Transcript Mindfulness in Psychotherapy: Anxiety

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
Anxiety
Physical 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 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
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 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
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
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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 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
Mindfulness Based
Stress Reduction
&
Psychotherapy
Steve Shealy, PhD
www.BeMindful.org
813-980-2700