Chapter 10
Taking the Next Step in Your Mindfulness Practice
In This Chapter
Mindfulness is a lifestyle rather than a short-term fix, and my hope is that this book provides you with the tools you need to get started with mindfulness and manage your anxiety a little better.
But anxiety is a complex condition that can appear in many different ways. You need to determine whether your level of anxiety requires you to see a medical professional or not. From time to time, everyone has some of the anxiety symptoms that I mention in this book – in many ways, they're what give people their little quirks and make them human! But as I discuss in this chapter, if you have several of those symptoms, they're at a disturbing or excessive level and are severely affecting your work and home life, you need to seek medical help.
This chapter is also about developing your mindfulness practice further, whether that's reading more on the topic, engaging in an eight-week mindfulness course or going on a retreat. In addition, I mention other therapies and organisations that are very beneficial for anxiety sufferers.
Determining Whether Your Anxiety Needs Medical Attention
You may just have mild anxiety occasionally and find that using self-help books and moving your focus onto other things helps you manage it. You may also have gone through a stressful event recently that caused anxiety, such as a divorce, starting a new job or place of study. Or you may have suffered the loss of a loved one or moved to a new area where you don't know anyone.
Anxiety developing in these life situations is very common. The anxiety may be short term and eventually fade away. This book is designed to help with such mild to moderate anxiety.
But some anxiety is more serious. This section describes the symptoms of severe anxiety to help you decide whether you need to seek medical attention.
If you think that you have a more severe form of anxiety, consult your GP before undertaking any kind of self-help.
Looking at the length of time
Severe anxiety usually lasts for a period of six months or more. In that time, you're likely to have experienced symptoms such as chronic worrying every single day. If you have had this type of anxiety for that amount of time, visit your GP who'll want to know how you're feeling and probably ask about your home, life and work situations.
Even though talking to someone about your feelings and emotions isn't easy when you have severe anxiety, the more information you give, the better the doctor can help you and decide what treatment is best going forward. Your GP may also do some tests to check whether any other health problems exist that can also contribute similar symptoms, such as anaemia.
Considering the level of intensity
Severe anxiety can feel overwhelming and hard to handle. It may manifest itself in uncontrollable worrying in which the worries are extremely upsetting and stressful.
Here are four common anxiety conditions and their symptoms, which can all be at a difficult level to deal with:
- Generalised Anxiety Disorder (GAD): Symptoms are restlessness, feeling constantly on edge, a real sense of dread, difficulty concentrating on anything and irritability.
- Social Anxiety: Symptoms may include a sense of dread when talking to strangers, talking on the phone, starting conversations, group activity, a massive fear of being criticised, being unwilling to make eye contact or just a fear of one particular situation.
- Panic Disorder: Symptoms include nausea, vomiting, trembling and a sensation that your heart is beating in an irregular way.
- Obsessive-Compulsive Disorder (OCD): This affects people in different ways. It usually has four steps: obsessive thoughts or urges in the mind, anxiety, a compulsion to think or repeat a behavior and then some temporary relief. Obsessive thoughts and behaviours can range from mild to severe.
You may also have some of or all the physical symptoms that go along with anxiety, such as a fast heartbeat, an urge to use the toilet more often, a dry mouth and sweating.
If you recognise any of these symptoms and they're at an excessive level, the time has come to see a doctor. They can determine whether these symptoms are due to anxiety or some other cause. They can also make a more precise diagnosis and determine the right course of action for you – which may or may not be mindfulness-based.
Investigating the impact on your life and behaviour
Severe anxiety can affect your life in many different ways and impact on your relationships, home life and work.
Check out the following behaviours that can occur in people with severe anxiety:
- Alone time: You may want to be alone more often because you feel tired by the amount of stressful thoughts running through your head and want to try to manage them on your own. Similarly, you may want to stay only in certain locations, such as your home or place of work, and not go anywhere new or different.
Anxiety can also make you needy and dependent. You may start to fear being left alone and not like your partner going out without you. You may also become very tearful.
- Compulsions: When you leave home, you may engage in behaviours such as needing to turn the light switch on and off several times before you leave and having to start again if you're interrupted. You may obsessively check the door is locked or make sure that you don't step on the cracks in the pavement. You may feel that if you don't engage in these behaviours, something terrible will happen to your loved ones or family.
- Self-medicating: You may try to cope with the overuse of alcohol or illegal drugs. But although drugs and alcohol can block out stressful thoughts and anxiety temporarily, in fact they make them worse, creating a vicious cycle in which you become stuck.
Engaging in an Eight-Week Mindfulness Course
The eight-week mindfulness course or Mindfulness Based Stress Reduction (MBSR) was started in 1979 by Jon Kabat-Zinn at the University of Massachusetts medical school. It has been running for over 30 years and is used in a secular way in hospitals, schools, prisons and workplaces.
Research shows that an eight-week mindfulness course can create the following benefits:
- Reduction in anxiety of 70 per cent
- Reduction in anxiety for at least three years after the course is completed
- Reduction in anger, tension and depression
Discovering the eight-week course
You can pursue the eight-week mindfulness course in many different ways, but every approach requires a certain level of commitment. You need to be able to do the following:
- Have one or two hours spare in the week to read the material that goes alongside the course.
- Spare at least 30 minutes a day to practise your formal mindfulness meditations.
Mindfulness isn't like developing other skills. If you start to learn a martial art, how to cook or any new skill, and you get bored, you can just give up. But mindfulness works differently; it's about sitting with those feelings of boredom and accepting them rather than giving up. In fact, mindfulness encourages you to bring attitudes of curiosity and acceptance to your boredom instead of quitting at the first hurdle.
Also, mindfulness has no specific goals and is about being rather than doing. If you're learning a martial art, with enough practice, you can eventually be a black belt or equivalent. But with mindfulness, your experience is different every time, and no right or wrong way exists on how to meditate. The only achievement you have to make in the eight-week course is to ensure that you do the practices!
Mindfulness also involves learning about yourself rather than about external things. You discover how to watch your thoughts, experiences, feelings and emotions. In many ways, the concept is completely different from what you may be used to, so it can feel challenging at first. But the rewards outweigh that.
The eight-week course may not be suitable if you've just been diagnosed with bipolar, post-traumatic stress disorder or have severe anxiety, such as I mention in the earlier ‘Determining Whether Your Anxiety Needs Medical Attention’ section. Always check with a GP or health professional before starting.
Practising the course alone
Lots of support and resources are available if you want to practise the eight-week mindfulness course by yourself. The benefits of doing so are that you don't have to stick to any set times and can practise whenever and wherever you feel like it, in a comfortable setting such as your own home.
Motivation is a little harder when practising on your own, however, because you don't have anyone else except yourself to push you or rely upon. Therefore, I outline here some great resources in the form of audio and books to help you get started:
- Full Catastrophe Living by Jon Kabat-Zinn: Jon Kabat-Zinn was instrumental in bringing mindfulness to the Western world and developed the MBSR course. He bridged the gap between science and meditation and is a Professor of Medicine emeritus at the University of Massachusetts Medical School where he formed MBSR.
Dr Kabat-Zinn wrote this book based on his MBSR course, and it provides a detailed eight-week practice schedule along with success stories and research findings. It also details how mindfulness can help with a wide range of problems from stress and anxiety to dealing with time pressures.
- Mindfulness: A practical guide to finding peace in a frantic world by Mark Williams and Danny Penman: Mark Williams is a professor of clinical psychology at the University of Oxford. He was part of a team of three who developed Mindfulness Based Cognitive Therapy (MBCT). Danny Penman is an award-winning journalist with a Ph.D. in biochemistry who found mindfulness meditation after becoming temporarily disabled after a nasty accident.
Their book is full of practical, simple and powerful practices, which can help break the cycle of anxiety, stress, unhappiness and exhaustion.
- Mindfulness Workbook For Dummies by Shamash Alidina and myself (Wiley): The book is a practical guide to help you with your mindfulness practice. It includes areas where you can record your practice and document your thoughts, feelings and emotions as you work through your mindfulness journey.
The book includes an eight-week mindfulness course and sections on mindful parenting and mindfulness for children, as well as mindfulness for stress, depression and anxiety.
- Calming your Anxious Mind: How mindfulness and compassion can free you from anxiety, fear and panic by Jeffrey Brantley: Dr Jeffrey Brantley is a consulting associate in the Duke Department of Psychiatry and the director of the MBSR programme at Duke University's Centre for Integrative Medicine.
The book explains the body's fear system and how anxiety arises. It offers healing mindfulness practices in a step-by-step format with testimonials and explanations.
- www.franticworld.com: This website is for the book by Mark Williams and Danny Penman. It includes several guided meditations that are part of the eight-week mindfulness course.
- www.joellemarshall.com: I offer a range of guided mindfulness meditations, including the body scan and loving-kindness meditation.
- www.tarabrach.com: This is a very reputable website where mindfulness meditations are available.
Finding a course to join
Mindfulness is increasingly common, so mindfulness courses have become widely available. Finding a course near you means that you can mix with like-minded people and have the support and motivation to keep going and stay focused.
Here are several ways to find a course near you:
- Have a look at The Mental Health Foundation's excellent website, www.bemindful.co.uk. Input your postcode to look for your local courses.
- Speak to your GP, who may know about local courses.
- Check public buildings, such as libraries and community centres, to see whether they have any notices about mindfulness courses.
Locating a mindfulness coach or therapist to guide you
A range of mindfulness coaching is available online or in person. Coaching can help you if you're struggling to meditate by yourself or having difficulty getting motivated.
A coach can guide you through an eight-week mindfulness course and give you support and help along the way. If you're struggling or even just have concerns or worries, a coach can help you overcome them and continue focusing on your mindfulness practice. Have a search online for mindfulness coaches in your area.
I offer mindfulness coaching online and in person. Visit www.joellemarshall.com for more information.
Using Mindfulness with Other Forms of Therapy
Mindfulness can work well alongside many different therapies and medication. It can help you manage your medication and boost other forms of therapy.
Anxiety often has a number of related conditions, such as adult Attention Deficit Hyperactivity Disorder (ADHD), chronic pain, fibromyalgia and Body Dysmorphic Disorder (BDD). You may find that knowing how mindfulness can work with therapy for some of these conditions is very useful.
In fact, therapists themselves are recommended to practise mindfulness because they can cultivate self-compassion, experience less burnout and thus have a better connection with their patients.
Mindfulness can work alongside therapy to help with a variety of conditions and create helpful programmes. You may be able to find these programmes in your local area through a simple search online, or you may even want to do an online course. For the UK, you could search bemindful.co.uk for example. Alternatively, your doctor or health professional may have specific recommendations for you. Here are some examples:
- Mindfulness-based Relapse Prevention (MBRP): This eight-week treatment approach from the University of Washington helps people in recovery from addictive behaviour. It focuses on relapse prevention and teaches people how to observe cravings and urges.
- Mindfulness-based Eating Awareness Training (MB-EAT): This programme helps with mindless eating, emotional eating and overcoming the guilt and shame that comes from overeating. It promotes a healthy lifestyle and helps manage conditions such as binge eating, obesity and diabetes.
- Mindful Awareness Programme for ADHD (MAPS for ADHD): The course includes education into the impact of ADHD and specific mindfulness exercises and meditations tailored to those with attention issues or ADHD.
Using ACT for anxiety
Research shows that Acceptance and Commitment Therapy (ACT) helps to treat anxiety along with numerous other mental-health conditions. It works by trying to stop controlling your anxious thoughts and feelings (acceptance), living in the present moment (mindfulness) and then preparing a course of action for moving on alongside your core values.
The idea behind ACT is that when you allow yourself to accept your anxious thoughts and feelings, you can then focus on the present moment and start to take steps to live how you want to.
The research results for ACT are very promising. It's definitely worth trying.
Therapies that work for some people may not work for others because everyone has slightly varying anxiety conditions. A combination of therapies may work for you, or a combination of therapy and medication, or just medication or just therapy. Always consult your doctor.
Changing how you think: Benefits of CBT for anxiety
Cognitive behavioural therapy (CBT) is the most common therapy for anxiety. It features a combination of two elements:
- Cognitive therapy: Your cognitive processes are your thoughts, attitudes, mental images and beliefs. A therapist goes through these with you and identifies any thought patterns, ideas and thoughts that can trigger your anxiety. The aim is to try to change your way of thinking so that you avoid these negative ideas. The therapist also tries to help you make your thoughts more realistic and helpful toward you.
- Behavioural therapy: This element helps to change any behaviours that are unhelpful to you. For example, if you're very anxious, you may start to avoid certain places or things, which can exacerbate your anxiety. This behaviour isn't helpful because it increases avoidance instead of managing your anxiety.
The therapist may gently guide you to face up to your fear and expose yourself to the place or thing that makes you anxious. You discover techniques on how to handle your anxiety, by gradually engaging in the activity that causes you anxiety, step by step.
These two techniques work in combination because how you behave is usually determined by how you think. Depending on your condition, the focus is more on the cognitive or the behavioural element.
CBT contains many advantages:
- You can sometimes find that it's as effective as medication or works in cases where medication hasn't succeeded.
- You can complete it in a relatively short period of time.
- You can access CBT resources through therapists, books and online resources.
- You develop skills in CBT that you can bring to everyday life to cope with a variety of situations.
CBT is different from mindfulness because it's about changing thoughts to change behaviour. In contrast, mindfulness is about identifying thoughts that arise in the present moment, seeing them as separate from you and being as nonjudgemental as possible toward them.
Although they are two very different techniques and approaches, Mark Williams, Zindel Segal and John Teasdale combined mindfulness and CBT to create Mindfulness Based Cognitive Therapy (MBCT). It's based on Jon Kabat-Zinn's MBSR programme (see the earlier section ‘Engaging in an Eight-Week Mindfulness Course’):
- Cognitive part: Breaks down negative thought patterns and helps patients to recognise incoming thoughts and feelings that can trigger a repeated episode of a condition, such as depression.
- Mindfulness part: Focuses on becoming aware of the thoughts that the patient is having, but not becoming attached to them, and observing them without judgement instead of reacting and acting upon them. To this end, the programme uses mindfulness exercises, such as the breathing space.
Although MBCT was specifically created for people with depression, it's also been scientifically proven to help with other disorders. The benefits of MBCT on people with anxiety are
- Reduced insomnia
- Tendency to be less neurotic, less needy and have a sense of greater self-worth
- Less dependence on alcohol, caffeine and illegal drugs to manage anxiety
The intention is that participants come to see their thoughts as mental events that arise with and are fueled by anxiety or depressed mood, but do not have to be taken personally. They no longer relate from their thoughts but to their thoughts as objects of awareness.
To find out more about CBT and MBCT, take a look at the following resources:
- Managing Anxiety with CBT For Dummies by Graham C Davey, Kate Cavanagh, Fergal Jones and Lydia Turner (Wiley)
- Cognitive Behavioural Therapy For Dummies by Rhena Branch and Rob Wilson (Wiley)
- Mindfulness-Based Cognitive Therapy For Dummies by Patrizia Collard (Wiley)
Also take a look at www.mbct.com, which is written by the developers of MBCT. It includes a clear explanation of the program and where to find a suitable therapist.
Managing the use of prescribed medication with mindfulness
Some people overuse medication for anxiety or use it as an avoidance tactic. They may take medication every time they have to face an anxious situation, such as meeting a new person, leading a work presentation or getting through a difficult family situation. But this behaviour doesn't help long term because you're essentially avoiding the feeling of anxiety. A fear of anxiety is what continues to feed the anxiety in the first place. Ultimately, mindfulness is about discovering how to accept and make space within you for the feeling of anxiety rather than trying to constantly fight it.
Mindfulness allows you to manage your anxiety more effectively in such events. It's about becoming aware of your thoughts, stepping back from them and seeing anxiety as part of your experience rather than part of you. You can then regain control over your life and lose the reliance on having to self-medicate.
Using mindfulness to manage everyday stressful events means that you don't have to overuse your anxiety medication, but instead just use it as prescribed by your doctor or health professional. In some cases, mindfulness has proved to be better than medication at curing conditions such as insomnia.
Mindfulness can work well alongside prescribed medication and can help you if you decide in the future to reduce your medication slowly, too.
Always talk to your doctor if you're thinking about reducing or coming off prescribed medication. Coming off medications needs to be done slowly and gradually with a lot of help, advice and support; going cold turkey may cause side effects. Always make sure that you consult with your doctor before changing anything about your prescribed treatments.
Expanding Your Mindfulness Practice
If you really want to deepen your experience of mindfulness, consider going on a mindfulness retreat. This section offers advice on how to make a choice about whether you should go on a retreat, and which one is right for you, at this time.
The section also includes lots of great organisations that can support you through your experience of anxiety.
Taking mindful retreats to move forward
Retreats are a great way of engaging in mindfulness without the distractions of home and work life. You can fully focus with like-minded people, often in beautiful settings and locations.
Here are some benefits of a retreat:
- You can get away from any destructive habits that you're used to, such as arguing with a partner, placing too much emotional demand on someone, overworking or using illegal drugs or alcohol to try and suppress your anxious feelings.
- You can be with other like-minded people in an environment that's all about mindfulness: nonjudgemental, supportive and welcoming.
- You have no responsibilities for the time you're on the retreat.
- You can live in the present moment for longer than you would normally.
- You have experienced mindfulness teachers on hand to help and guide you through the practice.
A lot of really great mindfulness retreats are available to you:
- www.learnmindfulness.co.uk: Shamash Alidina has authored several books on mindfulness, offers coaching and holds retreats in some lovely locations. Check out his website for more details of the next mindful retreat.
- www.gaiahouse.co.uk: Gaia house retreats have a rural setting in southwest England and are mostly silent. You can choose to do a group retreat, a work retreat or a personal retreat, and they vary in length from a day to a week. The silence aims to deepen the practice of meditation, but the teachers speak to guide the practice.
- www.amaravati.org: Amaravati is a Buddhist association in north London and runs mindfulness events such as ‘Mindfulness at Work’. If you're interested in mindfulness in the Buddhist sense, it's worth checking out.
- www.plumvillage.com: This retreat centre in southern France was founded by Thich Nhat Hanh, a Vietnamese Buddhist monk. He's one of the most famous teachers of mindfulness and was nominated for a Nobel Peace Prize by Martin Luther King. Not only do you do mindfulness formal practice, but Plum Village also encourages daily mindfulness practice, such as being mindful when you shower, wash dishes, eat breakfast and even use the toilet! The atmosphere is light-hearted and supportive, encouraging joy and peace in the community.
A retreat may not be for you at this point if you're suffering from severe anxiety and emotional distress, or have just been diagnosed with a mental-health condition such as clinical depression or post-traumatic stress disorder. You may need one-to-one support before experiencing a retreat. Consult your doctor or health professional before booking.
Discovering other helpful organisations
Many great organisations can give you round the clock support and advice, however you're feeling. If you want to discover more about your condition, you need someone to talk to or you want to research how different therapies can benefit you, all these organisations can help:
- Anxiety UK (www.anxietyuk.org.uk): A national registered charity that has been running for over 40 years. It was started by somebody with an anxiety disorder and helps people who've recently been diagnosed with, or suspect that they have, an anxiety condition. The charity offers one-to-one support, information and a range of services using external agencies as well. It can also help with specific phobias, such as fear of spiders or being in crowded places. In fact, the charity can help with any specific phobias that are holding you back from getting on with your life.
- MIND (www.mind.org.uk): A leading mental health charity in the UK. It offers an extensive range of support from counselling, crisis helplines and drop-in centres to employment and training schemes and supported housing. The charity supports over 250,000 people in England and Wales and works tirelessly to end mental health stigma and obtain equal rights for anyone who's encountered difficulties because of their mental-health condition. It offers tips on everyday living and mindfulness and has a mental health A-Z giving information and support. You can search for your local centre or check out the website.
- NHS (www.nhs.uk): The NHS website has a range of information about anxiety and anxiety disorders, covering GAD, social anxiety, post-traumatic stress disorder and panic disorder. You can read up about your symptoms, methods of support, treatment and finding out when to see your doctor.
- The Samaritans (www.samaritans.org): The Samaritans was started in 1953 by a vicar who wanted to reach out to people in need, though it's a nonreligious organisation. It provides a telephone service where you can talk to someone 365 days a year, 24 hours a day. The Samaritans doesn't keep any record of your call, and you can talk about anything that's troubling or disturbing you in a nonjudgemental and supportive environment. You don't have to be having suicidal thoughts to use the service and in fact the majority of callers aren't suicidal; they just need to talk their feelings through.
The Samaritans are listening. …
When you call the Samaritans, a volunteer answers your call. The person listens to you when you talk about how you're feeling. You may then be asked whether you're feeling suicidal and about other feelings you may be having. You can talk for as long as you want to and end the call when you feel ready.
You can contact the Samaritans as follows:
- Telephone: Call on 08457-909090. This method is best when you need to talk urgently.
- Email: At [email protected].
- Visit: The Samaritans have several different branches across the UK and Ireland. Go to www.samaritans.org/branches to find your nearest one.
- Write: The address is on the website.