As I, and many others, have mentioned numerous times before, exposure and response prevention (ERP) therapy is the evidence-based psychological treatment of choice for obsessive-compulsive disorder. However, over the years there is another acronym that has made its way into some “OCD tool boxes.” I am talking about ACT (Acceptance and Commitment Therapy), which involves mindfulness and the acceptance of our actions. It also delves into our commitment to making changes. Think Serenity Prayer.
In a wonderful seminar at the International OCD Conference back in 2012, I had the privilege of hearing Dr. Jonathan Grayson discuss ERP and ACT, which many people see as competing therapies. Dr. Grayson argued that the two therapies are really not at odds with one another at all, and ACT is actually woven into ERP therapy. Participating in an exposure involves acceptance. According to Dr. Grayson, the problem occurs when therapists choose to use ACT without ERP.
ACT involves the use of a top-down approach, meaning it starts with the big picture and then breaks it down. The person with obsessive-compulsive disorder concentrates on changing his or her relationship with the whole world. While this therapy can certainly complement ERP therapy, Dr. Grayson prefers starting with ERP, which uses a bottom-up approach. This means there is a progression from addressing individual elements (OCD for example), to tending to the whole person. At the conference, Dr. Grayson used the analogy of an alcoholic working on his or her life’s problems while still drinking. It just is not going to work. You’ve got to get the disease of alcoholism under control and then you can hopefully move forward in other areas of your life.
So there is no arguing here that ACT can help those who are dealing with OCD. Indeed this therapy can be extremely helpful for those who struggle with the acceptance of uncertainty- a huge issue for those with OCD. This acceptance is crucial for the successful treatment of the disorder. ACT can also motivate people with OCD who are engaging in ERP Therapy by helping them focus on their values, and what they really want out of their lives. ACT absolutely has its place in the treatment of obsessive-compulsive disorder, and might even work as the main treatment for other mental health issues.
But obsessive-compulsive disorder is unique, and the treatment for it is very specific. At this particular talk, and throughout the entire conference as well as subsequent conferences I’ve attended, one fact in particular is always stressed over and over: Exposure and response prevention therapy is the evidence-based treatment for OCD, and when done correctly, it works. While other therapies might have potential benefits as well, if you want to rid yourself of OCD’s grip, ERP Therapy is the way to go. If you are seeing a therapist or other health-care provider who tells you differently, then you need to find a professional who is an expert in treating OCD. He or she will use ERP therapy, and you will be on your way to beating OCD and reclaiming your life.
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