Clinical Psychology

What is statistical infrequency

Any unusual behaviour/ characteristic which deviates from the normal. When an individual has a less common characteristic.

ie being less intelligent

The normal distribution curve

•The normal distribution curve shows the majority of people as being in the middle - these people are defined as 'normal'.

Same as others

Challenge: Does having a high IQ

make you

'abnormal'?

Probably more than others

Probably less than others

•Relatively few people fall at either end. However, if they are then they are defined as 'abnormal'.

What is Deviation from social norms

Behaviour that is different from the accepted standards of behaviours in a community or society.

I.e. Antisocial behaviours

What is cultural relativism

social norms vary country to country

What is failure to function adequately

When someone fails to cope with ordinary demands of day to day living

Rosenham and Seligman (1989)

• When someone experiences severe personal distress

• When persons behaviour becomes irrational / danger to themselves or others.

• When someone no longer adheres to standard rules i.e. maintain eye contact/ respect personal space

OR

Who proposed the characteristics of failure to function adequately?

Rosenhan and Seligman

What is devotion from ideal mental health

Occurs when someone does not meet the ideal criteria for good mental health.

Marie Jahoda (1958) suggested we are in good mental health if we meet the following criteria

• No symptoms or distress

• Rational and perceive ourselves accurately

• We self actualise / have good self esteem
  We cope with stress
  We have a realistic view of the world

• Independent / can work, love and enjoy leisure

Who proposed ideal mental health?

Marie Jahoda.

what is a phobia

Phobias are an irrational fear of an object, place or situation.

What are the three types of phobia

Specific phobia

Social anxiety

Agoraphobia

what are Specific phobias

Phobias of an object, such as an animal, body part, or situation such as flying or having an injection.

what is social phobia/ social anxiety

Phobias of a social situation such as public speaking or using a public toilet.

What is agoraphobia

Phobia of being outside or in a public place

Behavioural characteristics of phobia

Panic

Adults : scream cry run away

Children freeze tantrums cling to someone

Avoidance

putting effort to avoid phobic stimulus

Endurance

person remains in presence of phobic stimulus endures high levels of anxiety

Emotional characteristics of phobiaf

Anxiety and Fear

Phobias are anxiety disorders.

Anxiety is an unpleasant state of high arousal and can be long term.

Fear is the immediate strong emotion when we encounter the phobic stimulus.

Unreasonable emotional response

Emotional response goes beyond what is reasonable

Cognitive factors of phobias

Selective attention

If sufferer sees phobic stimulus, they

constantly keep an eye on it is hard to look away.

Irrational beliefs

Phobic may hold irrational beliefs to phobic stimulus.

Cognitive distortion

Phobic perception of the phobic stimulus may be distorted

Who proposed the two-process model?

Orval Hobart Mowrer

explaining behaviour Two process model what did Mowrer belive

He believed that phobias are acquired and learnt by classical conditioning and maintained through operant conditioning.

Describe classical conditioning

Classical conditioning suggests that the person has learnt to fear something i.e. a neutral stimulus if it is paired with a frightening event (the unconditioned stimulus) i.e. learnt an association

Neutral stimulus (NS) - no response

Unconditioned stimulus (UCS) - > Unconditioned response (UCR)

Unconditioned stimulus (UCS) + neutral stimulus (NS) - > Unconditioned response (UCR)

Conditioned stimulus (CS) - > Conditioned response (CR)

Little albert

• Watson & Rayner conditioned a baby boy known as Little Albert to fear white rats - Highlight each stimulus

• For several weeks, Albert played happily with a white rat (NS) showing no fear. (NR)

• One day, while he was playing with the rat, the experimenters struck a steel bar with a hammer close to Albert's head.(UCS)

• Albert was very frightened by the noise.(UCR)

• This was repeated each time he reached for the rat. Albert then developed an intense fear of white rats.(CR CS)

operant conditioning

What is negative reinforcement?

Removing anxiety by avoiding the feared object, making avoidance more likely.

What is Systematic desensitisation

A behavioural therapy designed to reduce phobic anxiety through classical conditioning

What are the three stages of systematic desensitisation?

1. The anxiety hierarchy-this is a list of situations related to the phobic stimulus that provoke anxiety arranged in order from least to most frightening (3 or more steps)

2. Relaxation- therapist teaches patient to relax as deeply as possible-can be through meditation/mental imagery techniques or breathing exercises for muscle relaxation.

3. Exposure-patient is exposed to the phobic stimulus while in a relaxed state. Starting at the bottom of the anxiety hierarchy.
   Treatment is successful when the patient can stay relaxed in situations high on the anxiety hierarchy.

What is flooding?

Immediate exposure to the most feared stimulus until anxiety decreases.

What is depression?

A mood/mental disorder involving persistent low mood and loss of interest.

What are the 4 categories of depression

Major depressive disorder

• Severe but often short-term depression

• Effects daily routine e.g. sleep, waking up cycle.

Persistent depressive disorder

Long-term or recurring depression.

• Low-grade depression that lasts for at least 2 years.

Disruptive mood dysregulation disorder

Childhood temper tantrums

Persistent irritable or angry mood

• Frequent temper outbursts

Premenstrual dysphoric disorder

• Disruption to mood prior to snd/or during menstruation

Causes range of emotional and physical symptoms each month

What are the Behavioural features of depression?

ACTIVITY LEVELS

• Reduced levels of energy and lack of enthusiasm

• Withdrawal from work, education and social life.

• Extreme cases: they cannot get out of bed.

DISRUPTION TO SLEEP AND EATING

Some cases individuals struggle to relax and have the opposite effect

- Psychomotor agitation

• Reduced sleep (insomnia) or increased need for sleep (hypersomnia)

• Appetite may increase or decrease (weight or gain loss)

Key is sleep and eating behaviours are disrupted.

AGGRESSION AND SELF-HARM

Irritable behaviours, sometimes becoming verbally or physically aggressive to others or own self (self-harm, cutting, or suicide attempt)

This can have a knock off effect on their life eg quitting a job by displaying verbal aggression.

What are the emotional features of depression?

LOWERED MOOD

• Deeper than simply feeling "sad"

• Lost enjoyment in everyday life.

• Lack of interest or pleasure in what they used to enjoy before.

ANGER

• Extreme anger feelings towards others and self.

LOWERED SELF-ESTEEM

• "Why am I like this"
  "Why does no one understand me"

• This leads to aggressive or self-harming behaviours

• Sufferers despise and hate themselves.

• Can be extreme.

• Self-loathing e.g hating themselves. wanting to end their lives.

What are the cognitive features of depression

POOR CONCENTRATION

Unable to focus on tasks they usually would.

Indecisiveness: harder to make decisions they used to find

straightforward

This interferes with individuals work.

NEGATIVE DWELLING

Pay more attention to the negative aspect and ignore the positive.

Glass half empty than half full.

Have a bias towards unhappy events.

Absolute thinking

black and white" thinking.

If a situation is unfortunate they see it as an absolute disaster

Who proposed the cognitive explanation of depression?

Aaron Beck

What are the three components of becks negative triad

• Faulty information processinc

• Negative self-schemas

• The negative triad

Give examples of faulty information thinking

FAULTY INFORMATION THINKING

Those with depression, attend to the negative aspects of any situation, ignoring the positive. They are prone to have a cognitive bias (focus on the negative).

Misinterpreting informing

e.g. If I won £1 million on the lottery, I might focus on the fact that someone on the previous week had won £10 million, rather than my achievement.

Over-generalisation

Make a definite conclusion based on a single incident

"I've failed one end of uni test, therefore I am going to fail ALL of my AS exams"

Catastrophising

• Exaggerating minor setbacks and believe it to be a complete distaster.

"I've failed one end of unit test, therefore I am never going to study at University and get a good job"

Explain what negative self schemas are

Schema is a package of information developed through experience which act as a mental framework.

Beck believes depressed individuals have a negative schema which is acquired in childhood and adolescence.

What is becks negative triad

Negative views of the self, the world and the future.

Who proposed the ABC model?

Albert Ellis.

What does the A B C stand for in Rllis ABC model

Activating event

We get depressed when we experience negative events and these trigger irrational beliefs.

Belief

beliefs-range of irrational belief

Consequence

consequences- emotional and behavioral consequences

What is CBT?

A therapy that changes negative thoughts and behaviours.

What are the two steps of Becks CBT

CBT- Beck's cognitive therapy

1. Initial assessment to identify the automatic negative triad (beliefs) of the client. (self, world and future)

2. Setting goals, monitor improvements and challenge these negative thoughts of the negative triad

What is the goal of CBT?

To replace irrational thoughts with more realistic ones.

Clients are made aware of their negative views.

In this way, negative or irrational views can be replaced with more optimistic and positive beliefs.

The therapist would use a process of reality testing by setting

Homework's - diary keeping

What does the DEF stand for in Elliot rational emotional behavioural therapy REBT

REBT extends the ABC model to an ABCDE model

D = Dispute (challenge the thoughts)

E = Effect (see a more beneficial effect on thought and

behaviour)

F= the new feelings that are produced.

What are the three types of disputing

Empirical Disputing - disputing whether there is actual evidence to support their negative belief.

Logical Disputing - involves disputing whether the negative thought logically follows from the facts.

Pragmatic Disputing - involving disputing how the negative thought is going to help the person.

What is OCD

A disorder involving obsessions and/or compulsions.

What are obsessions?

Persistent intrusive thoughts

What are compulsions?

Repetitive behaviours performed to reduce anxiety.

what are behavioural features of OCD

Compulsions are repetitive

A sufferer of OCD feels compelled to repeat a ehaviour (mentally forced) these can be time consuming.

E.g. Hand washing 7 times in a row can make you late for work.

Compulsions reduce anxiety

10% of OCD sufferers show compulsivebehaviour alone - they have no obsession just a sense of irrational anxiety.

Compulsive behaviours are performed to manage the anxiety produced by obsession.

E.g. compulsive hand washing is due to obsessive fear of germs

Avoidance

OCD sufferers attempt to reduce anxiety by keeping away from the trigger.

Sufferers who wash hands compulsively may avoid coming into contact with germs e.g. avoid changing bins which can impact daily life.

What are the emotional characteristics of OCD

Anxiety & Distress

OCD creates unpleasant emotional experiences

Obsessive thoughts are unpleasant and

frightening, the urge to repeat a behaviour (compulsion) creates anxiety.

Depression

Those with OCD often also suffer from depression.

• Low mood

• Lack of enjoyment in activities.

Compulsive behaviour brings some relief from anxiety but this is temporary.

Guilt and disgust

Irrational guilt. alongside anxiety and negative thoughts

E.g. I am extremely dirty and feel disgusted towards their self.

Co-morbidity

What is Co morbidity

What are the cognitive characteristics of OCD

Obsessive thoughts

90% of OCD sufferers have obsessive thoughts

Vary from person to person but are always unpleasant.

E.g. recurring thoughts of being contaminated by dirt and germs.

Obsessive actions

OCD sufferers use cognitive strategies to deal with obsession. This is to help them continue with their day.

E.g. A religious person tormented by obsessive guilt may pray a lot, to deal with anxiety. But this can make the person appear abnormal and affect everyday tasks.

Selective attention

OCD suffers are aware of their irrational obsessions and compulsions.

Despite this, they cannot stop these catastrophic thoughts.

They also are hypervigilant and have selective focus on potential hazards.

what are the two biological explanations of ocd

genetic and neural explanation

What does the genetic explanation suggest?

OCD has an inherited genetic component

What is the research from family studies?

Lewis (1936) observed rates within families of OCD patients

• 37% of his OCD patients had parents with OCD

• 21% of his OCD patients had siblings with OCD.

This suggests that OCD runs in families -creates "genetic vulnerability" from one generation to another.

Provides support for the genetic explanation to OCD.

What is the diathesis stress model?

A theory which explains how psychological disorders develop.

According to this model, certain genes leave some pupil more likely to suffer a menta disorder - environmental experiences are needed to trigger this condition e.g. a stressful event such as "death of a close member/bereavement"

What are candidate genes?

Specific genes associated/ create vulnerability for with OCD.

What are the two candidate genes associated with ocd.

The COMT (catechol-O-methyltransferase) Gene : helps to increase the action of dopamine.

There is too much dopamine (associated with OCD)

• The SERT Gene (5-HTT): this affects the transport of serotonin (SERotonin Transporter)

Low levels of serotonin have been implicated with OCD.

What are polygenic disorders?

What are polygenic disorders?

What does the neural explanation suggest?

OCD involves abnormal brain circuits and neurotransmitters.

Which two neurotransmitter are linked to OCD?

Serotonin

Dopamine

Describe the figurine in levels of neurotransmitter with someone with ocd

Dopamine levels too high

Serotonin levels too low

What two parts of the brain are advocated with ocd

orbitofrontal cortex

basal ganglia

What is the basal ganglia and research attached

Basal ganglia is involved in multiple processes including coordination of movement.

Max et al (1994) found that when the basal ganglia is disconnected from the frontal cortex during surgery

OCD-like symptoms are reduced - provides support of the BG playing role in OCD

What is the orbit frontal cortex and research attached

• The OFC is involved in decision making and worry about social and other behaviour.
• PET scans found higher activity levels in the OFC in patients with OCD.
• Higher activity in OFC increases behaviours which leads to compulsion - Increased activity also prevents patients from stopping their behaviours (compulsion)

What are the SSRIs

Selective serotonin reuptake inhibitors

What do SSRIs do?

• Commonly used.

• Low levels of Serotonin are associated with depression and OCD so these drugs increase the levels of Serotonin.

• Normalise the worry circuit.

DESCRIBE THE SYNAPTIC

TRANSMISSION

• Impulse arrives at the pre-synaptic neuron which triggers the release of the serotonin from the vesicle.

• The serotonin travel across the synaptic gap, however instead of binding to the receptors of the post-synaptic neuron.

• It is reabsorbed by the presynaptic neuron.

• When the OCD patient takes SSRI, this prevents the re-absorption of serotonin by blocking the entrance of the presynaptic neuron.

• This prevents the reabsorption of the serotonin and effectively increase the level of this neurotransmitter.

• This continue to transfer the impulse to the postsynaptic neuron and mood

Give and example of and SSRI

Fluoxetine - example of SSRI

Fluoxetine 20mg

Hard Capsules

Fluoxetine

20 mg

• Dosage can vary depending on the prescription.

• A typical daily dose of Fluoxetine is 20mg although this may be increased if it is not benefitting the patient. The drug can be prescribed as either capsules or liquid. It takes

3 - 4 months of daily use for SSRI's to have much impact on symptoms.

What can drugs be used along side of to treat ocd

• CBT cognitive behavioural therapy

• The drugs reduce a patient's emotional symptoms, i.e. feeling anxious or depressed. The patient then responds better to CBT.

• Some patients respond better to CBT however others may benefit from drugs.
  Here are some other drugs.

Name two alternatives to SSRIs to treat OCD

Tricyclics

• Older type of antidepressant

• E.g. Clomipramine

• Has the same effect on the serotonin system as SSRI's, but the side-effects are more severe

• Used only when the patient does not respond to SSRI

SNRIs

• Serotonin-noradrenaline reuptake inhibitors

• More popular in the last 5 years or so

• Used when SSRIs don't work

• Increase levels of serotonin and the neurotransmitter noradrenaline (cognition, arousal and attention)