New approach to treating anxiety disorder

People who experience anxiety disorder – about 6.8 million adult Americans, twice as many women as men - have reason to keep tabs on the work being done at leading research institutions to improve treatments. A $2.4 million National Institute of Mental Health backed project under way at UMass Boston may well lead to widespread use of a new therapy for generalized anxiety disorder (GAD) that has shown much promise in clinical trials.

A team of investigators led by UMass Boston associate professor of psychology Lizabeth Roemer is comparing a mindfulness- and acceptance-based behavior therapy for GAD to an older, established treatment, which should lead to better matching of treatments to clients. In 2001 Roemer and her collaborator, Dr. Susan Orsillo of Suffolk University developed a therapy for generalized anxiety disorder that integrates mindfulness-based, as well as other acceptance-based, strategies into a behavioral approach to treating this chronic anxiety disorder.

GAD is characterized by excessive, uncontrollable, irrational worry about everyday things. Commonly occurring with other psychological disorders, GAD has been the least successfully treated of the anxiety disorders.

Roemer and her colleagues believe that better targeting of the function of worry and the nature of GAD is necessary. “Recent developments in understanding worry and GAD suggest the potential utility of mindfulness and acceptance-based elements in treating GAD,” she says. In the context of this work, this new approach means “paying attention, on purpose, in the present moment in a nonjudgmental way to both internal and external sensations.” The researchers propose that mindfulness may help individuals to respond to their naturally occurring internal experiences more adaptively and to lead richer, more satisfying lives.

The National Institutes of Health is financing more than 50 studies testing mindfulness and acceptance techniques, up from 3 in 2000, on a variety of applications, such as to help relieve stress, soothe addictive cravings, improve attention, and reduce hot flashes. For all these hopeful signs, the science behind mindfulness and acceptance techniques is in its infancy.

Roemer's hypothesis however appears to be well supported by the body of work on the subject. Studies have shown that worry plays an “avoidant” role in GAD that may be highly responsive to the practice of mindfulness. “Worry appears to reduce distressing internal experiences in the short-term, although it likely prolongs them over time by interfering with emotional processing… and limiting the ability to respond adaptively,” says the study’s co-principal investigator, Dr. Susan Orsillo of Suffolk University. “Experiential acceptance, which mindfulness practice promotes, may be the solution.”

Preliminary findings from an open trial have been encouraging, as has a controlled trial that compared the treatment to the effects of normal maturation and other influences. “This novel treatment seems to be targeting the phenomena at which it is directed, with corresponding improvements in symptoms and quality of life,” says Roemer.

Orsillo’s and Roemer’s book Acceptance- and Mindfulness-Based Approaches to Anxiety: Conceptualization and Treatment (Springer, New York, 2005) placed mindfulness and acceptance into the clinical lexicon, establishing links with established traditions, including emotion theory and experiential therapy.

The latest National Institute of Mental Health funding is for a large-scale follow-up study that will further validate if and how the unique features of mindfulness and acceptance-based behavior therapy make it more effective. The results of that study will be telling, but regardless, individuals with generalized anxiety disorder can now look to the future with more hope.