2011 IOCDF Grant

Combining acceptance and commitment therapy with exposure and response prevention to enhance treatment engagement

Michael Twohig, PhD

Utah State University (Logan, UT)

Award Amount: $50,344

Acceptance and commitment therapy (ACT) is a treatment that promotes acceptance of unwanted thoughts, commitment to the present moment and one’s values, and engaging in behaviors that are in line with one’s values. It has proven to be an effective treatment for OCD, due to high acceptability, low dropout, and low treatment refusal. What if ACT was combined with exposure and response prevention (ERP) — the first-line therapy for OCD?

With 58 participants with OCD, this study by Dr. Twohig and his team tested a course of ERP (28 participants) and a combination of ERP + ACT (30 participants) over the course of eight weeks to see if combining the two therapies would enhance outcome and engagement. Overall, ERP and ERP + CBT resulted in the same strong levels of engagement and resulted in strong outcomes , showing that both types were effective in treating people with OCD (Twohig et al., 2018). Other research into ERP and ACT resulted from this grant as well. An exploration of sudden rapid “gains” in ERP showed that although 27% of 44 participants with OCD did experience sudden gains in treatment response, this may not be important in terms of long-term outcome (Buchholz et al., 2019). An investigation of the role of cognitive fusion — the tendency to believe that thoughts and feelings constitute reality — showed that it may explain symptoms of OCD in the symmetry dimension (Hellberg et al., 2020). A study of moderators and processes of change related to these therapies found that comorbid anxiety and depression did not moderate either ERP or ERP + ACT, but less dysfunctional interpretations of intrusive thoughts were associated with better ERP treatment performance (Ong et al., 2020). Finally, homework assignments during ERP improved OCD symptoms after treatment for multiple dimensions except contamination OCD (Ojalehto et al., 2020).


Resulting Publications:

*Twohig, M. P., Abramowitz, J. A., *Bluett, E. J., Fabricant, L., Jacoby, R. J., Morrison, K. L., Reuman, L., & Smith, B. (2015). Exposure therapy for OCD from an acceptance and commitment therapy (ACT) framework. Journal of Obsessive Compulsive and Related Disorders, 6, 168-7-173.

*Twohig, M. P., Abramowitz, J. S., Smith, B. M., Fabricant, L. E., Jacoby, R. J, Morrison, K. L., Bluett, E. J., Reuman, L., Blakey, S. M., & Lederman, T. (2018). Adding Acceptance and Commitment Therapy to Exposure and Response Prevention for Obsessive- Compulsive Disorder: A Randomized Controlled Trial. Behaviour Research and Therapy, 108, 1-9.

*Buchholz, J. L., Abramowitz, J. S., Blakey, S. M., Reuman, L., & Twohig, M. P. (2019). Sudden Gains: How Important Are They During Exposure and Response Prevention for Obsessive-Compulsive Disorder? Behavior Therapy, 50, 672-681.

*Hellberg, S. N., Buchholz, J. L., Twohig, M. P., & Abramowitz, J. S. (2020). Not just thinking, but believing: Obsessive beliefs and domains of cognitive fusion in the prediction of OCD symptom dimensions. Clinical Psychology & Psychotherapy, 27, 69-78.

*Ong, C. W., Blakey, S. M., Smith, B. M., Morrison, K. L., Bluett, E. J., Abramowitz, J. S., & Twohig, M. P. (2020). Moderators and processes of change in traditional exposure and response prevention (ERP) versus acceptance and commitment therapy-informed ERP for obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 24, 100499.

*Ojalehto, H. J., Abramowitz, J. S., Hellberg, S. N., Buchholz, J. L., & Twohig, M. P. (2020). Adherence to exposure and response prevention as a predictor of improvement in obsessive-compulsive symptom dimensions. Journal of Anxiety Disorders, 72, 100210.