Archive for Exposure and Response Prevention (ERP)

Oct
25

Everyday Mindfulness for OCD

by Laura Johnson

Everyday Mindfulness for OCD: Tips, Tricks and Skills for Living Joyfully

By Jon Hershfield and Shala Nicely

Written by two clinicians who are honest about having their own personal struggles with Obsessive Compulsive Disorder, Everyday Mindfulness for OCD offers a unique perspective on strategies for staying one step ahead of OCD symptoms. As the title implies, the authors present tips not for just living despite OCD, but for living joyfully with OCD.

This book is not an introductory manual for OCD, instead filling a need for those who are further along in their treatment. It is tailored towards those who already have a solid understanding of OCD and exposure and response prevention, but are looking for more ideas to increase or maintain progress long-term. It may be helpful as a supplement to therapy, or as a secondary book for those who have already completed a self help treatment workbook.

Everyday Mindfulness for OCD is divided into three sections: mindfulness and self compassion, daily tools and games to promote joyful living, and long-term mastery over OCD. The strategies presented feel very practical and concrete. The authors’ suggestions regarding self-compassion seem especially useful, as self-compassion skills can be difficult to develop, yet essential to living a joyful life. There are also a variety of exposure games included, which offer a great way to mix up your ERP practice.

How to Get Help for Obsessive Compulsive Disorder in San Jose/Los Gatos and Sacramento/Roseville

The Cognitive Behavior Therapy Center specializes in therapy and counseling with adults, children and teenagers. Click to send an email for more information on how we can help you or your family members improve your outlook.

Silicon Valley and Sacramento Valley Communities We Serve

Cognitive Behavior Therapy Center of Silicon Valley offers evidence-based therapy for Anxiety and Obsessive Compulsive Disorder near the following Silicon Valley/San Jose communities:

San Jose Therapy Counseling • Saratoga Therapy Counseling • Los Gatos Therapy Counseling • Monte Sereno Therapy Counseling • Cupertino Therapy Counseling • Campbell Therapy Counseling • Mountain View Therapy Counseling • Los Altos Therapy Counseling • Sunnyvale Therapy Counseling • Santa Clara Therapy Counseling

Cognitive Behavior Therapy Center of Sacramento Valley offers evidence-based therapy for Anxiety and Obsessive Compulsive Disorder (OCD) near the following Sacramento Valley and Sierra communities:

Sacramento Therapy Counseling • Roseville Therapy Counseling • Rocklin Therapy Counseling • Granite Bay Therapy Counseling • Lincoln Therapy Counseling • Folsom Therapy Counseling • Citrus Heights Therapy Counseling •  El Dorado Hills Therapy Counseling • Loomis Therapy Counseling • Grass Valley Therapy Counseling  • Auburn Therapy Counseling

CONTACT US
Click to send an email

0 Categories : Cognitive Behavior Therapy, Exposure and Response Prevention (ERP), Mindfulness, OCD
Sep
19

What is CBT Anyway?

by Laura Johnson

Cognitive Behavior Therapy 101

Often in our initial assessment appointment, a new client will ask “so what is Cognitive Behavior Therapy anyway?” Most people have read some about the disorder they are seeking help for and know that CBT is the treatment of choice, but CBT itself can be a mystery.

The CBT Viewpoint

In order to understand what CBT treatment is like, you first need to understand how CBT views problems like anxiety, depression and OCD. There are four parts: the triggering thought or situation, unhelpful or inaccurate thoughts about that situation, negative emotions, and maladaptive coping strategies. Here is the cycle illustrated with two examples:

Maladaptive coping strategies don’t work because they only relieve your negative feelings in the short term and keep you from learning anything new about the triggering situations. These behaviors end up reinforcing your unhelpful thoughts and the cycle continues.

CBT Strategies

Once you understand how CBT view problems, and apply it to the difficulties in your own life, you are ready to look for solutions. There are skills that can help you in each stage of the CBT cycle. No one strategy will work for everyone, but once you acquire some that work for you, you can start to unhook yourself from the cycle and new, healthier patterns develop.

* For the triggering thought or situation we teach mindfulness skills. Here the important thing to do is learn to notice your triggers in an objective non-judgmental way. For example, in the case above of the person having anxiety about giving a speech, we might teach her to notice when the thoughts and feelings creep up and say things like “I’m noticing more worries about this speech”. The key with mindfulness is to notice your symptoms without trying to change them. This nonjudgmental perspective sets the stage for the strategies that come next.

** Next comes cognitive restructuring. Our thoughts have strong effects on how we feel but just because we think something, doesn’t make it true. Cognitive restructuring involves learning to evaluate our thoughts for accuracy and helpfulness and, when we find a thought that is inaccurate or unhelpful, we replace it with something that helps us to see the situation more clearly and to act in accordance with our values.

*** Some of the strategies we use to cope with unpleasant emotions are emotional regulation skills, distress tolerance and activity scheduling. These strategies are aimed at helping you cope with an unpleasant emotions even if you can’t change them.

**** This last category involves changing our behavior response when faces with negative emotions. Often it involves doing the opposite of what our thoughts and feelings try to convince us to do. With behavioral activation, we schedule potentially rewarding and productive activities into the day to break an avoidant cycle. Exposure involves being in a feared situation without trying to escape or avoid feeling anxious. Behavior experiments involve testing out beliefs about ourselves and the world instead of assuming that our thoughts are true.

How to Get CBT for Anxiety and OCD Disorders in San Jose/Los Gatos and Sacramento/Roseville

The Cognitive Behavior Therapy Center specializes in therapy and counseling with adults, children and teenagers. Click to send an email for more information on how we can help you or your family members improve your outlook.

Silicon Valley and Sacramento Valley Communities We Serve

Cognitive Behavior Therapy Center of Silicon Valley offers evidence-based therapy for Anxiety and Obsessive Compulsive Disorder near the following Silicon Valley/San Jose communities:

San Jose Therapy Counseling • Saratoga Therapy Counseling • Los Gatos Therapy Counseling • Monte Sereno Therapy Counseling • Cupertino Therapy Counseling • Campbell Therapy Counseling • Mountain View Therapy Counseling • Los Altos Therapy Counseling • Sunnyvale Therapy Counseling • Santa Clara Therapy Counseling

Cognitive Behavior Therapy Center of Sacramento Valley offers evidence-based therapy for Anxiety and Obsessive Compulsive Disorder (OCD) near the following Sacramento Valley and Sierra communities:

Sacramento Therapy Counseling • Roseville Therapy Counseling • Rocklin Therapy Counseling • Granite Bay Therapy Counseling • Lincoln Therapy Counseling • Folsom Therapy Counseling • Citrus Heights Therapy Counseling •  El Dorado Hills Therapy Counseling • Loomis Therapy Counseling • Grass Valley Therapy Counseling  • Auburn Therapy Counseling

CONTACT US

Click to send an email

0 Categories : Anxiety, Cognitive Behavior Therapy, Exposure and Response Prevention (ERP), OCD, worry
Apr
11

The Boy Whose Dreams Came True

by Laura Johnson

Here’s a letter one of male teen clients wrote after successful completion of cognitive behavior therapy. It’s a very motivating letter for all ages even adults!

Dear Self,

The engine of my car rumbled when I came here, but the funny thing was that I didn’t even know where I was going. Then my parents said “Remember those scary pictures the kids showed you and you were very scared about that?” and I said “Yeah…” Then they said “we’re going to do something about that so we’re going to take you to a therapist to deal with that and not be scared about them anymore.”

I had a lot of fears about looking at the pictures because if my parents said I was scared, I knew at some point I’d see those pictures again. I thought Saryna would be very mean, and I didn’t want to have to be one of those people lying down on the couch just talking. I was totally unready at first. I just didn’t want to be here when we started talking. Once we came up with the hierarchy list, I was completely not ready for doing anything on that list. For the first few times we did the hierarchy, I thought I could do them, but I knew I couldn’t do anything above a level 5. Especially with a level 10, I would have run away. But the third time I was here, we already started and I said “It was no big deal” afterwards. After that, I knew I could definitely get through all of these. If I were to do the highest thing on the hierarchy list then, I would have never came back here again. Currently, I am 11 years old and I can look at one of the scariest pictures in the world.

“Just do it. Don’t let your dreams be dreams. Just do it.”
This is the quote you should think about when something that you have great anxiety around happens.

The practices here were like the practices I did for the multiplication test I had in 3rd grade. I was practicing my multiplication tables with my mom every day. The day I took the test, I got a really good score – almost 100%. This reminds me of now and the whole year I was here. At the beginning, I was so scared to see the pictures. Now, it’s like the day I took the test. I may have a little anxiety when I see the pictures, but I can do it easily.

I learned that sometimes I go turtle speed and sometimes I go rabbit speed. Just like a band aid, if you go really slow to take it off, it’s really painful. But if you go really fast, it hurts too. If you go at the right speed, it doesn’t hurt as much. I realized this is my own speed. It’s my speed that helps me do things and doesn’t make me scared.

My fear was that I couldn’t handle myself in the dark, and I was constantly waking up and going to my parents’ bed. It has probably been a year and when I compare my new self with my old self, you can see a huge difference in my levels of anxiety.

There were two ways I realized my brain was tricking me. Recently, I have had many bloody noses in the middle of the night and whenever I had them I would usually depend on my parents to stop the bleeding and take care of it, and then I would go to their bed because I was awake and scared. But the latest one I’ve had was a very surprising experience because I handled the bleeding and my nose all by myself, and once I was done, I realized I didn’t need my parents to do it.
My brain was tricking me about that. I was really proud of myself after that happened because my brain would trick me all the time. Another reason why I learned my brain was tricking me, each time we looked at a cut up picture of the characters I was scared of, I realized I was willing to bring it closer to me. From that, I realized my brain was tricking me to be constantly cautious without being willing to try anything uncertain.

So that’s why I have created a character of my own called Mr. Muntz. Mr. Muntz helped me realize every time my brain kept saying “no you can’t do this!” That’s what Mr. Muntz would be saying. So to prevent that from happening, I created another character called Homeyeggagetasaurous Rex. Homeyeggagetasaurous Rex was a combined character of all of my favorite people and fantasy and real life. When I thought of Homeyeggagetasaurous Rex, it helped me realize that I can conquer whatever Mr. Muntz told me because the reckless dinosaur I created helped me think of a silly, cool, and strong personality of myself and I wouldn’t need to worry about anything that I’ve done or will be doing that would make me feel scared and have a really high anxiety level.

So as you can see, you can always try even if you’re scared of doing it. As I said, you should listen to the quote “Just do it. Don’t let your dreams be dreams. Just do it.” so that you can focus on the happy time and not let your worries control you.

Sincerely,
The Boy Whose Dreams Came True

0 Categories : Anxiety, Cognitive Behavior Therapy, Exposure and Response Prevention (ERP), Motivation, Uncategorized
Jun
25

OCD Specialty Outpatient Clinic for the OCD Foundation

by Laura Johnson

Cognitive Behavior Therapy Center Designated a Specialty Outpatient Clinic by International OCD Foundation

OCD Foundation LogoThe Cognitive Behavior Therapy Center of Silicon Valley and Sacramento Valley has been designated as a Specialty Outpatient Clinic by the International OCD Foundation. A Specialty Outpatient Clinic is defined as:
1) A minimum of three, licensed clinicians who maintain a professional membership in the IOCDF working in the same outpatient clinic.
2) These clinicians should have 10 combined years experience treating OCD and related disorders.
3) The identified clinic advertises itself as a facility where the primary focus is on the treatment of OCD and/or related disorders.

https://iocdf.org/clinics/cognitive-behavior-therapy-center-of-silicon-valley/
https://iocdf.org/clinics/cognitive-behavior-therapy-center-of-sacramento-valley/

How to Get Help for OCD in San Jose/Saratoga and Sacramento/Roseville

The Cognitive Behavior Therapy Centerspecializes in Obsessive Compulsive Disorder (OCD) therapy and counseling with adults, children and teenagers. Click to send an email for more information on how we can help you or your family members overcome OCD.

Silicon Valley and Sacramento Valley Communities We Serve

Cognitive Behavior Therapy Center of Silicon Valley offers evidence-based therapy for Anxiety, Obsessive Compulsive Disorder and Eating Disorders near the following Silicon Valley/San Jose communities:

San Jose Therapy Counseling • Saratoga Therapy Counseling • Los Gatos Therapy Counseling • Monte Sereno Therapy Counseling • Cupertino Therapy Counseling • Campbell Therapy Counseling • Mountain View Therapy Counseling • Los Altos Therapy Counseling • Sunnyvale Therapy Counseling • Santa Clara Therapy Counseling

Cognitive Behavior Therapy Center of Sacramento Valley offers evidence-based therapy for Anxiety, Obsessive Compulsive Disorder (OCD) and Eating Disorders near the following Sacramento Valley and Sierra communities:

Sacramento Therapy Counseling • Roseville Therapy Counseling • Rocklin Therapy Counseling • Granite Bay Therapy Counseling • Lincoln Therapy Counseling • Folsom Therapy Counseling • Citrus Heights Therapy Counseling •  El Dorado Hills Therapy Counseling • Loomis Therapy Counseling • Grass Valley Therapy Counseling  • Auburn Therapy Counseling

CONTACT US

Click to send an email

0 Categories : Anxiety, Cognitive Behavior Therapy, Exposure and Response Prevention (ERP), OCD
Jun
4

Book Review: Same Time Next Week

by Laura Johnson

Stories of Hope and Resilience in Mental Health

Read Laura Johnson’s book review of “Same Time Next Week” on Positive Psychology New Daily:

http://positivepsychologynews.com/news/laura-lc-johnson/2015060331717

How to Get Help for Anxiety, OCD and Anxiety-Related Problems

The Cognitive Behavior Therapy Center of Silicon Valley and Sacramento Valley specializes in Anxiety, OCD and Anxiety-Related Problems in adults, children and teenagers. We have two convenient locations to serve you.

The Silicon Valley office in Saratoga serves the Santa Clara County communities of San Jose, Saratoga, Mountain View, Santa Clara, Sunnyvale, Los Gatos, Los Altos, Palo Alto, Cupertino, Campbell and surrounding areas.

The Sacramento Valley office in Roseville serves the Placer County and Sacramento County communities of Sacramento, Roseville, Rocklin, Granite Bay, Lincoln, Folsom, Citrus Heights, El Dorado Hills, Loomis, Auburn, Penryn, Grass Valley, Colfax and surrounding areas.

Email us for more information on how we can help you overcome your anxiety-related problems.

0 Categories : Anxiety, Cognitive Behavior Therapy, Exposure and Response Prevention (ERP), Motivation, OCD, Positive Psychology
Aug
3

2014 Annual OCD Conference

by Laura Johnson

 

OCD Foundation’s Annual Conference

OCD ConferenceI recently attended the 21st annual OCD Conference in Los Angeles put on by the International OCD Foundation. The conference was well organized and had a wide variety of session topics from highly respected speakers in the field of OCD and OCD spectrum disorders with respect to research and treatment. By OCD spectrum, I’m referring to issues such as Trichotillomania, Body Dysmorphic Disorder, Hoarding, and Tourette’s Disorder. One aspect of this conference I appreciated was that attendees were not just treatment professionals, but included children, teens and adults with OCD, parents of children with OCD looking for support, and researchers. Not surprisingly, the overwhelming majority of treatment discussions focused on Exposure and Response Prevention (ERP). ERP is the gold standard for treatment of OCD for all age groups. ERP involves identifying the underlying obsession(s), illuminating the patterns of being triggered and engaging in compulsions, developing a fear hierarchy and finally defining response prevention guidelines.

OCD Treatment with Children and Teens

Because I enjoy working with children and have a number of children with OCD on my caseload at any given time, I attended several talks geared toward OCD treatment for children and teens. A few of these were intended for children with OCD and others had content intended for treatment professionals. One of the talks I attended was about developing an effective toolbox for beating OCD, geared toward children with the disorder. One of the tools imparted on the attendees was knowledge about the adaptive nature of anxiety; for instance, when your heart races, it’s the body’s way of pumping blood to your muscles faster to help with fight or flight actions; when your body sweats, it’s so the body is slick if an attacker grabs onto you. So reduction in fear of anxiety itself can be a good first step. Another tool they wanted to arm attendees with was knowledge and experience with ERP. They helped the kids in the audience identify which type of OCD thoughts they had and as a group, we brainstormed ways to engage in exposures by figuring out how to test contamination fears, for instance, by exposure to different things in the meeting room we were in.

Using Mobile Apps for OCD

Teen OCD Cell PhoneAnother session I attended was geared toward mobile applications that can help kids and teens develop exposures using cell phones and tablets. One of the applications that was highlighted turns spoken fears into songs that the child or teen can listen back to as exposure homework. The goal of this application is to turn a fear into something slightly comical or entertaining through song and music. By creating a competing reaction, like laughter, the fear diminishes because it’s fairly difficult to be entertained and laughing while also being fearful or scared. A second mobile application discussed in the presentation is useful with fears of harming others. The essential feature of this application allows users to create characters based on people they fear harming, and then allows them to virtually kill these people through the application. In essence, the user is acting out the feared behavior in a virtual world while still eliciting the anxiety. Both applications are useful in situations where an in vivo exposure is either not appropriate or difficult to execute.

Insight Helps with Beating OCD

Insight is a valuable tool in therapy. Research indicates that lack of insight with OCD is associated with greater symptom severity and higher risk for co-morbidity, or an additional diagnosis or clinical issue. I attended a panel discussion that focused on the role insight in the treatment of OCD and BDD among others disorders. Insight is not fixed and can be encouraged and modeled through the therapeutic process. Overvalued ideation was another concept tossed around that looks similar to insight but refers to the strength of conviction about a belief. Without insight, it’s difficult for someone dealing with OCD to entertain the idea that the rituals aren’t accurate. Lastly, the panel mentioned that when insight is low and progress is difficult to come by, psychopharmacological options can be helpful.

 

Health Anxiety Sub-Types

Health anxietyThere is a fair amount of overlap between health-related OCD and Somatic Symptom Disorder (SSD), formerly known as Hypochondriasis. Similar features include having thoughts about an illness, repeated self-checking, reassurance seeking with medical tests, doubting test results, and over-concern with the significance of bodily sensations. One of the main differences between the two is that with SSD, sufferers frequently experience visceral physical sensations, whereas OCD sufferers experience doubtful dysperceptions. It can be useful to think of health-related OCD and SSD on a continuum of doubt with OCD sufferers having considerable doubt and SSD sufferers having much less doubt. Exposure and Response Prevention can be an effective intervention with SSD as well OCD.

Another concept mentioned in the SSD vs. health-related OCD presentation was iCompulsions or CyberChondriasis, which both relate to the act of mining websites like WebMD for health and treatment information as a form of reassurance-seeking. This behavior typically results in an increase in anxiety from increased focus on the physical sensation or discomfort. This can quite easily lead to catastrophizing thoughts about what a possible diagnosis might be. Even for individuals without SSD or OCD, seeking health information online can be a confusing, scary and misleading process. So combined with a hyperfocus on physical symptoms and/or persistent doubt, it’s understandable to see how SSD and OCD can develop.

Face Your Fears!

And lastly, a quote that was provided during the conference that I think gets at the heart of ERP is as follows: “Do the thing you fear the most, and it will be the certain death of it,” attributed to Ralph Waldo Emerson.

Overcome Fear

0 Categories : Exposure and Response Prevention (ERP), OCD
Aug
2

Exposure & Response Prevention for Obsessive Compulsive Disorder (OCD)

by Laura Johnson

Exposure and Response (Ritual) Prevention for Obsessive Compulsive Disorder (OCD)

Exposure and Response Prevention OCD PennI recently attended intensive training in Exposure and Response Prevention for OCD at the Center for the Treatment and Study of Anxiety at the University of Pennsylvania in Philadelphia. In addition to terrific presentations by Dr. Elna Yadin, OCD Clinic Director, and staff members, we were honored with a Q&A session with Dr. Edna Foa. While I already considered myself a skilled therapist in treating OCD, this training helped refine my skills in systematically implementing a specialized form of OCD treatment called “Exposure and Response (Ritual) Prevention,” also know as EX/RP or ERP.

What is Obsessive Compulsive Disorder (OCD)?

Obsessive compulsive disorder (OCD) is a neurological disorder that causes severe anxiety/distress and affects your thinking and behavior. OCD tends to attack the things you value the most. When you feel anxious, it might feel like you are in danger. OCD tells you to respond, react, protect yourself, and do something to get rid of the distress. You might recognize that the fear is excessive or doesn’t make sense, yet it still feels very real, intense, and true. If you have OCD, the warning system in your brain is not working correctly. Your brain is telling you that you are in danger when you are not.

Common Types of OCD

Obsessions are unwanted, intrusive thoughts, images, or impulses that occur over and over again and feel out of your control. They are disturbing, anxiety-provoking and perhaps even disgusting to you. Common obsessions include contamination from germs, bodily fluids, diseases, or chemicals; causing or failing to prevent harm to others; fear of losing control; sexual, religious or morally offensive thoughts and images; perfectionism; and not-just-right feelings.

Compulsions are repetitive behaviors or mental rituals that you engage in to neutralize, undo or make your anxiety go away. Compulsions can also include avoiding situations that trigger obsessions. Common compulsions include checking, washing and cleaning, repeating an action, putting things in order, praying, counting, mental review, reassurance seeking, apologizing and confessing. These actions are designed to prevent or reduce emotional discomfort and avoid the occurrence of a dreaded event. Compulsions tend to provide temporary relief but the obsessions soon return.

It is important to note that OCD comes in many different forms and no two OCD sufferers are alike in their combination of obsessions and compulsions as well as the meaning they attribute to their feared catastrophe.

What is Exposure and Response (Ritual) Prevention (EX/RP)?

In a nutshell, EX/RP consists of exposing you to the triggers that cause anxiety and fear and teaching you to resist doing any compulsions or rituals to reduce the distress. The basic principles of EX/RP can be boiled down to three steps that need to be practiced consistently to overcome OCD:

  1. Confront the things you fear as often as possible.
  2. If you feel like you have to avoid something, don’t.
  3. If you feel like you have to perform a ritual to feel better, don’t.

With EX/RP, your brain learns that you can tolerate anxiety and that your anxiety will eventually come down without rituals. Your brain will learn that the feared catastrophe does not happen or that you could handle it if it did. And you may start to realize just how ridiculous or unrealistic your obsessional fears are and how much OCD is taking away from your life. Basically, OCD is a bully! We will teach you how to take charge and not give OCD the attention it craves.

The main treatment components of EX/RP include:

  • Assessment, Education and Treatment Planning: We’ll identify all your triggers, obsessional fears and related rituals and make a plan to systematically approach your fears without engaging in rituals. We will also teach you about the sneaky ways OCD tries to trick you and lies to you. You will learn that OCD is like a “tic” in the brain that is trying to protect you but instead OCD is making you a slave and ruining your life.
  • In Vivo Exposure: Exposures are the heart of OCD treatment. In this step, we will expose you to real life triggers that elicit fear, anxiety and/or disgust in a gradual hierarchical manner. We will start with easy exposures and, as you gain confidence you can cope with your anxiety, we will move up the hierarchy to confront situations that are more challenging.
  • Imaginal Exposure: This involves prolonged exposure in your imagination to your worst fears without doing any rituals. We’ll develop a script (or series of scripts) for you to record and listen to every day until you are no longer scared of the content of your obsessions and you can visualize yourself facing your fear without any rituals.
  • Response (Ritual) Prevention: RP is the identification and elimination of all physical and mental compulsions so you can learn you can cope with distress without doing rituals or avoidance. You will learn that while your rituals reduce anxiety/distress in the short term, they are not building your courage that you can handle anxiety without them. Rituals are actually fuel to OCD’s fire and maintain the OCD cycle.
  • Cognitive Processing: The key to long term, permanent change is gaining new beliefs and increasing your self-confidence. OCD is making you believe things that aren’t true and exaggerating the danger of your fears. In order to help you overcome OCD, we won’t tell you what to think because OCD will just argue with you. Instead, we’ll discuss what you have actually learned through your EX/RP activities and reinforce your experiential learning in order to create new beliefs about the meaning of your obsessions.

Treatment Description

In EX/RP, you will purposely experience your obsessive thoughts without ritualizing so you can learn that your discomfort/anxiety will come down and your fear is eventually extinguished. With your therapist, you will develop a hierarchy of exposures that will elicit your obsessional fear and we’ll develop a plan for systematically targeting each of the items. We’ll identify both behavioral and mental rituals to eliminate. EX/RP generally takes about 20 sessions total. We recommend two 75-minute sessions per week to help you maintain continuity and motivation in doing the exposures and to progress more quickly to relieve your suffering.

Initial Evaluation Session

The goal of the initial evaluation session is to learn about your background and history as well as determine what type of anxiety you have. If the diagnosis is OCD, then we will discuss the EX/RP treatment approach and determine if it is a good fit for you. We will also begin to assess your motivation since completing daily exposures in between sessions is essential to success in this program.

Information Gathering and Education

In the next one to two sessions, we will gather a lot of information about the content of your obsessions, types of compulsions/rituals you use to reduce obsessive fears, and the feared consequences if you are unable to perform your rituals. We will use a standardized assessment tool called the YBOCS, which helps us assess all the OCD symptoms and rate the severity of your OCD from mild, moderate to severe. You will also be asked to monitor your OCD symptoms throughout the week. The goal of this phase is to develop a thorough understanding of your obsessions and compulsions and the situations likely to trigger them. We will continue to assess your motivation for treatment and how much support you will need by the therapist and family members in implementing your EX/RP plan.

Treatment Planning

Next, we will spend one to two sessions determining what the feared catastrophe is, creating the hierarchy, identifying and ranking the order of exposures, deciding whether imaginal exposure is needed, creating the plan for reducing and eliminating rituals, and deciding whether exposure requires travel outside the therapist’s office such as a home visit. The question often arises as to whether we need to create different hierarchies for each type of OCD. While this may be helpful when the OCDs seem completely unrelated to one another, it is often not needed because the ultimate fear is often the same for all the OCDs. By creating one master hierarchy and working on fears by level of discomfort/anxiety, you will learn the principles of treatment and the therapy often generalizes more effectively from one symptom to the next.

To create a hierarchy, you and your therapist will generate a list of all the situations that provoke obsessive fear and avoidance behavior. We will then ask you to rate how much distress each situation causes for you on a scale of 0 to 100 and we will place the items in order from easiest to hardest. We generally start working on exposures rated in the 40-50 range and progress to harder exposures and the easier ones are mastered.

Imaginal exposures are used when engaging in the actual situation is not possible in real life, when your feared consequences are so far into the future that they can not be disconfirmed, or when you have so much fear approaching the real life situations that we need to start with thinking about the situation before progressing to actual exposures.

Exposure and Response Prevention Treatment

EX/RP treatment begins when we start working on the first situation on your hierarchy. Generally, 15 exposure sessions are recommended but some people with mild OCD may progress more rapidly while others with more severe OCD may need extra sessions. We will start with doing exposures during the therapy session and then assign the same exposure as homework for you to practice on your own. When your distress significantly declines and you no longer fear the situation, then we will move to the next item on the hierarchy. Since we are starting with items you ranked at a moderate level and only moving up when your distress has declined, it makes working on the harder items on the hierarchy feel much easier. If you find that you are not feeling a reduction of anxiety within 45 minutes, then we have probably underestimated the difficulty of that situation and we would move to an easier item. If we are working at the right pace, you should be feeling challenged in exposure sessions but not so uneasy that you can’t do it.

While doing exposures, you will not be allowed to perform any rituals to undo the anxiety or distress. Sometimes we may allow you to modify a ritual to allow you to approach situations that are more difficult and higher on the hierarchy but our goal will be to quickly eliminate the all rituals associated with that situation. We want your brain to learn that it can face your fears and overcome obsessional fears without doing any rituals.

A key to success in EX/RP is changing how you relate to the meaning of danger created by your OCD. This is called cognitive processing, where we will discuss what you learned from the exposure without doing your normal rituals. We will stress that the content of your obsessions doesn’t matter because OCD will latch onto whatever is important to you. Most people have multiple types of OCD and notice it morphs and evolves over time into new symptoms. We want you to learn the general principles of EX/RP so you can “zap” whatever part of your life OCD wants to target in the future.

We will move up the hierarchy as quickly as you can tolerate it. When all the items on your hierarchy no longer cause distress and you are no longer performing rituals to reduce anxiety, then we can formally end the EX/RP treatment phase.

Relapse Prevention

Generally, we’ll plan on two to three relapse prevention sessions spaced out over time. OCD symptoms often wax and wane with stress and life transitions. Relapse prevention consists of reviewing your progress, identifying the tools you can use to manage any future OCD flare ups, identifying and planning how to handle potential future stressors, and knowing the warning signs of OCD and how you can treat it yourself with your tools, especially self-exposure.

0 Categories : Anxiety, Cognitive Behavior Therapy, Exposure and Response Prevention (ERP), OCD, Uncategorized
May
8

Do You or a Loved One Have OCD?

by Laura Johnson

OCD Quiz: Do You Have Symptoms of Obsessive Compulsive Disorder?

Woman with OCDThe following questionnaire will help you identify the types of problems and symptoms that most trouble you. Don’t be surprised if you check more than one item in several groups. Many people have more than one type of OCD symptoms. In addition, OCD can appear in many different forms so it is possible that your particular symptoms are not on this list.

Typical OCD Symptoms

What symptoms bothered you? Note how much each item bothered you or interfered with your life in the last month. If you avoided things due to these symptoms, take that into account in your rating. Rate them as follows:

0 = Did not bother me at all /no avoidance due to symptoms / did not interfere with my life

1 = Bothered me a little / some avoidance due to symptoms / interfered with my life a little

2 = Bothered me a moderate amount / avoided several things due to symptoms / interfered with my life quite a bit

3 = Bothered me a lot / avoided many things  due to symptoms / significant interference with my life

Washing and Cleaning
___ 1. I avoid touching certain things because of possible contamination.
___ 2. I have difficulty picking up items that have dropped on the floor.
___ 3. I clean my household excessively.
___ 4. I wash my hands excessively.
___ 5. I often take extremely long showers or baths.
___ 6. I’m overly concerned with germs and diseases.

Checking and Repeating
___ 1. I frequently have to check things over and over again.
___ 2. I have difficulty finishing things because I repeat actions.
___ 3. I often repeat actions in order to prevent something bad from happening.
___ 4. I worry excessively about making mistakes.
___ 5. I worry excessively that someone will get harmed because of me.
___ 6. Certain thoughts that come into my mind make me do things over and over again.

Ordering Rituals
___ 1. I must have certain things around me set in a specific order.
___ 2. I spend much time making sure that things are in the right place.
___ 3. I notice immediately when my things are out of place.
___ 4. It is important that my bed is straightened out impeccably.
___ 5. I need to arrange certain things in special patterns.
___ 6. When my things are rearranged by other people, I get extremely upset.

Thinking Rituals
___ 1. Repeating certain words or numbers in my head makes me feel good.
___ 2. I often have to say certain things to myself again and again in order to feel safe.
___ 3. I find myself spending a lot of time praying for non-religious purposes.
___ 4. “Bad” thoughts force me to think about “good” thoughts.
___ 5. I try to remember events in detail or make mental lists to prevent unpleasant consequences.
___ 6. The only way I can stay calm at times is by thinking the “right” things.

Worries and Obsessions
___ 1. I often get upset by unpleasant thoughts that come into my mind against my will.
___ 2. I usually have doubts about the simple everyday things I do.
___ 3. I have no control over my thoughts.
___ 4. Frequently the things that pop into my mind are shameful, frightening, violent, or bizarre.
___ 5. I’m afraid that my bad thoughts will come true.
___ 6. When I start to worry, I cannot easily stop.
___ 7. Little, insignificant events make me worry excessively.

Time Spent on OCD Symptoms

The amount of time you spend on your symptoms is another indication of how much it intrudes in your life. In the past month, how much time have you spent, on an average day, engaged in these symptoms.

Hours/Minutes
________ Washing and Cleaning
________ Checking and Repeating
________ Ordering
________ Thinking Rituals
________ Worrying or Obsessing
________ Total Hours (on an average day)

When to Get Help for OCD

If you find that some symptoms bother you a lot or you are spending more than one hour per day on your symptoms, then you might have a clinical level of OCD. You should see a mental health therapist for an evaluation and possible treatment. The earlier you get help, the better as repeating rituals frequently increases anxiety and OCD.

Where to Get Help for OCD

The Cognitive Behavior Therapy Center of Silicon Valley specializes in obsessive compulsive disorders in adults, children and teenagers. With our convenient location just a 1/2 mile from highways 85 and the Saratoga Avenue exit, we serve the Silicon Valley communities of San Jose, Saratoga, Mountain View, Santa Clara, Sunnyvale, Los Gatos, Los Altos, Palo Alto, Cupertino and Campbell, CA. Contact us at (408) 384-8404 for more information on how we can help you overcome your OCD symptoms.

Source: This OCD Quiz was modified from the questionnaire appearing on anxieties.com.

0 Categories : Cognitive Behavior Therapy, Exposure and Response Prevention (ERP), OCD, Uncategorized
Oct
15

Pediatric OCD Treatment for Children and Teens

by Laura Johnson

OCD Treatment for Children and Teenagers

notobsessiveI just had the honor of attending the OCD Foundation’s first-ever Behavior Therapy Training Institute on Pediatric OCD, which was held at Rogers Memorial Hospital in Wisconsin in mid-September. The treatment for children and teens with OCD is not all that different from adults. The main components of OCD treatment include:

  • Education/Rapport Building (what is OCD? building the client’s trust)
  • Cognitive Therapy (motivation, naming and externalizing the OCD, responding to content vs themes, etc)
  • Exposure and Response Prevention (identifying triggers and gradually exposing the child until anxiety declines)
  • Family Therapy (teaching parents how to help their child)
  • Contingency Management (setting up a reward plan to increase motivation)
  • Relapse Prevention (what to do at the early signs of anxiety or stress)

While we do use cognitive strategies especially for motivation with children, we emphasize behavioral strategies even more with children. Children often aren’t able to articulate the thoughts driving their rituals. They may say “I don’t know” or “It just feels right” or “I can’t help it.” As children and teens mature, it may seem their OCD is becoming more sophisticated because they start attributing reasons to why they do things.

When we are assessing OCD in children, teens or adults, the process is the same. The therapist will be thinking about these factors:

  • Triggers: What stimuli trigger the obsession?
  • Obsession: What is the core fear?
  • Compulsions: How does the person attempt to neutralize the obsession?

There are four main steps in designing a personalized OCD treatment program for your child or teen.

Step 1: Define the Obsessions and Select the First Target Obsession to Work on

First, we need to determine if the thought is an obsession. If your child has a strange or irrational thought and can dismiss it, it’s not an obsession. Normal people have intrusive thoughts but the difference is that people without OCD do not attribute much meaning to them. Most people just shrug it off as a strange thought and go on with their day.

People often confuse the obsessions associated with OCD with the worries associated with Generalized Anxiety Disorder. It’s a worry if the content focuses on everyday problems that cause stress. GAD often has the same obsessional, repetitive feel to it except the theme of the worries are about real problems happening in the child’s life such as school, health, friends or family issues. An obsession, in contrast, is an intrusive, repetitive thought with senseless content. In children, common obsessions include doing things repeatedly until it feels “just right,” bad thoughts about sex or violence, superstitious thinking, and irrational concern about germs.

Step 2: Identify the Obsessions/Triggers and related Compulsions

Next, we need to identify the compulsions (rituals) that go along with the obsessive thoughts and what triggers the obsessive-compulsive cycle. External triggers are easier to work with because they are things, people, places or situations that scare people and trigger the OCD cycle. The types of OCD that usually involve external triggers include contamination, just right/not right obsessions, and doubt and uncertainty

Internal triggers, on the other hand, are the thoughts themselves, usually about sex, violence and blasphemy. For a thought to be a trigger, the thought itself must be perceived by the person as being dangerous. There are two categories of thoughts that people perceive as being toxic: the fear that having the thought can make it happen and/or the fear that having thought means something bad about the person who is experiencing the thoughts.

Step 3: Develop the Exposure Hierarchy

Exposure and Response Prevention (ERP) is the gold standard for treating OCD in all age groups. ERP is teaching you and your child an approach to life. Your child will learn that when something makes him afraid, he will face it. He will learn to approach his fears systematically through the Exposure Hierarchy. To develop a hierarchy, we will identify all the internal and external triggers for the obsessions and rank order them by level of difficulty. We will then proceed by working with you and your child in baby steps to approach their fears. We’ll use the feeling thermometer to help your child rate the difficulty of tasks. We will ask the parent to serve as the child’s ERP coach to help remind your child to practice their exposures during the week.

Step 4: Identify Response Prevention Guidelines for the Compulsions

The final step is to identify the compulsions (rituals) and to develop Response Prevention Guidelines that sound like this:
“When I get urge to (do my ritual), I will resist the urge and do this instead: XYZ.”

There are two categories of compulsions: Behavioral vs. Mental. Behavioral compulsions are things you can see your child doing such as washing, checking, reassurance seeking, straightening, etc. Mental compulsions are done in the child’s head and you may not even know they are doing them. These include counting, praying, figuring things out, replacing bad thoughts with good thoughts and mental checking.

We also need to determine if the compulsions are non-functional vs dysfunctional. Non-functional compulsions (rituals) are behaviors have no function other than to reduce anxiety related to OCD anxiety. Since these are non-sensical behaviors (like tapping three times on a door), our treatment plan will focus on eliminating these behaviors entirely because they have no function.

Dysfunctional compulsions (rituals) are excesses of normal behavior. We can’t completely eliminate these behaviors because done in moderation, they are normal behaviors like normal washing normal checking and normal prayer. For these, we help your child develop new rules for normal behavior.

During planned daily exposure time there is a schedule and specific tasks to be completed each day. Planned exposure time is generally 30 min to one hour per day. We’ll teach your child to engage in the obsessive thought while resisting the urge to ritualize. We will teach them that “When I get urge to …., I will resist the urge and do this instead …” We will also do some cognitive restructuring work where your child will learn to accept and even welcome anxiety and uncertainty by purposely choosing to expose himself to his triggers, knowing this will trigger his obsessive thoughts and urges to neutralize the anxiety with rituals.

The rest of the day, the child is taught how to deal with spontaneous exposures, or when the obsessive thoughts are triggered outside of planned exposure time. Again, we will teach your child that “When I get urge to …., I will resist the urge and do this instead …” We will help him learn to try to resist doing the compulsion and to focus on what he needs to doing instead (doing homework, watching TV, listening to music, paying attention in class, talking with friends, etc). The child will also have a list of guidelines to follow for any dysfunctional compulsions he may have an urge to do.

The key to Exposure and Response Prevention is to be ready to face your fears and to do your homework every night. You and your child will learn to ride up and down the OCD anxiety hill and beat OCD.

0 Categories : Cognitive Behavior Therapy, Exposure and Response Prevention (ERP), OCD