A New Take on OCD Exposures
A blog post by Sound Psych & Claude
A recent case study* published in the Journal of Clinical Psychology explores an alternative approach to exposure therapy for OCD that's gaining research attention. Instead of the traditional method of facing fears to reduce anxiety, this approach focuses on reconnecting with meaningful activities while learning psychological flexibility.
The research examines "values-based exposures" within Acceptance and Commitment Therapy (ACT), documenting how this method worked for one woman with severe contamination-focused OCD.
*Capel, L. K., & Twohig, M. P. (2025). ACT for OCD: An example of ACT and values‐based exposures. Journal of Clinical Psychology, 81(2), 93–101. https://doi-org.paloaltou.idm.oclc.org/10.1002/jclp.23759
How Traditional Exposure Therapy Works
Most people familiar with OCD treatment know Exposure and Response Prevention (ERP), which operates on a straightforward principle: repeatedly face feared situations without engaging in compulsions until anxiety naturally decreases through habituation. The primary goal is reducing distress and weakening fear responses.
For someone with contamination OCD, this might involve touching doorknobs, using public restrooms, or handling "dirty" objects until the anxiety subsides.
The Values-Based Alternative
Values-based exposures take a different approach entirely. Rather than asking "What are your biggest fears?" they ask "What meaningful activities have you stopped doing because of OCD?"
The exposures are then designed around re-engaging with those specific activities while practicing "psychological flexibility"—the ability to stay present and act according to your values even when difficult thoughts and feelings are present.
The goal isn't habituation or anxiety reduction, but rather learning to live meaningfully regardless of internal experiences.
The Case Study: Lana's Journey
The research follows "Lana," a married woman in her 30s whose contamination OCD had severely restricted her life. At the start of treatment, she:
Rarely left home except for grocery pickup
Homeschooled her children to avoid illness exposure
Had withdrawn from friends and extended family
Spent most of her time researching diseases and tracking contamination
Required extensive handwashing rituals from family members
Her OCD severity score was 33 out of 40—indicating extreme symptoms.
The Treatment Process
Lana's therapy involved 24 sessions over eight months, beginning with telehealth due to her avoidance of public spaces. The first nine sessions focused on building psychological flexibility skills:
Acceptance: Learning to make space for difficult thoughts and feelings rather than fighting them
Cognitive defusion: Recognizing thoughts as mental events rather than facts requiring action
Present moment awareness: Developing the ability to choose where to focus attention
Self-as-context: Understanding that you are not defined by your thoughts and feelings
Values clarification: Identifying what truly matters personally
Committed action: Taking concrete steps toward values despite internal experiences
A turning point came when Lana named her OCD "Martha" and described it as a "black, amorphous shadow monster"—helping her see OCD as something she experienced rather than something she was.
How the Exposures Actually Worked
Once Lana understood these concepts, her exposures were designed around what she wanted to be doing with her life:
Coming to therapy in person (practicing being around others in service of recovery)
Taking her children to parks (engaging in meaningful parenting)
Visiting her parents' home (maintaining family relationships)
Reconnecting with friends (pursuing community and connection)
Crucially, these weren't chosen because they were the most anxiety-provoking items on a fear hierarchy. They were selected because they aligned with her values and represented activities OCD had taken away from her.
During exposures, success wasn't measured by anxiety reduction but by psychological flexibility—could Lana remain open to whatever thoughts and feelings arose while continuing to engage meaningfully in the activity?
The Results
After treatment, Lana showed significant improvement across multiple measures:
OCD severity: Dropped from 33 (extreme) to 18 (moderate)
Anxiety symptoms: Decreased from severe to mild levels
Depression scores: Improved from severe to mild-moderate
Psychological flexibility: Clinically significant improvement
Beyond the numbers, her behavioral changes were striking. She was regularly taking her children to parks, had reconnected with high school friends, joined activity groups, and spent time with extended family. She described feeling "independent and joyful" about her life engagement.
Study Limitations and Broader Context
The researchers acknowledge several important limitations. This was a single case study with a highly motivated client working with an experienced therapist, so results cannot be generalized broadly. More research is needed across diverse populations and OCD presentations.
Importantly, existing research suggests that traditional ERP and ACT-based approaches produce comparable outcomes overall. This isn't about one method being superior, but rather having different tools available for different people and situations.
The approach may be particularly relevant for cases involving moral or religious concerns where traditional exposures might conflict with genuine values, or for individuals who haven't responded well to traditional ERP.
Learning More: Values-Based Approaches in Practice
If you're interested in understanding how these research concepts translate to practical application, Dr. Emily Wharton's course "Values at the Wheel: Living Life Fully with OCD" teaches exactly these principles.
Dr. Wharton's comprehensive course explores:
How ACT approaches OCD differently from traditional methods
Practical tools for developing psychological flexibility
Values-based strategies for engaging with life despite OCD symptoms
Real-world applications of acceptance-based approaches to OCD treatment
The course bridges the gap between research findings like those in this case study and actionable strategies people can implement in their daily lives.
Explore "Values at the Wheel" Course →
The Research Implications
This case study contributes to growing evidence that multiple pathways to OCD recovery exist. While traditional ERP remains well-established with extensive research support, values-based exposures represent an evidence-informed alternative that may resonate with certain individuals or situations.
The philosophical shift is significant: from trying to eliminate or reduce OCD symptoms to learning to live meaningfully alongside them. As the researchers note, this doesn't mean accepting diminished quality of life—Lana's improvements demonstrate otherwise—but rather building psychological skills that allow valued living regardless of internal experiences.
The research adds to our understanding of how different therapeutic approaches can help people with OCD reclaim meaningful engagement with their lives, offering another evidence-based option in the treatment toolkit.
To learn more about values-based approaches to OCD treatment, explore Dr. Emily Wharton's course "Values at the Wheel" and discover our full library of evidence-based mental health resources.