The ACT for OCD Toolbox: A Guide for Therapists

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Last Updated Nov 2, 2022|

Defusion Metaphors for OCD: The School of Fish

By Kate Morrison, Ph.D.

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

Highlights

  • Defusion practices are difficult to introduce as a new ACT therapist.
  • The school of fish metaphor helps with the deliteralization of our internal experiences.

 

Transcript

Defusion practices can be difficult to introduce especially as a new ACT therapist. The school of fish metaphor is a defusion practice that helps with the first component of defusion, the deliteralization of our internal experiences.

The way this metaphor plays out is you talk about this person who is swimming in the ocean and they’re going along and all of a sudden under the water they see this creature that is dark off in the distance. It looks really large. It’s moving toward them rather quickly. And you ask them, “What do you experience when you’re in that moment and you see this large dark figure coming at you very fast?” And you might hear things like “Oh, my heart started beating faster. I got really nervous thinking ‘Uh-oh, what is that?'”

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Publications.

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

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 ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual].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

And as it gets closer, you start to notice “Oh, that’s in the shape of a shark. There’s a shark coming at me right now.” Now, how do you feel? Like panicked, wanting to flee, wanting to run away. My body is in the mode of like really wanting to get out of this situation.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Publications.

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

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 ACT for OCD: Abbreviated treatment manual [Unpublished treatment manual].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

And then as it gets closer and closer, you start to see “Oh wait, that’s not a shark. That’s actually a bunch of little fish that are just smooshed together in the shape of a shark.” And they get next to you and they disperse and they go on their way. Now, the idea behind this is to show the similarity between this and the way our thoughts and our internal experiences can come at us.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Publications.

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

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

For example, let’s picture this for someone who has OCD and they have a contamination obsession. Now, when they have someone near them who they might perceive to be dirty or that this person maybe sneezed next to them, what’s the first thing that they experience? And I would break this down with them to say, “Okay, what is it that you are feeling in that moment?

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Publications.

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

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

This person that you think might be sick, they’re sniffling, they’re kind of like smelly, they seem dirty and now they just sneezed next to you.” And they say, “Oh, I feel overwhelmed. I feel disgusting. I just need to get out of here right now. I need to run away from this. I’m sure I have germs. I’m wanting to hold my breath. I don’t want to breathe anything that just came out of this person.”

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Publications.

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

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

Identify those experiences that they had. Their body might be feeling tense. They are having thoughts that “This is overwhelming. I need to get out of here. That’s gross. I’m going to get sick. I can’t breathe,” and thoughts telling them to hold their breath. And I would actually write this out on a board with them to show that all of these little fish are these different components of their experience, so a tense body, a heart racing, a thought of gross or an emotion of fear or panic. And really break all of those experiences down.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Publications.

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

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

And if they have the thought of like “Oh, that’s so disgusting. I need to get away from this person,” I wouldn’t put all of that within one fish. I would put oh and gross and away and person and I need. They break all this down. You can even break it down to the letters and the sounds that those are all those little fish that come together to make this thing that feels very scary and intimidating.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Publications.

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

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

When it feels like a shark that’s coming at you, the process you can do is to break it down into what all those little fish look like. And it’s much less intimidating and it’s much easier to hold when we’re looking at it as a bunch of tiny little fish.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Publications.

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

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

Practice this with your particular clients that have obsessions and experiences that feel quite overwhelming to them. This one I find it tends to sit with people well and they tend to get the concept rather quickly. And this is an adaptation or just another version of what’s called the tin can monster. It’s another ACT metaphor that’s very similar to this one where it’s a monster that’s actually just made out of a bunch of tin cans.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2012). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Publications.

Stoddard, J. A., & Afari, N. (2014). The big book of ACT metaphors: A practitioner’s guide to experiential exercises and metaphors in acceptance and commitment therapy. New Harbinger Publications.

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

Defusion practices can be difficult to introduce especially as a new ACT therapist.

An example of an introduction to defusion is provided. The school of fish metaphor is a defusion practice that helps with the first component of defusion, the deliteralization of our internal experiences.

Examples of defusion exercises are covered.

More The ACT for OCD Toolbox: A Guide for Therapists