Kathleen Kawamura, PhD Clinical Psychologist
Kathleen Kawamura, PhDClinical Psychologist

MINDFULNESS AND ANXIETY

THE VOICES OF ANXIETY

When listening to the chatter of the mind, there are usually three distinct voices that can be heard during the experience of anxiety. First, there is the “anxious voice,” the thoughts that continuously ask, “What if…?” and worries about worst case scenarios and fearful possibilities. Then there is the voice of “false comfort,” the inner voice that resists any experience of anxiety or distress. It minimizes, reassures, ignores, or argues with the anxious voice in an attempt to eradicate any discomfort. It is a nurturing, protective, well-meaning mechanism that is focused on avoiding or escaping a distressing situation. The problem is that the anxious voice often responds with more insistence leading to an unhelpful debate between the two voices about whether a situation is dangerous or not, which contributes to the spiral of anxiety.

A voice that is less involved and is removed from the back and forth argument generated by anxiety is the “wise mind.” The wise mind is aware of the anxious voice and of the needs of the voice of false comfort but it does not get involved and instead observes without immediately reacting. This is because the wise mind understands that attempts to ignore, deny, or engage with the anxiety in any way does not destroy the anxiety but rather pushes it aside where it builds up and grows stronger. On the other hand, by sitting with and observing the anxiety without immediately reacting, the wise mind is able to give you the space to respond in a way that does not add more pain and suffering to the situation. This is mindfulness.

MINDFULNESS

Mindfulness refers to the practice of observing without judgment your present moment experience. The present moment can be thoughts, feelings, or physical sensations you are experiencing internally, or it can be the sights, sounds, smells, tastes, and sensations from the world around you. With regards to anxiety, mindfulness means stepping outside of the cycle of anxiety, and instead of engaging with it, observing your experiences and reactions as they unfold. This idea can seem frightening to those with uncontrollable anxiety who have developed the protective habit of shutting out distressing thoughts, feelings, or physical sensations, or it can seem impossible to those whose minds stubbornly latch on to regrets over the past or fears of the future, but mindfulness is a skill that has been shown to have many benefits for anxiety and can be developed gradually with time and practice. 

BENEFITS OF MINDFULNESS

A nonjudgmental awareness of the present moment can allow you to see more clearly, rather than through the cloud of anxiety, whether you are in imminent danger and then make decisions accordingly. By observing the rise, crest, and fall of your anxiety, you are able to watch and wait, which also gives space for anxiety to slowly dissipate on its own. As you watch and wait, you may also notice urges to avoid or escape the anxiety and then be able to choose to respond more flexibly, rather than reacting to anxiety automatically or unconsciously in ways that contribute to more problems. In addition, mindfulness can help put anxiety into perspective, meaning that even as an important and distressing reality in your present moment, you learn to recognize that anxiety does not have to define your total experience in this world. 

In neurological terms (see the section on the brain in Understanding Anxiety), the "wise mind" and mindfulness refers to processes occurring in the cortex (the thinking brain). In fact, mindfulness has been shown to be related to increased activity in the cortex rather than decreased activity in the amygdala. This suggests that in anxiety, the amygdala still sends out an alarm, triggering the fight or flight system, but with mindfulness, the cortex is likely sending messages to calm the amygdala which then dampens the fight or flight response so that the relaxation response of the parasympathetic nervous system can kick in. In essence, mindfulness limits the fuel that is added to the anxiety and keeps from further igniting the anxiety response. This is in comparison to the anxious mind that is typically focused on past failures or future threats. It may be challenging in the beginning but as new neural connections are being made and developed, the brain is being trained to change your relationship to the present moment and to your anxiety. 

HOW MINDFULNESS IS PRACTICED

Mindfulness often starts with learning how to focus on the breath because breath awareness can lower baseline anxiety, helps with anxious breathing, is easily accessible, and increases awareness of one’s body, allowing the mind and body to reconnect. Breathing is also rooted in the now, not in the past nor in the future, and thus focusing on the breath is training your mind to focus on the present moment. Anxiety is constantly trying to pull you away into the questions of “what if” whereas breath awareness anchors you in the “what is.”

Mindfulness can also include focusing on thoughts, sounds, tastes, or an entire experience. Mindfulness practice can be done in short 3-minute sessions and can be done throughout the day in a variety of settings - while brushing your hair, while waiting in line, while eating, while washing the dishes. It is a process where you pull yourself out of autopilot and learn to re-experience life in the moment. Simple yet profound.

Each time your mind wanders from your breath or from your sensations, you have an opportunity to gently teach your mind how to refocus by observing your mind being pulled, allowing for the pull, and then gently guiding your mind back to your breath or your sensations and allowing the thoughts to pass through without getting caught up in them. It is a conscious decision to act differently, to try something new just for a moment, to not give in to anxiety’s pull, to disengage from anxiety, to accept uncertainty, and to come back repeatedly to the present moment. This is not a natural process of the mind, especially during anxiety. This ability to recognize the wandering mind and return to the present moment can be strengthened over time and with consistent practice.

FINDINGS ON MINDFULNESS

Mindfulness has been a powerful addition to cognitive behavioral therapy. Mindfulness Based Stress Reduction (MBSR) and Mindfulness Based Cognitive Therapy (MBCT) have both shown positive effects in treating a variety of mood disorders. In addition, brain imaging studies have found mindfulness practice to be associated with decreased amygdala activation which is responsible for the fight or flight response. Brain imaging studies have also found mindfulness practice to be associated with changes in brain structures associated with learning, memory, and mood regulation. 

ATTITUDES of MINDFULNESS

There are several attitudes that are central to mindfulness:

1) Non-judging: This means observing your own experiences without judgment. It is a powerful habit of our minds to constantly categorize our experiences as good, bad, or neutral, which we judge as boring. Mindfulness means stepping back and being aware of the constant pull to judge or react to our experiences in habitual ways. When you notice the mind judging, there is no need to stop it, but rather observe the judging quality of the mind and identify it as judgmental thinking. It is important not to judge the judging, but simply note that it is present.

2) Patience: This refers to simply being open and accepting the reality of the present moment and that we may not have control over the ways things unfold. Mindfulness means learning to recognize this impatience and the tendency to rush through one moment to the next. Patience also means cultivating patience towards your mind and body. Our minds have a mind of their own and this is okay. Try to be patient by accepting this wandering mind and accepting this mental chatter while remind yourself not to get caught up in it. It also requires a level of kindness and compassion for yourself.

3) Beginner’s mind: This is the quality of seeing the world or experiencing a moment as if for the first time and allowing each moment unfold moment to moment. It means engaging directly in an experience without judgment, without comparison to the past, and without expectations for the future. A beginner’s mind also means being receptive to new possibilities and trying to see the present moment with a clear and uncluttered mind.

With regards to anxiety, adopting a beginner’s mind can allow you to observe your current experience of anxiety with a clear and uncluttered mind as it is happening now rather than reacting to expectations based on past experiences. It prevents adding a layer of pain to the distress that already exists and being receptive to new possibilities. A beginner’s mind can also be used as a way to disengage with anxiety and instead engage with the present moment sensations of smell, touch, taste, or sound similar to a child experiencing the first smell of a flower, the first feel of rain, or the first taste of an orange where each moment is unique.

4) Trust: This attitude is about trusting yourself, including your feelings and your ability to see clearly what is happening to you. It means trusting that your abilities to observe and respond to your mind and body will develop over time and that you are the best person to know what is going on inside you and around you. Trust involves learning to pay attention to the abilities you already have and to what is important to you.

5) Non-striving: Those experiences we judge as good we become attached to, want more of, and do not want to lose, whereas those experiences we judge as bad, we feel an aversion to and want to avoid them or get rid of them. They are both about reactively changing our situation whereas non-striving is about allowing whatever is happening to happen so that instead of striving for an outcome, you learn to see and accept things as they are at least in this moment – the good, the bad, and the ugly. This is important for anxiety because the harder you try to get rid of it, the more powerful and elusive it becomes whereas by stepping back and accepting things as they are seems to loosen anxiety’s hold.

6) Letting go: This means recognizing the ways in which your mind clings to certain ideas and expectations and instead developing an attitude of nonattachment. It means letting go of expectations of good or bad, liking or disliking, pleasant or unpleasant, and allowing the experience be what it is. By letting things be, you have a better chance of letting go.

7) Acceptance: This means being aware of and acknowledging the way things are in the present moment. In comparison, we often waste energy denying and resisting what is already a fact. We try to force situations to be the way we like which only creates more tension. Acceptance is a willingness to see things as they really are at least in this moment without trying to impose ideas about what we “should” be feeling or thinking or seeing.

With regards to anxiety, acceptance means coming to terms with uncertainty and discomfort. It means that regardless of how you feel about it, anxiety is an unpleasant part of your reality at this time, that your fears are causing you suffering, and that those fears may or may not be happen. Acceptance does not mean you are satisfied with things as they are, that you don’t care, or that you have to stop trying to change things for the better, rather it means recognizing that the pain may be temporary, there may be hope for a better future, and you are learning to manage it more effectively.

There is a saying that we need “the serenity to accept the things we cannot change, the courage to change the things that we can, and the wisdom to know the difference.” This means that acceptance is not about resignation and succumbing to challenges in our lives. Acceptance is related to movement towards reasonable change, working with what we have, and recognizing when it is futile to try to control a situation. Wisdom comes in learning when to work for change or when to practice acceptance, and usually it is about balancing the two.

Acceptance of the past is related to understanding the impact past experiences have had on your current situation, grieving any losses, and then shifting the focus on the present. We cannot change the past, but we can try to minimize the impact it has on us now. Acceptance of the future is related to tolerating uncertainty about the future and knowing that you are making strides to create a better future for yourself and that you are developing the skills to assist you when the future does not turn out quite as expected. Acceptance of the future is patience, taking it one step at a time, and seeing life as a process.  

 

Click here for a thorough description of mindfulness based cognitive therapy for anxiety disorders.