Analysis of OCD Using Relational Frame Theory, Experiential Avoidance and Emotion Regulation

Obsessive-compulsive disorder (OCD) is classified as an anxiety disorder by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (American Psychiatric Association, 2000). It is characterized by distressing intrusive thoughts or sensations, known as obsessions, and unwanted repetitive behaviors aimed at reducing the distress associated with obsessions, known as compulsions, that cause functional interference and decreased quality of life. There is a functional relationship between obsessions and compulsions, with 90% of people with OCD engaging in compulsions in response to obsessions (Foa & Kozak, 1995). Although there is usually a predominant obsession and corresponding compulsion, most people with OCD tend to have multiple obsessions and compulsions varying in intensity and severity. According to current estimates, approximately 1% of the U.S. population (or 2.2 million people) meet criteria for OCD each year (Kessler, Chiu, Demler, & Walters, 2005).

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The obsessional aspect of OCD can be explained by Relational Frame Theory (RFT), which is a psychological theory of human language and cognition (Hayes, Barnes- Holmes, & Roche, 2001). RFT claims that verbal human beings respond to stimuli based on their histories of interaction with them as well as the mutual relations of stimuli to other events. To illustrate this concept, a rat, for example, must interact with a stimulus in order to learn its functions, but a human can be told or assume that a novel stimulus is “the same as” or “different than” something that he or she has interacted with; based on this information, the new stimulus will gain a meaning and function based on the relational network that these cues establish. Humans have the ability to form bi-directional stimulus relations, where a word and the actual item or event describing that word each can equally stand for the other. For example, the word “biscuit” and an actual biscuit are equal for humans because of language; we do not need to see the biscuit in order to anticipate getting one. Another example of this phenomenon is a child learning that touching a hot stove will burn him or her without having the direct experience of touching a hot stove and getting burned. Even if someone has never experienced a particular event, the ability to use language allows people to learn things about it. The concept of bi-directional stimulus relations explains why evaluative conditioning can occur and why arbitrary associations can be made, and these two processes are integral parts of Neziroglu’s (2012) learning model of body dysmorphic disorder (BDD); BDD is a subtype of OCD characterized by the obsessive idea that some aspect of one’s own appearance is severely flawed and warrants exceptional measures to hide or fix it (Cororve & Gleaves, 2001; Neziroglu & Mancusi). The principles of RFT, their associated explanatory functions of OCD symptomology, and relevant conclusions for the practice of clinical psychology will be elaborated upon.

 Experiential avoidance (EA) frequently occurs in response to obsessions and their associated anxiety (Barlow, 2002). EA is defined as the tendency to engage in behaviors to alter the frequency, duration, or form of unwanted private events (i.e., thoughts, feelings, physical sensations, and memories) and the situations that occasion them (Hayes, 1994; Hayes et al., 1996). People with OCD tend to avoid situations that give rise to their obsessions by actively avoiding, engaging in compulsions, rationalizing, distracting, and thought-suppressing in response to the distress associated with their obsessions. Therefore, EA serves as a form of negative reinforcement for such response behaviors in OCD. EA also serves as a form of emotion regulation (ER), which is defined as any action that is designed to influence “which emotions we have, when we have them, and how we experience and express them” (Gross, 2002, p. 282). ER is not a dysfunctional process in itself, but it can become a dysfunctional part of OCD when the anxiety one is attempting to regulate cannot and need not be regulated, and when the very act of ER gets in the way of meaningful life activities[1]. The compulsion-maintenance and ER functions of EA as well as related conclusions for the practice of clinical psychology will be further discussed.

An RFT Explanation of Obsessions in OCD and BDD[2]

 The principles of RFT offer explanations for the obsessional component of OCD. As mentioned previously, BDD is a subtype of OCD, and its obsessional symptomology related to bodily appearance can also be explained by RFT. Neziroglu’s learning model of BDD suggests that early experiences and conditioning begin to shape an individual’s cognitions and emotions, and language mediates learning and conditioning and development of appearance-related beliefs (Neziroglu & Mancusi, 2012). RFT then explains the role of language and how it influences cognitions and emotions in BDD. According to this model, evaluative conditioning strengthens obsessions in BDD. Evaluative conditioning is a type of classical conditioning defined as a change in liking, which occurs due to an association with a positive or negative stimulus (Hofmann, De Houwer, Perugini, Baeyens, & Crombez, 2010). Language supports classical conditioning by stimulating complex networks of associated ideas, images, and evaluations; for example, someone could learn that having a pimple (unconditioned stimulus or US) is associated with disgust (unconditioned response or UR), and later any blemish (conditioned stimulus or CS) would elicit disgust (conditioned response or CR). The word pimple is similar to acne or blemish, and thus those similar words alone gain the ability to elicit the same aversive affect through classical conditioning via the relational frame of coordination or similarity. This is why an individual with BDD may respond with aversive affect to any word or event that reminds him or her of his or her “defective” bodily feature. So, for example, if an individual with BDD has a disgust reaction at some point to a pimple, anything similar may give rise to the same reaction by thinking about it, even if it no longer exists. To summarize the role of evaluative conditioning in the development of BDD, a negative event about one’s physical appearance may serve as a US (e.g., being made fun of because of one’s weight or the size of one’s stomach), which leads to an unconditioned emotional response (e.g., anxiety, depression, shame, or disgust), then the US (being teased about one’s weight or stomach) is evaluated as negative, and finally anything paired with it is evaluated as negative as well. For example, if a person is made fun of for having a big stomach, this evokes negative affect, and subsequently, a word like “big” (CS) or a body part like the stomach (CS) is evaluated as negative. According to evaluative conditioning, any previously neutral word or body part can lead to the same negative reaction as the unconditioned stimulus (being teased about one’s weight or stomach), and when the individual is then exposed to the body part of concern, a negative emotional response occurs. Not only is the CS (the word “big” or a body part like the stomach) evaluated negatively, but it evokes the same response (e.g., anxiety or disgust) as the US (being teased about one’s weight or stomach). The interplay between language and evaluative conditioning seem to factor in to the obsessional component of BDD.

 Another idea within RFT called arbitrary associations, or the use of language as a way of making connections that may or may not be factual, also contributes to the explanation of BDD symptomology. It is possible that in people with BDD, arbitrary associations between appearance, social success, and/or undesirable physical traits are made, and these faulty associations rarely are tested and thus not likely to be extinguished (Neziroglu & Mancusi, 2012). To illustrate this point, a child may hear a parent comment about another child who is annoying to invite over because she is a finicky eater. However, the parent may also comment that this other child is so cute and pretty and it is a shame that she is such a difficult and finicky eater. Due to this, the first child may learn that people tolerate unpleasantness (finicky eating) when the person is pretty, and the child may start comparing herself with her friend in terms of looks in order for people to accept her as well. These faulty arbitrary associations could lead to BDD symptoms in the form of obsessing about appearance and associated emotional responses such as anxiety. Another example of an arbitrary association is if one thinks of using a spoon to eat, he or she may have a neutral response, but if one thinks of using a spoon that fell in a toilet bowl to eat, then he or she may have a disgust reaction; due to language, we make arbitrary associations and have certain emotional responses to thoughts. In addition, referring back to the role of conditioning and language in creating and perpetuating obsessions in BDD, language may be mediating the direct conditioning of the CS (the word “big” or a person’s stomach) and the US (being made fun for one’s weight or stomach size); as the CS (the word “big” or a person’s stomach) is paired with the CR (e.g., anxiety or disgust), a set of cognitions is strengthened and a set of beliefs initially introduced through life experiences continues to be reinforced. In line with this example, these beliefs may center on thoughts such as “Looking fit is the most important thing in the world,” “I can only succeed in life if I look fit,” “I am worthless if I do not look fit,” etc[3]. Arbitrary associations created using language seem to play an important role in causing the problematic obsessions associated with BDD.

 Building upon the role of language and evaluative conditioning in producing obsessions in BDD, higher-order conditioning also interacts with language to perpetuate obsessional symptoms. Higher-order conditioning is a form of learning in which a stimulus is first made meaningful for an organism through an initial step of learning, and then that stimulus is used as a basis for learning about some new stimulus (Jara, Vila, & Maldonado, 2006). An example of higher-order conditioning in BDD would be while someone is mirror-checking one body part, a secondary body part becomes more noticeable and elicits the same negative response as the original area of concern. In fact, it is common for individuals with BDD to obsess about more than one body part, as research has found that people with BDD are typically dissatisfied with up to three body parts, with one usually causing the most distress (Khemlani-Patel, 2001; Neziroglu, Khemlani-Patel, & Yaryura-Tobias, 2006b).

Higher-order conditioning can occur through relational framing. For example, initially a child is taught to see an object, then hear its name, and then say its name. Later, the child can hear the name and point to the object; this is an example of the training of the object-word and word-object relations and derived relational responding. So, if a child is taught about his nose, ear, and mouth, then the child can identify the those facial parts when asked about their locations even in the absence of reinforcement for doing so. This phenomenon is known as a derived arbitrarily applicable relation or relational frame, and it is under the control of contextual cues through a process of differential reinforcement. So, after a history of reinforcement, a derived relation emerges without reinforcement (the child being able to identify his or her nose simply by being asked about its location), and generalization to novel situations without direct reinforcement of these situations happens by using what was learned in the past. Relating this phenomenon to BDD and higher order conditioning, if a person has a disgust reaction to a big stomach and then equates a fatty stomach with fatty arms or any other body part, then the other body parts can elicit the same disgust response; this is similar to higher order conditioning where the conditioned stimulus (fatty stomach) is paired with another conditioned stimulus (fatty arms) and thus evokes the same response. Higher order conditioning, assisted by language, seems to play an integral role in the formation and perpetuation of obsessions in BDD.

 Moving away from BDD, RFT also provides explanations for obsessions in OCD. The abilities to relate stimuli based on arbitrary properties and to derive relations that were never directly trained are, together, known as arbitrarily applicable derived relational responding (AADRR). AADRR consists of three main processes known as mutual entailment, combinatorial entailment, and transformation of stimulus functions, all of which can be seen in an individual with OCD (Smith, Bluett, Lee, & Twohig, 2017; Twohig, 2009). For example, a person with obsessions related to contamination fears becoming ill due to germs, and consequently avoids the use of public bathrooms. Through language, illness is related to germs, germs are related to public bathrooms, and the person avoids bathrooms as he or she would avoid illness. In this example, germs are in a causal relation or frame with illness (in other words, germs cause the illness) and a hierarchical relation or frame with public bathrooms (in other words, germs are in restrooms). Both of these relations may have been directly trained at some point in the individual’s life, but due to language, the individual now derives that public bathrooms cause illness, which is a relation that was never directly trained between two stimuli that share no formal properties. The process by which the germs, illness, and bathroom become related is combinatorial entailment, and if the relation were only between two stimuli — such as illness and germs — this would be called mutual entailment. Transformation of stimulus function in this case would be the bathroom having acquired the same functions for the person as illness, and therefore leading to avoidance of the bathroom. Through AADRR, obsessions in OCD can be accounted for.

 The notion that language as explained by RFT can account for obsessions in OCD and BDD brings up important implications to the practice of clinical psychology. Acceptance and commitment therapy (ACT) promotes the therapeutic development of the self-as-context through awareness of a sense of perspective that RFT shows emerges through the diectic relational frames of I/you, here/there, and now/then. Self-as-context is a difficult concept to grasp at first, but it is known as the perspective/locus/space from where observing happens, the observing self, the silent self, self-as-perspective, pure awareness, or pure consciousness (Harris, 2009). This sense of self supports contact with the present moment that is open, undefended, and effective. Patients suffering from conditions such as OCD are helped to develop this sense of perspective in which experiences are noticed from an accepting and open stance and not judged as either good or bad (Twohig, Plumb, Mukherjee, & Hayes, 2010). Non-evaluative description and observation can help grow a sense of perspective for which thoughts and other private events have less power. Self-as-context can help people suffering from OCD recognize that they are not controlled by or defined by their private experiences or OCD symptoms, and they may learn to contain those experiences and observe them non-threateningly. [4]

The Role of EA In the Maintenance of Compulsive Responding and EA for ER

 Thus far, we have seen how RFT can explain language’s role in the production and perpetuation of obsessions. This is only one component of OCD, however, and does not address the compulsive aspect or emotional aspect of the disorder. Simply put, obsessions lead to distress/anxiety, and consequently people with OCD tend engage in EA of situations that give rise to obsessions and their associated anxiety.

 EA can maintain compulsive responding in OCD through negative reinforcement. Oftentimes, people with OCD tend to follow the verbal rule that obsessions cause behaviors, as well as the corollary that obsessions are dangerous and must be controlled (Hayes, Strosahl, Wilson, Bissett, Pistorello, J. et al., 2004); Hayes, Luoma, Bond, Masuda, & Lillis, 2006). This way of thinking leads to the problematic response style of EA. EA sustains itself through negative reinforcement, because it rewards the individual with a sense of temporary relief from the anxiety associated with obsessions (Bouton, Mineka, & Barlow, 2001).  EA can occur by way of compulsions, which are behaviors performed in the service of controlling obsessions (Twohig et al., 2010). For example, an individual who experiences distressing obsessions with regard to the symmetry of his or her work environment may engage in compulsive EA by ordering his or her work environment. This behavior will temporarily relieve anxiety or distress associated with the obsessions regarding symmetry, but this relief is only temporary as obsessions and compulsions will occur again when there is change to the work environment. EA also maintains compulsive responding in OCD by preventing opportunities for corrective emotional learning that would come about through direct experience with the distressing stimulus (e.g., Eysenck, 1987). It is evident that EA maintains compulsive behavior in OCD.

EA also serves as a method of ER in OCD. Anxiety in itself is a painful [5]emotion, but it transforms into problematic suffering through EA, because oftentimes EA occurs in response to the thoughts that anxiety is bad, dangerous, and requires a response (Eifert & Forsyth, 2005). Thoughts transform from just thoughts into bad thoughts, anything associated with anxiety or the likelihood of experiencing anxiety becomes a problem, and thus, anxiety is likely to be responded to with anxiety, and fear with fear. EA follows as an effort to manage anxiety and the circumstances that give rise to it — EA works as a form of ER. Marsha Linehan (1993) defined suffering as pain plus non-acceptance, and EA is exactly the response that results from the non-acceptance of pain [6]associated with anxiety; when we do not accept our feelings of anxiety and instead struggle to get rid of them, the pain [7]of normal anxiety turns into the suffering associated with OCD. Suffering manifests when we do not accept and acknowledge the reality of our experiences and instead act to escape from or avoid them. We can see how EA works as a form of ER in OCD and creates a sense of suffering.[8]

Social learning also creates a context where EA can thrive (Hayes, Strosahl, & Wilson, 1999). ER evidences maturity, health and wellness, emotional stability, success, happiness, and fulfillment, and therefore, we typically do not question how life might be if unpleasant emotions and thoughts were treated simply as events to be experienced as part of being human and not as experiences to be managed or controlled. We do not question that culture equates failures of ER with suffering and positive thoughts and feelings with the ability to engage life to its fullest. What results is the widespread attitude that feelings and thoughts must be managed and controlled through the response style of EA, which comes at a significant cost to the individual.[9]

Addressing EA and its negative outcomes is an important issue in the practice of clinical psychology. Acceptance is considered an alternative response to EA, and it is defined as a behavior involving the experience of private events as they are and not taking steps to regulate or control them (Twohig et al., 2010); it involves an active embrace of one’s inner experiences. Acceptance has been shown to increase an individual’s willingness to make contact with obsessive-like thoughts (Marcks & Woods, 2005, 2007). Acceptance is also central to many mindfulness-based therapies (e.g., Segal, Teasdale, & Williams, 2004), and the more that individuals with OCD are in contact with their obsessions — as seen in ERP –  the more effective the exposure therapy is likely to be (e.g., Abramowitz, Franklin, & Foa, 2002). So, when treating OCD from an ACT model, clients are encouraged to accept the presence of obsessions and their associated anxiety without attempting to change these experiences through EA in the form of avoidance, compulsions, cognitive actions or any other control strategy (Smith, et al., 2017). ACT can promote acceptance through the use of powerful metaphors. One such metaphor likens the struggle of OCD to an unfair match of basketball between amateurs and professionals. Acceptance is likened to a fair game of basketball that results in increased quality of life due to moving forward. In other words, rather than winning the unfair game, acceptance involves playing a different game that is fair.

Another metaphor to build acceptance involves the therapist holding a piece of paper, which is likened to be the obsession in OCD. The therapist instructs the patient to not let the paper touch him or her, and the patient puts in a large amount of effort to avoid contact with the paper or push it away when contact is made. Next, the therapist puts the paper on the client’s lap and asks the client to let the paper lay there. The therapist would then explain that the thought was touching the client in both situations, but the former situation took much more effort — the contrast between struggling and acceptance thus becomes clear (Twohig, 2009). Still another metaphor likens the experience of obsessions in the life of an individual with OCD to the fact that it rains sometimes. We could fight against the rain (our obsessions) every day, or we could learn how to live the lives that we want regardless of the weather (our mental state).

A clinically useful allegory for acceptance (and contact with difficult experiences) is the story of a moth. A man finds the cocoon of a moth, and notices that the moth starts forcing its body through a little hole in the cocoon. Thinking that the moth was stuck and stopped making progress, the man takes a pair of scissors and cuts off the remaining bit of the cocoon in order to help the moth get out. However, this stunts the moth’s growth and the moth is never able to fly. The reason for this is because the moth did not struggle getting out of the cocoon, fluid was not forced from its body into its wings, which would have allowed it to fly once out of the cocoon. For the moth, freedom and flight would only come after contact with difficult experiences, and by depriving the moth of this struggle, the man deprived the moth of health.

Exposure and response prevention (ERP) is another effective treatment for OCD to counteract the negative effects of EA. With at least 50% improvement as the cutoff, approximately 75% to 80% of those suffering with OCD can be treated successfully with ERP (Foa, Steketee, Grayson, Turner, & Latimer, 1984). ERP may work because it undermines the use of EA by promoting approach behaviors in a structured way. Fortunately, EA can be addressed through ACT and ERP.[10]

Conclusion

 OCD is an anxiety disorder characterized by distressing obsessions and functionally interfering compulsions, which combine to decrease quality of life and cause suffering (American Psychiatric Association, 2000). RFT acts as a framework utilizing the role of language to explain the occurrence of obsessions in OCD; through processes such as arbitrary associations, AADRR, bi-directional stimulus relations, and relational framing, evaluative and higher-order conditioning can occur and lead to BDD-related obsessions. Thus, obsessions in OCD and BDD are ultimately created through language and can be explained by RFT. Development of the self-as-context, as conceptualized by ACT, can support contact with the present moment that is open, undefended, and effective (i.e., acceptance). Acceptance of obsessions can ultimately give obsessions less power over the individual and reduce suffering. Further research and theorizing regarding the implications of RFT in the practice of clinical psychology could prove tremendously helpful, similar to acceptance. [11]

In response to the anxiety associated with obsessions, EA can act to maintain compulsive responding through negative reinforcement. Avoiding contact with an aversive experience through active avoidance, engaging in compulsions, rationalizing, distracting, and thought-suppressing (forms of EA) negatively reinforces such behavior by temporarily relieving anxiety. However, in the long-term, EA reduces quality of life and prevents individuals from engaging in meaningful and valuable activities. EA also serves as a dysfunctional method of ER and creates suffering by transforming the pain of normal anxiety into the suffering of disordered anxiety. Social learning contributes to the context in today’s society that allows EA to thrive by cultural norms associating positive emotions with happiness and negative emotions with dysfunction. Acceptance and ERP are two methods that promote engagement with difficult experiences, promote approach behavior, and reduce EA. Further research of metaphors and their associated increases with acceptance behavior would be useful. Studying the quality of what makes certain metaphors more effective than others for promoting acceptance behavior could be useful, and studying ways to combine acceptance and ERP more effectively could lead to positive outcomes for anxiety disorders such as OCD.

References

Abramowitz, J.S., Franklin, M.E., & Foa, E.B. (2002). Empirical status of cognitive–behavioral therapy for obsessive–compulsive disorder: A meta-analytic review. Romanian Journal of Cognitive and Behavioral Psychotherapies, 2, 89–104.

American Psychiatric Association. (2000). Diagnostic and statistical manual-text revision. Washington, DC: American Psychiatric Association, 256.

Barlow, D.H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic (second edition). New York: Guilford Press.

Bouton, M. E., Mineka, S., & Barlow, D. H. (2001). A modern learning theory perspective on the etiology of panic disorder. Psychological Review, 108, 4-32.

Cororve, M. B., & Gleaves, D. H. (2001). Body dysmorphic disorder: a review of conceptualizations, assessment, and treatment strategies. Clinical Psychology Review, 21(6), 949-970.

Eifert, G. H., & Forsyth, J. P. (2005). Acceptance and commitment therapy for anxiety disorders: A practitioner’s treatment guide to using mindfulness, acceptance, and values-based behavior change. New Harbinger Publications.

Eysenck, H. J. (1987). Behavior therapy. In H. J. Eysenck & I. Martin (Eds.), Theoretical foundations of behavior therapy (pp. 3-34). New York: Plenum.

Foa, E. B., & Kozak, M. J. (1995). DSM-IV field trial: Obsessive-compulsive disorder. The American Journal of Psychiatry, 152(1), 90.

Foa, E. B., Steketee, G., Grayson, J. B., Turner, R. M., & Latimer, P. R. (1984). Deliberate exposure and blocking of obsessive-compulsive rituals: Immediate and long-term effects. Behavior Therapy, 15(5), 450-472.

Gross, J. J. (2002). Emotion regulation: Affective, cognitive, and social consequences. Psychophysiology, 39, 281-291.

Harris, R. (2009). ACT made simple: An easy-to-read primer on acceptance and commitment therapy. New Harbinger Publications.

Hayes, S. C. (1994). Content, context, and the types of psychological acceptance. In S. C. Hayes, N. S. Jacobson, V. M. Follette, & M. J. Dougher (Eds.), Acceptance and change: Content and context in psychotherapy (pp. 13-32). Reno, NV: Context Press.

Hayes, S. C., Barnes-Holmes, D., & Roche, B. (Eds.). (2001). Relational frame theory: A post-Skinnerian account of human language and cognition. Springer Science & Business Media.

Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and Commitment Therapy: An experiential approach to behavior change. New York: Guilford Press.

Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experiential avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64, 1152-1168.

Hayes, S.C., Luoma, J.B., Bond, F.W., Masuda, A., & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behaviour Research and Therapy, 44, 1–25.

Hayes, S.C., Strosahl, K.D., Wilson, K.G., Bissett, R.T., Pistorello, J. et al. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54, 553–578.

Hofmann, W., De Houwer, J., Perugini, M., Baeyens, F., & Crombez, G. (2010). Evaluative conditioning in humans: a meta-analysis. Psychological Bulletin, 136(3), 390.

Jara, E., Vila, J., & Maldonado, A. (2006). Second-order conditioning of human causal learning. Learning and Motivation, 37(3), 230-246.

Kessler, R.C., Chiu, W.T., Demler, O., & Walters, E.E. (2005). Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Archives of General Psychiatry, 62, 617–627.

Khemlani-Patel, S. (2001). Cognitive and behavior therapy for body dysmorphic disorder: A comparative investigation. (Doctoral Dissertation, Hofstra University. 2001). Dissertation Abstracts International: Section B: The Sciences and Engineering, 62, 1087.

Linehan, M. M. (1993). Skills training manual for treating borderline personality disorder. New York: Guilford Press.

Marcks, B.A., & Woods, D.W. (2005). A comparison of thought suppression to an acceptance-based technique in the management of personal intrusive thoughts: A controlled evaluation. Behaviour Research and Therapy, 43, 433–445.

Marcks, B.A., & Woods, D.W. (2007). Role of thought-related beliefs and coping strategies in the escalation of intrusive thoughts: An analog to obsessive–compulsive disorder. Behaviour Research and Therapy, 45, 2640–2651.

Neziroglu, F., & Mancusi, L. M. (2012). A proposed learning model of body dysmorphic disorder. In Standard and Innovative Strategies in Cognitive Behavior Therapy. InTech.

Neziroglu, F., Khemlani-Patel, S., & Veale, D. (2008). Social learning theory and cognitive behavioral models of body dysmorphic disorder. Body Image, 5(1), 28-38.

Neziroglu, F., Khemlani-Patel, S., & Yaryura-Tobias, J. A. (2006b). Body dysmorphic disorder. In J. E. Fisher & W. T. O’Donohue (Eds.), Practitioner’s guide to evidence-based psychotherapy (pp. 142–150). New York: Springer.

Segal, Z.V., Teasdale, J.D., & Williams, J.M.J. (2004). Mindfulness-based cognitive therapy: Theoretical rationale and empirical status. In S.C. Hayes, V.M. Follette, and M.M. Linehan (Eds.), Mindfulness and acceptance (pp. 45–65). New York: Guilford Press.

Smith, B. M., Bluett, E. J., Lee, E. B., & Twohig, M. P. (2017). Acceptance and Commitment Therapy for OCD. The Wiley Handbook of Obsessive Compulsive Disorders, 596-613.

Twohig, M. P. (2009). The application of acceptance and commitment therapy to obsessive-compulsive disorder. Cognitive and Behavioral Practice, 16(1), 18-28.

Twohig, M., Plumb, J., Mukherjee, D., & Hayes, S. (2010). Suggestions from acceptance and commitment therapy for dealing with treatment-resistant obsessive–compulsive disorder. Treatment resistant anxiety disorders: Resolving impasses to symptom remission, 255-289.

[1]reword this sentence

[2]This was an amazing account. So well done!

[3]Avoid “etc.” in formal writing. “and so on” works as an alternative.

[4]Such a great point.

[5]Perhaps “aversive”?

[6]Distress?

[7]Maybe “unpleasantness”?

[8]So well said!

[9]Brilliantly said.

[10]All correct. Seems like maybe an example of how ERP treats EA would be useful.

[11]not fully clear idea/logic
 

How are Social Penetration Theory and Computer Mediated Communication used in relational development and relational maintenance

Introduction
Technology today has changed the way people communicate with one another, creating an abundance of new methods to self-disclose information to people in a faster and less stressful way. A large part of studying the Social Penetration Theory is trying to understand how much or what kind of impact self-disclosure and the Social Penetration Theory have on relationships. It has been discussed that the more information you can self-disclose in a relationship and have that self-disclosure be reciprocated will improve the closeness in the relationship.

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What is more commonly being researched now and days is how technology and Computer Mediated Communication play a role in relational development. However, with the use of Computer Mediated Communication, the quality of self-disclosure that is being communicated may not be received as efficiently as it would in a face-to-face interaction. The Social Penetration Theory is a very useful and important tool in being able to predict and explain how self-disclosure produces relational development and how it can also be used to maintain relationships. Whether it is maintaining friendships, family relationships or even romantic relationships.
This paper will discuss how the Social Penetration Theory and Computer Mediated Communication are used in relational development and relational maintenance.  Topics that will be covered throughout this paper are self-disclosure through Computer Mediated Communication; how Computer Mediated Communication is used in relational development and how Computer Mediated Communication is used to maintain relationships.
Theoretical Discussion
Social Penetration Theory assumes that self-disclosure over time helps develop relationships. Social Penetration theory attempts to predict and explain how the use of self-disclosure directly impacts relational development. Self –disclosure is defined as “The voluntary sharing of personal history, preferences, attitudes, feelings, values, secrets, etc., with another person; transparency” (Griffin, 2012, pg. 114). Theorists Irwin Altman and Dalmas Taylor, use “The Onion Metaphor” to further explain that people are more complex than what might originally meet the eye (Griffin, Ledbetter, & Sparks, 2019).
Like an onion, the qualities and attributes of a person that are clearly visible for society to see, are the outer layers of the onion (Griffin et al., 2019). With the process of social penetration, relationships are developed when the amount of self-disclosure is high. The more people can self-disclose in a relationship creates a better opportunity for the relationship to become more intimate.  Each time a person discloses more about his or herself in a relationship is another layer of the Onion being peeled back. As more layers are exposed, just like an onion you will eventually find the core. Someone’s inner core involves one’s values, insecurities, self-image, and deeply felt emotions (Griffin et al., 2019).
However, investing in self-disclosure to advance a relationship can be scary. When people disclose personal information about themselves, it is natural to assume that the other person in the relationship will do the same. This is known as the “Law of reciprocity”, meaning that one’s transparency with others should be lead to an equal return, creating closeness in the relationship (Griffin et al., 2019).  Technology, in today’s world, is creating a more comfortable space for self-disclosure to happen. Dating sites, text messaging, Facebook and Instagram are some examples of how people today are choosing to communicate. This form of communication is being seen between friends, family members and even romantic couples. Technology is not only being used to develop relationships but also maintaining relationships.
Synthesis of Scholarship: Self disclosure
A large part of the Social Penetration Theory is looking to understand how self-disclosure works in regards to relational development. Technology in today’s world is allowing people to take an impersonal approach to self-disclosing information instead of face-to-face communication. Removing cues that you would normally gain from face-to-face interaction could make it more complicated to convey emotion, but technology seems to be creating what some might describe as a more comfortable environment to self-disclose and open up to others. This enables people to use hyper personal communication, which occurs when individuals find it easier to self-disclose through technology rather than in face-to-face interaction. “Those who find their voices through computer-mediated communication (CMC) engage in hyper personal communication” (Walther, 1996, p. 4).
Ayash, Sidelinger and Tibbles state that “Despite the fact that CMC has generally been classified as a relational maintenance behavior. CMC has offered an alternate channel of communication for interactants. Whether by e-mail or IM, computer mediation allows relational development to occur in similar fashion to face-to-face communication”. There is also a correlation between Self-disclosure and relationship satisfaction, in that the more self-disclosure there is in a relationship will lead to a higher level of commitment and relationship satisfaction (Hendricks & Sprecher, 2004). The amount of information that someone is willing to self-disclose in a relationship is influenced by the amount of self-disclosure his or her partner can reciprocate (Hendricks & Sprecher, 2004). This means Self-disclosure is imperative to ensure relational development and relational growth.
Many studies suggest that the development and maintenance of interpersonal relationships is one of the main reasons for Internet use (Bargh & McKenna, 2004). Through numerous studies researchers are also finding out that relationships that are developed through Computer Mediated Communication are similar to relationships developed through face-to-face interactions. Estrada, Fleuriet and Houser (2012 P.3) stated, “relationships developed and maintained through Computer Mediated Communication can be as deep as those fostered in a solely Face-to-Face context”. Text messaging has become a significant form of communication amongst couples, family members, co-workers, etc. Also noted by Estrada, Fleuriet and Houser (2012), even though research supports the notion that Computer Mediated Communication is used to introduce and develop new relationships, it is important to understand how individuals use different forms of mediated communication to improve them and maintain them.
In today’s world, “People are continuously using a variety of behaviors to effectively maintain their relationships” (Ayash, G., Godorhazy, A., Sidelinger, R. J.  & Tibbles, D. 2008 P. 342). Computer Mediated Communication is even more imperative for relational maintenance in long distance relationships. Whether two people live far apart or one person in the relationship travels a lot, people have to find and easy way to communicate. Email and text messaging have proven to be a leader in forms of Computer Mediated Communication used in relational maintenance.               “The rapid advancement of technology has changed the way the world operates. Technology now allows people the opportunity to communicate from opposite ends of the globe” (Ayash, Sidelinger and Tibbles p. 3). Per Hendricks and Spreecher “Relationship maintenance is the process that occurs after a relationship begins and until a relationship ends, and it can be described as all the behaviors that keep relational partners satisfied and that contribute to relationship continuation” (Hendricks & Sprecher, 2004 p. 860).
Conclusion
Self-disclosure is imperative in regards to relational development and relational growth. Developing a relationship through self-disclosure can be tough because it takes courage and trust to put your self out there and open up. Having to self-disclose through Computer Mediated Communication does not make the process any easier. It might actually make it more difficult in the beginning because it is removing the normal cues one is used to getting through face-to-face interactions. However, now and days this form of communication is becoming ever more popular and is becoming the norm for the new generation. The articles provide useful information in comparing the differences between self-disclosing in face-to-face and Computer Mediated Communication. However, more research needs to be done on the similarities between the two and the benefits that can come from self-disclosure through Computer Mediated Communication. One example of a benefit would be the relational development that can evolve through Computer Mediated Communication.  As technology in the world today continues to develop, it is important to learn how to use these new forms of communication in order to maximize relational development.
References

Bargh, J. A., & McKenna, K. Y. A. (2004). The Internet and social life. Annual Review of Psychology, 55, 573–590. http://www.uvm.edu/pdodds/files/papers/others/2004/bargh2004a.pdf
Ayash, G., Godorhazy, A., Sidelinger, R. J.  & Tibbles, D. (2008). Couples Go Online: Relational      Maintenance Behaviors and Relational Characteristics Use in Dating Relationships. Human Communication, 11(3), 341–355.https://search-ebscohost-com.ezproxy1.lib.asu.edu/login.aspx?direct=true&db=ufh&AN=34919166&site=ehost-live
Estrada, D., Fleuriet, C., & Houser, M. (2012). The Cyber Factor: An Analysis of Relational Maintenance Through the Use of Computer-Mediated Communication. Communication Research Reports, 29(1), 34–43. https://doi-org.ezproxy1.lib.asu.edu/10.1080/08824096.2011.639911
Ramirez, A., & Broneck, K. (2009). “IM me”: Instant messaging as relational maintenance and everyday communication. Journal of Social & Personal Relationships, 26(2/3), 291–314. https://doi-org.ezproxy1.lib.asu.edu/10.1177/0265407509106719
Walther, J. B. (1996). Computer-mediated communication: Impersonal, interpersonal, and hyper personal interaction. Communication Research, 23(1), 3. https://doi-org.ezproxy1.lib.asu.edu/10.1177/009365096023001001

 

Relational Databases: Functional Dependency and Normalization

Abstract

Functional dependencies and Normalization play an important role in relational database design. Functional dependencies are key to establishing the relationship between key and non-key attributes in a relation. Normalization process works towards removing anomalies in a relation and prevents data redundancy. This paper, intended to be a graduate research paper, establishes the definitions of these concepts. The paper introduces Functional Dependency and explains its inference rules. The paper also introduces Normalization and various normal forms 1NF thru 5NF including the BCNF. The paper also explains how Functional Dependencies and Normalization are related, why they are important with regards to relational databases, and advantages of designing a normalized database.

Relational Databases: Functional Dependency and Normalization

Definitions and Concepts

Functional Dependency

A functional dependency is a constraint between two sets of attributes from the database. A functional dependency, represented by X → Y, between two sets of attributes X and Y that are subsets of a relation R specifies a constraint that, for any two tuples t1 and t2 in R that have t1[X] = t2[X],they must also have t1[Y] = t2[Y].

This means the values of the set of attributes Y of a tuple in R are determined by the set of attributes X. In other words, the values of the set of attributes X functionally determine the values of the set of attributes Y. We can also say that Y is functionally dependent on Y.

The set of attributes X on the left-hand side of the functional dependency is called determinant and the set of attributes Y on the right-hand side of the functional dependency is called dependent. Despite the mathematical definition a functional dependency cannot be determined automatically. It is a property of the semantics of attributes – the database designers will have to understand how the attributes are related to each other to specify a functional dependency. (Elmasri, Ramez and Shamkant B. Navathe. 2006)

Example

Consider the example of an SSN (Social Security Number) database. Every individual has a unique SSN. So, the other attributes of the relation, like name, address etc. can be determined using the SSN. That makes SSN a determinant, and name, address, the dependents – thus establishing the functional dependencies:

SSN  name

SSN  address

Inference Rules for Functional Dependency

Armstrong’s axioms are a set of inference rules used to infer all the functional dependencies on a relational database. They were developed by William W. Armstrong.

Axiom of reflexivity: if Y is a subset of X, then X determines Y

If Y is a subset of X then X  Y

Axiom of augmentation: if X determines Y, then XZ determines YZ for any Z

 If X  Y, then XZ  YZ

Axiom of transitivity: if X determines Y and Y determines Z, then X must determine Z

 If X  Y and Y  Z, then X  Z

Union: if X determines Y and X determines Z then X must also determine Y and Z

 If X  Y and X  Z, then X  YZ

Decomposition: if X determines Y and Z, then X determines Y and X determines Z separately

 If X  YZ, then X  Y and X  Z

Normalization

Database Normalization is a process that allows the storage of data without unnecessary redundancy and thereby eliminate data inconsistency. A normalized database eliminates anomalies in updating, inserting, and deleting data, which improves the efficiency and effectiveness of the database. Users can maintain and retrieve data from a normalized database without difficulty. Data Normalization can be used by the designer of a database to identify and group together related data elements (attributes) and establish relationships between the groups.

Database Normalization concept and its ‘Normal Forms’ were originally invented by Edgar Codd, the inventor of the relational model. The ‘Normal Forms’ provide the criteria for determining a table’s degree of vulnerability to logical inconsistencies and anomalies. The higher the normal form applicable to a table, the less vulnerable it is.

First Normal Form (1NF)

An entity type or table is in 1NF when each of its attributes contain simple values which are atomic and contains no repeating groups of data. The domain of an attribute in an 1NF table must include only atomic (simple, indivisible) values and that the value of any attribute in a tuple must be a single value from the domain of that attribute.

Example

Consider the address attribute in a sales database. It is not an atomic attribute, because it is made up of atomic attributes as street, city, state and zip. For the relation to be in 1NF, the appropriate database design should have the atomic attributes street, city, state and zip instead of an address attribute.

Un-Normalized: sales (date, order_no, product_no, product_description, price, quantity_sold, cust_name, cust_address)

1NF: sales (date, order_no, product_no, product_description, price, quantity_sold, cust_name, cust_street, cust_city, cust_state, cust_zip)

Second Normal Form (2NF)

An entity type or table is in 2NF when it is in 1NF and all its non-key attributes depend on the whole key (i.e., functional dependency). There cannot be partial dependencies.

Example

Continuing with the sales database, the order_no and the product_no form the composite key for the table. There are partial dependencies – date is dependent on order_no, but not product_no – which violates the requirement for 2NF. The product_description is dependent on product_no and not on order_no. Removing these partial dependencies will result in 2NF.

1NF: sales (date, order_no, product_no, product_description, price, quantity_sold, customer_name, customer_street, customer_city, customer_state, customer_zip)

2NF: order (date, order_no, cust_no);

product (product_no, product_description, price);

order_detail (order_no, product_no, quantity_sold);

customer (cust_no, cust_name, cust_street, cust_city, cust_state, cust_zip)

Third Normal Form (3NF)

An entity type or table is in 3NF when it is in 2NF and non-key attributes do not depend on other non-key attributes (i.e., there is no transitive dependency).

Example

Continuing with the sales database, the non-key attributes cust_city and cust_state are dependent on cust_zip which is a non-key attribute. Creating a separate zip table will transform the design into 3NF, where in there are no more dependencies between non-key attributes.

2NF: order (date, order_no, cust_no);

product (product_no, product_description, price);

order_detail (order_no, product_no, quantity_sold);

customer (cust_no, cust_name, cust_street, cust_city, cust_state, cust_zip)

3NF: order (date, order_no, cust_no);

product (product_no, product_description, price);

order_detail (order_no, product_no, quantity_sold);

customer (cust_no, cust_name, cust_street, zip_code);

zip (zip_code, city, state)

Boyce Codd Normal Form (BCNF)

An entity type or table is in BCNF when it is in 3NF and all candidate keys defined for the relation satisfy the test for third normal form.

Example

Continuing with the sales database, all the candidate keys already satisfy the 3NF requirements.

Fourth Normal Form (4NF)

An entity type or table is in 4NF when it is in BCNF and there are no non-trivial multi-valued dependencies. To move from BCNF to 4NF, remove any independently multi-valued components of the primary key to two new parent entities.

Example

For example, a professor can teach multiple subjects and can also mentor multiple students. To be in 4NF, the professor to subjects should be a separate relation and professor to students should be a separate relation – since they are independent of each other

Fifth Normal Form (5NF)

To be in 5NF, a relation decomposed into two relations must have lossless-join property, which ensures that no spurious tuples are generated when relations are reunited through a natural join.

Example

In the sales database example, when the sales database was split into order and product, the natural join of those two tables does not result in loss of data (tuples).

(Russell, Gordon. Chapter 4; Nguyen Kim Anh, Relational Design Theory)

Importance of Functional Dependency and Normalization to Relational Model

How are they related

Normalization theory draws heavily on the theory of functional dependencies. When a database designer sets out to design a database, it is essential to understand the semantics of the data – how the attributes are related to one another. This helps in establishing the functional dependencies between attributes. Once the functional dependencies are identified, the design the database in to a ‘normal form’ of the highest order possible is easier. Rules for each normal form, starting from the 1NF are invariably framed around maintaining the functional dependencies and are also based on the inference rules for functional dependencies (refer Inference Rules section). For example, to be in 2NF the non-key attributes should be dependent on the whole-key, which means the functional dependencies should be satisfied. Similarly, to be in 3NF, transitive dependency should be removed, which can be done if the functional dependencies are established correctly.

In other words, database normalization process ensures an efficient organization of data in database tables, which results in guaranteeing that data dependencies make sense, and also reducing the space occupied by the database via eliminating redundant data.

Why are they necessary for Relational Database model?

Functional dependencies play an important role in relational database design. They are used to establish keys that are used to define normal forms for relations. In addition, they help in deriving constraints based on the relationships between attributes. As a database grows in size and complexity it is essential that order and organization be maintained to control these complexities and minimize errors and redundancy in the associated data. This goal is managed by normalization. Database normalization minimizes data duplication to safeguard databases against logical and structural problems, such as data anomalies.

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Normalization can help keep the data free of errors and can also help ensure that the size of the database doesn’t grow large with duplicated data. Normalization permits us to design our relational database tables so that they “(1) contain all the data necessary for the purposes that the database is to serve, (2) have as little redundancy as possible, (3) accommodate multiple values for types of data that require them, (4) permit efficient updates of the data in the database, and (5) avoid the danger of losing data unknowingly (Wyllys, R. E., 2002).”

The resulting normalized database is highly efficient, which can be characterized by –

Increased Consistency: Information is stored in one place and one place only, reducing the possibility of inconsistent data.

Easier object-to-data mapping: Highly-normalized data schemas in general are closer conceptually to object-oriented schemas because the object-oriented goals of promoting high cohesion and loose coupling between classes results in similar solutions.

Moreover, a normalized database is advantageous when operations will be write-intensive or when ACID (Atomicity, Consistency, Isolation, Durability) compliance is required. Some advantages include:

Updates run quickly since no data being duplicated in multiple locations.

Inserts run quickly since there is only a single insertion point for a piece of data and no duplication is required.

Tables are typically smaller than the tables found in non-normalized databases. This usually allows the tables to fit into the buffer, thus offering faster performance.

Data integrity and consistency is an absolute must if the database must be ACID compliant. A normalized database helps immensely with such an undertaking.

Searching, sorting, and creating indexes can be faster, since tables are narrower, and more rows fit on a data page.

Minimizes/avoids data modification issues.

(https://en.wikipedia.org/wiki/ACID_(computer_science))

Summary

The paper defined the concept of functional dependency, which is the basic tool for analyzing relational schemas, and discussed some of its properties. Functional dependencies specify semantic constraints among the attributes of a relation schema. Next it described the normalization process for achieving good designs It presented examples to illustrate how by using the general definition of the normal forms, a given relation may be analyzed and decomposed to eventually yield a set of relations in 3NF. The paper also touches not often used BCNF, 4NF and 5NF normal forms.

Then the paper explains how functional dependencies and normalization are inter-related in the design of a relational model database. It explains the importance of functional dependency and normalization in the design of a relational database. A normalized database is highly efficient and has many advantages.

References

Wyllys, R. E., 2002. Database management principles and applications

Elmasri, Ramez and Shamkant B. Navathe. 2006. Fundamentals of Database Systems. 5th ed. Reading, MA: Addison-Wesley

Russell, Gordon. Chapter 4 – Normalization. Database eLearning

Nguyen Kim Anh, Relational Design Theory. OpenStax CNX

Gaikwad, A.S., Kadri, F.A., Khandagle, S.S., Tava, N.I. (2017) Review on Automation Tool for ERD Normalization. International Research Journal of Engineering and Technology (IRJET) [Online]. 4 (2), pp. 1323-1325. [Accessed 07 May 2017]. Available from: https://www.irjet.net/archives/V4/i2/IRJET-V4I2259.pdf

https://en.wikipedia.org/wiki/ACID_(computer_science)

Tables

Un-normalized Table: sales

sales

date

order_no

cust_no

product_description

price

quantity_sold

cust_name

cust_address

12/12/2018

1001

A320

MP3

10.00

8

Tom

1 Main St, Hartford, CT 06106

12/12/2015

1001

B101

Ipod

100.00

4

Tom

1 Main St, Hartford, CT 06106

01/05/2019

1002

C101

Blu Ray

80.00

3

Aaron

1 Holy Lane, Manchester, 06040

1NF Table: sales

sales

date

order_no

product_no

product_description

price

quantity_sold

cust_name

….

12/12/2018

1001

A320

MP3

10.00

8

Tom

12/12/2015

1001

B101

Ipod

100.00

4

Tom

01/05/2019

1002

C101

Blu Ray

80.00

3

Aaron

Continued..

sales

….

cust_street

cust_city

cust_state

cust_zip

1 Main St

Hartford

CT

06106

1 Main St

Hartford

CT

06106

1 Holy Lane

Manchester

CT

06040

2NF Table: order

order

date

order_no

cust_no

12/12/2018

1001

101

01/05/2019

1002

102

2NF Table: product

product

product_no

product_description

price

A320

MP3

10.00

B101

Ipod

100.00

C101

Blu Ray

80.00

2NF Table: order_detail

order_detail

order_no

product_no

quantity_sold

1001

A320

8

1001

B101

4

1002

C101

3

2NF Table: customer

customer

cust_no

cust_name

cust_street

cust_city

cust_state

cust_zip

101

Tom

1 Main Street

Hartford

CT

06106

102

Aaron

1 Holy Lane

Manchester

CT

06040

3NF Table: customer

customer

cust_no

cust_name

cust_street

zip_code

101

Tom

1 Main Street

06106

102

Aaron

1 Holy Lane

06040

3NF Table: zip

zip

zip_code

city

State

06106

Hartford

CT

06040

Manchester

CT