ACT for OCD: Deciding on a Course of Treatment
Key Points
- The behavioral first-line treatment for OCD is exposure and response prevention (ERP).
- When the client is unwilling to try ERP or hasn’t had good results in the past, acceptance and commitment therapy (ACT) is an empirically-established treatment that can be a suitable option.
- Clinicians should refer clients to receive medication when the symptoms are so severe that they can’t engage in therapy or are not responding favorably to treatment.
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Transcript
When you have a client come into your office that is presenting with symptoms of OCD, you’re initially going to need to decide on the best course of treatment for them.
And while we’re talking about ACT today, I wanted to talk a little bit about exposure and response prevention. And the reason for that is that exposure and response prevention is the gold standard treatment for OCD and this is with and without medication, typically SSRIs. So, if you are working with someone that has not had a quality course of ERP, I recommend starting them with that because it just has much more data behind it than ACT does currently.
American Psychiatric Association. (2006). American psychiatric association practice guidelines for the treatment of psychiatric disorders: Compendium 2006.,Ong, C. W., Blakey, S. M., Smith, B. M., Morrison, K. L., Bluett, E. J., Abramowitz, J. S., & Twohig, M. P. (2020). Moderators and processes of change in traditional exposure and response prevention (ERP) versus acceptance and commitment therapy-informed ERP for obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 24, 100499.
As I mentioned before, the III-31 questionnaire can be helpful in deciding a course of treatment. In a study where ERP alone was compared to ACT plus ERP, what Ong and colleagues found is that those that had III scores that fell in the low range responded better to ERP. When their scores were in the moderate to high range, they responded the same to both treatments. So, this is one piece of data, but it might be a useful piece of information and is the reason I recommend giving the III at intake so it can help you make the decision of what might be a better treatment course for the individual.
American Psychiatric Association. (2006). American psychiatric association practice guidelines for the treatment of psychiatric disorders: Compendium 2006.,Ong, C. W., Blakey, S. M., Smith, B. M., Morrison, K. L., Bluett, E. J., Abramowitz, J. S., & Twohig, M. P. (2020). Moderators and processes of change in traditional exposure and response prevention (ERP) versus acceptance and commitment therapy-informed ERP for obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 24, 100499.
