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Exposure Therapy’s Most Common Mistake: All Eggs in the Habituation Basket

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Many people have an incomplete understanding of exposure therapy… …be it exposure and response prevention (ERP) for OCD, intentional mistake practice for social anxiety, or interoceptive exposures for panic disorder… This is true for exposure newbies, seasoned exposure veterans, and even some good CBT therapists. This limited understanding is based on the following flawed logic: Premise 1: Anxiety disorders involve fear. Premise 2: Fear is reduced through habituation. Premise 3: Habituation is accomplished via exposure. Conclusion: Habituation is the process by which individuals recover from anxiety disorders. Note: This conclusion is only partially correct. Exposure, when done right, is about much more than just habituation. It’s about learning to see the world in a new way and developing a different type of relationship with your symptoms. Exposure can help you challenge unhealthy, false beliefs about yourself and the world;...

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Sensorimotor OCD & Social Anxiety Differential Diagnosis: “Obsessive Swallowing”

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Reader Question: For the past year, I have been dealing with OCD-related sensorimotor obsessions focused on swallowing. My symptoms started during a class discussion in which I noticed myself swallow. Since then, whenever I am in a lecture or quiet place surrounded by people, I become deeply focused on my own swallowing and worry that others will notice my swallowing and then judge me. I am practicing meditation and daily exposures in which I sit down in a quiet room and intentionally invite the swallowing in. I also purposefully invite the swallowing in throughout the day, even when I am in the presence of friends. I try to be mindful of my swallowing without doing anything to avoid it or mask it. Even though my awareness of swallowing has not entirely gone away, the anxiety associated with it has...

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Treatment for Body-Focused Obsessions & Compulsions in OCD (e.g., Swallowing, Breathing, Blinking)

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This post is the last in a series of posts discussing body-focused obsessions and compulsions (aka, sensorimotor, somatosensory, or somatic obsessions and compulsions) in obsessive-compulsive disorder (OCD). This series was inspired by an original article written by Dr. David Keuler for Beyond OCD. You can access Dr. Keuler’s excellent article here. Ruling out Medical Causes for Body-Focused Obsessions & Compulsions in OCD (sometimes called Sensorimotor or Somatic Obsessions) Before we begin discussing cognitive behavioral treatment for body-focused obsessions and compulsions, it is important to note that there are many non-psychological causes of physiological symptoms. Consequently, it is essential to be evaluated thoroughly by a medical doctor in order to rule out any possible physiological causes for your symptoms. If a medical disease is responsible for your issues with swallowing, breathing, blinking, or moving, the techniques I will be discussing...

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OCD Treatment (ERP & CBT): Exposure & Cognitive Restructuring

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Question: To what extent would a change of mindset (e.g., changing my expectations for myself) be helpful in recovering from OCD? What is likely to happen if I delay formal treatment with a psychologist and work instead on changing my own mindset? OCD Treatment Components: Cognitive Restructuring + Exposures Regardless of whether or not it occurs in the context of formal psychotherapy, changing your mindset will be a critical component of your recovery. If you do any reading on cognitive behavioral therapy (CBT), you’ll see this referred to as “cognitive restructuring.” Devoting time to challenging and modifying your underlying belief system is essential for fighting OCD, but research on OCD indicates that this process alone will probably be insufficient if it’s not integrated with appropriate exposure-based behavioral strategies (e.g., exposure and response prevention [ERP]). OCD Treatment Delays In general,...

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OCD Treatment: OCD vs. Me. How do I Tell the Difference?

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Question: Because many of my OCD rituals are related to my professional identity, I’m worried that changing my rituals will somehow change those parts of me that I like (e.g., my personal goals and ambitions). Should I be concerned about this? Early Onset OCD in Kids & Teens (Pediatric OCD) Many people worry that by fighting their OCD, they will lose essential parts of themselves. This is particularly true for adults with obsessive compulsive disorder, who have had to deal with OCD for most of their lives. Because OCD often begins early in childhood and can have a chronic course, it can be difficult to separate yourself from your OCD symptoms. In many pediatric OCD cases, kids with OCD exhibit symptoms by age 10. Shockingly, in certain cases, even toddlers can show clinical signs of obsessive-compulsive disorder. There are...

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Fear, Doubt, Uncertainty, ERP, & the Monster Under the Bed

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Everyone I know has, at some point, had to deal with the monster under the bed. Some do it with grace. Others falter. I’ve always been clumsy. I can vividly recall many terrified nights from my childhood, when I would lie rigidly in my bed, utterly paralyzed by fear. Afraid to make the slightest movement, to breathe, to call out for my parents…lest I be detected by IT. The pounding of my heart would be so loud in my ears, and my breathing so ragged, that I could swear the entire house could hear me. And yet…no one came to help. The moment would stretch out like taffy. At some point, my raw fear would ever so subtly decline, freeing me up to end the stalemate in one of several ways. Some nights, I would call out for help....

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