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Treatment of Impulse Control Disorders and Non-substance Addictive…
Treatment of Impulse Control Disorders and Non-substance Addictive Disorders
Biochemical (Grant et. al 2008)
Sample
284 participants (roughly split of equal genders)
Measures
Yale Brown Obsessive Compulsive Scale (Y-BOCS) to measure gambling severity
Aim
Whether taking opiates would reduce gambling behaviour by causing a 35% reduction in Y-BOCS scores for at least 1 month of study
Results
Opiate group had a significant reduction in gambling symptoms
Individual differences (eg: family history of alcoholism, or greater dosage of opiates taken) contributed to a greater reduction in Y-BOCS scores
Experiment
Double-blind experiment. The sample were divided to either take the 16-week course of opiate nalmefene or 18-week course of naltrexone (placebo)
Evidence
Research shows that drugs like opiates (painkillers) can be successful in treating gambling disorder
Covert Sensitisation (Glover 2011)
Uses classical conditioning
undesirable behaviour + unpleasant stimulus = change of behaviour
Case study of kleptomaniac woman
56 year old
14 year history of daily shoplifting without purpose (eg: baby shoes)
She had compulsive thoughts that disgusted her, but was hard to resist
Procedure of treatment
Woman went through 4 sessions at 2-week intervals
Muscle relaxation was used for the first 2 weeks
Used to relieve tension from within the body and mind
Can be done with medication, visualisation exercises or repetition of calming phrases
Progressive muscle relaxation = tensing and relaxing muscles
Nausea visualisation
She imagined vomiting as she stole which attracted attention and disgust from those around her
She practiced these visualisation exercises as homework
During the last session, she imagined the sickness went away
At 19-month check-up
She had a decreased desire to steal
1 relapse
Improvement in self-esteem and social life
Imaginal desensitisation (Blaszczynski & Nower 2003)
Relies on the use of images to help people with ICD
Progressive Muscle Relaxation technique used
Patient then visualises the triggering situation and thinks about acting on the impulse
They have to mentally leave the situation without acting on the situation
The sessions are audio recorded to use when practising outside therapy
Very effective
Reduces strength of compulsive drive
Decrease arousal and anxiety levels for gamblers at 5 year follow-up
Impulse Control Therapy (Miller 2010)
Doesn't aim to eliminate behaviour, but to establish normal behaviour
These aspects are identified
Most intense feeling
The intense positive feelings
Physical sensations
The aspects are measured on Positive Feelings Scale
The patient has to recreate the feeling state (combine images of intense desire and positive experience of compulsive act) while doing EMDR exercises
Patients re-evaluate their impulsive feelings on the scale
Usually 3 -5 sessions until compulsive behaviour is reduced
EMDR (Eye Movement Desensitisation and Reprocessing) - Individuals recall behaviour or memories while the therapist directs eye movement patterns using hands or other stimuli
John - compulsive gambler
Got depressed after losing first marriage
Identified feeling state as 'winning', which was connected to his compulsive behaviour
After visualisation and EMDR, he noticed a reduction in gambling and feeling state over 4 weeks
Felt healthy in follow-up