perfectionism and - Obsessive-Compulsive Foundation

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Addressing Relapse in CBT for OCD 6/14/13 Outline Addressing Relapse in CBT for OCD Op:mizing Long-‐Term Treatment Outcomes • Overview of CBT for OCD • Case presenta:on – “Lisa” • Explana:ons for Lisa’s relapse • Methods for op:mizing long-‐term outcome Jonathan S. Abramowitz & Ryan J. Jacoby University of North Carolina at Chapel Hill CBT Model of OCD • Obsessional thoughts – Basis in normal intrusive thoughts & doubts – Misinterpreted as significant or threatening – Intolerance of uncertainty – Provoke anxiety • Compulsive rituals and avoidance behavior – Performed to reduce obsessional anxiety and get assurance of safety – Reinforced by short-‐term anxiety reduc:on – Long-‐term maintenance of obsessional fear CBT for OCD • Derived from the conceptual model • Treatment techniques – Assessment and psychoeduca:on – Self-‐monitoring – Cogni:ve therapy – In vivo and imaginal exposure – Response preven:on -163- 1
6/14/13 “Lisa” • 27 yr old married woman • YBOCS = 26 (severe), no comorbidity • Obsessions about being possessed by the devil • Compulsions: Reassurance-‐seeking, mental rituals, excessive praying • Avoidance: reminders of hell, death, possession, devil, serial killers, “murder,” her high school • Onset: years earlier when she learned a high school classmate had murdered his wife Lisa’s Treatment: Sessions 1 & 2 • Informa:on-‐gathering – Triggers, thoughts, rituals, avoidance – Main fear: I’ll be possessed & become a serial killer • Educa:on about the CBT model of OCD – Lisa felt comforted to know everyone has bad thoughts • Ra:onale and explana:on of ERP – Lisa thought the ra:onale made sense Conceptual Model of Lisa’s OCD Beliefs about the meaning of feared s3muli “Thoughts are significant and meaningful” “I should have control over my thoughts” Aen3on toward threat Devil, possession, death-‐related sHmuli Normal intrusive thoughts Thoughts about demonic possession (“What if I become possessed”) Misinterpreta3on of thoughts “I could be possessed”; “I can’t take the chance”; thinking=truth Obsessional fear Compulsive rituals to reduce anxiety & feel safe Avoid, reassurance, praying, thought suppression/control Emo:onal Processing Theory (EPT), Habitua:on, and Exposure Therapy • EPT emphasizes the importance of within-‐ and between-‐session habitua:on – Provoke ini:al anxiety (SUDS) – Remain exposed un:l anxiety subsides naturally SUDS 90 80 70 60 50 40 30 20 10 0 10 20 30 40 50 60 Time (mins) Session 1 Session 2 Session 3 Session 4 SATURDAY -164- 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
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6/14/13 Dealing with Arguments
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Ask an Attorney - What Are My Right
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What is a major life activity Basic
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What is Reasonable Accommodation Mo
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Family and M edical L A eave ct IOC
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THE SPENCER LAW FIRM 2727 Camino de
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Importantly, the ADA requires cover
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Some possible reasonable accommodat
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THE SPENCER LAW FIRM 2727 Camino de
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insurance, sick leave, education be
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Protection and Advocacy The Protect
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Can’t - vs. -Won’t • If you s
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Rewards Fear Stimulus CBT Model of
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My Child-Brother-Sister Has OCD But
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I’m Afraid I’m Really Gonna Do
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Roger is a 52 year old widowed dent
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Fear of loss of impulse control: B:
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Fear of loss of impulse control ERP
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Sandra Practices walking with delay
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6/14/13 Defining the Problem- Raci
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6/14/13 Time for ERP Separation A
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Manipulating Language to Improve Pa
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6/24/13 SHIFT LANGUAGE TO PROMOTE H
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6/24/13 LABEL ANXIETY AND OCD Agai
Page 116 and 117: The BDD Challenge 6/14/13 The BDD C
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
Page 168 and 169: 6/14/13 Lisa’s Exposure Hierar
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Page 172 and 173: 6/14/13 Frame ERP to Mismatch
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Page 196 and 197: 6/14/13 Jenny Jenny • Referred
Page 198 and 199: 6/14/13 Appraisals of intrusions
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Page 204 and 205: 6/14/13 Study Comparing Individual
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Page 208 and 209: 6/14/13 Contact Information The OCD
Page 210 and 211: 6/14/13 Acceptance vs. Change Chan
Page 212 and 213: 6/14/13 Positive Reacting Styles P
Page 214 and 215: 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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