Clinical Psychology and Mental Health (Psycopathology)

What are the 4 definitions of abnormality

• Statistical Infrequency

• Deviation from social norms

• Failure to function adequately

• Deviation from ideal mental health

What is statistical Infrequency

• Defined by what falls outside the statistical range

• Common traits and behaviours are normal, uncommon traits aren’t

• E.g. those with an IQ below 70 can be diagnosed with intellectual disability

What are the limitations to statistical infrequency

• An uncommon behaviour isn’t necessarily an abnormal one

  • e.g. an IQ over 130 is just as uncommon as under 70 but we wouldn’t consider it abnormal.

• Not all disorders are uncommon

• The lifetime prevalence of depression is around 20% - however people with statistically common psychological disorders are still in need of treatment

What is Deviation from social norms

• A behaviour which goes against the standards of behaviour set by a society

• E.g. Pseudobulbar affect (PBA) is characterised by intense and uncontrollable displays of emotion - may be disproportionate

What are the limitations of Deviation from social norms

• Social norms may vary across time and across cultures

  • E.g. Hearing voices is seen as highly abnormal in Western society, but in some cultures, such as the Maori people of New Zealand, is it seen as a normal thing

• Many people engage in behaviours which are not strictly in line with social norms, but there aren’t psychologically abnormal

What is deviation from ideal mental health

• It argues that mental ill health is the failure to achieve good mental heath

• Good mental health consists of (according to Marie Jahoda - 1985):

  • Positive self attitudes

  • Autonomy, personal growth and self actualisation

  • Integration of all the peoples processes and attributes

  • The ability to cope with stress

  • Sense of reality

  • The ability to introspect

  • Environmental mastery

  • Absence of mental illness

What are the limitations of deviation from ideal mental health

• Do you have to satisfy all of the criteria to be considered abnormal

• Do you have to satisfy the criteria at all times

• Are these criteria still appropriate today

• Many only apply to certain societies (western)

What is failure to function adequately

• Cannot cope with day-to-day existence

• David Rosenhan and Martin Seligman defined it as:

  • When a person no longer conforms to standard interpersonal rules, for example maintaining eye contact and respecting personal space.

  • When a person experiences severe personal distress

  • When a person's behaviour becomes irrational or dangerous to themselves or others

• Positives: it represents a sensible threshold for when people need professional help so treatment and services can be targeted to those who need them most.

What are the limitations of Failure to function adequately

• It is easy to label non-standard lifestyle choices as abnormal

• E.g. Not having a job or permanent address might seem like failing to function, however people with alternative lifestyles choose to live ‘off-grid’

• Similarly those who favour high-risk leisure activities or unusual spiritual practices could be classed as irrational and perhaps a danger to self.

• Which risks limiting people’s freedom

What are the behavioural characteristics of phobias

• Avoidance - effort to stay away from phobic stimulus

• Panic in the presence of the stimulus

• Endurance - staying near phobic stimulus and experiencing high levels of fear

What are the emotional characteristics of phobias

• Anxiety - The sufferer will feel anxious whenever they are reminded of the phobic stimulus. Phobias are classed as anxiety disorders

• Fear - Sufferer will experience intense disproportionate fear when in the direct presence of the phobic stimulus

• Emotional response is unreasonable - the anxiety/fear that they will feel will be disproportionate to any threat posed

What are the cognitive characteristics of phobias

• Selective attention - The individuals attention will be drawn to the stimulus

• Irrational beliefs - The individual will hold irrational beliefs about the danger posed. The sufferer will likely know their beliefs are irrational

• Cognitive distortions - Their perceptions may be inaccurate and unrealistic

What are the behaviourist approaches to explaining phobias

• They suggest that people are a product of their experiences

• And that they learn phobias through the two process model introduced by Mower (1960):

  • Classical conditioning

  • Operant conditioning

What is classical conditioning

Involves learning to associate something of which we initially have no fear (neutral stimulus) with something that already triggers a fear response (unconditioned stimulus)

Explain the case study linked to classical conditioning

Little Albert Case Study completed by John Watson and Rosalie Rayner (1920) In which they were attempting to give him a phobia.

• Albert was presented with a Neutral Stimulus of a white rat amongst other animals that he originally had no fear of

• Whenever Albert attempted to touch the rat, researches made a loud noise which frightens Albert

  • This was an UnConditioned Stimulus which made an UnConditioned Response of fear.

• The NS became associated with the UCS which meant they both produced a fear response

• Even with the UCS removed the NS produced fear on its own meaning the NS became a Conditioned Stimulus which produced a Conditioned Response

• The conditioned then generalised to similar objects such as a fur coat

What is operant conditioning

The idea that we can increase or decrease certain behaviour by introducing consequences.

How does operant conditioning apply to phobias

• Mowrer believed that operant conditioning is what caused phobias to be long lasting.

• He suggested that when a phobic stimulus is avoided and we successfully escape the fear and anxiety, the reduction in fear [that we feel] reinforces the avoidance behaviour which maintains the phobia.

What are some limitations of the behavioural method to explaining phobias

• Not all phobias are caused by trauma

  • DiNardo (1988) found that conditioning events like dog bites are common in participants with dog phobias (56%) but they are equally common in participants without dog phobias (66%)

  • Menzies and Clarke (2003) examined 50 cases of children with water phobia.

    • Only 1 of the 50 parents could recall a traumatic experience involving water, and 28 claimed their child was always afraid of water, even on their first encounter.

• Seligman (1970) proposed the idea of biological preparedness

  • This is the idea that there are certain things it would be adaptive for us to be afraid of such as snakes and heights

  • Modern humans still have this genetic predisposition which is why these phobias are uncommon

  • The failure to account for biological preparedness means it is an incomplete explanation

What are the real world applications of the behavioural approach to explaining phobias

• Has led to the development of 2 successful treatments:

  • Systematic desensitisation

  • Flooding

• These are both forms of exposure therapy which:

  • counteracts avoidance behaviour

    • Which means they don’t experience the anxiety reduction that encouraged avoidance

      • Which decreases avoidance

• If these methods (which are based on behavioural ideas) are effective then it validates the behavioural approach

Name 3 emotional features of depression

• Sadness

• Anger

• Worthlessness

• Guilt

• Hollow/empty

• Anxiety

• Dyregulation - Can’t regulate emotion

Name the behavioural features of depression (6)

• Self-isolation

• Difficulty looking after oneself

• Procrastination

• Anhedonia - lack of pleasure

• Sleep disturbance

• Substance use

What are the cognitive features of depression (2)

• Executive dysfunction - unable to make decisions

• Suicidal thoughts

What does the cognitive approach to explaining depression suggest

It suggests that depression may be the result of faulty thinking

What are the cognitive approches to explaining depression

• Aaron Becks Cognitive theory of depression (1967)

• Albert Ellis’s ABC model (1962)

What is Becks cognitive theory of depression

• Faulty information processing

• Negative self-schemas

• The negative triad

What is faulty information processing

• Focusing on the negatives of a situation instead of the positives, even if the situation is a good one

• Blowing small problems out of proportion

• Thinking in black and white terms

What is a negative self-schema

• Schema = package of ideas and information developed through experience

• Beck linked this with childhood trauma - it leads to people developing a negative self-schema (sense of self)

  • If something unfortunate happens to me its my fault because I’m stupid

What is becks negative triad

A person develops a dysfunctional view of themselves because of three interconnected types of thinking - which happen automatically

• Negative view of self

• Negative view of the world

• Negative view of the future

Repeated intrusive thoughts of this nature can lead to depression

What is Ellis’s ABC model

• He developed this model to explain how some people react differently to events, and how different reactions may lead to depression

• Activating event:

  • According to Ellis, we get depressed when we experience negative events and these trigger irrational beliefs

• Beliefs

• Consequences

  • When an activating event triggers irrational beliefs there are emotional and behavioural consequences. For example, if you believe you must always succeed then fail at something, this can trigger depression

What are the strengths of the cognitive approach to explaining depression

• Grazioli & Terry (2000s):

  • Assessed 65 Women’s tendance to think negatively while pregnant

  • Assessed the same Women’s level of post-natal depression after birth

  • They found that negative thinking while pregnant predicted worse depression after birth

• Real world application:

  • If depression is caused by irrational negative thinking, it would suggest we should treat depression by changing the way patients think about

    • CBT aims to do that

What are the limitions of the cognitive approach to explaining depression

• Neurochemistry is an alternative explanation to depression

  • Neurotransmitters are used by neurons to communicate

  • Monoamines are a group of neurotransmitters involved in depression

    • Serotonin: Help to regulate emotions, calm and sleep

    • Dopamine: reward, motivation, movement

    • Noradrenaline: Increases alertness and focus

• Low levels of these can result in depressed mood, worthlessness/guilt and fatigue

• Doesn’t explain all aspects of depression:

  • Some depressed patients are deeply angry and beck cannot easily explain this extreme emotion.

What is cognitive behaviour therapy

• The cognitive treatment for depression

• As the cause of depression is negative thoughts, the aim of CBT is to challenge these thoughts

• Has been praised for targeting the root cause of the symptoms rather than just masking symptoms

What are the steps in CBT

1. Identifying irrational thoughts

2. Disrupting irrational thoughts

3. Patient as a scientist & homework

4. Behavioural activation

What is identifying irrational thoughts

• Client and therapist work together to identify the nature of the irrational thoughts of the client

• Also helps the client to gain an insight into their thought processes

What is disrupting irrational thoughts

• Once identified, the therapist will aim to disrupt the irrational thoughts via:

  • Logical Arguments: Arguing based on whether the clients thoughts actually make sense

  • Empirical Arguments: Arguing based on actual evidence

What is patient as a scientist & homework (include behavioural activation)

• The client is required to objectively assess the validity of their irrational thoughts just as a scientist would

• This is done via diary keeping of their experiences, such as their interactions with others

  • Behavioural activation:

  • The client will be encouraged to continue going out and doing things they usually enjoy

  • The more the client goes out and does things, the more opportunities there are for positive events and interactions occur

  • These can be used as evidence against irrational thoughts

What are the strengths of CBT

• Research evidence: March et al (2007)

  • Comparison between CBT and antidepressants

  • Assessed treatment response after 36 weeks in 387 adolescents

  • Those that used CBT: 81% improved

  • Those that used antidepressants: 81% improved

  • Combination of the two: 86% improved

  • Shows CBT is effective, although more effective with antidepressants

• Targets route cause - lower relapse rate

• Validifies experiences

• Take skills you learn into the future

• Doesn’t have side effects like nausea, dependency, irritability and sexual disfunction

  • Negative patient experience with a high drop out rate

• Has a lower drop out rate than anti-depressants

What are the limitations of CBT

• Antidepressants better:

  • Removes blame from the patient

  • Easy - less time invested

• CBT may not work for more severe cases

  • Requires a high level of motivation and engagement from the client

  • Those with sever depression may find this difficult - so for them CBT will be ineffective

  • May refer to use antidepressants to stabilise their mood and then use CBT

• Overly focused on cognition:

  • May ignore circumstantial issues

  • Many with depression may be facing real external issues such as poverty, debt or bullying

  • For these, it may be that their mental health is extricably linked to their circumstances

  • CBT may not change their circumstances but it may help them cope better

What are the behavioural characteristics of OCD

• Compulsions:

  • Repetitive

  • Simply to reduce anxiety. ~10% of sufferers show compulsive behaviour without any obsessions

• Avoidance: may avoid things that will trigger anxiety - eg. Germaphobes will avoid germs

What are the emotional characteristics of OCD

• Anxiety and distress - compulsions create anxiety

• Accompanying depression -

• Guilt and disgust