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Audio moment from the Anxiety Book Club Podcast

From Audio: Episode 22 - Bringing Compassion to Our Anxiety

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station description An interview based podcast exploring topics in anxiety, OCD, and other topics of me... read more
Anxiety Book Club
Duration: 34:11
Listen to Josh Malina speak with Dr. Dennis Tirch, a compassion focused clinical therapist discuss bringing compassion to our anxiety.
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Listen to Josh Malina speak with Dr. Dennis Tirch, a compassion focused clinical therapist discuss bringing compassion to our anxiety.
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be excited to talk to you about today, which seems to be your life work is compassion because I have the sneaking suspicion in my own anxiety journey, that it's kind of the missing ingredients for, for doing therapy or just doing life in a way that's not just kind of achieving ends or achieving goals are doing exposure, but maybe having a decent time as we go about doing some of the hard work. So can you talk a little bit about because it's the first time I've even heard of something called compassion focused therapy. Can you talk a little bit about that? What that is and what the goal of it is? Oh, absolutely, thank you for asking. And I really appreciate the way you described compassion and perhaps the role of compassion in working with anxiety is bigger than symptom reduction or bigger than, you know, uh specific therapy goals and more as you said, having a decent time, having a decent life living compassion itself has a definition that is rather old, but also that is now being applied in new ways. And that definition is a sensitivity to the presence of suffering in ourselves or others, combined with a dedication to do something about it, sensitivity to the presence of suffering blended with a commitment and a dedication to do something about it. And compassion focused therapy as a form of therapy form of psychotherapy that was developed originally by paul Gilbert in the UK and further has been studied and researched the world over. And that form of therapy integrates elements of buddhist compassion training with meditative practices and with a number of evidence based therapy traditions too, to help people use their body's innate capacity for compassion and warmth and grounding to better deal with threats and anxiety. Mhm. Yeah. Yeah, I hear that it sounds super useful and I'm kind of wondering why it seems and maybe this is from the outside looking in but it feels kind of niche. Why why isn't compassion more of a centerpiece in like cognitive behavioral therapy or one of the first things maybe that a therapist would would talk to you because I haven't encountered it that much and I've had plenty of anxiety therapist. So what's the story there? It's a very good question and you know, in my own life as a person with anxiety problems, you know, I publicly identify as having PTSD and A. D. D. And I've had a lot of struggles like a lot of us right? And a lot of therapy. Um and I came to becoming a therapist after a lot of years studying buddhism and studying contemplative traditions and like mystical traditions where compassion was central to the transformational process. Like recognizing your own interconnectedness with all being and understanding that underneath your individuality there is a flow of life, a flow of loving awareness. You're part of in those traditions. The techniques are about accessing that and that liberates you from suffering. It helps to liberate you from the grip of fear and and greed and threat for thousands of years. You know, that's been practiced as a way to liberate ourselves from anxious suffering and from shame and self blame. And somehow, you know, empathy is referenced and and throughout the different, you know, client centered therapies and Rogers work and Greenland and and you know, the therapeutic alliance is discussed a lot and different experiential therapies, emotion focused therapy. CBT all all the different alphabet soup of CBT S and F. B. I's and K G B s. You know, like so through all that, the concepts kind of obliquely referenced, but it's not really until like the beginning of this century that, you know, mainstream scientific psychology started to really take a good hard look at what the term compassion references and you know, the good work of people like paul Gilbert and other colleagues and Kristen enough and the people that you know, stanford uh and the greater good science, kind of good old Matthieu ricard. Those kind of folks started to understand that human beings from the moment that were born until the moment we die, the presence of warmth, care and compassion will affect our health and well being at every level, from our heart rate variability to our presence of mind, to our pro social engagement. And part of the reason for that is that we've evolved so that warmth and care and compassion and kindness actually down regulate our threat detection systems, they down regulate excessive arousal. They lead to greater heart rate variability. They help us to deal with stress better. We really function at our best when we feel emotionally connected, emotionally safe and socially safe and when we have a flow of compassion in and compassion out and that realization, the evolutionary emotional neuroscience and behavioral psychology, realizing that compassion could and should be a more central variable that we target has been pre revolutionary. But as you suggest Joshua, it's like it hasn't quite spread in the same way that it it could and that it will actually as a uh as a target for therapy interventions, it'll happen, it's happening but it's slow. Yeah, thanks for that answer. I think it's it's slow even in something that has taken off at least with I think greater speed which is just kind of mindfulness full stop like meditation and concentration and doing stuff with your breath. Like I feel like even within that community there is like the two wings right? One is attention and then one is compassionate. I almost feel like in its uh boiled down version or the way it's distilled and maybe offered to larger groups. Maybe the common denominator of mindfulness also doesn't seem to highlight compassion until maybe you get into it a little bit deeper. Do you think that's fair to say? Oh yeah, it's completely fair to say. And I think you know the, the historical teachers said Arthur got thomas referred to as the one who woke up or the buddha, the historical buddha, the teachings that are attributed to that figure uh in the pali canon and um that make up the corpus of like the oldest form of buddhism. Theravada buddhism, Like it took about 500 years before there was a radical shift in the ideal of the dharma in India and Asia from the original teachings of the buddha which were about individual Awakening and equanimity and compassion was not as central. 500 years later, the Bodhisattva ideal and an idea of interconnectedness being essential and the idea that compassion was the most important factor in waking up. So given that the first time around This took 500 years for people were probably going at a faster pace Uh in the last 20 years than than the 500 year track. But there's probably a lot of reasons why psychologically and socio culturally that people, they shy away from the idea of compassion, maybe it's a self compassion has been a little bit easier to take for people than compassion in general, which is interesting. Mm Yeah, that is interesting. I've actually heard the opposite where self compact, well at least like I took the live online mindful self compassion course and they suggested that. Yeah. Yeah it was it was a good program. I've learned to publicly rub my heart or chest with my hand without feeling embarrassed now. So that's uh that's a plus for me there. But yeah, I've heard from them that um offering ourselves compassion um is sometimes seen as you know like week I guess in our society you know that's kind of true. But if you look at the data analytics for how many people are searching for self compassion versus compassion or the broadness of adoption within sight of their positions of self compassion as opposed to compassion. Because I looked at that stuff and what you'll see is that it's generated a lot more interest in a lot more research and there's many many more people who want to adopt self compassion than the idea of like a compassion focused therapy or the compassion cultivation training program. I think targeting shame and having compassion for ourselves has a little more traction in some ways. Even though I'm not refuting the idea that self compassion is you know in the mainstream, let's say you know, like still not taken as seriously as it ought to be self kindness, self compassion. But I would suggest that like espousing compassion like for others and self as just one thing. Like the idea that there is this mode of being this default setting, your inner nature, the wisdom that you were born with your birthright is to have a flow of giving and receiving care that connects you to all beings. And that that when you are in that caring mode that you're at your best, that's been even slower to really land with people, it might be because a little more complicated it might be because it sounds like we're telling people to be nice or to be soft or woo. But it's a it's definitely it's surprisingly alien to people often. Yeah. Well I really appreciate that perspective. Especially if you've got the the data to back it up. I mean I'm super keen on having people on this podcast that really know their stuff and you know you're looking at the data analytics for google search queries on self compassion. Well that's a perspective. I surely welcome. Oh cool. Yeah it was funny conversation like you know my whole life is about this stuff and I was talking to somebody who's helping with the web and they said had this blog about self compassion and the person said well and no you can't use that. I was like what are you talking about? Like oh there's yeah you know there's just so many, there's so much interest in it and there's so many people writing blogs about it, like you know you have to write a block of a different topic. Uh and I was like okay I get it, but I don't care. It was like, you know, because like if you're like a space scientist and somebody you write a blog about space and I'm like no you should write about the ocean because there's too many people writing about space like I don't sorry buddy, like we're just gonna have to go with what you know here, you know? But it was interesting when I started looking at it, it was kind of shocked at how self compassion is really grown, you know, and Kristin Neff and chris grammar or friends of ours and and their work disseminating and promoting their approach has been really important, really taken off. Whereas it's still kind of hard to get people to like get the idea that, you know compassion for for others and also receiving compassion from others are really really really important. Yeah, this is this is making so many questions spot in my head. Cool. Um but but I am glad just as an aside that you're not obeying the commands of your SEO specialist in writing on whatever places, especially if it's your life work, you've got to have a balance. You know, you want people to to find is an old saying. Sufi saying that the reason there's fool's gold is because real gold exists, you know, and I think compassion science and understanding how to train the mind in resilience and psychological flexibility and compassion that's real gold, that's real gold. And so if there's a way that we can reach more people with it, you know, I'm open to however it can reach the people who need it which is all of us. So and that's an area of the Fool's gold or the blog posts that like sort of gesture at the self compassion but don't do a great job of explaining it or something like that. That works really. That's good too. I was thinking the Fool's gold is just the whole S. C. O. Thing. Do you know what I mean? Like hey here's five ways that you can liberate yourself from the buddha buddha bob and it's like really man like but if that if that's if that's how you can, you know, you can get it out to people and they'll see it rather than it getting buried, you know in the middle of like the interwebs then whatever. Yeah. And wasn't the buddha famous for making lists? So like top five ways to liberate yourself, might actually track, you know, the joke then, you, you know, you know, you know the joke that's based on that, What's the joke? I love it, I love it, Joshua, like it's a, you know, like christians love jesus and Buddhists love lists is the joke and it's kind of true. Yeah, Yeah. It's interesting. I say that as a buddhist and a late dharma teacher in zen, so it's not meant to be a judgy. Oh, um, yeah, lists are great. I mean they're great for productivity. Um, so, so let me ask you a question. Um, just to dig into the book a little bit more. So there's a character in the book who I think it's a real character, but maybe her name might have been changed. She's a her name is Jennifer and she's dealing with anxiety and on page five there's this sentence that says we focused on her self criticism and her sense that something was wrong with her, a feeling of some inner flaw so common in people who struggle with anxiety and that really resonated with me because and maybe with everyone, it's curious to think that a lot of anxiety comes with a critic. Um like is there is there situations or is it the case that people have anxiety without the critic? Like how often do they overlap? Like is that the crux of the is that why compassion is useful for treating anxiety? Because there's a critic there that needs to be soothed or like how how necessary is the critics kind of appearance in this um kind of situation. Wonderful, wonderful questions actually, and kind of taking them, I want to honor each of them. You will find people from time to time who struggle with anxiety problems and they're not particularly self critical or shame prone. And if we think of shame as a sense of personal, like like an emotional kind of motive being where you feel like a sense of being devalued or that you might be held in the minds of others as less than or worthless. That can also be a sense of yourself evaluating yourself as being bad and worthless. Like there are folks who don't have chronic or severe shame who have anxiety problems, but I think they more often than not, in my clinical experience, they arrive together, you know, and also shame. We know from the literature that trans diagnostically shame and chronic shame make make it harder to treat anxiety problems and actually all problems psychologically like if somebody has severe shame problems, all therapies are going to have a tricky time. So that's one of the reasons why paul Gilbert and his team in the eighties nineties two thousands, I began developing compassion focused therapy to deal with people who had chronic shame, who weren't responding to interventions for depression anxiety. So there are those folks who don't really have severe shame, but a lot of the people you'll see who really, you know, are having a hard time treating the anxiety. We'll have chronic shame or severe self criticism and I think it's really, really, it's very common. There's there's more to it in tune with the other questions that you had, but I just want to pause there. Let that maybe just kick it around for a moment rather than just keep going. Does that make sense so far that, like, you can have it, you can have anxiety problems without having a shame problems, but more often than not they'll be there together and like they make it harder to treat machine. Yeah, I totally, I totally get that and it's really interesting and it's, you know, it's sad for those. It almost sounds like it's like the third arrow or something you have, like the thing that bugs you, the anxiety about it, The shame, that's almost like the most heartbreaking part of it, I think is the shame more so than the anxiety because you have people, you know, beating themselves up for something that, you know, they they are not at fault for. That's very poignant the way you put it. I mean, shame, a sense that you're unlovable and in some way and it strikes to some core human survival, Nida core human, you know, dimension of dimension of not just what makes it survived, but what allows life to be to feel worth living. And the other really important part. And I'll try to say this with real economy because it's kind of a complicated thing and I've been trying to get it across for years, but it kind of takes a moment. So human beings, like all animals have a really sensitive threat detection system and that's necessary. If you think about like natural selection and evolution, designing the species, you need. The first thing is that it has to stay alive, right? Because if you don't stay alive long enough to procreate or you don't stay alive, you know, for the for genetic material to keep moving, well then the like the species just ends and most species do end, you know, eventually, like most species wind up extinct and and it's really hard for a species to make it on this planet. Humans, you know, we're having a reasonably good run of it and a big part of that has to do with our unique Threat detection system. So we have this 24/7 always on highly sensitive, highly attuned threat detection system. And our main evolutionary advantage is the way we think and the way we use language and the way we interact the way we cooperate in the way we care. And so much of that has to do with our brain and our brains ability to use symbols and thoughts and imagination. Two, you know, interpret the rest of the world and in order for that and our actions in the world in order to have a brain that big, you have a pretty big skull and a brain that needs a lot of, a lot of food when it's in utero. So we're born with these brains that are only sort of half cooked, were born pretty helpless relative to a lot of animals where they're born like horses born, it just pops out, it starts running around humans aren't like that. We need lots of time to develop the words and the language and the skills that we need in order to function in the world. So we have this species that has a really low birth rate and infant mortality is very high without modern medicine And it's really birthdays jeopardizes the mother as well. So the life of any individual human being like is really really important for the species survival more than a lot of other animals. Like a turtle has like 3000 eggs and like if only 1% or 2% make it. That's fine for the turtle, like it's just the way it is. But we also have these fragile Children's fragile infants. So like, you know, in order to keep them safe, we have these strong attachment bonds which create this really, really protective upset of behaviors from the parents. And also like the need to find proximity and emotional security and connectedness is like really important for the attachment behaviors of the baby. So all of our attachment and affiliation repertoires and all of the structures in the brain. They're so important for our survival and they are intimately tied up with our threat system. So human beings when we experience warmth and care and security and compassion and when we feel that we can we feel safe, we have a secure base that allows us to feel like we can rest and ground. And we also sometimes feel like safe enough to be playful or explore or have courage. So as it turns out like having a stable inner attachment system and the ability to activate things like the oxytocin system, the poly vagal complex, all of the neural architecture and hormonal architecture of warmth, care and giving and receiving care, all of that is like really intimately tied into how well we can regulate anxiety, not just shame but anxiety itself, right? So if we have like abuse or neglect or impingement or chronically threatening environments or parents who are like well intentioned and and very kind, but maybe they have severe anxiety. Or so many of us have multigenerational trauma in our families and so many problems right? With wars and depressions. So we have this like really compromised a series of factors that will compromise the development of an inner attachment system, an internalized compassion system and that is precisely what is involved in down regulating our threat response. So therapy is in compassion focused therapy is about building this inner attachment system, this inner caring system so that we have this neural architecture that allows us to overcome the threat of uh that are generated by the mind and anxiety and also to generate the social threat oven love ability that shows up with shame. That's kind of trying to in a nutshell encapsulates all the questions that come up around this. Yeah, well that's really thorough. I appreciate the the comprehensiveness there. I don't mean to pick a fight with evolution, but why don't we why don't we get this for free? Like why why do we need the stable loving caretakers to build the inner attachment inter soothing system? It seems very, very useful. So I'm kind of wondering and I don't know if you can answer this question, but why don't we just get it for free from our genes? That's a really kind of a good question. And when you say for free like why why does that not emerge as a wake up pre birth, heritable rep id like repertoire rather than something you kind of have to learn. Yeah like you know whether or not my there's good smells in the house, I still wind up with a nose you know, but apparently awesome, you know, I don't get the compassion system, you know, nobody's ever asked me that and it's really great. You actually do get it for free. It's the systems there, like the biological substrate of it is there? And what sort of the best guess we have like you know all evolutionary psychology a little bit is speculative, you know? But it kind of hangs together um The brain we have is not Terribly changed over the past like several 10,000 years or hundreds, thousands of years, you know? Certainly like it's a very similar brain and it has inside it like structures and behavioral if you will like um like programs or algorithms that are older than humans. In many ways we have like the brain of a reptile. I'm sure you've seen like McClain's trying brain with the brain of a reptile that's wrapped in, wrapped around it is there is a brain of a mammal and then around that we have a primate and then we have our human prefrontal cortex. So it's a very tricky brain and it it is kind of a collision of all of these different, you know, apocalypse uh ways that living things are in the world. And what happens is even though the brain hasn't changed that much and our bodies in many ways haven't changed over several millennia society and technology has a lot and human behavioral patterns have enormously, um, it's kind of one of the side effects of having like a, like a sort of a supercomputer ish brain metaphorically, which even even more powerful in a supercomputer, it adapted as parallel processing and finds symbols. It changes and then we pass on that information. So, so what where we're at now is you have a brain in a body that was basically designed for caring and sharing algorithms to be dominant in small groups of people like originally around the savannahs in africa like reasonable climate for our bodies with lots of co parenting, lots of caring relationships, looking after each other, alot parenting and resources basically not being like hoarded through agriculture, cities and things like that. You know, it's kind of like what were designed for and then with, you know, the kind of growth and change of human societies, civilizations, algorithms, you now have a situation where there's greater comfort, there's greater medicine, there's like hyper collaboration so that like I'm looking at a can of water, you know, sparkling water is like probably hundreds of people were involved in just bringing this thing into existence and poof, it's here right in front of me and there's a screen in front of me that in a given, probably in a day or a week, I will probably see more images of competition and potentially violence or struggle or you know, uh money or greed or sex. All those images. I'll see more in a week, let's say, than my generations of ancestors would have seen generations of them. So we have this kind of over driven competition system. In our societies, we've been over driven threat system. We have like wars and depressions and insufficient allocation of resources, all that stuff together predisposes us to be stuck in competition and threat mode. And we kind of like have a harder time with our social systems just cultivating and activating a general sense of warmth and interconnectedness and safe. Nous. That's basically you know that's the company answer on this one. That's that's how it tended to be seen within the C. F. D. Community. Got it. Yeah. Thanks for that. There's something that reminds me a little bit in the book, you make this distinction between sort of the brain's that we got through genetics and then our conditioning. And I think the metaphor you use is sort of hardware as referring to the genetic inheritance and then software mostly the stuff you just enumerated there at the end of your answer about conditioning and culture and all of that. But I do have a question here because that was just a statement. So On page 15, it talks a little bit about how if you have an anxiety problem or some trigger something's coming up. It can be hard either for ourselves or for others to talk us down because for some reason, even if our, even if the thing we're afraid of is irrational, it's somehow not always effective to try to use logic or other thoughts or like rational reasons for why are anxiety is not merited and therefore it's not, it's not maybe always the most useful tool for reconnecting us with something that feels safe. So it is how I guess how widespread would you say is that failure of being able to use logic to talk? You know, someone off the ledge? And also is that one of the reasons why there's an opportunity here for compassion? Because you know, just simple explanation doesn't always do the trick. When I began grad school in the early 90s, it was the beginning of cognitive behavioral therapy really really finding its ascendancy in the field and particularly around anxiety. And it came after decades of the idea that like insight, some kind of concept of insight which we don't talk about very much, but people would have realizations, they have understandings and insight and that would lead to you know, personal change. And instead there was this shift towards rationality and logic and perspective taking and that that would be more what would be useful alongside like just raw exposure to fear until you get your fear system, we call it the fear system being exhausted. It was like an idea that you would gain insight and that was around as a popular main process. And there's this idea that rationality and logic and exposure to anxiety, then that would be the healing thing and then I guess like maybe 15, 20 years later, the mindfulness and acceptance kind of revolution, what they call the third wave of behavior therapies and psychotherapy kind of happening like the zeitgeist everywhere from like Oprah and Eckhart Tolle and everything to like, you know, uh you know, yoga places popping up everywhere and, and and evidence based therapies that are derived from meditation like mindfulness and acceptance and commitment therapy and burn a brown all this kind of stuff. Right? So, so then the emphasis became like, no, no, don't fight your thoughts, don't challenge your thoughts, just accept them, observe them have equanimity around them. Also not bad. Like insights, not bad rationality is not bad, accepting things just as they are. Isn't bad mindful awareness. Your thoughts ain't bad and exposure to fear until it doesn't have as much of grip you all. That isn't bad. But as you said in the beginning, Joshua, the missing piece through a lot of this has been just understanding that it is in our nature to transform through the experience of compassion. It's in our human nature to feel calmed and soothed and stabilised when we're in the presence of the experience of care and caring and that, you know, they call it in buddhist psychology, one of the definitions of compassion is bogus, it'll, which is like naturally awakening, altruistic aspiration for all beings two be liberated from suffering and that doesn't mean that they don't experience bad stuff if they're if they're living things but that that their understanding can be so deep and so wide and they're loving, connection to all life can be so deep and so wide, the heart can be so wide open that it stabilizes even in the presence of great threats. And that's true. Like people in a battlefield like soldiers in the battlefield they don't fight for country. We know from a lot of research and a lot of reports they fight for each other. And the things that allow us to have the strength to go through exposure and response prevention if you have O. C. D. Or something like that, it's what matters to us is what we care about and that caring is related to care. It's related to the emotion of caring and that caring instinct. The compassion instinct compassion dr if you will it changes everything it's like a superpower and it's just so important and transformational. So it's not like it's not it's cool to do cognitive restructuring when you need it. It's good to have mindful awareness and metaphors and I mean there's so many therapy techniques that I've seen and that we use and I've met with so many clients for so many thousands of hours and when someone is able to touch that part of themselves that has a loving open heart so much becomes possible that just didn't even seem possible. It just changes everything. Yeah.
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