What Is Obsessive-Compulsive Disorder?

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Exposure and response is largely seen as the gold standard when it comes to the treatment of OCD.

Acceptance and commitment therapy helps individuals with OCD.

Further, acceptance and commitment therapy talks about working to take values based action.

Overall, ACT showed moderate improvements in symptom reduction in reducing OCD symptoms.

OCD is an exhausting mental illness that is characterized by intrusive thoughts often followed by physical and/or mental compulsions. Some individuals who are struggling may rationally understand that their fears are illogical, yet feel completely controlled by them. Fighting and engaging with the intrusive thoughts often backfires.

Exposure and response is largely seen as the gold standard when it comes to the treatment of OCD, however dropout rates can be real barriers when it comes to treatment. Enter acceptance and commitment therapy as a great adjunctive treatment for ERP. Acceptance and commitment therapy helps individuals with OCD change their relationship to their intrusive thoughts and anxiety.

Rather than a focus on eliminating intrusive thoughts, acceptance and commitment therapy has a lens of changing our relationship to unhelpful thinking. One of the core treatment aims of acceptance and commitment therapy is psychological flexibility. Additionally, acceptance and commitment therapy focuses on cognitive defusion strategies (Assaz et al., 2023). Some cognitive defusion strategies include the following:

Creating separation between yourself and the thought by telling yourself “I am having the thought that.”

Singing the thought to the tune of a popular song-this helps people to recognize that a thought is simply words and sounds, not something that you necessarily need to act on or pay attention to.

Rather than asking yourself ‘is the thought true?’ asking yourself ‘is the thought helpful, in terms of getting me in the direction of the life that I want to lead?”

Dr. Amber Groomes has weighed in on strategies for disengaging from unhelpful thoughts. Dr. Groomes writes that, “Defusion takes a different perspective. From a defused state, I might start by just noticing “I am having the thought that ‘I am going to look like a loser’ and another thought that ‘everyone will be judging me.’ These thoughts make me feel anxious.”

Dr. Groomes continues. “I may recall that I often have these thoughts before social situations, and usually, everything goes just fine. I no longer have an “awkwardness” problem. I have a thought problem. Thankfully, it is only a problem if I take the thought seriously” (Groomes, 2024).

Further, acceptance and commitment therapy talks about working to take values based action even when anxiety or intrusive thoughts are present. Act utilizes a variety of metaphors that can be helpful when it comes to practicing this. In this metaphor, we imagine that someone’s life is a bus and that some of the passengers on the bus are loud and unruly (the OCD thoughts and urges). In OCD, the passengers may yell things like ‘you didn’t wash your hands enough,’ or ‘how can you be sure that you really love your partner?’ When these passengers start screaming, someone with OCD might feel the urge to turn around and argue with them or pull over. ACT teaches that we can continue to steer the bus in the direction of our values, even if the passengers are on the bus making noise. Individuals with OCD can work to simply notice them, let them be there, and keep their hands on the steering wheel (Hayes, Strosahl & Wilson, 1999; Hayes et al., 2006).

New evidence: a meta-analysis

A 2026 meta-analysis looked at ACT for OCD. Researchers examined nine randomized control trials, which compared ACT to controls-that included no treatment and treatments like pharmacotherapy (Loureiro et al., 2026)..

Key findings from this study included:

Overall, ACT showed moderate improvements in symptom reduction in reducing OCD symptoms when compared to controls-that included medication-only approaches.

When compared to other psychotherapies, no significant differences emerged in symptom improvement-meaning ACT held its own against standard talk therapies.

Limitations remain and further research needs to be conducted with additional RCTs.

What Is Obsessive-Compulsive Disorder?

Take our Generalized Anxiety Disorder Test

Find a therapist to treat OCD

What does this mean for clinical practice?

Exposure and response prevention is still the gold standard for the treatment of OCD. However, acceptance and commitment therapy can be a meaningful adjunctive treatment that may serve to improve treatment outcomes, reduce dropout rates, increase psychological flexibility, and provide additional tools for those who are looking to regain freedom from OCD’s grip.

In my work as a therapist in private practice, I’ve seen how combining ERP with ACT-informed strategies can help clients navigate OCD more effectively. It’s validating to see research reflecting what many clinicians observe in practice.

Assaz, D. A., Tyndall, I., Oshiro, C. K. B., & Roche, B. (2023). A process-based analysis of cognitive defusion in acceptance and commitment therapy. Behaviour Therapy, 54(6), 1020–1035. https://doi.org/10.1016/j.beth.2022.06.003

Groomes, A., Ph.D. (2024, August 5). Disengaging from unhelpful thoughts: When “just think positively” isn’t enough. Dr. Amber_Writes. https://agroomes.substack.com/p/disengaging-from-unhelpful-thoughts

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change. Guilford Press.

Loureiro, C. P., et al. (2026). Acceptance and commitment therapy for obsessive-compulsive disorder: Cross-cultural systematic review and meta-analysis. Journal of Psychiatric Research. In press.https://doi.org/10.1016/j.jpsychires.2026.01.035

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