PSYCHOPATHOLOGY: OCD, depression and phobias approaches

Systematic desensitisation SD

Be) treatments: therapy gradually reduces anxiety through counterconditioning, phobic stimulus (CS) produces fear (CR), so CS is paired with relaxation and this becomes the CR. Due to reciprocal inhibition (cannot be afraid and relaxed at the same time) feelings of relaxation prevent fear. Anxiety hierarchy made with therapist and completed whilst doing relaxation techniques

Flooding

Be) treatments: immediate exposure to the phobic stimulus in one long session.

McGrath et al

Be) treatments: strength - found that 75% of patients with phobias were successfully treated using SD; this was particularly true when using in vivo (direct contact with stimulus), rather then using in vitro.

Gilroy

Be) treatments: strength - followed up 42 patients who had SD for a spider phobia in three 45min sessions. At both 3 and 33 months, the SD group were less fearful than a control group (treated by relaxation without exposure).

Wolfe (1969)

Be) treatments: limitation - recalled a case with a patient becoming so intensely anxious that she required hospitalisation after a flooding session. Therefore flooding can be traumatic for patients as it purposefully elicits high levels of anxiety, decreasing number of successful treatments.

Klein et al.

Be) treatment: limitation - being able to cope with a phobic stimulus may be more important than being able to relax in its prescience. found SD and supportive psychotherapy were equally effective in treatment of phobias. suggests that cognitive factors are more important than acknowledged

C) explanation for depression

argues that mental illnesses (depression) are caused by maladaptive thoughts.

C) key assumptions

1. sufferers of mental illness have distorted or irrational thinking - causing maladaptive thoughts

2. its the way you think about a problem, not the problem itself

3. can overcome mental illnesses by learning to use more appropriate cognitions

4. individual is the cause of their own behaviour, as they control their own thoughts

5. abnormality is a product of control

Beck’s cognitive triad

C) explanation: Depression is caused by negative self schemas (eg. ineptness schema-expect to fail) maintaining the triad of negative views on the world, future and yourself. For sufferers, these thoughts occur automatically. Also, found that depressed people are more likely to focus on the - than +, distorting info causing cognitive bias (eg. overgeneralisations)

Parts of Beck’s explanation

1. faulty info processing - errors in logic

2. negative self-schemas

3. negative triad

Ellis ABC Model

C) explanations : (A) activating event, (B) beliefs, (C) consequences - explains how irrational thoughts lead to depression. According to Ellis, good mental health is the result of rational thinking allowing people to be happy and pain free, whereas depression is the result of irrational thinking, preventing this.

C) CBT and REBT

C) strength: application to therapy - Beck’s CBT (cognitive behavioural therapy) and Ellis’ REBT (rational emotive behaviour therapy) attempt to identify and challenge the irrational thoughts.

Boury et al. (2001)

C) supports CE for depression: found that patients with depression were more likely to misinterpret info negatively (cognitive bias) and feel hopeless about the future (cognitive triad)

CE for depression weakness

C) CE for depression limitation: does not explain origin of the irrational thoughts. Since most research is correlational, cause and effect cannot be accurately established (depression cause thoughts, or thoughts cause depression).

REBT

Ellis developed model to contain (D) dispute and (E) effective. The therapist will challenge irrational thoughts and dispute the irrational beliefs, to replace beliefs with more effective attitudes.

Type of dispute for REBT

1. Logical dispute: therapist questions logic of a persons thoughts

2. Empirical dispute: therapist seeks evidence for a persons thoughts

3. Pragmatic dispute: therapist questions how helpful it is to think this way

CBT

Using Beck’s triad, therapist will identify irrational thoughts, and then the therapist and the patient work together to challenge these, by discussing evidence for and against them. The patient would then be encouraged to test the validity of their thoughts and may be set hw.

Genetic explanations for OCD: COMT

The COMT gene regulates the production of dopamine. One form of the COMT gene has been found to be common in people with OCD, and the variation produces lower activity of the COMT gene, and higher levels of dopamine (Tukel, 2013)

Genetic explanations for OCD: SERT

The SERT gene affects transport of serotonin, creating lower levels of this neurotransmitter. Amutation of this gene has been found in two unrelated families where 6 of 7 had OCD (Ozaki).

Taylor (2003)

Genetic explanations for OCD: suggested that many as 230 genes may be involved and different genetic variations contribute to the different types of OCD eg. hoarding; OCD is a polygenetic condition.

Neural explanations for OCD: serotonin

Lower levels of serotonin are associated with OCD, so anti-depressant drugs prescribed to increase serotonin