psychopathology

phobia definition

a persistent, excessive, or unreasonable fear of something to the point of impairment.

specific phobia

of an object, body part, animal or situation. they often develop during childhood and may become less severe as they get older.

social phobia

of a social situation

agoraphobia

being outside or in a public space

complex phobia

more disabling than simple phobias. develop during adulthood and are associated with a fear or anxiety about a situation or circumstance

behavioural characteristics of phobias

things people do e.g., washing hands 100 times a day, panic, avoidance.

emotional characteristics of phobia

things someone feels e.g., high levels of anxiety, out of proportion fear, irrational and immediate fear

cognitive characteristics of phobia

things someone thinks or a cognitive process e.g., catastrophic thinking, irrational beliefs, selective attention

mowrer

we learn and maintain a phobia through classical and operant conditioning.

little Albert

exposed at 9 months to a series of stimuli with a loud noise which Albert initially showed no fear to. after repeatedly pairing the stimuli with the noise, Albert began to cry at the sight of the rat alone.

weakness of little Albert

experimental design and process was not carefully contracted, they relied on their own subjective interpretations.

strength of two process model

good explanatory power as it goes beyond the concept of classical conditioning and explains how they are maintained. important real-life application for therapies unconditioning.

weakness of two process model

in agoraphobia, avoidance seems to be driven by positive feelings of sticking to safety rather than wanting to avoid the phobia. avoidant behaviours are not simply anxiety reduction.

biological preparedness from evolution explains why we develop phobias of things that would have been dangerous in the past, even if we have not had a traumatic experience of it.

systematic desensitisation 3 steps

• anxiety hierarchy

• relaxation training

• exposure

anxiety hierarchy

patient ranks the phobic situations from least to most terrifying

relaxation training

patient taught relaxation techniques as it is impossible to feel relaxed and afraid at the same time

exposure

start at the bottom of the anxiety hierarchy and gradually move up when they are relaxed. it is successful when they feel relaxed at the highest level.

weakness of systematic desensitisation

when phobias have not developed through classical conditioning, they are not as effectively treated.

an example is evolutionary phobias that have an innate bias

strength of systematic desensitisation

it is more ethical than flooding as it causes a lot less distress. a higher level persist, meaning it is not a waste of time or money.

weakness of flooding

not as effective in treating phobias that are not simple e.g., social as they are believed to be caused by irrational thinking rather than classical conditioning

strength of flooding

it is equally as effective as other treatments, yet requires less time and resources making it more cost effective and a quicker solution

depression definition

category of mood disorder divided into unipolar and bipolar

diagnostic criteria of depression

5+ symptoms in the same 2 week period. one must either be depressed mood or loss of interest or pleasure.

behavioural symptoms of depression

fatigue or loss of energy nearly all day every day

insomnia or hypersomnia nearly every day

agression and self harm

emotional symptoms of depression

depressed mood most of the day every day

feelings of worthlessness or inappropriate guilt

cognitive symptoms of depression

diminished ability to think or concentrate or indecisiveness

recurrent thoughts of death or suicidal ideation

absolutist thinking and dwelling on the negative

cognitive explanation on internal processing

input events lead to internal processing which leads to output symptoms

ellis’ view

sees irrational thinking as the root cause of maintaining a depressed state. sees activating events as the trigger for a depressive state.

Ellis theory

activating events are an external event that trigger a range of irrational beliefs and emotions which in turn produce emotional and behavioural consequences.

what does Beck’s theory explain

how a persons cognitive processing can cause a vulnerability

negative self-schemas

the result of early experience which causes us to interpret all the info about ourselves negatively

faulty information processing

pay elective attention to negative things they already know and fail to pay attention to positive aspects of life

negative triad

negative view of

1. self - confirms emotions of low self-esteem

2. wold - creates the impression that there is no hope

3. future - reduces hopefulness and enhances depressive feelings

lipsky et al (practical guy) - ellis strength

has good practical application in therapy. has face validity in the idea that challenging irrational beliefs to reduce depression supports basic theory.

Krants - ellis strength

depressed women showed more errors in belief when asked to interpret written material than non-depressed people. negative views impaired them from doing something relatively simple.

Bates (become more depressed) - ellis strength

depressed patients when given negative thought statements became more depressed. shows the impact negative thoughts have on cognitive functioning

weakness of ellis’ theory

only explains reactive depression. many cases can’t be tracked back to real life, meaning we can’t find an activating event. this makes it a partial explanation

locates responsibility for depression purely with the depressed person, effectively blaming them.

clark & beck (beck’s evaluation)

meta-analysis of studies relating to cognitive vulnerabilities. shows consistent support for the theory in studies.

grazioli & terry (beck’s evaluation)

assessed women for cognitive vulnerability and depression before and after birth. women with high vulnerability were more likely to suffer post-natal

weakness of beck

cowards is the false belief that your body is decaying. 90% of documented cases include depression. becks explanation cannot explain things like these delusions so is limited.

strength of beck

application in screening and treatment. Cohen et al suggested that assessing cognitive vulnerability allows to screen young people and identify those at risk. CBT

REBT assumption

people think their way out of distress. the therapist disputes ideas and tries to make the client see that sometimes life is difficult and unfair.

debating and disputing beliefs

providing evidence which contradicts the patients irrational beliefs

effective beliefs

by challenging ad changing the irrational beliefs, the link between negative thoughts and depression is broken, leaving space for new and healthier beliefs to be incorporated.

functional emotions and behaviours

beliefs should lead to healthier behaviours which will achieve a greater sense of happiness.

CBT

• behavioural activation

• graded task assignments

• negative thought capturing

behavioural activation

investigates the barriers to engaging with activities. discuss past activities that have brought pleasure and joy and attempt to reengage with these.

graded task assignment

develop goals which are increasingly demanding to complete in an attempt to help them reengage with positive behaviours.

negative thought capturing

recognise and capture negative/irrational thoughts. the therapist challenges these to develop more rational thoughts

John march et al - strength of CBT

compared CBT to antidepressants and found that CBT was equally as effective as antidepressants, and more so when used alongside them. this supports its evidence for effectiveness.

weakness of CBT

lack of effectiveness for severe cases and for clients with learning disabilities. some cases are so severe that client can’t motivate themselves to engage in tasks.

shehzah ali et al

42% clients relapsed in the 1st 6 months

53% relapsed after a year

long term outcomes are not as good as assumed

what is ocd classified as

anxiety disorder

cognitive symptoms of OCD

• obsessions

• distorted beliefs

• catastrophic thoughts

• cognitive strategies

• selective attention

• recognise thoughts and actions are unreasonable

emotional symptoms of OCD

• anxiety

• distress

• guilt

• depression

behavioural symptoms of OCD

compulsions

the OCD cycle

obsessive thoughts which give the individual anxiety, anxiety, compulsive behaviour to give temporary relief through realistic behaviours, temporary relief which is interrupted by the obsessive thoughts, obsessive thoughts

genetic explanations of OCD assumption

suggests that whether a person develops OCD is at least partly due to their genes, explaining why patients often have family members with OCD.

bellodi et al

did twin/family studies, finding that close relatives are more likely to have OCD than distant ones

Mceon & Murry

patients with OCD are more likely to have first degree relatives who suffer with anxiety disorders

Pauls et al

there is a higher percentage of OCD sufferers in relatives of patients with OCD than in a control group without OCD

COMT gene

regulates dopamine. one variation results in higher levels of dopamine, which is more common in OCD patients than non-OCD patients.

SERT gene

affects the transport of serotonin. transport issues lower serotonin in the brain and are associated with OCD.

Ozaki et al (SERT)

from two unrelated families with mutations of the SERT gene, 6/7 of the family members ended up having OCD

diathesis stress model

people gain a vulnerability towards OCD through genes but an environmental stressor is also required.

polygenic nature of OCD

its development is predicted by up to 230 genes.

aetiologically heterogenous

one group of genes can cause OCD in one person, but a different group in another

piggot et al ( neural )

drugs which increase the level of serotonin in the synaptic gap are effective in treating patients with OCD

brain scans on OCD

show relatively low levels of serotonin activity in the brains of OCD patients.

Brain structure on OCD

if the Orbifrontal cortex and anterior cingulate gyrus are overstimulated they fire at inappropriate times, sending incorrect messages to the basal ganglia. this creates the sense of dread and that something is wrong. this creates brain lock.

pichichero (environmental)

children with strep often displayed sudden indications of OCD shortly after being infected. they also often displayed symptoms of Tourettes, supporting the idea of infections having an impact on neural mechanisms

illnesses linked to OCD

streptococcal infection

lymes disease

influenza

fallon & nields (environmental)

40% of people contracting lymes disease incur neural damage resulting in psychiatric conditions.

strength of genetic (Nestadt et al)

individuals who have first degree relatives with OCD are up to 5x more likely to develop the disorder than the general public

weakness of genetic

little success in pinning down all the genes. it is etiologically heterogenous as each gene only increases the chance a tiny bit. this means it has little practical application

strength of genetic (lewis)

37% of patients had parents with OCD, 21% had a sibling with OCD

strength of neural (HU)

compared serotonin in OCD sufferers and non-sufferers and found the serotonin to be lower, supporting the association

strength of neural (Saxena & Rauch)

reviewed studies that used neuroimaging to find consistent evidence of the relationship between the orbifrontal cortex and OCD

weakness of neural explanations on OCD

we cannot establish a cause and effect relationship as it is difficult to know whether OCD is caused by the abnormalities, or the abnormalities by the OCD.

strength of environmental (Cromer et al)

over ½ OCD patients had a traumatic event in their lives, OCD was more severe with those with over 1 experience. this shows it can’t be completely genetic and we should focus on environmental causes we can do something about

weakness of environmental explanations of OCD

the alternative explanation of the two process model suggests that learning could play a role. this is found in the success of behavioural treatments.

how do SSRI’s work

drugs used to treat mood disorders. they block reuptake ports to stop serotonin being recycled, giving it more time to stimulate receptors, increasing the likelihood an action potential will be prevented from firing.

what do SSRI’s do

reduce the anxiety associated with OCD.

how do anti anxiety drugs (BZs) work?

slow down the activity of the central nervous system by enhancing GABA which has a quietening effect on the neuron’s

How does GABA work?

when locked in with GABA receptors, it opens a channel that increases the flow of chlorine ions in the neurone. this makes it harder for the neurons to be stimulated by other neurotransmitters, slowing down the activity and making the person feel more relaxed

how do tricyclics work

they block the transported mechanism that reabsorbs serotonin and noradrenaline into the pre synaptic cell. this results in more of the neurotransmitters being left in the synapse prolonging their activity. they target more than one neurotransmitter.

strength of SSRIs (soomro et al)

there were significantly better outcomes for people taking SSRIs than for the placebo condition. symptoms reduce for around 20% of people.

weakness of SSRIs

found that cognitive behavioural therapies were more effective in the treatment of OCD, they may not be the best treatment

strength of all drug therapies

they are cost effective and non disruptive as many tablets can be produced at the same time as a therapy session. they show a good use of limited funds. they are less disruptive to lives than therapy as you don’t have to take time to attend sessions.

weakness of all drug therapies

there can be serious side effects, which whilst are mostly short lasting, they can for a majority last long. these can be quite distressing for some.

biased evidence for drug therapies

some researchers could have been sponsored by drug companies and may selectively publish positive outcomes.

4 definitions of abnormality

• deviation from social norms

• deviation from ideal mental health

• statistical infrequency

• failure to function adequately

statistical infrequency

behaviour is abnormal if it is statistically uncommon in society.

strength of statistical infrequency

uses standardised tools, making it easy to replicate and therefore more reliable.

weakness of statistical infrequency

would not recognise depression as abnormal as it effects 280 million people. also categorises desirable behaviours as abnormal

deviation from social norms

if it goes against social norms it may be viewed as abnormal.

strength of deviation from social norms

social norms are arguably in place to make society run harmoniously. easy way of assessing abnormality through antisocial behaviour

weakness of deviation from social norms

they are time and culture bound, making it difficult to universalise, as well as not accounting for differences such as eccentrics.

Rosenhan & Seligman’s definition of abnormality

failure to function adequately - when someone is unable to continue their daily routine or cope with everyday life

signs of failure to function adequately

• severe personal distress

• behaviour going against social norms

• behaving irrationally

• self-inflicted harm