It’s like being caught in a riptide. You struggle against the current, the powerful urge to give in to those compulsions, to arrange things just so, to check the lock for the tenth time. But the harder you fight, the more exhausted and trapped you become. This is the reality for many of my patients who live with Obsessive-Compulsive Disorder (OCD).
In my years of practice, I’ve seen firsthand how traditional approaches to OCD, while helpful for some, can leave others feeling stuck. That’s why I want to introduce you to Acceptance and Commitment Therapy (ACT), a different way of relating to your OCD that can open up a path towards a richer and more meaningful life.
Acceptance and Commitment Therapy (ACT) isn’t about eliminating those unwanted thoughts or urges—it’s about learning to navigate them effectively. Research supports this approach; Twohig, Hayes, and Masuda (2006)1 found significant reductions in OCD symptoms when patients engaged in ACT.
Acceptance: Making Space for the Unwanted
Imagine holding a pebble in your palm. If you clench your fist tightly around it, the pebble digs into your skin, causing discomfort and even pain. But if you open your hand, the pebble simply rests there, a part of your experience, but not something that controls you. This is what acceptance is all about in ACT. It’s not about liking or wanting those intrusive thoughts or urges, but about acknowledging their presence without letting them dictate your actions.
In my clinical opinion, acceptance is a crucial first step in breaking free from the OCD cycle. It’s about saying, “Yes, these thoughts are here, but they don’t have to rule me.”
Cognitive Defusion: Unhooking from Your Thoughts
Our minds are incredible storytellers, weaving narratives that can sometimes be unhelpful or distressing—especially with OCD. Cognitive defusion, a term from Acceptance and Commitment Therapy (ACT), is all about learning how to detach or “defuse” from your thoughts. It’s about observing your thoughts without getting caught up in them, which can fuel the distress you already experience.
As I often tell my clients, “Just because you have the thought, it doesn’t mean it’s true.” This principle helps create distance between you and your thoughts. Instead of trying to suppress or change them, cognitive defusion teaches you to step back and observe without judgment.
Thought Observation
One technique is to recognize when you’re lost in thought processes causing discomfort. Rather than engaging fully with these thoughts, stand back and notice them. Simply say to yourself, “There’s a thought.” By doing this, you acknowledge the presence of the thought without letting it dictate your emotions or actions.
Using Metaphors
A helpful metaphor is to imagine your thoughts as leaves floating down a stream. You observe them as they come and go without getting attached. This visualization allows you to see thoughts as transient events in the mind.
Verbal Techniques
Altering the way you verbalize your thoughts can also reduce their impact. For instance, repeating the thought in a silly voice or singing it can diminish its seriousness, helping you see it in a different light.
If you want more information you can read my comprehensive guide on cognitive defusion techniques.
Being Present: Finding Stillness Amidst the Storm
When we’re caught up in our thoughts and worries, it’s easy to lose touch with the present moment. Mindfulness, a key component of ACT, is about bringing our attention back to the here and now, to the sights, sounds, and sensations around us. It’s about finding moments of stillness amidst the storm of OCD.
Even a few minutes of mindful breathing each day can make a world of difference. It’s like pressing the pause button on your internal struggle and allowing yourself to simply be.
Self-as-Context: You Are More Than Your Thoughts
I’ve tried very hard to explain this concept in a way that makes sense. I’ve had several drafts of this article and they all sounded to ‘flowery’ and I didn’t want you to skip over it, as once you really understand ‘self as context’ it is such an incredibly helpful tool and one that I use in my own personal life, not just when working with clients. Imagine your mind is a theatre, and your thoughts are the actors – you are out there in the audience, watching, not an active participant. Thoughts flit across the stage like actors, each vying for your attention. Some are loud and demanding, dressed in flamboyant costumes of worry or fear. Others are quieter, whispering doubts or insecurities in the wings. Feelings take the stage as well, sometimes a joyous chorus, sometimes a lone sorrowful violinist. And then there are the sensations – the prickle of anxiety, the weight of sadness, the flutter of excitement – all playing their part in the production.
But here’s the thing: you are not those actors. You are not your thoughts, your feelings, or your sensations. You are the audience, sitting in the velvet seat of awareness. You witness the performance, you feel the emotions it evokes, but you are separate from the drama unfolding on the stage.
This is your ‘Self-as-Context,’ the quiet observer within. It’s the part of you that can appreciate the show without getting caught up in the plot. It’s the part that recognizes that even the most intense emotions, the most gripping scenes, will eventually pass. And it’s this part, this awareness, that holds the key to freedom from OCD’s relentless grip.
Values: Charting Your Course
What truly matters to you? What kind of life do you want to live? Identifying your values is like setting your compass in ACT. It gives you direction and helps you make choices that align with what’s important to you, even when OCD tries to pull you off course.
Perhaps you value spending time with loved ones, pursuing creative passions, or contributing to your community. By clarifying your values, you can start to make choices that move you towards a life that feels meaningful and fulfilling.
Committed Action: Taking Steps Towards What Matters
ACT is not just about acceptance; it’s also about action. Committed action is about taking steps, however small, towards your values, even in the presence of OCD symptoms. It’s about learning to live a life that is guided by what matters to you, not by your fears and anxieties.
This might mean facing a feared situation, resisting a compulsion, or simply engaging in an activity that brings you joy. Every step you take, no matter how small, is a victory over OCD.
ACT and OCD
I’ve seen remarkable transformations in my patients who have embraced ACT. One young woman, plagued by contamination fears, was finally able to enjoy cooking for her family again. Another, trapped by the need for constant reassurance, started pursuing his dream of becoming a teacher.
ACT provides a framework for living with OCD, not just managing it. It helps you develop a new relationship with your thoughts and feelings, one that allows you to live a life that is rich, meaningful, and in alignment with your values.
Starting Your ACT Journey
Here are a few things you can do to start incorporating ACT principles into your life today:
- Practice mindful breathing: Take a few minutes each day to simply focus on your breath, noticing the sensations of each inhale and exhale.
- Label your thoughts: When you notice an intrusive thought, try saying to yourself, “I’m having the thought that…” This helps create distance between you and the thought.
- Identify your values: Reflect on what truly matters to you in life. What kind of person do you want to be? What kind of life do you want to create?
- Take small steps: Choose one small action you can take today that aligns with your values, even if it feels challenging.
Remember, this is a journey, not a race. Be patient with yourself, celebrate your successes, and don’t be afraid to seek support from a qualified ACT therapist.
References
- Twohig, M. P., Hayes, S. C., & Masuda, A. (2006). A Preliminary Investigation of Acceptance and Commitment Therapy as a Treatment for Obsessive-Compulsive Disorder. Behavior Therapy, 37(1), 30-41.
- Twohig, M. P., & Levin, M. E. (2017). Acceptance and Commitment Therapy as a Treatment for Anxiety and Depression: A Review. Psychiatric Clinics of North America, 40(4), 751-770.
- Ryan, E. (2023). Cognitive Defusion: Techniques to Unhook from Unhelpful Thoughts. Retrieved from https://moodsmith.com/cognitive-diffusion/
Association for Contextual Behavioral Science (ACBS)
- Reference:
- Association for Contextual Behavioral Science. (n.d.). ACT for OCD.
- Summary: The ACBS provides resources and research supporting the use of ACT for OCD, offering insights into how ACT principles apply to OCD treatment.