abnormal Flashcards
what is abnormal
- statistical deviation from the norm
- not following social norms criteria
- rosenhaun and seligman’s criteria for abnormality
- deviation from the norm
- symptoms from a classification system, ICD DSM
rosenhaun and seligmans criteria for abnormality
- maladaptiveness
behavior which makes life more difficult - irrationality
unable to communicate in a rational manner that is understood by others - suffering
the behavior causes suffering - vividness / unconventionality
the person experiences reality in a unconventional way - observer discomfort
the behavior makes other people uncomfortable - unpredictability
behavior is erratic and difficult to predict - violation of moral standards
behavior violates accepted standards for right and wrong
difficulty defining abnormality
statistical deviation, social norms, MIS VOUV
statistical deviation
- simple, reliable, objective
- not all statistically unusually behaviour is undesirable
social norms
- simple and reliable
- social norms vary greatly depending on where you are
MIS VOUV
- more subjective
- not clear how many out of the list they have to be considered abnormal
- many items related to social norms and judgements which vary across time and place
medical model of abnormality
- abnormal behaviour is a symptom of a mental disorder
- mental disorders are due to biological abnormalities in the brain
- no different to any other diseases
- can be treated
- normal behaviour is just the absence of any problems in your brain
- psychological disorders have physiological causes that can be diagnosed on the basis of symptoms, and treated, and sometimes even cured
evaluation of the medical model
- removes blame from patients
- enables research into causes and more effective treatments
limitations of the medical model
thomas sasz
- uncertain about what disorder is “real”
- no way to objectively diagnose mental disorders aka blood tests
- diagnosis can lead to stigmatization
ethics of mental health
- stigmatization
- labels
- confirmation bias from other people with your “normal” behavior, different if you have a mental ilness
rosenhan (1973)
aim
fake patient
- investigate whether abnormal behaviour can be detected and the ethical consequences of diagnosis
rosenhan (1973)
procedure
fake patient
- 8 healthy adults checked themselves into mental hospitals
- saying they (falsely) heard voices saying the words: empty, hollow and thud
- after being admitted they acted normally and said that the voices had stopped
- during any therapy sessions they told the truth about their lives
rosenhan (1973)
results
fake patient
- all the pseudo patients were diagnosed with schizophrenia and forced to take psychiatric medication
- kept for an average of 19 days, one person 52 days
- no doctors or nurses suspected anything
- when they were released they were diagnosed with schizophrenia in remission instead of being cured
rosenhan (1973)
conclusion
fake patient
- once a person is diagnosed with a mental disorder, people dehumanize you, misinterpret your behaviour and forever label you as mentally ill
rosenhan (1973)
evaluation
fake patient
- high ecological validity, real mental hospitals and doctors
- ethical concerns as participants lied to doctors and hospital staff, used their resources
- psychiatry relies on self report of symptoms and don’t expect people to fake symptoms
- however after weeks of observation, suggests there is something wrong with psychiatry
langer and abelson (1974)
aim
- investigate how stigma, labels and confirmation bias impacts perceptions of the mentally ill
langer and abelson (1974)
procedure
- group 1, analytic psychologists who view mental illness as a consequence of internal conflict and childhood trauma
- group 2, behavioural psychologists who focus on identifying and changing the negative pattern of behaviour in the present
- participants watched a video of a man being interviewed about his feelings and experience and his past job
- half the participants were told the man was a “job applicant” and the other half were told he was a “patient”
- participants then rated the man for how “disturbed” or “well adjusted” he was
langer and abelson (1974)
results
- behavioural rated the man pretty normal regardless of the label
- analytic psychologists rated the man more disturbed when they were told he was a patient
langer and abelson (1974)
conclusion
- labeled as mentally ill can cause psychologists to see evidence when there is none
- analytical psychologists more likely to be influenced by labels as they see mental illness as an internal struggle whereas behavioural psychologists see it as behaviour cues
langer and abelson (1974)
evaluation
- clear causal relationship between the label and how psychologists describe him
- ecological validity is high because real psychologists were used
- took place quite a while ago and analytic psychology is much less common
MDD
Major Depressive disorder
symptoms of MDD
- feelings of sadness, guilt worthlessness
- not enjoying activities
- lack of initiative
- self harm/suicide
- negative thoughts
- loss of energy
- sleep changes
- weight changes
prevalence facts
- higher rates of MDD in lower socioeconomic groups and young adults
- average of 4 depressive episodes across a person’s life
- in western countries 15% of people will experience depression at some point
weisman et al
aim
- investigate the prevalence of depression in different countries
weisman et al
procedure
- 10 countries across the world from a range of cultures
- participants randomly selected using phone registries
- trained interviewer would call the people selected and interview them about their mental health history
- 38,000 participants interviewed
weisman et al
findings
- rates of depression varied greatly in different countries
- 1.5% in Taiwan but 19% in Beirut
- depression rate in Paris almost as high as Beirut even though Beirut just experienced 15 years of civil war
- MDD in women 2-3x higher than in men
- divorced much higher than married
weisman et al
conclusion
- depression is a universal disorder
- risk factors, women, divorce
- some countries suffer more for unknown reasons
weisman et al
evaluation
- large number of participants
- strong random sampling method
- results can be generalized to each country
- multiple languages so translation may not be accurate
- doesn’t explain why there are different rates of depression in different countries
why does prevalence vary
different rates of depression
- socioeconomic conditions
- rates of urbanization, more urban more depressed
how often depression is reported
- cultural stigma
- difference in diagnose, more likely/ less likely
serotonin hypothesis of MDD
- the cause of depression is low levels of serotonin in the brain
- makes it harder for signals to be passed on slowing down brain activity resulting in low energy, lack of enjoyment and sadness
- treatment = selective serotonin reuptake inhibitors
- allowing more serotonin to remain in the synapse
nurnberger and gershon (1982)
aim
- the role of genetic factors in depression
nurnberger and gershon (1982)
procedure
- meta analysis of 7 studies comparing the concordance rates for depression in identical (MZ) twins (100%) and fraternal (DZ) twins (50%)
- twin studies assume twins have the same environment and if they have higher concordance it is due to genetics
nurnberger and gershon (1982)
results
- depression for MZ twins was 65%
- depression for DZ twins was 14%
nurnberger and gershon (1982)
conclusion
- genetic factors play an important role in determining who will become depressed
- although higher concordance rate for MZ twins it is still far below 100% showing environmental/ extraneous factors also play a role
nurnberger and gershon (1982)
evaluation
- large amount of data from 7 studies
- twin studies are reliable and well established
- does not identify which specific genes can contribute towards depression
- doesn’t explain which environmental factors impact depression
diathesis - stress model
- both biology and the environment are important factors in depression
- some people have genes that predispose them to depression (diathesis) but not all of those people will become depressed
- stressful life events, combination of environment and genetic predisposition will increase risk of depression
caspi
aim
- how genetic vulnerability and negative life experiences can interact to cause depression
caspi
procedure
- genetic testing on 847 New Zealand men to determine what version of the serotonin transporter gene they carried
- there is the short version and long version
- long version is associated with higher levels of serotonin in the synapse
- men completed a questionnaire about stressful life events and if they have ever suffered from depression
caspi
findings
- few stressful life events had low rates of depression regardless of genes
- participants with at least one short version of serotonin transporter gene who also had experienced 3 or more months of stressful life events had the highest rates of depression
- participants with 2 long serotonin transporter genes had low rates of depression no matter how many stressful life events
caspi
conclusion
- risk of depression is highest in people who have genetic predisposition (one or more short serotonin transporter gene) and multiple stressful life events
caspi
evaluation
- strong support for the diathesis stress model of depression, biology and life experience leads to depression
- large sample size, reliable
- casual relationship between genetics and depression is not certain, could be other factors
- supports the role of serotonin in depression
- other factors that haven’t been explored
evaluation of serotonin hypothesis
pros
- SSRIs work by increasing serotonin and are effective in treating depression for many people
- Caspi suggests that different versions of serotonin transporter gene determine the risk of depression
cons
- increases serotonin right away but often takes people 3-4 weeks to feel better
- only effective in around 60% of people
- just because SSRIs are effective treatment doesn’t mean low serotonin causes depression
- can’t be sure how much of a role serotonin plays
cognitive theory of depression (beck)
- depression is caused by cognitive distortions and illogical thinking processes
illogical thinking processes
- selective attention
only focusing on the negative aspects - magnification
exaggerating the importance of negative life events - overgeneralization
broad conclusions on the basis of a singular negative life event
illogical thinking processes leads to
- negative thoughts about oneself, the world and the future
evaluation of cognitive theory of depression
pros
- illogical thinking describes how most depressed people think about themselves, the world and their future
- possible to change negative thought patterns through therapy to treat depression
- evidence of cognitive behavioral therapy (CBT) effective depression treatment
cons
- unclear why people develop negative thoughts in the first place, could be biology
- unclear if negative thoughts and cognitive disorders cause depression or are a symptom
alloy
aim
- to determine if cognitive thinking styles can predict who will become depressed
alloy
procedure
- 347 american college freshman
- questionnaire to determine their thinking style
- style either “positive” or “negative”
- participants followed for 6 years and rates of depression compared between each thinking style
alloy
results
- participants with a negative cognitive style were far more likely to become clinically depressed within the 6 years of the study
alloy
conclusion
- negative thoughts is associated with depression
- cognitive style can predict who is likely to become depressed
- participants had negative thoughts before they became depressed suggests that cognitive style may cause depression not a consequence of depression
alloy
evaluation
- supports beck’s cognitive theory of depression, negative thinking pattern can lead to depression
- large sample size, increasing reliability
- correlational, can’t be sure cognitive style causes depression
- could be other differences such as biological, family support, social etc that could explain the findings
- study only american college students which is not representative of the general population
- depression in young people could be caused by other factors than other age groups
haefell et al
aim
- investigate if thinking style and risk for depression can be influenced by the people around you
haefell et al
procedure
- 103 college students that were randomly assigned a roommate during their first year
- completed an online questionnaire to measure cognitive vulnerability and depressive symptoms 1, 3 and 6 months after arriving on campus
haefell et al
findings
- participants who were randomly assigned to a roomate with high cognitive vulnerability “caught” the negative thinking style and became more vulnerable themselves
- students that developed increased cognitive vulnerability after 3 months had twice the level of depressive symptoms after 6 months compared to students who didn’t show an increase
haefell et al
conclusion
- cognitive style can be influenced by social environment
- cognitive style is not a fixed trait
haefell et al
evaluation
- provides further support for beck’s cognitive theory of depression
- highly applicable to real life treatment of mental illness, risk reduced by avoiding overly negative people
- only american college students, more research on other cultural and age groups to test generalizability of results
vulnerability model
- some people are more at risk for developing mdd than others
factors in the vulnerability model
decrease risk
- bonds with other people
- involvement with the community
increase risk
- unemployment
- social isolation
- three or more young children at home
- stressful life events
brown and harris
aim
- investigate the role of social factors and stressful life experiences in depression
brown and harris
procedure
- 458 south london women
- asked questions about any episodes of depression in the past year and describe any difficult life events
brown and harris
results
- 8% had experienced an episode of depression in the last year
- of the women who became depressed 90% experienced a stressful life event
- 30% of women who did not become depressed also experienced stressful life events
- lower class women with children 4x more likely than middle class women
brown and harris
conclusion
- social factors play a significant role in depression
- lower class women with children are more at risk, financial problems and other stressful situations
brown and harris
evaluation
- provides support for the vulnerability model, stressful life events, socioeconomic status influence risk of depression
- only south london women. unsure similar results in men or other regions
- correlational study, no casual relationship between stressful life events and depressive episodes
- could be having depression causes problems in relationships/at work creating additional stressful life events
- many women experienced stressful life events did not become depressed, biological and cognitive factors to consider
homes and rahe
aim
- determine what events are most likely to lead to illness
homes and rahe
procedure
- medical records of 5000 patients were reviewed for correlations between stressful life events and illness
homes and rahe
results
- positive correlation between number of life events and subsequent illness
- greater degree of life change = greater risk of illness
- death of a spouse or child, divorce, imprisonment, death or close family member, personal injury, marriage, retirement
homes and rahe
conclusion
- major life changes can lead to stress and increase the risk of illness
homes and rahe
evaluation
- findings have been replicated in other countries, cross culturally valid
- associations between life events and general illness not specifically depression
- scale based on average correlation and will naturally vary between participants
vulnerability model of mdd evaluation
pros
- considerable research
- consistent with diathesis stress model
cons
- correlational research, can’t tell what factors
- depression could cause negative life changes not negative life changes causing depression
- many people experience negative life events and do not become depressed, possibly cognitive factors matter more than the event itself
SSRI’s
selective serotonin reuptake inhibitors
how do SSRI’s work
- blocking the reuptake of the neurotransmitter serotonin back into the presynaptic neuron
- more serotonin remains in the synapse, changes in mood, activity levels and appetite
- if depression is caused by low levels of serotonin in the synapse, most direct cure
elkin
aim
- compare effectiveness of different treatments for depression
elkin
procedure
- 280 depressed people
- randomly assigned one of 4 groups
antidepressant drug
interpersonal therapy
cognitive behavioral therapy (CBT)
sugar pill (placebo) - double blind so neither clinician or patient knew if real antidepressant or placebo
elkin
results
- results on antidepressant showed fastest improvement
- few weeks therapy also showed improvement
- 50% of participants in each treatment group recovered
- 29% on placebo recovered
elkin
conclusion
- antidepressants interpersonal therapy and CBT are equally effective
- any treatment is better than no treatment (placebo)
elkin
evaluation
- large sample size, reliable
- controlled experiment design, casual relationship between treatment type and outcome
- double blind reduces researcher bias
- can’t explain why nearly 50% of participants did not respond to treatment
kirsch
aim
- evaluate the effectiveness of SSRIs in treating depression
kirsch
procedure
- meta analysis of 47 clinical trials of SSRIs
kirsch
findings
- patients with mild to moderate depression small difference between SSRI’s and placebo
- 75% of improvement seen with SSRIs also seen with the placebo
- severe depression, larger difference between SSRIs and placebo
- around half of studies failed to see a statistically significant difference between SSRIs and placebo
kirsch
conclusion
- SSRIs are not as effective as claimed, especially mild to moderate depression
- side effects of SSRIs may not be worth it for patients with mild depression
kirsch
evaluation
- analyzed all data submitted to the FDA, no publication bias
- not all studies may have been carefully carried out, drug companies rush studies to get approval
evaluation of use of SSRIs
pros
- better at treating depression than a placebo
- cheap and easy to prescribe, not long expensive therapy
- SSRIs show faster improvement than therapy
cons
- doesn’t work for everyone
- many side effects
- patients who stop taking are at risk of becoming depressed again
- can alleviate symptoms but may not be treating the root cause
CBT stands for
- cognitive behavioural therapy
components to CBT
- cognitive restructuring
- behavioral activation
cognitive restructuring
- helping patient become more aware of negative thoughts
- identifying cognitive distortions such as overgeneralization and magnification
- negative beliefs are then challenged
- replace negative thoughts with positive rational thoughts
behavioral action
- planning enjoyable activities with others
- overcoming obstacles (logical financial) to take part in activities
riggs
aim
- study the effectiveness of CBT on its own and in combination with SSRIs
riggs
procedure
- 126 teens either MDD or substance use
- randomly selected CBT placebo or CBT and SSRI
- double blind
riggs
results
- 67% of participants CBT and placebo very much or much improved
- 76% of participants CBT and SSRI very much or much improved
riggs
conclusion
- CBT is effective treatment in teens suffering from MDD and substance abuse
- CBT and SSRI is the most effective treatment option
riggs
evaluation
- experiment, casual relationship between treatment and results
- double blind eliminated placebo effect and researcher bias
- no control group, unethical to include one
- only teensso not generalizable to other age groups
CBT evaluation
pros
- considerable research (elkin, riggs), cbt is significantly more effective than a placebo and as effective as SSRIs without side effects
- combination of CBT and SSRIs best combination
- CBT doesn’t need years of therapy or childhood memories
- results orientated, focused and efficient
- develop lifelong cognitive skills, prevent future episodes
cons
- elkin suggests SSRIs are faster than CBT
- only effective is there is a good relationship between patient and therapist
- 10-12 hours of one on one therapy which can be expensive and not always covered by insurance
cultural barriers to treatment
- cognitive
- affective
- sociocultural
`cultural barriers to treatment - cognitive
- believe seeking professional psychological treatment is a weakness and unnecessary
- mental hardships should be overcome by willpower or traditional practices
- doubt the effectiveness
`cultural barriers to treatment - affective
- shame about seeking help
- fear of being judged
- embarrassment to the entire family
`cultural barriers to treatment - sociocultural
- reluctance to share personal or family problems with a stranger/ different culture
- must be willing to share to be effective
kinzie et al
aim
- investigate cultural barriers to treatment for depression
kinzie et al
procedure
- blood tests 41 south east asian patients with depression
- patients previously prescribed antidepressants
- blood tests to measure compliance with treatment
kinzie et al
results
- no sign of medication usage in the blood of 61% of patients
- only 6 patients had therapeutic levels of antidepressants in their blood
- discussion about the benefits and side effects, compliance rates increased
kinzie et al
conclusion
- cognitive and affective barriers to treatment of patients from different cultures
- shameful or doubt the efficacy
kinzie et al
evaluation
- blood tests, objective measures
- small sample size (41) and only south east asians, generalizability
indigenous therapy
- alternative for non white patients
- takes into account traditions, beliefs and cultural values
- able to overcome cultural barriers
- carried out by someone within the culture often in the language
- incorporates beliefs they have
zhang et al
aim
- test the efficacy of chinese taoist cognitive psychotherapy (CTCP) for patients with generalized anxiety disorder (GAD)
zhang et al
procedure
- 124 patients with GAD randomly assigned CTCP or anxiety medication or both
- assessed one month and six months after treatment
zhang et al
results
- patients on medication improved rapidly after one month but improvement was not sustained
- CTCP not much improvement after one month but significant improvement after six months
- both improvement at one and six months
zhang et al
conclusion
- medication short term CTCP is more effective long term for patients with GAD
zhang et al
evaluation
- support for indigenous therapy
- well designed, cause and effect relationship between treatment and outcome
- didn’t involve a comparison with CBT so unsure is CTCP is more effective
