Psychopathology

Question 1

What are the 4 definitions of abnormality?

Answer 1

1. Statistical infrequency
2. Deviation from the norm
3. Failure to function adequately
4. Deviation from ideal mental health

Question 2

What is statistical infrequency?

Answer 2

Where abnormality is defined as those behaviours that are extremely rare. For example, any behaviour found in very few people is considered to be abnormal. It is usually measured using a bell shaped curve or a distribution graph. We usually define people at either end of the graph as abnormal as this means they are more than 2 standard deviations away from the norm and so only represent 2% of the population.

Question 3

Why should duration and frequency be considered when looking at statistical infrequency?

Answer 3

Because traits like hearing voices would be considered more extreme if it happened every single day.

Question 4

What is the double evaluation about abnormal behaviours actually being desirable and then cultural differences?

Answer 4

The main issue is that there are many abnormal behaviours that are actually quite desirable.
For example, very few people have an IQ over 150 so it is considered to be abnormal. However, this trait is actually desirable and does not lead individuals to need any additional help. Equally, there are many undesirable behaviours that are considered to be ‘normal’. For example, depression is fairly common amongst the population which means it is considered to be within 2 standard deviations from the norm. This means that it can be overlooked when individuals with depression do actually require additional help and to be treated.
Therefore, using statistical infrequency to define abnormality means that we are unable to distinguish between desirable and undesirable behaviours.
Furthermore, behaviours that are considered to be ‘abnormal’ in some cultures may be an important part and even a desired characteristic in other cultures. For example, hearing voices is a symptom of schizophrenia and so it is considered abnormal in western cultures and a sign of poor mental health. However, in African cultures, this trait is very normal and even praised due to religious beliefs.
Therefore, this definition of abnormality should not be equally applied to all cultures and culturally relative considerations should be made instead.

Question 5

What is the evaluation about statistical infrequency being sometimes appropriate to use?

Answer 5

In some situations, it is appropriate to use statistical criterion to define abnormality.
For example, intellectual disability disorder is defined in terms of normal distribution using standard deviation to establish a ‘cut-off’ point for abnormality. Any individual with and IQ more than 2 standard deviations away from the mean, is considered to have a mental disorder. However, a diagnosis is only made in conjunction with failure to function adequately.
Therefore, this suggests that statistical infrequency is only used as one of a number of tools.

Question 6

What is the definition of failure to function adequately?

Answer 6

It is where individuals are judged on their ability to go about their everyday lives. If they cannot do this and they are also experiencing distress (or others are distressed by their behaviour) then it is considered a sign of abnormality.

Question 7

Who proposed characteristics of someone who is not functioning adequately?
And what are 4 examples?

Answer 7

Rosenham and Seligman 1989.
1. Maladaptive behaviour = where an individuals behaviour goes against their long term goals.
2. Observer discomfort= when the individuals behaviour causes distress to those around them by breaking the rules of societal expectations.
3. Irrationality= when it is difficult to understand the motivations behind someone’s unpredictable behaviour.
4. Personal anguish = where an individual is suffering with distress and anxiety.

Question 8

What is the evaluation about who makes the judgment of functioning adequately?

Answer 8

Who decides what is meant by failure to function adequately?
It may be that the individuals themselves can recognise that something is not quite right and that their behaviour has become undesirable and is causing them distress so they seek help. On the other hand, some individuals may be content with their situation and/or may be unaware they are not coping. In this case, others around them may be made to feel uncomfortable by their behaviour and so deem it to be abnormal. For example, some schizophrenics may be potentially dangerous but a symptom of schizophrenia is that they do not believe anything is wrong with them. A real life example of this is Peter Sutcliffe the ‘Yorkshire Ripper’.
Therefore, the limitation of this definition of abnormality is that the judgment depends on who is making it, meaning that it can be subjective.

Question 9

What is the evaluation about some behaviours actually being functional in failure to function adequately?

Answer 9

Another limitation is that some behaviours which are apparently ‘dysfunctional’ can actually be adaptive and functional for some people.
For example, some mental disorders like eating disorders and depression can manifest in ways which draw extra attention to those individuals. However, this attention can be adaptive as it can help them recognise a problem, get the help they need and find the root cause of the behaviours. These unusual behaviours may be used as coping mechanisms by those who are going through particularly difficult times in their lives. Additionally, transvestitism is considered a mental disorder, however those individuals probably regard it as being perfectly functional for them.
Therefore, failure to distinguish between functional and dysfunctional behaviours may mean that this definition is incomplete.

Question 10

What is the evaluation about WHODAS in failure to function?

Answer 10

It should be noted that on the positive side, this definition can be a useful means to judge abnormality.
For example, the DSM includes an assessment of ability to function called WHODAS (world health organisation disability assessment). It involves individuals rating items including things like ‘can dress self’ and ‘can prepare meals’ on a scale of 1 to 5 with a final score out of 180. Listing behaviours and rating them on a scale provides a quantitative measurement of functioning meaning an objective judgment can be made as to whether someone requires treatment. Furthermore, this assessment allows the subjective experience of the patients to be recognised as they give a rating that they identify with the most.
This definition of abnormality therefore, has a certain sensitivity and practicality to it.

Question 11

What is the definition of deviation from ideal mental health?

Answer 11

Abnormality is defined in terms of mental health, behaviours that are associated with competence and happiness. Ideal mental health would include a positive attitude towards the self, resistance to stress and an accurate representation of reality.

Question 12

Who proposed the 6 criteria for ideal mental health and what are the 3 points about her?

Answer 12

Marie Jahoda 1958
- Pointed out that physical illness is defined by the absence of signs of physical health like not having a normal temperature or blood pressure, and she suggested that we also apply this to mental illness.
- She reviewed things that had been said about good mental health and used them to devise 6 characteristics that enable people to be happy and behave competently.
- Her definition is from a humanistic perspective as it looks at how we can improve ourselves and become better people rather than on dysfunctional behaviours.

Question 13

What are Marie Jahoda’s 6 criteria for ideal mental health?

Answer 13

1. Self attitude= Having a high self esteem and strong sense of identity.
2. Personal growth and self actualisation= The extent to which a person develops their full capabilities.
3. Integration= Being able to cope with stressful situations.
4. Autonomy= Being independent and self regulating.
5. Having an accurate perception of reality.
6. Mastery of environment= The ability to ‘love’, function at work and in interpersonal relationships, adapt to new situations, and solve problems.

Question 14

What is the evaluation about Jahoda’s criteria being positive and humanistic?

Answer 14

One strength of Jahoda’s definition is that it takes a positive and holistic view.
Firstly, the definition focuses on positive and desirable behaviours rather than negative and undesirable traits. Jahoda’s criteria has real world applications. For example, it can be used as a basis for therapy and treatments with emphasis on the self as a whole and working towards goals such as self actualisation and integration. Her ideas were also used by Rogers 1959, who influenced counselling to take a more client centred approach.
Therefore, the strengths of this definition can be seen within its influences on humanistic approaches and the positive psychology movement.

Question 15

What is the evaluation about everyone being abnormal according to Jahoda?

Answer 15

One of the major criticisms of this definition is that according to the ideal mental health criteria, most of us would be abnormal.
It would be very difficult to achieve this criteria all the time. And according to Jahoda, most people would be diagnosed as abnormal as it is so unrealistic. For example, we all experience negativity and stress at times, especially if grieving a loved one for example. However, this definition suggests that these people would all be classified as abnormal irrespective of the circumstances. Furthermore, this criteria seems quite difficult to measure. For example, how easy would it be to assess capacity for personal growth?
Therefore, due to the high standards set by this criteria, the number of characteristics needed to be absent for a diagnosis should be questioned.

Question 16

What is the definition of phobias?

Answer 16

A group of mental disorders characterised by high levels of extreme anxiety produce in response to a stimulus or group of stimuli. They are instances of irrational fears that produce conscious avoidance of the feared object or situation.

Question 17

What are three examples of phobias?

Answer 17

1. Agoraphobia= the fear of being trapped in a public space with no escape. Common in middle age.
2. Social phobias= anxiety related to social situations like speaking to a new group or people or going to a party.
3. Specific phobias= Phobias of specific objects like spiders or snake, or of specific situations like heights or the dark.
   All phobias are more common in women.

Question 18

What are the behavioral characteristics of phobias (3)?

Answer 18

1. Avoidance= Physically avoiding phobic objects. E.g leaving the room that a spider is in.
2. Panic= Uncontrollable physical response usually when the feared object or situation appears suddenly. E.g screaming or hyperventilating.
3. Failure to function= Avoidance interfering with a person’s normal routine, work and relationships. This distinguishes phobias from less severe everyday fears.

Question 19

What are the emotional characteristics of phobias? (2)

Answer 19

1. Fear= The intense emotional state linked with the fight or flight response which causes the body to be unpleasantly alert for long and persistent periods. Likely to be excessive and uncontrollable.
2. Anxiety= An uncomfortably high and persistent state of arousal making it difficult to relax. Usually heightened when individual is likely to encounter phobia.
   These are both usually out of proportion to actual danger posed.

Question 20

What are the cognitive characteristics of phobias? (3)

Answer 20

1. Irrational beliefs= Negative mental processes that include exaggerated beliefs about the harm that the phobic object could cause them. E.g a person with aerophobia would not feel better knowing flying is the safest form of transport.
2. Reduced cognitive capacity= Where people with phobias cannot concentrate on everyday tasks like work due to the excessive attentional focus on phobic objects and the constant fear about the danger they are in.
3. Cognitive distortions

Question 21

What is the behavioural explanation of phobias and who proposed it?

Answer 21

The 2 process model proposed by Mowrer 1947.
The 2 process model says that phobias are acquired through classical conditioning (learning through association) and are maintained through operant conditioning (learning through consequences).

Question 22

Who is the key study for the acquisition of a phobia?

Answer 22

Watson and Rayner 1920
‘Little Albert’.
- They used an 11 month old infant who had no reaction to white furry objects to begin with.
UCS (banging a metal bar with a hammer behind his head to startle him)—> UCR (crying)
NS (rat) + UCS (banging bar every time he reached for the rat) ——> UCR (crying)
- They repeated this pairing 3 times and then again a week later.
CS (rat)———> CR (crying)
- They realised that the conditioned fear response could be generalised to other white furry objects.
- They also realised that the fear did not disappear overtime.

Question 23

How does operant conditioning lead to the maintenance of phobias?

Answer 23

Classical conditioning explains the acquisition, but can not explain why people continue to feel fearful and even avoid the phobic object.
Operant conditioning says: the likelihood of the behaviour being repeated is increased if the outcome is rewarding.

In terms of phobias, people will avoid the feared object or situation which reduces anxiety.
This reduced fear and anxiety is a pleasant sensation to negatively reinforces the belief that they should avoid the feared object. This strengthens the phobia and makes it more likely that they will avoid it again in the future.

Question 24

What is the evaluation about biological preparedness for phobias?

Answer 24

The fact that phobias do not always develop after a traumatic experience may be explained in terms of biological preparedness.
For example, Martin Seligman 1970 argued that animals, including humans are genetically programmed to rapidly learn associations between potentially life threatening stimuli and fear. These stimuli are known as ‘ancient fears’, things that would have been dangerous in our evolutionary past like heights, spiders and the dark. It would have been adaptive to rapidly learn to avoid such stimuli. This may explain why we are less likely to develop phobias of more modern objects such as toasters and cars which pose much more danger than a spider. But these objects were not a danger in our evolutionary history so we don’t.
Therefore, this suggests that the behavioural approach cannot fully explain all phobias.

Question 25

What is the double evaluation about support for classical conditioning Watson and Rayner?

Answer 25

Support for classical conditioning can be seen in research by Watson and Rayner 1920. Explain study. However, counter research by Di Nardo et al 1988 showed that conditioning events like ‘dog bites’ were common in people with a phobia of dogs (56%), however, they were equally common in people with no dog phobia (66%). This may be explained by the diathesis-stress model suggesting that we inherit genetic vulnerabilities to certain mental disorders but these disorders are only triggered by life events such as a dog bite. Furthermore, Mendes and Clark found that only 2% of children with a phobia of water could recall a negative experience with water and that 56% of parents told researchers that the phobia had been present since the first encounter with it. This suggests that dog bites only lead to phobias in people who are genetically vulnerable. Furthermore, whilst Watson and Rayner provided supporting evidence for classical conditioning, this evidence suggests that it is not a complete explanation for acquisition of phobias on its own.

Question 26

What are the 2 techniques used in behavioural treatment of phobias?

Answer 26

Flooding and systematic desensitisation.

Question 27

What are the 5 points about flooding?

Answer 27

Flooding is an alternative method. Rather than introducing the stimulus in a gradual progression using a hierarchy, the patient is fully immersed in the experience in one long session, experiencing their phobia at its worst. Immediately exposure is expected to cause an extreme panic response like screaming which is completely normal. However, the fear response uses energy and there is only so much adrenaline in the body to be used up, so eventually the client becomes exhausted and finally feels calm in the presence of the phobia. So a new stimulus-response link is learnt as the feared object is now associated with a non-anxiety response. This is based on operant conditioning as it is not reinforcing the behaviour of avoiding the phobia.

Question 28

What is reciprocal inhibition?

Answer 28

This is where fear and relaxation are 2 antagonistic emotions as you cannot feel 2 opposite emotions simultaneously. So the aim is replace the feeling of fear with relaxation.

Question 29

What are the 3 components of systematic desensitisation?

Answer 29

Counter conditioning: - This therapy is heavily based on counter conditioning as the patient is taught a new association that runs counter to the old one. - This is taught through classical conditioning as they are taught to associate the phobic stimulus with a new response (anxiety) which is incompatible with the undesirable response. - Joseph Wolpe 1958 also calls this reciprocal inhibition. Relaxation: - Firstly, the therapist teaches the client relaxation techniques such as slowed breathing, muscle relaxation and visualising peaceful scenes. Desensitisation hierarchy: - Gradually introducing the client to the feared situation with them in control of each stage is less overwhelming. - Therapist and client work together to create a graded series of anxiety provoking situations from least anxiety arousing to most like holding the phobia. - At each stage, relaxation techniques are practiced to make the situation more familiar and less overwhelming so the anxiety diminishes.

Question 30

What are the 5 steps of systematic desensitisation?

Answer 30

Stage 1: Client is taught to entirely relax muscles (a relaxed state is incompatible with anxiety). Stage 2: Together, they create a desensitisation hierarchy, a series of imagined scenes each one more anxiety provoking than the previous. Stage 3: Client gradually works their way through the desensitisation hierarchy, visualising each anxiety evoking scene whilst engaging in competing relaxation response. Stage 4: Once the client has mastered one stage (they can remain completely calm), they are ready to move on to the next. Stage 5: Patient eventually masters the feared situation that initially brought them to therapy.

Question 31

What is the evaluation about SD being successful with several phobias?

Answer 31

Research has shown that systematic desensitisation is successful with several different phobias. For example, McGrath et al 1990 reported that about 75% of patients with phobias responded well to SD. The key appears to be in having actual contact with the feared stimulus meaning that in vivo techniques are more successful than in vitro techniques like using photos and the imagination (Choy et al 2007). There are also a number of exposure techniques used together including the 2 mentioned above, and also modelling which is based on social learning theory where a patient watches someone coping well with the phobic stimulus (Comer 2002). Therefore, this demonstrates the effectiveness of SD but also the value of using a range of different exposure techniques.

Question 32

What is the evaluation about SD not treating all phobias?

Answer 32

However, whilst systematic desensitisation is successful with several types of phobias, it may not be effective in treating all phobias. For example, Öhman et al 1975 suggested that systematic desensitisation may not be as effective with phobias that have an underlying evolutionary component (like heights, dark and snakes) than with phobias acquired as a result of personal experiences. Additionally, both flooding and SD may be more effective in treating specific phobias (e.g fears of objects) rather than social phobias. It is generally easier to construct and gradually advance an anxiety hierarchy of object-related phobias, or undergo a complete and intense exposure to birds within a controlled setting than it is to reconstruct social situations or interactions using unfamiliar people in a therapist’s office. Therefore, behavioural treatments may be more effective in treating some types of phobias that are more physical, whereas other treatments like drugs may be more appropriate in tackling mental phobias like social ones.

Question 33

What is the evaluation about flooding not being for everyone due to individual differences?

Answer 33

A limitation of flooding is that it is not right for every patient or every therapist due to individual differences. For example, flooding can be a highly traumatic procedure. Patients are obviously warned of this beforehand, however, they may still choose to quit during the exposure which reduces the overall effectiveness of the therapy and once again, negatively reinforces the belief that escaping is the only way to subside anxiety. Furthermore, Wolpe 1969 recalled a patient who became so intensely anxious that she required hospitalisation. For this reason, flooding is not suitable for older patients, children, or individuals with heart problems. Therefore, individual differences in responding to exposure reduces effectiveness of the therapy, especially if they do not complete treatment which also results in a waste of money and time.

Question 34

What is the evaluation about phobia symptoms only being the tip of the iceberg?

Answer 34

Behavioural therapies may not work with certain phobias because the symptoms are only the tip of the iceberg. If the symptoms are removed, the cause still remains so the symptoms will simply resurface possibly in another form, known as symptom substitution. For example, according to the psychodynamic approach, phobias develop because of projection. Freud 1909 studied the case of Little Hans who developed a phobia of horses. The boy’s actual problem was an intense envy of his father which he could not directly express and so projected his anxiety onto the horse. The phobia was cured when the boy accepted his feeling towards his father. Therefore, this emphasises the importance of treating the underlying causes of a phobia rather than just the symptoms.

Question 35

What is depression?

Answer 35

Depression is where an individual feels sad or lacks interest in their usual activities. The DSM-V distinguishes between major depressive disorder and persistent depressive disorder which is longer term and recurring.

Question 36

What are the behavioural characteristics of depression?

Answer 36

1. Shift in activity levels= some individuals may experience a reduction in energy and wanting to sleep all the time whereas others may be agitated and restless so pace around rooms tearing at their skin. 2. Change in sleep= Some may want to sleep all day every day but others may have struggles sleeping and suffer with insomnia. 3. Change in eating= appetite may be significantly reduced leading to weight loss or may be significantly increased leading to weight gain

Question 37

What are the emotional characteristics of depression?

Answer 37

1. Sadness= the most common description of depression along with feeling empty, worthless, and low self esteem. 2. Lack of interest= Pleasurable activities and hobbies are now associated with feelings of despair and a lack of control. 3. Anger= often aimed towards others, coming from a place of hurt with a desire for retaliation, or reflected inwards causing self harm.

Question 38

What are the cognitive characteristics of depression?

Answer 38

1. Poor concentration= cannot give tasks their full attention due to constantly dwelling on negative thoughts and beliefs, being indecisive and struggling to choose between 2 options. 2. Absolutist thinking. 3. Dwelling on negative thoughts/negative schema.

Question 39

Why is the cognitive explanation appropriate for depression?

Answer 39

In terms of understanding abnormality, cognitive psychologists are most concerned with how irrational thinking leads to mental illness. Because depression is very much characterised by negative irrational thinking, cognitive explanations are particularly appropriate.

Question 40

What are the 2 cognitive explanations for depression?

Answer 40

Ellis’ ABC model 1962 Beck’s negative triad 1967

Question 41

What is the ABC model?

Answer 41

A cognitive explanation suggesting that individual’s irrational negative beliefs and misinterpretation of events causes their depression. A= Activating event. E.g mary and her boyfriend break up. B= Beliefs which may be rational e.g we weren’t right for each other but that doesn’t mean i am unlovable, or may be irrational e.g the break up was my fault because i don’t deserve to be loved. C = Consequences. Rational thinking leads to healthy emotions like acceptance and moving on, whereas irrational thinking leads to unhealthy emotions like depression and holding on to the past.

Question 42

What is mustabatory thinking and Ellis’ 3 examples?

Answer 42

Mustabatory thinking is where irrational belief systems stem from mustabatory thinking, thinking that certain things MUST be true in order for you to be happy. 1. I must do well or very well otherwise I am worthless. 2. I must be accepted and approved by the people that are important to me 3. The world must give me happiness otherwise I will die. People who hold these beliefs, will be at the very least, dissapointed and at the worst, depressed. The ‘musts’ need to be challenged.

Question 43

What did Beck believe about depression?

Answer 43

He believed that depressed people feel as they do because their thinking is biased towards a negative interpretation of the world and they have a lack of perceived sense of control.

Question 44

What are the 4 points about negative schemas in Beck’s negative triad?

Answer 44

1. Depressed people develop negative schemas usually in childhood which creates a tendency to adopt a negative view of the world. 2. They may have developed due to a variety of reasons like parental and/or peer rejection, and teacher criticisms. 3. These schemas (e.g like expecting to fail) are activated when in a new situation which resembles the original conditions of when the schema was first formed. 4. These create a cognitive bias where people over generalise and draw sweeping conclusions due to one small negative comment. This is absolutist thinking.

Question 45

What is the negative triad?

Answer 45

Negative views of the self Negative views of the world Negative views of the future.

Question 46

What is the evaluation about research supporting link between irrational thinking and depression?

Answer 46

The view that irrational thinking is linked to depression is supported by research. For example, Hammen and Krantz 1976 found that people with depression showed more errors in logic when asked to interpret written material than non-depressed people. Additionally, Grazioli and Terry 2000 analysed the thought patterns of 65 women before they gave birth and 6 weeks after. They found that those with the most negative thought styles were the most likely to develop postpartum depression. In fact, it is almost universally agreed that irrational thinking is involved in depression. This research does only show a link and not a cause, and it may be that genes or other biological factors are causing the depression which the negative beliefs then develop from.

Question 47

What is the evaluation about the cognitive approach assuming all irrational thoughts are irrational?

Answer 47

One criticism of the cognitive approach is that it assumes that depressed people must have irrational thoughts when they could actually be realistic but simply seem irrational. For example, Alloy and Adamson 1979 suggest that depressive realists tend to view things as they actually are whereas normal people tend to view the world through rose coloured glasses. Depression may actually be a reasonable response to the challenges being faced like racism or poverty. It may be that non-depressed people are actually the ones with the cognitive bias, selectively viewing the world in a positive light, having overly positive self evaluations and being unrealistically optimistic. They also found that depressed people gave more accurate estimates of the likelihood of a disaster compared to ‘normal’ controls and they called this the ‘sadder but wiser’ effect. These doubts as to whether irrational thoughts are actually irrational raises questions about the value of the cognitive approach.

Question 48

What is the evaluation about the biological approach being another explanation for depression?

Answer 48

The biological approach to understanding mental disorders suggests that genes and neurotransmitters are what is causing depression. For example, Zhang et al 2005 supports the role of low levels of the neurotransmitter serotonin in those with depression and also found a gene that relates to this, to be 10 times more common in depressed people. The success of drug therapies in the treatment of depression suggest that neurotransmitters do play an important role. At the very least, a diathesis-stress approach might be advisable, meaning that individuals with a genetic vulnerability to depression may be more prone to the effects of living in a negative environment, which leads to negative thinking. The existence of alternative approaches and effective therapies suggests that depression cannot be fully explained by the cognitive approach alone.

Question 49

What are the 2 cognitive treatments for depression?

Answer 49

Beck’s CBT Ellis’ REBT

Question 50

What is CBT and what was Beck’s aim?

Answer 50

It is a combination of cognitive therapy (changing maladaptive thoughts) and behavioural therapy ( a way of changing behavioural responses to irrational thoughts). His aim was to teach clients how to rethink and cognitively restructure by challenging those irrational thoughts.

Question 51

What does Beck’s CBT consist of?

Answer 51

The client as a scientist: - The client generates and tests their own hypotheses about the validity of their irrational beliefs. - When they realise that these irrational beliefs do not match up with reality, their schemas will change and the irrational beliefs can be discarded. Thought catching: - The client is first taught how to identify their irrational thoughts which are coming from the negative triad of schemas, they do this by using a diary. Homework tasks: - The client keeps a diary through the week between sessions of all negative thoughts they have and the situations and what happened in them to trigger the thoughts. Behavioural activation: - The client is encouraged to go to events that they used to enjoy before their irrational thoughts stopped them from going. They are encouraged to write down everything that actually happened at the event (gathering evidence) and comparing it to what their irrational and negative thoughts told them would happen. Which tests their hypotheses.

Question 52

What does REBT mean and what is Ellis’ aim?

Answer 52

He originally called it rational therapy to emphasise the fact that psychological problems occur due to irrational thinking, but changed it to rational emotional behavioural therapy as it also resolves behavioural and emotional problems. The aim is to replace irrational thinking with rational thinking.

Question 53

What does the D stand for and what are the 3 types?

Answer 53

D= disputing irrational beliefs and thoughts. 1. Logical disputing= self defeating beliefs do not logically follow the information available. E.g ‘Do these beliefs make sense?’ 2. Empirical disputing= self defeating beliefs are not consistent with reality. E.g ‘Where is the proof that these beliefs are accurate? 3. Pragmatic disputing= emphasising the lack of usefulness of these self defeating beliefs. E.g ‘How is this belief likely to help me?’

Question 54

What do the E and F stand for?

Answer 54

E= Effect of disputing and Effective attitude towards life. F= New feelings and emotions formed

Question 55

What is unconditional positive regard?

Answer 55

Ellis 1994 realised that successful therapy including the therapist convincing the client of their value as a human being. If they felt worthless, they were less likely to consider changing their beliefs and thoughts. However, if the therapist treated them with respect and appreciation no matter what, they were more likely to facilitate a change in attitudes and beliefs.

Question 56

What is the difference between Beck’s CBT and Ellis’ REBT?

Answer 56

In the CBT, the client is helped to figure out the irrationality of their thoughts by themselves by acting like a scientist whereas in REBT, the therapist directly explains the irrationality of the clients thoughts through disputation.

Question 57

What is the evaluation about support for changing behaviour helps depression?

Answer 57

The belief that changing behaviour goes some way to alleviate depression is supported by a study on the beneficial effects of exercise. For example, Babyak et al 2000 studied 156 adult volunteers diagnosed with major depressive disorder. They were randomly assigned to a 4 month course of either aerobic exercise, drug therapy or a combination of the 2. Clients in all 3 groups exhibited significant improvements after the 4 months. 6 weeks after the study ended, those in the exercise group had significantly lower relapse rates compared to the medication group. This suggests that drug treatments may help the biological component of depression but CBT therapy should be used in conjunction to also tackle the learnt behaviours. Therefore, this shows that a change in behaviour can indeed be beneficial in treating depression.

Question 58

What is the evaluation about REBT being 90% effective?

Answer 58

Ellis 1957 claims a 90% success rate for REBT, averaging 27 session to complete the treatment. Both REBT and CBT in general have done well in outcome studies of depression. For example, Cuijpers et al 2013, found of 75 studies, CBT was superior to no treatment. Additionally, March 2007 found that a CBT group had significantly lower suicidal events than a drug therapy group. However, Ellis does recognise that REBT may not always be effective and suggests this could be because some clients do not always put their revised beliefs into action (Ellis 2001). Additionally, therapist competency may explain the significant variations in CBT outcomes. This suggests the whilst REBT is effective, other factors relating to both client and therapist may limit its effectiveness.

Question 59

What is the evaluation about all treatments are equally effective and dodo bird for depression treatment?

Answer 59

All treatments for mental disorder may be equally effective. Rosenzweig 1936 names the ‘dodo bird effect’ after the dodo bird in Lewis Carroll’s ‘Alice in Wonderland’, who decided everyone should win. Research does tend to find fairly small differences in success rates. For example, Luborsky et al 1975 and 2002, reviewed over 100 different studies comparing different therapies and fount that there were only very small differences. Rosenzweig argues that the lack of differences may be because there are so many common factors between the various psychotherapies such as being able to talk to a sympathetic person (which may enhance self esteem) and being able to express ones thoughts (Sloane et al 1975). These commonalities therefore might explain the lack of difference in effectiveness of the different therapies.

Question 60

What is OCD?

Answer 60

OCD is an anxiety disorder where anxiety arises from both obsessions (persistent thoughts) and compulsions (actions repeated over and over). The compulsions are carried out as a response to the obsessions to try and reduce anxiety.

Question 61

What are compulsions? And what are obsessions?

Answer 61

Obsessions= Persistent, recurring and unwanted thoughts and cognitions that are usually irrational and unrealistic e.g contamination by germs Compulsions= Repetitive and ritualistic behaviours that reduce the anxiety caused by the obsessive thoughts e.g repetitively washing hands.

Question 62

What are the 3 behavioural characteristics of OCD?

Answer 62

1. Compulsions= Repetitive and unconcealed acts performed to reduce anxiety caused by obsessive thoughts but relief from anxiety is only temporary. May be mental acts such as praying or counting and person may feel compelled to perform these actions otherwise something terrible will happen. 2. Avoidance 3. Social impairment= where the person with OCD does not participate in or enjoy social activities anymore due to the constant obsessive thoughts and having to carry out compulsions being so time and energy consuming.

Question 63

What are the 3 emotional characteristics of OCD?

Answer 63

1. Anxiety and distress= from the constant worst case scenario thinking characteristic of OCD. 2. Depression 3. Guilt and anger= thoughts may be embarrassing like sexual images or inappropriate things they do not want to think.

Question 64

What are the 3 cognitive characteristics of OCD?

Answer 64

1. Obsessions 2. Hypervigilance 3. Selective attention

Question 65

What are the 2 biological explanations of OCD?

Answer 65

Genetic explanations and neural explanations

Question 66

What are the 3 points about genetic explanations of OCD?

Answer 66

- It is suggested that we inherit OCD by inheriting certain genetic vulnerabilities to the disorder from our parents. - Over 230 ‘candidate’ genes have been found linked to OCD but the 2 most important are the COMT and SERT gene. - This suggests that OCD is polygenic meaning it is caused by many different genes.

Question 67

What are the 3 points about the COMT gene?

Answer 67

- The way a gene expresses itself is thought to contribute to OCD, we inherit gene expression from our parents. - The variation of the COMT gene associated with OCD affects the production of the enzyme catechol-O-methyltransferase. - This reduces the reuptake of dopamine and noradrenaline meaning there are higher levels of dopamine available.

Question 68

What are the 2 points about the SERT gene?

Answer 68

- The variation of the SERT gene associated with OCD affects the transport of the neurotransmitter serotonin which reduces the levels of serotonin available. - Ozaki et al 2003 found a mutation of the SERT gene in 2 unrelated families where 6 out of the 7 members had OCD.

Question 69

What is diathesis stress? (2)

Answer 69

- This suggests that each gene we inherit only creates a ‘vulnerability’ to OCD or other disorders such as depression. Other factors (stressors) are what affect which mental disorder develops or whether any mental illness develops at all. - This means that some people can have the COMT and SERT gene but suffer no ill effects.

Question 70

What do neural explanations of OCD suggest?

Answer 70

They suggest that there are abnormal levels of neurotransmitters and abnormal brain circuits implicated.

Question 71

What do neural explanations of OCD say about serotonin?

Answer 71

- Low levels of the neurotransmitter serotonin have been associated with obsessive thoughts. - The serotonin receptors on the post synaptic membrane do not take up serotonin effectively meaning there is less available to transmit the action potentials. EVIDENCE: 1. Piggot et al 1990 found that SSRI’s (antidepressants) could reverse OCD symptoms- he found that drugs which increase serotonin activity could reduce OCD symptoms. 2. Jenicke 1992- found that antidepressants which had less effect on serotonin did not reduce symptoms.

Question 72

What do neural explanations of OCD say about dopamine?

Answer 72

- There are high levels of dopamine implicated in OCD. EVIDENCE: 1. Szetchman et al 1998- found that high doses of antipsychotics, drugs which trigger dopamine production, caused compulsive behaviours in animals. 2. 40% of people with OCD do not respond to SSRI’s but do respond to antipsychotics which suggests that dopamine is the other neurotransmitter involved in OCD.

Question 73

What do neural explanations say about abnormal brain circuits?

Answer 73

1. The ‘worry circuit’ included the orbitofrontal cortex, the caudate nucleus and the thalamus. 2. People with OCD are thought to have abnormal frontal lobes. 3. The caudate nucleus usually suppresses minor worry signals from the OFC, but people with OCD are thought to have a hyperactive caudate nucleus so it does not suppress the signals from the OFC which means the thalamus receives them and sends them back to the OFC creating a ‘worry loop’. 4. Repetitive motor functions (compulsions) are an attempt to break this loop and may result in temporary relief, but soon the basal ganglia will resume the worry loop. 5. There is evidence from this in PET scans done on people with active OCD symptoms which showed heightened activity in the OFC.

Question 74

What is the evaluation about human genome mapping for bio explanation of OCD?

Answer 74

The mapping of the human genome led to hope that specific genes could be linked to particular mental and physical disorders. For example, it might be that where one or the other parent to be has the COMT gene, the mother’s fertilised eggs can be screened, thus giving the couple the option of whether to abort or not. Additionally, gene therapies may produce a means of switching certain genes ‘off’ so that a disorder is not expressed. Both raise important ethical issues, not least being that these genes may off other beneficial characteristics. Furthermore, this presumes that there is a relatively simple relationships between disorders such as OCD and genes which may very well not be true. Applying biological therapies (such as gene therapy) is therefore much more complicated and controversial than might at first be thought.

Question 75

What is the evaluation about evidence for genetic basis from first degree relatives and twin studies for OCD?

Answer 75

Evidence for a genetic basis of OCD comes from studies of first degree relatives (parents or siblings) and twin studies. For example, Nestadt et al 2000 identified 80 patients with OCD and 343 of their first degree relatives and compared them to 73 participants with no mental illness and 300 of their relatives. They found that people who have a first degree relative with OCD had a 5 times greater risk of developing the illness at some point in their lives compared to the general population. Additionally, Billett et al 1998 did a meta analysis of 14 twin studies of OCD and found that monozygotic (identical) twins were 2 times more likely to develop OCD if their co-twin had it compared to dizygotic (non-identical) twins. However, the twins were most likely exposed to the same environmental factors due to a shared upbringing which makes it had to separate environmental influences and biological influences so would need to look at studies of identical twins separated at birth. This evidence points to a clear genetic basis for OCD, however the fact that concordance rates are never 100% means that environmental factors also play an important role, hence the diathesis stress model.

Question 76

What is the evaluation about biological approach to explaining OCD having strong competition with psychological?

Answer 76

The biological approach faces strong competition from psychological explanations. The two process model can also be applied to OCD. Initial learning occurs when a neutral stimulus (such as dirt) is associated with anxiety. This association is maintained as the anxiety-provoking stimulus is avoided. Thus, an obsession is formed and then a link is learned with compulsive behaviours (such as repetitive hand washing) which appear to reduce anxiety. Such explanations can be supported by the success of a treatment for OCD known as exposure and response prevention (ERP) which is fairly similar to systematic desensitisation. Patients have to experience their feared stimulus at the same time as being prevented from performing their compulsive behaviours. Studies have reported high success rates, for example Albucher et al 1998 reported that between 60 and 90% of adults with OCD improved considerably using ERP. This suggests that OCD may have a psychological cause as well as biological.

Question 77

What are the 3 biological treatments of OCD?

Answer 77

SSRIs, tricyclics and anti anxiety drugs

Question 78

What are the 5 points about SSRIs?

Answer 78

1. Antidepressants are the most commonly used drug to treat OCD and depression, both of which are associated with low levels of serotonin. 2. Antidepressants increase serotonin which may normalise the ‘worry circuit’ and reduce anxiety levels. 3. SSRI’s are called selective serotonin reuptake inhibitors as they only target serotonin in the brain and are reuptake inhibitors, as they slow down the reuptake process in the synapse. 4. Therefore serotonin is still present in the synaptic cleft and so can continue to stimulate the post synaptic neurone. 5. However, SSRIs can take up to 3 to 4 months to reduce symptoms and are not effective for all people. The dosage can be increased or other treatments can be trialled.

Question 79

What are the 3 points about tricyclics?

Answer 79

1. The tricyclic clomipramine was the first antidepressant to be used for OCD and is now primarily used for OCD rather than for depression. 2. They work by blocking the transporter mechanism that re-absorbs both serotonin and noradrenaline into the presynaptic cell after it fires. Leaving more of the neurotransmitters in the synaptic cleft prolonging their activity. 3. Tricyclics have the advantage of targeting more than one neurotransmitter but have more side effects than SSRIs so are used as a second line treatment to SSRIs.

Question 80

What are the 3 points about anti anxiety drugs?

Answer 80

1. Benzodiazepines also known as Xanax, Valium or diazepams. 2. They slow down the activity of the central nervous system by enhancing the activity of a neurotransmitter called GABA which has the effect of quietening and calming the body. 3. GABA binds to GABA receptors on receiving neurones which opens a channel that increases the flow of chloride ions into the neurone, making it harder to be stimulated by other neurotransmitters.

Question 81

What is the evaluation about evidence for effectiveness of drug treatments in OCD?

Answer 81

There is considerable evidence for the effectiveness of drug treatments. For example, Soomroo et al 2008, conducted a meta-analysis of 17 studies comparing SSRIs to placebos. There were 3097 participants in total. This large scale meta-analysis found that SSRIs significantly reduced the symptoms of people with OCD compared to placebos between 6 and 17 weeks post treatment. However, according to Koran et al 2007, one issue with the evaluation of treatment is that most studies are only 3 to 4 months in duration. Additionally, the biological approach to treating OCD is nomothetic, suggesting the same treatment for all people with OCD failing to consider individual differences. Therefore, while drug treatments have been shown to be effective in the short term, the lack of long term data is a limitation and therefore other treatments such as ERP may be more successful in treating long term sufferers.

Question 82

What is the evaluation about a great appeal of using drug therapies?

Answer 82

A great appeal of drug therapy is that it requires much less input from the user in terms of time and effort. In contrast, therapies such as CBT require the patient to attend regular meetings and apply a considerable amount of effort into tackling their problems. On the other hand, drug therapies are much cheaper for health services as they require little monitoring and cost less than psychological therapies. Additionally, a patient may benefit from just simply talking to a doctor. Therefore, these benefits suggest that drug treatments are much more economical for health services than psychological therapies and may also be more successful for patients who lack motivation to complete intense psychological treatments.

Question 83

What is the evaluation about all drugs having side effects?

Answer 83

All drugs have side effects, however some are more severe than others. For example, nausea, headaches and insomnia are all side effects of SSRIs according to Soomroo et al 2008. Although not necessarily severe, these are often enough for a patient to stop taking a drug altogether. Tricyclics tend to have more side effects (such as hallucinations and irregular heartbeat) than SSRIs and so are used only in cases where SSRIs are not effective. Additionally, the possible side effects of BZ’s are increased aggressiveness and long term impairments of memory. Furthermore, there is also the issue of addiction so Ashton 1997 suggests a recommendation that BZ use is limited to a maximum of 4 weeks. These side affects, along with the possibilities of addiction, therefore limit the usefulness of drugs as a treatment for OCD.

Question 84

What is the definition of deviation from social norms and what is an example?

Answer 84

Social norms are unwritten expectations that can change from culture to culture and over time. Deviation from the rules regulating how one should behave is seen as undesirable by the majority of society. E.g homosexuality used to be regarded as abnormal and as a mental disorder. It was even illegal in the UK. The judgement was based on social deviation. However, other sexual disorders such as voyeurism and beastiality are still considered to be abnormal as they deviate from social expectations and rules.

Question 85

What is the evaluation about things socially acceptable 50 years ago about deviation from social norms?

Answer 85

Thing that are socially acceptable now, may not have been socially acceptable 50 years ago. For example, today homosexuality is acceptable in most countries in the world, but in the past was considered to be under the sexual and gender identity disorders section of the DSM. Similarly, 50 years ago in Russia, anyone who disagreed with the state was at risk of being regarded as insane and placed in a mental institution. In fact, Thomas Szasz 1974 claims that the concept of mental illness is simply a way to exclude nonconformists from society. Therefore, by defining abnormality in terms of deviation from social norms, there is a real danger of creating definitions based on prevailing social morals and attitudes.

Question 86

What is the evaluation about social deviation depending on context and situation?

Answer 86

Another limitation is that judgments on deviance are often related to the context and severity of a behaviour. For example, when someone breaks a social norm once it may not be considered deviant behaviour, but persistent repetition of such behaviour may be considered evidence for a psychological disturbance. Likewise, at the beach wearing next to nothing is regarded to be normal, however wearing the same outfit in the classroom or at a formal gathering would be regarded abnormal and possibly an indication for mental disorder. As a consequence, this definition fails to offer a complete explanation in its own right, since different conclusions are reached in different contexts and situations.