Psychopathology

Question 1

Statistical infrequency

Answer 1

Implies that a disorder is abnormal if its frequency is more than two standard deviations away from the mean incidence rates represented on a normally-distributed bell curve. Also can be shown if something is in the top or bottom 2.5%.

Question 2

Deviation from social norms

Answer 2

Something is considered abnormal if a person behaves in a way that is different from how we expect them to behave. Within society there are standards of acceptable behaviour which are set by the social group and everyone within this social group is expected to follow these behaviours. These social norms are typically specific to the culture we live in, and vary worldwide.

Question 3

failure to function adequately

Answer 3

A person may cross the line between normal and abnormal when they are no longer able to cope with the demands of everyday life

Question 4

Rosenham and Seligman’s signs of failure to function adequately

Answer 4

• When a person no longer conforms to standard interpersonal rules, such as maintaining eye-contact or respecting personal space.
• When a person experiences severe personal stress.
  -WHen a person’s behaviour becomes irrational or dangerous to either themselves or others.

Question 5

Deviation from ideal mental health

Answer 5

occurs when a person does not meet the criteria for what is considered good mental health. This was proposed by Jahoda

Question 6

Jahoda’s ideal mental health

Answer 6

Jahoda suggested that we are in good mental health if we:
-have no symptoms or distress
-are rational and can perceive ourselves accurately.
-self actualise (strive to be our best selves)
-can cope with stress
-have a realistic view of the world
-have good self-esteem and lack guilt
-are independent of other people
-can successfully work,love and enjoy our leisure

Question 7

behavioural characteristics of phobias

Answer 7

PANIC- A person may panic in response to the presence of a phobic stimulus.May involve a range of behaviours such as crying, screaming or running away.
AVOIDANCE- Unless the person is making a conscious effort to face their fear they tend to go to extreme lengths to avoid contact with a phobic stimulus. This can make it hard to go about everyday life.
ENDURANCE- This occurs when a person chooses to remain in the presence of the phobic stimulus. The opposite of avoidance.

Question 8

Emotional characteristics of phobias

Answer 8

ANXIETY- Phobias are classed as anxiety disorders, and involve an emotional response of anxiety. This is an unpleasant state of arousal and can prevent a person from relaxing or prevent any positive emotions. This can also be long-term.
FEAR- The immediate and extremely unpleasant response we experience when faced with a phobic experience. This is more intense than anxiety but experienced for shorter periods.
These emotional responses are unreasonable and typically disproportionate to the threat posed.

Question 9

Cognitive characteristics of phobias

Answer 9

SELECTIVE ATTENTION TO PHOBIC STIMULUS- If a person can see a phonic stimulus it can be hard to look away from it. Keeping our eye on something is good if it’s dangerous as it gives us a good chance of reacting quickly, although not so good if irrational.
IRRATIONAL BELIEFS- A person with a phobia may have unfounded thoughts about a phobic stimulus which may not have any basis in reality or be easily explained. This kind of belief increases the pressure on the person to perform well in social situations.
COGNITIVE DISTORTIONS- The perception of a person with a phobia may be inaccurate or unrealistic.

Question 10

Behavioural characteristics of depression

Answer 10

ACTIVITY LEVELS- Typically people with depression have reduced levels of energy, making them lethargic. This has a knock-on effect, with people tending to withdraw from work, education and social life. In extreme cases, this can be so severe that the person cannot get out of bed. This can also lead to psychomotor agitation, the opposite.
DISRUPTION TO SLEEP AND EATING BEHAVIOUR- A person may experience reduced sleep (insomnia), or an increased need for sleep (hypersomnia). Appetite and eating may increase or decrease, leading to weight gain or loss.
AGGRESSION AND SELF-HARM- People with depression are often irritable and become verbally or physically aggressive. Depression can also lead to physical aggression towards the self, which can include self-harm or suicide attempts.

Question 11

Emotional characteristics of depression

Answer 11

LOWERED MOOD- This is more pronounced than in the daily kind of experience of feeling lethargic and sad. People with depression often describe themselves as ‘worthless’ and ‘empty’.
ANGER- This can be directed at the self or others. On occasion, such emotions lead to aggression or self-harming behaviour, which is why it appears behavioural as well.
LOWERED SELF-ESTEEM- People with depression tend to report lowered self-esteem and like themselves less. This can be so extreme, with some people describing a sense of self -loathing.

Question 12

Cognitive characteristics of depression

Answer 12

POOR CONCENTRATION- The person may find themselves unable to stick with a task as they normally would, or might find it hard to make decisions that they would normally find straightforward. Poor concentration and decision-making are likely to interfere with the individual’s work.
DWELLING ON THE NEGATIVE- When experiencing a depressive episode people are more likely to pay attention to the negative aspects of a situation and ignore the positives. People with depression also have a bias towards recalling unhappy events rather than happy ones.
ABSOLUTIST THINKING- When a person is depressed they tend to have ‘black-and-white thinking’. This means that if something bad happens, a depressed person may see it as an absolute disaster.

Question 13

Behavioural characteristics of OCD

Answer 13

COMPULSIONS ARE REPETITIVE- Typically people with OCD feel compelled to repeat a behaviour. A common example is handwashing.
COMPULSIONS REDUCE ANXIETY- Around 10% of people with OCD show compulsive behaviour alone (no obsessions). However, for the vast majority, compulsive behaviours are performed in an attempt to manage the anxiety produced by obsessions.
AVOIDANCE- The behaviour of people with OCD may also be characterised by their avoidance as they attempt to reduce anxiety by keeping away from situations that trigger it. People with OCD tend to try to manage OCD by avoiding situations that trigger anxiety. However, this avoidance can lead people to avoid very ordinary situations and interfere with everyday life.

Question 14

Emotional characteristics of OCD

Answer 14

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 creates anxiety.
ACCOMPANYING DEPRESSION- OCD is often accompanied by depression, so anxiety can be accompanied by low mood and lack of enjoyment in activities. Compulsive behaviour tends to bring relief but is temporary.
GUILT AND DISGUST- OCD sometimes involves other negative emotions such as irrational guilt or disgust, which may be directed at the self or something external, like dirt.

Question 15

Cognitive characteristics of OCD

Answer 15

OBSESSIVE THOUGHTS- For around 90% of people with OCD the major cognitive feature of their condition is obsessive thoughts. These recur over and over again and are unpleasant.
COGNITIVE COPING STRATEGIES- People may respond to OCD by adopting cognitive strategies to deal with obsessions. This may help to manage anxiety but can make the person seem abnormal to others and distract them from everyday tasks.
INSIGHT INTO EXCESSIVE ANXIETY- People with OCD are aware that their obsessions and compulsions are not rational. However, in spite of this insight, people with OCD experience catastrophic thoughts about the worst-case scenarios that may result if their anxieties were justified. They also tend to be hypervigilant.

Question 16

The behavioural approach to explaining phobias
(two-process model

Answer 16

Phobias are gained through classical conditioning:
Involves learning to associate something with which we initially have no fear of (neutral stimulus) with something that already triggers a fear response(unconditioned stimulus). This conditioning can be generalised to other objects.
Phobias are maintained through operant conditioning:
Negative reinforcement means an individual avoids an unpleasant situation, which produces a desirable consequence and the behaviour will be repeated.
Mowrer suggested that when we avoid a phobic stimulus we successfully escape the fear and anxiety we would have experienced if we were there. This reduction in fear reinforces the avoidance behaviour so the phobia is maintained.

Question 17

Watson’s little albert study

Answer 17

A child was in introduced to a loud noise (unconditioned stimulus) which produced the fear response (unconditioned response). A white rat (neutral stimulus) was introduced and paired with this loud noise which over time became paired with the fear response towards this white rat (conditioned response). The rat then becomes a conditioned stimulus as it produces the conditioned response of fear. This fear was then generalised to white fluffy things as well as white mice.

Question 18

The behavioural approach to treating Phobias
Systematic desensitisation

Answer 18

Systematic desensitisation is a behavioural therapy designed to gradually reduce phobic anxiety. Essentially a new response to the phobic stimulus is learnt (relaxation) in a process called counterconditioning
There are 3 processes involved:
An ANXIETY HIERARCHY is put together and is a list of situations related to the phobic stimulus that provokes anxiety in order from least to most frightening.
RELAXATION. The therapist teaches the client to relax as it is impossible to feel afraid and relaxed at the same time, so one emotion prevents the other. this is known as RECIPROCAL INHIBITION.
EXPOSURE. Finally, the client is exposed to the phobic stimulus while in a relaxed state over several sessions. This works its way up the anxiety hierarchy and treatment is successful when the client can stay relaxed in situations high on the anxiety hierarchy.

Question 19

The behavioural approach to treating phobias
Flooding

Answer 19

Flooding is a behavioural therapy designed to reduce phobic anxiety in one session, through immediate exposure to the phobic stimulus. This occurs in a secure environment from which the patient cannot escape - without the option of practising avoidance behaviour, such behaviour is not reinforced and so the phobia is not maintained. This relies on the principle that it is physically impossible to maintain a state of heightened anxiety for a prolonged period, meaning that eventually, the patient will learn that the phobic stimulus is harmless.
Is important to get informed consent.

Question 20

The cognitive approach to explaining depression
Beck’s negative triad

Answer 20

Beck suggested that people’s cognitions that create a vulnerability to depression. There are 3 parts:
FAULTY INFORMATION PROCESSING- This is when depressed people attend to the negative aspects of a situation and ignore the positives (black-and-white)
NEGATIVE SELF-SCHEMA- Someone with a negative self-schema interprets all information about themself in a negative way.
THE NEGATIVE TRIAD- Beck suggested that a person develops a dysfunctional view of themselves because of three types of negative thinking:
-Negative view of the world= creates the impression there is no hope anywhere
-Negative view of the future= Reduces hopefulness and enhances depression
-Negative view of the self= Enhance any existing depressive feelings because they confirm the existing emotions of low self-esteem.

Question 21

The cognitive approach to explaining depression
Ellis’ ABC model

Answer 21

To Ellis, conditions like depression are due to irrational thoughts. he defines irrational thoughts as any thoughts that interfere with us being happy and free from pain.
Ellis uses the ABC model to explain how irrational thoughts affect our behaviour and emotional state
ACTIVATING EVENT- We get depressed when we experience negative events and these trigger irrational beliefs.
BELIEFS- this is the belief the person holds about the event or situation that has just occurred. This may be rational or irrational. (eg musturbation is the belief we must always succeed)
CONSEQUENCES- When an activating event triggers irrational beliefs there are emotional and behavioural consequences.

Question 22

The cognitive approach to treating depression
Cognitive Behavioural Therapy

Answer 22

CBT is the most commonly used psychological treatment for depression and a range of other mental health issues.
COGNITIVE ELEMENT- CBT begins with an assessment in which the client and the cognitive behaviour therapist work together to clarify the problems. They jointly identify goals for the therapy and put together a plan to achieve them. One of the central tasks is to identify where there might be negative or irrational thoughts that will benefit from challenge.
BEHAVIOURAL ELEMENT- CBT then involves working to change negative and irrational thoughts and finally put more effective behaviours into place.
BEHAVIOURAL ACTIVATION- The goal of this is to work with depressed individuals to gradually decrease their avoidance and isolation, and increase their engagement in activities that have been shown to improve mood. The therapist aims to reinforce such activity.

Question 23

CBT: Beck’s cognitive therapy

Answer 23

The idea behind cognitive therapy is to identify automatic thoughts about the world, the self, and the future (the negative triad). Once identified these thoughts must be challenged. As well as challenging these thoughts directly, cognitive therapy aims to help clients test the reality of their negative beliefs. They might therefore be set homework, such as to record when they enjoyed an event or when people were nice to them. This is sometimes referred to as the ‘client as a scientist, investigating the reality of their negative beliefs in the way a scientist would. In future sessions, if clients say that no one is nice to them or there is no point in going to events, the therapist can then produce this evidence and use it to prove the client’s statements are incorrect.

Question 24

CBT: Ellis’ rational emotive behaviour therapy

Answer 24

Rational emotive behaviour therapy (REBT) extends the ABC model to an ABCDE model - D stands for dispute and E for effect. The central technique of REBT is to identify and dispute (challenge) irrational thoughts.For example, someone may talk about how unfair things may seem. An REBT therapist would identify these as examples of utopianism and challenge this as an irrational belief. This would involve a vigorous argument. The intended effect is to change the irrational belief and so break the link between negative life events and depression. This vigorous argument is the hallmark of REBT. Ellis identified different methods of disputing, For example, empirical argument involves disputing whether there is actual evidence to support the negative belief. Logical argument involves disputing whether the negative thought logically follows from the facts.

Question 25

Biological approach to explaining OCD
genetic explanations

Answer 25

Genes are involved in individual vulnerability to OCD. In a classic study, Lewis observed that of his OCD patients, 37% had parents with OCD and 21% had siblings with OCD. This suggests that OCD runs in families, although what is probably passed on from one generation to the next is genetic vulnerability not the certainty of OCD. According to the DIATHESIS-STRESS MODEL, certain genes leave some people more likely to develop a mental disorder but it is not certain. Some environmental stress (experience) is necessary to trigger the condition.
CANDIDATE GENES-Researchers have identified genes, which create vulnerability for OCD. Some of these genes are involved in regulating the development of the serotonin system.
OCD IS POLYGENIC- OCD is not caused by one single gene but by a combination of genetic variations that together significantly increase vulnerability. Taylor has analysed findings of previous studies and found evidence that up to 230 different genes may be involved in OCD. Genes that have been studied in relation to OCD include those associated with the action of dopamine as well as serotonin, both neurotransmitters believed to have a role in regulating mood.
DIFFERENT TYPES OF OCD-One group of genes may cause OCD in one person but a different group of genes may cause the disorder in another person. The term used to describe this is aetiologically heterogeneous, meaning that the origins (aetiology) of OCD vary from one person to another (heterogeneous).

Question 26

Biological approach to explaining OCD
Neural explanations

Answer 26

ROLE OF SEROTONIN-One explanation for OCD concerns the role of the neurotransmitter serotonin, which is believed to help regulate 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 a person may experience low moods. At least some cases of OCD may be explained by a reduction in the functioning of the serotonin system in the brain.
DECISION-MAKING SYSTEMS- Some cases of OCD, and in particular hoarding disorder, seem to be associated with impaired decision-making. This in turn may be associated with abnormal functioning of the lateral (side bits) of the frontal lobes of the brain. The frontal lobes are the front part of the brain (behind your forehead) that are responsible for logical thinking and making decisions. There is also evidence to suggest that an area called the left parahippocampal gyrus is associated with processing unpleasant emotions, which functions abnormally in OCD.

Question 27

Biological approach to treating OCD
Drug therapy

Answer 27

SSRIs- The standard medical treatment used to tackle the symptoms of OCD involves a particular type of antidepressant drug called a selective serotonin reuptake inhibitor (or SSRI for short). SSRIs work on the serotonin system in the brain. Serotonin is released by certain neurons in the brain. In particular, it is released by the presynaptic neurons and travels across a synapse. The neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then it is reabsorbed by the presynaptic neuron where it is broken down and reused. By preventing the reabsorption and breakdown, SSRIs effectively increase levels of serotonin in the synapse and thus continue to stimulate the postsynaptic neuron. This compensates for whatever is wrong with the serotonin system in OCD.
Dosage and other advice vary according to which SSRI is prescribed. A typical daily dose of fluoxetine is 20 mg although this may be increased if it is not benefitting the person. It takes three to four months of daily use for SSRIs to have much impact on symptoms.

Question 28

Biological approach to treating OCD
Drug therapy pt2

Answer 28

COMBINING SSRIs WITH TREATMENTS- Drugs are often used alongside cognitive behaviour therapy to treat OCD. The drugs reduce a person’s emotional symptoms, such as feeling anxious or depressed. This means that people with OCD can engage more effectively with the CBT. In practice, some people respond best to CBT alone whilst others benefit more when additionally using drugs like fluoxetine. Occasionally other drugs are prescribed alongside SSRIs.
ALTERNATIVES TO SSRIs- Where an SSRI is not effective after three to four months the dose can be increased or it can be combined with other drugs. Sometimes different antidepressants are tried. People respond very differently to different drugs and alternatives work well for some people and not at all for others.
Tricyclics (an older type of antidepressant) are sometimes used, such as clomipramine. This acts on various systems including the serotonin system which has the same effect as SSRis. Clomipramine has more severe side- effects so it is generally kept in reserve for people who do not respond to SSRIs.
SNRIs (serotonin-noradrenaline reuptake inhibitors) have more recently been used to treat OCD. These are a different class of antidepressant drugs and, like clomipramine, are a second line of defence for people who don’t respond to SSRIs. SNRIs increase levels of serotonin as well as another different neurotransmitter noradrenaline.

Question 29

Real-world application of statistical infrequency

Answer 29

One strength of statistical infrequency is its usefulness
“Statistical infrequency is used in clinical practice, both as part of formal diagnosis and as a way to assess the severity of an individual’s symptoms. For example, a diagnosis of intellectual disability disorder requires an IQ of below 7O (bottom 2%). An example of statistical infrequency used in an assessment tool is the Beck Depression Inventory (BDI). A score of 30+ (top 5% of respondents) is widely interpreted as indicating severe depression.
This shows that the value of the statistical infrequency criterion is useful in diagnostic and assessment processes.

Question 30

unusual characteristics can be positive
(stat infrequency weakness)

Answer 30

One limitation of statistical infrequency is that infrequent characteristics can be positive as well as negative. For every person with an IQ below 70, there is another with an IQ above 130. Yet we would not think of someone as abnormal for having a high IQ. Similarly, we would not think of someone with a very low depression score on the BDI as abnormal. These examples show that being unusual or at one end of a psychological spectrum does not necessarily make someone abnormal
This means that, although statistical infrequency can form part of assessment and diagnostic procedures, it is never sufficient as the sole basis for defining abnormality.

Question 31

Real-world application of deviation from social norms

Answer 31

One strength of deviation from social norms is its usefulness. Deviation from social norms is used in clinical practice. For example, the key defining characteristic of antisocial personality disorder is the failure to conform to culturally acceptable ethical behaviour i.e. recklessness, aggression, violating the rights of others and deceitfulness. These signs of the disorder are all deviations from social norms.
Such norms also play a part in the diagnosis of schizotypal personality disorder, where the term ‘strange is used to characterise the thinking, behaviour and appearance of people with the disorder.
This shows that the deviation from social norms criterion has value in psychiatry.

Question 32

Cultural and situational relativism of deviation from social norms

Answer 32

One limitation of deviation from social norms is the variability between social norms in different cultures and even different situations. A person from one cultural group may label someone from another group as abnormal using their standards rather than the person’s standards. For example, the experience of hearing voices is the norm in some cultures as messages from ancestors but would be seen as a sign of abnormality in most parts of the UK. Also, even within one cultural context social norms differ from one situation to another. Aggressive and deceitful behaviour in the context of family life is more socially unacceptable than in the context of corporate deal-making.
This means that it is difficult to judge deviation from social norms across different situations and cultures.

Question 33

Failure to function adequately represents a threshold for help (strength)

Answer 33

One strength of the failure to function criterion is that it represents a sensible threshold for when people need professional help.
Most of us have symptoms of mental disorders to some degree at some time. In fact, according to the mental health charity Mind, around 25% of people in the UK will experience a mental health problem in any given year. However, many people press on in the face of fairly severe symptoms. It tends to be at the point we cease to function adequately that people seek professional help or are noticed and referred for help by others.
This criterion means that treatment and services can be targeted to those who need them most

Question 34

Discrimination of failure to function adequately
(Weakness)

Answer 34

One limitation of failure to function is that it is easy to label non-standard lifestyle choices as abnormal.
In practice, it can be very hard to say when someone is really failing to function and when they have simply chosen to deviate from social norms - consider, for example, the table on the right. Not having a job or permanent address might seem like failing to function, and for some people, it would be. However, people with alternative lifestyles choose to live ‘off-grid’. Similarly, those who favour high-risk leisure activities or unusual spiritual practices could be classed, unreasonably, as irrational and perhaps a danger to self.
This means that people who make unusual choices are at risk of being labelled abnormal and their freedom of choice may be restricted

Question 35

ideal mental health is a comprehensive definition

Answer 35

One strength of the ideal mental health criterion is that it is highly comprehensive.
Jahoda’s concept of ‘ideal mental health’ includes a range of criteria for distinguishing mental health from mental disorder a fact is covers most of the reasons why we might seek (or be referred for help with mental health. This in turn means that an individual’s mental health can be discussed meaningfully with a range of professionals who might take different theoretical views e.g. a medically-trained psychiatrist might focus on symptoms whereas a humanistic counsellor might be more interested in self- actualsation.
This means that ideal mental health provides a checklist against which we can assess ourselves and others and discuss psychological issues with a range of professionals.

Question 36

Ideal mental health criteria may be culture bound

Answer 36

One limitation of the ideal mental health criterion is that its different elements are not equally applicable across a range of cultures.
Some of Jahoda’s criteria for ideal mental health are firmly located in the context of the US and Europe generally. In particular, the concept of self-actualisation would probably be dismissed as self-indulgent in much of the world. Even within Europe there is quite a bit of variation in the value placed on personal independence, e.g. high in Germany low in Italy. Furthermore, what defines success in our working, social and love-lives is very different in different cultures.
This means that it is difficult to apply the concept of ideal mental health from one culture to another.

Question 37

Real-world application of the two-process model
(Behavioural strength)

Answer 37

One strength of the two-process model is its real- world application in exposure therapies (such as systematic desensitisation)
The distinctive element of the two-process model is the idea that phobias are maintained by avoidance of the phobic stimulus. This is important in explaining why people with phobias benefit from being exposed to the phobic stimulus. Once the avoidance behaviour is prevented it ceases to be reinforced by the experience of anxiety reduction and avoidance therefore declines.
In behavioural terms, the phobia is the avoidance behaviour so when this avoidance is prevented the phobia is cured.
This shows the value of the two-process approach because it identifies a means of treating phobias.

Question 38

two-process model doesn’t account for cognitive aspects of phobias.

Answer 38

One limitation of the two-process model is that it does not account for the cognitive aspects of phobias.
Behavioural explanations, including the two-process model, are geared towards explaining behaviour. In the case of phobias, the key behaviour is avoidance of the phobic stimulus. However, we know that phobias are not simply avoidance responses - they also have a significant cognitive component. For example, people hold irrational beliefs about the phobic stimulus (such as thinking that a spider is dangerous). The two-process model explains avoidance behaviour but does not offer an adequate explanation for phobic cognitions.
This means that the two-process model does not completely explain the symptoms of phobias.

Question 39

two process model shows link between traumatic events and phobias.

Answer 39

A further strength of the two-process model is evidence for a link between bad experiences and phobias. The Little Albert study illustrates how a frightening experience involving a stimulus can lead to a phobia of that stimulus. More systematic evidence comes from a study by Ad De Jongh et al. (2006) who found that 73% of people with a fear of dental treatment had experienced a traumatic experience, mostly involving dentistry (others had experienced being the victim of violent crime). This can be compared to a control group of people with low dental anxiety where only 21% had experienced a traumatic event.
This confirms that the association between stimulus (dentistry) and an unconditioned response (pain) does lead to the development of the phobia.

Counterpoint Not all phobias appear following a bad experience. In fact some common phobias such as snake phobias occur in populations where very few people have an experience of snakes let alone traumatic experiences. Also, considering the other direction, not all frightening experiences lead to phobias.
This means that the association between phobias and frightening experiences is not as strong as we would expect if behavioural theories provided a complete explanation

Question 40

Evidence of effectiveness for systematic desensitisation
(behavioral treatment)

Answer 40

One strength of systematic desensitisation (SD) is the evidence base for its effectiveness. Gilroy et al. (2003) followed up with 42 people who had SD for spider phobia in three 45-minute sessions. At both three and 33 months, the SD group were less fearful than a control group treated by relaxation without exposure. In a recent review Wechsler et al. concluded that SD is effective for specific phobia, social phobia and agoraphobia.
This means that SD is likely to be helpful for people with phobias.

Question 41

SD is appropriate to help people with learning disabilities

Answer 41

A further strength of SD is that it can be used to help people with learning disabilities.
Some people requiring treatment for phobias also have a learning disability. However, the main alternatives to SD are not suitable. People with learning disabilities often struggle with cognitive therapies that require complex rational thought. They may also feel confused and distressed by the traumatic experience of flooding.
This means that SD is often the most appropriate treatment for people with learning disabilities who have phobias

Question 42

Flooding is cost effective

Answer 42

One strength of flooding is that it is highly cost-effective.
Clinical effectiveness means how effective a therapy is at tackling symptoms. However, when we provide therapies in health systems like the NHS we also need to think about how much they cost. A therapy is cost-effective if it is clinically effective and not expensive. Flooding can work in as little as one session as opposed to say, ten sessions for SD to achieve the same result. Even allowing for a longer session (perhaps three hours) makes flooding more cost-effective.
This means that more people can be treated at the same cost with flooding than with SD or other therapies.

Question 43

Flooding may be traumatic

Answer 43

One limitation of flooding is that it is a highly unpleasant experience.
Confronting one’s phobic stimulus in an extreme form provokes tremendous anxiety. Schumacher et al (2015) found that participants and therapists rated flooding as significantly more stressful than SD. This raises the ethical issue for psychologists of knowingly causing stress to their clients, although this is not a serious issue provided they obtain informed consent. More seriously, the traumatic nature of flooding means that attrition (dropout) rates are higher than for SD.
This suggests that, overall, therapists may avoid using this treatment.

Question 44

Research support for Beck’s cognitive model of depression

Answer 44

one strength generally of Beck’s cognitive model of depression is the existence of supporting research.
“Cognitive vulnerability’ refers to ways of thinking that may predispose a person to become depressed, for example, faulty information processing, negative self-schema and the cognitive triad. In a review Clark and Beck concluded that not only were these cognitive vulnerabilities more common in depressed people, but they preceded the depression. This was confirmed in a more recent prospective study by Cohen et al. They tracked the development of 473 adolescents, regularly measuring cognitive vulnerability. It was found that showing cognitive vulnerability predicted later depression.
This shows that there is an association between cognitive vulnerability and depression.

Question 45

Real-world application of Beck’s cognitive model of depression

Answer 45

A further strength of Beck’s cognitive model of depression is its applications in screening and treatment for depression.

Cohen et al concluded that assessing cognitive vulnerability allows psychologists to screen young people, identifying those most at risk of developing depression in the future and monitoring them. Understanding cognitive vulnerability can also be applied in cognitive behaviour therapy. These therapies work by altering the kind of cognitions that make people vulnerable to depression, making them more resilient to negative life events.
This means that an understanding of cognitive vulnerability is useful in more than one aspect of clinical practice.

Question 46

Real-world application of Ellis’ ABC model

Answer 46

One strength of Ellis’s ABC model is its real-world application in the psychological treatment of depression. Ellis’ approach to cognitive therapy is called rational emotive behaviour therapy or REBT for short. The idea of REBT is that by vigorously arguing with a depressed person the therapist can alter the irrational beliefs that are making them unhappy. There is some evidence to support the idea that REBT can both change negative beliefs and relieve the symptoms of depression (David et al. 2018).
This means that REBT has real-world value.

Question 47

Ellis’ ABC model only explains some depression cases

Answer 47

One limitation of Ellis’s ABC model of depression is that it only explains reactive depression and not endogenous depression.
There seems to be no doubt that depression is often triggered by life events - what Ellis would call ‘activating events’. How we respond to negative life events also seems to be at least partly the result of our beliefs. However, many cases of depression are not traceable to life events and it is not obvious what leads the person to become depressed at a particular time. This type of depression is sometimes called endogenous depression. Ellis’s ABC model is less useful for explaining endogenous depression.
This means that Ellis’s model can only explain some cases of depression and is therefore only a partial explanation.

Question 48

Evidence of CBT effectiveness

Answer 48

One strength of CBT is the large body of evidence supporting its effectiveness in treating depression.
Many studies show that CBT works. For example, March et al. (2007) compared CBT to antidepressant drugs and also to a combination of both treatments when treating 327 depressed adolescents. After 36 weeks, 81% of the CBT group, 81% of the antidepressants group and 86% of the CBT plus antidepressants group were significantly improved. So CBT was just as effective when used on its own and more so when used alongside antidepressants. CBT is usually a fairly brief therapy requiring six to 12 sessions so it is also cost-effective.
This means that CBT is widely seen as the first choice of treatment in public health care systems such as the National Health Service.

Question 49

CBT may not be effective for severe cases of depression

Answer 49

One limitation of CBT for depression is the lack of effectiveness for severe cases and for clients with learning disabilities.
In some cases, depression can be so severe that clients cannot motivate themselves to engage with the cognitive work of CBT. They may not even be able to pay attention to what is happening in a session. It also seems likely that the complex rational thinking involved in CBT makes it unsuitable for treating depression in clients with learning disabilities. Sturmey (2005) suggests that, in general, any form of psychotherapy (i.e. any ‘talking’ therapy) is not suitable for people with learning disabilities, and this includes CBT.
This suggests that CBT may only be appropriate for a specific range of people with depression.

Question 50

CBT has high relapse rates

Answer 50

A further limitation of CBT for the treatment of depression is its high relapse rates.
Although CBT is quite effective in tackling the symptoms of depression, there are some concerns over how long the benefits last. Relatively few early studies of CBT for depression looked at long-term effectiveness. Some more recent studies suggest that long-term outcomes are not as good as had been assumed. For example in one study, Ali et al (2017) assessed depression in 439 clients every month for 12 months following a course of CBT. 42% of the clients relapsed into depression within six months of ending treatment and 53% relapsed within a year.
This means that CBT may need to be repeated periodically.

Question 51

Research support for genetic explanation of OCD

Answer 51

one strength of the genetic explanation for OCD is the strong evidence base.
There is evidence from a variety of sources which strongly suggests that some people are vulnerable to OCD as a result of their genetic makeup. One source of evidence is twin studies. In one study Nestadt et al reviewed twin studies and found that 68% of identical twins (MZ) Shared OCD as opposed to 31% of non-identical (DZ) twins. Another source of evidence for a genetic influence on OCD is family studies. Research has found that a person with a family member diagnosed with OCD is around four times as likely to develop it as someone without (Marini and Stebnicki 2012).
These research studies suggest that there must be some genetic influence on the development of OCD

Question 52

Genetic explanation of OCD ignores environmental factors

Answer 52

One limitation of the genetic model of OCD is that there are also environmental risk factors.
There is strong evidence for the idea that genetic variation can make a person more or less vulnerable to OCD. However, OCD does not appear to be entirely genetic in origin and it seems that environmental risk factors can also trigger or increase the risk of developing OCD. In one study, for example, Cromer et al found that over half the OCD patients in their sample had experienced a traumatic event in the past. OCD was also more severe in those with one or more traumas.
This means that genetic vulnerability only provides a partial explanation for OCD.

Question 53

Research support for neural explanation of OCD

Answer 53

One strength of the neural model of OCD is the existence of some supporting evidence.
Antidepressants that work purely on serotonin are effective in reducing OCD symptoms and this suggests that serotonin may be involved in OCD. Also, OCD symptoms form part of conditions that are known to be biological in origin, such as the degenerative brain disorder Parkinson’s disease, which causes muscle tremors and paralysis (Nestadt et al. 2010). If a biological disorder produces OCD symptoms, then we may assume the biological processes underlie OCD.
This suggests that biological factors (e.g. serotonin and the processes underlying certain disorders) may also be responsible for OCD.

Question 54

No unique neural system
(neural explanation OCD weakness)

Answer 54

One limitation of the neural model is that the serotonin-OCD link may not be unique to OCD. Many people with OCD also experience clinical depression. having 2 disorders is called co-morbidity. This depression probably involves disruption to the action of serotonin. This leaves us with a logical problem when it comes to serotonin as a possible basis for OCD. It could simply be that serotonin activity is disrupted in many people with OCD because they are depressed as well.
This means that serotonin may not be relevant to OCD symptoms

Question 55

Evidence of effectiveness on drug treatments for OCD

Answer 55

One strength of drug treatment for OCD is good evidence of its effectiveness.
There is clear evidence to show that SSRis reduce symptom severity and improve the quality of life for people with OCD. For example, Soomro et al reviewed 17 studies that compared SSRIs to placebos in the treatment of OCD. All 17 Studies showed significantly better outcomes for SSRls than for the placebo conditions. Typically symptoms reduce for around 70% of people taking SSRIs. For the remaining 30%, most can be helped by either alternative drugs or combinations of drugs and psychological therapies.
This means that drugs appear to be helpful for most people with OCD.

Question 56

Drug treatments for OCD are cost-effective and non disruptive

Answer 56

One further strength of drugs is that they are cost-effective and non-disruptive to people’s lives.
A strength of drug treatments for psychological disorders, in general, is that they are cheap compared to psychological treatments because many thousands of tablets or liquid doses can be manufactured in the time it takes to conduct one session of psychological therapy. Using drugs to treat OCD is therefore good value for public health systems like the NHS and represents a good use of limited funds. As compared to psychological therapies, SSRIs are also non-disruptive to people’s lives. If you wish you can simply take drugs until your symptoms decline. This is quite different from psychological therapy which involves time spent attending therapy sessions.
This means that drugs are popular with many people with OCD and their doctors.

Question 57

Serious side effects in drug treatments for OCD

Answer 57

One limitation of drug treatments for OCD is that drugs can have potentially serious side effects. Although drugs such as SSRIs help most people, a small minority will get no benefit. Some people also experience side- effects such as indigestion, blurred vision and loss of sex drive. These side effects are usually temporary, however, they can be quite distressing for people and for a minority they are long-lasting. For those taking tricyclic clomipramine, sid -effects are more common and can be more serious. For example, more than 1 in 10 people experience erection problems and weight gain, and 1 in 100 become aggressive and experience heart-related problems.
This means that some people have a reduced quality of life as a result of taking drugs and may stop taking them altogether, meaning the drugs cease to be effective.