Psychology - Clinical and mental health

Symptoms of OCD, Behavioural apprach to explain and treat phobias,

What are the 4 definitions in the feild of mental health

1. Devation from social/cultural norms

2. Statistical infrequency

3. Faliure to function adequatley (FFA)

4. Devation from ideal ment health (DIMH)

Outline devation from social/cultural norms

• When a indiviudal deosnt follow generally accepted unwritten rules and expectations with in a society about what is acceptable behaviour

• They are often context dependent (wearing a bikini on a beach is a soical norm, but not soically acceptable to wear it to school or work)

• They can vary acorss cultures (E.g greeting beahaviour differs from culture to culutre - handshake or a bow, sexual behaviour - age of consenst varies across countires)

Argument to consider when using this defintion:

• the degree to which the norm is violated

• the importance of that norm with in soicety

• eg not saying thankyou is considerd rude rather than a sign of mental illness

Evaluation: Strength

• the definition is flexible

• deviation from social norms acknowledges that social norms vary across cultures, time periods and situations

• for example, certain behaviours would be more socially normal at home, or with friends, but not at work

• social norms about how to dress also vary depending on the situation (for instance, wearing a swimsuit on the beach is acceptable, but not at school)

• social norms are also age dependent and can change over time

• we can therefore say the concept has a flexibility that accounts for the variations in social norms (age groups, over time and across situations)

• this increases its relevance as a definition of poor mental health

Evaluation: Weakness

• Cultural relativism

• although definition acknowledges social norms may vary across culture

• in reality, there is so much more variation across cultures, including countries, that cultural differences in social norms may not always be clear.

• some may argue, that decisions about social norms can only be made by being immersed in that culture for a long period of time

• evidence suggests that, a failure to fully consider different cultural norms has led to certain ethnic groups being overdiagnosed with a mental illness

• Eg Cochrane showed that people with an Afro Caribbean heritage living in West were disproportionately (more) likely to be diagnosed with schizophrenia compared others (Asain, white)

• even though rates of schizophrenia were no higher in their countries of origin.

• this suggests that failure to consider cultural norms may lead to inappropriate and inaccurate diagnosis of mental illness.

Evaluation: Weakness

• social norms can change over time

• eg homosexuality was once seen as socially abnormal, whereas now it's accepted

• another example is historically social norms for women were very narrow. and if these norms were broken. It could be labelled as mentally unwell

• this suggests that defining abnormality in terms of deviation from social norms is not consistent across generations (therefore lacking temporal validity) because social norms can change

outline statistical infrequency

• someone is mentally unwell if they exhibit a rare or statistically unusual behaviour or trait

• scores at extreme ends of the distribution. Curves indicate a mental illness in the case of IQ if it is below 70 it is rare and it leads to intellectual disability diagnosis

Evaluation: Strengths

• provides clear guidelines for identifying mental illness.

• Because there can be a set, numerical cut off point for diagnosing disorders clear

• Guidance for, clinicians when diagnosing psychological disorders

• mental orders assessed by questionnaire or other measurement tool

• means patience can be given a score, which can be compared to the norm

• statistical deviation, therefore useful part of clinical assessments and ensures consistency between psychologists

Evaluation weakness

• unusual characteristics can be positive

• Individuals with high IQ is seen as desirable same with low scores in a test of depression

• this shows statistical infrequency alone is not sufficient of making judgement about, whether someone is abnormal

• it also needs to be considered whether the rare scores are desirable

evaluation: weakness

• some abnormal behaviours are not statistically rare

• Some are relatively common

• for example: estimated 20 to 30% of people will suffer from depression during their lifetime

• however, it is clear that depression is a mental illness

• This has affected individuals benefit from help from Mental Health professionals

• this weakens definition of abnormality

• Because, it doesn't apply to all mental disorders

outline failure to function adequately

• cannot cope with everyday tasks and roles expected by society

• leads to significant discomfort or distress

• Rosenham and seligman specifically proposed seven signs of FFA

• emphasises practical aspects of mental health focuses on observable behaviours an impact on individuals life

Rosenham and seligman: seven signs of FFA

1. unpredictability and loss of control.

2. maladaptiveness: behaviours that are harmful to oneself or others. Making it difficult to maintain relationships and perform daily tasks

3. personal distress: experiencing significant emotional suffering, anxiety or depression as part of everyday life

4. irrationality: behaviours that lack logic, reason, or common sense making them difficult to understand or explain,

5. observe a discomfort: behaviours that cause distress to those around individual

6. violation of moral and social standards

7. unconventionality: behaviours that stand out as being unusual or different from the norm

What is GAF

• assessment of function scale (GAF)

• method of measuring how well individuals function in everyday life based on Rosenhan and seligman's idea about FFA

• GAF scale rates functioning from 0 to 100

• high scores indicate better functioning

Evaluation: Weakness

• some individuals diagnosed with mental disorder

• yet. Able to function adequately and cope with demands of everyday life

• EG seria murder harold Shipman it's thought to have murdered over 250 of his patients

• and was after diagnosed with an antisocial personality disorder

• for years he carried out his duties as a doctor and did not clearly display any of the characteristics outlined by Rosahan and seligman

• this suggests that FFA does not apply to all cases of poor mental health

Evaluation: Strength

• it can be measured

• the GAF Scale means a person's ability to function can be measured in a standardised and consistent way

• because all individuals can be given the same questionnaire with cut off points clearly defined

• this allows for a more uniform reliable evaluation of an individual's ability to cope with daily life

Evaluation: Weakness

• FFA might be due to circumstances

• for example people may be unable to cope as they have a demanding lifestyle with multiple caring responsibilities

• in this case failure to cope adequately may be considered normal

• Means that whether or not person is judged to beFFA is subjective

• and partly depends on how much a clinician takes personal circumstances into account

Oultine deviation from ideal mental health

• mental illness can be diagnosed when a person does not meet the criteria for ideal mental health as outlined by jahoda

criteria outlined by jahoda

1. positive view of self: High self esteem and self acceptance

2. be focused on self actualisation: Reaching their potential in self development

3. function as autonomous (Indepednet) Individuals: the ability to act independently and make your own decisions next

4. Accurate view of reality: Seeing the world as it really is without distortions (Lack of parionia)

5. positive relationship and empathy to others: Normal people can form close satisfying relationships with other people both giving and receiving affection

6. masters of own environment: normal people can demands within different situations and are able to adapt to changing circumstances

7. Can cope with stress

More critiera failed to meet - the more ill they are

Evaluation: Stregnth

• comprehensive definition

• clearly applies to a wide range of mental illnesses

• johoda’s concept of ideal mental health covers reasons why people might seek help with mental health

• also provides clear checklist which a psychologist can use when assessing someone

• it is also clear what criteria are not met with wide range of mental illnesses

• for example people with schizophrenia often have inaccurate view of reality

• and people with depression lack positive view of self and struggle to cope with stress

• Therefore we can say it has clear value in psychiatry

Evaluation: Weakness

• it is too idealistic

• very few people meet all criteria at all

• criteria outlined makes ideal mental health particularly impossible to achieve

• this suggests majority of population using this definition would be abnormal next

• Therefore it becomes difficult to identify those who really do need mental health support

Evaluation: Weakness

• cultural relativism

• different cultures have different ideas about what is mentally healthy

• many would argue that jahoda’s criteria are biassed towards western views

• so they may apply less to non western cultures

• EG: criteria of autonomy is not necessarily a sign of good mental health in collectivist cultures where the needs of the community are prioritised and relying on others is part of everyday life

• this means that it is a culturally relative definition of abnormality

behavioural characteristics of phobias

• Panic: Includes crying, screaming,running away.Young children freeze or clinging to others

• avoidance: effort put into avoiding phobic stimulus can affect daily life

emotional characteristics or phobias

• anxiety and fear: Unpleasant stay of high arousal prevents the sufferer from relaxing

• levels of emotion disproportionate to threat: eg Strong emotional response to small harmless spider

cognitive characteristics of phobias

• Selective Attention to phobic stimulus: If phobic stimulus present - absorbs most of attention This may stop individual focus focusing on more important things

• irrational Beliefs: generally Concerns believing phobic stimulus more harmful than is eg. all spiders deadly and dangerous even though not

Behavioural approach to explaining phobias

• argues phobias are a learnt response

• howard mowers 2 process model suggests they are learned through classical conditioing and maintained through operant conditioing

Classical conditioing in terms of phoibas

• learning through assoication

• nuteral stimulus becmes associated with fear

• causes NS to become CS which causes conditioned response of fear (can be genralised to things that look/are the same)

Whatson and Rayner (Little Albert study)

• Used CC to cause Albert to develop a phobia

• Fisrt he showed no fear to a range of stimuli

• paired white rat (NS) with loud noise, loud nosie caused fear

• Alber then assoicated rat with fear

Evaluation of W&R Little Albert study

• Unethical as signficat risk of longterm harm to little Albert

• Only one person was tested so can not be genralised, cant be sure that everyone would react the same way that Albert did

Operant Conditioing in terms of phobias

• phobias tend to be long lasting due to OC

• Specifically negative reinfocment within OC

• People with phobias delibralty avoid their phoibc stimuli as fear and anxiety also avoided

• avoidance is a from of negative reinformcent as it takes away fear and anxiety encouriging the eprson to continually avoid the stimulli

Behaivoural Approach evaluation: Strength

• evidence supporting that phobias are iniated by a negative event event

• eg Ad De Jongh: Found that 73% of people with a dentist phobia had had a negative experince

• this suggests that it develpoped through classical conditioing

Behaivoural Approach evaluation: Strength (Counter point)

• However this does not explain the development of phobias amoung people who cannot identify any activating event which led to contditioned fear response

• however some behavourists argue traumatic events (especially in childhood) could of been forgotten

Behaivoural Approach evaluation: Weakness

• model explain why some phobias are more common than others

• this may be because humans may be biologically prepared for things like snakes and spiders

• This is known as evoulutioanry/biological preparedness

• Even though there was no negative experince, phobia may develop more easily as humans are naturally more sensitive to certain threats.

• these specific phobias are more common because thy were adaptive in out evolutionary past, protecting our ancestors from genuine threats

• This suggets that the behaovural explanation is incomplete as biologiy and evolution also play a role in phoabis

Treating phobias: Systematic desnsitisation

• form of counter conditioing

• attmepts to replace assocation with fear with an association of felling calmed and relaxed

• can be explained by reciprocal inhibition which states that 2 oppisite emotions can not occur at the same time

• SD helps individual feel relaxed so cannot feel fear

Steps of SD

1. Relaxation training - individual learns techniques to help feel calm when faced with phoic stimulus (eg deep breathing)

2. Anxiety heriachy - Indivual and therapist create a list of fear inducing situations realted to phobia from most to least scary

3. Gradual exposure - starting at the bottom of the pyramid, the indivudal slowly faces their fear and doesnt move up until they are calm at the stage

Differnce between in vivo and in vitro

In vivo - exposed to real phobic stimuli

In vitro - exposure in for of imagery

Systematic devation evaluation: Strength

• evidence that is is effective

• Cillory et al followed up 43 participants with spider phobia who has SD.

• At both 3 and 33 months the patients where alot less fearful suggesting it is effective in long term and short term

Systematic devation evaluation: Weakness

• Problem with in vitro method as it reiles on client to imagine fearful situation

• Indiviudals may stuggle to create vivd image

• so some forms of SD limit effectivness

Treating phobias: Flooding

• immediatley bombards patient with phobic stimuli

• effective as i prevents avoiadnace of phocib stimuli

• floodding initally causes huge stress

• but eventually fear response will become exahsted and calm down (known as extinction)

Flooding evaluation: Strength

• evidence taht it is effective

• Choy reported flooding improves sypmtoms of phobias significanlty more than SD of CBT

• However other studies suggests flooding and SD are equally effective

• This suggests flooding may be a prefferd option as it is much quicker

Flooding evaluation: Weakness

• Flooding is less effective for complex phobias like social phobias

• social phobias have significant cognitve elements (eg persintent negative thoughts about soical situations)

• This means that for social phobias CBT maybe be more effective beacuosue it addresed the engative patterns of thinking

behavioural characteristics of depression

• Activity levels: reduced energy levels leads to withdrawal from work education and social life

• disruption to sleep and eating behaviour: changes in sleep patterns (reduced sleep insomnia or increased need of sleep Hypersomnia) appetite may increase or decrease leading to weight loss or gain

• aggression: Often irritable Become aggressive easily Can lead to relationship or work problems

emotional characteristics of depression

• Low Mood: Feeling sad and may describe themselves as worthless and empty

• anger

• lowered self esteem: Low opinion of self

Cognitive apporach to explaining depression

• argues some people are more vunrable to deppresion beacuse of the way they think

• deppresion it due to negative, irrational patterns of thinking including cognitive distrotions

Becks cognitive theroy of depression

• aruges deppresion is due to negative faulty patterns of thinking

• consists of:

1. Cognitive bias

2. negative self scemas

3. the negative triad

Beck’s Cognitive Theory of Depression: 1. Cogntive bias

1. Cognitive bias examples:

• selective thinking: focusing on the negative aspects of a situation and ignoring positives

• Absolutist thinking: thinking in black and white

• Catastrophizing - blowing small problems out of proportion

• Over genrealisation: makeing a sweeping conclusion based in a sigle experince

Beck’s Cognitive Theory of Depression: 2. Negative self schemas

• beck argued that people with depression have a negative self schema (a deeply engrained negative set of beilefs and ideas about themsleves)

• This infulnces how and individual will percive themselves and how they interprat information about themselves

• Negative self schema is also lineked to low self esteem

• he argues a negative self schema is often activated in chilldhood

• For example beacuse of continual parental criticism or rejection by others

Beck’s Cognitive Theory of Depression: 3. The Negative Triad

• With depression, 3 types of negative thinking that occur automatically:

1. Negative feelings about the selves

2. Negative feelings about the future

3. Negative views about world

Beck’s Cognitive Theory of Depression evaluation: Strength

• Evidence depression is linked to cognitive biases, negative self schemas and the negative traid

• Grazioli and terry stuided 65 pregnant women before and after birth

• those showing negative patterns of thinking were more likley to develop post natal depression

• similarly cohen et al tracked development of 473 adolescents and those with negative patterns of thinking were more likley to develop deppresion

• this suggests that negative patterns of thinking do make individuals more vunrable to develop depression

Beck’s Cognitive Theory of Depression evaluation: Wekaness

• ignores biological explanations

• Evidence that biolgoical factors, including genes and depression, may be involved in the development of depression

• There is significant evidence linking low levels of serotonin to depression

• in further support anti depressants like SSRIs (which increase serotonon levels) can be effective in imrpoving deppresion symtoms

• suggesting that Becks CBT is not a complete explanation for depression and needs to be considered alongside biological explnations

Ellis ABC model

• Argues deppresion is a result of negative and irratioanl beliefs triggerd by activating events

• A - Activiating event: event that triggers irrational patterns of thinking

• B - Belifes: triggerd by activating agent and in case of depression are irratioanl and negative, can include:

Musterbatory thinking: holding absolute, unrealsitic demands on oneself, others or the wolrd ‘i must always get As‘ often is beleived that thesse things must be true for the individual to be happy

‘i cant-stand-it-itis’ - when things dont go smoothly is a disaster

‘Utopianism’ - the belief that life is always meant to be fair

• C - Consequnces - Emotional and behavioural consequnces of the beliefs. in the case of depression, irratioanl and negative beliefs typically lead to low mood and harmful behaviours

ABC model evaluation: Strength

• Application to therpay

• ABC model has led to development of rational emotive behavioural therpay (REBT)

• which is shown to through research to be very effective

• REBT aims to identify and chalange negative patterns of thinking, genrally through the use of reailty testing and empirical dispute

• gives validity to thery because it has led to a succesful therapies supporting the idea that irratioanl beilf patterns can cause depression

ABC model evaluation: Weakness

• cognitive appraoch downplays role of situational factors in the cause of depression

• suggests that negative thinking about a situation rather than the situation itself wichi increase vurabeillity to deppresion

• however it is clear that some social situations (extreme poverty of war) could play a significant role in development of depression and chanigng patterns of thinking about thesse situations are unlikley to help

• therefore cognitve appraoch ignores cases of depression which are related more to social circumstances rather than negative irratioanl cognitions

Cognitve Behavioural Therapy (CBT)

• form of talking therapy based on the idea that negative and irratioanl patterns of thinking cause negative emotions and patterns of behaviour

• negative patterns of behaviour then further reinfoce neagtive thinking leading to vicious cycle

• CBT therefore aims to identify and challange irrational and negative patterns of thinking in order to reduce negative emotion and behaviours

Stages of Becks CBT

1. Ideintify irratioanl and negative thoughts causing negative emotions and behaviours, these may be about themslves, the world of the futures (Becks negative triad)

2. Therapist helps client identify common ‘thinking errors’ of cognive distortions (eg black and white, catastrophising)

3. Challangeing irrational thoughts through validity testing - Client taought to recognise when thoughts dont match reality

Can be done through

• Questioing and logical disputing - therpaist asks questions to help the client evalute their thougths

• Considering alternative more likley explnations

• Fact checking - setting client task of collecting evidence as part of homework that can then be used to challange irratioanl thinking

4. Homework tasks: thoughts records/diaries - client asked to keep record of negative throuhts, situations in which they occur, the emotions they trigger, and then practice challangeing and remframing them. Helps clients independently practice challenging their irrational thoughts

Behavioural activtion

• Breaks the vicious cycle of inactivity in depression

• depression causes withdrawal and inactivity which worsens mood and negative thoughts

• Encourages clients to take part in enjoyable or rewarding activites

• activites may be broken into small managble steps if they feel overwhelming

• Helps clients recognise negative and irrational thoughts independently

• Clients learn to challenge irrational thinking

• Leads to more positive emotions and improved well-being

REBT and the ABCDE model

• based on Ellis belif that beliefs a out events not the events themselves cause depression

• REBT = Rational Emotive Behaioviour Therpay

• Helps lcients identify, challange and replace irratioanl conseqinces

• Extends the ABC model to ABCDE:

• A = Activating event

• B = Beliefs

• C = Consequnces

• D = Dispute (challanging irrational beliefs)

• E = Effect (new rational beilfs and healither emotions)

How does Ellis challenge irational beliefs in REBT

• Confrontal approach with intense debate

• Logical disputing = questioing the logic of beleifs

• Empirical disputing = asking for evidence

• Aim if for cleints to recognise beliefs are irratioanl

• Leads to healitheir emotions and behaviours

• also contains homework tasks

CBT evaluation Strength

• Evidence for CBTs effectivness

• March et al compared the effect of CBT with anti depressant drugs and a combination of the two in 327 depressed adolescents.

• After 36 weeks both 81% of the anti depressants and CBT groups improved

• however 86% of the CBT plus anti depressants group improved

• conclusion = CBT is as effective as medication and also helpful alongside medication

• This suggest there is a good case for making CBT first choice of treatment in public health care systems like the NHS

• Especialy beacuse unlike drugs there are no sid eeffects or withdrawal symptoms

CBT evaluation Weakness

• CBT may not work for sevre cases because they are unable to concentrate or motivate themslves to participate in session

• when this happens pateints should be treated with drugs and then CBT when they are more motivated and able to engage

• this means that in some cases CBT is unlikley to be effective alone

• Also evidence that CBT may only have short term effects

• Simons et al compared CBT with antidepressants and found that CBT was effective in reducing symptoms short term

• howeber a proportion of patrines relapsed within a year after treatment ended

• ali = evincde CBT is only effective hort term

• shes followed 439 pattines and within 6 months 42% relpased

• suggets follow up sesions may be needed

Emotional symptoms of OCD

• Anxiety and distress - caused by obsessibe thoughts

• Guilt and disgust - guilt about intrsive thoughts

• Shame and embaressemnt - Know thoights and behaviours are irrational

Behaivoural symptoms of OCD

• Compulsions - repetitive behaviours or mental acts performed to reduce anxiety

• Avoidance - staying away from situations that trigger obbsesions

Cognitive symptoms of OCD

• Obsessive thouhts - inturives, unwanted and repetive thoughts

• Catstrpohising

• Coping mechanisms - help deal with obbsessive thoughts

biological approach to explaining OCD: genetic explnations

• OCD may be a result of genetic inheritance - A result of genes (which increased vulnerability to OCD) passed on from parent to child

What does “OCD it polygenic“ mean

• no single Jean common to all OCD sufferers

• there are many involved in OCD (intertact with each other)

OCD polygenic study

• Taylor carried out meta analysis

• Find evidence that up to 230 different genes may be involved in OCD

• many of these genes are associated with the actions of dopamine and serotonin

• which are both believed to play an important role in regulating mood

the two candidate genes that have been linked to OCD

• SERT gene

• COMT gene

what does the SERT gene have to do with OCD

• involved in regulation of serotonin activity in the brain

• been linked to OCD

• mutated version of This gene makes people more vulnerable to OCD

• because it causes increase in serotonin reuptake

• therefore decreasing the amount of serotonin in the synapse

• These lower serotonin levels'cause low moods and anxiety

What does the COMT gene have to do with OCD

• it codes for an enzyme which breaks down dopamine

• Also linked to OCD

• evidence some individuals with OCD have mutated version of this gene

• as it causes less dopamine breakdown therefore greater dopamine activity next

• This may explain compulsions seen in OCD

evaluation: strengths

• the clear evidence for the role of genes in OCD

• Lewis observed that of his OCD patient 30 seven percent had parents with OCD and 21% had siblings with OCD

• This suggests that OCD runs in families

• this may be through genes

• Nestadt et al reviewed previous twins studies

• found that overall 68% of identical twins matched for an OCD diagnosis

• opposed to 30 One of non identical twins

• strongly suggests a genetic influence on OCD

• Identical twins shared 100% of their genes and non identical prints only 50%

• greater genetic similarity presumably why identical twins are more likely to have OCD in common

• Research increases validity of genetic explanation of OCD

Evaluation: Weakness

• genetic factors must be considered alongside environmental risk factors

• genes alone cannot explain OCD as no twin study has found a concordance (match) rate of 100% In identical twins

• Even though they share 100% of their genes next

• This shows environmental factors must be considered alongside genetic ones

• generally accepted that genetic vulnerability to developing OCD is triggered by environmental factors

• cromer et al found that in his sample: over half OCD patients had traumatic event in past

• and OCD was more severe in those with more than one trauma next

• this supports the diathesis - stress model (idea mental ilness is result of gentic vunribilty triggerd by stress)

• Suggets genes alone cannot explain OCD

Neural Chemical explanations OCD

• abnormal levels of serotonin and dopamine

• neurotransmitter serotonin = Helps Regulate mood

• low levels of serotonin linked to OCD next

• Neurotransmitter dopamine linked to OCD

• higher levels of dopamine = associated with compulsions

Evaluation: Strength

• neural explanations of acd supported by effectiveness of Biological treatments for OCD especially SSRIs

• SSRIs Increase serotonin activity in the synapse by blocking reuptake of serotonin

• Such drugs are effective in reducing OCD symptoms in 50% of OCD sufferers next

• this suggests OCD is linked to low levels of serotonin

Evalution: Weakness

• however SSRIs are not effective in all patients suffering from OCD

• suggesting that low levels of serotonin cannot explain OCD in all patients

Furthermore there is a time delay between taking drugs and any improvement in symptoms (up to 3 - 4 months)

• and yet SSRIs increased serotonin levels within hours

• this suggests that low levels of serotonin alone can't explain OCD

neuroanatomical explanations: overactive basal ganglia

• this is a brain area involved in movement

• It's been suggested that OCD is linked to an over active or hypersensitive ganglia

• which leads to repetitive motor behaviours

OFC-Thalamus Circuit

• been suggested that OCD sufferers have dysfunction OFC thalamus circuit

• the orbitofrontal cortex (OFC) is an area of the brain responsible for higher level decision making (detecting when something is wrong)

• one concern is detected a ‘worry signal’ it's sent to thalamus

• which then passes information on to further brain areas (including back injured the OFC)

• the OFC and Thalamus therefore create a ‘worry’ circuit in the brain

Caudate nuclues and its job in OFC-thalamus circuit

• caudate nucleus helps regulate OFC thalamus circut, suppressing some of the original minor worry signals sent from OFC to thalamus

• this prevents circuit becoming hyperactive

• an OCD caudate nucleus It's thought to function less effectively

• meaning worry signals from OFC are not suppressed as they would normally be

• this allows stalamus to overexcited and in turn causes it to send strong signals back to OFC

• This could explain obsessive distressing thoughts and anxiety seen in OCD

• which sufferers respond to with repetitive behaviours

evaluation of neural explanations: Strength

• clear evidence

• rates of OCD are higher than average among people suffering from Tourette's and Parkinson's disease

• which both are linked to abnormalities in the basal ganglia

• whitehead reviewed brain imaging research into OCD

• he found hyperactivity in the office was significantly more common in OCD patients compared to housing controls

• also evidence that this overactivity reduces after treatment next

• We can therefore say there is objective scientific evidence of brain abnormalities of OCD

evaluation of neural explanations: weakness

• Can't be sure neural abnormalities are the cause of OCD

• although strong evidence of neural abnormalities in OCD (eg low serotonin levels)

• no direct evidence that low serotonin is the cause of OCD next

• could be that OCD causes neural abnormalities (eg low serotonin levels or overactivity in the ganglia)

• therefore there is an issue with causation in neural explanations of OCD

overall Evaluation on biological Explanations of OCD

• reducing OCD to biological factors is biologically reductionist

• oversimplifies complex disorder

• OCD almost certainly result of a range of interacting biological and psychological factors

• CBT can significantly improve OCD shows OCD is linked to irrational patterns think

• therefore biological explanations of OCD need to be considered alongside other explanations including psychological ones

What is Drugy Therpay?

• aims to increase or decrease levels of neurotransmitters in the barin to increase/decrease their activity

• ODC is associated with low levles of serotonin so most drugs work by increasing the level of serotonin in the brain

How does serotonin work in the brain

• Neurotransmitter released by presynaptic neurons

• Travles across the synapse

• after binding to a recepotr on postsynaptic neurone

• it is relaeasd and reabsorbed by the presynaptic neuron where it is broken down and resued

How do SSRIs (Selective Reuptake Inhibitors) work

• works on the serotonin system in the brain

• prevent the re - absorbtion and breakdown of serotonin

• SSRIs increase levels of serotoin in the synapse

• This helps to regulate the low levels of serotonin asosciated with OCD

What is GABA

• inhibitory neurotransmitter which reduces neurone activity in the brain

What as Benzodiasepines (BZs)

• range of anti-anxiety drugs including Valium and Diazepam

• work by increasing activity of the neurotransmitter GABA

• by increasing levels of GABA Bzs slow down neurone activity in the brain

• Means BZs have a general quietening influnce on the brain and consequenlty reduce anxiety

• experinced as a result of obsessive thoughts

Evaluation of drug therpay: Strngth

• effectiveness of SSRI is supported by studies which uses randomised drug trials.

• These trials compare the effectiveness of SSRIs and placebos.

• Soomro et al. (2008) conducted review of the research examining the effectiveness of SSRIs

• found that SSRIs were more effective than placebos in the treatment of OCD in 100% of trials.

• This supports the use of biological treatments, especially SSRIs, for OCD.

Evaluation of drug therpay: Weakness

SSRIs and BZs both have side effects.

• SSRIs: indigestion, blurred vision, reduced sex drive. -

• However these are usually temporary.

• BZs: drowsiness, dizziness and lack of coordination.

• BZ are also well-known for their withdrawal effects

• this makes them very addictive

• In the long-term BZ can have quite serious negative effects including cognitive impairments.

• As a result, BZs are usually only prescribed for short-term treatment.

• In some instances, side effects will cause patients to stop taking the drug, preventing it from being effective.

Evaluation of drug therpay: Weakness

• Drugs are a passive treatment for OCD

• don’t require any active participation from patient.

• This contrasts from treatments like CBT

• where patients are taught to recognise and strategies to take control of their distressing and irrational thinking.

• For many patients It is important that they actively engaged in own treatment

• being taught coping strategies can give them a sense of control.

• This active involvement is missing from drug therapy.