Obsessive-compulsive disorder (OCD) is an illness characterized by intrusive and distressing thoughts, images, or impulses (i.e., obsessions) and by repetitive mental or behavioral acts (i.e., compulsions) that the person performs to prevent or reduce distress. The World Health Organization has identified OCD as one of the world’s leading causes of illness-related disability (Koran, 2000, Murray and Lopez, 1996, Robins et al., 1984 and Skoog and Skoog, 1999). Proven OCD treatments include pharmacotherapy with serotonin reuptake inhibitors (SRIs) and cognitive-behavioral therapy (CBT) consisting of exposure and ritual prevention (EX/RP). EX/RP is at least as efficacious as SRIs and may be more durable (Foa et al., 2005 and Simpson et al., 2004). However, EX/RP treatment has limitations: some refuse it, up to 25% of patients who enter drop out (Kozak, Liebowitz, & Boa, 2000), many who complete do not fully adhere to the procedures or achieve remission (Simpson, Franklin, Cheng, Foa, & Liebowitz, 2005), and not all maintain their gains in the long term (Foa and Kozak, 1996).
Given these limitations, alternative approaches to treatment or methods to enhance effectiveness of EX/RP merit further exploration. For instance, methods that emphasize the importance of noticing and accepting rather than attempting to change internal experiences such as thoughts, feelings, and bodily sensations may be useful in bolstering the effectiveness of EX/RP. Mindfulness is one such method that promotes awareness and attention to internal experience and is characterized by an acknowledging and witnessing stance towards this experience (Kabat-Zinn, 2003). From this witnessing perspective, participants learn to notice the thoughts, emotions, and sensations that arise without evaluating their truth, importance, or value and without trying to escape, avoid, or change them. In this way, mindfulness may help people to live satisfying lives while experiencing anxiety instead of being primarily preoccupied with attempting to control emotional experiences or actively changing the content of thoughts.
Recently, behaviorally oriented theorists have advocated renewed attention to the incorporation of mindfulness into psychotherapy to increase its effectiveness (Hayes et al., 1999, Linehan, 1993 and Orsillo et al., 2004) and several approaches utilizing mindfulness techniques have been developed as stand-alone treatments. These include Acceptance and Commitment Therapy (ACT), ACT for OC spectrum disorders (i.e., skin picking), Dialectical Behavior Therapy (DBT), and Mindfulness-Based Cognitive Therapy (MBCT), as well as variants of mindfulness techniques such as mindful awareness and the 4 R’s (Hayes et al., 1999, Linehan, 1993, Schwartz et al., 2005, Segal et al., 2002 and Twohig et al., 2006). These approaches and techniques, while incorporating a mindfulness component, do not focus on the formal practice of mindfulness meditation as an integral part of the treatment. They have, however, shown promise in helping individuals to cope with the symptoms associated with a variety of psychological disorders, including anxiety and depression. To date, there has not been a mindfulness meditation intervention applied to obsessive-compulsive disorder (OCD).
Mindfulness-Based Stress Reduction (MBSR) is an intensive outpatient stress-reduction program based on the formal practice of mindfulness meditation. Its primary goal is the integration of mindfulness into everyday life as a support in dealing with the individual’s unique stressful life situations. Through a sustained process of daily home assignments, program participants learn and refine a range of self-regulatory skills aimed at awareness of internal experience (i.e., thoughts, emotions, sensations) and their effects on symptoms, feelings of health and well-being, stress reactivity, and overall sense of self and self-in-relationship. The practice of these mindfulness meditation techniques incorporates mental and behavioral components - for example, exposure, cognitive change, self-management, relaxation, and acceptance—that have been shown to be efficacious and necessary in the treatment of anxiety disorders (Baer, 2003). In the only study of MBSR for treatment of anxiety disorders, Kabat-Zinn and colleagues (1992) found that participation in the program led to significant reductions in symptoms of anxiety and depression in 22 medical patients with generalized anxiety disorder and panic disorder with and without agoraphobia. Additionally, there was a high rate of completion: 92% of participants completed the MBSR program and 84% of participants reported practicing MBSR techniques at least three or more times a week at 3-month follow-up (Kabat-Zinn et al., 1992). Although this was not a controlled trial, the results suggested that MBSR might be helpful in the treatment of anxiety disorders. The purpose of this report is to present the case of an individual with OCD who participated in an individual mindfulness-based treatment that was adapted from the MBSR program.
