ACT for OCD: What Is Experiential Avoidance

By Kate Morrison, Ph.D.

This presentation is an excerpt from the online course “The ACT for OCD Toolbox: A Guide for Therapists“.

Highlights

• Experiential avoidance is an unwillingness to have uncomfortable inner experiences and attempting to reduce or avoid them.
• It’s the opposite of acceptance and willingness.
• Lay the groundwork for the client to understand how experiential avoidance plays a role in their life.

Transcript

Now, let’s talk about experiential avoidance.

So, experiential avoidance is one aspect of psychological inflexibility and it is basically the opposite of acceptance and willingness. And while I don’t share this phrase or this concept explicitly with clients at the beginning, I do begin to lay the groundwork for their understanding of it and how it plays a role in their life. And sometimes I don’t give the definition of it or use the phrase at all within treatment, but helping them understand the concept there.

References

Armstrong, A. B., Morrison, K. L., & Twohig, M. P. (2013). A preliminary investigation of acceptance and commitment therapy for adolescent obsessive-compulsive disorder. Journal of Cognitive Psychotherapy, 27(2), 175–190.

Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). Increasing willingness to experience obsessions: Acceptance and commitment therapy as a treatment for obsessive-compulsive disorder. Behavior Therapy, 37(1), 3–13.
 
Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., & Woidneck, M. R. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78(5), 705–716.

So, for the definition for experiential avoidance, it is the phenomenon that occurs when a person is unwilling to remain in contact with particular private experiences, for example, bodily sensations, emotions, thoughts, memories, and behavioral predispositions, and takes steps to alter the form or frequency of these events and the contexts that occasion them.

References

Armstrong, A. B., Morrison, K. L., & Twohig, M. P. (2013). A preliminary investigation of acceptance and commitment therapy for adolescent obsessive-compulsive disorder. Journal of Cognitive Psychotherapy, 27(2), 175–190.

Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). Increasing willingness to experience obsessions: Acceptance and commitment therapy as a treatment for obsessive-compulsive disorder. Behavior Therapy, 37(1), 3–13.

Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., & Woidneck, M. R. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78(5), 705–716.

So said more simply, this is not wanting to feel, think, or experience uncomfortable stuff and doing things to try to not experience them. You may notice that I’ve used the word “stuff” pretty often within this and that is how I talk about this with clients.

References

Armstrong, A. B., Morrison, K. L., & Twohig, M. P. (2013). A preliminary investigation of acceptance and commitment therapy for adolescent obsessive-compulsive disorder. Journal of Cognitive Psychotherapy, 27(2), 175–190.

Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). Increasing willingness to experience obsessions: Acceptance and commitment therapy as a treatment for obsessive-compulsive disorder. Behavior Therapy, 37(1), 3–13.

Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., & Woidneck, M. R. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78(5), 705–716.

Experiential avoidance may take the form of passive avoidance in which certain stimuli and situations are avoided altogether. Or it can be active avoidance. And that can be where individuals are engaging in ritualistic behaviors with the intention to lessen distress. So, you’re going to want to be looking for both forms of experiential avoidance. You’ll want to begin conceptualizing the client’s experiences from this framework.

References

Armstrong, A. B., Morrison, K. L., & Twohig, M. P. (2013). A preliminary investigation of acceptance and commitment therapy for adolescent obsessive-compulsive disorder. Journal of Cognitive Psychotherapy, 27(2), 175–190.

Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). Increasing willingness to experience obsessions: Acceptance and commitment therapy as a treatment for obsessive-compulsive disorder. Behavior Therapy, 37(1), 3–13.

Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., & Woidneck, M. R. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78(5), 705–716.

Individuals with OCD, they may be more motivated to avoid obsessions because the thoughts are treated as being literal and very powerful. This is a process of verbal entanglement known as cognitive fusion.

References

Armstrong, A. B., Morrison, K. L., & Twohig, M. P. (2013). A preliminary investigation of acceptance and commitment therapy for adolescent obsessive-compulsive disorder. Journal of Cognitive Psychotherapy, 27(2), 175–190.

Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). Increasing willingness to experience obsessions: Acceptance and commitment therapy as a treatment for obsessive-compulsive disorder. Behavior Therapy, 37(1), 3–13.

Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., & Woidneck, M. R. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78(5), 705–716.

The key points that you want to take away from this are that experiential avoidance is an unwillingness to experience uncomfortable inner experiences and doing something, attempting to reduce or avoid them. Experiential avoidance is the opposite of acceptance and willingness and is one aspect of psychological inflexibility.

And you’ll want to begin laying the groundwork for the client to understand how experiential avoidance plays a role in their life.

More The ACT for OCD Toolbox: A Guide for Therapists

• 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: Mindfully Doing Compulsions in Session and Interview
• ACT for OCD: The Tug of War Metaphor
• 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
• Values Exercises in ACT for OCD
• Why ACT for OCD
• Willingness and Acceptance in ACT for OCD