Psychopathology

Question 1

What affects abnormality

Answer 1

your subjective opinions, the culture you live in, the norms where you live or who you live with.

Question 2

Methods of defining abnormalities

Answer 2

1. Statistical deviation
2. Deviation from social norms
3. Failure to function adequately 4. Deviation from ideal mental health

Question 3

Statistical deviation

Answer 3

Occurs when a person has a less common characteristic than most of the population e.g. being more depressed or have less intelligence
This uses the STANDARD DEVIATION and DISTRIBUTION – to what extent does a person’s characteristics deviate from the norm.

Question 4

Limitations of statistical deviation

Answer 4

Fails to distinguish between desirable and undesirable behaviour. Statistically speaking, many very gifted individuals could be classified as ‘abnormal’ using this definition.
Some characteristics are regarded as abnormal even though they are quite frequent.
Depression affects 1 in 5 elderly people- makes it common but does not mea n it isn’t a problem

Question 5

Evaluation of statistical deviation

Answer 5

Real life application - Strength
Statistical deviation is a useful part of clinical diagnosis so it therefore applicable to real life – e.g. the IQ distribution is a representative of the real population – in fact, most disorders have some sort of statistical measurement.
Unusual characteristics could be positive!
Statistical deviation is useless when the “abnormality” is a good thing e.g. an IQ of 130!
This is statistically abnormal but not clinically a bad thing!

Question 6

Evaluation of Statistical Deviat

Answer 6

Labelling – does not always benefit the individual
Meet Dave.
Dave is a happy, kind man who leads a functional and fulfilled life. He is 40 years old and works in a supermarket stacking shelves and keeping all the trollies in order. He lives with his mother in a two bedroom flat and has never left home. He has an IQ of 56.
Should we diagnose Dave with Intellectual Disability Disorder? It will involve someone telling Dave he has a disorder and on his record

Question 7

Evaluation of Statistical Deviati

Answer 7

Labelling – does not always benefit the individual
Labelling is powerful and might affect people in a negative way. If you give people a label, they might start acting in a way that fulfils the label.
Some people are “abnormal” but lead happy and fulfilled lives. If we label someone then we run the risk of developing a self fulfilling prophecy

Question 8

failure to function adequately

Answer 8

cross the line between normal to abnormal at any point when they can no longer cope with the demands of everyday life. ​

Therefore they fail to function adequately.

Question 9

examples to not functioning adequately

Answer 9

Unable to meet basic standards of nutrition
Cannot hold down a job​
Cannot maintain relationships​
Unable to meet basic standards of hygiene

Question 10

rosenhan and selignan

Answer 10

proposed the following signs that can be used to determine whether someone is coping or not.

no longer conforms to standard interpersonal rules

When a person experiences severe personal distress (themselves) or causes distress and discomfort to others. ​

behaviour is unpredictable and sometimes uncontrolled​

behaviour is irrational and hard to understand

Maladaptiveness – the behaviour interferes with a person’s usual daily routine – goes against their long term interests ​

Question 10

Strength of FFA​

Answer 10

Represents a threshold for help​

One strength of FFA is that it provides a criterion for when people need professional help. Most of us have symptoms of mental disorder to some extent at some point in time​

Mind – around 25% of people in the UK will experience a mental health problem in any given year ​

However, many people continue to work despite of these symptoms. It tends to be when we cease to function adequately is when we need to seek professional help. ​

So this criterion means that treatment and services can be specifically targeted to those who need it the most ​

Question 11

weakness of FFA

Answer 11

n practice it can be hard to say when someone is failing top function adequately and when they are simply just deviating from social norms. We might see new age travellers as failing to function adequately but what if its just an alternative lifestyle? Similarly base jumpers might be seen as having a maladaptive lifestyle and spiritualists – irrational. If we class these as FFA, then we risk limiting personal freedom and discriminating against minority groups ​

Question 12

group eg ,New Age traveller

Answer 12

Do not live in permanent accommodation and may not work​

Question 13

group eg. base jumpers

Answer 13

Take part in extreme sports with a high mortality rate​

Question 14

group eg.spirtuality

Answer 14

take part in religious rituals believing they are communicating with the dead

Question 15

limitations of ffa

Answer 15

Having a Psychological Disorder ​
may not result in FFA.​

People often maintain adequate function ​
when facing anxiety or depression. ​
People with personality disorders can appear​
perfectly normal most of the time.​

​

3. Cultural Relativity is a key issue of FFA. Standard patterns of behaviour vary from culture to culture, so FFA may look different depending upon which culture you are in. ​

It is easy to label non-standard lifestyle choices as abnormal, but they may have simply chosen to deviate from social norms – new age travellers​

​

Question 16

good mental health

Answer 16

high self-esteem and a strong sense of identity are related to good mental health. According to Jahoda, to be mentally healthy, someone must know who they are and like what they see. Free from guilt ​
extent of a person’s self-development or progress towards Self-Actualisation. ​
autonomy - the extent to which an individual is free of social influences – independent of other people​
We have no symptoms or distress​

We can cope with stress​

​

Question 17

evaluation of dimh

Answer 17

Cultural relativism:​

Jahoda’s characteristics are rooted in Western societies and are therefore culture bound. – For example, the focus on personal achievement characterised by self actualisation is not the case in collectivist cultures which would instead be considered self-indulgent and they would rather focus on community rather than autonomy and the self– cultural relativity​
​

2. It sets an unrealistically high standard for ideal mental health!​

Very few people actually match the Jahoda’s criteria and probably none of us will achieve them all at the same time or be able to keep them up for very long. So by definition the majority of the population would be classified as abnormal. Thus its unclear how far a person could ​
deviate before being defined as abnormal.​

On the positive side, it makes clear to people the positives of seeking help – such as counselling to improve mental health​

Question 18

Phobias

Answer 18

anxiety disorder. An irrational fear of an object or situation which can interfere with daily living.

Question 19

How phobias are diagnosed

Answer 19

The dsm-5

diagnosing mental disorders

updated every so often as ideas about abnormalities change. We are currently on the 5th edition of the DSM hence the -5 (2013)

Question 20

What are phobias categorised by

Answer 20

excessive fear and anxiety triggered by a place, situation or object. This anxiety is is out of proportion by any danger presented by the phobic stimulus.
3 categories:

Question 21

Three types of phobias

Answer 21

1)agoraphobia
2)social phobias
3)specific phobias

Question 22

Agoraphobia

Answer 22

Fear of open space beings outside or in public spaces

Question 23

Social phobias

Answer 23

Fear of interacting or having social interactions ,public speaking ,using public toilet

Question 24

Specific phobias

Answer 24

Fear of a specific object animal or situations such as flying or an injection

Question 25

Behavioural characteristics of phobias

Answer 25

Panic
Avoidance
Endurance

Question 26

Panic

Answer 26

display panic in response to or in the presence of the phobic stimulus.

crying, screaming, running away, biting nail

freeze, cling to their parent or throw a tantrum.

Question 27

Avoidance

Answer 27

a lot of effort to avoid coming into contact with their phobic stimulu

someone who has a phobia of public toilets may limit the time they can stay outside based off of how long they can hold off using the toilet.

Question 28

Endurance

Answer 28

The alternative to avoidance is endurance, in which the person remains in the presence of the phobic stimulus but continues to experience high levels of anxiety. This may be unavoidable in some instances – such as a person with a fear of flying or social interaction

Question 29

Emotional characteristics of phobias

Answer 29

unpleasant state of high arousal

prevents the sufferer from relaxing or experiencing any positive emotions in the presence of the phobic stimulu

Fear is the immediate response we feel in the presence of the stimulus

Question 30

Arachnophobia

Answer 30

Arachnophobia: fear of spiders – anxiety will increase when you enter any place associated with a spider – zoo, gardens, garden shed. The fear is the immediate response when he actually sees a spider.
Emotional responses are unreasonable, excessive and disproportionate to the danger posed.

Question 31

Cognitive characteristics of phobias

Answer 31

1)selective attention to the phobic stimulus
2)irrational fear
3)cognitive distortions

Question 32

Selective attention to the phobic stimulus

Answer 32

Keeping our attention on something that can harm us or can pose a danger to us can be a good thing as it gives us the best chance to respond to a threat quickly, but this is not so useful when the fear is irrational.

Question 33

Irrational fear

Answer 33

irrational beliefs in relation to the phobic stimulus. For example, a person with social phobias may have beliefs like ‘I must always sound intelligent’ or ‘if I blush they’ll think I’m weak.’ This can add a lot of pressure on the sufferer to perform well in public situations.

Question 34

Cognitive distortions

Answer 34

The phobics perception of the phobic stimulus may be distorted. For example, someone with a fear of spiders – may see spiders as disgusting, ugly and huge. Someone with a fear of belly buttons may see them as ugly/disgusting.

Question 35

Outline characteristics of phobic disorders

Answer 35

One characteristic of a Phobic disorder is avoidance which Rita displays. Avoidance is when someone takes a lot of effort into staying away from their phobic stimuli here Rita doesn’t go to her friends house anymore as her friend now has two doffs and on top of that she also doesn’t leave the house if she sees a dog on the street
Another characteristic of phobic disorders is panic

Question 36

Systematic desensitisation

Answer 36

behavioural therapy designed to gradually reduce phobic anxiety using the principle of classical conditioning.
The idea is that if the sufferer can learn to relax in the presence of the phobic stimulus, they will be cured.
Systematic desensitization uses counter conditioning to unlearn the maladaptive response to a situation or phobic stimulus such as anxiety by replacing it with relaxation
A new response is learned to the phobic stimulus -> counter conditioning
It is impossible to be afraid and relaxed at the same time, so one emotion prevents the other. This is known as reciprocal inhibition.

Question 37

Three processes of systematic desensitisation

Answer 37

1)anxiety hierarchy
2)relaxation
3)exposure

Question 38

Anxiety hierarchy

Answer 38

Put together by patient and therapist together
List of situations relating to the phobia stimulus that provoke anxiety arranged in order from least to most frightening

Question 39

Relaxation

Answer 39

Therapist teaches the patient to relax using breathing techniques or meditation. They may also teach them mental imagery techniques, where the patient is taught to imagine themselves in pleasant situations such as being on the beach in the sun. Might also include drug therapy - valium
• Used throughout the anxiety hierarchy - aimed to reduce the anxiety in each stage. Patient may go back a stage if they find current stage too stressful.
• Further relaxation techniques are employed to help them move to the next step e.g. meditation

Question 40

Exposure

Answer 40

Finally in the last step, the patient is exposed to the phobic stimulus whilst in the relaxed state. This typically takes place across several sessions. According to SD, both fear and relaxation cannot be present at the same time (reciprocal inhibition), therefore, relaxation should take over the fear.
The patient starts of at the lowest level of the anxiety hierarchy, once they are relaxed in their lowest level, they then continue to work their way up the anxiety hierarchy until they are relaxed in the most feared situation.
At this point, systematic Desensitisation is successful and a new response to the stimulus has been learnt, replacing the phobia

Question 41

E valuation of treatment for phobias -systematic desensitisation

Answer 41

P:One strength of systematic desensitisation comes from research evidence that demonstrates the effectiveness of this treatment for phobias.
E:McGrath et al. (1990) found that 75% of patients with phobias were successful ly treated using systematic desensitisation.
E:This was particularly true when using in vivo techniques in which the patient c ame into direct contact with the feared stimulus rather than simply imagining (in
vitro)
L:This shows that systematic desensitisation is effective when treating specific p hobias, especially when using in vivo techniques

Question 42

Evaluation of treatment for phobias -systematic desensitisation

Answer 42

P:Further support comes from Gilroy et al. (2002) who examined 42 patients with ar achnophobia (fear of spiders).
E:Each patient was treated using three 45‐minute systematic desensitisation session s. When examined three months and 33 months later, the systematic desensitisation group were less fearful than a control group (who were only taught relaxation techn
iques).
E:The experimental group showed less fear compared to the control group
L:This provides further support for systematic desensitisation as an effective treatm ent for phobias in the long‐term

Question 43

Limitation of systematic desensitisation

Answer 43

P:However, a limitation of systematic desensitisation is that it is not effective in treating all phobias
E:Patients with phobias which have not developed through a personal exper ience (classical conditioning), such as a fear of snakes, are
not effectively treated using systematic desensitisation
E:Some psychologists believe that certain phobias have an evolutionary surv ival benefit and are not the result of learning
L:This highlights a limitation of systematic desensitisation, which is ineffectiv e in treating evolutionary phobias which have an innate basi

Question 44

Flooding

Answer 44

Involves exposing the phobic patient to their phobic stimulus but without the buildup of the anxiety hierarchy (still taught relaxation techniques)
Flooding involves inescapable exposure to the feared object or situation that lasts until the fear response disappears –e.g. someone who has claustrophobia might be shut into a small room for at least an hour or until their initial high levels of anxiety reduce.
The procedure assumes that very high levels of fear and anxiety cannot be sustained and will eventually fall.
This intense exposure is done longer sessions, with sessions lasting around two to three hours in a controlled and safe manner. Sometimes only one long sesson is only needed.
With flooding, a person is unable to negatively reinforce – avoid their phobic stimulus and through continuous exposure, the anxiety eventually decreases
Since the option of employing avoidant behaviour is removed, extinction occurs sin ce fear is a time‐limited response to a situation which eventually subsides. As exhau stion sets in for the individual they may begin to feel a sense of calm and relief which creates a new positive association to the stimulus as they realise the phobic stimulus cannot harm them.

Question 45

Extinction

Answer 45

since fear is a time‐limited response to a situation which eventually sub sides. As exhaustion sets in for the individual they may begin to feel a sense of calm and relief which creates a new positive association to the stimulus as they realise the phobic stimulus cannot harm them.
A learned response is extinguished when the conditioned stimulus such as a spider is encountered without the unconditioned stimulus – being bitten, which results in no conditioned response – f

Question 46

Ethical issues of flooding

Answer 46

Flooding is not unethical per say but it does create an unpleasant experience for the patient and so acquiring informed consent is essential to make sure they are fully aware and prepared for the experience. Patients are usually given the choice between SD and flooding

Question 47

Evaluation of phobias

Answer 47

P:One strength of flooding is it provides a cost‐effective treatment for phobia
s.
E:Research has suggested that flooding is equally effective to other treatme nts, including systematic desensitisation and cognition therapies (Ougrin, 20 11)
E: It is equally as effective
but takes much less time in achieving these positive results.
L:Thisis astrengthofthetreatmentbecausepatientscuretheirphobiasmor e quickly and it is therefore more cost‐effective for health service providers who do not have to fund longer options.

Question 48

Evaluation of phobias neg

Answer 48

P:Although flooding is considered a cost‐effective solution, it can be hi ghly traumatic for patients because
flooding purposefully elicits a high level of anxiety
E:Wolpe (1969) recalled a case with a patient becoming so intensely a nxious that she required hospitalisation.
E:Although it is not unethical as patients provide fully informed conse nt, many do not complete their treatment because the experience is to o stressful.
L:Therefore, initiating flooding treatment is sometimes a waste of time and money if patients do not engage in or complete the full course of
their treatment.

Question 49

Dsm5 and ocd

Answer 49

recognises OCD. What these disorders all have in common is repetitive behaviour accompanied by obsessive thinkin

Question 50

What ocd his described as

Answer 50

charecterised by either obsessions (recurring thoughts, images etc.) and/or compulsions (repetitive behaviours such as hand washing). Most people with a diagnosis of OCD have both obsessions and compulsions

Question 51

Trichotillomania

Answer 51

Compulsive hair pulling

Question 52

Hoarding disorder

Answer 52

the compulsive gathering of material objects and the inability to part with anything regardless of its importance or value

Question 53

Excoriation disorder

Answer 53

Compulsive skin picking

Question 54

Behavioural characteristics of ocd

Answer 54

Compulsions

Question 55

What are compulsions

Answer 55

The behavioural component of OCD is compulsive behaviour. There are two elements to compulsive behaviours

Question 56

Compulsions being repetitive

Answer 56

Typically sufferers of OCD feel compelled to repeat a behaviour. A common and popular example of this is hand washing. Other common compulsive repetitions may include counting, praying, tidying or ordering items

Question 57

Compulsions reducing anxiety

Answer 57

Around 10% of people who suffer from OCD show compulsive behaviour alone – they have no obsession, just a general sense of irrational anxiety. However, for the vast majority of individuals who suffer from OCD, compulsive behaviours are performed in an attempt to manage the anxiety produced by obsessions

Question 58

Example of compulsion

Answer 58

hand washing (repetitive hand washing) is carried out as a response to and obsessive fear of germs and dirt. Compulsive checking for example that the door is locked or that your appliances like hair straighteners are switched off is carried out in response to the obsessive though that it might be left unsecured

Question 59

Behavioural characteristics

Answer 59

Avoidance and compulsions

Question 60

Avoidance

Answer 60

The behaviour of OCD sufferers may also be characterised by their avoidance as
they attempt to reduce anxiety by staying away from the situations that trigger it.
For example, sufferers who wash compulsively may avoid coming into contact with germs – going outside, using public toilets, drinking from cups/glasses at a friends house.
However this avoidance can lead people to avoid very ordinary situations, such as emptying their rubbish bins, going out – and so can interfere with normal life

Question 61

Emotional Characteristics of OCD

Answer 61

Anxiety and distress:
OCD is regarded as an unpleasant emotional experience because of the powerful anxiety that accompanies both obsessions and compulsions. Obsessive thoughts can be both unpleasant and frightening for the individual – having thoughts such as your family will die if you don’t switch off the lights 50 times. The anxiety this produces can be overwhelming for individuals. The urge to repeat these behaviours (compulsions) can create anxiety.
Accompanying Depression:
OCD is often linked with depression, so anxiety can be accompanied with low mood and lack of enjoyment in usual activities. Compulsive behaviour tends to bring some relief from the anxiety but this is only temporary.
Guilt and Disgust:
Individuals who suffer from OCD may experience, anxiety, depression but also other negative emotions such as irrational guilt, for example over minor moral issues or disgust which may be directed at something external such as dirt or germs but also at the self

Question 62

Cognitive Characteristics of OCD

Answer 62

Obsessive thoughts:
Around 90% of individuals who suffer from OCD also experience obsessive thoughts – thoughts that recur over and over again. These obsessive thoughts vary largely from person to person but are always unpleasant. For example, a recurring thought may be worry about being contaminated by dirt or germs or constant worry that the door has been left open and an intruder will enter or you’ve left an appliance turned on and everything will burn down.
Cognitive strategies to deal with obsessions:
Obsessions are the major cognitive aspect of OCD but people also respond by developing cognitive coping strategies to help them deal with the anxiety that occurs from obsessive thoughts. For example a religious person tormented by obsessive guilt may respond by praying or meditating. This may help the individual manage their anxiety but make the person appear abnormal to others and may distract from everyday tasks

Insight into excessive anxiety:
People who suffer with OCD are aware that their obsessions and compulsions are irrational. In fact, this is actually a necessary facet in order to be diagnosed with OCD. If someone really believed their obsessive thoughts were based on reality that would be a symptom of a different form of mental disorder. It is therefore important that the individual is aware that their obsessions and compulsions are irrational.
However, although individuals are aware they often experience catastrophic thoughts about the worst case scenarios which might result if their anxieties were justified.
They also tend to be hypervilgilant – maintain constant alertness and keep attention focused on potential hazards

Question 63

The cycle of ocd

Answer 63

Obsessive thought
Anxiety
Compulsive behaviour
Temporarily revlif
Obsessive thought

Question 64

Biological approach of ocd

Answer 64

The biological approach to explaining OCD addresses both genetic and neural explanations.
Genetic explanations suggest that OCD is inherited and that individuals receive specific genes from their parents which influence the onset of OCD
Neural explanations suggest that abnormal levels of neurotransmitters and certain regions of the brain are implicated in OCD

Question 65

Genetic explanations of ocd

Answer 65

It has been proposed that there is a genetic component to OCD which predisposes some individuals to the illness.
• This may explain why patients often have other family members with OCD.
• Lewis (1936) observed that of his OCD patients 37% had parents with OCD and 21% had siblings with OCD. This suggests that OCD runs in families although what is passed on from one generation to another is probably the genetic vulnerability rather than the certainty of OCD
• According to the diathesis-stress model certain genes leave some people more likely to suffer a mental disorder but it is not certain – some environmental stress is required to trigger the onset of the condition

Question 66

Discuss the genetic explanation for obsessive compulsive disorder

Answer 66

-Genetic explanations have focused on identifying specific candidate genes which are implicated in OCD. It is believed that OCD is a polygenic condition, which means that several genes are involved..
-Two examples of genes that have been linked to OCD are the COMT gene and SERT gene. The COMT gene is associated with the production of catechol‐O‐methyltransferase (COMT for short), which regulates the neurotransmitter dopamine. Althoughall genes come in different forms, one variation of the COMT gene results in higher levels of dopamine and this variation is more common in patients with OCD, compared to people without OCD.

Question 67

Drug therapy

Answer 67

Is the most commonly used biological therapy for anxiety disorders
• Assumes that there is a chemical imbalance in the brain
• This can be corrected by drugs, which either increase or decrease the levels of neurotransmitters in the brain.

Question 68

Ssris

Answer 68

• The standard medical treatment used to tackle the symptoms of OCD involves a particular type of antidepressant drug called SSRIs – these are considered the first-line treatment for OCD
• SSRIs work on increasing certain neurotransmitter (serotonin) in the brain
• serotonin is usually reabsorbed by the nerve cells (known as “reuptake”). SSRIs work by inhibiting
reuptake, meaning more serotonin is available to pass further messages between nearby nerve cells and increases the amount of serotonin in the synapse

Question 69

Before ssri treatment

Answer 69

• Presynaptic neuron releases serotonin
• Serotonin travels across the synapse passing through the presynaptic neuron to
the postsynaptic neuron
• Serotonin is then reabsorbed by the presynaptic neuron where it is broken down and reabsorbed
- Serotonin remains low

Question 70

After ssri treatment

Answer 70

• Presynaptic neuron releases serotonin
• Serotonin travels across the synapse passing through the presynaptic neuron to
the postsynaptic neuron
• SSRI stops the reabsorption and break down of serotonin
• More serotonin in the synapse and therefore continues to stimulate the postsynaptic neuron
- Serotonin levels increase

Question 71

What do ssris do

Answer 71

SSRIs block the reuptake and reabsorption of serotonin thus increasing the amount of serotonin in the synapse

Question 72

How do ssri work

Answer 72

When serotonin is released from the presynaptic neuron in the brain and travels across the synapse. The neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron. It is then reabsorbed by the presynaptic neuron where it is broken down and reused. SSRIs work by increasing the levels of serotonin in the synapse by blocking the reuptake of serotonin by the presynaptic neuron. This means serotonin is not broken down and there is more serotonin in the synapse allowing it to continue to stimulate the postsynaptic neuron.
This then compensates for what may be wrong with the serotonin system in OCD.

Question 73

Example of drug therapy

Answer 73

• Dosage and other advice vary according to which SSRI is prescribed. Some people may respond better to one type of SSRI compared to another and so each persons circumstance is uniquely considered before being prescribed.
• A typical daily dose of fluoxetine is 20mg although this can be increased if it is not benefitting the person. The drug is available as either capsules or liquid. It takes three to four months of daily use of SSRIs to have an impact on symptoms.
• Other SSRIs include Sertraline and Escitalopram

Question 74

Combining ssri with other treatments

Answer 74

• Drugs are often used alongside Cognitive Behavioural Therapy (CBT) to treat OCD. The drugs reduce the persons emotional symptoms, such as feeling anxious or depressed.
• This means that as a result, people with OCD are more effectively engaged with CBT.
• In practice, some people respond best to CBT alone whilst others benefit more when additionally using drugs such as fluoxetine. Occasionally other drugs can also be prescribed alongside SSRIs.

Question 75

Alternative to ssris

Answer 75

When an SSRI is not effect9ive after three to four months the dose can be increased (e.g. 60mg of fluoxetine) or it can be combined with other drugs. Sometimes different antidepressants may be tried. People respond differently to different drugs and alternatives work well for some people and not at all for others
Tricyclics -(older antidepressant – E.G. Clomipramine)
Considered first generation antidepressants – work in the similar way as SSRI (reuptake inhibition leaving higher concentration of serotonin.) However, because these drugs have more side effects (such as urinary retention, constipation, dizziness) than SSRIs so it is generally kept in reserve for people who do not respond to SSRIs.
SNRIs– Serotonin-noradrenaline reuptake inhibitor
Have more recently been used to treat OCD. These are a different class of antidepressant drugs and like clomipramine are a second line of defence for people who do not respond to SSRIs.

Question 76

Strengths of drug therapy

Answer 76

One strength of biological treatments for OCD comes from research support for their e ffectiveness.

An advantage to biological treatments for OCD is their cost effectiveness.

Question 77

Limitation of drug therapy

Answer 77

A limitation of prescribing drug treatments for OCD is the possible side effects of drugs like SSRIs.

there is some evidence to suggest that even if drug treatments are helpful for most people with OCD they may not be the most effective treatment available. Skapinakis et al (2016) conducted a systematic review of outcome studies and found that both cognitive and behavioural treatments (exposure) might be more effective than SSRIs in the treatment of OCD.

Question 78

Eclectic approach

Answer 78

An eclectic approach appears to be the most effective
This is most likely due to the combined impact of drugs – tackling the feelings of anxiety and depression – and CBT – replacing the unwanted thoughts and changing behavioural habits.

Question 79

Behavioural characteristics of depression

Answer 79

1. Activity levels:
   Typically people who suffer from depression may experience reduced levels of energy often making them feel lethargic and constantly feeling tired. This has a knock on effect where sufferers tend to withdraw from work, education, social life (things that would usually make them happy). In some cases, the condition may be so severe the sufferer cannot get out of bed. In some cases, depression can lead to the opposite effect, where agitated individuals struggle to relax and may pace up and down a room. This is know as psychomotor agitation.
2. Disruption to sleep and eating behaviour:
   Depression is associated with changes to sleeping behaviour. Sufferers may experience either reduced sleep (insomnia) or an increased need for sleep (hypersomnia). Similarly, sufferers appetite and eating may increase or decrease – leading to fluctuations in weight.
3. Aggression and self harm:
   Sufferers of depression are often irritable and in some cases may be both verbally and physically aggressive. This can have knock-on effects for a persons life, for example, a sufferer may display verbal aggression by ending a relationship or quitting their job. Depression can also lead to physical harm against the self (self harm, often in the form of cutting or suicide attempts)

Question 80

Emotional characteristics of depression

Answer 80

1. Lowered mood
   The word ‘depressed’ in everyday life usually describes having a lowered mood or feeling sad. However, we are looking at depression in a more clinical sense. Lowered mood is still a defining emotional characteristic of depression but it is more pronounced In people with depression. Patients often describe themselves feeling ‘empty’ or ‘worthless’
2. Anger
   Sufferers tend to experience more negative symptoms and fewer positive symptoms during episodes, however this feeling of negative emotions is not limited to sadness. Sufferers also often experience anger, sometimes extreme anger directed at themselves or others – these can lead to aggressive or self-harming behaviour.
3. Lowered self-esteem
   Individuals who suffer from depression tend to report reduced self-esteem. This can be quite extreme with some sufferers nothing a sense of self-loathing (hating themselves).

Question 81

Two key cognitive theories which attempt to explain depression

Answer 81

-becks cognitive triad
-ellis abc model

Question 82

Becks cognitive theory of depression

Answer 82

suggested a cognitive approach to explaining why some people may be more vulnerable to depression than others. In particular, he highlighted that a person’s cognitions is what creates this vulnerability i.e. the way that they think.
Beck proposed three part to this cognitive vulnerability:
• Faulty Information Processing • Negative Self-schemas
• The Negative Triad

Question 83

Faulty information processing

Answer 83

When someone suffers from depression, they attend to the negative aspects of a situation and ignore the positives
For example; if I was depressed and won £1 million on the lottery, I might focus on the fact that the previous week someone had won £10 million rather than focus on the positives of everything I could do with £1 million.
People with depression also tend to blow small problems out of proportion and think in ‘black and white’ terms, often catastrophizing situations.
This leads to cognitive biases

Question 84

Cognitive biases

Answer 84

Overgeneralisation
Catastrophisng

Question 85

Overgeneralisations

Answer 85

may make a sweeping conclusion based on a single incident

Question 86

Catastrophising

Answer 86

exaggerate a minor setback and believe it’s a complete disaster

Question 87

Negative self schemas

Answer 87

A schema is a ’package’ of knowledge which stores information and ideas about the world around us developed through experiences. A self-schema is the package of information we have about ourselves.
We use schemas to interpret the world so if we have a negative self-schema, we interpret all information about ourselves in a negative way.
According to Beck, these self-schemas develop during childhood and people with depression have a negative self-schema – which may be the result of negative experiences for example, constant criticism from parents, peers, teachers.

Question 88

Examples of negative self schemas

Answer 88

• An ineptness schema – always expecting to fail
• A Self-blame scheme - makes them feel responsible for anything that goes wrong • A Negative self-evaluation schema – constant feelings of worthlessness

Question 89

Negative triad

Answer 89

A person develops a dysfunctional view of themselves because of three types of thinking which occur automatically – regardless of the reality. These three elements are called the negative triad. When we are depressed, we have negative thoughts about the world, the future and the self.

Question 90

What beck says about the negative triad

Answer 90

According to Beck, negative self‐schemas and cognitive biases maintain the negative triad which is a negative view of three key aspects of a person’s life which lead to depression. These include:
- The world – ‘The world is an unfair place.’
- The future – ‘I will always be a failure.’
- The self – ‘Nobody loves me.’

Question 91

Evaluation of becks negative processing

There is a range of evidence to support the idea that depression is associated with faulty information processing, negative self schemas and the cognitive triad

Answer 91

Grazioli and Terry (2000) assessed 65 pregnant women for cognitive vulnerability and depression before and after birth

They found that those women judged to have been high in cognitive vulnerability were more likely to suffer from post-natal depression

Beck (1990) concluded there was solid support for all these cognitive vulnerability factors. Critically, these cognitions can be seen BEFORE depression develops. Suggesting that Beck may be right about cognitions causing depression

Question 92

Evaluation of becks negative triad

One strength of the cognitive explanation for depression is its application to therapy

Answer 92

Cognitive explanations have been used to develop effective treatments for depression, including Cognitive Behavioural Therapy (CBT), and Rational Emotive Behaviour Therapy (REBT) which was developed from Ellis’s ABC model.
E: These therapies attempt to identify and challenge negative, irrational thoughts and have been successfully used to treat people with depression.
L: This provides further support to the cognitive explanation of depression.

Question 93

Evaluation of Beck’s Negative Triad
It doesn’t explain all aspects of depression

Answer 93

Some depressed patients are deeply angry and Beck cannot easily explain this extreme emotion

Some sufferers may also suffer from hallucinations and bizarre beliefs. Very occasionally depressed patients suffer Cotard syndrome, the delusion that they are zombies (Jarett 2013)

Beck’s theory cannot explain these cases, highlighting the complexity of depression

Question 94

Ellis abc model

Answer 94

Another American psychiatrist, Albert Ellis (1962) suggested a different cognitive explanation of depression. He suggested that good mental health is the result of rational thinking. Therefore, conditions such as anxiety and depression result from irrational thoughts.
Ellis defined irrational thoughts not as illogical or unrealistic thoughts but rather as any thought that interfered with us being happy and free of pain
Ellis used the ABC model to explain how irrational thoughts affect out behaviour and emotional state

Question 95

A in ellis model

Answer 95

activating event is when irrational thoughts are triggered by external events. According to Ellis we get depressed when we experience negative events and these trigger irrational beliefs

Question 96

B in ellis abc model

Answer 96

beliefs which is your interpretation of the event which results in either rational or irrational beliefs. Example: ‘musturbation’ – belief that we must always succeed or achieve perfection. ‘Utopianism’ - the idea that life is always meant to be fair

Question 97

C in Eli’s abc model

Answer 97

consequence
when an activating event triggers irrational beliefs
beliefs which is your interpretation of the event
(C) a
there are emotional and behavioural consequences. For example if you believe you must always succeed and then fail at something this can trigger depression

Question 98

Evaluation of abc model

One strength of the cognitive explanation for depression is its application to therapy.

Answer 98

Cognitive explanations have been used to develop effective treatments for depression, including Cognitive Behavioural Therapy (CBT), and Rational Emotive Behaviour Therapy (REBT) which was developed from Ellis’s ABC model.
E: These therapies attempt to identify and challenge negative, irrational thoughts and have been successfully used to treat people with depression.
L: This provides further support to the cognitive explanation of depression.

Question 99

Evaluation of Ellis abc model

Like Beck’s theory, Ellis’s explanation of depression may be an oversimplification of depression

Answer 99

Some depressed patients are deeply angry and Ellis cannot easily explain this extreme emotion
E: Some sufferers may also suffer from hallucinations and bizarre beliefs. Very occasionally depressed patients suffer Cotard syndrome, the delusion that they are zombies (Jarett 2013)
L: Ellis’s theory cannot explain these cases, highlighting the complexity of depression

Question 100

Evaluation of abc model

There are some cases of depression which follow activating events, but it cannot account for cases of depression which do not

Answer 100

Psychologists call depression which follows an activating event reactive depression and see it as different to the kind of depression that arises without an obvious cause
E: In this case, it might be more effective to look at potential alternative explanations of depression such as biological explanations which look at the neurochemical imbalances such as lack of serotonin which may cause depression.
L: This means that Ellis’s explanation only applies to some kinds of depression and is therefore only a partial explanation for depression

Question 101

Overall evaluation for elis and beck

Answer 101

• The cognitive explanation cannot account for the physical symptoms of mood disorders
• With depression these include aches and pains, a lack of energy, palpitations, headaches and stomach upsets. For women there may be menstrual changes. Sleep disturbance is another possible symptom. Sufferers can experience loss of appetite or weight.– how can irrational thought processes cause these symptoms?
• Is there an alternative explanation?

Question 102

CBT

Answer 102

Cognitive Behavioural Therapy (CBT) is the most commonly used psychological treatment for depression, if you see a psychologist for a mental health disorder you will most likely receive CBT.
• CBT involves both cognitive and behavioural elements. The cognitive element aims to identify irrational and negative thoughts, which lead to depression. The aim is then to replace these thoughts with more positive and rational ones. The behavioural element of CBT encourages patients to test their beliefs through behavioural experiments and homework
• The focus is on the present and the future not the past
• Some CBT therapists do this using techniques purely from Beck’s cognitive therapy, others solely use Ellis’s rational emotive behaviour therapy. Most will use parts of both.

Question 103

Two main therapies

Answer 103

a) Beck’s Cognitive Therapy for Depression
b) Ellis’s Rational Emotive behaviour Therapy (REBT)