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Obsessive-Compulsive Disorder (Clinical implications of basic research for…

- - - - Content is highly individualised and shaped by the thinker's personal experiences
      - Categories: contamination, responsibility for harm, violence, sex, religion, need for order or exactness
      - Obsessions often evoke intense distress and impairment that result from avoidance of related situations
      - Characteristics: (1) experienced as unwanted or uncontrollable, in that they intrude into consciousness, (2) content of obsessions is incongruent with the individual's belief system; (3) resisted, accompanied by the sense that they must be dealt with, neutralized and avoided
    - - Compulsive rituals: washing and cleaning, checking, seeking reassurance, ordering and arranging, repeating routine behaviours, counting
      - In some cases, patients perform rituals simply to reduce a general sense of anxiety or to achieve a feeling of 'completeness': can be overt behaviours or covert mental acts aimed at preventing a negative outcome
      - Use various overt and covert strategies that do not meet DSM-criteria for compulsions to control, remove, or prevent their obsessions: overanalysing meaning of obsessional thoughts, rational self-talk, reassurance seeking, replacing obsessional thought with a safe thought, brief behavioural act, distraction, thought suppression
    - - Obsessions and ritual are functionally related - the compulsive ritual is an attempt to reduce obsessional distress
      - Certain types of obsessions and rituals co-occur: (1) obsessions about responsibility for harm and mistakes is associated with checking rituals; (2) symmetry obsessions occur with ordering and counting; (3) contamination occur with washing and cleaning; (4) religious, sexual and violent obsessions trigger mental rituals and reassurance seeking
      - How does the ritual reduce anxiety or prevent feared negative consequences?
- - - - Proposed that obsessions and compulsions arise from abnormalities in serotonin transmitter system: hypersensitivity of postsynaptic serotonergic receptors
      - Why? SSRIs are more effective than medications with other mechanism of action
      - However, no support from biological makers - abandoned hypothesis
    - - OCD symptoms caused by neuroanatomical abnormalities: orbitofrontal-subcortical circuits (initiation of behaviours implemented with little conscious awareness)
      - Neuroimaging (PET/SPECT): those with OCD evidence more activity in the orbital gyrus and the head of caudate nucleus
    - - Little correspondence between patterns of symptoms and biological mechanisms proposed to account for them
      - Unable to explain that OCD symptoms concern some themes
      - Existing serotonin and neuroimaging studies are correlational in design and therefore do not provide evidence that biological abnormalities cause symptoms
  - - - Mowrer's two-stage theory of fear acquisition and maintenance
        
        Stage 1 (classical conditioning): obsessional fears acquired as a result of traumatic conditioning experience in which a previously neutral stimulus was paired with aversive stimulus, so to elicit fear response- specific situations that pose no objective threat may evoke obsessional fear
        
        Stage 2 (operant conditioning): avoidance behaviours and compulsive rituals become habitual, because they reduce obsessional anxiety immediately
        
        Limitations of learning models apparent
    - - Abnormally functioning executive processes, such as memory: compulsive checking might be a consequence of not being able to remember
      - However, little evidence of overall memory deficit: maybe memory problems only where their obsessional fears are concerned
      - Evidence suggest opposite: patients appear have a selectively better memory for OCD-related information relative to non-OCD-relevant stimuli
      - If dysfunctional information processing plays any causal role in OCD, it is most likely to be a non-specific vulnerability factor, as opposed to a specific cause
    - - Beck (1976) cognitive specificity theory of emotion
        
        Emotional distress arises not form negative or threatening situations and stimuli themselves, but from how one interprets or appraises such stimuli
        
        Obsessional fears are thought to arise from inaccurate beliefs about the importance of intrusive thoughts
        
        Rachman/Salkovskis: mental instrusions develop into clinical obsessions when they are misappraisal as overly significant, threatening, harmful or posing threat
        
        Different views: Salkovskis (inflated responsibility - rituals from strong pattern cause they work immediately), Rachman (over importance of thoughts), Clark (need to control intrusive thoughts)
        
        Obsessive Compulsive Cognitions Working Group: excessive responsibility, overimportance of thoughts, need to control thoughts, overestimation of threat, perfectionism, intolerance for uncertainty
        
        Rituals precent individuals from discovering that feared outcome is unlikely in first place
- - - - Pie technique: patient who overestimates personal responsibility -involves patient giving an initial estimate of the percentage of responsibility that would be attributable to him/her if a feared consequence were to occur
      - Cognitive continuum: difficulty discriminating between unwanted obsessional thoughts and actions, involves rating how immoral they perceive themselves to be for having the instrusive thoughts
  - - - Repeated and prolonged exposure to feared stimuli, in absence of rituals and avoidance, correct catastrophic overestimates of danger that underlie obsessional anxiety and fear
      - Three requirements: (1) physiological arousal and subjective fear must be evoked during exposure, (2) fear responses must gradually diminish during exposure in absence of rituals, (3) initial fear response should decline