clinical psychology and mental health

what are definitions used for in clinical psychology

clinical psychologictsts and other mental health practitioners use definitions to identify when someones thoughts, feelings or behaviours may indicate a mental health difficulty.

when would statistical frequency be used to decide if someone needs help

-if their behaviour or experience is statistically rare compared to the general population
-it is used to identify behaviours or traits that are statistically rare or numerically unusual

when would someone be considered statistically infrequent

-someone falls at extreme ends of a normal distribution
-5% of the population

• 2 standard deviations from the mean

what does statistical frequency as a definition rely on

accurate and up to date statistical data to make fair comparisons and informed decisions to who potentially receives support

give on example of how statistical frequency can be applied

-IQ
-normally distributed with an average of 100
-a person scoring less than 70 falls more than 2 standard deviations away from the mean
-intellectual disability diagnosis
-support in education, health and social care

what is a strength of statistical frequency

-provides an objective, data driven way to identify when someone needs support
-doesnt rely on subjective judgement like other methods and instead uses measurable data e.g IQ score to highlight statistically rare traits
-most methods today to diagnose or screen for mental health rely on statistical cut off scores (depression and failure to function)
-highly relevant to modern mental health care. fair, consistent decisions - reducing bias

what is a weakness of statistical infrequency

-rigid cut offs can ufanirly exclude people who genuinely need help
-deciding where the 'rare' threshold is arbitrary and may not reflect individual needs. e.g some people cant get support from CMHT because their scores fall just below threshold
-blocks people from receiving timely and nesseactry care even when in distress
-therefore cut of point is subjective which undermines it relativity in real world decisions leading to injustice

another weakness of statistical infrequency

-not complete definition on its own
-identifies statistically rare traits or behaviour in the population however it foist consider whether those experiences are distressing or interfere with someones ability to function - key for clinical practice
-professionals use other definitions alongside it (failure to function adequately/ideal mental health) offering more holistic approach
-not enough to decide if someone needs psychological support - numbers and context are needed in mental health care

what is failure to function adequately

-individual cant cope with the demands of every day living/life e.g having a job/maintaining relationships because of psychological stress
-distress to individual or danger to others is also considered

What is the WHODAS 2.0 and what are its 6 domains

-world health organisation disability assessment schedule- measures how much a person's mental or physical health affects their ability to function

1. cognition (memory/conc)
   2.mobility
   3.self care
   4.getting along (relationships)
   5.life activités
2. participation

what is a strenght of failure to function

-considers individual perspective when assessing if support is needed
-the persons own report of how they are coping with daily life is central to the assesement
-tools like WHODAS use self report across a myriad of domains making more person centred like other definitions on how someones beahvior appears to others
-makes definition more relevant in clinical practices as it values persons living experience and difficulties

what is a weakness of failure to function

-invloves subjective judgement
-tools like WHODAS aim to provide structure but professionals needed to asses severity of dysfunction
-one clinician might interpret a persons difficulty as serious whereas another might see it as manageable depending on their judgement/experince
-lack of consistency lead to difficulties making it less reliable

what is another weakness of failure to function

-not a complete definition on its own
-WHODAS assesses functioning and provides numerical score meaning it overlaps with statistical infrequency. but it over focuses on external beahvior and doesnt always reflect full range of mental health difficulties
-other definitions such as deviation from ideal mental health can capture things like isolation, self worth that dont always reflect day to day functioning
-shwows that it isn't sufficient on its own - must take into account other factors to make fair and accurate decisions

how does jahoda define ideal mental health

the presence of certain positive charachtersitics or qualities rather than the absence of illness
-mental health is judged by the presence of 6 qualities and the absence of one or more of the qualities is indicative of poor mental health
-more criteria they fail to meet, more serious the need to mental health support

what are the 6 criteria for optimal living as proposed by jahoda

1. Positive attitude towards self
2. Resistance to stress through coping statergies
3. Accurate perception of reality
4. Independence (autonomy) making them self reliant and able to make decisions
5. Self actualisation- focused on future and own personal growth and development
6. Environmental mastery - competent in all aspects of life

what is one strength of jahodas definition through the notion of deviation from ideal mental health

-takes a positive and holistic approach to understanding mental health
-instead of focusing on symptoms of dysfunction it highlights what good mental health should look like - such as self esteem, personal growth and the ability to manage every day life
-encourgaes a more complete view of a persons well-being and can help justify individuals who need support and in what areas - useful for long term support goals
-valuable addition to the field of mental health as it shifts from just treating illness to supporting mental wellness

what is one weakness of jahodas definition through the notion of deviation from ideal mental health

-the criteria for ideal mental health and too demanding and unrealistic
-very few people consistently meet all six of jahodas criteria - even healthy individuals struggle with stress or lack of self acculisation at times
-many people would be labelled as mentally unwell using these definitions even when they dont need support
-reduces accuracy and usefulness in identifying who genuinely needs help and issues regarding over diagnosis based on high standards leading to a misuse of reasoruces

what is another weakness of jahodas definition through the notion of deviation from ideal mental health

-culture bias
-criteria reflect western, individualist values like independence and autonomy - not valued the same way in collectivist cultures
-in some cultures depending on others and prioritising community over personal achievement is seen as healthy ands not a sign of poor mental health
-may undfailty pathologise people from non western cultures and does not reflect how mental health is viewed globally

how does deviation from cultural and social norms define mental health

-mental health professionals may decide someone needs support is their beheaviour is very different from what is generally excerpted or accepted in their culture or community

what is a social norm

all societies share ideas or make collective judgements about what counts as normal, acceptable or typical behaviour and when someone acts in a way that goes against these unwritten rules it may raise concern

why would deviations from social/cultural norms be seen as inconsistent

ideas on what is considered acceptable vary between different cultures and so this way of identifying who needs help is not very consistent

an example of how deviation of social norms can help identify if someone needs mental health support

if a person with schizophrenia may respond to hallucinations in public say shouting or talking to themselve
-others may see this is a serious violation of social expectations or conduct which can then lead to a referral for mental health support

what is a strenght of deviation from social norms as a definition

-it reflectors real world concern as people are often first referred for help because others notice something unusual or socially inappropriate
-e.g teachers, police officers or family members may raise concerns when someones beahvior violates expectations in public settings
-acts as a valuable starting point for identifying people who may be struggling and need support. e.g if a student starts talking to themselves loudly in class or acting upredictably a reacher may become concerned and seek help for them
-not a complete definition but it has practical value as an early warning sign

what is a weakness of deviation from social norms as a definition

-norms differ greatly between cultures
-what is considered unusual or unacceptable in one culture might be seen as normal in another, meaning someone could be labelled as needing support in one cultural context, but not in another, which raises concerns about fairness and bias (ethical)
-e.g Gera et al in uk people of African carribean descent are diagnosed used with schizophrenia 7 times more often than the general population partly because behaviours that differ from the dominant cultures norms may be misinterpreted as a sign of mental ill ness
-highlights that the definition is culturally relative making it less valid as a universal tool as it can lead to an unfair or biased assement in those that don't fit the dominant culture standard

what is another weakness of deviation from social norms as a definition

-limitation is that it cant be used in isolation
-defintion relies on social expectations to judge beahvior but it doesnt consider contexts like whether the person is distressed or coping day to day
-e.g when someone is talking to themselves in public it might break a social norm but without knowing whether they are distressed, functioning well or making a personal choice its hard to tell whether they need support
-defintions like statistical infrequency or failure to function offer Cleary, measurable signs of difficulty
-gives an incomplete view of mental health as it depends too much on judgement and misses the broader context needed

what sections are characteristics of mental disorders divided into

behavioural - how a person acts
emotional - how a person feels
cognitive - how a persons thinks
-psychologists use these to describe and diagnose mental health disorders by looking at patterns of beahvior, thoughts and feelings

what is a phobia

-a type of anxiety disorder characterised by an irrational or extreme fear of a specific object, situation or activity
-fear is often disproportionate to the actual danger posed

what can phobias leas to

-leads to avoidant behaviour which can become malidaptive meaning it disrupts and individuals ability to function in every day life

what are the behavioural characteristics of phobias

1. avoidance - making a conscious effort to to stay away from the phobic stimulus
2. panic - crying, screaming or running away
3. endurance - if remaining in the presence of the stimulus experiencing extreme anxiety

what are the emotional characteristics of phobias

1. anxiety - immediate or immense fear when confronted with phobic object or situation
2. unreasonable emotional response - disproportionate to actual danger

what are the cognitive characteristics of phobias

1. selective attention - focused on phobic stimulus
2. irrational beliefs - distorted ideas
3. cognitive distortions - perceiving stimulus in disorted way

what is depression

-mood (affective) disorder
-characterised by persistent low mood and lack of interest and pleasure in usual activities

how does the DSM-5 diagnose major depressive disorder

-requires minimum 5 symptoms to be present for a minimum of 2 weeks and must include either:

1. depressed mood most of the day, nearly every day
2. diminished interest and pleasure in almost all activities (anhedonia)

what are the behavioural characteristics of depression

1. activity levels - reduced activity (lethargy), reduced movement, social withdrawal or agitation
2. disruption to sleep and eating - insomnia or hypersomnia, appetite loss or increase

what are the emotional characteristics of depression

1. lowered mood - feeling worthless, empty or hopeless
2. anger - directed at self or others
3. low self esteem - worthlessness of self hate

what are the cognitive characteristics of depression

1. poor concentration
2. negative self schemas
3. absolutist thinking - black and white

what is OCD

-anxiety disorder characterised by:

• persistent, unwanted thoughts (obsessions)
• repetitive behaviours (compulsions) used to reduce anxiety

What are the behavioural characteristics of OCD?

1. compulsions - repeptive behaviours to reduce anxiety
2. avoidance - avoiding situations that can trigger obsessions or compulsions

What are the emotional characteristics of OCD?

1. anxiety and distress
2. depression

What are the cognitive characteristics of OCD?

2. obsessive thoughts
3. cognitive statergies
4. insight into excessive anxiety
5. hyper vigilance

who synthesised the two process Model and what does it propose

-mowrer
-suggests that phobias are learnt and assumes that phobias develop through an experience of a negative or traumatic event
-acquired through classical conditioning maintained through operant conditioning

how are phobias acquired through classical conditioning

-by forming an association between a neutral stimulus and an unconditioned stimulus which creates a fear response
-the neural stimulus now becomes a conditioned stimulus which creates a conditioned 'fear' response

what is an example of a case study of how a phobia can be axcquired through classical conditioning

Watson and Rayners - little Albert study

what was the aim and method of Watson and Rayners little Albert study

-they aimed to investigate whether a phobia could be created in an infant using classical conditioning
-child 'little Albert' was presented with a wide range of stimuli, was curious and wanted to interact and play with the rat (neutral stimulus). The researchers then paired the exposure of the white rat with the sound of a metal rod being hit by a hammer

what were the results of Watson and Rayners - little Albert study

-after pairing 7 times;
found that little amber began to cry and crawl away very time the white rat was bought over to him. white rat became the conditioned stimulus with fear being the condtioned response

what were the conclusions of Watson and Rayners - little Albert study

the researches concluded that classical conditioning in humans and explain a myriad of behaviours - in this case -phobia formation. however, it can also be applied to attachment, falling in love and mental illness

how are phobias maintained through operant conditioning

-avoidance of the feared object or stimulus reduces the unpleasant feelings of fear or anxiety caused by the conditioned stimulus
-this acts as negative reinforcement which strengthens the avoidance beahvior so the phobia is maintained

what is a strength of the behavioural approach as a way of explaining phobias

-there is strong reaserch evidence to support the idea that phobias can be acquired thorough classical conditioning
-watson and Rayner actively demonstrated this is in their study with little Albert, they paired loud noise (UCS) with the presence of white rat (NS) which he did not initially fear. after repeated pairings he began to show fear (CR) to the white rat (CS)
-shows how a neural object can become a source of fear through association whith an unpleasant experience supporting the role of classical condtionming
-howver this only explains how phobias are acquired but not how they are maintained - provides limited support for two-process model lacks OC

what is a weakness of the behavioural approach as a way of explaining phobias

-some common phobias such as snakes.may not always develop from a direct negative experience, giving alternate explantations
-better explained by seligmans biological preparedness theory - argues that humans are evolutionarily predisposed to fear certain things that posed a threat to survial in the past
-people who were more cautious of dangerous animals or heights were more likely to survive and pass on genes. explains why people today have phobias with no personal trauma linked to them
-challenges completeness of the two-process snorkel as it doesn't account for phobias that arise without learned experience

what is another strength of the behavioural approach as a way of explaining phobias

-understanding the notion of the development of phobias through classical and operant conditions had led to the development of effective behavioural treatments

• systemic desensitisation uses CC to help individuals form new associations with phobic stimulus - replacing fear with relaxation. flooding prevents avoidance behaviour preventing negative reinforcement (OC)
  -high effective in treating specific phobias which supports validity of two-process model by demonstrating the real world applicability of the principles
  -strengthens behaviourist explanation and highlights practical usefulness in developing successful intervention

What are the two cognitive explanations of depression

-Beck's negative triad
-Ellis' ABC Model

What are the three components of becks cognitive triad

1. Negative thinking about the self - individual sees themselves as hopeless,worthless and inadequate
2. Negative thoughts about the world - has the impression there is no hope anywhere
3. Negative thoughts about the future- pessimistic view of future

What is a schema and a self schema

-A schema is a mental framework developed through experience to help us interpret information

• a self schema refers to how we view ourselves

How did beck suggest negative self schemas develop and continue

-often develop in childhood or adolescence excuse of negative experiences such as criticism, abuse or bullying
-continue into adulthood and shape how an individual perceives themselves

2 examples of negative self schemas

1. Self blame schema - you are responsible for all misfortunes
2. Ineptness schema - always fail or incapable of success

What is a cognitive bias

-a habitual and faulty way of thinking which further reinforces depression

• referred to as automatic thoughts that occur quickly without any conscious awareness

What are two things that people with depression tend to do in regard to do cognitive bias

1. Focus on negative aspects of situation
2. Make overly negative, self defeating interpretations which led to hopelessness, low mood and lack of motivation

2 example of common cognitive biases

1. Overgeneralisation- drawing broad conclusions from a single event
2. Catastrophising - expecting worse possible outcome

What does Ellis's ABC model propose

-explains how irrational thought can lead to emotional issues
-not the negative event in itself that causes depression but rather the interpretation of the event though irrational belief

What does the A stand for in Ellis's ABC model?

Activating event - negative or stressful event e.g failing an exam

What does the B stand for in Ellis's ABC model?

Belief - event triggers irrational belief which are unrealistic and illogical. Come from mustabatory thinking - the believe that certain things must happen for a person to be happy or feel worthwhile e.g I must do well - if not I'm a failure

What does the C stand for in Ellis's ABC model?

Consequence- irrational belief lead to emotional and behavioural consequences such as low mood, feeling worthlessness and withdrawal

What is a strength of becks cognitive theory of depression

-supported by research evidence
-cohen et al conducted a prospective longitudinal study to investigate whether cognitive vulnerability predicted development of depression later
-found adolescents who showed cognitive vulnerability (e.g negative self schemas) were significantly more likely to experience depressive symptoms

• supports becks theory that cognitive distortions and negative self schemas ar or just present during depression but adds to development- predictive validity

What is a weakness of cognitive explanations for depression

-don't fully account for biological causal factors
-research shows link between depression and biological factors like low serotonin and genetic vulnerability. Diathesis stress model suggests individuals with genetic predisposition are more likely to develop depression when stressful life events
-faulty thinking may be a symptom rather than a cause. Biological factors could trigger depression which leads to negative or irrational thoughts described - not complete explanation

• as a result using biological explanations alongside cognitive ones offers more comprehensive account

Strength and weakness of depression

-led to development of effective treatments such as CBT
-works by identifying and challenging negative and ideation thoughts which reduces depressive symptoms among many patients
-suggests negative thoughts aren't just symptoms but play a causal role
-development of CBT highlights how cognitive explanations advance understanding and treatment irl settings

What did alloy et el do and find

-tested thinking styles of young Americans in early 20s
-placed in either negative or positive thinking group
-after 6 years the researchers found that only 1% of positive group developed depression compared to 17% of negative group

• support through research

What did taghavi et al find

Clinically depressed individuals scored higher on measures of irrational beliefs compared to control
Suggest that negative and irrational beliefs play a role in depression

Further weakness of depression

• may be more to do with social circumstances
• becks theory is generally more effective at explaining endogenous deprsssiob while Ellis theory is better suited for reactive depression. Becks helps us understand depression that arises from internal long term cognitive vulnerability whereas Ellis is usually for explaining depression what occurs as a reaction to external stressors

What does beck's negative triad propose

-That depression is the result of automatic distorted and negative thinking patterns
-particularly about self, world and future
-maintained by negative self schemas and cognitive biases

what is the most widely used treatment for depression and what is it based on

-CBT - cognitive behavioural therapy

• based on cognitive explanations of depression which suggests negative thinking causes depressive symptoms

how does CBT work

-aims to identify and challenge irrational/unhelpful cognitions
-encourgaes behavioural activation which helps individuals engage in positive, rewarding activities which can improve mood and reduce symptoms of depression

what are the two types of CBT

• Ellis's rational emotive behavioural therapy (REBT)
• Becks CBT

what does REBT do

-helps identify and challenge negative cognitions and beliefs
-encourages them to reinterpret their thoughts in a more positive and realistic way
-reduced negative feelings and depressive symptoms

What does the ABCDE model stand for?

A - activating event
B - Beliefs about event
C - consequences (emotional and behavioural)
D - dispute (challenging irrational beliefs)
E - Effect or exchange (replacing irrational beliefs with rational ones)

what does disputing irrational thoughts involve and what are 2 common methods

-invlvoes identifying past experiences that triggered negative beliefs/behaviours and using rational arguments to challenge them

1. empirical dispute - asking for evidence to support negative thought
2. logical dispute - questioning whether the belief is logically true

what does Becks CBT do

-aims to identify thoughts that cause depression.

1. schemas are identified
2. thoughts are challenged
3. patients are enoutgaed to test reality of their beliefs by 'putting thoughts on trial' by looking for evidence to support /contradict
4. patients are given homework to record positive event
5. known as patient as scientist collecting evidence that can be used to contradict negative thoughts to show they bare incorrect
6. behavioural activation

strenght of the cognitive approach to treat depression

-strong evidence which supports effectiveness of CBT
-March et al investigated 327 adolescents diagnosed with depression and compared the outcomes of CBT and SSRIS and combination of both. after 36 weeks of treatment 81% of those receiving CBT and those taking antidepressants showed significant improvement.
-supports validity of CBT and value as a non biological alternative with no medication
-found that combination group showed highest improvement rate at 86%. indicates that CBT may be best when part of integrated treatment approach

weakness of the cognitive approach to treat depression

-not suitable for individuals with severe depression as it requires a high level of motivation and engagement
-lack motivation or energy to attend sessions or engage with CBT tasks. antidepressants may be more suitable initially
-CBT most effective when used alongside medication for those w severe depression allowing patient to stabilise. also relies on quality of therapist client relationship not just therapy
-limiuts effectiveness as a stand alone approach for severe depression

another weakness of the cognitive approach to treat depression

-too much emphasis on cognitive porcedss while ignoring social and environmental factors
-e.g individuals experiencing depression due to difficult circumstances like DV or poverty may not benefit from being encouraged to reevealue their thinking patterns as they may be realistic
-attempting to alter 'irrational beliefs' may be unhelpful or harmful it it ignores the need for real life change. CBT does not directly address factors in external environment
-may be not appropriate for all individuals w depression especially those with symptoms linked to realistic negative experiences - one size fits all treatment

how does the biological approach explain ocd

-mental disorder involving obsessions and compulsions
-caused by genetic inheritance and abnormalities in brain chemistry

what are the two biological explanations of ocd

genetic and neural

what does the genetic explanation of ocd involve

-suggest that individuals may inherit a genetic vulnerability to developing ocd
-supported by the family and twin study as well as reaserch into candidate genes

what does the family study as an reaserch evidence for ocd involve

-nestadt found that ocd prevelce was 11.7% for people with a first degree relative with ocd compared to 2.7% in those without
-shows that individuals may inherit a biological vulnerability to the disorder. the higher prevelance among first degree relatives who share 50% of genes indicates that ocd may run in families due to shared genetic factors

what does the twin study as an reaserch evidence for ocd involve

-comapred identical (monozygotic) twins with non identical (dizygotic) twins
-MZ twins share 100% of genes and DZ share 50%.
-gottesman and Carey found an 87% concordance rate for MZ and 47% for DZ
-higher concordance rate in MZ twins suggest that genes play a major role in development of OCD

what are candidate genes

-specific genes thought to be involved in OCD.
-they influence biological process like nuerotrasmitter levels that are thought to contribute to symptoms of OCD
-COMT gene
-SERT gene

what is the COMT gene

-involved in the breakdown of dopamine in the brain
-varaition in gene leads to lower enzyme activity meaning dopamine does not break down as efficiently leading to higher levels
-higher dopamine levels may overstimulate brain areas involved in reward and habit formation - reinforcing compulsive behaviours

what is the SERT gene

-responsible for transporting seratonin across synapses
-mutation linked to reduced serotonin activity because it leads to faster reuptake of serotonin
-individuals who have lower serotonin levels may be more vulnerable to obsessive thoughts and increaced anxiety (cog)

how does the notion of polygenic relate to ocd

-thought to be polygenic
-Taylor suggested that up to 230 different genes may be involved and a different combination of genes may lead to different forms of OCD such as checking, hoarding or contamination

what does the neural explanation of OCD involve

-focuses on neurotransmitters and the structure and function of the brain

what is the invlvoemnt of neurotransmitters with OCD

1. serotonin - responsible for regulating mood and emotional responses. low levels of seratonin may lead to obessive thoughts and anxiety
2. dopamine - plays key role in reward seeking beahvior, motivation and movement. high levels of dopamine mat contribute to compulsive behaviours in OCD

what is the involvement of brain structure with OCD

-the worry circuit
-suggests the disorder is caused by abnormalities in specific areas of the brain including the orbitofrontal cortex, caudate nucleus and thalamus

how does abnormalities in the orbitofrontal cortex contribute to ocd

-processes sensory information from the environment
-Evaluates this input and turns it into thoughts and behavioural impulses
-might detect that hands feel dirty and generate a worry signal to prompt washing (action)

how does abnormalities in the caudate nucleus contribute to ocd

-filters out unnecessary or minor worry signals preventing overreaction to harmless stimulus
-may not function properly so irrational or exaggerated worry signals are not suppressed
-one explanation is low serotonin may reduce effective communication between brain areas
-another explanation is that high levels of dopamine may overstimulate caudate nucleus preventing it from functioning

how does abnormalities in the thalamus contribute to ocd

-recives unchecked signals and becomes overactive
-amplies the worry sending strong signals back to the OFC creating a loop of relative thoughts and actions reinforcing obsessions and encouraging compulsions

what is a strength of the biological approach to explaining OCD

-strong evidence supporting both genetic and neural explanations increasing biological credibility of biological basis
-nesdats reaserch (explain it)
-hu compared serotonin levels in 169 ocd suffered and 253 non suffered and found ocd had lower levels. supports idea of abnormal function of neurotransmitter serotonin leading to harder management of intrusive thoughts which causes obsessive thoughts and compulsions
-increaces support for genetic explanation by showing the effect of the genetic link and the neural explanation showing the effect of chemical imbalances in the brain

What is a limitation of the biological approach to explaining OCD

-both genetic and neutral explanations propose explanations for increaced risk factors but dont explain why ocd develops in some but not others
-cromer found that over half of ocd sufferers experienced traumatic events and those with more than one trauma had more severe sympoms - environmental triggers
-neural evidence is correlational and cannot prove that brain differences causes OCD. could be that the brain changes as a result of having OCD
-sugegsts that biological vulnerabilities like genetics and brain function interact with environmental stressors to cause OCD. diathesis-stress model

-biologically reductionist because they focus mainly on biological causes like genes and neurotransmitters while overlooking environmental factors
-genetic explanations focus on inherited vulnerability and neural highlight neurotrasmmier levels but neither fully consider social or cognitive influences. oversimplification
-however, understanding facts has been crucial for developing effective treatment. SERT has influenced the used of SSRIs increasing seratonin and reducing OCD symptoms
-may be reductionist but led to useful drug therapies that improve patients lives

how is drug therapy used to treat OCD

-works by targeting neurotransmitter imbalances - especially low levels of serotonin which are linked to obsessive behaviours and anxiety
-SSRI's most common drug - antidepressant that works by increasing amount of seratonin available in brain

how does serotonin usually work

-seratonin released into synapse, carries sign al to postsynaptic neuron.
-any seratonin not used is reabsorbed by the presynaptic neuron in a process called reuptake

how do SSRI's work

-blocks the reuptake of seratonin into the presynaptic neuron.
-means more seratonin remains in the synapse increasing the chance that it will bind to the receipts on the postsynaptic neuron
-leads to greater seratonin activity which has a calming effect causing reduced anxiety and intensity of obsession and compulsions decreaces - breaks cycle