clinical AO1

what is a frequently used system for classifying and diagnosing mental illnesses?

DSM-5

what are the 4 definitions of abnormality?

• statistical infrequency

• deviation from social and cultural norms

• failure to function adequately

• deviation from ideal mental health

what does statistical infrequency say?

behaviour that is common is normal, behaviour that is uncommon is abnormal

what does deviation from social and cultural norms say?

behaviour that goes against the unspoken rules of society is abnormal and a sign of poor mental health

deviation from social and cultural norms example

antisocial personality disorder- diagnosis includes a judgement about behaviour breaking social/cultural norms on moral standards

what does failure to function adequately say?

if a person cannot cope with the demands of everyday life that is an indicator of poor mental health

what is Rosenhan and Seligman’s criteria for failing to function adequately?

fail to function if…

• experiencing personal distress

• their own behaviour is dangerous or irrational

• behaviour is unpredictable and causes discomfort to others

what’s another way that failure to function adequately could be measured?

GAF scale (global assessment of functioning)

what does deviation from ideal mental health say?

behaviour that differs from criteria of good mental health is an indicator of poor mental health

who came up with the criteria of ideal mental health?

Jahoda

what are the 6 parts of Jahoda’s criteria of ideal mental health?

• positive attitude towards the self

• self actualisation

• personal autonomy

• resistance to stress

• environmental mastery

• accurate perception of reality and self

why is the amount of deviation important in deviation from ideal mental health?

the more deviation from ideal mental health criteria, the more likely you are to have poor mental health

what are some emotional characteristics of phobias?

• anxiety

• fear

• (unreasonable)

what are some behavioural characteristics of phobias?

• panic

• avoiding behaviour

• enduring behaviour

what are some cognitive characteristics of phobias?

• selective attention (unable to move attention away from the stimulus)

• irrational beliefs

• cognitive distortions

looking at phobias through a…

behaviourist perspective

phobias are learnt through…

classical and operant conditioning

the two process model for phobias

phobias are learnt through classical conditioning and then they are maintained by operant conditioning

how are phobias acquired through classical conditioning?

• US leads to an UR

• NS = phobic stimulus

• NS is paired with US

• NS becomes CS

• UR becomes CR

• CS leads to a CR

• phobia can then be generalised from the phobic object to a similar object

what’s an example of generalisation of phobias?

Little Albert study- his fear of the fluffy white rat generalised to other fluffy white things e.g. santa’s beard

how are phobias maintained through operant conditioning?

negative reinforcement- avoiding the phobic object leads to relief (removal of the negative stimulus) and therefore the behaviour is repeated

What are the 2 ways to treat phobias?

Systematic desensitisation and flooding

What is flooding?

Exposing people with a phobia to their phobic stimulus without gradual buildup.

How does flooding work?

• sessions often last 2-3 hours, but you only need 1 or 2

• without the option of avoidance behaviour, the client learns that the stimulus is harmless- this is called extinction

• stops phobic responses very quickly

What is systematic desensitisation?

A behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning- if a person can learn to relax in the presence of the phobic stimulus then they will be cured

What’s the learning of the different response I’m systematic desensitisation called?

Counter conditioning

What are the three processes involved in SD?

• Anxiety hierarchy

• Relaxation

• Exposure

Stages of SD- the anxiety hierarchy

• Put together by the client and the therapist

• List of situations related to the phobic stimulus that cause anxiety in order from most frightening to least frightening

Stages of SD- relaxation

• Therapist teaches the client relaxation techniques

• It’s impossible to be relaxed and anxious at the same time- this is called reciprocal inhibition

• Relaxation can be achieved by visualisation or breathing, or with drugs such as Valium

What’s the word that describes how you can’t be anxious and relaxed at the same time?

Reciprocal inhibition

Stages of SD- exposure

• Client exposed to phobic stimulus while in a relaxed state

• Takes place across several sessions, starting at the bottom of the anxiety hierarchy

• When the client can stay relaxed in the presence of the lower levels of the phobic stimulus, they move up the hierarchy

When is SD successful?

When the client can stay relaxed in situations high on the anxiety hierarchy.

What are the emotional characteristics of depression?

• Lowered mood

• Anger

• Lowered self esteem

What are the cognitive characteristics of depression?

• Poor concentration

• Attending to and dwelling on the negative

• Absolutist thinking

What are the behavioural characteristics of depression?

• Activity levels

• Disruption to sleep and eating behaviour

• Aggression and self harm

What are the two cognitive explanations to depression?

Becks negative triad and Ellis’s ABC model

Explaining depression- Beck and depression

It’s a persons cognitions that create this vulnerability e.g. the way they think

What are the three parts of cognitive vulnerability that Beck suggested?

• Faulty information processing

• Negative self schema

• The negative triad

Beck- faulty information processing

Attending to the negative aspects of a situation and ignoring positives- black and white thinking where something is either all bad or all good

Beck- negative self schema

interpreting all information about themselves in a negative way (can be caused by childhood events such as loss of a parent or criticism by parents)

Beck- the negative triad

• negative views about the world

• negative views about oneself

• negative views about the future

ABC model- what did Ellis say about good mental health?

it is the result of rational thinking

what does the ABC stand for in Ellis’ ABC model?

A- activating event (triggers)

B- belief (irrational beliefs)

C- consequence (what you feel)

ABC model- what do the irrational beliefs trigger?

the response, not the event itself

what is the cognitive approach to treating depression?

CBT

what are the two types of CBT used to treat depression?

• Beck’s cognitive therapy

• Ellis’ rational emotive behaviour therapy (REBT)

aim of Beck’s cognitive therapy

identify and challenge negative thoughts about the world/self/future (negative triad)

what does Beck’s cognitive therapy involve?

reality testing- client as a scientist, investigating the reality of negative beliefs like a scientist

what’s the aim of Ellis’ REBT?

identify and challenge irrational thoughts

what does Ellis’ REBT involve?

• empirical argument- is there evidence for the belief?

• logical argument- does it follow from facts?

• overall vigorous argument

what is OCD made up of?

obsessions (irrational intrusive thoughts) and compulsions (repetitive behaviours done to make you feel better)

what are the emotional characteristics of OCD?

• anxiety

• depression

• guilt

• disgust

what are the behavioural characteristics of OCD?

• compulsive, repetitive behaviour

• avoiding common behaviours (e.g. shaking hands)

what are the cognitive characteristics of OCD?

• obsessive thoughts

• catastrophic thoughts

• heightened awareness/alertness

what are the 2 parts of the biological explanation for OCD?

• it runs in families and is passed on via genes

• it is caused by the actions of specific neurotransmitters in particular areas of the brain

genetic explanations for OCD- Lewis

• genes are involved in individual vulnerability to OCD

• 37% of ppts with OCD also had parents with OCD

• 21% of ppts with OCD also had siblings with OCD

genetic explanations for OCD- diathesis stress model

certain genes make certain people more likely to develop OCD, however, some environmental stress is necessary to trigger the condition

genetic explanations for OCD- candidate genes

• some of the genes identified that create vulnerability to OCD are involved in regulating the development of the serotonin system

• OCD seems to be polygenic- 230 genes may be involved

• OCD is aetiologically heterogenous (origins of OCD vary between people)

neural explanations of OCD- what are the genes associated with OCD likely to effect?

levels of key neurotransmitters as well as structures in the brain

neural explanations of OCD- which neurotransmitter is involved and what does it do?

serotonin, which is believed to regulate mood

neural explanations of OCD- how might serotonin cause OCD?

if a person has low levels of serotonin then normal transmission of mood relevant information doesn’t take place and a person may experience low mood- some OCD is explained by a reduction in functioning of the serotonin system

neural explanations of OCD- parahippocamapal gyrus

associated with processing unpleasant information and in some cases of OCD it functions abnormally

what is used in the biological approach to treating OCD?

antidepressants are used to increase/decrease levels of neurotransmitters in the brain to increase/decrease their productivity

what is the name of the antidepressant commonly used to treat OCD?

SSRI’s

how are SSRI’s used to treat OCD?

• block the reuptake of serotonin at receptor sites, increasing concentration at the post-synaptic membrane, this artificially increases serotonin levels

how are SSRI’s given to patients?

• dosage varies

• capsules or liquid

• 3-4 months daily use needed for them to impact symptoms

what might be prescribed if SSRI’s don’t work?

• tricyclics, which have the same effects are SSRI’s but have more severe side effects

what is prescribed as a second line of defence if SSRI’s don’t work?

• SNRI’s, which inhibit the re-uptake of both serotonin and noradrenaline

what can be prescribed to combat the anxiety caused by obsessions?

anti-anxiety drugs such as Xanax, which slow down the activity of the neuron, making the person feel more relaxed

biological approach to treating OCD- combining treatments

• drugs often used with CBT to treat OCD

• drugs reduce emotional symptoms which mean people can engage with OCD more successfully

• other drugs can be prescribed alongside SSRI’s

• some patients respond to CBT alone with no drugs