Mindfulness
If you’ve been a regular reader of my blog, you’ve probably noticed that along with things like Exposure Response Prevention (ERP) and Acceptance Commitment Therapy (ACT), I like to also promote Mindfulness as a good way to help facilitate OCD recovery. But what exactly is mindfulness?
According to Wikipedia:
Mindfulness is the practice of purposely bringing one's attention to experiences occurring in the present moment without judgment, a skill one develops through meditation or other training.
I think this is a great high level summary of what mindfulness is. It’s a practice, a habit, a skill, and a mindset all wrapped up in one. If ERP and ACT are cognitive behavioral therapy frameworks, then I would say that mindfulness is a skill that can be applied to either or both approaches, because fundamentally the act of mindfulness strongly correlates to key principles in both ERP and ACT.
Notice that I just said “the act of mindfulness.” I would argue that being mindful is an action that you do, more so than just a simple description or adjective. Mindfulness is all about being able to catch yourself when you’re drifting (e.g. ruminating on thoughts in your head or obsessing over some past or future fear) and gently bringing your focus back to the present moment. It isn’t something you do unconsciously or naturally, like breathing. It’s a skill that we have to learn and develop through consistent practice. Because of that, mindfulness is challenging to grasp and even harder to develop. I know at least for me, I struggled greatly with being mindful when I first started trying to improve my capacity in this area. But as the old saying goes: practice makes perfect, and the more consistently you practice mindfulness, the better you will become, and eventually it will be an invaluable tool in your OCD recovery skillset.
In this blog post, I’ll break down mindfulness into two main topics:
Why does it work for OCD recovery?
How can I practice it / develop my mindfulness skillset further?
Why Does Mindfulness Work in OCD Recovery?
Regardless of what CBT based approach you are following (ERP, ACT, or both!) for OCD recovery, mindfulness is a great skill that can be applied to both frameworks and just life in general. By building our capacity and ability to ground ourselves in the present moment, we can learn to “tune out” the unhelpful noise buzzing around in our heads - things like intrusive thoughts, fears about the past or future, anxiety about “what if” scenarios - stuff in our brain that really doesn’t add much value, but can be hard to ignore unless we learn to accept it mindfully.
Generally, mindfulness is such an effective skill because when we suffer from OCD, we find ourselves wrapped up in compulsions. Either physical (like checking locks or doors) or mental (like ruminating on intrusive thoughts and obsessions). When we are doing OCD compulsions, we are being controlled by our brain’s illogical obsessions and worries - and these are ultimately driven by our fears of what may have happened in the past, or what may happen in the future.
Let’s say someone has a compulsion of checking to make sure their door is locked. That person may check their door 15, 20, or 30 times to ensure it is locked before they feel safe to leave the house. The physical act of checking is the compulsion, but the obsession driving that compulsion is the fear of leaving their door unlocked (maybe because they’re afraid someone will break into the house and rob them). In this case, your obsessions or fears revolve around some event (getting robbed) in the future that may or may not even happen! We are so consumed by our fear of what may come to pass that we end up performing compulsions and strengthening OCD’s grip on us.
When you practice mindfulness, you instead choose to stay grounded in the present (being mindful is a choice; it is an action!) Mindfulness is about recognizing that obsessing or worrying over things you can’t control, and which may or may not happen, is ultimately pointless and adds no value to our lives. When you are practicing mindfulness, you are consciously making yourself aware of your focus (am I grounded in the present moment or am I catastrophizing about something in the past or future?) and bringing your attention solely to the present.
Let’s use the previous example of a person obsessed over checking to make sure their door is locked. That person may leave their house, lock the door, and then while they’re driving to work they might get an intrusive thought that says: “What if you left the door unlocked? Maybe you should turn around and drive back to check, just to be safe.” Instead of trying to gain certainty by performing compulsions (ruminating in their head and wondering if they did indeed lock the door, or even going back and physically checking), the person may instead recognize: “OK. I just had an intrusive thought telling me to perform this compulsion. But, I can recognize that while I may have some level of fear or anxiety, ruminating on what might happen later or performing compulsions is not a valuable use of my time. Instead, I can keep my focus on the present moment - driving to work, making sure I am paying attention to the cars around me, and listening to the music on my radio.” And throughout the day, that person may get twinges of anxiety or urges to ruminate and try to convince himself that he did indeed lock the door that morning, but each time he can mindfully recognize when those OCD urges pop up and bring himself back to focusing on whatever he is doing in the present moment.
Mindfulness is so effective because by practicing it, you are ultimately refusing compulsions and accepting feelings of anxiety and uncertainty, both of which are core tenants of ERP and ACT. As I explained in this blog post, by doing so, you are breaking the OCD cycle and gradually re-conditioning your brain to refuse compulsions and not allow your obsessions and intrusive thoughts to control your behavior.
The way that I view mindfulness is that it is a key skill to have in OCD recovery, whether you are following ERP or ACT. If I was a therapist advising a client on how to handle OCD fears or intrusive thoughts, a general process would be this:
Recognize when you are having an OCD obsession or thought (mindfulness)
Refuse to do the compulsion (whether that be physical or mental) (ERP)
Focus yourself on the present moment rather than doing those compulsions (mindfulness)
Accept any uncomfortable feelings while still taking valued action (ACT)
How Can I Practice / Develop Mindfulness further?
Like any skill, you won’t start out as an expert, and you may struggle at first to get better at performing mindfulness. If so, don’t be discouraged! It’s a habit that must be built and developed through consistent practice. And like I stress in this blog post about mental fitness, mindfulness is a skill that you will develop throughout your entire life. You might get really, really good at being mindful, but there should never be a point where you tell yourself: “OK, I’m good at mindfulness. I can stop now.” Instead, view it as something that you should always be striving to develop and practice and get better at, no matter where you are in life or how good at mindfulness you are. Even once you’re recovered from OCD, being mindful is a great skill to have whenever anything stressful pops up in your life (work deadlines, family drama, etc…)
In general, I’d say there are two primary ways to practice mindfulness:
Planned, conscious training (Mindful Meditation)
Ad-hoc, unplanned exposures (e.g. practicing mindfulness when you get triggered by something unexpectedly)
The first bullet (planned training) will help develop your capacity to be mindful so that when the second bullet (unplanned exposures) occurs, you can handle it much better. Think of mindfulness meditation like basketball practice, and unplanned exposures as the actual basketball game. Sure, you can be mindful in both scenarios - but it helps first to improve your abilities through consistent practice and training before you start dipping your toes into actual game situations!
Something that I do every day to help develop my mindfulness capability is practicing Mindful Meditation. Even if you only practice it for ten minutes each day, it really pays dividends if you can do this consistently! An example of how to practice this:
Get yourself in a comfortable position (sitting or laying down).
Close your eyes and take in several deep breaths, paying attention to the way your chest rises with each inhale and deflates with each exhale.
Keep your focus on the gentle rhythm of your chest as you inhale and exhale.
During this time, you may notice your thoughts drifting. If you’re anxious, you might notice yourself trying to fixate on that uncomfortable feeling, or trying to ruminate on ways to “relieve” that anxiety. If you notice that your focus is drifting, acknowledge that and gradually bring yourself back to focusing on the present moment (breathing deeply). The key here is to not get upset if you find yourself drifting. That’s OK! The point of mindful meditation is NOT to have zero thoughts - rather, it is to practice our ability to acknowledge thoughts and feelings that we may have, but still practice bringing ourselves back into the present moment.
Once you get into a good rhythm of breathing, gradually expand your focus to your other senses. With your eyes still closed, make a mental note of what you can hear, smell, and feel as you sit and breathe. Can you feel your skin rubbing against the fabric of your clothes? Can you feel any uncomfortable kinks in your muscles while you sit and meditate? What are all the noises you can hear in your current environment (this one always amazes me. When I’m not paying attention, I can think I’m in a completely quiet house, but when I start to mindfully meditate, I suddenly pick up on all these different noises in my home that I wasn’t paying attention to before, like the hum of my refrigerator or the gentle thrumming of my air conditioner).
Do this as long as you need to (generally I like to target about 10 min, but sometimes I do more and sometimes I do less. The important thing is to do it consistently, e.g. try to make an attempt at practicing mindful meditation every day). And again, whenever you find yourself drifting or recognize that your brain is trying to ruminate on some uncertainty or obsession, gently bring yourself back to focusing on the present moment and on what you can feel, hear, smell, or sense.
Something important to remember about mindful meditation is that it is not a cure for anxiety or OCD. If you’re feeling anxious, meditating for ten minutes won’t make the anxiety go away. If you’ve been ruminating on something for 24 hours, meditating for 10 minutes isn’t going to make much of a difference. Instead, understand that mindfulness is both a skill and a habit. It’s something we choose to do. So if you have an obsessive thought or fear, you can “choose” to ruminate about it, or you can “choose” to be mindful instead. OCD recovery is all about the actions we perform. By choosing to be mindful instead of choosing to perform compulsions, we gradually improve our mindfulness skill and increase our capacity to handle uncomfortable thoughts and feelings. Choose to improve your ability to be mindful, not your ability to perform compulsions!
When you’re faced with unplanned exposures, the principles of mindfulness that you practice during meditation remain the same, but the scenario and stimuli differ greatly. In an unplanned exposure, it may be much harder to be mindful about the present moment because your sense of anxiety might be heightened or you might have a difficult time focusing on the present. That’s OK. As I’ve mentioned before, mindfulness takes time to develop and you won’t be an expert when you’re first starting out. So if you are faced with an unplanned exposure that causes your anxiety to spike, do your best to adhere to the tenets of mindfulness that I’ve outlined in this post, but don’t be upset or regard yourself as a “failure” if you are unable to do so. Every exposure is a learning opportunity and a chance to develop and grow our mental health and fitness skills to become even stronger. By practicing mindfulness regularly (via meditation), you will get better at it and ensure that you’ll be ready to handle the “real thing” whenever unplanned exposures pop up in real life.
I really do believe that Mindfulness is a core skill in OCD recovery and a fundamental technique in both ERP and ACT, so I’d encourage you to start practicing it and making it a routine habit in your life, even if it’s just ten minutes of meditation a day. Over time, that consistent practice will pay off and help you develop a deeper understanding of what it means to be mindful, and a better capacity to ground yourself in the present moment whenever you recognize OCD obsessions or uncomfortable feelings popping up.
As always if you are reading this - I hope you have a great weekend and I hope this post has been insightful in your own OCD recovery journey!
Eric