How much do I want to read more? 9/10

It may be simple, but I love it. It's clear and concise. Plus, it's practical.
I may not have this "disorder" but I think we all have it with different degrees. And it feels good to be reminded about mindfulness in this perspective.

I never read about OCD. Basically it's getting carried away by one's own "thoughts" in a way that is detrimental to us. Telling stories in our mind, and acting upon it when we shouldn't.


“This book is a breath of fresh air for anyone who suffers from obsessive-­compulsive disorder (OCD). Instead of just telling you what you should or shouldn’t do, the book helps you learn how to relate to yourself with more mindfulness and compassion. Rather than trying to fix or change yourself, the practices actually help you befriend who you are already, allowing you to heal through the power of presence and kindness.”

—- ­Kristin Neff, PhD, author of Self-­Compassion


Living with OCD means learning to address intrusive thoughts as they arise, whether while you’re chopping vegetables in your own kitchen or navigating a crowded store.

-- Alison Dotson


FOREWORD

Obsessive-­Compulsive Disorder (OCD) was once considered untreatable. Individuals with OCD could spend years in psychotherapy with minimal or no benefit, and medications available at the time were largely ineffective.

Receiving a diagnosis of OCD no longer meant a lifetime of hopelessness. With proper therapy, many people could expect to have a significantly better life.

As the title suggests, much of the book is focused on mindfulness. Being mindful teaches you how to reverse futile attempts to eliminate unpleasant thoughts, and how to accept and move past the things you cannot control.

avoidance is the enemy of recovery.

INTRODUCTION

Obsessions are unwanted thoughts that are perceived as intrusive and repetitive. Compulsions are physical or mental behaviors aimed at decreasing the discomfort associated with obsessions. The presence of obsessions and compulsions becomes a clinical issue when there is a related impairment of functioning or quality of life

As obsessions are unwanted, intrusive thoughts, you become uncomfortable when you become aware of them. It bothers you that the thought is there, in part because it just doesn’t line up with what makes sense for you and your identity. You may also associate the thought (specifically, the words or images that make up the content of the thought) with things that are upsetting or disgusting.

The problem with compulsions is that they work—­at least a little bit, some of the time. Compulsions usually provide some modicum of relief from the pain of your obsessions. This triggers a fascinating process called negative reinforcement. By removing pain, compulsions trigger the brain to calculate that the compulsion is tied to the obsession in a manner that should be repeated. This not only increases the urge to respond to obsessions with compulsions, but also increases your sensitivity to the obsession in the first place. When it makes itself known, it does so along with the message that it requires a compulsive response because it feels like a really big deal.

It’s like you’re getting slapped in the face for no discernible reason, then you stand on one foot and the slapping stops, so your brain thinks you should stand on one foot whenever you see a hand approaching your face. The more compulsions you do, the more you reinforce the cycle.
To beat an obsession, you need to starve it out, which means you need to target and eliminate compulsions.

A specific form of CBT called exposure and response prevention (ERP) works by having you gradually put yourself in the presence of the thoughts, feelings, or experiences that cause you discomfort (exposure) while resisting attempts to use physical or mental compulsions to neutralize or avoid the discomfort (response prevention).

One form of CBT, known as acceptance and commitment therapy (ACT), emphasizes openness to thoughts and feelings and a focus on the pursuit of clear values. Different people may respond differently to traditional CBT and ERP approaches.

Mindfulness is the ability to observe your experiences without judgment. Self-­compassion is the ability to relate to yourself with the desire to reduce your own suffering.

About the Authors

Jon Hershfield

Later that day, playing with my friend, I remember sitting on the floor under a table, a bowl of carrots between us, pretending to be rabbits.


PART ONE: Mindfulness and Self-­Compassion for OCD

CHAPTER 1: Mindfulness

Why Mindfulness for OCD

This enhanced attention to detail in the mind lends itself to creativity, humor, and ingenuity.
you have to be able to observe when you’ve been carried off by negative experiences and return safely from those as well.

You get pulled away from the present moment by obsessions, and by the time you realize that this has happened, you are so deep into it that it requires great effort to disengage. These efforts to disengage from unwanted thoughts, feelings, and sensations come in the form of judgment, analysis, rationalizations, and neutralizations (in other words, compulsions). But what if there were another way? What if you could (1) increase the speed with which you realize that you’ve been distracted by your thoughts and (2) return from that distraction without preconditions (that is, without rituals)? That skill is called mindfulness.

What Is Mindfulness?

Mindfulness, simply defined, is nonjudgmental awareness of the present moment. To experience the world mindfully is to observe it (both the external and internal) without evaluation, in the here and now, with no expectation or mandate to change it. In other words, it is using your noticing abilities to your advantage by stepping back and watching thoughts, feelings, and sensations as they arise. Mindfulness isn’t an intervention. You may hear people say things like, “I was really scared, but then I used mindfulness.” This fails to capture the true nature of mindfulness. Mindfulness is a way of experiencing the world, not something you do to it.

A Mindful Example of OCD:

Imagine for a moment that you are driving down the road when, all of a sudden, your OCD suggests that perhaps you weren’t paying enough attention at the last intersection and you might have run a red light. And not only that—­maybe in running the light you caused a horrific accident and someone is now really hurt or maybe even dead because of you. A non-­mindful approach to dealing with that obsession would be to react to the anxiety you are feeling (“I feel anxious, so something must be wrong!”), believe the obsession (“Oh, no! I may have killed someone!”), and start acting as if that obsession were true.

You then notice an urge to go back and check the road for evidence of your imagined crime. Rather than give in to this compulsion to get certainty about your obsession, you simply notice the presence of that urge: “I’m feeling an urge to go back and check.” You then make the decision to allow yourself to be in the presence of that urge (instead of dwelling on whether or not to do compulsions) and then bring your attention back to the present moment. You continue driving down the road toward your destination in the presence of your internal experience (your thoughts and feelings) while also being aware of what’s going on in the external world (cars passing you, vehicles entering and leaving the road around you, and so on).

Stepping Back

Mindfulness keeps us from fusing with our thoughts and feelings—­even those created by obsessive-­compulsive disorder. Being mindful does not mean pushing thoughts away or clearing our minds of obsessions or the urges to do compulsions; rather, it allows us to step back and see them for what they are, and this distance makes it easier for us to stop confusing the perceived intensity of the content of the thoughts with their importance.

he will play a game where he pretends that all the thoughts he’s having are coming from the person next to him.

If you could see the thoughts of the person sitting next to you as they occurred, scrolling by as if on a news stream on the bottom of a TV screen, you would just watch them, mostly without much emotion. You might find some of them interesting, boring, shocking, or entertaining, but overall they wouldn’t pack the same emotional punch as those same thoughts coming from your own head—­in fact, you might have a hard time staying focused on these thoughts coming from another person’s mind because to you they just don’t have any meaning. That’s why learning mindfulness in the context of OCD is so powerful: it helps you recognize that no thought is inherently more meaningful than any other thought, regardless of its content.

we can position ourselves as observers, rather than victims, of the mind, we immediately have the upper hand over OCD. To give this more clarity.

Staring at the Computer, Metaphorically

One way of understanding mindfulness is to think of awareness in three parts: the brain, the self, and the mind. The brain is that gelatinous mass in your skull. The self is you. And the mind is the interface with which you and your brain interact. Consider that the brain is somewhat like a computer hard drive. It creates, calculates, and stores data. This data is presented and displayed on a screen, like the computer monitor. This screen can be considered the mind in this metaphor. Though you may often hear about the mind doing this or that, being very active, you might also think of it as simply a stationary display of what is going on in the brain.

You are the self, the person who decides how much and what kind of attention to pay to the various things displayed on the monitor. You might focus most of your attention on an e-­mail in front of you, a little attention to some software update alert off to the side, and almost no attention to the different icons in your toolbar at the bottom. This attention can be shifted at will from one thing to another in different parts of the screen.

Problems occur when we find ourselves positioned too close to the screen. Imagine your nose squished up against a computer monitor, trying to process what’s going on. Whatever is directly in front of your eyes will get 100 percent of your attention, and whatever it is will seem severe, distorted by the intensity of its being right in your face. This is what it is like to be mind-less. You just can’t take it all in from that close. So to be mind-­full you must have enough distance from your mind (the monitor) to take it all in.

Establishing a Healthy Distance from the Screen

The farther away from the screen, the easier it is to choose what to focus on. Move back even farther, and we may choose to release a focus on our thoughts altogether. But if we can strive to be more mindful and back up from the screen even just a bit, we can live more mindfully and as joyfully as we choose. The trick is to become aware of when we have gotten too close to the screen and use this awareness as a cue to back up and give ourselves some distance.

Developing Mindfulness through Practice

One way to conceptualize this is to consider that you have a kind of muscle in your brain that brings you back from your obsessions.

You end up using compulsions to get back, and compulsions are the fuel for your OCD. However, if you have an internal willingness—­a muscle that you have exercised and is thus very strong—­it can supersede the OCD and allow you to bring yourself back to the present moment. One way to exercise that muscle in your brain is meditation.

The Exercise of Meditation

In the context of OCD, meditation is an exercise and nothing more—­like weightlifting for people in training for an athletic event. It is not a religious rite or a path to self-­realization.
Quite simply, meditation is an act of mental fitness or mental hygiene wherein you repeatedly flex and contract your ability to pay attention to the present moment.

Vipassana comes from an ancient Indian practice; it is a Pali word that can be translated as “insight meditation.” In this type of meditation, we gain insight in part by focusing on the body and its sensations, and most commonly, on the breath. In a larger sense, vipassana is a series of philosophical and moral perspectives, but one of the tools used to achieve this perspective is a form of meditation that involves training the mind to become aware of when it is distracted by thoughts or feelings and to remain attentive to the present moment.

Location, Location, Location: Finding a Suitable Place to Meditate

The most helpful environment for meditating is one where you feel you have privacy and are not going to be disrupted.

Comfortable But Dignified: Positioning Yourself in the Space

Start by sitting in a comfortable, but upright position, without straining or slouching; if in a chair, with your feet planted on the floor and your hands resting on your knees or thighs. It can be helpful to get in the mood before doing the work, so start by simply taking a few deep breaths and considering a simple concept: “Here I am…in this space.” Remember, the point of the meditation is to develop or strengthen the skill of returning to the present moment, so the more clear you are about the present moment, the better. After a few breaths and taking in your immediate environment, close your eyes and just breathe normally (in and out through your nose).

When thinking happens, the aim of mindfulness is to be aware that you are thinking instead of being lost in thought. The moment you close your eyes, you are likely to be very aware of your thoughts, feelings, and sensations. It will get noisy in there pretty quick. Just allow that to be. This is where you are in this moment, so it’s still perfectly welcomed in your meditation. Remember, the idea is, “Here I am…in this space.”

Your meditation is not about calming down or being mentally still. It’s actually quite active. So start by noticing all those thoughts and feelings and sensations. Go ahead and comment gently to yourself about how you’re feeling in this moment. “Wow, there’s a lot going on there” is a perfectly mindful statement. “Ugh, I am terrible at this, what a waste” is not so useful.

Print Yourself: Scanening Your Body

To begin, actively direct your attention to your feet.
So, considering the soles of your feet, mentally draw the areas of your feet that are in contact with your shoes or the floor. Again, “Here I am in this space, my feet pressing down in this way.” Let all of your other thoughts circle you and just keep coming back to this task of creating a mental image of the experience of your feet resting on the floor.

If you can observe the experience of how your feet feel, the sensation of each foot resting on the floor, that’s getting off on an even better foot. (Admit it—­that’s a functional pun.)
Next, scale back your attention from your feet and shift it to your buttocks.

Notice how you are pushing down on the seat, or rather, you are being pulled into the seat by gravity and the seat is pushing back against you. If you notice pressure on one side more than another, good. Just go ahead and notice that experience.
Now switch your attention to your hands. Mentally outline your fingers and sketch in your palms, paying special attention to where your hands are touching or not touching your legs. All of this may seem quite busy, which is fine. If you get distracted, also fine. Just notice when you’ve become distracted and return to what you were doing. At this moment, you are attending to your hands resting on your lap in this moment in this space.

Next, shift your attention to your face. Check in with whatever is going on there. Can you feel the air on your face? Is it warm or cold? Are there any smells or tastes worth noting? Now to your ears. Imagine, if you can, opening up your ear holes to the space you are in. Instead of the sounds you may encounter (an air vent, distant voices, your own breath, a fan, footsteps, and so on) being problems, try to view them as simply elements of the space you are in. Too much noise can be too distracting, of course, and may mean this is not an ideal space for meditating. But some noise can add shape and texture to your environment. If there are too many dynamic sounds distracting you, it’s perfectly fine to turn on a fan or white noise machine.

The final scanning step is the full body scan. A good way to think of scanning the body is that your mind is like an inkjet printer. It goes back and forth, back and forth, again quite actively, printing out line by line what it sees until it has produced a complete picture. Starting at the top of the head and gradually, slowly, and evenly working your way down to your feet, print out a mental picture of your body. This printout is not just what you think your body looks like in this moment, but what it feels like too. It’s your experience of your body. If at any point you come across a part that’s uncomfortable or that raises strong feelings, don’t stop printing. Just notice what’s going on there and let the printer move on evenly. At the end, you will have checked in with all of your points of contact, your senses, and your body as a whole in this space in this moment of time. You are now ready to begin the meditating part of meditation.

Resting Your Attention: Watching the Breath

For the next segment of the meditation exercise, you will rest your attention on your breath. This means shining a spotlight in your mind on where you feel your breath the most. It could be the whoosh as it enters your nose, or the sensation of your solar plexus rising and falling, or the feeling of your belly inflating and deflating. This is your anchor. Home base. For the next few minutes, this is the thing you will keep coming back to: this feeling of breathing in and breathing out.

You will have thoughts that disrupt your attention on the breath. This is perfectly fine. All distractions are just that: distractions. The idea is to become aware that you have wandered off, simply acknowledge this, and then return to the breath. This, in and of itself, is being mindful and practicing mindfulness.

It doesn’t matter if you catch yourself wandering away from the breath a little or a lot. Your mind is like a puppy that you’re training to sit or roll over, and it easily gets lured away by things in its environment (like an enticing smell or a bug it could chase). To bring the puppy back, you have to be gentle, friendly, and patient, and above all, you’ll want to just remember that puppies are like this: prone to distraction.

Actually, in the beginning at least, wandering off a lot is a good thing. Remember, what you are trying to teach yourself is to notice when you’ve wandered away from your anchor and to return without precondition. If you never wander off, there’s nothing to notice and there’s no opportunity to strengthen that coming-­back muscle. And again, it is this muscle in your brain that releases you from the power of your obsessions, so we want to exercise it.

You are going to be distracted by thoughts, feelings, and sensations. The key is to stay out of problem-­solving the content—­otherwise known as “anything at all that you’re stuck on and worried about” (Wilson 2016, p. 62)—­and stick to the main theme: that these are thoughts, feelings, and sensations, and only thoughts, feelings, and sensations. They are streams of data in the mind. Liking them or disliking them is not at issue here. The skill you are trying to develop is simply observing them.
Mindfulness entails observing things in the present moment without judgment as they are, not as they could or should be. When you observe a thought, then you have done just that, observed a thought. It doesn’t matter what the thought is about or where it came from, or how often you have been in its presence. When meditating, there is a thought, and then we return to the breath.

Reasonable people can agree that watching your breath for more than a few seconds is pretty boring. Remember that the purpose of meditation for OCD is to develop the skill of coming back to the present, back to your anchor. So it is precisely because the breath is so boring that it’s the perfect anchor for this exercise. It requires intention to both observe that you have wandered off into thought or feeling, and to allow yourself to return to the anchor of the breath even when that may seem unimportant. It is meant to be challenging. But it is also meant to open you up to having curiosity about the banal. Why, in the presence of an OCD thought or anxious feeling, are you not impressed by the flavor of your food or the sensation of a breeze? Consider that if you were to improve in your ability to return to and remain with something noncompelling, such as the breath, how could OCD ever hope to compel you to do your compulsions?

Run Credits: Ending the Meditation

By meditating and practicing the skill of returning to the present without judging your distractions, you are likely to find that you become better at doing so in your day-­to-­day life. You might say meditation is “working” when you notice that you are generally responding to OCD symptoms the way you might respond to those same symptoms if they occurred during a meditation exercise: by acknowledging them and then turning your attention back to what you were doing.

This approach often gets confused with ignoring your symptoms, but in fact it is much more powerful. Ignoring your thoughts is an act of denial, of pretending something isn’t there when it is. Mindfulness asks you to acknowledge the thoughts, but choose to respond to them openly and without attachment. We know, easier said than done. But that’s what we’re aiming for. More presence. More pursuit of the things we care about. Less wandering around lost, at the mercy of OCD.

Being Mindful of Expectations

“Good” meditations are just meditations you feel good about.
But if you position yourself as a success or failure based on how many thoughts you have or how relaxed you feel or how focused you were, then you will not benefit from this exercise.
happiness equals reality minus expectations. Try to reduce your expectations about meditation and mindfulness; this will help you peacefully tolerate, if not outright enjoy, the process.

In This Moment

Viktor Frankl, the Austrian psychiatrist and Holocaust survivor, is widely credited with the observation that there is a space between any stimulus and our response to it; that in that space we find the freedom and power to choose how we respond; and that in our response lies our growth, freedom, and happiness.