clinical psychology and mental health

abnormality + disorders

how many definitions of abnormality are there?

1. statistical infrequency

2. deviation from social norms

3. failure to adapt adequately

4. deviation from ideal mental health

what’s the definition of statistical infrequency

 

• A behaviour is abnormal if its statistically uncommon or rare in society

• Based on how behaviours are distributed within a population

normal distribution

• Bell-shaped curve.

• Middle = range

• As you move away from the centre ( + or -  standard deviations), fewer people have that score --> more abnormal

• Mean = median = mode

• if its falls under 2.5% of the population then its considered abnormal

positive skewed distribution

• Order: mean< median< mode

• The tail is on the right side (positive = right)

• Most scores are low, only few are high

• Example: a very difficult test (most student get low marks)

• Mean is dragged right by the few high scores

negative skewed distribution

• Order: mean>median>mode

• The tail is on the left side

• Most scores are high, only a few are low

• Example: a very easy test (most student got high marks)

• Mean is pulled left by the few low scores

evaluation on statistical infrequency

1. misdiagnosis: some common behaviours could be causing distress but according to this definition its normal e.g. depression

2. labelling someone who is happy as abnormal could cause low self esteem

3. Not all abnormal (rare) rates are undesirable, Example: high IQ = rare, but positive

Deviation of social norms

A person is seen as abnormal if their behaviour violates the unwritten rules (social norms) of what is acceptable within a particular society or culture

Real-life example:

1. Antisocial Personality Disorder (APD): Person is impulsive, aggressive, irresponsible, and lack guilt- behaviour that breaks social and moral standards

2. Schizotypal Personality Disorder (SPD): Shows eccentric or superstitious beliefs (e.g. seeing things not real), which deviate from cultural norms.

evaluation on deviation from social norms

1. Cultural relativism: What's "normal" varies across cultures and over time. e.g. in Thailand Karen women wears rings around their neck from young age as a sign of beauty and cultural identity 

2. Historical changes/Hindsight Bias: Norms change over time e.g. in the UK, homosexuality was classed as a mental illness until 1973 → it can also form social control to suppress minority groups (Szasz, 1947)

failure to function adequately

A person is consider abnormal of they are unable to cope with everyday life r meet the demands of daily living-like maintaining relationship, work, or self-care.

→ example: someone with depression may find it difficult to get out of bed, go to work, or communicate with others

Rosenhan and Seligman's criteria

• They suggested key sign to identify when someone isn't functioning adequately:

criterion	Description/example
suffering	Person feels distress (e.g. depression, headaches, exhaustion)
Maladaptive	Behaviour interferes with everyday goals (e.g. can't go to work)
Irrationality	Behaviour seems illogical (e.g. panic without reason)
Observer Discomfort	Makes others feel uncomfortable (e.g. shouting, swearing)
Vividness'	Behaviour appears strange (e.g. extreme body modification)
Violation of Moral Codes	Goes against social norms (e.g. paedophilia)
unpredictability	Behaviour is inconsistent or unexpected

 → acronym: VIVOUSM

evaluation on failure to function adequately

• Individual differences: Two people with same disorder may cope differently, so diagnosis can be inconsistent

• Subjective judgement: what count as "failing" can very between observers

• Cultural bias: people who live differently (e.g. alternative lifestyles) may be unfair labelled as abnormal 

deviation from ideal mental health

Made by Marie Jahoda

Made a criteria that all of them must be achieved to be normal

→ if you don’t meet one of them then you are not normal

Jahoda’s criteria

1. Positive attitude toward yourself- for ideal mental health, the individual should feel happy with themselves and have a positive attitude about who they are e.g. self-harm, insecurities, depression, social anxiety

2. Self-actualisation-  for ideal mental health, an individual should be able to visualise and reach their potential, this link with Maslow's hierarchy of needs, in the humanistic approach. It refer to a person ability to be content with themselves. e.g. social anxiety, CBA (lost motivation), schizophrenia 

3. Personal autonomy- for ideal mental health, an individual should not have to be dependent on others. This refers to having independence of thought and behaviour, and being able to make your own decisions and look after yourself e.g. depression, OCD, learning disability, ADHD

Jahoda’s criteria (part2)

4. Resistance to stress- for ideal mental health, an individual should be able to handle stressful situations competently without feeling distress. This refers to the tolerance for stress of an individuals, and their ability to cope with stressful situation. e.g. OCD, anxiety, aggression

5. Environmental mastery- for ideal mental health, an individual should be able to change their behaviour and attitudes when a change in society or daily life occur. e.g. autism, OCD, ADHD

6. Accurate perception of reality- for ideal mental health, an individual should interpret the world and environment similarly to others and not disability thinking such as delusions or hallucinations  e.g. schizophrenia

evaluation on deviation from ideal mental health

what’s a phobia

A phobia is an anxiety disorder involving an irrational fear of a specific object, situation, or place

 

what are the three types of phobia

1. Simple (specific) Phobias

2. Social Phobias

3. Agoraphobia

 

Simple (specific) Phobias:

Fear of one specific object/situation.

Categories of simple phobias

• Animal phobias --> spiders (arachnophobia), snakes, dogs

• Injury phobias --> blood (hemophobia), injections, needles

• Situational Phobias --> flying, lifts, dentists

• Natural environment phobias --> water, hights, storms

Social Phobias

Fear of social situations because the person feels judged, embarrassed or inadequate

three types of social phobias

• Performance phobia → speaking in public, eating in front of others

• Interaction phobia → talking to strangers, answering questions

• Generalised social phobia → fear of most social situations (e.g. crowds)

 

Agoraphobia

Fear of open or public spaces where escape feels difficult.

causes of agoraphobia

• Simple phobias (e.g., fear of contamination → avoiding public areas)

• Social phobia (fear of people → avoiding open spaces)

behavioural characteristics of phobia

1. Avoidance: Person a voids the phobic trigger. e.g. social phobias → avoids crowds; arachnophobia → avoids basements

 

2. Panic: Crying, shaking, screaming, running away, Extreme panic may trigger freeze (fight-flight-freeze response)

 

emotional characteristics of phobias

1. Intense, unreasonable fear

2. Anxiety + panic when thinking about or facing the phobic object

→ More than what is appropriate for the situation

cognitive characteristics

1. Selective attention: Hard to look away from the feared object, The person becomes hyper-focused on the threat

 

2. Irrational beliefs: e.g. believing "all spiders can kill me" even in the UK where non are  deadly

 

what type of disorder is depression?

mood disorder

two types of depression

• Unipolar depression: major depression

• Bipolar disorder: (includes mania)

behavioural characteristics of depression

• Activity levels: Reduced energy → fatigue → withdrawal from work/social life. In severe cases, unable to get out of bed

• Disruption of sleep & eating: Insomnia (difficulty sleeping) or Hypersomnia (sleeping too much) and Appetite changes (loosing or gaining 5% of body weight)

• Aggression & self-harm: Irritability and anger towards other. e.g. Self-harm behaviours (cutting) or suicide attempts/thoughts

emotional characteristics of depression

• Lowered mood: Intense, persistent sadness. e.g. Feeling "empty" hopeless, worthless.

 

• Anger: Anger may be directed at self or others.

 

• Lowered self-esteem: Feeling of worthlessness, In severe cases: self-harm

cognitive behavioural of depression

• Poor concentration: Difficulty focusing, slower decision making e.g. Struggle completing tasks

 

• Selective thinking: Pay more attention to negative event, Their attention become biased toward anything that fits their negative views and ignores positive events

 

• Absolutist thinking: Everything is  either completely good or completely bad, Small issues become catastrophes

what is OCD?

OCD is an anxiety disorder with two main components:

• Obsessions = intrusive, persistent thoughts

• Compulsions = repetitive behaviours used to reduce anxiety

random facts

• About 70% of suffers experience both obsessions + compulsions

• 20% have only obsessions

• 10% have only compulsion

• OCD create a cycle: Obsession → anxiety -→ compulsion → temporarily relief

behavioural characteristics

• Compulsions are repetitive: Sufferers feel a strong urge to carry out repetitive behaviours. Common examples:

  • Repeated hand-washing

  • Repeated checking (doors/windows locked, appliances off)

  • Repeating certain rituals

 

• Compulsions reduce anxiety: Compulsions are performed as a direct response to obsessive thoughts

 

• Avoidance: Some sufferers may avoid situations that trigger their obsessions. E.g. avoiding public places to avoid germs

 

emotional characteristics of OCD

• Anxiety and distress: Obsessions are frightening → produce high anxiety

  • Compulsions relieve anxiety temporarily, but the cycle continues

 

• Accompanying depression

  • Anxiety + constant interruption of daily life --> low mood and loss of pleasure

  • Sufferers may feel:

    • Worthless

    • Constant sadness

    • Irritability

 

• Guilt and disgust: Some sufferers experience Guilt and disgust toward themselves or the object of the obsession

cognitive characteristics of OCD

• Obsessive thoughts: Intrusive, recurring, uncontrollable thoughts such as:

  • Fear of contamination

  • Fear of harming someone

  • Religious fears

 

• Irrational thoughts: Sufferers hold beliefs that are illogical or disconnected from reality e.g. "if I don’t wash my hands 20 times, or I will get contaminated again"

 

• Cognitive coping strategies: Some sufferers use mental strategies to cope, e.g. Praying repeatedly

 

• Selective attention Sufferers focus only on anxiety-triggering stimuli e.g. A person with contamination fears will constantly notice dirt/germ in the environment

 

• Insight into excessive anxiety: Sufferers are usually aware that:

  • Their obsessions are irrational

  • Their compulsions do not logically prevent danger

  • Despite this insight, they cannot stop the behaviour

behavioural treatments to phobia

→ behaviourists believe phobias are learned, not inherited.

Mowrer (1947) proposed the Two-process model:

 1. classical conditioning

2. operant conditioning

classical conditioning

Phobias first developed when neutral stimulus (NS) becomes associated with fear-producing unconditioned stimulus (UCS)

Process

• NS → no fear

• UCS (e.g.,  loud noise) → fear

• NS + UCS paired together → fear

• NS becomes a conditioned stimulus (CS) producing conditional fear (CR)

 

example of classical conditioning

little Albert (Watson & Rayner, 1920)

• Albert showed no fear of a white rat (NS)

• Loud noise (UCS) paired with rat caused fear

• Rat became CS --> Albert cried

• Fear generalised to similar white objects (e.g. Santa beard)

operant conditioning

Once the phobias exists, it is maintained through negative reinforcement.

• Avoiding the fear situation reduces anxiety

• The relief reinforces avoidance behaviour

• Parson continues avoiding → phobias maintained long-term

example of operant conditioning

 someone with a lift phobias avoids lifts → avoids anxiety → relief → keeps avoiding → phobia stays strong

positive reinforcement

Reinforcement = increases behaviour

• Definition: adding something pleasant to increase behaviour

• Effect: behaviour is repeated

• Example: getting money for good grades

negative reinforcement

• Definition: removing something unpleasant to increase behaviour

• Effect: behaviour is repeated

• Example: seatbelt alarm stops when belt is fastened

→ key point negative reinforcement does not mean punishment

 

Positive consequences:

Consequence = observed outcomes of behaviour

 

• Definition: behaviour is followed by a reward

• Effect: observer is more likely to imitate behaviour

• Example: student sees someone rewarded --> imitates action

 

negative consequence

• Definition: behaviour is followed by punishment or disapproval

• Effect: observer is less likely to imitate behaviour

• Example: student sees someone getting told of --> avoids behaviour

evaluation on classical & operant conditions

• Ignores cognition: behavioural theory ignores irrational thoughts yet these often drive phobias

• Not all phobias come from trauma: many people with phobias cannot recall a bad experience.

• Evolutionary explanation suggests human are naturally predisposed to fear danger (snakes, spiders, heights)

• Reductionist: oversimplified phobias to stimulus- response learning and ignores emotions, biology, personality

what are the two behavioural treatment for phobia

1. Systematic Desensitisation (SD)

2. flooding

Systematic Desensitisation

1. Fear hierarchy:

• List of situations from least -> most frightening

• (e.g., picture of dog -> real dog)

2. Relaxation training

• Berating, muscle relaxation, imagery

3. Gradual exposure

• while relaxed

• Move up hierarchy

• Based on reciprocal inhibition

(cannot be scared and relaxed at the same time)

counter-conditioning

• CS → fear (CR)

•  relaxation → calm 

• CS + relaxation → calm

• CS become NS

evaluation on SD

• Less effective for complex phobias: social phobias & agoraphobia often caused by irrational thinking, not just learning

• Evolutionary phobias harder to treat: some fears may be biologically prepared

 

flooding

→ immediate, intense exposure to feared stimulus without gradual build-up

 

How it works:

• Person cannot avoid the stimulus

• Anxiety peaks -> eventually drops due to exhaustion

• No negative reinforcement available

• Anxiety decline -> new calm association formed

• Extinction occurs (phobic response is unlearned)

evaluation on flooding

• Highly traumatic: many patients drop out -> treatment may fail

• Not suitable for complex phobias: social phobias need treatments for cognition, not just fear responses

• Symptom substitution: removing the phobias may cause another symptom to appear (controversial)

Extension evaluation (issues & debates)

• Behavioural approach is reductionist (ignores thinking, biology)

• It assumes environmental determinism (no free will)

• It uses a nomothetic approach (general laws), ignoring individual differences

• Some phobias may have evolutionary advantages (preparedness)

cognitive approach to depression- Beck’s triad

Depression is caused by irrational and negative thinking.

Three types of negative thoughts (the negative triad) :

• Negative view of self --> "I'm worthless"

• Negative view of the world -->  "everyone is against me"

• Negative view of the future --> "things will never get better"

 

what’s a schema

 

• Shema’s = mental "packages" of beliefs.

• Depressed people have negative self-schemas, developed from early negative experiences (criticism, bullying)

examples of negative schema’s

• Ineptness schema --> "I will fail"

• Self-blame schema --> "everything is my fault"

• Self-evaluation schema --> constant self-criticism

Cognitive biases

Depressed people distort situations by focusing only on the negatives.

• Over-generalisation → making a broad negative conclusions from small events

• Catastrophising → exaggerating problems and expecting disasters

• absolutist thinking → using “everything” or “everyone” e.g. “everything will go bad if i get out of bed”

Ellis's ABC model (1962)

Depression comes from irrational beliefs, not events themselves:

A- Activating event: Something happens (e.g., friend ignores you)

B- Beliefs: Interpretation of the event:

• Rational belief--> "they didn't see me"

• Irrational belief--> "they hate me"

C- Consequence: Beliefs create emotional outcome:

• Rational --> healthy emotion + coping

• Irrational --> depression, anxiety, anger

Cognitive treatment: CBT

CBT is based on the idea that changing irrational thoughts reduces depression

 

Steps of CBT

1. Initial assessment --> identify problems

2. Goal setting

3. Identify and challenge irrational thoughts by using Beck’s negative triad: fore example, therapist might ask client to look for evidence for and against the thoughts, consider alternative, more realistic explanations

4. Homework (behavioural experiments)

Ellis REBT treatment

ABCD became ABCDEF:

• D -Dispute → challenge irrational beliefs

  • Logical dispute → "does this belief make sense?"

  • Empirical dispute → "where is the evidence?"

  • Pragmatic dispute → “is is good that you're thinking this way"

• E -effective beliefs → replace irrational thoughts with rational ones

• F -feeling → the new feeling that replaced the old ones

 

 

Evaluation (explaining depression)- strength

1. Practical application → therapies led to CBT and REBT, both effective treatment

2. Supporting research:

• Boury et al → depressed people show more negative thinking

• Ates et al → negative thought statements increased depression symptoms

Evaluation (explaining depression)- weaknesses

1. Cannot explain the origin of irrational thoughts

2. Biological factors are ignored

• Genes, neurotransmitters (e.g. serotonin) also play a role

• Drug treatment help --> suggests depression is not purely cognitive

1. Irrational thoughts may be realistic: "depressive realism", depresses people may have more accurate views of the world

Evaluation (treatment)- strength

1. Very effective

March et al --> CBT as effective as antidepressants; combination best

1. No side effects, unlike medication

 

Evaluation (treatment)- weaknesses

 

1. Requires motivation: depressed patients may be too tired/unmotivated to engage

2. Overemphasises thinking: ignore real-life causes (abuse, poverty)

3. Success may be due to therapist-client relationship: not the technique themselves (Rosenzweig)

Issue & debates- depression

• Nature + nurture --> irrational thinking may be automatic (nature). But can be changed (nurture)

• Soft determinism --> we have some control to change thoughts

• Scientific? --> uses scientific methods but cannot directly observe thinking