04 Psychopathology

Question 1

What are the criteria for failing to function adequately?

Answer 1

1. If they are no longer conforming to standard interpersonal rules e.g. eye contact, personal space
2. Experiencing severe personal distress - a common sign of many psychological disorders, main symptom of depression (however sometimes none because they lack insight)
3. Own behaviour is irrational or dangerous - becomes maladaptive if it interferes with individual’s ability to lead a normal life or has a negative effect on others’ lives

Question 2

What are the criteria of DIMH?

Answer 2

1. Be in touch with identity and feelings
2. High self-esteem
3. Resistant to stress
4. Focused on the future and self-actualisation
5. Function as autonomous individuals with accurate perception of reality
6. Being empathetic and showing understanding
7. Having environmental mastery - ability to love, function at work and form interpersonal relationships

Question 3

What are the behavioural characteristics of phobias?

Answer 3

• Panic = panicked behaviours include screaming, crying or running away; in children, they cling to others or throw tantrums
• Avoidance = going out of your way to aviod contact with phobic stimulus - this can interfere with you daily life
• Endurance = alternative to avoidance where you remain in presence of phobic stimulus but experience high levels of anxiety

Question 4

What are the emotional characteristics of phobias?

Answer 4

• Fear = immediate and immensely unpleasant response when we have to encounter phobic stimulus - intense but shorter than anxiety
• Anxiety = unpleasant state of high arousal which stops and individual from feeling relaxed or any positive emotion
• Unreasonable emotional response = response to phobic stimulus goes beyond what is reasonable e.g. screaming and running away for a small insect

Question 5

What are the cognitive characteristics of phobias?

Answer 5

• Selective attention to phobia = paying unnecessary attention to the phobic stimulus when it is present so you struggle to focus on what is really important
• Irrational beliefs = there are irrational beliefs attached to most phobias e.g. with social phobias you may think you must always sound intelligent which increases pressure on the individual to perform well in social situations
• Cognitive distortions = phobic’s perception of the phobic stimulus is distorted so thoughts about phobia s are unpleasant and misrepresented e.g, spiders are ugly, deadly, vile creatures

Question 6

Evaluate Systematic Desensitisation.

Answer 6

• Quick and requires less effort from the client to carry out compared to other forms of psychotherapy like CBT - suitable for people with severe learning disabilities
• Gilroy et al (2003) followed up with patients with blood and spider phobias who undertook SD after 3 months and 33 months. Much less afraid compared to control group who were only taught relaxation techniques - effective in long term
• Cannot treat complex phobias such as social phobias - requires more in-depth therapy such as CBT
• Relies on client’s ability to imagine the phobia when using in vivo technique - only technique for certain phobias e.g. heights

Question 7

Evaluate flooding as a treatment of phobias.

Answer 7

• Cost effective as it only requires one session; Ougrin found that flooding is highly effective and quicker than alternatives; Choy found flooding to be more effective than SD
• Less effective for complex phobias such as social phobias because they have a cognitive aspect to them
• Highly traumatic treatment - elicits high levels of anxiety; Wolpe (1969) had a patient who was so intensely anxious, she had to be hospitalised - many complete treatment because of stress - waste of time and money

Question 8

What are the behavioural characteristics of depression?

Answer 8

• Changes to Activity levels =
  Become lethargic - unable to attend work or school or socialise; or become agitated and struggle to relax (Psychomotor agitation)
• Disruption to sleep and eating behaviour =
  Low sleep = insomnia; excess sleep = hypersomnia; changes to eating leads to loss or gain of weight
• Aggression & Self harm =
  Often irritable and become verbally or physically aggressive - may lead to relationship or work problems; may start acting aggressively towards themselves (self-harm)

Question 9

What are the emotional characteristics of depression?

Answer 9

• Lowered Mood = feelings of sadness - describe themselves as ‘worthless’ or ‘empty’
• Anger = frequent anger towards themselves or others can lead to self-harm
• Lower Self-esteem = self-esteem is emotional experience of how much we like ourselves; reports of low self-esteem or even that they hate themselves

Question 10

What are the cognitive characteristics of depression?

Answer 10

• Poor Concentration = unable to concentrate on tasks as normal and difficulty making decisions
• Attending to and dwelling on the negative = inclined to pay more attention to the negative aspects of the situation and ignore positive
• Absolutist thinking = seeing in black and white; if a situation is slightly unfortunate it is seen as catastrophic

Question 11

What is Beck’s Cognitive Theory of depression.

Answer 11

A person’s cognitions create a vulnerability for depression. There are three processes:
1. Faulty Information Processing:

• Attending to negatives and ignore positives
• Based on overgeneralisations (i have failed one unit test so I am gonna fail all of my tests NOT ACTUALLY) and catastrophising (failed unit test so I will never get into university and I will be homeless)

2. Negative Self-schema:

• Schema is a package of ideas and information which act as a mental framework for the interpretation of sensory information
• Negative self-schema comes from criticism from parents, peers and teacher
• Interpreting information about our self in a negative way

3. Negative Triad:

• Three types of negative thinking developed from faulty information processing and negative self-schema
• negative feelings about self, the world and the future

Question 12

Evaluate Beck’s Model

Answer 12

• ADV1 = 65 pregnant women studied for negative patterns of thinking - those with them before giving birth were more likely to develop post-natal depression - negative cognitions were seen before depression so it is the cause
• ADV2 = Practical application to CBT, successful treatment for depression, supports theory
• DIS1 = Doesn’t explain all aspects of depression; some suffer hallucinations and delusions - cannot explain these symptoms thus incomplete

Question 13

Overall evaluation for cognitive approach to explaining depression.

Answer 13

ADV 1: Practical applications

• Used to develop CBT through Beck’s Theory and REBT through Ellis’ ABC model
• They work by challenging negative and irrational beliefs proven to reduce depression
• Many studies support effectiveness of treatments

ADV 2: Research Evidence Cohen et al (2019)

• Tracked the development of 473 adolescents, measuring their cognitive vulnerability to predict depression
• Those vulnerable were more likely to develop depression in future - supports Beck

DIS 1: Other explanations

• Extensive evidence shows support for idea that it is caused by genes and neurotransmitters
• SSRIs have proven to be an effective anti-depressant as it brings up the levels of serotonin to improve mood
• Therefore cognitive is incomplete explanation

DIS 2: Cause or effect?

• Difficult to determine if irrational thoughts are a cause or consequence of depression.
• If we don’t know cause it may be difficult to find treatment - may not tackle the root only symptom

Question 14

Briefly outline the steps of CBT.

Answer 14

1. Initial Assessment = client and therapist work together to clarify the patient’s problem
2. Goal setting = identify goals and create a plan for achieving them
3. Identify negative/irrational thoughts through Beck’s CBT or Ellis’ REBT
4. Homework = identifying irrational/negative thoughts themself and proving them wrong

Question 15

What is Beck’s CBT?

Answer 15

• Therapist helps identify negative thoughts about the self, world and future (negative triad)
• Client is encouraged to keep a diary to record these thoughts
• Challenging thoughts by drawing attention to positive incidents (reality testing)
• Give social skills training as homework
• Act as scientist and record when they enjoyed an event or interaction - investigating negative beliefs as a scientist would

Question 16

What is Ellis’ REBT?

Answer 16

• Rational Emotive Behaviour Therapy
• Extended ABCDE = D is dispute and E is effect
• Identify and dispute irrational thoughts by giving client more realistic perspective
• Client is challenged through intense debates involving logical disputing and empirical disputing
• Homework for identifying irrational thoughts and proving them wrong e.g. social anxiety = get drink with a friend

Question 17

Evaluate CBT.

Answer 17

ADV 1: March et al (2007)

• Three groups of depressed adolescents - one for anti-depressant, one for CBT and one with combination
• The individual treatments both had 81% improving and combination had 86% improving
• CBT is just as effective as drug therapy and even better when combined

ADV 2: Babyak et al (2000)

• Adults with major depression split into three groups
• Four month course of aerobic exercise, anti-depressants or combination
• 6 months after end of study found that exercise group had much lower relapse rates so a behavioural change is more effective than medication
• Also no withdrawal symptoms like drugs

DIS 1: Severe depression

• Doesn’t work for severe cases because they cannot concentrate or motivate themselves to participate
• They should be treated with drugs and CBT when alert
• Anti-depressants do not require much motivation so CBT cannot be used as a sole treatment

DIS 2: Time consuming and expensive

• Requires them to attend therapy sessions which require money and time and effort as they have to face and talk about their depression
• Drugs are quick and cheap
• Drugs are more beneficial to the economy as they may take days off to attend sessions

Question 18

What are behavioural characteristics of OCD?

Answer 18

• Compulsions = repetitive actions that reduce anxiety e.g. repetitive hand washing to reduce obsessive fear of bacteria
• Avoidance = attempt to reduce anxiety by avoiding situations that trigger it

Question 19

What are emotional characteristics of OCD?

Answer 19

• Anxiety and Stress = unpleasant emotional experience because of powerful anxiety than accompanies compulsions and obsessions
• Accompanying Depression = often accompanies by symptoms of depression; low mood and loss of enjoyment in certain activities or hobbies
• Guilt & Disgust = irrational guilt or disgust towards certain objects or at the self for certain obsessive thoughts (inappropriate or illegal)

Question 20

What are cognitive characteristics of OCD?

Answer 20

• Obsessive thoughts = 90% of OCD sufferers experience thoughts that recur over and over again and can only be relieved by compulsions
• Cognitive strategies to deal with obsessions = coping mechanisms e.g. religious person with obsessive guilt may turn to prayer or meditation to cope - helps manage anxiety but could appear strange to others
• Insight into excessive anxiety = People with OCD are aware that their obsessions are irrational but they still experience catastrophic thoughts and are hyper-vigilant about potential hazards

Question 21

Outline genetic explanations for OCD.

Answer 21

• Candidate genes are genes that create a vulnerability for OCD
• SERT gene involved in regulating serotonin levels (mood, sleep, appetite etc.) - mutation in gene leads to lower levels of serotonin
• COMT gene involved in regulating dopamine levels (reward pathways in the brain) - mutation leads to higher levels
• OCD is polygenic (not caused by single gene but up to 230 genes)
• Aetiologically heterogenous - origin of OCD has different causes (one group of genes causes OCD in one person adn diff group of genes in another)

Question 22

Evaluate genetic explanations of OCD

Answer 22

ADV 1: Supporting evidence

• Nestadt et al (2010) twin studies with OCD; MZ = 68% concordance rate and DZ = 31% rate
• Lewis (2006) family studies; parents = 37% and siblings = 21% so OCD runs in families

DIS 1: Diathesis stress model

• Cromer et al (2007) found that over half of the OCD patients in a sample had a traumatic event in the past
• OCD was more severe when there was more than one trauma
• Supports diathesis-stress model in that OCD is a result of biological vulnerability triggered by stress

DIS 2: Too many candidate genes

• Polygenic up to 230 genes causing OCD each only contributing by a fraction
• Theory provides little predictive value

DIS 3: Twin studies issues

• Twins are not only similar in genes but also their shared environments
• Difficult to separate nuture and nature

Question 23

Outline neuroanatomical explanations of OCD

Answer 23

Basal Ganglia

• involves in coordination of movement and abnormalities have been linked to OCD
• Rapport & Wise - hypersensitivity of basal ganglia = repetitive motor behaviours
• Max et al (1994) found that when the basal ganglia is disconnected from the frontal lobe during surgery, OCD symptoms reduce

Orbito-frontal cortex

• Involves in higher level cognitive processing including decision making and worrying behaviours
• Over-activity of OFC and thalamus in OCD
• Thalamus = increased motivation to clean or check for safety
• OFC = increased anxiety and planning to avoid anxiety
• Whitehead (2004) reviewed brain scans of OCD patients and found consistent hyperactivity in orbital region
• And after treatment, activity reduces to normal levels

Question 24

Evaluate neural explanations of OCD.

Answer 24

• Supported by drug therapy treatment of OCD
• Cannot distinguish between cause and effect
• Drug therapy is not effective for all, there is a sime delay between drugs and improvments but SSRIs increase levels within hours, so low levels of serotonin alone cannot explain OCD

Question 25

Describe SSRIs.

Answer 25

• Selective serotonin re-uptake inhibitors
• prevent serotonin from being re-absorbed and broken down
• this increases its levels in the synapse so it continues to stimulate the post-synaptic neuron to compensate for low levels of serotonin in OCD
• fluoextine (20 mg)
• Tricyclics have same effects but more severe side effects - reserved for those who don’t respond to SSRIs

Question 26

Describe BZs,

Answer 26

• Benzodiazepines - anti-anxiety medication
• Increases levels of inhibitory neurotransmitter GABA which reduces neurone activity
• Tells them to stop firing and 40% respond to GABA
• General quietening influence on brain and reduces anxiety and obsessive thoughts

Question 27

Evaluate drug therapy as a treatment of OCD.

Answer 27

ADV 1: Soomro et al (2008)

• Review of research for effectiveness of SSRIs
• SSRIs more effective than placebos in 17 randomised double blind clinical trials

ADV 1: Cost effective and non-disruptive

• Cost effective compared to psychological treatments such as CBT
• Take less time than CBT which also requires patients to complete homework
• More effective where patients lack motivation for intense psychological treatments

DIS 1: Side-effects

• SSRIs = indigestion, blurred vision and reduced sex drive
• BZs = drowsiness, dizziness and lack of coordination
• BZs have withdrawal effects making them addictive and can cause cognitive impairments in the long-term
• Side effects cause patients to stop taking them

DIS 1: Treats symptoms not cause

• more prone to relapse
• psych treatment more effective for long term