What are Social Norms?
The belief of what are acceptable behaviours, value and beliefs. There are two types; explicit and implicit. People who violate these are seen as abnormal and identified as social deviants.
Explicit Social Norms
Violating them means breaking the law
Implicit Social Norms
Unspoken but agreed upon
Evaluations of Deviation from Social Norms
- Social norms are not stable. E.g. homosexuality (removed in 1973) and gender identity
- Deviance is defined by context, any definition should apply in all circumstances.
- Cultural bias: is an issue because both major diagnostic tools were made by W.E.I.R.D teams.
- Gender Bias: research overwhelmingly done by/for/with men.
What is Statistical Infrequency?
A person’s abnormality can be indicated if it is found to be numerically uncommon/rare. The norm depends on ‘normal distribution’. Any individual who falls 2 standard deviations outside of the mean is considered to be abnormal.
What is Cultural Relativism?
Refers to the differences in meaning given to behaviours between and within cultures. Can be an issue for diagnoses in multicultural societies.
What is Failure to Function Adequately?
An inability to cope with everyday activities and thus unable to function adequately, making them abnormal. Individual is classed as abnormal if their behaviour causes distress to themselves or others.
What is Deviation from Standard Mental Health?
A Humanistic Approach proposed by JAhoda and looks at mental health rather than mental illness. She identified 6 criteria for optimal living. Claimed that anyone lacking any of these qualities would be vulnerable to mental disorders, the more characteristics they fail to meet, the further they are from realising them.
What are Jahoda’s Six Criteria for Ideal Mental Health?
- Self Attitudes
- Self Actualisation
- Integration
- Autonomy
- Accuracte Perception of Reality
- Mastery of Environment
Self Attitude Criteria of Ideal Mental Health
Having high self esteem and a strong sense of identity
Self Actualisation Criteria of Ideal Mental Health
Extent to which an individual develops their full capabilities
Integration Criteria of Ideal Mental Health
Being able to cope with stressful situations
Autonomy Criteria of Ideal Mental Health
Being independent and self reliant
Accurate Perception of Reality Criteria of Ideal Mental Health
Perceiving the world in a non distorted fashion
Mastery of Environment Criteria of Ideal Mental Health
Being competent in all aspects of life and being able to meet the demands of any situation
Emotional Symptoms of Phobias
- Feel Anxious
- Feel Nausea
Cognitive Symptoms of Phobias
- Catastrophising
- Rumination
Behavioural Symptoms of Phobias
- Fainting
- Avoidance
- Fast Breathing
Emotional Symptoms of Depression
- Lethargy
- Low mood
Cognitive Symptoms of Depression
- Rumination
- Catastrophising
Behavioural Symptoms of Depression
- Isolation
- Disturbance
Emotional Symptoms of OCD
- Anxiety
- Low Mood
Cognitive Symptoms of OCD
- Obsession
- Catastrophising
Behavioural Symptoms of OCD
- Compulsions
- Withdrawal/avoidance
What is the definition for phobias?
A group of mental disorders within the category of anxiety disorders. They are irrational fears of an object or situation. This anxiety interferes with normal living.
Who created the Two PRocess Model?
Mowrer (1947)
What is the Two Process Model?
Describes the combination of both conditionin types:
- Classical: learned association between a stimulus and a response
- Operant: Behavioural modification using reinforcements punishments
What does the Two Process Model assumer about Phobias?
That it is a result of learning:
- Patient must have associated something neutral with a traumatic consequence
- They then strengthen the conditioned association through avoidance (negative reinforcement)
What kind of approach is associated with Explaining and Treating Phobias?
The Behavioural Approach
Two ways of treating Phobias
- Flooding
- Systematic Desensitisation
What is Flooding?
Form of behavioural therapy where a client is exposed to an extreme form of the threatening situation until anxiety is extinguished. Either through Counterconditioning or Reciprocal Inhibition
What is Counterconditioning to treat Phobias?
Learning a new response. Occurs once a new response to the fear stimulus is learned.
What is Reciprocal Inhibition to treat Phobias?
You cannot feel afraid and relaxed at the same time, meaning that one emotion prevents the other.
The process of Flooding
Feared Stimulus > Avoidance > Reinforcement (-) to
Feared Stimulus > Acceptance > Reinforcement (+)
How many stages are involved in Reciprocal Inhibition?
Three stages
First Stage of Systematic Desensitisation
Agreeing a hierarchy
Second Stage of Systematic Desensitisation
Teaching relaxation techniques
Third Stage of Systematic Desensitisation
Gradual exposure to feared stimulus using hierarchy
What happens after the third stage of Systematic Desensitisation?
Reciprocal Inhibition occurs which causes Counterconditioning.
Evaluations of Flooding
- 70-78% effective
- No right to withdraw
- Not allowed on NHS in UK
Evaluation of Systematic Desensitisation
\+ Better for depressed patients \+ Much easier to get consent \+ Allowed on NHS in UK \+ Good for comorbidity patients - 70-78% effective
Who created the ABC Model for explaining depression?
Ellis (1962)
What is catastrophising?
Imagining the worst possible outcome
What is Rumination?
Repetitive, circular thinking with each though feeding the next
What is Musturbatory Thinking?
Inflexible, absolutist thought
What is the Process of the ABC Model?
Activating event > Rational Belief > Consequences
Activating event > Irrational Belief > Consequences
These cognitions include fixed terms (I want, I must, I need)
Who created the Negative Triad to explain Depression?
Beck (1967)
Process of Beck’s Negative Schema
- Negative schema leads to negative cognitive biases
- Negative cognitive biases affect perception, causing irrational thinking and perception of events
- Two processed are predicted: Rumination & Catasrophising
What is Cognitive Behavioural Therapy?
A talking therapy that aims to identify irrational core beliefs and uses practical activity ti challenge and change them. It involves cognitive and behavioural elements.
Cognitive element of CBT
Identifying and challenging irrational thoughts
Behavioural element of CBT
Once irrational thoughts have been identified, coping strategies are developed.
What was the first Cognitive Behavioural Therapy?
Ellis’ Rational Emotive Behaviour Therapy (REBT)
How did Ellis extend the ABC Model?
He included D,E & F:
- Disputing irrational cognition
- Effects of disputing/effective attitudes
- Feelings that result from the process
What are the principles of CBT?
- Homework
- Behavioural Action
- Unconditional Positive Regard (UPR)
Homework principle of CBT
Set patients tasks between sessions to challenge irrational beliefs and provide a basis for the next session. Must be accessible and agreed.
Behavioural Action principle of CBT
Activity is physiologically and psychologically rewarding. Any increase is helpful for recovery.
Unconditional Positive Regard (UPR) principle of CBT
Humanist principle os part of all modern therapy. Patients who feel valued and trusted are more motivated.
What type of approach is associated with Explaining and Treating Depression?
The Cognitive Approach
What is OCD?
Classed as an anxiety disorder. Characterised by obsessive thoughts and repetitive behaviours (compulsions).
What are Obsessions?
Internal Components because they are intrusive thoughts.
What are Compulsions?
External components because they are repetitive behaviours. They reduce the building anxiety.
What are the two biological explanations for OCD?
They both see psychological disorders as being similar to physical illnesses caused by abnormal biological processes:
- Neural Explanation
- Genetic Explanation
Neural Explanation of OCD
Occurrence of OCD through abnormal functioning of neural mechanisms and neurotransmitters.
Genetic Explanation of OCD
Hereditary influences through genetic transmission from parent to offspring.
What are the TWO Neural Mechanisms involved in the Genetic Explanation of OCD?
- COMT
- SERT (5-HTT)
COMT Explanation of OCD
- Produces an enzyme that degrades dopamine
- Low activity variant of this gene is found in OCD patients
- Their impaired ability to degrade dopamine leads to high levels in the synapses, which causes poor impulse control
SERT (5-HTT) Explanation of OCD
- Produces a protein that transports serotonin back to the Presynaptic Neuron (reuptake)
- OCD patients have a high activity variant of this gene
- Removing serotonin too quickly results in lower levels received and a shorter duration of serotonin’s effects, which leads to depression, anxiety and sleep trouble.
Two Neurotransmitters associated with OCD
- Dopamine
- Serotonin
Neurotransmitters as an explanation for OCD
Abnormal levels of neurotransmitters are associated with OCD. Dopamine levels are thought to be abnormally higher and levels of serotonin are thought to be lower/
Dopamine’s role in OCD
An Excitatory transmitter: - Reward - Movement - MEmory - Waking Up Released into emotional, executive and memory areas. One of its main functions is habit forming.
Serotonin’s role in OCD
An Inhibitory transmitter: - Appetite - Control of behavioural impulses - Mood Released into emotional, memory and muscle control areas. One of its main functions is impulse control.
Abnormal Brain Circuits associated with OCD
- Orbitofrontal Cortex (OFC)
- Thalamus
- Caudate Nucleus
Orbitofrontal cortex in OCD
Sends signal to the thalamus about things that are worrying
Thalamus in OCD
Leads to impulse to act and then to stop activity when the impulse lessens
Caudate Nucleus in OCD
Normally suppresses signals from OFC. IF damaged, it fails to do this and so the thalamus is alerted from minor ‘worry’ signals. It send signals back to the OFC, acting as a worry circuit.
COMT OCD process
COMT acitivity low > Dopamine levels high > Caudate Nucleus underactive > Hypervigilance (anxiety) > Obsessive thoughts
SERT OCD process
SERT activity high > Serotonin levels low > OFC overactive > Impulsiveness > Compulsive Behaviour
What approach is associated with Explaining and Treating OCD?
The Biological Approach
What are SSRIs?
Selective Serotonin Reuptake Inhibitors: Most commonly used drug treatments for OCD. Also most commonly used to treat depression.
What are the THREE SSRIs?
- Fluoxetine (e.g. Prozac)
- Sertraline (e.g. Zoloft)
- Citalopram (e.g. Celexa)
These work by blocking the reuptake of serotonin, while allowing other processes to happen normally. Leads to a ‘build up’ of serotonin in synapses.
What are Tricyclics?
Commonly used for OCD. Tend to have more powerful/wider effects than SSRIs so are rarely prescribed first.
What are TWO Tricyclics?
- Amitriptyline (e.g. Elavil)
- Clomipramine (e.g. Anafranil)
They block reuptake of serotonin and noradrenaline. This works because both NTs are in the same family. - Increased serotonin in OCD patients leads to better impulse control
- Increased Noradrenaline in OCD patients leads them to feel ‘awake’ and motivated (helps with comorbid depression)
What are Benzodiazepines?
BZs: Used for a range of anxiety disorders including panic disorder, addiction withdrawal and OCD.
What are THREE Benzodiazepines?
- Alprazolam (e.g. Xanax)
- Diazepam (e.g. Valium)
- Lorazepam (e.g. Ativan)
They work by mimicking Gamma Aminobutyric Acids (GABA). - Bind to receptors with chloride channels, causing them to open. GABA normally does this.
- Negative Chloride ions into the postsynaptic cell
- This creates IPSP, reducing neuron activity; addressing impulsivity and anxiety.