R. Hatton Therapy

My Mission

My mission is to diagnose and treat individuals with OCD and related issues and to provide the friends and family members of those individuals with the education they will need to better understand OCD and support those they care about struggling with OCD. 

Please call or email today, and I will be glad to answer your questions. My phone number is 858-703-7620 or you can contact me here.

 Treatment for OCD & Related Disorders

Further Information & Announcements

Every 2nd and 4th Friday of the month (every year in June, July, August, November, and December we meet the 2nd Friday ONLY7-8:30pm a FREE support group is offered to individuals struggling with OCD and other related disorders, family members of those listed above, as well as any interested professionals. Located at Mesa Vista Hospital's Day Treatment Lounge, (858.278.4110) 7850 Vista Hill Ave. Kearny Mesa, CA.

The 24th annual conference is in San Francisco, CA. Plan to join us on July 6- July 9, 2017. We are looking forward to another great time to meet people and learn more about OCD and those impacted by it. Go to the OCFoundation Website for further information. 

What is Exposure and Response Prevention (ERP)?

ERP is a very specific type of Cognitive Behavioral Therapy (CBT) that research has shown to be the most effective way of treating OCD. CBT is a form of therapy that addresses one's thinking and behaviors. The idea is that when one is able to change the way they think and behave through new awareness and insight, the way they feel will also being to change providing for increased satisfaction. Some treatment providers may use ERP and CBT interchangeably, but it is important to specifically use ERP when treating OCD.
The Steps of ERP

Step one is to get a better picture of what your OCD is like and how it impacts your life. We do this by using the Yale-Brown Obsessive Compulsive (YBOCS) checklist and scale. This will not only provide the forms of obsessions and/or compulsions you struggle with, but also how much it impacts your daily life. This also provides for discussions to come up about other OCD-related disorders.

Step two is to review and consider a number of factors that may be contributing to you OCD symptoms and/or general anxiety. These include but are not limited to

  • stress management
  • diet and exercise
  • family influence (or lack thereof)
  • sleep habits
  • distorted thinking (often related to depressed mood)
  • relaxation techniques
  • influence of medications/medical conditions (if any)

Step three is to begin developing the hierarchy. We call this the "road map" in therapy. It's a graduated list of all the things that you do that make you anxious, that you think make you anxious, or that you avoid because they make you anxious. This is a list of all the exposures and response preventions that you will work on while in therapy. This will also include a subjective unit of discomfort (SUD) number that indicates how difficult performing any given task will be. The hierarchy is always changing, so it is a critical part of therapy during the entire therapy process.

Step four is to begin developing and working on weekly homework assignments. Homework assignments will first begin with working on developing your hierarchy. All homework assignments after this will involve doing one of the tasks listed on your hierarchy. You will be encouraged to face your fears one at a time without doing the safety maneuver. You will begin with the easiest things on your list and when doing an "exposure" you will have to make sure to "prevent your typical response" that would ordinarily relieve the anxiety temporarily. You will slowly work up to the harder items on your hierarchy finding that the more easy things you do, the easier the more difficult items will become. The important piece about doing homework each is week is to make sure it's an assignment that you can do everyday with some anxiety but not so overwhelming that the anxiety lasts more than an hour or is impossible to complete some days.

During this process listed above, an important thing to consider is who you are without your OCD. We could call this the "post-OCD" vision for your life. Additionally, at the end, it will be important to discuss ways in which you can maintain your gains on your own. 

    Major Differences Between Treatment for 

OCD and Hoarding

While both OCD and hoarding are generally treated with CBT/ERP treatment, there are some significant differences between the two. First, individuals with hoarding often struggle with things like procrastination, decision making, scheduling, and organizing, so a few weeks of therapy are specifically dedicated to what we call "cognitive rehabilitation". This will address how to be better organized both with items and time.

The second major difference between the two is the importance of some home visits for hoarding. With hoarding there is often a great deal of shame that comes with one's home (we call this "CHAOS" - Can't Have Anyone Over Syndrome), so while this may be very difficult for the client, it provides for a great deal of understanding and insight on the therapist's part when working with the client.

The third most common difference is the way E&RP is approached with a hierarchy. While a hierarchy is still used in hoarding treatment, it is often used to describe various areas within/around the home that would be difficult to clear rather than specific items. Additionally, depending on whether there are any safety concerns in the home, the client may be asked to work on areas that are not the easiest item on his/her hierarchy to address safety issues first. See 
hoarding brochure for additional information.

 Habit Reversal Therapy

Habit reversal therapy is a form of therapy used to treat impulse control disorders and tics. It includes learning to increase awareness of unwanted behavior, create a competing response, utilize relaxation techniques or focusing techniques, and incorporate social reinforcement. The first step is to become aware of when these behaviors are most and least frequent. Steps are then taken to create a competing response while utilizing relaxation and/or focusing techniques to get rid of the impulse.

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