Clinical Psychology Flashcards
ABNORMALITY V NORMALITY
What are the 4 different approaches to classifying abnormality
Statistical approach, normative approach, functional approach, distress-based approach
explain the statistical approach
attributes or behaviour that deviate from the statistical norm.
good thing about it
offers objectivity and measurability
limitations- 3
1) measurement error- how accurate are the tests, different times of day for example. test retest reliability.
2) regression to the mean- normal fluctuation to go from extreme to normal is common
3) extreme values don’t always mean problems- what about high IQ for exampl
4) where do we draw the cut off
explain the normative approach
deviating from social norms is viewed as normal because acting in an acceptable way is seen as adaptive behaviour to thrive and survive in life.
limitations- 3
1) intolerant of individual differences
2) social normals are constructed and arbitary anyway
3) this approach can lead to an abuse of power- soviet gulag example
explain the functional approach
a compromise between stats and norm- based on a person failing to function correctly to meet their personal needs/goals to survive. if you can’t- its seen as maladaptive behaviour
limitations- 3
1) someone who is maladaptive might not necessarily be abormal (murderers are maladaptive but that doesnt mean every murderer has a mental health condition)
2) assumes ‘universal needs’
3) expects conformity
good thing about the functional approach
this approach says its down to context, so being homeless isnt socially normal but it doesnt make you mentally ill, it compares you to people within that group. So one homeless person might not be functioning the same as another homeless person, who is in their reference group
explain the distress-based approach
based on an individuals distress or inability to cope with their experiences or problems. its about their own perception of normal (good thing)
limitations- 3
1) lack of insight could be a problem- what if they’re a child
2) highly subjective. one person’s sadness is another’s depression.
3) danger of medicalizing/pathologising normal reactions to adverse events
what is the current view on classifying?
contemporary classification systems are informed by a combination of these perspectives
why is it important to classify things? 4 reasons
1) its important for aetiology and epidemiology- we need to study it systematically so we can know how to improve.
2) enables a shared language to recognise and treat
3) enables us to select appropriate treatments
4) enables us to evaluate different interventions
5) ) societal reasons, legal, financial etc- need diagnosis to support
where does classification come from
Emil Kraepelin. devised a way to classify mental disorders based on symptomatology- co-occurring symptoms. interviewed 100’s of patients. entered into the ICD (International classification of diseases) in 1939.
when did the first DSM drop
1952
what parts are diagnostic schemes organised into
1) core criteria. must have a specific 2, aswell as 5 alltogether and for over 2 weeks.
2) symptoms must cause significant distress
3) can’t be attributed to drugs or other medical condition
advantages to the DSM- 5
- specific criteria to diagnose similar conditions
- provides criteria that can be applied systematically
- the diagnostic criteria is theoretically neutral
- takes functional impairment into consideration- you have to consider it a problem
- advances in drugs and treatments and epidemiology
disadvantages of the DSM
- diagnosis is based on symptoms not aetiology
- the illusion of explanation, being diagnosed doesnt mean we know the causes or how to treat it
- different disorders have similar symptoms that need to be treated differently. danger of misdiagnosis
- within category heterogeneity- even in the same diagnosis, the manifestations are completely different. putting people in categories doesnt account for severity
- false positives- pathologising normal distress
- labelling leads to stigmatisation and self-fulfilling prophecy
ALTERNATIVES! what are the alternatives?
dimensional model, network models
describe dimensional models
places mental disorders on a continuum, rather than categories. is on a chart with normal experiences.
good things about the dimensional models
accounts for severity! allows for overlapping traits, symptoms of psychosis and depression can be mapped together.
problems
again problems with cut offs, where is the line between normal and pathological
what are some examples of the dimensional models
internalising/externalising dimensions. transdiagnostic psychosis-bipolar, transdiagnostic negative affectivity
describe the internalising/externalising dimensions
disorders can be thought of as either internalising or externalising.
internalising- anxiety, depression, self-identity, socially awkward
externalising- hyperactivity, aggression, conduct problems, disruptive
describe the transdiagnostic psychosis-bipolar,
all disorders can be mapped somewhere between these 2. high end is hallucinations and manic episodes and low end is nothing
describe the transdiagnostic
negative affectivity
depressive, anxiety traits. scale where at high level you may have full range of common mental health problems. (SA, GAD, MDD, panic)
describe eyesenck’s personality dimensions
everyone is along the spectrum is introvert-extroverted and stable- unstable. suggests all humans have different personalities and these can be mapped between stable and unstable
what is the network model perspective
fairly new, last 5 years- suggests that the way we have been thinking about psychopathology has been too simplistic. this says that psychological problems are a network of symptoms that co-occur in time
what are the 4 phases of the network model
phase 1- Dormant network in stable state. potential for disorder but no symptoms
phase 2- Network activation. something happens to trigger certain symptoms.
phase 3- Symptoms spread. symptoms cause other symptoms.
phase 4- environmental trigger stops but symptoms keep influencing eachother in a mutually reinforcing network
DEPRESSION
Define depression
a mood disorder involving emotional, motivational, behavioural, cognitive and physical aspects.
what do you have to have to diagnose it
5 or more symptoms over 2 weeks. one of them has to be an emotional characteristic. IN SAD CAGES- in- interest lost in activities s- sleep disturbed a- appetite changes d- depressed mood c- concentration difficults a- activity level change g- guilt or worthlessness e- energy loss s- suicidal thoughts
what is the controversy with this? ‘someone has gotlib- this is ridiculous’
Gotlib et al., 1995- why would we ignore those with 3-4 symptoms when its been shown that the level of distress and daily difficults is the same as someone with 5
epidemiology- global burden. how much of worldwide disability does depression account for?
21.2%
what did the 2013 global burden of disease study find
its the most prominent mental health condition, second leading cause of years lived with disability. primary driver of disability in 26 countries
what did the lancet 2017 find
it is in the top 10 causes of death in all buy 4 countries
‘Eiu, surely that can’t be true!’
Liu et al., 2019- there are 258 people living with it currently
Suicide: how many suicides were there in 2014
6,222- 1 death every 2 hours
what year was it the leading cause of death in men under 50
2014
where in the world has the highest rates and where the lowest
highest- north east of england. london has the lowest- maybe to do with deprivation levels/opportunities.
how many people didnt contact a gp a year before suicide
72%
prevalence in age?
steady rise from 16 to 50/60’s and then lowers as you hit 70’s
depression by age and sex?
young women is 4 times as much as young men. older women is 6 times as much as men. Stansfeld et al., 2014- women have higher prevalence
why is it difficult to measure prevalence?
lots of different measures are used and its often comorbid with other disorders (Moffit et al., 2017)
how does employment affect it?
being unemployed makes you more likely to have it and women still almost twice as likely
central ideas for the psychodynamic/psychoanalytic theory of depression
- importance of childhood experiences
- get stuck in the early oral stage, do thinks like chew gum, smoke etc
- people become vulnerable to depression if you needs are not met during the oral stage
- depression is response to actual or symbolic loss
why does freud think loss is so important to depression
thinks that experiencing loss leads to something called ‘introjection’ where the individual regresses to oral stage.
he says that natural loss causes feelings of loss, rejection and disappointment which makes you withdraw feelings from them and put them onto a new person.
he says that when on the depression pathway you refuse to accept the loss and the feelings of anger and disappointment are directed inwards and depression is caused.
good things about psycho
- very influential
- based on really detailed observations that are still used today
- modern theories have actually adopted the idea that childhood experiences are really key
bad things
- there is not much evidence
- many people experience loss and no depression. this doesnt explain that
what does it suggest in terms of the stress-diathesis model
that early experiences in childhood (whether orally fixed or not) are what create the vulnerability to depression
who made some recent adaptations to psychoanalytic theory
robert hobson. a conversational model of therapy. he coined the ‘aloneness-togetherness’ approach which said you need to be comfortable in your own and in others company. said that as long as the person had had 1 significant relationship in their life then they could be treated. also placed massive importance on relationship with the self
what are the central ideas to the interpersonal theories of depression. ‘you must get a job to maintain the coin’
Coyne, 1976- model is more about the maintenance of depression rather than the cause.
idea that-
1) depression arouses guilt, annoyance and eventual avoidance in those AROUND THE DEPRESSED PERSON.
2) this reinforces the idea for the depressed person they they are not loved
3) this results in increased distress and a behaviour-response pattern is established.
basic idea behind it
it is the actual behaviour of the depressed person that puts other people in the position that they start reinforcing the depressed persons view that they aint shit
who explained the idea? ‘i dont want to joiner cos shes so depressing!’
Joiner et al., 1992- explained maintenance in terms of ‘excessive reassurance seeking’- incessantly seeking assurance that they’re loveable. and ‘negative feedback seeking’ tendency to actively seek criticism.
where does negative feedback seeking come from? ‘if you hit a swann they will fucking come for you’
‘Swann, 1990= people want interpersonal feedback that is consistent with their own views because it means they can predict and control their environment
criticisms of interpersonal theories
the evidence is retrospective, its quite reasonable that depressed people would underestimate the support in their lives. also- are these two tendencies predispositions for getting depression or is it depression that causes these tendencies?
describe attachement theory of depression
theory of mono-trophy (single attachment) if this is broken then you get depression. in terms of stress-diathesis- attachment is a very important diathesis. its the basis that makes them vulnerable to not being able to cope with alter life stressors.
what do they say healthy attachment does to avoid depression
you get responsive reactions when you cry, builds up a ‘secure base’ which allows infants to build up internral working model
explain behavioural theory=
Lewinson 1976- you become depressed through lack of positive reinforcement if you lose something- bereavement, loss of job, relationship etc. the person then starts withdrawing, which leads to further reduction in reinforcement, create a cycle- behavioural vacuum
what is evidence for this
depressed people have a lack of motivation= perhaps because it has stopped being reinforced?
what 3 assumptions is it based on
1) low levels of response contingent (positive experiences)- act as a stimulus for depressive behaviour.
2) these low levels are a sufficient explanation for depression
3) the total amount of response-contingent reinforcement is made up of- number of potentially reinforcing events, availability of such events and finally, the behaviour of the individual in trying to get the reinforcement
caveats of the behavioural theory
reductionist- only talks about environment, what about biological or cognitive aspects
deterministic- suggests our behaviour is completely controlled by environment, that if you experience loss then you will get depressed
what about people with great lives who just get depression
ignores nature- only nurture
explain cognitive theory of depression
Beck, 1967- negative cognitive triad.
1) negative view of self
2) negative view of the world
3) negative view of the future
these views lead to cognitive bias, then to failure, then to loss and depression.
distorted thoughts and negative schemas influence what information we select, encode and evaluate.
how are negative schemas made
learned socially by watching family, or experiences that lead to maladaptive coping strategies
how is it explained in context of the stress-diathesis model
diathesis= dysfunctional beliefs
stress= significant life event
leads to negative schemas, leads to becks cognitive triad
vulnerabilities come from experiences, genes and personality and lay dormant until life events activate them
what are the bias’s that the triad leads to? alice sometimes over-magnifies all
Arbitrary interference- jumping to conclusions
Selective abstraction- abstracting info out of context and missing significant info
Overgeneralisation- make a small mistake and say you never do anything right
Magnification and minimisation- catastrophising events
All-or-nothing thinking- events are black or white, good or bad
what is support for this theory?
Alloy et al., 1997- depressed people remember more negative info about themselves then positive.
what is still unclear about it
whether depression causes them or they cause depression
what did brown and harris investigate?
Brown and Harris 1978- studied onset of depression in 458 south london women. found massive class effects- working class w children 4 times as likely as middle class w children.
how many women with depression had not experiences adverse life events
only 4 out of 37
what were the 3 major factors that effected it
1) protective factors such as education, employment, good relationship with husband
2) vulnerability factors such as family history, loss of mother before 11, lack of confiding relationship
3) provoking agents such as acute and ongoing stress that results in hopelessness and grief
ANXIETY!!!
When do we need anxiety?
Our brains have cognitive biases that are designed to jump to conclusions- like why we’d jump out of the way of a moving car. but if we start jumping every time we see a car thats when it becomes a problem.
what 3 things make it an issue?
proportionality, frequency, disruptiveness
PREVALENCE ‘kester, my mad fat diary’
Kessler et al., 2005- there is a 28% lifetime prevalence
‘roanoke series of AHS was so morbid’
Kroenke et al., 2007- very likely to be co-morbid with other disorders
‘simon says was played at school, they miss a lot of school’
Simone et al., 1995- anxiety poses high social and health costs to sufferer and government
‘they are anxty, wittchen turn leads to hospitalisation’
often end up in hospital because of the somatic symptoms
anxiety and age
looks very different in children, repetitive play etc.
phobias and GAD more common in older adults
social anxiety and panic disorder get less severe when you get older
gender and anxiety
women are twice as likely to get GAD, panic disorder and PTSD, and phobias. men and women have the same likelihood of OCD and social anxiety
why might this be? ‘kubrick was really sexist’
Pimlott-kubiak et al., 2013– women tend to experience more trauma due to socio-cultural factors, sexual assault.
class and anxiety
less income associated with higher risk of anxiety. they have higher psychological stress and less support
why might this be? ‘booka, they have less to learn’
Buka et al., 2001= more likely to experience trauma, adverse life events and less resources to cope with anxiety
the 9 disorders in the DSM
- separation anxiety
- social anxiety
- GAD
- specific phobias
- selective mutism
- panic disorder
- agoraphobia
- substance induced
- unspecified
what criteria must be present for a diagnosis of a specific phobia? 7
1) marked fear
2) immediate fear
3) object or situ is actively avoided
4) fear is out of proportion of actual threat
5) fear persists for more than 6 months
6) causes clinically significant distress/impairment
7) not better explained by another disorder- fear of spiders, paranoia not phobia?
what are the most common phobias
height, snakes, water, social, dentist, injection
was supposed to be further up but what are the common characteristics of anxiety disorder?
physiological symptoms of panic
bias towards negative/threatening information
worrying, jumping to conclusions
what disorders are within ocd
trichotillomania
hoarding
body dysmorphia
excoriation
what is ocd characterised by
obsessions (intrusive and recurring thoughts that are disturbing or uncontrollable) or compulsions (repetitive behaviour patterns that the individual feels driven to do to prevent bad things from happening)
what is PTSD characterised by
PTSD is a set of persistent anxiety-based symptoms that occur after witnessing a traumatic event
how does PTSD work?
1) exposure to trauma
2) intrusive symptoms
3) avoidance
4) negative alterations in cognition and mood
5) increased arousal
CO-MORBITIY WITHIN. ‘rhymes with frown’ how comorbid are GAD, OCD and social anxiety
Brown, 1996-
GAD- 83% comorbid
social- 45% comorbid
OCD- 56% comorbid
4 advantages to diagnosis
1) reasonably reliable and valid
2) makes communication between professionals easier
3) reassuring to be labelled? reduces self-efficacy
4) improves access to services/resources
4 disadvantages to diagnosis
1) labelling reduces self-efficacy, dont feel like they need to help selves anymore?
2) pathologising normal reactions?
3) high comorbidity, misdiagnosis danger
4) anxiety is common in all disorders
explain the psychoanalytic theory of specific phobias
its to do with hidden, unconscious fear of childhood conflict. hard to substantiate but it is thought that phobias do have something to do with avoiding more troubling life challenges. little hans
explain the learning theory ideas behind specific phobias,
Watson and Rayner, they made a baby anxious with a mental bar so they’ve shown how fear of things can be learnt.
explain how classical and operant conditioning can create anxiety
you have a panic attack (unconditioned response) at work (unconditioned stimulus) and then become fearful of work (conditioned stimulus). then, the reward of not being scared when you’re not at work reinforces the behaviour and it is maintained
learning theory intervention
based around idea of extinction, gradual decrease of conditioned response. either exposure leads to extinction or you over-learn a new conditioned response
what is the only rule in extinction
dont walk away when youre anxious because the reward of not going will reinforce the behaviour. could be used as evidence!
problems with conditioning theory
1) assumes that a bad event has happened, not everyone can trace it back like that
2) not all traumatic events cause phobias
3) doesnt explain why there are generally agreed things which are phobic
4) incubation- when exposure doesnt work
evolutionary accounts for phobias- ‘selig was fucked up’
Seligman- biological preparedness, evolutionary selection processes have meant we have biological predispositions to be fearful of things that could have been a threat to us in the past
evidence for this- ‘tarzan, monkeys’
Cook and Mineka- bred a fear of snakes into rhesus monkeys. shows it can be bred into out biology
what has evolution created and why is this different to before
evolution has created learned threat, out old brain was for relationship seeking, behaviours and emotions- the immediate responses you dont think much about. now we have learned threat that we ruminate on. imagination and rumination of the worst outcomes. treatments are all based on relaxing this phenomenon
criticisms of the evolutionary approach
it is all post hoc and very easy to just justify links- how do we know that selection processes were important for phobic content.
what is the main theory behind becks cognitive theory
it is not the thoughts that give us anxiety, its the processing!
How does this happen
the meaning we gives things gives them the emotional impact, the meanings we give are linked to your internal beliefs (schemas), which are linked to your early experiences
what is the difference between behavioural and cognitive theory
behavioural- about consequences after behaviour. cognitive is about the event- the thoughts you have of it, and then the behaviour
what are the 5 steps to becks cognitive theory
1) early experiences
2) create schemas, core beliefs
3) something happens to activate schema!!
4) information processing becomes distorted and negative automatic thoughts come
5) maintenance cycle of emotion, thoughts and behaviour
