Living a vital life with obsessions
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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

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Living a Vital Life with Obsessions

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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


An ACT view of OCD


Obsessive-Compulsive Disorder

  • 2.6% of population

  • ERP 60 to 85% effective

  • 25% refusals + 3 to 12% drop out

  • Private compulsions resistant to ERP


OCD and CT

  • OCD has a strong cognitive element

  • Cognitive therapy no more effective than ERP

  • Can CT increase ERP acceptability?


ACT and OCD

  • Fusion (aka Thought Action Fusion)

  • How we relate to thoughts rather than the nature of thoughts

  • Beware : giving functional importanceto thoughts!


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


RFT and OCD

  • Disorder of verbal regulation strategies

  • Transformationof stimulus functions

  • Faulty contextual control


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)


Some evidence for ACT with OCD


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)


Evidence for ACT with OCD

Schoendorff et al, 2009

Unpublished Data


Treating OCD with ACT


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?


Treating OCD with ACTFunctional Analysis

  • What has worked ?

    • Short term

    • Long term

    • Valued directions

  • Validate the client’s experience


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


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!


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.)


  • Treating OCD with ACTMindfulness & Acceptance

    • First video (exposure)


    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


    Self-as-Context

    • Second video (Self-as-Context)


    Treating OCD with ACTValues and Commited Action

    • Wider context

      • Decentering from symptoms

      • Increase acceptability

      • Exploring what matters…

        • Moment of peace, posture, etc.


    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


    Treating OCD with ACTValues and Commited Action

    • Third Video (choice)


    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


    Experiential Role-Play


    Workshop feedback

    • Did this workshop meet your expectations?

    • Thanks for filling-in our feedback sheet


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