Module 9

Question 1

What are three specifiers for OCD?

Answer 1

a. With good insight
b. With poor insight
c. With absent insight/delusional beliefs

Question 2

Obsessions in OCD are said to be ego-dystonic. What does that mean?

Answer 2

They are incongruent with the person’s belief system and resisted against through compulsions.

Question 3

What are a few common themes of OCD symptom dimensions?

Answer 3

Contamination; Responsibility for harm; Incompleteness; Taboo thoughts.

Question 4

One of the theoretical models of OCD is the conditioning approach. What is its main premise?

Answer 4

Obsessions and compulsions are acquired by classical conditioning and maintained by operant conditioning.

Question 5

What is the main premise of cognitive behavioral approaches to OCD?

Answer 5

Obsessions develop as intrusions are mistakenly appraised as threatening, causing distess.

Question 6

Why are compulsions counterproductive?

Answer 6

They prevent learning (that uncertainty is manageable and that distress subsides).
They increase obsessions by acting as reminders.
They preserve misinterpretations (person sees bad events don’t happen, attributes it to compulsions).

Question 7

Cognitive biases are important to OCD. What are examples of core dysfunctional belief domains in OCD?

Answer 7

1. Inflated responsibility.
2. Thought-action fusion.
3. Need to control thoughts.
4. Overestimation of threat.
5. Perfectionism.
6. Uncertainty intolerance.

Question 8

What are two main goals of OCD treatment?

Answer 8

1. Correct maladaptive beliefs and appraisals.
2. Decrease avoidance and compulsive behaviors.

Question 9

Another theory for the mechanism of exposure is the Inhibitory Learning Theory. What does it entail?

Answer 9

1. During extinction, fear associations remain intact, but a new one is created.
2. This leads to two subsequent meanings of the feared stimulus:
   Fear-based excitatory meaning and safety-based inhibitory meaning.

Question 9

Exposure Therapy and Response Prevention (ERP) is a treatment for OCD. There are models for the mechanisms of exposure. One of them is the Emotional Processing Theory (EPT). What does it entail?

Answer 9

1. Confrontation with a feared stimulus activates a fear structure.
2. Integration of info incompatible with said structure
3. Development of a new non-fear structure.
   -> habituation of fear

Question 10

What is a simplified way to explain the mechanism of ERP?

Answer 10

Exposure (reduces obsessions) + Response prevention (reduce compulsions) = ERP

Question 11

What is cognitive restructuring?

Answer 11

Rational and evidence-based challenging and correction of dysfunctional thoughts/beliefs.

Question 12

How can behavioral experiments be utilized in OCD treatment?

Answer 12

They can be used to facilitate the acquisition of corrective info about the realistic risks associated with obsessional fears.

Question 13

What is the main premise of acceptance and commitment therapy (ACT)?

Answer 13

A set of techniques aimed to foster acceptance of anxiety, uncertainty and obsessional thoughts.

Question 14

How does fostering acceptance complement inhibitory learning?

Answer 14

If the obsessional fear can be tolerated for longer, inhibitory associations can be maximally acquired.

Question 15

What is expectancy tracking?

Answer 15

Asking the client for continuous summaries about what the patient has learned during exposure.

Question 16

What is the main point of phenomenological perspectives?

Answer 16

A focus on the essence of things without being obstructed by preconceptions and theoretical notions.

Question 17

Obsessionality, an element of OCD, is the preoccupation with a specific thought or act. How does it relate to obsessions and compulsions?

Answer 17

Obsessions: passive obsessionality - being subjected to the overruling nature of the thought
Compulsions: active obsessionality - actively obsessing over something and acting upon it.

Question 18

Compulsivity is feeling compelled to think a thought or perform a specific act. How does it relate to obsessions and compulsions?

Answer 18

Obsessions: direct compulsivity - compulsivity is experienced from the start.
Compulsions: indirect compulsivity - compulsivity develops over time.

Question 18

What is meant by subjective reflection and how is it expressed?

Answer 18

It’s the attitude of the patient towards OCD symptoms. It’s seen in egodystonia and level of insight.

Question 19

What are techniques for cognitive biases in OCD?

Answer 19

1. 2 column technique: evidence for and against the beliefs.
2. Weighing (the likelihood of) the alternative.
3. Measuring chance (of feared effect)
4. Worst-case scenario

Question 20

How does negative reinforcement play a role in OCD?

Answer 20

The performance of compulsions temporarily lessens distress, which is a negative reinforcer for compulsions.

Question 21

What is the pharmacotherapy protocol for OCD?

Answer 21

1. Max. dosage of SSRIs
2. Switch to another SSRI
3. Clomipramine (TCA)
4. Low dosage of antipsychotic

Question 22

Which brain network is hyperactive in OCD?

Answer 22

The cortico-striatal-thalamo-cortical loop (CSTC)

Question 23

What are two concerns with the use of Deep Brain Stimulation (DBS) for OCD?

Answer 23

1. Complications due to surgery/hardware-related issues. 2. The brain stimulation itself can cause adverse effects (e.g., hypomania). These tend to be brief or reversible though.