Report on Shirley's case the three treatments, perspectives offered, and the conclusions one came to after discussing the pros/ cons of each form of therapy.

Psychology Homework Charlene Payne

Report on Shirley’s case the three treatments, perspectives offered, and the conclusions one came to after discussing the pros/ cons of each form of therapy.

Obsessions are recurrent, unwanted and intrusive thoughts or images that the individual feels that they have no voluntary control over. The thoughts experienced are morally repugnant or intensely distressing. The compulsions are the ritualistic actions that the individual feels compelled to perform and repeat many times over. The patient is probably well aware that the compulsive acts are unnecessary. However, they feel that without performing these rituals something dreadful will happen. (In Shirley’s case she may have carried out her obsessive thought.) Obsessions increase anxiety levels and compulsions help to reduce the anxiety levels.

Cognitive Therapy

In our everyday lives, on occasions we may experience unwanted thoughts although we are usually able to dismiss them. In Shirley’s case of obsessive compulsive disorder these thoughts have led her to become unbearably anxious. This anxiety coupled with the compulsion to act upon these thoughts; Shirley has obsessive thoughts about harming her two-year-old son and, believes that if she does not check her son regularly then something disastrous will happen. The compulsive checking is Shirley’s way of reducing her anxiety levels in order for her to cope in dealing with this.

Shirley does show evidence of accompanying negative schema. This is common within obsessive compulsive disorder patients, with their own irrational beliefs about themselves and how others might view them. Shirley’s sense of self-worthlessness is translated in the terms that she believes that she also is capable of harming her child. Shirley believes that this will be the outcome if she does not consistently monitor the health of her son.

The cognitive therapists wish to reduce the level of obsessive compulsive disorder by adopting rational emotive behaviour therapy. This therapy aims to replace the irrational, unreasonable negative beliefs and ideas with more positive and realistic ones. The therapy is carried out with initial relaxation techniques to lower levels of anxiety then treated by encouragement to test her negative sense of self worth. It is the hope and expectation that by cognitive restructuring, Shirley may reassess her sense of self worth. Therefore, she should be able to disassociate herself entirely from individuals who have committed grove acts upon children.

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The cognitive approach is considered by some as being the most effective treatment of obsessive compulsive disorder because it tackles the root cause if the problem, namely the obsessional thoughts rather than the compulsive actions. However, it has a low rate of success and the therapist cannot control the patient’s thoughts. This treatment of obsessive compulsive disorder can be very time consuming.

Behavioural Therapy

Shirley’s persistent checking of her son is maintained in the obsessive-compulsive disorder through negative reinforcement. For Shirley persistent checking of her son is reducing her anxiety and therefore, this compulsive form of behaviour is liable to recur.

Behavioural therapists aim to break the link between the obsessive thoughts which leads to increased anxiety, and consequential compulsion to check her son and reduce anxiety. Behavioural therapists use several methods for the treatment of obsessive compulsion disorder. It is considered that exposure and response prevention is effective in breaking the link between obsessive thoughts and compulsive actions. Exposure and response prevention works by exposing Shirley to some anxiety provoking stimuli. (Perhaps newspaper reports on maltreatment of children.) This should raise Shirley’s anxiety to the level that would normally initiate the compulsive behaviour. Shirley would then be prevented from enacting the compulsive behaviour until her anxiety levels reduced. Without the result of anxiety reduction (or the compulsive behaviour) here being the result of negative reinforcement. With this method the link between obsessive thoughts and compulsive behaviour may be disrupted.

Another method of breaking the link is systematic desensitisation. This involves gradually reducing the anxiety levels in a series of stages. In Shirley’s case the therapist would limit the amount of times Shirley could check on her son (Perhaps with the use of a baby monitor). This method also causes Shirley’s anxiety to peak then eventually reduce.

The most extreme behavioural method is flooding. Although considered as highly unethical today, it was once considered as the most effective form of treatment for obsessive compulsive disorder. However, there is no certainty that Shirley would permit herself to this degree of exposure; and in order for this technique to be effective Shirley must freely comply to not perform the anxiety reducing compulsive behaviour.

Exposure and response prevention technique is the most widely used behavioural technique in the treatment of obsessive compulsive disorder. Exposure and response prevention technique has approximately 50% success rate, which is higher than any other technique. Unlike the cognitive treatments the behaviourist therapists have focused on what is measurable and controllable, namely behaviour. Instead of treating irrational thoughts and emotions which are not measurable. Behavioural treatments will be very effective because it will cause Shirley’s anxiety to peak then reduce, which should consequently break the link between obsessive thoughts and compulsive behaviour.

Behavioural treatments can only be carried out if the patient agrees to undergo the treatment. Patients may be reluctant because they are aware that they will be exposed to a high level of anxiety provoking stimuli. Behavioural therapies do not tackle the root cause of the problem.

(For example: why is Shirley having thoughts about harming her son.)

Biological Treatment

Shirley has no family history of obsessive compulsive disorder. However, she has frequently complained of headaches and dizziness. It would be advantageous to perform a PET scan on Shirley to determine any abnormal activity within the left frontal lobe or the basal ganglia of her brain. Obsessive compulsion disorder is strongly linked to neurological activity in these two areas. It is considered that drugs that directly target neurological activity will provide a reduction on behaviours that are characterised in obsessive compulsion disorder. Obsessive compulsion disorder is associated with low levels of serotonin. Mood is very much implicated in obsessive compulsive disorder so drugs are effective in raising the levels of serotonin which will effect Shirley’s mood. As Shirley’s mood is causing her to question and doubt her own ability as a parent, which leads to anxiety and the compulsive behaviour. Raising Shirley’s levels of serotonin may therefore be beneficial in reducing the moods that lead to obsessional thoughts and consequential compulsive behaviour.

The biological therapists raise levels of serotonin to the brain, which is an attempt at tackling the symptoms of anxiety. However, drugs can only treat the symptoms and not the cause of anxiety. It would also be cause for concern if Shirley’s body developed a tolerance to the intake of these drugs. Eventually she would need a stronger dosage to achieve the same level of anxiety reduction enjoyed previously. Raising serotonin levels can take up to 12 weeks and failure to take her medication would mean that the obsessive-compulsive disorder symptoms would recur.

As a therapist for Shirley’s obsessive compulsive disorder I would recommend a combination of cognitive and behavioural treatments to overcome her disorder. This is because cognitive treatments tackle the cause of the anxiety and behavioural treatments tackle symptoms of the anxiety. I believe that it is unethical to include biological treatments in tackling obsessive compulsive disorder.