Psychopathology Flashcards
(133 cards)
1
Q
Who are the named psychologists for psychopathology?
A
Beck and Ellis
2
Q
What is abnormal defined as?
A
Those who are suffering from psychological disorders or mental illnesses
3
Q
What are the 4 ways to identify abnormality?
A
Deviation from social norms, failure to function adequately, statistical infrequency, deviation from ideal mental health
4
Q
What are social norms?
A
What is considered acceptable, expected ways of behaving, like a set of behavioural rules
5
Q
What are examples of implicit and explicit social norms?
A
Implicit (unspoken) e.g. not laughing at a funeral
Explicit (law) e.g. streaking in public
6
Q
Why is an individual defined as abnormal according to the deviation from social norms definition?
A
If they deviate from the social norms, their behaviour is abnormal
7
Q
What are the 3 weaknesses of defining abnormality using deviation from social norms?
A
Doesn’t account for choice, e.g. being vegan or following a minority religion.
Difficult to apply since social norms change over time e.g. being gay or unmarried mothers
Open to abuse e.g. abnormal in Russia if held different political beliefs from the ruling party, so can be used as a form of social control
8
Q
What is functioning adequately?
A
Managing tasks necessary to everyday life
9
Q
When is behaviour classed as abnormal in failure to function adequately?
A
They cannot cope with the daily demands AND distress is being caused to themselves or others
10
Q
What are the 6 features of abnormality Rosenhan and Seligman suggested? (failure to function adequately)
A
1) Personal distress
2) Maladaptive behaviour
3) Unconventionality
4) Observer discomfort
5) Violation of moral and social standards
6) Irrationality
11
Q
How many features of abnormality are needed to be present in order to be classed as abnormal? (failure to function adequately)
A
The more features present, the more abnormal an individual is
12
Q
What are the 3 weaknesses of defining abnormality using failure to function adequately?
A
Doesn’t account for the individual’s circumstances, sometimes it is normal to fail to function adequately.
Vague - unclear how extreme the behaviour has to be to be abnormal.
Ethnocentric - based on Western culture
13
Q
What is a strength of defining abnormality using failure to function adequately?
A
Practical applications - clinicians use this definition as it provides an objective and quantitative measurement of functioning, helps patients access treatments quicker as they are diagnosed
14
Q
When is behaviour classed as abnormal in statistical infrequency?
A
Behaviour that is statistically infrequent or very rare is abnormal
15
Q
On a normal distribution curve, how many standard deviations away is statistical infrequency? (+ percentages)
A
More than 2 σ which is less than 5% (both sides)
16
Q
What are the 3 weaknesses of defining abnormality using statistical infrequency?
A
Does not account for desirability e.g. high IQ, so doesn’t identify behaviours in need of treatment.
Some abnormal behaviour isn’t rare e.g. 37% teenage girls report low mood + high stress.
The cut-of point is subjective, so definition is subjective and depends on individual opinion
17
Q
What is a strength of defining abnormality using statistical infrequency?
A
Practical applications - all patient assessments include some measurement of severity of symptoms against statistical norms
18
Q
When is behaviour classed as abnormal in deviation from ideal mental health?
A
If they don’t have all 6 characteristics of ideal mental health
19
Q
What are the 6 characteristics of ideal mental health?
A
1) Positive self-attitudes - self-esteem + identity
2) Self-actualisation - full potential
3) Resistance to stress - cope, not immune
4) Autonomy - self-directed
5) Accurate perception of reality - rational
6) Mastery of the environment - looking after self/functioning (love, work, etc)
20
Q
What are the 3 weaknesses of defining abnormality using deviation from ideal mental health?
A
Sets bar too high, most people would be classed as abnormal, idealised set of expectations, not useful.
Not clear how many need to be lacking.
Ethnocentric - self-actualisation is selfish in some collectivist cultures, besides very few people achieve it
21
Q
What is a strength of defining abnormality using deviation from ideal mental health?
A
It offers a positive approach to identifying mental illness, more ethical
22
Q
What is a phobia?
A
An extreme and irrational fear of a specific stimulus that produces a conscious avoidance of the source of the fear which interferes with daily life
23
Q
What are clinical characteristics?
A
Symptoms (behavioural, emotional, and cognitive)
24
Q
What are behavioural characteristics/symptoms?
A
What the person does
25
What are emotional characteristics/symptoms?
What the person feels
26
What are cognitive characteristics/symptoms?
What the person thinks
27
What are the 2 behavioural characteristics of a phobia?
Avoidance of stimulus.
Fainting or freezing when with stimulus.
These must interfere with other daily activities
28
What are 2 emotional characteristics of a phobia?
Excessive, unreasonable, persistent fear/anxiety/panic when in presence/anticipation of stimulus.
Guilt as they stop doing other things/activities
29
What are 3 cognitive characteristics of a phobia?
Recognition of irrational nature.
Can't be helped by rational arguments.
Selective attention (only focusing on stimulus)
30
What approach is used to explain/treat phobias?
Behavioural approach
31
How do phobias occur?
They are learnt
32
Who came up with the two-process model to explain how a phobia develops and is maintained?
Mowrer
33
What is the first step of the two-process model called?
The Acquisition
34
How are phobias developed?
Through classical conditioning - they associate a reflex response of fear to a neutral stimulus, the response of fear transfers to the neutral stimulus
Often needs repeated exposure (around 5 times)
35
How are phobias manitained?
Through operant conditioning - negative reinforcement of avoidance
36
What is the supporting evidence of the behavioural approach to explaining phobias?
Watson and Rayner: Little Albert's fear of white rats.
They taught Albert to fear white rats.
They made a loud noise every time Albert saw the white rat, he then generalised this fear to anything white and furry
37
What are 2 criticisms of the behavioural approach to explaining phobias?
Challenging evidence: Munjack found only 50% of people with a driving phobia had had a frightening experience with a car.
Reductionist - heavily on nurture side of nature vs nurture debate, ignores biological evidence: evolution
38
What are the practical applications of the behavioural approach to explaining phobias?
Development of successful, effective behavioural therapies: systematic desensitisation (75%) and flooding (65%), helps economy as people able to work
39
What are the treatments for phobias?
Systematic Desensitisation and Flooding
40
Which aspect of the behavioural approach is systematic desensitisation based on?
Classical conditioning
41
What does SD involve?
Gradual exposure to their feared object/situation, based on counterconditioning and reciprocal inhibition
42
What is counterconditioning?
Classical conditioning where the new response (relaxation) is counter to the original response (fear)
43
What is reciprocal inhibition?
The notion that we cannot experience 2 incompatible/opposite emotional states at the same time (fear and relaxation)
44
What are the 3 main stages of SD?
Relaxation techniques learnt
Hierarchy of fear created
Gradual exposure (following the hierarchy of fear using the relaxation techniques)
45
What happens in the first stage of SD?
Relaxation techniques are learnt, e.g. deep breathing, visualising a peaceful scene, or progressive relaxation which is focussing on tightening muscles then relaxing throughout body
46
What happens in the second stage of SD?
The client creates a hierarchy of fear which is a list of situations/scenarios involving their feared stimulus, ranked from least to most frightening
47
What happens in the third stage of SD?
The client goes through their hierarchy of fear from least to most frightening, only moving on when completely relaxed/when the client wants to, using the relaxation techniques.
This can be in vivo (in real life) or in vitro (in brain)
48
How do we evaluate treaments?
Effectiveness and Appropriateness
49
What does the effectiveness of treatments refer to?
Does it work/was it successful?
50
What does the appropriateness of treatments refer to?
Is it right for the client/is it ethical/does it suit them?
51
What is the evidence to suggest SD is effective? (2 studies)
McGrath found 75% were successfully treated.
Gilroy found both 3 months and 33 months after treatment the SD group showed less fearful responses (arachnophobia)
52
What is the evidence to suggest some parts of SD are not effective? (not a specific study)
In vitro less effective than in vivo
53
What is the evidence to suggest SD is not effective in the long-term?
Craske & Barlow found 50% relapsed after 6 months
54
How can SD not be appropriate for all?
If their feared stimulus is intangible/abstract e.g. zombies.
Ignores underlying cause and only treats surface symptoms - Wolpe found woman scared of insects wasn't happy in her marriage, husband's nickname was Cricket
55
How is SD appropriate?
More ethical than other methods like flooding as work with client, this limits drop out rate (attrition).
Appropriate for wide range of patients e.g. those with learning difficulties or heart difficulties - unlike flooding
56
How does flooding differ from SD?
It involves full and immediate exposure
57
What happens in flooding?
The client is exposed to their feared stimulus for 1 long session (2-3 hours), using relaxation techniques, until their anxiety levels come down (body cannot maintain it) and a new association is learnt.
Can be in vivo or in vitro or virtual reality
58
Is flooding effective?
Yes: Choy et al found for those able to complete the session it was more effective than SD
Kaplin found 65% with a specific phobia given a single session showed no symptoms 4 years later
59
Is flooding appropraite?
Not always: deliberately creates high levels of anxiety, so is traumatic, this raises ethical concerns, high attrition rate.
Inaccessible for some e.g. with heart conditions
60
What are 2 strengths of behavioural treatments in general?
Relatively fast and require less effort, (e.g. CBT requires a lot of motivation), therefore they're appropriate for those who lack insight into their thought processes and emotions (e.g. young children).
Practical applications since less time off work as sick, benefits economy
61
What is a weakness of behavioural treatments in general?
Could do more damage than good since if they withdraw before completion, it could reinforce their phobia
62
What is depression?
A mood disorder that causes a persistent feeling of sadness and loss of interest
63
What are some behavioural characteristics of depression?
Reduced energy and tiredness, increased activity and restlessness, hypersomnia, insomnia, appetite increase/reduce, irritable, verbally/physically aggressive, stop hobbies, less sexual activity
64
What are some emotional characteristics of depression?
(Inescapable feelings) sad, empty, hopeless, worthless, loss of interest and pleasure in hobbies, anger towards others or self, low self-esteem, despair, feelings of doom and gloom
65
What are some cognitive characteristics of depression?
Negative thoughts that do not reflect reality (irrational), irrational focus on 'should', 'ought', 'must', poor levels of concentration and decision making, worst case scenario thoughts, think they are worthless
66
Which approach explains depression?
Cognitive
67
Which type of depression do we focus on?
Major Depressive Disorder (MDD)
68
What is the theory behind the cognitive approach explaining depression?
The way you think alters the way you behave: irrationally negative thoughts and beliefs cause the abnormality
69
What are the 2 cognitive explanations of depression?
Ellis' ABC Model and Beck's Negative Triad
70
What is Ellis' ABC Model?
Activating event (can be trivial/massive/positive/negative)
Belief system (which results in rational or irrational beliefs)
Consequential emotion (may be healthy or unhealthy)
71
What causes the development of depression according to Ellis?
The (negative and irrational) belief system (not the activating event!)
72
What is the key difference between Ellis and Beck's theories?
Ellis says there must be an activating event for beliefs, Beck doesn't, he says they sometimes automatically pop up
73
What was Beck's theory for depression?
Depression comes from having thoughts biased towards negative interpretations of their life (and negative schemas) and feel as though they have no control
74
What are the 3 things in Beck's negative triad?
Negative views about the world
Negative views about the future
Negative views about oneself
(in that order impacting the next one, but oneself can impact future too)
75
How does Beck say schemas affect depression?
Negative schemas which develop during childhood provide a negative framework for viewing events pessimistically, leading to biases such as overgeneralisation, magnification, and selective perception
76
What is the supporting evidence for the cognitive explanation of depression?
Grazioli and Terry assessed pregnant women for cognitive vulnerability and depression before and after giving birth. Women high in vulnerability were more likely to suffer from post-natal depression
77
What are the 2 weaknesses of the cognitive explanation of depression?
Partial explanation - cannot effectively explain mania or anger, only downturn of mood.
No cause and effect - irrational thinking could be the cause or effect of depression.
Slightly limited - cannot account for biological evidence like low levels of serotonin
78
What are the practical applications of the cognitive explanation of depression?
Successful therapy - Cognitive Behavioural Therapy, 2nd most effective out of 10, benefits economy
79
What does Cognitive Behavioural Therapy aim to do?
Replace negative irrational thoughts with positive rational thoughts, therefore improving their emotions and behaviour
80
What are the 3 stages of CBT?
Thought catching
Challenging irrational thoughts
Practising new thoughts and behaviours to change thinking
81
What happens in the thought catching stage of CBT?
Assessment through verbal discussions to clarify patient's problem and identify patterns (Ellis-based looks for ABC, whilst Beck-based looks for automatic thoughts).
Identify goals and make a plan to achieve them.
BECK ONLY: homework assignments like keeping a thought diary to identify where negative thinking is occurring
82
What happens in the second stage of CBT?
Ellis' ABC becomes ABCDEF
D = Disputing irrational thoughts and beliefs (*this is the key part*)
E = the Effects of disputing these thoughts
F = the new Feelings that are produced
This helps them move to more rational thoughts, leading to becoming more self-accepting
83
What are the 3 types of disputing irrational thoughts?
Empirical Disputing
Pragmatic Disputing
Logical Disputing
84
What is empirical disputing?
Considering whether there is any evidence for the irrational thought/belief
85
What is pragmatic disputing?
Considering whether they are useful thoughts/beliefs
86
What is logical disputing?
Considering whether they are sensible ways to think
87
What 2 techniques are used in the third stage of CBT?
Role play
Behavioural activation
88
What does role play involve in CBT?
The therapist role plays situations to help the client try to challenge their typical ways of thinking and replace the irrational with rational in a safe place
89
What is behavioural activation in CBT?
The therapist might set the client goals to increase their social contact and engage in activities they used to enjoy - the idea behind this is to identify mood triggers and then encourage them to engage in things that lift their mood
90
What is the evidence to suggest CBT is effective? (2 studies)
One study looked at 327 teens suffering from major depression, and compared the effectiveness of CBT and drug therapy. 80% responded well to both , showing it is as effective as drug therapy, but has no side effects.
Smith & Glass's meta-analysis showed CBT had the second highest success rate out of 10 (SD was first)
91
What is the evidence to suggest CBT is not always effective?
A study found as much as 15% of the variance in outcome may be attributable to therapist competence - who is performing CBT shouldn't matter
92
What are 3 reasons why CBT may not be appropriate for everyone?
Requires a lot of motivation and effort, takes time, requires talking - inappropriate for those with speech disorders or an unwillingness to talk.
There are alternatives which require no effort or time (drug therapy), using anti-depressants alongside CBT may be best for those highly distressed.
It ignores the circumstances of the patient's life (e.g. poverty) as it focusses on their mind - inappropriate for those whose depression has a cause
93
How is CBT more appropriate than drug theray in some situations?
It has no side effects, so good for children or simply those who don't want side effects like insomnia, weight-gain etc
94
What is the definition of Obsessive-Compulsive Disorder?
A mental health condition where a person has obsessive thoughts and compulsive activity. The thoughts and rituals associated with OCD cause distress and get int eh way of daily life as they are uncontrollable
95
What is the difference between the O and C in OCD?
O = Obsessional thoughts - internal components, invisible
C = Compulsive behaviours - external components, visible
96
Does there have to be a link between the obsessive thought and compulsive behaviour?
No
97
What are the 2 behavioural characteristics of OCD?
Repetitive, ritualistic behaviours to (temporarily/momentarily) reduce anxiety
Avoidance of situations that might trigger anxiety
98
What are the 3 emotional characteristics of OCD?
Anxiety and distress when feel they cannot perform the compulsion
Shame and embarrassment related to obsession or compulsion
Guilt for people around them
99
What are the 3 cognitive characteristics of OCD?
Recurrent, intrusive, irrational, persistent, uncontrollable thoughts
Irrational and distorted beliefs
Obsessions are recognised at some point as being irrational and excessive
100
What are the 2 factors that can explain OCD?
Genetics
Neural explanations (neurotransmitters + neuroanantomy)
101
What are the 2 potential candidate genes for explaining OCD?
COMT gene
SERT gene
102
What are both the genetic explanations for OCD based on?
That OCD can be passed from parent to child through genetic inheritance (OCD is hereditary)
103
How does the COMT gene explain OCD?
One form of the gene (commonly found in OCD sufferers) leads to lower activity of the COMT enzyme, which leads to higher levels of dopamine, which is linked to irrational thinking
104
What does the COMT gene do (in a healthy person)?
Involved in the production of COMT (an enzyme) which regulates the production of dopamine
105
How does the SERT gene explain OCD?
A mutation of the gene (commonly found in OCD sufferers) leads to higher activity of the protein, which leads to lower levels of serotonin, which is linked to happiness
106
What does the SERT gene do (in a healthy person)?
Involved in the production of a protein which removes serotonin from the synaptic gap (synaptic transmission)
107
What is the supporting evidence for the genetic explanations of OCD?
Nestadt did a meta-analysis of twin studies and found 68% of monozygotic twins showed concordance for OCD, compared to 31% for dizygotic twins, suggesting there is a genetic basis for OCD
108
What are 3 criticisms of the genetic explanations of OCD?
It is difficult to draw firm conclusions due to both twins being exposed to the same environmental factors so the higher concordance rates could be explained by them being treated in a more similar way.
Since the concordance rates of MZ twins aren't 100%, there must be other factors involved - this is consistent with the diathesis-stress model which suggests the gene makes them predisposed to OCD, but environmental triggers cause it.
It is reductionist since it seems to be polygenic (caused by several genes) - Taylor said it could be up to 230 genes - so may not be useful in predicting OCD
109
What are the 2 neural explanations of OCD?
Neurotransmitters: serotonin
Neuroanatomy: the worry circuit
110
How can neurotransmitters explain OCD?
It may be caused by a disruption of serotonin levels which has a knock-on effect on regulating the levels of other neurotransmitters such as GABA and dopamine - this is based on drug therapy evidence where OCD-sufferers who take anti-depressant drugs (which increase serotonin activity) have a reduction in symptoms
111
Is it high or low levels of serotonin that is associated with OCD?
Low - which also explains why OCD is comorbid with depression
112
How does neuroanatomy explain OCD?
It may be caused by structural damage to the brain - specifically the caudate nucleus which is in the basal ganglia
113
What are the 3 areas of the brain involved in the worry circuit?
Orbitofrontal cortex (OFC)
Caudate nucleus (part of the basal ganglia)
Thalamus
114
How does the worry circuit work?
1) The orbitofrontal cortex (OFC) sends 'worry' signals to the thalamus when we are concerned or anxious
2) If the caudate nucleus is damaged, it doesn't suppress these signals like it should, so the signals go to the thalamus
3) The thalamus is alerted and sends signals back to the OFC, and we go back to step 1
115
Wat is the supporting evidence for the neural explanations of OCD?
(only for neurotransmitter theory)
Zohar found that SSRI's (which increase serotonin levels) have been beneficial for up to 60% of patients with OCD
(but this is only 60%, so for 40% it doesn't help them, so it cannot be the only factor)
116
What is a weakness of using drug-therapy research?
It is not known if the problems with the neurotransmitters is a cause or consequence of OCD - this is the treatment-aetiology fallacy (which works like this: aspirin helps with headaches, but headaches aren't caused by a lack of aspirin)
117
What is a weakness with the neural explanations?
(only for neuroanatomy)
Neuroimaging studies have not identified basal ganglia impairments in all OCD sufferers, and some people with the impairment do not have OCD so it is difficult to draw firm conclusions
118
What are 2 general criticisms of the neural explanations of OCD?
Difficult to determine cause and effect between the body's biology and OCD - they might develop as a result of OCD - so it doesn't fully explain what it set out to do.
It is heavily focused on the nature side of the debate, making it reductionist. It ignores the impact our experiences may have - twin studies have shown that sometimes only 1 of the MZ twins has OCD, suggesting that biology makes us predisposed to OCD but it is our environment that determines if we develop it
119
What are the practical applications of neural explanations of OCD?
Helped to develop drug therapies which attempt to correct faults in the brain by rebalancing the chemicals that are thought to be causing OCD (dopamine and serotonin) - this requires little commitment or motivation and supports the economy by reducing the burden on the NHS
120
What are the 2 types of drugs used in drug therapy for OCD?
Anti-depressant
Anti-anxiety
121
Which anti-depressant drugs do we learn about?
Selective Serotonin Reuptake Inhibitors (SSRI)
Tricyclics
122
What do SSRI's do to serotonin levels and what impact does this have?
By increasing the amount of serotonin that passes around the brain, they reduce the symptoms of OCD
123
How do SSRI's work?
They prevent the serotonin being reabsorbed by the pre-synaptic neuron, so it continues to stimulate the post-synaptic neuron, so we feel the effect of serotonin more and calm down
124
What do tricyclics do?
Block the transporter mechanism that reabsorbs both serotonin and noradrenaline into the pre-synaptic neuron, but they generally have more side effects than SSRI's because they were an older type of anti-depressant
125
Which anti-anxiety drug do we learn about?
Benzodiazepines (BZs)
126
What effect do BZs have on our brains?
Reduce the level of brain activity (slow down the CNS) and bring about feelings of calm
127
How do BZs work?
BZs act as more GABA.
GABA binds to receptors and allows more chloride ions to enter the post-synaptic neuron, making it less responsive to excitatory neurotransmitters.
BZs also bind to GABA receptors and the same thing happens
128
Which neurotransmitter do BZs work on and what do they do it?
GABA - enhance it (GABA blocks the effects of excitatory neurotransmitters - it is inhibitory)
129
What is GABA?
An inhibitory neurotransmitter which is the body's natural form of anxiety relief
130
What is the supporting evidence for SSRI's and BZs being effective?
Soomro did a meta-analysis of 17 OCD treatment studies.
SSRI's more effective at reducing symptoms of OCD than a placebo.
BZs are also more effective than placebos (different study)
131
What is the challenging evidence for SSRI's being effective?
Zohar found only 60% improved from SSRI's, suggesting there are individual differences
132
What are 2 reasons why drug therapies are not always appropriate?
They do not cure OCD, only reduce symptoms so once they stop taking the drug, they go back to before (e.g. BZs only taken for 4 weeks as they are highly addictive).
They can cause negative side effects:
SSRI's: nausea, headaches, insomnia
BZs: aggression, long-term memory impairment, addiction (dependency)
Relapse rates are 90%.
30-50% derive no benefits at all
(Also not appropriate for kids)
133
What is 1 reason why drug therapies can be appropriate?
They are fast-acting and require little effort/time/motivation from the individual compared to behavioural therapies like CBT.
So it is appropriate to those who cannot commit the time other therapies require or those who lack insight into their own mental processes and emotions
