Copy - 12: Relapse Prevention

Module 13

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

& Relapse Prevention

Recovery, Burnout

Module 13

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

& Relapse Prevention

Recovery, Burnout

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

Bridging

The Obsessional Story

The Logic of OCD

Theory

Neurodivergent Stories

BONUS

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 and irrelevant

The Feared 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.

The Real Self

12

The Tricks & Cheats of OCD

11

The Alternative Story

10

Reality Sensing

Burnout What is neurodivergent burnout?

Burnout What is 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

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.

Increased Meltdowns or Shutdowns

Immune system problems

Chronic Exhaustion

Reduced Tolerance to Stimulus

Loss of Skills

Difficulty Performing Daily Tasks

What does Burnout Look Like?

Increased Meltdowns or Shutdowns

Immune system problems

Chronic Exhaustion

Reduced Tolerance to Stimulus

Loss of Skills

Difficulty Performing Daily Tasks

What does Burnout Look Like?

Over-stimulation

Masking

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

Continuously suppressing your natural traits to appear neurotypical.

Causes of burnout

Not receiving necessary support in educational or workplace settings.

Lack of accommodations

Not receiving necessary support in educational or workplace settings.

Lack of accommodations

over-stimulation

Masking

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

Continuously suppressing your natural traits to appear neurotypical.

Causes of burnout

Physical Health Conditions

Trauma

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

Past or ongoing traumatic experiences can trigger burnout.

Causes of burnout

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

Routine Change

Physical Health Conditions

Trauma

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

Past or ongoing traumatic experiences can trigger burnout.

Causes of burnout

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

Routine Change

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

Perfectionism

ableism & internalized ableism

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

Causes of burnout

Social pressure can force a neurodivergent person to chronically mask.

Social pressure

Ableism can fuel guilt & shame, reinforcing perfectionistic traits

Perfectionism

ableism

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

Causes of burnout

Social pressure can force a neurodivergent person to chronically mask.

Social pressure

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

capitalism

Overcompensation for Executive Functioning Challenges

Exhaustion from trying to meet neurotypical expectations

Causes of burnout

Believing that your struggles are personal failings instead of systemic issues

internalized ableism

Overcompensation for Executive Functioning Challenges

Exhaustion from trying to meet neurotypical expectations

Causes of burnout

Believing that your struggles are personal failings instead of systemic issues

internalized ableism

• 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

pro-long periods of stress

unprocessed trauma

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

Causes of burnout

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"

Lack of self-acceptance

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

pro-long periods of stress

unprocessed trauma

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

Causes of burnout

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"

Lack of self-acceptance

• Unable to recall words

• Unable to formualte sentences

• Difficulty staying organized

• Difficulty problem solving

• Initiate tasks

Executive Challenges

• Memory

• Finding words

• Emotion regulation

• Problem solving

Prefrontal Cortex

executive dysfunction in burnout

Dr. Neff's Misdiagnose Monday

Depression

Non-Existence Ideation

Loss of Skills

Loss of Ability to Mask

Rest & Unmasking

Sensory Sensitivities

Behavioral Activation

Fatigue

Emptiness

Executive functioning difficulties

Increased tearfulness

Concentration difficulties

Influences interpersonal decision-making

Socially withdraws

Apitite changes

Suicidality

Anhedonia

Fatigue

Depressed Mood & Mind

Increased Worthlessness

Behavioral Activation

Overlap

Autistic Burnout

Dr. Neff's Misdiagnose Monday

Depression

Overlap

Autistic Burnout

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

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

Managing Burnout

Relapse prevention Causes of relapse

routine or life changes

Increased stress and anxietyReduced coping mechanismsSensory overloadNeed for control

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.

Masking or camoflaging

interoceptive differences

discrimination

masking

communication challenges

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.

Trauma

Rejection Sensitivity Dysphoria

Ableism & internalized ableism

masking

communication challenges

discrimination

interoceptive differences

Ableism & internalized ableism

Rejection Sensitivity Dysphoria

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.

Trauma

• Lyme disease

• PANS/PANDAS

• Polycystic Ovary Syndrome (PCOS)

• Premenstrual Dysphoric Disorder (PMDD)

Hormones & infections

• Immune Dysregulation in Autism

• Neuroinflammation and Autism

• Infections as Triggers

• Innate Immune Dysfunction

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

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

helpful tips for relapse

what about exposures?

What recovery actually looks like

Stories come and go much faster

Improved functioning

Reduced avoidant behaviors

Reduced emotional responsonsivness to OCD narratives

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

What recovery actually looks like

Stories come and go much faster

Improved functioning

Reduced avoidant behaviors

Reduced emotional responsonsivness to OCD narratives

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

Catherine Goldhouse

Brittany Goff

Licensed Clinical Social Worker

Jacob Mcdonald

Licensed Graduate Social Worker

Licensed Independent Clinical Social Worker

asking the professionals

Catherine Goldhouse

Brittany Goff

Licensed Clinical Social Worker

Jacob Mcdonald

Licensed Graduate Social Worker

Licensed Independent Clinical Social Worker

asking the professionals

what Next?

what Next?

Obsessive Compulsive Disorder

Clinicians Handbook for

Obsessive Compulsive Disorder

Clinicians Handbook for

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.