Over the past few years, there has been an explosion of interest in the concept of "mindfulness" as it applies to mental health treatment. But most people, including many seeking help for OCD and related anxiety based conditions, are not exactly sure what mindfulness is, or how to apply it to their life.
Despite what some might suggest, mindfulness is not a new and simple technique that one can quickly implement in order to magically eliminate anxiety. It is a long-established philosophical tradition rooted in principles originally described in eastern philosophy. These principles have in recent years been adapted by psychotherapists who integrate some of the basic precepts of mindfulness with traditional Cognitive Behavioral Therapy (CBT). This growing interest in the combination of CBT and mindfulness presents those seeking help for OCD and other anxiety based conditions with two basic questions: what is mindfulness and does it work?
What is Mindfulness?
Mindfulness, as it applies to the treatment of Obsessive Compulsive Disorder (OCD) and other anxiety disorders, is perhaps most easily understood as developing the skill of non-judgmental awareness and acceptance of present-moment experience, including all of the unwanted thoughts, feelings, sensations, and urges that are at the heart of these conditions. What this means is that, from a mindfulness perspective, the individual's primary agenda ought not be to change or eliminate their unwanted thoughts, feelings, sensations, and urges, but rather to fully acknowledge and accept them.
Note that this does not mean to suggest that one should or must learn to enjoy these painful experiences. Rather, the aim of mindfulness is to recognize and accept that these uncomfortable experiences are transitory and inevitable aspects of human life. From a mindfulness perspective, not accepting these unwanted inner experiences is the source of much of our self-induced suffering. Furthermore, fully accepting the reality of their existence is more likely to lead to a reduction in our suffering than any attempts at resisting and controlling these experiences.
Mindfulness and Cognitive Behavioral Therapy
Some people have the mistaken belief that mindfulness is in some way a rejection of Cognitive Behavioral Therapy. On the contrary, mindfulness can be a refinement and expansion upon CBT. While traditional cognitive therapy teaches us to challenge the content of our distorted thoughts, mindfulness is more focused on challenging our perspective towards these thoughts. From a mindfulness perspective, the essential problem is our distorted belief that unwanted thoughts, feelings, sensations and urges are somehow automatically important and deserving of a strong behavioral response. But with mindfulness, the goal is to better recognize and accept that these transitory internal events, though uncomfortable, are merely a normal, predictable part of the human experience.
There is also a behavioral therapy component to mindfulness, which can be simply described as this: when faced with unwanted thoughts, feelings, sensations, and urges, it is best to make no effort whatsoever to avoid or control them. With mindfulness, the goal is to accept the presence of these unwanted experiences, and to act in a manner that is appropriate to the situation and in keeping with what we would actually like to do, rather than acting with the simple goal of short-term reduction of discomfort.
As the above demonstrates, mindfulness is to some extent both a cognitive and a behavioral process. Seen through the prism of traditional cognitive theory, the role of mindfulness is to help us learn to challenge and change our distorted beliefs about the importance of uncomfortable experiences. Likewise, from the perspective of traditional behavioral theory, the most mindful and effective long-term response to OCD and anxiety is to not perform the compulsive and avoidant behaviors commonly seen in these conditions, for doing so provides only a short-term reduction in our discomfort.
Integrating Mindfulness and CBT for the Treatment of OCD and Anxiety
The OCD Center of Los Angeles has long employed Mindfulness Based CBT for the treatment of OCD and related anxiety based conditions. From our perspective, mindfulness is a natural adjunct to traditional Cognitive-Behavioral Therapy, and seamlessly integrates with more traditional CBT techniques such as Exposure and Response Prevention (ERP) and Cognitive Restructuring.
The core principles of mindfulness have also been integrated with Cognitive-Behavioral Therapy in a number of other treatment modalities that are part of what is sometimes referred to as the "third wave" of CBT (the first two waves being traditional cognitive therapy and behavioral therapy). Some noteworthy examples of "third wave" Mindfulness Based CBT include:
- Acceptance and Commitment Therapy (ACT) - Originally developed by Steven Hayes, ACT focuses on choosing to willingly accept uncomfortable personal experiences, without avoidance or other efforts at control, while making a commitment to living fully according to one's personal values.
- Jeffrey Schwartz' Four Steps - Originally developed as a treatment for OCD, Schwartz' Four Step method, as described in his book Brain Lock, focuses on learning to non-judgmentally observe unwanted thoughts, feelings, sensations, and urges from the position of an "impartial spectator".
- Dialectical Behavioral Therapy (DBT) - Originally developed by Marcia Linehan as a set of tools to be used in treating Borderline Personality Disorder, its core principle of "radical acceptance" of unwanted feelings is completely applicable to the treatment OCD and other anxiety based conditions.
- Mindfulness Based Cognitive Therapy (MBCT) - Originally developed as a treatment for depression, its primary goal is for clients to see unwanted thoughts and feelings as "passing events in the mind rather than identifying with them or treating them as necessarily accurate readouts on reality".
Each of these treatment modalities asks us to change our relationship to our thoughts, as well as our behavioral reaction to them. Just because we have a thought doesn't mean that the thought is particularly meaningful, or accurate, or indicative of something "real" or "important". On the contrary,much of what we think is inaccurate, mundane, benign, and/or simply unimportant. For example, if someone with OCD has an obsessive thought about contamination, that doesn't mean that the thought is accurate or meaningful. It also doesn't mean that the thought merits a behavioral response.
From a mindfulness perspective, unwanted thoughts, feelings, sensations, and urges are neither good nor bad - they just are. From the perspective of third wave therapies, the goal is not to control or avoid these experiences, but to learn to peacefully co-exist with them. Put another way, the goal is to allow these unwanted personal experiences to exist, without behaviorally over-reacting to them.
Is Mindfulness Effective for the Treatment of OCD and Anxiety?
Our clinical experience over the years has been that that most clients report significant improvement in their symptoms using a treatment protocol that combines mindfulness and CBT. And while the application of mindfulness for the treatment of OCD and anxiety disorders is relatively new, there is already a growing pool of research data to suggest that it is beneficial in the treatment of these conditions, including a 2008 study that found mindfulness to be beneficial for the treatment of OCD.
There have also been studies that have specifically found Acceptance and Commitment Therapy (ACT) to be successful in the treatment of OCD, Trichotillomania, and Dermatillomania. And researchers at Temple University, Yale University, and Kent State University recently reported preliminary findings of a joint study of mindfulness for the treatment of Generalized Anxiety Disorder (GAD). Initial results have been promising, with subjects exhibiting "dramatic reductions" in anxiety.
Mindfulness Based Individual Therapy for OCD and Anxiety
The OCD Center of Los Angeles offers individual therapy for the treatment of OCD and related anxiety based conditions, with a strong emphasis on Mindfulness Based Cognitive Behavioral Therapy (MBCBT). Among the conditions we treat are:
To learn more about our individual therapy program for the treatment of OCD and related conditions, click here.
Mindfulness Based Group Therapy for OCD and Anxiety
In addition to individual therapy, the OCD Center of Los Angeles also offers five weekly low-fee therapy / support groups for adults with Obsessive-Compulsive Disorder (OCD) and related conditions. Research has shown that group therapy is extremely effective for the treatment of these conditions. All of our groups are led by our professional staff therapists and use a structured treatment protocol that integrates traditional CBT and Mindfulness Based CBT. Please note that all groups require an assessment prior to participation. To learn more about our group therapy program for the treatment of OCD and related conditions, click here.
Mindfulness Based Telephone / Online Therapy for OCD and Anxiety
The OCD Center of Los Angeles also offers webcam-based online therapy and telephone therapy to clients with OCD and anxiety. Our telephone and online treatment protocol integrates principles and techniques of traditional CBT and Mindfulness-Based CBT. Telephone and online therapy are cost-effective options for clients who have physical and/or psychological limitations that restrict their ability to come to our offices, and for those in remote areas who cannot find specialized OCD and anxiety treatment close to their home. To learn more about Mindfulness Based CBT via online therapy and telephone therapy, please click here.
Mindfulness Based Intensive Treatment for OCD and Anxiety
In addition to our standard outpatient program, the OCD Center of Los Angeles also offers an intensive treatment program for the adults, adolescents, and children with OCD and related anxiety based conditions. This program is designed to meet the needs of those for whom standard outpatient treatment is either unavailable or insufficient. Our intensive outpatient program is ideal for clients from other states or countries who cannot find effective treatment near to their homes, and for those whose symptoms require a more rigorous treatment protocol. To learn more about our intensive outpatient treatment program for OCD and related anxiety based conditions, click here.
About the OCD Center of Los Angeles
The OCD Center of Los Angeles is a private outpatient treatment center specializing in individual therapy, group therapy, online therapy, and intensive treatment for OCD and related anxiety based conditions. We treat adults, adolescents, and children, and offer services six days a week, including evenings and Saturdays. If you would like more information about Mindfulness Based CBT, or would like to discuss treatment options at the OCD Center of Los Angeles, you can call us at (310) 824-5200 (ext. 1), or click here to email us.