ABSTRACT
Introduction and denition .......................................................................... 256 ACT’s philosophy of science: functional contextualism .......................... 257 Relational frame theory ................................................................................. 259 Current state of evidence of ACT for OCD ................................................ 260 ACT conceptualization of OCD ................................................................... 262
Cognitive fusion versus defusion ........................................................... 262 Experiential avoidance and acceptance ................................................. 265 Lack of contact with the present moment
versus contact with the present moment ............................................ 265 Self as content versus self as context ...................................................... 266 Unclear chosen values versus clear values ............................................ 267 Behavioral inaction or impulsivity versus committed action ............. 267 Behavioral inexibility versus behavioral exibility ........................... 268
Issues of treatment resistance in OCD ........................................................ 268 Treatment refusal, dropout, and compliance ........................................ 268 Difcult-to-treat subtypes of OCD.......................................................... 271
Co-occurring issues and what is a good outcome? .............................. 273 Procedural issues ....................................................................................... 275
An ACT case example ................................................................................... 276 Summary ......................................................................................................... 284 References ........................................................................................................ 284
Introduction and definition Obsessive-compulsive disorder (OCD), classied as an anxiety disorder, is characterized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (American Psychiatric Association, 2000) by distressing intrusive thoughts and unwanted repetitive behaviors that cause functional interference. A functional relationship exists between obsessions and compulsions, with almost 90% of people with OCD engaging in the compulsion in response to the obsession (Foa & Kozak, 1995). Current estimates indicate that 1% of the U.S. population (or 2.2 million people) meet criteria for OCD each year (Kessler, Chiu, Demler, & Walters, 2005). The age of onset ranges between early adolescence and early adulthood, usually with an earlier onset in men than women (Rasmussen & Eisen, 1992); a slightly greater percentage of women are diagnosed with OCD, although pediatric clinical cases show a 2:1 male-to-female ratio (Hanna, 1995). Approximately 50 to 75% of those diagnosed with OCD are simultaneously diagnosed with another psychological disorder, with anxiety and mood disorders being the most common (Antony, Downie, & Swinson, 1998). Other psychological disorders that may commonly co-occur with OCD include substance dependence, eating disorders, body dysmorphic disorder, and Tourette’s disorder and other tic-related disorders (Antony et al., 1998).
