Task 4

Question 1

What is an obsession?

Answer 1

Intrusive and recurring thoughts that the individual finds disturbing and uncontrollable

Question 2

What is a compulsion?

Answer 2

Ritualised behaviour patterns that the individual feels driven to perform in order to prevent some negative outcome happenin

Question 3

What are the DSM-5 criterions for OCD?

Answer 3

1. Presence of obssesions, compulsions or both
   —> compulsions cannot happen without obsessions
2. The obsessions or compulsions are time consuming or cause clinically significant distress or impairment in social, occupational etc. areas
3. The symptooms are not attributable to effects of a substance or other medical condition
4. The disturbance is not better explained by other mental disorder

Question 4

Individual with OCD vary in the degree of insight they have about the accuracy of the beliefs.

What are the different categories/levels?

Answer 4

1. Good/fair insight –> recognises not to be sure whether OCD beliefs are or are not true
2. Poor insight –> thinks that beliefs are probably true
3. Absent insight–> individual is completly convinced that OCD beliefs are true

Question 5

Prevalence of OCD

Answer 5

• Internationally: 1.1% - 1.8%

• Females are affected at slightly higher rate in adulthood
Males more commonly affected in childhood

• Onset is usually gradual and often begins during childhood/adolescence following a stressful event

Question 6

What are some factors that may lead to OCD?

Answer 6

• Temperamental –> higher negative emotinality and behavioral inhibition in childhood
• Environmental–> abuse in childhood or other stressful or traumatic event
• Genetical –> familial transmission; dysfuntion in the Orbitofrontal cortex, ACC, basal ganglia and striatum
• Physiological –> memory deficits, less confidence in validity of memories, deficit distinguishing between memory or real or imagined actions

Question 7

Comirbidity

Answer 7

• Up to 30% have a lifetime tic disorder

* 76% of individuals with OCD also have anxiety disorder or a depressive or bipolar disorder (63%)

Question 8

What are OCD related disorders? Name them

Answer 8

• Body dysmorphic disorder: preoccupation with flaws in pyhisical appearence (usually not percieved by others)
• Hoarding disorder: distress from the thought of getting rid of things
• Trichotillomania: hair-pulling
• Skin picking

Question 9

Clinical psychology researchers develop constructs in order to describe the combination of thoughts, beliefs, cognitive processes and symptoms observe.

What are these constructs?

Answer 9

• Inflated responsability
• Thought-action fusion
• Mental contamination

Question 10

Inflated responsability

Answer 10

The belief that one has power to bring about or prevent subjectively crucial negative outcomes. Theses outcomes are perceived as essential to prevent, they may be actual: That is, having consequences in the real world or at a moral level

Question 11

Thought-action fusion (TAF)

Answer 11

Assumption that having a thought about an action is like performing it
—> thinking about killing means I will probably do it

Very common in OCD patients

Question 12

Mental contamination

Answer 12

Feelings of dirtiness can be provoked without any physical contact with a contaminant. Mental contamination can be caused by images, thoughts, and memories and may be associated with compulsive chasing and even betrayal experience

Question 13

What treatments are there for OCD?

Answer 13

1. Exposure and ritual prevention - involves graded exposure to the thoughts that trigger distress, followed by the development of behaviours designed to prevent the individual’s compulsive rituals
2. CBT
3. Drugs
   
   • -> Serotonin and selective serotonin reuptake inhibitors SSRI (work 60-70% of time; result show 4-6 weeks after)
4. Neurosurgical treatment –> Cingulotomy: destroying cells in cingulum, close to corpus collasum (last resort)

Question 14

What are the types of TAF?

Answer 14

1. Likelihood TAF: The brief that having unwanted, unacceptable intrusive thought increases the likelihood that a specific adverse event will occur (failling/passing an exam or getting sick)
2. Moral TAF: the belief that having an unacceptable intrusive thought is almost the moral equivalent of carrying out that particular act (murder)
   • -> strongly associated with blasphemous obssesions

Question 15

How has the TAF been assessed?

Answer 15

Most commonly by self-report questionnaires: “i hope ___ is in a car accident”

Question 16

What are the differences between normal and abnormal obsessions?

Answer 16

Higher intensity, frequency, duration and larger consequences (eg. urge to neutralize) in OCD individuals

Question 17

What is the Cognitive model of Compulsive checking about?

Answer 17

Inflated responsibility, perceived severity of harm and probability of harm interact to produce checking behaviour, which is maintained by self-perpetuating mechanism

Question 18

What does repeated relevant cheking lead to? (checking only one time)

Radomsky, Gilchrist, Dussault article

Answer 18

Participants who only checked once showed significant memory confidence, vividness and detail reductions compared to participants who checked several times.

Relevant cheking condition participants reported knowing (I know the stove is off) but not remembering (i don’t remember doing it)

Question 19

CBT with exposure and response prevention

Answer 19

Patients taught to confront situations that create fear and avoid performing compulsive behaviours in response by 1) direct confrontation e.g. touching objects in a public restroom and/or (2) through imagination

Question 20

What are some therapeutic strategies for enhacing inhibitory learning and retrieval?

Answer 20

1. Expectancy violation
2. Deepened extinction
3. Occasional reinforced extinction
4. Removal of safety signals (use of phone is social situation)
5. Retrieval cues (bracelet that reminds patient of progress - works as long as it does not become a safety signal)
6. Use of extinction therapy in multiple context
7. Use phase reconsolidation of memory to change original CS-US association
8. Effect labeling (express feelings after emotions)

Question 21

How does Expectancy Violation work?

Answer 21

In clinic, the atien learns that US (friend is ill) can happen without CS (person OCD thinking about it)

–> Occasional reinforced extinction is similar.. difference: sometimes US happens in presence on CS and sometimes not

Question 22

How does Deepened Extinction work?

Answer 22

Multiple fear CSs are extinguished separetly and then in combination

• -> Roberto places hand in son’s neck
• -> Roberto bring in minf aversive images of hurting his son
• -> Both at the same time: grabbing son and thinking about hurting him

Question 23

What is ego-syntonic?

Answer 23

When a instinct or idea is part of the patient, part of the self and accepted

—> whipping off devil’s word off mouth (65 year old man,lecture)

Question 24

What is ego-dystonic?

Answer 24

Refers to thoughts, impulses, and behaviors that are felt to be repugnant, distressing, unacceptable or inconsistent with one’s self-concept.

Question 25

What is an example of an intrusive thought?

Answer 25

Thinking of jumping when in a bridge, thinking of kicking a kid, idea that a loved one dies in an accident

—> they’re not necessarily triggered by external cues

Question 26

Cognitive theory of OCD

Answer 26

—> situation: using scissors
—> intrusions: stabbing my child with the scissors
—> automatic thought: if I think about it, I will do it - TAF
—> emotion: fear
—> behaviors (compulsions): avoid scissors (and think: I will not do that)

Question 27

Could compulsions be occasional? (Example of pre discussion)

Answer 27

Nope, compulsions are very repetitive and a ritual that happens every time you get these intrusive thoughts (obsession)