Obsessive-Compulsive Disorder (OCD) is often misunderstood as a problem of “too many thoughts” or “not enough control.” In reality, OCD is driven by a rigid relationship with internal experiences—thoughts, feelings, urges, and sensations—and a strong need to eliminate discomfort. Acceptance and Commitment Therapy (ACT) offers a compassionate, evidence-based approach that focuses on changing this relationship rather than eliminating symptoms.

Understanding OCD Through an ACT Lens

From an ACT perspective, OCD is maintained by experiential avoidance—the attempt to get rid of anxiety, uncertainty, or intrusive thoughts—and cognitive fusion, where thoughts are taken literally and treated as threats. Compulsions and mental rituals may temporarily reduce distress, but they reinforce the belief that discomfort is dangerous and must be controlled.

ACT does not aim to dispute obsessive thoughts or directly reduce anxiety. Instead, it builds psychological flexibility: the ability to stay present, open to internal experiences, and guided by values—even when anxiety is present.

Acceptance: Making Room for Discomfort

Acceptance in ACT does not mean liking anxiety or giving up. It means allowing uncomfortable thoughts and sensations to exist without trying to suppress or neutralize them. For someone with OCD, this might involve permitting uncertainty or fear without performing a compulsion.

For example, a person with contamination OCD may allow the urge to wash their hands to rise and fall without acting on it. The goal is not immediate calm, but learning that anxiety is temporary and manageable. Over time, this reduces anxiety’s control over behavior.

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Cognitive Defusion: Stepping Back From Thoughts

People with OCD often treat intrusive thoughts as facts that require action. ACT uses cognitive defusion techniques to help individuals see thoughts as mental events rather than truths that must be obeyed.

Strategies might include prefacing a thought with “I’m having the thought that…,” repeating a word until it loses meaning, or imagining thoughts floating by like leaves on a stream. These exercises loosen the grip of obsessions without debating them, making space for intentional choice.

Present-Moment Awareness

Mindfulness is a core ACT process and plays an important role in OCD treatment. By anchoring attention in the present moment, individuals can notice obsessions and urges without automatically reacting.

Mindfulness encourages observing anxiety, urges, and sensations with curiosity rather than judgment. This creates space between trigger and response—a critical skill for resisting compulsions and building flexibility.

Values: Building a Life Bigger Than OCD

ACT emphasizes values as a compass for behavior. OCD often narrows life, pulling people away from relationships, work, and meaning. Clarifying values helps clients reconnect with what matters beyond symptom relief.

A person might identify values such as being a present parent or supportive partner. When urges arise, values provide motivation to choose meaningful action over compulsions—even when anxiety remains.

Committed Action: Doing What Matters, With Anxiety Along for the Ride

The final step in ACT for OCD is committed action—taking consistent, values-based steps despite discomfort. This may overlap with exposure, but the focus shifts from reducing anxiety to living fully alongside it.

For example, someone with checking OCD may leave the house without repeated checking, not to prove certainty, but to move toward a valued life of freedom and trust. Anxiety may rise, but the action stays aligned with what matters.

Conclusion

Acceptance and Commitment Therapy offers a powerful alternative to control-based approaches for OCD. By fostering acceptance, defusion, mindfulness, values, and committed action, ACT helps individuals stop fighting their thoughts and start building a meaningful life—one choice at a time, even in the presence of uncertainty.

Contact me today to learn more about OCD therapy.