perfectionism and - Obsessive-Compulsive Foundation

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6/14/13 Sample Exposures For Health Obsessions CBT for Hypochondriasis Obsession HIV Hepatitis C Food poisoning Sample Exposure Watch movie “Philadelphia” Touch books on “how to manage your HIV” in public library Eating meal in restaurant frequented by gays Sit in hospital waiting room chairs without gloves Touch beef blood from meat section of market Touch dried blood on used Band-Aid Eat canned foods out of a slightly dented can Eat meal from “unclean” restaurant • Supported by a number of studies (Barsky and Ahern, 2004; Warwick, et. al., 1996; Speckens, et. al., 1995; Clark., et. al., 1998) • Offering it as “stress management” more acceptable to HC patients CBT for HC – Do’s and Don’ts CBT for HC – Do’s and Don’ts Do: – Acknowledge reality of patient’s bodily concerns – Explore and validate the patient’s reasons for holding the beliefs they have about their symptoms – “It’s understandable that you’ve come to this conclusion” – Acknowledge patient’s doubts about the role of psychological factors in their symptoms. Present psychological factors as “an open question to be further investigated” – Get to some agreement that psychological factors play a role in the experience of pain – example of pain felt by athletes competing; mothers/fathers rescuing a child in danger – Discuss pitfalls of “certainty seeking” strategies such as doctor shopping, internet research, etc. – Provide alternative, non-illness related explanations for the patient’s symptoms -259- 9
6/14/13 Emotions Can Cause Bodily Sensations “I’m such a fool, totally embarrassed” “I’m so overwhelmed at work! I’ll lose my job!” “That a—hole is getting away with murder!” “I miss him/her so much! I can’t stand it” “I’m so relieved that Johnny passed his college entrance exam” • In addition to the catastrophic explanation, write down as many non-catastrophic explanations for the symptoms you are experiencing. Rate the likelihood of each (0-100%) • Review the list. Are there non-catastrophic explanations that are just as ore even more probable that the catastrophic ones Seeing TV show on skin cancer Possible Reasons for Having a Headache Tolerating Health Uncertainty • Establish that distress about one’s health is associated with intolerance of uncertainty • List all of the ways that client already tolerates uncertainty in countless ways: – Drives car – risking car crash – Goes to bank – risks being caught in holdup – Goes to work – risks not knowing if house has burned down – Goes outside – risks being hit by falling objects – Eats in restaurant – risks getting food poisoning • The difference: you’ve already habituated to the uncertainties above. ERP promotes habituation to health worries. SUNDAY -260- 1 0
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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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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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6/14/13 Is Performance During E
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6/14/13 Frame ERP to Mismatch
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6/14/13 Implica:ons for Psychoed
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6/14/13 Jenny Jenny • Referred
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6/14/13 Appraisals of intrusions
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6/14/13 Bill • His intrusive
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6/14/13 Response Prevenaon • D
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6/14/13 Study Comparing Individual
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6/14/13 Exclusionary Criteria Struc
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6/14/13 Contact Information The OCD
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6/14/13 Acceptance vs. Change Chan
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Page 222 and 223: 6/14/13 THE ROLE OF ACCEPTANCE
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
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Page 252 and 253: Assessment and Treatment of Postpar
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Page 256 and 257: 6/14/13 iCompulsions (OCD) or Cyber
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Page 268 and 269: 6/14/13 Treatment • Stop all comp
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Page 282 and 283: So You Expect Them to Leave Home So
Page 284 and 285: Daniel G. Pruitt, Jr., PCC, SCAC In
Page 286 and 287: NEEDED TRANSITION SKILLS: • Time
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Page 292 and 293: Washer and Dryer TRANSITION SKILLS:
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Page 296 and 297: TRANSITION SKILLS: • Tell them wh
Page 298 and 299: TRANSITION SKILLS: This Isn’t It!
Page 300 and 301: Tigers, Too Tigers, Too: Supplement
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Page 308 and 309: WHEN REASSURANCE IS HARMFUL By Paul
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