OCR Applied Psychology Section A

supernatural explanation

widespread in middle ages

caused by witchcraft, demonic possession, or religious punishment for wrongdoing

treated by prayers, submersion in holy water, or exorcism by trepanning (drilling holes into the skull) to allow the devil to escape

humoral theory

developed by hippocrates in ancient greece

caused by an imbalance in the 4 humours, each relating to a different personality trait: black bile= introversion, yellow bile= impulsiveness, blood=courage, phlegm= calmness

treated by lifestyle changes such as diet and exercise, or more extreme circumstances a clinician would purge the patient via laxatives or bloodletting

psychogenic approach

developed by freud in the 19th century

caused by unconscious psychological factors

treated by free association and dream analysis to gain insight into past experiences and unconscious mind, picked apart by psychoanalysts

somatogenic approach

associated with the medical model in the 1900s

caused by an imbalance in neurotransmitters, genes or brain structure

treated by drugs, electroconvulsive therapy or psychosurgery, eg lobotomy or commisurotomy

statistical infrequency

behaviours that occur infrequently are classed as abnormal

some statistically infrequent behaviours are desirable, like low scores on a depression test

some statistically frequent behaviours are undesirable, like high scores on a depression test

deviation from social norms

anyone who behaves differently or deviates from social norms is classed as abnormal

distinguishes from desirable and undesirable behaviour, like a low depression score isn't abnormal because it is desirable

failure to function adequately

abnormality is judged in terms of not being able to cope with everyday life, like not eating or working

recognises subjective experience of someone with a disorder but can be judged objectively, as clinicians can identify behaviours, eg regular job, can dress, good diet

deviation from ideal mental health

jahoda listed characteristics of good mental health: good self attitudes, personal growth, integration, autonomy, accurate perception of identity, mastery of environment. if any of these were not fulfilled then an individual is abnormal

the criteria are ideal and unnattainable for most people most of the time, so we are all abnormal. criteria are also subjective and therefore difficult to measure

ICD-10

international classification of diseases

produced by world health organisation

used by europe

DSM-5

diagnostic and statistic manual of mental disorders

produced by the american psychological association

used in america

rosenhan background

prosecution and defense in murder trials often called their own psychiatrists who often disagreed on the defendants sanity, leading rosenhan to wonder if there was a reliable way to identify who was insane

rosenhan aims

study 1: to see if sane people presenting with a disorder were diagnosed as insane by staff at psychiatric hospitals

study 2: to see if psychiatrists would be more undercautious than overcautious due to the type one errors made by others in previous study

mini experiment: to see if staff behaved differently towards patients compared to a non patient asking similar questions

rosenhan design

study 1: participant observation

study 2: questionnaire

mini experiment: self report

rosenhan sample

study 1: patients and staff in 12 american psychiatric hopsitals, 8 pseudopatients

study 2: staff at one psychiatric hospital

mini experiment: staff and pseudopatients from 4 of the 12 hospitals, including a confederate

rosenhan procedure

study 1: pseudopatients made an appointment at the hospital admissions office

complained about hearing a same sex voice saying empty, hollow and thud

once admitted, pseudopatients behaved normally and obeyed instructions in order to be released

they would record observations in a notebook

study 2: hospital staff were told pseudopatients would be admitted in the next three months, but none were presented

staff asked to rate patients on a 10 point scale, with 1 being the most confident that a patient was really a pseudopatient

mini experiment: pseudopatient asked staff excuse me could you tell me when i will be presented at the staff meeting

confederate asked on campus can you tell me where this is?

rosenhan results

study 1: all but one patient diagnosed with schizophrenia and discharged with schizophrenia in remission

in hospital 7-52 days with a mean of 19

no pseudopatient was suspected by staff, but 35/118 patients did suspect pseudopatients, saying things like youre not crazy

normal behaviours were interpreted as symptoms, like queueing early for lunch was seen as pathological

patients were powerless and depersonalised by toilets without doors

study 2: 41/193 patients were suspected by at least one staff member

23/193 patients suspected by one psychiatrist

19/193 patients were suspected by both a psychiatrist and a staff member

mini experiment: 4% of pseudopatients recieved an answer from a psychiatrist out of 185 attempts

all 14 requests at the university were responded to

rosenhan conclusions

diagnosis is not valid as psychiatrists failed to distinguish the sane from insane

all but one patient were diagnosed with schizophrenia, so diagnosis is reliable

labels are sticky, once a person was labelled as insane, all behaviours were interpreted according to this label

rosenhans key research link to categorising mental health

indicates there is a lack of validity in categorising and diagnosing psychological disorders

pseudopatients were categorised as insane just by telling staff they had symptoms, the labels led to psuedopatients behaviour being interpreted according to the situation reducing validity

the study supports the anti psychiatry movement because it criticises the idea that psychological illnesses can be diagnosed in the same way physical disorders can

rosenhan methodology

highly valid, used real staff and patients who were unaware of the study, so no demand characteristics/social desirability led to ecological validity

mini experiments were standardised so high validity

observations were consistent, so reliable

no interrater reliability

a variety of hospitals used but only american so ethnocentric, sampling bias

rosenhan debates

individual view of psychological disorder as some patients took longer to be released, range of 7-52 days

situational view because sticky labels and interpretation of psychological disorder

horrendous ethics tbh

socially sensitive because could demonise healthcare workers

not socially sensitive because raised awareness of flaws of mental healthcare and made diagnostic systems better

affective disorders

have an affect on mood

eg major depression, bpd

icd10 key characteristics include low mood, loss of interest, reduced energy levels

other characteristics include changes in sleep pattern and appetite, reduced self esteem and concentration, feelings of guilt, thoughts of self harm or suicide

characteristics have to be present for 2 weeks or more for diagnosis

psychotic disorders

individual has lost touch with reality

eg paranoid schizophrenia, delusions/hallucinations, or hebephrenic schizophrenia, mostly negative symptoms

must be at least one positive and one negative symptom for a month for diagnosis

positive symptoms are behaviours added to normal behaviour, like hallucinations- hearing or seeing things that arent there- or delusions- irrational beliefs.

negative symptoms are behaviours no longer present, like alogia- speech poverty- or avolition- reduced motivation for activities,

cognitive deficits affect mental processes, such as disorganised thoughts or speech, or thought insertion

anxiety disorders

individual experiences feelings of anxiety and fear, often about things in the future. these worries cause biological symptoms, like increased heart rate

egs ocd, specific phobias

a strong, persistent and irrational fear of a specific stimulus, like arachnophobia, the fear of spiders, people take extreme measures to avoid the stimulus, so the phobia is clinical because it interferes with everyday life

biochemical explanation of affective disorders

physical causes of mental illness may be due to atypical biochemistry

major depression could be explained by the monoamine hypothesis, that low levels of monoamines cause illness

serotonin regulates monoamine transmitters, and deficiencies are related to low mood and erratic thinking

noradrenaline regulates heart rate and alertness, and deficiencies are related to lack of energy

dopamine regulates motivation, deficiencies are related to lack of interest in pleasure and reward

biochemical explanation for psychotic disorders

schizophrenia could be explained by the dopamine hypothesis, that unusually high levels of dopamine cause it

the revised dopamine hypothesis states that an excessive amount of d2 subtype dopamine receptors leads to excess dopamine in brain pathways

positive symptoms are linked to high dopamine activity in the mesolimbic pathway, responsible for motivation and emotion

negative symptoms are linked to erratic dopamine function in the mesocortical pathway, responsible for self regulation

biochemical explanation for anxiety disorders

gamma-aminobutyric acid or gaba counterbalances the excitatory response of glutamate. deficiencies lead to increased neuronal firings in the glutamate pathway, which leads to feelings of anxiety.

genetic explanation of affective disorders

genes we inherit from our parents determine our behaviour and personality, and similarity is measured between two individuals by concordance or correlation through twin, family, adoption, or gene association studies

the cause of bpd can be explained by gottesman, who used a family study to show that children of one parent with bipolar are 4.4% likely to develop it, compared to the 0.63% chance of the general population

genetic explanation of psychotic disorders

the cause of schizophrenia can be explained by glatt, who used a twin study to show that the concordance rate of monozygotic twins with schizophrenia is 50%, compared to dizygotic twins with a 15% chance, suggesting that schizophrenia has a genetic component

genetic explanation of anxiety disorders

the cause of specific phobias can be explained by kendler et al, who used a twin study to show that concordance rates for animal phobias were 25.9% in monozygotic twins, but only 11% in dizygotic twins, suggesting a genetic element

however, no significant difference was found in blood/injury/needle or situation specific phobias

brain abnormality explanation of affective disorders

there are differences in the brain structure of a person before and after the development of their mental illness, and compared to a neurotypical brain

reduced grey matter and activity levels in the limbic system could be the cause of major depression

the amygdala regulates emotions, but is disrupted in people with major depression, eg activity increases when shown negative stimulus

the hippocampus is responsible for memory, but is significantly smaller in those with major depression, and the more severe the depression, the more severe the loss of grey matter there. this could explain why depressed people process emotional memories in dysfunctional ways

brain abnormality explanation of psychotic disorders

schizophrenics have enlarged ventricles in their brain, which are spaces that hold cerebrospinal fluid to give nutrients and protect the brain from damage

the enlarged ventricles lead to a reduction of grey matter, particularly in the:

temporal lobes, which are responsible for verbal and acoustic memory. loss of grey matter here explains auditory hallucinations

frontal lobes, which are responsible for planning and coordination. loss of grey matter here explains incoherent speech and perceptual disturbances like delusions.

thalamus, which integrates sensory and motor information. loss of grey matter here may lead to verbal and auditory hallucinations

the reduced grey matter leads to a smaller brain size than an neurotypical brain. the longer a individual has had schizophrenia, the less grey matter there is.

brain abnormality explanation of anxiety disorders

the prefrontal cortex contains emotional centres, if it doesnt function correctly then if fails to suppress fearful urges from the amygdala

the amygdala detects and responds to threats, and people with anxiety disorders have a smaller amygdala, which is associated with the inability to control behavioural or biological responses to fearful objects or situations

the hippocampus is involved in memory and learning associations, like classical conditioning. reduced functioning may mean that an individual only links negative feelings to a memory, rather than positive or neutral ones.

gottesman background

past research had shown that when one parent has a psychological disorder, the risk of their child developing it increases, however the research had small samples and lacked generaliseability

gottesman aims

to use a large sample to investigate the likelihood of offspring being diagnosed with schizophrenia, bipolar disorder if one of both parents had been diagnosed with these disorders

to see if some of these genes underlie more than one disorder and whether a double dose from both parents would increase the risk

gottesman design

secondary data from a national database of medical history

gottesman sample

2.7 million danish children aged 10 and over with a registered link to both parents. obtained from danish civil registration system of children and danish psychiatric central register.

group 1- 279 couples who were both on psychiatric register

group 2- 20001 couples who had one on psychiatric register

group 3- neither parent had a disorder

group 4- no data on diagnosis

gottesman procedure

civil registration used to identify parents of each child

each child and parent checked to see if they were on psychiatric register

specific diagnosis was identified

data on each offspring was linked with their parents psychiatric history so that the likelihood of a diagnosis could be calculated

gottesman results

if both parents had schizophrenia, the incidence for the same diagnosis was 27.3% or 67.5% for any

if one parent had schizophrenia, incidence was 7%

if one parent had schizophrenia and one bipolar, incidence was 15.6%

if no parent had ever been admitted, incidence was 0.86%

if both parents had bipolar, incidence fro the same was 24.95% or 44.2% for any

if one parent had bipolar, the incidence was 4.4%

after age 45 there were very few new schizophrenia cases, but still many bipolar diagnoses

gottesman conclusions

if both parents have a serious psychological disorder, their childs has a high risk of developing that disorder or any other disorder

having one parent with a disorder increases risk but two parents creates an even greater risk, super high risk sample

supports genetic explanation because it shows increased likelihood of developing a disorder if a direct relative also has a disorder

gottesman key research link to medical model

supports the medical model because it is a genetic explanation of mental illness

found an increased risk of children being diagnosed with schizophrenia if one or both parents had schizophrenia

increased risk of developing any psychological disorder if parents have schizophrenia or bipolar, suggesting certain genes underlie multiple illnesses

gottesman methodology

diagnosis based on icd classification system, already deemed to be valid

some diagnoses may have been invalid as schizophrenia and bipolar symptoms do overlap

mri scans has varying reliability

very large sample, so very well generalised to denmark and potentially surrounding european countries

only included danish, so ethnocentric

only included those with hospital admissions for schizophrenia and bipolar, so less severe cases may not be the same

gottesman debates

genetic explanation, so nature

brain or biochemistry abnormality could be nurture, as they can be caused by circumstances such as drug abuse, injuries

determinist, neurotransmitters, genes, brain structure out of our control

all 3 medical model explanations are reductionist, break down complex behaviour into simplest form, genes, abnormalities, biochemistry

individualist as situation/culture not taken into account

biological treatment for schizophrenia

neurotransmitter irregularities cause schizophrenia, so drug treatments that modify neurotransmitters should alleviate the symptoms

antipsychotics block dopamine by occupying post synaptic receptor sites, particularly d2. this reduces activity in post synaptic neurons resulting in less activity in the mesolimbic pathway, and decreases positive symptoms

typical or first gen antipsychotics from the 1950s include haloperidol and chlorpromazine used as tranquilisers to calm people with schizophrenia, effective at reducing positive symptoms

atypical or second gen antipsychotics are newere include clozapine and risperidone, they gradually block dopamine receptors, and also effectively reduce negative and positive symptoms

the medication must be taken in tablet form daily and over a period of weeks to notice a difference, if not taken relapse will occur

can also be injected less frequently

biological treatment for schizophrenia evaluation

useful as they reduce symptoms, so reduce relapse rates and hospital admissions, better quality of life for schizophrenics, reduces aggression- leucht et al

effective as clozapine reduces hospital admissions and reduces use of other meds, has been found most effective, particularly when other antipsychotics hadn't been- stroup et a

less practical as frequent side effects, like tremors, spasms, slow movements, or restlessness. severity of side effects leads to reduced adherence, which makes medication less effective. ethics?

biological treatment for major depression

electroconvulsive therapy is a controversial therapy, used mainly for severe depression

the person is usually in hospital due to the severity of their depression, so are given a full medical examination to ensure it will be safe, and then they are given general anaesthetic, oxygen and muscle relaxant to prevent brain or muscle damage

once unconscious, electrodes are put on their head and a current of 0.6 amps is passed through for half a second, causing 20-50 seconds of seizures

six to eight treatments are given over a three to four week period

unsure exactly how it works, but it could be due to electric current changing neurotransmitter activity or blood stimulation in the limbic system. it can also stimulate new cell growth and new pathways.

unilateral ect is in one temple, slower, less side effects

bilateral ect is in two temples, quicker, more side effects, more widely used

biological treatment for major depression evaluation

useful for those with very severe depression who couldnt wait for drug treatments to work as they are at risk of self harm or suicide, or the drug treatment was unsuccessful

effective compared to simulated ect or drugs found by ect review group in 2013, bilateral better than unilateral, high dose better than low dose

less practical because informed consent may not be fully given if ill, severe side effects such as headaches, aching muscles, dizzy, distress, memory loss. risk of death or serious inury. protection from harm?

behaviourist explanation of affective disorders

mental illness is learned as a consequence of external events

classical conditioning, like when someone has early experiences of lack of control, they may be passive, inactive or depressed in similar situations when they are older. this is called learned helplessness

operant conditioning, depression can occur when positive reinforcers from an environment are removed, eg interactions with classmates are gone if you dont go to school. this can lead to avoidance of social situations. others may unconsciously encourage depressive behaviour if they give attention to the depressed individual.

behaviourist explanation of anxiety disorders

classical conditioning initiates the phobia

watson and rayner conditioned 11 month old little albert to be frightened of white furry objects through association with loud noise

neutral stimulus= white rat that albert was inititally not afraid of

unconditioned stimulus= banging a steel bar loudly

unconditioned response= crying and falling forward

ns paired with ucs= albert reached out to touch rat, researchers banged steel bar

several pairings caused albert to cry, producing a conditioned response crying, to a conditioned stimulus the white rat

albert had been conditioned to fear the rat, and developed a phobia of it

operant conditioning maintains the phobia

positive reinforcement involves attention from others after an extreme reaction. this attention acts as a reinforcer of the phobic actions

negative reinforcement involves avoiding the stimulus to reduce fear and reinforces the avoidance because it reduces the unpleasant feeling

social learning theory can also develop phobias

aquired by observing and imitating the behaviour of others, eg in askew and fields study children acquired phobias when images of unfamiliar animals were apired with a scared rather than happy adult face

cognitive explanation of affective disorders

mental illness is caused by faulty of maladaptive thinking

becks cognitive triad involves three parts

the self- the person feels that they are worthless, eg feeling unattractive of unlikeable

the future- the person thinks the future will be negative, eg not finding a job

the world- the person thinks that everyone around them ,and every situation, is negative eg, the world is a cold hard place with no hope

these beliefs form negative cognitive schemas, so the person expects situations to be this way and therefore interprets them this way, an example of systematic negative bias

the negative schemas stem from criticism and rejection early in life from parents or teachers, and may also come from overexpectations in childhood

butler et als meta analysis of over 300 studies found improvement in depressive characteristics stemmed from the use of cognitive therapies, which suggests that faulty cognitions may be related to depression

cognitive explanation of psychotic disorders

many symptoms of schizophrenia are cognitive, like speech poverty, disorganised speech and thought insertion, so it makes sense to assume it has a cognitive cause. the main assumption is that it is caused by disordered thinking.

frith suggests that schizophrenics are more consciously aware of processes that usually take place unaware. clinically healthy people are unaware still and can get on with tasks better. schizophrenics have too much information is being processed, leading to sensory overload.

cognitive explanation of anxiety disorders

beck et al suggested that fear responses are caused by a persons interpretation of the situation/object rather than the situation/object itself, called cognitive bias

attentional bias- people who develop specific phobias pay extreme attention to situations and objects that produce fear and anxiety

negative appraisal bias-people who develop specific phobias interpret harmless situations and objects as dangerous

systematic attentional bias- pflugshaupt et al found that people with arachnophobia detected spiders in photos quicker than those without the phobia

humanist explanation of affective disorders

self actualisation, the ability to realise potential, develop relationships and find meaning in life, is one of the key characteristics to mental health

taking personal responsibility- major depression occurs because external factors inhibit the growth of the individual

reduced self esteem- an individuals failure to live up to their self expectations reduces their self esteem. defence mechanisms such as distortion are used to reduce the percieved threat, but do not reduce the threat itself, diminishing contact with reality

downward spiral- threats to the self increase and it becomes harder to defend against such threats. the person becomes trapped in a depressive downward spiral and use more and more defences with less and less effect

humanist explanation of psychotic disorders

active and holistic- people with schizophrenia are not passive carriers of symptoms. the humanistic approach doesnt focus on a narrow aspect of functioning but on the whole person

striving for meaning and growth- schizophrenia is an interruption of the usual developmental process toward emotional maturity. the humanistic approach believes that schizophrenics are not ill, just immature, as their development into a healthy person has been interrupted by circumstances like stress

self esteem and parenting- the humanistic approach believes that harsh or neglectful parenting can drastically lower a childs self esteem, making them more vulnerable to schizophrenia in adulthood

szasz background

szasz wrote a book, the myth of mental illness, in 1961. this article was a review of his ideas and the situation 50 years later.

szasz aim

challenge the medical concept of mental illness

reject psychiatric treatments based on the medical model

encourage people to avoid labels like psychoses or neuroses, and instead think of individual behaviours that disorient the self

reject the image of people with mental illness being victims of pathological events

stop coercive psychiatric practices which are incompatible with free societies

1- fifty years of change

in the 1950s, nobody thought there should be free government healthcare, and people with mental illnesses were incurable and locked away.

in 2011, the government has taken responsibility for those with mental illness to prevent them posing a danger to themselves or others

2- mental illness- a medical or legal concept?

in the 21st century, mental illnesses are defined by politics and economy. many disorders like homosexuality are no longer seen as disorders. if mental illness was a real phenomenon it could not change so easily.

mental health is politicalised and those in charge decide whether it is a real illness or not, and their arguments are not based on scientific research.

psychiatric hospitals are like prisons, and those labelled are treated like prisoners rather than patients recieving treatment. psychiatrists are judges rather than healers. traditional psychiatric judgements should be replaced with morals.

3- 'mental illness' is a metaphor

a person diagnosed with mental illness may be later found as having physical illness, so they wre misdiagnosed, and didnt have a mental illness, but an undiagnosed bodily illness.

if all mental illnesses were found to be brain diseases,the term mental illness would become devoid of meaning

4- changing perspectives

medicalisation of the soul began in the 16th century, eg shakespeares lady macbeth experienced hallucinations. her husband sent for a doctor who prescribed religion, internal self conservation, rather than medicine. by the end of the 19th century, the physician took on the task of curing the soul.

5- in the eye of the beholder

diseases of the body have causes which can be understood. mental illnesses can be understood, but not cured. feelings dont matter in physical illnesses.

the ethical principle, protection from harm is not given to those with mental illnesses, as unlike those with a physical illness, they do not have a choice in treatment

6- revisiting the myth of mental illness

critics continue to see the myth of mental illness as a radical effort to recast mental illness from a medical problem into a linguistic problem.

some non psychiatrists believe that psychiatry is a method of social control that violates freedom and autonomy

7- having an illness doesnt make a person a patient

one of the worst assumptions of psychiatry is that if someone is labelled as mentally ill, they require medical help, whether they choose the treatment or not.

curing or healing via conversation, eg cbt

controlling or coercing patients forcefully, as authorised by the state, eg drugs or ect

szasz key research link to alternatives to the medical model

szasz claims that if a disorder has a physical basis then it should be diagnosed as a physical illness, not a mental one. behaviours that are disurbed should be explained psychologically because there are psychological symptoms

szasz identified that theres are two treatments, talking therapies that are consented to, or controlling people against their will via medication.

szasz methodology

not valid because it is subjective, based on his own views rather than empirical research.

case studies are used, eg little hans, little albert. cannot generalise from such unique and restricted samples.

szasz talked about the politicalisation of mental illness, suggesting that the assumptions of us political parties affected the cultural view of psychological disorders

szasz debates

medical model and cognitive neuroscience explanations support nature, as genes underlie the faulty neural circuits related to psychological disorders.

behaviourist explanations are nurture because they show how mental illness can be learned through situations, like conditioning

the humanistic explanation supports free will as it explains how our choices reduce the gap between the real and ideal self

behaviourist explanation states that only the environment has an influence of mental illness development, so environmental determinism

cognitive neuroscience reduces psychological activity to neuronal activity in the brain

humanistic explanations are more holistic as they take the individual as a whole into account- the self is a psychological entity

non biological treatment for phobias

systematic desensitisation is based on the principle of classical conditioning, the initiator of phobias according to behaviourists. four main stages:

functional analysis- the therapist and patient discuss reasons for phobia, how the patient responds to phobic stimulus and feared scenarios

construction of an anxiety hierarchy- the therapist and patient develop a hierarchy of phobic situations, from least to most fearful

relaxation training- the patient is taught relaxation techniques, eg box breathing

gradual exposure- starting with the least phobic situation, the patient experiences the fear response whilst practising relaxation techniques in the presence of the phobic stimulus. when the patient reports no anxiety, they move up to he next stage.

non biological treatment for phobias evaluation

useful because relaxation processes are learnt and practised that can be applied in multiple real situations, not just phobias. makes life much easier for patients

effective because lang and lazovik found that people with snake phobias who underwent sd displayed less avoidance of snakes when presented with them and reported less phobic behaviours, even up to 6 months later.

practical because sd is significantly cheaper than psychoanalysis which can last years.

impractical because treatment may not address root of phobia, so it may reappear in a different form.

some phobias cannot be replicated for desnsitisation, eg planes, or wild animals

non biological treatment for major depression

non biological treatment for major depression evaluation