Generalized Anxiety Disorder with Co-occurring Major Depression is Associated with Lower Mindfulness
By John M. de Castro, Ph.D.
“attempts to avoid uncomfortable thoughts and feelings may worsen anxiety. The paradox here is that mindfulness helps us turn toward those and learn to change our relationship to the actual thoughts and the physical sensations, rather than try to change them in any way. By changing [that] relationship, we actually stop feeding those cyclical processes and they start to die off on their own.” – Judson Brewer
Anxiety disorders are the most common mental illness in the United States, affecting 40 million adults, or 18% of the population. 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. Anxiety disorders have generally been treated with drugs. But there are considerable side effects and these drugs are often abused. There are a number of psychological therapies for anxiety. But, about 45% of the patients treated do not respond to the therapy. So, there is a need to develop alternative treatments.
One of the premiere measurement tools for mindfulness is the Five Factors of Mindfulness Questionnaire. It measures overall mindfulness and also five facets; observing, describing, acting with awareness, non-judgement, and non-reactivity. People differ and an individual can be high or low on any of these facets and any combination of facets. It is not known what pattern of mindfulness facets are most predictive of the ability of mindfulness to improve anxiety disorders.
Depression often co-occurs with anxiety disorders. Recently, it has been found that mindfulness training can be effective for anxiety disorders. Mindfulness has also been shown to be effective for depression. So, patients with generalized anxiety with co-occurring depression may have lower ability to be mindful.
In today’s Research News article “Facets of Mindfulness in Adults with Generalized Anxiety Disorder and Impact of Co-occurring Depression.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662732/), Baker and colleagues recruited adult patients with Generalized Anxiety Disorder (GAD) and measured them for mindfulness, including observing, describing, acting with awareness, nonjudging, and nonreactivity facets, worry, depression, and severity of psychopathology.
The participants were separated into GAD with and without Major Depressive Disorder. They found that the GAD participants who also had co-occurring Major Depressive Disorder were lower in mindfulness, especially the acting with awareness facet of mindfulness. They also found that over the entire sample that higher levels of depression and worry were associated with lover levels of mindfulness. Looking at the facets of mindfulness they found that depression was negatively associated with acting with awareness and worry was negatively associated with the nonjudging and nonreactivity facets.
These are correlative findings and causation cannot be determined. But previous research has demonstrated that mindfulness training reduces anxiety and depression. So, a causal connection is likely. The results, then, suggest that patients with Generalized Anxiety Disorder (GAD) are less likely to act with awareness if they also have Major Depressive Disorder. In addition, With GAD patients in general higher levels of depression were associated with lower levels of acting with awareness. Depression is associated with very low energy levels. So, it makes sense that the presence of depression would interfere with taking mindful action.
They also found that the higher the levels of worry the lower the levels of the nonjudging and nonreactivity mindfulness facets. This suggests that worry in patients with Generalized Anxiety Disorder (GAD) interferes with the ability to not judge and not react to inner experience. Conversely, worry promotes judging and reacting to inner experience. Patients who have high anxiety are worried about potential future negative occurrences and as such may judge inner experience as indicative of a problematic future and so react to it more.
So, the results indicate that Generalized Anxiety Disorder with co-occurring Major Depression is associated with lower mindfulness.
“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.” – George Hofmann
CMCS – Center for Mindfulness and Contemplative Studies
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Study Summary
Baker AW, Frumkin MR, Hoeppner SS, et al. Facets of Mindfulness in Adults with Generalized Anxiety Disorder and Impact of Co-occurring Depression. Mindfulness (N Y). 2019;10(5):903‐912. doi:10.1007/s12671-018-1059-0
Abstract
Anxiety and depressive symptoms are associated with lower levels of mindfulness, yet few studies to date have examined facets of mindfulness in adults with Generalized Anxiety Disorder (GAD). In this study, we examined differences in mindfulness between individuals with GAD with and without concurrent Major Depressive Disorder (MDD) and/or Dysthymic Disorder (DD). We also examined the associations of anxiety and depressive symptoms with facets (subscales) of mindfulness. We hypothesized that individuals with primary GAD and co-occurring MDD/DD would exhibit lower mindfulness than those without a concurrent depressive disorder. We also hypothesized that mindfulness would be negatively correlated with worry and depressive symptom severity. Subjects were 140 adults (M (SD) age = 33.4 (12.9); 73% female) with a primary diagnosis of GAD; 30.8% (n = 43) also met criteria for current MDD/DD as determined by a structured clinical interview for DSM-IV. Current worry and depressive symptoms were assessed using self-report measures at baseline of a 12-week treatment study. Individuals with GAD and co-occurring MDD/DD exhibited significantly lower mindfulness than those without a depressive disorder diagnosis and specifically lower scores on the Awareness sub-scale compared to individuals with primary GAD and no comorbid depression. In terms of the dimensional impact of worry and depression ratings, depression symptoms independently predicted lower Awareness scores and worry independently predicted lower levels of Nonreacting and Nonjudging sub-scales. This may have direct treatment implications. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662732/