Mindfulness Approaches for theTreatment 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 events 1. Thought structures 2. 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