Klinische Psychologie Bonus

• disparity between prevalence of ecological emotions & frequency of environmental discussions (two thirds of US americans rarely/ never talk about climate change -> "climate of silence"
• explanations (self silencing / impression managment, pluralistic ignorance/ underetstimating others interest, shared narratives can reduce perceived need to talk, defenses associated with loss/ shame/ guilt/ fear)
• current lack of evidence - based communication formats

Obsession

• recurrent & persistent thoughts, urges, imagies
• Experiences as intrusive / unwanted
• Eöocot unpleasant feelings (anxiety, distress, disgust)
• Individual attempts to ignore/ surpress such thoughts
• Inidivduals neutralize them with some other thought/ action

Compulsions

• Repetitive behaviours (e.g. handwashing, ordering, checking) / mental acts (counting, praxing etc)
• Individual feels driven to perforn in repsone to obsession
• Aimed at preventing/ reducing anxiety/ distress/ dreaded event or situation
• Arent connected in a realisitc way with what they are designed to neutralise/ prevent -> clearly exaggerated

= > obsession/ compulsions are time consuming (> 1h daily) / clinically significant distress/ impairment in social/ occupational/ important areas of functioning

• Checking
• Contamination/ washing
• Obsession
• Symmetry/ ordering

= > often overlapping, content of obsession/ compulsion clusters varies widely

• Lifetime prevalence: 2,3 %
• 12-month prevalence: 1,2%
• (but intrusive thoughts are normal, ca. 90% of healthy individuals have them, and  psychotherapists aren’t always good at distinguishing intrusive thoughts of ocd patients and non-ocd patients)

• Peaks around 11 years
• 25% boys, onset before age of ten
• (late onset: 23 peak)

Beginning: 

• onset usually insidious

Course:

• if untreated ususally chronic
• average duration 9-10 years
• fluctuations in intensity (usually episodic)
• often complicated by comorbidities 

Remission 

• without treatment, remission rate is low (~ 20% of those affefcted)
• when disorder began in childhoog / adolescene, 40% of those affected went into remission in early adulthood

• Only ten % without comorbid disorders
• Anxiety, ADHD, Panic Disorders, Specific Phobia, Tourette Syndrome etc
• Claim: Obsessive-compulsive disorder usually begins (in 80% of cases) after the onset of the comorbid disorder

(y-bocs am besten)

diagnosis often late, av. 12,78 years between first symptoms & diagnosis 

• often starts after comorbidity
• in old DSM 5 as anxiety disorder
• new: its own disorder -> old questionaires aren’t assessing properly anymore
• subscales: washing, obsessing, ordering, checking (neutralising, hoarding)

(e.g. misinterpretation usually you know just cause u have a thought doesn’t mean youre actually gonna do it

• perfectionism (intense need for things to be perfect/ “just right)
• Infalted Sense of Responsibility (Take full responsibility for causing / preventing negative event, Not related in a realistic way to what can be caused / prevented)
• Overestimation of Siginificance of Thoughts/Intrusions (Excessive ascription of meaning to thoughts, Causes subjective need for controlling thoughts)
• Intolerance of Uncertainty (Conviction that complete certainty is absolutely necessary and that such a state is also achievable)

Foundation

• Important basis for successful treatment – here the changeability is shown and the basis for exposure therapy is created

Disorder Model (-> picture)

• Development of the individual disorder model
•  Especially the interplay between obsessive thoughts and compulsive actions and the principle of negative reinforcement
• read picture 1. boxes left to right 2. arrows right to left

Demarcation: voluntary & involuntary

• Especially important for patients with mental neutralisation actions (e.g. good counter thoughts such as “I am a good person)
• Mental actions more voluntary than obsessive thoughts (which are often experienced as involuntary intrusions)

Goal:

• Change of the initial problem view
• Initial: Compulsive actions and consequences are seen as problematic ⬄ but not the misinterpretations behind them (e.g. Overestimation of the danger)
• New: Misinterpretation of dangers is in the focus – these misinterpretations should no longer be regarded as facts

1. Defining problematic situations
2. Planning exposure exercises (situations should be easy to control/ create, clear communication exercise can cause distress/ anxiety but are essential for treatment success, sufficient time should be planned)

Focus on clusters:

• Fusion beliefs (magic, thoughts can actually control)
• Biased attention
• Control of thought
• Inflated responsibility
• Perfectionism
• Overestimation of threat
• Biased cognitive networks
• Intolerance of uncertainty

e.g. focuses on different thought roads like HIV = aids -> to HIV = Heinrich der vierte

=  > offering alternative, new thoughts / ways of thinking

Frequency Range (Hz.): 0.5-3

Mental State (Activation): Deep sleep

Frequency Range (Hz.): 4 - 7

Mental State (Activation): Drowsy wakefulness, relaxation

Frequency Range (Hz.): 8 - 13

Mental State (Activation): Relaxed wakefulness, eyes closed

Frequency Range (Hz.): 14 - 30

Mental State (Activation): Wakefulness, mentally/ physically active, psychological stress

Frequency Range (Hz.): 31 - 60

Mental State (Activation): Special arousal conditions

Wakefulness

Non-REM Sleep Stages 1-4

REM Sleep

alpha & beta activity 

1. Low-amplitude, high-frequency EEG signal (alpha, beta, theta) 5% total sleep time

2. Higher amplitude, lower frequency (sleep spindles & K-complexes ) (K-complexes are stage specific) 20% total sleep time

Slow-Wave-Sleep (SWS), often get summoned up into one stage, 20% total sleep time

3. Appearance of first delta waves (10-50%)

4. Dominance of delta waves (>50%)

• EEG similar to stage 1: high frequency, occasional theta-activity
• High arousal threshold
• Rapid eye movements 
• Muscle atonia / muscular inhibition
• dreams
• 20-25% total sleep time

eye activity

Muscular activity

Cyclic sequence of sleep stages

• Period duration: ~ 90min
• 2 runter zu 4 hoch zu REM
• Non-REM & REM = basic Rest-Activity Cycle (BRAC)
• REM sleep increases towards end of night 
• SWS decreases towards end of the night

• Old
• Hypnotoxin -> produced during wakefulness -> fall alssep
• Reduced during sleep -> wake up

• Being awake disrupts the body‘s homeostasis
• Sleep restores body & brain
• E.g., tissue repair, energy replenishment & memory consolidation
• Pro: every animal sleeps, why make vulnerable if we dont need, however not related to physical size e.g. elephant only needs 3 hours of sleep