Clin psych so far

what are the 2 models in the cognitive approach that help explain depression?

• Ellis' ABC model

• Beck's negative triad

how does Beck’s negative triad theory explain depression as a whole?

result of faulty thinking, negative schemas and distorted perceptions

how does Ellis’ ABC model theory explain depression as a whole?

caused by irrational thoughts interfering with happiness

what is the ABC model?

 a cognitive approach to understanding mental illness, focusing on the effect of irrational beliefs on emotions

what is the negative triad model? (definition)

a cognitive approach to understanding depression, focusing on how negative expectations (schema) about the self, world and future lead to depression

what is a schema?

• a cognitive framework that helps organize and interpret information in the brain a

• schema helps an individual to make sense of new information

who came up with the ABC model to help explain depression?

Ellis

what does the ABC stand for (and what do they mean) in the ABC model that helps explain depression?

• A = an activating event (e.g. your Christmas job ends on 1 January)

• B = belief which may be rational (e.g. the job was always going to end after Christmas) or irrational (e.g. they never liked me)

• C = consequence - rational beliefs lead to healthy emotions (e.g. acceptance) whereas irrational beliefs lead to unhealthy emotions (e.g. depression)

what is musturbatory thinking? (ABC model)

• Source of irrational beliefs lie in musturbatory thinking

• Musturbatory thinking = thinking that certain ideas or assumptions must be true in order for an individual to be happy

what are the 3 most important irrational beliefs identified Ellis in the ABC model to help explain depression?

• I must be approved of or accepted by the people I find important

• I must do well or very well, or I am worthless

• The world must give me happiness, or I will die

what is an evaluation of Ellis ABC model?

• focuses on the client purely

• blames the client as responsible for their own depression

• could be good as it allows them to feel more in control and achieve more

• BUT:

• This is effectively blaming the person with depression which is unfair

• may lead therapist or client to look over situational factors e.g. how family problems may have contributed etc.
   

who came up with the negative triad to explain depression?

Beck

what did Beck believe, which lead to the negative triad?

He believed people with depression feel as they do because their thinking is biased towards negative interpretations of the world and they lack a perceived sense of control

how can negative schemas lead to depression (Beck’s negative triad)?

• Developed during childhood due to factors such as parental/peer rejection and teacher criticism

• Create a tendency to view the world negatively and expect failure

• Activated in situations resembling those in which they were learnt (e.g. exams)

• Cause cognitive biases such as overgeneralisation, e.g. judging self-worth from one piece of negative feedback

what is Beck’s negative triad? what are the 3 components and what do they mean?

Negative schemas and cognitive biases maintain Beck’s negative triad: a pessimistic, irrational view of:

• The self: e.g. 'I am just plain undesirable, what is there to like? I'm unattractive and seem to bore everyone'

• The world (life experiences): e.g. 'I can understand why people don't like me. They would all prefer someone else's company. Even my boyfriend left me.'

• The future: e.g. 'I am always going to be on my own, there is nothing that is going to change this

what is an evaluation point of Beck’s negative triad as an explanation of depression?

Inconsistent findings:

• Research challenges Beck’s theory that cognitive vulnerability causes depression

• Self-criticism and depression were found to be unrelated

• Although self-esteem and depression were related, depression appeared first, suggesting low self-esteem may be a result, not a cause, of depression

• Therefore, cognitive vulnerability may not cause depression as Beck proposed

what are 2 explanations of the cognitive approach to explaining depression as a whole?

Alternative explanations:

• Biological factors such as genes and neurotransmitters may contribute to depression

• Low serotonin and genetic vulnerability have been linked to depression

• Effectiveness of drug therapies supports a biological role

• Genetic vulnerability may make people more affected by negative environments, leading to negative thinking

• Therefore, depression cannot be explained by the cognitive approach alone

Practical application:

• Cognitive explanations underpin CBT

• CBT is consistently effective for treating depression, especially alongside drug therapy

• If challenging irrational thoughts reduces depression, this supports the role of negative thinking in depression

what are the 4 definitions of mental illness?

• Deviation from ideal mental health

• Deviation from social/cultural norms

• Failure to function adequately

• Statistical infrequency

what is the deviation from ideal mental health def?

• Jahoda - physical illness = absence of physical health so same for mental

• review of what ‘good’ mental health characteristics to behave competently and be happy

6 categories:

• Self-attitudes

• Personal growth and self-actualisation

• Integration

• Autonomy

• accurate perception of reality

• Mastery of the environment

• proposes absence of criteria may be sign of mental illness

what are the 6 criteria of ideal mental health and their meanings?

• Self-attitudes: having high self-esteem and strong sense of identity

• Personal growth and self-actualisation: extent to which an individual develops their full capabilities

• Integration: such as being able to cope with stressful situations

• Autonomy: being independent and self-regulating

• Having an accurate perception of reality

• Mastery of the environment: including the ability to love, function at work and in interpersonal relationships, adjust to new situations and solve problems

what are 3 evaluation points of deviation from ideal mental health as a definition for mental illness? (3)

Unrealistic criteria:

• According to criteria most people = identified as having mental illness

• Jahoda presented the ideal criteria - unrealistic for people to have them all

• criteria also quite hard to measure

• Not useful when trying to identify a mental illness

Positive approach so reduces stigma:

• As criteria is unrealistic and means most people would have a mental illness

• This could reduce the stigma as it isn't usual to fulfil the criteria all the time

Cultural relativism:

• Criteria is culture bound

• For example, goal of self-actualising is relevant to members of individualist cultures but not collectivist cultures

• If criteria is applied to those in a collectivist culture there would be a higher level of mental illness 

what is deviation from social/cultural norms def?

• soc/cultural norms = shared beliefs of what is deemed acceptable behaviour in spec group or culture

• Anyone who behaves diff from socially created norms = behaviour could be seen as sign of mental illness

• Standards are often in place for good reason for example politeness, people who aren't polite are considered socially deviant because people find it difficult to interact with them

• Can be implicit or explicit norms

what are some examples of implicit and explicit social norms?

Implicit	Explicit
Politeness Unwritten/spoken Queuing	Laws Legal/illegal Fines Criminal convictions

what are some evaluation points of deviation from social/cultural norms as a def of mental illness? (3)

Susceptible to abuse:

• In past gay or bi relationships were included in the sexual and gender disorders

• Also 50 years ago in Russia, anyone who disagreed with how the state was run was labelled with a mental illness and placed in a mental institution

• Therefore, if mental illness is defined in terms of deviation from social/cultural norms, there is a danger of discrimination or loss of free speech

Deviance is related to context and degree:

• Someone dressed up on Halloween is not seen as breaking social/cultural norms, but if they wore an outfit to a job interview they would be

• Breaking social/cultural norms in itself is not necessarily an indication of mental illness, but the degree to which they do it could be

•  for example, someone who momentarily loses their temper and shouts at someone, but then apologises and returns to being rational, is different to someone who is excessively and persistently shouting loudly in all situations 

• This shows social deviance on its own cannot offer a complete definition of mental illness, because it is inevitably related to both context and degree

Cultural relativism:

• Hearing voices of ancestors is viewed as a spiritual gift in some indigenous cultures but may be flagged as symptoms of psychosis in Western psychiatry 

• This shows how that including cultural differences in diagnostic systems is necessary

• Ignoring these cultural differences can cause misdiagnosis

what is the failure to function def?

• Mental illness can be judged in terms of not being able to cope with everyday living

• Functioning refers to day to day activities (e.g. going out, communicating with people)

• Not functioning adequately can cause distress and suffering for the individual and/or others too

what are some evaluation points of failure to function as def for mental illness? (2)

Failure to consider alternative lifestyles:

• A limitation = doesn’t consider people who live unconventional lives

• Always been people who don’t engage within mainstream society and choose to love a life that better fits their values

• e.g. hippies in the 1960s, digital nomads now

• Not having a home is usually an indication of not coping but this is not the case for those who choose an alternative lifestyle - labelling these people as mentally ill is inappropriate

Subjective experience recognised:

• Positive side: this definition of mental illness does recognise the subjective experience of the patient

• Allows us to view mental illness from the point of view of the person experiencing it

• Also, failure to function is also relatively easy to judge objectively because we can list behaviours (self-dress, prepare meals etc.) and thus judge failure to function objectively

• This definition therefore has a certain sensitivity and practicality

what is statistical infrequency as a def of mental illness?

• Mental illness defined as those behaviours that are extremely rare e.g. any behaviour found in very few people is regarded as a mental illness

• The mean, mode and median are descriptive statistics used to represent the typical value in any data set

• If we can define what is most common than we can also define what is not common or rare

• In statistics, scores that are rare fall into the groups that are over 2 standard deviations from the mean in a normally distributed population and represent about 5% of the population

what is some evaluation points of statistical infrequency as a def of mental illness? (3)

Some rare behaviours are desirable:

• Many statistical infrequent behaviours = desirable

• e.g. very few people have an IQ over 150 but this rare characteristic is desirable not undesirable

• Equally, some 'common' behaviours are undesirable

• e.g. experiencing depression is relatively common

• Therefore, the statistical infrequency definition is limited in its ability to define mental illness because it fails to distinguish between desirable and undesirable behaviours

Cut off point is subjective:

• Fact that cut off points are subjectively determined is a limitation

• Mental illness is defined in terms of infrequency - a decision needs to be made about what constitutes common and rare behaviours

• e.g. one symptom of depression is insomnia or hypersomnia - however, where do we draw the line on how much is too much or too little sleep. Some people may think less than 6 hours a night is rare, others may think cut off should be 5 hours

• Such disagreements mean it is difficult to define mental illness in terms of statistical infrequency

Cultural relativism:

• An issue is that behaviours that are statistically infrequent in one culture may be statistically more frequent in another

• e.g. one symptom of schizophrenia is claiming to hear voices. However, this is an experience that is common in some cultures

• What this means in practice is that there are no universal standards or rules for labelling a behaviour as rare or as a sign of mental illness

define cognitive behavioural therapy

a combination of cognitive therapy (a way of changing maladaptive thoughts and beliefs) and behavioural therapy (a way of changing behaviour in response to these thoughts and beliefs)

define irrational thinking

• rational thinking is flexible and realistic, where beliefs are based on fact and logic

• Irrational thinking is rigid and unrealistic and lacks internal consistency

who came up with cognitive behaviour therapy (CBT)

Ellis

what letters did Ellis use for cognitive behaviour therapy? and what did they stand for? example?

Letter	Meaning	What it means	Example
A	Activating event	Something happens	You get a C in a Psychology test
B	Beliefs	What you think/believe about what happened	“I’m terrible at Psychology. I MUST get an A or I’m a failure.”
C	Consequences	The emotional and behavioural consequences of your belief	You feel very anxious and upset and avoid revising
D	Disputation	Challenge the irrational belief	“Why MUST you get an A? Does one C really mean you’re a failure?”
E	Effective new belief	Replace the irrational belief with a rational one	“I’d like to get an A, but I don’t have to. One C doesn’t define my ability.”
F	New feelings	The healthier emotional/behavioural response	You feel disappointed but motivated to improve and revise

what is a key issue with cognitive behaviour therapy?

remember it's not activating events that cause unproductive consequences - it is beliefs that lead to self-defeating consequences

what does REBT focus on? (Ellis CBT)

challenging and disputing the irrational thoughts/beliefs and replace them with effective, rational beliefs

what is REBT?

a form of cognitive behavioural therapy used by Ellis to help treat depression

what does REBT stand for?

R- rational

E - emotive

B - behavioural

T - therapy

why might patients have ‘homework’ form CBT to help treat depression?

• Clients often asked to complete assignments between therapy sessions

• Might include asking someone out on a date if they had previously been afraid to do so out of fear or rejection

• Homework is vital in testing irrational beliefs against reality and putting new rational beliefs into practice

what is behavioural activation? (CBT treating depression)

• CBT encourages depressed clients to become more active and engage in pleasurable activities

• Based on the idea that activity provides rewards that counteract depression

• Depression often causes people to stop activities they previously enjoyed

• Therapist and client identify pleasurable activities and address cognitive obstacles to participation

what is unconditional positive regard? (CBT to treat depression)?

• Ellis recognised that successful therapy requires convincing clients of their value as human beings

• Feeling worthless makes clients less willing to change their beliefs and behaviour

• Therapist shows respect and appreciation regardless of what the client says or does, facilitating changes in beliefs and attitudes

what is some support for treating depression using the cognitive approach?

Research support:

• Ellis claimed a 90% success rate for REBT, taking an average of 27 sessions to complete the treatment

• REBT and CBT in general, have had good outcomes in studies of depression

• e.g.  A review completed of 75 studies found CBT was superior to no treatment

• However, Ellis recognised therapy was not always effective - suggested could be because some clients didn't put their revised beliefs into action

• Therapist competence also explained a significant variation in CBT outcomes

• Suggests REBT is effective, but other factors relating to both client and therapist may limit its effectiveness

what are 2 evaluation points that don’t support using the cognitive approach to treat depression?

Individual differences:

• CBT more suitable for some then others

• E.g. CBT appears to be less suitable for people who have high levels of irrational beliefs that are rigid to change

• CBT also less suitable in situations where high levels of stress in the individual reflect realistic stressors in the person's life that therapy can't resolve

• Ellis also explained a possible lack of success in terms of suitability - some people don't want direct advice like that those CBT practitioners dispense - they prefer to share their worries with a therapist without getting involved in the cognitive effort associated with recovery

• Therefore, limitation = individual differences in person's level of irrational beliefs or their circumstances or attitudes to advice and its effectiveness.

Alternative treatments:

• Other treatments are available

• Most popular treatment for depression is the use of antidepressants

• Drug therapies = require less effort on the part of the client

• Also can be used in conjunction with psychotherapy such as CBT

• May be useful as client may not be able to focus on demands of CBT and drug treatment could enable them to cope better

• Review by researcher found CBT was especially effective when used in conjunction with drug therapy

• Suggests using both CBT and drugs might be best option

define depression

• a mood disorder where an individual feels sad and/or lacks interest in their usual activities

define obsessive compulsive disorder (OCD)

• an anxiety disorder where anxiety arises from both obsessions (persistent thoughts) and compulsions (behaviours that are repeated over and over again).

• Compulsions are a responses to obsessions and the person believes the compulsions will reduce anxiety

define phobias

a group of mental disorders characterised by high levels of anxiety in response to a particular stimulus or group of stimuli

what are the emotional characteristics of phobias?

• Persistent, excessive and unreasonable fear and anxiety

• Cued by presence or anticipation of a specific object or situation

• Emotions are out of proportion to actual danger posed 

what are the behavioural characteristics of phobias?

• Avoidance that interferes with everyday life - avoid putting themselves in situations where they may encounter phobia or thinking about it (e.g. person with dog phobia may avoid taking their children to the park in case they encounter one) 

• Freeze - adaptive response as predator may think prey is dead

• Fainting

• Panic behaviours

what are the cognitive characteristics of phobias?

• Irrational nature of thinking

• Resistance to rational arguments - e.g. person with fear of flying is not helped by arguments that flying is actually the safest form of transport

• Person recognises fear is excessive or unreasonable (may be absent in children) - distinguishes between phobia and delusional mental illness (such as schizophrenia) where the individual isn't aware of the unreasonableness of their behaviour

what do we mean when we say the ‘emotional characteristics’?

the way we feel

what do we mean when we say the ‘behavioural characteristics’?

the way we act/react

what do we mean when we say the ‘cognitive characteristics’?

the way we think, believe, perceive, remember

what are the emotional characteristics of depression?

• Sadness (most common)

• Feeling empty

• Feelings of worthlessness, hopelessness and/or low self-esteem

• Inappropriate guilt

• Loss of interest and pleasure in usual activities and hobbies

• Feelings of despair and lack of control

• Anger - could be directed at themselves or others, could lead to verbal or physical aggression

what are the behavioural characteristics of depression?

• Tearfulness

• Shift in activity levels (could be increased or decreased) - effects behaviours such as sleep, eating and movement

• May sleep more (hypersomnia) or less (insomnia) than usual

• Eat less or more causing significant differences in body weight

• Movement and speech may be observably slower - may become agitated and compelled to move more than usual

what are some cognitive characteristics of depression?

• Negative thinking  - become automatic or 'normal' even to positive situations

• Negative thoughts are excessive and 'catastrophising' - when a person jumps to the worst possible outcome e.g. thinking there friends hate them as they haven't messaged back quickly

• Irrational thinking - thoughts interfere with the person being happy and free from pain e.g. their partner ends their relationship so they think they are unlovable. They are fuelled by unrealistic expectations of themselves and the world   

what type of disorder is a phobia?

an anxiety disorder

what type of disorder is depression?

mood

what type of disorder is OCD?

anxiety

what are the 2 main parts of OCD and what do they mean?

• Obsessions = persistent thoughts

• Compulsions = repetitive behaviours

what are some emotional characteristics of OCD?

• Anxiety

• Intrusive thoughts (obsessions) = frightening and cause intense distress that feels overwhelming

• Compulsions create anxiety due to repetitive nature which feels uncontrollable

• Low mood - constant cycle of compulsions and obsessions = physically and mentally exhausting

• Low mood = exuberated by guilt at neglecting themselves or others due to time taken with compulsions

• May have insights that their behaviour is irrational and excessive that may lead them to be secretive about their compulsions, feel embarrassed and experience shame and self-loathing

what are some behavioural characteristics of OCD?

• Compulsive behaviours - refers to actions people take to deal with their obsessions (behaviour is repetitive - e.g. obsession on contamination of germs will thoroughly wash and dry hand many times till they feel relief)

• Behavioural element of compulsions = reduce anxiety - anxiety is created by overwhelming feeling to compel to respond to thoughts by performing behaviour

• Avoidant behaviours - e.g. someone obsessed with germs may avoid touching surfaces

what are some of the cognitive characteristics of OCD?

• Obsessions in OCD = persistent, repetitive, intrusive thoughts that cause intense anxiety = key cognitive characteristic

• Common obsessions include thoughts of being contaminated by germs

• May focus their attention (hypervigilance) on the source of their obsession in new situations e.g. if obsession = germs that may show hypervigilance of poor hygiene in everyday environments

• Insight into irrationality of their thoughts/behaviours  - awareness doesn’t prevent compulsions or obsessions

what are the 2 behaviourist ways of treating phobias?

• systematic desensitisation

• flooding

what is the theory behind systematic desensitisation?

• phobias may persist as people with phobias avoid the phobic stimulus and therefore there is no opportunity to learn that their feared stimulus is not so fearful at all

who developed systematic desensitisation?

Joseph Wolpe

what is counterconditioning in systematic desensitisation?

• Basis of the therapy is counterconditioning because the patient is taught a new association that runs counter to original association

• Patient is taught, through classical conditioning, to associate the phobic stimulus with a new response e.g. relaxation instead of fear

• In this way their anxiety is reduced - they are desensitised

• Wolpe also called this 'reciprocal inhibition' because the response of relaxation inhibits the response of anxiety

what is the relaxation part of systematic desensitisation?

• 1st thing therapist does is teach patient relaxation methods

• Relaxation can be achieved by the patient focusing on their breathing and taking slow, deep breaths - slows down our breathing that speeds up when we are anxious

• Being mindful of 'here and now' can help, as well as focusing on a particular object or visualising a peaceful scene

• Progressive muscle relaxation is also used where one muscle at a time is relaxed 

what is the desensitisation hierarchy?

• Systematic desensitisation works by gradually introducing the person to the feared situation one step at a time so it's not overwhelming

• At each stage the patient practices relaxation so the situation becomes more familiar, less overwhelming and their anxiety diminishes

• Works through gradual steps that are determined at beginning of therapy by working out a hierarchy of most to least fearful stimuli

how does systematic desensitisation work?

• Patient practices mediation or other relaxation techniques at first stage of hierarchy till they no longer feel fear at this stage

• Repeat this at each stage of hierarchy till they reach the top

• At this point they’ve replaced their feared response to dogs with one of relaxation

what are 2 evaluation points for systematic desensitisation as treatment for phobias?

Effectiveness:

• SD is effective for a range of phobias; research found around 75% of patients respond to SD.

• Actual contact with the feared stimulus is key, making in vivo exposure more effective than pictures or imagination.

• Combining exposure techniques (in vivo, pictures and modelling) may improve effectiveness.

Not appropriate for all phobias:

• SD may be less effective for phobias with an evolutionary survival component (e.g. darkness or heights) than those acquired through personal experience.

• Suggests SD is only effective for certain phobias.

how does flooding work as a behavioural treatment for phobias?

• Person with phobia is immersed in the experience in one long session, experiencing their phobia at its worst

• Session continues till patient's anxiety has disappeared

• The procedure can be conducted in vivo (actual exposure) or virtual reality can be used

why does flooding work?

• Persons fear response (and release of adrenaline underlying this) has a time limit

• Adrenaline levels naturally decrease, a new stimulus response link can be learned - the feared stimulus is now associated with a non-anxious response

what is 2 evaluation of flooding?

Effectiveness:

• Flooding is effective for those who complete it and is relatively quick.

• One researcher found flooding more effective than SD, while another found them equally effective.

• Supports flooding as an effective treatment for phobias.

Individual differences:

• Flooding can be highly traumatic and isn't suitable for everyone.

• Despite warnings, some patients quit treatment, reducing its effectiveness.

• Individual differences limit flooding's overall effectiveness.

what are 2 evaluation points of behavioural approach to treating phobias as a whole?

Relaxation may not be necessary:

• SD and flooding may work because of exposure to the feared stimulus, rather than relaxation.

• Believing you can overcome your phobia may be the most important factor.

• Research found SD and supportive psychotherapy were equally effective for social and specific phobias.

• Suggests cognitive factors (e.g. positive expectations) may be more important than behavioural therapies acknowledge.

Strengths of behavioural therapies:

• Faster, cheaper and require less effort than CBT.

• Don't require changing thought patterns, making them suitable for children or those with learning difficulties or limited self-insight.

• Can be self-administered; research found this was as effective as therapist-guided therapy.

what is the model we use within the behavioural approach to explain phobias?

the two process model

what is the two process model?

• a theory that explains the two processes that lead to the development of phobias

• they begin through classical conditioning and are maintained through operant conditioning

what is the first stage in the 2 process model (explaining phobias)

classical conditioning - initiation

what is the second stage in the 2 process model (explaining phobias)

operant conditioning - maintenance

what happens during the first stage of the 2 process model (explaining phobias)?

• Initiation by classical conditioning

• Phobia = acquired by association (between neutral stimulus and conditioned response)

• e.g. little Albert with white rat and loud noise: continuously paired rat and loud noise to create a conditioned response to the white rat, now furry object now conditioned stimulus so now associated with fear

• Fear of dogs: being bitten (UCS) creates fear (UCR), dog (NS) associated with being bitten (UCS), dog (now CS) produces fear response (now CR)

• Same steps explain how a person might develop a fear of social situations after having a panic attack in such a situation

what happens during the second stage of the 2 process model (explaining phobias)?

• first step doesn't explain why individuals continue to feel fearful, nor does it explain why individuals avoid the feared object

• Next step = operant conditioning - maintenance

• Likelihood of behaviour being repeated is increased if the outcome is rewarding

• In case of a phobia, avoidance of phobic stimulus reduces fear and is thus reinforcing

• ^example of negative reinforcement

• The individual avoids the anxiety created by, for example, the dog or social situation by avoiding them entirely

what are the 3 evaluation points for the behavioural approach to explaining phobias?

• importance of classical conditioning

• incomplete explanation

• two process model ignores cognitive factors

explain the evaluation point for the behaviourist approach to explaining phobias: importance of classical conditioning

• People with phobias often recall a specific incident when their phobia appeared like being bitten by a dog

• However, not everyone who has a phobia can recall a specific incident - possible traumatic incidents did happen but just have been forgotten

• Sue et al. suggested different phobias may be the result of different processes

• For example, people with agoraphobia were most likely to describe their phobia in terms of a specific incident whereas those with arachnophobia were most likely to use cite modelling as a cause 

• Demonstrates the role of classical conditioning in developing habits, but other processes may involve in their maintenance 

explain the evaluation point for the behaviourist approach to explaining phobias: incomplete explanation

• Research found, for example, not everyone bitten by a dog develops a phobia of dogs

• Could be explained by the diathesis-stress model

• Proposes we inherit a generic vulnerability for developing mental illnesses

• However, an illness will only manifest itself if triggered by a life event, such as being bitten by a dog

• This suggests a dog bite would only lead to a phobia in those people with such a vulnerability, therefore behavioural explanation is incomplete on its own

explain the evaluation point for the behaviourist approach to explaining phobias: two process model ignores cog factors

• There are cognitive aspects to phobias that can't be explained in a traditionally behaviourist framework

• Alternative explanation is cognitive approach, which proposes that phobias may develop as the consequence of irrational thinking

• For example, if a person in a lift may think 'I could become trapped in here and suffocate' (an irrational thought) - could create extreme anxiety and may trigger a phobia