Psychopathology- P1 Flashcards
(19 cards)
Definitions of abnormality- statistical infrequency AO1and 3
- defines normal and abnormal according to how often we come across them, usual= normal, unusual= abnormal
- e.g. IQ and intellectual disorder- average IQ is 100, only 2% fall below 70, they are ‘abnormal’
S: real world application- used in clinical practice to diagnose and assess severity of symptoms e.g. Beck’s depression inventory (BDI) a score in top 5% (30+) indicates severe depression
W: unusual characteristics can be positive- e.g. abnormally high IQ wouldn’t make someone psychologically abnormal, or a very low score on the BDI
Definitions of abnormality- deviation from social norms AO1 and 3
- when a person behaves differently how we expect them to behave
- we make collective judgements in society about what is acceptable =norms, these are specific to cultures and generations
- e.g. anti-social personality disorder= impulsive and aggressive behaviour that doesn’t adhere to our norms
W: human rights abuses- this definition can lead to wrongful labelling and human rights abuses e.g. homosexuality
W: cultural relativism- norms vary between cultures e.g. hearing voices is normal in some cultures, could lead to incorrect labelling as mentally ill
Definitions of abnormality- deviation from ideal mental health AO1 and 3
- looks at what makes someone “normal” and deviation from this is abnormal
- Jahoda classified ideal mental health: no signs of distress, rational, can self-actualise, can cope with stress, realistic view of the worl, good self-esteem
S: comprehensive definition- includes a range of criteria for good mental health, covers most of the reasons why someone would seek help, more positive definition
W: may be culture bound: e.g. self-actualisation may only be applicable to western/ individualist cultures
Definitions of abnormality- failure to function adequately AO1 and 3
- someone becomes abnormal when they can no longer cope with the demands of everyday life e.g. hygiene and nutrition
- Rosenhan and Seligman: signs that someone is failing to function= don’t conform to interpersonal standards, severe personal distress, irrational/dangerous behaviour
S: provides a threshold for help- indicates when someone may need to seek professional help and means that services can be targetted to those who need them most
W: discrimination and social control- easy to label non-standard lifestyles as abnormal, someone may choose to live differently e.g. living ‘off grid’, this doesnt make them abnormal (labelling)
Phobias AO1 only
- phobia= excessive fear and anxiety triggered by an object, the fear is disproportionate to the danger of the phobic stimulus
- DSM-5 categories= specific phobia (relates to an object or situation), social anxiety (relates to social situations), agoraphobia (phobia of being outside/ in public)
- behavioural characteristics:
-panic: crying, screaming, fear, freezing
-avoidance: preventing contact with the phobic stimulus, limits everyday life
-endurance: remaining in the presence of the stimulus ‘frozen’ - cognitive characteristics:
-selective attention: fixation, staring for a long time
-irrational beliefs: illogical thoughts which have no basis in reality
-cognitive distortions: innaccurate and unrealistic perceptions - emotional characteristics:
-anxiety: state of high arousal
-fear: unpleasant response
-emotional response is disproportionate to the threat
Behavioural approach to explaining phobias AO1
- two-process model- Mowrer: phobias are learnt through conditioning
- aquired through classical conditioning - learning to associate something we have no fear of (neutral), with something that triggers fear (unconditioned stimulus)
- Watson and Rayner: conditioned Little Albert to be afraid of a white rat by associating it with a loud noise, this fear was then generalised to all things white and fluffy
- maintained through operant conditioning- learning a behaviour through reinforcement: when we avoid something which causes fear, we have a positive outcome (anxiety is reduced) so we repeat that behaviour= negative reinforcement
Behavioural approach to explaining phobias AO3
- S: real-world applications: two process model can be applied to exposure therapies such as systematic desensitisation, if fears can be learnt, they can also be unlearnt, in exposure therapy, they cannot avoid so their avoidance cannot be negatively reinforced
- W: only explains behavioural aspects- two process model doesn’t explain the faulty cognitions involved e.g. the irrational belief (cognition) causes the behavioural response
- W: only focusses on the nurture side of nature/nurture- some fears are adaptive- we have adapted to fear things that could harm us (biological preparedness), there could be biological factors involved in phobias
Behavioural approach to treating phobias AO1
- flooding-
* direct and immediate exposure to the phobias rather than gradual, e.g. someone afraid of snakes would have a snake placed on their shoulders for an extended period of time
* works by preventing avoidance, they realise that the phobic stimulus is harmless as they have to endure it until totally calm (extinction) - systamtic desnsitisation-
* counterconditioning to change the association to a positive one
* 3 stages…
-learning relaxation techniques: learn how to replace fear with calm as it is impossible to feel conflicting emotions at once (reciprocal inhibition)
-create anxiety heirarchy: list events relating to how fearful they are
-gradual exposure: working through the anxiety heirarchy, only moving on when completely calm in each stage, this can be in vivo (real-life) or in vitro (imagining the phobia)
Behavioural approach to treating phobias AO3
Flooding
* S: evidence of effectiveness: Nesbitt- case of someone with a 7 year phobia of escalators, they had to go up and down many times, after 27 mins they could do it without the therapist and after 29 mins they reported no anxiety (still none after 6 months
* W: ethical issues: extremely traumatic and unpleasant- high drop out rates, Wolpe reported a case in which a client was hospitalised due to anxiety caused by flooding
Systematic desensitisation
* S: evidence of effectiveness: Gilroy- treated 42 patients with spider fears using 3x 45 min sessions, compared to a control group who only learnt relaxation techniques, 11 months later, the SD group were less fearful
HOWEVER: not all aspects are equally as effective- in vivo is better than in vitro
* W: doesn’t work for evolutionary fears- these are more difficult to countercondition as they aid survival and are biological
OCD AO1 only
- obsessive compulsive disorder= a condition characterised by obsessions and/or compulsive behaviours
- DSM-5 categories= all involve repetitive behaviours and obsessive thinking: OCD, hoarding disorder, excoration disorder (skin picking)
- behavioural characteristics:
-compulsions: repetitive behaviours e.g. handwashing, counting, praying
-compulsions reduce anxiety: performed in attempt to manage anxiety caused by obsessions
-avoidance: of situations that trigger OCD - emotional characteristics:
-anxiety and distress: obsessive thoughts are unpleasant so are often accompanied by anxiety
-depression: anxiety is often accompanied by depression
-guilt and disgust: can be irrational - cognitive characteristics:
-obsessive thoughts: thoughts that recur over and over and are always unpleasant
-cognitive coping mechanisms: ways to manage anxiety e.g. praying/ meditation
-insight into their own anxiety: awareness that their ob’s and c’s are irrational (essential for diagnosis)
Biological approach to explaining OCD AO1
Genetic explanation
* we inherit genes that make us vulnerable to the disorder
* diathesis-stress model= certain genes make us more likely to develop an environmental stressor triggers it
* candidate gene= specific genes that may be linked to OCD e.g. SERT which is involved in the transportation of serotonin
* polygenic- caused by multiple genes
* aetiologically heterogenous= caused by different variations of genes
Neural explanation
* involves brain structures and hormones
* role of serotonin= regulates mood, OCD could be caused by low levels of serotonin, messages about mood regulation cannot be transmitted normally which may explain the anxiety and subsequent obsessions
* basal ganglia= set of brain structures responsible for making decisions about movements that are likely to have a positive outcome and avoid negative outcomes, an abnormality in the basal ganglia can explain the compulsions to avoid the negative consquences of obsessions
Biological approach to explaining OCD AO3
genetic explanations
* S: research support: twin studies e.g. Nestadt reviewed (meta-analysis) 14 twin studies and found that concordance rates were higher in identical twins than non-identical: 68% for MZ, 31% for DZ
HOWEVER: concordance wasn’t 100% so there must be some environmental influence
* S: support for SERT gene- Ozaki et al studied 2 unrelated families and found that 6/7 p’s with mutations of the SERT gene had OCD or related disorders
neural explanations
* S: evidence for basal ganglia: Wise and Rapoport- OCD is quite common in those with Parkinson’s and tourettes which both involve abnormalities in the basal ganglia
HOWEVER- not everyone does so other factors must be involved
* S: evidence for serotonin: OCD is often treated using SSRIs which block the reuptake of serotonin meaning it stays in the synapse for longer, this relieves the symptoms suggesting that serotonin must have a role
HOWEVER- cause and effect
Biological approach to treating OCD AO1
- drug therapy- aims to change hormone levels, OCD is partly caused by low serotonin, so drugs used to treat it usually aim to increase levels
- SSRI’s= selective serotonin reuptake inhibitors- block the reuptake of serotonin by the post-synaptic neuron so increase levels in the synapse, e.g. fluoxetine= typical daily dose of 20mg, taken as capsules or liquid, takes 3-4 months to impact symptoms
- alternative treatments: used when SSRIs are not effective after 3-4 months
-tricyclics= act on various systems including serotonin system where it does the same as SSRIs but worse side effects
-SNRIs= serotonin-noradrenaline reuptake inhibitors- type of anti-depressant used to increase serotonin and noradrenaline levels - drug therapy is often combined with CBT: drugs reduce emotional symptoms meaning they can engage more effectively with CBT
Biological approach to treating OCD AO3
- S: research to support SSRIs= Soomro reviewed 17 studies and found that SSRIs were more effective than a placebo at reducing symptoms, 70% of those using SSRIs saw a reduction in symptom severity
HOWEVER- evidence suggests that behavioural therapies may be more effective than drugs when used alone or in combination with drugs - W: side effects- anxiety, digestive problems, visual problems, replacing one set of problems with another limits use
- S: cheap and require little effort: a month’s worth of SSRIs cost the NHS £4.21 whereas CBT can cost £100’s, drugs require little effort to take unlike CBT making them more accessible
HOWEVER- less ethical, not empowering for the patient as it doesn’t require effort
Depression AO1 only
- all forms of depression are characterised by low mood
- DSM-5 categories= major depressive disorder (severe but short-term), persistent depressive disorder (long-term/recurring), disruptive mood dysregulation disorder, premenstrual dysphoric disorder (disruption to mood prior to/during menstruation)
- behavioural characteristics:
-activity levels: reduced, withdrawal from work, education, social life
-disruption to sleeping/eating: insomnia or hypersomnia, appetite changes= weight gain or loss
-aggression and self-harm - emotional characteristics:
-lowered mood: sadness, emptiness, worthlessness, lethargy
-anger: towards self and others
-lowered self-esteem: like themselves less, self-loathing - cognitive characteristics:
-poor concentration: inability to stick to tasks, hard to make decisions
-dwelling on negatives: ignoring positives
-absolutist thinking: ‘black and white’ thinking
Cognitive approach to explaining depression AO1
1. Ellis’ ABC model
* depression is a result of irrational thoughts (distorted versions of reality), these make it hard to achieve goals and be happy
* Activating event= negative situation which causes the irrational thoughts
* Beliefs= the resulting irrational beliefs
* Consequences= the irrational beliefs lead to emotional and behavioural consequences
2. Beck’s negative triad
* depression is caused by faulty cognitions
1. faulty information processing= focussing on negatives and ignoring positives
2. negative self-schema= negative way of viewing themselves
3. negative triad= dysfunctional thinking leads to negative views of the world, future and self
Cognitive approach to explaining depression AO3
- Ellis’ ABC model
* S: useful applicatipons to treatment- Ellis used the theory to develop REBT= rtional emotive behvioural therapy, tackles irrational beliefs by disrupting them and asking for evidence
* W: cognitive explanations can be reductionist- only focus on the cognitive aspects of the disorder, ignore biological influences like low levels of serotonin - Beck’s negative triad
* S: supporting evidence- Lewinsohn: gave 1507 students questionairres to measure any negative thinking (surrounding the triad) and found 1 year later, those who showed evidence of negative thinking were more likely to be diagnosed with depression
HOWEVER- correlational= other factors
* S: useful appications to treatment- assessing cognitive vulnerability allows for screening, can also be applied to beck’s CBT which alters the faulty cognitions
Cognitive approach to treating depression AO1
Ellis’ REBT
* rational emotive behavioural therapy
* helps to recognise and dispute irrational beliefs
* adds the D and E to the ABC(DE) model
* Dispute- therapist logically disputes the irrational beliefs
-logical dispute= questions their logic
-emperical dispute= questions their evidence
* Effect- irrational beliefs are replaced with effective ones which should help relieve symptoms
Beck’s Cognitive behavioural therapy
* Based on the negative triad, identifies and challenges negative thoughts about the self world and future then tests the reality of these beliefs
1. thought catching= negative beliefs are identified
2. patient as scientist= generates hypothesis to test validity of thoughts
3. homework tasks= patient tests hypothesis and reports findings
4. cognitive restructuring= therapist uses the patients evidence which disputes their views to restucture their beliefs
Cognitive approach to treating depression AO3
- S: researchsupport- March et al: tested 327 depressed adolescents in 3 groups, one group had CBT, one group had antidepressants, one had both; after 36 weeks, 81% drugs group had improved and 81% of CBT group= drugs and CBT are equally as effective
HOWEVER 86% of the ‘both’ group had improves= more effective when used together - W: high relapse rate- effective in the short term but many relapse as it can help treat but not cure the disorder
- S: CBT is more ethical than drug therapy- more empowering for patients, they put in effort and see direct results which could help with self-esteem
HOWEVER- requires effort: lack of energy is a symptom of depression so they may not attend= limits effectiveness
