perfectionism and - Obsessive-Compulsive Foundation

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6/14/13 Appraisals of intrusions • Doubt that might have acted on urges in the past review and analysis of behaviour • Worry that may act on thoughts and urges in the future avoidance of situaaons .. What if I lose control Worry that may be wrongly accused of acang on such urges reassurance-‐seeking • Evaluaaon ‘I am a bad person suppression and control a@empts. What if I have moved the child towards my genitals • Need to be vigilant, to re-‐examine my thoughts and acaons to be@er understand possibiliaes. • Disabled by the heightened anxiety, the distress of any possibility of harming his daughter. 13 Treatment explanaaon of the model: anxiety confused thinking overwhelming feelings avoidant and disrupave behaviors. Key trigger – Sense of disgust with self at any possibility of sexual behavior with daughter. CBT model based on evidence not impulse Program of exposure/behavioral tasks aimed at habituaaon of the felt anxiety that preceded the birth of daughter. Graded, repeated, intense, prolonged exposures. 14 Paaent collaboraaon in exposures • Model based on prolonged exposures and conanuous engagement with daughter. • Going towards the anxiety, not away from it. Se`ng targets like the panicky feelings that come before a@ending to baby. Increasing his own agency by appropriate engagement in tasks. Breakthrough exposures – (1) Increased play with daughter; (2) not avoiding spontaneous contact; (3) Reading with child si`ng on lap. 15 Discussion 1) Diagnosac issues: Before coming to OCD Program, paaent was referred for assessment by a Forensic Psychologist -‐ Pedophilia. 2) Does prior interest or browsing of porn sites suggest likelihood of increased risk for inappropriate contact with an infant or child 3) When assessing for OCD, should specific quesaons about sexual urges to be asked by the therapist 16 -195- 4
6/14/13 Bill Adult with a range of obsessional intrusions – religious, sexual and harming Throstur Bjorgvinsson Director, Houston OCD Program Bill • A married male in his 40s who had a successful law career previous to the worsening of his OCD symptoms. • He sought treatment aner he was unable to work due to the nature of his intrusive obsessions. • He described a normal childhood, one of four siblings, and reported that he was close to his parents and siblings. • He married his high school sweetheart and she was encouraging him to seek treatment. Bill 18 SATURDAY • His symptoms began to emerge about 10 years prior to seeking treatment when he first noaced intrusive and disturbing thoughts that he could not avoid. • He reported four types of obsessions: 1) religious, 2) intrusive sexual thoughts, 3) fear that he might harm or had harmed someone, and 4) fear of contaminaaon. • His religious obsessions were mostly associated with the devil. For example, any numbers that were remotely similar to “666” had to be neutralized or they would lead to something horrible. This included going to hell or harm coming to him, his wife, or his family. He had to neutralize (this was his compulsion) by changing the number 6 to the number 7, such as adding a 1 to each number and making it “777” as a way to neutralize the intrusive associaaon with the devil. 19 20 -196- 5
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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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6/24/13 Mo8va8on and Ambivalence
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Page 154 and 155: Perfecting Perfectionism Perfecting
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Page 166 and 167: Addressing Relapse in CBT for OCD 6
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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.
Page 242 and 243: Prepare the child for the path….
Page 244 and 245: How Can the Whole Family Fight OCD
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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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