2. The example of Depression
• Symptoms of Depression
• Why is someone depressed?
• Situational?
• Due to Parenting?
• Due to biological deficits?
• Due to Interpersonal Problems?
• Due to thinking problems?
3. E.g. of Violence
• Why are some people violent
• Washington D.C. murders: Why did he
kill?
• Psychopathology (Aspergers?
Schizophrenia?)
• Is aggression a natural part of human
nature?
• Biological Deficit?
4. Violence, cont.
• Is violence learned (Bandura=vicarious
learning)
• Psychodynamic (violence=catharsis)
• Is Violence due to irrational, illogical ideas
(cognitive)
5. Why use Theory
• Theory Provides a systematic way of
examining behavior (road map)
• Contains certain elements:
• Parsimony
• Internal Consistency
• Testability
• Empirical Support
6. Challenge Question
• Think of your own mood level or anxiety
level. What is your anxiety level on a 0-8
scale? What is your mood level? Why?
• Do you see your mood as linked to daily
events?
• Do you see your mood as linked to current
stressors?
• Do you see your mood linked to biology?
7. Panic
• Panic Attack vs. Panic Disorder
• Subsumed by the Anxiety Disorders
(PTSD, GAD, SP, PD, OCD)
• Biological: Autonomic Activity
• Psychological: Stressors
• GAD as precursor
9. What is a cured patient?
• Case of Smoking Cessation
• Threats to blind in any study (what is
blind?)
10. Breaking Down Panic
• Lang’s 3-system model of emotion:
Cognitive Behavioral Physio
I’m going to die Call E.R. HR, sweat
11. Panic Attack Scenario I: 1st
a
behavior
Run for the bus (behavior) HR increases
(phsiological) “Something’s wrong with
me” (cognitive) Further increase in HR,
Sweat, Dizziness”I’m really a mess”
Walk’s home (Behavior)”I can’t even go
to work” (mood drops)
12. Panic Attack Scenario II: 1st
a
physiological event
Nausea from eating bad food (physio)
“There is something wrong with me”
(cognitive) HR, BP, sweat, dizziness,
tingling (physio) “I’m seriously ill”
(cognitive misinterpretation) Further
exacerbation of physical sensations
(physiological) ER visit or call to doctor
for serious medical problem (behavior)
13. Tx follows 3-system analysis
• Enter each system
• Cognitive: Education about panic;
cognitive therapy
• Behavior: Exposure to panic situations;
avoid avoiding
• Physiological: BRT (Breathing Re-
training), Deep Muscle Relaxation;
Interoceptive Exposure
14. Delivery
• CBT delivered in 12 weekly sessions
• Follow-up important
• Compares well with meds (slightly more
effective)
• Combined meds and CBT most effective
• Theoretical issues (e.g., attribution
problems with meds)
15. CBT for Panic: Details
• Education: The Nature of Anxiety; The
Biology of Anxiety; Common Myths (cardio
disease, MVP, schizophrenia)
• Relaxation (BRT; Deep Muscle
Relaxation)
• Cognitive therapy: a) for panic and b) for
gen. anxiety
• De-catastropizing vs. Probability analysis
16. CBT Details (cont.)
• Interoceptive Exposure:
1. Review Concept
2. Ratings for Intensity of sensations 0-8
3. Ratings for Intensity of Anxiety 0-8
4. Repeat trials until extinction of anxiety
5. Need for Booster sessions
17. Challenge Question
• Tolerating anxiety related discomfort:
Have we become a culture of worriers who
can’t tolerate a bit of autonomic arousal?
Or, are these legitimate problems?
18. OCD
• One of most debilitating of AD’s
• 1-3% prevalence
• Strong Biological Issue: Orbital prefrontal
cortex and caudate nucleus shows
abnormal activity
• These areas repaired by successful meds
and Behavioral treatment
19. Other support for Bio Model
• Response to SSRI’s
• Marijuana increase OCD
• Encephalitis outbreaks (Robin Williams in
Awakenings) related to increased OCD
• OCD vs. other medical illnesses (e.g.,
diabetes)
• OCD and Tourette’s
• PANDAS http://en.wikipedia.org/wiki/PANDAS
20. More bio theories
• Mixed data on genetic studies
• One twin study shows 65% concordance
rate but some studies show no elevation in
1st
degree relatives
• Murphy et al (1997) and Swedo, et al
(1997) showed that a genetic marker for
rheumatic fever linked to increased
childhood OCD
23. Treatment
• Exposure with Response Prevention
• Based on tension reduction model
• Systematic nature of treatment
• Use of sig. others as coaches
• Treatment effectiveness (80-90%)
• Meds tx (60-75%) with SSRI’s
• Combined treatment
24. Co-morbidity
• Table 1: The Distribution of Symptom Scores of 910 Participants Meeting
• Full Screen Criteria for OCD
• Type I: THOSE WHO MET CRITERIA FOR OCD ONLY
• Anxiety Problem N %
• OCD only 65 7.1
• Type II: OCD AND ONE ADDITIONAL ANXIETY PROBLEM
• OCD + GAD 163 17.9
• OCD + PD 16 1.8
• OCD + PTSD 5 0.5
• OCD + SP 19 2.1
• Type III: OCD AND TWO ADDITIONAL ANXIETY PROBLEMS
• OCD + SP + GAD 116 12.7
• OCD + PD + GAD 145 15.9
• OCD + GAD + PTSD 21 2.3
• OCD + PD + SP 12 1.3
• OCD + PD + PTSD 3 0.3
• OCD + SP + PTSD 0 0.0
• Type IV: OCD AND THREE ADDITIONAL ANXIETY PROBLEMS
• OCD + PD + GAD + SP 200 22.0
• OCD + PD + GAD + PTSD 38 4.2
• OCD + GAD + SP + PTSD 20 2.2
• OCD + PD + SP + PTSD 5 0.5
• Type V: OCD AND FOUR ADDITIONAL ANXIETY PROBLEMS
• OCD + PD + GAD + SP + PTSD 82 9.0
• Key: OCD=Obsessive-Compulsive Disorder; GAD=Generalized Anxiety Disorder; PD=Panic Disorder; SP=Social Phobia; PTSD=Post-
Traumatic Stress Disorder
25. Ego Syntonic vs. Ego Dystonic
• Do you believe that your symptoms are
senseless or not?
• Case of Sarah: Describe
• Other case examples (how do we treat?)
• Use of hierarchies
• Use of sig. others as coaches
• Avoid involvement with rituals
26. Tx implications for Comorbid OCD
• OCD/GAD- differentiating obsession from
excessive worry (Cog. Therapy vs.
thought stopping)
• OCD/panic differentiating OCD fear from
panic fear (response blocking vs. cog.
Therapy
• OCD plus PTSD (more difficult to tx?)
27. Challenge for OCD
Think of repetitive behaviors in your own life.
What are they? What purpose do they
serve? How would you go about bringing
them under control?
Or, think of repetitive behaviors in a friend or
loved one? Answer the same questions
above.
