Clinical Psychology and Mental Health

What is Ellis’ ABC model?

Albert Ellis proposed that the key to mental disorders such as depression lay in irrational beliefs. In his ABC model:

• A refers to the activating event (e.g. being broken up with by your partner)

• B is the belief caused by the event (e.g. believing you are unlovable)

• C is the consequence of that belief (e.g. depressions)

What is mustabatory thinking?

Musturbatory thinking is thinking that something must happen (e.g. get full marks in the next test) to be worth something as a person.

Ellis identified the three most important irrational beliefs.

• I must be approved of or accepted by 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 Beck’s negative triad?

Aaron Beck believed that depressed individuals feel as they do because their thinking is biased towards negative views of the world.

Negative schemas and cognitive biases maintain what Beck calls the negative triad, a pessimistic and irrational view of three key elements in a person’s belief system:

• The self: e.g I am worthless and nobody wants to be around me.

• The world: e.g My life around me is terrible, everyone else prefers other people.

• The future: e.g I will never improve, things will never get better.

How does a negative schema explain depression?

We develop a nagative schema in our childhoods due to critism from parents, peers, and/or teachers.

When we encounter new experinces that have similar circumstances to the orginal critisisms the negativ schemas activate.

Negative schemas lead to systematic cognitive bias in thinking, leading to irrational conclusions about self worth over one small piece of criticism. For example, I failed this test so I fail every other test in the future.

How does cognitive behaviour therapy (CBT) work?

Developed by Beck focuses on challenging irrational thoughts.

• Thought catching - client writes down thoughts in a journal and therapist and client ‘catch’ irrational ones

• Client is given homework to challenge these irrational thoughts and collect evidence that does so - E.g. if the thought is nobody likes me they tally everytime someone starts a conversation with them or compliments them.

What is ‘deviation from mental health’?

6 distinct caterogies, if an indiviudal does not meet all of them they are considered mentally unwell. Jehoda defines these 6 categories:

• Good self-image

• Strive for self-actualisation

• Independent

• Able to adapt to environment

• Ability to cope with stress

• Having an accurate perception of reality

What is ‘failure to function adequately’?

If an individual is not able to carry out every day activites such as, eating, going to work, maintaining hygiene, they are considered mentally unwell.

What is ‘statistical infrequency’?

People who fall on either extreme of a statistic are considred mentall unwell, for example, if someone has a rarely and unusally high level of anxiety.

What is ‘deviation from social norms’?

If people stray from the societal expectations put on them for example, having a lot of tattoos, or walking around in shorts and t-shirt in freezing whether, they are considered mentally unwell. Norms = what is acceptable not what is most common.

What are the 4 definitions in the field of mental health?

• Deviation from social norms

• Failure to function adequately

• Ideal mental health

• Statistical infrequency

Evaluate deviation from social norms.

STRENGTHS

• Real life application in diagnosing antisocial personality disorder

• Flexible to include other variables such as place (it is normal to wear a bikini at the beach but not while shopping) and age (it is normal to drink out of a baby bottle if you are a baby but not if you an adult)

WEAKNESSES

• Who decides if deviating from social norms is a sign of mental illness, for example, some deviations like full body tattoos might just be self expression.

• It is culturally subjective - A deviation might be socially unacceptable in one culture but completely fine in another. If it is a sign of mental illness in one cultures does that mean the entire other culture where it is normal is mentally unwell? Therefore it is subjective

• Social norms change over time, for example, homosexuality used to be considered a mental illness but now it is widely accepted. This means that other deviations we consider a sign of mental illness might be completely accepted in the future.

Evaluate ideal mental health

STRENGTHS

• Has a positive outlook focusing on what is helpful and desirbale.

• Offers a more holisitc view point, considering lots of different aspects such as enviroment, mental state, life-style etc

• Clear and focused for diagnosis with a select 6 categories, making it less subjective than other definitions

• Allows the assessment of the degree of mentall illness (the more categories the individual does not meet the more severe their mental illness is considered to be)

WEAKNESSES

• Some of the critiria are vague and difficult to define

• Achieving all 6 categories is almost impossible and unfeasible meaning that a huge majority would be considered mentall unwell when they might actually be

• Some categories are not applicibale to all cultures, for example collectivist cultures depend on and help each other, so the independence categorie is not regularly met, however this doesn’t mean they are all mentall unwell.

Evaluate statistial infrequency

STRENGTHS

• Objective - using statistics and and data means it can not be biased

• Takes into account the entire population of a characteristic allowing a wide overview of the big picture

WEAKNESSES

• A rare/statistically infrequent characterisitc might actually be desirable or neutral and not a sign of mentall illness (for example, a high IQ or ginger hair)

• Inflexible - States that top and bottom 2.5% of population are considered ‘mentall unwell’. However, statistics such as OCD do not match this, (it is thought that roughly 3% of the population suffer with OCD)

Evaluate failure to function

STRENGTHS

• Takes into account the patients distress even though it is difficult

• Global Assessment of Functioning scale - Ability to function is measurable on a specific scale

• Behaviour to determine mental unwellness is observable, easy to understand/see - e.g. not being able to get up in the morning

WEAKNESSES

• Some people who are mentally unwell e.g. depression, Harold Shipman/psychopaths are able to function adequately

• Lifestyle and challenges within life vary - for example, someone may not get up due to a different body language but can still function. Alternatively, some people may have incredibly challenging lives that they are not able to deal with, however, this does not always mean they are mentally unwell. Therefore the definition is unclear.

What are the emotional, behavioural and cognitive characterisitics of phobias?

EMOTIONAL - Persistant fear, anxiety or panic

BEHAVIOURAL - Avoidance, fight/flight/fear

COGNITIVE - Irrational thoughts about phobic stimulus, knows their fear is irrational

What are the emotional, behavioural and cognitive characterisitics of depression?

EMOTIONAL - Feelings of despair and hopelessness, lack of pleasure in normal activities, lack of self esteem and worthlessness, possible feelings of anger

BEHAVIOURAL - Change in activity level/sleep/appetite

COGNITIVE - Negative thoughts about themselves, the world, the future, thinking they are worthess, negative thougths are irrational and do not reflect reality

What are the emotional, behavioural and cognitive characterisitics of OCD?

EMOTIONAL - Feelings of panic, disgust, embaressment and shame

BEHAVIOURAL - Compulsions, obsessive ritualistic like habits/behaviours

COGNITIVE - Unwanted intrusive thoughts, obsession on certain themes of thoughts (e.g. germs)

How does the cognitive approach explain depression?

Depression is caused by faulty cogntive function/thoughts, which lead to negative irrational views/beliefs about the world, the future, and the self.

• Ellis’s ABC mocel + Mustabatory thinking

• Becks negative triad + Negative schema

Evaluate the cognitive approach to explaining depression

STRENGTHS

• Research evidence to support it (particularly irrational logic) - Hammen and Krantz (1976) found that articipants with depression made more errors in logic when interpretating a written material than those without - Bates et al (1999) found that automatic negative thought statements made patients with depression more depressed - Shows there is a link between negative thoughts and depression although only a correlation not that one causes the other

• SOTIVOT - Success of treatment (CBT) - Ellis claimed 90% effective for patients who underwent 27 sessions - Cuijpers et al (2013) found that CBT is the best treatment for depression especially when in conjuction with drug therapies (WEAKNESS - However there are 10% who it didnt work for)

WEAKNESS

• Blames the patient rather situaltional factors - Benefits of this is it places the power of recovery with the patient but might overlook other reasons for depression such as situational factors - if other factors that are the real cause are over looked this might make treatment difficult

• Not all irration thoughts are irrational - Alloy and Abramson (1979) found that participants with depression were more able to accuratly predict the liklihood of a disaster - sadder but wiser effect - people with depression may not see the world through ‘rose coloured glasses’ as others might. - This suggests that irrational thoughts are not the cause or problem of depression

• REDUCTIONIST - It reduces the cause of an incredibly complex illness into one factor - irrational thinking/faulty cognition. This ignores other valuable and valid factors. - For example, the biological approach, situaltional factors of the diathesis-stress model (individuals are more genetically prone to depression e.g. low levels of serotonin, and enviroment factors activate this - this consideres more than one factor.

Outline how Rational emotional behaviour therpay (REBT) works.

A form of CBT developed by Ellis, also challanges irrational beliefs through:

• The DEF model: D - Dispute irrational thoughts, E - Effective new rational beliefs, F - Feelings are changed.

• Ellis categorised three ways of disputeing irrational thoughts, Logical - do they make sense? Empirical - is there any evidence to support them? Pragmatic - are they helpful?

• Homework - Similar to CBT, patients are given homework to challenge irrational beliefs - by asking someone on a date, asking to hang out with friends.

• Behavioural action - Patients are encouraged to partake in activites that they enjoy, this will lead to ‘reward’ systems being activated and improve mood.

• Unconditional positive regard - The therapist must always have and show respect for the client no matter how well the treatment is going etc. This will encourage the patients to see their worth as a human being

Explain the cogntive approach to treating depression

The cognitive approach focuses on challenging the irrational thoughts of the patient:

• CBT

• REBT

• Homework

• Behavioural action

• Challening irrational beliefs

• Unconditional positive regard

Evaluate the cognitive approach to treat depression

STRENGTHS

• Success rate - Eliis claimed REBT was 90% effective for pateints with depression that had 27 sessions - However there are 10% who it dintk work for - He also claimed that any variation is success was due to pateints not actively participating in it, putting in effort, challenging irrational beliefs, and enacting new rational beliefs. He also said variation could be due to therapists performing the treatment wrong

• Evidence support for behavioural action - Babyak et al (2000) found that (of 156 pateints split into three groups) groups that underwent excerise as therapy were much less likely to relapes than the group that only underwent drug therapy. - This suggests behvioural action is indeed influential in changing emotional and cognitive thinking.

WEAKNESSES

• CBT is not suitable for all patients - Elkin et al (1985) CBT has been found less effective for those who have more rigid beliefs that are not easily changed, and those who’s depression might becaused by realisitc stressors as situational factors (Simmons et al 1995)

• Alternative treatments - Other treatments such as drug therapies (SSRIs) are avaiable that are cheaper, easier to administer, and take less effort - these might be more suitable for some patients - Cuijpers et al (2013) found that CBT was most effective while in conjunction with drug therpaies - this suggests there are other factors than faulty cognition that cause depression and therefore other treatments that can be effective.

• Dodo bird effect - Larborsky meta analysis of 100 different psychotherapies and found little difference in effectiveness - This suggests that the exact procedures of CBT don’t really have a huge importance in the treatment, rather similarlites such as a sympathetic person to talk to are most helpful - undermines CBT

Outline the biological approaches explanation for OCD

Explanation for obsessions

• A normal SERT gene controls the reuptake/transportation of serotonin

• A faulty SERT gene leads to the reuptake of serotonin happening too quickly - and lower levels of serotonin

• Serotonin is inhibitory, so too low levels leads to an over active ortibofrontal cortex

• In people with OCD the caudate nucleus which is repsonsible for suppressing unwanted thoughts faulters and does not suppress them anymore

• This leads a singal to be sent to the thalumus singalling worry

• This worry singal is then sent back to OFC causing a worry circuit

Explanation for compulsions

• A normal COMT gene is responsible for making the enzyme for breaking down dopamine that’s in the synapse for reuptake

• A faulty COMT gene leads to less of this enzyme, a slower reuptake, and higher levels of dopamine in the synapse

• Dopamine is related to ‘rewards’ and so playing into the worry/ fear you have will give someone with OCD a large ‘dopamine hit’.

• These high levels of dopamine can also lead to an over active basal ganglia which is responsible for movement, and judgement, decinding whther we act on something or not

• Therefore, acting on a compulsion is more likely for someone with OCD

Evaluate the biological approach to explain OCD

STRENGTHS

• Evidence from twin and family studies - Nestadt et al (2000) found that concordance rate for OCD in monozygotic twins was 68% whereas for dizygotic twins it was 31%. They also found it was 5 times more likely to have OCD at some point in their lives if one of their first degree relatives had it was well.

• Evidence for genetic role from other disorders - Pauls and Leckan (1986) found that OCD is one form of expression from the same gene that sauses Tourettes, and that obsessional behaviour found in Tourettes and OCD is also found in children with autism who displayed steroetypical ritualistic behaviours - This supports the genetic role in OCD and the view that there is not one specifc gene for OCD

• Research evidence to support role of brain areas, genetics and neurotransmitters - Menzies et al (2007) found that people with OCD AND their family members had reduced grey matter in areas of the brain such as OFC (linked to OCD)

• SOTIVOT - Choy et al found that most patients said their symptoms improved with treatment of SSRI.

WEAKNESSES

• If OCD was purely genetic then the concordance rate for monozygotic twins should be 100% - the fact it isn’t suggests there is another factor, for example, enviromental factors (diathesis-stree model)

• Alternative explanations - The two-process model from the behaviourist approach explains obsessions as being leartn through classical conditioning (from a traumatic event for example) and reinforced by operant conditioning (through rituals and avoidance) - Supported by success of exposure and response prevention therapy which is similar to systematic desinsitisation.

Outline the biological approach to treat OCD

Antidepressents

• SSRIs - Selective serotonin reuptake inhibitors - Block reuptake channels for serotonin to increase level in synapse - his has a calming effect as serotonin is inhibitory (e.g. prozac)

• Trycyclics - Blocks reuptake channels for serotonin and noradrenaline to increase levels in the synapse - calming effect (e.g. anafranil)

Anti-anxiety

• Benzodiazepines - Enhance the action of GABA - GABA has a general inhibitory effect on neurons as it increases flow of chlorine ions which make it harder for other NTs to stimulate neuron (e.g. xanax, valium)

Other drugs

• Antibiotics - D-cycloserine - appears to enhance the transmission of GABA

Evaluate the biological approach to treat OCD

STRENGTHS

• Research support - Soomro et al (2008) found that SSRIs were more effective than placebos in treating OCD but only short term - shows biological factors to influence OCD

• Preferred over other therapies - Drug therapies suc as SSRIs and tricyclics are easier to administer, cheaper, take less time and effort - therefore they are more suitable for some patients

WEAKNESSES

• Side effects - SSRIs (nausea, headaches, insomnia), tricyclics (irregular heartbeat, hallucinations - side effects tend to be more common than for SSRI), Benzodiazepines (aggression, memory inpairment, addiction which can lead to over does - therefore only should use for max 4 weeks)

• Not a long lasting cure/treats symptoms rather than cause - Maina et al (2001) found that patients would relapse within a few weeks off of medication - Koran et al (2007) suggested that psychological therapies should be used first e.g. CBT

• Publication bias - Turner et al (2008) foud that positive results were more likely to be published and non-positive results were published in a way that seems positive - research is often funded by drug companies who would benefit from positive results - Therefore, some evidence in support might not be reliable