Alternative Therapies
This page explains two psychological approaches that are offered as alternatives to cognitive behavioural therapy (CBT), the main psychological treatment for OCD.
There are many psychological approaches available, but this page focuses on two that people with OCD often come across: the Four Steps method and ACT.
The first approach is the Four Steps method, which many people encounter through books or online resources.
Four Steps Method
The Four Steps method was invented specifically for OCD. It combines elements of CBT and mindfulness.
Its aim is to help reduce OCD symptoms by changing how you respond to intrusive thoughts.
Its premise is that the brain produces OCD intrusive thoughts because of a malfunction. The method teaches you to notice the thought, label it as an OCD symptom, and then shift your attention toward a meaningful activity such as gardening, work, or a hobby.
It uses a mindfulness style approach — you’re aware of the thought without analysing or challenging it. By letting the thought be there in this way, many people find that it affects them less over time. The method is as follows:
- Relabel – recognize your obsessions and compulsions as symptoms
- Reattribute - the thoughts are the result of a neurobiological/medical condition
- Refocus - engage yourself in constructive behaviours instead of giving in to the compulsion
- Revalue - see OCD thoughts for what they truly are - distractions without any real importance
When I first developed OCD many years ago, the Four Steps Method was the main approach I used. I liked that it explained things in a scientific way, and in the short run it worked extremely well. Within nine months my symptoms had reduced by around 90%, and I genuinely thought I was cured.
But later, the OCD returned. Looking back, this happened because the Four Steps Method focuses on managing the symptoms rather than addressing the root cause.
The method assumes that the cause of OCD is a neurobiological problem in the brain. At the time, this was the dominant scientific view, although later research showed that the picture was too simplistic.
But even if the neurobiological issue were the cause — it’s irrelevant, because the method doesn’t try to change that neurobiological issue. This isn’t because the science of the time was limited; the method was designed as a symptom management approach, which is why it focuses on reducing the number of intrusive thoughts and the intensity of the anxiety they create.
But this is only a temporary fix. Approaches like this can create short term relief because they reduce the intensity of the symptoms. But if the root cause isn’t addressed, the improvement doesn’t hold in the long term. The intrusive thoughts begin to increase again, because the thing that causes the thoughts hasn’t actually changed.
Therefore, with this method, for the rest of your life you will be stuck in a cycle of recovery and relapse.
For a deeper explanation of why short‑term approaches fail, see my ‘Why OCD Returns’ page.
The inventor of the four steps method is Dr Jeffrey Schwartz. He summarises his method in the below YouTube video, which lasts around 35 minutes
If you want to go into the details of the method, he wrote a book about it called ‘Brain Lock’. The book is interesting and may help reduce your current OCD symptoms.
Acceptance and Commitment Therapy (ACT)
ACT is a therapy that combines behavioural techniques with mindfulness.
ACT’s official position is that it does not aim for symptom reduction. This is one of its core principles. ACT assumes that many symptoms — including OCD thoughts and the anxieties they create — are a normal part of life and not something therapy should try to reduce. Because of this, ACT does not focus on changing symptoms or altering how often they appear.
ACT holds this position because it views symptoms as natural mental events rather than something that can be fixed. This idea can make sense for certain forms of distress (for example, bereavement), where it’s not possible to reduce the emotional pain in a meaningful way.
However, for many anxiety based symptoms, including OCD thoughts and anxiety, this assumption is not accurate. It is a proven fact that OCD symptoms can reduce — something shown consistently across decades of cognitive behavioural therapy (CBT) research papers and clinical studies.
Because ACT does not target symptoms, it is usually not the right approach for people who want their OCD symptoms to reduce.
So how does ACT aim to help people? ACT defines progress mainly in terms of functioning — meaning how well someone continues with daily life, routines, and values based actions, even if their symptoms stay the same.
It’s a bit like going to a doctor with a broken leg and being told that the bone won’t be treated, but you’ll be taught how to walk on it. You’re still in pain when you walk on it, but because you’re moving, the doctor calls it “success.”
Many ACT practitioners recognise that this focus on functioning can feel discouraging to people who want their symptoms to change. To make the approach feel more palatable, they often add that symptoms may reduce “indirectly” as a result of improved functioning. However, this does not change the fact that ACT does not target symptoms themselves.
You may be wondering why ACT is mentioned on this page at all when it does not aim to reduce OCD symptoms. The reason is that ACT is becoming increasingly common in mental health services, and some people with OCD are offered it as an alternative to CBT. The aim of this section is to help readers understand that ACT is unlikely to help someone recover from OCD.
Of the two approaches described above, the Four Steps method is the only one whose aim is to reduce OCD symptoms.
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