Clinical Psychology

Describe statistical infrequency as a definition for mental health

Any persons measurement which falls outside a defined field (typically 2 standard deviations away from the mean)

Majority- normal

Extremes (fewer people)- dysfunctional/ abnormal

These people who are statistically or numerically rare are defined as abnormal

What are the strengths of statistical infrequency?

• The objectivity that this definition gives allows for an impartial and fair assessment of abnormality. Building a ‘cut-off’ point for abnormality allows practitioners to see if the behaviour is statistically rare. For example, it allows for objective measurements as someone needs to be 2 standard deviations away from the mean which is a clear cut off point. Overall, this improves the reliability of diagnosis, as conditions will not be subject to medical opinion or doctor’s subjective perceptions.

• This definition of abnormality has useful practical applications. Statistical evidence that a person has a mental disorder can be used to justify requests for psychiatric assistance. There needs to be a system to determine if treatment should be given to patients. This suggests that there are potential benefits to society of using this definition to classify abnormality

What are the weaknesses of statistical infrequency?

• However, it could easily be argued that abnormality is not this ‘black and white’, and that abnormality is subject to different gradations. For example, you could be close to the cut off, e.g a depression score near the cut off for a diagnosis but may not get treatment as you are not defined as abnormal. This has a knock on effect as someone who is close to the cut off may still require treatment but due to this definition would not receive it. This implies that categorising abnormality as ‘abnormal’ or ‘normal’ ignores the grey area of abnormality and it could be argued that abnormality should follow the example of autism, whereby all individuals are placed on the same spectrum, not in opposing categories.

• Lastly, not all abnormal behaviours are infrequent and rare, creating problems for this definition. For example, depression can be considered to be a common behaviour (20% suffer a depressive episode at some point in their life), yet a medicated approach is often an effective approach in treating these episodes. Failure to categorise depression as ‘abnormal’ may prevent effective treatment strategies from being employed, prolonging the sufferer's experience. This implies that using this definition on its own it not sufficient to help with all psychological disorders.

Describe deviation from social/cultural norms as a definition for mental health

Norms are the expected way of behaving in society, decided by the majority.

2 types of social norms:

Situational- acceptable behaviour in situations e.g. wearing a bikini to a beach but not classroom

Developmental- acceptable behaviour at a certain age e.g using a dummy at 1year but not 25years

What are the strengths of deviation from social/cultural norms?

• This definition takes into account different types of norms; in this case situational and developmental norms.Therefore it could be argued to have a more holistic approach to defining abnormality. For example, wearing a nappy is normal for a 1 year old, but not for a 25 year old. For situational norms is allows for situations where the same behavior can be seen as abnormal or normal, for example wearing a bikini is perfectly acceptable at the beach but would not be acceptable to wear to dinner in the evening in a restaurant. This could imply that this is a useful definition of abnormality as it allows for behaviours to be judge due to the situation and age of the person. 

• By society setting the standards of its own expected behaviour and abnormality being considered the breaking of this norm, it allows society/therapists to intervene when necessary. Gives society the right to intervene in someone’s life, when they need it most as most people will be able to categorise the behaviour as abnormal as society sets the rules. For example, if someone is breaking a developmental norm like using a dummy it may allow people to help that person seek advice from their doctor. Therefore, this definition has practical applications for society helping the vulnerable and the abnormal by intervening on their behalf.

What are the weaknesses of deviation from social/cultural norms?

• The subjectivity of this definition does limit its usefulness. Social norms could be argued to be in the eye of the beholder, with huge differences between what an individual considers to be a norm. For example, not all British citizens will place huge emphasis on the importance of queueing, yet it is seen as a cornerstone of British society. This subjectivity does not allow for a fair and equal assessment of what is abnormal and normal, unlike the statistical infrequency definition.

• There are issues around the concept of social norms. Aside from the question of who decides these levels of societal normality, these norms change throughout time. For example, the norms defined by society often relate to standards that vary over time as social attitudes change. E.g. Homosexuality was not removed from the ICD (international classification of diseases and mental disorders) until 1990. Hence, it could be argued that this definition of abnormality is ERA DEPENDENT.

What are Jahoda’s 6 main characteristics of ideal mental health?

Positive attitude to oneself

Accurate perception of reality

Autonomy

Resisting stress

Self-actualisation

Environmental mastery

Describe some of Jahoda’s characteristics

Positive attitude to oneself- having self respect and a positive attitude

Autonomy- being independent, self reliant and able to make decisions

Self-actualisation- experiencing personal growth and meeting your full potential

Resisting stress- resisting and coping with stress

Define deviation from ideal mental health as a definition for ideal MH

According to this definition, behaviour is abnormal if a person deviates too far from the expected state of ideal MH outlined by Jahoda’s 6 characteristics. Rather than attempting to define abnormality it tries to define ideal MH. The absence of Jahoda’s characteristics would indicate abnormality.

What are the strengths of deviation from ideal mental health?

• This definition could be argued to be refreshingly positive. While other definitions have more focus on deficits and negative aspects of the human condition, this approach looks at what it takes to achieve perfect mental health. The definition emphasises positive achievements rather than failures and distress and stresses a positive approach to mental problems by focusing on what is desirable, not undesirable. Therefore, this can help with challenging negative stereotypes within mental health. 

• This definition allows for individuals to see exactly what goals they can set to achieve normality. For example if someone had low self esteem they could set the goal of writing down something positive about themselves every day. This can then be used in therapy and can work towards overcoming common symptoms. Hence, the 6 criteria can be used effectively in therapy to help people with psychological problems and help reduce psychological distress.

What are the weaknesses of deviation from ideal mental health?

• However, the criteria to achieve ideal mental health is very difficult and suggests that the majority of people are considered abnormal by the standards suggested. For example, humanism suggests that very few people in society will achieve self-actualisation, a key part of achieving ideal mental health. It may be that this definition needs to be more realistic to most of society for it to be an effective analysis of abnormality. This could imply that this definition may be unrealistic to use as the criteria is too high to achieve “normality”.

• Many of the 6 criteria of ideal mental health are not important in all cultures. For example, high self-esteem is particularly important in individualistic cultures but not as important in collectivist cultures. In addition, criteria such as ‘personal growth and autonomy’ may be more applicable to individualistic rather than collectivist cultures because…autonomy is not so important as decisions are shared amongst the family and not something the individual will decide on their own. Hence, not all societies feel that these are the ultimate aims for psychological health.

What are 7 features of personal dysfunction outlined by Rosenhan and Seligman?

Personal distress

Maladaptive behaviour

Unpredictability

Irrationality

Observer discomfort

Violation of moral qualities

Unconventionality

Describe some of the features of failure to function.

Maladaptive behaviour- behaviours that stop individuals from attaining life goals

Unpredictability- displaying unexpected behaviours characterised by a loss of control

Observer discomfort- behaviour is carried out that makes surrounding people uncomfortable

Unconventionality- displaying unconventional behaviours e.g being eccentric

Define failure to function adequately as a definition of mental health

In most societies we have expectations about how people should live their lives. When an individual is unable to meet these obligations they are seen as not functioning adequately. For example, not going to work, problems with maintaining relationships with loved ones, self harm and not looking after health or hygiene. Often people who are failing to function adequately are unaware of it themselves and it requires others to alert them to their abnormality.

What are the strengths of failure to function adequately?

• On the positive side, it’s relatively easy to assess the consequences of failing to function adequately. This definition is easy to asses as it focuses on observable behaviour which can physically be seen, improving the validity. For example, personal distress is easy to see. This quantitative data helps make this definition of abnormality more OBJECTIVE.

• On a positive note, this definition of abnormality has strong practical application in DIAGNOSIS. For example in many cases of mental illness (e.g. schizophrenia, depression) when the patient cannot fulfil social / occupational functioning (i.e. they are failing to function) it crosses a recognisable threshold for professional help. The definition provides a practical checklist individuals can use to assess their level of personal dysfunction based on set features that suggest they cannot cope with everyday life. This suggests the definition has a strong practical use, and hence more credible than the statistical and social norm definition of abnormality

What are the weaknesses of failure to function adequately?

• However, Abnormality is not always accompanied by dysfunction. Psychopaths, people with dangerous personality disorders, can cause great harm yet still appear normal. Harold Shipman, an English doctor who murdered at least 215 of his patients over a 23 year period, seemed to be a respectable doctor. He was abnormal under this definition but did not display features of dysfunction. This implies the definition may not be suitable for all abnormality, and a combined approach may need to be taken.

• Like most definitions of abnormality it seems to be culturally relative. There may be cultural differences, e.g what is classed as maladaptive in one culture may not be the same in an other. For example, maladaptive behaviour can be seen in different ways in different cultures. Therefore this definition is limited as we can not use it universally due to cultural differences. 

What are the emotional characteristics of phobias?

Persistent, excessive and unreasonable fear

high levels of anxiety when anticipating the object

Fear when presented with the object

What are the behavioural characteristics of phobias?

Panic attacks, screaming, crying, running away, freezing or clinging

Avoiding the feared stimulus

Disrupted everyday functioning

What are the cognitive characteristics of phobias?

Conscious awareness of exaggerated anxiety

Paying selective attention to the feared stimulus

Irrational beliefs or cognitive distortions

What are the emotional characteristics of depression?

Persistent low mood- pronounced feelings of sadness

Anger- directed at self and/or others

Lowered self-esteem: feeling worthless and empty

What are the behavioural characteristics of depression?

Lack of interest in normal everyday activities/ social withdrawal

Insomnia (reduced sleep) or excessive desire to sleep (hypersomnia)

Aggression towards others or self-harm

What are the cognitive characteristics of depression?

Poor concentration- difficulties attending to a task and/ or problem making decisions

Cognitive biases- focus on negative aspects of a situation

Suicidal thoughts

What are the emotional characteristics of OCD?

Anxiety and distress may accompany both obsessions and compulsions

Low mood and/or depression

Feelings of guilt and disgust may accompany OCD anxiety

What are the behavioural characteristics of OCD?

Compulsions: repetitive behaviours (e.g. hand washing, counting, ordering) which are often performed in an attempt to reduce anxiety

Avoidance: of situations that trigger anxiety e.g. individual with a germ obsession avoids emptying bins

What are the cognitive characteristics of OCD?

Obsessive thoughts- that reoccur over and over again (e.g. worries about being contaminated with dirt)

Cognitive coping strategies (e.g. praying or meditating)

Insight into excessive anxiety ie. understanding that their obsessions and compulsions are irrational

What is the explanation for phobias?

Mowrer’s Two Process Model of Phobias

What 2 types of conditioning make up the two process model?

Classical conditioning

Operant conditioning

Describe classical conditioning in the two process model

Suggests phobias are a conditioned emotional response which results from an association being made between 2 stimuli. Cynophboia (fear of dogs) neutral stimulus- dogs unconditioned stimulus- bite unconditioned response- fear

dogs then become associated with fear

Describe operant conditioning in the two process model

Stage 2- the maintenance of phobias

used when avoiding or escaping phobias and its an example of negative reinforcement

the absence or avoidance of the phobia acts as a reward so you further avoid the phobia.

What is stimulus generalisation?

Can occur when this anxiety can become generalised to all similar objects/ situations

What is high order conditioning?

As the person avoids all dogs and places where dogs may be (like the park), this ultimately reduces their fear and anxiety through negative reinforcement and can be referred to as higher order conditioning because now parks are associated with the CS of dogs (fear)

What are the strengths of the two process model of phobias?

• The theory has experimental support for explaining phobias. Watson & Rayner (1920) showed Albert a white rat which  he was unafraid of, this was the neural stimulus (NS). They repeatedly ( 8 times) paired the rat (NS) with a loud noise (UCS) which caused fear (UCR). Eventually, Albert began to show fear (CR) to the white rat (CS) alone, I.e. they had conditioned a fear response / phobia. As Albert was not afraid of the rat before they conditioning him this shows support that he learnt the phobia of the rat. Having research to support the two process model gives credibility to the behaviourist explanation for phobias.

• The theory has strong practical applications for treating phobias. Systematic desensitisation involves using classical conditioning to create new positive associations between a previously feared conditioning stimulus. The treatments works by pairing their phobia with calmness and relaxation. By having a behavioural  explanation suggest we learn phobias, we can use the same principle to unlearn the phobia. This illustrates that the explanation has helped society and the 20% of the population that suffer from phobias.

What are the weaknesses of the two process model?

• However, the explanation is significantly weakened by the fact that not all incidences of trauma result in subsequent phobias. This suggests there are elements of cognition that mediate the onset of phobia development as some people experience traumatic events and do not have phobias. For instance, many people may have a traumatic incident with a wasp yet do not develop phobias. This implies that the learning account of phobias is incomplete and has problems applying to real life.

• The theory is environmentally reductionist and fails to consider other valid accounts of phobias. The behavioural explanation only considers that phobias are developed through environmental influences such as classical conditioning and associating the phobia with fear. This explanation ignores other explanations such as Seligman’s evolutionary explanation of preparedness which suggests we are biologically pre-programmed to develop phobias of some stimuli. Meaning the 2 process model offers only a partial incomplete explanation of phobias

What are the two behaviourist approaches to treating phobias?

Flooding and systematic desensitisation

What are the 4 key features of systematic desensitisation?

Fear Hierarchy

Relaxation training

Graduated exposure

Reciprocal inhibition

What is the fear hierarchy?

A list of situations in which the client would feel anxiety, arranged from least to most anxiety inducing.

What is relaxation training?

The client is taught different techniques for relaxing. These would probably include controlling breathing (e.g. 7/11) and muscular tension by using progressive muscle relaxation. Could include other techniques.

What is graduated exposure?

Over the course of 6 to 12 sessions the client is gradually brought into contact with their phobic objector situation. They start at the bottom of their fear hierarchy and gradually work their way upward. At each level of exposure they are encouraged to use their relaxation techniques. Have to be completely calm before they can move on.

What is reciprocal inhibition?

When a behaviour fear is replaced with a more desirable one (counterconditioning)

What are the strengths of systematic desensitisation?

• There is research to support the effectiveness of systematic desensitisation. For example McGrath (1990) found that 75% of patients with specific phobias showed clinically significant improvement following the treatment. This supports systematic desensitisation is an effective way to treat phobias as the rates for improvement were so high. This implies that this is an effective treatment for phobias.

• The ethics of the therapy can be praised as it is considered to be more ethical than others based on classical conditioning e.g. flooding. This is because the patient is given more control in the procedure and will only move on when they are ready to. By allowing more control we are reducing psychological harm through distress and trying to keep it as controlled as possible. In this sense, the patient is PROTECTED from HARM

What are the weaknesses of systematic desensitisation?

• Some argue that systematic desentisation does not deal with the root cause of the phobia and therefore not a full cure. S.D. may appear to resolve a problem but eliminating/suppressing symptoms may result in other symptoms appearing (symptom substitution). This is where patients could develop further phobic responses to different new things. This implies the therapy could be considered superficial and provide only temporary relief.

• There is some evidence that suggests the benefit of systematic desensitisation is not the same for all phobias, especially social and complex phobias. Complex and social phobias such as agoraphobia do not respond so well and relapse rates are high. Craske and Barlow (1993) found that between 60% and 80% of agoraphobics show some improvement after treatment, but it was only slight and clients often relapse completely after 6 months. This implies the use of SD is only appropriate to certain phobias and has limited use. 

What are the key features of flooding?

• Before intense exposure the client is taught some relaxation techniques to help control their anxiety response

• Fear is a limited time response and flooding revolves around this. The initial strong bodily arousal can only last so long before the body calms down. Hence the initial anxiety response becomes exhausted and extinct

• This prolonged intense exposure then eventually creates a new association: the feared stimulus and the calm response. Prevents the escape or avoidance and should eliminate the phobia.

What are the strengths of flooding?

• The therapy has some supporting evidence for treating phobias. Wolpe (1960) effectively used flooding to remove a girl’s phobia of being in cars. The girl was forced into a car and driven around for 4 hours until her anxiety was eradicated. This demonstrated the effectiveness of the treatment. This shows the potential for flooding as a treatment for phobias

• The therapy is very cost effective in time and resources. Most patients will only require one or two sessions due to the treatment being done in one go. This might suit people who can not attend sessions for several weeks like SD, and may give a practical option to treating their phobia. This ultimately implies that the therapy may be an attractive option for the NHS.

What are the weaknesses of flooding?

• Flooding is accused of being unethical. Exposure to the height of their fear will cause high levels of anxiety, as there is not any gradual exposure or control. Therefore not protecting the ppt from harm. This may suggest that flooding is not the most appropriate way to treat phobias. However, the ppt knows they will experience this high level of anxiety and will consent to this before the treatment begins, so although it is more stressful than other methods the participant is aware of this before they start the treatment. 

• The therapy is less effective in treating complex phobias like agoraphobia or social phobia. Social phobias involve considerably more cognitive aspects than specific phobias as they do not just deal with an anxiety response but are accompanied by more unpleasant thoughts about a situation. Flooding does not deal with this part and as such may not treat the root cause of phobias

According to the cognitive explanation, abnormality is caused by what?

Irrational thoughts and Negative thought processes

Describe Becks Negative triad.

Beck suggested those who have depression are trapped in a cycle of negative thoughts.

• Negative view of oneself- (I am not good enough)

• Negative view of the future (There will always be emotional pain)

• Negative view of the world (It’s a hostile, cold place)

What does this negative thinking stem from?

Negative Self-Schemas

Self- Schemas are a package of ideas that we have about ourselves, people who are depressed develop a negative schemas and therefore interpret all information about them in a negative way.

What maintains the negative thinking?

Maintained by cognitive biases

These cause a misperception of reality

Arbitrary interference: conclusions drawn without sufficient evidence

Minimisation: minimising any positive events in life

Overgeneralisation: sweeping conclusions drawn on the basis of a single event

What does ellis’s ABC model focus on?

Irrational thinking

What do the A, B and C stand for in Ellis’s ABC model?

A- Activation/ Activating event

B-Beliefs

C-Consequences

If the activating event is Mary and her boyfriend breaking up, Describe the B and C.

B- Mary has irrational beliefs and starts telling herself the breakup was her fault, She will be alone forever. Mary experiences undesirable emotions, she feels guilty that she spoilt the relationship. She is unlovable.

C- As a result, Mary resolves to not form new relationships as she will only fail and get hurt again.

What are the strengths for the cognitive explanation for depression?

• There is a wealth of evidence that supports the role of cognition in depression. The Temple Wisconsin study of cognitive vulnerability to depression sampled 347 Uni students, none of which were suffering with depression, and were assessed every few months for 2 years. Results for first 2 yrs showed 17% of those with high scores on negative thinking went on to experience a period of severe depression compared to 1% of those with low scores i.e. positive thinkers. This illustrates the significant role of cognition in cases of depression. 

• The explanation of depression has led to useful practical applications that help society and those suffering from depression such as CBT - specifically REBT For example, cognitive behavioural therapy (CBT) is a treatment which involves challenging the irrational beliefs and this can help to reduce depressive symptoms. REBT (Rational Emotive Behaviour Therapy) focuses on the present and helps people develop new ways of thinking about events. Therefore, it could be suggested that the high success rate of CBT validates the cognitive theories. 

What are the weaknesses of the cognitive explanation for depression?

• While the theory is adequate in explaining a sufferer’s current state of mind, it does not fully outline the steps and processes for how the sufferer came to think in this way in much detail. For example, although negative thinking are symptoms of depression, how did this arise in the first place? The cognitive approach is vague in establishing how this occurs and why certain people seem more susceptible to these type of thinking patterns than others.  For example, young children don’t show many signs of negative thinking so it is unlikely people are born like this. This limits the extent to which we can practically use these theories and it could be argued that the cognitive approach can not fully explain the development of negative thinking and depression.

• Some psychologists believe that faulty information processing is actually an ‘effect’ of depression as opposed to a ‘cause’. Depressed people undoubtedly have negative thoughts but do the negative thoughts help cause depression, or do they merely occur as a result of being depressed? An issue is that we rarely study depressed participants BEFORE they develop depression, so are unaware of what their thinking was like before diagnosis. This suggests a theoretical weakness with the cognitive explanation of depression.

Briefly describe CBT

Cognitive behavioural therapy (CBT) works to try and challenge irrational thoughts and ultimately improve the heaviour of depressed patients. Weekly or fortnightly sessions. Focuses on the present.

What are the four features of CBT?

• Identifying negative thinking patterns in depressed patients

• Challenging irrational thoughts of depressed patients

• Skill acquisition and application

• Follow-up

Describe identifying negative thinking patterns in CBT

encourage the depressed patient to talk about their specific difficulties and identify negative automatic thoughts. Often the patient will complete self-report questionaries such as beck’s depression inventory (BDI).

Describe challenging irrational thoughts in CBT

The therapist then seeks to challenge negative thoughts and present alternatives to the depressed individual. Disputing beliefs and use this to rationalise an individuals beliefs. This can sometimes be called reframing.

Describe skill acquisition and application in CBT

Teaches the depressed patients new skills and ways of thinking about things such as using relaxation techniques and optimistic self- statements to challenge negative thoughts.

Describe Follow up in CBT

Final assessment using the self report questionnaires again (BDI) and compare the before and after scores.

What are the strengths of CBT?

• There is evidence that supports the use of CBT with depression. For example, March et al. (2007) compared i) CBT, ii) antidepressants and iii) a combination of CBT plus antidepressants in 327 adolescents. After 36 weeks, 86% of the CBT plus antidepressant group had significantly improved compared to 81% of other groups. This illustrates the effectiveness of CBT in treating depression (without the unwanted side effects of medication e.g., addiction).

• CBT tackles the root problem of depression, unlike biological treatments such as antidepressants. This improves the chances that the depressive episode will be short-lived and reduces the chances of relapses further down the line (some suggest it provides INOCULATION) This could be because of the skill acquisition component of CBT helps to INOCULATE depressed patients against further episodes of depression, meaning that once the therapy has ended their symptoms will still be managed. Therefore, it could be argued that the effects of CBT are more effective and longer lasting than alternatives.

What are the weaknesses of CBT?

• The success of CBT could lead to an aetiological fallacy being made, whereby we assume the causes of depression are cognitive because the cognitive treatments are successful. For instance, just because some symptoms can be removed in CBT, does not necessarily mean the causes can be solely cognitive in origin. For example negative thinking may develop AFTER depression develops. Therefore, it is important to keep an open mind to the causes of depression and not have this view narrowed by the success of certain treatments.

• Some psychologists argue that improvements with CBT are actually rooted in the therapist-patient relationship. It may be the quality of this therapeutic relationship that determines any improvement not techniques in CBT. Luborsky (2002) has found very little differences between therapies, which supports the view that having someone to talk to who will listen matters most in recovery from depression.

What are the 2 biological approaches to explaining OCD?

Genetic Explanation

Neural Explanation

What did Nedstadt find about first-degree relatives and OCD?

First degree relatives of OCD sufferers have a 12% chance of developing the disorder compared to a 3% risk in the general population.

Describe the genetic explanation for OCD

Specific genes could be responsible for OCD, these genes are called candidate genes.

One impaired gene is called the SERT gene. If this gene is impaired it leads to problems with the transport of the neurotransmitter serotonin. This ultimately leads to diminished levels of serotonin which correlates with cases of OCD.

Another candidate gene in cases of OCD is an impaired COMP gene. In short, this gene regulates the production of another neurotransmitter called dopamine. Leaves too much dopamine in the synapse, resulting in repetitive behaviours like the ones seen in OCD patients.

What are the strengths of genetic explanation of OCD?

• One strength of the genetic explanation for OCD is that there is evidence for the role of genes in the development of the disorder. For example, Nestadt (2010) review of twin studies found a concordance rate of 0.67 (or 67%) for MZ (identical) twins but only 0.31 (or 31%) for DZ (fraternal) twins. Hence, the closer the genetic relationship to a sufferer the greater the risk of developing OCD. As MZ twins share 100% of their genetic information and there was a higher concordance rate this suggests genetics must be involved. This suggests that genetics are certainly involved in the transmission of OCD.

• A strength of the genetic explanation is that it promotes psychology as a scientific discipline. This is because genetics can be studied objectively and reliably using DNA analysis and studying  family history (concordance rates) This would suggests that the genetic explanation of OCD promotes psychology as a scientific discipline.In addition, the genetic explanation may be biologically reductionist as it ignores factors other than genes that may affect the development of OCD such as the role of early trauma in childhood (which has been repeatedly linked to OCD). 

What are the weaknesses of Genetic explanation of OCD?

• However, this research also demonstrates that genes cannot be the only factor in the development of OCD. This is because if genes were the only explanation then MZ twins would show 100% concordance in OCD. As this is not the case, there must also be environmental influences, like imitation of role models. Therefore the genetic explanation of OCD could be seen as theoretically flawed.

• In addition, the genetic explanation of OCD can be considered to be biologically reductionist  as it ignores factors other than genes that may affect the development of OCD. Reductionism is when a theory explains behaviour from just one cause, such as genes. However there may be other explanations for OCD, for example people may make associations with stimuli that creates obsessions and compulsions. This implies that the genetic explanation may miss other factors, however biological reductionism is the lowest level of explanation making it more scientific. 

Neural Explanation: What is the role of a damaged caudate nucleus and the orbitofrontal cortex (OFC)?

The caudate nucleus normally suppresses signals from the OFC. In turn the OFC sends signals to the thalamus about things that are worrying such as a potential germ hazard. When the caudate nucleus is damaged it fails to suppress minor worry signals and the thalamus is alerted which in turn sends signals back to the OFC acting as a worry circuit.

Describe the role of low serotonin in the development of OCD

Lowered levels of the neurotransmitter serotonin which influences mood regulation and other mental processes such as anxiety, sleep, memory and social behaviour. Serotonin could be linked the repetitive behaviours in OCD.

Sacs contain neurotransmitters.

These neurotransmitters are released.

NTs will bind to receptors on the post-synaptic neuron.

Less serotonin binds in people with OCD.

What are the strengths of the Neural explanation for OCD?

• One strength of the neural explanation for OCD is that there is research support for the role of brain dysfunction in the development of the disorder. For example, Ursu and Carter (2009) monitored brain activity in 15 OCD patients using fMRI scans and found hyperactivity in the orbitofrontal cortex. Hyperactivity may indicate an abnormality in the orbitofrontal cortex. This research suggests the orbitofrontal may play a part in the development of OCD. 

• The neural explanation of OCD has been practically applied to help society and the 2-3% of the population who suffer from OCD. For example, as the explanation suggests that low levels of serotonin may contribute to OCD, drug treatments such as SSRIs have been developed to help reduce patients symptoms. SSRIs reduce the amount of serotonin going through the process of reuptake  and therefore forcing more serotonin in the synapse, making the levels of serotonin higher. Therefore the neural explanation can help patients and society, reducing the cost to the NHS if patients are managing their OCD symptoms. 

What are the weaknesses for the neural explanation of OCD?

• One theoretical flaw is the link between OCD and brain abnormality is merely correlational and we cannot establish cause and effect. For example, research in this area has only shown that hyperactivity in the orbitofrontal cortex and someone having OCD appears at the same time, but it is unclear if this is the cause of OCD. This is because people with OCD are rarely studied before their diagnosis so we do not know if the abnormality was there before their diagnosis,  suggesting a cause, or once the patient developed OCD the developed hyperactivity in this area, suggesting an effect. Hence, it could be that these biological abnormalities are a result rather than a cause of OCD.

What does SSRIs stand for?

Selective Serotonin Reuptake inhibitor

Give an example of an SSRI

Prozac

Describe how SSRI’s work

The SSRI blocks the re-uptake pump in the synapse. It reduces the rate of reabsorption of serotonin. As a result there is more serotonin available in the synapse to bind with the receptors. Therefore more serotonin can be transported from the synapse. The SSRI’s keep serotonin floating around in the synaptic space.

How long does it take to work?

Can take a few weeks to occur but alleviates OCD symptoms.

3-4 months of daily use

What are the strengths of Drug therapy in treating OCD?

• There is research to support the effectiveness of SSRIs from Soomro. Typically symptoms decline for 70% of patients taking SSRIs. Soomro et al (2008) found that Pt’s in all 17 different studies reviewed showed significantly more improvement with SSRIs than controls receiving placebo drugs. This shows that SSRIs are an effective treatment for OCD as there is a vast amount of research support for them. 

• The drug treatment are however cost effective. Drug therapies are also relatively cheap in comparison to psychological therapies and are also relatively easy for the patient to engage with. This means the NHS is likely to prescribe drug treatments to patients with OCD compared to CBT. This increases the effectiveness of the drug treatments as it is likely to be widely used, reducing the cost of the NHS.  

What are the weaknesses of drug therapy in treating OCD?

• However unwanted side effects can reduce the effectiveness of the treatment. Soomro also documented common side effects of taking the SSRIs were nausea, headaches and insomnia. This may mean that patients may stop taking the drug do to the unpleasant side effects being worse than the disorder. This reduces the effectiveness of the treatments as not all patients of OCD will continue to take the drug. 

• However, one issue with drug treatments is they are not a long term solution unless the patient takes medication for the rest of their life. Although symptoms may often improve with SSRIs, they do not generally disappear, and return if the drug has not been taken, which means that drug treatments for OCD are only partially successful.This reduces the long term use, and the effectiveness of the drug as patients will need additional treatments such as CBT for long term solutions.