perfectionism and - Obsessive-Compulsive Foundation

6/14/13
Confron:ng the Greatest Fear
Lisa’s Lapse and Relapse
• Session 14, Lisa planned to watch The Exorcist with
her husband at a showing on campus
• Prepared by reassuring herself that anxiety would go
down
• Reviewed her cogni:ve therapy materials
• Lisa became overwhelmed during the movie
– Couldn’t reassure herself that everything would be OK
(“just thoughts”; “anxiety going down”)
– Had to leave the theater before she had a “breakdown”
Factors involved in Lisa’s Relapse:
Insights from Learning Theory
• Over-­‐reliance on habitua:on as an indicator of
improvement
• Use of exposure to disconfirm obsessional fear
• Lack of varia:on in exposure prac:ces
• Misuse of cogni:ve therapy and educa:on
• OCD symptoms increased rela:ve to how she had
been doing (“lapse”)
– Fear of possession, more rituals
• Stopped exposure and began avoiding again
• Cancelled several sessions before stopping
treatment
– Therapist urged Lisa to con:nue
– Lisa felt it was hopeless, and that she needed a break
• 2-­‐wk follow-­‐up phone call confirmed Lisa’s
relapse (significant, las:ng return of symptoms)
Implica:ons of EPT for Lisa
• It was assumed that Lisa had improved if
– Self-­‐reported anxiety (SUDS) reduced during an
exposure trial
– Exposure to the same s:mulus evoked less anxiety
from one trial to the next
• Prior to watching The Exorcist, Lisa was
experiencing liple anxiety during exposures
and she was not performing rituals
– Her treatment goals seem to have been achieved
SATURDAY
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