1
Q
What are the 4 definitions of abnormality?
A
- Statistical Deviation
- Deviation from social norms
- Failure to function adequately
- Deviation from ideal mental health
2
Q
What is statistical deviation? Include an example.
A
Any behaviour that is different from relatively usual behaviour is abnormal. For example, an IQ below 70 is seen as abnormal and means you have an intellectual disability disorder.
3
Q
Evaluate statistical deviation (3).
A
- Real life application - diagnosis of intellectual disability disorder. All assessments of mental health compare symptoms with statistical norms.
- Unusual characteristics can be positive - a high IQ is abnormal, but its not bad - so it doesn’t require treatment like low IQ.
- Negative labels - someone with a low IQ may not be affected by it so does not need to be labelled as abnormal as this could have a negative impact on their self esteem.
4
Q
What is deviation from social norms? Include an example.
A
Behaving in a way that is different to how we are expected to behave. Norms are culturally specific e.g. homosexuality. For example, antisocial personality disorder has the symptom of failure to conform to moral standards.
5
Q
Evaluate deviation from social norms (4).
A
- Not a sole explanation - it has real-life application to anti-social personality disorder however other factors must be considered such as the stress from antisocial personality disorder.
- Cultural relativism - abnormality may vary from culture to culture. E.g. hearing voices is acceptable in some cultures but is schizophrenia in the UK.
- Human rights abuse - this way of diagnosis may lead to human rights abuse of ethnic/minority groups.
- Accounts for desirability - stat deviation does not.
6
Q
What is failure to function adequately? Include an example.
A
Unable to maintain basic standards of nutrition and hygiene and cannot hold down a job/relationship.
Rosenhan and Seligman -
-No longer conforms to interpersonal rules e.g. eye contact.
-Severe personal distress
-Irrational or dangerous behaviour.
For example, intellectual disability disorder requires a failure to function adequately diagnosis first.
7
Q
Evaluate failure to function adequately (3).
A
- Patient’s perspective - it acknowledges that experiences of the patient are important.
- Similarity to deviation from social norms - not having a job may just be deviation from social norms. It may be harmful or discriminatory to call this failure to function adequately.
- Subjective judgements - the judgements of the patient must be objective using measures. However, psychiatrists still have the right to make the final judgement.
8
Q
What is deviation from ideal mental health? Include an example.
A
Deviation from how we should be psychologically healthy. Jahoda good health criteria: -No symptoms or distress -Rational -Self-actualisation -Cope with stress -Realistic view of world -Good self-esteem -Independent -Work, love and enjoy leisure.
9
Q
Evaluate deviation from ideal mental health (4).
A
- Comprehensive definition - covers a broad criteria for mental health and the reasons why someone would seek help.
- Cultural relativism - some of the ideas of classification are culture bound to Western countries. e.g. idea of self-actualisation may be self-indulgent in some cultures.
- High standards - very few of us attain all of the criteria for mental health, so are we all abnormal? However, it provides a clear way for people to see why they could need treatment.
- Labelling - labelling someone as failing to cope may lead to them becoming more depressed.
10
Q
What is a phobia?
A
An irrational fear of an object, place or situation. The fear is out of proportion to the danger presented.
11
Q
What categories of phobia and anxiety disorder does the DSM-5 recognise?
A
- Specific phobia - object or situation.
- Social anxiety - public speaking
- Agoraphobia - public places
12
Q
What are the behavioural characteristics of a phobia?
A
- Panic - e.g. crying, screaming or running away.
- Avoidance - go to effort to avoid the phobia.
- Endurance - alternative to avoidance, remains in the presence but suffers extreme anxiety.
13
Q
What are the emotional characteristics of a phobia? Give an example.
A
- Anxiety - emotional response of anxiety and fear. Prevents relaxation and positive emotions.
e. g. Arachnophobia is a fear of spiders, anxiety increases when around spiders or places associated with spiders. This is unreasonable because the spider is harmless.
14
Q
What are the cognitive characteristics of a phobia?
A
- Selective attention - hard to keep focus away from the phobia and focus on something else.
- Irrational beliefs - in relation to the phobic stimuli.
- Cognitive distortions - view of the phobia may be distorted e.g. belly buttons look ugly.
15
Q
What is depression?
A
A mental disorder categorised by low mood and low energy levels.
16
Q
What categories of depression does the DSM-5 recognise?
A
- Major depressive disorder - severe but short term depression.
- Persistent depressive disorder - long term or recurring depression.
- Disruptive mood dysregulation disorder - childhood temper tantrums.
- Premenstrual dysphoric disorder - prior to and during menstruation.
17
Q
What are the behavioural characteristics of depression?
A
- Activity levels - reduced levels of energy and withdrawal from social life and work. In some cases it can lead to failure to relax.
- Disruption to sleep and eating behaviour - reduced sleep or increased need for sleep. Appetite may increase or decrease.
- Aggression and self harm - verbally or physically.
18
Q
What are the emotional characteristics of depression?
A
- Lowered mood - feeling worthless or empty.
- Anger - negative emotions.
- Lowered self-esteem - hating themselves.
19
Q
What are the cognitive characteristics of depression?
A
- Poor concentration - unable to focus on a task and find it hard to make decisions.
- Dwelling on the negative - ignore the positives in life - pessimistic.
- Absolutist thinking - black and white thinking, situations are ALL bad.
20
Q
What is OCD?
A
A condition characterised by obsessions and compulsive behaviour.
21
Q
What categories of OCD does the DSM-5 recognise?
A
- OCD - obsessions (recurring thoughts) and/or compulsions (repetitive behaviours).
- Trichotillomania - compulsive hair pulling.
- Hoarding disorder - compulsive gathering of possessions.
- Excoriation disorder - compulsive skin picking.
22
Q
What are the behavioural characteristics of OCD?
A
- Compulsions
- Repetitive compulsions - compelled to repeat behaviours such as hand washing.
- They reduce anxiety - compulsive behaviours manage the behaviour caused by obsessions. - Avoidance - attempt to reduce anxiety by keeping away from situations that cause it.
23
Q
What are the emotional characteristics of OCD?
A
- Anxiety and distress - unpleasant emotional experiences.
- Accompanying depression - low mood and lack of enjoyment in leisure.
- Guilt and disgust - negative emotions such as irrational guilt over moral issues.
24
Q
What are the cognitive characteristics of OCD?
A
- Obsessive thoughts - thoughts that recur over and over.
- Cognitive strategies - e.g. praying or meditating to overcome obsessions.
- Insight into excessive anxiety - aware that their compulsions are not rational.
25
What is the two process model to explaining phobias and who proposed it?
Behavioural approach. Phobias are acquired by classical conditioning and then continue because of operant conditioning. Mowrer proposed it.
26
Explain how a phobia is acquired by classical conditioning using an example?
Learning to associate something we initially have no fear of (neutral stimulus) with something that already triggers a fear response (unconditioned stimulus).
Watson and Rayner 'Little Albert Study -
- Showed him a rat, then made a loud bang.
- Bang (unconditioned stimulus) = Fear (unconditioned response)
- Bang (unconditioned stimulus) + Rat (neutral stimulus) = Fear (unconditioned response)
- Rat (conditioned stimulus) = Fear (conditioned response)
- Fear generalises to other objects.
27
Explain how a phobia is maintained by operant conditioning?
Mowrer -
Operant conditioning occurs when a behaviour is reinforced or punished.
Negative reinforcement - avoiding the situation so removal of fear.
28
Evaluate the behavioural approach to explaining OCD (5).
1. Good explanatory power - explains how phobias can be maintained over time and had implications to therapy.
2. Alternative explanation for avoidance - some people may avoid phobias to get safety, not to reduce anxiety. e.g. Agoraphobia sufferers can leave the house with people (Buck).
3. Incomplete explanation - Bounton, evolutionary factors have an important role in phobias. e.g. fear of snakes or the dark are as a result of biological preparedness (innate). So not just conditioning creates phobias.
4. Some phobias don't follow trauma - e.g. fear of snakes without actually seeing a snake before.
5. Ignores the cognitive factors involved in a phobia - e.g cognitive distortions and irrational beliefs.
29
What are the two behavioural approaches to treating phobias?
1. Systematic desensitisation - a behavioural therapy designed to gradually reduce phobic anxiety through counterconditioning.
2. Flooding - exposing patients immediately to their phobia.
30
What is systematic desensitisation and what processes are involved in SD?
A behavioural therapy designed to gradually reduce phobic anxiety through counterconditioning. Feeling relaxed and afraid is not possible at the same time so this is reciprocal inhibition.
3 processes -
1. Anxiety hierarchy - list of situations that provoke anxiety.
2. Relaxation - therapist teaches patient to relax as deeply as possible. e.g. breathing exercises.
3. Exposure - exposed to the phobia in a relaxed state over several sessions, starting at the bottom of the hierarchy.
31
Evaluate systematic desensitisation (4).
1. It is effective - Gilroy et al followed up 42 patients with arachnophobia. at 3 months and 33 months, the SD group were less fearful.
2. Suitable for all patients - some patients may have learning difficulties.
3. Acceptable to patients - patients prefer it to flooding as there is less trauma and more relaxation. Evidenced by low refusal rates.
4. Symptom substitution - other phobias may appear in place of the lost phobia as provided by evidence of symptom substitution.
32
What is flooding and how does it work?
Exposing patients immediately to their phobia.
Longer than SD sessions but less sessions needed.
It uses the process of extinction in classical conditioning. The conditioned stimulus (e.g. dog) is encountered without the unconditioned stimulus (e.g. being bitten).
Informed consent is important.
33
Evaluate flooding (4).
1. Cost-effective - highly affective and quicker than alternatives (Ougrin).
2. Less effective for some phobias - such as complex phobias like social phobias which have cognitive aspects.
3. Traumatic for patients - many patients are unwilling to see it through until the end, so time and money may be wasted.
4. Symptom substitution - other phobias may appear in place of the lost phobia as provided by evidence of symptom substitution.
34
What two theories are used to explain depression?
1. Beck's Cognitive Theory - a persons cognitions make them vulnerable to depression.
2. Ellis' ABC Model - depression results from irrational thoughts that interfere with us being happy and free of pain.
35
What is Beck's cognitive theory of depression?
A persons cognitions make them vulnerable to depression.
1. Faulty Information Processing - we attend to the negatives of every situation and ignore positives.
2. Negative self-schemas - a package of ideas and information. We interpret everything in a negative way.
3. Negative triad - three types of negative thoughts.
a) negative view of the world
b) negative view of the future
c) negative view of the self
36
What is Ellis's ABC model of depression?
Depression results from irrational thoughts that interfere with us being happy and free of pain.
A) Activating Events - irrational thoughts are triggered by external events.
B) Beliefs - we must always succeed or it is a disaster.
C) Consequences - emotional and behavioural consequences.
37
Evaluate Beck's Cognitive Theory of depression (5)
1. Good supporting evidence - Grazioli and Terry, 65 pregnant women for depression before and after birth. Women with high vulnerability were more likely to suffer post-natal depression. Clark and Beck, reviewed research and found solid support for cognitive factors.
2. Practical application in CBT - cognitive aspects of depression can be identified and challenged in CBT to successfully treat it.
3. Doesn't explain all aspects of depression - can't explain extreme emotions and hallucinations. e.g. Cotard syndrome as a result of depression.
4. Cognitive primacy - emotions are influenced by cognitive. However, some theories suggest emotion is stored like physical energy.
5. Insecure Attachment can cause vulnerability to depression. Internal working model.
38
Evaluate Ellis's ABC Model of depression (5)
1. Partial explanation - some depression is sudden and not as a result of activating events.
2. Practical application to CBT - challenging irrational thoughts can reduce depression (Lipsky et al).
3. Doesn't explain all aspects of depression - does not explain the anger associated with depression or the hallucinations associated with Cotard syndrome.
4. Cognitive primacy - emotions are influenced by cognitive. However, some theories suggest emotion is stored like physical energy.
5. Insecure Attachment can cause vulnerability to depression. Internal working model.
39
What is cognitive behaviour therapy and what are the two named therapies?
A method for treating depression. Therapist and patient work together to clarify the patients problems and put together a plan. Main task is to identify irrational thoughts and change them.
1. Beck's Cognitive Therapy.
2. Ellis's Rational Emotive Behaviour Therapy (REBT) - ABCDE model.
40
What is Beck's cognitive therapy?
Application of Beck's cognitive theory of depression.
- Identifying automatic thoughts about the world, the self and the future - the negative triad.
- Challenges the thoughts directly and helps patients to test the reality of their negative beliefs.
- Set homework to record when they enjoyed an event or when someone was nice 'the patient as a scientist'.
- Therapist uses this info to prove them wrong.
41
What is Ellis's REBT therapy?
Rational Emotive Behaviour Therapy extends the ABC model to ABCDE.
A - activating events
B - beliefs
C - consequences
D - dispute
E - effect
-Aims to identify and dispute irrational thoughts.
-Vigorous argument between therapist and patient
-
42
What is behavioural activation?
Encouraging the patient to be more active and engage in enjoyable activities.
43
Evaluate Cognitive Behaviour Therapy for treating depression (5).
1. Effective - March et al studied 327 people with depression. 81% CBT, 81% antidepressants and 86% of combo group were significantly improved.
2. CBT may not always work - depression can be so severe that the patients cannot motivate themselves to engage with the CBT. An alternative to this is antidepressants before the CBT.
3. Success may be therapist-patient relationship - Rosenzweig found that all therapies have a therapist-patient relationship which may cure the depression. Luborksy also found similar results.
4. Some patients want to explore past - some like to talk about past experiences that may have caused their depression such as childhood experience.
5. Overemphasis on cognition - McCusker said that CBT may ignore the conditions the patient is living in e.g. poverty or abuse which may be causing the depression.
44
What is the genetic explanation of OCD (overview)?
Genes are involved in vulnerability to OCD.
- Lewis observed that of his OCD patients 37% had parents with OCD and 21% had siblings - showing the vulnerability is passed on, this links to the diathesis stress model.
- Candidate genes
- Polygenic
- Different types
45
What are candidate genes of OCD?
Genes that create vulnerability, some involved in serotonin system. e.g. 5HT1-D beta.
46
Explain how OCD is polygenic with an example.
OCD is not caused by a single gene. Taylor found evidence of up to 230 genes involved with dopamine and serotonin.
47
OCD is aetiologically heterogeneous, what does this mean?
The origin has different causes, different genes may cause it in different people.
48
What are the two neural explanations of OCD?
1. Role of serotonin - a neurotransmitter that controls mood. Low serotonin may lead to no transmission of mood-relevant information so mood may be affected.
2. Decision-making systems - abnormal functioning of the lateral areas of the frontal lobes of the brain. An area called the parahippocampal gyrus is associated with processing unpleasant emotions.
49
Evaluate genetic explanations of OCD (4).
1. Good supporting evidence - Nestadt et al twin studies found 68% of identical twins shared OCD compared to 31% non-identical.
2. Too many candidate genes - little predictive value as you cant pick out exactly which genes are involved.
3. Environmental risk factors - diathesis stress model. Cromer et al found over half of OCD patients had traumatic events in their past, and OCD was more severe if they experienced more than one trauma.
4. Twin studies are flawed evidence - identical twins may experience the same environment, whereas non-identical twins who are boys and girls may experience different environments.
50
Evaluate neural explanations of OCD (4).
1. Some supporting evidence - antidepressants that work purely on the serotonin system by increasing the levels are effective in reducing OCD symptoms. Also similar symptoms to disease such as Parkinson's disease which is biological.
2. Not clear what neural mechanisms are involved - research has found neural systems involved in decision making however some systems may also be involved.
3. Shouldn't assume that neural mechanisms cause OCD - biological abnormalities could be as a result of OCD.
4. OCD may be co-morbid with depression - people who suffer OCD become depressed which involves serotonin. Is serotonin involved in OCD or depression?
51
What are drug therapies for treating OCD?
Increase or decrease levels of neurotransmitter in the brain to increase or decrease their activity.
- SSRI's
- SSRI's and CBT
- Tricyclics
- SNRI's
52
What are SSRI's?
Selective serotonin re-uptake inhibitor.
- SSRI's prevent re-asborption and breakdown of serotonin to increase its levels in the synapse and continue stimulate the post-synaptic neurone.
- Typical daily dose of Fluoxetine is 20mg.
53
What do SSRI's do in combo with CBT?
Reduce emotional symptoms such as anxiety and allow them to engage more effectively with the CBT.
54
What are 2 alternatives to SSRI's?
1. Tricyclics - e.g. Clomipramine which has more severe side effects and reserved for people who do not respond to SSRI's.
2. SNRI's - serotonin-noradrenaline re-uptake inhibitors, affects serotonin and noradrenaline.
55
Evaluate drug therapies for treating OCD (5).
1. Effective at tackling OCD symptoms - Soomro et al reviewed studies comparing SSRI's to placebos. All 17 studies showed better results for the SSRI's than placebos. Greatest effectiveness when combined with CBT.
2. Cost effective and non-disruptive - cheap compared to CBT so good value for NHS. No need to go to therapy, can just take drugs.
3. Side effects - some people get no benefit. Some side effects such as indigestion, blurred vision and loss of libido. Clomipramine has more common side effects. Reduces effectiveness as some people stop taking them.
4. Unreliable evidence - Goldacre found research for biological treatments is funded by drug companies who do not report all of the evidence.
5. OCD can follow trauma - not just biological origins, some can be caused by trauma.
Psychology AS
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