OBSESSIVE-COMPULSIVE DISORDER
According to the DSM IV , an obsessive-compulsive disorder is one in which the client experience either repetitive thoughts ,images , or impluses or repetitive overt actions that are serve enough tobe time consuming or cause marked distress or significant impairment. Some behavior modifiers distinguish between obsession defined as throughts, image, or impluse that generate anxiety or distress, and compulsions defined as behaviors perfomed to alleviate the distress brought on by the obsessions
The most common tratment for obsessive-compulsive disorder is in vivo exposure and response prevention. Suppose that a client experience obsessive thoughts about germs when touching unwashed objects, which causes considerable anxiety. Suppose further that enganging in variety of compulsive washing rituals appears to be maintained by anxiety reduction. An exposure and response prevention treatment would involve requesting the client to touch particular “contaminated” objects while refraining from performing the washing ritual. As is the case with agoraphobia,in vivo exposure the axiety evoking situations has been found to be superior to imaginal exposure. If the obsessive thoughts concern catastrophes that cannot be presented in vivo however those thoughts imagined exposure. A meta-analysis suggests further that: (a) the combination of in vivo and imaginal exposure is superior to in vivo exposure alone; and (b) exposure directed by therapist is more effective that leaving exposure totally under the control of the client
Regarding cognitive restructuring treatments for obsessive-complusive behaviors,the addition of cognitive components to exposure and response prevention alone. Also,althrough di fferent studies have found different results,the combination of drugs and behavior theraphy has shown little advantage over behavior theraphy alone
TREATMENT
During the 1970 and 1980,cognitive theraphy wa increasingly used as teratment for depression . Some researchers went so far as to conclude the beck’s cognitive theraphy wa the treatment of choice for depression. As indicated in chapter 26,however, in 1989 the NIMH treatment of depression collaborative study came to a different conclusion. Tht research indicated taht beck’s cognitive thearaphy was no more effective than a placebo control condition in the treatment of serve depression.
The occurrence of additive effects when cognitive behavioral theraphy is combined with drugs has also been questioned. Research condclude that’ in the cas of depression, the preferred treatment would be a combination of cognitive behavior theraphy and an anti depressant” drug. Subsequently,however,bellack and hersen,conclude that studies have not consistenly supported the supposed superiority of combined drug treatment and cognitive behavior theraphy over either alone.
Until research convincingly demonstrates the effectiveness and inefffectiveness of various treatments for depression,many practitioners treating this disorder are likely to include most of the following cognitive and behavioral techniques . Evoking and testing automatic thoughts that precede such emotions as anger,sadness,and axienty by attempting to elicit these emotions or having the client recall for imagine situations that elicited them. The client is then encouraged to operationally define situations that celicited them. The client is then oncuraged to operationally define and test the validity of the automatic thoughts through aprocess called reality checking or hypothesis testing.
Identifying and testing maladaptive asssumptions A maladaptive assumption is more general than an automatic througt and is usually not verbalized. Some examples are “ in order to be happy , i must have a wife” and “i’m no body ,if you i dont have a job” maladaptive assumptions can be tested by having the client examine their logic or gather evidence against the assumption,amomg various other ways. Schedullng of activies the client is provided with homework assignments to increase his or her mastery of various activities an to engage in a daily an weekly schedule of rewrding activities. If necessary,the therapist subdivides the activity into graduated segments that the client can readily perform. As we have seen ,research indicates that it would probably be effective to help the client schedule in an exercise program along with his orher other activities .
Cognitive rehearsal the client pictures or imagines each step involved in the completion of particular task . Self rellance and the problem – solving training depressed individuals frequently neglect even such rountine task
Self-Reliance and problems-solving,Depresed individuals frequently neglect even such rountine tasks as showering or bathing,bedmaking ,housecleaning,cooking and shooping. In such cases,homework assignments are directed toward reestablishing these behaviors.
Skills Training The client receives social skills training when thera are social skills deficits,job-seeking training ,when there arae is unemployment-realted depression, and studyskills training when there is academic difficulty.
Role playing and role reversal by acting out their roles in various situations,client learn appropriate overt behavior,automatic thoughts,and emotional behavior in those situations-by acting out the role of others responding to them,clients can test out their automatic thoughts concern ing hoe others see them,which can cause clients to make less servere judgments about themeselves,for example, a client whobelived that store clerks thought she was inept,cahnged this negative view of herself when seh played the role of a sales clerk waiting on her Diversion Techniques
ALCHOL PROBLEMS
Excessive alcohol drinking is a major health problems in america, one that costs the economy bilions of dollars each year in poor job perfomance and absenteeism. Althrough there is considerable diagreement in the alcohol treatment field concerning,defitional question,most agencies indentify three groups: non problem drinkers,problem drinkers,and alcoholics national institute on alcohol abuse .Defintions are further complicated by the DSM IV which distinguishes between subtance abuse and subtance depence. Problems drinkers would likely be adiagnosed as showing subtance and the occurrence of withdrawal symptoms when use of the subtance is stopped or delayed. Behavioral treatment procedures have been quite useful for helping problems drinkers but have shown only modest success with alcoholics
TREATMENT
Behavioral teratment procedures have been quite successful in helping problem drinkers to learn to drink in moderation. A program developed by sobell and sobell teaches problems drinkers to use goal setting to drink in moderation , to control “triggers” for drinking,to learn problem-solving skils to avoid high risk situations,to engage in self monitoring to detect control ing cues and maintaining consequences of drinking behaviors,and to paractice all of these techniques with various homework assignments.
Even through behavioral treatment programs for alcoholics have achived only modest success,the most effective programs have utilized a number of components inculding(a) strategies such as aversive conditioning described in to decrease the reinforcing properties of alcohol (b) program to teach alcoholics new skills to take the place of alcohol abuse,such as social skills to deal with social situations(c)strategis to prevent relapses and(d) contingency management to provide reinforces for work , social, and activiteis that do not in volve alcohol. Even with such multiple component programs,sucess rates across studies vvary termendously. They are influenced by individual’s socioeconomix status , the availability of regular job, the presence or absences of an intact family,and the circle of friends of the alcoholics.
Approximately quarter of american adults are at least 20% above wight. It is considered a problemnot merely because it detracts from one’s phsycial appearance according to the standards of our culture, but also because the obese individual is at increased risk for serious health problems. The causes of obesity are complex and not well understood.
