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On the last track we discussed uncertainty training in two steps. Step one was examining the costs and benefits of accepting uncertainty and step two was flooding with uncertainty. We also examined problems associated with "thought stopping" regarding anxiety.
On this track we will discuss overriding obsessive anxiety. In addition to discussing ways clients can prepare for this Cognitive Behavior Therapy technique, we will focus on the two steps to overriding obsessive anxiety. The two steps are exposure and response prevention.
As you know, the obsessive, unwanted thoughts that create anxiety may lead some clients to present with signs of OCD. Therefore, this track will discuss how to deal with your anxiety clients who appear to have a differential diagnosis of OCD. I find that this type of client is generally trying to relieve the anxiety caused by their thoughts by performing one of a number of compulsive acts. Unfortunately, it seems that the relief obtained from the compulsive acts only fuels the vicious cycle and keeps it going. Would you agree?
Step 1. Exposure
3-Step Exposure CBT Technique
Step 2. Response Prevention - ‘Tower of Fears.’
For example, Greg feared contamination from dirt and grime. Therefore, in one of our sessions, I brought in a plastic tub of potting soil. At the bottom of the tub was a rock. I asked Greg to reach into the soil and find the rock. Afterwards, I asked Greg if he could stand not washing his hands right away. Greg remained seated until his distress dropped by about 50 percent. If your client’s stress doesn’t drop that much, ask them to stay at least an hour and a half and try not to quit until a minimum of a third of your distress goes away. Also, you might suggest not proceeding to the next item until your client conquers the one that he or she is working on.
Preparing for Exposure and Response Prevention
Greg also carried out his compulsion at a much slower pace than usual. For example, when Greg felt compelled to wipe the doorknobs and the phones with Lysol, he went ahead and did it, but with excruciating slowness.
Perhaps your client, like Greg can benefit from change his or her compulsion in some way. If it’s a ritual, could you suggest changing the number of times that your client does it? If it involves a sequence, such as checking all the door locks in the house, maybe he or she can do them in a completely different order than usual. Could playing this track in your next session also be a productive way of implementing exposure and response prevention?
On this track we discussed overriding obsessive anxiety. In addition to discussing ways clients can prepare for this technique, we focused on the two steps to overriding obsessive anxiety. The two steps are exposure and response prevention.
On the next track we will discuss the first key to past redemption.
Online Continuing Education QUESTION 6
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