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Sunday, December 8, 2013

Mindfulness and Acceptance-Based Behavioral Therapy for Anxiety and Depression

From EverydayHealth.com

By Kristen Stewart
Medically reviewed by Lindsey Marcellin, M.D, M.P.H.

November 30, 2013

ABBT shows you how to focus on your emotions and responses and see them as natural and normal, rather than as signs of weakness or a problem.

When you experience anxiety or major depressive disorder, you know the pain of struggling with thoughts and feelings. A solution for some is Acceptance-Based Behavioral Therapy, or ABBT, which helps people respond and relate to thoughts and feelings in new ways to find relief.

“ABBT draws from behavioral therapy in that past learning is thought to cause and maintain psychological difficulties, and so treatment involves learning new patterns of responding,” said Lizabeth Roemer, Ph.D., a psychology professor at the University of Massachusetts in Boston, and co-author of the book, The Mindful Way Through Anxiety: Break Free From Chronic Worry and Reclaim Your Life.

“One specific area of new learning in ABBT is learning how to relate differently to one’s inner experience -- with awareness, curiosity, compassion, and acceptance rather than judgment, criticism, and avoidance.”

A 2013 study in the Journal of Consulting and Clinical Psychology found ABBT to be an effective treatment for people with generalized anxiety disorder and other co-occurring disorders. That confirmed findings of a 2008 study in the same journal that reported that 78 percent of people with generalized anxiety disorder no longer met the diagnostic criteria after treatment with ABBT.

What Is Behavioral Therapy?

ABBT comes from the broader tradition of behavioral therapy. “From a behavioral perspective, we learn certain patterns and habits of responding based on our observations and experiences,” Roemer said. Things like emotions and how to handle them, for instance, are often learned from parents, extended families, and societal messages. People also learn through the consequences they experience as a result of their actions.

Psychological problems can arise when habitual patterns of responding that are effective in some situations end up causing problems in another. Susan Orsillo, Ph.D., a psychology professor at Suffolk University in Boston and Roemer's co-author, gave the example of a woman who grew up in a family that discouraged emotional expression. She adapted to behave this way to fit in, but ultimately the behavior caused problems when trying to develop an intimate relationship.

Another example would be if you were anxious about giving a big presentation at work. Instead of confronting the fear, you call in sick and realize that avoidance reduces your anxiety. The problem this creates, though, is that you never have the chance to learn that you can successfully cope in an anxiety-provoking situation because the solution was to avoid it instead.

Defining Acceptance-Based Behavioral Therapy

ABBT is actually a group of therapies that fall under behavioral therapy. “Specifically, ABBTs focus on the way that people naturally learn to react negatively, critically, and judgmentally to their own internal experiences -- thoughts, feelings, sensations, memories -- and to see these experiences as defining, permanent ‘personality traits’ rather than as passing things,” Orsillo said.

For example, many people see fear as a negative emotion that shows inner weakness and stands in the way of success instead of what it really is: a simple, natural response to a potential threat or challenge.

ABBT encourages people to approach their emotions and reactions as natural and normal, and to realize that these feelings are not permanent ways of being, but that they will increase and decrease over time. You're taught to think about how you feel with curiosity and compassion rather than judgment, and to accept these experiences instead of trying to control them, which can result in less stress.

Ultimately, the therapy encourages people to act in ways that are consistent with what's important to them rather than in ways that will avoid undesired emotions.

How Does Mindfulness Play Into ABBT?

Mindfulness is encouraged in people using ABBT. “Mindfulness as defined by Jon Kabat-Zinn involves paying attention, on purpose, in the present moment, with open-hearted compassion and curiosity,” Roemer said.

Often, formal practices in which people set aside time to work on specifically developing this skill are mixed with informal practices where people are encouraged to use mindfulness in everyday life. Meditation is one kind of formal practice that can be used.

Mindfulness and Anxiety: What You Can Expect With ABBT

ABBT can be tailored to the individual, but Orsillo's and Roemer’s research has centered on a 16-session version. Early sessions focus on providing information, increasing awareness, and learning new skills, while later ones encourage applying the skills in real life. The length of therapy can be longer or shorter as needed, and a group format has been created as well.

The therapy focuses on teaching people more about their responses and encourages them to pay attention to their reactions throughout the week. During therapy sessions, participants practice skills to help them relate differently to their internal responses. Writing assignments and discussion with the therapist are also frequently used to help identify what people consider important in different areas of their lives.

Ultimately, ABBT can be quite helpful to many people. “Often people see their emotions or thoughts as evidence of weakness or something being wrong with them,” Orsillo said. “Therapy emphasizes the naturalness and humanness of all of our reactions, leading clients to look at these experiences in the same way.”


Downloadable mindfulness exercises and other information about ABBT are available at The Mindful Way Through Anxiety Web site.

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