Tuesday, August 3, 2010

What do you want your life to be about? Acceptance & Commitment Therapy for OCD

Circle of Life Values, part 2
My friend J. came over today for coffee, and I told her I was avoiding doing my therapy homework for tomorrow, writing down my values. Her eyes lit up and she said, "Oh, let's do it now, together." I think she would've made an excellent Exposure Therapist in another life! At first I was like "Crap." But enough of the healthy part of me said, ok, let's do it. J. lost her job just before I lost mine, and we are going some similar re-evaluations of our lives.

My therapist is having me work through "Get Out of Your Mind & Into Your Life: The New Acceptance and Commitment Therapy" by Steven C. Hayes, PhD. Some of the ideas of ACT are really useful for dealing with OCD, especially learning to observe your mind and let the noise be there, but doing what you really value in spite of it. At times the scientific language bogs me down, especially with an OCD desire to understand it perfectly, and I'm glad I'm working on it in the context of therapy, so I can get help with the perfectionistic tendencies.

My homework for tomorrow was to write down what I truly value in 10 different domains of my life, such as friendship, relationships, family, parenting, work, recreation, spirituality, citizenship, personal growth and learning, physical health and well being. J. set the timer for 1 minute for each category and we started writing what we want our lives to be about in each of these areas. Then Hayes asks us to re-read what we wrote, as if no one else would ever see it, and whether these are things we really value or whether they are things we think we are supposed to value. All of this is ripe for OCD over-interpretation, but framing the exercise as an exposure helped--writing things down in a minute, without knowing for sure if they really *truly* are my values, not to mention judging whether these are things I *should* value.

OCD only values reduction in anxiety--there isn't much else it cares for except certainty. When I do what my OCD demands, I get a temporary drop in anxiety, but I don't get to live much of my life. I value connections with people, and making art. I don't want my life to be about my rituals. The temptation is to fall back into my perfectionism OCD, and berate myself for ritualizing, as if somehow this will help me change. But one of my values is compassion, and persecuting myself for having OCD is not compassionate, and I am slowly learning how to have compassion for myself.

Sometimes the motivation to do exposures is hard to find because the anxiety is so gripping. My therapist is arguing that my values can help guide me, and help give me courage to face the OCD. What do you value? What motivates you to do exposures?

You can download the full 2-page version of the values chart here.

For a useful summary of ACT, Dr. Russell Harris has a good article:
Simple Overview of ACT: To download a simple, non-technical, easy-to-read overview of ACT ( called 'Embracing Your Demons', an article he wrote for Psychotherapy Australia magazine) click here. I read this article several years before getting any treatment for my OCD, and it stayed with me.


  1. The theme of your post today comes at the perfect time for me. I am really trying to push myself forward this week and out of the relative rut I have been in for some time.

    The idea of "learning to observe your mind and let the noise be there, but doing what you really value in spite of it" is something my therapist has addressed with me before, but reading it here again in your post reminded me that this is essentially what I am trying to do this week. Sometimes the key is taking a moment, cutting through all the distorted ideas about what doing or not doing a particular thing could mean about me, and giving myself a chance to look at the bigger picture and how the decision I make to go against OCD, no matter how wrong it may seem in the moment, helps me move towards the things I value in the bigger picture.

    I was talking with a friend I met at the conference the other day about the idea of responsibility, and how in the moment, the responsible thing to do seems to be the compulsive one. When you feel you should do something in the moment "just to be safe" it is hard give yourself permission not to, because it can feel like such irresponsibility. But in the end you have to look at the bigger picture and realize that, what may seem like an irresponsible action in the moment, is actually the responsible thing to do overall, if it means weakening your OCD so you can take care of yourself and the things you really value.

    I thought your post fit remarkably well with the subject of our conversation! I will try to keep the things you wrote here in mind as I attempt to be ever more compliant in completing my ERP homework. Thank you!

  2. Fellow Sufferer--Yes, this is a challenge for me too--the idea that"responsible" thing can seem to be the "compulsive" thing, and if I am not responsible and something bad happens it proves how worthless I am. I was very confused the first time my therapist said that feeling responsible isn't the same thing as being responsible. The big picture is so important.