Step Back, Want It, Step Forward, Be Cunning: A Self-Help Paradigm

Reid Wilson, PhDChapel Hill, NC

IOCD Conference11 AMJuly 30, 2016

Reid Wilson, Ph.D.

Anxiety Disorders Treatment Center421 Bennett Orchard TrailChapel Hill, NC 27516[919] 942-0700

rrw@med.unc.eduwww.anxieties.com

www.PlayingWithAnxiety.comwww. NoiseInYourHead.com

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Video clips of Robyn & Bob courtesy of Psychotherapy.net

Strategic Treatment of Anxiety Disorders

(6 video set)

Step back

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“This is serious!”

“This is a mental game”

Change your frame of reference

If a fearful thought pops up, take it seriously

I must get rid of my doubt

I must get rid of my distress

“This is a mental game”

The content of my obsession is irrelevant

I’m going to handle generic doubt

I’m going to handle the distress caused

by doubt

“This is serious!”

OCD’s Rules1. Be careful or you might cause a horrible

problem ORBe worried that you’ve already caused one2. If a fearful thought pops up, take it seriously

3. Feel absolutely certain

4. Use your anxiety as a gauge: if you feel uncomfortable, then there is still Danger

5. Always act defensively

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Back away/avoidGive up territory Do

rituals/compulsions

Worry/dread future

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Step away from the content – Make the content irrelevant

Step back from the moment & label it

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“I can’t handle that!”

 

 

“I don’t like it, but I can handle it”

• Contaminating my family with salmonella

• Accidentally burning down house

• Realizing that I’m a bad person

• Running someone over• Touching a child sexually• Causing something

horrendous

    

A generic sense of

uncertainty & distress

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Want it

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The Power of Paradox

Purposely, voluntarily, choose…

“I want this” “If it lasts, I want it to last”

“If it’s strong, I want it to be strong”

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The amygdala “I want this”

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Notice threatening thought, image or impulse

Want that!

Notice that you feel scared

Want that!

Hang out while feeling uncertain & frightened

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Giving Your Amygdala a Chance to Learn

“Only do what you want to do”

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“And if you want to get stronger,

you have to want to do the hard stuff”

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Step forward

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“Run hills hard”

• “Look 5-6 feet ahead”• “Shorten stride”• “Pick up tempo”

• “Raise the arms” • “Swing the arms”

Once commands relegated to unconscious…

1) get body forward by dropping head & raising arms 2) apply energy to task 3) push forward & up 4) get faster turnover of legs

Step 1: Create Your Strategy

“Run hills hard”

Step 2: Generate Commands

Step 3: Frame the Action

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1. Act as though the content is irrelevant 2. Accept the obsession when it pops up3. Seek out uncertainty 4. Seek out anxiety5. Create rules if you need them

Step 1: Create Your Strategy

Step 2: Generate Motivations or Commands• “I want this”• “Stop washing”• “Don’t figure it

out”

• “Let go”• “Give me your best

shot”• “I gotta risk something

here”

27Stepping Forward

DETACHMENT & OWNERSHIP• Challenging the difference between

what Disorder tells her to be afraid of & what she’s actually afraid of. She is just plain scared. Perfect.

• Therefore, we can [but don’t have to] go to the highest item on Disorder’s list. And why not? It’s a meaningless hierarchy.

• She picks the dirtiest spot on the floor to touch. Ownership in the protocol!

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Segment 11

3.5 min

Ownership by linking with outcome picture• She can’t get behind “I want this” • But totally gets behind “I want the

outcome”

[Again] The work is always moment-by-moment[Again] “It is totally understandable that you want to resist, but…”29

Segment 12 4 min

Be cunning

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Your Job

Disorder’s Job

Frequency

IntensityDuration Duration

Intensity

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Making the messages his own

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“What’s next?” “Let ‘em come – Give me your threats” “I don’t care… I’m not playing this game”

“You wanna go? Give it to me – Let’s go”

He’s mindful- starting activity that might trigger thought 5 min

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1. Move toward any task that you predict will generate at least some uncertainty or distress regarding your theme.

2. When you notice that you feel bothered by doubt or distress (whether before, during or after that task):

A.Step back and acknowledge that it’s happening (“Ugh. This is hard.”)

B.Welcome exactly what’s happening (“Yes, and this is what I’m looking for.”)

How to Score a Point

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C. Sub-vocalize a message that helps you stay engaged in your chosen activity:

1) Encourage yourself (“I can do this.”)2) Instruct yourself (“Keep moving!”), or 3) Talk in a cunning way to Anxiety (“Give

me more, please.”)3. Then turn your attention back to your

chosen task, even while you still feel uncertain and uncomfortable.

SCORE!

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