Compulsive behaviours are a response to anxiety, they are intended by the sufferer to either directly reduce anxiety or prevent an anxiety provoking event (e.g. harm to one’s self or another). Compulsive behaviours usually take the form or ritualistic counting, washing, touching or speaking (e.g. repetition of particular words or phrases).
Therapy for compulsive behaviours involves a combination of Cognitive Behavioural Therapy (CBT) and Exposure and Response Prevention Theory which are designed to help the sufferer gather evidence that not engaging in the compulsion does not result in the occurrence of the feared event and that the anxiety that is provoked by resisting the urge to carry out the ritual can be tolerated. However, the process of resisting the compulsion can be for someone sufferers, almost impossible and usually only psychoeducation about the process of anxiety and breathing techniques are offered by therapists to assist them in completing the exercise.
For some this is not enough. Therefore at The British CBT & Counselling Service our Clinical Psychologists have developed an additional technique to help sufferers of compulsive behaviours to expose themselves to ritual free activities so offering them the opportunity to gather evidence that the ritual are not necessary to keep them and others safe and to build their confidence in their ability to tolerate anxiety.
The technique is called Mindful Instruction and draws on the ideas of Mindful Meditation in which the individual is encouraged to focus on the present moment instead of following their mind to rumination about the past and worries about the future, patterns of thinking that makes sufferers vulnerable to engaging in compulsive behaviours. It also utilises the idea that our cognitive capacity is limited and so if we fill it with one thing (i.e. mindful instruction) there will be no room left for other things (i.e. the anxious thoughts that trigger compulsive behaviours); this is why in the short term distraction works.
It is important to restate the fact that Mindful Instruction is intended to facilitate Exposure and Response Prevention and associated Cognitive Behavioural Therapy (CBT) and not as a standalone therapy for Obsessive Compulsive Disorder (OCD).
Mindful Instruction for Compulsive Behaviours
1. Make a list of the activities that you find it difficult to complete without engaging in compulsive behaviours (e.g. washing your hands, leaving the house, making a cup of tea) then order that list according to how difficult you believe it would be to complete the activity without rituals.
2. Pick the easiest.
3. Now image that you are making an instructional video for this activity. Talk yourself and your imaginary audience through the activity making sure that you describe every single step that must be completed, trying to speak without pause (i.e. completely absorbing yourself in the moment and leaving no space in your mind for any other thoughts).
4. Now watch as the anxiety that has been provoked by not engaging in the compulsive behaviours rises and then falls. If necessary use diaphragmatic breathing or mindful meditation to assist you in this process.
5. Record the outcome and repeat tomorrow.
For more information about dealing with compulsive behaviours and associated mental health problems contact The British CBT & Counselling Service.