PSYCHOPATHOLOGY Flashcards
(134 cards)
1
Q
What is statistical infrequency?
A
Occurs when an individual has a less common characteristic
Example: being more depressed or less intelligent than most of the population.
2
Q
IQ and intellectual disability disorder as an example of statistical infrequency:
A
- in any human characteristic, majority of people’s scores will cluster around average, and the further above or believe the average, the fewer people who will get those scores.
- this is called NORMAL DISTRIBUTION
AVERAGE IQ is 100
- most people (68%) have an IQ in range of 85-115
- only 2% have score below 70
- individuals below 60 are very unusual/ abnormal
-these people liable to get diagnosis of a psychological disorder: INTELLECTUAL DISABILITY DISORDER.
3
Q
Statistical infrequency as a definition for abnormality
EVALUATION
Real life application
A
- strength of statistical definition is that it has real world application in diagnosis of intellectual disability disorder.
- therefore there’s a place for statistical infrequency in thinking about what are normal and abnormal behaviours + characteristics.
- all assessments of patients with mental disorders include some kind of measurement of how severe their symptoms are compared to statistica norms
- so statistical infrequency useful part of clinical assessment.
4
Q
Statistical infrequency as a definition for abnormality
EVALUATION
Unusual characteristics can be positive!
A
- IQ scores over 130 are just as unusual as those below 70, but wouldn’t think super intelligence as an undesirable characteristic that needs treatment.
- just because few people display certain behaviours DOES the behaviour statistically abnormal
- BUT doesn’t mean it requires treatment to return to normal
- serious limitation to concept of statistical infrequency and means that it would never be used alone to make a diagnosis.
5
Q
Statistical infrequency as a definition for abnormality
EVALUATION
Not everyone unusual benefits from a label
A
- where someone is living a happy fulfilled life, there’s no benefit to them being labelled as abnormal regardless of how unusual they are.
-so someone with a very low IQ but who is not distressed an quite capable of working would not need a diagnosis of intellectual disability
- if that person was labelled as abnormal this might have negative effect on way others view them and way they view themselves.
6
Q
What is deviation from social norms?
A
Concerns behaviour that is different demo the accepted standards of behaviour in a community or society
7
Q
Antisocial personality disorder as an example of deviation from social norms
A
- Peres with antisocial personality disorder (psychopathy) is impulsive, aggressive and irresponsible.
- according to DSM-5 , one important symptom is an ‘absence of prosocial internal standards associated with failure to conform to lawful or culturally normative ethical behaviour’.
- we make social judgement that a psychopath is abnormal as they don’t conform to out moral standards.
8
Q
Deviation from social norms as a definition of abnormality
EVALUATION
Not a sole explanation
A
- strength of deviation from social norms is that it has real life application in the diagnosis of antisocial personality disorder.
- so there’s a place for deviation from social noms in thinking about what is normal + abnormal.
- however, even in this case there are other factors to consider
E.g distress to other people resulting from antisocial personality disorder . - so deviation from social never the sole reason for defining abnormality
9
Q
Deviation from social norms as a definition of abnormality
EVALUATION
Cultural relativism
A
- another problem with using deviation from social norms to define behaviour as abnormal is that social norms are very different from one generation to another and from one community to another.
- means that a person from 1 cultural group may label someone from another cultural group as behaving abnormally according to their standards than the standards of the person behaving that way.
- e.g hearing voices is socially acceptable in some cultures but would be seen as a sign of mental abnormality in UK
- This creates problems for people from 1 culture living within another culture group.
10
Q
Deviation from social norms as a definition of abnormality
EVALUATION
Can lead to human rights abuses
A
- too much reliance on deviation from social norms to understand abnormality can lead to systematic abuse of human rights.
- looking at the historical examples of deviation from social norms it’s pretty clear that diagnoses were really there to maintain control over minority ethnic groups and women
- this classifications appear ridiculous nowadays- but only because social norms have changed
11
Q
Define failure to function adequately
A
Occurs when someone is unable to cope with ordinary demands of day-to-day living.
12
Q
What did Rosehan + Seligman 1989 propose as signs that someone is not coping?
A
- when person no longer conforms to standards interpersonal rules e.g maintaining eye contact and respecting personal space.
- when person experiences severe personal distress
- when persons behaviour becomes irrational or dangerous to themselves or others.
13
Q
Intellectual disability disorder as an example of failure to function adequately
A
One criteria is very low IQ
- however person must also be failing to function adequately before a diagnosis would be given.
14
Q
Define deviation from ideal mental health
A
Occurs when someone does not meet a set of criteria dor good mental health
15
Q
What did Jahoda 1958- suggest that we are in good mental health if we meet the criteria…..
A
- no symptoms of distress
- rational and can perceive ourselves accurately
- self- actualise
- cope with stress
- good self esteem and lack guilt
- independent of other people
- can successfully work, love and enjoy our leisure.
16
Q
Failure to function adequately as a detention of abnormality
EVALUATION
Patients perspective
A
- strength of failure to function adequately is that it does attempt to include the subjective experience of the individual.
- it may not be entirely satisfactory approach as it is difficult to assess distress but at least definition acknowledges the experience of the patient is important.
- failure to function adequate definition captures the experience of many of the people who need help.
- suggests that failure to function adequate is a useful criterion for assessing abnormality.
17
Q
Failure to function adequately as a detention of abnormality
EVALUATION
Is it simply a deviation from social norms?
A
- in practice it can be hard to say when someone is really failing to function and when they are just deviating from social norms.
- we may think not having job or permeant address is a sign of failure to function adequately.
- but some people choose alternative lifestyles
- those who practice extreme sports could be accused of behaving in maladaptive way
- whilst those with religious or super natural beliefs could be seen as irrational.
- if treat these behaviours as ‘failures’ of adequate functioning, we risk limiting personal freedom + discriminating against minority groups
18
Q
Failure to function adequately as a detention of abnormality
EVALUATION
Subjective judgements
A
- when deciding whether someone is failing to function adequately, someone has to judge whether patient is distressed or distressing.
- some patients may say they are distressed but may be judged as not suffering.
- there are methods for making such judgments as objected as possible, including checklists such as Global assessment of functioning scale.
- however principle remains that someone (e.g psychiatrists) has the right to make this judgment.
19
Q
Deviation from ideal mental halter as a definition of abnormality
EVALUATION
It is a comprehensive definition
A
- strength of deviation from ideal mental health is that it is very comprehensive.
- it covers a broad range of criteria for mental health.
- it probably covers most of the reasons someone would seek help from mental health services or be referred for help.
- the sheer range of factors discussed in relation to Jahoda ideal mental health make it a good tool for thinking about mental health.
20
Q
Deviation from ideal mental halter as a definition of abnormality
EVALUATION
Cultural relativism
A
- some of the ideas in Jahoda’s classification of ideal mental health are specific to Western European + North American cultures (culture bound)
- EXAMPLE:
- emphasis on personal achievement int he concept of self- actualisation would be considered self-indulgent in much of the world as the emphasis is so much on individual rather than the family or community.
- similarly, much of world would see independence from other people as a bad thing.
- such traits are typical of individualist cultures.
21
Q
Deviation from ideal mental halter as a definition of abnormality
EVALUATION
It sets an unrealistically high standard for mental health
A
- very few of us attain all Jahoda’s criteria for mental health, and probably none of use achieve all of them at the same time or keep them up for very long.
- therefore this approach would see pretty much all of us as abnormal.
- can see this as positive or negative
- positive side: males it clear to people the ways in which they could benefit from seeking treatment- e.g counselling- to improve their mental health.
- negative: deviation from ideal mental health is probably of no value in thinking about who might benefit from treatment against their will.
22
Q
Define a phobia
A
An irrational fear of an object or situation
23
Q
DSM-5
What is a specific phobia
A
Phobia of an objet, couch as animal or body part, o a situation such as flying or having an injection
24
Q
DSM-5
What is social phobia/ social anxiety
A
Phobia of a social situation such as public speaking or using a public toilet.
25
DSM-5
What is agoraphobia
Phobia of being outside or in a public space
26
What are the behavioural characteristics of phobias?
We respond to things or situations we fear by behaving in particular ways.
We respond by feeling high levels of anxiety and trying to escape.
The fear responses in phobias are the same as we experience for any other fear even if the level of fear is irrational.
27
Describe the behavioural characteristic: PANIC for phobias
A phobic person may panic in response to the phobic stimulus.
Panic may involve a range of behaviours including crying, screaming or running away.
Children may react slightly differently e.g freezing, clinging or having a tantrum
28
Describe the behavioural characteristic: AVOIDANCE for phobias
Unless the suffer is making conscious effort to face their fear they tend to go to a lot of effort to avoid coming into contact with the phobic stimulus.
Can make it hard to go about daily.
E.g: someone with fear of public toilets may have to limit the time the spend outside the home in relation to how long they can last without a toilet
- can interfere with work, education and social life.
29
Describe the behavioural characteristic: ENDURANCE for phobias
Alternative to avoidance is endurance, in which a sufferer remains in the presence of the phobic stimulus but continues to experience high levels of anxiety
This may be unavoidable in some situations
E.g for a person who has extreme fear of flying.
30
Describe the emotional characteristic: ANXIETY for phobias
- phobias classed as anxiety disorder.
- they involve an emotional response of anxiety and fear.
- anxiety is an unpleasant state of high arousal.
- this prevents the sufferer relaxing + makes it difficult to experience any positive emotion.
- anxiety can be long term
- fear is the immediate and extremely unpleasant response we experience when we encounter or think about the phobic stimulus.
31
Example of emotional characteristics of phobias
ARACHNOPHOBIA
Matt has a phobia of spiders
- his anxiety levels will increase whenever he enters place associated with spiders
- anxiety is general response to the situation
- when he actually sees spider, he experiences fear
32
Explain why emotional responses to phobic stimulus are unreasonable
Emotional responses we experience in relation to phobic stimuli go beyond what is reasonable.
- fear of spiders is irrational as they cannot harm you
33
What are cognitive characteristics of phobias
Cognitive element concerned with the ways in which people process information.
People with phobias process information about phobic stimuli differently from other objects or situations.
34
Describe SELECTIVE ATTENTION TO THE PHOBIC STIMULUS in terms of cognitive characteristics of phobias
If sufferer can see the phobic stimulus it is hard to look away from it it.
- keeping attention on something really dangerous is good thing as it gives us the best chance of reacting quickly to threat
- bit not so useful when the fear is irrational.
A POGONOPHOIC will struggle to concentrate on what they are Doug is there is someone with a beard in the room.
35
Describe IRRATIONAL BELIEFS as a cognitive stimulus of phobias
A phobic may hold irrational beliefs in relation to phobic stimuli
- e.g
- social phobias can include beliefs like ‘I must always sound intelligent’ or ‘if i blush people will think I’m weak’
- this kind of belief increases the pressure on the sufferer to perform well in social situations.
36
Describe COGNITIVE DISTORTIONS in terms of cognitive characteristics of phobias
The phobics perceptions of the phobic stimulus may be distorted.
E.g seeing belly buttons as ugly and disgusting
37
What is depression?
A mental disorder characterised by low mood and low energy levels
38
What did the DSM-5 suggest Major depression disorder was?
Severe but often short-term depression
39
What did the DSM-5 say persistent depression disorder was?
Long-term or recurring depression, including sustained major depression and what used to be called dysthymia.
40
What did DSM-5 say premenstrual dysphoric disorder was?
Disruption to mood prior to and/or during menstruation.
41
Describe anxiety levels in terms of behavioural characteristics of depression?
- typically suffers of depression have reduced levels energy, making them lethargic.
- this has knock on effects, with suffers tending to withdraw from work, education and social life, in extreme cases this can be so severe that suffer cannot get out of bed.
- in some cases depression can lead to the opposite effect- known PSYCHOMOTOR AGITATION
- agitated individuals struggle to relax + may end up pacing up and down a room.
42
Describe disruption to sleep and eating behaviour in terms of behavioural characteristics of depression.
Depression is associated with changes to sleeping behaviour.
- suffers may experience reduced sleep or increased need for sleep.
- similarly appetite + eating may increase or decrease, leading to weight gain or loss.
- key point is that such behaviours are disrupted by depression..
43
Describe aggression and self- harm in terms of behavioural characteristics of depression
Sufferers of depression are often irritable, and in some cases they can become verbally or physically aggressive.
- can have serious knock on effects on the number of aspects of their life.
- example: someone experiencing depression might display verbal aggression by ending a relationship or quitting job.
- depression can also lead to physical aggression directed against self.
- this includes self-harm, or suicide attempts
44
Describe lowered mood in terms of emotional characteristics of depression
Lowered mood is still a defining emotional element of depression but it’s more pronounced than in the daily kind of experience of feeling lethargic and sad.
Patients often describe themselves as ‘worthless’ and ‘empty’ .
45
Describe anger in terms of emotional characteristics of depression
Although sufferers tend to experience more negative emotions and fewer positive ones during episodes of depression, this experience of negative emotions is not limited to sadness
Sufferers of depression also frequently experience anger, sometimes extreme anger.
This can be directed at self or others.
On occasions such emotions lead to aggressive or self-harming behaviour
46
Describe lowered self- esteem in terms of emotional characteristics of depression
Self esteem is the emotional experience of how much we like ourselves.
Suffers of depression tend to report reduced self esteem
I.e like themselves less than usual.
This can be quite extreme, with som stuffers of depression describing a sense of self loathing i.e hating them selves.
47
What is the cognitive aspect of depression concerns with?
The ways in which people process information.
People suffering from depression or who have suffered depression tend to process information about several aspects of world quite differently from the ‘normal’ ways that people without depression think.
48
Describe poor concentration in terms of cognitive characteristics of depression
Depression associated with poor levels of concentration.
The suffer may find themselves unable to stick with a task as they usually would
Or might find it hard to make decisions that they would normally find straightforward.
Poor concentration and poor decision making are likely to interfere with the individuals work.
49
Describe attending to and dwelling on the negative = in terms of cognitive characteristics of depression
When suffering a depressive episode people are inclined to pay more attention to negative aspects of a situation and ignore the positives.
In other words they tend to see a glass as half empty rather than half full.
Sufferers also have a bias towards recalling unhappy events rather the happy ones- the opposite bias that most people have when no depressed.
50
Describe absolutist thinking in terms of cognitive characteristics of depression
Most situations are not all-good or all-bad, but when a sufferer is depressed they tend to think in these terms.
They sometimes call this ‘bald and white thinking’
This means that when a situation is unfortunate they tend to see it as an absolute disaster.
51
What is OCD?
A condition characterised by obsessions and/or compulsive behaviour
52
What did the DSM-5 say OCD is?
Characterised by either obsessions (recurring thoughts, images ect) and/or compulsions (repetitive behaviours such as hand washing). Most people with a diagnosis of OCD have both obsessions and compulsions.
53
What did DMS-5 say trichotillomania is?
Compulsive hair pulling
54
What did DSM-5 say hoarding disorder is?
The compulsive gathering of possessions and the inability to part with anything, regardless of its value.
55
What did the DSM-5 say excoriation disorder is?
Compulsive skin picking
56
Describe compulsions in terms of a behavioural characteristic of OCD
(Compulsions are repetitive)
Typically sufferers of OCD feel compelled to repeat a behaviour.
- common example= hand washing.
- other common compulsive repetitions include counting, praying and tidying/ordering groups of objects such as CD collections or containers in food cupboard.
57
Describe compulsions in terms of a behavioural characteristic of OCD
(Compulsions reduce anxiety)
- around 10% of OCD suffers show compulsive behaviour alone- they have no obsessions, just a general sense of irrational anxiety.
However vast majorly compulsive behaviours are performed in an attempt to manage the anxiety produced by obsessions.
Example: compulsive hand washing is carried out as a response to an obsessive fear of germs.
58
Describe avoidance in terms of a behavioural characteristic of OCD
- behaviour of OCD sufferers may also be characterised by their avoidance as they attempt to reduce anxiety by keeping away from situations that trigger anxiety.
59
Describe anxiety and distress in terms of an emotional characteristic of OCD.
OCD is regarded as a particularly unpleasant emotional experience because of the powerful anxiety that accompanies both obsessions + compulsions.
Obsessive thoughts are unpleasant + frightening and anxiety that does with these can be overwhelming.
Urge to repeat a behaviour creates anxiety.
60
Describe accompanying depression in terms of an emotional characteristic of OCD.
OCD often accompanied by depression, so anxiety can be accompanied by LOW mood + lack of enjoyment in activities.
Compulsive behaviour tends to bring some relief from anxiety but this is temporary.
61
Describe guilt and disgust in terms of an emotional characteristic of OCD.
As well as anxiety an depression, OCD sometimes involves other negative emotions such as irrational guilt, for example over minor moral issues or disgust which may be directed against something external like dirt or at the self.
62
Describe obsessive thoughts in terms of an cognitive characteristic of OCD.
For around 90% of OCD suffers the major cognitive feature of their condition is obsessive thoughts, i.e thoughts that recur over and over again.
These vary considerably from person to person but always are unpleasant.
Examples: of recurring thoughts are worries of being contaminated by dirt and germs or certainly that a door has been left unlocked and that intrudes will enter through it or impulses to hurt someone.
63
Describe cognitive strategies to deal with obsessions in terms of an cognitive characteristic of OCD.
Obsessions are the major cognitive aspect of OCD, but people also respond by adapting cognitive coping strategies.
Example: a religious perosn tormented by observe guilt may respond by praying or meditating.
This may help manage anxiety but can make the person appear abnormal to others and can distract them from everyday tasks.
64
Describe insight into excessive anxiety in terms of an cognitive characteristic of OCD.
People suffering from OCD are aware that their obsessions and compulsions are not rational.
This is necessary for a diagnosis of OCD.
If someone really believed their obsessive thoughts were based on reality that would be a symptom of a quite 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.
They also tend to be hyper vigilant
65
Who came up with the 2 process model based on the behavioural approach to phobias?
Mowrer 1960
66
What does the 2 process model state?
This states that phobias are acquired (learned in first place) by classical conditioning and then continue because of operant conditioning.
67
Explain the acquisition of a phobia by classical conditioning
- classical conditioning involves learning to associate something of which we initially have no fear (neutral stimulus) with something that already triggers a fear response (unconditional stimulus).
68
Explain acquisition by classical conditioning- ALBERT PHOBIA
- Watson + Rayer 1920
- created phobia in a 9-month-old baby ‘little albert’
- Albert showed unusual anxiety at start of study.
- when shown a white rat he tried to play with it.
- however, the experimenters then set out to give Albert phobia
- whenever rat was presented they made a loud, frightening noise by banging iron bar close to Alberts ear.
- noise = UNCONDITIONED STIMULUS
- It created an UNCONDTIONED RESPONSE= fear
- when the rat (NEUTRAL STIMULUS) and UNCONDITIONED STIMULUS are encountered close thogheter in time, NS becomes associated with the UCS and both now produce the fear response- Albert become fearful of rat.
- rat is now a learned/ CONDITIONED STIMULUS that produces a CONDITIONED RESPONSE.
- this conditioning then generalised to similar objects such as a non-white rabbit and a fur coat.
- Albert showed sign of distress to all of these.
69
Explain maintenance of a phobia by operant conditioning
- responses acquired by classical conditioning usually tend to decline over time.
- however, phobias are often long lasting.
- Mowrer has explained this as a result of operant conditioning.
- operant conditioning takes place when our behaviour is REINFORCED (rewarded) or PUNISHED.
- Reinforcement tends to increase the frequency of a behaviour.
- this is true of both NEGATIVE and POSITIVE reinforcement.
- in case of negative reinforcement an individual AVOIDS a situation that is unpleasant.
- such a behaviour results in desirable consequence, which means the behaviour will be repeated.
- Mowrer suggested that whenever we avoid a phobic stimulus, we successfully escape the fear +anxiety that we would have suffered if we had remained there.
- this reduction in fear reinforces the avoidance behaviour and so the phobia is maintained.
70
The behavioural approach to explaining phobias
EVALUATION
Good explanatory power
- the 2 way process was a definite step forward when it was proposed in 1960 as it went beyond Watson + Rayner’s concept of classical conditioning.
- it explained how phobias could be maintained over time + this had important implications for therapies because it explains why patients need to be exposed to the feared stimulus
- once a patient is prevented from practicing their avoidance behaviour the behaviour ceases to be reinforced and so it declines.
- the applications to theory is a strength of the 2 process model.
71
The behavioural approach to explaining phobias
EVALUATION
Alternative explanation for avoidance behaviour
- not all avoidance behaviour associated with phobias seems to be as a result of anxiety reduction. E.g AGPRAPHOBIA.
- there is evidence to suggest that at least some avoidance behaviour appears to be motivated more by positive feelings of safety.
- in other words the motivating factor in choosing an action like not leaving the house is not so much to avoid the phobic stimulus but to stick with the safety factor.
- this explains why some patients with agoraphobia are able to leave their house with a trusted person with relatively little anxiety but not alone (Buck 2010).
This is a problem for the 2-process model, which suggests that avoidance is motivated by anxiety reduction.
72
The behavioural approach to explaining phobias
EVALUATION
An incomplete explanation for phobias
- even if we accept classical + operant conditioning are involved in the development and maintenance of phobias, there are some aspects of phobic behaviour that require further explaining.
- Bounton 2007 points out, for example, that evolutionary factors probably have an important role in phobias but the 2- factor theory does not mention this.
- for example, we easily acquire phobias of things that have been a source of danger in our evolutionary past, such as fears of snacks or of dark.
- it is adaptive to acquire such fears
- Seligman (1971) called this BIOLOGICAL PREPAREDNESS- the innate predisposition to acquire certain fears.
- However, it is quite rare to develop a fear of cars or guns, which actually are much more dangers to most of us today than spiders or snakes.
- presumably this is because they have only existed very recently and so we are not biologically prepared to learn fear responses towards them.
This phenomenon of preparedness is a serious problem for the 2- factor theory because it shows there is more to acquiring phobias than simple conditioning.
73
The behavioural approach to explaining phobias
EVALUATION
Phobias that don’t follow a trauma
Sometimes phobias appear following a bad experience and it is easy to see how they could be the result of conditioning.
- however sometimes people develop a phobia and are not aware of having had a related bad experience.
- for example, I might have a fear of snakes although I have never actually met one, let alone been frightened by one.
74
What is systematic desensitisation?
A behavioural therapy deigned to gradually reduce phobic anxiety through the principle of classical conditioning.
If the sufferer can learn to relax in presence of phobic stimulus they will be cured.
75
What is counterconditioning?
A new response to the phobic stimulus is learned (phobic stimulus is paired with relaxation instead of anxiety)
Learning the different response is called counter conditioning.
76
What are the 3 processes involved in systematic desensitisation?
1. The anxiety hierarchy
2. Relaxation
3. Exposure
77
Describe the anxiety hierarchy in terms of the systematic desensitisation
It is put together by the patient and therapist.
This is a list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening.
Example: ARACHNOPHOCIC might identify seeing a picture of a small spider as low on their anxiety hierarchy and holding a tranatula at top of hierachy.
78
Describe relaxation in terms of systematic desensitisation
Therapist teaches the patient to relax as deeply as possible.
This might involve breathing exercises or, alternatively, the patient might learn mental imagery techniques.
Patients can be taught to imagen themselves in relaxing situations or might learn to mediate.
Or alternatively relaxation could be drugs like VALIUM.
79
Describe exposure in terms of systematic desensitisation
Finally the patient is exposed to the phobic stimulus while in a relaxed state.
This takes place across several sessions, starting at bottom of anxiety hierachy.
When the patient can stay relaxed in presence of lower levels of the phobic stimulus they move up the hierachy.
Treatment is successful when the patient can stay relaxed in situations high on the anxiety hierarchy.
80
What is flooding in terms of the behavioural approach to treating phobias
A behavioural therapy in which a phobic patient is exposed to an extreme form of a phobic stimulus in order to reduce anxiety triggered by that stimulus.
This takes place across a small number of long therapy sessions.
81
How does flooding work?
- flooding stops phobic responses very quickly.
- this may be because, without the option of avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless.
- classical conditioning terms, this process is called extinction.
- a learned response is extinguish when the conditioned stimulus (e.g dog) is encountered without the unconditioned stimulus (e.g being bitten)
- the result is that the conditioned stimulus no longer produces the condition response (fear).
- in some cases the patient may achieve relaxation in the presence of the phobic stimulus simply because they become exhausted by their own fear responses!
82
Describe ethical safeguards in terms of flooding
Flooding is not unethical but is unpleasant experience so it is important that patients give fully INFORMED CONSENTto this traumatic procedure and that they are fully prepared before the flooding session.
- patient would normally be given choice of systematic desensitisation or flooding.
83
Systematic desnesitation as a behavioural approach to treat phobias
EVALUATION
It is effective
Research shows that systematic desensitisation is effective in treatment of specific phobias.
- Gilory et al (2003): followed up 42 patients who had been treated for spider phobia in 3 x 45 minute sessions of systematic desensitisation.
- spider phobia was assessed on several measures including the Spider Questionaire and by assessing response to spider.
- control group: treated by relaxation without exposure.
- at both 3 months and 33 months after the treatment the systematic desensitisation group were less fearful than the relaxation group.
- strength because it shows that systematic desensitisation is helpful in reducing the anxiety in spider phobia and that the effects are long-lasting.
84
Systematic desnesitation as a behavioural approach to treat phobias
EVALUATION
It is suitable for a diverse range in patients
- the alternatives to systematic desensitisation like flooding and cognitive therapies, are not well suited to some patients.
- example: some sufferers of anxiety disorders like phobias also have learning difficulties.
- learning difficulties can make it very hard for some patients to understand what is happening during flooding or to engage with cognitive therapies that require ability to reflect on what you are thinking.
- for these patients systematic desensitisation = most appropriate treatment.
85
Systematic desnesitation as a behavioural approach to treat phobias
EVALUATION
It is acceptable to patients
- strength of systematic desensitisation is that patients prefer it.
- those given choice of systematic desensitisation or flooding tend to prefer SD.
- largely because it does not cause same degree of trauma as flooding.
- may be because SD includes some elements that are actually pleasant e.g learning relaxation techniques.
- this is reflected in the low refusal rates (number of patients refusing to start treatment) and low attrition rates (number of patients dropping out treatment) of SD.
86
Flooding as a behavioural approach to treating phobias
EVALUATION
It is cost-effective
Flooding is at least as effective as other treatments for specific phobias.
- studies comparing flooding to cognitive therapies have found that flooding= highly effective and quicker alternative.
- this quick effect is a strength as it means that patients are free of their systems as soon as possible anf that makes treatment CHEAPER
87
Flooding as a behavioural approach to treating phobias
EVALUATION
It is less affective for some types of phobia
- although flooding is highly effecting for treating simple phobias, it appears to be less so for more complex phobias like SOCIAL PHOBIAS.
- may be because social phobias have cognitive aspects
- e,g sufferer of social phobia does not simply experience an anxiety response but thinks unpleasant thoughts about the social situation.
- this type of phobia may benefit more from cognitive therapies because such therapies tackle the irrational thinking.
88
Flooding as a behavioural approach to treating phobias
EVALUATION
The treatment is traumatic for patients
- perhaps most serious issue with the use of flooding is fact that it is highly traumatic experience.
- problem is not that flooding is unethical (patients give consent) but that patients are often unwilling to see it through to end.
- Limitation of flooding because time + money are sometimes wasted preparing patients only to have them refuse to start or complete treatment.
89
What is Becks cognitive theory of depression?
Suggested cognitive approach to explaining why some people are more vulnerable to depression than others.
In particular it’s a persons cognitions that create this vulnerability i.e the way we think.
- beck suggested 3 parts to this cognitive vulnerability:
- faulty information processing
- negative self- schemas
- the negative triad
90
What is faulty information processing in terms of becks cognitive theory of depression
- when depressed we attend to negative aspects of a situation and ignore positives.
Example: if won £1 million, might focus on the fact that previous week someone had one £10 million rather than focus on positive of all you could do with £1 million.
- also tend to blow small problems out of proportion and think in ‘black and white’ .
91
What is negative self- schemas in terms of becks cognitive theory of depression?
A schema is a ‘package’ of ideas and info developed through experience.
- they act as metal framework for the interpretation of sensory info.
- a SELF-SCHEMA is the package of info we have about ourselves
We use schemas o interpret work, so if have negative self-schema we interpret all info about ourselves in negative way.
92
What is the negative triad in terms of becks cognitive theory of depression?
1) NEGATIVE VIEW OF THE WORLD- example: ‘the world is a cold hard place’.
- this creates the impression that there is no hope anywhere.
2) NEGATIVE VIEW OF FUTURE- example: ‘there isnt much chance that the economy will really get better’
- such thought reduce any hopefulness + enhance depression.
3) NEGATIVE VIEWOF THE SELF- example might think ‘I am a failure’
- such thoughts enhance any existing depressive feelings because they confirm the existing emotions of low self-esteem
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Becks cognitive theory of depression
EVALUATION
It has good supporting evidence
- range of evidence supports idea that depression is associated with faulty information processing, negative self schemas and cognitive triad of negative automatic thinking.
- example: Grazioli + terry (2000) assessed 65 pregnant women for cognitive vulnerability + depression before + after birth.
- found that those women judged to have been high in cognitive vulnerability were more likely to suffer post-natal depression.
- Clark + Berk (1999) reviews research on this topic + concluded there there was solid support for all these cognitive vunerablity factors.
Critically, these cognitions can be seen before depression develops, suggesting that Beck may be right about cognition causing depression.
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Becks cognitive theory of depression
EVALUATION
It has a practicle application in CBT
- strength is it forms the basis of CBT.
- all cognitive aspects of depression can be identified + challenged in CBT.
- These include the components of the negative triad that ere easily identifiable.
- this means a therapist can challenge them + encourage the patient to test whether they are true.
- strength of explanation because it translates well into successful therapy.
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Becks cognitive theory of depression
EVALUATION
Doesn’t explain all aspects of depression
- becks theory explains neatly the basic symptoms of depression
However depression= complex
-some depressed patients = deeply angry and Beck cannot easily explain this extreme emotion.
- some sufferers of depression suffer hallucinations + bizarre beliefs
- Becks theory cannot easily explain these cases
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What is Ellisis ABC model?
-proposed that good mental health = result of rational hinting, defined as thinking in ways that allow people to be happy + free of pain.
- Ellis defined irrational thoughts as thoughts that interfere with us being happy + free of pain.
Ellis use the ABC model to explain how irrational thoughts affect our behaviour and emotional state
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Explain A- activating event
- Ellis focussed on situations in which irrational thoughts are triggered by external events.
- according to Ellie, we get depressed when we experience negative events and these trigger irrational beliefs
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Explain B- Beliefs
MUSTRUBATION- must always succeed and be perfect
‘I-CANT-STAND-IT-ITIS’- belief that it is a major disaster whenever something does not go smooothly.
UTOPIANISM- belief that life is always meant to be fair
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Explain C- consequences
When activist event triggers irrational beliefs there are emotional and behavioural consequences
Example: if believe you must always succeed and then fail at something, can trigger depression
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Ellis’s ABC model- cognitive theory of depression
EVALUATION
A partial explanation
- REACTIVE DEPRESSION: cases of depression following activating event
- Ellis’s explanation only applies to some kinds of depression and is therefore only a partial explanation for depression.
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Ellis’s ABC model- cognitive theory of depression
EVALUATION
It has practical application in CBT
- strength, it has lead to successful therapy.
- the idea that, by challenging irrational negative beliefs, a person can reduce their depression
- supported by research by Lipsky et al 1980
- this in turn supports the basic theory because it suggests that the irrational beliefs had some role in depression.
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Ellis’s ABC model- cognitive theory of depression
EVALUATION
Doesn’t explain all aspects of depression
- although Ellis explains why some people appear to be more vulnerable to depression that others as a result of their cognitions, his approach has very much the same limitations as Becks.
- it doesn’t easily explain the anger associated with depression or that some patients suffer with hallucinations and delusions.
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What is cognitive behaviour therapy?
Method for treating mental disorders based on don both cognitive and behavioural techniques.
From cognitive viewpoint the therapy aims to deal with thinking, such as challenging negative thoughts.
The therapy also includes behavioural techniques such as behavioural activation.
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What happens when you go for CBT?
Begins with an assessment in which that patient and cognitive behaviour therapist work together to clarify the patients problems.
They jointly identify goals for the therapy and put together a plan to achieve them.
Identify where there might be negative or irrational thoughts and challenge them.
CBT then involves changing negative and irrational thoughts using techniques purely from becks cognitive therapy and some of Ellie’s rational emotive behaviour therapy.
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CBT: Becks cognitive therapy
(Recall)
- idea behind cognitive therapy is to identify AUTOMATIC thoughts abut the world, self + future (NEGATIVE TRIAD).
- once identified these thoughts must be challenged. (Central component)
- cognitive therapy also aims to help patients test the reality of their negative beliefs
- may set homework such as to record when they enjoyed an event or when someone was nice to them.
- ‘patient scientist’
- they investigate the reality of their negative beliefs .
- having evidence that people were nice to them ect could prove patient thoughts = incorrect.
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CBT: Ellis’s rational emotive behaviour therapy (REBT)
(RECALL)
- REBT extends the ABC model to an ABCDE model.
- D stands for dispute
- E stands for effect
- central technique of REBT is to identify and dispute (challenge) irrational thoughts.
E.g patient might talk about how unlucky they have been or how unfair things seem.
An REBT therapist would identify these as examples of UTOPIANISM and challenge this as an irrational belief.
This would involve VIGOROUS ARGUMENT
The intended effect is to change the irrational belief and so break link between negative life events and depression.
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What is empirical argument?
Involves disrupting whether there is actual evidence to support the negative belief.
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What is logical argument?
Involves disrupting whether the negative thought logically follows from the facts
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What is behavioural activation?
-alongside the purely aspects of CBT, the therapist may also work to encourage a depressed patient. To e more active and engage in enjoyable activities .
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The cognitive approach to treating depression
EVALUATION
It is effective
- large body of evidence to support the effectiveness of CBT for depression.
- example: study by March et al (2007) compared the effects of CBT with antidepressants drugs and combination of the 2 in 327 adolescents with main diagnosis of depression.
- after 36 weeks:
-81% of CBT group
- 81% of antidepressant group
- 86% of the CBT plus antidepressants group
- all significantly improved.
- CBT emerged as just as effective as medication and helpful alongside medication
- suggests there is a goof case for making CBT first choice of treatment in public care systems like NHS
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The cognitive approach to treating depression
EVALUATION
CBT may not work for the most severe cases
- some cases of depression can be sp severe patients cannot motivate themselves to engage with the hard cognitive work in CBT
- there may not be able to pay attention to what is happening in a session.
- it may be better to treat these patients with antidepressants medication and commence CBT when they are more alert and motivated.
- although it is possible to work around this by using mediation, this is a limitation of CBT because it means CBT cannot be used as the sole treatment for all cases of depression.
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The cognitive approach to treating depression
EVALUATION
Success may be due to the therapist- patient relationship
- Rosenzweig (1936) suggested that the differences between different methods of psychotherapy, such as between CBT and systematic desensitisation, might actually be quite small.
- all psychotherapies share one thing, therapist- patient relationship
- it may be the quality of this relationship that determines success rather than any particular technique that is used.
Many comparative reviews (e.g luborsky et al 2002) find very small differences, which supports the view that simply having an opportunity to talk to some who will listen could be what matters more.
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The cognitive approach to treating depression
EVALUATION
Some patients really want to explore their past
- CBT focuses on present and future, not patients past.
- this is different so some other psychological therapies
- some patients are aware of link between their childhood experiences and current depression and want to talk about their experiences.
They can find this ‘present- focus’ very frustrating.
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What are genetic explanations?
Genes make up chromosomes and consist of DNA which codes the physical features of an organism (such as eye colour) and psychological features (such as mental disorders + intelligence).
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What is a neural explanation?
View that physical and psychological characteristics are determined by the behaviour of the nervous systems, in particular the brain as well as individual neurons.
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What did LEWIS 1936 find about genes involved in individual vulnerability to OCD?
Observed that of his OCD patients:
- 37% had parents with OCD
- 21% had siblings with OCD.
This suggests that OCD runs in families
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Diathesis- stress model- OCD
According to the Diathesis- stress model, certain genes leave some people more likely to suffer a mental disorder but it is NOT certain, some environmental stress (experience) is necessary to trigger the conditon.
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Describe candidate genes in terms of OCD
- Researchers have identified genes, which create vulnerability for OCD (candidate genes).
- some of these genes are involved in regulating the development of the serotonin system.
Example: gene 5HT1-D beta is implicated in the efficiency of transport of serotonin across SYNAPSES.
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How is OCD polygenic and what does polygenic mean?
- Polygenic means that OCD is not caused by 1 single gene but that several genes are involved.
TAYLOR- found evidence that up to 230 different genes may be involved in OCD
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Describe neural explanations in terms of OCD.
The genes associated with OCD are likely to affect the levels of key neurotransmitters as well as structures in the brain.
These are neural explanations
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What is the role of serotonin in OCD?
- One explanation for OCD concerns the role of the neurotransmitter SEROTONIN, its believed to help regulate mood.
- Neurotransmitters are responsible for relaying information from 1 neuron to another.
- in a person has LOW levels of serotonin, then normal transmission of mood- relevant information does not take place and mood (and sometimes of mental processes) are affected.
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Explain decision- making systems in terms of OCD and neural explanations
- some cases of OCD, 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 int he brain.
- the frontal lobes are the front part if brain that are responsible for logical thinking and making decisions.
- also evidence to suggest that an area called LEFT PARAHIPPOCAMPAL GYRUS, associated with processing unpleasant emotions, it functions abnormally in OCD.
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The BIOLOGICAL approach to explaining OCD
Genetic explanations
EVALUATION
The is good supporting evidence
- evidence form variety of sources for the idea that some people are vulnerable to OCD as a result of their genetic makeup-up.
TWIN STUDIES:
- Nestadt et al 2010- reviewed previous twin studies and found that 68% of identical twins shared OCD as opposed to 31% of non identical twins
Strongly suggests a genetic influence on OCD.
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The BIOLOGICAL approach to explaining OCD
Genetic explanations
EVALUATION
Too many candidate genes
- although twin studies strongly suggest that OCD is largely genetic control, psychologists have been less successful at pinning down all the genes involved.
- one reasons is because it appears that several genes involved and that each genetic variation only increases risk of OCD by a fraction.
- consequence is:
- cannot be entirely genetic in origin
- it may be more productive to focus on the environmental causes because we are more able to do something about these.
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The BIOLOGICAL approach to explaining OCD
Genetic explanations
EVALUATION
Environment risk factors
- seems that enviromental factors can also trigger or increase the risk of developing OCD (the Diathesis- stress model).
- example: Cromer et al (2007) found that over 1/2 the OCD patients in their sample had a traumatic event in theory past, and OCD more severe in those with more than 1 trauma.
- suggests that OCD cannot be ENTIRELY genetic in origin.
- it may be more productive to focus on the environmental causes because we are more able to do something about these.
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The BIOLOGICAL approach to explaining OCD
Neural explanations
EVALUATION
There is some supporting evidence
- there’s evidence to support the role of some neural mechanisms in OCD
- example: ANTIDEPRESSANTS work purely on the serotonin system, increasing levels of this neurotransmitter.
- such drugs are effective in reducing OCD symptoms and this suggests that the serotonin system is involved in OCD.
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The BIOLOGICAL approach to explaining OCD
Neural explanations
EVALUATION
It is not clear exactly what neural mechanisms are involved
- studies of decision making have shown that that these neural systems are the same systems that function abnormally in OCD.
- however, research has also identified other brain systems that may be involved sometimes but no system has been found that always plays a role in OCD.
- We cannot therefore really claim to understand the neural mechanism involved in OCD
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The BIOLOGICAL approach to explaining OCD
Neural explanations
EVALUATION
We should not assume the neural mechanisms cause OCD
- There is evidence to suggest that various neurotransmitters and structures of the brain do not function normally in patients with OCD.
- However, this is not the same as saying that this abnormal functioning causes the OCD.
- These biological abnormalities could be result of OCD rather than its cause.
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What is drug therapy?
Treatment involving drugs, i.e chemicals that have a particular effect on the functioning of the brain or some other body system.
In the case of psychological disorders such drugs usually affect neurotransmitters.
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What are SSRIs and how do they work?
Selective serotonin reuptake inhibitors
- SSRIs work on the serotonin system in the brain.
- serotonin released by certain neurons in the brain.
- released by the PRESYNAPTIC NEURONSand travels across SYNAPSE.
- neurotransmitter chemically conveys the signal from the presynaptic neuron to the POSTSYNAPTIC neuron and this it is reabsorbed by the presynaptic neuron where it is broken down and re-used.
- by preventing the re-absorption and breakdown of serotonin, SSRIs effectively increase its levels in the synapse and so continue to stimulate the postsynaptic neuron.
-this compensates for whatever is wrong with the serotonin system in OCD.
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What are some alternatives to SSRIs?
TRICYCLICS (older type of antidepressants)- sometimes used such as CLOMIPRAMINE.
- these have same affect on the serotonin system as SSRIs.
- has more side effect than SSRIs so its generally kept in reserve for patients who do not respond to SSRIs
SNRIs (serotonin- noradrenaline reuptake inhibitors)
- in last 5 yrs a different class of antidepressant drugs called SNRIs has been used to treat OCD.
- also used as a second option who don’t respond to SSRIs.
- SNRIs increase levels of serotonin as well as another different neurotransmitter- NORADRENALINE.
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The biological approach to treating OCD
EVALUATION
Drug therapy is effective at tackling OCD symptoms
- clear evidence for effectiveness of SSRIs in reducing the severity of OCD symptoms and so improving quality of life for OCD patients
- Soomro et al 2009- reviewed studies comparing SSRIs to PLACEBOs in the treatment of OCD and concluded that all 17 studies reviewed showed significantly better results for the SSRIs than placebo conditions.
- effectiveness greatest when SSRIs combined with psychological treatment , usually CBT.
- typical symptoms decline significantly for around 70% of patients taking SSRIs
- remains 30%, alternative drug treatments or combination of drugs and psychological treatments will be effective for some.
- so drugs can help most patients.
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The biological approach to treating OCD
EVALUATION
Drugs are cost effective and non- disruptive
- advantage of drug treatment in general is they are cheap compared to psychological treatments.
- using drugs to treat OCD therefore is good value for NHS.
- compared to psychological treatments, SSRIs also non disruptive to patients lives.
- many doctors and patients like drug treatments for these reasons
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The biological approach to treating OCD
EVALUATION
Drugs can have side-effects
-although drugs like SSRIS often helpful to suffers of OCD, significant minority will get no benefit.
- some patients also suffer side- effects such as indigestion, blurred vision and loss from sex drive.
- side effects usually temporary.
- more that 1 in 10 suffer erection problems, tremors and weight gain.
- more than one in a hundred become aggressive and suffer disruption to blood pressure and heart rhythm
- such factors reduce effectiveness because people stop taking the medication.
