Psychopathology

Psychopathology

• field of stuy that deals with mental, emotional and behavioural problems

• involves research into classification, diagnosis, causation, prevention and treatment of psychological disorders

Statistical Infrequency

• satistical norms = any commonly seen behaviours

• defines behaviour according to how it's observed

• deviation = any unusual behaviour or characteristic that is raely seen is abnormal, behaviour doesn’t fit within the ‘normal distribution

• EXAMPLE: intellectual disability disorder, average IQ = 100,

Evaluation of Statistical Infrequency

• usual characteristics can be positive

  • many abnormal characteristics are desirable

  • e.g. high IQ is statistically abnormal but doesn’t require treatment to return to normal

  • and some undesirable behaviors are common, like depression

  • therefore unable to distinguish between desirable and undesirable behaviours using statistical infrequency

• issues with labelling

  • some people may not benefit from being labelled as abnormal

  • although labelling usually leads to treatment it can have nagtive side effects

  • e.g. someone with low IQ who is not distressed wouldn’t need a diagnosis of intellectual disability

  • therefore labelling them as such may damage their self-view and others’ view of them

• real life application

  • in some situations it is appropriate to use a statistical criterion to define abnormality

  • e.g. it can form a useful part of clinical assessment in diagnosing intellectual disability disorder for those with an IQ two SDs below the mean

  • helps determine severity of symptoms, but should be used alongside another method (e.g. failure to function adequately)

  • suggests statistical infrequency is only one of a number of tools to diagnose mental disorders

• cut off point is subjective

  • limitation is cut off points are subjectively determined

  • if abnormally is defined in terms of statistical infrequency, then we need to decide where to separate normal from abnormal

  • means that such disagreements are difficult to define abnormality 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. hearing voices in UK is likely to lead to diagnosis of schizophrenia, compared to African countries where this is a common experience

  • this means that there are no universal standards or rules for labelling a behaviour as normal

Deviation from Social Norms

• social norms: ways in which most people behave, established by social groups, varies depending on cultural and historical context

• deviation: a behavior different from how society expects people to behave, so behaviour that goes against the unwritten rules of society, antisocial or undesirable behaviour that goes against social norms

Deviation from Social Norms Evaluation

• human rights abuses

  • limitation is in the past some diagnoses were to maintain control over minority ethnic groups and women

  • e.g. drapetomania was previously listed in the DSM as mental illnesses affecting black slaves who ran away, nymphomania described women attracted to working-class men

  • nowadays this classification seems ridiculous as our social norms have changed which suggests that perhaps some modern classifications of mental disorders are abuses of people’s rights to be different

• desirable vs undesirable disorders

  • this definition distinguishes between desirable and undesirable behaviour

  • social deviance definition takes into account the effect the behaviour has on others

  • definition offers a practical way of identifying undesirable/damaging behaviour which may trigger help from others

• context and degree of behaviour

  • a limitation is that judgements of deviance are often related to the context of the behaviour

  • e.g. wearing a bikini at the beach vs at school

  • deviant behaviour is only considered so when it is out of context and behaviour that deviates from social norms isn’t always a sign of mental illness

  • social deviance on its own cannot offer a complete definition of abnormality as it is related to context and degree

• cultural relativism

  • defining abnormality by social norms is bound by culture as social norms are defined by our culture

  • cultural norms change between cultures and over time so we must update our ideas of abnormality to fit with them

  • the DSM-V has been updated to include reference to cultural context in many areas of diagnosis

  • shows that it is possible to address this issue by including different diagnostic systems

Failure to Function Adequately

• failure = unable to cope with everyday life

• not contributing to society adequately

• criteria for diagnosis:

  • obsever discomfort

  • unpredictability

  • irrationality

  • dysfunctional behavior

  • personal distress

  • maladaptive behaviours

FTFA - Rosenhan & Seligman’s Features of Personal Dysfunction

• irrationality = behaviours that cannot be explained in a rational way

• violation of moral standards = behaviours that go against society’s moral standards

• unpredictability = unexpected behaviours, characterised by loss of control, like committing suicide after failing a test

• unconventionality = displaying unconventional behaviours

• personal distress = key feature of abnormality includes depression and anxiety disorders

• observer discomfort = displaying behaviours which makes others uncomfortable, e.g. hoarding

• maladaptive behaviour = behaviours stopping individuals from attaining life goals socially and occupationally

Failure to Function Adequately Evaluation

strengths

• recognises the subjective experience of the patient, allowing us to view mental disorder from the perspective of the person experiencing it

• easy to judge objectively because we can list behaviours (e.g. dress self, prepare meals)

• has practicality and sensitivity as a definition

behaviour may be functional

• dysfunctional behaviour can be adaptive and functional for the individual

• definiton is incomplete as it fails to distinguish between functional and dysfunctional behaviours

who judges?

• someone may be unaware they are not coping or may feel distressed and seek help

• or others may judge the behaviour as abnormal

• unemployment may due to other circumstances rather than failure to function adequately

• limitation of the approach is that judgement is highly subjective

cultural relativism

• limited by being culturally relative

• defining abnormality according o adequate functioning is related to cultural ideas of how we should live our ives

• failue to function adequaltely defintion likely to vary for different cultures as the standard of one culture is being used to measure another

• important as it may explain why lower class and non-white patients are more often diagnosed with mental disorders as their lifestyles are different from dominant culture

Deviation from Ideal Mental Health

• good mental health = a set of criteria including lack of symptoms, independence, realistic view of the world and good self esteem

• deviation = failing to have one of Jahoda’s criteria for good mental health

DIMH - Jahoda’s Criteria for Ideal Mental Health

• resisting stress = having self-respect and a positive self concept (coping)

• accurate perception of reality = perceiving the world in a non-distorted fway with an objective and realistic view of the world

• self-actualisation = experiencing personal growth and development (fulfilment)

• environmental mastery = being competent in all aspects of life and able to meet the demands of any situation, having the ability to adapt to life hanging circumstances (interpersonal relationships)

• autonomy = being independent, self-reliant and able to make personal decisions (independence)

• positive attitude towards oneself = having self-respect and positive self-concept (high self esteem)

Deviation from Ideal Mental Health - Evaluation

• positive approach

  • adopts more positive approach in defining abnormality

  • focuses on ‘ideal’/desirable behaviours rather than undesirable which has influenced the positive psychology movement

  • therefore this definitio ahs played an important role in the development of the humanistic approach in psychology

• unrealistic criteria

  • difficult to fill all criteria

  • some criteria, like environmental mastery is difficult to measure

  • interesting concept but not very usable when defining abnormality

• cultural reltivism

  • Jahoda’s mental health criteria are culture bound

  • e.g. self actualisation more relevant to members of individualistic cultures than collectivist cultures

  • so, if we apply Jahoda’s criteria to those from collectivist cultures, there is likely to be a high incidence of abnormality \

  • limits generalisability to certain groups

Depresion

DSM-5 Classification

• low mood and energy levels

• major depressive disorder: severe but often short-term depression

• persistent depressive disorder: long-term depression

• disruptive mood dysregulation disorder: childhood temper tantrums

• premenstrual dysphoric disorder: disruption to mood prior to and/or during menstruation

Characteristics of Depression

Behavioural (actions)

• changes to usual activity levels = sufferers have reduced energy levels, causes them to feel lethargic and withdraw from work, education and social life

• changes sleep and eating patterns = increase or decrease in appetite and eating, increased or deceased sleep (insomnia or hypersomnia)

• possibly aggression or self-harm

Emotional (feelings)

• lowered mood

• anger

• decline in self-esteem

Cognitive (thoughts)

• poor concentration

• persistent concern: thoughts are biased towards seeing the negative

Physical Symptoms

• sick and run down

• difficulty sleeping

• poor appetite

• muscle pains

• weight loss

• tired

Types of Phobias

• specific phobia = fear of an object or situation

• social anxiety (social phobia) = fear of social situations

• agoraphobia = fear of public places (being trapped)

Phobia Classification

DSM-5 Classification: Specific Phobia

• unreasonable, excessive fear triggered by a specific object or situation

• immediate anxiety response which is out of proportion to the danger presented

• recognition the fear is irrational not required

• avoidance or extreme distress

• phobia is life limiting as it severely impacts the sufferers personal life

• six months or more duration

• not caused by another disorder

Phobia Characteristics

Behavioural (actions)

• crying

• screaming

• running away/avoidance

• failure to function

• endurance

Emotional (feelings)

• fear

• anxiety

• panic

Cognitive (thoughts)

• selective attention/reduced cognitive capacity

• irrational beliefs

• awareness of unreasonable behaviour

• cognitive distortions

Obsessive-Compulsive Disorder (OCD)

DSM-5 Classification

• repetitive behaviour accompanied by obsessive thinking

• OCD: obsessions (reoccurring thoughts) and compulsions (repetitive behaviours)

Types of OCD

• trichotillomania = compulsive hair pulling

• hoarding disorder = compulsive gathering of possessions and the inability to part with anything regardless of its value

• excoriation disorder = compulsive skin picking

OCD Characteristics

Behavioural (actions)

• compulsions to repeat behaviours usually to reduce anxiety

Emotional (feelings)

• anxiety

• depression

• guilt

Cognitive (thoughts)

• recurrent obsessive thoughts accompanied by rituals to cope with the obsession

• sufferers understand the irrationality of their perceived unlikely worst case scenario but still unable to control

Explaining Phobias: Behavioural Approach

According to behavioural approach abnormal behaviours caused by:

• classical conditioning

• operant conditioning

• social learning theory

These theories have been applied to a range of psychological disorders, most notably phobias.

Two-Process Model (Mowrer, 1947): explained how phobias are learned through classical conditioning and maintained through operant conditioning

Classical Conditioning

• first part of two process model

• a phobia is acquired through association

• association between a neutral stimulus and unconditioned stimulus will trigger an unconditioned response

• e.g.

  • neutral stimulus = dog = no response

  • unconditioned stimulus = pain (being bitten)

  • unconditioned response = fear

  • dog + pain (being bitten) = fear

  • conditioned response = fear of dogs

Little Albert

• Watson & Raynor (1920) conducted a laboratory experiment to examine whether a fear response could be learned through classical conditioning in humans

• participant was an 11 month old child called Little Albert

• Watson & Raynor noted he showed no response to various objects, like a white rat

• in order to test if they could create a fear response W&R struck a metal bar with a hammer to create a loud noise every time he went to reach for the rat

• they did this three times

• thereafter when Albert was show the rat he cried

• experiment demonstrated a fear response could be induced with classical conditioning in humans

• Little Albert also developed fear of similar objects like a Santa Claus beard which showed how he had generalised his fear to other objects

Operant Conditioning

• although classical conditioning explains why we develop our phobias it doesn’t explain why they don’t just decay over time and how they are maintained

• according to operant conditioning phobias can be negatively reinforced, this is where a behaviour is strengthened, because an unpleasant consequence is removed

• negative reinforcement = avoiding phobic stimulus reduces fear and results in desirable consequences

Social Learning Theory

• not part of the two process model but is a neo-behaviourist explanation

• phobias may also be acquired through the modelling of the behaviour from others

• e.g. seeing a parent respond to a dog with extremem fear may lead a child to acquire a similar behaviour because the behaviour appears rewarding (i.e. fearful person gets attention)

Evaluation Explaining Phobias Behaviourist Approach

Research Support

• Watson & Raynor (1920) demonstrated the process of classical conditioning in the formation of phobias in Little Albert, who was conditioned to fear white rats

• supports the idea that classical conditioning is involved in acquiring phobias

Application

• behaviourist approach can be applied to therapy

• behaviourist ideas been used to develop effective treatments including systematic desensitisation and flooding

• systematic desensitisation helps people unlearn their fears using the principles of classical conditioning

• flooding prevents people from avoiding their phobias and stops the negative reinforcement from taking place

Importance of Classical Conditioning

• two-process model supported by people recalling when their phobia appeared

• however, not everyone with a phobia can recall such traumatic incidents

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

• demonstrates the role of classical conditioning in developing phobias, but other processes may be involved in their maintenance (e.g. agoraphobics a specific incident, arachnophobes learned through modelling)

Incomplete Explanation for Phobias

• although operant and classical conditoing are involved in the development an maintenance of phobias, there are some aspects of phobic behaviour that require further explaining

• we have biologial preparedness to easily acquire phobias of things hat were a danger to our evoloutionary past (e.g. snakes, heights)

• shows that the two-process model cannot account for biological preparedness which explains why we develop phobias of some stimuli and not others as there is more to acquiring phobias than simple conditioning

• doesn’t take into account other factors

Alternative Explanations for Avoidance

• in more complex behaviour like agoraphobia avoidance behaviour may be motivated by positive feelings of safety

• this explains why some agoraphobics can leave their house with a friend with relatively little anxiety

• problem as the two process model suggests avoidance is motivated by anxiety reduction rather than seeking safety

Ignores Cognitive Factors

• behaviourist explanation been criticised for being too simple and reductionist

• behaviourist approach ignores role of cognition in the formation of phobias and cognitive psychologists suggests that phobias develop as a result of irrational thinking not just learning

• e.g. claustrophobics may think I am going to get trapped in this space and die which is an irrational thought

• cognition approach also led to the development of congitive behavioural therapy (CBT), a treatment which is said to be more successful than the behaviourist treatments

Systematic Desensitisation

• behavioural therapy combining relaxation and gradual exposure to the phobic stimulus

• important that patient remains relaxed a all times through relaxation techniques like deep muscle or progressive relaxation

• anxiety hierarchy constructed from least to most. frightening

• counterconditioning replaces anxiety with relaxation for the phobic stimulus

• reciprocal inhibition impossible to be afraid and relaxed at the same time

Evaluation of Systematic Desensitisation

Effective Treatment

• a strength of SD is that it is effective in treating specific phobias

• Gilroy et al 2003 found successful treatment of spider phobia using SD compared to control group treated by relaxation without exposure up to 33 months following treatment

• shows SD is helpful in reducing the anxiety in spider phobia and that effects are long lasting

Suitable for Diverse Range of Patients

• compared to alternative treatments SD is suitable for diverse range of patients

• e.g. flooding not suitable for children and those with learning difficulties as they may not fully understand what is happening (can’t give informed consent) during flooding or engage in the reflective aspects of CBT

Preferred Over Flooding

• patients often choose SD over flooding as it causes less trauma

• patients may also find talking with therapist during SD to be pleasant

• reflected in the low drop out rates (attrition) for SD compared to flooding

Not Appropriate for all Phobias

• may not be effective in treating all phobias

• Ohman (1975) suggests SD may be less effective in treating ‘ancient phobias’ with an evolutionary element and or effective in treating those acquired through personal experience

• suggests SD can only b used effectively in tackling some phobias, not all

• may only work in therapy situation and not useful in real world

• relies on participant’s ability to create a vivid mental image which some are not able to do so, ineffective for those who can’t

Flooding

• immediately exposing the patient to their phobic stimulus

• longer sessions required, but only one may be needed

• eliminates avoidance behaviour and extinguishes the phobic response untilt hey are calm and fear is reduced

• traumatic experience so patient needs to be well prepared

• uses principles of operant conditioning

Evaluation Flooding

Cost Effective

• can be an effective treatment fro those who stick with it and relatively quick compared to SD

• Choy at al 2007 found both SD and flooding to be effective, but flooding was more effective in treating phobias

Traumatic Experience

• highly traumatic experience so not suitable for every patient

• although patients fully consent to the therapy there is a high drop out rate which ultimately reduces its effectiviness

• individual differences in responding to looding limit the effectiveness of the therapy in the treatment of phobias

Limited Effectiveness

• although flooding is highly effective in treating simple phobias it. is less effective for complex phobias like social phobia

• may be due to the cognitive aspect of social phobias

• this type of phobia may benefit from more cognitive therapies like CBT that tackle irrational thinking

Depression

DSM recognises these categories of depression:

• major depressive disorder = short term but severe periods of low mood

• persistent depressive disorder = long term or recurring depression

• disruptive mood regulation disorder = childhood temper tantrums

• premenstrual dysphoric disorder = disruption to mood before and/or during

• bipolar depression = extreme mood swings, including periods of mania (high energy and elevated mood) and periods of depression (low energy and sadness).

• unipolar depression = persistent and intense feeling of sadness or a lack of interest in external activities

Explaining Depression: Cognitive Approach

• teaches that individuals who suffer from mental disorders have distorted and irrational thinking - which may cause maladaptive behaviour

• it is the way you think about the problem rather than the problem itself which causes the mental disorder

• individuals can overcome mental disorders by learning to use more appropriate cognitions, if people think in more positive ways they can be helped to feel better

• focues on an individual’s negative thoughts, irrational beliefs and misinterpretations of events as being the cause of depression

• 2 main theories as to how faulty cognitions cause depression:

  • Beck’s Negative Triad

  • Ellis’ ABC Model

Beck’s Theory

Explains vulnerability to depression in cognitive terms

• faulty information processing = selective attention to the negative aspects of situations, black and white thinking

• negative self schemas = affects how we interpret any new information

• negative tried = 3 kinds of automatic negative thinking world, self, future

Beck’s Negative Triad

Beck’s Negative Triad

Cognitive Biases/Faulty Information Processing

• Beck believed that people who are depressed make fundamental errors in logic

• Beck proposed that depressed people tend to selectively attend to the negative aspects of a situation and ignore the positive aspects

• tendency to blow small prob;ems out of proportion with thinking in terms of black and white and ignoring the middle ground

• they are prone to distorting and misinterpreting information, a process known as cognitive bias

• two types of cognitive bias include:

  • over-generalisation = make a sweeping conclusion based on a single incident

  • catastrophising = exaggerating a minor setback and believing it’s a complete disaster

Negative Self Schemas

• a schema is a building block of knowledge, a ‘package of ideas and information that has developed with experience

• self-schema is a package o ideas that we have about outre;ves

• people who have become depressed have developed negative-self schemas and therefore they interpret all information about themselves in a negative way, which may lead to cognitive bias

• these schemas may come from negative experiences, like criticism

Weissman and Beck (1978)

• AIM: to investigate the thought process of depressed people to establish if they use negative schemas

• PROCEDURE: thought processes were measured using dysfunctional attitude scale (DAS). participants were asked to fill in a questionnaire by ticking whether they agreed or disagreed with a set of statements.

• FINDINGS: depressed particiapants amde more negative assesmentsthan non-depressed people. when given some therapy to challenge and change their negative schemas there was an improvement in their self-ratings

• CONCLUSION: depression involves the use of negative schemas

Negative Triad

• Beck built on the idea of maladaptive responses and suggested that people with depression become trapped in a cycle of negative thoughts

• they have a tendency to view themselves, the world and the future in pessimistic ways - the triad of impairments

• cognitive biases and negative self schemas maintain the negative triad, a negative and irrational view ourselves, our future an the world.

• for sufferers of depression, these thoughts occur automatically and are symptomatic of depressed people

Ellis’ Theory

• the ABC model = irrational beliefs make us overreact to events and get depressed

• A-Activating Event = a negative life event

• B-Beliefs = irrational interpretations of A make us overreact to the life event

• C-Consequences = emotional and behavioural outcome is depression

Ellis’ ABC Model

• ellis proposed that good mental health is a result of rational thinking

• ellis argued that there are common irrational beliefs that underlie much depression and sufferers have based their lives on these beliefs

• ellis argued that the source of irrational beliefs lies in musturbatory thinking = certain ideas or assumptions must be true in order for an individual to be happy, 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

Evaluation Ellis’ Theory

Partial Explanation

• ellis’ model only describes reactive depression triggered by life events

• not all depression has an ‘activating event’ and can arise without an obvious cause

Practical Application

• led to succesful therapy (REBT)

• challenging irrational negative beliefs reduces depression and supports the model

• Lipskey et al (1980) found a correlation between difference in beliefs and changes in emotional distress

Doesn’t Explain all Aspects of Depression

• doesn’t explain anger, hallucinations and delusions that some patients experience

Evaluation Beck’s Model

Supporting Evidence

• view that depression is linked to irrational thinking is supported by research, Hammen and Krantz 1976 found that depressed participants made more errors in logic when asked to interpret written material than non-depressed participants

• Grazioli & Terry (2000) found pregnant women high in cognitive vulnerability were more likely to suffer PND

• Clark & Beck (1999) found evidence of cognitive vulnerabilities before depression developed

Practical Application

• explanation forms the basis of CBT (cognitive behavioural therapy) - a successful therapy

• all cognitive elements (negative triad) of depression are identified and challenged by the therapist

Incomplete Explanation

• doesn’t explain all elements of depression which is complex and has other symptoms e.g. anger, hallucinations, bizarra beliefs

Overall Evaluation

Narrow Explanation

• doesn’t take into account biological or genetic factors and so is reductionist

Blames the Patient

• overlooks situational factors which could be key, like major life events

Cause and Effects is Unclear

• unlcear which comes first, develop negative way of thinking due to depression or depression due to negative thinking

Not all Irrational Beliefs are Irrational

• Alloy and Abrahamson (1979) found that depressed people gave more accurate estimates of likelihood of disaster than normal control participants

• A + A proposed that depressed people are actually realists and see things how they really are

Alternative Explanations

• the biological approach to understanding mental disorders suggests that genes and neurotransmitters may cause depression

• the success of drug therapies for treating depression suggest that neurotransmitters do play an important role; the medication alters the levels of specific neurotransmitters and reduces the symptoms

• diathesis-stress approach suggests that people with genetic vulnerability for depression are more prone to the effects of living in a negative environment which then leads to negative irrational thinking

Treating Depression - CBT

• CBT most common psychological treatment for depression

• method for treating mental disorders based on both cognitive and behavioural techniques

• therapist aims to make the client aware of the relationship between thought, emotion and action

• it is a way of talking (psychotherapy) about:

  • thoughts on self and other people

  • how actions effect your thoughts and feelings

• from cognitive view therapy aims to change the way someone thinks, challenging negative thoughts

• therapy also includes behavioural techniques like behavioural activation with encourages patients to engage in activities they were avoiding, and coping mechanisms which therapists use role play to imagine acting out in real life

• when these parts of the sequence are clearly outlined and understood they can be changes so CBT helps break the cycle of maladaptive thinking, feelings and behaviour

Cognitive Approach to Treating Depression

Cognitive-Behaviour Therapy (CBT)

• most commonly used treatment for depression

• combines. cognitive and behavioural techniques

• cognitive element:

  • assessment - client and therapist identify problems and set goals

  • plan is put in place

  • identify negative and irrational thoughts

• behavioural element:

  • work to change unhelpful thought patterns and put more effective behaviours in place

• other key elements

  • homework: clients are asked to complete assignments between therapy sessions

  • behavioural activation: encourage patient to be more active and engage in enjoyable activities

  • unconditional positive read: non-judgemental relationship between client and therapist, therapist provides respect and appreciation regardless of what the client says and does

Beck’s CBT:

• identifies the negative triad

• challenges negative thoughts

• homework set to record positive experiences to use in therapy to demonstrate reality

  1. client assessed to discover the severity of their condition

  2. therapist will establish a baseline prior to treatment to help monitor improvement

  3. identify the negative triad and make client aware of the relationship between thought and emotion

  4. challenging negative thoughts by making clients aware of them, then replacing them with more optimistic and rational beliefs through process of reality testing

Ellis’ CBT Rational Emotive Behaviour Therapy (REBT):

• talking therapy that extends the ABC model

• identifies and disputes irrational thoughts (rational confrontation)

• replaces them with more effective ones

• results in new feelings being produced

• REBT is based on the premise that whenever we become upset it is not the events taking place in our ,ives that upset us; it is the beliefs that we hold that cause us to become depressed

• Ellis believed that irrational beliefs make impossible demands of the individual, leading to anxiety

• central technique of REBT is to identify amd dispute patient’s irrational negative thoughts. Ellis identified 3 different types of disputing:

  • logical disputing: “does this thinking make sense?” client’s self defeating beliefs don’t logically follow the information available

  • empirical disputing: “is there proof to support this belief? client’s self defeating beliefs are not consistent with reality

  • pragmatic disputing: “how useful is this belief?” self defeating beliefs are not useful

Newark et al 1973

AIM: to discover if people with psychological problems had irrational attitudes

METHOD: two groups of participants were asked if they agreed with the following statements identified by Ellis as irrational:

a) it is essential that one be loved or approved by virtually everyone in the community

b) one must be perfectly competent, adequate and achieving in order to consider oneself worthwhile

one group consisted of people with diagnosed anxiety. the other group has no psychological problems, defined as normal

RESULT: total of 65% of the anxious participants agreed with statement a) compared to 2% of non-anxious participants. b) 80% of anxious participants agreed, compared to 25% of non-anxious participants

CONCLUSION: people with emotional prolems think in irrational ways

CBT Evaluation

STRENGTHS

• effective in reducing symptoms and in preventing relapse

• John March et al (2007) found CBT to be as effective as drugs in treating depression

  • compared CBT and drugs alone then together

  • 327 adolescents, after 36 weeks 80% CBT, 80% drugs and 85% for both significantly improved

  • showed CBT to be as effective as drugs and more so when use alongside

• CBT first choice for treatment for depression in NHS

• clients learn to understand themselves and use skills learned in new situations

• patient can take active role in their recovery

WEAKNESSES

• CBT may not work in severe cases as patient may be unmotivated and unfocused during sessions to deal with cognitive demand of CBT, may need drugs first to keep them focused and alert, limitation of CBT as cannot be sole treatment for depression in all cases

• over emphasis on cognition, minimises importance of individual’s real life circumstances

• CBT focuses on here and now but some patients may have issues in their past they want to discuss, therefore find the present-focused approach frustrating and unhelpful

• doesn’t take into account social circumstances, not all depression stems from irrational beliefs or one specific activating event, but rather prolonged poor environment e.g. domestic abuse, CBT ineffective at treating these patients

• Rosenzweig (1936) suggested small differences between therapies mean success isn’t determined by technique but rather quality of relationship with therapist

• CBT takes longer than drugs and is more expensive, higher attrition rates

Economic Implications of CBT

• when people g to work more is contributed to the economy through taxes but when people don’t. go to work less tax is paid

• less time of work due to illness means less sick pay paid by employer

• absence from work costs the economy roughly £15 billion a year, most of this due to mild struggles with mental illness

• improvements in psychological health/treatment programmes mean people manage their health better, less likely to relapse and take less time off work which reduces cost to the economy

• influential scientific research findings may increase investment from overseas companies into the UK, boosting the economy

• individuals who are happier are more productive

• providing effective treatments could be a financial burden to the NHS