FoaWilson-StopObsessing-ajk$0#1 1,4101,272,psy,eng,20141007,20141007,5,Edna B. Foa & Reid Wilson: Stop Obsessing! ama,https://www.amazon.com/Stop-Obsessing-Overcome-Obsessions-Compulsions-ebook/dp/B002WJM56O/ref=cm_rdp_product_img eng,https://www.amazon.com/gp/review/R3AO80QKAMZUG0?ref_=glimp_1rv_cl 0,b,201410071220@ bkm: 1138,h,• Special triggering thoughts or events 1925,3,Changing Your Rituals 1951,s,Action 1: jy Action 2: {> Action 3: 0 Action 4: £ Action 5: /) Action 6: 2027,t,Weekly Practice Schedule: Changing Rituals Week of____________________£] 1’ick one. two, or :hrec changes per day. Place a / to indiote which skills you will practice. (.'hanging Your Ritual Monday Tuesday Wednesday Thursday Friday Saturday Sunday Order Repetitions 1 ocation Physical position Physical movement Hand actions Objccis Time Words and voice tone Image Participation of others Postpone ritual 2027,4,Self-help Practice 4: add a Consequence to Your RITUAL5 One simple change that can greatly increase your 2066,4,Self-help Practice 5: Choose Not to Ritualize 2083,t,Table 7: Vann's Daily checking Rituals 2160,1,Part III The Intensive Three-Week Program 2162,2,Treatment for Ritualizers 2208,t,Table 8? The Components of Treatment for Ritualizers Exposure: Staying for long periods in the presence of a feared object or situation that evokes anxiety and distress, e.g., actual contact with contaminants. Imagery Practice: Mentally visualizing oneself in the feared situations or visualizing their consequences, e.g., driving on the road and hitting a pedestrian. Ritual Prevention: Refraining from ritualistic behavior, e.g., leaving the kitchen without checking the stove, or touching the floor without washing one’s hands. Habituation: Reduction of fear during prolonged or repeated exposure to a feared object or situation. 2208,3,How Three Negative Beliefs Change 2268,3,The Program Design 2282,3,The Treatment of Washers 2297,s,The most distressing situations for Phil are listed as follows, with numbers indicating how distressing they were on a scale of 0 to 100: Touching a doorknob: 55 Touching a newspaper: 65 Touching someone’s sweaty shirt: 75 Touching toilet seats in public bathrooms: 85 Touching spots of urine or feces on toilet paper: 100 2433,3,The Treatment of Checkers and Repeaters 2536,3,The Treatment of Hoarders and Orderers 2564,3,The Treatment of Thinking Ritualizers 2592,2,8 Your Three-Week Self-Help Program 2606,3,Preparing for Your Self-Help Program 2606,4,1. Rearrange your daily commitments. 2606,4,2. Prepare your family and friends. 2620,h,Specifically, you and your family need to adopt the following guidelines: • Family members should stop helping you perform your rituals. For example, spouses should refuse to check doors and electrical appliances repeatedly or keep track of the number of times you rotate your hands while washing. • Family members should stop performing any rituals because of your obsessions. You should instruct your children to refuse your requests to wash excessively or to take their temperature repeatedly. If your children are young, your spouse should be in charge of routines that have been the focus of your compulsions. • Family members must agree that your requests for reassurances will not be granted. When you ask questions such as “Did I touch the toilet seat?” “Do I have a lump on my neck?” or “Should I call the Poison Control Center?” your family should respond by saying, "We have all agreed that we cannot answer this question.” 2635,4,3. Choose supportive people to help you practice. 2635,h,Consider these guidelines for selecting your support people: • They should be warm and encouraging. • They should be ready to suggest and participate in activities-taking a walk, engaging in conversation, shopping, or going to the movies-that will distract you from the urge to ritualize. • They should not use force or ridiculing comments if they find you engaging in your rituals. Instead, they should remind you of your commitment and help you engage in distracting activities. • As with family members, other support people should not reassure your obsessive concerns or help you perform your rituals. 2650,3,The Three Techniques of Your Self-Help Program 2666,h,Below you will find ten guidelines to help you with your exposure and imagery practice: 1. Start by turning back to Tables 1 and 2 in Chapter 3 and review the situations and thoughts that provoke your distress. 2. Begin your program with situations that evoke a discomfort rating of about 50. As the program progresses you will gradually proceed upward to the items that provoke your highest discomfort level. 3. Each time you practice, confront a given situation or image until your discomfort level decreases by at least half. 4. Practice again and again with each given situation or image until your discomfort decreases significantly. At that time you can proceed to the next highest item on your list. 5. Practice daily with sessions lasting at least one or two hours. Studies have repeatedly found that long exposures are much more effective than short ones. Therefore, it is best that your exposure be continuous and not interrupted. If you confront a distressing situation in time segments of five minutes each, your distress will not decrease much, even if your total exposure time is one or two hours. So make sure your exposure practice is continuous. The rule of thumb: Do not end an exposure practice until your discomfort is reduced at least by half. 6. Use Tables 9 and 10 to monitor each exposure practice. Write down the situation, object, or image you practiced that day and monitor your distress level periodically. 7. If your discomfort with a situation or image does not decrease during any given day, then practice this situation an extra day and, if possible, add another hour to your exposure practice. 8. Once your distress level stays consistently low over several days with a particular situation or thought, you need not continue practicing it regularly. 9. Continue the program until you have successfully confronted the most distressful situations or images on your list. If you do not confront the situations that evoke the highest distress, it is more likely you will lose the gains you made during the program. 10. Enlist the help of supportive friends or relatives whenever you feel that such help is going to encourage you to work harder. 2698,s,The Steps of Imagery practice 1. Review the five most distressing circumstances from Table 3 in Chapter 3. 2. Write an explicit, detailed (four- to five-page) story of the least distressing of these five consequences. 3. Record this story on an audiotape. 4. Listen to this tape twice in a row (about forty minutes) each day until it no longer evokes significant anxiety. 5. Then repeat this same process for the next-highest negative consequence on your list. 2715,3,Example of an Imagery Script for a Washer 2743,t,Table 9: Distress Levels during exposure1 I)ate__________________________________________ 1 Jay Number Initial Distress Level (0-100)____________________________ Initial Urge to Ritualize (0-100)____________________________ Description of Exposure______________________________________ During the Practice Session, Rate Your Distress Level (0-100): Initial Distress Level________________________________ At I hour___ At 5 minutes___________________________________ At I hr. 13 min.___ At 15 minutes__________________________________ At I hr. 30 min.___ At 25 minutes__________________________________ At I hr. 43 min.___ At 33 minutes_________________________________________ At 2 hours___ At 43 minutes__________________________________ At end of session___ 2750,t,Table 10: distress Levels During Imagery practice Date_________________________________ Day Number___________ Initial Distress Level (0-100)________________ Initial Urge to Ritualize (0-100)________________ Description of Imagery______________________________________ At the End of the Session, Rate Your Distress Level: During first five minutes______________ At peak____________ At end_____________ 2750,3,Self-Help Program for Washing and Cleaning Rituals 2871,3,Self-Help Program for Checking and Repeating Rituals 3017,t,General Rules in a program for Repeating 1. Identify the thought, image, or impulse that triggers your compulsion. 2. Generate exposure practices that will include continuously repeating those thoughts and images, or writing them down repeatedly for thirty to forty-five minutes. Don’t take breaks during this period. 3. Seek situations that will trigger your obsessions and confront them for at least thirty minutes each. 4. Pay close attention to your daily activities. Whenever you detect a reluctance to be in a situation or engage in an action, include that in your practice. 5. Detect any repeating patterns and reverse them. If you need to repeat actions seven times and avoid repeating three times, reverse that order. Repeat actions three times and avoid repeating them seven times. 6. Make use of imagery practice. If your obsessions are elaborate with details about the feared disaster, generate long tapes. If your obsessions include only short thoughts or images, create a loop tape. In both cases, practice imagery for forty-five minutes without breaks. 3017,3,Self-Help Program for Ordering Rituals 3047,s,General rules in a program for Ordering 1. Identify "disorders” that cause you considerable distress. 2. Ask your support person to disorganize your home. Each day have him or her disorganize one room. Schedule four to five uninterrupted periods during the day to look at the disordered rooms. The lengths of such periods are flexible. Stay in each room until you experience considerable reduction in your distress. 3. Keep your house disorganized throughout the program. 4. Keep some corners of some rooms disorganized forever. 3047,3,Self-Help Program for Hoarding Rituals 3063,s,General Rules in a program for hoarding Rituals 1. Start your program with imagery practice. Create several tapes. 2. Practice at least two hours per day by listening to your tapes. Try to imagine the events as vividly as you can, and try to become as distressed as possible. 3. Generate a list of your collections and decide which ones you will dispose of. 4. Enlist the assistance of your support people in setting up daily goals to throw away these collections. 3063,3,Self-Help Program for Thinking Rituals 3079,s,General Rules in a program for Thinking Rituals 1. Generate a tape for your imagery practice by following the guidelines. Create a four- to five-page story detailing the disasters that will occur if you do not undo your obsessional thoughts through thinking rituals. If, for example, you worry that you have insulted somebody and you pray compulsively for forgiveness, your tape might include the story of how rude you were to your boss, how you hurt his feelings, how he tells your coworkers about the incident, and about how everyone thinks you are an unworthy person. Listen to the tape in the manner described. 2. Create as many stories as you need to address your different obsessions. 3. Do not engage deliberately in your thinking rituals at any time. 4. If ritualistic thoughts begin spontaneously, do one of the following: • Immediately stop the thoughts. • Deliberately invoke the obsessional image or thoughts. • Continue to think about the obsessional material until your distress has decreased considerably. 3096,3,What lf I Have More Than One Ritual? 3096,3,Dealing with Setbacks 3124,3,Follow-Up Program 3124,s,For Washing Rituals 1. Take advantage of any opportunity in your everyday life to practice exposure. The more you continue your contact with previous contaminants, the faster you will get rid of residual distress. 2. Do not wash your hands more than five times a day, thirty seconds each time. 3. Do not use soap while washing your hands unless your hands are visibly dirty. 4. Hand washing should take place only after using the toilet, before handling food, or when hands are visibly dirty. 5. Take at most one ten-minute shower per day. Do not ritualize during the shower. 3140,s,For Other Rituals 1. For checking, do not check windows, doors, and the stove more than once when you leave home or before going to bed. Checking other items is prohibited. 2. For repeating, from time to time deliberately evoke thoughts or images that used to distress you, and refrain from repeating any actions. 3. For ordering, deliberately leave certain areas of your house slightly disorganized. From time to time, change the placement of decorative objects. Allow other people to make minor changes in the placement of objects and do not immediately rearrange them. 4. For hoarding, make a habit of throwing out unnecessary things on a daily basis. 5. For thinking rituals, from time to time deliberately evoke thoughts or images that used to distress you, and refrain from using thinking rituals. 3140,3,What If I’m Not Making Any Progress? 3155,2,Medications That Help OCD 3168,3,Should Medication Be Used Instead of a Self-Help Program? 3181,3,Which Medications Should I Take 3181,3,What Benefits Can You Expect from These Medications? 3194,3,Guidelines for Medication Use 3208,3,Medication Descriptions 3222,3,Tricyclic ANTiDEPRESSANT 3222,w,Clomipramine (Anafranit) 3237,3,Selective Serotonin Reuptake Inhibitors (SSRIs) 3296,3,10 Graduating from the Program: Encouraging Stories from Recovered Obsessive-Compulsives 3296,4,Shirley 3437,4,Joel 3546,4,Annette 3669,4,Kate 3760,4,Gustina 3913,3,A Last Word of Encouragement 3944,3,Resources 3957,3,National Service Organizations 3967,2,Appendix A 3967,3,The Obsessive-Compulsive Inventory 3967,3,The Obsessive-Compulsive Inventory (OCI) 4066,3,Appendix B 4071,3,About the Authors 4071,h,Edna B. Foa, Ph.D., is a professor of clinical psychology in psychiatry at the University of Pennsylvania, and director of the Center for the Treatment and Study of Anxiety Dr. Foa has devoted her academic career to the study of the psychopathology and treatment of anxiety disorders, primarily obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), and social phobia, and is currently one of the world’s leading experts in these areas. Dr. Foa was the chair of the DSM-IVSubcommittee for OCD and cochaired the DSM-IV Subcommittee for PTSD. Dr. Foa has published several books and more than 250 articles and book chapters and has lectured extensively around the world. Her work has been recognized with numerous awards and honors. Among them are the Distinguished Professor Award under the Fulbright Program for International Exchange of Scholars; the Distinguished Scientist Award from the American Psychological Association, Society for a Science of Clinical Psychology; the first annual Outstanding Research Contribution Award presented by the Association for the Advancement of Behavior Therapy; the Distinguished Scientific Contributions to Clinical Psychology Award from the American Psychological Association; and a Lifetime Achievement Award presented by the International Society for Traumatic Stress Studies. R. Reid Wilson, Ph.D., is associate clinical professor of psychiatry at the University of North Carolina School of Medicine and a psychologist in private practice in Chapel Hill, NC. He is author of Don't Panic: Taking Control of Anxiety Attacks and directs the free self-help site anxieties.com. He designed and served as lead psychologist for American Airlines’ first national program for the fearful flier. Dr. Wilson served on the board of directors of the Anxiety Disorders Association of America for twelve years and as program chair of the National Conferences on Anxiety Disorders for three years. 4087,h,This book is not intended to replace personal medical care and supervision: there is no substitute for the experience and information that a professional familiar with Obsessive- Compulsive Disorder can provide. Rather, it is our hope that this book will supplement the help which a professional can provide and prove of assistance to those without access to a professional experienced in this disorder. To protect the privacy of the individuals involved, the names and identifying characteristics have been changed in the case histories we recount. STOP OBSESSING! Revised Edition A Bantam Book PUBLISHING HISTORY Bantam trade paperback edition / September 1991 Bantam revised trade paperback edition / August 2001 All rights reserved. Copyright © 1991 and 2001 by Edna B. Foa, Ph.D., and Reid Wilson, Ph.D. Foreword copyright © 2001 by David H. Barlow, Ph.D. Library of Congress Catalog Card Number: 90-27748 No part of this book may be reproduced or transmitted in any form or by any means, or by any information storage and retrieval system, without permission in writing from the publisher. For information address: Bantam Books. elSBN: 978-0-307-57402-2 Bantam Books are published by Bantam Books, a division of Random House, Inc. Its trademark, consisting of the words “Bantam Books” and the portrayal of a rooster, is Registered in U.S. Patent and Trademark Office and in other countries. Marca Registrada. Bantam Books, 1540 Broadway, New York, New York 10036. 4101,b,20141008 FoaWilson-Obsessing ### en #eng Stop Obsessing! This kind of book, a whole practical course of health care, even if short, is a very interesting experience. It is esy to see that there is a huge experience behind the text. Scarcely anything, I think nothing, is agaist the bare common sense, although such hair rising cases of extreme developments of obsessions are presented. And declared as overcome by the methods presented here. It only encourages the reader: my case is nothing compared with these. Maybe also my problems can be solved. But by this simple approach, by just self-treatment, is it possible? The core of te solution of the most versatile appearances of obsession is its acceptance, diminution to futile commonplace sensation, a part of myself, feeling that comes and goes, nothing special. Trying to get rid of something that obsesses and haunts me to the limits of tolerance is according to this book a completely wrong treatment, as contrary as it seems to be at first sight. But there is also the common sense in it. What is common place and everyday, is acceptable and possible to live with. But it is also very easy to show certain weaknesses of this book form. And what is the best: it would be very easy to make the necessary improvements. I mean the communication between me, the reader, and the course. There are a host of questionaries and tables to be filled by the reader and yet no means to do it. If it were a paper book, you could write direct into the book, but not so here, but just that could be possible, and even much better than in case of paper book. Just introducing the common feedback forms, where you can fill in check boxes as well as write text to be send in pieces of any size even to the terapeut as well as to myself to be collected into a file of the complete course of just my case. It is amazig that this has not been done, but mere paper book table figures are repeated. Think what an increase of practical usability this simple improvement woud do for the otherwise excellent course worth of all five stars available even as such as it is!