Clinical Handbook of Mindfulness (48 page)

Psychopathology and Behavioral Assessment, 29
, 177–190.

Fresco, D. M., Moore, M. T., van Dulmen, M., Segal, Z. V., Teasdale, J. D., Ma, H., &

Williams, J. M. G. (2007). Initial psychometric properties of the experiences ques-

tionnaire: A self-report survey of decentering.
Behavior Therapy, 38
, 234–246.

Fresco, D. M., Segal, Z. V., Buis, T., & Kennedy, S. (2007). Relationship of posttreat-

ment decentering and cognitive reactivity to relapse in major depression.
Journal

of Consulting and Clinical Psychology, 75
, 447–455.

Germer, C. K., Siegel, R. D., & Fulton, P. R. (2005).
Mindfulness and psychotherapy
.

NY: Guilford Press.

Greco, L. A., Lambert, W., & Baer, R. A. (2008). Psychological inflexibility in child-

hood and adolescence: Development and evaluation of the Avoidance and Fusion

Questionnaire for Youth.
Psychological Assessment, 20
, 93–102.

Gregg, J. A., Callaghan, G. M., Hayes, S. C., & Glenn-Lawson, J. L. (2007). Improving

diabetes self-management through acceptance, mindfulness, and values: A random-

ized controlled trial.
Journal of Consulting and Clinical Psychology, 75
, 336–343.

Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual

differences in implicit cognition: The Implicit Association Test.
Journal of Person-

ality and Social Psychology, 74
, 1464–1480.

Chapter 9 Assessment of Mindfulness

167

Hayes, S. C. & Strosahl, K. D. (2004).
A practical guide to Acceptance and Commit-

ment Therapy
. New York: Springer.

Hayes, S. C., Strosahl, K., & Wilson, K. G. (1999).
Acceptance and commitment ther-

apy: An experiential approach to behavior change
. New York: Guilford.

Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., et al.

(2004). Measuring experiential avoidance: A preliminary test of a working model.

The Psychological Record, 54
, 553–578.

Hollon, S. D., & Beck, A. T. (1979). Cognitive therapy of depression. In P. C. Kendall

& S. D. Hollon (Eds.),
Cognitive-behavioral interventions: Theory, research, and

procedures
(pp. 153–203). New York: Academic Press.

Ingram, R. E., & Hollon, S. D. (1986). Cognitive therapy for depression from an

information processing perspective. In R. E. Ingram, (Ed.),
Information process-

ing approaches to clinical psychology
(pp. 259–281). San Diego, CA: Academic

Press.

Kabat-Zinn, J. (1982). An outpatient program in behavioral medicine for chronic pain

patients based on the practice of mindfulness meditation: Theoretical considera-

tions and preliminary results.
General Hospital Psychiatry, 4
, 33–47.

Kabat-Zinn, J. (1990).
Full catastrophe living: Using the wisdom of your mind and

body to face stress, pain, and illness
. New York: Delacorte.

Kabat-Zinn, J. (1994).
Wherever you go, there you are: Mindfulness meditation in

everyday life
. New York: Hyperion.

Kabat-Zinn, J. (2003). Mindfulness-based interventions in context: Past, present and

future.
Clinical Psychology: Science and Practice, 10
, 144–156.

Lau, M. A., Bishop, S. R., Segal, Z. V., Buis, T., Anderson, N. D., Carlson, L., et al.

(2006). The Toronto mindfulness scale: Development and validation.
Journal of

Clinical Psychology, 62
, 1445–1467.

Leigh, J., Bowen, S., & Marlatt, G. A. (2005). Spirituality, mindfulness and substance

abuse.
Addictive Behaviors, 30
, 1335–1341.

Levitt, J. T., Brown, T. A., Orsillo, S. M. & Barlow, D. H. (2004). The effects of

acceptance versus suppression of emotion on subjective and psychophysiological

response to carbon dioxide challenge in patients with panic disorder.
Behavior

Therapy, 35
, 747–766.

Lillis, J. & Hayes, S. C. (2008). Measuring avoidance and inflexibility in weight related

problems. Manuscript under review.

Linehan, M. M., (1993).
Cognitive-behavioral treatment of borderline personality

disorder
. New York: Guilford.

Lykins, E. L. B., & Baer, R. A. (in press). Psychological functioning in a sample of long-

term practitioners of mindfulness meditation.
Journal of Cognitive Psychotherapy
.

MacKillop, J., & Anderson, E. J. (2007). Further psychometric validation of the

Mindful Attention Awareness Scale.
Journal of Psychopathology and Behavioral

Assessment, 29
, 289–293.

Marlatt, G. A., & Kristeller, J. L. (1999). Mindfulness and meditation. In W. R. Miller

(Ed.),
Integrating spirituality into treatment
(pp. 67–84). Washington, DC: APA.

McCracken, L. M. (1998). Learning to live with pain: Acceptance of pain predicts

adjustment in persons with chronic pain.
Pain, 74
, 21–27.

McCracken, L. M., & Eccleston, C. (2003). Coping or acceptance: What to do about

chronic pain?
Pain, 105
, 197–204.

McCracken, L. M., Vowles, K. E., & Eccleston, C. (2004). Acceptance of chronic pain:

Component analysis and a revised assessment method.
Pain, 107
, 159–166.

Meyer, G. J., Finn, S. E., Eyde, L. D., Kay, G. G., Moreland, K. L., Dies, R. R., et al.

(2001). Psychological testing and psychological assessment: A review of evidence

and issues.
American Psychologist, 56
, 128–165.

Moore, R. G., Hayhurst, H., & Teasdale, J. D. (1996).
Measure of Awareness and Cop-

ing in Autobiographical Memory: Instructions for administering and coding
.

168

Ruth A. Baer, Erin Walsh, and Emily L. B. Lykins

Unpublished manuscript, Department of Psychiatry, University of Cambridge, Cam-

bridge, United Kingdom.

Santorelli, S. (1999).
Heal thyself: Lessons on mindfulness in medicine
. New York:

Bell Tower.

Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002).
Mindfulness-based cogni-

tive therapy for depression: A new approach to preventing relapse
. New York:

Guilford.

Shapiro, S. L., Carlson, L. E., Astin, J. A., & Freedman, B. (2006). Mechanisms of mind-

fulness.
Journal of Clinical Psychology, 62
, 373–386.

Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. (2002).

Metacognitive awareness and prevention of relapse in depression: Empirical evi-

dence.
Journal of Consulting and Clinical Psychology, 70
, 275–287.

Walach, H., Buchheld, N., Buttenmuller, V., Kleinknecht, N., & Schmidt, S. (2006).

Measuring mindfulness: The Freiburg Mindfulness Inventory (FMI),
Personality

and Individual Differences, 40
, 1543–1555.

Williams, J. M. G., Mathews, A., & MacLeod, C. (1996). The emotional Stroop task and

psychopathology.
Psychological Bulletin, 120
, 3–24.

Zettle, R. D., Hocker, T. L., Mick, K. A., Scofield, B. E., Peterson, C. L., Song, H., &

Sudarijanto, R. P. (2005). Differential strategies in coping with pain as a function of

level of experiential avoidance.
Psychological Record, 55
, 511–524.

Zettle, R. D., Peterson, C. L., Hocker, T. R., & Provines, J. L. (2007). Responding to a

challenging perceptual-motor task as a function of level of experiential avoidance.

Psychological Record, 57
, 49–62.

Part 3

Mindfulness-Based Interventions

for Specific Disorders

10

Mindfulness and Anxiety Disorders:

Developing a Wise Relationship

with the Inner Experience of Fear

Jeffrey Greeson, Jeffrey Brantley

. . . the term mental disorder unfortunately implies a distinction

between “mental” disorders and “physical” disorders that is a reduc-

tionistic anachronism of mind/body dualism. A compelling literature

documents that there is much “physical” in mental disorders and

much “mental” in physical disorders.

– American Psychiatric Association (DSM-IV-TR, 2000)

Introduction

Perhaps no condition better illustrates the intimate relationship between

brain and behavior – mind and body – as the inner experience of fear. In

this chapter, we present an integrative scientific view of anxiety and clini-

cal anxiety disorders, with an emphasis on awareness and acceptance as a

foundation for mind/body health. Whereas anxiety-related psychopathology

is characterized by a desire to avoid the inner experience of fear, we postu-

late that practicing mindfulness can promote a wise and accepting relation-

ship with one’s internal cognitive, emotional, and physical experience, even

during times of intense fear or worry. Further, we suggest that the “wise rela-

tionship” that develops by turning toward fear, anxiety, and panic with stable

attention, present focused awareness, acceptance, and self-compassion can

promote psychological freedom from persistent anxiety and greater behav-

ioral flexibility.

Mindfulness is a word that refers to a basic human capacity for non-

conceptual, non-judging, and present-moment-centered awareness. This

awareness arises from intentionally paying attention, from noticing on pur-

pose what is occurring inside and outside of oneself, with an attitude of

friendliness and acceptance toward what is happening while it is happen-

ing. Mindfulness has been cultivated by human beings using “inner tech-

nologies” of meditation in various spiritual contexts for literally thousands of

years. In the past 25–30 years, Western medical science has turned increas-

ing attention to the psychological and physical correlates of meditation and

mindfulness practices
(Walsh & Shapiro, 2006).
Modern clinical investigators have joined meditation teachers in offering definitions of mindfulness

(see Table
10.1).

171

172

Jeffrey Greeson, Jeffrey Brantley

Table 10.1.
Definitions of mindfulness.

Definition

Reference

“the non-judgmental observation of the ongoing

stream of internal and external stimuli as they

Baer
(2003)

arise.”

“self-regulation of attention [and] adopting a

particular orientation toward one’s experience in

Bishop et al.
(2004)

the present moment, an orientation that is

characterized by curiosity, openness, and

acceptance.”

“friendly, nonjudging, present-moment awareness.”

Brantley
(2003)

“awareness, of present experience, with acceptance.”

Germer
(2005)

“the awareness that emerges through paying

attention on purpose, in the present moment, and

Kabat-Zinn
(2003)

nonjudgmentally to the unfolding of experience

moment by moment.”

“the state of being fully present, without habitual

reactions.”

Salzberg and Goldstein

(2001)

Our central thesis in this chapter is that practicing mindfulness offers a

healthier and more effective means for relating to one’s inner experience of

fear and anxiety, through self-regulation built on intentional, non-judging

awareness
.

In the sections that follow, we present current theoretical, scientific, and

clinical evidence in support of our hypothesis that practicing mindfulness

enables a “wise relationship” to develop toward one’s own inner life, partic-

ularly the internal experience of anxiety and fear. By bringing inner processes

of thinking, feeling, and physical sensations into consciousness using mind-

fulness practice, identification with and perpetuation of unconscious pat-

terns in mind and body can be transformed into interactions that are “wise”,

that is, based in accurate perception and inclusive of all the domains of expe-

rience available to each human being in each moment. The healing benefits

of mindfulness practice to the conditions of anxiety and fear follow from this

more conscious, wise relationship.

Prevalence, Characteristics, and Current Treatment

of Anxiety Disorders

Human anxiety occurs along a continuum, from normal fear reactions that

help avert clear and present danger to uncontrollable panic and maladaptive

avoidance of people, places, and things in an effort to feel safe from harm.

The experience of acute fear and mild-to-moderate anxiety is ubiquitous in

the human condition. When it occurs in the appropriate context, some fear

and anxiety can increase attention to threatening circumstances or enhance

effective performance in the face of a challenge. Thus, some degree of anxi-

ety is good.

However, when anxiety is unwarranted, excessive, and persistent, and/or

it interferes with everyday functioning, it can be categorized as a psychi-

atric disorder
(American Psychiatric Association, 2000).
The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) includes six primary anxiety disorders (see Table
10.2).
Each anxiety disorder shares characteristic symptoms of intrusive and disturbing thoughts,