Mindfulness in Psychotherapy: Anxiety

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Mindfulness in Psychotherapy Anxiety

• with
• Steve Shealy, PhD

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Anxiety

• an uncomfortable emotional state in which one
• perceives danger
• feels apprehension and worry,
• powerlessness and fear
• experiences tension in preparation for an
• expected danger
• - even when no real threat exists

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Anxiety

• Physical symptoms include
• increased heart rate
• palpitations
• irregular breathing
• feeling faint
• trembling and sweating

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What is Mindfulness?
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Definition of Mindfulness

• As Mindfulness relates to psychotherapy, it may
  be best defined as
• awareness of
• ones present experience
• with acceptance.

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Mindful Approaches to Anxiety

• Befriending fear
• Turning attention toward rather than trying to
  escape unpleasant emotional experiences
• Mindful awareness vs. habitual reactive patterns
• Therapists comfort with anxiety making space
  for your clients distress

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Mindful Approaches to Anxiety

• Insight-Guided Mindfulness-Based Psychotherapy
• Key Insights
• Avoiding fear sensations causes panic
• You come by your panic naturally
• The wisdom of acceptance
• The brain raises false alarms about danger
• Panic is a temporary state
• We cannot control what we think and feel

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Mindful Approaches to Anxiety

• We believe false alarms and get hijacked by fear
• Progress is measured by how much I accept
  anxiety, not by how seldom I panic
• I may feel I am defective, but I am also OK
• We continually construct our world from past
  experiences
• I will always be more anxious than I would like
  to be

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Mindful Approaches to Anxiety

• GAD breaking the cycle of pervasive worry
  through the development of
• an attitude of awareness and acceptance
• of whatever is occurring in the present moment

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Mindful Approaches to Anxiety

• OCD breaking the cycle of obsessions (thoughts)
  and compulsions (behaviors)
• through the repeated matching of exposure to the
  OCD triggers/cycle
• with calm, relaxed awareness
• Along with cognitive techniques such as

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Mindful Approaches to Anxiety

• re-label its not the unlocked door, its my
  OCD
• reattribute my brain is doing this, not me
• revalue these thoughts/behaviors are a waste
  of my time
• refocus Ill do something useful instead

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Mindful Approaches to Anxiety

• Phobias
• non-reactive acceptance of associated subtle
  bodily changes
• turning toward the fear as it arises
• in memory
• in vivo exposure

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Mindful Approaches to Anxiety

• Post Traumatic Stress Disorder
• DBT with borderline per dx
• increasing stress tolerance
• shifting attention toward traumatic memories
  gradually as client develops mindfulness
• help client explore, befriend and trust their
  inner experience
• integration of past experiences into sense of
  self in current time

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Mindful Approaches to Anxiety

• Four important considerations for those working
  with anxious clients
• Importance of the therapists personal experience
  with mindfulness/meditation practice
• Communication about the paradox of goal-directed
  behavior and non-striving (balancing effort with
  acceptance)
• Distinguish between a clients moving through
  difficult mind states vs. disintegration
• Recognize that mindfulness is not a technique,
  it is a way of being, a life-long process
  requiring significant intention and effort

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MBSR and Anxiety Disorders

• Effectiveness of a Meditation-Based Stress
  Reduction Program in the Treatment of Anxiety
  Disorders, Kabat-Zinn, J.,American Journal of
  Psychiatry, 1992
• prospective cohort
• n22
• t pre-/post-, 3 mo. follow-up
• anxiety disorders (GAD, panic disorder
  /-agoraphobia)

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MBSR and Anxiety Disorders

• ? 20/22 individual improvement
• ? 25-65 decrease in mean Hamilton and Beck
  depression and anxiety scales
• ? decreased frequency of panic attacks
• ? decreased medical symptoms (MSCL)
• ? gains maintained at 3 month follow-up
• ? 90 still using techniques at 3 months

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MBSR and Anxiety Dx 3 Yr FU

• Three-Year Follow-Up and Clinical Implications
  of a Mindfulness Meditation-Based Stress
  Reduction Intervention in the Treatment of
  Anxiety Disorders. Miller, et al, General
  Hospital Psychiatry, 1995
• retrospective cohort
• n18
• t pre-/post-, 3 yr. follow-up
• anxiety disorders

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MBSR and Anxiety Dx 3 Yr FU

• 18/22 responded
• ?gains maintained at 3 years (mean Beck and
  Hamilton depression/anxiety all
  unchanged)
• 4 patients discontinued all other treatments
• 10/18 continued formal mindfulness practice
• 16/18 AOBDL
• anything of lasting value or importance?
  16/18 yes

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Mindfulness Based Stress Reduction
Psychotherapy

• Steve Shealy, PhD
• www.BeMindful.org
• 813-980-2700