psychpathology

4 ways of defining abnormal behaviour

deviation from social norms, failure to function adequately, deviation from ideal mental health, statistical infrequency

Social Norms

the expected, acceptable and desirable behaviours within a society

Deviation from social norms

behaviour that violates (does not conform to) social norms within a society i.e laughing at a funeral is wrong

Strengths of the deviation from social norms definition (2)

- Generally ensures that people get help because its obvious to others in society that their behaviour is abnormal
- Situational and developmental norms are taken into account - Behaviour that is normal in a particular situation/ at a particular age may not be considered normal in another- easy to spot

Limitations of deviation from social norms definition (3)

- social norms are subjective and based on opinions of the majority - those who don't conform may not be abnormal, just eccentric/ individualistic
- social norms relate to moral standards and change over time as social attitudes change
- vary between cultures- cultural relativism (Cochrane- in UK, black people were diagnosed with Schiz more than white/ Asian but this wasn't found in Jamaica where its majority black)

Failure to function adequately definition & who suggested the 7 abnormal features?

when an individuals behaviour is such that they are unable to work, form or maintain relationships, attend to their own physical needs etc.. they're considered to be abnormal
Rosenhan & Seligman

Rosenhan and Seligman

suggested 7 abnormal features related to failure to function adequately - the more present, the more abnormal one is considered
1. personal distress
2. maladaptive behaviour (stops attaining life goals)
3. unpredictability
4. irrationality
5. observer discomfort
6. violation of moral standards
7. unconventionality (displaying unusual, eccentric behaviours)

Strengths of the failure to function adequately definition (2)

- most people seek help for a psychological problem because its interfering with their ability to function normally
- recognises the personal experience of the individual and so mental disorders are regarded from the perception of the individual suffering them

Limitations of the failure to function adequately definition (3)

- abnormality is not always accompanied by dysfunction (psychopath can cause great harm yet appear normal)- Harold Shipman
- some of the features are subjective- 6&7 are based on social norms so vary within different cultures
- cultural bias - the features of dysfunction are based in western perceptions

Statistical infrequency definition

This is the idea that behaviour that is statistically rare according to a normal distribution curve are considered to be abnormal- any score that is so rare that it fails more than 2 standard deviations away from the mean is abnormal - would occur in 5% of the population

strengths of statistical infrequency (2)

- objective definition- once a way of collecting quantitative data has been decided, the data is based on real, unbiased data
- no value judgements are made- abnormal behaviour wouldn't be seen as wrong or unacceptable but simply less frequent

limitations of statistical infrequency (3)

- where to draw the line- two people could be one score apart yet one could be considered normal and the other abnormal
- not all infrequent behaviours are abnormal- some are desirable (highly intelligent)
- not all abnormal behaviours are infrequent - some psychological disorders are frequent (20% of people will suffer from depression in their lives- this wouldn't be considered infrequent

deviation from ideal mental health definition & who proposed the 6 features of ideal mental health?

Johoda looks at the positives rather than the negatives to determine whether an individual is considered abnormal

Johoda's 6 criteria for ideal mental health

1. positive attitude towards oneself- self respect
2. self- actualisation- personal growth
3. autonomy- independant, self reliant
4. resisting stress- effective coping stratagies
5. accurate perception of reality
6. environmental mastery- being competent in all aspects of life& able to meet demands of any situation
anyone who doesn't meet all 6 is considered abnormal

Strengths of deviation from ideal mental health(2)

- emphasises positive achievements and suggests a positive approach to mental problems- focussing on what is desirable not just undesirable
- identification of what is needed to achieve normality, allowing creation of personal goals to work towards and achieve

Limitations of deviation from ideal mental health (3)

- over demanding criteria - most people don't meet all 6
- many are subjective, vague and difficult to measure
- culturally relative criteria so is culturally bias

what is a phobia?

type of anxiety disorder that are characterised by uncontrollable, irrational and enduring fears

what are the behavioural characteristics of phobias?

* Panic (crying, screaming, running away)
* avoidance (affects daily life)
* endurance (remaining in prescence of phobia - high anxiety levels)

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what are the emotional characteristics of phobias?

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* Anxiety (phobias are anxiety disorders, prevents relaxation)
* irrational response (dispropotionate to danger)

what are the cognitive characteristics of phobias?

Selective attention, irrational beliefs, recognition that fear response is overstated and anxiety levels are disproportionate to the situation

What is depression?

mental disorder characterised by low mood and activity levels

what are the behavioural characteristics of depression?

-loss of energy
- social impairment
- weight changes
- poor personal hygiene - reduced washing, changing clothes etc
- sleep pattern disturbance- constant insomnia/ oversleeping

what is meant by a emotional characteristic?

how the sufferer feels

what is meant by a behavioural characteristic?

what the sufferer does as a result/ how they act

what is meant by a cognitive characteristic?

what the sufferer thinks

what are the cognitive characteristics of depression?

- poor memory
- delusions- experienced by some depressives, generally concerning guilt , punishment, personal inadequacy or disease- some will also experience hallucinations
- reduced concentration
- thoughts of death

what are the emotional characteristics of depression?

- loss of enthusiasm - lack pleasure of daily activities
-constant depressed mood- feelings of sadness and hopelessness
- worthlessness- feelings of reduced worth/ inappropriate feelings of guilt

what are the behavioural characteristics of OCD?

- repetitive behaviours
- social impairment - limitability to conduct meaningful, inter-personal relationships
- hinder everyday functioning- disrupts ability to perform everyday functions such as doing a job effectively

What are the emotional characteristics of OCD?

- extreme anxiety- obsessive and intrusive thoughts
- distress- the recognition that the compulsive behaviours cannot be consciously controlled leads to the strong feelings of distress

what are the cognitive characteristics of OCD?

- recurrent and persistent thoughts in an intrusive nature
- recognised as self- generated- they know their obsessions are self invented and not inserted externally
- realisation of inappropriateness- but cannot control them
- attentional bias- attention tends to be focussed on anxiety- generating stimuli
- uncontrollable urges to perform acts as they feel will reduce anxiety caused by the obsessions

how would you explain phobias?

the behaviourist approach using the two process model- learnt through association

What is the two process model and how does it explain phobias?

1. acquisition of phobias through classical conditioning
2. maintenance of phobias through operant conditioning

what are the strengths of the behavioural approach to explaining phobias? (3 cases, 1 point)

1. Di Gallo et al- 20% of people in car accidents developed a phobia- neutral stimulus of a car becomes associated with the fear response of crashing
2. Watson and Rayner- little Albert learnt to fear a rat when associated with a loud noise
3. treatment based on this model has been effective
4. Ost & Hugdahl- can be acquired through association as well as direct experience- witnessed grandfather be sick and die, now has a phobia of throwing up

Ost & Hugdahl- support of the behavioural approach to explaining phobias

can be acquired through association as well as direct experience- witnessed grandfather be sick and die, now has a phobia of throwing up

Watson and Rayner- support of the behavioural approach to explaining phobias

little Albert learnt to fear a rat when associated with a loud noise

Di Gallo et al- support of the behavioural approach to explaining phobias

20% of people in car accidents developed a phobia- neutral stimulus of a car becomes associated with the fear response of crashing

what are the limitations of the behavioural approach to explaining phobias? (2points, 1 case)

1. not everyone who experiences a traumatic event will develop a phobia
- reductionist- reduces the causes of phobias to simple stimulus response associations- fails to take into account the role of biology
- Bounton - doesn't take into account evolutionary explanations- avoidance behaviour is acquired faster and if avoidance response is similar to neutral defence mechanisms as displayed in animals

Bounton - limitation of the behavioural approach to explaining phobias

doesn't take into account evolutionary explanations- avoidance behaviour is acquired faster and if avoidance response is similar to neutral defence mechanisms as displayed in animals

how would you treat phobias?

the behavioural approach of:
1. systematic desensitisation
2. flooding

systematic desensitisation?

based on classical conditioning & aims to eliminate feae response, replacing it with calm and relaxation
1. relaxation training
2. hierarchy construction- work through invitro and invivo desensitisation
3. treatment - work through hierarchy and remain relaxed- these cannot occur at the same time (reciprocal inhibition) so they must stay relaxed so the fear response disappears

invitro desensitisation

imagined things

invivo desensitisation

real life things

reciprocal inhibition

reflex phenomenon that prevents muscles from working - stress and relaxation cannot occur at the same time

flooding

exposure to phobic stimulus straight to the top of the hierarchy involving invivo exposure - forced to confront their fear in real life

supporting research for flooding (2 cases)

Wolpe
Barlow

supporting research for systematic desensitisation

Brosnon and Thorpe
Jones

Wolpe- supporting research for flooding

flooding is effective, girl forced into car and driven around for 4 hours until her anxiety had completely subsided

Brosnon and Thorpe - supporting research for Systematic desensitisation (SD)

reduction in anxiety was 3 times greater in treated group of ppts than the group who didn't receive SD. after 1 year, those treated with SD were no different from a control group with no fear of computers atall

Barlow - supporting research for flooding & SD

flooding has bee shown to be equally as affective as SD, but SD is more tolerated by patients

Jones- supporting research for SD

'little peter' - relaxation techniques cannot be used so peter was rewarded with food as a rabbit was presented close each time to develop a positive association

limitations of flooding

- ethical issues- exposing patients to things they're afraid of (causing psychological harm) can also cause physical harm - high amounts of stress could cause a heart attack
-not appropriate for children because of ethical reasons
- not effective for all types of phobias (ie. social phobias)

limitations of SD

-children may not be able to do relaxation techniques
- in vitro desensitisation- learning to cope with imagined feared objects doesn't mean they'll be able to face them in real life
- ethical issues- exposing people to things they're afraid of could cause psychological harm
- not effective for all types of phobias (ie. social phobias)

how would you explain depression?

cognitive approach using:
1. Becks negative triad
2. Ellis' ABC model

Beck's Negative Triad of Depression

negative thoughts about the self, the world, and the future- based on a combination of negative schemas and cognitive biases - these maintain the triad of negative thinking and therefore depression

schema

knowledge structure about how an aspect of the world works based on own experiences - negative schemas usually stem from early experiences

cognitive biases

negative schemas lead to this- in the way we perceive our behaviour and others, causing misperceptions / misinterpretations of reality which confirm and strengthen negative schema ie. failed one mock and thinks they're a failure

Ellis' ABC model

cause of depression is irrational thought patterns and a tendency to interpret events in an irrational way- its their interpretation of events rather than the events themselves.
An activating event (A) will be accompanied by a belief (B) as to why this event happened. This belief (B) will then lead to a consequence (C) in the form of an emotional response. rational beliefs will lead to desirable emotions whereas irrational beliefs will lead to undesirable ones.

strengths of the cognitive approach to explaining depression (2)

Proven to be effective
Other explanations are taken into account - i.e genes and early experience

Limitations of Beck's Negative Thinking (2)

- not everyone with depression has the negative beliefs and cognitive biases
- unnecessarily separating negative thinking into 3 separate dimensions- research hasn't found a clear separation of negative thoughts but a one dimensional negative perception of the self

Boury et al- supporting research for Beck's negative triad

monitored students thoughts with BDI (Beck)- a depressive interprets facts and experiences in a negative fashion and feel hopeless about the future - correlational however so doesn't prove cause and effect

Koster et al - supporting research for Beck's negative triad

depressed ppts took longer to disengage from the negative words than non- depressed ppts which suggests the depressives were focussing more on the negative words in line with Beck's theory

How would you treat depression?

cognitive approach of CBT (cognitive behavioural therapy)- most common treatment and is an umbrella term for a number of therapies - aims to change negative / irrational beliefs and replace them with positive thinking

REBT (Rational Emotive Behavior Therapy)

type of CBT
1. Education phase- learn relationship between thoughts, emotions and their behaviours using Ellis' ABC model- process of reframing with any irrational beliefs
2. Behavioural activation and pleasant event scheduling - encouraged to increase physical activity and socialising with others to improve their mood and energy levels
3. Hypothesis testing - realistic goals set between sessions (achievable as failure would reinforce the clients negative schemas)

strengths of CBT (3 points, 1 case)

- effective- department of health found it effective but didn't endorse the use of CBT alone, as other treatments ie behavioural therapy was effective too
- Hollen et al- effective compared to drug therapy- only 40% of moderately- severely depressed patients with CBT for 16 weeks relapsed in the following 12 months, 45% for drug therapy and 80% with placebo- CBT is therefore more effective long term
- most effective treatment for moderate and severe depression- also helps mild turning into severe
- has few side effects and likely to have long term benefits as the techniques can be used by the patient after treatment to stop symptoms returning

limitations of CBT (2)

- its essential to use well trained therapists and NHS does not always have them to provide weekly, face to face sessions
- ethical concerns- power therapists have over their patients influence their thinking and patients become too dependent

Hollen et al- strength of CBT

effective compared to drug therapy- only 40% of moderately- severely depressed patients with CBT for 16 weeks relapsed in the following 12 months, 45% for drug therapy and 80% with placebo- CBT is therefore more effective long term

Reframing

the process of redefining negative events and experiences from a more positive and healthy point of view

how would you explain OCD?

biological approach either through:
- genetic explanations
- neural explanations

genetic explanations of explaining OCD

- gene mapping studies (compare the genetic material of OCD sufferers with non- sufferers to see if there is a difference- if there is then we can assume its down to genes)
- specific genes i.e OLIG- 2 gene has been found to make some individuals more vulnerable to developing OCD- but its likely that a combination of genes would determine an individuals level of vulnerability to the condition

Neural explanations of OCD

The perception that OCD is the result of abnormally functioning brain mechanisms.
- It can be detected using PET scans which measure serotonin levels in the brain- shows high levels of activity in the orbital frontal cortex- it may mean that they're unable to stop acting on impulses because of their overactive brain
- serotonin - low levels have been linked to OCD (causing overactivity). drugs that increase levels of serotonin are successful in reducing symptoms of OCD. OCD can be associated with two mutations of the human serotonin functioning (caused by throat infections, Lymes disease etc)- Most often in children- damage to neural mechanisms by infection

Groothest et al - supporting research for biological explanations of OCD

28 twin studies (10'000+)- found in children and adults that OCD is inheritable. Genetic influences range from 45-65% in children and 27-47% in adults- indicates genetic component

Stewart et al - supporting research for biological explanations of OCD

a variant of the OLIG-2 gene commonly occurred when gene mapping OCD patients

Saxena and Rauch - supporting research for biological explanations of OCD

reviewed studies that used neuroimaging techniques i.e PET & fMRI to find consistent evidence of an association between the orbital frontal cortex and PCD symptoms

What are the strengths of the biological explanations of OCD? (3 cases)

1. Groothest et al
2. Stewart et al
3. Saxena and Rauch

what are the limitations of the biological explanation of OCD? (4)

1. concordance rates not 100%- there must be some environmental influences aswell
2. not all sufferers respond positively to serotonin enhancing drugs which lessons support of abnormal levels of the neurotransmitter being the sole cause of the disorder
3. little research that have looked into how genetics and neural mechanisms relate to the precise mechanisms of the disorder
4. unclear whether different types of OCD have different degrees of inheritance

how would you treat OCD?

Biological approach- drug therapy

how would you use drug therapy to treat OCD?

main ones used are:
- antidepressants
- SSRI's (block the re-absorption of serotonin from synapses so more serotonin is available and causes orbital frontal cortex to function normally)- most common SSRI is prozac (treatments lasts 12-16 weeks)
- Anxiolytic drugs (anti- anxiety) lower anxiety levels by increasing the activity of the neurotransmitter GABA (general calming affect on brain activity)
- If SSRI's arent effective, antipsychotic drugs are used (lower dopamine levels)

what does an Anxiolytic drug do?

lowers anxiety levels by increasing the activity of the neurotransmitter GABA (general calming affect on brain activity)

what does an SSRI drug do?

block the re-absorption of serotonin from synapses so more serotonin is available and causes orbital frontal cortex to function normally

what does an antipsychotic drug do?

lowers dopamine levels

what is the most common SSRI?

Prozac

An example of an Anxiolytic drug:

Benzodiazepines

what is the most common antipsychotic drug used?

Risperidone

what are the limitations of the biological approach of using drug therapy to treating OCD? (2)

- drugs aren't a cure they only reduce obsessive thoughts and compulsions to a level that enables a more normal lifestyle
- may experience side effects- loss of sexual appetite or ability, irritability, sleep pattern disturbance, headaches, loss of appetite

Julien - supporting research for treatment of OCD using drug therapy

studies of SSRI's - although symptoms didn't fully disappear, 50-80% of patients improved

Soomro et al - supporting research for treatment of OCD using drug therapy

17 studies of SSRI's versus placebo treatments involving 3000+ patients and found SSRI's to be moderately effective in the short term of treating OCD in adults

strengths of drug therapy as a treatment for OCD (2 cases, 2 points)

1. Julien- although symptoms didn't fully disappear, 50-80% of patients improved with SSRI's
2. Soomro et al- found SSRI's to be moderately effective in the short term of treating OCD in adults
3. Relatively cheap and easy, don't require a therapist to administer them & are user friendly
4. some evidence shows that CBT and drug therapy combined can be the most effective treatment