Psychopathology

4 definitions of abnormality

deviation from ideal mental health

failure to function adequately

deviation from social norms

statistical infrequency

who established criteria for deviation from ideal mental health

Jahoda in 1958

what were Jahoda’s criteria

• No distress

• Rationality

• Self-actualising

• Cope with stress

• Realistic world view

• Good self-esteem

• Independent

• Success in work and relationships

EVAL: Comprehensive definition

Deviation from ideal mental health covers range of mental health

Makes it a good tool for looking at mental health

EVAL : Cultural relativism

Ideal mental health is specific to areas

E.g. independence is viewed differently viewed in individualistic cultures vs collectivist cultures

EVAL: Unrealistic standard for mental health

Hard to attain all of Jahodas criteria, can be viewed as positive and negative

POS = Encourages everyone to discuss mental health

NEG = May not provide value for thinking about treatment if everyone has failings

Statistical infrequency

Analyse the distribution, at any time, there will be a small proportion at the higher and lower ends

Example for use of statistical infrequency

Intellectual disorders

EVAL : Real life use for stats

Stats are used in diagnostic process

Helps determine severity

EVAL : Statistical infrequency doesn’t mean it’s bad

IQ : High IQ is just as infrequent as low

Infrequent behaviour require treatment or diagnosis

EVAL : Infrequency doesn’t need a label

Someone may have low IQ but be living a good life, won’t benefit from a label

Define deviation from social norms

Behaviour the offends sense of normality

Example for use of deviation from social norms

Antisocial personality disorder

EVAL: Deviation isn’t sole explanation

POS = Real life application

NEG = Shouldn’t be the sole reason for defining abnormality

EVAL : Cultural relativism

Norms differ widely between societies

What is seen as acceptable differs too greatly to appropriately label mental illness

EVAL: Focus on deviation can lead to abuse of rights

Deviation ignores minorities too much, looking through history highlights

Focuses on control of ethnic minority and women

Define failure to function adequately

Cannot cope with the demands of everyday

Who came up with the criteria for failure to function adequately

Rosenham and Seligman in 1989

Criteria for failure to function adequately

• Unpredictability

• Maladaptive behaviour

• Distress to self or others

• Irrationality

• Unconventionality

• Violation of morals

EVAL : Considers individuals

Failure to function looks at the individual and what they are struggling with

EVAL: How do we say someone is failing to function

Describing behaviours as failures may limit personal freedoms

E.g. not having a permanent address = someone who travels

EVAL: Subjective judgement of failure

Measured by how much distress others or self have / suffering caused

When does distress become enough, how do we measure others distress

Behavioural characteristics of phobias

• Panic

• Avoidance : Effort to avoid contact

• Endurance : Remain in presence, with high anxiety

Cognitive characteristics of phobias

• Irrational beliefs : increases pressure of stimulus

• Selective attention to stimulus : hard to look away, perceived danger

• Cognitive distortions : wrongful perception

Emotional characteristics of phobias

• Anxiety : emotional response to fear

• Unreasonable emotional response : beyond reasonable

Who came up with idea for acquisition through classical conditioning

Watson and Reyner (1920)

Little Albert and the white rat

What happened with Little Albert and the white rat

No fear initially

Paired rat (Neutral stim) with loud noise (unconditioned stim) to produce fear (unconditioned respo)

Overtime rat becomes a conditioned stimu and produces a conditioned response

Who suggested operant conditioning maintains phobias

Mowrer = two process model

Operant conditioning and phobias

Reinforcement increases behaviour

Negative reinforcement (screaming etc) = avoid situation

EVAL: Explanatory power

Explains how phobias are caused and maintained

Helps develop therapy ideas

EVAL: Alternative theory for avoidance

Two model says avoidance is to reduce anxiety

Agoraphobes avoid stimuli to increase positive feelings, staying inside doesnt reduce anxiety but maintains safety

EVAL: Incomplete explanation of phobias, evolutionary

Bouton : We have evolutionary phobias that primitive humans had to keep themselves safe

Seligman : biological preparedness, innate predisposition to certain fears

EVAL: Assumes all phobias follow trauma

Some phobias appear without bad experience to associate stimulus with

Two treatment types for phobias

Systematic desensitisation and flooding

How does systematic desensitisation work

• Utilises idea of classical conditioning, trains brain to have another response (counterconditioning)

• Reciprocal inhibition = Brain cannot have panic and relaxation occur at the same time

3 processes in systematic desensitisation

1. Anxiety hierarchy

2. Relaxation

3. Exposure

What is the anxiety hierarchy (SD)

-Patient ranks situations involving stimuli

-Rankings go from least anxiety inducing to most

What is relaxation (SD)

-Patient learns relaxation techniques

-Breathing techniques, visualisation

Sometimes drugs are used to aid

What is exposure (SD)

-Patient is exposed to stimuli in their relaxed state

-They work up their hierarchy, attempting to stay relaxed

EVAL : SD is effective

Gilroy et al : 42 patients with 3 45min sessions, control group of relaxation without exposure

Assessed at 3 months and 33 months, both times SD group were less fearful

EVAL : SD is good for diverse range of patients

Preferable for those with learning difficulties and other anxiety disorders

Aim is to maintain calm throughout, encourages reflection

EVAL: SD preferable to patients

Given choice, most pick SD,

doesnt cause same degrees of trauma, learning relaxation processes can be beneficial otherwise

Reflected in low refusal and drop-out rates

What does flooding need

Longer sessions, 2/3 hours

Extinction of response= Learning quickly that stimulus is actually safe

Flooding in terms of conditioning

Response is eradicated when conditioned stimulus is encountered without unconditioned stimulus

E.G. encountering a big dog without it biting

Ethics of flooding

Not unethical, informed consent MUST be given

Patient often given a choice between SD or flooding

EVAL : Flooding is cost effective

Ougrin: Flooding is effective and quicker than other alternatives

Free of symptoms quicker, treatment is shorter and therefore cheaper

EVAL : Flooding not effective for all phobias

Social phobias involve cognitive aspects, that may require reflection

Need to tackle irrational thoughts

EVAL: Flooding can be traumatic

Patients are likely to not see treatment through to the end, phobia not replaced

Money and time wasted

Behavioural characteristics of depression

• Change in activity levels

  • Low energy or psychomotor agitation = High energy, pacing and restlessness

• Disruption to sleep and eating

  • Insomnia or hypersomnia

• Aggression/ self-harm : irritability has knock on effects

Cognitive characteristics of depression

• Poor concentration

  • Leads to poor decision making

• Dwelling on negative thinking : bias towards unpleasant events

• Absolutist thinking

Emotional characteristics of depression

• Lowered mood

• Anger

• Lowered self-esteem

Aaron Beck = Cognitive vulnerability

Beck believed some people were more vulnerable to depression

It is their cognition that make them more vulnerable

BECK

Faulty information processing

Blown out of proportion

Black and white thinking

Focusing on the negative

BECK

negative triad

Negative triad is a person’s outlook

• Negative view on world

• Negative view on future

• Negative view on self

BECK

Negative self-schemas

Perceive information about self and world around self through negative lens

EVAL: Beck has supporting evidence GT

Grazioli and Terry : Assessed 65 mothers before birth for cognitive vulnerability and after birth for signs of depressions

Women judged as more vulnerable more likely to suffer post-natal depression

EVAL: Beck has supporting evidence CB

Clark and Beck: Reviewed research on cognitive vulnerability, found solid support for vulnerability factors

Cognitive weaknesses can be seen before depression develops

EVAL : Beck’s theory can be applied to CBT

All cognitive aspects of depression can be targeted by CBT

Negative triad is easily identified and challenged

EVAL : Beck’s theory doesnt explain all aspects of depression

Doesn’t explain all facets, but depression is wide, varying disorder

Depression can cause anger, delusions and hallucinations

Ellis = ABC

Albert Ellis thought that depression could be as result of irrational thoughts

Good mental health comes from thinking in a way that allows individual to be happy and free of pain

ELLIS

what does ABC stand for

A - Activating event

B - Beliefs

• Irrational interpretations of event

C - Consequences

• Emotional and behavioural events

EVAL - Ellis provides partial explanation

Some depression doesnt have obvious activating event

EVAL - Ellis’ theory is practical in CBT

Leads to successful therapy, challenge irrational beliefs and reduce depression

EVAL - Ellis’ theory doesn’t explain all aspects of depression

Depression has wide variety of symptoms, has same faults as Beck’s approach

What does CBT do

Tries to identify negative thoughts and challenge them

Beck’s CBT

• Specifically aims to identify NEGATIVE TRIAD and challenge it

• Patient as scientist : Therapist will aim to make patient identify evidence for and against their negative beliefs which therapist can use to highlight irrationality of beliefs

What is Ellis’ REBT

REBT = Rational Emotional Behavioural Therapy

Extends ABC to ABCDE

D : Dispute E: Effect

How does Ellis’ ABCDE REBT

• Identify B and C, and challenge them

• Involves vigorous argument (hallmark of REBT)

Ellis’ therapy involves many types of argument

• Vigorous argument - Actively argue against ideas

• Empirical argument - Dispute beliefs w/ evidence

• Logical argument - Argue whether their logic tracks

EVAL : CBT is effective

March et al : 327 adolescents, 3 groups: CBT, meds, CBT + MEDS, groups evaluated after 36 weeks

Findings: 81% CBT, 81% meds, 86% CBT and meds recalled improvement in symptoms

EVAL : CBT may not work for most severe cases

CBT requires engagement, hard if depression is severe

Meds can be provided alongside or as alternative

EVAL : CBT may be beneficial due to relationship to therapist

Rosenzweig : Suggests quality of patient-therapist relationship is key to improvement in therapy

EVAL: CBT focuses too heavily on present and future

Some cases may involve early trauma, which may be ignored by treatment

EVAL: CBT focuses too much cognition

McCullers : Circumstances may prevent individual from engaging or benefitting

Patient living in poverty or suffering abuse need to change environment to fully engage/ accept emphasis on cognition

Behavioural Characteristics of OCD

Compulsions

• Repetitive = Compelled to repeat

• Reduce anxiety

Avoidance

• Avoiding situations that trigger OCD

Cognitive Characteristics of OCD

Obsessive thoughts

Insight into irrationality

• Excessive anxiety and hypervigilance

Cognitive coping strategies

Emotional Characteristics of OCD

Anxiety and distress

• Accompanies obsessions, compulsions and intrusive thoughts

Accompanying depression

Guilt and disgust

Explanations for OCD

Neural explanation and Genetic explanation

Lewis - Genes for OCD

Of his OCD patients, 37% had parents with OCD, 21% had siblings with OCD

• Genetic vulnerability not certainty

Diathesis-Stress model

• Certain genes leave people more likely to suffer from mental disorder

What are candidate genes

• Genes that create vulnerability for OCD

  • Some involved in regulating development of serotonin system

Named candidate genes

5HT1-D beta gene

COMT gene

SERT gene

5HT1-D Gene

Function = Transporting serotonin across synapses

COMT gene

• Regulates dopamine production

  • Tukel et al: One form of COMT found more commonly in OCD patients

  • Variation means lower COMT gene = lower regulation = higher dopamine

SERT gene

• Affects transport of serotonin = lower levels of serotonin

• Mutation found in 2 families, where 6 of 7 members per family had OCD

• Ozaki et al.

Why would you describe OCD as aetiologically heterogeneous?

Means that the origin of OCD is different in each person

• Evidence suggests different types of OCD (hoarding, religious) have different genetic variations

Why is OCD polygenic?

OCD not caused by a single gene, multiple

Taylor = Found 230 genes that could be responsible for OCD

What does the neural explanation of OCD identify as cause

Transmitters and structure of brain

Parts of brain for OCD in neural explanation

OFC (Orbital Pre-Frontal Cortex)

Thalamus

Caudate nucleus

Orbital Pre-Frontal Cortex

Send signals to thalamus about things that are worrying

Thalamus

Acts on impulse sent by OFC, stop actions when impulses from OFC lessen

Caudate Nucleus

In normal brain, suppresses unnecessary signals from OFC to thalamus

In OCD brain, doesn’t suppress, so thalamus is triggered by minor ‘worry’ signals

Parahippocampal gyrus

Associated with processing unpleasant emotions

Found to function abnormally in people w OCD

Decision making and frontal lobes

Frontal lobes are responsible for logical thinking

Neurotransmitters in OCD

Dopamine and Serotonin

What is wrong with the neurotransmitters in OCD

Increased dopamine

Lowered serotonin

EVAL : Evidence for genetic cause OCD

Nestadt et al : 68% of identical twins shared OCD as opposed to 31% of non-identical twins

EVAL: Too many candidate genes for OCD

Twin studies highlight a genetic underlying, but less success in finding on specific

Each genetic variation only increase chances minorly

EVAL : Environmental factors for genes OCD

Environment can increase risk of developing OCD

Cromer et al: Over half OCD patients in sample had traumatic event, OCD more severe if more than one trauma

Suggests not an entirely genetic origin

EVAL: Supporting evidence for neural OCD

Some antidepressants only increase serotonin system, and this lowers OCD symptoms

Nestadt et al : OCD symptoms are found in other conditions with biological origin e.g. Parkinsons

EVAL: Neural involvement in OCD not clear

Cavedini et al : Neural systems in decision making are the systems that function abnormally in OCD

However no research shows ONE neural system ALWAYS involved in OCD