Acceptance and OCD, Part 1
In this Episode of Purely OCD, your hosts Kelley Franke, LMFT and Lauren Rosen, LMFT talk about Acceptance.
There’s a lot to talk about when it comes to Acceptance and OCD: metaphors & techniques, myths to bust and application across subtypes.
In this episode they cover:
- Acceptance and what we’re accepting with OCD
- What non-acceptance of thoughts can look like
- Acceptance of thoughts using cognitive defusion strategies
- Resignation vs. Acceptance
- Acceptance of feelings
- Examples of how to accept the presence of thoughts and feelings
So what does acceptance have to do with OCD?
Lauren explains, there is a lot to accept with OCD. In a broad overview, OCD recovery involves acceptance of:
- The presence of thoughts
- The experience of feelings
- The presence of urges and sensations
(Note: In Acceptance and Commitment Therapy, the three experiences referred to above are called “private experiences, because they happen internally and no one can see them)
- The uncertainty of life
- The diagnosis (in the face of “But I don’t want to have this!”)
So why is acceptance so integral to treatment?
Well that question is best answered by considering what the goal of therapy is. Kelley quotes Steven Hayes, and then goes on to discuss the concept behind his words:
“The goal is to not feel BETTER, but to learn to FEEL better.” To experience fully, but not with the goal that we are going to somehow make things better. That we’re going to feel all of the things that humans are meant to feel, and that if we try to push it away or alter it in some way we are actually causing a great deal of suffering.
Feel more feelings. If anyone knows me well, I feel everything. I cried at Frozen 2, I cry every time when Olaf dies. Oops, I’m sorry if I ruined the ending for anyone.”
Kelley Franke, LMFT
“And to your point with the Steven Hayes’ quote, it’s important to feel it well. The work of therapy really is at getting better at feeling your feelings, not feeling less.Lauren Rosen, LMFT
Next, Lauren and Kelley discuss Acceptance and Commitment Therapy (ACT).
Unsurprisingly, there’s a lot of Acceptance in the realm of good old ACT.
Kelley starts by referencing Russ Harris, a huge force in the world of ACT. He has written a lot of great books, including The Happiness Trap. “I recommend you get it and you read in multiple times throughout your life, because it’s definitely impacted mine”. She explains that he uses a metaphor as a way to express the difference between fusion and defusion.
“Fusion is being so fused with your thoughts that you believe them to be true or on some degree very true, which is people who have OCD. Defusion is really more acceptance.”
Kelley Franke, LMFT
Kelley takes the listeners through a real life example to illustrate Fusion vs Defusion:
Kelley: If you have a piece of paper please get it out and write down your feared thoughts…
(She holds up a clipboard and written on it is the phrase: “What if I microwave my cat?”)
Kelley: [With] fusion, people with OCD…often go like this:
(She holds the paper on the clipboard half an inch from her face)
Lauren: Like right up in it.
Kelley: Right up in it. This is it. This is all I can think about
Lauren: I can’t even see you. That’s how fused you are with this thought…
Kelley: So when we actually do it, what do we notice? You can’t see me, I can’t see you… I can only hear myself reverberating off of this. I have peripheral but it’s very limited, and I’m just sucked in with this… This is not acceptance. This (she gestures toward the paper that’s nearly on her face) is total fusion. And we’re missing the reality of what’s going on around us. Cause it’s not just this thought that’s happening. We’re missing other things and joy in the world and we’re only focusing here.
Kelley continues the metaphor, next talking about resisting thoughts:
If we push it away, we’re like “DON’T have this thought,” it becomes very exhausting and our arms and muscles get really tired, and it also just doesn’t work. It’s still there… You’re getting almost resentful, like it’s a duty and a job now… There’s a lot of anger there.”Kelley Franke, LMFT
So what does acceptance look like in this metaphor?
“Acceptance… would be gently laying the piece of paper down, the clipboard down, the feared thought down, on your lap or on the table. It’s still there, but we’ve let go of the tug-of-war, we’ve dropped the rope. And now we’re just sitting with – I can shift my attention to the present moment, which is having a conversation with my very dear friend and all of you, while having this thought about microwaving, Maude, on my desk. And I can choose now to look at it and notice it and observe it as words, and then I can choose to come back. It is choice. It’s about willingness.Kelley Franke, LMFT
A listener ask, “Any thoughts on OCD making someone make their circle very, very small? How to get out of that tiny bubble?”
Lauren notes that the answer to this is connected to what Kelley was just talking about.
“When you are hyper focused on this thing and trying to get rid of it, and not wanting it – which is the antithesis of acceptance – it does make your circle very small. Your world becomes the word on the piece of paper which is basically glued to your forehead…
If you’re having to navigate thoughts in a way that is resistant to them, your whole life is consumed. It’s constant.
So, if you want to widen your circle, and I’m not giving you direct advice, but generally speaking, widening your circle looks like putting the piece of paper in your lap and letting it be part of the picture without letting it be the whole thing.”
Lauren Rosen, LMFT
Another listener notes: “I have a bad phrase in my head that I told myself not to say, in my head now, and I can’t stop. How do I accept this?”
This leads Lauren and Kelley to talk about Defusion Techniques:
Now that the concept of Acceptance has been discussed, the question always is, How do we do it, though? How do we accept things?
Lauren leads the charge in discussing the “tips and tricks” of Defusion.
But first, Lauren explains that Cognitive DEfusion is different from diffusion (like a diffuser with essential oils). The idea is that you’re getting some space. In the context of Kelley’s metaphor, you’re putting the piece of paper in your lap.
Okay, so how do we take the word or the phrase and give some space to it? Lauren explains: “There are these techniques, and we call them Defusion Techniques.” One of her personal favorites? The old “give it a funny voice” technique. Here we use a funny voice as the mouthpiece for intrusive thoughts. We might consider a Valley Girl voice or Darth Vader impression.
Using Maude the cat, Kelley chimes in with her best Valley Girl voice:
Kelley: “Like, what if I put that cat in there and just pushed START?”
Lauren: “Oh, for real, you might just do that. You might just put your cat in the microwave.”
Kelley: We’re laughing, but when you first do these, you might not be laughing. It doesn’t mean it’s not working though. It’s that you are now allowing that scary thought to be there with a little more lightness.
17:07 Lauren clarifies:
To be clear, we’re not trying to get certainty that this thought doesn’t mean something, we are just trying to see it as a thought. It could be true, it could be false. Just words on a piece of paper.Lauren Rosen, LMFT
Lauren and Kelley introduce Relational Frame Theory (RFT). Acceptance and Commitment Therapy, is based on RFT. In order to try to explain RFT, Lauren talks to viewers about the Gub Gub.
20:24 Lauren explains the “Gub Gub”
“The idea behind Relational Frame Theory is that everything we experience through language is put into these frames. We see things as connected to one another. So, we draw these connections. It’s pretty impressive actually. Young children can begin to do this as well.
If we make up this creature… the Gub Gub, and if we show a picture and say, “this is Gub Gub” and then we say that the Gub Gub makes the sound, “Woooo”… If I then say to even a young child at a certain developmental stage “What does that say?” and I point to the picture that I’ve identified as the Gub Gub, they’ll say “Woooo”… The connections we draw… we are able to do so much of this in our minds… through language. Through abstraction.”
Lauren Rosen, LMFT
Kelley continues their discussion of Cognitive Delusion:
‘So the idea is that when people are having a thought like… “I’m with the wrong person. I’m with the wrong partner.” Our brain processes that as “Yeah, you’re with the wrong partner. You’re having these thoughts…you start going down this fusion path… In reality it’s just a bunch of words that have been put together and now you’re associating meaning to it….
Actually even saying, “I’m having the thought.” That is an initial form of Defusion. That’s the first step.
Lauren: When you are completely fused, you aren’t even aware that you’re having the thought; you’re just in it… You’ve got a Clipboard as a face.
Kelley: Clipboard face.
The practice of making space between you and your internal experiences extends beyond thoughts:
I find this helpful when pointing out compulsive behaviors, “Oh, I notice this urge to want to do this.”
Instead of, “I have to do this.” It’s a choice. It’s a hard difficult choice, and it is a choice nonetheless. You have the agency to do this. Do not sell yourself short, here.”Kelley Franke, LMFT
Another listener was asking about health anxiety and how this relates.
Generally speaking, most of the things said on this podcast – even though it’s called Purely OCD and we’re talking about OCD – OCD, anxiety, generalized anxiety, health anxiety, social anxiety, phobias, agoraphobia, panic disorder; all of these things tend to operate essentially the same way. So… if we’re working with a client we conceptualize it in a very similar way. Intolerance of thoughts, intolerance of feelings, intolerance of uncertainty
25:58 Lauren and Kelley Derealization, Depersonalization and Dissociation.
31:53 Lauren feels it’s important to touch on the idea of Acceptance vs Resignation.
Because a lot of people think, “Oh, I have to accept that this is the way it is, and the way it is going to be. “Now this is my life. “Now I’m just anxious forever, the end.”
When we talk about acceptance, we talk about acceptance NOW. ‘What’s happening right now. “Ooh I’m anxious right now.” “I’m having this thought right now.”
I’m not saying, “I’m going to have this thought forever.” I might have it ongoing and intermittently, but all I have to do is accept that it’s here, NOW.
Lauren Rosen, LMFT
Kelley compares this to the clipboard metaphor:
It’s like the clipboard and declaring, “I’m anxiety. This is never going away.”
You’re missing all the joy on the periphery. Your anxiety is here, yes, you can choose to put it down, it’s not going anywhere.
Don’t get into a power struggle where you’re trying to push it away, because you’re going to be in a place of resentment and anger and frustration. All equally suffering. Suffering is a choice. Pain is not. It’s not an option. Everyone gets pain. But to chosoe to prolong. Is suffering.Kelley Franke, LMFT
Kelley and Lauren take questions.
Question, “What is it like to live without anxiety? What am I shooting for?”
Kelley completely gets why this person is asking. Jokingly she says,
You go to an anxiety specialist and they say, “You’re going to feel more anxiety, and you say, “What?” “I want my money back.”
The answer is, I have no idea what it’s like to live without anxiety. I’m glad that I do have it, because it keeps me safe. I hate it sometimes. But when I’m in a place of hate and anger, it’s not resolving it either. That’s that power struggle. I’m pushing it away. You’re being resistant and not willing to accept reality.
Kelley Franke, LMFT
If resisting feelings was an effective approach, I wouldn’t be here. I never would have gone to therapy. I never would have gone back to school to do what I do now. It just wouldn’t have happened.
[But] It’s not an effective approach.
Lauren Rosen, LMFT
Question: “How can we accept thoughts and feelings in the realm of Sexual Orientation OCD (SO-OCD)?”
Kelley gives an example of a thought that might come up in SO-OCD: “What if I’m really sexually attracted to females?”
Lauren takes the listener through a technique by play acting with Kelley. She asks Kelley:
“I want you to think for 10 seconds that thought and believe it.” I’m going to time you and I really want you to think that thought. 10 seconds is up. How do you feel emotionally?”
Kelley responds that she is overwhelmed, a little anxious, sick, nauseous.
Lauren continues: “Now I want to you to do the same thing again, BUT, I want you to add the words, ‘I’m having the thought that…I may be attracted to women.’ After the next 10 seconds, people tend to feel less bothered by that.
Kelley provides another technique to address the same question:
“you can also say it really fast out loud. With Relational Frame Theory…language plays such a huge roll. If you actually say it very fast on a loop, it starts running together and begins to just sound like a sound. It loses its meaning.
A lot of people are just scared to even say the thought, so that can always be a good step. Say it, say it a lot, say it with a silly voice, sing it, but we’re not going to fuse with it.
Kelley Franke, LMFT
If you have Sexual Orientation OCD and you have that thought, you might also notice you have a huge lump in your throat and your heart is beating a little faster than it was before. What we want to do is accept those physical experiences too. “Oh, ok.” “Right now I’m feeling anxious.” ‘What is it like to feel anxious?” “Well, for me, anxiety looks like fill in the blank.”
I’m going to make space for that experience. You might say, “Ok, well, I guess the lump in the throat is coming with me on my jog today.”Lauren Rosen, LMFT
Question: “What are the basics we need to know to start incorporating this in our life? If feels so irresponsible.”
Oftentimes, this is the baggage that accompanies Acceptance. The side effect. “I feel guilty or irresponsible for doing this.”
Lauren explains that people often fear that accepting the presence of a thought or a feeling without attaching meaning to or responding to it might lead to some sort of disaster.
Kelley’s response? Let’s accept the thoughts and feelings. Let’s just notice them. They’re floating by like a leaf on a river.
Lauren finishes by pointing out that Irresponsible is a label we put on ourselves. ”You’re irresponsible!” And when we get down to it, it’s really being anxious. It’s uncomfortable. The notion of feeling irresponsible is going to perpetuate the feeling of anxiety.
Question: “How do I continually accept the same painful thoughts and feelings over and over?”
I think that the pain is actually in the meaning of the actual words, thoughts and feelings, rather than in the thoughts and feelings themselves.
For instance, even something beautiful, like a sunset. We humans could evoke feelings of sadness, because you see the sunset and, if you’ve lost a loved one recently, you might think, “Oh this sunset, they would love this sunset and are not here to enjoy it.”
So the pain is in the meaning we give to the experiences, including thoughts….
We get better at feeling our feelings as we practice. If we are willing to go in and have a better relationship with these feelings, and will be more accepting of them, over time your experience of them changes.’Lauren Rosen, LMFT
“Remember if you live with OCD and Anxiety, if you want to have long-term recovery you have to accept that you’ll have to do this over and over again.
However, how you are feeling it right now is not always going to feel as intense as it does right now. We want to look at it as though they are waves. There are peaks and there are valleys.Kelley Franke, LMFT
Kelley and Lauren share that they didn’t get to cover everything they set out to. So they decide to do a second episode on acceptance. In the next Episode, Part 2 of Acceptance, Kelley and Lauren will discuss:
- Accepting Uncertainty
- Accepting the diagnosis – that you have OCD
- Mindfulness meditation and how it can support acceptance
- Maybe an Expansion Exercise
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