CBT in the Treatment of Chronic Pain

Cognitive Behavioural Therapy (CBT) is one of the leading psychotherapies used to address chronic pain, and there’s good reason why. CBT explores clients’ underlying thought, behavioural, and emotional patterns, the relationship between them, and associated environmental circumstances that might sustain symptoms of distress. It encourages clients to develop new skills to change unhealthy ingrained patterns to in turn change their symptoms. CBT has been extensively researched and is widely used in the treatment of depression, anxiety, stress, anger, addictions, eating disorders, obsessive compulsive disorder, panic disorder, bipolar affective disorder, schizophrenia, and chronic pain, among other concerns.

Pain refers to an unpleasant sensory experience usually accompanied by a strong adverse emotional response. In fact, the same centres of the brain that process physical pain also process emotional pain, so oftentimes when one form [of pain] exists, the other may follow. Chronic pain can contribute to low mood (depressive symptoms), increased worry about health concerns (anxious symptoms), and increased use of the healthcare system, which can be emotionally taxing in itself. It can cause strain on relationships, long-term disability, a loss of one’s life as they knew it, and a loss of one’s identity. CBT is an effective treatment to address all of these concerns, because it emphasizes changing one’s habits within the means available to them, which can be empowering, because even if we can’t change our external or physical realities, we retain the option to shift our mindset.

With increased studies in neurobiology, largely due to advancements in brain imaging technology and accessibility of these technologies, the leading approaches in the field are shifting away from the older thinking that our brains and bodies should be treated separately. A more holistic approach is being adopted, treating the brain and body concurrently to affect changes in clients’ presenting symptoms. You might notice that if we change how our bodies feel physically, we tend to change how we feel emotionally, which often brings changes in our thoughts and behaviours, and vice versa, since they’re all considered interconnected in the CBT model. It also follows that the saying “it’s all in your head” misses the mark, because even if a difficulty is originally psychological in nature, if left untreated, it can impact one’s physiology, disrupting hormones, neurotransmitters, blood pressure, and various other body functions. And our mental and/or physical states can become entrenched; that is, our systems can become acclimatized to staying stuck in a certain ‘mode’ (e.g. feeling depressed or stressed), thereby contributing to symptom chronicity, thus calling for an active, change-oriented approach to therapy.

CBT encourages goal-setting, which can help address the low motivation frequently seen in clients dealing with chronic pain. It involves practices to identify and challenge inaccurate beliefs accompanying the pain, and helps develop cognitive behavioural coping strategies, such as pacing daily activities and shifting negative thoughts. CBT also integrates relaxation practices which teach clients how to decrease emotional reactivity to physical pain by changing how they respond to it (e.g. with calming practices rather than panic), which uncouples the negative association between experiencing physical pain and getting emotionally upset. Relaxation practices are helpful because decreased body tension is less likely to exacerbate the experience of physical pain (think about the powerful impact lamaze can have on childbirth, or relaxing your muscles when getting a needle).

CBT is often combined with mindfulness-based practices, such as Mindfulness-Based Cognitive Therapy (MBCT), which teaches participants to notice pain non-judgmentally, with curiosity and acceptance. This change in perspective often results in less emotional reactivity to pain (mental or physical), thereby cultivating a greater tolerance, which can be a central goal in the treatment of chronic pain. Luckily, in Canada it’s becoming increasingly common for rehab centres to integrate these types of approaches to enhance recovery.


Pain management strategies you can try at home:

  • Notice your beliefs about pain. Are they limiting you?
  • Practice spreading out your daily activities and/or planning to tackle strenuous tasks when you tend to feel better in the day, or leave them for “good days”
  • Anticipate needing extra recovery time after strenuous activities and don’t judge yourself for it.
  • Resist the urge to push beyond your limits. Take a break if you need one. Pushing yourself too hard can be counterproductive, leading to longer recovery times.
  • Getting proper sleep can reduce emotional reactivity (i.e. crankiness).
  • If the pain disturbs your sleep, relaxation training and meditation can offer a restful alternative that’s nearly as restorative as REM sleep.
  • Practice mindfulness: focus on the present moment with non-judgment, curiosity, and acceptance. Connect with a mindfulness-based therapist if you’d like to learn more.

Stop Judging Your Nervous System

We can’t judge ourselves for our responses to trauma. A judgement is a cognitive (thinking) action. It doesn’t matter what we think should be easy to deal with or talk about, or how we think we should have responded. Trauma is registered in the body in the nervous system, so our responses to trauma happen subconsciously. That’s why we need to go at the body’s pace in recovery and learn to speak our body’s language.

#traumaawareness #traumasense

The Importance of Somatic Approaches to Trauma Treatment

There are often a lot of misconceptions about therapy. Many of the therapy sessions we see in Hollywood films depict clients pouring their hearts out to silently nodding, onlooking therapists, usually wearing trendy spectacles. (I don’t wear spectacles. Yet.) While this approach to therapy does exist, it reflects a less frequently employed modality. It lends to the common idea that clients have to purge all details of their past to their therapists, sometimes within their first meeting! This can create an intense sense of pressure on the first meeting. But not all therapists or therapies are alike, and there are times when such cathartic monologues may be harmful; especially when trauma is concerned. That’s why it’s important to work with practitioners who specialize in trauma treatment, specifically somatic, or body-oriented, approaches, if you experience these types of concerns.

To understand the importance of this, one must grasp how the nervous system works. When a person is confronted with something their brains and bodies perceive to be threatening (a stressor), their nervous systems automatically react with the stress response, putting them into a state of fight, flight, or freeze, and when these are ineffective, a submit or feigned death (dissociative) state. These are our natural survival mechanisms. Neurologically, during this process, our frontal cortex (or thinking/executive brain) and hippocampus effectively shut down. The evolutionary psychological explanation for this is simple: when we’re confronted with a potential life-threatening stressor, we don’t need to be eating a ham sandwich, reproducing, or thinking analytically; we simply need to mobilize our survival instincts to ensure our safety. And it’s for this very reason that top-down therapy approaches miss the mark when it comes to trauma treatment, because it’s at this level of functioning that we’re most affected by trauma.

Thinking more about neuroanatomy, the frontal cortex, or “primate brain,” responsible for our executive cognition (thinking), uses verbal language and analytical reasoning; the mid-brain, referred to as the limbic system, or “mammalian brain” speaks the language of emotion; and the brainstem, or “reptilian brain” speaks the language of sensation and impulse (Ogden, 2002). There are psychotherapeutic approaches which address each part of the triune brain (the three subsections previously described), such as: CBT for the “thinking brain;” emotion-focused approaches for the “feeling brain;” and sensory-oriented approaches for the “sensory brain.” When we are traumatized, our brainstems are overwhelmed by the threat; the frontal cortex is compromised and we don’t fully encode or process the experience analytically or emotionally. Our trauma response gets ‘stuck’ in the body and continues to activate primitive parts of the brain, implicating impulses and reactions that don’t get fully ‘metabolized’ in higher-level cortical areas. That’s why we need to start with the body in trauma treatment in a bottom-up approach to address the impact of trauma that was stored somatically before we can facilitate subsequent emotional and thinking processes (which happen later in therapy).

Somatic approaches help clients respect their personal limits, such as, how much they can comfortably tolerate in discussion before becoming flooded or overwhelmed. Such approaches incorporate the most recent advancements in the field of neuroscience and teach clients how to regulate their bodies to achieve greater personal safety…before going into the stories. It’s for these reasons that I stop clients from going into detailed accounts of their trauma histories during our first moments together. While my interruption may seem surprising, to allow them to continue may compromise their nervous system functioning and possibly retraumatize them.

In my office, we’ll likely get to the trauma histories and move past them, if a client is ready; but we always go at the nervous system’s pace.

A Commentary on ‘The Lifelong Effects of Early Childhood Adversity and Toxic Stress’

[Article cited: “The Lifelong Effects of Early Childhood Adversity and Toxic Stress,” by Shonkoff and Garner, (2012)].

This is an excellent article that comprehensively outlines the connection between early childhood stress with disease and disorder in adulthood. Although highly scientific and medically focused, the implications this article point to (i.e. correlations between early life adversity and subsequent susceptibility to mental health concerns and chronic disease) needn’t be pathologized; rather, I see these biological changes merely as our body’s way of promoting a prolonged stress response to adapt to and survive difficult experiences. Certainly this can lead to increased disease, disorder, and/or morbidity later in life, but if we develop self-awareness of our weaknesses (i.e. an over-developed stress response), we can develop skills and strategies to overcome them. Thank goodness for neuroplasticity, neurofeedback, yoga, meditation, and psychotherapy which help to restructure our brains, rebalance hormonal and biochemical processes, and promote psychological resilience. (For example, mindfulness meditation has been shown to reduce grey (brain) matter in the amygdala (a neurological structure responsible for processing fear), thereby counterbalancing the implications of toxic childhood stress discussed here.

For further reading on the mind-body connection and study on correlations between trauma and disease, I recommend Dr. Gabor Mate’s (2003) book, “When the Body Says No.” (Note that I don’t receive any endorsements for this recommendation, it’s just a really informative book by an insightful author.)

My Take on Mindfulness-Based Cognitive Therapy Vs. Neurofeedback

As all of you know, Heartfulness Psychotherapy is offering a Mindfulness-Based Cognitive Therapy (MBCT) group this spring and has also recently been involved in offering neurofeedback treatment. As such, I was asked by some very clever clients the difference between the two treatments and the associated benefits to be gained from MBCT versus neurofeedback, which I thought was a really interesting question. So let’s get into it.

Research has shown that MBCT has been beneficial for treating numerous concerns, such as:

  • Stress
  • Anxiety
  • Anger
  • Depression
  • Postpartum Depression
  • Bipolar Disorder
  • Chronic Pain
  • Addictions
  • Trauma
  • Eating Disorders
  • Fibromyalgia and Chronic Fatigue
  • Sleep Difficulties
  • Compulsive Behaviours
  • Attention Regulation (and associated disorders)
  • Acquired Brain Injury (ABI & TBI)
  • Sexual Difficulties
  • Relationship functioning
  • High blood pressure
  • Stress factors in heart disease
  • Increased self-awareness
  • Genetic resilience from illnesses, including cancer
  • Increased control of thoughts & emotions
  • Affective (read emotional) dysregulation, thus having beneficial implications for concerns such as borderline personality disorder

MBCT is a particular type of mindfulness-based approach. It’s a manualized 8-week course that teaches techniques to manage difficult thoughts, feelings, emotions, stress, and pain to promote health and relaxation using guided meditation exercises. It’s not a therapy or support group per se, but rather an experientially focused group that encourages participants to try exercises and share their experience in group.

Mindfulness is a practice. This is good news and bad news for some. It means that it offers life-long skills to manage life’s challenges, which is empowering! It means if you practice these tools, you’ll have access to long-term resilience and skillfulness for the rest of your life, and once you know the practice, it effectively becomes free (you can practice it on your own), or with minimal follow-up/ “booster sessions” required. It also means that it’s most effective if it becomes part of a lifestyle (i.e. if it’s done on a regular basis), which some people aren’t willing to do consistently.

Neurofeedback uses EEG (electroencephalography) to get a baseline reading of the brain’s electromagnetic frequency waves such as delta, theta, alpha, beta, and gamma which may be over or under active in various brain regions, consequently affecting a range of functions. Based on the baseline reading of one’s neural activity, and based on their subjective reports about the symptoms or complaints they’re experiencing, a recommended treatment protocol is generated by the system. While neurofeedback systems may differ slightly, the overall premise behind their effectiveness is that they provide stimulation [in the form of auditory, visual, or tactile rewards (less commonly used)] to help the brain “train” or learn how to function at the healthier brainwave frequency for that particular brain region, as determined by the particular system. Every system is different. The technology I worked with compared each individual’s brain reading to a vast normative database, which has pros and cons in itself (e.g. some systems employ technology that only trains the brain in comparison to itself, since some people prefer not to have their brainwave frequencies modeled based on a normative sample, while others don’t mind).

Based on the preliminary research I’m familiar with, neurofeedback has received empirical (i.e. research) support most commonly for stress-related concerns such as:

  • Stress
  • Anxiety
  • Sleep Difficulties
  • ADD and ADHD
  • Depression
  • Trauma
  • Acquired Brain Injury (ABI, TBI, & concussive disorder)
  • Enhancing Cognitive Performance
  • Autism Spectrum Disorders & Asperger’s Syndrome
  • Chronic Pain
  • Eating Disorders
  • Learning Difficulties
  • It has been used with some benefits in Alzheimer’s Disease


MBCT Vs. Neurofeedback (My Pros and Cons List)

Neurofeedback is purported to have lasting effects that are produced within 3-10 treatments with a variable amount of follow-up required (on a case by case basis). It is often extremely costly but beneficial results can be seen relatively quickly, although the experienced benefits differ between individuals.

MBCT also has lasting impact but requires maintenance for best results. While the 8-week course can cost generally $600 -$975, it tends to be considerably more economical than neurofeedback and/or individual psychotherapy. However, neurofeedback might appeal to those looking for a ‘quick fix,’ which tends to be attractive in our fast-paced society.

Neurofeedback reflects new technology and all the benefits and limitations that come along with it, while MBCT has its origins in ancient Eastern traditions, thus carrying a sense of tried and true organic wisdom.

Mindfulness empowers individuals to cultivate internal skills and control whereas neurofeedback requires that patients be dependent on the skillfulness of the practitioner and the particularities of the technology being employed, thereby relinquishing personal agency.

Neurofeedback is intended to result in lasting neurological change. The number of brain regions “trained” or targeted during a 10-session treatment protocol largely depend on the particular system being employed. I trained on a system using four regions (i.e. during my treatment, I consistently worked on improving four brain regions). The neural regions selected were determined partly by the clinician and partly by the treatment protocol generated by the technology. Therefore, while there is greater ability to individualize which brain regions (and which associated symptoms) will be addressed by neurofeedback, there are often a limited number of options. Of course one could choose to pay for subsequent treatments and train additional regions.

Mindfulness meditation (and MBCT) affect significant beneficial brain changes too, (see Psychology Today’s listing and Harvard’s recent study) they’re just less individually customizable. Such practices affect the brain’s electromagnetic frequencies as well; again, they’re just less individually customizable than in neurofeedback treatment.

MBCT has few (if any) contraindications and to my knowledge has not been known to cause harm to anyone. Neurofeedback on the other hand is contraindicated for various conditions (e.g. epilepsy), and can be harmful if the clinician implementing it is not properly trained.

Since MBCT is manualized, it should theoretically be offered in a consistent manner irrespective of the group facilitator. Neurofeedback, however, may vary depending on the technology employed and operating clinician.

Both approaches require prolonged sitting (20-40 minutes). Both approaches can make people feel slightly sleepy afterward. MBCT requires approximately 1.5 – 2 hours a week commitment for an 8-week period, while neurofeedback generally requires a one hour assessment, a 30-minute report reading, and 2-3 20-minute subsequent training sessions a week for a minimum of 10 sessions, thus neurofeedback is more time intensive. And it involves hair gel that may hamper your plans if you have a date scheduled after your appointment. Just saying.

MBCT is offered amongst groups, while neurofeedback is offered individually, thus providing a greater sense of privacy during treatments. While some may shy away from groups, I’ve received a surprising amount of feedback suggesting that the group atmosphere helped individuals learn from one another, normalize their own experiences, and feel part of a supportive community. (Note that speaking in group is only voluntary). Nevertheless, it remains up to personal preference.


I prefer MBCT over neurofeedback because I like the self-empowerment, life-long skill acquisition aspect of it rather than feeling dependent on yet another service provider. It helps me feel greater alignment with my spirituality, (note: this component is NOT taught or required in MBCT groups but may be an pleasant and optional byproduct). It also supports my yoga practice since it incorporates some gentle yoga postures. Overall, both approaches are great non-medical alternatives, and both treatments are known to be helpful for a variety of concerns, so it all depends on the treatment outcome you’re looking for. Ideally, we should be so lucky to use both treatments!

Please note that this is my professional opinion on these practices based on my experience with them; feel free to offer your feedback if you feel I’ve missed something; I’m happy to start a dialogue. Happy brain health everyone!


15 Ways to Overcome Negativity

Negativity is often a lot about being in a protective, defensive state of mind. Evolutionary psychologists believe negativity served an important adaptive evolutionary function: it helped keep our ancestors alive long enough to procreate succedent generations of offspring to eventually produce you and me. That’s how researchers explain the negativity bias: the fact that it takes us about 20 seconds longer to encode positive thoughts or memories than we do negative ones. It would have been advantageous for our ancestors to attend to negative, possibly threatening events in their environment, such as floods, droughts, competing tribes, or dangerous packs of animals nearby, as this would have increased their chance of survival and reproduction (i.e. the goal of our genes). This negativity bias formed the foundation of our cognition (i.e. human thinking processes and associated neural/brain architecture), thus shaping how we think in modern life, since we still share the same cortical architecture as our forbearers.

This topic is highly relevant because depression, anxiety, and associated worrisome and/or negative thinking are among the most common psychological concerns seen in the psychology field today. So here are some strategies for dealing with negativity:

  • Identify the negative thought. Awareness is always the first step. Labeling it as such can help increase your awareness when it arises.
  • Learn to disengage from automatically believing every thought you have. Revisit my blog post, Just Because You Think it Doesn’t Mean it’s True
  • Note the underlying function the worry/thought is serving (e.g. it likely has your best interests at heart). E.g. the subtext might sound like: “Be careful not to get too excited and become disappointed”…or “If I anticipate bad things will happen, I will be less hurt if/when they do occur,”).
  • Give yourself permission to adopt new perspectives. You might even thank the negative thought, for example: “thank you worrisome thought for wanting to protect me from pain. I know you’re just trying to keep me safe, but I’m going to give myself permission to try seeing this differently…”. You might remind yourself that changing a habituated pattern may feel uncomfortable at first, but that’s often a sign of breaking the rut, and remind yourself of the good reasons for doing so. Sometimes we can get used to living in a certain state (e.g. unhappiness or stress), and need to consciously practice allowing ourselves the freedom to experience levity and optimism.
  • Become an observer: watch your thoughts like passing clouds in the sky; notice that they are fleeting if we do not hold onto them or endorse them with rumination, and that eventually they will be replaced by new thoughts (e.g. about what to have for lunch!).
  • Adopt a regular mindfulness practice as a way to disengage from troubling thoughts. If you’re new to mindfulness, seek out guided meditations online or in the app store.
  • Pick a mantra; any mantra. Kundalini yogis swear by repeatedly reciting uplifting mantras (aloud or internally), as they help reprogram our subconscious minds, rewiring us towards positivity and healing energy, or at the very least, acting as a welcome mental distraction.
  • Surround yourself with positive people. They say we’re the sum of the five people we’re closest to. Who’s in your inner circle?
  • Adopt a gratitude practice. Start keeping a written list of a few simple things you’re grateful for daily (there are apps for this!). It will shift your thinking to help you become better at recognizing and cultivating more pleasurable events.
  • Channel your inner 4-year old. You might envision yourself experiencing situations from fresh eyes the way children do. Use your sensory information to ground you in the present moment and stimulate your imagination. Try to savour the experience you take in through your senses. Allow yourself to experiment with different sensory stimuli. Play and feel fully alive. Spend time savouring small moments. By elongating your experience of pleasurable events, you’re more likely to reap their benefits and store them in memory for later.
  • Do the opposite. Mindfully choosing to do opposite action (or respond differently) can be helpful if you’re in a pattern that’s not working for you and you’re not sure how to break out of it. We usually have to change our behaviour to change the trajectory of the pattern, which reflects our ability to influence our circumstances and be empowered! This can be applied to relationships and other challenges. A good example is trying to break out of a depressed rut. Depression often causes a lack of motivation and increased isolation; but fighting against these impulses to hibernate can actually generate improved mood. Be mindful about the opposite actions you choose; ensure you’re choosing activities that are known to have a beneficial affect on you.
  • Consider the evidence for and against your negative thought. Make a list for both. Often there is more evidence supporting the contrary.
  • Practice reframing. Your reframes don’t necessarily have to be positive. Not everyone has a positive alternative thought handy, but just adopting an alternative perception could be enough to affect an emotional shift. Adopting other perspectives also reminds us that our original automatic interpretation is not a veridical truth, but rather, just one of many points of view, and we can switch them if we choose to.
  • Work with a professional. This can be hard work to do on one’s own when you’re already entrenched in a certain way of thinking or functioning. Therapists can be helpful catalysts for fostering movement out of old patterns. A good therapist should be a neutral observer, and they should create a sense of accountability in clients, gently motivating and supporting them through challenges.
  • Keep practicing. New habits take time!
  • Repeat.


Maintaining Heartfulness & Cheerfulness Throughout the Holiday Season

New Heartfulness Logo no text no background holiday wreath edition 2

Although the holidays can be a special time of year, they can also bring increased pressures, demands, and expectations, leaving many feeling overwhelmed. To help you get the most of the season, we’ve compiled a list of ways to mitigate holiday stress.

Plan Ahead

Anticipate extra errands when planning for guests and gifts and try to pencil time into your schedule well in advance. Expect and strategize for additional deadlines at work before the holiday break. Arrange specialist appointments reliant on extended healthcare coverage well before the end of the year when appointments become scarce. To fight off procrastination, make a list of simple, manageable steps needed to address each task and set reminders in your daily agenda, use visual cues (e.g. on your fridge) if you’re a visual person, or schedule timed reminders in your phone. Many people report feeling a sense of satisfaction and relief when checking off listed items, which helps maintain motivation and organization. Likewise, intentionally schedule extra time for relaxation and self-care activities since they’re likely to be overlooked when they’re needed most.

Identify Triggers

Mindfulness (i.e. increased awareness of one’s thoughts, feelings, and sensations in an accepting, nonjudgmental manner) helps us better identify our triggers and manage them before they lead to mental, physical, and emotional exhaustion. Although it’s a hectic time of year and one of the most common complaints from clients is a lack of time to devote to meditation or relaxation, short grounding exercises can fit into any hectic schedule and can have a lasting impact. For instance, three times a day, take a three-minute breathing space to check in with your thoughts, feelings, and sensations while tuning into the rhythms of your breathing. Use this time to note anything your body is telling you. Have you forgotten to eat properly? Do you need to get some extra sleep? Do you need to fit in a quick walk? If time permits, you can explore longer 10-30 minute meditation exercises. Research has shown that three 15-minute meditations weekly can reduce depression and 30-minute meditations daily have been shown to reduce grey matter and activation in the amygdala, a brain region associated with anxiety and stress. By decreasing our stress hormones, meditation also helps maintain a stronger immune system to help us thrive throughout the holidays.

Anticipate Triggers and Plan Accordingly

With increased social gatherings, the holidays can be emotionally draining. Often various boundary issues come up, for instance, through commonly held customs that challenge one’s lifestyle choices (e.g. typical holiday dinners that don’t accommodate veganism, family members who don’t accept your romantic partner, or a strong emphasis on celebratory drinks, which can be exclusionary to those who don’t drink.) Based on our past experiences, we can anticipate similar situations to come up again and again –especially with family dynamics. Planning, visualizing, and practicing skillful responses (versus reactions) to difficulties helps us remember them at the times we need them most –when we may be too activated to think clearly and make healthy decisions. Learn to set personal boundaries and say no. Saying yes to everything will leave you feeling depleted and resentful. Think ahead and strategize to keep yourself safe. If you’re concerned there might not be appropriate food to accommodate your lifestyle choices at a gathering, bring a dish you’re comfortable with. If it’s triggering to be around people who are consuming alcoholic beverages, bring your own special drink with you, bring a friend you feel safe with, practice assertively refusing offers, or plan strategic exit plans to use should you need them. If you notice yourself becoming triggered during an event, excuse yourself and do a brief grounding exercise in the washroom or leave the situation and reassure yourself that you’re exercising self-care. (Various guided meditation apps can be downloaded on smartphones for mobile mindfulness!)

Get Support

With so much emphasis on social gatherings, the holidays can also present poignant reminders of one’s lack of familial ties and supports, and romanticized ideologies around celebrations like New Years Eve can have the affect of making one acutely aware of their relationship status (if single). Or perhaps the holidays bring up difficult anniversaries. If you know this is a difficult time for you, build a support network. Reach out to friends, get professional support, or join a community group. Schedule purposeful activities with friends on difficult anniversaries to ensure you’ll have the supports you need. Or find a way to cultivate gratitude. Whether through journaling or sharing with others, research has shown that practicing gratitude has health benefits, such as decreased depression and longer and better quality sleep. Also, finding a way to give back to those less fortunate (e.g. through volunteering) can redirect us from focusing on our own problems and increase a sense of purpose, community, and connection in our lives.

Wishing you a cheerful, healthful, and heartful holiday season,


How to Manage Guilt

“Negative emotions like loneliness, envy, and guilt have an important role to play in a happy life; they’re big, flashing signs that something needs to change.”    

–Gretchen Rubin

In my experience, guilt is mostly about a person’s core values, which are shaped by our culture, upbringing, and socialization. Some cultures use ‘guilting’ as a parenting strategy (i.e. to make children feel shameful about their behaviour in an effort to promote good little boys and girls). While this might work in the short-term, the underlying long-term message it conveys to the child is a lack of unconditional positive regard from the parent, meaning, (from the child’s perspective), if they do something undesirable, they will be subject to humiliation and possible rejection by their loved ones. This in turn seems to promote anxiety in the child (and later adult), because who wouldn’t feel anxious if they believed they were always on the verge of possible humiliation and guilt?

Moreover, it’s problematic because we often unconsciously absorb the values held by our culture, parents, and society, which form the basis of our internal self-monitoring system which guides us through life according to our morals and principles. That is, we learn lessons in childhood which form the basis of our values, and we tend to develop a subconscious parental-type voice we use to govern our own behaviour as adults to ensure we stay aligned with our idea of “being a good person” (as a generalization for most of us anyways). So in this way, guilt can become a predominant schema that automatically arises to keep ourselves in check, but it may not always be necessarily rationally-based or warranted. And if it tends to be a very strong automatic impulse, it can take over.

Some steps to managing guilt before it manages you:

  1. Let go of regret. We can’t undo the past, but we can learn from it and hear what our emotions have to say about our past decisions. In this way, we can welcome the lessons guilt has to offer and become transcended rather than stuck by them.
  1. Acknowledge the guilt and listen to what it is telling you. What’s the underlying message? Perhaps you feel you made a mistake, acted selfishly, or did something embarrassing and can’t get past it. What are ways you can reconcile these uncomfortable actions? Do you need to make amends with someone you care about? Do you need to change your approach going forward? Are you acting in a manner that respects both yourself and the other person involved? If you’ve done everything you can to handle the situation with the grace and integrity it deserves, simply acknowledge your guilt and move on. Often the most guilty are the most self-conscious, strongly principled individuals. So find reassurance in the fact that you’re likely very considerate overall, therefore others can forgive the odd well-intentioned mishap or two. No one’s perfect.

Mantra: We don’t have to let every automatic thought or feeling we have control us.

  1. Develop an internal dialogue with it (yes, I’m actually advocating for talking to yourself!) It might sound like this “Hi guilt. Thanks for telling me that this is important. I’ve done everything I can do to be kind, compassionate, and respectful in this situation. So I’m doing my best. I’ve got this one covered.” (You might remind yourself of all the associated efforts you’ve made –I like to count them on my fingers.) And try your best to move on. Note that it may take time for the guilt to subside, but once you’ve acknowledged and validated the feeling, it will tend to dissipate over time.
  1. Learn to Re-Parent Yourself Compassionately. No blaming here. Most of our parents did the best they could with what they had. But even still, some of their approaches to parenting may have inadvertently had a negative effect on us. If you think you’ve been parented by ‘guilting’ and are controlled by it as a result, learn to identify the guilt as it automatically arises and try re-parenting yourself using more affirming, compassionate language (i.e. instead of using self-shaming language e.g.: “I’m such an idiot! Why did I do that?!” try a more understanding reframe: “I made a mistake. It happens. How can I approach this differently in the future?”) This can help undo the patterns of your past and set you free!

Just Because You Think it Doesn’t Mean it’s True

We commonly tend to ascribe too much meaning to our thoughts. After all, they’re largely responsible for guiding us through our daily lives, and we’d be lost without them; so why wouldn’t we naturally assume our thoughts to be all-important? While this is true and thoughts are important, falling into this fallacy overlooks the nature of how the brain works and the purpose thoughts serve. Antiquated views coming out of the Renaissance era venerating the importance of the mind and intellect over lowly emotions don’t help either, but that’s neither here nor there. (I happen to believe that emotions are equally as important, for the record.)

So how does the brain work?

Everything we think creates and strengthens neuropathways (connections) in the brain. The more we think things, the stronger, faster, and supercharged these thoughts become (they can even become super fast and sneaky, therefore subconscious and we might not even notice them anymore). All this relates to physical structures that are set up in the brain and reinforced the more you practice a skill or thought (hence why practice makes perfect).

Why does this matter to you?

Well, if we know how our brains work, we can harness this knowledge and put it to use when things aren’t working for us, for instance, when our thoughts aren’t serving us well. I see this amongst my clients all the time. Clients come in clinging to their old beliefs that may have once served them well, but are now causing terrible anxiety or depression. And it’s often very difficult for them to consider that alternative perspectives might have some validity (because their brains are used to thinking this way, not because what I’m suggesting is necessarily false). My work is often influenced by a mindfulness-based perspective, which sees the mind as having evolved simply to produce thoughts to make sense of our surroundings and keep us safe, just as the heart has evolved to pump blood, and our lungs have evolved to circulate oxygen within us. Mindfulness adopts a mechanistic view of these functions. From this perspective, we see that if our brains have been practicing thinking a certain way for a long time, they will automatically gravitate to thinking that way whether it’s true or not in our present situations. But we tend to make the mistake of believing the thought whether it’s relevant to the present situation or not! (Think of our tendency to make false assumptions based on past experiences.) In this way, our past references colour our interpretation of the present and the future, which is essentially how we make sense of our surroundings. But we can’t let this thinking process totally control us. That’s when we get into all kinds of mistaken beliefs (Google the 15 most common cognitive distortions for example).

So how can you use this information?

Notice when you’re having repetitive distressing thoughts. Next time they come up, instead of automatically believing them, pause and notice your thoughts, emotions, and physical sensations. Be curious about where the thought is coming from. Perhaps it’s just an “old tape recording” from the past. Is it serving you well? If not, simply note that your brain is really good at thinking that thought, that it’s not necessarily true, and mindfully resume what you were doing before you were rudely interrupted by the intrusive thought. Or use mindful distraction (i.e. activities carefully chosen based on their likelihood to have a helpful outcome for you). Note that this is a skill that requires practice, and it will take time for your brain to get used to thinking this way. If you need more support in this practice, join a mindfulness meditation group in your community, such as MBCT or MBSR, or I’m happy to connect with you for a counselling session to discuss this in person. Good luck and be well!

Our thoughts are not facts