Life After Treatment: Navigating Hidden Traps That Can Sabotage Your

RecoveryJonathan Grayson, PhD, and Shala Nicely, LPC

2019 IOCDF Conference

#1: Self-punishment as a ritual

The antidote: self-compassion as ERPObsession: You are bad

Shame/self-

hatred

Discomfort from being kind to

oneself

ERP: Self-compassion

Develop a self-compassion statement• Mindful awareness of feelings

• I’m feeling guilty and frustrated because I ritualized instead of doing exposure.

• Common humanity• I bet other people in recovery from OCD don’t

always do their maintenance exposure perfectly.

• Self-kindness• I’m not going to beat myself up. Instead, I’m

going to recognize recovery is an imperfect process, and it’s ok to mess up every now and then.

(Neff, 2011)

Why use self-compassion?

#2: Being overly nice• Affirmation that I’m

still good• Not good enough to

deserve anything so I do what everyone else wants

• Trying to prove to others I’m not bad

Being overly nice: people pleasing

Not caring what people think

Disconnected from others

Caring too much what people

think

People pleasing

Acceptuncertainty you

don’t have control over what others think, and that’s

ok.

Casually use profanity in public

Don’t hold the door for people

Don’t smile at the grocery store clerk

Steal candy from babies….J

Not say “thank you”

Don’t ask “how are you?” when you see

someone.

Interrupt people

Leave a gathering without saying

“goodbye”

Tip less

When in a public restroom with others, blatantly don’t wash

hands

#3: Micro-monitoring your recovery

You’re going to have symptoms.

Yes, even you sitting in the back….

#4: Afraid of your emotions

!

Self-compassionate care of your emotions!“I’m feeling ___________.I can handle feeling like this. My feelings are like the weather, and it’s ok to feel ____________ right now.”

Guilt

#5: Perfectionism

Why do you want to be perfect?

Clean the dishes really quickly (miss

some spots) and put them away.

Randomize/unorganize closet

Wear mismatched socks

Take a black marker and make a mark on something new you

boughtDon’t finish chores before….[going out,

having fun...]

Typos in emailz or texts msgs

Run your hands through your hair before leaving without

looking in a mirror

Don’t play as a completionist at

video games

YOUR IDEAS!

Put a book in upside down on a bookshelf

#6: The world needs to make sense

Expect the world won’t make sense! Work on rolling with the punches.

#7: You have a target on your back

Put your shoulders back and act as though you have a great life! Let yourself enjoy!

#8 BONUS! Excuses to slip

• “I’ll just do it this once.”• “I’m too upset now to

handle exposure right now.”

Strong Recovery Foundation

• Value and trust yourself• Feel like you’re good enough• Flexibly manage life• Develop self-compassion and self-acceptance• Cultivate emotional stability• Ability to enjoy the process of life

Handouts will be on the app!

Life After Treatment: Navigating Hidden Traps That Can Sabotage Your

RecoveryJonathan Grayson, PhD, and Shala Nicely, LPC

2019 IOCDF Conference

Life After Treatment: Navigating Hidden Traps That Can Sabotage Your Recovery

Jonathan Grayson, PhD, and Shala Nicely, LPC

2019 IOCDF Conference Summary Handout

Hidden trap

How do you know if it’s affecting you?

How do you address it? Resources

Self-punishment as a ritual

You beat yourself up a lot (and may not even realize you’re doing it!), rarely feeling good about you or anything you do.

Using self-compassion, and remember…it won’t feel good for a while because it’s an ERP!

• Everyday Mindfulness for OCD by Hershfield and Nicely, ch 2-3.

Being overly nice

You go way out of your way to make others happy, beyond what most people would do, and the thought of NOT doing so makes you uncomfortable.

Try to do things the way someone without this issue would: leave a normal-sized tip, don’t smile at everyone, don’t hold the door, etc.

• See the slides for specific ideas of exposure exercises you could do to be not so nice. J

People pleasing (subset of being overly nice)

You excessively ask others for reassurance about everyday things or for their opinions before you make decisions.

• Tell people to tell you “maybe yes, maybe no” when you ask them for reassurance!

• Put your shoulders back and accept uncertainty that you have no control over what others think of you!

• Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life by Nicely, ch 16.

Micro-monitoring your recovery

You “take your OCD temperature” every day. What that an obsession? How anxious am I? How many obsessions have I had today? Is that more or less than yesterday? Am I more or less anxious than yesterday? Etc.

Tell yourself that you’re going to have symptoms sometimes, and it’s fine, it’s part of being in recovery. Micro-monitoring them is a compulsion that’s likely to make your OCD worse!

• Freedom from Obsessive-Compulsive Disorder Updated Edition by Grayson, ch 15.

• Everyday Mindfulness for OCD, “Mindfully Monitoring the Signs of Relapse” p. 159.

*https://behavioraltech.org/resources/find-a-therapist/

Hidden trap How do you know if it’s affecting you?

How do you address it? Resources

Your emotions feel frightening and overwhelming at times

When you feel a challenging emotion, you share it with someone and confirm with them that it’s ok to be feeling this way.

Take self-compassionate care of your emotions. “I’m feeling _________. I can handle feeling like this. My feelings are like the weather, and it’s ok to feel ________ right now.” If emotions feel too overwhelming, you might benefit from DBT (dialectical behavior therapy).

• Emotional Agility by Susan David, PhD.

• Escaping the Emotional Roller Coaster by Patricia Zurita-Ona, PsyD

• Dialectical behavior therapy therapists*

Perfectionism You never feel what you do or who you are is good enough

Do exposure exercises where you’re purposely imperfect to help you enjoy the process of life (see slides for some specific examples)

• Freedom from Obsessive-Compulsive Disorder Updated Edition by Grayson, p. 34 and 201-206.

• The Gifts of Imperfection by Brène Brown, PhD

Wanting the world to make sense

You get overly irritated or annoyed when situations don’t make logical sense and perhaps even ruminate on “how stupid” they are.

Work on being flexible in situations of all types: things don’t go as planned? Practice rolling with it!

• Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life, ch 18.

You walk around feeling as if there’s a target on your back

You feel hypervigilant, always waiting for the “other shoe to drop,” and so you stay on guard.

Do the exposure of putting your Shoulders Back and acting as though you have a great life and letting yourself enjoy it!

• When in Doubt, Make Belief by Jeff Bell, ch 4.

• Is Fred in the Refrigerator? Taming OCD and Reclaiming My Life, ch 15.

You make excuses to slip

You tell yourself that you can do things to manage the traps above later, but later rarely comes…

Take a few minutes each day to practice addressing the things in this handout and strengthen your recovery!

• 13 OCD Excuse Modes Handout

The 13 OCD Excuse Modes Page 1adapted from Gayle Frankel

1. IT CAN'T HAPPEN TO ME MODE – This deals with the underlying idea that the personalthough previously warned by the therapist to deal with any slips that may arise in thefuture by immediately applying their behavioral tools is on such a high from their newfound abilities to live a symptom free life that they do not believe they will experience anyof the extreme triggers in their life (such as stress). This line of reasoning negates thatthey will ever again have a problem. Often, they can be heard to state "I am so muchbetter now, that a slight slip won't matter," "I know so much more now," "I've alreadyworked the program." This reasoning enhances the mistaken belief that they will neverhave to work on their problem again. The fallacy is that warned or not, we are nevercompletely prepared for the stubborn slip or relapse. If it has been a long time since theperson has completed treatment they are not prepared for a slip because it has been solong. If it is a short time since treatment they are not prepared for the disappointment.Since the person does not truly believe they will slip, when OCD again begins to rear it'sugly head they are devastated.

2. THIS IS DIFFERENT MODE – The person operating out of this mode forgets thatalthough the situation may be different, the way to handle it remains the same.In thewords of Spinoza, "If you want the present to be different from the past, study the past."Experience and research confirms the fact that slips of any kind must be handled byimmediately applying your previously learned behavioral techniques.

3. I CAN'T DO THIS ANYMORE MODE – This is a lament of discouragement and denial. After all, have you ever used this phrase in regard to your rituals? Have you stopped themall together just by applying this phrase alone? I THINK NOT! When someone begins tooperate in this mode, Dr. Grayson often reminds the group member of the phrase "It's notthat you can't but that you won't." Some of you may counter that this is just a differentchoice of words. Experience however, teaches us it is in reality a choice of will.

4. AM I GOING TO HAVE TO FIGHT THIS ALL OF MY LIFE MODE – Individuals operatingin this mode forget to ask themselves "Is it worse than not having a quality of life because Iwon't summon up the courage and strength to apply the tools I already possess in order tofight a slip thereby, preventing my own relapse?"

5. I'M TOO TIRED MODE – Doesn't ritualizing tire you out? The fallacy here is the premisethat performing rituals doesn't tire you out, which of course is ridiculous. Applying thetechniques you've learned may cause more immediate anxiety on a short-term basis, butyou will gain more freedom from your OC in the long run, which in turn will enable you tofeel that you have much more energy.

6. I’M TOO STRESSED OUT MODE – If you are stressed out from a life situation ritualizingwill not make that situation better. This year many of our group members could have usedthis excuse on a long term basis to impede their individual progress. For instance, onemember lost two sisters this year, another was in the middle divorce proceedingsaccompanied by the newly added stress of becoming a single parent via this. My husbandhad a heart attack and underwent quadruple by pass surgery. Did we all have a right tofeel too stressed out to work on our issues? You bet we did! Did we all encounter issuesand emotions that could be so stressful that it could trigger slips? Right again! Did ourgroup members, procedures and knowledge of relapse issues let this occur? No, and weare no different than any of you out there.

7. I FEEL TOO GOOD TO WORK ON MY ISSUES MODE – The fallacy here is that you cankeep feeling good by NOT confronting you issues. Ignore any slip that pops up, and youwon't be feeling this good for too long. Work on it, and you will guarantee feeling good on along range basis.

The 13 OCD Excuse Modes Page 2adapted from Gayle Frankel

8. I FEEL TOO ROTTEN MODE – If indeed you are feeling this badly ignoring yourproblems, allowing them to get worse will only add to this overwhelming feeling. If youwork on overcoming your problem, at least one aspect of whatever is causing you to feelthis way will be omitted.

9. WHY SHOULD MY HUSBAND, WIFE, OR FAMILY HAVE TO LIVE WITH THIS AGAIN?MODE – The answer to this is simple. If you do your part, they won't have to. After all, itis not their job to enable your rituals. It is your job and within your power to work on themwith the tools available to you in order to avert a crisis.

10. THE EMPEROR'S NEW CLOTHES MODE – The person operating in this mode acts as ifthere is no difficulty and consistently denies there is trouble brewing, expecting everyoneelse to ignore the impending problem and do nothing. In other words, there is a desiredconspiracy to pretend they are not headed for disaster. They are startled when confrontedwith the suddenness of unyielding confrontation by a group member, or therapist, whopoints out their problem. Reality, like it or not must be faced, and both the group and theperson using this mode of excuse must deal with it even if it is uncomfortable orembarrassing.

11. THE CARBONATED BEVERAGE OR SELTZER THEORY MODE - Operating from thisvantage point the individual fears that by discussing a difficult problem they have keptbottled up inside themselves, they will have to work on it, thereby losing control of thesituation. This is untrue. We always maintain more power when we give permission toanother to help us help ourselves. It is our permission that gives us the greatest control ofour lives, for we are taking control of our own destinies in a positive way in order to live asymptom free life. Perhaps Henry Kissenger summed it up best, "Competing pressurestempt one to believe that an issue deferred is a problem avoided, more often it is a crisisinvented."

12. PLEASE LET ME GET AWAY WITH MURDER MODE – This is a Killer Mode. Byoperating out of this mode you will kill any chance you have of living a symptom free life.The group member who begins to operate in this mode will try to take a goal that is justsignificant enough to appease both the group members and therapist. They offer apretense that they are working toward recovery, when in fact they are dragging their heelsin such a manner that they hope no one will catch on and decide to confront them. Thefallacy of this line of reasoning is that even if you succeed at it for a short while it inevitablybecomes a sure road to a major relapse. When you do relapse you will be forced to facethe work you are avoiding anyway, and it will involve more work than if you had just facedand worked on the original slip when it first appeared.

13. THIS IS TRUE FOR EVERYONE EXCEPT ME MODE – The person operating in thismode is well versed with successful relapse-prevention techniques and the need for theirimmediate application to slips. However, because they are unable to motivate themselvesto face their own personal challenge as they preach it to others, they adapt an attitude of,"In my particular situation it is different." Nonsense! This attitude then is a case of beinguntruthful not only to fellow group members but to oneself and as a commentary by Stonepointed out "The worst deception is self-deception." When finally confronted with the factthat they are operating in a state of denial by lying to themselves and their fellow groupmembers, it will be painful for awhile but as the individual once again progresses towardrecovery and a symptom-free life their pain will turn to pride.