Psychopathology

Question 1

What are the 4 definitions of abnormality?

Answer 1

1- statistical deviation
2- deviation from social norms
3- failure to function adequately
4- deviation from ideal mental health

Question 2

Describe statistical deviation

Answer 2

Defining abnormality in terms of statistics- the most obvious way to define anything as ‘normal’ or ‘abnormal’ is in terms of number times it has been observed- any often recurring behaviour can be thought as ‘normal’ and any behaviour different can be thought of as ‘abnormal’ i.e. a statistical deviation

Question 3

What’s an example of statistical deviation?

Answer 3

IQ and intellectual disability disorder- average IQ is between 85 and 115, only 2% score below 70 which is a normal distribution as majority are clustered around the mean. Those individuals scoring below 70 are statistically ‘abnormal’ and are diagnosed with intellectual disability disorder

Question 4

What are the evaluation points of statistical deviation?

Answer 4

❌ not everyone benefits from a label: if someone is living a happy and fulfilled life there is no benefit to them being labelled as ‘abnormal’ regardless of how statistically unusual they are for example, someone with a very low IQ e.g. below 70 is not distressed and quite capable of working etc, they would not need a diagnosis of intellectual disability disorder and if they are labelled as ‘abnormal’ this may have detrimental consequences on the way others perceive them and how they perceive themselves too

❌ statistically infrequent characteristics can be positive, for example if an individual’s IQ is over 30, they’re just as unusual as those below 70 but we don’t perceive super intelligence as an undesirable characteristic that requires treatment = serious limitation as the concept of SD cannot be used alone to make a diagnosis

✅real-life applications= all assessments of patients with a mental disorder include some kind of measurement of how severe their symptoms are compared to statistical norms- the example of intellectual disability disorder demonstrates how there is a place for SD in thinking about what are ‘normal’ and ‘abnormal’ behaviours and characteristics= SD useful part of clinical assessment, but as discussed, cannot be used alone to make a diagnosis

Question 5

Describe deviation from social norms

Answer 5

• ‘abnormality’ is based on the social context : when a person behaves in a way that is different from how they are expected to behave, they may be defined as ‘abnormal’. Societies and social groups make collective judgements about ‘correct’ behaviours in particular circumstances- definitions are related to the cultural context , which includes historical differences within the same society e.g. homosexuality is viewed as ‘abnormal in some cultures but not others, and was considered ‘abnormal’ in our society in the past
• norms are specific to the cultures we live in and so there are relatively few behaviours that would be considered universally ‘abnormal’

Question 6

What’s an example of deviation from social norms?

Answer 6

Antisocial personality disorder (APD), formerly psychopathy, is a failure to conform to ‘lawful and culturally normative ethical behaviours i.e. psychopathy ‘abnormal’ because they deviate from social norms or standards

Question 7

What are the evaluation points for deviation from social norms?

Answer 7

❌ not a sole explanation of abnormality: the definition has real-life application in the case of antisocial personality disorder so there is a place for for deviation from social norms in thinking about what is ‘normal’ or ‘abnormal’. However, there are other factors to consider e.g. the distress to other people resulting from APD- a failure to function adequately; so in practice, deviation from social norms is never the sole reason for defining abnormality

❌definition is culturally relative: social norms vary tremendously from one community to another and one generation to another. This means that a person from one cultural group may label someone from another culture as behaving abnormally using their standards rather than the standards of the person behaving that way. For example, hearing voices is socially acceptable in some cultures but would be seen as a sign of abnormality in the U.K.- this creates problems for people from one culture living within another culture group

❌ definition could lead to human rights abuse- too much reliance on deviation from social norms to understand abnormality can lead to a systematic abuse of human rights. A historical example of deviation from social norms, drapetomania (black slaves who tried to escape their masters), shows how these diagnoses were only ,ade to cartoon minority ethnic groups. These classifications appear ridiculous nowadays but some radical psychologists would argue that some of our modern categories of mental disorders are really abuses of people’s rights to be ‘different’

Question 8

Describe failure to function adequately

Answer 8

A person may cross the ‘line’ between ‘normal’ and ‘abnormal’ at the point they cannot cope with the demands of everyday life- they fail to function adequately e.g. not being able to hold down a job, maintain relationships or maintain basic standards of nutrition or hygiene

Question 9

Who proposed signs to determine when someone is not coping and what are the signs? (Failure to function adequately)

Answer 9

Rosenhan and Seligman (1989):

• when a person no longer conforms to interpersonal rules e.g. maintaining personal space
• when a person experiences personal distress
• when a person’s behaviour is irrational or dangerous

Question 10

What’s an example of failure to function adequately?

Answer 10

Intellectual disability disorder- having a very low Iq is a statistical deviation but diagnosis would not be made on this basis alone- there would have to be clear signs that as a result of this,the person was not able to deal with the demands of everyday life; so intellectual disability disorder is an example of failure to function adequately too

Question 11

What are the evaluation points for failure to function adequately?

Answer 11

✅attempts to include subjective experience of the individual- it may not be an entirely satisfactory approach because it is difficult to assess distress, but at least the definition acknowledges the experience of the patient is important. The definition captured the experience of many of the people who need help and is therefore a useful criteria for assessing abnormality

❌ difficult to say when someone is really failing to function adequately and when they are just deviating from social norms- for instance, people who live alternative lifestyles such as people who practise extreme sports, could be accused of behaving in a maladaptive way- if we treat these behaviours as ‘failures’ of adequate functioning, we risk limiting freedom and discriminating against minority groups

❌ involves subjective judgement- when deciding if someone is failing to function adequately, someone has to judge whether a patient is distressed- some patients may say they’re distressed but may not be judged as suffering. Unlike statistical deviation which is objective due to quantitative nature. Although,there are methods for making such judgements as objective as possible including checklists such as Global Assessment of functioning scale. Nevertheless, the principle remained that a psychiatrist for example, has the right to make this judgement

Question 12

Describe deviation from ideal mental health

Answer 12

A different way to look at ‘normality’ and ‘abnormality is to think about what makes someone ‘normal’ and psychologically healthy and then identify anyone who deviates from this ideal

Question 13

Who listed the 8 criteria for ideal mental health and what are they? (Deviation from ideal mental health)

Answer 13

Marie Jahoda (1958):

• we have no symptoms or distress
• we are rational and perceive ourselves accurately
• we self-actualise
• we can cope with stress
• we have a realistic view of the world
• we have good self-esteem and lack of guilt
• we are independent of other people - we can successfully work, love and enjoy our leisure

Question 14

There is an inevitable overlap between deviation from ideal mental health and

Answer 14

Failure to function adequately e.g. someone’s inability to keep a job may be a sign of their failure to cope with the pressures of work or as a deviation from the ideal of successfully working

Question 15

What are the evaluation points for deviation from ideal mental health?

Answer 15

✅ covers a broad range of criteria for mental health- most likely covers the majority of the reasons someone would seek help from the mental health services or be referred for help (if they didn’t possess Jahoda’s criteria characteristics)- the sheer range of factors discussed in relation to Jahoda’s criteria make it a good tool for thinking about mental health

❌ definition may be culturally relative- some of the ideas in Jahoda’s classification of ideal mental health are specific to Western European and North American cultures. For example, the emphasis on personal achievement in concept of self-actualisation would be considered self-indulgent in much of the world because the emphasis is so much on the individual rather than family or community. Such traits are typical of individualist cultures and are therefore culturally specific

❌ definition sets an unrealistically high standard for mental health- very few people will attain Jahoda’s criteria for mental health. Therefore, this approach would see the majority of people as abnormal. But on the positive side, it makes it clear to people the ways in which they could benefit from seeking help to improve their mental health

Question 16

What are the 3 mental disorders you need to know the emotional, behavioural and cognitive characteristics of?

Answer 16

Phobias, depression, OCD

Question 17

What explanations do we need to know for the 3 mental disorders?

Answer 17

• behaviourist approach to explain phobias
• cognitive approach to explain depression
• biological approach to explain OCD

Question 18

What is a phobia?

Answer 18

An anxiety disorder characterised by extreme anxiety and irrational fear of objects or situations. The DSM recognises the following categories:

• specific phobia= phobia of objects or situation
• social anxiety= phobia of a social situation like public speaking or using a public toilet
• agoraphobia= phobia of being outside or in a public space

Question 19

What are some examples of phobias?

Answer 19

• claustrophobia = fear of small spaces- estimated to affect approx 5-7% of world’s population
• aviophobia = fear of flying
• arachnophobia = fear of spiders

Question 20

What are the behavioural characteristics of phobias?

Answer 20

• panic (in response to phobic stimulus)- may include a range of behaviours including crying, screaming or running away
• endurance - sometimes may be unavoidable e.g. aviophoboa. Here they may remain in the presence of phobic stimulus but usually experience anxiety
• avoidance- make a conscious effort to avoid coming into contact with the phobic stimulus = can often make it hard to go about everyday life, especially if the phobic stimulus is often seen e.g. public spaces

Question 21

What are the emotional characteristics of phobias?

Answer 21

anxiety and fear:

• fear is the immediate and extremely unpleasant experience when a phobic encounters or thinks about phobic stimulus. Fear leads to anxiety.
• anxiety: state of emotional and physical arousal- emotions include having worried thoughts and feelings of tensions. Physical changes include increased heart rate and sweating
• emotional response to the phobic stimulus is widely disproportionate to the threat posed e.g. arachnophobes will have a strong emotional response to a tiny and harmless spider

Question 22

What are the cognitive characteristics of phobias?

Answer 22

• selective attention to phobic stimulus- if a sufferer is exposed to the phobic stimulus, they find it hard to divert their attention away from it e.g. an arachnophobe will find it difficult to maintain concentration on what they’re doing if a spider is in the room
• irrational beliefs- a phobic may hold irrational beliefs in relation to the phobic stimulus e.g. social phobics may hold beliefs like: ‘if I blush people will think I’m weak’ or ‘ I must always sound intelligent’
• cognitive distortions- phobic’s perception likely to be distorted

Question 23

Who argued that phobias are learned by classical conditioning and then maintained by operant conditioning

Answer 23

Mower (1960)-behaviourist approach to explaining phobias and so behaviour is learned through stimulus-response- Pavlov

Question 24

What is the name of the model that suggests that phobias are acquired through classical conditioning and maintained through operant conditioning?

Answer 24

Two-process model

Question 25

What does classical conditioning relating to phobias involve?

Answer 25

• the classical conditioning element involves learning to associate something which we initially have no fear (neutral stimulus) with something (unconditioned stimulus) that already triggers a fear response (fear is the unconditioned response)
• the result is that the neutral stimulus become s a conditioned stimulus producing fear, which is now the conditioned response

Question 26

how could being bitten by a dog lead to a fear of dogs?

Answer 26

• bitten by dog (unconditioned stimulus) which causes pain/ fear (unconditioned response) could lead to fear of dogs
• dog is neutral stimulus which becomes a conditioned stimulus causing a conditioned response of fear following the bite

Question 27

Who showed how a fear of rats could be conditioned in an 11 month old boy called ‘Little Albert’?

Answer 27

Watson and Raynor (1920)

Question 28

What are the before and after stages of conditioning Little Albert?

Answer 28

Before conditioning- whenever Albert played with a white rat a loud frightening noise was made close to his ear- the noise caused a fear response (unconditioned stimulus). The rat (neutral stimulus) did not create fear until the ‘bang’ and the rat had been paired together several times

After conditioning- Albert evolved a fear response (CR) every time he came into contact with the rat (now a CS)

Question 29

The fear response (CR) is often generalised to other stimuli- what happened in Albert’s case?

Answer 29

Albert showed a fear response to other white furry objects including a fur coat and a Santa Claus mask

Question 30

How does negative reinforcement maintain phobias?

Answer 30

In the case of negative reinforcement, an individual produces behaviour that avoids something unpleasant and so the avoidance is rewarding to the phobic
- when a phobic avoids the phobic stimulus they’ve successfully escaped fear and anxiety they would be have experienced and this reduction in fear negatively reinforces the avoidance behaviour I.e. avoidance is motivated by anxiety reduction = phobia maintained

Question 31

Give an example of how negative reinforcement maintains a phobia

Answer 31

If someone has a morbid fear of clowns (coulrophobia) they will avoid circuses and other situations where they may encounter clowns. The relief felt from avoiding clowns negatively reinforces the phobia and ensures it is maintained rather than confronted

Question 32

What are the evaluation points for behaviourist explanations for phobias?

Answer 32

✅ strength of the two-process model is that it has good explanatory power- two-process model was a definite step forward when it was proposed as it went beyond Watson and Rayner’s concept of simple classical conditioning explanation of phobias. Two-process model explains how phobias are marinated over time, which has important implications for therapy as according to the model, once a patient is prevented from avoiding the phobic stimulus, the phobic behaviour declines; so the application to therapy is a significant strength for the two-process model

❌ there are alternative explanations for avoidance behaviour- in more complex behaviours like agoraphobia (intense fear of being in a public place where it’s felt it may be difficult to escape) there is evidence that at least some avoidance behaviour is motivated by more positive feelings of safety- this explains why some agoraphobics are able to leave their house with a trusted friend, with relatively little anxiety, but not alone = problem for two-process model which suggests that avoidance is motivated by anxiety reduction = model may be too simplistic

❌ model is an incomplete explanation of phobias- even if we accept that classical and operant conditioning are involved in the development and maintenance of phobias, there are some aspects of phobic behaviour that require further explanation- e.g. we easily acquire phobias of things that were a source of danger in our evolutionary past e.g. fear of snakes or the dark; this is the theory of biological preparedness, that we are innately prepared to fear some things more than others. The phenomenon of biological preparedness is a serious issue for the two-process model as it shows that there is more to acquiring phobias than simple conditioning

❌some phobias don’t follow trauma- sometimes phobias appear following a bad experience and so it’s easy to see how they could be the result of conditioning. However, sometimes people develop phobias and are not aware of having a bad experience. For example, very few snake phobics have ever had a traumatic encounter with a venomous snake = phobias in absence of trauma may be better explained by the idea of biological preparedness than the two-process model

❌ two-process model does not properly consider the cognitive aspects of phobias- we know that behavioural explanations in general are orientated towards explaining behaviour rather than cognitive (mental thoughts and processes); this is why the two-process model explains maintenance of phobias in terms of avoidance, but we also know that phobias have cognitive elements. Therefore, the two-process model as a behavioural model of learning does not adequately address cognitive elements of phobias

Question 33

What are the behavioural approach’s ways of treating phobias?

Answer 33

• systematic desensitisation

- flooding

Question 33

What is systematic desensitisation?

Answer 33

A behavioural therapy based on classical conditioning which aims to gradually reduce anxiety through counterconditioning (works by eliminating the learned anxious response (CR) that is associated with the feared object or situation (CS) and replace it with another learned response, relaxation)

Question 34

Describe and explain the steps of systematic desensitisation

Answer 34

• phobic individual first taught relaxation techniques such as deep breathing and/or meditation- it is not possible to be relaxed and afraid at the same time so one emotion prevents the other = reciprocal inhibition —> conditioned response of fear is slowly substituted by relaxation and so the fear response is extinguished = phobic object (conditioned stimulus) now produces relaxation (new conditioned response) rather than fear
• before counter-conditioning can begin the patient and therapists design an anxiety hierarchy, a list of situations related to phobic stimulus that provokes anxiety. They are arranged in order from least to most frightening e.g. an arachnophobe may identify seeing a photo of a spider low on their anxiety hierarchy and being a couple feet away from a real spider very high. The phobic then works their way through the series of stages up the anxiety hierarchy each one more anxiety-provoking than the last. In this case, the final stage may involve the phobic holding a tarantula to demonstrate that the phobia has been ‘extinguished’ (disappearance of the learned fearful response). As the phobic works their way through the anxiety hierarchy the relaxation techniques are practised at each level ensuring reciprocal inhibition, which takes place over several sessions.
• treatment is successful when the person can stay relaxed in situations high on the hierarchy

Question 35

What are the evaluation points of systematic desensitisation

Answer 35

✅ evidence suggests SD is effective in the treatment of specific phobias particularly- Gilroy et al (2003) followed up 42 patients who had been treated for arachnophobia in in three 45 minute sessions of SD. The spider phobias was assessed by the ‘Spider Questionnaire’ and assessing their response to a spider. There was also a control group treated by relaxation techniques only, so no exposure to the phobic stimulus. At both 3 and 33 months, phobics in SD group significantly jess fearful than solely relaxation techniques group. This is a strength of SD as is shows SD is helpful in reducing anxiety by counter-conditioning which is the principle of SD and that the effects are long-lasting

✅ suitable for a diverse range of patients, where flooding and cognitive therapies may not be as well suited. For instance, people with learning difficulties may have difficulty fully comprehending what is happening in flooding and so may be counter-productive as patient may become extremely distressed from the trauma of flooding. So, often SD is the most appropriate treatment as it is circular the patient’s circumstances are taken into consideration

✅ patients often prefer it given the choice between flooding or SD as it does not cause the same degree of trauma as flooding. Patients may also prefer SD as there are pleasant elements involved such as spending time talking with a therapists; this is all reflected in low refusal rates and low attrition rates

Question 36

What is flooding?

Answer 36

A behavioural therapy in which a phobic patient is exposed to an extreme form of a phobic stimulus in order to reduce anxiety triggered by that stimulus, without a gradual build-up- takes place across a small number of long therapy sessions. For example, an arachnophobe receiving flooding treatment may have a large spider crawl over their hand until they can fully relax

Question 37

Describe and explain the further steps of flooding?

Answer 37

• flooding stops phobic responses very quickly- without the option of avoidance behaviour the patient very quickly learns that the phobic object is harmless through the exhaustion of their fear response- extinction
• flooding is not unethical but is undoubtedly an unpleasant experience so it’s crucial that participants give informed consent meaning they’re fully prepared and know what to expect

Question 38

What are the evaluation points of flooding?

Answer 38

✅ cost effective: comparing flooding to cognitive therapies, flooding is highly effective and quicker than alternatives. The quick effect is a significant strength as it means patients are free of their symptoms as soon as possible ultimately making the treatment cheaper, which would need to be considered by health services

❌ although flooding can be highly effective and cost-effective for treating simple phobias it appears to be far less so for more complex phobias like social phobias- this may be because social phobias have cognitive aspects. For example, a sufferer of social phobias does not simply experience an anxiety response but thinks unpleasant thoughts about the social situation. This type of phobia may therefore benefit more from cognitive therapies because such therapies tackle the irrational thinking

❌ perhaps the most serious issue with flooding is the fact that it is a highly traumatic experience. The problem is not that flooding is unethical (patients do give informed consent) but that patients are unwilling to see it through to the end. This is a limitation because it ultimately means that the treatment may not be effective and may actually be counter-productive as stronger feelings of fear and trauma could be associated with the phobic stimulus if the treatment is not fully completed and so the phobia may be maintained or even heightened

Question 39

What is depression?

Answer 39

A mental disorder characterised by low mood and energy levels

Question 40

What are the key assumptions of the cognitive approach?

Answer 40

1- human behaviour is heavily influenced by schemata (systems of knowledge we use to understand the world) e.g. ‘I am self confident’ or ‘I am happy’

2- schemata develop based on early experience- early traumatic experience may lead to negative schemata e.g. insecure attachment may lead to the belief ‘I am unloved and will always be alone’

3- these negative schemata when activated lead to negative automatic thoughts (NATS)

4- these are dysfunctional and misplaced (no one need always be alone, or is unsuccessful at everything

Question 41

What are the behavioural characteristics of depression?

Answer 41

• reduced energy/activity levels making sufferers lethargic- in extreme cases this can be so severe that the sufferer cannot get out of bed
• disruption to sleep and eating behaviour: depression is associated with changes to sleeping behaviour and sufferers may experience reduced sleep (insomnia) or an increased need for sleep (hypersomnia). Appetite may also increase or decrease leading to weight gain or weight loss

Question 42

What are the emotional characteristics of depression?

Answer 42

• lowered mood: the defining element of depression but it is more pronounced than in the daily experience of feeling lethargic or sad. Sufferers often describe themselves as ‘worthless’ or ‘empty’
• anger: sufferers of depression often experience anger, sometimes extreme anger. On occasion, such emotions lead to aggression or self-harming behaviour

Question 43

What are the cognitive characteristics of depression?

Answer 43

• poor concentration: the sufferer may find themselves unable to stick with a task as they usually would, or they might find simple decision-making difficult; this is likely to interfere with the individual’s work
• absolutist thinking: most situations are not all bad or all good, but when a sufferer is depressed they tend to think in these terms- ‘black and white thinking’ e.g. when a situation is unfortunate it is seen as an absolute disaster

Question 44

What’s the name of the cognitive theory of depression?

Answer 44

Beck’s cognitive theory of depression

Question 45

What does Beck’s cognitive theory of depression state?

Answer 45

That it is the way people think (their cognition) that makes them vulnerable to depression

Question 46

What are the 3 components of Beck’s cognitive theory of depression?

Answer 46

• faulty information processing
• negative self-schemes
• negative triad (or cognitive triad)

Question 47

Describe faulty information processing

Answer 47

Beck proposed that some people are more prone to depression because of faulty information processing- essentially thinking in a flawed way. When depressed, we attend to the negative aspects of a situation and ignore positives. We also tend to blow small problems out of proportion and think in ‘black and white’ terms.

Question 48

Describe negative self-schemas

Answer 48

A schema is a ‘package’ of ideas and information developed through experience and we use these schemas to interpret the world. Depressed people have negative self-schemas meaning that they interpret all the information about themselves in a negative way

Question 49

Beck also proposed the negative triad in what year?

Answer 49

1960s

Question 50

What is the negative triad?

Answer 50

Beck proposed that there are 3 kinds of negative thinking that contribute to a person becoming depressed: negative views of the world, negative view of oneself, which negatively impacts upon self-esteem, and negative view of the future- such negative views lead a person to interpret their experiences in a negative way and so makes them more vulnerable to depression

Question 51

Give an example of a negative triad

Answer 51

1- negative view about the world: “nobody values me”
2- negative view about oneself: “ I am worthless”
3- negative view about the future: “ I will never be good at anything”

Question 52

What are the evaluation points for Beck’s cognitive theory of depression?

Answer 52

✅ good supporting evidence- 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 post-natal depression. This is supporting evidence as these cognitions can be seen before depression develops, suggesting that Beck may be right about cognitions making people more prone to depression, at least in some cases
- BUT purely correlational, may be other factors involved e.g. hormones

✅the theory has practical application as a therapy as Beck’s cognitive explanations form the basis of cognitive behavioural therapy (CBT)- the components of the negative triad can be easily identified and challenged in CBT by a therapist encouraging a patient to test whether the elements of the negative triad are true. This is a strength of the explanation because it translates well in therapy.

❌ Beck’s theory does not explain all aspects of depression- the theory neatly explains the basic symptoms of depression however it is a complex disorder. For example, some depressed patients are deeply angry and Beck cannot easily explain this extreme emotion. Some sufferers of depression also experience hallucinations and bizarre beliefs; very occasionally, depressed patients suffer Cotard syndrome, the delusion they are zombies. As a result, Beck’s theory is not an entirely accurate account of depression and cannot always explain all cases of depression, however these accounts are very rare and will form the minority.

Question 53

Apart from Beck’s cognitive theory of depression, what is another explanation for depression?

Answer 53

Ellis’ ABC model (1950s)

Question 54

What does the ABC model propose?

Answer 54

That depression occurs when an activating event (A) triggers an irrational belief (B) which in turn produces a consequence (C) I.e. emotional response such as depression- the driving force of this process is irrational beliefs

Question 55

Describe activating event (ABC model)

Answer 55

Ellis proposed that depression arises from irrational thoughts and he used the ABC model to explain how these develop - A stands for activating event and according to Ellis we get depressed when we experience negative events and these trigger irrational beliefs e.g. failing an important test or ending a relationship might trigger or activate irrational beliefs

Question 56

Describe beliefs (ABC model)

Answer 56

Ellis identified a range of irrational beliefs- he called the belief that we must always succeed: musterbation. I-can’t-stand-it-itis is the belief that it is a disaster when things don’t go 100% smoothly. Also, Utopianism is the belief that the world must always be fair and just.

Question 57

Describe consequence (ABC model)

Answer 57

When an activating event triggers irrational beliefs there are emotional and behavioural consequences- for example, if you believe that you must succeed at everything (musterbation) and then you fail at something, the consequence is often depression

Question 58

What are the evaluation points for Ellis’ ABC model?

Answer 58

✅ partial explanation of depression- there is no doubt that some cases of depression arise following activating events such as the death of a loved one, and psychologists have called this reactive depression and view it differently from the kind of depression that arises without an obvious cause. This is a strength as a key component of Ellis’ ABC model (activating event) is the fundamental basis of identified, reactive depression.

✅ theory has practical application in CBT and like Beck’s theory, has led to successful therapy- the idea that by challenging irrational beliefs, a person can reduce their depression, is supported by vast research evidence such as Lipsky et al. This in turn supports the basic theory because it suggests that the irrational beliefs had some role to play in the patient developing depression.

❌ both cognitive explanations of depression share the idea that cognition causes depression- this is closely tied up with the concept of cognitive primacy, the idea that emotions are influenced by cognition (thoughts), which is definitely sometimes the case but not necessarily always. Other theories of depression see emotions such as anxiety stored like physical energy, which emerges some time after the causal event. As a result,this proves a challenge to both theories, as doubt is cast over the idea that cognitions are always the root of depression and suggests that cognitive theories may not explain all aspects of the complex disorder

Question 59

What is the cognitive approach’s treatment for depression?

Answer 59

Beck’s cognitive behavioural therapy (CBT)

Question 60

What is CBT?

Answer 60

A method for treating mental disorders based on both cognitive and behavioural techniques- from the cognitive viewpoint the therapy aims to challenge patients’ thoughts such as challenging negative thinking and irrational thoughts. Behavioural activation is a behavioural technique that the therapy includes.

Question 61

Explain CBT and how it works

Answer 61

• one of central aims is for the patients and therapist to work together to clarify the patients’ problems and identify where there may be negative or irrational thoughts that will benefit from challenge
• negative thoughts identified through the use of the negative triad and once identified, these thoughts must be challenged by the patient who takes an active part in their treatment
• as aim of CBT is to help patients test reality of their irrational beliefs, they may be set homework such as to record when people were nice to them or when they enjoyed an event; this is referred to as ‘patient as scientist’ and in future sessions if patient says no one is nice to them the therapist can produce their evidence to disprove the patient’s beliefs
• example of CBT is Ellis’ REBT (rational emotive behaviour therapy) that extends the ABC model to an ABCDE model with D standing for dispute and E for effects. The central technique of REBT is to identify and dispute/challenge irrational beliefs through vigorous argument. E.g. patient may discuss how unlucky they’ve been and/or how unfair life is. A REBT therapist would identify this as Utopianism and challenge it as an irrational belief
  (Empirical argument would involve disputing whether there is evidence to support irrational belief)
  (Logical argument would involve disputing whether the negative thoughts actually follow from the facts)
• another element of CBT is behavioural activation- therapy designed for depressed patients encouraging them to engage in those activities they were avoiding, to gradually decrease their avoidance and isolation and increase their engagement in activities that have been shown to improve mood such as exercising and socialising with close friends/family

Question 62

What are the pros and cons of CBT?

Answer 62

✅ large body of evidence to support the effectiveness of CBT for depression- for example, March et al compared the effects of CBT with antidepressant drugs and a combination of the two in over 300 adolescents with a main diagnosis of depression. After 9 months, 81% of CBT group, 81% of antidepressant group and 86% of CBT plus antidepressant group were significantly improved= CBT just as effective as medication and helpful alongside medication- this suggests there is a good case for making CBT first choice of treatment in public healthcare systems such as the National Health service

❌ CBT may not work on severely depressed patients- in some cases, depression can be so severe that patients cannot motivate themselves to attend CBT, and if so to take on the hard cognitive work required for CBT and such patients may not even be able to pay attention to what is happening in the session. Where this is the case, it is possible to treat patients with antidepressant medication and commence CBT when they are more alert and motivated. Although it is possible to work around this with medication, it is still a weakness of CBT because it means in some cases CBT cannot be used as the sole treatment for depression

❌ success may be due to therapist-patient relationship- all psychotherapies have one essential ingredient which is the therapist-patient relationship. It may be the quality of this relationship that determines success rather than any particular technique used. Many comparative reviews find very small differences, which supports the view that simply having someone to talk to who will listen could be what matters most

❌ some patients want to explore their past but one of the basic principles of CBT is the focus on the patient’s present and the future rather than their past. This is in contrast to other forms of psychotherapy and some patients may be aware of links between childhood experiences and their current depression and may want to discuss this. The ‘present-focus’ of CBT can be frustrating for some patients and the therapy may ignore an important aspect of the patient’s experience

❌ may be an over-emphasis on cognition- there is a risk because of its emphasis on what is happening in the mind of the patient, that CBT may end up minimising the importance of circumstances in which the patient is living. For example, a patient living in poverty or suffering abuse needs to change their circumstances, but any therapy that places it emphasis on what is happening in the patient’s mind rather than their environment can prevent this. As a result, CBT techniques used inappropriately can demotivate people to change their situation

Question 63

What is OCD?

Answer 63

A condition characterised by obsessions and/or compulsive behaviour

Question 64

What are the behavioural characteristics of OCD?

Answer 64

• compulsions: actions that are carried out repeatedly e.g. hand-washing. The same behaviour is repeated in a ritualistic way to reduce anxiety
• avoidance: suffers of OCD manage their OCD by avoiding situations that trigger anxiety e.g. sufferers who wash hands repeatedly may avoid coming into contact with germs

Question 65

What are the emotional characteristics of OCD?

Answer 65

• anxiety and distress: obsessive thoughts are unpleasant and frightening and the anxiety that goes with these can be overwhelming- the urge to repeat a behaviour causes anxiety
• guilt and disgust: OCD sometimes involves negative emotions such as irrational guilt e.g. over a moral issue or disgust may be directed towards oneself or something external e.g. dirt

Question 66

What are the cognitive characteristics of OCD?

Answer 66

• obsessive thoughts: for around 90% of OCD sufferers the major feature of their condition is obsessive thoughts e.g. recurring intrusive thoughts about being contaminated by dirt or germs
• insight into excessive anxiety: people suffering from OCD are aware their thoughts and behaviours are irrational and this is necessary for diagnosis. In spite of this, sufferers experience catastrophic thoughts and are hypervigilant (overly-aware of their obsessions)

Question 67

The biological approach is used to explain OCD. What are the 2 explanations for OCD?

Answer 67

• genetic explanations

- neural explanations

Question 68

What are the 3 major points of genetic explanations of OCD?

Answer 68

• candidate genes
• OCD is polygenic
• aetiologically heterogenous

Question 69

Explain how candidate genes can cause OCD

Answer 69

• Candidate genes are Specific genes that have been identified which create a vulnerability for OCD
• some of these genes are involved in regulating the development of serotonin system e.g. the gene 5HT1-D beta is important in the transmission of serotonin across synapses- dopamine genes are also implicated in OCD and both dopamine and serotonin are neurotransmitters that have a role in regulating mood

Question 70

Explain how OCD being polygenic can cause OCD

Answer 70

OCD is not caused by a single gene, in fact, many genes are involved. Taylor (2013) found evidence that 230 different genes may be involved in OCD

Question 71

Explain aetiologically heterogenous

Answer 71

One group of genes may cause OCD in one person but different groups of genes may cause cause the disorder in another person- aetiologically heterogenous- also evidence that different types of OCD may be result of particular genetic variations such as hoarding disorder

Question 72

What are the strengths and weaknesses of genetic explanations of OCD?

Answer 72

✅ good supporting evidence- there is evidence that some people are vulnerable to OCD as a result of their genotype (candidate genes). For example, Nestadt et al (2013) reviewed previous twin studies and found that 68% of monozygotic twins shared OCD compared to just over 30% of dizygotic twins, strongly supporting the idea of genetic causation of OCD
- however not 100% concordance rate so the ides that your genotype alone determines where you develop OCD= biologically deterministic as there must be external environmental factors must be involved. So at best, shows concordance is higher in MZ twins than DZ twins, suggesting that genetics play a role but perhaps aren’t the sole explanation

❌ too many candidate genes have been identified- although twin studies suggest OCD is largely under genetic control, researchers have had a much harder time isolating all the genes involved. One reason for this is that OCD’s supposed polygenic nature and that each genetic variation only increases the risk of OCD by a fraction. The consequence is that a genetic explanation is unlikely to ever be useful because it provides little predictive value

❌ not just genes, environmental risk factors are also involved that can also trigger or increase the risk of developing OCD. For example, Cromer et al (2007) found that over half of the OCD patients in their sample had a traumatic event in their past and OCD was more severe in those with one or more trauma but… correlation study. Nevertheless, suggests that OCD cannot be entirely genetic in origin, at least not in all cases, supporting the diathesis-stress model

Question 73

Describe neural explanations of OCD

Answer 73

• neurotransmitters are responsible for relaying ‘information’ from one neurone (nerve cell) to another. If a person has low levels of serotonin then a transmission of mood-relevant information does not take place and mood, and sometimes other mental processes, are affected.
• some cases of OCD, and in particular, hoarding disorder, seem to be associated with impaired decision making- this in turn may be associated with abnormal function of the lateral of the frontal lobes of the brain as the frontal lobes are responsible for logical thinking and decision making
• there is also evidence to suggest that an area called the left parahippocampal gyrus (associated with processing unpleasant emotions functions) abnormally in OCD

Question 74

What are the strengths and weaknesses of neural explanations of OCD?

Answer 74

✅ some supporting evidence of neural explanations for OCD: for example some antidepressants work purely on the serotonin system, increasing levels of the neurotransmitter and such drugs are highly effective in reducing OCD symptoms suggesting the serotonin system may be involved in OCD. Also, OCD symptoms form part of a number of other conditions that are biological in origin such as Parkinson’s disease. This suggests that the biological processes the cause the symptoms in those conditions may be may also be responsible for OCD.

❌ not exactly clear what neural mechanisms are involved in OCD: studies of decision- making have shown that these neural systems are the same systems that function abnormally in OCD. However, research has identified other brain systems that may be involved sometimes, but no system has yet been found that always plays a role in OCD and so, the neural mechanisms involved in OCD are not fully understood or possibly uncovered.

❌ the serotonin-OCD link may simply be co-morbidity with depression: many people who suffer from OCD become depressed and having two disorders together is known as co-morbidity. The depression probably involves disruption to the serotonin system and so this is a problem when it comes to the serotonin system being the basis of OCD- it could simply be that the serotonin system is disrupted in patients with OCD because they’re depressed aswell.

Question 75

What is the biological approach to treating OCD?

Answer 75

Drug therapy

Question 76

Describe and explain how drug therapy works to treat OCD

Answer 76

• Drug therapies for mental disorders aim to increase or decrease levels of neurotransmitters in the brain
• low levels of serotonin are associated with OCD
• therefore drugs work in various ways to increase the level of serotonin in the brain

Question 77

What are the different drugs needed to know to treat OCD?

Answer 77

• selective serotonin reuptake inhibitors (SSRIs) e.g. Fluoxetine
• tricyclics e.g. Clomipramine
• serotonin noradrenaline reuptake inhibitors e.g. Mirtazapine

Question 78

How do SSRIs work?

Answer 78

• SSRIs prevent the reabsorption and the breakdown of serotonin in the brain. This increases its level in the synapse and thus it continues to stimulate the postsynaptic neurone, compensating for whatever is wrong with the serotonin system in OCD
• typical daily dose of Fluoxetine is 20mg, although this may be increased if it is not benefiting the patient (this can be increased to 60mg daily for example, if appropriate)
• it takes 3-4 months of daily use of SSRIs to impact upon symptoms
• can combine SSRIs with CBT- drugs work to reduce a patient’s emotional symptoms such as feeling anxious or depressed = patients can engage more effectively at CBT

Question 79

When are tricyclics used and how do they work?

Answer 79

Occasionally, other drugs are prescribed alongside SSRIs such as tricyclics (an older type of antidepressant) are sometimes used such as Clomipramine; these have the same effect in the serotonin system however the side-effects can be very severe

Question 80

when are SNRIs used and how do they work?

Answer 80

In the last 5 years, a different class of antidepressant drugs called serotonin-noradrenaline reuptake inhibitors have also been used to treat OCD. Like tricyclics, these are a second line of defence for patients who don’t respond to SSRIs, but the key difference being that SNRIs increase levels of serotonin, as well as noradrenaline

Question 81

What are the evaluation points for drug therapy in treating OCD?

Answer 81

✅ effective at tackling OCD symptoms (Soomro et al)
✅ drugs are cost-effective and non-disruptive
❌ drugs can have side effects
❌ evidence for drug treatments is unreliable
❌ some cases of OCD follow trauma

Question 82

Explain how drug therapies are effective at tackling OCD symptoms

Answer 82

• Soomro et al reviewed studies comparing SSRIs to placebos in the treatment of OCD
• all 17 studies showed significantly better results for SSRIs than for placebo conditions
• in fact, effectiveness is greatest when SSRIs are combined with a psychological treatment, usually CBT
• typically, symptoms reduce for around 70% of patients taking SSRIs; of the remaining 30%, alternative drug treatments such as tricyclics or combinations of drugs and psychological treatment will be effective
• so drugs can help most patients with OCD

Question 83

Explain how drug therapies are drugs are cost-effective and non-disruptive

Answer 83

• one strength of drug treatments in general is that they are cheap compared to psychological treatments
• so using drugs such as SSRIs to treat OCD is therefore good value for a public healthy system like the NHS
• as compared to psychological therapies, SSRIs are also non-disruptive to patients’ lives
• if a patient wishes, they can simply take the drugs until their symptoms decline and not attend and engage in psychological therapies
• so many doctors and patients like drugs treatments due to their ability to reduce symptoms whilst being cost-effective and convenient for patients’ lives

Question 84

Explain how drugs can have side-effects

Answer 84

• although drugs like SSRIs can be helpful to sufferers of OCD as Soomro et al found, a significant minority will receive no benefit
• some patients also suffer side-effects such as indigestion, blurred vision and loss of sex-drive, although these side-effects are usually temporary
• for those taking Clomipramine (tricyclic) side-effects are much more common and potentially more serious
• more than 1 in 10 patients suffer erectile dysfunction, tremors and weight gain with 1 in 100 become aggressive and suffer disruption to blood pressure and cardiac rhythm
• such factors reduce drug therapy effectiveness as people stop taking their medication due to the often serious side-effects

Question 85

Explain how evidence for drug treatments is unreliable

Answer 85

• although SSRIs have been found to be fairly effective, and any side-effects are likely to be short-term, like all drug treatments SSRIs have some controversy attached
• some psychologists believe the evidence favouring drug treatments is biased because the research is sponsored by drug companies who do not report all the evidence I.e. file-drawer effect (Goldacre)
• such companies may have a vested interest in attempting to suppress evidence that does not support the effectiveness of particular drugs to maximise their economic gain

Question 86

Explain how some cases of OCD follow trauma

Answer 86

• OCD is widely believed to be biological in origin due to the evidence found regarding candidate genes such as 5HT1-D beta along with the neural explanations of OCD such as the serotonin system
• so it makes sense that the standard treatments should be biological e.g SSRIs or tricyclics
• however it is acknowledged that OCD can have a range of other causes, and that in some cases, is a response to traumatic life events
• it may not be appropriate to treat cases that follow a trauma with drugs when psychological therapies may provide the best option and benefit to the patient