Tag Archives: acceptance and commitment therapy

The lost art of joy – Resolve

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When it comes to New Year’s resolutions, we’re pretty abysmal.

Not that making New Year’s resolutions is abysmal, but our ability to actually keep them is particularly poxy. It’s said that about half of us make New Year’s resolutions, but only about eight percent of us actually keep them. Eight percent … that’s a solid F minus.

New Year’s Eve inevitably brings out the mantras, affirmations and aspirations, millions upon millions of people taking to social media to express how they’re making new goals or stepping into their destiny, moving to the next level or claiming their inheritance from the universe … something like that. It’s like someone coded a random phrase generator using the twitter feeds of Tony Robbins and Deepak Chopra and pumped out a random string of meaningless drivel.

Hey, we’ve all been there. This post certainly isn’t about judging the spirit of all these mantras, affirmations and aspirations. People genuinely want to change, to improve, to have a better life … to live a life of joy and meaning.

Wishing to have a life of joy and meaning isn’t enough though. We don’t get a life of joy by just wanting one. How do we go from etherial to tangible?

One day, I would like to visit England. I want to trace my family’s roots. I want to see the world famous landmarks like Buckingham Palace, Big Ben, St Paul’s Cathedral. I want to watch the first day of an Ashes test match at Lords. I would like to attend a lecture at Cambridge. I want to see sites of wonder like Stone Henge. I want to experience the local delicacies like black pudding. I would even love to go to Ireland and drink a pint of Guinness, or to the highlands of Scotland, put on a kilt, and have a haggis.

That’s all well and good, but I’m not going to get there unless I get a passport, buy plane tickets, book hotels, book transport, get some maps, and ensure that I’m in the right place at the right time to be at Lords for the opening session of the Ashes test.

Then I actually have to get on the plane and go, and do all those things I want to do.

We all want joy – no one ever seriously says that they want a life of misery. We all have values that we aspire to fulfil. We need those values. As I’ve written about before, they provide direction to our lives. Values reflect what is most important in the deepest part of ourselves that we can access.

In order to live by those values, and to experience the richness and meaning that our values add to our lives, we have to act on them.

We have to get on the plane. We have to take effective action.

In the framework of ACT, this sort of effective action is called “Committed Action”. Committed action means connecting with individual styles of effective action, driven and guided by core values. As we talked about yesterday, things in life inevitably change, so committed action also needs to be flexible – being able to adapt to the invariable changes of life but still being driven by your underlying values.

Committed action doesn’t mean perfect execution. We are human beings and we are bound to fail, to drift off course or to run into obstacles. No matter how many times we drift away from our values, when we are committed to our values, we can always reassess where we’re at and get back to them.

The word “resolution” comes from the word “resolve”. If we want a life of joy and meaning, we need to do more than make up some New Year’s aspirations. If we’re going to have New Year’s “resolutions”, we need “resolve”, “settle or find a solution to a problem or contentious matter, decide firmly on a course of action”.

Take the next step. What’s one specific, concrete thing you can do in the next day that’s in line with your values? It doesn’t have to be complex. It can be as simple as hugging your kids every day, or calling a friend to arrange a time to catch up over lunch, or getting up ten minutes earlier to go for a short walk in the morning sunlight. Whatever it is, take that step.

If we resolve ourselves to committed action in line with our values, we will be able to translate our desire for a life of joy and meaning into actually experiencing it.

The lost art of joy – Full

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Christmas time is a time of indulgence! And by the end of Christmas day, we’re usually full of something … stuffed full of food, or perhaps a skin full of Christmas ‘spirits’. There are some opinionated family members who are full of … ah … lets just say they’re metaphorically constipated.

While it’s nice to be full of good food and good wine, and not so nice to be full of oneself, the goal of this blog series is for everyone to be full of good cheer.

Which reminds me of a story … this story has been around a while so there are a few variations out there, but this is the one I remember.

A professor once cleared off his desk and placed on top of it a few items. One of the items was a large glass jar.

He proceeded to fill up the jar with golf balls until he could fit no more. He looked at the classroom and asked his students if they agree that the jar is full. Every student agreed that the jar was full.

The professor then picked up a box of small pebbles and poured them into the jar with the golf balls. The pebbles filled all of the openings in between the golf balls. He asked the students if the jar was full? Yes, they said, of course the jar is full.

Then the professor picked up a bag of sand and poured it into the jar. The sand filled in all of the empty space left between the golf balls and pebbles. He asked the class again if the jar was full. The students couldn’t argue, the jar was very full.

Finally, the professor pulled out two beers from under his desk and poured both of them into the jar filling the empty space between the sand. The students began to laugh. This demonstration had gone a lot further than any of them were expecting.

The professor waited until the laughter stopped. “I want you to recognize that this jar represents your life,” he started. “The golf balls represent the important things. Your family, children, health, friends and passions.”

“The pebbles represent the other things in life that matter, such as your job, house and car. The sand, that’s everything else, the small stuff.”

“If you put the sand in first, there is no room for the pebbles or golf balls.”

“The same goes for life. If you spend all of your time and energy on the small stuff, you will never have room for the things that are most important. Pay attention to the important things in your life. Take care of the golf balls first, the things that really matter. The rest is just sand. You are dismissed.”

“But, what about the beer?” asked one student.

The professor smiled.

“There’s always room for a couple of beers.”

It’s an important lesson, and a very good illustration. You can have a full life, but it’s easy to become full of the stuff that doesn’t matter. When we focus on what’s important and get the balance right, when we put our values in first, we can still have a full life, but full of the things that matter to us the most.

There will always be time to clean the house or watch Netflix or take yourself shopping, but if you want to experience a Christmas, and indeed, a life of full of joy, put your values first. Enjoy time with your family. Play games with your kids. Look after those who are struggling, donate to a charity, plant trees … committed action in accordance with your values is the way to a rich and meaningful life of true joy.

And of course, there’s always time for a couple of beers 🙂

The lost art of joy – Adaptability

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A few years ago, I performed in a Christmas musical.

Thankfully, I got the part of the narrator – lots of lines to learn but no singing, because I sing like a cat with laryngitis. I was also hoping to get away without any dancing, because I dance like a dyspraxic hippo, but the director was adamant – all the cast had to participate in the closing number.

Rehearsals for the dance were somewhat embarrassing. There was me – middle-aged, sedentary, overweight and unfit – surrounded by a bunch of skinny, limber teenagers and twenty-somethings. The dance instructor would take us through the warm up and while I would be struggling to get my feet more than shoulders width apart or my fingers much past my knees, the teenage whippets would be doing the splits all the way to the ground, or bending forward with their palms on the floor. Even those who weren’t very good dancers made up for it by the fact that their body had to strength and flexibility to adapt to the moves they had to learn. My body was tight and unforgiving, and I had to work really hard to do what the flexible people did very simply.

The world is in constant motion. Every day brings new challenges as the swirling currents of our social and physical environments push and pull us in different directions. Our inner world swirls just as much, as our feelings and emotions ebb and flow, churn and whirl. The collision of the swirling oceans of our outer world and the turbulent air of our inner worlds can create rain, storms or even hurricanes of psychosocial distress. Even without the bad weather, the constantly changing social and emotional forces creates never-ending demands on our ability to cope, and the exigencies can be exhausting.

Just like those people who were physically more flexible were able to better cope with the demands of the dance number, those people who are emotionally more flexible are able to better cope with the demands of our inner and outer worlds.

Psychological flexibility is being able to adjust our short term feelings in service of our long term values. In the research, psychological flexibility actually refers to a number of dynamic processes that unfold over time, such as how a person adapts to fluctuating situational demands, reconfigures mental resources, shifts perspective, and balances competing desires, needs, and life domains.

In other words, psychologically flexibility involves travelling in the direction of your deepest values, but being in touch with the present moment so that adjustments can be made to keep you on track.

Being psychologically flexible is like turning south for a little while to compensate for the northerly breeze so you can keep sailing in the direction of your long term values.

In day to day life, being psychologically flexible means not holding too tightly to our feelings, emotions or thoughts which can change rapidly and which aren’t always reliably in service of our deeper values.

So how can we become more psychologically flexible so that we can enhance the joy that psychological flexibility encourages?

It starts with knowing what your values are, and moving towards them.

We also need to work on acceptance, allowing our feelings and emotions, as strong and as distressing as they are at times, to ebb and flow as they do without rigidly fighting against them or trying to suppress them.

In order to build our capacity to cope with changing situational demands, we also need to “stretch” our mental “muscles” like I needed to stretch my physical muscles to be able to dance better. To become more mentally limber,
1. Learn something new every day, even if it’s something small
2. Do something differently, even if it’s a small change, but don’t always stick to the same routine
3. Do different things, things that you may not have done before. Again, doesn’t have to be much, but try a different coffee order, or a new meal at a restaurant. Listen to some new music.
4. Challenge yourself. Just a little bit every day. It’s ok to be a little bit mentally uncomfortable. Stretching is good for you!

As you continue to grow more psychological flexible, you will open yourself to new and greater experiences of joy.

The lost art of joy – The freedom of now

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How do drive your car?

We all have our own particular styles – cautious, sedate, zippy, or kamikazi. There are some drivers that drive like a tortoise on tranquillisers. I always seem to get stuck behind them at traffic lights. I would describe my driving style as ‘confident’, though when I quickly nip around them at the lights, I’m sure they would think I’m in too much of a hurry.

Whether we’re on a perpetual Sunday drive or we go like a bat out of hell, there are some commonalities to how we all drive. No one drives the whole journey looking in the rearview mirror and no one crawls along in first gear all the way just in case there might be a red light or a stop sign up ahead. When we’re in control of our car, we drive according to the conditions around us at the time.

In the first two posts of this series, we looked at acceptance and values, or as the Serenity Prayer says, “give me grace to accept with serenity the things that cannot be changed, Courage to change the things which should be changed, and the Wisdom to distinguish the one from the other.” Acceptance and values intersect in the present moment, the ‘now’.

We can’t change what has happened in the past, and we can’t control what is going to happen in our future. We can advance in the direction set by our values and embrace the freedom of living in the now.

Living in the now is just like driving. There’s no point looking in the rearview mirror the whole way. We can’t change the past. Getting lost in the if-only’s of the past means we don’t get to experience what is going on around us, and it effectively stops us moving forward because we’re looking the wrong way. We become stagnant and the lack of lack of forward progress makes it hard for joy to flourish. Neither can we control the future. Sometimes we allow the what-if’s of the inherently uncertain future to slow our progress and hold us back. We don’t know what’s around the bend, and after a while we prefer the familiarity of our rut.

When we move beyond the past and leave the future to our destiny, we can focus on the richness of the present moment. Living in the present moment is both liberating and invigorating – we are no longer being held captive by what has been or what might be, and we can allow our attention to absorb all of the plentiful and pleasing details that are going on all around us, every moment of our lives.

Living in the now is part of the practice of mindfulness. Mindfulness is a skill, and like every other skill, it takes some practice to get good at it. But the practice is worth it, as mindfulness is associated with higher levels of life satisfaction, agreeableness, conscientiousness, vitality, self esteem, empathy, sense of autonomy, competence, optimism, and pleasant affect.

There are many ways to practice mindfulness, but if you’re a novice, then a good place to start is through some apps like Smiling Mind or Headspace.  As you get better at living in the present moment, you will start to enjoy the richness and freedom that comes with it. If you start now, you won’t have to live haunted by the ghosts of Christmas-Past or Christmas-Future, but can have a marry and a mindful Christmas, living in the freedom of now.

The lost art of joy – Values

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“Wait … what are you doing?”

There’s a deep part of our consciousness that acts as our inner emergency brake. You know, when you’re about to call your boss a jerk, or drunk text someone, or post something narky on social media, there’s that little voice inside your head that says, “Uh, do you really think that’s a good idea?”

Thankful most of us don’t end up drunk-texting our boss and would never let ourselves get in a position to do so. Still, it’s a good idea every now and then to reevaluate our general day-to-day decisions, our routines and patterns, to say to ourselves, “Wait … what are you doing?”

Yesterday we talked about the Serenity Prayer – “grace to accept with serenity the things that cannot be changed, Courage to change the things which should be changed, and the Wisdom to distinguish the one from the other”. We talked about acceptance – accepting the things we can not change because fighting with things we can’t change wastes our energy and gets us nowhere. We can also waste a lot of energy and not get to where we want to go by using all our energy going to the wrong place – either we drift on autopilot, doing what we’ve always done because, you know, it’s what we’ve always done, or we can deliberately set sail in the wrong direction, thinking that we’re doing the right thing.

One way that we can build our joy is to live rich and meaningful lives in service of our values. In knowing our values, we can know ourselves, and engage in life in its fullness. ’Values’ can mean different things to different people, but in the Acceptance and Commitment framework, values refer to “Leading principles that can guide us and motivate us as we move through life”, “Our heart’s deepest desires: how we want to be, what we want to stand for and how we want to relate to the world around us.”

Values help define us, and living by our values is an ongoing process that never really reaches an end. Living according to your values is like sailing due west. No matter how far you travel, there is always further west you can go. While travelling west, there will be stops along the way, stopovers along our direction of travel like islands or reefs. These are like our goals in life.

The difference between goals and values is important. You could set yourself a whole list of different goals, and achieve every one of them, but not necessarily find meaning or fulfilment if they all go against the underlying values that you have. So goals are empty and unfulfilling if they aren’t undergirded by your deeper values.

How can you understand your values? There are a couple of ways. Ask yourself: “What do I find myself really passionate about? What things irk me? If I could do anything I wanted, and money was no object, what would I do?” Is there a recurrent theme running through your answers?

There are other ways to discover what your values are. Some people have suggested writing your own eulogy (the speech someone gives about you at your funeral). It sounds a bit morbid, and it’s only a figurative exercise, but it tends to sharply clarify what you want your life to be like. What do you want your legacy to be? Think about the things that you want to be known for at the end of your life, and see if there’s a word that best describes those desires.

Understanding our values can help us to navigate the seasonal madness without becoming overwhelmed. When you understand what’s truly important to you, it’s much easier to focus on what’s really important and say no to the things that aren’t. For example, Your boss invites you to exclusive Christmas drinks are her house, with some of the regional executives. It’s on at the same time as the Christmas Carols concert your sister is performing in. If your core values are career success, then the choice is easy. If you know your values are family first, then the choice is easy. You can make the choice that will bring you the most joy, and enrich your life.

So before the malaise of merriment takes hold, say to yourself, “Wait … what are you doing?” Ensure that what you’re doing is aligned with your deepest values to maximise your joy this Christmas season, and beyond.

Dr Caroline Leaf and the struggle spiral

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In Proverbs 12:25, the incredibly wise King Solomon wrote that, “Worry weighs us down; a cheerful word picks us up.”

Today, Dr Leaf posted to her social media stream that “An undisciplined mind is filled with worries, fears and distorted perceptions – These lead to degeneration of the mind and body.”

Well, that’s about as uplifting as a lead balloon.

Dr Caroline Leaf is a communication pathologist and a self-titled cognitive neuroscientist.  I’m sure her heart was in the right place when she posted her latest jewel of wisdom, but it may not be as encouraging or as helpful as she may have intended.

The biggest problem is her opening premise, “An undisciplined mind is filled with worries, fears and distorted perceptions”.  So … that’s not really accurate. The normal human mind is filled with worries, fears and distorted perceptions. It really doesn’t matter whether you discipline your mind or not, you won’t shift these ‘negative’ thoughts.

That’s because we’re meant to experience appropriate levels of fear and worry.  They’re a survival mechanism.  Without a certain amount of fear, we’d end up as a Darwin Award.  And as human beings, we’re naturally inclined to so many different cognitive biases that there’s a very long list (although ironically, those with the strongest confirmation bias will probably be the least likely to accept this).

By erroneously linking normal cognitive function to the concept of mental ill-discipline, Dr Leaf is simply setting people up for an unrealistic struggle with their normal psyche as they unnecessarily try to discipline it.

And for the people who really do struggle with excessive or inappropriate worry, fear or incorrect perceptions – i.e. people who suffer from formal anxiety disorders – this sort of statement is misleading because again, their issue isn’t mental ill-discipline. Anxiety is the result of a genetic predisposition and increased vulnerability to stress.

The second part of Dr Leafs meme is as unhelpful as the first.  For a start, it’s not true that worries, fears and distorted perceptions cause degeneration of the mind and body.  There may be a correlation between stress and some long term health problems, but correlation does not equal causation.  As Cohen and colleagues noted, “Although stressors are often associated with illness, the majority of individuals confronted with traumatic events and chronic serious problems remain disease-free.” [1]  Dr Leaf’s claim seems little more than a scare tactic, which can only lead to increased anxiety not increased motivation.

The important things to remember here are:
1. Experiencing worries, fears and distorted perceptions is normal, and not something that can be changed by disciplining your mind.  Don’t fall into the trap of trying to treat something that isn’t a disease.
2. If you do suffer from an anxiety disorder, don’t blame yourself.  That sets up a spiral of struggle.  Thoughts are just words. They have no power over you unless you engage with them.  Instead of trying to repress every worry and every fear, allow your thoughts to bubble away in the background, and instead, focus your energy on taking values based committed action which will ultimately help you live a life of meaning, not just struggling.

References

[1]     Cohen S, Janicki-Deverts D, Miller GE. Psychological stress and disease. JAMA: the journal of the American Medical Association 2007;298(14):1685-87.

The Prospering Soul – Christians and Anxiety

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When you say the word “anxiety”, it can mean different things to different people. To a lot of people, anxiety is the same as being a little frightened. To others, it’s being really scared, but with good reason (like if you have to give a speech and you’re afraid of public speaking).

Medically speaking, anxiety isn’t just being frightened or stressed. After all, it’s normal to be frightened or stressed. God made us so that we could experience fear, because a little bit of fear is actually protective. There are dangers all around us, and if we had no fear at all, we’d end up becoming lunch for a wild animal, or road-kill. So there’s nothing wrong with a little bit of anxiety – in the right amount, for the right reason.

But anxiety in the wrong amount or for the wrong reason, can disrupt our day-to-day tasks and make it hard to live a rich and fulfilling life. That’s the anxiety that we’ll be talking about today.

The official description of anxiety reflects this idea of the wrong amount of anxiety about the wrong things: “… marked symptoms of anxiety accompanied by either general apprehension (i.e. ‘free-floating anxiety’) or worry focused on multiple everyday events, most often concerning family, health, finances, and school or work, together with additional symptoms such as muscular tension or motor restlessness, sympathetic autonomic over-activity, subjective experience of nervousness, difficulty maintaining concentration, irritability, or sleep disturbance. The symptoms are present more days than not for at least several months and result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.” (This is taken from the beta-version of the latest WHO diagnostic guidelines, the ICD-11, but has yet to be formally ratified).

There are six main disorders that come under the “anxiety disorders” umbrella, reflecting either an abnormal focus of anxiety or an abnormal intensity:
1. Panic Disorder (abnormally intense anxiety episodes)
2. Social Anxiety Disorder (abnormal anxiety of social interactions)
3. Post-traumatic Stress Disorder (abnormally intense episodes of anxiety following trauma)
4. Obsessive-Compulsive Disorder (abnormally intense and abnormally focussed anxiety resulting in compulsive behaviours)
5. Specific phobias (abnormally focussed anxiety on one particular trigger), and
6. Generalised Anxiety Disorder (abnormal anxiety of everything)

The common underlying theme of anxiety is uncertainty. Grupe and Nitschke wrote, “Anxiety is a future-orientated emotion, and anticipating or ‘pre-viewing’ the future induces anxiety largely because the future is intrinsically uncertain.” [1]

The dysfunctional approach to uncertainty that underlies anxiety is in turn related to genetic changes which affect the structure and function of the brain, primarily in the regions of the amygdala and the pre-frontal cortex, which then alters the processing of our brain in five different areas:
> Inflated estimates of threat cost and probability
> Hypervigilance
> Deficient safety learning
> Behavioural and cognitive avoidance
> Heightened reactivity to threat uncertainty

In simpler language:
> the brain thinks that threats are more likely and will be worse than they are
> the brain spends more time looking for possible threats
> the brain fails to learn what conditions are safe, which is aggravated by
> the brain over-using avoidance as a coping mechanism, and
> the brain assumes that unavoidable uncertainty is more likely to be bad.

It’s important to understand at this point that anxiety disorders aren’t the result of poor personal choices. They are the result of a genetic predisposition to increased vulnerability to early life stress, and to chronic stress [2].

The other way of looking at it is that some people are blessed with amazing tools for resilience [3, 4].

It’s not to say that our choices have no impact at all, but we need to be realistic about this. Everyone will experience stressful situations at some point in their lives, and everyone will also make dumb choices in their lives. Some people are naturally better equipped to handle this, whereas some people have genes that make them more vulnerable. It’s wrong to blame yourself, or allow other people to blame you, for experiencing anxiety, just as it’s wrong for other people to assume that if one person can cope with the same level of stress, then everyone else should too.

It’s not to say that you shouldn’t fight back though. Just because your facing a mountain doesn’t mean to say you can’t climb it. It will be hard work, and you’ll need good training and support, but you can still climb that mountain.

Managing anxiety is very similar to managing depression like we discussed in a previous post. Following the tap model, there’s overflow when there is too much going into the system, the system is too small to handle it, and the processing of the input is too slow. So managing anxiety involves reducing the amount of stress going into the system, increasing the systems capacity through learning resilience and coping skills, and sometimes by improving the systems processing power with medications.

Reducing the input – stress management

Sometimes the best way of coping with anxiety is to reduce the stress that’s fanning the flames. It mightn’t seem to come naturally, but as we discussed in the last chapter, there are a few basic skills that are common to all stress management techniques that can form the platform of ongoing better skills in this area.

Engaging the “vagal brake” as proposed by the “Polyvagal Theory” [5] is as important in anxiety as it is in depression. By performing these techniques, the activity of the vagus nerve on the heart via the parasympathetic “rest-and-digest” nervous system is increased, which not only slows down the heart, but enhances the activity of other automatic parts of our metabolism. Some of the techniques allow a relaxed body to have a relaxed brain which can cope better with whatever is confronting it. The full list will be a blog for another time, but the simplest technique is to breathe!

It’s really simple. Sit in a comfortable position. Take slow, deep breaths, right to the bottom of your lungs and expanding your chest forward through the central “heart” area. Count to five as you breathe in (five seconds, not one to five as quickly as possible) and then count to five as you breathe out. Keep doing this, slowly, deeply and rhythmically, in and out. Pretty simple! This will help to improve the efficiency of your heart and lungs, and reduce your stress levels.

Remember, B.R.E.A.T.H.E. = Breathe Rhythmically Evenly And Through the Heart Everyday.

Increasing capacity – coping and resilience

Like with depression, anxiety responds well to psychological therapies which help to increase coping skills and enhance our innate capacity for resilience. And like depression, anxiety improves with CBT and ACT [6, 7], which enhance the activity of the pre-frontal regions of the brain [8]. For anxiety, CBT teaches new skills to handle uncertain situations, and to re-evaluate the chances of bad things happening and what would happen if they do. ACT puts the train of anxious thoughts and feelings in their place, and teaches engagement with the present moment, and a future focusing on values, and accepting the discomfort of uncertainty by removing the distress associated with it.

Practicing each of these skill sets is like practicing any other skill. Eventually, with enough practice, they start to become more like a reflex, and we start to cope with stress and anxiety better automatically.

Increased processing – Medications

Sometimes, to achieve long-term successful management of anxiety, a little extras help is needed in the form of medication. Like depression, the main group of medications used are the Selective Serotonin Reuptake Inhibitors (or SSRI’s for short). Medications appear to reduce the over-activity of a number of brain regions collectively called the limbic system [8], which are involved with many innate and automatic functions, but in its simplest form, the limbic system controls many of our emotions and motivations, including fear, anger and certain aspects of pleasure-seeking [9]. So essentially, SSRI’s help the anxious brain to make better sense of the incoming signals.

There are other medications commonly used for anxiety treatment, collectively called benzodiazepines. Most people wouldn’t have heard that term before, but would have heard of the most famous member of the benzo family, Valium. Benzos are like having a bit too much alcohol – they slow down the activity of the brain, and induce a feeling of relaxation. When used appropriately (i.e.: in low doses and in the short term), they can be helpful in taking the edge off quite distressing feelings of anxiety or panic. But benzos are not a cure, and after a while, the body builds a tolerance to them, where a higher dose is required to achieve the same effect. Continued long term use eventually creates dependence where a person finds it difficult to cope without them.

The final way to help manage anxiety is prayer. Like for depression, there is limited scientific information on the effects of prayer on, although a small randomised controlled trial did show that prayer with a prayer counsellor over a period of a number of weeks was more effective than no treatment [10].

Though given that anxiety is a future orientated emotion, excessively anticipating possible unwelcome scenarios and consequences, it’s easy to see why prayer should work well for anxiety. Trusting that God has the future in hand and knowing “that in all things God works for the good of those who love him, who have been called according to his purpose” (Romans 8:28) means that the future is less uncertain. The Bible also encourages us, “Do not be anxious about anything, but in every situation, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.” (Philippians 4:6-7) When we give the future to God, he will give us peace in return.

Again, like in the case of depression, it’s sometimes hard for Christians to understand how strong Christians can suffer from anxiety in the first place. After all, we’ve just read how God gives us peace. And the Bible says that the fruit of the Spirit is peace (Galatians 5:22).

So when you’re filled with the opposite, when all you feel is overwhelming fear, it makes you feel like a faithless failure. Christians without anxiety assume that Christians with anxiety aren’t living in the Spirit. And it’s the logical conclusion to draw after all – if the fruit of the Spirit is peace, and you’re not filled with peace, then you mustn’t be full of the Spirit.

But like depression, when you look through the greatest heroes in the Bible, you see a pattern where at one point or another in their lives, they went through physical and emotional destitution, including mind-numbing fear … Moses argued with God about how weak and timid he was (Exodus 3 and 4), Elijah ran for his life in panic and asked God to kill him, twice, over the period of a couple of months after Queen Jezebel threatened him (1 Kings 18 and 19). Peter had spent three years with Jesus, the Messiah himself, hearing him speak and watching him perform miracle after miracle after miracle. But Peter denied his Messiah three times when he was confronted with possible arrest (John 18).

For the same pattern is also seen in King David, Gideon, and a number of other great leaders through the Bible. The take home message is this: it’s human nature to suffer from disease and dysfunction. Sometimes it’s physical dysfunction. Sometimes it’s emotional dysfunction. It’s not a personal or spiritual failure to have a physical illness. Why should mental illness be treated any different?

As the stories of Moses, Elijah and Peter testify, being a strong Christian doesn’t make you impervious to fear and anxiety. Hey, we’re all broken in some way, otherwise why would we need God’s strength and salvation? Having anxiety simply changes your capacity to experience God’s peace. As I said in the last chapter, closing your eyes doesn’t stop the light, it just stops you experiencing the light. Being anxious doesn’t stop God’s peace, it just makes it harder to experience God’s peace.

In summary some anxiety, at the right time and at the right intensity, is normal. It’s not unhealthy or sinful to experience some anxiety. Anxiety at the wrong time or at the wrong intensity, can disrupt our day-to-day tasks and make it hard to live a rich and fulfilling life. Anxiety related to a dysfunctional approach to uncertainty, and is a future-orientated emotion because anticipating or ‘pre-viewing’ the future induces anxiety largely because the future is intrinsically uncertain. Anxiety disorders can be debilitating.

Like depression, anxiety disorders can be managed in four main ways, by reducing the amount of stress coming in with stress management techniques, by increasing capacity to cope with psychological therapies like CBT and ACT, and sometimes by using medications, which help the brain to process the uncertainty of each situation more effectively. Prayer is can also useful to helping to manage anxiety.

Christians are not immune from anxiety disorders, and it’s important for the church to understand that Christians who suffer from anxiety are not weak, backsliding or faith-deficient. Having anxiety is not because of making poor choices. Though if you have anxiety, trust in the promises of the Bible, that God has the future under control.

References

[1]        Grupe DW, Nitschke JB. Uncertainty and anticipation in anxiety: an integrated neurobiological and psychological perspective. Nature reviews Neuroscience 2013 Jul;14(7):488-501.
[2]        Duman EA, Canli T. Influence of life stress, 5-HTTLPR genotype, and SLC6A4 methylation on gene expression and stress response in healthy Caucasian males. Biol Mood Anxiety Disord 2015;5:2.
[3]        Wu G, Feder A, Cohen H, et al. Understanding resilience. Frontiers in behavioral neuroscience 2013;7:10.
[4]        Russo SJ, Murrough JW, Han M-H, Charney DS, Nestler EJ. Neurobiology of resilience. Nature neuroscience 2012 November;15(11):1475-84.
[5]        Porges SW. The polyvagal perspective. Biological psychology 2007 Feb;74(2):116-43.
[6]        James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. The Cochrane database of systematic reviews 2013;6:CD004690.
[7]        Swain J, Hancock K, Hainsworth C, Bowman J. Acceptance and commitment therapy in the treatment of anxiety: a systematic review. Clinical psychology review 2013 Dec;33(8):965-78.
[8]        Quide Y, Witteveen AB, El-Hage W, Veltman DJ, Olff M. Differences between effects of psychological versus pharmacological treatments on functional and morphological brain alterations in anxiety disorders and major depressive disorder: a systematic review. Neuroscience and biobehavioral reviews 2012 Jan;36(1):626-44.
[9]        Sokolowski K, Corbin JG. Wired for behaviors: from development to function of innate limbic system circuitry. Frontiers in molecular neuroscience 2012;5:55.
[10]      Boelens PA, Reeves RR, Replogle WH, Koenig HG. A randomized trial of the effect of prayer on depression and anxiety. Int J Psychiatry Med 2009;39(4):377-92.

If you’re suffering from anxiety or any other mental health difficulties and if you want help, see your GP or a psychologist, or if you’re in Australia, 24 hour telephone counselling is available through:

 Lifeline = 13 11 14 – or – Beyond Blue = 1300 22 4636

Seven Elements of Good Mental Health: 3. Mindfulness – The Prospering Soul

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Life shouldn’t just be about avoiding poor health, but also enjoying good health. Our psychological health is no different.

Before we take a look at poor mental health, let’s look at some of the ways that people can enjoy good mental health and wellbeing. This next series of posts will discuss seven elements that are Biblically and scientifically recognised as important to people living richer and more fulfilling lives.

These aren’t the only ways that a person can find fulfilment, nor are they sure-fire ways of preventing all mental health problems either. They’re not seven steps to enlightenment or happiness either.   But applying these principles can improve psychosocial wellbeing, and encourage good mental health.

3. Mindfulness

Mindfulness is a practice that we can all become better at.

Mindfulness involves directing our attention towards things in the present moment, and away from those thoughts that drag us into the faults of the past or the fear of the future [1]. Between the various disciplines of psychology and a number of different religions, there are many ways in which mindfulness has been defined. The way I consider mindfulness is similar to that in the ACT framework, which is simply non-judgemental awareness of one’s moment-to-moment experience. In other words, mindfulness involves accepting the experience our internal and external realities simply as they are, without judging them as good or bad, positive or negative. Mindfulness accepts the experience of events fully, without resorting to excessive preoccupation or suppression of the experience.

People who are naturally mindful are more likely to have higher levels of life satisfaction, agreeableness, conscientiousness, vitality, self esteem, empathy, sense of autonomy, competence, optimism, and pleasant affect, and are less likely to have depression, neuroticism, absent-mindedness, dissociation, rumination, cognitive reactivity, social anxiety, difficulties in emotion regulation, experiential avoidance and general psychological symptoms.

So mindfulness is obviously a good thing to have, though before we get too carried away, it may be that mindfulness isn’t the cause of all of these positive effects, but simply a common association. In other words, it might be that people who are psychologically health naturally tend to be more mindful.

For the most part, this is probably the case, but there is evidence for mindfulness as a psychological intervention for those who are not so naturally mindful.  Those who are taught to practice mindfulness skills also demonstrate an increased ability to cope with habitual urges (like a desire to smoke), feelings of anxiety, low mood, and fearfulness [2].

Mindfulness has some overlap with the psychological skill of acceptance. In mindfulness, we not only stop fighting with our feelings and thoughts, but we take a step back to pay attention to them and observe them in a non-judgemental way. With acceptance, we acknowledge the thoughts and feelings, but divert our attention to other things.

To clarify, mindfulness is non-judgementally observing our thoughts, feelings and emotions, not fighting with them to suppress them, or passively allowing our thoughts and feelings to overwhelm us. If our thoughts or feelings were like a hungry lion, mindfulness is standing outside of the cage, observing the different characteristics of the lion, rather than staying in the cage to try and fight it, or passively stand in the cage waiting to become lunch.

Mindfulness doesn’t need special training. Being mindful is simply being aware of your thoughts, feelings and emotions, and accepting them for what they are. Are you happy at the moment? What does that feel like in your body? What does anxiety feel like? Describe the feeling … hot or cold, squeezing, searing, heavy or light? Do you have an urge to do something, like have some chocolate or smoke a cigarette? What is that urge like? Can you put it into words?

Only one word of warning. It would be fair to assume that someone will be reading this who has experienced some severe trauma in their lives. Both acceptance and mindfulness will help to manage the feelings that your trauma will inevitably cause, but if the severity of that trauma causes you to be overwhelmed by your feelings, don’t try and tackle those memories and emotions on your own. Work with a psychologist or doctor who is experienced in mindfulness-based therapies, so there is someone to assist you through the process so you’re not overwhelmed, until you get better and stronger.

Often mindfulness is taught as a contemplative activity, that is, we think about the feelings as we observe them. However, there is nothing wrong with expressing your mindfulness in other ways, like drawing, painting or movement. You can also write them down. I often read through the Psalms that King David wrote, and wonder if he was modelling mindfulness for us in the way he acknowledged and described his feelings in the words that he wrote as prayer and poetry. Find what works best for you as you grow in the skill of mindfulness.

References

[1]        Harris R. The happiness trap : how to stop struggling and start living. Boston: Trumpeter, 2008.
[2]        Keng SL, Smoski MJ, Robins CJ. Effects of mindfulness on psychological health: a review of empirical studies. Clinical psychology review 2011 Aug;31(6):1041-56.

Seven Elements of Good Mental Health: 1. Temet Nosce – The Prospering Soul

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Life shouldn’t just be about avoiding poor health, but also enjoying good health. Our psychological health is no different.

Before we take a look at poor mental health, let’s look at some of the ways that people can enjoy good mental health and wellbeing. This next series of posts will discuss seven elements that are Biblically and scientifically recognised as important to people living richer and more fulfilling lives.

These aren’t the only ways that a person can find fulfilment, nor are they sure-fire ways of preventing all mental health problems either. They’re not seven steps to enlightenment or happiness either.   But applying these principles can improve psychosocial wellbeing, and encourage good mental health.

1. Temet nosce – “Know thyself”

Generally speaking, there are two ways that a person can live their lives, as a boat or as a buoy – those who set out to find life or to let life find them.

Some people are quite content to be buoys – to stay in the same place and let the social currents and tides bring different elements to them. They’re more passive in their approach, content to just accept that life will just come and go as it will.

Then there are those who don’t want to stay in the one place, but want to chart their own course, discover what life is for themselves. Whose to say what’s best for each individual person? We all have our own choices to make.

For those people who are boats, who want to set their course and discover life, it helps a lot in the journey to know where you’re going.

This may seem obvious enough. In fact, it seems too obvious – we often think we know where we’re going when in reality, we haven’t a clue where we really want to go or how to get there.

For starters, it helps to know where you want to go. Some of us are gifted with an amazing confidence, self-assurance and motivation, and have the ten year plan all mapped out, but those people are the minority. It’s fine if we don’t know where exactly we want to go, but what would help every since person is to at least know the direction you wish to sail in, which are our values.

The word ‘values’ can mean different things to different people, but in the Acceptance and Commitment framework, values refer to “Leading principles that can guide us and motivate us as we move through life”, “Our heart’s deepest desires: how we want to be, what we want to stand for and how we want to relate to the world around us.” [1] Values help define us, and living by our values is an ongoing process that never really reaches an end. Living according to your values is like sailing due west. No matter how far you travel, there is always further west you can go. While travelling west, there will be stops a long the way, stop-overs along our direction of travel like islands or reefs. These are like our goals in life.

The difference between goals and values is important. You could set yourself a whole list of different goals, and achieve every one of them, but not necessarily find meaning or fulfilment in their accomplishment if they’re all against the underlying values that you have. So goals are empty and unfulfilling if they aren’t undergirded by your deeper values.

How can you understand your values? There are a couple of ways. Ask yourself: “What do I find myself really passionate about? What things irk me? If I could do anything I wanted, and money was no object, what would I do?” Is there a recurrent theme running through your answers? I have always found myself irritated by mass-marketing, and more recently by disingenuous social media memes and unscientific health messages. The theme – ‘truth’. I know, it sounds a bit trite, like some second-rate comic book hero, but I’ve mulled over this a lot, and for me, ‘truth’ is one of my deepest values.

There are other ways to discover what your values are. Some people have suggested writing your own eulogy (the speech someone gives about you at your funeral). It sounds a bit morbid, and it’s only a figurative exercise, but it tends to sharply clarify what you want your life to be like. What do you want your legacy to be? Think about the things that you want to be known for at the end of your life, and see if there is a word that best describes those desires.

If that’s a bit too confronting, there are some on-line tools that can also give you an idea. There is only so much a long list of questions can discover about you, but results of the survey can provide a starting point for further thought. There is a couple of free resources that may be helpful (though you will have to register):
* https://www.authentichappiness.sas.upenn.edu – and click on the drop-down menu in the “Questionnaires” section, and select “Brief strengths test”
* http://www.viacharacter.org/Survey/Account/Register

One final note on the buoys and the boats – whether you’re a buoy or a boat, you’re still going to encounter large waves, strong currents, and wild storms, as well as peaceful weather. As a buoy, those adverse conditions will simply find you where you are. You can’t escape from them. You’re also going to experience those same large waves, strong currents and wild storms as a boat. The difference is that buoys have no choice but to ride out the adverse conditions. Boats, on the other hand, can use the power of the difficult circumstances to power them to their destinations if they can harness them correctly. Boats can’t outrun bad weather all the time. Adversity is inevitable. Happiness, contentment, enlightenment, or whatever you’re seeking, isn’t found in avoiding or controlling our adverse circumstances, but about learning how to follow our values in the midst of the calm weather or the wild.

As Christians, one of our primary values is our love for God and our desire to follow Jesus. Scripture teaches that each of us has our own unique path to follow. Ephesians 2:10, “For we are God’s workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do.” ‘Workmanship’ in the Greek is ‘poiema’ from which we get our English word ‘poem’. We are not a meaningless jumble of letters that makes no sense. We are a beautifully crafted blend of rhythm, harmony and meaning. You are a sonnet from the mouth of God. I believe that our individual purpose stems from our common purpose and values, like leaves are dependant on the branches, trunk and roots of the tree. I heard a brilliant summary of the purpose of the Christian life, which was simply “To know Christ, and to make Christ known.” I believe that it’s from this common value, shared by all Christians, that our direction in life stems from.

In knowing our values, we can know ourselves, and engage in life in it’s fullness.

References

[1]        Harris R. The happiness trap : how to stop struggling and start living. Boston: Trumpeter, 2008.

Understanding Thought – Part 3

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What is thought?

We’re all familiar with thought, to be sure, just like we’re familiar with our own bodies. But just because we know our own bodies doesn’t make us all doctors. In the same way, we might know our own thoughts well, but that doesn’t make us experts in the science of thought.

But understanding thought is important. If we don’t know what thoughts are, then it’s very easy to be conned into believing the myriad of myths about thought perpetuated about them by every pop-psychologist and B-grade life coach.

This series of blogs is taken from my book Hold That Thought: Reappraising the work of Dr Caroline Leaf. We’ve looked at some basic neurobiology and the neurobiology of thought itself. Today we’ll discuss some psychological models of our thought processing, and the common brain states and functions that are usually confused with thought.

Other cognitive frameworks of thought

Dual Systems

A number of models of thought use a dual systems approach, explaining our cognitive process in terms of two systems.

System 1 involves a set of different subsystems that operate in parallel, delivering swift and intuitive judgments and decisions in response to our perceptions. System 1 is unconscious, automatic and guided by principles that are, to a significant extent, innately fixed and universal among humans.

System 2 is the system that involves “thought” as people typically think about it. It is both conscious and reflective in character, and proceeds in a slow, serial manner, according to principles that vary among both individuals and cultures [1]. This system is in harmony with the Global Workspace/LIDA concept of the cognitive cycle.

System 2 is generally held to be subject to intentional control, hence why thoughts can be volitional. System 2 can be guided by normative beliefs about proper reasoning methods. In other words, we can learn ways of thinking about our thoughts to handle them better. And one of the principal roles often attributed to system 2 is to override the unreflective responses that are issued automatically by system 1 in reasoning tasks, when these fall short of appropriate standards of rationality. We can use thought to modulate or suppress our intuitive responses, the concept of “think before you act”.

Neuroscience research confirms the neural networks involved with the dual systems, and have taken the theory further [2]. Not only can stimuli that are emotionally significant activate the lower, emotional parts of our brain, they can do so without us ever being consciously aware they were detected. For example, when test subjects had their visual cortex temporarily stunned by a transcranial magnetic stimulator, they could detect whether a face was happy or sad and even where it was on a grid without consciously sensing that they had “seen” a face [3]. Subconscious emotional stimuli can modulate our attention before we are aware of their perception [4].

Relational Frame Theory / Acceptance And Commitment Therapy

Relational frame theory, and the clinical approach based on it called Acceptance and Commitment Therapy, sees thoughts as contextual. This is interesting, as new neurobiological approaches such as neurocognitive networks are also girded by the developing view of cognition which is that cognition “is marked by both dynamic flexibility and context sensitivity.” [5]

Relational frame theory posits that “the core of human language and cognition is learning to relate events mutually and in combination not simply on the basis of their formal properties (e.g., size, shape) but also on the basis of arbitrary cues.” [6] Basically, we understand things in both concrete and abstract ways. “The gold coin is small” is referring to the tangible properties of the gold coin. “The gold coin is very valuable” is referring to the arbitrary properties of the gold coin, which are values that we define in our minds.

Hayes states, “A key RFT insight of clinical importance is that relational framing is regulated by two distinguishable features: the relational context and the functional context … The relational context determines what you think; the functional context determines the psychological impact of what you think.” [6]

So in terms of thought, what we think isn’t necessarily reliable. It’s contextual, and often abstract and arbitrary. The meanings and values that are placed on our thoughts are related to the context in which they came to us, and the impact is also arbitrary, a function of our minds and our language.

As William Shakespeare wrote, “for there is nothing either good or bad, but thinking makes it so.” [7] Thoughts are just that – thoughts. So while there is a mountain of published literature on “negative” or “positive” thoughts, such distinctions are subjective, arbitrary, and often entirely unhelpful.

We often become fused to the meaning of our thoughts. We begin to take them literally, without noticing the process of thinking itself. When the thoughts become painful, we don’t know how to handle them, and we run from them, or try to suppress them. But in fighting with the thoughts, we actually draw attention to them and make them more powerful. This makes them even more painful, and makes the avoidance worse. We then lose flexible contact with the present moment, as we become more and more consumed with the internal battle with our painful thoughts and subsequent emotions. Rather than looking around us, all we can do is focus on the pain or be anywhere else where difficult events are not occurring. [6]

The key in this battle is not to engage with the “negative” thoughts by pushing them away or trying to change them. Pushing the painful thoughts away makes them go away for a while, but it takes a lot of effort. The thoughts return as we tire, but we have less energy to resist them.

Try holding a fully inflated basketball under water. It’s possible, but the basketball wants to get back to the surface. Holding it down is hard work. You usually can’t do it for long. Fighting our thoughts is the same.

Harris describes the focus of Acceptance and Commitment Therapy, “around two main processes: developing acceptance of unwanted private experiences which are out of personal control, commitment and action towards living a valued life … In ACT, there is no attempt to try to reduce, change, avoid, suppress, or control these private experiences. Instead, clients learn to reduce the impact and influence of unwanted thoughts and feelings, through the effective use of mindfulness.” [8]

The first principle of ACT is to start treating thoughts as what they really are … just thoughts. This is simply done by learning to observe the process of thinking again, to realise that the words going through our minds are just words. They only have the meaning that we give to them. They only have the power that we allow them to have.

The key to overcoming thought patterns we don’t want isn’t to change them, it’s to remove their power. Trying to change them means engaging with them, which only makes them stronger. Disempowering them means seeing them for what they are. They may sound like Rottweiler’s but when you actually look, they’re more like Chihuahua’s with megaphones. When you understand that your thoughts are not in control, you can move forward into the actions that really bring change.  If you want to know more about ACT, or you would like to use ACT to help stop fighting your thoughts, there are a number of free resources that are a great starting point = http://www.actmindfully.com.au/free_resources

What is, and is not, a thought?

Thought, therefore, is simply a broadcast of one part of a deeper flow of information. Thought is not a controlling force. It’s not a case of, “I think, therefore, I am”, but, “I am, therefore, I think.”

Thoughts are often described in the peer-reviewed publications as the “stream of thought” or the “stream of consciousness”. According to Baars and Franklin, thoughts arise from the broadcast step of multiple cognitive cycles, but the conscious broadcast of our thought stream is limited to a single cognitive cycle at any given instant. Thus, even though it is considered a “stream”, our awareness of our thought is in a serial, sometimes disparate, sequence of frames [9].

There are some features of our stream of thought that differentiate it from other brain activity. We have a level of voluntary control over our stream of thought, even if it’s not direct [10]. It is also characterized by a metacognitive level – we have “thinking about thinking” [1, 11], and we have “awareness of awareness” [12].

Yet there are still many neurological functions that are confused with thoughts.

Brain activity

“Thoughts” are often confused for any brain activity. The stream of thought is sometimes referred to as the “stream of consciousness” but that’s a misnomer.

Consciousness has varying levels (coma, deep sleep, lucid dreaming, awake, and alert). Only some of these levels of consciousness allow thought. Therefore, it would be fair to say that thoughts are a form of activity of the brain, just like Toyotas are a form of car.

Brain activity is largely subconscious. It carries on in the background without our awareness [2]. There are multiple simultaneous streams of data being perceived all the time – sensation from our ears, skin, eyes and internal organs – that our brain filters out before it reaches our awareness. Background traffic noise, the pressure of your clothes on your skin, joint position, heart rate and breathing, for example. It’s not that these sensations are not present, but you only become aware of them when your attention is drawn to them. Those data streams are not thoughts in and of themselves because we lack awareness of them. They only become part of our thoughts when attention is paid to them. Since thoughts are characterized by metacognition, “awareness of awareness”, then neural activity we aren’t aware of cannot be considered thoughts.

The other problem with defining all brain activity as “thought” is that such as definition would also mean that seizures were thoughts, or brainstem reflexes were thoughts. We intuitively know that’s not the case.

Dreams

So what about dreams? We’re aware of dreams, aren’t we? Could dreams be considered thoughts?

Dreams are awareness of perception and emotion, similar to our state of awareness when we’re awake. But dreams occur in an altered state of consciousness (that is, we are asleep). Dreams also lack self-awareness. When you dream, you don’t realise that you’re dreaming. Secondary consciousness, the level of consciousness that we possess when we are awake, is defined in part as having awareness of awareness. It is more than just having awareness of perception and emotion. It is “self-reflection, insight, judgment or abstract thought that constitute secondary consciousness.” [12]

Memories

As I wrote earlier, memories aren’t just simple recall, but a complex system involving both conscious and unconscious elements. The conscious elements of memory are simply stored representations of events and experiences. They may become part of a thought broadcast, but they are not thoughts per se.

References

  1. Fletcher, L. and Carruthers, P., Metacognition and reasoning. Philos Trans R Soc Lond B Biol Sci, 2012. 367(1594): 1366-78 doi: 10.1098/rstb.2011.0413
  2. Tamietto, M. and de Gelder, B., Neural bases of the non-conscious perception of emotional signals. Nat Rev Neurosci, 2010. 11(10): 697-709 doi: 10.1038/nrn2889
  3. Jolij, J. and Lamme, V.A., Repression of unconscious information by conscious processing: evidence from affective blindsight induced by transcranial magnetic stimulation. Proc Natl Acad Sci U S A, 2005. 102(30): 10747-51 doi: 10.1073/pnas.0500834102
  4. Ohman, A., et al., Emotion drives attention: detecting the snake in the grass. J Exp Psychol Gen, 2001. 130(3): 466-78 http://www.ncbi.nlm.nih.gov/pubmed/11561921
  5. Meehan, T.P. and Bressler, S.L., Neurocognitive networks: findings, models, and theory. Neurosci Biobehav Rev, 2012. 36(10): 2232-47 doi: 10.1016/j.neubiorev.2012.08.002
  6. Hayes, S.C., et al., Acceptance and commitment therapy and contextual behavioral science: examining the progress of a distinctive model of behavioral and cognitive therapy. Behav Ther, 2013. 44(2): 180-98 doi: 10.1016/j.beth.2009.08.002
  7. Shakespeare, W., Hamlet, Act II, Scene 2.
  8. Harris, R., Embracing Your Demons: an Overview of Acceptance and Commitment Therapy. Psychotherapy In Australia, 2006. 12(6): 1-8 http://www.actmindfully.com.au/upimages/Dr_Russ_Harris_-_A_Non-technical_Overview_of_ACT.pdf
  9. Franklin, S., et al., Conceptual Commitments of the LIDA Model of Cognition. Journal of Artificial General Intelligence, 2013. 4(2): 1-22
  10. Bonn, G.B., Re-conceptualizing free will for the 21st century: acting independently with a limited role for consciousness. Front Psychol, 2013. 4: 920 doi: 10.3389/fpsyg.2013.00920
  11. Scott, B.M., Levy, M. G., Metacognition: Examining the components of a fuzzy concept. Educational Research eJournal, 2013. 2(2): 120-31 doi: 10.5838/erej.2013.22.04
  12. Hobson, J.A., REM sleep and dreaming: towards a theory of protoconsciousness. Nat Rev Neurosci, 2009. 10(11): 803-13 doi: 10.1038/nrn2716