Psychopathology

What are 4 definitions of abnormality?

* Deviation from social norms
* Statistical infrequency
* Failure to function adequately
* Deviation from ideal mental health

Deviation from social norms

Abnormality is a violation of acceptable patterns of behaviour (social norms), which are explicit or implicit

Deviation from social norms AO3 - cultural issues

Social norms are not the same in all cultures so it is not possible to use one set of norms to decide if people are abnormal in all cultures.

* For example, in some cultures it is normal to see, hear, and talk to the dead whereas if you did that somewhere else people may class you as having schizophrenia and violating social norms.
* The deviation from social norms definition is not universal.

Deviation from social norms AO3 - changing over time

Culture can change over time and the ideas about what is normal according to this definition may not be able to keep up with the change so people would be seen as abnormal even when society does not.

* e.g. until 1973 the APA considered homosexuality a disorder whereas most people did not feel that way

Deviation from social norms AO3 - eccentricity

The definition isn't reliable as it cannot distinguish between eccentric behaviour and pathologically abnormal behaviour.

* Eccentric people may break social norms but they wouldn't be mentally ill in a pathological sense.

Deviation from social norms AO3 - criminal or abnormal?

The definition is not reliable as it cannot distinguish between criminal behaviour and pathologically abnormal behaviour

* Criminals break explicit social norms but are not always pathologically abnormal but would be according to this definition.

Failure to function adequately

Abnormality is when someone is unable to live a normal life and cope with the ordinary demands of day-to-day living

^^Rosenhan & Seligman (1989)^^ identified 7 characteristics:

* suffering
* maladaptiveness
* unpredictability
* irrationality
* causes observer discomfort
* unconventionality
* violation of moral/social standards

Assessed using the @@‘global assessment of functioning scale’@@

FtFA AO3 - cultural issues

What is defined as functioning adequately may be different from one culture to another, it’s not generalisable

* e.g. new age travellers don't have jobs and therefore would be considered abnormal when that is just their culture.
* Therefore this definition is not universal.

FtFA AO3 - subjective

Deciding whether an individual is coping or not is a subjective judgement that is affected by the opinions of the observer

* Two observers may not rate a person in the same way; there is potential low inter-rater reliability

FtFA AO3 - exceptions

Not all maladaptive behaviour is an indication of mental illness

* For example, smoking and poor diet are seen as against a person’s long-term interests in their personal health, but neither of these behaviours are assumed to constitute mental illness.

FtFA AO3 - direction of causality

Inability to cope with the demands of daily living may be a cause rather than an effect of a mental disorder

* This may explain why there’s a higher incidence of mental disorders among ethnic minorities due to prejudice and discrimination.

Deviation form ideal mental helath

Abnormality is an absence of normality and occurs when someone doesn’t meet a set of criteria for good mental health

^^Marie Jahoda^^ identified 6 factors necessary for living a normal life:

* Positive view of self
* Accurate view of reality
* Personal autonomy
* Environmental mastery
* Resistance to stress
* Self actualisation

DfIMH AO3 - ethnocentric

Criteria are culturally biased to reflect an ethnocentric Western viewpoint on what ideal mental health is.

* This is an example of a culturally specific viewpoint being applied to all people as a universal construct.
* For example, collectivist cultures place less value on the autonomy and self-actualisation found in Western cultures, seeing playing a social role as more important.

DfIMH AO3 - too demanding

It is very difficult to achieve all of these criteria, so most people would be judged as failing to achieve ideal mental health, and would therefore be classed as abnormal.

DfIMH AO3 - comprehensive

The definition covers a broad range of criteria for mental health and covers most of the reasons someone would seek help

* Therefore the sheer range of factors considered makes it a good tool for thinking about mental health.

DfIMH AO3 - difficult to measure

Vague criteria for ideal mental health are difficult to measure

* For example, how can we measure things like environmental mastery?
* It would lead to subjective judgments being made by psychiatrists when the individual themselves may not feel the same way.

Statistical infrequency

Abnormality is when an individual has a less common characteristic so their behaviour is statistically rare in a population

* A disorder is abnormal if its frequency is more than 2 standard deviations away from the mean incidence rates represented on a normally-distributed bell curve

SI AO3 - overlooks desirability

The statistical infrequency definition of abnormality overlooks desirability

* Not all statistically infrequent traits are negative
* This definition would include high IQ, but whilst this is statistically rare it is also highly desirable.

SI AO3 - exceptions

Some psychopathologies such as depression and anxiety are quite common.

* Around 1 in 6 adults surveyed in England by the NHS met the criteria for a common mental health disorder (CMD) in 2014.
* The statistical infrequency definition does not match the high incidence of mental health disorders within society.

SI AO3 - labelling

If someone is living a happy and fulfilled life there is no benefit to them being labelled as abnormal

* Being labelled as abnormal might have a negative effect on the way others view them and the way they view themselves.

SI AO3 - time

Sometimes behaviours are not rare at a given time in some cultures even though they are abnormal in the sense of being undesirable.

* For example the Rwandan genocide- hundreds of thousands of people were being murdered.

What is a phobia?

An irrational fear of an object or situation

* characterised by excessive fear and anxiety
* the extent of fear is out of proportion to the actual danger posed by the phobic stimuli
* the reaction is beyond voluntary control and is unreasonable and excessive

% of people in the UK with phobias?

approx. 5 - 10%

What is a specific phobia?

When sufferers are anxious in the presence of a specific object or specific situation eg spiders.

3 types of phobias

* @@Specific@@ phobias
* @@Social@@ phobias
* @@Agoraphobia@@

Specific phobia

Phobia of a particular object or specific situation

* e.g. spiders, blood, heights, flying, having an injection

Social phobia

Phobia of a social situation

* e.g. public speaking, meetings, using a public toilet

Agoraphobia

Phobia of being in situations you cannot easily escape

* e.g. open spaces, crowds

Characteristics of phobias can be…

* @@Behavioural@@ - how you behave in presence of feared object
* @@Emotional@@ - how you feel in presence of feared object
* @@Cognitive@@ - how you think about feared object

Behavioural characteristics of phobias

Panic, avoidance, endurance

* @@Panic@@ - an uncontrollable physical response such as screaming, escaping, or hyperventilating
* @@Avoidance@@ - behavioural adaptations made to prevent encountering the phobic object or situation
* @@Endurance@@ - when the patient remains exposed to the phobic stimulus for an extended period of time, but experiences heightened levels of anxiety during this time

Emotional characteristics of phobias

Anxiety, unreasonable emotional responses

* @@Anxiety@@ - an uncomfortable high-arousal state that inhibits relaxation and pleasurable emotions
* @@Unreasonable emotional response@@ highly disproportionate to the threat posed by the phobic stimuli

Cognitive characteristics of phobias

Selective attention, irrational beliefs, cognitive distortions

* @@Selective attention@@ - sufferers focus their attention on the phobic object to the extent that it interferes with other tasks
* @@Irrational beliefs@@ - sufferers overstate the potential danger of the phobic object or importance of the social situation
* @@Cognitive distortions@@ - the patient does not perceive the phobic stimulus accurately

The behavioural approach to explaining phobias

The behavioural approach to explaining phobias uses the @@two-process model@@ (^^Mowrer 1960^^) which proposes that phobias are acquired through classical conditioning and maintained through operant conditioning

What is classical conditioning?

Learning through association

Classical conditioning and phobias

Phobias are acquired by the association between something that initially produces no fear @@(neutral stimulus)@@ and an anxiety-provoking stimulus @@(unconditioned stimulus)@@.

This association produces the conditioned response of fear

Little Albert

^^Watson & Raynor (1920)^^ used a child called Little Albert to demonstrate how phobias could be induced through CC

* He was exposed to a white rat (NS), producing no response. When paired with a loud bang (UCS), this produced the UCR of fear. Through several repetitions, Albert made the association between the banging noise (UCS) and rat (CS) which led the rat (CS) to produce the CR of fear.
* This conditioning then generalised to other white fluffy objects e.g. rabbits

What is operant conditioning?

Learning through reinforcement

Operant conditioning

Phobias are maintained by negative reinforcement

* People with phobias avoid the phobic stimulus
* By avoiding this phobic stimulus, they avoid the associated fear
* By avoiding such an unpleasant consequence, the avoidance behaviour is negatively reinforced and likely to be repeated again, hence maintaining the phobia.

What is negative reinforcement?

The removal of an unpleasant feeling. This removal feels rewarding and so increases the frequency of behaviour.

\+ve explaining phobias AO3 - Little Albert

^^Watson & Raynor’s^^ Little Albert study provides supporting evidence for the acquisition of phobias through classical conditioning

* In the study, the researchers managed to make Little Albert develop a phobia of white rats and other white fluffy objects through classical conditioning

\+ve explaining phobias AO3 - application

The behaviourist explanation for phobias has good practical applications

* For example, it has led treatments for phobias such as systematic desensitisation and flooding which remove the conditioned association between the fear and the phobic stimulus
* These treatments are effective in treating many phobias and so have greatly improved the quality of life of many people with phobias

\-ve explaining phobias AO3 - incomplete

Alternative theories may provide better explanations for certain phobias

* For example, the @@diathesis-stress model@@ suggests that we inherit a genetic vulnerability for developing mental disorders which manifest if triggered by a life event
* So in the case of phobias, certain phobic stimuli would only result in a phobia in people with a genetic vulnerability for developing that phobia
* This explanation would explain why not all fearful experiences result in a phobia, which is something the behaviourist explanation cannot account for

Furthermore, ^^Seligman (1970)^^ argued that humans have a biological preparedness to develop certain phobias as they were adaptive in our evolutionary past

* This would explain why certain phobias which would have posed a threat to our evolutionary ancestors, such as heights and deep water are much more common than other phobias which wouldn’t have posed a threat to our evolutionary ancestors
* This is something the behaviourist approach can’t explain
* Therefore the behaviourist explanation for phobias is an incomplete explanation for phobias

\-ve explaining phobias AO3 - reducionist

The behaviourist explanation for phobias is environmentally reductionist, it doesn’t consider cognitive aspects that lead to phobias

* Phobias may actually develop as a consequence of irrational thinking which creates extreme anxiety and triggers the formation of a phobia
* The cognitive approach is valuable as it leads to cognitive therapies such as CBT which may be more successful than behaviourist treatments in treating phobias
* Therefore, it may be more worthwhile to consider cognitive aspects that contribute to the development of phobias rather than focusing on behaviour alone

The aim of the behaviourist approach to treating phobias

The aim of behavioural therapies is to remove the conditioned association between the fear and the phobic stimuli

2 commonly used behavioural therapies

* @@Systematic desensitisation@@
* @@Flooding therapy@@

What is systematic desensitisation?

Systematic desensitisation is a behavioural therapy designed to reduce phobic anxiety through gradual exposure to the phobic stimulus.

It’s based on the principle of classical conditioning and is designed to remove the fear response of a phobia and substitute it with a relaxation technique using @@counter conditioning@@.

Systematic desensitisation process

1. @@Anxiety hierarchy@@ is put together, starting at the stimuli that creates the least anxiety and building up in stages to the most fear provoking stimuli.
* Provides a structure for the therapy
2. @@Relaxation techniques and breathing exercises@@ are taught to the sufferer
* @@Reciprocal inhibition@@ - one response is inhibited as it’s incompatible with another - phobias involve tension, tension is incompatible with relaxation
3. @@Exposure@@ - the sufferer is gradually exposed to the phobic stimuli, either in vitro or in vivo
* In vitro - the client imagines exposure to phobic stimulus
* In vivo - client is actually exposed to phobic stimulus

The patient works their way up through the hierarchy, only progressing to the next level when they have remained calm in the present level

The phobia is cured when the patient can remain calm at the highest anxiety level @@(extinction)@@

What is flooding?

Flooding is a behavioural therapy designed to reduce phobic anxiety in one session, through immediate exposure to the phobic stimulus

* e.g. a claustrophobic person might be locked in a closet for hours

How flooding works

* The sufferer is exposed to the phobic stimulus for an extended period of time in a safe, controlled environment
* Fear is a time limited response; at first the person is in a state of extreme anxiety but eventually exhaustion sets in and anxiety levels begin to go down
* Usually, the person would avoid such a situation but they have no choice but to confront their fears and when the panic subsides and they find they have come to no harm, the phobia is extinguished
* Prolonged intense exposure eventually creates a new association between the phobic stimulus and something positive. It also prevents reinforcement of the phobia through escape or avoidance behaviour

\+ve SD AO3 - supporting evidence

There is supporting evidence for the effectiveness of systematic desensitisation in treating phobias

* ^^McGrath et al (1960)^^ found that 75% of patients with phobias were successfully treated using SD when using in-vivo techniques
* This shows that SD is effective in treating phobias
* There’s further supporting evidence from ^^Gilroy at al (2002)^^ who examined 42 patients with @@arachnophobia@@
* Each patient was treated using 3 45 minute SD sessions. When examined 3 months and 33 months later, the SD group were less fearful than a control group who were only taught relaxation techniques
* This suggests that SD is a long-term treatment for phobias, further highlighting is effectiveness

\-ve SD AO3 - not effective in treating all phobias

Systematic desensitisation is not effective in treating all phobias

* Patients with phobias which have not developed through a personal experience (classical conditioning) for example, a fear of heights, are not effectively treated using systematic desensitisation
* Some psychologists believe that certain phobias, like heights, are a result of a biological preparedness as they were beneficial in our evolutionary past
* These phobias therefore highlight a limitation of systematic desensitisation which is ineffective in treating evolutionary phobias.

\+ve flooding AO3 - cost effective

One strength of flooding is it provides a cost effective treatment for phobias

* Research has suggested that flooding is comparable to other treatments, including systematic desensitisation and cognition therapies, however it is significantly quicker
* This is a strength because patients are treated quicker and it is more cost effective for health service providers

\-ve flooding AO3 - traumatic

Flooding is highly traumatic for patients and causes a high level of anxiety

* Although patients provide informed consent, many do not complete their treatment because the experience is too stressful and therefore flooding is sometimes a waste of time and money as many patients do not finish their therapy.
* Systematic desensitisation has a higher completion rate, perhaps because it is a more pleasant experience.

What is depression?

Depression is a mental disorder characterised by low mood and low energy levels

DSM-5 categorises depression into…

* Major depressive disorder
* Persistent depressive disorder
* Disruptive mood dysregulation disorder
* Premenstrual dysphoric disorder

What two main types is depression divided into?

@@Unipolar@@ (major depression) & @@bipolar@@ (manic depression)

Unipolar depression can be…

Reactive or endogenous

* @@Reactive@@ - caused by a stressful event e.g. death
* @@Endogenous@@ - caused from within the person e.g. hormonal imbalances

Behavioural characteristics of major depression

* lowered activity levels
* disrupted sleep
* eating problems
* aggression
* self harm

Emotional characteristics of major depression

* lowered mood
* anger
* lowered self-esteem

Cognitive characteristics of major depression

* reduced concentration
* suicidal thoughts
* poor memory
* delusions
* dwelling on the negative
* absolutist thinking

What approach explains depression?

The cognitive approach

Beck (1967)

Suggested that depression is a disorder of thought rather than mood.

Some people are more vulnerable to depression than others; the person’s cognitions create this vulnerability

Beck suggested 3 parts to this cognitive vulnerability:

* @@Faulty information processing@@
* @@Negative self-schema@@
* @@The negative triad@@

Faulty information processing

* Depressed people focus on negative aspects and tend to ignore positives
* Depressed people tend to blow small problems out of proportion and think in ‘black-and-white’

Negative self-schema

A schema is a ‘package’ of ideas and information developed through experience. They act as a mental framework for interpretation of sensory information.

* A self-schema is the package of information people have about themselves
* Depressed people interpret all information about themselves in a negative way

The negative triad

Beck suggested a person develops a dysfunctional view because of 3 types of negative thinking that occur automatically, regardless of the reality of what’s happening at the time

* @@Negative view of the world@@
* @@Negative view of the future@@
* @@Negative view of the self@@

Ellis (1962)

Good mental health is the result of rational thinking - thinking in ways that allow people to be happy and free from pain

Depression is due to @@irrational thoughts@@ - any thoughts that interfere with us being happy and free from pain

Ellis’ ABC model

@@**A - activating event**@@

* We get depressed when we experience negative events which trigger irrational beliefs e.g. failing a test

@@**B - beliefs**@@

* Examples of irrational beliefs: @@musturbation@@ - belief that we must always succeed or achieve perfection; @@I-can’t-stand-it-itis@@ - belief that it’s a major disaster when something doesn’t go smoothly; @@utopianism@@ - belief that life is always meant to be fair

@@**C - consequences**@@

* When an activating event triggers irrational beliefs there are emotional and behavioural consequences

\+ve explaining depression AO3 - treatments

Cognitive explanations for depression have been used to develop successful and widely used @@CBT@@ and @@REBT@@ treatments

* The success of these treatments is shown by ^^March et al (2007)^^ who compared CBT with medication and found an effectiveness rate of 81% for both treatments, suggesting that the underlying cognitive theory that depression is due to faulty cognitions is valid as the treatment based on that idea is effective

\+ve explaining depression AO3 - supporting evidence

There is supporting evidence to validate the cognitive explanation for depression

* ^^Lloyd & Lishman (1975)^^ studied ppts with depression
* Ppts. were presented with stimulus words and asked to recall pleasant or unpleasant childhood experiences in response
* They found that those with low-level depression responded faster when recalling peasant memories than those with deeper depression
* This shows that depressed people have automatic negative thinking as suggested by the cognitive approach

\
* Furthermore, ^^Boury et at (2001)^^ found that people with depression were more likely to misinterpret information negatively @@(cognitive bias)@@ and feel hopeless about their future @@(negative triad)@@
* This supports Beck’s theory and ideas that cognition are involved in depression

\-ve explaining depression AO3 - incomplete explanation

The cognitive explanation for depression is an incomplete explanation as it doesn’t account for biological explanations

* There is significant evidence that biological factors play a large role in depression, with some people being genetically vulnerable and a neurochemical factor being apparent from the effectiveness of antidepressant medication
* This means that the cognitive explanation cannot be a full explanation.

\-ve explaining depression AO3 - situational factors

The cognitive approach to explaining depression doesn’t consider situational factors which contribute to depression

* The cognitive explanation suggests that the sufferer is responsible for their disorder and gives them the power to cure their depression by changing the way they think
* This explanation overlooks situational factors such as poverty or grieving which contribute to depression
* It may be more beneficial to consider ways to change overcome these situational factors rather than focusing solely on the sufferer’s cognition

What is the cognitive approach to treating depression?

CBT - @@cognitive behavioural therapy@@

What is CBT?

A talking therapy involving both cognitive and behavioural elements

* Cognitive element aims to identify irrational and negative thoughts that lead to depression and replace these with more rational and positive ones
* Behavioural element encourages patients to test their beliefs through behavioural experiments and homework

What general process does CBT follow?

1. General assessment
2. Goal setting
3. Identifying negative/irrational thoughts
4. Challenging and testing these thoughts

Beck’s CBT (ICT)

@@Identify@@

* Using the negative triad, the therapist helps the patient to identify negative thoughts about themselves, their world and their future

@@Challenge@@

* Therapist challenges the client’s irrational thoughts by asking them to provide evidence for their beliefs

@@Test@@

* Patient is encouraged to test the validity of their negative thoughts and may be set homework to challenge and test their negative thoughts on their own

\

Ellis’ Rational Emotive Behaviour Therapy (REBT)

Ellis built upon the ABC model to include D and E which are part of the REBT making it the ABCDE model

@@D - dispute@@

* Therapist will dispute the patient’s irrational beliefs through
* @@logical dispute@@ - encourages logical thinking e.g. ‘Does the way you think about this make any sense?’
* @@empirical dispute@@ - asking client for evidence for their thoughts e.g. ‘What makes you believe this is true?’

@@E - effective@@

* Once dispute has taken place, therapist seeks to replace their irrational beliefs with more effective and helpful beliefs

\+ve treating depression AO3 - supporting evidence

There is evidence to validate the effectiveness of CBT

* ^^March (2007)^^ found that CBT was as effective as antidepressants in treating depression
* Researchers examined 327 adolescents with depression and after 36 weeks, 81% of the antidepressant group and 81% of the CBT group had significantly improved
* This suggests that CBT is an effective treatment for depression and is arguably better than using antidepressants due to the fewer side effects and reduced risk of relapse

\+ve treating depression AO3 - empowering

A strength of CBT as a treatment for depression is that it can be seen as empowering

* In the therapy the patient acts as an engaged and active force in their own recovery, whereas antidepressants places the patient into a passive role
* This empowerment could lead the patient to feel motivated to continue bettering themselves by attending the CBT sessions
* And ultimately this motivation is the reason the patient is cured of depression through CNT

\-ve treating depression AO3 - not always appropriate

CBT is not appropriate for patients who are severely depressed

* This is because CBT requires motivation and willingness to engage in the process and patients with severe depression may not engage or even attend the sessions
* So, for more severe cases, antidepressants may need to come first to reduce symptoms initially before the patient can begin CBT

\-ve treating depression AO3 - due to therapist-patient relationship

Success may not actually be due to CBT techniques but due to a good therapist-patient relationship

* ^^Rozenweig (1936)^^ argued that the relationship between the client and therapist is of utmost importance
* If the client cannot build a trusting relationship with a specific therapist, the therapy may not be successful
* This raises the idea that it may simply be having someone trustworthy to talk to that leads to positive outcomes rather than any specific CBT techniques

What is OCD?

OCD is an anxiety disorder with two main components - obsessions and compulsions

Most sufferers recognise that their obsessions and compulsions are inappropriate but cannot control them which results in further anxiety

What are obsessions?

Obsessions are recurring, persistent thoughts not based on reality

* e.g. being convinced germs are everywhere, causing feelings of anxiety

What are compulsions?

Compulsions comprise of intense, uncontrollable urges to repetitively perform tasks

* e.g. intense handwashing

What are the behavioural characteristics of OCD?

* Compulsions
* Avoidance
* Social impairment

What are the emotional characteristics of OCD?

* Extreme anxiety and distress
* Accompanying depression
* Guilt and disgust

What are the cognitive symptoms of OCD?

* Obsessive thoughts
* Thoughts recognised as self generated
* Attentional bias
* Cognitive strategies to deal with obsessions

According to the DSM, OCD diagnosis requires what symptoms to be present?

* recurrent obsessions or compulsions
* past or present recognition that obsessions or compulsions are excessive or unreasonable
* obsessions or compulsions cause marked distress, take up > 1 hour a day, or interfere significantly with individual’s normal functioning

What does the biological approach to explaining OCD assume?

Abnormalities such as OCD are caused by physical factors such as genes or neural explanations.

The genetic explanation - inheritance

The genetic explanation for OCD suggests that individuals inherit specific genes that cause OCD

* ^^Lewis (1936)^^ observed that of his OCD patients 37% had parents with OCD and 21% had siblings with OCD
* This suggests that OCD runs in families

The genetic explanation - polygenic

* OCD is @@polygenic@@, up to 230 different genes are involved in its development
* These are often associated with the functioning of neurotransmitters, such as dopamine and serotonin, both associated with regulating mood

The genetic explanation - candidate genes

Researchers have identified candidate genes which increase a person’s vulnerability towards developing OCD

* Two candidate genes involved are the SERT gene and the COMT gene

SERT gene

The @@SERT gene@@ (also known as the 5-HTT gene) affects the transport of serotonin and causes lower levels of serotonin, which is associated with OCD

COMT gene

The @@COMT@@ gene is responsible for clearing dopamine from synapses and low activity of the COMT gene is also associated with OCD 

The genetic explanation - aetiologically heterogenous

OCD is aetiologically heterogenous, meaning that its origin has many different causes

* One group of genes may cause OCD in one person but a different group of genes may cause OCD in another person


* For example, it has been suggested that hoarding disorder is caused by a particular genetic variation

Neural explanations of OCD

Neural explanations of OCD focus on neurotransmitters and brain structures in the development of OCD

What two neurotransmitters are associated with OCD?

Serotonin and dopamine

Neural explanation - serotonin

* People with OCD have lower levels of @@serotonin@@
* It is thought that serotonin plays a role in preventing task repetition
* A lack of serotonin results in a loss of a mechanism that inhibits task repetition
* Therefore, OCD symptoms can be explained by lower serotonin levels

Neural explanation - dopamine

* The neurotransmitter @@dopamine@@ has also been implicated in OCD
* higher levels of dopamine are associated with some of the symptoms of OCD, in particular the compulsive behaviours.

What two brain regions are associated with OCD?

Basal ganglia and orbitofrontal cortex

Neural explanation - basal ganglia

* The @@basal ganglia@@ is a brain structure involved in multiple processes, including the coordination of movement
* Patients who suffer head injuries in this region often develop OCD-like symptoms, following their recovery suggesting that the basal ganglia is involved in the development of OCD