The battle against OCD often seems like an endless loop of obsessions—intrusive and compulsive rituals. Those with OCD have built significant resistance to feeling and engaging with their internal experiences with acceptance. One of the most common characteristics of OCD patients is cognitive distrust towards their private internal experience and basic functions of consciousness. There’s scepticism in perception (not trusting sensory data that contradicts fears), attention, intentions, memory, and one’s own judgement. These distrust processes can be eased with mindfulness-based techniques.
Mindfulness has been proven to reduce stress, actively aiding in breaking the OCD cycle (Hale, Strauss & Taylor, 2013). Imagine recognizing your thoughts without feeling enslaved by them. Mindfulness, in essence, trains you to do just that. It guides you to observe your thoughts and feelings without judgement, empowering you to choose your response rather than being dictated by OCD compulsions. In doing so, mindfulness brings a qualitative shift in perceiving and interacting with the internal and external environment.
Third-generation cognitive-behavioural therapies, including approaches such as mindfulness-based cognitive therapy (MBCT) and acceptance and commitment therapy (ACT), have been implemented alongside exposure and response prevention (ERP) in addressing some of the limitations of traditional cognitive-behavioural therapy (CBT) for OCD. These limitations include a lack of acceptance by all patients, difficulties related to ERP such as high dropout rates and treatment refusal, partial treatment responses with persistent residual symptoms, and relapse prevention. These treatments heavily incorporate mindfulness concepts and practices, as well as work with values, acceptance of emotions and internal experience. The focus here is on modifying one’s relationship with internal experiences (thoughts and emotions), rather than rejecting or suppressing the content of that experience.
What is mindfulness?
Mindfulness is a practice rooted in the cultivation of present-moment awareness and non-judgmental attention. It involves purposefully directing one’s focus to the current experience, be it thoughts, sensations, or surroundings, without dwelling on the past or anticipating the future.
At its core, mindfulness encourages a state of open receptivity to the unfolding of each moment. It’s about observing thoughts and feelings without becoming entangled in them, training a kind of detached awareness. By acknowledging and accepting the present without judgement, people develop a more profound understanding of their inner experiences.
Often associated with meditation, mindfulness doesn’t require elaborate rituals. It can manifest in simple activities like focused breathing, paying attention to sensations, or fully engaging in routine tasks. The aim is to anchor oneself in the present, breaking free from the distractions that pull attention away.
How does mindfulness help with OCD?
While mindfulness does not cure OCD, it can significantly help in managing its symptoms and improving the quality of life for those affected by this condition. Consider mindfulness as a supplementary skill that can complement specialised treatment. Here we explore some ways mindfulness helps with OCD:
Mindfulness changes the importance given to intrusive thoughts
In OCD, a significant challenge lies in the excessive importance attributed to intrusive thoughts. Those with OCD tend to perceive these thoughts as indisputable truths, becoming entwined with them, resulting in heightened anxiety that prompts compulsive behaviours.
Mindfulness practices disrupt this cycle of obsessions and compulsions by guiding the person to allow their thoughts without judgement. Through mindfulness, people acquire the skill to view their thoughts as mental events rather than absolute truths, creating a distance between the person and the thoughts. It provides an alternative approach, steering away from the usual tendencies of engaging with, suppressing, or avoiding such thoughts (Strauss, et al., 2018; Pérez-Aranda et al., 2021; Riquelme-Marín et al., 2022).
Mindfulness shifts from avoidance to acceptance
Mindfulness-based interventions, focusing on open and non-judgmental awareness and acceptance of the present moment’s experience, could decrease the need to escape intrusive thoughts and engage in compulsive acts (Fairfax, 2008). An open and accepting attitude towards intrusive mental events might alleviate distress more efficiently than attempts to suppress or control them (Jacoby and Abramowitz, 2016).
Mindfulness helps to engage with ERP
Mindfulness heightens awareness of thoughts, feelings, and bodily sensations, playing a vital role in recognizing and understanding obsessions and compulsions during ERP. Encouraging acceptance of the present moment without judgement, mindfulness extends to the uncertainty in exposure exercises, enabling tolerance of discomfort without immediate use of compulsive behaviours. Research suggests that a willingness to experience unpleasant thoughts, emotions, and bodily sensations is associated with a quicker response to ERP (Reid et al., 2017).
Moreover, mindfulness practices train the mind to stay focused on the present moment, a skill applicable to ERP where maintaining concentration during exposure tasks is pivotal.
Additionally, guiding individuals to observe their thoughts from a more detached perspective, mindfulness becomes a supportive element in ERP, allowing the confrontation of distressing thoughts without becoming overwhelmed. As a contributor to emotional regulation and resilience, mindfulness proves especially beneficial in ERP, coping better with intense emotions during exposure tasks.
Mindfulness techniques for OCD
Should you discover yourself entangled in an unproductive, unsettling, or distressing chain of intrusive thoughts, dedicating a deliberate moment to engage in these mindfulness practices might prove beneficial.
Formal meditation
Mindfulness involves the art of being fully present, embracing and acknowledging your experiences without passing judgement. An effective initiation into a more mindful lifestyle is through formal meditation. This practice can be done in a seated or reclined position, involving dedicated time focusing on an anchor in the present moment. The choice of your anchor varies with the type of meditation, ranging from your breath, body sensations, or external objects to sounds, mantras, or visualisations.
A simple way to commence your mindfulness journey is by grounding yourself in your breath. Direct your focus to the sensations of breath flowing in and out of your nose, observing how your belly or chest expands with each inhale, and cultivating curiosity about the breath’s length and the air’s temperature or other features. As your mind inevitably drifts and engages with thoughts, the essence of the practice lies in recognizing this diversion and gently guiding your attention back to the rhythm of your breathing. You can start with a daily practice of 10-15 minutes and extend the time as you become more experienced.
Thought observation
Rather than resisting intrusive thoughts, cultivate mindfulness by observing them without judgement. Assume the role of an observer for these mental experiences, approaching the thoughts with curiosity and allowing them to naturally ebb and flow. Picture these thoughts as leaves drifting down a river or clouds gently moving in the sky. Simply observe and acknowledge the thoughts without any further action.
Label your thoughts and emotions
Another method to improve awareness and create distance from your internal experiences is to label your thoughts and emotions. Whenever an intrusive thought, urge, or emotion arises, simply categorise it as “intrusive thought,” “urge,” or “emotion.” This practice helps establish a clear recognition of your mental and emotional states, fostering a more detached and mindful perspective.
Breathing exercises
Breathing exercises involve intentionally and attentively breathing, often following patterns like 4-7-8 (inhaling for 4 seconds, holding the breath for 7, and exhaling for 8). These breathing patterns serve as an anchor to help distance yourself from obsessive thoughts.
In conclusion, recognizing the inherent impossibility of attaining complete control over our thoughts, we empower ourselves by exercising influence over our reactions and the consequential impact on our lives. Through the practice of mindfulness, we discover the capacity to make peace with the occasional, potentially distressing creations of our minds, developing a sense of resilience and harmony in our mental landscape.
References
Fairfax, H. (2008). The use of mindfulness in obsessive compulsive disorder: Suggestions for its application and integration in existing treatment. Clinical Psychology & Psychotherapy, 15(1), 53-59.
Hale, L., Strauss, C., & Taylor, B. L. (2013). The Effectiveness and Acceptability of Mindfulness-Based Therapy for Obsessive Compulsive Disorder: A Review of the Literature. Mindfulness, 4(4), 375–382. https://doi.org/10.1007/s12671-012-0137-y
Jacoby, R. J., y Abramowitz, J. S. (2016). Inhibitory learning approaches to exposure therapy: A critical review and translation to obsessive-compulsive disorder. Clinical Psychology Review, 49, 28-40.
Pérez-Aranda, A., García-Campayo, J., Gude, F., Luciano, J. V., Feliu-Soler, A., González-Quintela, A., López-Del-Hoyo, Y., & Montero-Marin, J. (2021). Impact of mindfulness and self-compassion on anxiety and depression: The mediating role of resilience. International journal of clinical and health psychology : IJCHP, 21(2), 100229.
Reid, A. M., Garner, L. E., Van Kirk, N., Gironda, C., Krompinger, J. W., Brennan, B. P., y Elias, J. A. (2017). How willing are you? Willingness as a predictor of change during treatment of adults with obsessive–compulsive disorder. Depression and Anxiety, 34(11), 1057-1064.
Riquelme-Marín, A., Rosa-Alcázar, A. I., & Ortigosa-Quiles, J. M. (2022). Mindfulness-based psychotherapy in patients with obsessive-compulsive disorder: A meta-analytical Study. International journal of clinical and health psychology : IJCHP, 22(3), 100321.
Strauss, C., Lea, L., Hayward, M., Forrester, E., Leeuwerik, T., Jones, A.-M., & Rosten, C. (2018). Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial. Journal of Anxiety Disorders, 57, 39–47.
Further reading
Do you offer OCD therapy near me?
Edinburgh Therapy Service offers both in-person OCD counselling in Edinburgh (United Kingdom), and online therapy accessible worldwide. You can find our exact location here. We specialise in therapy for OCD, offering CBT with ERP as the main treatment option. We also integrate mindfulness, acceptance and compassion to help you engage in ERP.