chapter 4 Psychopathology

psychopathology

scientific study of psychological disorders

statistical infrequency

abnormality defined as those behaviours which are extremely rare

example of statistical infrequency

IQ and intellectual disability order (most people cluster around the middle)

are some abnormal behaviours admirable? (evaluation)

P - yes

E - some behaviours such as high IQ are desirable

E - this is because they are more knowledgeable meaning that they can share their knowledge leading to development and inventions

L - overall helps improve the world

can the cut-off points be subjective (evaluation)

P - yes

E - subjective because where do you separate normal or abnormal

E - 5 hours of sleep could be normal for some but others get a lack of sleep (insomnia)

L - this could be because of depression and therefore hard to distinguish the cut-off points

deviation from social norms

abnormal behaviour is seen as a deviation from unstated rules about how one should behave (anything that violates this is considered abnormal)

example of deviation from social norms

* antisocial personality disorder is impulsive, aggressive and irresponsible
* symptom of APD 'failure to conform to lawful and culturally normative ethical behaviour

does deviation from social norms make people more susceptible to abuse? (evaluation)

P - yes

E - some groups of people such as homosexual people are more susceptible to abuse

E - historically considered abnormal such as in Jamaica it is illegal to be homosexual

L - some places it is illegal to go against the state, result in punishment

does deviance depend on the context and degree? (evaluation)

P - yes

E - context is important because situations vary the appropriateness

E - beachwear is appropriate on holiday but seen to be inappropriate in a classroom environment

L - degree of deviance is important

failure to function adequately

people are judged on their ability to go about daily life, if they are unable to and experiencing distress then it's considered a sign of abnormality

example of failure to function adequately

agoraphobia

does it depend on who is making the judgement? (evaluation)

P - yes

E - observer discomfort is a way of judging abnormality as well as the individuals discomfort

E - psychopaths such as Peter Sutcliffe (Yorkshire Ripper) who suffered with schizophrenia

L - he believes that he functions normally meaning that everybody has their own judgement of abnormal

can some dysfunctional behaviours be functional? (evaluation)

P - yes

E - those suffering with eating disorders might seek an alternative motive

E - they may seek attention from others

L - making the behaviour functional

deviation from mental health

abnormality is defined in terms of mental health, behaviours that are associated with competence and happiness

Jahoda's six characteristics of good (ideal) mental health

1. self attitudes (high self esteem)
2. self actualisation
3. integration (coping with stress)
4. autonomous (independence)
5. accurate perception of reality
6. ability to love/function

does anyone have all 6 characteristics of good mental health? (evaluation)

P - no

E - its an unrealistic criteria

E - it is difficult to gain qualities of all characteristics

L - meaning that all of us would be considered abnormal which isn’t realistic

is mental health the same as physical health? (evaluation\`)

P - no

E - we cannot diagnose mental health the same as physical health

E - not all mental health disorders have a physical cause

L - however, life experience (e.g trauma) can trigger a mental health disorder

cultural relativism - statistical infrequency

infrequent in one culture may be frequent in another meaning that it is difficult to label abnormality by a universal standard

cultural relativism - deviation from social norms

cultural norms now recognised in the DSM e.g panic attacks in one culture (excessive crying) but shows as difficulty breathing in another (improves reliability of diagnosis)

cultural relativism- failure to function adequately

related to cultural beliefs of how one should live leading to different diagnosis of abnormal behaviour in different cultures

cultural relativism - deviation from ideal mental health

self-actualisation limited to individualistic cultures leading to higher rates of diagnosis in collectivist cultures

DSM

Diagnostic and Statistical Manual of Mental Disorders

phobia

excessive irrational fear and anxiety triggered by an object or situation

emotional characteristics of a phobia

feelings of anxiety and panic brought onto by the presence or anticipation of a specific object or situation

behavioural characteristics of a phobia

avoidance and freeze/faint

avoidance

avoidance of the situation/object causing fear

freeze/faint

high anxiety

cognitive characteristics of a phobia

irrational thinking and resistance to rational arguments

—> selective attention (focus only on phobia when presented with it)

two-process model

phobias are acquired through classical conditioning and maintained by operant conditioning

classical conditioning - initiation

phobias are acquired through association between a neutral stimulus and an unconditioned response

operant conditioning - maintenance

* reintroduced behaviour is likely to be repeated
* avoiding the feared object takes away the anxiety —> phobia is maintained by negative reinforcement

Little Albert study

* presented little Albert with a rat (NS) which he initially liked
* they made a loud noise (UCS) which made him cry (UCR)
* they then paired the rat and the noise together repetitively
* this lead to the rate becoming a CS
* he was then scared of the rat

how can we explain the cognitive factors linked to phobias? (evaluation)

P - a limitation of the two-process model is cognitive aspects to phobias cannot b explained in traditional behaviourist framework

E - alternative explanation is the cognitive approach, proposes phobias may develop as consequence of irrational thinking

E - irrational thoughts create extreme anxiety, so triggers a phobia

L - this explanation leads to cognitive therapies (CBT) which can be more successful than behaviourist treatments

how does Bandura’s research support the Social Learning theory? (evaluation)

P - experiment by Bandura and Rosenthal (1966) supported the social learning theory

E - the experiment had a buzzer and ever time a buzzer sounded pain was felt

E - participants who had observed this showed an emotional reaction (fear) to the buzzer

L - demonstrates that modelling the behaviour to others can lead to an acquisition of phobias

flooding as a treatment for phobias

* type of exposure therapy
* person immersed in the experience for one long session

—> experience phobia at it's worst until anxiety disappears and replaced with relaxation

flooding/exposure therapy

idea that a person fear responds to a time limit as adrenaline levels decrease

flooding step 1

patient is taught how to relax their muscles completely

flooding step 2

patient masters the feared situation that caused them to seek help this accomplished in one long session

systematic desensitisation as treatment for phobias

graduation exposure to the phobia under relaxed conditions to create a new association

counterconditioning

* teaching a new association that's counters the original association
* taught through classical conditioning to feel relaxed with the stimulus instead of fear

relaxation importance

anxiety \= quick breathing (slow breathing helps relax)

desensitisation hierarchy

gradually exposed to the stimulus one step at a time with relaxation techniques used at each stage

systematic desensitisation step 1

* patient is taught how to relax their muscles completely
* relaxed state is compatible with anxiety

systematic desensitisation step 2

therapist and patient together construct a desensitisation hierarchy

—> series of imagined scenes, each one causing a little more anxiety than the last

systematic desensitisation step 3

* patient gradually works their way through the hierarchy
* visualising each anxiety evoking event while engaging in the relaxation techniques

systematic desensitisation step 4

once patient has mastered one step in the hierarchy so they can move onto the next

systematic desensitisation step 5

patient eventually master the feared situation that caused them to seek help

what are the strengths of behavioural therapies? (evaluations)

P - behavioural therapies for dealing with phobias are relatively faster, cheaper and less effort on the patients than other psychotherapies

E - CBT requires willingness to think deeply about mental problems but the lack of ‘thinking’ means that it is useful who lack motivation

E - can be self-administered, and proved successful

L - benefits conformed in studies, found that self-administered therapy was as affective as therapist-guided therapy

is relaxation necessary for both flooding and systematic desensitisation? (evaluation)

P - success of both SD and flooding is more to do with exposure to the feared situation than relaxation

E -expectation of being able to cope is most important

E - the active ingredient in SD or flooding may simply be the generation of hopeful expectations that the phobia can be overcome

L - suggest that cognitive factors are more important that the behavioural approach

depression

mood disorder where an individual feels sad and lacks interest in their usual activities (characterised by low mood and energy levels)

formal diagnosis of depression

requires the presence of at least 5 symptoms

emotional characteristics of depression

sadness, loss of interest and anger

sadness

most common description, feeling of emptiness, worthlessness and low self-esteem

loss of interest

in usual hobbies and activities

anger

at others or turned inwards

behavioural characteristics of depression

sleep, appetite and activity levels

sleep

more or less than usual, possible insomnia

appetite

eating more or less than usual

activity levels

reduced or increased due to lack of energy or tiredness

cognitive characteristics of depression

* negative thoughts which are irrational
* negative self-concept (negative self-belief)
* negative view of the world around them

Ellis' ABC model

A - activating event

B - belief (may be rational or irrational)

C - consequence (rational belief lead to healthy emotions / irrational beliefs lead to unhealthy emotions)

mustabatory thinking

thinking that certain ideas or assumptions must be true in order for an individual to be happy

3 most important irrational beliefs (mustabatory thinking)

1. I must be approved of or accepted by people I find important
2. I must do well or very well, or I am worthless


3. The world must give me happiness, or I will die

Becks negative triad

depressed individuals feel as they do because their thinking is biased towards negative interpretations of the world (cognitive bias) and they lack perceived sense of control

the negative triad

negative schemas and cognitive biases maintain what Beck calls negative triad, a pessimistic and irrational of 3 key element in person's belief system

negative view of the self

e.g 'I am just plain undesirable, what is there to like? I'm unattractive and seem to bore everyone'

negative view of the future

(life experience) e.g 'I can understand why people don't like me. They would all prefer someone else's company. Even my boyfriend left me'

negative view of the world

e.g 'I am always going to be on my own, there is nothing that is going to change this'

negative schema

tendency to adopt a negative view of the world

—> caused by variety if factors, parental or peer rejection and criticism from teachers

—> activated whenever the person encounters a new situation

are irrational beliefs actually realistic? (evaluation)

P - limitation of cognitive approach is that not all irrational beliefs are ‘irrational’, they seem irrational

E - Alloy and Abramson (1979) suggest that depressive realists tend to see things for what they are

E - found depressed people gave more accurate estimates of likelihoods of disasters than ‘normal’ (sadder but wider affect)

L - doubts about whether irrational thinking really is really irrational raise questions about the value of the cognitive approach

explanation blames the client rather situational factors. It this a good thing or a bad thing? (evaluation)

P - cognitive approach, suggests that it is the client who is responsible for their disorder

E - emphasis on the client is a good thing because it gives the client power to change things

E - this has limitations, may lead client/therapist to overlook situational factors which can contribute

L - strength of cognitive approach therefore lies on its focus on the client mind and recovery (other factors like the environment need to be considered)

CBT (cognitive behavioral therapy)

aims to change the way we think to change our behaviour, specifically depressive behaviours

extended Ellis' ABCDEF model

D - disputing irrational thoughts and beliefs

E - effects of disputing

F - feelings produced

disputing irrational thoughts and beliefs

3 terms including logical, empirical and pragmatic

logical (D in ABCDEF model)

disputing thoughts that don't follow evidence available

empirical (D in ABCDEF model)

not consistent with reality

pragmatic (D in ABCDEF model)

how will these thoughts help me?

key components of CBT

1. challenging irrational thoughts
2. homework
3. behavioural activation
4. unconditional positive regard

challenging irrational thoughts

move from 'catastrophic' to rational interpretations

homework

assignment to test irrational beliefs e.g ask someone out

behavioural activation

engage in pleasure able activities as an antidote to social withdraw

unconditioned positive regard

therapist has respect and holds you in conditional positive regard

does CBT work for everyone? (evaluation)

P - CBT appears to be suitable for some individuals more than others

E - CBT appears to be less suitable for people with high levels of irrational beliefs that are both rigid and resistant to change

E - appears to be less suitable in situations where high levels of stress in the individual reflect realistic stressors in the person's life that therapy can’t resolve

L - explained a possible lack of success in terms of suitability, limitation of CBT, therefore, is the fact that individual differences affect its effectiveness

are there alternative treatments of CBT? (evaluation)

P - other treatments are available, the use of antidepressants such as SSRIs is the most popular

E - drug therapies have the strength of requiring less effort for the client, can also be used in conjunction with psychotherapy like CBT

E - may be useful because distressed clients may be unable to focus on the demands of CBT and the drug therapy could enable them to cope better

L - suggests that using CBT and drugs might be the best option

obsessive compulsive disorder (OCD)

an anxiety disorder with 2 components of obsessions and compulsions

emotional characteristics of OCD

obsessions and compulsions cause anxiety and distress

—> aware behaviour is excessive causing embarrassment and disgust

obsession

recurrent and persistent thoughts, impulses that cause distressing emotions such as anxiety, fear or disgust (internal components)

compulsions

repetitive behaviour you feel you need to do to temporarily relieve the unpleasant feelings brought on by the obsessive thought (external components)

behavioural characteristics of OCD

compulsive behaviours = compulsions performed to reduce anxiety, repetitive and unconcealed

—> not connected with what designed to prevent

—> some only suffer compulsions

cognitive characteristics of OCD

obsessions = recurrent, intrusive and inappropriate, scary and embarrassing = reluctant to share with others

—> themes include ideas, doubts, impulses or images

—> uncontrollable and recognised as product of their own mind

biological approach explaining OCD

genetic explanation + neural explanation

genetic explanation

heredity gene from biological parents related to OCD

COMT gene

regulates production of dopamine associated with OCD

SERT gene

affects transport of serotonin lowering levels associate with OCD

diathesis-stress model

psychological disorders result from an interaction between inherent vulnerability and environmental stressors

diathesis-stress model explanation of OCD

* unlikely to be 1 gene associated with OCD but multiple genes (polygenic)
* diathesis (vulnerability)


* stress (trigger in the environment)

neutral explanation

genetic factors affect certain brain circuits that may be abnormal

dopamine

high levels \= OCD

serotonin

low levels = OCD

—> anti-anxiety drugs are effective at reducing symptoms by raising serotonin levels

orbitofrontal cortex (OFC)

* abnormal brain circuits, PET scans when symptoms active show heightened activity in orbitofrontal cortex
* damage to caudate nucleus leads to suppression of worry signals alerting the thalamus gland to respond to worry signal