Dr. Trudi Edginton is a clinical psychologist, cognitive neuroscience lecturer and mindfulness practitioner. Dr Edginton is interested in how our thoughts and emotions relate to our physical responses and how these responses drive our ability to tolerate and respond to stress. We discuss the importance of applying a personalised approach to mindfulness therapy as an effective aid in the treatment of many mental and physical disorders. (Our conversation has been condensed and edited for clarity.)
Your background is in cognitive psychology and neuroscience. How did you get interested in mindfulness and decide to bring it into your research and therapy?
I’ve always had a mindfulness practice of my own. I started my career as a nurse and found that working with patients, in times of distress, I was able to form a real connection with my patients based on compassion. There was always this sense of being able to fully experience the moment as opposed to thinking about what I was going to do the next day or later in the day, to be really present with someone in an authentic way.
I would love to learn more about how this training is applied in a real-life therapy session. How do you incorporate mindfulness into more traditional CBT?
I’ve trained in a number of different psychological approaches so I tend to use an integrative approach that combines multiple methods and is tailored to an individual’s particular needs. I would describe it as neuro-CBT with compassion and mindfulness. For example, when working with someone who has chronic fatigue, I know there is a neurological impact of the disease but there is also an additional psychological element in terms of how you feel about it and respond to it. If you feel like the exhaustion is having a really negative impact on you as a person and you feel others are judging you then it adds to the burden of the problem you are experiencing and that then adds to the mental and physical exhaustion you feel. Therefore there is an emotional toll that needs to be managed alongside the physiological condition.
I find it very effective to add compassion to the person’s experience and to also understand what is happening at the neuronal level. I bring in mindfulness practices to guide patients to experience and be with what they have in the moment rather than worrying about the future or what other people will think of them. It’s almost like a toolbox where you can pick and choose what tools to use depending on the situation and an individual’s response to treatment.
How does the context in which the therapy is delivered impact results?
I had published research on men who had been diagnosed with prostate cancer looking at how it affected cognitive function. What I also tested was the preconceived idea that men don’t articulate their feelings because it is not seen as masculine to be open about your emotions. However, my research found that men do talk when they’re provided with the right setting and the right person to create the appropriate context. This context is key as it creates comfort. Once you have provided that context, I found that you could have really personal, in depth conversations.
If you’re not able to talk about your concerns, worries or fears it ends up being something you suppress. There is a lot of research showing that if you don’t express a negative emotion, your body holds onto it. That chronic stress that you live with on a day to day basis can really affect your immune function, your muscle tone, the way you hold your body, and your cognitive function as a result of the effects on your hippocampi their connections to the prefrontal cortex. Over time this can have a very gradual, detrimental effect on our physiology.
Is there a good level of stress that is acceptable for us to tolerate without experiencing a negative physiological response? How do we differentiate between stress that is good and bad for our body?
It is true that some level of stress is good for us as it motivates us and we actually require a minimal amount of stress to thrive. There is a different optimum level of stress for every single person. It’s about being in tune with yourself and getting to know what works for you. If you are someone who likes working with tight deadlines and you know you function better with a looming deadline ahead of you then you can put yourself in those situations. However, if you’re someone who finds last minute situations overwhelming then you should avoid those last-minute pressure points.
If you are someone who thrives under stress, does the stress still negatively impact you physiologically as you were describing before?
No, this is the interesting part. The detrimental impact of stress is determined by your perceived response to the stress. You can have a long term physiological effect of stress on your body and mind but it’s only when you perceive the situation as stressful that the stress will start to have a negative accompanying effect on your body. Predominantly it tends to be the emotion. If you appraise something as negative then, from an evolutionary perspective it becomes a threat. You activate your amygdala and the chronic stress and negative response becomes activated. If you perceive the same situation as a challenge instead, you won’t get the same pattern of increased activity in the amygdala and the natural release of cortisol, a stress hormone released by your adrenal glands, doesn’t become dysregulated.
If everyone responds to stress in a different way, how does this inform our mindfulness practice? Surely we should practise different techniques of mindfulness and therapy depending on our differing response to situations?
Absolutely. We need to get down to the individual level and I think that’s a really interesting avenue. I’ve modified mindfulness therapy for the different groups of people I work with – people with brain injuries or dementia and their carers. Some people might have a memory impairment or a cognitive impairment or a physical disability which means they can’t concentrate or sit for longer than 15 – 30 minutes. Being able to modify the mindfulness for the specific condition is really important.
It’s also important to note that mindfulness isn’t right for everybody. There are times when it might not be the right time to practise mindfulness and it could actually have a negative effect, particularly if you have experienced trauma, a recent bereavement, acute depression or psychosis as your cognitive and emotional resources may be limited at that particular time. If you ask someone during a time of overwhelming grief or depression to practise mindfulness, the negative thoughts can be incredibly difficult to manage, and it is possible for people to experience a sense of de-personalisation or dissociation, and feel like they are an outside observer of their thoughts, feelings or body. It is therefore crucial to not have a ‘one size fits all’ approach to mindfulness but instead to ensure that it is personalised on a case by case basis.
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