Ten Percent Happier with Dan Harris - 303: Depression and Anxiety: Your Old Enemies, Your Best Friends| Zindel Segal

Episode Date: November 25, 2020

Winter is coming. Not to get all Game of Thrones on you, but... while there are some optimistic signs on the horizon in the form of vaccines, it looks like we could be heading into some dark months of rising caseloads and restrictions on our lifestyle. Consequently, we are launching a 2-part series to help you ride this out. Next week, we will talk to happiness researcher Laurie Santos (host of the Happiness Lab podcast). Today, my guest today is Zindel Segal, a clinical psychologist from the University of Toronto and a pioneer in developing and studying ways to use mindfulness for depression and anxiety. While not all of us will experience clinical depression or anxiety in the coming months, we may well experience significant doses of sadness and worry. In this conversation, we talk about: what the science shows about the benefits of meditation for depression and anxiety; the importance of establishing and maintaining routines as a form of antidepressant; the differences between depression and anxiety; and how to treat depression like an old friend. Where to find Zindel Segal online: Website: https://www.utsc.utoronto.ca/psych/person/zindel-segal Twitter: https://twitter.com/zindelsegal Facebook: https://www.facebook.com/Zindel-Segal-955303284518859/ Book Mentioned: Lost Connections by Johann Hari: https://thelostconnections.com 2020 has been a doozy, so this year we’re offering Ten Percent Happier subscriptions at a 40% discount. Get this deal before it ends on December 1st by going to www.tenpercent.com/november. Take Part in the New Year’s Series To submit a question or share a reflection dial 646-883-8326 and leave us a voicemail. If you’re outside the United States, you can email us a voice memo file in mp3 format to [e-mail]. The deadline for submissions is Monday December 7th. Full Shownotes: https://www.tenpercent.com/podcast-episode/zindel-segal-303 See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Before we jump into today's show, many of us want to live healthier lives, but keep bumping our heads up against the same obstacles over and over again. But what if there was a different way to relate to this gap between what you want to do and what you actually do? What if you could find intrinsic motivation for habit change that will make you happier instead of sending you into a shame spiral? Learn how to form healthy habits without kicking your own ass unnecessarily by taking our healthy habits course over on the 10% happier app. It's taught by the Stanford psychologist Kelly McGonical and the Great Meditation Teacher Alexis

Santos to access the course. Just download the 10% happier app wherever you get your apps or by visiting 10% calm. All one word spelled out. Okay on with the show. to baby, this is Kiki Palmer on Amazon Music or wherever you get your podcasts. From ABC, this is the 10% happier podcast. I'm Dan Harris. Hey guys, before we get started, one item of business. 2020, as we all know, has been, let's just say interesting. So this year we're offering 10% happier subscriptions at a 40% discount. We don't do discounts of this size all the time. Of course, nothing is permanent. I think the Buddha said something about that, nothing being permanent. So get this deal before it ends

on December 1st by going to 10% dot com slash November. That's 10% one word all spelled out. Dot com slash November for 40% off your subscription to the 10% happier app. One more item of business and it is an invitation for you to participate in this show. For new years, we here at 10% are gonna do a whole series of episodes where we say goodbye

to the dumpster fire of 2020 and kickoff 2021 by taking a counterintuitive approach to the whole New Year, New Year narrative, which strongly implies that you have to completely reinvent yourself. That line of thinking is often based on shame and self-loathing. Our line of thinking is that perhaps we can flip the script a little bit. We are going to be exploring the science-based case for the rather cheesy notion of self-love. And then we're going to take the crucial next step of helping you operationalize that idea in your life.

Obviously, there are a whole lot of questions you might have. Like, if you love yourself, will you slide into sloppy resignation? How do you do self love anyway? Isn't it just an empty platitude, et cetera, et cetera? Hence this invitation. We would love to hear from you and we will answer your questions during the New Year's series right here on this podcast. So to submit a question or simply to share your reflections. Dial us at 646-883-836-646-883-8366 and leave us a voicemail. The deadline for submissions is Monday, December 7th. If you're outside the United States, we've put details in the show notes

on how to submit a question via an alternate method. To be clear, alongside the Special Podcast series, we're going to be launching around New Years. We're also doing a New Years meditation challenge on the 10% happier app, so feel free to ask us lots of meditation questions as well. All right, business concluded. Let's get to today's episode.

Winter, my friends, is coming. Not to get all game of thrones on you here, but while there are some optimistic signs on the horizon in the form of vaccines, it looks like we could be heading into some dark months here where we see rise in caseloads and restrictions on our lifestyle. So we're launching a two-part series today to help you ride this thing out. Next week, we're going to talk to Happiness Researcher Laurie Santos, who's the host of the really popular Happiness Lab podcast. Today, my guest is Zindl Segal, who's a clinical psychologist from the University of Toronto,

and a pioneer in developing and studying ways to use meditation and mindfulness for depression and anxiety. While not all of us will experience clinical depression or anxiety in the coming months, many, if not most of us, will probably experience significant doses of either sadness or worry or both. So in this conversation, we talk about what the science shows about the benefits of meditation for depression and anxiety, the importance of establishing and maintaining your routines as a form of anti-depressant. The difference is between depression and anxiety, which I had never really heard parsed as well as he does, and how to treat depression, and this is counterintuitive, how to treat depression like an old friend. So here we go with Zindl Segel. Zindel, hello, thanks for doing this. Hey, Dan, nice to be with you.

Yeah, I appreciate it. I'm curious by way of background, how did you get interested you personally in using mindfulness and meditation for depression? My way into it was a little different than a lot of the narratives that you hear, people who are working prominent in the field. A lot of people, I think, feel like they had a very personally transformative experience which led them to want to advocate more fully or more vocally for mindfulness and meditation. But my way in came through sort of following my empirical nose and at some point recognizing that mindfulness meditation can be a very direct and reliable way of helping

people encounter and practice states of mind that can be entirely antithetical to the places where depression, anxiety, and other kinds of mental health challenges automatically take their minds. And this is something that I saw that sometimes happens in psychotherapy that people can develop a way of getting a little bit of distance, a little bit of patience,

from the kinds of things they say to themselves, the kind of beliefs that they have about themselves, the ways in which they see themselves and their self-worth. But it didn't happen consistently, and a lot of it depended on kind of therapy that you were in, kind of care that you received. And when we got into this work, the therapy field itself was sort of in a state of flux with conflicts between more traditional forms of treatment and newer forms of treatment that were protocol driven and the value of evidence. And so it didn't seem to me like that was going to be a surefire way of helping people to develop the metacognitive abilities to watch the contents of their minds.

And yet mindfulness meditation is sort of in part exactly about learning how to do that, but not just saving it for negative thinking or judgmental ways of relating to yourself. It's about doing it for every possible moment. Did you encounter resistance when you first started talking about bringing mindfulness into the picture? Yeah, resistance, sort of, you know, warnings of career suicide. resistance, sort of, you know, warnings of career suicide. And the general, you know, sort of antipathy to the ideas of, you know, things that were popular in the 60s being used with vulnerable populations. I remember initially having a meeting with one of the psychiatrists who is at the research hospital that I worked at, and he was sitting in front of me, but behind this massive walnut beautifully filigree, a desk, and he flung this research article

across the desk at me and said, you know, here, read this, and this is a really influential paper that suggested for antidepressants to be continued three years after people who have had depression, had recovered in order to keep them well, almost like a kind of insulin model of, you know, you've got diabetes, what you've got to keep taking

it for a long time to protect yourself. And this is the argument made with antidepressants. And how is that going to convince or even sort of ask someone like this to consider the possibility that the same patients could benefit from learning mindfulness tied to preventing relapse and depression. And really, the only leverage I had and my colleagues had was to provide evidence that the practice of mindfulness could really impact these harder outcomes of people surviving for a longer if you follow them without relaps app saying then if you don't teach them this or if you give people an anti-depressant and you take it away and you give them a placebo, you compare them to folks who have been trained in practicing mindfulness, they survive longer than the folks on

the placebo and it wasn't just our work, but it was the replication of this work in other countries, across a number of other labs and with more and more patients. But I think eventually got people to pay attention to that proposition, which I think in the early 90s was seeing us somewhat heretical or unusual at best. So can you walk us through what the data show? What kind of evidence have you been able to provide?

Sure. We were able to show that, well, I think initially our strategy was like, is there anything here at all? Like if you develop a treatment for people that have recovered from depression and the idea is, you know, you've gotten better, but you're still at risk. You may not be feeling a lot of symptoms of depression. Your negative thinking or your judgments may not be super intense, but there still is a way in which a small setback, some small set moods, could end up tripping you back into a depression. And that's really what you want to guard against. And there weren't a lot of ways for people to learn how to maneuver and manage small setbacks if they were vulnerable.

So the first thing that we did was to see if we just compare people who were in recovery receiving usual care. And if we added this eight week program mindfulness-based cognitive therapy to their usual care, and we followed them for a year, We found that the people that had their usual care and mindfulness-based cognitive therapy ended up having about a 35% lower rate of relapse than those who just had usual care. And so we did that. We replicated that. The first was a three site study Toronto Wales and Cambridge in the UK.

And then there was a subsequent replication in the UK with a smaller study. So then we could say that there's a signal here, and you know, we couldn't say definitively that it's the mindfulness meditation piece, but we could say that these folks are doing better, if they take these skills on board, if they practice these skills, if they ten more sessions. And then really the next thing that was instrumental was comparing it against the standard of care at the time, and which it still continues to be, antidepressants. And so when we tested it against antidepressants, we found that we did just as well, as people who were maintained on an antidepressant for 18 months or two years, compared to people who were taken off an antidepressant and received MBCT. And so for us that was really important. We never really set out to be better than antidepressants or get involved in sort of polarized arguments

about you know we're good, they're bad or whatever. But there are so many people for whom antidepressants really are no longer an option once they've recovered even once they've recovered on an antidepressants really are no longer an option once they've recovered, even once they've recovered on an antidepressant people sometimes have a side effect burden that's really tough to tolerate. Women who are pregnant are very lary of continuing on antidepressants, even if they've had past depression episodes. Sometimes antidepressants themselves lose their potency, something called tachyphalaxis, where they work for a while, they work for a while and then all of a sudden they sort of stop working. There's enough people out there who are still at risk and they need some kind of protection.

So, NBCT really, I think, was able to show that there's enough territory for all of these different treatments to work well and also that for people who can't continue on an antidepressant, there's something else that provides equal protection. Is it either or though, is it possible that mindfulness and meditation would work well in concert with antidepressants? I'm a bit of a reactionary on this issue.

People are sort of pushing me to say, like no, like just, some of this depressed just start NBCT right away. I don't really think that that's really been shown in any convincing way. So my sense is that the very good way of doing it is to sequence these different forms of care so that you can help someone get better on an anti-depressant and do something totally different by getting them into a mindfulness-based cognitive therapy class to help them stay well. I think a lot of our listeners will be familiar with MBSR, which was founded by John

Kabatzin who's been on this show several times, mindfulness-based stress reduction, which is John's insight was, Buddhist meditation can be really helpful, but it's a hard to introduce into a clinical setting because it's religious, and there are metaphysical claims and religious lingo associated with it. So, he came up with something called mindfulness-based stress reduction, which was just a revolutionary move. And because he was a replicable protocol out scientists, to research what it did to participants. So you guys came up with NBCT.

NBCT, right. NBCT, okay. So mindfulness-based cognitive behavioral therapy. So you walk us through what that is? Yeah. So mindfulness-basedven therapy basically started in a dialogue with John and going to some of John's classes and some of the senior teachers at the Center

for Mindfulness who were teaching Mindful Space Dress Reduction. And we were interested in meeting John and talking to him about this because we felt like the Mindfulness element was really important. But not as a kind of general panacea for people, but because mindfulness was a very direct route to training the metacognitive capacities that we thought were the antidote for many people with depression. Metacognitive just means being able to de-center and step back and watch your thinking without identifying with it fully. So Jones Vision in some ways was revolutionary,

I would also say it was subversive in the sense that you know, you could participate in teaching people this stress reduction protocol, but you could also be teaching people Dharma and other things that you as a teacher might have an interesting attachment to. We weren't in through teaching people Dharma, that wasn't why we got into it, but we did think that there was a very important way that this could reliably deliver to folks, the capacity to watch and observe mental contents that were helpful and not being hooked into automatic patterns that are triggered by depression So for us the barrier was really getting a view of a meditation and mindfulness That was compatible with what we had as our pre-existing framework

I think a lot of people coming into amyas are already have no barriers to connecting with the meditation and contemplative aspects of the work and Then I think these two strands really dovetailed very nicely, as a way of just helping people deliver to themselves the capacity for care that was kinder and very different from what might be achieved just through, you know, psychotherapy alone because the capacities that get opened up through the practice of mindfulness are a lot more vast than anyways. So I'm damn yeah I'm reflecting back at my own non-trivial amount of psychotherapy. One of the things one of the things that happens with a good therapist is they will sort of reflect back to your own thought patterns.

Right. So they're taking on the role of mindfulness and what you're teaching people to do in this program is to kind of be their own therapist. And yet you say it's more vast. I think you're right. And I think one of the things that's important is what you said with a good therapist, working with a good therapist. I think generally therapies do try to provide people with a capacity to stand back and watch their experience from a different vantage point than being fully identified with it. The trouble is there's no direct training for how to do that. So whether you're

watching yourself be critical and judgmental or whether you're you know eating an orange first thing in the morning with mindfulness both of those moments provide you with an opportunity to watch and to immerse yourself in sensations and a way of slowing down time and building the capacity to develop this decentered quality that can really serve you when you're in moments of conflict. I think with therapy, what's missing is that the practice is really good for moments of conflict, but what's the training for just the everyday where conflicts may not be ever present, but you still want to be close to your experience and

connect with it more fully. I think that was the real appeal to us for mindfulness. Like these people who have recovered from depression and are at risk can practice every single day the skill that they might need. If one day someone rejects them, if one day someone cuts them off in traffic, if one day they do something really wrong and start to beat themselves up over it, you know, it'll be available to them if they're able to practice it and really keep it fresh and accessible. Did you have a meditation practice going into this?

You know, I had a couple of things going into it that I cast off when I was young. At one point, I was initiated into TM, practice TM for a little while, stepped away from it when it became about no disrespect intended, but when it started to sell sort of extraordinary powers related to what TM can do for you, like additional trainings, levitation, that kind of stuff. I didn't believe that stuff any longer, so I couldn't follow it. At one point, I was getting these little booklets from Menlopark, California, and Brad paper wrappers, which, no, although I wasn't adolescent,

they weren't pornography from Sweden, but they were this thing called Eckenkart, which was called the Science of Soul Travel. Talked about existence on these different planes, astral plane. I checked it out for a while. It didn't travel very far. I didn't earn a lot of frequent flyer points with Soul Travel. So I stepped away from that as well.

So I had that, let's say, when I was 18, 19, 20, 21, 22. And then I stepped away from it until, you know, I guess my mid-40s when we went and started to work on mindfulness-based cognitive therapy. And initially, my view of mindfulness was something akin to relaxation training where there was something that I could give people a cassette recording.

Well, here's a work of set recording of John Gabbitt's in doing, you know, mindfulness. Listen to it and tell me what you find when you come back. My first pilot groups really were me doing that and then finding out very quickly that I really ran out of runway to talk to people about how this could help them regulate difficult emotions, difficult moods. And so it was only through my own practice of mindfulness, which I started and you know, I've kept up ever since, that I could really understand

the stuff from the inside. Have you suffered from depression at all? Is this a personal issue for you? I don't suffer from depression. I think probably I'm more on the anxiety spectrum, I don't suffer from depression. I think probably I'm more on the anxiety spectrum, but people in my family have suffered from depression, so I'm close to it in that way. What is the difference between depression and anxiety and how often are they serve co-morbid or co-occurring? If you think about the kind of mind states

that depression triggers versus one anxiety triggers, you can think of them dichotomously as states of mind states that depression triggers versus one anxiety triggers. You can think of them dichotomously as states of mind that relate to loss and self-judgment, critical self-judgment is characterizing depression and threat and catastrophe is characterizing anxiety. And then you get into cycles where one can feed the other, and things can really sort of elaborate themselves into a place of being very, very overwhelming. In terms of comorbidity, sometimes depression gets treated, and some of the residual symptoms that are left are symptoms that relate to anxiety, and can show up in terms of insomnia, other ways in which people have physical concerns,

even though they're, let's say, appetite and sleep have been restored to some extent. And then I think with some of the anxiety disorders, chronic anxiety disorders, if people find that their functionality, their ability to kind of get around the world is really severely restricted. They can start to become very depressed and start to breathe that as well. So they're interlinked,

but they can also be very distinct if they show up in some other cardinal signs. And as MBCT, does it work for anxiety as well? It does. It does. And part of that is that because it's very rare to have someone who only has, like they may have a diagnosis of depression, and often that's a diagnosis that's required to come into our studies. But if they have a diagnosis of depression, a secondary diagnosis of, say, social anxiety

or generalized anxiety disorder, they wouldn't be left out of our studies. And so when we look back and we see that all these folks have been there, they do equally well. And one of the reasons for that, Dan, I think is because there are these underlying processes that actually tie depression and anxiety together in certain ways. And I think that's what's being touched by the mindfulness practice, which is something like learning how to relate differently to remination, learning how to relate differently to worry and catastrophization. Those things run underneath all kinds of disorders, and even for all of us, to show up from time to time,

and it's trying to find a way of developing a different relationship to that. Yeah, I mean, it seems to me, and I'm not in everybody's mind on the planet, but it seems to me that there's some universality here because you described some of the hallmarks of depression and some of the hallmarks of anxiety, and it's just sounded like an average Tuesday for me. And I don't know that I've been in clinical, I think I've reached clinical depression and anxiety, I'm sure, at points in my life, but I don't think I'm there right now.

So I would imagine that we all deal with gradations of these. Yeah, I mean, this is the big debate right now that's happening in psychiatry. It's a kind of psychiatry, psychology, mixed martial arts contest. Because in psychiatry, there is this belief of discrete illness syndromes. So they look at depression and they see, you know, everyone feels sad. Everyone can feel like their days are a struggle.

But not everyone has sleep that's disordered where they're waking up at 4 and they can't go back to sleep. Not everyone is losing 10 pounds because they're not interested in eating, not everyone is turning down social engagements because they just don't feel like they want to be with other people. And you might say, well, yeah, there are some people like if you're working a business and you're about to launch and open a new store and your boss is asking you, like, you got to work four days in a row and we've got to work at night. You might have some of those symptoms. But if all of those symptoms continue for a minimum of two weeks to a month,

then they would say you're in a different territory. And so the clinical part of the depression isn't just the symptoms. It's the persistence and the impairment that comes for like not being able to you know recover, if you stay up three nights in a row because you're cramming for exams, you can get to sleep the fourth night. But if it's twenty nights in a row, you're probably into a different territory. And in psychology, there's right now an effort to really talk more about dimensions. So everyone feels sad, and some people are further along the continuum of sadness, and they are arguing against these sort of nature, you know, cutting nature at its joints into discrete syndromes and saying that we're all

on these dimensions. Some of us have more of it, Some of us have less of it. But I think that people that I've seen who really end up exemplifying the press of disorders are really, really suffering in a way that is very difficult for them to turn around. So what is, I guess, apparently mistakenly called it, mbcbt, mindfulness-based cognitive

behavioral therapy, you corrected me too, mindfulness-based cognitive behavioral therapy, you corrected me to mindfulness-based cognitive therapy. What is cognitive therapy? Is it different from cognitive behavioral therapy? What are we talking about here? How is what you would learn in MBCT different from what you would learn if you downloaded a meditation app and started meditating that way? Let me get to the second question first,

because I think that's more interesting. You probably wouldn't learn anything really different. I mean, our teaching of mindfulness is my exposure to learning mindfulness came initially from the workbook that Sharon Salzburg and Joseph Goldstein put out, which was a thin little workbook, and it came with about eight cassette tapes that I used to listen to. It it was just Vipassana, you know, mindfulness meditation. And I think the wrinkle

that's different here is that the practice of mindfulness in and of itself in NBCT is then used as a way to investigate the press of states of mind that people become increasingly familiar with. So the aversion that many people have with their own disorder is to confront elements of it and to develop a different relationship to be friend aspects of their suffering. Mindfulness provides them with a way of both grounding the mind, stabilizing the mind, and

then allowing them to approach almost like you're pushing a little bruise in your thigh to feel how bad it is. You know, push it too hard because you don't want to re-engure yourself, but you can approach a certain degree of unpleasantness. And then you learn a different relationship to it. And so, NBCT is teaching people about these, are the states of mind that characterize depression or anxiety. These are the thoughts that come up in people's minds.

We even have a exercise that has people imagine that they're kind of making per rating a playlist for Spotify with their most popular negative thoughts. Which are both thoughts that you would put on your playlist, which would be number one, which would be number two, which would be number three, it's a way of approaching and holding some of these thoughts

with a different relationship than a version or just pushing them away. And there's a wonderful quote from a Billy Collins poem that I use, I'm imagining, you know, Billy Collins, used to be the poet laureate of the U.S. and he wrote this poem called Insomnia, or he writes about his struggles with insomnia. And at one point he calls insomnia my own worst enemy, my oldest friend. And it's really that attitude of recognizing the pervasiveness and the capacity for acquaintance with the phenomena of depression or anxiety that we try to teach.

And a lot of that comes out of the ability to use the space created by mindfulness practice to allow some of these elements in. And once people are able to develop a different relationship to them, they've got way more options to choose how to react when those things show up, even if they're unbidden. And CBT versus CT. Not much of a difference. I think CT has more of a focus on identifying thoughts that people have and kind of looking for evidence that supports or doesn't support those thoughts, gathering evidence, you know, conducting sort of experiments, making predictions, those predictions come true or not. CBT is adding a behavioral element where you're doing things to expose yourself to fearful situations. You're doing things to purposely engage in activities that are pleasurable even though you might not anticipate that

they would be. So it's kind of a nuance. Yeah, after I had, when I started working with the psychiatrist, after having had some panic attacks, we did a little bit of that, you know, trying to expose me to things that would give me panic. So let me just get back to something you said a moment ago, the befriending of these, you know, the, it's my old friend and Somniah. Do you get a lot of pushback from people who say, look, this in Somniah or this anxiety or this sadness has been bird

dogging me my whole life? I do not want to befriend it. What is the point? Yeah, for sure. For sure. You get people saying that because it just seems so possible. And the other reaction is like, why the hell would I ever want to? I want to get rid of this stuff. And so there is that possibility that is being offered to people. You know, there are solutions like every self-help book is all about how to get rid of and fix and problem-solve and do that kind of stuff. Medications also, I think, have in there an implicit promise of eliminating negative affect

or seriously, seriously reducing its intensity. And I think inside the practice of mindfulness, there is a different alternative that can be explored which is to approach something without a strategy of fixing it, but approach it with a strategy of fixing it, but approach it with a strategy of investigating it. And learning that through that investigation, there are elements of it that are entirely undervalued and unconsidered based on what people think about it in advance.

And in that discrepancy between the actual moment to moment experiential learning and the mind's forecasting of what things are. There's a tremendous option for things to be seen differently and even to feel liberated from the mind always telling you that the mind knows what's best. I know that's a mouthful, so let me give you an example. Someone with anxiety. For example, you know, the mind says, I don't really want to drive my car on this busy highway because it's really dangerous and I'm not going to drive my car, you know, I'm going to get anxious.

And part of investigating that anxiety with someone as their driving might be to say, can you give me a rating of how anxious you feel from 0 to 100, being the worst, zero being least anxious and people can notice that their anxiety goes up and down. There may be times when they're at a 90 times when they're at an 80, maybe they're at a 70, they jump back up to a 90. There's this movement even inside a static idea of anxiety. There are these moments of movement of flux and change that are the experiential reality of what's happening.

But the mind ossifies that into an idea of my anxiety will be here and I'm going to be locked down by it. I can't do anything. And mindfulness really encourages people to step inside the moments of the experience to notice that flux and change and there is that discrepancy with what the mind is telling you is actually going on and your ability to actually experience it quite differently inside of it. Now whether that's eating an ice cream, whether that's dealing with a moment of being frightened by something or responding to a female that tells you about something happening that you know is negative to you, that I think is really the pivot point inside the practice of

mindfulness that allows people to learn differently? For me, there was a huge shift in my own practice between investigation, which I did in a journalistic, clinical way of my own patterns, et cetera, et cetera. I would anger, it arrives, and I would look, where is it shown up in my body, et cetera, et cetera, and friendliness. Now that was a huge shift because, and I've said this before, but I like it, so I'm going to say it again, there is this notion of slaying the dragon in Western myth, but actually hugging the dragon is a much more effective form of disarmament. Seeing you can do it cognitively, like, oh yeah, this self-critical voice that has been just bringing me low since sentience is actually trying to protect me, not so skillfully, well, that actually can bring me to a state of

friendliness. And I have found that that approach is a much more effective way than feeding it, fighting it, or even just sort of investigating it, but with some sort of subtle, often unseen aversion or detachment in there. The full-on friendliness move has been really helpful to me. Does any of that make sense to you? Yeah, I think that that's the Billy Collins Paul. My own worst enemy, my oldest friend, because part of what you're really describing is how the ability to investigate can be done in a cold way, a kind of clinical noting. Oh, here's tightness in my chest. Oh, here's throbbing in my forehead. Oh, here's heart racing.

And you're like you're just kind of ticking off things on a list, but the real way of bringing curiosity also has embedded in it kindness. So that as you see these features show up in your body, there's also a kindness to the person who's experiencing this. And you're investigating them not to try to get rid of them, like, oh, if I pay enough attention to the tightness

in my chest, it'll go away. But what happens is that it actually, I think, implicit level communicates to you that you are actually bigger than is bigger than the tightness in the chest. That is bigger than the throbbing, and you are providing an attentional space in which these things can exist.

But they're not all of you. And when people do experience some of these very difficult sensations or frightening thoughts, they feel like that's really all that there is in front of them, and they really need to double down and get rid of this, or it's going to be destructive. So being able to have a larger attentional field in which you can watch, the rising, the resting, the passing through the mind of these things suggests a mind that's larger and not defined by any one of them. And that can be very, very, very helpful because it's that watching the movement that gives you a different place to stand when these things show up,

and then you can choose what you want to do. Much more of my conversation with his indosegul right after this. Raising kids can be one of the greatest rewards of a parent's life. But come on, someday, parenting is unbearable. I love my kid, but is a new parenting podcast from Wondry that shares a refreshingly honest and insightful take on parenting. Hosted by myself, Megan Galey, Chris Garcia, and Kurt Brown-Oller, we will be your resident not-so-expert experts.

Each week we'll share a parenting story that'll have you laughing, nodding, and thinking. Oh yeah, I have absolutely been there. We'll talk about what went right and wrong. What would we do differently? And the next time you step on yet another stray Lego in the middle of the night, you'll feel less alone. So if you like to laugh with us as we talk about the hardest job in the world, listen to, I love my kid, but wherever you get your podcasts.

You can listen ad-free on the Amazon music or Wondery app. Just to go back to something you said a while ago about we were talking about this apparently controversial notion that anxiety and depression may exist along a spectrum, even if we don't qualify as clinically depressed or clinically anxious, we may have depressed thoughts or states of passing states of mind or anxious thoughts or anxious days even.

We are now in the middle of a pandemic and winter is setting in and I would imagine that these are all anxiety and depression again, whether we're clinical or not and whether that even matters or not, whether that even matters or not, we're all experiencing, I would imagine, some tastes of both of these states. So what advice do you have for us as we enter this potentially difficult period of human history? Yeah, I think everyone's feeling a shared burden. It's not local, it's not national, it's international. And I think with that comes a casting about for solutions. Now I think for some

folks it was a little bit easier to try and find a way of dealing and coping with the pandemic because it started in the spring. And it went from spring to summer to fall. People had moral options at that point to do things outdoors and to be with people in a way or at least to see people. We're probably not gonna have a lot of that in the winter as we have to hunker down and temperatures get really cold and there's a lot less available to us. So what I would say is if you have routines that served you, be aware of how

increasing feelings of worry, increasing feelings of sadness, increasing feelings of disconnection may begin to persuade you to let go of your routines. They may make those routines seem puny compared to the, you know, troubles in the world, troubles in your neighborhood. They may make those routines seem ineffectual. But in fact, a lot of those kinds of ways of relating to your routines and things that have been helpful to you, wasting, which you've been able to show yourself kindness or connect through kindness to other people, are the very things that I think we need to hold on to. And so recognizing that some of these narratives

around needing more, needing different and maybe some of the anger or other ways in which those resentments can show up, if they start to chip away at their routines, sometimes that can be more of an effect or a side of moods, rather than something that's truly inadequate about the routines that you have been following. Just speaking for myself, my routines around exercise meditation, increasingly routines as well around both nature and making sure I engineer some sort of social connection in person or not,

those routines have really been helpful for me throughout this whole disaster. Yeah, and usually the thoughts that come to allow us to give up or to consider giving up the routines, they're fueled by a kind of estimation that they won't make a difference or that situation is much more grave than any routines can undo. But I think of fatigue of going through the same old routines and I wish for something different

and something a little bit more vigorous. But with all kinds of restrictions in place, both due to weather and maybe due to the need to control infection rates, sometimes those routines are the best thing that we can do. What about social connection? We had a gentleman on the show, I don't know, 18 months ago, his name is Johann Hari, he's journalist, he wrote a book called Lost Connections. And his thesis, I'll try to reproduce it and I apologize to Johan if I'm missing it. But there seems to be a consensus he's arguing that a big part of why we're seeing so much

depression globally is that we're undermining face-to-face social connection, meaningful relationships. Do you agree with that? Well, I'll start with that. Do you agree with that? I think I know his work. I think I've seen more red parts of his book where he's actually talking about depression as being curable through enhanced institutionalized systems for social connection and not necessarily through medication or as other forms of therapy.

If this could be rolled out on a kind of massive national scale. You know, I think that there is a way in which it's probably going to be helpful to anyone, but as a national depression treatment initiative, I think there are people who have a lot of others around them. We do care for them and that they're connected to, but that there are certain brain regions and other parts of their physiology that are really locked into cycles that sometimes can't just be helped by people around

or people willing to listen or people will like to be supportive. I'm in an interesting position because I haven't read his book, but I have sat and interviewed him. And when I did interview him, he made it pretty clear that he's not against antidepressants. He's against the overuse of them

and thinks that often we're missing the social connection piece, which could help a lot of people. I don't know if he uses the word cure. I mean, part of it depends on how you also see the social connection, saturation of social media. On the one hand, things like Facebook and other social media apps allow people to be connected to more individuals in a broadband network. But as the people have also suggested, it's a different type of social interaction

and is it a proxy for the kinds of social interactions that we've used to have? Does it take the place of having a socially distance dinner with friends or something like that? Are there kinds of social connections that are more enhancing? And does that mean face-to to face in person versus online? So I don't know, it's, it's not something

that I've really given damage to, although I know that there are a lot of people who, when they have a problem with depression or anxiety, some of the first places they go to is social disconnection. As we head into these dark winter months, made more dark by what appears to be perhaps a period of sort of decreased optionality when it comes to movement and socializing, do you think it would be important for our mental health for us to find ways to connect with other people safely and if so, what would you recommend?

I think that's actually imperative. Once again, I used to go to yoga classes on Sunday mornings and so what I've done is I now watch yoga classes on YouTube and take myself through it downstairs with a heater next to me to try to simulate a more warm environment. And I can see that as a appeal fax, similarly to anything I've had the experience of in the past, but at the same time, I'm not going to let that go and wait for in person to start up again. I think that's really the challenge for us to stay connected in this way.

So that's one way of doing it. I think the other way of doing it is via the video conferencing platforms that are available that everyone is using for work to continue to use them for social meeting people stay connected. The people that I know who have a weekly standing meeting with parents who might be living in another continent. You know, I could have done that in December a year ago. Parents are still living in the same place, but they only started doing a term pandemic because somehow it's like, oh,

wow, this is a good way of staying connected because now we need to. So I think these are things that ought to be continued and supported. In terms of an antidepressant, let me make a pitch for something and see what you, and I'm using antidepressant in a lay way here. I'm not talking about medication, although I have nothing against medication. I have found, and again, you can tell me if I'm off base here, but I've found regularly investing in getting outside to be extremely helpful. Am I imagining that? No, you're not imagining it. There's really good evidence actually if you look at what might seem trivial kinds of metrics for your instinct that you're spot on.

A number of studies that show if people spend time outside, that they show increases in recognition and recall memory, that there's something that enhances their ability to see themselves from a wider perspective, like they're embedded in something that's not just themselves, not just your head. And sometimes that can loosen the grip that very entrenched static views of the self or the ego have on us by giving us an experiential sense of spaciousness that can be very hard to create through concepts and ideas. And then you have these other benefits like I think even going for nature walks in and of

themselves has been shown to have some anti-depressive benefits. And I think part of it is because it's just like in the practice of mindfulness, you start to see the self as much bigger than what concepts and ideas are your own narrative about self is. And you touch into it experientially, you know, carry it with you forever. But when you're there, you know, it it with you forever. But when you're there, you know, it's there to be plugged into back again. It's interesting. I'm picking you may have said this earlier, but I'm only met maybe it's only now really hitting me belatedly, but there seems to be a real self centeredness to depression.

And I mean, it's certainly interpolating back to my own experiences of depression, which a real self-centeredness to depression. And I mean, it's certainly interpolating back to my own experiences of depression, which started pretty young. It's certainly that rings true for me. And this mindfulness, which allows you to kind of step and to view the self in a little bit in a different way where you're not so caught up in all of the terrible ideas, you know, the voice in your head is serving up. It kind of shaves down the solidity and all-encompassing nature of the ego.

Does that sound right to you? Once again, spot on. Okay. I'm glad. I like Gold Stars, thank you. Yeah, yeah. I mean, you're definitely Okay. I'm glad. I like gold stars, thank you. Yeah, yeah. I mean, you're definitely trending towards a gold star. The reason that I think what you're saying is really important

is that so much of what the mind does when people are depressed is that self becomes a problem to solve a domain to fix. People are continually reminded of their imperfections Ways in which they're not worthy, ways in which they're not good enough, ways in which they've made mistakes and so much of remination There's a kind of emotion inflected rehearsal of ways of fixing the self and you know why if you could just do this you'd be okay if you can just get this into gear If you can just get that so there is this purposefulness and problem solving perspective that we take on board in

a kind of vain hope that if we can kind of get these things sorted, we'll be okay. And mindfulness offers this entirely different perspective, which is you can work at having an experience for its own intrinsic sake and not how that experience will serve self. So it's like you're taking self out of the equation and you're just noticing a throbbing in your leg for what it is. And then what's it like in the next moment and what's it like in the next moment and what's it like in the next and start noticing qualities, start noticing movements, start notice intensity,

self isn't part of that equation. So here you have these two different ways of enhancing self-reference, which you know, we use a certain brain that are, you know, much more midline, frontal, and very well tuned to a narrative around self. And then with mindfulness, you're using brain networks that are a little bit more of the back of the brain, where you're just dealing with sensation and you're kind of looking at a flow of sensory input. Self isn't part of that. And the way that it works is these networks in the back start to feed forward

to the networks that are at the front and then self starts to make sense of these things. So yeah, in depression, in anxiety too, I mean, I think self is a big part of it as well in terms of protection and threat and all of that. I'll lay out another sort of technique that's been helpful for me in terms of dealing with the various, you know, slings and arrows that we've all been suffering through. And I say this in part because I want another gold star, but in part also because I think we might actually be helpful for people and it really jabs with everything else we've

been discussing here. I don't know if you're familiar with the work of Kristen Neff, psychologist who talks a lot about self-compassion. Self-compassion? Yeah. So she has a three-step sort of free range. You can do this sort of, you know, in the middle of everyday life when you notice something coming up that's painful.

So you've got this three step exercise and I'm gonna add a step, which it will jib with what we've just been discussing about the self. The first three steps are one is just to notice that this is a moment of suffering. I often like to use the phrase this sucks. So I'll walk past a reflective surface. Notice that I've got a whole story about how bad I look or whatever.

Step one, this sucks. Step two, connect to the fact that you are not alone, that this is at this very moment, there are untold millions of people who are having the same thought pattern that this is you're not, you know, the victim of some sort of bespoke lunacy. The third is to send yourself some friendliness, which we've been talking about before, which is sort of hugging the dragon. May I be free from suffering? They'll maybe use some of the phrases from loving

kindness meditation or compassion meditation. So those are her three steps. I'm going to add a fourth, which I think, which I've been doing lately, and I think really jibes with what we've been talking about the self, which is, this is nature. These thoughts that are coming up that feel like so me. They feel like vintage Dan are just nature. I did not ask for them. They are the result of sort of beginningless causes and conditions from the culture, from my family, from whatever. And then you're just, you're really out of being trapped in this self and seeing it from a much more, with so much more helpful perspective in it, isn't dissimilar to the kind of perspective

you can get from a nature walk where AWE can set in and you seem like you're part of a bigger system. Yeah, that sounds great. I mean, for you to be able to bring yourself to that more expanded view of that moment, is really, it's big. It's been helpful for me, so I throw that out there in the spirit of things that maybe we can all try as we head into

what could be an even more difficult period. Are you willing to try something now that's a little bit different from that, but equally aimed at the same kind of moment of exploration? Always, bring it on. Yeah. So this is called a three-minute breathing space.

And it's just so interesting, because I don't know, I don't want to say anything about it. I want us to just drop into it and then maybe we can try to take a look at what the Christineff influence practices compared to this. Great. So let's just take that moment. If you can even, I don't know, bring to mind a moment where you did pass

by reflective surface and you just like this thought popped into your head. And if that's where we are, is that possible? Not hard to conjure. Not hard, okay. Within reach. Okay, so going ahead and closing your eyes if you feel comfortable and just taking a second to feel the body sitting in the chair, settling in if you need to for just a few seconds. And then in the first step of the breathing space, seeing if you can look into the mind and just ask yourself what thoughts are here, what feelings are present, what bodily sensations are making picking themselves know. And perhaps a thought about seeing your reflection and any other emotions or sensations that come

along with that, just holding them, watching them from one moment to the next. Not needing to change or alter them in any way. And now seeing if you can let go of the contents of the mind, bringing your attention to a single point of focus on the breath of the belly. And feeling the belly rise as you breathe in, feeling the belly fall as you breathe out. And just giving the mind this one thing to do, staying with the focus on the breath, this gentle rhythm of rising and falling, moment to moment and breath by breath. And now seeing if you can expand your attention around the belly and around the breath, letting your attention radiate upwards into the whole body and feeling the whole body sitting and feeling the whole body breathing from the crowd of your head to the tips of your toes, one whole breath and one whole body.

If you're willing even allowing the attention to move beyond the body to feeling the air caressing the body or the clothes lying on the body. You're even feeling the space of the room itself that you're sitting in. Holding all of this as best you can in a wider or open awareness. And then when you're ready, just allowing and eyes to open. Did you notice anything about that practice? My soul traveled. No, kidding.

I'll put your name down in the middle of the box. So yes, I did notice something. I noticed that conjuring the moment from this morning as I was getting in and out of the shower and had lots of judgmental thoughts about the reflection, really conjuring it, and then dropping it, and focusing on the breath and the whole body, then the space around the body, it exposed the thoughts as merely thoughts. So it's not either or, it's not better or worse than what you described based on the other approach

But here's a taste of spaciousness and how thoughts can sit And the spaciousness isn't the concept it comes from feeling spaciousness as you create a sense of connection with the body and the breath and then all of a sudden not just the belly the whole body sitting whole body breathing and this field is a place where you can drop a thought like that and then notice what it brings up, but it's not just your entirely that thought and you got to do something about it and what's your next move and how you're going to fix it and what does it say about you. It's just a place where these thoughts can show up and you can eventually, you know,

watch them or do other things, but that spaciousness is really close at hand. If we travel It's just a place where these thoughts can show up and you can eventually, you know, watch them or do other things. But that spaciousness is really close at hand if we travel there through sensation. Yes. And so this is one of the core practices in NBCT. It's what we teach people to do as a kind of way of responding to things that are going to come up for them inevitably. That's great.

I thank you for doing that. Sure. Just in closing here, you had this, you're coming on the show was in the result of an email exchange we had about the fact that you're increasingly doing some thinking about how to get NBCT out to folks who can't necessarily do it in person. So what's happening there? Yeah, I mean, this is very pandemic relevant because as you probably know, a lot of people are not able to access care during these days,

elective surgeries, other kind of just routine mental health care. So son of the midgenit I've been working for a number of years because we recognize that it's much as MBCT is well supported and there's a really strong evidence-based friend. It's really, really hard to basically find an MBCT therapist if you want one. And so we developed a digital version of MBCT that's available on MindfulLoggin.com and that's a company that we started to enable the public

to have access to the same kind of treatment that you could only really get if you were in one of our clinical trials. And it's essentially a asynchronous digital version of the treatment. People can take themselves through it at their own convenience. And ironically, one of the, I guess, positive aspects of the pandemic is that online care

is now considered legitimate. Whereas before, it was considered a sort of consolation prize. And the evidence that we have is that it's effective and people are using this more and more as a way of helping themselves and working through exactly the same things that we've been speaking about. We think this is really the next public health challenge and we hope that this is on our part a very small way of trying to address that. MindfulNoggin.com. Yeah, we'll put a link to that in the show notes. Thanks, Dan. Is there anything else I should have asked? I think we're good. I mean, I feel this has been terrific. I really

appreciate the opportunity. Oh, it's been great. Anytime I can get gold stars, I've got to consider it a win. So I really appreciate your time. Thanks for coming on. Okay. Good to see you, Dan. Take care of yourself. Big thanks to Zendol and don't forget next Wednesday we'll be posting part two of this series with Lori Santos from Yale and the Happiest Lab podcast. She is just overflowing with ideas. So that's coming up in one week. Before we go, let me just say thanks to the team who works so hard to make this show a reality. Samuel Johns is our senior producer, DJ Cashmere is our producer. Jules Dodson is our AP.

Our sound designer is Matt Bolton from Ultraviolet Audio. Maria Wartel is our production coordinator. We get an enormous amount of incredibly helpful input from our TPH colleagues, such as Jen Poehnt, Nate Toby, Ben Rubin, and Liz Levin. And of course, I would be remiss if I didn't thank my ABC News Comrades Ryan Kessler and Josh Cohan. We'll see you on Friday for a bonus. Hey, hey, prime members.

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