Mindfulness and Cognitive Behavioral Therapy
Some people have the mistaken belief that mindfulness is in some way a rejection of Cognitive Behavioral Therapy. On the contrary, mindfulness can be a refinement and expansion upon CBT. While traditional cognitive therapy teaches us to challenge the content of our distorted thoughts, mindfulness is more focused on challenging our perspective towards these thoughts. From a mindfulness perspective, the essential problem is our distorted belief that unwanted thoughts, feelings, sensations and urges are somehow automatically important and deserving of a strong behavioral response. But with mindfulness, the goal is to better recognize and accept that these transitory internal events, though uncomfortable, are merely a normal, predictable part of the human experience.
There is also a behavioral therapy component to mindfulness, which can be simply described as this: when faced with unwanted thoughts, feelings, sensations, and urges, it is best to make no effort whatsoever to avoid or control them. With mindfulness, the goal is to accept the presence of these unwanted experiences, and to act in a manner that is appropriate to the situation and in keeping with what we would actually like to do, rather than acting with the simple goal of short-term reduction of discomfort.
As the above demonstrates, mindfulness is to some extent both a cognitive and a behavioral process. Seen through the prism of traditional cognitive theory, the role of mindfulness is to help us learn to challenge and change our distorted beliefs about the importance of uncomfortable experiences. Likewise, from the perspective of traditional behavioral theory, the most mindful and effective long-term response to OCD and anxiety is to not perform the compulsive and avoidant behaviors commonly seen in these conditions, for doing so provides only a short-term reduction in our discomfort.
Integrating Mindfulness and CBT for the Treatment of OCD and Anxiety
The OCD Center of Los Angeles has long employed Mindfulness Based CBT for the treatment of OCD and related anxiety based conditions. From our perspective, mindfulness is a natural adjunct to traditional Cognitive-Behavioral Therapy, and seamlessly integrates with more traditional CBT techniques such as Exposure and Response Prevention (ERP) and Cognitive Restructuring.
The core principles of mindfulness have also been integrated with Cognitive-Behavioral Therapy in a number of other treatment modalities that are part of what is sometimes referred to as the “third wave” of CBT (the first two waves being traditional cognitive therapy and behavioral therapy). Some noteworthy examples of “third wave” Mindfulness Based CBT include:
- Acceptance and Commitment Therapy (ACT) – Originally developed by Steven Hayes, ACT focuses on choosing to willingly accept uncomfortable personal experiences, without avoidance or other efforts at control, while making a commitment to living fully according to one’s personal values.
- Jeffrey Schwartz’ Four Steps – Originally developed as a treatment for OCD, Schwartz’ Four Step method, as described in his book Brain Lock, focuses on learning to non-judgmentally observe unwanted thoughts, feelings, sensations, and urges from the position of an “impartial spectator”.
- Dialectical Behavioral Therapy (DBT) – Originally developed by Marcia Linehan as a set of tools to be used in treating Borderline Personality Disorder, its core principle of “radical acceptance” of unwanted feelings is completely applicable to the treatment OCD and other anxiety based conditions.
- Mindfulness Based Cognitive Therapy (MBCT) – Originally developed as a treatment for depression, its primary goal is for clients to see unwanted thoughts and feelings as “passing events in the mind rather than identifying with them or treating them as necessarily accurate readouts on reality”.
Each of these treatment modalities asks us to change our relationship to our thoughts, as well as our behavioral reaction to them. Just because we have a thought doesn’t mean that the thought is particularly meaningful, or accurate, or indicative of something “real” or “important.” On the contrary, much of what we think is inaccurate, mundane, benign, and/or simply unimportant. For example, if someone with OCD has an obsessive thought about contamination, that doesn’t mean that the thought is accurate or meaningful. It also doesn’t mean that the thought merits a behavioral response.
From a mindfulness perspective, unwanted thoughts, feelings, sensations, and urges are neither good nor bad – they just are. From the perspective of third wave therapies, the goal is not to control or avoid these experiences, but to learn to peacefully co-exist with them. Put another way, the goal is to allow these unwanted personal experiences to exist, without behaviorally over-reacting to them.
Effectiveness of Mindfulness for the Treatment of OCD and Anxiety
Our clinical experience over the years has been that most clients report significant improvement in their symptoms using a treatment protocol that combines mindfulness and CBT. And while the application of mindfulness for the treatment of OCD and anxiety disorders is relatively new, there is already a growing pool of research data to suggest that it is beneficial in the treatment of these conditions, including a 2008 study that found mindfulness to be beneficial for the treatment of OCD.
There have also been studies that have specifically found Acceptance and Commitment Therapy (ACT) to be successful in the treatment of OCD, Trichotillomania, and Dermatillomania. And researchers at Temple University, Yale University, and Kent State University recently reported preliminary findings of a joint study of mindfulness for the treatment of Generalized Anxiety Disorder (GAD). Initial results have been promising, with subjects exhibiting “dramatic reductions” in anxiety.
