1 / 26

Living a Vital Life with Obsessions

Living a Vital Life with Obsessions. Jennifer Plumb MA, University Nevada Resno Benjamin Schoendorff MA,MSc, Claude Bernard U n iversity, Lyon 3 rd ACT World Conference, Enschede, July 2009. An ACT view of OCD. Obsessive-Compulsive Disorder. 2.6% of population ERP 60 to 85% effective

snana
Télécharger la présentation

Living a Vital Life with Obsessions

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Living a Vital Life with Obsessions Jennifer Plumb MA, University Nevada Resno Benjamin Schoendorff MA,MSc, Claude Bernard University, Lyon 3rd ACT World Conference, Enschede, July 2009

  2. An ACT view of OCD

  3. Obsessive-Compulsive Disorder • 2.6% of population • ERP 60 to 85% effective • 25% refusals + 3 to 12% drop out • Private compulsions resistant to ERP

  4. OCD and CT • OCD has a strong cognitive element • Cognitive therapy no more effective than ERP • Can CT increase ERP acceptability?

  5. ACT and OCD • Fusion (aka Thought Action Fusion) • How we relate to thoughts rather than the nature of thoughts • Beware : giving functional importanceto thoughts!

  6. The OCD paradox:Attempting to control one’s thoughts might make them less controlable

  7. RFT and OCD • Disorder of verbal regulation strategies • Transformationof stimulus functions • Faulty contextual control

  8. ACT Targets • Context of literality(defusion) • Emotional avoidance (acceptance) • Broader contextual control (broadening repertoire in presence of avoided stimulus) • Goal of Treatment: • Personal control over actions guided by values (Values, Commited Action) • reducing attempts to control obsessions & related distress (Mindfulness processes)

  9. Some evidence for ACT with OCD

  10. Empirical evidence • Twohig et al (2009): RCT of ACT and PRT (N = 80) • ACT – more tx responders, less drop out, cont’d improvement at 3 mo. fu • Clinically sig. decrease in YBOCS (many <9) • ACT processes change before OCD symptoms • Successful tx of primary obsessionals & hoarding • Schoendorff et al. prelim. data (non RCT pilot -group ACT w/tx resistant clients): • Y-Bocs at 1year fu (-29,86%) • Tx acceptability (high 4/5)

  11. Evidence for ACT with OCD Schoendorff et al, 2009 Unpublished Data

  12. Treating OCD with ACT

  13. A context of Choice • OCD means no choice • If you could choose between : • a life without your obsessions and no valued action • And • A life with obsessions and valued action?

  14. Treating OCD with ACTFunctional Analysis • What has worked ? • Short term • Long term • Valued directions • Validate the client’s experience

  15. Creative Hopelessness & Playing a New Game • Obsession Kid in a candy store • Helping client understand behavioral principles • Create a functional class of behavior: Managing/fixing/reducing obsessions & experiences • Controlas the problem • What we can control (compulsions & overt behavior) and cannot control (obsessions & distress) • Goal for treatment: Playing a new game - vitality

  16. Treating OCD with ACTDefusion • Strategies for Defusion • The way the mind works (Savannah = now) • Programming (1,2,3) – from where? • Physicalising thoughts • Metaphors (thoughts salespeople) • Mental Polarity: No peace at level of content • Beware: invalidation!

  17. Treating OCD with ACTMindfulness & Acceptance • Experientially broadening repertoire • Why? Awareness leads to increased choice • Mindfulness & Acceptance Strategies : • ‘Breathing in’ sensations and thoughts • Shifting attention (private exp to sounds, sights, smells, etc.)

  18. Treating OCD with ACTMindfulness & Acceptance • First video (exposure)

  19. Treating OCD with ACT Self-as-Context • An experiential base of security • Strategies • Introducing SAC in mindfulness • Chess board metaphor, Observer exercise • Passengers on bus • Explore ineffective self-rules (usually fused values) to free up alternatives • Concretize: Write/draw on cards

  20. Self-as-Context • Second video (Self-as-Context)

  21. Treating OCD with ACTValues and Commited Action • Wider context • Decentering from symptoms • Increase acceptability • Exploring what matters… • Moment of peace, posture, etc.

  22. Treating OCD with ACTValues and Commited Action • Values and Action Strategies: • If no OCD what would you do? • Trying on a value • Reducing compulsions = opportunity to practice acceptance • Non-OCD related committed actions

  23. Treating OCD with ACTValues and Commited Action • Third Video (choice)

  24. ACT & Traditional Exposure • Nothing in the model that says not possible • Goal: Flexibility of responding • During: broadening attention • Why? In service of values • Not directly linked, but as a class of behavior • Doing what YOU choose rather than what your obsessions say is possible • Why do things more intense than real life? • Tiger Woods – Practices in rain & snow

  25. Experiential Role-Play

  26. Workshop feedback • Did this workshop meet your expectations? • Thanks for filling-in our feedback sheet

More Related