Video 016 Working with OCD
Use this solution
Often, OCD is not easily resolved, and this protocol is one of several potential solutions for this condition.
Exposure prevention therapy (EX/RP) is one well recognised treatment option but carries a 25% risk that clients will drop out or be too frightened to enter this process.
EMDR along with EX/RP is another. Also, Flash forward can be used with the worst future fear experienced by a client.
Originator:
This particular protocol was developed by John Marr (2012)
Video production
Matthew Davies Media Ltd, Llanidloes, Powys. www.matthewmedia.com
What this covers
This video covers the use of John Marr’s “Adapted EMDR Phobia Protocol with Video Playback”.
The client, Lucy, was a young woman in her twenties. She was suffering from Obsessive compulsive disorder (OCD) and presented with anxiety and a constant need to check things over and over. This behaviour was significantly interfering with her life.
How long
10.57 minutes
Related videos
See Video 007 Flash forward and Video 008 Installing future templates
Go to ‘Take-away’?
For Aide mémoire to use in a client session; Wrap up includes some theoretical ideas upon which this protocol is based and which therapists need to understand.
Take-Away Section
+ Aide Mémoire
- Take a full client history as per the standard EMDR protocol in order to identify any underlying trauma memories and a touchstone event, if any, plus the OCD compulsions and obsessions the client experiences in the here and now of life. Use the float back or bridging technique to identify possible etiological events, if needed.
- In the preparation phase, install a safe/calm place with the addition of imaginal nurturing or strength, or protection figures if needed and teach the stop signal. Administer the Y-BOCS assessment if you choose to use this scale pre and post treatment.
- Tackle the OCD targets one at a time – these will be whole episodes such as getting out of the house with the locking compulsion, making the morning cup of tea, or leaving the car in a carpark before getting into work etc.
- ask the client to choose a target and play an imaginary video that covers the whole episode/event
- as the client becomes aware of feeling stress, ask the client to stop the video
- identify the exact nature of the disturbing image
- identify the negative cognition, positive cognition, VOC, emotion, SUD, and body sensations for that image
- desensitize the image using the standard protocol until it’s fully resolved, and install the positive cognition
- ask the client to continue to play the video through to identify any other stressful moments, and desensitize and reprocess these as above. You’ll know the target is desensitized and resolved when the video playback produces no disturbance or distress.
- then, you can move onto the next target and repeat the process described above. Repeat until all targets are processed.
- If any past related memories emerge, or have emerged in history taking, linked to the onset of OCD, they can be dealt with using the Standard EMDR protocol.
- Finally, install a future template.
+ Wrap up
What is OCD?
Obsessive compulsive disorder is a condition associated with anxiety and stress, experienced by about 1 in every 60 adults in the world (World Health Organisation).
OCD is a self-perpetuating disorder, characterised by the presence of recurrent obsessions and/or compulsions. Obsessions are persistent intrusive and inappropriate thoughts that cause anxiety or distress. Compulsions are repetitive behaviour or mental acts the purpose of which is often to alleviate intrusive obsessions and reduce fear. In practice, however, they increase anxiety and distress, which serves to maintain the OCD. Hence the self-perpetuating nature of this condition.
What is the basis for thinking EMDR can help with this condition?
It is based on research findings that trauma in a person’s past may be directly linked to the onset of OCD, and EMDR can desensitize and reprocess the original trauma memory. But what about the self-perpetuating character – where does EMDR fit with this? EMDR can be used to process the current triggers, obsessions and compulsions.
What is the order of processing?
The EMDR standard protocol is used for anxiety disorders with targets sequenced according to the three pronged protocol: past memories first, second current triggers and third future action template using a mental videotape of an imagined fear-free future action. With OCD the order is changed to:
First: Current triggers, obsessions and compulsions
Second: Past disturbing memories, if any, underlying the origin of OCD (Note, sometimes, after dealing with all the triggers in the present, underlying past events linked to the onset of OCD may be dispelled without being directly processed).
Third: When all targets have been desensitised, install the future template imagining successful future action (Flash forward protocol may also be useful).
Assessing OCD
This can be done with the Yale-Brown Obsessive Compulsive scale (Y-BOCS; Goodman et al., 1989). The scale can be downloaded via Google. It can be used to evaluate improvement by comparing pre and post treatment scores.
This is about Tom, a young man brought up in a dysfunctional family: an alcoholic mother and a controlling, sometimes violent, father who would belittle him for showing a desire to learn and do well in school. Tom grew up with a sense of being rejected by his family and carried thoughts of being ’bad’ and ‘shameful’. These became particularly troublesome after Tom developed a serious interest in a fellow student at university. He found himself holding back from the relationship, scared that she might reject him when she found out what a ‘bad’ person he was.
What you will learn:
The video demonstrates how Tom’s damaging and pervasive attachment experiences with his mother and father can be repaired and reversed through rewiring his thought patterns. The video shows how the therapist and Tom co-construct and install an alternative reality - a hypothetical ‘ideal’ mother as a resource. In turn, this led to new neural pathways that changed the way he felt about himself and how he related to others.
This video is about Sally, a young woman who has been in a car accident, the target memory, and has started treatment with the standard EMDR protocol. Unexpectedly during processing, she is flooded with memories of a previous event from her childhood.
What you will learn
The use of EMDr to successfully desensitize and reprocess the new intrusive memory through this narrow focussed adaption of the standard EMDR process, before going back to the original target memory.
The video of the case shows Carla, who is experiencing chronic pain with no evident cause in the here and now.
What you will learn
The latest thinking about how and why pain is made, and the basic mechanism behind how EMDR works to reduce pain. Step by step protocol for working with chronic pain – includes use of drawing/art.
The case is about Jane, who came for help about her relationship with her wife, Mary. This video is the third of a three part video series showing several important aspects of working with difficult partner relationships. The three videos focus on the relationship in the past, in the present and in the future. This final video demonstrates the use of Future template protocol to install new skills designed to prevent/manage conflict in future.
What you will learn:
Enable clients develop and deploy new skills to reduce risk of conflict and help resolve conflict should it arise in future. In particular it shows:
Case of a woman, Jane, whose marriage to Mary was in trouble. Video 035 describes how to identify and desensitize/reprocess past trauma affecting the relationship. This video deals with current difficulties
What you will learn:
What you will learn: Use of an adaption of the standard EMDR protocol to undo concurrent negative beliefs held by the client about herself and her partner in one process.
Case of a woman, Jane, whose marriage to Mary was in trouble. Differences between them, including experiences of trauma and educational achievements, were leading to serious discord.
What you will learn:
What you will learn: Use of EMDR to work with couples. Key questions for use in history taking to uncover causes of discord, and to identify EMDR targets. Consideration of whether to have both partners ‘in the room’ when using EMDR on one of them.
This video demonstrates the use of storytelling along with the standard EMDR process with a child who found it difficult to tell what happened to her, struggled to find cognitions and had problems following eye-movement bilateral stimulation.
What you will learn:
How to create a story describing a child’s traumatic experience, involve family members in the process, and carry out the adapted standard EMDR process.
The video demonstrates the application of the EMD protocol, generally thought of as an early EMDR intervention protocol (EEI).
What you will learn:
How to use this protocol with dysregulated clients who may want therapy soon after experiencing a very distressing event.
Intense affect often accompanies work with complex trauma. These can be a re-enactment of emotions experienced during the trauma and can be shocking to witness. The temptation is to stop processing and move into talking therapy or other mode of operation. Usually, a better way is to enable the client to safely continue to process while you ‘stay out of the way’.
What you will learn:
How to manage yourself as therapist and the client when there is a strong emotional response during an EMDR processing session and several different ways of working with abreactions.
This video demonstrates the development and installation of three types of resources that can be very useful for some clients who might benefit from access to sources of nurturing, protection or wisdom during treatment with EMDR. They can be installed prior to or during processing.
What you will learn:
To learn how to stabilise clients prior to using EMDR or during actual processing to overcome blockages or stuck situations.
Case of a singer who suffered an unexpected panic attack during a performance, seriously threatening his future ability to continue as a soloist.
What you will learn:
How to use the standard EMDR protocol along with the three prong approach to overcome performance anxiety. Can be used in many other situations, e.g. fear of a future medical procedure after a bad experience.
The sudden, accidental death of a grandson. While Video 019 dealt with the pain and loss associated with a past event and Video 020 with the present, this video deals with the future.
What you will learn:
How to use EMDR to help the client readjust to life without the loved one.
The sudden, accidental death of a grandson. While Video 019 dealt with the pain and loss associated with a past event, this video deals with the present: triggers and secondary losses associated with the death.
What you will learn:
How to use EMDR to help the client re-experience the absent loved one, relinquish memories of old (now unsuitable) attachments, while identifying memories he/she wants to hold on to.
When a client’s grief has become complex i.e. deviating from the norm in either the time or intensity of specific or general symptoms of grief and/or the level of impairment in social, occupational, or other areas of life.
What you will learn:
How to use EMDR to release the complex nature of stuck or distorted grief – the first phase in a three-phase process to address Complex grief. Also, how Narrative therapy provides a ‘bird’s eye’ picture of how the three phases work together.
Case of woman with history of childhood physical and emotional abuse. Video shows how to work safely when there is a high risk of dissociation, which can lead a client to lose contact with the present moment and be caught up in the past when asked to describe or focus on a traumatic event.
What you will learn
How to use CIPOS (Constant installation of present orientation and safety) and BHS (Back of the head scale) when risk of dissociation is high.
Many clients come to therapy with a problem that includes both positive and negative affect components. In terms of Shapiro’s Adaptive Information Processing Model, it’s as if there are two entry points to stored memory networks.
What you will learn:
What to target when clients come to therapy with a problem that includes both positive and negative affect components
Case of woman with history of childhood physical and emotional abuse. Video shows a Phase 3 Assessment with a dissociative client, stabilised with CIPOS and BHS, when the trauma is held by a part of the personality.
What you will learn
How to do a Phase 3 Assessment with a dissociative client when the trauma is held by a part of the personality. Phase 4, Desensitisation, follows.
This video covers the use of Socratic Questioning as a form of cognitive interweave.
What you will learn
Learn how to use this technique to overcome blocking and looping with the standard EMDR protocol.
This is about a company executive living in fear of his boss. His family history was one of negative interactions with powerful people over several generations. This was the source of his class inferiority - the introject or psychic object that he had unconsciously absorbed, and now blighted his relationship with his boss.
What you will learn
How to free clients from damaging generational and cultural practices using the standard protocol in conjunction with a process based on Narrative therapy in which the introject is ‘externalized, disowned by the client and removed with a two handed and imagination interweaves.
Procrastination is a recurring pattern of avoidance behavior. It can be thought of as a sort of addiction to the short term gratification of a delay. It involves avoiding action.
What you will learn
Step by step protocol borrowed from Popky’s use of EMDR with addictive disorders and Jim Knipe’s “Level of urge to avoid (LOUA).”
NAW stands for Notice, Acknowledge and Welcome. It’s a technique borrowed from sensorimotor psychotherapy to address psychological and physically experienced pain and in this application is incorporated into the standard EMDR protocol. This video shows two case examples. In the first, a 40 year old woman experienced lots of pain during the stabilization phase of the work with her therapist.
What you will learn
How to use this technique with a step by step protocol, and understand the basic mechanism that leads to pain relief.
In this video you will see a therapist work with a child part or ego state and an adult part or ego state using a two-handed interweave. This new child ego state has emerged following ego state work demonstrated in Videos 001, 002 and 003.
What you will learn
How to facilitate communication between two ego states.
This video demonstrates the use of Constant Installation of Present Orientation and safety (CIPOS) with Olivia, a child who had been in a car accident. She has had flashbacks about the accident and is reluctant to process the memories
What you will learn
How to use CIPOS (Constant installation of present orientation and safety) with children
This video is about a man who had had a serious car accident. Many years later he still could not remember what had happened to him. He came for therapy wondering if he could recover the memory.
What you will learn
How to access and process memories stored in close-to-original form (i.e. in non- linguistic somatosensory form).
Lucy, was a young woman in her twenties. She was suffering from Obsessive compulsive disorder (OCD) and presented with anxiety and a constant need to check things over and over. This behaviour significantly interfered with her life.
What you will learn
How to use John Marr’s “Adapted EMDR Phobia Protocol with Video Playback”.
Samantha is in her forties. She came to therapy after returning from holiday in a foreign country. There, she was hospitalised following an accident.
What you will learn
What you can do when client is terrified to revisit the trauma events.
John was a retired civil servant, who’d come to therapy because of anxiety. He had always been an anxious person, but it had become worse since retiring. Now his worries seemed to increase in number and intensity.
What you will learn
How to help clients manage stress.
This video demonstrates the use of three different types of questions designed to overcome blocking and looping in EMDR processing.
What you will learn
Learn how to use these question to overcome blocking and looping with the standard EMDR protocol.
Client was a young female executive caught in a dilemma over whether to focus on her career or on having a baby. This dilemma came to light after having EMDR to deal with stress related to some difficulties she was having with one of her staff.
What you will learn
How to help clients resolve dilemmas.
What this is about: The case is about a man in his forties who has lost his family and career. He experiences extreme dysregulation, suicidal thoughts and an inability to make sustained relationships. He has a childhood of extreme neglect and abuse. The defining condition is a lack of any hope of change or relief in the future. He is unable to contemplate dealing with past and current traumas.
What you will learn: How to work, first with the future loss of hope using the standard EMDR protocol. You will also learn how to use aspects of Brief Solution Focused Therapy to create a hopeful future, if the client is unable to do so himself. This hopeful future will become the target in this first phase of the three-part therapeutic journey.