Reduce Obsessions with Mindfulness
By John M. de Castro, Ph.D.
“mindfulness may be very beneficial for those of us who struggle with obsessive impulses, not just because it makes us more aware of them, but also because it enables our brains to deal with them better, in the same way that exercising makes our muscles stronger and more able to deal with stresses and strains.” – Mindfulness Project
Obsessive-Compulsive Disorder (OCD) sufferer have repetitive anxiety producing intrusive thoughts (obsessions) that result in repetitive behaviors to reduce the anxiety (compulsions). In a typical example of OCD, the individual is concerned about germs and is unable to control the anxiety that these thoughts produce. Their solution is to engage in ritualized behaviors, such as repetitive cleaning or hand washing that for a short time relieves the anxiety. The obsessions and compulsions can become so frequent that they become a dominant theme in their lives. Hence OCD drastically reduces the quality of life and happiness of the sufferer and those around them. At any point in time about 1% of the U.S. population suffers from OCD and about 2% of the population, 3.3 million people, are affected at some time in their life. Hence, the problem is widespread and there is a need for effective treatments.
OCD is often treated with drugs, but these are not always effective and relapse is common. In addition, the drugs can produce significant side effects. Cognitive Behavioral Therapy (CBT) has been shown to be effective in overcoming the symptoms of OCD. However, in many cases obsessions occur without overt compulsive behaviors and it is not known if CBT is effective for this subgroup. Mindfulness training has also been shown to be effective in treating OCD. So, the combination of Cognitive Behavioral Therapy (CBT) with mindfulness training Mindfulness-Based Cognitive Therapy (MBCT) may be especially effective.
In today’s Research News article “Efficacy of mindfulness-integrated cognitive behavior therapy in patients with predominant obsessions.” See summary below or view the full text of the study at:
Kumar and colleagues examined the effectiveness of combined mindfulness training and CBT on patients suffering from OCD with obsessive thoughts only. They recruited OCD patients diagnosed with obsessions only and treated them with Mindfulness-Based Cognitive Therapy (MBCT) tailored specifically for obsessions. It was delivered in 12-16 weeks of once a week, 90-minute sessions. The participants were also assigned homework. They were measured before treatment, mid-treatment, after treatment, and at 3-month follow-up on measures of obsessions, obsessive-compulsive severity, insight, global severity of illness, depression, anxiety, socio-occupational functioning, and quality of life.
They found that at the completion of treatment and at the 3-month follow-up there were significant reductions in obsessions, severity of illness, disability, depression, and anxiety and a significant improvement in the quality of life. Two thirds of the patients achieved clinical remissions. Hence, the MBCT treatment effectively improved the symptoms of OCD sufferers with only obsessions to a clinically significant extent. This was, however, an open label trial without a control group. As such, the conclusions must be tempered with the understanding that a number of alternative interpretations, including placebo effects, attentional effects, experimenter bias, etc. are also viable explanations.
Cognitive Behavioral Therapy (CBT) is targeted at altering aberrant thought processes which is the nature of obsessions. So, its effectiveness would seem predictable. By including mindfulness training, however, the effectiveness may be potentiated by adding increased non-judgmental awareness of the present moment. So, the patients are more aware of their thoughts and feelings in real time and also recognize the defective thought processes leading to them. This makes them better able to counteract and overcome obsessions.
So, reduce obsessions with mindfulness.
“Obsessive thinking is a tenacious addiction, a way of running from our restlessness and fears. Yet, like all false refuges, it responds to mindful awareness—to an interested and caring attention. We can listen to the energies behind our obsessive thinking, respond to what needs attention, and spend less and less time removed from the presence that nurtures our lives.” – Tara Brach
CMCS – Center for Mindfulness and Contemplative Studies
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Kumar, A., Sharma, M. P., Narayanaswamy, J. C., Kandavel, T., & Janardhan Reddy, Y. C. (2016). Efficacy of mindfulness-integrated cognitive behavior therapy in patients with predominant obsessions. Indian Journal of Psychiatry, 58(4), 366–371. http://doi.org/10.4103/0019-5545.196723
Cognitive behavior therapy (CBT) involving exposure and response prevention is the gold standard psychotherapeutic intervention for obsessive-compulsive disorder (OCD). However, applying traditional CBT techniques to treat patients with predominant obsessions (POs) without covert compulsions is fraught with problems because of inaccessibility of mental compulsions. In this context, we examined the efficacy of mindfulness-integrated CBT (MICBT) in patients with POs without prominent overt compulsions.
Materials and Methods:
Twenty-seven patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of OCD were recruited from the specialty OCD clinic and the behavior therapy services of a tertiary care psychiatric hospital over 14 months. Patients had few or no overt compulsions and were free of medication or on a stable medication regimen for at least 2 months prior to baseline assessment. All patients received 12–16 sessions of MICBT on an outpatient basis. An independent rater (psychiatrist) administered the Yale–Brown Obsessive-Compulsive Scale (YBOCS) and the Clinical Global Impression Scale at baseline, mid- and post-treatment, and at 3-month follow-up.
Of the 27 patients, 18 (67%) achieved remission (55% reduction in the YBOCS severity score) at 3-month follow-up. The average mean percentage reduction of obsessive severity at postintervention and 3-month follow-up was 56 (standard deviation [SD] = 23) and 63 (SD = 21), respectively.
Our study demonstrates that MICBT is efficacious in treating patients with POs without prominent overt compulsions. The results of this open-label study are encouraging and suggest that a larger randomized controlled trial examining the effects of MICBT may now be warranted.