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Kathleen Norris - Body Vigilance: When Hypersensitivity to Bodily Sensations Drive You Crazy!


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For the 2016 Annual OCD Conference

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Kathleen Norris - Body Vigilance: When Hypersensitivity to Bodily Sensations Drive You Crazy!

  1. 1. Body Vigilance: When Hypersensitivity to Bodily Sensations Drive You Crazy! Treating Sensorimotor Obsessions Mary Kathleen Norris, LPC 2700 Tibbets Drive Office 817-237-9889 Suite 500 Appointments 940-242-0501 Bedford, TX 76022 Fax 817-545-8417
  2. 2. Goals of Presentation • Explain typical sensorimotor obsessions found in OCD sufferers • Describe how these sensations develop a “life of their own” • Analyze the common fears associated with sensorimotor obsessions • Learn various techniques to successfully treat sensorimotor obsessions 2
  3. 3. What is a Sensorimotor Obsession? A preoccupation or focused awareness on an automatic bodily process or discrete physical sensation 3
  4. 4. Confused and May Be Misdiagnosed • Sufferers are concerned and don’t know where to turn for help. • Medical professionals may struggle pinpointing the core issues. • The connection between the sensorimotor awareness and OCD or other anxiety disorders may be missed. 4
  5. 5. Categories of Sensorimotor Obsessions Those concerning: • Automatic bodily functions • Awareness of symptoms of chronic physical disorders 5
  6. 6. Examples of Automatic Bodily Functions that May Become Obsessional • Breathing • Blinking • Eye contact (not as in social anxiety) • Eye movements or flickering • Eye twitching • Eye floaters • Visual awareness of body parts (not BDD) • Swallowing 6 • Amount of saliva • Mouth or tongue movements • Sound of swallowing • Lump in the throat • Pulse or heartbeat • Sound of heartbeat • Tingling in head
  7. 7. Awareness of Symptoms of Chronic Physical Conditions • Dizziness • Non reality feeling • Dryness of eyes or mouth • Coughing • Discharge in nose • Nausea • Heartburn • Distention or gas • Urge to burp 7 • Sensations in stomach • Sensations in intestines or bowel • Bladder fullness • Ringing in the ears • Ache in a muscle or body part • Muscle tremor • The presence of gray hair
  8. 8. What Causes these Sensations to “Come to Life”? • Experience sensory awareness • “Couple” that with reactive anxiety • Once it is linked to anxiety, the conscious mind will keep it present 8
  9. 9. A Function of Survival? • Anxiety mechanisms are part of the alarm system of the brain. • Survival skills have been honed over millions of years to protect us. • Anything that scares us, we need to remember – not forget. • Our brain will override attempts to not think about it. • It will remind us over and over. 9
  10. 10. The Glue that Makes the Awareness Stick Interpretation of fear • What if this never stops? • What if I have a brain tumor? 10 Awareness of a sensation Strong feeling of anxiety
  11. 11. Now the two are stuck!! 11 Sensation Anxiety
  12. 12. Impact on Daily Functioning • Frustrating to totally debilitating • May result in taking a leave of absence or quitting work • Avoidance of social activities • Marked increase in depressive symptoms 12
  13. 13. Treatment is Key First Step: • Thorough evaluation by a medical doctor to rule out medical problems causing symptoms • These workups may require a specialist • Once ruled out, find a trained mental health professional to diagnose and provide proper treatment 13
  14. 14. Treatment is Key An evidence based treatment will provide the following components: • Psychoeducation • Identification of the Obsessions • Identification of the Neutralizations • Exposure and Response Prevention • Mindfulness Strategies • Relapse Prevention 14
  15. 15. Treatment is Key Psychoeducational Components to Include: • How the body reacts to anxiety • How selective attention develops • How reactive anxiety glues the awareness to the mind • How ERP works to habituate to the sensations by increasing tolerance for anxiety • That the condition is not dangerous • Reassurance that once the anxiety dissipates, the sensory awareness will shift • The treatment will seem paradoxical 15
  16. 16. Treatment is Key Identify the Obsession • Awareness of the sensation • Situations that may trigger awareness 16
  17. 17. Treatment is Key What fears show up when you experience the sensation? • Worry the symptoms will never go away • Worry about the underlying cause • Worry about specific feared outcomes 17
  18. 18. Treatment is Key Worry my symptoms will never go away • What if I have to live this way forever? • What if the awareness ruins the satisfaction I could have in my life? • What if everything I do takes a back seat to this and I can’t focus? • Examples of feared loss include sleeping, eating, speaking, reading, writing, working, parenting, worshipping. 18
  19. 19. Treatment is Key Worry about the underlying cause I wouldn’t have these symptoms if they didn’t signal something serious. These symptoms may signal: • Brain tumor or brain damage • MS • ALS • Schizophrenia • Some rare degenerative disease 19
  20. 20. Treatment is Key Worry about specific feared outcomes • What if I just stop breathing, levels of CO2 and O2 are off, or I damage my lungs? • What if I damage my eyes because of over blinking, staring, or twitching? • What if I swallow so much I hurt my throat, swallow air, feel distended and burp constantly? • What if I seem so out of it because of paying attention to this and miss important moments, or embarrass myself? 20
  21. 21. Treatment is Key What are the Neutralizations or Compulsions? • Checking • Reassurance Seeking • Avoidance 21
  22. 22. Examples of Neutralizations or Compulsions Checking • Mental checking for status of symptoms • Mental review of how it started, what it could be, what should I do? • Mental review of the impact on quality of life • Mood checking 22
  23. 23. Examples of Neutralizations or Compulsions Reassurance Seeking • Treatment providers • Friends and family − Asking if it is serious or when it will go away Avoidance • Situations which might trigger awareness − Being alone − Quiet environments − Times of inactivity or low distraction 23
  24. 24. Exposure and Response Prevention Invivo Exposures Ways to trigger awareness or invite in the sensation • Sticky dots or notes remind us to cue the sensation or thought • Paradoxical worry – sit and focus at planned time • Have coaches mention or cue focus • Recite poems or songs • Create interoceptive exposures to trigger the unwanted sensation 24
  25. 25. Exposure and Response Prevention Imaginal Exposures Ways to trigger the anxiety to the “what if” thoughts • Write an imaginal script to include the feared outcomes • Use descriptive details to trigger anxiety • When recording, use emotional tones for more effect 25
  26. 26. Treatment is Key Remember to expose and not neutralize • Allow the sensations, invite them in with a dispassionate view • Resist the urge to lower the anxiety by checking, seeking reassurance or avoidance 26
  27. 27. Mindfulness Strategies Body Scan Exercises • Involves learning to shift focus to various bodily processes one at a time. Learn to move gently without emotion, without the “glue” of anxiety – allowing all sensations. Mindfulness Exercises • Provide ways to be “in” an experience in the absence of criticism, judgement, or defensiveness, just as it is. 27
  28. 28. Putting it All Together Using all of the components of the therapy, patients begin to experience fading of these sensory experiences, or more tolerance for them. Their anxiety diminishes as their acceptance and willingness to experience these sensations grows. 28
  29. 29. The Case of Kim 48-year-old female History of minor OCD symptoms Happily married, three grown children Career classroom teacher Complaint: Awareness of swallowing Referred by local MD psychiatrist Number of medications tried Resigned teaching position 29
  30. 30. The Case of Rachel 33-year-old female History of past OCD symptoms Happily married, three school-aged children Stay at home Mom Complaint: Ringing in the ears Referred by local MD psychiatrist Numerous meds tried Suicidal ideations 30
  31. 31. The Case of Chris 40-year-old male History of past OCD symptoms Marriage issues/near divorce Engineer, entrepreneur Complaint: Dry mouth and eyes Referred by psychologist Resistant to meds Strong suicidal ideations 31
  32. 32. References Hershfield, J. and Corboy, T. (2013) The Mindfulness Workbook for OCD. California: New Harbinger Keuler, David J. (2011) paper When Automatic Bodily Processes Become Conscious: How to Disengage from “Sensorimotor Obsessions.” Ramachandran, V. S. (2012) Encyclopedia of Human Behavior. New York: Academic Press Seay, Steven J. (2011) paper/post Sensorimotor OCD Body- Focused Obsessions and Compulsions, Part One. OCD Core Fears Related to Body-Focused Obsessions and Compulsions, Part Two. Treatment for Body-Focused Obsessions and Compulsions, Part Three. Williams, M., and Penman D. (2012) Mindfulness: An Eight-Week Plan for Finding Peace in a Frantic World. New York: Rodale 32