Making sense of CBT, ERP and ACT
All recommended therapies for OCD fall under a model of treatment known as Cognitive-Behavioral Therapy, or CBT. CBT focuses on creating strategies for managing negative thinking, behavior and emotions. It is rooted in the idea that symptoms of mental disorders can be minimized by learning new ways to process information and develop healthy coping habits. CBT Therapists help patients evaluate themselves, recognize harmful thoughts, behavior and emotions, and learn to react to them in less-distressing ways. Exposure and Response Prevention (ERP), Acceptance and Commitment Therapy (ACT), Cognitive Therapy and Dialectical Behavior Therapy are all forms of CBT. ERP and ACT in particular are highly recommended for OCD treatment.
As explained above, Exposure and Response Prevention therapy is the best option for OCD. In ERP, you voluntarily expose yourself to the source of your fear over and over and over again, without acting out any compulsions to neutralize or stop the fear. By repeatedly facing something you’re afraid of, you force your brain to recognize how irrational it is. For example, a person with Harm OCD who is afraid of being around kitchen knives might be asked to start cooking dinner with one nearby. From there, they may be asked to carry a pocket knife around with them. Over time, their massive fear diminishes and their brain realizes that they are not a threat to themselves or others. While their harm thoughts may not go away entirely, they are no longer debilitating. ERP practices should be used inside and outside of therapy for the greatest impact. Learning to resort to ERP during spikes is a big step in treatment. The more and more you do so, the stronger your coping mechanisms become. Certain apps, like nOCD, make ERP more convenient and accessible.
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Acceptance and Commitment Therapy, or ACT, is a type of CBT that combines acceptance and mindfulness practices together to help sufferers develop more flexible thinking patterns. ACT is not about eliminating intrusive thoughts. It is about learning to be at peace with them and distance their nature from your identity. ACT is different from traditional CBT because it does not teach people to recognize their negative thoughts and then develop strategies for dealing with them. Rather, ACT teaches peoples to recognize their negative thoughts and accept them for what they are. It is this acceptance that acts as a mitigator, not newly developed coping habits.
There are 6 core principles of ACT. They are:
- Cognitive Defusion: Learning to assign less weight to negative thoughts, images and emotions.
- Acceptance: Allowing thoughts to flow through you without feeling overly distressed.
- Contact with the present moment: Focusing on your present state rather than worrying about the future or the past. Being open to the things going on around you.
- Observing the self: Being conscious and aware of your transcendent self.
- Values: Determining what is most important to you, what pillars you aim to live you life on.
- Committed action: Setting goals based on your values and the things you are striving for, and then bringing these accomplishments to fruition.
Critics of ACT say that it should not be considered its own type of therapy. Instead, it should function as a component of other more robust therapy options.
From the Community
Getting started with therapy can be intimidating, expensive and time consuming. That said, professional support is amazingly valuable in overcoming and minimizing the symptoms of OCD.
If you’re searching for a doctor in your area, here are a few resources that might help: