Problem 4 Flashcards
Obsessions
Refer to
a) thoughts
b) images
c) impulses
which are persistent and uncontrollably intrude on consciousness
Compulsions
Refer to repetitive behaviors or mental acts that an individual feels must perform
Obsessive-compulsive disorder (OCD)
Is a chronic anxiety disorder, where people experience anxiety as a result of their obsessional thoughts + when they can’t carry out these behaviors
–> 1-3% prevalence, with a high rate of relapse
Why is OCD often undetected in people ?
OCDs know their thoughts are irrational (high insight) yet cannot control them, which results in a secretive behavior
–> tends to be chronic if not treated
Gender differences of OCD ?
Peak of onset for males (more counting, checking)
–> 6-15 y/o
for females (hand washing) --> 20-29 y/o
Comorbidity
- Depression
- -> 66%, suicide risk - Panic attacks
- Phobias
- Substance abuse
What are common Obsessive compulsions ?
- Aggressive impulses
- Sexual thoughts
- Fear of contamination and dirt
- Religion/Spiritual beliefs
- Symmetry + Ordering
- Magical thinking
–> think that repeating a behavior a certain number of times will ward off danger to themselves
Biological theories of OCD ?
Focuses dysfunctional primitive brain circuits of OCDs, which makes them unable to turn of primitive impulses
- Orbital region of the FL
- Caudate nucleus (BG)
- -> only lets strong impulses pass by - Thalamus
=> if the impulses actually reach thalamus, this will motivate people to act on their thoughts
Heritability of OCD ?
OCD runs in families and is genetically inheritable
Cognitive behavioral theories of OCD ?
- Suggests that OCD develops though Operant conditioning
–> as symptoms of compulsions are reduced when engaging in certain behaviors
- OCDs are unable to turn off intrusive + negative thoughts
–> because they
a) are depressed, or generally anxious anyways
b) Have a tendency toward rigid moralistic thinking
c) Feel more responsible for events that happen in ones life
d) Want to be able to control all thoughts
Biological treatments
Antidepressant drugs affecting levels of serotonin
–> Clomipramine, SSRIs
BUT: only reduced a half + chance of relapse when stopping to take them
Behavioral treatments
Combination of drugs + behavioral therapies
–> exposure and response prevention (ERP), where the patient learns that not engaging doesn’t lead to a terrible result
MOST EFFECTIVE
Thought action fusion
TAF
Refers to the belief that ones unpleasant, unacceptable thoughts can influence events in the world
–> is a cognitive bias, that can have 2 forms
a) Likelihood TAF
b) Moral TAF
Likelihood TAF
Refers to the belief that having an unwanted, unacceptable intrusive thought increases the likelihood of that a specific adverse event will occur
ex.: If i think about becoming ill, I will become ill
–> more/especially related to OCD
Moral TAF
Refers to the belief that having an unacceptable intrusive thought is almost the moral equivalent of carrying out that particular act
ex.: Thinking about swearing in church is almost as bad as actually swearing in church
–> related to depression + religion
TAF is important in the etiology and maintenance of OCD.
But is TAF only prominent in OCD ?
No,
It also occurs in other anxiety disorders such as
a) GAD
b) Panic disorder
c) Eating disorders
Do OCDs show memory deficits as a result of the compulsive checking behavior ?
If so, Why ?
Yes and No,
Memory accuracy is not affected but memory confidence/metamemory decreases significantly over time
- a) Checking leads to memory distrust which leads to more checking
- -> vicious cycle
b) Cognitive model of compulsive checking (Rachman)
Cognitive model of compulsive checking
Rachman
Suggests that
a) inflated responsibility
b) perceived severity of harm
c) probability of harm
interact to produce the checking behavior
–> it is then maintained by a self-perpetuating mechanism, that works for relevant not irrelevant checking
Extinction
Involves presenting the CS repeatedly in the absence of the associated aversive stimuli (US)
–> is the proxy to Exposure therapy
Inhibitory learning
Suggests that the original CS-US association that was learned is not erased during extinction but left intact as a new inhibitory learning about the CS-US develops (=CS no longer predicts US)
–> considered to be central to extinction
ex. : breaking the link between fear (US) + cue for contamination (CS)
- -> excessive handwashing (CR)
Why are individuals that have anxiety disorders vulnerable to relapse ?
Because to CS-US association is never fully extinct, but just reduced
–> they also show deficits in the mechanisms that are central to extinction learning
Habituation models
Suggest that fear reduction during an exposure trial is a necessary precursor to longer lasting cognitive changes in the CS-US association (=perceived harm associated with stimulus)
Name the 8 therapeutic strategies for enhancing inhibitory learning and its retrieval
- Expectancy violation
- Deepened extinction
- Reinforced extinction
- Variability
- Removing safety behaviors
- Attentional focus
- Affect labeling
- Mental reinstatement/Retrieval cues
How does linguistic processing/affect labeling enhance inhibitory regulation ?
It activates a region of the frontal cortex (VLPFC) which reduces the activity in the amygdala
–> this reduces anxious responding, as limbic system activity is dampened
The focus of exposure therapy may differ depending on the condition being treated.
Nonetheless each will contain 3 essential elements.
Name them.
- Specific goal
- -> deciding on duration + behavioral goals - Anticipated negative outcome
- -> engaging in a task designed to violate the expected outcome - Recognition and consolidation of the non-occurrence of the anticipated event
(4. Inhibitory learning enhancement and inhibitory regulation enhancement strategies)
Expectancy violation
Designing exposures to violate specific expectations
e.g.: “Test it out”
Deepened extinction
Presenting 2 cues during the same exposure after conduction the initial extinction with at least one of the 2
e.g.: “Combine it”
Reinforced extinction
Occasionally presenting the US during the exposures
–> restoring the old link which will scare them, because this will reinforce that it isn’t necessary
e.g.: “Face your fear”
Variability
Varying the stimuli and the contexts
Removing safety behaviors
Decreasing the use of safety signals + behaviors
e.g.: “Throw it out”
Attentional focus
Maintaining the attention to the target CS during the exposure
e.g.: “Stay with it”
Affect labeling/Linguistic processing
Encouraging the clients to describe their emotional experience during exposure
e.g.: “Talk it out”
Mental reinstatement/Retrieval cues
Using a cue that is present during extinction or imaginary reinstating previous successful exposures
–> re-consolidation, to prevent relapse
Related OCD disorders
- Hair pulling disorder
- Skin picking disorder
- Hoarding
- Body dysmorphic
- -> seeing the body as more strange than it actually is
Magical thinking
bla
What are the main differences that distinguish the negative + intrusive thoughts of normal people from abnormal ones ?
- Frequency
- Duration
- Intensity
- Consequences
- Threshold
- -> meaning sensitivity to the same context
Mood-as-input hypothesis
Suggests that people use concurrent mood as info about whether they have successfully completed a task or not
–> stopping the ritual due to a “mood-change” that serves as an indicator
Why is thought suppression rather counterproductive ?
Rebound effect
–> will think about it even more
