Don’t Go Down the Rabbit Hole!

Don’t Go Down the Rabbit Hole! A Clinical Approach to Unanswerable Questions and the Quest for Certainty 

This recorded webinar was featured at the 2021 ADAA Virtual Conference Resilience and Recovery: From Research to Practice. This webinar is part of a series of select recorded conference sessions which will be available on-demand.

Confessing, apologizing and reassurance-seeking may be pervasive symptoms associated with scrupulosity, unwanted violent and sexual thoughts, generalized and health anxiety, and perfectionism. Children and teens often depend on their parents to assuage their distress; parents may intuitively respond logically and rationally, with the goal of providing comfort and certainty. However, the questions often seem unanswerable, the need for relief seems insatiable, and parents and children become stuck in ruminative “anxiety/OCD scripts” and loops. No sooner does one worry seem quelled when another replaces it. Children demand more with meltdowns and coercive control, often sending parents down a rabbit hole of bafflement, exhaustion and frustration.

When parents attempt to set limits, usually with the guidance of a therapist, children and teens may resort to creative, subtle and indirect attempts to obtain relief. Not recognizing the traps, parents—and even clinicians—may get side-tracked by the ever-evolving presentation, fall further down the rabbit hole, and be at a loss for how to proceed. Often considered hard-to-treat or treatment-resistant, dropout or termination may occur when parents or therapists believe that treatment is “not working.”

This workshop, based in empirically-grounded cognitive-behavioral and exposure-based principles, tackles a complex symptom presentation using a seemingly counter-intuitive approach. It begins with cultivating treatment readiness. Clinicians, children and parents learn to distinguish between the face-value content of the symptoms and the underlying distress and intolerance of uncertainty, recognize direct, subtle and indirect neutralizing, parenting traps and OCD “pinch points” that send them down the rabbit hole, and the cycle of escape that is strengthened by negative reinforcement. The importance of defining the right and wrong goals of treatment proactively is emphasized. “Don’t go down the rabbit hole” functions as a quick prompt for parents and children to pause, recognize and break out of intuitive and repetitive anxiety/OCD scripts, and switch to proactively-developed scripts that promote exposure and tolerance of uncertainty. Using well-established in vivo and imaginal exposure techniques, the treatment focus treatment shifts away from the face-value content to addressing the underlying feeling, to “bring down the feeling temperature” and not go down the rabbit hole.

Learning Objectives:

1. Recognize neutralizing behaviors, parenting traps and “pinch points” that occur with confessing, apologizing and reassurance-seeking.
2. Differentiate right and wrong goals of treatment and face-value content of symptoms versus underlying distress.
3. Apply a systematic approach to focus on addressing the underlying process, instead of the content.

Registration for the 2022 ADAA Conference in Denver March 17-20, 2022 is now open.

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