Getting Your ACT Together

[Daniel E.]

Getting Your ACT Together
August 17, 2008
About.com OCD Blog

If you’ve done research on treatments for OCD, you’ve probably come across (or even tried) mindfulness meditation as a way to reduce your symptoms. In a nutshell, mindfulness techniques encourage you to simply take note of distressing thoughts, rather than trying to push them away or control them.

Recently, I was able to attend a workshop by Dr. John Forsyth – a leading clinical psychologist and author – on a relatively new psychological treatment called Acceptance and Commitment Therapy, or ACT, that is based, in part, on principles of mindfulness meditation. What struck me most was the philosophy of ACT, which is “control is the problem – not the solution.” This is the opposite of most other forms of psychotherapy, and often the view of people with anxiety disorders – if you have an anxiety disorder like OCD, you often want more control over your thoughts, not less!

Given how important feelings of control are in OCD, a therapy that targets thoughts and feelings related to control is very intriguing, as Dr. Forsyth showed evidence that ACT is effective in reducing suffering associated with OCD.

In my own research on ACT, I’ve come across a number of good resources:

Contextual Psychology - this is the official site for the Association for Contextual Behavioral Science and has lots of ACT resources for the public, including information, discussion groups, a search tool to find ACT therapists, recommended books and audio tapes for meditation, and centering exercises.

ACT for Anxiety Disorders - this is the homepage for the book Acceptance and Commitment Therapy for Anxiety Disorders, which is co-authored by Dr. Forsyth. The site contains excerpts from the book that will give you a nice overview of ACT for anxiety disorders and has a great list of websites and other online resources.

Do you have first-hand knowledge of the effectiveness of ACT? Share your thoughts with us here.

 

[Daniel E.]

A summary based on the book Acceptance and Commitment Therapy for Anxiety Disorders:

The ACT treatment for obsessive-compulsive disorder generally includes eight steps:

1. Educate about OCD, anxiety, and ACT
2. Develop creative hopelessness
3. Clarify values
4. Commit to taking action
5. Develop acceptance
6. Focus on contact with the present moment
7. Utilize cognitive defusion
8. Stay committed to values and actions

1. Educate About OCD, Anxiety, and ACT
The initial step of the ACT treatment for obsessive-compulsive disorder is to educate the person about OCD and the nature of anxiety. It’s especially important for the person to understand the nature of anxiety from an ACT point of view. According to this treatment, anxiety and fear themselves are not the causes of OCD. Rather, it’s the person’s avoidance of anxious and fearful emotions and thoughts that make OCD an overwhelming problem. Starting with the early stages of treatment, it’s also important for people to understand that ACT is an active, participatory treatment designed to help them live a more fulfilling life, not necessarily a “happier” one.

2. Develop Creative Hopelessness
In order to develop what ACT calls “creative hopelessness,” a person must conduct a thorough evaluation of the strategies that he or she has already used to cope with fear and anxiety. After doing this, the person often recognizes that all of these strategies have been unsuccessful or actually made the problem worse. This is because these strategies are actually attempts to avoid and control feelings of fear and anxiety, which can never be successful. For example, a man who attempts to control his fear of contamination by excessively washing his hands actually develops a worse problem, as does a woman who tries to avoid her anxious feelings about being imperfect by continually checking her actions over and over again. But rather than just being hopeless, this stage of treatment is also creative because it allows the person to begin exploring new, more successful ways of coping with fear and anxiety.

3. Clarify Values
ACT acknowledges that life is often lived on autopilot, without much sense of what a person really cares about. Clarifying and establishing what a person values can often help that person live a more fulfilling life, despite having occasional feelings of anxiety or fear. Values are the elements of life that give it meaning and importance, like “maintaining a loving relationship with my spouse or partner” or “being an active member of my community.” These values are like compass headings that guide a person through life. They are not destinations at which a person can ever arrive. A person can never stop maintaining a loving relationship and still have a loving relationship. Values are concepts that point a person in the direction of a fulfilling life, and ACT uses many types of values clarification tools to help people identify their values.

4. Commit to Taking Action
After a person has determined his or her values, it’s important to establish goals that support those values and then commit to taking actions that fulfill those goals. For example, if a person’s value is to be an active member of her community, she might list a number of different goals to fulfill that value, such as “attend community meetings twice a month.” This is something that can be completed and thereby create a sense of valued living. The ACT treatment for obsessive-compulsive disorder includes development of skills and goals that lead to taking committed action.

5. Develop Acceptance
In ACT, learning to accept feared situations and anxious emotions is the alternative to trying to control or avoid them. Acceptance can be hard, but it’s often the only way people can reclaim control of their lives. Many situations cannot be altered, no matter how much a person wishes them to be changed. Accepting this fact is often the first step in reengaging with life. Accepting what cannot be changed frees a person from struggling against it and allows that person to start taking actions based on what he or she values in life.

In order to cultivate acceptance, people are encouraged to experience the anxious emotions that they have been avoiding, to cease fighting things that cannot be altered, and to engage in situations that have been evaded.

6. Focus on Contact with the Present Moment
Focusing on what’s happening in the present moment can help people develop more flexible coping strategies for handling fear and anxiety. When people dwell on the past, they often become sad, and when they anticipate the future, they often become anxious. In both cases, they miss what’s happening at the present time. Paying attention to what’s happening in the moment gives people more control over the decisions they’re making and allows them to see more possibilities in life. This skill is often developed with present-focused mindfulness skills, such as focusing on the rising and falling of the breath or on physical sensations in the body.

7. Utilize Cognitive Defusion
Cognitive defusion is a mindfulness technique that helps people observe their anxious and fearful thoughts without becoming attached to them. “Defuse” is an invented word that means to unstick or to unfuse one’s self from the words that arise in thoughts. The goal of this stage of treatment is to allow people with OCD to function more freely without judging themselves, their feelings, or their thoughts. Thoughts and emotions often arise haphazardly, so it’s easy to see that OCD could worsen over time if a person were to follow or believe every thought and emotion that arose.

Cognitive defusion is often accomplished using meditation or mindfulness techniques, such as imagining thoughts floating by on a cloud, repeating the words of a thought over and over until they lose meaning, or imagining a thought as something outside of oneself. By observing the process of thinking and feeling, the goal is to create space between the person and his or her experience. This gives the person more control over decisions made based on those thoughts and feelings.

8. Stay Committed to Values and Actions
In order to create a fulfilling life, it’s crucial for people to continue making decisions based on what they value in life, rather than based on the thoughts and feelings they have tried to avoid in the past.

New Harbinger Publications: Obsessive-Compulsive Disorder

 

[Daniel E.]

Obsessive?compulsive symptoms: The contribution of obsessional beliefs and experiential avoidance

...It appears the construct of EA [emotional avoidance] is too general to explain OC [obsessive-compulsive] symptoms over and above cognitive?behavioral constructs such as core obsessive beliefs, which are more specific...

The present results suggest that with respect to the treatment of obsessions and checking symptoms, it may be more effective to modify obsessive beliefs (CBT) rather than to simply accept obsessions and anxiety (ACT). Naturally, this speculation requires empirical evaluation via direct comparisons between the two treatment approaches.