Psychological Problems

Question 1

What are the incidence rates 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 have the incidences 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

What are the theories as to why mental health incidence have increased over time?

Answer 3

Increased challenges of modern living

Lessening of social stigma

Increased recognition of the nature of mental health problems

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 individual effects?

Answer 5

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

Question 6

What are the individual effects of mental health problems?

Answer 6

Damage to relationships

Difficulties coping with day-to-day life

Negative impact on physical well-being

Question 7

What are social effects?

Answer 7

The way that mental health problems affect others in society.

Question 8

What are the social effects of mental illness?

Answer 8

Need for more social care

Increased crime rates

Implications for the economy

Question 9

What is clinical depression?

Answer 9

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

Question 10

How are sadness and depression different?

Answer 10

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 11

What is unipolar depression?

Answer 11

One emotional state (depression).

Question 12

What is bipolar depression?

Answer 12

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

Question 13

What is the ICD?

Answer 13

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 14

What is necessary for a diagnosis of depression?

Answer 14

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 15

What are the key symptoms of depression?

Answer 15

1. Low mood: Depressed mood most of the day and nearly every day.
2. Loss of interest and pleasure: Diminished interest or pleasure in most activities most of the day.
3. Reduced energy levels: This has a knock-on effect on work, education and social life.

Question 16

What are the other symptoms of depression?

Answer 16

4. Changes in sleep patterns: Reduced sleep (insomnia), early waking, or more need for sleep (hypersomnia).
5. Changes in appetite levels: This may increase or decrease, leading to weight gain or loss.
6. 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 17

What are neurotransmitters?

Answer 17

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 18

What is serotonin?

Answer 18

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.

Question 19

What are the effects of serotonin?

Answer 19

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 20

What are the reasons from low serotonin levels?

Answer 20

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 21

What are the evaluation points for the biological explanation of depression?

Answer 21

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

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

One weakness is that depression may not be solely caused by abnormal levels of neurotransmitters.
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 22

What is faulty thinking?

Answer 22

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 23

What are negative schemas?

Answer 23

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 24

What are attributions?

Answer 24

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.

Question 25

What is learned helplessness?

Answer 25

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 26

What are the evaluation points for cognitive explanations of depression?

Answer 26

One strength is that there is research support for learned helplessness.
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.

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

One weakness is that negative beliefs may simply be realistic rather than depressing.
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 27

What is selective serotonin reuptake inhibitor?

Answer 27

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 28

What is the presynaptic neuron?

Answer 28

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.

Question 29

What is the synaptic cleft?

Answer 29

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

Question 30

How does selective serotonin reuptake inhibitors work?

Answer 30

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 31

What are the evaluation points of antidepressants?

Answer 31

One weakness is that SSRIs have serious side effects.
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.

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

A weakness of antidepressant medication is that it is regarded as a reductionist explanation.
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 32

How does CBT affect the cognitive side of depression?

Answer 32

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 33

How does CBT affect the behaviour side of depression?

Answer 33

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 34

How do therapists deal with irrational thoughts?

Answer 34

‘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.

Question 35

How do clients deal with irrational thoughts?

Answer 35

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 36

What are the evaluation points of CBT?

Answer 36

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

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

A strength of CBT is that it is holistic.
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 37

What is are the statistics of patients getting better with depression?

Answer 37

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 38

What was the aim of Wiles study?

Answer 38

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.

Question 39

What was the method of Wiles study?

Answer 39

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.

Question 40

What were the results of Wiles study?

Answer 40

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.

Question 41

What was the conclusion of Wiles study?

Answer 41

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

Question 42

What are the evaluation points of Wiles study?

Answer 42

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

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

One strength of the study is that it is focused on developing a useful therapy.
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 43

What is addiction?

Answer 43

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 44

What is dependence versus addiction?

Answer 44

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 45

What is substance misuse versus abuse?

Answer 45

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 46

How is addiction diagnosed?

Answer 46

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 47

What are the clinical characteristics of addiction?

Answer 47

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 48

How do hereditary factors affect addiction?

Answer 48

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.

Question 49

What is genetic vulnerability in addiction?

Answer 49

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 50

What was the aim of Kaij’s study?

Answer 50

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.

Question 51

What was the method of Kaij’s study?

Answer 51

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).

Question 52

What was the results of Kaij’s study?

Answer 52

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.

Question 53

What was the conclusion of Kaij’s study?

Answer 53

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 54

What are the evaluation points of Kaij’s study?

Answer 54

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

One strength is that the results have been supported by later research.
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.).

One weakness with biological explanations of addiction is that they may be misleading.
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 55

What is peer influence?

Answer 55

‘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 56

What is the social learning theory?

Answer 56

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 57

What are social norms?

Answer 57

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 58

What is the social identity theory?

Answer 58

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.

Question 59

How to peers contribute to addiction?

Answer 59

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 60

What are the evaluation points for the psychological explanation of addiction?

Answer 60

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

One weakness is that peers may not be doing any influencing.
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.

One strength of the peer influence explanation is its real-world application.
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 61

What is aversion therapy?

Answer 61

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

Question 62

How is alcoholism treated?

Answer 62

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 63

How is addiction to gambling treated?

Answer 63

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.

Question 64

How is addiction to smoking treated?

Answer 64

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

Question 65

What are the evaluation points for aversion therapy?

Answer 65

Addicts may abandon the therapy as it uses stimuli that are unpleasant.
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.

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

One strength is that aversion therapy can be combined with CBT in a holistic way.
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 66

What are 12-step recovery programs?

Answer 66

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 67

What are the features of self-management?

Answer 67

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 68

What are the evaluation points of self-management?

Answer 68

One weakness is the lack of research showing effectiveness.
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.

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

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