AQA A-Level Psychopathology

Define statistical infrequency as a definition of abnormality.

- The statistical infrequency definition of abnormality states that abnormal behaviour is behaviour that is very rare.

- Statistics are how we measure how common behaviours or traits are when measured in comparison to the rest of the population. The most common are normal and the most uncommon ones are defined a abnormal.

Give an example of statistical infrequency.

IQ has a normal distribution, meaning the majority of scores will cluster around the average; the further it's above or below the average, the fewer people will attain that score.

Average IQ is set at 100.

- 68% of people have an IQ ranging from 85 to 115

- 2% have a score below 70, therefore, these individuals are abnormal and liable to be diagnosed with intellectual disability disorder.

What are the mathematical elements of statistical infrequency?

- Presence of abnormal behaviour in people should be statistically unusual in comparison to the rest of the population.

- The mathematical element of the definition is about the idea that human attributes fall into a normal distribution within the population.

- Anything that falls outside of +-2 standard deviations is likely to be judged as abnormal.

Evaluate statistical infrequency as a definition of abnormality (1): Real life application

POINT: One strength of statistical infrequency is its real-life usefulness.

EVIDENCE/EXPLANATION: Statistical infrequency is used in clinical practice, both as part of formal diagnosis and as a way to assess the severity of an individual's symptoms. For example a diagnosis of intellectual disability disorder requires an 1Q of below 70 (bottom 2%).

EVALUATION: This shows that the value of the statistical infrequency criterion is useful in diagnostic and assessment processes.

Evaluate statistical infrequency as a definition of abnormality (2): Unusual characteristics can be positive:

One limitation of statistical infrequency is that rare characteristics can be positive as well as negative.

Evidence/Explanation: For example, having a very high IQ is statistically rare but is not seen as abnormal, and someone with a very low depression score would not be considered disordered.

Evaluation: This shows that statistical infrequency alone is not enough to define abnormality and must be used alongside other definitions.

Define deviation from social norms as a definition of abnormality.

- Social norms are unwritten social expectations of behaviour that may differ from one culture to the next.

- They often change over time and vary depending on the context, and if those social norms aren't followed, that person is deviating from it.

- Therefore according to this definition, those who deviate from the society's’ expectations will be seen as abnormal ‘social deviants’.

- An issue with this explanation of mental illness is that, as norms are a group judgement on what is acceptable, certain behaviours in one culture that are considered acceptable may be considered deviant in another culture (i.e.: homosexuality, face/hair covering, queuing, chopsticks, public displays of emotions).

Give an example of deviating from social norms (ASPD)

Example: Antisocial Personality Disorder(ASPD):

- A person with antisocial personality disorder (psychopathy) is impulsive, aggressive and irresponsible.

- According to the DSM-5 (the manual used by psychiatrists to diagnose mental disorder) one important symptom of antisocial personality disorder is an 'absence of prosocial internal standards associated with failure to conform to lawful and culturally normative ethical behaviour.'

- In other words we are making the social judgement that psychopaths are abnormal because they don't conform to our moral standards.

- Psychopathic behaviour would be considered

abnormal in a very wide range of cultures.

Evaluate deviation from social norms as a definition of abnormality (1): Real-world application

POINT: One strength of deviation from social norms is its usefulness as deviation from social norms is used in clinical practice.

EVIDENCE/EXPLANATION: For example, the key defining characteristic of antisocial personality disorder is the failure to conform to culturally acceptable ethical behaviour i.e. recklessness, aggression, violating the rights of others and deceitfulness. These signs of the disorder are all deviations from social norms. Such norms also play a part in the diagnosis of schizotypal personality disorder, where the term 'strange is used to characterise the thinking, behaviour and appearance of people with the disorder.

EVALUATION: This shows that the deviation from social norms criterion has value in psychiatry.

Evaluate deviation from social norms as a definition of abnormality (2): Social norms changing (lack of temporal validity?)

POINT: One limitation of the 'deviation from social norms' definition is that it can be questioned, as social norms change over time and therefore behaviour that broke social norms and was considered abnormal in 1950 may not be viewed as abnormal today.

EVIDENCE/EXPLANATION: Being an unmarried mother in the 1940’s and 1950’s would be breaking social norms and therefore this behaviour was classed as abnormal. Many of these women were diagnosed with 'hysteria' or sectioned as ‘moral imbeciles’ and society demanded that they “give up” their babies.

EVALUATION: This is a limitation because as this example shows, it is not the individual who has changed but the classification of the behaviour by society. This brings into question the (temporal) validity of using this definition alone to define abnormality.

Evaluate deviation from social norms as a definition of abnormality (3): Cultural and situational relativism:

POINT: Social norms differ between cultures and situations and this definition may be problematic.

EVIDENCE/EXPLANATION: For example, in British culture, it is considered to be polite to finish the food on your plate at mealtimes. However, in India, to finish all food from you plate is a sign that you are still hungry. Or hearing voices would be considered abnormal and a sign of mental illness in the UK, but some (religious/spiritual) cultures would view that as ancestors communicating with the living. This could also apply to different situational contexts, e.g. aggressive and deceitful behaviour in the context of the family would be more socially unacceptable than in the context of corporate deal-making.

EVALUATION: This is a limitation because shows that what is considered ‘normal’ in one culture may actually be ‘abnormal’ in another. This means that this definition does not consistently produce an accurate definition of abnormal behaviour, and this makes it difficult to observe abnormal behaviour.

Define 'failure to function adequately' as a definition of abnormality.

- This occurs when someone is unable to cope with ordinary demands of day-to-day living, which is a sign of abnormality.

- This includes being unable to maintain basic standards of nutrition/hygiene, inability to hold a job etc.

When is someone failing to function adequately?

Rosenhan and Seligman (1989) have suggested some key characteristics of ‘failing to function adequately’:

1. Personal Distress - Most people who seek psychiatric help of any kind are suffering from a sense of psychological distress or discomfort (Sue et al, 1994) and a recognition that they are failing to function adequately.

2. Unconventionality - When a person no longer conforms to standard interpersonal rules, e.g.: not maintaining eye contact and not respecting personal space. These are all behaviours which go against normal expectations.

3. Observer Distress (or Discomfort) - Where someone’s behaviour causes discomfort and distress to others observing the behaviour.

4. Maladaptive Behaviour - Where someone’s behaviour interferes with their ability to lead a normal life (e.g. agoraphobia)

5. Unpredictable Behaviour - If behaviour is unpredictable if it does not fit the situation or if it is unexpected and uncontrolled (e.g. sobbing for no reason or laughing at bad news).

6. Irrational Behaviour - If a person’s behaviour doesn’t make sense to other people (difficult to understand)

Give an example of failure to function adequately.

Example = Intellectual Disability Disorder:

One criteria of IDD is having a very low IQ (statistical infrequency), but diagnosis is not made on this basis only as an individual must also be failing to function adequately.

Evaluate failure to function as a definition of abnormality (2): Discrimination and social control

Point: A limitation of failure to function adequately is that it can label unusual lifestyle choices as abnormal.

Evidence/Explanation: For example, people who choose to live off-grid or take part in high-risk activities may appear to be failing to function, even though this is a personal lifestyle choice.

Evaluation: This means individuals may be unfairly labelled as abnormal and have their freedom restricted.

Evaluate failure to function as a definition of abnormality (3): Failure to function isn't always an indicator of abnormality

POINT: One limitation of the 'failing to function' definition is that does not always indicate the presence of a psychological abnormality.

EVIDENCE/EXPLANATION: For example, someone who looses their job will not be able to get up and go to work/earn money for their family etc This may cause them personal distress but it does not indicate an abnormality.

EVALUATION: This is a limitation as environmental factors may cause a failure to function rather than any psychological abnormality and this therefore questions the validity of using this definition to identify abnormality.

Evaluate failure to function as a definition of abnormality -

(counterpoint to evaluation 3)

POINT: However, the presence of an abnormality doesn’t always result in a “failure to function.”

EVIDENCE/EXPLANATION: An individual with depression may still be able to hold a job and run a family successfully. there are people who suffer from abnormalities such as depression however, are able to carry out everyday tasks like going to work, looking after a family etc They do not necessarily display a failure to function.

EVALUATION: This is a limitation because it shows that this definition is inadequate in truly identifying behaviours that may be considered abnormal.

Define 'deviation from ideal mental health' as a definition of abnormality.

- This occurs when someone does not meet a set of criteria for good mental health.

- This definition stands out by not defining abnormality directly. Instead, it attempts to define a state of ideal mental health (i.e., factors necessary for ‘optimal living’).

What does ideal mental health look like?

Marie Jahoda (1958) suggested that someone is in good mental health if they meet the following criteria:

Environmental mastery- competent in meeting the demands of situations; involves flexible thinking.

Autonomy- able to act independently of others and rely on their own abilities.

Resisting stress- able to cope with the anxiety caused by the demands of life.

Self actualisation- maximising personal growth and development to reach their potential.

Positive attitude towards oneself- positive self-concept (so high self-esteem and self respect).

Accurate perception of reality- realistic view of the world; not distorted by personal biases.

Inevitably there is some overlap between what we might call deviation from ideal mental health and

what we might call failure to function adequately. So we can think of someone's inability to keep a job as

either a failure to cope with the pressures of work or as a deviation from the ideal of successfully working.

Evaluate deviation from ideal mental health as a definition of abnormality. (2): May be culture-bound

POINT: One limitation of the ideal mental health criterion is that the definition is ethnocentric.

EVIDENCE/EXPLANATION: : For example, Jahoda’s ideas of self-actualisation and personal independence may be valued in the US or Germany but seen as self-indulgent or less important in other cultures, and definitions of success vary widely.

EVALUATION: This means that it is difficult to apply the concept of ideal mental health from one culture to another since the subjectivity of the definition can create bias.

Evaluate deviation from ideal mental health as a definition of abnormality (3): Definition is idealistic/problematic

POINT: The definition is problematic, as the characteristics of 'ideal mental health' are seen as far too idealistic.

EVIDENCE: Evidence to support this comes from Maslow (1968) who argued that only a few people ever achieve ‘self-actualisation’ and so the criteria is set too high.

EXPLANATION/EVALUATION: This is a limitation because if this is true, most people are unable to achieve self-actualisation which means that the majority would be defined as being abnormal. However, if the majority of people are ‘abnormal’ then not achieving self-actualisation becomes ‘normal’ therefore indicating that the DIMH definition is a poor definition of abnormality.

Evaluate deviation from ideal mental health as a definition of abnormality (4): Subjective definition

POINT: The definition requires a subjective judgement on how many criteria need to be lacking in order to define someone as ‘abnormal.’

EVIDENCE/EXPLANATION: For example, one individual might consider a lack of 2 criteria to be abnormal, whereas another would consider lacking 4 criteria to be abnormal.

EVALUATION: This is a limitation because using subjective judgement in this way, decreases both the reliability (i.e., consistency) and the validity (i.e., accuracy) of this method of defining abnormality.

What are phobias?

Phobias are categorised as an anxiety disorder which cause an irrational fear of a particular object or situation.

Define and explain the three categories of phobias.

The DSM5 recognises these three categories of phobia:

Simple (specific) phobia = phobia of an object, such as an animal or body part, or a situation such as flying.

Social phobia (social anxiety) = phobia of a social situation such as public speaking or using a public toilet.

Agoraphobia = phobia of being outside or in a public space.

What are the behavioural characteristics of phobias?

Behavioural characteristics refer to how we physical react (like fear responses to phobic stimulus) when faced with a situation that may evoke an emotional reaction.

Panic = In the presence of phobic stimulus, people who have phobias panic and may start crying, screaming or freeze on the spot. Children may react differently by throwing a tantrum, clinging or freezing.

Avoidance = People with phobias will often avoid facing their fears (by avoiding the phobic stimulus) which can make it difficult to go out and about. For example, someone with a fear of public toilets may hold their urine in, which can harm their kidneys and may lead to interference in social situations and education.

Endurance = This is the the opposite of avoidance where the sufferer takes it by remaining in the presence of the phobic stimulus and endures the anxiety. For example, a person with arachnophobia might choose to remain in a room with a spider on the ceiling to keep an eye on it instead of leaving.

What are the emotional characteristics of phobias?

Anxiety = Phobias are classed as anxiety disorders. By definition then they involve an emotional response of anxiety which prevents a person relaxing and makes it very difficult to experience any positive emotion. Anxiety can be long term.

Fear = 'Anxiety' and 'fear' have distinct meanings. Fear is the immediate and extremely unpleasant response we experience when we encounter or think about a phobic stimulus. It is usually more intense but experienced for shorter periods than anxiety.

Emotional response is unreasonable = The anxiety or fear is much greater than is 'normal' and disproportionate to any threat posed. For example, a person with arachnophobia will have a strong emotional response to a tiny spider. Most people would respond in a less anxious way even to a poisonous spider.

What are the cognitive creations to phobias?

The cognitive element is concerned with the ways in which people process information. People with phobias process information about phobic stimuli differently from other

objects or situations.

Selective attention to the phobic stimulus = If a person can see the phobic stimulus it is hard to look away from it. Keeping attention on danger is a good thing as it gives us the best chance of reacting quickly to a threat, but this is worse when the fear is irrational. For example, person with pogonophobia will struggle to concentrate on what they are doing if there is someone with a beard in the room.

Irrational beliefs = A person with a phobia may hold unfounded, irrational/crazy thoughts in relation to phobic stimuli, For example, social phobias can involve beliefs like 'I must always sound intelligent' or 'if I blush people will

think I'm weak.' This kind of belief increases the pressure on the person to perform well in social situations.

Cognitive distortions = The perceptions of a person with a phobia may be inaccurate and unrealistic. For example, someone with mycophobia sees mushrooms as disgusting, and someone with ophidiophobia may see snakes as alien and aggressive-looking.

What is the behaviourist approach?

A way of explaining behaviour in terms of what is observable and in terms of learning.

What is the behaviourist approach to explaining phobias?

A behaviourist model for explaining phobias is the two-process model. Behaviourists see all behaviour (including phobias) as learnt via experience. As part of the two-process model, behaviourists use classical conditioning to explain the acquisition (beginning) of the phobia, whereas operant conditioning is used to explaining how the phobic behaviour is maintained.

What did Orval Hobart Mowrer (1960) propose?

Mower (1960) proposed the two-process model and suggested that phobias are first acquired (learned) via association (classical conditioning), and then maintained via reinforcement (operant conditioning).

Explain 'acquisition' by classical conditioning

- In acquisition (classical conditioning = learning by association) the phobic object(s) are at first neutral stimulus, not producing the phobic response. However, if the phobic object is presented with an unconditioned stimulus that produces an unconditioned negative response, then the neutral stimulus will then be associated with the unconditioned stimulus and thus the unconditioned response, and so the fear (the phobia) will happen whenever the neutral stimulus appears. As this point the neutral stimulus becomes the conditioned stimulus, and the unconditioned response becomes the conditioned response.

- This fear will then be passed onto other stimuli similar to the conditioned stimuli via generalisation (i.e.: fear of spiders generalised to all insects).

Example for acquisition of a phobia (1)

'Little Albert' study: Watson and Rayner, 1920

Little Albert learns to make associations between stimuli in the environment and reflexes --> Albert shows little fear with dog, monkey, or burning newspaper, neutral stimuli since he hasn't learned to fear anything --> shows Albert a white rat while making loud clanging noise, which upsets Albert, who eventually associates white rat with being upset --> proves fear is learned.

Example for acquisition of a phobia (2)

Laura's fear of bees:

Bees were originally a neutral stimulus for Laura, resulting in no fear response. However the pain of being stung (unconditioned stimulus) produced fear (unconditioned response). Bees (conditioned stimulus) became associated with the fear (conditioned response) due to the pain of the sting. So even when not stung there is now fear. However she now feels fear when seeing ants, moths, and spiders, even though she was never stung by them (generalisation).

Explain 'maintenance' by operant conditioning.

- Operant conditioning involves learning through the consequences (outcomes of behaviour).

- A behaviour that is rewarding reinforces the chances of that behaviour being repeated in future situations.

- An outcome of a behaviour that is pleasant is known as positive reinforcement, while the outcome of a behaviour that results in escaping something unpleasant is known as negative reinforcement.

- Operant conditioning explains how phobias are maintained as, once the phobia has been acquired (through classical conditioning) individuals then exhibited avoidance responses (behaviours that lessen the chances of contact with the feared object/situation) which reduce the fear response, reinforcing the avoidance responses, making them more likely to occur again in the future.

- For example, if a person has a phobia of the dark due to the fact that they were mugged at night time, this individual might chose to sleep with the lights on (negative reinforcement) because it reduces the fear response associated with being in the dark.

Evaluate the behavioural approach to explaining phobias: Reductionism (EXTRA)

POINT: The behavioural approach/two-process model of phobias can be criticised for being reductionist.

EVIDENCE/EXPLANATION: For example, the two-process model suggests that complex mental disorders such as phobias are caused solely by our experience of association, rewards and punishment (we learn all abnormalities including phobias).

(explain how this is reductionist).

EVALUATION: This is a problem because the behavioural approach to explaining phobias can be seen to be too simplistic as it ignores the role of other factors such as our childhood experiences, everyday stressors and the role of biology (e.g. genes, neurotransmitters) in the development of abnormality.

Evaluate the behavioural approach to explaining phobias: Scientific (EXTRA)

POINT: The behavioural approach to psychopathology is scientific and its key principals can be measured in an objective way.

EVIDENCE/EXPLANATION: For example, the phobia developed by Little Albert was clear for all to see and measure, variables could be manipulated and controlled to ensure that Little Albert’s phobia development was as a result of a neutral stimulus being associated with an unconditioned response.

EVALUATION: This is positive because it allows concepts such as classical conditioning to be demonstrated scientifically and has resulted in a large amount of empirical support for behavioural therapies.

Evaluate the behavioural approach to explaining phobias (EXTRA): Determinism

POINT: The behavioural approach/two-process model of phobias can be criticised for being deterministic.

EVIDENCE/EXPLANATION: For example, the two-process model suggests that when an individual experiences a traumatic event and uses this event to draw an association between a neutral stimulus and an unconditioned response they will go on and develop a phobia.

EVALUATION: This is a weakness because this theory of phobias suggests that we are programmed by our environmental experiences and ignores individual free will (for example, if a person is bitten by a dog this negative experience may not cause them to develop a phobia of dogs).

How is the behaviourist approach used to treat phobias?

1) Systemic desensitisation

2) Flooding

What is 'systemic desensitisation' (SD)?

- A behavioural therapy designed to reduce an unwanted response, such as anxiety.

- SD involves drawing up a hierarchy of anxiety-provoking situations related to a person's phobic stimulus, teaching the person to relax, and then exposing them to phobic situations.

- The person works their way through the hierarchy whilst maintaining relaxation.

- Systematic desensitisation (SD) is a behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning. If a person can learn to relax in the presence of the phobic stimulus they will be cured.

- Essentially a new response to the phobic stimulus is learned (phobic stimulus is paired with

relaxation instead of anxiety). This learning of a different response is called counterconditioning.

What are the three processes involved in SD?

1. The anxiety hierarchy is put together by a client with phobia and therapist. This is a list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening (e.g. arachnophobia = picture of

a small spider as low on anxiety hierarchy and holding a tarantula at the top of the hierarchy).

2. Relaxation = The therapist teaches the client to relax as deeply as possible. It is impossible to be afraid and relaxed at the same time, so one emotion prevents the other. This is called reciprocal inhibition. The relaxation might involve breathing exercises or, alternatively, the client might learn mental imagery techniques/mediation. Alternatively relaxation can be achieved using (relaxing) drugs such as Valium.

3. Exposure = Finally the client is exposed to the phobic stimulus while in a relaxed state. This takes place across several sessions, starting at the bottom of the anxiety hierarchy. When the client can stay relaxed in the presence of the lower levels of the phobic stimulus they move up the hierarchy. Treatment is successful when the client can

stay relaxed in situations high on the anxiety hierarchy.

Evaluate SD as a behaviourist approach to treating phobias (1): Evidence of effectiveness

Point – One strength of systematic desensitisation (SD) is the strong evidence supporting its effectiveness.

Evidence – Gilroy et al. (2003) followed 42 individuals who received SD for spider phobia in three 45-minute sessions. They found that, even after 33 months, these individuals remained less fearful than a control group who only received relaxation without exposure.

Analysis – This suggests that SD leads to long-term improvements in reducing phobic anxiety, demonstrating its effectiveness beyond short-term treatment. By gradually exposing individuals to their fear in a controlled manner, SD helps them build confidence and reduce avoidance behaviours.

Link – Therefore, SD is a well-supported and reliable treatment for phobias, making it a valuable option for individuals seeking lasting relief from their fears.

Counterpoint – However, the research by Gilroy et al. only tested individuals with spider phobias, meaning the findings may not generalise to other phobias, such as social phobia or agoraphobia. Different phobias may involve more complex cognitive and emotional components that SD alone may not effectively treat, limiting its overall applicability.

Evaluate SD as a behaviourist approach to treating phobias (2): People with learning disabilities

Additional - A further strength of SD is that it can be used to help people with learning disabilities.

Some people requiring treatment for phobias also have a learning disability. However, the main alternatives to SD are not suitable. People with learning disabilities often struggle with cognitive therapies that require complex rational thought. They may also feel confused and distressed by the traumatic experience of flooding.

This means that SD is often the most appropriate treatment for people with learning disabilities who have phobias.

Evaluate SD as a behaviourist approach to treating phobias (3): Ethical issues

Point – One limitation of flooding is that it is a highly unpleasant experience.

Evidence – Confronting a phobic stimulus in an extreme and immediate way can cause significant distress and anxiety. Sarah Schumacher et al. (2015) found that both participants and therapists rated flooding as more stressful than systematic desensitisation (SD). This stress can raise ethical concerns, as the procedure may cause significant discomfort, even if informed consent is obtained. Additionally, because of its traumatic nature, the dropout rates for flooding are higher than those for SD.

Analysis – This suggests that while flooding can be effective in treating phobias, its intense nature may make it unsuitable for some individuals, especially those with higher levels of anxiety or emotional distress. The ethical concern over inducing distress and the higher likelihood of people dropping out of treatment mean that therapists may be hesitant to use flooding as a first-line treatment.

Link – Therefore, while flooding can be effective, it may not always be the best option for all patients, particularly those who find the process too traumatic or who are more likely to drop out. This limitation suggests that less distressing treatments, such as SD, may be preferable in certain cases.

Evaluate SD as a behaviourist approach to treating phobias (4): lacks real world application

Point – One strength of flooding is that it is highly cost-effective.

Evidence – Flooding can achieve significant reductions in phobic symptoms in as little as one session, whereas systematic desensitisation (SD) may require up to ten sessions to produce the same results. Even if flooding sessions are longer (e.g., up to three hours), the overall cost remains lower compared to more gradual therapies. This makes flooding a more financially viable option for healthcare providers like the NHS.

Analysis – This suggests that flooding allows more patients to receive treatment within the same budget, increasing accessibility and efficiency in managing phobias. Its ability to produce rapid improvements also means individuals can return to their daily lives sooner, reducing the burden on healthcare resources.

Link – Therefore, flooding is not only clinically effective but also an economically advantageous treatment option, making it a preferred choice for both patients and healthcare systems aiming to maximise resource allocation.

What is 'flooding'?

A behavioural therapy in which a person with a phobia is exposed to an extreme form of a phobic stimulus in order to reduce anxiety triggered by that stimulus. This takes place across a small number of long therapy sessions.

How does flooding work?

Flooding stops phobic responses very quickly. This may be because without the option of avoidance behaviour, the client quickly learns that the phobic stimulus is harmless.

In classical conditioning terms this process is called extinction. A learned response is extinguished when the conditioned stimulus (e.g. a dog) is encountered without the

unconditioned stimulus (e.g. being bitten). The result is that the conditioned stimulus no longer produces the conditioned response (fear).

In some cases the client may achieve relaxation in the presence of the phobic stimulus simply because they become exhausted by their own fear response.

Explain the ethical safeguards of flooding

Flooding is not unethical per se but it is an unpleasant experience so it is important that clients give full informed consent to this traumatic procedure and that they are fully

prepared before the flooding session.

A client would normally be given the choice of systematic desensitisation or flooding.

Evaluate flooding as a behaviourist treatment to phobias (1): Cost-effective

POINT: One strength of flooding is that it is highly cost-effective.

EVIDENCE/EXPLANATION: Clinical effectiveness means how effective a therapy is at tackling symptoms. However when we provide therapies in health systems like the NHS we also need to think about how much they cost. A therapy is cost-effective because it is clinically effective and not expensive. Flooding can work in as little as one session as opposed to say, ten sessions for SD to achieve the same result. Even allowing for a longer session (perhaps three hours) this makes flooding more cost-effective.

EVALUATION: This means that more people can be treated at the same cost with flooding than with SD or other therapies (further explain the economical advantages).

Evaluate flooding as a behaviourist treatment to phobias (2): Traumatic

POINT: One limitation of flooding is that it is a highly unpleasant experience as confronting ones phobic stimulus in an extreme form provokes tremendous anxiety.

EVIDENCE/EXPLANATION: Saran Schumacher et al. (2015) found that participants and therapists rated flooding as significantly more stressful than SD. This raises the ethical issue for psychologists of knowingly causing stress to their clients, although this is not a serious issue provided they obtain informed consent. More seriously, the traumatic nature of flooding means that attrition (dropout) rates are higher than for SD.

EVALUATION: This suggests that, overall, therapists may avoid using this treatment.

Evaluate flooding as a behaviourist treatment to phobias (3): Symptom substitution

POINT: A limitation of behavioural therapies, including flooding, is that they only mask symptoms and do not tackle the underlying causes of phobias (symptom substitution).

EVIDENCE/EXPLANATION: For example. Jacqueline Persons (1986) reported the case of a woman with a phobia of death who was treated using flooding. Her fear of death declined, but her fear of being criticised got worse. However, the only evidence for symptom substitution comes in the form of case studies which, in this case, may only generalise to the phobias in the study (e g phobia of death may be different from a phobia of heights).

EVALUATION:...

What is depression?

All forms of depression and depressive disorders are characterised by changes to mood.

Define the categories of depression?

The latest version of the DSM recognises the following categories of depression/depressive disorders:

Major depressive disorder = severe but often short-term depression.

Persistent depressive disorder = long-term or recurring depression, Including sustained major depression and what used to be called dysthymia.

Disruptive mood dysregulation disorder = childhood temper tantrums.

Premenstrual dysphoric disorder = disruption to mood prior to and/or during menstruation.

What are the behavioural characteristics of depression?

Behaviour changes when we experience an episode of depression.

Activity levels = Typically people with depression have reduced levels of energy, making them lethargic which causes them to withdraw from work, education and

social life. In extreme cases this can be so severe that the person cannot get out of bed. In some cases depression can lead to the opposite effect - known as psychomotor

agitation where agitated individuals struggle to relax and may end up pacing up and down a room.

Disruption to sleep and eating behaviour = A person may experience reduced sleep (insomnia), particularly premature waking, or an increased need for sleep (hypersomnia). Similarly, appetite and eating may increase or decrease, leading to weight gain or loss. The key point is that such behaviours are disrupted by depression.

Aggression and self-harm = People with depression are often irritable, and in some cases they can become verbally

or physically aggressive which can have serious knock-on effects on their life. For example, someone experiencing depression might display verbal aggression by ending a relationship or quitting a job. Depression can also lead to physical aggression directed against the self and this

includes self-harm, often in the form of cutting, or suicide attempts.

What are the emotional characteristics of depression?

Lowered mood = Lowered mood is a defining emotional element of depression but it is more pronounced than in the daily kind of experience of feeling lethargic and sad. People with depression often describe themselves as worthless' and empty.

Anger = People with depression tend to experience more negative emotions and fewer positive ones in depression, but this isn't just limited to sadness. They also often experience anger, sometimes extreme anger. This can be directed at the self or others. On occasion such emotions lead to aggressive or self-harming behaviour - which is why this characteristic appears under behavioural characteristics as well.

Lowered self-esteem = Self-esteem is the emotional experience of how much we like ourselves. People with

depression tend to report reduced self-esteem. This can be quite extreme, with some people with depression describing a sense of self -loathing (hating themselves).

What are the cognitive characteristics of depression?

People experiencing depression or who have experienced depression tend to process information about several aspects of the world quite differently from the 'normal' ways that people without depression think.

Poor concentration = Depression is associated with poor levels of concentration. The person may find themselves

unable to stick with a task as they usually would, or they might find it hard to make decisions that they would normally find straightforward which are likely to interfere with the individual's work.

Attending to and dwelling on the negative = When experiencing a depressive episode people are inclined to pay more attention to negative aspects of a situation and ignore the positives. People with depression also have a bias towards recalling unhappy events rather than happy ones - the opposite bias that most people have when not depressed.

Absolutist thinking = Most situations are not all-good or all-bad, but when a person is depressed they tend to think in these terms. This is sometimes called 'black-and-white thinking.' This means that when a situation Is unfortunate they tend to see it as an absolute disaster.

How is the cognitive approach used to explain depression?

- The term 'cognitive' has come to mean 'mental processes', so this approach is focused on how our mental processes (e.g. thoughts, perceptions, attention) affect our behaviour.

- Since people's cognitions (e.g. how they think) creates this vulnerability, psychologists take a cognitive approach to explaining why some people are vulnerable to depression than others.

Define Beck's negative triad as an explanation for depression.

- Psychiatrists like Beck (1967) take a cognitive approach to explaining why some people are vulnerable to depression than others.

- Cognitive approach tries to explain depression by focusing on how negative expectations (schemas/negative triad) about the self, world and future lead to depression.

What is faulty information processing?

This is when depressed attend to the negative aspects of a situation and ignore the positives due to 'black and white' thinking. Depressed people also tend to blow small problems out of proportion due to this rigid thinking.

(e.g. a depressed person winning £1 million, but focusing on others who won more, and being upset about it).

What is negative self-schema?

- A schema is a 'package' of ideas and information developed through experience; they act as a mental framework for the interpretation of sensory information.

- A 'self' schema is the package of information people have about themselves.

- Depressed people who have acquired a negative schema during childhood have a tendency to adopt a negative view of the world. This may be caused by a variety of factors, including parental and/or peer rejection and criticisms by teachers.

- These negative schemas (e.g. expecting to fail) are activated when an individual encounters a new situation (e.g. an exam) that resembles the original condition of when the schemas were learned.

- Negative schemas lead to systematic cognitive biases in thinking. For example, individuals over-generalise, drawing a sweeping conclusion regarding self-worth on the basis of one small negative piece of feedback.

What is the negative triad?

Beck suggested that a person develops a dysfunctional view of themselves because of three types of negative thinking that occur automatically, regardless of its reality. These three elements are called the negative triad.

a) Negative view of the world - an example would be 'the world is a cold hard place." This creates the impression that there is no hope anywhere.

b) Negative view of the future - an example would be "there isn't much chance that climate change will end." Such thoughts reduce any hopefulness and enhance depression.

c) Negative view of the self - for example, thinking "I am a failure". Such thoughts enhance any existing depressive feelings because they confirm the existing emotions of low

self-esteem.

Evaluate Beck's cognitive approach to explaining depression (1): lacks real world application

Point: A limitation of cognitive-behavioral therapy (CBT) is that it may not be suitable for all individuals, particularly those with severe symptoms.

Evidence: CBT requires active engagement and commitment from clients, including completing homework tasks and applying therapeutic principles in their daily lives. This can be challenging for individuals experiencing severe depression, as they may lack the motivation or energy to fully participate in the structured steps of the therapy.

Evaluation: This reduces the effectiveness of CBT for some people, as those who are unable to engage fully may not experience the intended therapeutic benefits, limiting its applicability as a one-size-fits-all treatment.

Counterpoint: While this may limit CBT's suitability for certain individuals, combining CBT with pharmacotherapy (e.g., antidepressants) can sometimes help alleviate symptoms enough for clients to engage more fully, potentially improving their capacity to benefit from the treatment.

Evaluate Beck's cognitive approach to explaining depression (1): Research support EXTRA

POINT: One strength of Beck's cognitive model of depression is the existence of supporting research.

EVIDENCE/EXPLANATION: 'Cognitive vulnerability' refers to ways of thinking that may predispose a person to becoming depressed, for example faulty information processing, negative self-schema and the cognitive triad. In a review David Clark and Aaron Beck (1999) concluded that not only were these cognitive vulnerabilities more common in depressed people but they preceded the depression. This was confirmed in a more recent prospective study by Joseph Cohen et al. (2019). They tracked the development of 473 adolescents, regularly measuring cognitive vulnerability.

It was found that showing cognitive vulnerability predicted later depression.

EVALUATION: This shows that there is an association between cognitive vulnerability and depression.

Evaluate Beck's cognitive approach to explaining depression (2): Real-world application

POINT: A further strength of Beck's cognitive model of depression is its applications in screening and treatment for

depression.

EVIDENCE/EXPLANATION: Cohen et al. concluded that assessing cognitive vulnerability allows psychologists to screen young people, identifying those most at risk of developing depression in the future and monitoring them. Understanding cognitive vulnerability can also be applied in cognitive behaviour therapy (CBT). These therapies work by altering the kind of cognitions that make people vulnerable to depression, making them more resilient to negative life events.

EVALUATION: This means that an understanding of cognitive vulnerability is useful in more than one aspect of clinical practice.

Evaluate Beck's cognitive approach to explaining depression (3): A partial/limited explanation EXTRA

POINT: A limitation of Beck's theory is that despite its real life application, it doesn't explain all aspects of depression.

EVIDENCE/EXPLANATION: There seems to be no doubt that depressed people show particular patterns of cognition, and that these can be

seen before the onset of depression. It therefore appears that Beck's suggestion of cognitive vulnerabilities is at

least a partial explanation for depression. However, there are some aspects to depression that are not particularly well explained by cognitive explanations. For example, some depressed people feel extreme anger, and some experience hallucinations and delusions.

EVALUATION: This is a limitation because...(link back to validity)

How did Ellis use the cognitive approach to explain depression?

Another American psychiatrist, Albert Ellis (1962) suggested a different cognitive explanation of depression. He proposed that good mental health is the result of rational

thinking, defined as thinking in ways that allow people to be happy and free from pain.

To Ellis, conditions like anxiety and depression (poor mental health) result from irrational thoughts. Ellis defined irrational thoughts, not as illogical or unrealistic thoughts, but as

any thoughts that interfere with us being happy and free from pain. Ellis used the ABC model to explain how irrational thoughts affect our behaviour and emotional state.

What is Ellis' ABC model?

Ellis proposed that depression occurs when an activating event (A) triggers an irrational belief (B) which in turn produces a consequence (C) i.e. an emotional response like depression.

The key to this process is the irrational belief.

Define and explain the three parts of the ABC model.

A - Activating event:

- Irrational thoughts being triggered by external events.

- Ellis = we get depressed when we experience negative events and these trigger irrational beliefs.

- Events like failing an important test or ending a relationship might trigger irrational beliefs.

B - Beliefs:

Ellis identified a range of irrational beliefs:

1) The belief that we must always succeed or achieve perfection = 'musturbation'

2) 'I-can't-stand-it-itis' = the belief that it is a major disaster whenever something does not go smoothly.

3) Utopianism is the belief that life is always meant to be fair.

C - Consequences:

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

--> For example, if a person believes that they must always succeed and then falls at something this can trigger depression.

Evaluate Ellis' ABC model as a cognitive approach to explaining behaviour -strength (1): Real-world application EXTRA

POINT: One strength of Ellis's ABC model is its real-world application in the psychological treatment of depression.

EVIDENCE/EXPLANATION: Ellis's approach to cognitive therapy is called rational emotive behaviour therapy or REBT for short. The idea of REBT is that by vigorously arguing with a depressed person the therapist can alter the irrational beliefs that are making them unhappy. There is some evidence to support the idea that REBT can both change negative beliefs and relieve the symptoms of depression (David et al. 2018).

EVALUATION: This means that REBT has real-world value.

Evaluate Ellis' ABC model as a cognitive approach to explaining behaviour - limitation (2): Reactive and endogenous depression

POINT: One limitation of Ellis's ABC model of depression is that it only explains reactive depression and not endogenous depression.

EXPLANATION: There seems to be no doubt that depression is often triggered by life events - what Ellis would call 'activating events'. Such cases are sometimes called reactive depression. How we respond to negative life events also seems to be at least partly the result of our beliefs. However, many cases of depression are not traceable to life events and it is not obvious what leads the person to become depressed at a particular time. This type of depression is sometimes called endogenous depression. Ellis's ABC model is less useful for explaining endogenous depression.

EVALUATION: This means that Ellis's model can only explain some cases of depression and is therefore only a partial explanation.

Evaluate Ellis' ABC model as a cognitive approach to explaining behaviour - limitation (3): Ethical issues

POINT: The ABC model of depression is controversial because it locates responsibility for depression purely with the depressed person.

EXPLANATION: Critics say this is effectively blaming the depressed person, which would be unfair.

COUNTERPOINT/EVALUATION: On the other hand, provided it is used appropriately and sensitively, the application of the ABC model in REBT does appear to make at least some depressed people achieve more resilience and feel better.

What is the cognitive approach to treating depression?

The notion that underpins the cognitive approach is that mental disorders result from errors in thinking.

The aim of cognitive therapy (more often referred to as cognitive-behavioural therapy) is to challenge any irrational or dysfunctional thoughts and to replace them with more rational ones.

Two main therapies are based on the cognitive approach:

1) Beck's cognitive approach

2) Ellis' REBT

What is CBT therapy?

Therapist tries to change "maladaptive" behavior. Assumes maladaptive behaviour results from irrational thoughts, beliefs and ideas

Explain Beck's cognitive therapy

The application of Beck's cognitive theory:

- Aims to identify automatic thoughts about the world, future & self (negative triad) and challenge them.

- Cognitive therapy aims to help patients test the reality of their negative beliefs.

--> e.g. asking patients to record when they enjoyed an event, or when a person was kind to them. ('patient as scientist')

- This serves as evidence to prove a patient's irrational statements are incorrect.

--> e.g. if they said no one is ever nice to them.

What is Ellis' Rational-Emotive Behavioural Therapy (REBT)?

Rational-Emotive Behavioural Therapy (REBT) was developed by Ellis (1957) and is based on the idea that many problems are the result of irrational thinking.

It incorporates the ABC model developed by Ellis which helps to demonstrate the idea that beliefs are the main influence behind our emotional well-being.

Explain Ellis' REBT

- Ellis proposed that many problems are caused by irrational and self-defeating beliefs that put unreasonable demands on the individual.

- Ellis particularly focuses on how self-defeating attitudes cause problems when something unpleasant happens (such as failing a driving test).

- The therapy is designed to replace the beliefs in B with a new belief system called D (a dispute belief system) that allows the person to interpret what happens to them in ways that are more realistic and positive.

How does Ellis' REBT work?

1. The first part of the therapy is confrontational; the aim is for the therapist to persuade the client that their beliefs are irrational and are the cause of their emotional turmoil.

2. The client’s beliefs (their irrational thoughts) are constantly challenged (this is the cognitive part of the therapy).

3. Clients are given homework assignments which make them face up to their irrational beliefs in everyday life with the effect that they will then change their behaviour (this is the behavioural part of the therapy).

4. The eventual goal is a full acceptance of the new, rational beliefs.

What does Ellis emphasise in REBT?

Ellis emphasises that it is not the activating event that causes unproductive consequences, it is the beliefs that lead to the self-defeating consequences.

REBT therefore focuses on challenging or disputing these beliefs and replacing them with effective, rational beliefs. For example:

- Logical disputing: questioning ‘does thinking in this way make sense?’

- Empirical disputing: Asking ‘are these beliefs consistent with reality?’ ‘Where is the proof that this belief is accurate?’

- Pragmatic disputing: Emphasising the lack of usefulness of self-defeating beliefs, ‘how is this belief likely to help me?’

Evaluate CBT as a cognitive treatment for depression (2): Successful/effectiveness EXTRA

POINT: A strength of CBT is that research has suggested that it can successfully treat abnormalities such as OCD.

EVIDENCE: From a meta-analysis, Engels et al (1993) concluded CBT is an effective treatment for a range of different disorders such as depression and social phobia.

EXPLANATION/EVALUATION: This is positive because it suggests that CBT can be useful to more people than many other treatments, without the harmful side effects of drug therapies. Furthermore, CBT can be seen to not just assist individuals with dealing with the symptoms of their depression, many patients can transfer the skills they have developed through CBT to help them with other issues such as stress management.

Evaluate CBT as a cognitive treatment for depression (2): Not suitable for all

POINT: However, CBT may not be a suitable treatment for all depression sufferer.

EVIDENCE/EXPLANATION: For example, individual differences can affect whether or not CBT is effective from person to person. Some individuals feel very positive about treatments such as CBT and are prepared to engage with the programme whereas others refuse to engage with programme requirements such as the completion of homework tasks/find it difficult to actively apply the principals to their everyday life. Some people may be so depressed that they just can't partake in the steps of CBT...

EVALUATION: This is a weakness as it suggests that CBT would not be the best treatment for all depression sufferers, especially for the severely depressed, which means that it is vitally important that the needs of the individual client/patient should always be considered before a course of treatment is decided.

Evaluate CBT as a cognitive treatment for depression (3): Ignores biology (EXTRA)

POINT: CBT fails to acknowledge that some mental disorders may be due to biological factors.

EVIDENCE/EXPLANATION: For example, according to the biological approach, OCD may be linked to low levels of serotonin in the brain suggesting that the cognitive therapies ignore the role that biology can play in a mental disorder.

EVALUATION: This is problematic because it means that CBT will not work for some clients as the role of biology in mental disorders is not being considered.

What is OCD?

A condition characterised by obsessions and/or compulsive behaviour. Obsessions are cognitive whilst compulsions are behavioural.

Define the different categories of OCD.

The DSM5 system recognises OCD and a range of related disorders. What these disorders all have in common is repetitive behaviour accompanied by obsessive

thinking.

OCD = characterised by either obsessions (recurring thoughts, images, etc.) and/or compulsions (repetitive behaviours such as handwashing). Most people

with a diagnosis of OCD have both obsessions and compulsions.

Trichotillomania = compulsive hair-pulling.

Hoarding disorder = the compulsive gathering of possessions and the inability to part with anything, regardless of its value.

Excoriation disorder = compulsive skin-picking.

What are the behavioural characteristics of OCD?

The behavioural component of OCD is compulsive behaviour. There are two elements to compulsive behaviours.

Compulsions are repetitive = Typically people with OCD feel compelled to repeat a behaviour. A common

example is handwashing. Other common compulsive repetitions include counting, praying and tidying/ordering groups of objects or containers in a food cupboard.

Compulsions reduce anxiety = Around 10% of people with OCD show compulsive behaviour alone; they have

no obsessions, just a general sense of irrational anxiety. However, for the vast majority, compulsive behaviours are performed in an attempt to manage the anxiety produced by obsessions. For example, compulsive handwashing is carried out as a response to an obsessive fear of germs. Compulsive checking, for example that a door is locked or a gas appliance is switched off, is in response to the

obsessive thought that it might have been left unsecured.

Avoidance = The behaviour of people with OCD may also be characterised by their avoidance as they attempt to reduce anxiety by keeping away from situations that trigger it. People with OCD tend to try to manage their OCD by avoiding situations that trigger anxiety. For example, people who wash compulsively may avoid coming into contact with germs. However, this avoidance can lead people to avoid very ordinary situations, such as emptying their rubbish bins, and this car in itself interfere with leading a regular life.

What are the emotional characteristics of OCD?

Anxiety and distress = OCD is regarded as a particularly unpleasant emotional experience because of the

powerful anxiety that accompanies both obsessions and compulsions. Obsessive thoughts are unpleasant and frightening, and the anxiety that goes with these can

be overwhelming. The urge to repeat a behaviour (a compulsion) creates anxiety.

Accompanying depression = OCD is often accompanied by depression, so anxiety can be accompanied by low

mood and lack of enjoyment in activities. Compulsive behaviour tends to bring some relief from anxiety but this is temporary.

Guilt and disgust = As well as anxiety and depression, OCD sometimes involves other negative emotions such as irrational guilt, for example over minor moral issues, or disgust, which may be directed against something external like dirt or at the self.

What are the cognitive characteristics of OCD?

People with OCD are usually plagued with obsessive thoughts but they also adopt cognitive strategies to deal with these.

Obsessive thoughts = For around 90% of people with OCD the major cognitive feature of their condition

is obsessive thoughts. These vary considerably from person to person but are always unpleasant. Examples of

recurring thoughts are worries of being contaminated by dirt and germs, or certainty that a door has been left unlocked and that intruders will enter through it, or impulses to hurt someone.

Cognitive coping strategies = Obsessions are the major cognitive aspect of OCD, but people also respond by

adopting cognitive coping strategies to deal with the obsessions. For example, a religious person tormented by obsessive guilt may respond by praying or meditating. This may help manage anxiety but can make the person appear

abnormal to others and can distract them from everyday tasks.

Insight into excessive anxiety = People with OCD are aware that their obsessions and compulsions are not rational; in fact this is necessary for a diagnosis of OCD. If someone really believed their obsessive thoughts were based on reality that would be a symptom of a quite different form of mental disorder (psychosis). However, in spite of this insight, people with OCD experience catastrophic thoughts about the worst case scenarios that might result If their anxieties were justified. They also tend to be hypervigilant, i.e. they maintain constant alertness and keep attention focused on potential hazards.

What is the biological explanation of OCD?

1) Genetic explanations

2) Neural explanations

What are genetic explanations?

A popular explanation for mental disorders is that they are inherited. This would mean that individuals inherited specific genes from their parents that are related to the onset of OCD.

Genes make up chromosomes and consist of DNA which codes the physical features (such as eye colour, height) of an organism and psychological features (such as intelligence).

What are candidate genes?

Genes that create vulnerability for OCD. Some of these genes are involved in regulating the development of the serotonin system.

What does OCD being polygenic mean?

This means that OCD is not caused by one single gene but by a combination of genetic variations that together significantly increase vulnerability.

What are the different types of OCD?

One group of genes may cause OCD in one person but a different group of genes may cause the disorder in another person. The term of send to describe this is aetiologically heterogeneous meaning that the origin of OCD has different causes (heterogeneous).

There is also some evidence to suggest that different types of OCD may be the result of a particular genetic variations such as hoarding disorder and religious obsession.

1. Genetic explanation: COMT gene

This gene may be involved in the onset of OCD. It is called the COMT gene because it involves the production of catechol-O-methyltransferase.

In turn, COMT regulates the production of the neurotransmitter dopamine (associated with motivations, rewards and compulsions) that has been implicated in OCD.

All genes come in different forms (alleles) and one form of the COMT gene has been found to be more common in OCD patients than with people without the disorder.

It has been found (according to Tukel et al, 2013) that this form of the COMT gene produces lower activity of the gene and higher levels of dopamine.

2. Genetic explanation: SERT gene

Also called 5-HTT, the SERT gene is thought to affect the transport of serotonin (which is associated with regulation of mood) creating lower levels of the neurotransmitter. These changed levels of serotonin are also implicated in OCD (lower serotonin levels found common in people who have OCD).

3. The Diathesis Stress Model of OCD.

Genotype & phenotype: Although evidence suggests that OCD can have a genetic biological cause, it can also be seen that biology, specifically genetics, are not the sole reason why an individual can develop OCD.

It makes sense to suggest that an individual may have a genetic vulnerability to develop OCD (i.e. they have the SERT or the COMT gene) however, this gene alone does not cause the OCD, the interaction with our environmental triggers (e.g. stress, our upbringing) and the gene combined causes the OCD.

Evaluation of genetic explanations of OCD

1. Although research suggests genetics is a present factor, it can't purely be due to genetics as results would show 100% concordance rate.

2. The fact that relative OCD sufferers don't have the same symptoms suggests it's not genetic.

3. There is not one OCD gene, but suggests that many scattered throughout the genome contribute towards an individual's overall risk of developing OCD.

What are neural explanations?

The view that physical and psychological characteristics are determined by the behaviour of the nervous system, in particular the brain as well as individual neurons.

1. Neural explanation: Role of serotonin in OCD

Low levels of serotonin mean normal transmission of mood relevant info does not happen and they can experience low moods. OCD could be explained by a reduction in the functioning of the serotonin system.

2. Neural explanation: Abnormal numbers of serotonin and dopamine neurotransmitters.

Low Serotonin levels are associated with OCD. Pigott, 1990 found that antidepressant drugs (which increase serotonin activity) have been shown to reduce the symptoms of OCD.

High Dopamine levels are thought to be associated with OCD. Szechtman, 1998 conducted animal studies and found that high doses of drugs that enhanced levels of dopamine induced stereotyped movements that resembled the compulsive behaviours witnessed in OCD patients.

3. Neural explanation: Decision making systems

Some cases of OCD, particularly hoarding disorder seem to be associated with impaired decision making. This could be due to abnormal functioning of the lateral of the frontal lobes of the brain. The frontal lobes are the front part of the brain and are responsible for logical thinking and making decisions.

There is also evidence to suggest that an area called the left parahippocampal gyrus, which is associated with processing unpleasant emotions, functions abnormally in OCD.

4. Neural explanation: Increased activity in the orbitofrontal cortex

A feature that is often witnessed on PET scans of OCD sufferers is the orbitofrontal cortex (associated with higher level thought and conversion of sensory information into thoughts.) This brain area is thought to help initiate activity upon receiving impulses to act and then stop the activity when the impulses lessen.

A non-sufferer may have an impulse to wash dirt from their hands; once this is done, the impulse to perform the activity stops as does the behaviour. It may be that those with OCD have difficulty switching off or ignoring impulses so that they turn into obsessions resulting in compulsive behaviour.

Evaluation of neural explanations of OCD

1. Doesn't explain whether levels of serotonin are the causes of OCD or merely effects of the disorder.

2. Not all sufferers respond positively to increased serotonin suggesting it isn't the sole cause of the disorder.

3. Despite finding differences between sufferers and non-sufferers, it isn't known how these differences relate to OCD.

Evaluate the biological approach to explaining of OCD (1): Evidence support for a genetic and neural basis

GENETIC =

POINT: A strength of the biological explanation of OCD is that there is evidence to support that the disorder has a genetic basis.

EVIDENCE/EXPLANATION: Billett et al (1998) using a meta-analysis of 14 twin studies of OCD found that, on average, identical (MZ) twins were more than twice as likely to develop OCD if their co-twin had the disorder, the chances of developing OCD was lower for the co-twin of a non-identical (DZ) pair.

EVALUATION: This is positive because the research suggests that genetics does play a part in the development of OCD.

Counterpoint - Meta analysis, may be subject to publication bias