7: OCD Is Imaginary & irrelevant Client Copy

OCD is imaginary & irrelevant

Adapted by Brittany Goff from O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive-compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Start

Let's Review

Doubt Sequence

Obsessional Story

feared self/vulnerable self theme

Logic informs the doubt

neurodivergent stories

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Worry is the misuse of the imagination.

Dan Zadra

perception vs imaginAtion

perception

The 5 senses

What we perceive through our senses

Directly related to the here & now

perception

The 5 senses

Can you see it?

Can you feel it?

Can you hear it?

Can you smell it?

Can you taste it?

perception

The 5 senses

This includes outer sense data and inner sense data (emotions) as well as common sense.

Can you see it?

Can you feel it?

Can you hear it?

Can you smell it?

Can you taste it?

IMAGINATION

Lacks any direct sense information in the here & now.

Any idea, impression, inference, image, or sentiment of what could be.

30-70%

Of OCD patients report that sensory phenomena (e.g., uncomfortable feelings regarding physical sensations) drive their compulsive rituals

+ info

The research article "Obsessive-compulsive disorder: A ‘sensory-motor’ problem?" by M Russo (2014) explores the hypothesis that obsessive-compulsive disorder (OCD) may be fundamentally linked to sensory-motor integration dysfunctions.

we have eight sensory systems delivering information to our brain – not just five

Senses we can not trusT with sensory processing disorder

Proprioceptive

7th sense

+ Info

Interoceptive

8th sense

Vestibular (balance)

6th sense

+ Info

+ Info

The research article "Obsessive-compulsive disorder: A ‘sensory-motor’ problem?" by M Russo (2014) explores the hypothesis that obsessive-compulsive disorder (OCD) may be fundamentally linked to sensory-motor integration dysfunctions.

3 Canals:

Nodding up and down

Shaking side to side

This movement gives information to our vestibular system, which helps our brain to know where we are in space and how fast or slow we are moving.

Tilting up and down

+ Info

+ Info

Proprioception

• The body's ability to sense its position, movement, and actions in space.
• Also known as kinesthesia.

• Harm OCD
• Hit and Run OCD
• Driving Anxiety

Interoception

The ability to:

Notice Body Signals

Too high

Too low

& Connect those signals to emotions

• Difficulty making decisions

• Questioning internal sensations

other types of OCD

sensimotor

Since the evidence is not in the Here & Now, the story must come from within

Despite reasons, there is no direct evidence in the here & now

Those reasons make a story

Doubts have logical reasons

That source from within is the IMAGINATION

OCD is made up of doubts

FactsRulesHearsayPersonal ExperiencePossibility

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Obsessional Doubt

Reasonable 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.

Imagination

Perception

Obsessional Doubt

Reasonable 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.

Imagination

Perception

Obsessional Doubt

Reasonable 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.

While camping, you notice the bushes shaking and hear growling noises coming from behind them. You can't help but wonder if you're just being paranoid or if there might actually be a dangerous animal nearby.

After work, you decide to bake some brownies. Once they're in the oven, you start playing a video game. Immersed in the game, you lose track of time until your partner interrupts, asking about a strange smell. That's when you notice the burning scent, too. Realizing you forgot to set a timer, you rush to the kitchen, only to find it filled with smoke.

After a rough day at work, you get home, and your dog is excited to see you. He licks his bowl to indicate that he's hungry. You measure out his medicine, mix it into his food, and put his bowl on the floor. You start to wonder if maybe you could have given him too much medication, resulting in his death. Since you were so stressed, it's possible that you may not have been paying attention and gave him too much by mistake.

You are preparing for your coworkers to brief them on your latest project. The last time you discussed a previous project in front of your colleagues, they criticized your findings. You felt embarrassed and feared it could happen again.

Last year, you got sick after eating at your favorite burger restaurant. Finally, willing to give it a try again after this incident, you come into the burger shop hesitantly. You see that the cooks were all wearing gloves while prepping the food and washing their hands thoroughly, and nobody was sick. The counters were spotless, the floors were swept, and the tables were clean. You inspect the burger, and it is cooked all the way through. You wonder if you could get sick again.

Last year, you got sick after eating at your favorite burger restaurant. Finally, willing to give it a try again after this incident, you come into the burger shop hesitantly. You see that the cooks were all wearing gloves while prepping the food and washing their hands thoroughly, and nobody was sick. The counters were spotless, the floors were swept, and the tables were clean. You inspect the burger, and it is cooked all the way through. You wonder if you could get sick again.

exercise:

Let's go into the imagination!

Invitation to close your eyes.

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Inference (doubt)

What if I hit a pedestrian?

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

you don't use your senses

Inference (doubt)

What if I hit a pedestrian?

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Reality

the bubble

you don't use your senses

Inference (doubt)

You leave reality and go into the bubble

What if I hit a pedestrian?

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Reality

the bubble

you don't use your senses

Inference (doubt)

compulsions

You leave reality and go into the bubble

What if I hit a pedestrian?

You do compulsions in the here & now based on a story from the imagination.

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 is impossible because it goes against the senses.

Doubt is irrelevant to reality.

If the doubt is irrelevant, it's 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.

Doubt is impossible because it goes against the senses.

Doubt is irrelevant to reality.

If the doubt is irrelevant, it's 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.

quick recap on inferential confusion

Distrust of the senses

Over-reliance on Possibility

Irrelevant Associations

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

quick recap on 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.

The Meteor Story

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

What would need to happen to make this doubt relevant?

Remember to use the senses.

I would hear some alert

What would happen IN REALITY for this doubt to be relevant to the Here & Now?

I would see on the news that there was a meteor headed in my direction. I would need to see a meteor coming at me.

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

What if a nuclear bomb goes off?

Trigger

Doubt

Anxiety

Consequence

Compulsion

I couldn't live with myself knowing I put my family at risk.

What if a nuclear bomb goes off?

The people I love would get hurt because of my lack of preparation.

Leaving the house

I better go back home, quick.

Let's Tie it into your own ocd

What makes your OCD any different?

What would need to happen to make it relevant?

When would it make sense to start worrying about it?

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Let's Tie it into your own ocd

What makes your OCD any different?

What would need to happen to make it relevant?

When would it make sense to start worrying about it?

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Possibility can not be a relevant ingredient without direct evidence from our senses

trusting your senses outside of your ocd

• How do you decide when to cross the street?
• You trust your senses and self in all other areas of your life, but not when it comes to your OCD. Why?

Adapted by Brittany Goff from: O'Connor, K., & Aardema, F. (2012). Clinician's handbook for obsessive compulsive disorder: Inference-based therapy. Chichester: Wiley-Blackwell.

Up Next,

The monotropic bubble

Sensimotor OCD

Our proprioceptive system is crucial for managing our movements and ensuring our joints work smoothly and stably. However, when it goes away, it can make us overly tuned in to how our bodies feel and move, leading to an intense and overwhelming focus on

For those with proprioceptive difficulties, the usual process of sorting and understanding

sensory information gets thrown off. This jumble can make internal sensations seem amplified or distorted, pushing someone into a relentless loop of obsessing over these feelings. They might constantly try to figure out why their body feels strange or wrong, stuck in a cycle of worry and discomfort.

simple, automatic functions like breathing, blinking, or swallowing

Phobias:

Acrophobia: Fear of heights, a common fear often exacerbated by vestibular dysfunction as the sense of balance is compromised. Agoraphobia: Fear of open or crowded spaces, where a person might feel unsteady or dizzy due to the significant impact of vestibular issues. Claustrophobia: Fear of enclosed spaces, a valid fear that can be linked to a fear of disorientation or imbalance in tight areas.

Basophobia: Fear of falling, often seen in individuals with vestibular dysfunction as they feel unsteady on their feet. Thalassophobia: Fear of deep water, where the lack of a stable surface can trigger anxiety in those with vestibular issues. Gravitational Insecurity: A specific fear of movement experiences, particularly those involving changes in head position or rapid movements, due to impaired vestibular processing.

Sensorimotor OCD:

Trigger

DOUBT

COMPULSION

consequence

Anxiety

When an individual becomes excessively fixated on bodily sensations or autonomic functions, these functions are typically involuntary and operate without conscious awareness, such as breathing, swallowing, blinking, or the heartbeat.

Too high

Too low

Interoceptive Awareness

everybody has different sensory experiences & needs

Some people can leave the house without thinking about it their senses, where other people have to regulate their nevous system before thinking about leaving

Sexual Obsessions: Misinterpretations of sexual groinal responses

Health-Related Obsessions: Doubts about the accuracy of bodily sensations can lead to fears of having undiagnosed medical conditions, resulting in repetitive checking of physical symptoms and seeking reassurance from medical professionals. Contamination Obsessions: Misinterpretations of normal bodily sensations can cause doubts about being contaminated or unclean, leading to excessive washing and cleaning behaviors. Somatic Obsessions: Persistent doubts about the normalcy of bodily sensations (e.g., heartbeat, breathing, or digestion) can lead to constant monitoring and anxiety about potential physical malfunctions.