ACT and ERP for OCD by Stuart Miles

This week I’d like to share this post that was written in 2012…

As I’ve mentioned many times before, exposure and response prevention (ERP) therapy is the treatment of choice for OCD. However, a new acronym has recently made its way into the “OCD tool box.” Basically, ACT (Acceptance and Commitment Therapy) involves mindfulness and being able to accept your actions, as well as exploring your commitment to making changes. Think Serenity Prayer.

In a wonderful seminar at the 2012 IOCDF Conference, Dr. Jonathan Grayson discussed what is seen by many as competing therapies. He argued that the two therapies are really not at odds with one another, and that ACT is actually woven into ERP Therapy. Participating in an exposure involves acceptance. According to Dr. Grayson, the problem occurs when therapists use ACT without ERP.

ACT involves a top-down approach, where the sufferer works on changing his or her relationship with the whole world. While this therapy can certainly complement ERP Therapy, Dr. Grayson prefers starting with ERP Therapy, which is a bottom-up approach that specifically targets OCD. He used the analogy of an alcoholic working on his or her life’s problems while still drinking. It isn’t going to work. You’ve got to get the drinking under control and then you can move forward.

Surely, ACT can help those who suffer from OCD. For example, it can help with the acceptance of uncertainty, which is crucial in the treatment of the disorder. It can motivate sufferers who are engaging in ERP Therapy by helping them focus on their values, and what they want out of their lives. ACT has its place in the treatment of obsessive-compulsive disorder, and may even work as the main treatment for other mental health issues.

But OCD is unique, and the treatment for it is very specific. At this particular talk, and throughout the entire conference, this fact was stressed over and over: Exposure and response prevention (ERP) therapy is the accepted treatment for OCD, and when done correctly, it works. While other therapies may have benefits as well, if you want to rid yourself of OCD’s grip, ERP Therapy is the way to go. And while it’s not easy, I don’t know of anyone who has ever regretted committing themselves fully to it. The payback is huge…..freedom from OCD.

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4 Responses to ACT and ERP for OCD

  1. E says:

    I’ve not tried ACT but I do meditate daily as part of managing my stuff (I’m a list of acronyms haha) I’ve heard of ACT but haven’t taken any trainings yet. Thanks for the info.

  2. Alexander says:

    You know, this is one of the best websites I have ever found dealing with all the topics of OCD. I am so grateful for you to start this blog. Without this site, I might have have spiraled deeper and deeper into depression, but the knowing that there are others out there with OCD and even those without it advocating for us really brings me to tears. I just recently wrote my own blog post about my struggles with OCD and health anxiety. The main emotion I feel is desperation- and I know all of us with OCD share in that desperation. Thank you so much! Your insights might have saved a life or two. Here is a link to my blog post if you want to check it out:

    • Hi Alexander, Thank you so much for your kind comments. It means so much to me to know that my blog has helped you feel less alone, as that has always been one of my main goals – to let those whose lives have been affected by OCD know they are not alone. I just read your blog post. It’s great and really captures the anguish you feel. I wish you all the best as you continue to fight your OCD and hope to hear from you again!

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