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Living a Vital Life with Obsessions Jennifer Plumb MA, University Nevada Resno Benjamin Schoendorff MA,MSc, Claude Bernard University, Lyon 3 rd ACT World Conference, Enschede, July 2009
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An ACT view of OCD
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Obsessive-Compulsive Disorder 2.6% of population ERP 60 to 85% effective 25% refusals + 3 to 12% drop out Private compulsions resistant to ERP
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OCD and CT OCD has a strong cognitive element Cognitive therapy no more effective than ERP Can CT increase ERP acceptability?
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ACT and OCD Fusion (aka Thought Action Fusion) How we relate to thoughts rather than the nature of thoughts Beware : giving functional importance to thoughts!
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The OCD paradox: Attempting to control one’s thoughts might make them less controlable
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RFT and OCD Disorder of verbal regulation strategies Transformation of stimulus functions Faulty contextual control
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ACT Targets Context of literality (defusion) Emotional avoidance (acceptance) Broader contextual control (broadening repertoire in presence of avoided stimulus) Goal of Treatment: 1. Personal control over actions guided by values (Values, Commited Action) 2.reducing attempts to control obsessions & related distress (Mindfulness processes)
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Some evidence for ACT with OCD
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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)
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Evidence for ACT with OCD Schoendorff et al, 2009 Unpublished Data
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Treating OCD with ACT
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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?
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Treating OCD with ACT Functional Analysis What has worked ? Short term Long term Valued directions Validate the client’s experience
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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 Control as the problem What we can control (compulsions & overt behavior) and cannot control (obsessions & distress) Goal for treatment : Playing a new game - vitality
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Treating OCD with ACT Defusion 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!
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Treating OCD with ACT Mindfulness & 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.)
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Treating OCD with ACT Mindfulness & Acceptance First video (exposure)
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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
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Self-as-Context Second video (Self-as-Context)
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Treating OCD with ACT Values and Commited Action Wider context Decentering from symptoms Increase acceptability Exploring what matters… Moment of peace, posture, etc.
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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 ACT Values and Commited Action
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Third Video (choice)
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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
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Experiential Role-Play
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