erp games final€¦ · you feel anxious/ uncomfortable you interpret anxiety/discomfort...
TRANSCRIPT
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Jon Hershfield, MFTShala Nicely, LPC
IOCDF 2017
ERP Games for Living Joyfully with OCD
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Disclosures• Jon and Shala are co-authors of
Everyday Mindfulness for OCD: Tips, Tricks, and Skills for Living Joyfully
• Jon is the author of The Mindfulness Workbook for OCD and When a Family Member Has OCD
• Shala is a partner in Beyond the Doubt
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AGENDA
• What are ERP games?• The new meaning of JOY• Mindfulness and self-compassion as the
foundation for ERP games• Let’s play some ERP games!
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AGENDA
• What are ERP games?• The new meaning of JOY• Mindfulness and self-compassion as the
foundation for ERP games• Let’s play some ERP games!
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What are ERP Games?• Playful, creative, JOYful approach to exposures– Doing sports vs. Working out
• Based on concepts from CBT, enhanced with mindfulness and self-compassion
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AGENDA
• What are ERP games?• The new meaning of JOY• Mindfulness and self-compassion as the
foundation for ERP games• Let’s play some ERP games!
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It all starts with mindset
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Mindset matters and JOY is a mindset!
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The new meaning of JOY• J: Jump In!• O: Opt for Greater Good• Y: Yield to Uncertainty
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J: Jump In!
Approach ERP and anxiety with a “bring it on, baby!” attitude.
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The Paradox of Jump In!
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OCD’s Reason to Do Rituals
Resisting ritual means that
something bad might happen
Do ritual to prevent feared
outcomes
An obsession pops up in your mind
OCD Content
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Why People Really Do Rituals
Resisting ritual
produces anxiety
Do ritual to reduce
anxiety
An obsession pops up in your mind
Anxiety/ Discomfort!
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What happens with OCD
An obsession pops up
You feel anxious/
uncomfortable
You interpret anxiety/discomfort negatively:• I can’t handle feeling like this• If I don’t get rid of this feeling,
it will ruin my day!• Because I’m feeling like this, my
OCD content must be important (emotional reasoning)
You rev up your
amygdala even more
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The paradox of Jump In!An obsession
pops up
You feel anxious/
uncomfortable
You interpret anxiety/discomfort DIFFERENTLY:• I can handle feeling like this• It’s just a feeling, it’s not going
to kill me
You aren’t adding fuel to the amygdala
fire!
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Remember why we really do rituals…
Resisting ritual
produces anxiety
Do ritual to reduce
anxiety
An obsession pops up in your mind
NOT Wanting Anxiety/
Discomfort!
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The Secret Weapon: Jump In!
An obsession pops up
You feel anxious/
uncomfortable
You interpret anxiety/discomfort DIFFERENTLY:• I can handle feeling like this• It’s just a feeling, it’s not going
to kill me
You aren’t adding fuel to the amygdala
fire!
• It’s here, so why not want my discomfort?
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Jump In!: The Essence of Mindfulness
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O: Opt for Greater Good
Focus on WHY you are doing ERP: What’s your purpose? How can you be of service to others?
(Bell, 2010)
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Identifying Greater Good• Identify various roles in your life• Self• Family• Work• Community
• Consider your values– Life Values Inventory www.lifevaluesinventory.org/– The Foundation for a Better Life
www.values.com/teaching-values• Headstone test
(Strecher, 2016)
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Y: Yield to Uncertainty
People with OCD are already quite skilled at managing uncertainty….about the stuff OCD doesn’t care about.
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Certainty is an illusion
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The new meaning of JOY• J: Jump In!• O: Opt for Greater Good• Y: Yield to Uncertainty
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AGENDA
• What are ERP games?• The new meaning of JOY• Mindfulness and self-compassion as the
foundation for ERP games• Let’s play some ERP games!
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What is ERP?
A focus on discomfort in the present moment, without compulsions pulling you into the past or future
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What is mindfulness?
Non-judgmental awareness of the present moment
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ERP = Mindfulness
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Example: Meditation to sound
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What is self-compassion?
A desire to relieve our own suffering
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Three elements of self-compassion
Mindfulness
Common Humanity
Self-Kindness
(Neff, 2011)
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Self-kindness in depth• Notice what’s right• Give yourself permission• Invite yourself to do something helpful and
kind
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Example self-compassion coping statement
• I’m feeling really guilty right now for not doing my ERP.
• I bet most people with OCD find ERP pretty hard, don’t always do their homework and then feel guilty.
• I’m going to be kind to myself, congratulating myself on remembering to use self-compassion and giving myself permission not to do ERP perfectly. I’m going to go ahead and do an ERP exercise right now, knowing that will help me, and then read a little of my favorite book as a reward.
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Can be shortened to:
I’m feeling really guilty right now. I bet most people with OCD feel guilty about homework now
and then. I’m going to give myself a break and treat myself like I would a best friend.
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Self-Compassion Exercises• Recognize What an Achievement It Is to
Overcome OCD• Write Yourself a Permission Slip. “I give myself
permission to…”– Be messy–Make mistakes– Do something new and
do it imperfectly!• Use Your Self-Compassion Coping Statements
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As we start the games, keep in mind:• Mindfulness (non-judgmental awareness of
the present moment) = ERP• Self-compassion is much more motivating than
beating yourself up, even though it doesn’t seem like it would be!
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AGENDA
• What are ERP games?• The new meaning of JOY• Mindfulness and self-compassion as the
foundation for ERP games• Let’s play some ERP games!
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How is an ERP game different than plain ‘ole ERP?• Approached with JOY (although we recommend
this for ALL ERP)• Playful and involves a sense of humor• Requires creativity• Designed for spontaneity
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The May or May Not Game
What if I offended someone? I may or may not have offended someone.
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The Four Questions Game1. What changes am I going to make from this
point forward?2. What feared outcome is the OCD using to
threaten me—this is, what might happen if I make this change?
3. What is likely to happen if I continue to obey my OCD and don’t make any changes?
4. What is my purpose and Greater Good (remembering JOY) such that I am willing to make these changes and defy my OCD?
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The Trigger “Scavenger Hunt” Game
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The Trigger “Scavenger Hunt” Game
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The Trigger “Scavenger Hunt” Game
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Shoulders Back“I may or may not be a murderer in waiting, but I’m going to throw my shoulders back and act as though I’m on top of the world”
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The Headlines GameAREA WOMAN IDENTIFIED AS WORST PERSON EVER: Failure to Check Locks Results in Entire House Being Stolen (Including All the People in It, Who Are Still Missing).
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Make it funny!LOCAL MAN ACQUIRES VIRUS THAT WIPES OUT EASTERN SEABOARD: Should Have Taken Second Coffee Cozy from the Stack.
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Make it outrageous!ASYMMETRICAL TABLE SETTING ALTERS POLARITY OF THE EARTH: Billions of People Sent Orbiting Into Space Because Bob is Too Lazy to Move His Fork.
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Throw Open the Gates!
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Now’s a great time for self-compassion!
I’m feeling really guilty and weird right now. I bet most people in this room are feeling like this! I’m going to give myself a break and congratulate
myself for doing a rockin’ great ERP!
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That’s For Other People
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Do Things Halfway• Buy only some of the items on your grocery list• Leave out details in a story you are recounting• Fast-forward through 5 minutes of your binge-
watching show • Clean everything in the bathroom except for
the sink• Say only part of a prayer• Exercise for 29 minutes
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Questions?
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Contact Information• Jon Hershfield, MFT: [email protected]• Shala Nicely, LPC: [email protected]• You can download these slides at
shalanicely.com/iocdf2017
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References• Life on Purpose: How Living for What Matters
Most Changes Everything by Victor Strecher(2016).
• Self-Compassion Assessment: http://self-compassion.org/test-how-self-compassionate-you-are/
• Self-Compassion: Stop Beating Yourself Up and Leave Insecurity Behind by Kristin Neff (2011).
• When in Doubt, Make Belief: An OCD-Inspired Approach to Living with Uncertainty by Jeff Bell (2009).