I recently attended the Association for Behavioral and Cognitive Therapies (ABCT) annual conference November 18-21 in San Francisco. ABCT brings together the leading authorities/researchers in the field of CBT, Anxiety, and OCD.
Below are the highlights of the talks I attended. I am not endorsing or critiquing this information, but simply reporting.
– Hoarding is a severe psychological disorder that in the past was lumped under the OCD umbrella. It is now NOT believed to be OCD, but a completely separate disorder.
- It can be very treatment resistant due to defensiveness, dissociation, lack of insight, and lack of motivation on the part of the hoarder. Typically it is the family that suffers the most.
- Treatment adherence and success is more likely if in-home coaching from a friend, family member, organizer, etc., is utilized very frequently.
– Readiness for Change Therapy
- This is a therapy designed by Dr. Alec Pollard and involved vigilance on the part of the therapist to client‘s lack of follow-through with their treatment plan. He suggests immediately stopping formal CBT treatment and focusing 100% on the client’s Treatment Interfering Behaviors (TIB) and only agreeing to continue treating the anxiety or obsessive-compulsive disorder once the TIB is resolved.
- He states that therapists ought to stop therapy right away rather than go along with half-hearted client follow-through. His rationale is that half-hearted attempts will fail and the client will blame the therapy and give-up on their best chance for improvement. Better to not try then try half-hearted.
– Clients with “poor insight” tend to have significantly worse treatment outcomes. The hoarder who thinks they are just a little messy or the 98 lb. girl who believes she is 300 lbs. are unlikely to make significant progress without some loosening of their rigid beliefs.
- Sometimes low-levels of an anti-psychotic can help.
– Severe and persistent depression is associated with worse treatment outcomes.
– With clients who are not responding to standard outpatient CBT (1-2 x per week) MORE frequent and more intensive treatment can be helpful.
– If a child/teen refuses treatment, then working with the parents is a potentially good option.
– More frequent contact can improve treatment outcomes. This can be through increased sessions, longer sessions, and/or e-mail or phone check-ins.
– Social Phobia
- 75% of clients report significant treatment gains (though that also means 25% do not).
- Although the treatment gains can be significant, they do not tend to be huge—the socially avoidant person does not necessarily learn to feel comfortable being the life of the party.
- Due to the nature of social anxiety, most people never seek treatment and out of those who do only half receive adequate treatment.
- Self-help via books, web-based programs, or minimal therapist contact can be effective if the client is motivated.
- Changing maladaptive beliefs (e.g. I’m a social outcast, people are harsh and rejecting, etc.) is a primary strategy and exposures are designed to disprove maladaptive beliefs.
- Meds can help enhance biological/physiological control/regulation, but it does not change beliefs.
- ACT therapists would argue that behaviors need to change while belief change is secondary and not necessary as long as someone is moving towards their goals.
- Social skills training is not important for most people with social phobia. There is a wide range of acceptable behavior and trying to behave in narrowly prescribed ways can become a maladaptive ritual. Decreasing inhibition and increasing verbal and behavioral output is much more important for most.
– OCD treatment bottom-line is to learn to co-exist with obsessive thoughts. Anything that tries to force OCD thoughts away tends to make it worse. Even ERP, the main treatment for OCD, can become a safety behavior if the person with OCD uses it to GET RID OF THE THOUGHTS.
- Main treatment goals are to increase uncertainty/anxiety tolerance and to behave flexible (go after what you want in life) despite obsessive thoughts.
- Genuinely caring less about whether anxiety or OCD thoughts are reduced tends to lead to actual decreases in anxiety and OCD thoughts for most people.
- Goal then is to increase genuine willingness to experience anxiety and OCD thoughts. Need to develop the ability to feel what you feel rather than fighting it.
- Genuinely caring less about whether anxiety or OCD thoughts are reduced tends to lead to actual decreases in anxiety and OCD thoughts for most people.
– Behavioral Activation (BA) involves planning your days ahead of time, filling your time with pleasurable and mastery experiences. This can be a very effective intervention for many people with anxiety and depression (“live by the daily planner”).
- Here’s part of the theory behind it: Something negative happens (panic, rejection, embarrassment, etc) which creates negative emotions. The negative emotions lead the person to avoiding future things that might have the same outcome. As a result, they will not learn that they can handle similar situations and they will miss out on opportunities for positive experiences, further exacerbating negative emotions.
- The goal then is adaptive behaviors in the face of negative events rather than avoidant behaviors.
- May need to do values clarification exercises first to come up with personally meaningful activities.
- “What was important to you before you got anxious/depressed?”
- BA treatment has five stages
- Orientation and commitment
- Getting active
- Problem-solving
- Setting goals and sub goals
- Practice, practice, practice…
– Long-term strategies for the treatment of anxiety disorders
- A significant number of people drop out of treatment that includes ERP.
- Treatment gains are maintained better with regular therapy booster sessions (1 x month for a while after treatment is completed).
- People with panic disorder and agoraphobia that do not respond to adequate CBT treatment may need to switch from CBT to medication therapy.
- Continued treatment with either meds or CBT over time does seem beneficial for those who are initial treatment “non-responders.”
– Dr. David Barlow, who is one of the most eminent psychologists and researchers in the field of anxiety disorders stated that once someone has an anxiety disorder, they are always at risk for relapse even if it goes into remission. Good news is that continued treatment, even self-guided, decreases the risk and can manage anxiety relapses if they occur.
– Perfectionism is a rough way to live one’s life, though many perfectionists adamantly refuse to consider lowering their standards.
Much more interesting information was presented at the ABCT conference 2010 and the above are simply highlights from the talks I attended.
Eric Goodman, Ph.D.