Obsessive Compulsive Disorder (OCD)

Merging with intrusive thinking and compulsion as a control agenda

In Obsessive Compulsive Disorder, the pathology lies in an extreme fusion with intrusive thought content.

A person may have a fleeting image of pushing someone onto train tracks. For most, this is an unimportant extraneous thought.

For someone with OCD, the fusion turns that thought into an imminent threat: "If I've thought it, I'm capable of doing it" or "Thinking it is as bad as doing it."

Compulsion (praying, checking, washing) is the desperate attempt to control the anxiety generated by that fusion and to "override" the thought.

Treatment from ACT does not seek to debate the probability of the feared event occurring (logic), but to change the relationship to the thought (function).

If a patient has "love OCD" and is plagued by the doubt "Do I really love my partner?", the compulsion would be to analyze his feelings constantly.

The ACT intervention would be to help him say, "I'm having the obsessive thought that I don't love my partner. It's just a series of words.

I'm going to let that doubt be there, without answering it, and I'm going to give my partner a kiss because my courage is to act in love." The compulsion to "solve" the doubt mentally is blocked.

Exposure with response prevention from a values perspective

Exposure with Response Prevention (ERP) is the standard treatment for OCD, but ACT adds a layer of motivation and compassion.

Instead of exposing ourselves to fear just "to get the anxiety down," we expose ourselves "to get life back."

Imagine someone with contamination OCD who can't touch doorknobs. Traditional exposure would have him/her touch doorknobs until habituated.

From ACT, we frame this in values, "What is this fear costing you in your life? Is it keeping you from visiting your family or going to the movies?" The exhibition becomes an act of rebellion in favor of values.

"I'm going to touch this dirty doorknob and I'm not going to wash my hands, not because I want to be dirty, but because I want to be free to go where I choose, not where my OCD allows me to go."

Acceptance of the feeling of "dirty" or "contamination" as an uncomfortable private experience that we are willing to ca