Clinical Psych - paper 1

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What is statistical infrequency?

Statistical infrequency refers to behaviours or characteristics that are rare or uncommon within a given population. If someone exhibits a behaviour that is significantly different from the majority or 2 standard deviations from the mean, it may be considered statistically infrequent, helping to identify potential psychological disorders.

Example of statistical infrequency…

If someone has an IQ score below 70, where the average is 100, this is more than 2 standard deviations from the mean, which may indicate a developmental disorder.

A strength of using statistical infrequency?

-It provides an objective, data-driven criteria for identifying abnormal behaviour, reducing subjective bias in diagnosis.

-Uses non-subjective judgements, unlike other definitions, using measurable data, to highlight statistically rare behaviours.

-Most methods used to diagnose mental health, like the PHQ-9 for depression, rely on statistical cut-off scores. Even broader definitions, such as failure to function, involve rating scales.

-Helps to reduce bias in clinical practice.

Weakness of statistical infrequency…

• It has rigid cut-offs that can unfairly exclude people who genuinely need help.

• Although it relies on rare scores, that threshold may not reflect individual needs.

• For example, in the UK, many people are denied access to CMHT because their scores fall just below the threshold, even after being referred by a GP.

• Demonstrates how cut-offs can block support for those in need of care.

• Shows that although it seems objective, the cut-off point is ultimately subjective and can prevent people from receiving necessary support.

What is functional impairment?

Mental health professionals may decide someone needs help if their symptoms are affecting their ability to live a normal life.

Clinical psychologists assess failure to function using tools like what?

WHODAS 2.0

What 6 ideas does WHODAS focus on?

• Cognition- concentration, memory

• Mobility- being able to leave the house

• Self-care- washing, dressing, eating

• Getting along- with people

• Life activities- work, school

• Participation- social inclusion

A strength of failure to function adequately?

• Considers the individual’s perspective

• the person’s own report on how they cope with daily life

• Tools like WHODAS use self-report questions, making it more person-centred.

• makes this definition more relevant in clinical practice as it values personal experience.

Weakness of failure to function adequately?

• Involves subjective judgement

• Even though tools are used to provide structure, professionals still need to decide whether distress is severe enough to need intervention.

• As one psychologist may interpret someone’s difficulty attending work as serious, another may see it as manageable, depending on their judgment and experience.

• This lack of consistency can lead to differences in who gets support, making the definition less reliable when used alone.

Who proposed the criteria for ideal mental health?

Marie Jahoda (1958)

According to Jahoda, mental health is judged based on the presence of what 6 qualities?

P - positive attitude towards self

R - resistance to stress

A - accurate perception of reality

I - independent

S - self-actualisation

E - environmental mastery

Strength of ideal mental health?

• Takes a positive and holistic approach to understanding mental health.

• Rather than focusing on one symptom, Jahoda’s criteria outlines what good mental health looks like.

• Encourages a more complex view of a person’s wellbeing and identifies areas that need help as well as areas to promote recovery.

• Making it a valuable addition to the field of mental health as it shifts focus from just treating illness to supporting mental wellness.

Weakness of Jahoda’s definition of ideal mental health?

• Criticised for being culturally biased.

• Criteria reflect Western, individualistic values such as independence and autonomy, which are not valued in the same way in collectivist cultures.

• For instance, in some cultures, depending on others and prioritising community over personal achievement is seen as healthy, not a sign of poor mental health.

• Meaning that the definition may unfairly pathologise people from non-Western cultures and doesn’t reflect how mental health is understood globally.

What is deviation from social norms?

Mental health professionals may decide someone needs support if their behaviour is very different from what is generally expected or accepted within their community or culture.

Strength of deviation from social norms?

• Reflects real-world concern as people are often referred for help because others notice something unusual or socially inappropriate.

• For example, teachers, police officers or family members may raise concerns when someone’s behaviour violates social expectations.

• This can be a valuable starting point for identifying people who may be struggling and need mental health support.

• While not a complete definition, it has practical value as an early warning sign, helping professionals know when to carry out further assessments.

Weakness of deviation from social norms

• Norms differ between cultures.

• What is considered usual or acceptable in one culture may be seen as normal in another, meaning someone could be labelled as needing support in one cultural context but not another, raising ethical concerns about fairness and bias.

• For example, in the UK, people of African-Caribbean descent are diagnosed with schizophrenia 7 times more often than the general population (Gara et al.), as behaviours that can differ from dominant cultural norms can be misinterpreted as signs of mental illness.

• This highlights that the definition is culturally relative, making it less valid as a universal tool for identifying mental health needs.

What is a phobia?

• A phobia is a form of anxiety disorder characterised by an irrational and extreme fear of a specific object, situation or activity.

• The fear experienced is often disproportionate to the actual danger posed and leads to avoidant behaviour.

• This avoidance can become maladaptive, meaning it disrupts a person’s ability to function in everyday life.

What are the behavioural characteristics of a phobia?

• Avoidance

• Panic

• Endurance (remaining in the presence of the phobic stimulus but experiencing high anxiety)

What are the emotional characteristics of phobias?

• Anxiety

• Unreasonable emotional response

What are the cognitive characteristics of phobias?

• Selective attention (focusing on phobic stimulus)

• Irrational beliefs

• Cognitive distortions (perceiving the stimulus in an exaggerated way)

What is depression?

Depression is a mood-affecting disorder characterised by persistent low mood and a lack of interest or pleasure in usual activities.

What are the behavioural characteristics of depression?

• Activity levels (reduced energy, social withdrawal)

• Disruption to sleep or eating (insomnia/hypersomnia, appetite loss/increase)

What are the emotional characteristics of depression?

• Lowered mood

• Anger

• Low self-esteem

What are the cognitive characteristic of depression?

• Poor concentration

• Negative self-schemas

• Absolutist thinking (black and white thinking)

What does SADFACE, the acronym for depression, stand for?

S - Sleep and eating disruption

A - Activity level changes

D - Difficulty concentrating

F - Feelings of worthlessness

A - Anger

C - Cognitive distortions

E - Emotional low mood

What is OCD?

Obsessive-compulsive disorder is an anxiety disorder characterised by unwanted thoughts (obsessions) and repetitive behaviours (compulsions) performed to reduce anxiety.

What are the behavioural characteristics of OCD?

• Compulsions - repetitive behaviours to reduce anxiety

• Avoidance - avoiding situations that might trigger obsessions

What are the emotional characteristics of OCD?

• Anxiety and stress (from obsessions)

• Depression (common due to disruption of daily life)

What are the cognitive characteristics of depression?

• Obsessive thoughts

• Cognitive strategies (mental acts used to manage compulsions)

• Insight into excessive anxiety (recognises that obsessions/compulsions are irrational)

• Hyper-vigilance (constantly alert and focus on potential danger/threat)

What is the behavioural approach to explaining phobias?

The two-process model - Mowrer (1947) proposed this model, which suggests that phobias are learned and assumes that phobias develop through an experience of a negative or traumatic event.

The two-process model suggests phobias are acquired through classical conditioning and are maintained through operant conditioning.

Who suggested the two-process model in explaining the behavioural approach to explaining phobias?

Mowrer (1947)

Who conducted the Little Albert study?

Watson and Rayner (1920)

What did the Little Albert study involve? (AO1)

Aim - To investigate whether a phobia could be created in an infant using classical conditioning

Method - The infant, known as Little Albert, was presented with a little white rat (neutral stimulus). He was curious and wanted to stroke and play with it. But then researchers paired the exposure of the rat with a loud noise.

Results - After pairing the frightening sound with the rat several times, the researchers found that Little Albert began to cry and crawl away every time the rat was brought over to him. The white rat was now the conditioned stimulus and his fear the conditioned response.

How are phobias maintained?

• Through operant conditioning.

• Avoidance of the feared stimulus reduces unpleasant feelings of fear/anxiety caused by the conditioned stimulus.

• Outline the two-process model as an explanation for phobias?This acts as negative reinforcement by removing something negative; you are rewarded by feeling less anxiety/fear, strengthening the avoidant behaviour, meaning that the phobia is maintained.

Outline the two-process model as an explanation for phobias…

• The two-process model suggests that phobias are acquired through classical conditioning and maintained through operant conditioning.

• Phobias are acquired by forming an association between an object or situation and something which causes a trigger response.

• For example, a person being bitten by a dog. The dog (initially the NS) would become associated with being bitten (the UCS), which leads to fear (UCR). This pairing leads to the dog becoming a CS, which then creates fear, the CR.

• Phobias are maintained through negative reinforcement. Those with a phobia will avoid the phobic stimulus, which reduces anxiety, acting as negative reinforcement.

• For example, if a person with a dog phobia sees one whilst out, they might avoid it by crossing the road. Therefore, reducing their anxiety and so negatively reinforces their avoidance behaviour, making the person more likely to continue avoiding dogs, thus maintaining their phobia.

What is a strength of the behavioural approach to explaining phobias?

• Strong research evidence supports the claim that phobias can be acquired through classical conditioning.

• Watson and Rayner (1920) demonstrated this in their Little Albert study.

• +Explain study

• This shows how a neutral object can become a source of fear through association with an unpleasant experience, supporting the role of classical conditioning in the development of phobias.

• However, because this study only explains how phobias are acquired and not how they are maintained, it provides limited support for the two-process model.

What is a weakness of the behavioural approach to explaining phobias?

• There are alternative explanations for how phobias may develop, not just from a negative experience.

• Instead, these phobias (such as heights, snakes or insects) can be explained using Seligman’s biological preparedness theory, which argues that humans are evolutionarily predisposed to fear certain things that posed a threat to survival in the past.

• For instance, people who were naturally more cautious of dangerous animals or risky situations were more likely to survive and pass on their genes.

• This inherited fear response helps explain why many people have these phobias without any personal trauma linked to them.

• This challenges the completeness of the two-process model of phobias, as it does not fully account for phobias that arise without a learned experience.

What is systematic desensitisation?

• Systematic desensitisation is a treatment based on classical conditioning that helps people gradually overcome their phobias by learning to associate the phobic object with relaxation instead of fear (counterconditioning).

• It’s based on the idea that we can’t be scared and relaxed at the same time, so one emotion cancels out the other, known as reciprocal inhibition.

What are the two types of exposure in systematic desensitisation?

• In vivo - facing your fear in real life (e.g. seeing a real spider)

• In vitro - imagining the feared situation (e.g. thinking about holding a spider)

How does systematic desensitisation work? What are the three steps?

• Anxiety/fear hierarchy - You work with your therapist to create a list of situations involving the phobia, ranked from least to most scary.

• Relaxation training - You learn ways to relax before facing your fear. (Deep breathing, visualisation, progressive muscle relaxation).

• Gradual exposure - You slowly work through your anxiety hierarchy, using your relaxation techniques at each step. Over time, your fear is replaced with calmness (counterconditioning)

Outline systematic desensitisation as a treatment for phobias

• Systematic desensitisation uses principles of classical conditioning to create a relaxation response to the phobic stimulus instead of fear, known as counterconditioning.

• A patient works with a therapist to create an anxiety hierarchy, ranking the phobic situation from most to least anxiety-inducing.

• They are taught relaxation techniques to help them remain calm when exposed to their fear.

• They begin at the bottom of the hierarchy and end at the top.

• The therapist will encourage them to use relaxation techniques and will not move on until their anxiety levels are reduced. This process will be repeated at each step of the hierarchy.

• The treatment is considered effective when they can remain relaxed in situations at the top of the hierarchy.

• Systematic desensitisation works on the assumption that two emotional states cannot exist at the same time, a theory known as reciprocal inhibition, and eventually relaxation will replace fear.

What is flooding?

Flooding is a behavioural therapy which involves immediate and direct exposure to the phobic stimulus.

How does flooding work?

• The person is unable to avoid the feared object or situation.

• This means avoidance is prevented.

• Although anxiety is very high at first, it cannot stay that intense forever.

• Over time, the person learns that nothing bad happens, and the fear response gradually fades. This is known as extinction.

Strengths of flooding and systematic desensitisation?

• Evidence supports the effectiveness of both systematic desensitisation and flooding in treating phobias.

• Gilroy et al. (2003) found that participants who received 3 sessions of SD for a spider phobia showed significantly less fear than a control group who only received relaxation, with this effect lasting up to 33 months.

• This suggests that the gradual exposure of SD is important in reducing phobic symptoms and that the treatment has long-term benefits.

• Kaplan and Tolin (2011) found that 61% of people treated with just one session of flooding no longer showed symptoms of specific phobia even four years later.

• This provides strong support for flooding as an effective long-term treatment. However, not all participants were cured, suggesting flooding may not be appropriate for all, possibly due to its intensity.

• Overall, these findings support the use of behavioural therapies such as flooding and SD as an effective form of treatment for phobias, although individual differences may affect how successful each method is.

Negative of systematic desensitisation and flooding?

• Evidence suggests that SD is particularly useful for specific phobias because it targets the learned association between the phobic object and anxiety.

• However, for social phobias, cognitive factors like irrational thoughts often play a larger role. In these cases, cognitive behavioural therapy may be more effective.

• Flooding, although effective in treating specific phobias, may be less suitable for social phobias due to its lack of focus on the cognitive aspects of fear. For example, individuals may have persistent negative beliefs about how they are perceived by others, which flooding does not address.

• This means that both SD and flooding may have limited effectiveness depending on the type of phobia and highlights the importance of choosing treatment approaches based on the nature of the phobia.

What are the two cognitive explanations for depression?

• Beck’s negative triad

• Ellis’ ABC model

What are the three schemas in Beck’s negative triad?

• The self - individual sees themselves as worthless, hopeless and inadequate

• The world - individual has the impression that there is no hope anywhere

• The future - individual has a pessimistic view of the future

This triad is maintained by…

• Negative self-schemas

• Cognitive biases

Example of negative self-schemas include…

• Self-blame schema (the belief that you are responsible for all misfortunes).

• Ineptness schema (the expectation that you will always fail or are incapable of success)

Examples of cognitive biases may include…

• Overgeneralisation (drawing broad conclusions from a single event).

• Catastrophising (expecting the worst possible outcome)

• (These biased ways of thinking help to maintain the negative triad and are central to Beck’s explanation of depression.)

What does ABC stand for in Ellis’ model?

A - activating event (negative or stressful event)

B - belief (triggers irrational beliefs)

C - consequence (emotional and behavioural consequences - symptoms often associated with depression)

A strength of Beck’s cognitive theory of depression?

• Supported by research evidence

• Cohen et al. (2019)