Describe the treatment and management of impulse control disorders and non-substance addictive disorder.

Mark scheme

Marking points from the official mark scheme (May/June 2018). The mark or mark type is shown in brackets.

1. Describe the treatment and management of impulse control disorders and non-substance addictive disorder. Treatment and management of impulse control disorders and non-substance addictive disorder, including the following: ∞ biochemical (Grant et al., 2008) ∞ cognitive-behavioural: covert sensitisation (Glover, 2011), imaginal desensitisation (Blaszczynski and Nower, 2002), impulse control therapy (Miller, 2010) Biochemical (Grant et al., 2008) Opiates as a treatment for gambling. Opioid receptor antagonists inhibit dopamine release in the nucleus accumbens and ventral pallidum through the disinhibition of gamma-aminobutyric acid (GABA) input to the dopamine neurons in the ventral tegmental area. Opioid antagonists are thought to decrease dopamine neurotransmission in the nucleus accumbens and the motivational neurocircuitry, thus dampening gambling-related excitement and cravings. Study - 18 week trial with three doses of oral naltrexone for PG. 77 patients assigned randomly to the three conditions. Symptoms were not significantly different between the various doses. Gambling severity did decrease with naltrexone compared to control. Covert sensitisation (Glover, 2011) Covert sensitisation is a form of behaviour therapy in which an undesirable behaviour is paired with an unpleasant image in order to eliminate that behaviour. Therefore, the impulsive behaviour could be paired with an unpleasant image or experience. For example, if the person was addicted to gambling they could think about their gambling and then look at images of people who have gone bankrupt. They could eventually learn to do this while gambling or bring these images with them and look at them when they imagine gambling. Study involves a case study of a 56 year old woman seeking help with shoplifting. After the therapy her stealing behaviour had greatly reduced. Imaginal desensitisation (Blaszczynski and Nower, 2003) Abstract Taught progressive muscle relaxation, visualise situation where they feel the desire to carry out impulsive behaviour, they imagine carrying out the desire and then imagine leaving the situation. This works to reduce arousal and anxiety around the compulsive behaviour and can help to reduce the desires if practiced outside of the therapy sessions. Impulse control therapy (Miller, 2010) Abstract Impulse-control disorders such as pathological gambling, sexual addiction, and compulsive shopping cause enormous suffering in people's lives. The feeling-state theory of impulse-control disorders postulates that these disorders are created when intense positive feelings become linked with specific behaviors. The effect of this linkage is that, to generate the same feeling, the person compulsively reenacts the behavior related to that original positive-feeling event, even if detrimental to his or her own well-being. This reenactment creates the impulse-control disorder. The therapy described in this article is the Impulse-Control Disorder Protocol (ICDP), which uses a modified form of eye movement desensitization and reprocessing (EMDR) to address these fixations. A case study of an individual with pathological gambling illustrates the application of ICDP. Mark according to the levels of response descriptors in Table A. Other appropriate responses should also be credited.
2. Evaluate the treatment and management of impulse control disorders and non-substance addictive disorder, including a discussion of the application of psychology to everyday life. A range of issues could be used for evaluation here. These include: ∞ Named issue – application of psychology to everyday life. The treatments all have good applications to everyday life as they have all been shown by research to be effective in reducing impulses e.g. reduction in kleptomania as found in the case study by Glover. The research has been done in everyday environments/good ecological validity and this therefore also has good applications of everyday life. However, each piece of research has only investigated a particular disorder so has fewer applications e.g. Grant just used gamblers (but candidates could also argue that each treatment could potentially be done with a variety of different impulse control disorders and therefore this has good application to everyday life). ∞ nature versus nurture debate with reference to the various treatments. The biochemical suggests impulses are due to nature. The other treatments recognise the nature element of the disorder as all practice some form of muscle relaxation but also recognise the nurture element as the patients are trained to reduce their desire to participate in the compulsive behaviour. ∞ comparisons of different treatments – can use any issue to compare the treatments and the effectiveness. ∞ usefulness (effectiveness) of different treatments – the treatments have all been shown to work through the evidence provided. Credit evaluation of the evidence that links back to the usefulness of the treatments. ∞ reductionist nature of the treatments - the biochemical is the most reductionist as it suggests giving a medicine will relieve the symptoms whereas it may just mask the symptoms. The other treatments are less reductionist as they consider both the physical and the psychological causes that allow the treatments to work. ∞ deterministic nature of the treatments - biochemical is the most reductionist as the patient's desire to do the compulsive behaviour will reduce without any action on their part. The other treatments require the free will of the patient to act on the advice and practice the relaxation/imaging techniques outside of the sessions. ∞ appropriateness of treatments (e.g. if there are side effects). Opiates are very addictive the do have side effects. The therapies are time consuming and require the patient to have a good imagination and some may struggle with this. ∞ cost of treatments – biochemical is the least costly with the others involving therapists which will cost the health service and/or the patient more money. ∞ ethics of treatments – likely to be ethical as the patients will all approve their treatment and be willing to participate. In order to be ethical the patient needs to be aware of the side effects and addictive nature of the opiates. Mark according to the levels of response descriptors in Table B. Other appropriate responses should also be credited.