Psychopathology

what are the four defenitions of abnormality

1. statisical infrequency

2. deviation from social norms

3. failure to function adequately

4. deviation from ideal mental health

statisical infrequency

• uses numbers, behaviour rarely seen is abnormal

• eg average IQ 100, most between 85 and 115

• only 2% have one under 70 so are therefore statistically abnormal

• are diagnosed with intellectual disability disorder

strength of statisical infrequency - real world applications

• used in clinical pracice to diagnose and assess the severity

• assessment tool used called Beck depression inventory which can detect things like severe depression

• useful

weakness of statisical infrequency - unusual characterisics not always negative

• IQ of 130 is also abnormal but they arent viewed like that

• therefore shouldnt ever be used alone

deviation from social norms

• when one behaves in a way that is different from how they are expected to

• societies and social groups make collective judgement about correct behaviours in certain circumstances

• norms are specific to the culture we live in eg gay is illegal in some places

• eg antisocial personality disorder (psychopathy) who dont conform to our moral standards and generally lack empahty

strength of deviation from social norms - real world applications

• used in clinical practice

• eg key defining characteristic of APD is failure to conformto culturally normal ethical behaviour, so therefore deviation from social norms

• also used for diagnosis of schiz, showing its value

weakness of deviation from social norms - varies between cultures and situations

• eg hearing voices is socially acceptable in some cultures (messages from ancestors) but is abnormal in uk

• therfore creates problems for people from one culture, living in another

failure to function adequately

• inability to cope with everyday life

• eg cannot hold down a job, maintain relationships or maintain a basic standard of hygine/ nutrition

• Rosenhan suggests they can no longer maintain personal space, experienes personal distress, behave dangerously/ irratioally

strength of failure to function adequately - brings attention to the individual when they need it the most

• around 25% of people in uk will face mental health issues, so many are affected

• this means treatment can be targeted to those who need it the most

weakness of failure to function adequately - not subjective

• easy to label non standard choices as abnormal, it is not subjective

• eg travellers may not have a permanent job or home, but to them thats how they live

• or extreme sports people may be seen as acting irrational/ a danger to themselves

• also depends on how a psychiatrist views it (all diff)

deviation from ideal mental health

• Jahoda states good mental health includes; no symptoms of distress, we are rational and percieve ourselves accurately, we self actualise, can cope with stress, realistic views of the world, good self esteem and lack guilt, can work, love and enjoy our leisure

• anyone who deviates from this is abnormal

strength of deviation from ideal mental health - wide range of criteria

• covers many reasons people may need help

• can the find help with someone specially trained in that area

• can also assess ourselves using it = less intimidating

weakness of deviation from ideal mental health - not culturally relative

• mostly in context of western cultures

• where we view self actualisation as good, would be viewed as self indulgent elsewhere, where the focus is on the community

• therefore not general

what is a phobia

• an irrational fear of an object or situation

two behavioural characteristics

1. panic; may involve a range of behaviours such as crying, screaming or running away from stimulus

2. avoidance; considerable effort to avoid coming into contact - can make it hard to go about everyday life

two emotional characteristics

1. anxiety and fear; fear is the immediate experience when a phobic encounters or thinks about the stimulus - fear leads to anxiety

2. unreasonable responses; response is widely disproportionate to the threat posed eg arachnophobic and tiny spider

two cognitive characteristics

1. selective attention; finds it hard to look away from the stimulus (cannot concentrate on task if it is present)

2. irrational beliefs; eg for a social phobia ‘if i blush people will think im weak’

depression

• a mental disorder characterised by low mood and low energy levels

two behavioural characteristics

1. activity levels; reduced energy levels, making them lethargic, in extreme cases cannot get out of bed

2. disruption to sleep and eating; reduced (insomnia) or increased (hypesomnia) sleep, same with appetite

two emotional characteristics

1. lowered mood; describe themselves as worthless or empty, very extreme feelings

2. anger; directed at themselves (self harm), or at others

two cognitive characteristics

1. poor concentration; unable to stick with a task, or find it difficult to make a simple decision

2. absolutist thinking; ‘black and white thinking’, when a situation is unfortunate it is seen as an absolute disaster

OCD

• a condition characterised by obessions and/ or complusive behaviour

Two behavioural characteristics

1. compulsions; actions that are carried out repeatedly, eg handwashing  (repeated in a ritualistic way to reduce anxiety)

2. Avoidance; managed by avoiding situations that trigger anxiety eg may avoid contact with germs

two emotional characteristics

1. anxiety and distress; obsessive thoughts are unpleasant and frightening, which comes with overwhelming anxiety

2. guilt and disgust; irrational guilt eg over a minor moral issue, or disgust to things like external dirt

two cognitive characteristics

1. obsessive thoughts; about 90% experience this eg recurring intrusive thoughts about being contaminated by germs/ dirt

2. insight into excessive anxiety; awareness that these are irrational but are still hypervigilant of their obsession

Behavioural approach to explaining phobias

• a way of explaining behaviour in terms of what is observable and in terms of learning

Two process model

• created by Mowrer

• argues that phobias are learned by classical conditioning and are then maintained by operant conditioning.

Acquisition by classical conditioning

•  involves associating something we initially have no fear of, with something that already triggers a fear response.

Little albert

• Watson and Raynor on a 9 month old baby

• whenever he played with a white rat, a loud noise was made in his ear.

• The noise created a fear response, but the rat did not create fear until the noise and the rat had been paired together multiple times.

• Everytime Albert came into contact with a rat after this, a fear response was seen.

Generalisation of fear in little albert study

•  anything that resembled a white rat, like a fur coat casued a fear response

Maintenance by operate conditioning

• when a phobic avoids a stimulus they escape the anxiety they would have experienced

• this avoidance behaviour is negatively reinforced, causing avoidance and consequently the phobia to continue.

Strength of the two process model - practical applications

• Therapies such as systematic desensitisation and flooding have been created and are successful due to the understanding that if avoidance behaviour is prevented, then the phobic behaviour declines, and then cured.

• Therefore, it has had a valuable impact, creating treatments for phobias.

Weakness of the two process model - not all bad experiences lead to the development of a phobia

• While some do therefore making it clear how the development was due to classical conditioning, some don't.

• For example, not everyone who has been bitten by a dog has developed a phobia meaning that conditioning alone cannot explain phobias, and that they only develop where a vulnerability exists.

• This makes this explanation limited.

Weakness of the two process model - doesnt account for cognitive aspects

• It cannot be ignored that phobias are complex and have a key cognitive component, like when one had hard irrational beliefs about a stimulus, for example a spider.

• Therefore, this approach is not a complete model and consequently lacks validity. 

the two ways the behavioural approach treats phobias

1. systematic desensitisation

2. flooding

Systematic desensitisation

• a type of behavioural therapy that is designed to gradually reduce phobic anxiety and is based upon the idea of classical conditioning.

• It uses counterconditioning to ensure the individual learns a new response to the stimulus, which will pair it with relaxation instead of anxiety.

Three processes

1. the anxiety hierarchy; ranked list created by both the patient and therapist of situations related to the phobic stimulus that provokes anxiety.

2. relaxation; patients taught techniques like deep breathing. This is important because it isn't possible to feel afraid and relaxed at the same time (known as reciprocal inhibition).

3. exposure; works through the hierarchy in a relaxed state, this takes several sessions.

Flooding

• the patient is subject to immediate exposure to the stimulus

• for example an arachnophobic having a large spider crawl on their hand until they are fully relaxed.

Process

• very quick as there is no option for avoidance behaviour meaning that the individual will figure out very quickly that the stimulus is not harmful.

• Eventually they will also become exhausted by their fear response, known as extinction.

Ethical safeguards

• a very unpleasant experience so it is important that the client gives informed consent 

• must be fully prepared in knowing what to expect. 

Strength of systematic desensitisation - research shows its effectiveness

• Gilroy followed up on 42 patients after their sessions for spider phobia

• when compared to a control group treated with just relaxation without exposure, the ones who underwent systematic desensitisation were less fearful.

• It was also found systematic desensitisation is a preferred option because of limited trauma, with some parts even being peasant like speaking to a therapist. 

Weakness of systematic desensitisation - expensive and time consuming

• usually involves multiple sessions with a trained therapist, and the process of gradually working through the anxiety hierarchy takes time.

• This could make it less accessible, especially for people who can’t afford private therapy or don’t have time for regular appointments.

Strength of flooding - cost effective

• benefits the NHS.

• This is due to the fact that it may only require one session in comparison to around 10 sessions of systematic desensitisation which achieve the same result.

• It's also been found to be very effective which can be seen when a phobia is removed after just one session!

Weakness of flooding - very traumatic process

• It is a very unpleasant experience as it is directly confronting an extreme phobia that provokes severe anxiety.

• This can be seen by the high dropout rates and the fact that informed consent is required because of ethical issues.

• Therefore, it may not be the best option for treating phobias. 

The two cognitive approachs to explaining depression

1. Beck’s negative triad

2. Ellis’s ABC model

Beck's negative triad

• why some people are more vulnerable than others

• it's down to a person's conditions.

Three parts of the cognitive vulnerability

1. Faulty information processing

2. Negative self schema

3. the negative triad

Faulty information processing

• one attends to the negative aspects of a situation and ignores the positives, thinking in black and white

• also tend to blow smaller things out of proportion.

Negative self schema

•  interprets all the information about themselves in a negative way

the negative triad

• someone had negative views about the world, the future and themselves

Ellis’s ABC model

• poor mental health results in irrational thinking which then affects our behaviour and emotional state

• It explains this through the use of the acronym ABC.

 A

• an activating event

• a negative event that triggers irrational beliefs.

B

• beliefs

• there is a range of but includes things like believing things must always go smoothly (musterbation) and its a disaster if they don't

• belief that the world must always be fair and equal.

C

• consequences

• when an activating event triggers irrational beliefs then there will be emotional and behavioural consequences

• for example someone believing they must always succeed and then failing leading to depression.

Strength of Beck's negative triad - practical applications

• it forms the basis for CBT (cognitive behavioural therapy).

• The compounds of the triad can be easily identified and therefore challenged meaning that this understanding can lead to the person's vulnerability being altered.

• Therefore it is valuable in helping create a positive impact on people's lives.

Weakness of Beck's negative triad -

Strength of Ellis’s ABC model - practical applications

• lead to the development and creation of rational emotive behaviour therapy.

• This is where the therapist vigorously argues with a depressed patient to alter their irrational beliefs that are the cause of their unhappiness.

• Therefore, this will lead to them being relieved from their symptoms, having value.

Weakness of both models - incomplete explanations

• only partial explanations, ignoring the complexity of depression.

• Firstly, not all depression arises from an activating event (reactive depression) which is different from the kind that arises without an obvious cause - the cognitive approach doesn't account for this.

• Also some people with depression are angry or see hallucinations which are also not explained.

• Therefore this approach is limited.

what is the cognitive approach of treating depression

• uses cognitive behaviour therapy

• the most commonly used psychological treatment

• combines both cognitive and behavioural elements.

the cognitive and behavioural elements

1. cognitive; he treatment begins with an assessment to clarify the clients problems and put together a plan

2. behavioural; working to change negative and irrational thoughts and then putting more effective behaviours into place

Beck’s cognitive therapy

• identifies negative thoughts about the self, the world and the future (the negative triad)

• then challenges these with the patient taking an active role and being encouraged to test the reality of their beliefs.

• The therapist might also set them homework like to record when someone says something nice to them, which will then be used as evidence later on in the therapy.

Ellis’s rational emotive behaviour therapy

• extends the ABC model to ABCDE, which stands for activating event, beliefs, consequences, dispute and effect.

• The central technique in this therapy is to identify and dispute irrational thoughts.

• For example, the client may talk about how unlucky they are and the therapist would have a vigorous argument to break the link between negative life events and depression.

Two types of argument techniques

1. empirical; asking for evidence

2. logical; questions if it is following facts

Behavioural activation

• As individuals become depressed, they tend to avoid difficult situations and become isolated which can then worsen symptoms.

• Behavioural activation gradually decreases this isolation and increases their engagement in activities that improve mood like exercising.  

Strength of CBT - evidence for effectiveness

• March compared cognitive behavioral therapy with antidepressants as well as a combination of the two in 327 patients.

• After 36 weeks 81% of CBT patients, 81% of antidepressant patients and 86% who underwent both saw significant improvements.

• Not only is it effective but it also only requires a few sessions therefore making it cost effective which will benefit the NHS.

Weakness of CBT - may not work for severe cases

• Those who have a severe case of depression may not be able to motivate themselves to take on the hard cognitive work

• therefore other options, like antidepressants, may have to be used first.

• Therefore, CBT is limited as it cannot be used as the sole treatment for all cases of depression.

Weakness of CBT - patients may want to explore their past

• this does not happen during CBT as it focuses merely on the present and the future.

• This is a huge limitation as some cases of depression may have links with childhood so therefore it could potentially be ignoring an important aspect.

• Therefore CBT is rather limited. 

The two biological approaches to explaining OCD

1. genetic inheritance

2. neural function

Genetic explanation

• genes are involved in individual vulnerability to OCD.

Research for the genetic explanation - Lewis

• observed that of his OCD patients, 37% had parents with OCD and 21% had siblings with OCD, suggesting that vulnerability runs in families.

Diathesis stress model

• certain genes leave some people more likely to develop a mental disorder, but some environmental stress is needed to trigger it.

Candidate genes

• create vulnerability for OCD

• some of these involved in regulating the development of serotonin system

• eg the gene 5HT1-D beta is implemented in the transport of serotonin across synapses

OCD is polygenic + research

• it's caused by a combination of genetic variations that increase vulnerability, not just a single gene.

• Taylor had found evidence that up to 230 genes may be involved, some of which being associated with dopamine and serotonin (neurotransmitters that have an effect on mood).

origin of OCD varies

• The origin of OCD varies from one person to another

• one group of genes may cause it in one person, but not in another.

Neural explanation

• the genes associated with OCD are likely to affect the levels of key neurotransmitters as well as structures of the brain.

Role of serotonin

• neurotransmitters are responsible for relaying info from one neuron to another

• if a person has low levels of serotonin, then normal transmission of mood-relevant information does not take place which therefore leads to low moods.

• This reduction in functioning may explain some cases of OCD

Decision making

• some cases of OCD are associated with impaired decision making

• in turn may be associated with abnormal functioning of the frontal lobes which are responsible for logical decision making/ thinking. 

Strength of the genetic explanation - research support

• Twin studies have shown that 68% of identical twins shared OCD as opposed to 31% of non identical twins.

• Also family studies showed that a person with a family member with OCD is around 4 times more likely to develop it as someone without.

• This therefore suggests that there must be genetic influence.

strength of the neural explanation - research support.

• Antidepressants that work purely on serotonin are effective in reducing OCD symptoms, suggesting serotonin is involved in OCD

• showing that these biological processes may be responsible for it. 

weakness of the biological explanation- ignores the role of environmental risk factors

• barely talks about the role of environmental risk factors, even though they play a huge role in increasing or even triggering the risk of developing OCD.

• Research has found that over half of the OCD patients in their sample had a traumatic event in the past and OCD was more severe in those with one or more traumas, supporting the diathesis stress model.

• Therefore, focusing on environmental causes may be more important as something can be done about these to prevent the development of OCD. 

the biological approach to treating OCD

• Drug therapy

• works in various ways in order to increase the levels of serotonin in the brain, leading to a reduction in symptoms.

selective reuptake inhibitors (SSRIs)

• antidepressants that prevent the reabsorption and breakdown of serotonin in the brain. T

• his therefore then increases its levels in the synapse and thus serotonin continues to stimulate the postsynaptic neuron, compensating for whatever is wrong.

• The typical daily dose of Fluoxetine (a type of SSRI) is around 20 mg but this can be increased if necessary.

• It also takes around 3-4 months for an impact to be seen.

SSRI’s and CBT

• used together

• the drugs reduce emotional symptoms, like feeling anxious or depressed, and then the patients can then engage more effectively with CBT.

Alternative to SSRI’s

• if after the dosage of SSRIs has been increased and it's been more than 3-4 months with no impact being seen then there are alternative options.

• SSRIs can be combined with other drugs in order to resolve this.

Tricyclics

• an older type of antidepressant like Clomipramine for example, have the same effect on the serotonin system as SSRIs but have more severe side effects.

• More recently used are SNRIs which increase levels of both the neurotransmitter serotonin and noradrenaline. 

strength of the biological approach to treating OCD - evidence of effectiveness

• effectiveness in reducing symptom severity and improving quality of life.

• Research reviewing 17 studies comparing SSRIs to placebos found significantly better results for SSRIs in all cases, with the symptoms being reduced by around 70%.

• This research also found that the drugs were made more effective when combined with CBT.

• This therefore shows their value as drugs can help most patients.

strength of the biological approach to treating OCD - cost effective and non-disruptive

• This treatment is cheap when compared to psychological treatments like CBT, meaning that the NHS will benefit from this.

• Also, taking drugs isn't hard work unlike CBT which may make it a more attractive option to patients. 

weakness of the biological approach - serious side effects + may not work

• they can have serious side effects and some patients may also see no benefits.

• For example when taking SSRIs patients may suffer from indigestion, blurred vision and loss of sex drive (although these are all normally just temporary).

• On the other hand if Clomipeamine has to be taken then side effects are more common and serious

• for example more then 1 in 10 suffer from erection issues and weight gain and 1 in 100 become aggressive and suffer disruption to blood pressure and heart rhythm.

• Therefore, there are huge disadvantages that come with taking this treatment, making it reduce in value.