perfectionism and - Obsessive-Compulsive Foundation

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6/14/13 Bill • His intrusive sexual thoughts involved a flickering thought of sexually abusing his nieces and nephews, something that he found abhorrent and very difficult to tolerate. His way to cope with these obsessions was to avoid going to family gatherings, something that he used to enjoy in the past, and avoid places where he might run into children. Bill • His harming obsessions included intrusive images of him killing his two dogs with a shovel. This caused him tremendous distress and he would insist on removing all tools when he was close to the dogs and not be len alone with the dogs among other things. 21 22 Conceptualizaaon • Intrusive sexual or harming thoughts significant distress avoidance/neutralizaaon/distracaon temporary relief conanued distress upon triggers – Fears: “I must have liked it because I didn't’stop it,” and “I must have brought this on by thinking ‘bad’ thoughts” • Underlying fear: “If I think the ‘wrong’ thoughts, something bad might happen” An Adolescent with Intrusive, Blasphemous Thoughts C. Alec Pollard Director, St Louis Behavioral Medicine InsCtute and St Louis University -197- 6
6/14/13 Descripaon of the Paaent Symptoms • 16 yr-‐old boy, “Damien” • Lived with parents and an 18 yr-‐old sister • Raised Bapast, “moderate” • Hx of subclinical perfecaonism; symptom onset at age 13 Preparaaon for ERP • Intrusive thoughts: 1) harming family members; 2) thoughts that would offend God • Avoided: provocaave TV/movies, etc., church, family when possible • Compulsions: prayer/scripture review, reassurance-‐seeking • Fear: If I have these thoughts, I will be punished by God Exposure SATURDAY • Educaaon about OCD • Cogniave Tx: PISA Worksheet to help Damien clarify his beliefs • Consultaaon with minister • Developed ERP plan • Met with parents: educate about OCD, assess recepavity, obtain “blessing” • Recorded on digital voice recorder blasphemous thoughts: -‐ “F*** God” -‐ “I want to give my soul to the Devil” -‐ “I love Satan” • Listened to recording for extended amounts of ame • Exposure to thoughts constant as moved up hierarchy of contexts: e.g., therapist’s office (low), near a Bible (medium), at Church (high) -198- 7
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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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6/24/13 Skills Training: Objec8ve
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Page 154 and 155: Perfecting Perfectionism Perfecting
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Page 240 and 241: Curiosity vs Judgment! © Sheryl K.
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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 Health-Related OCD Case Exa
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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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