ACT for OCD: How it Works, Examples, & Effectiveness

What is Acceptance & Commitment Therapy?

ACT, or Acceptance and Commitment Therapy, is a type of behavioral therapy that’s becoming more popular for treating OCD. It was created by Steven C. Hayes in the 1980s when he was dealing with his panic disorder. ACT teaches that we can’t control our internal experiences like thoughts and feelings, but we can control our actions.

With OCD, it’s easy to get caught up in endless obsessions and compulsions and forget what’s important to you. But with ACT, you don’t have to wait for your OCD to improve before you start living the life you want. ACT helps you to become the person you want to be.

According to ACT, difficult thoughts and feelings aren’t the problem. The problem is when we let our mind’s warnings and negative thoughts take a toll, we often ignore what’s important and look for quick fixes. This might work for a while, but it distracts from what matters to you in the long run.

What is OCD?

OCD is not a rare disorder –In a recent study of 2024, 1 in 40 adults in the US has OCD, and many were struggling with this for their entire lives.

Obsessive-compulsive disorder (OCD) involves having unwanted thoughts and fears, called obsessions. These obsessions make you do repetitive actions, known as compulsions. You feel like you must do these compulsive actions to relieve stress. Even if you try to ignore or stop the bothersome thoughts or urges, they keep coming back, leading you to act ritualistically. This is a vicious cycle of OCD.

One clear symptom of OCD is how it disrupts daily life. Obsessions can distract for long periods, and compulsions can take hours to perform. OCD often focuses on specific fears, like a fear of germs. To ease these fears, you might wash your hands repeatedly until they’re sore. Having OCD can make you feel ashamed, embarrassed, and frustrated, but ACT therapy for OCD is an effective treatment.

Characteristics of OCD

OCD is characterized by obsession and compulsion, which go hand in hand.

Obsessions

Obsessions are like intrusive thoughts that bring a lot of distress and anxiety. Sometimes, you might try to push them away or use rituals to make them go away, but they can still pop up when you’re trying to concentrate on other things. It can feel really overwhelming. Types of obsessions include:

• Fear of contamination or germs
• Intrusive thoughts about harm or violence
• Obsessive doubts or fears about safety
• Need for symmetry or exactness
• Unwanted thoughts about taboo subjects

Compulsions

Compulsions are actions that people with OCD use to soothe themselves after distressing obsessive thoughts. Types of compulsions include

• Washing and cleaning
• Checking behaviors
• Mental compulsions
• Arranging things
• Repeating actions
• Avoiding triggering situations

Factors Affecting OCD

1. Brain Chemistry

OCD is linked to imbalances in certain neurotransmitters (like serotonin) in the brain. These chemicals play a role in regulating mood and anxiety levels.

2. Genetics

There is evidence that OCD can run in families, suggesting a genetic component. People with close relatives who have OCD may have a higher risk of developing the disorder themselves.

3. Learned Experiences

Individuals may develop OCD symptoms based on learned behaviors or experiences. For example, someone who excessively wash their hands due to fear of contamination may have learned this behavior from a traumatic event or by observing others.

How Does ACT Help With OCD?

ACT can help OCD by:

• Creating a more positive self-relationship
• Increasing self-awareness and flexibility
• Reducing the shame and anxiety caused by obsessions

ACT Therapy for OCD Obsessions

ACT helps OCD by changing how a person relates to their obsessions. It teaches that thoughts are separate from the person, and having an idea doesn’t mean you have to act on it.

ACT Therapy for OCD Compulsions

ACT therapy for OCD helps patients see their compulsions as choices rather than necessary for safety. It uplifts people with OCD to respond in different ways, not just their usual compulsions. It helps them focus on what matters most by aligning their actions with personal values.

Research shows that ACT effectively treats OCD spectrum disorders by enhancing psychological flexibility and disconnecting compulsions from obsessions.

ACT Therapy Techniques Applied to OCD

Metaphors to teach ACT Theory

ACT uses metaphors to change how clients see their thoughts and behaviors:

1. Thoughts as Leaves

Imagine thoughts as leaves floating in a stream—observe without reacting.

2. Drivers Vs. Passengers

Your mind is a car; thoughts and feelings are passengers. Thoughts and feelings can suggest things to you, but they don’t have the steering wheel—you do. You have the power to decide how to respond to them and where to drive your life, regardless of what thoughts or feelings come along for the ride.

3. Beach Ball Underwater

Avoiding emotions is like holding a beach ball underwater—exhausting and keeps popping up back.

4. Quicksand

Controlling thoughts with compulsions is like struggling in quicksand (a mixture of sand and water) —the more you struggle against it, the deeper you sink.

Acceptance, Mindfulness, and Defusion Skills

Skills taught in OCD treatment include:

1. Defusion

Learning that thoughts don’t define someone; actions speak louder about who they are.

2. Mindfulness

Being aware of thoughts, emotions, and physical responses in the present moment.

3. Acceptance

Non-judgmentally accepting thoughts and reactions after becoming mindful of them.

Identifying Values & Committing to Action

• Knowing your ideal self and living by your values helps you handle urges for compulsive behaviors better. When you recognize times you’ve strayed from your values, you can make more deliberate choices. This reduces compulsions and gives you more control over your actions, even with OCD.

What to Expect During ACT Treatment

ACT therapy for OCD typically requires 50-minute sessions for at least a year for symptom relief. ACT sessions involve:

• Building rapport with your therapist to establish trust and accountability
• Exploring your current mental state, including obsessions and internal reactions
• Identifying your ideal self and core values to guide intentional decisions
• Committing to specific actions aligned with your values to live a more fulfilling life.