Overview 

Did you know that obsessive-compulsive disorder (OCD) is the fourth most prevalent mental health condition after depression, substance misuse, and social phobia?¹

What is OCD?

OCD is a mental disorder which causes:

• Unwanted obsessions 
• Compulsions²

Symptoms of OCD

The obsessions and compulsions that an individual with OCD faces are explained in further detail. 

• The obsessions (intrusive thoughts, urges or mental images) are often characterised as being explicit, aggressive, sexual and/or religious in nature
• Compulsions are repetitive actions made to remedy the obsessive thoughts and the emotions of aversion, anxiety, and self-loathing felt by the individual upon thinking these thoughts
  
  Examples include:
  • checking if taps, gas cookers, electric devices, doors and windows are shut multiple times
  • washing, showering and cleaning multiple times due to concerns about dirt and germs
  • checking behaviour to ensure harm is not caused to themselves or another individual
  • hoarding behaviours
  • ensuring objects are lined up symmetrically until the obsessive thoughts are relieved²

Causes of OCD

Causes and triggers of OCD include:

• Stressful or traumatic events in life (such as the death of a loved one or an accident) 
• Perinatal birth complications 
• Brain injury
• Having other comorbid health conditions
• Age, the peak of onset is at adolescence and early adulthood
• Streptococcal infection in children²

Complications of OCD and their influence on quality of life

OCD can be debilitating by causing several complications that impact patients’ quality of life.³ These include:

• OCD may augment or present with comorbid mental health disorders which include:
  • Depression, causing lack of interest in life, low mood, suicidal thoughts, feeling guilty, low self-esteem, reduced socialisation with people and irritability 
  • Anxiety due to obsessive thoughts
  • Attention deficit hyperactivity disorder (ADHD)
  • Eating disorders (anorexia, bulimia, and binge eating disorder)
  • Post-traumatic stress disorder (PTSD)
  • Body dysmorphic disorder
• OCD and its comorbid conditions may impact life, work, study, and relationships with other people³
• The shame associated with being diagnosed with OCD can cause patients to not approach medical health professionals and seek treatment. This may be augmented by socioeconomic, cultural, and social barriers such as a lack of knowledge of mental health conditions, and a lack of resources and money to receive support
• Dermatitis, a skin condition in which pain, dryness, redness, and bleeding of the skin occurs in patients who wash their hands excessively⁴

Overview of mindfulness

What is mindfulness?

Mindfulness is the:

1. Awareness of one’s thoughts, feelings, perceptions, and the five senses from moment-to-moment 
2. Being in the present moment of time 
3. Accepting one’s thoughts, feelings, and perceptions with a non-judgemental view. This involves being curious, honest, understanding, and accepting of these thoughts, feelings, and perceptions⁵

Use of mindfulness to manage symptoms of OCD

OCD is characterised by obsessive thoughts and repetitive behaviours to momentarily alleviate the urges, ideas, and images created by those obsessive thoughts.²

Mindfulness is an adjunct to and can be combined with the current first-line treatments for OCD; cognitive behavioural therapy (CBT), exposure and response prevention (ERP) treatment and antidepressant medication (recommended for patients who do not respond to CBT and have been diagnosed with depression).⁶

Mindfulness can be practised in many forms. These include: 

• Guided meditation 
• Yoga
• Mindfulness-based cognitive therapy (MBCT)
• Keeping a diary detailing moments, feelings, and experiences felt 
• Breathing exercises
• Grounding technique, allowing focus on the five senses (seeing, hearing, touching, tasting and smelling)⁶

Mindfulness can alleviate the symptoms of OCD by:

• Allowing patients to recognise their thoughts, feelings, and perceptions in order to accept them without feeling guilt and shame. This allowss them to seek therapy and treatment from medical health professionals without fear and/or hesitation
• Detachment of beliefs from emotions. This would reduce the emotional reactivity to obsessive thoughts, images, and urges; therefore, preventing the development of compulsions
• Allowing patients to identify triggers of their symptoms and how to mitigate them
• Allowing patients to focus on a central idea/thought to distract them from focusing on anxiety-provoking obsessive thoughts^5,6

Mindfulness techniques to manage OCD 

Mindfulness techniques which are suitable to manage OCD include:

• Yoga — a series of postures and stretching exercises accompanied by controlled breathing exercises to relax and focus on a particular image and thought in the present moment
• Keeping a reflection diary — list your thoughts, feelings, and sensations when experiencing symptoms of OCD to identify potential triggers and note down your experiences after doing mindfulness-based exercises
• Guided meditation for increasing focus on the present and away from obsessive thoughts — this can be done by simple breathing in and out whilst closing the eyes, on meditation beads repeating positive and encouraging words, sound healing, spiritual meditation
• Exercise (e.g., walking, running or going to the gym)
• Five senses mindfulness technique — using the five senses to allow situation in the present moment (e.g., counting 5 blue objects in the room, naming something that one can smell in the moment, naming something you can hear, having a hot drink and feeling its heat, feeling the texture of food or an object, putting a face mask on your skin and describing how it feels
• Body scan — allows participants to pay attention to and become aware of their body and their five senses without judgement 
• Mindfulness-based cognitive therapy^6,7

Research on the effectiveness of mindfulness for OCD

Key findings

In a pilot study, 8 of 12 participants diagnosed with OCD undergoing mindfulness-based cognitive therapy (MBCT) showed a decline in OCD symptoms, living more in the present moment, allowing undesirable thoughts and resulting emotions to arise, having a calmer response to life and OCD, and elevated mood and sleep.⁶ 

Another study showed five patients who did a specific yogic breathing pattern on the Y-BOCS (Yale-Brown Obsessive-Compulsive Scale, which measures OCD symptom severity and type). An improvement of 83%, 79%, 65%, and 61% was observed respectively, with one at -18%.⁸

Challenges and solutions to practising mindfulness

Difficulties experienced whilst practising mindfulness for OCD

Difficulties in practising mindfulness to alleviate OCD symptoms include:

• OCD symptoms becoming present whilst practising mindfulness
• Incompatibility between patients' thoughts for a desire to change OCD related thoughts and feelings, and the ‘accepting thoughts and emotions as it is’ notion in mindfulness 
• Finding it challenging to apply mindfulness in an OCD-related situation⁶

Targeted mindfulness sessions for OCD patients 

• Targeted group, guided mindfulness sessions to learn how to apply mindfulness as a skill to OCD-related situations
• Tailored guidance and feedback on how to use mindfulness in daily life before and after prolonged MBCT therapy 
• Understanding individual triggers and tailoring mindfulness therapies to this
• Testing different mindfulness techniques to determine the most suitable for a patient⁶ 

Future studies

As technology-based mindfulness therapies emerge, future studies could make comparisons between the effectiveness of phone-based mindfulness therapy to in-person therapy.⁹

Another area of research could study the effectiveness of short-term 3-4 day group sessions with a trained meditation instructor with no practice required outside of the session. This information would be useful as it has been shown in a study that positive neuroendocrine and psychological effects were seen in response to stress after these short-term mindfulness sessions.⁹

FAQs

How effective is mindfulness for OCD?

Mindfulness can help patients divert their attention to their present instead of focusing on obsessions (thoughts and their resulting emotions) that may preoccupy their mind, thus allowing them to not react to these thoughts and not use compulsions to alleviate these thoughts.

How do I get peace of mind with OCD?

Practising mindfulness techniques which include yoga exercises, guided meditation, grounding techniques, journaling, and breathing exercises integrated with MBCT, prescribed medication, and ERP treatment will help to calm the mind from the obsessions/intrusive thoughts resulting from OCD. Medical health professionals must always be consulted if OCD is having an impact on a patient’s quality of life and/or is causing suicidal thoughts.

Summary

Mindfulness is important in allowing

• awareness of one’s thoughts and emotions
• acceptance of one’s thoughts and emotions
• being situated in the present and away from other occupying thoughts

Mindfulness used with CBT, ERP, and medication will help OCD patients in reducing obsessions with their resulting intrusive thoughts/images by allowing focus on a present thought and emotion, relaxation, non-reactivity to thoughts, and detachment of thought from feeling, which will in turn prevent compulsions resulting from obsessions.