Psychopathology: Essays Flashcards

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1
Q

Deviation From Social Norms AO1

A
  • in any society there are standards of acceptabke behaviour
  • anyone who deviates from these socially created norms is classed as abnormal
  • some are implicit and some are policed by laws
  • the behaviour usually offends other people in the social group
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2
Q

Statistical Infrequency AO1

A
  • we define many aspects of what is normal by referring to typical values
  • if we can define what is most common or normal with statistics then we also have an idea of what is not common
  • often depends on time, context and culture
  • abnormality identified as any value thats two standard deviation points away from mean on a normal distribution
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3
Q

DFSM AO3 Strength: Distinguishes Between Desirable and Undesirable

A

E: - social deviance model also considers effect behaviour has on others
- deviance defined in terms of transgression of social rules and social rules are established to help people live together
- according to this definition abnormal behaviour damages others

K: - offers practical way of identifying undesirable + potentially damaging behvaiours to alert others to the need to secure help for indiviuduals

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4
Q

DFSM AO3 Weakness: Context

A

E: - being nude on a nudist beach is normal but being nude in public may be abnormal and possibly an indication of a mental disorder.
- Also, the degree is important, shouting loudly and persistently is deviant behaviour but is only an indication of a mental disorder if it is excessive.

K: - social deviance on its own cannot offer a complete definition of abnormality, because it is inevitably related to both context and degree.

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5
Q

Statistical Infrequency AO3 Strength: Appropriateness

A

E: - Statistical infrequency is used in clinical practice, both as part of formal diagnosis and as a way to assess the severity of an individual’s symptoms.
- For example, a diagnosis of intellectual disability disorder requires an IQ of below 70 (bottom 2%).

K: - value of the statistical infrequency criterion is useful in diagnostic and assessment processes.

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6
Q

The Two Process Model AO1

A
  • Made by Mowrer in 1947 and suggests that all phobias are learnt from the environment
  • Classical and operant conditioning are able to explain the existence of phobias
  • Classical conditioning explains the acquisition of phobias and operant explains the maintenance
  • Stimulus generalisation often occurs and is when somebody who has a phobia has the same beliefs and responses towards other items which are similar to their feared phobic stimulus. This relates to classical conditioning.
  • Negative reinforcement is when someone avoids their phobic stimulus in order to reduce their anxiety which is rewarding. This relates to operant conditioning.
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7
Q

Two Process Model AO3 Strength: Successful Treatments

A

E: - systematic desensitisation is a behaviural treatment for phobias which gradually introduces patient to phobic stimulus
- over time counter conditioning occurs and fear is replaced with relaxation
- flooding is a successful exposure therapy
- patients are immediately exposed to phobic stimulus whilst avoidance is prevented
- causes adrenaline levels to subside after enough time

K: - the fact that both therapies have research to support suggests behaviourist approach must be correct, in part

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8
Q

Two Process Model AO3 Weakness: Doesn’t Explain All Phobias

A

E: - Seligman (1970) suggested that humans are more likely to develop phobias to things that would have been dangerous in our evolutionary past.
- For example, fire, predators, heights.
- Bregman (1934) tried to condition a ‘fear response’ in infants to a block of wood.
- He paired the block with a loud bell to try and condition the wood to produce the response the loud bell produces.
- This experiment failed.

K: - the model lacks population validity as it can’t always relate to other people.

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9
Q

Two Process Model AO3 Weakness: Incomplete Explanation

A

E: - DiNardo (1988) found some who had a traumatic experience developed a phobia of dogs others didn’t.
- Those with the phobia were more likely to believe they would have a similar negative experience in the future.
- This high level of anxiety may lead to catastrophising.

K: - He found that only half of people who had traumatic experiences develop a phobia therefore each person must interpret events differently.

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10
Q

Failure to Function Adequately AO1

A
  • Behaviour is considered abnormal when it causes distress leading to an inability to cope with the demands of everyday life.
  • ‘Demands’ refers to day-to-day activities such as getting up in the morning, eating regularly, communicating with others etc.
  • The abnormal behaviour being shown is often maladaptive, irrational or dangerous.
  • Abnormality is when a lack of proper functioning causes personal distress or distress for others, e.g. disrupting work or personal relations.
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11
Q

Deviation From Ideal Mental Health AO1

A
  • Abnormality is defined as behaviour which fails to meet particular criteria for psychological-wellbeing.
  • Mental health is seen the same as physical health.
  • Ideal mental health is defined by Jahoda’s 6 criteria.
  • The less of this criteria that an individual meets, the more abnormal they are seen to be.
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12
Q

FFA AO3 Strength: Includes Subjective Experience

A

E: - This means it allows us to view mental disorders from the point of view of the person experiencing it and recognises the importance of the experience of the patient.
- However, this may not be an entirely satisfactory approach as it is difficult to assess distress.
- As a result, WHODAS’ objective criteria makes it relatively easy to judge objectively because we can list behaviours (can dress self, can prepare meals).

K: - captures the experience of many people who need help.

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13
Q

FFA AO3 Weakness: Easy To Use Label of Abnormal

A

E: - In practice it can be very hard to say when someone is really failing to function and when they have simply chosen to deviate from social norms - consider, for example, the table on the right.
- Not having a job or permanent address might seem like failing to function, and for some people it would be.
- However, people with alternative lifestyles choose to live ‘off-grid’.
- Similarly, those who favour high-risk leisure activities or unusual spiritual practices could be classed, unreasonably, as irrational and perhaps a danger to self.

K: - people who make unusual choices are at risk of being labelled abnormal and their freedom of choice may be restricted.

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14
Q

DIMH AO3 Weakness: Tries to Apply Principles of Physical Health

A

E: - In general, physical illnesses have physical causes such as a virus or bacterial infection, and as a result this makes them relatively easy to detect and diagnose.
- It is possible that some mental disorders also have physical causes (e.g., brain injury or drug abuse) but many do not.
- They are the consequence of life experiences.

K: - it is unlikely that we could diagnose mental abnormality in the same way that we can diagnose physical abnormality.

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15
Q

Negative Triad AO1

A
  • 3 negative self schemas acquired during childhood: negative view of self, future and world
  • states depression is caused by faulty information processing and irrational thinking
  • these negative schemas are activated whenever a new situation is encountered
  • the schemas lead to systematic negative biases in thinking known as cognitive distortions
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16
Q

ABC Model AO1

A
  • proposed that depression is due to irrational thinking and that the source of this is mustabatory thinking: the thinking that certain ideas or beliefs must be true in order to be happy
  • A: activating event, B: beliefs, C: consequences
  • irrational beliefs and undesirable emotions and behaviour are most likely to lead to depression
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17
Q

Cognitive Explanation of Depression AO3 Strength: Successful Therapies

A

E: - For Beck’s therapy, patients identify automatic thoughts about the world, self, and future.
- These thoughts must then be challenged directly with the therapist for homework reality testing is done to allow them to question their negative beliefs.
- Whereas Ellis’s ABC model has led to Rational Emotive Behavioural Therapy (REBT). This involves the therapist working with the client to dispute and challenge their irrational beliefs.

K: - The fact that there is evidence supporting the effectiveness of CBT suggests that it is applicable and practical.

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18
Q

Cognitive Explanation of Depression AO3 Strength: Research Support

A

E: - The view that depression is linked to irrational thinking is supported by research.
- Hammen and Krantz (1976) found that depressed participants made more errors in logic when asked to interpret written material than non-depressed participants.
- Bates et al (1999) found that depressed participants who were given negative automatic-thought statements became more and more depressed, supporting the view that negative thinking leads to depression.
- However, there is an issue of bidirectional ambiguity as this is a correlation.
- We cannot be sure if the negative thoughts caused the depression or if the depression caused the negative thoughts.

K: - the research may not be fully supporting their view and there is an issue with validity

19
Q

Cognitive Explanation of Depression AO3 Weakness: Blames Individual

A

E: - The cognitive approach suggests that it’s the client who is responsible for their disorder.
- In one sense this is a good thing because it gives the client the power to change the way things are.
- However, there are disadvantages to this stance. It may lead the client or therapist to overlook situational factors, for example not considering how life events or family problems may have contributed to the mental disorder.
- The disorder is simply in the client’s mind and recovery lies in changing that, rather than considering how the client/therapist might change other aspects of the client’s environment and life.

K: - the cognitive approach can’t be used as a complete explanation for depression

20
Q

Genetic Explanation of OCD AO1

A
  • suggests that OCD is inherited in the genetic material which is passed down from parents
    COMT gene:
  • involved in production of enzyme COMT
  • regulates production of dopamine in synapse
  • involved in reward, motivation + motor control
  • form that is common with OCD is low level activity which results in higher levels of dopamine
    SERT gene:
  • regulates transport of serotonin in synapse
  • involved in feelings of well being and happiness
  • form of gene that is common with OCD is high level activity which results in lower levels of serotonin because reuptake mechanism works too hard
21
Q

Genetic Explanation of OCD AO3 Strength: Twin Studies

A

E: - Nestadt et al (2000) reviewed twin studies of OCD.
- It was found that the concordance rate for identical twins (MZs) was 68%, compared to 31% of fraternal twins (DZs).
- However, if it’s fully genetic the concordance rate would be 100% and 50%.

K: - nurture might play a role in OCD.

22
Q

Genetic Explanation of OCD AO3 Weakness: Alternative Explanations

A

E: - Cromer et al (2007) conducted structured clinical interviews of 265 people with OCD.
- Of these, 54% reported experiencing at least one traumatic life event in their lifetime.
- Those who reported traumatic life events tended to have more severe symptoms of OCD.

K: - an interactionist approach needs to be taken.

23
Q

Genetic Explanation of OCD AO3 Weakness: OCD is Polygenic

A

E: - COMT and SERT are not the only genes which contribute to OCD.
- Our understanding of the human genome is advancing all the time, and more genes are being discovered which contribute to OCD.
- Many of these genes contribute a very small risk of OCD, and many of them have many other functions as well.

K: - the knowledge of the brain is limited so this explanation can’t be seen as complete.

24
Q

Neural Explanation of OCD AO1: Worry Circuit

A
  • people with OCD tend to have high levels of activity in orbital frontal cortex (OFC)
  • OFC sends ‘worry’ signals to thalamus which is alerted and confirms ‘worry’ back to OFC
  • in neurotypical brain ‘worry’ signal is suppressed by the caudate nucleus however in atypical brain caudate nucleus is impaired allowing neural activity
  • caudate nucleus’ inability to filter small worries results in worry circuit being overreactive
25
Q

Neural Explanation of OCD AO1: Role of Serotonin and Dopamine

A

The role of serotonin:
- plays key role in operation of OFC and caudate nucleus
- abnormally low levels of serotonin might cause this area to malfunction
Role of dopamine:
- main neurotransmitter of basal ganglia
- high levels of dopamine leads to overactivity in this region which is associated with OCD

26
Q

Neural Explanation of OCD AO3 Strength: Using Brain Scans

A

E: - Saxena and Rauch (2000) reviewed studies of OCD that used PET, fMRI, and MRI neuro-imaging techniques.
- They found consistent evidence of an association between the orbital frontal cortex (OFC) and OCD symptoms.

K: - explanation is highly scientific and provides anatomical support for OCD.

27
Q

Neural Explanation of OCD AO3 Weakness: Comorbidity

A

E: - Depression is also thought to involve disruption to the serotonin system.
- This leaves us with a logical problem when it comes to the serotonin system as a possible basis for OCD.
- It could simply be that the serotonin system is disrupted in many patients with OCD because they are depressed as well.

A: - Furthermore, this creates an issue of bidirectional ambiguity in these correlations as biological

K: - could affect how we diagnose OCD and the treatments for it.

28
Q

Neural Explanation of OCD AO3 Weakness: Unclear Evidence

A

E: - It is not clear exactly what neural mechanisms are involved in OCD.
- Studies have shown that the neural systems involved in decision making are the same systems that function abnormally in OCD (Cavedini et al, 2002).
- Furthermore, some research has also identified other brain systems that may sometimes be involved in OCD.
- No system has been found that always plays a role in OCD.

K: - more research is needed.

29
Q

Systematic Desensitisation AO1

A

Counter-conditioning:
- Taught a new association (conditioned response) to replace the original association.
- Relaxation instead of fear.
- Reciprocal Inhibition - relaxation inhibits the anxiety (fear) as you can not be both scared and relaxed at the same time.
Relaxation:
- Relaxation techniques are taught. Helps to reduce anxiety.
- Encourages reciprocal inhibition.
- Gradual introduction to feared situations.
Desensitisation Hierarchy:
- Patients work their way through a series of events which start off as less stressful and build up to those which are more stressful.
- Relaxation practiced at each stage of hierarchy; patients must remain relaxed so reciprocal inhibition occurs.
- Each stage is practiced until the fear is extinguished.

30
Q

SD AO3 Strength: Effectiveness

A

E: - For example, McGrath et al. (1990) reported that about 75% of patients with phobias respond to this treatment.
- The key to success appears to lie with actual contact with the feared stimulus, so in vivo techniques are more successful than ones just using pictures or imagining the feared stimulus (Choy et al 2007).
- Often a number of exposure techniques are involved- in vivo, in vitro and also modelling, where the patient watches someone else who is coping well with the feared stimulus (Corner 2002).

K: - demonstrates the effectiveness but also the value of using a range of different exposure techniques.

31
Q

SD AO3 Strength: Faster, Cheaper and Require Less Effort

A

E: - For example CBT requires a willingness for people to think deeply about their mental problems, which is not true for behavioural therapies.
- This lack of ‘thinking’ means that the technique is also useful for people who lack insight into their motivations or emotions, such as patients with learning difficulties.
- A further strength is that it can be self administered- a strength that has proved successful with social phobia (Humphrey 1973)

K: - These benefits were confirmed in a study which also found that self-administered therapy was as effective as therapist-guided therapy.

32
Q

SD AO3 Weakness: Not Appropriate for All Phobias

A

E: - Ohman et al (1975) suggest that sd may not be as effective in treating phobias that have an underlying evolutionary survival component (e.g. fear of the dark, heights or dangerous animals), than in treating phobias which have been acquired as a result of personal experience.

K: - sd can only be used effectively in tackling some phobias.

33
Q

Flooding AO1

A
  • Immediate exposure to feared stimulus.
  • Patients are prevented from avoiding the phobic stimulus.
  • Relaxation techniques are practised and new stimulus-response links can be learnt replacing fear with relaxation.
  • Anxiety eventually subsides as adrenaline levels naturally start to decrease (1-3 hours).
  • This is practiced until the fear is extinguished as the patient will remain calm around the phobic stimulus.
  • This can be done in vivo (real life) or in vitro (virtual reality).
34
Q

Flooding AO3 Strength: Effectiveness

A

E: - For example, Choy et al reported that both SD and flooding were effective but flooding was the more effective of the two at treating phobias.
- On the other hand another review (Craske et al 2008) concluded that SD and flooding were equally effective in the treatment of phobias.

K: - flooding is an effective therapy, albeit just one of several options.

35
Q

Flooding AO3 Strength: Faster, Cheaper and Require Less Effort

A

E: - For example CBT requires a willingness for people to think deeply about their mental problems, which is not true for behavioural therapies.
- This lack of ‘thinking’ means that the technique is also useful for people who lack insight into their motivations or emotions, such as patients with learning difficulties.
- A further strength is that it can be self administered- a strength that has proved successful with social phobia (Humphrey 1973)

K: - These benefits were confirmed in a study which also found that self-administered therapy was as effective as therapist-guided therapy.

36
Q

Flooding AO3 Weakness: Individual Differences

A

E: - It can be a highly traumatic procedure.
- Patients are obviously made aware of this beforehand but, even then, they may quit during the treatment which reduces the ultimate effectiveness of the therapy for some people.

K: - Individual differences in responding to flooding therefore limit the effectiveness of the therapy.

37
Q

CBT AO1

A
  • There are lots of different types of CBT for everything from depression to stress.
  • General aim of cognitive therapies is to change negative schemas and irrational thoughts.
  • A cognitive and behavioural element: Reality testing of beliefs encourages reflection on patient behaviour so they can recognise their own faulty cognitions.
    Beck’s Cognitive Therapy:
  • Identify automatic thoughts about the self, world and future – the three negative schemas (‘thought-catching’).
  • ‘Patient as scientist’ – generate hypotheses to test validity of irrational thoughts. Which will be challenged directly with the therapist.
  • Reality testing is done for homework – the client may be asked to record positive things that happen to them – allowing them to question the negative beliefs and prove them incorrect.
    REBT: Rational Emotive Behavioural Therapy (Ellis, 1962):
  • based on ABC model; extended to ABCDEF
  • D: disputing + challenge irrational beliefs, E: effective new beliefs replace irrational ones, F: new feelings + emotions
38
Q

CBT AO3 Strength: Research Support

A

E: - Ellis (1957) claimed a 90% success rate for REBT, taking an average of 27 sessions to complete the treatment- impressive research support for his therapy.
- REBT, and CBT in general, have done well in outcome studies of depression.
- For example, a review by Cuijpers et al (2013) of 75 studies found that CBT was superior to no treatment.
- However Ellis recognised that the therapy wasn’t always effective, and suggested that this could be because some clients didn’t put their revised beliefs into action (Ellis 2001).
- Therapist competence also appears to explain a significant amount of the variation in CBT outcomes (Kuyken and Tsivrikos 2009).

K: - REBT is effective, but other factors relating to both client and therapist may limit its effectiveness.

39
Q

CBT AO3 Weakness: Individual Differences

A

E: - eg CBT appears to be less suitable for people who have high levels of irrational beliefs that are both rigid and resistant to change (Elkin et al 1985).
- CBT also appears to be less suitable in situations where high levels of stress in individual reflect realistic stressors in the person’s life that therapy can’t resolve (Simons et al 1995).
- Ellis also explained possible lack of success in terms of suitability- some people simply don’t want the direct sort of advice that CBT practitioners tend to dispense; they prefer to share their worries with a therapist without getting involved in the cognitive effort associated with recovery (Ellis 2001).

K: - a limitation is the fact that individual differences affect its effectiveness.

40
Q

CBT AO3 Strength: Support for Behavioural Activation

A

E: - belief that changing behaviour can go some way to alleviating depression is supported by study on beneficial effects of exercise.
- Babyak et al (2000) studied 156 adult volunteers diagnosed with major depressive disorder.
- randomly assigned to a four month course of aerobic exercise, drug treatment or a combination of two.
- Clients in all three exhibited significant improvement at end of 4 months.
- 6 months after end of study, those in exercise group had significantly lower relapse rates than those in medication group.

K: - a change in behaviour can indeed be beneficial in treating depression.

41
Q

Drug Therapy AO1

A
  • Drug therapy attempts to increase or decrease levels of neurotransmitters or the activity of neurotransmitters in the brain.
  • The general purpose is to decrease anxiety, lower arousal, lower blood pressure or heart rate.
    Selective Serotonin Reuptake Inhibitors (SSRIs):
  • Antidepressant drugs increase serotonin levels at synapses in the ‘worry circuit’ to help with reducing the anxiety associated with the obsessions in OCD.
  • SSRIs block the reuptake of serotonin at the presynaptic membrane, increasing serotonin concentration at receptor sites on the postsynaptic membrane.
    Tricyclic Antidepressants:
  • These were the first antidepressants used for OCD and now they are used more for OCD than depression.
  • Tricyclics block the transporter mechanism that re-absorbs both serotonin and noradrenaline into the presynaptic cell after it has fired. As a result, more of the neurotransmitters are left in the synapse and their activity is prolonged.
    Benzodiazepine Anxiolytics:
  • These drugs are known as anxiolytics, in that they reduce anxiety.
  • These work by slowing down the activity of the CNS by enhancing the activity of the neurotransmitter GABA (which regulates excitement and has a general quieting effect on many neurons in the brain).
42
Q

Drug Therapy AO3 Strength: Evidence for Effectiveness

A

E: - Typically, researchers use a randomised, double-blind control trial, using both real drug and placebo.
- Somoro (2008) reviewed 17 studies of SSRIs finding them more effective than placebos up to 3 months after.

K: - However, most studies are only on drug effectiveness are short-term, and little long-term data exists.

43
Q

Drug Therapy AO3 Strength: Little Effort from User

A

E: - in CBT, a patient must attend regular meetings and think about how to tackle problem.
- Drugs are also cheaper than CBT and require little monitoring from point of view of NHS.

K: - Additionally, patients may still benefit from fact that talking to a doctor in consultations may help.

44
Q

Drug Therapy AO3 Weakness: Side Effects

A

E: - Nausea, headaches, and insomnia are common in SSRIs, so some may choose not to take drug.
- Hallucinations and irregular heartbeats are common in tricyclics, so only used when SSRIs fail.

K: - There are also issues of addiction, particularly with BZs, so are only prescribed for app 4 weeks.