Cognitive behavioral therapy and Mindfulness to treat anxiety

Anxiety is one of the main reasons why people seek psychological help. Whether in the form of phobias, generalized anxiety, obsessions, panic attacks, anxiety derived from stress, etc.

In my office in Las Palmas de Gran Canaria I treat people with anxiety disorders every day. It is a great effort that I make with my patients to prevent anxiety from continuing to control their lives. And the effort is rewarded, since a very high percentage of them achieve the well-being they so badly needed. What can be done in therapy in these cases? Let's see.

• Related article: "What is anxiety: how to recognize it and what to do"

What is the usual treatment for anxiety?

Pathological anxiety has two main symptoms that are the focus of treatment. One of them is anxious worries or thoughts. The other is over-activation (nervousness, tension, tachycardia, etc.) that accompanies the cognitive component.

Traditional cognitive-behavioral therapy focuses its treatment on these two components as follows:

For physiological over-activation

Relaxation techniques are usedsuch as controlled breathing or progressive muscle relaxation. Exposure exercises are also carried out, when possible, to situations that cause anxiety.

By approaching the anxiogenic stimuli, a habituation is produced to them, reducing the feeling of nervousness.

Concerns

As for concerns, verbal cognitive restructuring and behavioral experiments they have proven highly effective.

With the help of restructuring, concerns begin to be recognized and identified. On the other hand, there is debate about intolerance to uncertainty and the need to face the feeling of not being able to control certain aspects of life. The usefulness of concerns is also reevaluated and the beliefs that sustain them are worked on.

Finally, behavioral experiments are created to expose the person to the results of the predictions of her worries. Thanks to these experiments patients' beliefs are disconfirmed, which usually predict much worse results than what happens in the end.

The usefulness of Mindfulness

Cognitive-behavioral therapy for anxiety, in each of its manifestations, has scientifically proven its efficacy in many studies. Then… Why include Mindfulness in the treatment?

Difficulty controlling thoughts

It is well known that trying to control or change your thoughts is an arduous task. Sometimes we can't remember something we want and other times, anxious thoughts come to our mind uncontrollably. In fact, the harder we try to remember, the more we become blocked. Y the more we try to forget, the more present our thoughts are.

It is estimated that we have about 4,000 thoughts during our waking state, which last only a few seconds, and rarely have to do with the task we are doing. They are automatic thoughts of all kinds, some neutral, others pleasant, many of them absurd, and others unpleasant.

People with anxiety problems they tend to get hooked on unpleasant thoughts and recreate them over and over again, along with an unpleasant mood.

• You may be interested: "Mindfulness: 8 benefits of mindfulness"

An alternative solution

Many of the automatic thoughts that cause us distress, as well as some of the beliefs that govern our lives, can be reevaluated and restructured. These changes that occur thanks to the rationalization of certain thoughts and mental schemes result in an improvement in the quality of life and the welfare of people.

But there are times when thoughts or beliefs cannot be changed, or doing so could lead to greater discomfort than the current one. It is then that I have found the extraordinary utility of third generation therapies.

Acceptance and Commitment Therapy (ACT)

ACT belongs to the latest generation of cognitive-behavioral therapies, and emphasizes the need to let go of control of internal events and accept experiences as they come. One of the most serious problems that we suffer is due to the so-called “experiential avoidance”. We strive to avoid feeling or thinking unpleasant things and try to control them as we do with external events.

If we want to stop watching tele5, we just have to change the channel. If we want to stop thinking that our son will have an accident when he goes to party with the car, and not feel anguish about it, that is more complicated.

The result of avoiding at all costs these emotions, thoughts and physical sensations that we find unpleasant, is to stop living to dedicate ourselves body and soul to fight against our "trouble". The effort in Acceptance and Commitment Therapy is put into recovering or find a meaningful life, based on the values ​​of each person.

To manage intrusive thoughts, ACT has developed a technique called cognitive defusion. One of the goals of this technique is to show that thoughts are just that, thoughts or memories, and that they should not be confused with their references (real events that cause fear or anxiety).

Cognitive defusion is achieved when the patient reaches a more objective and distance yourself from your own thoughts, thus reducing credibility and attachment to them, with a consequent improvement in mood.

What does Mindfulness contribute?

Surely we all have an idea formed of what Mindfulness is. Its rise in recent years has caused it to become part of mass culture. Everywhere there are courses, initiations and mindfulness therapists. It applies to almost everything and in any way, coming to be sold as a global solution to any problem. But we must be rigorous and cautious, since the practice of any therapeutic technique must be supervised by professionals.

Mindfulness is understood to be full consciousness and, although there is no precise definition of the term, various researchers claim that it is an experience characterized by attention to the present moment, without judgment and with acceptance.

Mindfulness aims to connect with the here and now, simply paying attention and being aware of what we are feeling, thinking and doing in the present moment. The mind constantly wanders by the uncertain directions of the future, which causes us anxiety, or by the irretrievable moments of the past, which make us feel melancholy. This constant temporary sway of our mind leads us to abandon the only thing that is real to us, which is our ability to act in the present moment.

Mindfulness in Anxiety Disorders

This tool has proven to be a powerful ally of Cognitive Behavioral Therapy for anxiety disorders, since it considers aspects that until now were neglected.

Physiological, emotional, cognitive and behavioral symptoms are related in clinical anxiety, all surrounded by the circumstances of each person. On many occasions, the problem of the anxious person is compounded by precisely avoiding unpleasant experiences.

Judging our thoughts, emotions, or physical reactions as unpleasant, and merging with these events internal, wanting to control and avoid them at all costs, are the elements that maintain the disorders of anxiety.

These symptoms of anxiety are based on 3 cognitive biases that people with this problem present:

Selective attention

People who suffer from anxiety focus their attention on potentially threatening stimuli, losing important additional information that occurs around him that has nothing to do with his anxiety.

Interpretive bias

It is also common for these people to interpret neutral, or slightly threatening, stimuli as catastrophic.

Thinking focused on the future

In order to avoid the misfortunes that the cognitive biases described above predict, anxious people spend most of their time living in "what could happen", instead of living in the here and now.

The usefulness of Mindfulness

With the help of Mindfulness we teach patients to refocus their attention on the present moment. As soon as they notice that you are focusing your attention on future thoughts, we bring your attention back to current experiences.

By applying Mindfulness in the treatment of clinical anxiety, we can also work on avoidance behavioral or experiential, cognitive rigidity, and the patient's limited repertoire of behavioral responses.

The first thing that is done is to expand awareness of the present moment and the experiences that occur there. This causes a change in attitude towards life, decreasing the tendency to judge and control internal events.

Mindfulness practice helps us realize the natural dissolution of our thoughts and emotions, leaving no "residue" or "footprint" in our mind. We see these internal events appear before our observing consciousness, unfold, and disappear again.

Updating is the key

Psychology is a young science, as well as evidence-based psychological treatments, and they are constantly updated. It is necessary to include the latest therapeutic advances in the daily work of psychologists in order to give the best service to patients.

The union of cognitive-behavioral therapy with the latest updates in contextual therapies, which They also have proven scientific evidence, such as Mindfulness and Acceptance Therapy and Commitment, is a combination that increases the chances of success in therapy.

The Serenity Prayer says "... grant me the serenity to accept the things I cannot change, the courage to change the things I can change, and the wisdom to know the difference."

A professional psychologist, committed to his work, can help you identify and change the thoughts and emotions that are possible, and to know those that cannot be modified. Once you have identified the aspects of your life that cannot be changed, it will help you accept them and focus on the present. On the other hand, it will work with you to enhance your capabilities, guiding your life based on your values, and helping you achieve the well-being you long for.