OCD & Acceptance and Commitment Therapy (ACT)

Obsessive-Compulsive Disorder (OCD) is not simply about “worrying too much” or being overly organized. OCD involves intrusive, unwanted thoughts (obsessions) that create distress, along with repetitive behaviors or mental rituals (compulsions) performed to reduce anxiety. While compulsions may provide temporary relief, they often reinforce the cycle of fear and avoidance over time.

Acceptance and Commitment Therapy (ACT) is an evidence-based therapeutic approach that can be particularly helpful in treating OCD. Rather than focusing on eliminating intrusive thoughts, ACT helps individuals change their relationship to those thoughts.

Understanding Intrusive Thoughts

One of the core principles of ACT is that thoughts are not the same as facts. In OCD, intrusive thoughts can feel urgent, dangerous, or morally significant. ACT teaches cognitive “defusion” — the skill of stepping back and noticing thoughts as mental events rather than truths that require action.

Instead of asking:
“Is this thought true?”
ACT invites:
“What happens if I simply notice this thought without engaging with it?”

This shift reduces the power and urgency of obsessive thinking.

Acceptance Instead of Struggle

Many individuals with OCD spend enormous energy trying to suppress, neutralize, or control intrusive thoughts. ACT encourages acceptance — not agreement with the thought, but willingness to experience discomfort without performing compulsions.

Paradoxically, when we stop fighting intrusive thoughts, they often lose intensity over time.

Values-Based Living

A central component of ACT is identifying personal values — what truly matters in one’s life. OCD often narrows life around avoidance and ritual. ACT helps individuals reconnect with:

• Relationships
  
  

• Meaningful work
  
  

• Creativity
  
  

• Personal growth
  
  

• Integrity
  
  

Rather than organizing life around fear reduction, ACT supports moving toward valued living, even in the presence of uncertainty.

Psychological Flexibility

ACT aims to build psychological flexibility — the ability to experience thoughts and emotions without being controlled by them. In OCD, flexibility allows a person to:

• Notice intrusive thoughts
  
  

• Allow anxiety to rise and fall naturally
  
  

• Resist compulsive behaviors
  
  

• Choose actions aligned with values rather than fear
  
  

ACT and OCD Treatment

ACT is often used alongside Exposure and Response Prevention (ERP), the gold standard behavioral treatment for OCD. While ERP focuses on reducing compulsive behaviors through exposure to feared stimuli, ACT strengthens the ability to tolerate discomfort and commit to meaningful action.

Together, these approaches help individuals develop a different relationship with intrusive thoughts — one based on awareness, flexibility, and values rather than avoidance and control.