Clinical Examples

Question 1

DSM - Phobia Criteria

Answer 1

• Fear or anxiety about specific object
• Object or situation always provokes fear or anxiety
• The phobic object or situation actively avoided
• Fear and anxiety is out of proportion to the danger it poses

Question 2

How common are Phobias

Answer 2

• Lifetime prevalence 12%
• Moree common in women than men
• majority of patients with specific phobia have at least one other excessive specific fear
• Most patients with social phobias suffer from one or more additional anxiety disorders

Question 3

Psychodynamic Theory of phobia

Answer 3

Freud, phobias are a result of unconscious anxiety being places onto a neutral or symbolic object
E.g. Hans Oedipal fears of his father, his desire to kill father became unbearable so he displaced it onto horses

Question 4

Theories of Phobias: Behavioural

Answer 4

• conditioned fear response
• OST and Hugdahl (1981), 58% of phobic clients cited traumatic conditioning experiences as the source of phobia

Question 5

Mowrer’s (1947) two factor theory of phobia acquisition/maintenance

Answer 5

1) Classical conditioning = rat paired with loud noise -> conditioned fear
2) Operant conditioning = individual avoids rats (reduces anxiety, reinforce avoidance and prevents extinction as rat is absent)

Question 6

Evolutionary Preparedness

Answer 6

Prepared learning, evolutionary prepared to associate certain objects with fear such as spiders rather than flowers

Question 7

Treatment of Phobia: Exposure therapy

Answer 7

Slowly expose patient to their fear I.e. go from a photo of slider all the way to holding one but over numerous sessions and slowly

Question 8

Treatment for Phobias: CBT

Answer 8

• CBT is effective for social phobias associate with cognitive distortions e.g. tendency to interpret ambiguous social info in a negative manner

Question 9

Obsessive Compulsive Disorder (OCD)

Answer 9

• Occurrence of unwanted and intrusive obsessive thoughts or distressing images
• Compulsive behaviours performed to neutralise the obsessive thoughts or images to prevent some dreaded event or situation
• Driven to perform compulsive ritualistic behaviour in response to an obsession
• Rules on how compulsive behaviour should be performed
• Used to be under anxiety disorder in DSM, now under loosely related conditions

Question 10

DSM-5 Definition of Obsession

Answer 10

• recurrent and persistent thoughts, impulses or images that are intrusive and disturbing
• attempts to neutralise but realises they are a product of their own mind

Question 11

Examples of Obsessions

Answer 11

- Contamination, ordering, repeated doubts, aggressive or blasphemous impulses, sexual thoughts and imagery

Question 12

DSM-5 Compulsion definition

Answer 12

• Repeated behaviours or mental acts carried out in response to obsession
• These acts are aimed to reduce stress and not to provide pleasure or gratification
• Excessive and not realistically connected to what they are intended to prevent

Question 13

Examples of compulsions

Answer 13

• Hand washing
• Hoarding
• Repeating
• Preying
• Saying thoughts silently

Question 14

DSM-5 Criteria of OCD

Answer 14

• Either obsessions or compulsions
• Time consuming and cause distress
• Not caused my physiological effects of another medical condition
• Disturbance is not better explained by the symptoms of another mental disorder

Question 15

DSM-5 Insight specifier

Answer 15

Good or fair insight - recognises that obsessive compulsive disorder beliefs are unlikely to be true
With poor insight - probably true
Absent insight - thinks beliefs are true

Question 16

OCD Risk factors and prevalence

Answer 16

• 1- 2% of general population
• Equal in men and women
• Late adolescence or early adulthood
• At least 50% of suffers have at least one other psychological disorder
• Contamination and cleaning - women
• Religious obsessions and compulsions more common in cultures that emphasise the importance of religious observance

Question 17

What causes OCD - Attempts to Suppress the thought

Answer 17

• Most people experience unwanted cognitive intrusions
• The interpretation of appraisal of a thought is critical
• Common place intrusions develop into obsessions when they are appraised as personally important or as posing a threat to which the individual is personally responsible

Dysfunctional beliefs - religion may impact these
1) Inflated personal responsibility
2) Thought action fusion
3) Excessive importance of controlling thoughts

Intrusive thought + Dysfunction belief
Stabbing child, thinking of something = having done it = distress

• Attempts to suppress distress

Question 18

What’s the White bear effect (Werner et al, 1987)

Answer 18

• If thought suppression works it should leave no sign of unwanted thoughts
• Try not to think of white polar bear, then all you can think about is the white polar bear
• Participants signalled more than one white bear thought per minute

Paradoxical rebound effect = attempts to suppress thought can ‘rebound’ and causes increase occurrence of thoughts ( may be stronger with ocd patients)

Question 19

Tollin et al (2002)

Answer 19

• Ps pressed a button for word ‘house’ and another for a made up word ‘jwose’
• Participants we’re told to suppress thoughts of bears
• OCD patients showed faster responses to the word bear than other words, this effect wasn’t seen in controls

Question 20

What causes OCD - Attempts to prevent any harmful consequences

Answer 20

• Compulsions removal of unwanted thoughts and also prevent people from realising their appraisals are unrealistic. They can also strengthen dysfunctional beliefs about responsibility.
• They think they are responsible for stopping their feared consequences

Question 21

Cognitive Behavioural Model of OCD

Answer 21

Intrusive thought-> misappraise as threatening -> distress -> suppress thoughts -> reduce stress

= maladaptive core beliefs - these also contribute to misappraising

Question 22

OCD Treatment - CBT

Answer 22

• Exposure and response prevention (I.e. trigger obsession and block compulsion)
• Individuals learn anxiety is temporary, the feared event doesn’t occur
• Very effective
• There is large drop out rates as causes anxiety
• Effects often last at least 2 years
• Personalise treatment
• Involves challenging the moralistic thoughts and excessive sense of responsibility