This morning, in-between seeing patients on rounds with the neurology team, we were discussing the potential for psychological disturbances to manifest themselves as physical symptoms.
The mind body connection is strong, so much stronger than we may ever fully realize. (I find it so encouraging that a topic such as the mind-body connection is being discussed among the medical community on morning rounds, but that’s beside the point.)
Our brain constantly receives input from millions of sensory nerves delivering tactile, noxious, thermal, proprioceptive, visual, auditory, olfactory or gustatory information from every micrometer of our body. Typically, our brain is adept at filtering these sensations in order to hone in on those that are most relevant and acute so that we may give our full attention to what matters most.
Mindfulness elevates our perception of these inputs so that we may become more aware of any number of these sensations at a given time. For the most part, this is a very good thing. It allows us to become more intentional—to live life with a little more presence and to avoid missing out on the little things that we often later find out were the big things.
This can be particularly helpful in the setting of medical conditions that involve perception as a key component, such as Attention-Deficit-Hyperactivity-Disorder (ADHD), phobias, anxiety, and chronic pain. Ironically, in the same way that mindfulness has the potential to help manage anxiety, it can also make it worse.
The key problem with anxiety is the underlying maladaptive tendency to perceive the world as inherently dangerous and uncontrollable. Mindfulness, though potentially therapeutic, can rewire our brains to be able to bring any number of sensations into the realm of conscious thought at a given time. These sensations, which would previously have gone unnoticed by the less mindful person, now give the anxious mind more material to distort from benign into potentially threatening.
For example, focusing on the breath can create sensations of having difficulty breathing, focusing on swallowing can create the sensation of difficulty swallowing or the presence of a foreign body—a condition known as “globus hystericus.” Many times, I have been told by people who admittedly struggle with anxiety that being told to focus on the breath in a yoga class—a presumably calming activity for most people—is enough to tip their latent anxiety over the edge. Normally, these transiently worrisome thoughts can be redirected, but when we start to become intensely aware of every sensory input, the anxious mind may magnify them to the point of causing an acute exacerbation of the anxiety or even a panic attack.
The idea behind mindfulness is, of course, to observe these sensations from a non-judgmental neutral space without acting on them (the potentially therapeutic effect), but sometimes we’re not able to get to that point. Particularly anxious people (myself included) may only get to the noticing part of the practice, which then sends them into a tailspin of anxious thinking—one anxious thought leading to the next.
This is not to say that we all shouldn’t practice mindfulness. The practice of mindfulness most certainly can unlock the door to freedom for people struggling with various medical conditions and can help even those who don’t to get more out of their lives. It can help us to live with more ease and less struggle—to cultivate an impenetrable sense of peace and contentment unaffected by the fluctuations of our surroundings. Rather, I write this to suggest that for some of us it may get worse before it gets better. And, in true mindful fashion, we should try not to judge ourselves if this is the case.
Now, what to do about it?
If the little voice inside your head is screaming, “Hey! That’s me! She’s talking about me!” as you’re reading this, or if you’ve just never been able to buy into the whole meditating-on-the-breath-thing, don’t lose hope just yet. Rather than giving up on the practice of mindfulness altogether, simply try switching the focus of your attention from a somatic sensation—one that is malleable and, depending on who you are, can be distorted into something potentially threatening—to one that is invariably neutral and disconnected from your perception of self.
Whether the problem is anxiety or that you simply find it difficult to focus on the breath or any other bodily sensation (I experience both), shifting attention to something more tangible may help unlock the door to the benefits of mindfulness. The object of your attention can be anything you’d like—a candle flame, your favorite mantra, mala beads, your surroundings as you take a walk outside, tonight’s dinner—the list is endless.
The breath is an obvious choice for mindfulness meditation because it’s free, permanent, and is inevitably always with us, but it’s far from the only one.
BONUS VIDEO: Contemplation Practice: The Four Reminders that Turn the Mind Towards the Dharma
Relephant Favorite:
How Mindfulness Helped My Fear of Public Speaking.
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Author: Jessica Johnson
Editor: Travis May
Photo: Used with permission, courtesy of Eva Fuze
Arun Eden-Lewis 
Dr. John Douillard 
Elyane Youssef 
Galina Singer 
Waylon Lewis 
I am so happy to read this as I can definitely relate. It didn't make any sense to me before, as we are taught that mindfulness reduces anxiety but you raise some very good points. I will definitely be trying your suggestions!
Noticing the anxious habitual response to your object of meditation will in and of itself lessen the anxiety in the long run. The practice is called mindfulness/awareness practice and they occur simultaneously . Group practice and a meditation instructor could prove helpful as well
Absolutely, Cathy. That’s where the benefits of mindfulness in treating anxiety come in, but reaching the point where it actually becomes helpful requires persistence. It’s important that we (people who struggle with anxiety) understand that things may seem to get worse before they get better so that we don’t write off the practice too quickly. It’s all a process. Thanks for highlighting that point!
Excellent conversation! The word "mindfulness" was the word of 2015, so it's important we discuss what that means and the various qualities that we can experience when practicing mindfulness. I can definitely see how we can become over sensitized, hyper focused, and how this can increase anxiety. However, as was mentioned in the article, we don't need to place judgement about these feelings of being anxious. Might I also add that initially when practicing mindfulness, there may come a subtle (or sometimes overt) feeling of attachment. It can manifest as wanting to hang on to a sense perception, feeling, or even the thought of maintaining a state of mind, which are possible indications of resistance and I think it is within this juncture that anxiety begins to churn. We can practice being mindful by noticing a short glimpse of awareness, but we don't need to hang on to it. I myself could not imagine practicing mindfulness in daily life without some formal meditation practice to anchor me. I often wonder if our society is wanting the "sound bites" of mindfulness and missing the deep connection of earthiness that a formal practice offers. Building the roots of a steady practice may serve us greatly when we feel flooded by this highly overstimulated culture.
What a rich topic!! One that is much appreciated by this therapist and yoga instructor. Thank you!
A very good article on a topic I have not seen addressed before; I can very much relate. THANK YOU: your article was very helpful–it certainly takes someone who feels Anxiety to understand how it may manifest during Meditation.
And Thank You too Ken for your friends' Mantra that: "Nothing needs to be done write now." I have written that one down for future use… 🙂
Well spoken. A friend of mine offered me a mantra that sometimes works for me – “Nothing needs to be done right now.” I like this because it’s simple and offers a good foil to the anxious part of my brain (which is my default) and helps dispel the illusion that worrying will somehow keep me safe. The other thing I like about it is the temporal statement of saying nothing needs to be done right now. That removes the pressure for me of thinking that I have to come up with a permanent solution to my anxiety; it offers the invitation to return to being anxious after I meditate (not that I want that..). There’s something about that “right now” piece that works well for me.
That's a very simple yet powerful mantra, Ken. I'll have to tuck that one away. Thanks for sharing!
Well said. Pertinent points. You had me at, are we really talking about this at rounds.
Thanks for reading, Margi! I appreciate the feedback.
great article, thank you. I can totally relate to this notion of anxiety being increased by mindfulness practice. I find it helpful to play with choosing different objects of focus; internal and external; in order to remain in a 'safe place'. I find mindfulness of sounds particularly calming. I also find the mantra "just this moment", and the principles of opening up and creating space for my anxiety to sit with me, non-judgement, acceptance, confidence, patience very helpful when feeling my bodily sensations lead to anxiety; aswell as remembering that I do not need to want things to be different to how they are in this moment. When I feel my anxiety taking up too much space, I also try to broaden my awareness to include more than my anxiety. Loving being part of this community, may you all be at peace.
Thanks for the thoughtful comment, Alicia. I appreciate you taking the time to read, but most importantly to share your own experiences. Wishing peace to you as well.
Very helpful. I've asked Buddhist teachers about what I call "sensory overload" that I experience at times when I practice being fully present and/or mindful, but I never really got a helpful answer. I guess maybe it takes one to know one, meaning that if you don't struggle with anxiety, then it is hard to relate to how sensory overload may happen during meditation or a mindfulness practice (and/or how to deal with it). Thank you for "getting it" and talking about it.
Hi, Holly! "Sensory overload" is exactly right. I'm so happy that this article found its way into the hands of someone who struggles with this as well. Thanks for sharing!
Or you could skip the meditation altogether. There are many ways to me mindful. My grandmother was the most present person I ever met… Never meditated a day in her life as far as I know. If it sounds like I’m against meditation myself, I’m not. I do it myself daily, but I don’t care for the dogmatic belief that we MUST meditate. Only a fool does something that makes it worse.
Very true, Rick. Different things work for different people. On the other hand, not everything needs to be (or is) so black and white. I find it helpful to try adapting my approach before throwing in the towel all together, but if you find something's not for you any way you look at it then, yes, by all means throw in the towel. There's no gold medal for meditating, after all 🙂
A lovely article. You are a gifted writer. Meditation can and should be practiced, especially if you have ADHD. It may take a little more work in the beginning, but the benefits are glorious.
Thank you, Lolen! I appreciate your feedback and kind words.
I really like and identified with what you said here. My only addition is that I think at some point -- maybe after a person gets used to focusing on an object rather than their breathing -- it may be helpful to practice focusing on your breathing or other sensory input. I say this because it is the very process of sensory input providing us something new to be anxious about, that it is helpful to work on changing. So in my instance, I used to be anxious when I would meditate (although not to the degree you describe in your article). My anxiety was more a persistent feeling that I was doing it wrong - that I wasn't belly breathing, that my mind wasn't under proper control, that I wasn't sitting up straight, etc etc. A breakthrough for me was when I realized that those anxious impulses to worry about those things are the very things mindfulness can teach us to notice, identify as unhelpful, and stop responding to. And I use the phrase "stop responding to" intentionally: we don't always have the power to control what comes in our mind, but we have relatively more power in deciding whether we will believe it or honor it as some important thing. I guess to sum up, it was the recognition that my anxiety during meditation was just useless noise, sound and fury signifiying nothing, that has helped me get a little more comfortable focusing on my breathing without going into a tailspin about whether I was doing it "right."
Also I have generalized anxiety disorder and ptsd, and i am hyper-sensitive to sounds/noises. In 2002, my therapy involved body scans in order to relax me to help me fall asleep. I returned to my therapist and complained about my anxiety increasing exponentially while i lied there doing body scans and breathing. I said i felt like i was going to suffocate, and i felt anxiety all up and down my body. I said i have chosen to immediately discontinue it. It increased my anxiety for days. She said, "really? that doesnt normally happen." So i stay away from breathing exercises, deep breathing suggestions, and "'simply just breathe/relax'" slogans.
The issue is that some popular American authors have made RELAXATION, particularly body-scans while breathing, into "mindfulness practice", the idea being that you are 'aware' of the body, so therefore you must be practicing mindfulness! I dont buy it. As a result, the medical community/ and therapeutic community has unfortunately mislabeled this body-scannning/breathing as "mindfulness". For me, mindfulness is more all-encompassing sense of connectedness to my surroundings, the earth, groundedness, and my spirit. Body-scanning and breathing just increases my anxiety and makes me notice the anxiety, which then generates more anxiety. SO instead i use grounding techniques, humming, mantras/phrases, singing to myself, walking barefoot in the grass, and nature contemplation, smiling; i use these tools to ground myself and connect myself to my own wholeness. THERE IS NO NEED FOR BREATHING SLOWLY OR BODY SCANNING> those are just TOOLS that SOME people use.