March 11, 2022
By: Dr. Leanne D. Rondeau, Clinical Psychologist
There is a special waiting room in the hospital for families of patients undergoing brain surgery. It seems that it was decided to put all of the unfortunate folks together. A sort of misery loves company gesture. Or perhaps it was simply convenient. 15 years later I am still wondering. If the intention was to make us feel better one would think that they could have arranged for a few plants, snacks, perhaps an aquarium or more comfortable chairs and lighting. A bit of artwork? Am I asking too much?
But it was just a room without much decor, uncomfortable furniture, and a lot of stressed people not talking. Having just flown three hours to get there on an early morning flight I eyed a cold plastic couch trying to see if I could lay down and get a bit of rest. My sisters, brother, father and I were waiting while our mother was undergoing a biopsy. Her prognosis was pretty grim. They simply were aiming to confirm that they could do nothing.
Attempting to control what he could in a situation completely out of his control my father began to nag at me to sit up and not take up so much room. Perhaps others wanted to sit as well. He motioned to people inviting them, “sit, sit, there is room!” My brother began to pace making several trips outside the room and back and forth amongst the families’ tense hearts and minds. I moaned and leaned my head up against the hard wall next to my seat.
And then they started to giggle. My sisters, who had not seen each other in person for over a year began to do Arnold Schwarzenegger impressions and tell brain tumour jokes! And they couldn’t stop. The scene was that of a Seinfeld episode: pacing brother, controlling father, exhausted daughter, and two irreverent comedians doing impressions that were bound to offend anyone within ear range.
But all is relative. Our mother, who died peacefully seven months later, is remembered by most who say, “she loved to laugh.” I can only imagine that she would have done the same or worse in their place.
So why do we do this? Why are we drawn to tell jokes in dire circumstances? Why do we listen to a friend in need over a bottle or two only to end the night laughing about the very thing that brought us there to begin with? And why do these moments feel so good? What role does humour play in therapy? In emotional regulation?
These are questions I have been asking myself for a long time. In 2016 I went to Italy for a retreat in a monastery north of Rome with Compassionate Mind Italia and Dr. Paul Gilbert, OBE, who founded Compassion Focused Therapy (CFT). After days of exploring compassionate mind training, our inner critics, our inner wisdom and inviting our shame and pains to be held gently by a compassionate motivation, one participant commented to Paul how she was happy that there wasn’t a lot of crying but rather quite a bit of laughter in our workshop sessions. “Well, we need to do it this way,” he said, “because this is pretty hard work!” And it was then that I began to think that I just might have stumbled upon some answers. Humour is not just important. It is very important.
The Three Emotional Regulation Systems
To understand how humour works to help us regulate, self reassure and soothe it is essential that we begin with CFT’s three circle model and explore how we typically fall into dysregulation. Gilbert imagines the nervous system in three colourful circles, playfully referred to as the red, blue, and green systems. It seems easy enough for a child to understand and it is. Indeed, Compassion in Schools make up an entire section of the Compassionate Mind Foundation UK’s work.
The threat system, referred to as the red system in CFT, is laden with adrenaline and cortisol. The sympathetic fight and flight response, and the parasympathetic freeze or shut down response are included inside this circle. In general, people who consult with a psychologist know exactly what this is, often expressing that they would like to “get rid of their anxiety” or “manage their emotions” better. They have, essentially, got too much going on in this system.
However, there is no getting rid of the red system, Gilbert outlines, because it is there for our survival. It is, after all, fight, flight or freeze which are all classic and useful ways to respond to danger. From an evolutionary perspective it is our negativity bias that leads us to think that the rustling in the bushes is not the wind but rather a hungry predator. Better to be a bit stressed than to be someone’s lunch, as it is said.
Next comes the dopamine-soaked blue or drive system. Here we are again in our sympathetic nervous system, but it is more active and focused on seeking resources. Bring home the bacon! Get the attention of that special someone. Perform on that exam! Shop until you drop! Party all night long! It is generally experienced as positive or, at the very least, busy. In our increasingly urban, time-poor world we are all too familiar with the need to perform, impress, do more than what we are doing, and go, go, go!!
Interestingly we often end up having an overlap of the red and the blue systems. In CFT terms this is referred to as threat-based drive. This is a classic pattern of dysregulation. It is like we realized, for example, that we are late starting to work on a paper for a course we are taking (“oh no! I am in trouble!”) and then go immediately into action. Our mind’s attention is half on the task at hand and getting it done (blue system) and half on the catastrophic scenarios we have going on in our head if we fail (red system). Obviously when we take a step back and look at what is going on here mindfully it is clearly not the most efficient, creative, or enjoyable strategy.
So, an enormous red or threat system often overlapping with a large blue or drive system is a typical pattern for how modern humans handle their challenges. It would be so much easier if we could just acknowledge the threat (“I risk failing if I continue to procrastinate”) and then leave that message behind deleting it from the inbox of our minds and get going on the task at hand in a fresh and creative way. So how do we do this? This is where the green or the soothing system comes in.
In Compassion Focused Therapy the green system involves the positive side of the parasympathetic nervous system. The rest and digest state, feelings of belonging, connection, of being good enough, the warm feelings of oxytocin, and self-reassurance are all in this system.
A classic introductory exercise in compassionate mind training is to describe these three systems and then ask people to draw how big they think their systems are at the present moment. It quickly becomes obvious that most people’s red and blue systems are large, and most people’s green systems are neglected, off to the side, and as small as a pea. How often do we actually relax, connect with others and feel content with where we are at and who we are? Most of us would respond, “Not often enough.”
Getting Back on Track with Playful Drive
One of the founders of the Compassionate Mind Foundation UK is psychologist Chris Irons. He and his colleagues have appropriately named their London-based psychology clinic Balanced Minds. Indeed, balance is a central concept in Compassion Focused Therapy: balance in the various flows of compassion, balance of our various emotional selves, and balance of our three emotional regulation systems. To the extent that we can increase our green or soothing system and increase our compassionate motivation we can move to a place of greater harmony amongst these three systems. Our green system grows bigger and the red and blue in turn get smaller, and the tendency to fall into the trap of threat-based drive or red-blue overlap is greatly decreased. In addition, as our connection with our soothing system increases so does our heart rate variability and cardiac health.
In an Introduction to Compassion Focused Therapy Chris Irons gave online in 2018 he demonstrated how human beings typically emotionally regulate their young. He asked us to imagine a young child who had fallen and scraped their knee. The child cries and is obviously in their red or threat system. The parent arrives quickly in a panicked state and joins the child in the red system. “Oh no!!! What happened here?” the parent exclaims. And then what do humans do? Once we realize that it is just a scraped knee, do we immediately dismiss the child and send them back to the playground? No. We enter the green system with the child. Quite literally we pick them up, hug them, whisper in low tones, and rock them back and forth to reassure them. If needed a colourful Band-Aid is applied, and depending upon the situation and the character of the child in question this stage of connection can last varying lengths of time. There is a certain sense of shared well-being and perhaps even a tiny bit of boredom.
And then out of the blue the parent tells a joke. Either verbally or non-verbally a sense of lightness enters the scene. “I am going to eat this little cheek” the parent jests, and there are attempts of munching and tickles and laughter at the thought. The parent and child laugh together, and soon the child is mobilized and ready to go back to the playground and start anew. The movement has been from red system to green system to blue.
This makes me question whether humour actively regulates emotional states or simply reflects that we are regulated or ready to move on to mobilization. In any case, if we can laugh at our challenges, we most certainly can take a mindful distance from them. If we can share that laughter with others, we immediately get an experience of connection and common humanity and are encouraged to move forward.
Safety Strategies Versus Safeness
When we try to distinguish safeness from safety strategies most people express bewilderment. What does it mean to prioritize the cultivation of safeness as opposed to safety strategies? Aren’t they the same thing?
In Compassion Focused Therapy there is nothing particularly wrong with safety strategies, but they are not seen as an end in themselves or the full story of emotional regulation or response to danger or threat. In terms of the three emotional regulation systems, safety strategies belong in the red or the threat system. When you are under attack or being threatened, safety strategies are your first line of defense. Your house has been broken into, for example, so what do you do? You change the locks, call the police, and install a new outside light. These are all concrete safety strategies. Most of the time it is only logical to start with safety strategies. Unfortunately, we are often unaware that we can actually ask for or do more.
For example, sharing our story, connecting with others, and working on a neighbourhood security and communication plan in such a situation could lead to a more profound confidence in our security, more connection with neighbours, and increased faith in our ability to react to challenges. This could constitute a feeling of safeness and would, in CFT terms, be considered to be more in the green system than the red system.
Most every psychological challenge can be looked at in terms of what we do in terms of safety strategies and what we can do in terms of increasing our feelings of safeness. Safety strategies are most often immediate and behavioural responses to challenges. Cultivating feelings of safeness, on the other hand, often involves confronting feelings and beliefs that there is something wrong with us for having the problem to begin with, and exploring a sense of mindfulness and common humanity in respect to the challenge at hand. In Compassion Focused Therapy safety strategies are red and safeness is green.
Conclusions
So how about that hospital waiting room? I don’t think anyone thought in terms of creating an atmosphere that would cultivate feelings of safeness when they designated all families of brain surgery to that room. It seemed like we were all trying to cope with a difficult situation the best way we could. We were all implementing safety strategies: trying to keep busy, controlling what we thought we could control, taking a time out. And who could blame us?
I wonder about all those people waiting with us. Who were they? Did they all lose their loved ones like we did? I find it sad that I cannot remember any details. It is like they were faceless. I wonder, on the other hand, if they remember my sisters’ Arnold impressions?
I smile thinking of my sisters’ giggling and jokes. In CFT terms they were in the green system while everyone else was in the red. Happy to see each other, feeling connected and with mutual support, dumbfounded by the task in front of them, they had moved on. Even within the context of stress and impending loss they were able to, at least temporarily, co-create a place of safeness, humanity, and joy.
This again inspires me to think about the role of humour in emotional regulation and in psychotherapy. How many times have I said to someone, “You know it’s funny … not funny in terms of ha – ha but rather in the sense of odd that …” and I continue. Isn’t it funny that the word “funny” itself not only means “amusing and causing laughter” but also means “difficult to explain or understand, strange or odd”?
The more closely I revisit these ideas the more I am convinced that what I stumbled upon years ago is not only important, but actually very important. A healthy amount of compassionate humour seems central to emotional regulation, seems central to therapy. And this is so true for the simple fact that, as Paul said so clearly years ago, being human is “pretty hard work.”
(1) Gilbert, P. (2010). Compassion Focused Therapy, Distinctive Features. New York: Routledge.
(2) Gilbert, P. (2009). The Compassionate Mind, A New Approach to Life’s Challenges. London: Constable.
(3) Gilbert, P.; Choden (2013). Mindful Compassion, How the Science of Compassion Can Help You Understand your Emotions, Live in the Present, and Connect Deeply with Others. Oakland: New Harbinger Publications Inc.
(4) Irons, C. & Beaumont, E. (2017). The Compassionate Mind Workbook, A step-by-step guide to developing your compassionate self. London: Robinson.
