Obsessive compulsive disorder - OCD treatment and therapy from NOCD

Mindfulness in the Treatment of OCD

Aug 27, 202110 minute read

Mindfulness sign

More people with Obsessive-Compulsive Disorder (OCD) are finding that mindfulness is a helpful component in managing OCD. Mindfulness can be applied in everyday life and is especially useful when practicing Exposure and Response Prevention (ERP) – the gold standard treatment for OCD.  Mindfulness skills are valuable to learn before doing the ERP work, as they help people accept the presence of thoughts and feelings (like anxiety or discomfort) that arise during exposures without engaging with them compulsively.

What is mindfulness?

Mindfulness is the practice of non-judgmentally observing thoughts, feelings, urges and sensations that we experience as humans. It involves accepting the presence of such stimuli without resistance. While we cannot always control what we are thinking or feeling, we do get to decide where to turn our attention to.  

People with OCD typically spend far too much time attending to unwanted thoughts and feelings that are not important or helpful to engage with.  Through mindfulness, they learn to turn the mind back to the present moment instead of following thoughts down the rabbit hole and getting stuck in a spiral of mental compulsions.

When I introduce the concept of mindfulness to clients and ask what they know about it, an image of someone sitting down meditating with their eyes closed often comes to their minds. While mindfulness is a part of meditation, as meditating involves noticing what arises while breathing and turning one’s attention back to the breath, one does not have to do a formal meditation to practice mindfulness.  We can utilize mindfulness skills at any point in the day, whether that be sitting at work, walking to the train, watching TV, etc.  

How does mindfulness apply to those with OCD?

People with OCD experience obsessions: repetitive and unwanted intrusive thoughts, images, feelings, sensations and urges that disturb them.  This could look like an intrusive sexual thought about one’s family member, an intrusive image of running over someone with their vehicle, or a relentless thought that one’s newborn will stop breathing while asleep.  This is not the passing intrusive thought that all humans get at some point, but rather an unrelenting intrusive thought that is sticky because of the way that the OCD brain is wired.

Since the obsessions are so persistent and anxiety-provoking, a person with OCD commonly resorts to fighting with and trying to get rid of them.  This might look like thought suppression, in which a person tries not to have certain thoughts, or an unwillingness to co-exist with a feeling (e.g., “I hate anxiety!  I don’t want to feel anxious!”).  It might also look like a person performing physical or mental compulsions to attempt to neutralize the obsessions, alleviate anxiety or prevent something bad from happening.  All of these attempts can be summed up as resistance.

The person with OCD mistakenly believes that the obsessions are the problem, when the actual problem is how a person is responding to obsessions.  Compulsions and resisting reality as-is (aka that the brain produces all kinds of thoughts and feelings) are the problem.  

This belief and resistance often stem from the false notion that there are “good” thoughts or feelings and “bad” thoughts or feelings, and that we must not experience the “bad” ones.  It also stems from the belief that we should be able to control our thoughts and feelings.

In theory, resistance makes sense.  Who wouldn’t want to get rid of intrusive thoughts that attack a person’s values?  In other words, who would want to go about their day with a mental playlist of disturbing thoughts on repeat?

The problem is that, in actuality, resistance intensifies a person’s symptoms and causes them to suffer more.  What we resist persists.  So, what is a person with OCD supposed to do about such obsessions?   

Enter two of the most important facets of mindfulness: non-judgment and acceptance.  Truth be told, thoughts and feelings are not good or bad.  They are not right or wrong.  Thoughts and feelings do not carry moral value.  They just are thoughts and feelings: internal experiences.  

When we look at the composition of a thought, we see words.  These words are not actions and, thus, are not inherently harmful.  Thoughts are not threats.  We get to decide whether we want to engage with a thought or not.  This is often a revolutionary notion for people living with OCD who view their unwanted intrusive thoughts as immoral and believe that thinking something is the same as acting out the thought.

When we observe our internal experiences as they are, without judgment, it helps us practice acceptance of these experiences without resistance.  Acceptance is a crucial part of OCD recovery.  This word often scares people with OCD who assume acceptance means that we agree with or enjoy our thoughts and feelings.  That is not what acceptance entails.  

Acceptance is synonymous with allowance; allowing thoughts, feelings, sensations, urges and images to exist.  This does not mean that we accept them as truths or facts, or that we enjoy them.  It means that we accept their presence.

Rocks balancing together to form an arch

Why is acceptance so important for people with OCD?

We cannot control our thoughts and feelings a lot of the time.  They show up and we have two choices: accept or resist them.  Resisting obsessions and attempting to control them are unhelpful at best and harmful at worst.  

When we tell ourselves that we cannot have certain thoughts, we end up getting a big influx of those very thoughts.  The obsessions that people with OCD try to suppress come back tenfold when they resist them.  Thought suppression does not work.  This principle applies to feelings as well.  When we fight with and resist a feeling, like anxiety, that feeling grows stronger and gets louder.

Think of resistance of thoughts and feelings in relation to a riptide in the ocean.  When a person fights with and pushes up against a riptide, they are pulled deeper into its current.  When a person surrenders to the sea and stops fighting, they are more likely to be set free.  With OCD, we must surrender to obsessions and discomfort.  We have no other choice.

When we accept the presence of thoughts and feelings, we are signaling to our brain that we are not actually in danger.  This is essential for people with OCD who receive false alarms from a malfunctioning fear center in the brain.  By practicing acceptance, we show the brain that these are not real alarms.  We can begin to rewire the brain. 

Mindfulness and mental compulsions

Mindfulness skills also help us cut out mental compulsions by creating awareness of them.  Sometimes a person with OCD has performed a mental compulsion so many times that it feels like they jump into it automatically when an obsession arises.  The person does not feel like they have much control over the mental compulsion because it has become a habit.  

When we apply mindfulness skills and start to observe our thought patterns, we are quicker to notice when we have spiraled into a mental compulsion.  When we notice it, we are able to stop performing the compulsion and redirect to the present moment.  As stated, we are not in control of what pops into our mind.  We are in control of what we do in response to what pops into our mind.  A mental compulsion is a behavior that one is choosing to perform.  

A woman with eyes closed practicing mindfulness and resisting mental compulsions in the snow

How to apply mindfulness skills

I like to think of mindfulness as an attitude of acceptance and a mental action that we take to guide where our attention goes.  The mental action involves noticing a thought/feeling/image/sensation/urge, deciding whether it is helpful or not to pay attention to it, and bringing oneself back to the present moment if it is not helpful to engage with.  Anything related to OCD is not helpful to engage with.

The first place I start with clients is having them utilize acceptance responses when intrusive thoughts or feelings arise to help with non-judgmental observation and acceptance.  Some examples include:

  • “I’m having the thought that (insert obsession).  This thought can be here.”
  • “I notice I’m feeling anxious.  Anxiety can accompany me while I run errands.”
  • “That’s a thought.  Thank you, brain.”

{Note: We do not say “This is just a thought”, as the ‘just’ is a judgment and can become reassurance for people.  We are observing thoughts and feelings as they are: thoughts and feelings.  Also, a lot of people with OCD have racing intrusive thoughts.  It is not possible or necessary to use acceptance responses every time a thought arises or if it continues to arise.}

Then, I instruct my clients to turn the mind to the present moment and engage with something values-based.  This is healthy redirection, in which we allow thoughts and feelings to exist while redirecting to something meaningful.  It is not a distraction, in which we try and do something to avoid having thoughts or feelings.

A metaphor I use when teaching these mindfulness skills is what I call the “bee on the shoulder” metaphor.  Imagine there is a bee on your shoulder and you really don’t like bees.  Mindfulness is not saying “Stare at the bee all day.  Look at it and try to figure out why it’s there.”  That is paying far too much attention to the bee.  Mindfulness is also not saying “Push that bee away!  Get it off of your shoulder!”  That is resistance.  Instead, mindfulness says “This bee can be on my shoulder while I move about my day.”  We don’t engage with the bee but we do allow it to exist because we have no other choice.

A formal meditation practice can be another tool to utilize, as it allows a person to practice strengthening the muscle of mindfulness.  People with OCD commonly fear meditation, as it involves sitting in silence with intrusive thoughts that are anxiety-provoking.  This is exactly why meditation is helpful.  The person gets to practice allowing thoughts and feelings to exist without resisting them and without engaging with them compulsively.  There are all kinds of meditations.  You can lay down and meditate or ride a bike and meditate.  Sitting down is not the only option.

The goal of mindfulness is to co-exist with thoughts and feelings.  I often hear, “Mindfulness is not working!  The thought still arises.”  That is okay.  Working does not mean that thoughts and feelings go away.  Working means that you are willing to accept the presence of thoughts and feelings, without engaging with them compulsively, as you move toward your values.  

I know what you might be thinking: this is so much easier said than done!  You’re right.  It is.  Mindfulness skills are not easy to apply but do get easier over time.  It’s like building muscle.  It can be painful to allow the thoughts and feelings that scare you deeply to exist.  Think of it as short-term pain for long-term gain.  

Resistance might feel better in the immediate but will absolutely exacerbate suffering in the long run.  Acceptance might feel more difficult in the immediate but will set you free in the long run.

How we can help

Using mindfulness for OCD along with ERP is most effective when practiced with a therapist who has received specialized training in OCD treatment. They know what to anticipate when you describe your thoughts and behaviors and how to personalize your treatment. Their expertise is in teaching you how to manage your OCD so you don’t feel stuck on disturbing thoughts. This is the same important training all of our NOCD Therapists receive.

Schedule a free call today with our team to learn more about how one of our OCD specialists can help you get better. This consultation is free and doesn’t take very long—and it could be one of the most important calls you ever make.

About Alegra Kastens:
Alegra Kastens is a Licensed Marriage & Family Therapist and received her master’s degree in clinical psychology from Pepperdine University. She specializes in the treatment of obsessive-compulsive disorder (OCD), anxiety disorders, eating disorders, body-focused repetitive behaviors (BFRBs), and body dysmorphic disorder (BDD). Her passion for OCD treatment, education, and advocacy comes from her own personal experience with the disorder. She understands firsthand the relentlessness of OCD and how painfully it holds one’s life captive. She also understands that relief and recovery are real with a large dose of evidence-based treatment and an equally large dose of willingness.

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