Recognizing Ambivalence When Treating Hoarding Disorder
Ambivalence – and a great deal of it – is a typical feature of hoarding disorder. Even clients who seek treatment for this debilitating condition bring considerable ambivalence to the goals and tasks of the treatment.
Does My Loved One Have Hoarding Disorder (HD)?
The visible signs that a loved one has Hoarding Disorder (HD) can, in some cases, be pretty obvious. Here are ten warning signs that your loved one may have HD.
Cognitive-Behavior Therapy and Harm Reduction for Hoarding Disorder
Hoarding disorder (HD) is a complex condition that affects approximately two to five percent of the population and is a difficult problem to treat. However, researchers have developed a special form of cognitive-behavior therapy that is promising for the treatment of the condition. For those who don’t seek treatment, communities have undertaken harm reduction approaches.
Addressing Family Accommodation in the Treatment of Pediatric Anxiety and OCD
As a clinician specializing in the treatment of pediatric anxiety and OCD, I am very fortunate to have access to so many effective interventions designed to treat the children suffering from these disorders. However, as anyone who works with this population knows, addressing the child’s symptoms is only half the battle.
Preventing Relapse in the Treatment of Obsessive-Compulsive Disorder: Self-Directed Exposures
Obsessive-compulsive disorder (OCD) is a chronic condition and therefore even following an effective treatment, your client always and will forever face the possibility of relapse. Assisting the client to manage the risk of relapse is an essential part of treatment for the condition. As you taper sessions with the client, use the times between sessions to assist the client to practice the relapse prevention plan you and the client developed. An effective relapse prevention plan includes several features, such as practicing and reinforcing self-directed exposures. Self-directed exposures. Develop a practice schedule that includes the top third of the client’s exposure with response prevention (ERP) hierarchy. Ask the client to practice one or more of the exposures (without engaging in compulsions and other neutralization strategies) listed in the practice schedule according to the schedule you and the client create. It is best that the client agrees to practice at a particular time and day to counter his tendency to practice exposures when less anxious. I usually include at least six exposures – numbered 1 to 6 — to the practice plan and instruct the client to toss a die to determine the exposure to perform. For example, if he tosses a 5, he performs exposure number 5 on his practice plan. This reinforces randomness and counters the client’s tendency to favor one exposure over another. Ask the client to record the results of the self-directed exposure on a form that includes the exposure tasks (numbered 1 to 6), the date and time the client agrees to perform the exposure, the date and time that he actually performed the exposure, and his maximum anxiety level. Review this form at each session during the therapy taper period.
Applying Lessons from Exposure Therapy to Daily Life
Exposure therapy is often a primary treatment component when working on anxiety. Whether an individual is coming to treatment for a specific fear, social anxiety, OCD, or another type of anxiety presentation, exposure can be a critical aid in reducing distress. It can also significantly change our relationship with anxiety and the role it plays in our lives. In structured exposure therapy, an individual systematically comes into contact with anxiety-provoking situations in order to both reduce their fight/flight response and develop new learning about anxiety and anxiety triggers. Through this new learning, a different relationship with anxiety develops. We learn to recognize anxiety triggers. We learn to stay aware of our anxious mind’s desire to avoid, distract, and do anything it can to stay away from fear. And we learn tools to help approach fear and fulfill goals that are meaningful despite anxiety’s attempts to dissuade. For example, individuals often find that through exposure they can learn to approach social situations, drive over bridges, travel on airplanes, and sit with incredibly distressing thoughts. Learning to approach fear and distress, allows us to begin to take the reins of our lives back and begin making our own life choices based on values rather than fears and aversions. Individuals who seek out exposure treatment often find that they can apply this experience more broadly to other areas of their livers. Anxiety is present in both overt and covert ways. It can alter or define small choices we make in relationships, professional situations, and just about any aspect of life. By applying some key strategies from exposure therapy, we can strive to improve our ability to make choices that are inline with what we want to promote in our lives. Mindful Awareness Mindful awareness allows us to become more conscious of how anxious emotions influence our actions. While it may be obvious when anxiety is getting in the way of volunteering to give a speech to a large group, anxiety can be much more covert. It can influence the types of conversations we have with our spouse or the way we subtly avoid professional interactions. Since our problematic choices are often driven by uncomfortable emotions, trying to introduce emotional awareness as part of decision-making can be helpful. Emotional awareness allows us to step back from this automatic pattern and name the emotions before choosing a behavior. Jon Kabat-Zinn defines mindfulness as “paying attention in a particular way; on purpose, in the present moment, and non judgmentally.” With practicing mindfulness, we can become better at noticing when our actions are driven by anxious emotions and thoughts. It can be helpful to practice noticing patterns of when anxiety has the most influence over our actions. It may then make it easier to use mindful awareness when approaching those challenging situations. Labeling the Value-Based Decision As noted above, it is important to recognize when you are making a decision due to anxiety. That identification becomes easier and more meaningful when you can focus on making choices that are congruent with what you want in your life. We may have a clear idea in our minds of what is important to us; however, the flow of day to day life can often lead to choices that are not consistent with those values. There are a variety of exercises that one can do to help clarify values. To get started, take some time to think through the different domains of your life. What is important to you? How do you want to interact with others? In what way do you want to express your beliefs? After clarifying your values, work to identify the coordinating choices and actions. The more clarity we have on what choices are consistent with our values, the better we are at keeping anxiety from being in the driver seat and determining our choices. Using Structure and Support Systems Motivation is always changing. There is a reason most of us set New Year’s resolutions only to see them go by the wayside by February. It is difficult to consistently make choices that are inline with what we want. This is especially true when facing anxiety. We naturally avoid and move away from things that make us anxious. After all, keeping us safe is a major benefit of this emotion. But when anxiety is being triggered by situations that aren’t life-threatening and perhaps not dangerous at all, anxiety becomes problematic and interferes with our lives. That is why we need structure and support to move towards our values in the face of anxiety’s influence. In exposure treatment, the therapy helps to provide the framework as individuals work to create a system they can use well past the end of treatment. You can create structure and support in a variety of ways. Be creative. Here are a few starting points to consider in helping you with that structure: set clear goals make goals measurable track progress/outcomes technology/applications can be helpful tools build in rewards for yourself use family and friends to provide additional motivation/structure