Mindfulness for OCD and Anxiety

Choosing a Different Route on the Anxiety Highway

Mindfulness can greatly enhance traditional
Cognitive Behavioral Therapy (CBT) for the
treatment of OCD and Anxiety

“Mindfulness” seems to be everywhere these days.  In the culture at large, mindfulness is becoming a common practice for many as a means to finding basic peace of mind. And in the field of mental health, mindfulness is quickly coming to be seen as a technique that can help relieve symptoms of OCD, anxiety, and other psychological conditions.

After reading the above paragraph, you may be thinking, “Sign me up!” After all, we live in an era of instant gratification, and most of us usually want a quick fix to our problems. But mindfulness is not something one masters overnight. It is a journey that requires effort, commitment, and dedication. While mindfulness may provide relatively rapid relief to one’s distress in certain situations, it is perhaps better conceptualized as a long-term shift in perspective that allows us to better manage the complexity of human psychological experience. Like learning a new language, mindfulness takes time and patience to master, and ongoing effort to remain fluent.

So what exactly is mindfulness, and how does it apply to OCD and anxiety?  A simple definition of mindfulness is that it is the practiced skill of non-judgmental awareness and acceptance of our present-moment experience, including all of our unwanted thoughts, feelings, sensations, and urges. Mindfulness teaches us to accept all of our unwanted internal experiences as a part of life, regardless of whether they are “good” or “bad”.  When treating OCD and related anxiety disorders, mindfulness is a tool that can supplement and enhance Cognitive Behavioral Therapy (CBT), which is the gold standard for managing these conditions.

Mindfulness originated in ancient eastern philosophy, and is based on the premise that our attachment to feeling good and our aversion to feeling bad are the cause of much of our suffering.  Much of the time, when things are difficult, we take up compulsive or avoidant behaviors in an attempt to make ourselves feel better.  I often joke with clients about the fact that we never find ourselves running out of our bedroom with our arms flailing above our heads screaming in fear, “Oh my, I am so happy! Why am I so happy?  What if I am happy forever?  What should I do?”  We only do this when what we are experiencing something we perceive as being “bad” or “wrong” or “unwanted”.

When discussing Obsessive Compulsive Disorder (OCD) and anxiety with clients, I often suggest that we conceptualize life as a metaphorical drive in the wilderness.  Imagine that you are driving a convertible car along a beautiful country road.  The roof is down and you are enjoying your surroundings. All of a sudden, a wave of anxiety comes over you.  You are hit with all sorts of wild thoughts and begin experiencing uncomfortable feelings that seem to come out of nowhere.  You quickly begin to feel so overwhelmed that you pull over.  After sitting on the side of the road for awhile, you realize that it all feels too scary to keep going.  After thinking it through to a point of exhaustion, you make yourself begin driving.

Out of desperation, you quickly put the roof up and roll the windows up as well.  You promise yourself that you won’t look out the windows just in case you might see something that will scare you again.  You fix your eyes on the road and won’t let yourself even dare to look out the windows.  If the anxiety gets bad enough, you may even shut your eyes tight and try to make your way home without looking.   Or you may call your family members or friends and make them reassure you that everything will be OK.  You may find yourself saying over and over again, “Do not think about anything that makes me anxious right now!” or “Just think good thoughts!”  When you return home, you may even vow to never go on that road again.  And if you must drive that road again, you may ask someone to come with you in order to ensure that nothing goes wrong throughout the entire drive.

Does any of this ring true for you?  Do you find yourself experiencing any of these common reactions to anxiety.  When we experience the discomfort of anxiety, we often move directly into reaction mode in an effort to control our feelings.  Or, we try to escape them at all costs.  Understanding our anxiety can be very difficult when it hits so hard and so fast.   Whether our anxiety is completely irrational (common in OCD and other anxiety disorders) or realistic (financial stress at home, relationship issues etc.), we can benefit if we stop to look at our reaction and see if it justifies the amount of energy we are giving it.

Below, I am going to walk you through a few easy steps that can help you be more mindful when faced with fear.  These simple steps can also be helpful when dealing with strong addictive urges, depression, and even pain. Using mindfulness, you can learn to view your unwanted thoughts and feelings in a more peaceful and non-reactive way, and strengthen your ability to sit with your discomfort.  Please note, this doesn’t mean that we are going to promote struggling or pain.  It simply means we are going to focus on learning to better accept unwanted thoughts and feelings, and on responding to them with fewer counter-productive behaviors.

Step One: Become Aware of Your Feelings

When we are anxious, we often react to our thoughts and feelings before we even know they are there.  Often, our clients report that they are performing compulsive behaviors before they even know that they are anxious.  Others report that while they may notice their feelings when they occur, they then focus all of their energy on trying to get away from them as fast as possible.  Step one is to slow down and notice what you are feeling.  Are you anxious? Irritable? Sad? Annoyed? Embarrassed?  Where do you feel it?  Is it in your chest?  Shoulders?  Stomach?  Is it racing in your mind or is it a sensation of heaviness in your entire body?  Don’t run from it.  Notice it.  Don’t immediately react.  Inquire first!

Step Two: Identify Your Feelings

Once we notice an unwanted feeling, we can choose to label it as “just a feeling”, and we can then begin to understand how our minds send us into reaction instead of acceptance.  When we identify what is really going on (discomfort), and not what our anxiety tells us is going on (unbearable catastrophe), then we can begin to work with it instead of against it.  Consider that while our unwanted thoughts and feelings may “feel” real, they may not be accurate or even remotely realistic.  It is often helpful to identify our thoughts and feelings as just thoughts or just feelings, not truths that are worthy of so much attention.

Step Three: View Your Feelings in a Non-Judgmental Way

Instead of saying, “I hate these feelings” or “these thoughts are very bad,” try to just look at the event and reply with something along the lines of “This event is just what it is”.  Taking a non-judgmental stance allows you to understand the event from a rational, objective point of view, instead of a biased and subjective point of view.  If you are struggling with this, you may find that talking with a therapist who is trained in mindfulness or Acceptance and Commitment Therapy (ACT) can help you immensely.

Step Four: Consider Other Behavioral Options

Once you begin to understand and label what is really going on, you can begin to consider other non-compulsive and non-avoidant options. When we are hit with a blast of anxiety, it may feel like a huge tidal wave that will destroy us.  In OCD and other anxiety disorders, we often move directly from experiencing an unwanted thought, feeling, or sensation, into immediately reacting.  We just want to make it all go away as soon as possible.  But we have the option of choosing to slow down and seeing how our brains have created an event that feels far more threatening than it actually is.  Perhaps putting the top up and rolling the windows up is not be the best idea!

Step Five: Take Action…By Not Reacting

This is the moment of truth.  In step five, you will have to be willing to take a risk and challenge your thoughts and feelings by not responding in a compulsive or avoidant manner.  You will have to be willing to experience discomfort instead of the relief of immediately being comforted.  This is a bold and courageous step.  It requires a full commitment to feeling your discomfort.  And this is where you will really begin to free yourself from the behaviors that have reduced the quality of your life.  In this step, you will make the decision to open your self to experiencing the unwanted thoughts, feelings, or sensations that you find so uncomfortable.

This is the moment where you have two options.  You can choose to avoid and/or control your thoughts, feelings, and sensations, or you can choose to allow the moment to be what it is.  It is the moment where you decide to either pull over and get short-term relief, or to sit with short-term discomfort in the hope of improving your long-term experience of life.

Step Six: Feel the Curves of the Road Beneath You

If you are willing to commit to sitting with your discomfort and getting back on the road, this step will help you to do it without doing compulsions.  Step six is all about just feeling the curves of the road beneath you and not trying to control or change anything about your experience.  Sit back and just be in the moment, letting the road and the wheels take you over all the bumps and sharp corners.  Take notice of the view, without placing any expectations on how the view “should” look, or how you “should” feel.  Let the car take the corners, without trying to hold on too tight.  Often, when we loosen our grip on how we want things to be and allow some flexibility, we enjoy our experience much more.

Accept whatever discomfort you are experiencing.  Befriend it and learn that it is rarely the horror that you fear it will be.  It is almost never the catastrophe that we anticipate.  I find it is often helpful to implement some kind of breathing training at this step.  Try to breathe into whatever it is that you are experiencing.  Breathe and take notice of your breath as you observe what your body is feeling.

The main goal of mindfulness is to accept whatever comes your way.  Pot holes!  Fear!  Cracks in the pavement!!  Irritability!  Huge hills!  Panic! Areas where there is no pavement at all!  Feeling out of control!  Try to take on each obstacle as it arrives, without anticipating or planning for a specific outcome.  Before you know it, you will be home and you will look back and be glad you took the drive.

Kimberley Quinlan, MA, is a psychotherapist at the the OCD Center of Los Angeles, a private, outpatient clinic specializing in Cognitive-Behavioral Therapy (CBT) for the treatment of Obsessive-Compulsive Disorder (OCD) and related conditions.  She can be contacted kimberley@ocdla.com.

Image: “Country Roads” © Capn Madd Matt – Used under a Creative Commons license.

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