Anxiety comes in many forms. According to the National Institute of Mental Health as many as 40 million Americans suffer from an anxiety disorder (source, and more info here). When there is a real surge of anxiety, the afflicted person can end up virtually non-functional. The mental activity tends to go in a dangerous spiraling motion (thoughts of dread, regret, meaninglessness, etc.), the body may respond violently (trembling, vomiting), and a panic attack can set off totally paranoid behaviors (e.g., unable to leave the house). This is mind and this is serious stuff.
Although I luckily have not experienced quite this intense form of anxiety except in extreme situations of crowds (perhaps some ochlophobia), I can sympathize to a certain degree due to a pervasive undercurrent of the emotion that is deeply conditioned at this point, and thus hard to pinpoint. One of the side effects is waking up in the middle of the night or first thing in the morning with an overwhelming sense of neglect and forgetfulness, as if I’ve forgotten the most important person (or dog – my baby) in my life completely. It’s possible this is PASS, but considering it’s been 16 years since exercising that not-so-much-of-a-choice, I’d be surprised.
A lot of people take prescription drugs (while others self-medicate), some use psychotherapy, and still others engage in a meditative practice to manage anxiety. One friend who does suffer from anxiety, and takes medication for it, has also begun to consider mindfulness-based approaches. There is some evidence that this may indeed be an effective form of treatment, though the study results generally have only moderate success rates.
I can attest to the benefits of of mindfulness practice in my own life — as this background noise of anxiety definitely disappeared during retreat — but, I can also see how the results could be difficult to maintain without diligence and sustained practice. In other words, the anxiety has slowly but surely emerged again in the conventional world as mindfulness weakens and old habits of mind reappear. Despite an extremely simple life: no house, no car, no phone, no job, no bills, the anxiety just starts to bubble up in sleep and waking life, undoubtedly because of more discursive thought.
Toni Packer in The Work of this Moment talks about how we can inquire into the nature of our difficult emotions and, in particular, question the validity of the thoughts that tend to bolster them. She says:
…Real questioning has no methods, no knowing–just wondering freely, vulnerably, what it is that is actually happening inside and out. Not the word, not the idea of it, not the reaction to it, but the simple fact…Anxiety arises…will one immediately act by “knowing” it from previous times and bracing against it? “Oh, not that again–I hate it–it’s going to get worse, how can I get rid of it.” and so forth. [Or] simply meeting it as for the first time, attending quietly, feeling it, letting it move on its own, revealing itself for what it is without interference by the brain.
When the emotion is just a background hum, it can be difficult to really identify the thought content that’s feeding it. That’s why moment-to-moment mindfulness is key – because you never know when with clear awareness that cause and effect process is going to make itself known. And when the mind is peaceful, during more formal meditation practice, that’s a good time to actually intentionally call up the emotion and investigate it. This is something I need to do more often, but it requires equanimity. Anything that’s deeply conditioned is difficult to penetrate. We have to recognize when is the right opportunity to really confront a strong emotion and also know when we really aren’t ready to deal with it. If we aren’t, it’s okay to redirect our attention to the breath or to the observing mind, which may be feeling aversion to the emotion, because the emotion will undoubtedly come up again when we can meet it with more wisdom. I believe though that even if we have gained some insight into the source of a particular emotion, without persistent application of mindfulness, we can’t be confident that it won’t arise again.
Quite certainly, in my case, the anxiety is related to a seemingly urgent sense of needing to live life meaningfully, and while that was stilled for a while on retreat, it has come up to the surface again in the cloud of uncertainty that hangs over my day to day and in the semi-isolation I have imposed on myself without the structure and discipline of before (as I alluded to in my last post). And again, if not aware, engaging in social media can exacerbate this.
While I do very much believe in the application of mindfulness meditation for the treatment of stress, difficult emotions, and the conditions associated with them, I also question an entirely secular approach as a stand-alone treatment. Knowing that even after 7 months of intensive meditation practice and with a tremendous amount of saddha, I still struggle with a lesser-grade anxiety condition, I suspect that it would be very challenging for someone that lacks that faith in the benefits of meditation and the Dhamma, and who may suffer from a more serious condition, to persistently apply mindfulness in such a way that it could have significant results.
But read up on it, I’m just one meditator so don’t take my word for it.
In the interview “What Is True Happiness?” (PDF), Tricycle, Fall 2005, B. Alan Wallace, director of the Santa Barbara Center for Consciousness Studies, talks about the importance of faith and, even more so, practice in order to live a meaningful life and understand the cause of stress. He refers to that niggling dukkha, and discusses it in the context of the Four Noble Truths and of modern psychotherapy. To paraphrase, he says that that depressive quality, that ever present hum of discomfort, is our golden opportunity. But far too often, on the advice of conventional society and mental health professionals, we treat only the symptom. Truly what we need to do is look at the cause of the suffering, understand it and learn from it. As my teacher has said, vipassana means, “face it, learn it, get it”.
So let’s get to the root of it and let’s do it through practice. But let’s also be wise and know what are skillful means and when to employ one over the other. There is no quick solution to dealing with stress, anxiety, fear, dukkha, but there is no doubt that by walking the path the Buddha laid out and practicing right mindfulness (samma sati), we can go a long way toward understanding it.
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Studies on Mindfulness-Based Therapies and Meditation to Treat Anxiety, Etc.
Hofmann, Stefan G.; Sawyer, Alice T.; Witt, Ashley A.; Oh, Diana. “The effect of mindfulness-based therapy on anxiety and depression: A meta-analytic review”, Journal of Consulting and Clinical Psychology, April, 2010 Volume 78, Issue 2, Pages 169-183
Kabat-Zinn, J., Massion, A. O., Kristeller, J., Peterson, L.G., Fletcher, K., Pbert, L., Linderking, W., Santorelli, S. F., “Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders”, Am. J. Psychiatry (1992) 149:936-943.
Miller, J., Fletcher, K. and Kabat-Zin, J., “Three-year follow-up and clinical implications of a mindfulness-based stress reduction intervention in the treatment of anxiety disorders”, Gen. Hosp. Psychiatry (1995) 17:192-200.
Evans, S., Ferrando, S., Findler, M., Stowell, C., Smart, C., Haglin, D. “Mindfulness-based cognitive therapy for generalized anxiety disorder”, J Anxiety Disord. 2008 May;22(4):716-21. Epub 2007 Jul 22.
Zylowka, et al. (2008). “Mindfulness meditation training in adults and adolescents with ADHD.”. Journal of Attention Disorders, 11, 737-746 (somewhat related)
And Some Blog Posts…
Finding Relief from Depression Through Mindfulness
A Buddhist Perspective on Coping with Anxiety
Online Mindfulness-Based Anxiety Therapy
A Video from Yongey Mingyur Rinpoche
Using Panic Attacks for Meditation
And Some Books to Consider (caveat: I haven’t read ’em)…
The Mindfulness Code: Keys for Overcoming Stress, Anxiety, Fear, and Unhappiness, by Donald Altman (you can also listen to an interview with the author, where he talks about overuse of technology and social media as part of our unhappiness, here)
The Mindful Way through Depression: Freeing Yourself from Chronic Unhappiness, by Mark Williams, John Teasdale, Zindel Segal, and Jon Kabat-Zinn
The Mindful Path Through Shyness: How Mindfulness & Compassion Can Help Free You from Social Anxiety, Fear, & Avoidance by Steve Flowers and Jeffrey, M.D. Brantley
on the precipice 
sharanam
/ July 6, 2010And here’s a commentary from Elisha Goldstein, the author of Mindful Solutions for Stress, Anxiety and Depression and A Mindfulness-Based Stress-Reduction Workbook at the Huffington Post:
Mindfulness Strategies for Anxiety and Depression