Paper 1 - Psychopathology

Question 1

What is abnormality and what are the 4 definitions of abnormality?

Answer 1

Behaviours and mental processes that deviate from the norms or expectations of a given society or culture.
1. Statistical infrequency
2. Deviation from social norms
3. Failure to function adequately
4. Deviation from ideal mental health

Question 2

Explanation of statistical infrequency

Answer 2

Behaviour is normal if it occurs frequently
Any behaviour that occurs relatively rarely is thought of as abnormal
This approach is most useful when dealing with human characteristics that can be reliably measured

Scores for a particular behaviour (the majority of scores will cluster around the average, further we move away from the average the fewer and fewer people will have this score)
Compare individual behaviour with what the average person does

Refers to the conditions that are rare compared to the normal (behaviour only found in a few people is regarded as abnormal.)
Many human characteristics fall into the normal distributions, this will tell us what is “normal”. (For example, when facing everyday challenges, it is rare to be excessively fearless or fearful and normal to experience some stress.
E.g. asking everybody in this class who fears dogs, I being no fear, 10 being absolutely fearful. Most people would sit around 4,5,6,7. Where there are outliers these become the abnormal.

Question 3

A03 : Statistical infrequency : Real world application

Answer 3

STRENGTH
Statistical infrequency is useful in diagnosis
Intellectual disability disorder requires an IQ in the bottom 2%
The BDI (Beck depression inventory) assesses depression, only 5% score 30+ (meaning severe depression)
This means that statistical infrequency is useful in diagnostic and assessment processes

Question 4

A03 : Statistical infrequency : Unusual characteristics can also be positive

Answer 4

WEAKNESS
Just because a behaviour is statistically infrequent doesn’t mean it is abnormal or undesirable
IQ scores above 130 are unusual and statistically infrequent, just like those below 70, but they are not | regarded as undersirable or needing treatment
This means that although statistical infrequency can be part of defining abnormality, it can never be its sole basis

Question 5

A03 : Statistical infrequency : Benefits versus problems

Answer 5

Some unusual people benefit from being classed as abnormal. For example someone who has a very low IQ and is diagnosed with intellectual disability can then access support services or someone with a very high BDI score is likely to benefit from therapy. On the other hand, not all statistically unusual people benefit from labels. Someone with a low IQ who can cope with their chosen lifestyle would not benefit from a label. There is a social stigma attached to such labels. Therefore sometimes it isn’t good to label people as abnormal

Question 6

What does deviance mean

Answer 6

Behaviour and emotions that deviate from the norm in a society. Must also be behaviour that is deemed unacceptable by society.

Question 7

Explain deviation from social norms

Answer 7

Social norms are created by a group of people and thus are “social”.
These compromise what behaviours are acceptable standards of behaviour.
Anyone who behaves differently deviates from social norms are classed as abnormal, therefore deviations from social norms.
These rules are often in place for good reason, i.e politeness, it oils the wheels of interpersonal relations. (Those that are rude are considered to be socially deviant and people find it hard to interact with them.)
Some rules about unacceptable behaviour are implicit whereas others are policed by laws.
They also differ over place and time due to cultural relativism (e.g alcohol consumption in public places). This is the view that behaviour cannot be judged properly unless it is viewed in the context of the culture in which it originates. (I.e Homosexually used to be considered as abnormal, a mental disorder and used to be against the law, in the Uk this has since changed.)

Question 8

A03 : Deviation from social norms : Real world application

Answer 8

STRENGTH
Deviation from social norms is useful in diagnosis.
Antisocial personality disorder - diagnosis requires failure to conform to ethical standards.
Schizotypal personality disorder - this involves strange beliefs and behaviour.
This means that deviation from social norms is useful in psychiatric diagnosis.

Question 9

A03 : Deviation from social norms : Social norms are situationally and culturally relative

Answer 9

WEAKNESS
What is considered abnormal in one situation or culture may be considered normal in another.
Hearing voices is socially acceptable in some cultures but would be seen as abnormal in the Uk - cultural norms of the patient and the clinician need to be considered.
Wearing your Pjs to school on a fancy dress day is considered normal, but wearing them everyday when others are in uniform is considered abnormal - it depends on the situation.
This means that it is difficult to judge deviation from social norms from one context to another.

Question 10

A03 : Deviation from social norms : Human rights abuses

Answer 10

Using deviation from social norms to define someone as abnormal carries the risk of unfair labelling and leaving them open to human rights abuses. Historically this has been the case where diagnoses like nymphomania (women’s uncontrollable or excessive sexual desire) have been used to control women, or diagnoses like drapetomania (black slaves running away) were a way to control slaves and avoid debate. On the other hand it can be argued that we need to be able to use deviation from social norms to diagnose conditions such as antisocial personality disorder.
Consider: Is the use of deviation from social norms as a criterion for defining abnormality ever justifiable?

Question 11

Define Cultural relativism

Answer 11

Cultural Relativism: the view that behaviour cannot be judged properly unless it is viewed in the context of the culture in which it originates.

Question 12

Define deviation from social norms

Answer 12

Deviation from social norms: abnormal behaviour is seen as a deviation from unstated rules about how one ought to behave. Anything that violates these rules in considered abnormal.

Question 13

Define DSM

Answer 13

DSM: Diagnostic and statistical manual disorders, a list of mental disorders that is used t o diagnose mental disorders. For each disorder a list of clinical characteristics if given, i.e. the symptoms that should be looked for.

Question 14

Define statistical infrequency

Answer 14

Statistical Infrequency: abnormality is defined as those behaviour that are extremely rare. i.e. if behaviour that is statistically infrequent is regarded as abnormal.

Question 15

Explain failure to function adequately

Answer 15

Not being able to cope with everyday living
The functioning refers to just going about day to day life, (such as eating regularly, washing clothes, getting ready, going to school, being able communicate with other)
Also causes distress and suffering for the individual and/or others around them (i.e. schizophrenia the person is ok but causes distress to those around them due to their paranoia)

If it distresses only others and but the individual then the judgement of abnormality is inappropriate (I.e. individuals may be content wearing unwashed clothes and not having a job, they just don’t cope in a normal way.)
EXAMPLE : The DSM includes an assessment of ability to function called WHODAS (World health org disability assessment). Individuals rate themselves on a scale of 1-5 and given an overall score. This is a quantitative measure.

WHODAS Questionnaire:
‘None’ (0)
‘Mild’ (1)
‘Moderate’ (2)
‘Severe’ (3)
‘Extreme’ (4)
Add all up and divide by 144, times by 100
A score of 0 means no disability, a score of 100 means full disability

Rosenhan and Seligman (1989), when someone is not coping (the no longer conform to interpersonal rules, e.g. maintaining personal space) (they experience severe personal distress) (they behave in a way that is irrational or dangerous)

Question 16

A03 : failure to function adequately : Provides a threshold for professional help

Answer 16

STRENGTH
In any given year, 25% of us experiences symptoms of a mental disorder to some degree (mind)
Most of the time we continue day to day life but when we stop being able to function adequately people seek or are referred for professional help
This means that the failure to function adequately criteria provides a way to target treatment and services to those who need them most.

Question 17

A03 : failure to function adequately : It can lead to discrimination/social control

Answer 17

WEAKNESS
It is hard to distinguish between failure to function adequately and a conscious decision to deviate from social norms
For example people may choose to live off grid as part of an alternative lifestyle choice or take part in high risk leisure activities
This means that people who make unusual choices can be labelled abnormal and their freedom of choice is restricted

Question 18

A03 : failure to function adequately : Failure to function may not be abnormal

Answer 18

There are some circumstances in which most of us fail to cope for a time (e.g, bereavement). It may be unfair to give someone a label that may cause them future problems just because they react to difficult circumstances. On the other hand the failure to function is no less real just because the cause is clear. Also some people need professional help to adjust to circumstances like bereavement. We shouldn’t call people abnormal when they fail to function following distressing circumstances.

Question 19

Explain deviation from ideal mental health

Answer 19

Jahoda (1958) we define physical illness in part by looking at the absence of signs of physical health (I.e. temperature, normal skin colour, normal blood pressure). So the absence of these indicate illness. We should do the same for mental illness.

The absence of the following criteria
1. We have no symptoms or distress
2. We are rational and perceive ourselves accurately
3. We self-actualise
4. We can cope with stress
5. We have a realistic view of the world
6. We have good self-esteem and lack guilt
7. We are independent of other people
8. We can successfully work, love and enjoy our leisure
There is some overlap with failure to function adequately - in both definitions not being able to cope with stressful situations.

Question 20

A03 : deviation from ideal mental health : The ideal mental health approach is comprehensive

Answer 20

WEAKNESS
Ideal mental health includes a range of criteria for mental health
It covers most of the reasons why we might need help with mental health
This means that mental health can be discussed meaningfully with a range of professionals
Therefore ideal mental health provides a checklist against which we can assess ourselves and others

Question 21

A03 : deviation from ideal mental health : It may be culture-bound

Answer 21

WEAKNESS
Some criteria for ideal mental health are limited to USA and Western Europe (e.g. self actualisation is not recognised in most of the world)
Even in Western Europe there are variations in the value placed on independence (high in Germany, low in Italy)
This means that is is very difficult to apply the concept of ideal mental health from one culture to another

Question 22

A03 : deviation from ideal mental health : Extremely high standards

Answer 22

Very few of us attain all of Johada’s criteria for mental health, and probably none of us achieve all of them at the same time or keep them up for very long, it can be disheartening to see an impossible set of stand to live up to. On the other hand, having such a comprehensive set of criteria for mental health to work towards might be of practical value to someone wanting to understand and improve their mental health. Is it helpful to have a comprehensive set of criteria for mental health?

Question 23

Define deviation from ideal mental health?

Answer 23

Abnormality is defined in terms of mental health, behaviours that are associated with competence and happiness. Ideal mental health would include a positive attitude towards the self, resistance to stress and an accurate perception.

Question 24

Define failure to function adequately

Answer 24

People are judged on their ability to go about daily life. If they can’t do this and area also experiencing distress then it is considered a sign of abnormality.

Question 25

Diagnostic and statistical manual of mental disorders

Answer 25

The current model of the DSM-V was published in 2013 and had about 300 disorders in. This is a classification system published by the APA and contains typical symptoms of each disorder and guidelines for clinicians to make diagnosis. Another model used is the ICD (currently on the 11th edition) produced by the WHO.

Question 26

Phobias and 3 types of phobias

Answer 26

Phobia disorders are included in diagnostics manuals within the category of anxiety disorders. Primary symptoms are extreme anxiety, irrational fear and conscious avoidance of a feared object or situation (i.e Agrophobia (extreme or irrational fear of open or public place) Social phobia (is an anxiety disorder in which a person has an excessive and unreasonable fear of social situations Specific phobia (specific phobia is any kind of anxiety disorder that amounts to an unreasonable or irrational fear related to exposure of a specific object/situation

Question 27

DSM-V : Criteria for diagnosis

Answer 27

Symptoms for 6 months Marked and persistent fear of a specific object or situation Exposure to the phobic stimulus nearly always produces a rapid anxiety response Fear of robe phobic object or situation is excessive The phobic stimulus is either avoided or responded to with great anxiety The phobic reactions interfere significantly with the individuals working or social life or he/she is very distressed about the phobia

Question 28

Phobia : define, emotional/cognitive/behavioural characteristics

Answer 28

An irrational fear of an object or situation Emotional characteristics: Anxiety, fear and emotional response is unreasonable Cogntive characteristics: Selective attention to the phobic stimulus, irrational beliefs and cognitive distortions Behavourial characteristics: Panic, avoidance and endurance (e.g. stay in room with spider to keep a wary eye on it instead of leave/avoid it)

Question 29

Depression : define, emotional/cognitive/behavioural characteristics

Answer 29

A mental disorder characterised by low mood and low energy Emotional characteristics: Lowered mood, anger and lowered self-esteem Cognitive characteristics: Poor concentration, attending to and dwelling on the negative and absolutist thinking Behavioural characteristics: Activity levels, distrusting to sleep & eating behaviour and aggression & self harm

Question 30

OCD : define, emotional/cognitive/behavioural characteristics

Answer 30

A condition characterised by obsessions and/or compulsive behaviour. Obsessions are cognitive whereas compulsions are behavioural. Emotional characteristics: Anxiety & distress, accompanying depression and guilt & disgust Cognitive characteristics: Obsessive thoughts, cognitive coping strategies and insight into excessive anxiety Behavioural characteristics: Compulsions are repetitive, compulsions reduce anxiety and avoidance

Question 31

Define agrophobia

Answer 31

Agrophobia - extreme or irrational fear of open or public places

Question 32

Define compulsion and obsession

Answer 32

Compulsion: behaviour that is repeated over and over in order to reduce anxiety Obsession: persistent, intrusive and unwelcome thoughts

Question 33

Define DSM and ICD

Answer 33

DSM: This is classification system published by the APA and contains typical symptoms of each disorder and guidelines for clinicians to make diagnosis. ICD: This is a Statistical Classification of Diseases and Related Health Problems, produced by the World Health Organisation

Question 34

Define social phobias and specific phobias

Answer 34

Social phobia - is an anxiety disorder in which a person has an excessive and unreasonable fear of social situations Specific phobia - A specific phobia is any kind of anxiety disorder that amounts to an unreasonable or irrational fear related to exposure to specific objects or situations

Question 35

Who proposed a model to explain phobias and what was this model called?

Answer 35

Known as the two process model Mowrer (1947) proposed the two process model, incorporating both classical and operant conditioning to explain the initiation and persistence of phobia. Explains phobias with behaviourist approach

Question 36

How does classical conditioning explain phobias & what is generalisation?

Answer 36

Classical conditioning - Initiation (how you get the phobia) Learnt by association by Pavlov Behaviourists believe that usually with phobias a traumatic event has lead to the development of a phobia. E.g. Little Albert (white rate), Clown example Generalisation - Generalise fear response to other stimuli (e.g. Little Albert also showed fear to other white furry objects (e.g. Santa’s beard & fur coats)

Question 37

How does operant conditioning explain phobias?

Answer 37

Operant conditioning - Maintenance (how you keep the phobia) Learnt through consequences by Skinner If the behaviour is rewarded it is more likely to be repeated. Negative reinforcement (remove an unpleasant stimulus to increase a behaviour). Escape from the phobia stimulus reduces fear = negative reinforcement (unpleasant consequence of fear/anxiety removed, increases avoidance behaviour and maintains phobia)

Question 38

A03: Phobia Explanations : Real world application

Answer 38

STRENGTH Idea that phobias are maintained by avoidance is important in explaining why some people benefit from exposure therapies - once avoidance is prevented it is no longer reinforced, avoidance behaviour then declines. This shows that the two-process approach is valuable because it identifies a way to treat phobias.

Question 39

A03: Phobia Explanations : Evidence linking phobias to bad experiences

Answer 39

STRENGTH Phobics often recall a specific incident when their phobia appeared, for example being bitten by a dog or experiencing a panic attack in a social event (Sue, 1994). De Jongh et al (2006) : 73% of dental phobics had experienced a trauma (control group with low dental anxiety, only 21% had experienced traumatic events). This confirms that the association between stimulus and an unconditioned response does lead to a phobia.

Question 40

A03: Phobia Explanations : Cognitive elements that the behaviourist cannot explain

Answer 40

WEAKNESS The cognitive approach proposes that phobia may develop as the consequence of irrational thinking. Cognitive therapies designed to treat this, such as CBT, may be more successful than the behaviourist treatments for certain phobias (cognitive treats obsession and behaviourist treatments the compulsion)

Question 41

A03: Phobia Explanations : Alternative explanations

Answer 41

WEAKNESS Not everyone can remember a traumatic experience/incident. DiNado found 50% of people could not remember a traumatic experience when they feared dogs. The diathesis-stress model could explain this (we inherit a genetic vulnerability for developing a mental disorder, however it will only manifest itself when triggered by a traumatic event). People without this vulnerability would not develop a phobia Social learning theory says we acquire a phobia and maintain it through social learning theory and vicarious reinforcement

Question 42

A03: Phobia Explanations : Biological Preparedness

Answer 42

WEAKNESS Animals including humans are genetically programmed to rapidly learn to fear certain stimuli (snakes, strangers) because they are potentially life threatening. This preparedness means that behavioural explanations alone cannot explain the development of all phobias. The two process model does not explain some important properties of phobias.

Question 43

Define nurture

Answer 43

Learn everything from our experience within our environment

Question 44

Define classical and operant conditioning

Answer 44

C = learning through association, neutral stimulus is partied with an unconditioned stimulus O = learning through reinforcement/punishment/consequence

Question 45

Define two process theory

Answer 45

Theory that explains the two process that lead to the development of a phobia (begin through classical and maintained through operant conditioning)

Question 46

What are the 2 methods for phobia treatment

Answer 46

systematic desensitisation (SD) and flooding

Question 47

Phobia Treatment : Explain systematic desensitisation (include counterconditioning, relaxation and desensitisation)

Question 48

Phobia Treatment : How does SD work

Answer 48

Teach relaxation techniques Construct a desensitisation hierarchy - least to most fear provoking Patient step by step gradually works through hierarchy Only once one step has been 100% mastered, then can they move on to the next step Patient will eventually overcome fear - reach the top of the hierarchy and realise that they shouldn’t fear it Can be in vivo (actually exposed to the phobic stimulus) or in vitro (imagines exposure to the phobic stimulus) Example of arachnophobia on docs

Question 49

A03 Phobia treatment : effectiveness of SD

Answer 49

Strength Researchers have found the SD is successful for a range of phobic disorders. McGrath (1990) reported that about 75% of patients with the phobic disorders respond to SD Choy (2007) found that in vivo (reality) is the best method compared to vret (pictures or imagining) Comer (2003) modelling can also help, watching someone else who is coping well with the feared stimulus

Question 50

A03 Phobia treatment : SD General effectiveness of behavioural therapies

Answer 50

Strength Therapies are generally fast and less effortful than psychotherapies that require the patient to think, CBT requires a lot of willpower from the patient, in understating their behaviour and applying the new insights. Therefore they are useful for those that lack insight, such as children or adults with learning difficulties SD can also be self-administrated and has been found to be just as effective as therapist lead SD, this will be a lot cheaper

Question 51

A03 Phobia treatment : SD not appropriate for all phobia

Answer 51

Weakness Ohman (1975) suggest that due to the preparedness, SD may not be as effective in treating phobias with an evolutionary survival component such as fear of the dark compared to those that have been developed due to a personal experience.

Question 52

Phobia Treatment : Explain flooding & how does it work

Answer 52

One long session (3 hours) where the patient experiences their phobia at its worst while, at the same time, practising relaxation techniques. E.g. patient that fears spiders being in a room full of fear roaming spiders (that could crawl in your body) Can be in vivo (actual exposure) or in virtual reality (VRET). The fear response has a time limit and, as it is exhausted, a new association between the feared stimulus and relaxation is learned. Very quick learning through extinction - no option of avoidance, fear response is exhausted (know as extinction). Flooding is not unethical but it is unpleasant. It is importance those being treated give informed consent - they must be fully prepared and know what to expect. How does flooding work Patient is taught relaxation techniques Patient flooded, patient overcomes fear Completed in one long session

Question 53

A03 Phobia treatment : Flooding quick and cost-effective

Answer 53

Strength Flooding is a quick treatment - 1 session compared to many for SD, Choy (2007) said it may be more effective then SD (implications of this in the real world?). However Craske (2008) concluded that SD and flooding were equally effective. Flooding is cost-effective because it is clinically effective and not expensive (can work in as little as one session). Even with a longer session, it is more cost-effective than alternatives.

Question 54

A03 Phobia treatment : flooding is traumatic

Answer 54

Weakness Flooding is not for everyone, it is very intense and puts the patient under immense anxiety, they are of course informed prior to taking the therapy. Therefore patients may quit during the treatment which reduces the ultimate effectiveness of flooding. It is traumatic - Schumacher et al (2015) found that participants and therapists rated flooding as more stressful than SD - there are ethical concerns about the stress caused, therapists may avoid using it.

Question 55

A03 Phobia treatment : Flooding symptom substitutions

Answer 55

Behavioural therapies remove symptoms but does not rest the overall cause This may lead to symptom substitution (i.e. a smoker quit smoking but then comfort eats because the underlying smoking issue was not dealt with).

Question 56

Define flooding and systematic desensitisation

Answer 56

Flooding = a behavioural therapy used to treat phobias. A client is exposed to an extreme situation under relaxed conditions until the anxiety reaction is extinguished. Systematic Desensitisation = a client is gradually exposed to a threatening situation under relaxed conditions, in a step by step/gradual approach, from least to most fear provoking situations. Two opposite emotions cannot co exist.

Question 57

What does the cognitive approach say about depression

Answer 57

The emphasis in this approach is on how thinking shapes our behaviour. Cognitive psychologists are most concerned with how irrational thinking leads to a mental disorder. Depression is characterised by negative irrational thinking, then the cognitive explanations are the most appropriate to using in explanation and treating the mental disorder. Examples of irrational beliefs = must always achieve perfection, it is awful & catastrophic when thinks don’t go the way I’d like them to

Question 58

Explains Ellis’ ABC model for depression

Answer 58

Ellis proposed that the key to mental disorders such as depression lay in irrational beliefs. ABC Model A : Activating event (you get fired) B : Belief, may be rational or irrational (the company is overstaffed or I was sacked as they don’t like me) C : Consequence, irrational beliefs lead to unhealthy emotions (depression) Negative event (A) -> Rational belief (B) -> Healthy negative emotion (C) Negative event (A) -> Irrational belief (B) -> Unhealthy negative emotion (C)

Question 59

Explain mustabatory thinking for depression

Answer 59

This is the source of the irrational belief that certain things must be true for an individual to be happy. Ellis identified three most important irrational beliefs I must be approved of or accepted by people I find important I must do well or very well, or I am worthless The world must give happiness, or I will die Other irrational assumptions include : “others must treat me fairly and give me what I need” and “people must live up to my expectations or it is terrible” Such musts need to be challenged in order for mental healthiness to prevail.

Question 60

Beck’s Cognitive Theory of Depression

Answer 60

Beck suggested that some people are cognitively more vulnerable to developing depression, believing that 3 factors create a ‘cognitive vulnerability’ to depression. These 3 factors are: Negative self-schemas Faulty information processing The negative triad

Question 61

Beck’s cognitive theory of depression (negative self schemas)

Answer 61

A schema is a ‘package’ of ideas and information developed through past experience. A self schema is therefore a package of information we hold about ourselves. We used these schemas when we interpret the world & therefore if we have a negative self-schema, we will interpret all information about ourselves negatively. These are acquired in childhood and activated in conditions resembling those in which they were learned.

Question 62

Beck’s cognitive theory of depression (faulty information processing)

Answer 62

Information processing or depressed individuals is cognitively biased (this means to have automatic negative and irrational thoughts). This makes them more prone to depression (as it perpetuates the feelings of hopelessness and helplessness), and once depressed these thoughts make it difficult to get better. Table on docs for selective abstraction, overgeneralisation, minimisation & magnification

Question 63

Beck’s cognitive theory of depression (negative triad)

Answer 63

Beck developed a cognitive explanation for mental disorders but one that focused on depression. Beck believed that depressed individuals feel as they do because their thinking is biased towards negative interpretations of the world and they lack a perceived sense of control. Negative schemas and cognitive biases maintain the negative triad a pessimistic and irrational view of three key elements in a personals belief system: The Self (I’m plain and undesirable) The World (I can’t understand why people don’t like me, everyone would prefer somebody else company, even my girlfriend/boyfriend left me) The Future (I am always going to be on my own)

Question 64

A03 : Explanation of depression : Research support the role of irrational thinking

Answer 64

STRENGTH Bates(1999) found that when depressed participants who were given negative automatic-thought statements became more and more depressed, supporting the view that negative thinking leads to depression. Cohen et al (2019) tracked 473 adolescents’ development and found that early cognitive vulnerability predicted later depression - the idea of cognitive vulnerability is therefore useful in clinical practice. HOWEVER this just proves there is a link between negative thoughts and depression does not give a cause. Beck’s idea is a partial explanation. Therefore people with maladaptive cognitive processes are at greater risk of developing mental disorders because of a possible genetic predisposition. The cognitive model is not a particularly good explanation for all depressive phenomena.

Question 65

A03 : Explanation of depression : Real World Application

Answer 65

STRENGTH Screening Assessing cognitive vulnerability in young people most at risk of developing depression means they can be monitored This understanding can be applied in CBT to alter cognitions underlying depression, making someone more resilient to life events, meaning the idea of cognitive vulnerability is useful in clinical practice Treatment Both methods have been usefully applied in the treatment programme CBT which consistently has been shown to be the best treatment for depression If depression is alleviated by challenging irrational thinking, then this suggests the irrational thoughts had a role in the depression developing in the first place

Question 66

A03 : Explanation of depression : Blames the patient rather than the situation

Answer 66

WEAKNESS The responsibility for the depression and recovery rests with the individual - this may lead the client or therapist to overlook situational factors, such as the impact of life events contributing to the disorder. Therefore this approach only focuses on the thought processes and will not deal with situational factors that may be the root cause.

Question 67

A03 : Explanation of depression : Ellis’ model only explains reactive depression

Answer 67

WEAKNESS Reactive depression is where it is triggered by negative activating effects However in many causes it is not obvious what triggers depression - Ellis’ model is less useful in explaining this. It can only explain some cases of depression not all.

Question 68

A03 : Explanation of depression : Irrational beliefs may be realistic

Answer 68

WEAKNESS Irrational beliefs just might seem irrational. Alloy and Abrahmson (1979) suggest that depressive realists tend to see things for what they are (normal people look through rose tinted glasses). They found that depressed people gave more accurate estimates of the likelihood of a disaster than normal controls - this is called "Sadder but wiser effect"

Question 69

A03 : Explanation of depression : Alternative Explanations

Answer 69

WEAKNESS The biological approach to understanding mental disorders suggest that genes and neurotransmitters may cause depression (Zhang (2005) found lower levels of serotonin in depressed people, and a gene has been found related to this which has been found to be 10 times more common in people with depression). The success of drug treatment does suggest a neurotransmitter is responsible. The Diathesis stress model suggests a genetic vulnerability to depression, these people are more prone to the effects of living in a negative environment which leads to irrational thinking.

Question 70

Explain cognitive behaviour therapy (CBT) as a treatment of depression

Answer 70

Cognitive Behaviour Therapy (CBT) - Patient and therapist carries out an assessment to clarify the patient's problem. They jointly identify goals, then put a plan together to achieve them. The main task is to identify where there might be negative or irrational thoughts that need challenging. CBT works to challenge negative and irrational thoughts, then to replace them with effective behaviours.

Question 71

Depression treatment : challenging irrational thoughts

Answer 71

Challenging irrational thoughts Ellis called his CBT based theory ‘rational emotional behaviour therapy’ (REBT) as it resolves emotional and behavioural problems. He extended his model to become ABCDEF: Disputing irrational thoughts and beliefs Effects of disputing and effective attitude to life Feelings that are produced

Question 72

Depression treatment : REBT

Answer 72

REBT focuses on challenging irrational thoughts and replacing them with rational ones: Logical disputing (self defeating beliefs do not follow from the event) Empirical disputing (self defeating beliefs are inconsistent with reality) Pragmatic disputing (the pointlessness of self defeating beliefs) Effective disputing changes self defeating beliefs into more rational beliefs, replacing catastrophizing with more rational interpretations of events.

Question 73

Depression treatment : what 3 things happen alongside CBT therapy

Answer 73

Homework - Patients are asked to complete homework outside therapy sessions to test irrational beliefs against reality and put new rational beliefs into practice. Behavioural Activation - Based on the assumption that being active leads to rewards that act as an antidote to depression, CBT often involves encouraging patients to become more active and engaged in pleasurable activities. Unconditional Positive Regard - If a client feels worthless they will be less willing to consider change. If the therapist provide respect for the client without judgement (i.e unconditional positive regard) a change in beliefs and attitudes should be facilitated.

Question 74

A03 : depression treatment : research support

Answer 74

STRENGTH Ellis (1957) claimed a 90% success rate for REBT, taking an average of 27 sessions to complete the treatment. HOWEVER Ellis said that the therapy was not always effective, he suggested this could be because some patients did not put their revised beliefs into actions. REBT and CBT do well in outcome studies of depression Cuijpers (2013) found that out of 75 studies CBT was far superior to no treatment March et al (2007) compared effects of CBT with antidepressant drugs and a combination of the two in 327 depressed adolescents. After 36 weeks found : 81% of CBT group, 81% of antidepressant group, 86% of CBT + drugs group were significantly improved.

Question 75

A03 : depression treatment : support of behaviour activation

Answer 75

STRENGTH Babyak (2000) randomly assigned 156 depressed adults to four months of aerobic exercise, drug treatment or both. All patients improves, but six months later the exercise group had lower relapse rates than the medication group, especially if they had continued with an exercise regime.

Question 76

A03 : depression treatment : combination of alternative treatment

Answer 76

STRENGTH Cuijpers found that CBT was especially effective when used with drug therapy e.g. SSRI may alleviate symptoms enough to allow the patient to focus on the demands of CBT.

Question 77

A03 : depression treatment : individuals differences

Answer 77

WEAKNESS Elkin (1985) states that CBT work less well with people who have high levels of irrational beliefs that are rigid as well as resistant to change. Or when realistic stressors cannot be resolved by therapy. The directness of REBT does not suit everyone, some people want to share their worries without expending the cognitive effort necessary for recovery. In severe cases, clients may not be able to pay attention in a session. Sturmey (2005) suggested that any form of psychotherapy (including CBT) in not suitable for people with learning differences.

Question 78

A03 : depression treatment : the dodo bird effect

Answer 78

WEAKNESS Rosenzweig (1936) argues that all method of treatment for mental disorder were pretty much equally effective, he called this the dodo bird effect, based upon Alice in Wonderland, everybody wins. Luborsky (2002) reviewed 100 different studies that compared different therapies and found that there were only small differences. Rosenzweig argues that this was because of common factors in different psychotherapies, such as being able to talk to a sympathetic person, which may enhance self-esteem and having an opportunity to express ones thoughts.

Question 79

A03 : depression treatment : high relapse rates

Answer 79

WEAKNESS Ali et al (2017) found 42% relapsed within 6 months of ending treatment, 53% within a year.

Question 80

OCD Explanation : genetic explanation : candidate genes

Answer 80

Specific genes have been identified that create a vulnerability for OCD - these are called candidate genes Serotonin genes - implicated in transmission of serotonin across synapses (e.g. 5HT1-D) Dopamine genes - implicated in OCD and may regulate mood Serotonin and dopamine are neurotransmitters

Question 81

OCD Explanation : genetic explanation : The COMT & SERT gene

Answer 81

The COMT gene Helps to 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 (associated with OCD). The SERT gene This affects the transport of serotonin, creating lower levels of this neurotransmitter. Low levels of serotonin have been implicated with OCD.

Question 82

OCD Explanation : genetic explanation : polygenic & Aetiologically heterogeneous

Answer 82

Polygenic - OCD is not caused by one single gene but several genes Taylor (2013) found evidence that up to 230 different genes may be involved in OCD Aetiologically heterogeneous - one group of genes may cause OCD in one person but a different group of genes may cause OCD in another person Different types of OCD may be the result of particular genetic variations e.g. hoarding disorder and religious obsession

Question 83

OCD Explanation : Neural Explanations

Answer 83

These are chemical messengers that transmit nerve impulses from one cell across the synapse (gap) to another cell. Serotonin - Lower levels of serotonin found in OCD sufferers Dopamine - Levels are high in people with OCD

Question 84

OCD Explanation : Neural Explanations : Abnormal levels of neurotransmitters

Answer 84

Dopamine levels are thought to be abnormally high in people with OCD. This is based on animal studies - high doses of drugs that enhance levels of dopamine induce stereotyped movements resembling the compulsive behaviours found in OCD patients (Szechtman, 1998). Lower serotonin - someone with low levels of serotonin then normal transmission of mood-relevant information does not take place and mood is affected (sometimes along with other mental processes) • Pigott (1990) found the fact that antidepressants that increase serotonin activity have proven to reduce OCD symptoms.

Question 85

OCD Explanation : Neural Explanations : Abnormal brain circuits

Answer 85

It is thought that serotonin and other neurotransmitters help the functioning of the OFC and the worry circuit. Several areas in the frontal lobes of the brain are thought to be abnormal in people with OCD, the orbitofrontal cortex (OFC) sends “worry” signals to the thalamus. These are normally suppressed by the caudate nucleus but, if this is damaged, the thalamus is alerted and confirms the “worry” to the OFC creating a worry circuit. Then the individual is driven to think more (anxiety) about them and to take action (compulsive behaviour)

Question 86

OCD Explanation : Neural Explanations : Frontal lobes

Answer 86

Frontal lobes are responsible for logical thinking/decision making Some cases of OCD associated with impaired decision making e.g. hoarding disorder May be associated with abnormal functioning of the lateral frontal lobes (side parts) -> Parahippocampal gyrus The left parahippocampal gyrus is associated with processing unpleasant emotions Evidence to suggest this functions abnormally in people with OCD

Question 87

A03 : OCD Explanation : Evidence for genetic explanations

Answer 87

STRENGTH Nestadt (2000) Compared to the general population, people with first degree relatives with OCD have a five times higher risk of having the illness at some point in their life. Billet (1998) Mz twins are more than twice as likely to develop OCD if their co-twin has OCD. This means that people who are genetically similar are more likely to shareOCD, supporting a role for genetic vulnerability HOWEVER concordance rates are not 100% therefore there must be other factors. Such as the environment as the twins grow up in the same environment and they may observe and imitate.

Question 88

A03 : OCD Explanation : Research Support for the OFC

Answer 88

STRENGTH Menzies (2007)Compared to unrelated healthy people, OCD patients and their immediate relatives had reduced grey matter in key regions of the brain, including OFC. This supports the view that anatomical differences are inherited and may lead to OCD.

Question 89

A03 : OCD Explanation : Support for Neurotransmitters Pigott et al (1992)

Answer 89

STRENGTH Antidepressant drugs that increase serotonin activity have been seen to reduce OCD symptoms - this suggests that serotonin may be involved in OCD

Question 90

A03 : OCD Explanation : Alternative explanations

Answer 90

WEAKNESS As not one gene has been identified it is clear that the environment may play a part. The two process model is a credible alternative, behaviourist explanations for OCD, e.g. a link between dirt and anxiety persists because compulsions such as hand-washing reduce the anxiety.

Question 91

A03 : OCD Explanation : Existence of environmental risk factors

Answer 91

WEAKNESS Genetic variation affects vulnerability to OCD, but there are environmental risk factors that can trigger it Cromer et al. (2007) found that over half of OCD patients in their sample had a traumatic event in their past This means that genetic vulnerability is only a partial explanation for OCD The diathesis stress model may be a better explanation (A genetic vulnerability (diathesis) but it has to be triggered by an environmental factor (stressor)).

Question 92

A03 : OCD Explanation : Tourette's Syndrome and other disorders

Answer 92

WEAKNESS Genes may merely predispose individuals towards obsessive-type behaviour. Pauls and Leckman (1986) argued that OCD is one expression of the same gene that also determines Tourette’s syndrome. Rasmussen (1992) OCD symptoms are also present in autism and anorexia nervosa, and two out of every three OCD patients also experience at least one episode of depression. There is, therefore no one gene directly and exclusively responsible for OCD.

Question 93

A03 : OCD Explanation : No unique neural system

Answer 93

WEAKNESS Many people who experience OCD also experience depression Depression likely involves disruption to the action of serotonin Therefore, serotonin may not be relevant to OCD symptoms, as it could just be disrupted due to the depression they are experiencing and NOT the OCD

Question 94

OCD Treatment : Drug therapy

Answer 94

The most commonly used biological therapy for anxiety disorders is drug therapy. This therapy assumes that there is a chemical imbalance in the brain This can be corrected by drugs, which either increase or decrease the levels of neurotransmitters in the brain. Is better combined with any other treatment The drugs reduce anxiety and get rid of depression, allow the person to live a normal life (while on drugs). As they suppress the symptoms, the drugs give them the motivation to go and seek help to change the obsessions (thoughts) and the Compulsions (behaviour) Otherwise they will have to remain on drugs for the rest of their lives.

Question 95

OCD Treatment : SSRIs

Answer 95

Drugs to increase serotonin are used with mental disorders. Antidepressants are used to reduce the anxiety associated with OCD Low levels of serotonin are involved in the worry circuit, so increasing levels can normalise this and so aid anxiety levels. SSRIs are the preferred drug (brand names Prozac, Zoloft) they increase the levels of the neurotransmitter serotonin which regulates mood and anxiety. As a result, more serotonin is available in the synapse for longer, so the activity is prolonged and this helps the neurons to communicate. (Diagram shows serotonin is released into the synapse from one nerve. It targets receptor cells on the receiving neuron at receptor sites and afterwards is reabsorbed by the initial neuron sending the message. In order to increase levels of serotonin at the synapse, and increase stimulation to the receiving neuron, this re-absorption is inhibited).

Question 96

OCD Treatment : Tricyclics

Answer 96

The antidepressant Tricyclics clomipramine (anafranil) is primarily used in the treatment of OCD not depression. Tricyclics block the mechanism that re-absorbs both serotonin and noradrenaline, prolonging their activity. Tricyclics have the advantage of targeting more than one neurotransmitter, HOWEVER they have greater side effects.

Question 97

OCD Treatment : Benzodiazepines

Answer 97

Benzodiazepines (BZ e.g. Valium) are commonly used to reduce anxiety. BZs slow down the activity of the Central nervous system by enhancing the activity of the neurotransmitter GABA (a neurotransmitter that has a calming influence on the brain). This is the neurotransmitter that has a general quieting effect on many of the neurons in the brain BZs bind to the GABA receptors on the post synaptic neuron, allowing the chloride ions to flow

Question 98

OCD Treatment : Other drugs

Answer 98

Research has shown that D-Cycloserine has an effect on reducing anxiety thus may be an effective treatment for OCD, particularly when used in conjunction with psychotherapy. D-Cycloserine is an antibiotic used in the treatment of tuberculosis. It also appears to enhance the transmission of GABA and thus reduce anxiety.

Question 99

A03 : OCD Treatment : Effectiveness

Answer 99

STRENGTH Soomro (2008) reviewed 17 studies of the use of SSRIs with OCD patients and found them to be more effective than placebos in reducing symptoms of OCD for up to 3 months after treatment - only short term. However most studies are only three to four months long, therefore little long-term data actually exists.

Question 100

A03 : OCD Treatment : Drug Therapies are preferred to other methods.

Answer 100

STRENGTH Drug therapy generally requires less time and effort than therapies such as CBT. Therefore it is quick, people only have to take a pill, rather than sit through 20 1 hour sessions with,a therapist. It is relatively cheap and requires less monitoring. Some benefits may derive from simply talking to the doctor during consultations (Dodo bird effect again)

Question 101

A03 : OCD Treatment : Side Effects

Answer 101

WEAKNESS SSRI side effect are nausea, headaches, insomnia BZ side effects include increased aggressiveness, long term impairments of memory and possible addiction. Side effects may amount to costs that more than outweigh benefits and thus stop a patient taking the drug.

Question 102

A03 : OCD Treatment : Not a lasting cure

Answer 102

WEAKNESS Koran (2007) suggested that, although drug therapy may be more commonly used, psychotherapy such as CBT should be tried first. Drug therapy must be efficient in the short term but it does not provide a lasting cure. A lot of patients relapse within a few weeks if medication is stopped (Maina, 2001)

Question 103

Define GABA & noradrenaline

Answer 103

GABA - A neurotransmitter that regulates excitement in the nervous system, thus acting as a natural form of anxiety reducer. Noradrenaline - A neurotransmitter found mainly in areas of the brain that are involved in governing the automatic nervous system activity, e.g. blood pressure and heart rate.