Week 5: OCD

Question 1

How does preservation impact uncertainty in OCD?

Question 2

Describe the rationale for Exposure and response prevention based on the Van Den Hout 2014 reading on compulsive perseveration.

Answer 2

Studies have found that repeated checking, a safety behavior done by OCD patients, although intended to increase certainty and decrease anxiety, actually increases uncertainty. Repeated behaviors, whether that is checking, re-reading (text comprehension), or visual perception (staring at something for a long time), increase uncertainty as the memory of the object becomes “ blurry”. In the case of preservative reasoning, uncertainty did not increase about the outcome. but the credibility ( of the negative outcome) significantly increased. Preservation deprives the stimuli and the actions associated with it to automatically activating, it blocks the spreading of activation.

Preservation may block the normal “ automatic spreading of activation” and this may be experinces as ambivalence about meaning ; like the semantic satiation. This shows that patients should be encouraged to refrain from checking behaviors and ERP, would aid in decreasing that behavior which would increase their certainty in memory and reduce compulsive behavior and later their obsessions could be relived.

Question 3

According to CBT perspective, how would you conceptualize obsessions?

Answer 3

Obsessions are conceptualized as normal intrusive thoughts, which the sufferer misinterprets as a sign that harm to themselves or others is a serious risk and that they are responsible for such harm ( or its prevention).

Question 4

Intrusive thoughts that are misinterpreted have what effects?

Answer 4

• increased discomfort, such as anxiety and depression
• focusing attention both on the intrusions themselves and triggers in the environment that may increase the occurrence of such intrusions
• increased accessibility to and preoccupation with the original thought and other related ideas
• behavioral responses: neutralizing reactions in which a person seeks to reduce or escape responsibility

Question 5

How does efforts at overt control increase distress in OCD?

Answer 5

• direct and deliberate attention to mental activity can modify the content of consciousness
• efforts to deliberately control a range of mental activities apparently and actually result in failure and even opposite effects
• attempts to prevent harm and responsibility for harm increase the salience and accessibility of the patient’s concerns with harm, neutralizing efforts directed at preventing harm

Question 6

Why is checking recurrent? What four elements contribute?

Answer 6

1. Unsuccessful search for certainty that the probability of harm to others has been reduced or removed
2. Loss of confidence in memory due to repeated checking
   - Under high responsibility there is less confidence in memory, and OCD indiv have a maladaptive interpretation of the memory is a problem ( see as a sign of mental deterioration)
   3.Cognitive bias that the probability of harm occurring more likely when they are responsible
3. Increase personal responsibility after they have completed a check for safety

Question 7

Multipliers that “multiply the checking” (3)

Answer 7

1. Persons perceived responsibility - if it rises it increases the checking
2. Perceived probability of the feared outcome occurring
3. Perceived severity or cost of feared harmful event

• Increase in any multiplier will increase compulsive checking and one is only needed for the equation
• When there is no perceived responsibility, even when there is high probability of harm and high perceived seriousness, there is no checking, showing that perceived responsibility is essential to the equation