Posts Tagged ‘therapy’

The digital clinic

Sunday, March 29th, 2020 | Business & Marketing

They say that the necessity is the mother of all invention. With the impending COVID-19 crisis looming, we decided it was finally time to make virtual appointments part of Leeds Anxiety Clinic’s offerings.

That was easier said than done. Because of the social distancing recommendations already in effect, and Amazon having halted warehouse shipments, the few webcams that were available had all been panic-bought by other people. Luckily, we were able to beg and borrow the equipment we needed until we could get our own.

We’re still playing around with how to produce the best quality experience, both in terms of the technical setup and the differences between delivering therapy face-to-face, where you can easily scribble a diagram or analyse holistic body movements, and delivering it digitally. Early efforts are working well, though.

Cognitive-Behavioral Treatment of Perfectionism

Wednesday, December 27th, 2017 | Books

Cognitive-Behavioral Treatment of Perfectionism is a book by Sarah J. Egan, Tracey D. Wade, Roz Shafran, and Martin M. Antony.

It’s written for therapists but is also useful for academics. And, as it turns out, for some introspection, too.

What exactly is perfectionism? There is no universal definition of clinical perfectionism but typically involves in a process of people setting unachievable standards for themselves and then feeling bad when they miss them. Treating it can have transdiagnostic benefits for a person’s mental health.

A key part is an over-reliance of self-feedback. It’s not enough that other people tell you that you are doing a good job: you need to meet your own high standards, not theirs.

How do you assess it? There is no single way, though a few inventories are emerging. And by “a few”, I mean loads:

  • Almost Perfect Scale-Revised (APS-R)
  • Behaviour Domains Questionaire (BDQ)
  • Burns Perfectionism Scale (BPS)
  • Clinical Perfectionism Questionaire (CPQ)
  • Consequences of Perfectionism Scale (COPS)
  • Frost et al. Multidimensional Perfectionism Scale (FMPS)
  • Hewitt and Flett Multidimensional Perfectionism Scale (HMPS)
  • Neurotic Perfectionism Qustionaire (NPQ)
  • Perfectionism Inventory (PI)
  • Perfectionistic Self-Presentation Scale (PSPS)
  • Positive and Negative Perfectionim Scale (PANPS)

The model

The standard model for perfectionism is that you set a standard and try to achieve it. These standards are typically inflexible, over-general (one mistake wipes off the entire report as failure) and filled with double-standards (it is okay for someone else to do that, but not me).

The height of the standard leads to avoidance.

You either then hit the standard, in which case you tell yourself it was too easy.

Or you miss the standard and beat yourself up.

The treatment

The book lays out a full treatment plan based on cognitive behaviourism. However, one thing I will point out for a quick win: merely monitoring your symptoms seems to improve things.

Ethlers and colleagues (2003) had people with PTSD perform daily monitoring of their symptoms. After three weeks, 12% had improved sufficiently to no longer meet the clinical level of PTSD.

Similarly, there is evidence that self-monitoring contributes to improvements in anxiety and depression (Coull & Morris, 2011).

Self-criticism

Perfectionists often see a value in self-criticism because they believe that if they accepted lower standards, they would be lazy and unproductive.

So, rather than eliminating self-criticism, we want to replace it with constructive feedback.

The authors suggest we think of it as the choice between two basketball coaches: do you want one who just calls you “stupid” and “a failure” when you make a mistake? Or do you want one that is encouraging, offers suggestions for improvements and guides you to the next level in performance? That is the difference between a self-critical inner voice and a compassionate but productive one.

This is important because of the Yerkes-Dodson Law. This states that there is an optimal level of arousal. Too little, and you will be lazy. Too much, though, and your performance starts to deteriorate as well. Moderation is the order of the day: gentle pressure produces optimal performance, not viciously beating yourself up.

Procrastination

One of the biggest problems for perfectionists is that they are often not productive because of procrastination. They put off tasks for a number of reasons:

  • The task is large, and therefore the time commitment to completing it perfectly is equally large
  • You feel overwhelmed by the idea of having to do it perfectly
  • Giving yourself too little time is an easy get-out: it’s okay for it to be imperfect because it is not a true reflection of your performance

So, they do nothing. Nothing pleasurable, either. There can be no enjoyable tasks because they “haven’t earned it”. So, the time simply goes to waste.

The motivation trap

A common reason for putting tasks off is “waiting for the motivation” to get it done. But the authors claim that this is a fundamental misunderstanding of causation.

We assume that motivation inspires action. But, in reality, action inspires motivation (Shafan et al 2010). If you want to feel motivated about a task, force yourself to start it and them motivation will follow.

This fits with my blog post on what comes first: thoughts or feelings? It is our behaviour that drives our feelings, not the other way around.

Summary

This is a really interesting read for anyone interested in perfectionism. It is aimed at clinicians, which means you don’t get all of the friendly hand-holding of popular science, and everything comes from a certain angle. However, it is written in a very engaging way, so doesn’t suffer from the stuffiness of academic texts.

EMDR

Tuesday, May 1st, 2012 | Thoughts

Recently, I undertook my first session of EMDR.

It’s a relatively new form of therapy (albeit, older than Elina), which in it’s full title is named “Eye movement desensitization and reprocessing” originally developed to help trauma victims and has since expanded into other areas.

So far, I’m quite torn about it. On one hand, EMDR is now approved and recommended by The National Institute for Health and Clinical Excellence (NICE) and has shown to be affective in dozens of randomised controlled trials.

On the other hand, it really, really sounds like Dianetics.

For those not familiar with it, Dianetics is a concept developed by Scientology founder L. Ron Hubbard which divided the mind into two parts – one of which is the reactive mind that stores traumatic memories, and anything associated with those memories, related or not.

This is why Scientologists are very quite around people who have been knocked out – because anything they say will be linked to the memory of being knocked out in the reactive mind. These are stored as negative engrams and the only way to get rid of them is to pay for Audit Counseling.

I’m not a subscriber to Dianetics, and even though EMDR has a lot of key differences (for example, the traumatic memories don’t just pop out of existence in a second), it’s similarities have thrown me somewhat, despite all the evidence to show EMDR genuinely does work. It’s like some kind of reverse-placebo affect, is there a term for that?