Week 6 - OCD

What paradoxical effect does repeated checking have

Enhancing uncertainty about memory rather than reducing it - backfires

What is the memory deficit hypothesis of OCD

Memory distrust in OCD reflects a realistic insight in memory failure

Memory uncertainty is highly domain specific though (car lock not window)

Preservation = Repeated Checking decreases memory confidence.

What are other uncertainties and preservations apart from memory?

• Understanding written text

• Perception

• Reasoning (impossible-to-predict situation outcomes appear to be persevarative - If I do not wash hands after bus I’ll get disease

  • It increases the credibility of the outcome and not the uncertainty of an outcome

  All relate to cognitive routines and all associated with perseveration

How does perseveration induce the type of ambivalent uncertainty experienced in OCD

It blocks spreading of activation

Perseveration (compulsions) as a response to uncertainty which increases uncertainty

Perseveration may block the normal automatic spreading of activation & this may be experienced as ambivalence about meaning

What are the 3 multiplier of the intensity and duration of compulsive checking?

1. Increased responsibility - the only multiplier essential for the equation if this is not there no compulsive checking takes place

2. Probability of harm

3. Anticipated seriousness of harm

How is the recurrence of checking promoted by self-perpetuating mechanism - 4 elements

1. Paradocical increases of responsibility

2. Paradoxial increases in perceived probability of har

3. Reduced confidence ein memory

4. The absence of a certain end to the threat

What is the theory of compulsive checking by Rahman

Compulsive checking occurs when pp who believe that they have a special, responsibility for preventing harm feel unsure that a perceived threat has be adequately reduced or removed

To achieve certainty about the absence of harm occurring - repeated checking for safety

• Which can produce adverse affects that turn the checking behaviour into a self-perpetuating mechanism

What are reasons why compulsive checkers experiencing recall difficulty of the safety checking behaviour?

• The interaction of the multipliers increase the persons anxious arousal which imairs recalling if the specific events

  • Most of the attention is focused in the threat & scanning of the emotional reactions to threat

• Evidence of a personal inadequacy or abnormality (I’m losing my mind)

• The problem is then exacerbated by triggering of the self-perpetuating mechanism,

  • Checking itself undermineds the persons confidence in their memory thereby strengthening the maladaptive interpretation of the personal sgnificance of the memory problems

What is the CBT approach in this article?

• Reduction of the core belief or inflated special responsibility for protecting others/self from harm

• Modification of the maladaptive cognitive misinterpretations of one’s behaviour and the impaired confidence in one’s memory

• Use of response prevention tactics

  — The role of responsibility is critical in compulsive checking but not in obsessions

What are the differences in compulsive checking and cleaning

1. Cleaning

   • Aim to remove harm that possibly occurred (remove germs)

   • Protect oneself from harm

2. Checking

   • Aim to prevent future harm

   • Protect others from harm (Lesser form oneself)

Explain the cognitive behavioural model (combination of two factor theory and salkovskis cog theory)

• Dysfunctional cognitive beliefs lead to salience of intrusive thoughts

• causing anxiety and distress which become conditioned

• Reducing disconmfort via ritualising or avoiding triggers

• These coping mechanisms become negatively reinforced and prevent the opportunity o learn that the stimulus is neutral

• Obsessions & compulsions act as triggers, perpetuating the broken system

What are the mechanisms of change of ERP?

• Behavioural aspect - Extinction learning of the conditioned fear response

• Cognitive element - Patients dysfunctional beliefs are disconfirmed

• Self efficacy factor - Master their fears by not relying on avoidance or rituals

Explain the emotional processing theory regarding ERP and how it occurs

During ERP a competing more easily retrievable fear structure is created

• Within- and between-session habituation of the fear response is the marker of success - critique (inhibitory)

Why is inhibitory better in ERP

Fear tolerance and the acceptance of intrusive thought is favoured over habituation

• The role of expectancy violation

  • Focused on disproving immediate expectations around experiencing obsessional thoughts, uncertainty about fears, anxiety around stimulus confrontation and the ability to tolerate negative states associated with exposure at high intensity and length

So what. is the verdict?

Cognitive techniques target dysfunctional beliefs which are integrated into ERP, which is often called just CBT

• But treatment with or without cognitive elements don’t change results (decrease) but it has efficacy (dependent of the individual)

What is the gold standard for measuring oCD symptoms

Yale brown Obsessive-compulsive scale