psychopathology 😶‍🌫️😓

What is Psychopathology?

What is Psychopathology?

The scientific study of mental health disorders and conditions. It examines the behaviours, symptoms, causes, developments and treatments for mental disorders.

What is the DSM-V?

It’s a standard classification of mental health disorders. It’s a list of mental disorders which include information about clinical characteristics that should be present in order for a diagnosis to be given.

What is abnormality?

Abnormality has no strict definition as it is subjective and therefore varies between each person.

What are the 4 definitions of abnormality?

Deviation from social norms, deviation from statistical norms, failure to function adequately and deviation from ideal mental health.

Define “deviation from social norms”.

Any behaviour which goes against a social norm is considered to be abnormal. A social norm is a behaviour which is considered socially acceptable.

Define “deviation from statistical norms”.

Uncommon behaviour can be considered abnormal. This explanation defines abnormality in a mathematical manner. People that fall 2 or more standard deviations away from the average behaviour are considered abnormal.

Define “failure to function adequately”.

People who are unable to cope with everyday life are considered abnormal. Their behaviour is considered to be abnormal when they are unable to manage day-to-day living

Define “deviation from ideal mental health”. Who came up with this?

Jahoda (1958) suggests there are certain things needed for good mental health: individuals who don’t meet the criteria are abnormal. Six categories were identified: self-attitude, personal growth and self actualisation, integration, autonomy, accurate perception of reality and mastery of environment.

There are 7 features of failure to function adequately. What are they and define them.

Observer discomfort - people who witness the behaviours may feel uncomfortable.

Maladaptive behaviours - they fail to thrive in new settings and do not respond well to new situations

Violation of moral standards -behaviour which doesn’t seem right in society, or is illegal.

Personal distress - they may suffer due to their behaviours

Unconventional - behaviour which doesn’t follow social norms and isn’t seen as common in society - it may be eccentric and attract attention.

Irrational - illogical thoughts or feelings without reasonable foundations

Unpredictable - behaviours that occur without warnings and out of the blue.

What are the two strengths of Johoda’s theory on deviation from ideal mental health?

• positive outlook on mental health

• Offers an alternative perspective on mental disorders

What are some of the limitations of deviation from Johoda’s theory ideal mental health?

• the theory is too unrealistic: most people would be abnormal - it’s an ideal

• doesn’t specify how many a person needs to be lacking to be abnormal

• difficult to measure

• lacks cultural consistency - not every culture has the same behaviours

• suggests mental health abnormalities are born from physical health issues

What is the strength of the theory of failing to function adequately?

• recognises the subjective experience of the patient.

What are the limitations of the theory of failing to function adequately?

• who judges what is functioning adequately? it’s subjective

• behaviour may be functional for that individual

• lacks cultural validity

What is the strength of deviating from social norms?

• distinguishes between desirable and undesirable behaviour - can help identify abnormal behaviour

What are the limitations of deviating from social norms?

• lacks temporal validity - what was socially acceptable 50 years ago may not be acceptable now

• judgements are often related to the context of the behaviour

• lacks cultural validity

What are the limitations of deviating from statistical norms?

• some abnormal behaviours are desirable - iq over 150

• lacks cultural validity

• cut-off point is subjective

What is meant by a phobia?

A group of mental disorders characterised by high levels of irrational fear/anxiety in response to a stimulus. This anxiety interferes with normal living.

What are the three categories categorising phobias? Give an example for each.

Emotional - the feeling when you see a feared object (i.e. panic)

Behavioural - the behaviour you exhibit when you see the feared object (i.e.fight or freeze repsonse)

Cognitive - the thoughts you have when seeing a feared object (i.e. irrational thoughts)

Who used the behaviourist approach and Pavlov’s dogs to explain phobias? Briefly outline the experiment.

Watson & Rayner (1920) used Little Albert (L.A.) to show how phobias are learnt as babies. They used a loud noise (ucs) to scare L.A. (ucr) and then paired the noise with animals (ns) to associate them to create a response.

Define maintenance of phobias.

Maintenance of phobic behaviour occurs with negative reinforcement - the avoidance of the frightful stimulus. This is the removal of something negative that increases the likelihood of a behaviour being reported.

What is the Two-Process Model?

It explains the development and maintenance of phobias. Acquisition - classical conditioning, where we learn our phobias through a process of association. We associate a previously nuetral stimulus with a newly conditioned response.

Maintenance - operant conditioning, where we maintain the presence of our phobia by being rewarded with the removal of unpleasant feelings every time we avoid the stimulus - negative reinforcement.

What are the strengths of the two-process model?

• effective treatments

• supportive research, which shows the importance of classical conditioning

What are the limitations of the two-process model?

• doesn’t explain all phobias

• ignores cognitive factors

• unethical research (L.A.)

• incomplete explanations - diathesis stress model

• biological preparedness - some phobia are more common than others.

Explain the importance of classical conditioning.

Point: two-process model is supported by research that asks people about their phobias.

Evidence: Sue et al (1994) suggests phobias are a result of other processes. Agoraphobics are more likely to describe their disorder in terms of a specific incident whereas arachnophobia cites modelling as the cause.

Explain: people with phobias often recall a specific incident when it arose: but not everyone can. It demonstrates the role of conditioning in developing phobias.

Challenge: shows that there might be other processes from which phobias can be developed.

Explain the incomplete explanation - diathesis stress model discussion. (Limitation)

Point: If a neutral stimulus becomes associated with a fearful experience the result should be a phobia but this doesn’t always happen.

Evidence: (Di Nardo et al) not everyone who is bitten by a dog develops a phobia. The diathesis stress model which proposes a genetic vulnerability to developing mental health conditions such as phobias. The disorder however will only manifest if triggered.

Explain: This suggests a dog bit would only lead to a phobia in those with such a vulnerability. Therefore, the behavioural explanation offered by the two-process model is incomplete.

Explain why ignoring cognitive factors is a limitation.

Point: There a re cognitive aspects of phobias that can’t be explained in the behaviourist framework.

Evidence: It leads to CBT which can be more successful than behavioural treatments. Social phobias responds better to CBT (Engels et al)

Explain: it proposes that phobias develop as a result of irrational thinking. These thoughts create extreme anxiety and may trigger a phobia.

Explain why biological preparedness is a strength.

Point: Not all phobias develop after a traumatic event.

Evidence: Seligman (1970) argued that animals are genetically programmed to rapidly learn an association between life-threatening and fear. This refers to an ancient fear which where things that were dangerous in the past, it would have been adaptive to avoid these.

Explain: It explains why people are much less likely to develop phobias of modern objects such as toasters and cars that are more of a threat than a spider.

Challenge: This suggests the behavioural approach can’t explain all phobias and that the evolutionary approach may be more applicable to the most common types of phobias.

What are the two ways of treating phobias?

Systematic desensitisation and flooding.

What is systematic desensitisation?

Aims to extinguish an undesirable behaviour (fear) by replacing it with a more desirable behaviour (relaxation).

What is flooding?

Exposes the individual to their phobic stimulus in the most frightening situation.

What’s the difference between in vitro and in vivo?

In vitro - artificial/ online

in vivo - real life

What are the 3 stages of systematic desensitisation?

1. Client learns relaxation techniques

2. The client works out a hierarchy of fear from the least frightening to the most frightening.

3. The client works through the hierarchy learning to use relaxation techniques in the presence of the feared object.

Explain flooding in more detail.

Exposes the individual to their phobic stimulus in the most frightening situation rather than using a hierarchy and gradual exposure. The individual is immersed in the experience in one long session. The therapy continues until the individual’s anxiety has disappeared.

Why do people do flooding? Give all 3 points.

• fear response and release of adrenaline that accompanies your fear is time limited

• adrenaline levels naturally begin to decrease

• a new stimulus response can be learned so the individual will now be able to associate the phobic stimulus with a non-anxious response (relaxation)

What is effective about systematic desensitisation?

• Research has found that it’s effective - 75% of patients with phobias respond to SD (McGrath et al, 1990)

In vivo techniques found to be most effect but often SD involves a combination of vivo and vitro.

What is appropriate about SD?

• much quicker treatment than other methods (such as CBT) and requires lots of motivation and effort

  -much better treatment for children/individuals with learning disabilities than CBT

Why might SD be ineffective?

• It may not be effective in treating all phobias as it focuses on replacing the learnt anxiety relaxation

may not be effective in treating evolution component as its not been learned.

What is effective about flooding?

• it can be effective and quick

Choy et al reported that SD and flooding was more effective of the two at treating phobias, suggesting that flooding is an effective therapy

Other research suggests that they’re of similar effectiveness in treating phobias

What is appropriate about flooding?

• flooding isn’t for every patient

could be highly traumatic, especially if they quit half way through the therapy

What is the limit to the effectiveness of behavioural therapies in general?

• these treatments don’t identify the underlying issue, so it may reappear later.

What are the limits to the appropriateness of behavioural therapies in general?

SD+F only treat the symptoms of the disorder, rather than the underlying phobia.

What is depression?

A mood disorder where an individual experiences low mood, loss of interest or pleasure, feelings of guilt and other characteristics. It usually occurs between 20 and 40 year olds.

What are the 4 different categories/types of depression recognised by the DSM-5? Explain them briefly.

Major depressive disorder - severe but often short term depression

Persistent depressive disorder - long term/recurring depression

Disruptive mood dysregulation disorder - childhood temper tantrums

Premenstrual dysphoric disorder - disruption to mood prior to and/or during menstruation

How is depression diagnosed? Name 5 symptoms a patient must display daily for 2 weeks according to the DSM.

• depressed mood

• lack of interest/pleasure in activities

• significant weight changes

• insomnia

• loss of energy

• feelings of worthlessness

• lowered ability to think/concentrate

• recurrent thoughts about death

What the three behavioural characteristics of depression?

Activity levels

Disruption of eating/sleeping

Aggression and self-harm

Explain the behavioural characteristic “activity levels” of depression.

• Individuals can have reduced energy levels: making them lethargic

• could be severe enough that they struggle to get out of bed in the morning

• psychomotor agitation - individuals may struggle to relax and may pace around

Explain the behavioural characteristic “disruption in eating/sleeping” of depression.

• episodes of insomnia or hypersomnia

• appetite is likely to increase/decreases leading to weight loss/gain

Explain the behavioural characteristic “aggression and self-harm” of depression.

• sufferers can often be irritable and can become verbally/physically aggressive

• can lead to aggression against themselves - self-harm or suicide

What are the 3 emotional characteristics of depression?

Low mood

Anger

Low self-esteem

Explain the emotional characteristic “low mood” of depression.

• the defining emotional element of depression

• Patient thinks they are worthless and empty

Explain the emotional characteristic “anger” of depression.

• anger in addition to sadness and low mood

• this could be directed at themselves or others

Explain the emotional characteristic “low self-esteem” of depression.

• they may have a reduced self-esteem

• this can be extreme (i.e. self loathing)

What are the three cognitive characteristics of depression?

Poor connection

Dwelling on the negative

Absolutist thinking

Explain the cognitive characteristic “poor connection” of depression.

• difficulty sticking to a task

• struggle to make decisions

• poor concentration will interfere with work and everyday life

Explain the cognitive characteristic “dwelling on the negative” of depression.

• dwelling on the negative

• bias towards recalling unhappy events

Explain the cognitive characteristic “absolutist thinking” of depression.

• most situations are either all-good or all-bad

• they’ll perceive an unfortunate situation as an absolute disaster

What is Beck’s negative Triad?

Those with depression feel the way they do because their thinking is biased towards negative interpretations.They have negative views about: the self, the future and the world/ society in general.

What is the role of negative schemas in the cognitive explanation of depression?

Depressive individuals have developed negative schemas during their childhood, which leads them to have a negative view of the world. The schema is activated whenever the person encounters a new situation that’s similar to the original situation. These lead to cognitive biases where individuals overgeneralize and reach a conclusion of their self-worth based on this one piece of negative feedback.

What are the 5 causes of these negative schemas?

• Loss of a person (attachment)

• Rejection by peers

• Criticism by parents/teachers

• Physical abuse

• Emotional abuse

What is Ellis’ ABC model?

Activating event - which triggers the beliefs

Beliefs being irrational - the even triggers the beliefs

Consequences and emotional response - the irrational beliefs which trigger the emotional response, not the event.

Give 5 examples of rational vs irrational thinking.

Reasonable/non-extreme VS catastrophic/extreme

Logical/flexible VS illogical/rigid

Self-enhancing VS self-defeating

Accurate VS inaccurate

Realistic VS unrealistic

Why is CBT a good therapy? Give evidence. Are there any counters? (Evaluating the cognitive explanation to depression).

It has lead to the development of a very effective therapy for many mental health conditions. It’s one of the most commonly and effective treatments where the client and therapist work towards a more self-aware approach to the clients irrational thinking.

Counter: CBT is effective as it challenges the irrational thoughts which supports the theory that irrational thoughts causes depression.

Irrational thinking is a theory as to why depression is caused. Why is it a good theory? Are there any counters? (Evaluating the cognitive explanation to depression).

There’s supporting evidence. Research found depressed people made more negative assessments on statements that non-depressed people. Therapy showed an improvement in their self-ratings which shows that depression involves the use of negative schemas.

Counter: this research doesn’t mean that negative thoughts are the cause. Depression could lead to the negative thoughts.

What is a weakness of the cognitive explanation to depression? Could this be countered.

A weakness is that it blames the client. Depression is a result of an individual’s negative/irrational thinking. This is an issue as it disregards situational factors and the impact of these on the mental health of the client isn’t considered.

Counter: however it could be argued that this gives the client the power/motivation to change their thinking.

Why might the biological approach be a weakness of the cognitive explanation to depression?

The biological approach suggests that depression may be cause by genes and neurotransmitters. Research found that individuals with depression have lower levels of serotonin. The influence gene is also 10x more common in those with depression. Drug therapies are more effective in treating depression that CBT, showing that depression isn’t solely irrational thinking.

What is cognitive behavioural therapy? (CBT)

CBT is the most common psychological treatment for mental health conditions as it helps people to change their thoughts and behaviour to help combat the symptoms and feelings associated with the mental health condition. It’s based on cognitive and behavioural techniques.

What does CBT aim to do?

• helps break the circle of maladaptive thinking, feeling and behaviour.

• It focuses on the present and helps the client to understand ways to improve their state of mind.

• When the client understands the process behind their thinking, they’re able to change their thinking.

• CBT aims to get clients to the point where they can DIY.

Who was Ellis?

One of the first psychologists to deliver a form of CBT:

Rational Therapy—> Rational emotive therapy—> rational emotional behaviour therapy

Ellis’s ABC method later evolved into ABCDEF. What does the DEF stand for?

D= disrupting irrational thoughts/beliefs

E= effects of disrupting and effective attitude to life

F= feelings produced

What are the other components of CBT?

Homework - clients are asked to complete “assignments” between sessions to allow them to practice what they’ve learnt and put into place more rational thinking.

Behavioural Activation- CBT encourages clients to be more active and re-engage in pleasurable activities. The client and therapist identify these activities and then dispute and overcome any cognitive obstacles.

Unconditional positive regard - Ellis recognised that successful therapy needed the client to understand their own self-worth. If the client feels respected and appreciated regardless of their behaviour, they’ll be more likely to change their beliefs/attitudes.

What is REBT? (Challenging and replacing)

Logical disputing = self-defeating thoughts do not logically follow the available info.

Empirical disputing = self-defeating thoughts aren’t consistent with reality

Pragmatic disupting = emphasises the uselessness of self-defeating beliefs

Name a strength for CBT.

• research support

• effective

• can be applied to many mental health conditions

Name a limitation for CBT.

• difficult to challenge rigid thoughts

• time-consuming and therefore costly

• more effective treatments: medication

• lack of motivation may mean people with depression don’t seek help

What evidence is there that CBT is an effective treatment? Explain this. Is there a counter/link? (Evaluating treatments for depression)

Evidence = Ellis demonstrated that it had a 90% success rate over 27 sessions

Explanation = studies into REBT+CBT showed that treatment is more effective than no treatment. Ellis did recgonise that treatment isn’t for everyone - this may be because they didn’t put their revised beliefs into action.

Counter = the competence of the therapist also has a significant impact on the variation in CBT outcomes.

What research showed that CBT is more appropriate for some individuals than others? Explain it. Is there a counter/link? (Evaluating treatments for depression)

Evidence = CBT is less suitable for individuals who have high levels of irrational beliefs that are rigid and resistant to change.

Explanation = Research found that CBT was less effective in times of high stress.

Counter = Ellis said some people don’t want the advice that CBT practitioners offer and therefore prefer therapies that don’t require cognitive effort

What research shows that alternative treatments may be more effective? Explain this and include a counter. (Evaluating treatments for depression)

Evidence = medication is the most popular treatment for depression.

Explanation = SSRIs require less effort and cognitive strength and can be used in conjunction with CBT. The client uses medication to cope and manages their emotions during therapy

Counter = CBT has found to be effective effective when used in conjunction with drug therapy.

What is OCD?

Obsessive Compulsive Disorder - an anxiety disorder where anxiety arises from obsessions and compulsions. The compulsions are a response to the obsessions and the individual believes that performing the compulsions will reduce the anxiety they’re feeling.

What is an obsession?

Recurring and persistent thoughts which are based on reality.

What are compulsions?

Repetitive behaviours that are physical urges to perform actions.

What are the 3 emotional characteristics of OCD? Expalin them.

Anxiety and distress = intrusive thoughts cause feelings of anxiety

Embarrassment and shame = the individual is aware of the excessiveness of their behaviour which can lead to them feeling embarrassed/hiding their behaviours

Disgust = individuals may feel disgusted at everyday situations (eg germs)

What are the 3 cognitive characteristics of OCD? Explain them.

Intrusive thoughts = forbidden or inappropriate thoughts which can be frightening

Ideas/doubts = obsessional themes include ideas, doubts and impulses

Unaware of obsessions and compulsions

What is the behavioural characteristic of OCD? Explain it.

Repetitive behaviours = behaviour performed in order to reduce anxiety created by obsessions. Individuals feel they need to perform these actions or something bad will happen.

How does the biological approach exaplain OCD?

It’s proposed that there’s a genetic component to OCD predisposing individuals to the illness.

Genetic explanation suggests that the likelihood of developing OCD is due to their genes - this explains why those with OCD often have family members with OCD.

What are the two genes that are associated with OCD?

COMT and SERT gene.

What is the COMT gene?

• It regulates the production of dopamine

• Provides instructions for making an enzyme

• A variation of the COMT gene leads to lower activity and therefore higher levels of dopamine in the pre-frontal cortex

What did Tukel et al (2013) discover about the COMT gene?

One form of the COMT gene has been found to be more common in OCD patients than patients without the disorder.

What is the SERT gene?

• Involved in the regulation of serotonin

• A mutation of the SERT gene causes lower levels of serotonin

What did Ozaki et al (2003) discover about the SERT gene?

Two unrelated families were found to have a mutation of the gene. 6/7 of the family members had OCD.

What evidence do we have that demonstrates the genetic explanation?

Twin studies - Nestadt et al (2010) found ina review of twin studies that the concordance rte for OCD in twins was:

• MZ = 68%

• DZ = 31%

The MZ concordance rate being higher than the DZ supports the genetic element

However it’s not 100% meaning there could be environmental factors which lead to OCD

How could the diathesis stress model be an explanation of OCD?

It is very oversimplified that OCD could be caused by a mutation in one gene. Genes are also implicated in other disorders. One explanation is that the gene creates a vulnerability for the individual for OCD and other conditions. Other stressors/factors will affect if and when the condition develop - some people could possess the COMT+SERT variation gene but not show any OCD symptoms.

What has research shown about the diathesis stress model theory affecting OCD?

• OCD is thought to be polygenic - meaning that its development culd be determined by a few (230) genes. This gives the explanation very little predictive power.

What are the neural explanations of OCD?

Abnormal levels of the neurotransmitters dopamine or serotonin impact OCD.

How does OCD affect dopamine? What research shows this? Can you challenge this?

Dopamine levels are thought to be extremely high in people with OCD.

Animal studies that drugs with increase dopamine levels induce movements resemble the compulsive behaviours found in OCD patients. However the research is difficult to generalise and unethical.

How does OCD affect serotonin? What research shows this? Can you challenge this?

Serotonin levels are lower in those with OCD.

Anti-depressants increase the levels of serotonin and this has been found to reduced OCD symptoms in patients. Anti-depressants that will have of an effect on serotonin dont’t reduced OCD.

However this doesn’t treat OCD, it only masks it.

In an abnormal brain circuit, what are the two main areas associated with OCD?

The orbitofrontal cortex (OFC) and caudale nucleus (CN)

What is the process of a worry circuit?

OFC is responsible for sending worry signals —> These signals are pciked up by the thalamus and directed around the body —> the CN is responsible for suppressing worry signals —> If the CN isn’t working properly, the worry signals are suppressed and the person worries too much, causing OCD.

What evidence is there for the biological explanation for OCD? Are there any downsides to this research?

PET scans of patients with OCD have found that when patient’s symptoms are active, there’s a heightened activity in the orbitofrontal cortex. However, there was no control group to compare these patients too, meaning there is a lack of cause-and-effect as we don’t know which came first.

MRIs have shown OCD patients have less grey matter in key areas of the brain, including the OFC.

Why is the biological approach good? (RLA) Are there any counters?

It has real life application, meaning medications are developed to help stabilise levels of neurotransmitters to help reduce OCD symptoms.

Counters = - drugs aren’t always effective

• reducing OCD symptoms isn’t treating it

• -time delay in improvement

What are SSRIs?

Selective serotonin reuptake inhibitors