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At university you are asked to write a lot of Essays. In year one, I was asked to discuss Treatment options for Obsessive-Compulsive Disorder. This is the Essay I came up with and it was graded B. I hope this helps anyone trying to learn about OCD and what is available to help with this.
Discuss different psychological approaches and their treatments of Obsessive-Compulsive Disorder
When looking treatments for Obsessive compulsive disorder (OCD) we can approach the treatment from different psychological fields. Firstly we need to understand what obsessive-compulsive disorder is.
OCD is classified as an anxiety disorder and defined as the presence of obsessions, compulsions, or both. Obsessions are defined as persistent thoughts that are intruding. Compulsions are repetitive or ritualistic behaviours, such as washing hands, counting or ordering. These are carried out to relieve anxiety caused by the obsessive thought (American Psychiatric Association., 2013).
Throughout this discussion, this essay will explore the Behaviourist approach to OCD by discussing behaviourist treatments and utilising information of studies carried out by Foa et al (McLeod, 1997). Focus will also be given to the Cognitive theory and their treatment, Cognitive Behavioural Therapy (CBT). This will be done using the case study of Karen Rusa (Oltmanns, Neale and Davison, 1995). To conclude, there will be an evaluation showing why CBT is the most effective method for treatment for OCD.
Skinner (1948) argues that obsessive fears cause anxiety which are reduced using compulsive behaviours. These behaviours are maintained through this negative reinforcement (McLeod, 1997). As Behaviourists do not see these behaviours as symptoms of another issue, only behaviours are treated because they are seen as the key issues. (Gleitman, Gross, and Reisberg, 2011., Schacter, Gilbert, Wegner, and Hood, 2011).
There are several studies which support the Classical conditioning method of Exposure and Response Prevention (ERP). Using ERP, Behaviourists aim to break the connection between the obsessive fear and the anxiety it causes through exposure. They also concentrate on breaking the habit of the performance of compulsive rituals after the exposure through response prevention. (Foa et al 1985., McLeod 1997). This entails the client being exposed, to what they fear, for instance, a ‘contaminated’ vase, then being delayed or prevented from washing their hands. This treatment shows effectiveness amongst patients who suffer from contamination, counting or checking rituals but cannot be generalised to other forms of OCD (Ball et al 1996., McLeod 1997).
Ost (1989) reviewed seven cases in which 85% of patients retained improvements after ERP treatment. Nine further studies by O’Sullivan and Marks (1991) showed improvements maintained from between one and six years. Follow up findings continue to report improvement at 79% which strongly supports this treatment. (McLeod, 1997). Keister et al (1994) however, stated that most often the documentation did not account for patients who discontinued treatment, when these were considered the success rate dropped to between 40%-50% (McLeod, 1997).
The Cognitive approach to this condition not only focuses on behaviours but on the thought process behind these. Becks argues that when in a state of depression/anxiety the patient has an unrealistic way of thinking. They think themselves as useless, their experiences as terrible and their future as being worse. Becks Calls this the ‘Negative Triad’ (Sammons, 2011) also known as dysfunctional beliefs. These beliefs inflate the patients perceptions of responsibility and they believe that they can stop negative outcomes (Olatunji, Rosenfield, Tart, Cottraux, Powers and Smits, 2013). This theory also states that the individual controls their own thoughts and that abnormality occurs when that control is faulty in some way (Williamson, Cardwell and Flanagan, 2007). This faulty control is dealt with by working on these dysfunctional beliefs.
In the Case of Karen Ruso, she had put many rituals in place. Shopping became difficult because of numbering rituals. Smoking was also transformed into a number ritual as she had to smoke one cigarette for each child, one after the other, to prevent harm coming to them. Karen had a strong religious emphasis within her life. It was noted that Karen no longer attended church as they had updated things and this horrified her, as she thought these modern changes were disrespectful. Her four children constantly misbehaved. Her husband was out of work due to illness, and was quite demanding of her; ie: asking her to get beers from the refrigerator as he was not supposed to walk far. Karen admitted that things had not been going well and that her situation was stressful (Oltmanns et al., 1995). She felt unhappy with her life but did not make the connection between her beliefs, rituals and current situation. The demands from her husband and children had caused a lack of assertiveness. The loss of her church routine impacted on Karen's confidence. It was apparent that the rituals were Karens way of maintaining some form of ‘faulty ‘control over her situation (Oltmanns et al., 1995). Treatment began by developing assertiveness to deal with the family. Karen kept a diary to log all situations where she needed to be assertive. She was challenged to write down (dysfunctional) thoughts of what would happen if she was assertive and further challenged to test these thoughts. She was asked to visit traditional churches, she joined one and gained more confidence. (Oltmanns et al., 1995). When Karen felt confident, she began the next stage of therapy, ERP. She was exposed to an obsession (cigarette) but the compulsive ritual was delayed. (Oltmanns et al., 1995). This removed the ‘faulty control’ by only allowing her one cigarette. By the end of Karen’s treatment her family life had improved and the rituals were minimal with little anxiety.
CBT is widely accepted as the most effective treatments for OCD (Taylor, Thordarson, Spring, Yeh, Corcoran, Eugster and Tisshaw, 2003). Dysfunctional thinking may cause the patient to perceive the treatment as confirmation that they are incapable of improvement. It is apparent however, from Karens case, that by dealing with this dysfunctional thought process as the priority, you can then deal with the faulty control of the rituals with more optimism from the patient. This can be done during the behavioural aspect of the treatment with less likelihood that patients will discontinue the treatment before completion.
The behaviourist treatment alone, is harsh and abrupt. Behaviour is the key focus and puts the patient under immediate pressure as they are exposed to their fears. There is no mental preparation for the patient and the focus is solely on the behaviours. As evidenced by the CBT Karen received, the behaviours treated during ERP are highly unlikely to have been the cause of her OCD. Alone, ERP can make the patient feel out of control causing patients to discontinue treatment prematurely and success rates to drop as evidenced by Keister. Although Behaviourism does acknowledge fear is the obsession, they see this as a learned behaviour rather than a thought process. This leaves a gap in the theory causing a lack of insight into the root cause of the patients form of OCD.
In conclusion CBT provides the insight needed to get to the root cause of the issue. This treatment can support the patient on different levels because it focuses on giving ‘true’ control back to the patient through correction of dysfunctional beliefs, followed by Behavioural therapy to correct faulty control methods such as rituals. The treatment of dysfunctional beliefs also helps to prepare the patient as treatment moves forward. This makes the transition into ERP smoother as the patients beliefs are more logical and overall anxiety is lessened, as evidenced clearly in Karens treatment.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders American Psychiatric Association. Arlington: American Psychiatric Publishing.
Gleitman, H., Gross, J. and Reisberg, D. (2011).Psychology. New York: W. W. Norton & Co..
McLeod, D. (1997). Psychosocial treatment of obsessive-compulsive disorder. International Review of Psychiatry, 9 (1), pp. 119--132.
Oltmanns, T., Neale, J. and Davison, G. (1995). Case studies in abnormal psychology. New York [etc.]: Wiley.
Olatunji, B., Rosenfield, D., Tart, C., Cottraux, J., Powers, M. and Smits, J. (2013). Behavioral versus cognitive treatment of obsessive-compulsive disorder: An examination of outcome and mediators of change.. Journal of consulting and clinical psychology, 81 (3), p. 415.
Sammons, A. (2011). Beck’s Cognitive Theory of Depression. [online] Retrieved from: http://www.psychlotron.org.uk/resources/abnormal/a2_aqa_abnormal_moodcognitivebeck.pdf [Accessed: 11 Nov 2013].
Schacter, D., Gilbert, D., Wegner, D. and Hood, B. (2011). Psychology. Basingstoke: Palgrave Macmillan.
Taylor, S., Thordarson, D., Spring, T., Yeh, A., Corcoran, K., Eugster, K. and Tisshaw, C. (2003). Telephone-administered cognitive behavior therapy for obsessive-compulsive disorder. Cognitive Behaviour Therapy, 32 (1), pp. 13--25.
Williamson, M., Cardwell, M. and Flanagan, C. (2007). Higher psychology. Cheltenham: Nelson Thornes.
Sunday, 3 April 2016
It is widely accepted that social beliefs and judgements influence how people feel and how they behave (Myers, Abell, Kolstad & Sani, 2010). It is through the study of social belief and judgements that the question of teachers expectations, influencing pupil performance has been researched since the 1940's. There are two main focus areas to this question; why a teacher has these expectations and who these expectations may or may not, effect. In this essay, these two areas will be discussed, and evidence will be provided for this argument. A summary will then conclude this discussion.
The reasoning behind expectations is not always logical. Consequently, expectations can be incorrect. Attractiveness of a child is evidenced as a factor in this field. Results from a study regarding attractiveness found that attractive children were afforded significantly favourable treatment than children classed as unattractive (Langlois, Kalakanis, Rubenstein, Larson, Hallam, & Smoot, 2000). Mathematics ability was used in a study by Robinson-Cimpian, Lubienski, Ganley and Copur-Gencturk, (2014) to evaluate what factors influence teacher expectations. The focus of this study was gender. Data was taken from the Early childhood longitudinal study ECLS and perceptions of boys and girls mathematical aptitude were evaluated. It was found that Boys are afforded a higher expectation in mathematics than girls. Furthermore, Madon, Jussim, & Eccles, (1997) discuss the conceptual model with the following as reasons for expectations, previous grades, previous test scores, motivation, self-esteem, attractiveness, demographics, personality and home life.
Langlois, Ritter, Roggman and Vaughn (1991) argue that expectations of teachers do influence pupils performance because of teacher interactions and facial expressions. Myers et al., (2010) state that when a teacher has higher expectations of a pupil they look, smile, nod and interact with that pupil more. In contrast to this, a videotaped experiment recorded various teachers discussing something. Ten seconds of the discussion was played back to viewers, with or without audio. Consequently, viewers showed an expectancy detection effect as they recognised, by the teachers facial expression, whether it was a good or poor student being discussed (Babad, Bernieri, & Rosenthal, 1991). In a study completed by (Montague & Walker-Andrews, 2001), it was evidenced that infants understand the emotion expressed in the face. Furthermore, they often match their emotions to other people's emotions based on the facial expressions. It is, therefore, supported that children of pre-school upwards can in-fact calculate what expectations the teacher has for them and other pupils.
The self-fulfilling prophecy (SFP), (Rosenthal & Jacobson, 1968) also support that expectations do influence performance. The Pygmalion in the classroom study is a good example of SFP and has stood the test of time. Rosenthal (1968) stated that "the self-fulfilling prophecy was in evidence primarily at [younger years] the lower grade levels. This prophecy has since been re-examined in several contexts now giving it much more depth. Madon & Jussim (1997) studied naturally occurring SFP to examine whether positive or negative expectations produced more powerful SFP. Their research model assumed that the teacher expectations would influence performance. With this in mind, they investigated, using different contexts as follows; do high or low expectations produce more powerful SFP; do expectations that match targets self-conception...provide a more powerful SFP; are targets of low self-concept more susceptible to SFP; Are low achievers more susceptible to SFP? The key question they were asking overall, was which expectation, and in which situation made the biggest influence on performance. Their study found that low achievers were much more vulnerable to SFP. Although this cannot be generalised, the SFP is supported within the low achievers group.
Bohlmann & Weinstein (2013) created a more advanced study, putting the classroom into the context. Other contexts were evaluated however the key focus was on highly differentiated classrooms and low differentiated classrooms. They took teacher ratings of students and self-reported student ratings. It was found that in 'highly differentiated' classrooms the low achiever, student rating matched the teacher expectation, however in 'low differentiated' classes it was not significant. It was also found that in 'highly differentiated' classrooms Teacher expectation did match the pupils actual performance in mathematics although, again, it did not occur as often in 'low differentiated' classroom environments. In support of the SFP, Again, the low achievers are highly influenced by teacher expectations, suffice to add that this is only in high differentiated environments.
Moreover, a longitudinal study also supports that low achievers are influenced. Using Reading, writing and verbal communication abilities as a tool to evaluate the influence of expectations, data was taken from ten sites within the National Institute of Child Care and Human Development (NICHD). The meta-analysis demonstrated that academic achievement in high school is influenced by teachers, high or low, misinterpretations (expectations) in first grade. These teachers expectations of abilities were found to influence students. Consequently, vulnerable pupils, including pupils from low-status backgrounds, low achievers and minority students, for up to ten years (Sorhagen, 2013). Sorhagen did, however, state that parents expectations may also play a part in performance.
To conclude, when looking at reasoning behind teacher expectations, these study's imply that factors out with the student's control recurrently influence these misjudgements. Therefore, leading to these expectations. Reasoning behind teacher expectations needs to be included and evaluated when investigating this area as they do support sorhagens' statement regarding teacher expectations being misinterpretations. Furthermore student performance results, must take into account outside factors such as environment, self-esteem, ability, academic level, age, and parent expectations (Langlois et al., 2000; Robinson-Cimpian et al., 2014; Madon & Jussim, 1997). Only then can it be clarified if the sole responsibility for performance is influenced by teacher expectation.
In saying this, It is however abundantly clear that Teachers expectations do have an influence on student performance. This does, however, seem highly focused around more vulnerable pupils such as minority groups, low-income pupils and younger children. It is also extremely visible when looking at the results from these studies; that low achievers are impacted greatly in many of these studies.
Babad, E., Bernieri, F., & Rosenthal, R. (1991). Students as Judges of Teachers' Verbal and Nonverbal Behavior. American Educational Research Journal, 28(1), 211-234.
Bohlmann, N., & Weinstein, R. (2013). Classroom context, teacher expectations, and cognitive level: Predicting children's math ability judgments. Journal Of Applied Developmental Psychology, 34(6), 288-298.
Langlois, J., Ritter, J., Roggman, L., & Vaughn, L. (1991). Facial diversity and infant preferences for attractive faces. Developmental Psychology, 27(1), 79-84.
Langlois, J., Kalakanis, L., Rubenstein, A., Larson, A., Hallam, M., & Smoot, M. (2000). Maxims or myths of beauty? A meta-analytic and theoretical review. Psychological Bulletin, 126(3), 390-423.
Madon, S., Jussim, L., & Eccles, J. (1997). In search of the powerful self-fulfilling prophecy. Journal Of Personality And Social Psychology, 72(4), 791-809.
Myers, D., Abell, J., Kolstad, A., & Sani, F. (2010). Attitudes and behaviour. Jacobs, N. Rotherham, J. (1st Ed) Social psychology (pp. 146-155). Maidenhead: McGraw-Hill.
Robinson-Cimpian, J., Lubienski, S., Ganley, C., & Copur-Gencturk, Y. (2014). Teachers' perceptions of students' mathematics proficiency may exacerbate early gender gaps in achievement. Developmental Psychology, 50(4), 1262-1281.
Rosenthal, R., & Jacobson, L. (1968). Pygmalion in the classroom. The Urban Review, 3(1), 16-20.
Sorhagen, N. (2013). Early teacher expectations disproportionately affect poor children's high school performance. Journal Of Educational Psychology, 105(2), 465-477.
Montague, D., & Walker-Andrews, A. (2001). Peekaboo: A new look at infants' perception of emotion expressions. Developmental Psychology, 37(6), 826-838.