Starting from a description of clinical cases, I shall describe procedures aimed at a greater degree of acceptance of the experience of guilt than normally tolerated by obsessive-compulsive patients. The theoretical framework is the conceptualisation of obsessive-compulsive symptomatology as aimed at preventing the threat of guilt.

Specifically, the proposed procedures promote the abandonment of attempts at solutions, i.e., of all the overt and covert behaviours aimed at subjectively ensuring that the feared threat will not materialise and that one is morally right.

Unlike the interventions based on cognitive restructuring, acceptance interventions do not aim at reassuring the patient that the feared guilt is inexistent, or is less likely, less serious, less under the patient’s responsibility; rather, the objective of such interventions is to help the patient to acknowledge the inevitability of a certain “amount” of guilt and to abandon behaviours aimed at preventing the feared guilt scenario.

The proposed procedures and techniques have a specific target, i.e., the modification of a specific belief that maintain the investment towards a goal:

• The belief that we have the power to prevent the threat (through the sharing of the symptomatology’s model of functioning with the patient, Socratic dialogue and the reductio ad absurdum argument).
• The belief that it is convenient to actively engage in attempts to evade, or at least reduce the threat (increased awareness of one’s own attempts at solution, evaluation of the effects and of their effectiveness, analysis of the existential costs).
• The belief that it is a duty to be morally perfect (through Socratic dialogue and decatastrophisation of the possibility of being guilty, the double standard technique, procedures for distancing from thoughts and emotions of guilt, behavioural experiments).
• the belief that there are no other moral goals to invest in (through identification of other goals and moral values and through support to the commitment in this direction with cognitive and behavioural interventions).

In line with the conceptualisation of OCD underlying this set of interventions, it will be highlighted how fostering acceptance offers greater therapeutic benefits than traditional restructuring interventions aimed at reassuring the patient that the feared scenario will not occur. Indeed, most clinical problems are conceptualisable in terms of threat, rather than damage; accepting higher degrees of risk is tantamount to reducing the risk of over-investment of a goal and, therefore, the vulnerability to automatic vicious circles fuelling the investment towards a goal even when it would be both possible and appropriate to give up.

Mindfulness refers to the capacity to pay attention to the present moment with awareness and without judging the experience that one is having, such as thoughts, emotions, impulses, sensations (Kabat-Zinn 1990). From this definition alone, it is easy to intuit how the practice of mindfulness could be particularly indicated in the treatment of Obsessive-Compulsive Disorder (OCD). Indeed, one particularly problematic aspect for the treatment of OCD is the overestimation of the importance of one’s mental contents. From a certain point of view, it could be affirmed that one of the main problems of this disorder is the difficulty of letting go of mental contents once they have appeared in one’s mind. These contents may be thoughts, but also mental images, which, once arisen, succeed in “hooking” the patient and lead him/her to enact rituals, hidden or manifest.
Developing mindful attitudes in the patient through the practice of mindfulness could be a valid instrument for helping people with OCD manage their internal experiences (thoughts, sensations, mental images) and learn how to respond to them in a functional way, rather than reacting automatically: Mindfulness is the opposite of acting mechanically on “automatic pilot,” and so, for OC patients it is an important ability, considering that it is precisely their reactivity to their obsessions and the subsequent enacting of compulsions that sets off the self-invalidating vicious circles of OCD.
Experiential Acceptance (EA), a core process in Acceptance and Commitment Therapy (ACT; Hayes, Strosahl, & Wilson, 1999) is the willingness to actively embrace “private events” (emotions, bodily sensations, thoughts, etc.) in the moment without attempting to change their frequency or form. EA is the opposite of experiential avoidance, the unwillingness to remain in contact with particular private events, such as anxiety and obsessions in OCD, leading to exhausting attempts at altering the form and frequency of these experiences.
The workshop will show, with practical exercises, how to incorporate these strategies into therapy: both Mindfulness and Experiential Acceptance offer a variety of strategies to help individuals with OCD to cope better with their symptoms, and that can be integrated into the treatment. Mindfulness and EA training can also prepare patients to exposure and increase their compliance to treatment, making them perceive E/RP as less upsetting than they do in other therapeutic contexts in which exposure with response prevention exercises are presented alone. Mindfulness and acceptance-based strategies can support patients in the work of accepting the discomfort and the negative emotions that accompany the presence of obsessions, and, finally, support them in not reacting with the enactment of compulsions, thereby promoting symptom alleviation.