For the 2016 Annual OCD Conference

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
www.dfwocd.com

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
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3. What is a Sensorimotor
Obsession?
A preoccupation or focused
awareness on an automatic bodily
process or discrete physical sensation
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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.
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5. Categories of Sensorimotor
Obsessions
Those concerning:
• Automatic bodily functions
• Awareness of symptoms of chronic
physical disorders
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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
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• Amount of saliva
• Mouth or tongue
movements
• Sound of swallowing
• Lump in the throat
• Pulse or heartbeat
• Sound of heartbeat
• Tingling in head

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
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• 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. 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
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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.
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10. The Glue that Makes the
Awareness Stick
Interpretation
of fear
• What if this
never stops?
• What if I have
a brain tumor?
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Awareness
of a
sensation
Strong
feeling of
anxiety

11. Now the two are stuck!!
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Sensation Anxiety

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
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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
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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
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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
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16. Treatment is Key
Identify the Obsession
• Awareness of the sensation
• Situations that may trigger awareness
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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
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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.
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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
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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?
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21. Treatment is Key
What are the Neutralizations or Compulsions?
• Checking
• Reassurance Seeking
• Avoidance
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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
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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
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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
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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
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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
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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.
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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.
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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
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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
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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
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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
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