How to approach OCD from a mindfulness perspective

What is OCD?

OCD or Obsessive Compulsive Disorder is a disorder where a person is obsessed with certain types of thoughts or feels compelled to act in certain ways. For example one may have fear of contamination from germs leading to repetitive hand washing or desire to have things symmetrical or in perfect order like keeping a pen parallelly aligned to the table edge etc.

A more uncommon yet challenging symptom of OCD is unwanted, forbidden, or taboo thoughts involving harm. Such thoughts are often interpreted by patients as “intrusive thoughts” and are associated with the fear of losing control over one’s behavior in ways one does not intend. People suffering from OCD often worry about this.

The origin of thinking and behavioral patterns causing OCD

One must remember that merely having these kinds of thoughts or even some of these behaviors does not make one have OCD. The test for having or not having OCD is-

• Is one bothered enough by such obsessive thoughts and compulsions?
• Do such thoughts or compulsions affect your daily functioning and wellbeing in a negative way?

If the answer to the above questions is “Yes”, then yes, you have OCD and you have to get help.

It is important to note however that it is important to develop vigilance around such thoughts and behaviors even when are they seem benign and do not bother us. “Especially” when they seem benign and do not bother us.

Why? One must know that OCD does not arise in a second, minute or even hour. It is never a sudden occurrence. We are all born with mental tendencies- thinking styles and behavioral patterns. For example, the tendency to check again and again whether a door is locked or always keeping pens or pencils at right angles on the desk are all already there from the time we are born or while growing up. These tendencies are in fact indicators of deeper mental patterns which cause us to think or act in these ways. I for example, have a quirkiness around having all wall tube lights perfectly parallelly aligned to the wall edges. If they are at an angle, it bothers me. This tendency indicates a deeper mental pattern in me of being a more spatially aware person but having taken aesthetics of space to an extreme. My obsession with parallel or right angles can also be seen in my fondness of Japanese architecture especially with the windows and doors all aligned in space. These likes and dislikes seem benign on the face of it, but when they become strong, they lose their charm and take on an extreme monster-like role and are very hard to be dealt with.

The dichotomy of judgment

The philosophy of mindfulness that arose in Buddha’s teachings explains this in great detail-

• According to mindfulness, likes or dislikes, aka cravings or aversions– (which are nothing but attachments) are the cause of our suffering. You would gasp- likes or dislikes? They seem so benign, right? But that is how we humans live? They are the source of our happiness, isn’t it? How can they cause us any problems? Well, let’s dig a little deeper.
• Likes or dislikes, rather let’s use the mindfulness language- cravings or aversions- are basically a result of our mentality of judgment. When we look at something, our mind processes the sensory information and we form a perception, labeling it as good or bad. Depending upon that we like or dislike something.
• This judgment is actually due to lack of objectivity. Judgment always happens because of an inherent bias and not because something is really good or bad.

It is because of our faulty perceptions that we think things are good or bad. Things are actually neither good nor bad. They are just how they are. 

Let’s take this to an extreme. Let’s say, you happen to come to know about a serial killer in news, who has recently been arrested. One will without hesitation label him or her as bad, right? One would even have a lot of aversion for him or her. However, if you actually sit with the person and interact for a long period of time, (let’s say you have full police protection) you might realize that the serial killer also deserves some compassion. In fact, it may seem that he is not all that bad. Or he is a mix of good and bad traits, the bad ones dominating. What what I want to draw your attention towards is this- we are often quick to use judgment, but when information unfolds in front of us slowly over time, and we get to observe more, we may come up with another perspective. This is almost always true. So judgment which is normally a result of quick decision making, is almost always incorrect. In fact, according to Buddha judgment is antagonistic to enlightenment. You can either use objective observation or judgment (subjectivity). You can’t use both. To dig deeper, one judges things as good or bad because one has tendencies to look at things incorrectly.

How we develop faulty perceptions

It is almost impossible to not develop faulty perceptions as human beings since complete knowledge of how the universe works is not available to us. Or at least our own perceptions block from receiving such wisdom.

• Human limitations– Since we use the senses to get information, an element of illusion is always there. For example, we can only see what is in front of us and not what is behind us, we can only see certain frequencies of sight (like we don’t see Ultra violet or viruses), we can only hear certain frequencies of sounds, we cannot know someone’s or our own pasts to verify some information, and similar many such limitations.
• Emotions– In addition to this, how we are feeling in the moment affects how we perceive things a lot. For example, let’s say I got into a spat with my spouse in the morning. With an already disturbed mind when I enter office, I see a pool of water and the security guard standing right next to it. I might quickly make a flash judgment that the guard spilled the water and he is irresponsible. And I might decide to not reply to his “Good morning” that day.
• Beliefs– Similarly, we develop erroneous beliefs and make a lot of assumptions, due to lack of complete information in the present moment. For example, if a beggar comes to your house and asks for money telling his story of how he lost all his money, we look at his talking style, behavior and other things to make some assumptions about whether he is a genuine person or not.
• Outside environment or circumstances– Who we are living with, our family, near and dear ones, office colleagues, society and culture also influence how we perceive realities in particular ways. Sometimes a very negative environment and lack of resources can put too much pressure in our lives and force us to think and act in certain ways.

How OCD develops

Reacting to stimulus

We as human beings are always reacting to outside stimulus on a daily basis. Forming biased perceptions and judgments due to ignorance are often an integral part of this.

How aversion develops

Sometimes when we are faced with a negative circumstance like a job loss, separation, disease or death of near or dear one. Or even on a day to day basis we may have to deal with stress – for example a marriage that is not working well, conflicts with colleagues, a difficult relationship with boss or financial challenges etc. Such circumstances act as a stimuli to our mind and a part of it immediately starts to react with bias or judgment. For example, we may develop a dislike for our boss or coworkers. Judgment is easy and supports our ego- we are good, they are bad- is a story we often tell ourselves to feel better in a situation. However, whenever such a tendency arises, we must realize that the tendency of aversion is arising in us. Aversion is just a faulty perception that gives us temporary comfort or identity with an illusive good, making us weaker inside. Once the tendency arises, our patterns start becoming more evident. As we become more averse, we also become more cautious- adding fuel to our tendencies of checking whether the door is locked or not or whether our hands are clean or not. Because aversion is really based in fear.

How craving develops

We might also see a strengthening of our craving tendencies in such circumstances since we are looking for support in something that makes us feel good. Feelings of craving or liking something make us feel good and so our mind generates more and more of these. For example, in a difficult time, we might like to rely more on cooking and baking yummy dishes or buy beautiful curtains for our home, we might paint our wall yellow or buy a beautiful lamp. All these actions in themselves have nothing wrong in them but our tendency to like or have strong craving for them, can affect us in the long run. How such seemingly benign patterns become characteristics of a disorder can look like a mystery. For example, now we suddenly become more bothered that the pen is at an angle to the edge of the drawer or a book is kept slanting over the stack.

These patterns arise as obsessions and compulsions because we start identifying with them. We start thinking of our tendencies to like or dislike something as right or good to such an extreme that they start bothering us.

Applying mindfulness to OCD

What is the way out? Objectivity.

It is true that once we have a tendency that has become strong enough to take on the garb of a disorder, we have to get help. Ideally, the mindfulness way is to be watchful of such patterns and tendencies long before these ever had the chance to develop. Can we apply mindfulness once we have OCD? Yes, we can, and we must. Mindfulness in fact is the only way out. It is also a superset of all the cognitive psychology methods and techniques like cognitive distortions, CBT, etc. However, we would have to be patient with ourselves and not look for results immediately.

A mindfulness technique is nothing but nonjudgmental observation

What is the mindfulness way? To develop in objectivity towards our thoughts and equanimity towards our emotions, aka by being objective in our thinking and not hurrying to be judgmental. The techniques of Anapana and Vipassana meditation help us become more aware of how we think and feel in a nonjudgmental way and help us develop the objectivity to not be affected by any tendencies and patterns. It is because the patterns or tendencies take over our senses and directly impact our minds and bodies that we feel disturbed or bothered. If we watch these patterns of cravings and aversions, from a distance (objectivity), we can enjoy our lives to the full.

The use of breath as a perfect observation object

The most immediate practice one can do to come out of an OCD obsession is to practice Buddha’s method of right concentration- the Anapana technique. It is about focusing on the breath and simply nonjudgmentally ignoring the thoughts as they arise. So, one focuses one’s attention on the incoming and outgoing breath and if a thought arises and mind gets distracted, one simply brings back attention to the breath. One can do this for 30 mins or more. In fact one can practice this as much as possible. It is the obsessive thoughts that bother us the most, hence the most important thing to do is to stay away from them. By thinking more or doing more mental analysis (like in cognitive therapies) one may not be able to come out of the disorderly patterns of thinking. One has to develop objectivity to become nonjudgmental towards these thoughts. To do that, one has to focus on breath. Breath is present, always available and we are nonjudgmental towards it by nature. It helps in developing objectivity and mental focus. It also shifts the focus completely away from all thoughts. If one is unable to bring one’s attention to breath, one can practice deep breathing techniques. Whatever you choose, breath is the only way forward. Sometimes exposure therapies are given for OCD however they can be very harmful also depending on the state of mind of the person doing them. By exposing to an extreme environment, one’s negative or biased tendencies cannot become Ok because this is feeding the negative pattern even more. One has to find a way to develop in objectivity and so using breath is foundational.

Anapana meditation is taught as a prequel to Vipassana and is an integral part of any 10 day Vipassana course. Anapana is as very simple technique and can be learnt even by an 8 yr old kid. To truly learn to observe the mind, it is best to enroll oneself in a Vipassana course which is taught for free all over the world.

Why aren’t cognitive therapies very effective in treating OCD

Exposure therapy and CBT related techniques which are often used in OCD don’t necessarily help much- in fact, can exacerbate the problem. An initial mental analysis of thoughts in CBT – can give some insight into our nature and thinking to some extent. One can understand from basic observation these thoughts are just thoughts and are not harmful unless we believe in them or use them into an action. So, one must not get carried away with them. However cognitive therapies ignore the fact that there are also heavy feelings associated with such thoughts that are not addressed.  There is too much analysis in thought related CBT which increases stress. And in exposure therapies there is danger of one feeling worse due to feeding of the negative pattern.

As a human being, one first has an intention, then it becomes strong enough to become a thought and an associated feeling and then when feeling becomes too strong, one might feel compelled to take action. The problem is not in the action but the attachment to the thought. It is the identification and attachment with the thought that makes one “do” things. When thought is free and nonattached- like “I observe a bird fly across the sky”, it arises and passes away. However, when the thought is sticky- like “I am good and he is bad”, one identifies with it- one cannot let go. It is the craving for such thoughts, opinions, beliefs or feelings that one gets attached to them and cannot let go. Thus, the problem we are dealing with is not a small one, but elephantine in nature. We are basically dealing with a strongly addictive or attachment tendency in us which has now arisen. More analytical thinking or exposure cannot resolve these and will bring up only more such thoughts and feelings. Just like Einstein said –“ You can’t solve a problem with the ways of thinking that created it”. Hence, one must use a different part of the mind to detach from these and observe these as thoughts and feelings from a distance. That part of mind is the observing mind and it can only be activated by using breath as a meditation object.

Hence, Anapana meditation or breath based techniques are critical to one’s health and wellbeing when dealing with disorderly patterns