Mindfulness in Psychotherapy: Anxiety

with

Steve Shealy, PhD

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

AnxietyPhysical symptoms include:

increased heart rate palpitations irregular breathing feeling faint trembling and sweating

What is Mindfulness?

Definition of Mindfulness:

As Mindfulness relates to psychotherapy, it may be best defined as

awareness of

one’s present experience

with acceptance.

Mindful Approaches to Anxiety Befriending fear

Turning attention toward rather than trying to escape unpleasant emotional experiences

Mindful awareness vs. habitual reactive patterns

Therapist’s comfort with anxiety: “making space for your client’s distress”

Mindful Approaches to AnxietyInsight-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

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

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

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:

Mindful Approaches to Anxiety

re-label: “it’s not the unlocked door, it’s my OCD”

reattribute: “my brain is doing this, not me”

revalue: “these thoughts/behaviors are a waste of my time”

refocus: “I’ll do something useful instead”

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

Mindful Approaches to AnxietyPost 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

Mindful Approaches to Anxiety

Four important considerations for those working with anxious clients:

Importance of the therapist’s personal experience with mindfulness/meditation practice

Communication about the paradox of goal-directed behavior and non-striving (balancing effort with acceptance)

Distinguish between a client’s 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

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 n=22 t= pre-/post-, 3 mo. follow-up anxiety disorders (GAD, panic disorder +/-agoraphobia)

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

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• n=18• t= pre-/post-, 3 yr. follow-up• anxiety disorders

MBSR and Anxiety Dx 3 Yr FU 18/22 respondedgains 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

Mindfulness Based Stress Reduction

& Psychotherapy

Steve Shealy, PhD

www.BeMindful.org

813-980-2700