Mind Dive
The Menninger Clinic’s Mind Dive podcast is a twice-monthly exploration of mental health topics from the professional’s perspective, including the dilemmas clinicians face in their practice. Hosts Dr. Bob Boland and Dr. Kerry Horrell dive into the complexities of mental health care including the latest research and other topical developments through lively discourse with distinguished colleagues from near and far.
Mind Dive
Episode 57: Fostering Self-Compassion with Dr. Willem Kuyken
Willem Kuyken, Ph.D., has been at the forefront of merging Eastern mindfulness practices with Western psychological standards. Dr. Kuyken’s academic work significantly contributed to the World Health Organization’s Quality of Life measure which set the standard for evaluating an individual’s perception of their position in life across cultural and national boundaries. Drawing on his years of experience, Dr. Kuyken discusses how important mindfulness practices are in clinical settings and how to move those practices into a patient’s daily life and form them into independent habits.
This episode of Menninger Clinic’s Mind Dive Podcast features Dr. Kuyken, accomplished psychologist author joining hosts Dr. Kerry Horrell and Dr. Bob Boland for a conversation on mindfulness practices, their importance in clinical settings and how to turn mindfulness practices from task-related labors to an ongoing enriching experience.
Dr. Kuyken is a scientist and author, and serves as a professor of Mindfulness and Psychological Science at the University of Oxford, and director of the University of Oxford Mindfulness Centre. Dr. Kuyken’s latest book, “Mindfulness for Life” releases on October 25th and is available for pre-order here.
“There can be negative thoughts that your mind can place between you and happiness,” said Dr. Kuyken. “I liken these thoughts to wrecking balls and while they are powerful, if you simply step out of their way, they’ll pass you by.”
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Visit The Menninger Clinic website to learn more about The Menninger Clinic’s research and leadership role in mental health.
Welcome to the Mind Dive podcast brought to you by the Menninger Clinic, a national leader in mental health care. We're your hosts, dr Bob Boland and Dr Keri Harrell Twice monthly.
Speaker 2:We dive into mental health topics that fascinate us as clinical professionals and we explore those unexpected dilemmas that arise while treating patients. Join us for all of this, plus the latest research and perspectives from the minds of distinguished colleagues near and far. Let's dive in. Welcome back to the Mind Dive podcast. We're really excited today to be joined with Dr Willem Keichen. Dr Willem Keichen earned his PhD from the Institute of Psychiatry, king's College London and his doctorate in clinical psychology from the Salomon's Clinical Psychology Training Program. Dr Keichen learned cognitive behavior therapy over two years as a postdoctoral fellow at the Center for Cognitive Therapy University of Pennsylvania and the Beck Institute. From 1999 to 2014, he worked at the University of Exeter, where he held numerous roles, including heading up the doctoral clinical psychology training program and leading the clinical research group. Dr Kaiken co-founded the Mood Disorder Center and co-founded the Masters in Mindfulness-Based Cognitive Therapies, and since 2014, dr Kaiken has directed the Oxford Mindfulness Center. So an absolute expert on mindfulness and we're so excited to have you here today. Thanks for joining us.
Speaker 1:Right and a new book out, I believe.
Speaker 2:Yeah, we're especially focusing in on your new book Mindfulness for Life Right Absolutely.
Speaker 3:Well, welcome. Thank you. It's a privilege to be on your podcast.
Speaker 1:Thank you. So for starters, can you just tell us about your career.
Speaker 3:So, far and just how you got interested in mindfulness. So I'm a research clinical psychologist and all of my work has been around the prevention of depression and psychological approaches to the prevention of depression, and actually my interest in mindfulness predated my work in this area. I was working as a young postdoc for the World Health Organization, traveling all around the world. It included traveling to places like Thailand and India and I got really interested in what could we learn from places like that about mental health and well-being and healthcare, and we were developing a quality of life measure that's actually still widely used around the world.
Speaker 3:And I decided to do a bit of research and I kind of got interested in Buddhism and mindfulness and started practicing retreats and having a daily meditation practice and in those days to have said that to one's boss or in a professional setting would have been professional suicide. A few years later I went to a conference called I think it was called East Meets West and there were people there like Francisco Varela, jon Kabat-Zinn, jon Teasdale, and it was a place where people were beginning to seriously think about what can modern psychology and contemplative traditions learn from each other and for the benefit of mental health and well-being? And that's where the kind of professional link came together and since those days I've been doing research around mindfulness-based approaches to preventing depression.
Speaker 2:Those days I've been doing research around mindfulness-based approaches to preventing depression. I do want to quickly ask what the measure is the life satisfaction measure?
Speaker 3:So it's called the WHO-QUAL, the World Health Organization Quality of Life Measure, and actually it was developed in North America. It's used a lot in clinical trials and studies of that yeah absolutely. It was a really cool development because we sat in focus groups with healthcare professionals and patients in 15 different countries, 15 different languages, first understanding how people understood quality of life and what the dimensions of quality of life were, and then we went through a whole psychometric validation and development of this measure and it's held up really well over the years.
Speaker 2:I believe we give that to our patients here as part of their outcomes. I think we do, yeah, which is really cool. I will say again yeah, we want to focus in on some of your work around mindfulness, and I know this. You know our podcast is geared towards mental health clinicians, so many of the people listening will probably already have thoughts about this, but from your perspective, I wonder why. You know, how do you see mindfulness being so integral?
Speaker 3:to mental health. Why is it an important thing to focus on? Well, the way I define mindfulness and think of mindfulness is it's kind of a combination of awareness and these attitudes of mind, curiosity and kindness and open-mindedness. And the third dimension is something around, I think, ethics and values. And so awareness on its own isn't mindfulness. Awareness is a very powerful capacity and it could be used in all sorts of ways, including by a sniper, for example. But when awareness is linked to a sort of ethical basis and when it's imbued with these qualities of what I call befriending, if you like, it becomes mindfulness.
Speaker 3:And I think a lot of what we do in therapy is about people's stories and people's narratives and formulating those and thinking about how we can treat whatever they present with, be that depression, anxiety or anything else.
Speaker 3:But I think what mindfulness is doing is it's adding to that by actually thinking about how the mind operates, how the kind of process of the mind can generate states of depression, states of anxiety, and so I think of it sometimes as being a bit like links in a chain, and what you're helping people to see through awareness is those links in a chain and the possibility then, potentially of not of breaking links in those chains.
Speaker 3:It's not necessarily about the story I'm not saying that isn't important but this is a different way of working with people, and I my understanding is, when you look at surveys now of psychotherapists and mental health professionals, I think that it's almost like a majority now are integrating some of these ideas into their practice.
Speaker 3:But one of the things that I think is actually quite powerful is there's been a couple of trials now where they've randomized the therapists to mindfulness training themselves, but the outcome has been patient outcomes, and what they found is that when therapists have trained in mindfulness themselves, their patient outcomes improve, and that's not because they're teaching mindfulness. It's because they are able to perhaps be more present to their patients and more able to regulate their own emotions in the face of patients who might be quite dysregulated, for example, and so I think it has a real adjunct role alongside the work that you and many of your listeners will be doing, but it also has a really, I think, crucial role for us as mental health professionals as well, in terms of our own work and our own well-being.
Speaker 1:Totally agree. So can you say a bit about the techniques used in it? I mean, probably a lot of people would know, but still, of what sort of things are taught in it.
Speaker 3:So two things that I think most mindfulness-based programs will use is what are called formal practices and informal practices. And the formal practice are things like body scan, mindful movement, attention on the breath, and these are sort of longer practices, and the idea is that these are kind of like you know, to use a physical exercise metaphor these are ways in which one can strengthen particular muscles, and traditionally this is thought of as being three parts. One is sort of focus and attention being able to train our attentional muscle, if you like, so that we can have a bit more volitional control about where we place our attention. Another form of practice I think of as being like cultivating different attitudes of mind. So you're actually cultivating curiosity, you're cultivating friendliness, and I think a lot of our patients and actually many therapists themselves, when they become aware of their mind, they can see how self-critical they are, they can see how they have this kind of imposter syndrome often, or they have this constant orientation to threat and befriending the mind enables people to actually have a different relationship. So some of the practices are about cultivating these attitudes of mind, and then the third class, I think, are insight practices, and this is about understanding.
Speaker 3:So, as I was saying just now, about, for example, being able to see that at the moment in which we judge in that process of the mind that something is pleasant, unpleasant or neutral is a really sweet spot, because that's the spot at which we will either go into a ruminative loop and potentially create something problematic and on the counter side to that, with sort of maybe something pleasant, people can skate over that. There's nothing to see here, nothing that needs paying attention to, there's no threat here. It's not salient, and I'll move on quickly. So that sweet spot in mindfulness, when people see that they have the potential to either go gosh this is a pleasant moment, this is a moment of connection with a loved one or this is a moment of feeling calm in nature and to learn to begin to savor those moments. I think that's a really important part of our work. It's not just working with the psychopathology, if you like, but also building up the kind of positive valence system, if you like, and so there's a so-called insight practices.
Speaker 2:Well, I'm thinking about too you know, when I work with patients around mindfulness, I tend to find the awareness piece probably comes the quickest, the easiest. It is the non-judgment piece and the kind of work around trying to consider different states of minds and hold them more, even at the beginning, more neutrally. Can we think about it more neutrally? That is so tough. Those cycles were so difficult to break and I know a few of my patients. When we're doing this, even in vivo, we're doing it in groups they're like this is so challenging. It's so challenging to hold your own mind with compassion. I think that's so easy for people to do what they've known to do, which is hold themselves with a lot of harshness and criticism.
Speaker 3:I guess one of the things that I'm arguing in the new book is that I think this is a lifelong journey. You know, I think what you've just described there is when people begin to step back and see the mind. These are long-held habits of thinking and it can be a lifelong journey, I think, to be able to stand back and change one's relationship and diminish the power of these ways of thinking.
Speaker 3:Winston Churchill used to talk about his depression as this black dog, and I think that's very skillful in a way, because what you're doing is you're stepping back, you're decentering and you're giving a name to the depression. So it's out there and more than that, like a black lab. A lot of people love black labs, so you actually there's so a different relationship one's developing to. It's not like the bad thing that I have to somehow cut out or get rid of, but it's something that's part of my life that I can somehow befriend. And I think for people maybe not for people with a first episode of depression, but for people with recurrent depression that can be a very skillful way of changing their relationship to their thinking.
Speaker 2:I care a lot about gratitude and gratitude practices, but whenever I teach them to my patients, I try really hard to say something along the lines of I want us to be thoughtful about how we think about gratitude, because so often for especially our folks with depression gratitude's been used and weaponized against them At times like how could you be depressed?
Speaker 2:Look at all you have to be grateful for.
Speaker 2:So I've noticed a lot of my patients have this sort of tendency when I say let's work on gratitude, to say ugh, they have this sort of frustrated response to it. And so I feel like I say something kind of similar. You know, along the lines of gratitude is as well that we can always pull from, even alongside our pain. It's not that we're saying that one washes over the other, or because you have gratitude or you take time to notice things in your life that are going well, that the other painful stuff their grief, depression, sadness isn't there. It's that we pay attention to both and don't let sort of one wash away the other. And again I found a similar sense of my patients feel like, oh yeah, I guess if it doesn't mean that, like I can't and don't have these other painful feelings I can pay attention to it with more open hands I think it's very common, isn't it, for people to have people with a history of mental health problems to have, as you say, these kind of beliefs that can invalidate the positive.
Speaker 3:I don't deserve this. This is self-indulgent, this is not acknowledging that the difficult pieces. But if you can actually bring that into awareness too and go gosh, there's a thought that actually that you, that your mind, is placing a thought between you and happiness, wow, and that's really. I remember. I remember having a patient once, a young woman with children and toddlers, and she was with the toddlers and she started having this flurry of thoughts about I'm no, you know, I'm a terrible mom and I'm going to screw up my kid. And we were sitting in a class with other patients and and she said, you know, I, I started to use some of the practices that we've developed and I saw these thoughts as being like wrecking ball thoughts, and everybody else in the class had this kind of look of and this nod of recognition. Yeah, I get those wrecking ball thoughts too. And what was so interesting about that metaphor is, of course, a wrecking ball is strong and powerful, right, but actually if you just step back back, you can see whoosh as it goes and if you just don't interfere with it, it will lose its power and its valence sorry, its power, and it's kind of like its strength. And that was her journey and I think, um, you know, in the book we we also talk about these practices.
Speaker 3:I broaden it it, I have to say, beyond gratitude and we call them appreciation practices, because in the wisdom traditions gratitude is just a small part of what's sometimes called sort of appreciation practices. So I think in that family there are. There's just hedonic pleasure, but there is also a sense of ease and contentment. There is also generosity and selfless generosity, and one of the practices that we use, that people love and is in the book, is this reviewing the day practice. So as you get to the end of the day, maybe when you're in bed, you're about to fall asleep and you just scan back through your day and go, what from the day have I got a sense of appreciation for? It might be a moment of love, a moment of connection, a moment of joy or something really simple, like my first cup of coffee this morning was amazing.
Speaker 3:Or you know, I was just sitting in the other room here and I've got in london is we've got a lot of parakeets, and so the parakeets are outside my balcony eating and then all of a sudden a squirrel came by, um, and it was carrying its young from one nest to another. And it's like there's little moments like that so you can just look back on your day and reflect on those and enjoy them and savor them and actually so they become like a you know, you're really developing that ability to savor and appreciate and at the same time then opening up, was there anything from the day that you felt didn't go so well? Is what I learned from that, but not with that kind of ruminative mindset. But what can I learn from that? And then can I put that down and let it go. And our patients seem to just, you know, really love those kinds of practices because you're, in a way, you're retraining the mind to change what it focuses on and how it focuses on things.
Speaker 1:Sure, you know. Can you tell us like in your new book you focus on the reality that you know a lot of people drop their practice over time. You know certainly people I've known, including both colleagues, not just patients.
Speaker 2:I thought you were going to say both you and me.
Speaker 1:No well, I won't speak for you, you just patience. I thought you were going to say both you and me no well, I won't speak for you. You know, they kind of start strong and they're very excited and stuff, and then it trails off. I don't know. What have you learned from that? Why do people drop out of this if it's so helpful?
Speaker 3:You know, it's really interesting, isn't it? And the same happens with cardiac rehab, doesn't it People? Have a real scare with a hard time. Why don't I?
Speaker 1:exercise all the time.
Speaker 3:Yeah, why don't I exercise all the time? Yeah, that's right, and they start off really well and they drop it off. And I think what we're learning is that if you, you know, one of the motivators for doing something like practice is that you're suffering, right, you're in a bad way, and you practice because you know it's going to help you. And that's the same with the early days of cardiac rehab. You had a real scare and so you're going to do everything that the doctors ask you to do. But we've reframed how we think about mindfulness practice and it seems to be paying off. So what we're doing is we're moving away from a metaphor of, um, physical exercise. You know you've got to go to the gym. Go to the gym, you're going to get the strength and this fitness and that's. There's a kind of a validity to that. But actually a lot of people join the gym and then the same thing.
Speaker 1:Well, gyms, that's where they make their money.
Speaker 3:And so we're using two ideas which seem I mean, the research needs to be done but seems to be working. The first is to change one's relationship to mindfulness practice to be more like it's your best friend. And if you think about the qualities of a best friend, right, they're loyal, they've got your back, you like hanging out with them. You know sometimes they're a bit of a pain in the behind. Give them that, because actually you're lifelong friends and you invest in them. You put energy into them. Lifelong friends and you invest in them. You put energy into them and when people think about their mindfulness practice and indeed their body and mind, as being like their best friend, this is something you want to invest in because it's going to be there from this moment to the moment we die. So this is a relationship that will actually support you through your life. And then what I'd say is you start to build in something so that it becomes intrinsically rewarding, that appreciation practice I was just talking about. People don't go away and do that and go. That was fun and I stopped doing it, and I think they do do that with the gratitude practice, by the way, because for a while they go. Yeah, okay, I'm grateful for my kids, I'm grateful for my dog, I'm grateful for my job, I'm grateful for my health. It's like a checklist, but if you're actually looking back to, the richness of your day is like what I just described with the parakeets and the squirrels. That's unique, that's not happened any other time and you know we were just sitting and watching and laughing and um, it was. You know, it was extraordinary.
Speaker 3:So you build in this sense of intrinsic motivation and you link it to values.
Speaker 3:So one of the things I do, for example, is at the end of a year I look at my appreciation list and I go gosh, that's really interesting. Pretty well, consistently all the way through physical exercise, and my daughter's has been there all the way through, and so I'm actually going to prioritize that in my life. And then I think people don't see practice as being like the gym. They see it as this is actually. This is is my life, and this is a really rewarding part of my life and I invest in it because I care about it in the same way we invest in our friendships. It's quite a subtle shift, but I think it's quite a profound shift in a way, and certainly it's the way I feel when I get on the mat every morning, I get on the mat because this is, it's like a friend, it's like a chance to set for the day. I'm not doing it because I have to, or I feel like I've got some Zen monk with a stick behind me. I'm doing it because it adds value to my life.
Speaker 2:Well, it's making me think. Actually, this whole conversation is making me think about mentalizing, and it is. I think there's a lot of overlap in the mentalizing literature and concept and mindfulness as a concept. But you know, when I teach this to my patients, I, you know, I say mentalizing isn't a checklist, it's not something that we do as far as, like, you do this, this and this and you're mentalizing.
Speaker 2:It's a stance, it's a posture and it's one where I try to cultivate that. It's a, it's a way of being rather than as a. I'm going to take the time to do it, and that completely tracks with what you're saying, that mindfulness is a posture towards your mind. Yes, so there's practices to, to get better at that, like any other skill that ultimately becomes a part of your life, like this is how I relate to my mind yes, throughout the day, with awareness, you know, with, with compassion, with non-judgment. That, again, it's not like I'm going to take this 40 minutes just to do a meditation so that I can check off that I did mindfulness today, but it's a, a noticing that, again, I think, is hard to do.
Speaker 3:It's hard to practice that, yeah, I think it's a really nice way of describing and I I try to encourage people when they have their morning practice is to end the practice with setting an intention for the day. So so that's your idea of mentalizing, right. It's not just that you're doing the practice, you're saying all right, today's a day that's going to be really busy and really quite stressful. Is there a way I can keep a sense of being anchored and grounded throughout the day? And can I just try and stay connected through the day? And I think that that works, you know, particularly if you link it to the review of the day at the end of the day, because then you're sort of, in a way, holding yourself to account. I mean a nice way.
Speaker 3:I would add one other thing to what you said about mentalizing, because I think some people sometimes have this idea that mindfulness is a sort of very internal activity and maybe even a selfish activity.
Speaker 3:I've heard it described as, and I really don't think it is.
Speaker 3:I think it's quite the opposite, because what you were just describing is also, then, how you're going to show up to your friends and to your colleagues and to your kids and your family members and whoever else, so that internal how we relate to ourselves is also how we relate to other people, and I've done a fair amount of research on compassion and we developed this measure of compassion which has got these two scales compassion for self and compassion for others. And what's very interesting is that they're not as correlated as you think they might be, and I think, particularly in our profession, a lot of people are able to be compassionate to their patients but not particularly compassionate to themselves, and I think that's a recipe for burnout. And I think the ability to have genuine what you described as mentalizing or friendliness to our own inner landscape If we have that, we're more genuinely going to be able to show it, I think, to other people in a long and sustainable way, and that's why I think these skills are so very important.
Speaker 2:I tend to tell my patients and I don't know if you'd agree with this and, quite frankly, I don't know if the research would agree with me, but anecdotally I tell my patients that our self-compassion can at times be our ceiling for our compassion towards others. I think, cognitively, people think I have so much more grace towards other people than I do to myself and I'm like but do you? I don't say it like that, but I'm like, do you? Because how can we really look at ourselves, our own bodies, our own minds, our own experiences, with such hostility and then look at somebody else's where it's similar, and be like oh no, but it's fine. And again, maybe there is that like a at a level that's more conscious. But again I think, like there is this my sense is a deep relationship between these things that when we can get better at connecting with ourselves through compassion, through acceptance, we really do have more of an ability to show up for other people in a way that feels so much more profound.
Speaker 3:I agree with you wholeheartedly. Mother Teresa used to with her nuns in Calcutta. She used to spend, they used to spend several hours before they went into the slums of Calcutta in prayer and prayer to develop a sense of compassion for themselves. So they were resourced to show up and really show up right, because when you're faced with that amount of suffering it's really difficult to show up. So she was resourcing her nuns in the same way. And I have to say, when I do clinical work and I think this is maybe why those trials I was describing earlier, where therapists with a mindfulness practice have better outcomes I will sometimes sit and meditate before a session and bring to mind the patient and bring to mind the client, and particularly the one that I'm feeling quite hopeless about, or I'm kind of hoping maybe doesn't show up. Yeah right, I will cultivate a sense of compassion and care for them and it transforms the way you're able to show up and be present for people, I think clinically. So I think the point you make is very well made.
Speaker 1:This is fascinating. You know. We have a lot of people listening who are clinicians and I'm curious, you know, what would you share with them, especially if they're having patients who are struggling starting with mindfulness, or perhaps they're having trouble sticking with it and stuff. What is their practical advice?
Speaker 2:maybe even and it sounds like we've all had this experience where the patient rolls their eyes. They're like, yeah, we got to work on mindfulness. They're like, oh, that's not gonna be, that's not gonna help with my real life, real depression or I've done that before and that just doesn't help we hear that one all the time, yeah, yeah what? What advice might you offer to our clinicians?
Speaker 3:you know, I'm british and we, we're really keen not to be self-promoting, but I, I would. I would recommend the book I've just written because it's essentially, it's essentially this, and I yeah, so it's essentially an answer to this question and I, I really hear what you say about. I've tried that before and it doesn't work. And I, I never say this, but I, I think that you know that's a bit like saying I've tried relationships, it doesn't work. Or I've tried exercise and it doesn't work. I've tried not smoking and it doesn't work.
Speaker 3:I think you've got to just somehow just like, do some sort of jujitsu on that and move past that. And I think the way to do it is to actually use different language and not talk about mindfulness, but talk about the subcomponents of mindfulness and what it is that might be helpful. I mean, nobody's really going to say you know, my ability to pay attention, that's not important, that doesn't work, I'm not interested in improving that. Or my ability to regulate my impulses, that's not important, I don't care about that, I don't want to learn about that, and I think you know. If you so, I think the book talks about this quite a lot, but it's how you describe what it is you're trying to teach someone and that you remember what I was saying earlier about these different practices for different functions. It's like what is this person's challenge and then how do you make the practice bespoke to their challenge? Um, so, somebody who might be very dissociative you want some more grounding and anchoring practices. For somebody whose attention is all over the place, you might want some focus practices and very practical focus practices.
Speaker 3:And for somebody who has problems regulating their impulses and you know and spend a lot of time on the internet, I mean, I find this metaphor really powerful. You know it's like would you actually let somebody else stock all the cupboards and the fridge in your house and you just eat what's exactly in front of you? And that's what you're doing when you're not managing your attention. You're essentially saying I don't care what comes into my mind, I'm just going to go on TikTok or I'm going to go on news channels, I'm going to let somebody else decide what goes into my body or all goes into my mind and most people. When you describe things like that, you're not even using the word mindfulness. You're saying you're coming with this particular issue and, if you've understood it correctly, this is what's happening for you, and here's a practice I think could help, and you don't have to call it a mindfulness practice, you can call it a practice that is bespoke to that particular person's challenge.
Speaker 2:I really again. I so appreciate this approach because it does feel particularly useful for people who maybe have heard this word before, have kind of given up on it and having a different approach. I want to make sure I say this I think your book's not quite out yet.
Speaker 3:No, it's coming out. I think it's on the 10th of September in the States.
Speaker 2:Okay, so we almost have your book out. You can look up Mindfulness for Life by Dr Willem Kuyken and again gosh. Thank you so much for coming and sharing your wisdom with us and our listeners.
Speaker 3:Yeah, thank you, my pleasure, it's been a really stimulating discussion.
Speaker 2:Thank you Again. You've been listening to the MindEive podcast. I'm one of your co-hosts, dr Keri Harrell.
Speaker 1:And I'm Bob Bowen. Thanks for diving in.
Speaker 2:The Mind Dive podcast is presented by the Menninger Clinic. If you're curious about the professional experiences of mental health clinicians, make sure to subscribe wherever you listen.
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