Outline and Evaluate 2 Psychological Treatments of OCD

One psychological treatment of OCD is Behavioral Therapy. According to the behavioral explanation of OCD, both obsessions and compulsions have been acquired through conditioning and therefore, in order to recover, patient must unlearn these behaviours. This can happen by Exposure and Response Prevention therapy. ERP therapy aims to provide opportunities for reconditioning and consists of two components. Firstly there is exposure, and in this element, the patient is repeatedly presented with the feared stimulus until anxiety subsides, known as habituation. The exposures move gradually from least to most threatening in manner similar to systematic desensitization. However, If the pace is too slow, patients may lose motivation. The underlying principle of this explanation is that the anxieties persist due to negative reinforcement. ERP aims to break this cycle by forcing the patient to experience the stimulus and learn, through association and relaxation, that it no longer produces anxiety. The second part of the process is Response prevention. The patient is prohibited from engaging in their usual compulsive ritual. This is important in order for the patient to recognize that anxiety can be reduced without the compulsive ritual, this involves the patient being given a list of things that they are not allowed to do. If a patient can control their behaviours then they learn that those obsessions that previously created anxiety no longer produce this response.

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One strength of this treatment is that research has suggested that it is effective. For example, Albucher (1998) reports that between 60 and 90% of adults with OCD have improved considerably using ERP. Research has found that the effectiveness of ERP was improved when integrated with discussions of feared consequences and dysfunctional beliefs i.e. cognitive therapy as found by Huppert and Franklin (2005). They also found that in particular this helped to prevent relapse. This implies that there are high levels of internal validity, and therefore that a casual cause and effect relationship can be established between anxiety and ERP. However, it could be argued that this treatment is not as effective due to the presence of contradictory evidence. Some studies have found that 25-30% of patients begin to drop out due to high levels of anxiety in the exposure phase, while 20% do not benefit at all. Abramowitz identified three key factors in ERP not being totally successful. One factor is that the therapist rather than the patient controls the exposure situation meaning that the patient may not actually be facing the thing that causes them anxiety, but what the therapist thinks is the main issue. Therefore the patient will not feel in control and due to this may have even higher anxiety levels. Due to this, the ERP as a treatment of OCD is weakened due to the presence of contradictory evidence.

It can be said that this treatment is appropriate as it focuses directly on treating the cause of the problem, the obsession itself and therefore does not just treat what is causing the OCD, but also focuses on removing the compulsion therefore breaking the association. In addition this shows the patient that if they do not carry out their compulsion then there are no adverse consequences. However it could be argued that this treatment is not appropriate for all patients as it depends on the commitment of the participants and therefore if they do not want to treat their OCD then they will not find this treatment as appropriate as some other treatments. Therefore, this weakens the reliability of the treatment as consistent results will not be found for all patients.

Another psychological explanation of OCD is cognitive therapy which focuses on changing thoughts, which contrasts behavioral therapies which focus on actions. Cognitive therapies aim to identify, challenge and modify dysfunctional beliefs. Firstly, the therapy tackles obsessions, the therapist questions how patients interpret their beliefs, including why they think they are true and why they think their obsessions developed. These beliefs are then challenged and reinterpreted so the patient never has any activity that causes them anxiety. Then the therapist questions the patient’s value of their compulsion and will help them prove that their belief is false and this in turn helps control the behaviour.

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sydneyhopcroft

27th of Jun 2012

Quality of writing

The Quality of Written Communication (QWC) here is very good. The candidate accurately uses a wide range of speciality terminology and spells them all correctly. There is not much else to say regarding this candidate's QWC as, for the most-part, there are no huge errors that compromise the essay's clarity.

Level of analysis

The Level of Analysis is fair, but I would argue that better strengths and limitations of ERP therapy could be chosen, such as the curing of "abnormal" behaviour being a strength and the ethical issues with deliberately presenting someone with an anxiety-inducing stimulus being the weakness. Simply using the existence of supporting empirical evidence as validation for a study, and the existence of refuting empirical evidence as a weakness does not seem particularly analytical of the studies and the ways they use the ERP and cognitive treatments themselves. Also, I would recommend two strengths and two weakness for each treatment. One strength and one limitation was given for ERP, but a very flimsy evaluation is given for cognitive treatments (none specified - could use SIT) and this is why time management is so crucial to these essay questions. As the candidate has not given sufficient attention to a second theory, they cannot expect to achieve many marks for this part of their answer. This may seem like a tall order given the allotted time but this is why it is important to understand what is meant by the term "Outline" - the amount the candidate has written here is more like the response expected from a "Describe" question and therefore costs them time to complete the question set. "Outline" questions need only about four/five lines of explanation.

Response to question

The candidate has responded well to the question set, and as this question does not require an introduction, it is good to see the candidate attacking the question clearly and precisely within the first paragraph. There is an extensive description of ERP (a behavioural treatment for anxiety disorders like OCD), but some examiners may consider this lengthy description superfluous as the question only asks for an "Outline". Question that ask for an outline do not have to, by default, be as detailed as a question with "Describe" as the command word. This would have left more time to discuss the second treatment (chosen as "Cognitive treatments"), because as it stands, this essay only goes into a sufficient depth on one psychological treatment. Time management is important here - divide time equally between the two theories.

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