McLean Hospital 115 Mill Street Belmont, MA 02478
One of our goals at the OCDI Office of Clinical Assessment and Research (OCAR) is to advance clinical assessment and scientific research by providing relevant and useful information to guide and improve treatment for OCD. As part of our mission, we are constantly asking ourselves why and how our patients get better. What factors can help predict improvement in treatment? Because each patient has a unique and valuable perspective, and is the expert on their lives and their symptoms, we ask a lot of questions throughout the process of each patient’s treatment program. Our questions help us assess a variety of factors relevant to treatment progress and serve to: a) encourage patients to think about their progress in treatment, b) provide useful information to the treatment teams so they can focus on what is most important for each patient, and c) help us better understand how and why various treatments work, so that we can continue to refine and improve them.
Recently, we’ve become more and more interested in better understanding the role that the six processes of acceptance and commitment therapy (ACT) play in treatment. New research points to the fact that psychological flexibility may help to reduce OCD symptoms and the associated distress and impairment. While exposure and response prevention (ERP) therapy still remains the gold-standard treatment for OCD, ACT has been effective in increasing treatment acceptability, reducing OCD symptoms, and improving quality of life (Twohig et al., 2010).
At the OCDI, we are interested in further investigating the underlying processes of ACT in order to better understand how our patients are approaching ERP treatment and what is driving their changes in symptoms and behavior. For example, ACT teaches some patients to view their intrusive thoughts as simply “passengers on a bus,” rather than very important parts of themselves that interfere with their ability to engage in meaningful experiences. In other words, obsessions and life experiences do not have to be one and the same. Furthermore, patients are taught to tolerate fear rather than trying to fight or reduce it. It may seem intuitive to push the negative feelings away, but research actually shows that it may be more helpful to learn to tolerate them (Arch & Craske, 2008).
As a result, we hypothesize that targeting ACT processes in treatment may help patients approach treatment from a different perspective, thereby changing the behaviors that may be creating barriers to their treatment and the fulfillment of their values. Specifically, we predict that greater psychological flexibility and willingness to engage in treatment will be associated with greater reductions in OCD symptom severity and higher quality of life. From a clinical perspective, patient data helps our treatment teams determine which processes are changing and which ones to target. Preliminary findings from our research suggest that greater willingness to engage in treatment is significantly associated with improvement in symptom severity and greater tolerance of fear (Elias et al., 2013). As we continue to refine our assessment measures, we will be looking for trends to help us to see how these mechanisms are influencing treatment, both positively and negatively. Through our work at OCAR, we hope to shed light on some of these relationships in the near future.
Brittany Mathes is a staff member at McLean’s OCD Institute.