Mindfulness Approaches for the Treatment of Anxiety disorders

Marcio Guzman, Psy.D.Castlewood Treatment Center

Time

• “Time is what keeps the light from reaching us. There is no greater obstacle to God than time…” --M. Eckhart

• “The secret of health for mind and body is to not mourn for the past, nor worry about the future but to live in the present moment wisely and earnestly.”

• --Buddha

• “Past and future veil God from our sight…” --Rumi

Differentiating Anxiety and Fear

• Anxiety is a response to the mind wondering into the past or the future.

• Fear is a response to a clear and present threat/danger.

Anxiety

• Anxiety is not a random process. It has a pattern and structure (like all other emotions).

• It is produced by two events1. Thought structures2. Emotional energy

Conceptualizing Anxiety Disorders

• Products of not being attuned/connected to the present moment.

• Anxiety is maintained by having one foot in the past and/or the other in the future, which then leads to a myriad of avoidance strategies.

• Consequences involve debilitating and incessant mind noise (worrying, obsessing, planning, JUDGING, etc) decrease in QOL

Avoidance Strategies

• Choosing to avoid people, places, and activities that activate fear.

• Subtle changes in behavior that are sometimes disguised as preferences.

• Going through the motions automatically/disconnected.

• Making small choices and compromises to reduce distress w/o awareness of consequences.

Anxiety and Presence

• The individual is no longer present for himself/herself.– Disconnection from the body (existence is dominated by

the mind)– Misinterpretation of body sensations (when connected)– Consequences?

• The individual is no longer present for others.– “the greatest gift a human being can give to another is

being fully present for them…” –T.N. Hahn

– Consequences?

What Is Mindfulness?

• It’s the moment to moment non-judgmental awareness that is cultivated by paying attention. ---J.K. Zinn

• http://www.youtube.com/watch?v=gWaK2mI_rZw&feature=related

• Discernment through paying attention. • Its about paying attention on purpose.• Attending leads to awareness– Awareness leads to clarity– Clarity leads to less emotional reactivity…– Thoughts?

Research has shown that Mindfulness…

• Decreases:– Anxiety– Insomnia– Substance use– Urges to smoke– Relapse into depression– Chronic pain

Research has also shown that…

• Mindfulness improves:– Quality of life– Relationship satisfaction and closeness– Sexual functioning– Attention– Immune system functioning– Skin clearing in psoriasis

Conceptualizing Mindfulness

• Mindfulness is:– Open awareness– Non-judgmental curiosity – Being in the here and now– A Way of being– Connection with Interoception and Proprioception– Promotes compassion and kindness

Conceptualizing Mindfulness

• Mindfulness is not:– Avoidance– Suppression of emotional experience or behavior– Distraction – Rumination (on + or -)– Cognitive reframing/restructuring of emotion– Thinking– A technique

Mindfulness does not mean

• Don’t plan anymore

• Don’t think anymore

• Don’t do anymore

• Don’t judge anymore

Mechanism of Action

• De-centering/Dis-identifying: witnessing that the contents of mind (thoughts, emotions, events, images. memories, sensations) are events that are happening but are not “me.”

• Developing attentional focus: cultivating the ability

to place and maintain attention.

• Resting in awareness/befriending silence and stillness.

Mechanism of Action

• Emotional regulation is a byproduct because it (mindfulness) increases the gap between action and reaction.

• It slows things down.• Changes self-view: arises inevitably with the

practice.• Negative self focus (rumination) is decreased.

Forms of Self-Processing

• Analytic/Narrative Self (saturated with judgment)– Past/Future oriented – Fixed Self Concept (rigid and arbitrary)– Rumination (preoccupied)

Forms of Self Processing

• Experiential Self– Present moment focused– Continuously changing the experience of self

(seeing self as context)– Reduced over-generalized memory, anxiety, and

depression – Mindfulness studies have shown a shift from

analytic to experiential self.

Mindfulness

• labeling>judgment>preference>resistance> conflict>emotion>behavior>>>

-where in the chain would you apply mindfulness?

• Paying attention to an urge to avoid discomfort can break the cycle of fear -> avoidance -> temporary relief -> restricted life -> low QOL

• The practice does not have to be formal meditation but how you live your life moment to moment… difficult due to conditioning. (Thoughts?)

Mindfulness Skills

• Awareness practice• Self-Compassion• Present moment • Beginner’s Mind• Accepting things as they are (non-resistance)• Exercising the muscle of attention• “…attention is the key to transformation.” – ET

Mindful Practices that must be practiced “when not needed”

• Mindful breathing• Body scan (sensations, proprioception,

interoception)• Mindful eating• Shifting attention from sense to sense• Combining sensory awareness• Compassion practice• Meaningful pauses*

Awareness vs. Thinking

• Thinking requires awareness.

• Awareness does not require thought.

• Thought exists within the construct of awareness.

• Thoughts?

Most common complaints

• I’m not good at this• When I try to practice I become more anxious,

sad, etc (increased emotional awareness)• Nothing happens…• This is too hard!• Can’t remember to do it

Mindfulness Meditation

• Much ongoing research with brain imaging looking at the effects of contemplative practices on brain functioning and plasticity.

• Associated with changes in neural bases of-attention regulation of emotion.

• Discernment from conceptual to experiential self.

Resources

• Center for Mindfulness at U of Massachusetts• Mindful Awareness Research Center UCLA • Mind & Life Institute• Authors: Jon K. Zinn, Thich N. Hahn, E. Tolle,. C. Huber• Books: “Present Perfect” (P. Somov), “Calming Your

Anxious Mind” (J. Brantly), “The Mindfulness and Acceptance Workbook for Anxiety” (Forsyth & Eifert), “The Mindful Way Through Anxiety” (Orsillo & Roemer)

• Google