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Imaginal Exposure vs. In Vivo Exposure for OCD

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As I’ve talked about in numerous posts, overcoming OCD involves learning to co-exist with doubt and uncertainty. This idea can be a bit counter-intuitive at first, as many people initially expect OCD treatment to reduce uncertainty. One therapeutic approach that helps with this process is exposure and response prevention (ERP) for OCD. Not surprisingly, ERP consists of two parts: 1) exposure, and 2) response prevention. An exposure is when you do something on purpose to provoke an anxiety spike. By definition, exposures are not accidental; rather, they are pre-planned, deliberate offensive strikes against your OCD. Exposures are designed to help you build up your tolerance to fear-producing situations. Exposures are often completed according to an exposure hierarchy, meaning that people typically complete lower level exposures (i.e., less distressing exposures) before gradually working up to higher level ones. Response prevention...

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OCD Treatment Group Using ERP

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OCD Treatment Group! I am pleased to announce the availability of our new exposure and response prevention (ERP)-based treatment group.  The intent of this group is to provide a supportive environment for completing ERPs. Participants wishing to attend are required to register using the links at the bottom of this post. This group will first meet on Saturday (8/10/13), 1pm-3pm.  The fees for attending this group are $75/session or $50/session if you pay in advance and commit to a 4-week group treatment sequence.  Insurance will not be accepted; however, if you have out-of-network benefits, you may be eligible to submit your bill for reimbursement by your insurance company.  Subsequent 2-hour sessions will be held on 8/17, 8/24, and 8/31 @ 1pm. You are free to participate in any or all of these sessions; however, individuals are most likely to...

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OCD & Checking: Part 2 (Mental Checking)

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Behavioral Checking (Overt Checking) Many examples of compulsive checking rituals in OCD involve direct inspection of a target stimulus by sight, sound, or feel. Common OCD checking behaviors include relocking doors, visually examining the position of one’s parking brake, or holding one’s hands above stove burners in order to detect warmth. Behavioral checking is often accompanied by the thought, “Did I do it the right way?” These checking behaviors are often referred to as behavioral checks, manual checks, or overt checks. Overt rituals (by definition) are visible behaviors that can be perceived by external observers. However, in some cases, overt rituals may be subtle or purposefully hidden in order to avoid embarrassment. Mental Checking (Covert Checking) In contrast, other compulsive checking rituals can only be perceived by the individual engaging in the behavior. These types of OCD rituals are...

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Worry & “What If” Questions

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Anxiety, Worry, & What If Questions If you have anxiety, it’s likely that you wrestle with worry and “what if” questions. Many what if questions are easily recognizable and start with the obvious, “What if…?” Others are more subtle and begin with phrases like “How am I ever going to…?” By definition, what if questions prompt us to solve problems that haven’t actually happened yet. The possibilities are truly endless. These worries may involve fears about current situations or about situations set far in the future. What if questions are often difficult to resist because by answering them, we often feel that we become more mentally “prepared” or “ready” to deal with life’s uncertainties. In fact, many individuals feel stressed out if they ignore their worries. They think that because what ifs involve potentially dangerous situations, it’s irresponsible or...

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Treatment of Unwanted Thoughts & Sensations in OCD

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In my post about the treatment of sensorimotor OCD, a reader asked about the ultimate goal of treatment. Should the goal of treatment be to never notice an unwanted thought or symptom? Suppressing Unwanted Thoughts & Sensations in Pure-O & Sensorimotor OCD Let’s explore this idea in detail. Suppose I adopt the goal of being 100% symptom free. After all, this is the endpoint of treatment that most people are seeking. What are the implications of this goal? You will likely slow down your progress. Why? Because every day you will encounter something that violates your expectations. Unwanted thoughts are a normal part of the human experience. Everyone has thoughts that are unwanted, aggressive, selfish, perverse, or deviant at times. For people without OCD, these thoughts tend to be fleeting because the thoughts themselves aren’t treated as significant. They...

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