perfectionism and - Obsessive-Compulsive Foundation

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6/14/13 THE ROLE OF BETRAYAL • “Betrayal is a sense of being harmed by the intenonal acons, or omissions, of a person who was assumed to be a trusted and loyal friend, relave, partner, colleague, or companion” -‐ Rachman • TYPES OF BETRAYAL – Harmful disclosures of confidenal informaon – Disloyalty – Infidelity – Dishonesty – Failures to help during significant mes of need EMOTIONAL CONTAMINATION AND INTERPERSONAL DYSFUNCTION • Is there a connecon • Possible co-‐morbidity with Axis II perhaps mediated by history of trauma • Betrayal is form of trauma • Betrayal leads to feelings of humiliaon, degradaon, and worthlessness which lead to feeling dirty and “polluted” • The “betrayer” can become focus of contaminaon MAGICAL THINKING IN OCD • Beliefs about relaonships between events that do not follow laws of nature or causality • Coincidental co-‐occurrence of a thought and negave event • Cultural influences • Religious moral influences from authority figures (parents, clergy, etc.) • Magical thinking increases during mes of stress • Need to control things that ma^er to us as human beings – Found in cultures all over the world in which ritualisc behaviors are performed to alter natural events THOUGHT ACTION FUSION • Moral TAF – unacceptable thoughts are morally equivalent to immoral acons • Likelihood TAF – certain thoughts cause parcular events or increase likelihood of events occurring • Part of the construct of magical or supersous thinking -217- 5
6/14/13 THOUGHT OBJECT FUSION MAGICAL THINKING AND OCD – Thoughts, events, or feelings can be transferred onto objects • Death, bad luck, a person’s personality traits are transferred onto objects • Believing that personality characteriscs act like germs which linger on objects or places • Objects retain the negave qualies of significant events • The more severe the OCD, the more likelihood to have magical thinking • The more magical thinking person experiences, the less tolerant of obsessive thoughts (more distress associated with obsessive thoughts) TREATMENT CONSIDERATIONS STANDARD CBT TREATMENT TECHNIQUES • Proper assessment – Assess level of OVI – Thorough psychosocial to idenfy possible trauma and betrayal • Assess for expression of other emoons associated with obsessive belief (anger, sadness, disgust) • Role of emoon dysregulaon and balancing validaon with exposure response prevenon in cases with dysregulaon • Behavioral experiments to challenge beliefs • Place oneself on a connuum in relaon to other people who act on their thoughts – Best ever person -‐-‐-‐-‐-‐-‐-‐worst ever person • Cognive therapy to address core beliefs • In vivo or imaginal exposure to person, place, or object that has taken on aversive emoonal quality • Response prevenon SUNDAY -218- 6
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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 5 -13-
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6/14/13 -15- 7
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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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6/24/13 Behavioral Experiment: C
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6/24/13 Treatment Responders (%)
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Perfecting Perfectionism Perfecting
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Types of Perfectionism Being th
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Healthy Perfectionism In general
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The cost of perfectionism • T
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Let’s Focus on Two Problemati
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• Are we there yet • The r
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Addressing Relapse in CBT for OCD 6
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6/14/13 Lisa’s Exposure Hierar
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Page 204 and 205: 6/14/13 Study Comparing Individual
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Page 208 and 209: 6/14/13 Contact Information The OCD
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Page 212 and 213: 6/14/13 Positive Reacting Styles P
Page 214 and 215: 6/14/13 What is P-N-P What is P-N-
Page 216 and 217: People and Places - Emotional Conta
Page 218 and 219: 6/14/13 CASE EXAMPLE • 67 year
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Page 224 and 225: Challenging Kids Challenged Adults
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Page 228 and 229: Tips for Non-OCD Anxiety Disorders
Page 230 and 231: Sleep Problems Tips for Sleep Probl
Page 232 and 233: EXECUTIVE FUNCTION “He is such a
Page 234 and 235: Write It or Regret It! CL UE Tips f
Page 236 and 237: Slow Processing Speed (Sluggish Cog
Page 238 and 239: Tips for Handwriting • Reduce cop
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
Page 246 and 247: Task Description & Reminder of spec
Page 248 and 249: Using Scaffolding Steps in Unplanne
Page 250 and 251: 6/14/13 Examples of Behavioral
Page 252 and 253: Assessment and Treatment of Postpar
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Page 256 and 257: 6/14/13 iCompulsions (OCD) or Cyber
Page 258 and 259: 6/14/13 Similarities Between HC and
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Page 262 and 263: 6/14/13 Sample Exposures For Health
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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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