Calming Your Anxious Mind Page 4

  Freeman notes that mindfulness meditation “differs significantly from the other three” in that the first three are all essentially concentrative techniques that instruct the meditator to focus attention on a single object, such as a phrase or a sound. Mindfulness is a nonconcentrative technique in which the person widens his or her consciousness “to include the observation, in a nonjudgmental way, of his or her mental activities and thoughts” (Freeman and Lawlis 2001, 168).

  Jon Kabat-Zinn pioneered the medical use of mindfulness meditation when he founded the Stress Reduction Clinic at the University of Massachusetts Medical Center in 1979. The approach used in that program has come to be known as mindfulness-based stress reduction (MBSR). In MBSR, Kabat-Zinn and his colleagues used a combination of mindfulness meditation methods and mindful yoga to help thousands of participants cope more effectively with stress, pain, and illness .

  Mindfulness & Medical Research

  Since 1979, a number of clinical studies have documented the health benefits of practicing mindfulness. Mindfulness has been reported to be associated with improvements in levels of anxiety, panic, and general mood disturbance. In addition, mindfulness has been reported to be useful as a self-regulation practice in a variety of other conditions.

  Kabat-Zinn and colleagues (1992) published results from the Stress Reduction Clinic documenting significant reductions in symptoms of anxiety and panic in patients with generalized anxiety disorder, panic disorder, and panic disorder with agoraphobia (fear of being in a place or situation from which escape is difficult).

  In 1995, J. Miller and colleagues published results of a follow-up report on the earlier group studied by Kabat-Zinn in 1992. They found that after three years, a majority of subjects still practiced meditation and had maintained significant improvements in reduced anxiety.

  Speca and colleagues (2000) reported significant benefits from mindfulness meditation in a group of cancer patients. Meditation reduced mood disturbance in general and significantly reduced depression, anxiety, anger, and confusion.

  In 1998, Shapiro, Schwartz, and Bonner reported findings from a group of medical and premedical students who practiced mindfulness-based stress reduction. They found significant reductions in overall psychological distress, including anxiety and depression. They also reported increased levels of empathy and increased scores on a measure of spiritual experiences.

  John Teasdale, Zindel Segal, and colleagues (2000) reported results from a multicenter trial in Canada and the United Kingdom. They studied the application of mindfulness with cognitive therapy to prevent relapse in people with major depressive illness. For people with three or more previous episodes of major depression, they found that mindfulness practices combined with cognitive therapy principles significantly reduced the risk of relapse.

  Linehan (1993a, 1993b) described the use of mindfulness techniques as a way of integrating acceptance into change-based psychotherapies. Her work has focused on individuals diagnosed with borderline personality disorder, and the model she developed, dialectical behavior therapy (DBT), has been widely replicated .

  Other reports support the use of mindfulness meditation in chronic pain (Kabat-Zinn et al. 1986), fibromyalgia (Kaplan, Goldenberg, and Galvin-Nadeau 1993), psoriasis (Kabat-Zinn et al. 1998), with a population of inner-city residents (Roth 1997), in binge eating (Kristeller and Hallett 1999), and stress reduction (Astin 1997).

  There is still much to be understood about how practicing mindfulness actually helps in these various conditions. That it helps seems clear.

  What’s New

  Since the first edition of Calming Your Anxious Mind was released, many interesting and important developments have occurred in the areas of medical research and treatments for anxiety and panic. While it is beyond the scope of this revised version to detail all of this new information, some highlights are worthy of note.

  Can Nonstriving and Nonjudging Attention Actually Help?

  Steven C. Hayes has been the leader of an approach to transforming emotional pain, including anxiety and depression, that utilizes mindfulness and acceptance as starting points for relating to the experiences themselves (Hayes, Strosahl, and Wilson 1999; Hayes and Smith 2005). Hayes calls his approach “acceptance and commitment therapy.” In this approach, Hayes notes that mindfulness acts to enable you “to look at your pain rather than seeing the world from the vantage point of your pain” (Hayes and Smith 2005, 6). A growing number of professionals have taken an interest in this method, and there is an expanding body of research that supports its value .

  Is Mindfulness Really Useful for a Variety of Anxiety Disorders and Conditions?

  As mentioned earlier, Susan M. Orsillo and Lizabeth Roemer have edited a book, Acceptance and Mindfulness-Based Approaches to Anxiety (2005), that is of particular note. This is the first such work bringing together both clinicians and clinical researchers specializing in anxiety disorders who present perspectives on the integration of mindfulness and acceptance-based behavioral therapies. In addition to relevant theoretical models and research data, the book details applications of mindfulness and acceptance-based approaches with specific populations, including people with panic disorder, social anxiety disorder, generalized anxiety disorder, post-traumatic stress disorder, and obsessive-compulsive disorder.

  Can Meditation Cause Changes in Your Brain & Body?

  A final study that is worthy of particular note due to its innovation and intriguing findings was done by Richard Davidson, Jon Kabat-Zinn, and their colleagues and published in the journal Psychosomatic Medicine in February 2003.

  In this study, brain activity and immune system response to flu vaccine were measured in a group of twenty-five subjects who were taught and practiced mindfulness meditation over an eight-week training period. The group was compared to a control group of sixteen people who received no instructions and did not meditate.

  The results of the study showed that, compared to the control group, the group that meditated had significantly increased electrical activity in the left frontal region of their brains. Such increased activity in this region of the brain has been associated with reduced anxiety and a positive emotional state.

  In addition, the group that meditated had significantly more robust immune system responses to an injection of flu vaccine than did the control group .

  This is believed to be the first study to correlate changes in brain activity with reduced anxiety, and changes in immune function directly with the practice of mindfulness meditation.

  Keep in Mind

  In this book we will look at some of the basic understandings about fear systems and anxiety, and the role of thoughts and attitudes in health. Medical science has not yet reached a final conclusion about how anxiety and panic happen or how they should best be treated.

  By learning to be present and to stay connected with your body and mind and what is happening in the present moment, you have your best chance of understanding your own experiences of fear, anxiety, and panic. Out of that understanding, you will make the most effective response for healing.

  There is a promising new body of research that supports mindfulness meditation as an aid in a variety of medical conditions, including anxiety and panic.

  Chapter 3

  The Body & Its Fear System

  You already know how it feels to be afraid. It has been said that fear is one of the most basic of all human emotions. A key point here is that fear is something you can actually feel. The racing heart, the tensing muscles, the heightened sense of alertness, and the sweaty palms can all be felt. Deeper in the body, in the layers of muscle and in the visceral organs, you can feel sensations, movements, gripping, and hardening.

  You may have noticed that the feelings in your body associated with fear are very similar to feelings you may have associated with anxiety, worry, or panic. Based on what we know about the mind-body connection, this is not surprising.

  In the 1990s, research related to the brain’s anatomy, neuroc
hemistry, and electromagnetic operation was intense and productive. We now know much more about how the brain functions under both normal and abnormal conditions. These discoveries are quite relevant as you practice mindfulness and face fear and anxiety in your own life.

  Research is beginning to reveal how deeply the body and mind are interconnected. The emerging picture is both complex and fascinating. As a human being, you are in a dynamic, continuously changing, and interactive relationship involving your mind, body, and the surrounding environment.

  This relationship requires that you have functioning systems to take in information via the senses. More systems must then act to assess, compare, and process the new information. Finally, you need systems to store, manage, and retrieve the information for future use.

  Your brain and nervous system communicate with each other and the rest of your body constantly to assess and maintain contact with your surrounding external environment; to generate, measure, and direct your responses to that environment; and to maintain the moment-by-moment conditions of your interior environment.

  As a key part in this interactive relationship, you have a built-in emergency capacity called the fight-or-flight reaction , and you also have a powerful built-in quieting and calming capacity called the relaxation response. Each of these responses is wired into us as human beings. The responses function in such a way that they can happen in your body yet outside of your conscious experience, but, importantly, they can also be modified by your conscious experience.

  Richard Davidson of the University of Wisconsin, Madison, is a founder of the field of affective neuroscience , a branch of psychology that studies the brain circuitry involved in the experience of emotions. Dr. Davidson is quoted by Daniel Goleman in Destructive Emotions (2003, 189): “One of the most exciting discoveries in neuroscience over the last five years is that the areas of the brain . . . the frontal lobes, the amygdala, and the hippocampus, change in response to experience. They are the parts of the brain dramatically affected by the emotional environment in which we are raised and by repeated experience”. In other words, your brain function can actually change in response to experience. And what you do as part of that experience—for example, learning to meditate—has the power to change how your brain actually functions.

  Fear is the reaction you feel in your body in the presence of an external threat or danger, and anxiety is the reaction you feel in your body when the danger or threat comes from within and is more vague. Either way, the fear system of the body is operating.

  What exactly is happening in the brain and body when you experience the fight-or-flight response, or the fear reaction ?

  Fight or Flight

  The fight-or-flight response is what you feel in your mind and body and call fear. This response is also sometimes called the stress response. Early researchers in the field of stress, such as Walter B. Cannon and Hans Selye, came to recognize and describe the arousal and physical changes animals experience in the face of danger or stressors (Freeman and Lawlis 2001). They saw that the increases in blood pressure, heart rate, muscle tone, and alertness—paired with the secretion of powerful hormones in the body—prepared the animal to defend itself or to flee. It was Cannon, working in the 1920s, who coined the term fight-or-flight. Selye, working in the 1950s, popularized the term stress.

  It is interesting to note that Selye defined stress as a response to a stressor or demand. He viewed stress as the total response—mind and body—to whatever pressure or demand the animal (or person) faced.

  To summarize, what we call fear, anxiety, or even panic is the felt or sensed component of a mind-body experience that is activated and controlled by a fear system wired into us as human beings.

  The connections of the fear system involve several brain centers and body systems. The messages are transmitted over nerve pathways and through the blood as it circulates, and modulated by an astonishing array of stress hormones, proteins, and other neuroendocrine substances.

  As a result, dramatic physical, cognitive, and emotional elements activate when the fear system alarms go off. This experience in its totality is designed to prepare you either to defend yourself or to flee from danger. When viewed as a response to a danger or stressor, this total mind-body response is also called stress.

  When a person says, “I feel stressed,” what he or she actually feels is the various sensations of arousal and preparation to fight or flee that have arisen in the mind and body. The reason the feelings are so intense and unpleasant is usually that they have been building up over time as extended or chronic stress, or have developed especially strongly in a sudden, intense, and acutely stressful situation.

  The dramatic physical changes are mediated by a variety of powerful chemical messengers (stress hormones) in the body. The best known are adrenaline and cortisol .

  Adrenaline plays a major role in the activation of the body for fight or flight. The racing heart, the rapid and shallow breathing, the profuse sweating, and the shaking and trembling are all due to the action of adrenaline.

  The known effects of cortisol include mobilizing glucose (stored sugar) to provide immediate energy, increasing the body’s sensitivity to other stress-related hormones, and inhibiting the immune and inflammatory responses.

  In the acute or immediate stress response, adrenaline, cortisol, and all the other stress hormones are released and act on their target organs and tissues. As the threat subsides, the response eases, and the body returns to a more balanced state.

  How the Fear System Operates

  According to current research, the key to understanding the fear system lies in the amygdala, a small, almond-shaped structure located deep in the brain. This structure has powerful connections to a wide range of brain and body regions. It is the area of the brain most involved in fear.

  Joseph LeDoux calls the amygdala the “hub in the wheel of fear” (1996, 168). To understand this, imagine the following.

  In the center of a wheel is the amygdala. Surrounding it and connected to it by the spokes of the wheel are information-processing systems of the brain and body. These systems gather, send, and receive information constantly from the amygdala. This information includes:

  Direct sensory input (what is coming in from the eyes, ears, nose, tongue, and body).

  Sensory input that has been processed by “higher centers” in the brain. For example, when the sensory cortex decides that the shape on the ground in front of you is a stick and not a snake, it sends signals to the amygdala to turn off the fear reaction.

  Input not related to the senses, but associated with memories and contexts. For example, simply having a certain thought or memory may stimulate a feeling of fear or worry.

  Input that can inhibit or turn down the amygdala’s alarm. This inhibitory action is believed to be centered in an area at the front of the brain called the prefrontal cortex.

  There is a very fast, direct pathway for input from any of the senses straight to the amygdala. The information is not “clean” or precise, but because it arrives so quickly, the body can respond almost immediately to danger.

  A dog charges at you out of nowhere, a fire alarm goes off nearby, a truck runs the stop sign and almost hits you: such vivid sights and sounds can set off the amygdala. The message travels by this first, most direct route.

  The amygdala sounds the alarm to the rest of the fear system. It activates the hypothalamus (a regulatory center in the brain), which fires signals to the autonomic nervous system (a part of the nervous system that acts without our conscious control), which in turn sends the signals to release the chemical messengers that act on organs and tissues to produce the fight-or-flight reaction.

  There is a second, slower pathway that the incoming message also takes while the first, most immediate pathway is activating.

  In the normal (nonstressed) order of brain function, various higher brain centers also process the incoming sensory data. They assess the information, compare it with similar information or ex
perience stored in the memory, and interpret the situation as safe or dangerous. When the incoming information is judged safe, these centers have the power to override or inhibit the emergency alarm activated by the amygdala.

  The fast pathway brings new sensory information to the amygdala and triggers the emergency response. The slower pathway processes the same information and can then communicate with the amygdala to either turn off or sustain the emergency response.

  This means the higher centers must process the message correctly to turn off the emergency response. The main function of the higher centers is to prevent the inappropriate emergency response from continuing .

  If this inhibitory function of the higher centers—especially the prefrontal cortex—does not operate correctly, or if the higher centers mistakenly identify the input as dangerous, then the alarm sounds louder. Many researchers now believe that this dysfunction or failure of inhibition in the fear system contributes to the development of anxiety disorders. As Edmund J. Bourne (2000, 38) notes, “panic attacks are more likely to occur when this entire ‘fear system’ is overly sensitized, perhaps from having been previously activated too frequently, too intensely, or both.” Bourne further suggests that “changes in this system can take place as a result of acute stress, or as the long-term result of multiple stresses over time.”

  The implications are clear. If anxiety arises out of fear system dysfunction, then management of anxiety depends on doing everything possible to enable the fear system to function properly. Developing skills in relaxation and present-moment awareness through meditation is an important way to support the healthy functioning of your body’s fear system.