alternatives to the medical model Flashcards
behaviourist explanation base principle?
we are born as a tabula rasa
all behaviour (including mental illness symptoms) is learnt
types of conditioning/learning and what they are?
classical conditioning - pavlov - association
operant conditioning - b.f. skinner - reinforcement
social learning - bandura - imitation
classical conditioning creating a phobia?
watson & rayner
used little alberts unconditioned response to a fear of loud noises (crying) to make the neutral stimulus (a white rat) a phobic stimulus
operant conditioning creating a phobia?
learning through the reinforcement or punishment of a behaviour
if a child retreats to their parents bed during a storm and is allowed to stay, the behaviour is positively reinforced, so they will remain afraid of storms
social learning creating a phobia?
learn through observation and imitation
blood-injection-injury phobias common in first degree relatives
if parent is worried about their child getting immunized then the child will pick up on this
vicarious transmission of a conditioned emotional response
behaviourist explanation: application?
systematic desensitisation for specific phobias
three step: teach relaxation techniques, create fear hierarchy, work up hierarchy until agreed upon therapeutic goal is reached
mcgrath: successfully used this with a nine yo girl who was afraid of loud noises. her fear rating went of party poppers went from 9/10 to 3/10 after ten sessions
systematic desensitization: step one?
relaxation techniques taught
meditation, controlled breathing, muscle detensioning
reciprocal inhibition as fear incompatible with relaxation
systematic desensitization: step two?
creation of a fear hierarchy
patient lists and rates feared stimulus from least to most provoking fears
systematic desensitization: step three?
patient works up fear hierarchy along with the relaxation techniques
when comfortable with one stimulus, they move onto the next
therapy finished when agreed therapeutic goals are met
quick behaviourist cure?
flooding
patient directly exposed to phobic stimulus
fear response will eventually pass, which should associate the stimulus with calm
if successful will lead to the extinction of the fear, but if unsuccessful, will make it worse
behaviourist explanation strengths?
considerable scientific support for it as an explanation of anxiety disorders
basis in nurture provides general hope for treatment
provides effective therapy for phobias
behaviourist explanation weaknesses?
not effective explanation for many disorders
deterministic
treatment can be distressing, take time and needs significant patient input
cognitive explanation base principle?
behaviour is the product of mental processing of information
if something is wrong with how we attend, perceive or store it then behaviour will be abnormal
cognitive distortions?
irrational thinking that can make an individual’s worldview negative or disturbed
distortions include: black & white thinking, overgeneralization, mental filter, disqualifying the positive, jumping to conclusions, magnification, minimization, emotional reasoning, labelling, personalization and should/must/ought
these form in childhood but can resurface with mental disorders, trauma and stress
cognitive explanation for depression?
beck described triad of beliefs that are seen in people with depression: negative self, world and future view
formed in early life but can be triggered later by adverse life events
from these, all information is processed with a negative bias, resulting in emotional, cognitive and behavioural symptoms of depression
cognitive explanation: application?
cognitive behavioural therapy
therapist and patient agree on what needs to be changed
the patients negative beliefs are talked through, the therapist explaining links between thinking, behaviour and emotions and provides rational alternatives
patients are tasked with strategies, like reality checks, to perform in their everyday life, and to keep a diary which should provide evidence to challenge cognitive distortions
sessions to happen once a week/fortnight and targets should be achieved by 5-20 sessions
beck et al?
compared effectiveness of drug therapy and cbt
two groups: one given 100 imipramine tablets over 12 weeks, the other given 2x 1 hour cbt sessions a week over same period
cbt group showed 79% decrease in symptoms compared to 20% decrease for drug therapy (self-report and observer based ratings). however, for those with chronic depression there was little difference
drop out rates: 5% for cbt, 32% for imipramine
cognitive explanation strengths?
considers the individuals thoughts, feelings and beliefs
well-suited to explaining affective disorders
optimistic in that patients can change their behaviour
basis of highly effective treatments
therapies like cbt aim to treat the cause not just the symptoms of a disorder
cognitive explanation weaknesses?
could be seen as implying patients are responsible for their symptoms
reductionist in disregard for biological factors
therapies long and need a lot of patient input, also a considerable delay between therapy and relief from symptoms
effective in explaining social phobias, but not specific (patients know they’re irrational)
szasz background?
response to his essay from the 60s
challenged the concept of mental illness as medical, claiming that psychiatry stands on a conceptual error. this is that it interprets unwanted or undesirable behaviours as symptoms of mental illness
szasz four headings?
50 years of change in US mental health care
mental illness: a medical or legal concept
‘mental illness’ is a metaphor
revisiting ‘the myth of mental illness’
50 years of change in mental health care?
distinction between mental and medical hospitals has disappeared
most mental health care is responsibility of government, public money; legally responsible for preventing patients being a threat to themselves or others
argues there is no legally valid non-medical approach to mental illness, just as there is none to measles
mental illness: a medical or legal concept?
politicians now claim mental illness to be like physical illness, diagnosed and treated as accurately
this turns these false beliefs into lying facts
this isn’t based off of scientific research and is a revival of the humoural theory
mental hospitals are like prisons: involuntary hospitalisation and coercion
‘mental illness’ is a metaphor?
accepts physical causes for some mental illnesses but argues this means they were never mental illnesses, but undiagnosed physical illnesses
eg. historically, illnesses such as syphilis have manifested in ways interpreted as ‘madness’
the term refers to judgements of others behaviours, creating an ever expanding list of conditions
the principle ‘do no harm’ is discarded and replaced with preventing the patient from harming themselves or others, discarding liberty
