In this chapter, we will explore ways to help boost your mindfulness and self-compassion skills to navigate life with OCD. We recommend you establish a basic daily meditation practice as part of your everyday maintenance, using the tools you learned in chapter 1. Opportunities for distraction are everywhere, and the better we are at noting when we’ve become distracted by our thoughts, feelings, and sensations, the more mastery we have over OCD. So here you can find additional mindfulness and self-compassion-based exercises to keep your brain muscles strong and flexible. To do this, we must first understand that mindfulness and ERP are not alternatives to one another, but two sides of the same coin.
You may have heard the terms “mindfulness” and “ERP” used to describe alternate interventions or different approaches to treatment. Often mindfulness is referred to as a gentle and accepting approach to unwanted thoughts, and ERP as an aggressive and harsh approach. A therapist may have told you “I only do ERP” or “I am a more mindfulness-focused therapist.” This reflects an unfortunately poor understanding of OCD and what it means to be mindful of thoughts or to be exposed to them.
Mindfulness asks that we view thoughts as events of the mind and not as intrinsically meaningful. When we investigate and attempt to make sense of that thought, we call this activity “thinking.” Having a thought about unicorns doesn’t automatically provide much information about unicorns, whether they exist, and what (if anything) should be done about them. All we know is that a thought has occurred. OCD pressures us to do specific kinds of thinking, such as reviewing, checking, and analyzing, in order to attempt to get certainty about the meaning of our thoughts and feelings. Mindfulness requires only that we acknowledge the urge to do this kind of thinking, but essentially abandon it the moment we become aware that this urge is distracting us from the present.
When practicing mindfulness, we release compulsions (mental or otherwise), and we release “thinking” and return only to present-moment awareness. “I am a person in a chair, at a computer, with the taste of coffee in my mouth, the sound of keys being typed, a sense of discomfort in my chest, and thoughts that feel like they mean something but may mean nothing—their meaning is uncertain.” This is where we invite our attention to rest, and not on “What if that thought means something terrible really is about to happen and I really must do something to prevent it? How can I best prove that no harm will come to me and those I love because of this thought?”
For the OCD sufferer, to be aware that this is going on in the mind, and remain present with the experience—to observe and let go of the urge to do compulsions and thereby get certainty—is a huge exposure. Mindfulness is exposure to not taking your thoughts, feelings, and sensations seriously enough. To a person with OCD, this is a top-level exposure, not an easy way out. It is taking the risk that allowing certain kinds of thoughts to come and go might have terrible consequences that we may have to cope with.
Different schools of cognitive behavioral therapy (CBT) emphasize ERP in different ways. Some forms of CBT may emphasize the role of values, such as acceptance and commitment therapy (ACT), or the role of emotional regulation, as in dialectical behavioral therapy (DBT), but any therapists who say they simply don’t do exposure do not treat OCD. As just stated, mindfulness is ERP because it requires one to choose to be in the presence of triggering thoughts or feelings and resist the urge to judge or neutralize them. But those who emphasize exposure in OCD treatment and leave out the mindfulness are also missing an important point. ERP entails bringing triggering stimuli to the forefront (exposure), experiencing the thoughts, feelings, and sensations that arise, and then choosing not to do compulsions (doing response prevention). Though it may ask the OCD sufferer to engage with the thoughts and feelings in a specific way, ERP requires mindfulness skills to resist the powerful urges to do compulsions. In fact, research suggests that “affect labeling” or intentionally describing your emotional experience during exposures actually enhances inhibitory learning (Craske et al. 2014).
ERP is essentially a meditation on a trigger. The trigger is the anchor, and the distractions of thinking, avoiding, reassuring, are exactly that—distractions. And when you become aware that you are distracted from your exposure, you return to it, in all its dreadfulness. The neutral tendency when doing ERP is to try not to feel the pain, but the whole point of the exposure is to feel that pain. By feeling that pain in the absence of doing rituals, the brain learns that rituals are not a necessary component to experiencing the things that upset us. For you to learn anything in the course of an exposure, you have to bring on the thoughts, feelings, and sensations associated with your obsessive fear and practice sitting with them.
Consider what the endgame is: to be able to be in the presence of an OCD trigger and experience whatever comes up without falling into compulsive behavior that reinforces the unwanted thoughts. ERP is being in the presence of a specific kind of moment, without judgment, without trying to change it—and that is exactly what mindfulness is too.
Let’s look at a few different ways to practice mindfulness and develop the mindfulness muscles in the brain. The next few sections include additional meditation exercises you can incorporate into your daily OCD maintenance. The basic breathing-focused meditation described in chapter 1 uses the breath as an anchor of attention. The aim is to rest your attention on the breath and sit in the presence of the physical sensations associated with the breath, as well as the thoughts and feelings that may arise alongside it. The work of the meditation is to notice when you’ve wandered off into storylines and to gently bring yourself back to the anchor of the breath. This central concept, of noticing when you’ve become distracted and bringing yourself back to the present without judgment, analysis, or ritual, is an essential component of mastering OCD.
To become aware of an unwanted thought and in relatively short order notice that your awareness has abandoned the present moment for that thought, and to then return to the present without compulsions, is how you get the upper hand. If we drill down deeper into this concept, consider the two areas in which you are most likely to get carried away by your OCD. First, there is slipping into mental narratives about what could go wrong, but not realizing it. Think of how many times you thought you were just eating a meal or having a conversation and then realized you were thinking, ruminating over some obsessive thought. What if you could catch this earlier? Second, there is the problem of needing to do something before disengaging from the thought and returning to the present. What if at the moment you realized you were obsessing, you could simply acknowledge this and then return to the present moment without any preconditions? Here are some ideas for practicing this with anchors other than the breath.
A fun way to practice mindfulness is to meditate on sound. You can anchor yourself to a specific sound, such as music, or you can simply anchor to the sense of sound itself.
Find a piece of music that has layers to it. This exercise is best done with instrumental music, so as not to be tempted into too much thinking about the meaning of lyrics. The music need not be relaxing, though if it is, that’s fine. But if you like activating music, that works too. Start playing the piece and give yourself a few moments to acclimate to it. If you begin to think about whether this is the exact right piece, that’s okay (that’s just how you think), but then try to gently return to the experience of the sound itself, not ideas about it. Similarly, if you begin to think about how you never learned to play an instrument, that is fine (that’s just how you think), but note it and return to the specific experience of sound in this moment.
Once you have rested on the music for thirty seconds or so, let yourself identify just one layer of what follows. Perhaps you home in on one instrument, such as the drums. Rest your mind on the experience of the drums alone, as if isolating the track from the other elements of the music. When your mind naturally wanders to explore the strings or piano or other element, simply note it and return to the percussion.
Remember, this is the exact same model as traditional meditation. Instead of the breath, you are anchoring to a sound. As you notice thoughts or feelings, as well as other elements of the music, welcome them and then bring yourself back to your anchor. Meditation for OCD is all about noticing when you have become distracted (awareness of obsessions) and returning to the present moment without judgment or analysis (abandoning compulsions).
Another variation on this exercise is to sit in any space with any number of ambient sounds and meditate on sound more generally. For example, you might sit near a window where you can hear the traffic of a busy street, or you might sit near a fountain with the constant whirring of water. Start by attending to the loudest or most obvious sound. As your attention rests, you will likely begin to notice other sounds (such as birds, distant voices, an airplane overhead). These are like itches and other potentially distracting sensations that occur when we are meditating. Rather than focus on these other sounds, you welcome them to present themselves and then return your attention to the primary sound of your choosing. In this exercise we are using sound as an anchor in the same manner that you might use the sensation of breathing as an anchor.
For many, taste and smell elicit very powerful emotions and memories. Consider what you experience when you notice the scent of a specific spice that was used frequently in your kitchen when you were younger, for example. How quickly does it elicit memories of your youth, images of your mother’s kitchen, and so on? The power of this sense makes for a great meditation challenge. By meditating on taste and/or smell, you invite all kinds of thoughts and feelings, and with them, all kinds of opportunities to practice nonjudgmental observation.
Start by selecting a small edible object, such as a raisin or a chocolate candy. Let it rest in your hand for a moment and take a few breaths. Then hold it up to your nose and breathe in slowly. Next, place the item in your mouth and let it rest on your tongue. Note the sensations, the textures, the taste, the smell, all coalescing into one. This is your anchor. Resist the urge to chew; allow the item to sit in your mouth. As thoughts and feelings arise, including memories of when you have eaten this before or thoughts about whether it is healthy, or feelings of longing for an event where you once ate this item, simply note that these thoughts and feelings are arising, allow them, and return to the focus on taste and smell.
Once again, by attending to the experience of the present moment, being pulled aside by thoughts and feelings, then returning, you exercise the muscle in your brain that stands up best against OCD. You increase your awareness of storylines forming and increase your ability to leave compulsive urges alone.
It’s easy to be so distracted by OCD that we lose all awareness of the world around us and the ground beneath our feet. We get confused into believing that first we must get certainty over the content of our thoughts and the significance of our feelings, and then later, we imagine, we will start appreciating the present moment and our surroundings. This is unfortunate. However, we can work to change this, with the right kind of effort.
The core concept of a walking meditation is that you are, well, walking, and that your anchor is the sensation of your feet pressing down on the ground beneath you. Walking meditations may take different forms with various levels of strictness. At its most strict, a walking meditation asks that you walk in one direction a few paces, then turn around and walk back, then repeat for however long you want the meditation to last.
A less strict version would be to simply take a walk through some low-stimulation space (a nature trail, for example, not a busy street), and as you walk, really try to notice how it feels to have your feet make contact with the ground. With each step, a new contact. Just as with the breath in traditional meditation, where you may notice the beginning of a breath, the end of the breath, and the space in between, so too can you notice the beginning, end, and in-between of your steps. As competing thoughts, feelings, and sensations arise, you allow them, welcome them, and then return your attention to the steps.
Not everyone has time or an appropriate space to meditate as much as they would like. Furthermore, formal meditation is not best used as a strategy for reducing anxiety when the anxiety is coming from your OCD. You don’t want to associate meditation with reducing anxiety, because then meditation (yes, even meditation) can become a compulsion. However, nobody gets a prize for suffering the most. If you are struggling with your OCD and you are looking for a way to reduce the intensity of your discomfort, you can do so without its being a compulsion.
One quick way to take some of the edge off is by grounding yourself. Consider the image of a person charged with electricity, wired, all over the place, and then “grounding” like an electrical wire, with the charge dissipating into the earth.
The first segment of formal meditation (see chapter 1) is all about grounding yourself in the present moment. This can be truncated and used as an exercise on its own to help you reconnect with the present and reduce discomfort without engaging in compulsions and without having to sit with your eyes closed for fifteen minutes (which is awkward at dinner parties).
The neat thing about grounding exercises is you can do them without anyone noticing. You can do them in a class, at a restaurant, even in the midst of a conversation, if you don’t feel too distracted. Plus, this is a free-form exercise. We have just offered four steps, but you can ground yourself however you like. As long as the effort is aimed at grounding yourself back in the present moment and away from mental rituals and OCD storytelling, then you are doing a swell job of keeping it together. As in meditation, when we become distracted, we return our attention to the breath. We begin once more. In meditation, the anchor is the breath. In regular life, the anchor is wherever you are.
Bigger triggers in OCD can be extremely dysregulating. Our bodies remain on the earth, but our minds get blasted so far back into the past or ahead into the future that simple grounding exercises don’t feel adequate. As a general policy for living joyfully with OCD, you want to err on the side of acceptance of your feelings, even feeling disconnected from reality at times. But if you’re in the throes of a major OCD spike and need to function for work or to enjoy time with family, or if the emotional toll of feeling this triggered creates more pain than a reasonably self-compassionate person would demand of themselves, you may want to turn to a more concrete mindfulness tool. Typically, relaxation techniques are not at the core of OCD treatment. We make space for uncomfortable experiences, rather than targeting and destroying them. But if you are so anxious that you can’t think straight, it can be hard to effectively use any of your therapeutic tools to deal with the episode. Progressive muscle relaxation is a tool you can use to take things down a notch.
You may recall the body scan from the basic meditation exercise in chapter 1. By directing your attention to the top of your head and then gradually down to the soles of your feet, you establish your body’s full presence in the moment. This exercise expands on that. Rather than simply observing how your body feels, you can consciously invite your body to release tension and relax back into the present moment. Traditional progressive muscle relaxation may include purposely tensing your muscles one at a time and then releasing them to relax, but many may find it hard to let go of this initial tension. You can choose whichever way you prefer, but here we will describe simply using visualization to achieve the same results. Because this takes more time and attention than a simple grounding exercise, you will want to find a quiet and private space suitable for this practice.
Start by sitting in silence with your eyes closed and taking some slow, intentional breaths in through your nose and out through your mouth. These should be belly breaths, which may feel like a little bit less than a full chest breath, but should be deep and slow nonetheless. You can place a hand on your belly if it helps you feel the inflation and deflation of each breath. This should be in contrast to a chest breath that makes your shoulders rise. It may be helpful to think of your breaths as waves in the ocean, with each exhale being a prolonged and intentional “whoosh,” like a wave crashing onto the sands and sliding back to sea. After a few introductory breaths, direct your attention to the top of your head and very slowly begin to scan down across your scalp, forehead, eyebrows, and eyes. But this time, rather than building up a mental picture, invite yourself to imagine that the scan itself is taking with it some of your tension, some of your pain, even some of your OCD worries, washing it all away with the tide. When your attention rests with your eyes, imagine that everything above your eyes is just ever so slightly more relaxed than everything below your eyes, which remains the same as it was before. Take a moment to actually sense the invisible line between the two.
After a few more breaths, imagine that you are breathing into the line itself, and as you exhale, your breath pushes the line down past your eyes, across your cheeks and nose, down past your lips, and then rests at your chin. Stop here for a few breaths and again imagine that as the line passed across your face it took with it some of the tension. Experience the line removing tension from your face muscles, and actively allow those muscles to soften. Let your jaw drop. See if you can sense a difference on either side of the imaginary line, with everything above your chin feeling just a little bit lighter and easier than everything below it.
After a few breaths, begin again: breathe into the line, and as you exhale, imagine the breath guiding the line down across your throat and the back of your neck, and then resting just below your shoulders. Picture the individual fibers of muscle in your neck relaxing, lengthening, softening. Drop your shoulders as you did your jaw, as if your arms could just slide off, were they not attached. Notice how your entire head and neck, everything above your shoulders, carries with it a certain gentleness and warmth, whereas everything below feels the same as it did before the exercise. Repeat this behavior of using your breath to guide the scanner line down across the rest of your body at whatever intervals you like, at whatever pace you like, until you get to your toes.
Reconciling relaxation exercises with the broader theme of tolerating, accepting, and even wanting (as we will discuss in an upcoming chapter) uncomfortable thoughts and feelings can be a bit confusing, so let us clarify what we are recommending. In our experience, the situations in the context of OCD in which using relaxation is helpful are typically those where the anxiety meets the following criteria:
If you’re doing an exposure and your anxiety feels too overwhelming, you may want to work on an ERP task that feels a little more manageable. Doing exposures that cause overwhelming anxiety can sometimes backfire and lead you into doing compulsions to get rid of anxiety that feels intolerable. We’ll talk more in the next chapter about strategies to change your perception of how much anxiety you can handle. If you’re not doing an exposure and your anxiety is building over time to the point of being unmanageable, you are likely doing mental rituals. In this case, doing some ERP rather than a relaxation exercise is likely to make you feel better. In sum, if you’re not in an exposure, you suddenly get walloped by anxiety, and you are in such a heightened state that you cannot attend to what’s around you, that’s the time to do a relaxation exercise.
If you experience overwhelming anxiety much or all of the time, we have two recommendations. First, make an appointment with a psychiatrist who specializes in OCD so that she can determine whether you would benefit from an SSRI medication to take the edge off of your anxiety. We’ll talk more about medication in the last chapter of the book. Second, you may want to consult with a therapist who specializes in dialectical behavior therapy (DBT). DBT can be very effective in helping people learn how to more effectively regulate their emotions and tolerate emotional distress. DBT skills, which can include exercises for soothing and relaxation, do not directly address OCD, but instead help you learn to better manage your emotional life so that you don’t feel constantly overwhelmed by your feelings.
When you have OCD, it can be hard to be nice to yourself, for all the reasons we listed in part 1. So we thought it would be helpful to give you a bunch of ideas for how you can treat yourself right. Choosing self-compassion can feel selfish, and choosing to do things that feel selfish can be a major exposure. “Maybe I don’t deserve it. Maybe I owe a debt of self-punishment and I’m getting away with something.” Being good to yourself can be scary, but we encourage you to try the things on the list, even if it’s an exposure for you.
OCD can be incredibly disabling. In fact, it’s the tenth leading cause of disability in the modern world (Murray and Lopez 1996). Getting to a point where you are working on long-term management of the disorder (as opposed to its managing you most of the time) is a real achievement. Don’t let your OCD tell you it’s not. Recognize that through your hard work and perseverance, you’ve taken your life back.
To help yourself feel the full, wonderful weight of your accomplishment, make a “positive steps log” of all the obsessions and compulsions you’ve overcome, or all the things you can do now that you couldn’t do before (Davidson 2014). And give yourself credit for the small victories, because those have built the foundation for your bigger successes. If you don’t identify yet with the word “overcome” and are somewhere else on your OCD mastery journey, take the time to identify what you have taken back from your OCD so far and congratulate yourself for putting yourself in the thick of it.
You may think of permission slips as being only for elementary school students heading on a field trip, but they are an incredibly powerful tool for cultivating self-compassion. Brené Brown introduces the concept of writing permission slips in her eCourse The Gifts of Imperfection (http://brenebrown.com/classes/). In this art journaling course, she encourages people to get sticky notes and write permission slips that say things such as “I give myself permission to…”
People with OCD tend to be pretty good rule followers, and what we’re suggesting here is to make your own rules that give yourself permission to practice self-kindness. For instance, permission slips for people with OCD might say: “I give myself permission to…”
For this exercise, at the beginning of each day write yourself a few permission slips and put them into your pocket or purse. Refer to them during the day to remind yourself that you have permission to do, think, or feel things that allow you to experience self-kindness.
Different situations call for different techniques, and sometimes it behooves us to speak nicely to OCD. It is, after all, trying to help—in its own twisted way. For this self-compassion exercise, try saying to your OCD, “You know, OCD, I get that you are trying to help. And that you’re scared. But I’ve got this. We can handle this. And I’m going to be firm and compassionate with you as I tell you that I’m not doing your compulsion, even though it’s going to make you more scared.”
People often confuse being self-compassionate with being passive. You may think, “If I’m acknowledging that OCD is just trying to help me avoid some terrible threat, then I’m making my compulsions seem more reasonable. Further, if I then invite myself to do something kind, I’ll assume that means I’ll choose to get relief by doing my compulsions.” On the contrary, the self-compassionate move is to treat the OCD like a confused child and reflect back that it has been heard, but this just isn’t the way things are going to go today. Today you are going to choose exposure over compulsion and gently let the OCD know it’s simply misinformed. After all, it’s just trying to help, right?
If you consider the OCD experience in broader terms—as more than just a set of unwanted symptoms, but an experience of a heightened awareness—this viewpoint can take the focus from being exclusively on the negative to valuing a bigger, more self-compassionate picture. We recommend you remind yourself regularly how your laser-like attention to details, for example, is responsible for more than just noticing what’s wrong. It is also a major contributor to the depth with which you love things. For example, maybe you notice that the director of the movie you are watching used a visual style that was similar to the one in your favorite movie from when you were a teen, and you think, “Nobody else would have noticed that!”
In other words, recognizing that your skill at awareness is influenced by your OCD can help open you up to self-compassion when the skill feels like a burden. See if you can find things you’ve noticed or created that are clearly influenced by this type of attention. It could be a piece of music or artwork, a relationship you’ve cultivated, or a professional achievement. Or it could be more abstract, like your “twisted” sense of humor. Get in the habit of highlighting your good “obsessive” qualities, not to encourage behavior that impairs your functioning, but to discourage blanket criticism of yourself as just a product of a mental disorder.
Make it a habit to create a self-compassion statement any time you’re suffering, from OCD or anything else (see chapter 2). And then use it frequently! Remind yourself. Write it down and stick it on your bathroom mirror. Make it the wallpaper on your phone. The more you use it, the more self-compassion will become your default response any time you suffer.
I’m feeling frustrated and angry that my obsessions are so distracting today. (mindfulness statement) Many people find intrusive thoughts hard to cope with, especially when they have other things they want to attend to. (common humanity statement) I’m doing a decent job not allowing my anger to keep me from taking care of business today, and I’ve resisted a lot of compulsions so far. I’m going to give myself permission to be a little off and annoyed sometimes and invite myself to enjoy what I am capable of enjoying today even while distracted. (self-kindness invitation)
Sometimes people with mental disorders like OCD feel like they should be able to just get over whatever challenges the OCD is presenting, because the disorder is “mental.” But if you had a physiological disorder, would you feel the same way? Would you treat yourself unkindly and say you should just “get over” whatever symptoms you were experiencing because you have asthma? Heart disease? Diabetes?
No, you wouldn’t. And guess what? OCD is not just a problem of thinking the wrong things or making the wrong choices. It is also a physiological disorder. The brains of people with OCD are structurally and functionally different from those of people without OCD (Goncalves et al. 2016). This predisposes them to challenges they might not otherwise have, such a tendency to overanalyze and a more hair-trigger flight/fight/freeze response. You are going to have symptoms that are hard to manage sometimes, just as people with asthma are going to have trouble breathing sometimes. And as you would give yourself a break if you had an asthma attack, we’d like to suggest that you give yourself the same courtesy when you have an OCD episode.
Consider being in the throes of an OCD trigger and stepping outside of it to view the situation and saying, lovingly, “Well, looks like my brain is not cooperating right now.” Because regardless of how well you manage your OCD, sometimes symptoms are going to flare up. And that’s okay. Flare-ups just mean you are human. And they have the added benefit of giving you an opportunity to strengthen your ERP, mindfulness, and self-compassion skills.
OCD is a disorder of ideas. How we experience the world in the context of our personal narrative makes all the difference between being curious about a friendly universe (Bell 2009) and feeling oppressed by what our OCD perceives as an unfriendly one. Let’s discuss some ways of approaching your experience of OCD that encourage greater mindfulness and openness in your journey. The disorder is always going to push “bad ideas” your way, encouraging you to doubt yourself, set yourself up for failure, even hate yourself. Here are some counter-ideas that can help you see through the OCD trickery.
Living with OCD is much like running for office and having a political opponent in your head. A political opponent wants to keep you down, away from your goals and your aspirations. He wants to confuse you and your beliefs (your political platform). Most of all, he spends his time mining through your mental history looking for dirt, hoping to find something to judge and shame you with. He’ll take any small mistake or inconsistency and twist it into some egregious stain on your character, repeatedly baiting you to go on the defensive.
What does a campaign manager do? Well, consider what the campaign manager wants. She wants you to win. She has a personal investment in seeing you achieve your goals. This often means being kind and encouraging in the face of adversity, but it doesn’t always mean being permissive or “nice.” The campaign manager says things like, “You may not want to, but you’ve got to get out to Iowa tonight and talk to these corn people about subsidies, or you’ll never get their vote!” In other words, the campaign manager pushes you to do challenging things (such as exposure or resisting compulsions), not to see you suffer, but because she wants to see you win.
OCD makes a lot of rules for you, many of them contradictory (like “Do your job perfectly and make everyone happy all the time”). You might be thinking, “More rules? I don’t think so.” But some rules can help render OCD’s input irrelevant. For example: “Take the first of everything.” Many people with OCD, especially with contamination obsessions, will feel an urge to avoid taking the top plate, fork, or lid from a stack. The OCD probably has something to say about the likelihood that the top object has been touched or has germs on it. The problem with taking the second or third object from a stack isn’t the extra time it takes or the compulsive reassurance it may provide, but the message it sends to the brain that OCD’s input is always relevant—that the voice of OCD is the voice of an adviser you must take seriously. Not just in this context, but in any context. By committing to a new rule like taking the first of everything, you eliminate OCD from the role of adviser.
For someone with a tendency toward compulsive research and reassurance-seeking, another example of a good non-OCD rule might be more specific, such as, “I don’t read the fine print on prescriptions.” Why? “It’s written in small letters to discourage me from compulsively analyzing on my own. If I have a question about my medication, I can ask my prescribing doctor, not start down a path that ends with WebMD.”
Other non-OCD rules can be focused less on avoiding compulsive behavior and more on self-kindness. For example, “I am my number one priority at least once a day.” Of course, this doesn’t mean that you should enact this policy as a way of letting yourself do compulsions. Recall our earlier point that self-compassion is not about letting yourself off the hook, but treating yourself as if you want to be successful. It means, for example, that on your fifteen-minute work break, instead of using it to catch up on more work, you go for a walk or get that coffee drink made just the way you like it.
Mindfulness is about more than just being nonjudgmental and staying present. Mindfulness is the art of detecting distraction. When you meditate, your primary activity is bringing your awareness to not just thoughts, feelings, and sensations, but also to distractions. Distraction is the mind being focused anywhere other than on your anchor. In the meditation approach described in chapter 1, the anchor is your breath. When you become aware that your attention is anywhere other than your breath, you are distracted. Returning to the breath without judgment is the exercise part of the meditation, strengthening that muscle in your brain to return from wherever it went. The implications for OCD are obvious: our intrusive thoughts distract us from the present moment, and we can use meditation to improve our ability to return to a place of focus.
Mindfulness is often confused with ignoring, but it’s so much better than that. Ignoring implies a denial of the experience we are having. Mindfulness asks that we actually take a moment to acknowledge the experience, but choose not to respond judgmentally (or compulsively) to it. To aid in this approach, notice when you are interacting with obsessions and compulsions in different settings, and simply ask yourself, “Is this what I came here to do?” For example, imagine being at a library and noticing a stain on a book that you want to read for a report you’re doing. You have a fear of germs, so you begin to debate whether it’s okay to check out the book, whether you need to wash, avoid, and so on. Try telling yourself, “I came here, to the library, to get a book for my report, not to prove I am germ-free.” Or imagine, if you have harm OCD, being at a grocery store and having a thought about pushing someone in the aisle. You start to debate in your head whether you would really do it and whether the thought means you’re a bad person. Then consider, “I came here to buy lettuce, not to prove I’m a good person.”
There are situations in which trying to get a deeper understanding of thoughts, feelings, or the meaning of life is the thing you came to do (perhaps a therapy session or a philosophy class). But in most settings you’re not trying to convince yourself of anything. You’re just choosing to do the thing you came to do in the place you came to do it. This is a combination of mindfulness, because of its commitment to being nonjudgmental and present; self-compassion, because of its commitment to letting go of the burden of criticism; and exposure, because of its commitment to allowing space for uncertainty. Take a moment to consider when your obsessive thoughts and compulsive urges are the greatest distraction, and the next time you are in that situation, practice using this way of thinking mindfully about your OCD.
OCD is a thief. It sneaks into your life at various points and takes away your possessions. It starts small, with objects, mostly. It says, “Don’t use this” or “Don’t look at that” because it reminds you of an upsetting thought or feeling. Once it has stripped you of things you are more than willing to do without, it goes for bigger fish. It starts to tell you what to watch on TV, what music to listen to, what subjects to read about. Next, it goes after your very essence: your character, what you believe, what you think is funny or acceptable. It doesn’t let up until it has achieved total domination. Unless of course, you put your foot down and demand in a clear voice, “No, OCD. You can’t have this.”
It all started innocently enough. Phoebe was in the kitchen with her husband, making stew for dinner. Somewhere between cutting the carrots and the potatoes, the thought popped into her head that nothing of significance stood between cutting the vegetables and stabbing her husband. He was right there, after all, just standing next to her, putting a pot on the stove. She had had “harm thoughts” before, but they had never seemed so real. She pictured herself turning to the right and plunging the knife into her husband’s belly. Guilt and disgust welled up inside her. She gasped, dropped the knife, and ran from the kitchen. Her OCD offered false compassion, telling her everything would be fine, so long as she hid the knives and never went near them. Hiding the knives ultimately led to avoiding all sharp objects, and within weeks, she couldn’t go out in public without seeing something that made her think she could stab someone. This led to pervasive self-doubt, shame, and self-hatred. But what else could she do? How could she allow herself to cut vegetables for dinner, knowing that she could easily use the knife to commit murder?
Phoebe has become a victim of OCD trickery. She has come to believe that the removal of triggers is an effective way to remove obsessions, but the opposite is true. Avoidance of triggers simply makes more things triggering. If you sacrifice one thing, the OCD just turns its sights on something bigger. It is never satisfied, and it has no sense of decency. But if Phoebe can get in before the obsession takes hold, before the urge to avoid overwhelms her, she can remember the policy of using objects in the manner in which they are intended to be used. A knife can be used to commit a violent act; this much is true. But Phoebe bought that knife to be kept in the kitchen. The purpose of the knife is to murder potatoes, not husbands. She doesn’t need certainty about her obsessive fears to use the kitchen knife as it was intended. What she needs is to make space for thoughts about the knife being used in some other way, while she continues to destroy the lives of potatoes and their children. By committing to a policy of using objects as they were intended, she can also commit to a policy of allowing thoughts to be thoughts.
In our example, Phoebe bought into an OCD narrative that because the knife could be used for scary purposes, she must have some moral obligation to presume that it would be used for those purposes. If instead she considers that long-term management of her OCD necessarily involves making space for scary stories without behaving like those stories are meaningful, she can warmly, but firmly, state, “No, OCD, you can’t have this. I need the knife to make this meal, and I’ll make this meal using it as a knife, and if you have more to say about it, I don’t mind, as long as the potatoes get into the stew.”
You may have noticed rules and recommendations in public life that appear to be accepted by everyone. However, some of these ideas may make it difficult for you to stay on top of your OCD. For example, at the grocery store, you may see a box of hand sanitizing wipes next to a sign that says something like, “Please use these to clean your cart and help prevent the spread of germs.” That may feel like a lot of pressure for someone with contamination OCD (or harm OCD, or both!) who is better off being exposed to uncertainty than falling for an OCD trap.
You could follow the rule, if you want to. Or you could not follow it, if you don’t feel like it. Is it more trouble than it’s worth? Ask yourself: does following some random sign you saw in public open up a case file in your mind for sanitizing other public items you have to come in contact with? You came to the grocery store to buy groceries, not to be perfect or dwell on the nature of germs (remember, “Do the thing you came to do in the place you came to do it”). Can you look at that sign and tell yourself, “Hey, that’s a good idea—for other people”?
Another example might be the conveniently placed paper towel dispenser at the exit door to a public restroom, a common feature in some restrooms. The sign reads, “Please use these to open the door handle hygienically,” with an even more conveniently placed trash bin for these towels. This is perfectly appropriate behavior—for other people. But we live in a world where we touch things. We live in a world where handles are meant for hands. So whether you call this an exposure, or just a matter of policy for long-term management of your disorder, we recommend identifying multiple public “good ideas” and responding to them with, “That’s for other people.”
We’ve noticed that many, many people with OCD are people-pleasers, meaning they will do anything to keep everyone around them happy. They never want to upset, offend, insult, demean, condescend to, intentionally ignore, or be rude to anyone. And that, ladies and gentleman, is exhausting and does not make it easy to think mindfully about your OCD. One way to counter this is to change your physical stance.
The next time you think you’ve done something that someone else would not be pleased about, physically pull your shoulders back into the very best posture you can, put your hands on your hips, and hold that pose for two minutes while holding the challenging thought in your mind. For instance:
Here you combine the exposure to uncertainty with a physical “power pose” that connects you mindfully to your body. According to Harvard researcher Amy Cuddy, “power posing activates the behavioral approach system—the system that makes us more likely to assert ourselves, approach and seize opportunities, take risks, and persist” (2015, p. 220). Holding the power pose for two minutes raises the level of testosterone (the “assertiveness hormone”) and lowers the level of cortisol (one of the fight-or-flight hormones). Thus, people in high power poses end up feeling more powerful. In contrast, people adopting low power poses experience the opposite: they have a drop in testosterone and an increase in cortisol, so they feel less powerful.
Consider the various ways in which you do the opposite of power posing when you are triggered. Do you fold your arms, hold your breath, scrunch up your face, try to curl your body into a ball like a cat? What message does this send to your brain about what preceded this behavior? If we breathe smoothly and stand more powerfully, with our shoulders back, we are acting like OCD’s content is meaningless, and simultaneously giving ourselves a boost in hormones that make us feel more powerful against the OCD.
So next time you think you’ve made someone mad, or your OCD tells you that you should feel guilty for any reason, remember to throw those shoulders back!
Along the lines of standing tall with your shoulders back, we recommend you also adopt an assertive attitude. Being self-compassionate doesn’t mean feeling sorry for yourself and resting in a victim stance. It means getting yourself back on your feet with kindness instead of criticism. Along these lines, we like to encourage people with OCD to adopt the “Bring it on, baby!” attitude. It’s a little like friendly trash-talking to an opponent before a sports matchup, but instead it’s aimed at your OCD, and it doesn’t necessarily have to be friendly.
Neil’s OCD liked to tell him that when he saw an ambulance race by in the opposite direction, somewhere in his wake was an accident that he alone had caused. When Neil adopted the “Bring it on, baby!” attitude, he used the sight of any sort of emergency vehicles as an opportunity to one-up his OCD: “Right, OCD; I may have caused the fire that truck is racing to. In fact, I may have had a hand in most accidents in the metropolitan area today. The police may be heading to my house right now to arrest me, and I may not even get a trial. They may just chuck me in the federal penitentiary and throw away the key. I may lose my job, rot in jail while my family becomes homeless, and never see anyone I care about again. Ha—try to top that, OCD! Bring it on, baby!”
Thinking mindfully about OCD’s antics doesn’t have to mean accepting them as they are. It can also mean opening up, embracing them, and one-upping them with humor and bravado.
Mindfulness reminds us that we are not in a hurry when it comes to thoughts, feelings, and sensations. Yes, we sometimes have to make quick behavioral decisions in life, but we don’t need to make decisions about our internal experiences. You just need to observe them. For instance, consider what you experience in the exact moment that you get triggered by something. If you have contamination obsessions, it might be from touching something you think is dirty. If you have obsessions about violence, it might be from seeing a picture of a gun. In the exact moment you become aware of the experience you are having, you might sense something in your body—perhaps an increased heart rate or a tightness in your chest. This expands to a feeling of anxiety or disgust. This reveals a thought like “I shouldn’t have done that. My fears are going to come true! I’m a failure!” All of this may happen in the first second of your experience, before you even become aware that your OCD has distracted you from what you were doing. Remember, mindfulness enables us to notice when we are present and when we are not, and to pick up the difference between the two more quickly. So if you are feeling a sense of urgency to address an OCD trigger and not paying mindful attention, you may follow the sensations, feelings, and thoughts right down into the hole of obsession, and before you know it, compulsions will seem like the obvious and most responsible choice.
But if you can notice in that very moment that you’ve become distracted by your OCD, you might hold off just an extra second or two before taking those initial sensations, feelings, and thoughts as gospel. When people without OCD say, “I’m having second thoughts,” it usually implies that they are in a state of doubt. But for the OCD sufferer, “second” thoughts often spell out a clearer, more reasonable, more self-compassionate perspective. You might reposition yourself as a spectator of this experience and just wait. As you shift your perspective from victim to observer, you might become aware of other sensations, such as a more stable and controlled breath, incongruent with your pounding heart rate. You might notice subsequent feelings, such as empowerment, or determination to stand up to your OCD with your shoulders back. Or maybe even self-compassion is waiting just around the corner to give you permission to not be perfect and not follow the OCD rules. Maybe more objective, evidence-based thoughts about what triggered you are just waiting to be heard. Or perhaps thoughts about your values are trailing behind just a moment—thoughts about how beating yourself up and doing compulsions doesn’t bring you closer to those values.
If you live in a warm-weather climate, you might notice that when you turn on the faucet for a drink of water (right, like you drink out of the faucet—just humor us), the first few seconds of flow comes out warm, cloudy, and metallic-tasting. The water’s just been sitting there in nice warm pipes until you came along. So you let the faucet run for a few seconds, and pretty soon it comes out clear and cold. You can do the same with your thoughts, feelings, and sensations. Your triggers turn on the faucet, and what initially comes out is OCD sludge. Give yourself a moment to let the faucet run. Be patient with yourself. You have more time than you think to address your experience of a trigger. Watch the mind do what it does, and be open to letting the cool clear thoughts follow soon after. Thoughts like those we just mentioned—“I shouldn’t have done that. My fears are going to come true! I’m a failure!”—are just the stagnant, unpleasant water sitting in your pipes. Letting the faucet run a bit, you’ll find that trailing just behind are clearer, cleaner thoughts, like, “This experience is typical of my OCD. I don’t need to walk on eggshells. I saw something that triggered me, and that’s okay. I can be triggered. I got this.”
One of the most common tricks OCD uses to knock you off your game is the threat of rocking the boat, or tempting fate. If you’re feeling pretty good and have your OCD under control, but then a circumstance pops up where you become aware of compulsive urge or the temptation to avoid, you might think it best to just avoid or get the compulsion out of the way and not anger the sleepy demon of your OCD. It’s easy to fall into this trap. Why tempt fate? Why mess with something that could bring on more uncertainty, anxiety, or obsession?
The answer is a scientific one. The inhibitory learning model of ERP (Craske et al. 2014) posits that if you face a fear without doing a compulsion and your brain’s expectancies are violated (that is, what your brain expects to happen doesn’t happen), then you develop inhibitory learning, which impedes the part of the brain that thinks the OCD trigger is a problem that you must flee from. So it’s important to take ERP opportunities to keep the inhibitory section of your brain alive and alert. On the mindfulness front, if we do our best to remain present, we keep our arms open to the future, which is constantly arriving. Resisting compulsions, however dysregulating that may seem, invites the unknown future in mindfully. It positions us as caretakers of the moment, not slaves to it.
In this chapter we looked at different ways to use the lessons of mindfulness and self-compassion in your everyday mastery of OCD. We started by exploring how mindfulness and ERP are two sides of the same coin, as both ask us to hold challenging experiences in the mind without judgment. Next, we shared some different ways to practice mindfulness techniques and self-compassion skills. Then we explored several ways to help yourself think more mindfully about your OCD. In the following chapter, we will focus on how to use these skills to enhance your approach to exposures and stay in command of your OCD every day.