How ACT Can Compliment Therapy for OCD

Acceptance and Commitment Therapy (ACT)  is a form of Cognitive Behavioral Therapy (CBT). While Exposure and Response Prevention (ERP) remains the gold-standard treatment for Obsessive Compulsive Disorder (OCD), ACT is an evidence-based therapy that is complimentary to ERP.

ACT helps people with OCD build psychological flexibility — the ability to stay connected to the present moment, notice inner experiences without judgment, and choose actions guided by personal values. ACT targets six interrelated processes: acceptance, cognitive defusion, contact with the present moment, self-as-context, values, and committed action.

Acceptance

I often describe OCD as the  “annoying family member” who means well but oversteps. When they show up at the door, bossy as ever, we often react with “Oh no, not again.”  Acceptance invites us to make space for the visitor, noticing how they arrived, allowing them to be present, and even appreciating their persistence. Anxiety and discomfort have purpose, without them our species wouldn’t have survived. All feelings, even unpleasant ones, add depth to our lives. Acceptance strategies helps us change our relationship with internal experiences rather than trying to eliminate them. When a difficult feeling or thought arrives, you learn to respond to it in accordance with your values.

Cognitive Defusion

The brain is spectacular at pushing out thoughts. Some are pleasant and exciting while others are baseless and intrusive. People with OCD often experience cognitive fusion, a phenomenon in which thoughts are mistaken as facts, warnings, or commands. Cognitive defusion strategies create distance by observing thoughts as thoughts, not truths or omens. Does the experience of a thought change when you change its voice? Would you be so likely to take your thoughts seriously if they were in the voice of a cartoon like Micky Mouse? Or what if you sang them to the tune of a song? When you learn cognitive defusion strategies, you take the power back by observing rather than resisting.

Contact with the Present Moment

OCD is a thief of the present moment as the mind drifts into imagined danger and “what if” scenarios. Mindfulness strategies help by teaching you to gently notice when the mind has wandered, and return to the here and now. Contact with the here and now means using your senses to tune into what’s actually happening — what you can see, hear, feel, and notice — instead of what your mind imagines.

Self as Context

You experience your thoughts and feelings. They happen within you, but they aren’t you. OCD often tells you that your thoughts and feelings mean something important and that you must do something about them. Self as context helps you step back and create distance from your thoughts and feelings.  Just like you notice smells with your nose and sounds with your ears, you notice thoughts with your mind. You probably wouldn’t say, “I am a pizza,”  just because you smell one cooking in the oven in the same way you don’t have to believe, “I am a bad person,” just because the thought showed up.

In ACT, we talk about three ways of relating to the self:

• Self as content means defining yourself by yourself by your thoughts or feelings (e.g., “I’m a bad person for feeling frustrated.”)

• Self as process means noticing what’s happening in the present moment (e.g., “I notice I’m having the thought that I’m bad.”)

• Self as context means recognizing the part of you that can observe thoughts and feelings (e.g., “There’s a part of me that can watch my thoughts come and go. I am not my thoughts.”).

Values

OCD latches onto what is most important to us. Because of this, it can cause self-doubt in knowing what you really care about. When you stop and consider how you’d live your life if it weren’t for OCD, you get a little closer to identifying what your values are. OCD only cares that we listen to it, not ourselves. Living by our values fosters conviction and confidence. We become more sure of ourselves and less dependent on avoidance or compulsions.

Committed Action

Committed action involves taking values-guided steps, even when it is difficult. It’s not about waiting until anxiety disappears or the time feels right. It’s about doing what matters most, even in the presence of discomfort, and learning from experience along the way. Clinically, I often think of committed action as a way to explore: What can I learn from this difficult moment? and Does this experience bring me closer to what matters most?

Many of us have painful experiences we would never undo because of how they shaped us. From heartbreaks that led to love, to failures that led to breakthroughs. Growth often hides inside discomfort. When we can stay with it long enough, we learn to move through the pain in the direction of our values.

Interested in Getting Started?

If you are somebody you know could benefit from working with Amanda, give her a call at (405) 451-3476 or at Amanda@PanaceaTherapyGroup.com.