Psychopathology (Paper 1)

Question 1

What is Deviation from Social Norms as a definition of abnormality?

Answer 1

Deviation from social norms is a definition of abnormality where behaviour is measured against the general standards set by society. People who fail to adhere to the accepted moral and ethical norms are most likely seen as deviating and therefore abnormal. These include behaviours such as ASPD (anti-social personality disorder) and pedophilia.

Question 2

What is Statistical Infrequency as a definition of abnormality?

Answer 2

Statistical infrequency as a definition of abnormality judge attributes and behaviours based on how often they occur. Using a graph of normal deviation the most common “normal behaviours” would lie in the middle while the rare “abnormal behaviours” would lie on the tail ends. This is due to their behaviour or attribute being statistically infrequent / uncommon making it abnormal.

Question 3

What is Failure to Function Adequately as a definition of abnormality?

Answer 3

Failure to Function Adequately as a definition of abnormality is the inability to go about your daily life and cope with these general tasks. Identifications of not being able to cope are: no longer conforming to standard interpersonal rules, severe personal distress and irrational / dangerous behaviour. This measured through the (General assessment of functioning) GAF scale allow the extent of failure to be measured.

Question 4

What is Deviation from Ideal Mental Health as a definition of abnormality?

Answer 4

Deviation from Ideal Mental Health judges abnormality based on what it perceives as normality. Thus normality showing good mental health in the same way that one would look at physical health. This is done by following a comprehensive set of criteria from Jahoda such as: high self esteem, stress-resistant, in touch, showing empathy, accurate perceptions of reality, focused on the future and environmental mastery. DIMH suggest that the absence of any of these criteria is an indication of abnormality.

Question 5

What are the advantages of Deviation from Social Norms?

Answer 5

Using this definition we can normal behaviour from abnormal behaviour as it gives a clear distinction between the two as it is easy to recognise someone not following societal norms e.g a person with schizophrenia may be talking to themselves which is not normal

It has real life applications for example: in the diagnosis of anti-social personality disorder, the symptoms clearly state that this persons behaviour is deviating from social norms. This means we can apply the definition to real life making it an authentic definition

Question 6

What are the advantages of Statistical Infrequency?

Answer 6

Statistical Infrequency has a real life application as it allows for the diagnosis of intellectual and disability disorders. It allows for the severity of different symptoms to be measured. If those symptoms were to fall in “normal distribution” they are normal and if not then it is abnormal. This definition therefore allows us to compare normal to abnormal.

This definition is also very objective as there is a cut-off point between normal and abnormal which has been agreed upon meaning that people who fall outside the normal range are objectively abnormal according to this definition. This would reduce and bias or subjectivity held.

Question 7

What are the advantages of Failure to Function Adequately?

Answer 7

One strength of Failure to Function Adequately is that it does include the subjective experience of the individual and allow their thoughts and feelings to be acknowledged. This therefore suggest that Failure to Function Adequately is a useful model for assessing psychopathological behaviour.

Another strength is that this definition of abnormality can be objectively measured using the GAF (General assessment of functioning) scale and allows the extent of failure to function to be measured. This means that whether a person is normal or abnormal it can be made objectively.

Question 8

What are the advantages of Deviations from Ideal Mental Health?

Answer 8

It is a comprehensive definition that covers a broad range of criteria for mental health including most reasons why someone would seek help in the first place e.g low self esteem, inaccurate perceptions of reality and no empathy meaning that this person would clearly need help.

The criteria set also allows for clear goal to be set and focused upon to achieve ideal mental health and in Jahoda’s opinion “normality”. It therefore allows the individual to be aspirational, focus on the future and hope to achieve self-actualisation.

Question 9

What are the disadvantages of Deviation from Social Norms?

Answer 9

Cultural relativism - Attempts to define abnormality is influenced by cultural factors because social norms are defined by our culture. According to this definition a person’s behaviour could be abnormal in one culture but not in another culture. Voice pitch and volume, touching, directions of gaze and acceptable subjects for discussion have all been found to vary between cultures. This creates problems for people from one culture living in another culture.

Deviation related to context - Making judgements on deviance from a social norm is often related to context of a behaviour. In other words a person nearly naked on a beach is normal but not in a classroom. In many cases, there is not a clear distinction between what is seen as abnormally deviant behaviour and what behaviour is just harmless ‘eccentricity’.

Definitions of socially “normal” behaviour can change over time -.e.g. homosexuality, was not socially acceptable 50 years ago. If we define abnormality according to social norms what is classed as abnormal will vary greatly over time. This is a weakness because it means abnormality cannot be judged across eras. Can also lead to human rights abuses – historically were used to maintain control over minority groups

Question 10

What are the disadvantages of Statistical Infrequency?

Answer 10

Some unusual characteristics may be positive - This definition states that if you don’t fall in the main percentage of the population (68%) then you are abnormal. However, there are some people for example, whose IQ scores are over 130. Clearly, these people are not abnormal but super intelligent! But, again only 2.5% of the population will have this high intelligence score so these people are just as unusual as those below 70. However, we do not think of super-intelligence as being an undesirable characteristic that needs treatment. Just because very few people display a behaviour doesn’t mean that the behaviour requires treatment. Therefore an individual not fitting into the normal statistics can be seen as a positive thing but this definition does not acknowledge this.

Not everyone benefits from the stigma of being abnormal - If someone may be living a happy, fulfilled life there is no benefit to them being labelled as abnormal regardless of how unusual they are. Being labelled as abnormal may be negative if it causes others (or themselves) to view them differently – it could create a self-fulfilling prophecy whereby the individual starts to believe themselves as being abnormal. For example, if one has a low IQ and thus seen as abnormal may start seeing themselves as ‘thick’ and ‘mentally inferior’ because there IQ is statistically low. This is not a good thing as the person could start acting inferior and label him/herself as that – leading to a self-fulfilling prophecy of being a failure. This means that the Statistical Infrequency definition of abnormality could actually cause someone to be abnormal

Question 11

What are the disadvantages of Failure to Function Adequately?

Answer 11

Cultural relativism - as with the other definitions, this definition is also culturally relative in terms of what is not functioning adequately in one culture many be adequate in another culture e.g. sleeping during the day – for example in some countries they go through a Siesta period in the summer months where they sleep during the day – this would not be really acceptable in the UK and could be a sign of depression (especially if that person has no reason to sleep during the day)

Who judges - who is the person who decides if someone is failing to function adequately as this is related to the subjective experience of the individual, who then has the right to judge if a particular individual is abnormal – for example, a person may not eat for 2 days – do we have the right to assume that this person may be anorexic? Therefore this definition may result in making incorrect judgements about individuals which is not fair.

Abnormality doesn’t stop the person from functioning - The focus on how someone is coping in their everyday life is the focus of this definition. This may mean that some abnormal behaviour is missed. People may appear to be functionally adequately as they fit into society and have jobs and homes, but they may have distorted thinking which is causing them inner distress that they hide. Therefore this definition only focuses on coping in everyday life but may not always recognise inner turmoil and distress because the person appears normal and functioning well.

Question 12

What are the disadvantages of Deviation from Ideal Mental Health?

Answer 12

Who can achieve all the criteria - According to these criteria, most of us are abnormal to some degree. No one shows all the criteria at all times for example, we are not always resistant to stress or we don’t always have a high self-esteem. This definition is therefore too ideal meaning that in reality no one can be mentally healthy all time!

Cultural relativism - Many, if not most of the criteria of the ideal mental health definition are culturally specific. Because of this, the criteria in this definition would not apply to non-western cultures but that does not mean that individuals from these cultures are not mentally healthy. For example, the idea of self-actualisation may not apply to countries where just having food and a roof over their head is important and education is not a necessity – people in these countries may have a different view of self actualisation.

Subjectivity - Many of the criteria that Jahoda outlines are vague and therefore very difficult to measure. This makes the decision as to whether someone fulfils the criteria difficult to make. For example, how can you judge if someone has a high self-esteem or is resistant to stress? These features can only really be judged by the individual themselves – making the criteria very subjective

Question 13

What are the behavioural characteristics of phobias?

Answer 13

Panic - (screaming, running, freezing or throwing a tantrum)

Avoidance - affects daily life as they avoid their phobic stimulus and may not venture outside home

Endurance - when a sufferer remains in the presence of their phobia but continues to have high levels or anxiety

Question 14

What are the emotional characteristics of phobias?

Answer 14

Anxiety - unpleasant state of high arousal stopping a person from feeling any positive emotion

Fear - immediate and immensely unpleasant response

Being unreasonable - having strong emotional response to even a minuscule phobic stimulus

Question 15

What are the cognitive characteristics of phobias?

Answer 15

Selective attention - keeping focus on on your phobic stimulus as it is hard to look away but it is beneficial as it gives the person the best chance to react quickly

Irrational beliefs - a phobic may hold irrational beliefs that they must always act or say something in a certain way for example people with social phobias may always want to sound intelligent

Cognitive distortions - perceptions of the phobia are misrepresented and their phobias are taken out of proportion and seen as unpleasant and disgusting

Question 16

What is the two process model?

Answer 16

The two process model consist of classical conditioning and operant conditioning. Phobias are induced via classical conditioning and are then reinforced by operant conditioning

Question 17

What is classical conditioning?

Answer 17

Classical conditioning is learning through association and has been used to account for the development of phobias. When a neutral stimulus (NS) is paired with an unconditioned stimulus (UCS) this will produce an unconditioned response (UCR). The NS will become the conditioned stimulus (CS) and the feeling associated with the UCS with become the Conditioned response (CR). Thus a phobia has been induced, the phobia being the CS and the response is the CR.

Question 18

What is operant conditioning?

Answer 18

Operant conditioning is learning through reinforcement and punishments. They both have two aspects positive and negative. Positive reinforcement is giving a reward to the individual and incentivises them to repeat the action and maintain it. Negative reinforcement would be taking something away, an example being avoidance behaviour which takes away the persons anxiety. Positive punishment is giving pain to make sure that the individual associates pain with the action thus reducing the repetitive action. Negative punishment is to get something positive the individual had and take it away so that the individual learns not to do that action again.

Question 19

What are the strengths of the two process model

Answer 19

This model doesn’t label people with the stigma of being mentally ill as such labels can be damaging and difficult to remove. Instead making phobias perceive as incorrect responses to be corrected.

King (1998) received several case studies and found that children acquire phobias after having been through traumatic experiences with the phobic object. (E.g dog bites may lead to phobias of dogs). This supports the idea of phobias being learned through classical conditioning.

Question 20

What are the weaknesses of the Two process model

Answer 20

Many people who have a traumatic experience such as a car accident do not go on to develop a phobia so classical conditioning doesn’t explain how all phobias develop.

Some people are scared of an object but have never had a negative experience with that object or even encountered the object before. One case study found 50% of people who have a phobia of dogs have never had a bad experience involving a dog. So learning couldn’t have been a factor in developing the phobia.

This model focuses on learning and the environment but doesn’t take into account biological factors that can cause phobias. Some people have a genetic vulnerability to phobias.

Question 21

What is systematic desensitisation?

Answer 21

This is the most popular form of behaviour therapy, and based on the principles of classical conditioning. It was first developed by Joseph Wolfe in the 1950s and is a form of counter-conditioning, where the therapist attempts to replace the fear response by an alternative and harmless response. It is designed to gradually relax phobic anxiety, as a new response to the phobic stimulus is learned. It is impossible to be afraid and relaxed at the same time, so one emotion prevents the other (reciprocal inhibition).

Question 22

The Three Processes Involved in Systematic Desensitisation

Answer 22

The Anxiety Hierarchy, Relaxation and Gradual Exposure

Question 23

The Anxiety Hierarchy

Answer 23

The Anxiety Hierarchy is put together by the patient and the therapist. This is a list of situations relating to the phobic stimulus arranged from least to most frightening. For example a person with arachnophobia might identify a picture as lower down the hierarchy and holding a tarantula at the top of the hierarchy

Question 24

Relaxation

Answer 24

The therapist teaches the patient to relax as deeply as possible. As it is impossible to be afraid and relaxed at the same time, one emotion therefore prevents the other – known as reciprocal inhibition. This may involve breathing exercises, mental imagery techniques, and/or access to drugs such as Valium for relaxation.

Question 25

Gradual Exposure

Answer 25

Finally, the patient is exposed to the phobic stimulus while in a relaxed state. This takes place across several sessions, beginning at the bottom of the anxiety hierarchy. When the patient can remain relaxed in the presence of the phobic stimulus, they can move up the hierarchy. Treatment is considered successful when patients can stay relaxed in situations high up on the anxiety hierarchy.

Question 26

What are the stages of the Anxiety Hierarchy

Answer 26

1. Therapist and client together construct a fear/anxiety hierarchy – a series of imagined scenes, each causing more anxiety than the previous 2. Client is then taught to relax – using different techniques such as breathing, muscle relaxation, mental imagery 3. Client gradually works his/her way through desensitisation hierarchy, visualising each anxiety-evoking event while engaging in the competing relaxation response (reciprocal inhibition) 4. Once the Client has mastered one step in the hierarchy (i.e. they can remain relaxed while imagining it), they are ready to move on to the next step 5. At each stage, if the client becomes upset they can return to an earlier stage and regain their relaxed state. 6. Client eventually masters the feared situation that caused them to seek help in the first place - This means that when the client remembers their fear – it is now replaced with relaxation and calmness.

Question 27

What is flooding?

Answer 27

Flooding exposes patients to their phobic stimulus without gradual build up. It generally stops phobic response quickly as they don’t have the option of avoidance so the patient learns that the stimulus is harmless. This is called extinction. It is a very unpleasant experience this it is important patients give their full consent for the traumatic procedure.

Question 28

What are the strengths of systematic desensitisation?

Answer 28

It is, in general, quite quick and requires less effort than other forms of psychotherapies where the patient needs to play an active role. Behavioural therapies may be the only treatment suitable for certain groups of people .e. g. individuals with severe learning difficulties. It is an ethical method to use for treating phobias because the stages enable participants to feel comfortable unlike flooding where the person is ‘thrown into the deep end’ quickly which could be very stressful thus patients generally prefer this procedure because it does not involve the same level of trauma as some other procedures. It does work for certain phobias – e.g. blood injection and spider phobias – success rate is up to 90%. For example Gilroy et al (2003) followed up 43 patients with spider phobias who had SD in three 45-minute sessions. At both 3 months and 33 months the patients were significantly less fearful of spiders than a control group who were treated only with training in relaxation. This suggests that it is effective, in the long term as well as the short term.

Question 29

What are the weaknesses of Systematic Desensitisation?

Answer 29

It only works for certain phobias for example, systematic desensitisation may not work for social phobias which may require more detailed or an alternative therapy such as cognitive behavioural therapy (CBT). It relies on the client’s ability to be able to imagine the fearful situation e.g. when using the in vivo technique. Some people cannot create a vivid image in their mind in which case the in-vitro technique might be more useful – but this could be costly – especially for someone who has a fear of heights - thus SD will not be effective in this case While SD might be effective in the therapeutic situation, it may not work in the real world. Patients with phobias which have not developed through a personal experience (classical conditioning) for example, a fear of heights, seem to be less effectively treated using systematic desensitisation. Some psychologists believe that certain phobias, like heights, have an evolutionary survival benefit and are not the result of personal experience, but the result of evolution. These phobias highlight a limitation of systematic desensitisation which is ineffective in treating evolutionary phobias.

Question 30

What are the strengths of Flooding?

Answer 30

Flooding is highly effective and often quicker than alternative treatments, enabling patients to be free of their symptoms as soon as possible which makes treatment cheaper. Studies comparing flooding to cognitive therapy e.g. Ougrin (2011) have found that flooding is highly effective and quicker than alternatives. In fact, Choy (2007) found flooding to be more effective that systematic desensitisation in treating phobias. Wolpe (1960) supports the use of flooding to remove a patient’s phobia of being in cars. The girl was forced into a car and driven around for four hours until her hysteria was eradicated. This demonstrates how effective flooding is as a treatment for phobias.

Question 31

Weaknesses of Flooding?

Answer 31

Flooding is less effective for complex phobias such as social phobias, because these phobias often have a cognitive aspect to them. These types of phobias would benefit more from cognitive therapies, which tackle irrational thinking. Although flooding is considered a cost‐effective solution, it can be highly traumatic for patients since it purposefully elicits a high level of anxiety. Wolpe (1969) recalled a case with a patient becoming so intensely anxious that she required hospitalisation. Although it is not unethical as patients provide fully informed consent, many do not complete their treatment because the experience is too stressful. Therefore, initiating flooding treatment is sometimes a waste of time and money if patients do not engage in or complete the full course of their treatment.

Question 32

What are the Strengths of the behavioural approach?

Answer 32

It provides good explanations for how phobias could be maintained over time and this had important implications for therapies because it explains why patients need to be exposed to the feared stimulus. Once a patient is prevented from practising their avoidance behaviour, the behaviour ceases to be reinforced and so it declines – this has been successfully proven through behavioural therapies such as flooding and systematic desensitisation. It is supported by experimental evidence .e.g. the Little Albert Case study (Watson and Raynor, 1920) – in this study it was shown how a phobia could happen through classical conditioning by pairing a loud noise with a white rat, Little Albert showed a fear of white rats and this fear generalised to other white fluffy animals. Thus this study supports the idea that a phobia can be formed through a bad or frightening experience.

Question 33

What are the weaknesses of the behavioural approach?

Answer 33

One weakness of the behavioural approach is that not all avoidance behaviour associated with phobias seems to be the result of anxiety reduction. There is evidence that suggests that at least some avoidance behaviour appears to be motivated more by positive feelings of safety. The two-process model suggests that avoidance is motivated by anxiety reduction, but it can also be motivated by safety. This suggests an incomplete explanation. Another weakness of the behavioural approach is that the behavioural approach may not provide a complete explanation of phobias. For example, Bounton (2007) highlights the fact that evolutionary factors could play a role in phobias, especially if the avoidance of a particular stimulus (e.g. snakes) could have caused pain or even death to our ancestors. Consequently, evolutionary psychologists suggest that some phobias (e.g. snakes and heights) are not learned but are in fact innate, as such phobias acted as a survival mechanism for our ancestors. This innate predisposition to certain phobias is called biological preparedness (Seligman, 1971) and casts doubt on the two‐process model since it suggests that there is more to phobias than learning. A final weakness of the behavioural approach is the fact that the evidence to support it is flawed and not always ethically sound – for example, the Little Albert case where a phobia for rats was induced in a 10 month old boy was ethically unsound - for example, Little Albert did not give his consent to take part in the study. This means that Watson and Raynor breached the ethical code of consent . Also as Little Albert was a baby, he would be too young to understand the consequences of this study which meant that this study posed a significant risk of long term harm for Little Albert. In fact, by inducing a phobia in the boy, meant that this child would grow up fearing rats even though this fear was not due to a natural experience. This means that we should be cautious when looking at the evidence to support the behavioural approach in explaining phobias because of the serious ethical issues.

Question 34

Who proposed Deviation from Social Norms?

Answer 34

Perkins and Berkowitz (1986)

Question 35

Who proposed Failure to Function Adequately?

Answer 35

Rosenham and Seligman (1989)

Question 36

Who proposed Deviation from Ideal Mental Health?

Answer 36

Jahoda

Question 37

Who proposed the two-process model?

Answer 37

Howard Mowrer (1960)

Question 38

Who did the Little Albert experiment?

Answer 38

Watson and Raynor (1920)

Question 39

Who demonstrated operant conditioning in rats and pigeons and using what tool?

Answer 39

Skinner (1974) using the Skinner box

Question 40

Behavioural Characteristics of Depression

Answer 40

Activity Levels -Typically, sufferers of depression have reduced levels of energy, making them lethargic. Consequently, sufferers tend to withdraw from work, education and social life. Sometimes people may find it difficult to get out of bed. Alternatively, people may become agitated and struggle to relax – this is known as psychomotor agitation. Disruption to Sleep and Eating Behaviour -Sufferers may experience changes to their sleeping patterns. Some may experience reduced sleep (insomnia), or an increased need for sleep (hypersomnia). Similarly, appetite and eating behaviour may increase or decrease, leading to weight loss or gain. These behaviours are disrupted by depression. Aggression and Self-Harm -Depressed individuals are often irritable and can easily become verbally or physically aggressive. This behaviour towards others may lead to relationship or work problems. For example, a depressed person may display verbal aggression by ending a relationship or quitting a job. Individuals may start to act aggressively towards themselves – self-harm – through cutting or suicide attempts.

Question 41

Emotional Characteristics of Depression

Answer 41

Lowered Mood - A lowered mood can also be referred to as feeling sad. Patients have been known to describe themselves as ‘worthless’ and ‘empty’. Anger - The experience of negative emotions is not limited to sadness. Sufferers of depression frequently experience anger, which can be directed towards themselves of others. Such emotions can lead to self harming. Lowered Self-Esteem - Self-esteem is the emotional experience of how much we like ourselves. Depressed individuals tend to report a lowered self-esteem. In extreme circumstances, individuals may state that they hate themselves.

Question 42

Cognitive Characteristics of Depression

Answer 42

Poor Concentration - The sufferer may find themselves unable to concentrate on a task as they normally would, or they might find it hard to make decisions they would normally find straightforward. Poor concentration and decision-making are likely to interfere with the individual’s work. Attending to and Dwelling on the Negative - When suffering a depressive episode people are inclined to pay more attention to the negative aspects of a situation and ignore the positives. They also have a tendency to recall unhappy events rather than happy ones. Absolutist Thinking - Most situations are not all-good or all-bad, but when a sufferer is depressed they tend to think in these terms. In other words, this is sometimes called ‘black and white’ thinking. For example, when a situation is unfortunate they see it as an absolute disaster.

Question 43

3 main aspects of Beck’s Cognitive Theory of Depression

Answer 43

Faulty Information Processing, Negative Self-Schemas and The Negative Triad

Question 44

Faulty Information Processing

Answer 44

Faulty Information Processing (also known as Cognitive Bias): when depressed we attend to the negative aspects of a situation and ignore the positives. For example, if I was depressed and won £1 million in the Lottery, I might focus on the fact that the previous week someone won £10 million, rather than focus on the positive things I could do with £1 million. This means that the cognitive biases are based on overgeneralisations and catastrophising e.g. I have failed in one end of unit test therefore I am going to fail all my exams – this is over generalising. Or a depressed person may experience catastrophising e.g. I have failed my end of unit test and thus I am never going to get in university or get a good job.

Question 45

Negative Self-Schemas

Answer 45

Negative Self-Schemas: A schema is a package of ideas and information which acts as a mental framework for the interpretation of sensory information. A self-schema is the package of information that we have about ourselves. These schemas develop during childhood and according to Beck, depressed people possess negative self-schemas which may come from negative experiences, for example criticism from parents, peers or even teachers. Examples of negative self-schema are: an ineptness schema – when you expect to fail; a self- blame schema – which makes them feel responsible for their failures; a negative self evaluation schema – that constantly reminds them of their worthlessness. If we have a negative self-schema, it means that we are interpreting all the information about ourselves in a negative way. E.g. I am worthless, failure etc

Question 46

The Negative Triad

Answer 46

The Negative Triad: According to Beck, due to cognitive biases and negative self schema, a person develops three types of negative thinking that occur automatically, regardless of the reality that is happening. These three elements are called the negative triad: 1. Negative feelings about themselves (‘nobody loves me’) 2. Negative feelings about the future (‘I will always be useless and a failure’) 3. Negative views about world (‘ the world is an unfair place’)

Question 47

Evaluation of the Beck’s Model - Strengths

Answer 47

There is evidence depression is associated with cognitive biases, negative self-schemas and cognitive triad of negative thinking .e.g. Grazioli and Terry (2000)- studied 65 pregnant women before and after birth. Those showing negative patterns of thinking (high in cognitive vulnerability) were more likely to develop post-natal depression. The fact that negative cognitions were seen before depression developed suggests that they may have been the cause of their depression. Beck’s theory can be applied to Cognitive Behavioural Therapy so this theory has a practical application. This means that his theory is a successful explanation of depression. Furthermore this therapy is extremely successful in treating depression suggesting the theory is strong.

Question 48

Evaluation of the Beck’s Model - Weaknesses

Answer 48

Beck’s Negative Triad doesn’t explain all aspects of depression – for example, some patients are also very angry and some even suffer hallucinations and delusions. Beck’s theory cannot explain these symptoms – thus the theory may lack validity

Question 49

3 key parts of Ellis’s ABC Model

Answer 49

A – Activating Event, B – Beliefs, C – Consequences

Question 50

A – Activating Event

Answer 50

A – Activating Event - Ellis believes that irrational thoughts are triggered by external events. We get depressed when we experience negative events and these trigger irrational beliefs. Events like failing an important test or ending a relationship might trigger irrational beliefs.

Question 51

B – Beliefs

Answer 51

B – Beliefs - Are the beliefs a person has, which may be rational or irrational. Ellis identified a range of irrational beliefs, including - ‘Musturbation’ (the belief we must always succeed or achieve perfection. - ‘I-can’t-stand-it-it is’ (the belief that it is a major disaster whenever something doesn’t go smoothly) - ‘Utopianism’ (the belief that life is always meant to be fair)

Question 52

C – Consequences

Answer 52

C – Consequences - When an activating event triggers irrational beliefs there are emotional and behavioural consequences. For example, is you believe you must always succeed and then fail at something, this can trigger depression.

Question 53

Weaknesses of the ABC model

Answer 53

Although there is no doubt that some cases of depression follow activating events this does not seem to be case for all. Psychologists call depression triggered by activating events reactive depression distinguishing it from depression that arises without an obvious cause. This means that Ellis’ model is not a complete explanation of depression- it only applies to some kinds.

Question 54

Overall Evaluation of the Cognitive Approach in Explaining Depression - Strengths

Answer 54

1. Practical Applications in CBT – one strength of the cognitive explanation of depression is its application to therapy. Cognitive explanations have been used to develop effective treatments for depression, including CBT developed through Beck’s explanation of depression and REBT developed through Ellis’ explanation of depression. These therapies work by challenging irrational, negative beliefs, and have been proven to reduce a person’s depression. In fact, there are many studies that support how successful Beck’s and Ellis’ therapies are in treating depression. 2. Research evidence to support the cognitive explanations of depression – There is research evidence that supports the cognitive explanation of depression. For example, Cohen et al., (2019) tracked the development of 473 adolescents, regularly measuring their cognitive vulnerability and it was found that cognitive vulnerability predicted their later depression. In other words, those adolescents who showed cognitive vulnerability (e.g. issues in their thinking patterns) were more likely to develop depression in the future supporting Beck’s theory.

Question 55

Overall Evaluation of the Cognitive Approach in Explaining Depression - Weaknesses

Answer 55

There could be other explanations of depression so the cognitive approach overlooks other Factors – There is extensive evidence that depression is lined to genes and neurotransmitters. Research has focused on the role of the neurotransmitter serotonin and found lower levels in patients with depression. In addition, drug therapies, including SSRIs (selective serotonin reuptake inhibiters), which increase the level of serotonin, are found to be effective in the treatment of depression, which provide further support for the role of neurotransmitters, in the development of depression. This shows that the cognitive explanations is not a complete explanation of depression. Does not explain the origins of the irrational thoughts - Because most of the research in this area is correlational, psychologists are unable to determine if irrational beliefs are the cause or consequence of depression. It may be, for example, that a depressed person develops a negative way of thinking because of their depression rather than the other way round. This means that if we don’t know the cause, then it may be difficult to find the treatment or the depression could keep coming back because we can’t identify a single cause?

Question 56

Beck’s Cognitive Behaviour Therapy (CBT)

Answer 56

· Beck’s CBT aims to challenge irrational thoughts and replace them with more realistic ways of thinking – this is the cognitive element · The behaviour element of the CBT involves working to change negative and irrational thoughts and finally put more efficient behaviours into place · First the therapist helps the clients identify negative thoughts about the world, the self and the future (the negative triad) – often the client is encouraged to keep a record of their thoughts in a diary. · Using this material the therapist challenges the negative thoughts by drawing attention to positive incidents – a form of reality testing. · Challenging the negative thoughts is the central component of the therapy because this is the initial phase of eradicating the negative triad- in terms of the self, world and future · Along with challenging negative thoughts the therapist uses techniques to encourage more positive thinking and behaviour and may provide sessions or homework for training the patient in social skills. · The purpose of the homework tasks is to get the client to ‘act as a scientist’ for example, a homework task might be to record when they enjoyed an event or when someone was nice to them – in this way the client is investigating their negative beliefs as a scientist would

Question 57

Ellis’ Rational Emotive Behaviour Therapy (REBT)

Answer 57

· REBT extends the ABC Model to an ABCDE Model – the D stands for Dispute and the E for effect. · REBT seeks to identify and dispute/challenge irrational thoughts. · The therapist and client work together to identify trigger situations and the negative reactions they produce. · The therapist then helps the client to rationalise the situation, giving the client a more realistic perspective. · Ellis specifically believes in a more confrontational approach to therapy, where the client was challenged on his/her self-defeating beliefs in intense debates. This may be through logical disputing (Does that really make sense?), and/or asking the client to give evidence for a certain negative belief. · Following a session, the therapist may set their patient homework. The idea is that the patient identifies their own irrational beliefs and then proves them wrong. As a result, their beliefs begin to change. For example, someone who is anxious in social situations may be set a homework assignment to meet a friend for a drink.

Question 58

Strengths of CBT

Answer 58

1. There is evidence of CBT’s effectiveness, especially for depression. For example, a study by March et al (2007) compared the effects of CBT with anti-depressant drugs and a combination of the two in 327 depressed adolescents. After 36 weeks, both 81% of the anti-depressants and CBT groups improved. However, 86% of the CBT plus anti-depressants group improved, suggesting that the treatment is as effective as medication and also helpful alongside medication. 2. There is evidence that the benefits of CBT last longer than those of antidepressant drugs, and unlike drugs there are no side-effects or withdrawal symptoms. For example, the fact that CBT also requires the individual to change their behaviour as well as their thoughts shows how change is occurring in the long term. In a study by Babyak et al (2000), they studied 156 adult volunteers diagnosed with major depression and randomly assigned them to either a four month course of aerobic exercise, antidepressants or a combination of both. It was found that six months after the end of the study, those in the exercise group had significantly lower relapse rates than those on the medication group suggesting that exercise (a behavioural change) is more effective than medication.

Question 59

Weaknesses of CBT

Answer 59

1. CBT may not work for severe cases because they are unable to concentrate or motivate themselves to participate in the sessions. When this happens, patients should be treated with drugs, then CBT when they are alert and motivated. 2. Success may be due to the quality of therapist-client relationship, rather than any particular technique that is used – for example some therapists may have excellent social skills thus consequently, the patient may be reinforced to be more dedicated to the treatment 3. CBT focuses on the client’s thoughts about a situation and not the situation itself .e.g. bullying partners. As a result these environments continue to encourage irrational thoughts. (An over-emphasis on cognitions ends up minimising the importance of the circumstances in which the patient is living). 4. One issue with CBT is that it requires motivation. Patients with severe depression may not engage with CBT or even attend the sessions and therefore this treatment will be ineffective in treating these patients. Alternative treatments, such as antidepressants, do not require the same level of motivation and may be more effective in these cases. This poses a problem for CBT, as CBT usually cannot be used as the sole treatment for severely depressed patients, who often lack the motivation to attend therapy and to speak about their depression. 5. CBT is time-consuming and expensive compared to, for example, drug therapy. The reason being that CBT requires the client attending therapy sessions which obviously require money and time and of course effort from the client as they have to face and talk about their depression whereas with drug therapy it is quick and cheap to pop an antidepressant into your mouth if you are depressed without having to talk about it!

Question 60

Behavioural Characteristics of OCD

Answer 60

Compulsions - The behavioural component of OCD is compulsive behaviour. There are two elements of compulsive behaviours: 1. Compulsions are repetitive, for example, handwashing, counting, praying, tidying/ordering objects. 2. Compulsions reduce anxiety, for example, compulsive handwashing is carried out as a response to an obsessive fear of germs. Avoidance - OCD sufferers may be characterised by their avoidance because they attempt to reduce anxiety by keeping away from situations that trigger it. For example, those individuals who compulsively wash their hands may avoid coming into contact with germs by avoiding everyday tasks, such as emptying their rubbish bins, or changing a baby’s nappy.

Question 61

Emotional Characteristics of OCD

Answer 61

Anxiety and Stress - OCD is regarded as a particularly unpleasant emotional experience because of the powerful anxiety that accompanies both obsessions and compulsions. Obsessive thoughts are frightening and the urge to repeat a behaviour creates anxiety. Accompanying Depression - OCD is often accompanied by depression, so OCD can be accompanied by low mood and a lack of enjoyment in activities. Compulsive behaviour may bring some relief from anxiety, but often only on a temporary basis. Guilt and Disgust - OCD may involves other negative emotions, such as irrational guilt or disgust (which may be directed at external objects (e.g. dirt) or at the self.

Question 62

Cognitive Characteristics of OCD

Answer 62

Obsessive Thoughts - For around 90% of OCD sufferers, the major cognitive feature of their condition is obsessive thoughts, i.e. thoughts that recur over and over again. These vary from person to person but are always unpleasant, for example, being worried about being contaminated by germs or dirt. Cognitive Strategies to Deal with Obsessions - People respond to obsessions by adopting cognitive coping strategies. For example, a religious person who is experiencing obsessive guilt may turn to prayer or meditation as a method of coping. This may help to manage anxiety, but may appear odd to others and/or impact on their daily lives. Insight into Excessive Anxiety - People with OCD are aware that their obsessions and compulsions are not rational, but in spite of this insight, sufferers experience catastrophic thoughts about the worst case scenarios that might result if their anxieties are justified. They also tend to be hyper-vigilant to keep focused on potential hazards.

Question 63

Types of studies for the Genetic Explanations for explaining OCD

Answer 63

Twin Studies, Family studies, Adoption Studies

Question 64

Twin Studies for OCD (genetic)

Answer 64

The best way to test this is through using twin studies and observing whether, if one identical twin has a disorder, how likely it is that the other twin (who shares 100% of their genes with the first twin) also has the disorder. Often psychologists focus on identical twins (also known as MZ – monozygotic twins) who share 100% genes who have been separated at birth, so been bought up in completely different environments. If concordance (match) rates for a psychological disorder are high (.i.e. if one twin has it, it is very likely that the other twin will also have it) this suggests that genes play an important part in the development of that disorder. Alternatively (because it is now very uncommon to find twins who were separated at birth) psychologists can compare to concordance rates for psychological disorders for identical twins (who share 100% of their genes) and then non-identical twins (also known as dizygotic twins) - who share only 50% of their genes). If the concordance rates for identical twins is higher this suggests that genes do play a role in the disorder.

Question 65

Family studies for OCD (genetic)

Answer 65

Genetics has been shown to play a role in a variety of psychological disorders including Obsessive Compulsive Disorder. Genes are involved in individual vulnerability to OCD. Lewis (1936) observed that of his OCD patients, 37% had parents with OCD and 21% had siblings with OCD, which suggests that OCD runs in families. According to the diathesis-stress model, certain genes leave some people more likely to suffer a mental disorder, but it is not certain and some environmental stress may be necessary to trigger the condition.

Question 66

Adoption Studies for OCD (genetic)

Answer 66

If OCD is in the genes, then adoption studies are a good way to test this as if a baby is born with an OCD gene but adopted by parents who do not have OCD, will the baby end up with OCD as an adult? If OCD is genetic, then the baby could end up with OCD as an adult but if it is not genetic then the baby will not end up with OCD as an adult as the environment that the baby will be reared in will not have parents that have OCD

Question 67

Specific Genetic Explanations for OCD

Answer 67

Candidate Genes (OCD is Polygenic) and Different Types of OCD

Question 68

Candidate Genes for OCD

Answer 68

Genes that create vulnerability for OCD are called candidate genes. Some of these genes regulate the development of the serotonin system. For example, 5HT1-D beta is implicated in the efficiency of transport of serotonin across synapses. Two examples of candidate genes would be the SERT and COMPT genes.

Question 69

SERT

Answer 69

The SERT gene- involved in regulation of serotonin activity in the brain. There is some evidence that some individuals with OCD have a mutated version of this gene leading to reduced serotonin activity.

Question 70

COMT

Answer 70

The COMT gene, involved in the regulation of dopamine activity. There is some evidence that some individuals with OCD have a mutated version of this gene which this time leads to increased dopamine activity.

Question 71

How is OCD polygenic

Answer 71

OCD seems to be polygenic, which means that OCD is not caused by a single gene, but rather several genes are involved. Taylor (2013) analysed findings of previous studies and found evidence that up to 230 different genes may be involved in OCD. Many of these genes are associated with the actions of dopamine and serotonin, which are both believed to play an important role in regulating mood.

Question 72

Different Types of OCD

Answer 72

One group of genes may cause OCD in one person but a different group of genes may cause the same disorder in another person. The term aetiologically heterogeneous means that the origin of OCD has different causes. Some evidence suggests that different types of OCD may be the result of particular genetic variations, such as hoarding disorder and religious obsession.

Question 73

Strengths of Genetic Explanations for OCD

Answer 73

There is evidence from a variety of sources, particularly twin studies, for the idea that people are vulnerable to OCD as a result of their genetic makeup for example, twin studies show us whether OCD is due to genetics (nature) or the environment (nurture) through concordance rates – the higher the concordance rates, the higher the chance that OCD is genetic for example Nestadt et al (2010) reviewed previous twin studies and found that 68% of identical twins shared OCD as opposed to 31% of non-identical twins, which strongly suggests a genetic influence on OCD. Supporting evidence can also be shown through Lewis (1936) observed that of his OCD patients, 37% had parents with OCD and 21% had siblings with OCD, which suggests that OCD runs in families, and this may be through genes. Therefore because the evidence for genetics is strong, this suggests that OCD does indeed have a genetic basis

Question 74

Weaknesses of Genetic Explanations for OCD

Answer 74

Psychologists have not been successful at identifying all the genes involved in OCD. It appears that several genes are involved and they only increase your risk of OCD by a fraction. Consequently, the genetic explanation for OCD is not very useful because it provides little predictive value. Environmental risk factors can also trigger or increase the risk of developing OCD. Cromer et al (2007) found that over half the OCD patients in their sample had a traumatic event in their past, and that OCD was more severe in those with more than one trauma, which suggests that OCD cannot be entirely genetic in origin. Also this can be seen through the diathesis –stress model whereby an individual may be born with an OCD candidate gene (diathesis) but a particularly stressful life may bring on the disorder quicker than just having the genes. It is now generally accepted that a genetic vulnerability to developing OCD is triggered by environmental factors. For example, Cromer et al (2007) found that over half the OCD patients in their sample had a traumatic event in their past, and that OCD was more severe in those with more than one trauma. This supports the diathesis-stress model, the idea that mental illness (in this case OCD) is a result of a biological vulnerability triggered by stress. Twin studies overlook the fact that identical twins may be more similar in terms of shared environments for example, even though twins may be genetically identical, they may also share the same environment e.g. go to the same school, wear the same clothes etc. This then makes it very difficult to separate the nature (genes) and nurture (same upbringing and experiences) on whether the OCD was indeed due to genes or the environment (although this can be overcome through adoption studies)

Question 75

What are the Neural Explanations of OCD

Answer 75

The Role of Serotonin and Neuroanatomical Explanations

Question 76

The Role of Serotonin

Answer 76

The neurotransmitter serotonin is believed to help regulate mood. As neurotransmitters are responsible for relaying information from one neuron to another, if a person has low levels of serotonin then normal transmission of mood-relevant information does not take place. This may mean that mood and other mental processes may be affected. Some cases of OCD can be explained by a reduction in the functioning of the serotonin system in the brain. In other words, the fact that OCD patients feel sad and generally have a low mood, this may be linked to low levels of serotonin.

Question 77

Neuroanatomical Explanation

Answer 77

These explanations focus on specific parts of the brain being responsible for specific behaviours. Two main brain regions have been implicated in OCD, including the basal ganglia and orbitofrontal cortex.

Question 78

Basal Ganglia

Answer 78

The basal ganglia is a brain structure involved in multiple processes, including the coordination of movement, and abnormalities in the basal ganglia have been linked to OCD. Rapport and Wise have proposed that hypersensitivity of the basal ganglia leads to repetitive motor behaviours as seen in OCD, for example, repetitive washing/cleaning/checking In support patients who suffer head injuries in this region often develop OCD-like symptoms, following their recovery suggesting that if the basal ganglia is damaged, then OCD may occur. Furthermore, Max et al. (1994) found that when the basal ganglia is disconnected from the frontal cortex during surgery, OCD-like symptoms are reduced. This clearly suggests a link between the basal ganglia and OCD.

Question 79

Orbitofrontal Cortex

Answer 79

The orbitofrontal cortex is found on the frontal lobes, and is thought to be involved in higher level cognitive processing including decision making and worrying about social and other behaviours. It has significant connections to the thalamus, an area whose functions include controlling, checking and other safety behaviours. When the OFC detects when something is wrong it sends a ‘worry’ signal to the thalamus. In OCD the OFC and the thalamus are believed to be overactive. An overactive thalamus would result in an increased motivation to clean or check for safety. If the thalamus was overactive the OFC would also become overactive as a result. An overactive OFC would result in increased anxiety and increased planning to avoid anxiety. In a study by Whitehead (2004), he reviewed brain-imaging research into OCD and found hyperactivity in the orbital region was consistently found in OCD patients compared to healthy controls (Whitehead, 2004). After treatment, activity in reduces to a level comparable to that of controls, as found by Saxena and Rauch (2000) – showing supporting evidence

Question 80

Strengths of Neural and Neuroanatomical Explanations for OCD

Answer 80

Neural Explanations are Supported by the Effectiveness of Biological Treatments for OCD, Especially Anti-Depressants - Anti-depressants typically work by increasing levels of serotonin. Such drugs are effective in reducing OCD symptoms which suggests that OCD is linked to low levels of serotonin. However anti-depressants are not effective in all patients suffering from OCD and are rarely completely effective. Furthermore, there is a time delay between taking drugs and any improvements in symptoms and yet SSRIs increase serotonin levels within hours. This suggests that low levels of serotonin alone cannot explain OCD.

Question 81

Weaknesses of Neural and Neuroanatomical Explanations for OCD

Answer 81

It is Not Exactly Clear What Neural Mechanisms are Involved - Studies of decision making have shown that these neural systems are the same systems that function abnormally in OCD, however research has also identified other brain systems that may be involved sometimes, but not system has been found that always plays a role. Therefore, we cannot truly claim to understand the neural mechanism involved in OCD. We Should Not Assume the Neural Mechanisms Cause OCD - Various neurotransmitters and brain structure do not function normally in people with OCD, however this does not suggest that this abnormal functioning causes OCD. These biological abnormalities could be a result of OCD, not the cause. For example, did someone have low levels of serotonin and high levels of dopamine and then develop OCD or did someone develop OCD and then develop abnormal levels of serotonin and dopamine? It is always difficult to work this out as we never know when someone could develop OCD so do a brain scan?

Question 82

SSRIs (Selective Serotonin Reuptake Inhibitors)

Answer 82

The standard drug treatment of OCD is through an anti-depressant drug called a Selective Serotonin Reuptake Inhibitor. SSRIs work on the serotonin system in the brain. Serotonin is released by certain neurons on the brain (presynaptic neurons) and travels across the synapse. The neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then it is reabsorbed by the presynaptic neuron where it is broken down and reused. By preventing the re-absorption and breakdown of serotonin, SSRIs effectively increase its levels in the synapse and thus continue to simulate the postsynaptic neuron. This compensates for whatever is wrong with the serotonin system in OCD. The drug fluxoetine (20mg) is available as liquid or capsules and generally takes three to four months of daily doses to have an impact on symptoms.

Question 83

Anti-anxiety drugs

Answer 83

Benzodiazepines (BZs) are a range of anti-anxiety drugs including Valium and Diazepam. BZs work by increasing activity of the neurotransmitter GABA. GABA is an inhibitory neurotransmitter which reduces neurone activity. Effectively GABA tells neurons in the brain to ‘slow down’ and ‘stop firing’ and around 40% of the neurons in the brain respond to GABA. This means that BZs have a general quietening influence on the brain and consequently reduce anxiety, which is experienced as a result of the obsessive thoughts.

Question 84

Combining SSRIs with Other Treatments

Answer 84

Drugs are often used alongside CBT to teat OCD. The drugs reduce the patient’s emotional symptoms (feeling anxious or depressed. Etc.) which allows the patient to engage more effectively with CBT. Occasionally other drugs are prescribed alongside SSRIs.

Question 85

Alternatives to SSRIs

Answer 85

When SSRIs are not effective three to four months, the dose can be increased or it can be combined with other drugs. Sometimes different anti-depressant drugs can be tried such as Tricyclics or SNRIs (Serotonin-Noradrenaline Reuptake Inhibitors).

Question 86

Tricyclics

Answer 86

An older type of anti-depressant which has the same effect on serotonin as SSRIs but they have more severe side effects, so are generally kept in reserve for people who do not respond to SSRIs.

Question 87

SNRIs

Answer 87

SNRIs (Serotonin-Noradrenaline Reuptake Inhibitors) are also a second line of defence for people who do not respond well to SSRIs. SNRIs increase levels of serotonin and noradrenaline.

Question 88

Strengths of Drug Therapy for OCD

Answer 88

The effectiveness of SSRI’s is supported by studies which uses randomised drug trials. These trials compare the effectiveness of SSRIs and placebos. Soomro et al. (2008) conducted a review of the research examining the effectiveness of SSRIs and found that SSRIs were more effective than placebos in the treatment of OCD, in 17 different trials. This supports the use of biological treatments, especially SSRIs, for OCD. Anti-depressants and anti-anxiety drugs, are relatively cost effective in comparison to psychological treatments like cognitive behavioural therapy (CBT). Consequently, many doctors prefer the use of drugs over psychological treatments, as they are more cost-effective for the NHS. Drugs are also non-disruptive to patients’ lives- patients can just take them until their symptoms improve. In contrast psychological treatments take time and effort, often requiring the patient to complete homework in their own time. It can therefore be said that drugs are more are likely to be more successful for patients who lack motivation to complete intense psychological treatments.

Question 89

Weaknesses of Drug Therapy for OCD

Answer 89

SSRIs and BZs both have side effects. Possible side-effects of SSRIs: indigestion, blurred vision, reduced sex drive. However these are usually temporary. Possible side-effects of BZs: drowsiness, dizziness and lack of coordination. BZ are also well-known for their withdrawal effects- this makes them very addictive. In the long-term BZ can have quite serious negative effects including cognitive impairments. As a result, BZs are usually only prescribed for short-term treatment. In some instances side effects will cause patients to stop taking the drug, preventing it from being effective. Drug treatments are criticised for treating the symptoms of the disorder and not the cause. Although SSRIs work by increasing the levels of serotonin in the brain, which reduces anxiety and alleviates the symptoms of OCD, it does not treat the underlying cause of OCD. This means that once a patient stops taking the drug, they are prone to relapse, suggesting that psychological treatments may be more effective, as a long-term solution.