Living a Vital Life with Obsessions Jennifer Plumb MA, University Nevada Resno Benjamin Schoendorff MA,MSc, Claude Bernard University, Lyon 3 rd ACT World Conference, Enschede, July 2009

An ACT view of OCD

Obsessive-Compulsive Disorder 2.6% of population ERP 60 to 85% effective 25% refusals + 3 to 12% drop out Private compulsions resistant to ERP

OCD and CT OCD has a strong cognitive element Cognitive therapy no more effective than ERP Can CT increase ERP acceptability?

ACT and OCD Fusion (aka Thought Action Fusion) How we relate to thoughts rather than the nature of thoughts Beware : giving functional importance to thoughts!

The OCD paradox: Attempting to control one’s thoughts might make them less controlable

RFT and OCD Disorder of verbal regulation strategies Transformation of stimulus functions Faulty contextual control

ACT Targets Context of literality (defusion) Emotional avoidance (acceptance) Broader contextual control (broadening repertoire in presence of avoided stimulus) Goal of Treatment: 1. Personal control over actions guided by values (Values, Commited Action) 2.reducing attempts to control obsessions & related distress (Mindfulness processes)

Some evidence for ACT with OCD

Empirical evidence Twohig et al (2009): RCT of ACT and PRT (N = 80) ACT – more tx responders, less drop out, cont’d improvement at 3 mo. fu Clinically sig. decrease in YBOCS (many <9) ACT processes change before OCD symptoms Successful tx of primary obsessionals & hoarding Schoendorff et al. prelim. data (non RCT pilot - group ACT w/tx resistant clients): Y-Bocs at 1year fu (-29,86%) Tx acceptability (high 4/5)

Evidence for ACT with OCD Schoendorff et al, 2009 Unpublished Data

Treating OCD with ACT

A context of Choice OCD means no choice If you could choose between : a life without your obsessions and no valued action And A life with obsessions and valued action?

Treating OCD with ACT Functional Analysis What has worked ? Short term Long term Valued directions Validate the client’s experience

Creative Hopelessness & Playing a New Game Obsession  Kid in a candy store Helping client understand behavioral principles Create a functional class of behavior: Managing/fixing/reducing obsessions & experiences Control as the problem What we can control (compulsions & overt behavior) and cannot control (obsessions & distress) Goal for treatment : Playing a new game - vitality

Treating OCD with ACT Defusion Strategies for Defusion The way the mind works (Savannah = now) Programming (1,2,3) – from where? Physicalising thoughts Metaphors (thoughts  salespeople) Mental Polarity: No peace at level of content Beware: invalidation!

Treating OCD with ACT Mindfulness & Acceptance Experientially broadening repertoire Why? Awareness leads to increased choice Mindfulness & Acceptance Strategies : ‘Breathing in’ sensations and thoughts Shifting attention (private exp to sounds, sights, smells, etc.)

Treating OCD with ACT Mindfulness & Acceptance First video (exposure)

Treating OCD with ACT Self-as-Context An experiential base of security Strategies Introducing SAC in mindfulness Chess board metaphor, Observer exercise Passengers on bus Explore ineffective self-rules (usually fused values) to free up alternatives Concretize: Write/draw on cards

Self-as-Context Second video (Self-as-Context)

Treating OCD with ACT Values and Commited Action Wider context Decentering from symptoms Increase acceptability Exploring what matters… Moment of peace, posture, etc.

Values and Action Strategies: If no OCD what would you do? Trying on a value Reducing compulsions = opportunity to practice acceptance Non-OCD related committed actions Treating OCD with ACT Values and Commited Action

Third Video (choice)

ACT & Traditional Exposure Nothing in the model that says not possible Goal: Flexibility of responding During: broadening attention Why? In service of values Not directly linked, but as a class of behavior Doing what YOU choose rather than what your obsessions say is possible Why do things more intense than real life? Tiger Woods – Practices in rain & snow

Experiential Role-Play

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