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.

With 100% Certainty...

By Jonathan Kaplan, Ph.D.

Recently, I started biking to work.  I've enjoyed the breeze and view as I bike over the Manhattan Bridge (especially at night), and it allows me to experience the city in a whole new way.  While I miss sharing the subway ride with my fellow New Yorkers, I do appreciate the sights and smells of the various neighborhoods--Chinatown, the Bowery, Union Square--through which I pedal.  For the past couple days however, I left my bike at home due to predictions of rain.  (At present, I haven't developed the fortitude (or inclination) to be biking in thunderstorms.)

Before I left home each morning, the sky looked overcast, but it was not raining.  The news assured me that it would be raining "morning, noon, and night," so I decided to refill my MTA pass and travel underground.  At work, I waited for the rain.  And, it did rain:  a little bit of drizzle off and on.  And, when I returned home each night, the sky was clear and the ground was relatively dry.  As such, I realized that I could have biked to work in relative comfort both days.  As I pondered my decision to ignore my immediate sensory experience of the weather in favor of others' predictions, I was reminded of something that I discuss with patients who suffer from anxiety and worry.

From the perspective of cognitive therapy, worry is characterized by a demand for certainty in ambiguous situations.  Specifically, we want to know what will happen in the future.  And, because we don't really know what will happen, we become anxious.  In clinically significant circumstances, it can get to the point where we're imagining quite catastrophic results.  Part of cognitive therapy involves developing a tolerance of this uncertainty, while learning how to consider the future in terms of probabilities, not guaranteed outcomes.

So, what is guaranteed?  Maxims tell us that nothing is guaranteed, or that change is the only constant.  Indeed, these are true as we look towards the future.  However, the present moment--as it is happening right now--is immune to these considerations.  That's right:  the present is 100% certain.  If you're looking for certainty, you'll find it nowhere except now.  My immediate experience is undeniably real.  If my knee is itchy, it is itchy.  If I'm thinking about my book, then my thoughts are focused on my book.  If I'm judging someone as being rude, then my critical mind is active.  If I'm anxious about the future, then I'm worrying now.  Will these aspects of my experience be present in five minutes?  I don't know.  These examples show how mindfulness can illuminate the world as it exists, and potentially provide some relief for those of us who cannot tolerate ambiguity.

So, the next time that I consider whether or not to bike to work, I'll consider both the weather that I see (e.g., cloudy) and the current predictions (e.g., showers), and make a decision that honors both of my experiences.  And, if I do decide to bike, maybe I'll just toss a poncho into my bag...