Mindfulness: the key to treating OCD?

Mindfulness: the key to treating OCD?

Only 50-65% of patients with Obsessive-Compulsive Disorder (OCD) benefit from standard OCD treatments. Until recently, the remaining individuals needed to live with the debilitating effects of the illness. Fortunately, mindfulness is now emerging as an alternative.

Obsessive Compulsive Disorder (OCD) is one of the ten most debilitating psychiatric disorders and affects between 1-3% of adults globally. This illness commonly has a lifelong, fluctuating course with complete remission occurring in less than half of the patients, meaning that a beneficial treatment is essential in increasing patients’ quality of life. Individuals suffering from this illness experience two distinct debilitating phenomena: First, they are faced with obsessions, which are intrusive, recurrent, and uncontrollable thoughts that cause adverse emotions like anxiety. Second, they experience compulsions, which are repetitive and irrepressible behaviours that arise in response to obsessions in an attempt to alleviate the unpleasant sensations. Suppressing the urge to act out compulsions can induce further distressing emotions, creating a vicious cycle that is difficult for the individual to break.

To aid patients with alleviating their OCD, professionals conventionally employ Cognitive Behavioural Therapy (CBT), which primarily aims to identify and reduce obsessions through cognitive restructuring, and Exposure Response Prevention (ERP), which attempts to reduce compulsions through structured exposure to obsessions or feared objects. As stated, not all OCD patients respond to these standard treatments, which is why additional treatment methods are needed. Mindfulness-based treatments seem to be a very strong contender.

What is Mindfulness-based treatment?

Mindfulness-based treatment can come in multiple forms. The most common and beneficial in the treatment of OCD is Mindfulness Based Cognitive Therapy (MBCT), which prompts patients to pay attention to the present moment and simply observe their thoughts without judgement. Usually, patients practise this mindful approach in the form of guided meditation for an hour each week, even though more frequent practice is encouraged as it can improve effects further. These exercises reflect four principles which are rooted in Buddhism, yoga, and other mindfulness-centred philosophies that consist of noticing your thoughts, not directing energy towards them, observing the natural flow of thought, and returning to your breath. The simple engagement with these principles aids patients in identifying their obsessive thoughts and the situations in which they frequently occur. By observing these thoughts without judgement and refraining from actively spending energy on suppressing them, patients begin to attach less meaning and power to them. Consequently, the need to engage in compulsions is often also diminished. The employment of these exercises as a form of OCD treatment can frequently alleviate the symptoms experienced by patients within two weeks; results are often observable for the therapist within eight weeks.

How exactly does it reduce OCD symptoms?

OCD patients frequently experience a high thought-action fusion (TAF), meaning they believe that having a thought about performing a specific action automatically leads to them executing the action. This makes it difficult to gain control over their compulsive behaviours. Furthermore, individuals suffering from OCD often try to suppress their obsessions in an attempt to gain control over their illness, which paradoxically leads to an increase in intrusive thoughts rather than an improvement of symptoms.

MBCT targets the patients’ TAF, allowing the individuals to break the tight connection between thoughts and actions by cognitively restructuring their beliefs and understanding of the illness and showing them that they can learn to control their actions. Moreover, mindfulness teaches patients to observe their intrusive thoughts without judgement instead of suppressing them. This allows them to attach less meaning and power to the obsessions, consequently diminishing the need to engage in compulsions. Additionally, research suggests that when mindfulness is used in conjunction with other therapies like CBT or ERP, it not only increases treatment efficacy but also significantly reduces relapse rates. A possible explanation for this phenomenon seems to be that mindfulness teaches individuals metacognitive thinking, which, among other things, can improve communication with the therapist and target relapse before the symptoms become a life-altering impairment again.

Improving future treatment

As illustrated, mindfulness can be a key in the successful treatment of OCD because it has the potential to reduce symptoms significantly, allowing patients to regain control over their obsessions and compulsions. Unfortunately, thus far the game-changing effects of mindfulness are mostly limited to experimental settings, as the majority of standard treatment remains focused on CBT and ERP. The abundance of evidence supporting the value of mindfulness in OCD treatment, however, begs for more professionals to incorporate this new addition into their traditional treatment. Therefore, the next step in improving OCD treatment lies in the incorporation of mindfulness exercises into standard treatment so that professionals can provide their OCD patients with the best possible therapy. An approach of this kind can even serve as the key to help 'non-responsive' individuals.