This article addresses the use of exposure therapy for OCD as informed by an acceptance and commitment therapy (ACT) framework. The model on which ACT is based is covered, including its philosophy, basic research, targeted process of change, individual treatment components, and general manual. Specific suggestions for how to prepare, select, set up, and conclude exposure exercises from an ACT perspective are included and illustrated using the case of Monica as an example. Empirical support for this approach is briefly covered.
Acceptance and Commitment Therapy (ACT) is an experiential, contextual approach to psychotherapy that falls within the broad category of cognitive behavior therapies (CBT; Twohig, Woidneck, & Crosby, 2013). This approach is grounded in a philosophy of science known as functional contextualism, based on behavioral theory and research including relational frame theory, with this larger line of work often called contextual behavioral science (Hayes, Levin, Plumb-Vilardaga, Villatte, & Pistorello, 2013). ACT promotes psychological flexibility, which is defined as being able to be in the present moment, just noticing inner experiences, while engaging in actions that are personally important. In order to increase psychological flexibility, ACT targets six core processes of change, including acceptance, cognitive defusion, awareness of the present moment, self as context, values, and committed action. These processes are described in Table 1. Data exist on ACT for OCD alone (see Twohig, Morrison, & Bluett, 2014), but its incorporation with exposure and response prevention (ERP) is new.
