introduction

HOW THIS BOOK WILL HELP YOU

Fear and anxiety are like a pair of overzealous bodyguards. Instead of issuing sensible warnings about potential danger, they scream alarms or nag incessantly. Rather than providing security so that you are free to move through your daily life without constantly looking over your shoulder, they lock you in your room. Rather than bringing you peace of mind, they commandeer your attention until everything seems like a potential threat, making it hard to pursue what matters most to you. And once fear and anxiety take hold, it can be hard to loosen their grip.

Of course, it’s only natural to respond to a warning by trying to escape the threat. Once we know that danger lurks in certain places, it’s wise to steer clear. But when we listen too zealously to anxiety and fear, we can end up spending more and more time and energy fleeing and avoiding—physically, mentally, and emotionally. Our field of vision narrows; our breadth and depth of experience shrink. We become imprisoned by our self-preservation instincts, our own reactivity. To break free from anxiety’s tight grip on our lives, we need to cultivate a new type of awareness—a compassionate, gentle, yet unwavering way of processing our reactions and surroundings that doesn’t trigger an urge to head for the hills. This awareness is called mindfulness.

Mindfulness makes it possible to build a new relationship with worry and fear—to stop just surrendering to anxiety and stress. It may seem downright foolhardy to sit still when our every neuron is screaming at us to get away from whatever has set off the alarms in our body and mind—the racing heart, the tightening chest, the sense of impending doom. And yet this is the key to unlocking anxiety’s hold. Our valiant efforts to fight anxiety, avoid stress, and silence those bossy inner bodyguards are the very things preventing us from keeping our responses proportionate and useful, finding solutions for our concerns, and focusing our attention where it belongs: on pursuing what matters most to us in life.

The goal of this book is to help you discover how mindfulness can help you break free from your struggle with anxiety and open your life to new possibilities. We’ll start by helping you build a new understanding of anxiety in general—where it comes from, how it operates, how it affects your life in ways you’re hardly aware of. Befriending these unfamiliar aspects of anxiety will give you a taste of mindfulness and its power to free you from a struggle that may be robbing you of life’s purpose and meaning.

People struggle with anxiety in many ways. Some fear very specific activities like public speaking or driving over bridges. Others are uncomfortable in certain situations, such as at social events or in crowded stores. You may be consumed with worry, stressed out, and tense over major life events, like the loss of a job, or minor matters, like being late for appointments. Perhaps you wrestle most with the physical symptoms—the pounding in your chest, the knot in your stomach, or overall jitteriness that sometimes come with anxiety. Or it might be the constant burden of worry and doubt that weighs you down.

Fortunately, many anxiety-related problems can be addressed through developing and applying new skills and strategies. Behavioral and cognitive-behavioral psychotherapy and self-help approaches to treating anxiety problems are, in fact, among the most successful programs in the field of psychology. Yet they are not always enough. They don’t help everyone, and for some people they lead to improvement but not to the comprehensive life change desired. In an attempt to address these concerns, researchers are constantly examining ways to improve these already powerful approaches.

One of the most promising of these directions, it turns out, is mindfulness. Mindfulness, with its deep roots in the Buddhist spiritual tradition, involves intentionally bringing a curious and compassionate attention to one’s experiences as they are in the present moment. A recent explosion in research has been evaluating whether this kind of attention can be adapted for use in medical and mental health settings. Thanks to the pioneering work of scientists like Jon Kabat-Zinn and his colleagues at the University of Massachusetts Medical School; Marsha Linehan at the University of Washington; Steven Hayes and colleagues at the University of Nevada at Reno; Alan Marlatt at the University of Washington; and Zindel Segal, Mark Williams, and John Teasdale, we have seen that the principles and practices of mindfulness can help those struggling with chronic pain and medical conditions, depression, borderline personality disorder, addictions, and a variety of life problems. Over the last 10 years the two of us have been building on this pioneering work and looking specifically at how mindfulness can be integrated into cognitive-behavioral approaches to help those dealing with anxiety.

First we identified three common patterns of responding to anxiety that seemed to contribute to the distress and dissatisfaction associated with anxiety-related problems—that is, the patterns that seemed to turn helpful self-preservation mechanisms into metaphorical overprotective bodyguards. As you’ll have a chance to see for yourself in this book, this three-part sequence involves reacting to the painful emotions of anxiety with narrowed attention and self-criticism and judgment; then trying to escape the anxiety mentally; and, finally, when that doesn’t ease the discomfort, trying to avoid whatever triggers the anxiety. We have found over and over that mindfulness can reveal to someone whose attention has become chronically constricted by anxiety how these patterns unfold: how a fluttering in the chest or worrisome thought can immediately shift our attention exclusively to scanning for potential threats and how we instantly interpret this sensation, emotion, or thought as unwelcome, potentially dangerous, or a sign of inherent weakness. Mindful awareness can show us when we are trying to distract ourselves or suppress and override these thoughts, emotions, or physical sensations. It can open our eyes to how much of our life is squandered trying to skirt the people, places, and activities that could trigger anxiety.

Mindfulness practice can increase your awareness of even the most subtle cues of anxiety, allowing you to apply new skills before your emotional response escalates. Incorporating mindfulness practice into our daily lives helps us cultivate a willing stance toward anxiety, freeing us from our ongoing internal battle. Mindfulness practice helps us gain the clarity we need to take intentional actions in our life so that we are less likely to react mindlessly out of habit. It can show us how, to avoid risks, we often pass up opportunities and how we can stop focusing on avoiding anxiety more than on pursuing fulfillment.

HOW TO GET THE MOST OUT OF THIS BOOK

Although the book is intentionally organized so that each chapter builds on the preceding one, as you probably know from your own experiences, the process of change is rarely linear. To get the most of out of this book, we recommend that you read it all the way through to build a strong foundation for change and then cycle back through the chapters to see if there are new points to be discovered or challenges to try. One of the things we find most exciting about this work is how our own understanding and connection with the material deepens each time we work with a client, supervise a therapist, apply it to our own lives, or write about it. We sincerely hope you share in that experience.

In the first three chapters of the book, we share our knowledge of fear and anxiety and how it can impair quality of life, and we provide a number of exercises designed to help you reflect on how these concepts fit your personal experience and prepare you to make the life changes you desire. The middle section of the book is aimed at helping you cultivate the foundational skills of mindfulness, build a practice that can work within the demands of your daily life, and gradually move toward bringing mindfulness to anxiety and other challenging internal states. You may want to pause a week or so between chapters in this section so that you can try out the practices and learn how they apply to your life before reading new material. The rest of the book is an invitation to engage more fully and freely with the things in life that matter most to you. In these chapters we explore how the knowledge you’ve gained about anxiety and the mindfulness skills you’ve cultivated can be used to deepen and enhance your life. We address obstacles that can cause you to veer off course and provide suggestions for how to get back on track and maintain the life changes we hope you experience. Again, taking at least a week off between chapters can give you the time you need to try out suggestions from the book and see how they relate to your own life.

The material in this book is drawn from an acceptance-based behavioral treatment program we developed for people with generalized anxiety and worry, as well as the panic, social fears, and depression that are often associated with these experiences. Given the success of the program in helping clients to both decrease their anxiety and depression and increase their quality of life, we adapted the underlying principles and exercises into this book. Through experience with our clients, we believe reading this book will lead you to reexamine how you view anxiety, other emotions, even your thoughts. This shift in perspective is extremely powerful, yet it’s just a starting point for change. The way you will benefit most from what we share in this book is by applying these concepts to your life. In every chapter we have provided exercises aimed at bridging the gap between reading and living. Mindfulness is something that is experienced. It is a way of being. Our most sincere advice is to attempt all the practices we describe in the book, even if you think you know what it would be like to do them. Then, based on your own experience, you’ll be able to build a practice that is right for you.

To help you build your practice, we’ve made audio recordings of some of the exercises we include here and posted them on a website, www.guilford.com/orsillo-materials. It can be helpful to listen to someone lead you through specific exercises as you are learning them, so we hope these recordings will help with that process. You may also choose to record yourself reading some of them, so you can be your own guide. We also encourage you to practice at times without recordings so that you can internalize the practices and have them available to you wherever you are. This will give you flexibility and help to make mindfulness an integral part of your life.

Struggling with anxiety can be all-consuming, and it’s easy to lose sight of your inner strengths and resources. Our purpose in writing this book is to help you discover the capacity you already possess to move beyond the limits that anxiety has placed on your life. Our sincere hope is that, as you read, you will develop a deeper understanding of your anxiety and related patterns of emotional response, cultivate a curious and compassionate stance toward experiences that you previously found frightening or confusing, and participate in your life in satisfying and meaningful new ways. Although the material in this book is derived from our research and clinical experience, it is also deeply personal to us. Mindfulness and the concepts we write about in this book inform how we live our personal lives, how we teach, parent, connect with friends, love our partners, and approach our own struggles. We hope you find these concepts as useful and life-enhancing as we have.

Is This Book for You?

I don’t think I have an anxiety disorder or anything like that. I am just really anxious about everything going on in my life right now. Does this book make sense for me?

Although this book was informed by our research with those who have significant clinical anxiety, we believe the principles and processes described are universal. Anxiety is part of being human, and many of our first-line coping responses, like distraction or avoidance, are driven by basic biological and cultural forces. Mindfulness directly targets these common habits by increasing our awareness and allowing us to respond more flexibly.

My anxiety is pretty severe, and in the past I have been diagnosed with an anxiety disorder. Does this book make sense for me?

This book is based on and informed by the work we do with clients who struggle with significant anxiety. We think people with anxiety disorders may find it extremely relevant to their experience and helpful. If you are currently in therapy, we encourage you to talk to your therapist about mindfulness and find out how he or she thinks it may fit with the work you are already doing. If you are not in therapy, you may find that the book inspires you to seek that extra support. Finding the right therapist sometimes takes patience and perseverance. A few resources you might try are the Association for Behavioral and Cognitive Therapies (www.abct.org), the Anxiety Disorders Association of America (www.adaa.org), or the Association for Contextual Behavioral Science (www.contextualpsychology.org). All of these organizations have a “Find a Therapist” feature on their websites that can serve as a starting point. Feel free to try meeting with multiple therapists in order to find one whose style fits best with you. Although reading a book like this one can definitely help people with significant anxiety, we also highly recommend therapy, which can help you to personalize and apply these concepts to your own life.

Does it matter whether I am taking medication for anxiety?

A lot of people we treat are taking prescription medication for anxiety, depression, or both issues. Often they tell us that they find their emotions too intense, distressing, and life interfering and that the medication brings them some relief. Because mindfulness involves being open to, accepting, and allowing of one’s experiences, however pleasant or unpleasant they may be in a given moment, it can seem like taking medication runs counter to this stance. Our opinion is that if you are contemplating medication because you are finding your anxiety uncomfortable and you want to control it, the methods described in this book may offer an alternative. If you are already on medication because you find your emotions too intense to experience, we still believe that you can use and benefit from mindfulness practice and the other concepts described in this book. Sometimes we work with clients who feel they need to be on medication for anxiety at the beginning of treatment, but as they develop a mindfulness practice they become interested in coming off the medication. If that happens to you in the course of reading the book and practicing mindfulness, we encourage you to talk with your health care provider to choose the safest and most appropriate option for you.

My anxiety comes from real-life stressors. How can this book help me?

The approach we describe can help people whose anxiety seems to come out of nowhere, as well as those whose anxiety is clearly tied to real-life stressful circumstances. Anxiety is a natural human response, and many people’s lives naturally elicit a great deal of fear, stress, and anxiety. Although we would much rather be able to remove those sources of stress, we can’t always do that. The approach we present can help you to respond to these real-life stressors in ways that may allow you to live your life more fully and in a more satisfying way, despite the real-life restrictions you face.

I’m trying to deal with both anxiety and depression. Will this book help me?

Depression and anxiety commonly co-occur, and many of the people we have treated have also had significant symptoms of depression. We have found that a mindful approach typically leads to a significant reduction in depressive symptoms as well. Research has shown that mindfulness can reduce depressive relapse, and effective treatments for depression often include a focus on behavioral engagement that we also present here. So our approach is very likely to help with both the depression and the anxiety you experience.

I am having other psychological problems (e.g., drinking or using substances, an eating disorder), but I also experience a great deal of anxiety. Can this book help me?

People who have difficulties with drinking, using substances, or restricting food intake often experience high levels of anxiety, either as a cause of the other difficulties, as a result of them, or both. This book may be a useful in combination with treatment or support groups that are directly aimed at the other challenges you are experiencing.