clinical examples Flashcards
what are phobias?
excessive or unreasonable fears of objects, places or situations
when is the phobic stimulus avoided or endured?
with intense anxiety or distress
specific phobia DSM-5 critera
marked or fear anxiety about a specific object or situation
types of phobias
5 types
- animal (spiders, insects)
- natural environment (heights, water)
- blood-injection-injury (needles)
- situational (planes, elevators)
- other
social phobia DSM-5
marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others
types of social phobia
- performance situations (public speaking)
- general (eating in public)
prevalence and gender ratio
lifetime prevalence & specific phobias
4 points
- lifetime prevalence around 12%
- more common in women than men
- most patients with specific phobia have at least one other excessive specific fear
- most patients with social phobia suffer from on ore more additional anxiety disorders
theories
psychodynamic (Freud)
phobias result when unconsious anxiety is displaced onto a neutral or sympolic object
e.g. Hans Oedipal fears of his father - desire to kill his father - became unbearble and was displaced onto horses
theories
behavioural: Ost and Hugdhal 1981: phobic clients
58% of phobic clients cited traumatic conditioning experiences as the source of phobia
theories
behavioural: McCabe et al 2003: teasing
92% socially phobic adults reported a
history of severe childhood teasing
Mowrer’s two factor theory of phobia acquisition/maintenece (1947)
1) Classical conditioning: rat paired with loud noise -> conditioned fear.
2) Operant conditioning: individual avoids rats.
* Prevents extinction
* Reduces anxiety, produces relief, thus avoidance is reinforced.
evolutionary preparedness
what is prepared learning
when primates seem evolutionarily prepared to rapidly associate certain objects with frightening or unpleasant events
evolutionary preparedness
what are prepared fears?
they are not innate but easily acquired and resistant to extinction
what is tryphobia?
when individuals have an aversion towards clusters of roughly circular shapes
treatment: exposure therapy
e.g. someone with a fear of snakes may be instructed to handle a snake or someone with social anxiety might be instructed to giva speech in front of an audience
treatment: CBT (cognitive behavioural therapy)
e.g. to treat social phobias
what is obsessive-compulsive disorder (OCD)
occurrence of unwanted and intrusive obsessive thoughts or distressing images
what does a person with OCD feel?
- they feel driven to perform a compulsive ritualistic behaviour in response to an obsession
- they need to follow very rigid rules regarding how the compulsive behaviour should be performed
classification controversy
DSM-IV & 5 OCD
- in the DSM-IV OCD was categorised under ‘anxiety disorders’
- it was then removed from this category and was grouped under “obsessive-compulsive and related disorders” in the DSM 5
DSM-5 obsession definitions
- recurrent and persistant thoughts/impulses that are experienced as intrusive, disturbing, inappropriate and uncontrollable
how do individuals try and suppress obsessions
with some other thought or action
frequent types of obsessions
3 types
- contamination
- repeated doubts
- odering
obsessions
agressive or blasphemous impulses
- to shout an obscenity in a church
- to hurt a loved one
obsessions
sexual thought and imagery
a reccurent pornographic image - that violates one’s morals
DSM-5 compulsions definition
repetitive behaviours or mental acts the person feels driven to perform in repsonse to an obsession, or according to rigid rules
compulsions: repetitive behaviours
4 examples
- hand washing
- ordering
- cleaning
- hoarding
compulsions: mental acts
4 examples
- counting
- praying
- saying words silently
- thinking good thoughts to undo bad ones
compulsion: washing rituals
2 rituals
- washing hands for about 20 minutes after using the toilet
- washing hands for hours with disinfectants up to the point of bleeding
compulsions: checking
2 examples
- all the lights, appliances, and locks 2-3 times before leaving the house
- going back to a junction where one thinks one may have run over a pedestrian
compulsions and obsessions DSM-5 critera
- obsessions or compulsions are time-consuming or cause clinically significant distress or impairment in social, occupational, or other important ares of functioning
insight specifier DSM-5 criteria good/fair insight
individual recognises obsessive-compulsive disorder beleifs are definitely or probably not true or that they may or may not be true
insight specifier DSM-5 criteria poor insight
individual thinks O-C disorder beliefs are probably true
insight specifier DSM-5 criteria absent insight
individual is completely convinced that O-C disorder beliefs are true
insight and executive functions DSM-5 criteria
Recent work on the neuropsychological and cognitive characteristics of OCD patients with poor insight has highlighted the role played by the executive functions in insight.
OCD examples from celebs: Leo DiCaprio
Leo would step on cracks on the way to school and would have to walk back a block and step on that same crack/gum stain
what causes OCD?
risk factors and cognitive aetiology
OCD prevalence
estimated prevalence 1-2% of general population
OCD gender
equally common in men and women
when does OCD begin?
usually begins in late adolescence or early adulthood
* in childhood disorder is more common in boys than girls
how many sufferers have another psychological disorder with OCD
50%
Gender and OCD types:
- themes of sexuality, exactness and symmetry are more common in men
- contamination and cleaning more in women
OCD and culture
culture may influence themes of obsessions and compulsions
* example: religious obsessions and compulsions more common in cultures that emphasise the importance of religious observance
what causes OCD: psychological factors (cognitive intrusions)
- unwanted cognitive intrusions are experienced by most people i.e. unpleasant thoughts
- these intrusions typically have similar contents to clinical obsessions
what causes OCD: appraisals
unwanted cognitive intrusions are experienced by most people
* interpretation or appraisal of a thought is critical
what causes OCD: dysfunctional beliefs
1 point 2 examples
misapprasials are due to dysfunctional beleifs
e.g.
1. beleifs about inflated personal responsibility over one’s own and other’s safety
2. thought-action-fusion - thinking about an unacceptable or disturbing event makes it more likely to happen
what are obsessional thoughts equivalent to?
forbidden actions
OCD: dysfunctional beliefs evidence
Tolin et al. 2003: dysfunctional beliefs were associated with OCD symptoms in both clinical and non-clinical samples
what causes OCD: if thought supression works it should…
if thought supression works, it should leave no mark of the unwanted thought at all
what causes OCD: thought supression
Wegner et al. 1987 white bear study
- 5 minute supression session, participants had to ring a bell each time a white bear came to mind
- participants signaled more than one white bear thought per minute
Participants had to supress any thoughts of a bear
what causes OCD: thought supression
what is the paradoxical rebound effect?
attempts to supress thoughts can ‘rebound’ and result in an increased occurence of the thoughts
what do thought supression attempts lead to?
it results in more rather than less intrusions
* the paradoxical effect of thought supression may result in full blown obsessions
results of white bear effect
OCD patients showed faster responses to the word bear than to other words. this effect was not seen in controls
what causes OCD: distress as a motivators
distress -> attempts to suppress the thought -> attempts to prevent any harmful consequences
EXAMPLE:
by avoiding knives and continually asking other people to
check on the safety of the child
what causes OCD: psychological factors (compulsions)
compulsive rituals develop as efforts to remove intrusions and to prevent any perceived harmful consequences
what do comuplsions prevent people with OCD to do?
prevents people with OCD from learning that their appraisals are unrealistic
EXAMPLE:
the affected individual fails to learn that unwanted harm-related images do not lead to acts of harm
TREATMENT
OCD: exposure
systematic, repeated, and prolonged confrontation with stimuli that provoke anxiety and the urge to perform compulsive rituals
TREATMENT
OCD: response prevention
person refrains from performing compulsive rituals
what do individuals learn from exposure and response preventions?
4 key points
- anxiety is temporary
- the feared catastrophic consequence never transpires
- their interpretation of the obsession weakens
- obessional thoughts are harmless
what have randomised controlled trials demonstarted about exposure and response prevention?
RCT have demonstrated that E/RP is more effective than any other forms of psychotherapy and placebos
* However E/RP provokes anxiety in patients: approx 25% drop out of treatment
