AQA A Level Psychology - Psychopathology

Psychopathology

A field of study concerned with cognitive, emotional, and behavioural problems.

Statistical Infrequency

Where an individual has less common characteristics

Statistical Infrequency - Examples

Individual having an IQ of < 70 would make them less intelligent than the majority of the population

Individual being more depressed than the majority of the population.

Statistical Infrequency - Evaluation

STRENGTH - It is a useful definition in the real-world application, especially in clinical practice as a way to diagnose disorders.

LIMITATION - Uncommon characteristics can be positive, such as having less depression levels or a higher IQ than the majority of the population. Not sufficient on naming abnormality.

LIMITATION - Not all individuals benefit from being labelled as abnormal, such as those with a low IQ which doesn't affect their way of living. It would just lower their self-esteem and being labelled as abnormal can be harmful.

Deviation from Social Norms

When an individual's behaviour does not conform to a cultures' or societies' accepted standards.

Deviation from Social Norms - Examples

People with impulsive, aggressive and irresponsible behaviour may be labelled as having Antisocial Personality Disorder (APD) as they do not conform to social norms.

Deviation from Social Norms - Evaluation

STRENGTH - Applicable in the real world as it's used in clinical practices to diagnose disorders.

LIMITATION - Lacks cultural relativity, with not every "deviating" behaviour being considered a deviation from all societies/cultures social norms. For example, hearing voices in the UK would mean you have Schizophrenia, but in other cultures these could be signs/voices of ancestors.

LIMITATION - Can be used in a way which abuses human rights. For example, slave owners created a disorder for slaves who ran away from captivity, therefore no one was able to question what occurred when they were brought back. Men also had a disorder for women who were "too sexual", using it as a way to control them.

Failure to Function Adequately

When an individual is unable to cope with the ordinary demands of day-to-day living.

Failure to Function Adequately - Examples

Not being able to maintain basic standards of hygiene or nutrition.

Failure to Function Adequately - Rosenhan and Seligman's 3 Signs

1. When a person experiences severe personal distress

2. When a person does not conform to standard interpersonal rules

3. When a persons' behaviour is irrational or dangerous to themselves and/or others

Failure to Function Adequately - Evaluation

STRENGTH - It sets a sensible threshold of standards when people need to seek professional help, with services being able to send out help to those who need it most.

STRENGTH - Considers the individual's subjective experience.

LIMITATION - Having a subjective judgement makes it difficult to measure and judge distress.

LIMITATION - It is too easy to label non-standard lifestyle choices as being a failure to function, when they are just deviation from social norms. Those labelled are at risk of restriction of freedom of choice and abnormality.

Deviation from Ideal Mental Health

When someone does not meet a set of criteria for good mental health.

Deviation from Ideal Mental Health - Jahoda's 9 Criteria

1. No symptoms or distress

2. Rational behaviour

3. Accurate perception of one's self

4. Self-actualisation

5. Able to cope with stress

6. Realistic view of the world

7. Independence

8. Good self-esteem and lack of guilt

9. Successful work, love, and leisure

Deviation from Ideal Mental Health - Evaluation

STRENGTH - The criteria is highly comprehensive for distinguishing mental health from illness, and provides a checklist against where we can assess our self and others.

LIMITATION - Not all parts of the criteria are applicable across a range of cultures.

LIMITATION - The standards are extremely high, with very few people being able to meet them all at once and keep them them there.

Phobia

An extreme or irrational fear of something.

Phobia - DSM-5's Categories

1. Specific Phobia - Phobia of a specific object or animal.

2. Social Phobia (Anxiety) - Phobia of social situations.

3. Agoraphobia - Phobia of being in a public space-outside.

Phobia - Behavioural Characteristics

PANIC - A person may panic in response to the phobia. This may be a range of behaviours, such as screaming, crying, running.

AVOID - A person may actively avoid the presence of the phobic stimuli.

ENDURE - A person may endure the presence of the phobic stimuli.

Phobia - Emotional Characteristics

ANXIETY - An emotional response to the phobia may be anxiety, which prevents relaxation and positive emotions.

FEAR - An emotional response to the phobia may be intense fear.

UNREASONABLE RESPONSE - All emotional responses may be disproportionate to the phobia.

Phobia - Cognitive Characteristics

SELECTIVE ATTENTION - The presence of the phobic stimulus may make it hard to look away.

INRRATIONAL BELIEFS - Any beliefs in relation to the stimuli may be irrational.

COGNITIVE PERCEPTION DISTORTED - Their perception may be inaccurate and distorted.

Phobia - Mowrer's Two Process Model (BEHAVIOURAL EXPLANATION)

This model states that "phobias are acquired through classical conditioning and continue because of operant conditioning".

An example of acquiring a phobia through CC would be the Little Albert (next card further explains) experiment. The phobia then becomes long-lasting though OC, where the behaviour in response to the stimuli is reinforced positively or negatively. An example of maintaining a phobia would be through negative reinforcement, where avoiding the situation results in the removal of the phobia and the fear/anxiety it produces, causing the behaviour to be repeated.

Phobia - Little Albert Experiment

Watson and Rayner showed a baby named "Albert" a white rat and would create a loud noise close to his ear when shown. This was repeated until "Albert" showed signs of phobia towards the white rat, as well as other similar looking objects. Such as, Santa's Beard, non-white rabbit, fur coat.

The noise was the UNCONDITIONED STIMULUS, creating the UNCONDITIONED RESPONSE of fear. The rat is a NEUTRAL STIMULUS which then becomes a CONDITIONED STIMULUS when associated with the US and UR. This then, put together, creates a CONDITIONED RESPONSE.

Phobia - Evaluation (BEHAVIOURAL EXPLANATION)

STRENGTH - It has real-world application in exposure therapies such as Systematic Desensitisation. It explains why those who take exposure therapies benefit from the therapies procedure, therefore identifying a mean of treating phobias.

STRENGTH - There is evidence of the link between bad experiences and phobias. The Little Albert experiment is a piece of evidence, as well as a study by JONGH who found that 73% of people with a phobia of dentists had a traumatic experience as compared to a group with low dental anxiety, where only 2% had a traumatic experience.

LIMITATION - It does not account for the cognitive side of phobia, such as an explanation for why individuals avoid the phobic stimuli or the irrational fear.

LIMITATION - Not all phobias occur from traumatic experiences, such as those with a phobia with snakes. Those with phobias of snakes are usually those who have never contacted one or have had few experiences with them.

Depression

A mental disorder characterised by low mood and energy levels.

Depression - DSM-5's Categories

1. Major Depressive Disorder - Severe but short-term depression.

2. Persistent Depressive Disorder - Severe and long-term depression, characterised by dysthymia.

3. Disruptive Mood Dysregulation Disorder - Childhood temper tantrums.

4. Premenstrual Dysphoric Disorder - Disruption to mood prior menstruation.

Depression - Behavioural Characteristics

ENERGY LEVELS - They have increased or decreased energy levels, either struggling to relax or being lethargic.

DISRUPTION TO EATING AND SLEEPING - They may experience insomnia or hypersomnia.

AGRESSION AND SELF-HARM - They can become very aggressive, or have the need to self-harm.

Depression - Emotional Characteristics

LOWERED MOOD - People with depression are usually described as having a "lowered" mood or being "depressed". This lowered mood would include a feeling of worthlessness and being empty.

LOWERED SELF-ESTEEM - Those who are depressed report to having reduced levels of self-esteem.

ANGER - Depressed people tend to frequently experience anger, it either being directed at themselves or others.

Depression - Cognitive Characteristics

POOR CONCETRATION - They may find themselves unable to stick to a task or find it hard to make decisions that they would normally find straightforward.

ATTENTION TO NEGATIVES ONLY - In a depressive episode, they may only pay attention to the negatives of a situation, and ignore the positives.

ABSOLUTIST THINKING - They may have absolutist thinking, such as seeing an unfortunate situation as a disaster.

Depression - Beck's Cognitive Theory (COGNITIVE EXPLANATION)

He took a cognitive approach to explaining why people are more VULNERABLE to depression. He suggested 3 parts to this cognitive vulnerability: Faulty Information Processing, Negative Self-Schema, and the Negative Triad.

FAULTY INFORMATION PROCESSING - Depressed people attend to the negative aspects of a situation and ignore the positives. They also tend to blow small problems out of proportion and think in "black and white" terms.

NEGATIVE SELF-SCHEMA - It is a package of information people have about themselves, but it is only negative.

NEGATIVE TRIAD - The idea that there are 3 types of negative thinking that contributes to depression: negative view of the world, one's self and the future.

Depression - Evaluation (BECK'S COGNITIVE THEORY)

STRENGTH - There is much supporting evidence, such as by CLARK AND BECK who concluded that these cognitive vulnerabilities are most common in depressed people, as well as preceding the depression itself. COHEN confirmed this in a study, where researchers tracked the development of 473 adults and measured their cognitive vulnerability. It was found that showing cognitive vulnerability predicted later depression.

STRENGTH - It has real-world application, especially in screening and treatment of depression. COHEN concluded that assessing someone's cognitive vulnerability allows psychologists to identify those who are most at risk of developing depression in the future. Cognitive vulnerability can also be applied in Cognitive Behaviour Therapy (CBT).

LIMITATION - It doesn't explain all aspects of depression, such as the hallucinations, irrational beliefs etc.

Depression - Ellis' ABC Model (COGNITIVE EXPLANATION)

Ellis proposed that good mental health is the result of rational thinking (thinking in a way that allows people to be happy and free from pain). Irrational thinking is where our thoughts interfere with us being happy and free from pain.

He uses the ABC model to explain how irrational thoughts affect our behaviour and emotional state:

A Affecting Event - People become depressed when a negative experience/event triggers irrational belief.

B Beliefs - Our beliefs become irrational, such as the belief that we must always succeed (MUSTERBATION), or that if something doesn't go smoothly then it is a disaster (ICANTSTANDITITIS).

C Consequence - When an activation event triggers irrational beliefs, there are emotional and behavioural consequences.

Depression - Evaluation (ELLIS' ABC MODEL)

STRENGTH - It has real-world application in the psychological treatment of depression. Ellis' approach to cognitive therapy is called Rational Emotive Behaviour Therapy (REBT), where by vigorously arguing with a depressed person then the therapist can alter the irrational beliefs.

LIMITATION - The ABC model only explains cases of depression that are linked to a traumatic event "non-endogenous depression", but does not explain the many cases of depression which are not traceable to life events "endogenous depression", and it is not obvious what leads them to becoming depressed. The model can only explain some cases of depression, so it is only a partial explanation

LIMITATION - It doesn't explain all aspects of depression, such as the hallucinations, irrational beliefs etc.

Depression - CBT: Cognitive Element (COGNITIVE TREATMENT)

Cognitive Behaviour Therapy is a common method for treating mental disorders based on both cognitive and behavioural techniques. One element of this therapy is the cognitive aspect.

Cognitive Therapy is the application of Beck's Cognitive Theory of Depression. It aims to identify automatic thoughts of the negative triad, and once identified, the thoughts will be challenged through testing the reality of their beliefs (recording when they enjoyed an event, when someone was nice to them etc.). This is referred back to, to prove the clients statements as incorrect. The notion of a client documenting their own data is when the client is the scientist.

Depression - CBT: Behavioural Element (COGNITIVE TREATMENT)

Cognitive Behaviour Therapy is a common method for treating mental disorders based on both cognitive and behavioural techniques. One element of this therapy is the behavioural aspect.

The behavioural element is referred to as Rational Emotive Behaviour Therapy (REBT), which extends Ellis' ABC model:

A Activating Event

B Beliefs

C Consequences

D Dispute

E Effect

REBT aims to identify and dispute irrational thoughts, such as through vigorous arguments with the intended effect to change the irrational belief and break the link between the traumatic event and depression. He identified different types of disputing, EMPIRICAL argument (disputing where there is actual evidence to support the negative belief) and LOGICAL argument (disputing whether the negative argument follows fact).

Depression - Evaluation (COGNITIVE TREATMENT)

STRENGTH - CBT has a range of evidence which supports its effectiveness in treating depression. MARCH found that, after 36 weeks of treating 327 depressed clients with either drugs, CBT, or a combination, 81% of the CBT group, 81% of the drug therapy group, and 86% of the combination group were significantly improved. CBT is shown just to be as effective on its own, more so when combined with drug therapy.

STRENGTH - It has long-term effects on the economy, as individuals miss work because of their poor mental health which costs society around 2 billion annually which can be regained when psychologists can effectively help to lessen peoples poor mental health so it doesn't interfere with their labour.

LIMITATION - It lacks effectiveness for severe depression and those with learning disabilities, with STURMEY concluding that any form of psychotherapy is not suitable for those with learning disabilities. Depression also may be severe enough that people cannot motivate themselves to engage with the therapy.

COUNTERPOINT - TAYLOR concluded that CBT can be effective for all people with learning disabilities, when done appropriately. LEWIS AND LEWIS concluded that CBT is as effective as drug therapy and behavioural therapy for those with severe depression.

LIMITATION - There is a high relapse rate for CBT, studies showing that the long-term outcomes are not as good as assumed. ALI assessed depression in 439 clients every month for a year, 42% relapsed into depression within 6 months, and 53% relapsed within a year. This shows that CBT needs to be repeated periodically as patients begin to rely on it.

LIMITATION - CBT, especially REBT, may cause psychological stress because of the arguing factor. This creates an unethical environment for patients, causing later effects because of the distress.

OCD

A disorder characterised by obsessions and compulsions.

OCD - DSM-5's Categories

1. OCD - characterised by obsessions or compulsions

2. TRICHOTILLOMANIA - compulsive hair-pulling

3. HOARDING DISORDER - a compulsive gathering of possessions and the inability to part with anything

4. EXCORIATION DISORDER - compulsive skin-picking

OCD - Behavioural Characteristics

REPEAT BEHAVIOURS - They may feel compelled to repeat behaviours.

MANAGE THE ANXIETY - Compulsive behaviours are done to manage their anxiety. For example, a#hand-washing is a way to manage the obsessive fear of germs.

AVOID - Avoiding the trigger is a way to reduce the anxiety.

OCD - Emotional Characteristics

UNPLEASANT EMOTIONS - Emotions such as anxiety are accompanied by OCD.

DEPRESSION - OCD is often followed with depression.

NEGATIVE EMOTIONS - OCD may involve other emotions such as guilt or disgust.

OCD - Cognitive Characteristics

OBSESSIVE THOUGHTS - Obsessive thoughts are a major cognitive feature to OCD.

COPING STRATEGIES - People with OCD respond to their obsessions through adopting coping strategies.

AWARE THEIR ACTIONS AREN'T RATIONAL - Being aware of the irrationality of one's actions is necessary for the diagnosis for OCD.

Cycle of OCD

Obsessive thoughts > Anxiety > Compulsive behaviour > Temporary Relief

OCD - Genetic Explanation (BIOLOGICAL EXPLANATION)

The genetic explanation is a form of the biological explanation. The genetic explanation is where "genes make up chromosomes and consist of DNA which codes physical and psychological features. These genes are inherited.".

An example of this explanation is a study by LEWIS, who observed his OCD patients, with 37% having parents who had OCD and 21% who have siblings with OCD. This study suggests that OCD runs in the family, through genetic inheritance. The Diathesis-Stress-Model shows that certain genes leave people more VULNERABLE to developing a certain mental disorder.

These genes are called CANDIDATE GENES, which creates vulnerability within OCD.

OCD - Evaluation (Genetic - BIOLOGICAL EXPLANATION)

STRENGTH - strong amount of evidence. NESTADT reviewed twin studies and found that 68% of identical twins shared OCD as opposed to 31% of non-identical twins. As well as that, within family studies, research has found that a person with a family member diagnosed with OCD is around 4x as likely to develop it as someone without. These studies suggest that there is some genetic influence on the development of OCD.

COUNTERPOINT to the above strength is that using family studies to prove the existence of inherited genes can be argued. Living in the same house with a person who has OCD means that you could have learnt the behaviours rather than it being genetically inherited.

LIMITATION - environmental risk factor. There is evidence for the idea that genetic variations can make a person more or less vulnerable to OCD. However, OCD is seen to be triggered by environmental factors which increases the risk of development. For example, CROMER found that over half of OCD clients in their sample had experienced a traumatic event in the past. OCD was more severe with those who experienced trauma. This means that genetic vulnerability is only a partial explanation.

LIMITATION - the genetic variations which cause OCD are found in animal studies rather than human ones, such as repetitive behaviour in mice. Comparing the behaviour of mice and humans is not possible because of the cognitive differences.

OCD - Neural Explanation (BIOLOGICAL EXPLANATION)

The neural explanation is a biological approach to understanding of OCD, specifically the idea that physical and psychological characteristics are determined by the behaviour of the nervous system.

The explanation comes in 2 sections:

1. Serotonin - Neurotransmitters are responsible for relaying information from one neuron to another. If serotonin levels are low, then normal transmission of mood-relevant information doesn't take place and a person may experience low moods.

2. Decision-Making Systems - Cases of OCD may be associated with impaired decision-making i.e. hoarding-disorder. This may be associated with abnormal functioning of the lateral part of the frontal lobe. The frontal lobes are responsible for logical thinking and making decisions.

OCD - Evaluation (Neural - BIOLOGICAL EXPLANATION)

STRENGTH - the existence of supporting evidence. For example, the intake of antidepressants that work purely on serotonin are effective in reducing OCD symptoms which suggests that serotonin is effective in the involvement of OCD. Also, OCD symptoms form part of conditions that are known to be biological in origin, so if a biological disorder produces OCD symptoms then we can assume the biological processes underlie OCD. This suggests that biological factors may be responsible for OCD.

LIMITATION - the serotonin link may not be unique to OCD. Many people with OCD also experience clinical depression. Having two disorders is called CO-MORBIDITY. It could simply be that serotonin activity is disrupted in people with OCD because they are also depressed. This means that serotonin may not be relevant to OCD symptoms.

OCD - Drug Therapy (TREATMENT)

Drug therapy aims to increase or decrease the levels of neurotransmitters in the brain to change the level of activity.

The standard medical treatment used to tackle symptoms of OCD involves an antidepressant drug called "selective serotonin reuptake inhibitors" (SSRI's). They work on the serotonin system in the brain. When serotonin is released by the presynaptic neurons, it travels across a synapse towards the postsynaptic neuron while releasing a chemical signal. This chemical signal is reabsorbed by the postsynaptic neuron where it is broken down and reused.

SSRI's effectively increase levels of serotonin in the synapse and thus continue to stimulate the postsynaptic neuron. The drug treatment does this through preventing reabsorption and breakdown in the postsynaptic nerve.

When an SSRI is not effective after 3-4 months, the dose can be increased or combined with other drugs, such as:

· TRICYCLICS: they are an older variation of antidepressants that can be used i.e. clomipramine. This works on various systems such as the serotonin system where it has the same effect on SSRI, however, there are more side effects to be considered.

· SNRIs: are a more recent drug used to treat OCD. They are used as a second line of defence for people who don't respond to SSRIs.

OCD - Evaluation (DRUG THERAPY)

STRENGTH - evidence on its effectiveness. SOOMRO reviewed 17 studies that compared SSRIs to placebos. All 17 studies showed significantly better outcomes for drug therapy than for the placebos. Typically, symptoms were reduced for 70% of people taking SSRIs.

COUNTERPOINT of the above strength would be that there is evidence to suggest that the drugs that help those with OCD may not be the most effective. SKAPINAKIS carried out a systematic review of outcome studies and concluded that both cognitive and behavioural therapies were more effective than SSRI treatment.

STRENGTH - cost effective and non-disruptive to people's lives. They are cheap compared to psychological treatments because the number of medication can be manufactured in the time it takes to conduct one session of a therapy session. Therefore, drug therapy is of good value to public health systems and represents a good use of limited funds.

LIMITATION - potentially dangerous side effects. A small minority who use SSRI treatment will get no benefit. Some also experienced side-effects such as indigestion, blurred vision and loss of sex-drive. This means that some people will have a reduced quality of life as a result of taking drugs and may stop taking them altogether, meaning the treatment ceases to be effective.

LIMITATION - pharmacies may have unreliable information being presented to the public. For example, drug companies may do many pieces of research on a drug but they could only allow the positive pieces of research to read journalists and the public. These companies can withhold evidence on why certain drugs aren't the best medically because of both money and the lack of reinforced laws. This is called publication bias.

LIMITATION o- not all causes for OCD are biological. It can be the consequence of trauma or the copying of other people's behaviours who may have OCD. Providing drugs to those who don't have biological OCD can cause individuals to form dangerous effects that could cause other issues.