Acceptance and Commitment Therapy by Lisa Coyne, PhD
BRIEF DESCRIPTION:
Acceptance and commitment therapy (ACT, pronounced “act”) is an empirically supported (per the American Psychological Association) type of cognitive-behavioral treatment that has strong research support across mental health conditions, including depression, anxiety disorders, psychosis, chronic pain, and OCD.
ACT aims to reduce compulsions and help you re-engage in activities that are important to you that your struggle with OCD may have shut down. As a transdiagnostic treatment, ACT may also be useful if you are experiencing mood issues, and/or if you are feeling stuck in other areas of your life beyond OCD. While it can be helpful on its own, ACT is most commonly used in conjunction with ERP because ACT and ERP have overlapping features.
ACT targets experiential avoidance, which refers to the tendency to try to fight off unpleasant private experiences such as unwanted thoughts, feelings, sensations; or avoid the situations that give rise to them. To address this, ACT promotes engagement in meaningful important life activities even in the face of unwanted private experiences such as unwanted thoughts and anxiety.
ACT can be thought of as an exposure-based treatment in that it encourages individuals to allow and make space for difficult experiences, such as obsessional thoughts, without defense (in other words, without rituals or avoidance), so that they might re-engage in their lives and relationships in satisfying and meaningful ways. ACT also includes mindfulness processes and behavior change processes. Treatment components include mindfulness exercises, metaphors, and other experiential strategies.
It is typically delivered by a mental health professional (psychologists, social workers, mental health counselors, coaches), in individual and group settings, in person, and via teletherapy.
There is not a certification process for ACT therapists; however, most skilled providers have been trained by “ACT Trainers,” a group of teachers who have completed a rigorous process of peer-review through the Association of Contextual Behavioral Science (ACBS). In vetting providers, it may be useful to ask about a clinician’s training experience, whether they regularly use this modality, and whether they use it for OCD and related disorders.
WHY/HOW IT WORKS:
ACT works by promoting “psychological flexibility,” or increased willingness to experience discomfort in the service of pursuing one’s values. It does so through helping you notice that attempts to control or avoid unwanted thoughts or feelings, such as by doing rituals, don’t work, and as an alternative, similar to ERP, helping them practice being present with, making space for, and allowing those experiences.
Regarding disturbing or distressing thoughts, ACT helps individuals observe and accurately label them as thoughts — rather than literal truths, regardless of how compelling they feel — and to let them come and go without engaging with them. ACT also shifts one’s perspective from trying to control thoughts and emotions to engaging in valued activities that evoke a sense of meaning and purpose. For example, connecting with friends and family may be one such activity, even though one might experience unwanted obsessions or fears.
SUMMARY OF THE RESEARCH SUPPORT:
To date, there have been over 1,000 clinical trials evaluating the efficacy and effectiveness of ACT for different mental and behavioral health problems. Although the level of rigor and quality of these varies, ACT can be considered to have moderate to strong research support depending on the specific condition. A small but growing number of relatively small randomized clinical trials have shown that ACT works better than no treatment or relaxation, for treatment of OCD. ACT has been shown to be beneficial for OCD in about 12–16 sessions. Although it can be used on its own and has been found to be effective as a stand alone treatment for OCD in small studies, it is recommended that ACT be used as an adjunct to exposure and response prevention (ERP) for OCD.
AGE CONSIDERATIONS
Most clinical trials have evaluated ACT with adults, although a few clinical trials with children with anxiety and related disorders have also had positive outcomes.
OTHER IMPORTANT CONSIDERATIONS:
ACT can be a helpful treatment approach if you are experiencing comorbid conditions, for example, OCD and depression, or OCD and substance use or other disorders.
WHEN TO TRY THIS TREATMENT:
ACT is considered a second-line treatment for OCD and is often used as an adjunctive treatment for OCD, added on to first-line treatment(s) such as ERP or SRI medications.