Anxiety Disorders and Mindfulness
Mindfulness can become a powerful and effective means of relating to one’s internal experience, such as that of anxiety or fear in anxiety disorders, learning to know it and recognize it every time it presents itself to our conscience, and to accept it with patience and trust rather than trying to repress it; so thanks to mindfulness, we will learn to “be” with our anxiety rather than fear it and therefore avoid it.
Advertising message Anxiety is a normal emotion of the human condition that signals an undefined threat. In fact, the main purpose at evolutionary level is to signal an imminent danger and to prepare our organism, through the activation of the sympathetic nervous system and the secretion of cortisol, to two possible reactions, that of attack or escape. But if in the animal world it is much easier to identify which sources of danger may be possible, in the human world it is extremely more complex to give a unique and certain definition of what can represent a danger to an individual. For example, everything that jeopardizes one’s survival, or a danger can also be psychological when life itself is not at stake but the problems can be economic, relational, working, etc. Timing also makes a difference: in fact the danger can be present at this precise moment or it can be imagined, envisaged in the future or even remembered from past situations. So, perhaps, to try to give a definition of danger in our society, it consists in all that we can describe as a problem, or a question that at a given moment of our life needs all our energies, our resources , of our attention in order to be addressed and which cannot be set aside, much less ignored until we find a solution. Anxiety becomes pathological by going beyond normal levels when the anxiety system is activated even in situations where it would not be necessary (such as public speaking), when it reaches levels of intensity such as to reduce the capacities of cognitive functions such as attention or memory and finally when this activation occurs repeatedly and constantly for an extended period of time reducing the person’s quality of life and causing impairment of the functioning in the workplace, social or other important areas. In these cases we can speak of a real anxiety disorder (American Psychiatric Association, 2000). According to DSM5, separation anxiety disorder, selective mutism, specific phobia, social phobia, panic disorder, agoraphobia, generalized anxiety disorder and anxiety disorder are classified among Anxiety Disorders. substance / drug induced anxiety. Although there are significant differences between the various anxiety disorders, there are cognitive, emotional, bodily and behavioral mechanisms that not only maintain but even feed all anxiety disorders. To explain some of these typical mechanisms of anxiety disorders, we give the floor to patients.
In this situation we can notice a selective attention towards the physical (lack of air, heat) and cognitive (emptiness in the head) symptoms that made the patient interpret what was going on in a catastrophic way (catastrophization).
This patient describes a typical mechanism of anxiety or a repetitive thought of concern called brooding that feeds an anticipatory anxiety before situations that the person may face leading sometimes to avoiding exposure to the feared event ‘exam).
In this example, two other mechanisms are evident, namely protective behaviors, that is, all the behaviors that are put in place to avoid the feared consequences (in this case bring the droplets given by the psychiatrist, water and keep the mobile phone handy ) and the fear of fear, that is, the fear that bodily sensations related to anxiety may be felt again, as in previous moments.
In the story of this patient we can find the selective abstraction or of a situation only one aspect is detected, to the detriment of others (in this situation the moment in which the patient was recovered losing instead all the other positive moments in which he intervened) , dichotomous thought i.e. black / white, all / nothing (in this situation a criticism received from the boss made the patient remember this event as a total failure) and finally the a posteriori revaluation more precisely called rumination (rethinking and still rethinking by focusing on the memory of a negative, clumsy, self-conscious image).
Advertising message Standard approaches to anxiety disorders include psychotherapy and drug treatment (American Psychiatric Association, 2005). For a short-term improvement of symptoms, psychotherapeutic interventions such as behavioral therapy that focuses on the gradual exposure of the person to feared situations to reduce avoidance, cognitive-behavioral therapy (CBT, Cognitive-Behavioral Therapy) are equally effective. there is a cognitive intervention of identification and restructuring of distorted and dysfunctional beliefs and evaluations combined with a behavioral intervention of gradual exposure to the feared situations (Barlow, 2002) and drug therapy such as benzodiazepines, tricyclic antidepressants, monoamine oxidase inhibitors and selective serotonin reuptake inhibitors (Sheehan & Harnet Sheehan, 2007). In the long term, CBT has shown greater efficacy than drug therapy (Otto, Smits & Reese, 2005). In chronic and treatment-resistant cases, an integrated intervention of psychotherapeutic and pharmacological therapy was effective (Sheehan & Harnett Sheehan, 2007).
In recent years, these standard approaches have been accompanied by new generation interventions such as mindfulness in order to increase the results obtained in the short and long term with regard to various psychopathologies including anxiety disorders (Feldman, 2007; Hayes, 2005; Lau & McMain, 2005; Orsillo & Roemer, 2005; Segal et al., 2002).
After observing the cognitive, emotional, bodily and behavioral mechanisms closely typical of anxiety disorders, let’s see why and how mindfulness can effectively contribute to increase and stabilize the improvements obtained thanks to standard approaches.
Through meditation practices it is possible to train a very important cognitive function such as that of attention by keeping an attentional focus intentionally at the present moment as opposed to an attentional focus that is usually driven by our automatisms or by our emotional reactions. During meditation practices, as well as in our daily life, we experience the fact that our mind wanders continuously (monkey mind). This is a normal phenomenon and can happen an infinite number of times. But while we are practicing we are invited to notice when this happens, to recognize what had distracted our attention (for example a thought, a noise, etc. ) and with kindness and intentionality let this distraction go in the background to bring our attention back to what we were focusing on at that precise moment of meditation practice (for example, breathing or support points). This is already an act of awareness. This is how the more we practice the more we become aware of what is happening to us at a specific moment in terms of thoughts, bodily sensations and even emotions of the present moment (Hahn, 1976; Kabat-Zinn, 1990); Salberg & Goldstein, 2001; Brantley, 2003). This is how the more we practice the more we become aware of what is happening to us at a specific moment in terms of thoughts, bodily sensations and even emotions of the present moment (Hahn, 1976; Kabat-Zinn, 1990); Salberg & Goldstein, 2001; Brantley, 2003). This is how the more we practice the more we become aware of what is happening to us at a specific moment in terms of thoughts, bodily sensations and even emotions of the present moment (Hahn, 1976; Kabat-Zinn, 1990); Salberg & Goldstein, 2001; Brantley, 2003).
Mindfulness therefore becomes a powerful and effective means of relating to one’s own internal experience, for example how anxiety or fear can be like in anxiety disorders, learning to know it with curiosity and openness and to recognize it every time it presents itself. to our consciousness (this is the beginner’s mind, one of the 7 pillars of mindfulness; Kabat-Zinn, 1990). The knowledge of internal experience (thoughts, emotions and bodily sensations) also allows us to accept it with patience and trust rather than try to repress it, to fight it or to fight against its unpleasantness (in this sentence there are 4 other pillars of mindfulness: acceptance , patience, trust and not looking for results; Kabat-Zinn, 1990). So thanks to mindfulness,
Furthermore, in this way we can take a different observation point from which to look at our internal experience, instead of being merged, identified with it, we can see ourselves distinct, detached as if we were on a river bank to observe the flow of bodily sensations, of emotions and also of thoughts that at that moment pass through our awareness (Salzberg & Goldstein, 2001; Segal et al., 2002; Teasdale et al., 2002). Shapiro et al. (2006) write about it “instead of being immersed in the drama of one’s own narrative or personal life story, we are able to take a step back and simply become witnesses”. In anxiety disorders therefore it will be possible for example to recognize one’s thoughts as simple mental events and not as an accurate description of reality and consequently recognize when we ended up in the river of our thoughts, return to the river bank and let it flow and flow the river of our thoughts (letting go is another of the 7 pillars of Mindfulness; Kabat-Zinn, 1990). Thus processes such as brooding and rumination will be reduced accordingly.
And knowledge, awareness, acceptance, letting go create further virtuous circles instead of vicious in anxiety disorders. In fact, thanks to all these skills continuously trained during mindfulness we can also disable the autopilots that we used to use continuously without our awareness, especially in response to our emotional reactions. Some autopilots typical of anxious reactions are the avoidance of feared situations, the rumination, the rumination or immunizing strategies such as the abuse of alcohol or substances that have the effect of temporarily reducing the anxious state but which instead maintain it in the long term and feed it.
Finally, through mindfulness we also train another ability or that of non-judgment (another pillar of Mindfulness; Kabat-Zinn, 1990) both towards us but also towards others. During the practices we will learn to recognize this natural tendency of our mind to want to judge everything and everyone, we will observe this phenomenon as a thought, a simple mental event, and as well as other thoughts we will let it go in the river of our thoughts. Let’s just imagine what benevolent effects this ability can have for people with social phobia, who tend to be very critical of themselves. Each of us will therefore have the opportunity to develop greater compassionate kindness towards ourselves and towards others.
So, in conclusion, it is clear that mindfulness can be a valid integration aid to both psychotherapeutic and pharmacological interventions that are effective in the treatment of short-term anxiety disorders to interrupt the maintenance cycles typical of anxiety and long-term for reduce vulnerability and therefore to maintain and strengthen the improvements obtained over time.