Mod 1 Client Version
Bee McDonald
Created on October 6, 2024
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Transcript
Module 1
Brittany Goff, LCSW-C
Inference-based cognitive behavioral therapy
Teaches the learner how to accept uncertainty
Differences from ERP
Thoughts are Inferences
Thoughts are intrusions
Teaches the learner how to gain certainty
ERP
I-CBT
Differences
FROM ERP
Content doesn't matter
Purposefully provokes anxiety through exposures
Content matters
Does not purposely provoke anxiety
Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.
Irrelevant Associations
Distrust of the senses
For example: I dry my hands on a clean paper towel after washing them. But what if they are still dirty?
Obsessional doubts lack direct evidence from the senses in the present moment.
Obsessional reasoning
obsessional reasoning
Over-reliance on Possibility
Irrelevant Associations
Distrust of the senses
For example: I dry my hands on a clean paper towel after washing them. But what if they are still dirty?
Obsessional based doubts fail to have any direct evidence from the senses in the here and now.
Obsessional reasoning
obsessional reasoning
Over-reliance on Possibility
Relevant Associations
Trusting our senses
For example: I can visibly see poop on my hands and wonder if my hands are dirty.
Reality based conclusions established from having direct evidence from the senses in the here and now.
normal reasoning
normal reasoning
Direct evidence of possibility
Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.
Inferential Confusion
In essence, inferential confusion represents a metacognitive dysfunction wherein the individual fails to accurately discriminate between an imagined probability and actual reality.
This concept refers to a cognitive distortion where individuals with OCD mistake their intrusive thoughts, doubts, or imaginative inferences for reality. This over-reliance on inferences often leads to the creation of distorted narratives and obsessive doubts, even when there is no concrete evidence to support these doubts.
WHat causes ocd?
Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.
Irrelevant Associations
Over-reliance on Possibility
Distrust in the Senses
inferential confusion
Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.
Distrust in the Senses
Irrelevant Associations
Over-reliance on Possibility
inferential confusion
Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.
Compulsion
Consequence
Trigger
Doubt
Anxiety
The OCD Sequence
Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.
Compulsion
Consequence
Trigger
Doubt
Anxiety
The OCD Sequence
Re-reads email
I wouldn't be able to live with the embarrassment
If I make a mistake, all my colleagues will see and laugh
What if I made a mistake on my email?
Sends email
Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.
Compulsion
Anixety
Trigger
Consequence
Doubt
Doubt sequence
Compulsion
Anixety
Trigger
Consequence
Doubt
Re-reads email
I wouldn't be able to live with the embarrassment
If I make a mistake, all my colleagues will see and laugh
What if I made a mistake on my email?
Sends email
Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.
Doubt sequence
Compulsion
Anixety
Trigger
Consequence
Doubt
Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.
Locks the door again
If it’s not shut, the car will be stolen
Locking the vehicle door
What if the door isn’t shut properly?
I’d be a negligent person if my car got stolen
Doubt sequence
Compulsion
Anixety
Trigger
Consequence
Doubt
Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.
Locks the door again
If it’s not shut, the car will be stolen
Locking the vehicle door
What if the door isn’t shut properly?
I’d be a negligent person if my car got stolen
Doubt sequence
Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.
Same predictable sequence
Where OCD Starts
Obsessional Doubts
OBSESSIONAL DOUBTS
Obsessional doubts are simply a possibility or a “what if” statement
A person starts with certainty, then it’s followed by doubt
Symptoms of OCD begin with the doubt
Symptoms of OCD begin with a doubtA per
Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.
Same predictable sequence
Where OCD Starts
Obsessional Doubts
OBSESSIONAL DOUBTS
Obsessional doubts are simply a possibility or a “what if” statement
A person starts with certainty, then it’s followed by doubt
Symptoms of OCD begin with the doubt
Symptoms of OCD begin with a doubtA per
Allison is terrified of harming her husband. Anytime she watches true crime shows, Allison contemplates if she could be a killer as well. She has never felt any desire to harm him, but the thought keeps crossing her mind. She avoids sharp objects around the house in case she suddenly feels the urge to harm him. Even though she knows she loves her husband, anything is possible.
What if i harm my husband?
What is the obsessional doubt?
Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.
Shifting away from
Learning to sit with uncertainty is a helpful skill. However, it’s not necessary for this treatment.
UNCERTAINTY
We are teaching you how to GAIN certainty in yourself through your senses.
shifting away from UNCERTAINTY
The Logic of OCD
Next up,
What is the “what if” question you asked yourself? Where did your mind make a “could be” statement?
Doubt
If that doubt were to come true, what is the consequence to it? What is the scary story at the end?
Consequence
Hearsay
Taking logical reasonings and applying them out of context to the here and now.
Possibility
Personal Experience
Rules
Facts
The Logic of OCD- Next Module
Anxiety
And what would that mean to you? If your doubt were to come true, what would it say about your identity?
If that doubt were to come true, what is the consequence to it? What is the scary story at the end?
Consequence
Using hypothetical scenarios about reality in place of the present-moment sensory data
Distrust of the Senses
What happened to set this sequence in motion? What is the earliest thing they can remember happening before you did a compulsion?
Trigger
What happened to set this sequence in motion? What is the earliest thing you can remember happening before you did a compulsion?
Trigger
Compulsion
What behavior did you feel compelled to do as a result of that story?
Compulsion
What behavior did yo feel compelled to do as a result of that story?
Anxiety
And what would that mean to you? If your doubt were to come true, what would it say about your identity?
What is the “what if” question you asked yourself? Where did your mind make a “could be” statement?
Doubt
Putting excessive reliance on potential possibilities without having direct evidence.
Over-reliance on Possibility
What happened to set this sequence in motion? What is the earliest thing you can remember happening before you did a compulsion?