Option A Step 1: Carefully Read The Brief Case Study

Option Astep 1carefully Read The Following Brief Case Studybernice W

Carefully read the following brief case study. Bernice was hesitant during her initial counseling session because she feared what the therapist would think of her. The therapist focused on building a therapeutic alliance with Bernice by engaging in empathic, nonjudgmental listening. Soon, Bernice shared that she feared contamination. She was particularly upset by touching wood, mail, and canned goods. She also disliked touching silver flecks—such as silver embossing on greeting cards, eyeglass frames, shiny appliances, and silverware—and was unable to explain why these objects were sources of possible contamination. Bernice became more distressed during the session and started sharing her reasons for seeking counseling: disturbing images that pop in her mind of her "worst fear." These images are so disturbing that she shows marked distress when talking about them. Bernice explained that these images involve her child, whom she loves most in the world and desires to protect at all costs. She feels compelled to perform specific behaviors to reduce her distress, engaging in rituals that consume much of her day. In the mornings, she spends hours washing and rewashing, even scraping away layers of soap to ensure they are germ-free. Her rituals to protect her child are detailed and repeated multiple times to be "done right," driven by a sense of urgency to do them perfectly.

Paper For Above instruction

Introduction

The case of Bernice presents a complex picture of psychological distress characterized by compulsive behaviors, intrusive distressing images, and intense fears related to contamination and harm. These symptoms are highly suggestive of Obsessive-Compulsive Disorder (OCD), a mental health condition recognized by persistent obsessions and compulsions that interfere significantly with daily functioning. Understanding Bernice's symptoms, their underlying cognitive and emotional mechanisms, and evidence-based treatment approaches informs effective intervention strategies to improve her quality of life.

Identifying the Psychological Disorder

Based on the description provided, Bernice's symptoms align most closely with Obsessive-Compulsive Disorder (OCD). OCD is classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition marked by the presence of obsessions—persistent, intrusive thoughts, images, or urges—and compulsions—repetitive behaviors or mental acts that an individual performs to reduce the anxiety associated with obsessions (American Psychiatric Association, 2013). Bernice exhibits classic obsessions related to contamination fears and fears of harm, particularly concerning her child. Her compulsions involve elaborate rituals such as hours of washing, scrubbing, and ritualistic behaviors like scraping soap layers, which are performed to mitigate her distress and prevent perceived catastrophes.

Her inability to articulate why certain objects provoke contamination fears suggests that her obsessions are not specific phobias but rather intrusive thoughts that generate high levels of anxiety. The distress associated with these thoughts and rituals indicates a recognized component of OCD rather than a specific phobia, which would typically be limited to a particular object or situation. Moreover, her compulsive rituals are time-consuming and interfere with normal functioning, which aligns with the diagnostic criteria for OCD (Fineberg et al., 2019).

The compulsions appear to be driven by her need to alleviate anxiety and prevent harm to her child, which demonstrates the typical urge-driven compulsive behavior aimed at controlling or neutralizing obsessive thoughts. The compulsions reduce her anxiety temporarily, but the persistent nature of her obsessions and rituals suggests a chronic pattern characteristic of OCD.

Understanding OCD from the Literature

Research indicates that OCD involves dysfunction in brain circuits responsible for error detection, threat appraisal, and compulsive ritualistic behaviors. Neuroimaging studies have implicated hyperactivity in the cortico-striato-thalamo-cortical (CSTC) loops, particularly involving the orbitofrontal cortex, anterior cingulate cortex, and basal ganglia, which might underpin the intrusive thoughts and compulsive behaviors observed in OCD (Pauls et al., 2014). These neural anomalies contribute to impaired response inhibition and heightened error detection, leading individuals like Bernice to perform rituals to alleviate distress caused by intrusive thoughts of contamination and harm.

Additionally, cognitive-behavioral models emphasize that OCD symptoms are maintained by maladaptive thought patterns, such as inflated responsibility and thought–action fusion, leading individuals to believe that their intrusive thoughts are morally equivalent to actions or will inevitably cause harm (Rachman, 2014). Bernice’s compulsive rituals serve as neutralizing or safety behaviors, which temporarily reduce her anxiety but reinforce the disorder’s persistence through a cycle of avoidance and ritual performance.

The emotional component involves high levels of anxiety and guilt associated with perceived responsibility for preventing harm. Bernice's rituals, particularly protecting her child, mirror the compulsive cleaning and checking behaviors typical of OCD, which are driven by the need for certainty and control in the face of perceived threat. These compulsions are often time-consuming and cause impairments in daily life, consistent with clinical descriptions of OCD.

Effective Treatment Approaches for OCD

Cognitive-behavioral therapy (CBT), specifically Exposure and Response Prevention (ERP), is considered the gold standard treatment for OCD (Foa et al., 2015). ERP involves gradually exposing individuals to anxiety-provoking stimuli—such as touching objects Bernice fears are contaminated—without allowing them to perform compulsive rituals. Over time, this process diminishes the anxiety associated with obsessions and helps patients develop healthier responses.

A recent study by Tolin et al. (2020) underscores the efficacy of ERP in reducing OCD severity, especially when paired with cognitive restructuring techniques that challenge dysfunctional beliefs about responsibility and threat. Cognitive restructuring aims to modify the inflated responsibility beliefs and catastrophizing thoughts that underpin compulsions, enabling patients like Bernice to tolerate uncertainty and reduce ritualistic behaviors.

In addition to ERP, pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) has demonstrated effectiveness in decreasing OCD symptoms (Bloch et al., 2018). Medications help regulate serotonin levels, which are involved in mood and anxiety regulation, thereby reducing obsessive thoughts and compulsions.

Overall, a combined approach of ERP and medication, tailored to the individual’s specific fears and rituals, provides a comprehensive treatment strategy for OCD. Empathetic engagement and building a strong therapeutic alliance, as indicated in Bernice’s case, are vital for treatment adherence and success.

Conclusion

Bernice’s symptoms align closely with OCD, characterized by intrusive contamination fears and compulsive rituals aimed at protecting her child and alleviating distress. Her case exemplifies how cognitive, behavioral, and neurobiological factors interact in OCD to produce significant impairment. Evidence-based treatments such as ERP, complemented by pharmacotherapy, offer effective pathways toward symptom reduction and improved functioning. Educating patients about the disorder, fostering a strong therapeutic relationship, and customizing treatment approaches are essential components in overcoming OCD’s debilitating impact.

References

• American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). American Psychiatric Publishing.
• Bloch, M. H., McGuire, J. F., Stewart, S. E., & Pittenger, C. (2018). Pharmacological treatment of obsessive-compulsive disorder: The evidence-based approach. CNS Drugs, 32(2), 133-146.
• Foa, E. B., Gillihan, S. J., & Bryant, R. A. (2015). Challenges and successes in training clinicians to administer exposure therapy. Cognition and Emotion, 29(7), 1241-1252.
• Fineberg, N. A., et al. (2019). Obsessive-compulsive disorder. Nature Reviews Disease Primers, 5(1), 52.
• Pauls, D. L., et al. (2014). The neurobiology of obsessive-compulsive disorder. The Psychiatric Clinics of North America, 37(3), 405-416.
• Rachman, S. (2014). The evolution of cognitive-behavior therapy for the treatment of obsessive-compulsive disorder. Journal of Obsessive-Compulsive and Related Disorders, 3, 241-246.
• Tolin, D. F., et al. (2020). Exposure and response prevention for OCD: A comprehensive review. Clinical Psychology Review, 82, 101929.