1
Q
What are the symptoms to look for in OCD?
A
Obsessions
Compulsions
2
Q
What are obsessions?
A
Intrusive, recurring thoughts that the individual finds distressing (e.g. causing harm to someone you love)
3
Q
What are compulsions?
A
Repetitive or ritualised behaviour patterns that the individual feels driven to perform
4
Q
Can you have obsessions without compulsions?
A
Yeah
5
Q
What forms do obsessions come in?
A
Words, images, and impulses
Tend to involve ideas or content that is inconsistent with your personality, moral values, ideas and goals.
6
Q
What are the characteristics of obsessive thoughts?
A
- intrusive quality
- unwanted
- involve resistance
- uncontrollable
- uncharacteristic
7
Q
Why do compulsions occur in OCD?
A
- to reduce the distress they feel as a result of their obsessions
- when it is repeated in the same way every time it is called a compulsion
8
Q
What types of compulsion are there?
A
- Compulsive checking
- Compulsive washing
- Compulsive counting
- Superstitious Ritualised Movements or Thoughts (e.g. counting background til a thought has gone)
- ‘undoing’ or ‘neutralising’ a bad thought by thinking of a good or safe thought to counteract it
- Systematic arranging of objects
- Compulsive hoarding
9
Q
What is the DSM-5 criteria for OCD?
A
- Obsessions and/or compulsions
- Interferes with functioning
- Not due to drugs/medical condition
- Not another disorder
10
Q
What is the DSM-5 criteria for obsessions?
A
- recurrent and persistent thoughts, urges, or images that are experiences, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress
- person attempts to ignore or suppress such thoughts or to neutralise them with some other thought or action
11
Q
What is the DSM-5 criteria for compulsions?
A
- repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession or according to rules that must be applied rigidly
- behaviours or mental acts are aimed at preventing or reducing anxiety or distress, or preventing some dreaded event or situation; however, these behaviours or mental acts are not connected in a realistic way with what they are designed to neutralise or prevent, or are clearly excessive
12
Q
What is the worldwide prevalence for OCD?
A
approx 2%
13
Q
What is the prevalence of OCD in the UK?
A
1.1%
14
Q
What biological factors are there of OCD?
A
- Head injury
- Inability to inhibit genetically stored behaviours
15
Q
What parts of the brain have been associated with OCD?
A
- Frontal lobes
- Basal ganglia
- but unlikely that all sufferers of OCD have similar brain injury
16
Q
How can compulsions result from inability to inhibit genetically stored behaviours?
A
- failure in inhibitory pathway from the basal ganglia, so that genetically stored behaviours are no longer inhibited
- but how can this explain the wealth of different compulsion?
17
Q
What psychological factors are there of OCD?
A
- Memory deficits
- inflated responsibility
- thought suppression
18
Q
How do memory deficits cause OCD?
A
- ‘doubting’ is a central feature of OCD so may question the role of underlying memory deficits
- however ‘doubting’ seems to be a consequence of compulsive behaviour rather than a cause of it
19
Q
What psychodynamic accounts are there for OCD?
A
- Importance of the unconscious
- Role of defence mechanisms
20
Q
What is the importance of the unconscious?
A
- unconscious feelings and emotions: unacceptable to the self
- unconscious trauma
- these can lead to internal conflicts, if an emotion/memory is deemed unacceptable
21
Q
What is the role of defence mechanisms?
A
- people cope with conflict using different methods
- may include avoiding the emotion, focussing the emotion on something else, and experiencing the emotion from another person
- people often seek help for the defence mechanism without realising the key issue is the unconscious conflict
- key defence in OCD may be displacing the anxiety and undoing the bad thought
22
Q
Explain appraisals in OCD.
A
Intrustion -> Appraisal -> Behaviour
23
Q
What appraisals are there in OCD?
A
- Thought-Action Fusion
- Inflated Responsibility
- Overestimation of Threat
- Mental Control
- Intolerance of Uncertainty
24
Q
Explain thought-action fusion.
A
If I have a thought I will act on it. Thinking about negative events make them more likely to happen. Bad thoughts are equivalent to bad deeds
25
Explain inflated responsibility.
I have the power to prevent or bring about negative outcomes, If I have any influence over an outcome I am responsible for doing whatever to prevent it
26
Explain overestimation of threat
Tendency to overestimate the severity/likelihood of negative consequences
27
Explain mental control
The belief that is necessary to exert control over unwanted thoughts in order to maintain mental health and good behavioural control
28
Explain intolerance of uncertainty
The belief that you need perfect certainty that something bad has not or will not happen
29
What evidence is there for inflated responsibility?
- inflated responsibility is a key characteristic of individuals with OCD
- studies that have manipulated inflated responsibility show that it causes increases in compulsions
- OCD is associated with inflated personal responsibility and biased processing of threat-related information contributes to overestimation of threat in OCD
30
What other evidence is there for appraisals?
- Thought-action fusion is a causal factor in the development of intrusions and is central in the aetiology, maintenance and treatment for OCD
- Greater obsessionality is related to heightened sense of personal guilt and beliefs that individuals are personally responsible for controlling unwanted, threatening intrusive thoughts
- Significant association between intolerance of uncertainty and symptoms of OCD
31
Who proposes the cognitive model for OCD?
Salkovskis et al (2000)
32
What are unhelpful behaviours?
- use unhelpful behavioural strategies to cope with the anxiety caused by their thoughts
- thought suppression - actively trying to suppress your thoughts
33
What evidence is there for thought suppression?
- both thought suppression and thought-action fusion are correlated with severity of OCD and can go down after psychotherapy
- asking people with OCD to suppress their most distressing obsessional thought leads to the behaviours occurring more frequently - rebound effect
- OCD sufferers experience more intrusions than non clinical populations
34
What is the importance of psychoeducation?
To understand how the human brain works and that intrusive thoughts are normal and natural - education is the start of challenging inaccurate and unhelpful assumptions
35
What is the most effective treatment for OCD?
- Exposure & Ritual Prevention (ERP)
- aka Exposure & Response Prevention (ERP)
36
How does ERP treat OCD?
- expose the person to face their fears (exposure)
- letting obsessive thoughts occur without attempting to 'put them right' or neutralising them with any form of internal or external compulsive behaviour (response prevention)
37
How do exposure hierarchies work?
step by step developing the exposure and pushing the person just a little bit more out of their comfort zone each time
38
What pharmacological treatments for OCD
- short term
- SSRI's are most popular
- Tricyclic antidepessants can have some effect on some symptoms of OCD
- not as effective as psychological treatments
39
What do the NICE guidelines recommend for mild symptoms of OCD?
Low intensity psychological treatments (including ERP)
40
What do the NICE guidelines recommend for moderate symptoms of OCD?
Monotherapy - either psychological therapy or use of pharmacological treatments
41
What do the NICE guidelines suggest for more severe symptoms of OCD?
Combination therapies - SSRI and CBT with ERP
42
What would be a useful way of identifying critical incidents in patients during therapy?
Making a timeline - may seem irrelevant but find other things happening at the time the symptoms started
43
What resources can you use in therapy to explain OCD to children?
Different storybook and accessible ways + parents are usually involved
44
What other therapies other than ERP and CBT are found to be possibly efficacious for OCD?
- Acceptance and Commitment Therapy
- Motivational Interviewing
- Eye Movement Desensitisation and Reprocessing
- Satiation Therapy
45
What is Acceptance and Commitment Therapy?
- Form of psychotherapy
- psychological intervention that uses acceptance and mindfulness strategies along with commitment and behaviour-change strategies to increase psychological flexibility
46
What is motivational interviewing?
- Counselling approach
- Eliciting behaviour change by helping clients explore and resolve the state of having mixed feelings of contradictory ideas
47
What is eye movement and desensitisation and reprocessing?
- form of psychotherapy
- designed to alleviate the distress associated with traumatic memories
48
What is Satiation therapy?
prolonged listening to or acting out an obsession or compulsion usually using a closed-loop audiotape or repeated ritual
49
What are responsibility beliefs?
not only measures of general responsibility attitudes but also more specific responsibility appraisals consequent on intrusive cognitions
50
What is Excessive Reassurance Seeking (ERS)?
- need to check in with someone over and over again to make sure everything is okay with respect to a particular worry or obsession
- under-searched and poorly understood behaviour that resembles the compulsive behaviours that are typically seen in OCD
- can be complex, persistent, extensive, debilitating and may dominate people's interactions
51
What other OCD-related disorders are there?
- Body dysmorphic disorder
- Hoarding disorder
- Hair-pulling disorder
- Skin-picking disorder
52
What is body dysmorphic disorder?
a pre-occupation with perceived defects or flaws in physical appearance that are not usually perceived by others. this gives rise to compulsive grooming, mirror checking, and reassurance-seeking
53
what is hoarding disorder?
difficulty discarding or parting with possessions to the point where the individual's living area is severely congested with clutter
54
what is trichotillomania?
hair-pulling disorder in which the individual compulsively pulls out their own hair resulting in significant hair loss
55
what is skin-picking disorder?
recurrent picking of the skin that results in skin lesions
56
What psychological factors are there of OCD?
- Memory deficits
- Clinical constructs in OCD
- Thought suppression
- Perseveration and the role of mood
57
What is the link with clinical constructs and OCD?
- purpose is to link thoughts, beliefs, and cognitive processes to subsequent symptoms
58
What are clinical constructs?
clinical psychology researchers develop constructs in order to describe the combination of thoughts, beliefs, cognitive processes and symptoms observed in individual psychopathologies
59
what is mental contamination?
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 event betrayal experiences
60
what is the mood-as-input hypothesis?
a hypothesis claiming that people use their concurrent mood as information about whether they have successfully completed a task or not
61
what is a cingulotomy?
a neurosurgical treatment of OCD involving destroying cells in the cingulum, close to the corpus collosum
CBT
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