Over the past 10 years, I think I’ve become much more adept at treating anxiety disorders and wonder if the boost is due to adding mindfulness-based therapies into my repertoire. I have read about research demonstrating that mindfulness-based therapies are at least as effective as cognitive-behavioral therapy (CBT) in treating anxiety, with some suggestive evidence that mindfulness-based approaches can actually be more effective. These findings are a big deal in my field because CBT has been considered one of the gold standards in evidence-based mental health treatment for decades. In my day-to-day practice, I’ve noticed that people with anxiety often respond much more robustly to treatment as I’ve learned to incorporate mindfulness-based approaches, giving a big boost to CBT (which is still an excellent type of therapy, by the way).
Hmmm, why would mindfulness-based therapy be more effective than CBT for anxiety? Let’s start with a basic understanding of CBT and please note that I’m going to vastly oversimplify the explanation in the interest on brevity. One of the fundamental principles of CBT is that problematic thinking can lead to mental health problems such as anxiety. As such, a primary treatment focus of CBT is encouraging people to challenge and restructure their unhelpful thoughts, which can inform healthier decisions. This can be a powerful therapeutic intervention and I use it every day at work. In a way, CBT actually encourages us to argue with our own anxiety, challenging irrational thinking with more constructive, helpful thoughts. That sounds logical, right? It is, but people suffering with intense anxiety often have rapid-fire thoughts, especially when it comes to their anxiety triggers. In the mind of an anxious person who is triggered, thoughts may come at high speed, with physical symptoms of anxiety kicking their nervous system into overdrive. Maintaining the ability to rationally challenge problematic thoughts coming at warp speed may be too much for someone in the throws of severe anxiety, potentially leaving them feeling exhausted and even more overwhelmed. Here’s where mindfulness can come in! In my mind right now, mindfulness is coming onto the stage, wearing a cape and assuming a superhero posture, with superhero music blaring. Too much? Well, how about if it comes onto the stage as a wise, humble, old teacher, radiating wisdom, the whole scene enhanced by serene wood-flute music? Or you can come up with your own imagery. Now where was I?
Right, mindfulness for anxiety. As an intervention for anxiety, mindfulness actually allows the person to let go of the fight with anxiety. This is very important because we can inadvertently make something stronger by fighting with it! Let me stop for a moment to explain a bit about how anxiety works because it’s a tricky little sucker and the more we understand it, the better we can learn to work with it. First of all, it’s important to note that we are all hard-wired to experience anxiety and fear. We need these emotions to help us detect and respond to danger effectively. Anxiety disorders, though, involve hyperactive nervous systems that tell us we’re in immediate and serious danger when we’re really pretty much ok. Dang it, why would our nervous systems do that to us? We’re not totally sure yet about the “why” question. We can certainly learn to be anxious from those around us; anxiety is known to very contagious. Furthermore, some people probably have a genetic predisposition to be anxious. I prefer to think about this fact in a different way: some people are simply more gifted at scanning for potential danger. Unfortunately, though, this ability to scan for danger comes at a heavy price these days because most of us live fairly cushy lives, relatively speaking, free from the daily, imminent threats of saber-tooth tigers, natural disasters, and deadly plagues. Yes, we will all face hardships in our lives, some of us even surviving natural disasters and severe illness and even war, but most of us will not have to deal with these threats on a daily or even yearly basis. An anxious brain, however, does not know the difference between an imminent threat (think footfalls behind us in a dark alley) and an anticipated threat (like that root canal appointment later in the week or the possibility of getting rejected on the phone interview for the job you really want). Because our brains cannot tell the difference between these types of threats, our nervous systems may get riled up in very similar ways: heart palpitations, shallow breathing, muscle tension, thoughts sharply focused on the perceived danger and how to fight or get away from it.
Cue the superhero music and cape again: Ba da bum pa—Mindfulness! Or did we decide on serene wood-flute music? Anyway, mindfulness teaches us not to fight with our anxiety. Instead, mindfulness teaches us to observe our anxiety from a compassionate, accepting stance. Right now, it’s entirely possible that your’e asking yourself, “But WHY would this crazy woman be asking me to accept my anxiety when I HATE it?!” That’s a great question that I’d like to answer with a little exercise. Go with me for a moment. Please do not think about the pink elephant sitting outside your door right now or why it’s there or how it got there. Again, do not think about it. Just don’t think about the pink elephant at all. Every time you think about the pink elephant, push it out of your mind and tell yourself to not think about it. DO NOT THINK ABOUT THE PINK ELEPHANT! Now, answer honestly: what have you been thinking about for the past 30-60 seconds? This is a silly example of what can happen inside our minds when we try to push thoughts out and tell ourselves not to think about them. Instead of ridding ourselves of the thoughts, we may actually be obsessing over them.
Ok, another exercise. If you have two hands available, push them against each other as hard as you can. Notice what is happening in your arms, shoulders, and hands. Do you feel your muscles tightening and straining? Go ahead and release your arms and notice what changes. When we push something away, physically or mentally, we tense our muscles. When we are highly anxious, tensing our muscles can actually worsen the anxiety by reinforcing the heightened arousal of the nervous system, which is exactly the opposite of what we really want to happen. When we let go, our muscles relax. Learning to be mindful of our anxiety gives us a a few more options for responding to our anxious thoughts and feelings. We can learn to surf the wave of anxiety rather than try to barricade against it, allowing ourselves to go with the flow and know that the wave will pass. We can learn to have compassion for ourselves while we’re experiencing anxiety and ask ourselves, “What can I do to help myself through this?” With an accepting, compassionate attitude towards the anxiety, we may actually take away some of the energy that serves to fuel the anxiety and keep it going. Perhaps we can simply let it be.
As I sat down to write this blog, I had no idea I’d be incorporating saber-tooth tigers and capes and music and pink elephants. Phew! We’ve covered a lot of ground and I’m hoping you have a better understanding of why mindfulness-based therapy can offer a boost to the benefits of CBT for treating anxiety. Are you interested in getting a boost from mindfulness? Excellent! I specialize in offering mindfulness-based interventions for anxiety and other problems so feel free to check out my website for more information. There are also some other resources listed on my website here. One resource I highly recommend is the book The Mindful Way Through Anxiety by Susan M. Orsillo and Lizabeth Roemer. It’s a great read.
With gratitude and well wishes,
Dr. Jen
