Reminders Exam 1 Friday Bring a pencil Bring a single sided sheet of notes typed or handwritten Review session Today 6 PM Herter 231 Key questions What are intrusive thoughts What is OCD and how is it treated What are intrusive thoughts Involuntary thought image urge or idea involuntary thought Can be bizarre or unpleasant Not a reflection of actual impulse desire Even if you haven t gone through that specific experience it can be an Intrusive thoughts in non clinical subjects people who don t have OCD or anxiety related disorder How often do you ever have intrusive thoughts about these things Running car off the road Female 64 and Male 56 Insulting strangers Female 50 and Male 59 Accidentally left heat stove on Female 79 and Male 66 Grabbing money Female 21 and Male 38 Strangers naked Contamination from doors Pink Elephant Experiment Don t think about a pink elephant Most people will think about one within the first minute Since you re told not to think about it you are thinking about it more Actively pushing a thought away is distracting To not think about going through a lot of mental activity which can be very exhausting if you are trying to do it all the time The paradox of thought suppression the more we try to suppress a feeling thought or image the stronger it tends to come back the next time and the more mental energy it takes What is obsessive compulsive disorder OCD Obsessions Intrusive unwanted thoughts images or impulses Highly distressing Attempts to ignore suppress or neutralize Compulsions Repetitive behaviors or mental acts in response to obsessions The person feels driven to perform Associated with a temporary relief when you perform engage with the compulsion The goal is to reduce anxiety distress or prevent a negative outcome Diagnostic Criteria 1 hour per day can take up the entire day Distress and or impairment Variations and individual differences about this some people can work through their ocd and not have it be impairing but others are home bound due to their symptoms Lifetime prevalence 1 3 Obsessions in OCD Can be about anything aggression sexuality religion Symmetry and ordering Contamination Themes around taboo topic What OCD is not I m so OCD Being neat and organized is not considered OCD How does OCD develop Biological Genetics Altered brain circuitry Cognitive Higher frequency of intrusive thoughts Thought action fusion having the thought is as bad as doing it Personal responsibility Certain thoughts are unacceptable Environmental Learning Stressors and or traumatic events Learning that compulsions reduce anxiety negatively reinforcing Researchers have identitified a cricuit of different regions that seem more active in Brain circuitry in OCD indicuduals with oCD Orbital Frontal Cortex Decision Making Input of Stimuli Sends Impulse Filter out irrelevant impulse Receives information Stereotyped Automatic Behaviors Video Living with Pure O An Internal Form of OCD Living with OCD Stimulus driving down the road Thought What if I hit that person Interpret Weird thought but I am not going to do that Emotion Neutral Behavior keep driving Consequence neutral Harm related OCD interpretation I must want to actually hurt someone I am dangerous very threatening to them because that is the last thing they want to do Emotion anxious Behavior compulsion ex going back to check Consequence reduced anxiety The behavior will be reinforced Treatments for OCD Biological treatments CBT Ssri s are commonly prescribed for OCD Antipsychotic medications will be added if the initial dosage of ssris is insufficient 50 80 response rate since medication can be very helpful Exposure and response prevention expose client to obsession or fear without engaging in the compulsion Allows client to see that thoughts themselves are not harmful 60 90 response rate Exposure and response prevention Sample exposure hierarchy Situation Fear level 0 100 Drive over a mannequin 95 100 Drive through busy intersection with pedestrians 85 Drive over speed bump 70 Drive around side streets 60 Drive around parking lot 50 Sit in car while people walk by 30 Summary Intrusive thoughts What OCD is Paradox of thought suppression Obsessions and compulsions Biological cognitive and environmental learning factors Treatment of OCD Medication and exposure and response prevention