Healing OCD and Anxiety- My story (the long version)
While certainly not always a pleasant path(what treatment for OCD is though?!), my experience has shown me that there is astonishing healing possible when combining exposure therapy with mindfulness practices and training. In the long run, and with practice, it’s the mindfulness practice itself that becomes the exposure therapy. One is able to turn towards the difficult sensations with awareness and expose oneself to the very scary and unpleasant sensations themselves- the core emotions and body sensations that are the root OCD.
I suffered from severe, debilitating anxiety and emotional anguish for the better part of three decades. My earliest memories from first grade are colored with sadness and obsessive patterns starting to take form. I remember 13 years ago when I was first diagnosed with OCD I felt some relief that I was finally able to put a name to something that had always felt off with me. Yet, there was also a sense of sadness and confusion over what my life might look like in the future. I read many books on OCD in the years after diagnosis. I also started to do exposure therapy, yet I was still very much unclear about what the end game was – What was the point of all this therapy? What life could I expect to lead in the future? What was a healthy mind actually like?
I remember searching for just one story of someone who had recovered in such a way that they were living a fulfilling life of internal freedom. There were some stories about people getting treatment and learning how to live with OCD which is incredibly admirable, but I was looking for something more hopeful and I wanted to understand the whole range of possible outcomes. This article seeks to fill that void- not as a beacon of false hope, but as one of many possible paths that can be presented to the person who is coming to terms with their anxiety and looking to make some changes towards leading a life of courage and meaning. I can only really share my own experience, but from that experience I am convinced of the innate neuroplasticity of the mind.
During my darkest hours where OCD was completely running my life, I spent 10-12 hours a day obsessing. I remember the years when I was living at home after college completely trapped and debilitated by my thoughts and terrified of the anxiety surging through my body. I would go to the computer after dinner and often stay searching online doing compulsive mental rituals until 6 in the morning when my Dad would be getting up to go to work. I was only able to wean myself off the computer and away from the obsessions keeping me on it by the intense shame, sadness and fear I felt thinking that he may see that I was still awake.
OCD can truly control one’s life and make life feel utterly despondent. I remember also times on a family trip to Italy when I was possessed by scrupulosity or religious/moral OCD and just couldn’t get out of my mind even as I was living my supposed dream of exploring Europe. This was my reality for most of my life. I was terrified of the anxiety raging in my body so I spent almost all of my waking existence in my mind. I was completely and utterly disconnected from my physical body and from the emotions that reside there. Fast forward to today and I am typing this in the middle of a pandemic with a drastically different mind and outlook on life. Of course the journey isn’t over. Dealing with the ups and downs of being alive is a lifelong journey, yet I feel more resilient now and far more able to cope with life’s inevitable stressors.
At the beginning of the pandemic I was gripped by panic and yet now I have developed some courage that I can be with what comes up in my experience. I have very few thoughts that would be considered OCD thoughts and there are occasional panic thoughts, but what has changed is my relationship to those thoughts. Through deliberate practice of training in mindfulness and compassion I have trained myself to catch many of the thoughts that come in the mind and appreciate them for what they are- simply events of the mind. Exposure therapy started the journey and has been helpful over the years to me, and I have no doubts about its usefulness to help one to lead a fulfilling life. However, in my experience I have found that exposure therapy can only take you so far. This is because it’s not really the triggering events that one’s mind is afraid of. The fear is of the physical sensations of anxiety, fear, anger, ect that live in the body. One practical way of looking at it is that the mental obsessions are simply ways to avoid and keep us safe from those sensations. Exposure therapy can train one to be more comfortable with all sorts of situations that may bring up scary sensations and thoughts, yet it doesn’t get to the core. To truly heal, one must turn towards the difficult sensations in the body and that’s where mindfulness and compassion have a role to play in treatment.
There is the suffering that we experience as simply part of being a human in a physical body and there is the suffering we add onto this lived experience by our minds’ resistance to it. This second form of suffering is what the Buddha (the first exposure therapist?) called the second arrow. OCD is literally millions of second arrows that keep coming without an end in sight. We resist the unpleasant sensations in the body by performing various physical and mental rituals or compulsions. These compulsions ultimately fuel more unpleasant sensations which we now need to create more rituals to avoid. The ultimate goal of a therapeutic mindfulness and compassion training is to teach oneself to actually be with these unpleasant sensations in a friendly way. We learn to not just merely observe them dispassionately but to actually offer some compassion not only to the sensations but to the beautiful being that’s experiencing them.
I spent the large part of a decade seeking out some of the most well trained therapists specializing in treatment of OCD and at one point I was seeing a therapist for exposure therapy 3 times per week for a couple of years. This all helped a lot but there was something missing. It was like the exposures helped but the OCD would always come back, often in different or more subtle forms.
About six years ago I joined a Mindfulness Based Stress Reduction (MBSR) course which is an 8 week mindfulness training course. I figured I could add this to the exposure therapy I was already doing and see if I noticed any changes. The course dropped me into the deep end and we were instructed to meditate daily for up to 45 minutes by doing a body scan, or a meditation on the breath or other types of meditation. I remember when I first started to meditate my OCD thoughts were so incredibly compelling. I would start to meditate and then get lost in thought which is completely normal. When the magic moment came where I noticed my mind was off in thought and was encouraged to gently return to the breath, the OCD thoughts would often compel me to stay with them a little bit longer. However, if I have learned anything from this whole process, it’s that the brain is astonishingly malleable. Each and every time I was able to pull myself away from the OCD thoughts and put my attention back onto my breath, I was actually rewiring my brain.
I started to notice some changes after the 8 weeks of the course that gave me enough verified faith from my own lived experience to believe that there might be something to this meditation thing. Continuing to practice in the ensuing months, I started to notice that the OCD thoughts became slightly less sticky. I also had more courage to do my exposures. There was beginning to be some space between my thoughts and my actions.
As I kept practicing I started to notice that I could actually watch a thought come and go on its own accord. The thought wasn’t me because I was watching it and I did not necessarily have to do anything with it. I would sit and bring my awareness into my body and focus on sensations in my feet or in my sitting posture for example. I noticed that there were all these “events” happening in the body. Movement, tingling, pulsing- whatever. I just noticed them as events and when my mind would wander I tried to follow the instructions to bring my mind back to the body sensations. What I came to notice was that the thoughts in my mind were no different than the physical sensations. They were simply events of the mind. They didn’t necessarily have any meaning unless I gave them meaning by following them.
All of this was great but even after a few years and some awesome progress something still felt off. The OCD was still really powerful and meditation was a bit challenging because it wasn’t super interesting. I tried to remind myself that I had had OCD since I was a kid and change takes time, but I didn’t have any real map as to whether it was really possible to radically change my mind with exposure and meditation. Around that time, I was going to a weekly sitting meditation group at Umass Medical School led by Judson Brewer, an addiction psychiatrist and mindfulness researcher. One day I asked him whether he thought meditation could be a big help with OCD. He responded very much in the affirmative. This conversation stuck with me over the years as there was this little nagging feeling that he may know something that I had yet to verify in my own experience.
I ended up finding a mentor to help me sustain a daily practice. Consistency and repetition is far more important than anything else when it comes to meditation. This mentor helped me to learn some games and tools to make meditation enjoyable and less rigid. I started practicing for shorter periods of time but enjoying it more. I was doing it every day and over time I built up to longer periods. My mind was still wandering all over the place of course but I was becoming comfortable in my intention and desire to meditate every day. The support was really helpful and the guidance to keep going and make it fun and enjoyable kept me engaged. I was starting to notice more benefits of practice and I noticed that the practice was helping me quite a bit with my exposures. Yet I was still not tapping into what I now believe are the real fruits of the practice and the radical transformational power of these practices. I believe that there is a way to learn this stuff and bring it into one’s life that doesn’t involve the zig zagging proces that I took.
It also does not involve endless hours of sitting meditation. With hindsight I realize that I made formal meditation a goal and developed a daily practice, which no doubt has had a massive impact on my life. However, I often neglected using the informal moments when I was triggered with anxiety as opportunities to practice befriending the anxiety and understand how my mind works.
I started to become more familiar with Jud Brewers work on addiction and anxiety and with the work of psychologist and meditation teacher Tara Brach. I was reading more about meditation and mindfulness and learning about different ways to use the practice to work with anxiety. I figured OCD was a bit of a different beast (it’s not all that different, however!) but that the same techniques could apply. At some point I learned that I could use mindfulness techniques to actually turn towards the difficult sensations in the moment when I was triggered. If my OCD fears were not of the external events themselves but of the physical body sensations and emotions that were happening in my body, I could consciously choose to locate the sensations of OCD in my body and get curious about them.
The Buddha taught that there is suffering in life. There are some things that are painful and difficult that we cannot control. The emotion of fear is certainly one such difficult emotion. If a tiger has escaped from a nearby zoo and is running at us we will feel fear. It’s going to feel unpleasant and that’s the point. Our bodies are doing us a favor to save our lives. This is the first arrow I mentioned above. The second arrow is the suffering that we add on because of our own mental ruminations.
If the tiger is now gone and we are obsessing about whether or not we saw it had a tracking collar that may be dripping radioactive substances that we are now breathing in, we are inflicting the second arrow on ourselves. Fear was flowing through the body, but now the tiger is gone. Without the mental dialogue, the fear would be able to perform its function and leave when it was ready. However, new mental rituals about the potential contamination event are what can trap us in a potentially neverending feedback loop of anxiety.
What I learned is that we can actually use mindfulness to turn towards the anxiety as it’s showing up in our bodies and short circuit the obsessive feedback loop and allow the sensations and emotions to come or stay as they please. By training our awareness to look at the anxiety and get curious about it and where it’s located in the body, what it feels like etc, we are training ourselves to gain more and more courage to be with the difficult sensations. The more we are able to be with the difficult sensations the less we jump back into our minds and perpetuate the OCD or anxiety feedback (habit) loop. That’s the beauty of mindfulness training.
When we are triggered we can make the conscious choice to turn our attention into our bodies and “expose” ourselves to any of the unpleasant sensations that are going on there. This is the real exposure. As we sit with the sensations we let them ride themselves out. One of the best metaphors for this comes from the poem “The Guest House” by the 13th century Persian Poet Rumi. We can think of our bodies as a guest house and the OCD thoughts and sensations as the guests. Rumi talks about how every morning there is a new visitor arriving at the guest house and suggests that we welcome and entertain them. We can choose to welcome these OCD thoughts into our guest house knowing that these thoughts are simply visitors. We don’t know how long they will stay for but we know they are guests. We know that if we welcome them and allow them to have a nice stay then eventually they will move on . Eventually they will move out and the next guest will arrive. Maybe it will be joy or sadness or happiness or whatever and we can welcome that guest as well.
As I kept practicing I realized that there was something to all of this. The more I could train myself to turn towards the difficult and hold it with mindfulness and compassion, the more I became free from my OCD and could start to make my own decisions in my life. However, there were still many things I was subtly resisting. A couple years ago I was on a meditation retreat and a number of events set off a massive bout of full blown panic that lasted for more than a year. I tried everything to work with it but the honest truth was that it was so difficult that I just wanted to get rid of it. I used my mindfulness and compassion techniques as a way to plead with the panic to go away. As a result, the panic was constant 24/7 suffering that never went away. I tried to do exposure therapy and just simply live my life and at times it helped a little bit but the panic was still omnipresent.
I decided to really trust my mindfulness practice and dip my toe in the water. I turned towards the panic just a little bit and accepted it. The panic was ultimately about being terrified of the sensations of fear and anxiety in my body and of the physical sensations of breathing. I had a hunch that if I could progressively train myself to be with those sensations then I could be free from the panic loops in my mind. So over time I progressively brought my awareness to different parts of the body starting with the parts that felt the most safe and moving to the parts that felt the most unsafe. I was training myself to be with the difficult without needing the difficult to leave. I was training myself to hold the difficult sensations with mindful awareness and compassion. I also tried to be acutely aware of the panic thoughts, watching them like a sentinel as they entered my mind. I was able to see that if I noticed them when they appeared in the mind then they wouldn’t have much of an effect on my body sensations, but if I wasn’t aware of them, they would produce more sensations of panic in my physical body.
At times, when things got really really difficult and threatened to overwhelm my mindfulness, I used the compassion techniques that I was learning. With compassion we learn to treat ourselves and our lived experience with friendliness. We learn to meet our own needs and soothe ourselves. I learned that sometimes when I was turning towards the difficult sensations that they were simply too strong and I had to turn away for a bit and let the intensity of the panic ride itself out. I would turn to compassion meditation. My body would be raging with panic and I would turn to memories of my dog or my family loving me or I would offer myself some caring touch Having practiced compassion meditation for a bit, my body was able to elicit a warm caring response that was able to hold that panic. I felt the warmth of my parents love actually holding the difficulty of the panic.
There are all sorts of tools that the Buddha taught that we can use to skillfully work with anxiety and OCD. The beautiful thing about mindfulness and compassion is that it’s a journey that never ends. The more we practice the more we find the courage to be with more and more of life’s varied experiences. We can be with these experiences and allow them to move through us on their own accord. When we stop resisting life we actually start to suffer less and over time we are able to open to more joy and beauty. It’s been a windy road and I never really thought it would take a pandemic to wake me up to the reality that these practices really work, but it has and they truly have been a lifesaver for me. I know that there will be many difficult times ahead, but I feel some courage knowing that I have practices that can hold me in difficult times. And no matter how difficult things get I can offer myself compassion by reminding myself that life isn’t easy, all of humanity experiences suffering, and I’m doing the best I can.
One other piece I wanted to add before I end this little essay is the power of belief and support in this practice. If we have some trauma it’s often unwise to just turn towards our traumatic experiences or the locations in our body where they may live. With anxiety, however, I think that ,although terrifying, we may have more courage and ability to be with the difficult anxiety sensations than we might think. That was certainly the case for me. If you have been doing exposure therapy for OCD or anxiety you have already built up an extraordinary amount of courage to be with the difficult. I had too but I didn’t really trust it.
The mentor who helped me find some enjoyment in my daily sitting practice recommended I read the story of this Tibetan monk named Mingyur Rinpoche who had panic disorder as a kid and healed his panic through mindfulness and compassion training. They did his brain scans at University of Wisconsin decades after he had healed his panic and he had one of the healthiest brains they had ever seen. Of course his body felt and registered fear and anxiety, but he was able to return to an equilibrium state at an astonishing rate. There was zero trace of any panic even as he was spending hours in the fmri machine.
This story inspired me to believe that I could take more risks and investigate the scary sensations in my body. It’s not easy though and it’s often important to find someone to guide you on your journey inward. If you believe that mindfulness and compassion training may be of some help to you, I truly believe that you have the courage to turn towards the difficult in your own body and radically transform your life. OCD is not easy. Panic and anxiety are not easy. Life contains all sorts of suffering even as it contains immense beauty and wonder. However, if the choice is between the difficulties of OCD and the difficulty of the courageous and life affirming act of turning towards our difficult experiences, then I believe the latter is worth the risk.
I recently read a quote from secular meditation teacher Stephen Batchelor where he said that “nirvana” means that in the absence of our default reactions and reactivity we find ourselves facing moral dilemmas that require us to risk a response that may make things worse. That’s the ultimate freedom. Can we risk living the lives that we value knowing that we can’t predict the outcome? Things may not work out and they may get worse, but with mindfulness and compassion we can love ourselves either way and embrace the totality of our experience of being alive!
I can only write from my experience and I can’t say this path is for everyone, but i hope that my experience can offer a different perspective on what’s possibly in healing from OCD. Mindfulness and compassion practices require commitment but may offer a compelling adjunct to whatever therapy you are already doing! If you have any questions or want to learn more, feel free to send me an email!