Anxiety is one of the main reasons why people seek psychological help . Whether in the form of phobias, generalised anxiety, obsessions, panic attacks, anxiety derived from stress, etc.

In my practice in Las Palmas de Gran Canaria I see people with anxiety disorders every day. It is a great effort that I make together with my patients to prevent anxiety from continuing to control their lives. And the effort is rewarded, since a very high percentage of them manage to achieve the well-being they so much need. What can be done in therapy in these cases? Let’s look at it.

What is the usual treatment for anxiety?

Pathological anxiety has two main symptoms that are the focus of treatment. One of them is worry or anxious thoughts. The other is the overactivation (nervousness, tension, tachycardia, etc.) that accompanies the cognitive component.

Traditional cognitive-behavioral therapy focuses its treatment on these two components as follows:

For physiological overactivation

Relaxation techniques are used, such as controlled breathing or progressive muscle relaxation. Exposure exercises are also performed, when possible, to situations that cause anxiety.

By approaching the anxious stimuli, an habituation to these is produced, reducing the sensation of nervousness.


As regards concerns, cognitive verbal restructuring and behavioural experiments have shown great effectiveness.

With the help of restructuring, concerns are beginning to be recognized and identified. On the other hand, there is a debate about intolerance to uncertainty and the need to deal with the feeling of not being able to control certain aspects of life. The usefulness of the concerns is also re-evaluated and the beliefs that support them are worked on.

Finally, behavioral experiments are created to expose the person to the results of the predictions of their concerns. Thanks to these experiments , patients’ beliefs are disconfirmed , which usually predict much worse results than what happens in the end.

The utility of Mindfulness

Cognitive-behavioral therapy for anxiety, in each of its manifestations, has been scientifically proven to be effective in many studies. So… Why include Mindfulness in the treatment?

The difficulty of controlling thoughts

It is well known that trying to control or change thoughts is an arduous task. Sometimes we fail to remember something we want, and sometimes anxious thoughts come to our mind without control. In fact, the harder we try to remember, the more we block ourselves out. And the more we try to forget, the more present our thoughts are .

It is estimated that we have about 4,000 thoughts during our waking state, which last only a few seconds, and rarely have to do with the task at hand. They are automatic thoughts of all kinds, some neutral, some pleasant, many of them absurd and some of them unpleasant.

People with anxiety problems often get hooked on unpleasant thoughts and recreate them over and over again , along with a fractious mood.

An alternative solution

Many of the automatic thoughts that cause us distress, as well as some of the beliefs that govern our lives, can be reevaluated and restructured. These changes that are produced thanks to the rationalization of certain thoughts and mental schemes result in an improvement in the quality of life and the well-being of people.

But there are times when thoughts or beliefs cannot be changed, or doing so may lead to greater discomfort than the present. That is where I have found the extraordinary usefulness of third generation therapies.

Acceptance and Commitment Therapy (ACT)

ACT belongs to the latest generation of cognitive-behavioral therapies, and emphasizes the need to let go of control of internal events and accept experiences as they come . One of the most serious problems we suffer is due to the so-called “experiential avoidance”. We strive to avoid feeling or thinking unpleasant things and try to control them as we do external events.

If we want to stop watching TV5, we just have to change the channel. If we want to stop thinking that our child will have an accident when he goes out to party with the car, and not feel anguish about it, that is more complicated.

The result of avoiding at all costs these emotions, thoughts and physical sensations that we find unpleasant, is to stop living to devote ourselves body and soul to fight our “problem”.
The effort in the Acceptance and Commitment Therapy is put into recovering or finding a life with meaning, based on the values of each person .

For the management of intrusive thoughts, ACT has developed a technique called cognitive defusion . One of the goals of this technique is to make it seem that thoughts are just that, thoughts or memories, and that they should not be confused with their referents (real events that cause fear or anxiety).

Cognitive defusion is achieved when the patient reaches a more objective attitude and takes distance from his or her own thoughts , thus diminishing credibility and attachment to them, with a consequent improvement in mood.

What does Mindfulness bring?

Surely we all have an idea of what Mindfulness is by now. Its rise in recent years has caused it to become part of mass culture. Everywhere there are mindfulness courses, initiations and therapists. It is applied to almost everything and in any way, and it is sold as a global solution to any problem. But we must be rigorous and cautious, since the practice of any therapeutic technique must be supervised by professionals.

Mindfulness is understood as full consciousness and, although there is no precise definition of the term, several researchers claim that it is an experience characterized by attention to the present moment, without judgment and with acceptance .

Mindfulness aims to connect with the here and now, simply by paying attention and being aware of what we are feeling, thinking and doing in the present moment. The mind constantly wanders through the uncertain paths of the future, which causes us anxiety, or through the unrecoverable moments of the past, which make us feel melancholy. This constant temporal swaying of our mind leads us to abandon the only thing that is real for us, which is our ability to act in the present moment.

Mindfulness in Anxiety Disorders

This tool has proven to be a powerful ally of Cognitive Behavioral Therapy for anxiety disorders, since it contemplates aspects that have been neglected until now.

In clinical anxiety, physiological, emotional, cognitive and behavioural symptoms are related , all surrounded by the circumstances of each person. On many occasions, the problem of the anxious person is aggravated by the fact that he/she avoids unpleasant experiences.

Judging our thoughts, emotions or physical reactions as unpleasant, and merging with these internal events, wanting to control and avoid them at all costs, are the elements that maintain anxiety disorders.

These symptoms of anxiety are based on 3 cognitive biases that people with this problem have:

Selective care

People suffering from anxiety focus their attention on potential threatening stimuli , missing important additional information that occurs around them that has nothing to do with their anxiety.

Interpretive Bias

It is also common for these people to interpret neutral, or slightly threatening, stimuli as catastrophic.

Future-oriented thinking

In order to avoid the misfortunes that the cognitive biases described above predict, anxious people spend most of their time living in “what could happen” , rather than living in the here and now.

The Usefulness of Full Care

With the help of Mindfulness we teach patients to refocus their attention on the present moment . We make them, as soon as they notice that you are focusing their attention on thoughts of the future, bring their attention back to the present experiences.

By applying Mindfulness in the treatment of clinical anxiety, we can also work on behavioral or experiential avoidance, cognitive rigidity and the limited repertoire of behavioral responses of the patient.

The first thing that is done is to expand the awareness of the present moment and the experiences that take place there. This provokes a change in attitude towards life , diminishing the tendency to judge and control internal events.

The practice of mindfulness helps us to realize the natural dissolution of our thoughts and emotions, without leaving “residue” or “tracks” in our mind. We see how these internal events appear before our observing consciousness, develop, and disappear again.

Updating is the key

Psychology is a young science, as are evidence-based psychological treatments, and they are constantly being updated. It is necessary to include the latest therapeutic advances in the daily work of psychologists in order to provide the best service to patients.

The union of cognitive-behavioral therapy with the latest updates in contextual therapies, which also have proven scientific evidence, such as Mindfulness and Acceptance and Commitment Therapy, is a combination that increases the chances of success in therapy.

The serenity prayer says “…grant me the serenity to accept the things I cannot change, the courage to change the things I can change, and the wisdom to know the difference.

A professional psychologist, committed to his or her work, can help you identify and change the thoughts and emotions that are possible, and to know those that cannot be changed. Once you have identified the aspects of your life that cannot be changed, he or she will help you accept them and focus on the present. On the other hand, it will work with you to enhance your capabilities, orienting your life based on your values, and helping you achieve the well-being you so desire.