Mindful Therapy Group for Anxiety

My Story with Mindfulness Groups

Some years ago a treatment center in LA asked my husband and I if we would come lead meditation groups for the clients. At the time my only experience leading meditation groups was reading out loud from a script once a week at a recovery group. Even there I was not really leading the group so much as I was facilitating and following a pre-made format. When the treatment center called, I felt completely unqualified.

Despite my fear I began leading this weekly meditation group for people in recovery. It was this experience that got me interested in becoming a therapist. Every week I would show up and I began thinking that I was essentially leading a mindful therapy group, but I still didn’t have any credentials to do that. As I was approaching the end of my undergraduate career, I started to think about going to graduate school to become a licensed therapist.

During my time in graduate school I have continued to work with other treatment centers leading mindful therapy groups. What draws me to leading these groups is that mindfulness and meditation helped me with anxiety and recovery. I am grateful that I get to work with people and bring them the very tools that have helped me create a happier less stressful life.

As a therapist, I try to base my modalities and interventions off of evidenced based practices. Rather than trying things and hoping they work, I want to know how and why what I am doing is effective. Through this lens, I have gotten to go back and look at why mindfulness is do helpful for treating anxiety.

Cooking Light 1

Meditation and Mindfulness in Group Therapy

My Group Format

Meditation and mindfulness are sometimes elements of group therapy and other times they are the focus of group therapy. For my groups I use meditation and mindfulness as the focus of the whole group. I start each group with a brief check in where everyone goes around and says how they are feeling. Then I lead a 10-20 minute guided meditation. I try to pick the type of meditation we do based on what people are dealing with that day. If many people check in and say that they are coping with anxiety, I focus on a relaxation meditation.

After the meditation I open it up to the group for any questions or comments about the meditation. I also offer some psychoeducation about the type of meditation we just did. This way we can have a conversation about the experience of meditation while also learning about how and why meditation is useful. This might include education about how breathing can calm the body or how thought recognition can help us worry less.

Ways to Use Mindfulness in Group Therapy

Many other therapy groups are not focused on meditation or mindfulness but they do use some elements of these practices in the group. I have heard other therapists say that they start each session with a short 2-5 minute grounding exercise. I also know therapists who teach breathing techniques to clients. Elements of mindfulness that you might find in group therapy include:

  • Breathing techniques
  • Guided meditation
  • Recognizing thoughts
  • Somatic experiencing
  • Feeling your feet on the floor
  • Mindful listening

Mindfulness-Based Cognitive Group Therapy

One particular type of group therapy has been shown to be particularly effective for helping people who are coping with anxiety. Mindfulness-based cognitive group therapy, or MBCT for short, is derived from mindfulness based stress reduction. MCBT often includes helping clients recognize thoughts, breath meditation, and psychoeducation. This therapeutic approach that was developed by Zindel Segal, Mark Williams, and John Teasdale in order to help clients recognize their thoughts and moods without reacting to them.

Anxiety Group Therapy

Anxiety

What Is Anxiety?

The APA defined Anxiety as an emotion that is characterized by a combination of worried thoughts and physiological arousal. The DSM-5 lists a number of anxiety disorders including generalized anxiety, social anxiety, post-traumatic stress, and more. In addition to these specific anxiety disorders, many other disorders have anxiety listed as a symptom.

According to the National Institute of Mental Health, an estimated 19% of adults in the US meet the diagnostic criteria for some anxiety disorder in a given year. Given that anxiety is also listed as a symptom of many other disorders, it is likely that the percentage of people who cope with anxiety in a given year is actually much higher. Because anxiety is so common in the US it is crucial to develop an effective treatment for anxiety.

Therapy Groups for Anxiety

There is evidence to suggest that group therapy is an effective treatment for anxiety disorders (Wergeland et al., 2014). Researchers found that there was no difference in how effective individual vs. group therapy were for treating anxiety. This means that group therapy would be just as effective as individual therapy for people who are coping with anxiety. However, there are some possible benefits to group therapy, including:

  • Treating more than one person at a time
  • Social learning
  • Social facilitation

Mindfulness and Meditation for Anxiety

Many clinicians use meditation or mindfulness in group therapy in order to help lower client’s anxiety. Recent research has demonstrated that there is good reason therapists might do this: it works! Research has also shown that mindfulness-based cognitive therapy can helpful for treating for a variety of anxiety disorders including social anxiety disorder, posttraumatic stress disorder, and generalized anxiety disorder (Evans et al., 2008; King et al., 2013; Koszyckia, et al., 2007; Thurston et al., 2017).

Mindfulness-based cognitive therapy can be used with groups in order to treat symptoms of anxiety as well as anxiety disorders. In 2014 researchers Kim, Kim, & Ki found that using breath meditation in group therapy helped reduce anxiety in children. The participants in this study also reported more feelings of well-being after breath meditation. This shows that the participants felt the meditation was effective.

Additionally, research has demonstrated that mindfulness-based group therapy is helpful for reducing anxiety in people with social anxiety disorder (Kocovki, Felming, & Rector 2014). This research suggests using mindfulness in group therapy might help lower client’s anxiety.

Closing Thoughts

Anxiety is an important topic to address given how many people deal with anxiety and stress in the United States. My interest in the topic came from my observations of clients in the groups I was leading. I noticed that the number one thing people were trying to cope with was anxiety. I now work with teenagers as well as people in inpatient treatment for addiction. In both of these settings, I have observed that people cope with anxiety for many different reasons. Some people might feel anxious due to family problems, physical withdrawal, school, and more.

I like mindfulness-based group therapy because it can teach clients tools for coping with anxiety that can be used regardless of the source of the stress. Rather than helping clients reduce anxiety in one particular situation or with one disorder, mindfulness techniques may help clients cope with anxiety whenever and however it arises.

Sample Agenda

Week One: Informed Consent, Confidentiality, What Mindfulness Is and Isn’t

75 Minutes Total

5 minutes – Short introduction to the group

  • Present the agenda for the day and let clients know we will always start with a check in about how they are doing.
  • Tell the clients that today will be slightly different than most days because it will partially be an introduction to the group.

5 minutes – Check in

  • Ask client to check in by introducing themselves.
  • Please say your name, how you are doing right now, and one thing you are hoping to get out of this group.

10 minutes – Informed consent and confidentiality

  • Review informed consent and guidelines for confidentiality
  • Leave time for questions, concerns, and comments

10 minutes – Creating group Guidelines activity

  • Together we will come up with some ground rules for how we want the sessions to go.
    I would like everyone to contribute something to these guidelines and for us all to agree upon them once we have created them.

20 minutes – Introduction to mindfulness and meditation

  • What is your experience with mindfulness and meditation?
  • What do you think mindfulness means?
  • Provide education about what mindfulness is and correct misconceptions about meditation and mindfulness.
  • Psychoeducation about the benefits of meditation for anxiety.
  • Allow time for processing. What are you excited for? What are you afraid of?

15 Minutes – Guided breath meditation

  • The counselor will give a few short tips about how to sit for meditation. You can have your eyes open or closed. Also if you need to start meditating at any time you can look around the room and come out of the meditation but please remain sitting. If you are too overwhelmed and absolutely must you can get up and leave the room.

Lead a meditation focused on building concentration and awareness of the breath.
10 minutes – Process, check out, homework

  • What did you notice during the meditation
  • What was difficult about meditating?
  • Do you have any questions before we wrap up?
  • The counselor will introduce the check out and say we will end each group with one word about how we are feeling. The counselor will also assign and hand out any homework for the week.

References

Kind, A.P., Erickson, T.M., Giardino, N.D., Favorite, T., Rauch, S., Robinson, E., Kulkarni, M., Liberzon, I., (2013). A pilot study of group mindfulness-based cognitive therapy (MBCT) for combat veterans with posttraumatic stress disorder. Depression and Anxiety 30(7), 638-645. doi: 10.1002/da.22104

Evans, S., Ferrando, S., Findler, M., Stowell, C., Smart, C., & Haglin, D., (2008). Mindfulness-based cognitive therapy for generalized anxiety disorder. Journal of Anxiety Disorders 22(4), 716-721. doi:https://doi.org/10.1016/j.janxdis.2007.07.005

Kim, S., Kim, G., & Ki, J., (2014). Effects of group art therapy combined with breath meditation on subjective well-being of depressed and anxious adolescents. The Arts in Psychotherapy 41, 519-526. doi: http://dx.doi.org/10.1016/j.aip.2014.10.002

Kocovski, N.L., Fleming, J.E., & Rector, N.A., (2009). Mindfulness and acceptance-based group therapy for social anxiety disorder: an open trial. Cognitive and Behavioral Practices 16(3), 276-289. doi: https://doi.org/10.1016/j.cbpra.2008.12.004

Koszycki, D., Benger, M., Shlik, J., & Bradwejn, J., (2007). Randomized trial of a meditation-based stress reduction program and cognitive behavior therapy in generalized anxiety disorder. Behaviour Research and Therapy 45, 2518-2526. doi:/dx.doi.org/10.1016/j.brat.2007.04.011

Wergeland, G.J., Fjermestad, K.W., Martin, C.E., Haugland, B., Bjaastad, J.F., Oeding, K., Bjelland, I., Silverman, W.K., Ost, L.G., Havik, O.E., & Heiervang, E.R., (2014). An effectiveness study of individual vs. group cognitive behavioral therapy for anxiety disorders in youth. Behaviour Research and Therapy 57, 1-12. doi: https://doi.org/10.1016/j.brat.2014.03.007

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