A mindful path through OCD
Mindfulness-based therapies encourage people to replace the distress and avoidance associated with obsessions with a non-judgemental awareness and acceptance of their inner mental state. This is proving effective even in those who have been not been helped by other treatments.
Mindfulness-based therapy for Obsessive Compulsive Disorder
Mindfulness, with its focus on the non-judgemental awareness of the present, can help people with OCD to conquer the recurrent, intrusive thoughts, images or impulses (obsessions) and repetitive mental or overt acts (compulsions) characteristic of this particular form of anxiety.
By definition, mindfulness is a state which can be viewed as the antithesis of obsession and compulsion: in adopting a mindful approach, we can learn to change the way in which we relate to our private experience, thus breaking the cycle between obsessions and compulsions that can otherwise seem overwhelmingly impossible to overcome.
An important feature of OCD, shared with other forms of psychological concern, is ‘experiential avoidance’: an intolerance of aspects of our inner experience accompanied by methods of avoidance to remove ourselves from these undesirable factors. In the case of OCD, the affected person is often highly distressed by and ashamed of their obsessions, which can be highly disturbing in nature (often violent or sexual).
The compulsions are the mind’s attempt to distract from this distress: for example the compulsion to flick all the light switches in the building on and off three times in the belief that this will prevent the imminent threat of death to one’s family.
Unfortunately, these ‘safety responses’ serve only to reinforce the OCD: they rule out any opportunity for ‘disconfirmation of threat’: when the person performs the repetitive behaviours with the light switches and their family comes to no harm, this only strengthens the bond between their obsessions and compulsions because they haven’t allowed themselves to see what will actually happen if they resist the compulsions (i.e. that their family will not all suddenly die).
An alternative to avoidance
What mindfulness offers is an alternative to this experiential avoidance. Mindfulness-based therapies help us to accept exposure to various aspects of our inner states which we may fear or be horrified by. Fabrizio Didonna, president of the Italian Institute for Mindfulness, suggests that the power of mindfulness in the fight against OCD comes from the status of the mindful state as “a pre-metacognitive attitude or mode that prevents patients from falling into the speciﬁc evaluations, judgments, and biases that maintain and/or over-activate the psychopathological problems.
“It allows people to recognise and accept their obsessions instead of jumping into the compulsive behaviours which can be so disabling to them… “it teaches patients how to “observe” their experience without entering into the mode of meta-evaluation.”
The other factor that makes OCD particularly susceptible to mindfulness-based interventions is the fact that people with OCD generally have very good insight (i.e. they recognise that their behaviours are problematic). Because awareness is so crucial to mindful practice, it is understandable that an awareness that you have a problem at all is essential in order for you to begin to fix it!
Empirical support for the effectiveness of mindfulness-based therapies is growing rapidly. Much concerns the co-called ‘third wave’ of cognitive behavioural therapies which are strongly influenced by mindfulness techniques. In 2007, a group of psychologists from Los Angeles investigated the effectiveness of mindfulness-based behaviour therapy, which combines exposure and response prevention (ERP, a component of CBT) with mindfulness training and writing exercises.
When this therapy was given to 139 patients with severe or extreme OCD who had previously proved resistant to other psychological interventions, their OCD as measured by the Yale-Brown Obsessive-Compulsive Scale decreased substantially, along with measures of phobia, generalised anxiety and depression. Their insight and general functioning improved. If such substantial improvements can be elicited with groups who have previously struggled to find relief with other therapies, mindfulness may just be the key to freedom from obsessions and compulsions for many people.