Clinical Examples Flashcards
DSM - Phobia Criteria
- Fear or anxiety about specific object
- Object or situation always provokes fear or anxiety
- The phobic object or situation actively avoided
- Fear and anxiety is out of proportion to the danger it poses
How common are Phobias
- Lifetime prevalence 12%
- Moree common in women than men
- majority of patients with specific phobia have at least one other excessive specific fear
- Most patients with social phobias suffer from one or more additional anxiety disorders
Psychodynamic Theory of phobia
Freud, phobias are a result of unconscious anxiety being places onto a neutral or symbolic object
E.g. Hans Oedipal fears of his father, his desire to kill father became unbearable so he displaced it onto horses
Theories of Phobias: Behavioural
- conditioned fear response
- OST and Hugdahl (1981), 58% of phobic clients cited traumatic conditioning experiences as the source of phobia
Mowrer’s (1947) two factor theory of phobia acquisition/maintenance
1) Classical conditioning = rat paired with loud noise -> conditioned fear
2) Operant conditioning = individual avoids rats (reduces anxiety, reinforce avoidance and prevents extinction as rat is absent)
Evolutionary Preparedness
Prepared learning, evolutionary prepared to associate certain objects with fear such as spiders rather than flowers
Treatment of Phobia: Exposure therapy
Slowly expose patient to their fear I.e. go from a photo of slider all the way to holding one but over numerous sessions and slowly
Treatment for Phobias: CBT
- CBT is effective for social phobias associate with cognitive distortions e.g. tendency to interpret ambiguous social info in a negative manner
Obsessive Compulsive Disorder (OCD)
- Occurrence of unwanted and intrusive obsessive thoughts or distressing images
- Compulsive behaviours performed to neutralise the obsessive thoughts or images to prevent some dreaded event or situation
- Driven to perform compulsive ritualistic behaviour in response to an obsession
- Rules on how compulsive behaviour should be performed
- Used to be under anxiety disorder in DSM, now under loosely related conditions
DSM-5 Definition of Obsession
- recurrent and persistent thoughts, impulses or images that are intrusive and disturbing
- attempts to neutralise but realises they are a product of their own mind
Examples of Obsessions
- Contamination, ordering, repeated doubts, aggressive or blasphemous impulses, sexual thoughts and imagery
DSM-5 Compulsion definition
- Repeated behaviours or mental acts carried out in response to obsession
- These acts are aimed to reduce stress and not to provide pleasure or gratification
- Excessive and not realistically connected to what they are intended to prevent
Examples of compulsions
- Hand washing
- Hoarding
- Repeating
- Preying
- Saying thoughts silently
DSM-5 Criteria of OCD
- Either obsessions or compulsions
- Time consuming and cause distress
- Not caused my physiological effects of another medical condition
- Disturbance is not better explained by the symptoms of another mental disorder
DSM-5 Insight specifier
Good or fair insight - recognises that obsessive compulsive disorder beliefs are unlikely to be true
With poor insight - probably true
Absent insight - thinks beliefs are true
OCD Risk factors and prevalence
- 1- 2% of general population
- Equal in men and women
- Late adolescence or early adulthood
- At least 50% of suffers have at least one other psychological disorder
- Contamination and cleaning - women
- Religious obsessions and compulsions more common in cultures that emphasise the importance of religious observance
What causes OCD - Attempts to Suppress the thought
- Most people experience unwanted cognitive intrusions
- The interpretation of appraisal of a thought is critical
- Common place intrusions develop into obsessions when they are appraised as personally important or as posing a threat to which the individual is personally responsible
Dysfunctional beliefs - religion may impact these
1) Inflated personal responsibility
2) Thought action fusion
3) Excessive importance of controlling thoughts
Intrusive thought + Dysfunction belief
Stabbing child, thinking of something = having done it = distress
- Attempts to suppress distress
What’s the White bear effect (Werner et al, 1987)
- If thought suppression works it should leave no sign of unwanted thoughts
- Try not to think of white polar bear, then all you can think about is the white polar bear
- Participants signalled more than one white bear thought per minute
Paradoxical rebound effect = attempts to suppress thought can ‘rebound’ and causes increase occurrence of thoughts ( may be stronger with ocd patients)
Tollin et al (2002)
- Ps pressed a button for word ‘house’ and another for a made up word ‘jwose’
- Participants we’re told to suppress thoughts of bears
- OCD patients showed faster responses to the word bear than other words, this effect wasn’t seen in controls
What causes OCD - Attempts to prevent any harmful consequences
- Compulsions removal of unwanted thoughts and also prevent people from realising their appraisals are unrealistic. They can also strengthen dysfunctional beliefs about responsibility.
- They think they are responsible for stopping their feared consequences
Cognitive Behavioural Model of OCD
Intrusive thought-> misappraise as threatening -> distress -> suppress thoughts -> reduce stress
= maladaptive core beliefs - these also contribute to misappraising
OCD Treatment - CBT
- Exposure and response prevention (I.e. trigger obsession and block compulsion)
- Individuals learn anxiety is temporary, the feared event doesn’t occur
- Very effective
- There is large drop out rates as causes anxiety
- Effects often last at least 2 years
- Personalise treatment
- Involves challenging the moralistic thoughts and excessive sense of responsibility
