Jon Hershfield, MFT, co-author of Everyday Mindfulness for OCD
Significant evidence suggests that mindfulness, the skill of being aware of the present moment without judgment, is effective for reducing suffering and improving the symptoms of obsessive-compulsive disorder (OCD) and related disorders. It follows, therefore, that meditation, a behavioral exercise for developing mindfulness skills, may play an important role in OCD treatment. But OCD sufferers often have an initially negative response to suggestions by their treatment providers to meditate. This comes from beliefs about meditation, how hard it is, and why it is specifically so hard for people with OCD. Some of these beliefs are mistakenly perpetuated by the very same therapists promoting the activity.
Here are some tips on meditation that can help people with OCD understand its utility and accessibility in their treatment.
1. You’re Not Focusing on the Breath, Just Returning to It
Rather than strangle the breath by trying really hard to stick with it and avoid unwanted thoughts, meditation is at its most effective when your attention is rested gently on the breath. Yes, it will mean your attention strays, and that’s good—something to notice. The purpose of meditation is to improve your ability to notice when your attention has strayed (e.g., from the breath) and enhance your capacity to return your attention from its many distractors. When you notice it, simply start over with the breath. It’s not prying yourself out of the hands of your OCD and latching to the breath. It’s simply noticing where your mind is, and just setting it back up where it was.
2. Thinking Is Allowed
People often associate “thinking” with failing at meditation. But one of the greatest benefits of being mindful is recognizing that thinking is simply a form of mental activity. Though problem-solving and certainty-seeking are not activities you’ll benefit from pursuing, recognizing that thinking is happening, and simply knowing that this is thinking, is a fundamental part of meditating. What you want to avoid is mindlessly thinking, getting carried off in trains of thought without paying attention and then criticizing yourself for it. Instead, notice that thinking is happening. Good that this was noticed. Now begin again with the breath.
3. It’s Normal for OCD to Take Offense
Many people with OCD find the idea of being alone with their thoughts to be terrifying. Clinicians need to understand that this is not just a metaphor or resistance to treatment. By sitting and allowing thoughts to come and go without ritualized responses to neutralize them, OCD sufferers very often do get taunted, bullied, and terrorized by their thoughts. In other words, the OCD meditator may think “OK, I’m going to watch my breath go in and out” and then the OCD says “OK, here’s an intrusive image of your loved one getting hit by a car.” Understanding that the OCD gets, well, jealous of your attention is an important first step. Scary as the unwanted thought may be, it is still nonetheless a thought, an object of attention that can be noted and responded to by simply beginning again.
4. An Anxious Meditation Is as Good (or Better) Than a Relaxed One
Many OCD sufferers report a sense of failure when meditating because of false expectations that they should not be anxious or that anxiety itself renders the meditation pointless. To the contrary, anxiety is a feeling, and this another object of attention. Noticing when your attention is attached to it and then returning to the breath is what meditation is all about. If you spend ten minutes going back and forth between the breath and noting the presence of anxiety, then you spent ten minutes meditating and enhancing your mindfulness skills.
5. You Can’t Fail Unless You Grade
OCD sufferers may be likely to evaluate their meditation experience as a performance and view it as something they must succeed in or fail at. They often have the same experience when engaging in compulsions, trying to “succeed” at getting certainty about their fears. But meditation is different from other forms of exercise in that if you attempt to be mindful, then you have succeeded at the exercise even if you did not achieve a sense of mindfulness itself. Rather than approaching meditation from a place of judgment, one actually begins to benefit from meditation by strengthening their non-judgmental skills.
Clinicians working with OCD sufferers need to approach the topic of meditation with compassion, taking into account that being alone with intrusive thoughts can be a painful experience which meditation may initially intensify. Approaching meditation gently, with realistic expectations and without false assumptions, can turn this scary activity into something empowering that can be an important adjunct to cognitive behavioral approaches to OCD treatment.
Jon Hershfield, MFT, is a psychotherapist specializing in the treatment of OCD and related disorders and is the director of the OCD and Anxiety Center of Greater Baltimore in Hunt Valley, Maryland. He is the coauthor of Everyday Mindfulness for OCD.