Psychological Problems

Question 1

What is the (approximate) incidence of mental health problems?

Answer 1

MIND – Incidence rates per 100 people:

Anxiety: 4.7

Depression: 2.6

Eating disorders: 1.6

1 in 2 people will experience mental health problems

Question 2

How has incidence of mental health problems changed over time?

Answer 2

In 2007 24% of adults were accessing treatment.
Rising to 37% in 2014.
It’s estimated that by 2030 two million more adults will have mental health problems than in 2013.
More women are treated than men and the gap is widening.

Question 3

How has the increased challenges of modern living affected mental health?

Answer 3

Those in lower income households are more likely to have mental health problems (e.g. 27% of men) compared to higher income households (e.g. 15% of men).

Greater social isolation due to city living increases loneliness and is linked to increased depression.

Question 4

What are the cultural variations in beliefs about mental health problems?

Answer 4

In Western society hearing voices is a symptom of mental health problems such as schizophrenia, but it is a positive experience in India and Africa.

Some syndromes are culture-bound, occurring only in certain cultures, e.g. eating disorders were relatively rare for many years outside the Western world

Question 5

What are the characteristics of mental health?

Answer 5

Like with physical illnesses doctors look for signs and symptoms of mental health illnesses and diagnose accordingly

But the signs and symptoms relating to mental illness are subjective, e.g. behaviours like difficulty sleeping and problems socialising are hard to measure.

Question 6

Has there been an increased recognition of the nature of mental health problems?

Answer 6

Signs and symptoms are focused on illness instead of health.

Instead Jahoda suggested we look for signs of mental health.

She listed six characteristics, e.g. accurate perception of reality and autonomy (independence)

Question 7

Has there been a lessening of social stigma surrounding mental health?

Answer 7

Labelling a person as ‘mentally ill’ or a ‘schizophrenic’ develops expectations about their behaviour. These act as a stigma and can be harmful.

The preferred term is mental health, which has less stigma and is focused on health.

Question 8

What does ‘individual effects of mental illness’ refer to?

Answer 8

The way that mental health problems affect the person experiencing them.

Question 9

How can mental illness affect relationships?

Answer 9

Mental health problems:

Affect the ability to talk to others, which affects relationships because communication is important.

Are isolating as people avoid being with others as they feel bad about themselves and fear judgement.

Question 10

How can mental illness cause difficulties coping with day-to-day life

Answer 10

Mental health problems are linked to difficulties with getting dressed, socialising, cleaning the house, etc.

This could cause a patient little distress but it may be distressing to others.

Question 11

How can mental illness have a negative impact on physical well-being?

Answer 11

If you are anxious or stressed the body produces cortisol.

This prevents the immune system functioning properly, so physical illness is more likely.

Question 12

What does ‘social effects of mental illness’ refer to?

Answer 12

The way that mental health problems affect others in society.

Question 13

How does mental illness impact on social care?

Answer 13

Taxes are used to fund social care, offering people who are in need the basic necessities, i.e. food, warmth, human company.

Social care includes helping people to learn how to care for themselves and teaches new social and work skills.
We should all feel more personally responsible.

Question 14

How is mental illness linked with crime rates?

Answer 14

There is an increased risk of violence in people with mental health problems (up to four times greater).
However this may be explained by co-occurring problems, e.g. substance abuse.
It was found that only 1 in 20 crimes of violence were linked to mental health problems.

Question 15

How does mental illness affect the economy?

Answer 15

The McCrone report estimates that mental health care costs £22 billion a year.
Cheaper drug treatments should be researched more.
Increase in dementia is also an issue.

Question 16

What is Clinical depression and how does it differ from sadness?

Answer 16

Clinical depression is the name for depression as a medical condition.

Sadness is a ‘normal’ emotion where you can still function.

Depression involves an enduring and all-encompassing sadness that stops the ability to function.

Question 17

What is the difference between unipolar and bipolar depression?

Answer 17

Unipolar depression - One emotional state (depression).

Bipolar depression - Depression alternates with mania, and also periods of normal mood.
Mania is an exaggerated state of intense well-being.

Question 18

What is the ICD?

Answer 18

Mental health problems are diagnosed in the same way as physical illnesses. Symptoms are agreed by professionals.

The International Classification of Diseases (ICD-10) lists symptoms of different disorders and a person is diagnosed with any one disorder if they display the symptoms

Question 19

What is the number and severity of symptoms for depression?

Answer 19

A diagnosis of mild unipolar depression requires two of the three key symptoms plus two others.

Moderate requires five or six symptoms and severe requires seven or more.

Symptoms should be present all or most of the time, and for longer than two weeks.

Question 20

What are the key symptoms of depression?

Answer 20

Low mood: Depressed mood most of the day and nearly every day.

Loss of interest and pleasure: Diminished interest or pleasure in most activities most of the day.

Reduced energy levels: This has a knock-on effect on work, education and social life.

Question 21

What are the other symptoms of depression (apart from the key symptoms)?

Answer 21

Changes in sleep patterns: Reduced sleep (insomnia), early waking, or more need for sleep (hypersomnia).

Changes in appetite levels: This may increase or decrease, leading to weight gain or loss.

Decrease in self-confidence: May have a sense of self-loathing (hating themselves).

Four further symptoms: such as guilt, pessimism, ideas of self-harm or suicide, reduced concentration.

Question 22

What is the difference between biological and psychological explanations of depression?

Answer 22

Biological explanations focus on physical influences (nature).
Psychological explanations focus on other factors, like the influence of others or our thinking (nurture).

Question 23

According to the biological approach, how do neurotransmitters cause depressive symptoms?

Answer 23

Messages travel along a neuron electrically but the message is transmitted chemically across the synapse by neurotransmitters.
Serotonin is a neurotransmitter which has been linked to several behaviours including depression.

Question 24

What role does Serotonin play in depression?

Answer 24

High levels of serotonin in the synaptic cleft means the postsynaptic neuron is stimulated, improving mood.
Low levels at the synapse means less stimulation of the postsynaptic neuron, resulting in a low mood.
Serotonin also affects memory, sleep and appetite.
These are linked to the characteristics of depression, e.g. lack of concentration, disturbed sleep and reduced appetite.

Question 25

According to the biological approach, what causes low serotonin levels?

Answer 25

Genes may cause low serotonin levels where someone inherits a poor ability to produce serotonin.
Diet (an environmental influence) may cause low levels of tryptophan, a key ingredient of serotonin. High-protein foods and carbohydrates contain tryptophan.

Question 26

According to the cognitive approach, how does faulty thinking lead to depression?

Answer 26

The cognitive approach sees depression as caused by faulty or irrational thinking.
When a person is depressed they focus on the negative and ignore positives and think in black-and-white terms.
This creates feelings of hopelessness and depression.

Question 27

According to the cognitive approach, how does negative schemas lead to depression?

Answer 27

Schemas are mental frameworks containing ideas and information developed through experience.
Having a negative self-schema means you are likely to interpret all information about yourself in a negative way.

Question 28

According to Seligman (psychological approach), how does a negative attributional approach lead to depression?

Answer 28

Attribution is the process of explaining causes of behaviour.
Seligman proposed that some people have a negative attributional style.
There are internal, stable and global attributions which result in depression.

Seligman suggested that a negative attributional style is learned.
An unpleasant experience makes you try to escape but if you can’t escape, you learn to give up trying. This is called ‘learned helplessness’.

Question 29

One strength of the biological explanation of depression is that there is supporting research evidence . . .

Answer 29

McNeal and Cimbolic found lower levels of serotonin in the brains of people with depression.
This suggests that there is a link between low levels of serotonin and depression.

Question 30

One weakness of neurotransmitter explanations is low levels of serotonin could be an effect of being depressed . . .

Answer 30

Thinking sad thoughts and having difficult experiences could cause low serotonin levels.
This means low levels of serotonin may be an effect of psychological experiences rather than the cause of them.

Question 31

One weakness of the biological approach is that depression may not be solely caused by abnormal levels of neurotransmitters . . .

Answer 31

Some people with low levels of serotonin don’t have depression and some people with depression don’t have low levels of serotonin.
This means that the neurotransmitter explanation isn’t enough on its own.

Question 32

One strength of the cognitive explanation of depression is that there is research support for learned helplessness . . .

Answer 32

Seligman has demonstrated the process of learned helplessness. Dogs learned to react to challenge by ‘giving up’.
Therefore, this research supports his explanation of depression due to negative attributions.

Question 33

One strength is that the cognitive explanation leads to ways of treating depression . . .

Answer 33

Cognitive behaviour therapy teaches people to think differently replacing faulty, irrational thinking with rational thinking to help relieve depression.
Therefore, the explanation leads to successful ways to help people with depression.

Question 34

One weakness of the cognitive explanation of depression is that negative beliefs may simply be realistic rather than depressing . . .

Answer 34

Alloy and Abramson found that depressed people gave more accurate estimates of the likelihood of a disaster than ‘normal’ people (‘sadder but wiser’).
Therefore, a negative attributional style may not be all bad.

Question 35

Briefly describe how Selective serotonin reuptake inhibitor (SSRI) is used as a treatment for depression

Answer 35

Low levels of serotonin may cause depression, therefore increasing serotonin levels may treat depression.

SSRIs selectively target serotonin at the synapse.

SSRIs inhibit the reuptake of the serotonin molecules.

Question 36

Describe in detail how SSRIs treat depression

Answer 36

Serotonin is stored at the end of a transmitting (presynaptic) neuron in sacs called vesicles.
The electrical signal travelling through the neuron causes the vesicles to release serotonin into the synaptic cleft.

Serotonin locks into the postsynaptic receptors, chemically transmitting the signal from the presynaptic neuron.

Normally serotonin is taken back into the presynaptic neuron, broken down and reused.
SSRIs block this reuptake so when new serotonin is released it adds to the amount held in the synaptic cleft.

Question 37

One weakness of using SSRIs to treat depression is that they have serious side effects . . .

Answer 37

The side effects include nausea, insomnia, dizziness, weight loss or gain, anxiety and, most seriously, suicidal thoughts.
Side effects mean that people stop taking the drugs, affecting the effectiveness of drug therapies.

Question 38

A weakness of antidepressant medication is that the evidence for the effectiveness of them is questionable . . .

Answer 38

Research by Asbert shows that the serotonin levels of depressed people may not actually be that different from the normal population.
This suggests that the effectiveness of the drug may not be related to serotonin. It may be a placebo effect.

Question 39

A weakness of antidepressant medication is that it is regarded as a reductionist (reduces the explanation down to a simple explanation when it could be more complex) explanation . . .

Answer 39

Antidepressant medication targets serotonin (and sometimes noradrenaline) so focuses on only one kind of factor.
This suggests that other treatments are not necessary but a more successful treatment might include both biological and psychological approaches (a holistic approach).

Question 40

How does Cognitive Behavioural Therapy deal with the ‘Cognitive’ side of depression?

Answer 40

CBT focuses on what a client thinks.
Negative, irrational or faulty thinking causes depression because people tend to catastrophise and think in all-or-nothing terms.
Aim of therapist is to change this to rational thinking to reduce depression.

Question 41

How does Cognitive Behavioural Therapy deal with the ‘Behavioural’ side of depression?

Answer 41

CBT also aims to change behaviour indirectly through changing thinking.
Direct change to behaviour, e.g. behavioural activation where a pleasant activity is planned each day, creates more positive emotions and mood.

Question 42

What are the Therapist’s and Client’s roles in CBT?

Answer 42

Therapist: ‘Disputing’ is used to deal with the negative and irrational thoughts. The client’s irrational thoughts are challenged.
More rational thinking leads to greater self-belief and self-liking.

Client: Any negative emotions experienced are recorded in a ‘thought diary’, where the client also records the ‘automatic’ thoughts created by these emotions. The client rates how much they believe in these thoughts.
A rational response to the automatic thoughts is then recorded and rated.

Question 43

One strength of using CBT to treat depression is that it has lasting effectiveness. . .

Answer 43

The ‘tools’ learned in CBT to help challenge irrational thoughts can help the client deal with future episodes of depression.
Therefore this therapy offers a long-term solution where they can draw on the skills they learned in the future.

Question 44

One weakness of CBT is that it takes a long time and thought for CBT to be successful . . .

Answer 44

Therapy takes months, homework is expected so a lot of effort is needed in comparison to just taking a pill.
This means that many people drop out or fail to engage enough for it to work.

Question 45

A strength of CBT is that it is holistic . . .

Answer 45

CBT focuses on treating the whole person and what they think/feel.
This may be preferable because it deals with the core symptoms of depression (e.g. feeling sad).

Question 46

Why did Wiles carry out a study into therapies for depression?

Answer 46

Only 30% of patients with depression respond fully to antidepressants. The remaining 70% are ‘treatment resistant’ and need an alternative therapy.
There is evidence that treatment-resistant patients do improve when receiving a combination of antidepressant medication plus cognitive behaviour therapy (CBT).

Question 47

Outline Wiles’ study into therapies for depression?

Answer 47

Aim: Wiles et al. set up the CoBalT trial to test the benefit of a holistic approach (CBT plus antidepressants) for treating people with treatment-resistant depression, compared to antidepressants alone.

Method: 469 patients with treatment-resistant depression were randomly assigned to one of two groups:

Usual care (just antidepressants).

Usual care and CBT.

Improvement was assessed using the Beck Depression Inventory (BDI) before and after.

Results: After six months 21.6% of usual care group and 46.1% of usual care + CBT had more than a 50% reduction in symptoms.
After 12 months those having usual care + CBT continued to show greater levels of recovery.

Conclusion: CBT plus antidepressant medication is more effective in reducing depressive symptoms than antidepressant medication alone.

Question 48

One strength of Wiles’ study is that extraneous variables were carefully controlled . . .

Answer 48

The two groups had the same average depression score at the start and participants were randomly assigned to groups.

This means that we can conclude that changes in the dependent variable (reduction in symptoms) were not affected by extraneous variables.

Question 49

One weakness of Wiles’ study is the use of self-report methods to determine levels of depression . . .

Answer 49

This means that participants have to make subjective judgements about how they felt.

Some people might have underestimated how sad they feel and others might have overestimated.
This questions the validity of the information collected about depression.

Question 50

One strength of Wiles’ study is that it is focused on developing a useful therapy . . .

Answer 50

The study shows that a more holistic approach to treating depression is more successful than antidepressant medication alone and was relatively cheap.

Such real-world usefulness is one of the main reasons for conducting research.

Question 51

What is addiction?

Answer 51

Griffiths suggests that salience, dependence and substance abuse are key characteristics.
Salience means the substance/activity becomes the most important thing in a person’s life.

Question 52

What is the difference between dependence and addiction?

Answer 52

Dependence is a characteristic of addiction but is not the same as addiction.
Dependence is doing something (e.g. drug taking) because of psychological reliance and to prevent withdrawal symptoms.
Addiction is where a person is dependent on the substance/activity but also does it because of the buzz or sense of escape.

Question 53

What is the difference between substance misuse and abuse?

Answer 53

The difference between substance misuse and abuse lies in the person’s intentions.
Misuse is not following the ‘rules’ for usage like taking a substance more often than recommended or using it for something else.
Abuse is using the substance to ‘get high’ or to escape because a person’s intentions are about the outcome of taking the drug.

Question 54

How is addiction diagnosed?

Answer 54

International Classification of Diseases (ICD-10) has a category called ‘Mental and behavioural disorders due to psychoactive substance abuse disorders’.
A diagnosis of addiction should usually be made only if three or more characteristics have been present together at some time during the previous year.

Question 55

What are the ICD-10 clinical characteristics of addiction?

Answer 55

A strong desire to use the substance.

Persisting despite known harm.

Difficulty in controlling use.

A higher priority given to the substance.

Withdrawal symptoms if substance/activity is stopped.

Evidence of tolerance, i.e. needing more to achieve the same effect.

Question 56

According to the Biological Approach, how do hereditary factors and genetic vulnerability lead to addiction?

Answer 56

Research suggests that addictions are moderately to highly inherited. Genetic information passed down from parents may determine whether a person is likely to become addicted or not.

Multiple genes – not one single gene – are involved which create a vulnerability.
Diathesis-stress explanation proposes a genetic vulnerability (nature) is only expressed if a person’s life stresses and experiences (nurture) act as a trigger.

Question 57

Outline Kaij’s twin study of alcohol abuse

Answer 57

Aim: To see whether alcoholism could be explained in terms of heredity, using twin studies.
Twin studies can assess the contributions of nature and nurture to behaviour: genes and environment.

Method: Male twins from Sweden were identified, where at least one twin was registered with the temperance board as having alcohol abuse problems.
They were interviewed and close relatives were interviewed, to collect information about drinking habits.
48 were identified as identical (MZ) and 126 as non-identical (DZ).

Results: 61% of the MZ twins were both alcoholic whereas only 39% of the DZ twins were.
Twins with social problems were overrepresented among temperance board registrants.

Conclusions: Alcohol abuse is related to genetic vulnerability:

If it was entirely genetic we would expect all MZ twins to be the same.

If it was entirely due to environment we would expect no difference between MZ and DZ twins.

Question 58

One weakness of Kaij’s twin study is that there were flaws in the design of the study. . .

Answer 58

Temperance board data only includes drinkers who made a public display of their alcohol abuse, e.g. committing an alcohol-related crime or drink driving.
This means that the results lack validity.

Question 59

One strength of Kaji’s twin study is that the results have been supported by later research . . .

Answer 59

Kendler et al. conducted a well-controlled study using a similar but larger sample and found that MZ twins are more likely to both be alcoholics than DZ twins.
Research generally supports the view that hereditary factors have a major influence on alcoholism in both males and females (Prescott et al.).

Question 60

One weakness of biological explanations of addiction is that they may be misleading . . .

Answer 60

People assume that, if you inherit certain genes, then addiction is inevitable. But both nature and nurture are important.

It is very important to fully understand the implications of genetic research.

Question 61

What does ‘Peer Influence’ mean?

Answer 61

‘Nurture’ refers to the influence of experience from the physical and/or social environment.
Peers are people who are equal in terms of, for example, age or education.

Question 62

What is the Social Learning Theory?

Answer 62

Bandura states we learn how to behave and think by observing what others do.
We imitate them especially if they are seen to be rewarded.
We especially imitate those we identify with, e.g. peers.

Question 63

What are Social Norms?

Answer 63

We don’t always know what behaviour is ‘right’.
We look to the behaviour of others to know what is ‘normal’ or acceptable (social norms).
Social norms may be over-estimated.

Question 64

How does the Social Identity Theory explain addiction?

Answer 64

You identify with your social groups (e.g. supporters of a football team, a group of students in your class).
You want to be accepted by them, therefore you behave and think like them.
Adolescents in particular may feel ‘pressure’ to conform to the social norms of their peer group.

Peers also influence addictive behaviour because they provide opportunities for an individual to smoke or use alcohol.
Peers may provide direct instruction about what to do.

Question 65

One strength of peer influence as an explanation of addiction is that there is research support. . .

Answer 65

Simons-Morton and Farhat reviewed 40 studies into the relationship between peers and smoking and found that all but one showed a positive correlation between the two factors.
This shows a strong relationship between peers and addiction.

Question 66

One weakness of the influence of peers as an explanation of addiction is that peers may not be doing any influencing . . .

Answer 66

Individuals may just be actively selecting others who are like them rather than conforming to the social norm of the group.
This means addictive behaviour is a consequence of addiction rather than the group causing the addiction.

Question 67

One strength of the peer influence explanation is its real-world application . . .

Answer 67

Programmes using normative education have had more success than just resistance skills (Hansen and Graham).
This shows the positive value in peer influence explanations.

Question 68

What is the aversion therapy for addiction?

Answer 68

Based on classical conditioning.

Addict learns to associate their addiction with something unpleasant, and therefore avoids the addictive substance.

Question 69

How can aversion therapy be used to treat alcoholism?

Answer 69

A drug like Antabuse is taken which causes nausea.
Just before vomiting, the addict has an alcoholic drink several times.

Antabuse (UCS) leads to vomiting (UCR)

Alcohol (NS) is associated with Antabuse (UCS).

Alcohol becomes a learned/conditioned stimulus (CS) producing nausea (CR).
Alcohol is no longer associated with pleasure but vomiting.

Question 70

How can aversion therapy be used to treat gambling and smoking?

Answer 70

Gambling: An addicted gambler writes phrases related or unrelated to gambling on cards.
The gambler reads out each card and gets an electric shock for gambling-related phrases.

Electric shock (UCS) leads to pain (UCR)

Gambling-related phrase (NS) is associated with electric shock (UCS).

Gambling-related phrase becomes a learned/conditioned stimulus (CS) associated with pain (CR).
Gambling-related behaviours now associated with pain.

Smoking: Addicted smoker rapidly smokes in closed room.
Disgust/nausea from smoking is associated with smoking.

Question 71

One problem with using aversion therapy to treat addiction is that addicts may abandon the therapy as it uses stimuli that are unpleasant . . .

Answer 71

Many addicts drop out before the treatment is completed. It wouldn’t work unless the aversive stimulus was negative.
This means it is difficult to assess the effectiveness of the treatment.

Question 72

A weakness is that benefits of aversion therapy seem to be short-term rather than long-term . . .

Answer 72

In a long-term follow-up of up to nine years McConaghy et al. found that aversion therapy was no more effective than a placebo, and covert sensitisation was more effective.
This suggests that aversion therapy lacks overall effectiveness.

Question 73

One strength is that aversion therapy can be combined with CBT in a holistic way . . .

Answer 73

Aversion therapy gets rid of the immediate urge to use the addictive substance and CBT provides longer lasting support where a person’s thoughts and feelings are worked on.
This provides a longer-term solution to the addiction.

Question 74

What are the 12 step recovery programmes (self management programmes used to treat addition)?

Answer 74

Self-management programmes require individuals to organise their treatment with no professional therapist guiding them.

The 12-step recovery programme was developed over 65 years ago by a group of alcoholics.

Alcoholics Anonymous (AA) continues today to offer a programme based on the same spiritual principles.

Question 75

What are the key elements of the 12 step recovery programme to treat addiction?

Answer 75

The higher power - One key element to the 12-step recovery programme is giving control to a higher power and letting go of your own will.

Admitting and sharing guilt - Person comes to terms with the things they have done.
Members of the group and the higher power listen to the confession to accept the ‘sinner’.

Lifelong process - Recovery is a lifelong process where the group supports each other.
They can call other members if they need help in the case of relapse.

Self-help groups - A peer-sharing model to support each other.
Some avoid the religious element of surrendering to a high power. Some involve local traditions.

Question 76

One weakness of the 12 step programme to treat addition is the lack of research showing effectiveness . . .

Answer 76

The AA reported in 2007 that 33% of its 8000 North American members have remained sober for ten years or more but this doesn’t include how many left without success.
This suggests that it is difficult to get clear evidence on effectiveness.

Question 77

A weakness is that the 12-step programme may only be effective for certain types of people . . .

Answer 77

The dropout rates are high which suggests that the self-help approach is demanding and requires high levels of motivation.

This means that the treatment is a limited approach.

Question 78

One strength is that the 12-step recovery programme focuses on the whole person . . .

Answer 78

Many steps are concerned with emotions, particularly guilt, together with providing social support to help a person cope with their emotions.
This can be contrasted with more reductionist programmes, such as aversion therapy which targets just stimulus-response links.