perfectionism and - Obsessive-Compulsive Foundation

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6/14/13 Jenny Jenny • Referred to psychiatrist, meds – Clomipramine • Next 3 years (21-‐24), thoughts of harming family by punch, hit, slap, similar compulsions, reassurance seeking • Age 24-‐35 – improved with medicaaon (CMI 200mg), CBT/ERP avoided – “coasted along” with occasional flaring of symptoms, especially harm and sexual a@racaon thoughts • First pregnancy 2006, complicated by thyroid disease • Withdrawn from medicaaon prior to conceiving and no meds throughout pregnancy • Daughter born June 2007, induced @ 40 weeks, 12 hour labour, NVD, birth weight 6.5 lbs, N development • Few symptoms during pregnancy or for 2 mths pp • Sudden onset “What if I harm her” • Rapid increase in thoughts, anxiety, review of thoughts and acaons, checking, franac requests for reassurance, harming self to keep husband from leaving 5 6 Jenny – subsequent progress Jenny – current status • Rapid return to medicaaons despite breast-‐feeding, iniaally 3 different SSRI’s (F, Cit, S) • Late 2007 – 2 admissions to PND unit – no specific OCD treatment, CBT more focussed on depression • 2008-‐2009 – severe symptoms, back to CMI • Late 2009 – ceased medicaaon when a@empang second pregnancy return of severe symptoms and depression two further admissions (2010) • Ongoing treatment incl outpaaent ECT • Intrusive thoughts of harming daughter and family plus doubt over her acaons and moavaaons • Some other OCD intrusions • Frequent reviewing of thoughts, images, video of acaons • Frequent requests for reassurance • “Tesang procedure” – deliberately bringing on thoughts to prove to self that she would be repulsed, revolted by thoughts. Source of reassurance iniaally, subsequently ritualised and then source of doubt and anxiety. Catch 22 scenario if felt less anxiety – “if I’m not repulsed then maybe I’ll do it!” 7 8 -193- 2
6/14/13 Talking points 1. Would earlier and more intensive treatment (preferably with ERP) make a difference in the long term Is this harder to achieve with sexual obsessions And when paaent seems to be funcaoning well 2. What about stopping meds before, during and aner pregnancy Risks versus benefits 3. How do you successfully do ERP in paaents who ritualise constantly Case 2 9 Father with sexual intrusions re contact with infant daughter Christopher Mogan Director, The Anxiety Clinic Richmond Australia Model for Case 2 SATURDAY • 35 year old man with a strong family history of contaminaaon, order and symmetry, high avoidance, contaminaaon worries re pregnant wife …increased hand-washing, fear of harm. • Employed as an electrical engineer in large mula-‐naaonal company. Previous 10 years, avoided bins, door handles, sharing drinks, fear of transferring germs wife; increasing moral/ethical concerns –woman in shop touched his hand giving change – “Was that sexual contact Should I have prevented it Am I a monster”. interest in pornography as a uni student. • Early 2010 – wife pregnant, recall of event when surfing the net, felt guilty, would not hug wife for fear of “crossing the line”, harming unborn child. Baby born 2011 – sweaang and shaking at any contact, standing near, changing the baby. 11 SituaCon trigger LiOing baby to sit on lap Obsession intrusion “What if this creates a sexual connecCon with my daughter” Appraisal Interpret-‐ aCon “Maybe I want this. I have to watch myself like a hawk. Maybe I’m really a paedophile, a monster” I couldn’t cope with even the slightest chance of harming her.” Anxiety or NJR Anxiety and guilt Compulsion Neutraliz-‐ aCon Agitated & lengthy analysis and reviewing of the event, Reassurance-‐ seeking, hypervigilant in all acCons 12 -194- 3
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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
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6/14/13 COGNITIVE THERAPY CONT. IDE
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6/14/13 ERP HIERARCHY #1 BDD ISSUE:
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6/14/13 IN CLOSING EDUCATION TREA
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6/14/13 FAMILY ACCOMMODATION & MAIN
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6/14/13 HMO HMO = Health Maintenan
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6/14/13 RECOGNIZE THE SIGNS OF OCD
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6/14/13 COLLABORATING WITH SCHOOLS
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Conceptualizing and Treating Hoardi
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6/24/13 DSM-‐5 criteria for
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6/24/13 Family Burden • Growin
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6/24/13 Biological vulnerability
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6/24/13 • Depression • Self-
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Page 154 and 155: Perfecting Perfectionism Perfecting
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Page 158 and 159: Healthy Perfectionism In general
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Page 228 and 229: Tips for Non-OCD Anxiety Disorders
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Page 240 and 241: Curiosity vs Judgment! © Sheryl K.
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Page 244 and 245: 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 Sample Exposures For Health
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6/14/13 The Effect of Attention (Ta
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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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