Psychopathology - P1 Flashcards
(144 cards)
1
Q
What is Psychopathology? - AO1
A
it is the study of psychological disorder
- ‘psycho’ for psychological
- ‘pathology’ meaning the study of the causes of diseases
2
Q
What are the four definitions of abnormality? - AO1
A
- Statistical infrequency
- Deviation from social norms
- Failure to function adequately
- Deviation from ideal mental health
3
Q
What is Statistical Infrequency? - AO1
A
Occurs when an individual has a less common characteristic, for example being more depressed or less intelligent than most of the population.
4
Q
How do you define abnormality in terms of statistics? - AO1
A
- 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.
5
Q
What makes behaviour rarely seen as abnormal? - AO1
A
- Any relatively ‘usual’, or often seen behaviour, can be thought of as normal.
- Any behaviour that is different, or rare, is abnormal, i.e. a statistical infrequency.
6
Q
Give an example of statistical infrequency as an abnormality. - AO1
A
- IQ and intellectual disability disorder (IDD)
- IQ is normally distributed.
- The average IQ is 100. Most people have an IQ between 85 and 115. Only 2% have a score below 70.
- Those individuals scoring below 70 are statistically ‘unusual’ or abnormal and are diagnosed with IDD.
7
Q
What is a strength of Statistical Infrequency? - AO3
A
One strength of statistical infrequency is its real-world application.
- Statistical infrequency is useful in Diagnosis e.g., Intellectual Disability Disorder because this requires an IQ in the bottom 2%.
- It is also helpful in assessing a range of conditions. e.g., the BDI assesses depression, only 5% of people score 30+ = severe depression.
- This means that statistical infrequency is useful in diagnostic and assessment processes.
8
Q
What is a limitation of Statistical Infrequency? - AO3
A
One limitation is that a useful characteristics can also be positive.
- If very few people display a characteristic, then the behaviour is statistically infrequent, but doesn’t mean we would call them abnormal.
- IQ scores above 130 are just as unusual as those below 70, but not regarded as undesirable or needing treatment.
- This means that although statistical infrequency can be part of defining abnormality, it can never be its sole basis.
9
Q
What is deviation from social norms? - AO1
A
Concerns behaviour that is different from the accepted standards of behaviour in a community or society.
10
Q
What is abnormality based on? - AO1
A
- Abnormality is based on social context.
- When a person behaves in a way that is different from how they are expected to behave. They may be defined as abnormal.
- Societies and social groups make collective judgements about ‘correct’ behaviours in particular circumstances.
11
Q
What are the three types of consequences of behaviour? - AO1
A
- There are relatively few behaviours that would be considered universally abnormal therefore definitions are related to cultural context.
- This includes historical differences within the same society.
- E.g. homosexuality is viewed as abnormal in some cultures but not others, and was considered abnormal in our society in the past.
12
Q
Give an example of deviation from social norms as an abnormality. - AO1
A
- One important symptom of antisocial personality disorder, formerly psychopathy, is a failure to conform to ‘lawful and cultural normative ethical behaviour’
- In other words, a psychopath is abnormal because they deviate from social norms or standards. They generally lack empathy.
13
Q
What is a strength of deviation from social norms? - AO3
A
One strength of deviation from social norms is its real-world application.
- Deviation from social norms is useful in the diagnosis of antisocial personality disorder because this requires failure to conform to ethical standards.
- Deviation from social norms is also helpful in diagnosing schizotypal personality disorder, which involves ‘strange’ beliefs and behaviour.
- This means that deviation from social norms is useful in psychiatric diagnosis.
14
Q
What is a limitation of deviation from social norms? - AO3
A
One limitation is that social norms are situationally and culturally relative.
- A person from one culture may label someone from another culture as abnormal using their standards rather than the person’s standards.
- For example, hearing voices is socially acceptable in some cultures, but would be seen as a sign of abnormality in the UK.
- This means it is difficult to judge deviation from social norms from one context to another.
15
Q
What is the failure to function adequately? - AO1
A
Occurs when someone is unable to cope with ordinary demands of day-to-day living.
16
Q
What makes the inability to cope with everyday living an abnormality? - AO1
A
- 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 adequately.
- For instance, not being able to maintain basic standards of nutrition and hygiene, hold down a job, or maintain relationships.
17
Q
What did Rosenhan and Seligman (1989) propose onto further signs of failure to cope? - AO1
A
When someone is not coping:
- They no longer conform to interpersonal rules, e.g. maintaining personal space.
- They experience severe personal distress.
- They behave in a way that is irrational or dangerous.
18
Q
Explain an example of the failure to function adequately. (IDD) - AO1
A
- Having a very low IQ is a statistical infrequency, but diagnosis would not be made on this basis alone.
- There would have to be clear signs that the person was not able to cope with the demands of everyday living.
- So intellectual disability disorder is an example of failure to function adequately.
19
Q
What is a strength of failure to function adequately? - AO3
A
Strength of failure to function is a threshold for professional help.
- In any given year, 25% of us experience symptoms of mental disorder to some degree.
- Most of the time we press on, but when we cease to function adequately, people seek or are referred for professional help.
- This means that the failure to function criterion provides a way to target treatment and services to those who need them most.
20
Q
What is a limitation of failure to function adequately? - AO3
A
One limitation is this definition can lead to discrimination/social control.
- It is hard to distinguish between failure to function and a conscious decision to deviate from social norms.
- For example, people may choose to live off grid as part of an alternative lifestyle choice or take part in high risk leisure activities.
- This means that people who make unusual choices can be labelled abnormal and their freedom of choice restricted.
21
Q
What is deviation from ideal mental health? - AO1
A
Occurs when someone does not meet a set of criteria for good mental health.
22
Q
How can deviation from ideal mental health be identified by looking at what is normal? - AO1
A
- A different way to look at normality and abnormality is to think about what makes someone ‘normal’ and psychologically healthy.
- Then identify anyone who deviates from this ideal.
23
Q
What did Jahoda (1958) suggest in her listed 8 criteria? - AO1
A
Jahoda (1958) suggested the following criteria for ideal mental health:
- We have no symptoms or distress.
- We are rational and perceive ourselves accurately.
- We self-actualise.
- We can cope with stress.
- We have a realistic view of the world.
- We have good self esteem and lack guilt.
- We are independent of other people.
- We can successfully work, love and enjoy our leisure.
24
Q
How can there be an inevitable overlap between definitions? - AO1
A
- Someone’s inability to keep a job may be a sign of their failure to cope with the pressures of work (failure to function)
- Or as a deviation from the ideal of successfully working.
25
What is a limitation of deviation from ideal mental health? - AO3
One limitation is this definition can lead to discrimination/social control.
- It is hard to distinguish between failure to function and a conscious decision to deviate from social norms.
- For example, people may choose to live off grid as part of an alternative lifestyle choice or take part in high risk leisure activities.
- This means that people who make unusual choices can be labelled abnormal and their freedom of choice restricted.
26
What is a limitation of deviation from ideal mental health? - AO3
One limitation is the definition may be culture-bound.
- Some criteria for ideal mental health are limited to the US and Europe, e.g. self-actualization is not recognised in most of the world.
- Even in Europe, there are variations in the value placed on independence (high in Germany, low in Italy)
- This means that it is very difficult to apply the concept of ideal mental health from one culture to another.
27
What is a phobia? - AO1
It is an irrational fear of an object or situation.
28
What are the 3 aspects of a phobia? - AO1
- Behavioural
- Emotional
- Cognitive
29
Give the definition of Behavioural in terms of phobias. - AO1
Ways in which people act.
30
What are the behavioural characteristics of phobias? - AO1
- Panic
- Avoidance
- Endurance
31
How is Panic a characteristic of phobias? - AO1
- May involve a range of behaviours such as crying, screaming or running away from the phobic stimulus.
32
How is Avoidance a characteristic of phobias? - AO1
- Considerable effort to prevent contact with the phobic stimulus. This can make it hard to go about everyday life.
33
How is Endurance a characteristic of phobias? - AO1
- An alternative behaviour to avoidance.
- It is remaining with the phobic stimulus and continuing to experience anxiety.
34
Give the definition of Emotional in terms of phobias. - AO1
Related to a person's feelings or mood.
35
What are the emotional characteristics of phobias? - AO1
- Anxiety
- Fear
- Having an emotional response that is unreasonable
36
How is Anxiety a characteristic of phobias? - AO1
- An unpleasant state of high arousal.
- Prevents an individual relaxing and makes it very difficult to experience positive emotion.
37
How is Fear a characteristic of phobias? - AO1
- The immediate response we experience when we encounter or think about a phobic stimulus.
38
How is Emotional response being unreasonable a characteristic of phobias? - AO1
- Disproportionate to the threat posed e.g., a person with arachnophobia will have a strong emotional response to a tiny spider.
39
Give the definition of Cognitive. - AO1
Refers to the process of ‘knowing’, including thinking, reasoning, remembering, believing.
40
What are the cognitive characteristics of phobias? - AO1
- Having a selective attention to the phobic stimulus
- May have irrational beliefs
- Cognitive distortions
41
How is having selective attention to the phobic stimulus a characteristic of phobias? - AO1
- Selective attention to the phobic stimulus. A person with a phobia finds it hard to look away from the phobic stimulus.
42
How are irrational beliefs a characteristic of phobias? - AO1
- Phobias may involve beliefs, e.g. ‘if I blush, people will think I'm weak’
43
How are cognitive distortions a characteristic of phobias? - AO1
- Unrealistic thinking e.g. belly buttons appear ugly.
44
How is the behavioural approach used to explain phobias? - AO1
- what is it
It is a way of explaining behaviour in terms of what is observable and in terms of learning.
45
What is the two-process model? - AO1
It is an explanation for the onset + persistence of disorders that create anxiety, such as phobias. The two processes are classical conditioning for onset and operant conditioning for persistence.
46
What did Mowrer (1960) argue about Classical conditioning and operant conditioning - AO1
Mowrer (1960) argued that phobias are learned by classical conditioning and then maintained by operant conditioning. i.e. 2 processes are involved.
47
How does acquisition occur by classical conditioning? - AO1
Conditioning involves association.
1. UCS triggers a fear response. Fear is a UCR e.g. Being bitten creates anxiety.
2. Rat (NS) did not create fear until the bang and the rat had been paired together several times.
3. NS becomes a CS, producing fear (which is now the CR). The rat becomes a CS, causing a CR of anxiety/fear following the bite.
48
Who was Little Albert: How was he conditioned to fear? - AO1
- What two psychologists did this test (1920)
Watson + Rayner (1920) showed how a fear of rats could be conditioned in ‘Little Albert’.
1. Whenever Albert played with a white rat allowed, noise was made close to his ear. The noise (UCS) caused a fair response (UCR)
2. Rat (NS) did not create fair until the bang and the rat had been paired together several times.
3. Albert showed a fair response (CR) every time he came into contact with the rat, now a (CS).
49
How was the fear generalised to other stimuli? - AO1
For example, Little Albert also showed fear in response to other White hairy objects, including a fur coat and a Santa Claus beard.
50
Explain maintenance by operant conditioning (negative reinforcement). - AO1
- Operant conditioning takes place when our behaviour is reinforced or punished.
- Negative reinforcement - an individual produces behaviour that avoids something unpleasant.
- When a person with a phobia 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.
51
Give an example of negative reinforcement. - AO1
- fear of clowns (coulrophobia)
- If someone has a morbid fear of clowns (coulrophobia), they will avoid circuses and other situations where they may encounter clowns.
- The relief felt from avoiding clowns negatively reinforces the phobia and ensures it is maintained rather than confronted.
52
What is one strength of the two-process model? - AO3
One strength is its real-world application.
- The idea that phobias are maintained by avoidance is important in explaining why people with phobias benefit from exposure therapies e.g. SD.
- Once avoidance behaviour is prevented, it ceases to be reinforced by the reduction of anxiety. Avoidance behaviour therefore declines.
- This shows the value of the two-process approach because it identifies a means of treating phobias.
53
What is one limitation of the two-process model? - AO3
One limitation is the inability to explain cognitive aspects of phobias.
- Behavioural explanations like the two-process model are geared towards explaining behaviour - in this case avoidance of the phobic stimulus.
- However, we know that phobias also have a significant cognitive component, e.g. people hold irrational beliefs about the phobic stimulus
- This means that the two-process model does not fully explain the symptoms of phobias.
54
What is another strength of the two-process model? - AO3
Another strength is evidence, linking phobias to bad experiences.
- De Jongh et al. (2006) found that 73% of dental phobics experienced a trauma (mostly involving dentistry), evidence of link between bad experienced + phobias
- Further support came from the control group of people with low dental anxiety, where only 21% had experienced A traumatic event.
- This confirms that the association between stimulus (dentistry) and an unconditioned response (pain) does lead to the phobia.
55
What is a counter point of a strength of the two-process model? - AO3
- Not all phobias appear following a bad experience. Snake phobias still occur in populations where very few people have any experience of snakes. Also, not all frightening experiences lead to phobias.
- This means that behavioural theories probably do not provide an explanation for all cases of phobia.
56
What are the two ways in which the behavioural approach is used to treat phobias? - AO1
- Systematic desensitisation (SD)
- Flooding
57
What is systematic desensitisation (SD)? - AO1
A behavioural therapy designed to reduce an unwanted response, such as anxiety.
- SD involves drawing up a hierarchy of anxiety-provoking situations related to a person's phobic stimulus, teaching the person to relax, + then exposing them to phobic situations
- The person works their way through the hierarchy whilst maintaining relaxation
58
How is SD based on classical conditioning, counterconditioning and reciprocal inhibition? - AO1
The therapy aims to gradually reduce anxiety through counterconditioning:
- That is learned so that phobic stimulus (CS) produces fear (CR).
- This is paired with relaxation and this becomes the new CR.
Reciprocal inhibition - not possible to be afraid and relaxed at the same time, so one emotion prevents the other.
59
How is an anxiety hierarchy formed? - AO1
- Client and therapist design an anxiety hierarchy - fearful stimuli arranged in order from least to most frightening.
- A person with arachnophobia might identify seeking a picture of a small spider as low on their anxiety hierarchy and holding a tarantula as the final item.
60
How is relaxation practised at each level of the hierarchy? - AO1
- Person with phobia is first taught relaxation techniques such as deep breathing and/or meditation.
- Person then works through the anxiety hierarchy. At each level, the person 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 high-anxiety situations.
61
What is flooding? - AO1
A behavioural therapy in which a person with a phobia is exposed to an extreme form of a phobic stimulus in order to reduce anxiety triggered by that stimulus.
- This takes place across a small number of long therapy sessions
62
How does flooding involve immediate exposure to the phobic stimulus? - AO1
- explain also for arachnophobia
- Flooding involves exposing a person with a phobia with the phobics object without a gradual build up.
- A person with arachnophobia receiving flooding treatment may have a large spider crawl over their hand until they can fully relax.
63
How is it very quick learning through extinction? - AO1
Without the option of avoidance behaviour, the person quickly learns that the phobic object is harmless through the exhaustion of their fear response. This is known as extinction.
64
Explain the ethical safeguards of flooding? - AO1
Flooding is not unethical, but it is an unpleasant experience, so it is important that people being treated give informed consent. They must be fully prepared and know what to expect.
65
What is one strength of SD for treating phobias? - AO3
One strength is evidence of effectiveness.
- Gilroy et al. (2003) followed up 42 people who had SD for spider phobia. At follow-up, the SD group were less fearful than a control group.
- In a recent review, Wechsler et al. (2019) concluded that SD is effective for specific phobia, social phobia, and agoraphobia.
- This means that SD is likely to be helpful for people with phobias.
66
What is another strength of SD for treating phobias? - AO3
Another strength is usefulness for people with learning disabilities.
- Main alternatives to SD are unsuitable for people with learning disabilities. e.g. Cognitive therapies require a high level of rational thought and flooding is distressing.
- SD, on the other hand, does not require understanding or engagement on a cognitive level and is not a traumatic experience.
- This means that SD is often the most appropriate treatment for some people.
67
What is one strength of flooding for treating phobias? - AO3
One strength is that it is cost-effective
- A therapy is described as cost effective if it is clinically effective and not expensive. Flooding can work in as little as one session.
- Even with a longer session e.g. 3 hours, this makes flooding more cost effective than alternatives.
-This means that more people can be treated at the same cost by flooding then by SD or other therapies.
68
What is one limitation of flooding for treating phobias? - AO3
One limitation is that it is traumatic.
- Schumacher et al. (2015) found that both participants and therapists rated flooding as more stressful than SD.
- Thus, there are ethical concerns about knowingly causing stress (offset by informed consent) and the traumatic nature of flooding also leads to higher attrition rates than for SD.
- This suggests that overall, therapists may avoid using this treatment.
69
What is depression? - AO1
It is a mental disorder characterised by low mood and low energy levels
70
What is the cognitive approach? - AO1
The term ‘cognitive’ has come to mean mental processes. So this approach is focused on how our mental processes (e.g. thoughts, perceptions, attention) affect behaviour.
71
What are the behavioural characteristics of depression? - AO1
- reduced activity levels
- disruption to sleep + eating behaviour
- aggression + self-harm
72
How are reduced activity levels a characteristic of depression? - AO1
People with depression have reduced levels of energy making them lethargic, e.g. cannot get out of bed
73
How is disruption to sleep + eating behaviour a characteristic of depression? - AO1
- Reduced sleep (insomnia) or increased (hypersomnia).
- Appetite + weight may increase or decrease
74
How is aggression and self-harm a characteristic of depression? - AO1
Depression is associated with irritability + this may extend to aggression + self-harm
75
What are the emotional characteristics of depression? - AO1
- lowered mood
- anger
- lowered self-esteem
76
How is a lowered mood a characteristic of depression? - AO1
People with depression describe themselves as 'worthless' or 'empty'
77
How is anger a characteristic of depression? - AO1
Such emotions lead to aggression or self-harming behaviour
78
How is a lowered self-esteem a characteristic of depression? - AO1
The person likes themselves less, even self-loathing
79
What are the cognitive characteristics of depression? - AO1
- poor concentration
- attention to the negative
- absolutist thinking
80
How is poor concentration a characteristic of depression? - AO1
The person may find themselves unable to stick with a task, or might find simple decision-making difficult
81
How is attention to the negative a characteristic of depression? - AO1
Depressed people have a bias towards focusing on negative aspects of current situations + recalling unhappy (instead of happy) memories
82
How is absolutist thinking a characteristic of depression? - AO1
'Black-and-white thinking', when a situation is unfortunate it is seen as an absolute disaster
83
What are the two cognitive explanations of depression? - AO1
- The Negative Triad (Beck 1967)
- The ABC model (Ellis 1962)
84
What is the Negative Triad? - AO1
Beck proposed that there are three kinds of negative thinking that contributes to becoming depressed: negative views of the world, the future and the self.
- Such negative views lead to a person to interpret their experiences in a negative way and so make them more vulnerable to depression.
85
How does faulty information processing make people more prone to depression? - AO1
- Beck (1967) suggested that some people are more 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.
86
What is a negative self-schema? - AO1
- A schema is a ‘package’ of ideas and information developed through experience. We use schema to interpret the world.
- So if a person has a negative self-schema, they interpret all information about themselves in a negative way.
87
What are the 3 elements to the negative triad? - AO1
- Negative view of the world.
- Negative view of the future.
- Negative view of the self.
88
What is the ABC model? - AO1
Ellis proposed that depression occurs when an activating event (A) triggers an irrational belief (B), which in turn produces a consequence (C), i.e., an emotional response like depression. The key to this process is the irrational belief.
89
Explain the (A) activating event. - AO1
- 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.
90
Explain (B) beliefs. - AO1
Negative events trigger irrational beliefs, for example:
- Ellis called the belief that we must always succeed "musterbation"
- I-can’t-stand-it-itis is the belief that it is a disaster when things don’t go smoothly
- Utopianism is the belief that the world must always be fair and just.
91
Explain the (C) consequences. - AO1
- When an 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.
92
What is one strength of Beck's model? - AO3
One strength is supporting research.
- Clark and Beck (1999) concluded that cognitive vulnerabilities (e.g., faulty Information Processing, Negative self-schema) are more common in depressed people.
- A recent prospective study by Cohen et al. (2019) tracked 473 adolescents' development and found that early cognitive vulnerability predicted later depression.
- This shows that there is an association between cognitive vulnerability and depression.
93
What is another strength of Beck's model? - AO3
Another strength is real-world application to screening for depression.
- Assessing cognitive vulnerability in young people most at risk of developing depression means they can be monitored.
- Understanding Cognitive vulnerability is applied in CBT to alter cognitions underlying depression, making a person more resilient to life events.
- This means that the idea of cognitive vulnerability is useful in clinical practice.
94
What is one strength of Ellis’s model? - AO3
One strength of the model is its application in treating depression.
- Ellis applied the ABC model to treat depression (Rational Emotive Behaviour Therapy, REBT).
- Evidence that REBT can both change negative beliefs and relieve the symptoms of depression (David et al. 2018)
- This means that REBT has real-world value.
95
What is one limitation of Ellis’s model? - AO3
One limitation is the model only explains reactive depression.
- Reactive depression describes a form of depression which is triggered by negative activating events.
- Many cases it is not obvious what triggers depression. Described as endogenous depression. Ellis’s model is less useful in explaining this.
- This means that Ellis’s model can only explain some cases of depression.
96
How is the cognitive approach used to treat depression? - AO1
Cognitive Behaviour Therapy, CBT, is the most common psychological treatment, e.g. for depression. CBT is an example of the cognitive approach to treatment, though it also includes behavioural aspects.
- Cognitive - challenge, negative irrational thoughts.
- Behaviour - change behaviour so it is more effective.
Client and therapist work together.
97
What is Cognitive Behaviour Therapy (CBT)? - AO1
A method for treating mental disorders based on both cognitive and behavioural techniques. From the cognitive viewpoint, the therapy aims to deal with thinking such as challenging negative thoughts. The therapy also includes behavioural techniques such as behavioural activation.
98
How does challenging negative thoughts help depression? - AO1 (Beck)
- The aim is to identify negative thoughts about the self, the world and the future - the negative triad.
- These thoughts must be challenged by the client taking an active role in their treatment.
99
The ‘client as Scientist’ - AO1
- Clients are encouraged to test the reality of their irrational beliefs.
- They might be set homework e.g. to record when they enjoyed an event. This is referred to as the ‘client as scientist’.
- In future sessions, if clients say that no one is nice to them, the therapist can produce this evidence to prove the clients beliefs are incorrect.
100
Ellis’s Rational Emotive Behaviour Therapy, REBT. - AO1
REBT extends the ABC model to an ABCDE model:
- D for dispute, challenge, irrational beliefs.
- E for effect.
101
What are irrational thoughts? - AO1
Also called dysfunctional thoughts. In Ellis’s model and therapy, these are defined as thoughts that are likely to interfere with a person's happiness. Such dysfunctional thoughts lead to mental disorders such as depression.
102
Challenging irrational thoughts. - AO1
A client might ask about how unlucky they have been or how unfair life is. An REBT therapist would identify this as utopianism and challenge it as irrational.
- Empirical argument - disputing whether there is evidence to support the irrational belief.
- Logical argument - disputing whether the negative thought actually follows from the facts.
103
What is
behavioural activation. - AO1
- As individuals become depressed, they tend to increasingly avoid difficult situations and become isolated, which maintains or worsens symptoms.
- The goal of behavioural activation, therefore, is to work with depressed individuals to gradually decrease their avoidance in isolation and increase their engagement in activities that have been shown to improve mood, e.g. exercise
104
What is one strength of CBT? - AO3
One strength is that there is evidence of effectiveness.
- March et al. (2007) compared the effects of CBT with antidepressant drugs and a combination of the two in 327 depressed adolescents.
- After 36 weeks, 81% of CBT group, 81% antidepressants groups and 86% of CBT + antidepressants group were significantly improved.
- This means there is a good case for making CBT the first choice of treatment in public healthcare systems like the NHS.
105
What is a limitation of CBT? - AO3
One limitation is suitability for diverse clients.
- In severe cases, depressed clients may not be able to motivate themselves to engage with the cognitive work of CBT. They may not even be able to pay attention in a session.
- Sturmey (2005) suggests that any form of psychotherapy, including CBT, is not suitable for people with learning disabilities.
- This means that CBT may only be appropriate for a specific range of clients.
106
What is a counterpoint of a limitation of CBT? - AO3
- There is now evidence to challenge this conventional wisdom. Lewis and Lewis (2016) concluded that CBT was as effective as other treatments for severe depression. Taylor (2008) concluded that CBT can be effective for people with learning disabilities.
- This means that CBT may have much wider application than was once thought.
107
What is another limitation of CBT? - AO3
Another limitation of CBT is its high relapse rates.
- Few early studies looked at long term effectiveness and recent studies suggest that relapse is common.
- Ali et al. (2017) assessed depression from 12 months following a course of CBT. 42% relapsed within six months of ending treatment and 53% within a year.
- This means that CBT may need to be repeated periodically.
108
What is OCD? - AO1
Obsessive compulsive disorder is a condition characterised by obsessions and/or compulsive behaviour. Obsessions are cognitive, whereas compulsions are behavioural.
109
What are the three examples of compulsions of OCD? - AO1
- Trichotillomania - Compulsive hair-pulling.
- Hoarding disorder - The compulsive gathering of possessions and the inability to part with anything, regardless of its value.
- Excoriation disorder - Compulsive skin-picking.
110
What are the behavioural characteristics of OCD? - AO1
- Compulsions are repetitive.
- Compulsions reduce anxiety.
- Avoidance.
111
How are repetitive compulsions a characteristic of OCD?
- Actions carried out repeatedly in a ritualistic way. e.g. hand washing.
- Anxiety may be created by obsessions or just anxiety alone.
112
How is avoidance a characteristic of OCD? - AO1
OCD is managed by avoiding situations that trigger anxiety, e.g. avoid rubbish bins because they have germs.
113
What are the emotional characteristics of OCD? - AO1
- Anxiety and distress
- Depression.
- Guilt and disgust.
114
How is anxiety and distress a characteristic of OCD? - AO1
Obsessive thoughts are unpleasant and frightening, and anxiety that goes with these can be overwhelming.
115
How is depression a characteristic of OCD? - AO1
low mood and lack of enjoyment
116
How is guilt and disgust a characteristic of OCD? - AO1
Irrational guilt, for example, over a minor moral issue or disgust which is directed towards oneself or something external like dirt.
117
What are the cognitive characteristics of OCD? - AO1
- Obsessive thoughts.
- Cognitive coping strategies.
- Insight into excessive anxiety.
118
How are obsessive thoughts a characteristic of OCD? - AO1
About 90% of people with OCD have recurring intrusive thoughts e.g. about being contaminated by dirt or germs.
119
How are cognitive coping strategies a characteristic of OCD? - AO1
Some people with OCD use strategies to cope e.g. Meditation.
120
How is an insight into excessive anxiety a characteristic of OCD? - AO1
Awareness that thoughts and behaviour are irrational. May have catastrophic thoughts and be hypervigilant.
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What is the biological approach? - AO1
A perspective that emphasises the importance of physical processes in the body such as genetic inheritance and neural function
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What are two biological explanations of OCD? - AO1
- Genetic explanations
- Neural explanations
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How can genetics link to OCD? - AO1
Genes make up chromosomes and consist of DNA which codes the physical features of an organism (such as eye colour, height) and psychological features (such as mental disorders, intelligence). Genes are transmitted from parents to offspring
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How can candidate genes be a genetic explanation of OCD? - AO1
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 and may regulate mood
both dopamine and serotonin are neurotransmitters
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What makes OCD polygenic? - AO1
- Who researched this
OCD is not caused by one single gene but several genes are involved
- Taylor (2013) found evidence that up to 230 different genes may be involved in OCD
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How can genetics explain the different types of OCD? - AO1
- 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
- There is also evidence that different types of OCD may be the result of particular genetic variations, such as hoarding disorder and religious obsession
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How can neural function link to OCD? - AO1
- what is it
The view that physical and psychological characteristics are determined by behaviour of the nervous system, in particular the brain as well as individual neurons
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How can low serotonin levels be a neural explanation of OCD? - AO1
- what are responsible for relaying info across neurons
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 info doesn't take place and mood (sometimes other mental processes) is affected
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How can an impaired frontal lobe be a neural explanation of OCD? - AO1
- how does it link to hoarding
Some cases of OCD, and in particular hoarding disorder, seem to be associated with impaired decision-making
- This in turn may be associated with abnormal functioning of the lateral (side bit) frontal lobes of the brain
- The frontal lobes are responsible for logical thinking and making decisions
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How can parahippocampal gyrus dysfunction be a neural explanation of OCD? - AO1
There is also evidence to suggest that an area called the left parahippocampal gyrus, associated with processing unpleasant emotions, functions abnormally in OCD
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What is one strength of the genetic explanation of OCD? - AO3
One strength is evidence for the genetic explanation of OCD
- 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
- Marini and Stebnicki (2017) found that a person with a family member with OCD is around four times as likely to develop it as someone without.
- This means that people who are genetically similar are more likely to share OCD, supporting a role for genetic vulnerability.
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What is one limitation of the genetic explanation of OCD? - AO3
One limitation is the existence of environmental risk factors
- Genetic variation affects vulnerability to OCD, but there are also environmental risk factors that trigger or increase the risk of OCD.
- Cromer et al. (2007) found in one sample over half of people with OCD experienced a traumatic event. OCD severity correlated positively with number of traumas.
- This means that genetic vulnerability only provides a partial explanation of OCD.
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What is one strength of the neural model explanation of OCD? - AO3
One strength of the neural model is supporting evidence
- Antidepressants that work on serotonin reduce OCD symptoms. Suggests that serotonin may be involved in OCD.
- OCD symptoms form part of conditions that are known to be biological in origin e.g., Parkinson's disease. (Nestadt et al. 2010)
- This means that biological factors (e.g. serotonin and processes underlying Parkinson's disease) are likely to be involved in OCD.
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What is one limitation of the neural model explanation of OCD? - AO3
One limitation of the neural model is there is no unique neural system
- Many people with OCD also experienced depression. This depression probably involves disruption to the action of serotonin.
- It could simply 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.
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What is drug therapy? - AO1
- what does it aim to achieve
Drug therapy for mental disorders aims to increase or decreases levels of neurotransmitters in the brain or to increase/decrease their activity
- Low levels of serotonin are associated with OCD
- Therefore drugs work in various ways to increase the level of serotonin in the brain
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What is the purpose of Selective serotonin reuptake inhibitors (SSRIs)? - AO1
- SSRIs prevent the reabsorption and breakdown of serotonin in the brain. This increases it levels in the synapse and thus serotonin continues to stimulate the postsynaptic neuron
- This compensates for whatever is wrong with the serotonin system in OCD
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What is the typical dosage of a drug in drug therapy to treat OCD? - AO1
- A typical dosage of fluoxetine, an SSRI, is 20mg, although this may be increased if it's not benefiting the person.
- Takes three to four months of daily use for SSRIs to impact upon symptoms.
- Dose can be increased (e.g. to 60mg) if this is appropriate.
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Why can SSRIs and CBT be combined? - AO1
- Drugs are often used alongside cognitive behaviour therapy CBT to treat OCD.
- The drugs reduce a person's emotional symptoms, such as feeling anxious or depressed. This means that they can engage more efficiently with CBT.
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What is tricyclics? - AO1
- how are they an alternative to SSRIs
- Tricyclics (an older type of antidepressant) are sometimes used, such as clomipramine
- These have the same effect on the serotonin system as SSRIs but the side-effects can be more severe
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What are SNRIs? - AO1
- how are they an alternative to SSRIs
- In the last five years, a different class of antidepressant drugs called serotonin noradrenaline reuptake inhibitors, SNRIS, has also been used to treat OCD.
- Like tricyclics, they are a second line of defence for people who don't respond to SSRIs.
- SNRIs increase levels of serotonin as well as noradrenaline.
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What is one strength of drug therapy to treat OCD? - AO3
One strength of drug therapy is its effectiveness
- Soomro et al. (2009) reviewed 17 studies of SSRIs for this treatment of OCD. All 17 studies showed better outcomes following SSRIs than placebos.
- Typically, OCD symptoms reduce for around 70% of people taking SSRIs.
- This means that drugs can be of help to most people with OCD.
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What is a counterpoint of a strength of drug therapy to treat OCD? - AO3
- Although drug treatments may be better than placebos, they may not be the most effective treatments. Cognitive and behavioural (exposure) therapies may be more effective than SSRIs in the treatment of OCD (Skapinakis et al. 2016)
- This means that drugs may not be the optimum treatment for OCD
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What is another strength of drug therapy to treat OCD? - AO3
Another strength is that drugs are cost-effective and non-disruptive
- A strength of drug treatments for psychological disorders in general is that they are cheap compared to psychological treatments. Using drugs to treat OCD is therefore good value for the NHS.
- As compared to psychological therapies, SSRIs are non disruptive to people's lives. If you wish, you can simply take drugs until your symptoms decline, rather than spending time going to therapy sessions.
- This means that many doctors and people with OCD preferred drug treatments.
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What is one limitation of drug therapy to treat OCD? - AO3
One limitation is that drugs can have serious side effects
- A minority of people taking SSRIs get no benefit. Some people also experience side effects such as indigestion, blurred vision, and loss of sex drive, although these side effects are usually temporary.
- For those taking Clominpramine, side effects are more common and can be more serious. More than 1 in 10 people experience erection problems and gain weight, 1 in 100 become aggressive.
- This means that people's quality of life is poor and the outcome is they may stop taking the drug altogether, reducing the effectiveness of the treatment.
