PSYCHOPATHOLGY (4)

Question 1

AO1 - DEVIATION FROM SOCIAL NORMS (DSN)

Answer 1

This definition defines abnormality in terms of behaviour that goes against (deviates) the unwritten rules and norms in a given society or community. In any society there are social norms – standards of acceptable behaviour that are set by the social group. This definition is concerned with behaviour that is antisocial or undesirable.
These can be implicit (unwritten) or explicit (laws).
Link to a disorder…
An example could be Antisocial Personality Disorder (APD) – a person with APD is impulsive, aggressive and irresponsible.

Question 2

AO3 - EVALUATION OF THE DEVIATION FROM SOCIAL NORMS DEFINITION

Answer 2

Social norms change over time.

A problem is that social norms change over time and this means that this approach to defining abnormality is very much era-dependent – behaviours that are considered abnormal now may not be considered abnormal in the future. For example, homosexuality was once considered abnormal behaviour because it broke the social norms of the day. Attitudes have changed considerably now and homosexuality is no longer an abnormal behaviour, yet homosexuality was only removed from Diagnostic and Statistical Manual (DSM) as a mental disorder in 1990. This suggests that we have to be careful when using DSN as a way of defining abnormal behaviour because social norms change over time.

Lack of cultural relativity – a further limitation of the deviation from social norms definition is cultural validity. Social norms by their very definition vary tremendously from one community to another. This means for example, that a person from one cultural group may label someone from another culture as behaving abnormally according to their standards rather than the standards of the person behaving that way. For example, hearing voices is socially acceptable in some cultures but would be seen as a sign of mental abnormality in the UK. Therefore, this definition may not apply in many cases.

Question 3

AO1 - FAILURE TO FUNCTION ADEQUATELY (FFA)

Answer 3

The Failure to Function Adequately definition sees individuals as abnormal when their behaviour suggests that they cannot cope with everyday life. Behaviour is considered abnormal when it causes distress leading to an inability to function properly, like disrupting the ability to work and/or conduct satisfying relationships. Such people are often characterised by not being able to experience the usual range of emotions or behaviours. The key issue with this is that abnormal behaviour interferes with day-to-day living.

Rosenhan & Seligman suggested characteristics of abnormal behaviour that are related to this definition including irrational behaviour and observer discomfort
Link to a disorder…
A common example would be severe depression, which can lead to a lack of interest meaning that the depressed person may fail to get up in the morning and hold down a job.

Question 4

AO3 - EVALUATION OF THE FAILURE TO FUNCTION ADEQUATELY DEFINITION

Answer 4

Lacks cultural relativity.

Definitions of adequate functioning are related to cultural ideas of how one’s life should be lived. The ‘failure to function adequately’ criteria is likely to result in different diagnoses when applied to different cultures. This may explain why people of a lower-class and non-white patients are often diagnosed with psychological disorders – because their lifestyles are different from the dominant culture, and this may lead to a judgement of failing to function adequately. This is a limitation as clearly FFA does not provide a universal definition of abnormality.

POINT: ..Abnormality is not always associated with failing to function adequately EVIDENCE: – a further limitation of the FFA definition of abnormality is that many individuals with mental health issues can appear to lead perfectly normal lives most of the time. For example, Harold Shipman was a doctor who was responsible for the death of over 200 of his patients over a 23 year period. In spite of his appalling crimes, Shipman functioned adequately and was seen to be a respectable doctor. He was clearly abnormal, but he did not display the features of dysfunction and was able to escape detection for many, many years. LINK:/ This suggests that using FFA as a single way of defining abnormality is inadequate.
.

Question 5

AO3 - EVALUATION OF THE STATISTICAL INFREQUENCY DEFINITION

Answer 5

Statistical infrequency definition is objective and sometimes appropriate -

A strength of the statistical infrequency definition is that once a way of collecting data about a behaviour and a ‘cut off point’ has been agreed, it becomes an objective way of deciding who is abnormal. Additionally, it has a real-life application in the diagnosis of some disorders, for example it can be used to define and diagnose somebody as suffering from intellectual disability disorder (IDD). (People who have an IQ in the range from 85-115 are viewed as normal, only 2% have a score below 70. Those individuals scoring below 70 are rare and are therefore labelled as having IDD). Statistical infrequency is therefore a useful part of clinical assessment.

however, it Focuses on FREQUENCY of behaviour, NOT its desirability – a limitation of the statistical infrequency definition is that there are many abnormal behaviours that are actually infrequent but quite desirable. For example, a very low IQ is, statistically just as abnormal as a very high IQ, but it is desirable to have a high IQ. For example, very few people have an IQ over 150, yet we would not want to suggest that having such a high IQ is undesirable. Equally, there are some normal behaviours that are frequent but undesirable. For example, experiencing depression is relatively common, yet it is undesirable. Therefore using statistical infrequency to define abnormality means that we are unable to distinguish between desirable and undesirable behaviours. In order to identify behaviours that need treatment, there needs to be a means of identifying infrequent AND undesirable behaviours.

Question 6

AO1 - STATISTICAL INFREQUENCY

Answer 6

The idea behind this definition is that ‘abnormal behaviour is behaviour’ which is rare (uncommon). Any behaviour that strays statistically FAR from the average would be seen as abnormal.
People who use this definition measure specific characteristics and assess how these characteristics are distributed in the general population. One way of doing this is by means of a normal distribution curve, which is bell shaped and tells us for instance that for a given characteristic most people score around the middle (mean). Any individuals who fall outside the ‘normal distribution’, usually about 5% of the population are perceived as being abnormal.
Link to a disorder…
For example, scoring below 70 on a standardised IQ test would be considered as abnormal (Intellectual Disability Disorder – IDD)

Question 7

AO1 - DEVIATION FROM IDEAL MENTAL HEALTH (DIMH)

Answer 7

Jahoda suggested that NORMAL mental health includes:

Positive attitudes towards the self – having self-respect and a positive self-concept

Accurate perception of reality – perceiving the world in a non-distorted fashion. Having an objective and realistic view of the world.

Personal autonomy – being independent, self-reliant and able to make personal decisions.

Environmental mastery – being competent in all aspects of life and able to meet the demands of any situation. Having the flexibility to adapt to changing life circumstances.

resistant to stress – being able to cope with stressful situations and cope with anxiety

Self-actualisation and personal growth - having a motivation to achieve our full potential

Link to a disorder…
The more characteristics individuals fail to meet and the further they are away from realising individual characteristics, the more abnormal they are. For example, lacking a positive attitude towards self and a lack of personal growth may be a symptom of depression.

Question 8

EVALUATION OF THE DEVIATION FROM IDEAL MENTAL HEALTH DEFINITION (AO3)

Answer 8

It sets an unrealistically high standard for mental health, who CAN achieve these criteria – a limitation of the DIMH is that very few people would match all the criteria laid down by Jahoda, and probably nobody achieves all of them at the same time or keep them up for very long. Therefore this approach would see pretty much everybody as abnormal. This can be seen as a positive or a negative. On a positive side it makes it clear to people the ways in which they could benefit from seeking treatment – counselling – to improve their mental health, however at the other extreme, DIMH is probably of no value in thinking about who might benefit from treatment against their will.

Cultural relativism – a further limitation of the DIMH is that the characteristics listed by Jahoda above are rooted in Western societies and a Western view of personal growth and achievement. For example self-actualisation (seeking to fulfil one’s full potential), positive attitude towards self, and personal autonomy may be seen as key goals in life within some cultures e.g. Western (individualistic) cultures but not other cultures e.g. Non-Western (collectivist) cultures. It may therefore be regarded as abnormal to go after your own goals if they are in conflict with those of your own culture. This cultural relativity severely limits the validity of the DIMH definition when looking at abnormality just from a Western society point of view.

Question 9

outline 3 types of characteristics of phobias

Answer 9

Behavioural Characteristics

Emotional Characteristics

Cognitive Characteristics

Question 10

Emotional Characteristics (A01) in relation to phobias

BEHAVIOUR APPROACH

Answer 10

Anxiety – phobias involve an emotional response of anxiety and fear. Anxiety prevents the sufferer relaxing and makes it very difficult to experience any positive emotion.
Emotional responses are unreasonable – the emotional responses experienced in relation to phobic stimuli go beyond what is reasonable.

Question 11

Cognitive Characteristics (A01) in relation to phobias.

Answer 11

Decrease in concentration – people with phobias often find it very difficult to concentrate and therefore they have an inability to complete tasks when the phobic object or situation is around.
Irrational beliefs – a phobic may hold irrational beliefs in relation to phobic stimuli, for example, social phobias can involve beliefs like ‘I must always sound intelligent’, or ‘if I blush people will think I’m weak.’ This kind of belief increases the pressure on the sufferer to perform well in social situations.

Question 12

Behavioural Characteristics (A01) of phobias

Answer 12

Panic – A phobic person may panic in response to the presence of the phobic stimulus. Panic may involve a range of behaviours including crying, screaming or running away
Avoidance – unless the sufferer is making a conscious effort to face their fear they tend to go to a lot of effort to avoid coming into contact with the phobic stimulus. This can make it hard to go about daily life.
Endurance – the alternative to avoidance is endurance, in which a sufferer remains in the presence of the phobic stimulus but continues to experience high levels of anxiety.

Question 13

what is the two step model in phobias?

Answer 13

The idea that the phobia is acquired via classical conditioning and maintains via operant conditioning.

Question 14

1. Acquisition by Classical Conditioning, explain using dog bite example

Answer 14

Dog
NS —> NO RESPONSE

UCS —–> UCR
pain crying, anxiety

UCS + NS —> UCR
pain dog crying, anxiety

CS ——> CR

Question 15

Maintenance by Operant Conditioning (A01)

Answer 15

an individual avoids a situation that is unpleasant, e.g. someone with a fear of the dentist will avoid going to the dentist. Such a behaviour (avoiding the dentist) results in avoiding a potentially negative consequence, which means the behaviour will be repeated. Therefore the individual will avoid their phobic object or situation (the source of their fear).

Question 16

Strengths of behaviorist explanation of phobias, the two step model

Answer 16

Point: Research Support for the two process model – One strength of the two process model is that there is research support for the ideas. For example,

Evidence: research by Watson & Rayner who created a phobia in a 9 month old baby called ‘Little Albert’. Albert showed no unusual anxiety at the start of the study. When shown a white rat he tried to play with it. However the experimenters then set out to give Albert a phobia. Whenever the rat was presented they made a loud, frightening noise by banging an iron bar close to Albert’s ear.
Elaborate: Eventually Albert became frightened when he saw a rat even without the noise. The rat then became a conditioned stimulus (CS) that produced a conditioned response (CR) of fear.

Link: This conditioning then became generalized to similar objects, demonstrating that initiation of phobias does occur through classical conditioning.

Practical application - therapy – The behaviourist explanation both how phobias can be acquired and maintained. Based on the theory, once a patient is prevented from practicing their avoidance behaviour the behaviour ceases to be reinforced and so it declines. This can be seen in the success of systematic desensitization, which leads to extinction of the bond between the feared stimulus and the feared response, and instead pairs the feared stimulus with relaxation, which are two incompatible emotions, as a treatment for phobias. The effectiveness of systematic desensitisation in addressing phobic symptoms lends support to the behaviourist explanation of phobias.

Question 17

Limitations of the two step model

Answer 17

Point: Alternative explanation – a weakness of the two process model is that even if we accept that CC and OC are involved in the development and maintenance of phobias, there are some aspects of phobic behaviour that require further explaining.

Explain: Bounton (2007) points out for example, that evolutionary factors probably have an important role in phobias however the two-factor model does not mention this. For example, we easily acquire phobias of things that have been a source of danger in our evolutionary past, such as fears of snakes or the dark.

Elaborate: It is ADAPTIVE to acquire such fears. Seligman called this biological preparedness – the innate predisposition to acquire such fears. However it is quite rare to develop a fear of cars or guns, which are actually much more dangerous to most of us today than spiders or snakes. Presumably this is because they have only existed very recently and so we are not biologically prepared to learn fear responses towards them.
Link: This concept of preparedness is a serious problem for the two-factor theory because it shows there is more to acquiring phobias than simple conditioning.

Reductionist – another limitation of the behaviorist explanation of phobias is that it simplifies complex behaviours such as phobias down to a stimulus-response bond. As a result, it does not account for factors such as faulty cognitions. The cognitive approach proposes that the phobias may develop as a result of irrational thinking. Thoughts like these then contribute to feelings of anxiety that lead a person to show emotional symptoms of phobias. It has been found that cognitive therapies such as CBT may be more successful at treating more complex phobias such as social phobias.

Question 18

Behaviourist approach to treating phobias (A01)

Systematic Desensitisation

Answer 18

Anxiety Hierarchy - this is put together by the patient and the therapist. It is a list of situations related to the phobic stimulus that provoke anxiety, arranged in order from the least to most frightening. For example, an arachnophobia might identify seeing a picture of a small a spider as low on their anxiety hierarchy and holding a tarantula at the top of the hierarchy.

Relaxation - the therapist teaches the patient to relax as deeply as possible. This might involve breathing exercises or mental imagery techniques. The central idea is that it is impossible to experience two opposite emotions (fear and relaxation) at the same time. This is known as reciprocal inhibition.

Exposure - finally the patient is exposed to the phobic stimulus while in a relaxed state. This takes place across several sessions, starting at the bottom of the anxiety hierarchy. When the patient can stay relaxed in the presence of the lower levels of the stimulus, they move up the hierarchy. Essentially a new response to the phobic stimulus is learned (the phobic stimulus is paired with relaxation instead of anxiety). This learning of a different response is known as counterconditioning.

Question 19

Behaviourist approach to treating phobias (A01)

• Flooding

Answer 19

Immediate and direct exposure – rather than a gradual progression through a hierarchy, patients are placed directly into a situation that causes high levels of fear and panic.

Prevention of avoidance - patients are prevented from leaving the situation that causes the high levels of anxiety (they have given informed consent). Flooding sessions are typically longer than systematic desensitization sessions, one session often lasting two to three hours.

Exhaustion of phobic response – patients are required to remain in the presence of the phobic stimulus until they recognise that the stimulus is harmless. In terms of classical conditioning, this process is called extinction. This is when the conditioned stimulus (e.g. dog) is encountered without the conditioned stimulus (e.g. being bitten).

Question 20

AO3 - The Behavioural approach to treating phobias.

Strengths SYSTEMATIC DESENSITISATION

Answer 20

POINT: Research support for SD – Research has found that SD can be extremely effective in the treatment of specific phobias.

EVIDENCE: Gilroy et al. (2003) followed up 42 patients who had been treated for spider phobia in three 45-minute systematic desensitisation sessions. A control group was treated by relaxation without exposure.

ELABORATE: At both three months, and 33 months after the treatment, the systematic desensitization group were significantly less fearful than the control group.

LINK: This is a strength of systematic desensitization as it shows the effects are long lasting.

Question 21

Limitations of phobia treatments A03.

Answer 21

POINT: Symptom substitution – the psychodynamic model claims that behavioural therapies focus only on symptoms and ignores the causes of abnormal behaviour.
ELABORATE: Psychoanalysts claim that the symptoms are merely the tip of the iceberg - the outward expression of deeper underlying emotional problems. LINK: Psychoanalysts (Psychodynamic approach) believe that whenever symptoms are treated without any attempt to work out the deeper underlying problems, then the problem will only show itself in another way, through different symptoms. This is known as symptom substitution.

POINT: Less effective for some types of phobias. Although flooding and SD are highly effective for treating simple phobias it appears to be less so for more cognitive phobias such as social phobias. ELABORATE: This may be because social phobias have a cognitive aspect – for example, negative irrational thoughts about social situations.
LINK: This type of phobia may benefit more from cognitive therapies because behavioural therapies do not deal with irrational thinking.

POINT: Flooding treatment is traumatic – a major criticism of the use of flooding is that it is a highly traumatic experience for the patient. EXPLAIN: The problem is not that the treating is unethical (patients have given consent) but that patients are often unwilling to see the treatment through to the end.
LINK: This is a limitation of flooding because time and money are sometimes wasted preparing patients only to have them refuse to complete the treatment.

Question 22

Depression has characteristics within the three types of categories.

outline 3 of each

Emotional:

Cognitive:
Behavioural: .
/

Answer 22

Emotional Characteristics

Depressed Mood - a key characteristic is the ever present and overwhelming feelings of sadness / hopelessness. Lowered mood is a defining emotional element of depression but it is more intense and pronounced than in the daily kind of experience people in general can have.

Loss of Interest and Pleasure – depression is often characterised by a lack of enthusiasm associated with a lack of concern or pleasure in daily activities.

Worthlessness - those suffering from depression often have constant feelings of low self-worth and or inappropriate feelings of guilt

Cognitive Characteristics

Reduced Concentration– difficulty in paying and maintaining concentration and/or slowed down thinking and difficulty making decisions. Poor concentration and poor decision making are likely to interfere with the individual’s work.

Negative Beliefs about Self – those suffering from depression often experience persistent negative beliefs about themselves and their abilities.

Suicidal Thoughts – depressives can have constant thoughts of death and/or suicide.

Behavioural Characteristics

Change in Activity – typically depressed people have reduced amounts of energy resulting in fatigue, lethargy and high levels of inactivity. In some cases depression can lead to the opposite effect – known as psychomotor agitation.
Agitated individuals struggle to relax and may end up pacing up and down.

Change in Eating and Sleeping Patterns – people may experience a change in appetites which may mean they eat more or less than usual, and have significant weight changes (5%) either gaining or losing weight. Insomnia or excessive sleeping are characteristics of depression. The key point is that eating and sleeping behaviours are disrupted by depression.

Social Impairment – there can be reduced levels of social interaction with friends and relations.

Question 23

AO1 - Beck’s Negative Triad (1967)

Cognitive

Answer 23

The self – where individuals see themselves as being helpless, worthless and inadequate, e.g. ‘I am unattractive, what is there to like in me?’

The world (life experiences) – where obstacles are perceived within one’s environment that cannot be dealt with, e.g. ‘I can understand why people do not like me, even my boyfriend left me.’

The future – where personal worthlessness is seen as blocking any improvements, e.g. ‘I am always going to be on my own and nothing will change it’

Question 24

what does the negative triad lead to

Answer 24

Negative self schemas – Beck believes that depressed people develop negative schemas about themselves, which makes them think in this negative way. Negative schemas develop in childhood and adolescence as a result of rejection by parents or friends in the form of criticism and exclusion, or perhaps by the loss of a close family member. Such negative events mould the person’s concept of themselves as unwanted or unloved. This then filters into adulthood providing a negative framework to view life in a pessimistic fashion. Negative schemas lead to systematic cognitive biases in thinking.

Cognitive biases – people with negative schemas become prone to making errors in their thinking. They tend to focus selectively on certain aspects of a situation and ignore equally relevant information known as cognitive biases. One example is over generalisation where people with depression make a sweeping conclusion on the basis of a single event (e.g. he did not smile at me so he must hate me).

Question 25

AO1 - Ellis ABC Model (1957)

Answer 25

Albert Ellis believed that depressives mistakenly blame external
events for their unhappiness however it is their interpretation of
these events that is to blame for their distress. He proposed that
the key to depression lay in irrational beliefs. According to this
model, depression is produced by the irrational thoughts triggered
by unpleasant events. In his ABC
model:
A refers to an activating event: something happens in the
environment around you
B is the belief which is held about the event which may be
rational or irrational
C is the consequence – rational beliefs lead to healthy
emotions whereas irrational beliefs lead to unhealthy
emotions.
It is not the activating event that causes the consequence; the
consequence is caused by the beliefs about the activating
event. Having irrational beliefs leads to unhealthy negative reactions and emotions, which in turn can lead to depression. Individuals who become depressed interpret unpleasant events in excessively negative or threatening ways at point

Question 26

AO3 - Evaluation for the Cognitive Explanation of Depression.

Strengths

Answer 26

1. Supporting research – There is a wealth of research
   to support Beck’s cognitive explanation. Koster et al’s
   study used student volunteers who took part in an
   attention task and were presented with positive, negative
   and neutral words. They found that depressed
   participants spent longer attending to the negative words
   than the non-depressed group (measured through
   eye-tracking). The result supports the aspect of cognitive biases and that people with
   depression attend to negative aspects of their life rather than the positive.
2. Practical application – Both Ellis’ ABC model and Beck’s cognitive explanation of
   depression has been very influential and has stimulated a huge
   amount of research into the disorder over the last few decades.
   They have contributed greatly to our understanding of
   depression and to the rise of cognitive behavioural therapies,
   which have been very helpful in alleviating the symptoms of
   depression. Beck reviewed the effectiveness of CBT and found it
   highly effective in treating depression especially unipolar
   depressive disorder. This evidence concerning the effectiveness
   of both Ellis’ and Beck’s forms of CBT can be taken as support
   for the theory it’s based on.

Question 27

AO3 - Evaluation for the Cognitive Explanation of Depression.

Limitations

Answer 27

3. Cause or effect – it is difficult to determine the extent to which
   distorted cognitive pattern’s cause depression. Numerous studies have
   shown that depressed people do show more negative thinking than
   controls. For example, Evans used a questionnaire of pregnant women
   and found that women with a high negative schema were
   subsequently 60% more likely to become depressed than those with a
   low negative schema. However, as yet there is not enough convincing evidence that
   such thinking comes before a depressive episode.

(alternative approach) - The cognitive
explanation is only one psychological
explanation of depression and ignores other
explanations. For example, it tends to underplay
the biological aspects of depression, research
supports the role of low levels of serotonin in
depressed people and the success of drug therapies for treating depression offer
further strength to a biological explanation. Taking an eclectic approach, including
social, biological and psychological theories, would be a better way of explaining such
a complex disorder. To fully understand depression a more holistic approach is
therefore needed.

Question 28

The Cognitive Approach to Treating Depression
AO1 - Becks Cognitive Behavioural Therapy (CBT)

Answer 28

CBT was developed by Beck and is based on his theory of depression. The idea behind
Beck’s cognitive behavioural therapy is to identify the automatic thoughts about the world,
the self and future.

● Thought Catching - Once identified these thoughts must be
challenged. Individuals are taught how to see the link between
their thoughts and how they feel. They might, as part of their
homework assignments be asked to record in a diary any
emotion-arousing events and the automatic negative thoughts
that are associated with these events. (cognitive element)

● Cognitive Restructuring - Clients are asked to challenge these
dysfunctional thoughts and replace them with ones that are more
constructive. This cognitive restructuring can then lead to the
individual to have more positive thoughts and can alleviate the
depressive symptoms. (cognitive element)

● Behavioural activation (behavioural element) – a characteristic of many depressed
people is that they no longer participate in activities that they previously enjoyed.
During CBT and REBT, the client and therapist identifies negative behaviour that they
engage in, and then come up with positive
behaviours/activities to replace them with.
With the help of the therapist they will create a
plan in carrying them out, and discuss ways to
overcome any obstacles in carrying them out.
This may take the form of a weekly behaviour
schedule which is then reviewed in each session.

Question 29

AO1 - Ellis’ Rational Emotive Behavioural Therapy, outline

Answer 29

The central technique of Ellis REBT is to identify and dispute (challenge) irrational
thoughts. Ellis identified different methods of disputing. (cognitive element)

Empirical Disputing:
Irrational beliefs may not be consistent with reality, e.g.,
Where is the evidence that this thought or belief is
true?

Logical Disputing:
Irrational beliefs do not follow logically from the
information availabl, e.g.,. Does this belief make
common sense?

Pragmatic Disputing:
Emphasises the lack of usefulness of irrational beliefs
e.g. Is my irrational belief making things worse or
better?

Effective disputing changes self-defeating beliefs into more rational beliefs, and the client
can move to more rational interpretations of events. This, in turn, helps the depressed client
feel better and become more self-accepting.

● Behavioural activation (behavioural element) – a characteristic of many depressed
people is that they no longer participate in activities that they previously enjoyed.
During CBT and REBT, the client and therapist identify negative behaviour that they
engage in, and then come up with positive
behaviours/activities to replace them with.
With the help of the therapist, they will create a
plan in carrying them out, and discuss ways to
overcome any obstacles in carrying them out. This
may take the form of a weekly behaviour
schedule, which is then reviewed in each session

Question 30

AO3 - Evaluation for the Cognitive Treatment of Depression, strengths

Answer 30

there have been numerous studies that have
shown that CBT is effective in reducing symptoms of moderate and
severe depression and in preventing relapse, especially for those who
only have depression. Ellis claimed a 90% success rate of REBT, taking
an average of 27 sessions to complete the treatment. David et.al
(2008) compared the effectiveness of REBT, Beck’s CBT, and drug
therapy. All three forms of therapy were comparably effective at the
end of treatment. At 6 months, follow up. However, there was evidence
that REBT was more effective than the other two forms of therapy.
This suggests that as a long-term treatment, REBT is the most
effective.

Appropriateness of CBT
1) Factors affecting the choice of treatment – A strength of CBT can be seen in how its
techniques are appropriate for use in a wide variety of situations and modes of delivery, e.g.,
interactive software programmes. It has been used successfully with people of all ages with
degrees of depression from mild to severe. However, in some cases, the depression can be so
severe that patients cannot motivate themselves to engage with the hard cognitive work of
CBT. They may not also be able to pay attention to what is happening in a session. Therefore
a range of factors need to be considered when weighing up the costs and benefits of CBT as
an appropriate therapy in treating depression.

Question 31

AO3 - Evaluation for the Cognitive Treatment of Depression, Limitations

Answer 31

Competence of Therapist – one issue with assessing the
effectiveness of CBT is the competence of the therapist. This
appears to explain a significant amount of variation in CBT
outcomes. Kuyken (2009) supports this claim, concluding that as
much as 15% of the variance in outcome may be attributed to
therapist competence. They found that the therapists who were
assessed as most competent had better patient outcomes
regardless of the complexity of the case. It appears that, to some extent, the effectiveness of
CBT depends upon the training and skills of the therapist.

Responses to CBT – a criticism of the appropriateness of CBT, it is difficult to predict which
clients will respond well to CBT. It appears that CBT is
effective for both severe and milder forms of depression.
However, Simons (1995) found that CBT was not effective
for people who have very rigid attitudes and who are
resistant to change. It is also not effective for people who
have high stress levels due to long-term problems in their
lives; that a brief treatment like CBT cannot resolve.
Therefore, an alternative form of therapy may be more
appropriate for these types of individuals.

Bonus evaluation…
Remember, if you are struggling to think of ways to evaluate CBT, you can look at
comparisons with the use of drugs to treat depression such as SSRIs (selective serotonin
reuptake inhibitor). This should be written as one evaluation point.

Question 32

DEFINE OBSESSIONS AND COMPULSION, OCD

Answer 32

OCD is an anxiety disorder characterised by either obsessions and/or compulsions.
According to DSM-5 the diagnosis of OCD requires the following symptoms to be present:
1. Obsessions: recurrent and persistent thoughts that are intrusive, unwanted and cause
anxiety and distress. The individual tries to suppress the thoughts or neutralise them
with some other thought or action.
2. Compulsions: repetitive behaviours (e.g. checking) or mental acts (e.g. counting) in
response to an obsession. These behaviours are designed to reduce anxiety or
prevent a dreadful event occurring. They are excessive and can be unrealistic.

Question 33

Cognitive characteristics – OBSESSIONS, OCD

Answer 33

● Recurrent and persistent thoughts – sufferers experience constantly repeated
obsessive thoughts, images and ideas of an
intrusive nature. They are uncontrollable and
cause distress.

● Insight into excessive anxiety – people suffering
from OCD are aware that their obsessions and
compulsions are not rational. In fact, this is
necessary for a diagnosis for OCD. If someone
really believed their obsessive thoughts were
based on reality that would be a symptom of a
different form of mental disorder. However, in spite of this insight, OCD sufferers
experience catastrophic thoughts about the worst case scenarios that might result if
their anxieties were justified

Question 34

Behavioural characteristics - COMPULSION,

Answer 34

● Compulsions are repetitive – sufferers feel compelled to
repeat behaviours as a response to their obsessive thoughts,
ideas and images. Common examples include hand washing,
counting, praying, and tidying groups of objects such as
containers in a food cupboard.

● Compulsions reduce anxiety - the vast majority of compulsive
be.
.haviours are performed in an attempt to manage the anxiety produced by obsessions. For example, compulsive hand washing is carried out
as a response to an obsessive fear of germs. Compulsive checking, for example, that a door is locked or a gas appliance is switched off, is in response to the obsessive
thought that it might have been left unsecured. However, around 10% of sufferers of
OCD show compulsive behaviour, although they have no obsessions, just a general
sense of anxiety.

Question 35

Emotional characteristics, OCD

Answer 35

● Anxiety and distress – obsessive thoughts are unpleasant
and frightening and the anxiety that goes with these can be
overwhelming. The urge to repeat a behaviour (a
compulsion) creates anxiety
● Guilt and disgust – OCD often involves irrational guilt, for
example over minor moral issues, or disgust, which may be
directed against something external like dirt or at the self.

Question 36

AO1 - Genetic Explanations for OCD

Answer 36

The genetic explanation centres on OCD being inherited through
genetic transmission, with research originally focusing on family
and twin studies in order to investigate if there are specific genes
that can lead to development of OCD.
5-HTT/SERT Gene – Researchers have found genes that lead to a vulnerability for OCD,
known as OCD candidate genes. An example of this, the 5-HTT gene, has an effect on the
transportation of serotonin causing a lower level of serotonin in the synapses. A study has
even found a mutation of the 5-HTT gene in families where 6 out of the 7 people had OCD
(Ozaki et al, 2003)
Other researchers believe that OCD might be a polygenic disorder (not caused by a single
gene). Taylor (2013) conducted a meta-analysis and found evidence of up to 230 different
genes involved in OCD.

Question 37

AO3 - Evaluation of the Genetic Explanation for OCD

Answer 37

Research Support – Supporting evidence for the genetic basis of OCD comes from studies of
first degree relatives and twin studies. Nestadt et al (2000) found the lifetime incidence of
OCD was higher in the relatives of OCD patients (11.7%) compared to relatives of healthy
controls (2.7%). A meta-analysis of 14 twin studies of OCD found that identical twins (MZ)
were twice as likely to develop OCD if their co-twin had the disorder, than was the case for
non-identical twins (DZ) (Billet). This research strongly suggests a genetic influence on OCD.

Diathesis Stress Model - Rather than focus on a purely genetic explanation it may be
beneficial to use the diathesis stress model to explain the origins of OCD. According to this
model certain genes leave the individual more vulnerable to
OCD. Whether an individual actually does develop OCD is
influenced by environmental factors (stressors). Cromer et al
(2007) found that over half of the OCD patients in their sample
had a traumatic experience in their past, and that OCD was
more severe in those with more than one trauma. This suggests
that OCD cannot entirely be genetic in origin, at least not in all
cases. This suggests it may be more beneficial to look at
environmental causes as we are more able to do something about these.

Question 38

AO1 - Neural Explanations for OCD

Abnormal Levels of Neurotransmitters

Answer 38

It is thought that lower levels of serotonin are associated with
OCD. Although, serotonin’s contribution to OCD is not fully
understood, it is thought that serotonin has a role in preventing
the repetition of tasks. A lack of serotonin therefore results in the
loss of a mechanism that inhibits task repetition. Antidepressant drugs that increase
serotonin activity have been shown to reduce OCD symptoms (Pigott et al 1990) whereas
antidepressants that have less effect on serotonin do not reduce OCD symptoms. Also
dopamine levels are thought to be abnormally high in people with OCD.

Question 39

AO1 - Neural Explanations for OCD

Abnormal Brain Circuits

Answer 39

In all of us, the obitofrontal cortex (OFC) is triggered by a stress response (e.g. touching
something dirty, or accidently cutting a finger while cooking). This sends a ‘worry’ signal to
the caudate nuclues (located in the basal ganglia). The caudate nucleus judges the worry
signal and normally suppresses these signals. If the worry signal is not surpressed
(considered to be a threat that needs dealing with), this is allowed through to the thalamus.
The thalamus confirms the worry signal, creating a ‘worry circuit’ (a repetitive thought
about the threat until we deal with it).
In people with OCD… an overactive OFC, coupled with a damaged caudate nucleus means
that minor threats are triggered by the OFC (there is a lower threshold to what is considered
a worry) and the caudate nucleus fails to suppress these worry signals. From there, the
thalamus is alerted and confirms
the ‘worry’ to the OFC creating a
worry circuit that leads to an
obsessive thought.
Serotonin is linked to these
regions of the frontal cortex.

Comer (1998) reports that
serotonin (as an inhibitory
neurotransmitter) plays a key
role in regulating the OFC and
the caudate nuclei and it appears
that abnormaly low levels of
serotonin might cause these areas to malfunction.

Question 40

AO3 - Evaluation of Neural Explanations of OCD

Answer 40

Research Support for the Neural Explanation of OCD - There is
strong evidence that suggests certain brain circuits are
associated with OCD. PET scans of patients with OCD, taken
while their symptoms are active (e.g. when a person with a
germ obsession holds a dirty cloth) show heightened activity in
the OFC. Paul et. al. (2014) using neuroimaging has repeatedly
found unusually high activation within the OFC and several
studies have found excessive activity in the caudate nucleus.

Practical application – One practical application that has arisen because
of the neural explanation of OCD is the use of drugs to treat the disorder.
SSRIs work by blocking the reuptake channel and as a result increasing
the amount of serotonin available in the synapse. This helps those with
OCD who are believed to have lower levels of serotonin. This increase in
serotonin leads to a reduction in repetitive behaviour. This supports the
theory as if such treatments reduce the symptoms associated with OCD,
clearly there must be some biological aspect to the disorder.

Cause and Effect – One limitation of the neural explanations for
explaining OCD is that we cannot assume that neural mechanisms
cause OCD. Brain scan studies show an association between
increased activity in certain brain areas (e.g. the orbitofrontal cortex)
and OCD. As it is only an association it doesn’t show that those brain
areas play a role in causing OCD. These biological abnormalities could
be a consequence of OCD rather than its cause.

Question 41

AO1 - The Biological Approach to Treating Obsessive Compulsive
Disorder

Answer 41

SSRIs - Selective Serotonin Reuptake Inhibitors (SSRIs) (Prozac) are antidepressants used to
reduce the anxiety associated with OCD. SSRIs are currently the
preferred drug for treating OCD.

SSRIs increase levels of the
neurotransmitter serotonin, which regulates mood and anxiety.
SSRI’s work by blocking the reabsorption of serotonin at the
presynaptic nerve; therefore, leaving more serotonin available in
the synapse. The end result is there is an increased amount of
serotonin available to be taken up by other neurons. If a deficiency
of serotonin is associated with the development of OCD, it is
reasonable to expect drugs that increase serotonin will prove
effective in treating OCD. It can take three to four months of
daily use for SSRIs to have much impact on symptoms.

SNRIs (Serotonin-Noradrenaline Reuptake Inhibitors) – In the
last five years a different class of antidepressant drugs called
SNRIs has also been used to treat OCD. These are a second line
of defence for patients who don’t respond to SSRIs. SNRIs
increase levels of serotonin as well as another
neurotransmitter involved in impulsive behaviour –
noradrenaline.

Question 42

AO3 - Evaluation of Drug Therapy for Treating OCD

Answer 42

Not a Lasting Cure – Unfortunately the relapse rate following discontinuation of medication
is quite high. According to Simpson et. al. 45% of patients treated with SRIs – an older form
of SSRIs) relapsed back into the disorder within 12 weeks of completing medication. This is
poor in comparison to only a 12% relapse rate in the same period for those who had
received psychological therapy. Drug therapy does not provide a lasting cure as indicated by
the fact that patients relapse within a few weeks if medication is stopped. This suggests
that, although drugs are most commonly used, psychotherapies such as CBT should be tried.

Appropriateness
Side Effects – Drug therapy is not appropriate for all patients with OCD as some may suffer
from side effects. Common side effects when taking SSRI’s include nausea, headache,
insomnia, loss of sex drive, indigestion and blurred
vision (Soomro et.al 2008). Side effects reduce the
effectiveness of the drug because people might stop
taking the medication.

Preferred Treatment – Drug therapy is a preferred
treatment for OCD because it is non-disruptive to
the patient’s life as it requires little effort from the
user and little input in terms of time; compared to
CBT where the patient has to attend regular
appointments. From the point of view of the health service, drugs are good value, as they
are cheaper than psychological therapies partly because they don’t require a therapist to
administer them. However drug therapy is not successful for all OCD sufferers, which
suggests that the causes of OCD may not originate solely with levels of serotonin and there
are other factors that play a role in its origins. Therefore an eclectic approach to therapy
may be more successful.

Question 43

AO3 - Evaluation of Drug Therapy for Treating OCD

Research support

Answer 43

Effectiveness
Research Support – Supporting research comes from Soomro (2008) reviewed 17 studies of
the use of SSRIs with OCD patients and found them to be more effective than placebos in
reducing the symptoms of OCD up to three months after treatment. Typically symptoms
decline significantly for around 70% of patients taking SSRIs. Of the remaining 30 % alternative drug treatments or combinations of drugs and psychological treatments will be
effective for some. So drugs can help most patients with OCD