Psychopathology

Question 1

Statistical infrequency

Answer 1

Defining abnormality in terms of statistics– The most obvious way to define anything as ‘normal’ or ‘abnormal’ is in terms of the number of times it is observed.
- Statistics is about analysing numbers

Behaviour that is rarely seen is abnormal

Example:
IQ - Most individuals scoring below 70 are statistically unusual or ‘abnormal’ are diagnosed with intellectual disability disorder.

Question 2

strength of of statistical infrequency

Answer 2

• Strength includes its real life applications.
  All assessment of patients with mental disorders includes some comparison to statistical norms.
  Intellectual disability disorder demonstrates how statistical infrequency can be used
  Statistical infrequency is thus a useful part of clinical assessment

Question 3

limitation of statistical frequency

Answer 3

Limitation is that not everyone unusual benefits from a label When someone is living a happy life there is no benefit to them being labelled as normal
Someone with a very low IQ who was not distressed or out of work, etc would not need a diagnosis of intellectual disability
Being labelled as abnormal might have a negative effect on the way others view them and the way they see themselves.

Question 4

Deviation from social norms

Answer 4

Abnormality is based on social context - when a person behaves in a way that is different from how they are expected to behave
- Societies and social groups make collective judgements about ‘correct’ behaviours in particular circumstances

Three types of consequences for this behaviour:
– relatively few behaviours that would be considered universally abnormal therefore definitions as abnormal
- This includes historical differences within the same society
- For example, homosexuality is viewed as abnormal in some cultures but not others and was considered abnormal in our society in the past

Example: Antisocial personality disorder
- A psychopath is abnormal because they deviate from social norms or standards. They generally lack empathy.

Question 5

limitation 1 of social norms

Answer 5

Could lead to human rights abuse
Can lead to systematic abuse of human rights
EG drapetomania (black slaves trying to escape) or nymphomania (women attracted to working class men) are examples of how diagnosis was used for social control
Such classifications appear ridiculous but some psychologists argue some modern abnormal classifications are abuses of people’s right to be different

Question 6

limitation of social norms

Answer 6

Social norms are culturally relative
A person from one cultural group may label someone from another group as abnormal using their standards rather than the person’s standards.
Eg, hearing voices is socially acceptable in some cultures but would be seen as a sign of abnormality in the UK
This creates problems for people from one culture living within another cultural group

Question 7

failure to function adequately

Answer 7

Inability to cope with everyday living – A person may cross the line between normal and abnormal at the point that they cannot deal with the demands of everyday life – they fail to function

When someone is not coping:

• They no longer conform to interpersonal rules e.g maintaining personal space
• They experience personal distress
• They behave in a way that is irrational or dangerous

Example – Intellectual disability disorder – an example of failure to function adequately

Question 8

Limitation of failure to function adequately

Answer 8

This is a subjective judgment Someone has to judge whether a patient is distressed. Some may be seen as distressed but not suffering
There are methods for making such judgements as objective as possible, including checklists like global assessment of functioning scale
However, the principle remains whether someone, e.g a psychiatrist, has the right to make this judgement.

Question 9

limitation 2 Failure to function adequately

Answer 9

Recognizes patient’s perspective
It is difficult to assess distress
The definition acknowledges the experience of the patient is important
It captures the experience of many people who need help and is useful for assessing abnormality.

Another limitation is that the definition is the same as deviation from social norms so it is hard to say if someone is really failing to function or deviating from social norms. People who live alternative lifestyles or do extreme sports could be seen as behaving differently and if we treat these behaviours as ‘failures’ of adequate functioning we may limit freedom.

Question 10

Deviation from ideal mental health

Answer 10

Changing the emphasis – a different way to look at normality and abnormality is to think about what makes someone ‘normal’ and psychologically healthy and then identify anyone who deviates from this ideal
Inevitable overlap between definitions – Someone’s inability to keep a job may be a sign of their failure to cope with the pressures of work
Or as a deviation from the ideal of successfully working

Question 11

Jahoda listed 8 criteria examples

Answer 11

• We have no symptoms or distress
• We are independent of other people
• We can cope with stress
• We have a realistic view on the world

Question 12

strength of Deviation from ideal mental health

Answer 12

Deviation from ideal mental health is comprehensive Covers a broad range of criteria for mental health
It covers most of the reasons someone would seek help from mental health services or be referred for help
The sheer range of factors discussed in relation to Jahoda’s criteria make it a good tool for thinking about mental health

Question 13

limitation of Deviation from ideal mental health

Answer 13

Unrealistically high standard for mental health
Few people will attain all Jahoda’s criteria for mental health so most of us would be seen as abnormal
Positive side – It makes it clear to people the ways in which they could benefit from seeking help to improve their mental health
However, it is probably of no value in thinking about who might benefit from treatment against the will.

Question 14

Phobias

behavioural
emotional
cognitive

Answer 14

Behavioural

Panic – this may involve a range of behaviours such as crying, screaming or running away from the phobic stimulus
Avoidance – Considerable effort to avoid coming into contact with the phobic stimulus. This can make it hard to go about everyday life, especially if the phobic stimulus is often seen, e.g public places

Emotional

Anxiety and fear – fear is immediate experience when a phobic encounters or thinks about the phobic stimulus. Fear leads to anxiety.
Reponses are unreasonable – Response is widely disproportionate to the threat posed e.g an arachnophobic will have a strong emotional response to a tiny spider

Cognitive

Selective attention to the phobic stimulus – The phobic finds it hard to look away from the phobic stimulus e.g pogonophobic – fear of beards and cannot concentrate if a bearded person was in the room
Irrational – For example, social phobias may involve beliefs such as ‘if I blush people will think I’m weak’ or ‘I must always sound intelligent’

Question 15

Depression

behavioural
emotional
cognitive

Answer 15

Behavioural

Activity levels – sufferers of depression have reduced levels of energy making them lethargic. In extreme cases, this can be so severe that the sufferer cannot get out of bed
Disruption to sleep and eating behaviour- Sufferers may experience reduced sleep (insomnia) or an increased need for sleep (hypersomnia). Appetite may decrease or increase leading to weight loss or gain.

Cognitive

Poor concentration – Sufferers may find themselves unable to stick with a task as they usually would, or they might find simple decision making it difficult.

Emotional

Lowered mood – More pronounced than the daily experience of feeling lethargic or sad often describing themselves as ‘worthless’ or ‘empty’.
Anger – On occasion, such emotions lead to aggression or self-harming behaviour
Absolutist thinking – ‘Black and white thinking’, when a situation is unfortunate it is seen as an absolute disaster.

Question 16

Compulsive disorder

behavioural
emotional
cognitive

Answer 16

Behavioural

Compulsions – Actions that are carried repeatedly , e.g handwashing. The same behaviour is repeated in a ritualistic way to reduce anxiety.
Avoidance – The OCD is managed by avoiding situations that trigger anxiety, e.g sufferers who wash repeatedly may avoid coming into contact with germs

Emotional

Anxiety and distress – Obsessive thoughts are unpleasant and frightening, and the anxiety that goes with these can be overwhelming
Guilt and disgust – Irrational guilt, for example over a minor moral issue, or disgust which is directed towards oneself or something external like dirt.

Cognitive

Obsessive thoughts – About 90% of OCD sufferers have obsessive thoughts, e.g recurring intrusive thoughts about being contaminated by dirt or germs.
Insight into excessive anxiety – awareness that thoughts and behaviour are irrational. In spite of this, suffers experience catastrophic thoughts and are hypervigilant, i.e ‘over-aware’ of their obsession.

Question 17

Explaining phobias

Answer 17

The two-process model - Orval Hobart Mowrer argued that phobias are learned by classical conditioning and maintained by operant conditioning (2 processes involved).

Classical conditioning – involves learning by association and occurs when two stimulus’ are paired together a UCS and an NS. The NS eventually produces the same response that was first produced by the unlearned stimulus alone

1. UCS (unconditioned stimulus) triggers a fear response (fear is a UCR – unconditioned response), e.g. being bitten creates anxiety
2. NS (‘neutral stimulus’) is associated with the UCS, e.g being bitten by a dog (the dog previously did not create anxiety)
3. NS becomes a CS (conditioned stimulus) producing fear (which is now the CR). The dog becomes a CS causing a CR (conditioned response) of anxiety/ fear following the bite

Question 18

Little Albert

Answer 18

Little Albert conditioned fear: Watson and Reynor showed how fear of rats could be conditioned in ‘little albert’.
1. Whenever Albert played with a white rat, a loud noise was made close to his ear. The noise (UCS) caused a fear response (UCR)
2. Rate (NS) did not create fear until the bang and the rat had been paired together several times
3. Albert showed a fear response (CR) every time he came into contact with the rat
(now a CS)

Generalisation of fear to other stimuli – For example, Little albert also showed a fear in response to other white furry objects including a fur coat

Question 19

operant conditioning The two process model

Answer 19

Maintenance by operant conditioning – Operant conditioning takes place when our behaviour is reinforced or punished.

• Negative reinforcement- An individual produces behaviour that avoids something unpleasant
• When a phobic avoids a phobic stimulus, they escape the anxiety that would have been experienced. This reduction in fear negatively reinforces the avoidance behaviour and the phobia is maintained.
• For example, if someone has a morbid fear of clowns, they will avoid circuses and other situations where they ay encounter clowns. The relief felt from avoiding clowns negatively reinforces the phobia and ensures it is maintained rather than confronted.

Question 20

strength of two-process model

Answer 20

Good explanatory power
Two-process model went beyond Watson and Rayner’s conditioning of phobias
It has important implications for therapy. If patient is prevented from practising their avoidance behaviour, then phobic behaviour declines
The application to therapy is a strength of the two-process model

Question 21

Limitations of two processes model

Answer 21

There are alternative explanations for avoidance behaviour

• There is evidence that at least some avoidance behaviour is motivated by positive feelings of safety eg in complex behaviour, like agoraphobia
• This explains why some agoraphics are able to leave their house with a trusted friend with relatively little anxiety, but not alone.
• This is a problem for the 2-process model, which suggests that avoidance is motivated by anxiety reduction.

An incomplete explanation of phobias

• Even if we accept that classical and operant conditioning are involves in phobias, there are some aspects that require further explaining
• We easily acquire phobias of things that were a danger in our evolutionary past eg, fear of snakes. This is biological preparedness – We are innately prepared to fear some things more than others.
• The phenomenon of biological preparedness is a problem for the two-process model because it shows there is m ore acquiring phobias than simple conditioning

Not all bad experiences lead to phobias

• Sometimes phobias do appear following a bad experience and it is easy to see how they could be the result of conditioning - However, sometimes people have a bad experience and don’t develop a phobia e.e being bitten by a dog
• This suggests that conditioning alone cannot explain phobias. They may only develop where vulnerability exists.

Question 22

Treating phobias

Answer 22

Systematic desensitisation (SD) – based on classical conditioning, counterconditioning and reciprocal inhibition
- The therapy aims to gradually reduce anxiety through counterconditioning
• Phobia is learned so that phobic stimulus (CS) produces fear (CR)
• CS is paired with relaxation and this becomes the new CR
- Reciprocal inhibition: It is not possible to be afraid and relaxed at the same time, so one emotion prevents the other

Question 23

Hierarchy when treating phobias

Answer 23

Formation of an anxiety hierarchy – Patient and therapist design an anxiety hierarchy – a list of fearful stimuli arranged in order from least to most frightening
- An arachnophobic might identify seeing a picture of a small spider as low on their anxiety hierarchy and holding a tarantula as the final item.

Relaxation practised at each level of the hierarchy – Phobic individual is taught relaxation technique such as deep breathing or meditation

• Patient then works through the anxiety hierarchy. At each level the phobic is exposed to the phobic stimulus in a relaxed state
• This takes place over several sessions starting at the bottom of the hierarchy. Treatment is successful when the person can stay relaxed in situations high on the hierarchy

Question 24

Strengths of SD

Answer 24

Very effective

• Gilroy et al followed up 42 patients who had SD for spider phobia in three 45-minute sessions At both three and 33 months, the SD group were less fearful then the control group treated by relaxation without exposure
• This shows that SD is helpful in reducing the anxiety in a spider phobia and that the effects of the treatment are long lasting.

suitable for diverse group of patients

• The alternative to SD such as flooding and cognitive therapies are not well suited to some patients
• E.G, having difficulties can make it very hard for some patients to understand what is happening during flooding or to engage with cognitive therapies which require reflextion
• For these patients, SD is probably the most appropriate treatment

Tends to be acceptable to patients

• Patients prefer it, those given the choice of SD or flooding tend to prefer SD This is because It does not cause the same degree of trauma as flooding. It may also be because SD includes elements that are actually pleasant such as time talking to a therapist.
• This is reflected in the low refusal rates (number of patients refusing to start treatment) and low attrition rates (number of patients dropping out of treatment) for SD

Question 25

flooding

Answer 25

Immediate exposure to the phobic stimulus - flooding involves bombarding the phobic patient with the phobic object without a gradual build up - An arachnophobic receiving flooding treatment may have a large spider crawl over their hand until they can relax fully (the phobic not the spider) Very quick learning through extinction - Without the option of avoidance behaviour, the patient quickly learns that the phobic object is harmless through the exhaustion of their fear response. This is known as extinction. Ethical safeguards - Flooding is not unethical but it is an unpleasant experience so it is important that patients give informed consent. They must be fully prepared and know what to expect.

Question 26

2 limitations of flooding

Answer 26

Less effective for some types of phobia Although flooding is highly effective for treating simple phobias, it appears to be less so for more complex phobias like social phobias This may be because social phobias have cognitive aspects, e.g a sufferer of social phobia doesn’t simply experience anxiety but thinks unpleasant thoughts about the social situation This type of phobia may benefit more from cognitive therapies because such therapies tack the irrational thinking. Flooding is traumatic for patients Perhaps the most serious issue with the use of flooding is the fact that it is a highly traumatic experience. The problem is not that flooding is unethical (patients do give informed consent) but patients are often unwilling to see it through to the end Ultimately it means that the treatment is not effective, and time and money are wasted preparing patients only to have them refuse to start or complete treatment.

Question 27

Explaining depression Beck’s cognitive theory of depression

Answer 27

Faulty information processing – Aaron Beck (1967) suggested that some people are prone to depression because of faulty information processing, i.e thinking in a flawed way - When depressed people attend to the negative aspects of a situation and ignore positives, they also tend to blow small problems out of proportion and think in ‘black and white’ terms. Depressed people have negative self-schemas – A schema is a ‘package’ of ideas and information developed through experience. We use schemas to interpret the world, so if a person has a negative self-schema they interpret all information about themselves in a negative way The negative triad – There are three elements to the negative triad: • Negative views of the world, e.g. ‘the world is a cold hard place’ • Negative view of the future, e.g. ‘there isn’t much chance that the economy will get any better • Negative view of the self, e.g. thinking ‘I am a failure’ and this negatively impacts upon self-esteem

Question 28

2 strengths of becks theory

Answer 28

It has good supporting evidence -For example, Grazioli and Terry (2000) assessed 65 pregnant women for cognitive vulnerability and depression before and after birth -They found that those women judged to have been high in cognitive vulnerability were more likely to suffer post-natal depression - These cognitions can be seen before depression develops, suggesting that Beck may be right about cognition causing depression, at least in some cases The theory has a practical application as a therapy Beck’s cognitive explanation forms the basis of cognitive behaviour therapy (CBT) - The components of the negative triad can easily be identified and challenged in CBT. This means a patient can test whether the elements of the negative triad are true - This is a strength of the explanation because it translates well into a successful therapy

Question 29

limitation of becks theory

Answer 29

Does not explain all aspects of depression - Depression is a complex disorder. Some depressed patients are deeply angry and Beck cannot easily explain this extreme emotion. - Some depression patients suffer hallucinations and bizarre beliefs, or suffer Cotard syndrome, the delusion that they are zombies (Jarret 2013) - Beck’s theory cannot always explain all cases of depression, and just focuses on one aspect of the disorder

Question 30

Explaining depression | Ellis’s ABC model

Answer 30

A – Activating event - Albert Ellis suggested that depression arises from irrational thoughts. - According to Ellis depression occurs when we experience negative events, e.g. failing an important test or ending a relationship B – Beliefs - Negative events trigger irrational beliefs, for example: • Ellis called the belief that we must always succeed ‘musterbation’ • I-can’t-stand-it-it is’ is the belief that it is a disaster when things do not go smoothly • ‘Utopianism’ is the belief that the world must always be fair and just C- Consequences - When activating event triggers irrational beliefs there are emotional and behavioural consequences - For example, if you believe you must always succeed and then you fail at something, the consequence is depression

Question 31

2 limitations of Ellis's ABC model

Answer 31

A partial explanation of depression -There is no doubt that some cases of depression follow activating events - Psychologists call this Reactive depression and see it as different from the kind of depression that arise without an obvious cause - This means Ellis’ explanation only applies to some kinds of depression May not cause all aspects of events -Cognitive explanations are closely tied up with the concept of cognitive primacy, the idea that emotions are influenced by cognition (your thoughts) -This is sometimes the case, but not necessarily always. Other theories of depression see emotions, such as anxiety and distress, as stored like physical energy, to emerge some time after their casual event. - This casts doubt on the idea that cognitions are always the root cause of depression and suggests that cognitive theories may not explain all aspects of the disorder.

Question 32

Treating depression

Answer 32

Beck: patient and therapist work together Patient ad therapist: work together to clarify patient’s problems - Identify where there might be negative or irrational thoughts that will benefit from challenge Challenging negative thoughts relating to negative triad - The aim is to identify negative thoughts about the self, the world and the future -negative triad - These thoughts must be challenged by the patient taking an active role The ‘patient as the scientist’ - Patients are encouraged to test the reality of their irrational beliefs - They might be set homework, e.g to record when they enjoyed an event - In future sessions if patients say that no-one is nice to them or there is no point going on, the therapist can produce this evidence to prove the patient’s beliefs incorrect

Question 33

Treating depression REBT Challenging irrational beliefs Behavioural activation

Answer 33

Ellis’s rational emotive behaviour therapy (REBT) Extends the ABC model to an ABCDE model - D for dispute irrational beliefs - E for effect Challenging irrational beliefs A patient might talk about how unlucky they have ben. An REBT therapist would identify this as a utopianism and challenge it as an irrational belief - Empirical argument – disputing whether there is evidence to support the irrational belief - Logical argument – disputing whether the negative thought actually follows from facts Behavioural activation - As individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms - The goal of treatment is to work with depressed individuals to gradually decrease their avoidance and isolation and increase their engagement in activities that have been shown to improve their mood, eg exercising

Question 34

Strength of CBT

Answer 34

CBT is effective A lot of evidence to support its effectiveness e.g march et al, compared the effectiveness of CBT with antidepressant drugs and a combination of the 2 in adolescents After 36 weeks, 81% of the CBT group, 81% of the antidepressant group and 86% of combined group had improved. CBT emerged just as significant as drugs This suggests there is a good case for making CBT the first choice of treatment in public health care systems like the NHS

Question 35

limitations of CBT

Answer 35

does not work for serious cases of depression Some depression is so severe they cannot motivate themselves to take up the cognitive work required for CBT Where this is the case it is possible to use antidepressants and commence CBT when they are motivated and alert It means CBT cannot be sole treatment for all cases of depression some patients really want to explore their past One of the basic principles of CBT is to focus on present and future not past In some forms of psychotherapy patients make links between childhood experiences and current depression The ‘present-focus’ of CBT may ignore an important aspect of the depressed patient’s experience overemphasis on cognition CBT may end up minimising the importance of the circumstances in which the patient is living A patient living in poverty or suffering abuse needs to change their circumstances and any approach that emphasises what it is in the patient’s mind rather than their environments can prevent this CBT technique used inappropriately can demotivate people to change their situation.

Question 36

The biological approach to explaining OCD Genetic explanations

Answer 36

Candidate genes e.g. 5HT1-D – Researchers have identified specific genes which create a vulnerability for OCD, called candidate genes. • Serotonin genes, e.g. 5HT1-D beta, are implicated in the transmission of serotonin across synapses • Dopamine genes are also implicated in OCD Both dopamine and serotonin are neurotransmitters that have a role in regulating mood OCD is polygenic – OCD is not caused by one single gene but several genes are involved - Taylor (2013) found evidence that up to 230 different genes may not be involved in OCD Different types of OCD – one group of genes may cause OCD in one person but a different group of genes may cause the disorder in another person – known as aetiologically heterogeneous

Question 37

strength of Genetic explanations of explaining OCD

Answer 37

good supporting evidence for genetic explanation of OCD Evidence from a variety of sources which suggests that some people are vulnerable to OCD as a result of their genetic make-up E.G. Nestadt et al (2010) reviewed twin studies and found that 68% of identical twins (MZ) shared OCD as opposed to 31% of non-identical (DZ) twins This strongly supports a genetic influence on OCD

Question 38

limitations of Genetic explanations of explaining OCD

Answer 38

Too many candidate genes have been identified Twin studies strongly suggest that OCD is largely genetic, but psychologists have been less successful at pinning down all the genes involved One reason for that is that it appears that several genes are involved and that each genetic variation only increases the risk of OCD by a fraction The consequence is that a genetic explanation is unlikely to ever be very useful because it provides little predictive value environmental risk factors are involved It is not just genes but it seems that environmental risk factors can also trigger or increase the risk of developing OCD E.G. Cromer et al (found that over half the OCD patients in their sample had a traumatic event in their past and OCD was more severe in those with one or more traumas This supports the diathesis-stress model. Focusing on environmental causes may be more productive because we are more able to do something about these

Question 39

The biological approach to explaining OCD | Neutral explanations

Answer 39

Low level of serotonin lowers mood – Neurotransmitters are responsible for relaying information from one neuron to another - For example, if a person has low levels of serotonin then normal transmission of mood-relevant information does not take place and mood (and sometimes other mental processes) is affected Decision-making systems in frontal lobes impaired – Some cases of OCD and in particular hoarding disorder, seem to be associated with impaired decision making. - This turn may be associated with abnormal functioning of the lateral (the side bits) frontal lobes of the brain - The frontal lobes are responsible for logical thinking and making decisions Parahippocampal gyrus dysfunctional – There is evidence to suggest that an area called the left parahippocampal gyrus associated with processing unpleasant emotions, functions abnormally in OCD

Question 40

strength of Neural explanations

Answer 40

some supporting evidence for neural explanations Antidepressants that work purely on the serotonin system are effective in reducing OCD symptoms and this suggests that the serotonin system may be involved in OCD Also, OCD symptoms form part of biological conditions such as Parkinson’s disease (nestasdt et al. 2010) This suggests that the biological processes that cause the symptoms in these conditions may also be responsible for OCD

Question 41

limitation of Neural explanations

Answer 41

Serotonin-OCD link may not be unique to OCD Many people who suffer from OCD become depressed. Having two disorders together is called co-morebidity This depression probably involves (though is not necessarily caused by) disruption to the serotonin system. This leaves us with a logical problem when it comes to the serotonin systems as a possible basis for OCD It could simply be that the serotonin system is disrupted in many patients with OCD because they are depressed as well