Psychology - Psychopathology

What are the four ways we can decide if someone needs help with their mental health?

• Deviation from social norms

• Failure to function adequately (FFA)

• Deviation from ideal mental health

• Statistical abnormality

What is deviating from social norms?

What is observer discomfort?

social norms are implicit and explicit rules for acceptable behaviours in a specific society

• implicit means unspoken e.g queuing

• Explicit means written e.g laws

Deviating from social norms is behaviour that violates societies expectations this may or may not include criminal behaviour, when people deviate from social norms they make other people uncomfortable, this is called observer discomfort

What is failure to function adequately (FFA)?

Functioning adequately is when we can cope with the day to day demands of life, individuals create expectations of themselves and society also has demands on us

The expectation we have for ourselves often matches the demands of society but they don’t always

A person would be considered to be psychologically abnormal if they cannot meet demands of life e.g keeping personal hygiene, not managing relationships

What is deviation from ideal mental health? (Maria Jahoda)

This is a positive approach to assess psychological abnormality, it sets out criteria for ideal mental health rather than what is missing

Criteria for ideal mental health;

• positive attitudes towards the self

• Self actualisation

• Resistance to stress

• Personal autonomy

• Accurate perception of reality

• Adapting and mastering the environment

What is the opposite criteria

• Negative attitude towards self

• Not reaching full potential

• Being easily overwhelmed, lacking coping mechanisms

• Co-dependency

• Hallucinations and delusions

• FFA, not functioning or coping

What is statistical abnormality?

Deviating from a numerical average, either because it is carried out very frequently or hardly at all

Based on normal distribution of behaviour

• best example is IQ tests

• Average score is 100, 130 indicates genius, 70 and below indicates intellectual disability

What is standard deviation?

• It is a measure of dispersion (how spread out scores are in a data set) in psychological terms this is about how variable people are

• Standard deviation is a reliable measure of dispersion because it takes into account every data point in a set, this means the standard deviation is less skewed by anomalies which in turn makes the results more representitive of a data set

• The range is the highest - lowest score, it may be skewed by anomalies e.g a large anomaly taking away a small one will be unrepresentitive of the avarage

• small range or standard deviation means there is little variablility between ppts and with large meaning there is wide variability

What are the positives of defining abnormalty with deviation from social norms?

• Makes identifying people who need help a straightforward process we all have understanding of social norms so when someone deviates from them, it is easy to identify

• It has face value, on the surface it seems to make the most sense and a useful way of defining abnormality

What are the limitations of definng abnormality with deviation from social norms?

• it is culturally relative within society, there is variability in what is considered abnomal. Different people have different standards of behaviour between societies, there are cultural differences and different social norms. This means we don’t have a universal definition of abnormality

• This definition lacks temporal validity, societies norms change overtime so what society considers abnormal also changes e.g homosexuality used to be considered a mental disorder and homosexuals would undergo therepy like conversion therepy. This practive was removed from the DSM (diagnostic and statistical manual) in the early 1970s

What are the positives of defining abnormality by using FFA?

• Reflects an indivduals response to their ability to meet demands of everyday life. People often come forward to get help because they don’t feel able to cope

• Takes into account a persons perspectives of how well they are functioning

• FFA can be used to assess the extent to which someoneisn’t coping as we can use the global assessment functioning scale (GAF) to decide if someone needs intervention

• We can use the seven criteria listed by Rosenhan and Seligman to discuss to extent to which someone is FFA

What are the negatives of defining abnormality by using FFA?

• some people fail to cope with daily life because demands made on them are just too overwhelming. Given this we should’nt conclude someone is abnormal as it is the fault of the situation or enviroment they are in

• FFA would miss peoplewho are abnormal but functioning well. E.g Harold Shipman who murdered numerous elderly female patients of his only got caught by chance

What are the positives of defining abnorrmality by deviation from ideal mental health?

• giving a standard to work from rather than focussing on inadequaties

• positive approach focussing on what qualities an indivdual has rather than what they don’t have

• It can be used as a guide in therepy and councilingshowing areas of strength and improvements

What are the negatives of defining abnormality by using deviation from ideal mental health ?

• Not only based on observable behaviour (like deviation from social norms) we would need to discuss someone’s self esteem with them to find out about themselves

• sets a very high standard for good mental health, most of us at some point don’t meet all of the criteria but that doesn’t make us abnormal

What are the positives of defining abnormality by using statistical abnormality?

• it is an objective method, this is because it is quantitative and has a set of points

• Judgement is straightforward as set cut off points are made

• There is a wide range of scores either side of the mean before someone is considered abnormal like with IQ tests if some is below 70 they are abnormal but if someone is over 130 they are too, there are 2 standard deviations

• Standardised tests with pre-determined normal distributions and standard deviations allows for rapid assessment and reliability

What are the limitations of defining abnormality by using statistical abnormality?

• allows us to decide that there is a problem in an objective which but not why the problem exists making the method reductionist, idea of normality and abnormality simplified into numerical value

• Not all abnormal behaviour can be quantified or distributed meaning this has limited applicability

What are the cognitive characteristics of OCD?

• Obsessions, intrusive thoughts that are unwanted, often the thoughts are disgusting and repulsive

• from this anxiety is caused which could extend to fear or panic

• irrational beliefs, if i can do X this can prevent Y

• Catastrophic thoughts, if i don’t do X something terrible will happen

• Hypervigilance, selective attention, being alert to dangers, paying attention to certain situations

What are the emotional and behavioural characteristics of OCD?

• emotional, anxiety caused by obsessional thought, Disgust or repulsion

• behavioural, compulsions that are repetitive, ritualistic, these behaviours are carried out to reduce the anxiety

What is the main idea about genetic cause of OCD?

• Genetic inheritance can play a part in if someone has OCD

• the more closely related you are to someone with OCD the more likley you are to have it

• the prevalence rate for people who have OCD according to the national institute of clinical excellence (NICE) was 1-4%

What did Lewis find about OCD’s association to genetic inheritance?

in 1936, Lewis found OCD may have a genetic explanation, he found 37% of parents had OCD and 21% of siblings showing there could be an inherited factor

This study was concluded by the idea that OCD seems to run in families as the rates are far higher than found in the general population

What has modern research shown about OCD and it’s link to genetic inheritance?

OCD is polygenetic, modern research using DNA analysis shows that OCD is not caused by a single gene but a combination of genes

• Taylor in 2013 found that in a meta-analysis study 250 genes could be combined

Aetiologically heterogenous, this is the idea that the combination of candidate genes (genes that are likely to be involved in OCD) vary between differant people, there is no fixed combination

What is an example of a candidate gene that is involved with OCD?

5HT1Dbeta

How are neurotransmitters regulated through candidate genes?

Neurotransmitters like seritonin and dopamine are regulated by candidate genes which are associated with OCD e.g 5HT1Dbeta which is a receptor gene, it is involved with the transmission of seratonin across the synapse

What is the neural explanation of OCD?

• Lateral frontal cortex, which is responsible for logical thinking and descion making. If changed, irrational thoughts and catastrophying can be part of abnormal functioning

• Parahippocampal Gyrus, this is responsible for processing unpleasant emotions like disgust, if changed, there are persistant intrusive thoughts and feelings of disgust

How can a underactive seretonin system become a cause of OCD?

• groups of neurons that respond to seretonin are not active enough due to a lack of seretonin

• The groups of neurons are known as pathways as they often stretch from one area of the brain to another

What are the positives of the genetic biological explanation for OCD?

• It has scientific credibility, e.g DNA studies contain objective data, it has a testable hypothesis, research can be replicated to verify the results

• There is lot’s of evidance that there is a genetic component to OCD from Lewis, Nestadl and Taylor

What are the limitations of the genetic biological explanation for OCD?

• Nestadl’s study; the concordance rate (CR) is not 100% meaning OCD is not entirely genetically inheritied (MZ CR would be 100% if this would be the case)

• The understanding from above indicates there are other factors involved in OCD like the enviroment and severity of trauma (cromers study) he found 51% of his patients had trauma, There is a positive correlation between OCD severity and trauma severity

  • E.g, diathesis stress model, genetic vunerability, trauma acts as a trigger for OCD, this combiines nature and nurture

• This purely genetic explanation is reductionist, it over simplifies a complex disorder, it is highly unlikely that different combinations of genes can cause different types of OCD, your enviroment/trauma are more likely to cause the specific type of OCD

• Another explanation of OCD is that it is learnt through other family members which it explains why OCD seems to run in families e.g imitating older siblings or twin to gain gratitude

What are SSRI’s? How do they work?

• SSRI’s are often used as the first strategy in treating OCD, They are Selective seretonin repuptake inhibitors

• They target seretonin and prevent the re-uptake in the synapse which means it is left in the synaptic gap for longer, this increases the levels of seretonin which should ease the symptoms of OCD like obsessions

• Reuptake is when sertonin is taken back to brain cells = increase in seretonin

How is the process of drug therepy for OCD conducted from SSRI to Neurosurgery?

• The typical dosage of SSRI starts at 20mg, (homeopathic dose), if this is not effective at reducing the symptoms of OCD patients can increase their dose through stages 20-40-60mg, 60 is the maximum, SSRIs may take 3-4 months till they work. If SSRIs work and don’t cause major issues with side effects treatment is combined with CBT (cognitive behavioural therepy)

• SNRIs which prevent the re-uptake of seretonin and noradrenaline

• Trcycilics which are not used often as they come with long-term side effects and example of a drug is clomipramine

• Patients may go on to anti-psychotics or as a last resort neurosurgery

What are the positive elements of using drug therepy for treating OCD?

Yes it does work for some people, It reduces symptoms

• 1980, a study conducted by Thoren et al found SSRIs reduced irrational thoughts and obsessions

• 1991, a study by insel found that 50-60% of patients had their symptoms reduced by SSRIs

• 1996, a study by Zohar et al found that 60% of patients had seen improvement in symptoms

What are the limited elements for using drug therepy treating OCD?

• we can see from the % effectiveness that SSRIs don’t help all who are suffering with OCD, this means around 40-50% of sufferers are not being helped. Other therepy is needed like CBT which challange obsessions and compulsions

• SSRIs need to be taken for 3-4 months in order for patients to see the results, this may mean a patient may stop using SSRIs

• They come with side effects that put people off e.g Nausa, headaches, blurred vision, loss of sex drive. SNRIs have similar effects whilst Tryciclics cause 1:10 to gain weight and 1:100 to have heart related problems

• There may be an ethical issue with the idea that medication causes side effects which could decrease a persons quality of life

What are the costs of partaking in drug therepy?

• They take a whild to work, this could be demoralising for the patient

• Side effects can decrease someones quality of life

• Trycicles have long term side effects like heart problems

• Neurosurgery is expensive and could go wrong and cause permenant damage

• Patients need to commit regularly to therepy for them to work

What are the benefits of partaking in drug therepy?

• They provide an improved quality of life overall for the 50-60% SSRIs work for

• it is easy to stop side effects if you stop taking SSRI

• Free to the patient

• Little disruption to someones life compared to councelling

• cheaper than therepy for the NHS

• you can alter dosage to suit patient, if one drug doesn;t work there are others to try

What is a phobia, what are the three types of phobia and an example of them?

A phobia is an extreme irrational fear of a non-threatening object or situation there are three types of phobias;

• Specific phobias, e.g claustrophobia

• Social phobias, public speaking, eating in front of others

• Agoraphobic, a fear of open spaces where theres no place to hide

What are the cognitive characterisics of phobia?

• Catastrophic thoughts

• hypervigilance

• Selective attention

• Insight, they are aware they are being irrational

What are the behavioural and emotional characterisitcs of phobia?

Behavioural

• Panic, running away, crying, shaking etc

• Avoidance

• Freezing

Emotional

• extreme anxiety

What is the main proposal of the behviourist approach to phobia?

Phobia is learnt from a traumatic event, an object or situation that was previously neutral or enjoyable has become associated with threat hence the fear experianced

The issue is that the fear is generalised to all situations

What is Mowrer’s two process model?

Mowrer proposed that phobia is learnt in two stages;

• Acquisition, the formation or starting point through the process of classical conditioning

• Maintenace, fear isn’t extinguished but is kept going and persists through operant conditioning and negative enforcement

How does acquisition work through classical conditioning?

• we start with a neutral stimulus e.g dogs

• An unconditioned stimulus and response are in-built reflexes for classical conditioning to occur

• The NS and UCS matched together leads to an UCR e.g the dog jumping up or biting could cause a response of extreme anxiety and fear

• The dog (NS) would become associated with it’s negative behaviour and the indivdual would generalise all dogs and situations involving dogs

How does maitenance work through operant conditioning and negative reinforcement?

When the removal of something unpleasant increases the likliehood of behaviour

• phobia causes extreme anxiety, a phobic person can decrease their anxiety by staying away from an object or situation, the avoidance maintains the phobia

• operant conditioning = something with a negative outcome can change behaviour

What was Watson and Raynor’s experiment? Little Albert - A03 point

• This was their justification of classical conditioning being responsible for phobias being acquired

• They used a 9 month old boy ‘little Albert’

• The NS was a white rat, initially Albert showed no fear of the rat. However when paired with the unconditioned stimulus of a loud noise the unconditioned response would be fear

• Eventually they conditioned little Albert to fear the rat as he associated the fear from the UCS with the Rat (NS)

• This was repeated several times and once they presented the rat on its own Little Albert started to cry demonstrating behavioural symptoms of phobia

• Little Albert’s fear extinguished overtime but once the rat had been paired with the loud noise again this reignited his fear

• Little Albert’s fear generalised to all furry white objects (looking like the rat). E.g his mothers jacket and a Santa Claus mask

• They concluded it was possible to classically condition a phobia by pairing a traumatic/frightening experience with a NS

What were the limitations of Watson and Raynors study? What discussion points are there to be had?

• their experiment took placeon a single ppt - little Albert. We shouldn’t generalise the findings to others and use Classical conditioning as a universal explanation

• You could argue however that when asked what caused the phobia, individuals usually can link it back to one reason or a traumatic event, but this depends on the type of phobia. Some phobias can be acquired through social learning theory as children could learn to have a phobia e.g spiders

What is another positive of the behavioural explanation for phobia?

It is likely that phobias are maintained through avoidance and negative reinforcement because exposure therapy where avoidance is prevented is successful at removing the fear

What are the limitations of the behavioural approach to phobias?

• the fact that some people cannot acquire phobias through classical conditioning as they haven’t encountered it, an explanation for this is cognitive appraisal in the cause of traumatic events. For some people a traumatic event is interpreted as ‘bad luck’ whilst for others it is threatening and leads to catastrophising and hypervigilance. In the case of people developing phobias of things they haven’t encountered could be irrational beliefs “what if”

• The behaviourist approach ignores the role of thoughts so it is an oversimplification and reductionist

What is another explanation of certain types of phobia from a biological perspective?

Seligman argued that certain types of phobia are more common because we are “biologically prepared” to be cautious of them. These fears have been passed down as we were previously vunerable to them, it doesn’t take much for extreme anxiety to show. E.g fears of the dark, thunder and heights

What is Systematic desentisation? How is it an example of exposure therapy?

• this is a process of gradual exposure, based on the principle of counter conditioning, phobia is learned so psychologists try and help people unlearn by replacing fear with feelings of calm

• The psychologist and the patient will organise a hierarchy of anxiety, this would go through around a 10 step process of exposing patients from the least fearful interaction and the most fearful

• The psyvhologist will organise relaxation techniques to help the patient keep a sense of calm when encountering their phobia e.g controlled breathing

What is the process of systematic desentisation, how long can it take?

The patient will start exposure with the least fearful interaction, they expose the patient by using relaxation techniques to keep them with a sense of calm, when this method is effective the therapist moves on and exposes them to the next level of fear, this is repeated until the patient can keep calm in the most fearful situation

• once this is achieved the phobia becomes unlearnt

• This usually takes several months to complete and for a phobia to be eliminated, each level of fear can take more than one session

How can systematic desentisation be carried out in two ways?

• this approach can take place in vivo (real life) or in vitro (in imagination)

• in vivo may include dogs, spiders and insects

• in vitro may include planes, deep water

What is Flooding, how is it an example of exposure therapy?

• This is immediate exposure to the most feared encounter with the phobia, the patient and the therapist decide what is the most fearful situation

• The patient is made to be exposed to the most fearful situation and is not allowed to avoid it, the patient must remain in the situation

• They will wait until the fear response has been extinguished and hopefully the phobia will become unlearnt

• This usually has 2 sessions, the first is the exposure with lasts around 1-2 hours whilst the second is a follow up to see how the patient is coping

What general discussion points could be made about exposure therapy?

• Both methods of exposure therapy may be difficult for patients to remain motivated, flooding requires patients to be in the most fearful situation which could be overwhelming and stressful, systematic desnentisation needs longer commitement and attendance to each session, this type of gradual exposure has a high drop out rate which makes it less effective

• However, both techniques appear to work and be effective for patients, this is most successful combined with cognitive therapy where irrational beliefs are challanged

What are the disccusion points made for both methods of exposure therapy?

• Flooding is a fast process compare to systematic desentitisation

• However, there is no guarentee that the phoba wouldn’t return, Pavlov witnessed spontaneous recovery of salivation from the bell even after the response had been extinguished so it is possible the phobia may come back following a subsequent encounter with it

• Flooding is also a stressful procedure many people couldn’t have their phobias treated by it for example, elderly, children, anyone with a medical condition made worse by stress. Individuals cannot really give informed consent

• Systematic desentisisation is a gentle approach compared to flooding, it uses relaxisation techniques that patients can take away for future encounters

What are the cognitive characteristics of depression?

• Poor memory

• suicidal thoughts

• reduced concentration

• Delusions

• Loss of motivation and enthusiasm

What are the behavioural characteristics of depression?

• Loss of energy

• Social withdrawal

• Weight change (gain or loss)

• change in appetite

• Poor personal hygiene

• sleep pattern changes

• reduction of physical movement

What are the emotional characteristics of depression?

• Constant low mood

• feelings of worthlessness

Who were Albert Ellis and Aaron Beck, what key terms did they use to explain depression?

• Both Beck and Ellis were American psychologists who empathised the cognitive approach

• Ellis discussed irrational and rational thoughts and how they can be caused by an activating event. Key beliefs causing depression are believed to be utopianism, the three musts, “i cant stand it”s

• Beck believed in faulty thinking, e.g catastrophising and black and white thinking, this leads to negative self schema and a negative triad

What is the general assumption with the cognitive approach’s explanation of depression?

Some people are more vunerable to developing depression because of the way they think

What did Albert Ellis’ ABC model propose?

the model proposed that good mental health is a result of rational thinking allowing them to be happy and free from mental distress. Poor mental health is a result of irrational thinking, thoughts will interfere with our happiness and feeling pain free

• The three must’s play a major role in creating irrational thoughts they are; I must do well, you must treat me well, the world must be easy. People who believe in the three musts won’t have an accurate perception of the world and think irrationally

How does the ABC model work?

The model explains how someone may become depressed

• A - activating event, this is a triggering event that creates irrational beliefs

• B - beliefs, these are irrational and cause pain e.g utopianism and the “i cant stand it”s

• C - consequences, emotional and behavioural outcomes of beliefs e.g depression

this could be applied to failing an exam as an example

• A - failing the exam

• B - utopianism beliefs like ‘it’s not fair’

• C - depression, giving up

What did Aaron Beck propose about the negative triad in 1967?

Beck proposed three ways in which some people’s thinking can be unhelpful and cause depression. These thoughts are automatic, habitual and dominant. They don’t reflect reality these thoughts are seen as irrational and faulty

Faulty information processing e.g pessimistic outlook, black and white thinking and catastrophysing. This faulty thinking would cause a negative self schema and all encompass a negative triad (negative thoughts of the self, future and world

What is fallacy of fairness and how is it an example of cognitive distortion?

whilst we do want to live in a world that’s fair the assumption that it is fair can lead to negative feelings when faced with the reality of life’s unfairness. A person who judged every experience by fairness has fallen leading to feelings of resentment, hopelessness and anger.

What are strengths of Albert Ellis’ explanation of depression?

• It has practical application, Ellis developed rational emotive behavioural therapy based on the ABC model. The irrational beliefs are vigorously challenged with the patient, some evidence has suggested this is effective (David et al 2018)

• It is a plausible explanation, has face value

What are the limitations of Albert Ellis’ explanation of depression?

• not all cases of depression behave a traceable activating event, this type of depression is called endogenous depression. Ellis’ model is not suitable for this form of illness

• Ethical issues, the idea suggests that responsibility of depression lies with the person, some people would say this is akin to blaming the person with the depression which is unfair

What are the strengths of Aaron Beck’s explanation of depression?

• there is evidence to support his ideas;

  • Clark and Beck in 1999, cognitive vulnerabilities e.g faulty information processing can predict depression

  • Cohen et al, 2019, in a longitudinal study they found cognitive vulnerability predicted depression in young people

• Two practical applications

  • screening for possible depression and acting early to prevent it developing

  • Development of cognitive behavioural therapy which has been found to be successful in treating depression

What are the limitations of Aaron Beck’s explanation for depression?

• lacks explanatory power and fails to address the origins of depression

  • depression is often caused by an activating event such as physical or psychological trauma, the negative triad may have some basis in reality if this is how the person has experienced the word

• Can not explain extreme types of depression like cortards syndrome, the person feels like a zombie and their body doesn’t belong to them

What conclusions can be made from the cognitive explanation of depression?

• both models provide us with very useful insight into the thought processes typical of depression

• Both have practical applications in themes of screening people for depressive tendencies and both have created effective therapies

• However, both have a lack of explanatory power, failing to account for deep rooted or serious forms of depression which are accompanied by delusions or hallocinations

What is Cognitive behavioural therepy?

CBT has two elements;

• Cognitive, changing thought processes

• Behavioural, changing habitual behaviour

Based on the premise that if we change someones thoughts we can change their behaviour and feelings.

What is the Basic CBT model made of?

• Identify

• Challenge

• Change

• Behavioural activation

ICCB

What is Step 1 and 2 of CBT?

Step 1

• Identify, when the therapist and the client work out the faulty or irrational thoughts that dominate. They identify these thoughts as being habitual and automatic

Step 2

• Challenge, the therapist will use questioning techniques such as socratic questioning to encourage clients to question the logic behind their thought processes

• Ellis’ rational emotive behavioural therapy is based on his ABC model, questioning here is “vigourous”

• However, with Beck’s CBT approach, the questioning style is open minded, curious and gentle

What are examples of socratic questioning?

• They evaluate the automatic thoughts a client has, they test thoughts and allow clients to reassess them

• For example, an underlying belief like ‘if i’m not perfect then i’m a failure’ would be challanged

• They may use evidence questioning like what is the evidence that your belief is true?

• They may ask alternative explanation questions like is there another point of view? Are you making assumptions?

• They may use distancing questions like what would you advise a friend who told you something similar?

Overall CBT therapists use socratic questioning to make clients use critical thinking in a structured way

What is step 3 and 4 of CBT?

Step 3

• Change, the client re-assess their automatic negative thinking and alter them to become more rational and logical and hopefully more positive or at least neutral

Step 4

• Behavioural activation, focussed on symptoms like social withdrawal, lack of movement, loss of interest or pleasure in previously enjoyed activities

• Clients will keep a diary and ‘thought capture’ the client makes note of automatic negative thoughts e.g i should, i must and write alternitives instead. Aiming to bring conscious awareness of their faulty thinking, restart a hobby or activity they used to enjoy and record how they felt about it. aiming to break habitual behaviours

What are the strengths of CBT to treat depression?

• Does it work, yes! evidence shows that is effective for treating mild-moderate depression, March et al found CBT improved young peoples depressive symptoms by 85%

• CBT teaches clients how to be their own therapist, once the therapy session is over they have learnt skills to use in the future

• cost effective for the NHS, it works even if only given 2-3 months usually in 6-12 sessions

What are the limitations of using CBT to treat depression?

• Requires active participation from the client and they might struggle with this due to the symptoms of depression, the more severe the depression the more difficult it is to engage with CBT

• It has little value for people with serious depression which may have a neurochemical cause or an unusual form of depression like cortards syndrome

• it is a reductionist approach, it focuses on faulty thinking being the cause of depression. fails to account for other factors like poor relationships, poverty, social circumstances.