Improve Generalized Anxiety Disorder by Decentering and Mindfulness
By John M. de Castro, Ph.D.
“Mindfulness allows us to interrupt automatic, reflexive fight, flight, or freeze reactions—reactions that can lead to anxiety, fear, foreboding, and worry.” – Bob Stahl
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. 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. 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. So, there is a need to develop alternative treatments. Recently, it has been found that mindfulness training can be effective for anxiety disorders. Mindfulness-Based Cognitive Therapy (MBCT) is targeted at changing unproductive and unreasonable thought patterns and has been shown to be effective for anxiety disorders. Mindfulness-Based Stress Reduction (MBSR) has also been shown to be effective. Acceptance and Commitment Therapy (ACT) combines elements from MBCT and mindfulness training and has also been shown to be effective.
These therapies have in common the attempt to decenter thought processes. Decentering changes the nature of experience by having the individual step outside of experiences and observe them from a distanced perspective. The individual learns 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). The individual, then, sees their thoughts as a constructed reality produced by their self and not as absolute truth. This, in turn, results in an ability to see anxiety provoking thoughts as not true, but simply a construct of the mind’s operation, allowing the individual to begin to change how they interpret experience.
In today’s Research News article “Change in Decentering Mediates Improvement in Anxiety in Mindfulness-Based Stress Reduction for Generalized Anxiety Disorder.” See summary below or view the full text of the study at:
Hoge and colleagues examine the degree to which decentering and mindfulness mediate the effect of Mindfulness-Based Stress Reduction (MBSR) on Generalized Anxiety Disorder (GAD). They recruited adult patients who were diagnosed with GAD and randomly assigned them to receive either an 8-week MBSR program or stress management education program which aimed to improve “overall health and wellness through education about diet, exercise, sleep, time management, and resilience.” Before and after the 8-weeks of training the participants were measured for anxiety, worry, mindfulness, and decentering.
They found that both groups showed improvements but the MBSR group had significantly greater increases in mindfulness and decentering. In addition, they found that the greater the increase in mindfulness the greater the decrease in anxiety levels and similarly, the greater the increase in decentering the greater the decrease in anxiety. A sophisticated statistical mediation analysis technique revealed that MBSR had its primary effect on anxiety levels through decentering rather than mindfulness. On the other hand, MBSR training reduced worry by increasing the mindfulness facets of acting with awareness and non-reactivity to inner experience.
The results are interesting and suggest that Mindfulness-Based Stress Reduction (MBSR) reduces anxiety and worry through different mechanisms; anxiety by increasing decentering and worry by increasing mindfulness. This is reasonable as anxiety is highly affected by illogical thought processes and decentering provides a means by which these thoughts can be seen as false. Mindfulness, on the other hand produces a focus on the present moment and thereby reduces worry about the future.
So, improve generalized anxiety disorder by decentering and mindfulness.
“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 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.
CMCS – Center for Mindfulness and Contemplative Studies
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Hoge, E. A., Bui, E., Goetter, E., Robinaugh, D. J., Ojserkis, R. A., Fresco, D. M., & Simon, N. M. (2015). Change in Decentering Mediates Improvement in Anxiety in Mindfulness-Based Stress Reduction for Generalized Anxiety Disorder. Cognitive Therapy and Research, 39(2), 228–235. http://doi.org/10.1007/s10608-014-9646-4
We sought to examine psychological mechanisms of treatment outcomes of a mindfulness meditation intervention for Generalized Anxiety Disorder (GAD).
We examined mindfulness and decentering as two potential therapeutic mechanisms of action of generalized anxiety disorder (GAD) symptom reduction in patients randomized to receive either mindfulness-based stress reduction (MBSR) or an attention control class (N=38). Multiple mediation analyses were conducted using a non-parametric cross product of the coefficients approach that employs bootstrapping.
Analyses revealed that change in decentering and change in mindfulness significantly mediated the effect of MBSR on anxiety. When both mediators were included in the model, the multiple mediation analysis revealed a significant indirect effect through increases in decentering, but not mindfulness. Furthermore, the direct effect of MBSR on decrease in anxiety was not significant, suggesting that decentering fully mediated the relationship. Results also suggested that MBSR reduces worry through an increase in mindfulness, specifically by increases in awareness and nonreactivity.
Improvements in GAD symptoms resulting from MBSR are in part explained by increased levels of decentering.