing our stress responses to the chaos in our lives. Mindful individuals appear to have greater amounts of patience, able to avoid impulsive responses to stress, process rather than react to emotions, have greater capacities to be curious, open, accepting, and loving.

Stress and your body

It is well-known that small amounts of stress activate the body but larger amounts make us sick. But, did you know that the same biological response system that fights viral intruders activates with high levels of stress? Your immune system works in this manner (okay, my simplistic rendition): Your body senses an intruder. The microphages that come in contact with a virus act like little ants sending messages to their buddies to come and defend the colony. One of the messenger chemicals is interleukin-1. Your resulting fever is evidence that the body is working. But to work this hard, other bodily systems get such down. Your stomach and intestines stop or slow down their contractions, you lose your appetite, sexual drive, you have difficulty thinking clearly. These sick symptoms are more likely the result of your body’s defense mode than the virus that has intruded.

The SAME thing happens with high stress. Your pleasures centers shut down to conserve energy. Such activity decreases clarity of thought and pleasure and thus increases experiences of depression and anxiety. See how a vicious cycle of stress/distress leads to greater symptoms of depression/anxiety–a vicious cycle!

What is mindfulness?

Well, it depends upon who you ask. Definitions range from Buddhist forms of meditation, to being present in the moment, to being aware, to centering prayer, to having a nonjudgmental stance. So, for some it is a religious activity. For others it is a form of consciousness. And still others describe it as a relational “attunement” (e.g., a mother’s awareness of the meaning of her infant’s needs even before the cry; a service dog who picks up subtle clues that it’s owner is about to have a seizure). The truth is that each one of these fragments of definitions captures a little bit of what one observes in someone who is able to, in the moment, stand back from the chaos in their life and not react to it. Such people seem to be alert (not dissociated) to the moment, are being in the moment rather than reacting and doing something, are more likely to be describing events, feelings, perceptions, etc. rather than judging them.

In Dan Siegel’s The Mindful Brain (W.W. Norton, 2007), he lists a number of component parts to mindfulness:

  • Intention (rather than reactive), attention (aware), attitude (open, curious, non-judgmental)
  • Nonreactive to inner experiences (I notice my inner experience, but I am not merely my inner experience)
  • Observation, noticing, describing, labeling
  • Attending to sensations; acting with awareness
  • Either focused attention on the present or merely noticing all that passes through the mind

What about the Buddhist part?

There are two terms you’ll find when reading up on Buddhist meditation: vipassana (insight, clear thinking), samatha (concentration or tranquility). I’m not a Buddhist scholar but I do believe I’m in the ballpark about these next bullet points:

  • The goal is to get beyond (ab0ve) the experience of good and evil; of pleasure and pain to a higher level of experience
  • The goal is personal transformation and character development; awareness leading to the drying up of demands (desires?)

It is important to point out that Buddhism is not the only religion that espouses meditational practices. Christianity, from the beginning of the Church, has promoted the concept of meditation, albeit in significantly different form and purpose.

How ought we Christians to think about it?

Some might suggest that engaging in practices that encourage openness, neutrality (which is a misrepresentation of Buddhist practices) open oneself up to the occult. Others might be suspicious of hidden, subtle belief systems (personal transformation vs. Spirit-led transformation). These are legitimate questions. And yet I contend that we do not need to reject these concerns to acknowledge that God has given all humans the capacity to observe and grasp concepts that are true and right–even if we might staunchly disagree with their personal philosophies. This does not mean we take a concept into our life and practices without considerable critical thinking, but it does mean we are open to learning something that our own tradition has lost, ignored, or deemed unnecessary to healthy living.  I’ll attempt to do just that in the next post.

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Mindfulness and meditation


In my own reading I’ve been exploring the concept of mindfulness and its similarity to meditation, being present, etc. There are biblical corollaries that make this an important topic as so frequently we react to life rather than observe it without giving in to impulsive reactions. Mindfulness and meditation are different but may share some commonalities. For example, healthy biblical meditation includes focusing on the character of God, his word, his creation, etc. It includes being aware of these things rather than judging experience or anxiously running after a feeling. Mindfulness also includes this focus and being present. Consider the opening words in Erica Tan’s recent essay,

According to Germer (2005, p. 7) in Mindfulness and psychotherapy, mindfulness is “the awareness of present experience with acceptance.” Mindfulness is a skill that enables an individual to be aware of the present–feelings, thoughts, situation, other people., and so on–without being reactive.

She goes on to quote Germer again about the opposite of mindfulness,

To be mindful is to wake up, to recognize what is happening in the moment. We are rarely mindful. We are usually caught up in the distracting thoughts or in opinions about what is happening in the moment. (p. 4-5).

In this way, mindfulness is similar to meditation in that both are focused on “noticing” things with our reactivity. Meditation does assume or judge things from God’s point of view in such a way that frees us from worry or fighting the situation. Both include an acceptance but meditation includes acceptance of God’s point of view.

I think mindfulness research in psychology has exploded because of the propensity for us to be constantly and anxiously judging our worlds. We confirm our own fears about what is right, wrong, good, bad. It recognizes that there can be wise thinking about these things but much of our lives are reactive and anxiety based. So, we benefit from the reminder that acceptance of feelings, and experiences helps us to be aware of that there is a “bigger picture” as Tan reminds us. While some may think this acceptance makes us passive or allows us to become unwilling to do something about sinfulness, that is not the point of mindfulness or meditation and would be a mis-use of these tools.

Tan, E. (2008). Mindfulness in Sexual Identity Therapy. Journal of Psychology and Christianity, 27, 274-278.

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