Acceptance and Commitment Therapy (ACT) for OCD

Cutting Edge Evidence-Based OCD Treatment

ACT Psychologist. Getty Images

Many clients diagnosed with obsessive-compulsive disorder (OCD) find Acceptance and Commitment Therapy (ACT) to be an effective treatment when paired with Exposure and Response Prevention (ERP), the gold standard treatment for OCD. 

ACT is gaining popularity as a “third-wave” form of Cognitive Behavioral Therapy (CBT). There is ​a growing body of research supporting ACT as a viable treatment for anxiety, depression, chronic pain, psychosis, and obsessive compulsive disorder.

ACT is based on contextual behavioral science. It combines traditional behavioral techniques with processes such as mindfulness, cognitive defusion, acceptance, and values clarification. The core concepts, include:

Mindfulness—According to Jon Kabat-Zinn, a well-known proponent and teacher of mindfulness for stress reduction, mindfulness is defined as “paying attention on purpose, in the present moment, and nonjudgmentally, to the unfolding of experience moment to moment.” 

Cognitive defusion—A process of distancing oneself from the content of thoughts, and instead looking at and noticing thoughts as mental processes that come and go.

Acceptance—Allowing oneself to experience the thoughts, feelings, and physical sensations that are present in order to foster continued growth and progress.

Values clarification—A process of identifying and clarifying what gives meaning to a client’s life. Clarifying values assists clients in setting specific behavioral goals.

For example, a client who values being a good parent may identify several specific goals that would lead the client in that direction. Values are freely chosen and need not be justified. 

ACT encourages clients to examine their relationship with their inner experiences (e.g., thoughts, feelings, and physical sensations).

Often, clients’ relationship with their inner experience has become one of struggle, suffering, and battling for control. ACT teaches clients to understand this tendency and how it has kept the client “stuck” and inflexible. Using the techniques and processes described above, an ACT therapist assists clients to become more psychologically flexible and less avoidant.

When clients have OCD, their lives often become constricted as a result of their obsessions and compulsions. For example, a client with contamination OCD may spend hours per day washing and bathing, which limits his or her ability to engage in other valued activities (e.g., work, school, or social relationships). A client with harm avoidance OCD may avoid driving, cooking, or engaging in other important behaviors out of fear that he or she will inadvertently harm others or themselves. Clients often present to therapy feeling helpless, overwhelmed, and disengaged from important aspects of their lives.

ACT and ERP are highly compatible, as both approaches encourage purposeful and meaningful behavior change. When ACT is combined with ERP, clients with OCD are encouraged to identify how the struggle with their unwanted, uncomfortable internal experiences is leading to unnecessary suffering and disengagement with their values.

Clients are assisted in learning how to pursue value-based living in the face of symptoms. From an ACT perspective, the goal of exposure is to learn to confront feared situations in new and more functional ways so that the client can live a more meaningful life. Although a reduction in the frequency and intensity of OCD symptoms is not the direct target of ACT, clients often report a reduction in symptoms in the long term.

If you would like to learn more about ACT or are interested in locating an ACT therapist near you, please visit the website for the Association for Contextual Behavioral Science:

There are many books, research articles, and online resources available.


Twohig, M.P., et al. Exposure therapy for OCD from an acceptance and commitment therapy (ACT) framework. Journal of Obsessive-Compulsive and Related Disorders (2015),

Continue Reading