The ACT for OCD Toolbox: A Guide for Therapists

Earn 8.75 CE/CME Credits and ACT Right Away in OCD

Willingness and Acceptance in ACT 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

  • Clients want to try something other than control.
  • Introduce willingness as an alternative to the control strategy.
  • Willingness is also known as acceptance.
  • It’s the action of being open and welcoming to internal experiences that don’t change.

 

Transcript

At this point in therapy, clients are often open to try something other than what they have been doing in response to their internal experiences, and you can help them determine what they would like to do next with a couple of exercises.

One that I find that can be helpful in transitioning from the concept of control as a problem into the concept of acceptance or willingness, which we’ll be covering in this video, is the distinction between clean vs dirty pain.

References

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., 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.

Now, clean pain is this natural, expected pain and distress that we experience because we’re living, breathing humans. So, our loved ones die. There’s uncertainty and risk around every corner. There are terrible events that happen in the world. We get sick. We have scary thoughts. Our bodies feel pain and discomfort. And this is a reality for all of us.

References

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., 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 I show this to clients by holding my hands together and showing this circle shape. This is where my fingers are all touching each other, just to show a smaller circle and to say this small circle of clean pain is expected.

References

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., 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.

But what can happen is, when we choose not to feel clean pain or we say it’s not okay to have clean pain or that there’s something wrong with that, we start to notice that that circle expands.

References

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., 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 once it starts expanding from that space of clean pain outward—and I show this by just spreading my hands outward to make a larger circle—that is the piece that’s called dirty pain. And that’s the extra stuff or the extra pain that we don’t necessarily have to experience, but it’s a byproduct of us saying we don’t want clean pain.

References

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., 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 can use examples from their life. “Okay. Well, you’ve been having this thought about wondering if you may have inappropriately touched a child. And think about all the things that you’ve done to try to not have that thought.”

Then you can actually list out all the things that go around that, so all the distress, and the worry, and the nights of not being able to sleep, and the amount of time that they’ve spent trying to figure this out, and how that’s just impacted their life, and then the guilt and the shame that comes with that, and how it’s been disruptive for them. All of that is dirty pain.

References

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., 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.

Other words that can be used to describe this are clean pain can just be called pain, and the dirty pain can be called suffering. And the thing about this is that we don’t have to experience suffering or dirty pain because it is a thing that we are creating. So, instead, an option can be is learning how to experience clean pain if it’s going to be there anyway.

References

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., 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 by showing this to clients, however you can physically, to say if you can have this much pain, showing them the smaller amount of clean pain, or this much pain, showing them the larger amount of clean and dirty pain, which would you prefer? Most people are going to say, “Well, yeah. If those are my only 2 options, I’d much prefer to just have clean pain.” So you say, “Okay. Well then, it seems reasonable and worthwhile for us to discuss how to experience clean pain if it’s going to be there throughout your life. Wouldn’t you agree?”
 
References

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., 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.

Most people might have some resistance to that idea because they may hope that the clean pain could go away, but all in all, we just have to keep coming back to “Yeah, but it is here. So let’s talk about ways that we can approach it if it’s going to be here.”

References

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., 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 this leads very nicely into the concept of acceptance and willingness because that’s entirely what this process is about. It’s to say, “Okay, we all have stuff that doesn’t feel great internally. It’s stuff that can be unpleasant. It’s painful. This is part of us being humans. Let’s learn how to live with it.”

Here’s a bit of information on acceptance. It is not toleration. So, keep an eye out for clients that are simply just pushing through their distress. This is not acceptance.

References

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., 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 you can share this with them through an example of a roller coaster. It’s a different experience if you’re gritting your teeth and waiting for it to be over vs embracing it and throwing your hands in the air. You’re still going to be riding the roller coaster, but it’s a very different way of going about it. And toleration is much more the gritting your teeth and waiting while acceptance or willingness are more the embracing of that experience.

References

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., 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 also want to be watchful for clients that use acceptance as a control strategy. This often sounds something like, “You know, I’m willing to have it if it goes away,” or you can start to hear some of the same strategies that they’ve used in the past and how they’ve talked about their attempts to control their thoughts, and they might just include acceptance into that. And you want to avoid that if possible.

References

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., 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 if I see this in my clients, I will just call it out and say, “It sounds like we’re maybe just using this thing we’re talking about as another way to get rid of that.” And once they catch that, they’re like, “Oh, right.” So, you can help them see that acceptance is a genuine acceptance. We can’t pretend it. Our minds know if we’re faking acceptance.

References

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., 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’m going to walk through some metaphors with you that I use with my clients. I recommend just choosing 1 of these metaphors to go through in session. Don’t try to fit them all in. Really take your time and walk through the metaphor properly instead of trying to just go through this list of metaphors that are possible.

References

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., 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.

Some of the relevant metaphors are treating your distress like an old friend that follows you around all day, one that’s called 2 dials—I’ve made an adaptation to this one where it’s a 1 dial and 1 switch and I’ll go through that one with you. A common one that you’ll often hear in ACT trainings or books is a quicksand metaphor and then also treating your distress as if you’re watching a sunset.

References

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., 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’m going to walk you through the light switch one. What this is, and I’ll just say this as I say it to my clients, is that most of us are very aware of this dial that we have that says how intense our distress is. It can be at a 0 all the way up to a 10. And we go through our lives knowing that we have this dial that represents that intensity of distress.

References

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., 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.

Many of us focus our attention there, that if the distress goes up to 10 or to an 8 and that feels uncomfortable for us, then our minds go into the problem-solving mode and say, “Okay, I need to get this dial to go down.”

But with this dial, there’s this funky thing that happens that we’ve been talking about lately. It’s that when our dial is up high and we want it to go low, there’s this locking mechanism where when we try to turn it down, it actually just gets stuck.

References

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., 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, if it’s at a 10, we might be able to get to like a 9 or an 8. But it doesn’t seem like it can go any further down than that as soon as we’re trying to turn it down. We always have the option to turn it up, but going back down—it doesn’t seem that we can do that. People can get stuck really focusing on this dial because that’s the thing that we’re aware of, but what I want us to talk about today is this other aspect of your experience that you just may not know that you have access to.

References

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., 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 this is called a willingness switch. The reason this one is a switch is because it’s either on or off. But what’s cool about the switch is when we have our willingness turned on, that means whatever that dial of distress is doing, doesn’t matter because I’m saying, “I’m okay with it being at a 10,” “I’m okay with it being at a 2,” “I’m okay with it rapidly cycling between those,” “I’m okay if it just gets stuck at a 5.”

When willingness is on, that distress dial can do whatever it wants. But when willingness is off, that’s when we get stuck in focusing on what that dial is doing and what it needs to do.

References

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., 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.

In treatment, what we’re going to do is focus on if your willingness switch is on or off because, as we talked about with the clean pain, our dial is going to go up. That’s just part of being human. So if we have it on, that’s just saying, “Okay. I’m just willing to have this be here.”

References

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., 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.

When I talk with clients about these concepts, I rarely use the word “acceptance” other than at the beginning of treatment when I say, “The treatment that we’re going to be doing is called acceptance and commitment therapy.” The reason I don’t use this word with them is because that can be heard as resignation, and this is not at all what that concept means.

References

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., 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 not having them give up on their life. What we’re saying is, “Control what you can and be open to everything else.” Thus, I use openness or willingness instead of the word acceptance.

And while we’re on this topic, I often hear people say that ACT says you have to be open to all of your experiences and not ever try to change them. This is an inaccurate representation of ACT. And it can lead therapists to use ACT in a very rigid manner and not adjust your intervention based on the information this client is giving you.

References

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., 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.

The goal of ACT is to help you attend to the contingencies that are at play and to respond to your internal experiences in a flexible manner. So, that means if exercising every day helps you feel energized and lessens your feelings of sadness and the amount of exercising you’re doing matches with how you want to live your life, great!

References

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., 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.

Willingness is a concept that’s useful when you find that you’re unable to change the way that you feel and trying to change it makes it grow and/or the way you’re trying to change it is causing problems in your life.

Willingness is an all-or-nothing concept. You either are or you are not. And that’s why we talk about that as a switch because there’s no such thing as partially willing. If you’re partially willing, you are not willing. So, it’s like taking a jump. You either do or you don’t.

References

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., 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.

The key points for this video are that at this point in therapy, clients are usually considering the option of trying something other than attempting to control their internal experiences. At this point, you can introduce willingness as an alternative to this control strategy through exercises and metaphors.

Willingness, which is also known as acceptance, is the action of being open and welcoming to internal experiences that do not change.

More The ACT for OCD Toolbox: A Guide for Therapists