2. Mindfulness in Psychotherapy: Anxiety with Steve Shealy, PhD

3. 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

4. Anxiety Physical symptoms include:  increased heart rate  palpitations  irregular breathing  feeling faint  trembling and sweating

5. What is Mindfulness?

6. Definition of Mindfulness: As Mindfulness relates to psychotherapy, it may be best defined as awareness of one’s present experience with acceptance.

7. 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”

8. 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

9. 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

10. 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

11. 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:

12. 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”

13. 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

14. 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

15. 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

16. 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)

17. 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

18. 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

19. 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

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