The Importance of Acceptance in Dealing with Obsessive-Compulsive Disorder

People with OCD are often plagued with a wide variety of painful thoughts. These include horrible images, worries they might harm themselves or others, or beliefs that they are condemned altogether. It’s natural why people would struggle with these, why they would try to push them away and get rid of them.

However, there’s a wide literature of research demonstrating that efforts to get rid of painful thoughts make them more intense and more intrusive. And there’s newer research that finds that acceptance of painful thoughts and feelings may be the most effective way for defusing OCD.

The study

OCD expert Dr. Jonathan Abramowitz’s lab looked at the relationship of two ways of dealing with OCD. The study found an advantage for mindful acceptance over brute endurance of obsessions.

One way of relating to inner experiences, called distress tolerance, refers to enduring painful emotions. This is akin to “gritting your teeth” and powering your way through it.

The other way is called psychological flexibility, the opposite of what is called experiential avoidance. One major process in psychological flexibility involves experiential acceptance, being “open and willing” to experience uncomfortable thoughts and feelings.

What the researchers found was that willingness (i.e., choosing) to accept painful thoughts and feelings was associated with lower obsessions. They further suggest that this relationship may be especially true for people who struggle with mental rituals (e.g., Pure “O”).

Limitations

There are limitations to this study. It was correlational and involved college students. The study did not specifically look at the impact of treatment.

Summary

New research suggests that how people relate to OCD-related thoughts and emotions may be important in the maintenance of OCD symptoms. Specially, people who are more willing to experience discomfort without engaging in compulsions may do better than those who can resist compulsions but do so through gritting their teeth and enduring it.

For these reasons, newer acceptance-based treatments such as Acceptance and Commitment Therapy (act for short), which already has good research support in treating OCD, may have something unique to offer.

In working with OCD, I often start with ACT skills building to help people learn to mindfully accept unwanted thoughts and emotions before moving into ERP (exposure and response prevention). In my experience, the ACT work offers people—especially those with more mental rituals—additional tools for working with OCD symptoms, and helps prepare them to engage in the tough exposure work.

If you or some you know is struggling with anxiety-related problems, please check out the Portland Psychotherapy Anxiety Clinic. If you would like to learn more about my approach to OCD specifically, check out my OCD website, where I described how I use Acceptance and Commitment Therapy to help enhance exposure and response prevention

Evaluating Self Help: The Mindfulness & Acceptance Workbook for Anxiety

There’s no shortage of self-help books on the market. There is, however, a paucity of research on whether those self-help books are actually helpful to the people who use them. In an ideal world, every self-help book would be submitted to scientific scrutiny to determine if people actually benefit from using them. Unfortunately, this happens only rarely.

Even a self-help book that is based on well-researched cognitive behavioral principles and written by leaders in the field is not guaranteed to be effective.  For example, one recent study found that college students with greater rumination exhibited more depressive symptoms after using Greenberger & Padesky’s Mind over Mood, a well-respected cognitive behavioral self-help book for depression. These findings suggest that evidence-based psychotherapy interventions don’t always translate into effective self-guided techniques that people can use on their own, and in some instances can actually be harmful.

The Mindfulness & Acceptance Workbook for Anxiety

Over 5 years ago, I wrote a few blogs posts about Forsyth & Eifert’s The Mindfulness & Acceptance Workbook for Anxiety in 2 prior blogs for which I used to contribute. The first, on my blog Scientific Mindfulness, reported on pre-publication research I heard about at a conference. (Unfortunately, it appears the other post has been taken down.) The first author of the workbook, SUNY-Albany professor John Forsyth, PhD, conducted 2 studies on his ACT-based self-help book. He gave copies of the book to people for free, and had them complete online self-report measures at various intervals.

Dr. Forsyth recently posted a summary of this research on his personal blog in anticipation of the upcoming 2nd edition of The Mindfulness & Acceptance Workbook for Anxiety that will be released April 1, 2016. One paragraph in his blog post caught my attention:

Reductions in anxiety and fear did not happen by going after anxiety and fear directly. It was just the opposite. By first focusing on the skills needed to live a more valued life, readers then experienced a decline in their anxiety, fears, and depression, and ultimate improvements in their lives. This is an important message––one that supports the approach we offer in this workbook.

The workbook emphasizes ACT skills to help people engage in meaningful living, and it appears that those skills—rather than interventions aimed at alleviating anxiety and worry—appear the most effective.  Said another way, the findings suggest that people using the workbook improved more from doing things that were important to them than from any particular technique. This is quite profound, if you think about it, and very different from how many people approach anxiety. Attempting to directly suppress or control anxiety-related thoughts and feelings can often backfire.

Because it’s one of the rare self-help books that has been researched specifically as a self-help book, I find myself recommending The Mindfulness & Acceptance Workbook for Anxiety more than any other self-help books, and I was excited to hear there’s an updated edition coming out. I encourage readers to check it out.

Anxiety Treatment at Portland Psychotherapy

How to Read Your Emotions Part I: Don’t Judge a Book by Its Cover

Sometimes when you first start having a feeling, your brain will very quickly make up its mind that the emotion is somehow dangerous or bad. Then it tries to escape from the emotion or control the emotion by turning your attention elsewhere and getting you to do something that makes the emotion go away. Because our brains are trying to protect us from harm, this well-intentioned judgment about our feelings comes from a good place. However, somewhere along the way our brains got a little confused about what is actually harmful. Emotions themselves are not harmful, our brain just says they are. 

Doing something that makes fear go away can work to keep you safe, but it’s only a stand-in for the real solution, which is to get away from the actual danger. Put another way, fear isn’t ever harmful, but masked figures holding knives often are. It’s much more important to get away from any danger in the world than to get away from any fear you are experiencing. In fact, when you are attuned to your environment, fear is just awareness of danger. In that sense, fear is probably a handy thing to experience – if you aren’t aware of real danger, you are less likely to respond and more likely to get hurt. The lesson is — don’t be so quick to judge fear. It may be your friend.

The same goes for other emotions: Sadness isn’t bad, it’s just awareness of loss, and loss is bad. Anger isn’t bad, it’s just awareness of conflict, and conflict isn’t great for relationships. Anxiety isn’t bad, it’s just awareness that something is important to you, and caring about things is good. For that matter, joy isn’t good, it’s just awareness that something wonderful is happening, and wonderful things are good. Emotions are there to be felt because they say something about the world in which you are living. Don’t leave your emotions on the shelf – check them out!

You can’t really blame your brain too harshly for making snap judgments – that’s what it evolved to do. Go ahead and thank your brain for its noble intentions of keeping you safe. But when it comes to your emotions, remember that they’re meant to be an open book.
For more on how to observe emotions without getting caught up in judgments, see How to Read Your Emotions Part II: Put on Your Spec’s.

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