Copy - 12: Relapse Prevention

Recovery, Burnout

& Relapse Prevention

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

Module 13

Recovery, Burnout

& Relapse Prevention

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

Module 13

1

Theory

2

The Logic of OCD

3

The Obsessional Story

4

Bridging

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

6

The Feared Self

7

OCD is imaginary and irrelevant

8

The Monotropic Bubble

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

BONUS

Neurodivergent Stories

9

Reality Sensing

10

The Alternative Story

11

The Tricks & Cheats of OCD

12

The Real Self

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

BurnoutWhat is neurodivergent burnout?

BurnoutWhat is neurodivergent burnout?

Neurodivergent Burnout

Burnout is a state of intense physical, mental, or emotional exhaustion experienced by neurodivergent individuals, often accompanied by a loss of skills and a decreased ability to perform daily functions. It is characterized by pervasive, long-term exhaustion (typically lasting 3 or more months), loss of function, and reduced tolerance to stimuli. This condition reflects the cumulative effect of having to navigate a world designed for neurotypical individuals, leading to chronic overwhelm and distress in various areas of life.

Neurodivergent Burnout

Burnout is a state of intense physical, mental, or emotional exhaustion experienced by neurodivergent individuals, often accompanied by a loss of skills and a decreased ability to perform daily functions. It is characterized by pervasive, long-term exhaustion (typically lasting 3 or more months), loss of function, and reduced tolerance to stimuli. This condition reflects the cumulative effect of having to navigate a world designed for neurotypical individuals, leading to chronic overwhelm and distress in various areas of life.

Neurodivergent burnout can result in significant impairments, including a decrease in executive functioning, an increase in sensory sensitivity, and a withdrawal from social interactions or activities once found enjoyable. It is a critical aspect of the neurodivergent experience that underscores the need for understanding, accommodations, and support tailored to the unique challenges faced by neurodivergent individuals.

Neurodivergent burnout can result in significant impairments, including a decrease in executive functioning, an increase in sensory sensitivity, and a withdrawal from social interactions or activities once found enjoyable. It is a critical aspect of the neurodivergent experience that underscores the need for understanding, accommodations, and support tailored to the unique challenges faced by neurodivergent individuals.

What does Burnout Look Like?

Difficulty Performing Daily Tasks

Loss of Skills

Reduced Tolerance to Stimulus

Chronic Exhaustion

Immune system problems

Increased Meltdowns or Shutdowns

What does Burnout Look Like?

Difficulty Performing Daily Tasks

Loss of Skills

Reduced Tolerance to Stimulus

Chronic Exhaustion

Immune system problems

Increased Meltdowns or Shutdowns

Lack of accommodations

Not receiving necessary support in educational or workplace settings.

Causes of burnout

Continuously suppressing your natural traits to appear neurotypical.

Constant exposure to bright lights, loud noises, or crowded environments.

Masking

Over-stimulation

Causes of burnout

Continuously suppressing your natural traits to appear neurotypical.

Constant exposure to bright lights, loud noises, or crowded environments.

Masking

over-stimulation

Lack of accommodations

Not receiving necessary support in educational or workplace settings.

Routine Change

Neurodivergent individuals often rely on routines, and unexpected changes can be stressful.

Causes of burnout

Past or ongoing traumatic experiences can trigger burnout.

Chronic pain or other health conditions can contribute to burnout, or vice versa.

Trauma

Physical Health Conditions

Routine Change

Neurodivergent individuals often rely on routines, and unexpected changes can be stressful.

Causes of burnout

Past or ongoing traumatic experiences can trigger burnout.

Chronic pain or other health conditions can contribute to burnout, or vice versa.

Trauma

Physical Health Conditions

Social pressure

Social pressure can force a neurodivergent person to chronically mask.

Causes of burnout

Striving for perfection and never giving your body rest is a fast track to burnout

ableism & internalized ableism

Perfectionism

Ableism & internalized ableism can fuel guilt & shame, reinforcing perfectionistic traits

Social pressure

Social pressure can force a neurodivergent person to chronically mask.

Causes of burnout

Striving for perfection and never giving your body rest is a fast track to burnout

ableism

Perfectionism

Ableism can fuel guilt & shame, reinforcing perfectionistic traits

internalized ableism

Believing that your struggles are personal failings instead of systemic issues

Causes of burnout

Exhaustion from trying to meet neurotypical expectations

Overcompensation for Executive Functioning Challenges

capitalism

• Environments that prioritize productivity and efficiency
• Constant push to keep up with societal demands

capitalism

• Environments that prioritize productivity and efficiency
• Constant push to keep up with societal demands

internalized ableism

Believing that your struggles are personal failings instead of systemic issues

Causes of burnout

Exhaustion from trying to meet neurotypical expectations

Overcompensation for Executive Functioning Challenges

Lack of self-acceptance

Struggling with accepting you have a disability Struggling to acknowledge your need for accommodations Operating beyond natural limits due to fear of being seen as "less capable"

Causes of burnout

If the perfectionism is an over compensation strategy for your disability, you may need to address the underlying trauma that is preventing you from accepting you are disabled

unprocessed trauma

pro-long periods of stress

• Environments that prioritize productivity and efficiency
• Constant push to keep up with societal demands

Lack of self-acceptance

Struggling with accepting you have a disability Struggling to acknowledge your need for accommodations Operating beyond natural limits due to fear of being seen as "less capable"

Causes of burnout

If the perfectionism is an over compensation strategy for your disability, you may need to address the underlying trauma that is preventing you from accepting you are disabled

unprocessed trauma

pro-long periods of stress

• Environments that prioritize productivity and efficiency
• Constant push to keep up with societal demands

executive dysfunction in burnout

Prefrontal Cortex

• Memory

• Finding words

• Emotion regulation

• Problem solving

Executive Challenges

• Unable to recall words

• Unable to formualte sentences

• Difficulty staying organized

• Difficulty problem solving

• Initiate tasks

Autistic Burnout

Overlap

Behavioral Activation

Increased Worthlessness

Depressed Mood & Mind

Fatigue

Anhedonia

Suicidality

Apitite changes

Socially withdraws

Influences interpersonal decision-making

Concentration difficulties

Increased tearfulness

Executive functioning difficulties

Emptiness

Fatigue

Behavioral Activation

Sensory Sensitivities

Rest & Unmasking

Loss of Ability to Mask

Loss of Skills

Non-Existence Ideation

Depression

Dr. Neff's Misdiagnose Monday

Generally shows a positive response to behavioral activation.

Overextending oneself intensifies burnout.

Overwhelming feeling of worthlessness

Persistent negative thoughts regarding oneself, work, and future. Ongoing depressed mood for a minimum of two weeks.

May experience insomnia or excessive sleep.

Loss of pleasure in previous enjoyable hobbies & activities.

Thoughts and behaviors around ending one's life.

Heightened sensitivity to sensory stimuli.

Practicing self-care, finding sensory relief, unmasking, and pursuing personal interests can help reduce burnout.

This often causes the person to appear "more autistic" during burnout.

Reduction in executive functioning, communication, and life skills.

A desire for demands and sensory input to cease, occasionally resulting in fantasizing about non-existence.

Autistic Burnout

Overlap

Depression

Dr. Neff's Misdiagnose Monday

Managing Burnout

• Prioritize rest
• Set boundaries
• Limit social obligations
• Reduce demands
• Simplify schedule
• Enhance special interests
• Reduce sensory Input

• Seek accomodations
• Reevaluate "normal"
• Repair sleep routine
• Utilize support system
• Find sensory soothers
• Daily flexible routines
• Seek professional help

Relapse preventionCauses of relapse

Increased stress and anxietyReduced coping mechanismsSensory overloadNeed for control

routine or life changes

Masking or camoflaging

You may be engaging in masking to fit into social situations, which can be exhausting. The ongoing effort to hide your compulsions or to appear "normal" can further exacerbate your stress and lead to burnout.

Ableism & internalized ableism

Rejection Sensitivity Dysphoria

Trauma

When you experience trauma, especially trauma that resonates with your feared self, it can lead to a profound sense of vulnerability and a heightened threat perception. This can trigger or worsen your OCD symptoms as your coping mechanisms, such as compulsions, are mobilized in an attempt to manage or mitigate these intensified fears and the distress they cause.

communication challenges

masking

discrimination

interoceptive differences

Trauma

When you experience trauma, especially trauma that resonates with your feared self, it can lead to a profound sense of vulnerability and a heightened threat perception. This can trigger or worsen your OCD symptoms as your coping mechanisms, such as compulsions, are mobilized in an attempt to manage or mitigate these intensified fears and the distress they cause.

Rejection Sensitivity Dysphoria

Ableism & internalized ableism

interoceptive differences

discrimination

communication challenges

masking

• Immune Dysregulation in Autism

• Neuroinflammation and Autism

• Infections as Triggers

• Innate Immune Dysfunction

Hormones & infections

• Lyme disease

• PANS/PANDAS

• Polycystic Ovary Syndrome (PCOS)

• Premenstrual Dysphoric Disorder (PMDD)

helpful tips for relapse

return to pre-burnout functioning (if you're in burnout)working through un-processed traumawork through the doubt sequence againcare for physical health if necessary

Relapses are inevitable because neurodivergent clients will always face: ableism masking rejection from neurotypical people

what aboutexposures?

Awareness of how ableism and society will always fuel certain Vulnerable Self Themes

Reduced emotional responsonsivness to OCD narratives

Reduced avoidant behaviors

Improved functioning

Stories come and go much faster

What recovery actually looks like

Awareness of how ableism and society will always fuel certain Vulnerable Self Themes

Reduced emotional responsonsivness to OCD narratives

Reduced avoidant behaviors

Improved functioning

Stories come and go much faster

What recovery actually looks like

asking theprofessionals

Licensed Independent Clinical Social Worker

Licensed Graduate Social Worker

Jacob Mcdonald

Licensed Clinical Social Worker

Brittany Goff

Catherine Goldhouse

asking theprofessionals

Licensed Independent Clinical Social Worker

Licensed Graduate Social Worker

Jacob Mcdonald

Licensed Clinical Social Worker

Brittany Goff

Catherine Goldhouse

what Next?

what Next?

Clinicians Handbook for

Obsessive Compulsive Disorder

Clinicians Handbook for

Obsessive Compulsive Disorder

I-CBT Workbook

I-CBT Workbook

I-CBT Website

I-CBT Website

Good Luck

Knowing I-CBT has shown me the power stories have over our lives and helped me really understand that the stories we buy into shape our experience. When I'm feeling stressed or overwhelmed, I have started asking myself, "okay, what's the story you're telling yourself here?" and "do you actually have evidence for that or does it just exist in your imagination?" This reminds me that I can choose to stay connected to reality and I don't have to get lost in the world of possibilities.

Exposures around the fear of nucelar war slowely helped me relearn to leave my home again. Even though it was terrifying, I was doing it. This wasn't an exposure, this is me returning back to my old self before OCD story many years of my life. I was in South Korea and just happened to stumble accross the spontanious opportunity to go. Traveling wasn't just a hobby, cultures are my special interest. After a bad PANDAS flare, OCD controlled me to the point I could barley leave my home. Fears about terrorism, human trafficking, war, and COVID turned my special interets against me into monotropic nightmares revolving around nuclear wars, being kidnap, or other harm obessional doubts. No exposures, I was went...

Recovery does not mean all of the stories have vanished. Recovery means that those thoughts no longer hold the same power. I still experience obsessive doubting, but I am able to see them for what they are, and go about my life the way I want to. I still experience anxiety and I always will. Anxiety comes with the human condition. But the anxiety has significantly decreased. It has changed from being crippling to being annoying. And annoying anxiety does not stop me from being fulfilled in life.

Post I-CBT, my symptoms would be considered 'sub-clinical' and I no longer fit the diagnostic criteria for OCD. For the first time in my life, I feel like I have trust in myself and don't buy into the OCD stories anymore. In fact, I don't even go there in my mind anymore. The moment I see a trigger, I can trust my senses to identify if the doubt is relevant or not, and go about my business. Over time, reality sensing is no longer a conscious equation, it just becomes natural.

Knowing I-CBT has shown me the power stories have over our lives and helped me really understand that the stories we buy into shape our experience. When I'm feeling stressed or overwhelmed, I have started asking myself, "okay, what's the story you're telling yourself here?" and "do you actually have evidence for that or does it just exist in your imagination?" This reminds me that I can choose to stay connected to reality and I don't have to get lost in the world of possibilities.

Recovery does not mean all of the stories have vanished. Recovery means that those thoughts no longer hold the same power. I still experience obsessive doubting, but I am able to see them for what they are, and go about my life the way I want to. I still experience anxiety and I always will. Anxiety comes with the human condition. But the anxiety has significantly decreased. It has changed from being crippling to being annoying. And annoying anxiety does not stop me from being fulfilled in life.