Research is always looking at improving patient engagement and to decrease drop-out rates. A pilot study to integrate Mindfulness into ERP (Strauss et al, 2015) showed the drop-out rate was twenty-five percent. It could be said that the reason for this is that people on the OCD spectrum who show poor distress tolerance need the combined approach to help them complete their course of ERP treatment.
What about those who do ERP successfully, how can Mindfulness help them?
Well, while some do complete their course of exposure response prevention (ERP) therapy successfully, there are others who don’t fully engage with the assigned ERP homework tasks out of the therapy room. This means treatment outcome is poorer than it is for others who do fully engage. Bringing in Mindfulness can be an additional benefit either way.
If ERP effectively desensitises a person from the things they fear, wouldn’t Mindfulness distract away from this goal?
No, because Mindfulness opposed to distraction is that the first represents a state of awareness and so the focus is the accepted attention towards intrusive thoughts in a non-judgmental way. Whereas, distraction is non-acceptance; therefore, avoidance/escape from the intrusive thoughts, which, as compulsions go, only serve to reinforce the problem.
But what about anxiety, how can someone manage this whilst accepting the thoughts?
Mindfulness training is also about accepting feelings and bodily sensations. It means a person remains concentrated on the exposure situation and leans into the anxiety. Therapy teaches them that anxiety rises and falls and eventually reaches a plateau.
So Mindfulness enhances therapy, is that right?
Yes, many take very well to Mindfulness. One reason that it enhances therapy is that a person learns to be non-judgmental about their intrusive thoughts during exposure. The chance of attempting to divert from the intrusive thoughts (by yielding to compulsions) therefore becomes less likely. In a nutshell, the aim is to Acknowledge unwanted thoughts are there; to Accept the thoughts as intrusive and nothing more; and to then Allow the thoughts to come and go without giving into compulsive responses.
How does Mindfulness help with emotions such as guilt and shame?
It teaches someone that it’s counterproductive to fall into ruminations about these emotions. Guilt and shame are best seen as intrusive and treated as such. For example, just like an intrusive thought might be about harm and Acknowledging that, Accepting it, and Allowing it to come and go, the same would apply to guilt, shame, disgust etc. This is because the harm obsession is null and void; therefore, guilt and other destructive emotions would be too.
What if guilt is carried over from a real-live event and has become part of the obsession related to that guilt?
Despite past events morphing into an obsession, it’s important to recognise that resulting emotions about the obsession are sensations that make us believe something is true about us, yet are non-factual. In other words, if I were to label myself “disgusting” for having intrusive thoughts about paedophilia, and feeling guilty about that, it would be the result of erroneous beliefs about the obsession, not a past event where I was a victim of child sexual abuse; and where I carried the blame/guilt throughout my childhood. Active listening from a therapist helps to legitimately address and resolve blame/guilt from the real-life event, and then it moves on and concentrates on the process for Mindfulness exposure to treat the obsession.
Does Mindful-based ERP combine well with medication?
Yes, medication helps reduce the symptoms of OCD by changing the brain’s chemistry on a passive level. This helps a person engage in the cognitive side of therapy. The benefit from cognitive change plus the decrease in symptoms from medication further prepares for the active part in therapy, ERP, which ultimately leads to recovery.
How else can Mindfulness encourage people to respond more positively to ERP?
To understand that it provides an opening for full awareness, and to see that they are in charge of their choices. This way, they learn to mindfully influence what happens in any situation; instead of reacting automatically (emotionally). A Mindfulness-based approach to ERP, therefore, helps someone better recognise the urges that would have them give in to compulsions for temporary gain, and to make a choice to resist these for long-term gain, which is recovery (remission) or much-reduced symptoms.
Which book do you recommend?
Discover how you can stay one step ahead of your OCD. You’ll learn about the world of mindfulness, and how living in the present moment non-judgmentally is so important when you have OCD. You’ll also explore the concept of self-compassion; what it is, what it isn’t how to use it, and why people with OCD benefit from it. Finally, you’ll discover daily games, tips, and tricks for outsmarting your OCD, meditations and mindfulness exercises, and much, much more.Review
Exposure response prevention has been practiced for almost half-a-century and remains the most effective therapy for treating OCD. With Mindfulness integrated into the process this offers a solution for improving task engagement (in and out of the therapy room) and offers scope for preventing relapse.
By Carol Edwards 2018 Updated 2019
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