Psychology Chapter on Exposure Therapy and OCD

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Questions and Answers

Under what condition do tricyclic antidepressants have an effect?

In patients with generalized anxiety disorder

Only when OCD is comorbid with depression (correct)

When used alone without any other treatments

During exposure therapy sessions

What should be considered as a second-line pharmacological treatment after not responding to at least two SSRIs?

Paroxetine

Sertraline

Fluoxetine

Clomipramine (correct)

Which treatment is considered a last resort for OCD?

Cognitive Behavioral Therapy

Neurosurgery (correct)

Pharmacological treatments

Standard psychotherapy

What does the inhibitory learning model suggest about fear associations during exposure therapy?

They develop a new inhibitory learning alongside the original association Signup and view all the answers

What evidence is there regarding cingulotomy as a treatment for OCD?

There is evidence of some symptom improvement Signup and view all the answers

How does the amygdala behave during fear conditioning and extinction learning?

It is inhibited by the medial PFC during extinction learning Signup and view all the answers

What can cause conditioned fear to return after exposure therapy?

Changing the context between extinction and retest Signup and view all the answers

What is one potential risk after undergoing exposure therapy?

Spontaneous recovery of conditioned fear Signup and view all the answers

What can cause conditioned fear to return after extinction?

Adverse events encountered in anxiety-inducing contexts Signup and view all the answers

What is a key characteristic of individuals with anxiety disorders regarding exposure therapy?

They often experience deficits in inhibitory learning and processing Signup and view all the answers

Which of the following best describes the difference between habituation-based models and inhibitory learning models in exposure therapy?

Habituation models emphasize fear reduction; inhibitory models do not Signup and view all the answers

What is the role of expectancy violation in exposure therapy?

It focuses on designing exposures that contradict expectations of outcomes Signup and view all the answers

What factor does NOT significantly influence fear expressed at follow-up assessments?

The level of fear experienced at the end of exposure Signup and view all the answers

What happens during rapid reacquisition of conditioned responses (CR)?

It happens if the conditioned stimulus-unconditioned stimulus pairing is repeated Signup and view all the answers

What is a common outcome for people who do not respond well to exposure-based therapies?

They frequently experience a return of their fears afterwards Signup and view all the answers

Which strategy can help optimize inhibitory learning during exposure therapy?

Maximizing violation of expectations with exposure designs Signup and view all the answers

What is deepened extinction primarily aimed at achieving?

Facilitating memory consolidation after exposure. Signup and view all the answers

How does occasional reinforced extinction enhance treatment outcomes?

By introducing unexpected CS presentations. Signup and view all the answers

What effect does the removal of safety signals have during exposure therapy?

It decreases reliance on safety behaviors. Signup and view all the answers

What is variability in exposure therapy meant to accomplish?

Enhance retention of learned non-emotional material. Signup and view all the answers

Which scenario best exemplifies deepened extinction for panic disorder and agoraphobia?

Shopping in a crowded mall while consuming coffee. Signup and view all the answers

What is the primary focus of the expectancy violation model in exposure therapy?

Violating the patient's conscious expectations for aversive events Signup and view all the answers

Why is the occasional reinforcement during extinction training beneficial?

It contributes to an expectancy violation effect. Signup and view all the answers

How does the approach of interoceptive conditioning differ from standard exposure therapy?

It stops when the expectation of an aversive outcome is low Signup and view all the answers

What approach is commonly agreed upon regarding safety behaviors in exposure therapy?

Immediate removal is preferred if the client agrees. Signup and view all the answers

What is the result of cognitive interventions prior to exposure in the expectancy violation model?

They may reduce the effectiveness of inhibitory learning Signup and view all the answers

What is a potential consequence of maintaining safety signals during exposure therapy?

Increased expectation of the unconditional stimulus. Signup and view all the answers

In the context of social anxiety, how should a patient frame their predictions regarding expected outcomes?

To predict specific negative events like rejection Signup and view all the answers

What does the expectancy violation model state about the attention during exposure?

Attention must focus on both the conditioned stimulus and the non-occurrence of the unconditioned stimulus Signup and view all the answers

What does the study suggest about the duration of exposure in relation to learning outcomes?

One trial of exposure can yield similar benefits as repeated trials Signup and view all the answers

How does the gradual exposure technique in the expectancy violation model function?

By gradually increasing the length of exposure while maintaining expected discomfort Signup and view all the answers

How should patients consolidate learning after each exposure trial?

By reflecting on what they learned from the trial outcomes Signup and view all the answers

What is the primary purpose of the sentence paradigm used to induce TAF?

To measure emotional responses to hypothetical situations Signup and view all the answers

How is TAF related to responsibility for harm?

TAF is a consequence of inflated feelings of responsibility Signup and view all the answers

What might a participant believe about a negative event after experiencing TAF?

Their intrusive thoughts increase the likelihood of the event Signup and view all the answers

Which of the following best describes the relationship between TAF and obsessional complaints?

Likelihood TAF is significantly related to obsessional psychopathology Signup and view all the answers

What is a unique feature of moral TAF as it relates to clinical samples?

It is more commonly associated with depression than OCD Signup and view all the answers

What statistical correlation was observed in the study regarding TAF and event probability?

A moderate correlation (r = 0.6) was identified Signup and view all the answers

In recent cognitive models, how is TAF characterized?

As one condition among many for catastrophic interpretation of thoughts Signup and view all the answers

Which factor has been found to correlate with moral TAF?

Religiosity and its psychological implications Signup and view all the answers

What factor structure is considered optimal for TAF in clinical samples?

2-factor structure Signup and view all the answers

Which disorder is NOT mentioned as being associated with Moral TAF?

Bipolar Disorder Signup and view all the answers

Which belief is specifically NOT reported as being common among OCD patients?

Believing that positive thoughts can influence outcomes Signup and view all the answers

What has been found about the prevalence of TAF in individuals with Generalized Anxiety Disorder (GAD)?

Many people with GAD believe that worrying prevents harm Signup and view all the answers

What is implied about the role of TAF in the treatment of OCD?

TAF may decrease with successful treatment even if not targeted Signup and view all the answers

What statement reflects a possible misconception about TAF?

TAF is a phenomenon seen only in psychopathology Signup and view all the answers

Based on the evidence, what can be said about the specific type of TAF related to positive outcomes?

There is no evidence supporting its commonality in OCD Signup and view all the answers

In which specific case might TAF need to be addressed in treatment?

When patients are resistant to standard interventions Signup and view all the answers

Study Notes

Obsessive-Compulsive Disorder (OCD)

OCD is a disorder characterized by obsessions (disturbing, intrusive thoughts) or compulsions (ritualistic behaviors) or both.
Common obsessions include harming oneself or others, contamination fears, accidents, or unacceptable sexual thoughts.
Doubting, indecision, and a need for order can lead to compulsive behaviors like checking, washing, hoarding, and arranging objects in a specific way.
Compulsions are performed to reduce anxiety stemming from obsessions.
Ritualistic compulsions are often excessive or unreasonable.
Magical thinking often links obsessions and compulsions: belief that certain rituals prevent harm.
OCD rituals are usually stereotyped and rigid, often with concern over performing behaviors correctly.

DSM-5 Criteria for OCD

Obsessions: Recurrent, unwanted thoughts, urges, or images that cause significant anxiety or distress. Individuals try to ignore or suppress these thoughts.
Compulsions: Repetitive behaviors (e.g., hand washing, checking) or mental acts (e.g., praying, counting) performed in response to an obsession or according to rigid rules. These behaviors aim to prevent distress or a dreaded event. Actions are usually not realistically connected to the feared outcome and are excessive.

Symptoms and Subtypes

Symptom onset is usually gradual in adolescence or adulthood following a stressful event.
Obsessions can center on themes like sex, violence, or religion.
Common OCD subtypes include:
- Early-onset
- Hoarding
- "Just right."
- Tic-related (current or past history of tic disorder)
- Scrupulosity (religious or moral obsessions)
High rates of comorbidity often occur with OCD, particularly with other anxiety disorders, mood disorders, ADHD, and body dysmorphic disorder.

Diagnosis and Prevalence

OCD symptoms are often a common manifestation of anxiety in childhood.
The lifetime prevalence of OCD is about 2.5%.
Women are slightly more often affected than men.
Cultural factors can influence expression and type of OCD (e.g., obsessions in certain cultures might be aggressive or religious).

Body Dysmorphic Disorder (BDD): Preoccupation with perceived flaws in physical appearance, even when not apparent to others. This preoccupation leads to repeated appearance-checking and grooming behaviors.
Hoarding Disorder: Persistent difficulty discarding or parting with possessions, regardless of their value or actual need. Leads to a cluttered living space.

Etiology of OCD

OCD likely has a strong genetic component.
Some neurological structures and pathways (e.g., frontal lobes, basal ganglia, and thalamus) implicated in OCD.
Deficits in inhibitory learning and inhibitory neural processes may contribute to both poor response and the development of excessive fear and anxiety in OCD.
Dysfunction in the serotonin system may play a role.
Psychosocial factors (e.g., previous life events, or current social circumstances, such as relationship problems) may influence onset and expression.

Treatment

Exposure and Response Prevention (ERP) is a common and often effective behavioral therapy. This involves facing the feared obsessions or situations, and not engaging in the associated compulsions.
Cognitive Behavioral Therapy (CBT) is also often used, aiming to identify and challenge dysfunctional thoughts and beliefs.
Medications such as selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed, and other second-line medications that can be useful in combination with therapy.
Neurosurgery is reserved as a last-resort option for severe, treatment-resistant cases.

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Description

This quiz explores key concepts related to exposure therapy and obsessive-compulsive disorder (OCD). It covers treatment options, the mechanisms of fear conditioning, and evidence-based therapeutic approaches. Test your understanding of effective strategies and risks associated with exposure therapy.