perfectionism and - Obsessive-Compulsive Foundation

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The BDD Challenge 6/14/13 The BDD Challenge Key Concepts Our body parts aren’t meant for this Scott M. Granet, LCSW The OCD-BDD Clinic of Northern California The IOCDF 20 th Annual Conference Atlanta, GA July 20, 2013 Feeling good has to be more important than looking good We have these thoughts because of having BDD; not because we should or need to look better We’re more sensitive to minor changes in appearance than someone who doesn’t have BDD ***We actually DO look different everyday Key Concepts Cont. Our negative thoughts and irrational beliefs are the main culprits We don’t treat others differently based on how they look on any particular day, so why should we do it to ourselves Yes, appearance is important in our culture, but is it supposed to be THIS important Does it really make sense to hold onto behaviors and beliefs which ultimately fail us It works Importance of CBT It takes: COURAGE PERSISTENCE RESILIENCE PATIENCE It’s VERY HARD work -113- 1
6/14/13 Enough Talking! Let’s Get to the BDD Challenge! BDD PREVALENCE This isn’t meant to be just TALK about BDD and treatment Estimates: 3-5 million in U.S. alone Men and women equal Who’s first Me Getting well is about taking chances Age of onset: teens Inpatient settings: 13% BDD PREVALENCE CONT. Source: K. Phillips and R. Dufresne, Am J Cln Dermatol 2000 Jul-Aug WHERE ARE THEY SATURDAY In dermatologic settings: 11.9%-15.8% --1 in 8 patients seeking dermatologic treatment* --1 in 7 patients seeking cosmetic surgery* 1 in 8 to 9 outpatients with social phobia (11%-13%) 6-14% of patients receiving treatment for anxiety or depressive disorders** Shame Seeking medical appointments and procedures Frequently misdiagnosed *Source: Katharine Phillips, Current Psychiatry, Jan. 2002 **Source: Feusner, Winograd, Saxena, Current Psychiatry, October 2005 -114- 2
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IMAGINE THAT!: A SCRIPTING WORK- SH
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Themes and Variations - Theoretical
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Themes and Variations - Theoretical
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6/14/13 • Subjects (N = 20) with
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The Social Experiment 6/14/13 The
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6/14/13 How Do We Treat Social
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6/14/13 Exposure therapy is: A
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6/14/13 Detailed Inves5ga5on of
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6/14/13 Why Imaginal Exposure
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6/14/13! Common obsessions, continu
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6/14/13! 1# This circuit is called
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6/14/13! -33- 6!
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6/14/13! People with OCD experience
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6/14/13! 1a. Behavior Therapy! •
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ERP Exposed OCD Cycle Obsessions Re
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OCD Definition: OCD Cycle COMPULSIO
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Somatic Obsessions Miscellaneous Ob
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Exposure and Response Prevention -
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Strategic Model of Cognitive Treatm
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Segment 3 Every step of the way, ch
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You also have to tolerate anxiety
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Segment 9 Segment 10 Habituation re
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Get rapport (and get it again) Get
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6/14/13 Example #2: “Dave”
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6/14/13 Talking about Accommoda@o
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6/14/13 Making Decisions about A
Page 66 and 67: 6/14/13 Dealing with Arguments
Page 68 and 69: Ask an Attorney - What Are My Right
Page 70 and 71: What is a major life activity Basic
Page 72 and 73: What is Reasonable Accommodation Mo
Page 74 and 75: Family and M edical L A eave ct IOC
Page 76 and 77: THE SPENCER LAW FIRM 2727 Camino de
Page 78 and 79: Importantly, the ADA requires cover
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Page 84 and 85: insurance, sick leave, education be
Page 86 and 87: Protection and Advocacy The Protect
Page 88 and 89: Can’t - vs. -Won’t • If you s
Page 90 and 91: Rewards Fear Stimulus CBT Model of
Page 92 and 93: My Child-Brother-Sister Has OCD But
Page 94 and 95: I’m Afraid I’m Really Gonna Do
Page 96 and 97: Roger is a 52 year old widowed dent
Page 98 and 99: Fear of loss of impulse control: B:
Page 100 and 101: Fear of loss of impulse control ERP
Page 102 and 103: Sandra Practices walking with delay
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Page 106 and 107: 6/14/13 Defining the Problem- Raci
Page 108 and 109: 6/14/13 Time for ERP Separation A
Page 110 and 111: Manipulating Language to Improve Pa
Page 112 and 113: 6/24/13 SHIFT LANGUAGE TO PROMOTE H
Page 114 and 115: 6/24/13 LABEL ANXIETY AND OCD Agai
Page 118 and 119: 6/14/13 WHICH BODY PARTS ASSOCIATED
Page 120 and 121: 6/14/13 WHAT DOESN’T APPEAR TO WO
Page 122 and 123: 6/14/13 COGNITIVE THERAPY CONT. IDE
Page 124 and 125: 6/14/13 ERP HIERARCHY #1 BDD ISSUE:
Page 126 and 127: 6/14/13 IN CLOSING EDUCATION TREA
Page 128 and 129: 6/14/13 FAMILY ACCOMMODATION & MAIN
Page 130 and 131: 6/14/13 HMO HMO = Health Maintenan
Page 132 and 133: 6/14/13 RECOGNIZE THE SIGNS OF OCD
Page 134 and 135: 6/14/13 COLLABORATING WITH SCHOOLS
Page 136 and 137: Conceptualizing and Treating Hoardi
Page 138 and 139: 6/24/13 DSM-‐5 criteria for
Page 140 and 141: 6/24/13 Family Burden • Growin
Page 142 and 143: 6/24/13 Biological vulnerability
Page 144 and 145: 6/24/13 • Depression • Self-
Page 146 and 147: 6/24/13 Mo8va8on and Ambivalence
Page 148 and 149: 6/24/13 Skills Training: Objec8ve
Page 150 and 151: 6/24/13 Behavioral Experiment: C
Page 152 and 153: 6/24/13 Treatment Responders (%)
Page 154 and 155: Perfecting Perfectionism Perfecting
Page 156 and 157: Types of Perfectionism Being th
Page 158 and 159: Healthy Perfectionism In general
Page 160 and 161: The cost of perfectionism • T
Page 162 and 163: Let’s Focus on Two Problemati
Page 164 and 165: • Are we there yet • The r
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Addressing Relapse in CBT for OCD 6
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6/14/13 Lisa’s Exposure Hierar
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6/14/13 Is Performance During E
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6/14/13 Frame ERP to Mismatch
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6/14/13 Implica:ons for Psychoed
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6/14/13 Jenny Jenny • Referred
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6/14/13 Appraisals of intrusions
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6/14/13 Bill • His intrusive
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6/14/13 Response Prevenaon • D
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6/14/13 Study Comparing Individual
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6/14/13 Exclusionary Criteria Struc
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6/14/13 Contact Information The OCD
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6/14/13 Acceptance vs. Change Chan
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6/14/13 Positive Reacting Styles P
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6/14/13 What is P-N-P What is P-N-
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People and Places - Emotional Conta
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6/14/13 CASE EXAMPLE • 67 year
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6/14/13 THE ROLE OF BETRAYAL
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6/14/13 THE ROLE OF ACCEPTANCE
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Challenging Kids Challenged Adults
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Regulatory Disorders Challenging Ki
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Tips for Non-OCD Anxiety Disorders
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Sleep Problems Tips for Sleep Probl
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EXECUTIVE FUNCTION “He is such a
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Write It or Regret It! CL UE Tips f
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Slow Processing Speed (Sluggish Cog
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Tips for Handwriting • Reduce cop
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Curiosity vs Judgment! © Sheryl K.
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Prepare the child for the path….
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How Can the Whole Family Fight OCD
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Task Description & Reminder of spec
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Using Scaffolding Steps in Unplanne
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6/14/13 Examples of Behavioral
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Assessment and Treatment of Postpar
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Cognitive-Behavioral Strategies in
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6/14/13 iCompulsions (OCD) or Cyber
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6/14/13 Similarities Between HC and
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6/14/13 C = Increased Fear and Doub
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6/14/13 Sample Exposures For Health
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6/14/13 The Effect of Attention (Ta
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6/14/13 Health-Related OCD Case Exa
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6/14/13 Treatment • Stop all comp
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So You Expect Them to Leave Home So
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Daniel G. Pruitt, Jr., PCC, SCAC In
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NEEDED TRANSITION SKILLS: • Time
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Memory Functioning CL UE Short-Term
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Taking Medications Exercise! •Und
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Washer and Dryer TRANSITION SKILLS:
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TRANSITION SKILLS: Ready ! Money Ma
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TRANSITION SKILLS: • Tell them wh
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TRANSITION SKILLS: This Isn’t It!
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Tigers, Too Tigers, Too: Supplement
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WHEN REASSURANCE IS HARMFUL By Paul
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APOSTOLIC CHRISTIAN Counseling and
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