WS25/26 Klinische Psychologie Bonus

• 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

• Pathological fear can be reduced by exposure
• Exposure: CS – US associtation is activated, but usually US doesnt happen so CS-noUS association (die andere bleibt schon, CS-noUS muss halt stärker sein)
• wichtig: in unterschiedl. kontext machen damit CS-noUS in mehr situationen aktiviert wird
• theory: strong expectation violation faster learning, aber Gromer at al. (2025) -> es gibt net wirklich nen unterschied nen Tag später

• konditionierung = avoidance -> negative event doesnt happen -> verstärkung (das lässt sich im lab net nachmachen/ übertreffen)
• lack of consistent amygdala activation in human fear conditionine & extinction studys 
• only weak evidence for strategies derived from basics research in clinical (analogue) studies
• animal studies maybe not measure the correct thing: cognitie circuit humans, defensive survival circuit animals

Mental illness diagnosed solely on symptoms (anders als andere Erkrankungen die rein somatisch sind)

Faktoren die interessant sind: Komorbiditäten, Überschnitt diagnostische Kriterien, Heterogenität Patient*innen

= > dsm/ icd diagnosis: entity (existing as itself)/ heuristics: ("good enough" as an approximation)

First phenomenon:

• direct & indirect health consequences for people exoeriencing extreme weather events & envirionmental degradation
• post-traumatic stress, sleeping problems, eco grief, eco anxiety

Second phenomenon: 

• impact on individuals without expereince of high-impact climate change related events
• climate change awareness & environmental concern

(scarce emporocal evidence of prevalence in diff. population groups, evidence-based interventions)

identified pathways: 

• grief associated with physical ecological losses & attendant ways of life & culture
• grief associated with disruptions to enviornmental knowledge systems & resulting feelings of loss &  identity
• grief associated with anticipated future losses 

• change dynamically
• can be contradictive/ conflicting

• 2/3 US americans rarely/ never talk about climate change -> climate of silence
• self silencing, impression manaement, pluralistic ignorance (underestimating others itnerest), shared narratives reduce percieved need to talk, defenses associated with loss/ shame/ guilt/ fear
• current lack of evidence-based communication formats

emotional & mental states associated with heightened awareness of climate change & concurrent distress in face of threatening implications for future

anxiety as key symptom (but theres more emotions)

different descriptions in literature (e.g. form of pre-traumatic stress disorder)

•  Fostering clients’ inner resilience
• Helping clients find social connection and emotional support by joining groups
• Encouraging clients to take action
• Practitioner’s inner work and education
• Connecting clients with nature

• cognitive interventions
• meaning-focused & existential interventions
• emotion-focused interventions
• self-care interventions
• interventions connecting clients with their lyrical self

• joining established groups & organizations
• group rituals
• ecouraging clients to take action (indivudal, collective)

yes

false

false

yes

false

• adaptive value
• competition & status
• territorial defence

• any behaviour aimed at harming a person/ object
• all violence is aggresion, but not all aggression is violent
• intent: involves intention/ perceived intent to hurt someone 
• physical, verbal
• indirect / relatinal (e.g. social exclusion, spreading rumors)

• Emotional, hot-blooded responses to perceived threat or frustration
• Sudden, unplanned, high arousal (e.g., yelling in anger)
• Often linked to fear or threat

• Planned, goal-oriented, and unemotional
• Deliberate and used as a means to an end (e.g., bullying to achieve dominance)
• The person appears calm, controlled, not overtly angry

• Direct bodily harm or property destruction (e.g., hitting, biting, breaking objects)