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Research is the process of going up alleys to see if they are blind.
—Marston Bates
There are many self-help books out there for anxiety problems. Most are written with the guiding intention to offer something that may be helpful. This was our intention in writing the first, and the second edition, of The Mindfulness & Acceptance Workbook for Anxiety too.
Still, we know that good intentions do not always translate into good outcomes. You know this yourself as well. You may intend to help someone but lack the skills or resources to make a difference. In the same way, writing a wonderful book is no guarantee that it will actually enrich the lives of those who read it.
The only way to really find out is to test the book by doing systematic research. And there are only three possible outcomes: (a) the book helps, and the lives of readers significantly improve; (b) the book hurts, and people get worse; or (c) the book doesn’t make one bit of difference, and people are no better off after finishing it than when they started.
Of course, most authors would love to hear that their book was helpful, but to know that, they need to be willing to find out if they were wrong. The only way to find out in an unbiased way is test the book itself using sound research methods. We did just that with first edition of The Mindfulness & Acceptance Workbook for Anxiety.
Here, we’d like to share what we learned and what it means for you.
WORKBOOK STUDY 1
The focus of this study was to see if this workbook is, in fact, helpful and in what ways. So, we designed a study to see if the workbook makes a difference in the lives of people just like you (Ritzert, Forsyth, Berghoff, Boswell, & Eifert, in press).
We recruited an international sample of 503 people who reported struggling with severe anxiety and depression. Our research team then randomly assigned them, by flip of a coin, to either begin using the workbook right away for a period of twelve weeks, or to be on a wait-list for twelve weeks. After the twelve weeks, we offered the workbook to those who were initially on the wait-list, who then used the workbook for a period of twelve weeks too. We then followed everyone to see how they were doing six and nine months later.
You should also know that we had no contact with any readers in the study, so there was no coaching or therapist guidance. All we asked was that participants read and work with the material in the workbook on their own. That’s it!
Improvements in Skills to Disarm Anxiety and Fear
As you will find out, this workbook teaches many skills to help foster a different kind of relationship with anxiety and fear. These skills include being less avoidant and less tangled up with difficult thoughts, and more present, flexible, compassionate, kind with yourself, and accepting of your internal experiences just as they are. In this study, we measured these facets of peace and genuine happiness at the beginning of the study, after twelve weeks, and six and nine months later.
The good news is the results strongly support the benefits we mention throughout the workbook. Readers who used the workbook reported significant and meaningful improvements in mindfulness, self-compassion, and the ability to detach from unpleasant thoughts; they also became less avoidant and more accepting of anxiety, fear, and other unpleasant emotions. These changes coincided with using the workbook. Those on the wait-list showed these benefits once they started working with the workbook, but not before. Most importantly, readers maintained their improvements at the six- and nine-month check in.
So, the bottom line here is one of justified hope. The results show that the workbook radically changes the relationship people have with their anxious minds and bodies. Moreover, the results also show that—in line with its strong focus on values and doing what matters—the workbook improves the quality of people’s lives.
What About Anxiety and Fear?
As you read the workbook, you'll find that we don’t focus much on anxiety and fear reduction. The reason is that it’s not the absence of anxiety and fear that brings true and lasting happiness. What truly brings us more genuine happiness and peace is the presence of a high quality of valued living. In short, learning to put your precious time and energy into what truly matters to you. That’s why we focus on improving your quality of life by helping readers move toward their values. Still, we did look at what happened to the anxiety and fear in this large study of people from all over the world. What we found will be good news to you.
Readers who worked with the workbook reported significant reductions in their anxiety, fear, worry, and depression. You may wonder how that might be. How could a book that doesn’t focus explicitly on anxiety reduction end up decreasing anxiety, fear, and worry as well as depression?
To get the answer, we reanalyzed the data using sophisticated statistical analysis (called multiple mediation, in case you're interested). We will walk you through what we found in the section below.
What Accounts for the Good Outcomes?
Using mediation analyses, we looked to see if the skills we emphasize in the workbook have anything to do with the reductions we found in anxiety and depression and the improvements in quality of life. It turns out that they do (Sheppard & Forsyth, 2009).
In fact, when you focus on learning the skills and cultivating a kinder and gentler relationship with your anxious mind and body, you will feel better. It is the skills that lead to anxiety lessening, depression lifting, and quality of life improving. It doesn’t work the other way around. Working to be less depressed and anxious does not lead to learning to be more skillful or having a better life. Let this sink in, and linger with it a bit.
Reductions in anxiety and fear did not happen by going after anxiety and fear directly. It was just the opposite. By first focusing on the skills needed to live a more valued life, readers then experienced a decline in their anxiety, fears, and depression, and ultimate improvements in their lives. This is an important message––one that supports the approach we offer in this workbook.
Above all, these findings mean that you should spend time focusing on the skills, for each will help you cultivate a new relationship with yourself, your anxious mind and body, and your world. This is how you will attain real relief from anxiety and fear and cultivate genuine happiness and satisfaction with your life!
THE TAKE-HOME MESSAGE
We took a risk in evaluating this workbook, and it paid off. In truth, we would have been fine if the results didn’t turn out as they did. But, across the board, the results show that the workbook works well and works in many ways.
But it only works for those who actually work with it. Readers in our study spent an average of four hours per week working with the exercises and material in the workbook, and most reported that it significantly changed their lives.
What this means is that to benefit, you need to be willing to take time with the material and allow yourself a chance to learn new skills. This is a point we stress throughout the workbook and is another reason we keep coming back to old themes and concepts throughout. All the skills you learn must be nurtured and carried into your life from this point forward. They are not to be tried and then forgotten. They must be lived and become your guiding light from here on out. It’s all up to you.
This is actually one of two studies we did to evaluate The Mindfulness and Acceptance Workbook. To keep things focused, we don’t spend a lot of time discussing our second study, which compared the workbook to a more traditional cognitive-behavioral workbook for anxiety (Russo, Forsyth, Sheppard, & Promutico, 2009). Nor do we cover another large study by Eifert and colleagues looking at the benefits of the ACT approach for highly anxious people receiving more traditional face-to-face therapy (Arch et al., 2012). But these studies support everything we’ve shared with you here.
Many other researchers are also exploring ACT for anxiety concerns, with positive outcomes. We know there’s more work to do, but you can be confident in knowing that you’re not walking into a blind alley without reason. There is hope for you to find genuine happiness and to get your life moving in ways that matter to you. Now it’s time to commit to doing that important work yourself.
We hope that the updates, new exercises, and materials we’ve included in this, the second edition of The Mindfulness and Acceptance Workbook, will set the stage for you breaking free from anxiety and fear so that you can embrace and live your life to the fullest.
Wishing You Heartfelt Peace
~ John
