psychopathology (Paper 1)

Question 1

What is Statistical infrequency?

p. 134

Answer 1

Occurs when an individual has a less common characteristic, e.g being more depressed or less intelligent than most of the population.

A01

This is 5% on both extremes of the normal distribution curve

Question 2

Statistical infrequency when it comes to IQ

p. 134

Answer 2

This statistical approach for intelligence - This characteristic can be reilably measured and you can see the normal distribution of IQ on page 134.

A01

We know that, in any human characteristic, the majority of people’s scores will cluster around the average, and that the further we go above or below that average, the fewer people will attain that score.
This is called the normal distribution.

Question 3

Statistical infrequency when it comes to intellectual disability disorder

p. 134

Answer 3

• The average IQ is set at 100.
• Most people (68%) have an IQ in the range from 85 to 115.
• Only 2% of people have a score below 70.
  Those individuals scoring below 70 are very unusual or ‘abnormal, and are liable to receive a diagnosis of a psychological disorder - intellectual disability disorder.

A01

Question 4

What is normal distribution?

p. 134

Answer 4

We know that, in any human characteristic, the majority of people’s scores will cluster around the average, and that the further we go above or below that average, the fewer people will attain that score.
This is called the normal distribution.

A01

Question 5

What does it mean to deviate from social norms?

p. 134

(social deviation)

Answer 5

Behaviour that is different from the accepted standards within a community/society.

A01

Question 6

What is deviation and why do we notice it?

p. 134

Answer 6

Groups of people who choose to define behaviour as abnormal on the basis that it offends their sense of what is ‘acceptable’ or the norm. We are making a collective judgement as a society about what is right.

A01

Question 7

Example of norms specific to the culture we live in:

p. 134

Answer 7

Of course those social norms may be different for each generation and every culture, so there are relatively few behaviours that would be considered universally abnormal on the basis that they breach social norms. e.g, homosexuality continues to be viewed as abnormal (and illegal) in some cultures.

A01

For example in April 2019 Brunei introduced new laws that make sex between men an offence punishable by stoning to death.

Question 8

What is anti-social personality disorder?

p. 134

Answer 8

• According to the DSM-5 (the manual used by psychiatrists to diagnose mental disorder) one important symptom of antisocial personality disorder is an ‘absence of prosocial internal standards associated with failure to conform to lawful or culturally normative ethical behaviour’.

In other words we are making the social judgement that a psychopath is abnormal because they don’t conform to our moral standards. They tend to be impulsive, aggressive and irresponsible.

A01

Psychopathic behaviour would be considered abnormal in a very wide range of cultures.

Question 9

Give a real-life example of a deviatior from social norms

p. 134

Answer 9

Antisocial personality disorder involves socially unacceptable behaviour.

A01

Question 10

Positive evaluation

Statistical infrequency - Real life application

p. 135

Answer 10

Has a real-life application in the diagnosis of intellectual disability disorder.
There is therefore a place for statistical infrequency in thinking about what are normal and abnormal behaviours and characteristics.

All assessment of patients with mental disorders includes some kind of measurement of how severe their symptoms are as compared to statistical norms (as distinct from social norms). Statistical infrequency is thus a useful part of clinical assessment.

A03

Question 11

limitation (negative evaluation)

Statistical infrequency - Unusual characteristic and it’s negative ideology for the need of treatment:

p. 135

Answer 11

Unusual characteristics can be positive,
1Q scores over 130 are just as unusual as those below 70, but we wouldn’t think of super-intelligence as an undesirable characteristic that needs treatment.

Just because very few people display certain behaviours does make the behaviour statistically abnormal but doesn’t mean it requires treatment to return to normal.

This is a serious limitation to the concept of statistical infrequency and why it would never be used alone to make a diagnosis.

A03

Question 12

Evaluation - negative

Statistical infrequency - the negative effect of being ‘labelled’

p. 135

Answer 12

Not everyone unusual benefits from a label
Another problem with statistical infrequency is that, where someone is living a happy fulfilled life, there is no benefit to them being labelled as abnormal regardless of how unusual they are. So someone with a very low IQ but who was not distressed, quite capable of working, etc., would simply not need a diagnosis of intellectual disability.
If that person was ‘labelled’ as abnormal this might have a negative effect on the way others view them and the way they view themselves.

A03

Question 13

Evaluation, negative

Limitations of Deviation from social norms Defining Abnormality

p. 135

what is a positive evaluation for Deviation from social norms Defining Abnormality?

Answer 13

Deviation from social norms is not the only factor to consider. The distress caused to others by antisocial behavior (p. 136) is also important. Therefore, deviation from social norms is never the sole factor in defining abnormality.

A03

It has a real-life application in the diagnosis of antisocial personality disorder. There is therefore a place for deviation from social norms in thinking about what is normal and abnormal.

Question 14

Negative evaluation

Deviation from social norms- Cultural relativism

p. 135

Answer 14

Using deviation from social norms to define abnormal behavior has its problems because social norms change over time and differ between cultures. E.g, someone from one culture might label another person as behaving abnormally based on their own cultural standards, not the other person’s.

A03

For instance, hearing voices is accepted in some cultures but seen as abnormal in the UK. This creates problems for people in one culture living within another cultural group.

Question 15

negative evaluation

The reliance on deviation from social norms and its ethicallity

p. 135

Answer 15

Too much reliance on deviation from social norms to understand abnormality can lead to the systematic abuse of human rights. Looking at historical examples of deviation from social norms, it is pretty clear that these diagnoses were really just there to maintain control over minority ethnic groups and women.

A03

More radical psychologists suggest that some of our modern categories of mental disorder are really abuses of people’s rights to be different.

Question 16

Extra evaluation - positive

The strengths of Deviation from Social Norms: Desirability of Behavior

p. 135

Why is this therefore a limitation from the Statistical infrequency approach?

Answer 16

A strength of the deviation from social norms approach - is that it includes the issue of the desirability of a behaviour. This means that social norms can be more useful than e.g statistical norms who dont take diserability into account.

E.g. Highly aggressive people are equally unusual as highly non-aggressive people. However, as aggression is low in social acceptability we tend to regard high levels of aggression (but not low levels) as abnormal. Here deviation from social norms works better than statistical infrequency because we are not simply looking at how unusual the behaviour is, but also at its social unacceptability.

A03

The statistical infrequency approach doesn’t take desirability into account. e.g, genius is statistically abnormal but they wouldn’t want to include that in the definition of abnormal behaviours, this rejects a great social norms factor.

Question 17

Failure to function adequately definition:

p. 136

Answer 17

When someone is unable to cope with the ordinary demands of day-to-day living.

A01

We might decide that someone is not functioning adequately when they are unable to maintain basic standards of nutrition and hygiene, cannot hold down a job or maintain relationships with people around them.

Question 18

Deviation from ideal mental health definition-

p. 136

Answer 18

When someone does not meet a set of criteria for good mental health.

A01

Question 19

According to David Rosenhan and Martin Seligman, when might we decide someone is failing to function adequately?

p. 136

Answer 19

• When a person no longer conforms to standard interpersonal rules, E.g, maintaining eye contact and respecting personal space.
• When a person experiences severe personal distress.
• When a person’s behaviour becomes irrational or dangerous to themselves or others.

A01

One of the criterias for diagnosing intellectual disability disorder is having a very low IQ (a statistical deviation). However, a diagnosis would not be made on this basis only - an individual must also be failing to function adequately before a diagnosis would be given.

Question 20

What is Marie Jahoda’s checklist for what ideal mental health looks like?

p. 136

Answer 20

Marie Jahoda (1958) suggested that we are in good mental health if we meet the following criteria:
* Positive self-attitude
* Autonomy
* Self-actualisation
* Resistance to stress
* Accurate perception of reality
* Environmental mastery

A01

Inevitably there is some overlap between what we might call deviation from ideal mental health and what we might call failure to function adequately. So we can think of someone’s inability to keep a job as either a failure to cope with the pressures of work or as a deviation from the ideal of successfully working.

Question 21

Application

Psychologists and their current classifications on abnormality

p. 136

Answer 21

Psychologists no longer classify abnormality based on just one definition:
Under the DSM-5, paraphilias (ppl who exhibit unusual sexual behaviours) (e.g., paedophilia -attraction to children, exhibitionism- flashing, and frotteurism - rubbing against people) are only classed as disorders if they cause harm or distress. Consensual behaviours like cross-dressing or sadomasochism, are not considered abnormal unless they interfere with daily functioning.

This shift from social norm-based definitions to more ethical, flexible criteria’s like failure to function adequately, recognise that abnormality is often context-dependent.

A02

E.g, homosexuality was once seen as abnormal for breaking social norms but is no longer considered a disorder as it does not cause others harm.

Question 22

Evaluation - Positive

Failure to function adequately - Patients perspective

p. 137

Answer 22

A strength of ‘failure to function adequately’ is that it attempts to include the subjective experience of the individual.
It may not be an entirely satisfactory approach because it is difficult to assess distress,
but at least this definition acknowledges that the experience of the patient (and/or others) is important.

Therefore the ‘failure to function adequately’ definition captures the experience of many of the people who need help; and suggests that ‘failure to function adequately’ is a useful point of reference for assessing abnormality.

A03

Question 23

Failure to function adequately - Evaluation ( - )

When is Deviating from Social Norms NOT Failing to Function Adequately?

p. 137

Answer 23

Distinguishing between someone failing to function and simply deviating from social norms can be difficult. E.g, a person without a job or permanent address might be seen as failing to function, but they may have chosen an alternative lifestyle. Similarly, extreme sports or supernatural beliefs might seem irrational or maladaptive to some, but are not necessarily signs of dysfunction.

If we label these behaviors as failures of adequate functioning, we risk limiting personal freedom and potentially discriminating against minority groups. It’s important to consider whether behaviour causes harm or involves non-consenting victims—this is a clearer indicator of genuine dysfunction.

A03

Question 24

Evaluation - Negative

Failure to function adequately and its subjective judgements:

p. 137

Answer 24

When deciding whether someone is failing to function adequately, someone has to judge whether a patient is distressed or distressing.
Some patients may say they are distressed but may be judged as not suffering. There are methods for making such judgments as objective as possible, including checklists such as Global Assessment of Functioning Scale.
However, the principle remains that someone (e.g. a psychiatrist) has the right to make this judgement.

A03

Question 25

# Evaluation - positive Name a positive evaluation for the 'deviation from ideal mental health' definition for abnormalities | p. 137 ## Footnote talk about Jahoda

Answer 25

A strength of deviation from ideal mental health is that it is a very **comprehensive definition**. * It covers a broad range of criteria for mental health. In fact it probably covers most of the reasons someone would seek help from mental health services or be referred for help. | A03 ## Footnote The sheer range of factors discussed in relation to Jahoda's 'ideal mental health' suggestion, makes it a good tool for thinking about mental health.

Question 26

# Evaluation - Negative Deviation from ideal mental health - Cultural Relativism | p. 137

Answer 26

Some of the ideas in **Jahoda's classification of ideal mental health are specific to Western European and North American cultures** (we say they are **culture-bound**). E.g, the emphasis on personal achievement in the concept of self-actualisation would be considered self-indulgent in much of the world because the emphasis is so much on the **individual** rather than the family or community. Similarly, much of the world would see independence from other people as a bad thing. Such **traits are typical of individualist cultures**. | A03

Question 27

# Evaluation - positive/negative 'Deviation from ideal mental health definition - for abnormality' and its standards for mental health: | p. 137

Answer 27

It sets an unrealistically high standard for mental health Very few of us attain all Jahoda's criteria for mental health, and probably none of us achieve all of them at the same time or keep them up for very long. Therefore this approach would see pretty much all of us as abnormal. We can see this as a positive or a negative. * On the positive side it makes it clear to people the ways in which they could benefit from seeking treatment - say counselling - to improve their mental health. * On the negative side, it may not be helpful when considering who might need treatment against their will. | A03

Question 28

# Extra evaluation - negative Labelling someone when they are failing to function adequatley or deviating from the ideal mental health: | p. 137

Answer 28

When we make a judgement that someone is failing to cope we may end up giving them a label that can add to their problems. E.g, it would be very normal to get depressed after the loss of a job, home or relationship. Someone in that position might well benefit from psychological help. However, future employers, partners and even finance organisations may attach a permanent label to that person. | A03

Question 29

Phobia definition - | p. 138

Answer 29

An irrational fear of an object or situation. | A01

Question 30

Behavioural definition - | p. 138

Answer 30

Ways in which people act. | A01

Question 31

Emotional definition - | p. 138

Answer 31

Ways in which people feel. | A01

Question 32

Cognitive definition - | p. 138

Answer 32

Refers to the process of thinking --> knowing, perceiving, believing. | A01

Question 33

What is the DSM system? | p. 138

Answer 33

There are a number of systems for classifying and diagnosing mental health problems. Perhaps the best known is the DSM. This stands for Diagnostic and Statistical Manual of Mental Disorder and is published by the American Psychiatric Association. The DSM is updated every so often as ideas about abnormality change. The current version is the 5th edition so it is commonly called the DSM-5. This was published in 2013. | A01

Question 34

What is the 'DSM-5' 's categories of phobia: | p. 138

Answer 34

All phobias are characterised by excessive fear and anxiety, triggered by an object, place or situation. The extent of the fear is out of proportion to any real danger presented by the phobic stimulus. The latest version of the DSM recognises the following categories of phobia and related anxiety disorder: * Specific phobia: phobia of an object, such as an animal or body part, or a situation such as flying or having an injection. * Social anxiety (social phobia): phobia of a social situation such as public speaking or using a public toilet. * Agoraphobia: phobia of being outside or in a public place due to fear of being trapped, helpless or embarrassed. | A01

Question 35

What is Behavioural characteristics of phobias? | p. 138

Answer 35

We respond to things/situations we fear by behaving in particular ways. We respond by feeling high levels of anxiety and trying to escape. The fear responses in phobias are the same as we experience for any other fear even if the level of fear is irrational (out of all proportion to the phobic stimulus). | A01 ## Footnote Responses may be Panic, Avoidance or Endurance.

Question 36

Talk about what Panic may look like as a Behavioural characteristic of phobias: | p. 138

Answer 36

A phobic person may panic in response to the presence of the phobic stimulus. Panic may involve a range of behaviours including crying, screaming or running away. Children may react slightly differently, e.g by freezing, clinging or having a tantrum. | A01

Question 37

Talk about Avoidance as a Behavioural characteristic of phobias: | p. 138

Answer 37

Unless the sufferer is making a conscious effort to face their fear they tend to go to a lot of effort to avoid coming into contact with the phobic stimulus. This can make it hard to go about daily life. E.g, someone with a fear of public toilets may have to limit the time they spend outside the home in relation to how long they can last without a toilet. This in turn can interfere with work, education and a social life. | A01

Question 38

Talk about Endurance as a Behavioural characteristic of phobias: | p. 138

Answer 38

The alternative to avoidance is endurance, in which a sufferer remains in the presence of the phobic stimulus but continues to experience high levels of anxiety. This may be unavoidable in some situation, e.g for a person who has an extreme fear of flying. | A01

Question 39

Behavioural characteristic of phobias: Name them only --> | p. 138

Answer 39

* Panic * Avoidence * Endurance | A01

Question 40

# Application Hypothetical Case study of Padraig and his gynophobia (to show how a specific phobia can impact your everyday life) | p. 138

Answer 40

Cases where phobias have been diagnosed as a mental disorder (called clinical phobias) can be disabling and cause tremendous suffering. In fact a clinical phobia is only diagnosed if anxiety is considerable and it impacts on the sufferer's life. Padraig who is a psychology undergraduate, suffers from gynophobia - a phobia of women. This is an unusual condition and one which Padraig finds causes offence to many people he meets. Others don't take it seriously and laugh at Padraig. Padraig finds his studies very difficult because most of the students on his course are women. His social life is very limited because the people he likes best at the University all hang out in mixed-sex groups. This causes Padraig severe distress and he feels guilty - he does not dislike women, he is just very anxious around them. His self-esteem is low and this is made worse by the fact that Padraig has no idea where his phobia comes from. | A02

Question 41

Emotional characteristics of phobias: | p. 139 ## Footnote Give an example of 'Emotional characteristics of phobias' for someone's fear of E.g, spiders

Answer 41

Phobias are classified as anxiety disorders, meaning they involve feelings of **anxiety and fear**. Anxiety can be long-term. Its an unpleasant state of high arousal that makes relaxation difficult and prevents positive emotions. Fear is the immediate, intense emotional response experienced when encountering or even thinking about the phobic stimulus. | A01 ## Footnote E.g, in arachnophobia (fear of spiders), Matt's anxiety rises whenever he enters areas associated with spiders, like his shed. This anxiety is a general response to the environment. However, when he actually sees a spider, the fear response becomes much stronger, directly targeting the spider itself. The emotional responses to phobias are unreasonable. E.g, Matt's intense fear of a harmless, small spider is greatly out of proportion to the actual danger posed by any spider he is likely to encounter.

Question 42

Talk through what **Cognitive** characteristics are for phobias: | p. 139 ## Footnote (Don't need to mention the cognitive phobias but rather just what it means for it to be 'cognitive')

Answer 42

The cognitive element is concerned with the ways in which people **process** information. People with phobias, process information about phobic stimuli differently from other objects or situations. | A01

Question 43

Cognitive characteristics of phobias: Selective attention to the phobic stimulus | p. 139

Answer 43

* **Selective attention to the phobic stimulus** If a sufferer can see the phobic stimulus it is hard to look away from it. Keeping our attention on something really dangerous is a good thing as it gives us the best chance of reacting quickly to a threat, but this is not so useful when the fear is irrational. | A01 ## Footnote A pogonophobic will struggle to concentrate on what they are doing if there is someone with a beard in the room.

Question 44

Cognitive characteristics of phobias: Irrational beliefs | p. 139

Answer 44

* **Irrational beliefs** A phobic may hold irrational beliefs in relation to phobic stimuli. E.g, social phobias can involve beliefs like 'I must always sound intelligent' or 'if I blush people will think I'm weak'. This kind of belief increases the pressure on the sufferer to perform well in social situations. | A01

Question 45

Cognitive characteristics of phobias: Cognitive distortions | p. 139

Answer 45

* **Cognitive distortions** The phobic's perceptions of the phobic stimulus may be distorted. So, for example, an omphalophobic is likely to see belly buttons as ugly and/or disgusting, and an ophidiophobic may see snakes as alien or aggressive looking. | A01

Question 46

Cognitive characteristics of phobias: Name them only --> | p. 139

Answer 46

* **Selective attention to the phobic stimulus** * **Irrational beliefs** * **Cognitive distortions** | A01

Question 47

depression definition - (How is it characterized?) | p. 140

Answer 47

A mental disorder characterized by low mood and low energy levels | A01

Question 48

DSM-5 categories of depression: | p. 140

Answer 48

All forms of depression and depressive disorders are characterised by changes to mood. The latest version of the DSM recognises the following categories of depression and depressive disorders: * **Major depressive disorder**: severe but often short-term depression. * **Persistent depressive disorder**: long-term or recurring depression, including sustained major depression. * **Disruptive mood dysregulation disorder**: childhood temper tantrums. * **Premenstrual dysphoric disorder**: disruption to mood prior to and/or during menstruation. | A01

Question 49

Behavioural characteristics of depression: activity levels | p. 140

Answer 49

**Activity levels** * Typically sufferers of depression have reduced levels of energy, making them sluggish. This has a knock-on effect, with sufferers tending to withdraw from work, education and social life. In extreme cases this can be so severe that the sufferer cannot get out of bed. * In some cases depression can lead to the opposite effect - known as **psychomotor agitation**. Agitated individuals struggle to relax and may end up pacing up and down a room. | A01

Question 50

Behavioural characteristics of depression: Disruption to sleep and eating behavior | p. 140

Answer 50

* **Disruption to sleep and eating behavior** Depression is associated with changes to sleeping behaviour. Sufferers may experience reduced sleep (insomnia), particularly premature waking, or an increased need for sleep (hypersomnia). Similarly, appetite and eating may increase or decrease, leading to weight gain or loss. The key point is that depression disrupts these normal behaviors | A01

Question 51

Behavioural characteristics of depression: Aggression and self-harm | p. 140

Answer 51

**Aggression and self-harm** * Sufferers of depression are often irritable, and in some cases they can become verbally or physically aggressive. e.g, someone experiencing depression might display verbal aggression by ending a relationship or quitting a job. * Depression can also lead to physical aggression directed against the self. This includes self-harm, or suicide attempts. | A01

Question 52

Behavioural characteristics of depression: Name them only | p. 140

Answer 52

* Activity levels * Disruption to sleep and eating behaviour * Aggression and self-harm | A01

Question 53

Emotional characteristics of depression: Lowered mood | p. 141

Answer 53

When we use the word 'depressed' in everyday life we are usually describing having a lowered mood, in other words feeling sad. There is more to clinical depression than this. Lowered mood is still a defining emotional element of depression but it is more pronounced than in the daily kind of experience of feeling sluggish and sad. Patients often describe themselves as 'worthless' and 'empty'. | A01

Question 54

Emotional characteristics of depression: Anger | p. 141

Answer 54

Although sufferers tend to experience more negative emotions and fewer positive ones during episodes of depression, this experience of negative emotion is not limited to sadness. Sufferers of depression also frequently experience anger, sometimes extreme anger. This can be directed at the self or others. On occasion such emotions lead to aggressive or self-harming behaviour. | A01

Question 55

Emotional characteristics of depression: Lowered self-esteem | p. 141

Answer 55

Self-esteem is the emotional experience of how much we like ourselves. Sufferers of depression tend to report reduced self-esteem, in other words they like themselves less than usual. This can be quite extreme, with some sufferers of depression describing a sense of self-loathing, i.e. hating themselves. | A01

Question 56

Emotional characteristics of depression: Name them only --> | p. 141

Answer 56

* Lowered mood * Anger * Lowered self-esteem | A01

Question 57

What is the Cognitive characteristics of depression about? | p. 141

Answer 57

The cognitive aspect of depression is concerned with the ways in which people process information. People suffering from depression or who have suffered depression tend to process information about several aspects of the world quite differently from the 'normal' ways that people without depression think. | A01

Question 58

Cognitive characteristics of depression: Poor concentration | p. 141

Answer 58

Depression is associated with poor levels of concentration. The sufferer may find themselves unable to stick with a task they usually would, or might find it hard to make decisions that they would normally find straightforward. Poor concentration and poor decision making are likely to interfere with the individual's work. | A01

Question 59

Cognitive characteristics of depression: Attending to and dwelling on the negative | p. 141

Answer 59

When suffering a depressive episode people are inclined to see the glass as half empty. Sufferers also have a bias towards recalling unhappy events rather than happy ones. | A01

Question 60

Cognitive characteristics of depression: Absolutist thinking | p. 141

Answer 60

Most situations are not all-good or all-bad, but when a sufferer is depressed they tend to think in these terms. They sometimes call this 'black and white thinking'. This means that when a situation is unfortunate they tend to see it as an absolute disaster. | A01

Question 61

OCD definition - | p. 142

Answer 61

An anxiety disorder characterized by persistent, intrusive thoughts (obsessions) and repetitive behaviors or mental acts (compulsions). These compulsions are performed to reduce the anxiety caused by the obsessions or to prevent a feared event or situation, even though the actions may not be connected to the feared event in a realistic way (involves irrational thinking). | A01

Question 62

# Talk about what it is and name the 3 most popular diagnosis of OCD DSM-5 categories of OCD | p. 142

Answer 62

DSM-5 categories of OCD The DSM system recognises OCD and a range of related disorders. What these disorders all have in common is repetitive behaviour accompanied by obsessive thinking. * OCD: characterised by either obsessions (recurring thoughts, images, etc.) and/or compulsions (repetitive behaviours such as hand washing). Most people with a diagnosis of OCD have both obsessions and compulsions. * 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. | A01

Question 63

Behavioural characteristics of OCD: Compulsions as repetitive | p. 142

Answer 63

Typically sufferers of OCD feel compelled to repeat a behaviour. A common example is hand washing. Other common compulsive repetitions include counting, praying and tidying/ordering groups of objects such as CD collections (for those who have them) or containers in a food cupboard. | A01

Question 64

Behavioural characteristics of OCD: Compulsions in reducing anxiety | p. 142

Answer 64

Around 10% of sufferers of OCD show compulsive behaviour alone - they have no obsessions, just a general sense of irrational anxiety. However, for the **vast majority** compulsive behaviours are performed in an attempt to manage the anxiety produced by obsessions. E.g, compulsive hand washing is carried out as a response to an obsessive fear of germs. Compulsive checking, for example that a door is locked or a gas appliance is switched off, is in response to the obsessive thought that it might have been left unsecured. | A01

Question 65

Behavioural characteristics of OCD: Avoidance | p. 142

Answer 65

OCD sufferers attempt to manage their OCD and reduce anxiety, by keeping away from situations that trigger it. E.g, sufferers who wash compulsively may avoid coming into contact with germs. However, this avoidance can lead people to avoid very ordinary situations, such as emptying their rubbish bins, and this can in itself interfere with leading a normal life. | A01

Question 66

# OCD What are the 3 elements of behaviour characteristics of OCD?: Just name them | p. 142

Answer 66

1. Compulsions are repetitive 2. Compulsions reduce anxiety 3. Avoidance | A01

Question 67

What is the Cycle of OCD? | p. 143

Answer 67

Obsessive thought, Anxiety, Compulsive Behaviour, temporary relief (and then it starts all over again). | A01

Question 68

Emotional characteristics of OCD: Anxiety and distress | p. 143

Answer 68

OCD is regarded as a particularly unpleasant emotional experience because of the powerful anxiety that accompanies both obsessions and compulsions. Obsessive thoughts are unpleasant and frightening, and the anxiety that goes with these can be overwhelming. The urge to repeat a behaviour (a compulsion) creates anxiety. | A01

Question 69

Emotional characteristics of OCD: Accompanying depression | p. 143

Answer 69

OCD is often accompanied by depression, so anxiety can be accompanied by low mood and lack of enjoyment in activities. Compulsive behaviour tends to bring some relief from anxiety but this is temporary. | A01

Question 70

Emotional characteristics of OCD: Guilt and disgust | p. 143

Answer 70

Negative emotions such as irrational guilt, for example over minor moral issues, or disgust, which may be directed against something external like dirt or at the self. | A01

Question 71

What is Cognitive characteristics of OCD about? | p. 143

Answer 71

The cognitive approach is concerned with the ways in which people process information. People suffering from OCD are usually plagued with obsessive thoughts but they also adopt cognitive strategies to deal with these. | A01

Question 72

Cognitive characteristics of OCD: Obsessive thoughts | p. 143

Answer 72

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 considerably from person to person but are always unpleasant. | A01 ## Footnote Examples of recurring thoughts are worries of being contaminated by dirt and germs or certainty that a door has been left unlocked and that intruders will enter through it or impulses to hurt someone.

Question 73

Cognitive characteristics of OCD: Cognitive strategies to deal with obsessions | p. 143

Answer 73

Obsessions are the major cognitive aspect of OCD, but people also respond by adopting cognitive coping strategies. E.g, a religious person tormented by obsessive guilt may respond by praying or meditating. (This may help manage anxiety but can make the person appear abnormal to others and can distract them from everyday tasks). | A01

Question 74

Cognitive characteristics of OCD: Insight into excessive anxiety | p. 143

Answer 74

People suffering from OCD are aware that their obsessions and compulsions are not rational. In fact this is necessary for a diagnosis of OCD. If someone really believed their obsessive thoughts were based on reality that would be a symptom of quite a different form of mental disorder. However, in spite of this insight, OCD sufferers experience catastrophic thoughts about the worst case scenarios that might result if their anxieties were justified. They also tend to be hypervigilant, i.e. they maintain constant alertness and keep attention focused on potential hazards. | A01

Question 75

Behavioural approach definition- | 144

Answer 75

The behavioral approach is a psychological perspective that focuses on studying and modifying observable behaviors through principles of learning, such as conditioning and reinforcement. | A01

Question 76

Classical conditioning - | 144

Answer 76

Classical conditioning is a learning process in which a neutral stimulus becomes associated with a meaningful stimulus, eventually triggering a similar response, as demonstrated by Ivan Pavlov's experiments with dogs | A01 ## Footnote book's definition: Learning by association. Occurs when two stimuli are repeatedly paired together - an unconditioned (unlearned) stimulus (UCS) and a new 'neutral' stimulus (NS). The neutral stimulus eventually produces the same response that was first produced by the unlearned stimulus alone.

Question 77

Operant conditioning definition - | p. 144

Answer 77

A form of learning in which behaviour is shaped and maintained by its consequences. Possible consequences of behaviour include positive reinforcement, negative reinforcement or punishment. | A01

Question 78

# Behavioural approach The two-process model | p. 144 ## Footnote What is the behaviour approach all about? for Phobia's:

Answer 78

Mowrer's idea that phobias are: (a) learned and (b) maintained. **Hobart Mower** (1960) proposed the **two-process model** based on the behavioural approach to phobias. This states that *phobias are acquired (learned in the first place) by classical conditioning and then continue because of operant conditioning.* | A01 ## Footnote The behavioural approach emphasises the role of learning in the acquisition of behaviour. The approach focuses on behaviour - what we can see. On page 138 we identified the key behavioural aspects of phobias - avoidance, endurance and panic. The behavioural approach is geared towards **explaining** these rather than the cognitive and emotional aspects of phobias.

Question 79

# behavioural approach - classsical conditioning. (Name the psychologists) Little Albert study: | 144 ## Footnote How does classical conditioning work for phobias?

Answer 79

**John Watson** and **Rosalie Rayner** (1920) created a phobia in a 9-month-old baby called 'Little Albert'. Albert showed no unusual anxiety at the start of the study. When shown a white rat he tried to play with it. However, the experimenters then set out to give Albert a phobia: Whenever the **rat was presented** they made a loud, frightening noise by **banging an iron bar close to Albert's ear**. This **noise** is an unconditioned stimulus (UCS) which creates an unconditioned response (**UCR**) of fear. When the **rat** (a neutral stimulus, **NS**) and the unconditioned stimulus are encountered close together in time the **NS becomes associated with the UCS and both now produce the fear response** - Albert became frightened when he saw a rat. The rat is now a learned or conditioned stimulus (CS) that produces a conditioned response (CR). This conditioning then generalised to similar objects. They tested Albert by showing him other **furry objects** such as a non-white rabbit, a fur coat and Watson wearing a Santa Claus beard made out of cotton balls. **Little Albert displayed distress at the sight of all of these**. | A01 ## Footnote done by classical conditioning Classical conditioning involves learning to associate something of which we initially have no fear (neutral stimulus) with something that already triggers a fear response (unconditioned stimulus).

Question 80

Behavioural approach - Maintenance by operant conditioning | 144

Answer 80

Responses acquired by classical conditioning usually tend to decline over time. However, phobias are often long lasting. **Mower** has explained this as **the result of operant conditioning**. Operant conditioning happens when our behavior is either rewarded (reinforced) or punished. Reinforcement makes a behavior more likely to happen again. This is true for both positive reinforcement (where we get something good) and negative reinforcement (where we avoid something bad). For example, in negative reinforcement, **if someone avoids an unpleasant situation, they feel better, and this encourages them to repeat the behavior**. **Mower suggested that when we avoid something we're afraid of** (like a phobic stimulus), we escape the fear and anxiety we would have felt if we stayed. This reduction in fear strengthens the behavior of avoidance, which helps keep the phobia going. | A01

Question 81

# Evaluation - positive What is a positive evaluation of the two-process model? | p. 145

Answer 81

It has good explanatory power The two-process model was a definite step forward when it was proposed in 1960 as it went beyond Watson and Rayner's concept of classical conditioning. It explained 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. The application to therapy is also a strength of the two-process model | A03

Question 82

# Evaluation - Negative What is a negative evaluation of the two-process model? | p. 145

Answer 82

Not all avoidance behaviour associated with phobias seems to be the result of anxiety reduction, at least not in more complex phobias like agoraphobia. There is evidence to suggest that at least some avoidance behaviour appears to be motivated more by **positive feelings of safety**. In other words the motivating factor in choosing an action like not leaving the house is not so much to avoid the phobic stimulus but to stick with the safety factor. This explains why some patients with agoraphobia are able to leave their house with a trusted person with relatively little anxiety but not alone (Buck, 2010). This is **a problem for the two-process model, which suggests that avoidance is motivated by anxiety reduction**. | A03

Question 83

# Evaluation - Negative Negative evaluation for the two-process model pointed out by Bounton | p. 145

Answer 83

**Incomplete explanation of phobias – Bounton (2007)** Even though classical and operant conditioning explain how phobias develop and are maintained, they don’t account for why some phobias are more common than others. Bounton argues that **evolutionary factors** likely play a role. For example, we easily develop phobias of things that posed threats in our evolutionary past (e.g., snakes, the dark), which is **adaptive**. **Seligman** (1971) called this **biological preparedness** – we are genetically predisposed to fear some things more than others. We rarely fear modern dangers like cars or guns, even though they’re more deadly today, because we’re not biologically prepared for them. This **preparedness challenges the two-process model, showing that conditioning alone can’t fully explain phobias**. | A03

Question 84

# Extra Evaluation - negative for 2- process model Give the social learning and psychodynamic approach explanation for how we attain phobias, and why therefore classical conditioning alone can't explain the development of phobias. | p. 145

Answer 84

Not all phobias can be explained by classical conditioning. E.g, someone may fear snakes despite no traumatic experience. **Social learning** may play a role—e.g., a **child imitates a parent's fear** and is reinforced by reduced anxiety. **Psychodynamic explanation suggests displacement**—e.g., a fear of zombies could reflect a displaced fear of death after losing a loved one. These alternatives show classical conditioning alone cannot fully explain the development of phobias as **not all phobias follow a trauma**. | A03

Question 85

# Extra Evaluation - negative How does cognitive factors challenge the behavioral explanation of phobias? | p. 145

Answer 85

Phobias also have cognitive aspects, which go beyond just behavioral explanations. While the behavioral approach, like the two-process model, explains how phobias are maintained through avoidance, it tends to focus on behavior rather than the thoughts behind it. However, it’s clear that phobias involve a cognitive component as well. One possibility is that the **cognitive features of phobias might be a result of the behavioral aspects**. In other words, the way we behave when we have a phobia (such as avoiding the feared object) could shape our thinking patterns, like catastrophizing or overestimating danger. Many behaviorists believe this. On the other hand, **cognitive aspects might not always require learning. It’s possible that we're "hard-wired" to focus our attention on things that make us anxious** because, evolutionarily, those things are often dangerous. This heightened attention to anxiety-provoking stimuli could help us survive, making it a sensible response. | A03

Question 86

Systematic desensitisation (SD) Definition - | p. 146

Answer 86

Systematic Desensitization (SD) is a behavioral therapy aimed at reducing unwanted responses like anxiety to a specific stimulus. It involves creating a hierarchy of anxiety-provoking situations related to the phobic stimulus, teaching the patient relaxation techniques, and gradually exposing them to these situations while maintaining relaxation, working through the hierarchy step by step. | A01

Question 87

Flooding (psychology) definition - | p. 146

Answer 87

A behavioural therapy in which a phobic patient 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. | A01

Question 88

Talk through Systematic desensitisation: | p. 146

Answer 88

Systematic desensitisation (SD) is a behavioural therapy designed to gradually **reduce phobic anxiety through the principle of classical conditioning**. If the sufferer can learn to relax in the presence of the phobic stimulus they will be cured. Essentially a new response to the phobic stimulus is learned (phobic stimulus is paired with relaxation instead of anxiety). This learning of a different response is called **counterconditioning**. In addition it is impossible to be afraid and relaxed at the same time, so one emotion prevents the other. This is called **reciprocal inhibition**. There are three processes involved in SD. | A01

Question 89

Name the first process involved in SD. | p. 146

Answer 89

**The anxiety hierarchy** Put together by the patient and therapist. This is a list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening. | A01 ## Footnote E.g, an arachnophobic might identify seeing a picture of a small spider as low on their anxiety hierarchy and holding a tarantula at the top of the hierarchy.

Question 90

Name the second process involved in SD. | p. 146

Answer 90

**Relaxation:** The therapist teaches the patient to relax as deeply as possible. This might involve **breathing exercises** or, alternatively, the patient might learn **mental imagery techniques**. Patients can be taught to imagine themselves in relaxing situations (such as imagining lying on a beach) or they might learn meditation. Alternatively relaxation can be achieved **using drugs** such as Valium. | A01

Question 91

Name the third process involved in SD. | p. 146

Answer 91

**Exposure** Finally the patient is exposed to the phobic stimulus while in a relaxed state. This takes place across several sessions, starting at the bottom of the anxiety hierarchy. When the patient can stay relaxed in the presence of the lower levels of the phobic stimulus they move up the hierarchy. Treatment is successful when the patient can stay relaxed in situations high on the anxiety hierarchy. | A01

Question 92

What are the three processes involved in SD? | p. 146

Answer 92

1. The Anxiety Heriarchy 2. Relaxation 3. Exposure | A01

Question 93

Within what time frame will a flooding session typically last? | p. 146

Answer 93

Flooding **involves immediate exposure to a very frightening situation ( So no gradual build-up** in an anxiety hierarchy.) *E.g an arachnophobic receiving flooding treatment might have a large spider crawl over them for an extended period.* Flooding sessions are typically longer than systematic desensitisation sessions, **one session often lasting two to three hours**. Sometimes only one long session is needed to cure a phobia. (But an average of 1- 4 sessions) | A01

Question 94

# Talk about the classical conditioning term 'Extinction' How does flooding work? | Page 146

Answer 94

Flooding stops phobic responses very quickly. This may be because, **without the option of avoidance behaviour, the patient quickly learns that the phobic stimulus is harmless. In classical conditioning terms this process is called extinction**. E.g, A learned response is extinguished when the conditioned stimulus (e.g. a dog) is encountered without the unconditioned stimulus (e.g. being bitten). The result is that the conditioned stimulus no longer produces the conditioned response (fear). | A01 ## Footnote In some cases the patient may achieve relaxation in the presence of the phobic stimulus simply because they become exhausted by their own fear response!

Question 95

Ethical safeguards to Flooding: | p. 146

Answer 95

Flooding is not unethical per se but it is an unpleasant experience so it is important that **patients give fully informed consent** to this traumatic procedure and that they are fully prepared before the flooding session. | A01 ## Footnote A patient would normally be given the choice of systematic desensitisation or flooding.

Question 96

For systematic desensitisation, bullet point positive and negative evaluations | p. 147

Answer 96

* It is effective (+) * It is suitable for a diverse range of patients (+) * It is acceptable to patients (+) * Sympton substitution (-) | A03

Question 97

systematic desensitisation - Evaluation on its effectiveness: | p. 147

Answer 97

Research shows that systematic desensitisation **is effective** in the treatment of specific phobias. E.G, Gilroy et al. (2003) followed up **42 patients** who had been treated for spider phobia in *three* **45-minute sessions of systematic desensitisation**. Spider phobia was assessed on several measures including the **Spider Questionnaire** and by assessing response to a spider. A control group was treated by relaxation without exposure. *At both three months **and** 33 months after the treatment, **the systematic desensitisation group were less fearful than the relaxation group***. This is a strength because it shows that systematic desensitisation is **helpful in reducing the anxiety in spider phobia and that the effects are long-lasting**. | A03

Question 98

# evaluation Why might the diverse range of patients be **best suited to systematic desensitisation** *rather* than **cognitive therapies and flooding?** | p. 147

Answer 98

*It is suitable for a diverse range of patients* The alternatives to systematic desensitisation - flooding and cognitive therapies - are not well suited to some patients. E.g, some **sufferers of anxiety disorders** like phobias also have **learning difficulties**. Learning difficulties can make it very hard for some patients to understand what is happening during flooding or to engage with **cognitive therapies that require the ability to reflect on what you are thinking** (p 148-149). For these patients systematic desensitisation is probably the most appropriate treatment. | A03

Question 99

# Evaluation - Positive How do we know if systematic desensitisation is something patients prefer? | p. 147

Answer 99

*A strength of systematic desensitisation is that patients prefer it.* This is reflected in the **low refusal rates** (number of patients refusing to start treatment) and **low attrition rates** (number of patients dropping out of treatment) of systematic desensitisation. It includes learning relaxation procedures that are pleasant. When given the choice, systematic desensitisation is usually prefered over flooding. This is largely because it does not cause the same degree of trauma as flooding. | A03

Question 100

For Flooding, bullet point the negative and positive evaluations | p. 147

Answer 100

* It is cost-effective (+) * It is less effective for some types of phobia (-) * The treatment is traumatic for patients (-) * Sympton substitution (-) | A03

Question 101

# Evaluation - Negative Name a positive evaluation for Flooding: | p. 147

Answer 101

It is cost-effective: The **quick effect** is a strength because it means that patients are free of their symptoms as soon as possible and that makes the **treatment cheaper**. | A03 ## Footnote Studies comparing flooding to cognitive therapies (such as Ougrin 2011) have found that flooding is highly effective and quicker than alternatives.

Question 102

# Evaluation - negative How effective is Flooding for treating most phobias? | p. 147

Answer 102

Flooding is highly effective for treating simple phobias but appears to be less so for more complex phobias like so social phobias. This may be because social phobias have cognitive aspects. E.g, a sufferer of a social phobia does not simply experience an anxiety response but thinks unpleasant thoughts about the social situation. This type of phobia may benefit more from cognitive therapies because such therapies that tackle the irrational thinking. | A03

Question 103

# Evaluation - negative The experience of flooding: | p. 147

Answer 103

Flooding can be a highly traumatic experience. The problem is not that flooding is unethical since patients give consent, but that patients are often unwilling to see it through to the end. | A03 ## Footnote This is a limitation of flooding because time and money are sometimes wasted preparing patients only to have them refuse to start or complete treatment.

Question 104

Name a negative evaluation for both flooding and systematic desensitisation: | p. 147

Answer 104

**Symptom substitution** A common criticism of both systematic desensitisation and flooding is that when one phobia disappears another may appear in its place. For example, a phobia of snakes might be replaced by a phobia of trains. | A03 ## Footnote Evidence for symptom substitution is very mixed, however, and behavioural therapists tend not to believe it happens at all

Question 105

Cognitive approach definition - | p. 148

Answer 105

This approach is focused on how our mental processes (e.g. thoughts, perceptions, attention) affect behaviour. | A01 ## Footnote The term 'cognitive' has come to mean 'mental processes'.

Question 106

Negative triad definition - | p. 148

Answer 106

Aaron Beck proposed that there were three kinds of negative thinking that contributed to becoming depressed: * negative views of the world, * the future * and the self. Such negative views lead a person to interpret their experiences in a negative way and so make them more vulnerable to depression. | A01

Question 107

# Proposed by Albert Ellis ABC model definition - | p. 148

Answer 107

Represents 3 stages that determine our behaviour: * **Activating** event: What happens before the behavior. This could be a situation or event that triggers the behavior. * **Behavior**: The action or actions that take place E.g irrational belief * **Consequence**: The response that follows the behavior. This could be a feeling or action e.g depression | A01 ## Footnote The key to this process is the irrational belief.

Question 108

What is Beck's cognitive theory of depression? | p. 148 ## Footnote Name only Beck suggested three parts to cognitive vulnerability:

Answer 108

Aaron Beck suggested a cognitive approach to explaining why some people are more vulnerable to depression than others. Specifically due to the way they think (a person's cognition). | A01 ## Footnote Beck suggested three parts to this cognitive vulnerability. 1. Faulty information processing 2. negative self-schemas 3. The negative triad

Question 109

Explain Aaron Beck's cognitive vunerability: Faulty information processing | p. 148

Answer 109

When depressed we attend to the negative aspects of a situation and ignore positives. We also tend to blow small problems out of proportion and think in 'black and white' terms. | A01

Question 110

Explain Aaron Beck's cognitive vunerability: Negative self-schemas | p. 148

Answer 110

A self-schema is the 'package' of information we have about ourselves. We use schemas to interpret the world. If we have a negative self-schema we interpret all information about ourselves in a negative way. | A01

Question 111

Aaron Beck's cognitive vunerability: Explain what is the negative triad | p. 148

Answer 111

A person **develops a dysfunctional view of themselves** because of **three types of negative thinking** that occur automatically, **regardless of the reality** of what is happening at the time. These three elements are called the negative triad. When we are *depressed*; * **negative thoughts about the world**, * **the future** * **and oneself** often come to us. | A01 ## Footnote Try and give examples of these 3 types of examples for negative thinking as you will have to do so in another flashcard!

Question 112

# Aaron Beck's cognitive vunerability Explain the 3 elements of the negative triad | p. 148

Answer 112

* **Negative view of the world** - E.g 'the world is a cold hard place'.This *creates the impression that there is no hope anywhere*. * **Negative view of the future** - E.g 'there isn't much chance that the economy will really get better'. Such thoughts *reduce any hopefulness* and enhance depression. * **Negative view of the self** - E.g, 'I am a failure'. Enhances any existing depressive feelings because they *confirm the existing emotions of low self-esteem*. | A01

Question 113

What is Albert Ellis's idea for what causes poor mental health? | p. 148 ## Footnote What did he use to explain this?

Answer 113

Albert Ellis (1962) proposed that good mental health is the result of rational thinking, defined as thinking in ways that allow people to be happy and free of pain. To Ellis, **poor mental health result from irrational thoughts**. They are any thoughts that interfere with us being happy and free of pain.Ellis used the **ABC model** to explain how irrational thoughts affect our behaviour and emotional state. | A01

Question 114

Explain the 'A' in Albert Ellis's ABC model | p. 148

Answer 114

**A**ctivating event 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. | A01

Question 115

Explain the 'B' in Albert Ellis's ABC model and give existing examples | p. 148

Answer 115

**B**eliefs Ellis identified a range of **irrational** beliefs. * He called the belief that we must always succeed or achieve perfection 'musturbation'. * 'I-can't-stand-it-itis' is the belief that it is a major disaster whenever something does not go smoothly. * Utopianism is the belief that life is always meant to be fair. | A01

Question 116

Explain the 'C' in Albert Ellis's ABC model | p. 148

Answer 116

**C**onsequences When an **a**ctivating event triggers irrational **b**eliefs there are *emotional and behavioural* **c**onsequences. | A01 ## Footnote E.g, if you believe you must always succeed and then fail at something this can trigger depression.

Question 117

What is the cognitive approach to depression? | p. 148

Answer 117

Most concerned with explaining the kinds of thinking and selective attention that characterise depression. The approach does not ignore emotion and behaviour but it sees them as the result of cognition. | A01

Question 118

# Positive Evaluation Talk through 2 good supporting evidence for Beck's cognitive theory of depression: | p. 149

Answer 118

Evidence that depression is associated with faulty information processing, negative self-schemas and the cognitive triad of negative automatic thinking: **Grazioli and Terry** (2000) assessed 65 pregnant women for cognitive vulnerability and depression before and after birth. They found that those women judged to have been high in cognitive vulnerability were more likely to suffer post-natal depression. **Clark and Beck** (1999) reviewed research on this topic and concluded that there was solid support for all these cognitive vulnerability factors. Most importantly, these cognitions can be seen before depression even develops, suggesting that Beck may be right about cognition causing depression (at least in some cases). | A03

Question 119

# Beck's cognitive theory of depression positive evaluation The cognitive theory of depression: Practical application | p. 149

Answer 119

It forms the basis of CBT. All cognitive aspects of depression can be identified and challenged in Cognitive behavioural therapy. (These include the components of the negative triad that are easily identifiable and means a therapist can challenge them and encourage the patient to test whether they are true). This is a strength of the explanation because it translates well into a successful therapy. | A03

Question 120

# negative evaluation What's a negative evaluation of Beck's cognitive theory of depression | p. 149

Answer 120

It doesn't explain all aspects of depression Beck's theory explains neatly the basic symptoms of depression, however depression is complex. Some depressed patients are deeply angry and Beck cannot easily explain this extreme emotion. Some sufferers of depression suffer hallucinations and bizarre beliefs. Very occasionally depressed patients suffer Cotard syndrome, the delusion that they are zombies (Jarrett 2013). Beck's theory cannot easily explain these cases. | A03

Question 121

# Ellis's ABC model - negative evaluation A partial explanation of depression: | p. 149

Answer 121

There is no doubt that in some cases of depression they are triggered by activating (specific) events. Psychologists refer to this as reactive depression, distinguishing it from the type that occurs without any apparent cause. This means, Ellis's activating events explanation only applies to certain forms of depression and serves as only a partial explanation for the condition. | A03

Question 122

# Ellis's ABC model - positive evaluation Ellis's ABC model practical application and research support: | p. 149

Answer 122

A strength of Ellis' explanation is that It has a practical application in CBT, Similar to Beck's theory, it has contributed to the development of an effective therapy. The concept that challenging irrational negative beliefs can help reduce depression is backed by research, such as the study by Lipsky et al. (1980). This provides further support for the core theory, indicating that irrational beliefs play a role in the development of depression | A03

Question 123

# Ellis's ABC model - Negative evaluation Faliure to account for certain symptons of depression: | p. 149

Answer 123

It doesn’t account for all aspects of depression. Although Ellis explains why some people appear to be more vulnerable to depression than others as a result of their cognitions, his approach has very much the same limitation as Beck's. It doesn't easily explain the anger associated with depression or the fact that some patients suffer hallucinations and delusions. | A03

Question 124

# Extra evaluation- limitation Cognitive Primacy and Its Limitations in Explaining Depression: | p. 149

Answer 124

Cognitive explanations for depression propose that depression is caused by cognitive processes. This is linked to the concept of cognitive primacy, which suggests that emotions are shaped by our thoughts. While this is true in some cases, it is not always the case. Some other theories propose that emotions aren't just triggered by thoughts right away. Instead, emotions can be stored, like physical energy, and may emerge later, after something happens. | A03

Question 125

# Extra evaluation for Beck cognitive theory - positive Attachment and Depression: | p. 149

Answer 125

Studies of attachment (see Chapter 3) have shown that infants who develop insecure attachments to their parents are more vulnerable to depression in adulthood. this supports Beck's theory as he emphasizes the role of early negative experiences. | A03

Question 126

Cognitive behaviour therapy (CBT) definition- | p.150

Answer 126

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. | A01 ## Footnote Behavioral activation is a therapeutic technique used in cognitive-behavioral therapy (CBT) that focuses on helping individuals engage in activities that are positively reinforcing and aligned with their values.

Question 127

# To do with Ellis's model Irrational thoughts definition- | p. 150

Answer 127

Also known as dysfunctional thoughts, these are thoughts in Ellis's model and therapy that are likely to disrupt a person's well-being. Such thoughts can contribute to mental disorders, including depression. | A01

Question 128

Cognitive behaviour therapy (CBT) overview: | p. 150

Answer 128

Cognitive Behavioral Therapy (CBT) is a common treatment for depression and other mental health issues. If you see a psychologist for help, you will likely receive CBT. 1. The therapy starts with an assessment where the patient and therapist work together to understand the problems. 1. They set goals and create a therapy plan. A key part of CBT is finding negative or irrational thoughts that need to be challenged. CBT works by changing those negative thoughts and replacing them with healthier ones, as well as encouraging better behaviors (Some therapists use only Beck’s approach, others use Ellis’s, but many combine both). | A01

Question 129

Explain Beck's CBT's Goal + 'patient as scientist': | p. 150

Answer 129

CBT: Beck's cognitive therapy It's the application of Beck's cognitive theory of depression (see page 148). Goal: **identify** automatic negative thoughts about the world, oneself, and the future, known as the **negative triad**. Once identified, these thoughts must be challenged, which is the main part of the therapy. In addition helps patients test the reality of their negative beliefs. They might be asked to do **homework**, E.g noting when others were kind to them. This is called the **"patient as scientist"** approach, where **patients investigate the truth of their negative beliefs** as a scientist would. In later sessions, if patients claims E.g no one is nice to them , the therapist can use the recorded evidence to show their beliefs are false. | A01

Question 130

What is Ellis's REBT? | p.150

Answer 130

REBT extends the ABC model (p.148) to an ABCDE model - adding two more components: D stands for dispute and E for effect. The central technique of REBT is to identify and dispute **(challenge) irrational thoughts**. E.g, a patient feels always unlucky or how everything seems unfair. An REBT therapist would identify these as examples of utopianism and challenge this as an irrational belief. This would involve a vigorous argument. The intended effect is to change the irrational belief and so break the link between negative life events and depression. Ellis identified different methods of disputing. E.g, empirical argument involves disputing whether there is actual evidence supporting the negative belief. Logical argument involves disputing whether the negative thought logically follow the facts. | A01

Question 131

Behavioural activation: | p. 150

Answer 131

A CBT therapist may work to encourage a depressed patient to be more active and engage in enjoyable activities. | A01 ## Footnote Along other factors, encouraging individuals to engage in enjoyable or meaningful activities, helps them experience positive emotions and rewards, which can improve their mood over time.

Question 132

# Evaluation - positive What does the study by March et al. (2007) suggest about the effectiveness of CBT for depression? | p. 151

Answer 132

The study compared CBT, antidepressants, and a combination of both in 327 adolescents with depression. After 36 weeks: * 81% of the CBT group, * 81% of the antidepressants group, and * 86% of the combination group showed significant improvement. This shows that CBT is as effective as medication and works well alongside it, suggesting CBT should be considered a first-choice treatment in public health systems like the NHS. | A03

Question 133

# Negative evaluation Why might CBT not work for the more severe cases of depression? | p. 151

Answer 133

In severe cases of depression, patients may struggle to motivate themselves for the cognitive work required in CBT or may find it hard to focus during sessions. In these cases, antidepressant medication can be used to improve motivation and alertness before beginning CBT. However, this would be a limitation of CBT because it means CBT cannot be used as the sole treatment for all cases of depression. | A03

Question 134

# Negative evaluation What did Rosenzweig (1936) suggest about the success of psychotherapy methods like CBT? | p. 151

Answer 134

Rosenzweig (1936) suggested that the differences between psychotherapy methods, such as CBT and systematic desensitization, might be very little. The key factor for success may be the therapist-patient relationship rather than any specific technique. Comparative reviews (e.g., Luborsky et al., 2002) show small differences between therapies, supporting the view that having someone to listen and engage with you may be what matters most in therapy. | A03

Question 135

# Extra evaluation - limitation Why might some patients find CBT frustrating? | p. 151

Answer 135

One of the basic principles of CBT is that the focus in therapy is on the present and future, not the patient's past. Some patients are aware of the link between their childhood experiences and current depression and want to talk about their experiences. Therefore they can find this 'present-focus' very frustrating. | A03

Question 136

What is the debate between CBT and exploring the past in therapy? Talk about assimilation therapy | p. 151

Answer 136

The conventional wisdom in the CBT world is that there is generally little benefit in talking about the past – and the fact that CBT has good outcomes suggests they may be right. On the other hand, counsellors and therapists of most non-CBT brands disagree. Therefore assimilation therapy was designed as a compromise between these two positions. This begins with an exploration of the patient's past and moves on to cognitive techniques when the patient is ready. | A03

Question 137

# Extra evaluation - limitation What ethical issue arises from CBT's focus on cognition? | p. 151

Answer 137

CBT's strong focus on the individual's thoughts may downplay the importance of their life circumstances, for most patients not facing abuse or injustice, focusing on cognition in CBT isn't a major issue. However, challenging 'irrational' beliefs like "My boss shouldn't treat me like that" in an REBT-style could cause a patient to remain in an unjust situation. This presents an ethical issue, as it may overlook the importance of changing external circumstances. Therapists must remember that not all problems are solely mental and should consider the patient's external environment. Cognition in therapy can prevent necessary changes in the patient's environment and may even demotivate them from addressing their external challenges. | A03

Question 138

Biological approach definition for mental disorders - | p. 152

Answer 138

Suggests that mental disorders are caused by biological factors such as genetic inheritance and neural function (which we will touch on later), abnormal brain activity, imbalances in neurotransmitters, genetic vulnerabilities, ect. Rather than psychological or environmental influences. | A01

Question 139

Genetic explanations definition - | p. 152

Answer 139

Genes make up your chromosomes and consist of DNA which codes the physical features of an organism (such as eye colour, height) and psychological features (such as mental disorder, intelligence). Genes are transmitted from parents to offspring, i.e. inherited. | A01

Question 140

Neural explanations definition for OCD- | p. 152

Answer 140

The idea that physical and psychological characteristics are determined by the behaviour of the nervous system, (in particular the brain as well as individual neurons). The genes associated with OCD are likely to affect the levels of key neurotransmitters as well as structures of the brain. | A01

Question 141

# THE BIOLOGICAL APPROACH TO EXPLAINING OCD - Genetic explanations How do genetic factors contribute to OCD, according to Lewis (1936)? | p. 152

Answer 141

OCD appears to have a strong biological component and understood as biological in nature. There could be a genetic explanation to this where your genes can make you more vunerable to OCD: **Lewis** (1936) found that 37% of his OCD patients had parents with OCD and 21% had siblings with OCD, although what is probably passed on from one generation to the next; is genetic vulnerability and not the certainty of OCD. According to the diathesis-stress model, certain genes increase the likelihood of developing a mental disorder, like OCD. But environmental stress/experiences are needed to trigger the condition. | A01

Question 142

# THE BIOLOGICAL APPROACH TO EXPLAINING OCD - Genetic explanations What are candidate genes and how are they related to OCD? | p. 152

Answer 142

Candidate genes are genes that have been identified as contributing to vulnerability for OCD. Some of these genes are involved in regulating the development of the serotonin system. E.g, the gene 5HT1-D beta is associated with the efficiency of serotonin transport across synapses, which may play a role in the development of OCD. | A01

Question 143

# THE BIOLOGICAL APPROACH TO EXPLAINING OCD - Genetic explanations What does it mean that OCD is polygenic? | p. 152 ## Footnote Talk about Taylor (2013)

Answer 143

OCD is polygenic, meaning it is not caused by a single gene but by several genes. Taylor (2013) analyzed previous studies and found evidence that up to 230 different genes may be involved in OCD. These genes are associated with neurotransmitters like dopamine and serotonin, which play roles in regulating mood and are believed to influence the development of OCD. | A01

Question 144

# THE BIOLOGICAL APPROACH TO EXPLAINING OCD - Genetic explanations What does "aetiologically heterogeneous" mean in relation to OCD? | p. 152

Answer 144

"Aetiologically heterogeneous" means that the origin of OCD can have different causes. This suggests that different groups of genes may cause OCD in different people (One group of genes may cause OCD in one person but a different group of genes may cause the disorder in another person). There is also evidence to suggest that specific genetic variations may contribute to particular types of OCD, such as hoarding disorder or religious obsession. | A01

Question 145

# THE BIOLOGICAL APPROACH TO EXPLAINING OCD - Neural explanations The Role of Serotonin in OCD: | p. 152

Answer 145

Serotonin, a neurotransmitter that helps regulate mood, plays a key role in OCD. Neurotransmitters relay information between neurons (from one neuron to another) , and low levels of serotonin can disrupt the transmission of mood-related information. This **reduction in serotonin function may contribute to the development of OCD in some individuals**, affecting both mood and other mental processes. Therefore at least some cases of OCD may be explained by a reduction in the functioning of the serotonin system in the brain. | A01

Question 146

# THE BIOLOGICAL APPROACH TO EXPLAINING OCD - Neural explanations Decision-Making Systems and OCD: | p. 152

Answer 146

In some cases of OCD, particularly **hoarding disorder, impaired decision-making is observed**. This is linked to abnormal functioning in the lateral frontal lobes of the brain, which are responsible for logical thinking and decision-making. Additionally, there is evidence suggesting that the left parahippocampal gyrus, an area involved in processing **unpleasant emotions, functions abnormally in OCD**. | A01

Question 147

# THE BIOLOGICAL APPROACH TO EXPLAINING OCD - genetic, positive evaluation Supporting Evidence for Genetic Influence on OCD | p. 153

Answer 147

Nestadt et al. (2010) reviewed twin studies and found that 68% of identical twins shared OCD, compared to only 31% of non-identical twins. This strongly suggests that genetics play a significant role in the vulnerability to OCD. The Twin studies provide strong evidence for the genetic influence on the disorder. | A03

Question 148

# THE BIOLOGICAL APPROACH TO EXPLAINING OCD - genetic, negative evaluation Limitations of Genetic Explanation for OCD: | p. 153

Answer 148

Too many candidate genes: Although twin studies suggest that OCD is largely genetically influenced, identifying all the genes involved has been difficult. Many genes contribute to OCD, but each one only increases the risk by a small amount. As a result, the genetic explanation for OCD has limited predictive value and is unlikely to be very useful for treatment or prediction. | A03

Question 149

# THE BIOLOGICAL APPROACH TO EXPLAINING OCD - genetic, negative evaluation Environmental Risk Factors for OCD: | p. 153 ## Footnote Talk about Cromer et al. (2007)

Answer 149

As suggested by the diathesis-stress model. Environmental factors can trigger or increase the risk of developing OCD. Cromer et al. (2007) found that over half of his OCD patients had experienced a traumatic event, and OCD was even more severe in those with more than one trauma. This suggests that OCD is not entirely genetic, and focusing on environmental causes may be more productive, as we have more control over these factors. | A03

Question 150

# THE BIOLOGICAL APPROACH TO EXPLAINING OCD, neutral, positive evaluation What evidence supports the role of neural mechanisms in OCD? | p. 153

Answer 150

Evidence suggests that neural mechanisms, particularly the serotonin system ( which is used in some antidepressant work), play a role in reducing OCD. Antidepressants that increase serotonin levels are effective in reducing OCD symptoms, indicating the involvement of serotonin. Additionally, OCD symptoms are seen in other biological conditions E.g Parkinson's Disease (Nestadt et al., 2010), This suggests that the biological processes that cause the symptoms in those conditions, may also be responsible for OCD. | A03

Question 151

# THE BIOLOGICAL APPROACH TO EXPLAINING OCD, neutral, negative evaluation What is the issue with claiming to understand the neural mechanisms involved in OCD? | p. 153

Answer 151

Although studies show that neural systems involved in decision-making function abnormally in OCD (Cavedini et al., 2002), research has identified other brain systems that may also play a role at times - but **no single system has been consistently found that links to always playing a role in OCD, meaning we cannot fully claim to understand the exact neural mechanisms involved in OCD**. | A03

Question 152

# THE BIOLOGICAL APPROACH TO EXPLAINING OCD, neutral, negative evaluation Why should we be cautious about assuming that abnormal neural mechanisms cause OCD? | p. 153

Answer 152

While there is evidence that neurotransmitters and brain structures function abnormally in OCD patients, this does not necessarily mean that these abnormalities cause the disorder. It's possible that these biological changes are a result of OCD, rather than its cause. Therefore, we should be cautious about assuming that abnormal neural mechanisms directly cause OCD. | A03

Question 153

# Extra evaluation - limitation What is the issue with linking serotonin to OCD due to co-morbidity with depression? | p. 153 ## Footnote counter point this -->

Answer 153

Many people with OCD also suffer from depression, which is called co-morbidity (having two disorders together). Depression likely involves disruption to the serotonin system, which could suggest that serotonin disruption in OCD is due to depression, not OCD itself. | A03 ## Footnote there are antidepressants that do not affect the serotonin system, and these antidepressants have no effect on OCD. This suggests that serotonin is directly involved in OCD, not just in the accompanying depression.

Question 154

# Extra evaluation - limitation What is a flaw in using twin studies as genetic evidence for OCD? | p. 153

Answer 154

Twin studies assume that **identical twins are only more similar to eachother than non identical twins due to their genetic similarity**, but they overlook the fact that non-identical twins may share a more similar environment e.g both same sex non-identical twins rather than opposite sex identical twin who will have a different experiences due to their gender. | A03

Question 155

# Extra evaluation: advantage How does the shared environment of identical twins affect the results of twin studies on OCD? | p. 153

Answer 155

Identical twins may share a more similar environment than non-identical twins because they are often treated more alike by their parents. E.g, they may dress the same, receive similar toys, or share a room. This greater environmental similarity of factors could explain why identical twins are more likely to both have OCD, challenges the assumption that twin studies solely reflect genetic influence. | A03

Question 156

Drug therapy definition - | p. 154

Answer 156

Treatment involving drugs, i.e. chemicals that have a particular effect on the functioning of the brain or some other body system. In the case of psychological disorders such as OCD drugs usually affect neurotransmitter levels. | A01

Question 157

How does drug therapy aim to treat OCD? | p. 154

Answer 157

Drug therapy for OCD aims to increase or decrease the levels of neurotransmitters in the brain/adjust their activity. Since low levels of serotonin are associated with OCD, drugs such as SSRIs are used to increase serotonin levels in the brain, helping to regulate mood and compulsive behaviors / alleviate OCD symptoms. | A01

Question 158

How do SSRIs work in treating OCD? | p. 154

Answer 158

SSRIs (Selective Serotonin Reuptake Inhibitors) are a type of antidepressant used to treat OCD. * They work by preventing the re-absorption and breakdown of serotonin in the brain, effectively increasing its levels in the synapse. * This helps to stimulate the postsynaptic neuron and compensates for the serotonin system dysfunction in OCD. * A typical daily dose of Fluoxetine is 20mg, and it takes 3-4 months of daily use to see significant improvements in symptoms. | A01

Question 159

How are SSRIs combined with other treatments for OCD? | p. 154

Answer 159

SSRIs are often used alongside cognitive behaviour therapy (CBT) to treat OCD. The drugs help reduce emotional symptoms, like anxiety and depression, allowing patients to engage more effectively with CBT. Some people respond better to CBT alone, while others benefit more from combining it with drugs like Fluoxetine. Occasionally, other drugs may also be prescribed alongside SSRIs, for enhanced treatment. | A01

Question 160

What are some alternatives to SSRIs for treating OCD? | p. 154

Answer 160

If SSRIs are not effective after 3/4 months, the dose can be increased up to 60mg a day or combined with other drugs. Alternatives include: * Tricyclics (e.g., Clomipramine): These work similarly to SSRIs by affecting the serotonin system but have more severe side effects, so they are typically used only when SSRIs are ineffective. * SNRIs (Serotonin-Noradrenaline Reuptake Inhibitors): A newer class of antidepressants that, like Clomipramine act as a second line of defence for patients who don't respond to SSRIs. It increases serotonin levels and also affects noradrenaline, a different type of neurotransmitter. Patients respond differently to these drugs, with some finding them more effective than others. | A01

Question 161

Tricyclics (e.g., Clomipramine) for treating OCD: | p. 154

Answer 161

These work similarly to SSRIs by affecting the serotonin system but have more severe side effects, so they are typically used only when SSRIs are ineffective. | A01

Question 162

SNRIs (Serotonin-Noradrenaline Reuptake Inhibitors) for treating OCD: | p. 154

Answer 162

A newer class of antidepressants that, like Clomipramine, increase serotonin levels and also affect noradrenaline. SNRIs are often used when SSRIs do not work. | A01

Question 163

# Evaluation - Positive What evidence supports the effectiveness of drug therapy for OCD? | p. 155

Answer 163

There is strong evidence supporting the effectiveness of SSRIs in reducing OCD symptoms. **Soomro et al**. (2009) **reviewed 17 studies comparing SSRIs to placebos in the treatment of OCD, and found that all showed significantly better results for SSRIs**. The effectiveness is greatest when SSRIs are combined with psychological treatments like CBT. Typically, **SSRIs help reduce symptoms for about 70% of patients** (so drugs have a high effectivness rate). | A03 ## Footnote For the remaining 30%, alternative drug treatments or combinations of drugs and therapy may be effective.

Question 164

# Postive evaluation What are the advantages of using drug therapy to treat OCD? | p. 155

Answer 164

Drug treatments for OCD, E.g SSRIs, are **cheap** compared to psychological treatments, making them a good option for public health systems like the NHS. Compared to psychological therapies SSRIs are also **non-disruptive to patients' lives**, as individuals can take the medication until their symptoms improve, without needing to engage in the demanding process of psychological therapy. **These advantages make drug treatments appealing to both doctors and patients.** | A03

Question 165

# Negative Evaluation What are the disadvantages of using drug therapy to treat OCD? | p. 155

Answer 165

The drug's side effects: * Although SSRIs are helpful for many OCD sufferers, some patients experience no benefit, and others suffer side effects such as indigestion, blurred vision, and loss of sex drive, although these are usually temporary. * For those taking Tricyclics, side effects are more common and serious, they can include issues like erection problems, tremors, weight gain, More rarely - aggression, and disruptions to blood pressure or heart rhythm. Such factors reduce effectiveness because people stop taking the medication. | A03

Question 166

# Extra Evaluation - limitation What is the concern regarding the evidence for drug treatments for OCD? | p. 155

Answer 166

There is concern that the evidence supporting drug treatments like SSRIs may be unreliable due to potential bias: Some psychologists, such as **Goldacre** (2013), **argues that the evidence favouring drug treatments is biased because the research is sponsored by drug companies who do not report all the evidence as that would effect their drug market**. Currently many drug companies do not publish all of their results and may indeed be supressing evidence. If not all evidence is reported, it leads us to question the trustworthiness of the data on the effectiveness of drugs. | A03

Question 167

# Extra Evaluation - limitation What is the issue with using drug treatments for OCD when trauma is a factor? | p. 155

Answer 167

OCD is widely believed to be biological in origin. It makes sense, therefore, that the standard treatment should be biological. However some cases of OCD may follow a traumatic life event **rather than having a biological origin**. There is a case proposing that OCD cases without a family history of the disorder, but with a relevant life event should be treated differently from those where there is a family history with no trauma. As drug treatments may not be appropriate. (However, there is no clear evidence suggesting that psychological therapies are more/less effective than drugs for cases following trauma). **The concern is that drug treatments may be used indiscriminately, without considering the cause of the OCD, which could affect the treatments effectiveness.** | A03