6. Theories and Therapeutic Approaches of OCD Flashcards
DSM-5 OCD:
The person experiences either o____ or c____ that cause d____, are t____ consuming and/or interfere markedly with d____ l____
obsessions, compulsions, distress, time, daily life
OCD affects about __-__% of the population at any one time
1-2%
Intrusive thoughts:
1. I____ unpleasant thoughts, i____ or i____ that pop into our minds a____ o____ w____
2. Have u____ content - often but not always themes of harm to s____ or o____, or of harm cause by s____ to o____
3. Are not simply e____ w____ about real-life problems
4. Are e____-d____ (i.e. inconsistent with own values and ideal self)
5. Are c____ - we all have them
- Involuntary, images, impulses, against our will
- unpleasant, self, others, self, others
- excessive worries
- ego-dystonic
- common
Intrusive thoughts can be:
1. V____
2. I____
3. U____
- Verbal (e.g. “I want to hit him”)
- Images (e.g. visualising a car accident with a loved on tin the car)
- Urges (e.g. an unwanted urge to shout and swear in Church)
Intrusive thoughts are NOT:
1. W____ thoughts
2. D____ r____
3. T____ m____
- Worry thoughts – e.g. concerns about everyday issues such as exams or money (and these are ego-syntonic and have more voluntary control)
- Depressive rumination – e.g. dwelling on negative thoughts and feelings (which also are ego-syntonic and have more voluntary control)
- Trauma memories – e.g. memories of a traumatic event that are involuntary activated (as in post-traumatic stress disorder)
Obsessions:
1. Are r____ i____ thoughts that are a____ as i____ and m____ that leads to significant a____, d____, s____ or another unpleasant emotion
2. The person attempts to i____ or s____ obsessive thoughts, impulses or images and tries to n____ them with another thought or action
3. The person recognises that the obsessional thoughts, impulses, or images are a p____ of their o____ m____
- repetitive intrusive, appraised, important, meaningful, anxiety, disgust, shame
- ignore, suppress, neutralise
- product, own mind (i.e. not thought insertion)
Obsessions vs intrusive thoughts:
1. Obsessions are r____ intrusive thoughts
2. Obsessions have the same type of c____ as t____ intrusive thoughts
3. Obsessions are associated with s____ d____ and/or i____ on daily life
- Recurrent (i.e. the same thought, image or urge repeats itself again and again)
- Content, typical
- significant distress, impact
Compulsions:
1. R____ o____ behaviours or c____ m____ behaviour that the person feels driven to perform in r____ to an o____
2. The behaviours or mental acts are aimed at p____ the intrusive thought from h____ or at p____/r____ distress
3. However, these behaviours either are not clearly c____ with what they are intended to n____ or p____ or are clearly e____
- Repetitive overt, covert mental, response, obsession
- Preventing, happening, preventing/reducing
- connected, neutralise, prevent, excessive
The role of avoidance:
1. OCD doesn’t just involve c____, it can stop people doing important tithing in e____ l____
2. May a____ t____ o____ or p____ so don’t trigger obsessions about g____ or d____
3. May a____ b____ a____ p____ so don’t trigger obsessions about h_____ other people
4. May not use a____ so don’t trigger c____ obsessions
- compulsions, everyday lives
- avoid touching objects or people, germs or dirt
- avoid being around people, harming
- appliances, checking
Two psychological theories of OCD are:
1. B____ theories
2. C____ theories
- Behaviour
- Cognitive
Classical conditioning and OCD:
1. An object or event becomes p____ with a f____ object or event
2. The object then e____ o____ and a f____ response
- paired, feared
- elicits obsessions, fear
In operant conditioning, the c____ of a behaviour influence its f____ l____
consequences, future likelihood
Operant conditioning and OCD involves n____ c____ being t____ a____ (n____ r____), therefore c____ b____ i____
negative consequences, taken away, negative reinforcement, checking behaviour increases
(e.g. Someone repeatedly checks their front door is locked until they no longer feel anxious and so a negative consequence (anxiety) is removed, the checking behaviour is negatively reinforced)
Two Factor Theory and OCD (Mowrer, 1960):
1. An object or event is c____ c____ to elicit f____
2. The person a____ the object or event and/or they develop b____ to reduce their feelings or f____
3. A____ and r____ behaviours (c____) are n____ r____ (o____ c____), making their occurrence more likely in the future and p____ e____ of f____
- classically conditioned, fear (e.g. a door paired with burglary in childhood)
- avoids (e.g. avoids going out), behaviours, fear (e.g. repeatedly checking the door is locked)
- Avoidance, repeated, compulsions, negatively reinforced, operant conditioning, preventing extinction, fear
Two key components of Behaviour Therapy: Exposure and Response Prevention (ERP)…
1. C____ c____: exposure to objects or events that t_____ o____
2. O____ c____: r____ p____ of all r____ and c____ behaviours
- classical conditioning, trigger obsessions (objects/events that may have previously been avoided)
- Operant conditioning, response prevention, rituals, compulsive (e.g. counting, self-reassurance)
Evidence for Exposure plus Response Prevention:
32 people diagnosed with OCD allocated with 3 conditions…
1. E____ to feared object/event: r____ a____ (c____ conditioning)
2. D____ from c____: r____ a____ (o____ conditioning)
3. E____ + d____ r____ a____ to a greater degree than either on its own (t___- f____ theory)
- Exposure, reduced anxiety, classical
- Disengaging, compulsions, reduced anxiety, operant
- Exposure, disengagement reduced anxiety, two-factor
Two theories of how exposure-based therapies work:
1. E____ P____ theory
2. I____ L____ theory
- Emotional Processing Theory (EPT)
- Inhibitory Learning Theory (ILT)
A n____ linking o____ thoughts, their t____, f____ c____ and the f____ itself is s____ in memory along with c____ behaviour u____. This n____ is activated when any part of the n____ is t____.
N____ activation a____ and s____ pathways in the n____ making the n____ more r____ a____ in the future relevant c____
network, obsessional, triggers, feared consequences, fear, stored, compulsive, urges, network, network, triggered
Network, activates, strengthens, network, network, reading activated, cues
Emotional Processing Theory:
1. R____ a____ = network s____ in memory
2. A____ of triggers and c____ behaviours leads to pathways in network being s____ over time - activation of one part of the network means that activation of the whole network becomes more and more l____
3. P____ e____ with r____ p____ to obsessional triggers leads to h____ (a____ gradually reduces) and new n____-f____ information about the triggers and intrusive thoughts become i____ with the old memory
4. Over r____ e____ and r____ p____ sessions the old fear network is replaced with new n____-f____ network
- Repeated activation, strengthened
- Avoidance, compulsive, strengthened, likely
- Prolonged exposure, response prevention, habituation, anxiety, non-fear, integrated
- Repeated exposure, response prevention, non-fear
In the Emotional Processing Theory:
In Old Fear Memory there are s____ p____ between elements of the network. In New Fear Memory, p____ between elements of the network are b____.
strong pathways, pathways, broken
Evidence for Emotional Processing Theory:
1. Degree of h____ is generally not correlated with e____ t____ o____
2. This suggests that h____ may not be the p____ m____ through which exposure therapies have their effect
3. Also, r____ following exposure and response prevention is c____ - if the therapy leads to c____ information stored in memory r____ shouldn’t happen
- habituation (how much anxiety falls during and between exposure sessions), exposure treatment outcomes
- habituation, primary mechanism
- relapse, common, changed, relapse
Inhibitory Learning Theory:
1. Exposure-based learning does not result in m____ of the existing fear memory about the s____ and r____. Rather, the original fear information is r____ in m____ and easily a____ as it is thought to be i____ of c____
2. New non-fear information from exposure-based tasks is stored in memory, but as a s____ memory
3. The new memory is thought to be c____ d____ as new info is stored along with c____ c____ in which the new learning took place
4. The old (fear) and new (non-fear) memories may continue to be a____ - the new memory is more likely to be a____ when cues are available that match the c____ in which the new learning took place
- modification, stimulus, response, retained, memory, activated, independent, context
- separate
- context dependent, contextual cues
- activated, activated, context
In the Inhibitory Learning Theory:
In Old Fear Memory there are strong p____ between elements of the network. New Fear Memory exists a____ the old fear memory and c___ for r____
pathways, alongside, competes, retrieval
Support for Inhibitory Learning Theory:
1. There isn’t a well-established association between the degree of h____ and exposure-based therapy outcomes
2. Exposure and response prevention appears to be more effective when tasks are performed in a variety of c____
3. R____ rates following exposure-based therapy for OCD is common - this fits with ILT as the old fear memory is r____ and may become r____-a____ in the future
- habituation
- context (so that the new learning can be cued across many different situations)
- Relapse, retained, re-activated
Limitations with ERP for OCD:
1. Exposure and response prevention is challenging as encouraging people to e____ t____ to d____ events or objects
… 15.6% of people r____ ERP
… 15.9% of people d____ o____ from ERP therapy
… People often don’t f____ e____ in ERP in-session and home tasks, at least __% of tasks need to be completed for the best therapy outcomes
expose themselves, distressing
refuse
drop out
fully engage, 75%
The cognitive model of OCD:
1. E____ has intrusive thoughts, so intrusive thoughts are not the p____
2. According to the cognitive model, OCD is c____ and m____ by what people b____ about their intrusive thoughts
- Everyone, problem
- caused, maintained, believe
A cognitive formulation of OCD…
I____ thought (IT) –>
B____ about ITs –>
A____ –>
C____ b____
intrusive
beliefs
anxiety
compulsive behaviour
Cognitive factors in OCD:
Obsessive Compulsive Cognitions Working Group identified six beliefs associated with OCD…
1. Beliefs about the i____ or thoughts
2. Beliefs about the importance or c____ thoughts
3. Beliefs about the n____ to be __% c____
4. Beliefs that t)____ are more likely to happen than they really are
5. Believing that I am p____ and s____ r____ for causing/preventing harm
6. P____ beliefs
- Beliefs about the importance of thoughts
- Beliefs about the importance of controlling thoughts
- Beliefs about the need to be 100% certain (99% certain isn’t sufficient)
- Beliefs that threats (indicated by intrusive thoughts) are more likely to happen than they really are
- Believing I am personally and solely responsible for causing/preventing harm
- Perfectionistic beliefs
A factor analysis of 87 self-report questionnaire items revealed 3 key factors:
1. Beliefs about the i____ of thoughts and the importance of c____ thoughts
2. Beliefs about p____ r____ for c____ or p____ harm and o____ of threat
3. Need for c____ and p____
People diagnosed with OCD scored significantly more highly than people with other anxiety conditions on __ and __
- importance, controlling
- personal responsibility, causing, preventing, overestimating
- certainty, perfectionism
1 and 2
R____ b____ are associated with OCD. However, c____ doesn’t prove c____. Experimental studies:
1. Manipulating sense of r____ led to d____ u____ to check in people diagnosed with OCD
2. In a non-clinical population, manipulating r____ b____ led to greater c____ behaviours
… Some evidence that heightened r____ b____ might cause e____ c____
Responsibility beliefs
correlation, causation
1. responsibility, decreased urge
2. responsibility beliefs, checking
responsibility beliefs, excessive checking
Beliefs about the i____ of thoughts and thought c____ are associated with OCD. In an experimental study, manipulating beliefs about the i____ of thought c____ led to more i____ and greater d____
importance, control
importance, control, intrusions, distress
Limitations of the Cognitive Model:
1. Limited research that beliefs about intrusive thoughts play a c____ role in OCD (beliefs may be s____)
2. Cognitive therapy for OCD is not more effective than E____ for OCD
3. Most people with OCD are concerned about some of their i____ thoughts but not all - the cognitive model of OCD doesn’t explain why only some i____ thoughts cause d____
- causal, secondary
- ERP
- intrusive, intrusive, distress
ERP in practice:
1. Working c____ the therapist and client identify and write down the main areas of OCD d____
2. For each OCD d____, identify and write down ERP tasks that will:
a) t____ the distressing intrusive thoughts and
b) prevent e____ in all compulsive b____ and r_____
ERP should be prolonged and repeated at least d____ in a wise v____ of e____ s____
Select __-__ tasks r____ from their list each week, including e____ and more d____ tasks
- collaboratively, difficulty
- difficulty
a) trigger
b) engagement, behaviours, rituals
daily, variety, everyday settings
2-3, randomly, easy, difficult
Response prevention is a crucial addition to graded exposure to discourage e____ with compulsive behaviours. It is a way of encouraging p____ e____ to the f____ s____. Prevented responses may be e____ or i____
engagement, prolonged exposure, feared stimulus, external, internal
Cognitive Therapy for OCD:
1. Based on the theory that OCD is caused and maintained by b____ about i____ t____
2. Seeks to i____ and r____-e____ the a____ of beliefs about intrusive thoughts by gathering e____
3. CT is not p____ thinking, it involves gathering e____ and evaluating what the means
- beliefs, intrusive thoughts
- identify, re-evaluate, accuracy, evidence
- positive, evidence
Cognitive therapy for OCD involved 3 stages:
1. Identify b____ about intrusive thoughts
2. Develop a s____ f____ d____ with the person
3. Develop b____ e____ to test the a____ of beliefs
- beliefs
- shared formulation diagram
- behavioural experiments, accuracy
The addition of cognitive therapy to ERP can help people understand h____ their OCD w____ and can help to m____ them to e____ in ERP tasks
how, works, motivate, engage
Breaking the OCD cycle includes:
1. I____ trigger intrusive thoughts and stop a____
2. Drop all c____ behaviours, including m____ behaviours and asking o____ p____ to do behaviours for us
3. R____-e____ the a____ of our beliefs that intrusive thoughts are i____ and m____
- Intentionally, avoidance
- compulsive, mental, other people
- Re-evaluate, accuracy, important, meaningful
New learning involves:
1. Learn that intrusive thoughts aren’t i____ and often don’t c____ t____
2. May still notice u____ feelings but learn these feelings aren’t d____ and that the person can c____ with them
3. May also not u____ feelings become less s____
- Important, come true
- unpleasant, dangerous, cope
- unpleasant, strong
Evidence from multiple r____ controlled trials (RCTs) shows that ERP and cognitive therapy are more e____ than c____ conditions at improving symptoms of OCD (e.g. Hougaard et al, 2008 meta-analysis). However, there was no differences between ERP and CT after therapies had been c____ and this remained the case at the __ and __ follow-up
randomised, effective, control
completed, 3-month, 2-year
A Systematic Review of RCTs comparing ERP to CT for OCD (Ougrin, 2011) showed no significant different between ERP and CT at p____-t____ or at f____-u____ (up to __ years later)
post-therapy, follow-up, 2
__% of people do not recover following ERP or CT or a c____ of the two. This may due in part to p___ therapy e____ for ERP/CT/CBT for OCD
50%, combination, poor, engagement
Mindfulness involves:
1. C____ and i____ a____ of present-moment experiences
together with…
2. A non-j____, a____ attitude towards whatever is p____
- Curious, interested awareness
- judgemental, present
Mindfulness-based ERP might improve engagement by enabling people to:
1. T____ unpleasant feelings during ERP tasks
2. Lessen c____ in beliefs about the i____ of intrusive thoughts
3. C____ choose to d____ from compulsions, rather than engaging with then on a____
- Tolerate
- conviction, importance
- Consciously, disengage, autopilot
A pilot study found mindfulness incorporated with ERP may not i____ outcomes compared to ERP alone
improve
