Mindfulness and Anxiety: An interview with Dr. Lizabeth Roemer

By Jonathan Kaplan, Ph.D.

Recently, a wonderful new book was released to help people suffering from anxiety.  Authored by Drs. Susan Orsillo and Lizabeth Roemer, The Mindful Way Through Anxiety provides a systematic, mindfulness-based approach to the alleviation of anxiety and the promotion of values-based living.  I highly recommend this book to my patients because of the many exercises and case examples.  This book also reflects the research-based treatment that they've developed over the past several years.  Recently, I was fortunate to have the opportunity to speak with Dr. Roemer.  Here is an excerpt of our chat.

What prompted you to write this book?

After spending years developing this approach to treatment and training therapists in the approach, we wanted to bring the work we’d been doing directly to people with anxiety who we weren’t seeing therapy.  We wanted to help more people experience the kinds of meaningful changes we were seeing our clients make and felt like we could write a book that would make a valuable contribution to the available self-help books.


Why use mindfulness to address anxiety?  Why would anyone want to become more aware of anxiety, fear, and other unpleasant emotions?

An important thing about mindfulness is that it is a particular kind  of awareness.  It is an expanded awareness, not a narrow one.  Most  people with anxiety are too narrowly focused on things that are  threatening or anxiety-provoking as opposed to their whole  experience.  Also, mindfulness involves an awareness with compassion  as opposed to the very narrow, critical awareness that accompanies  anxiety.  Anxiety prompts people to be hyperaware of threat, which leads  to avoidance.  That avoidance interferes with learning new things as  well as fully experiencing life.


How is your treatment different than cognitive-behavioral therapy (CBT) alone?

CBT is very effective for anxiety and our treatment is firmly grounded in cognitive-behavioral theory and practice.  We started incorporating mindfulness because we thought it could enhance treatment effects for some people.  By promoting acceptance, mindfulness allows people  to relate differently to experiences that are not amenable to change.   Ultimately however, technique isn’t as important as function.  Our emphasis is on helping people relate differently to their symptoms of anxiety so that they can live their lives more fully.  We think mindfulness allows us to accomplish this better with CBT.

You include several meditations in your book and on the accompanying  website.  What do you say to folks who tell you that they can't meditate?


If meditation was something that you could do easily, then you would  have already done it!  The point of the exercises is to cultivate this  new skill of mindfulness, which can be learned through practice--just  like any other skill.  So, we work with many ways to cultivate this  skill.  Most people can find five minutes to sit and practice  mindfulness.  Setting some time outside of our lives to practice  allows us to be better able to use it in our lives. We have also worked with people who practice doing everday activities, like brushing their teeth or folding laundry, with mindfulness instead of setting aside time to meditate.  The book provides flexible suggestions of different ways to incorporate practice into your life.

Given the topic on this blog--mindfulness in the city--do you find that folks in the city are more or less anxious than others?

I treated anxiety for a long time in State College in Pennsylvania and  now for a while in Boston.  I find that people's lives are more  complicated in the city.  People encounter more real life barriers and stressors that  naturally elicit anxiety, like the faster pace.  And, relatedly, it's harder to be mindful.  It's harder to naturally have the spaces and moments to come back to ourselves.  We have to do that more intentionally.

Is there anything else you'd like to add?

Yes.  I'd like to discuss the importance of engagement in life.  An crucial part of the book--in addition to finding ways to be more open,  expansive, and relate to experience differently--is to find meaningful  experiences in life.  Anxiety leads us to focus on whatever is threatening and avoid it.  People avoid certain experiences in order to  not feel anxious and that doesn't really work.  An alternative is to  cultivate skills of mindfulness and have anxious responses, but not react to them.  And, then proceed to do the things that matter to us, like opening-up in a relationship, being present with your children, or advancing professionally.  It's a way of responding to anxiety that is in the service of living a full life.  What do you want to move  towards that you haven't been moving towards becuase of your fears?  Can you have your reactions and do what matters to you anyway?  The book helps people to develop skills so that they can live their lives more fully.

Mindfulness in Mental Health

By Jonathan Kaplan, Ph.D.

Today, I'm going to take a little detour from my usual discussions of mindfulness practice in the city, and write a little more clinically.  Today is a Mental Health Blog Day (sponsored by the American Psychological Association), and I wanted to describe briefly the major mindfulness-based psychotherapies that have been developed.  All of these approaches have been subject to scientific research, establishing their helpfulness in treating people with particular kinds of problems.

Mindfulness-based Stress Reduction (MBSR)

MBSR was designed by Dr. Jon Kabat-Zinn to help people suffering from chronic pain as well as stress-related medical conditions.  The program consists of 8 weeks of group-based sessions in which participants learn how to practice mindfulness through meditation, yoga, and daily activities.

Dialectical Behavior Therapy (DBT)

Created by Dr. Marsha Linehan, DBT incorporates individual psychotherapy and group-based skills training for people who meet criteria for Borderline Personality Disorder.  Mindfulness is a core component of the program, in addition to distress tolerance, emotional regulation, and interpersonal effectiveness.

Mindfulness-based Cognitive Therapy (MBCT)

Based on MBSR, MBCT helps to prevent relapse in people who have experienced three or more episodes of depression.  Because it is a prevention-based program, it is not recommended for people who are currently depressed.  It is curious to note that the program did not prevent relapse in people who experienced 2 or fewer episodes of depression, yet the people who suffered from three or more episodes presumably fell into this former group at an early point in life (i.e., they had a first and second episode before becoming depressed a third time).

Acceptance and Commitment Therapy (ACT)

ACT is a relatively new form of behavioral therapy that emphasizes the pernicious roles of language, thought, and avoidance in causing and perpetuating our distress.  As an example, if I tell myself that I have "low self-esteem," I am likely to avoid challenging social situations, and maybe even enter therapy in order to achieve "high self-esteem."  ACT would encourage me to notice and "defuse" myself from pre-occupation with "self-esteem" and re-engage with life in valued directions.  Some amount of pain and anxiety would be expected, and ACT normalizes these feelings as part of life.

I hope that you've appreciated this very brief primer on mindfulness-based psychotherapies.  If you're interested in learning more, a simple Internet search will get you all the information you need.  And, if you'd like to learn more about mental health, please visit the APA page:  Your Mind, Your Body

Spring Forward!

Welcome, spring. Let’s plant some habits!

As the season’s change, we often attempt to cultivate new habits. Think “spring cleaning” or the “summer diet.”

Understandably, as busy people, we face the challenge of maintaining awareness and intention in following through with the behaviors we yearn to implement. I can’t begin to calculate the number of hours my clients spend sharing the universal human struggle of keeping up with a gym routine, sleep schedule, budgets, work tasks or other valued goals.

Are you eager to pursue a task on a regular basis and struggling with the requisite steps? If so, you may consider the following exercise.

Spring Goal Setting, Step by Step:

1. Perhaps for a few moments, you might consider a habit you’ve been yearning to commit to pursuing. Think about what it is that matters a lot.  You might imagine how you may feel if you take steps toward this goal.  For example, you’ve been meaning to organize your desk, and taking steps towards creating a nice work space relates to your value of productivity. You’d imagine feeling more relaxed if you had a peaceful work space with room for a nice vase and some lavender.


2. Next, without judgment, notice some of what has getting you stuck from taking the leap forward, again and again.  Using the aforementioned example, the thing that gets you with stuck is that mountain of papers and tax documents piling up. When you think about it, it feels overwhelming and too time consuming.


3. Add mindfulness! A culprit of difficulty with habit follow through may include mindlessness or a desire to escape difficult feelings that arise. Hey, most people don’t like to wake up at 6 am to do pushups and piles of paperwork can be painful! An alternative to forgetting or running from feelings that arise is bringing awareness to the moment and noticing feelings without avoiding them or the task at hand. “Oh, there’s anxiety as I approach my desk, hello muscle tension and rapid heartbeat,” as you continue to move forward with a reasonable goal in mind.


4. Sign up! I recently stumbled upon a novel website- www.habitforge.com. This wonderful website allows you to plug in a habit you’d like to cultivate and will send you email reminders to follow through.

Shout out to BMCC

Submitted by Jonathan S. Kaplan, Ph.D.

I just wanted to thank the staff, students, and faculty who came to my talk at BMCC today.  I really appreciated your enthusiastic participation and generous attention, which we well know is such a precious commodity these days.  Given the nice reception, maybe we should refer to BMCC as the "Being Mindful College and Community?"  < smile >

Mindful Walking in NYC: The Great Saunter

Submitted by Jonathan S. Kaplan, Ph.D.

New York City is notorious for its stressful, fast pace.  And, with the coming of warmer weather, there will be plenty of athletic races in which New Yorkers can strut their stuff (quickly, of course).  While it is possible to be mindful while running, perhaps you've wondered if there is such a thing as a mindful walking event in NYC.  Well, this one comes close:  on the first Saturday in May, Shorewalkers will be hosting The Great Saunter, an all-day walk around the island of Manhattan.  The route spans 32 miles, so there should be plenty of opportunities to appreciate our surrounding coastline.  The organization estimates that people should be able to complete the walk in 12 hours (at a rate of 3 miles per hour with breaks), and there are NO prizes for first, second, or third place.  Yes, that's right:  the whole purpose is simply to go for a walk (okay, a really long walk).  So, if you're looking for a fun way to enjoy the spring, why not consider participating in this mindful, memorable stroll?