4. Psychopathology Flashcards
(105 cards)
1
Q
Psychopathology definition?
A
Psychopathology is the field of study that deals with mental, emotional and behavioural problems.
2
Q
What are the four definitions of abnormality?
A
- Statistical infrequency
- Deviation from societal norms
- Failure to function adequately
- Deviation from ideal mental health
3
Q
Statistical infrequency definition?
A
Statistically “rare” behaviour should be seen as abnormal.
4
Q
What do we use to model normal distribution?
A
Bell curve.
5
Q
What type of abnormality does statistical infrequency study?
A
Extremes of abnormality.
6
Q
Deviation from societal norms definition?
A
Variation from societal ‘norms’ is considered to be abnormal. Behaviour that is undesirable is abnormal. It interferes with everyday life.
7
Q
Failure to function adequately definition?
A
Cannot cope with everyday life - doesn’t just interfere.
8
Q
Features of the failure to function adequately definition of abnormality?
A
- Unpredictability.
- Personal distress.
- Irrationality.
- Unconventionality.
- Maladaptive behaviours.
- Observer discomfort.
- Violation of moral standards.
9
Q
What is the deviation from ideal mental health definition of abnormality?
A
Looks for an absence of wellbeing.
10
Q
Who studied the deviation from ideal mental health definition?
A
Studies by Jahoda (1958).
11
Q
What did Jahoda find in the studies about deviation from ideal mental health?
A
6 characteristics should be exhibited to demonstrate ‘normal’ behaviours. Absence of any characteristic indicates abnormality. The 6 characteristics are as follows:
1. Self-actualisation of one’s potential.
2. Personal autonomy.
3. Positive attitudes towards self: you like yourself.
4. Environmental mastery (you feel you have control over your immediate environment).
5. Accurate perception of reality.
6. Resistance to stress.
12
Q
Evaluate the statistical infrequency definition.
A
Strength:
Real-life applications: in the diagnosis of intellectual disability orders
Weaknesses:
- Unusual characteristics can be positive: IQ scores over 130 are just as unusual as those below 70 but super-intelligence wouldn’t be considered an undesirable characteristic.
- Labels aren’t always beneficial.
13
Q
Evaluate the deviation from societal norms definition.
A
Strength:
Practical applications: it has a real-life application in the diagnosis of antisocial personality disorder.
Weaknesses:
- Cultural relativism: One weakness of this definition is that societal norm differ massively from generation to generation and from culture to culture.
- Human rights abuses: One weakness of the definition is that people become too dependent on it as a way to explain abnormality. E.g: Diagnosing women with nymphomania is they were attracted to a working class man.
14
Q
Evaluate the failure to function adequately definition.
A
Strengths:
- Patient’s perspective.
- Behaviour is observable: Failure to function adequately can be seen by others around the individual.
Weaknesses:
- Subjective judgements: what is deemed to be normal daily life.
- Abnormality does not always stop the person functioning: The focus on how someone is coping of this definition may mean that some abnormal behaviour is missed.
15
Q
Evaluate the deviation from ideal mental health definition.
A
Strength:
- Comprehensive definition.
Weaknesses:
- Cultural relativism: mental health differs massively from generation to generation and from culture to culture. This means that people could be perceived in different ways depending on when and where they are from.
- Unrealistic standards for mental health.
16
Q
Definition of a phobia?
A
A persistent fear out of “proportion” - characterised by excessive fear and anxiety triggered by an object, place or situation.
17
Q
How does the DSM recognise categories of phobia and anxiety related disorders?
A
- Specific phobia - phobia of an object , body part or situation.
- Social anxiety - phobia of a social situation.
- Agoraphobia - phobia of being outside or in a public place.
18
Q
What behaviour occur with specific phobias?
A
- Remove yourself from the space with the object - because you feel unable to be around the object.
19
Q
What behaviours occur with social anxiety?
A
- Panic attacks - due to cognitive factors.
- Self-conscious - fear of what other people will think of them.
- Avoidance of doing things or speaking to people out of fear of embarrassment.
20
Q
What behaviours occur with agoraphobia?
A
- Housebound: may not leave the house unless it is absolutely necessary to do so.
- Avoidance of public areas - wouldn’t get on public transport because of the unknown factors.
21
Q
What occurs cognitively with specific phobias?
A
- Irrational thoughts about the object.
- Distortion bias - thinking it is normal to have the irrational thoughts.
22
Q
What occurs cognitively with social anxiety?
A
- Worried about everyday activities.
- Finding it difficult to do something when someone is watching/there.
23
Q
What occurs cognitively with agoraphobia?
A
- Irrational: they don’t have real reasoning behind their phobia.
- Overwhelmed by anxiety.
24
Q
Emotional effects for specific phobias?
A
- Frightened/scared.
- Excessively anxious.
25
Emotional effects for social anxiety?
- Sadness.
- Feeling sick/ill.
- Depressed.
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Emotional effects for agoraphobia?
- May get upset.
- Feel they're being embarrassing.
- May lose control in public.
27
Who proposed the two process model?
Mowrer (1960).
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What was the two-process model?
States that phobias are acquired by classical conditioning and maintained by operant conditioning.
29
How are phobias acquired through classical conditioning - example?
Fear can be learnt be through association. Example: Fear of flying:
Turbulence (UCS) + Plane (NS) → Fear (UCR)
Plane (CS) → Fear (CR)
30
How are phobias maintained through operant conditioning - example?
Fear can be maintained through reinforcement. Example: Fear of flying:
If someone had a fear of flying and then their plane was cancelled they might feel relief that they don't have to fly - negative reinforcement. Equally, if there was another mode of transport available to them then they could chose that instead - avoiding and strengthening their fear.
31
Strengths of the behavioural explanation of phobias?
- Can provide some convincing explanations for phobias: Sue et al. (1994) found that people often remember traumatic events that lead to phobia - shows the importance of classical conditioning.
- The two-process model has good explanatory power: it went beyond the classical conditioning explanation of Watson and Rayner.
32
Weaknesses of the behavioural explanation of phobias?
- Doesn't explain why traumatic experiences don't always lead to phobias.
- Pavlov's studies were on animals.
- Ignores nature: ignores studies such as the 'Diathesis Stress Model'.
- Biological preparedness is ignored - Seligman's Study (1970) argued that 'ancient fears' would play a role in our evolutionary past.
- Ignores cognition and cognitive therapies.
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What are the possible treatments for phobias?
- Systematic desensitisation.
- Flooding.
- VREP
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Systematic desensitisation definition?
A behavioural therapy designed to gradually reduce phobic anxiety through the principle of classical conditioning.
35
What is involved with systematic desensitisation?
- Relaxation techniques
- Counterconditioning
- Exposure: Over many weeks in vitro (artificial) and in vivo (real) objects are reviewed.
- Using a fear hierarchy - the therapy starts at the bottom of the pyramid and works up.
36
What relaxation techniques are used in systematic desensitation?
PMR - progressive muscle relaxation.
37
What occurs during flooding?
Exposing the patient directly to their worst fears; you're thrown in at the deep end.
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What principle does flooding work on?
The principle of extinction; when a person is exposed to a feared stimulus repeatedly and for a prolonged period without any negative consequences occurring, their fear response will diminish.
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What are the strengths of flooding?
- In general, flooding produces results as effective (sometimes even more so) as systematic desensitization.
- The method’s success confirms the hypothesis that phobias are so persistent because the object is avoided in real life and is therefore not extinguished by the discovery that it is harmless.
40
What are the weaknesses of flooding?
- It can be dangerous if you are not careful.
- It is not an appropriate treatment for every phobia.
- It can increase their fear after therapy.
→ Wolpe (1969) reported the case of a client whose anxiety intensified to such as degree that flooding therapy resulted in her being hospitalized.
- Some people will be unable to tolerate the high levels of anxiety induced by the therapy and are, therefore, at risk of exiting the therapy therefore strengthening the phobia.
41
What is VRET?
- Virtual reality exposure treatment.
- It is a gradual prolonged repeated experience - in a virtual world.
42
What is OCD?
Obsessive compulsive disorder.
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What are obsessions?
Persistent intrusive recurring thoughts or images.
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What are compulsions?
Repetitive ritualistic behaviours e.g. excessive washing, excessive checking, hoarding.
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What percentage of the world has OCD?
1.2%
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What are the behavioural characteristics of OCD?
Compulsive behaviours:
- Repetitive compulsions: sufferers feel compelled to repeat a behaviour.
- Counting, praying and tidying are all common
- Most of the compulsions are performed to reduce or manage the anxiety.
Avoidance:
- Used to reduce the anxiety which is triggered by the situation.
47
What are the cognitive characteristics of OCD?
Obsessive thoughts:
- 90% have obsessive thoughts
- Always unpleasant although differ in nature
- Cognitive coping strategies e.g. religious person tormented by guilt may pray.
- The coping strategies help to manage anxiety but makes the sufferer appear abnormal.
Insight into excessive anxiety:
- Aware it is not rational, in fact irrational is part of the diagnosis
- Catastrophic thoughts about worst case scenarios that could occur if their anxieties were justified.
- Hypervigilant.
48
What are the emotional characteristics of OCD?
Anxiety & distress:
- Unpleasant emotional experience due to the anxiety it creates.
- Obsessions are unpleasant and frightening, anxiety can be overwhelming.
- Urge to repeat behaviours creates the anxiety.
Accompanying depression:
- Comorbid with depression, anxiety accompanied by low mood & lack of enjoyment in activities. Compulsive behaviour provides only temporary relief.
Guilt and disgust:
- Irrational guilt, disgust directed at external object or self.
49
What is the OCD cycle?
Obsessions → Anxiety → Compulsions → Temporary relief → Obsession....
50
What are the genetic explanation for OCD?
- OCD tends to run in families, suggesting that there may be a genetic link.
51
How is twin studies used in the study of OCD?
- Comparison of MZ and DZ twins.
- If a trait has a biological basis then we would expect MZ twins to have higher concordance rates the DZ twins.
- Biopsychologists argue that the higher the concordance rate the more likely it is that the trait was inherited.
52
How is gene-mapping used in OCD?
- This is when we compare genetic material from OCD sufferers with non-sufferers.
53
Which specific genes have implicated OCD?
- The COMT Gene - helps reduce the action of dopamine. The variation in the COMT gene decreases the amount of COMT available and therefore dopamine is not controlled and there is probably too much dopamine.
- The SERT Gene - this affects the transport of serotonin, creating lower levels of this neurotransmitter.
54
Strengths of the genetic explanation.
- Lenane et al (1990): prevalence of OCD in related family members shows evidence for heritability.
- The diathesis-stress model suggests certain gene leave some people more likely to suffer with OCD.
55
What are the limitations of the genetic explanation?
- No one is really sure what exactly is being inherited via the genes – nothing specific found.
- We never get 100% concordance.
- Research suggests some forms of OCD are more genetic in nature than others.
56
How is brain structure linked to OCD?
1. Orbito-frontal cortex: part of brain involved in decision making, noticing something is wrong.
2. Thalamus: directs signals from parts of your brain to areas that can interpret them.
3. Caudate Nucleus: this regulates the signals sent between the OFC and the thalamus.
57
What is the worry circuit?
- The OFC, sends signals to the thalamus via the caudate nucleus about things that are worrying.
- To get to the caudate nucleus, the cingulate cortex acts a as relay system between the two. It is involved in emotions also.
- The caudate nucleus suppresses signals from the OFC but when it's damaged, it fails to suppress minor 'worry' signals and the thalamus is alerted, which sends signals back to the OFC and confirms the worry.
- This increases compulsions and anxiety.
- It is thought that low serotonin in these brain areas could be related to this problem of signal regulation.
58
What are neurotransmitters?
Chemical messengers.
59
What is the role of neurotransmitters?
They carry, boost and regulate signals between neurons and other cells in the body. They are linked to mood.
60
What is the role of serotonin?
- Serotonin is a neurotransmitter linked to OCD. It sends mood-relevant information. If this does not take place, then mood & mental processes can be affected.
- Serotonin is said to play a very active role in the orbito-frontal cortex and the caudate nucleus.
61
How has it been suggested that low serotonin levels
- It may well be that these low serotonin levels lead to abnormal functioning in the areas of the brain involved in OCD.
- Low levels of serotonin have been found in people with OCD (Hu, 2006).
62
How do we know there is a link between OCD and serotonin?
- Use of drugs called SSRI’s, increases the levels of serotonin in the brain
- People who take SSRI’s show a reduction in OCD symptoms.
- SSRIs prevents neurotransmitters from returning to the synapse and increases the chance that it will bind to the next synapse.
63
What are the weaknesses of twin studies?
- Ethical issues: wrong to separate twins at birth.
- It doesn't take into account the environment therefore its seen as deterministic.
- A 100% concordance rate would suggest completely identical traits but there is no 100% rate recorded - OCD cannot be 100% genetic.
- The small sample size reduces the reliability of the biological explanation.
64
Weaknesses of the neural explanation?
- It can be difficult to establish a cause and effect relationships in biological explanations of OCD.
- Said to be reductionist: it can it can oversimplify the human behaviour.
65
Strengths of the structure of the brain explanation?
Neurosurgery targets specific areas of the brain associated with OCD, such as the OFC, anterior cingulate cortex, and caudate nucleus. Improvements in symptoms following surgery suggests that these brain regions play a crucial role in the disorder.
66
What is the problem with identifying cause and effect in the brain abnormalities explanation of OCD?
There is evidence to show that some neural system (e.g. serotonin) don't work normally in people with OCD. According to the biological model of mental disorder this is most easily explained by brain dysfunction causing the OCD. However, this is simply a correlation between neural abnormality and OCD, and such correlations do not necessarily indicate a causal relationship.
67
What treatments can be used for OCD?
- Drugs
- CBT
68
What drugs are used to treat OCD?
- Antidepressants
- Tricyclics/SSRI's
- Benzodiazepines
69
What do antidepressants do?
Aim to raise serotonin levels by blocking reuptake of neurotransmitters, meaning that serotonin is available for a longer period – it can take 12 weeks for people to be effect and some don’t respond to it.
70
What do tricyclic/SSRI's do?
They function by blocking serotonin reuptake leaving the area more concentrated with certain neurotransmitters. This contributes to an antidepressant effect – only used if SSRI’s fail as they have MORE side effects than SSRI’s.
71
What do benzodiazepines do?
BZs are anti-anxiety drugs – they increase the action of a neurotransmitter called GABA – meaning the neuron is less likely to fire effectively therefore slowing the brain down. Stops the ‘worry circuit’.
72
What is cognitive component of CBT for OCD?
Cognitive therapy assumes that the way to cure a disorder is by changing thought processes. Patients are encouraged to focus on their thoughts and the responses to them. The aim of therapy is not to remove the intrusive thoughts, but to change the beliefs that they trigger. Therapy starts gradually, starting with thoughts that are least anxiety provoking. An additional technique used in cognitive therapy is habituation training (Franklin et al 2000); the client is asked to think repeatedly about their obsessive thoughts. The idea is by deliberately thinking about obsessions, they will become less anxiety provoking.
73
What is the behavioural component of CBT for OCD?
- Exposure and Response Prevention Therapy (ERPT).
- ERPT focuses only on the compulsions found in OCD, so it complements the use of cognitive therapy which targets the obsessions.
- ERPT exposes clients to objects or situations that cause anxiety and requires the client to resist performing the compulsive behaviour.
74
Strengths of treatments of OCD?
- Drugs are cheaper.
- Soomro et al. reviewed 17 studies of the use of SSRIs with OCD patients and found them to be more effective than placebos.
- Little effort required in taking drugs, much less effort involved compared to than CBT.
75
Weaknesses of treatments for OCD?
- Side effects of BZ’s include aggression and long-term memory loss. Problems with addiction, therefore they can only be used for a limited time.
- Little long term evidence exists for effectiveness (Koran et al 2007).
- Soomro et al (2008) stated the common side effects of SSRIs include headaches, nausea and insomnia.
- Drugs: Not a lasting cure and relapse is common (Marina et al 2001).
- Much research is funded by drugs companies. Turner et al (2008) à Publication is bias towards studies that show a positive outcome.
76
Definition of depression?
A category of mood disorders, which is often divided into two main types: unipolar/bipolar disorder.
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How does a depression diagnosis come about?
To be given a diagnosis of depression, sufferers are required to display at least five symptoms, every day, for at least two weeks.
78
What are the symptoms of depression?
- Thinking/actually committing self-harm.
- Thinking/actually attempting suicide.
- Sleeping too/too little.
- Eating too much/too little.
- Low mood.
- Lack of interest.
79
Behavioural traits of depression?
- Ruining appetite.
- Masking: pretending to be happy.
- Easily fatigued.
- Self-medication: alcohol, drugs and smoking.
- Keeping up the emotional 'lie' to family/friends.
80
Emotional traits of depression?
- Feeling empty/Lack of joy.
- Activities that give you pleasure cease to do so.
- Totally isolated from everything and everyone.
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Cognitive traits of depression?
- Highly repetitive negative thoughts.
- Biggest fear; being found to have depression.
82
Categories of depression in the DSM-5?
1. Major depressive disorder - severe short term depression.
2. Persistent depressive disorder - a long term recurring depression.
3. Disruptive mood dysregulation disorder - where children/teens have ongoing irritability anger and outbursts.
4. Premenstrual dysphoric disorder - disruption to mood prior to female menstruation.
83
What is the assumption of the cognitive approach to depression?
Individuals who suffer from mental disorders have distorted and irrational thinking – which may cause maladaptive behaviour.
84
What did Beck propose in relation to depression?
3 part cognitive triad.
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What maintains the cognitive triad?
- Negative self-schemas.
- Faulty information processes.
86
What is a negative self-schema?
This was studies by Weissman and Beck in 1978. Results: depressed participants made more negative assessments than non-depressed people. When given therapy to challenge and change their negative schemas there was an improvement in their self-ratings.
87
What is the faulty information process?
Beck proposed depressed people tend to selectively attend to the negative aspects of a situation and ignore the positive aspects. There is a tendency to blow small problems out of proportion - this was known as black and white thinking.
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What are the characteristics of faulty information processes?
- Overgeneralisation.
- Personalisation.
- Selective abstraction.
- Magnification.
- Minimisation.
89
Strengths of Beck's theory?
- Scientific: a lot of lab based research.
- There are practical applications from the theory: CBT.
- Much research has supported the proposal that depression is associated with faulty information processing, negative self-schemas and the triad of impairments:
→ Grazioli and Terry – 65 pregnant women assessed for cog vulnerability and depression before and after birth. Those with high cog vulnerability more likely to suffer post-natal depression.
- Clark and Beck (1999) – solid support for cognitive vulnerability factors.
90
Weaknesses of Beck's theory?
- It does not explain all aspects of depression.
- It is a person centred explanation and doesn't take into account how our environment can affect our mental health.
- The role of biology and leaning is ignores.
91
What are the three key patterns of thinking of people with depression - Ellis?
1. I must be thoroughly competent and successful in everything I do.
2. Others must treat me kindly and fairly, and if they do not, they are awful people who deserve to be punished.
3. The world must give me happiness, or else life is unbearable.
92
The ABC model?
(A) an action is affected by
(B) an individual’s beliefs (about A) which results in
(C) a consequence (of B).
93
Strengths of Ellis' theory?
- Simplistic: so may help healthcare professionals to relate to patients.
- It has practical application in CBT: Ellis’ explanation has led to successful therapy.
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Weaknesses of Ellis' theory?
- Reductionist: ignores biology.
- It is very extreme "thinking".
- It only offers a partial explanation: not all depression arises as a result of an obvious cause.
- It does not explain all aspects of depression: does not explain why some individuals experience anger, hallucinations and delusions with their depression.
- Irrational beliefs or beliefs that “seem” irrational – Alloy & Abramson (1979) depressive realists see things for what they are (with normal people seeing the world through rose tinted glasses).
95
What are the assumptions of cognitive treatments of depression?
If depression is caused by irrational, negative thinking then changing the thinking will change the behaviour.
96
What was the treatment proposed by Beck for depression?
CBT - about 20 sessions over 16 weeks.
97
What are the 4 strategies used during CBT?
1. Behavioural activation.
2. Homework.
3. Thought catching.
4. Cognitive restructuring.
98
What is behavioural activation in CBT?
- Focuses on encouraging the client to become active in pleasurable activities. These rewarding activities act as an 'antidote' to depression.
- Gives the client the opportunity to practice challenging their negative thoughts.
- Pleasant event scheduling encourages participation in social activities.
99
What is homework in CBT?
- Clients are asked to complete homework between sessions in order to test irrational beliefs against reality.
- They will only set tasks confident the patient can succeed at.
- Relapse is avoided by using of booster sessions.
100
What is thought catching in CBT?
- The client is encouraged to identify and record their automatic negative thoughts and consider how they might challenge these.
101
What is cognitive restructuring in CBT?
- Analysing your thoughts: changing negative automatic thoughts (NATs) to rational thoughts.
- A thought log is used.
- Cognitive restructuring can also occur during therapy: the therapist can help to restructure our thoughts.
102
What was the treatment proposed by Ellis for depression?
REBT ('Rational Emotional Behavioural Therapy').
103
What was REBT?
- Irrational thoughts cause negative self-statements so REBT involves making irrational and negative thoughts more rational and positive.
- Extends the ABC model to ABCDEF: D = dispute irrational thoughts and beliefs, E = effects of disputing and effective attitude to life, F = feelings that are produced.
104
Strengths of CBT?
- It is effective: there's much evidence to support CBT.
→ Example: a study conducted by March et al. (2007) compared the effects of CBT patients with those on antidepressants and a combination of the two in 327 adolescents. After 36 weeks 81% of the CBT group, 81% of the antidepressants group and 86% of the combination group saw improvements.
105
Weaknesses of CBT?
- It may not work for the most severe cases.
- Success may be due to a patient-therapist relationship; Rosenzweig (1936).
- Overemphasis on cognition: there is a risk that because of its emphasis on what is happening in the mind of the individual patient CBT may end up minimising the importance of the circumstances in which a patient is living - McCusker 2014. CBT.
