The Mindfulness Workbook for OCD by Jon Hershfield and Tom Corboy has just been released in its second edition. I was curious what a mindful approach to OCD would look like, but, as the subtitle says, this is a mindfulness and cognitive behavioural therapy (CBT) in combination book; it’s not a pull up a cushion and meditate book.
Sometimes mindfulness books start going into the territory of suggesting that you can meditate an illness away. This book definitely doesn’t do that. It ties acceptance into exposure, and frames compulsions as resistance (to the discomfort of obsessions) rather than acceptance.
The book emphasizes that “thoughts are thoughts, not threats.” Meditation in this context isn’t about trying to empty the mind; it’s about being there with those uncomfortable thoughts and just letting them be rather than trying to do anything about them.
Some CBT basics are covered, like ways to challenge cognitive distortions. Exposure and response prevention (ERP) is emphasized throughout the book as a fundamental of treatment.
The authors explain that trying to control the thoughts running around in your head is a form of compulsion. Automatic thoughts and feelings simply aren’t under your control. Different forms of mental compulsion are discussed, including rumination, mental rehearsals, rationalizing, and self-criticism. Self-criticism is identified as an area where mindfulness can play a role, as it “represents a confusion over what you can and can’t control.” I thought that was a really interesting way of framing it.
Compulsions are explained as a type of reinforcement; they temporarily reduce distress, but they reinforce to the brain that those thoughts were distressing and intolerable. Choosing not to act on a compulsion is a choice that requires mindfulness, and mindfulness can help in identifying what has led up to the compulsive urge. It also provides feedback to the brain that obsessive thoughts don’t need to be acted on.
The books explains that the fundamental rule of a mindfulness approach to OCD is
… to fully accept that the thoughts going through your head are indeed the thoughts that are going through your head. It means dropping any denial that what you are thinking is anything other than what you are thinking. Compulsions are strategies for resisting the experience you are having, whether it be an experience of thought, emotion, or anything else. So mindfulness is the anticompulsion, the antiresistance.
The second part of the book included chapters on several specific types of OCD, including contamination, checking, harm, sexual orientation, pedophilia, relationship, scrupulosity (religious/moral), hyperawareness/sensorimotor, and existential. These were quite interesting to read, and the authors offered some really insightful exposure ideas, including for pedophilia-focused OCD. For scrupulosity OCD, they pointed out that “the present of guilt is not evidence of the commission of a crime.” The authors’ tone was very nonjudgmental; they were realistic about the nature of the illness and kept the focus on thoughts being just thoughts.
I must admit, I was slightly dubious about a mindfulness for OCD book, but I was very pleasantly surprised. It was more CBT with a twist, and the authors were very skillful at bringing in acceptance and mindfulness in a practical, focused way. This is a book that can enhance ERP without going off in a different direction. I can see this book being helpful both for people who’ve been recently diagnosis and people who’ve been dealing with this illness for a while. It could also provide some good insights for loved ones of people with OCD. Overall, I thought this book was really well done.
The Mindfulness Workbook for OCD is available on Amazon.
I received a reviewer copy from the publisher through Netgalley.