OCD and ACT

What is OCD?

OCD stands for obsessive compulsive disorder. It is a mental health issue characterised by recurring, intrusive thoughts (obsessions) and repetitive behaviours or mental acts (compulsions). People with OCD often experience intense anxiety or distress due to their obsessions, and they engage in compulsions to alleviate or reduce the anxiety.

Obsessions are unwanted and intrusive thoughts, images, or urges that occur repeatedly and cause significant distress. Common obsessions include fears of contamination or germs, excessive concerns about symmetry, order, or exactness, intrusive thoughts of violence or harm, and a need for things to be “just right.”

Compulsions, on the other hand, are repetitive behaviours or mental acts that individuals with OCD feel driven to perform in response to their obsessions. These compulsions are often aimed at reducing anxiety or preventing a feared event. Some common examples of compulsions include excessive handwashing or cleaning, checking behaviours (such as repeatedly checking locks or appliances), counting, repeating phrases or prayers, and arranging objects in a specific way.

It’s important to note that OCD can vary in severity and impact different individuals in different ways.

Core symptoms of OCD

OCD can present in many ways and is usually identified by specific themes or patterns of obsessions and compulsions. Some common subtypes include:

• Contamination OCD: This involves obsessions and compulsions related to contamination, germs, or cleanliness.
• Checking OCD: In this subtype, individuals have obsessions related to harm or danger and engage in repetitive checking behaviours to alleviate anxiety.
• Symmetry and ordering OCD: People with this subtype have obsessions about symmetry, order, or exactness, and they perform rituals to achieve a sense of balance or symmetry.
• Hoarding OCD: This involves persistent difficulty discarding or parting with possessions, leading to excessive accumulation and clutter.
• Pure-O OCD: This is characterised by primarily experiencing obsessions without obvious external compulsions. The obsessions are often related to intrusive thoughts, doubts, or taboo or morally unacceptable themes.

OCD commonly co-occurs with other mental health conditions such as depression, anxiety disorders, and other obsessive-compulsive spectrum disorders. These conditions can further complicate the symptoms and treatment of OCD. It can significantly impact a person’s self-esteem. Individuals may feel ashamed or embarrassed by their obsessions and compulsions, leading to a negative self-perception and a desire to hide their symptoms from others.

What can trigger OCD?

The triggers for OCD symptoms can vary from person to person, as the specific obsessions and compulsions experienced in OCD are highly individualised. However, there are some common triggers that can provoke OCD symptoms:

• Environmental triggers: Certain situations, places, or objects can trigger obsessions or compulsions. For example, being in a crowded public space may trigger contamination fears, or seeing something disorganised or asymmetrical might trigger the need for order or symmetry.
• Personal triggers: Personal events or experiences can also act as triggers. These may include traumatic events, significant life changes, or stressful situations. OCD symptoms can be exacerbated during times of increased stress or emotional upheaval.
• Negative emotions: Negative emotions such as anxiety, fear, guilt, or disgust can trigger OCD symptoms. The obsessions and compulsions may serve to temporarily alleviate or manage these emotions.
• Thoughts or images: Certain thoughts, mental images, or intrusive ideas can trigger obsessive thinking in individuals with OCD. These thoughts may be unrelated to any external stimuli and may spontaneously arise in the person’s mind.
• Uncertainty: The presence of uncertainty or doubt can be a trigger for OCD symptoms. Individuals with OCD often seek certainty or reassurance through repetitive behaviours or mental rituals to alleviate the anxiety caused by uncertainty.
• Perfectionism: Perfectionistic tendencies can contribute to OCD symptoms. The fear of making mistakes or a strong desire for things to be “just right” can trigger obsessions and compulsions.

It’s important to note that while these triggers can provoke OCD symptoms, they are not the root cause of the disorder. OCD is a complex condition with biological, genetic, and environmental factors contributing to its development. Understanding and identifying triggers can be helpful in managing OCD symptoms, but comprehensive treatment usually involves addressing the underlying mechanisms and employing therapeutic strategies like exposure and response prevention (ERP) to break the cycle of obsessions and compulsions.

How does OCD affect a person’s daily life and relationships?

OCD can significantly impact a person’s daily life and relationships in several ways:

• Time-consuming rituals: Individuals with OCD often spend a significant amount of time engaging in their compulsions or performing rituals. This can interfere with daily activities, work, and relationships. For example, excessive handwashing or checking behaviours can consume hours each day, making it difficult to complete tasks or maintain a normal routine.
• Interference with daily functioning: OCD can interfere with various aspects of daily life, such as work or school performance, personal hygiene, and social activities. The distress caused by obsessions and the need to perform compulsions can make it challenging to focus, concentrate, and engage in typical activities.
• Strain on relationships: OCD can place strain on relationships with family members, friends, and romantic partners. The obsessions and compulsions may be difficult for others to understand, leading to frustration, impatience, or conflict. Loved ones may also feel burdened or overwhelmed by the need to accommodate or support the person with OCD.
• Social withdrawal: Some individuals with OCD may withdraw from social activities or avoid certain situations due to their obsessions or fear of triggering anxiety. This can lead to isolation, reduced social support, and limitations on participating in enjoyable activities or events.
• Emotional distress: OCD can cause significant emotional distress, including anxiety, guilt, shame, and frustration. The obsessions and compulsions can create a cycle of anxiety, as the relief provided by engaging in compulsions is often temporary and followed by a return of obsessions.

Many individuals with OCD have insight into the unhelpfulness and excessiveness of their obsessions and compulsions. However, even with this awareness, they find it challenging to resist the urge to perform the compulsions due to the anxiety and distress associated with their obsessions. It’s important to remember that OCD is a treatable condition, and with appropriate therapy and support, individuals can learn to manage their symptoms and improve their quality of life.

How can ACT therapy support someone with OCD?

Acceptance and commitment therapy (ACT) can be a helpful approach in supporting individuals with OCD. While traditional cognitive-behavioural therapies like exposure and response prevention (ERP) are often the first-line treatment for OCD, ACT can be a complementary approach. Here’s how ACT therapy can support someone with OCD:

• Acceptance: ACT encourages individuals to accept their obsessions, intrusive thoughts, and uncomfortable emotions without attempting to suppress or control them. Rather than struggling against or avoiding these experiences, ACT emphasises the importance of accepting them as a natural part of the human experience.
• Defusion: Defusion techniques in ACT help individuals distance themselves from their thoughts and see them as mere mental events rather than literal truths. This can be particularly useful for individuals with OCD who often attach excessive importance or meaning to their intrusive thoughts.
• Mindfulness: Mindfulness involves bringing attention to the present moment and observing thoughts, emotions, and sensations without judgement. Mindfulness can help individuals with OCD develop greater awareness and non-reactivity to their obsessive thoughts, reducing their impact and influence.
• Values clarification: The process of value clarification and committed action helps individuals with OCD shift their focus from symptom reduction as the primary goal to pursuing a meaningful and fulfilling life. By focusing on their values, individuals can engage in activities that are personally significant, even in the presence of OCD symptoms.
• Psychological flexibility: ACT aims to enhance psychological flexibility, which involves being open to experiences, adapting to changing circumstances, and taking valued actions despite the presence of difficult thoughts or emotions. This helps individuals with OCD better cope with obsessions, engage in valued behaviours, and reduce the impact of OCD on their lives.

As mentioned earlier, ACT is often used in conjunction with other evidence-based treatments for OCD, such as ERP and medication. The specific treatment approach should be tailored to the individual’s needs and preferences. It’s recommended to work with a qualified mental health professional experienced in ACT and OCD to receive appropriate guidance and support.

Please visit our psychological therapy page for more information and to see our ACT trained specialists. To learn more about ACT therapy specifically we have a fantastic schedule of workshops covering a range of professional specialisms.