Obsessions
Persistent thoughts, ideas, impulses, or images that seem to invade a person's consciousness
Compulsions
Repetitive and rigid behaviors or mental acts that people feel they must perform to prevent or reduce anxiety
Who suffers OCD?
- It is equally common in men and women and among different racial and ethnic groups
- Between 1% and 2% of U.S. population suffer from OCD in a given year; as many as 3% over a lifetime
-The disorder usually begins by young adulthood and typically persis
What Are the Features of Obsessions?
- Obsessions (Eg., contamination, orderliness)
- Thoughts become intrusive and foreign
What Are the Features of Compulsion?
- Compulsions (Eg, cleaning, checking)
- "Voluntary" behaviors or mental acts
- Feel mandatory/unstoppable
- Most recognize that their behaviors are unreasonable
- Believe, though, that something terrible will occur if they do not perform the compulsive a
The Behavioral Perspective/ Behavioral therapy
- Exposure and response prevention (ERP)
-Clients are repeatedly exposed to anxiety-provoking stimuli and are told to resist performing the compulsions
- Many behavior therapists now use this technique in individual and group therapy formats
- Homework is
The Cognitive Perspective
- To avoid such negative outcomes, they attempt to "neutralize" their thoughts with actions (or other thoughts)
- Neutralizing thoughts/actions may include:
- Seeking reassurance
- Thinking "good" thoughts
- Washing
- Checking
Cognitive-Behavioral Therapy (CBT)
Research suggests that a combination of the cognitive and behavioral models is often more effective than either intervention alone. These treatments typically include psychoeducation as well as exposure and response prevention exercises.
OCD: The Biological Perspective (Families)
Increased rates, supported by twin studies.
OCD: The Biological Perspective (Pandas)
Subgroup increased rate of OCD symptoms after Strep throat. Autoimmune inflamation.
Abnormal serotonin activity
- Evidence that serotonin-based antidepressants reduce OCD symptoms; recent studies have suggested other neurotransmitters also may play important roles
- Serotonin-based antidepressants
- Clomipramine (Anafranil), fluoxetine (Prozac), fluvoxamine (Luvox)
DSM 5
- No longer classified as part of the group of disorders on Anxiety.
- DSM-5 has created the group name "Obsessive-Compulsive-Related Disorders" and assigned four patterns to that group: hoarding disorder, hair-pulling disorder, excoriation (skin-picking)
Clinical assessment
- used to determine how and why a person has symptoms, is behaving abnormally or suffering -- and how that person may be helped
- Also may be used to evaluate treatment progress
Characteristics of Assessment Tools
To be useful, assessment tools must be standardized (administration, scoring, and interpretation ) and have clear reliability and validity
Conducting Clinical Interviews
- Can be either unstructured or structured
- In an unstructured interview, clinicians ask open-ended questions
- In a structured interview, clinicians ask prepared questions, often from a published interview schedule.
- May include mental status exam
Limitations of Clinical Interviews
- May lack validity or accuracy
- Individuals may be intentionally misleading
- Interviewers may be biased or may make mistakes in judgment
- Interviews, particularly unstructured ones, may lack validity
Projective tests
- Require that clients interpret vague and ambiguous stimuli or follow open-ended instruction
- Mainly used by psychodynamic practitioners
- Most popular
- Rorschach Test
- Thematic Apperception Test
- Sentence completion tests
- Drawings
- Strengths and
Personality inventories
- Designed to measure broad personality characteristics
- Focus on behaviors, beliefs, and feelings
- Usually based on self-reported responses
- Most widely used: Minnesota Multiphasic Personality Inventory (MMPI)
- Strengths and weaknesses:
- Easier, che
Responsive inventories (Self-report questionnaires)
Strengths and weaknesses:
- Have strong face validity
- Not all have been subjected to careful standardization, reliability, and/or validity procedures (Beck Depression Inventory and a few others are exceptions)
Psychophysiological tests
- Measure physiological response as an indication of psychological problems
- Includes heart rate, blood pressure, body temperature, galvanic skin response, and muscle contraction
Neurological and Neuropsychological tests
- Neurological tests directly assess brain function by assessing brain structure and activity. Examples: EEG, PET scans, CAT scans, MRI, fMRI
- Neuropsychological tests indirectly assess brain function by assessing cognitive, perceptual, and motor functio
Intelligence tests
- Designed to indirectly measure intellectual ability
- Typically comprised of a series of tests assessing both verbal and nonverbal skills
- General score is an intelligence quotient (IQ)
-Represents the ratio of a person's "mental age" to his or her "ch
Naturalistic and analog observations
- Naturalistic observations occur in everyday environments
- Can occur in homes, schools, institutions (hospitals and prisons), and community settings
- Most focus on parent-child, sibling-child, or teacher-child interactions
- Observations are generally
Diagnosis: Does the Client's Syndrome Match a Known Disorder?
- Using all available information, clinicians attempt to paint a "clinical picture"
- Influenced by their theoretical orientation
- Using assessment data and the clinical picture, clinicians attempt to make a diagnosis
- A determination that a person's ps
DSM-5
- Requires clinicians to provide two types of information:
- Categorical information - the name of the category (disorder) indicated by the client's symptoms
- Dimensional information - a rating of how severe a client's symptoms are and how dysfunctional
Can Diagnosis and Labeling Cause Harm?
- Misdiagnosis is always a concern
- Major issue is on the reliance on clinical judgment
- Also present is the issue of labeling and stigma
- Diagnosis may be a self-fulfilling prophecy
Treatment decisions
- Begin with assessment information and diagnostic decisions to determine a treatment plan
- Use a combination of idiographic and nomothetic information
- Other factors:
- Therapist's theoretical orientation
- Current research
- General state of clinical
Is therapy generally effective?
- Research suggests that therapy is generally more helpful than no treatment or than placebo
- In one major study using meta-analysis, the average person who received treatment was better off that 75% of the untreated subjects
Are particular therapies generally effective?
- Generally, therapy-outcome studies lump all therapies together to consider their general effectiveness
- Some critics can call this the "uniformity myth"
- An alternative approach examines the effectiveness of particular therapies
- There is a movement
Are particular therapies effective for particular problems?
- Studies now being conducted to examine the effectiveness of specific treatments for specific disorders:
- "What specific treatment, by whom, is the most effective for this individual with that specific problem, and under which set of circumstances?"
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