The ACT for OCD Toolbox: A Guide for Therapists

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Self-as-Context Exercises for OCD

By Kate Morrison, Ph.D.

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

Highlights

  • The observer self and holding an object are self-as-context practices.
  • Set home practice plans that include relevant self-as-context practice.
  • Set behavioral commitments.

 

Transcript

Now, I’m going to walk you through some additional exercises that are focused on this concept of self-as-context. I’m going to start you off with one that’s very simple and straightforward and then we’re going to go into one that’s a little bit more in-depth.

The first one is the holding an object exercise and I learned it from one of my supervisors in grad school. They primarily work with kids. They would hold out their hand and they would place an object into their hand. Let’s say you had a piece of candy. And you put it in your hand and ask them, “Who am I?” And they’re like, “Well, you’re Dr. Kate.“

References

Barney, J. Y., Field, C. E., Morrison, K. L., & Twohig, M. P. (2017). Treatment of pediatric obsessive compulsive disorder utilizing parent-facilitated acceptance and commitment therapy. Psychology in the Schools, 54(1), 88-100.

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

I’m like, “Right. But I’m holding this candy. Am I still Dr. Kate or am I now candy?” And they’re like, “What? No, you’re not candy. You’re Dr. Kate.” “I’m like, “Right. But I’m holding candy. How can I be Dr. Kate and also hold candy at the same time?”

References

Barney, J. Y., Field, C. E., Morrison, K. L., & Twohig, M. P. (2017). Treatment of pediatric obsessive compulsive disorder utilizing parent-facilitated acceptance and commitment therapy. Psychology in the Schools, 54(1), 88-100.

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

When we look at a concept in this way, it seems very simple. You’re still you and you’re holding candy. As soon as you hold candy, you don’t suddenly become candy. This is the same as how we hold our internal experiences. I can still be Kate and hold the thought, I’m tired today. You can still be someone with OCD and hold the thought, I might harm my child. We hold those thoughts, but it doesn’t then make them us.

Now, these can be thoughts, these can be rules, these can be identities, these can be emotions. But when we practice this observer’s stance, it’s getting into contact with that part of ourselves that is holding these things.

References

Barney, J. Y., Field, C. E., Morrison, K. L., & Twohig, M. P. (2017). Treatment of pediatric obsessive compulsive disorder utilizing parent-facilitated acceptance and commitment therapy. Psychology in the Schools, 54(1), 88-100.

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

And so you can ask clients to practice this in particular when they feel very entangled with those particular experiences that they’re having. Just say, “Hey, let’s practice holding that one right now and noticing who’s holding it.” And so they could actually put out their hand and imagine the thought or the emotion sitting in their hand and say, “I’m holding that. I am still here. I am constant. And I’m holding the thought.”

References

Barney, J. Y., Field, C. E., Morrison, K. L., & Twohig, M. P. (2017). Treatment of pediatric obsessive compulsive disorder utilizing parent-facilitated acceptance and commitment therapy. Psychology in the Schools, 54(1), 88-100.

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

This longer exercise is called the observer self exercise. It’s a common self-as-context practice. It’s one of the ones that was originally written about in ACT and I come back to it time and time again because it is one that is consistently effective for my clients.

Now, the full script for this takes about 30, 40 minutes to go through depending on how long you pause and how long you settle into certain experiences. When you choose to do this in session with a client, I warn them. I say, “Hey, this is a long one. We’re going to devote much of the session to walking through this practice and then we’ll talk about how it goes after.”

References

Barney, J. Y., Field, C. E., Morrison, K. L., & Twohig, M. P. (2017). Treatment of pediatric obsessive compulsive disorder utilizing parent-facilitated acceptance and commitment therapy. Psychology in the Schools, 54(1), 88-100.

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

I’m actually going to walk through some of that with you today. Obviously, we don’t have time to do 40 minutes of it but we’re going to go through some of it so you can get a sense of what this experience is. I’d invite you to join me in doing this practice, meaning you’re welcome to close your eyes, sit back in a relaxed but alert position so you can listen and practice what this exercise is all about.

References

Barney, J. Y., Field, C. E., Morrison, K. L., & Twohig, M. P. (2017). Treatment of pediatric obsessive compulsive disorder utilizing parent-facilitated acceptance and commitment therapy. Psychology in the Schools, 54(1), 88-100.

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

Go ahead and sit back if you’re choosing to do the practice with me today and close your eyes. And for a moment, turn your attention to yourself in the space you’re in right now, getting in touch with your body inside of your skin. Notice if you have any bodily sensations that arise. And as you see each one, just sort of acknowledge it and allow your consciousness to move on. Notice any emotions you’re having. And again, just acknowledge them. Get in touch with your thoughts and just quietly watch them for a few moments.

References

Barney, J. Y., Field, C. E., Morrison, K. L., & Twohig, M. P. (2017). Treatment of pediatric obsessive compulsive disorder utilizing parent-facilitated acceptance and commitment therapy. Psychology in the Schools, 54(1), 88-100.

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

I want you to notice that as you noticed these there’s a part of you that noticed them. You noticed those sensations, those emotions, those thoughts and that part of you we will call the observer you. There is a person here behind those eyes and is aware of what I am saying right now and is the same person you’ve been your whole life. In some deep sense, this observer you is the you that you call you.

References

Barney, J. Y., Field, C. E., Morrison, K. L., & Twohig, M. P. (2017). Treatment of pediatric obsessive compulsive disorder utilizing parent-facilitated acceptance and commitment therapy. Psychology in the Schools, 54(1), 88-100.

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

I want you to remember something that happened last summer. Remember all the things that were happening then, the sights, the sounds, your feelings. And as you do that, see if you can notice that you were there then noticing what you were noticing. See if you can catch the person behind your eyes who saw and heard and felt. You were there then and you are here now.

References

Barney, J. Y., Field, C. E., Morrison, K. L., & Twohig, M. P. (2017). Treatment of pediatric obsessive compulsive disorder utilizing parent-facilitated acceptance and commitment therapy. Psychology in the Schools, 54(1), 88-100.

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

I’m just asking you to note the experience of being aware and just check and see if it isn’t so, that in some deep sense the you that is here now was also there then and the person aware of what you are aware of is here now and was there then. See if you can notice that essential continuity in some deep sense at the level of experience you have been you your whole life.

References

Barney, J. Y., Field, C. E., Morrison, K. L., & Twohig, M. P. (2017). Treatment of pediatric obsessive compulsive disorder utilizing parent-facilitated acceptance and commitment therapy. Psychology in the Schools, 54(1), 88-100.

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

Now, I want you to remember something that happened when you were a teenager. Remember all the things that were happening then, the sights, the sounds, your feelings, and see if just for a second you can catch that there was a person behind your eyes who saw and heard and felt all of this. You were there then too and see if it isn’t true. There is an essential continuity between the person aware of what you are aware of now and the person who was aware of what you are aware of as a teen in that specific situation. You have been you your whole life.

References

Barney, J. Y., Field, C. E., Morrison, K. L., & Twohig, M. P. (2017). Treatment of pediatric obsessive compulsive disorder utilizing parent-facilitated acceptance and commitment therapy. Psychology in the Schools, 54(1), 88-100.

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

And now, imagine yourself in the room that you’re in, in this moment. And when you are ready, you can open your eyes. This is the beginning stages of the observer self-exercise. And as you may have experienced, clients start to notice that there is a part of themselves that’s been constant throughout their lives and throughout different stages of their lives.

References

Barney, J. Y., Field, C. E., Morrison, K. L., & Twohig, M. P. (2017). Treatment of pediatric obsessive compulsive disorder utilizing parent-facilitated acceptance and commitment therapy. Psychology in the Schools, 54(1), 88-100.

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

The remainder of this exercise goes into taking that stance of the observer self and noticing your thoughts, your emotions, your sensations, the different roles that you’re in and seeing that you can have these things, but you are something separate from that and that is that observer self. Again, this allows people to take a more detached stance with the content that they’re experiencing.

References

Barney, J. Y., Field, C. E., Morrison, K. L., & Twohig, M. P. (2017). Treatment of pediatric obsessive compulsive disorder utilizing parent-facilitated acceptance and commitment therapy. Psychology in the Schools, 54(1), 88-100.

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

At the end of this session, as with any, you’ll be setting practices for them to do at home, and this just depends on what practice you did in session of what you’re going to have them do at the end or throughout the week or between your sessions. What I’ve done is I create handouts for clients to complete based on the practice that we did that day.

References

Barney, J. Y., Field, C. E., Morrison, K. L., & Twohig, M. P. (2017). Treatment of pediatric obsessive compulsive disorder utilizing parent-facilitated acceptance and commitment therapy. Psychology in the Schools, 54(1), 88-100.

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

For example, the observer exercise, I have this handout where it says, what is the obsession?

Did you practice taking the observer stance? Just yes or no.

And what did you notice? This may be something like, “I noticed myself taking a step back from it. I noticed getting in touch with that constant part of me.”

And then asking how do you experience that obsession now. And if all goes as intended, they may say something like, “I just see it as being there.”

This is just a practice for them to attend to their experience when they take that observer stance and what they learned from that. And then as with any of our sessions, we’re going to be setting behavioral commitments as well in addition to their self-as-context practices.

References

Barney, J. Y., Field, C. E., Morrison, K. L., & Twohig, M. P. (2017). Treatment of pediatric obsessive compulsive disorder utilizing parent-facilitated acceptance and commitment therapy. Psychology in the Schools, 54(1), 88-100.

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

Our key points here are that we walked through additional practices of self-as-context that include the observer self and holding an object.

At the end of session six, you’ll set home practice plans that include the self-as-context practices that are relevant based on what you covered in session and then finish the session with setting behavioral commitments similar to all the other sessions that we’ve covered.

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