"50 CBT tools for panic and anxiety are divided into several categories: general skills, initial relaxation training, initial cognitive restructuring, advanced mindfulness training, advanced cognitive restructuring, and exposure treatment."
Mindfulness, although it can feel good, is not about feeling good. Mindfulness is about learning to BE with all experiences, even uncomfortable ones. A commonality that I see across different psychological problems as well as many physical problems is the inability to handle discomfort. Our society has become very focused on the idea that life should be easy and comfortable. People compare themselves to others and think “Look how easy their life is. It is so unfair!”
If you have read some of the articles about irrational thinking, you may be able to recognize the irrational style of thinking in this idea. The fact is we don't have control over whether life will be easy and pleasant. Therefore, the idea that life “should” be comfortable is irrational. Life is what it is. Whether it should be different is a question for philosophical debate but doesn't help us with everyday coping in life.
The inability to handle discomfort appears to contribute to increased difficulty managing many of life's problems. For instance, parents who don't want their children to suffer don't set limits or provide consequences which leads to unmanageable behavior and more suffering in the long-term. However, the parent didn't have to feel the discomfort of saying “no.” It is the child who suffers as she or he grows up with the expectation of an easy life and the inability to know how to cope with problems or frustration.
Or, people pursue addictions whether it is alcohol, drugs, food, gambling or shopping to feel good. Instead of recognizing and accepting that life doesn't always feel good, they pursue these artificial means of “happiness” that often come with negative consequences. The problem is that almost any immediate “feel good” remedy is likely to have long-term consequences that won't feel good. Conversely, many things that have long-term benefits don't feel good in the short term.
The methods taught in CBT have a long-term focus on changing your life in a positive way. But it doesn't always feel good immediately. You have to make the time to practice the methods. You have to examine uncomfortable aspects of yourself. You have to learn to tolerate the frustration of not having immediate rewards.
Therefore, mindfulness is a practice about learning to tolerate discomfort. I view advanced mindfulness as a method that is complementary to cognitive therapy. In other words, mindfulness helps with changing the thought process that you have regarding being comfortable. The more that you can accept the idea that you don't have to feel comfortable, happy, or pleasant all the time, the more you are likely to experience contentment and learn to be comfortable with discomfort. The Tau te Ching states “To be given everything, you must give everything up.”
Learning to tolerate discomfort involves not giving attention to the thoughts about discomfort. For instance, if it is a hot day and you think “Oh, it is so hot! This is horrible! I can't tolerate this! I'm just miserable” you are more likely to feel miserable. However, if you learn to observe the heat and the effect on your body without the judgment, you may find that it becomes more tolerable. It becomes just a sensation, nothing more.
As you may realize, this method can be helpful for many types of problems other than anxiety. For instance, people with chronic pain can benefit from learning advanced mindfulness. You may find that as you practice these techniques that many aspects of your life can improve.
One of the most common problems for people with anxiety is excessive worry. Learning how to categorize worry in terms of how important and how controllable the worry is provides an initial method of managing worry. For more information read: The Worry Box Technique. However, what if you have already determined that there is nothing you can do about the worry, at least at the present moment? How do you let go of worry especially when you have categorized it as important? This is one of the more difficult aspects of worry, but also one that is particularly responsive to mindfulness.
As I have indicated previously and can't emphasize enough, mindfulness is a developed skill. You can't expect to start practicing mindfulness and expect an immediate reduction in worry. You would not expect to have the conditioning of an athlete if you just started an exercise program. The initial practice of mindfulness involves learning to refocus your attention when unimportant but distracting thoughts intrude.
However, worry tends to be much more insistent. When you first refocus your attention away from the worry and back to your immediate experience, you may find that the worry pops back into your mind a few seconds later. This is normal and okay. Don't worry about it! What I mean is the more you think of the mindfulness practice as learning to refocus your attention, the more you can think of these intrusions as opportunities to practice refocus. Over time, with practice, you will find that the worries don't return as quickly.
Another important aspect of mindfulness practice that I have discussed previously is “gently” refocusing your attention. This is especially critical with worry as the tendency for many people with worry is to be overly critical. Don't criticize yourself if you have trouble refocusing. Instead, just gently refocus as many times as you need to. This is also why initial practice is best for only a few minutes at a time. Otherwise, it can lead to frustration and quitting the practice. Be gentle with yourself.
Many people with anxiety, particularly Panic Disorder, do not have a well-developed sense of body awareness. This may seem like a strange statement because many of those same people are overly sensitive to sensations in the body. You might even be thinking “How can that be? I'm aware of every little sensation I get in my body! That's why I'm so anxious.” Yet, these two seemingly contradictory statements are part of the same issue for many of those with anxiety disorders.
First, understanding what body awareness is and is not can help explain this concept further. Then, we will focus on learning how body awareness can help manage anxiety. Finally, I will explain how mindfulness practice can help improve body awareness.
The best way to describe the difference between body awareness and body sensitivity is in terms of accuracy. Most people with anxiety and panic are overly aware of body sensations. In fact, for many, panic is triggered due to changes in body sensations. For instance, if the heart rate increases or they feel warm or a sense of dizziness, they may become concerned about these sensations which, in turn, increases anxiety and can lead to a panic attack.
Although they are sensitive to these bodily sensations and changes, the problem is they do not have an accurate perception and understanding of their body. The term “body awareness” typically refers to being aware of one's own body and how it is positioned in space. In other words, having a good sense of the movement of your body and how it is interacting with the environment. However, for our purposes, body awareness also refers to “interoceptive” awareness which is being aware of internal changes and sensations of the body and what these sensations mean.
People with a highly developed sense of body awareness are not only aware of their body, sensations, and any changes but they can accurately interpret those internal cues. They know the difference between a tired muscle due to an intense workout and a strained muscle indicating a need to be cautious. They can tell when stomach distress is due to something they ate or due to stress. They are aware of the difference between a common tension headache and an unusual headache signifying something else.
However, people who are sensitive to body sensations but not aware of the meaning of these sensations may not be able to tell when a sensation signals a need for concern or is a normal change in the body. For example, many times in my clinical practice I have had clients with panic disorder become panicky about diffuse symptoms such as lethargy, feeling “out of sorts,” dizziness, changes in body temperature, etc. However, when we examined what they were experiencing, it appeared they were reacting to having a cold virus. In other words, they had become so sensitized to the anxiety symptoms it was difficult for them to determine the difference between anxiety and a common cold. To further complicate understanding the difference, when the body is fighting off a virus it activates the autonomic nervous system (“fight or flight response”) which is the same system involved with anxiety. Therefore, a person without body awareness experiences these symptoms but cannot accurately interpret them.
When a person improves body awareness, they become better able to accurately interpret sensations. This ability to interpret sensations reduces the likelihood of an anxiety reaction. Most anxiety reactions are related to the unknown potential negative possibilities. Therefore, when a person can say “My heart is beating fast because I was thinking of something that makes me nervous” they are less likely to become overly concerned about their heart rate.
How can the practice of advanced mindfulness help improve the accuracy of interpreting body sensations? I have seen with many of my clients with Panic Disorder that although they are overly sensitive to sensations in their bodies, they also try to ignore the feelings in their bodies. They don't want to feel discomfort so they try to distract themselves from the sensations. So they tend to be both overly anxious about these sensations as well as overly suppressing awareness of the full sensation.
Advanced mindfulness practice is about awareness. It involves being fully aware of the present moment. As people become more skilled at mindfulness, they become more in tune with their bodies. Instead of ignoring an unpleasant sensation, through awareness they become able to tell the difference between a normal sensation and a symptom to be concerned about. They become able to recognize which sensations may signify anxiety, which are due to a harmless discomfort such as a cold or over-tired muscles from exercise, and which may be due to a more serious problem that requires medical attention.
However, to develop this level of awareness of the body it requires paying attention to the body in a way that may be uncomfortable initially. The more you are fully aware of your internal experiences, the more accurately you will be able to interpret them. READ MORE: page 10