The Mindfulness Workbook for OCD

1. OCD Involves a Brain, a Mind, and You: Understanding the distinction is key.

Mindfulness is a concept grounded in the idea that you can observe what your mind is doing and decide for yourself how involved you want to be in the process.

Three Separate Entities. To master OCD, recognize the distinction between your brain (the physical organ), your mind (the processor of thoughts and feelings), and you (the observer). This separation allows you to detach from the content of your thoughts and choose how to respond.

The Mind as a Processor. The mind filters, promotes, and rejects data from the brain, adding meaning and color. Mindfulness helps you observe this process without automatically identifying with it. You are the witness, not the content.

Breaking the Cycle. OCD often makes you feel like a slave to your thoughts. By developing the ability to observe your mind, you can choose measured responses instead of automatic reactions, breaking the cycle of obsessions and compulsions.

2. Mindfulness: Observe Thoughts Without Judgment.

Mindfulness is acknowledging and accepting whatever is happening in the present moment exactly as it is.

Present Moment Awareness. Mindfulness is about paying attention on purpose, in the present moment, and nonjudgmentally to the unfolding of experience. It's about remembering to be aware, or sati, as the Buddha called it.

Thoughts as Empty Vessels. View thoughts as words: empty vessels given power after the mind organizes and considers them. The thought of being contaminated isn't the same as being contaminated. It's a thought of it.

Meditation as Practice. Meditation is simply practicing mindfulness. It's setting aside time to stop resisting the present experience and to simply notice it. The practice is truly straightforward: tether your attention to one thing (e.g., the experience of breathing, sitting, or hearing) and acknowledge whenever your attention strays from that thing.

3. Cognitive Therapy: Challenge Distorted Thinking Patterns.

If you can notice when you engage in cognitive distortions, you can identify them as part of the OCD.

Identifying Cognitive Distortions. Cognitive distortions are faulty beliefs or lenses that distort your thoughts, leading to dysfunctional behavior. Common distortions in OCD include all-or-nothing thinking, catastrophizing, and emotional reasoning.

Challenging Distortions Mindfully. Challenge the distortion, not the thought itself. For example, instead of trying to convince yourself that you are clean, challenge the notion that because you had a thought about being dirty, you must wash.

Automatic Thought Records. Use automatic thought records to document triggers, identify automatic thoughts, and shift them toward a more objective stance. This helps you create alternative responses to OCD thoughts.

4. Behavioral Therapy: Exposure and Response Prevention (ERP) is Key.

You only get to decide what you do with your thoughts, not what thoughts you have.

Exposure and Response Prevention (ERP). ERP involves systematic, repeated, and prolonged exposure to situations that provoke obsessional fear, along with abstinence from compulsive behaviors. It's about getting time in the ring with your fears instead of constantly running.

Inhibitory Learning. ERP works by creating new associations with triggers, replacing the trigger-danger-response pairing with a trigger-new response pairing. Key elements include anxiety tolerance, disconfirming expectations, surprise, combining fear cues, and variety.

Types of Exposure. Exposure can be in vivo (confronting fears in real life) or imaginal (writing and repeatedly reading a script about your fears). Constant contamination exposures and interoceptive exposures (recreating feared bodily sensations) can also be effective.

5. Compulsions: Identify and Resist the Urge.

Choosing not to engage in a compulsion is always an act of mindfulness.

Compulsions as Avoidance. All compulsions are a form of avoidance, an attempt to distance yourself from uncomfortable thoughts and feelings. Common compulsions include washing, checking, reassurance seeking, and mental rituals.

The Compulsive Cycle. Obsessions lead to distress, which leads to compulsions, which provide temporary relief but reinforce the compulsive behavior. Breaking this cycle requires identifying and resisting compulsions.

Mindfulness for Compulsions. Mindfulness helps you see where the seed of the compulsion is planted. It's the art of waiting, of choosing to respond to your mind by acknowledging its message but not acting on it.

6. Acceptance, Assessment, Action: A Practical Approach to OCD.

The power of noticing when your thinking is distorted is the crossroad between cognitive therapy and mindfulness.

The AAA Framework. A simple, practical approach to managing OCD involves three steps: Acceptance of your experience, Assessment of your thought process, and Action you can take toward mastery over your obsessions.

Acceptance First. Start by using mindful awareness to shift your perspective and let go of resisting the presence of unwanted thoughts, feelings, and sensations. This doesn't mean agreeing with the thoughts, but acknowledging their presence.

Assess Distortions. Use cognitive therapy skills to assess the nature of your relationship to the intrusive OCD thought or feeling. Identify and challenge cognitive distortions that fuel compulsive urges.

7. Contamination OCD: Confronting Dirt and Disgust.

You don’t have to touch feces or blood or toxic chemicals to overcome a fear of being contaminated by these things.

Triggers and Compulsions. Contamination OCD involves fears of getting or spreading germs or diseases, leading to compulsions like excessive washing, avoidance, and reassurance seeking. The goal is to get some time in the ring with your fears instead of constantly running.

Acceptance and Mindfulness. Mindfully accept the feeling of contamination and allow yourself to see the bigger picture. The bigger picture is that no amount of washing ever gets you "clean," because your definition of the word "clean" necessarily involves experiencing a specific feeling that you call "clean."

Exposure and Response Prevention. ERP involves increasing contact with feared contaminants and decreasing washing rituals. The goal is to walk away from the shower, the sink, or wherever your decontamination rituals take place feeling imperfect, irresponsible, unclean, and uncertain.

8. Responsibility/Checking OCD: Letting Go of the Need for Certainty.

The door feels locked, and the stove feels shut off.

The Urge to Check. Responsibility/Checking OCD involves a heightened sense of responsibility for preventing tragic events, leading to compulsions like repeated checking of locks, appliances, and other items.

Acceptance of Uncertainty. Mindfulness involves acknowledging the urge to check, the thought about an item going unchecked, and the feeling that something isn't the way it's supposed to be, and choosing to move forward anyway.

Challenging Catastrophizing. Cognitive restructuring involves challenging the catastrophizing and overestimating of responsibility that drive the checking urge. The goal is to embrace mindful acceptance of the triggering situation and to make the choice not to do compulsions.

9. Harm OCD: Accepting Violent Thoughts Without Action.

The primary difference between people with OCD and those without it is not the content of the thoughts, but their perspective on the thoughts.

Intrusive Violent Thoughts. Harm OCD focuses on unwanted, intrusive thoughts of a violent or aggressive nature, leading to fears of harming others or yourself.

Acceptance of Thoughts. Mindfulness involves accepting that these thoughts are normal and that you are not your thoughts. It's about acknowledging the thoughts without judgment and choosing not to act on them.

Exposure and Response Prevention. ERP involves confronting the fear of having violent thoughts and resisting the urge to engage in compulsions like avoidance, reassurance seeking, and mental rituals.

10. Sexual Orientation OCD (SO-OCD): Embracing Uncertainty About Identity.

The primary difference between people with OCD and those without it is not the content of the thoughts, but their perspective on the thoughts.

Uncertainty About Orientation. SO-OCD involves obsessive doubts and fears about one's sexual orientation, leading to compulsions like mental review, reassurance seeking, and avoidance.

Acceptance of Thoughts. Mindfulness involves accepting the presence of unwanted thoughts about sexual orientation without judgment. It's about acknowledging that these thoughts are just thoughts, not indicators of your true identity.

Exposure and Response Prevention. ERP involves confronting triggers that provoke doubts about your sexual orientation and resisting the urge to engage in compulsions. This might involve looking at triggering images or visiting places associated with the feared orientation.

11. Scrupulosity OCD: Reconciling Faith and Mental Health.

The primary difference between people with OCD and those without it is not the content of the thoughts, but their perspective on the thoughts.

Religious and Moral Obsessions. Scrupulosity OCD targets people who place a high value on morality, ethics, and religious doctrine, leading to obsessions about sin, guilt, and failing to adhere to religious or moral standards.

Acceptance of Imperfection. Mindfulness involves accepting that you are not perfect and that you will make mistakes. It's about letting go of the need for certainty and embracing the gray areas of morality and faith.

Exposure and Response Prevention. ERP involves confronting situations that trigger scrupulous thoughts and resisting the urge to engage in compulsions like excessive prayer, confession, and reassurance seeking.

12. Existential OCD: Finding Peace in the Unanswerable.

The primary difference between people with OCD and those without it is not the content of the thoughts, but their perspective on the thoughts.

Obsessions About Existence. Existential OCD involves obsessive thoughts about the meaning of life, the nature of reality, and other philosophical questions, leading to anxiety and compulsions.

Acceptance of Uncertainty. Mindfulness involves accepting that some questions have no answers and that it's okay to live with uncertainty. It's about letting go of the need to figure everything out and embracing the mystery of existence.

Exposure and Response Prevention. ERP involves confronting existential questions and resisting the urge to engage in compulsions like excessive researching, theorizing, and reassurance seeking.

Last updated: March 15, 2025