Living a vital life with obsessions
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Living a Vital Life with Obsessions. Jennifer Plumb MA, University Nevada Resno Benjamin Schoendorff MA,MSc, Claude Bernard U n iversity, 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

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Living a Vital Life with Obsessions

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Living a vital life with obsessions

Living a Vital Life with Obsessions

Jennifer Plumb MA, University Nevada Resno

Benjamin Schoendorff MA,MSc, Claude Bernard University, Lyon

3rd ACT World Conference, Enschede, July 2009


An act view of ocd

An ACT view of OCD


Obsessive compulsive disorder

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 and CT

  • OCD has a strong cognitive element

  • Cognitive therapy no more effective than ERP

  • Can CT increase ERP acceptability?


Act and ocd

ACT and OCD

  • Fusion (aka Thought Action Fusion)

  • How we relate to thoughts rather than the nature of thoughts

  • Beware : giving functional importanceto thoughts!


The ocd paradox attempting to control one s thoughts might make them less controlable

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


Rft and ocd

RFT and OCD

  • Disorder of verbal regulation strategies

  • Transformationof stimulus functions

  • Faulty contextual control


Act targets

ACT Targets

  • Context of literality(defusion)

  • Emotional avoidance (acceptance)

  • Broader contextual control (broadening repertoire in presence of avoided stimulus)

  • Goal of Treatment:

    • Personal control over actions guided by values (Values, Commited Action)

    • reducing attempts to control obsessions & related distress (Mindfulness processes)


Some evidence for act with ocd

Some evidence for ACT with OCD


Empirical evidence

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

Evidence for ACT with OCD

Schoendorff et al, 2009

Unpublished Data


Treating ocd with act

Treating OCD with ACT


A context of choice

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

Treating OCD with ACTFunctional Analysis

  • What has worked ?

    • Short term

    • Long term

    • Valued directions

  • Validate the client’s experience


Creative hopelessness playing a new game

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

  • Controlas 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

Treating OCD with ACTDefusion

  • 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

Treating OCD with ACTMindfulness & 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 acceptance1

    Treating OCD with ACTMindfulness & Acceptance

    • First video (exposure)


    Treating ocd with act self as context

    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

    Self-as-Context

    • Second video (Self-as-Context)


    Treating ocd with act values and commited action

    Treating OCD with ACTValues and Commited Action

    • Wider context

      • Decentering from symptoms

      • Increase acceptability

      • Exploring what matters…

        • Moment of peace, posture, etc.


    Treating ocd with act values and commited action1

    Treating OCD with ACTValues and Commited Action

    • 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 action2

    Treating OCD with ACTValues and Commited Action

    • Third Video (choice)


    Act traditional exposure

    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

    Experiential Role-Play


    Workshop feedback

    Workshop feedback

    • Did this workshop meet your expectations?

    • Thanks for filling-in our feedback sheet


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