Acceptance and Mindfulness-Based Approaches to Anxiety: Conceptualization and Treatment

379 Pages·2005·1.718 MB·English

by  Susan M. Orsillo, Lizabeth Roemer, Darren W. Holowka (auth.), Susan M. Orsillo, Lizabeth Roemer (eds.)

Acceptance and
Mindfulness-Based
Approaches to Anxiety
SERIES IN ANXIETY AND RELATED DISORDERS
SeriesEditor:MartinM.Antony,AnxietyTreatmentandResearchCentre,
St.Joseph’sHospital,Hamilton,Ontario,Canada
ACCEPTANCEANDMINDFULNESS-BASEDAPPROACHESTOANXIETY
ConceptualizationandTreatment
EditedbySusanM.OrsilloandLizabethRoemer
CONCEPTSANDCONTROVERSIESINOBSESSIVE-COMPULSIVEDISORDER
EditedbyJonathanS.AbramowitzandArthurC.Houts
SOCIALANXIETYANDSOCIALPHOBIAINYOUTH
Characteristics,Assessment,andPsychologicalTreatment
ChristopherA.Kearney
AContinuationOrderPlanisavailableforthisseries.Acontinuationorderwillbringdeliveryofeachnewvolume
immediatelyuponpublication.Volumesarebilledonlyuponactualshipment.Forfurtherinformationplease
contactthepublisher.
Acceptance and
Mindfulness-Based
Approaches to Anxiety
Conceptualization and Treatment
Editedby
Susan M. Orsillo
SuffolkUniversity
Boston,Massachusetts
and
Lizabeth Roemer
UniversityofMassachusetts
Boston,Massachusetts
Library ofCongress Control Number:2005925980
ISBN-10:0-387-25988-0 e-ISBN 0-387-25898-9 Printed on acid-free paper
ISBN-13:978-0387-25988-8
© 2005 Springer Science+Business Media,LLC
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CONTRIBUTORS
SonjaV.Batten,VAMarylandHealthCareSystemandUniversityofMary-
landSchoolofMedicine,Baltimore,Maryland,USA
JohnT.Blackledge,UniversityofNevada,Reno,Nevada,USA
Jennifer Block-Lerner, Department of Psychology, Skidmore College,
SaratogaSprings,NewYork,USA
JeffreyBrantley,DukeCenterforIntegrativeMedicine,DukeUniversity
MedicalCenter,Durham,NorthCarolina,USA
LeeAnnCardaciotto,DrexelUniversity,Philadelphia,Pennsylvania,USA
LisaW.Coyne,BrownUniversity,Providence,RhodeIsland,USA
JillEhrenreich,BostonUniversity,Boston,Massachusetts,USA
MatthewT.Feldner,UniversityofVermont,Burlington,Vermont,USA
Kim L. Gratz, McLean Hospital and Harvard Medical School, Belmont,
Massachusetts
Laurie A. Greco, Vanderbilt University Medical Center, Nashville,
Tennessee,USA
Scott E. Hannan, The Institute of Living/Hartford Hospital, Hartford,
Conecticut,USA
v
vi CONTRIBUTORS
StevenC.Hayes,DepartmentofPsychology,UniversityofNevada,Reno,
Nevada,USA
JamesD.Herbert,DrexelUniversity,Philadelphia,Pennsylvania,USA
DarrenW.Holowka,UniversityofMassachusetts,Boston,Massachusetts,
USA
Maria Karekla, University at Albany, State University of New York,
Albany,NewYork,USA
EllenW.Leen-Feldner,UniversityofVermont,Burlington,Vermont,USA
JillT.Levitt,NewYork,NewYork,USA
AkihikoMasuda,DepartmentofPsychology,UniversityofNevada,Reno,
Nevada,USA
DouglasS.Mennin,YaleUniversity,NewHaven,Connecticut,USA
SusanOrsillo,SuffolkUniversity,Boston,Massachusetts,USA
Lizabeth Roemer, University of Massachusetts, Boston, Massachusetts,
USA
Kristalyn Salters-Pedneault, Boston VA Healthcare System and Boston
UniversitySchoolofMedicine,Boston,Massachusetts,USA
David F. Tolin, The Institute of Living/Hartford Hospital, Hartford,
Conecticut,USA
Matthew T. Tull, Boston VA Healthcare System and Boston University
SchoolofMedicine,Boston,Massachusetts,USA
Michael P. Twohig, Department of Psychology, University of Nevada,
Reno,Nevada,USA
AletheaA.Varra,DepartmentofPsychology,UniversityofNevada,Reno,
Nevada,USA
AmyW.Wagner,UniversityofWashington,Seattle,Washington,USA
CONTRIBUTORS vii
RobynD.Walser,VAPaloAltoHealthCareSystem,NationalCenterfor
PTSD,PaloAlto,California,USA
AndrewR.Yartz,UniversityofVermont,Burlington,Vermont,USA
MichaelJ.Zvolensky,UniversityofVermont,Burlington,Vermont,USA
PREFACE
Fearandanxietyarenatural,humanresponsestothethreatsweencounter,
perceive,oranticipate.Theuncertaintiesinherentinourlivesonapersonal
andgloballevelalmostinevitablygiverisetofeelingsofanxiety.Mostof
us experience bodily responses (e.g., muscle tension, rapid heart beat),
cognitive responses (e.g., anticipating something unfortunate happening
inourfuture),andbehavioralresponses(e.g.,choosingnottodosomething
becauseitmaymakeusuncomfortable)thatsignalthepresenceofanxiety
from time to time. However, for some, these anxious responses become
severeandpervasive,causingintensedistressand/orseverelyrestricting
orimpingingonqualityoflife.
Anxietydisordersconstitutethemostprevalentclassofmentalhealth
problemsintheUnitedStates(Narrow,Rae,Robins,&Regier,2002)and
are associated with significant disruptions in functioning (Leon, Portera,
&Weissman,1995)andsubstantialhealthcarecosts(forbothmedicaland
psychological treatment, Greenberg et al., 1999). Fortunately, efficacious
psychosocial (cognitive-behavioral) treatments have been developed for
the anxiety disorders (see Barlow, 2002, for extensive reviews), so that
many individuals are able to successfully address their spiraling anxiety
and habitual avoidance patterns and learn new ways of responding to
actual and perceived threats. However, not all clients accept or respond
to these interventions, demonstrating a need for further treatment inno-
vation in order to maximize the beneficial impact of our psychosocial
interventions.
The last decade has seen an explosion of interest in acceptance- and
mindfulness-basedapproacheswithinthecognitive-behavioraltradition.
ix
x PREFACE
These approaches, drawn in part from experiential (e.g., Rogers, 1961;
Greenberg,2002)andBuddhist(e.g.,Kabat-Zinn,1990;NhatHanh,1992)
traditions,butgroundedinbehavioraltheory(e.g.,Hayes,Barnes-Holmes,
&Roche,2001;Linehan,1993),emphasizethewaythateffortstocontrolour
internalexperiencesmightinfactexacerbatethem.Theysuggestthatcul-
tivating an open, expansive, compassionate, present-moment awareness
mightfacilitateadaptivefunctioningandreducedistressassociatedwith
livinginthepastorthefuture.Withintheseperspectives,fearandanxiety
willnaturallyarise,aswillotherpainfulemotionalexperiences.However,
bybringinggentleawarenesstotheseexperiences,andrecognizingtheir
transience,wecanallowtheseexperiencestoinformus,butnottocontrol
usandinterferewithourlives.
These acceptance-based behavioral therapies have begun to accrue
promising data supporting their efficacy in both experimental and treat-
ment settings. Their applicability to and utility for anxiety disorders is
supportedbothempiricallyandtheoretically.Itmaybethatintegrationof
theseapproachesprovidestheenhancedefficacythatisneededtobroaden
ourimpactonthissignificantmentalhealthproblem.
In this volume, for the first time, clinicians and clinical researchers
specializinginanxietydisorderscometogethertopresentperspectiveson
the utility of this integration. In the first part of the book, “Integrating
AcceptanceandMindfulnessandExistingPsychologicalTraditions,”we,
along with Darren W. Holowka, begin with a conceptual and practical
overview of how acceptance-based approaches complement and expand
existingcognitive-behavioraltheoriesandtherapies,emphasizingboththe
commonalities and distinctions in these approaches. Doug Mennin then
highlightsthewaythatanemotionperspective(basedonemotiontheory
and research, as well as experiential therapy traditions) can inform and
enhanceacceptance-basedbehavioraltreatmentsforanxietydisorders.
In the second part, “General Approaches to Assessment and Treat-
ment,”JennBlock-Lerner,KristiSalters-Pedneault,andMattTullprovide
an extensive review of conceptual and operational definitions of mind-
fulness and acceptance that provides an important basis for work in this
area.Thenextthreechaptersprovideexamplesofhowexistingacceptance-
basedtherapiescanbedirectlyappliedtotheanxietydisorders.First,Mike
Twohig,AkihikoMasada,AletheaVarra,andSteveHayesreviewaccep-
tanceandcommitmenttherapy(ACT)anditsapplicationtoanxiety.Then
JeffBrantleyprovidesanoverviewofmindfulness-basedstressreduction
(MBSR) as it applies to anxiety disorders. Finally, Kim Gratz, Matt Tull,