Mindfulness is increasingly common and important in OCD treatment. While relatively new to the field of western medicine, the term mindfulness now encompasses several long-used aspects of therapy centered around living in the moment, engaging with the present, and avoiding worry. Today, mindfulness-based stress reduction therapy (MBSR), mindfulness-based cognitive therapy, and mindfulness therapy as a complement to Cognitive behavioral therapy (CBT) are among the most common therapy prescriptions for OCD.
Most importantly, while mindfulness does not constitute a full treatment for OCD on its own, it has shown to markedly improve the daily lives of people with OCD. This is especially true as many people attending therapies like CBT find they still have negative thoughts and focus on worry and inner thoughts too much following that treatment. Mindfulness-based treatments have been shown to reduce this for patients while they take mindfulness courses. This means that taking mindfulness therapy and working to live in a mindful way could improve the quality of life for many people with obsessive compulsive disorder.
Why Mindfulness Therapy
An estimated 2-2.5% of the U.S. population struggles with OCD. Most of those have taken or are in treatment of some kind. Yet, traditional OCD treatment (exposure and response prevention) does not help a remarkably large percentage of patients. In fact, some 37%-50% of OCD patients see zero benefit from this therapy. This has led professionals to switch focus away from exposure and response prevention towards a 3-part treatment focus including:
Psychoeducation – Education designed to help patients understand the disorder and themselves
Cognitive Therapy – Therapy designed to tackle thought patterns, emotional patterns, and “Spiraling” behavior.
Behavioral Therapy – Therapy, especially CBT, to recognize, analyze, and build new behaviors wherever possible. ERP (Exposure and Response Prevention) is still common here and is more effective in combination with other forms of treatment.
With this shift away from single treatment modes, most professionals have also shifted away from “single treatment phase” to “ongoing treatment”. Most people do better when regularly reinforcing and following up on the initial treatment. Mindfulness can play an important role here, both in terms of ongoing complimentary therapy and as an addition to original treatment.
What is Mindfulness?
Mindfulness was first brought to Western medicine by John Kabat-Zinn, an American professor of Medicine. Kabat-Zinn used the information he learned from Buddhist teachers to combine Buddhist meditation with traditional therapy. His program, Mindfulness-Based Stress Reduction Therapy (MBSR) was quickly popularized by both his medical center, the media, and multiple studies picking it up. Mindfulness, like other forms of meditation and therapies designed to help individuals release stress and embrace living in the present, consistently shows marked improvement in worry, anxiety, and depression. For patients with OCD, it may also help with alleviating a range of symptoms including:
Negative feelings around intrusive thoughts
Focus and attention paid to intrusive thoughts
Focus on compulsions
Negative feelings around compulsions
Depression surrounding compulsions
Some theories also posit that someone who is practicing mindfulness daily may be less likely to attach meaning to compulsions and therefore less likely to develop obsessions. This theory was first posited in 1997, but has become a central tenant of ongoing mindfulness therapy.
While mindfulness is now often used to add to CBT and ERP, some physicians are increasingly large number of psychiatrists are adjusting therapies to make mindfulness a key element. This is known as Mindfulness-based cognitive therapy. This treatment focuses on building daily skills for emotional acceptance and regulation, resolving behavioral barriers, and reducing how symptoms affect the daily life of the patients.
How Does Mindfulness Impact OCD?
Attending regular mindfulness classes, taking mindfulness-based therapy, and otherwise actively practicing living in a mindful way has been shown to improve quality of life for people with OCD. In most cases, mindfulness impacts individuals with OCD in the following ways:
Challenging Worry – A large part of OCD is a combination of intrusive thoughts and obsessive worry. Compulsions to wash hands following touching the sidewalk might end up in obsessively washing your hands until they bleed. ERP and CBT both challenge these types of thinking and behavior by asking the individual to question the root of that behavior and why. Essentially, it asks you to counter a compulsion or an obsession with logic.
Mindfulness, on the other hand, adds a new tool to your coping mechanisms. Rather than asking you to counter the compulsion with logic alone, it teaches you to focus on physical and present things. For example, mindfulness involves creating an awareness of the body and the breath, of paying attention to the moment you are in, and to focusing on what you are doing now. This makes it harder to give credence to the worry because you can shift your focus to something else. While it’s not a cure-all, it is a tool that helps.
In the same way, someone who has spent a significant amount of time practicing mindfulness can better understand that they only interact with the present. Rather than challenging a compulsion on the basis of logic “my hands are as clean as I can get them”, you can challenge the behavior on the basis that it is time to switch focus to something else and continue living in the present. E.g., “I will get an infection if I don’t completely clean my hands after touching the floor” “I have done the best I can at cleaning my hands and I can’t predict or control the future”. These types of challenges require practice but are ultimately as or more useful than behavioral-only approaches, because you have training to shift your attention with it.
Accepting Discomfort – A core tenant of mindfulness is to accept thoughts, to watch them nonjudgmentally, and to let them go. Many people with OCD report this mindset is highly beneficial to their ability to deal with compulsions as well as intrusive thoughts. This eventually helps with both CBT and ERP, because it encourages acceptance rather than avoidance of compulsions and intrusive thoughts. So, rather than taking exposure to something very seriously and developing a compulsion to get rid of it, you might accept that it was uncomfortable and be able to move on. Of course, that’s the ideal outcome not a guaranteed one, but it is one of the goals of using mindfulness in OCD treatment.
Mindfulness is useful both as a complementary therapy in primary treatment and for ongoing therapy. If you or a loved one has OCD, taking mindfulness therapy as part of ongoing mental care may help to reduce symptoms, reduce the impact of OCD, and give you new tools to cope with thoughts, negative emotions, and compulsions. However, mindfulness (in any form), is not a primary therapy for OCD. You or a loved one may need additional treatment to get symptoms under control. Your best option is to see your doctor or seek out a consultation from one of our therapists specializing in OCD to get recommendations for your mental health.