Cognitive Interventions for Anxiety 223
2-hour group sessions guide participants in exercises that increase moment-by- moment
nonjudgmental awareness of bodily sensations, thoughts, and feelings. Daily homework
in awareness exercises is a critical component of the treatment. The rationale behind
mindfulness approaches is that a nonjudgmental “decentered” approach will counter the
automatic patterns of cognitive- affective processing that can lead to depressive relapse
(Segal et al., 2005).
Although clinical trials on the efficacy of MBCT are at a preliminary stage, there is
evidence that the intervention can significantly reduce depressive relapse rates in those
with three or more previous episodes of major depression compared with a treatment
as usual condition (Ma & Teasdale, 2004; Teasdale et al., 2000). Furthermore, MCBT
was most effective in preventing relapse/recurrence of episodes that were unrelated to
negative life experiences. Since MBCT is an adaptation of Jon Kabat-Zinn’s mindfulness
meditation that has been used extensively at the University of Massachusetts for reduc-
tion of stress, pain, and anxiety, it has obvious relevance for treatment of anxiety dis-
orders (see Germer, 2005; Kabat-Zinn, 1990, 2005; Kabat-Zinn et al., 1992). In a pilot
study 14 patients with panic disorder and eight with GAD received an 8-week group
meditation-based stress reduction and relaxation program (Kabat-Zinn et al., 1992).
Twenty patients showed significant reduction in BAI and Hamilton Anxiety scores at
posttreatment and a significant decrease in panic attacks. Although these preliminary
findings are encouraging, full randomized controlled clinical trials will be needed before
the full implication of mindfulness interventions for countering anxious cognition and
reducing anxiety states is known.
Acceptance and commitment therapy (ACT), introduced by Dr. Steven Hayes, is
a psychotherapeutic perspective linked to post- Skinnerian radical behaviorism that
focuses on the context and function of psychological phenomena (i.e., cognition) rather
than on its form and content (Hayes, 2004). ACT is based on an underlying philosophy
of functional contextualism in which the function of phenomenon (e.g., a worrisome
thought) is understood in terms of the whole organism interacting within a historical
and situational context (Hayes, 2004; Hayes, Strosahl, & Wilson, 1999). The goal of
functional contextualism is the prediction and influence of events that lead to psycho-
logical flexibility, that is, the ability to change or persist with functional behaviors that
serve valued ends (Hayes, 2004). The following is a brief description of the six core
therapeutic processes in ACT (for more detailed discussion, see Hayes, Follette, & Line-
han, 2004; Hayes & Strosahl, 2004; Hayes, Strosahl, Buting, Twohig, & Wilson, 2004;
Hayes et al., 1999).
••Acceptance—an openness to experience thoughts and feelings with nonjudgmen-
tal awareness; to embrace thoughts and feelings as they are rather than as events that
must be controlled or changed. Clients learn through various experiential and mindful-
ness exercises to psychologically accept even their most intense thoughts, feelings, and
bodily sensations.
••Cognitive defusion—refers to the process of objectifying thoughts so that thoughts
are viewed as merely thoughts and no longer fused with the self or personal experience.
A variety of techniques can be used to help clients defuse or separate themselves from
the literal meaning of thoughts such as having clients repeatedly verbalize a difficult
thought until it is merely heard without meaning or evaluation, or watch thoughts as
external objects without use or involvement (Luoma & Hayes, 2003).