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Treatment Targets and Goals in ACT for OCD

By Kate Morrison, Ph.D.

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

Highlights

  • ACT increases healthy relationships with internal experiences and behavior patterns that align with a meaningful life.
  • ACT focuses on what can be changed, looking to change the behavior.

 

Transcript

Let’s now talk about the specific treatment targets and goals within ACT for OCD.

So, given that internal experiences are often uncontrollable and this can actually have a paradoxical effect of increasing the unwanted experiences when there is an attempt to control them, the goal of treatment is to focus on what can be changed.

References

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. 

And what can be changed is our behavior. And so when our behavior is solely guided by our internal experiences, this can be confusing. So, if our thoughts don’t agree with each other on the best course of action, it’s hard to know what we should do.

References

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. 

So if you have a thought that, “I want pizza for dinner,” and then your mind says, “Pizza’s not healthy. You should eat a salad,” and then the other side says, “No, I want pizza,” and then the other side says, “No, you should eat healthy,” they’re probably not going to agree with each other at any point.

References

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. 

So instead of trying to make our thoughts agree with each other or trying to see which one is the better thought, what we focus on instead, is looking to what we want our life to be like, what we want our behavior to be like, and using our values as a guide rather than the confusing internal world that we can experience.

References

Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44(1), 1–25. 

So within ACT, we’re looking to increase a healthy relationship that we have with our internal experiences rather than changing those internal experiences. So for OCD, we’re looking to have openness to obsessions and reducing the impact that these obsessions have on the individual. We’re also looking to increase valued living.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Values are these intrinsically motivating, freely chosen patterns of behavior, and this can provide a guide for a meaningful life. So you can think of this like a compass that’s guiding someone where to go.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

Increasing flexible behavior patterns that are aligned with a vital and meaningful life, we do this through reducing rituals. We’re reducing a particular problematic behavior and we’re providing this alternate behavior that is going to be more consistent with how they want to live their life and more consistent with that meaningful life. So we’re not just taking away one behavior, we’re increasing another as well.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

And then we also are looking not to just have them identify what their values are, but we’re looking to increase gradual and persistent action toward these important life goals and these life values. And as I mentioned before how OCD can really start to narrow someone’s life and really restrict the types of interactions they can have through avoidance, we look to broaden that out by gradually having them take steps toward things that they normally would avoid and for things that are important to them.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

And because avoidance and compulsions can reduce meaningful actions and that they tend to be guided by fears and distress, values, like I said, are given as an alternative guide for this so that it’s like that compass. And living a life consistent with how someone wants to be naturally reduces avoidance, this OCD-specific avoidance. And it can reduce time-consuming compulsions. So I think of this as as you expand your life to be about what you want it to be, you start to have less time for these things that are consuming more of your day.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

So, if you go to your child’s soccer game and you choose to be there on time and be there fully for it, it’s going to squeeze out the time that you have to do that hour of checking and driving back and forth to make sure that you didn’t harm someone on the road when you were driving. So it just will naturally squeeze those out.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

And value is also really nice to give a person a guide or motivation or rationale in the moment for engaging in difficult tasks. So they might be willing to experience that fear that they may have just accidentally hit someone with their car because it is so important to them to be at their child’s soccer game on time and to be present for that.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

There’s a common misunderstanding in ACT that I hear often. And people say that ACT doesn’t target reduction of symptoms. So what “symptoms” refers to, that applies to the entire set of experiences that are classified within a diagnosis. So within OCD, symptoms include behaviors.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

And behaviors are absolutely a target of ACT. It’s one of the main targets, in fact. And so ACT doesn’t attempt to change the frequency or the content of internal experiences. These are only the part of the symptoms that are thoughts, emotions, and sensations. So ACT absolutely does target this or does target the behaviors. It just doesn’t target the internal experiences.

What we’re looking for, again, is to adjust the relationship that someone has with their obsessions and work to change the compulsions and other behaviors.

References

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (2011). Acceptance and commitment therapy: The process and practice of mindful change (2nd ed.). Guilford Press.

The main target in ACT is psychological flexibility, and is the specified mechanism of change in this therapy. And ACT promotes psychological flexibility through working and targeting these 6 core processes of change. These are acceptance, defusion, being in the present moment, self as context, values, and committed action. And we will dive into each of these in much more detail and how they apply to OCD.

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., Abramowitz, J. S., Bluett, E. J., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., Reuman, L., & Smith, B. M. (2015). Exposure therapy for OCD from an acceptance and commitment therapy (ACT) framework. Journal of Obsessive-Compulsive and Related Disorders, 6, 167–173.

Now, let’s go through the key points for this portion of the information that we have discussed today. We’re looking, in ACT, to increase healthy relationships with internal experiences and increase behavior patterns that align with a meaningful life. And given that internal experiences are often unchangeable and, in fact, can have a paradoxical effect of increasing when we try to change them, ACT focuses on what can be changed, so not focusing on the internal experience, but looking to change the behavior.

More ACT for OCD presentations