perfectionism and - Obsessive-Compulsive Foundation

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6/14/13 Frame ERP to Mismatch Expectancies • When the expecta:on that a fear trigger produces a nega:ve outcome is disconfirmed, an alterna:ve non-‐threatening associa:on is generated – Tricky in OCD because obsessional fear is oken cued by uncertainty about long-‐term or unknowable disasters – Conduc:ng exposure to feeling uncertain can help diminish the significance and intolerance of uncertainty • Implica:ons – Set up exposure to violate expectancies about uncertainty • Instead of tracking SUDS, track length of :me Lisa can manage feeling uncertainty without ritualizing • Violate Lisa’s expecta:ons that she can’t manage uncertainty, anxiety, obsessions Elimina:ng Safety Behaviors and Cues • Response preven:on enhances the genera:on of non-‐threat associa:ons • Allows the pa:ent to learn that feared situa:ons, thoughts, and uncertainty are tolerable even without rituals • Therapist can be an unintended safety cue • Implica:ons – Target more than just rituals—any ac:on to reduce anxiety, doubt, or remove an obsession • Reassurance-‐seeking, thought suppression, neutralizing, etc. – Ensure that Lisa prac:ces ERP in mul:ple contexts without the therapist or other “safety person” or cues. Combining Fear Cues During Exposure • When an expected nega:ve outcome fails to occur despite the presence of mul:ple fear cues, inhibitory learning is greater than when only a single fear cue is present – “Deepened ex:nc:on” (Rescorla, 2006) • Implica:ons – In OCD, exposure can involve confron:ng external fear cues along with imaginal exposure to the feared consequences of (or uncertainty about) doing so • Lisa: Exposure to driving past her old high school while imagining becoming possessed and eventually ac:ng in evil ways Linguis:c Processing • Puung feelings into words disrupts the feelings being verbalized • Implica:ons – Might be beneficial to have OCD pa:ents label their feelings during exposure • “I am very scared that being at my old school will cause me to become possessed” • “I feel very unsure of whether I will become possessed and one day murder my child.” -169- 7
6/14/13 Enhancing the Retrieval of Non-‐Threat Associa:ons • Maximize variability during ERP • Expanding the interval between sessions • Aid context retrieval Expanding the Inter-‐session Interval Maximize Variability During ERP • Prac:ce in varied contexts makes short-‐term learning more difficult, but enhances long-‐term reten:on (Bjork & Bjork, 2006) – The more diverse the condi:ons under which learning takes place, the greater the number of retrieval cues that are generated • Implica:ons – Prac:ce ERP under as many different condi:ons as possible – Use random (rather than gradual) exposure – Vary imaginal exposure (uncertainty, worst possible outcome) – “I’ll be OK because I know anxiety will go away” becomes “I’ll be OK because I know I can tolerate anxiety” Aiding in Context Retrieval SATURDAY • Temporally spacing learning trials results in beper long-‐term reten:on of what was learned – More opportuni:es to strengthen long-‐term memory by forgeung and prac:cing re-‐learning associa:ons • Implica:ons – Expanding spaced scheduling • 2x/week 1x/week every other week, etc. • Prac:cing ERP in as many different contexts as possible – Enhances accessibility and retrieval of new safety learning • Implica:ons – Prac:ce ERP in as many contexts as possible – Aim for prac:ce in situa:ons where symptoms are likely to be triggered -170- 8
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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
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The BDD Challenge 6/14/13 The BDD C
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6/14/13 WHICH BODY PARTS ASSOCIATED
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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
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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 166 and 167: Addressing Relapse in CBT for OCD 6
Page 168 and 169: 6/14/13 Lisa’s Exposure Hierar
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Page 196 and 197: 6/14/13 Jenny Jenny • Referred
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Page 204 and 205: 6/14/13 Study Comparing Individual
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Page 212 and 213: 6/14/13 Positive Reacting Styles P
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Page 216 and 217: People and Places - Emotional Conta
Page 218 and 219: 6/14/13 CASE EXAMPLE • 67 year
Page 220 and 221: 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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