2017 Cog characteristics of OCD (2) Behaviourist treat phobias (6)

2017 Cog characteristics of OCD (2) Behaviourist treat phobias (6)
Outline and evaluate failure to function adequately and deviation from ideal mental health as definitions of abnormality. Refer to the experiences of Rob in your answer (16)

2018 Is negative schema score best described as measuring a cognitive, emotional or behavioural characteristic of depression? (1) Draw a suitable graphical display to represent the data in Table 1. Label your graph appropriately. (4) With reference to level of measurement, explain why Spearman’s rho is an appropriate statistical test for this data. (2) Discuss the cognitive approach to treating depression. (16)

Explanation

Aaron Beck Beck suggested that there is a cognitive explanation as to why some people are more vulnerable to depression than others. He suggested three parts to this cognitive vulnerability negative self-schemas Cognitive biases: faulty information processing the negative triad

1. Negative self-schemas
A self-schema is a package of ideas that we have about ourselves People who have become depressed have developed negative self-schemas and therefore they interpret all the information about themselves in a negative way Self-blame schema- feel responsible for all misfortunes Ineptness schema- expect to fail

2. Cognitive biases Faulty Information processing
Beck believed that people who are depressed make fundamental errors in logic Beck proposed that depressed people tend to selectively attend to the negative aspects of a situation and ignore the positive aspects Overgeneralisation- sweeping conclusions drawn on the basis of a single event. For example, a student regarding poor performance on one test as proof of his worthlessness. Catastrophising- exaggerating a minor setback until it becomes a complete disaster. For example, believing that if you make one small mistake at your job, you may get fired.

3. The negative triad Beck built on the idea of maladaptive responses, and suggested that people with depression become trapped in a cycle of negative thoughts They have a tendency to view themselves, the world and the future in pessimistic ways – the triad of impairments Negative view of the self (I am incompetent and undeserving) Negative view of the world (it is a hostile place) Negative view of the future (problems will not disappear, there will always be emotional pain)

Beck’s Model of Depression (1979) ‘The Cognitive Triad’
In depression attributions for negative events are internal, global and stable. Attributions for positive events are external, specific and unstable. Negative view of the self (I am incompetent and undeserving Negative view of the world it is a hostile place Depression Negative view of the future problems will not disappear, there will always be emotional pain Negative Automatic Thoughts Beck built on the idea of maladaptive responses, and suggested that people with depression become trapped in a cycle of negative thoughts Negative view of the self (I am incompetent and undeserving) Negative view of the world (it is a hostile place) Negative view of the future (problems will not disappear, there will always be emotional pain) Attributions are internal or external ( the cause is seen as internal (it’s my fault’, or due to external circumstances beyond their control Attributions can be specific or global, i.e. The cause may be specific to a particular event or apply to all events Attributions can be stable or unstable (the individual consistently makes the same types of attribution, or they can vary over time and situation) In depression attributions for negative events are internal, global and stable. Attributions for positive events are external, specific and unstable. 8

Albert Ellis Ellis proposed that good mental health is the result of rational thinking Ellis argued that there are common irrational beliefs that underlie much depression (poor mental health), and sufferers have based their lives on these beliefs For example: “I must be successful, competent and achieving in everything I do if I am to consider myself worthwhile”

Ellis’ ABC model Ellis suggested that … (A) an Activating Event causes
(B) and individual's Beliefs which results in (C) a Consequence Example: Emma overhears a remark made in class ‘she really gets on my nerves’. It could have referred to anyone but Emma believes that she is unworthy and people don’t want to be friends with her. She withdraws from the friendship group and becomes more and more isolated and depressed. If beliefs are subject to cognitive biases (in the same way as Beck’s) then they can cause irrational thinking which may produce undesirable behaviours. Example: Emma overhears a remark made in class ‘she really gets on my nerves’. It could have referred to anyone but Emma believes that she is unworthy and people don’t want to be friends with her. She withdraws from the friendship group and becomes more and more isolated and depressed.

Undesirable Behaviour
A: Activating event Mary and her boyfriend split up. Rational Thoughts Mary tells herself that although it is a sad situation they were not compatible and she may learn from the experience. Irrational Thoughts Mary tells herself that the break up is her fault and that she is not loveable, and so will always fail at relationships. B: Beliefs (about A) Desirable Emotions Mary feels sad, but is hopeful that she will have successful relationships in the future. Undesirable Emotions Mary feels guilty that she spoilt the relationship and that she is unlovable. Desirable Behaviour Mary looks forward to forming new healthy relationships and tries to learn from her experience. Undesirable Behaviour Mary resolves not to form new relationships as she will only fail and get hurt again. C: Consequences (of B)

Common irrational thoughts
Ellis identified what he saw as the most common faulty beliefs experienced by people with mental health problems. I am worthless unless I am competent at everything I try I must be approved of and loved by everyone I meet My unhappiness is always caused by external events; I cannot control my emotional response It is upsetting when things are not the way I would like them to be Certain people are thoroughly bad and should be severely blamed or punished for it Because something once affected my life, it will do so indefinitely There is always a perfect solution to human problems and it is awful if it is not found I should depend on others who are stronger than I am It easier to avoid difficulties and responsibilities than to face them If something unpleasant happens I should keep dwelling on it

One strength of the cognitive explanation for depression is its application to therapy. The cognitive ideas have been used to develop effective treatments for depression, including Cognitive Behavioural Therapy (CBT) and Rational Emotive Behaviour Therapy (REBT), which was developed from Ellis’s ABC model. These therapies attempt to identify and challenge negative, irrational thoughts and have been successfully used to treat people with depression, providing further support to the cognitive explanation of depression.

However, one weakness of the cognitive approach is that it does not explain the origins of irrational thoughts and most of the research in this area is correlational. Therefore, we are unable to determine if negative, irrational thoughts cause depression, or whether a person’s depression leads to a negative mindset. Therefore, it is possible that other factors, for example genes and neurotransmitters, are the cause of depression and one of the side effects of depression are negative, irrational thoughts.

There are alternative explanations which suggest that depression is a biological condition, caused by genes and neurotransmitters. Research has focused on the role of the neurotransmitter serotonin and found lower levels in patients with depression. In addition, drug therapies, including SSRIs (selective serotonin reuptake inhibiters), which increase the level of serotonin, are found to be effective in the treatment of depression, which provide further support for the role of neurotransmitters, in the development of depression.

Treatments

Cognitive Behavioural Therapy
Cognitive: identify irrational and negative thoughts, which lead to depression. The aim is to replace these negative thoughts with more positive ones. Behavioural: CBT encourages patients to test their beliefs through behavioural experiments and homework. It focuses on the 'here and now' problems and difficulties. Instead of focusing on the causes of distress or symptoms in the past, it looks for ways to improve the state of mind now

Cognitive Behavioural Therapy: AGI
There are two different strands of CBT, based on Beck’s and Ellis’s theories. There are various components to CBT, including: Initial assessment (identify problems) Goal setting (how the patient is going to achieve the goals set) Identifying negative/irrational thoughts and challenging these: Either using Beck’s Cognitive Therapy or Ellis’s REBT Homework CBT is the most commonly used psychological treatment for depression, as well as other mental health problems (e.g. anxiety, panic, phobias, stress, bulimia, OCD, Post-Traumatic Stress Disorder, bipolar disorder, etc.) This is a method for treating mental disorders based on both behavioural and cognitive techniques The therapist aims to make the client aware of the relationship between thought, emotion and actions CBT can help people to change how they think (‘cognitive') and what they do (‘behaviour'). These changes can help them to feel better.

Beck’s cognitive therapy
NEGATIVE TRIAD: Help the patient to identify negative thoughts in relation to themselves, their world and their future, using Beck’s negative triad. The patient and therapist will then work together to challenge these irrational thoughts, by discussing evidence for and against them. The patient will be encourage to test the validity of their negative thoughts and may be set homework, to challenge and test their negative thoughts.

Beck’s Cognitive Therapy Negative triad . Reality testing
The therapist would use a process of reality testing e.g. if the client says, ‘I’m useless, and I always fail’, they will be asked whether in reality, they have been successful at something. The therapist might ask the client to do something to demonstrate their ability to succeed. Clients are made aware of their negative views. In this way, irrational ideas can be replaced with more optimistic and rational beliefs.

REBT Ellis’ Rational Emotive Behaviour Therapy
REBT extends the ABC model to an ABCDE model D = Dispute (challenge the thoughts) E = Effect (see a more beneficial effect on thought and behaviour) Like Beck, the main idea is to challenge irrational thoughts, however, with Ellis’s theory this is achieved through ‘dispute’ (argument).

REBT: how it works? There are different types of dispute which can be used, including: logical dispute – where the therapist questions the logic of a person’s thoughts, for example: ‘does the way you think about that situation make any sense?’ empirical dispute – where the therapists seeks evidence for a person’s thoughts, for example: ‘where is the evidence that your beliefs are true?’ Following a session, the therapist may set their patient homework. The idea is that the patient identifies their own irrational beliefs and then proves them wrong. As a result, their beliefs begin to change. For example, someone who is anxious in social situations may be set a homework assignment to meet a friend for a drink.

Evaluation

How effective is CBT? CBT may not work for the most severe cases
In some cases depression may be so severe that patients cannot motivate themselves to engage in the therapy In these cases, it is possible to treat the patient with antidepressants and then CBT can commence at a later date This is therefore a limitation as it means that CBT cannot be used as the sole treatment in all cases

How effective is CBT? Some patients may want to explore their past
CBT focuses on the ‘here and now’ however there may be links to childhood experiences and current depression and patients might want to talk about these experiences They can find this ‘present-focus’ very frustrating An over-emphasis on cognition There is a risk that in focusing on what is happening in the mind of the individual may end up minimising the importance of the circumstances the individual is living in There is thus an ethical issue for cognitive behavioural therapists here, and it is important for therapists to keep in mind that not all problems are in the mind.

Success may be due to the therapist-patient relationship
How effective is CBT? Success may be due to the therapist-patient relationship Research has shown that there is little difference between CBT and other forms of psychotherapy It may be the quality of the therapist- patient relationship that makes the difference to the success of the treatment rather than the treatment itself Simply having the opportunity to talk to someone who will listen could be what matters most

Implications for the economy
The World Health Organisation (WHO) have predicted that by 2020, depression will be the biggest single disease burden, costly to individuals, families, communities and the economy as a whole through lowered productivity, absenteeism and unemployment Therefore, if psychological research shows that people with a disorder such as depression are less likely to suffer a relapse after having cognitive therapy then, even though cognitive therapy might initially be more expensive than drug therapy, in the long-term it might be more economically sound to offer cognitive therapy as people would have less time off work.

Phobia: Explanation

Explanation Classical conditioning Operant conditioning
May becomes generalised Operant conditioning (negative reinforcement – avoidance becomes reinforcing - becomes resistance to extinction)

Research One strength of the behaviourist explanation of phobias comes from research evidence…Watson & Raynor (1920) demonstrated the process of classical conditioning in the formation of phobias in Little Albert, who was conditioned to fear white rats. This supports the idea that classical conditioning is involved in acquiring phobias. Sue et al (1994) found that people with phobias often recall a specific incident when their phobia appeared e.g. being bitten by a dog or experiencing a panic attack in a social situation. Barlow & Durand (1995) report that 50% of those with specific fear of driving remember a traumatic experience while driving (e.g. an accident) as having caused the onset of the phobia, e.g. some people become intensely afraid of driving a car after a serious accident (associate car with accident)

Practical applications
Another strength of the behaviourist explanation is its application to therapy. The behaviourist ideas have been used to develop effective treatments, including systematic desensitisation and flooding. Systematic desensitisation helps people to unlearn their fears, using the principles of classical conditioning, while flooding prevents people from avoiding their phobias and stops the negative reinforcement from taking place. Consequently, these therapies have been successfully used to treat people with phobias, providing further support to the behaviourist explanation.

Biological preparedness (Seligman)
Seligman argued that animals, including humans, have evolved to be fearful of potentially life-threatening stimuli because having such phobias are adaptive. In our evolutionary past, our ancestors have survived because they have avoided dangerous situations or objects. Therefore, this biological preparedness has been selected into our genes. Ost (1987) notes that many people with severe fears of snakes, germs, aeroplanes & heights have had no particularly unpleasant experiences with any of these objects or situations.

Reductionist However, the behaviourist explanation has been criticised for being reductionist and overly simplistic. The behaviourist approach ignores the role of cognition (thinking) in the formation of phobias and cognitive psychologists suggest that phobias may develop as a result of irrational thinking, not just learning. For example, sufferers of claustrophobia (a fear of confined space) may think: ‘I am going to be trapped in this lift and suffocate’, which is an irrational thought and not taken into consideration in the behaviourist explanation. Furthermore, the cognition approach has also led to the development of cognitive behavioural therapy (CBT), a treatment which is said to be more successful than the behaviourist treatments.

Extra!!! Supporting evidence e.g. Di Nardo et al (1988) 60% of dog phobics reported painful experience with a dog, Watson and Rayner (1920) Little Albert. Numerous lab studies show that fear reactions can be easily conditioned in animals It is possible to decondition phobias (flooding and systematic desensitisation) Individual differences - Not everybody who experiences a traumatic event goes on to develop a phobia Some fears develop gradually and can’t be traced back to a specific conditioning incident Some people have a phobia of something they have never come in to contact with so how can it be learnt?! Reductionist – ignores other factors e.g. thought processes, genetics, evolution Poor ecological validity – the evidence is largely lab based Nature/Nurture – only account for nurture and ignores nature ( behavior is more likely to be a combination of both)

Phobia: treatment

Systematic desensitisation
Systematic desensitisation uses reverse counter-conditioning to unlearn the maladaptive response to a situation or object, by eliciting another response (relaxation). These are the critical components to systematic desensitisation: Fear/Anxiety hierarchy Relaxation training (meditation, breathing techniques) Exposure to phobic stimulus Reciprocal inhibition Firstly, the client and therapist work together to develop a fear hierarchy, where they rank the phobic situation from least to most terrifying. For example:

Thereafter, an individual is taught relaxation techniques, for example breathing techniques, muscle relaxation strategies, or mental imagery techniques. The final component of systematic desensitisation involves exposing the patient to their phobic situation, while relaxed. According to systematic desensitisation, two emotional states cannot exist at the same time, a theory known as reciprocal inhibition. A person is unable to be anxious and relaxed at the same time and the relaxation should overtake the fear. The patient starts at the bottom of the fear hierarchy and when the patient can remain relaxed in the presence of the stimulus, they gradually progress onto the next level. The patient gradually moves their way up the hierarchy until they are completely relaxed in the most feared situation; at this point systematic desensitisation is successful.

Flooding Extreme behavioural therapy is flooding.
Rather than exposing a person to their phobic stimulus gradually, a person is exposed to the most frightening situation immediately. With flooding, a person is unable to avoid (negatively reinforce) their phobia and through continuous exposure, anxiety levels decrease. In classical conditioning terms it leads to extinction or the phobic stimulus becomes exhausted Flooding can take one of two forms: in vivo (actual exposure) in vitro (imaginary exposure) A patient is taught relaxation techniques and these techniques are then applied to the most feared situation either through direct exposure, or imagined exposure.

Evaluation: research One strength of systematic desensitisation comes from research evidence which demonstrates the effectiveness of this treatment for phobias. McGrath et al. (1990) found that 75% of patients with phobias were successfully treated using systematic desensitisation, when using in vivo techniques (see below). This shows that systematic desensitisation is effective in treating phobias. Gilroy et al. (2002) examined 42 patients with arachnophobia (fear of spiders). Each patient was treated using three 45-minute systematic desensitisation sessions. When examine three months and 33 months later, the systematic desensitisation group were less fearful than a control group (who were only taught relaxation techniques). This provides further support for systematic desensitisation, as a long-term treatment for phobias.

Comparison: Flooding Systematic desensitisation it provides a cost effective treatment for phobias. It is significantly quickly cost effective for health service providers. Although flooding is considered a cost effective solution, it is highly traumatic for patients and causes a high level of anxiety. Although patients provide informed consent, many do not complete their treatment because the experience is too stressful and therefore flooding is sometimes a waste of time and money, if patients do not finish their therapy. . Appropriate for younger children/individuals with learning disabilities Lower rates of refusal/attrition.

Not beneficial to treat all phobias
However, systematic desensitisation is not effect in treating all phobias. Patients with phobias which have not developed through a personal experience (classical conditioning) for example, a fear of heights, are not effectively treated using systematic desensitisation. Some psychologists believe that certain phobias, like heights, have an evolutionary survival benefit and are not the result of personal experience, but the result of evolution. These phobias highlight a limitation of systematic desensitisation which is ineffective in treating evolutionary phobias. Finally, although flooding is highly effective for simple (specific) phobias, the treatment is less effective for other types of phobia, including social phobia and agoraphobia. Some psychologists suggest that social phobias are caused by irrational thinking and are not caused by an unpleasant experiences (or learning through classical conditioning). Therefore, more complex phobias cannot be treated by behaviourist treatments and may be more responsive to other forms of treatment, for example cognitive behavioural therapy (CBT), which treats the irrational thinking.

Explanation

Polygenic – 230 genes (different variations – different types of OCD)
Genetic explanations include • Specific gene markers eg, COMT gene, SERT gene. • Looking for gene markers that might have been inherited – such as gene Polygenic – 230 genes (different variations – different types of OCD) A second gene which has been implicated in OCD is the SERT gene (also known as the 5-HTT gene). The SERT gene is linked to the neurotransmitter serotonin and affects the transport of the serotonin (hence SERotonin Transporter), causing lower levels of serotonin which is also associated with OCD (and depression) The COMT gene is associated with the production and regulation of the neurotransmitter dopamine (motivation, reward, compulsion). One variation of the COMT gene results in higher levels of dopamine and this variation is more common in patients with OCD, in comparison to people without OCD.

neurophysiological cause
The orbital-frontal cortex (OFC) is the part of the brain that notices when something is wrong. For example, when the OFC registers that there is dirt nearby, it sends a 'worry' signal to the thalamus. The thalamus directs signals from many parts of the brain to places that can interpret them - in this case back to the OFC. These nerve cell connections form a loop in the brain. The caudate nucleus lies between the OFC and the thalamus and regulates signals sent between them.

Thalamus  cleaning, checking and other safety behaviour
The OFC is part of a brain circuit which includes the basal ganglia (caudate nuclei) and converts sensory information in to thoughts. It also Initiates activity after receiving an impulse and stops activity once impulse lessens. OCD patients have high levels of activity in their orbital frontal cortex resulting in difficulty in switching off or ignoring impulses. (Seretonin plays a part in preventing repetition of task - a lack of serotonin would therefore prevent the ability to inhibit the repetition of tasks…. So repetition would occur) Caudate nuclei are areas in the basal ganglia that filter messages coming from the OFC before passing important ones to other parts of the brain (thalamus). (dopamine is the main neurotransmitter in basal ganglia and high levels can lead to over activity) The hypersensitivity of the basal ganglia gives a rise to the repetitive motor behaviours seen in OCD, for example, repetitive washing/cleaning/checking. Thalamus  cleaning, checking and other safety behaviour – low levels of serotonin associated with anxiety; high levels of dopamine linked to compulsive behaviour / stereotypical movements. Physiological explanation - basal ganglia in the brain responsible for psychomotor functions, hypersensitivity of the basal ganglia may result in repetitive movements; linked to abnormality / excessive activity in the orbital frontal cortex as a result of being removed too quickly before it has transmitted its signal)

When the thalamus receives a 'worry' signal, it becomes excited and sends strong signals back through the loop to the OFC, which interprets them. Normally, the caudate nucleus acts like the brake pedal on a car, suppressing the original 'worry' signals sent by the OFC to the thalamus. This prevents the thalamus from becoming hyperactive. But in OCD, the caudate nucleus is thought to be damaged, so it cannot suppress signals from the OFC, allowing the thalamus to become over-excited. If this occurs, the thalamus sends strong signals back to the OFC, which responds by increasing compulsive behaviour and anxiety. This could explain the repetitive and seemingly senseless rituals performed by obsessive- compulsives

Possible evaluation points
The findings from neural explanations are problematic as drugs used to affect serotonin such as SSRIs may decrease the symptom but that does not mean that an imbalance of serotonin was he cause in the first place. Improvement rates from use of drugs are only at 50% so there must be other causes. There is a time delay in which drugs affect levels of serotonin within hours / immediately but the effect on OCD may take up to weeks. Some research into brain structure has suggested the involvement of structural abnormalities such as dysfunction in the neuronal loop/lower grey matter density in people with OCD. Neurophysiological factors are not consistent with specific areas/circuits in the brain being implicated. Sometimes evidence relates only to one aspect of the disorder – the compulsions rather than the obsessions. Findings from family studies could be explained by shared environments as well as shared genes by SLT.

Research Hu (2006) compared serotonin activity in 169 OCD sufferers and 253 non-sufferers, finding serotonin levels to be lower in the OCD patients. Zohar et al (1987) gave mCPP (a drug that reduces serotonin levels) to 12 OCD patients and 20 non-OCD control participants, finding that symptoms of OCD were significantly enhanced in the OCD patients. Menzies (2007) found an association between ability to stop a repetitive task and a decrease in grey matter in the orbital frontal cortex in participants with OCD Lewis (1936) examined patients with OCD and found that 37% of the patients with OCD had parents with the disorder and 21% had siblings who suffered. Research from family studies, like Lewis, provide support for a genetic explanation to OCD, although it does not rule out other (environmental) factors playing a role. Further support for the biological explanation of OCD comes from twin studies which have provided strong evidence for a genetic link. Nestadt et al. (2010) conducted a review of previous twin studies examining OCD. They found that 68% of identical twins and 31% of non-identical twins experience OCD, which suggests a very strong genetic component.

Issue and debate Nature vs. Nurture Biological reductionism
Not 100% Concordance rates Environmental factors Diathesis stress model offers a more complete explanation Biological reductionism There is consistent evidence for genetic factors Ignore the complexity of the disorder e.g. cognitive characteristics. Does not offer a whole explanation Hard determinism Behaviour is controlled by internal factors. Neurotransmitters/genes led to successful treatments (targeting low levels of serotonin (SSRI’s)

Treatments

The biological explanation suggests that OCD is the result of low levels of the serotonin in the brain. SSRIs (selective serotonin re-uptake inhibitors) are one type of anti-depressant drug, which include drugs like Prozac. When serotonin is released from the pre-synaptic cell into the synapse, it travels to the receptor sites on the post-synaptic neuron. Serotonin which is not absorbed into the post-synaptic neuron is reabsorbed into the sending cell (the pre-synaptic neuron). SSRIs increase the level of serotonin available in the synapse by preventing it from being reabsorbed into the sending cell. This increases level of serotonin in the synapse and results in more serotonin being received by the receiving cell (post-synaptic neuron). Anti-depressants (like anti-anxiety drugs) improve mood and reduce anxiety which is experienced by patients with OCD.

Alternatives to SSRIs Where an SSRI is not effective after three to four months the dose can be increased or it can be combined with other drugs Patients respond differently to different drugs and sometimes alternatives work well for some people and not at all for others Fluoxetine-a type of SSRI Tricyclics - have the same affect as SSRI’s but have much worst side effects so only used if the above do not work. SNRI’s- newly developed anti depressant that increase serotonin and noradrenaline.

Soomro et al. (2008) conducted a review of the research examining the effectiveness of SSRIs and found that SSRIs were more effective than placebos in the treatment of OCD, in 17 different trials. This supports the use of biological treatments, especially SSRIs, for OCD. Another strength of biological treatments is their cost. Biological treatments, including antidepressants and anti-anxiety drugs, are relatively cost effective in comparison to psychological treatments, like cognitive behavioural therapy (CBT). Consequently, many doctors prefer the use of drugs over psychological treatments, as they are a cost effective solution for treating OCD (and depression), which is beneficial for health service providers. Extension: In addition, psychological treatments like CBT require a patient to be motivated. Drugs however are non- disruptive and can simply be taken until the symptoms subside. As a result, drugs are likely to be more successful for patients who lack motivation to complete intense psychological treatments. However, one weakness of drug treatments for OCD is the possible side effects of drugs like SSRIs and BZs. Although evidence suggests that SSRIs are effective in treating OCD, some patients experience mild side effects like indigestion, while other might experience more serious side effects like hallucinations, erection problems and raised blood pressure. BZs are renowned for being highly addictive and can also cause increased aggression and long-term memory impairments. As a result, BZs are usually only prescribed for short-term treatment. Consequently, these side effect diminish the effectiveness of drug treatments, as patients will often stop taking medication if they experience these side effects. Finally, drug treatments are criticised for treating the symptoms of the disorder and not the cause. Although SSRIs work by increasing the levels of serotonin in the brain, which reduces anxiety and alleviates the symptoms of OCD, it does not treat the underlying cause of OCD. Furthermore, once a patient stops taking the drug, they are prone to relapse, suggesting that psychological treatments may be more effective, as a long-term solution

Evaluations Drug therapy is effective at tackling OCD symptoms
There is clear research to suggest that SSRIs are effective in reducing the severity of OCD symptoms (Soomro: 2009) SSRI’s significiantly reduce symptoms in around 70% of patients (Sansone 2011). This means that alternative treatments are needed for the remaining 30%. Drugs are cost-effective and non-disruptive Drug treatments are cheap in comparison to psychological treatments and, unlike psychotherapy, they are non-disruptive to patients’ lives Drugs can have side-effects Although the use of drugs is effective for most, a significant minority receive no benefit and/or may suffer side-effects: weight gain, dry mouth, sexual dysfunction and loss of memory. Coming off a drug is a slow process in which the dosage has to be gradually reduced over a period of six months – risk of relapse.

Evaluations Unreliable evidence for drug treatments
If drug companies sponsor the research they may decide to supress any results that do not support the drug they are marketing. Currently many drug companies do not publish all of their results and may indeed be supressing evidence. This suggests that the data on the effectiveness of drugs may not be trustworthy. Some cases of OCD follow trauma Although OCD is widely believed to be biological in origin, it is also accepted that OCD can have different causes. There is a case for proposing that cases of OCD where there is no family history of OCD, but there is a relevant life event, should be treated differently from those where there is a family history and no trauma. It may be that for these cases drugs are not appropriate.

2017 Cog characteristics of OCD (2) Behaviourist treat phobias (6)

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