perfectionism and - Obsessive-Compulsive Foundation
perfectionism and - Obsessive-Compulsive Foundation
perfectionism and - Obsessive-Compulsive Foundation
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6/14/13 <br />
Frame ERP to Mismatch Expectancies <br />
• When the expecta:on that a fear trigger produces a nega:ve <br />
outcome is disconfirmed, an alterna:ve non-‐threatening <br />
associa:on is generated <br />
– Tricky in OCD because obsessional fear is oken cued by <br />
uncertainty about long-‐term or unknowable disasters <br />
– Conduc:ng exposure to feeling uncertain can help diminish the <br />
significance <strong>and</strong> intolerance of uncertainty <br />
• Implica:ons <br />
– Set up exposure to violate expectancies about uncertainty <br />
• Instead of tracking SUDS, track length of :me Lisa can manage <br />
feeling uncertainty without ritualizing <br />
• Violate Lisa’s expecta:ons that she can’t manage uncertainty, <br />
anxiety, obsessions <br />
Elimina:ng Safety Behaviors <strong>and</strong> Cues <br />
• Response preven:on enhances the genera:on of <br />
non-‐threat associa:ons <br />
• Allows the pa:ent to learn that feared situa:ons, <br />
thoughts, <strong>and</strong> uncertainty are tolerable even <br />
without rituals <br />
• Therapist can be an unintended safety cue <br />
• Implica:ons <br />
– Target more than just rituals—any ac:on to reduce <br />
anxiety, doubt, or remove an obsession <br />
• Reassurance-‐seeking, thought suppression, neutralizing, etc. <br />
– Ensure that Lisa prac:ces ERP in mul:ple contexts <br />
without the therapist or other “safety person” or cues. <br />
Combining Fear Cues During Exposure <br />
• When an expected nega:ve outcome fails to occur <br />
despite the presence of mul:ple fear cues, <br />
inhibitory learning is greater than when only a <br />
single fear cue is present <br />
– “Deepened ex:nc:on” (Rescorla, 2006) <br />
• Implica:ons <br />
– In OCD, exposure can involve confron:ng external fear <br />
cues along with imaginal exposure to the feared <br />
consequences of (or uncertainty about) doing so <br />
• Lisa: Exposure to driving past her old high school while <br />
imagining becoming possessed <strong>and</strong> eventually ac:ng in <br />
evil ways <br />
Linguis:c Processing <br />
• Puung feelings into words disrupts the <br />
feelings being verbalized <br />
• Implica:ons <br />
– Might be beneficial to have OCD pa:ents label <br />
their feelings during exposure <br />
• “I am very scared that being at my old school will cause <br />
me to become possessed” <br />
• “I feel very unsure of whether I will become possessed <br />
<strong>and</strong> one day murder my child.” <br />
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