By John M. de Castro, Ph.D.
“People with anxiety have a problem dealing with distracting thoughts that have too much power. They can’t distinguish between a problem-solving thought and a nagging worry that has no benefit. If you have unproductive worries, you can train yourself to experience those thoughts completely differently. You might think ‘I’m late, I might lose my job if I don’t get there on time, and it will be a disaster!’ Mindfulness teaches you to recognize, ‘Oh, there’s that thought again. I’ve been here before. But it’s just that—a thought, and not a part of my core self.’” – Elizabeth Hoge
Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults, or 18% of the population. Generalized Anxiety Disorder (GAD) affects about 3.1% of the U.S. population. GAD involves excessive worry about everyday problems. People with GAD become anxious in anticipation of problems with their finances, health, employment, and relationships. They typically have difficulty calming their concerns, even though they realize that their anxiety is more intense than the situation warrants. Physically, GAD sufferers will often show excessive fatigue, irritability, muscle tension or muscle aches, trembling, feeling twitchy, being easily startled, trouble sleeping, sweating, nausea, diarrhea or irritable bowel syndrome, and headaches.
Anxiety disorders have generally been treated with drugs. It has been estimated that 11% of women in the U.S. are taking anti-anxiety medications. But, there are considerable side effects and these drugs are often abused. Although, psychological therapy can be effective it is costly and only available to a small numbers of sufferers. So, there is a need to develop alternative treatments. A characterizing feature of anxiety disorders is that the suffer overly identifies with and personalizes their thoughts. The sufferer has recurring thoughts, such as impending disaster, that they may realize are unreasonable, but are unable to shake. This may indicate that treating the cognitive processes that underlie the anxiety may be an effective treatment.
Cognitive Behavioral Therapy (CBT) is targeted at changing unproductive and unreasonable thought patterns and has been shown to be effective for anxiety disorders. Recently, it has been found that mindfulness training can be effective for anxiety disorders. Acceptance and Commitment Therapy (ACT) combines elements from CBT and mindfulness training and has also been shown to be effective. These therapies have in common the attempt to decenter thought processes; that is to learn to observe thoughts and feelings as objective events in the mind rather than personally identifying with the thoughts or feelings which is so characteristic of Generalized Anxiety Disorder (GAD).
In today’s Research News article “Decentering as a Potential Common Mechanism across Two Therapies for Generalized Anxiety Disorder.” See:
or see summary below or view the full text of the study at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4380615/
Hayes-Skelton and colleagues recruited adults who had been diagnosed with Generalized Anxiety Disorder (GAD) and randomly assigned them to receive 16-weeks of either an applied relaxation therapy or an acceptance-based behavioral therapy (ABBT). ABBT is very similar to ACT and contains mindfulness training. They measured anxiety, worry, and decentering before and after treatment and in order to look at the changes occurring during therapy, they also measured anxiety and decentering at weeks 4, 8, and 12 during treatment.
They found that over the 16-weeks of treatment the decentering scores increased significantly by 22% improving approximately 5% every 4 weeks and these increases were significantly related to decreased worry scores. At the same time, the anxiety levels decreased significantly by 89% improving approximately 12% every 4 weeks. In addition, they found that decentering was a leading indicator for changes in anxiety; that is that improvements in decentering preceded improvements in anxiety levels. This is an important indicator of a causal connection. There were no significant differences found between applied relaxation therapy or acceptance-based behavioral therapy (ABBT) in effectiveness for increasing decentering or decreasing anxiety.
These findings are important as they add to the accumulating evidence that treatments that include mindfulness training are effective in treating anxiety disorders. They are especially important as they suggest that the most important effect of treatment is to increase decentering and this, in turn, reduces anxiety. So, the ability to see thoughts as objects of awareness and not something personal may be the most important change to accomplish to improve Generalized Anxiety Disorder. This suggests why Cognitive Behavioral Therapy and mindfulness training are effective as each changes the relationship of the patients with their thoughts, making them less personal.
So, relieve generalized anxiety with mindfulness.
“instead of changing thoughts, mindfulness-based therapies (MBTs) seek to change the relationship between the anxious person and his or her thoughts. In mindfulness-based therapy, the person focuses on the bodily sensations that arise when he or she is anxious. Instead of avoiding or withdrawing from these feelings, he or she remains present and fully experiences the symptoms of anxiety. Instead of avoiding distressing thoughts, he or she opens up to them in an effort to realize and acknowledge that they are not literally true.” – George Hofmann
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Hayes-Skelton, S. A., Calloway, A., Roemer, L., & Orsillo, S. M. (2015). Decentering as a Potential Common Mechanism across Two Therapies for Generalized Anxiety Disorder. Journal of Consulting and Clinical Psychology,83(2), 395–404. http://doi.org/10.1037/a0038305
Abstract
Objective:
To examine decentering as a potential mechanism of action across two treatments for generalized anxiety disorder: an acceptance based behavioral therapy (ABBT) and applied relaxation (AR).
Method: Sixty-four individuals who completed at least half of the 16 total sessions of either ABBT or AR (65.6% female, 79.7% identified as White, average age 34.41) completed measures of decentering (Experiences Questionnaire) and of symptoms of anxiety (Depression Anxiety Stress Scale-Stress subscale) at five time points over the course of therapy and a measure of worry (Penn State Worry Questionnaire) at pre and post-treatment.
Results: Initial growth curve models showed that decentering increased significantly over therapy (z = 7.09) and this increase was associated with a decrease in worry symptoms (PSWQ) at post-treatment (z = −8.51). The rate of change did not significantly vary across treatments (Δχ2/Δdf = 0.16/1, p = 0.69). Further, a series of bivariate latent difference score models indicated that the best fitting model was one in which decentering was a leading indicator of change in symptoms (DASS-Stress). Allowing this coupling to vary across treatments did not significantly improve the fit of the model (Δχ2/Δdf = 0.71/1, p = 0.40).
Conclusions: In this sample, results suggest that increased decentering was associated with decreases in anxiety and that changes in decentering appear to precede changes in symptoms within both ABBT and AR, indicating that decentering may be an important common mechanism of action.