Assessing Models of Exposure Therapy

The objective of this study is to learn how to improve treatment for clients who are working
hard in treatment at the McLean Hospital Obsessive Compulsive Disorder Institute (OCDI), but
who are not making the progress that would typically be expected. Therefore, the
investigators will be comparing the performance of such clients in a treatment as usual
(TAU)-Exposure and Response Prevention (ERP) session with their performance in an Acceptance
and Commitment Therapy (ACT)-focused ERP session that follows an ACT booster session. The
investigators hypothesize that clients will perform significantly better in the ACT-focused
ERP session than they will in the TAU-ERP session. More specifically, the investigators
hypothesize that clients and an independent rater will report that in the ACT-focused ERP
session, clients performed significantly fewer rituals and/or avoidance behaviors, exerted
significantly more effort, had significantly less difficulty getting started with the ERP,
were significantly less influenced by their uncomfortable thoughts/feelings, were
significantly more willing to experience discomfort, were significantly more focused on
working towards what is important to the client. The investigators also hypothesize that an
independent rater will rate clients as significantly more compliant with the ACT-focused ERP
session than with the TAU-ERP session. The investigators also hypothesize that clients will
rate the ACT-focused ERP session as significantly more preferable and acceptable than the
TAU-ERP session, and that they will report being significantly more willing to do the
ACT-focused ERP session again.