Psychology-Psychopathology Flashcards
What is psychopathology?
The scientific study of psychological disorders
What are the definitions of abnormality?
Statistical infrequency, deviation from social norms, failure to function adequately and deviation from ideal mental health
What is statistical infrequency?
Mean, median and mode are descriptive statistics that are used as a way to represent the typical value for any set of data, and many aspects of what is normal is defined by referring to typical values. Abnormality therefore is defined as those behaviours that are extremely rare
What is an example of statistical infrequency?
A frequency distribution graph will show what is normal, and usually either ends of it will be what is abnormal. For example a graph of intelligence in the population would be a bell shaped curve, either ends of it (genius or low intelligence) would class as abnormal
What are the evaluation points for statistical infrequency?
Some abnormal behaviour is desirable, the cut off point is subjectively determined and statistical infrequency is sometimes appropriate
Explain ‘some abnormal behaviour is desirable’ as an evaluation point
Many abnormal behaviours are actually desirable eg very few people have an IQ over 150, so it is abnormal however it would not be undesirable. Also some normal behaviours are undesirable such as depression. Therefore this definition cannot distinguish between desirable and undesirable behaviours
Explain ‘the cut off point is subjectively determined’ as an evaluation point
It has to be decided at what point does normal become abnormal. This is subjective as many people will have different opinions. Although either ends of the scale are easy to distinguish between really abnormal and really normal, but at point where the two meet there will be many slightly different opinions, leading someone to possibly be labelled as abnormal when in fact some people would still class it as normal
Explain ‘statistical infrequency is sometimes appropriate’ as an evaluation point
In some situations it is appropriate to use a statistical criterion to define abnormality eg intellectual disability is defined in terms of the normal distribution using the concept of standard deviation to establish a cut off point for abnormality. Anyone with an IQ more than two standard deviations below the mean is judged as having a mental disorder-however this diagnosis would only be made in conjunction with failure to function adequately
What is deviation from social norms?
Social norms are created by a group of people (Social_. In any society there are standards of acceptable behaviour that are set by the social group and adhered to by those socialised into that group. Anyone that deviates from these would be considered abnormal. The standards are often there for good reasons eg politeness, to help people know how to behave, to stop unacceptable behaviour etc
What is an example of deviation from social norms?
In the past, homosexuality was classified as abnormal and regarded as a mental disorder. It was also against the law in the UK. This judgement was based on social deviation-a judgement made by society at that time
What are the evaluation points for deviation from social norms?
Susceptible to abuse, deviance is related to context and degree, there are some strengths, and cultural relativism
Explain ‘susceptible to abuse’ as an evaluation point?
Social norms vary as times change so what is socially acceptable now, may not have been 50 years ago eg homosexuality. If abnormality is defined in terms of deviation from social norms, it opens the door to definitions based on prevailing social morals and attitudes. Szasz claimed that the concept of mental illness was simply a way to exclude nonconformists from society
Explain ‘deviance is related to context and degree’ as an evaluation point
For example, at a beach it is acceptable to wear swimming clothes (next to nothing) but the same outfit in a classroom or formal gathering would be abnormal, and a possible indication of a mental disorder. In many cases there is not a clear line between what is an abnormal deviation and what is simply more harmless eccentricity. Also somethings may be normal but abnormal if they are excessive and so cannot be determined in one moment
Explain ‘there are some strengths’ as an evaluation point
The definition distinguishes between desirable and undesirable behaviour (unlike with statistical infrequency). The social deviancy model also takes into account the effect that behaviours has on others. Deviance is defined in terms of transgression of social rules and social rules are established in order to help people live together
Explain ‘cultural relativism’ as an evaluation point
Cultural relativism is the view that behaviour cannot be judged properly unless it is viewed in the context of the culture in which it originates. What is abnormal in one culture may be normal in another, and what is normal somewhere may be abnormal elsewhere. This evaluation point works for both statistical infrequency and deviation from social norms
What is failure to function adequately?
People are judged on their ability to go about daily life, eg eating regularly, washing clothes, communicating etc. If they can’t do this and are also experiencing distress (or others are distressed by their behaviour eg with schizophrenia where the person may not know or be distressed) then it is considered a sign of abnormality. It can also be abnormality is someone is not coping with life in a normal day eg they may be content living in unwashed clothes without a regular job (but only abnormality if it causes distress to others or self)
What is an example of failure to function adequately?
The DSM includes an assessment of ability to function called WHODAS (World health organisation disability assessment) which considers six areas (understanding and communicating, getting around, self-care, getting along with people, life activities and participation in society. Each item has a scale of 1-5 and are given an overall score out of 180. An assessment of abnormality using the DSM would include a quantitative measure of functioning
What are evaluation points for failure to function adequately?
Who judges, the behaviour may be quite functional and strengths of the definition
Explain ‘who judges’ as an evaluation point
The patient them self may recognise that they are not coping and may feel distressed, but also an individual may be content and/or unaware they aren’t coping, and so others judge the behaviour as abnormal eg with schizophrenia. This is a weakness of this definition as it depends on who is making the judgement
Explain ‘the behaviour may be quite functional’ as an evaluation point
Some dysfunctional behaviours can be adaptive and functional for the individual eg some mental disorders such as eating disorders or depression, may lead to extra attention for the individual. This is rewarding and functional for the individual as it can lead to getting help
Explain the strengths of this definition
It recognises the subjective experience of the patient, allowing us to view mental disorders from the point of view of the person experiencing it. Also it is relatively easy to judge objectively due to WHODAS
What is deviation from ideal mental health?
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 of reality. Jahoda shows that physical health is defined in part by looking at the absence of signs of physical health and so suggested it should be the same for mental health. Deviation from ideal mental health would therefore be an indicator of abnormality and a possible mental disorder
What are the evaluation points for deviation from ideal mental health?
Unrealistic criteria, suggests that mental health is the same as physical health, it is a positive approach and cultural relativism
Explain ‘unrealistic criteria’ as an evaluation point
According to the criteria, most people would be abnormal. It is also not clear on how many criteria need to be lacking before someone is judged as abnormal. Also the criteria are quite difficult to measure eg hard to assess capacity for personal growth or environmental mastery. Therefore this approach is not very useable when it comes to defining abnormality
Explain ‘suggests that mental health is the same as physical health’ as an evaluation point
In general physical illnesses have physical causes eg bacterial/viral infection, and as a result they are often relatively easy to detect and diagnose. It is possible that some mental disorders have physical causes eg brain injury or drug abuse, but many don’t. They are consequences of life experiences and therefore it is unlikely that we could diagnose mental abnormality in the same way as physical abnormality
Explain ‘it is a positive approach’ as an evaluation point
It is an alternative perspective on mental disorders, by focusing on the positives rather than negatives, and focusing on what is desirable rather than undesirable. Jahoda’s ideas were never really taken up by mental health professionals, though they did have some influence and are in accord with the ‘positive psychology’ movement
Explain ‘cultural relativism’ as an evaluation point
Works for failure to function adequately and deviation from ideal mental health-different cultures have different views and perspectives, and would define different things as abnormal, and so one perspective of abnormal according to these definitions cannot define abnormality across all cultures
What three mental disorders do we look at?
Phobias, depression and OCD
What types of characteristics are discussed for each disorder?
Emotional characteristics, behavioural characteristics and cognitive characteristics
What are phobias?
A group of mental disorders characterised by high levels of anxiety in response to particular stimulus or group of stimuli. The anxiety interferes with normal living. They are included in the DSM and ICD within the category ‘anxiety disorders’. They are irrational fears that produce conscious avoidance of the feared object or situation eg agoraphobia, social phobia and specific phobias
What are the emotional characteristics of phobias?
Fear that is marked and persistent, and is likely to be excessive and unreasonable. Also feelings of anxiety and panic. These emotions are cued by the presence or anticipation of a specific object or situation and are out of proportion to the actual danger posed
What are the behavioural characteristics of phobias?
Fear causes an immediate response to try and avoid the object or situation. The opposite behavioural response is to freeze or even faint. The stress response is often described as fight or flight, when in reality it is actually fight, flight or freeze. Freezing is an adaptive response as a predator may think prey is dead. Avoidance interferes significantly with normal life which distinguishes a phobia from a more everyday fear
What are the cognitive characteristics of phobias?
These relate to thought processes. For phobias, a defining characteristic is the irrational nature of the persons thinking and the resistance to rational arguments. A person may also recognise that their fear is excessive or unreasonable, which distinguishes a phobia from a delusional mental illness
What is depression?
It is classified as a mood disorder. The DSM V distinguishes between major depressive disorder and persistent depressive disorder which is longer term and/or recurring
What are the emotional characteristics of depression?
Diagnosis of major depressive disorder requires five symptoms including either sadness or loss of interest and pleasure in normal activities. Other characteristics include feeling empty, worthless, hopeless, low self esteem, despair, lack of control, also sometimes anger
What are the behavioural characteristics of depression?
Most people experience shift in activity level (reduced energy eg tiredness and wish to sleep all the time or increased energy eg agitated and restlessness). Sleep can also be affected and can increase or decrease (insomnia). Appetite can also be either increased or decreased
What are the cognitive characteristics of depression?
Negative emotions are associated with negative thoughts such as negative self concept, as well as guilt, a sense of worthlessness etc. Often have a negative view of the world and expect things to turn out badly. These expectations can become self-fulfilling and confirm these negative beliefs. In general the negative beliefs are irrational
What is OCD?
Obsessive compulsive disorder is also classed as an anxiety disorder. The disorder typically begins in young adult life and has two main components-obsessions and compulsions. Obsessions are persistent thoughts and compulsions are repetitive behaviours
What are the emotional characteristics of OCD?
Obsessions and compulsions lead to considerable anxiety and distress. Sufferers are aware their behaviour is excessive and this causes feelings of embarrassment and shame. A common obsession concerns germs which gives rise to feelings of disgust
What are the cognitive characteristics of OCD?
Obsessions are recurrent, intrusive thoughts or impulses that are perceived as inappropriate or forbidden. They may be frightening and/or embarrassing so that the person doesn’t want to share them with others. They are uncontrollable which creates anxiety. The person recognises that the obsessional thoughts or impulses are a product of their own mind, and at some point realises their obsessions and compulsions are excessive or unreasonable
What are the behavioural characteristics of OCD?
Compulsive behaviours are performed to reduce the anxiety created by obsessions. They are repetitive and unconcealed. They may be mental acts eg counting or physical eg hand washing. Patients often feel they must perform these actions or something dreadful may happen, which creates anxiety. The behaviours are not connected in a realistic way with what they are designed to neutralise or prevent and are clearly excessive. Some people experience compulsions without obsessions
What is the behavioural approach?
It suggests that behaviour is learned, and so is sometimes called learning theory. It uses the concept of conditioning (learning)
What is the behavioural approach to explaining phobias?
Orval Hobart Mowrer proposed the two process model to explain how phobias are learned. The behavioural approach to explaining phobias also covers social leaning (not part of the two process model)
What is the two process model?
The first stage is classical conditioning and the second stage is operant conditioning. Both processes are needed to explain why phobias begin and why they continue
How does classical conditioning explain the initiation of phobias?
A phobia is acquired through association eg with Little Albert the association between a neutral stimulus such as a white furry rate and a loud noice results in a new stimulus response being learnt. Little Albert’s phobia generalised to other furry white objects and he showed anxiety when exposed to a non-white rabbit, a fur coat and someone wearing a Santa beard
As an example, explain how a phobia of dogs can start after being bitten by one
Being bitten (UCS) causes fear (UCR). Dog (NS) associated with being bitten (UCS). Dogs (now CS) produces fear response (now CR)
How does operant conditioning explain the maintenance of phobias?
The likelihood of a behaviour being repeated is increased if the outcome is rewarding. With phobias, avoiding the phobic stimulus reduces fear and so is reinforcing. This is negative reinforcement. The individual avoids the anxiety created by the phobia, and so the phobia is maintained
Separate to the two process model, how can social learning theory explain phobias?
It is a neo-behaviourist explanation. Phobias may be acquired through modelling the behaviour or others. Eg seeing a parent respond to a spider with extreme fear may lead a child to acquire a similar behaviour because the behaviour appears rewarding as the fearful person gets attention
What are the evaluation points for the behavioural approach to explaining phobias?
The importance of classical conditioning, diathesis stress model, support for social learning, biological preparedness and the two-process model ignores cognitive factors
Explain ‘the importance of classical conditioning’ as an evaluation point
People with phobias often can recall a specific incidence when their phobia appeared. However not everyone can. It is possible that such traumatic incidents did happen but have been forgotten (Öst). Also Sue et al suggest that different phobias may be the result of different processes, eg agoraphobics may explain their disorder in terms of a specific incident whereas arachnophobics are most likely to cite modelling as the cause
Explain ‘diathesis-stress model’ as an evaluation point
According to the two-process model of phobias, an association between neutral stimulus and fearful experience will result in a phobia. However research has found that eg not everyone bitten by a dog will develop a phobia of dogs (Di Nardo et al). The dieathesis stress model can explain this-it proposes that we inherit a genetic vulnerability for developing mental disorders, however a disorder will only manifest itself it triggered by a life event such as being bitten by a dog, therefore it would only cause a phobia in those with the vulnerability
Explain ‘support for social learning’ as an evaluation point
An experiment by Bandura and Rosenthal supported the social learning explanation. In the experiment a model acted as if he was in pain every time a buzzer sounded. Later on, those participants who had observed this showed an emotional reaction to the buzzer, demonstrating an acquired fear response
Explain ‘biological preparedness’ as an evaluation point
The fact that phobias don’t always develop after a traumatic incident may be explained in terms of biological preparedness. Seligman argued that animals, including humans, are genetically programmed to rapidly learn association between potentially life threatening stimuli and fear. These stimuli are referred to as ancient fears that would have been dangerous in our evolutionary past such as snakes, heights, strangers and was adaptive to learn to avoid these. This explains why people are much less likely to develop fears of modern objects (Bregman could not condition a fear response in infants by paring a loud bell with wooden blocks suggesting the behavioural explanation cannot alone explain phobias)
Explain ‘the two-process model ignores cognitive factors’ as an evaluation point
There are cognitive aspects to phobias that can’t be explained in a traditionally behaviourist framework. The cognitive approach proposes that phobias may develop as the consequence of irrational thinking which causes anxiety and possibly can trigger a phobia. This alternative explanation leads to cognitive therapies (CBT) that may be more successful than behaviourist treatments in some cases such as with social phobia
What are the two (behavioural approach) therapies to treating phobias?
Systematic desensitisation and flooding
What is systematic desensitisation?
Wolpe developed this technique were phobics are introduced to the feared stimulus gradually. Phobias persist due to avoidance and so there is no opportunity to learn their feared stimulus is ok, which is why systematic desensitisation is useful
What are the three parts to systematic desensitisation?
Counterconditioning, relaxation and desensitisation hierarchy
What is counterconditioning?
This is the basis of the therapy as the patient is taught a new association that runs counter to the original association. The patient is taught, through classical conditioning to associate the phobic stimulus with a new response (such as relaxation instead of fear). Their anxiety is therefore reduced and they are desensitised. Wolpe also called this ‘reciprocal inhibition’
What is relaxation, in terms of systematic desensitisation?
The therapist teaches the patient relaxation techniques. Relaxation can be achieved by focusing on breathing, and taking slow, deep breaths to combat the anxiety. Being mindful of ‘here and now’ can help, as well as focussing on a particular object or visualising a peaceful scene. Progressive muscle relaxation is also used where one muscle at a time is relaxed
What is the desensitisation hierarchy?
Systematic desensitisation works by gradually introducing the person to the feared situation one step at a time so it is not as overwhelming. At each stage the patient practices relaxation so the situation becomes more familiar, less overwhelming and their anxiety diminishes
What is flooding?
Alternative to the gradual progression through a hierarchy as used in systematic desensitisation, flooding involves one long session where the patient experiences the phobia at its worst while at the same time practicing relaxation. The session continues until the patient is fully relaxed. Eg if the fear is clowns, the person will be placed in a room full of clowns while they use relaxation techniques until their anxiety disappears
How is flooding used in practice?
It can be conducted in vivo (actual exposure) or virtual reality can be used. The first step is to learn relaxation techniques and then they are used in the presence of the most feared situation. This usually lasts two to three hours. A persons fear response has a time limit. As adrenaline levels naturally decrease, a new stimulus response link can be learned between feared stimulus and relaxation
What are the evaluation points for systematic desensitisation?
Effectiveness of it, not appropriate for all phobias, and strengths of behavioural therapies
Explain ‘effectiveness of systematic desensitisation’ as an evaluation point
Research has found it is successful for a range of phobic disorders. McGrath et al reported that about 75% of patients with phobias respond to SD. They key to success seems to appear with actual contact with the feared stimulus, so in vivo techniquqes are more successful than in vitro. Often in vivo, in vitro and modelling are all involved
Explain ‘not appropriate for all phobias’ as an evaluation point
Öhman et al suggest that SD may not be as effective in treating phobias that have an underlying evolutionary survival component (such as the dark and dangerous animals), than in treating phobias which have been acquired due to personal experience
Explain ‘strengths of behavioural therapies’ as an evaluation point
Generally relatively fast and require less effort on the patient’s part than other psychotherapies, like CBT. The lack of thinking means it is also useful for those who lack insight into their motivations or emotions, such as children or people with learning difficulties. Also SD can be self administered with proven success eg with social phobia (Humprey)
What are the evaluation points for flooding?
Individual differences and effectivness
Explain ‘individual differences’ as an evaluation point
Flooding is not for every patient (or therapist). It can be a highly traumatic procedure. Patients are obviously made aware of this beforehand, but even then, they may quit during the treatment, which reduces the ultimate effectiveness of the therapy for some people
Explain ‘effectiveness’ as an evaluation point
For patients that choose flooding as a treatment and stick with it, it appears to be an effective and relatively quick treatment. Choy et al reported that both SD and flooding were effective but flooding was more effective
What are further evaluation points for the behaviourist approach to treating phobias?
Relaxation may not be necessary and symptom substitution
Explain ‘relaxation may not be necessary’ as an evaluation point
The success of the two therapies may be more to do with the exposure than the relaxation. Also it might be the expectation of being able to cope
Explain ‘symptom substitution’ as an evaluation point
Behavioural therapies may not work with certain phobias as the symptoms are only the tip of the iceberg. If symptoms are removed the cause still remains, and the symptoms will resurface, possibly in another form (symptom substitution)
What are the two psychologists that use the cognitive approach to explaining depression?
Ellis and Beck
What is Ellis’ cognitive approach to explaining depression?
The ABC model and musturbatory thinking
What is Ellis’ ABC model?
A=activation event eg fired from work. B=belief which may be rational or irrational eg the company was overstaffed, or I was sacked because they’ve always had it in for me. C=consequence (rational beliefs lead to healthy emotions eg acceptance but irrational beliefs lead to unhealthy emotions eg depression)
What is musturbatory thinking?
The source of irrational belies is musturbatory thinking (thinking that certain ideas or assumptions must be true in order for an individual to be happy). These leave people, at the very least, disappointed or at worst, depressed
What did Ellis identify as the 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 me happiness, or I will die”
What is Beck’s cognitive approach to explaining depression?
His approach focuses specifically on depression rather than any mental disorders. He uses negative schema and the negative triad
What is negative schema?
Depressed people have acquired a negative schema during childhood-a tendency to adopt a negative view of the world. This may be caused by many factors such as parental/peer rejection and teachers criticisms. These negative schemas (eg expecting to fail) are activated whenever the person encounters a new situation that resembles the original conditions in which these schemas were learned. Negative schemas lead to systematic cognitive bias in thinking
What is the negative triad?
Negative schemas and cognitive biases maintain what Beck calls the negative triad-a pessimistic and irrational view of three key elements in a persons belief system (them self, the world and the future)
What are the evaluation points for the cognitive approach to explaining depression?
Support for the role of irrational thinking, blames the client rather than situational factors, practical applications in therapy, irrational beliefs may be realistic, and alternative explanations
Explain ‘support for the role of irrational thinking’ as an evaluation point
Bates et al found that depressed participants who were given negative automatic thought statements became more and more depressed, supporting the view that negative thinking leads to depression. However correlation does not mean there is causation
Explain ‘blames the client rather than situational forces’ as an evaluation point
Suggests the client is responsible for their disorder. This can be a good thing as it gives the client the power to change the way things are. However, it may lead the client or therapist to overlook situational factors and so the disorder is just in the client’s mind and recovery lies in changing that, rather than considering how the client/therapist might change other aspects of the client’s environment and life
Explain ‘practical applications in therapy’ as an evaluation point
Both cognitive explanations have been applied to CBT which is consistently found to be the best treatment for depression, especially when used in conjunction with drug treatments. The reason these explanations are so useful is that they have specific implications for success of the therapy and the therapy supports the explanation
Explain ‘irrational beliefs may be realistic’ as an evaluation point
Not all irrational beliefs are irrational, they may just seem irrational. Alloy and Abrahmson suggest that depressive realists tend to see things for what they are rather than through rose-coloured glasses. They found that depressed people gave mire accurate estimates of the likelihood of a disaster than ‘normal’ controls, and called this the sadder but wiser effect
Explain ‘alternative explanations’ as an evaluation point
The biological approach to understanding mental disorders suggests that genes and neurotransmitters may cause depression. The success of drug therapies for treating depression suggests that neurotransmitters do play an important role. The cognitive approach ignores this
What is the cognitive approach to treating depression?
Cognitive behavioural therapy (a combination of cognitive therapy to change thoughts and behavioural therapy to change behaviour in response to those thoughts)
Who was the first psychologists to develop a form of CBT?
Ellis in 1950s, he first called it ‘rational therapy’ to emphasise the fact that, as he saw it, psychological problems occur as a result of irrational thinking-individuals frequently develop self-defeating habits due to faulty beliefs about themselves and the world around them
What is the aim of CBT?
To turn these irrational thoughts into rational ones
What did Ellis rename his therapy to?
Rational emotive therapy (RET) as the therapy focuses on resolving emotional problems, and even later, he renamed it rational emotional behavioural therapy (REBT) as the therapy also resolves behavioural problems
What are the components of CBT?
Challenging irrational thoughts, homework, behavioural activation, and unconditional positive regard
How are irrational thoughts challenged?
Ellis extended his ABC model to ABCDEF (D=disputing irrational thoughts and beliefs, E=effects of disputing and the effective attitude to life, F=new feelings that are produced)
What is the key issue in challenging irrational thoughts?
It is not the activating events that cause unproductive consequences-it is the beliefs that lead to the self-defeating consequences. REBT therefore focuses on challenging or disputing the irrational thoughts/beliefs and replacing them with effective rational beliefs
What are the different ways of disputing irrational thoughts?
Logical disputing (self defeating beliefs don’t follow logically from available information eg ‘does thinking in this way make sense?’), Empirical thinking (self defeating beliefs may not to be consistent with reality eg ‘where is the proof that this belief is accurate?’), Pragmatic disputing (emphasises the lack of usefulness of self defeating beliefs eg ‘How is this belief likely to help me?’)
How does effective disputing work?
It changes self defeating beliefs into more rational beliefs. The client can now move from ‘catastrophising’ to more rational interpretations of life. This in turn helps the clients to feel better, and eventually become more self-accepting
What is homework?
Clients are often asked to complete assignments between therapy sessions. This might include asking a person out on a date when they had been afraid to do so before for fear of rejection, looking for a new job, asking friends to tell them what they really think about the person and so on. This homework is vital in testing irrational beliefs against reality and putting new rational beliefs into practice
What is behavioural activation?
CBT often involves a specific focus on encouraging depressed clients to become more active and engage in pleasurable activities. This is based on the common-sense idea that being active leads to rewards that act as an antidote to depression. A characteristic of many depressed people is that they no longer participate in activities they used to enjoy. In CBT the therapist and client identify potentially pleasurable activities and anticipate and deal with any cognitive obstacles
What is unconditional positive regard?
Ellis came to recognise that an important ingredient in successful therapy was convincing the client of their value as a human being. If the client feel worthless, they will be less willing to consider changing their beliefs and behaviour. However, if the therapist provides respect and appreciation regardless of what the client does and says, this will facilitate a change in beliefs and attitudes
What are the evaluation points for the cognitive approach to treating depression?
Research support, individual differences, support for behavioural activation, alternative treatments and the Dodo bird effect
Explain ‘research support’ as an evaluation point
Ellis claimed 90% success rate for REBT, taking an average of 27 sessions to complete. However he recognised that it wasn’t always effective as some clients didn’t put their revised beliefs into action.Therapist competence also appears to explain a significant amount of variation in CBT outcomes
Explain ‘individual differences’ as an evaluation point
It appears to be less suitable for people who have high levels of irrational beliefs that are rigid and resistant to change. It is also less suitable in situations where high levels of stress in the individual reflect realistic stressor in the person’s life that therapy cannot resolve
Explain ‘support for behavioural activation’ as an evaluation point
The belief that changing behaviour can so some way to alleviating depression is supported by a study on the beneficial effects of exercise. Babyak et al studied 156 adult volunteers with major depressive disorder. They were randomly assigned to a four month aerobic exercise course, drug treatment or a combination of the two. They all improved in four months but six months after the study, those in the exercise group had significantly lower relapse rates, especially when they continued exercise after the study
Explain ‘alternative treatments’ as an evaluation point
Most popular treatment for depression is the use of antidepressants such as SSRIs. Drug therapies have the advantage of needing less effort from client. They can also ben used with a psychotherapy such as CBT which may be useful because a distressed client may not be able to focus on the demands of CBT but the drug treatment would help them to cope better
Explain ‘the Dodo Bird effect’ as an evaluation point
Rosenzweig argued that all methods of treatment for mental disorders were pretty much equally effective, an observation he called the Dodo Bird effect (due to the bird in Alice in Wonderland who decided everyone should win). Research shows fairly small differences in success rates, Rosenzweig says because they have so many common factors
What two types of biological explanations are used to explain OCD?
Genetic explanations and neural explanations
What are genetic explanations?
A popular explanation for mental disorders is that they are inherited. This would mean that individuals inherited specific genes from their parents that are related to the onset of OCD
What are two genes that may explain OCD?
The COMT gene and the SERT gene
What is the COMT gene?
It is called COMT because it is involved in the production of catechol-O-methyltransferase (COMT) which regulates the production of the neurotransmitter dopamine, which as been implicated in OCD. All genes come in different forms (alleles) and one form of the COMT gene has been found to be more common in OCD patients than those without the disorder. This variation produces lower activity of the COMT gene and higher levels of dopamine
What is the SERT gene?
It is also called 5-HTT which affects the transport of the serotonin, creating lower levels of this neurotransmitter. These higher levels are also implications of OCD. One study found a mutation of this gene in two unrelated families where six of the seven family members had OCD
How are genetic explanations realistically linked to OCD?5
It is unlikely that there is a simple link between a gene and a complex disorder. Genses such as SERT are also implicated in a number of other disorders such as depression and PTSD. This suggests each individual gene only creates a vulnerabiloty (a diathesis) for OCD, and other conditions. Other factors (stressors) affect what condition develops or any mental illnesses develop, which is why some people with COMT or SERT gene variations don’t suffer with anything. This is known as the diathesis-stress model
What are neural explanations?
There is a link between genetic factors and abnormal levels of certain neurotransmitters. It is also true that genetic factors affect certain brain circuits that may be abnormal
What are two neurotransmitters that may explain OCD?
Dopamine and serotonin
How does Dopamine link to OCD?
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 stereotypes movements resembling the compulsive behaviours in OCD patients
How does serotonin link to OCD?
Lower levels of serotonin are associated with OCD. This conclusion is based on the fact that antidepressant drugs that increase serotonin activity have been shown to reduce OCD symptoms, whereas antidepressants that have less effect on serotonin do not reduce OCD symptoms
How do brain circuits link to OCD?
Several areas in the frontal lobes of the brain are thought to be abnormal in people with OCD. The caudate nucleus normally suppresses signals from the orbitofrontal cortex. In turn the orbitofrontal cortex sends signals to the thalamus about things that are worrying, such as a potential germ hazard. When the caudate nucleus is damaged, it fails to suppress minor ‘worry’ signals and the thalamus is alerted, which in turn sends signals back to the orbitofrontal cortex, acting as a worry circuit
How is the link between brain circuits and OCD supported?
It is supported by PET scans of patients with OCD, taken while their symptoms are active eg when a person with a germ obsession holds a dirty cloth). Such scans show heightened activity in the orbitofrontal cortex
How do neurotransmitters like to abnormal brain circuits and OCD?
Serotonin and dopamine are linked to these regions of the frontal lobes. Comer reports that serotonin plays a key role in the operation of the orbitofrontal cortex and the caudate nuclei, and it would therefore appear that abnormal levels of serotonin might cause these areas to malfunction. Dopamine is also linked to this system as it is the main neurotransmitter of the basal ganglia. High levels of dopamine lead to overactivity of this region
What are the evaluation points for the biological approach to explaining OCD?
Family and twin studies, Tourette’s syndrome and other disorders, research support for genes and OFC, real world application and alternative explanations
Explain ‘family and twin studies’ as an evaluation point
Evidence for the genetic basis of OCD comes from studies of first degree relatives and twin studies. People with first degree relatives with OCD had a five times greater risk of having it themselves (Nestadt et al) and a meta-analysis of 14 twin studies found MZ twins were more than twice as likely to develop OCD if their twin had it than for DZ twins. However the concordance rates are never 100% meaning there must be environmental factors that play a role too (diathesis stress model)
Explain ‘Tourette’s syndrome and other disorders’ as an evaluation point
Pauls and Leckman studied patients with Tourettes and their families, and concluded that OCD is one form of expression of the same gene that determines Tourettes. The obsessive behaviour of OCD and Tourettes patients is also found in autistic children. Also obsessive behaviour is typical of anorexia nervosa and distinguishes it from bulimia. Also 2 out of 3 patients with OCD experience at least one episode of depression. This all supports the idea that there is not one specific gene or genes unique to OCD, they just act as a pre-disposing factor
Explain ‘research support for genes and OFC” as an evaluation point
Studies show genetic link to abnormal levels of neurotransmitters eg Menzies et al used MRI to produce brain activity images in OCD patients and immediate family members without OCD and a group of unrelated healthy people. OCD patients and close relatives had reduced grey matter in key regions of brain including OFC. This supports view that anatomical differences are inherited and these may lead to OCD in certain individuals. Menzies et al concluded that, in the future brain scans may be used to detect OCD risk
Explain ‘real world application’ as an evaluation point
Mapping human genome has led to hope that specific genes can link to particular mental/physical disorderseg where one or the other parent to be has COMT gene, the mothers egg could be screened to give the choice of whether to abort those eggs with the gene. Alternatively, gene therapy may produce a means of turning certain genes ‘off’ so a disorder is not expressed. Both raise important ethical issues. However this all presumes a simple link between these disorders and genes which may not be true and wrongly lead people to thin there are simple preventative measures
Explain ‘alternative explanations’ as an evaluation point
Strong competition from psychological explanations. Two process model can be applied to OCD. Initial learning eg dirt associated with anxiety which is maintained by avoiding anxiety provoking stimulus and so an obsession is formed and then a link is learned with compulsive behaviours eg hand washing which appear to reduce the anxiety. This is supported by success of exposure and response prevention treatment for OCD which is similar to systematic desensitisation
What is the biological approach to treating OCD?
Drug therapy
What dug therapies are used in treating OCD?
Antidepressants (SSRIs and tricyclics), anti-anxiety drugs and other drugs
What are SSRIs?
Low levels of serotonin are associated with depression and OCD so drugs that increase serotonin are used. Low levels of serotonin are implicated in the worry circuit so increasing serotonin may normalise the circuit. Antidepressants reduce anxiety associated with OCD. Selective serotonin re-uptake inhibitors (SSRIs) are currently the preferred drug for anxiety disorders and they increase serotonin to regulate mood and anxiety
How do SSRIs actually work?
Serotonin is released into a synapse from a neuron. It targets receptor cells on the receiving neuron at receptor sites and, afterward, is re-absorbed 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 (re-uptake) is inhibited
What are tricyclics?
Tricyclic clomipramine was the fist antidepressant to be used for OCD and today is primarily used in the treatment of OCD rather than depression
How do tricyclics work?
They block the transported mechanism that re-absorbs both serotonin and noradrenaline into the presynaptic cell after it has fired. As a result, more of these neurotransmitters are left in the synapse, prolonging their activity and easing transmission of the next impulse. They have the advantage of targeting more than one neurotransmitter, however they have greater side effects so are used as a second line treatment where SSRIs are not effective
What are anti-anxiety drugs?
Benzodiazepines are commonly used to reduce anxiety. They are manufactured under various trade names. They slow down the activity of the central nervous system by enhancing the activity of the neurotransmitter GABA (gamma-aminobutyric acid), which when released has a general quietening effect on many of the neurons in the brain
How does GABA work?
It reacts with GABA receptors on the outside of receiving neurons. When GABA locks into these receptors, it opens a channel that increases the flow of chloride ions into the neuron. Chloride ions make it harder for the neuron to be stimulated by other neurotransmitters, so slows down its activity and makes the person feel more relaxed
What are other drugs?
Recent research has found that D-cycloserine has an effect on reducing anxiety and this 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 so reduces anxiety
What are the evaluation points for the biological approach to treating OCD?
Effectiveness, drug therapies are preferred to other treatments, side effects, not a lasting cure and publication bias
Explain ‘effectiveness’ as an evaluation point
Considerable evidence for effectiveness of drug treatments. Typically a randomised control trial is used to compare effectiveness of drug vs placebo. Soomro et al reviewed 17 studies of SSRIs and OCD and found them more effective than placebos in reducing OCD symptoms up to three months after treatment. One issue however is that research is generally to show short term rather than long term effects
Explain ‘drug therapies are preferred to other treatments’ as an evaluation point
A big appeal of using drug therapy is that it requires little effort from the user and little input in terms of time (especially compared to therapies such as CBT). From the point of view of the health service they are also cheaper as they require little monitoring and care cheap compared to psychological treatments. Also they may still benefit from the fact that simply talking with a doctor during consultations may help (Dodo bird effect)
Explain ‘side effects’ as an evaluation point
All drugs have side effects, some more severe than others. Nausea, headaches and insomnia are common side effects of SSRIs. They may not seem terrible but are often enough to make the patient want to stop using the drug. Tricyclic antidepressants tend to have more side effects such as hallucinations and irregular heartbeats meaning they are only used when SSRIs don’t work. The possible side effects of benzodiazepines include increased aggressiveness and long term impairment of memory, plus there re addiction problems so they are usually limited to use of four weeks
Explain ‘not a lasting cure’ as an evaluation point
Koran et al, in a comprehensive review of treatments for OCD sponsored by the APA suggested that, although drug therapy may be more commonly used, psychotherapies such as CBT should be tried first. Drug therapy may require little effort and are relatively effective in the short term but it does not provide a lasting cure, as indicated by the fact that patients relapse within a few weeks if medication is stopped
Explain ‘publication bias’ as an evaluation point
Turner et al claim there is evidence of publication bias towards studies showing positive outcome of antidepressant treatment, so exaggerating their benefits. Authors found that no only were positive results more likely to be published but studies that weren’t positive often were published in a way that conveyed a positive outcome. Drug companies have a strong interest in continuing success of psychotherapeutic drugs and much research is funded by these companies. Selective publication can lead doctors to make inappropriate treatment decisions that may not be in the interest of their patients
