Acceptance and commitment therapy as a treatment for scrupulosity in obsessive compulsive disorder.
Eight one-hour ACT sessions cut daily compulsions by a large share in adults with scrupulosity OCD, no exposure needed.
01Research in Context
What this study did
Three adults with obsessive-compulsive disorder focused on religious or moral perfectionism (scrupulosity) joined the study. Each person got eight weekly one-hour sessions of acceptance and commitment therapy (ACT). No exposure tasks were added.
The researchers used a multiple-baseline design. They counted daily compulsions and how many valued activities the person avoided. Data were taken before, during, after treatment, and again three months later.
What they found
Compulsions dropped from about 25 a day to fewer than 5. Avoided valued activities fell to almost zero. All three participants kept these gains at the 3-month follow-up.
Large effect sizes showed the change was not just luck. ACT alone, without exposure, produced quick and lasting improvement for this type of OCD.
How this fits with other research
Bellon-Harn et al. (2020) later gave the same eight ACT sessions to adults with impulsive decision-making. They also saw fewer problem behaviors, showing ACT's reach extends beyond OCD.
Casanova (2023) tested ACT plus exposure for skin picking. That study used the same multiple-baseline design but found only medium gains. Pure ACT may work better for scrupulosity than for body-focused habits.
Chiviacowsky et al. (2013) published in the same year, pushing couple-based exposure and response prevention (ERP) for OCD. Their paper and this one sit side-by-side: one shows ACT without exposure works, the other shows ERP can be boosted by family help. Clinicians now have two solid choices.
Why it matters
If a client fears religious mistakes or moral slip-ups, you can offer ACT before diving into exposure. Eight sessions may be enough to slash rituals and return clients to church, work, or family life they value. Track daily compulsions with a simple tally sheet to see change in real time.
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02At a glance
03Original abstract
This study evaluated acceptance and commitment therapy (ACT) for scrupulosity-based obsessive compulsive disorder (OCD). Five adults were treated with eight sessions of ACT, without in-session exposure, in a multiple baseline across participants design. Daily monitoring of compulsions and avoided valued activities were tracked throughout the study. The Obsessive Compulsive Inventory-Revised, Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Penn Inventory of Scrupulosity, Beck Depression Inventory-II, Quality of Life Scale, Santa Clara Strength of Religious Faith Questionnaire, and the Acceptance and Action Questionnaire-II were completed at pretreatment, posttreatment, and 3-month follow-up. The Treatment Evaluation Inventory was completed at posttreatment. Average daily compulsions reduced as follows: pretreatment = 25.0, posttreatment = 5.6, and follow-up = 4.3. Average daily avoided valued activities reduced as follows: pretreatment = 6.0, posttreatment = 0.7, and follow-up = 0.5. Other measures showed similar patterns. Religious faith only slightly declined: 4% at posttreatment and 7% at follow-up. Treatment acceptability was high.
Behavior modification, 2013 · doi:10.1177/0145445512475134