8: Reality Sensing Client Copy

Module 9

Reality Sensing

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.

The Monotropic Bubble

OCD Is Imaginary & Irrelevant

The Feared Self

Let's Review

Bridging

Neurodivergent Stories

The Obsessional Story

The Logic of OCD

Theory

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

Compulsion

Compulsion

Exercise

You and a friend go out for drinks. The server brings you two drinks but doesn't say which one is which. How can you use your senses to figure it out?

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How would you know if you were getting a phone call?

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How can you assess the weather before leaving home?

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How would you know if there was a fire?

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How would you know if you stepped in dog poop?

How would you know if you stepped in dog poop?

You could smell itYou might feel yourself step in it or feel the poop on the bottom of your shoe when you go to clean it off.You can see the dog poop on your shoe

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How would you know if you were getting a phone call?

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How can you assess the weather before leaving home?

+ INFO

How would you know if there was a fire?

+ INFO

How would you know if you stepped in dog poop?

How would you know if you stepped in dog poop?

You could smell itYou might feel yourself step in it or feel the poop on the bottom of your shoe when you go to clean it off.You can see the dog poop on your shoe

+ INFO

How would you know if you were getting a phone call?

+ INFO

How can you assess the weather before leaving home?

+ INFO

How would you know if there was a fire?

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How would you know if you stepped in dog poop?

Lying down for bed

I couldn't live with myself knowing I wasn't better prepared

What if an intruder breaks in?

If an intruder broke in, they could harm my family

Checks to make sure the door is locked

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Doubt

Compulsion

Anxiety

Consequence

Trigger

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

If the possibility of somebody breaking in is an imagined state, it can't be true. The doubt is taking me away from reality. It's false.

True?

Direct Evidence?

Relevant?

I can see the door is locked. I don't hear any glass shattering or breaking in. I can see my family is safe. I don't see anybody breaking in either.

Without evidence, the idea of somebody breaking in is an imagined state.

What if an intruder breaks in?

Obsessive 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.

If the possibility of somebody breaking in is an imagined state, it can't be true. The doubt is taking me away from reality. It's false.

True?

Direct Evidence?

Relevant?

I can see the door is locked. I don't hear any glass shattering or breaking in. I can see my family is safe. I don't see anybody breaking in either.

Without evidence, the idea of somebody breaking in is an imagined state.

What if an intruder breaks in?

Obsessive 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.

OCD is False

Since there is no direct evidence to be found in REALITY, then the doubt is irrelevant.

Imaginary

False

Obsessional doubt goes against reality, and this makes OCD false.

Irrelevant

We've confirmed that there is no immediate evidence in the present moment to validate the doubt.

Obsessions go against reality. They are always irrelevant to the here and now, which makes them false.

Irrelevant

You cross-over from reality into the imagination, immersed in the story (the obsession).

No evidence

False

The Cross-over

Obsessions are irrelevant to reality since there is no evidence to support them in the here and now. They are not valid possibilities.

Obsessions occur without any direct evidence in reality; they originate from the imagination.

Falsehood of Obsessions

“We’ve got lots of theories; we just don’t have the evidence.”

“Unfair changes in election laws!”

“Illegal votes and vote counting!”

“The voting machines!”

”Shredded ballots!”

“Mail-in voter fraud!”

The election was stolen!

Numerous lawsuits investigated the election results, which were all dismissed due to lack of evidence

Imagine turning yourself in for being a pedophile…

Think of our legal process..

Imagine turning yourself in for being a pedophile…

Think of our legal process..

The defendant claimed, "because he had the thought."

“What claims do you have that you are a pedophile?”

No

Next sense

“Thoughts aren’t evidence. Let's look at the evidence. Did anybody see him molest a kid?"

Next sense

No

Did we hear any reports of him inappropriately touching a kid?

Next sense

No way

Sir, do you recall touching any kids?

Case dismissed due to lack of evidence

Act upon information from your senses by dismissing the obsession and not engaging in any compulsive rituals.

Realize that this is the only information that you need. Trying to obtain more information from elsewhere means you are in the bubble.

6.

5.

4.

3.

2.

Check in with your reality/senses once. Notice what is there without extra effort.

1.

Take a moment to realize that this void is merely imaginary, and that you can return back to reality.

Look down from the bridge you see yourself standing on. Take note of any feeling that makes you feel you are not doing enough.

Notice the doubt – pause and notice you are on the bridge between reality and imagination.

Steps for reality testing

Senses should be used without EXTRA effort.

And part of that is trusting when our senses are quiet and NOT telling us that something is wrong.

Trusting Our Senses

Most of the day, you aren’t even thinking about the trust you have in your senses.You just have it.

REMINDER

You lock your front door. Your senses say it’s locked. You go about your business and dismiss any doubt as irrelevant.

Reality sensing should be done ONCE without extra effort

You shower yourself; your senses say you are clean. You do not wait and reflect on whether maybe you are clean. You leave the shower.

What type of direct evidence from the senses would I need for this to be true?

What if a tornado destroys my house?

What type of direct evidence from the senses would I need for this to be true?

What if my partner is cheating on me?

What type of direct evidence from the senses would I need for this to be true?

What if I have cancer and I don’t know it?

I could FEEL and HEAR the thump!

Just because they FELT or HEARD a bump, that is not direct evidence that they hit a person. Have them look around.

• Do they see a dead body?
• Do they hear somebody screaming from being hit by a car?

For example: Hit & Run OCD “What if I hit a pedestrian?”

Senses can be used incorrectly

We're using the senses to look for DIRECT EVIDENCE

Remember, we aren't JUST using the senses....

I could FEEL and HEAR the thump!

Just because they FELT or HEARD a bump, that is not direct evidence that they hit a person. Have them look around.

• Do they see a dead body?
• Do they hear somebody screaming from being hit by a car?

For example: Hit & Run OCD “What if I hit a pedestrian?”

Senses can be used incorrectly

We're using the senses to look for DIRECT EVIDENCE

Remember, we aren't JUST using the senses....

Correct use of the senses would be:

• Do they see themselves harming the person?
• Do they hear themselves physically harming them?
• Do they feel themselves hurting them?

Anxiety is not evidence. This is one of the tricks and cheats of OCD called living in fear. This is only evidence that your system has been hijacked by OCD because the brain can’t differentiate reality from imagination.

"I feel anxious, which is evidence I'm going to do it"

What if I snap and hurt this person?

Seeing a todler naked is not the same as seeing yourself molest a todler the todler

"What if i'm a pedophile because I saw my nephew was running around naked?"

"I felt myself have a groinal response."

Feeling yourself wipe them is direct evidence that the child has been wiped, not molested

• ANXIETY
• Living the Fear
• Misinterpretation of interoceptive cues
• Mirror-touch synesthesia

A groinal response is not evidence. It could mean several things:

"I felt myself wipe them, therefore I'm a pedophile"

What if I inappropriately touched my kid by accident?

Their sense of balance and spatial orientation

According to I-CBT, we turn to "common sense"

What if the senses can't be used?

Alternative option is to explore:

Interoception

Vestibular

The body's ability to sense its position, movement, and actions in space.

Proprioception

The ability to notice signals and connect those signals to emotions

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Negligent Fears

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.

30-70%

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

Sensory Processing disorder

A condition where the brain has difficulty receiving and responding to information that comes in through the senses. Individuals with SPD may be over-sensitive or under-sensitive to sensory stimuli such as sounds, lights, textures, tastes, and smells.

Negligent Fears

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.

30-70%

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

Sensory Processing disorder

A condition where the brain has difficulty receiving and responding to information that comes in through the senses. Individuals with SPD may be over-sensitive or under-sensitive to sensory stimuli such as sounds, lights, textures, tastes, and smells.

Intense Focus

Some neurodivergent people have enhanced senses

Heightened Sensitivity

Sensory Processing Differences

Enhanced Perception

Aphantasia is a cognitive phenomenon characterized by the inability or difficulty in voluntarily generating visual mental imagery. Coined by Professor Adam Zeman, a cognitive and behavioral neurologist, aphantasia describes the absence of the mind's eye.

Aphantasia

Hyperphantasia is a condition characterized by extremely vivid and lifelike mental imagery. Individuals with hyperphantasia can visualize scenes, objects, or events with a level of detail and clarity that rivals actual perception. This heightened visual imagination allows for photorealistic experiences in the mind's eye, making imagined experiences nearly indistinguishable from reality. People with hyperphantasia often describe their mental images as rich in color, definition, and movemen

Hyperphantasia

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

If the obsession is false, do we need compulsions?

Makes it extra hard to not get pulled right back in.

The 8 Senses

The doubt is false because it's irrelevant

Looking for direct evidence

Monotropism

OCD is False & Irrelevant

When our five senses try and trick us, there may be an issues with one of our other 3 senses.

We're not just using the senses; we are using the senses to look for DIRECT evidence of that specific doubt.

Wrap Up..

The Alternative Story

Next up,

You might see it light upYou would hear it ringYou might feel it vibrate

How would you know if you were getting a phone call?

May-Benson TA, Lopes de Mello Gentil J, Teasdale A. Characteristics and Prevalence of Gravitational Insecurity in Children with Sensory Processing Dysfunction. Res Dev Disabil. 2020 Jun;101:103640. doi: 10.1016/j.ridd.2020.103640. Epub 2020 Apr 1. PMID: 32247101.

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.

Acrophobia: Fear of heights, 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 vestibular issuesClaustrophobia: Fear of enclosed spaces, which can be linked to a fear of disorientation or imbalance in tight areas.

Phobias

You might see it light upYou would hear it ringYou might feel it vibrate

How would you know if you were getting a phone call?

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.

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

Patel N, Jankovic J, Hallett M. Sensory aspects of movement disorders. Lancet Neurol. 2014 Jan;13(1):100-12. doi: 10.1016/S1474-4422(13)70213-8. PMID: 24331796; PMCID: PMC4759644.

Sensimotor OCD

You might feel yourself step in itYou can look outside the window or the weather appYou could smell it

How can you assess the weather before leaving home?

Look outsideLook on the weather appListen for thunder, rain, or bad weather

How can you assess the weather before leaving home?

How would you know if you stepped in dog poop?

You could smell itYou might feel yourself step in it. Or feel the poop on the bottom of your shoe when you go to clean it off.You can see the dog poop on your shoe

You could smell itYou woud feel the heat of itYou can see tthe fire

How would you know if there was a fire?

You might feel yourself step in itYou can look outside the window or the weather appYou could smell it

How can you assess the weather before leaving home?

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 bodily 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.

You would smell fire and smokeYou woud feel the heat You can see the fire

How would you know if there was a fire?

You could smell itYou woud feel the heat of itYou can see tthe fire

How would you know if there was a fire?

You might see it light upYou would hear it ringYou might feel it vibrate

How would you know if you were getting a phone call?

I-CBT describes leaving the bubble as a gentle shift in attention. For neurodivergent people, this shift can be more difficult because of your thinking style. You may get sucked right back into it, so we need a major shift in attention—something you can shift the tunnel to. Somethingsuch as a special interest.

Shifting Attention

Most neurodivergent people identify with a monotropic thinking style. Autistic people find comfort in repetition, so leaving the bubble after reality sensing once can be more challenging than for a polytropic thinker.

Monotropism

How would you know if you stepped in dog poop?

You could smell itYou might feel yourself step in it. Or feel the poop on the bottom of your shoe when you go to clean it off.You can see the dog poop on your shoe

No evidence Possibility alone doesn’t matter Entering into the imagination Leaving reality Truth resides in reality

Obsessions must be false