Psychopathology Flashcards
(100 cards)
1
Q
what are the four definitions of abnormality?
A
-statistical infrequency ( SI )
-deviation from social norms ( DSN )
-failure to function adequately ( FTFA )
-deviation from ideal mental health ( DIMH )
2
Q
what is the SI definition of abnormality?
A
-a behaviour is abnormal if its frequency is more than two standard deviations away from the mean incidence rates represented on a normally-distributed bell curve, i.e. a relatively rare / unusual characteristic
-this defines it in terms of the number of times it is observed
3
Q
what is an example of defining abnormality in terms of SI?
A
-IQ is normally distributed, with 68% of people scoring between 85 and 115, and only 2% below 70, so those scoring below 70 are statistically abnormal and can be diagnosed with intellectual disability disorder ( IDD )
4
Q
evaluate SI as a definition of abnormality
A
-one strength is real-world application
-one limitation is that unusual characteristics can be positive
-another limitation is that not everyone will benefit from being classed as abnormal
5
Q
why is it a strength that the SI definition has real-world application?
A
-E = it is useful in diagnosis, e.g. IDD because this requires an IQ in the bottom 2%, as well as in assessing a range of conditions, e.g. the Beck depression inventory ( BDI ) assesses depression and only 5% of people score 30+, indicating severe depression
-E = this means that SI is useful in diagnostic and assessment procedures, demonstrating its practical value
6
Q
why is it a limitation that unusual characteristics can be positive?
A
-E = if very few people display a characteristic, then the behaviour is statistically infrequent but it doesn’t necessarily make someone abnormal, e.g. IQ scores above 130 are just as unusual as those below 70 but not regarded as undesirable or needing treatment
-E = this means that, although SI can be part of defining abnormality, it can never be sufficient as its sole basis
7
Q
why is it a limitation that not everyone will benefit from being classed as abnormal using the SI definition?
A
-E = when someone is living a happy and fulfilled life, there is no benefit to them being labelled as abnormal since the label of abnormality ( e.g. IDD ) might carry a social stigma
-E = this means that labelling someone as abnormal just because they are statistically unusual is likely to do more harm than good
8
Q
what is the DSN definition of abnormality?
A
-a behaviour is abnormal if it’s different from the accepted standards ( social norms ) specific to a certain culture, which is a collective judgement about what is right
-there are both culturally-specific and general norms ( applicable to the majority of cultures ), so this definition is related to cultural context
9
Q
what is an example of defining abnormality in terms of DSN?
A
-a person would be diagnosed with antisocial personality disorder ( APD ) if they behave aggressively towards strangers ( thus breaching a general social norm ) and if they experience hallucinations ( which also breaches the social norms of multiple cultures, but some cultures may encourage this as a sign of spirituality )
10
Q
evaluate DSN as a definition of abnormality
A
-one strength is real-world application
-one limitation is that social norms are situationally and culturally relative
-another limitation is the risk of unfair labelling and human rights abuse
11
Q
why is it a strength that the DSN definition has real-world application?
A
-E = it is useful in diagnosis, e.g. APD because this requires a failure to conform to ethical standards, as well as schizotypal PD which involves ‘strange’ beliefs and behaviours
-E = this means that DSN is useful in psychiatric diagnosis, demonstrating its practical value
12
Q
why is it a limitation that social norms are situationally and culturally relative?
A
-E = a person from one culture may label someone from another culture as abnormal using their standards rather than the person’s standards, e.g. hearing voices is socially acceptable in some cultures ( as messages from ancestors ) but would be seen as a sign of abnormality in the UK
-E = this means that it is difficult to judge DSN across different contexts
13
Q
why is it a limitation that using the DSN definition risks unfair labelling and human rights abuse?
A
-E = reliance on DSN to understand abnormality can lead to abuse of human rights, e.g. historically, diagnoses like drapetomania ( black slaves running away ) have been used to control slaves and avoid debate, but we need to be able to use DSN to diagnose conditions such as APD
-E = this suggests that, overall, the use of DSN to define abnormality may do more harm than good due to the potential for abuse
14
Q
what is the FTFA definition of abnormality?
A
-Rosenhan and Seligman ( 1989 ) suggested that a person is abnormal if their current mental state is preventing them from being able to cope with the demands of everyday life, e.g. if they aren’t able to maintain basic standards of nutrition and hygiene, relationships and a job
-this occurs when they no longer conform to interpersonal rules ( e.g. maintaining eye contact and respecting personal space ), experience severe personal distress and behave in a way that is irrational or dangerous
15
Q
what is an example of defining abnormality in terms of FTFA?
A
-having a very low IQ is a statistical infrequency but an individual would also need to be failing to function adequately to be diagnosed with IDD
16
Q
evaluate FTFA as a definition of abnormality
A
-one strength is that it represents a sensible threshold for professional help
-one limitation is that it can lead to discrimination / social control
-another limitation is that FTF can be normal
17
Q
why is it a strength that the FTFA definition represents a sensible threshold for professional help?
A
-E = according to the mental health charity Mind, around 25% of people in the UK will experience symptoms of mental disorder to some degree in any given year, but when we cease to function adequately, people seek or are referred for professional help
-E = this means that the FTFA criterion provides a way to target treatment and services to those who need them the most
18
Q
why is it a limitation that the FTFA definition can lead to discrimination / social control?
A
-E = it is hard to distinguish between FTF and a conscious decision to deviate from social norms, e.g. people may choose to live off-grid as part of an alternative lifestyle or take part in high-risk leisure activities
-E = this means that people who make unusual choices are at risk of being labelled as abnormal and having their freedom of choice restricted
19
Q
why is it a limitation that FTF can be normal?
A
-E = there are some circumstances in which most of us fail to cope for a time, e.g. bereavement / grief, so it is unfair to give someone a label for reacting normally to difficult circumstances, but some people may need professional help to adjust to circumstances like bereavement
-E = this means that it is hard to know when to base a judgement of abnormality on FTFA
20
Q
what is the DIMH definition of abnormality?
A
-Jahoda ( 1958 ) suggested that a person is abnormal if they don’t meet a set of 8 criteria for good mental health, which includes being able to self-actualise ( fulfill one’s potential ), maintain motivation to carry out everyday tasks, not being distressed, having an accurate perception of self, displaying good self-esteem etc.
21
Q
evaluate DIMH as a definition of abnormality
A
-one strength is that Jahoda’s criteria is highly comprehensive
-one limitation is that Jahoda’s criteria sets extremely high standards for IMH
-another limitation is that it may be culture-bound
22
Q
why is it a strength that Jahoda’s criteria is highly comprehensive?
A
-E = her concept of IMH includes a range of criteria which covers most of the reasons why we might need help with MH, which means that an individual’s MH can be discussed meaningfully with various professionals ( e.g. psychiatrist or CBT therapist )
-E = therefore, IMH provides a checklist against which we can assess ourselves and others
23
Q
why is it a limitation that Jahoda’s criteria sets extremely high standards for IDM?
A
-E = very few of us attain all of Jahoda’s criteria for IMH and even fewer of us are able to maintain them for long, so an impossible set of standards can be disheartening, but having such comprehensive criteria might be of value to someone wanting to understand and improve their MH
-E = this means that a set of highly comprehensive criteria for IMH isn’t equally helpful for everyone
24
Q
why is it a limitation that the DIMH definition may be culture-bound?
A
-E = some of her criteria for IMH are limited to the US and Europe, e.g. self-actualisation isn’t recognised in much of the world and would probably be dismissed as self-indulgent, and even within Europe, there are variations in the value placed on personal independence ( e.g. high in Germany, low in Italy )
-E = this means that it is very difficult to apply the concept of IMH from one culture to another
25
what is the DSM-5?
-the latest version of the Diagnostic and Statistical Manual of Mental Disorder which was published by the American Psychiatric Association in 2013 and is a system for classifying and diagnosing mental health problems
26
what is the difference between behavioural, emotional and cognitive characteristics?
-behavioural = ways in which people act
-emotional = a person's feelings or mood
-cognitive = refers to the process of knowing, including thinking, reasoning, remembering and believing
27
what is the DSM-5 description of phobias?
-an excessive, irrational fear of an object, place or situation
-recognises specific phobia ( i.e. of an object e.g. an animal or situation e.g. flying ), social anxiety / phobia ( i.e. of a social situation e.g. public speaking ) and agoraphobia ( i.e. of being outside or in a public place ) as categories of phobia and related anxiety disorder
28
what are the behavioural characteristics of phobias?
-panic = a person may cry, scream or run away from the phobic stimulus
-avoidance = considerable effort to prevent contact with the PS which can make it hard to go about everyday life
-endurance = the alternative behaviour to avoidance which involves remaining in the presence of the PS and continuing to experience anxiety
29
what are the emotional characteristics of phobias?
-anxiety = an unpleasant state of high arousal which prevents a person relaxing and makes it very difficult to experience any positive emotion
-fear = the immediate response we experience when we encounter or think about a PS which is usually more intense but shorter-term than anxiety
-unreasonable emotional response = the anxiety or fear is much greater than is normal and disproportionate to the threat posed
30
what are the cognitive characteristics of phobias?
-selective attention to the PS = if a person can see the PS it is hard to look away from it
-irrational beliefs = a person with a phobia may hold unfounded thoughts in relation to phobic stimuli
-cognitive distortions = inaccurate and unrealistic thinking
31
what is the DSM-5 description of depression?
-a mental disorder characterised by low mood and low energy levels
-recognises major depressive disorder ( severe but often short-term depression ), persistent depressive disorder ( long-term or recurring depression ), disruptive mood dysregulation ( childhood temper tantrums ) and premenstrual dysphoric disorder ( disruption to mood prior to and/or during menstruation ) as categories of depression and depressive disorders
32
what are the behavioural characteristics of depression?
-activity levels = people with depression have reduced levels of energy, making them lethargic e.g. cannot get out of bed
-disruption to sleep and eating behaviour = a person may experience reduced sleep ( insomnia ) or an increased need for sleep ( hypersomnia ), and appetite and weight may increase or decrease
-aggression and self-harm = depression is associated with irritability and this may extend to aggression and self-harm
33
what are the emotional characteristics of depression?
-lowered mood = people with depression often describe themselves as worthless and empty
-anger = negative emotions such as this can lead to aggression or self-harming behaviour
-lowered self-esteem = a person likes themselves less, even self-loathing
34
what are the cognitive characteristics of depression?
-poor concentration = the person may find themselves unable to stick with a task as they usually would, or might find simple decision-making difficult
-attention to and dwelling on the negative = depressed people have bias towards focusing on negative aspects of current situations and recalling unhappy memories whilst ignoring the positive or happy ones
-absolutist thinking = black-and-white thinking which means that when a situation is unfortunate it is seen as an absolute disaster
35
what is the DSM-5 description of OCD ( obsessive-compulsive disorder )?
-a condition characterised by obsessions ( e.g. recurring thoughts, images etc. which are cognitive ) and/or compulsions ( repetitive behaviours e.g. handwashing )
-recognises OCD and a range of related disorders e.g. trichotillomania ( compulsive hair-pulling ), hoarding disorder ( the compulsive gathering of possessions and the inability to part with anything, regardless of its value ) and excoriation disorder ( compulsive skin-picking )
36
what are the behavioural characteristics of OCD?
-repetitive compulsions = actions are carried out repeatedly in a ritualistic way, e.g. handwashing or counting
-compulsions may reduce anxiety = for the vast majority of people with OCD, compulsive behaviours are performed in an attempt to manage the anxiety produced by obsessions
-avoidance = OCD is managed by avoiding situations that trigger anxiety which can interfere with leading a regular life as very ordinary situations, e.g. emptying rubbish bins, may be avoided
37
what are the emotional characteristics of OCD?
-anxiety and distress = obsessive thoughts are unpleasant and frightening, and the anxiety that accompanies these can be overwhelming
-depression = anxiety can be accompanied by low mood and lack of enjoyment in activities
-guilt and disgust = other negative emotions such as irrational guilt, e.g. over a minor moral issue, or disgust, which may be directed towards oneself or something external like dirt, may be involved
38
what are the cognitive characteristics of OCD?
-obsessive thoughts = about 90% of people with OCD have recurring intrusive thoughts ( e.g. impulses to hurt someone ) which vary from person to person but are always unpleasant
-cognitive coping strategies = some people with OCD use strategies like meditation to help manage anxiety but this can make them appear abnormal to others and distract them from everyday tasks
-insight into excessive anxiety = people with OCD are aware that their obsessions and compulsions are irrational but experience catastrophic thoughts and tend to be hypervigilant ( i.e. constantly alert )
39
what is meant by the behavioural approach?
-a way of explaining behaviour in terms of learning and what is observable
40
what is the two-process model of phobias proposed by Mowrer ( 1960 )?
-the behavioural explanation for the acquisition and persistence of disorders that create anxiety, such as phobias
-the first process is classical conditioning, which involves learning to associate a NS with an UCS when the two are repeatedly paired together, and the second is operant conditioning which maintains the phobia by its consequences ( reinforcement / punishment ), specifically negative reinforcement
41
what is the role of CC is the acquisition of phobias?
-before CC, the NS produces no CR ( no fear ) and the UCS produces the UCR of fear
-during CC, the NS is paired / associated with the UCS
-after CC, the NS becomes a CS and produces the CR of fear
-e.g. Watson and Rayner ( 1920 ) showed how a fear of rats could be conditioned in 'Little Albert' as whenever Albert played with a white rat ( NS ), a loud noise ( UCS ) was made close to his ear which caused a fear response ( UCR ) so the NS became associated with the UCS and is now a CS which produces a CR
-this conditioning then generalised to other similar stimuli, e.g. Little Albert displayed distress at the sight of a non-white rabbit, a fur coat and Watson wearing a Santa Claus beard
42
what is the role of OC in the maintenance of phobias?
-responses acquired by CC tend to decline over time, but phobias are often long-lasting since a person with a phobia avoids a PS to escape the fear and anxiety that would have been experienced
-the relief and reduction in fear negatively reinforces the avoidance behaviour and ensures that the phobia is maintained rather than confronted
43
evaluate the two-process model of phobias
-one strength is its real-world application in exposure therapies
-another strength is evidence for a link between bad experiences and phobias
-one limitation is that it doesn't account for the cognitive aspects of phobias
-another limitation is that evolutionary theory may provide a better explanation for phobias
44
why is it a strength that the two-process model has real-world application in exposure therapies?
-E = the idea that phobias are maintained by avoidance of the PS is important in explaining why people with phobias benefit from exposure therapies ( e.g. systematic desensitisation ) because avoidance behaviour declines once it is prevented as it is no longer negatively reinforced by the reduction of anxiety
-E = this shows the value of the two-process approach because it identifies a means of treating phobias which can help to improve people's lives
45
why is it a strength that there is evidence linking phobias to bad experiences?
-E = the Little Albert study illustrates how a frightening experience involving a stimulus can lead to a phobia of that stimulus, and De Jongh et al. ( 2006 ) found that 73% of people with a fear of dental treatment had experienced a trauma, mostly involving dentistry, compared to 21% of a control group of people with low dental anxiety
-E = this supports the idea that the association between a NS ( dentistry ) and an UCR ( pain ) does lead to the development of a phobia
-counterpoint = not all phobias appear following a bad experience and not all frightening experiences lead to phobias, meaning that behavioural theories don't provide a complete explanation for all cases of phobia
46
why is it a limitation that the two-process model doesn't account for the cognitive aspects of phobias?
-E = behavioural explanations like the two-process model are geared towards explaining behaviour ( i.e. avoidance of the PS ), but phobias also have a significant cognitive component, e.g. people hold irrational beliefs about the PS, which this approach doesn't provide an adequate explanation for
-E = this means that the two-process model doesn't fully explain the symptoms of phobias
47
why is it a limitation that evolutionary theory may provide a better explanation for phobias?
-E = we tend to develop phobias of things that presented a danger in our evolutionary past due to the operation of natural selection as those who feared e.g. the dark or heights avoided these and thus survived, so were able to reproduce and pass on this advantageous phobia to their offspring
-E = this means that preparedness ( Seligman 1971 ) can explain important properties of phobias that the two-process model can't, making it a limited explanation
48
what are the two behavioural therapies used in the treatment of phobias?
-systematic desensitisation ( SD ) = designed to reduce phobic anxiety through gradual exposure to the PS and counterconditioning
-flooding = immediate exposure to an extreme form of a PS without a gradual build-up to reduce anxiety, which takes place across a small number of long therapy sessions
49
what are the three processes involved in SD?
-the anxiety hierarchy = client and therapist put together a list of stimuli / situations related to the PS that provoke anxiety arranged in order from least to most frightening
-relaxation = the therapist teaches the client to relax as deeply as possible such as via breathing exercises or meditation
-exposure = finally the client works up the anxiety hierarchy over several sessions and at each level is exposed to the PS in a relaxed state until the most feared step is responded to with relaxation ( so the bond between the CS and CR has been broken and treatment is successful )
50
how does SD work?
-counterconditioning = the PS ( CS ) is paired with relaxation instead of anxiety so the patient learns to associate the two stimuli and relaxation becomes the new CR
-reciprocal inhibition = it is impossible to be afraid and relaxed at the same time, so one emotion prevents the other
51
evaluate SD as a treatment for phobias
-one strength is evidence of its effectiveness
-another strength is that it can be used to help people with learning disabilities
-one limitation is that it is costly and time-consuming
52
why is it a strength that there is evidence of SD's effectiveness?
-E = Gilroy et al. ( 2003 ) followed up 42 people who had SD for spider phobia in three 45-minute sessions and found that the SD group were less fearful than a control group at both 3 and 33 months
-also, Wechsler et al. ( 2019 ) recently concluded that SD is effective for specific phobia, social phobia and agoraphobia, suggesting that this evidence has temporal validity
-E = this means that SD is likely to be helpful in the long-term for people with phobias
53
why is it a strength that SD can be used to help people with learning disabilities?
-E = main alternatives to SD are unsuitable for people with learning disabilities, e.g. cognitive therapies require a high level of complex rational thought and flooding is distressing, whereas SD doesn't require understanding or engagement on a cognitive level and is not a traumatic experience so it can be adapted to suit individual needs
-E = this means that SD is often the most appropriate treatment for some people and is preferred by many patients
54
why is it a limitation that SD is costly and time-consuming?
-E = e.g. it requires multiple sessions to complete and thus more time and resources than flooding
-E = this suggests that alternative treatments may be more suitable for treating phobias
-counterpoint = the exposure part of SD can be done in virtual reality ( VR ) which avoids dangerous situations ( e.g. heights ) and is cost-effective, however this may be less effective than real exposure for social phobias as it lacks realism
55
how does flooding work?
-flooding stops phobic responses very quickly because without the option of avoidance behaviour, the client quickly learns that the PS is harmless through exhaustion of their fear response ( which is known as extinction ) so the CS no longer produces the CR of fear
56
evaluate flooding as a treatment for phobias
-one strength is that it is highly cost-effective
-one limitation is that it is traumatic
-another limitation is that it only masks symptoms and doesn't tackle the underlying causes of phobias ( symptom substitution )
57
why is it a strength that flooding is highly cost-effective?
-E = a therapy is considered to be cost-effective if it is clinically effective and not expensive, and flooding can work in as little as one long session in comparison to SD which takes around 10 sessions to achieve the same result
-E = this means that more people can be treated at the same cost by flooding than by SD or other therapies
58
why is it a limitation that flooding is traumatic?
-E = Schumacher et al. ( 2015 ) found that both participants and therapists rated flooding as significantly more stressful than SD, thus there are ethical concerns about knowingly causing stress to clients ( offset by informed consent ), and the traumatic nature of flooding also leads to higher attrition / dropout rates than for SD
-E = this suggests that, overall, therapists may avoid using this treatment due to the waste of time and money, and instead favour e.g. SD
59
why is it a limitation that flooding doesn't tackle the underlying causes of phobias?
-E = Persons ( 1986 ) reported the case of a woman with a phobia of death who was treated using flooding and her fear of death declined, but her fear of being criticised got worse ( i.e. symptom substitution occurred )
-E = this suggests that behavioural therapies don't treat causes, so symptoms reappear
-counterpoint = the only evidence for this comes in the form of case studies which may only generalise to the phobias in the study, meaning that symptom substitution is largely a theoretical idea and there is only relatively poor empirical evidence to support it
60
what is meant by the cognitive approach?
-how are mental processes ( e.g. thoughts, perceptions, attention ) affect behaviour
61
what are the two cognitive approaches to explaining depression?
-Beck's negative triad ( 1967 ) = there are three types of negative thinking that occur automatically and contribute to becoming depressed / create this vulnerability: negative views of the world, the future and the self
-Ellis's ABC model ( 1962 ) = depression occurs when an activating event ( A ) triggers an irrational belief ( B ) which in turn produces a consequence ( C ), i.e. an emotional response like depression
62
what does Beck's negative triad involve?
-some people are more prone to depression due to faulty information processing ( depressed people focus on the negative aspects of a situation and ignore positives ), leading to black and white thinking where something is either all bad or all good
-negative self-schema = depressed people interpret all information about themselves in a negative way
-negative view of the world = these create the impression that there is no hope anywhere
-negative view of the future = these reduce any hopefulness and enhance depression
-negative view of the self = these enhance any existing depressive feelings because they confirm the existing emotions of low self-esteem
63
evaluate Beck's negative triad as an explanation for depression
-one strength is supporting research
-another strength is real-world application to screening and treatment for depression
-one limitation is that it may be a partial explanation
64
why is it a strength that Beck's model is supported by research?
-E = Clark and Beck ( 1999 ) concluded that cognitive vulnerabilities ( e.g. faulty information processing, negative self-schema and the cognitive triad ) are more common in depressed people, and a recent prospective study by Cohen et al. ( 2019 ) tracked 473 adolescents' development and found that early cognitive vulnerability predicted later depression
-E = this shows that there is an association between cognitive vulnerability and depression
-counterpoint = a correlation cannot establish a cause-and-effect relationship and there may be a third variable causing the association
65
why is it a strength that Beck's model has real-world application?
-E = assessing cognitive vulnerability in young people most at risk of developing depression means they can be monitored, and understanding cognitive vulnerability is applied in CBT to alter cognitions underlying depression, making a person more resilient to negative life events
-E = this means that the idea of cognitive vulnerability is useful in clinical practice
66
why is it a limitation that Beck's model may be a partial explanation?
-E = depressed people show particular patterns of cognition, even before the onset of depression, but some aspects of depression aren't explained by cognitive factors, e.g. experiences of extreme anger, and for some people, hallucinations and delusions
-E = this suggests that the cognitive model is not a particularly good explanation for all depressive phenomena
67
what does Ellis's ABC model involve?
-poor mental health ( e.g. anxiety and depression ) results from irrational / dysfunctional thoughts, which Ellis defined as any thoughts that interfere with us being happy and free from pain rather than those that are illogical or unrealistic
-the ABC model explains how irrational thoughts affect our behaviour and emotional state
-according to Ellis, we get depressed when we experience external, negative events ( A ) which trigger irrational beliefs ( B ), such as musturbation ( we must always succeed or achieve perfection ) and utopianism ( life is always meant to be fair and just ), which lead to emotional and behavioural consequences ( C )
68
evaluate Ellis's ABC model as an explanation for depression
-one strength is real-world application in the psychological treatment of depression
-one limitation is that it only explains reactive depression and not endogenous depression
-another limitation is that it may be unethical
69
why is it a strength that Ellis's model has real-world application in the psychological treatment of depression?
-E = Ellis applied the ABC model to treat depression ( i.e. rational emotive behaviour therapy, REBT ), which involves vigorously arguing with a depressed person in order to alter the irrational beliefs that are making them unhappy
-there is some evidence to support the idea that REBT can both change negative beliefs and relieve the symptoms of depression ( David et al. 2018 )
-E = this means that REBT and thus the ABC model has real-world value
70
why is it a limitation that Ellis's model only explains reactive depression and not endogenous depression?
-E = reactive depression describes a form of depression which is triggered by negative activating events, but in many cases, it is not obvious what triggers depression ( described as endogenous depression ), which Ellis's model is less useful in explaining
-E = this means that Ellis's model can only explain some cases of depression and is therefore a partial explanation
71
why is it a limitation that Ellis's model may be unethical?
-E = the ABC model of depression locates responsibility for depression purely with the depressed person, which critics see as victim-blaming
-on the other hand, the application of the ABC model to REBT does appear to make at least some depressed people achieve more resilience and feel better
-E = this means that REBT gives reason for concern but can be ethically acceptable as long as it is carried out sensitively to avoid victim-blaming
72
what are the two cognitive therapies used in the treatment of depression?
-Beck’s cognitive behavioural therapy ( CBT ) = based on both cognitive and behavioural techniques, including challenging negative, irrational thoughts and replacing them with more effective behaviours
-Ellis’s rational emotive behaviour therapy ( REBT ) = a type of CBT which extends the ABC model to ABCDE ( D for dispute and E for effect )
73
what does CBT involve?
-it starts with an assessment in which the client and therapist work together to identify automatic, negative thoughts about the self, world and future ( the negative triad ), and then a plan is put together to achieve the client’s goals for the therapy
-these thoughts must be challenged by the client taking an active role in their treatment, so they are encouraged to test the reality of their irrational beliefs ( this is referred to as the 'client as scientist' )
-they might therefore be set homework ( e.g. to record when they enjoyed an event ), which the therapist can use as evidence in future sessions to prove that the client’s ITs are incorrect
74
what does REBT involve?
-the therapist identifies any examples of ITs ( e.g. utopianism and musturbation ) and challenges them through vigorous disputes, including empirical arguments ( disputing whether there is evidence to support the negative thought ) and logical arguments ( disputing whether the belief actually follows from the facts ) in order to break the link between negative life events and depression
-effect involves behavioural activation which aims to gradually decrease depressed individuals' avoidance and isolation, and increase their engagement in activities that have been shown to improve mood ( e.g. exercising or going out for dinner ) which in turn decreases depressive symptoms and reinforces these activities
75
evaluate CBT as a treatment for depression
-one strength is evidence of its effectiveness
-one limitation is its lack of suitability for a diverse range of clients
-another limitation is its high relapse rates
-another limitation is that it's not preferred by clients
76
why is it a strength that there is evidence of CBT's effectiveness?
-E = March et al. ( 2007 ) studied 327 depressed adolescents and found that after 36 weeks, 81% of the CBT group, 81% of the antidepressants group and 86% of the CBT plus antidepressants group were significantly improved
-also, CBT is usually a fairly brief therapy requiring 6 to 12 sessions, making it cost-effective
-E = this suggests that CBT is just as effective as antidepressants when used on its own, and even more so when used alongside antidepressants, meaning that CBT is widely seen as the first choice of treatment for depression in public healthcare systems like the NHS
77
why is it a limitation that CBT lacks suitability for a diverse range of clients?
-E = in severe cases, depressed clients may not be able to motivate themselves to engage with the cognitive work of CBT or even pay attention in a session, and Sturmey ( 2005 ) suggests that any form of psychotherapy ( e.g. CBT ) is not suitable for people with learning disabilities due to the complex rational thinking involved
-E = this means that CBT may only be appropriate for a specific range of people with depression, reducing its universal effectiveness and usefulness
78
why is it a limitation that CBT has high relapse rates?
-E = few early studies of CBT for depression looked at long-term effectiveness and more recent ones suggest that relapse is common, e.g. Ali et al. ( 2017 ) assessed depression in 439 clients every month for 12 months following a course of CBT and found that 42% relapsed within 6 months of ending treatment and 53% within a year
-E = this means that CBT may need to be repeated periodically in order to effectively treat depression
79
why is it a limitation that CBT isn't preferred by clients?
-E = although there is a large body of evidence to show that CBT is highly effective in tackling depressive symptoms ( at least in the short term and when used appropriately ), some clients prefer to take medication or explore their past trauma and rate CBT as their least preferred therapy ( Yrondi et al. 2015 )
-E = this suggests that depressed people should have the right to choose their therapy even if it may not be the one with the best evidence of effectiveness
80
what is meant by the biological approach?
-a perspective that emphasises the importance of physical processes in the body such as genetic inheritance and neural function
81
what are the two biological approaches to explaining OCD?
-genetic explanations = the view that physical and psychological characteristics ( such as mental disorders ) are inherited / transmitted from parents to offspring
-neural explanations = the view that characteristics are determined by the behaviour of the nervous system, in particular the brain as well as individual neurons
82
what is the genetic explanation of OCD?
-genes are involved in individual vulnerability to OCD, e.g. Lewis ( 1936 ) observed that of his OCD patients, 37% had parents with OCD and 21% had siblings with OCD
-researchers have identified specific genes which create a vulnerability for OCD ( called candidate genes ), including serotonin genes ( e.g. 5HT1-D beta ) which are involved in the transmission of serotonin across synapses and dopamine genes, both of which are neurotransmitters believed to have a role in regulating mood
-OCD is caused by a combination of genetic variations that together significantly increase vulnerability ( i.e. polygenic ), e.g. Taylor ( 2013 ) found evidence that up to 230 different genes may be involved in OCD
-the origins of OCD vary from one person to another ( etiologically heterogeneous ), so one group of genes may cause OCD in one person but a different group of genes may cause the disorder in another person
-there is also evidence that different types of OCD may be the result of particular genetic variations, such as hoarding disorder and religious obsession
83
what does the diathesis-stress model suggest about OCD?
-people gain a vulnerability to OCD through genes, but an environmental stressor ( such as a stressful event, e.g. bereavement ) is also required to trigger the condition
84
evaluate the genetic explanation of OCD
-one strength is the strong evidence base
-one limitation is the existence of environmental risk factors
85
why is it a strength that there is a strong evidence base for the genetic model of OCD?
-E = Nestadt et al. ( 2010 ) reviewed twin studies and found that 68% of identical ( MZ ) twins shared OCD as opposed to 31% of non-identical ( DZ ) twins, and family studies such as Marini and Stebnicki ( 2012 ) found that a person with a family member with OCD is around 4 times as likely to develop it as someone without
-E = this means that people who are genetically similar are more likely to share OCD, suggesting that there must be some genetic influence on the development of OCD
86
why is it a limitation that there are also environmental risk factors that trigger or increase the risk of OCD?
-E = Cromer et al. ( 2007 ) found that over half of the OCD clients in their sample had experienced a traumatic event in their past, and OCD severity correlated positively with the number of traumas
-E = this means that genetic vulnerability only provides a partial explanation for OCD
87
what is the neural explanation of OCD?
-the genes associated with OCD are likely to affect the levels of key neurotransmitters as well as structures of the brain ( neural explanations )
-if a person has low levels of the neurotransmitter serotonin, normal transmission of mood-related information doesn't take place and mood ( along with other mental processes ) is affected due to a reduction in the functioning of the serotonin system in the brain
-some cases of OCD, and in particular hoarding disorder, seem to be associated with impaired decision-making, which in turn may be associated with abnormal functioning of the lateral frontal lobes of the brain as these are responsible for logical thinking and making decisions
-there is also evidence to suggest that the left parahippocampal gyrus, associated with processing unpleasant emotions, functions abnormally in OCD
88
evaluate the neural explanation of OCD
-one strength is supporting evidence
-one limitation is that the serotonin-OCD link may not be unique to OCD
-another limitation is that correlation doesn't imply causation
89
why is it a strength that there is supporting evidence for the neural model?
-E = antidepressants that work purely on serotonin are effective in reducing OCD symptoms, which suggests that serotonin may be involved in OCD
-also, OCD symptoms form part of conditions that are known to be biological in origin, such as Parkinson's disease ( Nestadt et al. 2010 )
-E = this means that biological factors ( e.g. serotonin and processes underlying Parkinson's disease ) are also likely to be involved in / responsible for OCD
90
why is it a limitation that the serotonin-OCD link may not be unique to OCD?
-E = many people with OCD also experience clinical depression ( co-morbidity ), which involves disruption to the action of serotonin, so it could simply be that serotonin activity is disrupted in many people with OCD because they are depressed as well
-E = this means that serotonin may not be relevant to OCD symptoms
91
why is it a limitation of the neural model that correlation doesn't imply causation?
-E = some neural systems don't work normally in people with OCD, which the biological model suggests is explained by brain dysfunction causing the OCD
-however, this is just a correlation which doesn't necessarily indicate a casual relationship between neural abnormality and OCD as the disorder may be influenced by a third factor
-E = this means that there is a lack of strong evidence for a neural basis to OCD, though correlations may eventually lead us to a cause
92
what is the biological approach to treating OCD?
-drug therapy = treatment involving drugs ( chemicals ), which aims to increase or decrease levels of neurotransmitters in the brain to increase / decrease their activity
-low levels of serotonin are associated with OCD, so drugs to treat OCD work in various ways to increase the level of serotonin in the brain
93
what is the standard medical treatment used to tackle the symptoms of OCD?
-a type of antidepressant drug called selective serotonin reuptake inhibitors ( SSRIs )
-in the brain, serotonin is released from synaptic vesicles in the presynaptic neuron and diffuses across the synaptic cleft to the postsynaptic neuron where it is reabsorbed, broken down and reused
-by preventing the reabsorption and breakdown of serotonin in the brain, SSRIs effectively increase its levels in the synapse and thus serotonin continues to stimulate the postsynaptic neuron, which compensates for whatever is wrong with the serotonin system in OCD
-the typical daily dosage of fluoxetine ( an SSRI, e.g. brand name Prozac ) is 20 mg, although this may be increased ( e.g. to 60 mg a day ) if it's not benefiting the person
-the drug is available as capsules or liquid, and it takes 3 to 4 months of daily use for SSRIs to have much impact on symptoms
94
how can drugs be used alongside other treatments to treat OCD?
-SSRIs are often combined with CBT because the drugs reduce a person's emotional symptoms ( such as feeling anxious or depressed ), meaning that they can engage more effectively with the CBT
95
what are some alternatives to SSRIs?
-where an SSRI is not effective after 3 to 4 months, the dose can be increased or it can be combined with other drugs
-tricyclics ( an older type of antidepressant ) are sometimes used, such as clomipramine, which have the same effect on the serotonin system as SSRIs but the side-effects can be more severe, so it is generally kept in reserve for people who don't respond to SSRIs
-also, a different class of antidepressant drugs called SNRIs ( serotonin-noradrenaline reuptake inhibitors ) have more recently been used as a second line of defence for people who don't respond to SSRIs since they increase levels of serotonin as well as another neurotransmitter, i.e. noradrenaline, that plays a role in regulating stress responses in the brain
96
evaluate drug treatment for OCD
-one strength is good evidence for its effectiveness
-another strength is that drugs are cost-effective and non-disruptive
-one limitation is that drugs can have potentially serious side-effects
-another limitation is biased evidence for the effectiveness of drugs
97
why is it a strength that there is good evidence for the effectiveness of drug therapy?
-E = Soomro et al. ( 2009 ) reviewed 17 studies that compared SSRIs to placebos in the treatment of OCD and they all showed significantly better outcomes following SSRIs than placebos
-typically OCD symptoms reduce for around 70% of people taking SSRIs, and for the remaining 30%, most can be helped by either alternative drugs or combinations of drugs and psychological therapies
-E = this means that drugs appear to be helpful for most people with OCD
-counterpoint = although drug treatments may be better than placebos, they may not be the most effective treatments available, e.g. cognitive behavioural ( exposure ) therapies may be more effective than SSRIs in the treatment of OCD ( Skapinakis et al. 2016 ), meaning that drugs may not be the optimum treatment for OCD
98
why is it a strength that drugs are cost-effective and non-disruptive?
-E = drug treatments are cheap compared to psychological treatments because many thousands of tablets or liquid doses can be manufactured in the time it takes to conduct one session of a psychological therapy, so using drugs to treat OCD is good value for the NHS
-also, SSRIs are non-disruptive to people's lives because if you wish you can simply take drugs until your symptoms decline rather than spending time attending therapy sessions
-E = this means that many doctors and people with OCD prefer drug treatments
99
why is it a limitation that drugs can have potentially serious side-effects?
-E = a small minority of people taking SSRIs get no benefit and some people experience usually temporary but quite distressing side-effects such as indigestion, blurred vision and loss of sex drive
-for those taking clomipramine, side-effects are more common and can be more serious, e.g. more than 1 in 10 people experience erection problems and weight gain, and 1 in 100 become aggressive and experience heart-related problems
-E = this means that some people have a reduced quality of life as a result of taking drugs and may stop taking them altogether, reducing the effectiveness of the treatment
100
why is it a limitation that evidence for the effectiveness of drugs is biased?
-E = some psychologists believe that the evidence for drug effectiveness is biased because researchers are sponsored by drug companies and so may selectively publish positive outcomes for the drugs their sponsors are selling ( Goldacre 2013 )
-E = this means that we may not be able to trust the evidence for the effectiveness of drugs, invalidating their support
