perfectionism and - Obsessive-Compulsive Foundation

6/14/13
Lisa’s Exposure Hierarchy: Session 3
Item SUDS
School and names/pictures of classmates 40
Words (“devil”, “murder”)
50
Names of serial killers 65
Cemetery/funeral home/funeral 75
Documentaries about serial killers
80
Images of being possessed and killing family members 85
Horror movies (The Exorcist) 95
• Response preven:on: gradual; depending on
exposures
Exposure Sessions: Session 4+
• Therapist emphasized the importance of
habitua:on within and between sessions
• Each prac:ce provoked anxiety
• Anxiety fell to mild levels with repeated
prac:ce
• Generally successful in resis:ng urges to
ritualize
• Very compliant with ERP in general
Use of Cogni:ve Therapy
• Used informally to help Lisa engage in
exposure prac:ces
– Examine the evidence for/against Lisa’s percep:on
of risk with each exposure situa:on
• Lisa took notes from cogni:ve therapy
discussions and oken read them over to help
her complete exposure exercises on her own
– She used cogni:ve techniques to help anxiety go
down during exposures
Lisa’s Progress
• Consistent but very gradual
– Very gradual progression up the fear hierarchy
• Concerns about exposure
– “Am I going too far”
– “What if I am really possessed”
– “Will too much exposure turn me into a killer”
• Lisa felt relieved aker each exposure was over
– Self-­‐reassurance that anxiety would always go down
• “I know I’ll be OK because anxiety will always go away”
– Felt successful because anxiety went away
– No obvious generaliza:on across exposures
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3