Psychopathology

Question 1

4 definitions of abnormality

Answer 1

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

Question 2

Statistical infrequency

Answer 2

Abnormality is when an individual has a less common feature than most of the population.
Uses numbers to define abnormality so it’s an objective measure.
Any individuals that fall outside the normal distribution curve (2 SD points away from the mean) are perceived as being abnormal.
A normal distribution can be drawn to show which proportions of people share the behaviour, most people fall on/near the mean.

Question 3

Statistical infrequency evaluation - objective way of defining abnormality

Answer 3

This way of deciding who is abnormal could be argued to be objective.
This is because it is uses unbiased statistical data to establish rare behaviours within a population. Therefore, this definition of abnormality avoids the criticism of the other definitions which are based on subjective standards of what is considered normal or abnormal.
This could be considered a strength of this definition as it attempts to define abnormality in a way that is free from human bias.

Question 4

Statistical infrequency evaluation - some disorders aren’t statistically rare

Answer 4

There are some mental health disorders identified by the diagnostic manuals for mental illness that would not fit within this definition.
For example, depression and anxiety are common mental health disorder however they would not be deemed abnormal according to this definition as they are not statistically rare.
This raises questions over how well statistical infrequency can be used to define abnormality.

Question 5

Statistical infrequency evaluation - doesn’t account for behaviours that are statistically rare yet desirable

Answer 5

For example, individuals with a very high IQ, which is statistically infrequent, would be deemed abnormal under this definition however this is a very desirable trait therefore it is unlikely to be treated as an
‘abnormality’.
Therefore, using statistical infrequency to define abnormality means that we are unable to distinguish between desirable and undesirable behaviours.
This is problematic because we need to be able to identify infrequent and undesirable behaviours in order for the definition to be useful in helping people with mental health issues.

Question 6

Deviation from social norms

Answer 6

Abnormal behaviour is that which goes against unwritten rules/expectations in a given society/ culture
It draws a line between desirable and undesirable behaviours and labels individuals behaving undesirably as social deviants.
This is done for both the individual and for society as a whole.
We are making a collective judgement as a society about what is right/correct behaviour.
One important consideration is the degree to which a social norm is deviated from and how important society sees that norm as being.
Norms are specific to the culture that we live in and are likely to be different for different situations and different generations, so there are very few behaviours that would be considered universally abnormal.
The definition of abnormality is an example of cultural relativism.
It’s the way in which the function and meaning of a behaviour, value are relative to a specific cultural setting.
Interpretations about the same behaviour may differ between cultures.

Question 7

Deviation from social norms evaluation - social norms consider age

Answer 7

Judging behaviours as abnormal based on social norms means that factors like age are considered.
For example, a child having a tantrum in a supermarket would no be seen as abnormal however the same undesirable behaviour would be deemed abnormal if displayed by an adult.
Therefore, the social norms definition takes into account important factors when establishing if behaviour is abnormal.

Question 8

Deviation from social norms evaluation - social norms vary with time

Answer 8

The norms defined by a society vary over time as social attitudes change.
For example, homosexuality was deemed illegal however social norms have changed since then so it is now no longer deemed an ‘abnormal’ behaviour in our society.
Therefore, the social norms definition is limited in its ability to define abnormality because norms are constantly changing.

Question 9

Deviation from social norms evaluation - social norms vary across cultures

Answer 9

Social norms vary within and across cultures so it is difficult to use this definition to assess abnormal behaviour.
There is no universal agreement over social norms, they are culturally specific which means that a person from one cultural group could be labelled abnormal because they are deviating from the norms of a culture different to their own.
For example, in Western societies hearing voices is a sign of a mental health disorder (schizophrenia) however in other cultures it’s common
This is a problem because using the deviation from social norms definition could lead to people being incorrectly labelled as abnormal.

Question 10

Failure to function adequately

Answer 10

Abnormal behaviour is judged as inability to cope with everyday life.
E.g. going to work.
Behaviour is also considered abnormal when it causes distress, leading to an inability to function properly.
The definition can be used with others (statistical infrequency).
Someone with a low IQ is unlikely to be diagnosed with intellectual disability disorder (IDD). if the low IQ was a barrier to them functioning adequately, it may ne appropriate to diagnose them to access support.

Question 11

RoseHan and Seligmam 1989

Answer 11

Suggested possible features of dysfunction.

Maladaptive behaviour : Behaviour stopping individuals from attaining life goals, both socially and occupationally.
Irrationality : Displaying behaviour that cannot be explained in a rational way
Observer discomfort: Displaying behaviour that causes discomfort to others i.e. friends, family members
Unpredictability :Displaying unexpected behaviours.

Question 12

Failure to function adequately evaluation - focuses on the individual’s experience

Answer 12

This definition recognises the personal experience of the individual.
It acknowledges the importance of considering how the individual feels and how well they are managing to cope unlike other definitions, that simply make judgements on whether the individuals behaviour fits with society’s expectation.
This suggests that this definition is a useful tool for assessing abnormal behaviour as it allows us to view mental disorders from the perspective of the person experiencing it.

Question 13

Failure to function adequately evaluation - some abnormal behaviours don’t accompany failure to function

Answer 13

There are some behaviours that would be considered ‘abnormal’ but do not stop the person from functioning or cause them distress.
E.g. Harold Shipman was an English doctor who murdered at least 215 patients however he was considered to be a respectable doctor and do not display any of the features of dysfunction.
This demonstrates that many people may not be identified as abnormal according to this definition because they do not suffer from any personal distress and appear to function normally.
Therefore, this definition alone is not sufficient enough to use to determine if a person’s behaviour is abnormal.

Question 14

Failure to function adequately evaluation - normal abnormality

Answer 14

This definition does not consider situations in which a healthy, psychological response for someone may mean a period of failing to function adequately.
E.g. when a loved one dies it is normal to suffer distress and not be able to cope with everyday demands. Grieving is a natural response to overcoming loss and should not become a factor in defining that person as abnormal.
This is an issue as it means someone’s behaviour may be incorrectly identified as abnormal.

Question 15

Deviation from ideal mental health :

Answer 15

Abnormality is that which fails to meet prescribed criteria for psychological normality/wellbeing.
It focuses on the absence of ideal mental health to judge abnormality.
Marie Jahoda (1958) suggested the six key features that define ideal mental health.
The more criteria someone fails to meet, the more abnormal they are.

Question 16

Maria Jahoda 1958 PRAISE

Answer 16

•Positive attitude towards self: high self esteem
Resistance to stress: have effective coping strategies.
• Accurate perception of reality: individuals should have an objective and realistic view of the world.
• Independent (Autonomy): independent and self-reliant and able to make personal decisions.
• Self-actualization: ability to reach full potential .
• Environmental mastery: being competent in all aspects of life + having the flexibility to adapt to changing life circumstances.

Question 17

Deviation from ideal mental health evaluation - comprehensive criteria for mental health

Answer 17

Unlike other definitions, the deviation from ideal mental health definition of abnormality attempts to define abnormality by looking at the person as a whole, considering a multitude of factors that can affect their mental health and well-being.
It covers a broad range of criteria such as how the person views themselves and how they cope with stressors and the demands of varying situations.
Therefore, this definition of abnormality could be praised for providing comprehensive criteria for mental health.

Question 18

Deviation from ideal mental health evaluation - criteria too demanding

Answer 18

Most people do not meet all the criteria set out by Jahoda and as a result, under this definition, the majority of people would be classified as abnormal.
E.g. few people achieve self-actualisation and experience personal growth all the time.
The absence of these features is unlikely to indicate that someone is suffering from a mental health disorder.
Therefore, we need to question the usefulness of this definition as a way of classifying abnormal behaviour.

Question 19

Deviation from ideal mental health evaluation - ethnocentric criteria

Answer 19

This definition reflects Western views of psychological ‘normality’.
Many of the concepts, such as autonomy and self-actualisation, may not be recognised as aspects of ideal mental health in many cultures.
E.g. collectivist cultures emphasise the importance of inter-dependence rather than autonomy.
This is problematic because it could lead to people from non-Western cultures being incorrectly labelled as ‘abnormal’.

Question 20

Books used by professionals to diagnose + categorise mental disorders :

Answer 20

1. DSM : diagnostic statistic manual.
   published by the American Psychiatric Association (APA)
   5th version DSM-V
2. ICD : international statistical classifications of diseases
   published by WHO
   11th version ICD-11

Question 21

Phobias definition :

Answer 21

Extreme fear of an object/situation which is irrational to the actual danger.
It’s a type of anxiety disorder

Question 22

phobias behavioural features

Answer 22

1. panic : phobic people experience physical panic (fight or flight), which can cause shortness of breath, high heart rates
2. avoidance : avoiding any situations where they may come in contact with the phobic stimulus
3. endurance : remaining with the phobic stimuli yet experiencing extreme anxiety

Question 23

phobias emotional features

Answer 23

1. fear : immediate response when the phobic stimulus is encountered, showing feelings of terror
2. anxiety : feelings of distress in the presence of the phobic stimulus. unpleasant state of high arousal

Question 24

phobias cognitive features

Answer 24

1. cognitive distortions : thoughts about the phobic stimulus are distorted
   e.g. arachnophobia people seeing spiders bigger than they really are.
2. irrational thought process : phobic person doesn’t respond to te evidence
3. selective attention : the phobic person will find it hard to look away from the stimulus
   a person’s selective attention causes them to become fixated on the object they fear, because of their irrational beliefs about the danger period.

Question 25

depression definition

Answer 25

a mood disorder that is shown by persistent sadness + a lack of interest in previously rewarding activities. can also disturb sleep and appetite ; tiredness and poor concentration are common. at least 5 symptoms must be seen everyday for 2 weeks for depression to be diagnosed by a doctors with an impairment in general functioning also evident.

Question 26

types of depression

Answer 26

1. major depressive disorder : severe, yet often short term 2. unipolar depression : sufferers only experience depression and not manic episodes. classical symptoms usually occur in cycles. 3. bipolar depression : sufferers experience mixed episodes of mania and depression

Question 27

cost on the economy (depression)

Answer 27

1. NHS 2. business (lost productivity, lots of tax revenue for the government)

Question 28

depression behavioural features

Answer 28

1. change in activity levels : greater lack of energy and withdrawal from once enjoyed activities. 2. neglecting personal hygiene : e.g. wearing clean clothes. 3. sleep disruption : decreased sleep + insomnia, or increased sleep + hypersomnia (oversleeping)

Question 29

depression emotional features

Answer 29

1. low mood : ever present and overwhelming feelings of sadness and negativity. feelings of ‘emptiness’ 2. worthlessness : those suffering from depression often have constant feelings of low self worth and inappropriate feelings of guilt. in extreme cases, it can involve a feeling of self-loathing (hating themselves).

Question 30

depression cognitive features

Answer 30

1. poor concentration : difficulty in paying attention and slowed down thinking and indecisiveness 2. negative schemas : people with depression tend to posses negative self-schemas which are a set of beliefs and expectations about themselves that are negative and pessimistic.

Question 31

OCD definition

Answer 31

obsessive compulsive disorder is an anxiety disorder where sufferers experience persistent and intrusive thoughts occurring as obsessions, compulsions, or both. most sufferers realise their obsessions / compulsions are excessive, but can’t consciously control them, resulting in high anxiety. they become very time consuming and interfere with conducting daily tasks.

Question 32

difference between obsessions and compulsions

Answer 32

obsessions are things people think about, leading to feelings of extreme anxiety (the cognitions). they compromise forbidden ideas + visual images that are not based on reality e.g. being convinced that gems are everywhere. compulsions are what people do as a result of the obsessions (the behaviour). they comprise intense, uncontrollable urges to repetitively perform tasks. compulsions are carried out in order to reduce distress or prevent feared events.

Question 33

types of OCD

Answer 33

1. counting + numbers e.g. multiples 2. hygiene + contamination 3. fear of harming others

Question 34

OCD behavioural features

Answer 34

1. compulsive behaviour : repeating a behaviour to help reduce anxiety. e.g. washing hands. 2. avoidance : keeping away from situations that triggers it.

Question 35

OCD emotional features :

Answer 35

1. anxiety + distress : OCD is regarded as unpleasant due to excessive anxiety that accompanies obsessions and compulsions. obsessive thoughts - unpleasant - anxiety - urge to repeat compulsion - anxiety 2. accompany depression : anxiety is accompanied by low mood + lack of enjoyment in activities. can involve other negative emotions such as irrational guilt or disgust

Question 36

OCD cognitive features

Answer 36

1. hyper vigilant : mantis in constant alertness and attention focused on potential hazards 2. obsessive thoughts : major cognitive feature of OCD is obsessive thoughts. they vary from person to person, but are always unpleasant

Question 37

explaining phobias - 2 process model (behavioural)

Answer 37

Mower (1947) proposed this model which suggests that phobias are learnt and assumes that phobias develop through an experience of a negative or traumatic event. The 2-process model suggests phobias are acquired through classical conditioning and then maintained through operant conditioning.

Question 38

how phobias are acquired - classical conditioning

Answer 38

Phobias are acquired by forming an association between a neutral stimulus and an unconditioned stimulus which creates a fear response. The once neutral stimulus now becomes a conditioned stimulus which creates a conditioned 'fear' response.

Question 39

the case study of little Albert (Watson & raynor , 1920)

Answer 39

Before conditioning: When Albert was presented with a white rat, he showed no fear response. White rat = neutral stimulus (NS) During conditioning: Albert was presented with the white rat (NS) again and at the same time the researchers struck a steel bar, making a loud noise (UCS) - this led to Albert crying (unconditioned response -UCR) This was repeated several times. After conditioning: Now, the white rat (previously the NS but is now the conditioned stimulus -CS) alone makes Albert afraid/ cry (conditioned response - CR) Once a phobia has been acquired, it is maintained by operant conditioning.

Question 40

how phobias are maintained - operant conditioning

Answer 40

Avoidance of the feared object or situation reduces the unpleasant feelings of fear/anxiety caused by the conditioned stimulus. This acts as negative reinforcement (you are removing something negative and are rewarded for doing so i.e. you feel less anxiety/fear) which strengthens the avoidance behaviour so the phobia is maintained.

Question 41

evaluation of 2 process model - supporting evidence for the acquisition of phobias via classical conditioning

Answer 41

There is evidence to support the acquisition of phobias via classical conditioning. For example, Watson and Rayner (1920) Little Albert Study (already discussed) Furthermore, Sue et al (1994) found that people with phobias often recall a specific incident when their phobia appeared e.g. being bitten by a dog or experiencing a panic attack in a social situation. Both of these studies show how phobias can be learnt through association however they do not tell us how these phobias were maintained therefore we cannot conclude that they fully support the two-process model.

Question 42

evaluation of 2 process model - other factors play a role

Answer 42

An issue with this explanation is that some people have negative experiences without developing a phobia. For example, Dinardo (1988) found participants without a phobia of dogs experienced a similar proportion of fearful incidents with a dog as those with a phobia of dogs. This challenges the two-process model as it suggests that not everyone will learn to fear situations or objects through association with a negative experience. This could mean that there are other factors such as cognition or individual differences that play a role in the development of the phobia which the behaviourist approach does not consider.

Question 43

evaluation of 2 process model - application (SD and flooding)

Answer 43

Understanding how phobias are acquired and maintained through classical and operant conditioning has led to the development of behavioural treatments for phobias. For example, systematic desensitisation helps people form a new association with the phobic stimulus (relaxation instead of fear) using the principles of classical conditioning while flooding prevents people from avoiding their phobias and stops negative reinforcement taking place. These treatments have been found to be very effective at treating specific phobias which not only provides support for the validity of the two-process model but also demonstrates the usefulness of explaining phobias using the behaviourist approach.

Question 44

evaluation of 2 process model - alternative explanation , biological preparedness

Answer 44

Some common phobias such as fear of heights, snakes and insects often do not develop as a result of a negative experience. These phobias could be better explained using the biological preparedness theory which suggests humans develop certain phobias because the were adaptive in our evolutionary past. For example, individuals that avoided dangerous animals or situations would be more likely to survive long enough and pass on their genes than those who did not. This suggests that the two-process model does not provide a full explanation for how all phobias develop.

Question 45

treating phobias - systematic desensitisation

Answer 45

Sustematic desensitisation (SD IS a behavioural therapy designed to gradually reduce phobic anxiety through the principles of classical conditioning. Essentially a new response to a phobic stimulus is learned (phobic stimulus is paired with relaxation instead of anxiety). This is called counterconditioning. in addition, it is impossible to be afraid and relaxed at the same time, so one emotion prevents the other. This is called reciprocal inhibition. SD can be in-vivo (where they are directly exposed to phobic stimulus) or in-vitro (where they imagine exposure to the phobic stimulus).

Question 46

2 main processes involved in SD

Answer 46

1. Relaxation: Relaxation techniques are taught to the service user; these include: • Focussing on breathing and taking slow, deep breaths as when we are anxious we breathe quickly so slowing this down helps us to relax. visualising a peaceful scene. Progressive muscle relaxation is also used where one muscle at a time is relaxed. 2. Hierarchy : At the beginning of therapy, the therapist and the service user will identify fearful situations involving the phobic stimulus and will rank these in order of least feared to most feared situations. SD works by gradually exposing the service user to fearful situations one step at a time. They begin at the bottom of the hierarchy, with the least fearful stimuli. The therapist will encourage them to use the relaxation techniques and will not move on until their anxiety reduces. This process is then repeated at each step of the hierarchy. The treatment is considered successful when they can remain relaxed in situations at the top of the hierarchy.

Question 47

Stages of the therapy SD

Answer 47

Step 1: Relaxation techniques are taught Step 2: Hierarchy is established Step 3: Service user starts to work their way through hierarchy Step 4: Once each step is mastered, they move onto next Step 5: Service user eventually masters the feared situation or object that caused them to seek help.

Question 48

evaluation of SD - ethical issues

Answer 48

deliberately exposes patients to their fears which can cause psychological harm as there is no guarantee they will cope with it well. they may have nightmares + their fear may get worse to a point where their lives become dysfunctional. it may not always be appropriate for all patients so a cost - benefit analysis may be needed to weigh all the benefits + costs with both short and long term in mind.

Question 49

evaluation of SD - effectiveness

Answer 49

Gilroy et al (2003) found that at both 3 and 33 months after treatment, a group who were given three sessions of SD for a spider phobia were less fearful than a group who were treated with lust relaxation. This shows that the gradual exposure element of systematic desensitisation is crucial to the effectiveness of treating phobias as the control group showed more fear when only relaxation was used. It also suggests systematic desensitisation is an effective long term treatment for phobias.

Question 50

evaluation of SD - appropriateness less stressful

Answer 50

As systematic desensitisation involves the individual having to confront their fear it can lead to the person experiencing psychological distress however, in comparison to flooding, this would be to a lesser extent as SD involves gradually exposing the person to the phobic stimulus whilst practicing relaxation. This means SD could be seen as a more ethical treatment and may be more appropriate to use when treating vulnerable people such as children.

Question 51

evaluation of SD - appropriateness for all phobias

Answer 51

Evidence suggests that SD may be more effective in treating specific phobias whilst other treatments, like CBT, are better for treating more complex phobias such as social phobias. This might be because, rather than simply trying to change the person's response to the phobic stimulus, CBT aims to identify and challenge irrational thoughts which can have more of an impact on the development of complex phobias in comparison to specific phobias. This means that SD may not be an appropriate treatment for all types of phobias and that it is important to consider the type of phobia when deciding on which treatments to use.

Question 52

What is flooding ?

Answer 52

Behavioural therapy which involves immediate exposure to the phobic stimulus. Person is unable to avoid the phobia + through continuous exposure, anxiety levels eventually decrease. Since the option of avoiding the phobic stimulus is removed, and high levels of anxiety can’t be maintained for a long time, the fear will eventually extinguish (extinction). Sessions usually last longer than SD sessions (2-3 hrs). Sometimes only one session is needed to cure the phobia

Question 53

evaluation of flooding - cost effective

Answer 53

Ougrin (2011) compared flooding to other cognitive therapies and found that it’s highly cost effective + quicker than alternatives. Patients are free from their symptoms faster. The evidence has implications for the economy as it could reduce the increasing financial burden on the NHS by offering a quicker and cheaper treatment for phobic people.

Question 54

evaluation of flooding - effectiveness

Answer 54

Kaplan and Tolin (2011) found that 65% of people with a specific phobia who were given a single session of flooding showed no symptoms of specific phobia 4 years later. This shows that flooding is an effective long-term treatment for specific phobias however not all sufferers were completely cured of their phobia so this suggests flooding may not be suitable for everyone.

Question 55

evaluation of flooding - less effective for complex phobias

Answer 55

Flooding is effective for specific phobias however it appears less effective for more complex phobias such as social phobias. This may be because social phobias have a cognitive element to them for example sufferers can experience irrational thoughts about social situations. Therefore, similar to SD, we must be cautious when using flooding as a general treatment for all phobias, perhaps considering other treatments such as CBT for phobias which involve fear of particular situations.

Question 56

evaluation of flooding - highly traumatic

Answer 56

Although people give consent to take part in flooding, it can be highly traumatic for them as it involves forcing the sufferer to experience high levels of anxiety. Because of the intense levels of anxiety, the drop-out rate is sometimes rather high which means that it could actually enhance their fear rather than reducing it. Furthermore, it may not be seen as suitable for children or vulnerable adults. Therefore, it could be argued that flooding is not suitable treatment for all sufferers.

Question 57

what are cognitive explanations ? (depression)

Answer 57

how mental processes affect behaviour. maladaptive biases in thinking can lead to depression.

Question 58

What is Ellis ABC model

Answer 58

developed to explain responses to negative events and how people react differently to stress. suggests that a particular situation will trigger irrational beliefs which then lead to unhealthy emotional consequences e.g. low mood, feelings of low self-worth.

Question 59

ABC model explained

Answer 59

A - Activating event - e.g. your friend doesn't greet you in the hallway B - Belief about why the event occurred, which may be rational or irrational C- Consequence - the feelings and behaviour the belief now causes. In depression, irrational beliefs lead to unhealthy emotions - e.g. feeling sad Activating event = rational belief = healthy emotion or Activating event = irrational believe = unhealthy emotion

Question 60

what is the source of irrational beliefs ? (Ellis ABC model)

Answer 60

lies in mustabatory thinking which is thinking that certain ideas must be true in order for an individual to be happy. Ellis identified a range of irrational beliefs: • I must be approved of or accepted by people I find important. • I must do well or very well, or I am worthless.

Question 61

Beck’s negative triad

Answer 61

1. The self : person sees themselves as worthless 2. The future : person has a pessimistic view of the future (e.g. I will never be good at anything) 3. The world : person has the impression that there is no hope anywhere (e.g. nobody values me) beck believed people experience depression as their thinking is biased towards negative interpretations of themselves, the world, and the future (the negative triad).

Question 62

What did Beck suggest the negative triad is maintained by ?

Answer 62

negative schemas or cognitive biases.

Question 63

what are cognitive biases (Beck’s interpretation)

Answer 63

faulty thinking patterns. referred to some of these biases as “automatic thoughts" (suggesting they are not entirely under conscious control). people with depression are more likely to focus on the negative aspects of a situation and ignore positives. tendency for them to make overly negative and self-defeating interpretations that lead to a lack of motivation and feelings of hopelessness. Common cognitive biases include: • Overgeneralisation- applying one experience to all experiences, including those in the future. E.g. 'Nothing ever goes my way' • Catastrophising- exaggerating the negative consequences of an event or situation. Thinking that that the worst possible outcome will occur in a particular situation. Often comes with what if questions

Question 64

what are negative schemas (Beck’s interpretation)

Answer 64

negative self-schemas are developed in childhood and adolescence, which may come from negative experiences (e.g. bullying) . These then continue into adulthood. We use schemas to interpret the world, so if we have a negative self-schema (information about ourselves) we interpret all information about ourselves in a negative way. Examples include: • Self-blame schema- makes people with depression feel responsible for all misfortunes • Ineptness schema- makes people with depression expect to fail

Question 65

evaluation of cognitive approach to depression - supporting evidence

Answer 65

There is a lots of evidence to support the idea that faulty thinking is associated with depression. Alloy et al. (1999) tested the thinking styles of young Americans in their early 20's and placed them in either a 'positive thinking group' or 'negative thinking group'. After 6 years the researchers found that only 1% of the positive group developed depression compared to 17% of the 'negative' group. Furthermore, Taghavi et al (2006) found that clinically depressed individuals scored higher on measures of irrational beliefs compared to a control group. These results suggest that negative and irrational beliefs play a role in depression.

Question 66

evaluation of cognitive approach to depression - issue of causation

Answer 66

Although the supporting evidence shows a link between faulty thinking and depression, it does not provide evidence for a cause and effect relationship. This means we are unable to conclude that faulty thinking causes depression. It is possible that other factors, for example genes and neurotransmitters, are the cause of depression and the negative, irrational thoughts are a symptom of the disorder. The cognitive explanations for depression could be seen as limited.

Question 67

evaluation of cognitive approach to depression - application (CBT)

Answer 67

Cognitive explanations for depression have led to the development of very effective treatments such as CBT. It involves challenging negative + irrational thinking which lessen the symptoms of depression suggesting that such thoughts play a role in depression in the first place. This demonstrate the usefulness of these explanations, and supports the validity of cognitive explanations for depression.

Question 68

evaluation of cognitive approach to depression - a combined approach

Answer 68

It could be argued that trying to explain depression from a purely cognitive standpoint may not be appropriate. Although the cognitive approach can explain the distorted thinking present in people with depression, there is also evidence supporting the role of biological factors, such as genetics and low levels of serotonin. Therefore, it may be better to explain depression by adopting a combined approach, where both the biological and cognitive factors are considered.

Question 69

what is cognitive behavioural therapy ?

Answer 69

Most common treatment for depression and has been developed based on the key concepts from the cognitive explanation of depression. As behaviour is seen as being a result of negative thinking, the most logical and effective way of treating depression is to challenge irrational thoughts. Alongside the cognitive aspects of CBT, the therapist may also work to encourage the service user to be more active and engage in positive behaviour activities (Behavioural Activation) . CBT is an umbrella term for many different therapies that share some common elements. One form of CBT is Ellis's Rational Emotive Behaviour Therapy (REBT).

Question 70

Ellis rational emotive behavioural therapy (REBT)

Answer 70

aim = person with depression to identify and challenge their negative thoughts by re-interpreting them in a more positive way. helps prevent further negative thinking and feelings of worthlessness. REBT extends the ABC model to an ABCDE model. D = dispute (challenging irrational thoughts) E = effect (irrational beliefs are replaced with rational ones) individual will firstly identify any previous experiences which may have caused their negative thinking and subsequent behaviours. the therapist then uses rational confrontation to reduce negative cognitive and emotional symptoms of depression.

Question 71

2 types of disputes used in REBT

Answer 71

1. empirical dispute : asking the individual for proof that their negative thoughts are true. 2. logical dispute : asking the individual if the negative thoughts are logical or based on common sense.

Question 72

evaluation of CBT - supporting evidence

Answer 72

There is a large amount of supporting evidence for the effectiveness of CBT as a treatment for depression. David et al (2008) found people suffering from major depressive disorder who were treated with 14 weeks of REBT had better treatment outcomes than those treated with the drug fluoxetine 6 months after treatment. Suggests that CBT is a more effective treatment for depression than the drug therapies and that it provides a suitable long-term treatment for depression.

Question 73

evaluation of CBT - not most effective

Answer 73

there is evidence that suggests using CBT alone is not the most effective treatment option. Craighead and Dunlop (2014) carried out a meta-analysis to find out whether CBT is more effective when used on its own or in combination with drug therapy and found a combined treatment was generally more effective. This suggests that CBT is most effectiveness when used in combination with drug therapy.

Question 74

evaluation of CBT - requires commitment

Answer 74

CBT requires commitment and motivation which may be a problem for people with depression, especially if they are suffering from severe depression. This is because they may not be able to engage with CBT or even attend the sessions. It may be more appropriate to treat these people with anti-depressants (which don't require the same level of motivation) and start CBT when they are able to fully engage with the treatment. CBT may be more appropriate to use as part of a combination treatment for cases of severe depression.

Question 75

evaluation of CBT - criticised for minimising the importance of a person's social circumstances.

Answer 75

CBT focuses on altering the thoughts and behaviours of the individual and does not address any wider problems which could contribute to the person's depression. For example, someone who is living in poverty or suffering abuse may need to change their circumstances rather than their thought processes. CBT may be an inappropriate treatment for these people until their circumstances change.

Question 76

genetic explanations of OCD

Answer 76

focus on whether individuals inherit a genetic pre-disposition to developing OCD. concordance rate : the probability that a pair of individuals will both have a certain characteristic, given that one of the pair has the characteristic.

Question 77

family studies (OCD)

Answer 77

relatives of OCD are more vulnerable to developing OCD. Nestadt et al (2000) found lifetime prevalence of OCD was 11.7% in people who had first-degree relatives (e.g. parents) with OCD compared with 2.7% in the control group who had no first-degree relatives with OCD.

Question 78

twin studies (OCD)

Answer 78

involve a comparison between identical twins (monozveotic - M2) and non-identical twins (dizygotic - DZ). MZ twins share 100% of their genes. DZ share onlv 50% of their genes. If genes do play a role in developing OCD we would expect to find a higher concordance rate for MZ than DZ. For example, Carey and Gottesman (1981) found MZ twins has a concordance rate of 87% for obsessive symptoms and features compared to 47% in DZ twins.

Question 79

Candidate genes (OCD)

Answer 79

genes suspected to play a role in a particular trait. COMT gene = regulates the neurotransmitter dopamine. One variation of the COMT gene results in higher levels of dopamine and this variation has been found to be more common in people with OCD, in comparison to people without OCD. SERT gene (also known as the 5-HTT gene) = linked to the neurotransmitter serotonin and affects the transport of the serotonin (hence Serotonin Transporter), causing lower levels of serotonin which is also associated with OCD (and depression) However, OCD seems to be polygenic. This means that OCD is not caused by one single gene but that several genes are involved. Taylor (2003) suggests that as many as 230 genes may be involved and different genetic variations contribute to the different types of OCD.

Question 80

evaluation of genetic explanations - supporting evidence

Answer 80

There is a large amount of consistent evidence from twin and family studies which show that genetic factors are important in developing OCD. Nestadt et al (2010) reviewed previous twin studies and found that 68% of identical twins shared OCD as opposed to 31% of non-identical twins. This study supports the link between genetics and OCD as MZ twins share 100% of their genes whereas D2 twins only share 50%. Therefore, as the concordance rates and percentages are higher for MZ twins, this shows that genetics must play a role in developing OCD.

Question 81

evaluation of genetic explanations - research on twins (issue)

Answer 81

Although research from twin studies suggests there may be a genetic influence, they do not support genetics being the sole cause of the disorder. If OCD was entirely caused by genetics we would expect the concordance rates for identical twins to be 100% as they share 100% of their genes, however concordance rates for MZ twins are not 100%. This suggests that there are other factors that play a role in OCD e.g. cognition or the small differences in the environments of twins. Genetic explanations alone do not offer a sufficient explanation for OCD.

Question 82

evaluation of genetic explanations - alternative diathesis stress model

Answer 82

Evidence for the genetic explanation suggests that some people may be more susceptible to OCD, however it does not suggest that genes are the sole cause of OCD. It seems that environmental factors also increase the risk of developing OCD. Cromer et al (2007) found over half the OCD sufferers in their sample had a traumatic event in their past, and that OCD was more severe in those with more than one trauma. This suggests that the genetic explanation alone is not a sufficient explanation for OCD and that the diathesis-stress model would be a more suitable explanation.

Question 83

evaluation of genetic explanations - family members can show different forms of OCD behaviour

Answer 83

some adults can become obsessive about constantly washing dishes, while children may become obsessed with arranging dolls. If the disorder was indeed inherited it would be assumed that the behaviour would be similar between family members but this is not always the case. This is where psychological explanations may be better suited as the child may learn the obsessive behaviour from their parents modelling it. They may then demonstrate the same tendencies due to learning rather than genetics. This may explain the high concordance rates among family members as the behaviour may be learned from one another rather than genetic.

Question 84

neural explanations for OCD

Answer 84

include the role of neurotransmitters and abnormal brain functions. neurotransmitters : Serotonin: Low levels of serotonin are associated with abnormal transmission of mood-related information and are suggested to be linked to the obsessive thoughts and feelings of anxiety that people with OCD experience. Pigott (1990) found that anti-depressant drugs (which increase serotonin activity) have been shown to reduce the symptoms of OCD. Dopamine: High levels of dopamine have been linked to OCD symptoms, particularly compulsive behaviours. Kim et al (2007) gave OCD sufferers drugs that affected their dopamine levels and found this was correlated with less compulsive behaviours.

Question 85

evaluation of neurotransmitters - supporting evidence

Answer 85

Hu (2006) compared serotonin activity in 169 OCD sufferers and 253 non-sufferers, finding serotonin levels to be lower in the OCD group. Soomro et al (2009) found SSRIs were more effective than placebos in reducing symptoms of OCD. These studies support the link between low levels of serotonin and OCD.

Question 86

evaluation of neurotransmitters - issues (causation)

Answer 86

Although the supporting evidence shows a link between neurotransmitter activity and OCD it does not provide any causal evidence. It is possible that low levels of serotonin or high levels of dopamine is an effect of having the disorder rather than being the cause of it. Not all OCD sufferers respond to SSRI treatment suggesting that other factors could play a role. This explanation could be seen as limited as no firm conclusions can be made as to what actually causes OCD.

Question 87

evaluation of neurotransmitters - application (drug therapies)

Answer 87

Understanding the role neurotransmitters play in OCD has led to the development of treatments such as drug therapies. SSRIs are used as a treatment for OCD and have been found to be successful in reducing the symptoms (Soomro et al, 2009). This highlights the usefulness of the neural explanations as well as providing further support for the idea that low serotonin levels are involved in OCD.

Question 88

abnormal brain functions

Answer 88

Research using PET scans has found sufferers of OCD have elevated levels of activity in the orbitofrontal cortex (OFC) and the caudate nucleus. The OFC is part of a brain circuit known as 'the worry circuit'. includes the caudate nucleus in the basal ganglia and the thalamus. The OFC is thought to turn sensory information into thoughts. When the OFC detects something is wrong it sends a 'worry' signal to the thalamus. These signals are normally suppressed or filtered by the caudate nucleus. However, if the caudate nucleus doesn’t work correctly it cannot filter the worry signals which leads to the thalamus becoming overactive. When this happens, the thalamus sends strong signals back to the OFC to carry out an action (e.g. washing hands). This leads to an overactive worry circuit (the worry message keeps repeating on a loop) which could explain why people with OCD perform compulsions (repetitive rituals).

Question 89

evaluation of abnormal brain functions - supporting evidence

Answer 89

A review of brain-imaging research show elevated activity in the orbital region and the caudate nucleus has been found consistently in OCD sufferers compared to healthy controls. After treatment, activity in these brain areas reduces to a level comparable to that of controls as found by Saxena and Rauch (2000). This supports the neurophysiological explanation as it shows that these areas of the brain are linked to OCD.

Question 90

evaluation of abnormal brain functions - challenging evidence

Answer 90

Many neural mechanisms have been identified but these are not always present in all OCD cases. Neuroimaging studies have so far failed to identify basal ganglia impairments in all OCD sufferers, and some people with brain impairments involving the basal ganglia show no signs of OCD (Ring and Serra Mestres, 2002). This suggests there may be other factors that are also involved in OCD. Therefore, this neural explanation does not provide a complete explanation of OCD.

Question 91

evaluation of abnormal brain functions - causation (issue)

Answer 91

Although the supporting evidence shows a link between abnormal brain functions and OCD it does not provide any causal evidence. We are unable to conclude that an overactive worry circuit is the cause of the disorder. It is possible that having OCD leads to changes in the brain meaning that abnormal brain functions are an effect of having OCD rather than the cause. This explanation could be seen as limited as no firm conclusions can be made as to what actually causes OCD.

Question 92

drug therapy

Answer 92

drugs aim to increase/decrease the level of neurotransmiters in the brain. In relation to OCD, drug therapy consists of drugs that increase levels of the neurotransmitter serotonin. SSRIs (selective seratonin reuptake inhibitor) are a type of antidepressant drug which prevent the reabsorption and breakdown of serotonin. this results in more serotonin being made available in the synapse. increasing levels of serotonin can result in improved symptoms for the sufferer. As a treatment for OCD, it is common for drugs to be used alongside other treatments, such as CBT.

Question 93

how do SSRIs work ?

Answer 93

When serotonin is released from the pre-synaptic neuron into the synapse, it travels, and binds, to the receptors on the post-synaptic neuron. Serotonin which is not absorbed into the post-synaptic neuron is reabsorbed into the pre-synaptic neuron. SSRIs increase the level of serotonin available in the synapse by preventing it from being reabsorbed into the pre-synaptic neuron cell. This results in more serotonin being received by the post-synaptic neuron.

Question 94

types of SSRIs and other treatments

Answer 94

Fluoxetine. If SSRIs prove ineffective then the dose can be increased or it can be combined with other drugs. Sometimes , alternative drugs are given as people can respond differently to different drugs. Two other examples of drug treatments are; Tricyclics : have the same effect as SSRI's (however these are generally only used when people do not respond to SSRIs as the side effects are more severe) SNRIs : which are newly developed anti-depressants that increase the level of serotonin and noradrenaline.

Question 95

evaluation of biological treatments - effectiveness

Answer 95

There are a number of research studies that have investigated the effectiveness biological treatments of OCD. Soomro et al (2009) reviewed 17 studies comparing SSRIs to placebos in the treatment of OCD and found SSRIs were more effective than placebos in reducing symptoms of OCD, being specifically effective in reducing symptoms between 6 and 13 weeks after starting the treatment. This suggests that drug therapies are an effective short-term treatment for OCD.

Question 96

evaluation of biological treatments - side effects

Answer 96

There are a number of common side effects to using drug treatments for OCD. e.g. loss of appetite and headaches. If these side effects are severe enough, it could lead to the person stopping the treatment all together. In addition, it is suggested that SSRIs may increase the risk of self-harm in people with depression and in younger people. drug therapy might not always be an appropriate treatment for all OCD sufferers.

Question 97

evaluation of biological treatments - may not be a biological cause

Answer 97

Drug therapies may not be an appropriate long-term treatment if the cause of OCD is not biological. Evidence from Cromer et al (2007) suggests some cases of OCD are linked to trauma. Although SSRIs could help reduce the symptoms in the short-term, they would not be treating the underlying cause. This could also explain why many people relapse once medication has been stopped. It may be more appropriate to offer drug therapy alongside other psychological therapies such as CBT.

Question 98

evaluation of biological treatments - advantages

Answer 98

Antidepressant drugs are cheap to manufacture, easy to administer and user-friendly when compared to psychological treatments such as CBT which can be time-consuming.