PSYCHOPATHOLGY (4) Flashcards

Question

AO1 - Ellis ABC Model (1957)

Answer 1

Albert Ellis believed that depressives mistakenly blame external events for their unhappiness however it is their interpretation of these events that is to blame for their distress. He proposed that the key to depression lay in irrational beliefs. According to this model, depression is produced by the irrational thoughts triggered by unpleasant events. In his ABC model: A refers to an activating event: something happens in the environment around you B is the belief which is held about the event which may be rational or irrational C is the consequence – rational beliefs lead to healthy emotions whereas irrational beliefs lead to unhealthy emotions. It is not the activating event that causes the consequence; the consequence is caused by the beliefs about the activating event. Having irrational beliefs leads to unhealthy negative reactions and emotions, which in turn can lead to depression. Individuals who become depressed interpret unpleasant events in excessively negative or threatening ways at point

Answer 2

1. Supporting research – There is a wealth of research to support Beck’s cognitive explanation. Koster et al’s study used student volunteers who took part in an attention task and were presented with positive, negative and neutral words. They found that depressed participants spent longer attending to the negative words than the non-depressed group (measured through eye-tracking). The result supports the aspect of cognitive biases and that people with depression attend to negative aspects of their life rather than the positive. 2. Practical application – Both Ellis’ ABC model and Beck’s cognitive explanation of depression has been very influential and has stimulated a huge amount of research into the disorder over the last few decades. They have contributed greatly to our understanding of depression and to the rise of cognitive behavioural therapies, which have been very helpful in alleviating the symptoms of depression. Beck reviewed the effectiveness of CBT and found it highly effective in treating depression especially unipolar depressive disorder. This evidence concerning the effectiveness of both Ellis’ and Beck’s forms of CBT can be taken as support for the theory it’s based on.

Answer 3

3. Cause or effect – it is difficult to determine the extent to which distorted cognitive pattern’s cause depression. Numerous studies have shown that depressed people do show more negative thinking than controls. For example, Evans used a questionnaire of pregnant women and found that women with a high negative schema were subsequently 60% more likely to become depressed than those with a low negative schema. However, as yet there is not enough convincing evidence that such thinking comes before a depressive episode. (alternative approach) - The cognitive explanation is only one psychological explanation of depression and ignores other explanations. For example, it tends to underplay the biological aspects of depression, research supports the role of low levels of serotonin in depressed people and the success of drug therapies for treating depression offer further strength to a biological explanation. Taking an eclectic approach, including social, biological and psychological theories, would be a better way of explaining such a complex disorder. To fully understand depression a more holistic approach is therefore needed.

Answer 4

CBT was developed by Beck and is based on his theory of depression. The idea behind Beck’s cognitive behavioural therapy is to identify the automatic thoughts about the world, the self and future. ● Thought Catching - Once identified these thoughts must be challenged. Individuals are taught how to see the link between their thoughts and how they feel. They might, as part of their homework assignments be asked to record in a diary any emotion-arousing events and the automatic negative thoughts that are associated with these events. (cognitive element) ● Cognitive Restructuring - Clients are asked to challenge these dysfunctional thoughts and replace them with ones that are more constructive. This cognitive restructuring can then lead to the individual to have more positive thoughts and can alleviate the depressive symptoms. (cognitive element) ● Behavioural activation (behavioural element) – a characteristic of many depressed people is that they no longer participate in activities that they previously enjoyed. During CBT and REBT, the client and therapist identifies negative behaviour that they engage in, and then come up with positive behaviours/activities to replace them with. With the help of the therapist they will create a plan in carrying them out, and discuss ways to overcome any obstacles in carrying them out. This may take the form of a weekly behaviour schedule which is then reviewed in each session.

Answer 5

The central technique of Ellis REBT is to identify and dispute (challenge) irrational thoughts. Ellis identified different methods of disputing. (cognitive element) Empirical Disputing: Irrational beliefs may not be consistent with reality, e.g., Where is the evidence that this thought or belief is true? Logical Disputing: Irrational beliefs do not follow logically from the information availabl, e.g.,. Does this belief make common sense? Pragmatic Disputing: Emphasises the lack of usefulness of irrational beliefs e.g. Is my irrational belief making things worse or better? Effective disputing changes self-defeating beliefs into more rational beliefs, and the client can move to more rational interpretations of events. This, in turn, helps the depressed client feel better and become more self-accepting. ● Behavioural activation (behavioural element) – a characteristic of many depressed people is that they no longer participate in activities that they previously enjoyed. During CBT and REBT, the client and therapist identify negative behaviour that they engage in, and then come up with positive behaviours/activities to replace them with. With the help of the therapist, they will create a plan in carrying them out, and discuss ways to overcome any obstacles in carrying them out. This may take the form of a weekly behaviour schedule, which is then reviewed in each session

Answer 6

there have been numerous studies that have shown that CBT is effective in reducing symptoms of moderate and severe depression and in preventing relapse, especially for those who only have depression. Ellis claimed a 90% success rate of REBT, taking an average of 27 sessions to complete the treatment. David et.al (2008) compared the effectiveness of REBT, Beck’s CBT, and drug therapy. All three forms of therapy were comparably effective at the end of treatment. At 6 months, follow up. However, there was evidence that REBT was more effective than the other two forms of therapy. This suggests that as a long-term treatment, REBT is the most effective. Appropriateness of CBT 1) Factors affecting the choice of treatment – A strength of CBT can be seen in how its techniques are appropriate for use in a wide variety of situations and modes of delivery, e.g., interactive software programmes. It has been used successfully with people of all ages with degrees of depression from mild to severe. However, in some cases, the depression can be so severe that patients cannot motivate themselves to engage with the hard cognitive work of CBT. They may not also be able to pay attention to what is happening in a session. Therefore a range of factors need to be considered when weighing up the costs and benefits of CBT as an appropriate therapy in treating depression.

Answer 7

Competence of Therapist – one issue with assessing the effectiveness of CBT is the competence of the therapist. This appears to explain a significant amount of variation in CBT outcomes. Kuyken (2009) supports this claim, concluding that as much as 15% of the variance in outcome may be attributed to therapist competence. They found that the therapists who were assessed as most competent had better patient outcomes regardless of the complexity of the case. It appears that, to some extent, the effectiveness of CBT depends upon the training and skills of the therapist. Responses to CBT – a criticism of the appropriateness of CBT, it is difficult to predict which clients will respond well to CBT. It appears that CBT is effective for both severe and milder forms of depression. However, Simons (1995) found that CBT was not effective for people who have very rigid attitudes and who are resistant to change. It is also not effective for people who have high stress levels due to long-term problems in their lives; that a brief treatment like CBT cannot resolve. Therefore, an alternative form of therapy may be more appropriate for these types of individuals. Bonus evaluation… Remember, if you are struggling to think of ways to evaluate CBT, you can look at comparisons with the use of drugs to treat depression such as SSRIs (selective serotonin reuptake inhibitor). This should be written as one evaluation point.

Answer 8

OCD is an anxiety disorder characterised by either obsessions and/or compulsions. According to DSM-5 the diagnosis of OCD requires the following symptoms to be present: 1. Obsessions: recurrent and persistent thoughts that are intrusive, unwanted and cause anxiety and distress. The individual tries to suppress the thoughts or neutralise them with some other thought or action. 2. Compulsions: repetitive behaviours (e.g. checking) or mental acts (e.g. counting) in response to an obsession. These behaviours are designed to reduce anxiety or prevent a dreadful event occurring. They are excessive and can be unrealistic.

Answer 9

● Recurrent and persistent thoughts – sufferers experience constantly repeated obsessive thoughts, images and ideas of an intrusive nature. They are uncontrollable and cause distress. ● Insight into excessive anxiety – people suffering from OCD are aware that their obsessions and compulsions are not rational. In fact, this is necessary for a diagnosis for OCD. If someone really believed their obsessive thoughts were based on reality that would be a symptom of a different form of mental disorder. However, in spite of this insight, OCD sufferers experience catastrophic thoughts about the worst case scenarios that might result if their anxieties were justified

Answer 10

● Compulsions are repetitive – sufferers feel compelled to repeat behaviours as a response to their obsessive thoughts, ideas and images. Common examples include hand washing, counting, praying, and tidying groups of objects such as containers in a food cupboard. ● Compulsions reduce anxiety - the vast majority of compulsive be. .haviours are performed in an attempt to manage the anxiety produced by obsessions. For example, compulsive hand washing is carried out as a response to an obsessive fear of germs. Compulsive checking, for example, that a door is locked or a gas appliance is switched off, is in response to the obsessive thought that it might have been left unsecured. However, around 10% of sufferers of OCD show compulsive behaviour, although they have no obsessions, just a general sense of anxiety.

Answer 11

● 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 (a compulsion) creates anxiety ● Guilt and disgust – OCD often involves irrational guilt, for example over minor moral issues, or disgust, which may be directed against something external like dirt or at the self.

Answer 12

The genetic explanation centres on OCD being inherited through genetic transmission, with research originally focusing on family and twin studies in order to investigate if there are specific genes that can lead to development of OCD. 5-HTT/SERT Gene – Researchers have found genes that lead to a vulnerability for OCD, known as OCD candidate genes. An example of this, the 5-HTT gene, has an effect on the transportation of serotonin causing a lower level of serotonin in the synapses. A study has even found a mutation of the 5-HTT gene in families where 6 out of the 7 people had OCD (Ozaki et al, 2003) Other researchers believe that OCD might be a polygenic disorder (not caused by a single gene). Taylor (2013) conducted a meta-analysis and found evidence of up to 230 different genes involved in OCD.

Answer 13

Research Support – Supporting evidence for the genetic basis of OCD comes from studies of first degree relatives and twin studies. Nestadt et al (2000) found the lifetime incidence of OCD was higher in the relatives of OCD patients (11.7%) compared to relatives of healthy controls (2.7%). A meta-analysis of 14 twin studies of OCD found that identical twins (MZ) were twice as likely to develop OCD if their co-twin had the disorder, than was the case for non-identical twins (DZ) (Billet). This research strongly suggests a genetic influence on OCD. Diathesis Stress Model - Rather than focus on a purely genetic explanation it may be beneficial to use the diathesis stress model to explain the origins of OCD. According to this model certain genes leave the individual more vulnerable to OCD. Whether an individual actually does develop OCD is influenced by environmental factors (stressors). Cromer et al (2007) found that over half of the OCD patients in their sample had a traumatic experience in their past, and that OCD was more severe in those with more than one trauma. This suggests that OCD cannot entirely be genetic in origin, at least not in all cases. This suggests it may be more beneficial to look at environmental causes as we are more able to do something about these.

Answer 14

It is thought that lower levels of serotonin are associated with OCD. Although, serotonin’s contribution to OCD is not fully understood, it is thought that serotonin has a role in preventing the repetition of tasks. A lack of serotonin therefore results in the loss of a mechanism that inhibits task repetition. Antidepressant drugs that increase serotonin activity have been shown to reduce OCD symptoms (Pigott et al 1990) whereas antidepressants that have less effect on serotonin do not reduce OCD symptoms. Also dopamine levels are thought to be abnormally high in people with OCD.

Answer 15

In all of us, the obitofrontal cortex (OFC) is triggered by a stress response (e.g. touching something dirty, or accidently cutting a finger while cooking). This sends a ‘worry’ signal to the caudate nuclues (located in the basal ganglia). The caudate nucleus judges the worry signal and normally suppresses these signals. If the worry signal is not surpressed (considered to be a threat that needs dealing with), this is allowed through to the thalamus. The thalamus confirms the worry signal, creating a ‘worry circuit’ (a repetitive thought about the threat until we deal with it). In people with OCD… an overactive OFC, coupled with a damaged caudate nucleus means that minor threats are triggered by the OFC (there is a lower threshold to what is considered a worry) and the caudate nucleus fails to suppress these worry signals. From there, the thalamus is alerted and confirms the ‘worry’ to the OFC creating a worry circuit that leads to an obsessive thought. Serotonin is linked to these regions of the frontal cortex. Comer (1998) reports that serotonin (as an inhibitory neurotransmitter) plays a key role in regulating the OFC and the caudate nuclei and it appears that abnormaly low levels of serotonin might cause these areas to malfunction.

Answer 16

Research Support for the Neural Explanation of OCD - There is strong evidence that suggests certain brain circuits are associated with OCD. PET scans of patients with OCD, taken while their symptoms are active (e.g. when a person with a germ obsession holds a dirty cloth) show heightened activity in the OFC. Paul et. al. (2014) using neuroimaging has repeatedly found unusually high activation within the OFC and several studies have found excessive activity in the caudate nucleus. Practical application – One practical application that has arisen because of the neural explanation of OCD is the use of drugs to treat the disorder. SSRIs work by blocking the reuptake channel and as a result increasing the amount of serotonin available in the synapse. This helps those with OCD who are believed to have lower levels of serotonin. This increase in serotonin leads to a reduction in repetitive behaviour. This supports the theory as if such treatments reduce the symptoms associated with OCD, clearly there must be some biological aspect to the disorder. Cause and Effect – One limitation of the neural explanations for explaining OCD is that we cannot assume that neural mechanisms cause OCD. Brain scan studies show an association between increased activity in certain brain areas (e.g. the orbitofrontal cortex) and OCD. As it is only an association it doesn’t show that those brain areas play a role in causing OCD. These biological abnormalities could be a consequence of OCD rather than its cause.

Answer 17

SSRIs - Selective Serotonin Reuptake Inhibitors (SSRIs) (Prozac) are antidepressants used to reduce the anxiety associated with OCD. SSRIs are currently the preferred drug for treating OCD. SSRIs increase levels of the neurotransmitter serotonin, which regulates mood and anxiety. SSRI’s work by blocking the reabsorption of serotonin at the presynaptic nerve; therefore, leaving more serotonin available in the synapse. The end result is there is an increased amount of serotonin available to be taken up by other neurons. If a deficiency of serotonin is associated with the development of OCD, it is reasonable to expect drugs that increase serotonin will prove effective in treating OCD. It can take three to four months of daily use for SSRIs to have much impact on symptoms. SNRIs (Serotonin-Noradrenaline Reuptake Inhibitors) – In the last five years a different class of antidepressant drugs called SNRIs has also been used to treat OCD. These are a second line of defence for patients who don’t respond to SSRIs. SNRIs increase levels of serotonin as well as another neurotransmitter involved in impulsive behaviour – noradrenaline.

Answer 18

Not a Lasting Cure – Unfortunately the relapse rate following discontinuation of medication is quite high. According to Simpson et. al. 45% of patients treated with SRIs – an older form of SSRIs) relapsed back into the disorder within 12 weeks of completing medication. This is poor in comparison to only a 12% relapse rate in the same period for those who had received psychological therapy. Drug therapy does not provide a lasting cure as indicated by the fact that patients relapse within a few weeks if medication is stopped. This suggests that, although drugs are most commonly used, psychotherapies such as CBT should be tried. Appropriateness Side Effects – Drug therapy is not appropriate for all patients with OCD as some may suffer from side effects. Common side effects when taking SSRI’s include nausea, headache, insomnia, loss of sex drive, indigestion and blurred vision (Soomro et.al 2008). Side effects reduce the effectiveness of the drug because people might stop taking the medication. Preferred Treatment – Drug therapy is a preferred treatment for OCD because it is non-disruptive to the patient’s life as it requires little effort from the user and little input in terms of time; compared to CBT where the patient has to attend regular appointments. From the point of view of the health service, drugs are good value, as they are cheaper than psychological therapies partly because they don’t require a therapist to administer them. However drug therapy is not successful for all OCD sufferers, which suggests that the causes of OCD may not originate solely with levels of serotonin and there are other factors that play a role in its origins. Therefore an eclectic approach to therapy may be more successful.

Answer 19

Effectiveness Research Support – Supporting research comes from Soomro (2008) reviewed 17 studies of the use of SSRIs with OCD patients and found them to be more effective than placebos in reducing the symptoms of OCD up to three months after treatment. Typically symptoms decline significantly for around 70% of patients taking SSRIs. Of the remaining 30 % alternative drug treatments or combinations of drugs and psychological treatments will be effective for some. So drugs can help most patients with OCD

PSYCHOPATHOLGY (4) Flashcards

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