How ‘Acceptance and Commitment Therapy’ can help treat Obsessive Compulsive Disorder (OCD)
When you’re caught in a cycle of intrusive thoughts and compulsive behaviors, it’s natural to want them to go away — especially when they bring painful emotions like shame, fear, or sadness.
If you’re navigating life with Obsessive-Compulsive Disorder (OCD), you may have already explored evidence-based treatments like Exposure and Response Prevention (ERP) and Cognitive Behavioral Therapy (CBT) — the gold standard frontline treatments for OCD. While these approaches are highly effective, Acceptance and Commitment Therapy (ACT) offers a complementary approach that is becoming increasingly popular in the treatment of OCD.
What is ACT?
ACT is a mindfulness-based behavioral therapy that encourages acceptance rather than control of thoughts and emotions. Unlike CBT, which often focuses on challenging negative thoughts, ACT focuses on helping individuals change their relationship with their thoughts.
Developed in the 1980s by psychologist Steven C. Hayes, whose interest in this intervention emerged from his own experience with panic attacks, the primary goal of ACT is to help clients develop psychological flexibility — the ability to respond to thoughts and emotions in a way that aligns with their values.
Here’s what that looks like in practice:
- Acceptance: The therapist guides the client in acknowledging their thoughts and emotions as they arise, without judgment or resistance. Over time, the client learns to recognize uncomfortable feelings, such as anxiety or intrusive thoughts, as temporary experiences rather than signals requiring immediate action.
- Cognitive Defusion: The therapist helps the client create distance from distressing thoughts through a technique known as cognitive defusion. By reframing statements like “My behaviors are embarrassing” to “I am having the thought that my behaviors are embarrassing,” the client gradually reduces the power of negative self-talk and develops self-compassion.
- Present-Focused Awareness: ACT encourages the client to focus on the present moment rather than dwelling on the past or worrying about the future. Through mindfulness techniques, the therapist supports the client in breaking the cycle of rumination and regret.
- Values-Driven Work: The therapist and client work together to identify what truly matters to the client, aligning their actions with personal values rather than fear. Developing a values-based plan provides a sense of purpose and direction.
- Committed Action: The therapist helps the client create a concrete plan to take meaningful steps toward well-being, even in challenging moments.
How effective is ACT?
ACT is used to treat a wide variety of mental health conditions, including anxiety, depression, eating disorders, substance use, and OCD. While it may not outperform CBT or ERP in symptom reduction, research suggests it can be just as effective when combined with medication.
ACT is particularly beneficial for individuals who have struggled with ERP due to difficulty tolerating distress or who experience co-current mood disorders like depression. It is also beneficial for those who want to focus on living well despite symptoms instead of mainly focusing on reducing symptoms.
It’s important to note that while ACT is focusing on accepting your thoughts and behaviors, using it does not mean giving up on reducing symptoms.
In fact, one of the major benefits of this approach is that it can be used alongside CBT, ERP, and medication to support your OCD treatment. Even more promising is its ability to enhance ERP by helping people tolerate discomfort during exposure rather than fighting it.
Could ACT help with managing your OCD symptoms?
ACT may be an appropriate treatment option for you if you’ve struggled to control or regulate obsessions and anxiety in the long-term, or if despite being able to mitigate some of the behavior associated with OCD, you are continuing to deal with negative thinking and judgement because of your mental health condition.
ACT can help improve the quality of life for individuals with OCD by focusing on meaningful behavior changes, even before obsessions and anxiety decrease.
This treatment approach helps clients openly experience their thoughts, feelings, and bodily sensations without being overwhelmed and impeded by them, so they can continue to take steps towards a more rewarding life.
As the International OCD Foundation notes, “obsessions and anxiety are not inherently bad events, but they are treated that way by most of society.”
The ACT school of thought does not subscribe to the judgement that others may place on compulsive thoughts and behavior. Instead, it treats them as an inherent part of living — one that does not need to prevent them from living meaningfully.
This approach can lead to greater functioning “without a change in severity or frequency of obsessions or anxiety,” per the International OCD Foundation.
If you’re considering ACT as a treatment option, here are some questions you may want to ask yourself, according to the International OCD Foundation:
- “Has attempting to control or regulate obsessions and anxiety worked over the long-term?
- Has this lessened the obsessions and anxiety in a meaningful way?
- Finally, has your life become more open and fulfilling as a result of these attempts to regulate obsessions and anxiety?”
If you’ve answered no to these questions, ACT offers an alternative approach: instead of controlling thoughts, you can learn to live alongside them without letting them dictate your actions.
With treatment focused on living according to your values and accepting your thoughts and feelings without judgement, you can lead a meaningful life regardless of the OCD symptoms you experience.
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