1.5.3 Treatment and management of obsessive-compulsive disorder

Question 1

SSRIs - Biological treatments

What medication is most used to treat OCD?

Answer 1

SSRIs.

Question 2

SSRIs - Biological treatments

How do SSRIs work?

Answer 2

These medications work by blocking the serotonin from being reabsorbed once a message has been passed from one neuron to another, meaning serotonin levels remain higher.

Question 3

SSRIs - Biological treatments

What is the effect of SSRIs on OCD?

Answer 3

They reduce the severity of obsessive-compulsive symptoms, as they seem to lessen the anxiety associated with the disorder.

Question 3

SSRIs - Biological treatments

What did Soomro et al. (2008) find out about treating OCD with SSRIs?

Answer 3

He reviewed the results of 17 studies which compared the effectiveness of SSRIs with placebos.

The studies measured symptoms using Y-BOCS, and in all studies, SSRIs as a group were more effective than placebos at reducing OCD symptoms 6-13 weeks after treatment.

Question 4

SSRIs - Biological treatments

What did Selvi et al. (2011) discover about the effectiveness of 2 other drugs on OCD patients who did not respond successfully to SSRIs?

Answer 4

They tested aripiprazole and risperidone on 41 patients with OCD who did not repond successfully to SSRIs, and found that risperidone was the better drug to improve the OCD condition.

Question 5

SSRIs - Biological treatments

Remission

Answer 5

If you’re in partial remission, it means you can take a break from treatment as long as the illness doesn’t begin again.

Complete remission means that tests, physical exams and scans show that all signs of your illness are gone.

Question 6

SSRIs - Biological treatments

What did Askari et al. (2012) learn about the effectiveness of granisetron being used alongside SSRI fluvoxamine?

Answer 6

Some ppts were given granisetron, whilst the others received a placebo.

They were assessed using the Y-BOCS and had all been diagnosed prior using the DSM-5.

By week 8 of treatment, 100% of the granisetron group had scored a complete response (minimum 35% reduction in Y-BOCS) and 90% had met the remission criterion. This is compared to only 35% in the placebo group.

Question 7

SSRIs - Biological treatments

Why should SSRIs be effective at treating OCD?

Answer 7

If we assume low serotonin levels cause OCD, then drugs can be used to increase serotonin activity.

Clomipramine is a drug like this.

Question 8

SSRIs - Biological treatments

Criticisms of SSRIs to treat OCD

Answer 8

• Cannot offer full explanation or cure.
• Drugs may be palliative- when they stop being taken, symptoms return.
• Psychological interventions show a strong effect and yet don’t rely on drugs/physical intervention.

Question 9

Exposure and response therapy (ERP) - Psychological treatments

Exposure and response prevention (ERP)

Answer 9

A form of CBT.

Individuals are exposed to stimuli that provoke their obsessions and the associated distress, while at the same time they are helped to prevent their compulsive behaviours.

Question 10

Exposure and response therapy (ERP) - Psychological treatments

Example of ERP

Answer 10

Individual may be exposed to a door handle, which would elicit obsessions surrounding dirt/germs, along with a desire to carry out a compulsion like handwashing.

Individual is helped not to wash their hands but instead tolerate the anxiety and accept their obsession.

Question 11

Lehmkuhl et al. (2008) - ERP - Psychological treatments

Aim

Answer 11

To investigate the efficacy of CBT for a child with Autism Spectrum Disorder (ASD) and OCD.

Question 12

Lehmkuhl et al. (2008) - ERP - Psychological treatments

Method

Answer 12

Case study.

Question 13

Lehmkuhl et al. (2008) - ERP - Psychological treatments

Participant

Answer 13

• 12-year-old
• Named Jason
• Obsessions = contamination
• Compulsions = handwashing
• Had ASD
• ASD symptoms = sensory issues, self-harm, limited/repetitive language and play, poor social responses.

Question 14

Lehmkuhl et al. (2008) - ERP - Psychological treatments

Part 1

Answer 14

Jason identified feelings of distress with the therapist and was taught ‘coping strategies’.

Question 15

Lehmkuhl et al. (2008) - ERP - Psychological treatments

Example of a coping strategy

Answer 15

‘I know that nothing bad will happen.’

Question 16

Lehmkuhl et al. (2008) - ERP - Psychological treatments

Part 2

Answer 16

Exposed to ‘contaminated’ stimuli, such as door handles/elevator buttons, which produced anxiety or disgust.

The exposure involved Jason being asked to tough these repeatedly until his anxiety levels dropped.

Exposure became increasingly more difficult and in between sessions, he practised the exposure by handing out papers at school, for example.

Question 17

Lehmkuhl et al. (2008) - ERP - Psychological treatments

Results

Answer 17

• Y-BOCS score dropped from 18 to 3.
• 3 months later, Jason showed no sign of relapse.

Question 18

Lehmkuhl et al. (2008) - ERP - Psychological treatments

Conclusion

Answer 18

CBT can be personalised for children with additional needs.

Question 19

Lehmkuhl et al. (2008) - ERP - Psychological treatments

Strength

Answer 19

Valid = triangulation of data using psychometric tests, observations, medical records etc.

Question 20

Lehmkuhl et al. (2008) - ERP - Psychological treatments

Criticisms

Answer 20

• Case study = ungeneralisable to others.
• RWA = may have only been effective due to that specific therapist.

Question 21

LOVELL ET AL. (2006)

Context

Answer 21

Weekly, in-person therapy is costly and lengthy waiting lists can make it inaccesible.

Question 22

LOVELL ET AL. (2006)

Aim and hypothesis

Answer 22

To compare telephone vs face-to-face ERP CBT treatment.

Telephone ERP is not less effective than face-to-face ERP.

Question 23

LOVELL ET AL. (2006)

Method

Answer 23

Randomised control trial, independent measures, longitudinal.

Question 24

LOVELL ET AL. (2006)

Participants

Answer 24

72 16-65 year-old outpatients with OCD from the UK.

All scored 16+ on the Y-BOCS and did not suffer from substance misuse or other conditions.

Question 25

LOVELL ET AL. (2006)

Sampling

Answer 25

Opportunity sample.

Question 26

LOVELL ET AL. (2006)

How were ppts assigned to each condition?

What were the conditions?

Answer 26

Randomly assigned to either the telephone or face-to-face condition (independent measures design).

Question 27

LOVELL ET AL. (2006)

Explain the sessions of CBT

Answer 27

Exposure response prevention therapy, either delivered traditionally through a 60-minute face-to-face session, or by a shorter telephone call (up to 30 minutes).

Question 28

LOVELL ET AL. (2006)

How many sessions were given to each ppt?

How often?

Answer 28

10 weekly sessions.

Question 29

LOVELL ET AL. (2006)

How many therapists carried out the treatments?

How was the consistency of treatment maintained?

Answer 29

2 experienced therapists (one at each clinic carried out both type).

Therapist manuals were used, alongside fortnightly supervision sessions and 4-monthly training days.

Question 30

LOVELL ET AL. (2006)

How were ppts assessed prior to treatment?

Answer 30

Prior to treatment, all ppts were assessed twice, 4 weeks apart, using the Y-BOCS to measure the severity of their OCD and BDI to measure feelings of depressive disorder.

Question 31

LOVELL ET AL. (2006)

How were ppts assessed after treatment?

Answer 31

Ppts were assesed using the Y-BOCS and BDI immediately following treatment, then at 1, 3 and 6-month follow-ups.

There were also given a client satisfaction questionnaire.

Question 32

LOVELL ET AL. (2006)

What was there no significant difference in between the groups before treatment or at any of the follow-up assessments?

Answer 32

No significant difference in symptom severity between the telephone and face-to-face groups.

Question 33

LOVELL ET AL. (2006)

Did client satisfaction differ?

Answer 33

Client satisfaction did not differ immediately after treatment.

Question 34

LOVELL ET AL. (2006)

For what percentage of ppts in each group was treatment successful for?

Answer 34

• Telephone group = 77%
• Face-to-face group = 67%

Question 35

LOVELL ET AL. (2006)

Conclusions

Answer 35

Telephone ERP CBT for OCD is as effective as face-to-face therapy, despite 50% less therapist contact time.

Question 36

LOVELL ET AL. (2006)

Strengths

Answer 36

• Valid = random allocation should control for researcher bias/individual differences.
• Reliable = baseline measure were taken twice (test-retest reliability).
• Standardised = objective scales for measurement and trained therapists.
• RWA = cheaper more accessible alternative to traditional CBT but just as effective.

Question 37

LOVELL ET AL. (2006)

Criticisms

Answer 37

• Cultural bias = hard to generalise since the sample was small.
• Self-report = risk of demand characteristics/social desirability bias since answers are subjective.
• Longitudinal = 11 ppts dropped out, attrition can cause reduced validity/generalisability.

Question 38

Issues and debates

Do SSRIs show individual or situational factors?

Answer 38

Only takes individual serotonin levels into account, not the situation that may cause the symptoms to appear.