1.4 psychopathology

Question 1

four definitions of abnormality

Answer 1

deviation from social norms, statistical infrequency, failure to function adequately and deviation from ideal mental health

DSN, SI, FFA, DIMH

Question 2

deviation from social norms

Answer 2

anyone who behaves differently from the accepted standards of behaviour in a community is classed as abnormal

social norms are in place for good reason - for example, impolite people are considered socially deviant as others find it hard to interact with them

other examples include not giving people personal space or being unhygienic in public

Question 3

three disorders that can be identified with DSN

Answer 3

ASPD - antisocial personality disorder, where people may not understand how to behave towards others and can be considered reckless or manipulative

voyeurism - gaining sexual pleasure watching people when they are naked

paedophilia - disorder where there is a preference for sexual activity with children

Question 4

two strengths of using DSN

Answer 4

+ we can clearly distinguish between normal and abnormal behaviour. for example if someone is talking to themselves loudly in public they are not adhering to social norms (politeness), and can be considered abnormal.

+ real life application, we can use this definition to diagnose certain disorders where the symptoms clearly state that the person’s behaviour deviate from social norms, eg. ASPD or schizophrenia when people may talk to themselves. application to the real world makes the definition authentic.

Question 5

three weaknesses of using DSN

Answer 5

• in some cases, it can be beneficial to break social norms eg. the suffragettes broke social norms by getting involved in work that was traditionally male led and protesting an unorthodox cause, but this led to women gaining the right to vote.
• definition of social norms changes over time eg. homosexuality was classed as a mental illness in the ICD in 1990 but isn’t anymore. the definition cannot be judged across eras
• deviation is related to the context and degree, it could just be harmless eccentricity or something severely wrong eg. being naked on a beach vs a classroom

Question 6

statistical infrequency

Answer 6

this definition suggests that abnormal behaviour is that which is statistically rare and lie at both extremes of a statistical infrequency graph (normal distribution/bell curve).

34% to either side = normal

2.5% to either side = abnormal

for example, the average persons IQ is 100. scores which are significantly higher or lower (eg. 130 or 70) are classed within the abnormal category, as they are rare/statistically infrequent.

Question 7

two strengths of statistical infrequency

Answer 7

+ real life application. for example identifying someone with an IQ outside of the normal distribution could help with diagnosing disorders like intellectual disability disorder.

+ data is collected about a behaviour or characteristic. SI is objective, meaning it is unbiased as it is based on real statistics (you either fit in or you don’t)

Question 8

two weaknesses of statistical infrequency

Answer 8

• this definition fails to account for behaviour that is statistically rare but desirable. eg. an IQ above the normal average would not be seen as abnormal, but highly regarded for intelligence.
• not everyone unusual benefits from a label - self-fulfilling prophecy means that SI could CAUSE someone to be abnormal. eg. having a low IQ could cause someone to believe that they are mentally inferior, and start acting like it too.

Question 9

failure to function adequately

Answer 9

suggests that abnormal behaviour is when someone is unable to cope with everyday life. this may disrupt their ability to work or have satisfying interpersonal relationships.

eg. depression results in low moods that can lead to a person feeling unwilling to get up each morning, let alone go to work each day

Question 10

failure to function adequately case study

Answer 10

rosenhan & seligman (1989) suggested you can identify whether someone is not coping with three rules:

extreme personal distress. this can be a sign of many psychological disorders like depression. some severe mental disorders cause sufferers no personal distress (being oblivious to their condition)

irrational or dangerous behaviour. this interferes with daily life/other people, which is maladaptive.

not conforming to standard interpersonal rules (eg. eye contact, personal space) which can be measured by GAF scale. general assessment of functioning, measuring how well individuals function in everyday life.

Question 11

two strengths of using failure to function adequately

Answer 11

+ it recognises the patients thoughts and feelings, unlike DSN which measures abnormality based on social norms. this is a useful definition when assessing psychopathological behaviour of the individual

+ it is measurable, using the GAF scale - this means abnormality is defined relatively objectively

Question 12

three weaknesses of using failure to function adequately

Answer 12

• cultural relativism. it depends on the culture to decide what functioning adequately actually looks like eg. sleeping during the day is called siesta in spain but may be a sign of depression in the UK
• this definition doesn’t specify how much distress an individual can feel to be classed as ‘normal’. there are times in a person’s life when it is normal and psychologically healthy to suffer from personal distress, like when a loved one dies. it would be abnormal not to feel distress under these circumstances, which contradicts the failure to function adequately definition
• abnormality doesn’t always stop someone from functioning. psychopaths can commit murders while still appearing normal. eg. harold shipman was a doctor who murdered 215 patients over 23 years and maintained a respectable appearance. no one knew he was a serial killer. this definition may not recognise inner distress as the individual may look normal

Question 13

define deviation from ideal mental health

Answer 13

DIMH suggests that abnormality can be identified by looking at the opposite of normality.

jahoda (1958) suggested that physical illness is the absence of good health, and mental health can be defined in the same way.

thus, abnormal individuals do not meet the standard set of criteria for good mental health.

Question 14

deviation from ideal mental health case study

Answer 14

jahoda (1958) suggested mental health can be defined with 6 criteria:

APPRES

1. autonomy (A) - being independent, self-reliant, and able to make personal decisions for oneself
2. perception of reality (P) - having an objective and realistic view of the world (no delusions/hallucinations)
3. positive attitudes towards oneself (P) - high self esteem, self-respect, confidence and a positive self concept
4. resistance to stress (R) - having effective coping mechanisms and being able to manage everyday stressful situations
5. environmental mastery (E) - being competent in all aspects of life and the ability to meet the demands of any situation and the flexibility to adapt
6. self-actualisation (S) - experience personal growth and development to reach ones full potential

Question 15

two strengths of using deviation from ideal mental health

Answer 15

+ the definition is comprehensive (broad) so it includes all of the reasons one might seek help eg. an inaccurate perception of reality could mean that someone feels like a failure when they achieve an objectively good score on an exam.

+ encourages one to focus on achieving ideal mental health by following the set criteria. jahodas list allowa an individual to be aspirational in their outlook on life.

Question 16

three weaknesses of using deviation from ideal mental health

Answer 16

• this list is demanding and unrealistic. it suggests that most of us are abnormal to some degree, because not many people meet all of the ideals. eg. not many people meet self-actualisation at every point in their life
• cultural relativism - depends on the culture to say which ones apply, eg. collectivist cultures like india or japan emphasise communal goals and regard autonomy as undesirable, unlike individualist cultures. therefore people from these collectivist cultures may be seen as abnormal using the criteria.
• many of the criteria jahoda mentions are subjective, vague and difficult to measure. for example, attempting to judge self-actualisation or resistance to stress is very individual based

Question 17

phobias

Answer 17

an irrational fear of specific objects, places or situations causing excessive fear and anxiety

Question 18

behavioural characteristics of a phobia

Answer 18

panic: the person might panic in the presence of the phobic object. this can be characterised by screaming, crying or running away, young kids may react by clinging/tantrum/freezing

avoidance: the person makes a conscious effort to avoid coming in contact with the phobic object in the first place. this can interfere with daily life

endurance: the person remains in presence of the phobic object but with high levels of anxiety. it can be unavoidable in cases like flying (it is an alternative to avoidance)

Question 19

emotional characteristics of a phobia

Answer 19

fear: persistent, excessive and unreasonable distress might be felt in the presence of a phobic object. intense but for shorter periods than anxiety.

anxiety: a person will feel terror when encountering a phobic object, and be apprehensive about what is going to happen

unreasonable emotional responses: for example, a person with a phobia of spiders will have a huge reaction when seeing a harmless spider

Question 20

cognitive characteristics of a phobia

Answer 20

selective attention: when a person encounters a phobic object, they will become fixated on it because of their irrational beliefs about the danger posed

irrational beliefs: the persons thoughts about their phobia do not make logical sense, and they will resist rational arguments that counter it. eg. people who are scared of flying will not listen to the fact that ‘flying is the safest form of transport’

cognitive distortions: perceptions of the phobic object are distorted and unpleasant, for example arachnophobes may see all spiders as dangerous and deadly, despite the fact there are no deadly spiders in the UK.

Question 21

behavioural explanation of phobias

Answer 21

phobias are learned through experience through association.

howard mowrers (1960) two process model suggests that phobias are initiated by classical conditioning and then maintained by operant conditioning

Question 22

classical conditioning

Answer 22

learning through association. a stimulus produces the same response as another stimulus because they have been constantly presented at the same time.

this could be how phobias develop, as the phobic object has been associated with another stimulus in the past for the sufferer.

Question 23

operant conditioning

Answer 23

learning through reinforcement - whether it be positive or negative reinforcement/punishment.

reinforcement encourages repetition whilst behaviours that are punished will not be repeated.

a phobia can be maintained through avoidance behaviour, as avoiding the phobic object takes away fear and anxiety, and so is reinforcing (negative).

Question 24

reinforcement

Answer 24

positive reinforcement: receiving a reward when a certain behaviour is performed, for example receiving praise from a teacher when you answer a question right. this makes it more likely that the behaviour is repeated

negative reinforcement: behaviour is carried out to avoid a negative consequence/punishment, eg. doing your homework to avoid getting shouted at

Question 25

punishment

Answer 25

positive punishment: a behaviour leads to something unpleasant being added, making it less likely that the action will be repeated eg. a fine on a wrongly parked car

negative punishment: taking away something to prevent the behaviour from being repeated eg. taking away screen time for not doing chores

Question 26

watson and raynor (1920) experiment

Answer 26

they conditioned an 11-month-old to have a fear of white rats.

initially the boy was keen to play with the rat. in the experiment, the psychologists struck a metal bar behind his head every time albert reached for the rat. this would make a loud noise that started albert and made him cry. eventually, albert cried every time he saw the rat, and this fear then generalised to other white fluffy objects.

Question 27

watson and raynor (1920) findings

Answer 27

an infant is born with certain reflexes. the unconditioned stimulus of the loud bang produced the reflex of fear, crying and screaming as an unconditioned (natural) response.

the white rat was a neutral stimulus as it produced no reflexes (albert was unaffected). however, over time the white rat became associated with the unconditioned stimulus of a loud noise.

the white rat then became the conditioned stimulus, which then produced fear/phobia of the white rat as a conditioned response

albert associated the rat with fear. the conditioned response of fear was then generalised to all white or fluffy objects.

Question 28

operant conditioning evidence

Answer 28

skinner (1938)

the ‘skinner box’ supported operant conditioning by proving in rats and pigeons that complex controlled responses like pressing bars and spinning a wheel could be learnt if the behaviour was rewarded

positive reinforcement was shown as the rat learned to press the lever to get more food

negative reinforcement was shown as the rat learned to press the lever to avoid getting shocked again

Question 29

two strengths to the behavioural approach to explaining phobias

Answer 29

+ provides good explanations of how phobias can be acquired and maintained over time. this impacted the way behavioural therapies like flooding and systematic desensitisation were developed. it explains why patients need exposure to the phobic stimulus. once the patient stops practicing their avoidance behaviour, the behaviour is no longer reinforced and declines.

+ proven by scientific experimental evidence, for example watson and raynor (1920) or pavlov’s dogs (1927). ivan pavlov (1927) proved that dogs could be conditioned to salivate at just the sound of a bell.

neutral stimulus (bell) is paired with the unconditioned stimulus (food) that produces an unconditioned response (salivating) repeatedly. the neutral stimulus then becomes the conditioned stimulus (bell), which produces a conditioned response (salivating to the bell), as the dog now associates the bell to tasty food.

Question 30

two weaknesses to the behavioural approach to explaining phobias

Answer 30

• many people who have a traumatic experience, such as a car accident, do not then go on to develop a phobia (e.g. of cars/driving), so classical conditioning does not explain how all phobias develop.
• there are many issues involved with the studies that support the two-process model. little albert’s study was extremely ethically flawed. he did not give his consent to take part in the study, meaning watson and raynor breached the ethical code of consent. he was also too young to understand the long term harm towards him. also, this study involved a child and pavlov’s involved dogs, and skinners used rats and pigeons - this means it cannot be generalised to adult human beings as they encounter less unconditioned stimuli than babies/animals.

Question 31

behavioural treatments: systematic desensitisation

Answer 31

behavioural therapy developed by joseph wolpe (1958) to reduce phobias by using classical conditioning.

a person experiences fear and anxiety as a behavioural response to a phobic object. SD replaces this fear and anxiety with relaxed responses instead.

the central idea of SD is reciprocal inhibition, which is that it is impossible to experience two opposite emotions at the same time e.g. fear and relaxation.

therefore if the patient can learn to remain relaxed in the presence of their phobia, they can be cured (counter-conditioning).

Question 32

two methods of SD

Answer 32

in vivo - the person experiences the phobia in real life

in vitro - the person imagines or visualises their phobia

Question 33

three stages of systematic desensitisation (1)

Answer 33

1. anxiety hierarchy

a list of situations relating to the phobic stimulus are arranged from most to least frightening.

an arachnophobe might put holding a spider at the top but looking at a picture of a spider at the bottom.

Question 34

three stages of systematic desensitisation (2)

Answer 34

2. relaxation training

the therapist teaches the patient to relax as deeply as possible, whilst sitting comfortably and with their eyes closed.

reciprocal inhibition is put into practice as a patient cannot be afraid and relaxed at the same time.

breathing exercises and meditation can be used in conjunction with drugs like valium and mental imagery techniques.

Question 35

three stages of systematic desensitisation (3)

Answer 35

3. gradual exposure

the person is exposed to the phobic object in a relaxed state and moves up the hierarchy starting with the least frightening stage.

they use their relaxation techniques when they are exposed to the phobic object.

when they are comfortable they move onto the next stage. eventually the phobia is eliminated.

Question 36

three strengths of systematic desensitisation

Answer 36

+ quicker and less effort than other therapies that need the patients to play such an active role. it is easy and accessible for all groups of people to do eg. those with learning disabilities to do

+ effective in the short and long term for certain phobias. treatment for blood and spider phobias saw a 90% success rate. gilroy et al (2003) followed up with 43 patients who had SD for arachnophobia in three 45-minute sessions. at both 3 and 33 months, SD group was less fearful than the control group (treated by relaxation without exposure)

+ ethical method of treating phobias because the stages enable the participants to feel comfortable, in contrast to flooding, which is known to be very stressful.

Question 37

three weaknesses of systematic desensitisation

Answer 37

• it only works for certain phobias. for example, SD does not work for social phobias like social anxiety which requires a more detailed therapy (normally CBT). this incorporates a cognitive element into the therapy.
• relies on the clients ability to imagine the fearful situation, especially when using the in vitro technique. using in vivo might be more costly, for example if a patient has a fear of heights. thus, SD is ineffective.
• while it may be effective in the therapy situation, SD lacks ecological validity. patients with phobias that have not developed through personal experience (classical conditioning) seem to be less effectively treated. this is because certain phobias are rooted in evolutionary explanations, such as a fear of heights. therefore, SD is ineffective to treating evolutionary phobias.

Question 38

flooding process

Answer 38

flooding involves directly exposing a patient to their phobic object.

beforehand, the patient would be taught relaxation techniques such as deep breathing and meditation.

unlike SD, there is not a gradual build-up using the anxiety hierarchy - instead, flooding involves immediate exposure to a very frightening and extreme situation, e.g. a person scared of snakes might be expected to hold a snake for a long time.

this can be done for real, or it could be in vitro (imagining the situation).

flooding therapy sessions usually last 2-3 hours, which is much longer than SD sessions

Question 39

flooding effect

Answer 39

flooding stops phobic responses very quickly. this is because the patient does not have the option for any avoidance behaviour, and they quickly learn that the phobic object is harmless, and therefore extinction occurs.

in some cases the patient might achieve relaxation in the presence of their phobic object because they are so exhausted by their own fear response.

flooding is ethical, even though it can cause a great deal of initial psychological harm. the patient would have to give their fully informed consent so that they were fully prepared for the flooding session.

Question 40

two strengths of flooding

Answer 40

+ research support: wolpe (1960) supports the use of flooding to remove a patient’s phobia of being in cars. the girl was forced into a car and driven around for four hours until her hysteria was eradicated. this demonstrates how effective flooding is as a treatment for phobias.

+ ougrin (2011) found flooding was a cheaper alternative to cognitive therapy for patients because it removed the phobia quicker than several sessions of SD. this may have economic implications as a person who may have been getting to work late every day because of a fear of elevators may now not be scared.

Question 41

two weaknesses of flooding

Answer 41

• highly traumatic treatment and many patients might be unwilling to continue with therapy until the end. time and money might be wasted prepping patients (relaxation etc), and then the patient may decide they do not want to take part. the phobia remains uncured. it is not suitable for children as it is traumatic.
• less effective for phobias like social anxiety because it doesn’t have a cognitive element to it like CBT which tackles irrational thinking

Question 42

depression

Answer 42

mental disorder characterised by low mood.

Question 43

DSM-5 categories of depression

Answer 43

major depressive disorder (severe but short term), persistent depressive (long time/recurring, including sustained major depression and what used to be called dysthymia), disruptive mood diregulation disorder (childhood temper tantrums), premenstrual dysphoric disorder (disruption to mood prior to and/or during menstruation)

Question 44

behavioural characteristics of depression

Answer 44

disrupted activity levels: people will depression may experience lethargy, withdrawal from social activity (anhedonia) OR THE OPPOSITE which is being agitated and unable to relax (psychomotor agitation), with an increased activity level.

disruption to sleeping/eating: reduced sleep (insomnia) OR increased sleep (hypersomnia). dramatic weight loss or gain.

aggression/self-harm: sufferers are often irritable, and verbally or physically aggressive which can lead to relationship or work issues. aggression towards themselves can be in the form of cutting/suicide attempts.

Question 45

emotional characteristics of depression

Answer 45

lowered mood: feeling sad, worthless, empty

anger: negative emotions are not limited to sadness. anger can be directed at themselves or others (can also lead to self-harm)

lowered self esteem: sufferers often have constant feelings of reduced worth and/or inappropriate feelings of guilt. they might also experience very low levels of self-esteem.

Question 46

cognitive characteristics of depression

Answer 46

poor concentration: difficulty in making straightforward decisions or concentrate as they usually could. this can interfere with work and retrieving memories.

negative schema: negative view of themselves, the world and the future. they tend to recall unhappy events rather than happy ones. can be a self-fulfilling prophecy.

absolutist thinking: black and white thinking (all good or all bad). when a situation is unfortunate, they believe it is an absolute disaster. this is out of proportion and irrational.

Question 47

cognitive approach to explaining depression

Answer 47

cognitive explanation suggests depression is the result of disturbance in ‘thinking’. depression is a consequence of faulty and negative thinking about events and it can be managed by challenging this faulty thinking.

Question 48

beck’s cognitive triad (1967)

Answer 48

beck (1967) theorised that a person’s cognitions create vulnerability to depression

faulty information processing: attending to the negatives of a situation and ignoring the positives. this means cognitive bias is based on over generalisations and catastrophising (eg. ill fail in life because i failed one unit test).

negative self-schemas: negative information we hold about ourselves based on negative past experiences, like criticism from teachers, parents or peers.

examples include ineptness schema (when you expect to fail), self-blame schema (feeling responsible for your failures), negative self-evaluation schema (constantly reminding you that you’re worthless)

the negative triad: negative views of the self, the world, and the future

Question 49

two strengths of beck’s cognitive triad

Answer 49

+ there is evidence depression is caused by negative and irrational thinking.

eg. grazioli and terry (2000) assessed 65 pregnant women for cognitive vulnerability (negative patterns of thinking) before and after giving birth.

cognitively vulnerable women were more likely to develop post-partum depression. negative cognitions were seen before depression so the idea that negative thinking might have been the cause is valid.

+ this theory has practical application as it can be applied to cognitive behavioural therapy, which is a successful method of treating depression. this means that becks theory is a strong explanation of depression.

Question 50

two weaknesses of beck’s cognitive triad

Answer 50

• the negative triad doesn’t explain all aspects of depression eg. some are also angry and some even suffer hallucinations and delusions (becks theory doesn’t explain these symptoms = invalid?)
• cause and effect is still unclear. negative and irrational thoughts might develop first and then cause depression (like in grazioli and terry’s experiment).

or, depression might develop first from a different source, like genetics, and cause irrational and negative thinking.

Question 51

albert ellis’ ABC model (1962)

Answer 51

suggested a good mental health stems from rational thinking, and disorders like depression stem from irrational thinking. he developed the ABC model to explain how these beliefs are formed.

ABC:

(a)ctivating event - an external incident from someones life (eg. getting fired)

(b)eliefs - irrational/rational thoughts after the fact. (eg. the company was overstaffed VS they hate me)

(c)onsequences - emotional and behavioural responses to these beliefs. rational = healthy emotions (eg. acceptance). irrational = unhealthy emotions (g. depression)

Question 52

two strengths of ellis’ ABC model

Answer 52

+ there is research support for the ABC model and negative thinking as a cause of depression. bates (1999) found that depressed participants who were given negative thought statements became more and more depressed.

+ one strength of the ellis’ cognitive explanation is its application to therapy. REBT (rational emotive behaviour therapy) was developed through ellis’ explanation of depression. this therapy challenges irrational, negative beliefs through the added ‘dispute’ and ‘effect’, and has been proven to reduce a person’s depression.

Question 53

two weaknesses of ellis’ ABC model

Answer 53

• not all cases of depression follow activating events or ‘reactive depression’. ellis’ model is not a complete explanation of depression, it only applies to some kinds
• the ABC model gives the client some power to change the situation and improve their symptoms but blames the client for the depression as well (their thinking).

Question 54

two strengths of the cognitive approach to explaining depression

Answer 54

+ practical explanation, it can be used to treat depression. CBT, which was developed through becks and REBT (rational emotive behavioural therapy) based on ellis. these therapies have been proven to challenge irrational, negative thoughts and reduce depression.

+ research evidence to support it eg. cohen et al. (2019) is RECENT: tracked development of 473 adolescents regularly measuring cognitive vulnerability - found that those showing cognitive vulnerability predicted later depression

Question 55

two weaknesses of the cognitive approach to explaining depression

Answer 55

• there could be other explanations to depression eg. genes and low levels of neurotransmitters like serotonin (drug therapies like SSRI’s are found to help depression, increasing serotonin levels. cognitive explanations are not complete.
• does not explain where the irrational thoughts come from because most of the research is correlational, is depression a cause or consequence of irrational thoughts? therefor it is difficult to find the correct treatment

Question 56

beck’s cognitive behavioural therapy

Answer 56

combines cognitive and behavioural elements.

1. thought catching - identifying and challenging irrational negative thoughts (cognitive).
2. patient as the scientist - the patient is then encouraged to generate a hypothesis to test the validity of their irrational thoughts

> though homework assignments to test out their irrational thoughts in the real world

> keeping thoughts in a diary to identify situations in which negative thinking occurs so these can be targeted

> when patients report positive thoughts they are praised by the therapist, which provides positive reinforcement.

3. the aim of this therapy is cognitive restructuring; learning to identify, dispute, and change irrational thoughts by putting more efficient behaviours into place to replace bad thoughts (behavioural)

Question 57

ellis’s rational emotive behavioural therapy (1994)

Answer 57

CBT for depression

this therapy aims at challenging automatic negative thoughts (D ispute) and replacing them with rational beliefs (E ffect).

the therapist uses logical arguments to show patients that their self-defeating beliefs do not logically follow from the information available (e.g. just because your friend does not say hello to you does not mean they hate you, it could be that they just didn’t see you).

the therapist also uses empirical arguments to show patients that their self-defeating beliefs are not consistent with reality (e.g. it does not make sense to believe everyone hates you when they keep inviting you out for dinner).

patients undertaking REBT are encouraged to engage in behavioural activation, which is becoming more active and taking part in pleasurable activities. many depressed patients often do not engage in activities that they used to enjoy

Question 58

two strengths of CBT

Answer 58

+ march et al. (2007) found that CBT was as effective as antidepressants in treating depression. the researchers examined 327 adolescents with depression. they looked at the effectiveness of CBT, anti-depressants and a combination of the two.

after 36 weeks, 81% of the anti-depressant group and 81% of the CBT group significantly improved. however, 86% of the combination group had significantly improved. this suggests that a combination of CBT and anti-depressants is the most effective treatment.

+ there is evidence that CBT lasts longer than just antidepressants, and also has no side effects or withdrawal symptoms.

CBT requires the individual to change their thoughts and behaviour, showing it is a long term change.

babyak et al (2000) found that 156 volunteers with major depression were randomly assigned a four-month course of aerobic exercise, drug treatment or combination.

exercise groups had lower relapse rates than drugs after six months, showing that a behavioural change is more effective than medication.

Question 59

three weaknesses of CBT

Answer 59

• one issue with CBT is that it requires commitment and motivation. patients with severe depression may not engage with CBT or even attend the sessions, and therefore this treatment will be ineffective in treating these patients.

alternative treatments like anti-depressants do not require the same level of motivation and may be more effective in these cases. this poses a problem for CBT, as it cannot be used as the sole treatment for severely depressed patients.

• CBT relies on patients self-reporting their thoughts as thoughts cannot be objectively observed or measured. these self-reports could be unreliable and it is difficult to verify if they are accurate or not.
• CBT is time-consuming and more expensive than other therapies, such as using antidepressants. this also effects the economy, because the longer that people with depression are in therapy, the less time they are committed to working. antidepressants on the other hand, allow employees to function at work and maintain their mental wellbeing in the short term.

Question 60

ocd

Answer 60

obsessive compulsive disorder

an anxiety disorder which stems from both obsessions (persistent thoughts) and compulsions (behaviours that are repeated)

compulsions are a response to obsessions and sufferers believe compulsions reduce anxiety

Question 61

DSM-5 categories of ocd

Answer 61

OCD, trichotillomania (compulsive hair pulling), hoarding disorder (compulsive gathering of possessions), excoriation disorder (compulsive skin picking)

Question 62

behavioural characteristics of ocd

Answer 62

compulsions: these are repetitive actions that could seriously hinder the person’s ability to perform everyday functions. compulsive behaviours reduce the anxiety that is created by obsessions. the person feels they must perform these actions otherwise something dreadful might happen. the person may wash their hands over and over again so that they are very late for work, in response to an obsessive fear of germs.

avoidance: sufferers may try to reduce anxiety by avoiding situations that might trigger it. for example, those who wash their hands continuously might avoid coming into contact with germs by never empting their bins. this can affect daily life

Question 63

emotional characteristics of ocd

Answer 63

high anxiety and stress: powerful anxiety accompanies both obsessions and compulsions. obsessive thoughts are frightening and the urge to repeat behaviour creates anxiety

accompanying depression: compulsions may reduce anxiety temporarily but cause low mood and a lack of enjoyment in activities

guilt and disgust: other negative emotions like IRRATIONAL guilt and disgust can be directed at external objects or themselves

Question 64

cognitive characteristics of ocd

Answer 64

obsessive thoughts: these are recurrent, intrusive and irrational thoughts that can be frightening or embarrassing. present for around 90% of ocd sufferers, they vary from person to person but are always unpleasant.

cognitive strategies to deal with obsessions: people cope with obsessions through cognitive strategies, eg. a person with obsessive guilt may turn to praying for forgiveness which can impact their lives/appear odd to others

awareness that behaviour is irrational: most sufferers understand their compulsive behaviours and obsessive thoughts are inappropriate and irrational, but they cannot consciously control or stop them. they may still experience catastrophic thinking.

Question 65

ocd cycle

Answer 65

obsessions, anxiety, compulsions, relief

Question 66

biological explanations of ocd

Answer 66

there are two biological explanations of ocd: genetic and neural (and neuroanatomical) explanations

Question 67

genetic explanations

Answer 67

abnormality in the brain can be a result of genetic inheritance, meaning passed from parent to child.

this is proven through twin (identical twins should both have the same disorder since they share 100% genes), family (ocd is in genetics and can be passed down) and adoption (baby with ocd in their genes should end up with the disorder regardless of environment/adopters) studies.

Question 68

genetic explanations: diathesis stress model

Answer 68

according to the diathesis-stress model, certain genes leave some people more likely to suffer from a mental disorder, but some environmental stress may be necessary to trigger the condition.

Question 69

genetic explanations: candidate genes

Answer 69

ocd has been classed as polygenic; this means that one single gene is not responsible for the disorder. instead, as many as 230 genes (taylor 2013) might create a vulnerability for ocd, and they are known as candidate genes.

1. the COMT gene may have a role in causing ocd. this gene regulates the production of a neurotransmitter called dopamine. people with ocd have a mutated version of the gene leading to INCREASED dopamine activity, in comparison to those without the disorder.
2. a second gene which has been implicated in ocd is the SERT gene. this gene affects the transportation of serotonin. people with ocd have a mutated version of the gene leading to REDUCED serotonin activity.

Question 70

three strengths of genetic explanations

Answer 70

+ there is evidence to explain that genes play a part in developing ocd. nestadt et al (2000) found that people who had a first-degree relative who already had ocd were 5 times more likely to get the disorder too.

+ there is research evidence that comes from twin studies. nestadt (2010) reviewed previous twin studies and found that 68% of identical MZ twins (100% shared DNA) shared ocd whereas only 31% of non-identical DZ twins (50% shared DNA) did, which strongly suggests a genetic influence on ocd. this is because there was a higher concordance rate in MZ twins.

+ family studies show that genetics are involved in vulnerability for OCD. lewis (1936) found that of his OCD patients, 37% had parents with ocd and 21% had siblings with ocd. this suggests ocd runs in families

Question 71

two weaknesses of genetic explanations

Answer 71

• ocd is polygenic, meaning that several genes are involved, and they only increase the risk of ocd by a fraction. this means genetic explanations have little predictive value and we can’t pinpoint which gene actually affects ocd. therefore the genetic explanation is not very helpful
• twin studies are flawed:

the concordance rate for ocd in identical twins is not 100%. therefore it cannot be caused entirely by genetic factors. it also overlooks the fact that MZ twins may be more similar in terms of environment as they are brought up the same. you can’t generalise these studies to the general population as there not many twins in the world.

Question 72

neural explanations of ocd

Answer 72

neural explanations of ocd are based on brain chemicals (neurotransmitters) and abnormal brain circuits (neuroanatomical).

dopamine and serotonin are neurotransmitters that regulate mood, and abnormal levels of these are associated with abnormal transmission of mood-related information.

Question 73

neural explanations of ocd: dopamine

Answer 73

those with ocd have high levels of dopamine, which has been linked to over-hyperactivity in the basal ganglia area in the brain.

this part of the brain is involved in many processes, like coordination and movement.

hypersensitivity to this area causes repetitive motor functions (eg. compulsions like washing/checking).

Question 74

neural explanations of ocd: serotonin

Answer 74

ocd sufferers often have a reduced functioning serotonin system in the brain (characterised by feeling sad/low mood etc).

serotonin plays a key role in operating the caudate nucleus in the basal ganglia of the brain, and it seems that low levels of serotonin cause the caudate nucleus to malfunction. low levels of serotonin result in obsessions.

Question 75

two strengths of neural explanations of ocd

Answer 75

+ there is evidence that the basal ganglia is linked to ocd through head injury case studies.

max et al (1994): suggested when the basal ganglia is disconnected from the frontal cortex during surgery, ocd like systems are reduced. this shows a clear link between basal ganglia and ocd

+ anti-depressant drugs increase serotonin levels in ocd patients, which has led to a reduction in ocd symptoms. therefore there is good evidence to suggest that low levels of serotonin could be a cause for OCD

Question 76

two weaknesses of neural explanations of ocd

Answer 76

• studies of decision-making show that it isn’t clear what neural mechanisms are involved in ocd: other brain systems are involved in some research, but there is no clear defining one. an overactive frontal cortex doesn’t mean you have ocd.
• we cant assume the neural mechanisms cause ocd: they could be a consequence. did ocd cause low serotonin and high dopamine or did they cause ocd?

Question 77

biological treatments for ocd

Answer 77

drug therapy aims to increase or decrease the amount of a certain neurotransmitter (serotonin) in the body. the general purpose is to decrease anxiety, lower arousal, and lower blood pressure and decrease heart rate.

includes SSRIs, benzodiazepines, CBT.

Question 78

SSRI’s: serotonin

Answer 78

selective serotonin reuptake inhibiters work on the serotonin system in the brain.

serotonin is released by presynaptic neurons (brain cells) and travels across the synaptic cleft (gap between neurons). it chemically conveys the signal from the presynaptic neuron to the postsynaptic neuron and is then reabsorbed (re-uptake) by the presynaptic neuron, where it is broken down and reused.

SSRI’s increase serotonin levels by preventing the reabsorption and breakdown of the serotonin in the synapse. here, it stimulates the postsynaptic neurone.

Question 79

SSRI’s effect

Answer 79

this should reduce anxiety by compensating for flaws in the serotonin system in ocd. eg. fluoxetine (20mg), which is available as a liquid or capsule + takes three to four months to have an impact on symptoms

Question 80

anti-anxiety drugs

Answer 80

benzodiazepines are anti-anxiety drugs that include valium and diazepam

they increase the activity of the inhibitory neurotransmitter GABA, which slows down the activity of the CNS and calms anxiety. this is a result of obsessive thoughts.

drugs are often combined with CBT - the drugs reduce the patients emotional symptoms which allows the patient to engage more effectively in CBT

Question 81

two strengths of SSRI’s

Answer 81

+ soomro (2009) reviewed 17 studies that compared SSRIs to placebo drugs for treating OCD and found that all 17 studies showed that SSRI drugs were more effective than placebos, especially when SSRIs were combined with (CBT)

+ cost effective for the NHS (CBT requires a paid therapist, time out of work) and is non-disruptive for the patient’s life

Question 82

two weaknesses of drug therapy

Answer 82

• there are very severe side effects that are not an issue with CBT therapies. soomro (2008) found evidence of common side effects of SSRIs such as nausea, headaches, and insomnia
• drugs treat the symptoms but not the cause - SSRIs increase serotonin levels but do not treat the underlying cause of OCD (once the patient stops taking the drug they will relapse, it is a temporary fix)