Presentation in an IAPT service for PWPs

1. Overdoing
When we assess we assess for either too much or too little of things
Behavioural too little=Depression
Behavioural too much=focus of this paper
Although one thing to mention, is we can never not act, so too littlemuch is of different types of things!

2. Overdoing=too much time spent in the drivethreat systems, not enough in the content system
Or
Too much striving and not enough relaxing

3. Types of Overdoing
Balance
Striving in one type of thing, e.g. work, or helping etc.
Quality:
Striving for high standards in specific areas
Quantity:
Striving in all areas

4. Clinical motives to overdoing
Conditions of worth: (CoW)
Client learns that they have to earn love from their primary
care giver.
If I am x I am lovable, where x is some achievable goal, e.g.
good, pretty, clever successful etc..
Avoidance:
There is something in the clients life, that they either feel is
overwhelming due to its traumatic nature or something they
have difficulty in dealing with
Anxiety Management:
A desire for certaintyperfection as a way to have a feeling of
control over fearsdoubts

5. Characteristics of Overdoing
CoW characteristics
Martyr
Driven
Duty bound
Anxiety Management
characteristics
Obsessional
Perfectionistic
Avoidant characteristics
Avoidant

6. Specific Signs of Overdoing
Behavioural
Moving from activity to
tirednesssleepsubstance misuse
Flip flop from high activity to low
Avoiding things that need doing
Emotions
Stress
Anxiety
Anger
NumbEmpty
Cognitive
Inflexible thinking: I shouldmust etc.
If I don’t do x, then I have failedlet people down etc.
Self critical in an attempt to motivate
Doubting/Worrying about standards
Background
Insecure attachment
Criticaldemanding upbringing
Achievement more important than lovesoothing
In treatment
Good client (agrees, compliments, low scores)
Ensuring you get all the information
Can’t do homework
Moves from subject to subject

7. Cultural influences on Overdoing
CoW
Anxiety
Management
Avoidant
characteristics
Individual competitive success
I must be better than me and you!
Capitalism
Be worried your bathroom isn’t
clean enough but buy product x and
it will be
Capitalism
Achieve and acquire
Busy =important
Capitalism
Upgrade=make it better
Rationality more valued than
emotionality
Good emotions and bad emotions
Happiness and sadness
Strong emotions and weak ones
Capitalism
Specialisism (neo-liberal) valued
more than generalism (renaissance)

8. Treatment of Overdoing
Understanding
Past: Influences on overdoing?
Present: How the overdoing gets maintained?
Future: Why do you want to deal with overdoing ?
Assess
Maintenance cycle
With longitudinal
element
Values based goal.
I want rid of my problem
because I really want x
Treatment Techniques

9. Values based goals
Value
To get more of: things that are
important to me e.g. to be a
better mum
Problem
To be got rid of:
overdoing

10. Assessing Overdoing: some ideas
OriginsCurrent episode:
When did it start to be a problem both for origincurrent episode?
Was there anything significant happening at these times (avoidant)?
Purpose of overdoing:
This can highlight intended consequences and rules that maintain it
Effects of overdoing:
This can highlight unintended consequences
EmotionsBehavioursThoughts
TriggersModulators:
What triggers it specificallymakes it worse generally?
What things over time have made it increasedecrease?
What would happen if you didn’t do this?
This can point to the fear that maintains the overdoing
History
Were there any key people who influenced you?

11. Maintenance cycle of Overdoing
Fear
(SelfWorld)
Behaviour
Attempts to protect self
Behaviour
Unintended consequences
reinforces beliefs
Triggers
Pay off
Achievement etc

12. Treatment Techniques for Overdoing
See Saw=>Values based approach
Things to do more of things to do less of
ERP
Graded hierarchy and emotional acceptance to
reduce maintenance cycle
SoothingContentment
Increase relaxing, compassion, self care
Decrease self criticismshamingblaming
Unhelpful thoughts
Notice, evaluate (intentioneffects) and
mindful approach to return to the valued
BA
With a values question, look at the overall
week
Understanding=>Buy in
Unintended effects and Value
Urge surfing
To help resist desire to do something

13. Your overdoing
In session what are your ways of overdoing and how does this
affect the client?