Psychopathology Flashcards
(95 cards)
1
Q
Abnormality
A
Any deviation from what is considered typical, usual or healthy particularly if the deviation is considered harmful or maladaptive
2
Q
Cultural Relativity
A
The idea that a definition might change across or within culture
3
Q
Statistical Infrequency
A
A trait, behaviour or thought is considered abnormal if it falls far from the average or if statistically frequent
4
Q
Deviation from Social Norms
A
A behaviour, trait or thought is considered if it deviates from the set norms of a society or culture as it behaves differently to how they are expected
5
Q
Failure to Function Adequately
A
A behaviour, thought or trait is considered abnormal if it leads to an interference with the ordinary demands of day-to-day living
6
Q
Maladaptiveness
A
Any interference with an individual’s ability to lead to normal, everyday life
7
Q
Deviation From Ideal Health
A
A behaviour, traait or thought is considered abnormal if they deviate from the factors which indicate normality such as positive view of self
8
Q
Phobia
A
An irratioonal or disproportionate fear which leads to constant avoidance of the feared object which is maladaptive to everyday life
9
Q
The two-process model
A
The idea that phobias are learnt through classical conditioning and maintained through operant conditioning
10
Q
Systematic Desensitisation
A
A method of unleranring a phobia by counterconditioning them, slowly working up a hierarchy of situations in a state of deep relaxation
11
Q
Flooding
A
Direct and constant expose of phobic stimulus until response is exhausted
12
Q
Symptom substitution
A
Temporarily removing a disorder which causes it to recur at a later date and often worse than before
13
Q
Attrition
A
A lack of motivation which may cause a patient to leave a treatment
14
Q
Depression
A
A mood disorder which involves a prolonged and fundamental disturbance of mood and emotion generally involving low mood and energy levels
15
Q
Insomnia
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Lack of sleep
16
Q
Hypersomnia
A
Too much sleep
17
Q
Psychomotor agitation
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Struggle to relax manifested by fidgeting
18
Q
Cognitive primacy
A
The idea that psychological disorders are caused by negative or irrational thought processes
19
Q
Automatic negative bias
A
When a patient automatic thoughts suh as faulty information processing
20
Q
Faulty Information Processing
A
Attending to negative aspects of situations and ignore Positives
21
Q
Negative self schemas
A
A negative mental framework gained through experience which leads a patient to interpret all information about themselves as negative
22
Q
Negative Triad
A
As a result of negative automatic bias, a patient will adopt negative views about self, world and future
23
Q
Rational and Irrational Thoughts
A
Thoughts that can either make us happy or prevent us fro being happy
24
Q
ABC Model
A
The idea that depression has an activating event, either a rational or irrational belief which determines the consequence which is whether or not to be happy
25
Assessment in CBT
Where a patient and therapist work together to clarify the patients by though catching
26
Thought catching
Identifying automatic negative thoughts during an assessment
27
Thought challenging
The patient has the reality of their negative thoughts tested
28
Thought restructuring
Challenging the negative thought processes will lead to change in behaviour as a response to new thinking thinking patterns
29
Homework
Patient as scientist; recording an enjoyable event
30
Logical disputing
Questioning whether a belief makes sense
31
Empirical disputing
Questioning whether a belief if statistically consistent with reality
32
Pragmatic disputing
Emphasis to the lack of usefulness of an irrational belief
33
Obesessive Compulsive Disorder
Frequent, intrusive and unpleasant obsessional thoughts which are often followed by repressive behaviors that seem to reduce the anxiety but only provide temporary relief
34
Intrusive Thoughts
Thoughts that cannot be resisted
35
COMT
A candidate gene for OCD which leads to higher levels of neurotransmitter dopamine
36
SERT
A candidate gene for OCD which leads to lower levels of the neurotransmitter serotonin
37
Polygenic
Involving multiple genes
38
Heterogeneous Aetiology
Having different causes; different genes acts as a trigger in different individuals
39
Predictive value
The ability of an idea or concept to predict something
40
Diathesis stress
The idea that genetic vulnerability and environmental factors increase the likelihood of a psychological disorder but do not determine it
41
Caudate nucleus
A part of the brain that signals the thalamus of threats
42
Orbifrontal cortex
A corte that sees and scans visual information
43
Thalamus
A relay Center that receives the threat signal from the Caudate nucleus
44
Worry circuit
Obsessional thoughts that are continuously caused by the Orbitofrontal cortex scanning visual info, the Caudate nucleus scanning for threats and not filtering out non-threats and sending threat signals to the thalamus
45
SSRIs
Selective Serotonin Reuptake Inhibitors which increase the amount of serotonin in the synapse and amplifying its effect
46
An explanation of norms in relation to statistical Infrequency
A norm is a standard or rule that regulates social behaviour in a social setting, such as it is a norm in our society to be polite by saying please and thank you.
Norms are socially acceptable or ‘normal’ standards of behaviour. Under this definition of abnormality, a person's trait, thinking or behaviour is considered abnormal if it is statistically rare or far away from the average.
In statistical terms, human behaviour is abnormal if it falls outside the range that is typical for most people, in other words the average is ‘normal’.
47
Examples related to statistical Infrequency
An example would be the Normal Distribution Curve for IQ. The norm or average IQ is 100 and the cut-off points for abnormal IQ is anything below 70 and above 130 as most people fall within this range. Therefore, anything outside that range is abnormal as it is statistically significant
Therefore, traits such as height, weight and intelligence fall within fairly broad areas. People outside these areas might be considered abnormally short or tall, fat or thin, intelligent or unintelligent and they would be considered abnormal because their behaviour has moved far away from the norm.
48
Evaluate Statiscal Infrequency
One problem is the lack of consideration of cultural differences.
For example, hearing voices in the West is considered abnormal and would require some medical intervention. However, in some cultures such as African or Asian cultures, it is a legitimate contact with the spirit world and would be considered normal, and to some extent, encouraged.
This means that behaviours considered normal in one culture would be statistically rare in another and therefore considered abnormal in another culture.
This is a weakness because this definition cannot be used across different cultures.
Another limitation is that the definition doesn't distinguish between desirable and undesirable behaviour.
For example, very few people have an IQ over 150 yet this is not a negative circumstance nor does it require a return to the ‘normal’ through treatment.
Alternatively, depression is considered an undesirable behaviour and would be considered abnormal under failure to function adequately definition. However, under statistical infrequency, depression is considered normal because, on average, it is the disorder that affects a large number of people.
This means that we need a way of identifying behaviour that is both infrequent and undesirable.
49
What are the four definitions for abnormality?
Statiscal Infrequency, Deviation from social norms, deviation from ideal mental health and Failure to Function Adequately
50
Explains social norms in relation to deviation from social norms explanation (refer to imp and exp norms)
A behaviour, trait or thought is considered abnormal deviates from the accepted and expected standards or norms. This is because every society and culture has set these unwritten rules on how people are expected to behave.
Social norms are approved and expected ways of behaving in a particular society or situation. For example, there are social norms in every society regarding dress and grooming.
Norms are either implicit or explicit. Implicit norms are unwritten rules or expectations such as hoovering in the park. Explicit norms are rules that are formally codified as breaking and entering.
51
Evaluate deviation from social norms
One limitation of DSN is that whether or not a behaviour deviates from social norms will depend on the context and degree.
For example, wearing a bathing suit on a beach would be considered normal while doing so on your monthly shopping would be considered abnormal. Therefore, the context determines Deviation from social norms.
Furthermore, getting upset about a sports result would be considered normal by excessive anger, such as publicly abusing the sportspeople would be referred to as abnormal under deviation from social norms. Therefore, degrees also determine deviations from social norms.
This is a limitation as Deviation from social norms cannot offer a complete definition of abnormality and may need to be used alongside other definitions.
Another limitation of Deviation from social norms is cultural relativism.
Whether or not a behaviour does deviate from social norms can only be determined when viewed in a cultural context. It could be argued that social norms most likely reflect the white, middle class values of leading practitioners working in medicine, psychology and therapy. This may lead to culturally biassed diagnoses if the criteria is applied to individuals from other cultures or backgrounds.
For example, habitual drug use may seem to deviate from social norms in the West, but in Rastafarian culture smoking cannabis is seen as a religious act.
This is a weakness as DSN does not provide culturally universal standards or rules for labelling behaviours as abnorma
52
examples of failure to function adequately
For example, they may struggle to hold down a job or complete other tasks such as grocery shopping; activities that a normal person would be able to cope with.
An individual with agoraphobia, for example, would be considered abnormal as they are unable to leave their house, seriously impairing their ability to leave normal lives.
53
Indicators of failure to function adequately
Rosenhan and Seligman) There are various indicators of failure to function adequately and the more indicators an individual has, the more likely they are to be diagnosed with a psychological disorder and be labelled abnormal. Other indicators are unconventionality, unpredictability, irrationality, observer discomfort and violation of moral standards.
Two main indicators are maladaptiveness of behaviour and personal distress. Maladaptiveness of behaviour is when a behaviour interferes with an individuals’ ability to lead a normal, everyday life as it has adverse effects on individual and society. Personal distress is a sign of many psychological disorders and may cause failure to function adequately. For example, those who suffer from depression may experience headaches and disturbed sleep.
54
Evaluate failure to function adequately
The presence of an abnormality does not always result in a failure to function adequately.
There are many examples of celebrities who have suffered from psychological disorders who have had successful careers and would not be considered as failing to function adequately such as David Beckham who has OCD.
There are also examples of people who suffer from abnormalities such as depression who are still able to carry out everyday tasks, not necessarily displaying a failure to function due to high functioning or masking.
This is a limitation because it shows that this definition is inadequate in truly identifying behaviours which may be considered abnormal.
One strength of this definition is that it recognizes the subjective experience of the patient.
For example, the criteria of personal distress allows the sufferer to give personal insight into their experience.
Unlike other definitions, this allows us to view the mental disorder from the point of view of the person experiencing it.
This allows for a more valid definition of abnormality.
55
How does Jahoda describe a deviation from ideal mental health?
Therefore, it defines a behaviour as abnormal when it fails to reach these criteria for normality. However, it is difficult to define normality. Jahoda approached this problem by identifying the various factors that are necessary for ‘optimal living’. The presence of these factors indicates psychological health and well-being while absence indicates illness.
56
Indicators of Ideal Mental Health
The six elements include positive view of self (having high self-esteem and self-acceptance), self actualisation (developing talents and abilities to the full), autonomy (acting independently and making your own decisions), an accurate view of reality (seeing the world without distortions), resistance to stress (the ability to handle stressful situations competently) and being the master of your own environment (being able to adapt to changing circumstances)
57
Evaluate deviation from ideal mental health
It is a positive approach to the human condition.
Instead of focusing on the presence of undesirable features, it focuses on the presence of desirable ones.
This approach helps the individual and professionals to see how an individual’s quality of life can be further improved, such as by coping with stress better and being more independent. This positive view mimics the humanistic approach and accepts humans’ ability to always improve and find fulfilment.
However, this is viewed as problematic as such characteristics are seen as far too idealistic as the criteria is set so high, making a majority of people being defined as abnormal.
This is a strength as this original approach may make this definition a useful tool in order to facilitate happiness and quality of life amongst individuals.
The criteria used in the Deviation From Ideal Mental Health definition is seen as ethnocentric.
This is because it is based on Western culture, an individualistic culture that places emphasis on personal development, as opposed to collectivist cultures that prioritise the greater good of the community.
Jahoda’s emphasis on personal growth and autonomy would be considered self-indulgent in some parts of the word where family and community are put first.
This is a limitation because it means that the definition should only be used in the culture in which it was developed, is not value-free and therefore may be culturally biassed.
58
Examples of phobias
Specific phobias, social phobias and agoraphobia
59
Emotional characteristics of phobias
Anxiety and Fear
Unpleasant state of arousal
Emotional response is disproportionate to real threat
60
Behavioural characteristics of phobias
Panic manifested by crying, screaming or fainting
Avoidance
Endurance in unavoidable situations
61
Cognitive characteristics
Selective attention to the phobic stimulus
Irrational thought processes to exaggerate the threat
Failure to respond to rational arguments
62
How does the behavioural approach explain phobias?
According to the behavioral approach, phobias are learnt as a behavior.
Mowrer proposed the two-process model to explain phobias which states that phobias are first learnt in the first place by classical conditioning and then maintained by operant conditioning.
63
Who investigated the behavioural approach to phobias? How? And what did they find?
This was then investigated by Watson and Rayner who conditioned a baby named Little Albert to fear white rats. For several weeks, Albert happily played with a white rat which was initially the neutral stimulus as it gained no response. However, Albert was frightened (unconditioned response) by a loud noise (unconditioned stimulus) made by striking a steel bar with a hammer. This loud noise was repeated every time he reached for the white rat so Albert then became afraid (conditioned response) to the white rat (conditioned stimulus) and developed an intense fear or phobia of white rats.
64
Operant conditioning from phobias
Operant conditioning means learning by reinforcing behavior either by a positive outcome (positive reinforcement) or removal of something unpleasant (negative reinforcement). Avoidance, a form of negative reinforcement, reinforces the phobia by a reduction of anxiety, maintaining the phobia. In contrast, frequent contact with the phobia would show that it is harmless and extinguish the phobia. People often go to great lengths to avoid phobias, leading to inconvenience.
65
Evaluate the behavioural approach to explaining phobias
The behavioral approach to psychopathology is scientific as key principles are measured in an objective way.
For example, Little Albert's phobia was developed clearly as variables could be manipulated and controlled to ensure that Little Albert's phobia development was as a result of a neutral stimulus being associated with an unconditioned response. Therefore, it explains the role of classical conditioning in the development of phobias.
Furthermore, Sue et al suggested that people with phobias do recall specific incidents when phobias appeared e.g a panic attack when bitten by a dog.
This is positive because it allows concepts such as classical conditioning to be demonstrated empirically and has resulted in a large amount of empirical support for behavioral therapies.
This approach can be criticized for being environmentally deterministic.
For example, the two-process model suggests that when an individual experiences a traumatic event creating an association between a neutral stimulus and an unconditioned response, they will go on and develop a phobia. However, this is problematic as this theory suggests that we are passively shaped by environmental experiences and denied the possibility of free will.
With that said, many people have frightening experiences and they do not develop phobias. An example would be a person confronting their fears so they do not develop a phobia. Similarly, many people have phobias that are not preceded by frightening experiences.
This is a weakness as the behavioral approach cannot account for different phobias due to its overemphasis on determinism.
This approach can also be criticized for being reductionist.
For example, the process model suggests that complex mental disorders such as phobias are caused solely by our experiences of association, rewards and punishment and we learn all abnormalities including phobias,
Therefore, it only explains all behavior through learning experience and ignores all other factors, such as the role of biology, e.g genes, neurotransmitters, in the development of abnormalities and has no role for any genetic contributions. Seligmann argued that we are biologically prepared to learn associations between stimuli; he refers to this as a fear for survival.
This is a limitation as the behavioral approach is too simplistic as it ignores other factors.
66
How do behavioral therapies aim to treat phobia?
Behavioral therapies aim to change specific behavior learnt by classical conditioning and maintained by operant conditioning.
As behaviors are learnt, they can also be unlearned by a similar process called counterconditioning. This is the main principle behind systematic desensitisation. Joseph Wolpe developed this approach into the following steps
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Process of systematic desensitization
First, the patients are taught relaxation techniques such as square breathing.
Then, with the help of the therapist, patients construct a fear hierarchy—a list of feared objects or situations ranked from least to most feared e.g a person scared of dogs may start with a picture of a spider and develop to holding one.
Following this, the patient confronts each item starting from the least feared in the presence of the therapist while in a state of deep relaxation. Once comfortable, the patient imagines the next stage and the procedure is repeated. Each confrontation can be in vitro (imagined) or in vivo (live). The process continues until they reach the top of the hierarchy and feel relaxed in the presence of all items.
A patient can also stop and restart at a lower level until they feel relaxed.
If the systematic desensitisation works, clients have been counterconditioned as they no longer associate the conditioned stimulus with fear.
68
Evaluate systematic desentization
Research shows that systematic desensitisation effectively treats specific phobias.
McGrath et al found that 75% of patients responded positively to systematic desensitisation. This was also supported by Gilroy who stated that after three 45-minute sessions of systematic desensitisation, 42 patients at 3 and 33 months were less fearful, hence helpful at reducing anxiety in spider phobia.
This is a strength as this therapy is effective at removing the symptoms of a phobia and these effects are long lasting.
Systematic desensitisation is a suitable treatment for a diverse range of patients.
It is much better suited to some patients than flooding or other cognitive therapies.
Some sufferers of phobias also have learning difficulties which may make it difficult to gain insight to the process of flooding or other cognitive therapies as they are unable to describe cognitions. However, systematic de sensitization is considered the most appropriate treatment.
This matters because it provided a treatment for different types of patients to help them with their phobia.
This therapy is not effective for more complex phobias.
Ohman et al suggested that systematic desensitisation might not be effective in treating anxieties that have an underlying survival component such as a fear of heights or snakes.
This suggests that this therapy focuses on the removal of symptoms rather than the identifying the cause. Therefore, a disorder may only be removed temporarily and may reoccur at a later date and often even worse than before; this is referred to symptom substitution, e.g fear of dogs replaced with fear of going out. This could be the case for the other 25% of McGrath’s study whose fears may have been overgeneralised.
This is a weakness as the behavioral therapy may be significantly reductionist as it ignores root causes and therefore fundamentally ineffective.
69
Explain the process of flooding and how it will help the patient
This involves a direct exposure to the full extent to the phobic stimulus which will trigger a full phobic response where avoidance is not tolerated to stop negative reinforcement from occurring. This usually occurs with informed consent for one to three hours until the fear is exhausted. This is because the fight-or-flight response which is being triggered is instantaneous and cannot be maintained for a long period of time.
For example, someone afraid of a dog is put in a room with one and encouraged to remain there.
In theory, exposing them repeatedly to the feared stimulus will allow them to see that there is no basis for their fear which will lead to an extinction of their phobia rather than being counterconditioning
70
Evaluate flooding
One strength of following is that it is cost-effective.
It can be achieved in one session only, allowing patients to carry on with their own lives.
This is a strength as it is a popular choice amongst sufferers and is more appropriate for publicly funded healthcare.
One issue is that it is ineffective in some types of phobia.
For example, social phobias are known to be complex in nature as they likely involve cognitive factors.
Therefore, this is a limitation as it only targets behavioral responses making it ineffective for complex phobias where cognitive and behavioral treatment such as CBT would be more useful.
One ethical issue that arises is that the treatment may be traumatic for patients.
It is inappropriate for patients lacking insight, such as children or those with learning difficulties, they are unable to understand the flooding process. Furthermore, there are issues with informed consent.
As the patient is encouraged to remain with the phobic stimulus, there may be an issue understanding when the patient has reached their limit and would like to withdraw.
This is weakness as it is unethical as it may cause harm and is ineffective as the patients may leave before treatment, referred to as attrition, reinforcing their phobias.
71
Emotional characteristics of depression
Lowered mood
Anger (at others and at self) which may lead to self harming
Low self-esteem
72
Behavioural characteristics
Change in energy levels (low energy/lethargy or high energy/psychomotor agitation)
Disruption to sleep (hypersomnia or insomnia)
Appetite changes by either increasing or decreasing which affects 10% of weight
Verbal aggression or physical aggression
73
Cognitive characteristics
Poor levels of concentration or more attention to negative aspects and ignoring the positive aspects and absolutist thinking
74
How does the cognitive approach aim to explain depression
The cognitive approach focuses on how our thinking changes our behavior. Depression is seen as being caused by negative and irrational thought processes. This is known as cognitive primacy.
75
What are the two explanations for depression?
The Negative Triad and The ABC model
76
Explain the negative triad
Beck suggested that a person's cognition creates vulnerability and this cognitive vulnerability is divided into three parts:
The first is faulty information processing: an automatic cognitive bias to only view the negative aspects of a situation and ignore the positives, such as focusing on a couple of marks lost in a test. This is also the ability to blow small problems out of proportion called absolutist thinking.
The second is negative self schemas. This is when schemas, which are packages of information gained through experience which serve as a mental framework for interpreting sensory information, interpret all information about themselves in a negative way.
The last is the negative triad, a result of these negative biases and schemas which will lead a depressed person to have a negative view about the world, future and self, producing the experience of depression, i.e the behavioral, emotional and cognitive characteristics.
77
Explain the concept of a self-fulfilling prophecy in relation to the Negative Triad
This pessimistic view becomes a self-fulfilling prophecy as depressed people focus on the negative aspects of their lives and ignore the positive ones, leading them to manifest these negative behaviors which then leads to negative emotions, trapping them in a vicious cycle of depression
78
Evaluate the negative triad
A range of evidence supports the explanation that depression is associated with faulty information processing, negative self-schemas and the negative triad.
For example, Grazioli and Terry found that women with pre-coexisting vulnerabilities were more likely to develop postnatal depression than women without
Furthermore, Clark and Beck reviewed research on this topic, therefore a meta-analysis and concluded there is evidence to suggest that cognitions come before depressive symptoms.
Therefore, this is a strength as there is accumulated evidence supporting that Beck may be correct in some cases in the assumption of cognitive primacy, giving his explanation scientific credibility.
Another strength of Beck’s explanation is that it has practical applications in CBT.
All cognitive aspects of depression can be identified and challenged in CBT. These include components of the negative triad.
The therapist can challenge these thoughts and encourage them to be replaced with more accurate and positive thoughts.
This is a strength of the explanation because the explanation can be transferred into a therapy to improve the sufferers’ quality of life.
One problem with Beck’s explanation is that it doesn't explain all aspects of depression.
It only seems to explain the basic cognitive symptoms of depression.
However, depression is much more complex. Some patients are deeply angry and even suffer hallucinations. These cannot be explained by Beck’s ideas alone.
Therefore, Beck’s theory cannot explain the more complex cases of depression. This suggests that it may be an incomplete explanation.
79
Explain the ABC model
Ellis focuses on irrational beliefs as the source of depression.
He defined irrational thoughts as those that interfere with us being happy and free of pain, not necessarily illogical or unrealistic thoughts.
It is not what happens to someone that causes depression but how they deal with it.
His model is made up of three parts: the activating event or the traumatic event e.g failing an exam, belief (which can be rational or irrational) e.g I’m a failure and consequence where rational beliefs would lead to positive responses while irrational ones would lead to negative ones which could lead to depression.
80
What are some irrational beliefs?
Ellis identified a range of irrational beliefs such as mustabatory thinking (certain ideas must be true in order to be happy e.g I must succeed), utopianism (the belief that life is always meant to be fair) and catastrophising (where small events are made to seem like ultimate failures or significant problems)
81
Evaluate the ABC model
Ellis only offers a partial explanation for depression due to his focus on an activating event.
Many cases of depression do follow an activating event and this is known as reactive depression. However, there are some cases, in endogenous depression, that do not follow an activating event.
These cases are not fully explained using the ABC model. Critics have suggested that it is an incomplete explanation.
It has practical applications through implementation of CBT.
A successful therapy called REBT has been developed around the ABC model.
Furthermore, there is empirical evidence that this therapy has positive outcomes for patients (Lipsky)
This has raised the quality of life for sufferers.
It does not explain all elements of depression.
Specifically, in some cases sufferers experience deep anger and hallucinations. These cannot easily be explained by the holding of irrational beliefs.
Therefore, Ellis’ theory cannot explain the more complex cases of depression, suggesting that it may be an incomplete explanation.
82
How does the cognitive approach aim to treat depression?
The Cognitive approach aims to change the way a patient thinks by challenging irrational beliefs and negative thought processing, leading to new thinking patterns, a process known as thought restructuring.
A couple factors are necessary for this option: it can be expensive and time consuming. The patient must be motivated and really want to change. A good relationship must also be formed between the patient and therapist. In some serious cases, antidepressants are used first.
83
How does CBT treat phobias?
Cognitive Behavioral Therapy (CBT) is an application of Beck’s theory of depression.
It begins with an assessment where the patient and the therapist work together to clarify the patient’s problems, aiming to identify automatic thoughts about the world, self and future (the negative triad). This is known as ‘thought catching’.
Once these thoughts are identified then they must be challenged. This is the central component of the therapy where the patient has the reality of their negative beliefs tested.
Homework may be set to record when they enjoyed an event or when someone was friendly to them. This is referred to as ‘patient as scientist’. It helps investigate the reality of negative beliefs and use the record as evidence to process patients' statements are incorrect.
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How does REBT treat phobias?
Rational Emotional Behavioral Therapy (REBT) is an application of Ellis’ ABC model.
Here, the model is extended to dispute irrational beliefs leading to a positive effect of new emerging beliefs and attitudes.
The central technique of REBT is identifying irrational beliefs and disputing them by subjecting them to vigorous argument. This will make more Rational interpretations of events more likely and break the link between negative life events and depression. This can be be done logically (showing the belief makes no sense), empirically (making the belief statistically consistent with reality) or pragmatically (emphasising the lack of usefulness of the irrational belief).
Like CBT, homework is set which may involve putting themselves in situations which they may have previously avoided or telling someone close how they feel.
Another key element is behavioral activation where the patient is encouraged to be more active and engage in more pleasurable activities to lift mood which may have been avoided due to depression.
Ellis strongly believed in the importance of unconditional positive regard, thus, by doing this, the patient convinces themselves of their self-worth.
85
Evaluate treatments of depression
There is empirical evidence supporting the effectiveness of CBT.
March et al found that 81% of patients with depression positively to CBT.
However, this figure rose to 90% when paired with drug therapy suggesting that biology also plays a key in depression and could be targeted alongside cognitions.
This is a strength as it is effective and can be used by the NHS to raise the quality of life for sufferers.
Neither CBT nor REBT work in severe cases of depression.
CBT requires insight and willingness to participate in such an emotionally demanding and self-reflective therapy such as challenging and disputing. This is not easy as effort is required to change such automatic thoughts. Furthermore, both require patients to complete homework which will also require effort on the part of the patient
Those with severe depression may not be able to benefit fully without medication first.
This is a weakness as it cannot treat all cases of depression effectively as a sole treatment.
CBT ignores that some individuals may live in a negative environment.
The therapy focuses on thought reconstruction and ignores the wider environment.
Some have suggested that this may discourage suffered from making meaningful changed to their wider environment which may impact their progress if there is any (McCusher)
This is a weakness as it may be ineffective and may cause harm to patients.
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Emotional characteristics of OCD
Repetitive compulsions such as hand washing to help manage anxiety from obsessive thoughts. These compulsions are often irrational and excessive
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Behavioural characteristics of OCD
Unpleasant emotions such as anxiety and distress
Depression and low mood because compulsion only bring temporary relief, guilt and self-reproach
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Cognitive characteristics of OCD
Obsessive thoughts which are recurrent
Irresistible and unpleasant
Cognitive coping strategies such as praying and counting and awareness that obsessions are not normal
89
How does the genetic explanation aim to explain OCD?
Candidate genes create and increase vulnerability for OCD.
One example is the COMT gene, a potentially important gene for understanding OCD. It is called the COMT gene because it is involved in the production of Catechol-O-Methyltransferase. Tukel et al found that lower levels of activity of the COMT Gene leads to higher levels of the excitatory neurotransmitter dopamine. Higher levels of dopamine are associated with stereotypical movements which manifest themselves as compulsions in OCD.
Another candidate gene is the SERT gene, also known as ‘5-HT1-D’. This gene is involved in the transport of inhibitory transmitter serotonin. Low levels are also implicated in OCD. Ozaki et al found evidence that two unrelated families with mutations of this gene where 6 of the 7 family members have OCD.
90
Refer to some research of the genetic explanation of OCD
OCD is polygenic—caused by several genes. In fact, Taylor analysed findings from previous studies and found 230 potential candidate genes in relation to OCD associated with the action of dopamine, serotonin and both neurotransmitters are believed to have a key role in regulating mood.
Genes are involved in individual vulnerability to OCD. Lewis observed that of 37% of his patients with OCD, 21% has siblings with OCD, suggesting that OCD runs in families. However, this genetic vulnerability is passed on to generations and not a certainty of OCD.
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Evaluate the genetic explanations for OCD
There is evidence supporting that genes influence individual vulnerability.
Lewis found that if a parent is diagnosed with OCD, their children have a 37% concordance rate. If a sibling has an OCD diagnosis, their siblings have a 21% concordance rate. As the UK population average is 1–2%, the only possible explanation for the increased likelihood that a relative will have OCD if a member of their family already does is genetic vulnerability is being inherited through shared genetics.
Similarly, Nestadt studied the concordance rate of twins. They found that 68% of monozygotic twins shared OCD whilst only 31% of dizygotic twins shared OCD. The only possible explanation for this difference is that dizygotic twins share 50% genetic similarity while monozygotic twins share 50% genetic similarity.
This is a strength as twin and family studies provide strong supporting evidence to the genetic explanation for OCD.
The genetic explanation lacks causability.
In total, 230 genes have been identified that may have a link to OCD. This means that no single gene or even group of genes can be said to always play a role in the development if OCD. This could mean that each gene only increases an individual’s likelihood of having OCD by a fraction and is therefore relatively insignificant and maybe several of the candidate genes are needed to be faulty at the same time, suggesting OCD is polygenic.
Another explanation is that different genes act as a trigger in different individuals, known as heterogeneous aetiology so some individuals who may have one of the faulty genes may not experience OCD.
This is a weakness as identifying certain genes in an individual that increase vulnerability does not statistically increase their chance of getting the condition so identifying different genes has little predictive value in treatment or early intervention.
The genetic explanation can be said to be reductionist.
It has been demonstrated that OCD sufferers are likely to have had a traumatic past. For example, Cromer found that over half of sufferers have self-reported a past traumatic event. This suggests that OCD cannot be entirely genetic in origin and may have an environmental factor. Many psychologists believe the best explanation for OCD involves the diathesis stress model. This is where genetic vulnerability and environmental exposure combine to cause OCD symptoms.
This can be further supported by the concordance rate of monozygotic twins because if OCD is purely genetic then the concordance rate should be 100% but it's only 68%, suggesting that there must be another factor influencing the development of OCD.
This is a limitation that the genetic explanation is reductionist as it suggests that there may be an alternative or at least competing explanation for OCD.
92
Explain the neural explanation for OCD
There is evidence from PET scans that people with OCD have areas of abnormality with their brains. The orbitofrontal cortex send signals to the thalamus about potential worries, e.g germ alert, usually these minor worries are suppressed by the caudate nucleus.
However, if the caudate nucleus is damaged, it does not filter out the non-threats and continues to send an alert signal to the thalamus. This is the worry circuit.
This can explain the obsessional thoughts as this is how they are made. The anxiety due to the constant alertness and intrusive thoughts as they cannot be resisted.
Robinson (1993) used fMRI to establish that OCD sufferers were likely to have smaller caudate nuclei. Other studies have found that some sufferers have bigger caudate nucleus.
93
Evaluate the neural explanation for OCD
The neural explanation makes it difficult to assert causation.
It is not clear whether the neural dysfunctions associated with OCD were present before the onset of OCD and therefore caused the condition or whether it was the OCD that went on to cause the neural dysfunctions.
As a result, whilst the two conditions may have correlated, this does not mean that neural dysfunctions caused the OCD symptoms.
This is a weakness as clear evidence about the role that neural systems play in the development of OCD are still not understood.
The neural explanation of the worry circuit is supported by brain scanning evidence.
Baxter found that the orbitofrontal cortex is hyperactive when an OCD sufferer is holding a dirty cloth.
Additionally, Robinson found that OCD sufferers are likely to have a smaller caudate nuclei. This is reliable evidence for a physical difference in the bio-structure of OCD sufferers.
This is a strength of the neural explanation because empirical evidence that certain neural systems have abnormal activity in OCD sufferers as predicted by the worry circuit.
Several neural systems have been identified in relation to OCD.
These include a suggested link to the para hippocampal gyrus. Another suggested link involves the basal ganglia.
All of these neural systems have been involved in some cases of OCD but no one system is always involved.
This is a weakness because the exact role of neural mechanisms remains unclear.
94
How does Drug therapy aim to treat OCD
Gava et al found that the most common treatment for OCD was drugs.
The use of drug therapy is based on the theory that serotonin is a candidate gene for OCD. Therefore, Selective Serotonin Reuptake Inhibitors (SSRIs) are used as the treatment for OCD.
The drug simply blocks the reuptake sites thereby increasing the amount of serotonin in the synaptic gap and essentially amplifying its effect.
As serotonin is an inhibitory neurotransmitter, it reduces levels of activity in the brain, for example, the worry circuit.
It possibly reduces the intrusive and unpleasant thoughts associated with OCD.
Some types of SSRIs are Fluxoetine (which can take between three and four months to have an effect), Zoloft, Paxil and Prozac.
Other types of antidepressants which can have an effect on the levels of serotonin include tricyclic such as clomipramine and SNRIs which increase serotonin and noradrenaline.
Drugs are often used alongside Cognitive Behavioral Therapy (CBT).
If not effective, SSRI dose can be increased, i.e 20mg to 60mg.
95
Evaluate the treatment of OCD
Evidence suggests that drug therapy is effective.
Soomro et al reviewed studies that compared SSRIs to placebos in the treatment of OCD and concluded that all 17 studies showed significantly better results for SSRIs.
Symptoms decline for around 70% taking SSRIs. Other drug treatments are available for those who don't respond to SSRIs such as increasing the dosage.
However, effectiveness is greater when combined with psychological treatment such as CBT.
This is a strength because SSRIs are an effective therapy that can improve people's quality of life and has empirical support for its effectiveness.
An advantage of drug treatment is that they are cost-effective and non-disruptive compared to psychological treatments.
They are good value for the NHS.
They are non-disruptive to the patients’ lives which is beneficial bevause they can take drugs until symptoms decline and not engage with the hard work of psychological therapy. Therefore, it is preferred by doctors and patients.
This is a strength as they are an appropriate treatment for most sufferers.
One problem is drugs can have side effects.
These usually temporary side effects include blurred vision and indigestion.
However they may reduce the effectiveness because people stop taking them as they are unable to deal with the effects. This may also lead to attrition as they lack the motivation to look for a cure.
This is a weakness as SSRIs may not be the most appropriate or most effective treatment for sufferers who respond with negative side effects to the treatment.
