psychology- psychopatholgy

what are the 4 definitions for mental health

1. deviation from ideal mental health

2. deviation from social norms

3. statistical infrequency

4. failure to function adequately (FFA)

outline deviation from social/cultural norms

when an individual doesn’t follow generally accepted social standards or rules or expectations about what is acceptable behaviour. this may make people feel threatened or uncomfortable. social norms are often context dependant and can vary across cultures.

it is important to consider:

• the degree to which the norm has been violated

• the importance of that norm within society

evaluate deviation from social norms

strengths:

• flexibility as a definition- acknowledges norms vary across cultures, time periods, age etc

weakness:

• social norms can change over time- eg, being gay used to be highly frowned upon

• cultural relativism- variation across cultures can lead to inappropriate diagnosis

• can lead to people who display unique behaviour to be unfairly labelled as mentally ill

outline deviation from ideal mental health

according to Jahoda: a mental diagnosis can be given if a person does not meet the following criteria:

1. positive view of self

2. be focused on self-actualisation (reaching potential/ development)

3. function as autonomous (independent)

4. accurate view of reality

5. positive relationships and empathy to others

6. master of your own environment (can adapt to change)

7. can cope with stress

the more criteria a person fails to meet, the more mentally ill they are.

evaluate deviation from ideal mental health

strengths:

• it is a comprehensive definition which clearly applies to a wide range of mental illnesses

• can provide a clear checklist for psychologists to use for assessment

• achievement of goals- can provide criteria

weakness:

• too idealistic- very few people meet all the criteria at all times, so the majority of the population would be mentally ill according to this definition. this makes it hard to tell who really needs help.

• cultural relativism- different cultures have different ideas about what is mentally healthy, this theory is based on western ideas.

explain FFA

a person who is failing to function adequately cannot cope with everyday tasks.

Rosenham and seligman (1989) proposed 7 signs of FFA:

1. unpredictability and loss of control

2. maladaptiveness (behaviours that are harmful to oneself or others)

3. personal distress- eg, anxiety

4. irrationality

5. observer discomfort

6. violation of moral and social standards

7. unconventionality

assessment of functioning scale (GAF)- a method of measuring how well individuals function in every day life. GAF scale rates functionality from 0 to 100. a higher score indicates better functioning.

evaluate the FFA:

strengths:

• provides a clear, sensible threshold for when a person should seek help

• measurable- allows a more reliable evaluation of and individuals ability to cope with daily life

• behaviour is observable- can be detected by others

weakness:

• some people have mental disorders but can cope with life- eg, psychopath serial killers like Harold Shipman the doctor who killed patients with drugs

• everyday life varies across cultures

• FFA may be due to certain circumstances- eg, a person may not get out of bed because they are grieving.

• some people may choose abnormal routines

outline statistical infrequency

a person is mentally unwell if they exhibit a rare or unusual behaviour

eg- 1/100 people suffer with schizophrenia

evaluate statistical infrequency

strengths:

• provides clear guidelines for identifying mental disorders as it provides a clear numerical cut off

weakness:

• unusual chracteristics can be positive- eg, high IQ is desirable

• some abnormal behaviours are not statistically rare like depression

• deciding on a numerical cut off point is subjective

• labelling may not be beneficial, even harmful- can lead to stigmas

phobias are…

anxiety disorders

what are the 3 symptom catergories for phobias

1. behavioural

2. emotional

3. cognitive

what are 3 behavioural characteristics

1. PANIC- can involve crying, running away, freezing, screaming

2. AVOIDANCE- tendency to avoid phobic stimulus

3. ENDURANCE- alternative to avoidance- person chooses to remain in the presence of phobia

what are 3 emotional characteristics

1. ANXIETY- prevents a person from relaxing, can be long term

2. FEAR- the immediate unpleasant response to a phobia

3. EMOTIONAL RESPONSE CAN BE UNREASONABLE- (to others)

what are 3 cognitive characteristics to phobias

1. SELECTIVE ATTENTION- hard to look away from it and focus on other things

2. IRRATIONAL BELIEFS- thoughts that can’t be easily explained and don’t have a basis in reality

3. COGNITIVE DISTORTIONS- perceptions may be unrealistic

outline the behavioural approach to EXPLAINING phobias

• argues phobias are a learnt response

• Howard Mowrer’s two-process model states that phobias are acquired (learnt in the first place) by classical conditioning and continue (are maintained) by operant conditioning

outline classical conditioning in relation to phobias

• learning through association

• phobia is caused when neutral stimulus (eg- dog) becomes associated with fear after a negative experience. neutral stimulus is now a conditioned stimulus which causes the conditioned response of fear

• the CS is usually generalised to similar objects so in this case a person may fear all dogs

evaluate classical conditioning in developing phobias

in support= WATSON AND RAYNER (1920)

• used CC to cause an 11- month old child to develop a phobia

• at the beginning of study showed no fear of range of stimuli

• paired a tame white rat (NS) with a loud bang (UCS) and the noise caused fear (CR)

• eventually Albert was conditioned to associate the rat and similar stimuli with fear

evaluation=

• unethical- cause long term harm - arguably this is unjustifiable

• sample of one so limited generalisability

outline operant conditioning

the association between a phobic stimulus and fear should be gradually unlearnt over time as person is exposed to stimulus and learns it causes no harm. according to Mowerer’s model phobias tend to be long lasting because of OC and negative reinforcement.

he argues people avoid their phobias to avoid fear and anxiety. this is negative reinforcement as it encourages person to keep avoiding.

evaluate the behavioural approach

strengths=

• effective treatments have been developed based on approach (SD and flooding). there is evidence that both are effective which supports the validity of the behaviouralist explanation

• evidence that supports the ide phobias are learnt through negative experiences- Ad de jongh found 73% of ppl scared of the dentist had a negative experience

  • however, this doesn’t explain the development of phobias for ppl who cannot identify a negative experience

• idea that phobias are learnt through CC is supported by controlled lab research (little albert study)

weaknesses=

• the model cannot explain why some phobias are more common that others

  • we tend to acquire phobias of things that once threatened our survival from an evolutionary pov

  • suggesting the evolutionary theory also has a role in explaining phobias

• the two-process model also ignore cognitive aspects of phobias as we know in many cases phobias involve irrational thinking. this suggests the cognitive theory also has a role in explaining phobias

what are 2 treatments for phobias

1. systematic desensitisation

2. flooding

outline SD

• a form of counter conditioning when you replace the association with fear with association of feeling relaxed

three stages:

1. relaxation training

2. anxiety hierarchy

3. gradual exposure

two forms:

1. IN VIVO- in real life

2. IN VITRO- in the form of imagery

• works due to reciprocal inhibition (two opposite emotions cannot happen at once)

evaluate SD

strengths=

• evidence that it is effective- Gilroy

  • 43 patients

  • spider phobias

  • checked in 3 months and 33 months and all were significantly less scared of spiders

  • suggests its effective short and long term

• suitable for a wide range of patients- eg, autistic ppl, kids, ppl with learning disabilities

• less traumatic then flooding so often a preferred choice- low attrition and refusal rates

weakness=

• potential problems with IN VITRO method- relies on patients ability to realistically imagine scenario so limited effectiveness

outline flooding

• immediately bombarding patient with phobia

• prevents avoidance

• fear response eventually becomes exhausted

• causes ‘extinction’

evaluate flooding

strengths=

• quicker and cost effective compared to SD

• evidence for effectiveness (choy)

weakness=

• can be traumatic- despite patients giving consent they may back out and not complete treatment

• less effective for complex phobias like social phobias as they have a higher cognitive element which needs addressing like patterns of thinking

what are 3 behavioural characteristics of depression

1. activity levels:

   1. reduced energy

   2. struggle to complete work

   3. struggle to get out of bed

   4. struggle to relax (psychomotor agitation)

2. disruption to sleep/eating behaviour

3. aggression and self-harm

what are 3 emotional characteristics of depression

1. lowered mood

2. anger

3. lowered self-esteem

what are 3 cognitive characteristics of depression

1. poor concentration

   1. unable to stay on task

   2. hard to make easy decisions

2. attending to and dwelling on the negative

3. absolutist thinking

explain what is the cognitive approach to EXPLAINING depression and what are the 2 theories

• argues some people are more vulnerable to depression due to the way they think

• due to negative, irrational patterns of thinking

2 theories:

1. Beck’s cognitive theory

2. Ellis’ ABC model

outline BECK’S theory

1. COGNITIVE BIAS

• selective thinking

• absolutist thinking

• catastrophising

• over-generalisations

2. NEGATIVE SELF SCHEMA

• deeply engrained negative set of beliefs about yourself

3. NEGATIVE TRAID

• negative feelings about themselves

• negative feelings about the future

• negative feelings about the world

evaluate BECK’S theory

strengths=

• there’s is evidence depression is linked to cognitive bias, negative triad and negative self schema- GRAZIOLI AND TERRY (2000)

• it has led to the development of successful treatments- eg, CBT

weaknesses=

• it ignores biological explanations like genes so it suggests this is not a complete explanation

outline ELLIS’ abc model

argues that depression is a result of negative and irrational beliefs triggered by activating events

A= activating event

B= beliefs (triggered by activating event)

• musterbatory thinking- holding unrealistic demands on oneself or others

• utopianism- the belief life is always meant to be fair

• ‘I-can’t-stand-it-itis’- when things don’t go smoothly it is a disaster

C= consequences (low mood or harmful behaviour)

evaluate ELLIS’ abc model

strengths=

• application to therapy- has led to REBT and other successful therapies

weakness=

• depression is not always caused by an activating event so it only applies to some cases

• the cognitive approach downplays the role of situational factors causing depression

what is CBT: what does it believe and what does it aim to do

a form of talking therapy based on the idea negative and irrational patterns of thinking cause negative emotions and patterns of behaviour. these patterns of behaviour further reinforce the negative thinking leading to a vicious cycle

it aims to identify and challenge these irrational thoughts and negative patterns of thinking in order to reduce negative emotions and behaviours

outline becks CBT

generally time limited, ranging from 6-20 sessions

STAGES:

1. identify negative and irrational thoughts causing negative emotions or behaviours

2. the therapist helps identify common ‘thinking errors’, eg- catastrophising

3. challenging irrational thoughts through validity testing:

   1. questioning and logical disputing

   2. considering alternative, more likely explanations

   3. fact-checking

4. homework tasks: thought records and diaries

BEHAVIOURAL ACTIVATION:

• clients are also helped to understand the ‘vicious cycle of inactivity’ where depression leads to withdrawal which worsens mood and negative thoughts

• BA aims to break this habit by encouraging clients to engage in activities like hobbies that are likely to bring some pleasure

• is this feels overwhelming then the therapist will help break this down into manageable steps

outline ellis’ REBT- rational emotive behaviour therapy

• based on ellis’ belief that it’s a persons beliefs about an event (rather than the event itself) which cause depression

• REBT aims to identify, challenge and replace irrational beliefs leading to more positive consequences

• REBT extends the ABC model to ABCDE where D stands for dispute (challenging irrational beliefs) and E stands for effect

• ellis believes in a more confrontational approach to therapy where the client is challenged in debates- this may be through:

  • logical disputing- questioning the logic of the belief

  • empirical dispute- when the therapist asks for evidence

• also involves homework

evaluate CBT

pros:

• there is evidence for effectiveness

  • MARCH (2007)- compared the effects of CBT and anti-depressants and a combination of the two in 327 depressed teens

  • after 36 weeks both 81% of the anti-depressant and CBT groups improved

  • however, 86% of the CBT and anti-depressant group improved

  • this shows CBT is just as effective as ADs but having both together is most effective

• CBT has no side effects so it is often the preferred choice

cons:

• CBT may not work for severe cases because they are unable to concentrate or motivate themselves to participate in sessions- in this case they should take ADs so this suggests it is not always effective alone

• success based largely off of client-therapist relationship, if patient does not form trusting bond with therapist it is possible it may not work

• evidence it may only be effective short term:

  • ALI (2017)- followed 439 CBT patients every month

  • within 6 months, 42% relapsed

  • within 1 year, 53% relapsed

  • suggests follow up sessions may be needed for full long term effectiveness

outline the biological explanations for explaining OCD- genetic explanations

GENETIC EXPLANATIONS

• genes are involved in individual vulnerability to OCD

• Lewis observed that of his OCD patients, 37% had parents with OCD and 21% had siblings with OCD which suggests OCD runs in the family although what is probably passed on is genetic vulnerability rather than the certainty of OCD

• diathesis-stress= genes caused by stress

• candidate genes:

• researchers have identified genes which create vulnerability to OCD

• specific genes linked to OCD:

  • SERT gene= regulates serotonin, a mutated version of this gene increases serotonin reuptake which decreases serotonin

  • COMT gene= a mutated version of this gene means dopamine doesn’t get broken down leading to too much dopamine, causing compulsions

• OCD is polygenic:

• this means it isn’t caused by one single gene but variations of genes that come together to increase vulnerability

• Taylor has analysed findings of previous studies and found evidence that up to 230 different genes are involved in OCD

• there are different groups of genes which may cause OCD in one person compared to another

• the term for this is aetiologically heterogeneous (the origins very from one person to another)

outline the biological explanations for explaining OCD- neural explanations

NEURAL EXPLANATIONS

• the genes associated with OCD are likely to effect the levels of key neurotransmitters as well as structures of the brain

• the role of serotonin:

• serotonin helps regulate mood

• neurotransmitters are responsible for relaying info from one neuron to another

• if a person has low levels of serotonin they may experience low mood

• some cases of OCD can be explained by reduction in the functioning of serotonin in the brain

• neuroanatomical explanations:

• overactive basal ganglia- the brain area involved in movement

• leads to repetitive motor behaviours

• suggested that people with OCD have disfunction in their OFC-thalamus circuit

• the OFC (orbitofrontal cortex) is an area of the brain responsible for higher decision making- this detects worry

• when a worry is detected a signal is sent to the thalamus which is then sent back to the OFC, creating a loop

• the caudate nucleus helps regulate the circuit by supressing some of the ‘minor’ worries to prevent the circuit from becoming overactive

• when someone has OCD it is likely that their caudate nucleus isn’t working very well

evaluate genetic explanations as part of the biological approach to explaining OCD

strengths:

research support

• Nestadt reviewed previous twin studies and found that 68% of identical twins matched for an OCD diagnosis as opposed to 31% of non-identical twins

• this suggests a genetic influence on OCD and increases validity of explanation

weakness:

environmental factors

• environmental factors should also be considered alongside genetic factors

• no twin study found concordance rates of 100% in identical twins even though they share 100% of their genes

• this shows environmental factors play a role

• cromer found that over half the OCD patients in their sample had a traumatic event in the past and that OCD was more severe in those who had trauma

• this supports the diathesis-stress model, the idea that mental illness is a result of a genetic vulnerability triggered by stress

• this suggests that genes alone cannot explain OCD

evaluate neural explanations as part of the biological approach to explaining OCD

strengths:

explanations for OCD supported by effective treatments

• SSRIs increase serotonin activity in the synapse by blocking the reuptake of serotonin

• these are effective in reducing OCD symptoms in 50% of sufferers which suggests OCD is linked to low levels of serotonin

HOWEVER> SSRIs are not effective in all patients suffering with OCD and not all OCD can be explained by low serotonin, furthermore- there is a time delay in taking drugs and any improvements in symptoms, yet the SSRIs boost serotonin levels within hours

clear evidence for neural explanations

(basal ganglia)

• rates of OCD are higher than average among people suffering with parkinsons disease or tourettes, two disorders linked to abnormalities in the basal ganglia

(OFC)

• Whitehead reviewed brain imaging research into OCD and found hyperactivity in the OFC was significantly more common in OCD patients compared to healthy controls

• there is also evidence that overactivity reduces after treatment

• we can therefore say there is objective, scientific evidence of brain abnormalities in OCD

outline drug therapy in treating OCD

• drug therapy aims to increase or decrease levels of neurotransmitters in the brain to decrease/increase their activity

SSRIs:

• serotonin is released by certain neurons in the brain

• released by presynaptic neurons and travels across the synapse

• the neurotransmitter chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and then it is reabsorbed by the presynaptic neuron where it is broken down and reused

• SSRIs stop this process of reabsorption and reuptake from happening which increases levels of serotonin in the synapse and thus continues to stimulate the postsynaptic neuron

• it can take up to 3 months for SSRIs to take effect

combining SSRIs with other treatments:

• drugs are often used with CBT to treat OCD

• the drugs enable people to engage more effectively with CBT as the drugs reduce emotional symptoms such as anxiety or depression

alternatives to SSRIs:

• if SSRIs are not effective after 3 months of use the dose can be increased (eg- up to 60mg of fluoxetine from 20mg) or it can be combined with other drugs

• tricyclics are sometimes used or SNRIs

anti-anxiety drugs:

• benzodiazepines (BZs)- a range of anti-anxiety drugs

• they work by increasing activity of the neurotransmitter GABA which is an inhibitory neurotransmitter which reduces neuron activity

• increasing GABA slows down neuron activity further so BZs have a quietening influence on the brain which reduces anxiety and obsessive thoughts

evaluate the use of drug therapy for treating OCD

strengths:

evidence for its effectiveness

• soomro conducted a meta analysis (review) of the research examining the effectiveness of SSRIs and found they were more effective than placebos in the treatment of OCD 100% of trials

• this supports biological treatments of OCD, especially SSRIs

cost effective

• anti-depressants and anti-anxiety drugs are cost effective in comparison to psychological treatments such as CBT

• doctors may prefer the sue of drug therapy to talking therapy as it is cost effective for the NHS

weaknesses:

side effects:

• drug therapy has side effects

• SSRI side effects= indigestion, blurred vision

• BZs side effects= dizziness, lack of coordination

• BZs are well known for their withdrawal effects which makes them very addictive and BZs can have very negative long term effects such as cognitive impairments

passive treatment:

• drugs dont require any active participation from patients

• for many patients it is important that they are actively engaged in their treatment as it can give them a sense of control

• this active involvement is missing from drug therapies