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what was considered the cause of mental illness before science?
supernatural forces - meant treatment was poor (holes in the skull etc)
What are the 4 definitions of abnormality?
statistical infrequency
deviation from social norms
failure to function aquately
deviation from ideal mental health
What is statistical infrequency?
a persons thinking and behaviour an be considered abnormal if it is consiered statistically rare
most useful when dealing with characteristics that can be measured
eg inteligence measured using an IQ score
the average IQ = 100
68% = score between 85 -115
only 2.5% = below 70
this is unusual so made lead to a diagnosis of a dissorder
What are the two weaknesses of using statistic infrequency to define abnormality?
some characteristics can be positive
a very high IQ is desirable but still abnormal
there are also common behaviours that do need treatment but are common (eg depression)
this means that this alone should not be used to determine abnormality as may moss some that are more uncommon
hard to determine where to draw the line
it is hard to identify what is abnormal and what is not numerically and how rare a behvaiour must be to be considered abnormal
means it isnot a universal way to identify abnormality
What is deviation from social norms?
societies have unwitten rules of what is acceptable
eg. norms of decency, politeness and interpersonal behaviour
if a person behaves in a way that is different from theses rules they are considered abnormal
eg. antisocial personality dissorder
What is both a strength and weakness of deviation from social norms as a definition of abnormality?
social norms change over time
explanation has temporal validity as is subject to change based on the current attitudes.
however may cause people to unfairly discriminate others based on certain attitudes of the time
eg homosexuality in 1973 changed from a mental disorder in the DSM to sexual orientation disturbance and then later in 1987 was removed completely.
what is a weakness of deviation from social norms as a defnition of abnormality?
social norms are dependant on culture
eg hearing voices in western societies is considered abnormal but in some cultures it is respected and praised.
this means there is no universal criteria for what defines abnormality based on social norms. and could lead to different diagnosis across cultures, lacking in reliability.
What is failure to function adequately?
when behaviour is interfering with a persons daily routine
an inability to cope with day-to-day living so there is stress and discomfort casued to themselves and others
eg. depression may cause a person to stop going to work and eat normally.
what is a strength of failure to function adquately as an definition of abnormality?
recognises the patients perspective (subjective)
unlike other definitions it recognises the subjective circumstance of the person, rather than eg. statistical infrequency that compares a person to the whole population
means it is more suitable in defining abnormality.
what is a weakness of failure to function adquately as an definition of abnormality?
exceptions to the rule
there are times where a person may behave in a way that prevents ability to function adequately that is not abnormal in the circumstance
eg. gandhi went on hunger strike in campaign for indian independance
means some behaviour may be considered failure to function when it is not.
What is deviation from ideal mental health?
jahoda 1958
identified 6 characteristics which promote good psychological health
positive attitudes towards the self
accurate perception of reality - (able to see self and world in realistic terms not overly opt/pesimistic
resistance to stress - coping strategies
personal autonomy - self contained and independent
mastering the environment - competance in all areas of life
self actualisation - focus on future and their potential
if unable to show these qualities then there is indicationof abnormality, and therefor a vulnerability to mental dissorder
the more criteria that is not met the worse
what are two weaknesses of deviation from ideal mental health as a definition of abnormality?
difficult to meet all criteria
many people are lacking in one or more of the criteria and therefor by this defnition, most people are abnormal
eg. most people dont have positive attitudes towards themselves all of the time
unrealistically high standard for mental health
culturally relative
based on idealised western ideas of psychological health
may not be appropriate for some societes eg. those that do not value self autonomy and are more colectivist.
What are some culturally specific phobias?
TKS - almost exclusively of those from Japanese decent, not wanting to embarrass themselves in front of others
koro - Asian males, fear of genitals retracting into the body, eventually leading to death
What are the key assumptions of the behaviourist approach in relation to phobias?
abnormal behaviour is learnt like any other (phobias are learnt)
same applies to animals and humans
behaviour can be determined by the environement.
what are the 2 behavioural characteristics of a phobia?
panic - crying, screaming, running away, freeze
avoidance - effort made to avoid comming into contact with the trigger
what is the emotional characteristic of phobias?
anxiety
unpleasant state of high arousal
prevents sufferer from relaxing and experiencing plesant emotions
can arise from presence or anticipation of the trigger
response is disproportionate to the danger posed by the trigger
What are the 3 cognitive characteristics of phobias?
irrational beliefs - sufferer cannot be persuaded by rational arguments
cognitive distortions - perception of the phobia may be distorted (eg wasp may be seen as aggressive)
selective attention - sufferer cannot move attention from phobic situation
Breifly explain the two process model
used to explain phobias
phobias are aquired by classical conditioning
phobias are maintained by opperant conditioning
who put forward the two process model and when?
mower 1947
explain the role of classical conditioning in the two process model?
learning is due to pairing of neural stimulus and another stimulus that produces an automatic response.
eventually the NS can produce the automatic response alone
little Albert
a UCS (a bang) leads to a UCR (crying)
this UCS is then paired with an NS (white mouse)
through conditioning this NS becomes a CS leading to a CR (crying when seeing the white mouse)
this is also generalised to similar things such as a white rabbit etc.
explain the role of operant conditioning in the two process model
learning is based on the principle of consequences
if reinforced behaviour is more likely to continue
negative reinforcement → a behaviour will be repeated if the unpleasant situation will be avoided. (phobic responses)
the reduction in fear due to phobic responses reinforces the avoidance behaviour so the phobia is maintained.
what are two strengths of the two process model?
supporting evidence
this is a plausible explanation of phobia reinforced with evidence (little albert)
provides validity for the theory
practical applications/real world applications
(systematic desensitisation prevents operant conditioning and flooding prevents classical conditioning). exposing the patient to the feared stimuli and preventing the avoidance behaviour, phobic responses are reduced - counter conditioning is effective
shows it is a useful way of understanding phobic reactions
What are three weaknesses of the two process model?
evolutionary fears
we acquire phobias of things that have been an evolutionary source of danger, which explains why phobias of more modern things are rarer. shows that there is more to phobias than conditioning
not everyone can recall a traumatic incident
different processes may lead to acquiring a phobia (eg SLT). shows two-process model is not a complete explanation
genetic predisposition
not all people bitten by a dog develop a phobia but some do. we can inherit a genetic predisposition and vulnerability to developing phobias. means not a complete way of explaining the cause of phobias
what are two behavioural therapies used to treat phobias?
systematic desensitisation
flooding
What is flooding as a treatment for phobias?
patients given sudden exposure to a frightening situation
stops phobic responses very quickly
gives no option for avoidance behaviours so patient quickly learns that the stimulus is harmless
in classical conditioning this is extinction
a CS is removed when the CS (dog) is encountered without the UCS (being bitten)
unpleasant experience so patient must have full informed consent before this takes place.
what is a positive evaluation of flooding?
it is cost effective compared to other therapies, as it is more effective and faster
means patients are free from symptoms sooner
what are 2 weaknesses of flooding?
not appropriate for all patients
often find the procedure traumatic so aren’t willing to see it through
means time and money may be wasted with refusal to start or complete the treatment
not effective for all phobias
not as effective for complex phobias as they may have a cognitive component, not only feeling anxious but having unpleasant thoughts about the situation. means this method is limited
what is systematic desensitisation as a treatment for phobias?
based on counter conditioning (relearning a response)
aims to replace an undesirable behaviour (fear) with a more desirable one (relaxation)
who developed systematic desensitisation?
joseph wolpe 1950s
what is the process of systematic desensitisation?
patient uses relaxation techniques
patient and therapist construct a anxiety hierarchy - series of imagined stages, each one increasing a little in anxiety
patient imagines a stage whilst engaging in relaxation techniques
once a stage has been mastered (patient is able to remain relaxed when confronted with their fear) they move onto the next stage
patient eventually masters the most feared situation
what are two strengths of using systematic desensitisation?
works for a variety of anxiety disorders
75% of patients with a range of disorders and phobias responded well to SD compared to 33% that found drugs helpful. suggests it is more effective than drug treatments.
SD is quick and needs less effort than other psychotherapies.
patients are therefor more likely to continue with treatment making success more likely
what are the two weaknesses of using systematic desensitisation?
doesn’t seem to work well with phobias of dangerous animals
we may have a biological predisposition to have fears of animals that may pose a threat. so it may be an evolutionary survival strategy
treats the symptoms, not the causes
when the cause of the problem is not treated, symptoms may resurface as a different phobia, meaning it isn’t always completely effective
what are the 3 behavioural characteristics of depression?
disruption of sleep and eating behaviour
insomnia or hypersomnia, appetite may increase or decrease
activity levels
reduced energy makes people withdraw from life
aggression and self-harm
some sufferers can be aggressive towards others, or aggression can be directed towards the self
what are the emotional characteristics of depression?
lowered mood/self-esteem
more than feeling sad, feeling like you are worthless/empty
anger
directed at others or the self (which can lead to SH)
what are the cognitive characteristics of depression?
attending to and dwelling on the negative
pay more attention to the negatives of a situation or themselves, with a bias towards recalling unhappy events
poor concentration
cannot stick to a task and finds decision-making difficult
what does the cognitive approach state about depression?
examines how depression involves negative patterns of thinking and cognitive patterns such as schema.
what is becks theory of depression?
beck suggested that a person’s cognitions makes them more vulnerable to depression.
faulty informational processing
negative self schemas
the negative triad
What is faulty information processing as part of becks theory of depression?
when depressed we pay attention to the negative aspects of the situation, ignoring the positives
What is negative self-schema as part of beck’s theory of depression?
self-schemas are a package of information we have about ourselves
people with depression interpret all things about themselves negatively
What is the negative triad as part of beck’s theory of depression?
when depressed people have negative thoughts about the
self
world
future
Who developed the ABC model of depression?
Albert ellis 1962
explain the ABC model of depression and it’s assumptions
good mental health is the result of rational thinking
conditions like depression result from irrational thoughts (thoughts that interfere with happiness or being free from pain) shows how irrational thinking can affect our behaviours and emotions
A = activating events - an event that triggers irrational beliefs (eg failing a test or ending a relationship)
B = beliefs - a range of irrational beliefs contribute to depression (eg the belief that we must always achieve perfection, called ‘musturbation’)
C = consequences - when the activating event triggers irrational belief there are emotional and behavioural consequences.
give an example of the ABC model in a situation
A = Yasmine has been made redundant
B = Yasmine tells herself it was her own fault as she made too many mistakes
C = Yasmine feels she is incapable of doing any job and is struggling to sleep feeling there is little hope for the future
What are two strengths of the cognitive approach to depression (ABC model)?
good supporting evidence
Grazoli + Terry 2000 = assessed 65 pregnant women for cognitive vulnerability and depression before and after giving birth. women with high cognitive vulnerability were more likely to deal with post-natal depression
this shows the link between faulty cognitions and depression
by assessing before pregnancy we can determine that faulty cognitions are a causal factor
practical applications
forms the basis of CBT
butler et al 2006 reviewed 16 meta-analysis including 332 studies, which concluded that CBT is effective in treating disorders such as PTSD and depression
What are two weaknesses of the cognitive approach to depression (ABC model)?
neglects biology
there is evidence that there are biological components in depression. eg low levels of serotonin
means it is not a complete explanation for aggression
blames the client rather than situational factors
suggest the patient is responsible for their disorder however ignores situational factors such as life events and family problems that may be contributing
can be a strength as the client is able to change things to take control of their disorder
can be a weakness as it does not consider how changing life circumstances may help their depression
what is the cognitive treatments for depression?
CBT - rational emotive behavioural therapy (type of CBT)
what are the two functions of CBT
helps the patient recognise irrational thoughts and the consequences of thinking this way
substitutes irrational thinking patterns with rational ones, involving challenging irrational beliefs
how often to CBT session tent to be ?
how long does a course of CBT tend to last ?
once a week/every two weeks
course usually lasts between 5 and 20 session with each lasting 30-60 mins
Who developed Rational emotive behavioural therapy (REBT)?
albert ellis 1950s
a type of CBT
explain the 4-step process of rational emotive behavioural therapy…
identify and break down the problem
therapist begins to challenge the irrational beliefs by arguing
empirical argument = whether there is evidence to back up negative beliefs
logical argument = whether the thoughts follow logically from the facts
homework = patients complete tasks between sessions that challenge the irrational beliefs, and put rational beliefs into practice
behavioural activation = depressed client encourages to engage in enjoyable activities
what are 4 pros of CBT?
helpful in cases where medication has not worked
can be over a short time compared to other therapies
highly secured nature of CBT means it can be done in many formats eg groups, self-help books etc - very accessible
teaches helpful strategies that can be used in everyday life
what are 4 cons of CTB?
The patient must be willing to be invested and commit to therapy or it will not be effective
attending regular sessions and doing homework between them can be time-consuming
involves confrontation of anxieties
doesn’t address wider problems that may have an impact
What is the supporting evidence for an interactionist approach to treat depression?
march et al 2007
studied 327 adolescents with depression
after 36 weeks 81% per cent of both the drug group and the CBT group had shown significant improvements
however 86% in the interactionist group (CBT + drugs) had significantly improved meaning a combination of treatments may be more effective
what are two weaknesses of the CBT-based treatments of depression?
doesn’t address irrational environment
ignore potential factors that are consistently feeding into the disorder (eg bullying)
means it can demotivate people to change their circumstances
doesn’t work for all cases
CBT requires lots of motivation and some people struggle or refuse to change the way that they think. doesn’t work as well for severe depression where cognitive symptoms are worse than in other cases
means it is not a universally successful approach
What does the biological approach state?
all behaviour has a biological cause
behaviour is influenced by neurochemicals, genes and brain structure
psychological disorders are best treated with biological methods
what are obsessions and compulsions? (OCD)
obsessions = internal intrusive thoughts
compulsions = external behaviours which are repetitive
what are the behavioural characteristics of sufferers of OCD?
complusions
repetitive - eg hand washing, tapping etc
purpose is to reduce anxiety in response to a fear
avoidance
keeping away from triggering situations
what are the cognitive characteristics of sufferers of OCD?
obsessive thoughts
recurrent intrusive thoughts
cognitive strategies to deal with the obsessions
actions and compulsions can help anxiety but can cause failure to function adequately
what are the emotional characteristics of sufferers of OCD?
anxiety and distress
obsessive thoughts are frightening and anxiety about them may be overwelming, the urge to repreat the behaviour may also be frightening
guilt and disgust
irrational guilt over minor issues
disgust directed at something external or the self
what is the cycle of OCD?
obsessive thought
anxiety
compulsive behaviour
temporary relief
what are the genetic explanations for OCD?
candidate genes
there are specific gene markers that make people vulnerable to developing OCD
some genes involve the serotonin system eg the SERT gene which is linked to lower levels as it regulates serotonin transfer across the synapse
OCD is polygenic - 230 different genes have been linked to OCD
what are 2 strengths of the genetic explanations for OCD?
supporting evidence
family studies indicate a higher percentage of relatives of people with OCD also have the disorder (10%), than the prevalence rate which is 2%.
twin studies - nestadt et al 2010 reviewed previous twin studies and found that 68% of MZ twins shared OCD compared with 31% of DZ twins
practical applications
understanding biological processes linked with OCD can aid diagnosis, early detection and treatments that balance neurochemicals (eg. drugs to change serotonin levels)
what are 3 weaknesses of the genetic explanations for OCD?
Cromet et al 2007
found over half of OCD patients had experienced a traumatic event in the past and their OCD was worse if they had experienced more than one traumatic event
suggests OCD is not entirely genetic in origin
reductionism
reducing complex cognitive processes to biological causes, ignoring situational and environmental factors
determinism
What are the neural explanations of OCD?
the role of serotonin
OCD is linked with low levels of the neurotransmitter serotonin which is used in the brain to regulate mood
low levels prevent normal transmition of mood relevant information from neuron to neuron
mood and other mental processes may be impacted
brain structure
basal ganglia system and others have been implicated. if communication within these areas is disturbed may account for repetitive behaviours seen in OCD
what are two strengths of the neural explanations of OCD?
role of serotonin supporting evidence = drugs which increase levels of serotonin are effective in reducing OCD symptoms
role of basal ganglia supporting evidence = DBS (deep brain stimulation) that targets loops in the basal ganglia had helped to reduce symptoms
also supporting evidence provided by max et al 1994
What is a weakness of the neural explanations of OCD?
neural mechanisms may not cause OCD
people with OCD do have abnormalities in neurotransmitter levels and brain structures, but these could be the result of OCD and not the cause of it.
means it is not a clear cause
explain the process of synaptic transmission
an electrical impulse (also known as an action potential) travels down the axon of the presynaptic neuron.
when this impulse reaches the axon terminal the impulse triggers a release of synaptic vesicles which contain chemicals called neurotransmitters
these travel across the synapse and bind with the receptor sites on the membrane of the postsynaptic neuron.
the neurotransmitters then create either an excitatory or inhibitory effect making the neuron more or less likely to fire again
neurotransmitters are recycled between impulses
Explain the use of drug therapy in treating OCD
SSRIs (selective serotonin reuptake inhibitors)
OCD is associated with low levels
SSRIs prevent reuptake and the breakdown of serotonin in the presynaptic neuron
increases the levels of serotonin in the synapse so it continues to stimulate the post-synaptic neuron.
eg fluoxetine (20mg taken daily for 3-4 months to have an impact on symptoms)
what are the alternatives to SSRIs in the treatment of OCD?
not all patients respond to SSRIs
if not effective after 3 months dose can increase or a combination of meds can be given
eg SNRIs (serotonin-noradrenaline reuptake inhibitors) increases levels of both serotonin and noradrenaline
what are two strengths of using drugs to treat OCD?
effective in treating symptoms
Soomro et al 2009 reviewed 17 studies concluding that SSRIs are more effective than placebo with a decline in symptoms for 70%
cost-effective and non-disruptive
cheap compared to psychological therapy to good value for NHS
drugs do not disrupt patient’s normal routine (no need for regular sessions)
What are two weaknesses of using drugs to treat OCD?
can have side effects
side effects of SSRIs include indigestion and temporary blurred vision. can have more serious side effects that are less common (10% experience tremours and weight gain)
means effectiveness is reduced in cases where people stop taking their medication
treats the symptoms and not the causes
if OCD is a response to a traumatic life event, drug therapy can deal with symptoms, but not what is causing the disorder
to process the trauma psychological therapy may be necessary
mean drug therapy alone may not be appropriate for all cases.
what is the supporting evidence for the role of the basal ganglia in OCD?
Max et al. (1994) found that when the basal ganglia is disconnected from the frontal cortex during surgery, OCD-like symptoms are reduced, providing further support for the role of the basal ganglia in OCD.
