Re: OCD-Typical ERP vs ACT

[Guest guest]

I've been waiting for someone to answer this post but maybe no one else noticed it? I also suffer from so-called pure-o OCD my main compulsions here being mental reviewing which I can see is unhelpful and I am doing much better now just asking myself if this is actually helping me live the life I want to lead. However, I have been treated (pretty successfully) with CBT, mostly cognitive but also behavioural in that I had to learn to stop avoiding situations and people liable to trigger my anxiety. I wonder how I would have done with ACT from the start.Would I have been able to engage with it, would it have involved the same level of exposure maybe as CBT? Before anyone suggests that my CBT involved changing thoughts I'd like to point out that exactly the same stance was adopted as in the ACT books I've read namely that the problem with OCD arises

from trying to control anxiety-provoking intrusive thoughts. Wegner and all that!

I don't think standard ERP uses relaxation though. It is more about facing your fears and not trying to push anxiety away but just sitting it out till it dies down naturally as it generally will. Relaxing while doing exposures sounds a bit more like a control strategy to me.

How would ACT specialists treat OCD? Look at how it is spoiling life as a starting point? And after that?

I know many people with severe OCD who are very aware that their fears are not realistic and that they are ruining their lives trying to control their anxiety but funnily (?) enough many of my OCD friends cling on to their safety behaviours while very concerned to help others deal with their obsessions. Most of them are excessively caring people. It is very sad.

S.

S.

Subject: OCD-Typical ERP vs ACTTo: ACT_for_the_Public Date: Sunday, 26 December, 2010, 0:53

I have GOOYMIYL and The Happiness Trap. I am also starting ERP with a CBT therapist for my OCD ("pure obsessional" type) but he incoporates meditation during the same session, constantly switching between exposure and meditation which I think is unconventional and I think it is actually hurting the habituation process. He was also not familiar with ACT until I told him about it.From what I can tell, ACT incorporates exposure and response prevention but it is not taken to the extent that some therapists take it for ERP. For example, the "The OCD Workbook" by Hyman and the "OCDONLINE" website by Dr. on are very aggressive in treating OCD with ERP. The patient creates fear hierarchies for exposure and even amplifies their worst fear using an imaginal script until they basically "get used to it" and are able to move on with their life. These are considered to be 2 of the best therapists for OCD in my support groups. I also noticed the

third edition of "The OCD Workbook" by Hyman is now incorporating ACT as well in one of his chapters, but I do not have this copy yet.I wanted to see if there are any opinions from people that have been through ERP for OCD and/or have used ACT for OCD. After doing the "Tin Can Monster" exercise, it was easier because of the methodical breaking apart of my "worst fear" and I actually prefer it because of this aspect. But it doesn't explicitly use a numerical anxiety rating system where the patient stays in the worst case situation a certain amount of time until the anxiety level drops; to say half of what it was in the beginning of the exposure. Subsequent ERP sessions would further the exposure and habituation process until the numerical anxiety level continues to drop. ACT also does not appear to amplify a patient's worst fear the way that say on does for OCD during exposure. I think habituation to a patient's worst fear using

ACT still happens but it may take longer since it is not as aggressive? At the core of willingness of ACT, it appears to be the same as standard ERP for OCD and does not employ any detrimental "neutralizing" techniques. Any thoughts?Will Haynes

[Guest guest]

I don't know if this would be helpful, but I thought I would share this article with you. , Ph.D. writes about a randomized controlled trial in which ACT without ERP is compared to Progressive Relaxation Training for the treatment of OCD. Surprisingly, ACT without ERP did very well! As Dr. wrote, "Although not directly compared, reductions in OCD were similar to those indicated in a review of ERP treatment for OCD."Here's the link:http://www.scientificmindfulness.com/2010/10/rct-of-acceptance-and-commitment.htmlSignatureIf you live in New York City and are interested in joining or forming an ACT Study Group,

please contact me. C.

Subject: OCD-Typical ERP vs ACTTo: ACT_for_the_Public Date: Sunday, 26 December, 2010, 0:53

I have GOOYMIYL and The Happiness Trap. I am also starting ERP with a CBT therapist for my OCD ("pure obsessional" type) but he incoporates meditation during the same session, constantly switching between exposure and meditation which I think is unconventional and I think it is actually hurting the habituation process. He was also not familiar with ACT until I told him about it.From what I can tell, ACT incorporates exposure and response prevention but it is not taken to the extent that some therapists take it for ERP. For example, the "The OCD Workbook" by Hyman and the "OCDONLINE" website by Dr. on are very aggressive in treating OCD with ERP. The patient creates fear hierarchies for exposure and even amplifies their worst fear using an imaginal script until they basically "get used to it" and are able to move on with their life. These are considered to be 2 of the best therapists for OCD in my support groups. I also noticed the

third edition of "The OCD Workbook" by Hyman is now incorporating ACT as well in one of his chapters, but I do not have this copy yet.I wanted to see if there are any opinions from people that have been through ERP for OCD and/or have used ACT for OCD. After doing the "Tin Can Monster" exercise, it was easier because of the methodical breaking apart of my "worst fear" and I actually prefer it because of this aspect. But it doesn't explicitly use a numerical anxiety rating system where the patient stays in the worst case situation a certain amount of time until the anxiety level drops; to say half of what it was in the beginning of the exposure. Subsequent ERP sessions would further the exposure and habituation process until the numerical anxiety level continues to drop. ACT also does not appear to amplify a patient's worst fear the way that say on does for OCD during exposure. I think habituation to a patient's worst fear using

ACT still happens but it may take longer since it is not as aggressive? At the core of willingness of ACT, it appears to be the same as standard ERP for OCD and does not employ any detrimental "neutralizing" techniques. Any thoughts?Will Haynes

[Guest guest]

Thanks very much for sending this. I have heard Twohig speak and have great respect for him, and value his work on treating trich with habit reversal and ACT.

Funnily enough he describes my experience of CBT very well in the following passage:

"Instead of ERP, ACT treatment focused on typical ACT processes. Participants learned to notice how attempts at controlling obsessions made them worse over time, respond to obsessions more flexibly, and make behavioral commitment to things that were important to them. The behavioral commitments may resemble in vivo or real-world exposure exercises often found in ERP treatments. However, emphasis was placed less on deliberate exposure as in traditional ERP. Instead, the emphasis was placed on moving towards something important and responding to any distress that showed up."

No specific ACT terminology was used by my CBT therapist however!

S.

Subject: OCD-Typical ERP vs ACTTo: ACT_for_the_Public Date: Sunday, 26 December, 2010, 0:53

I have GOOYMIYL and The Happiness Trap. I am also starting ERP with a CBT therapist for my OCD ("pure obsessional" type) but he incoporates meditation during the same session, constantly switching between exposure and meditation which I think is unconventional and I think it is actually hurting the habituation process. He was also not familiar with ACT until I told him about it.From what I can tell, ACT incorporates exposure and response prevention but it is not taken to the extent that some therapists take it for ERP. For example, the "The OCD Workbook" by Hyman and the "OCDONLINE" website by Dr. on are very aggressive in treating OCD with ERP. The patient creates fear hierarchies for exposure and even amplifies their worst fear using an imaginal script until they basically "get used to it" and are able to move on with their life. These are considered to be 2 of the best therapists for OCD in my support groups. I also noticed the

third edition of "The OCD Workbook" by Hyman is now incorporating ACT as well in one of his chapters, but I do not have this copy yet.I wanted to see if there are any opinions from people that have been through ERP for OCD and/or have used ACT for OCD. After doing the "Tin Can Monster" exercise, it was easier because of the methodical breaking apart of my "worst fear" and I actually prefer it because of this aspect. But it doesn't explicitly use a numerical anxiety rating system where the patient stays in the worst case situation a certain amount of time until the anxiety level drops; to say half of what it was in the beginning of the exposure. Subsequent ERP sessions would further the exposure and habituation process until the numerical anxiety level continues to drop. ACT also does not appear to amplify a patient's worst fear the way that say on does for OCD during exposure. I think habituation to a patient's worst fear using

ACT still happens but it may take longer since it is not as aggressive? At the core of willingness of ACT, it appears to be the same as standard ERP for OCD and does not employ any detrimental "neutralizing" techniques. Any thoughts?Will Haynes

[Guest guest]

I also suffer from Pure O and for me the only things that have worked is accepting and different ACT exercises. It really depends on the thought. I have about 3 Pure O themes. The "Milk, Milk, Milk" exercise works for the most disturbing one. I think because I can't focus on it to much and saying the theme over and over again is enough. That did take time to work though. I still have those thoughts of course but they don't take me over the edge like they use to. Now they are noise in the background(most days). The two other themes have responded well to "I noticed I'm having the thought........................" or imagining something funny with the theme. IE. That there is something contaminating my water I will imagine that there is Runts (a type of candy) floating around in my water. I hardly ever even have that thought anymore but when I do it's like a leaf on a stream. I watch it go right on by.

M.

[Guest guest]

> It is very difficult to convince others though that that is possible when the

obsessions have been there for years and they simply don't accept that there is

no truth in these fears. Most obsessions at least have a grain of truth in them!

>

>  

> S.

I'll have to disagree with you there. Pure " O " thoughts are usually irrational

thoughts with no grain of truth in them. Like my water, I absolutely know there

is nothing wrong with my water but I'll still have the thought that there is

something wrong with it and that thought will give me anxious feelings even

though I know rationally that there is not an ounce of truth to that. Some

people ruminate over and over than they are going to kill or have killed

someone. There's no truth in that and if there is it's not Pure " O " they are

dealing with. The thoughts are usually based on things that a person holds

dear to them, fears or revolves around a certain theme like control or religion.

[Guest guest]

>

> Hi ,

>  

> One of my " Pure-O " thoughts did  come true and upset me for some time. I

think you are referring to a very limited number of examples if you say they

never come true. I am not talking about fear of committing a murder (but what if

I don't pay attention when driving and kill someone) but of other types of

harm/ethical obsessions eg feeling responsble for preventing harm coming to

others, fears of not being perfectly honest etc..Actually more than one has come

true.

>  

> I don't think it is ever possible to say there is 100% certainty something

will not happen and indeed it is very easy for this to become a form of

compulsion or avoidance. Wouldn't you agree?

>  

> S.

>  

>

I'll answer the second part first because it's easier for me. Nothing in

life is 100% From what I understand from personal experience and research is

compulsions and/or avoidance doesn't come from the fear of the pure " o " from

happening but to escape the anxiety that comes from the obsession.

Now to the first part. There is always the exception. Typically though they are

just irrational thoughts with no truth to them. Thoughts that everyone has but

only some obsessive over and have a hard time switching off. Like I said there

are exceptions but I'm really talking about the most common forms of Pure " o "

though which are:

- intrusive thoughts or mental images of killing ones spouse, parent, child, or

self

- recurrent fear of molesting a child

- repeatedly worrying that one has or will physically assault another person or

run over a pedestrian while driving a car

- excessive fears that one might accidentally cause harm to other people (i.e.,

burning down the house, unknowingly poisoning others, inadvertantly exposing

others to toxic chemicals)

- repetitive thoughts that one has said or written something inappropriate, such

as swearing at ones employer or writing hate-filled letters to a friend

- recurrent fears that one might be a homosexual, when in fact he or she is not

(sometimes called " gay ocd " or " HOCD " )

- intrusive thoughts or mental images that one considers to be sacrilegious or

blasphemous, such as wanting to worship Satan or have sex with Christ.

- repeatedly thinking about benign somatic issues such as breathing, swallowing,

blinking, eye " floaters " , ringing in the ears, digestion, etc.

I think ACT is wonderful for these typical types of pure " O " because who want to

expose themselves to these things. IME it causes unneeded stress. I guess I do

expose myself to my obsessions just living everyday life but then I use ACT to

move me forward when I feel like my obsessions might be holding me back.

heather.