Studied by 1 person
Definitions of abnormality
Statistical Infrequency
Deviation from Ideal Mental Health
Deviation from Social norms
Failure to Function Adequately
Statistical Infrequency
This is deviating from the statistical norm or average
Many individual human characteristics can be measured and be plotted on a normal distribution
These behaviours at either end of the distribution (2SD above and below the mean) can be considered abnormal
Examples: IQ, Mood, Height, Weight- all of these can be lower or higher than the ‘average’ range
AO3 EVALUATION: Statistical Infrequency
Does not recognise many known disorders - e.g. Schizophrenia - where behaviours and symptoms are noticeable, but not measurable.
The ‘cut off’ point is subjective – sometimes symptoms of disorders (e.g. depression) are difficult to measure and assign a ‘statistical’ cut off point to show where help is needed. (e.g. sleeplessness, low mood)
Cultural Relativism- this relates to characteristics of behaviour that are specific to each culture. Defining abnormal characteristics and generalising across cultures can cause an ethnocentric bias (by imposing an etic). This could misrepresent other cultures. This is a weakness of all other definitions. Defining abnormality would be best left culturally relative e.g. statistics, social norms, daily living activities, mental health characteristics
Deviation from Social Norms
Society sets norms and values (both written and unwritten)
Any behaviour that deviates from these norms is considered abnormal
For example Cannibalism or Nudity
AO3 EVALUATION: Deviation from Social Norms
Usefulness - The definition can be used in clinical practice e.g. to define characteristics of antisocial personality disorder (e.g. failing to conform to culturally normal ethical behaviour e.g. recklessness, deceitfulness), depression, anxiety, eating disorders, OCD, schizotypal personality disorders, tourettes, etc.
Deviance is related to context – e.g wearing a bikini on the beach vs in the classroom
Cultural Relativism
Failure to Function Adequately
Unable to live a ‘normal’ day-to-day life.
Do not possess a ‘normal’ range of physical abilities, emotions or behaviours.
Behaviours which disrupt a person’s ability to work & form/maintain relationships.
For example- Disabilities, mood disorders, OCD/ADHD/phobias/eating disorders, etc.
Rosenhan and Seligman’s Checklist of Dysfunction:
Personal distress
Maladaptive behaviour (stops you achieving goals)
Unpredictable behaviour (doesn’t suit circumstances)
Irrational behaviour (unexplainable)
Cause observer discomfort
Deviation from social norms and values.
The more of these a person has, the more abnormal the person is viewed as
AO3 EVALUATION: Failure to Function Adequately
Abnormality isn’t always accompanied by dysfunction- Psychopaths can lead seemingly ‘functional’ lives (family, friends, jobs, outward behaviours) e.g. Harold Shipman / Fred & Rose West
Functional dysfunction- e.g. attention seeking behaviours that gain (wanted) attention
Cultural Relativism
Deviation from Ideal Mental Health
Jahoda defines ‘normal’ mental health characteristics.
Abnormality is seen as anything which deviates from these characteristics.
For example- Depression, hallucinations, anxiety
Jahoda’s Checklist of Ideal Mental Health:
No symptoms of distress
Rational and accurate perception of the self
Can self actualise
Can cope with stress
Realistic view of the world
Good self-esteem
Independent of other people
Can successfully work, love and enjoy leisure
The more of these you have, the more ‘normal’ you are considered
AO3 EVALUATION: Deviation from Ideal Mental Health
Over-demanding (unrealistic) criteria – most people can’t meet the demands of Jahoda’s checklist (therefore if you can, are you abnormal?). Plus it’s Jahoda’s subjective criteria
Changes over time (temporal validity) – Homosexuality 50 years ago was a mental illness.
Cultural Relativism
Phobias
All phobias are characterised by excessive/overwhelming fear and anxiety, triggered by an object, place or situation. The extent of the fear is out of proportion to any real danger presented by the phobic stimulus
Phobias are more pronounced than fears. They develop when a person has an exaggerated or unrealistic sense of danger about a situation or object (disproportionate to the actual danger)
If a phobia becomes very severe, a person will organise their life around avoiding the thing that's causing them anxiety.
As well as disrupting their day-to-day life, it will also cause them considerable anguish.
Categories of Phobias
The DSM-5 categories phobias into:
Specific phobia= irrational fear of an object e.g. animal, body part or situation
Social anxiety= irrational fear of a social situation such as public speaking
Agoraphobia= irrational fear of being outside
Behavioural characteristics of phobias
Panic- examples are fight, flight, freeze and faint
Avoidance- the avoidance must interfere with the person’s life significantly to be considered clinically diagnosable. For example, relationships or work must be affected.
Emotional Characteristics of Phobias
Anxiety- the anxiety felt is extreme and unreasonable in relation to the situation. It is also persistent and coupled with feelings of panic and fear.
Fear- must be extreme and excessive. Most of the time, people recognise that the fear that makes up their phobia is excessive (i.e. is not delusional)
Cognitive characteristics of Phobias
Irrational beliefs- resistance to rational arguments. For example, a person with arachnophobia may still feel that all spiders are dangerous and harmful, despite being aware that no spiders in the UK are actually deadly.
Selective attention- If a person with a phobia is presented with an object or situation they fear, they will find it difficult to direct their attention elsewhere. Therefore, a person’s selective attention will cause them to become fixated on the object they fear, because of their irrational beliefs about the danger posed.
The behavioural approach to explaining phobias
The two process model:
Mowrer (1990) proposed that phobias are learned/initiated and then maintained by two different processes. They are learned/initiated via classical condition and then maintained through operant conditioning
Classical conditioning in phobias
Learning through association
Key words:
Neutral stimulus- no response (neutral to the participant/test subject)
Unconditioned stimulus- stimulus that causes an innate/reflex response
Unconditioned response- the innate response to the UCS
Conditioned stimulus- a neutral stimulus that becomes associated to a specific response over time
Conditioned response- a behaviour that is learned by an individual pairing a neutral stimulus with a potent stimulus
Example from research:
Watson & Rayner (1920) classically conditioned a fear response to a rat in Little Albert
If a negative stimulus is associated with an object enough, then a fear of the object will eventually develop. This association becomes semi-permanent and will cause a phobia of the object.
How can classical conditioning explain phobias?
This theory can be used to explain the acquisition of a phobia (of any NS) if the UCS is something unpleasant that triggers a fear response. This is why it is irrational to fear the NS, as it started out as a neutral stimulus.
For example:
A fear of spiders. The spider starts out as the NS. The UCS is discomfort from a parent to the spider e.g. screaming or running away. The UCR is fear/discomfort. The CS then becomes the spider and this is paired with the CR of fear and discomfort.
What is stimulus generalisation in relation to phobias?
generalising a fear onto other similar objects/associations. Therefore, the conditioned response is paired with more than one stimuli
What is Extinction in relation to phobias?
If an object is now a phobic stimulus caused by a negative association through classical conditioning. It will remain so for some time, but this association is not permanent. Over time, with repeated exposure to the phobic stimulus, without the negative UCS present, this association will deteriorate and eventually become extinct.
Operant conditioning in phobias
Operant conditioning relates to learning a certain behaviour through reinforcement and punishment (consequences)
The maintenance of a phobia is done through the process of negative reinforcement
Key words:
If a behaviour is rewarded (reinforced) then it will continue or increase.
If a behaviour is punished, then it will decrease or stop.
Positive reinforcement = eliciting a positive state. (e.g. gain money, gain praise, gain food). Leads to maintenance or increase of behaviour.
Negative reinforcement = removing an unwanted negative state. (e.g. removal of being ignored, removal of fear). Leads to maintenance or increase of behaviour.
How does Operant conditioning prevent the extinction of a phobia?
The likelihood of a behaviour being repeated is increased if the outcome is rewarding. In the case of phobias, avoidance of the feared stimulus is rewarding (reduces fear) and therefore reinforces the behaviour. This is an example of negative reinforcement. An individual learns that avoiding their feared object completely is rewarding, so continues to do so, and therefore they would prevent extinction of the fear – so maintain the phobia long term.
AO3 EVALUATION: Behavioural approach to explaining phobias (two process model)
Strengths- The Behavioural model allows clear predictions to be made that can be measured scientifically (mostly laboratory evidence). It is therefore a scientific, falsifiable model which adds credibility to the theory. There is also supporting evidence from the Little Albert study which adds validity to the theory
Weaknesses- It cannot explain how all phobias occur. Not all phobias appear following bad experiences. For example phobias of snakes appear in populations where very few people have any experiences of snakes. Also not all frightening experiences lead to phobia Therefore it is limited in usefulness as it cannot explain all phobias.
Reductionism- The behaviourist model is reductionist, seeing behaviour as purely a result of conditioning, reducing the explanation to simple terms. Phobia cases could be more complex than this and involve biological (heritability), psychodynamic (trauma) or cognitive (irrational beliefs) elements. An interaction with a more holistic view (involving more of these explanations) may be a more valid explanation of phobia acquisition.
Behavioural approach to treating phobias
One of the reasons that phobias may persist is that individuals with a phobia will avoid their phobic stimulus and therefore there is never an opportunity to learn that their fear is irrational and that their phobic stimulus is not actually harmful. The behaviour approach to treating phobias removes this avoidance.
There are two treatments:
Systematic Desensitisation
Flooding
The principles of ‘unlearning’
Maladaptive (mis-learned) behaviour can be corrected by replacing it with a new and appropriate conditioned (learned) behaviour = this is called Counter-conditioning.
Systematic desensitisation
This is where a patient is trained to substitute a relaxation response for the fear response in the gradual presence of the phobic stimulus.
What is reciprocal inhibition?
suggests that it’s impossible to hold two opposite emotions. Relaxation is incompatible with fear. Wolpe (1958) created Systematic Desensitisation. This is used very gradually to introduce the feared stimulus – using 3 steps
Relaxation techniques
Formation of Anxiety Hierarchy
Counterconditioning
Systematic desensitisation steps
Relaxation Techniques
Training the patient to relax (on demand), e.g. breathing techniques and mindfulness
Formation of Anxiety Hierarchy
Establishing a anxiety hierarchy of the feared stimulus (identify steps; from a picture, to interaction with the stimulus)
Counterconditioning
Counter Conditioning a relaxation response (instead of a fear response) to the feared stimulus at each step of the hierarchy. Relaxation techniques are practiced at each level of the hierarchy
These steps causes a new association between the feared stimulus and a calmness to be made
AO3 EVALUATION: Systematic Desensitisation
Systematic desensitisation is an effective therapy. It had a 75% success rate at curing phobias by 1990 (McGrath, 1990).
Good for people who lack insight, as no ‘thinking’ is required.
Research support- Jones et al (1924) cured Peter of his rabbit phobia through techniques now recognised as Systematic Desensitisation. By using relaxation techniques Peter was able to hold a rabbit (calmly) at the end of a series of steps of increasingly distressing interactions with rabbits. This gives validity to the success of systematic desensitisation.
However, Reciprocal inhibition (relaxation) has been found to be an unnecessary part of the therapy – exposure to feared stimulus alone works just as effectively.
Flooding
Flooding invoices immediately exposing a client to a stimulus that causes undesirable response to show that stimulus isn't dangerous. Flooding can lead to extinction of a fear.
Immediate exposure to the phobic stimulus
Patient taught to relax muscles totally.
One long immediate exposure to the (worst case of the) feared stimulus.
Very quick learning through extinction
This prevents avoidance of the feared stimulus - so after the initial f/f response has exhausted itself, the phobia will run into extinction. The phobia will be cured.
Ethical Safeguards:
Ethical safeguards are important. The patient will need to consent to this treatment. Also medical (esp heart) checks will be administered before the therapy can begin.
AO3 EVALUATION: Flooding
Quicker at curing phobias than Systematic desensitisation.
Good for people who lack insight, as no ‘thinking’ is required, but a great deal of anxiety (Psychological harm) can be caused to patients
Reductionism- These behaviourist treatments are reductionist, seeing a change in behaviour as purely a result of conditioning is reducing the explanation to simple terms.
Phobia cases could be more complex than this and involve biological (heritability), psychodynamic (trauma) or cognitive (irrational beliefs) elements too.
An interaction with a more holistic view (involving more of these explanations in the treatment of phobias) may lead to a more valid treatment of phobias.
Categories of Depression
Major depressive disorder- severe but often short term disorder
Persistent depressive disorder- long term of recurring disorder
Disruptive mood dysregulation disorder- childhood temper tantrums
Premenstrual dysphoric disorder- disruption to mood during menstruation
Behavioural characteristics of depression
Change to activity levels- less socialising and withdrawal from activities
Disruption to sleep and eating behaviour- with reduced energy levels comes tiredness and a desire to sleep more. Alternatively, agitation and restlessness may be felt (this then pairs with insomnia). Appetite may be reduced or increased.
Emotional Characteristics of Depression
Low Mood- sadness is a common characteristic, as well as feeling empty, worthlessness, hopelessness and suffering low self esteem
Anger- anger is also common; directed towards others or to the self. Often paired with hurt feelings and a desire to retaliate
Cognitive characteristics of depression
Irrational thinking- negative thoughts about oneself, the world and the future. Guilt and a sense of worthlessness. An expectation that things will turn out badly. These thoughts are irrational (no basis in real experiences).
Poor concentration- a difficulty focusing on tasks
What is OCD?
OCD is a disorder where repetitive actions or behaviours (compulsions) are caused by anxious persistent thoughts (obsessions). Compulsions are a response to obsessions and the person believes the compulsions will reduce their anxiety. The disorder typically begins in young adulthood.
Obsessions are classed as persistent thoughts (internal components)
Compulsions are repetitive behaviours (external components)
Behavioural Characteristics of OCD
Compulsions- Compulsive behaviours are performed to reduce feelings of anxiety (created by obsessions). These behaviours are repetitive and unable to be hidden (e.g. hand washing, checking, arranging, repeating, counting, praying).
Avoidance- Keeping away from situations that may trigger anxiety. This can interfere with daily life. For example, avoidance of dirt and germs
Emotional Characteristics of OCD
Fear and Anxiety- Obsessions and compulsions both cause considerable fear, anxiety, and distress
Disgust- Obsessions concerning germs can cause feelings of disgust and guilt (which can be irrational)
Cognitive Characteristics of OCD
Obsessive Thoughts- Obsessions are recurrent, intrusive thoughts or impulses that are perceived as inappropriate. These obsessions may be frightening and/or embarrassing. Common obsessional thoughts are a constant worry that something important has been missed or forgotten and that germs are everywhere and harmful. These obsessions are uncontrollable, which creates anxiety.
Awareness of Excessive Anxiety- the sufferer is aware that these thoughts are a product of their own mind. They are aware that these thoughts are irrational and excessive anxiety is felt.
Cognitive explanation of Depression
Ellis (1962) proposed that depression can be caused by irrational thoughts- these can be defined as faulty, illogical, unreasonable or unrealistic. Faulty thinking is caused by cognitive errors. They interfere with wellbeing and prevent individuals from feeling happy or free of pain. They have an impact on emotional state and therefore behaviour.
Ellis’s ABC model
A: Activating event- don’t know the reason for… your schema will have to ‘fill in the gap. According to Ellis, we get depressed when we experience negative events and these trigger irrational beliefs
B: Belief - from schema - which can be rational or irrational. If cognitive errors occur at the belief stage, then negative/unhealthy consequences can occur
C: Consequence- action - which may be a behavioural characteristic of depression
What is Musturbatory thinking?
Ellis believed that the source of these irrational beliefs stems from Musturbatory thinking (Thinking that certain ideals must hold true for one to be happy). Some examples are; I must do well, or I’m worthless, I must be accepted by people I find important, the world must bring me happiness. Such thoughts can cause irrational beliefs as they are being applied to the activating event, wrongly – causing negative thinking and depression.
Beck’s Negative Triad
The Negative Triad:
Negative view of the self
Negative view of the world
Negative view of the future
Negative Schema:
Cognitive errors can be held in our schemas- these cause a negative cognitive bias
People use scheme to interpret the world, so if a person has a negative self schema they interpret all information about themselves in a negative way
Cognitive Errors:
Magnification- blowing things out of proportion
Overgeneralisation- making sweeping conclusions based on a single event
Minimisation- downplaying the importance of a positive thought, emotion or event
Selective Abstraction- drawing conclusions on the basis of just one of man elements of a situation
Arbitrary Inference- drawing conclusions when there is little or no evidence
Personalisation- attribution personal responsibility for events, which aren’t under a person’s control
AO3 EVALUATION: Cognitive explanation of depression
Research Support- Grazioli & Terry (2000) assessed 65 pregnant women for cognitive vulnerability and depressive thinking before and after birth (cognitive errors). They found that those women judged to have been high in cognitive vulnerability were more likely to suffer post natal depression. These cognitions can be seen before depression develops suggesting that Beck and Ellis may be right about irrational cognitions (cognitive errors) causing depression.
Unfalsifiable- The cognitive model empowers the individual and gives a positive view of mankind; the individual is given responsibility and power to change their cognitions. However, It is unscientific (unfalsifiable) as thoughts cannot be observed and measured
Practical Application (treatments)- Cognitive explanations have led to the development of effective treatments of depression such as CBT (Cognitive Behavioural therapy). Ellis’ ABC model led to REBT (Rational Emotive Behaviour Therapy). Beck’s Negative Cognitive triad led to TNAT (Treatment of Negative Automatic Thoughts. These treatments work by altering irrational thoughts to become rational. These treatments are consistently found to be very effective in treating depression (Cuijper’s et al, 2013). Therefore, as CBT is useful at treating depression by challenging irrational thoughts, it suggests that cognitive errors play a role in depression. This adds validity to cognitive explanations of depression.
Reductionism- using the cognitive approach alone (cognitive errors) is ignoring other potential factors that may cause depression, e.g. biological causes (e.g. lack of serotonin), Psychodynamic causes (e.g. trauma), lifestyle (e.g. diet/exercise/friendships/family) etc. Using a more holistic approach to explaining depression may be a more useful way of explaining it. The Cognitive approach on its own is reductionist, and therefore an oversimplification of a potentially complex disorder.
Cognitive approach to treating depression
CBT (Cognitive Behaviour Therapies):
This is a method of treating depression based on both cognitive techniques. The therapy aims to deal with thinking, such as challenging the negative thoughts that interfere with a person’s happiness
Elli’s Rational Emotive Behaviour Therapy (REBT)
D (Dispute)- relates to challenging irrational beliefs:
Empirical disputing- where is the evidence for my belief?
Logical disputing- is this a logical way to think?
Pragmatic disputing- is this a useful way to think?
Elli’s Rational Emotive Behaviour Therapy (REBT)
E (Effect)- The challenges made to the irrational thoughts will affect the knock-on behaviour and thoughts of the patient. The effect of this over time is to reduce the emotional, behavioural and cognitive characteristics of their depression.
Behavioural activation- encouraging patients to be physically active, and join in with activities that they previously enjoyed… endorphins will be released too. This will help to decrease avoidance and isolation
Unconditional positive regard- convincing patients of their value as a human being. Providing respect and appreciation (regardless of the patient’s actions) to facilitate a change in belief and attitude (esp if the patient feels worthless).
Homework tasks- patients can also be asked to complete tasks between therapy sessions that challenge these beliefs, e.g ask someone out – to challenge a belief that they ‘must be liked by everyone’
Beck’s Treatment of Negative Automatic Thoughts (TNAT)
Challenging the cognitive errors that cause the irrational thinking sending individuals into a negative cognitive triad
Patient and therapist work together to identity cognitive errors- Identification of irrational thoughts/negative triad (‘thought-catching’)
‘Patient as scientist’ – generate hypotheses to test validity of irrational thoughts;
Homework tasks- tally chart evidence gathering e.g. recording when people are nice to them
Reinforcement of positive thoughts
Cognitive restructuring
AO3 EVALUATION: Cognitive approach to treating depression
Research Support- There is evidence that CBT is an effective treatment of depression. March et al (2007) compared the effects of CBT with antidepressant drugs and a combination of the two in 327 depressed adolescents. After 36 weeks 81% of the CBT group, 81% of the antidepressant group, and 86% of the combination group were significantly improved. CBT emerged as just as effective as medication and helpful alongside medication – however, it is a long term solution (which medication is not). So overall suggests a good case in making CBT the first choice of treatment in the NHS.
Nature/Nurture- This therapy considers only changing thoughts and beliefs (nurture), and therefore ignores anything biological (nature). Drug therapy (e.g. SSRIs) has been shown to be a very effective treatment for depression, and should not be ignored. Therefore an interactionist approach to the therapy – using both CBT and drugs together may be a more effective way to treat depression.
Good for the economy- CBT is a cost effective treatment for depression, therefore the patient feels better so can return to work and then companies can be more productive. Also, if patients are treated more effectively, they spend less time accessing NHS services and therefore the NHS has to spend less- boosting the economy overall
Other Positives- CBT has long term benefits as the patient is given control over their symptoms. Also, successful treatment for many disorders e.g. PTSD, OCD, eating disorders, & phobias, as well as depression.
Biological approach to explaining OCD
The biological approach is interested in the importance of physical processes in the body such as genetic inheritance and neural function
Genetic explanations
Neural explanations
Genetic explanations of OCD
SERT Gene: people with the high function variant of this gene do not have enough serotonin at the synapse. (Low levels of serotonin are implicated with OCD).
COMT Gene: people with the low-functioning variant of this gene have too much dopamine at the synapse (high levels of dopamine are implicated with OCD).
Diathesis- stress model: OCD sufferers are born with a vulnerability in these genes which must be staggered by diathesis stress. The diathesis stress model explains the role of the environment in the triggering of genes into their vulnerable states (e.g. high or low function, if they have a predisposition). Usually through stress or trauma.
Neural explanations of OCD
Role of serotonin and dopamine:
High levels of dopamine and low levels of serotonin are associated with the disorder
Neurotransmitters are responsible for relaying information from one neuron to another. If a person has low levels of serotonin than normal transmissions of mood-relevant information does not take place and a person may experience low moods (other mental processes may also be affected). At least some cases of OCD may be explained by a reduction in the functioning of serotonin system in the brain
Neural explanations of OCD
Abnormal brain circuits (the ‘worry circuit’):
PET scans also indicate high activity in Orbital Frontal Cortex (OFC), a brain area associated with higher thought processes (inc. worry) and conversion of sensory information into thoughts. This area is important in impulse control (e.g. compulsive hand washing as an impulse which cannot be ignored).
The Caudate Nucleus should suppress signals from the OFC, (e.g. worry about potential germ hazard). If the Caudate Nucleus is damaged, these worry signals cannot be suppressed, and a minor hazard can be misperceived as a major hazard (e.g. dirt and germs causing major harm/death).
These together are known as the Worry Circuit
AO3 EVALUATION: Biological approach to explaining OCD
In support of the genetic explanation- There is evidence from a variety of sources which strongly suggests that some people are vulnerable to OCD as a result of their genetic make-up. Gerald Nestadt (2010) reviewed twin studies of OCD and found that 68% of identical twins (MZ) shared OCD as opposed to 31% of non-identical twins (DZ) . Another source of evidence for a genetic influence on OCD is family studies. Research has found that a person with a family member diagnosed with OCD is around four times as likely to develop it as someone without (Marini and Stebnicki 2012). This adds validity to the biological approach to explaining OCD (via genetics).
A limitation of the serotonin link to OCD- Many people who suffer from OCD also suffer from low mood. This leaves us with a problem when it comes to using serotonin as a cause of OCD, as it could simply be that the serotonin system is disrupted in many patients with OCD because they are suffering from depression as well as OCD. This means that serotonin may not be implicated in OCD specifically. This limits the usefulness of the serotonin explanation, as cause and effect, or correlation is unclear.
Environmental risk factors- one limitation of the genetic model of ocd is that there are also environmental risk factors. There is strong evidence for the idea that genetic variation can make a person more or less vulnerable to OCD. However, OCD does not appear to be entirely genetic in origin and it seems that environmental risk factors also trigger or increase the risk of developing OCD. Kiara Croner et al (2007) found that over half the OCD clients in their sample had experienced a traumatic event in their past. OCD was also more severe in those with one or more traumas. This means that genetic vulnerability only provides a partial explanation.
Nature/Nurture- This is mostly a nature explanation (e.g. both genetic and neural explanations) but also interactionist with nurture in the diathesis stress model explanation (e.g. stress situation triggers genes into a vulnerable state). A strength of the theory is therefore taking both nature and nurture into account.
Biological treatment of OCD: Drug therapies
Drug therapy for OCD aims to increase or decrease levels of certain neurotransmitters in the brain- to increase/decrease their activity.
OCD is most often linked with low levels of serotonin, so must drug therapies aim to increase their level of serotonin available at the synapse
If people no longer have their high levels of anxiety, they will no longer need to undertake the repetitive, compulsive behaviours for relief from this
SSRIs (Selective Serotonin Reuptake Inhibition)
These are currently the most commonly prescribed drug for anxiety and mood disorders (e.g. OCD).
Serotonin is released into a synapse (from a nerve/neuron) and targets receptor sites at the receiving neuron.
Afterwards, any serotonin left in the synapse is reabsorbed by the original neuron (via re-uptake).
However, often in OCD, there is not enough serotonin in the synapse (too much is re-absorbed too quickly).
SSRIs block (inhibit) the reuptake of serotonin at the original neuron, so more serotonin is available in the synapse (as it becomes trapped there) to target the receiving neuron.
If anxiety (obsession) is not an issue – there will be no need for compulsive behaviours.
Alternatives to SSRI’s
Tricyclics and SNRIs
Tricyclics and SNRIs (Serotonin Noradrenaline Reuptake Inhibitors) block the reuptake mechanism that reabsorbs both serotonin and noradrenaline into the presynaptic neuron after it has fired. As a result, more of these neurotransmitters are left in the synapse, prolonging their activity, and easing transmission of the next impulse.
Tricyclics: e.g. Clomipramine- primarily used to treat OCD (rather than depression)
SNRIs: e.g. Venlafaxine
Alternatives to SSRIs
Benzodiazepines
These are anti-anxiety drugs e.g. Valium and Xanax
Benzodiazepines slow down the activity of the central nervous system by enhancing the activity of the neurotransmitter GABA (which has a calming effect on many neurons in the brain).
It does this by reacting with the GABA receptors on the outside of receiving neurons. When GABA locks into these receptors, it opens up a channel that increases the flow of chloride ions into the neuron.
This makes it harder for the neurons to be stimulated by other neurotransmitters, thus slowing down its activity, and making the person feel more relaxed.
AO3 EVALUATION: Biological approach to treating OCD
In support of the use of SSRI drugs to treat OCD- Soomro (2009) reviewed 17 studies (meta analysis), comparing the use of SSRIs with placebos in patients with OCD. All 17 studies found SSRIs to be more effective than placebos in reducing symptoms. However the most effective treatments were those combining SSRIs with CBT. This adds validity to the treatment method.
Limitations of drug therapy- Side effects of SSRIs include headaches, insomnia, & nausea. Tricyclics side effects include hallucinations, irregular heart beat, erection problems and weight gain. And BZ side effects include aggressiveness and LTM impairment. – All drugs involve issues with addiction and dependence. This means that some people have a reduced quality of life as a result of taking drugs and may stop taking them altogether , meaning the drugs cease to be effective. Drugs are only a cover of symptoms; not a long lasting cure
Cost effective and non disruptive- A strength of drug treatments for psychological disorders in general is that they are cheap compared to psychological treatments because many thousands of tablets or liquid doses can be manufactured in the time it takes to conduct one session of a psychological therapy. Using drugs to treat OCD is therefore good value for public health systems like the NHS and represents a good use of limited funds. As compared to psychological therapies, SSRIs are also non-disruptive to people’s lives. If you wish you can simply take drugs until your symptoms decline. This is quite different from psychological therapy which involves time spent attending therapy sessions. This means that drugs are popular with many people with OCD.
Nature/Nurture- Nature side is the use of drug therapy as it involves altering biological processes within the body to increase or decrease levels of neurotransmitters (serotonin). However, many individuals use CBT therapy alongside drug therapies which have proven to be effective. Therefore taking an interactionist approach.
