Acceptance and the “Self as Context”
If you read any OCD recovery resource (my blog included), you’ll see Exposure Response Prevention (ERP) listed as the Gold Standard for OCD treatment - and for good reason. ERP is a fundamental Cognitive Behavioral Therapy (CBT) framework for any effective OCD recovery program and if you are serious about recovery, you owe it to yourself to look into ERP and start implementing its practices and mindset into your daily routine.
However - one area that I feel ERP doesn’t touch on enough is the idea of self acceptance, which is the idea that regardless of whatever intrusive thought or uncomfortable feeling we are experiencing, we can still love ourselves and do the things that we care about in life. ERP focuses strongly on identifying compulsions and eliminating them, but the gap I see there is oftentimes people start practicing ERP and will say “I’ve eliminated X compulsion using ERP, but I still feel horrible!” (of course, you could argue that focusing on how you’re feeling is a compulsion as well, but I find this isn’t helpful for people who are still in the early phases of ERP and OCD recovery).
Self Acceptance helps address this gap and acts as a great complement to ERP. Acceptance is a core tenet of Acceptance Commitment Therapy (ACT) as the name implies, and if you’ve read some of my previous blog posts, you’ll know that I like to touch on ACT quite a bit as well when referencing CBT frameworks. To me, ACT is the natural complement to ERP… ERP teaches you how to eliminate compulsions and break the OCD cycle, and ACT teaches you how to accept any thought or emotion and live your life according to your values. Some therapists may argue for ERP only, and others may advocate for ACT… to me, this is a silly argument. Both ERP and ACT can and should be used together, as OCD recovery with one but not the other feels incomplete.
An overview of ACT in greater detail requires an entirely separate blog post for another day, but in this particular post I wanted to touch upon a core tenet of ACT, which is the “Self as Context.” From Wikipedia, it is:
the concept that people are not the content of their thoughts or feelings, but rather the consciousness experiencing said thoughts and feelings
Basically, it is the idea that you are not your thoughts. So many OCD sufferers struggle with feelings of guilt, shame, and self-hatred, because they think “I must be a murdering psychopath because I had a harm thought!” or “I must be an awful spouse, because I had a thought of cheating on my wife!” As we know from studies on intrusive thoughts, everyone has these weird and crazy thoughts - yes, even “normal” people. The difference is that “normal” people recognize these thoughts for what they are - weird, crazy brain fluff that doesn’t make any sense - and disregard the thoughts and move on without a second thought. OCD sufferers, on the other hand, get trapped into a mental spiral of rumination and self-judgement as they feel these thoughts must represent some deeper, darker side of them. This is where ACT, self-acceptance, and the “Self as Context” come in to play - they help OCD sufferers view these thoughts from a different lens, which makes it easier to disregard and move on from the thoughts.
Practically speaking, how does this work and how is it implemented in OCD recovery? At a high level:
Be mindful when you recognize you are having an intrusive thought or feeling. This can be during a planned practice session (e.g. meditation) or just during your every day life.
Instead of immediately reacting to that thought (i.e. with feelings of fear or trying to ruminate on the thought), instead observe it objectively, using the self-as-context. Take a step back and separate yourself from the thought by saying “I observe I am having this thought about [insert subject here].” Observe what the thought is, how it makes you feel, and explain to yourself that you are experiencing this thought but you are not the content of that thought. Treat the thought like a cloud passing by in the sky - you are observing the cloud, making notes about its shape, height, how fast it’s moving in the sky… but you are not the cloud itself.
Gently bring yourself back to the present moment. Mindfully focus on whatever you were doing before the thought came in - whether that is breathing exercises (if you were meditating) or going back to your daily routine.
As an example, let’s say you have an obsessive fear of stabbing or harming your spouse. You are preparing dinner and you pick up a knife (the trigger) and suddenly the intrusive thought flashes in your mind: What if you stabbed and murdered your spouse right now?
Most OCD sufferers would immediately react with feelings of fear or anxiety. They may try to argue with the thought - No, I would never do that!” These are compulsions and they are the wrong thing to do - reacting to the thought only strengthens it and conditions your brain to treat it as a real threat. Instead, try practicing acceptance and viewing the thought using the self-as-context lens:
Observe that you are having an intrusive thought (stabbing your spouse). Don’t judge it as good or bad - it’s only a thought! The content of the thought may scare you, but the thought itself is not inherently good or bad… it is just random noise that floats around in your brain, like clouds in the sky. Would you judge clouds as good or bad? Of course not.
Instead of reacting, step back and observe it curiously. “I observe that I am having a thought about stabbing my spouse.” (this is important to distance yourself from the thought - to say something like “I observe that… I am having X thought or Y feeling”). “The thought is interesting to me. It makes me feel uneasy. But also a little bit silly, because the thought appears to be quite illogical. Wouldn’t I rather use this knife to chop the carrots for dinner instead?”
Bring yourself to the present moment and focus mindfully on valued action. If you were preparing dinner, then focus on the aroma in the kitchen, the tactile feel of the knife in your hand as you chop the carrots, the “thunk” sound the wooden cutting board makes with each slice, the music that you have playing in the background, etc…
I realize that when you are suffering with OCD and just starting out with ACT, it may sound easy when I write it up like that, but it is a LOT harder to practice this in reality. And that’s OK. No one starts out being amazing at self-acceptance, but if you continue to practice it, you will get better and you will gradually learn to distance yourself from your thoughts and recognize that you are a separate entity from your thoughts. I believe that many people struggle with intrusive thoughts because they judge their thoughts as good or bad, and then they conflate their personal identity with their thoughts (this is called “Cognitive Fusion” in ACT). So if they have bad thoughts, it must mean they are a bad person, right?
Acceptance is about CHOOSING to be non-judgmental - both to your thoughts, and to yourself! Our thoughts - no matter how amazing or horrifying they may be - are not inherently good or bad. Clouds floating in the sky are not good or bad. Cars driving past on the highway are not good or bad (although we may dislike the paint scheme). They are what they are - just things passing you by. Instead of tying your identity and self-worth to thoughts, or clouds, or cars, recognize that you are separate from all of them. You can observe them from afar and recognize that no matter what thoughts are floating around in your brain, at the end of the day, you are your own self. These thoughts occur in your mind as the setting, but they are not your identity, just like how clouds are things which float in the sky, but they are not actually the sky. That is the idea of the "Self-as-Context” - the ability to separate yourself from the random bits of brain fluff (intrusive thoughts and feelings) which you may experience on a day to day basis.
People get caught up believing they are bad because they judge themselves for having “bad” thoughts, which then results in compulsions like mental rumination and trying to counteract the “bad” thoughts with “good” ones. Once you learn to stop judging thoughts and to stop associating yourself to these thoughts, it becomes much easier to accept them and choose to spend your time and energy on things that add value to your life, rather than ruminating and performing compulsions. That is the core idea of self-acceptance and why ACT focuses so heavily on the idea of the “Self-as-Context.”
I recognize that at first, this whole concept may be hard to grasp and to fully understand, but I firmly believe that practicing self-acceptance through ACT techniques like the “Self-as-Context” are important building blocks in the OCD recovery journey. So if you are on the journey and using ERP, but maybe haven’t dipped your toes into ACT yet, I’d highly encourage you to start practicing some of the self-acceptance techniques that I’ve mentioned today. And most importantly, to also practice non-judgment and to stop judging your thoughts (and yourself) as good or bad.
As always, I’m definitely happy to answer any questions or provide additional clarity if needed - feel free to reach out. Wherever you are reading this, I hope you are having a great start to your 2021 and I hope this helps in your own personal OCD recovery journey!
Eric