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ACT for OCD: The Tug of War Metaphor

By Kate Morrison, Ph.D.

This video is part of our upcoming online course about ACT for OCD.

Highlights

  • The tug of war metaphor is a creative hopelessness exercise.
  • It highlights the struggle with internal experiences and the exhaustion that can come from the struggle.
  • Act this metaphor out in session because it can be more powerful when the client feels physically exhausted.

 

Transcript

Now, let’s talk about the tug of war with a monster metaphor.

So this one, as I said, is a pretty common one that’s used to highlight this concept of creative hopelessness. And I’ll walk through this in the way that I would set this up with clients.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

So I’ll say, “Okay, you have this experience that you would like to not have.” So let’s say, for this person, that they have a fear that they’re going to get a disease. “And so I want you to picture it in front of you. You have this monster that’s standing there that is saying to you, ‘You are going to get sick.’ There are lots of diseases out there. You need to learn how to manage this. You need to make sure that you do not do anything that is going to even put you at risk of being sick.”

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

And I’ll really walk through it with them and build up, “What does this monster look like? What sounds are they making? What’s their voice like? What do they smell like?” Really get them into that.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

Tell them that in between them and the monster, there is this deep, deep hole. Your job is to grab on to this rope that the monster has, and the two of you are going to play tug of war. What you need to do is make sure you don’t fall into that hole. That’s your job here. Because if you fall in that hole, you’re done for.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

If you are in person with your client and you have a rope, I recommend actually acting this out with your client, where you are playing the monster and the client is on the other end pulling. And you say, “Okay. Here’s the rope. Here’s your job. Don’t fall in that hole that’s in between us.” And you pull back and forth and back and forth. And let them really pull and you really pull back.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

Talk with them as they’re doing this, about “What does it feel like to be pulling on this?” and have them actually talk out how they respond to the monster. And when they are trying to fight with that monster with their words, have them pull back on the rope. So, for example, they might say, “I’m going to be fine.”

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

“I was around that kid the other day and they sneezed, but it’s probably all right.” And when they say that, tell them, “Okay. That sounded like you’re just pulling and fighting with this monster. I want you to pull back on the rope. Notice what that feels like to be fighting with me.” And then after they say that, you, as the monster, pull back on the rope and say, “Oh, it doesn’t matter. You’re totally going to get sick. That kid—do you know how many germs kids have? They’re so germy. And it doesn’t matter how much you convince yourself. You’re so going to get sick. You don’t know what they have. You don’t know where they’ve been.”

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

And you do this back and forth and back and forth. Let them get to the point where they are running out of ideas, where they are feeling tired. Ask them how their arms are feeling, how their body is feeling, how they feel about you as the monster.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

And then start asking them what they would rather do. And with this, often, what you’re looking for is some sort of response that gets them to step out of that fight. So, one of the ways they can do this is actually dropping the rope, but you don’t offer that option to them. Continue to ask them, “Okay. What do you want to do here?” And they say, “Okay. I’m going to just let go of the rope.” You say, “Okay. Let’s see how that goes.”

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

And then you, as the monster, you continue to dangle in front of them this rope and say, “Hey, did you feel that thing in your body right now? You might be having a heart attack. I don’t know. There’s a little twinge that you felt in your brain. That could be a tumor. You should probably go get that checked out.” And as you’re saying this to them, physically dangle the rope in front of them, tempting them to get back into this game. And when they pick it up, talk with them about what that feels like. And when they ignore it, talk with them about what that feels like.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

And when they say, “I’m not going to play this game with you,” or they start arguing with it, then you say, “Okay. You’re fighting with it again. Grab the rope. What does that feel like to fight with it? What does it feel like to let go of it or to drop it?”
 
References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

So, you get the idea of this. This can be a really powerful metaphor when you fully play it out, so don’t rush this. Actually walk through it with clients and see what they learn from it, see what they notice.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

Often, people say things like, “I am exhausted,” and “I don’t want to play this game anymore,” “I don’t want to do this.” And you can help them see their options and what they do in that moment. They don’t have to play with this monster. The monster is going to keep yelling at them just as the weather is going to keep doing what it does, just as the moles are going to keep popping back up, but they don’t have to be fighting with it. They don’t have to play the game. And again, this sets the ground for other options. This is just to help them see they don’t have to be part of this game.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Twohig, M. P. (2004). ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual]. University of Nevada.

The tug of war metaphor is another creative hopelessness exercise or metaphor. This metaphor highlights the struggle with internal experiences and the exhaustion that can come from the struggle.

Act this one out in session, if possible, as it can be much more powerful when the client feels physically exhausted.

More ACT for OCD presentations