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Participants completed standard exposure as a continuation of standard clinic treatment, followed by an acceptance and commitment therapy (ACT) consultation session to assess psychological inflexibility processes interfering with treatment progress, and then an ACT-based exposure targeting behavior change through increasing psychological flexibility. After each exposure, participants and independent raters reported levels of psychological flexibility, rituals, distress, treatment engagement, and treatment perceptions. We observed that the shift to ACT-based exposure was associated with greater psychological flexibility, treatment engagement, treatment acceptability, and treatment preference. These findings suggest that there may be situations where ACT-based exposure has particular utility.<\/jats:p>","DOI":"10.1891\/jcp-2022-0033","type":"journal-article","created":{"date-parts":[[2024,3,5]],"date-time":"2024-03-05T15:55:47Z","timestamp":1709654147000},"page":"255-272","source":"Crossref","is-referenced-by-count":0,"title":["Investigating an Acceptance and Commitment Therapy-Based Exposure Therapy Intervention in Treatment-Refractory OCD and Related Disorders: Changes in Psychological Flexibility, Treatment Engagement, and Treatment Perceptions"],"prefix":"10.1891","volume":"38","author":[{"given":"Nate G.","family":"Gruner","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenifer M.","family":"Cullen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesse M.","family":"Crosby","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie N.","family":"DeCross","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brittany","family":"Mathes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauryn","family":"Garner","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christina","family":"Gironda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuanjun","family":"Hu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason W.","family":"Krompinger","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason A.","family":"Elias","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael P.","family":"Twohig","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"793","published-online":{"date-parts":[[2024,3,5]]},"reference":[{"key":"2024081903200885000_38.3.255.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2012.04.007"},{"key":"2024081903200885000_38.3.255.2","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/j.brat.2015.05.008","article-title":"The credibility of exposure therapy: Does the theoretical rationale matter","volume":"72","year":"2015","journal-title":"Behaviour Research and Therapy"},{"key":"2024081903200885000_38.3.255.3","doi-asserted-by":"publisher","DOI":"10.1037\/a0028310"},{"issue":"3","key":"2024081903200885000_38.3.255.4","doi-asserted-by":"crossref","first-page":"348","DOI":"10.1080\/00273171.2018.1446320","article-title":"Testing mean differences among groups: Multivariate and repeated measures analysis with minimal assumptions","volume":"53","year":"2018","journal-title":"Multivariate Behavioral Research"},{"key":"2024081903200885000_38.3.255.5","doi-asserted-by":"publisher","DOI":"10.2307\/1165312"},{"key":"2024081903200885000_38.3.255.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2014.06.008."},{"issue":"6","key":"2024081903200885000_38.3.255.7","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1002\/da.22728","article-title":"Cognitive behavioral therapy for anxiety and related disorders: A meta\u2010analysis of randomized placebo\u2010controlled trials","volume":"35","year":"2018","journal-title":"Depression and Anxiety"},{"key":"2024081903200885000_38.3.255.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2007.10.003"},{"key":"2024081903200885000_38.3.255.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2014.04.006"},{"key":"2024081903200885000_38.3.255.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbtep.2003.11.001"},{"issue":"3","key":"2024081903200885000_38.3.255.11","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1891\/0889-8391.27.3.195","article-title":"A comparison of two brief interventions for obsessional thoughts: Exposure and acceptance","volume":"27","year":"2013","journal-title":"Journal of Cognitive Psychotherapy"},{"key":"2024081903200885000_38.3.255.12","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.99.1.20"},{"issue":"2","key":"2024081903200885000_38.3.255.13","doi-asserted-by":"crossref","first-page":"380","DOI":"10.32614\/RJ-2019-051","article-title":"Resampling-based analysis of multivariate data and repeated measures designs with the R package MANOVA.RM","volume":"11","year":"2019","journal-title":"The R Journal"},{"key":"2024081903200885000_38.3.255.14","unstructured":"Friedrich, S. , Konietschke, F. , & Pauly, M . 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