Treating OCD with ACT
A practical approach to exposure and values-based treatment
Obsessive-compulsive disorder (OCD) is one of the more entrenched presentations clinicians see, and even well-trained therapists can find themselves stuck. Some clients understand exposure intellectually but resist it, compulsions can mutate faster than a protocol can keep up, and obsessions can be so taboo that neither client nor therapist quite knows how to name them.
This workshop, presented by Professor Michael Twohig, one of the most published researchers in ACT worldwide, takes acceptance and commitment therapy (ACT) and applies it directly to OCD. You will get a working model for conceptualisation and a set of exposure skills you can use with your next OCD client, not just a theoretical overview of a well-known treatment.
Background to the workshop
Working with OCD asks a lot of a therapist. Clients often disengage partway through treatment, and when that happens it rarely comes down to a lack of skill or understanding. Motivation and the willingness to sit with distress are usually the harder part. Some presentations are especially difficult to talk about openly. Sexual and taboo obsessions, such as unwanted thoughts about being a paedophile, come up often in clinical practice but are rarely given proper airtime in standard training. Therapists are left managing their own discomfort alongside their client’s, often with little guidance on how to do either well.
An ACT-based approach to OCD works directly with this territory. Compulsions, reassurance seeking and avoidance are understood functionally, as behaviour maintained by the short-term relief it brings, which is exactly what keeps the cycle going. Rather than treating exposure as a technique to be delivered, it builds treatment around psychological flexibility, helping clients respond differently to intrusive thoughts, clarify what matters to them, and move towards valued action even when discomfort is present. This shifts the focus from managing symptoms to building a workable life alongside them, and gives therapists a steadier framework for staying present when the content gets difficult. For behaviour analysts, it offers a way of working with private events such as obsessions and urges that stays grounded in behavioural principles.
What you will gain from this workshop
- An understanding of how ACT compares with, and can be combined with, more traditional cognitive and exposure-based approaches to OCD, including the evidence for combining ACT with exposure
- A clear framework for conceptualising OCD through the six core ACT processes, including self-as-context and present-moment awareness, and how they map onto obsessions, compulsions and avoidance, and the role of negative reinforcement in keeping compulsions going
- Practical strategies for building creative hopelessness, working with control as the problem rather than the solution, and strengthening acceptance and defusion with OCD-specific content
- An understanding of how cultural context shapes the way OCD presents and is expressed, and what that means for assessment and treatment
- Skills for collecting the right stimuli to build effective, individualised exposures, and for linking each exposure explicitly to client values so it functions as committed action rather than a technique performed in isolation
- Guidance on designing and running exposures for a full range of presentations, including contamination, harm, checking, scrupulosity, relationship OCD and sexual or taboo obsessions
- Approaches for delivering exposure both in session and as structured at-home practice, and for keeping exposure going between sessions
- Ways to track progress meaningfully, combining psychological flexibility indicators and functional outcomes with standard OCD symptom measures such as the Y-BOCS
- Approaches for troubleshooting the clinical challenges that derail treatment: poor motivation, strong fusion with obsessional beliefs, family accommodation (how other people’s responses can reinforce avoidance), perfectionism in therapy and dropout
About this workshop
The workshop moves quickly through the underlying theory and evidence base so that the bulk of the two sessions can be spent on application: working through a real clinical case, practising conceptualisation and exposure design, and problem-solving the clinical snags that come up in your own caseload. Expect short teaching segments, case-based discussion and practical exercises rather than lecture-heavy delivery. For anyone wanting to brush up on OCD prevalence, presentation and diagnostic detail beforehand, optional pre-reading will be made available, but the workshop itself assumes you are already working with OCD clients and are ready to go straight into applying the model.
It is led by Professor Michael P. Twohig, Ph.D., a licensed clinical psychologist and Professor at Utah State University, where he co-directs the ACT Research Group. He is one of the most published researchers in ACT worldwide, with a body of work concentrated specifically on ACT for OCD and related disorders, making this workshop as close as you will get to learning the approach from the person shaping the evidence for it. Alongside his ACT and OCD research, he has published behaviour-analytic work in journals including the Journal of Applied Behavior Analysis, the Journal of the Experimental Analysis of Behavior and Behavior Analysis in Practice.
Who will benefit from this workshop?
This workshop is for psychologists, psychotherapists, counsellors, behaviour analysts (BCBAs and BCaBAs) and other mental health professionals who already have some familiarity with OCD and have worked with at least a small number of OCD clients. It is not designed as an introduction to OCD or to ACT itself. Participants should come with a working knowledge of both, ready to deepen and apply their skills rather than learn the basics from scratch. Behaviour analysts working with obsessive-compulsive presentations within their scope of competence will find a functional, values-based approach to exposure that builds directly on their work with avoidance and reinforcement.
Feedback from Mike’s previous workshops
“Mike was fantastic, thank you”
-Sarah Baxter, Psychiatric Nurse
“I got so much from this training. I really respect and respond well to his clinical evidence based approach. Excellent stuff.”
-Ange South, Senior Lived Experience Practitioner, NHS England
“He [Mike] was superb in delivering a great workshop… I started using the knowledge very soon after with clients”
-R.P.
Continuing education credits are available both for attending the live workshop and for completing the workshop by viewing the recording of the live event.
APA psychologists: This program is sponsored by Contextual Consulting and is approved for 6 CE credits for psychologists. Contextual Consulting is approved by the American Psychological Association to sponsor continuing education for psychologists. Contextual Consulting maintains responsibility for this program and its content.
Nationally certified counselors: This workshop is available for 6 credit hours. Contextual Consulting Ltd. has been approved by NBCC as an Approved Continuing Education Provider, ACEP No. 7578.
New York psychologists: This program is sponsored by Contextual Consulting and is approved for 4 CE credits for psychologists. Contextual Consulting is recognized by the New York State Education Department’s State Board for Psychology as an approved provider of continuing education for licensed psychologists #PSY-0316.
If you have disability and require adjustments or accommodation, please email us at admin@contextualconsulting.co.uk to discuss your needs and we will do our best to help you.
Booking cancellation
The registration fee will be refunded minus a administration charge if cancellations are received at least two weeks before the workshop date.
Cancellations within two weeks of the event date are charged the full registration fee, other than in exceptional circumstances that can be verified.
Event cancellation
In the event of cancellation of the course outside of our control we will not be held accountable for travel and/or accommodation costs incurred. However, the workshop fees will be refunded.
All workshops will be subject to minimum delegate numbers being met; in the event that a workshop should be cancelled delegates will be given no less than 2 months’ notice.
Replacing delegates
If a delegate is unable to attend and a replacement is nominated there may be a charge depending on the individual circumstances, this will be advised at the time. Please contact the us to request a replacement of delegates at least a week before the workshop date.
Contextual Consulting is committed to the identification and resolution of potential conflicts of interest in the planning, promotion, delivery, and evaluation of continuing education. Potential conflicts of interest occur when an individual assumes a professional role in the planning, promotion, delivery, or evaluation of continuing education where personal, professional, legal, financial, or other interests could reasonably be expected to impair their objectivity, competence, or effectiveness.
There was no commercial support for this event. None of the planners or presenters for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.
References
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Öst, L.-G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive–compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40, 156–169. https://doi.org/10.1016/j.cpr.2015.06.003
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Twohig, M. P., Abramowitz, J. S., Bluett, E. J., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., Reuman, L., & Smith, B. M. (2015). Exposure therapy for OCD from an acceptance and commitment therapy (ACT) framework. Journal of Obsessive-Compulsive and Related Disorders, 6, 167–173. https://doi.org/10.1016/j.jocrd.2014.12.007
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Twohig, M. P., Abramowitz, J. S., Smith, B. M., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., Bluett, E. J., Reuman, L., Blakey, S. M., & Ledermann, T. (2018). Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial. Behaviour Research and Therapy, 108, 1–9. https://doi.org/10.1016/j.brat.2018.06.005
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Twohig, M. P., Capel, L. K., & Levin, M. E. (2024). A review of research on acceptance and commitment therapy for anxiety and obsessive-compulsive and related disorders. Psychiatric Clinics of North America, 47(4), 711–722. https://doi.org/10.1016/j.psc.2024.04.013
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Twohig, M. P., Hayes, S. C., Plumb, J. C., Pruitt, L. D., Collins, A. B., Hazlett-Stevens, H., & Woidneck, M. R. (2010). A randomized clinical trial of acceptance and commitment therapy versus progressive relaxation training for obsessive-compulsive disorder. Journal of Consulting and Clinical Psychology, 78(5), 705–716. https://doi.org/10.1037/a0020508
Recommended reading
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Krafft, J., Petersen, J. M., & Twohig, M. P. (2021). Acceptance and commitment therapy for obsessive-compulsive and related disorders. In E. A. Storch, J. S. Abramowitz, & D. McKay (Eds.), Complexities in obsessive compulsive and related disorders (pp. 352–369). Oxford University Press.
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Mazza, M. T. (2020). The ACT workbook for OCD: Mindfulness, acceptance, and exposure skills to live well with obsessive-compulsive disorder. New Harbinger Publications.
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Twohig, M. P., Levin, M. E., & Ong, C. W. (2020). ACT in steps: A transdiagnostic manual for learning acceptance and commitment therapy. Oxford University Press.
By the end of this workshop, participants will be able to:
- Conceptualise OCD presentations, including sexual and taboo obsessions, using the six core processes of the ACT model, including the function of compulsions and avoidance in maintaining the problem
- Design and deliver exposure exercises tailored to specific OCD symptom presentations, linking each exposure explicitly to client values so that approach behaviour contacts valued reinforcement
- Apply ACT-consistent strategies, including defusion, acceptance and self-as-context, to address common clinical obstacles such as fusion with obsessional beliefs, rule-governed avoidance and poor motivation
- Evaluate treatment progress using psychological flexibility indicators and functional outcomes alongside standard OCD outcome measures