Psychopathology

Question 1

Behavioural Approach: Explaining Phobias

Answer 1

• The Behavioural Approach is a way of explaining behaviour in terms of what is observable and measurable.
• Mowrer (1960) proposed the “Two-Process Model” which perceives phobias being acquired by Classical Conditioning and maintained by Operant Conditioning

1. Acquisition by Classical Conditioning - based on the work of Ivan Pavlov (1903)
   > This conditioning is learning by association. This occurs when two stimuli are repeatedly paired together - The Unconditioned Stimulus and the Neutral Stimulus. The NS eventually produces the same response that was first produced by the UCS alone. This behaviour is now learned and this is called the Conditioned Response.
2. Maintained by Operant Conditioning
   > This conditioning occurs when a certain behaviour is reinforced or punished. Both positive and negative reinforcement increases the frequency of a behaviour.
   > Mowrer suggested that whenever we avoid a phobic stimulus we successfully escape the anxiety we would have felt. This reduction in anxiety reinforces the avoidance behaviour thus the behaviour is maintained.

Evaluation

1. An alternative approach - The Psychodynamic Approach.
   Freud suggested that phobias arise when anxieties are displaced onto the phobic object that reflects the initial conflict. Freud uses the case of Little Hans to illustrate the process. Hans developed a fear of horses because the horse represented the boy’s unconscious fear of his father. He was also afraid of getting bitten by a horse, he was actually afraid that his mother would leave him. This contradicts Mowrer’s model.

2, An alternative approach - Evolutionary Approach.
Bounton (2007) argues the model neglects the influence of evolution. This sees phobias having an adaptive value. This explains adaptive functions that behaviourists cannot. For example, the element of fear can immobilise individuals and aids concealment from predators.

3. Good explanatory power.
   The model has explained how phobias could be maintained over time. This has important implications for therapies because it explains why patients need to be exposed to their feared stimulus. Once a patient is prevented from practising their avoidance behaviour, it ceases to be reinforced and so it declines.
4. An alternative approach - Biological Explanation
   Individuals may inherit genetically determined predispositions to develop phobias. This is supported by twin studies such as Togersen (1983). He found that a 31% concordance for agoraphobia in MZ twins whereas there was 0% concordance in DZ.
   This suggests that the higher the concordance rate between individuals the more likely they are to inherit panic disorders.
5. Deterministic.
   The two-process model rejects the concept of free will. This is the idea that we have control over our behaviour and no external factors are considered. Classical conditioning states that phobias will definitely occur if an association occurs.
   This is a weakness because behaviourists are suggesting that we don’t have the mental capability to view certain stimulus as just the stimulus and not a potential threat.
6. Watson and Rayner (1920) created a phobia in a 9-month-old baby called “Little Albert”. When they created a loud, banging sound (UCS), Albert would cry and show signs of distress (UCR). They then presented the baby with a rat (NS) every time they created the loud sound. This then resulted in Albert crying (CR) whenever he saw the rat by itself (CS)
   This fear then generalised to similar objects. E.g. a furry coat.
   Weakness: This study lacks validity because they did not use a control group. This means we cannot be sure if the conditioning caused the fear. It could have been repeated exposure to a strange animal.

Question 2

Behaviourist Approach: Treating Phobias

Answer 2

1. Systematic Desensitisation is a behavioural therapy technique into treating anxiety disorders. This was developed by Wolpe in 1958.

> An anxiety Hierarchy is put together by the patient and therapist. This consists of a list of situations related to the phobic stimulus that provokes anxiety, arranged in order from least to most frightening.
Relaxation. The therapist helps the patient completely relax.
Exposure to the phobic stimulus whilst in a relaxed state which takes place over several sessions. Treatment is deemed successful when the patient can remain relaxed in situations high on the Anxiety Hierarchy.

• Reciprocal Inhibition: when one emotion prevents the other. So in relation the SD, a patient cannot panic when exposed to the phobic stimulus if they are completely and truly relaxed.
• Counter-conditioning: gradually reducing phobic anxiety through classical conditioning. The patient will start to associate the stimulus with relaxation and not fear.
  2. Flooding is a behavioural therapy used to remove phobias through a direct confrontation of the feared stimulus. This takes place over a small number of long therapy sessions

> Flooding stops phobic responses quickly because, without the option of avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless. This is called extinction.
A learned response is extinguished when the conditioned stimulus (a dog) is encountered without the unconditioned stimulus (being bitten). This results in the conditioned stimulus no longer produces the conditioned response (fear)

Evaluation

1. Ohman et al (1975) suggested that SD may not be effective in treating phobias that have an evolutionary survival component. For example, the fear of the dark of heights. SD may only be suitable for phobias that have been acquired through experience
   Weakness: reduces the validity.
2. Klein et al (1983) compared SD with supportive psychotherapy for patients with either social or specific phobia. They found no difference in effectiveness, both therapies showed improved symptoms. This suggests that the main factor in SD may be the expectation to overcome the phobias.
   Weakness: this reduces the internal validity of the therapy technique because this study suggests relaxation may not be necessary for the treatment.
3. McGrath et al (1990) reported that 75% of
   patients with phobias responded to SD. The key to success seems to lie in actual contact with the feared stimulus. Again, this shows that relaxation may not be a key factor in improved symptoms. However, this study does prove the effectiveness of SD.
4. Wolpe (1960) used flooding to remove a girl’s phobia of being in cars. The girl was forced into a car and was driven around for 4 hours until her hysteria was eradicated. This demonstrates the effectiveness of flooding which increases the validity of the therapy. However, this study is based around one sufferer, it makes it hard for us to generalise the findings to the wider population of sufferers.
5. Ost (1997) found that flooding has a rapid treatment that often delivers immediate improvements, especially when patients are encouraged to continue self-directed exposure to feared objects outside of therapy sessions.
6. Barlow (2002) reports that flooding has been shown to be equally as effective in phobias as SD. But SD is preferred and better tolerated by patients. Flooding is prone to have ethical issues – protection from harm.

Question 3

The Cognitive Approach: Explaining Depression

Answer 3

• The Cognitive Approach focuses on how internal mental processes affect behaviour. Such as thoughts, attention and perception
  1. Beck’s Cognitive Theory: the aim is to find out why people are more vulnerable to have depression.

> The Negative Triad. Beck suggested that there were three kinds of negative thinking that contributed to becoming depressed. A negative view ofThe World, The Future, The Self.

> Negative self-schemas. A schema is a mental framework of ideas and information acquired through experiences. We use them to interpret sensory information.

• Ineptness schemas: make sufferers expect to fail
• Self-blame schemas: make sufferers feel responsible for all misfortunes.
• Negative self-evaluation schemas: constantly reminding themselves of their worthlessness.

> Cognitive Bias. When depressed we attend to the negative aspects of a situation and ignore positives.

• Arbitrary inference: conclusions drawn in the absent of sufficient evidence.
• Selective abstraction: conclusions drawn from just one part of the situation
• Overgeneralisation: sweeping conclusions drawn on the basis of a single event.
• Magnification and minimisation: exaggerations in the evaluation of performance.

2. Ellis’ ABC Model: proposes that good mental health is the result of rational thinking. This is defined in thinking in ways that allow people to be happy and free of pain.

(A) Activating Event. Something happens in the environment around you. Irrational or rational thoughts are triggered by external events.
(B) Beliefs. You hold a belief about the event. These thoughts can be rational or irrational.
(C) Consequences. There are emotional and behavioural consequences.

Evaluation

1. Doesn’t explain all aspects of depression. Both Beck and Ellis’ theories into explaining depression explains the basic symptoms of depression, however, depression is very complex. Some sufferers have extreme anger and the theories cannot explain that extreme emotion. Also, some sufferers even have hallucinations or Cotard Syndrome.
   - Weakness: These theories are too simplistic so it cannot account for all symptoms of depression. This means both theories lacks external validity because it cannot be generalised to all sufferers who experience a variety of symptoms.
2. Grazioli and Terry (2000) assessed 65 pregnant women for cognitive vulnerability and depression before and after giving birth. They found that women who were judged to have been high in cognitive vulnerability were more likely to suffer post-natal depression. Clark and Beck reviewed the research and showed that these cognitions can be seen before depression develops.
   Strength: This supports Beck’s theory that cognition can be the cause of depression.
3. Hamman and Krantz (1976) found that depressed participants made more errors in logic when asked to interpret written material than non-depressed participants.
   - Strength: this supports the link between irrational or illogical thinking and depression.
4. The Biological Approach suggests that genes and neurotransmitters may cause depression. Zhang et al shows the low levels of serotonin in depressed people and also found a gene that related to depression. The success of drug therapies for treating depression suggests that neurotransmitters do play an important role in depression.
   Weakness: Both theories do not take into account biological factors when it comes to the development or occurrence of depression.
5. Blames the client. The cognitive approach suggests that it is the client that is responsible for their disorder. This is a weakness because the therapist and client may overlook situational factors that could have contributed to depression.
   - Weakness: this reduces the validity of both theories because clients may not ever fully recover due to them ignoring crucial situational factors.

Question 4

The Cognitive Approach: Treating Depression

Answer 4

• Cognitive Behaviour Therapy (CBT) is a method for treating mental disorders based on both cognitive and behavioural techniques. The therapy aims to deal with challenging negative thoughts and behavioural activation.
  CBT begins with an assessment in which the patient and therapist work together to clarify the patient’s problems. They identify goals and put together a plan to achieve them.

1. Ellis’ Rational Emotive Behaviour Therapy (REBT) extends the ABC model to ABCDE model. D standing for dispute and E for effect. The central technique is to identify and dispute irrational thoughts and making them positive and rational.
2. Beck’s Cognitive Therapy (BCT) aims to identify and challenge automatic thoughts about the world, self and future. This therapy aims to help test the reality of their negative beliefs. The patient is asked to record when they enjoyed an event or when others were nice to them. (“Patient as scientist”). If patients said something false about an event then the therapist would be able to provide evidence of that not being the case.

Evaluation

1. David et al (2008) found, using 170 patients suffering major depressive disorder, that patients treated with 14 weeks of REBT had better treatment outcomes than those treated with fluoxetine six months after treatment.
   Strength: shows REBT is a better long-term treatment than drug therapy, therefore, showing its effectiveness.
2. Ellis claimed 90% success rate for REBT, taking an average of 27 sessions to complete the treatment. This increases the validity and application to real life.
3. March et al (2007) compared the effects of CBT with antidepressant drugs and a combination of the two in 327 adolescents with a diagnosis of depression. After 36 weeks, 81% of the CBT and antidepressant group and 86% of the combination group improved.
   Strength: shows the effectiveness of CBT on it’s on but also shows that if combined with drug therapy, rates are even higher.
4. Ethical issues with CBT as it can be too therapist centred. Therapists may abuse their power of control over patients, forcing them into certain ways of thinking and patients can be too dependent on the therapist. (PFH)
5. CBT are structured. The structured nature of therapy sessions reduces the possibility that sessions will become “chat sessions” in which not much is accomplished therapeutically. Methodologically good.
6. CBT are cross-cultural. They are based on universal laws of human behaviour. They also focus on the client’s goals, rather than attempting to impose the therapist’s goals on the client.

Question 5

The Biological Approach: Explaining OCD

Answer 5

• The Biological Approach emphasises the importance of physical process in the body. Such as, genetic inheritance.
  1. Genetic Explanations: OCD is a condition that may be biologically occurring.

> Diathesis-stress model states that certain genes may leave some people more likely to suffer a mental disorder but it isn’t certain. Environmental stress (experience) is needed to trigger the condition.

> Candidate genes are certain genes which create vulnerability for OCD. Some genes are involved in regulating the development of the serotonin system.

> Polygenic. OCD is caused by several genes.

> Different types of OCD. The origin of OCD has different causes. So, a group of genes may affect one person but a different group of genes will affect another.

2. Neural Explanations: physical and psychological characteristics are determined by the behaviour of the nervous system.

> The role of Serotonin. ‘The happy drug’ Neurotransmitters are responsible for relaying information from one neurone to another. If a person has low levels of serotonin then normal transmission of mood-relevant information does not take place so their mood is affected.

> Decision-making system. Hoarding disorder seems to be associated with impaired decision making. This may be related to abnormal functioning of the lateral of the frontal lobes (responsible for thinking logically)

Evaluation

1. Lewis (1936) observed 50 patients of his that suffered from OCD and found that 37% had parents with OCD and 21% had siblings with OCD.
   This suggests that there could be a biological factor into the disorder.
2. Taylor (2013) analysed findings of previous research and found that up to 230 different genes may be involved in OCD.
   This supports the polygenic concept.
3. Hu (2006) compared Serotonin activity in 169 OCD patients and 253 non-sufferers. He found that serotonin levels were lower in the OCD patients.
   - This is a strength because it shows that neural factors could have an impact on the disorder.
4. Alternative Approach: The two-process model. Initial learning occurs when a NS (dirt for example) is associated with anxiety. This association is maintained because the anxiety-provoking stimulus is avoided (negative reinforcement). Thus an obsession is formed and then a link is learned with compulsive behaviours which appear to reduce anxiety.
5. Nature vs Nature. Biologists say people are born a certain way which determines their behaviour. This is a weakness because they wouldn’t deem environmental factors to be relevant. This may lead patients never fully recovering from their symptoms due to situational factors.
6. Ethnocentric. The approach doesn’t take cultural differences into account when it comes to the symptoms of OCD. Findings conducted would be generalised to all cultures regardless of the differences.

Question 6

The Biological Approach: Treating OCD

Answer 6

1. SSRIs work on the serotonin system in the brain. When serotonin is released from the pre-synaptic cell into the synapse, it travels to the receptor sites on the postsynaptic neurone. Serotonin which is not absorbed into the post-synaptic neurone is reabsorbed into the sending cell. SSRIs increase the level of serotonin available in the synapse by preventing it from being reabsorbed into the sending cell. This increases the level of serotonin in the synapse and results in more serotonin being received by the receiving cell (postsynaptic neurone).
2. Tricyclics. This blocks the transporter mechanism that reabsorbs both serotonin and noradrenaline into the pre-synaptic cell after it has fired. This results in the neurotransmitters extending their activity. Usually used when SSRIs are not effective due to having more side effects.
3. Benzodiazepines (Bzs) are commonly used to reduce anxiety. It slows down the activity of the neurotransmitter, GABA (it has quieting effects on the neurones of the brain). This makes it harder for the neurone to be stimulated by other neurotransmitters, this slows down activity, making the person feel relaxed.

Evaluation

1. Julien (2007) reported that studies of SSRIs show that although symptoms don’t fully disappear, between 50-80% of sufferers improve.
   Strength because it allows sufferers to live a fairly normal lifestyle, which they wouldn’t be able to do without the treatment.
2. Soomro et al (2008) reviewed 17 studies of SSRIs versus placebo treatments involving 3097 patients and found that SSRIs are moderately effective in the short-term OCD.
3. Sansone and Sansone (2011) found significant reductions in symptoms in 70% of patients
4. Cost effective. In comparison to psychological treatments, like CBT. Consequently, many doctors prefer the use of drugs over psychological treatments, as they are a cost-effective solution for treating OCD (and depression), which is beneficial for health service providers.
5. Side effects. Benzodiazepines are renowned for being highly addictive and can also cause increased aggression and LTM impairments. As a result, BZs are usually only prescribed for short-term treatment. These side effects diminish the effectiveness of drug treatments as patients will often stop taking the medication if they experience such side effects.