As part of Erin’s clinical requirements for her holistic nursing program, Erin works with children with various anxiety disorders. One child, Amanda, age eleven, was diagnosed with obsessive-compulsion disorder (OCD) when she was nine years old. Before entering into therapy with Erin, Amanda met with a clinical psychologist for one year, which helped Amanda alleviate some of her symptoms. However, over time Amanda’s OCD began to increase. Some of Amanda’s symptoms included her fixation on making her bed, which she sometimes made repetitively in one day. Amanda also had severe fears of dogs, Santa Claus and men who resembled Santa Claus. In addition, Amanda often asked repetitively upon leaving their home if the stove and the lights were turned off.
Although Amanda’s former therapist led her through exposure and response prevention (ERP—a common therapy used to treat OCD), she did not respond well. ERP involves patients confronting their anxiety-causing thoughts and committing to not performing the compulsive behavior unless their anxiety drops, which often leads to extinguishing the behavior. Amanda’s resistance to this work is common. In fact, experts report 50% of patients with OCD do not benefit from ERP. Therefore, some psychologists are turning to alternatives, including mindfulness.
Why Mindfulness Reduces OCD Symptoms
According to recent research (see endnote), patients with OCD who practice mindfulness reduce their unwelcomed thoughts significantly. In addition, these experts say patients with OCD often let go of their need to act on the unwelcomed thoughts that remain with the help of mindfulness. This is because mindfulness helps us release (a) our need to keep thinking a thought, (b) our need to believe a thought is real, and (c) our compulsion to act on a thought.
As a natural instinct, patients with OCD typically suppress their unwelcomed thoughts, which elevates their anxiety. However, experts believe mindfulness stops patients from suppressing their unwelcomed thoughts by teaching them to accept their obsessive thoughts instead of attempting to make the go away.
Teaching Mindfulness to Patients with OCD
Erin, privy to the research on mindfulness and OCD, speculated that leading Amanda through mindfulness exercises on a weekly basis would help reduce her OCD symptoms. Erin began by teaching Amanda a sitting meditation from The Relaxation and Stress Reduction Workbook by Martha Davis, Elizabeth Robbins Eshelman, and Matthew McKay. During this practice, Erin led Amanda to focus on the sensations of her breath entering her nose and mouth, as well as, the sensations of her breath filling her lungs and diaphragm. Whenever her mind wandered, Erin directed Amanda to gently bring her attention back to her breath. Erin also taught Amanda how to name the thoughts that came up as she focused on her breathing. For example, if Amanda was worried about something, she said to herself, “Worry, worry, there is worry.” Amanda labeled other thoughts planning, reminiscing, and longing. This skill helped Amanda stop identifying herself with her thoughts and to instead separate from them.
Erin also taught Amanda a simplified version of the sitting mediation. This exercise involved Amanda taking five belly breaths while she placed her own hands on her belly and counted each breath with the intention to calm her breathing. Erin asked Amanda to practice this breathing exercise in-the-moment when she experienced difficult emotions and thoughts. Lastly, Erin taught Amanda the “Grounding Cord” meditation from my book, Sensational Meditation for Children, which Amanda also practiced at least once a week at home in addition to when she and Erin met.
The Fruitful Results of Mindfulness
Erin measured Amanda’s heart rate, respiratory rate, and overall stress before and after each five- to ten-minute meditation. Erin was pleased with the progress Amanda made during each session. For starters, Amanda consistently showed decreases in both her heart rate and respiratory rate after each meditation. In addition, Erin documented Amanda’s stress levels by asking Amanda to rate her own stress using a 10-point worry scale. As a result, the data showed that Amanda’s worry decreased after each meditation.
When Erin asked Amanda how she felt after the meditations, Amanda offered “a lot better,” “calm,” “relaxed,” “happy," and “less worried.” Erin also noticed that Amanda appeared more relaxed and positive after meditating. Erin also observed that Amanda came to her sessions each week with less anxiety than she had at the beginning of the previous session (as shown by Amanda’s worry ratings). This showed Erin that Amanda progressively improved over the course of the treatment.
As stated earlier, one of Amanda’s biggest fears were men who resemble Santa Claus. This was especially evident when Amanda was around her uncle who has white hair and a white beard. Before working with Erin, Amanda could not be in the same room as her uncle, let alone speak to him. However, after nine weeks of practicing mindfulness, Amanda was able to talk to her uncle. Amanda says, “Taking five belly breaths really helped me when I spoke to my uncle for the first time.”
What’s more, Amanda’s mom reports that her daughter has become more comfortable around dogs. Erin witnessed this breakthrough. When Erin and Amanda began meeting in Erin’s home, Erin’s two dogs were kenneled outdoors. Amanda’s mother carried Amanda from their family van into Erin’s house due to Amanda’s fear of dogs. Astonishingly, after eight weeks of Amanda’s mindfulness sessions, Amanda was not only able to walk into the home on her own, she was also able to physically pet Erin’s dog without feeling anxious.
Amanda’s mother also says Amanda is not as bothered by the stove and the lights when they leave their home. Overall, her mother says Amanda’s self-esteem has improved. “Amanda is demonstrating more confidence and trying new things, more than ever before.”
Arts and Crafts as Therapy
In addition to mindfulness practice, Erin also believes creative projects played a role in reducing Amanda’s OCD symptoms. Erin reports, “Amanda loved being free and comfortable to express herself through crafts and I believe it's been a big part of her healing.” After each meditation session, Erin provided an art project for Amanda to work on. Erin noticed that Amanda was consistently at peace and relaxed during the art projects, in comparison to the beginning of her sessions when Amanda showed little eye contact and had difficulty separating from her mother. Amanda told Erin, “The art projects take my mind off my worries and make me calm.”
Some of the projects included polymer clay, decorating jars and bottles, handmade affirmation cards, and a worry scale Amanda could use at home to become more mindful of her anxiety.
Endnote: The Effects of a Mindfulness Intervention on Obsessive-Compulsive Symptoms in a Non-Clinical Student Population. Marijke Hanstede, MA, Yori Gidron, PhD, and Ivan Nyklícˇek, PhD* The Journal of Nervous and Mental Disease. volume 196, Number 10, October 2008.
Article written by Sarah Wood Vallely Copyright 2014 Sarah Wood Vallely