Psychopathology

Question 1

In the psychopathology topic, what do we mean by ‘normal’ and ‘abnormal’?

Answer 1

Normal is mentally healthy and abnormal is mentally ill

Question 2

Name the four definitions of abnormality

Answer 2

Deviation from social norms

Statistical infrequency

Failure to function adequately

Deviation from ideal mental health

Question 3

According to deviation from social norms, what is a social norm?

Answer 3

Social norms are the rules that a society (hence social) has about what are acceptable behaviours, values and beliefs. These are adhered to by those socialised into that group.

Question 4

Explain the difference between implicit and explicit social norms

Answer 4

Some of these rules are explicit, where violating them may mean breaking the law e.g. causing a public disturbance. Other rules are implicit (unspoken), but are agreed upon as a matter of convention within a society e.g. not laughing at a funeral or not standing too close to someone in a face-to-face conversation (although the definition of ‘too close’ may change in different cultures).

Question 5

When are people classed as abnormal according to deviation from social norms?

Answer 5

People who violate (deviate from) such norms (i.e. behave differently from how we would expect them to behave) are classed as abnormal.

Question 6

What do we mean when we say that someone ‘deviates’ from a social norm?

Answer 6

They do not adhere to the social norms

Question 7

Give an example of a mental illness that would be classed as abnormal according to deviation from social norms. Justify your decision.

Answer 7

Paedophilia - their actions and behaviours are not socially acceptable

Question 8

Social norms change over time. Give an example of this and explain why it may be a problem for the deviation from social norms definition of abnormality.

Answer 8

One limitation of the definition is that social norms vary as times change. What is socially acceptable now may not have been 50 years ago. For example, homosexuality is acceptable today but in the past it was included under the sexual and gender identity disorders in the DSM. This suggests that the definition may lack temporal validity unless changing social norms are taken into account. Therefore, the definition should only be used with caution, and perhaps in combination with a more objective definition of abnormality in order to prevent defining people as abnormal simply because the definition has taken into account changing social norms.

Question 9

What do we mean by cultural relativism?

Answer 9

The idea that a concept only applies in the culture it was created in

Question 10

Give an example of how this is an issue for the deviation from social norms definition of abnormality

Answer 10

Social norms are defined by the culture. This means that a person from one cultural group may label someone from another culture as behaving abnormally according to their standards rather than the standards of the person behaving in that way. For example, hearing voices is socially acceptable in some cultures but would be seen as a sign of mental abnormality in the UK. This suggests that the definition may not be externally valid and so shouldn’t be applied outside the culture it was created in without caution. In particular, the definition creates problems for people from one culture living within another culture group as they may be abiding by their culture’s social norms but be deviating from the social norms of the culture in which they now live. Therefore, psychologists must be sensitive to such cultural differences when defining abnormality.

Question 11

Relying on deviation from social norms as a definition of abnormality can lead to human rights violations. Give an example of this and explain why this is an issue for the definition.

Ignore

Answer 11

Historical examples of deviation from social norms, such as drapetomania (black slaves running away) and nymphomania (women being sexually attracted to working-class men), are clearly diagnoses that were used to maintain control over minority ethnic groups and women. These appear ridiculous today, but this is because our social norms have changed. Some radical psychologists argue that even today’s definitions of deviation from social norms are abuses of people’s rights to be different. This suggest that the definition can be used unethically and so should be used to define abnormality with caution or in combination with other definitions to prevent such violations.

Question 12

Explain one strength of deviation from social norms as a definition of abnormality.

Answer 12

One strength of the definition is that it factors in the desirability of behaviour, which is ignored by other definitions of abnormality. This means that behaviours that are numerically rare (and so statistically abnormal) can be socially acceptable and therefore not abnormal. For instance, being a genius is statistically abnormal but we wouldn’t want to suggest that is an abnormal behaviour in terms of psychopathology. This suggests that social norms can be a more useful definition of abnormality than using statistical norms (statistical infrequency).

Question 13

According to statistical infrequency, when is someone considered to be abnormal? i.e. What does statistical infrequency mean?

Answer 13

A person’s trait, thinking or behaviour would be considered an indication of abnormality if it was found to be numerically (statistically) rare/uncommon/anomalous. Therefore, it relies on up-to-date statistics.

Question 14

How far away from the mean does a behaviour need to be to be considered abnormal? And what % of the population is this?

Answer 14

Two standard deviations away from the mean

5%

Question 15

Give an example of a mental illness that would be classed as abnormal according to statistical infrequency. Justify your decision.

Answer 15

Schizophrenia - only affects 1% of the population

Question 16

Some behaviours can be numerically rare but desirable. Others can be undesirable but numerically frequent. Give an example of each one and explain why this is a problem for the definition of abnormality.

Answer 16

There are many statistically rare/infrequent behaviours that are actually quite desirable. For example, very few people have an IQ over 150, but we would not want to suggest that having a high IQ is undesirable or abnormal. Equally, there are some statistically frequent behaviours that are undesirable. For example, about 10% of people will be chronically depressed at some point in their lives, which suggests that depression is so common that it is not seen as abnormal according to this definition.

Therefore, using statistical infrequency to define abnormality means that we are unable to distinguish between desirable and undesirable behaviours. In order to identify behaviours that need treatment, there needs to be a way of identifying infrequent and undesirable behaviours. This suggests that the definition should never be used in isolation to make a diagnosis.

Question 17

Give an example of how statistical infrequency is culturally relative. Explain why this is an issue for the definition of abnormality.

Answer 17

An issue for the definition is that it is culturally relative. Behaviours that are statistically infrequent in one culture may be statistically more frequent in another. For example, one of the symptoms of schizophrenia is claiming to hear voices. However, this is an experience that is common in some cultures, especially immediately after a loved one has died. In some cultures, spiritualists take part in religious rituals believing that they are communicating with the dead.

This suggests that the definition may not be externally valid and so shouldn’t be applied outside the culture it was created in without caution. In particular, the definition creates problems for people from one culture living within another culture group as their behaviour may be common in their own culture, but statistically infrequent in the culture in which they are now living. Therefore, psychologists must be sensitive to such cultural differences when defining abnormality.

Question 18

Explain why labelling someone as abnormal using statistical infrequency is not always useful.

Answer 18

When someone is living a happy and fulfilled life, there is no benefit in them being labelled as abnormal, regardless of how unusual they are. For example, someone with a very low IQ but who is not distressed, quite capable of working etc. would not need a diagnosis of intellectual disability. If that person is labelled as abnormal, it could have a negative effect on the way others view them and how they view themselves. This suggests that the definition could cause unnecessary psychological harm and so a cost-benefit analysis should be applied before using it to define someone as abnormal.

Question 19

How is statistical infrequency a useful definition?

Ignore

Answer 19

The definition can be useful as part of clinical assessment. For example, it has real-life application in the diagnosis of intellectual disability disorder. There is therefore a place for statistical infrequency in thinking about normal and abnormal behavioural characteristics. One of the assessments of patients with mental disorders includes some kind of measurement of the severity of symptoms compared to statistical norms. This suggests that the definition is externally valid as it can be applied to usefully applied to different situations to aid in clinical assessments.

Question 20

According to failure to function adequately, when is someone classed as abnormal?

Answer 20

The failure to function adequately definition sees individuals as abnormal when their behaviour suggests that they cannot cope with the demands of everyday living. ‘Functioning’ refers to going about everyday life e.g. eating regularly, washing clothes, getting up to go to work, being able to communicate with others, having some control over your life etc. Behaviour is considered abnormal when it is maladaptive, irrational or dangerous, which causes distress, leading to an inability to function properly e.g. disrupting the ability to work or conduct satisfying interpersonal relationships.

Question 21

What do we count as ‘everyday living’?

Answer 21

Eating regularly, washing clothes, getting up to go to work, being able to communicate with others, having some control over your life etc

Question 22

Not functioning adequately causes distress. According to the definition, to who?

Answer 22

The individual, and/or may cause distress to others (or be irrational or dangerous to themselves or others)

Question 23

Give an example of a mental illness that would be classed as abnormal according to failure to function adequately. Justify your decision.

Answer 23

OCD - unable to cope with the demands of everyday living which causes distress to others and yourself

Question 24

Explain the case of Harold Shipman and why this is an issue for the failure to function adequately definition of abnormality.

Answer 24

Psychopaths (people with dangerous personality disorders) can cause great harm and yet still appear normal. Harold Shipman, the English doctor who murdered at least 215 of his patients over a 23 year period, seemed to be a respectable doctor. He maintained a job, personal hygiene, interpersonal relationships (married with children) etc. He was abnormal, but didn’t display features of functioning inadequately and so would be classed as normal according to this definition.

This suggests that the definition lacks validity because it is not able to measure what it intends to measure i.e. It doesn’t always lead to a definition of abnormality when it should.

Question 25

Give an example of how failure to function adequately is culturally relative. Explain why this is an issue for the definition of abnormality.

Answer 25

The definition suffers from cultural relativism. In some cultures (and sub-cultures within the UK), women are not expected to maintain a job, or people are expected to go without food for significant periods of time. Using the definition, such people would be classified as abnormal simply because their cultural norms differ from our own. This may explain why lower-class and non-white patients are more often classified as abnormal; their lifestyles are different from the dominant culture and this may lead to a judgement of failing to function adequately.

This suggests that the definition may not be externally valid and so shouldn’t be used outside the culture it was created in without caution. In particular, the definition creates problems for people from one culture living within another culture group as their behaviour may be classed as coping with everyday living in their own culture, but not coping with everyday living in the culture in which they are now living. Therefore, psychologists must be sensitive to such cultural differences when defining abnormality.

Question 26

Explain one strength of failure to function adequately.

Ignore

Answer 26

It attempts to include the subjective experience of the individual. It may not be an entirely satisfactory approach because it is difficult to assess distress, but the definition acknowledges that the experience of the patient is important. Therefore, the definition captures the experience of many who need help.

Therefore it seems to be a useful way of assessing abnormality by taking into account the person’s subjective experience.

Question 27

Failure to function adequately involves someone having to judge distress. Why is this an issue?

Answer 27

When deciding whether someone is failing to function adequately, someone has to judge whether a patient is distressed or distressing others. Some patients may say that they are distressed but may not be judged as suffering. There are methods for making such assessments as objective as possible, such as the Global Assessment of Functioning Scale. However, the principle remains that someone (e.g. a psychiatrist) has the right to make this judgement. The judgements are subjective and so may mean that people who would benefit from help may not get it as they are not classed as abnormal and vice versa. Therefore it should only be used in combination with other definitions.

Question 28

Who proposed the deviation from ideal mental health definition of abnormality?

Answer 28

Jahoda (1958)

Question 29

What do we mean by ‘ideal mental health?’ (hint: not the criteria)

Answer 29

Optimal living, psychological health and well-being, enabling an individual to feel happy (free of distress) and behave competently.

Question 30

How many criteria for ideal mental health are there and how many do you have to lack to be classed as abnormal?

Answer 30

Jahoda identified 6 major criteria. She claimed that anyone lacking any of these qualities would be vulnerable to mental disorder, and therefore ‘abnormal’. The more characteristics they fail to meet and the further they are from realising them, the more abnormal they are

Question 31

Name and define 4 criteria for ideal mental health.

Answer 31

Self-attitudes – having high self-esteem and a strong sense of identity, high self-respect and a positive self-concept

Personal growth and self-actualisation – the extent to which an individual develops their full capabilities i.e. fulfilling their potential

Autonomy – being independent and self-reliant and able to make personal decisions

Having an accurate perception of reality – perceiving the world in a non-distorted fashion. Having an objective and realistic view of the world.

Question 32

Give an example of a mental illness that would be classed as abnormal according to deviation from ideal mental health. Justify your decision.

Answer 32

Depression as you are missing self-attitudes an accurate perception of reality

Question 33

Give an example of how deviation from ideal mental health is culturally relative. Explain why this is an issue for the definition of abnormality.

Answer 33

Most of the criteria are culture bound to Western European and North American cultures (this is the issue of cultural relativism). For example, in terms of self-actualisation, seeking to fulfil your own potential is a prime goal in individualistic cultures but not in collectivist cultures. E.g. in some cultures, the Elders plan the young person’s future for them (career paths, arranged marriages etc.), so it may be regarded as abnormal for them to pursue individual goals. In terms of autonomy, there is an overwhelming sense of duty in some cultures such as collectivist cultures where communal goals and behaviours are desirable; in such cultures it would not be seen as ‘normal’ to be independent and self-regulating.

This suggests that the definition may not be­­ externally valid and so shouldn’t be applied outside the culture it was created in without caution. In particular, the definition creates problems for people from one culture living within another culture group as their behaviour may be optimal in their own culture, but deviating from the optimal in the culture in which they are now living. Therefore, psychologists must be sensitive to such cultural differences when defining abnormality.

Question 34

According to the criteria for ideal mental health, most of us would be classed as abnormal. Give an example of how and explain why this is a problem for the definition.

Answer 34

For example, few people experience personal growth all of the time. Therefore, the criteria may be ideals (how you would like to be) rather than actualities (how you actually are).

This could be a positive, as it makes it clear how everyone could improve their mental health, and therefore could be used to identify who might benefit from seeking treatment (e.g. counselling) in order to improve their mental health. However, it’s also a weakness as it means that the definition is probably of no value in thinking about who might benefit from treatment against their will.

Question 35

The criteria are quite difficult to measure. Give an example of this and explain why this is an issue. For example, how easy is it to assess capacity for personal growth or environmental mastery?

Answer 35

This means that this approach may be an interesting concept but not really useable when it comes to identifying abnormality because the criteria are too subjective to be applied consistently by psychologists. This could pose problems for psychologists using the definition as one may identify abnormality where another doesn’t i.e. it isn’t a reliable means of identifying abnormality. As such, patients who may benefit from treatment may not be given the opportunity to access it.

Question 36

Which criteria would likely change over time? Give an example of this and explain why this is a problem for the definition.

Ignore

Answer 36

Perceptions of reality change over time. Once seeing visions was a positive sign of religious commitment, whilst now it would be perceived as a sign of schizophrenia.

This suggests that the definition may not be a valid way of identifying abnormality unless such changes are taken into account.

Question 37

Explain one strength of deviation from ideal mental health as a definition of abnormality.

Answer 37

The definition is very comprehensive. It covers a broad range of criteria for mental health, and therefore most of the reasons why someone would seek help from mental health services or be referred for help.

This suggests that the definition is a useful tool for thinking about mental health, even if it is not the most useful for identifying abnormality.

Question 38

What is a phobia?

Answer 38

An irrational fear of an object or situation that interferes with everyday living

Phobias are a type of anxiety disorder. Anxiety is an emotion that all people experience and is a natural response to potentially dangerous stimuli, but phobias are characterised by uncontrollable, extreme, irrational and enduring fears and involve anxiety levels that are out of proportion to any actual risk. They produce a conscious avoidance of the feared object or situation.

Question 39

What is an emotional characteristic?

Answer 39

A characteristic related to a person’s feelings or mood

Question 40

What is a cognitive characteristic?

Answer 40

Refers to the process of ‘knowing’, including thinking, reasoning, remembering and believing

Question 41

What is a behavioural characteristic?

Answer 41

Ways in which people act

Question 41

Give two examples of an emotional characteristic

Answer 41

Anxiety

Emotional responses are unreasonable

Question 42

Give three examples of cognitive characteristics?

Answer 42

Selective attention to the source of the phobia

Irrational beliefs

Cognitive distortions

Question 43

Give three examples of behavioural characteristics

Answer 43

Panic

Avoidance

Endurance

Question 44

Define panic

Answer 44

A person with a phobia may panic in response to the presence of a phobic stimulus. This may involve a range of behaviours, including crying, screaming or running away. Children may react slightly differently, such as by freezing, clinging or having a tantrum.

Question 45

Define selective attention to the source of the phobia

Answer 45

If a person sees the phobic stimulus, it is hard to look away from it. Keeping attention on something dangerous is positive as it gives us the best chance of reacting quickly to a threat, but it is not so useful when the fear is irrational.

Question 46

Define irrational beliefs

Answer 46

They may hold irrational beliefs in relation to the stimuli. For example, social phobias involve beliefs such as ‘I must always sound intelligent’ or ‘If I blush people will think I’m weak.’ These kinds of beliefs increase the pressure on the sufferer to perform well in social situations.

Question 47

Define avoidance

Answer 47

One obvious behavioural characteristic of phobias is avoidance. When a person is faced with the object or situation which creates the fear, the immediate response it to avoid it in order to reduce the chances of such anxiety responses occurring. This can make it hard to go about daily life. For example, people with a phobia of public toilets may limit their time outside of their home so that they can last without a toilet. This can interfere with education, work and a social life.

Question 48

Define anxiety

Answer 48

Anxiety is an unpleasant state of high arousal. This prevents the sufferer relaxing and makes it very 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.

Question 49

Define emotional responses are unreasonable

Answer 49

The emotional responses that we experience in relation to phobic stimuli go beyond what is reasonable (i.e. it is disproportionate to the danger posed by the phobic stimulus).

Question 50

Define endurance

Answer 50

Instead of avoiding, endurance may occur. This is when 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, such as for a person who has an extreme fear of flying.

Question 51

Define cognitive distortions

Answer 51

The phobic person’s perceptions of the phobic stimulus maybe distorted. So someone with a phobia of snakes may see them as alien and aggressive looking.

Question 52

In the two-process model of phobias, what are the two processes?

Answer 52

Classical and operant conditioning

Question 53

How are phobias acquired (initally learned)?

Answer 53

Through classical conditioning

Question 54

How are they maintained?

Answer 54

Through operant conditioning

Question 55

What is one-trial learning?

Answer 55

One-trial learning can occur where the phobia is learned after only one pairing of the NS and UCS.

Question 56

What is generalisation?

Answer 56

The phobia can then generalise to similar objects - the person may display the same conditioned response (fear) to objects similar to the conditioned stimulus (e.g. Someone afraid of the sea may also be scared of taking a bath)

Question 57

Use the full two-process model to explain why someone might develop a phobia of clowns.

Answer 57

Before conditioning:
Clown (NS) –> no response
Loud noise (UCS) –> fear (UCR)

During conditioning:
Clown (NS) + Loud noise (UCS) –> fear (UCS)

After conditioning:
Clown (CS) –> fear (CR)

Question 58

Explain what happened in Watson and Rayner’s (1920) study of Little Albert and/or Di Gallo’s (1996) study and explain how they support one or both processes of the two-process model

Answer 58

Watson and Rayner (1920):
Aim: to provide empirical evidence that human emotional responses could be learned through classical conditioning.

Procedure: A laboratory experiment was conducted with one participant, an 11-month-old boy who lived in the hospital where his mother was a nurse. Albert was presented with various stimuli, including a white rat, a rabbit and some cotton wool, and his responses were filmed. He showed no fear reaction to any stimuli.

A fear reaction was then induced into Albert by striking a steel bar with a hammer behind his head. This startled Albert, making him cry. He was then given a white rat to play with, of which he was not scared. As he reached to touch the rat, the bar and hammer were struck to frighten him. This procedure was repeated three times. Variations of these conditioning techniques continued for three months.

Findings: Subsequently, when shown the rat, Albert would cry, roll over and crawl away. He had developed a fear towards the white rat, which he also displayed with less intensity to other white furry objects, like a white fur coat and Santa Claus beard. This is known as generalisation.

Conclusions: Conditioned emotional responses, including love, fear and phobias, are acquired as a direct result of environmental experiences, which can transfer and persist, possibly indefinitely, unless removed by counter-conditioning.

Supports that phobias can be acquired via classical conditioning (first process only) and that this part of the model is valid:

NS (white rat) –> no response

UCS (bar struck) –> fear (UCR)

NS (white rat) + UCS (bar struck) –> UCR (fear)

CS (white rat) –> CR (fear) - learned phobia via association. Also supports generalisation as the fear generalised to other white furry objects.

Di Gallo (1996):
Di Gallo reported that around 20% of people experiencing traumatic car accidents developed a phobia of travelling cars, especially of travelling at speed. This can be explained by classical conditioning, as the car becomes associated with the crash. They then tended to make avoidance responses involving staying at home rather than making car journeys to see friends, which can be explained by operant conditioning in terms of negative reinforcement. This made the phobia resistant to extinction.

Supports that phobias can be acquired via classical conditioning and maintained by operant conditioning that the model is valid:

NS (car) –> no response

UCS (crash) –> fear (UCR)

NS (car) + UCS (crash) –> UCR (fear)

CS (car) –> CR (fear) - learned phobia via association

Supports one-trial learning

Operant - negative reinforcement - avoid going in cars, removes anxiety, repeat avoidance –> maintains phobia of cars

Question 59

Which type of characteristic of phobias are not really explained by the two-process model? Why is this a problem?

Ignore

Answer 59

Behavioural explanations are geared towards explaining behaviour rather than cognitions. This is why the two-process model explains maintenance of phobias in terms of avoidance. However, phobias do also have cognitive and emotional elements, such as irrational beliefs and selective attention.

This suggests that the theory is not completely valid as it cannot explain all of the characteristics of phobias. They could be explained by the ABC model or by evolution [you would have to explain how], and so combining the behaviourist approach with these models may make a more complete explanation of phobias.

Question 60

What good implications does the two-process model have for therapies?

Answer 60

The two-process model has good explanatory power. It explained how phobias could be maintained over time and this has important implications for therapies because it explains why patients need to be exposed to the feared stimulus. Once a patient is prevented from practising their avoidance behaviour, the behaviour ceases to be reinforced and so it declines.

As flooding and systematic desensitisation have been found to be effective, for example 42 patients who had been treated for a spider phobia in three 45 minute sessions of systematic desensitisation being less fearful than a control group after 3 and 33 months, this supports the validity of the explanation as if de-conditioning and preventing avoidance are effective, these may have been involved in the development of the phobia. Additionally, as the explanation is useful for creating effective therapies that improve people’s lives, this supports the external validity of the theory.

Question 61

The model proposes that phobias are maintained because avoiding them results in anxiety reduction. How might this be incorrect?

Ignore

Answer 61

Not all avoidance behaviour associated with phobias appears to be the result of anxiety reduction. In more complex phobias such as agoraphobia, there is evidence to suggest that at least some avoidance behaviour appears to be motivated by the positive feelings of safety. Therefore, in choosing not to leave the house, it is less about avoiding the phobic stimulus, and more about sticking where it is safe. This explains why some agoraphobics are able to leave the house when with a trusted person with relatively little anxiety, but not alone. This is a problem for the model as it suggests that avoidance is motivated by anxiety reduction. Therefore, it may not be a completely valid explanation of phobias.

Question 62

It is thought that some phobias have evolved. How? Why is this a problem for the two-process model?

Answer 62

Evolutionary factors probably have an important role to play in phobias, but the two-process model does not mention this. We easily acquire phobias of stimuli that would have been a source of danger in our evolutionary past, such as spiders, snakes, and the dark. It is adaptive to acquire such fears as we then would have avoided these stimuli and so survived, passing down the preparedness to learn to fear such stimuli to our offspring. Seligman calls this biological preparedness – the innate predisposition to acquire certain fears. This explains why it is quite rare to develop phobias of cars or guns, which are much more dangerous in modern society, but did not exist in our evolutionary past so we are not biologically prepared to learn fear responses towards them. This suggests that there is more to acquiring phobias than simple conditioning, and therefore it may not be a completely valid explanation of developing phobias.

Question 63

What is flooding?

Answer 63

This is a form of behavioural therapy used to treat phobias and other anxiety disorders.

Question 64

Describe the process of flooding to treat a phobia.

Answer 64

A client is immediately/directly/fully exposed to (or imagines) an extreme form of the threatening situation (phobic stimulus) where avoidance is prevented until the anxiety reaction is extinguished.

Question 65

What is counterconditioning?

Answer 65

Learning a new response. In flooding, counterconditioning occurs as a new response (relaxation instead of anxiety) to the phobic stimulus is learned.

Question 66

What is reciprocal inhibition?

Answer 66

The idea that you cannot feel afraid and relaxed at the same time, meaning that one emotion prevents the other

Question 67

Explain why flooding works to treat phobias. Classical conditioning is based on the principle of association. Flooding uses this idea to get people to associate their phobia with relaxation.

Answer 67

Flooding is a behaviourist therapy. The patient is first taught relaxation techniques such as focusing on breathing, taking slow, deep breaths, visualising a peaceful scene or progressive muscle relaxation. The patient is then immediately exposed to an extreme form of the threatening situation. The patient cannot make their usual avoidance responses as they are not given the right to withdraw (although they have given informed consent to this). To begin with, the person feels extremely anxious, but the fear response (and the release of adrenaline underlying this) has a time limit. As adrenaline levels naturally decrease, a new stimulus-response link can be learned between the feared stimulus and relaxation, and the patient overcomes their phobia. Therefore, the patient has learned to associate the phobic stimulus with a new response (relaxation). This is counterconditioning. This is able to occur because of reciprocal inhibition; a patient cannot feel afraid and relaxed at the same time, meaning that one emotion (relaxation) prevents the other (anxiety).

Question 68

Why does flooding seem unethical even though it technically is?

Answer 68

Flooding is not unethical as patients give fully informed consent about the procedure. However, it is a very traumatic experience.

Question 69

How can patients make their phobia worse by having flooding?

Answer 69

Additionally, if patients exorcise their right to withdraw during the procedure, they can make their phobia worse. This is because they have reinforced that the phobic stimulus is associated with anxiety and have not learned the new stimulus-response (phobic stimulus-relaxation) from the therapy. This is not the case with systematic desensitisation, as patients are not exposed to the most feared situation initially. This means that if they withdraw, they won’t get any better, but they won’t get worse either. Patients are normally given the choice of flooding or systematic desensitisation.

Question 70

What is systematic desensitisation?

Answer 70

A behavioural therapy designed to reduce an unwanted response, such as anxiety. SD invloves drawing up a hiearchy of anxiety-provoking situations related to a person’s phobic stimulus, teaching the person to relax, and then exposing them to phobic situations. The person works their way through the hierarchy whilst maintaining relaxation.

Question 71

What is an anxiety hierarchy?

Answer 71

A list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening

Question 72

Create an anxiety hierarchy for someone who has a phobia of birds.

Answer 72

Looking at a picture of a bird
Seeing one in a cage from a distance
Touching one

Question 73

Describe the process of desensitisation to treat a phobia.

Answer 73

Firstly they are taught relaxation techniques. Then they create an anxiety hierarchy with the therapist (a list of anxiety inducing situations from least to most frightening). They are then gradually exposed to the phobic stimulus (least frightening step of the hierarchy) until they can remain relaxed (by using their techniques). Then they move onto the next step and repeat until they can remain relaxed in the most anxiety inducing situation.

Question 74

Explain why systematic desensitisation works to treat phobias.

Answer 74

Systematic desensitisation works for the same reasons as flooding – counterconditioning and reciprocal inhibition.

Question 75

When evaluating therapies, we have to consider the effectiveness of the therapy and the appropriateness of it. What do we mean by effectiveness and appropriateness?

Answer 75

Effectiveness - does the therapy work

Appropriateness - should we use the therapy/can it be used by different types of people on different types of phobia?

Question 76

Explain evidence to support the flooding is an effective therapy for phobias.

Answer 76

Flooding is as effective as other therapies at treating specific phobias, with studies finding that it is highly effective and quicker than alternatives. This suggests that patients are free of symptoms as soon as possible (due to the counterconditioning and removal of avoidance) and so makes treatment cheaper. This impacts the economy as more people will be available to work to increase productivity and mean more people will be paying taxes.

Question 77

Why is flooding less effective for complex phobias?

Answer 77

Flooding is less effective for more complex phobias, such as social phobias. This may be because such phobias have cognitive aspects, such as thinking unpleasant thoughts about a social situation. Therefore, patients may benefit more from cognitive therapies that tackle irrational thinking, which flooding does not provide, so flooding isn’t always effective. As such, it shouldn’t always be used to treat phobias.

Question 78

Flooding is considered to be not very appropriate for treating phobias. Why?

Answer 78

This therapy is a highly traumatic experience. It is not that it is unethical (as participants give informed consent) but that many patients are often unwilling to see it through to the end. Therefore, time and money can be wasted preparing patients who then refuse to start or complete treatment. This suggests that less traumatic options such as systematic desensitisation may be more appropriate, especially as it won’t make the phobia worse if the patient decides to withdraw (which is the case for flooding as it will reinforce the phobia).

Question 79

Both flooding and systematic desensitisation face the problem of symptom substitution. What is this and why is it a problem for these therapies as ways of treating phobias?

Answer 79

A common criticism of flooding (and systematic desensitisation) is that when one phobia disappears another may appear in its place. For example, a phobia of snakes might be replaced by a phobia of trains. This is called symptom substitution. It is thought that this occurs because the cause of the phobia is not behavioural. It may be that the cause of the phobia of snakes was unconscious.

Therefore, the behavioural therapy can help the person to stay relaxed around snakes, but it won’t treat the unconscious problem. Therefore, another phobia will take the place of the phobia of snakes. This suggests that the underlying idea of the therapies (that phobias are conditioned and therefore can be counter-conditioned) is flawed and therefore the therapy won’t always be effective. Counterargument: However, evidence for symptom substitution is mixed and behavioural therapists tend to believe it doesn’t happen at all.

Question 80

Explain evidence to support that systematic desensitisation is effective.

Answer 80

Research suggests that the therapy works. Some researchers followed up 42 patients who had been treated for a spider phobia in three 45 minute sessions of systematic desensitisation. A control group was treated by relaxation without exposure. At three months and 33 months after the treatment, the systematic desensitisation group were less fearful than the control group.

This suggests that systematic desensitisation is helpful in reducing anxiety (through counterconditioning and removing avoidance) and that the effects are long-lasting, supporting the use of it in treating phobias.

Question 81

Why is systematic desensitisation considered to be more appropriate than flooding (2 possible answers)?

Answer 81

Patients seem to prefer this therapy. Those given the choice between the two behavioural therapies often choose this one. This is largely because it does not cause the same degree of trauma [you need to explain how here]. This is reflected in the low refusal rates and attrition rates of the therapy.

This suggests that systematic desensitisation is more appropriate than flooding as it is less traumatic and people learn relaxation techniques that are useful in the long-term.

Question 82

What is depression?

Answer 82

Depression is a mood disorder, characterised by low mood and low energy levels

Question 83

Name and define two emotional characteristics of depression

Answer 83

Lower mood - feelings of sadness but also feelings of emptiness

Lowered self-esteem - how you feel about yourself i.e. How much you like yourself - self-loathing

Question 84

Name and define two cognitive characteristics of depression

Answer 84

Absolutist thinking (black and white thinking) - everything is seen as either all good or all bad

Poor concentration - difficulty sticking with tasks and also have difficulty making decisions

Question 85

Name and define two behavioural characteristics of depression

Answer 85

Aggression - person could be physically or emotionally violent. Can be aimed at others or themselves

Change in activity levels - can be a reduction in energy levels to the point of not being able to get out of bed or can be an increase which leads to psychomotor agitation (restlessness)

Question 86

According to cognitive explanations of depression, how is depression caused?

Answer 86

The cognitive approach generally explains depression in terms of faulty and irrational thought processes and perceptions. Where behaviourist explanations would focus on maladaptive (faulty) behaviours, the cognitive approach focuses on maladaptive cognitions that underpin such maladaptive behaviours.

Question 87

According to Ellis’ ABC model, what do the A, B and C stand for?

Answer 87

A = activating event. Ellis focused on situations in which irrational thoughts are triggered by external events. We get depressed when we experience negative events and these trigger irrational beliefs. The activating event is therefore the negative event, such as getting fired at work.

B = beliefs. You hold a belief about the event or situation. This may be rational (e.g. ‘the company was overstaffed’) or irrational (‘I was sacked because they’ve always had it in for me’). There are a range of irrational beliefs, including mustabatory thinking (the belief that we must always succeed or achieve perfection), utopianism (the belief that life is always meant to be fair) and I-can’t-stand-it-itis (the belief that it is a major disaster when something doesn’t go smoothly).

C = consequence. You have an emotional response to your belief. Rational beliefs lead to healthy emotions (e.g. acceptance), whereas irrational beliefs lead to unhealthy emotions (e.g. depression).

Question 88

Explain faulty information processing

Answer 88

When depressed, we attend to (focus on) the negative aspects of a situation and ignore the positives. We also tend to blow small problems out of proportion and think in ‘black and white’ terms.

Question 89

Explain negative self-schemas

Answer 89

A schema is ‘package’ of ideas and information developed through experience. They act as a mental framework for the interpretation of sensory information. A self-schema is a package of information that we have about ourselves. We use schemas to interpret the world, so if we have a negative self-schema we interpret all information about ourselves in a negative way.

Question 90

Explain the negative triad

Answer 90

A person develops a dysfunctional view of themselves because of the three types of negative thinking that occur automatically, regardless of the reality of what is happening at the time. These three elements are called the negative triad. When we are depressed, negative thoughts about ourselves, the world and future often come at us:

Negative view of the self – where individuals see themselves as being helpless, worthless and inadequate e.g. ‘I am just plain and undesirable, what is there to like? I’m unattractive and seem to bore everyone.’ These thoughts enhance existing depressive feelings because they confirm the existing emotions or low self-esteem.

Negative view of the world (life experiences) – where obstacles are perceived within one’s environment that cannot be dealt with e.g. ‘I can understand why people don’t like me. They would all prefer someone else’s company. Even my boyfriend left me.’ This creates the impression that there is no hope anywhere.

Negative view of the future – where personal worthlessness is seen as blocking improvements e.g. ‘I am always going to be on my own, there is nothing that is going to change this.’ These thoughts reduce hopefulness and enhance depression.

Question 91

The cognitive explanations of depression have important real-world applications. What are they? How exactly do both explanations contribute to this and what do these explanations tell us about the cognitive explanations of depression.

Answer 91

Both theories have important applications as they have led to the development of cognitive behavioural therapy as a way of treating depression. Beck – Beck’s theory forms the basis of CBT. All cognitive elements of depression (including the negative triad) can be identified and challenged in CBT. This means that a therapist can challenge them and encourage the patient to test whether they are true. Ellis – Ellis’ theory has led to a successful CBT. His idea that by challenging the negative, irrational beliefs a person can reduce their depression is supported by research evidence [you would need to add some from lesson 8].

These are strengths of the theories because they translate well into successful therapies (suggesting the theories are externally valid) and suggest that negative/irrational cognitions play some role in the development of depression and so they are at least somewhat valid explanations of depression.

Question 92

It is thought that the direction of causality may be wrong in the cognitive explanations.

Ignore

Answer 92

What does this mean and why is it a problem for the explanations? Cognitive explanations of depression share the idea that cognitions cause depression. This is linked to the idea of cognitive primacy, which suggests that emotions are influenced by your cognitions. This is certainly the case sometimes, but not always. Other theories of depression see emotions as influencing your cognitions.

Therefore, the explanations may not be completely valid as in some cases the direction of causality may be the opposite to that proposed by the cognitive explanations (emotions cause cognitions instead of cognitions causing emotions), and so they cannot be considered to be complete explanations of cases of depression.

Question 93

Which symptoms of depression can’t be explained by the cognitive explanations? Why is this a problem?

Ignore

Answer 93

Both explanations cannot explain all of the symptoms of depression. For instance, some depressed patients are deeply angry, some suffer hallucinations, and very occasionally some suffer Cotard syndrome, the delusion that they are zombies. The explanations cannot easily explain these cases. This suggests that the explanations cannot be considered to be completely valid as they can’t explain all cases of depression.

Question 94

Sometimes depression can arise without an obvious cause. Which cognitive explanation is this a problem for and why?

Answer 94

Some cases of depression follow activating events. Psychologists call this reactive depression and see it as different from the kind of depression that arises without an obvious cause. This type of depression is much more difficult for Ellis’ model to explain. This suggests that Ellis’ ABC model only applies to some kinds of depression (those that follow activating events) and so it can only be considered a partial explanation of depression.

Question 95

Explain evidence to support Beck’s explanation of depression.

Answer 95

A range of evidence supports the idea that depression is associated with faulty information processing, negative self-schemas and the cognitive triad of negative automatic thinking. For example, research has found that women judged to have been high in cognitive vulnerability were more likely to develop post-natal depression. Additionally, a review study concluded that there was solid support for each cognitive vulnerability factor. The cognitions could be seen before depression develops. This suggests that Beck may be right about cognitions causing depression, at least in some cases, so the theory may be internally valid.

Question 96

What does CBT stand for?

Answer 96

Cognitive behavioural therapy

Question 97

What is CBT?

Answer 97

CBT assists patients to identify irrational thoughts and change them.

As behaviour is seen as being generated by thinking, the most logical and effective way of changing maladaptive behaviour is to change the irrational thinking underlying it.

Therefore, CBT involves cognitive and behavioural elements:

Cognitive – identifying and challenging irrational thoughts

Behavioural – once irrational thoughts have been identified, coping strategies are developed (behavioural change)

Question 98

What are the 5 key elements of CBT

Answer 98

Identifying irrational thoughts

Disputing

Effect

Behavioural activation

Homework

Question 99

Describe disputing

Answer 99

Challenging the irrational thoughts through direct questioning. This includes using evidence to contradict the client’s irrational thoughts. This can be done through either empirical disputing or logical disputing.

Question 100

Describe effect

Answer 100

The intended effect is to change the irrational thoughts and so break the link between negative life events and depression. Changing the thoughts therefore leads to healthier emotions, and the symptoms of depression are alleviated.

Question 101

Describe behavioural activation

Answer 101

CBT often involves a specific focus on encouraging depressed clients to become more active and engage in pleasurable activities. This is based on the common-sense idea that being active leads to rewards that act as an antidote to depression. Such activity then provides more evidence of the irrational nature of the client’s thoughts.

Question 102

Describe homework

Answer 102

Clients are often asked to complete homework assignments between therapy sessions. This might include asking a person out on a date when they had been too afraid to do so for fear of rejection, looking for a new job, asking friends to tell them what they really think of the person etc. Such homework is vital in testing irrational thoughts against reality and putting new rational beliefs into practice

Question 103

Explain the difference between logical disputing and empirical disputing.

Answer 103

Empirical disputing involves the therapist challenging irrational thoughts to show that they may not be consistent with reality (e.g. ‘where is the proof that the thought that you have no friends is accurate?’). The therapist would also present evidence to act as a counterargument e.g. messages from friends that are asking the person to come to dinner with them.

Logical disputing involves the therapist challenging irrational thoughts to show that they do not logically follow from the information available/facts (e.g. ‘does it make sense that if your friend doesn’t text you back straight away that he hates you?’)

Question 104

Therefore, how does CBT help to overcome depression?

Answer 104

CBT works by identifying and challenging irrational thoughts to show the client how irrational their thoughts are, and replacing them with more effective and rational beliefs and therefore healthier behaviours.

Question 105

Describe evidence to support that CBT is an effective treatment for depression.

Answer 105

There is lots of evidence to suggest that CBT is effective in treating depression. For example, it has been found that after 36 weeks, 81% of depressed patients treated with CBT, 81% of depressed patients treated with medication, and 86% of depressed patients treated with a combination of the two had significantly improved.

This suggests that there is a good case for making CBT the first choice treatment for the NHS as it is more likely to be effective in the long-term by teaching clients new behaviours and ways to challenge their own thinking (unlike drug therapies where once the drug is no longer taken, it is likely the depression will return), and therefore it should be used to treat depression. Potentially, the gold standard for treating CBT should be a combination of both - drug therapy when the person is severely depressed until they have the motivation to engage with CBT to give them long-term strategies.

Question 106

CBT only focuses on the present and future rather than the past. Why is this a problem for both the effectiveness and appropriateness of the therapy?

Ignore

Answer 106

This is in contrast to some other therapies. Some clients are aware of the link between childhood experiences and current depression and want to talk about these experiences. They can therefore find the ‘present-focus’ very frustrating. This suggests that if depression is due to psychodynamic factors, CBT will not be an effective treatment for depression. Additionally, it may not be suitable for people who want to explore the effects of the past on their depression, and so CBT should only be used in some cases of treating depression.

Question 107

CBT focuses on what is happening in the mind. Therefore other factors may be overlooked that may be contributing to the depression. Which ones? How? Why is this a problem for the therapy as a treatment for depression?

Answer 107

There is a risk that because the therapy emphasises what is happening in the mind, the circumstances in which the client is living are overlooked. A client living in poverty or suffering abuse needs to change their circumstances, and any approach that focuses on the individual’s mind rather than their environment can prevent this. CBT techniques used inappropriately can demotivate people to change their situation. This suggests that if the environment is not changed, CBT will be not be an effective treatment for depression, and so perhaps it shouldn’t be used in such cases, or it needs to be used in combination with an environmental intervention in order to be effective.

Question 108

Why might CBT not be able to be used as the sole treatment of severe depression?

Answer 108

In some cases, depression can be so severe that patients cannot motivate themselves to engage with the hard cognitive work of CBT. They may not even be able to pay attention to what is happening in a session. In such cases, it may be possible to treat patients with medication initially, and commence CBT when they are more alert and motivated.

This suggests that CBT cannot be used as the sole treatment for all cases of depression [you could suggest combining CBT with medication here (see top row) as it’s more effective and then the drug therapy would be used to alleviate the most severe symptoms and then when patients have the motivation to engage they could then start CBT. This would mean it then has the same long-term benefits as it suggests in the top row]

Question 109

Different therapies for depression seem to be roughly as effective as each other at treating depression. Why is this thought to be the case? Why is this a problem for CBT as a treatment for depression?

Ignore

Answer 109

It has been suggested that the differences between different therapies (e.g. CBT and SD) might actually be quite small. It is thought that this is because they share one common aspect – the therapist-client relationship. It may that the quality of this relationship determines the success of the therapy rather than any particular technique used within the therapy. This has been supported by review studies where little difference was found between different therapies. This suggests that CBT itself may not be essential in treating depression as the therapy itself may not be the reason for patients’ improvements. Therefore, its principles may not be effective in treating depression.

Question 110

What does OCD stand for?

Answer 110

Obsessive compulsive disorder

Question 111

What is OCD?

Answer 111

Obsessive compulsive disorder is classed as an anxiety disorder, characterised by obsessive thinking and repetitive behaviours.

Question 112

What is an obsession?

Answer 112

Internal components because they are recurrent intrusive thoughts (something you think)

Question 113

What is a compulsion?

Answer 113

External components because they are repetitive behaviours (something you do). These reduce anxiety.

Question 114

Explain the difference between an obsession and a compulsion.

Answer 114

Obsessions are something you think and compulsions are something you do

Question 115

Out of obsessions and compulsions, which is a cognitive characteristic of OCD? Which is behavioural?

Answer 115

Obsessions are cogntive and compulsions are behavioural

Question 116

Another important cognitive characteristics of OCD is hyper vigilance, define it

Answer 116

Being on the lookout for signs of the source of the OCD.

Question 117

Describe two emotional characteristics of OCD

Answer 117

Anxiety - heightened level of physiological arousal (distress) - the obsessions are overwhelming and create distress and then the urge to carry out compulsions adds to this

Accompanying depression - lowered mood less interest in everyday activities

Question 118

Another important cognitive characteristics of OCD is catastrophic thinking, define it

Answer 118

Thinking that the worst will happen if something is or isn’t done e.g. thinking that a family member may die if the kitchen isn’t cleaned again to get rid of germs.

Question 119

Describe at least one other behavioural characteristic of OCD

Answer 119

Avoidance - removing self from the situation where they ay encounter the source of their OCD

Question 120

According to the biological explanations of OCD, how is OCD caused?

Answer 120

Caused by abnormal biological processes.

Question 121

Define neural explanations

Answer 121

The occurrence of OCD through abnormal functioning of neural (brain) mechanisms and neurotransmitters. (biochemistry)

Question 122

Define genetic explanations

Answer 122

Hereditary influences through genetic transmission from parent to offspring (i.e. inheritance).

Question 123

According to the neural explanations of OCD, are dopamine levels too high or too low in people with OCD? Which characteristic of OCD is this associated with?

Answer 123

Dopamine levels are thought to be abnormally high in people with OCD. This may be associated with compulsive behaviours.

Question 124

According to the neural explanations of OCD, are serotonin levels too high or too low in people with OCD? Which characteristic of OCD is this associated with?

Answer 124

Lower levels of serotonin activity (which communicates mood-relevant information, affecting mood and other mental processes) in the brain are also associated with OCD. The lower levels of serotonin are associated with the obsessive thoughts experienced in people with OCD.

Question 125

According to the neural explanations of OCD, how is OCD caused by abnormal brain circuits?

Answer 125

OFC sends a signal about a ‘minor’ worry (more than usual due to higher levels of activity in the OFC) –> Caudate nucleus is damaged and so the message continues to the thalamus (it is not suppressed) –> The thalamus creates the impulse to act –> The thalamus sends a message back to the OFC, creating a ‘worry circuit’. The worries become obsessions, and impulses to act become compulsions

Question 126

According to the genetic explanations of OCD, OCD is thought to be caused by certain alleles of certain genes. Explain how the COMT gene are thought to cause OCD

Answer 126

One form (allele) of the COMT gene leads to lower activity of the COMT gene –> This leads to higher levels of dopamine –> This is associated with OCD (compulsive behaviours - overactivity in basal ganglia impact caudate nucleus)

Question 127

According to the genetic explanations of OCD, OCD is thought to be caused by certain alleles of certain genes. Explain how the SERT gene are thought to cause OCD

Answer 127

One form (allele) of the gene affects the transportation of serotonin) –> This leads to lower levels of serotonin –> This is associated with OCD (obsessive thoughts - higher levels of activity in OFC)

Question 128

Both biological explanations are reductionist. Explain how and therefore what other factors may be involved in causing OCD (using evidence)

Answer 128

Environmental factors can also trigger or increase the risk of developing OCD. For example, it has been found that over half of OCD patients in one study had a traumatic experience in their past, and that OCD was more severe in participants with more than one trauma. This suggests that OCD cannot be entirely biological in origin, at least not in all cases. It may be more productive to focus on environmental causes of OCD because we are more able to do something about these and so they may have more real-world applications than biological explanations.

Question 129

The genetic explanations of OCD are supported by twin studies. What did they find and how does this support the genetic explanations?

Answer 129

There is evidence that people are vulnerable to OCD because of their genetic make-up. For example, a review of twin studies found that 68% of MZ twins shared OCD compared to 31% of DZ twins.

This strongly suggests that there is a genetic influence on OCD as people who are more genetically similar were more likely to have OCD in common. This implies that the theory is a valid way of explaining OCD. However, as the concordance rate for MZ twins is not 100% when they share 100% of their genes, this suggests that the genetic explanation is not a complete explanation of OCD, and the environment must play some role in the development of the disorder.

Question 130

What is the problem with using twin studies as evidence to support the genetic explanations?

Answer 130

Twin studies make the assumption that identical twins are only more similar than non-identical in terms of their genes. They overlook that identical twins may also be more similar in terms of shared environments (e.g. non-identical twins might be a boy and girl who have quite different experiences). Therefore the studies to support the role of genetics can’t strongly support the validity of the theory as they cannot determine cause and effect between genetics and OCD.

Question 131

Psychologists have not been very successful at determining which genes are involved in OCD. Why? How could this be considered both a strength and weakness of the genetic explanations?

Ignore

Answer 131

One reason for this is that it seems that several genes are involved and that each genetic variation only increases OCD risk by a fraction. Therefore the studies to support the role of genetics can’t strongly support the validity of the theory as they cannot determine cause and effect between genetics and OCD.

Question 132

Describe evidence to support the neural explanations of OCD.

Answer 132

There is evidence to support the role of some neural mechanisms in OCD. For example, antidepressants that only alter levels of serotonin have been effective in reducing OCD symptoms. This suggests that the serotonin system is involved in OCD and that therefore the theory has some validity.

Question 133

The direction of causality may be an issue for the neural explanations of OCD. What does this mean in this case and why is it a problem for the neural explanations?

Answer 133

There is evidence to suggest that various neurotransmitters and brain systems do not function normally in patients with OCD. However, this does not necessarily mean that this abnormal functioning caused the OCD. This suggests that whilst neural mechanisms play a role in OCD, they may be a result of OCD rather than the cause (i.e. having OCD may cause neurotransmitter levels to change or cause brain system to not function normally). Therefore, from the research we cannot strongly support the internal validity of the theory.

Question 134

What do we mean by drug therapy?

Answer 134

Drug therapy is a treatment involving taking drugs (chemicals) that have a particular effect on the functioning of the brain or other bodily systems.

Question 135

You can get marks for knowing basic things about drug therapies (other things that aren’t to do with how they biologically work). Name three of these things.

Answer 135

Dosage and other advice vary according to which kind of SSRI is prescribed e.g. the typical daily dosage of fluoxetine is 20mg, but this can be increased if it isn’t benefitting the person

The drug is available in capsule or liquid form.

It can take 3-4 months of daily use for SSRIs to have an impact on symptoms.

Question 136

OCD is treated using SSRIs. How do these work biologically?

Answer 136

SSRIs prevent the reabsorption and breakdown of serotonin. This effectively increases the levels of serotonin in the synapse and they contiune to simulate the post-synaptic neurone.

Question 137

What is done if after 3-4 months SSRIs don’t work for the patient?

Answer 137

The dosage can be increased (up to 60mg per day) or it can be combined with other drugs

Question 138

SSRIs have side effects. Give some examples of these. Is this then an issue for the effectiveness or appropriateness of the therapy?

Answer 138

A significant minority of users of SSRIs get no benefit from doing so. Some patients also have side effects, such as indigestion, blurred vision, loss of sex drive, nausea, headaches and insomnia. For patients taking Clomipramine, side effects are more common and more serious. More than one in ten suffer erection problems, tremors and weight gain. More than one in 100 become aggressive and suffer disruption to blood pressure and heart rhythm.

This suggests that the treatment may not be appropriate for all patients, and may do more harm than good, and so should only be prescribed with caution. The side effects could also explain some suggestions that drug therapies are not very effective as people may stop taking the medication due to the side effects and so not get better.

Question 139

Describe evidence to support the effectiveness of SSRIs as a treatment for OCD.

Answer 139

There is clear evidence for the effectiveness of SSRIs in reducing the severity of symptoms of OCD. For example, a review which compared SSRIs to placebos showed significantly better results for the SSRIs than for placebos. Effectiveness is greatest when SSRIs are combined with a psychological treatment, usually CBT. Typically, symptoms decline significantly for around 70% of patients taking SSRIs. Of the remaining 30%, alternative drug therapies or combinations of drugs and psychological treatments will be effective for some.

This suggests that drug therapies can help most patients with OCD as their symptoms do decline by taking them, and therefore is an effective way to treat OCD. It also implies that the best treatments for OCD may be a combination of therapies based on different approaches, taking an interactionist approach to treatment.

Question 140

It is thought that drug companies who sponsor drug therapy research may not report all of the evidence. Why is this a problem? Is it a problem for the effectiveness or appropriateness of the therapy?

Ignore

Answer 140

For instance, less positive results (e.g. Instances where the drugs are not effective) may be less likely to be reported as the drug companies will be less likely to profit as a result. This suggests that drug therapies may be less effective than we have been led to believe by the research.

Question 141

Why might drug therapy be preferable for the NHS and patient as a treatment of OCD?

Answer 141

Drug therapies are cheap compared to psychological treatments. Using drugs to treat OCD is therefore good value for a public health system like the NHS. SSRIs are also less disruptive to patients’ lives. You simply take drugs until your symptoms decline, rather than having to engage with the hard work of psychological therapy.

This explains why many doctors and patients like drug therapies as a means of treating OCD and therefore that they should be used to do so. [if you then combine this with the supporting evidence, you could argue that in the long-term, the cheapest option may be drug therapy to treat the severe symptoms and then psychological therapies such as CBT to change the cognitions and behaviours]

Question 142

It is thought that drugs are not a lasting cure for OCD. What evidence is there to support this and why might this be the case? Is this then a problem for the effectiveness or appropriateness of the therapy?

Ignore

Answer 142

Some psychologists have suggested that drug therapies are not a lasting cure for OCD. This is indicated by the fact that patients often relapse within a few weeks if medication is stopped. Drugs reduce the anxiety associated with OCD to such a level that a more normal lifestyle can be achieved. However, they do not change the cognitions or behaviours. This suggests that whilst drug therapies are effective in the short-term, they are not always an effective long-term treatment for OCD. Furthermore, as the drug therapies do not change the cognitions or behaviours, this implies that biology may not be the sole cause of OCD, explaining why biological treatments alone can’t be 100% effective in treating the condition.