This is a magazine about addiction and compulsions.
This bundle contians all sorts of information about addiction and compulsions.
In this bundle, you can find information about pyschiatrical disorders and clinical psychology.
This is a video about trauma and addiction from the youtube series 'crash course'
A (really) quick overview of how our neurological reward system works in combination with drugs.
This is a video about eating and body dysmorphic disorders from the youtube series 'crash course'
This might help you with studying for PCHP (IBP) or PKG (Psychologie)
Anxiety and mood disorders 
This is a magazine about anxiety and mood disorders
Addictions and compulsions 
This is a magazine about addiction and compulsions.
Personality disorders 
Personality disorders are pervasive, persistent and pathological personality structures. In this magazine, information is given about the personality disorders, the current theories and a bit about how to treat a personality disorder.
What are the ten personality disorders?
How do personality disorders come to be and how do you treat them?
Post-traumatic stress disorder 
This is a bundle about Post-traumatic stress disorder. In this bundle, it is described how post-traumatic stress disorder is diagnosed and some theoretical background.
Verslavingsgedrag van DSM-IV naar DSM-5 - samenvatting van een artikel van van den Bink (2014)
Verslavingsgedrag van DSM-IV naar DSM-5
Van den Brink, W. (2014).
Tijdschrift voor psychiatrie, 56(3), 206-210
Introductie
Van immoreel gedrag naar afhankelijkheidssyndroom
In de DSM-I en DSM-II werden alcoholisme en drugsverslaving opgenomen als subcategorie van sociopathische persoonlijkheidsstoornis. Hiermee werd verslaving gezien als immoreel gedrag op basis van een ernstige persoonlijkheidsstoornis. Verslaving werd in de DSM-III voor het eerst een aparte categorie. Hier werd een onderscheid gemaakt tussen misbruik en afhankelijkheid van psycho-actieve midellen. In de DSM-III-R werd aansluiting gezicht bij het alcoholafhankelijkheidssyndroom, waarbij er onderscheid werd gemaakt in mate van afhankelijkheid.
In de DSM-IV bleef het onderscheid tussen misbruik en afhankelijkheid ongeveer gelijk. Er werd ook onderscheid gemaakt tussen vroege en langdurige remissie.
Pathologisch gokken
Vanaf de DSM-III was er sprake van een diagnostische categorie ‘pathologisch gokken’. Hier ging het voornamelijk om de onmogelijkheid om de impuls om te gokken te weerstaan en om financiële en juridische gevolgen.
De belangrijkste veranderingen van de DSM-5 ten opzichte van de DSM-IV zijn: de samenvoeging van de DSM-IV stoornissen in en door het gebruik van middelen en de DSM-IV diagnose pathologisch gokken werd één DSM-5 categorie ‘verslaving en stoornissen door het gebruik van middelen’, en de samenvoeging van DSM-IV diagnosen ‘misbruik’ en ‘afhankelijkheid’ tot één DSM-5 diagnose ‘stoornissen in het gebruik van middelen’. Deze heeft de niveaus beperkt, matig en ernstig.
Samenvoeging stoornissen in het gebruik van middelen en pathologisch gokken
Deze samenvoeging kwam doordat deze stoornissen fenomenologisch grote overlap vertonen, veel samen voorkomen, er sprake is van een gedeelde genetische kwetsbaarheid en doordat beide stoornissen gekenmerkt worden door vergelijkbare hersenfunctiestoornissen. Ook blijken interventies die effectief zijn bij de behandeling van stoornissen in het gebruik van middelen in veel gevallen effectief bij het behandeling van pathologisch gokken.
Naast de herplaatsing werden er ook enkele veranderingen aangebracht in de criteria. Het criterium ‘illegale activiteiten’ werd verwijderd, de drempel voor het stellen van de diagnose werd verlaagd van 5/10 tot 4/9, en er moest voldaan worden aan een periode van 1 jaar.
Samenvoeging van DSM-IV stoornissen misbruik en afhankelijkheid tot nieuwe DSM-5 stoornis in het gebruik van middelen
De belangrijkste redenen voor deze verandering zijn: 1) de betrouwbaarheid en validiteit van de DSM-IV diagnose misbruik werd algemeen als onvoldoende beoordeeld en voor een deel toegeschreven aan de hiërarchische relatie tussen misbruik en afhankelijkheid. 2) De definitie van een syndroom waarbij in principe één criterium hoeft worden voldaan, werd als ongewenst beschouwd. 3) Uit psychometrisch onderzoek was naar voren gekomen dat de diagnostische criteria voor misbruik en afhankelijkheid waarschijnlijk deel uitmaken van één onderliggende verslavingsdimensie, waarbij sommige criteria van de stoornis misbruik en ernstiger deel van de dimensie vertegenwoordigen dan sommige criteria van de stoornis afhankelijkheid. 4)
.....read more Addiction is a brain disease, and it matters - summary of an article by Leshner (1997)Addiction is a brain disease, and it matters
Leshner, A. I (1997)
Science, 278
Drug addiction is a chronic, relapsing disease that results from the prolonged effects of drugs on the brain. Addiction has embedded behavioural and social-context aspects that are important parts of the disorder itself. Therefore, the most effective treatment approaches will include biological, behavioural, and social-context components.
Scientists have identified neural circuits that subsume the actions of every known drug of abuse, and they have specified common pathways that are affected by almost all drugs. They have also identified and cloned the major receptors for virtually every abusable drug, as well as the natural ligands for most of those receptors. Research has begun to reveal major differences between the brains of addicted and non-addicted individuals and to indicate some common elements of addiction.
Drug abuse is a dual-edged health issue, as well as a social issue. It affects both the health of the individual and the health of the public. Drug use, directly or indirectly, is a major vector for the transmission of many serious infectious diseases. Because of this, we must include in our overall strategies a committed public health approach, including extensive education and prevention efforts, treatment, and research.
It doesn’t matter what physical withdrawal symptoms, if any, occur. Many of the most addicting and dangerous drugs do not produce severe physical symptoms upon withdrawal.
What matters is whether or not a drug causes the essence of addiction, compulsive drug seeking and use, even in the face of negative health and social consequences. These behaviours are the elements responsible for the massive health and social problems that drug addiction brings in its wake. The treatment should be directed to this.
Virtually all drugs of abuse have common effects, either directly or indirectly, on a single pathway deep within the brain. This is the mesolimbic reward system.
Acute drug use modify brain function in critical ways. Prolonged drug use causes pervasive changes in brain function that persist long after
.....read more Drug addiction as incentive sensitization - summary of an article by Berridge & Robinson (2011)Drug addiction as incentive sensitization
Berridge, K. C., & Robinson, T. E. (2011).
Addiction and responsibility, 21-54. The MIT Press.
Addiction refers specifically to a pathological and arguably compulsive pattern of drug-seeking and drug-taking behaviour, which occupies an inordinate amount of an individual’s time and thoughts, and persists despite adverse consequences. Addicts find it difficult to quit taking drugs, even when they express a strong desire to do so. If they manage to abstain, addicts remain highly vulnerable to relapse for long periods of time.
Drugs themselves can change the brains of susceptible individuals in complex ways. These drug-induced changes contribute to the transition to addiction. Some of these changes, especially those related to mesolimbic sensitization, are very persistent and far outlast other changes associated with tolerance and withdrawal.
Drug-induced changes in the brain alter a number of different psychological processes in parallel, contributing to multiple symptoms of addiction. The incentive-sensitization theory of addiction holds that the most important of these psychological changes is a persistent ‘sensitization’ or hypersensitivity to the incentive motivation effects of drugs and drug-associated stimuli. Incentive sensitization produces a bias of attentional processing toward drug-associated stimuli and a pathological motivation of drug themselves.
An addictive drug is a stimulus that both potently activates the mesolimbic brain system and initiates neurobiological events that enduringly sensitize that system. The intensified ‘wanting’ for drugs is not matched by an intensification of ‘liking’ for the same drugs. This dissociation occurs because brain ‘liking’ mechanisms are somewhat separable from ‘wanting’ mechanisms, even for the same reward.
After sensitization of brain mesolimbic systems, excessive ‘wanting’ can be triggered by drug-associated cues or their mental representations. When combined with impaired executive control over behaviour, perhaps due to drug-induced prefrontal cortex dysfunction, incentive sensitization culminates in the core symptoms of addiction.
Incentive sensitization refers to particular neurobiological changes in brain mesolimbic dopamine systems and in related structures belonging to the same larger brain circuit that mediate the psychological function of incentive salience (wanting). Sensitization is associated with an increase in the ability of drugs to elevate dopamine neurotransmission in brain regions that receive dopamine inputs, and with changes in the physical structure of neurons in the dopamine-related circuits. It
.....read more Control of behaviour by competing learning systems - summary of chapter 11 of The Wiley Handbook of cognitive control The Wiley Handbook of cognitive control
Chapter 11
Control of behaviour by competing learning systems
Most of us struggle sometimes to control our behaviour. Habit learning may play a role in this ‘intention-behaviour’ gap.
A dual-system theory of action control holds that these learning processes sometimes compete, but also cooperate, to control action.
The term goal-directed actions refers to instrumental behaviours that are only performed when one has a certain goal and believes that this behaviour will increase the likelihood of reaching that goal.
Instrumental behaviours are learned as a consequence of a causal relationship between the action or response (R) and its outcome (O), as opposed to being controlled purely by predictive Pavlovian relationships between environmental stimuli (S) and the outcome. Once the instrumental status of behaviour has been established, we need to assess whether it meets the belief and desire criteria of goal-directed action. The belief criterion stipulates that goal-directed actions are mediated by knowledge of the causal action-outcome relationship. The desire criterion holds that goal-directed actions are only executed when the outcome is currently desirable, they need to constitute a goal.
When a goal-directed action is repeatedly performed, it can gradually turn into a habit, which is triggered by contextual stimuli, even when the consequences are no longer valuable.
Thorndike proposed that the experience of reward following an instrumental response leads to the strengthening of a mental association between contextual stimuli (S) and the response (R). On future occasions, the context will directly activate the response through the S-R association. The omission of a dreaded aversive event may also act to strengthen the S-R link. The occurrence of an aversive outcome should weaken the S-R association.
The difference between habits and goal-directed actions is that only in the latter case the performance is mediated by knowledge of the R à O relationship and an evaluation of the anticipated outcome in light of one’s current motivation. Habits are mediated by S-R links. They are ‘behaviourally autonomous’ of the current desirability of the outcome.
Habits are considered to have adaptive value. They can be executed fast in an efficient manner. By freeing up other cognitive resources, habit formation allows us to attend to other important matters.
Frequent repetition leads to a shift from goal-directed control towards habit. Habits are
.....read more Controleverlies - samenvatting van hoofdstuk 13 van Handboek verslavingHandboek verslaving
Hoofdstuk 13
Controleverlies
Verlies van controle is een belangrijk kenmerk van verslavingsgedrag. Controleverlies betekent het onvermogen om weerstand te bieden aan de zucht tot gebruik, en het verder gebruiken ondanks de negatieve gevolgen.
Verslavingsgedrag kan begrepen worden als het eindresultaat van twee grote pathogenetische dimensies. Dit zijn de neurobiologische mechanismen die verantwoordelijk zijn voor een overmatige waarde die gehecht wordt aan het gebruik van middelen en aan gebruiks-gerelateerde stimul, en de neurobiologische processen die een rol spelen bij het, deels bewust, onder controle houden van een impuls tot actie.
Verslaving wordt beschreven als een chronische stoornis waarbij er, naast een overmatige waarde die gehecht wordt aan het gebruik, tegelijkertijd sprake is van een stoornis in de top-downreguleringsmechanismen.
Op gedragsniveau kan impulsiviteit omschreven worden als een waaier van veelal onaangepast gedrag. Dit kan zijn: een onvermogen om een onaangepaste (re)actie te onderdrukken, een onvermogen om uit te stellen of rekening te houden met langetermijngevolgen van gedrag, een verandering in de tijdsbeleving, of het volharden in gedrag ondanks negatieve gevolgen. Impulsieve mensen hebben moeite om hun respons te inhiberen, hebben een voorkeur voor directe beloningen en hebben moeilijkheden om negatieve gevolgen of mislukkingen te leren vermijden.
Impulsiviteit als een persoonlijkheidskenmerk kan gemeten worden aan de hand van vragenlijsten.
Verschillende auteurs wijzen erop dat impulsiviteit op te vatten is als een construct met meerdere dimensies, elk met hun eigen kenmerken en met verschillende onderliggende neuro-anatomische circuits en cognitieve processen. Impulsief gedrag is dan het resultaat van stoornissen in een of meerder zelfregulatiemechanismen die een rol spelen in het geheel van zelfcontrole.
Een model
Verschillende cognitieve functies spelen een rol bij de zelfcontrole over het gedrag. Twee hoofddimensies hiervan zijn: 1) Het niveau van impulscontrole, in het bijzonder de mate waarin motorische responsen en perceptuele responsen kunnen worden onderdrukt. 2) Besluitvorming, vooral die functies die een rol spelen bij het afwegen van, of het maken van keuzen die betrekking hebben op beloningen. Errormonitoring vind plaats op een lagere cognitieve dimensie. Dit is het kunnen opsporen van ‘fouten’ of ‘afwijkingen’ lijkt vooraf te gaan aan de keten van cognitieve responsen die uiteindelijk leidt tot het toelaten of inhiberen van een respons. Dit is vereenvoudigd.
Errormonitoring
Het interne cognitieve systeem dat fouten of afwijkingen signaleert op de
.....read more Klinische interventies - samenvatting van hoofdstuk 2 van alcohol en drugsverslavingAlcohol en drugsverslaving
Hoofdstuk 2
Klinische interventies
Aanvankelijk stelden gedragsmodellen dat middelenmisbruik gedrag is dat wordt aangeleerd en in stand gehouden door klassieke en operante conditionering. Moderne cognitief-gedragstherapeutische modellen benadrukken hoe belangrijk cognities en gevoelens zijn die voorafgaan aan het gebruik en deze sturen, hoewel ze erkennen dat middelenmisbruik een genetische component kan hebben.
Vanuit een cogniefgedragstherapeutisch gezichtspunt wordt middelenmisbruik en – afhankelijkheid gedefinieerd als een aangeleerde, verkeerde, niet-effectieve methode om te proberen om te gaan met de spanningen van alledag. Deze verkeerde manier van omgaan met spanningen wordt veroorzaakt door interne en externe prikkels, en wordt bekrachtigd door positieve beloning en/of vermijding van negatieve consequenties.
Bij de behandeling legt de cognitieve gedragstherapie de nadruk op het oplossen van tekorten in vaardigheden. Er worden verschillende technieken gebruikt om de patiënt te leren om risicovolle situaties te signaleren en hier adequaat mee om te gaan. Dit is het aanleren van nieuwe technieken en vaardigheden om met het probleemgedrag en –cognities om te gaan en om deze verminderen met behulp van modelling, gedragsoefening en huiswerk.
Impliciet wordt bij cognitieve gedragstherapie verondersteld dat de patiënt gemotiveerd is, er zijn geen strategieën om motivatie op te bouwen. De therapeut probeert dysfunctionele cognities te identificeren en aan te passen en leert hij specifiek copinggedrag aan.
Functieanalyse
Functie- of gedragsanalyse is een gestructureerde manier om uitlokkende factoren en consequenties van probleemgedrag in kaart te brengen. Het is een hypothetisch model over het probleemgedrag. Het wordt gebruikt om behandeldoelen op te stellen en om het soort en de volgorde van de te gebruiken interventies te kiezen, en het is een flexibel werkmodel, dat tijdens de behandeling kan worden aangepast als informatie over nieuwe belangrijke uitlokkers of consequenties opduikt, of als behandelinterventies niet genoeg invloed hebben.
Vermijden van uitlokkende factoren versus leren ermee om te gaan
In het algemeen zijn er twee belangrijke strategieën die zich richten op de factoren die aan probleemgedrag voorafgaan. 1) Patiënten kunnen proberen om uitlokkende factoren te vermijden, dit is over het algemeen eenvoudiger, maar niet alle risicovolle situaties kunnen vermeden worden. 2) Patiënten kunnen leren anders om te gaan met risicovolle situaties, dit vergt tijd.
Omgaan met trek
Bijna alle patiënten ervaren trek in reactie op het veranderen van hun drank- en drugsgebruik, dit is nauw verbonden met terugval en vaak verontrustend voor patiënten.
Trek kan al vroeg in de behandeling aangepakt worden door de patiënt te informeren over het fenomeen trek, vertekende overtuigingen met betrekking tot trek aan te pakken, en/ of nieuwe copingsvaardigheden om met trek om te gaan aan te leren.
Er
.....read more Interventies in de cognitieve gedragstherapie van problematisch middelengebruik en gokken - samenvatting van hoofdstuk 2 uit Handboek cognitieve gedragstherapie bij middelengebruik en gokkenHandboek cognitieve gedragstherapie bij middelengebruik en gokken
Hoofdstuk 2
Interventies in de cognitieve gedragstherapie van problematisch middelengebruik en gokken
Cognitieve gedragstherapie (CGT) helpt mensen met problematisch middelengebruik door het identificeren van de functies die middelengebruik of het gokken heeft en de wijze van gebruik. Op grond hiervan richt CGT zich op het aanleren van vaardigheden waarmee die functies kunnen worden veranderd en het gebruik kan worden verminderd of gestopt.
Inleiding
Het laten uitvoeren van registraties vormt doorgaans het vertrekpunt van de cognitieve gedragstherapeutische behandeling van verslaving. Het gaat hier om het registreren van twee specifieke momenten. Dit zijn het gebruik van middelen of het gokgedrag en de aandrang (trek) om te gaan gebruiken.
Gedurende de behandeling houdt de cliënt bij wanneer, onder welke omstandigheden, en in welke mate het gebruik of de trek zich voordoen. Hiermee komen risicosituaties in beeld waarop de interventies zijn af te stemmen. Dit bied ook de mogelijkheid om te evalueren of de behandeling het juiste effect oplevert.
Theoretische beschouwing
Observeren en registreren is nodig om inzicht te krijgen in de externe en interne variabelen die het problematische middelengebruik uitlokken en in stand houden. Dit zijn stimuli.
Volgens het klassieke of Pavloviaanse leerparadigma hebben dergelijke stimuli betekenis verworven doordat zij herhaaldelijk in samenhang met de inname van het middel zijn voorgekomen. De associatie die hierdoor ontstaat maakt dat de stimuli na verloop van tijd het gebruik van het middel doen voorspellen of aan het gebruik doen denken. Het wordt een factor die de persoon als het warde doet voorbereiden op het gebruik.
Volgens het operante paradigma is het gebruik aangeleerd gedrag doordat het geassocieerd wordt met gunstige uitkomsten. Het gedrag veroorzaakt iets aangenaams of doet iets onaangenaams verdwijnen of niet optreden. De bekrachtiging vindt voor iedere cliënt plaats in een specifieke context. In deze belonende context wordt de registratieopdracht in kaart gebracht.
Het registreren brengt de variabelen in kaart die een bepaalde associatie hebben met het middelengebruik.
De cognitieve gedragstherapie bestaat uit interventies gericht op het aanleren van nieuwe associaties waardoor de oorspronkelijke associaties hun kracht verliezen.
Doelen
Het primaire doel van de registratieopdracht is om de aangrijpingspunten in kaart te brengen voor de daaropvolgende interventies. Daarnaast biedt de registratieopdracht de mogelijkheid om te evalueren of de interventies aanslaan en of de cliënt nog gemotiveerd is om zich hiervoor in te zetten. Het is ook bedoeld om zelfcontrole te bevorderen door de opeenvolging van uitlokkende factoren en het
.....read more Cognitive motivational processes underlying addiction treatment - summary of chapter 9 of Frontiers in social psychologyFrontiers in social psychology
Chapter 9
Cognitive motivational processes underlying addiction treatment
The currently standard treatment approaches are based on the assumption that human behaviour is controlled and largely determined by personal intentions and propositional knowledge, reflective processes. The more novel treatment approaches view human behaviour as unfolding (more or less) automatically in reaction to motivationally significant stimuli, impulsive processes. Behaviour can best be understood and influenced when taking both types of processes into account as well as different goals.
Several theories on behaviour regulation stress the pivotal role of conscious goals attitudes and subjective norms.
In goal-setting theory, goals are consciously accessible action plans aimed at meeting a certain standard. They serve as reference points against which current states are evaluated and on the basis of which further action is taken. If a discrepancy between the current and the desired end state is perceived, motivation to reduce this discrepancy increases and action will be taken. The higher the commitment, importance or accessibility of the goal, the more likely such a behavioural adjustment becomes.
According to the theory of reasoned action, there are additional factors that influence whether and what action will be taken. Those are one’s explicit beliefs about the action and the evaluation of its outcome, as well as normative pressures. There is an emphasis on the intentional process by which goals and attitudes control action.
For behaviour change to occur in a meaningful and sustained manner, it is necessary that the person feels able to perform the action and that the person expects the action to lead to the expected outcome. Perceived behavioural control is often compared to perceptions of self-efficacy which has positive effects on planning and goals setting, commitment, task performance and persistence in the face of obstacles. Increased control can help to break with maladaptive habits and explore new behavioural alternatives. Self-efficacy is a central determinant of whether action is taken, but goals and intentions are equally necessary in providing to behavioural standards to act upon.
Behaviour change can be achieved and maintained by setting goal-incompatible with continued unhealthy behaviour, and by strengthening commitment to these alternative goals.
Deciding which actions to take through assessing their utility for goal-attainment or through weighing attitudes against norms
.....read more Retraining automatic action tendencies changes alcoholic patients’ approach bias for alcohol and improves treatment outcome - summary of an atricle by Wiers, Eberl, Rinck, Becker & Lindenmeyer (2011) Retraining automatic action tendencies changes alcoholic patients’ approach bias for alcohol and improves treatment outcome
Wiers, Eberl, Rinck, Becker & Lindenmeyer (2011)
Psychological science 490-497
A short intervention change alcoholics’ automatic approach bias for alcohol and may improve treatment outcome.
Behaviour is partly governed through relatively automatic processes that may exert their influence outside conscious control. Addictive behaviours are an imbalance between strong impulsive or associative reactions to drug-related cues and relatively weak reflective or controlled processes. This makes the individual susceptible to sensitized cues triggering action tendencies leading to the addictive behaviour.
This can be reflected in different cognitive biases: an attentional bias for alcohol-related stimuli, a memory bias for the automatic activation of alcohol-related associations, and a bias toward automatically activated action tendencies to approach alcohol
If people are not willing or able to counter these biases, the addictive behaviour is likely to continue.
In the alcohol approach/avoidance task (alcohol-AAT), participants are instructed to respond with an approach movement (pulling a joystick) to pictures of one type and to respond with an avoidance movement (pushing a joystick) to pictures of another type. Pulling the joystick increases the size of the picture, and pushing it decreases the size. This zooming effect generates a sensation of approach or avoidance respectively.
Heavy drinkers show an approach bias toward alcohol pictures.
Training is associated with congruent changes in alcohol consumption in a taste test.
A brief CBM intervention aimed at modifying automatically activated action tendencies in alcoholic patients changed their approach bias for alcohol to an avoidance bias, with generalized effects across stimuli and measures.
Targeting action tendencies may have strong effects because they relate to a motivational state at the heart of an emotional response.
The association between the object and the concept of approach or avoidance might be crucial.
Verslaving en internaliserende problematiek - samenvatting van hoofdstuk 26 uit Handboek verslavingHandboek verslaving
Hoofstuk 26
Verslaving en internaliserende problematiek
De aanwezigheid van comorbide psychiatrische stoornissen bij mensen met een stoornis in het gebruik van middelen komt veel voor. Dit kan negatieve effecten hebben voor de uitkomst van therapie.
Externaliserende stoornissen zijn openlijk ontwrichtend en zijn geclusterd in twee categorieën: aandachts- en impulsproblemen en gedragsstoornissen. Internaliserende stoornissen zijn niet-ontwrichtend en naar binnen gericht, wat vooral een innerlijke belasting veroorzaakt.
Internaliserende stoornissen spelen een belangrijke in zowel oorzaak als gevolg van middelengebruik, in een complexe wederkerige relatie.
Angst en stemmingsstoornissen koen vaak voor bij mensen die middelen gebruiken. Geschat wordt dat 20-50% van de verslaafden comorbide internaliserende stoornissen heeft. Vrouwen hebben een hogere prevalentie van internaliserende problematiek.
De samenhang in termen van causaliteit tussen de stoornissen in gebruik van middelen en internaliserende problematiek kan op verschillende manieren verklaard worden: 1) directe causaliteit, de aanwezigheid van de ene aandoening is de directe oorzaak voor de andere aandoening 2) gedeelde risicofactoren, risicofactoren voor de ene aandoening hangen samen of overlappen met risicofactoren voor de andere aandoening 3) ketenrisicofactoren, de aandoening die voortvloeit uit bepaalde risicofactoren veroorzaakt op zichzelf weer risicofactoren voor de andere aandoening, waardoor beide aandoeningen vaker samen voorkomen 4) derde aandoening, het gelijktijdig voorkomen van beide aandoeningen is het gevolg van de aanwezigheid van een derde aandoening die beide veroorzaakt 5) verergering of psychoplastie, de ene aandoening veroorzaakt een ernstiger beloop van de andere aandoening, waardoor ze langduriger samen bestaan.
Internaliserende wegen naar stoornissen in middelengebruik
De zelfmedicatiehypothese verondersteld dat een internaliserende route tot het gebruik van middelen leidt, waarbij mensen middelen gebruiken om psychiatrische symptomen te dempen. Volgens deze hypothese moet het middelengebruik beginnen na het begin van eerste symptomen van de aandoening.
Stemmingsproblematiek geeft een verhoogd risico voor een stoornis in middelengebruik.
Onderzoek suggereert een gedeelde kwetsbaarheid tussen beide stoornissen.
Middelengebruik als oorzaak van internaliserende problematiek
Er zijn aanwijzingen dat stoornissen in middelengebruik de kans op internaliserende stoornissen vergoten.
Bij stoornissen in middelengebruik speelt disregulatie van het beloningssysteem een cruciale rol. Dit systeem bestaat uit hersenstructuren die verantwoordelijk zijn voor motivatie en verlangen naar beloning, associatief leren en positieve emoties. Als gevolg van langdurig excessief middelengebruik treden veranderingen op in dit beloningsysteem, waardoor er minder dopaminereceptoren beschikbaar zijn en de hersenen anders reageren op belonende prikkels. Veranderingen
.....read more Community reinforcement and family traning: an effective option to engage treatment-resistant substance-abusing individuals in treatment - summary of an article by Roozen, de Waart & van der Kroft (2010)Community reinforcement and family traning: an effective option to engage treatment-resistant substance-abusing individuals in treatment
Roozen, de Waart, & van der Kroft (2010)
Addiction, 1729-1783
Many individuals with substance use disorders are opposed to seeking formal treatment, often leading to disruptive relationships with concerned significant others (CSO)s. Community reinforcement and Family Training (CRAFT) provides an option to the more traditional treatment and intervention approaches. CRAFT has been found to be superior in engaging treatment-resistant substance-abusing individuals compared with traditional programmes.
The vast majority of individuals with substance use disorder refuse to be engaged into treatment.
Substance-suing individuals often have a dire impact on the lives of family members and friends, inflicting marital distress, social problems, financial troubles, aggression and violence. This co-occurs frequently with a myriad psychological problems. Many family members desperately need help to stop the disruption of their family life, to improve the ongoing substance-using individual.
Concerned significant others are not powerless and pursuing couples’ disconnection may be counterproductive. Community Reinforcement and Family Training (CRAFT) is a rigorous treatment package designed to specifically engage resistant substance users into treatment by working with their concerned significant others. Environmental contingencies play an important role in promoting treatment entry of the substance-abusing individual and reducing physical and psychological distress of the concerned significant other.
Clinical implications
Community Reinforcement and Family holds clear promise to be a more effective treatment option. It produces a high rate of interpersonal engagement. It also produces an concerned significant other improvement in terms of anger, depression, family cohesion and relation happiness.
Community Reinforcement and Family can be implemented in routine clinical practice.
Research implications
In the Community Reinforcement and Family programme, the concerned significant other learns to communicate and interact actively with the important person more positively.
The focus on empowerment helps concerned significant others to improve their mental and physical wellbeing, allowing them to prevail over the deliberating consequences of addiction. Community Reinforcement and Family encourages empowerment by supplying family members with vital knowledge and relies upon skills training and other strategies to promote self-reliance and self-care that lead to personal independence and improved self-esteem.
Disordered gambling: the evolving concept of behavioural addiction - summary of an article by Clark (2014)Disordered gambling: the evolving concept of behavioural addiction
Clark (2014)
Annals of the New York academy of sciences
There are similarities between gambling disorder and substance use disorders in symptom profile, comorbidity, heritability, and brain changes.
Episodes of gambling are linked to activation of the sympathetic nervous system and cortisol release, with associated (nongenomic) changes. Gambling disorder is reasonably comorbid with substance use disorders.
Gambling disorder may constitute a prototypical addiction and offer a means of studying the addictive processes in brains that are not disrupted by exogenous drug effects. Impulsivity is a key shared marker. It is therefore proposed to reflect the predisposition to develop a range of addictive disorders.
Changes in whit matter tracts and resting-state connectivity have been reported in gambling disorder.
Pathophysiology within the mesolimbic dopamine system has emerged as central to gambling disorder. There are consistent abnormalities across the key nodes in this circuit in gambling disorder, the striatum, medial PFC, amygdala and insula.
Addictions may be associated with an imbalance between different reward types. The compatibility of the task reward in research with the abused commodity will determine changes in the brain reward system.
There are clear perturbations in dopamine transmission.
There are dissociations in the processing of natural rewards and drug rewards. Treatments for addiction need not necessarily induce reductions in naturally rewarded behaviours.
Drug-induced stimulation of dopamine transmission is exogenous. Pavlovian processes are pervasive in drug addiction. Comparable Pavlovian processes seem to occur in gambling behaviour.
Many people with gambling disorder retrospectively describe receiving major payouts in the first few times that they ever gambled. These wins constitute profound positive prediction errors that will activate the neural machinery of reinforcement learning.
There is a asymmetry between appetitive and aversive outcomes. Financial gains promote straightforward learning acquisition. Financial losses do not trigger simple unlearning. They may promote specific instances of learning. The explaining away of losses in a manner that does not erode the player’s belief in his/her ability to win is state splitting.
Drugs of abuse are quantitatively more potent than natural rewards.
.....read more A specific role for posterior dorsolateral striatum in human habit learning - summary of an atrticle by Tricomi, Balleine & O'Doherty (2009)A specific role for posterior dorsolateral striatum in human habit learning
Tricomi, Balleine, & O’Doherty (2009)
European journal of neuroscience
Extensive training on a free-operant task reduces the sensitivity of participants’ behaviour to a reduction in outcome value. There is an increase in task-related cue sensitivity in a right posterior putamen/globus pallidus region as training progressed.
Cue-driven activation in a specific region of dorsolateral posterior putamen may contribute to the habitual control of behaviour in humans.
The development of habits allows responses to be efficiently executed, freeing up valuable cognitive resources.
Different neural systems contribute to habitual and goal-directed behaviour and learning. Goal directed action are in the prefrontal cortex and the dorsomedial striatum. Habit-based behaviour are in the dorsolateral striatum
There is a habit learning system in humans.
There is a region in the posterior putamen extending into the globus pallidus that becomes increasingly sensitive to stimuli that were associated with a particular behavioural response, consistent with a potential role in S-R learning. The posterior putamen/globus pallidus region may play a central role in the development and/or control of habitual behaviour in humans.
The transition from goal-directed to habitual control of behaviour is highly dynamic and the early phase of the habit learning process occurs even while behaviour is still demonstrably goal-directed. The recruitment of the DLS, and the degree to which S-R associations influence performance, increases gradually with training.
S-R habit learning may be mediated separately from goal-directed learning. It is commonly thought to depend on a process of response-outcome association. The development of S-R habits, not response-outcome associations, relies on the DLS, which corresponds to the dorsal putamen in humans.
The vmPFC has been implicated in governing goal-directed action in humans. This region may play a role in supporting goal-directed behaviour by representing the value of the upcoming outcome. Habitual behaviour may come about because regions such as the DLS may come to preferentially influence behaviour. It appears that circuits responsible for goal-directed and habitual behaviour are simultaneously engaged, by may compete for control of behaviour.
A commentary on the associations among ‘food addiction’, binge eating disorder, and obesity: Overlapping conditions with idiosyncrating clinical features - summary of an article by Davis (2017)A commentary on the associations among ‘food addiction’, binge eating disorder, and obesity: Overlapping conditions with idiosyncrating clinical features
Davis (2017)
Appetite
There is accumulating evidence that some vulnerable individuals display addictive symptoms in relations to their consumption of certain highly rewarding foods. Despite a positive relationship between obesity and addictive tendencies toward food, it is over-inclusive to model obesity as an addiction disorder, especially given the multi-faceted etiology and current pervasiveness of weight gain worldwide.
The experience of ‘loss-of-control’ (LOC) over food consumption can reflect a clinically significant eating disturnabce irrespective of the amount of food that is eaten. Binge eating is neither a necessary nor a sufficient component of food addiction, and other forms of compulsive intake may also characterize this disorder.
Obesity is a mutable physical state characterized by higher levels of adipose tissues than are deemed healthy, but which can change relatively rapidly as a result of alternations in energy input or energy expenditure. It is a condition that can only be assessed by proxy in the living organism. Obesity is a condition with multiple causes, which must, prominently, include dramatic changes in food environment during the same time period as tis most prominent increase. In addiction, casual factors tend to function in the form of interactions between our inherited biology and our physical surroundings.
Binge eating disorder has been conceptualized as a psycho-behavioural pathology. The diagnostic criteria include only behavioural and psychological symptoms. There are typically marked feelings of loss of control, and a guilty, disgusted, and depressed mood state. It is a culture-bound syndrome.
Addiction disorder are viewed as a state of developing pathology fostered by excessive motivation of rain reward circuitry, and inferred by symptoms like tolerance, withdrawal, and strong cravings, all of which have an established biological basis. They can be viewed as self-perpetuating clinical phenomena.
Commonalities
There is a strong empirical interconnection between obesity, binge eating disorder and addiction. If binge eating disorder persists over time, weight gain will occur given that the absence of compensatory behaviour is a hallmark of binge eating disorder. There is a comorbidity between binge eating disorder and food addiction. Binge eating disorder and food addiction are greatly over-represented in obese individuals.
Not all individuals with binge eating disorder meet the diagnosis for food addiction, nor vice versa. One viewpoint is that among those with binge eating disorder, food addiction may reflect a more compulsive and more severe form of the disorder.
‘Grazing’ as a
.....read more Obesity and the brain: how convincing is the addiction model? - summary of an article by Ziauddeen, Farooqi & Fletcher Obesity and the brain: how convincing is the addiction model?
Ziauddeen, Farooqi & Fletcher (2012)
Nature reviews neuroscience
Central to weight gain is the development of an energy imbalance, a situation that arises as a result of complex interactions between an individual’s biology and environmental factors.
Central is the idea that someone can become a ‘food addict’.
Two broad ideas of food addiction are: 1) Certain foods are akin to addictive substances insofar as they engage brain systems and produce behavioural adaptions comparable to those engendered by drugs of abuse. What the putatively addictive foods are has yet to be fully defined. 2) A behavioural phenotype that is seen in a subgroup of people with obesity and resembles drug addiction. Food-addiction phenotype is most apparent in individuals with binge-eating disorder.
At a population level, one of the main drivers of the rise in prevalence of obesity seems to be increased availability of food, with a consequent imbalance between energy intake and expenditure. Any loss of control of eating, which is important to the idea of obesity as addiction, is very subtle in most of the obese population. We cannot ignore social circumstances.
Five key pieces of evidence cited in support of the addiction model are: 1) A clinical overlap between obesity (or more specifically binge eating disorder) and drug addiction. 2) Evidence of shared vulnerability to both obesity and substance addiction. 3) Evidence of tolerance, withdrawal, and compulsive food-seeking in animals models of overexposure to high-sugar and/or high-fat diets. 4) Evidence of lower levels of striatal dopamine receptors in obese humans. 5) Evidence of altered brain responses to food-related stimuli in obese individuals.
Clinical overlap
Substance dependence is defined by the presence of characteristic patterns of behaviour, and it has been suggested that similar patterns characterize obesity. Although some features translate reasonably well form substance abuse to overeating, others do not. Tolerance and withdrawal are not convincingly observed in the human eating literature. Food is necessary for survival, is easy to obtain openly and does not (generally) provoke social opprobrium.
In binge eating disorder, we can recognize a behavioural syndrome more convincingly like that of drug addiction, entailing loos of control of eating, escalating consumption, compulsivity, restriction of activities, time spend in perusing behaviour, and possibly consuming to ameliorate dysphoric and negative effects.
Shared vulnerabilities
There may be
.....read more Brain dopamine and obesity - a summary of an atricle by Wang, Volkow, Logan, Pappas, Wong, Zhu & Fowler (2001)Brain dopamine and obesity
Wang, Volkow, Logan, Pappas, Wong, Zhu & Fowler (2001)
The Lancet
The availability of dopamine D2 receptor was decreased in obese individuals in proportion to their MBI. Dopamine modulates motivation and reward circuits and hence dopamine deficiency in obese individuals my perpetuate pathological eating as a means of compensate for decreased activation of these circuits.
Eating disorders - summary of an article by Treasure, Claudino & ZuckerEating disorders
Treasure, Claudino & Zucker
The Lancet
Diagnostic symptoms and associated behaviours substantially overlap across the range of eating disorders. The subjective interpretation and justification behind diagnostic behaviours is often not clear or is limited by developmental constraints.
In the DSM-IV, three broad categories of eating disorders are delineated. These are: Anorexia nervosa, Bulimia nervosa, Eating disorder not otherwise specified. Binge eating disorder is a subcategory of this.
Support is growing for recognition of binge eating disorder as a specific entity.
Interest is growing in a transdiagnostic approach to eating disorders.
Comorbidity is common for people with eating disorders.
Eating disorders and related behaviours are common in young people. Eating disorders have been reported worldwide. Women are more affected than men.
Genetic factors
The most potent risk factor is female gender. How much this association can be attributed to biological factors is uncertain.
Eating disorders are complex genetic diseases.
Biological factors
Although many of the biological findings in eating disorders can best be understood as results of starvation and disturbed eating behaviours, some are causally linked as risk for maintaining factors.
Poor nutrition has a general effect on brain function in addition to the specific effect on the appetite system. Most eating disorders emerge during adolescence. This is a vulnerable period for being reogranisation. Malnutrition during this period can negatively affect illness trajectories.
Starvation shrinks the brain and is associated with many behavioural and psychosocial disturbances, such as rigidity, emotional dysregulation, and social difficulties. Many symptoms resolve with weight gain and when brain mass is restored.
The characterisation of the central control of appetite could improve our understanding of eating disorders. This contains: 1) The homeostatic system is centred mainly in the brain stem and hypothalamus, which integrates peripheral metabolic markers with information form the gastrointestinal tract to affect subjective states of hunger, satiety, and autonomic nervous activity. 2) The drive system, with distributed neural circuitry within the mesolimbic cortex and striatum that has afferent inputs from sense organs and neural structures that are implicated in learning and memory. This registers the reward value associated with food and is involved in the motivation to seek food and eat. 3) Self-regulation system. A form of top-down control contextualises appetite within life goals, values, and meaning
Abnormal changes in all three of these systems have
.....read more Cognitive remediation therapy for eating disorder - summary of an article by Danner, Dingemans, & Steinglass (2015)Cognitive remediation therapy for eating disorder
Danner, Dingemans, & Steinglass (2015)
Current opinion in psychiatry
Cognitive remediation therapy (CRT) is a behavioural-based training intervention that aims to improve cognitive processes with the goal of durable improvement in functional outcomes.
Cognitive remediation may be administered in different forms. All forms use the technique of specific and explicit training of strategies and use the use of various transfer techniques to functional improvements.
For anorexia nervosa, a manual for CRT has been proposed to focus specifically on improving cognitive flexibility by training set shifting abilities and central coherence strength. The intervention combines simple brain exercises, with reflection on thinking styles and strategies. It translates these processes to everyday life.
RCT does not directly emphasize core features of eating disorders, or emotional processes or the content of thoughts.
Patients with anorexia nervosa manifest inefficient set-shifting abilities and have a superior local processing, but inefficient global processing. These cognitive inefficiencies might relate to the inflexible behaviours and thoughts observed in anorexia nervosa patients.
Cognitive remediation therapy is theorized to capitalize on neuroplasticity. Through repetition of cognitive exercise changes in underlying neural pathways can occur. With improvement in cognitive exercises, individuals are thought to experience self-efficacy. Confidence in the capacity to achieve change is believed to be important in allowing CRT successes to generalize to life functioning.
Improvement of neuropsychological impairments alone will not improve functional outcome. There is often ambivalence about treatment in individuals with eating disorders.
CRT provides opportunities of success in treatment.
Intrinsic motivation is inherent satisfaction derived from behaviours independent of their external consequence. Extrinsic motivation is driven by some external gain or avoidance of loss or punishment.
Functional improvement requires practice of newly learned skills, and therefore intrinsic motivation is necessary to translate cognitive gains into changes in everyday life.
Intrinsic motivation is dynamic and can be enhanced by encouraging personal goal setting, delivering treatment in group settings to create a supportive learning environment, using instructional techniques that provide a meaningful context, as well as feedback during learning activities, and by emphasising the malleability of cognitive problems.
An aim of a program to enhance intrinsic motivation is to become an independent learner, able to continue the learning process outside the program in educational and social settings.
CRT is delivered in an emphatic reflective style, with a focus on the
.....read more E-health interventions for eating disorders: Emerging findings, issues, and opportunities - summary of an article by Aardboom, Dingemans, & van Furth (2016) E-health interventions for eating disorders: Emerging findings, issues, and opportunities
Aardboom, Dingemans, & van Furth (2016)
Curr psychiatry rep
Internet-based cognitive behavioural therapy and guided self-help have demonstrated promising results in terms of reducing eating disorder psychopathology. E-health interventions reach an underserved population and improve access to care.
E-health for eating disorders: emerging findings
Treatment and self-help interventions
Internet is a potentially useful mean to deliver interventions targeting individuals with an eating disorder who are ambivalent towards change.
Aftercare and maintenance treatment
Flexibility may be one of the key reasons for individuals to prefer E-health interventions over face-to-face interventions.
Predictors of outcome and dropout
Higher motivation to change, higher harm-avoidance, higher drive for thinness, lower binge eating, and lower body dissatisfaction at baseline predicts better outcomes.
Higher baseline levels of depression and eating disorder psychopathology were shown to predict dropout.
Smartphone applications in the treatment of eating disorders: emerging findings
The apps available for eating disorders are of limited functionality.
The development and implementation of E-health interventions is challenging. Most E-health interventions have been developed to use before, after, or as a supplement to existing treatments. It can be used to give stepped care.
Blended care in the combination of face-to-face and online therapy could provide good results.
In daily clinical practice, the standard for determining a psychiatric diagnosis is a face-to-face clinical interview.
A face-to-face interview may be at odds with the aims or clinical evaluation of anonymous E-health interventions or applications. In order to preserve the potential advantages that come with the Internet as delivery mode of the intervention, a valid and reliable online self-report questionnaire for diagnostic classification would be of great value.
Reaching an underserved population is often a goal or presumed potential advantage of E-health interventions.
Targeting habits in anorexia nervosa: a proof-of-concept randomized trial - summary of an article by Steinglass, Glasofer, Walsh, Guzman, Peterson, Walsh, Attia & Wonderlicht (2018) Targeting habits in anorexia nervosa: a proof-of-concept randomized trial
Steinglass, Glasofer, Walsh, Guzman, Peterson, Walsh, Attia & Wonderlicht (2018)
Psychological medicine
Habits are behavioural routines that are automatic and frequent, relatively independent of any desired outcome, and have potent antecedent cues. Among individuals with anorexia nervosa, behaviours that promote the starved state appear habitual.
Maladaptive behaviours characteristic of anorexia nervosa are cue-dependent, consistent with relying on mechanisms underlying habits. The habit strength of these behaviours is modifiable.
REaCH is a treatment tool that essentially ‘zooms in’ on the behavioural routines experienced as highly automatic by individuals with anorexia nervosa. It emphasizes fine-grained behavioural analysis, antecedent and in-the-moment cues, and proximal rewards.
Breaking habits with implementation intentions: A test of underlying processes - summary of an article by Adriaanse, Gollwitzer, de Ridder, de Wtit & Kroese (2011)Breaking habits with implementation intentions: A test of underlying processes
Adriaanse, Gollwitzer, de Ridder, de Wtit & Kroese (2011)
Personality and social psychology bulletin
Implementation intentions specifying the replacement of a habitual response with an alternative response in a critical situation can overrule habits. Implementation intention eliminate the cognitive advantage of the habitual means in the race with the alternative response. The cognitive advantage of the habitual means is not immediately replaced by an automatic activation of the alternative means.
Formulating counter-habitual implementation intentions increases individuals’ flexibility to choose with behaviour to perform in the critical situation. Actual behaviour will depart form their habits only to the extent that individuals have strong alternative goal intentions.
Habits develop as people repeatedly perform a specific behaviour in a stable situation to pursue their goals. This co-occurrence between the situation and the behaviour eventually creates a direct mental association between the situation and the behaviour, which is strengthened each time they subsequently covary. This association is strengthened to the extent that when the situation is encountered, the behaviour follows automatically.
The most important moderator of the intention-behaviour relation is the extent to of habitual control over the behaviour.
One self-regulatory strategy that has been proposed to support individuals in managing the critical stimulus in such a way that there are able to act on their counter habitual intentions is to furnish one’s intentions with implementation intentions. Implementation intentions are simple action plans stipulating where, when, and how one will perform an intended behaviour. These promote goal-directed action.
Planning one’s goal striving with implementation is helpful for two reasons. These are: 1) By specifying a situation for enacting one’s intentions in advance, the mental representation of this critical situation is highly accessible in memory and therefore more easily detected as a good opportunity to act on one’s intentions. 2) By linking this critical situation to a specific goal-directed behaviour in an if-them structure, the control of the behaviour is delegated from the self to the specified situational cue, resulting in automatic elicitation of this goal-directed behaviour when the situation is encountered.
Habits and implementation intentions seem to instigate similar automatic responses that differ only in origin. Implementation intentions
.....read more Implementation intentions: can they be used to prevent and treat addiction? - summary of chapter 29 of Handbook of implicit cognition and addictionHandbook of implicit cognition and addiction
Chapter 29
Implementation intentions: can they be used to prevent and treat addiction?
Forming an implementation intention involves an individual planning when, where, and how to perform a specific behaviour. Implementation behaviours could be employed to successfully link critical environmental cues to non-addictive behaviour or techniques to refuse the addictive substance. They could inhibit addiction-related cognitions, maintain self-regulatory resources, promote adherence to treatment, or deal effectively with internal factors.
Implementation intentions involves an individual deciding when, where, and how they will perform a behaviour. It takes the form of an if-then plan that links behaviour or cognitive response to a good opportunity to act as a means to achieve a goal.
Through implementation intentions, individuals commit themselves to act when faced with a certain situation in a particular manner.
Implying motivational intentions are insufficient to tackle addiction.
Deciding in advance the context in which to act allows one to select an appropriate situation that prompts few competing goals. Choosing a specific context increases the accessibility to environmental cues that eases detection of critical opportunities to act even when busy with other tasks.
Making decisions enhances the accessibility of decision-consistent information. Implementation intention change behaviour through this heightened accessibility of environmental cues. Once the opportunity to act is detected, implementation intentions automatize behaviour within the preplaned context. Action intention becomes immediate, efficient, and occurs outside conscious awareness.
Implementation intentions change behaviour by helping the identification of good opportunities to act by heightening the accessibility of environmental cues. These environmental features then cue behaviour so that it occurs immediately, efficiently, and without conscious awareness.
Health behaviour
Implementation intentions increase the performance of important health behaviours (like eating behaviours).
Preventing addiction
To prevent addictive behaviours, strategies must be able to promote actions that hinder the development of problematic behaviour.
Even if an individual possesses an intention to refrain from drug use, encountering drug cues may trigger urges that temporarily override the intention to remain
.....read more Cognitieve gedragstherapie - samenvatting van hoofdstuk 10 van Handboek angst- en dwangstoornissenHandboek angst- en dwangstoornissen
Hoofdstuk 10
Cognitieve gedragstherapie
De basis voor de te gebruiken interventies wordt bij cognitieve gedragstherapie gevormd door verschillende soorten analyses die de therapeut maakt van de individuele problematiek van de patiënt.
Nadat de classificatie is gesteld en daarna de diagnose, worden de klachten van de patiënt en de samenhang daartussen in kaart gebracht. De analyses om deze in kaart te brengen zijn gebaseerd op de leerprincipes. De meeste gebruikte analyses zijn: 1) Funciteanalyses (FA’s), de beschrijving van de operante conditionering bij de patiënt. Er wordt onderscheid gemaakt tussen de context/situatie (discriminatieve stimulus Sd), de respons daarop ® en de consequenties (C+ of C-). 2) Betekenisanayses (BA’s) De beschrijving van de klassieke conditionering bij de problematiek van de patiënt. Er wordt hier onderscheid gemaakt tussen de gebeurtenis of het gedrag (CS) en de verbonden cognitieve representatie van een andere betekenisvolle gebeurtenis (UCS/UCR-representatie) en de emotionele reactie daarop (CR).
Deze kunnen worden gezien als individuele diagnostiek. Er wordt hier op microniveau gekeken naar de factoren die klachten in stand houden of versterken.
Hoe de verscheidene problemen en klachten onderling samenhangen wordt in kaart gebracht door een holistische theorie. Hier wordt er op ‘macroniveau’ naar de problemen gekeken.
De eerste gesprekken met de patiënt zullen onder andere gaan over het ontstaan, het beloop en de huidige toestand van klachten. In het intakegesprek is het handig om te beginnen met de huidige toestand van de klachten, aangezien dat het meest aansluit bij de beleving en de hulpvraag van de patiënt.
De belangrijkste vragen die de therapeut probeert te beantwoorden zijn: 1) Welke stimuli lokken onder welke omstandigheden het gedrag uit? 2) Welke responsen (emotioneel, fysiologisch, cognitief en in waarneembaar gedrag) treden op? 3) Wat zijn de gevolgen van het gedrag, welke factoren bekrachtigen het gedrag en houden het in stand?
Het opstellen van de functieanalyses, betekenisanalyses en een holistische theorie heeft een hypothese-formulerend karakter. Ze moeten regelmatig worden bijgesteld.
De cognitieve gedragstherapie richt zich op het verminderen van angst- en dwangklachten. Hierbij speelt vermindering van het vermijdingsgedrag een cruciale rol.
Soorten vermijding: 1) Passieve vermijding. Zoals situaties uit de weg gaan 2) Actieve vermijding. Zoals vluchten of gebruik van rituelen.
Ook richt de interventie zich op het verminderen van angst gerelateerde cognities.
Gedragsmatige interventies
Gedragsmatige interventies kunnen verschillende doelen hebben. Dit zijn: 1) Gedrag dat te weinig aanwezig is en wordt vermeden laten toenemen. Afname vermijdingsgedrag door exposure. 2) Gedrag dat te
.....read more Enhanced Avoidance habits in obsessive-compulsive disorder - summary of an article by Gillan et al (2014)Enhanced Avoidance habits in obsessive-compulsive disorder
Gillan, Morein-Zamir, Urcelay, Sule, Voon, Apergis-Schoute, Fineberg, Sahakian, & Robbins (2014)
Biological psychiatry
Obsessive compulsive disorder (OCD) is a psychiatric condition that typically manifests in compulsive urges to perform irrational or excessive behaviours. OCD patients have a tendency to develop excessive avoidance habits.
Most patients with OCD recognize that their concerns are unrealistic and that their behaviour is absurd or at least excessive.
OCD patients have a bias toward appetitive habit formation at the expense of goal-directed behaviour, an imbalance that might contribute to the repetitive and seemingly senseless compulsions that exemplify the disorder.
The compulsions in OCD are avoidant rather than appetitive.
One of the longest standing accounts of OCD symptomatology is that compulsions are not habits but rather are rational avoidance responses triggered by irrational beliefs. Irrational beliefs are considered the product of cognitive bias in OCD. These beliefs are thought by some to form the basis of obsession, and, in turn, anxiety in OCD, to which compulsions are a goal-directed avoidance response.
Excessive behavioural repetition in OCD might be driven by a failure to learn about safety.
Conditioned fear and anxiety are also thought to be important for OCD, and can bias healthy individuals to behave habitually.
OCD patients have a bias toward developing avoidance habits and these habits are related to a subjective urge to respond. Avoidance habits are not the result of any measurable differences in contingency knowledge, explicit threat appraisal, or physiological arousal. Habits might be an independent contributor to the disorder.
Habits can manifest as more than just accidental slips.
Responses to a devaluated stimulus in OCD are indicative of habit.
A simple stress-habit account does not appear to explain the excessive behavioural habits observed in the OCD group. This doesn’t rule out the possibility that stress or anxiety mediated the habit responses observed.
Apparent inhibitory failures emerge over time and with repetition. Stimuli, rather than goals, control behaviour.
Goal-directed learning and obsessive-compulsive disorder - summary of an article by Gillan and Robbins (2014)Goal-directed learning and obsessive-compulsive disorder
Gillan & Robbins (2014)
Philosophical transactions of the royal society
Compulsions in OCD may derive from manifestations of excessive habit formation. The irrational threat beliefs (obsessions) characteristic of OCD may be a consequence, rather than an instigator, of compulsive behaviour in these patients.
Compulsivity is ‘a hypothetical trait in which actions are persistently repeated despite adverse consequences’.
There are two main schools of thought regarding the underlying mechanism that leads to compulsive behaviour. These are: 1) Cognitive, compulsivity is mediated by dysfunction in the assignment of value to available alternatives. The compulsive individual may view the cost of cessation of behaviour to be higher than the benefits of thereof. In this sense, the choice to continue the behaviour is purposeful and goal directed. Compulsions are performed to reduce the likelihood that an unwanted, or feared, consequence will take place. 2) OCD doesn’t necessarily arise form faulty value attribution or cognitive bias. It may result from goal-directed dysfunction that interacts with anxiety and irrational belief. Patients with OCD largely understand the relative value of the available outcomes and the cost of actions, and aim to promote expected values of outcomes and desist from compulsive behaviour, but cannot exert the necessary control over their actions to realise this goal.
Habits are responses that are automatically triggered by stimuli and are considered the functional reciprocal of goal-directed behaviours that are intentional and sensitive to the value of prospective goals.
Animals use both reflective and reflexive models of action selection. Goal-directed behaviour is more accurate, but requires effort and attention. It suffers in times of stress, perhaps as a result of increases in working memory load It subsides as we become comfortable with repetitive action following over-training of the stimulus-response pair, and when outcomes are less tightly coupled with responses.
A shift from associative to sensorimotor fronto-striatal circuits mediates the transition from goal-directed to habitual control over behaviour.
An important double dissociation between medial and lateral subregions of the dorsal striatum in the balance between goal-directed and habitual control over behaviour. Habitual responding can be induced in rodents by lesions of the dorsomedial striatum (caudatus). The drosomedial striatum is critical for goal-directed action control.
Disrupting activity in the dorsolateral striatum (putamen) preserves sensitivity to outcome value in rodents, even after extended training. The rodent prefrontal cortex there has been some
.....read more Addiction and compulsions - uvaTo succesfully finish the course addiction and compulsion in the third year of the uva, here are all summaries you need.
Addictions and compulsions This is a magazine about addiction and compulsions.
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