Pure "O"
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I am just curious what type of exposures could be incorporated for someone with a Pure "O" form of OCD. If there is no elevator to go into, or plane to fly in, it is all in the mind. I have done the CBT exposures outline by Foa, with awfull results.
Would the same type of exposures work, IE writing stories, visualization, etc.., except take a mindful, defused state of mind? Does ACT have a better way of doing exposures, or are exposures worth doing for this type of OCD? Is just noticing that these are thoughts and continue to move in your valued direction enough?
Just thought I'd bring this up as I haven't seen much about this from an ACT perspective.
OCD
To my thinking this is the point where you need to return to a functional analysis. Help the client discriminate between the part of the "O" that is automatic (respondent-like) and the part that is active, the thinking he/she does in respons (operant) to the first part. Trying to figure it out, answering back, follow it to the bitter end, whatever. Once you discriminate the second part, encourage the client to do something different, something that does not have the same function as what he/she usually does (internaly). This,then, would be exposure. In my experience it is not that difficult to experiment with different alternatives at this point, once you have discriminated what he usually does, even if most of this takes place "under the skinn"