Copy - 12: Relapse Prevention
Bee McDonald
Created on October 21, 2024
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Transcript
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.