ICD Flashcards
Characteristics of impulse control disorders and non-substance addictive disorder
P1 - definitions (Griffiths)
P2 - types : kleptomania, pyromania (Burton et al) + gambling disorder
P3 - measures: Kleptomania Symptom Assessment Scale (K-SAS)
Causes of impulse control disorders and non-substance addictive disorder
P1 - biochemical: dopamine
P2 - behavioural: positive reinforcement
P3 - cognitive: feeling-state theory (Miller)
Treating and managing ICDs and Non-substance addictive disorder
P1 - biochemical (Grant et al)
P2 - cognitive-behavioural: covert sensitisation (Glover)
imaginal desensitisation (Blaszczynski and Nower), impulse control therapy (Miller)
Definition (Griffiths) for ICD and non-substance addictive disorder
- salience (most important activity)
- mood modification (buzz)
- tolerance (increasing amount of activity)
- withdrawal (unpleasant when stopped/reduced)
- conflict + relapse (can’t stop, return back to)
What is Kleptomania?
- stealing objects not needed for personal use or monetary value
- tension before stealing, pleasure afterwards
- intrusive thoughts, urge to steal
- affect concentration
- not committed to express anger, not due to delusion/hallucination
What is pyromania?
- deliberately and intentionally set fires on more than one occasion
- feel tense/emotionally charged before the act and pleasure when setting fire or participating in their aftermath
What is gambling disorder?
- non-substance addictive disorder
- difficulty in controlling impulses
- stimulate brain’s reward centre —similar to substance abuse
- persistent + problematic gambling behaviour
- difficulty withdrawing
- impact family/individual/society
What is the feeling state theory (Miller)
- Cognitive theory, describes how intense, positive feelings can be linked with a behaviour
- Miller refers to this link as a state-dependent memory —> build over time through association, known as feeling-state
Explain the intense feeling in feeling state theory
- persist over time and different circumstances, early positive feeling states, affect later behaviour
- underlying negative thoughts/experiences —> most likely to create the feeling states that lead to ICDs
- e.g. the pyromaniac who has the feeling state ‘ I am powerful’ when setting a fire may have underlying negative beliefs about themselves, such as they are weak or unimportant
Describe the behavioural causes
- positive reinforcement, positive reinforcer
- The reward that the person gets from their action is positive reinforcement which makes the behaviour more likely to be repeated
Behaviourists claim that the reward can be external or internal
Skinner next investigated the effect of different frequencies and types of rewards and their effect on behaviour - schedules of reinforcement.
Variable-ratio schedule: when reward is delivered after an unpredictable number of responses. e.g. slot machine
Gambling Disorder (NSAD): external reinforcement=money internal reinforcement=dopamine reward pathway
Describe the biological causes
- dopamine reward pathway
- striatum
- reward deficiency syndrome
Normally, the ____striatum_____ is activated when we do something pleasurable. However, Da levels become ___lower_____ when behaviours are compulsive.
This part of the brain is responsible for ___reward_____ and behavioural control. Therefore, a deficiency in ____dopamine______ could lead to a cycle of compulsions and addictions.
As part of the striatum seems to be involved in feelings of _____pleasure____, together with other areas it is known as the ___dopamine reward pathway__.
Describe the biochemical treatment of ICD and NSADs (Grant et al)
- a group of drugs: OPIATES ANTAGONIST = successful in treating gambling disorders
- NALTREXONE (alcohol dependents) and NALMEFENE (both opiates antagonist)
A: examine how individuals responded to this biochemical treatment
P:
- double-blind experiment, 16 week course of the NALMEFENE
18 week course of NALTREXONE
- gambling severity assessed with Yale Brown Obsessive Compulsive Scale
R: overall opiate groups = significant reduction in symptoms
- family history of alcoholism + highest dose of opiates = greatest reduction in gambling disorder symptoms
—> suggest opiates may be even more effective in some gambling addicts than others
Describe the K-SAS
- psychometric
- 12 item questionnaire for kleptomania
- with 5 point likert scale (0=none, 4=extreme)
- higher score = more severe symptom
- e.g. if u had urges to steal last week, on average, how strong were your urges?
Describe Impulse Control Therapy (Miller)
Cognitive change:
Behavioural change:
Miller suggests that this therapy takes place over two sessions, with homework in between the session. The process has 12 stages
Why does impulse control therapy not simply eliminate the impulsive behaviour itself?
(impulse control therapy)
So the patient can still engage in that activity, e.g. shopping, but in a normal, healthy way (without stealing). Without long term sacrifices/changes.
What is first identified in the therapy and how?
impulse control therapy
The aspect of the behaviour which produces the most intense feelings will be identified first. These are measured on a standardised scale known as the ‘Positive Feelings Scale’ to allow for later comparisons.
take into accounts for individual differences
How are clients encouraged to recreate the feeling-state in their mind? (Impulse Control Therapy)
IMAGERY - The client is then asked to combine the image of performing the compulsive behaviour, the positive feelings and physical sensations.
During this time, they are directed to perform eye movement desensitisation and reprocessing exercise (EMDR)
also practice that feeling a lot at home, so can generalise to different environment
What is EMDR
Eye Movement Desensitisation and Reprocessing: the individual recalls problem behaviour or memories while the therapist directs their eye movement in one of several patterns, using their hands or other stimuli.
What is the supporting research for Impulse Control therapy
Case study of John:
- Through his therapy he was able to identify his ‘feeling-state’ of a particular memory when he won during a gambling session and this was associated with a powerful feeling.
- Through visualising this feeling state along with EMDR the following things emerged.
- A reduction in the urge to gamble
- Less excitable feelings towards gambling
At a 3 month post interview, John reported he could play poker twice a week but was able to leave after a set time
Doing well in his job and relationship
What is Covert sensitisation
- behavioural modification
- behaviour learned and unlearned
- classical conditioning
- nausea, undesirable behaviour
- eliminate
- homework
- self-administrating
- 6-12 months
Describe covert sensitisation (Glover)
- 56 year old woman
- treat kleptomania, using covert sensitisation
- 14yrs of shoplifting, impossible to resist
- without purposeful gain
- 8 weeks, 4 sessions at two-weekly intervals
- increasing nausea visualisation
- practiced visualisation outside
Describe Imaginal desensitisation (Blaszczynski & Nower)
A: images, specific types of ICD
P:
- progressive muscle relaxation
- visualise being exposed to a situation that triggers the drive to carry out impulsive behaviour
- mentally leave the situation
- audio-recorded to assist with practising technique outside session
R:
- effective, reducing physiological + psychological arousal
Problems of imaginal desensitisation
- may lie about their progressive
- Trigger monitoring table (lie about progress, forget to fill in)
Describe Burton et al (Pyromania comparison)
- FIRESETTING
- intentional, accidental
- concurrent with range of other psychiatric disorders - ARSON
- against the law
- often at night
- always willful
- early adulthood
- male, uneducated, unmarried
- concordant with another mental illness - PYROMANIA
- not always a crime
- beings in early adulthood
- frequency + intensity increases over time
- triggers: boredom, stress
