Clinical Psychology

Definitions of Mental Health

Specification

  • Definitions of mental health: deviation from ideal mental health, deviation from social norms, failure to function adequately & statistical infrequency

Deviation from Ideal Mental Health

Based on the idea that there are distinct markers that signal ideal mental health.

The DIMH measure assumes that if a person is mentally well, they will possess all the markers of IMH. To diagnose a mental health disorder, it is necessary to look for a lack of IMH behaviours in someone.

The 6 criteria - Marie Jahoda

Peter Is Really Struggling At Everything

  1. Positive self-attitudes

High self-esteem, strong sense of identity, knowing where u fit in the world

  1. Independence

Self-regulation, being able to work on your own

  1. Resistance to stress

Resisting stress and being able to cope in stressful situations

  1. Self actualisation

Developing yourself and achieving the goals you set for yourself in life

  1. Accurate perception of reality

Having a realistic view of the world and your place in it

  1. Environmental mastery

Being able to adapt and meet the demands of the environment and the situation you are in

strengths

  • Holistic measure

    • A person is not viewed simply in terms of their innate, biological traits. The person’s place in the world, their lifestyle and their individuality are all components

  • IRL application

    • This measure can be used as the basis for therapy treatments as a checklist

Limitations

  • Unrealistic

    • It is almost impossible to maintain all of the criteria.

  • Culture bias

    • It’s not aligned with the attitudes and beliefs of collectivist cultures

Deviation from Social Norms

Social norms = unwritten rules of how members in a society are expected to behave, think and act

When a behaviour goes against social norms, it may be labelled as ‘abnormal’ and therefore a deviation from social norms.

Strengths

  • Easily applicable

    • Socially deviant behaviour can indicate if a person has a mental illness

  • Protects society

    • Social norms ensure that societies are harmonious, and identifying socially deviant behaviour can protect members from distressing or harmful acts

Limitations

  • Dispositional variables

    • Some behaviours could be examples of eccentricity, and therefore not abnormal

  • Not generalisable

    • Cannot apply to other cultures as they have different social and cultural norms. In China, it is considered polite and a compliment to the food to burp while eating, whereas in the Western world, burping is seen as rude.

    • Cannot apply over time, things that were considered abormal 50years ago, are no longer considered abnormal. Homosexuality was once considered a disorder; in modern society, it has been recognised as a normal thing.

Failure to function adequately

When a person is unable to cope with the demands of everyday life. Those being:

  • good personal hygiene

  • Regular eating habits

  • Attending work or school

  • Socialising with others

People who experience FFA struggle with all of these aspects, and as a result, they often have to deal with a reduction in income, job loss and a lack of contact with colleagues. Including that, FFA can lead to damaging effects within interpersonal relationships.

Identifying factors

  1. Severe distress - personal or to others around them

  2. Behaviour that goes against social norms

  3. Behaving irrationally

  4. Harm - self-inflicted or at others

Strengths

  • Easily observable

    • Behaviours are easily recognisable, and the definition provides a clear classification and diagnosis for them.

  • Checklists provided by Rosenham & Seligman

    • used to assess the degree of FFA, which increases the reliability of the measure

Limitations

  • Overly subjective measure

    • Someone’s version of hygiene may be different from another’s

    • Some behaviours are expressions of personal choice, e.g. swimming with sharks

Statistical Infrequency

Defining mental health using statistical measures.

A behaviour is abnormal if it is statistically infrequent: 2 standard deviations from the average, top/bottom 2.5% of the population.

Measured using normal distribution (when the graph is symmetrical)

Strengths

  • Clear Measure

    • provides clear points of comparison between people, making it easy to test and use as an analytical tool

  • Reliable

    • Measures are replicable, meaning large data sets can also be included in the calculation, as it is less likely that they will be affected by outliers or anomalous results.

Limitations

  • Prevalent disorders

    • Disorders like depression wouldn’t be recognised, as it is a disorder that has a high prevalence rate, and therefore is not statistically infrequent.

  • Desirable characteristic - measuring utility

    • characteristic such as a high IQ is considered statistically infrequent, it is a desirable characteristic.

Phobias

Specification

  • Behavioural, emotional and cognitive characteristics of phobias

  • The behavioural approach to explaining phobias: the two-process model, classical and operant conditioning

  • Treatment for phobias (behavioural): systematic desensitisation & flooding

Characteristics

Phobias are an anxiety disorder

To be diagnosed, all of these symptoms must be present when confronted by the phobic stimulus:

  • Persistant fear and anxiety due to the phobic stimulus

    • Emotional

  • Irrational beliefs about the phobic stimulus

    • Cognitive

  • Avoidance or endurance of the phobic stimulus

    • Behavioural

Types of Phobias

  • Specific phobia - fear of objects or situations

  • Social phobia - fear of social situations or interactions

  • Agoraphobia - fear of not being able to escape public places or the outsides

Explanation

The Two-Process Model

  1. Behaviour is learned through classical conditioning

  2. Behaviour is maintained through operant conditioning

Classical Conditioning

When a neutral stimulus becomes associated with an unconditioned stimulus, which provokes a response. e.g. Little Albert:

NS (white rat) = no response

UCS (loud noise) = UCR (fear & anxiety)

NS (white rat) + UCS (loud noise) = UCR (fear & anxiety) x3

CS (white rate) = CR (fear & anxiety)

Supporting Study - Little Albert by Watson & Rayner (1920)

  1. Little Albert was introduced to various animals, and it was established that they caused no emotional response, he took a particular liking to the white rat

  2. Whenever Little Albert tried to touch the white rat, researchers made a loud noise. This loud noise would scare Little Albert and make him cry. They repeated this process 3 times.

  3. Little Albert would no longer attempt to play with the rat, and instead began to cry and experience fear whenever he saw it.

  4. Including that, whenever Little Albert saw any animal with fur, a fur coat, and a Santa Claus beard, he began to cry. This shows that his phobia generalised to all objects that resembled the white rat.

Operant Conditioning

Takes place when our behaviour is either reinforced or punished, positive & negative reinforcement.

Negative reinforcement = avoidance of unpleasant situations

Positive reinforcement = behaviour will be repeated

Phobias are reinforced via positive reinforcement, for example:

Phobic stimulus = anxiety and fear

Avoidance of phobic stimulus = relief

Because they always experience relief in the absence of the phobic stimulus, they are inclined to repeat the behaviour of avoiding the phobic stimulus.

Evaluation

  1. Phobias and trauma

    1. The LA study illustrates how a traumatic experience can lead to a phobia. A study was done for people with driving phobias, 50% of people said that they had a traumatic experience with a car.

  2. Alternative explanation

    1. Not all phobias are caused by a traumatic experience. In the driving phobias study, 50% could not recall a traumatic event. This means there could also be a genetic component which causes phobias.

  1. IRL application

    1. The idea of the two-process model is present in exposure therapies, and it is crucial in explaining why people benefit from exposure therapy.

  2. Cognitive aspects of phobias are ignored

    1. The two-process model explains behaviour, but cannot explain the cognitive aspects of a phobia (irrational beliefs, etc.). Overall, this means that the two-process model cannot explain all of the symptoms of phobias.

Treatments

Systematic Desensitisation

Behavioural therapy, reducing anxiety of the phobic stimulus via counterconditioning.

If a person can learn to relax around a phobic stimulus = cured.

It requires multiple sessions, over a period of time.

The 3 Processes:

  1. The anxiety hierarchy

    1. The client with a phobia and a therapist create a list of situations related to the phobic stimulus. Arranged from least to most frightening.

      1. For example:

        1. picture of a small spider

        2. video of a spider

        3. same room as a spider

        4. holding a tarantula

  2. Relaxation techniques

    1. The therapist teaches the client breathing exercises (controlling breath) and visualisation (imagined environment).

    2. To ensure that when facing the phobic stimulus, they remain as calm as possible.

  3. Exposure

    1. While in a relaxed state, the client is exposed to the phobic stimulus, gradually going up on the fear hierarchy.

    2. The aim is for the patient to move up to the top of the hierarchy whilst remaining relaxed and in control

Evaluation

  1. Case Study - Ost et al (1989)

    1. 20 patients with a phobia of blood or injury went through systematic desensitisation. After 4 years, patients were interviewed - 90% had completely recovered from their phobia.

  2. Ethical

    1. Less distressing for a patient

  1. Phobia types

    1. Less effective at treating social phobias & agoraphobias, as cognitive factors play a key role in them.

Flooding

Sudden, extreme exposure to the phobic stimulus without any prior build-up or gradual approach. For example, putting someone with arachnophobia in a room full of spiders.

To extinguish the association between the CS and the UCS, so that the person is forced to deal with the phobic stimulus and realise that it is, ‘just a spider…’

One session only.

Evaluation

  1. Case Study - Kaplan & Tolin (2011)

    1. Patients went through 1 flooding session. After 4 years, patients were interviewed - 65% of patients showed no symptoms of specific phobias.

  2. Cheap

    1. One session, and it has a high chance of working.

  1. Unethical & risky

    1. Patients will become extremely distressed. This can lead to the risk of an accident, meaning a new UCS will become associated with the CS, overall worsening the phobia.

  2. Phobia types

    1. Less effective at treating social phobias & agoraphobias, as cognitive factors play a key role in them.

Depression

Specification

  • Behavioural, emotional and cognitive characteristics of depression

  • The cognitive approach to explaining depression: Beck’s negative triad & Ellis’s ABC model

  • Treatment for depression (cognitive): CBT & SSRIs

Characteristics

Depression is a mood disorder

To be diagnosed, 5 symptoms must be present, at least 1 emotional symptom and must last over 2 weeks.

  • Low mood

    • Emotional

  • Loss of pleasure

    • Emotional

  • Irrational negative beliefs

    • Cognitive

  • Difficulty concentrating

    • Cognitive

  • Change in appetite (more/less)

    • Behavioural

  • Change in sleeping patterns (more/less)

    • Behavioural

  • Social Withdrawal

    • Behavioural

Explanations

Beck’s Negative Triad

Irrational thoughts, faulty information processing and distorted perceptions are what cause depression.

https://www.savemyexams.com/dp/psychology/hl/17/revision-notes/abnormal-psychology/etiology-of-abnormal-psychology-explanations-for-disorders/cognitive-explanations-of-major-depressive-disorder-mdd/

  1. Negative Self Schema

    1. A negative self-schema is when a person solely focuses on the negative, undesirable aspects of themselves. This creates a constant cycle of feeling worthless and self-evaluation.

      1. Schema = a mental framework people use to organise their ideas based on their real-life experiences.

      2. Self-schema = the framework a person has about themselves, e.g. ‘I am worthy of love’

  2. Negative Cognitive Bias

    1. Pay attention only to the negative aspects in a conversation. This contributes to a persons irratonal negative beliefs, which assimilate and strengthen their negative self-schema.

      1. Cognitive Bias = The tendency to pay attention to only some info.

      2. Positive, negative and none.

Ellis’s ABC Model

Irrational thoughts interfere with happiness.

  • A = Activating event

    • Losing your job

  • B = Beliefs about activating event

    • ‘I lost my job because I’m useless and talentless’

      • Musturbation - ‘I must never fail’

      • I-can’t-stand-it-itis - ‘I can’t stand this jerk being my boss’

  • C = Consequences of beliefs

    • ‘I will never find another job, so my whole life will fall apart’

Evaluation

  1. Case Study - Koster et al (2005)

    1. Two groups were tested: the non-depression group (control group) and the depression group (experimental group).

    2. Participants were seated in front of a computer that flashed a word (positive, negative, neutral) before showing a square on the left or right side of a screen, and asking the person to click a button for the corresponding side (left or right).

    3. Findings: (The experimental group)

      1. Negative word = longer reaction time

      2. Positive word = same reaction time as control

      3. Neutral word = same reaction time as control

    4. Conclusion

      1. People with major depression have a negative cognitive bias, which causes their delayed reaction times.

  1. Case Study - McGuffin et al

    1. Investigated the concordance rate for depression in monozygotic and dyzygotic twins

    2. Findings:

      1. Monozygotic twins = 46%

      2. Dyzygotic twins = 20%

    3. Conclusion:

      1. Depression is likely to be partially inherited, as the concordance rate of monozygotic twins was higher than dyzygotic twins.

      2. Irrational negative beliefs are not the only cause of depression

  2. Case Study - Alloy & Abramson (1979)

    1. Two groups were tested: the non-depression group (control group) and the depression group (experimental group).

    2. Participants were asked to press a button, and could see a light that turned on/off (the button was not connected to the light).

    3. Participants were asked how much control they had over the light bulb.

    4. Findings:

      1. The control group massively overestimated their control

      2. The experimental group was more accurate than the control group

    5. Conclusion:

      1. People with major depression don’t always have irrational beliefs.

Treatments

Cognitive Behavioural Therapy (CBT)

The most common psychological treatment for depression.

Client learns how to be independent and to use strategies to help regulate themselves. It lasts around 5-20 sessions.

Focused on the here-and-now.

Cognitive Therapy

The application of Beck’s theory of depression within a CBT framework

  1. Identifying negative beliefs

  2. Challenging negative beliefs

  3. Testing their hypothesis

  4. Evaluating the evidence

The therapist uses this to confront the client directly and to highlight their irrational thoughts, or at least to look for other reasons why people may have acted the way they did.

Ellis’ Rational Emotive Behaviour (REBT)

Extends the ABC model to ABCDE.

  • D = Dispute

    • The therapist gives robust arguments to dispute the irrational thought

      • Empirical arguments - disputing whether there is real evidence to support the irrational belief

      • Logical arguments - disputing whether negative thoughts follow logically from the facts

  • E = Effect

    • Breaking the link between negative life effects and depression by changing the client’s irrational beliefs.

Evaluation of CBT

  1. Review - Cujipers et al (2013)

    1. Reviewed the effectiveness of CBT as a treatment in studies with a control and an experimental group.

    2. Findings:

      1. The experimental group improved while the control group did not

    3. Conclusion:

      1. CBT is more effective than no treatment

  1. Effectiveness

    1. CBT may not be effective for everyone, and it may not be as effective as other treatments.

    2. Studies have shown that some people with depression have naturally lower levels of serotonin - this is something that CBT cannot resolve.

SSRIs

Selective Serotonin Reuptake Inhibitors

Drug therapy

The most effective antidepressant.

https://www.savemyexams.com/gcse/psychology/aqa/19/revision-notes/psychological-problems/depression/biological-interventions-and-therapies-of-depression/

Some people with depression have less naturally occurring serotonin. SSRIs combat this:

  1. Serotonin is a neurotransmitter that circulates throughout the body via synapses.

  2. Serotonin that is left in the synapse is taken back into the presynaptic nerve - this reduces the amount of serotonin in the body

  3. SSRIs inhibit the reuptake of serotonin, meaning more serotonin is left in the synapse

  4. Therefore, more serotonin is sent throughout the body.

Evaluation

  1. Most effective treatment for depression

    1. Works for people with clinical depression - there is no cure; however, it can be treated effectively

  2. Relatively easy to use

  1. Side effects

    1. Nausea, sleep problems, etc.

  2. Relapse risk

    1. After stopping medication, depression could return

  3. Not ideal for people without clinical depression

OCD

Obsessive Compulsive Disorder

Specification

  • Behavioural, emotional and cognitive characteristics of OCD

  • The biological approach to explaining OCD: genetic & neural

  • Treatments for OCD (biological): drug therapy

Characteristics

To be diagnosed, a person must display all 3 of these symptoms:

  • Obsessions - recurring disturbing thoughts about certain topics

    • Cognitive

  • Guilty & Anxiety - caused by obsessions, feel ashamed → guilt and panic → Anxiety

    • Emotional

  • Compulsions - a strong urge to perform specific actions to try reduce feelings of anxiety, can be repetitive

    • Behavioural

Explanations

Neural Explanation

Normal brain:

Worrying stimuli → OFC → Motor Cortex → BG → (inhibiting neurotransmitters) → OFC

OCD:

Worrying stimuli → OFC → Motor Cortex → BG → (impaired communications) → OFC → obsessions/compulsions

Orbital Frontal Cortex (OFC)

Detects worrying stimuli in the surroundings and makes decisions in order to deal with the stimuli.

Motor Cortex

Part of the brain that controls movement.

Basal Ganglia (BG)
Monitors the outcome of our actions, and determines if the worrying stimuli has been dealt with.

IF it has been dealt with, the BG sends neurotransmitters to inhibit the OFC

Impaired Communications (between BG and OFC)

This is when the BG sends less inhibiting neurotransmitters, and therefore the OFC is left hyperactive. This means that the brain is constantly being signalled for worrying stimuli, even though they are unnecessary.

Evaluation

  1. OCD after car accident - Max et al (1995)

    1. Patient had an MRI, to evaluate her brain structure

    2. Findings: Brain damage to the BG

    3. Conclusion: The BG has a crucial part in OCD

  2. Brain-imaging studies in adults - Saxena & Rauch (2000)

    1. Two groups were tested, control & experimental

    2. Findings: OCD group had more activity in the OFC

    3. Conclusion: The OFC has a crucial part in OCD

  1. Brain-imaging studies have been inconsistent - Aylward et al (1996)

    1. Two groups were tested, control & experimental

    2. Findings: No significant difference of the BG between both groups

    3. Conclusion: Damage to the BG is not the only cause of OCD

Genetic Explanation

  • OCD is heritable

    • Can be passed on generationally as a recessive or dominant trait

  • Polygenic

    • Several genetic variations (candidate genes) that contribute to an individuals vulnerability to OCD.

  • Candidate Genes

    • SERT

      • Controls the levels of serotonin available at the synapse by producing reuptake proteins. More reuptake proteins = less serotonin.

      • A lack of serotonin is associated with OCD

      • Variation in SERT gene can contribute to the vulnerability to OCD

    • COMT gene

      • Controls the levels of dopamine by de-activating it

      • Irregular dopamine levels is associated with OCD

      • Variation in COMT gene can contribute to the vulnerability to OCD

  • Can be ‘awakened’ by environmental factors

Evaluation

  1. Review of twin studies - Billet et al

    1. Concordance rate between monozygotic and dizygotic twins was compared

    2. Findings: MZ = 68%, DZ = 31%

    3. Conclusion: Percentage difference indicates that OCD is partially inherited

  2. Family Studies - Nestadt et al

    1. Two groups were tested, control & experimental

    2. Parents & siblings were interviewed

    3. Findings:

      1. 12% of participants with OCD had a relative with OCD

      2. 3% of participants without OCD had a relative with OCD

    4. Conclusion:

      1. It is likely that a person with OCD has a relative who also has OCD - OCD is partially inherited

  3. DNA analysis - Hu et al

    1. Two groups were tested, control & experimental

    2. Findings:

      1. OCD were more likely to carry the long allele of the SERT gene (more serotonin reuptake)

    3. Conclusion:

      1. Genetic variation in the SERT gene contributes to the likelihood to develop OCD

  1. Twin Studies

    1. They are based on the assumption that both pairs are the same, and have grown up in the same encironment

Treatments

SSRIs

https://www.savemyexams.com/gcse/psychology/aqa/19/revision-notes/psychological-problems/depression/biological-interventions-and-therapies-of-depression/

Commonly used to treat depression, but it is also highly effective for OCD as it also has low serotonin levels.

  1. Serotonin is a neurotransmitter that circulates throughout the body via synapses.

  2. Serotonin that is left in the synapse is taken back into the presynaptic nerve - this reduces the amount of serotonin in the body

  3. SSRIs inhibit the reuptake of serotonin, meaning more serotonin is left in the synapse

  4. Therefore, more serotonin is sent throughout the body.

Anti-anxiety drugs

Benzodiazepines (BZs)

Anti-anxiety drugs designed to induce a feeling of calm. They control neuron hyperactivity, which is associated with fear, anxiety and stress.

They help ‘quieten’ the brain.

Evaluation

  1. Cost-effective and widely-available

    1. cheaper and more readily available

    2. Impact on the economy is lessened

  1. Side effects

    1. SSRIs cause blurred vision, loss of libido, irritability, indigestion and sleep problems

    2. BZs cause drowsiness, light-headedness, confusion, dizziness and slurred speech

      1. Limiting usefulness of these drugs in the treatment of OCD