Comment on: “A Short Review on Practice of Mindfulness as Treatment in Obsessive–Compulsive Disorder” by Borgohain (2024)

We read with interest the 2024 review by Borgohain concerning mindfulness-based interventions (MBIs) in obsessive–compulsive disorder (OCD). The integration of mindfulness into OCD treatment paradigms represents an important and evolving area of inquiry, particularly given the limitations and attrition challenges associated with conventional exposure and response prevention (ERP). While Borgohain’s review makes a valuable contribution to this growing discussion, we wish to respectfully highlight several substantive limitations that, in our view, constrain its interpretability and clinical applicability. First, the review does not fully integrate its discussion within established cognitive-behavioral models of OCD (e.g., Rachman, 1998; Salkovskis, 1985). Constructs such as thought–action fusion, metacognitive beliefs, and inhibitory control deficits (Wells, 2002; Chamberlain et al., 2005) are not adequately examined in relation to mindfulness mechanisms. As a result, the hypothesized effects of MBIs on OCD symptomatology remain theoretically underspecified and mechanistically ambiguous. Second, the methodological synthesis does not fully align with contemporary standards for evidence-based reviews. Case reports and small uncontrolled trials (e.g., Singh et al., 2004; Liu et al., 2011) are presented alongside randomized controlled trials (e.g., Külz et al., 2019) without a structured appraisal of methodological quality or risk of bias, such as through the GRADE framework (Moher et al., 2009). In addition, the review does not address heterogeneity in intervention content and fidelity, including adaptations incorporating non-mindfulness elements (e.g., ACT components), which complicates attribution of therapeutic effects specifically to mindfulness practices. Moreover, there is no consistent reporting of effect sizes, confidence intervals, or follow-up outcomes, which limits the evidentiary rigor of the review. Third, the review inconsistently interprets outcomes across divergent psychometric instruments (e.g., Y-BOCS versus OCI-R) without a critical discussion of their differing conceptual scopes (Abramovitch et al., 2021). This leads to interpretive contradictions—such as suggesting both significant and nonsignificant effects of MBIs on OCD—thereby undermining coherence. Fourth, the review conflates MBIs as primary interventions and adjunctive strategies (e.g., as relapse prevention alongside ERP), without clearly delineating these roles. This lack of distinction compromises clinical specificity and risks overgeneralization (Strauss et al., 2018; Fairfax et al., 2014). Furthermore, the absence of citations or discussion of mediation and process-outcome studies limits insight into the mechanisms by which MBIs exert therapeutic effects. The absence of long-term follow-up data across most cited studies further limits conclusions regarding the durability and maintenance of MBI effects in OCD populations. Such omissions constrain our understanding of whether clinical improvements are driven by decentering, attentional shift, or emotion regulation. Finally, the review omits key recent meta-analyses (e.g., Riquelme-Marin et al., 2022) and does not address comorbid conditions such as major depressive disorder—an important omission given the origins and transdiagnostic scope of MBCT (Teasdale et al., 2000). These gaps reduce the review’s comprehensiveness and limit its relevance to current clinical contexts. We believe that explicitly addressing these theoretical and methodological issues is critical to improving both clinical practice recommendations and future systematic reviews in the field of mindfulness-based interventions for OCD. In summary, while Borgohain’s review makes a valuable contribution to the dialogue on MBIs in OCD, its scientific utility would be considerably strengthened by greater methodological rigor, theoretical integration, and structured synthesis. We respectfully encourage future reviews to adopt systematic frameworks, incorporate process-level analyses, and contextualize findings within contemporary neurocognitive and behavioral models to better inform clinical science and practice. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.