psychopathology

Abnormality

Definitions of abnormality:

  • statistically infrequency = persons trait, thinking or behaviour classified under abnormal if it is rare or statistically unusual

  • deviation from social norms = persons thinking or behaviour is classified as abnormal if it violates the unwritten rules about what is expected or acceptable behaviour in a particular social group

  • failure to function adequately = person abnormal if they are unable to cope with demands of every day life e.g. holding down a job, self care, interacting meaningfully with others

    • Rosenhan and Seligman suggest: suffering, maladaptiveness, unpredictability etc. characteristics

  • deviation from ideal mental health = define what is normal and anything that deviates from this is abnormal. Includes positive view of self, capability for growth and development, independence, perception of reality, positive friendships and relationships, environmental mastery

AO3

-statistically infrequency does not consider desirability of traits e.g. high IQ rare but not classed as abnormal. Also many rare behaviours/characteristics don’t affect normality or abnormality e.g. left handedness. Some behaviours regarded as abnormal even though they are quite frequent e.g. Depression affects 27% of elderly people which makes it common but doesn’t mean it is not a problem

-deviation from social norms - social norms change over culture and time (lack consistency) so people’s conceptions of abnormality do as well. E.g. homosexuality regarded as mental illness until 1973. Cross cultural misunderstandings common and may contribute to wrong diagnosis e.g. Escobar 2012 - white psychiatrists tend to over interpret symptoms of black people

-deviation from social norms - classification of abnormality can only be based on the context in which the behaviour occurs - e.g. undressing in a bathroom is normal but in a classroom is abnormal

-failure to function adequately - most people fail to function adequately at some point in their lives but not considered abnormal e.g. after a bereavement most people find it difficult to cope normally and may actually be considered more abnormal if they functioned as usual

-failure to function adequately - most people engage in behaviour that is maladaptive/harmful to self but not classed as abnormal e.g. adrenaline sports, drinking alcohol

-deviation from ideal mental health - what is considered ideal is historically and culturally specific and Jahoda may have set the bar too high so that only few people may actually meet all the characteristics and everyone becomes classified as abnormal and concept becomes meaningless

Phobias

Behavioural explanation of phobias - 2 process model

phobias are an irrational fear

Behavioural explanation believes phobias are learnt

2 process model includes acquisition of phobias via classical condition and maintenance of phobia via operant conditioning

Classical: example apiphobia

  • UCS sting, NS bee, UCR fear

  • UCS and NS associated

  • CS bee, CR fear

  • = phobia

Operant

  • negative reinforcement = avoiding phobic stimulus (e.g. sting) = rewarding

  • = keep avoiding stimulus to get more relief

  • facing fear = anxiety = punishment = don’t want to face fear again

AO3

+Watson and Raynor - Little Albert - classically conditioned to fear white rats = classical conditioing involved in aquisition of phobias. Maintained through operant conditioning = understanding helped develop treatments to phobias

-too simplistic - ignores role of cognition in phobias such as social phobias e.g. public speaking - people may have faulty conditions such as ‘everyone will laugh at me’ - 2 process doesn’t account for this so limited explanation

-overlooks lack of associated trauma - not all phobias caused by trauma e.g. some people phobia of snakes but never met one - may be other factors not considered

-evolutionary explanation - biologically prepared to be fearful of common phobias e.g. heights, dark could all potential harm us = phobias adaptive response to avoid such things to aid survival - undermines validity of behaviourist explanation

Behavioural treatments of phobias

Aims to remove the conditioned association between fear and phobia

Systematic desensitisation:

  • counter conditioned replacing fear with relaxation

  • gradual, slow process with different stages

  • create anxiety hierarchy by listing situation from least to most fearful

  • client trained in deep relaxation techniques e.g. breathing techniques, meditation - fear can be replaced with relaxation

  • client must be exposed or visualise least feared situation and at the same time practise the relaxation technique

  • once client feels comfortable at the level they move on to next level of hierarchy until they reach the top (gradual)

Flooding:

  • treatments aims to extinguish the association between anxiety provoking situation and patients responses to it

  • immediate, fast process

  • exposed to maximum perceived threat immediately and prevents avoidance

  • state of peak anxiety cannot last forever

  • this process is called extinction

  • however if session ends to soon it may reinforce phobia

AO3

-doesn’t address deeper psychological or emotional issues and only focuses on symptoms not the causes - meaning that phobias could potentially come back again as it wasn’t fully resolved ad didn’t treat underlying issue

+however - it can be very effective and for phobias such as spiders it has success rates of 60-90% - there must be some validity in the process

+systematic - suitable for wide range of people as some people with phobias also have learning difficulties etc. so more complex treatments such as cognitive therapy are difficult for them to participate in. Also its not too traumatic so there is a lower drop out rate than flooding so more effective

-flooding - may eradicate one phobia but may be replaced by another - symptom substitution. And if people drop out too early the phobia will not be eradicated and may be worse and will have also wasted money

-less successful with cases of social phobias as cognitive factors to consider with this phobia - CBT may be better alternative

Characteristics of phobias:

  • Behavioural (APE)

    • avoidance - going to a lot of effort to prevent coming into contact with phobia

    • panic - panic in response to presence of phobic stimulus e.g. crying, screaming

    • endurance - person choosing to stay in contact with phobia e.g plane flights

  • Cognitive (SIC)

    • selective attention to phobic stimulus - hard to look away from phobia - keeping attention on something dangerous gives us best chance of survival to react to threat but not so useful when fear is irrational

    • irrational beliefs - person with phobia may hold unfounded thoughts in relation to phobic stimulus

    • cognitive distortions - perceptions may be unrealistic and inaccurate

  • Emotional (FEA)

    • fear - immediate and unpleasant response we experience when we encounter or think about phobic stimulus - more intense but shorter periods than anxiety

    • emotional response is unreasonable - fear os disproportionate to any threat posed

    • anxiety - unpleasant state of high arousal prevents a person relaxing and makes it difficult to experience any positive emotion

Depression

Characteristics of depression:

  • behavioural e.g. neglect of personal appearance, loss of appetite, insomnia/hypersomnia, loss of energy, withdrawal from others

  • emotional e.g. intense sadness, irritability, apathy, anger, feeling of worthlessness

  • cognitive e.g. negative thoughts, lack of concentration, low self esteem, poor memory, recurrent thoughts of death, low confidence

Cognitive explanations for depression

Depression is due to faulty thinking

Focus on negative thoughts, irrational beliefs and misinterpretation pf events as cause of depression

BECKS THEORY: Cognitive triad

  • depression is a result of faulty or maladaptive cognitive processes - negative thinking

  • Negative view of self, the future and experiences

  • silent assumptions play an important role in making people vulnerable to depression - including absoluteisms such as should, must

  • Negative schemas - schemas are mental frameworks of information about world around us - depressed people have developed negative schema during childhood which can be caused by a variety of factors e.g. parents - when a person encounters a new situation the schema is activated which maintains Becks cognitive triad

ELLIS THEORY

  • believes peoples irrational beliefs take the form of absolute statements e.g. must and always (perfectionism) - ‘musterbation’

  • depressed people make unqualified demands of themselves and others leading to symptoms of depression

  • ABC model:

    • depression does not occurs as a direct result of negative event but rather produced by irrational thoughts triggered by negative events e.g. a breakup

    • A = activating negative event

    • B = rational or irrational belief

    • C = healthy or unhealthy negative emotion (consequence)

AO3

+effectiveness of CBT as a treatment - March et al 2007 - CBT as effective as antidepressants - 327 adolescents with diagnosis of depression - 81% of both groups improved, 86% when used together. Valid

-doesnt explain all aspects of depression - depression is complex e.g. Cotards syndrome - rare condition in which patient denies existence of one own body to extent of delusions of immortality (think they are zombies) - cognitive explanation cannot easily explain this characteristic = other factors

-places blame on client rather than situational - depression caused by negative thinking but some people may be in bad situations e.g. domestic abuse or death - person not problem for faulty thinking = may overlook situational factors and not be motivated to change circumstance they are in as believe their faulty thinking it the problem

+Grazioli and Terry - assessed 65 pregnant women for cognitive vulnerability and depression before and after birth and found those who were high in levels of cognitive vulnerability are more likely to suffer from post natal depression = cognition may cause depression

Cognitive treatments of depression (CBT)

Cognitive:

  • Client helped by therapist to identify negative thoughts (e.g. by keeping diary)

  • therapist challenges them and points out positives in situations to challenge negative assumptions made my client

  • thought catching = getting client to spot the link between their thoughts and how they feel

  • reality testing - client investigates reality of their beliefs via patient as scientist

Behavioural:

  • encouraging positive behaviour e.g. setting small goals for person e.g. having breakfast

  • skills taught to help cope with stressful situations

AO3

+March et al

-CBT critisised for overemphasis on role of cognition - suggests irrational thinking is primary cause of depression and CBT doesn’t take into account other factors - e.g. situations = CBT ineffective as situation not negative thoughts

-patients with severe depression may not engage with CBT - gives homework which people have to be willing to do and have to be honest and if they don’t then reduced impact in helping people with depression. Alternative treatments e.g. antidepressants don’t require same motivation so more effective in some cases

-CBT only focuses on present - some patients may be aware of a link between childhood and depression and therefore become frustrated of the process and be unengaged meaning CBT may be inappropriate for these people

OCD ??

Biological explanations of OCD

Neural:

Orbifrontal cortex responsible for anxiety feelings

Caudate nucleus plays vital role in how brain learns, specifically storing and processing of memories - uses information from past experiences to influence future actions and decisions

Thalamus responsible for saftey behaviours like cleaning and checking - it activates orbifrontal cortex

In OCD thalamus is over active

AO3

-Research evidence shows that OFC damage from brain tumours can give rise to OCD - however in neuroimaging results have shown impairement not always found in OCD patients

+OCD symptoms can be relived using SSRI medication - SSRIs inhibit activity in OFC

Hormonal or neural?:

Serotonin is an inhibitory neurotransmitter - does not stimulate brain

Adequate amounts of serotonin necessary for stable mood and balance excessive excitatory neurotransmitter firing in brain

in OCD serotonin is lower = abnormal functioning in OFC and caudate nucleus

UNFINISHED

Biological treatments for OCD

Antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) - increase serotonin in brain by limiting reuptake by neurones