Conquering Fear

The boss loves your work. Your spouse thinks you're sexy. The kids—and even the cat—shower you with affection. But then there's the Voice, the nagging presence in your head that tells you you're a homely, heartless slacker.

Even people who appear supremely fit, highly successful and hyper-organized are sometimes riddled with debilitating doubts, fears and self-criticisms.

"Most people are struggling with difficult thoughts and feelings. But the show we put on for others says 'I've got it handled,'" says Steven C. Hayes, a professor of psychology at University of Nevada-Reno. In reality, however, "there's a big difference between what's on the outside and what's on the inside."

Cognitive-behavioral therapy aims to help patients conquer their self doubts in two ways: Either by changing the behaviors that go along with it (I'm so fat—I need to get to the gym!) or by challenging the underlying thoughts, which are often distorted. (I'm 45-years old and I'm comparing myself to anorexic models. Get serious!)

Now, a third-wave of cognitive-behavioral therapy is catching on in psychology and self-help circles. It holds that simply observing your critical thoughts without judging them is a more effective way to tame them than pressuring yourself to change or denying their validity.

" 'Tame' is an interesting word," says Dr. Hayes, who pioneered one approach, called Acceptance and Commitment Therapy. "How would you go about taming a wild horse? You wouldn't whip it back into a corner. You'd pat it on the nose and give it some carrots and eventually try to ride it."

This new psychology movement centers on mindfulness—the increasing popular emphasis on paying attention to the present moment. One of its key tenets is that urging people to stop thinking negative thoughts only tightens their grip—"like struggling with quicksand," Dr. Hayes says. But simply observing them like passing clouds can diffuse their emotional power, proponents say, and open up more options. ("Here's that old fat feeling again. You know, this happens every time I look at fashion magazines. I am sure judging myself harshly. Do I want to go to the gym? Or I could go to a movie. Or I could stop reading magazines.")

"Part of what mindfulness does is get to you to recognize that these critical thoughts are really stories you have created about yourself. They are not necessarily true, but they can have self-fulfilling consequences," says Zindel V. Segal, a professor of psychiatry at the University of Toronto who devised Mindfulness-Based Cognitive Therapy to help depressed patients. "If you can get some distance from them, you can see that there are choices about how to respond."

Mindfulness also involves paying attention to your breathing and other physical sensations while observing your thoughts so you have a tapestry of information to consider, says Dr. Segal. In fact, neuro-imaging studies have shown that when people consider problems mindfully, they use additional brain circuits beyond those that simply involve problem-solving.

Although some critics initially dismissed mindfulness-based therapies as vacuous and New Age-y, dozens of randomized-controlled trials in the past decade have shown that they can be effective in managing depression, panic disorders, social phobias, sleep problems and even borderline personality disorder.

A study of 160 patients with major depression, led by Dr. Segal and published in the Archives of General Psychiatry last month, found that mindfulness-based cognitive therapy was just as good at as antidepressants at warding off relapses of depression.

The National Institutes of Health is funding more than 50 research studies involving mindfulness treatments for psychological problems.

A growing number of therapists are also using mindfulness-based acceptance in their practices. Katherine Muller, associate director of the Center for Integrative Psychotherapy in Allentown, Pa., says she sometimes brings out a little plastic gnome to represent a patient's negative feelings. "The idea is, 'These feelings are going to come. What are you going to do about them?' " she says. "You don't have to react to them at all. Just allowing them to exist takes away their power."

She also finds that practicing mindfulness is more effective at easing her own fear of flying than being reminded about the safety statistics.

On one flight, she says, "all my cognitive skills were going right out the window." Then another psychologist suggested focusing on the tray table rather than fighting her fears. "It helped me center my head and get a grip," she says. "It gave me a chance to watch the movie and talk to the person next to me, rather than focus on how the plane might go down in a fiery ball."

Psychologist Dennis Tirch, director of the New York Center for Mindfulness, Acceptance and Compassion-Focused Therapies, uses this formula to help even people with profound developmental disabilities take control of their emotions: "Feel your soles of your feet. Feel yourself breathe. Label your emotions and make space for your thoughts."

Extending some compassion for yourself is also an important part of the new mindfulness therapies, Dr. Tirch says. "I can't tell you how many clients I have who are just beating themselves up about things" says Dr. Tirch. "Give yourself a break—not so you can curl up in bed and stay home, but so you can interact better with the world."

Kindness and accepting your thoughts nonjudgmentally doesn't mean having to settle for the status quo, proponents say. Rather than be paralyzed by negative thoughts, you can opt to change your situation—get to the gym or work harder—but with a clearer set of options based on what really matters.

Some critics note that such advice doesn't sound so different from standard cognitive-behavioral therapy or being kind to the "inner child" of earlier psychotherapy approaches. And some experts say that still more scientific data are needed to evaluate its effectiveness, particularly now that it's being applied to such a wide array of disorders.

It's also not clear yet who might benefit most from mindfully accepting their thoughts rather than reasoning with them. For example, Dr. Tirch thinks that it's still important to convince someone with severe agoraphobia that a piano won't fall on their head if they leave the house.

Yet Marsha Linehan, a professor of psychology at the University of Washington, found that the acceptance therapy she developed in the 1990s enabled suicidal patients and those with borderline personality disorder to accept their feelings and get help while trying to challenge them would only have created more bad feelings.

"It's the nonjudgmental part that trips most people up," says Dr. Linehan. "Most of us think that if we are judgmental enough, things will change. But judgment makes it harder to change." She adds: "What happens in mindfulness over the long haul is that you finally accept that you've seen this soap opera before and you can turn off the TV."

Write to Melinda Beck at HealthJournal@wsj.com