Impulse control disorders: treatment and management

Psychology A2 · Clinical Psychology. The idea in plain words, the rules to remember, the mistake to avoid and a worked example, written and checked by Mega Lecture.

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The idea

The biological treatment uses opiate antagonists such as naltrexone and nalmefene. They block opioid receptors, so the act gives less pleasure and urges weaken. Grant et al. (2008) pooled data from double-blind, placebo-controlled trials of these drugs for gambling disorder to find out who responds. A family history of alcoholism predicted a good response to the drug.

Two cognitive-behavioural therapies use imagination. In covert sensitisation the person imagines the behaviour together with something very unpleasant, so the behaviour loses its appeal. In imaginal desensitisation the person relaxes, imagines a tempting situation and then imagines walking away calmly, so the situation stops triggering the urge.

Rules to remember

Antagonist: a drug that blocks a receptor instead of activating it.
Double-blind: neither participants nor those assessing them know who has the drug or the placebo.
Placebo: an inactive tablet that controls for the effect of expecting to improve.
Grant et al. (2008): response was judged by a fall in scores on a gambling version of the Y-BOCS; family history of alcoholism went with a better drug response.
Glover (1985): a case study of a woman with a long history of shoplifting; imagining nausea and vomiting while stealing reduced the behaviour.
Blaszczynski and Nower (2003): imaginal desensitisation uses muscle relaxation, then imagined gambling scenes that end with leaving without gambling.
Drugs reduce urges but teach no coping skills; a single case study cannot be generalised.

Common mistake

Students confuse the two imaginal therapies. Covert sensitisation pairs the behaviour with an unpleasant image; imaginal desensitisation pairs the tempting scene with relaxation and resisting.

Worked example

A therapist teaches Yusuf to relax his muscles. He then pictures walking past a betting shop, feeling the urge, staying calm and walking on home. Which therapy is this?

The scenes are imagined, so it is one of the imaginal therapies.
No unpleasant image such as sickness or arrest is used, so it is not covert sensitisation.
Relaxation is paired with the trigger scene and with resisting the urge.

Answer: Imaginal desensitisation.

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