On Demand OCD & Anxiety Lecture Series: Preparing Your Patients for Learning to Live With Uncertainty: ERP+

This presentation was originally reviewed on October 5, 2023, and broadcast live online on October 6, 2023, from 12:00 PM – 1:30 PM ET. Go to the Register tab above to learn how to participate for continuing education credit, watch the broadcast, and download the slides.

The views and opinions expressed by this presenter in this lecture are their own, and do not represent the views of Sheppard Pratt.

    Exposure and response prevention (ERP) is considered to be the gold standard of treatment for obsessive compulsive disorder (OCD). However, despite both the fact that the following groups, American Psychological Association, the American Psychiatric Association, the International OCD Foundation, and almost all OCD experts, have agreed with this since the 1990's, it remains hard for sufferers to find proper treatment.  To further complicate this, if they can find a provider who claims to use ERP, it is often poorly done.

    One of the main sources of this problem is the failure of therapists to understand the actual goals of treatment; goals that go beyond simply lowering anxiety and reducing/eliminating rituals.  As a result, clients cannot agree to the goals (goals that are necessary prerequisites for the successful implementation of ERP) that have never been presented to them.

    This presentation will focus on the underlying treatment goals of ERP and how to properly prepare clients for treatment.  Furthermore, the many different manifestations of OCD (e.g., contamination, checking, harm ocd, pedophile OCD, scrupulosity, etc), require different 'arguments' to help the client decide to take, what seems to them, the risk of committing to ERP.  Sample dialogs, tailored to different OCD presentations, will be included in the presentation.

    LEARNING OBJECTIVES

    After this lecture, registrants will be able to:

    1. Recognize intolerance of uncertainty as a core OCD issue and will be able to effectively discuss and help clients to accept the goal of learning to live with uncertainty before implementing ERP.
    2. Modify and tailor treatment preparation discussions to the client's particular manifestation of OCD.
    3. Understand the nature of acceptance as choosing to live the second best life and why this would make sense.

    SESSION II: Sleep, Dreams and Rumination in OCD

    In humans, approximately 30% of a 24-hour period is spent sleeping or trying to sleep. It is incredibly hard to NOT sleep. Over the past 25 years of working with individuals with mental health disorders, I cannot think of a single person who reported that they couldn’t sleep at all. And yet it also seems incredibly hard to sleep “well”. The vast majority of people I have worked with clinically have reported wanting more sleep, or sleeping too much, or having trouble falling asleep, or having chronic nightmares and nighttime panic or waking up exhausted. When it works well, sleep is supposed to be restorative - which means we wake up rested and ready for the challenges of a new day. Under the umbrella of sleep terminology, there are a variety of terms - sleep architecture, sleep continuity, sleep onset latency, rapid eye movement latency and narrative and emotional experiences while dreaming.  In this talk we are going to learn about these terms and apply them to individuals struggling with OCD. A quick pubmed search for journal articles on OCD and sleep show that from 1979-2010 there were 60 published papers on the topic. That’s about 2 papers per year. Since 2011 to now, there have been 163 published articles - that’s about 13 papers per year. Quite a nice increase in interest in this topic. But type in sleep and depression and from 2011-to now you will see more than 24,000 published papers. This is my long-winded way of saying, we really do need more research. But here are some things we know. Poor sleep seems to be a problem in people with OCD - but the nature of the poor sleep varies across studies. Perhaps one of the more consistent findings is something called a delayed sleep phase. People with OCD sleep later in the night. Although there are a variety of other findings such as reduced total sleep, shortened REM latency, more frequent waking through the night and trouble falling and staying asleep. These findings are less consistent across studies and when these sleep problems have been detected in studies, they may be due to co-morbid depression. In the context of dreams, the content of dreams has not been studied much in OCD, but there has been at least one study to find that people with OCD have dreams related to their obsessions and compulsions. There is an established set of treatments for poor sleep derived from treating insomnia and other sleep problems that we can apply to helping individuals who are sleeping poorly and have OCD. We will go over these treatments including sleep restriction training, stimulus control procedures and nighttime mood management strategies. 

    LEARNING OBJECTIVES

    After this lecture, registrants will be able to:

    1. Describe sleep and what poor sleep actually means.
    2. Define the most common sleep problem associated with OCD.
    3. Identify some basic behavioral strategies to help individuals with OCD sleep better.

    Target Audience

    This activity is intended for physicians, nurses, psychologists, social workers, counselors, and other mental health professionals.

    Learning Objectives

    After this lecture, registrants will be able to:

    1. Recognize intolerance of uncertainty as a core OCD issue and will be able to effectively discuss and help clients to accept the goal of learning to live with uncertainty before implementing ERP.
    2. Modify and tailor treatment preparation discussions to the client's particular manifestation of OCD.
    3. Understand the nature of acceptance as choosing to live the second best life and why this would make sense.
    Course summary
    Available credit: 
    • 1.50 ACEP NBCC clock hours
    • 1.50 AMA PRA Category 1 Credit™
    • 1.50 Category II credits for Social Workers
    • 1.50 Psychologists
    • 1.50 MNA Contact Hours for Nurses
    • 1.50 Participation
    Course opens: 
    11/07/2023
    Course expires: 
    11/04/2025

    There is no commercial support for this activity.

    About the speaker

    Jonathan B. Grayson, Ph.D. is a licensed psychologist (PSY26643), director of the Grayson Center. Dr Grayson has been specializing in the treatment of obsessive-compulsive disorder (OCD) for over 40 years and is a nationally recognized expert and author of Freedom from Obsessive Compulsive Disorder: a Personalized Recovery Program for Living with Uncertainty, a self‑help guide for sufferers. In 2010, the International OCD Foundation awarded Dr. Grayson the Patty Perkins Lifetime Achievement Award for his devotion and contributions to the treatment of those with OCD. In October of 2010, the Association of Behavioral and Cognitive Therapies gave his book, Freedom from Obsessive Compulsive Disorder, the Self Help Book of Merit Award, recognizing his book as providing sufferers with the highest level of information about the best practices treatment for OCD. Dr. Grayson has presented workshops and written numerous articles and book chapters for both professional and lay audiences, including two manual/ videotape sets made for the International OCD Foundation (The GOAL Handbook: Running a Successful Support Group for OCD and How to Recognize and Respond to Obsessive‑Compulsive Disorder in School Age Children). His work and expertise has been featured in national media including, People Magazine, The Oprah Winfrey Show and Nightline. He serves on the Scientific Advisory Board of the International OCD Foundation. In 1981, along with Gayle Frankel (the former president of the Philadelphia Affiliate of the OC Foundation), he started the first support group in the country for OCD. In 2015, helped to form and donate his time to a free GOAL support group in LA. Finally, he has the distinction of being the first and possibly the only professional to run a yearly OCD camping trip.

    Disclosure Statements

    Sheppard Pratt holds the standard that its continuing medical education programs should be free of commercial bias and conflict of interest. In accord with Sheppard Pratt's Disclosure Policy, as well as standards of the Accreditation Council for Continuing Medical Education (ACCME) and the American Medical Association (AMA), all planners, reviewers, speakers and persons in control of content have been asked to disclose any relationship he /she  has with any entity producing, marketing, selling, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 24 months. All planners, reviewers and speakers have also been asked to disclose any payments accepted for this lecture from any entity besides Sheppard Pratt, and if there will be discussion of any products, services, or off-label uses of product(s) during this presentation.

    Jonathan Grayson, PhD, reports that he has no relationships with any entity producing, marketing, selling, re-selling, or distributing health care goods or services consumed by, or used on, patients during the past 24 months. He will not discuss any products, services, or off-label uses in this presentation.

    Event Planners/Reviewers Disclosures: The following event planners and/or reviewers are reported as having no financial interest, arrangement or affiliation with any entity producing, marketing, selling, re-selling, or distributing health care goods or services consumed by, or used on, patients, during the past 24 months: Jon Hershfield, MFT, Todd Peters, MD, Deepak Prabhakar, MD, Elizabeth Ryznar, MD, MSc, Louis Marino, MD, Ehsan Syed, MD, Devi Bhuyan, PhD, Faith Dickerson, PhD, Carrie Etheridge, LCSW-C, Tom Flis, LCPC, Stacey Garnett, RN, MSN, Stephanie M. Robinson, MSN, RN, PMH-BC, NPD-BC, NE-BC , Heather Billings, RN, Lisa Illum, MLIS, MEd, and Jennifer Tornabene.

    Physician Statement: Sheppard Pratt is accredited by The Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.  Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity.  Sheppard Pratt designates this enduring activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Nurse Statement: Sheppard Pratt is approved as a provider of nursing continuing professional development by the Maryland Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this CME activity. This activity provides 1.5 contact hours for nurses.

    Psychologist Statement: Sheppard Pratt is authorized by the State Board of Examiners of Psychologists as a sponsor of continuing education. Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this continuing education activity.  Sheppard Pratt designates this educational activity for a maximum of 1.5 contact hours for Psychologists.

    Social Worker Statement: Sheppard Pratt is authorized by the Board of Social Work Examiners of Maryland to offer continuing education for Social Workers.  Sheppard Pratt takes responsibility for the content, quality, and scientific integrity of this continuing education activity. This activity is approved for 1.5 contact hours in Category II credits for Social Workers.

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    Available Credit

    • 1.50 ACEP NBCC clock hours
    • 1.50 AMA PRA Category 1 Credit™
    • 1.50 Category II credits for Social Workers
    • 1.50 Psychologists
    • 1.50 MNA Contact Hours for Nurses
    • 1.50 Participation
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    ON DEMAND WEBINAR: FOR BEST RESULTS WATCH USING GOOGLE CHROME

    OCD & Anxiety Workshop: Preparing Your Patients for Learning to Live With Uncertainty: ERP+

    Jonathan B. Grayson, PhD

    Director, The Grayson LA Treatment Center for Anxiety & OCD

    Pasadena, CA

    Originally reviewed October 5, 2023.
    Originally broadcast live October 6, 2023, from 12:00 PM – 3:15 PM ET
    Enduring Activity Credit Expiration Date: November 4, 2025

    Activity Time: Ninety-minute webinar lecture with a 15-minute evaluation process. Total Time: 1:45.

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    After the video follow the prompts to complete the posttest, evaluation and attestation of credit. 
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