CLINICAL- Obsessive Compulsive Disorder

Question 1

What is the diagnosis for OCD

Answer 1

• This is characterized by the presence of persistent obsessions or compulsions or most commonly both.
• Obsessions: unwanted repetitive thoughts
• Compulsions: Repetitive behaviors as a response to obsessions
• The obsessions and compulsions must take up more than an hour per day and must result in significant distress and impairment of functioning

Question 2

Describe the boy in Rapoports case study

Answer 2

• 14 year old boy
• Would spend 3 hours or more showering
• and at least 2 hours getting ready
• He had a repetitive routine of holding soap in one hand
• He dropped out of school due to the washing rituals he had

Question 3

What are the 2 measures used to assess OCD

Answer 3

• Maudsley Obsessive -Compulsive Inventory (MOCI)
• Yale- Brown Obsessive Compulsive Scale (Y-BOCS)

Question 4

Describe the MOCI

Answer 4

• 30 items
• responses are either “TRUE” or “FALSE”
• It assess symptoms relating to; checking, washing, slowness and doubting
• produces a score range of 0-30 and takes 5 mins to complete
  EXAMPLE:
  “I frequently have to check things(gas, doors, e.t.c”

Question 5

Describe the Y-BOCS

Answer 5

• A semi - structured interview developed by Goodman et al.
• measures the nature and severity of symptoms
• takes 30 mins to conduct
• Involves a checklist of several obsessions and compulsions with a 10-item scale
  EXAMPLE:
  Obsessions> Aggressive
  Compulsions>Washing
• scores range from 0-40 and scores above 16 are the clinical range

Question 6

Evaluate the 2 measures

Answer 6

• They have good concurrent validity
• have good test-retest validity
• Socially desirable responses reduces validity

Question 7

Describe the biochemical explanation

Answer 7

• Research has shown ( Szechtman et al.) that those with OCD tend to have abnormally high levels of dopamine . Increased level of dopamine in rats resulted to repetitive behaviours.
• Research also shows that those with OCD tend to have abnormally low levels of serotonin due to evidence from anti-depressants that increase serotonin and have improved OCD symptoms (Pittenger &Bloch)
• The biochemical, oxytocin also plays a role as it involves trust and attachment.
• there is mixed evidence surrounding it from Leckman et al proving that forms of OCD is related oxytocin dysfunction but is countered by Den Boer et al. showing theres no link

Question 8

Describe the genetic explanation

Answer 8

• Monzani et al. found a strong concordance between MZ twins (52%) compared to DZ twins (21%)
• The SERT gene which is responsible for serotonin levels had a mutation which leads to its low levels in OCD - Ozaki et al.
• Mettheisen et al. found the PTPRD gene and SLITRK 3 genes are linked to the symptoms of OCD

Question 9

Evaluate the biological explanation

Answer 9

• Reductionist
• Deterministic
• Individualistic as it focuses primarily on their hormonal abnormalities
• Supports the nature side
• supported by scientific research which is objective through gene testing

Question 10

Describe the cognitive (thinking error) explanation

Answer 10

• They base their reasoning on faulty thinking as a result of obsessive thoughts
• these mistakes in cognition worsen under stressful conditions
• the compulsive behaviour will remove the unwanted thoughts and anxiety created
  e.g washing hands because they believe they have harmful germs that could kill them (Rachman et al.)

Question 11

Describe the behavioral (operational condition) explantion

Answer 11

-The compulsive behaviour will act as a negative reinforcer as it has relieved something unpleasant
- They can also be a positive reinforcer because the person is ‘rewarded’ by knowing they have clean hands

Question 12

Evaluate the cognitive and behavioural explanation

Answer 12

• Application to everyday life has led to treatments including CBT
• Individual side due to faulty though processes
• Holistic as it considers distorted thoughts and reinforcements in explaining OCD
• Nurture side of debate

Question 13

Describe the psychodynamic explanation

Answer 13

• it claims that symptoms of OCD are a result of conflict between the id and ego and such conflict will arise in the anal stage of psychosexual development
• This is due to tension between parents and children when potty training them. In an attempt to regain control, the child will be anally expulsive; messy and careless.
• OR they may fear their harsh responses and retain urine to regain control
• This will lead to to anally retentive behaviour which is the compulsive need for everything to be neat
• obsessive thoughts from the id will disturb the rational part of self leading to obsessive rituals later on in life due to childhood trauma

Question 14

Evaluate the psychodynamic explanation

Answer 14

• Holistic as it focuses on the psychosexual stages
• Application to everyday life for treating OCD from knowing its origin
• Situational factors due to early relationship conflicts can affect their life later
• has no empirical evidence

Question 15

describe the biological treatment in OCD

Answer 15

• Selective serotonin reuptake Inhibitors (SSRIs) are used to treat OCD but at a higher dosage
• They work by blocking the serotonin from being reabsorbed once a message has been passed from one neuron to another so serotonin levels remain high
• Soomro et al. provides evidence from 17 studies. It showed SSRIs were most effective in reducing symptoms than placebos

Question 16

Evaluate the biological treatment of OCD

Answer 16

• reductionist treatment
• deterministic as patient has no control over how it will work.
• relapse may occur
• effective when combined with therapy
• side effects such as nausea
• supports the individual side as it treating the individuals serotonin uptake and ignores the environment

Question 17

What are the 2 psychological treatments

Answer 17

• Exposure and response prevention (ERP)
• Cognitive behavioural therapy (CBT)

Question 18

Describe the ERP treatment

Answer 18

• This is a form of CBT
• The aim is to prevent the compulsive behaviour as a response to the obsessive behaviour
• The individual is instead taught how to tolerate the anxiety and learn to accept their obsession and become habituated

Question 19

How was treatment used in Lehmkuhl et al.

Answer 19

• Jason attended ten 50-min CBT sessions over 16 weeks
• he learned ERP techniques that catered to his ASD; not visualization
• He learned coping statements for when he felt anxious such as “ I know that nothing bad will happen”
• The next step involved Jason bein exposed to the stimuli which he felt were contaminated such as a door handle. The exposure involved Jason being asked to touch these items and repeat it until it became a habit and his anxiety levels dropped.
• In between sessions he practiced this exposure through specific tasks in his normal environment such as using ‘contaminated’ items in his house
• His Y-BOCS scores went down from 18 to 3

Question 20

Evaluate the study of Lem et al.

Answer 20

• Case studies provide in-depth rich data
• Lack of generalisability as the Y-BOCS had to be modified to deal with his autism
• applicable to several patients
• supports the nurture debate and learned how to deal with his behaviour and un-learned his complusions
• consent was given by his parents

Question 21

Describe the CBT treatment

Answer 21

• CBT is effective and works by understanding and challenging these irrational thoughts and bring out the positive change in their emotional and behavioural responses

Question 22

What is the main theories and explanations of Lovell et al.

Answer 22

• offering CBT on the the telephone has seen to be effective
• CBT on the telephone can offer shorter waiting lists and reduce the amount of time patients have to wait to be treated
• some patients did not have transport or the money to afford public transport
• patients may feel more comfortable on telephone compared to a new environment that is face to face

Question 23

What is the aim of Lovell

Answer 23

• To compare the effectiveness of telephone CBT and face-to-face CBT

Question 24

Describe the sample of Lovell

Answer 24

• 72 participants
• all diagnosed with OCD
• ages 16-65 years
• all patients are from the UK .

Question 25

Describe the design/ procedure used in Lovell

Answer 25

- they used a randomised control trial - They were randomly assigned to the telephone sessions or face-to-face and so was an independent measures design - They compared exposure therapy and response prevention delivered by 60-mins face to face OR telephone sessions 30-mins - 10 weekly session were provided for each participant in each condition.

Question 26

How was the study controlled

Answer 26

- 2 experienced therapists carried out the treatments and consistency was maintained by use of: - Therapist manuals - Fortnightly supervision - 4 monthly training days

Question 27

What were the participants assessed with before and after treatment in Lovell et al.

Answer 27

BEFORE: - Twice 4 weeks apart using the Y-BOCS - BDI to measure the feelings of depression AFTER: - One-three- and six-month follow ups with the same measures - a satisfaction questionnaire

Question 28

State 2 results from Lovell

Answer 28

- Prior to treatment there was no significant difference between the mean scores for Y-BOCS and BDI between the 2 conditions. - Scores on the client satisfaction questionnaire showed that patients were very satisfied with their treatment.

Question 29

State the conclusion from Lovell

Answer 29

- the results suggest that patients with OCD can equally benefit from CBT delivered over the phone with reduced contact time as with the traditional face-to-face sessions

Question 30

Evaluate Lovell study

Answer 30

- With the use of an independent measure, randomly placing participants in either condition reduces researcher bias - High reliability as the duration of therapy was kept the same and used the same validated scale - applicable to everyday life. a cheaper and more accessible form of CBT is equally effective as the traditional sessions - The sample was relatively small and all participants were from the UK - the use of self reports can reduce validity as responses could be inaccurate. Answers may be subjective and individuals could exaggerate or downplay their symptoms.