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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

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.

Theory

The Logic of 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.

The Obsessional Story

Bridging

BONUS

Neurodivergent Stories

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.

OCD is imaginary and irrelevant

The Monotropic Bubble

Reality Sensing

10

The Alternative Story

11

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 Tricks & Cheats of OCD

12

The Real Self

Burnout What is neurodivergent burnout?

Burnout What 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

Chronic Exhaustion

Increased Meltdowns or Shutdowns

Reduced Tolerance to Stimulus

Immune system problems

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

Causes of burnout

Lack of accommodations

Not receiving necessary support in educational or workplace settings.

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.

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

Routine Change

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

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

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

Social pressure

Social pressure can force a neurodivergent person to chronically mask.

Causes of burnout

Overcompensation for Executive Functioning Challenges

capitalism

internalized ableism

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

Believing that your struggles are personal failings instead of systemic issues

Exhaustion from trying to meet neurotypical expectations

Causes of burnout

capitalism

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

Exhaustion from trying to meet neurotypical expectations

Overcompensation for Executive Functioning Challenges

internalized ableism

Believing that your struggles are personal failings instead of systemic issues

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

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"

executive dysfunction in burnout

Executive Challenges
  • Unable to recall words
  • Unable to formualte sentences
  • Difficulty staying organized
  • Difficulty problem solving
  • Initiate tasks
Prefrontal Cortex
  • Memory
  • Finding words
  • Emotion regulation
  • Problem solving
Dr. Neff's Misdiagnose Monday
Autistic Burnout
Depression

Overlap

Behavioral Activation

Behavioral Activation

Apitite changes

Increased Worthlessness

Sensory Sensitivities

Socially withdraws

Influences interpersonal decision-making

Depressed Mood & Mind

Rest & Unmasking

Concentration difficulties

Increased tearfulness

Loss of Ability to Mask

Fatigue

Executive functioning difficulties

Emptiness

Anhedonia

Loss of Skills

Fatigue

Suicidality

Non-Existence Ideation

Dr. Neff's Misdiagnose Monday
Autistic Burnout
Depression

Overlap

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 prevention Causes 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.

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.

Ableism & internalized ableism

Rejection Sensitivity Dysphoria

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 trauma work through the doubt sequence again care for physical health if necessary

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

what about exposures?

What recovery actually looks like

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

Reduced avoidant behaviors

Improved functioning

Stories come and go much faster

Reduced emotional responsonsivness to OCD narratives

What recovery actually looks like

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

Reduced avoidant behaviors

Improved functioning

Stories come and go much faster

Reduced emotional responsonsivness to OCD narratives

asking the professionals

Jacob Mcdonald

Brittany Goff

Catherine Goldhouse

Licensed Graduate Social Worker

Licensed Clinical Social Worker

Licensed Independent Clinical Social Worker

asking the professionals

Jacob Mcdonald

Brittany Goff

Catherine Goldhouse

Licensed Graduate Social Worker

Licensed Clinical Social Worker

Licensed Independent Clinical Social Worker

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.