Mental Health Awareness week | Could mindfulness be the key to OCD?

As part of Mental Health Awareness week, we spoke to  Dr Ioannis Angelakis , Associate Professor of Psychology, who has recently published an article on obsessive-compulsive and related disorders (OCRDs), in the Journal of Psychiatric Research.

Tell us about your research…

“My research is co-authored with Mrs. Foteini Pseftogianni, an NHS mental health therapist, whom I have worked with previously. She works with people with various mental health issues and sees first-hand how depressed and anxious people are, especially during this pandemic, so we came up with the idea for this research.

“OCRDs are on the rise, so if we identify potential risk factors, we can suggest ways to help. That is the point of research - to make a difference.

“We identified and re-analysed data from 36 existing studies examining the relationships between OCRDs and experiential avoidance.”

What is experiential avoidance?

“Experiential avoidance is an inherent element of human nature. It is the need to suppress or avoid anything that feels unpleasant to us. It could be something that makes us feel unhappy, stressed, sad about the past, worried about future etc.

“It is when we have this tendency to suppress things, we are afraid to face our fears. The severity with which we do this is our degree of tolerance. The more tolerant we are, the more resilient we are when facing unwelcome internal events, such as emotions, sensations, and thoughts.

“For those people reporting higher experiential avoidance scores, their threshold is very limited or low. They are sensitive, they may feel uncomfortable, and may be inflexible to new situations. For example, they might be thinking ‘I cannot take much more’ or ‘I cannot cope’.

“So, the individual engages in attempts to avoid the uncomfortable feelings, sensations and/or thoughts. This could be any behaviour – whatever works for the individual in a given situation.”

And OCRDs?

“Obsessive compulsive disorder is when someone is having intrusive thoughts that something bad is going to happen or is happening. To prevent this awful thing from happening, the person is compelled to engage in extreme behaviours. For example, ‘I won’t catch COVID if I extensively wash my hands’. So, the person will spend most of the day in the bathroom engaging in extreme hand washing, potentially to the point of exhaustion. The person will be very upset when other people will not wash their hands, after touching a surface, for example. The person may also demand that all family members wash their hands which makes them sensitive and intolerant.

“Other forms of OCRDs are body dysmorphia and trichotillomania. With body dysmorphia, the person is obsessed with their own appearance and feel they are unattractive. They will spend a lot of time in front of the mirror, examining how unattractive they are and how they can disguise the repulsive parts that they see.

“Trichotillomania, also known as, hair-pulling disorder, is where the person has the urge to pull hair out of their head or body. Having bald patches of hair is noticeable, so causes further anxiety, and has social consequences. There is also a chance of infection, especially in skin-picking disorder, which is another form of OCRDs.

“OCRDs have many negative consequences on quality of life because they will avoid being with people. They cannot share their compulsions with others for fear of judgement or shame and then become more isolated. As you can imagine, OCRDs are closely linked to depression.

“OCRDs are on the rise since the start of the COVID pandemic, which is hugely important to recognise and support. Lockdowns have led to a new lifestyle of social isolation. The more socially isolated we are, the more obsessed we may become with our fears - fear of contracting the virus, fear of not being able to do the usual things, such as looking after our appearance (like beauty treatments or go to the gym). In turn, this leads to more extreme behaviour.”

What were your findings?

“Our research discusses the association between symptoms of OCRDs and being intolerant to having upsetting or negative thoughts, emotions and/or bodily sensations. We found that the less tolerant the higher the symptoms.”

What can be done to change this?

“By increasing the tolerance, by enabling people to be more capable of accepting the fact that negative thoughts and emotions are normal, and that negative sensations are normal, such as, tension, increased heart rate, butterflies in the stomach etc.

“Our findings led us to conclude that reducing experiential avoidance may be beneficial for attenuating symptoms that characterise OCRDs. Research supports that experiential avoidance can be effectively reduced through mindfulness-based exercises. These exercises help us live in the moment, rather than contemplating the past or getting stressed about the unknown future. The best life we have is in this moment. In Greece, we have a saying ‘When people make plans, God laughs’. We can never know what is going to happen, we can try to focus on the here and now.

“I have written another paper, soon to be published, which discusses the relationship between experiential avoidance and suicidal experiences. So, the more intolerant to negative internal states we are, the more likely we are to consider taking our lives. This is because when we feel so uncomfortable with ourselves, then thinking, planning, or attempting to take our own lives may seem to be the solution to the problem.

“How can you make someone less suicidal? Increasing people’s tolerance to negative internal states looks promising. Again, using mindfulness-based exercises may be among the key exercises to practise.”

Examples of mindfulness exercises

·       Live in the moment. When someone is open and responsive to the present stimuli.   

·       Accept yourself. When the person treats themselves with respect and kindness.

·       Pay attention. When the person pays close attention to whatever activities they are engaging in rather than getting    distracted by other activities that will follow. 

·       Focus on breathing. This technique instructs the person to focus on them breathing in and out especially in anxiety-provoking situations.  

If you are affected by any of the issues discussed in this article, you can find further support and information on the MIND website.

Dr. Angelakis is a member of the Lifespan Health & Wellbeing Research Group.