I recently had the pleasure of attending a two day training on “Harnessing the Power of the Mind, presented by Dr Daniel Siegel (American psychiatrist and author of Mindsight:The New Science of Personal Transformation). 

In this training, Dr Siegel highlighted the results of the latest research into “neuroplasticity” which he defined as the capacity to grow new brain cells and create new connections in the brain in response to experience.  

The good news about neuroplasticity is that, unlike what was previously believed, new brain cells and new connections in the brain can be grown throughout our lives, not just during our childhood. Through his work in this area, Dr Siegel has identified six daily practices which everyone can do to maximize their well-being, brain health and ability to change their brain to create a better life.

Neuroplasticity and Psychotherapy
Dr Siegel explained that how we focus our attention actually shapes the structure of the brain. He highlighted how psychotherapy changes your brain by combining the attuned, empathic and safe relationship you develop with your therapist with the integration of past and current experiences, new information and insights.

Dr Siegel sees therapists as being “integrationists”. We integrate new ways of seeing things into growing new brain pathways as we choose who we want to be rather than being a slave to our past. Ultimately, as therapists, we harness neuroplasticity to grow integrative fibres in our client’s brains.  His research has found that both mindfulness (i.e. non-judgemental, focused attention) and secure relationships increase integration.

I have found these principles to be invaluable when I am helping my clients who have become demoralized by the seemingly insurmountable challenges of changing life-long mental health conditions and unhelpful habits. These ideas and the following six practices are relevant to anyone trying to recover from or overcome a whole range of conditions including depression, trauma, anxiety, substance abuse and unresolved issues from childhood.

It takes around two to three months to grow new brain cells and connections. Thus, while new insights may occur in therapy, allow time for these changes to consolidate. You can further boost the process of change by engaging in these daily practices that facilitate neuroplasticity. 

Six things you can do to maximise brain neuroplastcity
 
1.  Develop relationships with people and put time into connecting and interacting with others. Ideally, this is done face-to-face to fully engage the brain with verbal and non-verbal aspects of communicating and relating. Take time to appreciate your connection to the people around you as it will activate and reinforce your brain's relational circuitry.

2. Novelty promotes brain growth. Novelty can involve humour (as Dr Siegel notes,  most jokes and good stories involve a “violation of expectation”) as well as new experiences (e.g. travelling, learning a new language or musical instrument or skill).

5. Adequate sleep will give the brain the rest it needs to consolidate learning and recover from the experiences of the day.

6. Focused Attention - Close paying of attention (instead of multi-tasking which involves continuous partial attention) stimulates neuroplasticity. Regular mindfulness meditation practices strengthen your ability to focus your attention and thus change your brain. Dr Siegel recommends allowing time for sustained focused attention on both external stimuli (e.g. reading, artwork) and inner experiences (e.g. reflecting on sensations, images, thoughts and feelings). 

The Wheel of Awareness Meditation
Dr Siegel has developed a meditation called the Wheel of Awareness. It utilizes his principles of internal and external focus as well as focus on connection with others to promote well-being and strengthen your mind. A variety of free downloadable Wheel of Awareness meditations and other resources can be found at Dr Siegel’s website – just click the tab under resources.

Chronic health conditions bring many challenges such as pain or irritating sensations; fatigue; and restrictions on what you can do or eat. Which psychological therapies offer the most effective coping strategies for managing such challenges? My experience, (both personally and professionally) leads me to put Acceptance and Commitment Therapy (ACT) and Compassion Focused Therapy at the top of my list. In this article, I will discuss some core principles of ACT and how they can help with managing chronic illness and pain. ACT is a mindfulness–based behaviour therapy. In another article, I have talked more about the use of mindfulness and Compassion.

ACT (pronounced as the word “act”) was developed in the late 1980s by American psychologists Steve Hayes, Kelly Wilson and Kirk Strosal. They saw it as an evolution of the well-established school of Cognitive Behaviour Therapy. Since its development, research involving controlled randomized trials has supported the effectiveness of ACT in managing a range of conditions including depression, anxiety and chronic pain.

As the name implies, ACT involves both acceptance and commitment. ACT aims to assist you to acknowledge and accept what you cannot control (thoughts, feelings, body sensations … whatever life throws at you) so that you do not waste your energy struggling with and judging your illness and your reactions to it.  Instead, you commit to take effective action in areas you can control – like how you want to be in the domains of your life that you value (e.g. relationships, health, and personal growth).

When you have a chronic illness, the aim of ACT is to create a life that is rich and meaningful around pain, illness and negative emotional states and thoughts - rather than a life free of pain/ illness/anxiety/depression/stress etc. Trying to be free of these symptoms is simply an unhelpful pursuit as, by definition, a chronic condition is one you need to learn to live with. Paradoxically, despite what many believe, acceptance actually leads to symptom reduction as we remove the overlay of the disabling distress that comes from the ‘I want this illness gone’ mindset.

Acceptance
The principle of “acceptance” is the most valuable concept for you to embrace on your journey with chronic Ill health. The Buddhist teacher, Shinzen Young, developed this formula to explain suffering. He said Suffering = Resistance x Pain. This is where the notion of acceptance comes in, as acceptance is the opposite of resistance. So, the more you resist and struggle with your illness, the greater the suffering you experience.

In ACT, acceptance does not mean you like your illness or have no negative thoughts or feelings about it. It means:  

• you stop struggling to get rid of it or control it (which is not a battle you can win with a chronic condition) 
•  you stop judging it or criticising yourself for having it (which only compounds your negative feelings)  
• you stop analysing why you have a flare up now (when there are often no answers) 
  

Instead, you acknowledge and make room for feelings like physical pain, or sadness about limitations, so that you can be the person you want to be around these feelings. You do not let your pain and illness hold you back from life-enhancing and meaningful actions. And you don’t let them stop you from being the person you aspire to be. 

Clean and Dirty Distress.
ACT makes a distinction between “clean distress” and “dirty distress” when dealing with the emotional and physical pain associated with chronic illness. The essence of “clean distress” is that you are just experiencing the pure distress in the present moment (“I’m sad, this is unpleasant”; “I am in pain”) without muddying the waters by adding in further negative thoughts like:

•  judgements (“I should be able to cope better”; “I shouldn’t feel upset”), or
• assumptions (“This is my fault”; “Other people cope better than I do”)
• or predictions (“I’ll never be able to cope with this”).

 “Dirty distress” also refers to additional feelings about your feelings (e.g. irritated about being sad - “I shouldn’t feel sad – I should just get on with it”).  Thus, feeling irritated about your sadness over how you can no longer do that favoured activity or eat that favoured food is “dirty” distress. Judging yourself for being sad would also be “dirty” distress, while the sadness itself is “clean” distress. 

Just to be clear, it is not about being a “stoic” and soldiering on regardless. For example, ignoring pain could mean you do not pace yourself which could also take you down a path of more pain.  You do still need to make time and space to acknowledge the emotional distress that goes with the physical pain or chronic condition.

So how do you do this? Studies have shown that writing about or talking out loud (even if it is to yourself) about upsetting situations reduces emotional distress. On the other hand, just thinking about it increases negative feelings.  Keeping a journal will assist you with expressing your emotions, particularly if you want an alternative to talking to loved ones about it. (When pain and illness is chronic, friends and family do have their limits on how much they want to hear about it). 

Clarify Values
In ACT we also help people clarify their values so they can take actions towards creating the life they want. One ACT exercise to assist with this is to picture your funeral and imagine what people from different areas of your life (friends, family, work) will remember about you and how you lived your life. If what you imagine is not what you would like, this may guide you in making some changes now while you still have time.

Some other questions to ask yourself which may also help with values clarification are:

• What do I want my life to be about? 
• If my health was to get significantly worse in 12 months time, what would I regret not having done?
• What is most important to me? 
• Are my choices and actions in line with what I value?
• How do I want to be with friends/family/community/myself despite the challenges of this chronic health condition?
• In this moment, if I were being the person I want to be, how would I act right now? 
• If my health wasn’t such a problem for me, then I would _____________________.

Think about if there is anything you value that you have put on hold because you are making your life all about coping with your health condition. Actions and choices that take you away from the direction of what you value will lead to greater suffering. Actions and choices in the direction of what you value will lead to vitality. 

Applying ACT to Flare-ups
Coping with some health conditions may also mean coming to terms with the fact that they are chronic, waxing and waning ailments. Flare-ups happen, and finding a reason for a flare-up can drive you crazy. Often there is no pattern or obvious trigger to explain a flare-up. Therefore, no way of predicting it, and accordingly, no way of controlling it. This can be very frustrating.

Rather than trying to look back over what you did or did not do to cause this flare-up, or planning for every way you might avoid it in the future, it is better to acknowledge that you are having a flare-up because you have a condition that flares up. It is what it is.

So how do you want to be in the face of this flare-up? Kind and gentle with yourself in the present. Allowing yourself some space to feel the sadness, anger, frustrations etc, before engaging with how you want to be in this next part of your day. Making choices in areas that you do have control over. Choices that will be in the direction of managing this flare up and your health as best you can. This may involve:   

• meditating and/or medicating to assist with discomfort
•  pacing what you do if your are in pain 
• reminding yourself that flare-ups pass 
• shifting your attention away from “why?” to other things (sounds, people, and activities) in your present environment
• you may even choose to set aside some time to acknowledge (and even write about) your feelings now or later

Writing thoughts down (just as they are, without arguing with them) is a key strategy from ACT as it strengthens the “observing part of you” who can step out of negative spirals of thoughts and feelings. While you can’t control whether you have negative thoughts and feelings, you can choose what to do next. You can choose to believe the thoughts (like “I can’t do anything” or “I am a failure”) or you can see them as just thoughts which come and go and may or may not be true.

ACT emphasises that it is best to be guided by what your experience tells you is doable, rather than what your thoughts tell you that you “should” be able to do. Therefore, give yourself permission to take small steps in the direction of meaningful activities if you are unable to do as much as you would like. Even if they are small steps, they are still in the direction of what is important to you.

In a nutshell
To summarise, ACT is all about accepting what you can’t control, and committing to doing what you can in spite of the pain, fatigue, limitations and other challenges that come with chronic health conditions.  You do this in order to create a life you value.

Exposure (and response prevention) therapy is the most well established therapy for OCD, with those treated with it reporting around 75% reduction in their symptoms. One of the drawbacks of exposure therapy, however, is that the client may be required to tolerate high levels of anxiety in the process of getting better. Some studies have found that around 25% of patients may drop out of therapy because of this. This concern led two Canadian psychologists – Dr Kieron O’Connor and Dr Frederick Aardema to develop a new approach to treating OCD, called Inference Based Therapy (IBT). In a nutshell, this approach sees doubt as the basis of OCD and their treatment of OCD involves targeting the OCD doubts and OCD “stories” directly.

Obsessional doubts
Obsessional doubts lead people to doubt their own senses and perception of reality, and confuse them with what they imagine is possible. For example, take the case of a woman with obsessions about harming her children, or a man fearing he may be homosexual or a paedophile. Even though the reality is that these people have never exhibited any behaviour along these lines, they imagine it is possible and so doubt themselves.

They obsess about who they could become, rather than who they are in reality. Or in the case of people who wash or check repeatedly, they rely on what they imagine could happen (germs could be spreading; appliances could be left on and burn the house, doors could be unlocked and the house could be burgled) rather than their here and now senses that show them their hands have no visible dirt; they heard the lock click the first time they turned the key; there is no smell of burning. 

The opposite of what you fear
Those who are tricked by OCD have also lost touch with common sense about the likelihood of imagined catastrophes happening, particularly in view of the type of person they are, which is usually the opposite of what they fear. What I find time and time again with my OCD clients is that the OCD story about who they could become is actually the complete opposite of who they are in reality. For example, the clients I have seen who fear harming their children have been very caring parents.

Imagination confused with reality
Thus, people who have OCD are making inferences based on imagining what could happen, rather than what does happen in reality. Their doubts lead to rituals that make their doubts seem real and lead to more doubts. They are stuck in a viscous cycle. The core of the problem is that they have confused an imaginary possibility with a real probability. The inference based approach helps those with OCD to distinguish between normal doubt and obsessional doubt.

Normal, ‘authentic” doubt is based on new sense based information (I smell burning; did I leave the stove on?). Obsessional doubt is based on imagination, with no new sense based information in the present (e.g. I am leaving the house, the door looks locked, I heard it click, but I need to check it again and again because I am worried it may not really be locked, or it may have unlocked itself).

Logical and possible does not make it true
IBT accepts that people have logic and reasoning behind their doubts which make their doubts and OCD story seem credible. It is possible to leave doors unlocked and be burgled. They have heard stories about people “snapping” and attacking their children. Germs do exist and cause diseases, that is why there are rules about hand washing (e.g. after toileting). They may have experienced times when they did leave an iron turned on, or know of elderly relatives who forget to turn taps off. But this logic and reasoning does not make their obsessional doubts and OCD stories about themselves true. 

Rituals make the imagined feel true
OCD reasoning goes beyond common sense and what is likely to happen in the present situation. It turns a few possible ideas and doubts into a probable and imagined story which triggers anxiety and the need to undo the anxiety with some sort of ritual (either inside the head or an action). While the story is entirely made up, it starts to feel real because it is acted on with neutralising rituals and safety behaviours like avoidance. The OCD sufferer thinks that actions taken in reality can change imagined consequences.

Who you could be is not who you are in reality
The OCD sufferer relies on the imaginative story about who they could be (if they do not take OCD precautions, do rituals and other ways of neutralising their obsessions) instead of who they are in reality. So the problem is their central focus is on who they could be, not who they are in realty. And who you are in reality, is defined by your actions (did you actually harm your child), not your thoughts or feelings, because these are not under your control.

An alternative story helps you stop the rituals
Through a series of steps, IBT helps the OCD sufferer to become aware of the story they have bought into about themselves (and about what might happen) which is driving their OCD. It helps them consider a more reality based view of themselves and how the world operates. An alternative story about who they may become or what might happen is then developed. Once this alternative story is accepted, actions can be based on real here and now sense information instead of doubts about what could be. When this approach is followed, it is easier to stop doing the rituals which feed the OCD.

IBT is a new approach to OCD which has helped people free themselves from the tyranny of having OCD run (and ruin) their lives.

Established psychological treatments
When it comes to psychological treatment, research suggests the most effective treatment is some form of Cognitive Behaviour Therapy (CBT). This would usually involve Exposure and Response Prevention (ERP) which means the OCD sufferer is asked to repeatedly confront the triggers of their OCD behaviour and refrain from doing any neutralising rituals.

For example, someone who compulsively checks locks when they leave their house would be asked to leave the house and only check once. Someone who fears contamination and washes repeatedly would be asked to touch something dirty and not wash, and to allow the anxiety to go down with time. While this may initially cause considerable anxiety, OCD sufferers soon learn that the anxiety goes down even when they do not ritualise. By repeatedly doing the ERP, they will create new pathways in their brain and the urge to check or wash will decrease.
 
Cognitive Therapy
Because ERP is a challenging task, often seeming too scary to even contemplate, it is broken down into manageable steps, sometimes beginning with delaying the ritual, or changing it in some way, before being able to resist doing it all together. Cognitive Therapy (CT) is often used before ERP to help reduce any anxiety about doing ERP.
 
Cognitive therapy with obsessional thoughts differs from traditional CT with “negative thoughts” as  instead of questioning the evidence for and against the obsession, (eg “I might harm someone”) and  trying to convince  someone they would not harm anyone,  it challenges the thoughts about the obsession (eg, “Having these obsessions means I need to take precautions because it could happen"). Learning to step back and observe obsessions rather than argue with them or try to stop having them is key to managing them.  

Involving Family
Family members can get unwittingly caught up in the OCD. Attempts to help, while calming the OCD sufferer in the short term, may end up making it worse in the long run. Moreover, hostility from relatives toward the OCD sufferer can lead to a poor response to treatment. Thus, educating family members about OCD and how to assist with ERP is also very important. 
 
Newer psychological treatments
While CBT is a well established treatment for OCD, more recent developments in psychotherapy are also being trialled with some success. For example, Acceptance and Commitment Therapy (ACT) has been found to help with OCD. A new form of Cognitive Therapy, called Inference based Therapy (IBT) has also been effective with OCD.

IBT sees doubt as the basis of OCD. Persons with OCD may doubt their senses (“Even though I can see it is locked, is it really?“ ) and themselves (”Could I be someone who sexually abuses children?"). IBT helps the OCD client distinguish between “normal” doubt and “obsessional” doubt and understand how they have been confusing real probabilities with imagined possibilities.  

I have found both these newer approaches to therapy very useful to use along with ERP to help my OCD clients gain back control over their lives. For more information about IBT, see my article. 

The Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder (PTSD) recommend two therapies which have the best evidence. These are EMDR (Eye Movement Desensitization & Reprocessing) and trauma focused Cognitive Behaviour Therapy (CBT).


EMDR faster than CBT
While I am trained in both CBT and EMDR, when it comes to treating trauma, I prefer EMDR as it more rapidly resolves symptoms. Clients also prefer EMDR as it has no real homework attached to it. 

My preference for using EMDR has also been supported by a study that was recently published in the British Journal of Psychiatry. This study compared EMDR with a trauma based CBT to treat 140 patients diagnosed with Post Traumatic Stress Disorder. It found that while both therapies were effective, EMDR worked faster and had less people who drop out of therapy. You can read the full study here. 

EMDR better than Aropax
Another recent study compared EMDR with an antidepressant (Aropax) to treat male survivors of war trauma who had moderate to severe PTSD. This study was presented at the 2013 International Congress of the Royal College of Psychiatrists. It found that 90% of the patients treated with EMDR improved while only 36% of those treated with Aropax improved. More importantly, those treated with EMDR had a significantly greater reduction in symptoms and without the side effects of medication.

EMDR is Well Researched
When EMDR first came out (In the early 1990’s) there was a lot of scepticism about it as it seemed a bit weird (involving moving one’s eyes back and forth while recalling upsetting memories) and seemed to work much faster than other trauma therapies. This has meant that a great deal of research has been done to demonstrate its effectiveness.  For more information on EMDR research see this website 

Understanding, Coping skills and Safety First
Treatment of PTSD begins with understanding exactly how the trauma has affected a person as similar events can hold very different meanings to different people. Next, a range of coping skills (like relaxation strategies) are taught to assist with the high levels of distress that may occur while reprocessing traumatic memories and between sessions. 

Once the client feels safe, therapy would move on to working through the trauma and reprocessing it in an atmosphere of support so the client is able to process the traumatic memories and finally put them behind them.

Medication may also play a role in treatment, particularly if psychological therapy is not available, or the client has not benefited from therapy. Either way, if insomnia is a problem, this should be treated, as sleep deprivation aggravates the condition.

Feelings, Thoughts and Body sensations
Trauma has many components that need to be targeted in therapy. Along with intrusive traumatic memories and images, and high levels of emotional distress, people often have negative beliefs about themselves and strong bodily sensations.  Sometimes they cannot put into words what has happened so a therapy that involves more than just talking about it is needed. In fact, just talking about major traumas can make things worse as it may get the person in touch with painful emotions but does not help them process them at an emotional level.

EMDR
EMDR (Eye Movement Desensitization & Reprocessing) is one of the two evidenced- based therapies recommended in the Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder. In addition, the World Health Organisation (WHO) recommends EMDR for treating trauma-related conditions in adults and children.

EMDR provides the therapist with a structure that guides the client through their trauma and helps them to reprocess what happened, learn from it and put it behind them. Read this article to see why I prefer EMDR over other treatments for trauma.

I have just returned from a three day training in Compassion Focused Therapy (CFT) with Professor Paul Gilbert who founded this ground breaking therapy. CFT uses understandings of the evolution of our brain and how the brain works to harness a powerful resource we all have within us. This resource will allow you to manage negative emotions and transform the way you relate to yourself and others. What is this resource? You guessed it - Compassion.


Three brain systems
In CFT, we learn that our brains have evolved to have three different systems to help us manage our emotions and feel better. They are:
1. The “threat system” which puts us into the mode of threat detection and self protection. It is associated with feelings of anger, anxiety, disgust, blame, shame and sadness. 
2.    The “reward system” which involves excitement and craving and feeling better by pursuing, achieving and consuming.
3.    The “caring soothing” system which involves compassion and kindness and facilitates calming of distress and feeling safe through connecting and relating with nurturing others.

These systems operate in different areas of the brain, and have different neural pathways which involve different neurotransmitters. This leads to particular patterns of feelings, body sensations, thoughts and behaviours associated with each system. They will all feel different in the body and we can all activate them by using our imagination. 

Choice
We all have access to these different systems at any time.  However, our default state is to be in the “threat system”. Our western society gives us the message that the way to solve this and be happy is to shift into the drive system of competing, consuming and achieving. CFT highlights the alternative system we have access to, of caring and kindness to self and others. With practice, we can learn to master the art of choosing which system we activate.

For example, we can learn to shift modes from defensiveness and anger to self soothing with compassion and being kind to ourselves. This will calm us down so we are not so overwhelmed, and can then engage with the world in a way we aspire to be.  If our way of self soothing is to routinely shift into the reward system of compulsive eating or working, we can train ourselves to shift into the mode of compassionate behaviours and thoughts towards ourselves.

In some situations, we do want to be protecting or achieving. The question is, if you could develop the skills, which one would do you choose to activate - which would serve you best in which situations? Which system offers you the most benefit when dealing with the challenges of life? 

How to develop skills so you can choose
We have the capacity for great cruelty, aggression as well as caring and kindness. What we focus on can shape our brain as it will activate certain brain circuits. For those of you who have grown up in a home characterised by criticism, any form of abuse (or absence of nurturing, protection or guidance), the compassionate system may be under-developed, with the threat system being highly developed. For example, you may have become highly self critical as a way of monitoring yourself to avoid stirring the anger of abusive parents. This helped you to survive and is not your fault.

The good news is that because the brain is neuroplastic  you can strengthen the caring, connecting system by practising compassionate and loving kindness meditations. And this is what CFT is all about. 

Wisdom, Strength and Commitment
The compassionate resource of CFT is not wishy washy, weak or self indulgent. It is a powerful presence that combines three attributes - wisdom, strength and a commitment to your well being:

Wisdom
Your compassionate resource has the wisdom to know that our minds are (as Professor Gilbert says) “tricky....complex and chaotic, dangerous and crazy”. We have evolved to crave, to love, to grieve, to fear, to be defensive and aggressive, to compare and strive to be better than others, with a negativity bias to noticing deficiencies and threats. And our brains seek permanence in a world of impermanence where we will ultimately lose everything we care about.

Moreover, we inhabit a fragile body, and are subject to all kinds of random adversities and health issues. And who we are is a function of the genes we inherited and the environment we grew up in – both out of our control and not our fault. Your compassionate resource knows all of this and that we are all trying to do the best we can with what we have in the midst of this challenging life.

Strength
Your compassionate resource comes from a grounded, present centred place in the body which is strong. It is solid, like a mountain. It is a resilient part of you that has been able to tolerate great distress and has persevered in the face of many difficulties.   

Commitment to your well being and happiness
Your compassionate resource is totally committed to be as helpful to you and others as possible. It has a genuine desire for you to have a joyful life and to nurture your personal growth and inner peace. It delights in the idea of you being free from suffering. It understands and validates your feelings.

Compassion Focused Therapy Techniques
CFT involves developing your compassionate resource and then learning (through particular therapeutic exercises) to identify, understand and disengage from the part of us that criticises and puts us down (i.e. the “Inner Critic”). This approach differs from some other therapies which set up a struggle with the Inner Critic by trying to get rid of it or argue with it. 

As the compassionate resource has the powerful combination of wisdom, strength and commitment to your well being, it is the better authority when it comes to running your life. So it is the authority you can trust when it comes to deciding who to believe – the self critical thoughts that deflate you, or the kind thoughts that enable you to engage fully with whatever life throws at you.

CFT and ACT
CFT melds very well with Acceptance and Commitment therapy (ACT) which also aims at detachment from negative thinking so you can do what matters to you. In CFT, compassion is not to soothe away negative feelings, but to help you be with the pain that is inevitable in life. As with ACT, this allows you to engage fully with life in the midst of painful feelings, so that you are not overwhelmed by what is happening at the time, and you can take life affirming actions.

Surprise yourself
The compassionate pathways in the brain can be activated by using your imagination (in guided visualisations), with a loving body posture, tone of voice and facial expression and kind words to get into a state of compassion, the way a “method actor” would.  Repeatedly activating these pathways with daily practice will lead to you developing a resource that may surprise you one day when you hear a loving kind inner voice soothing you at a time of distress.  It will seem like a voice, coming from out of nowhere, that is wise, strong, and committed to helping you and nurturing your personal growth.

What if I can’t do it?
For many of you, allowing yourself to receive compassion will be very challenging. You may feel you do not deserve kindness and compassion.  Do not give up, as repeated practice will eventually over ride old learning. You may have to fake it until you make it - one of the few times it’s appropriate!  As a start, rather than sending yourself peace and happiness, Professor Gilbert suggested the words “May the part of me that resists compassion for myself find peace”.

Try this for a couple of weeks, just three or four minutes a day and then re-evaluate.  A good time is just before sleep and upon awakening – a great way to start your day. You may also consider seeing a therapist to help you with this if you find yourself struggling.

Free audio guides
I invite you to use my free loving kindness meditation mp3 to guide you in developing your own compassionate resource and begin to transform your relationship with yourself and others. For additional free audios to help you develop compassion, see Paul Gibert's , Kristen Neff's or Chris Germer's websites on compassion. For even more  free loving kindness audios by a leading psychology professor who has done ground-breaking research into how love and other positive emotions enhance your life, go to  Dr Barbara Fredrickson's website here.

Tinnitus and negative thinking
Tinnitus is a noise (often ringing, swishing, buzzing or whistling) that is heard in the ears or head. While the perception of the noise is real, there is no actual external physical noise present. It is very easy to fall into the trap of negative thinking when you are coping with a chronic stressor like tinnitus.  As tinnitus is often made worse by stress, watch your thoughts and check you are not adding to the distress with negative thoughts about it. The more stressed you are by tinnitus, the more aware you will be of it, leading to more irritation and distress.

Psychological Treatment for Tinnitus
There are psychological strategies to assist with getting out of these negative cycles.  Cognitive Behaviour Therapy (CBT) has been found to reduce the distress from tinnitus. More recently, Acceptance and Commitment therapy (ACT) has also been used as treatment for tinnitus. Of the two therapies – and I practice both of them – I think that ACT has probably more to offer for this particular problem. This is because the very essence of ACT is learning ways of managing troubling thoughts, feelings and chronic conditions so they do not stop you from leading a rewarding and meaningful life.   

Clean and dirty distress
ACT makes a distinction between “clean distress” and “dirty distress” when dealing with chronic conditions. The essence of clean distress is that you are just experiencing the pure distress (I’m sad, this is unpleasant) without muddying the waters by adding in further negative thoughts like judgements (I should be able to cope better), assumptions (this is my fault) or predictions (I’ll never be able to cope with this). It also refers to additional feelings about your feelings (e.g. sad about being sad, angry about feeling anxious). So feeling irritated about your sadness over how silence is no longer a peaceful experience for you is “dirty” distress. Judging yourself for being sad would also be “dirty” distress. The sadness itself is “clean” distress.

Stop struggling
Coping with tinnitus also means coming to terms with the fact that it is a chronic condition. This means you need to give up struggling with trying to get rid of it. Instead, the key is to work out how to live around it. While you can shift your attention from it and focus on other things (sounds, people, and activities) in your present environment, it may always be there in the background. 

Trying to get rid of something that you cannot control is also “dirty” distress. ACT teaches you ways of acknowledging and accepting “clean” distress and ways of managing and letting go of the “dirty” distress that could pull you into a downward spiral of further distress. 

Enjoy life around it
Fortunately, you live in a world where this challenging problem can now be managed much more effectively than a few years ago. The essence of managing tinnitus it to learn not to fight it, but to enjoy life around it. Making this cognitive shift to true acceptance can free you up more than you might imagine. By applying these strategies, getting appropriate treatment for tinnitus and becoming an expert at identifying your tinnitus free moments, tinnitus can be relegated to just one of life’s myriad, minor problems.

Side effects?
Clients often ask me about natural remedies and alternatives to  antidepressant medications as they are troubled by possible side effects.  The hope is that a "natural" remedy or supplement will have no side effects and be totally safe. While psychological therapy is the obvious alternative, there  are a range of supplements that have been found to assist with depression that you can discuss with your GP. Two common ones are St John’s Wort (see this) and Omega-3 supplements like Fish Oil (see this). However, it is important to be aware that supplements, like medications, can all have side-effects (note the side-effects for these two supplements mentioned in the links). They can also cause allergic reactions or interact with other medications or natural remedies. Just because a product is “natural” or occurs in a food, does not mean that in a supplement form it is safe.
 
Safety?
Many medications and supplements have only demonstrated safety or effectiveness in short-term studies, often with animals. This does not mean that long term use in humans is safe. Don’t get me wrong – I am all for natural alternatives to medications and have spent many hours looking for natural remedies for my own health issues. This is when I became aware of how hard it is for the average person to work out safety of supplements. At least I was able to apply my years of training to both finding relevant studies and evaluating the research I found. Alternative health professionals gave me conflicting information and were often not aware of the risks of some supplements that my research uncovered. It left me wondering if it was better to take a medication with known risks of X, Y and Z, than a natural remedy with no good research on long term side-effects.
 
Some advantages of medications
While I would prefer to take a natural remedy, there are some advantages to conventional medications. All medications have to go through controlled research trials that demonstrate effectiveness before they can go to market. Research is often ongoing and may reveal side-effects from long term use that then lead to the product being withdrawn from the market (as happened with the arthritis drug Vioxx). With the list of side-effects that pharmaceutical companies are required to provide with their product, patients can do a risk benefit analyses of taking the product with their GP. Interactions with other drugs can also be looked at. Also, with medications, the exact dose of the drug has to be standardised so you know how much you are taking in each tablet.
 
Some disadvantages of natural remedies 
Supplements, on the other hand, are not required to go through the same rigorous testing and standardisation before they go to market and before claims can be made about their benefits.  A lot of information about benefits of natural remedies is “anecdotal” which means that testimonials (i.e John Smith says “this really helped me”) are provided by the seller of the supplement to demonstrate their effectiveness.  It is assumed that because they are “natural”, or can be bought without a prescription, and can be found in food, they are safe. But research has found that food constituents that may be safe in the diet, can increase the risk of developing certain medical conditions (e.g. cancer, heart disease, liver damage) when taken as supplements.  Beta-carotene (an antioxidant found in a range of food sources) noni juice and curcumin are a few examples of this.
 
Quality of natural remedies?
Another thing to keep in mind is, unlike with medications, the manufacturing of supplements is not always standardised.  This means that different brands (and even different lots of the same brand) may have different doses and quality of the constituents. So how well they work, and side-effects may vary and the form you are buying may differ from the form you have found good research on. So you do not always know how good your supplement is if you buy off the shelf. As a guide, higher quality and dose forms are often “practitioner only” (only accessible by seeing a health practitioner) and kept behind the counter of health food stores. 
 
More research on natural remedies needed
Hopefully, as the use of supplements becomes more popular, the government will require higher standards of research to demonstrate efficacy and long term safety before they go to market. A requirement should be that side-effects be listed with the product so we can all make an informed choice about what we take – whether it be medication or supplements. On the positive side, more information is becoming available about risks and interactions of herbal supplements with medications and if you are taking herbal supplements, you should mention this to your GP. 
 
Resource to check out your supplements 
If you are looking at taking a vitamin or supplement for any health issue, a good website to help you check out the benefits, risks, side-effects and interactions of what you might be taking is here.