Evaluating Self Help: The Mindfulness & Acceptance Workbook for Anxiety

There’s no shortage of self-help books on the market. There is, however, a paucity of research on whether those self-help books are actually helpful to the people who use them. In an ideal world, every self-help book would be submitted to scientific scrutiny to determine if people actually benefit from using them. Unfortunately, this happens only rarely.

Even a self-help book that is based on well-researched cognitive behavioral principles and written by leaders in the field is not guaranteed to be effective.  For example, one recent study found that college students with greater rumination exhibited more depressive symptoms after using Greenberger & Padesky’s Mind over Mood, a well-respected cognitive behavioral self-help book for depression. These findings suggest that evidence-based psychotherapy interventions don’t always translate into effective self-guided techniques that people can use on their own, and in some instances can actually be harmful.

The Mindfulness & Acceptance Workbook for Anxiety

Over 5 years ago, I wrote a few blogs posts about Forsyth & Eifert’s The Mindfulness & Acceptance Workbook for Anxiety in 2 prior blogs for which I used to contribute. The first, on my blog Scientific Mindfulness, reported on pre-publication research I heard about at a conference. (Unfortunately, it appears the other post has been taken down.) The first author of the workbook, SUNY-Albany professor John Forsyth, PhD, conducted 2 studies on his ACT-based self-help book. He gave copies of the book to people for free, and had them complete online self-report measures at various intervals.

Dr. Forsyth recently posted a summary of this research on his personal blog in anticipation of the upcoming 2nd edition of The Mindfulness & Acceptance Workbook for Anxiety that will be released April 1, 2016. One paragraph in his blog post caught my attention:

Reductions in anxiety and fear did not happen by going after anxiety and fear directly. It was just the opposite. By first focusing on the skills needed to live a more valued life, readers then experienced a decline in their anxiety, fears, and depression, and ultimate improvements in their lives. This is an important message––one that supports the approach we offer in this workbook.

The workbook emphasizes ACT skills to help people engage in meaningful living, and it appears that those skills—rather than interventions aimed at alleviating anxiety and worry—appear the most effective.  Said another way, the findings suggest that people using the workbook improved more from doing things that were important to them than from any particular technique. This is quite profound, if you think about it, and very different from how many people approach anxiety. Attempting to directly suppress or control anxiety-related thoughts and feelings can often backfire.

Because it’s one of the rare self-help books that has been researched specifically as a self-help book, I find myself recommending The Mindfulness & Acceptance Workbook for Anxiety more than any other self-help books, and I was excited to hear there’s an updated edition coming out. I encourage readers to check it out.

Anxiety Treatment at Portland Psychotherapy

How to Read Your Emotions Part I: Don’t Judge a Book by Its Cover

Sometimes when you first start having a feeling, your brain will very quickly make up its mind that the emotion is somehow dangerous or bad. Then it tries to escape from the emotion or control the emotion by turning your attention elsewhere and getting you to do something that makes the emotion go away. Because our brains are trying to protect us from harm, this well-intentioned judgment about our feelings comes from a good place. However, somewhere along the way our brains got a little confused about what is actually harmful. Emotions themselves are not harmful, our brain just says they are. 

Doing something that makes fear go away can work to keep you safe, but it’s only a stand-in for the real solution, which is to get away from the actual danger. Put another way, fear isn’t ever harmful, but masked figures holding knives often are. It’s much more important to get away from any danger in the world than to get away from any fear you are experiencing. In fact, when you are attuned to your environment, fear is just awareness of danger. In that sense, fear is probably a handy thing to experience – if you aren’t aware of real danger, you are less likely to respond and more likely to get hurt. The lesson is — don’t be so quick to judge fear. It may be your friend.

The same goes for other emotions: Sadness isn’t bad, it’s just awareness of loss, and loss is bad. Anger isn’t bad, it’s just awareness of conflict, and conflict isn’t great for relationships. Anxiety isn’t bad, it’s just awareness that something is important to you, and caring about things is good. For that matter, joy isn’t good, it’s just awareness that something wonderful is happening, and wonderful things are good. Emotions are there to be felt because they say something about the world in which you are living. Don’t leave your emotions on the shelf – check them out!

You can’t really blame your brain too harshly for making snap judgments – that’s what it evolved to do. Go ahead and thank your brain for its noble intentions of keeping you safe. But when it comes to your emotions, remember that they’re meant to be an open book.
For more on how to observe emotions without getting caught up in judgments, see How to Read Your Emotions Part II: Put on Your Spec’s.

Riding the Wave: Using Mindfulness to Help Cope with Urges

Changing a habit is hard. Anyone who has tried to change their eating habits, quit smoking, start an exercise program, or stop drinking or using drugs can tell you how difficult it can be at times to change old habits. In my last post I discussed how slipping (i.e., falling back into an old habit) can sometimes set us up for a relapse (i.e., continuing a habit beyond the initial slip) due to a phenomenon known as the Abstinence Violation Effect. In this post, I’d like to talk about a technique that can help you before you slip, a technique called “urge surfing.”

What is Urge Surfing?

Urge surfing is a technique attributed to the late psychologist Alan Marlatt, Ph.D., a pioneer in the field of addictions treatment. We can think of an urge as an impulse to engage in an old habit, such as drinking or using, and they are often experienced as physical sensations in the body. Urges are like waves in that they rise in intensity, peak, and eventually crash.

Here’s a brief exercise you can do to explore this technique: Stop for a moment and think about an urge that you recently experienced. As you think about this urge, see if you can notice all the sensations that come up as you think about it; see if you notice how these sensations shift across time. Use your breath to help you ride out the waves (i.e., the urge); like a surfboard, you can simply observe your breath as you ride out each wave that arises. Congratulations! You just successfully surfed your first urge!

Urges usually peak between 20 – 30 minutes, if we let them. What I mean by this last phrase is this:  if we adopt an open and curious attitude about the urge and watch it without doing battle with it, then the urge will subside. However, if we go to battle with our urges (e.g., “I can’t stand this urge! I have to get rid of it right now!”), they will subside more slowly. Worse, by giving into urges we can actually strengthen them and we can lose confidence in our abilities to change our old habits.

How to Surf an Urge

There are slight variations of the urge surfing technique, but most include the following steps:

  1. Take a few moments to notice where you experience urges in your body. You can do this by taking some time to sit in a quiet place, and if you are comfortable doing so, closing your eyes, and just allowing your attention to go to the place(s) in your body where you tend to feel urges. For some people they notice that urges are most connected to sensations in their abdomens; for others, they notice urges in their mouth (e.g., their mouths water when experiencing an urge to drink). There is no right or wrong place for an urge to be located. What is most important is that you notice where in your body you most notice urges when they show up. If you are having trouble noticing urges, think back to a time when you experienced an urge to engage in an old habit. If you are concerned that thinking about a particular instance when you had an urge will lead to doing the habit, pick a situation where the urge was less strong or you successfully prevented yourself from acting on the urge. Picture the situation as clearly as you can in your imagination. Once the situation is clear in your mind notice where in your body you are experiencing the urge.
  2. Once you have noticed what part of your body is most connected to the urge, focus your attention on it (if you notice that more than 1 area of your body is connected to an urge, start with the place that you most intensely notice the urge). Take note of the sensations you are having in this body part. What do the sensations feel like? Does it feel like pressure, tingling, warmth, or coolness? How much space do these sensations take up in this place in your body? Try to draw an outline around the place where the sensations are felt. See if the sensations have any movement. Some people tend to associate sensations with colors or temperatures. Check to see if you notice any colors or temperature associated with these sensations. For some people it can be helpful to silently describe the sensations in an objective and non-judgmental manner (e.g., I notice warmth and tingling in my belly). If more than one part of your body is associated with an urge, go through this exercise with each body part.
  3. Bring your attention to your breath. You do not need to change your breathing at all. Notice your breath for the next 1-2 minutes. Some people find it helpful to bring their attention to a particular place in their body where they notice their breath (e.g., the abdomen); some find it helpful to say phrases like “breathe in,” “breathe out” as they inhale and exhale.
  4. Gently shift your attention back to the part(s) of your body where you notice the urge. Allow yourself to notice whatever sensations come up in these places. If it becomes overwhelming to notice the sensations, gently return your attention back to breath for a few moments and then go back to noticing the sensations connected to the urge. You may find it helpful to imagine sending your breath to the parts of your body that are associated with the urge (e.g., you can breathe into your shoulders and let your breath fill up that part of your body). Notice if and how the sensations change as you watch them. Be sure to practice this step for at least 1 minute, but longer is probably better.
  5. This next step is optional, but I have found it to be helpful in my own life and in working with people with addictions. Imagine that the sensations connected with your urge are a wave. Watch the wave rise and fall over and over again as the intensity of your sensations peak and subside. Your job is to use your breath as a surfboard to ride these waves. No matter how big the wave gets, no matter how much you feel as if the wave will consume you, you are a skilled surfer and you will use your breath to ride each wave as it comes. Practice this for at least 1 minute, but again, longer is probably better, particularly the first few times you practice this.
  6. As you’re riding the wave (or just noticing the sensations), you may find it helpful to silently describe the sensations in an objective and non-judgmental way (e.g., I notice warmth in my belly that is increasing…the warmth in my belly is decreasing and my belly feels cooler).
  7. When you are done surfing the urge, take a moment to thank yourself for taking the time and being willing to do something different with your urges. You can also use this time to set your intention for the next few minutes, hour, or day.

That’s it! With practice urge surfing gets easier and you may discover that you are an excellent surfer. You can practice this technique in two ways:

  1. You can start urge surfing whenever you notice yourself having an urge.  This can be a particularly useful technique when you notice urges to go back to old habit that you are trying to break.
  2. You can practice this on a regular basis by setting aside time to practice using the technique. Many people find that listening to an audio recording of the technique is useful at first.  Through this kind of formal practice, you can get better at urge surfing so that you’re better at it when you need it.

You’ll find that, with practice, urges will become easier to ride out. You may even start to feel a sense of pride or accomplishment as you successfully surf urges and act according to your values, instead of according to your urges.

If you would like to learn more about how to use techniques like urge surfing to cope with urges, the book below is a good option:

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