ACT for OCD: Mindfully Doing Compulsions in Session and Interview
By Kate Morrison, Ph.D.
This presentation is an excerpt from the online course “The ACT for OCD Toolbox: A Guide for Therapists“.
- Before doing this exercise, it’s essential to give the client the rationale and ask for their consent.
- Make the client pause while they’re doing their compulsions, to help them analyze their experience.
- The therapeutic importance of this practice lies in breaking the autopilot mode of the compulsions.
- This helps clients to redirect their attention to meaningful aspects of their lives.
The Rationale of the Exercise
We’re going to go about this in two different ways today. The first way is, I want us to practice having you mindfully do one of your compulsions, and this might sound a little strange based on what we’ve talked about so far. I know you’re trying to reduce them, so it might feel strange that we’re trying to practice them. But that’s not what we’re going for here. What we want is to pay attention and be very purposeful about any of our behaviors.
Doing Compulsions Mindfully Practice
Dr. Morrison: I see that your bottles are not in order right now, which is great.
Jessica: I feel a little bit anxious about that. That’s not the way I like them.
Dr. Morrison: That’s why I love seeing that you have them that way. So first, let’s practice putting them into the order in which it does feel more comfortable for you.
And when you do this, I want you to go super-slow. Notice what that feels like in your hand, what thoughts you experience, and what shows up in your body.
For us to move off of autopilot, we’ve got to go slowly and be very aware. And I’ll help you with that as we go along today. Do you have any questions before we get going?
Jessica: No. I’ll put my bottles in the order I like them, but I’ll do it very slowly. You’re saying that I should be aware of my thoughts and feelings as I’m doing that in slow motion.
Dr. Morrison: Exactly. I’m ready to start when you are.
Jessica: This is not that easy, but I’m going to give it a try.
Dr. Morrison: Tell me what you’re noticing inside as you do this.
Jessica: I’m trying to focus on the bottles. On how they feel in my hand and how it feels when I’m moving them. Also, when I put them side by side, I feel relief. For example, the smooth slope between these two bottles makes me feel good. I wish I could do it a little bit quicker, but I’m sticking to the exercise.
Dr. Morrison: Go ahead and pause at that moment when you say it feels good. Tell me what is feeling different.
Jessica: I feel less anxious in my chest or my belly. The feeling of being constricted is slowly going down. I can breathe better now because I’m seeing that the slope is forming, and it’s smooth. And somewhere in the back of my mind, it’s saying, “That’s helping my mother and father not be in an accident.”
Dr. Morrison: Do you have urges to shift any more bottles?
Jessica: It’s not the way I like it yet.
Dr. Morrison: Describe that urge.
Jessica: I feel better because some of the bottles are in the order I like them, but I’m still feeling a little anxious because I see that the other bottles are not in order. So it looks like the slope is like a rollercoaster, which is not good. Somebody could be in an accident, my mother or father.
Dr. Morrison: Good job catching that thought. Your mind is saying, “Fix it. Someone could get hurt. They could be in an accident.” How about in your body? How does that feel right now?
Jessica: Well, I feel a little anxious. However, as you’re talking to me and I’m trying to breathe, that helps the anxiety go away a little bit. I’m still aware of the bottles, but breathing and talking to you is helping.
Dr. Morrison: So part of the way your mind says to fix how that feeling is right now is to change your breathing.
Jessica: I never saw it that way. So it’s good if I breathe, then.
Dr. Morrison: If the goal is to get that feeling to stop. Right now, I just want us to pay attention to how the mind gives suggestions, and you’re choosing either to follow them or not follow them. So that was one of the suggestions, is that your mind said, “Breathe, that feels nice.”
Therapeutic Importance of Doing Compulsions Mindfully
Dr. Morrison: I don’t always do mindful compulsions with a client. Sometimes, it’s doing other behaviors and not doing their compulsions mindfully. We want to be cautious about not condoning compulsions here. We want to be focusing on the intention and awareness of all of our behavior. So it’s more about mindful decision-making, and that can be whether it’s a compulsion or any other behavior clients choose to do in their day.
The thing that I was hitting on with Jessica is that doing actions mindfully is in itself a useful practice, and what we’re looking for is that there’s a reason she’s in the session. There’s a reason that she’s choosing to try to adjust her behavior. Therefore, it’s hitting on the values component of ACT, which means that all the things we choose to do in our lives can be about something bigger, not just about the small tasks we’re doing in the moment.
Jazmin: It’s important to remember that this exercise is not a mandatory practice you have to do. It’s an exercise you’ll do if you find that your client needs it. The objective of being present is to help our clients focus more on the activities they want to be doing instead of their compulsions, and help them to find meaning in their lives.
Guidelines for an Effective Practice
Jazmin: Which key points should we consider beforehand to make this an effective practice, and not condone compulsions?
Dr. Morrison: The main thing is to give a client a heads-up about the rationale and purpose of this practice before you get started with it. I talked about it with Jessica through the analogy of whether we’re on autopilot or manual override. I explained to her that we focus on intentionality, ensuring that we notice what drives our actions internally and how we choose them. Primarily pointing out that compulsions are actions they’re doing and can be adjusted just like any other behavior.
The goal is to attend to how all of our behaviors affect us and impact the world around us, not just assume that particular behaviors are good or bad. We have to attend to this process, see how it works for our clients, and let them decide if it’s a behavior that works or not.
More The ACT for OCD Toolbox: A Guide for Therapists
- Values Exercises in ACT for OCD
- ACT for OCD: Assessing Treatment Progress
- ACT for OCD: Behavior Tracking and the Self-Monitoring Form
- ACT for OCD: Deciding on a Course of Treatment
- ACT for OCD: Diagnostic Criteria and Differential Diagnosis
- ACT for OCD: Key Initial Concepts
- ACT for OCD: The Tug of War Metaphor
- ACT for OCD: What Is Experiential Avoidance
- ACT for OCD: Why Problem Solving Obsessions Doesn’t Work
- Behavioral Commitments in ACT for OCD
- Committed Action in ACT for OCD
- Committed Action Metaphors: The Passengers on the Bus
- Defusion Metaphors for OCD: The School of Fish
- How ACT Works for OCD
- Introducing the Client to ACT for OCD
- Mindfulness Exercises for OCD
- Self-as-Context Exercises for OCD
- The ACT Advisor for OCD
- The ACT Beginners’ Guide
- Treatment Targets and Goals in ACT for OCD
- Why ACT for OCD
- Willingness and Acceptance in ACT for OCD