How ACT Works for OCD
By Kate Morrison, Ph.D.
This presentation is an excerpt from the online course “The ACT for OCD Toolbox: A Guide for Therapists“.
- Obsessive-compulsive disorder consists of 3 main components: obsessions, compulsions, and the disorder aspect.
- ACT is an acceptance and mindfulness-based behavioral intervention and is used for OCD. It’s based on relational frame theory and rule-governed behavior.
- Treatment goals within ACT are to have a healthy relationship with internal experiences and increase behavior patterns that align with the individual’s values.
- ACT for OCD has a strong research base and has been found to be an effective treatment.
You’ve reached the end of Module 1. So we’re going to talk about the take-home messages from this module.
Obsessive-compulsive disorder consists of 3 main components. Distressing intrusive thoughts, images, and urges, which are the obsessions. Excessive repetitive behaviors that are mental and physical, those are the compulsions. And the disorder aspect of the word refers to that these have a negative impact on the person’s life.
OCD can look similar to other disorders. So when you are working with someone that has OCD, make sure to rule out the other potential symptoms and diagnoses that the person may have in order to guide your treatment planning.
Acceptance and commitment therapy, also known as ACT, is an acceptance and mindfulness-based behavioral intervention, and it is used often for OCD. It’s based on the basic behavioral science of language and cognition, referred to as RFT, relational frame theory, and rule-governed behavior.
ACT focuses on the ways that we interact with our internal experiences, rather than attempting to change those internal experiences which can be unchangeable.
ACT aims to increase psychological flexibility. It’s the main mechanism of change and it does that through 6 core processes. These are being in the present moment, acceptance, defusion, self-as-context, values, and committed action.
The treatment goals within ACT are to have a healthy relationship with internal experiences. So this is to be open, disentangled from them, and present and aware—and to increase behavior patterns that align with the individual’s values.
Progress in ACT is measured through behavioral measures and self-report measures. And Behavioral measures can include tracking the quantity of compulsions or problematic behaviors, and it can be used to track the engagement and valued behaviors or behaviors that are more useful or healthy for them. Self-report measures can include measures of psychological flexibility, specifically, the AAQ-II. OCD severity measures are partially inconsistent with the ACT framework—some OCD severity measures—but they still provide value and I still recommend including those as part of your assessment.
Exposure and response prevention or ERP: it’s recommended as the first behavioral treatment to use in treating OCD, just based on the robust evidence base that it has.
Yet when you have clients that don’t respond to ERP, or they choose not to participate in a course of ERP, ACT is a great option. ACT for OCD has a strong research base. It just has fewer studies than ERP at this time. ACT has been studied with and without exposures and has been found to be effective in both of those scenarios.
Congratulations for finishing Module 1 and I will see you in Module 2.
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: Mindfully Doing Compulsions in Session and Interview
- 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
- 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