Psycopathology

Question 1

statistical deviation-

Answer 1

A definition of abnormality that Implies that a disorder is abnormal if it deviates from the usual common characteristic/behaviour displayed in observations of humans.

Question 2

A strength of statistical infrequency as a definition of abnormality is that it has real life application and so is beneficial when determining abnormal behaviour.

Answer 2

Statistical infrequency has been implicated to be an important part of clinical assessment and is almost always used in the clinical diagnoses of mental health disorders as a comparison with a baseline or ‘normal’ value. This is used to assess the severity of the disorder e.g., the idea that Schizophrenia only affects 1% of the general population. Thus, we can successfully distinguish between the severity of different mental disorders resulting in the correct treatment being provided.

Question 3

However, a limitation of statistical infrequency as a definition is that it assumes that any abnormal characteristics are automatically negative, whereas this is not always the case.

Answer 3

For example, displaying abnormal levels of empathy (and thus qualifying as a Highly Sensitive Person) or having an IQ score above 130 (and thus being a genius) would rarely be looked down upon as negative characteristics which require treatment. Being examples of statistical infrequencies, they would induce the problem of unnecessary labels and so further problems are caused with how they view themselves and how others view them only because the definition determines them as abnormal. Therefore, statistical infrequency cannot be used alone in the diagnosis of abnormal behaviours and would need to be used in conjunction with another definition of abnormality for it to be considered an accurate measure of abnormality. Implications when using this definition would include the factor of it being time consuming for psychologists due to having to use it alongside other definitions for effective diagnosis.

Question 4

Deviations from social norms-

Answer 4

A definition of abnormality suggests that ‘abnormal’ behaviour is based upon straying away from the social norms specific to a certain culture. There are general norms, applicable to the vast majority of cultures, as well as culture-specific norms.

Question 5

A limitation to this definition of abnormality is due to its reliance on subjective social norms, meaning the definition also suffers from cultural relativism.

Answer 5

One such example would be the hearing of voices which have no basis in reality, or ‘hallucinations. Some African and Asian cultures in particular would look upon this symptom positively, viewing it as a sign of spirituality and a strong connection with ancestors, as opposed to a symptom of Schizophrenia. This therefore suggests that the use of this definition of abnormality may lead to some discrepancies in the diagnoses of mental health disorders, between cultures. This means that deviation from social norms is limited in its explanation for abnormality and so cannot be used alone when making a diagnosis of such behaviour.

Question 6

Furthermore, Reliance on this definition of abnormality can lead to the systematic abuse of human rights and social control.

Answer 6

The fact that mental health diagnoses based on this definition vary so significantly between different cultures and has historically led to discrimination, as a mechanism for social control. For example, in the nineteenth century within Great Britain, ‘nymphomania’ described the mental health disorder suffered by women who demonstrated sexual attractions towards working-class men. In reality, this diagnosis was simply made to prevent infidelity, cement the differences between social classes and further discriminate against women, thus being a reflection of a patriarchal society. Consequently, a result of accepting and incorporating this definition can lead to some individuals suffering he detrimental effects of being labelled abnormal. Labelling will also affect the way the individual sees themselves and how others view them.

Question 7

The failure to function adequately –

Answer 7

A definition of abnormality that was proposed by Rosenhan and Seligman (1989) and suggests that if a person’s current mental state is preventing them from leading a ‘normal’ life, alongside the associated normal levels of motivation and obedience to social norms, then such individuals may be considered as abnormal.

Question 8

David Rosenham and Martin Seligman (1989)

The 7 aspects to not functioning adequately. 
#

Answer 8

unpredictability,

maladaptive behaviour,

personal distress,

irrationality,

observer discomfort,

violation of moral standards

unconventionality.

Question 9

A Strength to this definition is that it considers the patient’s perspective and so the final diagnosis will be compromised of both the patient’s self-reported symptoms and the psychiatrist’s opinion.

Answer 9

The acknowledgement of the patient’s own experience is something that’s very important in assessment of abnormality and so because this definition accounts for it makes it one that captures the experience of many people that require help. This may lead to more accurate diagnoses of mental health disorders because such diagnoses are not constrained by statistical limits, as is the case with statistical infrequency. Thus, the definition, which determines abnormality by a wide range of perspectives including the actual patient, leads to an accurate diagnosis and effective treatment as a result.

Question 10

However, a limitation to using this definition of abnormality is that it runs the risk of labelling where patients would be known as ‘strange’ or ‘crazy’, increasing the traditional negative stereotypes of abnormality.

Answer 10

It fails to accept that not everyone with a mental health disorder is incapable and so do not need a diagnosis, especially if they live a high-quality life and the illness does not impact themselves or anyone else. Furthermore, labelling also increases the individual’s risk of facing discrimination and prejudice from employers and other people they may meet.

Question 11

Yet another limitation to this definition of abnormality is that the Failure to function adequately (FFA) may not be linked to abnormality but in fact other factors, such as alternative lifestyles.

Answer 11

For example, new age travellers do not live-in permanent accommodation and may not work. Similarly, spiritualists communicate with the dead. Therefore, reliance of this definition could be mislabelling individuals as abnormal. This again could lead to discrimination and as a result having to experience the negative effects of labelling and limits personal freedom.

Question 12

FFA is also context dependent and cannot be applied in all situations.

Answer 12

For example, not eating does not describe the inability to function adequately when it comes to prisoners on hunger strikes as a form of protesting. Therefore, in practice other factors will need to be considered and evaluated before using the sole definition of the FFA to determine abnormality.

Question 13

Deviation from ideal mental health -

Answer 13

A definition of abnormality, proposed by Jahoda (1958). Instead of focusing on abnormality, Jahoda looked at what would comprise the ideal mental state of an individual.

Question 14

The criteria include being able to (PRAISE)

Answer 14

self-actualise (fulfill one’s Potential, in line with humanism!),

Having a Realistic view of the world

having an Accurate perception of ourselves,

Having Independence

Environmental mastery

Question 15

A strength of this definition of abnormality as opposed to many others is that it considers and takes into account many aspects in its diagnosis of abnormality.

Answer 15

Including having independence environmental mastery and many other aspects makes the criteria broad when assessing abnormality with this definition. This makes it a good tool when thinking of mental health as its all reasons someone would seek mental health help. Its inclusive assessment criteria ensure an accurate diagnosis and so effective treatment as a result.

Question 16

A limitation to this definition of abnormality is that Jahoda may have had an unrealistic expectation of ideal mental health, with the vast majority of people being unable to acquire, let alone maintain, all of the criteria listed.

Answer 16

This means that the majority of the population would be considered abnormal, even if they have missed a single criterion e.g. being able to rationally cope with stress. Therefore, deviation from ideal mental health may be considered a very limited method of diagnosing mental health disorders and so cannot be used as a sole definition when diagnosing.

Question 17

Furthermore, the definition suffers from cultural relativism and so is culturally bound.

Answer 17

For example, the concept of self-actualisation, which suggests that we must each put ourselves first in order to achieve our full potential, may be viewed as selfish in collectivist cultures (e.g. China) where the needs of the group are valued more than the needs of the individual. On the other hand, self-actualisation may be a more popular concept in individualist cultures (e.g. the UK), where personal achievement is celebrated, and the needs of the individual are greater than the needs of the group. This suggests that deviation from ideal mental health would only be accepted as a definition for abnormality in some (individualist) cultures.

Question 18

The 3 Characteristics of phobias

Answer 18

Behavioural characteristics

Emotional characteristics

Cognitive characteristics

Question 19

Behavioural characteristics

of phobias

Answer 19

Panic – suffering of heightened response upon exposure to phobic stimulus (screaming, freezing.crying)

Avoidance – making daily life harder by carrying out a series of measure to avoid the unpleasant consequence of exposure to the phobic stimulus.

Endurance – when the patient remains exposed to the phobic stimulus for an extended period and experiences heightened levels of anxiety.

Question 20

Emotional characteristics of phobias

Answer 20

Anxiety (as a response to the panic being experienced)

Unawareness that the anxiety being endurance is irrational.

Emotional response of fear

Prevents the patient from being able to relax.

The reaction is disproportionate to the fear being posed by the phobic stimulus.

Question 21

Cognitive characteristics of phobia

Answer 21

Selective attention – the patient remains focused on the phobic stimulus even when it causes them severe anxiety *could be a result of irrational beliefs/cognitive distortions = hard to look away

Irrational beliefs – may be a cause of unreasonable responses of anxiety towards the phobic stimulus due to the patient’s incorrect perception of the danger posed by the phobic stimulus causes fear and pressure.

Cognitive distortions - the patient does not perceive the phobic stimulus accurately therefore it could appear distorted to the individual.

Question 22

Mowrer’s (1960) two process model

Suggested that phobias are acquired through classical conditioning and reinforced by operant conditioning.

Answer 22

PROCESS

phobics practice avoidance behaviours, meaning that they avoid the phobic stimulus.

By avoiding this phobic stimulus, they avoid the associated fear.

By avoiding such an unpleasant consequence, the avoidance behaviour is negatively reinforced and likely to be repeated again,

hence maintaining the phobia.

Question 23

Classical conditioning

Answer 23

how a phobia is acquired.

Learning by association occurs by an unlearnt stimulus and a new stimulus are associated with each other.

The new stimulus produces the same response that was once produced by the unlearnt stimulus alone.

Question 24

Operant conditioning –

Answer 24

Operant conditioning – how a phobia is maintained.

When a behaviour is rewarded or punished

Positive Reinforcement leads to the increased frequency of the behaviour.

Negative reinforcement = a person avoiding an unpleasant situation which is a pleasant response (as they do not experience the fear) - REPEATION of the avoidance behaviour and so the fear is maintained

Question 25

Little Albert – John Watson and Rosalie Rayner (1920)

Answer 25

Watson and Rayner demonstrated how Little Albert associated the fear caused by a loud bang with a white rat. He was exposed to a white rat (NS), producing no response. When paired with the loud bang (UCS), this produced the UCR of fear. Through several repetitions, Albert made the association between the rat (CS) and fear (CR). This conditioning then generalised to other objects e.g. white fluffy Santa Claus hats. Operant conditioning takes place when a behaviour is rewarded or punished.

Question 26

There is supporting evidence for Mowrer’s two process model by a study conducted by Watson and Rayner in 1920.

Answer 26

Whilst researching phobia’s they created a phobia in a 9-month-old baby called ‘little albert’. ‘little albert’ not having any unusual anxiety to begin with was presented with a loud noise in combination to the presence of a rat to which they were able to condition an unconditioned stimulus with a conditioned response. This supports the two-process model which states the acquisition of a phobia is through classical conditioning as shown through the ‘little albert’ situation. This increases our confidence in Mowrer’s two process model and furthers our understanding in the acquisition of phobias. This has positive implications for society as it expresses the cause of phobias making us aware as a society and so actions can be taken to prevent phobia's from arising in children.

Question 27

Furthermore, the two-process model has good explanatory power which has been used to determine the mechanism behind the acquisition and maintenance of phobias, which classical or operant conditioning alone cannot do.

Answer 27

. This translates to practical benefits in systematic desensitisation and flooding. Mowrer emphasises the importance of exposing the patient to the phobic stimulus because this prevents the negative reinforcement of avoidance behaviour. The patient realises that the phobic stimulus is harmless and that their responses are irrational/disproportionate, thus translating into a successful therapy.

Question 28

However, there are alternative explanations for avoidance behaviour.

Answer 28

For example, Buck suggested that safety is a greater motivator for avoidance behaviour, rather than simply avoiding the anxiety associated with the phobic stimulus. For example, he uses the example of social anxiety phobias - such sufferers can venture out into public but only with a trusted friend, despite still being exposed to hundreds of strangers which would usually trigger their anxiety. This means that Mowrer’s explanation of phobias may be incomplete and only suited for some and are limited when explaining the avoidance behaviour.

Question 29

Furthermore, there is alternative explanations for the acquisition of phobias.

Answer 29

Seligman suggested that we are more likely to develop phobias towards ‘prepared’ stimuli. These are stimuli which would have posed a threat to our evolutionary ancestors, such as fire or deep water, and so running away from such a stimulus increases the likelihood of survival and reproduction, and so this behaviour has a selective evolutionary advantage. This means that alternative theories can explain why some phobias (i.e. towards prepared stimuli) are much more frequent than other phobias (i.e. towards unprepared stimuli) and limits Mowrer’s explanation which doesn’t take this into account and instead suggests that the phobia is learnt.

Question 30

Systematic desensitisation | definition

Answer 30

Systematic desensitisation is a behavioural therapy designed to reduce phobic anxiety through gradual exposure to the phobic stimulus. It relies upon the principle of counterconditioning --- learning a new response to the phobic stimulus - one of relaxation rather than panic.

Question 31

systematic desensitisation STAGES

Answer 31

This works due to reciprocal inhibition; it’s impossible to be both relaxed and anxious at the same time. Firstly, the patient and therapist draw up an anxiety hierarchy together, made up of situations involving the phobic stimulus, ordered from least to most nerve-wrecking. The therapist then teaches the patient relaxation techniques e.g. breathing techniques and meditation, to be used at each of these anxiety levels. The patient works their way up through the hierarchy, only progressing to the next level when they have remained calm in the present level. The phobia is cured when the patient can remain calm at the highest anxiety level

Question 32

There is evidence that suggests that the SD is an effective treatment for specific phobias.

Answer 32

Gilroy et al. (2003) followed up 42 patients treated in three sessions of systematic desensitisation for a spider phobia. Their progress was compared to a control group of 50 patients who learnt only relaxation techniques. The extent of such phobias was measured using the Spider Questionnaire and through observation. At both 3 and 33 months, the systematic desensitisation group showed a reduction in their symptoms as compared to the control group, and so has been used as evidence supporting the effectiveness of flooding. We can confidently claim that it is an effective treatment for phobias and so for this reason it is used as a standard treatment for some phobias.

Question 33

Furthermore, Systematic desensitisation is appropriate for a diverse range of patients of all ages and groups and for people with a range of medical conditions. be used indiscriminately to treat all types of patients.

Answer 33

Ohman et al (1975) believes it to be the most appropriate form of treatment for phobias that have arisen as a result of personal experiences such as a fear of clowns. Additionally, it's also the most appropriate treatment for those with learning difficulties. Anxiety disorders are often accompanied with learning disabilities meaning that such patients may not be able to make the full cognitive commitment associated with cognitive behavioural therapy, not having the ability to evaluate their own thoughts. Therefore, systematic desensitisation would be a particularly suitable alternative for them and so can be used indiscriminately to treat all types of patients.

Question 34

Other than ensuring that patients fully understand the steps involved within the SD and have given their consent, there are no other ethical considerations,

Answer 34

unlike flooding, which exposes the patient to unpleasant experiences. This also makes the SD a more acceptable to patients, as shown by low refusal and attrition rates. This idea also has economic implications because it increases the likelihood that the patient will agree to start and continue with the therapy, as opposed to ditching the treatment halfway and wasting the time and effort of the therapist.

Question 35

Flooding definition

Answer 35

Flooding is a behavioural therapy designed to reduce phobic anxiety in one session, through immediate exposure to the phobic stimulus.

Question 36

flooding STAGES

Answer 36

This occurs in a secure environment from which the patient cannot escape - without the option of practising avoidance behaviour, such behaviour is not reinforced and so the phobia is not maintained. Thus, in the case of a spider phobia, the patient will instantly be exposed to a room full of large spiders, which can crawl over them. This relies on the principle that it is physically impossible to maintain a state of heightened anxiety for a prolonged period, meaning that eventually, the patient will learn that the phobic stimulus is harmless.

Question 37

There is evidence to suggest that flooding is more effective for simple phobias and cost effective.

Answer 37

Ougrin compared flooding to cognitive therapies and found it to be cheaper. This is because the patient’s phobia will typically be cured in one session, thus freeing them of their symptoms and allowing them to continue living a normal life. We can confidently advise flooding to be used as a standard treatment for specific phobias, s patients opt for it. Furthermore, this has positive implications as the time efficient and cheap treatment of phobia would encourage patients to pay the money and time to cure their phobia, allowing them to get on with their everyday life.

Question 38

However, flooding is Less effective for complex phobias such as social phobias.

Answer 38

Social phobias involve both anxiety and a cognitive aspect like thinking unpleasant thoughts about a situation. Thus, in such cases, cognitive therapy may be more appropriate because this therapy can target the main causes of the phobia (tackling irrational thoughts), as opposed to the mere indirect causes. This suggests that alternatives may be more effective and so may be of more use when treating a phobia.

Question 39

Flooding is not appropriate to use as a treatment method for all patients, including children, the elderly and those with a heart condition.

Answer 39

It also appears to work best for specific phobias, for example a phobia of beards. For these reasons flooding must be used with care and personal characteristics/ medical conditions of patients must be taken inconsideration prior to the treatment.

Question 40

There are no ethical implications as long as patients fully understand the procedure of the treatment and

Answer 40

everything involved and have then given consent. Being an unpleasant situation that causes distress many patients fail to complete sessions and so money and time are therefore wasted.

Question 41

A common limitation to both treatments is that when one phobia disappears another may appear in its place.

Answer 41

This is known as symptom substitution. Patients need to be fully aware of this when consenting to either of the treatments.

Question 42

Behavioural characteristics of depression

Answer 42

changed activity levels (may result in agitation or, on the other end of the spectrum, an inability to wake up and get out of bed in the morning), aggression (towards oneself and towards others, which may be verbal or physical) Change in patterns of sleeping and eating (insomnia and obesity on one end of the spectrum, whilst anorexia may appear on the other).

Question 43

Emotional characteristics | of depression

Answer 43

lowered self-esteem, constant poor mood (lasting for months at a time and high in severity, therefore not simply ‘feeling down’) and high levels of anger (towards oneself and towards others)

Question 44

Cognitive characteristics of depression

Answer 44

absolutist thinking (jumping to irrational conclusions e.g. “I am unable to visit my mother today and so I am a failure of a son”), selective attention towards negative events (patients with depression often recall only negative events in their lives, as opposed to positive) and poor concentration (the consequent disruptions to school and work add to the feelings of worthlessness and anger)

Question 45

COGNITIVE EXPLAINATION FOR DEPRESSION – Ellis’s ABC Model

Answer 45

Albert Ellis (1962) proposed that good mental health is a result of rational thinking. Poor mental health results in irrational thoughts that interfere with our happiness- Good mental health is shown through rational thinking.

Question 46

ABC

Answer 46

A- Activating event According to Ellis we get depressed when we experience negative events and these trigger irrational beliefs. B- Beliefs Beliefs about how we should always succeed or be perfect. Seeing events as a major disaster when they don’t go smoothly. C- Consequences The beliefs cause negative emotional and behavioural consequences. The key here is the specific interpretation of the irrational belief, which is why some people have depression, whilst others don’t, according to the ABC model.

Question 47

One strength of Ellis’s ABC model is that it has practical application which has led to successful therapy having positive implications for further research.

Answer 47

Ellis’ ABC model proposes the idea of irrational beliefs resulting in the depression; Lipsky et al found that in turn challenging these beliefs had led to successful treatment when reducing depression. Furthermore, the effectiveness of CBT when curing depression also supports the theoretical basis of the ABC model as it exemplifies that the role of misled cognitions leads to the depression and by identifying and challenging these irrational beliefs are effective when treating depression. Therefore, it supports the basic therapy as it suggests that the irrational beliefs had influenced the depression.

Question 48

However, Ellis’s explanation is limited as some cases of depression occur with no activating event.

Answer 48

For example, reactive depression, which is depression built up over time rather than the trigger of an activating event causing the depression. Many people suffer from depression without an apparent cause and may feel frustrated that their concerns/experiences are not reflected in this theory. This limits our understanding on the cause of depression as his therapy assumes an activating event is necessary for the leading up to depression and so further research is required to show a more diverse explanation for depression.

Question 49

Additionally, Ellis’s model fails to explain all aspects of depression such as the behavioural aspects and simply disregards them in his theory.

Answer 49

Anger, hallucinations, and delusions are all indications of depression which shows depression being more complicated than Ellis’s explanation. This limits his research and shows how an alternative explanation to understand depression and its cause and poses a difficult practical issue in that patients may become frustrated that their symptoms cannot be explained according to this theory and therefore cannot be addressed in therapy.

Question 50

COGNITIVE EXPLAINATION FOR DEPRESSION – Beck’s cognitive theory of depression

Answer 50

Proposed by Aaron Beck (1967) the idea that one has a cognitive vulnerability towards developing depression, through faulty information processing, negative self-schemas and the cognitive triad of automatic negative thoughts. Through faulty information processing, the patient blows small problems out of proportion, attending to and dwelling on the negative, whilst thinking in ‘black and white’ terms. Through negative self-schemas, the patient interprets all information about themselves from the world in a negative light, further lowering their self-confidence. Through the cognitive triad, the patient suffers from negative automatic thoughts about the self, the future and the world.

Question 51

There is supporting evidence for Beck’s cognitive theory.

Answer 51

. Bates et al (1999) found that depressed p’s were given negative automatic thoughts statements that made them more depressed. Similarly, salkovskis in 1992 found negative thinking higher in depression sufferers. This supports the link between faulty cognition and depression, which is in line with the predictions made by Beck’s cognitive theory, thus increasing the validity of his theory. Furthering our understanding into depression and its causes, as a positive implication which aids the progression of treatment.

Question 52

Beck’s theory has practical application, having led to successful therapy.

Answer 52

REBT-CBT are examples of the treatment of depression, this supports and validates becks theory that faulty information processing, negative self-schema and negative triad causes depression. For example, elements of the cognitive triad can be easily identified by a therapist and challenged as irrational thoughts by the patient. As a result, the cognitive theory translates well into a successful therapy and the consequent effectiveness of CBT as a treatment is indicative of the accuracy of Beck’s cognitive theory as an explanation of depression.

Question 53

However, there are alternative explanations to suggest that depression is caused by a chemical imbalance- too much dopamine/too little serotonin is also thought to lead to depression.

Answer 53

This theory is supported by the effective use of drug therapy (anti-depressants) to treat depression. This is a limitation of the cognitive explanation and suggests that we cannot solely rely on it as it has not considered other factors such as patient biology. This makes it a simplified explanation which is trivialized by dismissing all other factors that contribute towards depression.

Question 54

CBT as a depression treating approach.

Answer 54

CBT - aims to identify and challenge irrational thoughts, replacing them with more productive behaviours, and thus treating depression. Beck’s CBT aims on identifying the patient’s thoughts and challenging them as irrational. Cognitive therapy also aims for patients to test the reality of their beliefs. For example, a patient may record each time someone was nice to them for the past week. Next time they say that everyone hates them, the therapist can point towards the journal as counterevidence, thus proving the patient’s beliefs as irrational. This demonstrates the idea of ‘patient as scientist’.

Question 55

REBT- Ellis’s rational emotive behaviour therapy

Answer 55

REBT- Ellis’s rational emotive behaviour therapy aims to identify the patient’s thoughts and challenge them as irrational, leading to a vigorous argument. This may be a logical argument (i.e. the belief doesn’t follow on logically from the facts) or an empirical argument (there is no evidence to support the irrational belief). Thus, this aims to change the irrational belief and to break the link between negative life events and depression. Through behavioural activation, patients are encouraged to engage in enjoyable activities, to provide further counterevidence for their irrational beliefs.

Question 56

Behaviour activation

Answer 56

where alongside CBT the therapist encourages depressed patients to become active and engage in activities, providing evidence for the irrational beliefs.

Question 57

Supporting evidence illustrates the effectiveness of CBT when used as a treatment for depression.

Answer 57

For example, March et et al studied a group of 327 adolescents with a main diagnosis of depression. After 36 weeks - 81% - (CBT), 81% - (Antidepressants) 86% - (CBT and antidepressants used in conjunction) were the improvement rates for each of the three experimental conditions. This exemplifies how CBT is a successful treatment approach for depression with high achieval rates

Question 58

However, his research also illustrates that the rate of treatment was higher when treatment consisted of CBT and antidepressants used in conjunction being 86%.

Answer 58

This shows that, although the rates of CBT treatment are high it would be further improved using a combination treatment and so advice to doctors would be to prescribe a conjunction of treatments.

Question 59

However, CBT is not an appropriate treatment for all patients with depression, in particular those with more severe depression.

Answer 59

This idea could also have been reflected in the evidence provided by March et al, where a combination of CBT and antidepressants is the most effective combination. This is because those with severe depression may not be able to attend the regular CBT sessions, due to a lack of motivation, and a loss of hope. This means that CBT cannot be used to address all cases of depression, and arguably is not suitable for cases which need help the most. For this reason, CBT needs to be offered on a ad hoc basis rather than as a standard treatment for all patients, each case of depression needs to be acknowledged and assessed separately to distinguish for the best treatment.

Question 60

Furthermore, the focus of the cognitive approach is on present life and its challenges.

Answer 60

Therefore, the assumption is made that a patient's current circumstance is responsible for their depression when merely the situation could be, as shown in a significant number of patients, as a result of a past experience or traumatic event such as the death of a loved one. Therefore, as CBT therapists talk more about the future, disregarding the past patients could feel an overwhelming sense of frustration not being able to interfere and control the therapy, its practices and focus.

Question 61

Behavioural characteristics of OCD

Answer 61

compulsions (repetitive and intrusive thoughts focused around the stimulus which reduce anxiety through being a method of acting upon obsessive thoughts) avoidance behaviour. This avoidance behaviour is once again negatively reinforced (in terms of classical conditioning) because an individual who avoids the specific stimulus will avoid the anxiety associated with having to carry out compulsive behaviours and suffer from obsessive thoughts.

Question 62

Emotional characteristics of OCD

Answer 62

Guilt Disgust, depression (due to the constant compulsion to carry out compulsive/repetitive behaviours, which often interfere with day-to-day functioning and relationships) anxiety (associated with the acknowledgement that the obsessive thoughts are irrational, but despair at the fact that they will always lead to compulsive behaviours).

Question 63

Cognitive characteristics of OCD

Answer 63

patient’s acknowledgement that their anxiety is excessive and irrational. the development of cognitive strategies to deal with obsessions (such as always carrying multiple bottles of hand sanitiser) and obsessive thoughts (these are repetitive, focus on the stimulus, are intrusive, cause excessive amounts of anxiety and lead to compulsive behaviours).

Question 64

The 4 categories of OCD

Answer 64

Checking Mental contamination Hoarding Ruminations (intrusive thoughts)

Question 65

The genetic explanation, through the diathesis-stress model, suggests that some have a genetic vulnerability towards developing depression.

Answer 65

For example, Lewis et al. found that of his OCD patients, 37% had parents with OCD and 21% had siblings with OCD. OCD is polygenic, meaning that up to 230 different genes are involved in its development (Taylor). These are often associated with the functioning of neurotransmitters, such as dopamine and serotonin, both associated with regulating mood. Researchers have identified candidate genes which increase a person’s vulnerability towards developing OCD. One of these is 5HT1-D beta, which is implicated in the efficiency of serotonin transport across synapses. OCD is also aetiologically heterogenous, meaning that its origin has many different causes. For example, it has been suggested that hoarding disorder is caused by a particular genetic variation.

Question 66

The genetic hypothesis definition

Answer 66

Genes make up chromosomes and consist of DNA which codes the physical feature of an organism and psychological features. Genes are inherited from parent to offspring.

Question 67

The genetic hypothesis explaination

Answer 67

Genes are involved in an individual's vulnerability to OCD Candidate genes – Researchers have identified genes; some are involved in regulating the development of serotonin. Polygenetic- Is not cause by one particular gene. Taylor’s meta-analysis shows that up to 230 different genes are involved in OCD. There are different types of OCD and so one group of genes may cause OCD in one person but a different set of genes causes OCD in another.

Question 68

A strength of the genetic hypothesis for OCD is that there is supporting evidence to agree with OCD being polygenetic – not caused for a particular gene.

Answer 68

Lewis (1936) assessed OCD patients and concluded that 37% had parents with OCD and 21% had siblings with OCD. Similarly, Nesdtadt in 2004 discovered that there is a 11.7% concordance rate between OCD sufferers and their first-degree relatives. Furthermore, Miguel in 2005 found that monozygotic twins had a concordance rate of 53-87% whilst dizygotic twins have a concordance rate of 22-47%. This strongly suggests that there is a genetic basis for OCD because identical twins share 100% of their genes with each other, whilst dizygotic twins only share 50% of genes with each other. However, we should avoid being deterministic - just because an individual has a particular combination of candidate genes does not mean that the individual is to develop OCD, but rather the genetic vulnerability must be paired with an environmental stressor which results in OCD, as dictated through the diathesis-stress model. This validates and increases our confidence in the genetic explanation, furthering our understanding into the genetic influence of OCD.

Question 69

The neural explanation Definition

Answer 69

The view that physical and psychological characteristics are determined by the behaviour of the nervous system, in particular the brain as well as individual neurons.

Question 70

The neural explanation -explanation

Answer 70

Role of serotonin - known to regulate mood. If a person has low serotonin, then normal transmission of mood-relevant information does not take place and sometimes other processes are affected. Decision making systems- in some cases of OCD such as hoarding disorder may be associated with abnormal functioning of the lateral bits of the front lobes of the brain (which are responsible for decision making). Furthermore, there is evidence to suggest that the left Parahippocampal gyrus is associated with processing unpleasant emotions and is seen to be functioning abnormally in OCD patients.

Question 71

There is supporting evidence for the neural explanation of OCD; antidepressant’s work on the serotonin system.

Answer 71

These drugs are effective in reducing the symptoms of OCD - serotonin is suggested to be involved in OCD. Max 1994 has found that disconnecting the basal ganglia from the rest of the brain can reduce OCD symptoms. Coredini et al found that the decision-making neural system functions inadequately in OCD patients. This validates and increases our confidence in genetic explanation for OCD, furthering our understanding into the genetic influence of OCD.

Question 72

A limitation to the biological explanation OCD is that it has low predictive validity; it cannot be used as an accurate sole explanation for the development of OCD.

Answer 72

A meta-analysis done by Taylor in 2013 showed that there are up to 230 genes involved in OCD. Thus, we cannot simplify the reason for OCD being a specific group of genes as the group of genes causing OCD in one person may differentiate from the group of genes causing OCD in another person. this poses a practical issue; it is difficult to assess which candidate genes have the greatest influence and so which genes drug treatments should target. Therefore, the genetic explanation is a limited explanation of OCD and so of low use when it comes to treatment as we need to consider the other factors to increase the predictive value of the explanation.

Question 73

A limitation to the neural explanation is that it does not distinguish between the cause and effect of OCD it's correlational not causal.

Answer 73

For example, the hypothesis establishes the link between the levels of serotonin and OCD. However, it does not acknowledge whether OCD is a cause of low levels of serotonin or vice versa. Thus, we cannot differentiate symptom, from cause. An implication of this is that effective treatment cannot be identified and so limits the application of the hypothesis into the real world. Making it an explanation that isn't detailed enough to be used as treatment and remains as a fact which isn't much use when it comes to treating OCD. However, it may be of use where it can initialize and aid further research which could then be translated into effective treatment.

Question 74

The Biological Approach to Treating OCD

Answer 74

Selective serotonin reuptake inhibitors (SSRIs) act on the serotonin system by preventing the reuptake and breaking down of serotonin by the presynaptic neuron. Thus, the concentration of serotonin within the synapse increases, causing the post-synaptic neuron to be continually. Tricyclics have a similar effect but are reserved for those who do not respond well to SSRIs due to having more severe side effects. Selective noradrenalinereputake inhibitors (SNRIs) increase the concentration of the noradrenaline neurotransmitter in the brain.

Question 75

A strength to drug therapies such as SSRIs is that it is effective in tacking symptoms of OCD.

Answer 75

Soomro et al (2009) reviewed studies comparing SSRIs to placebos in the treatment of OCD and concluded that all 17 studies reviewed showed significantly better results for the SSRI effectiveness than placebo conditions. However, effectiveness was at its peak where SSRIs were combined psychological treatment, for example CBT. Therefore, advice to doctors would be to use a combination of SSRIs and psychological treatment to ensure the effective tackling of OCD.

Question 76

A positive implication of the increased knowledge about the effectiveness of certain drug treatments for OCD and cognitive treatments is that time people take off work through sick days are reduced,

Answer 76

thus increasing the productivity of the workforce and ensuring that more people are working. This means that more people will be paying taxes. Research into the cost-effectiveness of treatments for OCD can be the basis of public health services choosing which treatments they use, which can help organisations like the NHS save money.

Question 77

A strength of such drug use is that it’s cost-effective and non-disruptive

Answer 77

They are cheap compared to psychological treatments, and so prove to be good value for public health organizations like the NHS. They are also non-disruptive. Patients can discretely take the drugs to manage their symptoms and lead a relatively normal life, as compared to engaging in psychological cognitive treatments such as CBT where time and effort is required.

Question 78

A limitation of drug therapy are the serious side effects.

Answer 78

For example, for those takin Clomipramine, more than one in 10 suffer from weight gain and tremors. More than 1 in 100 suffer from increased heart rate and aggressiveness. These side effects can have serious implications on how the patient can go about their everyday lives. These factors can discourage an individual from taking the drug as they may find that the symptoms of the drug are worse than those of OCD itself. These side effects may be a concern for some patients and result in non-compliance with their treatment and ultimately relapse; additionally, compliance could result in a secondary disorder which may also need treatment. Thus, although drug therapies have proven to be effective the overall side effects make them an infective treatment in many ways and so research into different drugs would be required to make drugs a standard treatment for OCD.

Question 79

Furthermore, an SSRI would need to be taken for 12 weeks before any benefit is noticed and so most people with moderate to severe OCD need to take one for at least 12 months.

Answer 79

People with more severe OCD, however, may need to take the medication for many years to prevent the condition recurring. Therefore, the time required to see any benefit is long and so could again lead to patients being non-compliant with their treatment and could also discourage OCD patients from taking drug therapy to begin with. This limits the use of drug therapy with patients suffering with OCD and lowers the use of them when treating OCD.