Demystifying ACT: A Practical Guide for Therapists

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Introducing the Client to ACT for OCD

By Kate Morrison, Ph.D.

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

Highlights

  • Explain what OCD is to the client from an ACT-consistent perspective.
  • Highlight the normality and the automaticity of your client’s thoughts.
  • Help the client understand their relationship with their internal experiences and how that influences their life.

 

Transcript

Now, let’s shift to introducing ACT specifically for OCD with your clients.

I start with providing them information about OCD. And how I talked about that earlier is often how I’ll talk about it with clients. I let them know that there are 3 main components of OCD. The obsessions, which are intrusive unwanted thoughts, images, urges, sensations, stuff that happens inside of us and that these are things that we don’t choose to be there. And sometimes, they’re inconsistent with how we are as people. You want to talk about this in ACT-consistent language.

References

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.

You’re going to be referring to this as the internal world, that there’s not anything that’s wrong with their thoughts, or that their thoughts are bad, or that they need to think about them differently, that they need to shift the ways that they’re thinking. To maintain ACT consistency, you can describe it just as I did there.

References

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.

Then you’ll want to share with them the second part, which are compulsions. I describe this to my clients as these are things that you do in order to try to not feel, or think about, or experience the obsessions. This can be something that you do over and over, or this can be something that you are doing once in that instance, but if it was effective, you tend to do it again in the future. It can be useful in the moment, but they often tend to not work in the long run as far as getting rid of the obsessions.

References

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.

Then I describe the disorder piece to them. What that means is just that it’s impairing or negatively impacting their life or their functioning. And I often share with clients that I’m not a big fan of the diagnostic system that we have because it labels normal experiences as abnormal, sharing with them that intrusive unwanted thoughts are absolutely typical and are not always a part of OCD, that people have these types of thoughts and do not have OCD.

References

Morrison, K. L., Smith, B. M., Ong, C. W., Lee, E. B., Friedel, J. E., Odum, A., Madden, G. J., Ledermann, T., Rung, J., & Twohig, M. P. (2019). Effects of acceptance and commitment therapy on impulsive decision-making. Behavior Modification, 44(4), 600–623.

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.

People without OCD can experience OCD symptoms. And letting them know that OCD is just a name that we, as professionals, gave to this group of symptoms to make it easier to talk about. But that doesn’t mean that this is something that is permanent or that there’s something broken in their brain because that is a message that can be shared with people. And so I really try to undo that from the beginning of treatment to let them know that there’s nothing wrong with their brain.

References

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.

We’re just going to help them think about or interact with their thoughts differently. Then I really shift into talking about the normality and the automaticity of our thoughts. I hit this pretty hard at the beginning and this really touches on the defusion concept in ACT. And how I approach this with them is I say things like, “I want you to notice what happens in your mind.”

References

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.

If I were to say, “Mary had a little,” what happened? Most people will say “lamb” if they are familiar with that. So obviously, doing culturally appropriate phrases that someone’s going to know, responds to, or something that will come up quick like that.

References

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.

And so I talk with people. I ask, “Did you choose for that to be there? Did you purposely make yourself think ‘lamb’? Or did your mind just immediately create that because you have a history with ‘Mary had a little’ and it happens?” Then I say, “Why would we expect our other thoughts to be any different from that?”

References

Morrison, K. L., Smith, B. M., Ong, C. W., Lee, E. B., Friedel, J. E., Odum, A., Madden, G. J., Ledermann, T., Rung, J., & Twohig, M. P. (2019). Effects of acceptance and commitment therapy on impulsive decision-making. Behavior Modification, 44(4), 600–623.

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.

If we have random thoughts that come up in our head, it’s very similar to lamb just popping up there, but we have much less of a reaction to “lamb” than we do on “I’m going to stab my child.”

References

Morrison, K. L., Smith, B. M., Ong, C. W., Lee, E. B., Friedel, J. E., Odum, A., Madden, G. J., Ledermann, T., Rung, J., & Twohig, M. P. (2019). Effects of acceptance and commitment therapy on impulsive decision-making. Behavior Modification, 44(4), 600–623.

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.

And so if the thoughts are inconsistent with who we are like “I’m going to stab my child,” it can be just as random. We can’t always choose what our thoughts and emotions are. I talk with people about examples from my own life and I share with them that I don’t have OCD and I have intrusive thoughts. Or I have unwanted thoughts or random thoughts.

References

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.

And the example I will give them is that I’ll have thoughts while I’m driving like, “Oh, what if I just turn my steering wheel and just drove off the road? I wonder what would happen. I wonder if I would die. Hmmm.” I think—especially if you share ones that people wouldn’t expect you to talk about, for example, “When I’m driving and there are people walking on a crosswalk in front of me, sometimes I have the thought of, ‘Maybe I should just push the gas and hit people with my car,’” I think people will start to get the sense of, “Oh. Okay. These things are things that other people have and often people just don’t talk about them.”

References

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.

And then we talk about if our thoughts are always consistent with what we want to do or what we don’t want to do. So, I will try to bring this out for clients by saying, “Do you always feel like going to work when you go to work?” Most people can say no. There are days you wake up tired and that you don’t feel like going and yet you still go because there’s something about that that’s important. Or have they ever given a presentation when they felt nervous? Or did they ever go to the gym and worked out when they’re feeling tired? Or not getting drunk in the middle of your workday?

References

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.

There are certain things that people may have thoughts and urges to do, but we definitely don’t do them or we do do them because there are reasons for that. And there can be forces that are larger than just what our thoughts and our emotions need to do. And so helping them see—What we’re going to talk about is how do we get in touch with what those larger forces are. And how do we live our lives according to those rather than just random stuff that our minds throw at us?

References

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.

I talk with them about how in the work with me, we’re going to focus on what makes those thoughts, the obsessions, different from other thoughts—if they are different. So you want to leave it open to them and see if how we respond to them has anything to do with what those obsessions do. If we treat them differently, do they act differently? Or do they feel differently if we treat them differently?

References

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, the key points I want you to take away from this video are you want to share OCD and what OCD is with your client from an ACT-consistent perspective, making sure that they understand what the components of OCD are so you’re talking in the same language.

You want to highlight the normality and the automaticity of their internal experiences and, particularly, thoughts.

And then explain that the work that you’re going to be doing with them will help them understand the relationship to their internal experiences and how that influences their life and their internal experiences.

More ACT for OCD presentations