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The
Mindful Way
through Break
Free from
Chronic Worry

Anxiety and Reclaim
Your Life

Susan M. Orsillo, PhD

Lizabeth Roemer, PhD
Foreword by Zindel V. Segal

THE GUILFORD PRESS

New York   London
© 2011 The Guilford Press
A Division of Guilford Publications, Inc.
72 Spring Street, New York, NY 10012
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All rights reserved

The information in this volume is not intended as a substitute for consultation with
healthcare professionals. Each individual’s health concerns should be evaluated by a
qualified professional.

No part of this book may be reproduced, translated, stored in a retrieval system, or

transmitted, in any form or by any means, electronic, mechanical, photocopying,
microfilming, recording, or otherwise, without written permission from the
publisher.

Printed in the United States of America

This book is printed on acid-free paper.

Last digit is print number: 9 8 7 6 5 4 3 2 1

Library of Congress Cataloging-in-Publication Data

Orsillo, Susan M., 1964–

The mindful way through anxiety : break free from chronic worry and reclaim
your life / by Susan M. Orsillo and Lizabeth Roemer. — 1st ed.
   p.   cm.
Includes bibliographical references and index.
ISBN 978-1-60623-464-8 (pbk. : alk. paper) — ISBN 978-1-60623-982-7
(hardcover : alk. paper)
1. Anxiety—Popular works.   I. Roemer, Lizabeth, 1967–   II. Title.
BF575.A6O77 2011
152.4′6—dc22
2010039235
 ebook
THE GUILFORD PRESS
 Praise for
the mindful way through anxiety
“Potentially of great benefit to anyone suffering from anxiety in this era of
relentless drivenness, social isolation, stress, and perpetual digital distrac-
tion. The authors’ wise counsel based on their own clinical experience and
research, coupled with vivid stories of their own and other people’s lives, pro-
vide compelling evidence for why mindfulness is so important in reclaiming
your life, and effective guidance in how to go about it in meaningful and very
practical ways.”
—Jon Kabat-Zinn, PhD, coauthor of The Mindful Way
through Depression

“If you’re looking for a fresh way of relating to—and healing—anxiety, you’ll
find this book an invaluable guide. The authors bring alive the path of mind-
fulness in a clear and accessible way.”
—Tara Brach, PhD, author of Radical Acceptance

“This book is user friendly, practical, and quite comprehensive. Readers will
benefit greatly from the insights and exercises provided in these pages.”
—Sharon Salzberg, author of Lovingkindness

“By far the most sophisticated and engaging guide I have seen on mindfulness
and anxiety. This book is a gem. Two of the field’s most knowledgeable and
creative experts skillfully take you on a journey into the hidden corners of
your anxious mind. With a seamless blend of interesting stories, state-of-the-
art research, and exercises, this book leads you step by step toward a fuller,
more meaningful life. It is an excellent resource for anyone who seeks a path
to freedom from anxiety and stress.”
—Christopher K. Germer, PhD, author of The Mindful Path
to Self-Compassion

“Anxiety is an emotion that begs us to mishandle it through worry and rumi-

nation. In a careful, step-by-step fashion, Drs. Orsillo and Roemer show you
how to use mindfulness to break free from the grip of anxiety and move for-
ward now toward the kind of life you want to live.”
—Steven C. Hayes, PhD, author of Get Out of Your Mind
and Into Your Life
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“Whether you suffer from milder worries or a clinical disorder, this book shows
you a clear, scientifically validated path toward feeling better. Lots of books
propose to teach how to beat anxiety. Some are good, others less so. The
Mindful Way through Anxiety is destined to be one of the best. Drs. Orsillo
and Roemer are renowned experts in the science of beating anxiety, and their
book is readable, informative, and practical.”
—David F. Tolin, PhD, coauthor of Buried in Treasures:
Help for Compulsive Acquiring, Saving, and Hoarding

“In the Alice in Wonderland world of emotions, anxiety is the Red Queen—
always a future threat and sometimes a present danger. This superb book
shows how mindfulness can help ease the ravages of anxiety. Nobody knows
more about this topic than Drs. Orsillo and Roemer, and their approach will
be a godsend for many.”
—David H. Barlow, PhD, ABPP, Professor of Psychology and
Psychiatry, Boston University, and Founder and Director
Emeritus, Center for Anxiety and Related Disorders
 contents

foreword v

acknowledgments vii

introduction: how this book will help you 1

1 understanding fear and anxiety: turning toward 9

your emotions

2 how is anxiety getting in your way? 38

3 changing your relationship with anxiety: 58
embarking on a new path

4 an introduction to mindfulness: noticing a skill you 75

already possess

5 developing the skills of mindfulness: how to bring kind 95

attention into your daily life

6 befriending your emotions 123

7 using mindfulness to clarify muddy emotions 135

8 the allure and cost of trying to control your 148

internal experience

iii
iv contents

9 acceptance and willingness: increasing flexibility 168

and opening up to new possibilities

10 clarifying what matters to you and setting a course 188

for change

11 bringing it all together: making a commitment to yourself 214

12 overcoming challenges to cultivating self-compassion 237

13 staying open when the going gets tough 259

notes 283

additional resources for anxiety self-help, psychotherapy, 293

and mindfulness practice

index 301

about the authors 307

 foreword

A t the turn of the 20th century, no less a psychological sage than

William James recognized that the present moment offers us a wonder-
ful vantage point from which to engage with distressing experiences.
But what he was less certain of was how this could be taught to others:
“the faculty of voluntarily bringing back a wandering attention, over
and over again, is the very root of judgment, character, and will . . . but
it is easier to define this ideal than to give practical instructions for
bringing it about.” Things have certainly changed since then. Today,
the clinical uses of meditative practices are oriented toward cultivating
a particular form of awareness, known as mindfulness, which originated
in the wisdom traditions of Asia. These practices, which have been
taught for millennia, have been faithfully adapted for use in modern
medical and mental health settings. As the authors of this wise and
practical book point out, they also fit remarkably well with the needs of
anxious clients who are intent on seeing beyond fitful cycles of worry
and engaging with those parts of their lives inadvertently sequestered in
the hope of averting further catastrophe.
Combining an accessible writing style with a surefooted clinical
sense of those moments when anxiety sings its siren song of protection,
the authors describe their approach with a heartfelt understanding of
how difficult beginning this work can be. Going against the grain is
never easy, much less for clients who are nudged to consider that many
of their surefire routines aimed at reducing fear turn out to work against
them. Clinical vignettes and case examples vividly illustrate how a nar-
row focus on the self and an unexamined preference for behaving in

v
vi foreword

ways that ensure an anxiety-free life have high costs, even if they deliver
relief in the short term.
The Mindful Way through Anxiety succeeds at conveying these essen-
tial insights in two distinct ways. Readers will find a gentle step-by-step
structure that first educates them about anxiety in its different guises
and shows the relevance of mindfulness backed by explicit guidance for
developing these skills. Once established, this sturdy mental platform
supports your engagement in practices that may appear at first counter-
intuitive or threatening, such as befriending emotions, letting go of con-
trol agendas, or sharpening the detail of bodily sensations, but turn out
to be at the core of this approach’s effectiveness. In addition, Drs. Orsillo
and Roemer’s work follows in the best behavioral and cognitive tradition
of teaching people how to change their relationship to anxiety rather
than eliminate it. Chapter by chapter, the reader comes to appreciate
how each of the specific interventions have embedded within them the
same metamessages of awareness, investigation, and compassion.
Many readers will use this book effectively on their own, but
because the format of their treatment can be so easily incorporated into
the framework of individual therapy, readers may choose to work with a
clinician to develop mindfulness skills in the context of regulating their
emotions. As demonstrated in outcomes from numerous clinical trials,
drawing on these skills throughout the day makes it easier to allow dis-
tressing moods, thoughts, and sensations to come and go without the
need to battle them. In time, those willing to commit to the practice
come to see that it is possible to take a wholly different approach to the
endless cycles of mental strategizing that are part and parcel of anxiety
disorders. What often comes as a surprise is that the route taken for
this new learning leads them to discover a range of inner resources for
growth and healing that they may not even have believed they pos-
sessed. What is clear is that on some occasions this new relationship
with anxious thoughts and feelings can cause those feelings to abate,
whereas at other times the best one can do is achieve a sort of détente
with his or her problematic emotions so that even in their presence
there is more room for living and valued action. Drs. Orsillo and Roe-
mer have done both therapists and their patients a tremendous service
in offering The Mindful Way through Anxiety as a guide to this valuable
but perennially challenging process.
Zindel V. Segal, PhD, University of Toronto
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 acknowledgments

S o many people have contributed to this book, by inspiring and

influencing our ideas, contributing to the process and content of our
approach to treating anxiety, and supporting us personally and profes-
sionally. It’s a daunting task to try to acknowledge them all and we’re
sure we have left some important people out. Interconnections and
influences of ideas and insights are so pervasive that we can’t accurately
identify them all. So we would like to begin by expressing our gratitude
to everyone who has contributed to our work, our lives, and this book,
in any way, including those who provided large and small offerings of
support and encouragement (such as serving us sustaining food and pro-
viding carpooling services), those who challenge us regularly to practice
and apply our skills, and, of course, those who have shaped our thinking
about mindfulness and anxiety.
Still, we would like to try to name some key people who helped
make this book and our work together happen. We are extremely
appreciative of the pioneers in the field who showed us how cognitive-
­behavioral therapy could be deepened and enhanced with the integra-
tion of acceptance and mindfulness. Their work inspired a profoundly
satisfying decade of personally meaningful clinical research aimed at
developing and testing the ways that effective therapies might better
promote life transformations. For this we thank Mark Williams, John
Teasdale, Zindel Segal, and Jon Kabat-Zinn, authors of The Mindful Way
through Depression, for modeling how to skillfully convey the healing

vii
viii ack nowledgments

potential of mindfulness to help people struggling with depression and

for inspiring our work with anxiety. We particularly thank Zindel for his
continual support of our work and our development over the years. Sim-
ilarly, we are deeply grateful to Steve Hayes, Kelly Wilson, Kurt Stro-
sahl, and Sonja Batten, whose work with acceptance and commitment
therapy (ACT) has informed and influenced our work immensely over
the years. Many of the exercises, metaphors, and principles in this book
are drawn from ACT. We’re also grateful to the many other psycholo-
gists who directly influence our work, including Andrew Christensen,
Sona Dimidjian, Christopher Germer, Leslie Greenberg, Neil Jacobson,
Marsha M. Linehan, Alan Marlatt, Christopher Martell, Doug Mennin,
Ron Siegel, and Paul Wachtel, as well as the Buddhist writers who shape
and inspire us, including Ezra Bayda, Tara Brach, Pema Chödrön, Lin
Jensen, and Sharon Salzberg.
We thank Tom Borkovec and David Barlow for their pioneering
work in the understanding and treatment of anxiety and worry, which
forms the sturdy foundation that we attempt to build on here. In addi-
tion to the tremendous contributions both have made as scientists and
scholars in the field, they have specifically informed and supported our
current line of research. We are deeply grateful to Kitty Moore at The
Guilford Press for encouraging us to write the book, believing we had
something important to share with people, and supporting us through-
out the process. We are extremely appreciative for the care and sensitiv-
ity Chris Benton brought to the task of helping us communicate our
ideas clearly and effectively. This book benefited immensely from her
ability to translate our intentions into easily readable prose. We also
thank Paul Gordon for designing such a beautiful cover.
We are indebted to Sarah Hayes-­Skelton for skillfully overseeing
our grant while we were immersed in the book and, more important, for
sustaining us with her friendship and support. We also thank Sarah and
the other therapists we work with for sharing their wisdom and experi-
ence to help us further develop our understanding of how mindfulness
can transform lives and free people from worry and anxiety. Most of all,
we are grateful to the clients we and our therapists have worked with
over the years. Their courage and willingness to turn toward their emo-
tions and move toward living lives that matter to them have inspired
and motivated us to share their lessons with other people struggling
with anxiety.
 ack nowledgments ix

I (S. M. O.) am truly blessed to have had the opportunity to write

this book with my long-term colleague and friend, Liz. It is a rare privi-
lege to collaborate with someone who can simultaneously inspire, chal-
lenge, and support your work in the ways that Liz has through our 15
years of shared research and scholarship. Even more rare is that this col-
laborative relationship is intertwined with such a deep and sustaining
friendship. Thank you, Liz, for the immeasurable ways you contribute
to my personal and professional life. I also had the good fortune while
writing this book to be surrounded by an amazingly supportive and fun
group of students and colleagues at Suffolk University. A special thanks
to Lisa Coyne, Gary Fireman, Amy Marks, David Pantalone, Tracey
Rogers, and Lance Swenson for their continuous support and friend-
ship. I appreciate the close network of friends and neighbors, particu-
larly Cathy McCarron and Kelly Bukovich, who graciously provided a
watchful eye and shuttle service to my kids when I was immersed in
writing. Finally, I am deeply thankful to my family for their support of
my work. Thanks to my parents, for their unshakable confidence in my
ability to pursue my academic goals. Also to my children, Sarah (14)
and Sam (12), for being willing to genuinely invite mindfulness and
valued living into our home and for allowing me to share some of their
stories. Most of all, I am thankful for the steady and unfailing love,
support, and encouragement of my husband, Paul. In addition to help-
ing in every practical way to co-­manage our crazy, hectic life, Paul has
supported and understood my need to deeply engage in this work and to
incorporate it into our shared life.
As always, I (L. R.) find myself at a loss for words when trying to
express my appreciation for Sue. Our friendship and collaboration is sus-
taining and enriching and makes everything—this book, our research,
my thinking, the dance party at our annual conference, my life—better.
One of the great joys of writing this book has been the way we worked
together, each one stepping in when the other was depleted for various
reasons, always improving both the process and the content with our
partnership. I also can’t possibly find the words to capture my immense
gratitude for my husband, Josh, whose wisdom, care, skillfulness, sup-
port, and experience contributed to every aspect of creating this book.
Josh’s deep commitment to “not sparing the dharma’s assets” led to his
insights being reflected throughout the book, without attribution. From
the first moment we were asked to write the book, Josh’s deep belief
x ack nowledgments

in our ability to write something that could truly be of service to oth-

ers has sustained my faith in that ability and kept me writing, rewrit-
ing, revising, and revising again. He has patiently provided advice and
guidance on every aspect of the book, from important ideas to vivid
examples to specific word choices, always improving the work with his
contributions. And his love, partnership, and friendship help me keep
living a life that matters to me every day. As always, I thank my students
past and present (and future) for teaching, inspiring, and motivating me
and enriching our work. I’m also deeply grateful for all the friends and
family, particularly my parents, who love and support me, even when I’m
immersed in an all-­consuming task and not nearly as attentive as I’d like
to be. Thanks especially to Carolyn, whose grace and courage during a
tragic time was a source of inspiration, and whose friendship is always
cherished. I also thank the members of the Boundless Way Zen and O2
Yoga communities for their support and their teachings.
Finally, we thank the National Institute of Mental Health for sup-
porting our work and this book with grants MH63208 and MH074589.
 introduction
How This Book Will Help You

F ear and anxiety are like a pair of overzealous bodyguards. Instead of

issuing sensible warnings about potential danger, they scream alarms
or nag incessantly. Rather than providing security so that you are free
to move through your daily life without constantly looking over your
shoulder, they lock you in your room. Rather than bringing you peace
of mind, they commandeer your attention until everything seems like
a potential threat, making it hard to pursue what matters most to you.
And once fear and anxiety take hold, it can be hard to loosen their
grip.
Of course, it’s only natural to respond to a warning by trying to
escape the threat. Once we know that danger lurks in certain places, it’s
wise to steer clear. But when we listen too zealously to anxiety and fear,
we can end up spending more and more time and energy fleeing and
avoiding—­physically, mentally, and emotionally. Our field of vision nar-
rows; our breadth and depth of experience shrink. We become impris-
oned by our self-­preservation instincts, our own reactivity. To break free
from anxiety’s tight grip on our lives, we need to cultivate a new type of
awareness—a compassionate, gentle, yet unwavering way of processing
our reactions and surroundings that doesn’t trigger an urge to head for
the hills. This awareness is called mindfulness.
Mindfulness makes it possible to build a new relationship with

1
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Chronic Worry and Reclaim Your Life 1st Edition
Susan M. Orsillo

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