OCD

Question 1

What is obsessive compulsive disorder?

Answer 1

• OCD - ANXIETY disorder (differs from Schizophrenia, which is a PSYCHOTIC disorder).
• OCD - characterized by OBSESSIONS (thoughts) and/or COMPULSIONS
(behaviours)

Question 2

What are obsessions?

Answer 2

Persistent, unwanted, irrational thoughts.
Might include:
• Being contaminated or contaminating others,
• Fear of not having completed a ritual or specific act
• Hurting people
• Unwanted sexual thoughts, images, urges

Question 3

What are compulsions?

Answer 3

Compulsions are the tasks that people do to relieve themselves of the obsessions. Compulsions can be mental or physical. Common compulsions include cleaning and/or washing;

Question 4

Describe the OCD cycle

Answer 4

1) Obsession
Constant thoughts
2) Anxiety
Strong, uncomfortable feelings
3) Compulsion
Behaviour to relieve anxiety
4) Relief
From anxiety. Obsession response has been strengthened for future

Question 5

Summaries the 5 diagnostic criteria for OCD listed by the DSM 5.

Answer 5

1) The obsessions cannot be ignored or suppressed and cause anxiety and/or distress.
2) The obsessions and/ or compulsions are time-consuming (take up more than one hour a day) and/ or cause clinically significant distress to daily life.
3) The symptoms cannot be explained by substance use or another medical condition or other mental disorders.
4) The clinician must determine if individual has fair insight the order or not and recognises that their beliefs are probably not true or if they have no inside and are definitely true.
5) Find out if the individual has a current or past history of attack disorder as this can affect the severity of the disorder

Question 6

What is the onset of OCD when describing the features

Answer 6

For most people, the age of onset is late teens and early twenties, although it can start earlier or later - in 25% of male sufferers, before the age of 10. The symptoms usually develop
gradually, though occasionally there is a sudden, acute onset.

Question 7

What is the prevalence of OCD when describing the features

Answer 7

Prevalence means how often or how widespread it occurs. The prevalence rate is between 1.1 and 1.8 percent of the population. In adults, OCD is more common in females than in males. However, in children, it is more common in males than females.

Question 8

What is the prognosis of OCD when describing the features?

Answer 8

Prognosis is the likely course of the disorder. Although treatment can reduce symptoms, about 70% of people experience a chronic and lifelong course, with worsening and
improving symptoms.
The factors associated with a good prognosis include the following:
•Milder symptoms
•Brief duration of symptoms
•Good functioning before full onset

Question 9

What is the risk factors of OCD when describing the features

Answer 9

• Family history. Having parents or other family members with the disorder can increase the risk of developing OCD.
• Stressful lite events People who have experienced traumatic or stressful events or who tend to react strongly to stress may have an increased risk of getting OCD.

Question 10

What is the difference between symptoms features of a disorder

Answer 10

Symptoms of how a disorder shows itself in a patient. Features refer to the general information about the disorder

Question 11

Describe the main features of OCD

Answer 11

The age of onset for OCD is late teens and early twenties, although it can start earlier or later - in 25% of male sufferers, before the age of 10.

Good prognosis for OCD is associated with milder and brief duration of symptoms and good functioning before onset.

The prevalence rate for OCD is between 1.1 and 1.8 percent of the population.

Risk factors for OCD include Family history. Having parents or other family members with the disorder can
increase the risk of developing OCD.
Stressful lite events People who have experienced traumatic or stressful events or who tend to react strongly to stress may have an increased risk of getting OCD.

Question 12

Name one difference between OCD and schizophrenia

Answer 12

OCD is an ANXIETY disorder this is different to Schizophrenia, which is a PSYCHOTIC disorder

Question 13

List the areas of the brain thought to be involved in OCD

Answer 13

•Thalamus
•Orbitofrontal Cortex
•Cingulate Gyrus
•Basal ganglia (which consists of the following two structures)
-Globus pallidus
-Caudate nucleus

Question 14

Describe the role of the thalamus

Answer 14

The thalamus contains primitive checking and cleaning behaviours hardwired in the brain. If this is
overactive, it triggers a compulsion to engage in these behaviours.

Question 15

Describe the role of the orbitofrontal cortex

Answer 15

The orbitofrontal cortex alerts the brain to potential worries in the environment. If overactive, the person would experience anxiety.

Question 16

Describe the role of the cingulate gyrus

Answer 16

Connects orbitofrontal cortex to thalamus

Question 17

Describe the role of the globus pallidus

Answer 17

• Part of BASAL GANGLIA
• Acts as a braking mechanism, controlling activity in thalamus
(“calming” Thalamus)

Question 18

Describe the role of the caudate nucleus

Answer 18

• Part of Basal Ganglia
Inhibits action of globus pallidus fibres. If caudate nucleus is overactive, it over inhibits the globus pallidus fibres. This means the Globus pallidus can’t do its job of calming the Thalamus and it therefore becomes over reactive.

Question 19

How can malfunction of different areas of the brain relate to OCD?

Answer 19

In OCD, the Basal Ganglia can malfunction. This means that the thalamus is overactive - therefore
cleaning and checking behaviours are more likely. These would be the compulsions found in OCD.
The overactive thalamus causes a cascade reaction in the orbitofrontal cortex, leading to the orbitofrontal cortex becoming overactive. The orbitofrontal cortex is hardwired to alert the brain when something seems odd, causing anxiety. This would lead the obsessions found in OCD.

Question 20

Describe the feedback loop theory of OCD

Answer 20

An overactive caudate nucleus means that the globus pallidus does not perform its braking mechanism of inhibiting activity in the thalamus.
This means that the thalamus (which controls primitive checking and cleaning behaviours hardwired in the brain) is overactive. The overactive thalamus in turn causes over-activity in the orbitofrontal cortex. The overactive thalamus explains the compulsions found in OCD because it is responsible for primitive checking and cleaning behaviours. The overactive orbitofrontal cortex explains the obsessions found in OCD, because it is hardwired to alert the brain when something seem odd, causing anxiety.

Question 21

strengths of a biological explanation for OCD (brain structure and functioning) evidence to support

Answer 21

There is a lot of supporting evidence for the idea that brain structure and functioning explains OCD.
•Brain scans show differences in brain structure between people who have OCD and healthy controls.
• Evidence for this: Menzies (2007) found people suffering from OCD had different amounts of grey matter in the orbitofrontal cortex.
• High in Scientific credibility - brain scans are objective and many studies have come up with similar results

Question 22

strengths of a biological explanation for OCD (brain structure and functioning) applications

Answer 22

Surgical lesioning of the cingulate gyrus (the area that connects the thalamus with the orbitofrontal cortex has been used successfully as a treatment for OCD. This would suggest that the idea that OCD results from a faulty feedback loop between the thalamus and the orbitofrontal cortex is correct, since breaking the loop can cure OCD. However, Some people respond to surgery on the cingulate gyrus, some
don’t

Question 23

Limitations of a biological explanation for OCD (brain structure and functioning)

Answer 23

• However, sometimes this surgery does not work; this might mean that OCD is more complex than this theory suggests. For example, Kireev et al (2013) suggest that the functions usually performed by the cingulate gyrus can be taken over by other areas of the brain. Therefore, a weakness of this explanation is that it is reductionist: it does not fully explain OCD.
• A further weakness is that is difficult to show cause and effect using this model. The differences
in brain activity in people with OCD may be a symptom of their OCD, rather than the cause.
• Brain activity & thoughts are related, so it is not easy to say whether the brain activity altered the thoughts, or the thoughts altered the brain activity, as they cannot be separated.

Question 24

Describe one piece of supporting evidence for brain functioning as a biological explanation of OCD

Answer 24

When people with OCD are shown objects that bring on their symptoms, such as a dirty piece of clothing with someone who hates dirt & has a cleaning compulsion, there is an increase in the activity in the orbitofrontal cortex & the caudate nucleus
(McGuire et al. 1994)

Question 25

Explain how surgical lesioning of the cingulate gyrus both - Supports the theory - Argues against the theory

Answer 25

•Supports: Surgical lesioning of the cingulate gyrus (the area that connects the thalamus with the orbitofrontal cortex has been used successfully as a treatment for OCD. This would suggest that the idea for OCD results from a faulty feedback loop between the thalamus & the orbitofrontal cortex is correct, since breaking the loop can cure OCD. •However sometimes this surgery does NOT work; this might mean that OCD is more complex. KIREEV et al. (2013) suggest that the functions usually performed by the cingulate gyrus can be overtaken by other areas of the brain

Question 26

According to the cognitive explanation what are the causes of obsessive thoughts in OCD

Answer 26

False beliefs learned in childhood Memory problems Hypervigilance (attentional problem)

Question 27

Explain how false believes in the cognitive approach can explain OCD

Answer 27

People misinterpret their thoughts due to false beliefs (learned in earlier life) Most people have intrusive thoughts but can shrug them off. People with OCD tend attach importance to them Respond as if thought were a threat - leading to high anxiety and negative emotions (shame, guilt) Tend to interpret thoughts as catastrophic, leading to anxiety and then the practicing of avoidance or ritual behaviours

Question 28

List the five beliefs that researchers suggest may be important in the development and maintenance of obsessions.

Answer 28

1. Exaggerated responsibility that one is responsible for preventing harm to others 2. Belief - certain thoughts are important & should be controlled 3. Somehow having a thought/ urge will increase the chances of it happening 4. tendency to overestimate the likelihood of danger 5. belief that one should always be perfect & mistakes are unacceptable

Question 29

Explain how the faulty beliefs can lead to obsessive behaviours found in OCD

Answer 29

People who fear their own thoughts usually attempt to neutralize feelings that arise from their thoughts. They might avoid situations which may spark such thoughts. Another way is by engaging in rituals, such as washing or praying. The anxiety produced by the thoughts lead to the compulsive behaviours seen in OCD.

Question 30

Give a piece of research evidence that shows cognitive psychology can explain OCD as being due to memory problems.

Answer 30

Sher et al (1989) found that people with OCD had poor memories for their actions, for example, they really could not remember if they had turned the light off.

Question 31

Describe hypervigilant explain OCD

Answer 31

Hypervigilance means that they have an attentional bias which means that are overly sensitive to threat. This is seen where they may use rapid eye movements to scan the environment, and they may attend selectively to threat related stimuli rather than neutral stimuli. This means that they feel very anxious. The threats that are perceived therefore become the basis of their obsessions. The compulsive behaviours are designed to reduce their anxiety.

Question 32

Provide one argument AGAINST the cognitive explanation for OCD in terms of C&E

Answer 32

Cognitive theories do not really provide a cause & effect explanation of OCD. It does not show that faulty thinking is because of OCD; it could well be that faulty thinking is a symptom of OCD (with the underlying cause being something else e.g. brain structure/ functioning)

Question 33

What is a biological treatment for OCD

Answer 33

Drug treatment

Question 34

What are the three types of drug treatments used for OCD

Answer 34

1) antidepressants 2) anti-anxiety drugs 3) beta blockers

Question 35

Describe how antidepressants work by treating OCD

Answer 35

Antidepressants such as sertraline are used to raise serotonin levels. They do this by blocking its reuptake from the pre-synaptic neuron. This means that more serotonin is available for a longer period. dosage used to treat OCD is higher than that used to treat depression. It may take up to 12 weeks for the drugs to take effect. Some people do not respond to medication.

Question 36

Describe how anti-anxiety drugs work by treating OCD

Answer 36

Anti-anxiety drugs called such as valium work by increasing the effectiveness of GABA in regulating anxiety. GABA is an amino acid that acts to lower physiological arousal and return the body to a resting state.

Question 37

Describe how beta blockers work by treating OCD

Answer 37

work by blocking the stress hormones which are released into the blood stream by the adrenal glands. These stress hormones create symptoms of anxiety such as increased heart rate and respiration; beta blockers prevent this physiological response from occurring. Because the person feels less physiological stress, they may have fewer obsessional thoughts and therefore (because the obsessional thoughts lead to compulsive behavior) less compulsive behaviour.

Question 38

Give a strength of drug treatments for OCD to do with alternative treatments

Answer 38

One strength of drug treatment is that is useful, because it can be used to treat cases of OCD which have not responded to cognitive behaviour therapy.

Question 39

Give a strength of drug treatments for OCD to do with scientific credibility

Answer 39

There is empirical evidence to show that drug treatment can be effective in OCD. For example, Soomro et al (2007) found that antidepressants were more effective than placebo in reducing the symptoms of OCD. This means that the treatment has scientific credibility.

Question 40

Give a strength of drug treatments for OCD to do with effectiveness

Answer 40

•Drug treatment can be combined with CBT and has been shown to raise the effectiveness of CBT (POTS, 2004) • Koran et al. (2002) found that anti-depressant medication did have long term effects compared to a placebo & was effective at preventing relapse over an 80 week trial.

Question 41

Give a strength of drug treatments for OCD to do with ethics

Answer 41

Modern drug therapy combined with psychological therapy has reduced the need to resort to neurosurgery, which had some serious ethical issues.

Question 42

Give a weakness of drug treatments for OCD to do with ethics

Answer 42

• One limitation of drug therapy is that it may cause side effects such as nausea and headaches. Although these do not last, they are not pleasant for the patient. The side effects may also limit the usefulness of drugs because people may not want to take them. •In rare cases, use of medication may increase the patient's anxiety rather than decreasing • Patients are likely to relapse if drug treatment is stopped.

Question 43

Give a weakness of drug treatments for OCD to do with effectiveness

Answer 43

• Drug treatments alone cannot treat most people with OCD; they are most effective when combined with other forms of treatment such as CBT. • There are individual differences in the way that people respond to drugs; for example Ravizza et al (1995) found that SSRis were not effective for 40% of people.

Question 44

What are the two techniques of CBT that focus on obsessions?

Answer 44

•Test beliefs •Habituation training

Question 45

Cognitive therapy aims to prevent a common cognitive distortion of catastrophising. What is catastrophising?

Answer 45

In catastrophising, the person firstly predicts a negative outcome, and secondly, jumps to the conclusion that if the negative outcome did in fact happen, it would be a catastrophe.

Question 46

How does CBT use habituation training?

Answer 46

the client is asked to repeatedly think about their obsessive thoughts. The idea is that by deliberately thinking about obsessions, they will become less anxiety provoking, with the consequence that compulsive behaviour is not required to reduce high levels of anxiety.

Question 47

What is ERPT in CBT?

Answer 47

A behavioural therapy used as part of CBT for OCD is known as Exposure and Response Prevention Therapy (ERPT). ERPT focuses only on the compulsions found in OCD, so it complements the use of cognitive therapy which targets the obsessions ERP deliberately exposes clients to objects or situations that cause anxiety and requires the client to resist performing the compulsive behaviour. The role of the therapist is to help the person develop ways in which they can resist performing the compulsive behaviours.

Question 48

List the steps in ERPT

Answer 48

•Inform the client about ERPT •Construct an EXPOSURE HIERARCHY •Repeated exposure to situations which cause anxiety •Client must RESIST performing the compulsive behaviour

Question 49

Explain what is meant by catastrophising

Answer 49

Jumping to the worst possible outcome

Question 50

What is habituation?

Answer 50

Asking the client to think repeatedly about their obsessive thoughts

Question 51

What does ERPT stand for?

Answer 51

Exposure and Response Prevention Therapy

Question 52

Strengths of CBT as a treatment for obsessive-compulsive disorder to do with ethics

Answer 52

One strength of CBT is that it is said to be an ethical form of treatment. This is a strength as it means the treatment is approved by society and does not cause the patient anymore distress as it is ethical. For example CBT teaches the patient to expose themselves to feared situations even outside of the therapy session. This shows that therapy is ethical as in powers patient to use learned techniques on their own. This also helps with the issue and debate of social control as CBT empowers the patient which means and implies that they are less controlled by others in society.

Question 53

Strengths of CBT as a treatment for obsessive-compulsive disorder

Answer 53

•The use of CBT is supported by evidence which shows that it is effective in reducing the symptoms of OCD. For example, it is endorsed by the National Institute for Health and Clinical Excellence (NICE, 2006). •CBT does not have any side effects (unlike medication for OCD). •CBT has lower relapse rates than medication when it is discontinued.

Question 54

Limitations of CBT as a treatment for obsessive-compulsive disorder to do with why the treatment is limited

Answer 54

POTS 2004 found that CBT is an effective therapy for OCD when compared to a placebo group, they also found that sertraline (a drug therapy) was effective, and most effective was a combination of CBT and sertraline. This suggests that although CBT is effective, it is a limited treatment which should ideally be used in combination with other forms of therapy. • It is difficult to disentangle which of the benefits from CBT are due to the cognitive component and which are due to the behavioral component.

Question 55

Limitations of CBT as a treatment for obsessive-compulsive disorder to do with individual differences

Answer 55

•Although about 70% of people respond well to CB, there are still many for whom it is ineffective. Individual dilferences mean that therapy needs to be tailored for the needs to the particular person. For example, Overbeek et al (2002) tound that a third of participants with OCD also had clinical symptoms of depression. This group showed less improvement when treated with ERP and drug treatment combination compared with a group of participants with OCD only symptoms. •ERPT - would not be effective for clients that do not have compulsions MASELLIS et al. (2003) found that a substantial proportion of clients (up to 44%) only suffer from obsessions They also found that up 75% had co-morbid depression, which lessens effects of ERPT.

Question 56

Describe one similarities between CBT and drug treatment for OCD

Answer 56

There is evidence that both treatments are effective for OCD. For example, Soomro's research found that antidepressants were more effective than placebo in reducing symptoms of OCD. Similarly, CBT is endorsed by NICE (2206) who found that CBT is effective in reducing symptoms of OCD.

Question 57

Describe one difference between CBT and drug treatment for OCD

Answer 57

Drug treatments for OCD may have side effects, such as nausea and headaches. This may reduce the effectiveness of drug treatments, as people may not wish to take them. In contrast to this, CBT for OCD does not have any side effects, which may make it more likely for people to continue with their therapy.

Question 58

What is your contemporary study for clinical psychology

Answer 58

Obsessive-Compulsive Disorder by POTS (2004)

Question 59

What was the aim of POTS (2004)

Answer 59

To compare three treatments: 1) CBT on its own 2) An SSRI (sertraline) on its own 3) CBT and sertraline combined These were compared against a baseline placebo condition

Question 60

What was the procedure for POTS (2004)

Answer 60

• Drugs only and placebo, condition - required the children to fitters westay for first 6 weeks and then every other week (9 • CBT condition: 14 visits • Combined condition - same treatment as CBT only condition + Sertraline • Ps assessed at baseline, 4 weeks, 8 weeks, and 12 weeks

Question 61

What type of sample was used in POTS (2004)?

Answer 61

• A volunteer sample the study ran across centres, in the USA All diagnosed using the DSMIV 112 people (participant attrition= 97) Ages 7-17 years

Question 62

How many participants were used in POTS (2004)?

Answer 62

• 112 • All American; 92% white

Question 63

What was the age range for participants in POTS’s study

Answer 63

7-17 years old

Question 64

How was the severity of the participants' symptoms measured in POTS’s study?

Answer 64

•A standardised test - the Children's Yale-Brown Obsessive- Compulsive Scale was used. •Only those with a score of 16 or above on this scale were included.

Question 65

Which children were excluded from POTS’s study, and why?

Answer 65

Children who were comorbid with other disorders such as Tourette’s s and major depression To avoid interaction effects. (Comorbid refers to having an additional disorder ) this controls for confounding variables;

Question 66

Why were children who had been diagnosed with ADHD required to be on stimulant medication and stable in POTS’s study?

Answer 66

To ensure that their ADHD would not affect the treatment for OCD. •controlling for the confounding variable of ADHD;

Question 67

Why were none of the children on any anti-obsessional medication at the start of POTS study?

Answer 67

To ensure that any change in the participants was due to the treatments offered in the study (CBT and/or sertraline)

Question 68

How were children allocated to the four conditions in POTS study?

Answer 68

Randomly, using computerised system

Question 69

Name each of the four conditions in POTS study

Answer 69

• Drugs only • Placebo pill only • CBT only • CBT and drug treatment

Question 70

How were the children assessed at the start of treatment in POTS study?

Answer 70

They were interviewed • Their baseline measure was taken using the CY-BOCS using independent evaluators.

Question 71

How long did POTS study last?

Answer 71

• 12 weeks • This means it is a longitudinal study • Strength: can show change and development in OCD symptoms over time

Question 72

Why did each child have a specialist psychiatrist assigned to them for the duration of POTS study?

Answer 72

• To monitor their progress • To provide them with support

Question 73

Describe the procedure for the drugs-only and placebo conditions.

Answer 73

• Children attended weekly sessions for the first six weeks • Thereafter they attended every other week. (9 sessions in total). •The dose would be established and changed during the clinical session. •During the week their parents would monitor that the medication was being taken, bf they kept a medication diary. • Any adverse reactions would result in the medication being changed or stopped.

Question 74

How many sessions did the CBT group have in POTS study?

Answer 74

14

Question 75

What were the components of the CBT therapy in POTS study?

Answer 75

• Psychological education •Cognitive training •Mapping OCD target symptoms •Exposure and response ritual prevention.

Question 76

What did each CBT session consist of in POTS study?

Answer 76

• Goal setting • Review of the previous week • Therapist assisted practice • Homework • Monitoring

Question 77

What was the combined condition, and when did the sessions take place in POTS study?

Answer 77

• Drugs and CBT in conjunction • Sessions were time linked and provided simultaneously.

Question 78

After the initial baseline assessment, when were the participants assessed again during the course of POTS study?

Answer 78

They were assessed at weeks 4, 8, and 12.

Question 79

Who assessed the participants in POTS study?

Answer 79

• Independent evaluators trained to a reliable standard. • Controls for researcher effects • Increases validity of the study

Question 80

How did the authors of POTS study try to ensure that the assessments were reliable?

Answer 80

The evaluators were carefully trained The evaluation process was strictly supervised and reviewed. Another strength of the study: high interobserver reliability!

Question 81

How many of the original participants completed POTS study?

Answer 81

• 97 out of 112. Low participant attrition- high generalisability

Question 82

What is meant by remission?

Answer 82

Where a person has no signs and symptoms of the disorder

Question 83

How did the authors of the study define "entering remission" in POTS study?

Answer 83

• A drop below 10 on the CY-BOCS • Objective; quantitative data

Question 84

Which condition shows the smallest drop in symptoms over the course of POTS study?

Answer 84

Placebo

Question 85

Which condition shows the greatest drop in symptoms?

Answer 85

Combination (drug treatment + CBT)

Question 86

Rank the treatment in POTS study in terms of effectiveness

Answer 86

Best to worst: •Combination treatment •CBT alone •Drug treatment alone •Placebo

Question 87

What did POTS study conclude?

Answer 87

•CBT led to more improvement than drugs; this suggested that the first line of treatment should be CBT •Minimal gain can be added by including the drugs where effective CBT is provided; but the drug may compensate for less effective therapy. •Drugs require careful monitoring if used, as SSRIs have been linked to suicidal ideation in young people. •However, drug treatment was well tolerated, •Early intervention effective for children and young people with OCD

Question 88

List the strengths of generalisability in POTS study

Answer 88

/ Large sample -112 children (relatively low drop out rate) Representative of the target population (children and young people with OCD) Analysis of sample showed there was no difference in groups (therefore any difference in groups would be down to IV)

Question 89

List the limitations of generalisability in POTS study

Answer 89

• Conducted in USA may not generalise to non-Western societies. Other societies may respond differently to CBT and/or to medication. Excluded children who were co-morbid

Question 90

List the strengths of reliability in POTS study

Answer 90

The evaluators who assessed the children's symptoms had been trained to a reliable standard The scale used to assess their symptoms was a standardised measure and thus reliable All participating centres (three) used the CBT manual in order to maintain consistency in treatment

Question 91

List the weaknesses of reliability in POTS study

Answer 91

The study was conducted over three centres BUT One centre had better results on the CBT-only condition. This may be due to the therapist effect, as one therapist may have been more proficient at CBT than the others.

Question 92

List the applications of POTS study

Answer 92

•Useful, as it provides strong evidence about the most effective treatments for OCD in children and young people. •Shows value of clinical treatments -cause & effect. •Findings have shown effectiveness of CBT & sertraline combined (although individual differences mean that therapies still need to be tailored to the person - Although this study cannot show this). •Shows usefulness of psychological therapies •SSRI's can lead to suicidal ideation in some individuals - which needs to be taken into account

Question 93

List the strengths of validity

Answer 93

The assessment scale used (CY-BOCS) had been validated as an accurate measurement of OCD symptoms The assessors were blind to the condition that the participants were in so they could not be biased in their evaluation of improvements. The participants in the placebo condition were unaware that the drug was not active, as was the therapist. This controlled for demand characteristics and therefore increased validity. Participants were randomly allocated into conditions - can infer cause & effect..

Question 94

List the strengths of ethics in POTS study

Answer 94

All participants gave full written consent as did at least one of their parents. Volunteer sample (so no one was coerced into it/ did it against their will) BUT... Is it always easy for a child to decline if their parents want them to be a part of study? Each participant was assigned a psychiatrist to monitor and support them. Those in the drug treatment condition were regularly checked and dosages changed as necessary, thus protecting them from harm. Use of deception in the placebo condition: but this was necessary in order to ensure validity of the study. Everyone in the placebo condition was offered the therapy on completion of the study.

Question 95

How does POTS study link to the issue and debate of change over time?

Answer 95

• Practice changed as a result of POTS study, Before 2004 CBT not routinely used for children - this study has helped change this... So that CBT is now the first line of treatment for OCD. However it also shows that CBT and drug treatment are very effective in combination (We are using less drastic measures like drugs with side effects or brain surgery to help relieve OCD)

Question 96

How does POTS study link to the issue and debate of practical issues?

Answer 96

Volunteer sample - therefore may not be typical - may be more motivated therefore CBT results may be better than in the general population Sample from 3 academic centres - but only in U.S. - generalisability Didn't have co-morbid participants - don't know how effective for children with multiple issues. Longitudinal Study: Carried out over 12 weeks (time consuming & expensive)