Clinical Psychology (AQA AS Level Psychology)

Deviation from ideal mental health

Behaviour is considered abnormal if it fails to meet the criteria points, proposed by Jahoda, for ideal mental health. These include an inaccurate perception of reality, inability to cope with stress, negative attitudes towards the self, lack of autonomy, poor environmental mastery and problems with self-actualisation.

+ Is a positive approach to defining abnormality, focussing on what is good rather than what is not, giving people a goal and a way to get better.

- Is unrealistic to achieve Jahoda’s definition of ideal mental health and the majority would be considered abnormal. Therefore it is difficult to differentiate between those that do and don’t need intervention.

- Culturally biased because self-actualisation is a Western concept and is not relevant in collectivistic cultures, and there would be more abnormality as they prioritise community, not the self individually.

Deviation from social/cultural norms

Behaviour is considered abnormal if it is very different from social norms/the acceptable behaviour produced by other members of the same society. Abnormal behaviour often offend others in a group.

+ Is used in clinical practice to diagnose by easily distinguishing between desirable and undesirable behaviour.

- Norms are different across different cultures, therefore implying mental health disorders are not universal. Ethnocentricity.

- Social norms change so is susceptible to abuse. For example homosexuality used to be considered a mental disorder and a crime, until the socially acceptable behaviour changed and now homosexuality is a protected characteristic in the Equality Act. Lacks temporal validity.

Failure to function adequately

Mental illness can be judged in terms of not being able to cope with everyday living (e.g. eating regularly, going to work etc). Not functioning adequately can cause distress for the individual and/or others.

- Could lead to discrimination against people with non-standard living choices. For example people who live in a van are causing no harm to themselves or others but are classified as mentally abnormal because they do not align with the ‘normal’ everyday life.

- Is susceptible to manipulation because of the subjectivity of “adequate everyday life”. Who decides you are failing? Some people may be content with their abnormal lifestyle choices.

Statistical infrequency

Behaviours are considered abnormal if they are numerically rare, characterised by 2 standard deviations away from the mean (classing people in the most extreme 5% of the population).

- Some statistically infrequent characteristics are desirable, for example an extremely high IQ is rare but positive and doesn’t require intervention. So who decides what behaviours are desirable/undesirable? Is susceptible to manipulation.

+ Used in clinical practice to set a clear threshold for intervention, meaning people who need interventions can access them.

Characteristics of phobias

Phobias are irrational fears that cause excessive fear and anxiety out of proportion to the actual danger posed.
Panic, fight or flight, avoidance, endurance/freeze. Selective attention, fixation, irrational thinking, cognitive distortions, catastrophising. Anxiety, fear.

Behavioural approach to explaining phobias

Mowrer 1960 proposed the two-process model which describes the process of acquiring and maintaining a phobia.
Phobias are acquired by classical conditioning. UCS naturally produces UCR of fear. The NS becomes the phobic stimulus through association with the UCS.
Phobias are maintained by operant conditioning. Negative reinforcement (avoidance behaviour of phobic stimulus) results in a desirable consequence (loss of fear) which increases the likelihood of avoidance being repeated.

Evaluating explanations of phobias

+ Case study classically conditioned Little Albert to develop a phobia of rats by pairing a rat with a loud banging sound. Proving a phobia can be acquired by classical conditioning.
BUT is only a case study so lacks generalisability to wider population.

- The evolutionary perspective offers an alternate explanation, suggesting phobias are passed down through natural selection and are therefore not learned through conditioning.

+ Understanding has led to the development of exposure therapies. Systematic desensitisation and flooding use counter-conditioning to treat phobias. Has economic value to the NHS.

Behavioural treatments of phobias

Systematic desensitisation uses counterconditioning to treat the phobia. Using relaxation techniques at each stage of the anxiety hierarchy to replace the fear associated with the phobic stimulus with relaxation in a gradual process. Reciprocal inhibition is the idea that a person cannot feel anxiety and relaxation at the same time.

Flooding is immediate exposure to the phobia at its worse, not leaving the situation until the patient’s anxiety has disappeared and they have fully relaxed. This relaxation can come about by exhaustion, because the body cannot maintain fight or flight response for a prolonged period of time. Therefore counter-conditioning the phobia.

Evaluate behavioural treatments of phobias

Systematic desensitisation

+ Is used for people with learning disabilities who would not be able to experience flooding due to the extreme distress. This makes SD a universal treatment.

- May not be practical, is time consuming when compared to flooding because gradual exposure is necessary to work up the anxiety hierarchy. And can only be used in a clinical setting because requires a therapist to be present. ALSO has a negative impact on the economy as it costs the NHS, BUT leads to a healthier workforce.

Flooding

+ Cost-effective and time-efficient because only 1 or 2 sessions are necessary so can save the NHS money and create a healthier workforce.

- Has ethical issues. Informed consent is necessary to take part BUT flooding breaches the the right to withdraw and protection from harm. There is a chance it could make the phobia worse.

Characteristics of OCD

Compulsions, avoidance. Obsessions, insight into irrationality, hypervigilance. Anxiety, distress, guilt, disgust, low mood.

Genetic explanation of OCD

Believes OCD is inherited through genes from parents. OCD is polygenic, Taylor found up to 230 genes are involved in OCD including:

COMT gene regulates dopamine. One form of the COMT gene (one specific allele) has found to be more common in people with OCD. This variation produces higher levels of dopamine.

SERT gene affects the transport of serotonin. These lower levels of serotonin are directly linked to OCD.

Diathesis-stress model suggests other factors (stressors) affect whether a condition develops in someone who possesses the COMT or SERT gene.

Neural explanation of OCD

People with OCD tend to have high levels of dopamine (affects how the brain processes rewards and habits, reinforcing compulsions) and low levels of serotonin (low mood, intrusive thoughts and difficulty shifting attention).

The worry circuit:
Overactive orbitofrontal cortex (responsible for detecting threats, leads to excessive worry). Dysfunctional caudate nucleus (fails to filter unnecessary thoughts from OFC). Overactive thalamus (prepares body to respond when a threat is detected, reinforces compulsions).

Evaluate explanations of OCD

+ Nestadt et al. 2010 used twin studies to determine the extent of genetics in causing OCD. Found a 68% concordance rate with MZ compared to a 31% concordance between DZ.

- Social learning theory could provide an alternate explanation for the development of OCD. You could observe and imitate a family member who has OCD and see the decrease in their anxiety from compulsions and learn to copy by vicarious reinforcement. HOWEVER you cannot directly observe all the symptoms of OCD, e.g. obsessions, so must be at least partly genetic.

+ Application to drug therapies. For example, SSRIs correct the imbalance in serotonin by preventing the reuptake mechanism. This discovery means people can return to work which has a positive impact on the economy. HOWEVER side effects.

Treatments for OCD

SSRIs - Selective Serotonin Reuptake Inhibitors increase the levels of serotonin (which regulates mood and anxiety) by blocking the reuptake mechanisms in the synapse so serotonin has a higher chance of binding to the postsynaptic neuron.

Benzodiazepines - increase GABA (an inhibitory neurotransmitter) activity which has a calming effect on the brain. BZs bind to GABA receptors, increasing the flow of chloride ions into the neuron, which act as an inhibitory charge. Calms the nervous system as a whole so helps with compulsions and anxiety but not obsessions.

Tricyclics - block the reuptake mechanism of both serotonin and noradrenaline, meaning both of these are in the synapse for longer and have a higher chance of binding. Effects are unpredictable because serotonin is inhibitory and noradrenaline is excitatory. Most dangerous drug.

Evaluate treatments of OCD

- All 3 drugs have extensive side effects. For example, drowsiness, sexual dysfunction and dependency. These have a major impact on daily lives, causing people to drop out of drug treatment, stopping taking them (ineffective treatment as people do not finish it).

+ Cost-effective, cheap to manufacture so benefits the NHS and creates a healthier work force.

+ Soomro 2009 found in a meta-analysis that SSRIs were more effective than placebos, reducing symptoms for 70% of patients.

- Publication bias. The drug companies conduct and publish only the research that supports drug treatments of OCD.

Characteristics of depression

Low activity levels, sleep and eating disruptions, aggression and self harm. Poor concentration, negative attention/rumination, cognitive distortions. Low mood, anger, low self-esteem.

Ellis’ explanation of depression

The ABC model (1962) states depression is caused by irrational beliefs. A: an activating event leads to B: irrational beliefs about the activating event - can be musturbatory (holding preferences as absolutist demands) or utopianistic (becoming distressed when reality falls short of desired perfection). C: the consequence of the beliefs is depression.

Beck’s explanation of depression

The negative triad (1967) states 3 main distorted thought patterns: A negative view of the self, the world and the future. This is caused by faulty informational processing, negative thoughts, and cognitive distortions (absolutist thinking, catastrophising, overgeneralising and personalisation). Depressed people also have a negative self-schema, meaning all information about themselves is viewed through a negative lens. This is typically developed during childhood.

Evaluate cognitive explanations of depression

+ Bates et al. 1999 found depressed participants who were given negative automatic-thought statements became more depressed. Negative thoughts contribute to depression.

+ Application to cognitive behavioural therapies which alleviate depressive symptoms and improve quality of life. Healthier workforce.

- Social sensitivity due to blaming the patient, could make depression worse and decrease likelihood of seeking help due to embarrassment and blame. HOWEVER could encourage people they have the power to change their negative thoughts.

- Biological approach offers an alternate explanation of depression. An imbalance of neurotransmitters (e.g. serotonin) causes depression. Zhang found SERT gene 10x more likely in people with depression.

Cognitive treatments of depression

Beck - Cognitive behavioural therapy (CBT) identifies and challenges depression by focusing on finding evidence that challenges negative thoughts. Hypothesis testing (collecting evidence) via homework and behavioural activation (engaging in activities to decrease avoidance).

Ellis - Rational Emotive Behavioural Therapy (REBT) identifies and challenges irrational thoughts with rational thinking. ABC (explain) DEF (treat). D: dispute (logical, empirical, pragmatic). E: effect and F: feeling. The therapist confronts the patient with logic and rational thinking. Shame-attacking exercises overcome self-consciousness and embarrassment.

Evaluate treatments of depression

+ March et al. 2007 found CBT was as effective as antidepressants. After 36 weeks, 81% of both the antidepressants group and the CBT group had improved, However, both together showed an 86% improvement.

- CBT requires motivation, patients with severe depression may not have the motivation to attend sessions. Antidepressants do not require as much motivation and are therefore a more accessible treatment.