Task 4 OCD

Question 1

Cormobidity

Answer 1

Around 66% of people with OCD are also significantly depressed; Panic attacks, phobias and substance abuse are also common

Question 2

Prevalence

Answer 2

1-3% of people will develop it at some time; Does not seem to differ across countries; Some studies found slightly higher rates in women

Question 3

Common types of thought

Answer 3

Aggression, sexuality and/or religion; Symmetry and ordering; Contamination often accompanied by cleaning compulsion

Question 4

Rituals

Answer 4

 People with OCD believe that repeating behavior certain number of times will ward off danger to themselves or others – Ritual becomes stereotyped and rigid and they develop obsessions and compulsions about not performing them correctly.

Question 5

Hoarding

Answer 5

Closely related to OCD but classified as separate diagnosis because of some distinct features & different biological correlates.
 Thoughts about possessions, not as intrusive, unwanted or distressing as OCD, but instead as part of their natural stream of thought.
 People with hoarding behavior may become anxious, sad or angry when pressured to get rid of possessions.
 They show emotional attachment to possessions, equating them with their identity or giving them human characteristics.
 2-5% of population engage in hoarding and a small subset of hoarders meet criteria for OCD.
 Significant comorbidity with depression, social anxiety and generalized anxiety disorder

Question 6

body dysmorphic

Answer 6

Excessive preoccupation with part of their body they believe is defective but that others see it as normal or only slightly unusual.
 Preoccupation results in a lot of time spent checking themselves in mirror, attempting to hide or change body part, or seeking reassurance.
 Women are more concerned with breasts, hips, legs and weight; Men with body build, genitals, body hair and thinning hair.
 30% attempt suicide; High comorbidity with anxiety and depressive disorders, PDs, substance use & OCD; Average age of onset is 16.

Question 7

Skin picking

Answer 7

Recurrently pick at scabs or places on their skin, creating significant lesions that often become infected and cause scars.
 Tend to feel tension before or while attempting to resist impulsive, and pleasure/relief when giving in to it (same for hair-pulling disorder).
 2-5% and often begins in adolescence.

Question 8

Hair pulling

Answer 8

People diagnosed with it have history of recurrent pulling out of their hair, resulting in noticeable hair loss.
 1-3% with average age of onset 13.

Question 9

DMS-5

Answer 9

Criterion A – Presence of obsessions, compulsions or both
CRITERION B – Obsessions or compulsions are time-consuming (more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational or other important areas of functioning.
CRITERION C – Obsessive-compulsive symptoms are not attributable to physiological effects of substance or another medical condition.
CRITERION D – Disturbance is not better explained by symptoms of another mental disorder (excessive worries, like generalized anxiety; ritualized eating behavior, like eating disorders; preoccupation with appearance, like BDD).

Question 10

Obsessions are defined by

Answer 10

• Recurrent and persistent thoughts, urges, or images that are experienced, at some time during disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress.
• Individual attempts to ignore or suppress such thoughts, urges or images, or to neutralize them with some other thought or action (= performing a compulsion).

Question 11

Compulsions are defined by

Answer 11

• Repetitive behaviors or mental acts that individual feels driven to perform in response to an obsession or according to rules that be applied rigidly.
• Behaviors or mental acts are aimed at preventing or reducing anxiety/distress or preventing some dreaded event/situation. However, these behaviors or mental acts are not connected in realistic way with what they are designed to neutralize/prevent or are clearly excessive.

Question 12

Biological factors

Answer 12

 Caudate nucleus filters powerful impulses arising in OFC, so only most powerful ones reach thalamus. Possibly, OFC and/or CN are so active in OCD that numerous impulses reach thalamus, generating obsessive thoughts or compulsive actions.
 Example – Continuing to wash hands because brains cannot shut hand-washing behavior when it is no longer needed.
 Support for this brain circuit – Many obsessions and compulsions are related to contamination, sex, aggression and repeated patterns of behavior, which are issues that this brain circuit deals with.

Question 13

Difference between normal and OCD

Answer 13

Main difference between people with and without OCD, is that people with OCD are unable to turn off negative & intrusive thoughts.

Question 14

Why do they have trouble turning off their thoughts?

Answer 14

1. They may be depressed/generally anxious most of the time, so that minor negative events are likely to invoke intrusive, negative thoughts.
2. People with OCD have tendency toward moralistic thinking – Judging negative thoughts as more unacceptable than most would and feeling more anxious/guiltier for having them, making it harder to extinguish these thoughts.
3. People with OCD believe that they should be able to control all their thoughts and believe these will make them go crazy, making it harder to dismiss them.

Question 15

Operant conditioning in OCD

Answer 15

 People with anxiety-provoking obsessions discover that if they engage in certain behaviors, their anxiety is reduced. Each time obsessions return, and person uses behaviors to reduce them, behaviors are negatively reinforced and thus, compulsions arise.

Question 16

Clinical constructs and OCD

Answer 16

Clinical psychology researchers developed constructs to describe combination of thoughts, beliefs, cognitive processes and symptoms seen in different psychopathologies. These can be developed in a way that allows them to be objectively measured (= questionnaires).

Question 17

inflated responsibility (clinical construct)

Answer 17

Belief that one has power to bring about/prevent subjectively crucial negative outcomes. These negative outcomes may be actual: that is, having consequences in real world and/or at moral level.

Question 18

thought-action fusion (clinical construct)

Answer 18

Dysfunctional assumption held by OCD sufferers that having a thought about an action is like performing it.

Question 19

Mental contamination

Answer 19

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 washing and even betrayal experiences.

Question 20

Thought suppression

Answer 20

Defense mechanism used by individuals with obsessive thoughts, to actively suppress them. Explains why intrusive thoughts are uncontrollable.
 There is good evidence that actively suppressing unwanted thought, will actually cause it to occur more frequently (= rebound effect).
 Suppressing unpleasant thought induces strong negative emotional state, resulting in suppressed thought becoming associated with that negative mood state.

Question 21

Perseveration

Answer 21

OCD is one example of perseverative psychopathologies. These are characterized by dysfunctional perseveration of certain thoughts, behaviors and activities.

Question 22

Mood as Input hypothesis

Answer 22

Claims that people use concurrent mood as information about whether they have successfully completed task or not.
 OCD sufferers persevere with compulsive activities until they are certain to have fully completed tasks. Their endemic negative mood is interpreted as providing information that they have not completed task, so they persevere.

Question 23

Biological and Pharmacological treatments

Answer 23

Drug treatments are a short-term, effective and cheap way of reducing symptoms of OCD, but relapse is quite common.
 Serotonin & SSRIs – Most commonly prescribed and have effect of increased serotonin levels. Also effective on people with hoarding disorder and BDD.
 50-80% of OCD patients experience decreases in obsessions & compulsions while on these drugs (which are reduced only 30-40%).
 Side effects – Drowsiness, constipation, loss of sexual interest.
 Tricyclic antidepressants – Reduce persistence of compulsive rituals but seem to be effective only with comorbid depression.

Question 24

Exposure and ritual prevention treatment

Answer 24

Most common and most successful therapy for OCD. It consists of two components: (1) Gradual exposure to situations and thoughts that trigger distress; (2) Ritual and response prevention, involving strategies such as practicing competing behaviors, habit reversal (for skin-picking and hair-pulling) or modification of compulsive rituals.
 Positive aspects – It allows anxiety to extinguish by habituating links between obsessions and their associated distress; It eliminates ritualistic behaviors that may negatively reinforce anxiety. Highly flexible therapy that can be adapted to group, self-help, inpatient, outpatient, family therapy and computer guided interventions.
 Effectiveness – It led to improvement in obsessions and compulsive behavior in 60-90% of OCD patients.

Question 25

CBT

Answer 25

For patients that find ERP treatment too difficult, CBT is a good alternative. It is based on targeting and modifying dysfunctional beliefs that OCD sufferers hold about their fears, thoughts and significance of rituals.
 Dysfunctional beliefs that are challenged in CBT include: (1) Responsibility appraisals (= sufferer believes they are responsible for preventing harmful outcomes); (2) Over-Importance of thoughts (= sufferer believes that having thought about action is like performing it (TAF); (3) Exaggerated Perception of threat (= sufferer has inflated estimates of likelihood of harmful outcomes).

Question 26

repeated checking and memory distrust

Answer 26

 Studies have found that as responsibility increased, memory confidence declined. However, this reduction was associated with increases in memory accuracy.
 Such findings are in line with Cognitive Model of Compulsive Checking – Proposes that increased responsibility, perceived severity of harm and perceived probability of harm, interact to produce checking behavior.

Question 27

Repeated relevant checking leads to memory distrust

Answer 27

When participants were asked to repeatedly check stove, their memory confidence, vividness and detail, significantly declined. Results lead to conclude that incorporation of elevated threat, as well as conditions that promote increased responsibility, do not inhibit significant declines in meta-memory, following repeated relevant checking.

Question 28

Normal obsessions

Answer 28

NON-PSYCHIATRIC SUBJECTS COMMONLY EXPERIENCE OBSESSIONS + PEOPLE VARY IN CRITERION OF WHAT IS ACCEPTABLE

Question 29

Study 2 similarities

Answer 29

Sought to discover similarities and differences between clinical and non-clinical obsessions.
 Method – Structured interviews of obsessional patients and non-clinical subjects with obsessions (= positive respondents).
 Results – Total of 23 obsessions were reported by 8 participants from clinical sample. Total of 58 obsessions were listed by 40 subjects in non-clinical sample. Clinical obsessions were not all readily discernible by clinicians.
THEY ARE SIMILAR IN FORM, EXPRESSED RELATION TO MOOD, MEANINGFULNESS AND ALMOST IN CONTENT

Question 30

Abnormal and normal obsessions conclusion

Answer 30

 Obsessions in the form of thoughts and/or impulses are a common experience and a large majority of people report experiencing them.
 Normal and abnormal obsessions are similar in form and content, as well as in expressed relation to mood and meaningfulness to respondent.
 Normal and abnormal obsessions differ in frequency, intensity and consequences.
• Frequency – Abnormal obsesses are more frequent and last longer.
• Intensity – These obsessions are more intense, but they are also more strongly resisted; Threshold of acceptability is higher for abnormal obsessions.
• Consequences – Abnormal obsessions produce more discomfort and provoke more urges to neutralize. They are also easier to dismiss.

Question 31

Exposure therapy takes various forms

Answer 31

Graduated versus intense (or flooding therapy), brief versus prolonged, with and without various cognitive and somatic coping strategies, imaginal, interoceptive or in vivo (or real life).
 Other approaches to exposure therapy – Habituation-based models (emphasize reduction in fear throughout exposure) and behavioral testing to explicitly disconfirm threat-laden beliefs and assumptions.

Question 32

Inhibitory learning models

Answer 32

Posit inhibitory learning central to extinction learning. These models mean that original CS-US association learned during fear conditioning is not erased during extinction, but rather is left intact as secondary inhibitory learning about CS-US develops (CS no longer predicts US).
 Therefore, after extinction, CS has two meanings – (1) Excitatory meaning CS-US and (2) Inhibitory meaning (CS-no US).

Question 33

Expectancy violation (optimizing)

Answer 33

Design exposures that maximally violate expectancies regarding frequency or intensity of aversive outcomes. It stems from idea that mismatch between expectancy and outcome is critical for new learning and for development of inhibitory expectancies that will compete with excitatory expectancies. The more the expectancy can be violated by experience, the greater the inhibitory learning.

Question 34

Deepened extinction (optimizing)

Answer 34

Present two cues during same exposure after conducting initial extinction with at least one of them. This strategy reduces spontaneous recovery and reinstatement of fear and distinguishes from belief disconfirmation approach.

Question 35

Main aim inhibitory learning approach

Answer 35

 Main aim of this paper is to provide examples to clinicians for how to apply this model to optimize exposure therapy with anxious clients, in ways that distinguish it from ‘fear habituation’ approach and ‘belief disconfirmation’ approach within CBT.

Question 36

occasional reinforced extinction (optimizing)

Answer 36

Involves occasional CS-US pairings during extinction training. Benefits derive from expectancy violation effect. Also, procedure of occasional reinforcement during extinction may enhance salience of CS which in turn contributes to new learning about CS.

Question 37

Removal of safety signals/behaviours (optimizing)

Answer 37

Decrease the use of safety signals and behaviors. Common safety signals and behaviors are presence of another person, therapists, cell phones, medications or food/drink.

Question 38

Stimulus variability (optimizing)

Answer 38

Vary stimuli and contexts.

Question 39

multiple contexts (optimizing)

Answer 39

Context renewal involves return of fear to phobic stimulus when it is encountered in a context that differs from context in which exposure therapy was conducted. In clinical perspective, it involves conducting interoceptive, imaginal and in vivo exposures in multiple different contexts, such as when alone, in unfamiliar places, or at varying times of day.

Question 40

Retrieval cues (optimizing)

Answer 40

Use a cue present during extinction or imaginally reinstate previous successful exposures. A risk is that these cues may acquire inhibitory value and become safety signal. Best employed as relapse prevention skill.
 Difference with safety signal – Retrieval cues retrieve CS-no US relationship, whereas safety signals are directly associated with non-occurrence of US.

Question 41

Reconsolidation (optimizing)

Answer 41

Retrieving already stored memories induces reconsolidation. Thus, it may be possible to change memories during reconsolidation time frame upon retrieval. In clinical setting, encourage clients to describe emotional experience during exposure.

Question 42

likelihood TAF

Answer 42

Belief that having unwanted, intrusive thought increases likelihood that specific adverse events will occur. These events can either involve the self (= Likelihood-Self) or someone else (= Likelihood-Other).
- Example – If I think about falling ill, it will be likely that I will become ill.

Question 43

Moral TAF

Answer 43

Belief that having unacceptable, intrusive thought is almost the moral equivalent of carrying out particular act.
- Example – If I think about swearing in church, it is almost as bad as actually swearing in church.

Question 44

Conclusion TAF article

Answer 44

 Interest in TAF arises in large part from its clinical resonance and it can be assessed using different methods.
 It can be provoked, and it is associated with obsessional problems and with other anxiety and eating disorders.