There are several therapeutic modalities with significant research backing as being effective in the treatment of anxiety: Mindfulness Based Stress Reduction (MBSR) and Cognitive Behavioral Therapy (CBT), are two of the leaders. Below, you'll find a little information about each of these therapies and why they are helpful in the treatment of anxiety.
Mindfulness Based Stress Reduction (MBSR)
Background Info: Founded in 1979 by Jon Kabat-Zinn, Mindfulness Based Stress Reduction (MBSR) is a melding of medicine and psychology, the Buddhist principle of mindfulness and yoga. Initially developed for the treatment of stress and chronic pain, this 8-week program has been used successfully in schools, prisons, athletic programs and places of employment. Within this treatment modality, there is (1) an emphasis on maintaining a perspective of challenge (as opposed to chore or “I have to”); (2) importance is placed on regular (daily) practice of mindfulness; (3) a significant schedule adjustment in order to incorporate the recommended 45-minutes per day, six days per week of practice; and (4) decreased focus on time-time and increased focus on present awareness moment by moment.
What to expect during therapy: Due to the large emphasis on daily practice of mindfulness, part of the therapy process will be learning MBSR techniques/tools that you will then practice throughout the week. Additional sessions may include an assessment of how the practice went, what got in the way of the practice, and then making a plan for more practice (homework) the following week. Skills and techniques build upon each other.
How to get the most from MBSR therapy:
QUE YOUR PRACTICE — We aren’t very good at remembering to practice a new skill, so connecting that practice with something you already do can be very helpful. For example, practice grounding through touch every time you brush your teeth or feel each step under your foot every time you walk up a set of stairs. Another helpful trick is to set a reminder in your calendar/phone to practice a particular technique each hour (i.e. “Time to take 4 mindful belly breaths!”).
GUIDED PRACTICE — You don’t have to do it alone. There are hundreds and hundreds of options for guided meditations and mindfulness practices on Youtube or the App store. Look around and try out several. Do you like a male or female voice? Do you want someone who speaks straightforward or is more airy and melodic? Keep checking out different authors/creators until you find a meditation you connect with.
GET OUTSIDE THE BOX — While a formal practice of meditation is helpful, mindfulness practice can happen at any given moment. Every time you take a moment to really look at something or check in with yourself (without judgement) you are practicing mindfulness. The more opportunities you create to be present (aka mindful) when your anxiety isn’t high, the better able you’ll be to use the skills when your anxiety is high. Basically, practice when you DON’T need it in order to be able to use it when you DO need it.
Cognitive Behavioral Therapy (CBT)
Background Info: Cognitive Behavioral Therapy (CBT) was originally developed by Dr. Aaron T. Beck in the 1960s to treat depression. Since then, there have been thousands of clinical trials demonstrating the effectiveness of these techniques on numerous mental health conditions. According to the Beck Institute for Cognitive Behavioral Therapy, "In contrast to other forms of psychotherapy, cognitive therapy is usually more focused on the present, more limited in duration, and more problem-solving oriented." An underlying belief within CBT, is that how we view what's going on around us (the meaning we give to things) influences how we feel. So, it isn't what happens to us that determines how we feel, but rather how we view what happens to us - the meaning we give to a situation (aka perspective) - that will determine how we feel.
What to expect during therapy: Each CBT session is usually focused and goal oriented. During the initial session, your therapist will help you outline overall goals and individual steps to get there. The main focus will be on helping you to identify unhelpful/irrational thinking patterns. Common questions from your therapist will include, “What are you thinking about this event?” and “What were your thoughts at the time of the event?” From here, the unhelpful or irrational thinking patterns can be identified and challenged. Throughout therapy, you’ll learn specific skills such as modifying beliefs, recognizing distorted thinking, changing perspective, adapting behaviors, and relating to people differently. Often, homework is assigned and expected to be completed between sessions. This can take the form of tracking certain behaviors/thinking patterns and listing times when you practice a particular technique.
How to get the most from CBT therapy:
PRACTICE — You'll see the most benefit by taking the therapy session with you into the "real world" through practice. The skills identified in the therapy session will need to be practiced - you’re literally creating new ways of thinking, which doesn’t happen over night.
TAKE NOTES — Jot down a few notes about your experiences with the practice between sessions, including situations where it was easier or harder to complete the practice. Bring your notes to the next therapy session and share with your counselor.
MAKE A LIST — List the healthy coping skills you’ve learned and keep it in a place that’s easily accessible. This will become a great resource when times get tough.
How does CBT and MBSR help to reduce Anxiety?
Anxiety targets two parts of the brain… For the sake of simplicity, the mid-brain and the top-brain. When our fight/flight system (mid-brain) is activated we feel shaky, tightness in our chest, we may start to sweat, or even get tunnel vision. This is an automatic response and vital for our survival - it is the part of the brain that allowed us to fight off saber tooth tigers. The problem comes when our mid-brain is over active and trying to protect us from things that aren’t actually life threatening (i.e. a social setting, the future, rejection, bridges, failure - the list goes on and on). MBSR techniques help to reduce the overactivity in this mid part of the brain. There is some instant relief from this fight/flight anxiety and then we can move onto using CBT strategies with our top-brain.
We know anxiety is running rampant in our top-brain when we are playing out the worst case scenarios, catastrophizing, outlining what-if’s, worrying, and awfulizing. Not only are these ways of thinking not helpful, they actually act to increase and sustain anxiety. CBT strategies focus on identifying, challenging and changing these thinking patterns that are not helpful.
As you can see, through the use of Mindfulness Based Stress Reduction (MBSR) and Cognitive Behavioral Therapy (CBT), we are able to target the two places in our brain where anxiety begins and continues. But, it takes persistence some perseverance. Happy practicing!
Rachel Baker is a Spokane, Washington-based psychotherapist, helping driven and successful people who are overwhelmed and anxious create peace and purpose. Her goal is to connect individual client strengths and experiences with proven therapeutic approaches that increase skill and insight in order to create a life filled with peace and purpose. If you are interested in individual therapy to address worry, overwhelm or anxiety, please call: (509) 999-8696 or email: firstname.lastname@example.org to schedule a free 15-minutes consultation.