Transcription of Maureen Callnan for the show Mindfulness, #120
Dr. Lisa: During the holiday season, one of the things that we like to think about is how we can make it through and then enjoy ourselves and enjoy our families and be looking forward to the New Year in a way that really generates wellbeing. This individual who is sitting across the microphone from me today is well-versed in the area of wellbeing and mindfulness. This is Maureen Callnan who is a mental health clinical nurse and specialist in mindfulness and memory issues. Thank you for coming in and talking to us today.
Maureen: Thanks for having me.
Dr. Lisa: Maureen, you are a board-certified psychotherapist and a psychiatric nurse practitioner. You work in private practice and at the Maine Medical Center. You’ve earned an undergraduate degree in psychology, a master’s degree in nursing and you’ve done post-graduate work in psychotherapy at Boston College. You likely could have chosen any way of looking at this and yet something about mindfulness called to you. What is it about mindfulness that you found so intriguing?
Maureen: I think the road that I took in getting to this particular specialty or therapeutic modality is that I had been working in cognitive behavioral therapy for quite some time and wanted to expand that work. At about the same time, which was about 10 years ago, there were some researchers who were looking to develop what’s called the maintenance therapy for people who were struggling with chronic depression. We had good therapies to help people out of acute episodes but what they were really looking for is how could we prevent relapse situations from happening? About the same time a researcher in Canada and a couple in England have hooked up Jon Kabat-Zinn’s program Mindfulness-Based Stress Reduction and they were intrigued.
They thought, “Well, what would happen if we put together the mindfulness approach with cognitive behavioral therapy?” Then they moved into what’s called mindfulness-based cognitive therapy. It appealed to me both professionally and personally. I think it really enhanced cognitive behavioral therapy. It made it more useful for different stages of illness with depression. I think it just brought wellness skills to individuals that were struggling with mental illnesses and also people that were not necessarily struggling with mental illness but just experiencing emotions that were difficult to get through.
Dr. Lisa: We’ve discussed cognitive behavioral therapy before. I believe it was on a show related to anxiety. For people who aren’t as familiar with cognitive behavioral therapy or mindfulness work, can you describe what those two are and the similarities and differences?
Maureen: Cognitive behavioral work is about developing the skills to really take a look at your thinking. Could we all have an inner dialogue that’s chatting away all day long throughout the day? Some of the things that we tell ourselves are very accurate and factual and some of the things that we tell ourselves are completely non-accurate and not factual. What happens when we go through depression or if we’re struggling with anxiety? Our distortions in how we see ourselves in the world around us will become more magnified.
Cognitive behavioral therapy is really to address that very predictable thought process change. You help a person learn how to challenge and become more flexible with their thinking and also to change their behaviors, sometimes just to add more fun or enjoyable activities into their daily schedule or weekly schedule.
In contrast but also very complementary, what mindfulness brings is that it really brought more attention to how you check in with yourself throughout the day and really monitor that inner dialogue. Because it’s so familiar to us, a lot of times where we have this chatting going on in our head that we’re just barely aware of. The mindfulness skills which is really about just paying attention in a particular way really helps bring attention to that. Also, there’s a softness or a kindness that goes in that checking in with gentle curiosity. Sometimes that works very well with the harshness that can go with anxiety or depression where sometimes we can be very hard on ourselves for hardly any reason at all.
Dr. Lisa: Can you give me an example of some of the things that we tell ourselves that could be possibly harmful?
Maureen: A lot of times they can be things about who we are in general in which we’ll doubt our worth. If I’m not exceeding in this part of my life then I’m worthless, or if I’m not loved by this person then that might mean that I’m not loveable at all. Really kind of extremes in terms of one part of our experience may really magnify to have a lot of meaning in terms of who we are in that moment.
Dr. Lisa: In that situation how would you work with cognitive behavioral therapy and mindfulness to help people to pay attention more and to rethink things?
Maureen: One of the things that I think is particularly helpful with the mindfulness combined with the CBT is that part of my work in the groups that I’ve done, we invite people to have what’s called the formal practice where they may be sitting down and doing a mindfulness meditation for 5 minutes, 45 minutes. They choose the length of time but then to try really stick with that. What that does it’s a formal practice of really tuning in to what happens with the mind when you try to sit down and focus on one thing. What most people discover is that the mind then wants to go all over the place with a busy mind. That’s okay. It’s really about just paying attention and noticing.
Then there’s also informal practices of perhaps you’re going to try to brush your teeth and keep your mind on brushing your teeth while you’re brushing your teeth. Often what people notice is that in the matter of 2 minutes they may have thought about twelve different things other than brushing their teeth during an exercise.
How that then translates into helping therapeutically is that the more vulnerable a person is to depression and often that vulnerability is about the number of depressions, of depressive episodes that they’ve been through, the more easily it is for a sad mood. Even a tint of a sad mood can hijack a person’s attention and get them on to one of these thought patterns that really aren’t accurate, and in a long scheme of things aren’t really doing them any favors. It helps with the attention of noticing, “Oh, I’ve left this conversation and I’m now in my head thinking about something completely different,” in which the theme of it is I’m not doing so great or I’m not such a great person.
The first part is the awareness and the second part which is more the CBT is then being able to challenge the thought process. Maybe you’d say to yourself again in your head, “Hey. Is that really accurate? Is that really true?” Sometimes you’ll say, “Oh yeah, it’s really true.” Then another step would be well, what evidence do you have to support that? What evidence do you have to support that because I don’t have a date tonight, I’m going to be alone for the rest of my life. Kind of phrases that are intended to help interrupt some of that automatic thought process.
Dr. Lisa: Most of us have people in our lives and have experienced these ourselves but really have people in our lives that have the sort of mantra that they come to their life with. I’m too fat, I’m not good enough, nobody loves me and it can be really hard as … I mean it’s hard enough for us as individuals to deal with our own stuff. It can be really hard to deal with somebody who has this mantra that we want to help. We feel compassion towards but nothing we say ever seems to help change their mind. How do you work with that?
Maureen: That’s also an area in which the two modalities differentiate. With CBT, I think sometimes that sounds a lot like how we talk with a friend who’s being very harsh on themselves and in which we might try to talk them out of coming to the conclusions that they’re coming to. Really challenge their thinking, see if they can broaden that.
With the mindfulness approach, it’s really not about getting in there and wrestling with the thought but rather it’s about changing the relationship with the thought that they have. With this approach it’s less of a fix it kind of approach and more of a just notice it. With that, if I’m sitting across from someone and they start to talk about their weight and how they feel about that in terms of their worth I might just say, “Okay, so just notice the judging.” In that moment I don’t want them to get caught up in the content of their appearance or how they smart they are. I just want them to notice that they’ve now moved into judging.
What happens once people have really spent some time with this work, they’ll just smile and say, “Oh yeah. Hmm? How did I get there?” Then they’ll go right back to where they were before that thought hijacked them out of the present moment.
Dr. Lisa: There’s also some noticing of ourselves and how when somebody else is sitting in front of us says something about themselves as bad says, “I don’t like my weight or nobody loves me.” We also can notice how it makes us feel as individuals and that can go a long way toward not trying to fix it and not feeling frustrated because we really often can’t.
Maureen: Yeah, absolutely. Yeah.
Dr. Lisa: The goal of the Dr. Lisa Radio Hour is to help make connections between the health of the individual and the health of the community. The goal of Ted Carter Inspired Landscapes is to deepen our appreciation for the natural world. Here to speak with us today is Ted Carter.
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Dr. Lisa: Using the breath is an important part of re-centering. This is something that is used in most major spiritual practices. It’s something that’s really very easy to do. Do you work with this in your population of clients?
Maureen: Absolutely. One of the things that I say to folks is that the breath is always with us. It’s not like we have to worry about whether or not we have a particular tool in our briefcase or our pocket. We always have the breath. I think sometimes folks can be rather skeptical because it’s a simplicity of just pausing and dropping into our breaths. I just invite that and say, “Okay. You know, you don’t have to be completely on board with this. That’s okay.” What I do invite people to do is just try it. Utilize the breaths to help you to pause. Utilize the breath to help you to cope when you’re going through a stressful moment and then just see what happens.
Basically, I invite them to not necessarily trust me or what’s been written about for hundreds, thousands of years but rather to just trust their own experience. A lot of times either in that session or they’ll come back and say that there’s really something to this.
Dr. Lisa: There is a practice involved with this. It’s not something that magically transforms itself overnight.
Maureen: Yeah, absolutely. Yeah, I was talking with a person this morning and I said, “You know, it’s not like it’s a magic pill.” You can’t just hope that by wanting to be better or wanting to be more comfortable that you will be. There’s a lot of effort that goes into this work. The efforting can be very different in terms of what’s going on at that moment in terms of what’s needed.
Dr. Lisa: The end of the year during which we’re celebrating holidays but we’re also looking into the New Year and we’re thinking about our family dynamics. Say you’re celebrating Hanukkah with your aunt who you’ve never gotten along with or you’re celebrating Christmas with your father and you feel like he judges you. That can be particularly challenging as can starting a new year thinking I need to change myself, I need to this differently, I need to do that differently. How do you work with clients who come in and talk to you about the stressors of all of that? Are there specific things that you suggest to people?
Maureen: I think in terms of the Christmas, Hanukkah holidays I think one of the things that gets in the way again is how much we are in our head around those holidays. Thinking about the way that they should be with the future orientation of okay, this is how my culture says that they’re supposed to be. Beautiful, amazing food, fun times with family. We put a lot of expectation on how an experience is supposed to be as opposed to just allowing the holiday to unfold in whatever way it’s going to unfold and just trying to enjoy the pleasant moments. Also to be able to trust that we can get through the unpleasant moments such as being able to feel the twinge of rejection that might happen if there’s a critical statement, but just to know that okay, that’s one part of this whole experience.
I can feel that, I can pause and allow that, investigate it if I need to and then move on. That’s kind of the foreword or future part that can get in the way. I think also there are a lot of individuals in which they are looking backward and they are thinking about the holidays that they’ve been through either as children or adults that weren’t great holidays. There’s that regret that’s coming up around that.
Again, the skills are very similar in terms of noticing that you’re in your head, noticing that you are remembering an event or you’re recall of that event as opposed to truly being present for this holiday and just being open to whatever it is that’s going to happen. Kind of letting go of striving and just the attitudes of allowing and letting be. I talk about those a lot in December.
I think in terms of the pressure that we can put on ourselves in terms of goals for the New Year, I think a lot of the time that can really create opportunities for our inner critique to just have a heyday. What I invite people to do is absolutely to put together the goals but also to do that in a soft way. In that maybe some of these goals you’re going to find yourself moving towards, maybe some you won’t. Then also to balance that with values and to really think about what’s valuable in your life in terms of how you spend your time, the people that you choose to be with and the characteristics of yourself that you want to develop.
With that it’s not so much a goal of, “Oh, I’m going to exercise 5 days a week in 2014.” It’s really about thinking about the core characteristics of who you are and developing some kind of practice for being able to check in periodically and just asking yourself, “Am I living or did I live this day in a way that was consistent to my values and trying to have a balance between the two?” The inner critique has a more difficult time when we’re moving or trying to live in a way that’s consistent with our values than it does when we are putting together goals or traditional new year resolutions.
Dr. Lisa: These can also be important things to remember. Again, as we’re talking to other people in our lives, if we focus more on the fact that all we really have any ability to change is the way that we perceive things, the way that we feel things. If we’re constantly frustrated by the people in our lives and the way that they are doing things then that really doesn’t get us anywhere. If we focus in on our values, in our own lives and how we want to live then we wind up feeling better about things and possibly impacting some sort of change.
Maureen: Absolutely, yeah. Sometimes when I’m working with a person who’s really struggling with the way someone else is living their life, I just ask them that question, in whose business are you in? Sometimes it can be pretty tempting to try to work on someone else’s self-improvement plan or how they could be a better person. It really protects us from doing our own work. Sometimes just gentle reminders of where’s your attention? What are you focused on? Are you trying to manage something that’s beyond your control, and then bringing it back to self and what is it that I can do in this moment? Is it really about not doing anything at all? Maybe it’s about just being with the feelings that are coming up as I react to someone else’s behaviors or life choices.
Dr. Lisa: The holidays are particularly good for getting us all distracted. It seems like distraction can be on one hand a very good thing, another hand kind of debilitating. How do you deal with distraction when it comes to this time of year? How do you deal with people who are chronically distracted, people who might have some ADHD, people who might have some issues with not being able to be fully present long term?
Maureen: I think in particular with ADHD, one of the things that I’m really concerned about is how the person perceives themselves. Because I think a lot of times this is a childhood illness. They have a lot of practice of really being harsh with themselves related to their difficulty with attention and that they take it very personally and develop or have the vulnerability to develop beliefs about themselves that aren’t true. I think a lot of the work is really about helping that person come to a place where they can accept who they are, difficulties and strengths as well and then trust that they can dabble in this work as well.
With the mindfulness approach, when the developers for this particular therapeutic modality were starting they didn’t want to use the word meditation. They were trying to skirt around that and they were calling it attention control. They were trying to teach people attention control rather than meditation and then finally they got to the point where they just let that go. Whether it’s a person just who is not necessarily struggling in significant ways with their attention or someone who is with ADHD, I think a lot of people can benefit from just learning the skills about how to sustain their attention in a different way and how to be gentle with themselves when they’ve lost their focus, and how to bring their focus back to whatever it is that they had been intending on resting their attention on.
Dr. Lisa: This can be useful also during busy times of the year where just being able to acknowledge that things are a little busier than usual, that we might get a little distracted but it’s okay. We don’t need to judge ourselves. We can pull ourselves back to a place of centeredness.
Maureen: Right, absolutely. I think in addition to that in terms of the distraction, one of the things that happens is that the more distracted we are the more vulnerable we are for these negative tapes to come in and take hold. If we go into the holidays knowing that that’s a vulnerability and at the end of a stressful weekend we’re feeling a little crazed just in terms of, “Oh, I can’t juggle all this. I can’t … How can I start Monday with the weekend that I just have. I wasn’t … I don’t feel rested or restored.” Then just part of our awareness says, “Oh yeah.” That can be part of the holidays, yeah. It doesn’t mean that I’m losing it or anything else. It’s just part of when there’s a lot that’s happening and we’re more likely to be distracted, we’re also more likely to get caught up in these negative thought loops.
Dr. Lisa: Maureen you have a private practice right here in Portland.
Maureen: I do.
Dr. Lisa: How can people find out more about your private practice or the work that you’re doing locally?
Maureen: They can find me via Psychology Today and I also have a website which is just maureencallnan.com. If anyone still uses the telephone book, I’m in the yellow pages.
Dr. Lisa: I know there are people who are out there still using the telephone books. That is very helpful. For those of you who might be interested in calling Maureen, her last name is spelled C-A-L-L-N-A-N. We’ve been speaking with Maureen Callnan who is a mental health clinical nurse and specialist in mindfulness and memory issues. This is certainly an important topic for us all and I am very pleased that you’re offering this type of work to the people in our community.
Maureen: Yes and thank you so much for the opportunity. It’s really meaningful work and it’s great to have the opportunity to have a few moments to talk about it.
Dr. Lisa: You have been listening to the Dr. Lisa Radio Hour & Podcast show number 120, Mindfulness. Our guests have included Dr. Joe Dreher and Maureen Callnan. For more information on our guests and extended interviews visit D-O-C-T-O-Rlisa.org. The Dr. Lisa Radio Hour & Podcast is downloadable for free on iTunes. For a preview of each week’s show sign up for our e-newsletter and like our Dr. Lisa Facebook page. Follow me on Twitter and Pinterest and read my take on health and wellbeing on the Bountiful blog.
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