Week 2 OCD Flashcards
List the DSM-V criteria for OCD.
Presence of obsessions, compulsions or both
Obsessions are defined by (1) and (2)
Recurrent and persistent thoughts, urges or images that are experienced at some times during the disturbances. The thoughts are intrusive, unwanted, and cause marked anxiety and distress
Individual Response: The individual attempts to ignore or suppress such thoughts or to neutralise them with some other thought or action (by forming a compulsion). e.g. Case study of an individual who has intrusive thoughts about having sexual intercouse with his sister. Instead of visualising himself as the perpetrator, he replaces it with the devil’s face so that he will feel less guilty
Compulsions are defined by (1) and (2)
Repetitive behaviours or mental actions that the individual feels is necessary to perform in regards to these thoughts or according to rules that must be applied rigidly.
The behaviours are aimed at reducing anxiety. However, the behaviours might not necessarily solve the solution and can be dysfunctional or excessive (e.g. excessive hand-washing does not resolve the problem of being free from germs)
The obsessions or compulsions are time-consuming and causes clinically significant distress or impairment in social, occupational areas of functioning (disrupts functional behaviour)
The symptoms are not attributable to physiological effects of a substance or another medical condition
The disturbance is not better explained by symptoms of another mental disorder - e.g. excessive worry e.g. worry thoughts by those experiencing GAD.
OCD is an anxiety-based disorder. True or false?
True.
List certain limitations that come with using CBT or ERP to treat OCD.
ERP:
Obsessions are unwanted, most find it revolting and intolerable. Very stressful to keep getting exposed to unwanted stimuli
No violation of expectations to thoughts. It’s just accepting that thought is there but you don’t need to act on your compulsion. So can be difficult in practice.
CBT:
Compulsions can be mental also. E.g sex with sister example from class
What is the difference desc OCD and OCPD?
OCD: Specific to something
OCPD: Personality traits that are unrelenting and stable, won’t change for a long period of time
OCD: Know that something is wrong with them
OCPD: Think there is nothing wrong with them and don’t need to have triggers. Just very specific and rigid in everything.
Describe how ERP works.
Starts with low intensity exposure to the stimuli that is causing distress. Feelings of anxiety will peak as the person experiences the stimulus (without adopting any safety behaviour). After a while, the feelings of anxiety will decrease. Follow an inverted U-shape graph. However, the time taken for anxiety to decrease varies for individuals
Can follow a symptom hierarchy which lists a list of the person’s feared responses. E.g. a person with a dirt phobia. Can start exposing him to low stimulus e.g. stepping on a dirty floor. Once ERP is carried out on that and he is no longer fearful of dirty floors, get him to do the next feared task on the list e.g. to step in mud.
Why are expectancy violations so important in ERP?
Introduces an element of surprise to enhance learning
How to find out what violates the client’s expectations?
ASK THEM. Must have exposure that maximally violate expectations.
Expose for as long as possible, increased intensity and with greater frequency. Must experience feared cues during extinction for as long or longer than their feared cues acquired during acquisition.
Why is continuous exposure better than interrupted exposure?
to allow them to be exposed to the full intensity of the feared stimulus.
How can mindfulness be a form of ERP?
Subset in that mindfulness is just exposure without prevention. Gotta see how you’re using it.
What if doing it encourages mental rituals though?
But is good when they can accept without acting.
List the stages in ERP and why they are done.
- Forms new associations between feared stimuli and anxiety (or lack there of). Because anxiety will usually subside after 30 minutes. But the point is you want client to know that no matter how long it takes, the distress will subside.
- Repeated exposure to reduced intensity of aversion or anxiety. Need to do homework to allow experience to be applicable outside of therapy.
KEY CONCEPT: Habituation in ERP = The individual is exposed to the feared stimuli until habituation occurs, where the stimuli does not evoke such a high intensity of feared response (a decline in distress) - Symptom Hierarchy – Start somewhere around a 5 or 6 and slowly move up. Repeated trials, a person must keep doing it. Once no more anxiety, expose yourself to the stimuli again.
- Do we allow for AR techniques? But this can be considered a safety behaviour and will not allow a person to realise that their anxiety can subside on their own.
When teaching new associations, the old will be unlearned. True or false?
False.
The key is that old learning is never completely removed, but new learning develops which aims to override the old associations. As the old associations are not completely removed, they can be reactivated again which results in relapse.
However, that said, therapy makes these old associations less accessible
ERP encourages ____________ towards feelings and responses towards obsessional thoughts. Given that these thoughts are non-threatening, universal, the aim is to encourage __________ towards these thoughts and to __________ the emotions that come along with it, even shame-based and guilty emotions
open-mindedness
acceptance
acknowledge
When is safety behavior allowed?
When client find ERP too aversive and painful, allow safety behaviour. Don’t lose the client completely.
What can safety behaviours provide clients with?
To alleviate distress such that exposures are
more tolerable
• Examples: distraction (calling a family member,
praying, reading, eating), limit duration of
exposure
By allowing safety behaviours, what is being compromised?
Tradeoff between persistence through the
exposure, and reduction of distress desired from
de-arousal phase of exposure
Also, in the case of mental ritual, how do you stop them from thinking that?
Describe the learning approach to OCD and ERP.
Classical conditioning and generalizing the unconditioned response to other stimuli.
Inhibitory learning approach: Low anxiety paired with the feared stimuli –> you should aim to get this so you spam it until the person’s memory or consciousness if flooded with memories of neutral associations. So next time when they see a similar stimuli they will recall a neutral state instead.
