An Interview with Psychologist Hamilton Fairfax
Hamilton Fairfax, Ph.D. is consultant counseling psychologist in the National Health Service (NHS) in the UK. He has developed Adaptation-based Process Therapy (APT), an integrative group-based approach for complex clients, especially those with a personality disorder diagnosis and another medical condition. His work also focuses on the benefits of mindfulness for those with OCD.
Preeti Kota: Hi, everyone. Thank you for joining this installment of the Seattle Psychiatrist Interview Series. I’m Preeti Kota, a research intern Seattle Anxiety Specialists. We are Seattle-based psychiatry, psychology, and psychotherapy practice specializing in anxiety disorders.
I'd like to welcome with us psychologist, Dr. Hamilton Fairfax who joins us from England today. Dr. Fairfax was a recipient of 2014 Society’s Professional Practice Board’s Award for Practitioner of the Year for his development of innovative therapeutic techniques when working with clients with complex needs. He specializes in adaptation-based process therapy, APT, an integrative group-based approach for complex clients and OCD. Before we get started today, can you let our listeners know a little bit more about you and what made you interested in becoming a psychologist as well as in mindfulness and OCD?
Hamilton Fairfax: Yeah, of course. Thank you for inviting me.
So, I'm Hamilton. I'm a consultant counseling psychologist in the NHS, the National Health Service, which in the UK is a publicly funded health care system. And I'm working in Devon, which is in the far west end of England. And I'm in charge of psychology and psychological therapies for adults, secondary mental health care clients and that's people who've got severe enduring difficulties.
What's the next bit? Oh, it's why did I want to become a psychologist? Yeah. Good question. I started off doing theology and philosophy and classics and I suppose probably because I'm very bad at philosophy, I got a bit frustrated that it was all really interesting, but I wanted some practical ways of helping people and I think that was my interest all the way along was trying to find ways of trying to be helpful to people and I haven't got many other skills to do so and I ended up being a psychologist and that's still debatable in terms of the skills thing as well.
In terms of mindfulness, I was probably first introduced to it as a concept about 20-odd years ago through DBT and I pursued it from there. And the main focus on OCD is in the work that we were doing. We see anybody here with a complex, any diagnosis of complex care. And in that particular team I was working at the moment, at that time there was a really, really long waiting list and a lot of people with OCD. So, it was a case of how can we see people with the resources we have? And that led to, I'd be thinking as well about limited thoughts and mindfulness and just seemed like let's give it a go for an OCD group, mindfulness based.
Preeti Kota: Great. So, just to begin generally, what is OCD?
Hamilton Fairfax: Really difficult question there, isn't it? I guess traditionally, that would be seen as part of an anxiety disorder. I think it's a bit more than that. So, I suppose OCD is the idea of sort of a compulsive need to perform some behavioral or thinking rituals to help neutralize, prevent, or manage really distressing, intrusive thoughts in somebody's mind. And I guess it's on a continuum as well that I feel is about most mental health difficulties, that it's on the continuum, it's dimensional, we've all got a bit of something that it gets more and more extreme. And what OCD really is is awful. It's really, really life bothering and distressing for people. And I think the World Health Organization's still have it high on their worst conditions to have. So, OCD and it's worse because can be completely debilitating for people.
Preeti Kota: Mm-hmm. Yeah, definitely. Why do you think many clients failed to engage or complete treatment for OCD when using the techniques of cognitive behavioral therapy or exposure and response prevention? Also, if you want to go into what those are generally.
Hamilton Fairfax: Yeah, sure. So, it's a really good point, isn't it? Because I think they have some studies certainly in the UK saying that sometimes people weren't diagnosed with OCD for up to 15 years from their first presentation because there is something quite shameful that people can feel about OCD. Logically, they know this isn't the case, but they just feel compelled to do it. So, there's something often very shameful about that.
Also, when you start to tell people about exposure and response prevention. So, that is developing a series of graded ways of confronting your fear, that could be really scary. So, if you really think that something really bad could happen if I don't wash my hands 50 times and someone comes along, "Right, the treatment we're going to give you is we're going to make you stop washing hands 50 times and we're going to do it week after week after week in slow steps," it could be really, really off-putting for people to do that. So, there's a lot of fear and I think some people perhaps have read about things and they think, "Oh, no. I've got worries about contamination. I'll have to stick my hand down the toilet." They see these kind of videos out there. So, I think there's something about education in that as well.
And it's a really, really hard condition to treat. So, people won't tell people in huge details about what their thoughts are. Sometimes these thoughts and behaviors are really embarrassing for them. Sometimes they're really shameful and sometimes they're really scary. So, if you've got intrusive thoughts, for example, about being a pedophile, telling people that can have some really difficult consequences and people will respond differently to you. So, that's very, very difficult.
And I guess what we know from people with OCD is often, say, they'll present maybe the top of an iceberg of their difficulties and it would be for the therapist to really, really drill down into what's really going underneath that. And that takes time that you need to build a relationship, not just necessarily steam in with the behavioral side of things. So, it takes time to build that trust. And if you don't address the core, the roots, you might change certain behaviors but they could substitute different behaviors, which happens a lot from the evidence. Sometimes it can be 50, 60% of people relapsing or having a different kind of OCD. I think those are some of the reasons why it can be difficult.
Preeti Kota: Hmm. Is one in particular CBT or ERP more effective or ...
Hamilton Fairfax: If so, in the UK we have something called NICE, which is the National Institute for Clinical Health and Excellence. So, that's basically an organization that looks at the RCT forms of research and recommends treatment on that for the more common mental health conditions. So, they would argue that cognitive behavioral therapy with exposure and response prevention would be the best way of treating that. But, of course, the more complex people become, the more you need a bit more sophistication.
Preeti Kota: Hmm. Yeah, definitely. What about mindfulness do you think makes it an effective solution for OCD?
Hamilton Fairfax: Yeah. I think there's several things that helpful. One, I mean, it's incredibly portable. I think there's a book on mindfulness, isn't it? I think they're called “Wherever You Go, There You Are” in the sense that if you're being mindful, your body and who you are is always around. So, there's something you can practice and try out wherever you are in the world. I think, as well, I got particularly interested in cognitive mechanism suggested behind OCD called thought-action-fusion. And that's the idea that to have the thought is exactly the same as if you've done the behavior. And there were two types of thought-action-fusion. One's called moral thought-action-fusion, which is, if I have a thought that I'm a pedophile, what kind of person does that make me? I must be that evil person. And then it sets off.
So, the thought is just as bad as being that thing and there's a likelihood thought-action-fusion. If I keep thinking about the plane could crash, it could crash. So, I need to do something about it. It's almost like I'm making it crash. So, this way of the thought-action-fusion is really awful because it really starts that behavioral response automatically. So, I think something good about mindfulness is it begins to start to have a break between that thought-action-fusion. It begins to say, "Hang on, hang on. Okay. Yeah. That happens, but let's just stop and try and get that meta mindful position and try and break that link between thought-action-fusion."
Preeti Kota: Do you think it's also ... Sorry.
Hamilton Fairfax: It's also ... Sorry. Go ahead.
Preeti Kota: Do you think thought-action-fusion is something that we have as an automatic bias or something we develop?
Hamilton Fairfax: Good question. I'm guessing it's both. I think it has a function as well but that, over time, you feel more... I suppose it depends on the nature of the thoughts, as well, behind it if something is so horrific, either morally- or likelihood-wise, it might become more an ingrained pattern. Good question, though. It's difficult one to answer, but I think it's probably down to individuals-
Preeti Kota: Yeah.
Hamilton Fairfax: ... and what happened.
Preeti Kota: And I'm sorry.
Hamilton Fairfax: Yeah, yeah. No worries. I think also what's useful about mindfulness and the treatment of OCD is that it really helps engage in a behavior. So, for example, if you think checking the door loads of times is going to help prevent something happen. If you do it mindfully, if you mindfully check the door, you have to say, "Okay, I'm going to mindfully do this. I'm going to observe myself moving the handle and feeling what the metal feels. Oh, I'm surprised. Oh no, no, bring it back to that task." It really makes that person engage in that behavior. So, you're going to be obsessed with mindfully in a sort of paradoxical way. That helps because what we know about OCD, the way that it affects certain brain areas, but also anxiety and distress in general, is it hits our executive functions and our memories. So, it's very hard to do that.
So, when you begin to doubt yourself. "Oh, did I do it 15 times? Actually, no. I do remember really moving the handle." So, you get this whole sensory as well as to format memories as it lays down the links, which makes it more, "Okay. Maybe I didn't ... No, I don't need to go back and check, because I do remember doing it." So, it has that utility as well.
Preeti Kota: Yeah. Are there specific types of mindfulness that are more beneficial than others, such as meditation over yoga?
Hamilton Fairfax: I guess they are different practices. So, yoga obviously would be more physical-based. And I suppose the, it's the intention behind what you're doing it. I mean, there's different kinds of traditions in mindfulness and there's loving kindness meditation as well. But I guess they're doing different things in some way. So, I would always say, "Whatever kind of mindfulness you are doing, what's the intention behind doing it?" I mean, to be mindful is not to be relaxed. Far from it, often. You're really sort of immersed in the experience of feeling, "Oh, my god. What's all this about?"
So, it's not a relaxation technique at all. And the same with yoga. It embodies you, which is really important. That's what mindfulness can do as well. Embody you, but I guess with yoga there's an explicit meaning behind the practice.
Preeti Kota: Can you elaborate on what you mean behind the intention of doing the practices?
Hamilton Fairfax: Yeah. So, I'm thinking, well, and a poor example, some people will think, "Okay, so mindfulness is about being relaxed," and it isn't, but if your intention is, "I'll do this and I'll feel more capable of managing my distress or getting out there in the world," that's a bit difficult because mindfulness, I guess, personally for me, I don't feel is a set of skills. I think it's a way of being and that's a very different way to approach it. So, I think that's what I mean by the intention.
So, if we set the intention in treating OCD with mindfulness in the sense that, "Okay, what I'd like you to do is just really be aware of when you touch the desk 10 times. I really want you to feel it. I want you to notice." So, you're really actually priming the person about why you're doing what you're doing. You're being really explicit. "Okay." And then you'll say, "What will happen is we'll do this. Your mind will wander. You'll feel racy. You will have those in compulsive thoughts. That's alright. All I want you to do is practice bringing your head back and forth to that sensation." So, it's something again there about why you're doing what you're doing. I think that's what I mean by intention.
Preeti Kota: Okay. In treating OCD, is mindfulness best suited as in addition to traditional therapy, in addition to medication or involving both?
Hamilton Fairfax: I would say it depends completely on the person. How I've used it is all of the above. Most people I see will be on medication and they'll need more than just mindfulness practice. It needs to be contained within a wider psychological formulation. So, I'd say complete depends on the individual. I think I'd go back to intention again, but if you're wanting to talk to people about mindfulness in a therapeutic way, it needs to be part of a formulation that's explicit and co-constructive and like, "We're doing this because, and this is what I'd like you to ..." So, I think it depends on the person. I wouldn't separate it.
Preeti Kota: So, when you're deciding based on the individual, is that related to the severity of the OCD or ...
Hamilton Fairfax: In terms of medication, yes. So, sometimes medication can be helpful, sometimes it can't. I think I don't I'd ever just do be mindfulness, use mindfulness with somebody, but it would need to be part of the ... I wouldn't say as adjunct. I just say it's part of the therapeutic process.
Preeti Kota: Okay. How long do the techniques of mindfulness last after completing a mindfulness program? Is it something you have to continue practicing often?
Hamilton Fairfax: Well, you see, this is where we're bad practitioners in the NHS, because often we don't do follow-ups. But, actually, some of our groups, we did manage to do that. I can't remember if there's a paper written on it, but I think it was 12 months we did, certainly six months. And mindfulness people continue to feel better. When we asked them what was the thing they found most helpful in the group, which was cognitive behavioral as well as ERP and mindfulness, it was mindfulness. So, they carried on practicing the mindfulness.
In terms of what do you have to do? Yes, you do have to keep doing it because it gives you that authenticity. If you're asking someone to sit with their thoughts and manage that meta and the struggle of not getting it right, whatever that means. You need to have your own experience of doing that. It doesn't have to be... Sorry.
Preeti Kota: Oh, no. You continue.
Hamilton Fairfax: No. No. I was going to say it doesn't have to be wedded to any particular religious belief or whatever, but you do need to have that authenticity. So, you know what it's like to struggle.
Preeti Kota: Is it the thing that … casually or something like dedicate time to each day?
Hamilton Fairfax: I'm sorry. I lost you there over the Atlantic. I couldn't quite hear that.
Preeti Kota: It's okay. Is mindfulness something that becomes more of an automatic habit or a scale or is it something that you have to dedicate time explicitly to practice each day?
Hamilton Fairfax: Right. See this is why, depends on who you are as a person and what you need to do to remind yourself to do it. So, I'm very bad, because I suspect as a practitioner I need to be reminded to do these things. I need to have a commitment to do it, not me. I have to do it for an hour or anything like that. But there's also something, back with our client, it's very portable. You can do mindfulness. You find a form of mindfulness practice that suits you. For example, I quite like mindful walking, just really sort of noticing what it means to walk, which can make you feel really unbalanced.
But, so, I think it does take a commitment to actually doing it on an ongoing way. Does it become automatic? I think we're human beings, we resist these things and sometimes they become more familiar and sometimes they don't. Just depends where we are, but it does take a commitment.
Preeti Kota: Okay. Do mindfulness and OCD affect similar brain areas neurologically?
Hamilton Fairfax: Tricky and this is where I'll probably get in trouble with all my neuroscience colleagues. I'm not a neuroscientist, but what I'm aware of is that I think what mindfulness does in some of the studies I've seen, it certainly helps, I think it's thick in some of the prefrontal cortex. And I think it's been linked with a lot of the regulation of the limbic system and small amygdalas, I think. So, that would.
And with what we know of OCD, we know, again, the prefrontal cortex, the caudate nucleus, and the singlets are all sort of implicated, particularly that sort of relationship between the frontal cortex and the basal ganglia and the caudate nucleus. That sort of idea that here's the front bit that says here's our choice decision-making and here's the sort of more movement-y bit and that sort of error checking bit that gets skewed in OCD. That's a terrible, terrible neurological description. But anyway, so what I think that mindfulness does is that I think it calms down the reactivity of the system. So, I don't think it necessarily targets brain areas as such. Perhaps it just helps reduce the energy in those certain areas.
Preeti Kota: Okay. So, I mean this might be too neurological of a question, but it doesn't really rewire the brain. It kind of just-
Hamilton Fairfax: Well, I think that's interesting because if you go with... I mean, yeah, neuroplasticity I don't but I think, absolutely, because if you do something enough times you are going to rewire that kind of connection. So, absolutely. But I think that's true of any of our experiences. So, yes, I'm sure, I think therapy does help to do that kind of neuroplasticity change.
Preeti Kota: And that's probably most likely in the prefrontal cortex that does that?
Hamilton Fairfax: Again, I think you need someone who's much better qualified than me to do that. But, I guess, I think about brain functioning in terms of systems and yeah, across regions, but also systems. I don't know if it's just in the prefrontal because I guess you got the temporal lobes with the memory and all sorts of things. So, I think it might be more diffuse than that. I think that's what mindfulness might do as well. I think it's probably diffuse neural. But again, talking to someone who knows what they're on about.
Preeti Kota: Okay. Is there a genetic basis for OCD, and also, is there a genetic basis for the ease of practicing mindfulness? Does it come automatically to someone more than another person?
Hamilton Fairfax: Yeah. The best I've ever come across. I mean, you haven't looked at it for ages, was that 50/50 in terms of genetic bias of OCD. It might be slightly more than that.
It also means, yeah, on that continuum of OCD, we've got tick disorders, we've got neurological things, we've got other things. So, I think it's in maybe about 50/50. In terms of genetic for practicing mindfulness. I guess it's more about personality and temperament than genetics for being why to do it, I guess. I mean, that's a hard one. That's back to the nature/nurture. So, I don't know about that. But what we do know about mindfulness it’s been practiced for thousands of years in cultures across societies and across cultures. So, everyone can do it. Yeah. So, I don't really know about a genetic thing. I wouldn't have thought so but we're animals as well.
Preeti Kota: Mm-hmm. Are there certain personalities that you were referring to personality-wise, that it depends? Are there certain path personalities you think are better at mindfulness?
Hamilton Fairfax: Just on my experience and sort of just in gut feeling, I guess again, it's those people who are openness to experience who are sort of perhaps slightly more extroverted. You don't need to do that. But openness to experience that are willing to give things a go that are psychologically minded, that can make connections between things, that like to do new things. I suspect they'll probably be more willing to engage. But that certainly doesn't mean that people who are more reserved or more introverted can't do it.
Preeti Kota: Yeah, I would actually expect people who are more introvert to be better because they're already kind of in tune or with themselves I guess.
Hamilton Fairfax: Or a perception of themselves. And I guess that's the thing that we do with the mindfulness is are you introverted or someone called you... I mean, it could be. You could be absolutely right. There's something about that almost as diagnosis of introverted or extroverted but you probably could unpack through mindfulness.
Preeti Kota: Mm-hmm. Yeah, definitely. Does mindfulness involve dissociation in that it practices separating the self from sensory experiences?
Hamilton Fairfax: No, I don't think so at all. I think it's quite the reverse. I think it is about engaging with sensory experiences, either very explicitly, such as smell this coffee literally, or smell these. We did an exercise in one of these groups which was smelling Quavers, which in this country, is an incredibly fragrant, almost sick-making crisp that smells very strongly of cheese. So, we thought, "Fantastic. We're doing Quavers, not raisins," because they're far too traditional. But to do that, we were asking people to really engage with this Quaver. So, it felt funny and it really strongly smelled. So, they had to engage with that crisp and having all these thoughts going on and actually nobody really wanted to eat it, because the more you engage with it, the smell took over.
So, that's just an example I think of... It's not. It's about immersing yourself in the experience but having that step back that observes. It's not dissociative. It's an observing mind, it's an observing way of being. So, you need to know all these kind of things and it asks you to be in your body, because if you're sitting there thinking, "Oh, god, I didn't know my stomach felt like that when I'm having this thought." Okay, just observe it. Just hold on to it. Carry on with what you're doing. So, I think it really invites you to be far more embodied. And you can use mindfulness with psychosis as well. I know some can be quite worried about that, but there's some really good evidence of mindfulness in psychosis.
Preeti Kota: Hmm. Can you just elaborate on the differences between mindfulness and disassociation, because I feel like mindfulness also involves kind of taking perspective, but I don't know much about dissociation.
Hamilton Fairfax: Dissociation are often a highly understandable and effective way to deal with trauma. But what you're doing in dissociation is literally cutting off from an experience. You're putting your head somewhere else out of that environment. Whilst you're being mindful, you are engaging yourself in that environment. Yes, you're trying to have a meta-perspective to observe it, but you are fully immersed.
Preeti Kota: Okay.
Hamilton Fairfax: You're fully present, well dissociation to cut off.
Preeti Kota: Okay. And then, do certain emotions or situations increase one's tendency to urge surf or act impulsively? And if you want to generally go over what urge surfing is as a concept.
Hamilton Fairfax: Yeah. Well, I think it takes me back to my DBT days. So, this idea that you'll be flooded with, it's about emotional regulation often. So, you'll be flooded with feelings that just takes you to certain kinds of ways. And how mindfulness and DBT with certain other ways as well is to sort of stop and say, "Yeah, here's that flood of emotions. You can surf the wave, you don't have to be swamped under it."
So, mindfulness is a way of sitting back, setting the board on the wave as opposed to drowning under it. And in terms of acting impulsive, I guess that's what we're trying. That's the antidote that you're surfing it, you're riding it, you're not ignoring it, you're being aware that you feel pissed off or angry or whatever it is, but you're not letting it take you over.
Preeti Kota: Okay.
Hamilton Fairfax: And in certain situations do that, I think anything that's traumatic will do that. In terms of the emotion dysregulation. So, if you ask somebody who might have been diagnosed with personality disorder, which I prefer to say, "Complex trauma," there's lots of hardwiring for your environment where you are going to be highly sensitive to certain environments that you might feel abandoned, rejected, or under assault. And that could trigger you instantly into that sort of emotional overload, that storm of affect.
Preeti Kota: Okay. How long does the emotions of trauma affect the tendency to urge surf?
Hamilton Fairfax: How does it ... Go on. Say that again?
Preeti Kota: How long do the emotions of traumatic situations affect one's tendency to urge surf?
Hamilton Fairfax: How long? I guess it really depends on the situation and what's happening. If, for example, someone is self-harming and that's been what they've done before and we know that the positive thing of self-harming is that the cutting helps express a feeling, helps regulate an emotion, what we're wanting to do is try and change that behavior differently. So, it will depend, again, on the individual. It'll depend again on the context. In terms of a timescale, it's difficult. If that's how you've had to manage your life to survive for decades, it's going to be an instant thing.
Preeti Kota: Okay. And then, for cases not directly relating to trauma, are there daily emotions or more common emotions that trigger urge surfing or impulsivity?
Hamilton Fairfax: So, yeah. I mean I think anything that's ... There's small-t trauma, not necessarily sexual abuse and all the rest of, but small-t traumas, things that sort of interfere with our quality of life will lead to arousal of affect. And again, it is going be dependent on the person, what triggers you in that way. And again, the triggering is not necessarily always extreme. So, we're talking about I suppose the fight/flight's freeze way of understanding situations and how that relates to your emotions.
Preeti Kota: So, it doesn't necessarily have to be negative emotions in terms of arousal, it can also be positive?
Hamilton Fairfax: Sorry. I missed the first part.
Preeti Kota: So, it doesn't necessarily have to be negative emotions just in terms of arousal. It could also be positive emotions that ...
Hamilton Fairfax: Absolutely. Absolutely. If you're a big sport fan or a music fan, you know can really be easily taken over impulsively in the moment and sometimes do things you wish you hadn't or whatever or just be in a different place. Absolutely. So, it's just all mindfulness and I suppose other techniques is other ways of therapy is just trying to rebalance.
Preeti Kota: Okay. Just also getting on a little bit of a tangent. For positive emotions, since it feels very good to be very happy, how would one be motivated to practice mindfulness to kind of tame those kinds of emotions? Because I feel like more … some people with maybe bipolar, with before you have something might not want to do that.
Hamilton Fairfax: Yeah. I heard most of that I think, but tell me if I haven't answer your question properly. So, something here about how do you convince people with really high positive emotions that they want to stop doing that and try and be it more balanced?
Preeti Kota: Yes.
Hamilton Fairfax: Really ridiculous. Particularly people with bipolar disorder, cyclothymia and often when you meet the people that actually miss those high states, because there's something really addictive about not caring and just being happy in the moment. But I suppose what you need to do, again, is to look at the consequences of behaviors and they can often be really, really bad and they can often influence the bipolar shift the other way sometimes.
So, I think what it is, again, it's all about balance. It's not about destroying those high states. It's building relationships therapeutically with that person and saying, "Look, we want you to be in control of your feelings. That doesn't mean you have to be a robot. So, it doesn't mean you have to do these kind of things." But, like with OCD, we all have it a bit, but when it interferes with the quality of our lives, then it becomes a problem. And that's all we'll be saying to our bipolar people as well, I guess. These things, these emotional states interfere with the quality of your life and the quality of other people's lives. So, that's why we just need to bring this down a bit.
Preeti Kota: What about-
Hamilton Fairfax: Sorry, go ahead.
Preeti Kota: It's okay. What about for people with OCD who just experienced such a high level of satisfaction from performing certain behaviors that they're just not motivated to practice mindfulness, to kind of change those behaviors even though it's affecting their life?
Hamilton Fairfax: If someone doesn't want to change their behaviors, nothing we can do about that. But I'm guessing the fact that they've come in to talk about it would be some chink of saying, "Something's not okay here." I don't know if I fully answered that question. What was the first part of that?
Preeti Kota: I think it was how people with OCD could be motivated to resist the satisfaction they get from performing the compulsive behaviors.
Hamilton Fairfax: Yeah, okay. Yeah. That's an interesting one. I guess the people I tend to see aren't satisfied. It's all they're far from it. So, although there's a sort of, "I've done this. Things are okay." They're not happy because it's controlled their lives for 20 odd years or longer. So, there's a sense of satisfaction, but it becomes something really, really very toxic and they're there because this isn't okay. Or they can live with it, but no one around them can. So, that's a chink in as well. Or they don't want their children to pick up their behavior. There's some knowledge, there's some awareness that they don't want anyone else to have what they're doing.
Preeti Kota: Okay. And then you're talking about the spectrum of OCD before, how some cases are very extreme and some are mild. So, on that spectrum, I guess what range can mindfulness help with, even mild is there?
Hamilton Fairfax: Oh, yeah. You see how massively optimistic. I think you can help in all presentations because, again, it's about, the formulation, it's about the intention behind it. It's a very helpful way to get into exposure and response prevention in a certain way. Because the first thing you're doing is I'm gluing thoughts and saying, "Look, all I'm going to ask you to do is spend 30 seconds just sitting with that." So, it's a way of inducting people. So, I think you can work at any level of extremists and we've certainly had people, the OCD groups who were really intensive OCD units in the UK, real lifelong people, 40, 50 years plus of OCD. Had some lady who was so concerned about contamination that she would unscrew her floorboards throughout the house and clean the screws every single day. So, it's really quite extreme things and people benefitted from that.
Preeti Kota: Mm-hmm. That's great to hear. So, what advice do you have for beginners trying to get into mindfulness?
Hamilton Fairfax: Don't be put off and don't think you have to be a guru or anything like that at all. You don't have to be Buddhist. You can be. Don't have to be. It's just the way of being and the idea about being a beginner is what we all are. Because it's not about failing or succeeding, it's just noticing and being kind to yourself. So, please, please, please be kind to yourself. We're all beginners. There's a path of mindfulness practice, which is seeing as if for the first time, and that's a really good reminder because we become automatic with our perceptions. And so, if you all begin it, great. You're doing it. It's not about pass or fail. It's just about practice and just noticing what's happening.
Preeti Kota: And do you also have advice for when someone with OCD relapses or even just someone without OCD trying to practice mindfulness but struggling and they're just harsh on themselves and they get kind of demotivated or unmotivated?
Hamilton Fairfax: Really kind of compassionate. And also this is a good thing about having your own practice. It's just say, "Me, too. It's a bugger, isn't it? It's really difficult." And so, then you sit with them and think, "Okay, so what were you trying to do?" Well maybe they got into thinking, "I must be mindful, I must be mindful this time and this time. Well, I'm not doing my mindfulness." And just trying to work out what's getting in the way. And sometimes it just might be they've got really busy lives. So, just sort of stop and be compassionate and find out what's happening.
I guess one thing with OCD, I did notice with mindfulness is we saw one gentleman who had really, really severe mindfulness, was in several inpatient units, specifically for OCD. And what we noticed with him, I think he was able to say eventually, is that, when he was given instructions like CBT or whatever, he would internalize them as a ritual.
So, with the mindfulness, when we were talking about wise mind and the rest of it, it became an obsessive ritual. So, he would say things like, "Right, I'm doing my mind," while he wasn't being mindful. So, there's something to watch in that as well, just to make sure that people are doing, and that's why it has to be experiential and talking about the practice.
Preeti Kota: Yeah, definitely.
Oh. Lastly, is there anything else you would like to share with our listeners or any final words of advice?
Hamilton Fairfax: Yeah, this is for people with OCD and people treating OCD. Yeah, I just have enormous amount of hope. As I said, in these groups and I haven't run them all. Other people run them as well. People with 60 year histories of OCD, people who have had their life controlled by it - it can change. And you can tell your therapist anything. They're really unlikely to be flustered. Even if it's something you're really, really fearful of, we're here to help you. But it's the massive amount of hope that there can be change in OCD or any mental health difficulty.
Preeti Kota: Great. I love that. We ended on a very optimistic note. Well, thank you so much for being here.
Hamilton Fairfax: No problem.
Preeti Kota: I definitely learned a lot and it was great to have you.
Hamilton Fairfax: Thank you very much for inviting me.
Preeti Kota: Of course. Bye.
Please note: The views expressed by the interviewee are for educational and informational purposes only, are not meant to diagnose or treat any condition, and do not necessarily reflect the views of Seattle Anxiety Specialists, PLLC.
Editor: Jennifer (Ghahari) Smith, Ph.D.