Acceptance and Commitment Therapy (ACT) for OCD

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Acceptance and Commitment Therapy (ACT) for OCD

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 ACT teaches us a very different way of being in the world. Instead of white-knuckling through life, it helps us move toward what is meaningful to us. It is a very empowering approach that allows us to do what matters without being consumed by whichever feelings and thoughts may show up.

 Instead of spending our days in between avoidance and autopilot modes and trying to mindlessly chase endless tasks and goals (many of them meaningless to us), ACT helps us move strategically toward what is really important with intention and purpose. 

To summarize, ACT will help you:

–       Learn to make room for your emotions and thoughts.

–       Choose what truly matters to you.

–       Take steps toward being the person you want to be and living the life you want to live while being strongly rooted in the present moment.

“And what if my compulsions stand in my way to this?” you may ask. Great question as your OCD will certainly attempt to sabotage your progress. Thankfully, ACT is a very practical, action-oriented therapy approach (that’s why it’s so aptly abbreviated as “act”). It will provide numerous practical skills to help you handle your obsessions and compulsions.

ACT vs ERP

You probably heard that the most effective treatment for OCD is ERP. So how does ACT fit into the treatment and how is it different from ERP?

ERP (Exposure with Response Prevention) is a specialised CBT approach that teaches people with OCD to face scary stimuli (external or internal) while refraining from performing compulsions.

 ACT is, by itself, an exposure therapy. As stated above, its main foundation is the ability to experience difficult thoughts and feelings without doing anything to get rid of them or letting them consume us, and instead, to flexibly choose to take value-driven actions toward our goals.  

One of the most important components of ACT is the willingness to experience uncomfortable internal experience and moving in the direction of our values.

So, in this way, ACT and ERP have a lot of similarity as both promote exposure.

One of the differences between ACT and ERP is that ACT approaches exposure as a way of taking steps toward the life that is full of purpose. So instead of just “tolerating” the scary thought or object and waiting for the distress to subside, an ACT therapist will encourage you to identify your values, establish value-driven goals, and take steps toward those goals regardless of what thoughts or feelings are showing up.

That is, ACT is an exposure therapy, but provides a much more fulfilling way to do exposure. You are taking steps to being the best version of yourself instead of just learning to endure your anxiety. You discover that you may feel anxious and still do the things that are important to you. Instead of doing the hard stuff for the sake of “getting rid of OCD,” you work toward something bigger, something that is deeply important to you. This makes your therapy work so much more meaningful and increases motivation to work hard toward recovery. 

While many ERP therapists track anxiety levels while doing exposure (they use SUDS – Subjective Units of Distress as a measurement), ACT therapists do not view anxiety levels as important and don’t track them. After all, anxiety, like every other emotion, comes and goes in its own time and we don’t have control over it. If anything, tracking your anxiety just brings more of your attention to it and makes you feel it’s important, sending your mind and body a message to produce more of it. Instead, ACT therapists may track things like willingness to experience whichever feelings show up and doing what is important. They may also track how effectively you were able to unhook from your intrusive thoughts, or how you are progressing toward your value-guided goals. This allows you to drop the struggle, to get out of the tug of war with OCD and to focus on what matters.  

In addition to never trying to encourage you to get rid of anxiety, an ACT therapist may actually encourage you to see your anxiety as helpful. We experience strongest emotions about the things we care about. And an ACT therapist will urge you to look which yearnings –-things that matter the most to you — may be underneath your anxiety. These insights will help you channel your anxiety or other emotions in the right direction.

Exposure exercises in ERP are often driven by a certain topic and by the severity of anxiety (low to high). In ACT, however, the exposures are driven by what stands in your way of being the person you want to be and living the life you want to live. ACT helps people to be more motivated and engaged when practicing exposure.

Can OCD be treated with ACT only – without ERP?

First of all, who is asking this question – you or your OCD?

This content was originally published here.

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