Tuesday, April 11, 2017

Mindfulness and Anxiety

Anxiety disorder is much more than being very nervous or edgy.  In anxiety, a person will report an unreasonable exaggeration of threats, repetitive negative thinking, hyperarousal, and a strong identification with fear.  The fight or flight response is kicked into overdrive and physical symptoms such as rapid heartbeat, high blood pressure, and digestive problems often join with the cognitive challenges that anxiety disorder presents.  In General Anxiety Disorder (GAD) and Social Anxiety Disorder (SAD) the symptoms become so severe that normal daily functioning becomes impossible.


A common treatment for anxiety disorders is Cognitive Behavioral Therapy (CBT).  In CBT anxiety is conceptualized as a disturbance where the patient overestimates the danger of disruptive events and underestimates his ability to cope.  CBT attempts to replace maladaptive thinking with beneficial consideration by examining the patient’s distorted thinking and resetting the fight or flight response to reasonably deal with difficult or challenging events.  The patient and the therapist work to actively change the patient’s thought patterns.

By contrast, instead of changing thoughts, Mindfulness-based Therapies (MBTs) seek to change the relationship between the patient and his thoughts.  In MBTs the person focuses on the bodily sensations that arise when he is anxious.  Instead of avoiding or withdrawing from these feelings, the patient remains present and fully experiences the symptoms of anxiety.  Instead of avoiding distressing thoughts, the patient opens up to them in an effort to realize and acknowledge that they are not literally true.  Although it may seem counterintuitive, fully realizing the experience of anxiety enables the patient to release overidentification with negative thoughts.  The person practices responding to disruptive thoughts, and letting these thoughts go.  By remaining present in the body the patient learns that the anxiety they experience is merely a reaction to perceived threats, and that by positively responding to threatening events instead of being reactive they can overcome an erroneous fight or flight response.

At the University of Bergen in Norway, Vollestad, Nielsen, and Nielsen surveyed nineteen studies of the effectiveness of MBTs on anxiety and found that MBTs are associated with robust and substantial reductions of symptoms of anxiety.  MBTs proved as effective as CBT.  They also found that MBTs are successful in reducing symptoms of depression.  This is especially important since major depressive disorder presents in 20 – 40% of patients with GAD and SAD.  The study finds the success of MBTs notable “given that these approaches put less emphasis on the removal of symptoms as such, and more emphasis on cultivating a different relationship to distressing thoughts, feelings, and behavioral impulses.  It seems that this strategy paradoxically could lead to less distress.”  In other words, a way to reduce the symptoms of anxiety is to be fully, mindfully, anxious.  As anxiety reveals itself to be a misperception, symptoms will dissipate. 

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  3. many mental conditions can be effectively treated with one or a combination of the following therapies:

    Medication.
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    Group therapy.
    Day treatment or partial hospital treatment.
    Specific therapies, such as cognitive-behavior therapy and behavior modification.

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