From the Guidelines
Acceptance and Commitment Therapy (ACT) is a recommended treatment approach for compulsive behaviors, as it helps individuals change their relationship with unwanted thoughts and urges, rather than trying to eliminate them, and has been shown to be effective in reducing symptoms of OCD and improving quality of life 1.
Overview of ACT
ACT focuses on accepting uncomfortable feelings and thoughts while committing to behavior changes aligned with personal values. The therapy typically involves six core processes:
- acceptance of unwanted experiences
- cognitive defusion (separating oneself from thoughts)
- being present
- self-as-context (observing thoughts without attachment)
- clarifying values
- committed action toward those values. In treating compulsive behaviors like OCD, ACT helps patients recognize that fighting against urges often strengthens them, while mindfully acknowledging these experiences without judgment reduces their power.
Treatment Regimen
A typical ACT treatment regimen involves weekly 50-minute sessions over 8-16 weeks, with daily home practice of mindfulness exercises (10-15 minutes) and gradual exposure to triggering situations while practicing acceptance skills. Unlike traditional cognitive approaches that challenge thought content, ACT works by changing how people relate to their thoughts, helping them pursue meaningful activities even when uncomfortable urges are present. This approach is effective because it addresses the paradoxical nature of compulsions, where attempts to control unwanted experiences often intensify them, as noted in the context of OCD treatment 1.
Effectiveness of ACT
While ERP and CBT are established treatments for OCD, ACT offers a unique approach that can be particularly helpful for individuals who struggle with the traditional exposure and response prevention methods. The use of ACT as a treatment for compulsive behaviors is supported by its ability to improve patient outcomes and reduce symptoms, making it a valuable option for clinicians to consider 1.
From the Research
Overview of Acceptance and Commitment Therapy (ACT)
- Acceptance and Commitment Therapy (ACT) is a modern form of cognitive behavioral therapy based on a distinct philosophy and basic science of cognition 2.
- ACT is focused on increasing psychological flexibility, which is its theorized process of change 2, 3.
Application of ACT for Compulsive Behaviors
- ACT has been used to treat obsessive-compulsive disorder (OCD), including scrupulosity-related OCD 4.
- It has also been applied to treat problematic internet pornography viewing, with studies showing significant reductions in viewing and improvements in quality of life 5.
- Additionally, ACT has been used to treat problematic pornography use, with meta-analyses showing large effect sizes for reducing symptoms 6.
Key Components of ACT
- ACT involves exposure and response prevention (ERP) from an ACT perspective, which can be an option for individuals with OCD who may be reluctant to engage in traditional forms of ERP 4.
- The therapy focuses on processes such as thought-action fusion, thought control, and psychological flexibility 5, 3.
- Increases in psychological flexibility are associated with positive treatment outcomes in ACT 2, 5.
Efficacy of ACT
- Studies have shown that ACT is more efficacious than waitlist conditions and treatment-as-usual, with equivalent effects to traditional cognitive behavioral therapy for depression and anxiety disorders 2.
- Meta-analyses have also supported the efficacy of ACT in treating problematic pornography use and related problems 6.
- While the literature is not yet mature, the available evidence suggests that ACT works through different processes than other active treatments, including traditional Cognitive-Behavior Therapy (CBT) 3.