Clinical Psychology

Phobia Definition

Intense, irrational and debilitating fear of objects, situations or activities

Behavioural Characteristics Definition

Actions

Emotional Characteristics Definition

Feelings

Cognitive Characteristics Definition

Thoughts

Behavioural Characteristics of Phobias

• Avoidance of contact to the phobia

• Nausea

• Panic Attacks

Emotional Characteristics of Phobias

• Feeling worried

• Feeling overwhelmed

Phobia Timeframe (Diagnosis)

Fear must be present for at least 6 months

Depression Definition

Mood disorder characterised by persistent sadness, low energy and loss of interest

Behavioural Characteristics of Depression

• Guilt

• Feelings of worthlessness

• Lack of hope

• Feeling empty or suicidal

Emotional Characteristics of Depression

• Guilt

• Feelings of worthlessness

• Lack of hope

• Feeling empty or suicidal

Cognitive Characteristics of Depression

• Negative or distorted thinking

• Memory loss

Cognitive Characteristics of Phobias

• Distorted or catastrophic thinking

• Difficulty concentrating

Depression Time (Diagnosis)

Symptoms must be shown every day for at least 2 weeks

OCD Definition

Anxiety disorder characterised by intrusive thoughts and repetetive behaviour

Behavioural Characteristics of OCD

• Excessive repetetive behaviours

• Excessive double checking

Emotional Characteristics of OCD

• Fear

• Anxiety

• Sadness

Cognitive Characteristics of OCD

• Catastrophic thinking

• Intrusive thoughts

• Irrational thoughts

OCD Time (Diagnosis)

Symptoms must be shown every day for at least 2 weeks

Statistical Infrequency Definition

When someone is considered abnormal if their behaviour is rare

Statistical Infrequency

• Measured on a normal distribution curve

• Majority of the population are clustered around the mean for certain characteristics

• Those who fall ±2 standard deviations from the mean are abnormal

Statistical Infrequency Abnormality Link

• Behaviour of someone suffering from OCD could be considered abnormal, as the majority of the population do not experience compulsions

Statistical Infrequency Weaknesses

• Overly simplistic - some behaviours like high IQ are abnormal by this definition but are a desireable behaviour

• Culturally biased - there are no universal standards for labelling behaviour as abnormal, eg Maori people hear voices which would be abnormal in other countries

Deviation From Social Norms Definition

When someone is considered abnormal if they break social norms

Deviation From Social Norms

• Social norms are unwritten rules describing how people should behave

• Social norm is to wear clothes, so being naked is abnormal

Deviation From Social Norms Abnormality Link

Behaviour of someone suffering from depression could be considered abnormal as it is a social norm to have good hygeine

Deviation From Social Norms Weaknesses

Culturally biased - Wearing teeth of dead relatives is normal in some cultures but abnormal in the west, behaviour may be unfairly judged

Historically biased - Social norms are not fixed and can change over time, eg homosexuality being abnormal several years ago

Ignores context - Behaviour is relative to context so wearing next to nothing at a beach is normal but abnormal in other settings

Failure To Function Adequately Definition

When someone is considered abnormal if their behaviour prevents them coping with normal life

Failure to Function Adequately (Rosenhan and Seligman)

• It is expected that people can cope with the demands of jobs and relationships

• Set of characteristics to show failure, more shown means more likely to be abnormal

• Suffering, maladaptiveness, unconventional behaviour, unpredictability, loss of control, irrationality, observer discomfort and violation of moral standards

Failure to Function Adequately Abnormality Link

Behaviour of someone suffering from OCD could be considered abnormal as obsessive cleaning is irrational and unconventional

Failure to Function Adequately Weaknesses

• Subjective - not standard measurements, for example observer discomfort will vary and behaviour will be judged differently, so there is a lack of reliability

• Cultural bias - may be restricted to Western cultures, as non white patients from different cultures are diagnosed more

Failure to Function Adequately Strengths

• Helpful - creates a criteria list for diagnosis

Deviation From Ideal Mental Health Definition

When someone is considered abnormal if they do not show certain behaviours

Deviation From Ideal Mental Health (Jahoda)

• Defines a criteria list of ideal mental health

• Personal growth, resistance to stress, autonomy, perception of reality, mastery of the enviornment, self attitudes

Deviation From Ideal Mental Health Abnormality Link

• Behaviour of someone suffering from a phobia could be considered abnormal as they lack perception of reality and resistance to stress

Deviation From Ideal Mental Health Weaknesses

• Culturally biased - focus on personal growth is a criteria specific to the west that would be seen as self indulgent in collectivist cultures

• Unrealistic criteria - Few experience all criteria at the same time, eg students in exam season will have poor resistance to stress + however, it is a holistic explanation because it considers multiple aspects

Explanation of Phobias

The behavioural approach suggests phobias are learned through experience

Explanation of Phobias - Two Process Model (Mowrer)

• Phobias are initiated through classical conditioning (Pavlov)

• Phobias are maintained through operant conditioning (Skinner)

Explanation of Phobias - Initiation (Two Process Model)

• Phobias are initiated through association, where a neutral stimulus is paired with an unconditioned response through repeated presentations

• For example, Little Albert study

• Phobias can become generalised to a fear of things associated with that thing

Explanation of Phobias - Maintenance (Two Process Model)

• Phobias are continued through reinforcement and punishment

• Avoiding something unpleasant means behaviour (avoidance) is more likely to be repeated (negative reinforcement)

• Carrying out a behaviour punished by the enviornment means it is less likely to be repeated

• Interaction is punishing because of anxiety, avoidance reinforces behaviour

Explanation of Phobias Strengths

• Supporting research evidence - Little Albert or interveiws found many phobias begin with a traumatic event + however may be biological eg fear of snakes because of danger

Explanation of Phobias Weaknesses

• Enviornmentally reductionist - Ol Nardo et al found not everyone bitten develops a phobia of dogs, weaknening validity of model

• Ignores cognitive factors - Provides an incomplete explanation of phobias as it overlooks thought processes like catastrophising

Treatment of Phobias

The behavioural approach suggests that abnormality can be treated by learning adaptive behaviours to replace maladaptive ones through conditioning

Treatment of Phobias - Systematic Desentisation

• Based on counterconditioning where a patient is taught a new association that runs counter to the original association

• Taught relaxation through breathing excercises and muscle control

• Asked to develop a fear hierarchy, stages that become increasingly unpleasant

• Gradually exposed to each stage up the hierarchy, moving up once completely relaxed in the presence of the phobia

• Learns to associate the object with relaxation rather than fear

Systematic Desensitisation Strengths (Treatment of Phobias)

• Supporting research evidence - Gilroy et al followed 42 patients recieving SD and found after 3 and 33 months they were less fearful than control group

• More effective than other - Much lower refusal and dropout rates for SD, less traumatic for patients + although it is more expensive and time consuming

Treatment of Phobias - Flooding

• Individual is forced to face their phobia immediately

• One long session where they experience the phobia at its worst

• Practise relaxation techniques, only can leave when fully relaxed

• Vivo exposure (facing object directly) or vitro exposure (imaginary exposure)

Flooding Strengths (Treatment of Phobias)

• Supporting research evidence - Wolpe drove a girl with a fear of cars around for 4 hours until her fear got hysterical and receded, effective when seen through

Flooding Weaknesses (Treatment of Phobias)

• Psychological Harm - Causes emotional and mental distress, high dropout rates + although is just as effective despite drawbacks

Treatment of Phobias Weakness

• Symptom substitution - Both flooding and SD are criticised as they do not address the underlyig causes, so phobias may resurface

Explanation of Depression

The cognitive approach suggests depression is caused by negative irrational thoughts

Explanation of Depression - The Negative Triad (Beck)

• Negative self-schemas (expectation of yourself) created by unhappy childhood experiences or people saying about negative things lead to:

• Negative views of the self, world and future

• These then lead to negative behaviour - depression

• Negative self-schemas can also lead to minimisation (bias to minimise success) and have a ‘glass half empty’ look on life

Explanation of Depression - ABC Model (Ellis)

• Ellis believes people develop depression because of irrational beliefs

• A-activating event, B-belief, C-consquences, the belief causes the depression not the event itself

• Rational beliefs lead to healthy emotions and behaviour

• Irrational beliefs lead to unhealthy emotions and maladaptive behaviour

Explanation of Depression Strengths

• Supporting research evidence - Grazioli and Terry found that 65 women assessed for faulty thought processes before and after birth, finding those with negative self schemas were more likely to suffer from post partum depression

• Practical applications - Led to development of cognitive behavioural therapy which is an effective treatment that challenges irrational thoughts associated with depression

Explanation of Depression Weaknesses

• Alternative explanations - low levels of serotonin have been linked to depression (mood regulator) showing impact of genes

Treatment of Depression

The cognitive approach suggests abnormality can be treated by challenging the patient to replace irrational thoughts with rational ones

Treatment of Depression - Rational Emotive Behavioural Therapy (Ellis)

• Form of cognitive behavioural therapy (CBT) to treat depression

• Structured and time limited sessions, describing negative self-schema, negative automatic thoughts and negative cognitive biases

• Emphasis on present beliefs and current irrational beliefs

• Therapist challenges irrational thinking with ABCDE (disputing and effects)

• Logical disputing - consider does it makes sense?, Empirical disputing - consider do I have any evidence?

• Patient hypothesis test reality against beliefs

• Therapist praises patient, encouraging cognitive restructuring

Treatment of Depression Strengths

• Supporting research evidence - March et al found across 327 patients, 81% in CBT showed improved symptoms, same as 81% drug therapies, showing it is just as effective and may be a first port of call + he also found 86% showed improvement when on both therapies

Treatment of Depression Weaknesses

• Limited - CBT only focuses on disputing current irrational beliefs, so may not be effective for underlying causes ie the past

• Time consuming - CBT takes 10-15 sessions of 45 minutes, which someone with severe depression will not have the energy to engage in

Explanation of OCD

The biological approach suggests people develop OCD as a result of genetic predisposition of biochemical imbalances in the brain

Genetics - Explanation of OCD

• Gene mapping shows how a single OCD gene does not exist, and that it is polygenic as it is associated with 230 genes which increase vulnerability

• Nesdadt et al found 68% concordance in identical twins, 31% in non identical

Neural Explanations - Explanation of OCD

• Role of neurotransmitters (dopamine and serotonin) influenced by cadidate genes

• Dopamine - regulated by COMT gene, faulty variations lead to increased dopamine linked to development of compulsions

• Serotonin - regulated by SERT gene, faulty variations lead to descreased serotonin linked to development of obsessions

• Frontal lobe impairment - leads to impaired decision making, increasing activity levels so it is harder to ignore impulses

Explanations of OCD Strengths

• Supporting research evidence - Nestadt et al found 68% concordance for OCD in identical twins compared to 31% + not 100%, can not be sole reason

Explanation of OCD Weaknesses

• Cause and effect issues - does not show whether OCD causes abnormal neurotransmitter and brain structure or is caused by them

• Practical applications - Led to development of SSRIs by altering levels of serotonin

• Biologically determinist - ignores enviornmental factors, Cromer et al found 50% of patients with OCD experienced a traumatic event

Treatment of OCD

The biological approach suggests abnormality can be treated physically

Drug Therapy - Treatment of OCD

Aim to change neurotransmitter levels in the brain

• Anti depressants (SSRIs)

• Anti anxiety

Anti Depressants (Treatment of OCD)

• Increase low levels of mood regulator serotonin (ie prozac)

• SSRIs block reabsorbtion into the presynaptic neuron so serotonin levels increase in the synapse and can reach the post-synaptic neuron

Anti Anxiety (Treatment of OCD)

• Adjust neurotransmitter levels (Diazepam)

• Slow down activity of CNS by increasing neurotransmitter GABA which has a general relaxing effect on the neurons responsible for anxiety, reducing brain activity and impact of dopamine

Treatment of OCD Strengths

• Effective - Soomro et al found SSRIs showed a symptom reduction in 70% of patients across 17 studies, however are much more effective when combined with a psychological treatment (CBT)

• Cost effective/Non disruptive - Require little monitory from doctors and can be mass produces, also require little patient effort, economical for NHS

Treatment of OCD

• Side effects - SSRIs can cause blurred vision, indigestion, weight gain which can reduce quality of life so people may prefer CBT treatment