We’re going to start of OCD Awareness Week with a post on Mindfulness. Remember, I’m not an expert or a professional so what follows is just my interpretation of things.
So Bellsie, I can see that you’re desperate to start. So what on earth is mindfulness?
Mindfulness has been defined by Jon Kabat-Zinn, an American doctor who first conceived the Mindfulness Based Stress Reduction (MBSR) course, as “paying attention in a particular way: on purpose, in the present moment, and non-judgmentally.” (Kabat-Zinn, 1994)
What does that actually mean in practice?
There are all sorts of different ways that mindfulness can be incorporated into daily life – from mindful breathing and body scan exercises to carrying out your normal activities (eating, getting dressed or even driving, although I haven’t tried that yet).
Mindfulness is not a relaxation technique. There’s no tinkly music or whale song. It’s more a way of being.
In some ways, mindfulness can be thought of as the antithesis of the incessant rumination that develops with OCD, choosing to observe the thoughts that pass through without passing judgment or interpreting the meaning of them.
And how would that help with OCD?
Potentially it could help in different ways for different people. The main way that mindfulness has helped me is reducing thought-action fusion and thought suppression, but people also might just find that it makes them calmer and helps them to deal with stress in a more healthy way.
Wait a second, what on earth is Thought-Action Fusion?
Thought-action fusion (TAF) is a pretty common cognitive distortion that is often present in individuals with OCD and that falls within the larger category of magical thinking.
What’s magical thinking? That sounds fun!
Magical thinking is the attribution of causality to unrelated events and is the root of non-clinical superstitious behaviour as well as a component of OCD and something that we all do.
You mean like touching wood or saluting a magpie?
Yep. Thought action fusion is a type of magical thinking and it comes in different types.
Thought-action fusion can for example be defined as the belief that ‘having an unwanted, unacceptable intrusive thought increases the likelihood that a specific adverse event will occur’ (which is known as likelihood thought-action fusion), or maybe ‘that having an unacceptable intrusive thought is almost the moral equivalent of carrying out that particular act’, (known as moral thought-action fusion) (Shafran & Rachman, 2004).
So it’s like thinking of killing someone is as bad as doing it? Or that thinking about someone having an accident makes it more likely?
Exactly. Mindfulness can be effective in helping the individual to cognitively decentre – a metacognitive process that allows the individual to view thoughts as temporary and objective. It is possible to imagine two different applications for this within the treatment of OCD – with the intrusive thoughts themselves, but also with the anxiety that is experienced during ERP.
Back up a second, what’s ERP?
ERP is exposure with response prevention. I’ve written about it here.
For example, we can take the case of an individual whose exposure exercise involves touching something viewed as contaminated without responding with their usual cleaning rituals. Prior to exposure, they can use cognitive decentring to observe their intrusive thought as objective, therefore changing their perspective to ‘I am having the thought that this object is contaminated and will make me ill’. During exposure, where they would previously have thought ‘I am too anxious to resist the urge to wash my hands’ they could instead observe the thought objectively, shifting their perspective to ‘I am having the thought that I am too anxious to resist the urge to wash my hands’.
Is decentring a new thing?
Decentring is also seen in traditional cognitive therapy, although perhaps more as a tool to help patients identify their negative thought patterns rather than a more enduring technique to prevent relapse.
And what about thought suppression?
Thought suppression is exactly what it says on the tin – pushing away thoughts and trying as hard as you can not to “think” them.
That makes sense though, doesn’t it? I mean if you have a thought that you don’t want then you should push it away, right?
One of the defining characteristics of intrusive thoughts in OCD is that they are seen as distressing and unwanted by the sufferer. The act of thought suppression is paradoxical in that the harder one tries not to think of something, the more frequent the thought becomes.
Yes. Let’s do a quick experiment (this is one of my favourite examples!). I want you to try your hardest not to think of a pink elephant for a whole minute. Are you ready? Go.
Well that didn’t work.
No. You see, it’s like I said – the harder you try not to think about something, the stronger it becomes.
Research has shown that not only is a tendency towards thought suppression correlated with obsessional thinking, but also that people with OCD are more likely to put the inevitable failure to suppress their thoughts down to their own personal psychological weakness (Tolin et al. 2002).
Mindfulness, as I said earlier, invites individuals to regard their thoughts as temporary and objective. Instead of trying to push the thoughts away, mindfulness teaches people to experience the thoughts without judging them or trying to control their content or frequency. One could argue that mindfulness would therefore prevent the thought suppression paradox occurring.
So are you saying that mindfulness could be used to treat OCD?
The current research findings indicate that mindfulness has a potentially positive effect in the treatment of OCD, generally when integrated with CBT.
One possible criticism of mindfulness is that it could become a form of neutralisation, thus becoming a ritual itself and reducing the effect of ERP interventions. It is important therefore to clarify that mindfulness is neither a distraction technique nor a relaxation exercise, but a state of mind, congruent with the immediate reality.
It would be interesting to see larger studies in order to not only confirm the presence of an effect, but also to examine whether there are any differences between different sub-types of OCD (e.g. contamination, symmetry, harm etc.). Additionally, larger studies should be conducted to investigate the different ways of integrating mindfulness into the current treatment of OCD as well as considering the role of established programs such as MBSR and MBCT.
It would also be interesting to study the effect of performing OCD related rituals ‘mindfully’ – thus using the non-judgmental perspective encouraged by mindfulness to reduce the self-critical thoughts experienced by patients who perceive themselves as failing exposure tasks.
Wow Bellsie! That sounds really interesting! Where can I find out more about mindfulness?
Why thank you! There will very likely be courses going on around where you live, but you can also find all sorts of resources online.
Check out Be Mindful – full of interesting things.
I would also read Jon Kabat-Zinn’s book Wherever You Go, There You Are or listen to one of the many audio CDs out there.
But above all – don’t be scared to give it a go. And keep at it – even just for a week or so. You might discover that it isn’t for you, but you might also find that it opens up a whole new way of living.
Obsessively compulsively yours,