In fact, in the mental health department, anxiety has become an emotional pandemic and the world is desperate for a cure. We talked to a new wave of psychotherapists who believe a dose of good, old-fashioned compassion just might do the trick.
Joanne smiles with her eyes, offers affection with gusto and when she’s worried about a friend, is quick to step in with a walk in the park, a pot of tea, an invitation to dinner, a shoulder to cry on. She’s a loyal friend, the magnificently encouraging mother of two bright-spark university students and a clinical psychologist with a Master’s degree and 20 years of successful practice under her belt. Yet until not long ago, Joanne thought she was “a bit of a loser”.
“My constant companion,” she explains, “was a part of me that said, ‘You’re not good enough. Other people do it better. What do you know? Who do you think you are?'”
That voice was so insistent, vicious and so convincing, it defeated every attempt to battle it with reason, and dragged her into dark spaces of depression, anxiety and despair.
Joanne wasn’t alone. The World Health Organisation has estimated anxiety and depression will be the number one health concern globally within a decade. They’re debilitating conditions that suck the joy from life, and kill. But there’s a new movement in psychotherapy that believes the key to defeating them might lie in a motivating force that exists alongside them in the human brain.
Professor Paul Gilbert OBE, the instigator of compassion-focused therapy, champions the power of kindness. It’s not a panacea, he admits, but it’s one of the most effective tools we have against anxiety and depression. The human impulse to kindness and compassion can be directed within to heal ourselves and beyond to heal the world.
Joanne is perched on the edge of a stylish sofa in the basement of the rambling old Sydney terrace house where she has her practice. She’s running through a potted history of life with the “inner critic” who sabotaged her every joy and victory for so many years.
“I got through university, in my 20s, with a lot of anxiety and self-doubt but I didn’t believe I was smart enough to take those studies further and do Honours,” the says. “Then I got a job in public relations, but I didn’t think I was good enough for that either. I did my best, followed my nose, but by 30, I was deeply depressed, constantly anxious and always feeling so unworthy. It forced me to a crashing halt. I had about six months of falling into the abyss and not really knowing where to begin to make sense of my life. But gradually, one step at a time, I found that I really wanted to study psychology and become a therapist.”
Joanne explains what happened next to illustrate how persistent and irrational a critical inner voice can become.
“So in my early 30s, I went back to university. I couldn’t believe that I could get through a psychology degree, then do Honours and finally complete a Master’s. But I did all that, and I did it across three universities as we moved with my husband’s job, while having two children. When I was doing Honours, it was the most stressful time. I had a one-year-old and our roof fell in during the 1999 hailstorm, and somehow I got through. Yet all the while this inner critic was telling me I was lazy and good-for-nothing and everyone around me was doing no much better.”
The “light-bulb moment” came a full 20 years later. Paul Gilbert was in Australia for a series of lectures, and on a whim, Joanne went along.
“We did a simple compassion-focused therapy exercise, which is to imagine what that critical voice sounds like and what it is saying. Mine was fairly caustic,” she recalls. “It was like: ‘You’re overweight, you’re undisciplined, you’re lazy. You know what you should be doing to live the perfect life but you don’t do it, so you’ve got no one to blame but yourself. You’re a waste of space’.
“There were about 200 therapists in the room and Paul asked some of them to describe their inner voice, and people were saying things like ‘mine’s quite harsh’ or ‘mine doesn’t say much at all’. But my immediate thought was that mine was telling me the truth. I really believed that. So I put my hand up and said, ‘What if it’s the truth?’ I felt like a complete idiot saying it.
But afterwards, at the tea break, Paul found me in the crowd and said, ‘You know, that voice is not the truth’. And that just seeded enough doubt in my mind that I was prepared to look further. It got me asking, ‘What if he’s right?’ And I began to recognise how much pain and suffering that voice had caused me. On some level, I think I’d always known I wasn’t a bad person. I knew I had a good heart and I was a good friend to other people. I just wasn’t being a good friend to me.
“So after that, when the attacking voice came into play, I could stand back from it a bit, and say, ‘You know, you could give yourself a bit of a break here. You’re doing your best. You’re just a human being. You don’t have to be perfect, and what you’re going through is really hard. What if you offered yourself a bit of kindness?’
“Seriously, overnight I developed a completely different relationship to that critical voice, and I realised compassion can be for the self as well as for others.”
Paul Gilbert is based at the University of Derby in England but he returns to Australia often, working with the University of Queensland, where researchers are studying the efficacy of compassion-focused therapy in treating weight issues and eating disorders. Sitting on a park bench on a balmy Brisbane morning, he explains why critical inner voices, such as Joanne’s, are so common and how they can be overcome.
“It’s not our fault,” he begins earnestly. “You have two arms and two legs, blue eyes and brown hair because these things have been built for you. Your brain has also been built for you, and all the things that go on in your brain — fear, anger, anxiety — have been built into it by evolution, your genes and background. Many of our most difficult emotions are rooted in the systems in our brain that have evolved over millions of years.”
“What we see now is quite a problematic increase in anxiety and depression,” Joanne adds. “But if we look at what type of design the brain has, that isn’t very surprising. The brain has evolved to respond to threat, to keep us safe, to ensure we’re always ready to defend ourselves. So we are walking around constantly monitoring and scanning for threats and that was very useful in the wilderness. The trouble is that now, in the 21st century, we’re living in this fast-paced world, overloading our senses, and things we can perceive as threats are coming at us 24/7. It never stops. So we’re perpetually on high alert and that creates anxiety.”
We haven’t chosen to be hard-wired with knee-jerk reactions to protect ourselves when we feel threatened. Nor have we chosen most of the formative experiences in our lives that mould us. Joanne didn’t choose to have an inner conscience that spoke so cruelly to her. She suspects that voice grew out of high expectations, a propensity for anxiety and a hefty childhood dose of Catholic guilt, and the inner voices of many of her clients have too.
“We don’t choose any of this stuff,” Paul says. “We don’t choose the way our brains have developed, whether through loving kindness or trauma. We shouldn’t blame ourselves, but once were aware of it, it’s our responsibility to take control, because if we don’t, the results can be harmful to ourselves and others.”
Fortuitously, although evolution has laid down basic systems in our brains through which aggression, anxiety and fear can flourish, it has also made possible our disposition for compassion. And we have the power to choose compassion.
“As a species, I think we’re all capable of great kindness and great cruelty,” Joanne explains. “That’s just us, the way we’ve evolved to survive. We can choose where we put our attention. We can make that choice between kindness and cruelty. Each one of us has that responsibility and capacity within us.”
Joanne has been fascinated by the way people reacted to COVID-19, in an almost textbook example of those two very different, very natural human impulses.
“It illustrates what humans do in the face of prolonged and intense threat,” she says. “The hoarding and attacks in supermarkets to get supplies are so understandable because that’s what humans do when they’re under threat. And for Australians — coming off the back of a summer of bushfires and drought and concern over global climate change — it was no wonder we were panicking about toilet paper.
“But then, when the threat subsided a little, we started to think: I wonder how that elderly neighbour’s going; I wonder what I could do to help; and all those frontline medical people are amazing; I wonder if I can support them in some way. We activated a different part of our brains. We moved out of the threat space into a more connected, helpful and compassionate understanding of what it’s like to be human going through such intense suffering. We took a little while to come to that because that’s the thing about compassion: It’s a response you have to choose — a motivation you have to move your brain over to. We can stay in threat mode easily but it’s much better for at and the world around us if we move on to compassion.”
So what is compassion?
According to the Oxford Dictionary, it’s a noun that refers to a “sympathetic concern for the suffering of others” but that’s not the whole story. Compassion therapy has been influenced by a combination of evolutionary theory, clinical psychology and Buddhism. And in the context Paul uses it, compassion feels as much like a verb as a noun. There’s movement in it.
He often refers to the Dalai Lama’s definition: “a sensitivity to the suffering of self and others, with a deep wish and commitment to relieve that suffering”. So the first step is to become aware of the suffering — one’s own or someone else’s — and the second step is to try to alleviate it. The Irish counsellor and author, Padraig O’Morain, coined the term ‘kindfulness’ to describe this ephemeral mix of a way of thinking and a way of being in the world.
A mountain of scientific evidence tells us that if we can become kinder, more compassionate people, we will be happier, and that happiness will ripple out into the world around us. Compassion has been found to reduce blood pressure, anxiety, symptoms of PTSD and depression, to improve sleep and boost serotonin. “If you want others to be happy, practise compassion,” says the Dalai Lama. “If you want to be happy, practise compassion.”
So, how do we flick the switch? Neva time we feel threatened or insecure, how do we quiet the voice that judges and condemns, and apply compassion?
“Like everything, it takes practice,” says Joanne.
First, we need to understand that the emotional tone we use can either increase our sense of threat, and with it our levels and stress and anxiety, or decrease it. We can choose to go into battle, or not. So Joanne suggests we begin by really listening to and observing our inner critic. “You have to know how you are triggering your threat system with your own internal messages,” she says, “and acknowledge the feelings that come with it.”
Then we can begin to develop a more compassionate voice. “That gentle, wise voice might not be something you can see coming from yourself initially,” says Joanne, so she often asks her clients to imagine a calm, helpful, caring friend. “What would they say? How would they say it? What would they look like? What qualities would they have? You might imagine Christ or Buddha or your grandmother or Oprah Winfrey, or you might create someone completely imaginary who will just sit with you, understand you and give you a hug.”
Joanne also uses meditation and conscious breathing to activate the parasympathetic nervous system, which is the gentle, collaborative, social part of our brain and emotional system, and which helps us to calm our breathing and heart rate, lower our levels of cortisol and adrenaline, and reduce that hyper-vigilant response to threat.
Finally, she says, we need to maintain motivation and keep practising. “When you feel anxious or Threatened, remember your slow, deep breathing, and respond to that vicious, judgmental aspect of yourself in a way that’s more accepting, understanding and comforting. If you can do that, it will soothe your anxiety and you will be able to think through problems more calmly and clearly.”
Life still throws Joanne the occasional curveball. “I mill sometimes feel anxious about whether I’m doing a good enough job as a parent. I worry about how my kids will fare in the world and whether I’ve done enough to prepare them,” she says. “It’s okay to feel a bit overwhelmed or unsure from time to time. We all make mistakes, and I’m doing the best job I know how to.”
The difference now is that she doesn’t beat herself up about it.
“Difficult things are still going to happen; you’re still going to feel hurt by life. But knowing how to be more helpful to yourself when you’re suffering makes a world of difference. I feel like I’ve become a really nice friend to myself,” she says. “I’m happy to walk around with me in my head.”
Text: Bauer Syndication