Clinical Psychology and Mental Health

what is clinical psychology

the study of mental illnesses

what is a mental illness

a psychological condition where people display changes in their thoughts, feelings and behaviours which are long lasting

why is clinical psychology good

helps diagnose people and provide treatment, also benefits the economy (reduced absenteeism)

what are the 4 definitions used to identify mental illnesses

• deviation from ideal mental health

• deviation from social/ cultural norms

• failure to function adequately

• statistical failure

what is deviation from ideal mental health

a person might be experiencing mental illness if they fail to display behaviors that indicate ideal mental health

Jahoda’s 6 criteria for ideal mental health

• Self-attitudes – having positive self-concept and a strong sense of identity

• Self-actualisation – the extent to which an individual develops their full capabilities

• Integration – being able to cope with stressful situations

• Autonomy – being independent and self-reliant and able to make personal decisions

• Having an accurate perception of reality – perceiving the world in a non-distorted fashion.

• Mastery of the environment – being competent in all aspects of life and being able to meet the demands of any situation

what is deviation from social/ cultural norms

when a person's behaviour doesn't follow or deviates from what's considered culturally or socially normal

what is failure to function adequately

Defines a person as abnormal if they are not able to cope with everyday living.

Not functioning adequately causes distress and suffering for the individual and/ or to others

what is statistical failure

when someone displays attitudes or behaviors that are statistically infrequent more specifically two standard deviations away from the norm

evaluate deviation from ideal mental health

• enables participants to set clear goals

• the criteria is overly demanding and difficult to measure objectively

evaluate deviation from social/ cultural norms

norms change over time - lacks temporal validity. can lead to misdiagnosis

can offend some cultures that considers behaviour normal

evaluate failure to function adequately

• involves behaviours that are easy to measure, observe and therefore diagnose

• mentally ill people don’t always struggle with day to day life

• not all maladaptive behaviours are signs of mental illness

evaluate statistical infrequency

• objective and practical

• some mental illnesses aren’t statistically infrequent

• some statistically infrequent traits are desirable

what is a phobia

an irrational fear of an object or situation

what 3 symptoms are used to identify phobias

• Emotional Characteristics - Fear, anxiety and panic (cued by the presence or anticipation of the object)

• Behavioural Characteristics - Avoidance

• Cognitive Characteristics - Irrational thinking and resistance to rational arguments

what is the 2 process model

the idea that phobias are acquired by classical conditioning and maintained by operant conditioning

research/ evidence for the 2 process model: classical conditioning

• LITTLE ALBERT CASE STUDY:
  9-month-old Albert was shown a white rat (initially showed no fear).

• Researchers paired the rat with a loud metal noise that frightened him.

• After several pairings, Albert became scared of the rat even without the noise.

• His fear generalised to other white fluffy objects

• concluded fear can be learned through classical conditioning.

research/ evidence for the 2 process model: operant conditioning

BARLOW AND DURAND:

• found 50% of participants with a severe driving phobia, could recall a traumatic event during driving and haven't drove since (CC)

evaluate behaviourist approach on phobias

• not all phobias caused by past traumatic experience

• genetically determined? ancestors fighting bears eg

what is flooding

person with phobia experiences fear in one, prolonged session, experiencing the phobia at its worst. the session continues until the anxiety has disappeared. (Can be virtual reality or in vivo exposure).

what is systematic desensitisation

introduced by Wolpe. Involves introducing patients to the feared stimulus gradually and bringing about a relaxation response through counterconditioning.

what are the steps involved in systematic desensitisation

• relaxation techniques are taught

• a fear/ desensitization hierarchy is created

• gradually work way through hierarchy

• patient then masters feared sensation

what is the rationale for flooding

A person’s fear response (and adrenaline release) has a time limit. As adrenaline levels naturally decrease, a new stimulus-response can be learned (a relaxation response).

Strength of behavioural treatments for phobias

• Faster, cheaper and less effort on the patients part than CBT (in turn benefits the economy)

• CBT requires a willingness for the patient to think deeply about their mental problems, but this is not required for behavioural therapies.

• This lack of thinking means the therapies work for people who lack insight into their motivations or emotions such as children or patients with learning difficulties (good population validity).

evidence on how both treatments (flooding and sd) are effective

• McGrath et al reported that about 75% of patients with phobias were successfully treated using systematic desensitisation, when using in vivo techniques; shows SD is effective in treating phobias

• Choy et al compared the effectiveness of various treatments for specific phobias; reported both flooding and SD are effective but that flooding is more effective.

weaknesses for flooding

• Ethical concerns

• If people are highly anxious would quit during process and reduce effectiveness

weaknesses for SD

• Öhman et al. (1975) suggested that SD may not be as effective in treating phobias that have underlying evolutionary survival components, compared to phobias which have been acquired as a result of personal experiences.

• This reduces the real-world applications of the treatments.

support for flooding

KAPLAN AND TOLIN:

• 65% of patients treated for specific phobias with a single session of flooding showed no symptoms four years later.

support for SD

McGRATH ET AL:

• reported that about 75% of patients with phobias were successfully treated using systematic desensitisation, when using in vivo techniques; shows SD is effective in treating phobias

what are the emotion symptoms of depression

• low mood

• loss of pleasure

what are the cognitive symptoms of depression

• irrational negative beliefs

• difficulty concentrating

what are the behavioural symptoms of depression

• change in appetite

• change in sleep patterns

• social withdrawal

Catastrophizing meaning

Viewing a situation as worse than it actually is (driven by negative core schemas).

Musturbatory Thinking meaning

The irrational belief that certain things must be a particular way (e.g., "I must be loved by everyone").

what criteria needs to be met in order to be diagnosed with depression

• must experience 5 or more symptoms for more than 2 weeks

• one of those symptoms must be emotional

what is manic depression

when someone cycles between manic (high mood for at least 1 week) and depressive episodes (low mood for at least 1 week)

Explain ellis ABC model

when a person with depression experiences a negative activating event, they form irrational negative beliefs about the event. as a consequence, they experience the symptoms of depression

A- activating event occurs

B- beliefs are formed about causes of activating event

C- consequences are formed due to thoughts, behaviour and feelings of belief

Becks cognitive triad

Beck argues negative self schemas cause irrational negative beliefs leaving people to form negative expectations about themselves, the world and the future.

He also suggests people with depression have a negative cognitive bias, meaning they fixate on negative information, which is assimilated into their negative self schema, making it even stronger.

evidence against the cognitive role in depression

ALLOY ET AL

• investigated expectations of participants with and without depression

• participants were asked to press a button and observe whether a green light came on

• researchers manipulated the degree of control the participants had over the light, ranging from 0% (no control) to high control.

• they were asked to estimate the degree of control they had over the light changing

• partic’ with depression estimated more accurately than control group

what is CBT

a treatment for depression that aims to remove the negative beliefs that cause depression. involves 4 steps:

• identify negative core beliefs

• challenge negative beliefs

• test hypothesis through homework

• evaluate the evidence

The role of "Homework" in CBT

Accessible, agreed-upon tasks set between sessions to challenge beliefs and provide data for the next session.

support for CBT

CUIJPERS ET AL

• reviews all studies in the USA that compared depressive patients receiving and not receiving cbt

• experimental group had a significant improvement in symptoms compared to control group

limitations of CBT

• may not be effective for everyone, there are individual differences in depressive experiences (cuijpers et al found variation between individuals)

• not as effective as other treatments such as antidepressants - may more effective

OCD: Emotional Characteristics

Fear, Panic, Dread, and Despair.

OCD: cognitive characteristics

Obsessive thoughts, Catastrophization, Hypervigilance

OCD: behavioural Characteristics

Compulsions, Avoidance, Withdrawal, and Preparation.

Ruminating meaning

Repetitive, deep thinking about self, others, and the future.

Obsessions vs. Compulsions

Obsessions: Internal/Intrusive thoughts.

Compulsions: External/Repetitive behaviors used to reduce anxiety.

Two biological explanations for OCD

1. Neural: Abnormal brain mechanisms and neurotransmitters.
2. Genetic: Hereditary transmission from parents.

what does the genetic explanation of ocd say

• we can inherit ocd

• the are specific alleles on different genes that can increase a persons risk of developing ocd

Neurotransmitter levels in OCD

Dopamine: Abnormally high.Serotonin: Abnormally low.

Function of Dopamine in OCD

An excitatory neurotransmitter linked to reward and memory; its main function in OCD is habit forming

Function of Serotonin in OCD

inhibitory neurotransmitter. Its main behavioral function is impulse control. Low levels lead to a lack of control over behavioral impulses

what is the COMT gene

A low-activity variant that fails to degrade dopamine properly, leading to high dopamine levels and therefore compulsive behaviors

what is the SERT gene

A high-activity variant that removes serotonin from the synapse too quickly via the reuptake process, leading to low serotonin levels and therefore, hypervigilance and obsessive thoughts.

explain the two alleles of the SERT gene

short and long.

the long allele produces more reuptake proteins (less serotonin available in synapse and therefore less inhibition of neural activity in post s.n)

outline the neural chemistry process of someone without ocd

• orbitofrontal cortex detects worrying stimuli and decides on action

• once action has been decided it sends signals to the motor cortex

• basal ganglia monitors outcomes of our actions

• when worrying stimulus has been dealt with, the BG send inhibitory responses to the orbitofrontal cortex

• this shuts down signals responding to worrying stimulus

outline the neural chemistry process of someone with ocd

• OFC is overactive and sends "worry signals" to the thalamus.

• impaired communication between BG and OFC

• therefore the caudate nucleus that normally suppresses OFC signals is underactive/damaged, failing to stop minor worry signals.

• since the signal isn’t stopped, OFC is less inhibited than it should be and becomes hyperactive

• thalamus receives unsuppressed signals and becomes overactive; generates learned response of compulsions and sends signals back to the OFC.

• this generates the symptom of ocd

case studies for the neural explanation on ocd

MAX ET AL

• studied a girl who developed ocd after brain damage

• conducted an mri and found damage in the BG

• suggests structural damage to BG can cause ocd

• supports idea that disturbed communication between BG and OFC is the cause of ocd

brain imaging studies for the neural explanation on ocd

SAXENA AND RAUCH

• compared brain activity of adults with and without ocd

• found increased activity in OFC in adults with ocd

• suggest hyperactivity of OFC can cause ocd

limitations of neural explanation of ocd

• brain imaging results are inconsistent and haven’t always been replicated →Aylward et al found no difference of the activity in BG between those with and without ocd

• suggest structural damage in BG and hyperactivity in the OFC may not be the only causes of ocd

twin studies for the genetic explanation of ocd

BILLET ET AL

• review of twin studies

• found concordance rate of twins w ocd was 68% for MZ and 31% DZ

• large difference suggests ocd is partially inherited

CAREY AND GOTTESMAN:

• MZ twins (identical): 87% concordance.

• DZ twins (non-identical): 47% concordance.

limitations of twin studies

assume MZ and DZ twins have the same amount of shared environment

how do SSRIs work for ocd

block the reuptake of serotonin at the synapse. This creates a "build-up" of serotonin, increasing its inhibitory effect and improving impulse control.

how do Tricyclics differ from SSRIs

wider effects, blocking the reuptake of both serotonin (improving impulse control) and noradrenaline (increasing motivation/arousal).

They are rarely prescribed first due to more powerful side effects

how does Benzo work

mimic GABA and bind to GABA receptors, increasing its inhibitory effect. This causes hyperpolarization, reducing neuron activity and lowering impulsivity.

strengths of drug treatment for ocd

• success and speed - benzo works in minutes, ssris in few weeks. crucial for suicidal patients. fast action = ethical

• scientific validity/ objectivity - objective methods like fmri showing brain functions provides high validity compared to subjective therapies

weakness of drug treatments for ocd

• side effects - benzos cause lethargy, reduced cognitive ability, driving bans. ssris cause weight gain, permanent sexual dysfunction, reduced empathy, and increased suicide risk after stopping (lederberg 2022)

• biological determinism/ reductionism - ignores environmental triggers, impling genes = disorder