Calming Your Anxious Mind Read online

  For example, you have awakened every morning for weeks feeling afraid, and you do not know why. Or you know it is “irrational,” but you are terrified to ride the elevator in the building where you work. Or you are so frightened about flying that you have turned down job opportunities that would have required air travel.

  Worry is the mind’s expression of anxiety. It can be understood as the combination of the physical experience of anxiety (fear without the identified danger) and the thoughts, stories, images, and other cognitive activity driven by the anxiety.

  For example, you cannot plan a vacation without thinking about all the things that could go wrong. Or you cannot stop anticipating every detail of a meeting with your boss scheduled in two weeks. Or you cannot stop worrying about how dangerous the wiring is in your home since a neighbor’s house caught fire .

  When the feeling of fear is intense, sudden, and overwhelming but comes without any apparent cause, it is called panic. Panic attacks can come from out of the blue, with no apparent cause. People experiencing such acute apprehension and intense fear often think they are about to die. Panic is so unpleasant that people usually begin to modify and restrict their activities because of it.

  It is important to acknowledge that whether it is fear or anxiety, whether the danger is present or vague, the experience of the fear reaction —what you feel as fear or anxiety—in the present moment is compelling.

  The fear reaction is expressed and experienced in the body, in the mind, and in behavior. When you experience the fear reaction, you endure some (or even many) of the following as the physical, cognitive, emotional, and behavioral elements flow into and out of the present moment.

  Physical Experience

  Your heart pounds and races. Your muscles tense and tighten. You sweat, tremble, or shake. You feel tingling sensations or numbness. You may have a sense of choking or difficulty breathing. You may have discomfort or even pain in your chest. A feeling of queasiness, abdominal distress, or nausea often arises. Headaches and backaches are common. You may feel dizzy, unsteady, or like you might faint.

  Psychological & Emotional Experience

  The interior psychological and emotional experience is also intense. You may have feelings of unreality and dissociation. You fear losing control or going crazy. If the anxiety is very intense, you may wonder if you are about to die. Your ability to concentrate and to think clearly is disturbed. Your mind is confused. Thoughts repeat. You may become preoccupied with a particular thought or idea, so that you feel “stuck” on a theme .

  Feelings of despair and hopelessness arise. You feel helpless or powerless to do anything about these deeply unpleasant feelings and the burden they create.

  Behavioral Experience

  Anxiety may manifest itself in your behavior. For example, you may avoid people or situations. You may develop elaborate rituals that must be performed before you can do any other activities. Or you may be bound by repetitive compulsions such as hand washing or door checking that interfere with the flow of daily life.

  When the fear reaction arises repeatedly and persists over time, it is called chronic. We could say that to call fear or anxiety chronicmeans that it is a frequent visitor to the present moment. Chronic fear and anxiety can affect your relationships, work, social life, personal health, and inner life.

  When you suffer from chronic fear and anxiety, your feelings of restlessness and ill ease grow stronger. Your energy is low, and you are easily fatigued. Sleep is disturbed. You may be unable to think or concentrate. You may feel like your mind is going blank. Participation in conversations, even social ones, can become difficult. You may feel more irritable, lash out at others, become overly critical, or withdraw from people. The use of alcohol and drugs (prescribed or recreational) often increases.

  Normal or Excessive Anxiety?

  Everyone experiences anxiety. The arousal from anxiety, in its milder forms, can actually be helpful. Anxiety increases your attention, as when a barely avoided collision brings your attention back to your car and the traffic for the rest of your drive home. Mild anxiety can enhance performance and productivity, as when speakers become more focused or athletes are motivated to put aside all other distractions immediately before the game begins .

  Everyone worries. Many people regard some worry as good. In its milder forms, worry can warn of danger or point toward useful action.

  When anxiety is moderate or high rather than mild, however, the results are usually not so positive. The experience of moderate levels of anxiety can be notably uncomfortable. This level of anxiety can lead to cognitive disorganization and to some or many of the physical symptoms mentioned earlier. High levels of anxiety definitely interfere with daily life and function, and, if chronic, may need professional treatment.

  You may have mild, moderate, or even occasional high levels of anxiety and not have an anxiety disorder. Just reacting to life can evoke those feelings.

  The following criteria can help you understand the difference between normal and excessive anxiety. It is the presence of excessive or pathologic anxiety that defines anxiety disorders. Excessive anxiety:

  has very little recognizable cause and is present for no good reason

  has a disturbing level of intensity well beyond everyday anxiety

  lasts longer than everyday anxiety, up to weeks or months at times

  has a significant and detrimental impact on living. in fact, the pain may lead to destructive behaviors such as withdrawal, avoidance, or abuse of food, alcohol, or other substances.

  Anxiety disorders are the most prevalent of all psychiatric conditions. They are a huge burden for the afflicted individuals and their loved ones, and also for society through lost work productivity and the high utilization of health care resources by those suffering from anxiety disorders. Anxiety disorders afflict 15.7 million people in the United States each year, and 30 million people in the United States at some point in their lives (Lepine 2002).

  The American Psychiatric Association (1994) recognizes ten distinct anxiety disorders, plus “anxiety disorder not otherwise specified.” From the viewpoint of mindfulness, the important thing to remember is that the characteristic symptoms in these disorders—combinations of physical arousal, intrusive and disturbing thoughts, and intensely unpleasant sensations—all occur in the present moment. Excessive anxiety is the fear response happening in the present moment for no apparent reason, or for a reason that does not justify the intensity of the fear.

  Self-help is a vital component of a comprehensive treatment plan, but it is not a substitute for needed treatment. If you think you may have a diagnosable anxiety disorder, you should consider consulting a qualified mental health professional.

  Causes of Anxiety & Anxiety Disorders

  Our understanding of the causes of anxiety and pathologic anxiety has increased dramatically in recent years as the physical and neurochemical pathways of fear and anxiety have been studied. However, much more research is needed, and our understanding is far from complete at present. This incomplete understanding is reflected in the variety of models that seek to explain anxiety and its pathologic forms.

  Current understanding of fear and anxiety identifies the causes as a powerful interaction of biology, cognitive-emotional influences, and stress.

  Biology

  Each person has a body. Your body is the fundamental biological and neurological platform from which your moment-by-moment experience and interaction with life occurs. Crucial elements of the body’s role in anxiety lie in the function of the central and peripheral nervous systems, and in the array of organs and systems that respond to and communicate with the nervous system.

  Since the body is vital to experience, it makes sense that the genetic influence on anxiety would be important. Although there is limited evidence at present, it does appear that, to some degree, anxiety disorders are inherited. This inheritance is probably mediated through differences in each person’s sensitivity in key areas of the brain. The
se areas vary in their response to the array of stress modulators and neurotransmitters active in the brain and body. However, there is much more to be learned about how this tendency to be anxious is passed on from generation to generation and how this tendency should be handled in treatment.

  In some ways, you have little control over what your body does reactively, but your body is intelligent and can be trained. There is growing evidence that people can learn to exert considerable influence over the reactions and ongoing activities of the body by learning and using a variety of mind-body methods. The meditation and relaxation practices you will learn in this book are potent examples of the mind-body connection.

  Certain medical conditions, medicines, and other substances can contribute to or cause anxiety and panic attacks. A detailed discussion of these is beyond the scope of this book. However, if anxiety interferes significantly in your life, please consult a medical professional to determine if there is a treatable medical cause for the anxiety. Consider your own use of medications and other substances, since the list of anxiety-causing agents is quite long and includes such common items as caffeine, tobacco, and aspirin.

  Cognitive-Emotional Influences

  A second important contributing factor in anxiety and panic seems to be the effect of childhood experiences and the family environment on a person’s self-perception, ways of relating to others, and ways of handling the demands and stressors of living.

  For example, factors such as your view of the world as threatening or supportive, your level of self-confidence and belief in your ability to handle stressors, and how you handle and express feelings (toward yourself and toward others) have all been shown to have a major impact on health and the ability to cope. Each of these sets of views arises repeatedly in you—in the present moment—and in turn influences how you experience what is happening and what you do about it .

  Your experience of fear and anxiety is directly affected by the thoughts, perceptions, and emotions you have in that moment. Just as you can learn skills to work with the physical reactions of fear and anxiety in the present moment, you can also work with these powerful attitudes and views. It is crucial to realize that views and patterns of reactivity can be recognized, they can be changed, and they can be replaced with more adaptive and healthy alternatives.

  Stress

  The third major factor contributing to the development of anxiety—and especially anxiety disorders—is the cumulative or long-term role of stress. There can be many sources of this chronic stress, but the effects of leaving it unmanaged are clear. Chronic stress greatly increases the likelihood of illness and the breakdown of physical, emotional, social, and even spiritual life.

  Treating Anxiety Disorders

  The most widely used mainstream approaches to treating anxiety are medications, specific types of psychotherapy, or both.

  Commonly prescribed medications include tricyclic antidepressants and another class of antidepressants known as selective serotonin reuptake inhibitors . In some cases, monoamine oxidase inhibitors may be prescribed instead.

  The most common psychotherapies are behavioral therapy and cognitive behavioral therapy. Behavioral therapy uses methods such as relaxation training and gradual exposure to whatever frightens a person as a means to cope with fears. Cognitive behavioral therapy teaches people to recognize thought patterns, body sensations, and situations that trigger fears, and to react differently.

  However, even after a number of years of research and concerted efforts to develop more effective treatment for anxiety disorders, the currently available treatments do not work for everyone with an anxiety disorder .

  Because of this, health-care providers and researchers continue to seek new approaches. In recent years, self-help methods, including meditation, have gained attention. There is a growing recognition that individuals have an important part to play in their own treatment and recovery.

  Meditation methods that specifically emphasize mindfulness are being used more often in clinical treatment settings. Medical literature concerned with anxiety treatments is beginning to reflect this trend. The term mindfulness-based cognitive therapy is gaining popularity, and a growing number of professionals are working to research and apply this combination of mindfulness, meditation, and cognitive behavioral therapy.

  John Teasdale, Zindel Segal, and colleagues (2000) have published research that suggests a mindfulness-based cognitive therapy approach can prevent relapse and recurrence in major depression. In 2002 Lizabeth Roemer published a comprehensive review of cognitive approaches to anxiety and discussed the role of mindfulness in treating anxiety. She concluded that mindfulness may be particularly useful for individuals with generalized anxiety disorder. Although both articles caution against drawing premature conclusions, the authors make a strong case for exploring this interface of mindfulness and therapeutic approaches. In 2005, Susan M. Orsillo and Roemer edited a book titled Acceptance and Mindfulness-Based Approaches to Anxiety that suggests exciting new treatment possibilities using mindfulness in a variety of anxiety disorders.

  Keep in Mind

  Fear, anxiety, and panic can be overwhelming experiences. They can also be understood as experiences that flow into and out of the present moment. This is true of either normal or excessive anxiety.

  You can learn to handle fear and anxiety by bringing relaxation and attention into your life and keeping a present-moment focus. Because fear and anxiety happen in the present moment, it is vital that you learn to establish yourself—and remain—in the present moment in order to manage them. Mindfulness meditation practice establishes attention in the present moment. There is a growing body of evidence that developing a daily practice of meditation—one that emphasizes mindfulness (friendly, nonjudging awareness)—is something you can do to help yourself manage fear, anxiety, and panic.

  Chapter 2

  Paying Attention on Purpose

  Practicing mindfulness means learning to relax and stay present with a nonjudging and friendly awareness. Mindfulness is cultivated by paying attention—on purpose and carefully—to the contents of this moment in a friendly and allowing way. As we are using the term in this book, mindfulness is developed through a daily practice of meditation.

  To teach yourself a better way to manage fear, anxiety, and panic, it is important for you to learn to relax, and practice this way of “paying attention on purpose.” As you develop your capacity to be mindful through meditation, you will discover that you can be relaxed and aware. You will begin to relate to the experiences of fear, anxiety, or panic rather than from them or as if they are who you are.

  As you increasingly come to see these experiences as conditions in the present moment instead of as your enemy or your “problem,” they will no longer dominate your life. You will make more effective responses to them.

  In this book, several themes will appear and reappear.

  Although you may be struggling with fear, anxiety, or panic, you already have what you need to transform your life. Mindfulness, kindness, and compassion are within you.

  The ground for this transformation is mindful presence , which is nonjudging, nonstriving, accepting, present-moment awareness. The emphasis when practicing mindfulness is on being, not doing.

  Your experience of fear, anxiety, or panic is transformed when you make it the direct object of mindfulness. In a mindfulness-based approach, the instruction is to turn toward fear, anxiety, and panic when they arise. You do not recoil, run away, or try to suppress them.

  This approach to fear, anxiety, and panic works best when you make mindfulness a way of living. To approach life mindfully is to meet and connect with each experience as it arises and flows through the present moment of life. Mindfulness will not work so well if you think of it as a method or technique and wait to use it only when fear, anxiety, or panic is here and troubling you. Mindfulness becomes a way of living when you ground it in a daily practice of meditation and extend this practice into your life.

 
Specific meditation practices, including those in this book, are meant to assist you in making mindfulness a way of living. The focus varies in different practices, yet all aim to help you be present for the moments of your life , regardless of what is happening in and around you during those moments.

  Does Practicing Mindfulness Really Help?

  The only way to know whether mindfulness will work for you is to try it. However, a growing, encouraging body of medical research suggests that people facing a wide variety of problems, including anxiety and panic, can enjoy significant benefits when they develop mindfulness through a committed practice of daily meditation.

  Mindfulness itself is a basic human quality. It is the capacity for conscious presence. It is the awareness that is friendly, nonjudging, and allowing.

  People have systematically cultivated this quality through meditation for thousands of years. Historically, the goal has been to enhance spiritual practice and to aid the realization of a higher purpose and meaning in life.

  Since the 1960s, when a large-scale social transformation sparked interest among Westerners in meditation, Eastern spirituality, and altered states of consciousness, there has been growing interest in meditation and mindfulness as it relates to health and healing.

  Lyn Freeman points out in Mosby’s Complementary and Alternative Medicine (Freeman and Lawlis 2001) that despite thousands of years of human experience with meditation, “it has only been in the last twenty-five years that meditation has been researched as a medical intervention in Western cultures” (168). According to Freeman and Lawlis, this research has focused on four separate forms of meditation: transcendental meditation ; respiratory one method ,developed by Herbert Benson; clinically standardized meditation ,developed by Carrington and others; and mindfulness meditation .