Psychopatholgy 🦋 Flashcards

Question

What are the two aspects of the cognitive approach to explaining depression?

Answer 1

- BECKS NEGATIVE TRIAD - ELLIS’ ABC MODEL

Answer 2

- cognitive vulnerabilities (eg the way a person thinks) can increase likelihood of depression - three parts to this vulnerability 1) FUALTY INFORMATION PROCESSING - pessimistic views, dwell on the negative and ignore the positive (black and white thinking) - blow small problems out of proportion - eg one million in lottery not ten million won last week 2) NEGATIVE SELF SCHEMA - schema= a package of information developed though experience - mental framework for interpretation of sensory information - use schema to interpret world - self schema= ideas about self - negative self schema= interpret all info about themselves in a negative way 3) THE NEGATIVE TRIAD - dysfunctional view of self comes from three types of automatic negative thoughts - thoughts present regardless of reality - negative view of world (cold and hard place) , future (no hope for economy) , self (I am a failure- enhances and validates low self esteem)

Answer 3

- Good mental health= result of rational thinking, allowing people to be happy and free from pain - Bad mental health comes from irrational thoughts, any thoughts which prevent the stated above - ABC model to explain how irrational thoughts affech our emotional state and behaviour A= Activating event - get depressed when we experience negative events - these trigger irrational beliefs - eg failing a test B= beliefs - range of beliefs - musturbation= must always succeed or reach perfection - I can’t stand it itis= catastrophising minor inconveniences - utopianism= life is always meant to be fair C= Consequences - when activating event triggers irrational beliefs, emotional and behavioural consequences - musturbation person fails test= may trigger depression

Answer 4

BECK ✅ RESEARCH SUPPORT P- one positive of the cognitive approach to explaining depression is existing supporting research E- for example, CLARK AND BECK concluded that cognitive vulnerabilities were not only more common in depressed people, but preceded depression. This was confirmed in a prospective study by Cohen, who tracked the development of 243 adolescents, monitoring cognitive vulnerabilities. Found correlation between vulnerability and those who would go on to develop depression E- this shows that there is a genuine link between cognitive vulnerability and depression ✅ RWA P- another benefit of the cognitive approach is applications in screening and treatment of depression E- for example, CONEN suggested that screening young people for cognitive vulnerabilities can be used to predict who is at risk of developing depression in the future and monitoring them. It can also be used in CBT to change people’s cognitions and make them more resilient to adversity. E- this means they understanding cognitive vulnerabilities can be useful in clinical practise ❌ partial explanation P- one limitation is that the cognitive approach is only a partial explanation E- this is because whilst most depressed people show particular patterns of cognition which can be detected before the onset of depression, some aspects, eg anger, hallucinations are not well explained the cognitive models. This means that it only has partial application relating to depression ELLIS ✅ RWA P- one strength of Ellis ABC model is the real world application in the cognitive treatment of depression E- this is through REBT, a method which involves vigorously arguing with the client in order to challenge their irrational beliefs. Evidence for effacy of REBT comes from DAVID E- tmt REBT has some real world value ❌ REACTIVE AND ENDOGENOUS DEPRESSION P- one weakness is that this model only explains reactive and not endogenous depression E- whilst depression is sometimes triggered by negative life events (activating events), some cases of depression are not traceable to any negative life events and have no clear cause. This is endogenous depression. Ellis ABC model is not good at explaining it E- model is only a partial explanation as only explains reactive depression ✅ RESPONSIBILY P- whilst placing responsibility on the individual may seem unethical, it can actually encourage the client to consciously counter their depression E- this is because it encourages individuals that their fate is in their own hands, and that they have power to change their depressive thoughts E- TMT it is useful in improving resilience and symptoms of depression AND client more likely to have an active role in recovery

Answer 5

- CBT - BECKS COGNITIVE THERAPY - ELLIS RATIONAL BEHAVIOUR THERAPY - BEHAVIOURAL ACTION

Answer 6

-cognitive approach for treatment with some behavioural elements - mostly used on depression - COGNITIVE= assessment and clarification of problems. Identify irrational thoughts and come up with a goal and plan to counteract them - BEHAVIOURAL- working to change negative and irrational thoughts and replacing with effective behaviours

Answer 7

- application of cognitive theory - identify and challenge irrational thoughts surrounding negative triad - helps test reality of negative beliefs through homework (client as scientist) to investigate reality of thoughts - eg record when someone is nice - if person says no one was nice, therapist can produce evidence and prove client wrong

Answer 8

- REBT extends ABC model to ABCDE model, with D being dispute and E being effect - identify and dispute irrational thoughts - eg therapist could identify utopianism based off client descriptions and challenge it though rigorous argument - effect is to break link between negative life event and depression - different types of disputing: eg EMPIRICAL ARGUMENT= disputing if there is real evidence to support belief. LOGICAL ARGUMENT= if belief logically aligns with facts

Answer 9

- more depressed > more avoidance > more isolation > worsen depression - behavioural action works with depressed people to decrease avoidance and isolation and inc engagement in enjoyable activity, eg sport

Answer 10

✅ EVIDENCE FOR EFFACY P- one strength of CBT is large body of evidence supporting effacy of it E- ie, MARCH conducted a study on 327 depressed adolescents. He found that after 36 weeks, 81% of the (CBT) and (antidepressant) groups had improved, and 86% of the combined group had improved. CBTis a short therapy with 6-12 sessions, is cost effective, and works as well as drugs E- this means that is is first choice for NHS ❌DIVERSE CLIENT SUITABILITY P- one limitation is that it is less accessible for clients with learning disabilities E- This is because hard cognitive work and rational thought may not be suitable for people with learning disabilities (STURMEY). Furthermore in severe cases of depression clients cannot self motivate to engage with cognitive work of CBT. E- tmt may only be appropriate for a specific range of people ✅ COUNTERPOINT P- New evidence challenges idea that CBT is ineffective in severe cases of depression or on those with learning disabilities E- for example (Lewis and Lewis) found that it’s as good as antidepressants and CBT combined. Furthermore (Taylor) found that it can be used for those with learning disabilities when applied appropriately. E- this means that CBT may be suitable for a wider range of people than originally thought ❌ RELAPSE RATES P- another limitation if the cognitive approach to treating depression is high relapse rates E- whilst CBT can tackle symptoms of depression , there are concerns that these effects may not last long. This is because most early studies looked at short term efficacy. More recently, (ALI) assessed depression in 439 clients every month for 12 months following CBT. 42% relapsed within six months and 52% relapsed within year. E- tmt CBT needs to be repeated periodically

Answer 11

- OCD= obsessions and or compulsions - TRICHOTILLOMANIA= compulsive hair pulling - HOARDING DISORDER= compulsive gathering of possessions and the inability to part with anything - EXCORIATION DISORDER= compulsive skin picking

Answer 12

COMPULSIONS ARE REPETITIVE - compelled to repeat behaviour - Eg hand washing, praying, ordering COMPULSIONS REDUCE ANXIETY - around 10% show compulsive behaviour alone with no obsessions - However, for most people it is in attempt to manage anxiety produced by obsessions - Eg compulsive hand washing is a response to a fear of germs AVOIDANCE - Reduce anxiety by keeping away from situations which trigger it - Eg thoes who wash hands compulsively may avoid coming into contact with germs - Can prevent someone from leading a normal life by interfering with normal daily tasks, eg taking out bins

Answer 13

ANXIETY AND DISTRESS - Unpleasant emotional experience due to powerful anxiety accompanying both obsessions and compulsions - Obsessive thoughts are unpleasant and frightening and accompanying anxiety is overwhelming - Compulsions create anxiety ACCOMPANYING DEPRESSION - OCD accompanied by low mood and lack of enjoyment in activities - Compulsive behaviour only brings temporary mood relief GUILT AND DISGUST - As well as anxiety and depression, may have other negative emotions such as guilt over minor moral issues or disgust directed at other things (eg dirt) or self

Answer 14

- Adopt cognitive strategies to deal with obsessive thoughts OBSESSIVE THOUGHTS - Around 90% of people with this condition have obsessive thoughts - Vary between people but are always unpleasant - Eg, that a door has been left unlocked and someone will come in COGNITIVE COPING STRATERGIES - Adopt cognitive strategies to deal with obsessions - Eg a person tormented by guilt or morality issues may adopt the cognitive strategy of praying - Manage anxiety but make the person appear abnormal and interfere with daily life INSIGHT INTO EXCESSIVE ANXIETY - Are aware that obsessions and compulsions are irrational (if not, indication of different disorder) - People with OCD experience catastrophic thoughts about worst case scenario that might result if anxieties were justified - Hypervigilant

Answer 15

- Genetic explanations - Neural explanations

Answer 16

- Some people have genes which make them more vulnerable to OCD - These genes are known as candidate genes - LEWIS= of his OCD patients, 37% had parents with OCD and 21% had siblings with OCD - DIATHESIS STRESS MODEL= Genes not causal, just vulnerability. Environmental stress trigger required - E.g. SERT which decreases serotonin - E.g. COMT which increases dopamine - POLYGENIC= OCD caused by many genes that together increase vulnerability - TAYLOR= over 230 different genes may be responsible - Aetiologically heterogenous- different genes cause it in different people - This may lead to the different types of OCD

Answer 17

- Genes affect neurotransmitter levels - OCD lowers serotonin levels - Normal transmission of mood relevant signals does not occur, and person may experience low moods - Applicable for at least some cases of OCD - High dopamine= compulsions - Some cases have impaired decision making (e.g. hoarding disorder) - Due to abnormalities in left frontal lobes (logical thinking) and left parahippocampal gyrus (processing unpleasant emotions)

Answer 18

GENETIC ✅ STRONG EVIDENCE BASE P- one strength of the genetic explanation is the strong evidence base E-For example, NESTADT reveiwed twin studies and found 68% of MZ twins share OCD as opposed to 31% of DZ twins. Furthermore, MARINI and STEBNIKI found that OCD is 4x more likely if a family member has OCD E- tmt there must be some genetic influence of the development of OCD ❌ ENVIRONMENTAL RISK FACTORS P- one limitation of the genetic model is that there are also environmental risk factors E- ie CROMER found that over half their OCD clients had suffered trauma in the past. Furthermore, OCD was more severe in those clients with severe trauma. E- this means that whilst genes do play a part in OCD development, it is only a partial explanation ANIMAL STUDIES ❌ P- One weakness is that due to evidence for candidate genes being difficult to identify, lots of evidence comes from animal studies E- ie AHMARI found that particular genes in mice are linked to repetitive behaviours. However, this is a problem since the human mind and brain are more complex than these mice E- TMT hard to generalise data NEURAL ✅ RESEARCH SUPPORT P- one strength of neural explanations is research support E- ie antidepressants that work on seratonin are effective in reducing OCD symptoms. As a result, serotonin is likely involved in OCD symptoms. Furthermore, OCD symptoms form part of conditions, e.g. Parkinson's disease, which are known to be biological in origin. Due to this, we can assume biological processes underlie OCD E- TMT biological factors are likely responsible for OCD ❌NO UNIQUE NEURAL SYSTEM P- one limitation of the neural model is that serotonin OCD link may not be unique to OCD E- due to common co-morbidity of clinical depression alongside OCD, it may be that low serotonin levels are as a result of this depression rather than OCD (since depression is associated with low serotonin) E- TMT seratonin may not be linked to OCD at all

Answer 19

- Inc or dec levels of neurotransmitters in brain - Work to inc serotonin in brain

Answer 20

- SSRIs - SSRIs + CBT - Stronger drugs, eg tricyclics and SNRIs

Answer 21

- Selective seratonin reuptake inhibitor - Antidepressant - Presynaptic neurone > synapse > postsynaptic neurone - Prevents reabsorption and breakdown of serotonin back into the presynaptic neurone - Increases levels of serotonin in synapse which continues to stimulate the postsynaptic neurone - Compensates for what is wrong - Dosage varies from person to person - Typical of fluoxetine (prozac) is 20 mg although may be inc - Capsule or liquid - 3-4 months befroe benefits seen

Answer 22

- Often used alongside CBT - Since drugs reduce emotional symptoms, client can engage better with CBT - Some best with CBT alone, others best with drugs and CBT (SSRIs or occasionally other drugs)

Answer 23

- Sometimes different antidepressants are used if SSRIs aren’t working - Fluoxetine can be increased up to 60mg a day if not working or can be combined with other drugs - OTHER ALTERNATIVES: Tricyclics: - E.g. clomipramine - Older drugs, work on many systems including serotonin system (similar effects to SSRIs). - More severe side effects that SSRIs so used when SSRIs fail SNRIs - Serotonin noradrenaline reuptake inhibitors - Increace levels of noradrenaline and serotonin - Second line of defence when SSRIs fail

Answer 24

✅ EVIDENCE FOR EFFACY P- one benefit of drug treatments for OCD is evidence for effacy E- E.g. SOOMRO reviewed 17 studies comparing placebos to SSRIs. All 17 showed better outcomes form SSRIs compared to placebos. Around 70% of symptoms are alleviated by SSRIs and the remaining 30% is alleviated by CBT or other drugs E- tmt drugs are helpful for most people with OCD ❌ COUNTERPOINT P- Drug treatments may not be the most effective treatments even if they are helpful for most people E- E.g. SKAPINAKIS found carried out a systematic review of outcome studies and found that both cognitive and behavioural therapies were more effective than SSRIs in OCD treatment E- tmt drugs may not be the optimum treatment for OCD ✅ COST EFFECTIVE AND NON-DISRUPTIVE P- further strength is cost effective and non-disruptive E- for example, they are cheap since many thousands of tablets or liquid doses can be manufactured in the time on therapy session takes. Good for NHS with limited funds as a result. Furthermore, they are non-disruptive, e.g. they can be taken until symptoms decline and are fast to take. Therapy is long. E- drugs are popular with OCD ppl and doctors ❌ SERIOUS SIDE EFFECTS P- one limitation of OCD drugs is potentially serious side effects E- for example, someone may get blurred vision, indigestion, loss of sex drive. Whilst short term, they can be very distressing and are long lasting for a minority. For those taking the tricyclic clomipramine, more serous side effects, e.g. 1 in 10 gain weight and 1 in 100 get angry and have heart problems E- tmt due to decreased quality of life experienced, people any stop taking drugs and effacy decreases as a result

Answer 25

- Statistical infrequency - Deviation from social norms - Failure to function adequately - Deviation from ideal mental health

Answer 26

- Occurs when an individual has a less common characteristic, e.g being more depressed or less intelligent than the general population - We define normal as how often we come across it - Any usual characteristic/ behaviour= normal - Any unusual characteristic or behaviour= abnormal - When measuring into people's characteristics, we know that scores will cluster around the average. - Further above or below that average we go, the fewer people will attain that score - E.g IDD - Avarage IQ= 100 - 68% have a score from 85-115 - Only 2% have a score below 70= can be diagnosed with IDD

Answer 27

- Concerns behaviour that is different from the accepted standards of behaviour in a community or society - Often noticeable if someone doesn’t conform to expected behaviour - Groups of people choose to define behaviour as abnormal on the basis of what offends what they deem to be acceptable - We collectively judge as a society what is right - Norms differ varying time and culture, not many universal norms - E.g. in Brunei, sex between men is punishable by stoning to death - E.g antisocial personality disorder - DSM-5= absence of prosocial internal standards associated with failure to conform to lawful and culturally normative ethical behaviour - Abnormal since don’t conform to moral standards - Abnormal in most cultures

Answer 28

- Occurs when someone is unable to cope with the ordinary demands of day to day living - E.g. the person may not be able to maintain basic standards of hygiene or nutrition. They may also be unable to hold a relationship or job. - ROSENHAN and SELIGMAN additional signs that someone is failing to function adequately - 1. no longer conforms to standard interpersonal rules - 2. severe personal distress - 3. behaviour become irrational or dangerous to themselves or others. - E.g. IDD, individual must have both low IQ AND be failing to function adequately for a diagnosis

Answer 29

- Occurs when someone does not meet a set of criteria for good mental health - Looks at what makes someone psychologically healthy and hence ‘normal’ so we can begin to identify who deviates from this ideal. - JAHODA: criteria for good mental health (8) - Overlap between FTFA and DFIMH

Answer 30

RWA P- one strength of statistical infrequency is its real-world application in clinical practise, both in diagnosis and assessment of symptoms E- for example, the Beck depression inventory is used in diagnosis of depression, with a score of 30+ (top 5% of respondents) indicating severe depression. (IDD requires an IQ below 70) E- this means that statistical infrequency criterion is useful in clinical practise UNUSUAL CHARACTERISTICS CAN BE POSITIVE P- one limitation of statistical infrequency is that unusual characteristics can be positive or negative. E- for example, for every person with an IQ below 7, there is another person with an IQ above 130. However, we would not class this person as abnormal for having a high IQ. We also wouldn't consider someone with a low score on the Beck depression inventory as abnormal. E- TMT whilst it can form part of assessment/ diagnostic procedures, it is insufficient as a sole basis for defining abnormality BENEFITS VS PROBLEMS P- one strength is that a diagnosis of abnormality can be beneficial for some individuals E- for example, someone with a very low IQ can access help services and someone with a very high score on the BDI may benefit from therapy. E- TMT it can be used as a tool/ guidance for people to use to seek help that they may benefit from

Answer 31

RWA P- one benefit of deviation from social norms is its usefulness in clinical practise. E- for example, by identifying abnormal behaviours such as the inability to conform with acceptable and ethical behaviour, many conditions such as antisocial personality disorder can be diagnosed. Furthermore, deviation from social norms is also involved in diagnosis of schizotypal personality disorder, where ‘strange’ characteristics involve appearance and behaviour. E- TMT the criterion has a valuable use in psychiatry RELATIVISM P- one limitation of deviation from social norms is the variability between social norms in different cultures and situations. E- for example, a person from one cultural group may label someone from another cultural group as abnormal based off their personal standards rather than the other persons standards. Examples include hearing voices, which is normal in some cultures but would be classed as abnormal in the UK. Furthermore, deceitful behaviour is more acceptable in business and trade than it is in family life. E- TMT it is difficult to judge deviation from social norms across some cultures and situations

Answer 32

REPRESENTS A THRESHOLD FOR HELP P- one strength of failure to function adequately is that it represents a sensible threshold for when to seek professional help E- for example, whilst most of us will experience symptoms of a mental disorder at some point (MIND states that 25% of us will experience a mental health problem in a given year), it is often only when indivivduals develop more severe symptoms that they fail to function adequately and would benefit from help E- TMT professional help can be targeted at those who need it most SOCIAL CONTROL AND DISCRIMINATION P- one limitation of failure to function adequately is that it is easy to label non standard lifestyle choices as abnormal E-for example, living off grid may be considered abnormal since the individual doesn’t have a permanent job or address, even though they are not failing to function adequately. Furthermore, those who enjoy high risk leisure activities may be unreasonably classed as irrational and as a danger to self E- tmt freedom of choice of individuals which alternative lifestyles may be restricted by the risk of being labelled as abnormal

Answer 33

A COMPREHENSIVE DFINITION P- one strength of DFIMH is that it is a highly comprehensive definition E- Since JAHODAS concept of ideal mental health contains a wide range of criteria for distinguishing mental health from illness, an individual's mental health can be discussed meaningfully with a range of professionals (e.g. a psychiatrist may focus on symptoms whilst a councillor may focus on self-actualisation) CULTURE BOUND P- One limitation of the ideal mental health criterion is that not all elements are applicable across a range of cultures E- for example, many of Jahoda's criteria are based off USA and western Europe beliefs. As a result, they may not be applicable to all places, as many cultures view self-actualisation as selfish and indulgent. Even within Europe there is some variation, as personal independence is valued highly in Germany, whereas it is valued much less in Italy. What defines success is very different between cultures as a result. E- TMT it is difficult to apply the concept of ideal mental health from one culture to