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CBT > OCD > Flashcards

OCD Flashcards

1
Q

What are the symptoms to look for in OCD?

A

Obsessions
Compulsions

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2
Q

What are obsessions?

A

Intrusive, recurring thoughts that the individual finds distressing (e.g. causing harm to someone you love)

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3
Q

What are compulsions?

A

Repetitive or ritualised behaviour patterns that the individual feels driven to perform

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4
Q

Can you have obsessions without compulsions?

A

Yeah

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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.

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6
Q

What are the characteristics of obsessive thoughts?

A
  • intrusive quality
  • unwanted
  • involve resistance
  • uncontrollable
  • uncharacteristic
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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
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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
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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
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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
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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
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12
Q

What is the worldwide prevalence for OCD?

A

approx 2%

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13
Q

What is the prevalence of OCD in the UK?

A

1.1%

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14
Q

What biological factors are there of OCD?

A
  • Head injury
  • Inability to inhibit genetically stored behaviours
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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
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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?
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17
Q

What psychological factors are there of OCD?

A
  • Memory deficits
  • inflated responsibility
  • thought suppression
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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
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19
Q

What psychodynamic accounts are there for OCD?

A
  • Importance of the unconscious
  • Role of defence mechanisms
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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
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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
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22
Q

Explain appraisals in OCD.

A

Intrustion -> Appraisal -> Behaviour

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23
Q

What appraisals are there in OCD?

A
  • Thought-Action Fusion
  • Inflated Responsibility
  • Overestimation of Threat
  • Mental Control
  • Intolerance of Uncertainty
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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

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25
Q

Explain inflated responsibility.

A

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
Q

Explain overestimation of threat

A

Tendency to overestimate the severity/likelihood of negative consequences

27
Q

Explain mental control

A

The belief that is necessary to exert control over unwanted thoughts in order to maintain mental health and good behavioural control

28
Q

Explain intolerance of uncertainty

A

The belief that you need perfect certainty that something bad has not or will not happen

29
Q

What evidence is there for inflated responsibility?

A
  • 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
Q

What other evidence is there for appraisals?

A
  • 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
Q

Who proposes the cognitive model for OCD?

A

Salkovskis et al (2000)

32
Q

What are unhelpful behaviours?

A
  • use unhelpful behavioural strategies to cope with the anxiety caused by their thoughts
  • thought suppression - actively trying to suppress your thoughts
33
Q

What evidence is there for thought suppression?

A
  • 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
Q

What is the importance of psychoeducation?

A

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
Q

What is the most effective treatment for OCD?

A
  • Exposure & Ritual Prevention (ERP)
  • aka Exposure & Response Prevention (ERP)
36
Q

How does ERP treat OCD?

A
  • 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
Q

How do exposure hierarchies work?

A

step by step developing the exposure and pushing the person just a little bit more out of their comfort zone each time

38
Q

What pharmacological treatments for OCD

A
  • 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
Q

What do the NICE guidelines recommend for mild symptoms of OCD?

A

Low intensity psychological treatments (including ERP)

40
Q

What do the NICE guidelines recommend for moderate symptoms of OCD?

A

Monotherapy - either psychological therapy or use of pharmacological treatments

41
Q

What do the NICE guidelines suggest for more severe symptoms of OCD?

A

Combination therapies - SSRI and CBT with ERP

42
Q

What would be a useful way of identifying critical incidents in patients during therapy?

A

Making a timeline - may seem irrelevant but find other things happening at the time the symptoms started

43
Q

What resources can you use in therapy to explain OCD to children?

A

Different storybook and accessible ways + parents are usually involved

44
Q

What other therapies other than ERP and CBT are found to be possibly efficacious for OCD?

A
  • Acceptance and Commitment Therapy
  • Motivational Interviewing
  • Eye Movement Desensitisation and Reprocessing
  • Satiation Therapy
45
Q

What is Acceptance and Commitment Therapy?

A
  • Form of psychotherapy
  • psychological intervention that uses acceptance and mindfulness strategies along with commitment and behaviour-change strategies to increase psychological flexibility
46
Q

What is motivational interviewing?

A
  • Counselling approach
  • Eliciting behaviour change by helping clients explore and resolve the state of having mixed feelings of contradictory ideas
47
Q

What is eye movement and desensitisation and reprocessing?

A
  • form of psychotherapy
  • designed to alleviate the distress associated with traumatic memories
48
Q

What is Satiation therapy?

A

prolonged listening to or acting out an obsession or compulsion usually using a closed-loop audiotape or repeated ritual

49
Q

What are responsibility beliefs?

A

not only measures of general responsibility attitudes but also more specific responsibility appraisals consequent on intrusive cognitions

50
Q

What is Excessive Reassurance Seeking (ERS)?

A
  • 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
Q

What other OCD-related disorders are there?

A
  • Body dysmorphic disorder
  • Hoarding disorder
  • Hair-pulling disorder
  • Skin-picking disorder
52
Q

What is body dysmorphic disorder?

A

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
Q

what is hoarding disorder?

A

difficulty discarding or parting with possessions to the point where the individual’s living area is severely congested with clutter

54
Q

what is trichotillomania?

A

hair-pulling disorder in which the individual compulsively pulls out their own hair resulting in significant hair loss

55
Q

what is skin-picking disorder?

A

recurrent picking of the skin that results in skin lesions

56
Q

What psychological factors are there of OCD?

A
  • Memory deficits
  • Clinical constructs in OCD
  • Thought suppression
  • Perseveration and the role of mood
57
Q

What is the link with clinical constructs and OCD?

A
  • purpose is to link thoughts, beliefs, and cognitive processes to subsequent symptoms
58
Q

What are clinical constructs?

A

clinical psychology researchers develop constructs in order to describe the combination of thoughts, beliefs, cognitive processes and symptoms observed in individual psychopathologies

59
Q

what is mental contamination?

A

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
Q

what is the mood-as-input hypothesis?

A

a hypothesis claiming that people use their concurrent mood as information about whether they have successfully completed a task or not

61
Q

what is a cingulotomy?

A

a neurosurgical treatment of OCD involving destroying cells in the cingulum, close to the corpus collosum

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