Present Moment Awareness: ACT Tools for Anxiety in OCD


Utah State University
Boys Town Center for Behavioral Health

Key Points

  1. ACT addresses the cycle of uncertainty and secondary anxiety in OCD, helping Stacy understand and differentiate between ‘clean pain’ and the resultant ‘dirty pain’ caused by her responses.
  2. Visualization and mapping techniques are used to illustrate the vicious cycle of OCD, showing how it impedes engagement in meaningful life aspects.
  3. Techniques like externalizing OCD and focusing on present-moment awareness, including bodily sensations, are employed to develop a more flexible response and reduce the impact of OCD on Stacy’s life.
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Understanding Uncertainty and Anxiety in OCD

In Stacy’s case, uncertainty is a natural part of long-term commitments like marriage, representing what is termed ‘clean pain’ in ACT. However, Stacy’s interpretation of this uncertainty as something negative leads to secondary anxiety. Her constant evaluation and monitoring of her feelings, both internally and in response to potential external triggers, intensify her anxiety.

This heightened state of alertness often results in mental compulsions, which further disconnect her from her life and partner, fueling more doubt and uncertainty. This cycle illustrates how initial clean pain can escalate into a more significant issue dominated by OCD behaviors.

Mapping Out the Vicious Cycle

This cycle might be visualized in therapy using concentric circles on a whiteboard, with the natural doubt and uncertainty at the center. The therapist then explores how Stacy responds to this core feeling, what additional feelings arise, and how these reactions further complicate her emotional state. This exercise helps to illustrate the extent to which OCD occupies her life and limits her engagement in meaningful activities.

Externalizing OCD and Building Flexibility

One technique involves externalizing OCD to help Stacy view it as separate from herself. This might include visualizing OCD in physical terms – its appearance, size, texture, and sound. In Stacy’s case, labeling her OCD as ‘Runaway Bride,’ drawing from the movie, introduces humor and fun, which can be signs of successful defusion. This new perspective offers a more flexible response to her thoughts.

Present Moment Awareness in ACT

Present moment awareness is a crucial process in ACT, especially for conditions like OCD. For Stacy, her preoccupation with her mental compulsions and worries about the past or future detracts from her engagement with the present.

Building present-moment awareness involves exercises that prompt Stacy to focus on her immediate internal and external experiences. It’s about distinguishing between her internal thoughts and the tangible, external world around her. This could include focusing on physical sensations like feeling her feet on the ground or identifying the physiological manifestations of her uncertainty.

The Role of Bodily Awareness

Given that individuals with OCD often live in their heads and are less attuned to their bodies, using the body as an entry point to present-moment awareness can be effective. Techniques might involve Stacy tuning into bodily sensations associated with her feelings of uncertainty, helping her to ground herself in the present moment.

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Present Moment Awareness: ACT Tools for Anxiety in OCD