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When I work with a client with Obsessive Compulsive disorder (OCD), one of the first things I do is try and provide a clear understanding of what OCD is and how it operates.  I try and make it clear that OCD thrives and is usually made worse with reassurance strategies.  For example, if a client comes to me with a concern that they might lose control and end up harming a loved one, (often known as harm OCD), such as with a child or spouse, but has no history of doing so,  I might feel inclined to provide the client with reassurance that the likelihood of them doing so is very low.

The problem with me providing this reassurance however is that learning to live with uncertainty, as uncomfortable and scary as it is, provides the best long term treatment and symptom relief for the disorder.   I am more inclined then to remind the client, especially if they are looking for reassurance, that me providing them with reassurance is not likely to help with their OCD,  but that accepting some uncertainty about their fears is.

While it might be true that most OCD sufferers are not likely to act on their obsessive fears, it is probably not a good idea to overly emphasize this fact.  The goal here is to help sufferers to learn to accept and live uncertainty,  much like the general population does.

Acceptance and Commitment Therapy, or ACT for short, is a type of therapy which uses mindfulness techniques like diffusion in the service of living one’s values.  The idea here is that when we are struggling to stay in the present moment, for example by becoming  overly focused  on our thoughts and emotions, (what ACT calls fusion), it makes it much harder to make choices which are in line with our values or how we would like to show up in the world.    ACT provides strategies like diffusion techniques where we are able to get distance around problematic thoughts and feelings.   This in turn makes it easier to re-focus on living a life which is in line with our purpose and allows us to take steps towards who we are trying to become.    For example, if we are ruminating about some negative experience we had and it is making it harder for us to stay present and to connect with our values we could use a diffusion technique.   One diffusion technique, as there are many, is to imagine that we are putting our thoughts on a leave and then sending that leave upstream as we observe it flowing through the water.   With ACT the goal here is not to immediately get rid of our thoughts and feelings, which ACT would consider problematic, but to change how we relate to them.  You might have heard the old adage “to not let your emotions get the best of of you”.   ACT provides a method to make that reality possible.

References:

Harris, R. (2019). ACT made simple: an easy-to-read primer on acceptance and commitment therapy (2nd ed.). New Harbinger Publications.

When it comes to mindfulness there seems to be an ongoing debate in the research community, about how effective mindfulness works and how effective it is for conditions like depression,  anxiety, and stress reduction to name but a few.   Perhaps part of the issue with determining whether mindfulness can be considered an evidence based practice like Cognitive-Behavioral Therapy, or other modalities which have been studied extensively, is due to the unique qualities which mindfulness can promote and encourage in an individual which aren’t easy to measure.   For example, in my own life I have seen how mindfulness helps me to be less reactive to other people in general and to have a relationship with uncertainty which is is novel and which cannot be easily quantified or tested using normal empirical methods.

To elaborate, by noticing my uncertainty I still sense the discomfort and even have some of the previous inclinations to try and minimize uncertainty, but with mindfulness I am able to have a new experience with uncertainty which is hard to describe.  I am more aware of the real cost to my energy resources of requiring an answer to all of my uncertainties and realize how drained I feel after attempting to eliminate uncertainty.   This novel awareness at times facilitates the desire to stay present minded because of the practical value it holds for being able to accomplish certain tasks without the added strain of trying to figure out and predict the future.   Uncertainty is known in anxiety literature and research to be a key component in generalized anxiety disorder and obsessive compulsive disorder.   Having a new way of orienting towards uncertainty which does not immediately remove the fear of uncertainty but instead helps a person to become more acquainted with the here and now practical costs of deciding to try and eliminate anxiety can be highly therapeutic.   It puts a person in touch with the practical reality of continuing to try and eliminate uncertainty and to recognize the value of to learning to allow the discomfort and angst to come and go just as an individuals allow pleasant feelings and thoughts to do the same.

SOURCES:

Farias, M., & Wikholm, C. (2016). Has the science of mindfulness lost its mind?. BJPsych bulletin, 40(6), 329–332. https://doi.org/10.1192/pb.bp.116.053686

Martínez-Esparza, I. C., Rosa-Alcázar, A. I., Olivares-Olivares, P. J., & Rosa-Alcázar, Á. (2022). Obsessive beliefs and uncertainty in obsessive compulsive and related patients creencias obsesivas e incertidumbre en pacientes con trastorno obsesivo compulsivo y afines. International journal of clinical and health psychology : IJCHP, 22(3), 100316. https://doi.org/10.1016/j.ijchp.2022.100316