Worked example 1
A patient with kleptomania reports intense urges when passing shops. Outline CBT and pharmacological treatments. Evaluate covert sensitisation as a treatment option. [10 marks]
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AO1 — CBT approach:
- Functional analysis: Identify triggers (passing shops), thoughts ('I must take it'), and consequences (relief).
- Coping skills: Urge delay, alternative behaviours, relapse prevention plan for high-risk situations.
- Cognitive restructuring: Challenge beliefs that theft is 'unavoidable'.
AO1 — Pharmacological approach:
- SSRIs (e.g. fluoxetine) — reduce urge intensity via serotonin; may help when comorbid anxiety/OCD features present.
- Mood stabilisers (e.g. lithium) in some impulsive–aggressive presentations — less specific evidence for kleptomania.
AO3 — Covert sensitisation evaluation:
- AO1: Client imagines aversive outcome (e.g. nausea, arrest) while visualising urge — aims for classical conditioning of disgust to cue.
- Strengths: Some case study success; no physical punishment required unlike overt aversive methods.
- Limitations: Weak evidence base — few controlled trials; effects may not generalise beyond therapy.
- Ethics: Manipulative imagery; patient distress; autonomy concerns — largely replaced by CBT and SSRIs.
Judgement: CBT + SSRI is preferred — evidence-based and ethical; covert sensitisation is historical option with limited support.