psychopathology Flashcards
(72 cards)
1
Q
what is a social norm? (psychopathology)
A
- a shared standard or expectation of behaviour within a group or society
2
Q
what is deviation from social norms? (psychopathology)
A
- concerns behaviour that is different from the accepted standards of behaviour within a community or society
3
Q
what can happen to social norms across different generations & cultures? (2) (psychopathology)
A
- social norms may be different across different generations & cultures
- there are few behaviours that care considered to be universally abnormal in the basis that they breach social norms
4
Q
outline antisocial personality disorder as an example of deviation from social norms (5) (psychopathology)
A
- people with APD (psychopathy) are impulsive, aggressive & reckless
- DSM-5 states one important symptom (for diagnosis) is an ‘absence of pro social internal standards associated with failure to conform to lawful & culturally normative ethical behaviour’
- diagnosis ranges on a spectrum
- psychopaths deviate from social norms because they don’t conform to moral standards
- psychopathic behaviour is considered to be abnormal in a wide range of cultures
5
Q
evaluate deviation from social norms as a definition of abnormality (2) (psychopathology)
A
real world application (S):
- DFSN is used in clinical practice
- e.g. antisocial personality disorder has a key defining characteristic of the failure to conform to culturally acceptable ethical behaviour, & sings of the disorder are all deviations from social norms (e.g. recklessness, aggression, irresponsibility)
- also play a part in diagnosis of schizotypal personality disorder, where the term ‘strange’ is used to characterise the thinking, behaviour, & appearance of people with the disorder
- this shows that the DFSN criterion has value in psychiatry, & therefore has high credibility & ecological validity
cultural & situational realism (W):
- variability between social norms & different cultures/situations
- a person from one cultural group may label someone from another cultural group as abnormal using their standards & not the other person’s standards
- e.g. hearing voices is the norm (as messages from ancestors) in some cultures, but would be seen as a sign of abnormality in others
- even within one cultural context social norms can differ between situations
- e.g. aggressive/deceitful behaviour is more socially unacceptable in the context of family life than in the context of corporate deal making
- this means that it is difficult to judge deviation from social norms across different situations & cultures, decreasing its external validity
6
Q
what is statistical infrequency? (psychopathology)
A
- occurs when an individual has a less common characteristic than the majority
7
Q
how is statistic infrequency a definition of abnormality? (psychopathology)
A
- a person’s traits, thinking or behaviour is classed as abnormal if they are rare or statistically unusual
8
Q
outline IQ & intellectual disability disorder as an example of statistical infrequency (5) (psychopathology)
A
- the normal distribution curve puts the mean IQ at around 100
- in a normal distribution, 68% of the population have an IQ score between 85 & 115 (within 1 standard deviation of the mean)
- 96% have an IQ score between 70 & 130 (within 2 standard deviations of the mean)
- only 4% have an IQ below 70 or above 130
- those in the 2% with an IQ below 70 are considered ‘abnormal’ & may receive a diagnosis of intellectual disability disorder
9
Q
evaluate statistical infrequency as a definition of abnormality (2) (psychopathology)
A
real world application:
- used in clinical practice as part of a formal diagnosis & as a way to assess severity of an individual’s symptoms
- e.g. a diagnosis of intellectual disability disorder required an IQ of below 70 (bottom 2% of the population)
- an example of statistical infrequency used in an assessment tool is the Beck depression inventory (BDI), where a score of 30+ (top 5% of respondents) is interpreted as indicating severe depression
- shows the value of SI criterion is useful in diagnostic & assessment processes, therefore it has high credibility & ecological validity
universal characteristics can be positive:
- infrequent characteristics can be positive as well as negative
- for every person with an IQ below 70, there is a person with an IQ above 130 - but we wouldn’t typically think of someone as abnormal for having a high IQ
- similarly, we wouldn’t think of someone with a very low depression score on the BDI as being abnormal
- these show that being unusual, or at one end of the psychological spectrum, doesn’t necessarily make someone abnormal
- this mean that (although statistical infrequency can form part of assessment & diagnostic procedures), it is never sufficient as the sole basis for defining abnormality, therefore it has decreased validity
10
Q
outline the characteristics proposed by Rosenhan & Seligman (1989) for when someone isn’t coping (3) (psychopathology)
A
- when a person no longer conforms to standard interpersonal rules (e.g. maintaining eye contact or personal space)
- when a person experiences severe personal distress
- when a person’s behaviour becomes irrational or a danger to themselves/others
11
Q
outline failure to function adequately as a definition of abnormality (2) (psychopathology)
A
- occurs when someone is unable to cope with ordinary demands of day-to-day life
- this may be because a person is unable to maintain basic standards of nutrition/hygiene or because they can’t maintain a job or fulfilling relationships
12
Q
outline intellectual disability disorder as an example of FFA (2) (psychopathology)
A
- one of the criteria for diagnosis is a very low IQ (statistical infrequency)
- a diagnosis wouldn’t be made on this basis alone, so an individual must also be failing to function adequately before a diagnosis would be given
13
Q
evaluate failure to function adequately as a definition of abnormality (2) (psychopathology)
A
represents a threshold for help:
- represents a sensible threshold for when people may need professional help
- according to mental health charity Mind, 25% of people in the UK will experience a metal health problems in any given year
- however, many people don’t seek professional help even when they are experiencing severe symptoms
- it tends to be that when we stop being able to function adequately people seek professional help, or are noticed & referred for help by others
- this criterion means that treatment serviced can be targeted to those who need them most
discrimination & social control:
- it is easy to label non-standard lifestyle choices as abnormal
- it may be hard to say when someone is failing to function adequately & when they have just chosen to deviate from social norms
- e.g. not having a job/permanent address my seem like failure to function for some but not for others
- also, people who take part in high risk leisure activities may be labelled a danger to themselves
- this means that people who make unusual choices are at risk of being labelled abnormal & their freedom of choice may be restricted
14
Q
outline deviation from ideal mental health as a definition of abnormality (4) (psychopathology)
A
- occurs when someone doesn’t meet a set of criteria for good mental health
- defines what is ‘normal’ or ‘ideal’ & regards anything that deviates from this as abnormal
- the more a person deviates from the criteria, the more abnormal they are considered
- there can be overlap between deviation from ideal mental health & failure to function adequately
15
Q
outline & explain Jahoda (1958) criteria for ideal mental health (6) (psychopathology)
A
- positive view of self —> involves self awareness & self-esteem
- personal growth & development —> developing talents, goals & ambitions
- autonomy —> are independent & able to make decisions
- accurate view of reality —> possess an objective & realistic outlook on life/reality
- resistance to stress —> are able to cope with everyday anxiety-provoking situations
- environmental mastery —> can meet the demands of situations & adapt to changes in life circumstances
16
Q
evaluate deviation from ideal from ideal mental health as a definition of abnormality (2) (psychopathology)
A
comprehensive definition:
- ideal mental health criterion is highly comprehensive
- Jahoda’s concept of ‘ideal mental health’ includes a range of criteria for distinguishing between mental health & mental disorder
- it covers most of the reasons why we may seek help for mental health
- this means that an individual’s mental health can be discussed meaningfully with a range of professionals who may have different theoretical views
- this means that ideal mental health provides a checklist against which we can assess ourselves & others & discuss psychological issues with a range of professionals
may be culture bound:
- different elements of the criterion aren’t equally applicable across a range of cultures
- some of Jahoda’s criteria is based on western cultures’ ideas (e.g. US & Europe) & reflects western ideas of individualism
- in some parts of the world, self actualisation would be considered to be self indulgent
- even within Europe there is variation in the value placed on personal independence
- also, the definition of success in working, social & love lives may be different in different cultures
- this means that it is difficult to apply the concept of ideal mental health from one culture to another, so it has low external validity
17
Q
what is a phobia? (psychopathology)
A
- an irrational fear of an object or situation that causes intense anxiety
18
Q
state & define the 3 types of phobia, including examples (psychopathology)
A
- specific phobia: phobia of an object (e.g. animal or body part) or a situation (e.g. flying)
- social phobia: (social anxiety) phobia of an object social situation (e.g. public speaking)
- agoraphobia: phobia of being outside or in a public space
19
Q
outline & explain the 3 behavioural characteristics of phobias (psychopathology)
A
panic:
- a person with a phobia may panic in response to the presence of the phobia stimulus
- panic may involve a range of behaviours such as crying, screaming or running away
- children may react differently, e.g. by freezing, clinging or having a tantrum
avoidance:
- unless the person is making a conscious effort to face their fear, they tend to avoid coming into contact with the phobic stimulus
- this can make it hard to go about daily life
endurance:
- alternative behavioural response to avoidance
- occurs when the person chooses to remain in the presence of the phobic stimulus
20
Q
outline & explain the 3 emotional characteristics of phobias (psychopathology)
A
anxiety:
- phobia are classes as anxiety disorders
- by definition they involve an emotional response of anxiety (an unpleasant state of high arousal)
- this prevents a person relaxing & makes it very difficult to experience any positive emotion
- anxiety can be long term
fear:
- fear & anxiety have distinct meanings
- fear is the immediate & unpleasant response experienced when we encounter or think about a phobic stimulus
- it is usually more intense than anxiety but is experienced for shorter periods of time
emotional response is unreasonable:
- the anxiety or fear is greater than is ‘normal’ & disproportional to any threat posed
- the majority of people would respond in a less anxious way to the same phobic stimulus
21
Q
outline & explain the 3 cognitive characteristics of phobias (psychopathology)
A
selective attention to phobic stimulus:
- is a person can see the phobic stimulus, it is hard to look away from it
- keeping our attention on something dangerous is good as it gives us the best chance of reacting to a threat, but this is not useful when the fear is irrational
irrational beliefs:
- a person with a phobia may have unfounded thoughts in relation to the phobias stimuli (ie that can’t be easily explained & don’t have any basis in reality)
- this kind of belief increases the pressure on the person to perform well in social situations
cognitive distortions:
- the perceptions of a person with a phobia tend to be inaccurate & unrealistic
- may become debilitating if severe
22
Q
outline the two process model as proposed by Mowrer (1960) (2) (psychopathology)
A
- behvaioural approach focuses on explaining characterstics of phobias
- two process model states that phobias are aqcuired by classical conditioning & maintained by operant conditioning
23
Q
outline Mowrer (1960)s proposal on how phobias are acquired by classical conditioning (9) (psychopathology)
A
- we learn to accociate something we initally have no fear of (NS) with smething that already triggers a fear response (UCR)
- Watson & Rayner (1920) created a phobia in 9 month old ‘Little Albert’
- Albert was shown a white rat, which he went to play with
- whenever he tried to play with the rat researchers made a loud baning noise next to his ear
- UCS (noise) —> UCR (fear)
- NS (white rat) + UCR (noise) —> UCR (fear)
- CS (white rat) —> CR (fear)
- conditioning is generalised to similar objects
- Little Albert displayed distress as the sight of other white & fluffy objects
24
Q
outline Mowrer (1960)s proposal on how phobias are maintained by operant conditioning (3) (psychopathology)
A
- explained phobias as being long term via operant conditioning
- suggested that whenever we avoid a phobic stimulus we escape the fear & anxiety we would’ve experienced if we stayed in the presence of it
- this reduction in fear negatively reinforced the avoidance behaviour (as unpleasant situation is escaped), so the phobia is maintained
25
give 2 strengths of the two process model (psychopathlogy)
real world application:
- real world application in exposure therapies (e.g. systematic desensitisation)
- distinctive element of two process model is the idea that phobias benefit from exposure to the phobic stimulus
- once the avoidance behaviour is prevented, it stops being reinforced (by the experience of anxiety reduction) & therefore avoidance decreases
- in behvaioural terms, the phobia is the avoidance behaviour so when this avoidance is prevented, the phobia is cured
- this shows the value of the two process model approach because it identifies a means of treating phobias
- high external & ecological validity
phobias & traumatic experience:
- evidence for link between bad experiences & phobias
- Little Albert study shows how a frightening experience involving a stimulus can lead to a phobia of that stimulus
- Ad De Jongh (2006) found 73% of people with a fear of the dentist had a traumatic experience (mostly involving dentistry)
- this can be compared to a control group with low dental anxiety where only 21% had a traumatic experience
- this condirms that the asociated between stimulus (dentistry) & an UCR (pain) leads to the development of a phobia
- high external validity
26
give 2 weaknesses of the two process model (psychopathology)
cognitive aspects of phobias:
- two process model doesn’t account for cognitive aspects
- behavioural explanations are geared towards explaining behvaiour (in case of phobias key behvaiour is avoidance of the phobic stimulus)
- however phobias aren’t just avoidance responses & also have a significant cognitive component
- e.g. epople hold irrational beliefs that a phobic stimulus is dangerous, even if it isn’t
- the two process model explains avoidance behvaiour but doesn’t offer an adequate explanation for phobic cognitions
- this means that the two process model doesn’t completelt explain the symptoms of phobias
- lacks external validity
phobias & traumatioc expereinces CP:
- not all phobias appear following a bad experience
- a few common pjobias (e.g. snakes) occur in populations where few people have any experience with snakes, let alone a traumatic one
- also not all frightening experiences lead to the development of a phobia
- this means that the association between phobias & frightening experiences is not as string as we would expect if behvaioural theories provided a compele explanation
- lacks external validity
27
what is systematic desensitisation? (4) (psychopathology)
- behavioural rherapy designed to gradually reduce phobic anxiety through classical conditioning
- if a person can learn to relax in the presence of the phobic stimulus, they will be cured
- a new response to the phobic stimulus is learned )phobic stimulus is paired with relaxation instead of anxiety
- this is counterconditioning
28
outline & explain the 3 processes involved in systematic desensitisation (psychopathology)
the anxiety hierarchy:
- list put together by client & therapist related to the phobic stimulus of things that provoke anxiety, from least to most frightening
relaxation:
- therapist teaches client relaxation techniques
- it is impossible to experience anxiety & be calm at the same time, so one counteracts the other (reciprocal inhibition)
- e.g. breathing techniwues, anti-anxiety medication or meditation
exposure:
- client is exposed to phobic stimulus while they are in a relaxed state
- this takes place across multiple sessions & start at the bottom of the anxiety hierarch
- when the client can stay relaxed in the lower levels of the phobic stimulus they move up the anxiety hierarchy
- treatment is successful when the client can stay relaxed in situations high on the anxiety hierarchy
29
state 2 strengths of systematic desensitisation as a treatment for phobias (psychopathology)
evidence of effectiveness:
- Gilroy et al (2003) followed up 42 people who had systematic desensitisation for a spider phobia in 3 45 minute therapy sessions
- at both 3 & 33 moths the SD group was less fearful than a control group treated by relaxation without exposure
- Wechsler et al (2019) concluded that SD is effective for specific phobia, social phobia & agoraphobia
- this means that SD is likely to be helpful for people with phobias
learning disabilities:
- some people requiring treatment for phobias may also have a learning disability, however the main alternatives to SD aren’t suitable
- people with learning disabilities often struggle with cognitive therapies that require complex & rational thought
- they may also feel confused & distressed by the traumatic experience of flooding
- this means that SD is often the most appropriate treatment for people with learning disabilities who have phobias
30
what is flooding? (2) (psychopathology)
- involved the immediate exposure to the phobic stimulus
- sessions are typically longer than systematic desensitisation sessions but only one session may be needed to cure a phobia
31
how does flooding work as a treatment for phobias? (3) (psychopathology)
- stops phobic responses quickly because the client learns the phobic stimulus is harmless (as there is no option for avoidance - extinction)
- learned response is changed when the CS is encountered without the UCS, resulting in the CS no longer producing the CR
- relaxation may be achieved due to exhaustion
32
is flooding ethical? (2) (psychopathology)
- is an unpleasant experience so it is important clients give fully informed consent & are fully prepared before the flooding session
- a client would normally be given the choice of systematic desensitisation or flooding
33
evaluate flooding as a treatment for phobias (psychopathology)
cost effective (S):
- clinical effectiveness is how effective a therapy is at tackling symptoms
- when we provide therapies via health systems like the NHS we also need to think about how much they cost
- a therapy is cost effective if it is clinically effective & not expensive
- flooding can take only 1 session whereas SD may need 10 sessions to achieve the same result
- even allowing for a longer session makes it cost effective
- means that more people can be treated at the same cost with flooding than with SD or other therapies
traumatic (W):
- highly unpleasant experience
- confronting a phobic stimulus provokes extreme anxiety
- Schumacher et al (2015) found Ps & therapists rated flooding as significantly more stressful than SD
- this raises ethical issues of knowingly causing stress to clients (not as serious if informed consent is obtained)
- traumatic nature means attrition/drop out rates are higher than for SD
- suggests that overall, therapists may avoid using this as treatment as it may be deemed unethical to do so
34
what is depression? (psychopathology)
- a mental disorder characterised by low mood & low energy levels
35
state & define the 4 categories of depressive disorder (psychopathology)
- major depressive disorder: severe but often short term depression
- persistent depressive disorder: long term or recurring depression, including sustained major depression
- disruptive mood dysregulation disorder: childhood temper tantrums
- prementrual dysphoric disorder: disruption to mood prior to &/or during menstruation
36
outline & explain 3 behavioural characteristics of depression (psychopathology)
activity levels:
- typically people have reduced levels of energy, making them lethargic
- has an effect as people tend to withdraw from work, education & their social life
- in extreme cases can lead to someone not being able to get out of bed
- in some cases it can lead to the opposite effect (psychomotor agitation) where agitated individuals struggle to relax & may end up pacing up & down a room
disruption to sleep & eating behaviour:
- associated with changes to sleeping behaviour
- someone may experience reduced sleep (insomnia) or an increased need for sleep (hypersomnia)
- appetite may increase or decrease, easing to weight gain or loss
- such behaviours are disrupted by depression
aggression & self-harm:
- people are often irritable & may become verbally & physically aggressive
- this can have serious effects on several aspects of daily life (e.g. may display verbal aggression by ending a relationship or quitting a job)
- can also lead to physical aggression against self (e.g. self-harm in the form of cutting or suicide attempts)
37
outline & explain 3 emotional characteristics of depression (psychopathology)
lowered mood:
- lowered mood is a defining emotional element of depression, but it is more pronounced than daily experiences of feeling lethargic & sad
- people often describe themselves as ‘worthless’ & ‘empty’
anger:
- experience of negative emotions to people with depression isn’t just limited to sadness
- people can also frequently experience anger or extreme anger, directed towards self or others
- these emotions can lead to aggressive or self-harming behaviour
lowered self-esteem:
- self-esteem is the emotional experience of how much we like ourselves
- people with depression tend to report reduced self-esteem (like themselves less than usual)
- this can be quite extreme, with come people describing a sense of self-loathing
38
outline & explain 3 cognitive characteristics of depression (psychopathology)
poor concentration:
- depression is associated with poor levels of concentration
- the person may find themselves unable to stick to a task they usually would, or may find it hard to make decisions they would usually find straight forward
- poor concentration & poor decision-making are likely to interfere with the individual’s work
attending to & dwelling on the negative:
- when experiencing a depressive episode people are inclined to pay more attention to negative aspects of a situation & ignore the positives
- they may also have a bias towards recalling unhappy events rather than happy ones
absolutist thinking:
- people tend to think a situation is either ‘all good’ or ‘all bad’
- sometimes called ‘black & white thinking’
- means that when a situation is unfortunate they tend to see it as an absolute disaster
39
explain faulty information processing as a part of Beck (1967) proposal of cognitive vulnerability (2) (psychopathology)
- depressed people focus on the negative aspects of a situation & ignore the positives
- depressed people may tend to towards ‘black & white’ thinking (where something is either all good or all bad)
40
explain negative self-schema as a part of Beck (1967) proposal of cognitive vulnerability (3) (psychopathology)
- schema = collection of ideas & info that are developed through experience
- self-schema = collection of info that people have about themselves
- people use schemas to interpret the world & sensory info, so if a person has a negative self-schema they interpret all info about themselves in a negative way
41
outline & explain Beck’s negative triad (5) (psychopathology)
- part of proposal of cognitive vulnerability
- suggested that a person develops a dysfunctional view of themselves because of 3 types of negative thinking that occur automatically
- 1 = negative view of the world (this creates an impression that there is no hope anywhere)
- 2 = negative view of the future (thoughts reduce any hopefulness & can enhance depression)
- 3 = negative view of self (thoughts can enhance any depressive feelings because they confirm the existing emotions of low self-esteem)
42
state & explain 2 cognitive biases (3) (psychopathology)
- caused by negative triad
- personalisation = blaming yourself/taking responsibility for something that wasn’t your fault
- jumping to conclusions = (mind reading - imagining we know what others think), (fortune telling - trying to predict the future)
43
outline the aim, procedure & findings of Beck et al (1974) (12) (psychopathology)
aim:
- to understand cognitive distortions on patients with depression
procedure:
- 50 patients diagnosed with depression (16 men & 34 women) of upper/middle classes & average intelligence
- independent design
- matched with 31 non-depressed patients undergoing therapy
- matched on age, sex & social status
- face-to-face interviews & retrospective reports of patients thoughts recorded before & during therapy sessions
- some patients kept diaries & brought them to therapy sessions
- record kept of non-depressed patients verbalisations
findings:
- themes appeared in depressed patients that didn’t appear in non-depressed patients (e.g. low self-esteem, self-blame, overwhelming responsibilities & anxiety)
- depressed patients had stereotypical responses to situations even when inappropriate (e.g. feeling inferior if a passer by didn’t smile at them)
- depressed patients regarded themselves as inferior in intelligence & attractiveness compared to other in their social/occupational groups
- these distortions tended to be automatic, persistent & involuntary
44
outline the 3 stages of Ellis (1962) ABC model (7) (psychopathology)
A - activating event:
- focused on situations where irrational thoughts are triggered by external events
- according to Ellis, we get depressed when we experience negative events, & these trigger irrational beliefs
B - beliefs:
- Ellis identified a range of irrational beliefs that are about the activating event
- ‘mursturbation’ = the belied that we must always succeed or achieve perfection
- ‘utopianism’ = the belief that life is always meant to be fair
C - consequences:
- consequences of the beliefs
- when an activating event triggers irrational beliefs, there are emotional & behavioural consequences
45
outline 2 strengths for Beck’s negative triad (psychopathology)
research support:
- ‘cognitive vulnerability’ = ways of thinking that may predispose an individual to becoming depressed
- Clark & Beck (1999) concluded that not only were cognitive vulnerabilities more common in depressed people, but they preceded the depression
- this was confirmed by a more recent prospective study by Cohen et al (2019), who found that showing cognitive vulnerability predicted later depression
- this shows that there is an association between cognitive vulnerability & depression, so the explanation has high external validity
real-world application:
- has application in screening & treatment for depression
- Cohen et al (2019) concluded that assessing cognitive vulnerability allows psychologists to screen young people & identify those most at risk of developing depression in the future (so they can be monitored)
- understanding cognitive vulnerability can also be applied in CBT
- these therapies work by altering the kind of cognitions that make people vulnerable to depression, making them more resilient to negative life events
- this means that an understanding of cognitive vulnerability is useful in several aspects of clinical practice, so it has high ecological validity
46
evaluate Ellis’ ABC model (2) (psychopathology)
real world application:
- application int he psychological treatment of depression
- Ellis’ approach to cognitive therapy = rational emotive behaviour therapy (REBT)
- idea of REBT is that by vigorously arguing with a depressed person the therapist can alter the irrational beliefs that are making them unhappy
- there is some evidence to support the idea that REBT can both change negative beliefs & relieve the symptoms of depression (David et al 2018)
- this means REBT has real-world value, so they ABC model has high ecological validity
reactive & endogenous depression:
- ABC model only explains reactive depression & not endogenous depression
- some cases where depression os triggered by a life events are sometimes called reactive depression
- however, many cases of depression aren’t traceable to a life events are & it isn’t obvious what leads a person to become depressed at a particular time
- this type of depression os sometimes called endogenous depression
- this means that Ellis’ ABC model can only explain some cases of depression & is therefore only a partial explanation, so it lacks external validity
47
outline what cognitive behavioural therapy is & explain the cognitive & behavioural elemtnts (7) (psychopathology)
- CBT: a method for treating mental disorders based on both cognitive & behvaioural techniques
- from the cogntitive viewpoint it aims to deal with thinking (such as challenging negative thoughts)
- it also includes behavioural techniques such as behavioural action
cognitive element:
- begins with as assessment in which the client & the cogntitve behavioural therapist work together to clarify the client’s problems
- the jointly identify goals for therapy & put together a plan to achieve them
- one central task is to identify where there might be negative or irrational thoughts that will benefit from challenge
behavioural element:
- then involves working to change negative & irrational thoughts & put more effective behaviours into play
48
outline Beck’s cognitive therapy as a treatment for depression (4) (psychopathology)
- idea is to identify automatic thoughts about the world, self & future (negative triad)
- once identifies, these thoughts must be challanged (this is a central component of the therapy)
- also aims to help clients test the reality of their negative beliefs
- yhey might therefore be set homework to investigate the reality of their views
49
outline Ellis’ REBT as a treatment for depression (7) (psychopathology)
- rational emotive behaviour therapy
- extends ABC model to ABCDE model
- D = dispute, E =2.718 effect
- central technique is to identify & dispute/challenge irrational thoughts
- therapist challenges clients irrational beliefs, leading to a dispute between them
- intended effect of argument is to change the irrational belief & therefore break the cycle between negative life events & depression
- identified different methods of disputing (emirical argument = disputing whether there is actual evidence to support a negative view, logical argument = disputing whether the negative thought follows from the facts)
50
outline behavioutal activation as a treatment for depression (3) (psychopathology)
- as individuals become depressed, they tend to avoid difficult situations & become isolated, which maintains or worsens symptoms
- goal is to work with depressed individuals to gradually decrease their avoidance & isolation, & increase their engagement in activities that have been proven to improve mood
- therpaist aims to reinforce these activities
51
outline 2 strengths of CBT as a treatment for depression (psychopathology)
evidence for effectiveness:
- evidence for effectiveness in treating depression
- March et al (2007) compared CBT to antidepressant drugs & a combination of both treatments when treating 327 depressed adolescents
- after 36 weeks, 81% CBT group, 81% of antidepressant group & 86& of combination group were significantly improved
- this means that CBT was jsut as effective when used on its own & even more effective when used alongside antidepressants
- CBT is also usually a fairly brief therapy (only requiring 6-12 sessions) & therefore it is cost-effective
- this means that CBT is widely seen as the first choice of treatment in public health care systems like the NHS, so it has high external validity as a treatment
suitability for diverse clients CP:
- there si some evidence that challenges the idea that CBT is unsuitable for very depressed people & people with learning disabilities
- a review by Lewis & Lewis (2016) concluded that CBT was as effective as antidepressant drugs & behavioural therapies for severe depression
- another review by Taylor et al (2008) concluded that when used effectively, CBT is effective for people with learning disabilities
- this means that CBT may be suitable for a wider range of people than was once thought, therefore it is a valid & credible treatment for depression
52
outline 2 weaknesses of CBT as a treatment for depression (psychopathology)
suitability for diverse clients:
- lack of effectiveness for severe cases & clients with learning disabilities
- in some cases depression can be so severe that client’s can’t motivate themselves to engage with the cognitive work of CBT
- it also seems likely that the complex rational thinking involved in CBT makes it unsuitable for treating depression in clients with learning disabilities
- Sturmey (2005) suggests that any form of psychotherapy (e.g. talking therapies) isn’t suitable for people with learning disabilities (this includes CBT)
- means that CBT may not be a valid treatment as it may only be appropriate for a specific range of people with depression
relapse rates:
- although CBT is quite effective in tackling symptoms of depression, there are concerns over how long the benefits last
- recent studies show that long-term outcomes aren’t as good as has been assumed
- e.g. Ali et al 92017) assessed depression in 439 clients every month for 12 months after a course of CBT
- 42% of clients relapsed into depression within 6 months of ending treatment & 53% had relapsed within a year
- means CBT may need to be released periodically, decreasing its cost-effectiveness & validity as a treatment for depression
53
what is OCD? (2) (psychopathology)
- disorder characterised by either depression (recurring thoughts or images) &/or compulsions (repetitive behaviours like handwashing)
- most people with. diagnosis of OCD have both obsessions & compulsions
54
outline & explain 3 disorders related to OCD (psychopathology)
- trichotillomania: compulsive hair pulling
- hoarding disorder: compulsive gathering of possessions & the inability to part with anything, regardless of its value
- excoriation disorder: compulsive skin picking
55
outline & explain 3 behavioural characteristics of OCD (psychopathology)
compulsions are repetitive:
- people feel compelled to repeat a behaviour
- e.g. handwashing, counting, tidying etc
compulsions reduce anxiety:
- 10% of people with OCD show compulsive behaviour alone (no obsessions but have a general sense of irrational anxiety)
- compulsive behaviours are performed to reduce anxiety produced by obsessions
- e.g compulsive handwashing is a response to an obsessive fear of germs
avoidance:
- behaviour of people with OCD may be characterised by avoidance as an attempt to reduce anxiety by keeping away from situations that trigger it
- avoidance can lead to people avoiding very ordinary situations, which can interfere with leading a regular life
56
outline & explain 3 emotional characteristics of OCD (psychopathology)
anxiety & distress;
- OCD is regarded as an unpleasant emotional experience because of the powerful anxiety that accompanies both obsessions & compulsions
- obsessive thoughts are unpleasant & the anxiety that accompanies them can be very overwhelming
- the urge to repeat a behaviour creates anxiety
accompanying depression:
- OCD is often accompanied by depression, so anxiety can be accompanied by low mood & lack of enjoyment in activities
- compulsive behaviours are tends to bring some relief from anxiety but this is temporary
guilt & disgust:
- OCD is also sometimes accompanied by other negative emotions like irrational guilt (e.g. over one minor moral issue) or disgust (which may be directed towards something external, or towards self)
57
outline & explain 3 cognitive characteristics of OCD (psychopathology)
obsessive thoughts:
- for 90% of people with OCD the major cognitive feature is obsessive thoughts
- these vary from person to person but are always unpleasant
- e.g. impulses to hurt someone
cognitive coping strategies:
- people also respond by adopting cognitive coping strategies to deal with obsessions
- this may help to manage anxiety but can make the person appear abnormal to others & cane is tract them from everyday tasks
insight into obsessive anxiety:
- people with OCD are aware that their obsessions & compulsions aren’t rational (this is actually necessary for a diagnosis)
- despite this, people with OCD experience catastrophic thoughts about worst case scenarios that may result if their anxiety were justified
- they also tend to be hyper vigilant (ie keep attention focused on potential hazards & maintain constant alertness
58
briefly outline the genetic explanation for OCD (4) (psychopathology)
- genes are involved in individual vulnerability to OCD
- Lewis (1936) observed that of his OCD patients, 37% had parents with OCD & 21% has siblings with OCD
- this suggests that OCD runs in families & vulnerabiity most likely passes it from generation to generation
- the diathesis stress model suggests that certain genes leave some people for likely to develop a mental disorder, but it isn’t certain (some environmental stress is necessary to trigger the condition)
59
outline the idea of candidate genes as part of the genetic explanation for OCD (3) (psychopathology)
- researchers have identified candidate genes that create vulnerability for OCD
- some of these candidate genes are involved in regulating the development of the serotonin system
- e.g. the gene 5HTI-D beta is involved in the transport of serotonin across synapses
60
outline the idea of OCD being polygenic as part of the genetic explanation for OCD (4) (psychopathology)
- OCD is polygenic because it isn’t caused by a single gene
- is instead caused by a combination of genetic variations that together significantly increase vulnerability
- Taylor (2013) found evidence that up to 230 genes may be involved in OCD
- genes that have been studies in relation to OCD are also associated with dopamine & serotonin (neurotransmitters involved in mood regulation)
61
outline the idea of different types of OCD as part of the genetic explanation for OCD (3) (psychopathology)
- one group of genes may cause OCD in one person, but a different group of genes may cause it in another person
- this means that OCD is aetiologically heterogeneous
- there is also some evidence to suggest that different types of OCD may be the result of particular genetic variations (e.g. hoarding disorder & religious obsessions)
62
what is the basis of the neural explanation for OCD? (psychopathology)
- genes associated with OCD affect levels of neurotransmitters & key structures in the brain
63
outline the role of serotonin as part of the neural explanation for OCD (4) (psychopathology)
- serotonin is a neurotransmitter that regulates mood
- abnormally low levels of serotonin have been linked to OCD
- low serotonin means the normal transmission of mood regulated info doesn’t take place & an individual then experiences low mood
- at least some cases of OCD may be explained by a reduction in the functioning of the serotonin system in the brain
64
outline effects on decision making systems as part of the neural explanation for OCD (4) (psychopathology)
- some cases of OCD are associated with impaired decision making
- this may be associated with abnormal functioning of the lateral frontal lobes in the brain
- lateral frontal lobes are responsible for logical thinking & decision making
- there is also evidence to suggest that the left parahippocampal gyrus (which is associated with processing unpleasant emtions) also functions abnormally with OCD
65
evaluate the genetic explanations for OCD (psychopathology)
research support (S):
- there is evidence from a variety of sources that some people are vulnerable to OCD because of their genetic makeup
- one source of evidence is twin studies
- Nestadt et al (2010) reviewed twin studies & found that 68% on identical twins shard OCD compared to 31% of non-identical twins
- another source is family studies
- research has found that a person with a family member diagnosed with OCD is around 4x more likely to develop it at some point that someone without (Marini & Stebnicki 2012)
- research studies suggest that there must be some genetic influence on the development of OCD, so it has high internal validity
environmental risk factors (W):
- there is strong evidence for the idea that genetic variations can make a person more or less vulnerable to OCD
- however, OCD doesn’t appear to be entirely genetic in origin & that environmental factors can also trigger or increase the risk of developing git
e.g. Gromer et al (2007) found that over half of the OCD clients in their sample experienced a traumatic event in their past
- OCD was also more severe in those with one or more traumas
- this means that genetic vulnerability isn’t a valid explanation for OCD because it only provides a partial explanation
66
evaluate to neural explanations of OCD (psychopathology)
research support (S):
- antidepressants that work purely on serotonin are effective in reducing OCD symptoms, & this suggests that serotonin may be involved in OCD
- also OCD symptoms form part of conditions that are known to be biological in origin (e.g. Parkinson’s disease - Nestadt et al 2012)
- if a biological disorder produces OCD symptoms, then we may assume that the biological processes underlie OCD
- this suggests that biological factors (e.g. serotonin & the processes underlying certain disorders) may also be responsible for OCD
- research supports means high internal validity environmental
no unique neural system (W):
- the serotonin-OCD link may not be unique to OCD
- may people with OCD also experience clinical depression
- comorbidity = having two disorders together
- this depression probably involves (though isn’t necessarily caused by) disruption to the action of serotonin
- this leaves a logical problem when it comes to serotonins as a possible basis for OCD as it could be that serotonin activity is disrupted in many people with OCD because they are depressed as well
- this means that serotonin may not be relevant to OCD symptoms & therefore isn’t a valid explanation for
67
what is drug therapy & why is is used to react OCD? (3) (psychopathology)
- drug therapy is the most commonly used biological therapy for anxiety disorders
- this therapy assumes that there is a chemical imbalance in the brain
- this can be corrected by drugs, which either increase or decrease levels of neurotransmitters in the brain
68
explain how SSRIs are used as. treatment for OCD (7) (psychopathology)
- SSRI = selective serotonin re uptake inhibitor
- when serotonin is released from the pre-synaptic cell into the synapse, it travels to receptor sites in the post synaptic neuron
- serotonin which isn’t absorbed into the post-synaptic neuron is re absorbed into the sending cell (pre-synaptic neuron)
- SSRIs increase the level of serotonin available in the synapse by preventing it from being reabsorbed into the sending cell
- this increases levels of serotonin in the synapse & results in more serotonin being received by the receiving cell (post-synaptic neuron)
- dosage varies according to the prescribes SSRI
- e.g. typical daily dose of fluoxetine is 20mg but this can be increased/decreased
69
outline how SSRIs can be combined with other treatments to treat OCD (3) (psychopathology)
- drugs are soften used alongside other treatments like CBT
- the drug treatment reduced emotional symptoms of OCD so that clients can engage with CBT more effectively
- in practice some people respond best to CBT alone & others benefit more when additionally using drugs
70
outline alternatives to SSRIs as a treatment for OCD & explain 2 of them (7) (psychopathology)
- if SSRIs aren’t effective after 3-4 months different antidepressants can be administered
- parents respond differently to different drugs
tricyclics:
- have a similar effect to SSRIs but have more severe side effects
- e.g. clomipramine
SNRIs:
- serotonin-noradrenaline reuptake inhibitor
- more recent treatment that increases levels of serotonin & noradrenaline
- e.g. duloxetine
71
outline 2 strengths of the biological approach to treating OCD (psychopathology)
evidence for effectiveness:
- evidence to show that SSRIs reduce symptom severity & improve the quality of life for people with OCD
- Soomro et al (2009) reviewed 17 studies that compared SSRIs to placebos in the treatment of OCD
- all 17 studies shows significantly better outcomes for SSRIs than placebo
- typically symptoms reduce by around 70% for people taking SSRIs
- for the remaining 30% most can be helped by either alternate drugs or combinations of drugs & psychological therapies
- this means that drugs appear to be helpful for most people with OCD & therefore are a valid treatment
cost-effective & non-disruptive:
- drug treatments are cheaper than psychological treatments because thousands of doses can be manufactured in the same time it takes to conduct a session of psychological therapy
- using drugs to treat OCD is therefore good value for public health systems & represents a good use of limited funds
- compared to psychological therapies SSRIs are also non-disruptive to people’s lives (e.g. can stop taking drugs when symptoms decrease which is very different to psychological therapy)
- this means that drugs are popular with many people & their doctors & they are therefore a valid treatment
72
outline 2 weaknesses of the biological approach to explaining OCD (psychopathology)
evidence of effectiveness CP:
- some evidence to suggest that even if drug treatments are helpful for most people with OCD, they may not be the most effective treatments available
- Skapinakis et al (2016) carried out a systematic review of outcome studies & concluded that both cognitive & behavioural/exposure therapies were more effective than SSRIs in the treatment of OCD
- this means that drugs may not be the optimum treatment for OCD & may not be valid
serious side effects:
- a small minority will get no benefit from taking SSRIs
- some people also experience side effects like indigestion & blurred vision
- these are usually temporary but can be distressing for the person & are long-lasting for some
- side effects of the tricyclic clomipramine are more common & can also be more serious
- e.g. weight gain, aggression & heart problems
- means that some people have a reduced quality of life as a result of taking drugs & may stop taking them altogether, therefore they aren’t entirely effective & aren’t a valid treatment
