New Strategies for Combining Mindfulness with Integrative Cognitive Behavioral Therapy for the Treatment of Generalized Anxiety Disorder

Abstract

Generalized anxiety disorder (GAD) severely impacts social functioning, distress levels, and utilization of medical care compared with that of other major psychiatric disorders. Neither pharmacological nor psychotherapy interventions have adequately controlled cardinal symptoms of GAD: pervasive excessive anxiety and uncontrollable worry. Research has established cognitive behavioral therapy (CBT) as the most effective psychotherapy for controlling GAD; however, outcomes remain at only 50% reduction, with high relapse rates. Mindfulness has been integrated with CBT to treat people suffering from numerous psychiatric disorders, with mindfulness based stress reduction (MBSR) being the most researched. Preliminary evidence supports MBSR’s potential for controlling GAD symptoms and key researchers suggest mindfulness practices possess key elements for treating GAD. Classical mindfulness (CM) differs significantly from MBSR and possesses unique potentials for directly targeting process and state GAD symptoms inadequately treated by CBT. This article introduces the theory and practice of CM, its differences from MBSR, and a critical review of MBSR and CBT treatments for GAD. CM strategies designed to complement CBT targeting cardinal GAD symptoms are outlined with a case study illustrating its use.

The relationship between low levels of mindfulness skills and pathological worry: The mediating role of psychological inflexibility. [La relación entre habilidades de mindfulness y preocupación patológica: El rol mediador de la inflexibilidad psicológica]

“…This seems plausible to the extent that the ability of acting with awareness could lead to the enhancement of: (a) concentration in worry as a mean of controlling fear, and/or (b) actively avoiding worry by focusing attention on the present moment. This last option is consistent with the suggestion that focusing on the present moment experience may be another subtle form of control used to avoid engaging with worry (Craske & Hazlett-Stevens, 2002;Rapgay et al, 2011). Previous studies have found that low levels of mindfulness skills and psychological inflexibility are significantly correlated to pathological worry (e.g., Roemer et al, 2009;Santanello & Gardner, 2007;Van Dam et al, 2011).…”

“…However, some authors have argued that, although mindfulness can be useful in treating GAD, it can also lead to counterproductive effects when it is used with an inadequate rationale (e.g., Craske & Hazlett-Stevens, 2002;Rapgay, Bystritsky, Dafter, & Spearman, 2011;Wells, 2002). For instance, Wells (2002) warned that mindfulness may be counterproductive if it is used as a means of controlling or escaping from nonexistent threat because the nonoccurrence of the catastrophe could be attributed to the use of mindfulness.…”

“…For instance, Wells (2002) warned that mindfulness may be counterproductive if it is used as a means of controlling or escaping from nonexistent threat because the nonoccurrence of the catastrophe could be attributed to the use of mindfulness. Similarly, Craske and Hazlett-Stevens (2002) and Rapgay et al (2011) suggested that focusing on the present moment experience may be another subtle form of control used to avoid engaging with worry.…”

The Relation of Dysfunctional Cognitive Schemas and Personality Dimensions in Generalized Anxiety Disorder

“…For this purpose, however, the conceptualization of the MCSbased model (specific to ST) should be transitioned to a more MCT specific model. Moreover, an integrative approach of CBT, combining multiple techniques or orientations (i.e., Rational Emotive Behavior Therapy, Cognitive Therapy, Schema Therapy or Metacognitive Therapy, and Mindfulness) can also be a good therapeutic approach for GAD (20).…”

“…These dysfunctional cognitive schemas (see Table 1) greatly influence the way individuals think, feel, and behave in various social environments. Similarly, the CBT model explains the etiopathogenesis of GAD as being facilitated by learning processes which could explain why emotions and interpersonal relationships are a constant source of perceived danger for GAD patients (20).…”