5 Roadblocks to Acceptance in the Treatment of OCD
Misconceptions about mindfulness could be getting in the way of recovery.
Posted Dec 20, 2019
Mindfulness, otherwise known as acceptance, is an essential tool—albeit a difficult one to put into practice for many people—that is used in the treatment of Obsessive-Compulsive Disorder (OCD). This practice involves accepting the presence of thoughts and feelings without trying to change them, solve them, resist them, or react to them. Mindfulness is noticing thoughts and feelings without judgment.
Of the many reasons that mindfulness is helpful, its role in combatting resistance in those living with OCD is vital. OCD involves the presence of unwanted and disturbing (to the sufferer) intrusive thoughts such as “What if I am a pedophile?” or “What if I snap and kill someone?” or “How am I certain of my sexual orientation?” The list goes on. Obsessions are ego-dystonic, inconsistent with one’s values and self-concept, and it makes sense as to why the sufferer would want to make the thoughts and feelings go away. However, resistance to the thoughts and feelings is the fuel that feeds the OCD fire.
When we resist thoughts and feelings, we signal to our brain that these thoughts and feelings are dangerous and meaningful when—in reality—they are the exact opposite: harmless and unimportant. Obsessions are false alarms and resisting them is treating them as if they are real alarms. Naturally, the brain produces more of these false alarms because it is ultimately trying to keep you safe, though it is malfunctioning greatly while doing so.
Despite it being evidence-based and utilized commonly by OCD specialists, you might find yourself digging your heels in when it comes to practicing mindfulness. Maybe you think that acceptance makes thoughts and feelings true or that acceptance is dangerous.
There are common misconceptions about mindfulness that act as roadblocks in utilizing this very important practice. As a therapist, I often flesh out these misconceptions with clients and have done so below. If this is you, have compassion for yourself. Mindfulness is tricky for many people, whether you have OCD or not.
Misconception #1: Acceptance means that I am accepting the thoughts as truths.
Mindfulness is accepting the presence of thoughts and feelings. It is not accepting them as truths and then living your life according to them. Mindfulness is letting the thoughts and feelings be there without fusing with them.
A mindful response is, “I am having the thought that I could be a pedophile (or whatever it is that your OCD comes up with). Alright, I’ll accept its presence. The thought is allowed to be here while I move about my day.”
A mindfulness response is not saying, “I am a pedophile. I’ll accept this as a truth.”
Misconception #2: It is irresponsible to accept the presence of anxiety without reacting to it.
When we feel anxious, our body naturally wants to go into the fight-flight-or-freeze response to keep us safe. This is helpful when we are faced with an actual threat but when it comes to OCD, the brain is malfunctioning. The filtration system is off, and thoughts are flagged as dangerous when there is no danger present. Therefore, you feel anxiety without the presence of a threat. This is referred to as a false-alarm feeling.
The work here is to trust the process and acknowledge that you are experiencing false-alarm feelings. It seems counterintuitive to not react to anxiety, but it’s counterproductive to react to anxiety when danger is not present. The reaction (compulsion) signals to the brain that the obsessions are dangerous and reinforces them. This perpetuates the obsessive-compulsive cycle.
Feeling anxious does not automatically mean that you are in danger.
Misconception #3: Allowing a thought to be there will make it come true.
This is the cognitive distortion referred to as thought-action fusion at play, which is very common amongst those living with OCD. The sufferer may believe that thinking a thought makes it more likely that the thought will come true. A common example is someone thinking that if they have the thought about stabbing someone, it increases the likelihood that they will actually stab someone.
Thoughts are not actions. You can think a thought one million times without it being true, coming true, or meaning something about you. An example I often give clients is as follows: Look at that lamp and try to make it move with your thoughts. Can they do it? Nope!
Usually, thought-action-fusion is pervasive with unwanted thoughts and is focused heavily on negative outcomes. When I ask a client if they can make something positive happen with their thoughts, they are likely to say no.
Thought-action fusion is irrational, as is OCD.
Misconception #4: I don’t like the thoughts/feelings and I do not want them to be there. I’m not accepting their presence.
It is uncomfortable to accept the presence of unwanted thoughts and feelings. I can also tell you that it is more uncomfortable to resist them. If we got to choose what thoughts pop into our mind and stick around, or what we are feeling, we would not be in this predicament. The reality is that we cannot control what we are thinking and feeling much of the time. To say that we do not want the thoughts, emotions, or any physical sensations that accompany them is to say that we have a choice that we do not.
Thought suppression, which is trying to actively resist and not think about certain things, is commonly used when someone does not want to accept the presence of thoughts. The person's logic is that if they try not to think about something, they will not. The problem is that thought suppression has a paradoxical effect. The more you try not to think about something, the more you think about that thing. This creates more distress long-term. Conversely, when you give yourself permission to think about something you actually think about it less. That thing does not hold as much power in your mind.
Misconception #5: These are “bad” thoughts and I’m a bad person for letting them be there.
Those with OCD often feel a lot of guilt and shame for having intrusive thoughts. They may think they’ve done a bad thing by having a thought (irrational and unfounded guilt) or are a defective person for having the thought (irrational and unfounded shame). Having an anxiety disorder does not make you defective or bad.
As difficult as it can be for OCD sufferers to believe, there are not good or bad thoughts. There are just thoughts. What makes them “good” or “bad” in our minds is the meaning we assign to them. A thought is a string of words inside of our head. Those words are then a string of letters. The letters are not good or bad. They are simply letters.
Thoughts and feelings are out of our control most of the time and that does not make us bad. That makes us human.
Acceptance does not happen overnight but is rather a daily practice that you get better at over time. It is a lot like building a muscle. When you first start lifting weights, you likely get sore and experience some difficulty. As time goes on, you get stronger and stronger. That ten-pound weight that you started with feels light as a feather over time.
When we can see thoughts and feelings as what they are, simply thoughts and feelings, it becomes easier to accept their presence. The more we practice acceptance, the stronger our muscle for tolerating discomfort and uncertainty becomes.