Paper 1 - Psychopathology

Question 1

What are the 4 definitions of abnormality

Answer 1

Deviation from social norms
Social infrequency
Deviation from ideal mental health
Failure to function adequately

Question 2

Define and outline ‘deviation from social norms’ as a definiton of abnormality

Answer 2

It argues that abnormality is any behaviour which goes against from what is considered as normal and acceptable by society

Social norms refers to the commonly accepted standards of behaviour within a culture or society which allows for the regulation of normal social behaviour. Any behaviour which deviates from social norms can be classified as ‘abnormal’. Norms do change over time and across cultures though, so there are relatively few behaviours that would be considered universally abnormal, on the basis of breaching social norms

Question 3

Evaluate Deviation from social norms

Answer 3

A strength of the deviation from social norms definition is that is has real life applications. There is a place for the deviation from social norms explanation when thinking about what is normal and abnormal. And as such, it has been a useful tool in the diagnosis of antisocial personality disorder. Therefore deviation from social norms has had a place in a clinical setting and has actually improved our understanding and practice

A limitation however is that this definition fails to take into account cultural relativism. Social norms are specific to particular cultures. This means behaviour may deviate from the social norms of one culture but may be perfectly acceptable. This means that the deviation from social norms definition is an incomplete definition of abnormality as it des not recognise the influence of culture

In addition, another limitation of this definition is that it lacks temporal validity and is era dependent. This definition does not take into account the fact that social norms vary over time. A behaviour may therefore be classed as abnormal in the past but may be perfectly acceptable in today’s society. This means that from social norms definition of abnormality may lack temporal validity and that it needs to be adapted to take into account how social norms change across generations

Question 4

Define and outline ‘Statistical infrequency’ as a definition of abnormality

Answer 4

Statistical infrequency states that behaviour is abnormal if it is a less common characteristic in most of the population

This is a mathematical method for defining abnormality that is based on how frequently a behaviour occurs within a population. It works on the idea that abnormality should be based on infrequency. Under this definition of abnormality, a person’s trait, thinking or behaviour is classified as abnormal if it is rare or statistically unusual The mathematical element of the definition is about the idea that human attributes fall into anormal distribution within the population. Anything that falls outside of +/-2 standards deviations is likely to be judges as abnormal

Question 5

Evaluate statistical infrequency

Answer 5

A strength of the statistical infrequency definition of abnormality is that it has real life applications. This explanation has real life applications in the diagnosis of intellectual disability disorder. There is therefore a place for statistical deviation in thinking about what are normal and abnormal behaviours and characteristics. All mental health patients are assessed in measures of how severe their symptoms are in comparison to statical norms therefore this means that statical infrequency is a useful part of clinical assessment

However, a limitation is that unusual characteristics can be positive. Not all behaviours which deviate from statistical averages are seen as undesirable and so we shouldn’t think of abnormal behaviours as a negative. For example those with high IQ are statistical infrequent but we don’t see that as abnormal. This is a limitation of the concept of statistical infrequency and means that it should never be used alone to make a diagnosis or to classify a behaviour as ‘abnormal’.

Not everyone statically ‘unusual’ will benefit form a label of abnormality. A further weakness with statistical infrequency as a definition of abnormality is that, when someone is living a happy and fulfilled life, there is no benefit from being labelled as abnormal regardless of how abnormal they are in comparison to the majority of the population. Attaching such a label to a person who’s behaviour may be less common in comparison the rest of the population is that it can escalate the behaviour further. This is known as a ‘self-fulfilling prophecy which is a situation in which something happens because you excepted or said it would happen

Question 6

Define and outline ‘a failure to function adequately’ as a definiton of abnormality

Answer 6

It states that abnormality is any behaviour which prevents a person from living their day-to-day life and functioning ‘adequately’

When someone deviates from their normal pattern of behaviour they are ‘failing to function adequately’ and are judged as abnormal. To support this definition Rosenhan and Seligman identified seven characteristics of abnormal behaviour. If a behaviour fits into one of more of these categories, it is judged as abnormal

Question 7

What are the seven characteristics of abnormal behaviour

Answer 7

1. Maladaptiveness - Behaviour is maladaptive if it interferes with a persons usual daily routine
2. Observer discomfort - Behaviour is abnormal if it causes other people discomfort or distress
3. Unpredictable behaviour - Behaviour is abnormal if it is not what would be expected in a given situation
4. Irrational behaviour- Behaviour is abnormal if it appears irrational and difficult to understand
5. Severe personal distress - A persons abnormal behaviour will normally cause them a great deal of personal distress
6. Violation of ideal standards- Behaviour is abnormal; if it no longer conforms to standard interpersonal rules, for example, maintain eye contact

Question 8

Evaluation of failure to function adequately

Answer 8

A strength is that this definition captures the experiences of people who need help. The failure to adequately definition should be praised for the fact it considers the subjective experience of the individual. Despite it actually being difficult to assess and measures distress, the fact that this definition acknowledges the experience of the patient is a positive thing

A limitation of this definition is that it relies on subjective judgments. This means professionals have to decide if a behaviour fits one of the seven features of abnormality and is causing, a person to fail to function adequately. This decision relies heavily on personal attitudes which may bias their decision and and the individuals behaviour may be classified as abnormal by one professional but normal by another. Therefore, the definition may be prone to researcher/ clinician bias

Another limitation is that the definition ignores cultural relativism. Standards pattern of behaviour differ from culture to culture. What may be maladaptive and cause discomfort in one culture may not in another. This means that this definition is therefore limited as it is culturally dependent and does not recognise culture specific behaviours may not always be abnormal

Question 9

Define and outline ‘deviation from ideal mental health’ as a definition of abnormality

Answer 9

It is when a person is abnormal if they do not possess what are considered to be the features of ideal mental health

This definition is different from the previous two because it firstly defines what is meant by ideal mental health. Researcher Mary Jahoda established 6 categories of mental health. So according to this definition, if a person’s behaviour causes the above ‘needs’ to be unmet, then they are classified as having a degree of abnormality

Question 10

What are the 6 categories of mental health

Answer 10

1. Self attitudes - A person who is psychologically healthy should have high self esteem and a strong sense of identity
2. Personal growth and self actualisation - An individual should be striving to achieve and develop to their potential/ capability
3. Integration - An individual should be able to function within society and cope with stressful situations which may arise
4. Autonomy - An induvidual should be independent and be able to look after oneself
5. Accurate perception of Reality - A psychologically healthy people should be able to separate fantasy from reality and have a realistic view of the world
6. Mastery of the environment - a psychologically healthy induvial should be in control of their environment and so should be in control of their environment and so should be able to adjust to new environments

Question 11

Evaluate deviation from ideal mental health

Answer 11

The criterion outlined in this definition of abnormality probably covers most of the reason someone would seek help from mental health services or be referred for help. Therefore, the range of factors discussed provides a comprehensive and useful tool for thinking about mental health

Another strength of this definition is that is emphasises a positive attitude to human behaviour. The other definitions focus on the identifying features of psychological abnormality, whereas the deviation from ideal mental health definition focuses on the characteristics needed in order for a person to be psychologically healthy. This is a positive view to take regarding human behaviour and it also has practical applications as it can be used in therapy to help a person improve their lives and achieve psychological well-being by focusing on certain areas of their life’s

A key limitation of the deviation form ideal mental health definition is that it is cultural bound and ignores cultural relativism. The characteristics of ideal mental health proposed by Jahoda are rooted in western norms and ideals for example in individualist cultures which strive towards personal growth and achievements. Because of this, the definition may only be relevant for use in western societies. If it is used with people from other cultures. This definition is limited as it cannot be applied universally. It is ethnocentric/ culturally bias

Question 12

Define DSM

Answer 12

The Diagnostic and statistical manual of mental disorders

Question 13

What are the DSM sub-categories of Phobias

Answer 13

1. Specific phobia : phobia of an object, such as animal or body part, or a situation such as flying or having an injection
2. Social anxiety : phobia of a social situation such as public
3. Agoraphobia : phobias of being outside or in a public place

Question 14

What are the behavioural characteristics of phobias

Answer 14

1. Panic – in the presence of the phobic stimulus behaviours include crying, screaming, running away. Children may react slightly differently, for example, by freezing or
   clinging onto an adult.
2. Avoidance – Not going to any places or situations where they might come into contact with the phobic stimulus. E.g. avoiding parks or picnics during the summer because of a wasp phobia.

Question 15

What are the emotional characteristics of phobias

Answer 15

1. Fear – feelings of terror or feeling scared e.g. feeling terrified of dying in an aeroplane
   crash.
2. Anxiety – feelings of worry or distress in the presence of the phobic stimulus.

Question 16

What are the cognitive characteristics of phobias

Answer 16

1. Selective attention to the phobic stimulus – in the presence of the phobic stimulus, the person will find it difficult to direct their attention elsewhere e.g. not being able to look away from a moth that’s come into your house. Therefore, a person’s selective attention will cause them to become fixated on the object they fear, because of their irrational beliefs about the danger posed.
2. Irrational beliefs – illogical, erroneous, or distorted ideas. E.g. a person with a phobia of spiders may believe that all spiders are dangerous and deadly, despite the fact that no spiders in the UK are actually deadly

Question 17

DSM 5 recognises 4 categories of depression. What are they?

Answer 17

1. Major depressive disorder Severe but often short-term depression
2. Unipolar depression Sufferers only experience depression and not manic episodes. Clinical symptoms usually occur in cycles.
3. Bipolar depression Sufferers experience mixed episodes of mania and depression.

Question 18

What are the behavioural characteristics of depression

Answer 18

1. Change in activity levels – for example, increased lethargy (lack of energy) and withdrawal from activities that were once enjoyed.
2. Neglecting personal hygiene – e.g. bathing, wearing clean clothes etc.
3. Sleep disruption – decreased sleep, insomnia (inability to fall asleep or stay asleep) or increased sleep, hypersomnia (oversleeping).

Question 19

What are the cognitive characteristics of OCD

Answer 19

• Obsessive thoughts - The major cognitive feature of OCD is obsessive thoughts i.e. thoughts that recur over and over again. They vary from person to person but are always unpleasant.
• Hyper-vigilant i.e. maintain constant alertness and attentions focused on potential hazards

Question 20

What are the emotional characteristics of depression

Answer 20

1. Low mood - A key characteristic is the ever present and overwhelming feelings of sadness/negativity, sometimes described as feelings of ‘emptiness’.
2. Worthlessness - Those suffering from depression often have constant feelings of low self-worth and/or inappropriate feelings of guilt. In extreme cases, it could involve a feeling of self-loathing (hating themselves).

Question 21

What are cognitive characterises of depression

Answer 21

1. Poor concentration- There can be difficulty in paying attention/maintaining attention and/or slowed down thinking and indecisiveness. This is likely to interfere with an individual’s work or everyday functioning.
2. Negative schemas – People with depression tend to possess negative self-schemas which are a set of beliefs and expectations about themselves that are essentially negative and pessimistic.

Question 22

What does DSM recognise that OCD involves and what are the 5 categories?

Answer 22

OCD- Characterised by either obsessions (recurring thought, images, etc) and/or compulsions (repetitive behaviour such as handwashing)

• Trichotillomania- compulsive hair-pulling
• Hoarding disorder- the compulsive gathering of possessions and the inability to part with anything, regardless of its value
• Excoriation disorder- compulsive skin-picking

Question 23

What are the behavioural characteristics of OCD

Answer 23

• Compulsive behaviour - repeating a behaviour to help reduce anxiety e.g. washing hands, counting etc.
• Avoidance - keeping away from situations that trigger it

Question 24

What are the emotional characteristics of OCD

Answer 24

• Anxiety and distress - OCD is regarded as a particularly unpleasant emotional experience because of the excessive anxiety that accompanies both obsessions and compulsions. Obsessive thoughts unpleasant/frightening-> anxiety-> urge to repeat compulsion-> anxiety
• Accompanying depression - Anxiety is often accompanied by low mood and lack of enjoyment in activities. It can also involve other negative emotions such as irrational guilt or disgust (directed at the self or something external e.g. dirt).

Question 25

Outline the two process model as an explanation of phobias

Answer 25

The two‐process model suggests that phobias are acquired through classical conditioning and are maintained through operant conditioning. Phobias are acquired by forming an association between an object/situation and something which triggers a fear response for example, a person being bitten by a dog. The dog, which was initially a neutral stimulus (NS), would become associated with being bitten, the unconditioned stimulus (UCS). This pairing leads to the dog becoming a conditioned stimulus which then creates fear, a conditioned response (CR).

Phobias are maintained through reinforcement. Those with a phobia will avoid the phobic stimulus which reduces anxiety, acting as negative reinforcement. For example, if a person with a dog phobia sees one whilst out walking, they might avoid it by crossing the road. This reduces the person’s anxiety and so negatively reinforces their behaviour, making the person more likely to continue avoiding dogs, thusmaintaining their phobia.

Question 26

Outline the first part of the two part model of phobias

Answer 26

Classical conditioning involves learning through association. This relates to phobias in the sense that we learn to associate something which we initially have no fear of (NS) with something that already triggers a fear response (US)

Dog (neutral stimulus)&raquo_space;> No response (neutral response)
Being Bitten (unconditioned stimulus)&raquo_space;> Anxiety (unconditioned reflex)
Dog + being bitten ( neutral stimulus + conditioned stimulus)&raquo_space;> Anxiety ( unconditioned reflex)
Dog (conditioned stimulus)»> Anxiety ( conditioned response)

Baby Albert was therefore conditioned to fear white rats. This conditioned also generalised to other similar objects, such as non-white rabbit, a fur coat and Santa Claus. The distress shown by Albert at the presence of these objects highlights the strength of learning through association

Question 27

Outline the second part of the two process model of phobias

Answer 27

Maintenance of a phobia by operant conditioning says that although classical conditioning can explain why we develop a phobia, it struggles to explain why out phobias to not decay over time; as such responses tend to decline.

As most phobias tend to be long lasting Mowrer has explained that phobias are therefore maintained through operant conditioning. According to operant conditioning, phobias maintain because they are negatively reinforced. Mowrer argues that whenever we avoid a phobic stimulus, successfully escape the fear and anxiety it has caused. This reduction in gear reinforces the avoidance behaviour and so the phobia is maintained. in the future, a person will show the same phobic behaviour in order to achieve the same negative reinforcement

Question 28

Evaluate the behavioural approach as an explanation of phobias

Answer 28

A strength is that there is supporting evidence from lab based research. Watson & Raynor (1920) demonstrated the process of classical condition in the formation of phobias in Little Albert, who was conditioned to fear white rats. He found that Little Albert could be conditioned have a fear of white rats if the stimulus was presented with an accompany loud noise. This research supports and validates the ideas that classical conditioning is involved in acquiring phobias

A strength is that the behavioural approach has practical applications in the form of therapy. The behaviourist ideas about phobias have been used to develop effective treatments, including systematic desensitisation and flooding. Systematic desensitisation helps people to unlearn their fears, using the principles of classical conditioning, while flooding prevents people from avoiding their phobias and stops the negative reinforcement from taking place. These therapies have been successfully used to treat people with phobias thus providing further support to the behaviourist explanation as they validate the underlying theories

However the behavioural approach to explain phobias may be incomplete as it cannot explain why some phobias develop in the absence of a traumatic experience; it fails to recognise the important rile of Biological preparedness and evolutionary pressures. Bouton (2007) points out that evolution may have a played a role in the acquisition of phobias, in that we may fear objects/animals which have been a source of danger in our evolutionary past. Therefore the acquisition of such fears in a adaptive process, which is not considered in the two-process model. This could explain why it is rare to develop phobias of objects such as cars or guns, because they have only existed recently and so we are not biological prepared to fear these yet.

Question 29

Outline and describe the behavioural therapy of systematic desensitization

Answer 29

Systematic desensitization is a behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning

The aim of systematic desensitization is to replace a conditioned response a fear with a more appropriate response. This learning of a different response is called counterconditioning. It is also based on the idea that a person cannot experience two emotions for the same aspect (i.e. a person cannot experience both anxiety and calm for the same aspect; one always replaces the other). This is called reciprocal inhibition. Therefore, if the sufferer can learn to relax in the presence of the phobic stimulus, they will be cured

Question 30

What are the 3 process involved in SD

Answer 30

1. Developing an anxiety hierarchy- The therapist conducts a functional analysis of the client’s phobias. Part of this involves the creation of the fear hierarchy, which is a list that a client and therapist develop, that specifies increasing more fearful situations for the client.
2. Relaxation - The therapist teaches the client the patient relaxation techniques, such as deep muscle relaxation, breathing exercises, mental imagery and progressive relaxation, which can be applied throughout the therapy
3. Graduated exposure- Finally the client is exposed to the phobic stimulus while in a relaxed state, This involves gradually exposing the client to each step of the fear hierarchy. Treatment is successful when the patient can stay relaxed in situations high on the anxiety hierarchy

Question 31

Evaluate of systematic desensitisation as a treatment for phobias

Answer 31

A strength of systematic desensitisation is that there is research to support its effectiveness as a treatment for phobias. Gilroy et al (2003) followed up 42 people who had SD for spider phobia and he did a follow up, the SD group were less fearful than a control group. This shows that SD is an effective therapy for reducing Spider Phobias, but also that it is effective in the long term as the phobia is removed

A further strength is that the use of gradual exposure is considered less traumatic than other therapies. This means that patients tend to prefer it to other methods of treatment, such as flooding. This is due to the fact that the elements involved, such as learning relaxation techniques and only being gradually exposed to phobic stimuli when the patients is ready, make it a more pleasurable experience than some of the traumatic and excessive elements in other treatments, This also means that there are low refusal rates and low attribution rates which makes it a more effective treatment overall.

Another weakness is that there is an argument that SD controls systems but do not treat the root cause of disorders/ phobias. Behavioural therapies like SD arguably do not target the deeper emotional, psychological and biological issues related to a person disorder. Because of this symptom substitution sometimes occurs following behavioural therapies. This is when a client develops a new phobia in place of the old phobias, indicating the root cause of their abnormality has not been dealt with. Therefore a more complete therapy for phobias would take a combination approach, where a psychological or biological therapy is used alongside a behavioural therapy in order to not control the phobia and treat the root cause

Question 32

Outline flooding as a behavioural therapy

Answer 32

Flooding is a form of behaviour therapy based on the principles of operant conditioning. Like SD, flooding also involves exposing the patient to their phobic stimulus but without a gradual build-up in a fear hierarchy.

It is to expose the sufferer to the phobic object or situation for an extended period of time in a safe and controlled environment, in order to extinguish the fear response and replace it with a more positive response
Flooding generally involves in vivo (actual) exposure. Flooding sessions are typically longer than SD, often 2-3 hours. Sometimes though, only one long session is needed to cure a phobia. Flooding also works on the assumption that fear is a time limited response. Flooding also works on the assumption that fear is a time limited response. At first the person is in a state of extreme anxiety but eventually exhaustion sets in and the anxiety level begins to go down. Now they have no choice but confront their fears and when the public subsides and they find they have come to no harm.

Prolonged intense exposure eventually creates a new association between the feared object and something positive. It also prevents reinforcement of phobia throughout escape or avoidance behaviours. Flooding may also work due to a process called extinction, whereby the association between feared stimulus and fear response gradually weakens and eventually extinguishes

Question 33

Evaluate flooding as a treatment for phobias

Answer 33

A strength is that it is cost-effective due to the speed of effectiveness. Research has demonstrated that flooding is highly effective in the treatment of phobias in comparison to cognitive therapies. Moreover, it is quicker than alternative treatments. In fact, flooding is every bit as effective as SD and does not always involve muscle relaxation. This is a major strength because it means that patients’ symptoms are reduced as soon as possible and they wont have to spend as much money on treatment because of the small number of sessions required and it seems reasonable to assume that the recovery is due to the conditioned fear being extinguished

However, a weakness is that flooding is less effective for some types of phobias. Although flooding is highly effective for treating simple phobias of specific objects, it appears to be less effective for the treatment of more complex phobias such as social phobias. This may be because of the cognitive aspects involved in social phobias. Therefore, the most complete therapeutic option would be to take a combination approach, where flooding is used alongside a cognitive that would tackle the root cause

A final criticism is that the treatment is traumatic for patients and so suffers from ethical issues. Flooding is unethical as per say, but it is an extremely unpleasant experience so it is important that patients give fully informed consent to this traumatic procedure and that they are fully prepared before the flooding therapy. But it still does involve a highly traumatic experience and this is a serious issue. Because of this considerations, flooding should only be used with clients who have undergone a full psychological assessment who have given full informed consent following a full explanation of the procedure involved

Question 34

Outline the cognitive approaches in depression

Answer 34

The cognitive approach is concerned with how out mental process (thoughts, perceptions, attention) affect behaviour. The approach argues that the way we see the world and our subsequent behaviour are determined by our thoughts cognitions and schemas, so abnormal and/or irrational thought process and beliefs will lead to mental disorders.

Question 35

Outline negative self-schema in beck’s cognitive negative triad theory of depression

Answer 35

American Psychiatrist Aaron Beck (1967) suggested that a persons cognitions create a vulnerability to depression. Beck argues that negative schemas develop in childhood (schemas are a ‘package’ of information and ideas developed through experiences. They act as a mental framework for the interpretation of sensory information). These negative schemas cause people to view events pessimistically, which may lead to the symptoms of depression. Beck argues that people with depression have particular negative/ irrational schemas about the self, the world and the future. This is known as the negative triad and will lead to cogntive distortions ( a person processing information and situations inaccurately)

Question 36

Outline faulty information processing in beck’s cogntive triad theory of depression

Answer 36

This occurs when a patient attends to the negative aspects of a situation and ignores the positives. They may blow small problems out of problems out of proportion and think in ‘black and white terms’. Beck also identified some specific irrational thoughts that may lead to symptoms of depression this includes….

Minimisation and maximisation is when a there are errors in the evaluation and judgment which are disproportionation as well as a minimization which downplays events or emotions as unimportant and unworthy as well as maximisation which exaggerates the events or emotions. Selective abstraction which is the tendency to focus and believe in one detail often taken out of context and ignore more important parts/ details of an experience

Question 37

Outline and describe Ellis’ ABC model in the cogntive approach in explaining depression

Answer 37

Albert Ellis proposes that the A-B-C model can be used to understand role of our beliefs in behaviour. A person experiences an (activating) event. They then think about apply cognitions to the event (‘beliefs’). If their beliefs are irrational, it will lead to cognitive distortion. This will then lead to negative consequences
1. A stands for activating event which is a focus on situations that are triggered by external events.
2. B stands for beliefs which are a belief is the interpretation of the event which could be rational or irrational
3. C stands for consequences of the beliefs the consequences will be symptoms of depression which include when an event triggers beliefs that can be rational or irrational. A belief that leads to a healthy consequences

Question 38

Evaluation of the Cognitive approach to explaining depression

Answer 38

A strength is that it has good supporting evidence. Grazioli and Terry (2000) and Clark and Breck (1999) have provided strong support for the idea that depression is associated with faulty information processing, negative self-schemas and the cogntive triad of negative automatic thinking. For example, Grazoli and Terry (2000) found that women judged to be high in cogntive vulnerability due to faulty information processing and negative self-schemas, were more likely to suffer from postnatal depression

Although the supporting evidence shows a link between faulty thinking and depression, it does not provide evidence for a cause and effect relationship. This means
we are unable to conclude that faulty thinking causes depression. It is possible that other factors, for example genes and neurotransmitters, are the cause of depression and the negative, irrational thoughts are a symptom of the disorder. As a result, the cognitive explanations for depression could be seen as limited.

A weakness is that there are cause and effect issues with cognitive approach to psychopathology. it is argued that dysfunctional, irrational beliefs and cognitions may actually be an effect of disorders like depression as opposed to a cause. Irrational negative thinking may actually be a cause of disorders like depression as depression may actually encourage a focus on the negative thinking

Question 39

Outline the cogntive approach to treating depression

Answer 39

CBT can be used to treat people with a wide range of mental health problems. CBT is based on the idea that how we think (cognition), how we feel (emotion) and how we act (behaviour) all interact together. Specifically, our thoughts determine our feelings our behaviour. Therefore therapies based on the cognitive approach assume depression is caused by negative irrational and dysfunctional beliefs/ cognitions. CBT is the application of beck’s cognitive theory of depression and the idea behind negative theory is to identify automatic thoughts about the world, self and the future- this is the negative triad

Question 40

Outline and Ellis’ rational emotive as a Cognitive behaviour therapy

Answer 40

The aim is for the individual with depression to identify and challenge their negative thoughts and beliefs
by re-interpreting them in a more positive way. This helps to prevent further negative thinking and emotions such as low mood and feelings of worthlessness.

REBT extends the ABC model (see explanation) to an ABCDE model – the D stands for dispute (challenging
the irrational thoughts) and the E stands for effect (irrational beliefs are replaced with rational beliefs). The central part of REBT is to identify and dispute irrational thoughts and beliefs. The individual will firstly identify any previous experiences and activating events, which may have resulted in their negative and irrational beliefs and subsequent behaviours.

The therapist then uses rational confrontation to reduce negative cognitive and emotional symptoms of
depression. One way the therapist does this is through
empirical dispute; this involves asking the individual for proof that their negative thoughts or beliefs are true. For example asking for evidence to support the individual’s
negative self-schema “what evidence do you have that others no one likes you.” Another way is logical dispute which involves asking if the negative belief is logical or based on common sense “Is it rational to assume that you are a complete failure after this one set back.”

Question 41

Evaluate of cognitive behavioural therapy as the treatment for depression

Answer 41

In evaluation , a strength of therapies based on the cognitive approach is that there is evidence that they are an effective treatment For example Ellis (1957) claimed a 90% success rate for REBY ( a popular form of CBT as well as Elkin (1989) also concluded that cognitive therapy has more long lasting positive effects when compared to either psychotherapy or drug treatments and has the added advantage of having fewer negative side effects. These studies also suggest that cognitive therapies are effective in the treatment of depression

A major strength of cognitive therapies is that they are effective in the long term. CBT aims to adapt a clients belief system and teach behavioural strategies which can be applied by the client in the real world. This gives the client the skills and tools manage their own life and therefore they do not become over reliant on the therapist. The cognitive changes and behavioural techniques will not just help the client overcome their immediate problems but will also inoculate them against future problematic situations. Therefore cognitive therapy is likely to be more effective in the long term and reduce the likelihood of relapse

However, CBT may not work/ be effective for the most severe case of depression. in some cases of depression can be so severe that patients lack the motivation themselves to take on the hard cognitive demands required for CBT. Where this is the case though, it can be possible to treat patients with antidepressant medication and commence CBT when they are motivated and alert. This is a limitation of CBT because it means CBT cannot be used as a sole treatment for all cases of depression

Question 42

Outline why the biological approach is used to explain OCD

Answer 42

Some mental disorders appear to have a stronger biological component than others, and OCD is a good example of a condition that may be largely understood as biological in nature. This means then that OCD may be a result of sufferer’s genetic make-up and/or how the brain functioning of a sufferer may differ form that of someone without the condition. AS such, the biological approach is made up of two forms; the Genetic explanation and the Neural explanation

Question 43

Outline and describe the genetic explanation for the biological approach in explaining OCD

Answer 43

Genes make up chromosomes and consist of DNA which codes the physical features of an organism and psychological features which are inherited from our parents. Therefore the genetic explanation is concerned with how such genes play a role in the onset of OCD.

Lewis provides research suggesting that genes are involved in individual vulnerability to OCD. He assessed 50 patients with OCD at the Maudsley Hospital in London, looking for an occurrence of OCD in immediate families. He found out that 37% of his patients had parents with OCD, and 21% has siblings with OCD, which suggests a genetic basis of OCD. There may be candidate genes that if abnormal, will lead to the development of OCD. Researchers have identified specific genes which could create vulnerability for OCD, these are called candidate genes. For example, 5-HT1D (which is responsible for regulating serotonin system) and Sapap 3 was also recently identified as possibly leading to OCD. This makes sense as OCD symptoms have been linked to abnormal activity at serotonin pathways as serotonin influences mood and impulse control

Question 44

What contradicts the genetic is the only reason to explaining OCD (hint think model!)

Answer 44

The diathesis -stress model would stipulate that a person needs to possess these candidate gene abnormalities but must experience an environmental trigger (e.g. some form of trauma) before the OCD develops

Question 45

Further outline the Candidate genes to explaining OCD

Answer 45

Candidate genes (genes suspected to play a role in a particular trait):

The COMT gene regulates the neurotransmitter dopamine. One variation of the COMT gene results in higher levels of dopamine and this variation has been found to be more common in people with OCD, in comparison to people without OCD.

The SERT gene (also known as the 5-HTT gene) is linked to the neurotransmitter serotonin and affects the transport of the serotonin (hence Serotonin Transporter), causing lower levels of serotonin which is also associated with OCD (and depression)

However, OCD seems to be polygenic. This means that OCD is not caused by one single gene but that several genes are involved. Taylor (2003) suggests that as many as 230 genes may be involved and different genetic variations contribute to the different types of OCD.

Question 46

Evaluate the genetic explanation of OCD

Answer 46

In evaluation, a strength of this approach is that there is supporting evidence which strongly suggests that some people are vulnerable to OCD as a result of their Genes. Nestadt et al (2010) reviewed twin studies and found a concordance rate of 68% for OCD in identical (MZ) twins compared to 31% of non-identical twins (DZ). This strongly supports a genetic influence on OCD. As well as this, Marini and stebnicki (2012) reported that relatives of suffers of OCD are around 4 times more likely to be diagnosed than those without relatives who have OCD. This means there is a range of good supporting evidence for the genetic explanation to OCD. However, as concordance rates are never 100%, it does indicate that other factors (e.g. environmental trauma must influence some cases of OCD)

A further limitation that environmental risk factors are also involved, so we cannot rule our the role of nurture. It is biologically deterministic it suggest that OCD is caused by genetic abnormalities. It appears that genes alone that trigger the onset of OCD, nut the environmental risk factors can increase the risk of developing the disorder. It is overly deterministic to suggest that having a genetic abnormality lead to OCD developing and this is not the case. This suggests , for a complete explanation of OCD we need to consider an interactionist approach. The diathesis-stress model, argues that a person inherits a genetic abnormality that pre-disposes them towards OCD, but the disorder is only triggered if the person encounters a suitable environmental trauma or stressor

That being said, genetic theories are OCD have had major practical applications. Identifying that OCD can be a result of genetic abnormalities allow us to screen individuals; this provides a diagnostic advantages as, if they are found to possess the candidate genetic abnormality, we can offer help and support at any early stage. This will significantly increase the quality of life of people with OCD and may also have a positive impact on the economy.

Question 47

Briefly outline the neural explanation

Answer 47

The genes associated with OCD are likely to affect levels of key neurotransmitters as well as the structures of the brain, and so the neural explanation outlines that brain dysfunction, i.e. abnormalities in functionality and structures of the brain may explain the onset of OCD

Question 48

Outline the neurochemical explanation for OCD

Answer 48

The role of serotonin and low kevels of serotonin lowers mood. Neurotransmitters are responsible for relaying information from one neuron to another. If a person has low levels of serotonin then normal transmission of mood-relevant information does not take place and so mood, and potentially other mental processes will be affected, This could explain the anxiety, distress and depression that suffers of OCD experience in response to environmental stimuli. In addition, serotonin is thought to play an inhibitory role. Low levels of serotonin will therefore lead to an unstable mood and behaviours in addition to poor impulse control.

Question 49

Outline the neuroanatomical explanation for OCD

Answer 49

The role of the frontal lobes and impaired decision-making system stems from frontal lobe abnormalities. Some cases of OCD seem to be associated with impaired decision making. The frontal lobes of the brain are responsible for logical thinking and decision-making and impulse control and so this impairment seen in OCD may be associated with abnormal functioning of the lateral of the the frontal lobes

Question 50

Evaluate the neural explanation of the biological approach to explain OCD

Answer 50

In evaluation, a strength of the neural explanation to explain OCD is that there is supporting research from drug treatments. Antidepressant medication works by targeting the neurotransmitter serotonin and linked serotonin systems. Theses drugs have been effective in reducing symptoms of OCD and this suggests therefore that serotonin may be involved in the development of OCD

However, there are cause and effect issues with the neural explanation of OCD. Research has simply found correlations between the neural abnormalities identified and OCD. However, we cannot be sure that things like neurotransmitter abnormalities existed prior to the onset of OCD; they may in fact be an effect of the disorder and not the cause. For this reason we have to consider prospective studies that look at neural factors prior to the onset of OCD so we can compare any differences to an adequate baseline

In addition, Antidepressants (SSRIs) are not effective for all OCD patients. SSRIs, which are an antidepressant that target serotonin systems, are only actually effective in relieving obsessions and compulsions for around 50% of OCD suffers. This therefore suggests that alternative explanations to biochemistry need to be considered when thinking about the case of OCD

Question 51

Outline Drug Therapy in treating OCD

Answer 51

Based on the biological approach to explaining OCD, biological treatments have been developed in order to target the identified biological abnormalities that may underline OCD. The most obvious and successful treatments have been drug treatments that target abnormal neurotransmitter levels

Drug treatments for mental disorders work by targeting abnormal neurotransmitter levels, and therefore aim to normalise/ stabilise abnormal levels of neurotransmitters/ abnormal activity at neural pathways

SSRIs (selective serotonin reuptake inhibitor) are a type of antidepressant drug which prevent the reabsorption and breakdown of serotonin. This results in more serotonin being made available in the synapse. Increasing levels of serotonin can result in improved symptoms for the sufferer.

Question 52

Outline how SSRI works in Drug therapy in treating OCD

Answer 52

When serotonin is released from the pre synaptic neuron into the synapse, it travels, and binds, to the receptors on the post-synaptic neuron.

Serotonin which is not absorbed into the post-synaptic neuron is reabsorbed into the pre-synaptic neuron.
SSRIs increase the level of serotonin available in the synapse by preventing it from being reabsorbed into the pre-synaptic neuron cell. This results in more serotonin being received by the post-synaptic neuron.

Question 53

Evaluate the biological approach to treating OCD

Answer 53

In evaluation, a strength of this approach is that there is evidence to suggest that drug therapy is effective at tackling symptoms of OCD. Research has shown that for around 70% of OCD suffers symptoms will decline if they take SSRIs. To further support this, Soomro (2009) reviewed studies that compared SSRI treatments to placebo treatments for OCD suffers. In all 17 studies reviewed, the patients who were given SSRIs showed significantly better outcomes and reduction of symptoms. The effectiveness was further increased if SSRis were given in combinations with psychological therapy CBT. This clearly shows that biological approaches are an effective treatment for OCD

Another strength is that drug treatments are cost-effective and non-disruptive. Drug treatments in general are cheap compared to psychological treatment. They are also less disruptive to a patients life, and they are self-administered and do no have to engage in lengthy time consuming psychological therapy which involves a trained therapist. This means that biological approach to OCD treatment are preferred by many professionals due to their economic benefits and ease of use

However, a limitation is that drugs can have side-effects. A minority of OCD sufferers will get no benefits from SSRIS. Further, some patients also suffer adverse reactions such as blurred vision and a loss of sex drive. Although temporary, these side effects are not seen in other treatment options. It is also the case that, due to these side effects patients will stop taking SSRIs medication altogether which could lead to a relapse of symptoms. This means that some professionals will view the biological approaches to the treatment of OCD as not appropriate as they can cause additional harm and stress o the patient.

Question 54

Outline Abnormal brain functions in the neural explanations of OCD

Answer 54

Research using PET scans has found sufferers of OCD have elevated levels of activity in the orbitofrontal cortex and the caudate nucleus (located in the basal ganglia).

The orbitofrontal cortex (OFC) is part of a brain circuit also known as ‘the worry circuit’. This circuit involves the OFC, a specific area called the caudate nucleus in the basal ganglia and the thalamus.

The OFC is thought to turn sensory information into thoughts and actions. When the OFC detects something is wrong it sends a ‘worry’ signal to the thalamus. These
signals are normally suppressed or filtered by the caudate nucleus however if the caudate nucleus does not work correctly it cannot filter the worry signals which leads to the thalamus becoming overactive. When this happens, the thalamus sends strong signals back to the OFC to carry out an action (e.g. washing hands). This leads to an overactive worry circuit (the worry message keeps repeating on a loop) which could explain why people with OCD perform compulsions which are repetitive rituals.

For example, a non-suffer of OCD may have an impulse to wash dirt from their hands; once this is done the impulse to perform the activity stops and so does the behaviour. It may be that the brains of those with OCD have difficulty switching off these impulses so that they turn into obsessions, resulting in compulsive behaviour.

Question 55

Evaluate Abnormal Brain functions in the explanations of OCD

Answer 55

Research Supporting evidence- A review of brain-imaging research show elevated activity in the orbital region and
the caudate nucleus has been found consistently in OCD sufferers compared to healthy controls. After treatment, activity in these brain areas reduces to a level comparable to that of controls as found by Saxena and Rauch (2000). This supports the neurophysiological explanation as it shows that these areas of the brain are linked to OCD.

Research Challenging evidence - Many neural mechanisms have been identified but these are not always present in all OCD cases. Neuroimaging studies have so far failed to identify basal ganglia impairments in all OCD sufferers, and some people with brain impairments involving the basal ganglia show no signs of OCD (Ring and Serra Mestres, 2002). This suggests there may be other factors that are also involved in OCD. Therefore, this neural explanation does not provide a complete explanation of OCD.

Issue Causation - Although the supporting evidence shows a link between abnormal brain functions and OCD it does not provide any causal evidence. This means we are unable to conclude that an overactive worry circuit is the cause of the disorder. It is possible that having OCD leads to changes in the brain meaning that abnormal brain functions are an effect of having OCD rather than the cause. Therefore, this explanation could be seen as limited as no firm conclusions can be made as to what actually causes OCD.